{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T00:56:29Z","timestamp":1785372989971,"version":"3.55.0"},"reference-count":16,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2015,8]]},"abstract":"\nOBJECT<\/jats:title>\nSubarachnoid hemorrhage (SAH) from ruptured posterior inferior cerebellar artery (PICA) aneurysms is uncommon, and long-term outcome data for patients who have suffered such hemorrhages is lacking. This study investigated in-hospital and long-term clinical data from a prospective cohort of patients with SAH from ruptured PICA aneurysms enrolled in a randomized trial; their outcomes were compared with those of SAH patients who were treated for other types of ruptured intracranial aneurysms. The authors hypothesize that PICA patients fare worse than those with aneurysms in other locations and this difference is related to the high rate of lower cranial nerve dysfunction in PICA patients.<\/jats:p><\/jats:sec>\n\nMETHODS<\/jats:title>\nThe authors analyzed data for 472 patients enrolled in the Barrow Ruptured Aneurysm Trial (BRAT) and retrospectively reviewed vasospasm data not collected prospectively. In the initial cohort, 57 patients were considered angiographically negative for aneurysmal SAH source and did not receive treatment for aneurysms, leaving 415 patients with aneurysmal SAH.<\/jats:p><\/jats:sec>\n\nRESULTS<\/jats:title>\nOf 415 patients with aneurysmal SAH, 22 (5.3%) harbored a ruptured PICA aneurysm. Eight of them had dissecting\/fusiform-type aneurysms while 14 had saccular-type aneurysms. Nineteen PICA patients were treated with clipping (1 crossover from coiling), 2 were treated with coiling, and 1 died before treatment. When comparing PICA patients to all other aneurysm patients in the study cohort, there were no statistically significant differences in age (mean 57.6 \u00b1 11.8 vs 53.9 \u00b1 11.8 years, p = 0.17), Hunt and Hess grade median III [IQR II\u2013IV] vs III [IQR II\u2013III], p = 0.15), Fisher grade median 3 [IQR 3\u20133] vs 3 [IQR 3\u20133], p = 0.53), aneurysm size (mean 6.2 \u00b1 3.0 vs 6.7 \u00b1 4.0 mm, p = 0.55), radiographic vasospasm (53% vs 50%, p = 0.88), or clinical vasospasm (12% vs 23%, p = 0.38). PICA patients were more likely to have a fusiform aneurysm (36% vs 12%, p = 0.004) and had a higher incidence of lower cranial nerve dysfunction and higher rate of tracheostomy\/percutaneous endoscopic gastrostomy placement compared with non-PICA patients (50% vs 16%, p < 0.001). PICA patients had a significantly higher incidence of poor outcome at discharge (91% vs 67%, p = 0.017), 1-year follow-up (63% vs 29%, p = 0.002), and 3-year follow-up (63% vs 32%, p = 0.006).<\/jats:p><\/jats:sec>\n\nCONCLUSIONS<\/jats:title>\nPatients with ruptured PICA aneurysms had a similar rate of radiographic vasospasm, equivalent admission Fisher grade and Hunt and Hess scores, but poorer clinical outcomes at discharge and at 1- and 3-year follow-up when compared with the rest of the BRAT SAH patients with ruptured aneurysms. The PICA's location at the medulla and the resultant high rate of lower cranial nerve dysfunction may play a role in the poor outcome for these patients. Furthermore, PICA aneurysms were more likely to be fusiform than saccular, compared with non-PICA aneurysms; the complex nature of these aneurysms may also contribute to their poorer outcome.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2014.10.jns141079","type":"journal-article","created":{"date-parts":[[2015,4,17]],"date-time":"2015-04-17T13:59:19Z","timestamp":1429279159000},"page":"441-445","source":"Crossref","is-referenced-by-count":52,"title":["Clinical characteristics and long-term outcomes in patients with ruptured posterior inferior cerebellar artery aneurysms: a comparative analysis"],"prefix":"10.3171","volume":"123","author":[{"given":"Richard W.","family":"Williamson","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David A.","family":"Wilson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adib A.","family":"Abla","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cameron G.","family":"McDougall","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Nakaji","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felipe C.","family":"Albuquerque","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert F.","family":"Spetzler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-jns141079","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1227\/01.NEU.0000145784.43594.88","article-title":"Vertebral artery-posteroinferior cerebellar artery aneurysms: clinical and lower cranial nerve outcomes in 52 patients","volume":"56","author":"Al-khayat","year":"2005"},{"key":"b2-jns141079","series-title":"Neuroradiology","doi-asserted-by":"publisher","first-page":"1006","DOI":"10.1007\/s00234-004-1245-8","article-title":"Endovascular treatment of the posterior inferior cerebellar artery aneurysms","volume":"46","author":"Bradac","year":"2004"},{"key":"b3-jns141079","series-title":"Neuroradiology","doi-asserted-by":"publisher","first-page":"315","DOI":"10.1007\/s00234-007-0333-y","article-title":"Ruptured, dissecting posterior inferior cerebellar artery aneurysms: endovascular treatment without parent vessel occlusion","volume":"50","author":"Cellerini","year":"2008"},{"key":"b4-jns141079","series-title":"J Neurosurg","doi-asserted-by":"publisher","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"},{"key":"b5-jns141079","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"855","DOI":"10.3171\/jns.2007.106.5.855","article-title":"Surgical and endovascular management of symptomatic posterior circulation fusiform aneurysms","volume":"106","author":"Coert","year":"2007"},{"issue":"2 Suppl Operative","key":"b6-jns141079","series-title":"Neurosurgery","first-page":"ons204","article-title":"Technical considerations in the endovascular management of aneurysms of the posterior inferior cerebellar artery","volume":"71","author":"Crowley","year":"2012"},{"key":"b7-jns141079","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1227\/01.neu.0000440730.59133.1f","article-title":"Far lateral suboccipital approach for the treatment of proximal posteroinferior cerebellar artery aneurysms: surgical results and long-term outcome","volume":"55","author":"D'Ambrosio","year":"2004"},{"key":"b8-jns141079","series-title":"Neurosurgery","doi-asserted-by":"publisher","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"},{"key":"b9-jns141079","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"1026","DOI":"10.1097\/00006123-199811000-00012","article-title":"Posteroinferior cerebellar artery aneurysms: surgical results for 38 patients","volume":"43","author":"Horowitz","year":"1998"},{"key":"b10-jns141079","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"381","DOI":"10.3171\/jns.1983.58.3.0381","article-title":"Aneurysms of the posterior inferior cerebellar artery. 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