• R Aboukaïs, F Zairi, F Boustia, P Bourgeois, X Leclerc, and J-P Lejeune.
• Department of Neurosurgery, Lille University Hospital, rue E.-Laine, 59037 Lille cedex, France. Electronic address: rabihdoc@hotmail.com.
• Neurochirurgie. 2016 Apr 1; 62 (2): 72-7.

IntroductionManagement of vertebral artery-posterior inferior cerebellar artery convergence (VA-PICA) saccular aneurysms requires a specialized neurovascular team. The objective is to preserve the functional outcome while performing a complete and reliable long-term exclusion of the aneurysm.ObjectiveThe aim of our study was to evaluate the outcome of patients with VA-PICA saccular aneurysms after treatment.Materials And MethodsThis was a retrospective series of 21 consecutive patients with a VA-PICA saccular aneurysm treated between 2000 and 2012 at our institution. Treatment option (endovascular or microsurgical) was decided for each patient following a multidisciplinary discussion.ResultsTwenty-one patients were treated for a VA-PICA saccular aneurysm including 16 for a ruptured aneurysm and 5 for an asymptomatic aneurysm. Among all patients, 11 underwent endovascular treatment and 10 had microsurgical treatment. Our results showed a major aneurysm recurrence after endovascular treatment in 3 patients that required a further endovascular treatment in 2 cases. These 3 major recurrences occurred after treatment of a ruptured aneurysm when the initial angiography demonstrated the origin of the PICA at the neck of the aneurysm. After microsurgery, angiography showed a remnant neck in 2 patients including 1 treated by further endovascular procedure.ConclusionVA-PICA aneurysms are rare and require multidisciplinary management. Microsurgical treatment should be discussed when the PICA originates from the aneurysmal neck, particularly in patients with a ruptured small aneurysm, in order to obtain a reliable and long-term exclusion of the aneurysm.Copyright © 2016 Elsevier Masson SAS. All rights reserved.

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