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Shintoku R, Marushima A, Okune S, Hiramine T, Nakao J, Takahashi T, Hino T, Hosoo H, Ito Y, Hayakawa M, Ishikawa E, Matsumaru Y. Endovascular Embolization with n-Butyl Cyanoacrylate for Ruptured Distal Posterior Inferior Cerebellar Artery Dissecting Aneurysm. Asian J Neurosurg 2023; 18:651-655. [PMID: 38152529 PMCID: PMC10749849 DOI: 10.1055/s-0042-1757432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023] Open
Abstract
Parent artery occlusion is a definitive treatment method for preventing rebleeding of dissecting aneurysms. We herein report a case of a ruptured distal posterior inferior cerebellar artery (PICA) dissecting aneurysm treated with internal trapping using n-butyl-2-cyanoacrylate (NBCA). A 65-year-old man visited our hospital with a complaint of headache and neck pain that began 1 week before his arrival. He had a history of spontaneous subarachnoid hemorrhage of unknown cause. Computed tomography of the brain revealed a small amount of subarachnoid hemorrhage, and distal subtraction angiogram showed a distal PICA dissecting aneurysm. We placed a guiding catheter in the left vertebral artery and an intermediate catheter in the PICA. A microcatheter was guided toward the proximal side of the aneurysm and was wedged into the parent artery. The dissecting aneurysm was treated with parent artery occlusion using 50% NBCA. The postoperative course was uneventful, and the patient was discharged 3 weeks after treatment without any neurological deficit. Parent artery occlusion with internal trapping using NBCA could be a safe and definitive treatment method for distal PICA dissecting aneurysms. Angiographical evaluation of the collateral network in the distal branch of PICA before embolization and wedged microcatheter technique in the parent artery are important for successful embolization using NBCA.
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Affiliation(s)
- Ryosuke Shintoku
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
- Department of Stroke and Cerebrovascular Diseases, University of Tsukuba Hospital, Tsukuba, Japan
| | - Aiki Marushima
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
- Department of Stroke and Cerebrovascular Diseases, University of Tsukuba Hospital, Tsukuba, Japan
| | - Sho Okune
- Department of Stroke and Cerebrovascular Diseases, University of Tsukuba Hospital, Tsukuba, Japan
| | - Takato Hiramine
- Department of Stroke and Cerebrovascular Diseases, University of Tsukuba Hospital, Tsukuba, Japan
| | - Junzo Nakao
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
- Department of Stroke and Cerebrovascular Diseases, University of Tsukuba Hospital, Tsukuba, Japan
| | - Toshihide Takahashi
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
- Department of Stroke and Cerebrovascular Diseases, University of Tsukuba Hospital, Tsukuba, Japan
| | - Tenyu Hino
- Department of Stroke and Cerebrovascular Diseases, University of Tsukuba Hospital, Tsukuba, Japan
| | - Hisayuki Hosoo
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
- Department of Stroke and Cerebrovascular Diseases, University of Tsukuba Hospital, Tsukuba, Japan
| | - Yoshiro Ito
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
- Department of Stroke and Cerebrovascular Diseases, University of Tsukuba Hospital, Tsukuba, Japan
| | - Mikito Hayakawa
- Department of Stroke and Cerebrovascular Diseases, University of Tsukuba Hospital, Tsukuba, Japan
- Division of Stroke Prevention and Treatment, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Eiichi Ishikawa
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yuji Matsumaru
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
- Department of Stroke and Cerebrovascular Diseases, University of Tsukuba Hospital, Tsukuba, Japan
- Division of Stroke Prevention and Treatment, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Hou K, Lv X, Guo Y, Yu J. Endovascular treatment of posterior inferior cerebellar artery trunk aneurysm. Acta Neurol Belg 2022; 122:1405-1417. [PMID: 34677822 DOI: 10.1007/s13760-021-01826-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 10/14/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND The posterior inferior cerebellar artery (PICA) generally originates from the vertebral artery (VA) and is the most complex cerebellar artery. Aneurysms can occur at any site along the PICA trunk. Although most PICA aneurysms are located at the VA-PICA junction, a small proportion is located at the PICA trunk. Endovascular treatment (EVT) of aneurysms in the PICA trunk may be difficult and complex. METHODS We performed a review to expound upon EVT of PICA trunk aneurysms. RESULTS The PICA can be divided into five segments (p1-5); the p1-3 segments are proximal segments, and the p4-5 segments are distal segments. Most PICA trunk aneurysms are dissecting aneurysms. Sometimes, the PICA can give rise to flow-related aneurysms in association with cerebellar arteriovenous malformations. Most aneurysms of the PICA trunk require aggressive treatment, especially those that have ruptured. Currently, the EVT mainly includes selective coiling with/without stent assistance and parent artery occlusion. Recently, some new devices, such as flow diversion and Barricade and Kaneka ED coils, can be used to treat PICA trunk aneurysms. The risk of complications with EVT seems to be higher; however, most complications are only transient or mild, and some are even clinically silent. In addition, open surgery is still an important option. CONCLUSION For PICA trunk aneurysms, the treatment choice should be assessed on a case-by-case basis. The rate of permanent morbidity of the EVT is low. EVT is an effective method for treating PICA trunk aneurysms.
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Affiliation(s)
- Kun Hou
- Department of Neurosurgery, First Hospital of Jilin University, 1 Xinmin Avenue, Changchun, 130021, China
| | - Xianli Lv
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, 102218, China
| | - Yunbao Guo
- Department of Neurosurgery, First Hospital of Jilin University, 1 Xinmin Avenue, Changchun, 130021, China
| | - Jinlu Yu
- Department of Neurosurgery, First Hospital of Jilin University, 1 Xinmin Avenue, Changchun, 130021, China.
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Bele K, Ullal S, Mahale A, Rani S. Unusual Intracranial Manifestation of Infective Endocarditis. Open Neuroimag J 2021. [DOI: 10.2174/1874440002114010028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective:
The mycotic aneurysm is a rare intracranial pathology seen with pre-existing infective endocarditis. It has a high mortality rate due to its risk of rupture and needs early diagnosis and treatment.
Methods:
A 23-year male patient who presented with infective endocarditis subsequently developed a left parietal-temporal intracranial haemorrhage with suspicion of aneurysm after the course of antibiotic treatment as seen on Computed Tomography (CT) scan. Digital Subtraction Angiography (DSA) revealed a ruptured fusosaccular aneurysm in the distal parietal branches of the left Middle Cerebral Artery (MCA), for which glue embolization of the distal parent artery and aneurysm was done.
Result:
The interventional endovascular procedure was done with complete obliteration of the distal parent artery, mycotic aneurysm, and normal filling of the left internal cerebral artery (ICA) branches.
Conclusion:
Mycotic intracranial aneurysms (MIA) are a rare form of cerebrovascular pathology which needs early diagnosis with endovascular intervention when rupture occurs.
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Frisoli FA, Catapano JS, Singh R, Lawton MT. Dissecting Fusiform PICA Aneurysm Repair With Trapping and an Unconventional End-to-Side Reanastomosis: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2021; 21:E252-E253. [PMID: 33930170 DOI: 10.1093/ons/opab123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 02/23/2021] [Indexed: 11/13/2022] Open
Abstract
Dissecting fusiform posterior inferior cerebellar artery (PICA) aneurysms are rare and challenging.1,2 One common treatment is occlusion of the aneurysm and parent artery via an endovascular approach without revascularization.3 Revascularization of the artery requires an open microsurgical bypass or endovascular placement of a newer-generation flow diverter.4 We present an end-to-side reanastomosis of the PICA for treatment of a dissecting fusiform left PICA aneurysm with anatomy deemed unfavorable for endovascular treatment in a 62-yr-old man with subarachnoid hemorrhage. After discussions regarding risks, benefits, and alternatives to the procedure, the family consented to surgical treatment. A far-lateral craniotomy was performed, with partial condylectomy to widen the exposure. The cisterna magna was opened, and the dentate ligament was cut to visualize the vertebral artery. The PICA was identified and traced distally to the aneurysmal segment, which was circumferentially diseased. Perforators were noted immediately distal to the aneurysm. The aneurysm was then trapped, and the afferent artery was transected and brought to the sidewall of the distal artery. The recipient site was trapped with temporary clips, and a linear arteriotomy was made. An end-to-side reanastomosis was performed, temporary clips were removed, and hemostasis was achieved. Postoperative angiography confirmed bypass patency and preservation of the PICA perforators. Conventional reanastomosis of the parent artery after aneurysm excision is achieved by end-to-end reanastomosis. In contrast, we performed an unconventional end-to-side reanastomosis to revascularize the PICA while leaving the efferent artery in situ to protect its medullary perforators. This bypass is an example of a fourth-generation bypass.5,6 Used with permission from the Barrow Neurological Institute, Phoenix, Arizona.
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Affiliation(s)
- Fabio A Frisoli
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Joshua S Catapano
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Rohin Singh
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Michael T Lawton
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
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5
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Wang G, Yu J, Hou K, Guo Y, Yu J. Clinical importance of the posterior meningeal artery: a review of the literature. Neuroradiol J 2019; 32:158-165. [PMID: 30924401 DOI: 10.1177/1971400919840843] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
The posterior meningeal artery, which arises from the vertebral artery, is a critical artery in neurological lesions. However, a comprehensive review of the importance of the posterior meningeal artery is currently lacking. In this study, we used the PubMed database to perform a review of the literature on the posterior meningeal artery to increase our understanding of its role in vascular lesions. The posterior meningeal artery provides the main blood supply to the paramedial and medial portions of the dura covering the cerebellar convexity. The posterior meningeal artery is often involved in dural arteriovenous fistulas occurring near the posterior fossa, and the posterior meningeal artery can be the path for transarterial embolisation or a path through which to monitor the degree of dural arteriovenous fistula embolisation. In posterior circulation ischaemia and moyamoya disease, the posterior meningeal artery can form transdural anastomoses with pial arteries at the surface of the brain, and these can help prevent ischemia. The posterior meningeal artery can also develop aneurysms, most of which are traumatic pseudoaneurysms; patients should therefore be treated in a timely manner or followed up carefully in cases of rebleeding. In addition, during a craniotomy, the posterior meningeal artery should be protected intraoperatively to avoid damaging any transdural anastomosis that may be present. In addition, when the posterior meningeal artery is the main feeding artery of an intracranial tumour, that artery is a satisfactory path for preoperative embolisation. Briefly, the posterior meningeal artery is a very important artery in neurosurgery.
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Affiliation(s)
- Guangming Wang
- 1 Department of Neurosurgery, The First Hospital of Jilin University, China
| | - Jing Yu
- 2 Department of Operation Room, The First Hospital of Jilin University, China
| | - Kun Hou
- 1 Department of Neurosurgery, The First Hospital of Jilin University, China
| | - Yunbao Guo
- 1 Department of Neurosurgery, The First Hospital of Jilin University, China
| | - Jinlu Yu
- 1 Department of Neurosurgery, The First Hospital of Jilin University, China
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6
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Strickland BA, Bakhsheshian J, Rennert RC, Fredrickson VL, Lam J, Amar A, Mack W, Carey J, Russin JJ. Descending Branch of the Lateral Circumflex Femoral Artery Graft for Posterior Inferior Cerebellar Artery Revascularization. Oper Neurosurg (Hagerstown) 2018; 15:285-291. [PMID: 30125010 DOI: 10.1093/ons/opx241] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 02/07/2018] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Posterior inferior cerebellar artery (PICA) revascularization can be achieved with relative ease when a contralateral PICA is present. However, without a contralateral PICA, identification of a suitable vessel alternative can be challenging due to a size mismatch. OBJECTIVE To propose the descending branch of the lateral circumflex femoral artery (DLCFA) to be an acceptable, if not preferred, arterial graft for PICA revascularization. METHODS Data from patients who underwent PICA revascularization with DLCFA grafts were obtained from an institutional review board-approved prospectively maintained database with informed consent from the patients. RESULTS Three patients, all presenting with ruptured aneurysms, were treated with PICA revascularization using the DLCFA. All cases achieved bypass patency and no ischemic events occurred during the bypass procedures. Graft spasm occurred in 2 patients. Two patients that presented with neurological deficits achieved excellent neurological outcomes and 1 suffered an anterior spinal artery stroke during a repeat endovascular treatment 1 wk after revascularization. CONCLUSION The DLCFA is favorable for PICA revascularization when a contralateral PICA is not a viable option.
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Affiliation(s)
- Ben A Strickland
- Department of Neurosurgery The Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Joshua Bakhsheshian
- Department of Neurosurgery The Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Robert C Rennert
- Department of Neurosurgery, The University of California San Diego, San Diego, California
| | - Vance L Fredrickson
- Department of Neurosurgery The Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Jordan Lam
- Department of Neurosurgery The Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Arun Amar
- Department of Neurosurgery The Keck School of Medicine of the University of Southern California, Los Angeles, California.,Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - William Mack
- Department of Neurosurgery The Keck School of Medicine of the University of Southern California, Los Angeles, California.,Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Joseph Carey
- Department of Plastic Surgery, The Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Jonathan J Russin
- Department of Neurosurgery The Keck School of Medicine of the University of Southern California, Los Angeles, California.,Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, California
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7
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Mascitelli JR, Yaeger K, Wei D, Kellner CP, Oxley TJ, De Leacy RA, Fifi JT, Patel AB, Naidich TP, Bederson JB, Mocco J. Multimodality Treatment of Posterior Inferior Cerebellar Artery Aneurysms. World Neurosurg 2017; 106:493-503. [DOI: 10.1016/j.wneu.2017.07.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Revised: 07/03/2017] [Accepted: 07/06/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Justin R Mascitelli
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
| | - Kurt Yaeger
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Daniel Wei
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Christopher P Kellner
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Thomas J Oxley
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Reade A De Leacy
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Johanna T Fifi
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Aman B Patel
- Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Thomas P Naidich
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Joshua B Bederson
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - J Mocco
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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8
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Bonda DJ, Labib M, Katz JM, Ortiz RA, Chalif D, Setton A, Langer DJ, Dehdashti AR. Intracranial Bypass of Posterior Inferior Cerebellar Artery Aneurysms: Indications, Technical Aspects, and Clinical Outcomes. Oper Neurosurg (Hagerstown) 2017; 13:586-595. [DOI: 10.1093/ons/opx064] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 03/03/2017] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND: For some posterior inferior cerebellar artery (PICA) aneurysms, there is no constructive endovascular or direct surgical clipping option. Intracranial bypass is an alternative to a deconstructive technique.
OBJECTIVE: To evaluate the clinical features, surgical techniques, and outcome of PICA aneurysms treated with bypass and obliteration of the diseased segment.
METHODS: Retrospective review of PICA aneurysms treated via intracranial bypass was performed. Outcome measurements included postoperative stroke, cranial nerve deficits, gastrostomy/tracheostomy requirement, bypass patency, modified Rankin scale (mRS) at discharge, and mRS at 6 mo.
RESULTS: Seven patients with PICA aneurysms treated with intracranial bypass were identified. Five had fusiform aneurysms (4 ruptured, 1 unruptured), 1 had a giant partially thrombosed saccular aneurysm (unruptured), and 1 had a dissecting traumatic aneurysm (ruptured). Two aneurysms were at the anteromedullary segment, 4 at the lateral medullary segment, and 1 at the tonsillomedullary segment. Three patients underwent PICA-to-PICA side to side anastomoses, 2 PICA-to-PICA reanastomosis, 1 vertebral artery-to-PICA bypass, and 1 occipital artery-PICA bypass. Six out of 7 aneurysms were obliterated surgically and 1 with additional endovascular occlusion after the bypass. All bypasses were patent intraoperatively; 2 were later demonstrated occluded without radiological signs or symptoms of stroke. No patients had new cranial nerve deficit postoperatively. With the exception of 1 death due to pulmonary emboli 3 mo postoperatively, all others remain at a mRS ≤ 2.
CONCLUSION: Constructive bypass and aneurysm obliteration remains a viable alternative for treatment of PICA aneurysms not amenable to direct surgical clipping or to a vessel-preserving endovascular option.
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Affiliation(s)
- David J. Bonda
- Department of Neurosurgery, North Shore University Hospital, Northwell Health, Manhasset, New York
| | - Mohamad Labib
- Department of Neurosurgery, North Shore University Hospital, Northwell Health, Manhasset, New York
| | - Jeffrey M. Katz
- Department of Neurology, North Shore University Hospital, Northwell Health, Manhasset, New York
| | - Rafael A. Ortiz
- Department of Neurosurgery, Lenox Hill Hospital, Northwell Health, New York, New York
| | - David Chalif
- Department of Neurosurgery, North Shore University Hospital, Northwell Health, Manhasset, New York
| | - Avi Setton
- Department of Neurosurgery, North Shore University Hospital, Northwell Health, Manhasset, New York
| | - David J. Langer
- Department of Neurosurgery, North Shore University Hospital, Northwell Health, Manhasset, New York
- Department of Neurosurgery, Lenox Hill Hospital, Northwell Health, New York, New York
| | - Amir R. Dehdashti
- Department of Neurosurgery, North Shore University Hospital, Northwell Health, Manhasset, New York
- Department of Neurosurgery, Lenox Hill Hospital, Northwell Health, New York, New York
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Chung Y, Ryu J, Choi SK, Kim EJ, Choi JH, Lee SH. Treatment Strategy for Isolated Posterior Inferior Cerebellar Artery Dissection. World Neurosurg 2016; 98:644-653. [PMID: 27890746 DOI: 10.1016/j.wneu.2016.11.094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 11/15/2016] [Accepted: 11/16/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Isolated dissections that develop on the posterior inferior cerebellar artery (PICA) require intensive treatment because of their potential fatality. However, because of the rarity of these dissections, the optimal treatment has not yet been established. METHODS We retrospectively reviewed the clinical records of all patients who underwent any PICA dissection treatment in our institute over the last 4 years. Ten patients were enrolled, including 7 patients with subarachnoid hemorrhage (SAH) and 3 with PICA territory infarction. Dissection was seen at the proximal portion in 8 patients, whereas the remaining 2 patients showed distal PICA dissecting aneurysms. RESULTS Among the 7 patients with hemorrhage, 5 were actively treated (trapping and bypass, 2 patients; surgical clipping, 1 patient; coil embolization, 2 patients). Conservative management was performed in the other 2 patients. Among the 3 patients with infarction, 2 received conservative treatment. Endovascular treatment was performed in 1 patient, who showed rapid progression, aneurysm formation, and conversion to massive SAH within 10 days after the initial attack. Although 7 patients showed relatively good outcomes (modified Rankin Scale score, ≤2) after 30 days of follow-up, 1 patient had a final modified Rankin Scale score of 3. In addition, the other 2 patients (1 in each group) died as a result of major SAH. CONCLUSIONS Given the dynamic clinical course and potential fatality of PICA dissection, meticulous evaluation, intensive treatment with a diverse range of modalities, and proper follow-up are required for patients with PICA dissection to achieve favorable outcomes.
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Affiliation(s)
- Yeongu Chung
- Department of Neurosurgery, College of Medicine, Kyung Hee University, Kyung Hee University Hospital, Seoul, Korea
| | - Jiwook Ryu
- Department of Neurosurgery, College of Medicine, Kyung Hee University, Kyung Hee University Hospital, Seoul, Korea
| | - Seok Keun Choi
- Department of Neurosurgery, College of Medicine, Kyung Hee University, Kyung Hee University Hospital, Seoul, Korea
| | - Eui Jong Kim
- Department of Radiology, College of Medicine, Kyung Hee University, Kyung Hee University Hospital, Seoul, Korea
| | - Joon Ho Choi
- Department of Medicine, Graduate School, Kyung Hee University, Seoul, Korea
| | - Sung Ho Lee
- Department of Neurosurgery, College of Medicine, Kyung Hee University, Kyung Hee University Hospital, Seoul, Korea.
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Xu F, Hong Y, Zheng Y, Xu Q, Leng B. Endovascular treatment of posterior inferior cerebellar artery aneurysms: a 7-year single-center experience. J Neurointerv Surg 2016; 9:45-51. [DOI: 10.1136/neurintsurg-2016-012489] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Revised: 05/30/2016] [Accepted: 06/01/2016] [Indexed: 11/03/2022]
Abstract
AimTo report our experience with endovascular treatment of posterior inferior cerebellar artery (PICA) aneurysms.MethodsBetween January 2007 and December 2014, 40 patients with 42 PICA aneurysms were treated with endovascular embolization at our institution. Twenty-eight patients had 29 saccular aneurysms and 12 patients had 13 fusiform/dissecting aneurysms. The endovascular modalities were: (1) selective occlusion of the aneurysm with or without stent assistance (n=19); (2) occlusion of the aneurysm and the parent artery (n=22); and (3) occlusion of the aneurysm including the vertebral artery and PICA origin (n=1). Specifically, selective embolization was performed in 93.3% of aneurysms (14/15) proximal to the telovelotonsillary segment.ResultsImmediate angiographic results included 31 complete occlusions (74%), 3 nearly complete occlusions (7%), and 8 incomplete occlusions (19%). Mean follow-up of 20 months in 31 aneurysms showed 27 stable results, 3 further thromoboses, and 1 recurrence. Final results included 27 complete occlusions (87.1%) and 4 incomplete occlusions (12.9%). There were 5 overall procedural-related complications (12.5%), including 1 infarction (2.5%) and 4 intraprocedural ruptures (10.0%). Procedure-related morbidity and morbidity was 5.0% (2/40) and 2.5% (1/40), respectively. Clinical outcome was excellent (Glasgow Outcome Scale 5 in 31 of 33 patients at long-term follow-up).ConclusionsPICA aneurysms may be effectively treated by different endovascular approaches with favorable clinical and radiologic outcomes. Further studies are required to compare the safety and efficacy of endovascular treatment with open surgery.
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Dinc G, Oguz S, Eyuboglu I, Guven S. Ruptured dissecting PICA aneurysm with spontaneous thrombosis during pregnancy with long-term follow-up. J OBSTET GYNAECOL 2015; 36:345-6. [PMID: 26503898 DOI: 10.3109/01443615.2015.1060209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- G Dinc
- a Medical Park Hospital, Obstetrics and Gynecology Clinic , Trabzon , Turkey
| | - S Oguz
- b Karadeniz Technical University, Faculty of Medicine , Department of Interventional Radiology , Trabzon , Turkey
| | - I Eyuboglu
- b Karadeniz Technical University, Faculty of Medicine , Department of Interventional Radiology , Trabzon , Turkey
| | - S Guven
- c Karadeniz Technical University, Faculty of Medicine , Department of Obstetrics and Gynecology , Trabzon , Turkey
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12
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Sejkorová A, Cihlář F, Hejčl A, Lodin J, Vachata P, Sameš M. Microsurgery and endovascular treatment of posterior inferior cerebellar artery aneurysms. Neurosurg Rev 2015; 39:159-68; discussion 168. [DOI: 10.1007/s10143-015-0659-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Revised: 05/01/2015] [Accepted: 06/27/2015] [Indexed: 11/28/2022]
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13
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Li H, Li XF, He XY, Zhang X, Zhu GH, Fang QR, Wang ZQ, Duan CZ. Endovascular Treatment of Dissecting Aneurysms of the Posterior Inferior Cerebellar Artery and Predictors of Outcome. J Stroke Cerebrovasc Dis 2015; 24:2134-42. [PMID: 26150084 DOI: 10.1016/j.jstrokecerebrovasdis.2015.05.034] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 05/19/2015] [Accepted: 05/26/2015] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Isolated dissecting aneurysms of the posterior inferior cerebellar artery (PICA) are rare lesions, which carry high risk of rebleeding and mortality. However, the existing literature concerning predictors of outcome after endovascular treatment is limited and controversial. Our present study retrospectively reviewed and analyzed the clinical outcome of endovascular treatment-ruptured PICA-dissecting aneurysms and explored the predictors of outcome. METHODS We retrospectively reviewed 17 consecutive patients with ruptured PICA dissecting aneurysms that underwent endovascular treatment from January 2003 to January 2014. Nine patients underwent selective coiling, whereas 7 patients underwent parent artery occlusion and 1 patient underwent stent-assisted coiling. Follow-up outcomes were evaluated using the modified Rankin Scale. The clinical outcomes of patients were categorized as favorable (modified Rankin Scale [mRS] score 0-1) or unfavorable (mRS score 2-6). RESULTS Favorable outcomes (mRS score 0-1) were obtained in 13 of 17 patients. Post-treatment recurrence occurred in 1 patient with selective coiling in the 15-month follow-up, and the patient received stent-assisted coiling. The only patients with stent-assisted coiling developed PICA occlusion during follow-up. Aneurysm located in distal segment usually presented with intraventricular hemorrhage (P = .015). Hypertension, coexisting hydrocephalus, and time to operation (latter than 2 weeks) were associated with unfavorable outcome. CONCLUSIONS Endovascular treatment of isolated dissecting aneurysm of PICA had excellent clinical outcomes, hypertension, coexisting hydrocephalus, and time to operation (latter than 2 weeks), which were associated with unfavorable outcome. Long-term follow-ups are necessary to provide stronger conclusions.
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Affiliation(s)
- Hui Li
- Department of Neurosurgery/Neurosurgery Institute/Key Laboratory on Brain Function Repair and Regeneration of Guangdong, Southern Medical University, Zhujiang Hospital, 510282, Guangzhou, Guangdong, China
| | - Xi-Feng Li
- Department of Neurosurgery/Neurosurgery Institute/Key Laboratory on Brain Function Repair and Regeneration of Guangdong, Southern Medical University, Zhujiang Hospital, 510282, Guangzhou, Guangdong, China
| | - Xu-Ying He
- Department of Neurosurgery/Neurosurgery Institute/Key Laboratory on Brain Function Repair and Regeneration of Guangdong, Southern Medical University, Zhujiang Hospital, 510282, Guangzhou, Guangdong, China
| | - Xin Zhang
- Department of Neurosurgery/Neurosurgery Institute/Key Laboratory on Brain Function Repair and Regeneration of Guangdong, Southern Medical University, Zhujiang Hospital, 510282, Guangzhou, Guangdong, China
| | - Guo-Hui Zhu
- Department of Neurosurgery/Neurosurgery Institute/Key Laboratory on Brain Function Repair and Regeneration of Guangdong, Southern Medical University, Zhujiang Hospital, 510282, Guangzhou, Guangdong, China
| | - Qin-Rui Fang
- Department of Neurosurgery/Neurosurgery Institute/Key Laboratory on Brain Function Repair and Regeneration of Guangdong, Southern Medical University, Zhujiang Hospital, 510282, Guangzhou, Guangdong, China
| | - Ze-Qun Wang
- Department of Neurosurgery/Neurosurgery Institute/Key Laboratory on Brain Function Repair and Regeneration of Guangdong, Southern Medical University, Zhujiang Hospital, 510282, Guangzhou, Guangdong, China
| | - Chuan-Zhi Duan
- Department of Neurosurgery/Neurosurgery Institute/Key Laboratory on Brain Function Repair and Regeneration of Guangdong, Southern Medical University, Zhujiang Hospital, 510282, Guangzhou, Guangdong, China.
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Puri AS, Massari F, Hou SY, Lozano JD, Howk M, Perras M, Brooks C, Gounis MJ, Kan P, Wakhloo AK. Onyx embolization in distal dissecting posterior inferior cerebellar artery aneurysms. J Neurointerv Surg 2015; 8:501-6. [PMID: 25838199 DOI: 10.1136/neurintsurg-2014-011622] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 03/13/2015] [Indexed: 11/03/2022]
Abstract
BACKGROUND Dissecting aneurysms located along the distal segments of the posterior inferior cerebellar artery (PICA) are extremely rare, accounting for only 0.5-0.7% of all intracranial aneurysms. Treatment of these aneurysms is challenging, both surgically and endovascularly. We present our preliminary experience and clinical data utilizing Onyx as an embolization agent in the treatment of these lesions with proximal parent artery preservation. METHODS 7 consecutive ruptured peripheral PICA aneurysms, in 7 patients, were treated with superselective Onyx embolization at our institutions. According to the anatomical classification of Lister et al, these aneurysms were located in the lateral medullary segment (n=1), tonsillomedullary segment (n=1), and the telovelotonsillary segment (n=5) of the PICA. Technical feasibility, procedure related complications, angiographic results, follow-up diagnostic imaging, and clinical outcome were evaluated. RESULTS In all cases, endovascular treatment was successful, with complete occlusion of the aneurysm with proximal parent artery preservation at the final postprocedural angiogram. Procedure related complications were not observed. One patient with a poor clinical condition at admission died during the initial hospital stay due to extensive subarachnoid and intraventricular hemorrhage. No rebleeding or recanalization was noted during follow-up. Two patients had a residual moderate to severe disability at follow-up. Favorable outcomes, with no or mild disability, were observed in four of the surviving patients. CONCLUSIONS Angiographic, diagnostic imaging, and clinical results of our small series indicate that Onyx embolization of dissecting distal PICA aneurysms with parent artery preservation is an effective option with acceptable morbidity and mortality rate, in those cases in which surgical clipping or endovascular coiling of the aneurysmal sac is not suitable.
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Affiliation(s)
- Ajit S Puri
- Division of Neuroimaging and Intervention (NII), Department of Radiology and New England Center for Stroke Research, University of Massachusetts, Worcester, Massachusetts, USA
| | - Francesco Massari
- Division of Neuroimaging and Intervention (NII), Department of Radiology and New England Center for Stroke Research, University of Massachusetts, Worcester, Massachusetts, USA
| | - Samuel Y Hou
- Division of Neuroimaging and Intervention (NII), Department of Radiology and New England Center for Stroke Research, University of Massachusetts, Worcester, Massachusetts, USA
| | - Juan Diego Lozano
- Division of Neuroimaging and Intervention (NII), Department of Radiology and New England Center for Stroke Research, University of Massachusetts, Worcester, Massachusetts, USA
| | - Mary Howk
- Division of Neuroimaging and Intervention (NII), Department of Radiology and New England Center for Stroke Research, University of Massachusetts, Worcester, Massachusetts, USA
| | - Mary Perras
- Division of Neuroimaging and Intervention (NII), Department of Radiology and New England Center for Stroke Research, University of Massachusetts, Worcester, Massachusetts, USA
| | - Christopher Brooks
- Division of Neuroimaging and Intervention (NII), Department of Radiology and New England Center for Stroke Research, University of Massachusetts, Worcester, Massachusetts, USA
| | - Matthew J Gounis
- Division of Neuroimaging and Intervention (NII), Department of Radiology and New England Center for Stroke Research, University of Massachusetts, Worcester, Massachusetts, USA
| | - Peter Kan
- Division of Cerebrovascular and Endovascular Neurosurgery, University of South Florida College of Medicine, Tampa General Hospital, Tampa, Florida, USA
| | - Ajay K Wakhloo
- Division of Neuroimaging and Intervention (NII), Department of Radiology and New England Center for Stroke Research, University of Massachusetts, Worcester, Massachusetts, USA
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Lehto H, Harati A, Niemelä M, Dashti R, Laakso A, Elsharkawy A, Satopää J, Billon-Grand R, Canato B, Kivisaari R, Hernesniemi J. Distal Posterior Inferior Cerebellar Artery Aneurysms: Clinical Features and Outcome of 80 Patients. World Neurosurg 2014; 82:702-13. [DOI: 10.1016/j.wneu.2014.06.012] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 12/03/2013] [Accepted: 06/09/2014] [Indexed: 11/29/2022]
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17
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Trivelato FP, Salles Rezende MT, Castro GD, Manzato LB, Santoro Araújo JF, Ulhôa AC. Endovascular Treatment of Isolated Posterior Inferior Cerebellar Artery Dissecting Aneurysms: Parent Artery Occlusion or Selective Coiling? Clin Neuroradiol 2013; 24:255-61. [DOI: 10.1007/s00062-013-0247-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 07/20/2013] [Indexed: 11/24/2022]
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