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Spontaneous Resolution of a Ruptured Dissecting PICA Aneurysm. Report of Two Cases
R L Piske1, R Darwich, C M Campos
1Secao de Neuroradiologia Intervencionista da Med Irnagern, Hospital Beneficencia Portuguesa; Sao Paulo, Brasil.
Summary
Spontaneous dissecting aneurysms of the posterior inferior cerebellar artery (PICA) are rare. Conservative management may lead to spontaneous resolution, suggesting a potentially benign clinical course.
Area of Science:
- Neurology
- Vascular Surgery
- Neuroradiology
Background:
- Spontaneous dissecting aneurysms (SDAs) rarely affect the intradural vertebral artery (VA), posterior cerebral, basilar, or PICA, often causing subarachnoid hemorrhage or ischemia.
- These dissections occur spontaneously or after minor trauma, predominantly in young individuals without identifiable underlying abnormalities.
Purpose of the Study:
- To investigate the natural history and optimal management of spontaneous dissecting aneurysms of the posterior inferior cerebellar artery (PICA).
Main Methods:
- Case report of two patients with PICA dissection presenting with subarachnoid hemorrhage.
- Review of literature for similar cases and their treatment outcomes.
- Conservative management with clinical and angiographic follow-up.
Main Results:
- Two cases of PICA dissection treated conservatively showed spontaneous resolution confirmed by angiography at 5 and 4 months.
- Literature review identified 11 similar cases with favorable spontaneous thrombosis and no rebleeding.
- Surgical or endovascular treatments for PICA dissection are controversial due to risks of vessel occlusion.
Conclusions:
- Spontaneous dissecting aneurysms of the PICA may have a benign clinical course with potential for spontaneous cure.
- Conservative management with careful clinical and angiographic monitoring is proposed before considering aggressive interventions.
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