Posterior Cerebral Artery Aneurysm Research Articles

Endovascular Embolization by Parent Artery Reconstruction of a Symptomatic Fusiform Posterior Cerebral Artery Aneurysm Using Onyx HD-500: A Neurointerventional Report

Posterior cerebral artery aneurysms are treatment challenge for the neurosurgeon. Parent artery occlusion, trapping and bypass have been the classic treatment options for aneurysms in this location. With the introduction of newer embolic agents such as Onyx®, endovascular intervention is now a viable therapy for these aneurysms. We report the case of a 60-year-old man who presented with a symptomatic, though unruptured, fusiform left posterior cerebral artery aneurysm. Given the distal location of this dominant sided aneurysm, post-operative visual deficits and aphasia were a concern if parent vessel occlusion were to be performed. Therefore, an endovascular reconstruction using Onyx HD-500 and two closed-cell stents was performed. This report illustrates the ability of a high-density liquid embolic agent to provide immediate reconstruction of a fusiform aneurysm in a distal location.

Hemiparkinsonism Due to Coiled Posterior Cerebral Artery Aneurysm

Hemiparkinsonism Due to Coiled Posterior Cerebral Artery Aneurysm

Endovascular Treatment of a Giant Dissecting Aneurysm of the Posterior Cerebral Artery

We describe the case of a 60-year-old man who presented with a giant dissecting aneurysm of the left P2 segment. Intracranial dissecting aneurysms often occur in the vertebrobasilar system, but rarely involve the posterior cerebral artery (PCA). PCA aneurysms tend to have some peculiar features and therefore may be considered a separate entity, even from the vertebrobasilar aneurysms. The patient was treated by endovascular occlusion of both parent vessel and the aneurysm, and he tolerated the procedure well with a complete resolution of clinical deficit, following volume reduction of the aneurysm. This paper presents additional evidence to literature reports suggesting that endovascular parent artery occlusion with coils is an effective and well-tolerated treatment for distal PCA aneurysms. Our review contributes to collect data regarding the incidence of recurrence as a measure of long-term efficacy of this therapeutic approach.

Management of a Recurrent Coiled Giant Posterior Cerebral Artery Aneurysm With Trapping and Thrombectomy

Management of a Recurrent Coiled Giant Posterior Cerebral Artery Aneurysm With Trapping and Thrombectomy

Traumatic Dissecting Posterior Cerebral Artery Aneurysm

Dissecting posterior cerebral artery (PCA) aneurysms are among rare cerebrovascular malformations accounting for 2% to 6% of all aneurysms. Herein we describe a case of pediatric dissecting aneurysm located in the PCA with documentation of aneurysm development. In addition, we discuss its treatment with a new therapeutic method involving glue injection.

Clinical observation of surgical treatment of posterior cerebral artery aneurysm

Introduction. Surgical treatment of brain ruptured arterial aneurysms (AA) has no alternative and includes both microsurgical and endovascular interventions. In some cases AA microsurgical clipping is the only possible and adequate method of treatment.The most dangerous and difficult AA are aneurysms of cerebral arterial posterior semi-ring, in particular, located on basilar artery (BA) bifurcation and R1 segment of posterior cerebral artery (PCA).Material and methods. The result of surgical treatment of AA of left PCA initial part is given. Transcranial clipping of AA neck was performed under dynamic ultrasonic Doppler examination (UDE) control using flexible intraoperative sensor of catheter-type with frequency 16 MHz. Microsurgical access to BA bifurcation, R1 segment of PCA was used, aneurysmal neck blockage was made through left carotid-oculomotor triangle under UDE control from optic-carotid triangle. The operation was planned on the base of neurovisualizing methods results complex assessment (MRI, CT, cerebral angiography, UDE) with appropriate control after operation.Results and their discussion. Surgical treatment was performed routinely, the patient’s general state was satisfactory. The combined microsurgical access to initial PCA segment was used. Intraoperative UDE ensured the possibility to estimate hemodynamic situation in vessels of the appropriate zone after surgical intervention, and to control the extent of radicalism of operation.Conclusion. Technical possibilities of PCA AA microsurgical direct exclusion are the basis of differentiated application of intracranial methods at unproved advantages or technical difficulties of endovascular method under condition of surgical tactics planning and corresponding technical providing.

Parent artery occlusion for treatment of posterior cerebral artery dissecting aneurysms

Objective To study the safety and efficacy of parent artery occlusion for the treatment of posterior cerebral artery dissecting aneurysms.Methods 23 patients with posterior cerebral artery dissecting aneurysms were treated via endovascular parent artery occlusion in our institution.All of the aneurysms were at P2 or distal segment of PCA.Glasgow Outcome Scale (GOS) was used to evaluate the clinical outcome.Results The procedure was technically suocessful in all cases.Four procedure-related complications occurred:rebleeding ( n =1 ),hemiparesis ( n =1 ),and hemianopisia ( n =2).In the trapping group and the proximal occlusion group,all of the immediate angiography showed occlusion of the parent vessel and the aneurysm without retrograde filling from collateral vessels.And follow-up imaging showed no recurrence of the aneurysms.In the palliative embolization group,one of five patients was died of rebleeding after the procedure.The follow-up DSA showed that the other four aneurysms recurred.Conclusions Deliberate parent artery occlusion with detachable coils appears to be well tolerated for P2 or distal segment of PCA dissecting aneurysms.The technique may be the first choice of treatment for the treatment of dissecting aneurysms ofposterior cerebral artery. Key words: Posterior cerebral artery; Aneurysm; Parent artery occlusion

E-047 Novel treatment of isolated P1 segment “blister” aneurysm with telescoping stents

PurposeDissecting posterior cerebral artery aneurysms are rare lesions that pose difficult treatment options. The purpose of this case is to describe the complications of stenting of a posterior cerebral artery...

Potential proneness of fetal-type posterior cerebral artery to vascular insufficiency in parent vessel occlusion of distal posterior cerebral artery aneurysms

The purpose of this study was to report the potential proneness of a fetal-type posterior cerebral artery (PCA) to develop vascular insufficiency in parent vessel occlusion of distal PCA aneurysms. Between January 2005 and January 2011, 19 patients (9 females and 10 males) with 20 distal PCA aneurysms (16 dissecting and 4 saccular) were treated with endovascular parent vessel occlusion. The ages of the patients ranged from 5 to 71 years, with a mean age of 40.2 years. Of the 20 aneurysms, 4 were ruptured and 16 were unruptured. One of the unruptured aneurysms was additional to another ruptured aneurysm, and 15 were incidentally discovered. Five aneurysms were smaller than 10 mm, and the other 15 were 10 mm or larger. All aneurysms were successfully treated with simultaneous coil occlusion of the aneurysm and the parent PCA. One patient had hemianopia at the initial presentation, and 2 patients had new persistent hemianopia due to insufficient leptomeningeal collateral circulation; in 16 patients with an intact visual field, no hemianopia developed because there was sufficient leptomeningeal collateral circulation. A fetal-type PCA was involved in all 3 patients with hemianopia, which was initially presented or caused by parent vessel occlusion. However, in the patients without hemianopia, an adult-type PCA was involved in all cases. Endovascular treatment via coil occlusion of the aneurysm as well as the parent artery can be used to cure distal PCA aneurysms. A fetal-type PCA could be an important predictive factor for vascular insufficiency in parent vessel occlusion treatment.

Dissecting Aneurysms of the Posterior Cerebral Artery

Posterior cerebral artery (PCA) aneurysms are relatively rare, making up 1% to 2% of all intracranial aneurysms. To date, most clinical series are heterogeneous in nature, with few reports of isolated PCA dissecting aneurysms. Their clinical presentation can vary greatly, and the potential for long-term sequelae during or after treatment remains relatively high. To report our recent experience in 9 consecutive patients with PCA dissecting aneurysms with a discussion of the unique clinical challenges of their evaluation and treatment. We conducted a retrospective review of 9 consecutive patients with PCA dissecting aneurysms from November 2003 to February 2010. Their hospital charts and follow-up records were reviewed and summarized. : We identified 6 male and 3 female patients ranging in age from 7 months to 69 years (median age, 53 years). None had any associated trauma. Four patients presented with subarachnoid hemorrhage. Three presented with intraventricular and intracerebral hemorrhage. The remaining 2 presented with headache and acute onset of right-sided numbness, respectively. Four underwent endovascular embolization; 2 underwent surgical clipping; and the remaining 3 were managed medically and followed up conservatively. The dissecting aneurysms involved P1 (n = 2), P1-2 junction (n = 1), P2 (n = 4), and P2-3 junction (n = 1). At a mean follow-up of 3 months, 6 patients had excellent functional outcome with modified Rankin Scale score of 0 or 1. The remaining 3 patients who presented in deep coma did poorly (1 died and 2 had severe disabilities). PCA dissecting aneurysms pose a unique challenge and have many unresolved issues regarding treatment modalities.

Supracerebellar transtentorial approach—resection of the tentorium instead of an opening—to provide broad exposure of the mediobasal temporal lobe: anatomical aspects and surgical applications

The aim of this study was to describe the surgical anatomy of the mediobasal aspect of the temporal lobe and the supracerebellar transtentorial (SCTT) approach performed not with an opening, but with the resection of the tentorium, as an alternative route for the neurosurgical management of vascular and tumoral lesions arising from this region. Cadaveric specimens were used to illustrate the surgical anatomy of the mediobasal region of the temporal lobe. Demographic aspects, characteristics of lesions, clinical presentation, surgical results, follow-up findings, and outcomes were retrospectively reviewed for patients referred to receive the SCTT approach with tentorial resection. Ten patients (83%) were female and 2 (17%) were male. Their ages ranged from 6 to 59 years (mean 34.5 ± 15.8 years). All lesions (3 posterior cerebral artery aneurysms, 3 arteriovenous malformations, 3 cavernous malformations, and 3 tumors) were completely excluded or resected. After a mean follow-up period of 143 months (range 10-240 months), the mean postoperative Glasgow Outcome Scale score was 4.9. Knowledge of the surgical anatomy provides improvement for microsurgical approaches. The evolution from a small opening to a resection of the tentorium absolutely changed the exposure of the mediobasal aspect of the temporal lobe. The SCTT approach with tentorial resection is an excellent alternative route to the posterior part of mediobasal aspect of the temporal lobe, and it was enough to achieve the best neurosurgical management of tumoral and vascular lesions located in this area.

Subarachnoid Hemorrhage from Posterior Cerebral Artery Aneurysm during Puerperium – Case Report and Review of Literature

Subarachnoid hemorrhages (SAH) due to true aneurysms of the Posterior Cerebral Artery (PCA) during puerperium in young and healthy females are extremely rare. We present the case of a 31-year old, healthy woman that experienced a spontaneous SAH due to a PCA aneurysm, arising from the P3 segment, 9 days post-delivery. The aneurysm was successfully treated via an endovascular approach and the patient recovered well. After 21 days she was discharged from hospital without neurological deficits. The clinical course is described in detail and illustrated with a computed tomography scan (CT) and digital subtraction angiography (DSA) pre – and post-embolization. The literature is reviewed and possible etiologies of the formation and rupture of the aneurysm are discussed.

Endovascular management of giant intracranial aneurysms of the posterior circulation

Large size, and location in posterior circulation, both individually portend high risk in the endovascular management of intracranial aneurysms. The purpose of this study was to investigate the outcome of endovascular management of giant posterior circulation aneurysms at our centre. This is a retrospective analysis of 22 consecutive patients with giant posterior circulation aneurysms, who were managed by endovascular techniques between 1997 and 2009. The aneurysms included: Vertebral-6 (27%), basilar or vertebrobasilar - 7 (32%) and nine posterior cerebral artery (PCA) - 9 (41%). There were 14 males and eight females with a mean age of 37 years. Treatment modalities included: Parent vessel sacrifice (PVS), coil embolization, flow reversal, stent-assisted coiling, and telescopic stent placement. Angiographic cure or stasis was achieved in 21 (95%) patients and no recurrence was observed in 17 of the 18 patients who had follow-up. Complications occurred in 9 (41%) patients, death in 4 and morbidity in 5 (3 with good eventual outcome). Overall, good clinical outcome was noted in 16 (73%) patients. The majority of the poor outcomes were observed in the management of basilar/vertebrobasilar aneurysms and flow reversal. Parent vessel sacrifice showed the best outcomes with stable results. Our results suggest that PVS remains the procedure of choice wherever possible and is relatively safe, particularly for giant vertebral and PCA aneurysms. When PVS is not feasible, stent-assisted coiling is a reasonable and safe option and requires follow-up. Management of basilar or vertebrobasilar aneurysms is complicated and still evolving.

Distal anterior choroidal artery aneurysm following iatrogenic posterior cerebral artery occlusion

Aneurysms of the anterior choroidal artery are uncommon and account for only 2-5% of all intracranial aneurysms. Distal anterior choroidal artery aneurysms are rare and the pathogenesis of this aneurysm may be different from typical proximal ones. We describe an unusual case of ruptured de novo distal anterior choroidal artery aneurysm in a 55 year-old man who had previously undergone endovascular proximal occlusion for a fusiform aneurysm of the ipsilateral posterior cerebral artery (PCA). A comprehensive review of literature using Medline, PubMed and all related journals was also performed. Only 34 reported distal AchoA aneurysms were found: 16 associated with moyamoya disease, 10 idiopathic, two with atherosclerosis, two with arteriovenous malformation, two dissecting, one infectious and one due to trauma. It is probable that the increased hemodynamic stress within the AchoA contributed to the formation and rupture of the reported aneurysm. This late complication needs to be considered when large intracranial vessels are iatrogenically occluded in the management of complex intracranial aneurysms.

Traumatic Aneurysm on the Posterior Cerebral Artery Following Blunt Trauma in a 14-Year-Old Girl: Case Report

A 13-year-old girl sufferring from a car accident presented with a symptom of oculomotor nerve palsy. A CT scan revealed diffuse SAH in the suprasellar cistern, cisterna ambiens and interpeduncular cistern. MRI showed contusion of the left cerebral peduncle and a flowing void signal in front of the left cerebral peduncle. Cerebral angiography revealed a bilobulated aneurysm on the P1-P2 junction of the left posterior cerebral artery. Endovascular treatment was performed, with coil packing within the aneurysm and occlusion of the parent vessel. There were no neurological deficits and no recurrence of the aneurysm on follow-up studies. Endovascular embolization of traumatic posterior cerebral artery aneurysm is a safe and effective therapeutic approach.

Incidental aneurysms in temporal lobe epilepsy surgery: report of three cases and a review of the literature

Objective and importance. In rare instances, patients who are undergoing evaluation for temporal lobe epilepsy surgery will also be found to have an incidental aneurysm adjacent to the temporal lobe. Although busy epilepsy centers will eventually come across cases like this, to our knowledge there are currently no publications regarding such cases or the complex management decisions that follow in caring for these patients. Factors affecting decision making in these cases are discussed in detail. Clinical presentation. Three cases where an incidental aneurysm was discovered during the evaluation and treatment of temporal lobe epilepsy are discussed. Two cases of middle cerebral artery (MCA) aneurysm, one ipsilateral to the planned temporal lobectomy and one contralateral aneurysm unsuitable for coiling, were discovered preoperatively. In one case, an incidental posterior cerebral artery (PCA) aneurysm was noted during an amygdalohippocampectomy. Intervention. In the ipsilateral MCA aneurysm case, the aneurysm was clipped during the temporal lobectomy. In the case of a contralateral MCA aneurysm, the aneurysm was electively clipped prior to the temporal lobectomy. In the PCA aneurysm case, the aneurysm was clipped at the time of discovery during surgery. Conclusion. Incidentally noted unruptured aneurysms in patients undergoing evaluation and treatment of medically intractable epilepsy add a level of complexity to medical decision making in these cases. Factors affecting treatment decisions include the size and location of the aneurysm, risks of aneurysm treatment, patient age, severity of the epilepsy condition and patient wishes after discussion of treatment options.

Endovascular treatment for aneurysms of the posterior cerebral artery: 12 years′ experience with 21 cases

To discuss and summarize the strategies and complications of endovascular embolization for aneurysms of the posterior cerebral artery (PCA). Data of patients with PCA aneurysms treated by an endovascular procedure were analyzed retrospectively (n = 21). Twenty patients with aneurysms were treated by detachable coil embolization, and one patient was treated with n-butyl cyanoacrylate. Of the 21 aneurysm embolization cases, 9 were treated by parent artery occlusion (PAO), and 12 were treated by selective occlusion of the aneurysm (SOA). All 12 aneurysms treated by SOA showed complete occlusion. Two aneurysms became recanalized 6 months after the first embolization and were then re-embolized; complete healing was observed on follow-up angiography. All patients showed acceptable outcomes without any procedural complications, except one patient who died 2 days after treatment. PAO resulted in 100% occlusion of all aneurysms. Cerebral infarction was noted in most patients (78%, n = 7). However, the area of infarction was small. Permanent neurological deficit was observed in two patients (22%), but their condition was not critical. Aneurysm embolization with SOA is well indicated for saccular aneurysms with well-defined necks, whereas PAO carries a risk of ischemic complications. Although the PCA is rich in collateral circulation, ischemic complications were noted in most patients after PAO, and it was difficult to predict occurrence of these complications. However, the area of cerebral infarction tended to be small, and the neurological deficits observed were not critical.

Deliberate Parent Artery Occlusion for Non-Saccular Posterior Cerebral Artery Aneurysms

Posterior cerebral aneurysms are rare vascular lesions and usually present as non-saccular or dissecting in nature. We present a retrospective review of our experience in the deliberate parent artery occlusion of posterior cerebral artery (PCA) aneurysms.From June 2006 to June 2010, 12 patients (seven men, five women) with posterior cerebral artery non-saccular aneurysms presented to our department and were treated by parent artery occlusion. There were eight (66.7%) aneurysms located at the P2 segment, two (16.7%) at the P2-3 junction, one (8.3%) at the P1-2 junction and one (8.3%) at the P3 segment. Ten of the 12 patients were treated by aneurysm together with parent artery occlusion and two were treated by proximal occlusion.The procedure was technically successful in all cases. Angiography was performed immediately after the procedure in all patients and showed occlusion of the parent vessel with no filling of the aneurysm. Only one patient (8.3%) developed procedure-related transient hemianopsia and recovered within one month. The other 11 patients showed no additional neurological symptoms after procedure. Deliberate parent artery occlusion by detachable coils appears to be well tolerated for P2 or distal segment of PCA in our limited case series. We propose that this technique could be a good treatment option in treating non-saccular aneurysms in this location.

Microsurgerical treatment of PCA aneurysms via subtemporal approach monitored by microvascular doppler(10 cases report)

Objective To summarize the clinical features of intracranial aneurysms of posterior cerebral artery (PCA), and the surgical approaches and operative skills to treat them. Method The aneurysms arose from the P1 segment in 3 patients, the P2 segment in 5 patients and the P3 segment in 2 patients. Aneurysms on P1 segment were surgically treated via subtemporal associated pterional approach. Aneurysms on P2 and P3 segment were surgically treated via subtemporal approach. 7 aneurysms were successfully treated by clipping the aneurysmal neck,2 aneurysms were shaped and 1 aneurysm was isolated. 3 giant aneurysms were resected. Microvascular Doppler was conducted to examine the blood flow of aneurysms and parent arteries. Results 6 of 10 patients had postoperative good recovery. Temporal oculomotor palsy occurred in 2 patients, syntropic hemiablepsia occurred in 1 patients,light hemiplegia in 1 patient. All these patients were recovery with treatment. 1 oculomotor palsy and 1 syntropic hemiablepsia preoperation recovered postoperation after three months. Conclusions The microsurgery is one of the major methods for treating aneurysm of PCA. The subtemporal approach in treating aneurysm of PCA is simple,safe and good exposure. Microvascular doppler is a feasible, safe, and very reliable technique in aneurysm surgery. Key words: Posterior cerebral artery; Intracranial aneurysm; Microsurgery; Microvascular doppler

Characteristics and endovascular treatment of aneurysms of posterior cerebral artery

Aneurysms of the posterior cerebral artery (PCA) are a distinct rarity and present with some peculiar morphologic features and specific clinical findings. These aneurysms can be managed endovascularly with good results. To evaluate the clinical features and endovascular management of PCA aneurysms. Between 2000 and 2008, we treated 24 patients (14 male and 10 female; mean age: 36 years) with PCA aneurysms. Clinical presentations, radiologic images, and endovascular management were reviewed. There were 11 saccular aneurysms, including 4 giant or large aneurysms, and 13 dissecting aneurysms, including 11 giant or large aneurysms. Of the 24 patients, 13 presented with hemorrhage and 6 with neurologic deficits. Five patients presented with headaches without any neurologic deficits. Parent vessel occlusion was performed in 12 patients, selective coil embolization was performed in 11 patients, and 1 patient conservatively. Eighteen patients had a good recovery, 5 had a moderate disability (one with 1 visual deficit after the treatment) related to hemorrhage, vasospasm, or infarction before aneurysm trapping, and 1 patient died because of rebleeding. The conservatively treated patient made a good recovery. PCA aneurysms have specific clinical characteristics compared with aneurysms located elsewhere. Endovascular technique can achieve good outcomes despite the aneurysmal site and size.