Endovascular treatment of superior cerebellar artery aneurisms

Abstract

The study objective is to evaluate the effectiveness of various endovascular techniques for treatment of patients with superior cerebellar artery (SCA) aneurisms (depending on anatomical location of the aneurisms). Materials and methods . Between 2014 and 2018, 27 (7 men, 20 women) patients with saccular aneurisms underwent surgery implementing endovascular techniques. The patients’ mean age was 50.4 years. The relations between the basilar artery and the SCA, size, symptoms during manifestation were evaluated. For favorable aneurism geometry (neck diameter <4 mm, neck/dome ratio >2, absence of involvement of the parent artery branches in the pre-neck part of the aneurism) only microcoil occlusion was performed, in other cases various assisting techniques were used; if the aneurism deformed the distal part of the basilar artery, flow diversion stents (FDS) in combination with other techniques were used. Clinical results were evaluated using the modified Rankin Scale, occlusion grade — sing the Raymond—Roy scale immediately after the surgery and 6 months later. Results. Microcoil occlusion was performed in 4 (14.8 %) patients, in combination with balloon assistance — in 4 (14.8 %) patients, with stent assistance — in 13 (48.2 %) patients, with balloon and stent assistance — in 2 (7.4 %) patients, implantation of FDS — in 1 (3.7 %) patient, implantation of an assisting stent — in 1 (3.7 %) patient, microcoil occlusion with balloon an stent assistance and implantation of FDS — in 2 (7.4 %) cases. Total occlusion immediately after the surgery was achieved in 15 (55.5 %) patients, subtotal — in 7 (25.9 %). Long-term, total occlusion was observed in 82.3 % patients: in 2 (7.4 %) patients with preserved pre-neck contrast spontaneous thrombosing of the aneurism was observed, in 2 cases aneurisms were excluded after installation of FDS. Functional outcome of the surgery was favorable in 18 (66.7 %) patients, deterioration was observed in 4 (14.8 %) patients. Long-term, 6patients experienced improvement, condition of 11 patients did not change. In 1 (3.7 %) male patient, thromboembolism with occlusion of the posterior cerebral artery and hemianopsia developed during surgery; in 1 female patient cerebral subarachnoid hemorrhage occurred which led to death; 2 (7.4 %) patients developed ischemic complications associated with distal thromboembolism aggravating overall cerebral and neurological symptoms; in 1 (3.7 %) female patient, damage of the oculomotor nerve occurred. Conclusion. Endovascular treatment of SCA aneurisms using microcoil occlusion and/or other intravascular techniques is effective and sufficiently safe. Treatment tactics should be decided taking into account anatomical characteristics of the aneurism, structure of the Willis artery, condition of the precerebral vessels. Indication for use of FDS in SCA aneurisms require specification, but our results demonstrate their effective use in complex aneurisms of this localization.