No abstract available.
Pica*

Although dissecting aneurysm of vertebral artery were once thought to be extremely rare, they are now recognized with increasing frequency by dint of aggressive work-up using sophisticated imaging techniques. Vertebral dissection most commonly result from cervical hyperextension and lateral cervical rotation. Our two cases followed suit respectively and presented with ischemic symptoms. The vertebral angiogram demonstrated a pseudoaneurysm at the site of dissection in both cases. Presence or absence of SAH, size of dissection and incorporation of the PICA into dissection greatly have influence upon the outcome after treatment. The authors report two cases of dissecting aneurysm of vertebral artery, in which complete resolution of the pseudoaneurysm was spontaneously achieved following conservative management.
Aneurysm, Dissecting* ; Aneurysm, False ; Pica ; Vertebral Artery*

OBJECTIVE: Aneurysms arising from the posterior inferior cerebellar artery(PICA) are uncommon. We review literature on that and surgical results on aneurysmal treatment by choice of surgical approach. METHODS: On the basis of radiologic findings & charts, we review retrospectively the surgical results of 12 cases from Mar 1999 to Dec 2003. RESULTS: The mean age of the 12 patients was 55.8(ranged from 36 to 71) and female was predominant (female: male=8: 4). Locations of PICA aneurysms revealed variously(vertebral artery-PICA junction: 8, lateral medullary segment: 2, PICA-anterior inferior cerebellar artery common trunk: 1, telovelomedullary: 1). Surgical approaches & treatments were attempted in 11 cases and embolization was done in 1 case(Far lateral transcondylar or supracondylar approach & clipping: 9, Far lateral transcondylar or supracondylar approach and trapping: 2, suboccipital approach & clipping: 1). The surgical result were 8 of 12 patients were good outcome, 1 of 12 was severely disabled and 3 of 12 were died. CONCLUSION: First, we choose surgical approach by the laterality of aneurysms and surgical or interventional treatment is attempted as soon as possible. The PICA aneurysm is regarded as having a relatively good surgical outcome without drilling of the posterior arch of the atlas.
Aneurysm* ; Arteries* ; Female ; Humans ; Pica ; Retrospective Studies

Aneurysms of the posterior inferior cerebellar artery (PICA) are rarely encountered. In particular, due to frequent anatomic complexity and the presence of nearby critical structures, PICA origin aneurysms are difficult to treat. However, recent reports of anecdotal cases using advanced endovascular instruments and skills have made the results of endovascular treatment rather outstanding. PICA preservation is the key to a successful endovascular treatment, based on the premise that a PICA origin aneurysm is well occluded. To secure PICA flow, stenting into the PICA would be the best method, however, it is nearly impossible technically via the ipsilateral vertebral artery (VA) if the PICA arose at an acute angle from the sac. In such a case, a bilateral approach for stent-assisted coiling can be a creative method for achievement of two goals of both aneurysm occlusion and PICA preservation: ipsilateral approach for coil delivery and contralateral cross-over approach for stent delivery via a retrograde smooth path into the PICA.
Achievement ; Aneurysm ; Arteries ; Intracranial Aneurysm ; Pica ; Stents ; Vertebral Artery

A case of ruptured aneurysm of the distal PICA presenting with isolated intraventricular hemorrhage is presented. The diagnosis of distal PICA aneurysm should be considered if isolated intraventricular hematoma is found without obvious parenchymal hemorrhage or subarachnoid blood in the basal cisterns. Complete vertebral arteriography is a requiste for the recognition of this condition. The outcome in patients with these aneurysms should be good if surgical repair is performed before rebleeding occurs.
Aneurysm* ; Aneurysm, Ruptured ; Angiography ; Arteries* ; Diagnosis ; Hematoma ; Hemorrhage* ; Humans ; Pica

BACKGROUND: Many studies about unilateral cerebellar infarctions (UCI) have been reported to delineate the clinical findings and stroke mechanisms but have not been studied extensively in acute bilateral cerebellar infarctions (BCI). In order to evaluate the neurological features and mechanisms of BCI, we compared those between BCI and UCI. METHODS: Using diffusion-weighted imaging, we divided 103 patients with acute cerebellar infarctions into two groups: BCI and UCI. Clinical features, outcome and their mechanisms were compared between the groups. RESULTS: Among the 103 patients, 45 patients (44%) had BCI and the remaining 58 patients had UCI. The PICA territory was the most frequently involved site in both groups, and 15 patients were non-territorial infarctions. Clinical symptoms and signs were not different between the groups, however, most patients with decreased mentality had BCI (86%) and also had concomitant lesions outside the cerebellum (72%). Patients with BCI showed poorer prognosis than UCI (modified Rankin score, 1.41 and 2.87 respectively). Other factors included the presence of concomitant lesiona outside the cerebellum, however, mass effect did not affect their prognosis. The main cause of BCI was large artery disease (57%), whereas about half of the patients with UCI (51%) had no demonstrable cause of stroke. CONCLUSIONS: Owing to its poorer outcome and its higher frequency of demonstrable causes of stroke, more intensive work-up, such as vascular study, may be warranted in the patients with acute BCI.
Arteries ; Cerebellum ; Humans ; Infarction* ; Magnetic Resonance Imaging ; Pica ; Prognosis ; Stroke

Aneurysms arising from the posterior inferior cerebellar artery (PICA) are uncommon. Surgical treatment of PICA aneurysm was difficult and had relatively poor outcome. This study was undertaken to analyze the surgical and endovascular results of PICA aneurysm with review of the literature. Medical records and neuroimaging studies of nine patients who underwent treatment of PICA aneurysm from March 1995 to December 2003 were reviewed. The mean age of the nine patients was 57.9 (ranged from 41 to 68) and female was predominant (female : male = 7:2). Locations of PICA aneurysms was various and surgical treatments were attempted in 7 cases and endovascular treatment was done in 2 cases. The results of treatment were as follows : 4 patients showed good outcome, 5 patients showed poor outcome. Although clipping of the aneurysm neck is preferable in the aneurysm of PICA, trapping is useful when neck clipping is impossible in distal segment of telovelotonsillar segment. Endovascular treatment is becoming a promising treatment option.
Aneurysm* ; Arteries* ; Female ; Humans ; Male ; Medical Records ; Neck ; Neuroimaging ; Pica

Humans ; Metals, Heavy ; toxicity ; Paint ; toxicity ; Pica ; complications

OBJECTIVE: The purpose of this study is to characterize the Posterior Inferior Cerebellar Artery aneurysm distribution (location, age, sex, multiplicity and associated vascular anomalies), clinical presentation, neuroradiological findings and surgery outcome. MATERIALS AND METHODS: From Jul. '96 to Jun. '99, the admission chart and radiologic study material of 24 cases of angiographically confirmed PICA aneurysm patients were reviewed, retrospectively. RESULTS: Mean age of the patients was 53.4 years (ranged from 24 to 75), and majority of these aneurysms occurred in females (20 of 24). 22 of 24 patients presented with subarachnoid hemorrhage. The most common subarachnoid hemorrhage observed at ambient cistern, crural cistern, and the forth ventricular hemorrhage. In 19 of 24 cases the aneurysm size was 5+/-2 mm, and 23 cases show saccular aneurysm. PICA aneurysm patients have many associated intracranial vascular diseases (multiple aneurysm: 5, arteriovenous malformation: 2, abnormal vasculature: 4) and concomitant medical diseases (diabetes mellitus and tuberosclerosis). Direct surgical approaches were attempted in 22 cases (lateral suboccipital approach: 10, far lateral approach: 8, midline suboccipital: 2, pre-sigmoidal and combined approach in each case) and the surgical result was acceptable (favorable outcome: 19, unfavorable: 5). CONCLUSIONS: Based on this study, the incidence of PICA aneurysm was 1.3% and shows female predominance. In 46%, intracranial vascular abnormality was associated. On brain CT examination, subarachnoid hemorrhage at peimesencephalic cistern and intraventricular hemorrhage at the forth ventricle were most frequent CT finding. In most surgical cases, lateral or farlateral suboccipital approach was a good surgical approach enough to reach the PICA aneurysm and the surgical result was acceptable.
Aneurysm* ; Arteries* ; Arteriovenous Malformations ; Brain ; Cerebrovascular Disorders ; Female ; Hemorrhage ; Humans ; Incidence ; Pica ; Retrospective Studies ; Subarachnoid Hemorrhage

Aneurysms arising from the posterior circulation are relatively uncommon and are regarded as the most difficult aneurysms for surgical management because of its confined surgical space and complicated blood vessels around brain stem. Twenty cases of posterior circulation aneurysm were operated between Jan. 1984 and July, 1987. At the same period total surgically treated aneurysms were 181 cases. Among 20 cases, aneurysms at the basilar artery bifurcation were 12 cases, 4 cases at the SCA-basilar artery, 3 cases at the distal PICA and one case was at the PCA(P2-P3). Five patients had multiple aneurysms and one patient had concomitant arteriovenous malformation. For the operative management of these 20 cases, direct neck clipping was done in 16 cases and wrapping was done in 4 cases. Surgical outcome was evaluated: "good" in 10 cases, "fair" in 3 cases, "poor" in 6 cases and one patient expired. Surgical consideration of posterior circulation aneurysms was also disussed on the basis of personal experience.
Aneurysm* ; Arteries ; Arteriovenous Malformations ; Basilar Artery ; Blood Vessels ; Brain Stem ; Humans ; Neck ; Pica