Posterior Inferior Cerebellar Aneurysm Research Articles

Microsurgical treatment of posterior inferior cerebellar aneurysms based on angioarchitecture supplemented by high-resolution vessel wall MRI: a case series report

BackgroundSurgical treatment of posterior inferior cerebellar artery (PICA) aneurysms is challenging because many are nonsaccular and atherosclerotic. We report our tailored approach to PICA aneurysms, which is based on angioarchitecture...

Effect of different surgical options for posterior inferior cerebellar artery aneurysms

Objective To explore the clinical effect of various surgical operations on the treatment of posterior inferior cerebellar aneurysm. Methods The clinical data of 36 patients with a total of 36 posterior inferior cerebellar aneurysms admitted to Department of Neurosurgery, Weihai Central Hospital from October 2014 to May 2017 were retrospectively analyzed. Among all 36 patients, 22 underwent transcatheter embolization, 9 underwent aneurysm clipping using craniotomy, and the remaining 5 underwent cerebral artery bypass surgery combined with transcatheter embolization. The treatment outcome was evaluated using Glasgow outcome scale(GOS) at discharge and modified Rankin scale (mRS) at follow-up. Imaging outcome was evaluated by digital subtraction angiography (DSA) or CT angiography (CTA). Results Of the 22 patients undergoing transcatheter embolization, 21 were completely embolized. Aneurysms in 8 of the 9 patients were successfully clipped. Successful vascular anastomosis and complete embolization were achieved in 5 patients undergoing cerebral artery bypass surgery combined with transcatheter embolization. Among the 36 patients, 9 cases developed non-newly developed postoperative neurological deficits and 1 died. Thirty-five patients were discharged with GOS grade Ⅴ in 18 cases, Ⅳ in 14 cases and Ⅲ in 3 cases. Thirty-five cases were reexamined by CTA or DSA at 2 weeks post operation, which indicated disappearance of aneurysm. At follow-up of 3 months to 1 year post operation, 3 cases(8.6%) of aneurysm recurrence were reported which had undergone interventional embolization, and the rest of 32 patients had no recurrence. Thirty-five patients were followed up for 1 year. The mRS score was 0-1 in 21 cases, 2 in 8, 3 in 3, 4 in 1 and 5 in 1 case. The rate of good outcome were 85.3% (29/34) and there was 1 patient lost to follow-up. Conclusions According to the specific condition, interventional embolization, craniotomy of aneurysm clipping, or cerebral artery bypass surgery combined with transcatheter embolization could be performed to treat the posterior inferior cerebellar aneurysm, which might lead to relatively good clinical outcome with low incidence of aneurysm recurrence. Key words: Incranial aneurysm; Embolization, therapeutic; Microsurgery; Treatment outcome; Inferior cerebellar artery

Treatment of Acutely Ruptured Cerebral Aneurysms With the Woven EndoBridge (WEB) Flow Disruptor: A Multicenter Experience

Abstract INTRODUCTION Coiling has become the first-line treatment option for acutely ruptured aneurysms 1 to 3. However, coiling of wide-necked bifurcation aneurysms is challenging and stent-assisted coiling requires dual anti-platelet therapy. The Woven EndoBridge (WEB) flow disruptor has been recently Food and Drug Administration (FDA)-approved for bifurcation aneurysms and is designed to achieve intrasaccular flow diversion without the need for antiplatelet therapy. However, its use has been mostly reserved for unruptured aneurysms. Here, we present our series of ruptured aneurysms that were treated with the WEB-device post FDA approval. METHODS We performed a review of the first cohort of patients with acute subarachnoid hemorrhage (SAH) from ruptured aneurysms who underwent endovascular treatment with the WEB-device at Thomas Jefferson and Iowa University Hospitals and identified 7 patients. RESULTS All 7 patients were female and the mean age was 71 yr (range 57-81). Hunt and Hess grades ranged from 2 to 5. The aneurysms treated included anterior communicating, posterior communicating, posterior-inferior cerebellar (PICA), basilar apex, and vertebrobasilar junction (VBJ). In 6 of the 7 aneurysms, 1 WEB device was sufficient to achieve adequate obliteration; the VBJ aneurysm was 14 mm in size and required 2. The majority of patients underwent treatment via transfemoral access followed by transradial. One patient underwent direct carotid puncture due to vessel tortuosity. Aneurysm rebleeding was not encountered in any of the WEB-treated aneurysms. One patient had an intraoperative rupture of their PICA aneurysm after dislodgment of the WEB device. There were no treatment-related deaths, but one patient died of cardiopulmonary failure. CONCLUSION Our series shows that the WEB device can be safely used in ruptured bifurcation aneurysms of various sizes in the anterior and posterior circulation. It does not require adjunctive stent use and is a valuable alternative to stent-assisted coiling as it obviates the need for anti-platelet therapy.

Transvascular treatment of giant aneurysms of the cavernous carotid and vertebral arteries: Functional investigation and embolization

Functional angiographic investigation and percutaneous embolization using detachable balloons in nine carotid cavernous aneurysms, three petrous aneurysms, one vertebral artery aneurysm, and one posterior inferior cerebellar aneurysm are reported. A double-lumen balloon catheter is used to evaluate acute tolerance to occlusion of the carotid or vertebral arteries. Occlusion is tested under systemic heparinization. Local perfusion of heparinized saline, proximal as well as distal, to the balloon occlusion is used. The procedure was successful in all but one cavernous aneurysm. The arterial lumen was sacrificed in all cases. Clinical improvement occurred in all successful cases. Retroorbital pain was relieved in all. Ocular cranial nerve palsies improved or resolved in most. One delayed ophthalmic episode that improved represents the only complication. No such embolic problems occurred in any case in which the cavernous carotid artery was occluded by balloon trapping. The delayed embolic complications after carotid artery occlusion are related to the collateral vessels to the C-4 and C-5 segments of the artery. Balloon trapping decreases the length of the thrombosed segment and prevents retrograde filling of the aneurysm.

Radiometric study on posterior inferior cerebellar aneurysms with special reference to accessibility by the lateral suboccipital approach.

Radiometric studies were conducted in 21 cases of posterior inferior cerebellar aneurysms and 52 normal subjects to determine the variability of location of the vertebral-posterior inferior cerebellar artery complex in the posterior fossa. Accessibility using a lateral suboccipital approach was evaluated in relation to the radiometric data. Lateral suboccipital openings offered a sufficient surgical field in all cases under minimal retraction of the cerebellum and the results were satisfactory. The range of accessibility of this lateral approach was between 0 to 17 mm from the midline, 1 to 23 mm from the foramen magnum, 6 to 16 mm from the clivus and 35 to 61 mm from the posterior clinoid process. Postoperative neurological deficits were seen in patients with an aneurysm within 10 mm of the midline and at more than 13 mm from the clivus. Advantages of the lateral suboccipital approach are discussed.