Posterior Inferior Cerebellar Artery-Posterior Inferior Cerebellar Artery Bypass versus Occipital Artery-Posterior Inferior Cerebellar Artery Bypass for Treating Posterior Circulation Aneurysms: A Systematic Review and Comparative Meta-Analysis

Authors

• Leonardo de Oliveira, Department of Neurosurgery, State University of Ponta Grossa, Ponta Grossa, Paraná, Brazil. Electronic address: leobarrosoliveira09@gmail.com.
• Marcelo Porto Sousa, Department of Neurosurgery, Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil.
• Gabriel Semione, Department of Neurosurgery, University of West Santa Catarina, Joaçaba, Santa Catarina, Brazil.
• Marcio Yuri Ferreira, Department of Neurosurgery, Ninth of July University, São Paulo, São Paulo, Brazil.
• Sávio Batista, Department of Neurosurgery, Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil.
• Lucca B. Palavani, Department of Neurosurgery, Max Planck University Center, Indaiatuba, São Paulo, Brazil.
• Filipi F. Andreão, Department of Neurosurgery, Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil.
• Jordana B. Diniz, Neurological Institute of Goiânia, Goiânia, Goiás, Brazil.
• Nicollas Nunes Rabelo, Department of Neurosurgery, University of São Paulo, São Paulo, São Paulo, Brazil.
• Raphael Bertani, Department of Neurosurgery, University of São Paulo, São Paulo, São Paulo, Brazil.
• Leonardo C. Welling, Department of Neurosurgery, State University of Ponta Grossa, Ponta Grossa, Paraná, Brazil.
• Michael T. Lawton, Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA.
• Eberval Gadelha Figueiredo, Department of Neurosurgery, University of São Paulo, São Paulo, São Paulo, Brazil.

Document Type

Article

Abstract

BACKGROUND: When traditional therapies are unsuitable, revascularization becomes essential for managing posterior inferior cerebellar artery (PICA) or vertebral artery aneurysms. Notably, the PICA-PICA bypass has emerged as a promising option, overshadowing the occipital artery-PICA (OA-PICA) bypass. The objective was to compare the safety and efficacy of OA-PICA and PICA-PICA bypasses. METHODS: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, we conducted a systematic review and meta-analysis to evaluate the safety and efficacy of OA-PICA and PICA-PICA bypasses for treating posterior circulation aneurysms. RESULTS: We analyzed 13 studies for the PICA-PICA bypass and 16 studies on the OA-PICA bypass, involving 84 and 110 patients, respectively. The median average follow-up for PICA-PICA bypass was 8 months (2-50.3 months), while for OA-PICA, it was 27.8 months (6-84 months). The patency rate for OA-PICA was 97% (95% confidence interval [CI]: 92%-100%) and 100% (95% CI: 95%-100%) for PICA-PICA. Complication rates were 29% (95% CI: 10%-47%) for OA-PICA and 12% (95% CI: 3%-21%) for PICA-PICA. Good clinical outcomes were observed in 71% (95% CI: 52%-90%) of OA-PICA patients and 87% (95% CI: 75%-100%) of PICA-PICA patients. Procedure-related mortality was 1% (95% CI: 0%-6%) for OA-PICA and 1% (95% CI: 0%-10%) for PICA-PICA. CONCLUSIONS: Both procedures have demonstrated promising results in efficacy and safety. PICA-PICA exhibits slightly better patency rates, better clinical outcomes, and fewer complications, but with a lack of substantial follow-up and a smaller sample size. The choice between these procedures should be based on the surgeon's expertise and the patient's anatomy.

Medical Subject Headings

Humans; Cerebellum (blood supply, surgery); Cerebral Revascularization (methods); Intracranial Aneurysm (surgery); Treatment Outcome; Vascular Surgical Procedures; Vertebral Artery (surgery)

Publication Date

5-1-2024

Publication Title

World neurosurgery

E-ISSN

1878-8769

Volume

185

First Page

403

Last Page

416.e7

PubMed ID

38458251

Digital Object Identifier (DOI)

10.1016/j.wneu.2024.02.153

Recommended Citation

Oliveira, Leonardo de; Sousa, Marcelo Porto; Semione, Gabriel; Ferreira, Marcio Yuri; Batista, Sávio; Palavani, Lucca B.; Andreão, Filipi F.; Diniz, Jordana B.; Rabelo, Nicollas Nunes; Bertani, Raphael; Welling, Leonardo C.; Lawton, Michael T.; and Figueiredo, Eberval Gadelha, "Posterior Inferior Cerebellar Artery-Posterior Inferior Cerebellar Artery Bypass versus Occipital Artery-Posterior Inferior Cerebellar Artery Bypass for Treating Posterior Circulation Aneurysms: A Systematic Review and Comparative Meta-Analysis" (2024). Neurosurgery. 2018.
https://scholar.barrowneuro.org/neurosurgery/2018