Distal posterior inferior cerebellar artery dissecting aneurysms: a systematic review and meta-analysis

TL;DR

This study reviews distal PICA dissecting aneurysms, finding that endovascular treatment is effective and highlights the need for better management strategies.

Contribution

The paper provides a systematic review and meta-analysis of treatment outcomes for a rare type of cerebellar aneurysm.

Findings

91.2% of patients presented with subarachnoid hemorrhage.

Endovascular treatment achieved 90% complete occlusion with low retreatment and rebleeding rates.

Surgical and endovascular approaches showed similar efficacy in occlusion rates.

Abstract

Distal posterior inferior cerebellar artery (PICA) dissecting aneurysms are rare, anatomically complex, and clinically underreported. Management strategies remain poorly standardized, and long-term outcomes are not well defined. This paper aims to systematically review the anatomical, clinical, and therapeutic characteristics of distal PICA dissecting aneurysms.

Following PRISMA guidelines, a comprehensive search of PubMed and SCOPUS identified 15 eligible studies, including 68 patients. Data on clinical presentation, aneurysm characteristics, treatment strategies, and outcomes were extracted. Pooled proportions and meta-analyses were conducted using random-effects models.

Among 68 patients, 91.2% presented with subarachnoid hemorrhage. Endovascular treatment was preferred (69.1%), achieving a higher complete occlusion rate (90%) and low retreatment (9%), and rebleeding rates (8%). Surgical treatment (23.5%) had similar efficacy (81% occlusion). The complete occlusion rate was not significantly different between the two (OR: 1.43; log OR = 0.360; 95% CI: –0.848 to 1.569, p = 0.559). Functional outcomes were favorable overall, with 79.4% of patients achieving mRS < 2. Stroke was the most frequent complication (14.2%). No significant differences were found between reconstructive and deconstructive approaches (p = 0.971). Flow diversion was not utilized in any case.

Distal PICA dissecting aneurysms, though uncommon, pose a high risk of hemorrhage. Endovascular parent artery occlusion offers high occlusion rates with low morbidity. The absence of flow-diversion strategies highlights current device limitations and illustrates the need for anatomy-specific, prospective studies to guide optimal management.

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