{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T17:52:33Z","timestamp":1786125153093,"version":"build-2736575974"},"reference-count":26,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Operative Surg.","ONSURG"],"published-print":{"date-parts":[[2018,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Posterior inferior cerebellar artery (PICA) aneurysms represent a challenging pathology. PICA sacrifice is often necessary, due to the high proportion of nonsaccular aneurysms that can be found in this location. Several treatments are available, but the infrequency of these aneurysms and the increasing number of endovascular techniques have limited the development of a standardized algorithm for cases in which open surgery is indicated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>We present our series of nonsaccular PICA aneurysms, in the attempt to define an algorithm for their surgical management.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>We retrospectively reviewed the operation database, identifying patients harboring nonsaccular PICA aneurysms who were surgically treated at our institution from 2007 to 2016.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>During a 9-yr period, 17 patients harboring 18 nonsaccular PICA aneurysms were surgically treated at our institution. Fourteen (7.7%) aneurysms were located within the proximal PICA (including those located at the vertebral artery\u2013PICA junction), and 4 were located distally. We performed PICA revascularization in 8 (57.1%) cases of proximal aneurysms (n = 4, PICA\u2013PICA bypass; n = 4, occipital artery\u2013PICA bypass). We based our decision whether to perform bypass on intraoperative test occlusion with indocyanine green (ICG) videoangiography and neurophysiological monitoring. In no cases, bypass was necessary for distal aneurysms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION<\/jats:title>\n                    <jats:p>For nonsaccular PICA aneurysms, in which vessel occlusion is often necessary, it is possible to adopt a selective use of revascularization techniques. Intraoperative occlusion test with ICG videoangiography and neurophysiological monitoring provides reliable indications, allowing real-time assessment of collateral circulation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ons\/opx141","type":"journal-article","created":{"date-parts":[[2017,6,27]],"date-time":"2017-06-27T14:19:44Z","timestamp":1498573184000},"page":"422-431","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":11,"title":["Decision Making in Surgery for Nonsaccular Posterior Inferior Cerebellar Artery Aneurysms With Special Reference to Intraoperative Assessment of Collateral Blood Flow and Neurophysiological Function"],"prefix":"10.1227","volume":"14","author":[{"given":"Alessandro","family":"Narducci","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Charit\u00e8-Universit\u00e4tsmedizin Berlin, Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ran","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Charit\u00e8-Universit\u00e4tsmedizin Berlin, Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Vajkoczy","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Charit\u00e8-Universit\u00e4tsmedizin Berlin, Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2018,4]]},"reference":[{"issue":"2","key":"bib1-20240909","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1227\/00006123-198202000-00004","article-title":"Microsurgical anatomy of the posterior inferior cerebellar artery","volume":"10","author":"Lister","year":"1982","journal-title":"Neurosurgery"},{"issue":"3 suppl","key":"bib2-20240909","first-page":"S29","article-title":"The cerebellar arteries","volume":"47","author":"Rhoton","year":"2000","journal-title":"Neurosurgery"},{"issue":"4","key":"bib3-20240909","doi-asserted-by":"crossref","first-page":"756","DOI":"10.3171\/jns.2002.97.4.0756","article-title":"Distal posterior inferior cerebellar artery aneurysms: clinical features and management","volume":"97","author":"Lewis","year":"2002","journal-title":"J Neurosurg"},{"issue":"12","key":"bib4-20240909","doi-asserted-by":"crossref","first-page":"2415","DOI":"10.1007\/s00701-016-2965-3","article-title":"Safety and efficacy of treatment strategies for posterior inferior cerebellar artery aneurysms: a systematic review and meta-analysis","volume":"158","author":"Petr","year":"2016","journal-title":"Acta Neurochir"},{"issue":"1","key":"bib5-20240909","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1007\/s10143-010-0296-z","article-title":"Clinical presentation and treatment of distal posterior inferior cerebellar artery aneurysms","volume":"34","author":"Tokimura","year":"2011","journal-title":"Neurosurg Rev"},{"issue":"3","key":"bib6-20240909","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1227\/01.NEU.0000079493.50657.1D","article-title":"Characteristics of distal posteroinferior cerebellar artery aneurysms","volume":"53","author":"Horiuchi","year":"2003","journal-title":"Neurosurgery"},{"issue":"5","key":"bib7-20240909","doi-asserted-by":"crossref","first-page":"702","DOI":"10.1016\/j.wneu.2014.06.012","article-title":"Distal posterior inferior cerebellar artery aneurysms: clinical features and outcome of 80 patients","volume":"82","author":"Lehto","year":"2014","journal-title":"World Neurosurg"},{"issue":"5","key":"bib8-20240909","doi-asserted-by":"crossref","first-page":"991","DOI":"10.3171\/2012.12.JNS121240","article-title":"Endovascular treatment of proximal and distal posterior inferior cerebellar artery aneurysms","volume":"118","author":"Chalouhi","year":"2013","journal-title":"J Neurosurg"},{"issue":"2","key":"bib9-20240909","doi-asserted-by":"crossref","first-page":"398.E397","DOI":"10.1016\/j.wneu.2010.05.002","article-title":"Temporary occlusion test using a microcatheter","volume":"77","author":"Huang","year":"2012","journal-title":"World Neurosurg"},{"issue":"2","key":"bib10-20240909","doi-asserted-by":"crossref","first-page":"387","DOI":"10.3171\/2011.3.JNS101413","article-title":"Segmental anatomy of cerebellar arteries: a proposed nomenclature. 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