Artikel
Radiological characters, treatment and clinical outcome of anterior inferior cerebellar artery (AICA) aneurysms – a case series from Helsinki aneurysm data bank
Radiologische Merkmale, Behandlung und klinisches Ergebnis von AICA-Aneurysmen – eine Fallserie aus der Helsinki-Aneurysmadatenbank
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Autoren
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Sajjad Muhammad
- Heinrich-Heine-Universität Düsseldorf, Abteilung für Neurochirurgie, Düsseldorf, Deutschland
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Ahmad Hafez
- University of Helsinki, Department of Neurosurgery, Helsinki, Finland
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Behnam Rezai Jahromi
- University of Helsinki, Department of Neurosurgery, Helsinki, Finland
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Daniel Hänggi
- Heinrich-Heine-Universität Düsseldorf, Abteilung für Neurochirurgie, Düsseldorf, Deutschland
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Mika Niemelä
- University of Helsinki, Department of Neurosurgery, Helsinki, Finland
| Veröffentlicht: | 26. Juni 2020 |
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Gliederung
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Objective: Anterior inferior cerebellar artery (AICA) aneurysms are rare posterior circulation lesions and are challenging to treat. Here we present morphological/ anatomical characteristics, treatment and clinical outcome of AICA aneurysms in a series of 15 patients from Helsinki aneurysm data bank.
Methods: A retrospective analysis of DSA and CT angiography images of 15 consecutive patients harboring AICA aneurysms who were treated between 1968 to 2017 at Helsinki University Hospital. Different anatomical characteristics including morphology, location, length, width, neck width, aspect ratio, and bottleneck factor were quantified. Moreover, treatment modality and clinical outcome at 1 year was analyzed
Results: Of the 15 AICA aneurysm patients studied, 12 (80%) were female and the mean ± SD age was 52.4 ± 9.6 years. Seventy-three percent of patients were smokers. Ten out of fifteen patients (67%) had a saccular aneurysm; the remaining 33% had a fusiform aneurysm. Ten out of fifteen AICA aneurysms (67%) were located in the proximal segment, 20% in the meatal segment, and the remaining 13% in the distal segment. The mean ± SD size of AICA aneurysms was 14.8 ± 18.9 mm. The mean ± SD aspect ratio was 0.92 ± 0.47 and the mean ± SD bottleneck factor was 1.66 ± 1.65. Eleven out of fifteen (73%) patients presented with subarachnoid hemorrhage (SAH); 82% of SAH patients had a good-grade SAH (Hunt and Hess grade 1-3). Eleven patients (73%) were treated surgically, 3 (20%) were treated conservatively, and 1 (7%) had coil embolization. In 27% of patients, a sub-temporal approach with anterior petrosectomy was performed. A retrosigmoid approach was used in the remaining 73%. In 18% of the patients, a parent vessel occlusion was necessary to occlude the aneurysm. Five out of eleven (47%) of the patients developed post-operative cranial nerve deficits. All patients who presented with an unruptured AICA aneurysm had good clinical outcome (mRS 1-2) at one year follow-up. In patients with SAH, 82% achieved good clinical outcome (mRS 1-2) and 18% had poor clinical outcome (mRS 3-6) after 1 year.
Conclusion: AICA aneurysms are mostly large and are more often fusiform in the distal segment. Although surgical treatment of AICA aneurysms has a high rate of cranial nerve deficits, most of patients achieved a good long-term clinical outcome. Currently, surgical treatment could still be an alternative treatment option in selected cases of AICA aneurysms.
