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

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

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