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

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

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

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

The dissecting aneurysms of the posterior cerebral circulation arise most commonly from the vertebral artery and occasionally extend to the posterior inferior cerebellar artery(PICA). The dissecting aneurysm localized in the PICA without involving the vertebral artery is rare. We present a PICA dissecting aneurysm that had kaleidoscopic clinical course of bleeding, occlusion, and recanalization before the surgery. The patient had serial follow-up angiograms based on significant changes of clinical status. The patient successfully underwent microsurgical trapping with clips for the dissecting aneurysm and showed neurological improvement.
Aneurysm, Dissecting* ; Arteries* ; Follow-Up Studies ; Hemorrhage ; Humans ; Pica ; Subarachnoid Hemorrhage ; Vertebral Artery

OBJECTIVE: Since posterior circulation vascular lesions are adjacent to important structures such as the brain stem and lower cranial nerves, the acquisition of anatomical information and the careful selection of approaches are essential for the surgical treatment of these lesions. We examined the characteristics and the indications of the far lateral suboccipital approach which exposes lesions without retraction of the brain stem for the treatment of either a vertebral artery (VA) or posterior inferior cerebellar artery (PICA) aneurysm. We present the best diagnostic tool to determine the approaches. METHODS: We have reviewed 11 patients who received surgical treatments between 2005 and 2011 for VA or PICA aneurysms. All of the patients had 3-dimensional computed tomography (3DCT) angiography performed to investigate the relation of the location between the aneurysm and hypoglossal canal. RESULTS: Eight of the 11 patients were treated with the transcondylar fossa approach (TCFA) as their lesions were located proximal to the hypoglossal canal, while three were treated with the transcondylar approach (TCA) as their lesions were located distal to the hypoglossal canal. Of the three patients treated with the TCA, one had temporary palsy of the 11th cranial nerve and the others recovered without any neurological defects. 3DCT angiography showed the relation of the location between the aneurysm and hypoglossal canal. CONCLUSION: The TCFA and TCA are good approaches to expose lesions without retraction of the brain stem. To determine the approaches for the surgery of VA or PICA aneurysms, using 3DCT before surgery is advantageous in understanding the positional relations between the hypoglossal canal and the lesions. During the actual surgery, the posterior condylar canal through which the posterior condylar emissary vein passes can be used as an anatomical landmark for TCFA. With this approach, craniocervical instability can be avoided.
Aneurysm ; Angiography ; Arteries ; Brain Stem ; Cranial Nerves ; Humans ; Paralysis ; Pica ; Veins ; Vertebral Artery