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Enriquez-Marulanda A, Ravindran K, Salem MM, Ascanio LC, Kan P, Srinivasan VM, Griessenauer CJ, Schirmer CM, Jain A, Moore JM, Ogilvy CS, Thomas AJ, Alturki AY. Evaluation of Radiological Features of the Posterior Communicating Artery and Their Impact on Efficacy of Saccular Aneurysm Treatment with the Pipeline Embolization Device: A Case Series Study. World Neurosurg 2019; 125:e998-e1007. [PMID: 30771544 DOI: 10.1016/j.wneu.2019.01.228] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 01/24/2019] [Accepted: 01/25/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Posterior communicating artery segment aneurysms are one of the most frequent intracranial aneurysms. Currently, limited data have described the use of the pipeline embolization device (PED) in these aneurysms. METHODS We conducted a multicenter retrospective review of 3 prospectively collected databases of patients treated with the PED from January 2013 to December 2017. The primary objective was to assess the efficacy and safety of the PED in the treatment of saccular posterior communicating artery (PComA) aneurysms. We also assessed the effect of anatomical variations on the angiographic and clinical outcomes, including the presence of fetal PComA, vessel origin relationship to the aneurysm, and patency after PED placement. RESULTS We identified 57 patients with 60 saccular aneurysms; Their mean age was 60.5 years, and 49 were female (86.0%). A total of 55 aneurysms (91.7%) were unruptured. The median imaging follow-up duration was 8.5 months. Complete occlusion at the last imaging follow-up study was 84.0%. At the last follow-up examination, 94.5% of patients had a modified Rankin scale score of ≤2. The presence of fetal PComA, origin type, and patency during follow-up did have a significant effect on aneurysm occlusion (P = 0.61, P = 0.40, and P = 0.14, respectively). CONCLUSIONS PED use for treatment of PComA aneurysms resulted in acceptable occlusion rates. The present study did not find that fetal PComA, its origin, or its patency during follow-up had an effect on aneurysm occlusion.
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Affiliation(s)
| | - Krishnan Ravindran
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Mohamed M Salem
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Luis C Ascanio
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Peter Kan
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | | | - Christoph J Griessenauer
- Department of Neurosurgery, Geisinger, Danville, Pennsylvania, USA; Research Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria
| | | | - Abhi Jain
- Department of Neurosurgery, Geisinger, Danville, Pennsylvania, USA
| | - Justin M Moore
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Christopher S Ogilvy
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Ajith J Thomas
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Abdulrahman Y Alturki
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA; Department of Neurosurgery, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia.
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Taweesomboonyat C, Tunthanathip T, Kaewborisutsakul A, Saeheng S, Oearsakul T, Riabroi K, Khumtong R. Outcome of Ruptured Posterior Communicating Artery Aneurysm Treatment Comparing Between Clipping and Coiling Techniques. World Neurosurg 2019; 125:e183-e188. [PMID: 30684714 DOI: 10.1016/j.wneu.2019.01.037] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 12/31/2018] [Accepted: 01/02/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Very few data stratify the functional outcome of ruptured posterior communicating artery (PCoA) aneurysm treatment based on each treatment strategy. Therefore, the authors aimed to evaluate the outcome of PCoA aneurysm treatment to compare the clipping and coiling techniques and find the factors that determined the treatment outcomes. METHODS Patients with ruptured PCoA aneurysm at Songklanagarind Hospital between November 2002 and March 2018 were retrospectively reviewed and classified into the clipping group or the coiling group. The primary outcome was the modified Rankin Scale (mRS) at 6 months after treatment, and the patients were stratified into "good outcome" (mRS 0-2) and "poor outcome" (mRS 3-6). Using logistic regression analysis, various factors were analyzed for association with the treatment outcome. RESULTS This study included 189 patients: 104 and 85 patients in the clipping and coiling groups, respectively. Patients in the coiling group were significantly older, with more underlying diseases. However, the treatment outcomes at 6 months were not significantly different between the 2 groups. The percentages of poor outcomes in the clipping and coiling groups were 28% and 31%, respectively (P = 0.734). Older age, seizure, higher Hunt and Hess grade, deterioration before aneurysm obliteration, an aneurysm on the left side, and a medially projected PCoA aneurysm were statistically significantly correlated with poor outcomes. CONCLUSIONS Neurosurgical clipping and endovascular coiling are effective treatments for aneurysm obliteration in ruptured PCoA aneurysm. An aneurysm on the left side and a medially projected PCoA aneurysm were the factors correlated with poor outcome.
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Affiliation(s)
- Chin Taweesomboonyat
- Division of Neurosurgery, Department of Surgery, Songklanagarind Hospital, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.
| | - Thara Tunthanathip
- Division of Neurosurgery, Department of Surgery, Songklanagarind Hospital, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Anukoon Kaewborisutsakul
- Division of Neurosurgery, Department of Surgery, Songklanagarind Hospital, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Sakchai Saeheng
- Division of Neurosurgery, Department of Surgery, Songklanagarind Hospital, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Thakul Oearsakul
- Division of Neurosurgery, Department of Surgery, Songklanagarind Hospital, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Kittipong Riabroi
- Division of Diagnostic Radiology, Department of Radiology, Songklanagarind Hospital, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Rujimas Khumtong
- Division of Diagnostic Radiology, Department of Radiology, Songklanagarind Hospital, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
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Mohammad AA, Yasuhiro Y, Seng LB, Rajagopal N, Yoko K. Outcome Analysis of Surgical Clipping for Incidental Internal Carotid Posterior Communicating and Anterior Choroidal Artery Aneurysms. Asian J Neurosurg 2019; 14:415-421. [PMID: 31143255 PMCID: PMC6516038 DOI: 10.4103/ajns.ajns_155_18] [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: 11/04/2022] Open
Abstract
INTRODUCTION Surgical outcome and ischemic complications of Internal carotid Posterior Communicating (IC PC) and anterior choroidal aneurysms have been questionable due to frequent occlusion of the anterior choroid artery and also due to low incidence of true anterior choroid artery aneurysms. The present series describes the postoperative outcome after clipping of such aneurysms at a single centre. METHODS A retrospective analysis of 73 cases with IC PC and Anterior choroidal aneurysms performed at a Fujita Health University, Banbuntane Hotokukai Hospital, Nagoya, Aichi, Japan from 2014 to 2018 have been studied and emphasis is made on the demography and ischemic complications. RESULTS A total of 73 patients with IC PC and anterior choroidal aneurysms were studied, out of which 57 patient had a true IC PC aneurysm, 14 patients had aneurysms involving the anterior choroidal artery and only 2 patients had aneurysms which involved both the IC PC and the anterior choroidal arteries. None of the patients had a permanent Anterior Choroidal Artery syndrome, whereas only 2 out of the 73 patients had postoperative complications in the form of transient hemiparesis. CONCLUSION Ischemic complications following surgical clipping of IC PC and anterior choroidal aneurysms can be minimised by meticulous micro dissection to identify the anterior choroidal artery thus preserving the patency of the same.
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Affiliation(s)
- Ameen Abdul Mohammad
- Department of Neurosurgery, Aayush Hospital, Vijayawada, Andhra Pradesh, India,Address for correspondence: Dr. Ameen Abdul Mohammad, Department of Neurosurgery, Aayush Hospital, Vijayawada, Andhra Pradesh, India. E-mail:
| | - Yamada Yasuhiro
- Department of Neurosurgery, Fujita Health University, Banbuntane Hospital, Nagoya, Aichi, Japan
| | - Liew Boon Seng
- Department of Neurosurgery, Hospital Sungai Buloh, Selangor, Malaysia
| | - Niranjana Rajagopal
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bengaluru, India
| | - Kato Yoko
- Department of Neurosurgery, Fujita Health University, Banbuntane Hospital, Nagoya, Aichi, Japan
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Soliman R, Zohry G. [Effect of magnesium sulphate and milrinone on cerebral vasospasm after aneurysmal subarachnoid hemorrhage: a randomized study]. Rev Bras Anestesiol 2018; 69:64-71. [PMID: 30409409 DOI: 10.1016/j.bjan.2018.09.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 07/19/2018] [Accepted: 09/04/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Aneurysmal subarachnoid hemorrhage is an important cause of premature death and disability worldwide. Magnesium sulphate is shown to have a neuroprotective effect and it reverses cerebral vasospasm. Milrinone is also used in the treatment of cerebral vasospasm. The aim of the present study was to compare the effect of prophylactic magnesium sulphate and milrinone on the incidence of cerebral vasospasm after subarachnoid hemorrhage. METHODS The study included 90 patients with aneurysmal subarachnoid hemorrhage classified randomly (by simple randomization) into two groups: magnesium sulphate was given as an infusion of 500mg.day-1 without loading dose for 21 days. Group B: milrinone was given as an infusion of 0.5μg.kg-1.min-1 without loading dose for 21 days. The cerebral vasospasm was diagnosed by mean cerebral blood flow velocity in the involved cerebral artery (mean flow velocity≥120cm.s-1), neurological deterioration by Glasgow coma scale, or angiography (the decrease in diameter of the involved cerebral artery >25%). RESULTS The mean cerebral blood flow velocity decreased significantly in the magnesium group compared to milrinone group through Day 7, Day 14 and Day 21 (p<0.001). The incidence of cerebral vasospasm decreased significantly with magnesium compared to milrinone (p=0.007). The Glasgow coma scale significantly improved in the magnesium group compared to milrinone group through Day 7, Day 14 and Day 21 (p=0.036, p=0.012, p=0.016, respectively). The incidence of hypotension was higher with milrinone than magnesium (p=0.012). CONCLUSIONS The incidence of cerebral vasospasm after aneurysmal subarachnoid hemorrhage was significantly lower and Glasgow coma scale significantly better with magnesium when compared to milrinone. Milrinone was associated with a higher incidence of hypotension and requirement for dopamine and norepinephrine when compared to magnesium.
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Affiliation(s)
- Rabie Soliman
- Cairo University, Department of Anesthesia, Cairo, Egito.
| | - Gomaa Zohry
- Cairo University, Department of Anesthesia, Cairo, Egito
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Soliman R, Zohry G. [Effect of magnesium sulphate and milrinone on cerebral vasospasm after aneurysmal subarachnoid hemorrhage: a randomized study]. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ELSEVIER) 2018; 69. [PMID: 30409409 PMCID: PMC9391725 DOI: 10.1016/j.bjane.2018.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Aneurysmal subarachnoid hemorrhage is an important cause of premature death and disability worldwide. Magnesium sulphate is shown to have a neuroprotective effect and it reverses cerebral vasospasm. Milrinone is also used in the treatment of cerebral vasospasm. The aim of the present study was to compare the effect of prophylactic magnesium sulphate and milrinone on the incidence of cerebral vasospasm after subarachnoid hemorrhage. METHODS The study included 90 patients with aneurysmal subarachnoid hemorrhage classified randomly (by simple randomization) into two groups: magnesium sulphate was given as an infusion of 500mg.day-1 without loading dose for 21 days. Group B: milrinone was given as an infusion of 0.5μg.kg-1.min-1 without loading dose for 21 days. The cerebral vasospasm was diagnosed by mean cerebral blood flow velocity in the involved cerebral artery (mean flow velocity≥120cm.s-1), neurological deterioration by Glasgow coma scale, or angiography (the decrease in diameter of the involved cerebral artery >25%). RESULTS The mean cerebral blood flow velocity decreased significantly in the magnesium group compared to milrinone group through Day 7, Day 14 and Day 21 (p<0.001). The incidence of cerebral vasospasm decreased significantly with magnesium compared to milrinone (p=0.007). The Glasgow coma scale significantly improved in the magnesium group compared to milrinone group through Day 7, Day 14 and Day 21 (p=0.036, p=0.012, p=0.016, respectively). The incidence of hypotension was higher with milrinone than magnesium (p=0.012). CONCLUSIONS The incidence of cerebral vasospasm after aneurysmal subarachnoid hemorrhage was significantly lower and Glasgow coma scale significantly better with magnesium when compared to milrinone. Milrinone was associated with a higher incidence of hypotension and requirement for dopamine and norepinephrine when compared to magnesium.
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Affiliation(s)
- Rabie Soliman
- Cairo University, Department of Anesthesia, Cairo, Egito.
| | - Gomaa Zohry
- Cairo University, Department of Anesthesia, Cairo, Egito
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Development of a statistical model for discrimination of rupture status in posterior communicating artery aneurysms. Acta Neurochir (Wien) 2018; 160:1643-1652. [PMID: 29922867 DOI: 10.1007/s00701-018-3595-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 06/11/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND Intracranial aneurysms at the posterior communicating artery (PCOM) are known to have high rupture rates compared to other locations. We developed and internally validated a statistical model discriminating between ruptured and unruptured PCOM aneurysms based on hemodynamic and geometric parameters, angio-architectures, and patient age with the objective of its future use for aneurysm risk assessment. METHODS A total of 289 PCOM aneurysms in 272 patients modeled with image-based computational fluid dynamics (CFD) were used to construct statistical models using logistic group lasso regression. These models were evaluated with respect to discrimination power and goodness of fit using tenfold nested cross-validation and a split-sample approach to mimic external validation. RESULTS The final model retained maximum and minimum wall shear stress (WSS), mean parent artery WSS, maximum and minimum oscillatory shear index, shear concentration index, and aneurysm peak flow velocity, along with aneurysm height and width, bulge location, non-sphericity index, mean Gaussian curvature, angio-architecture type, and patient age. The corresponding area under the curve (AUC) was 0.8359. When omitting data from each of the three largest contributing hospitals in turn, and applying the corresponding model on the left-out data, the AUCs were 0.7507, 0.7081, and 0.5842, respectively. CONCLUSIONS Statistical models based on a combination of patient age, angio-architecture, hemodynamics, and geometric characteristics can discriminate between ruptured and unruptured PCOM aneurysms with an AUC of 84%. It is important to include data from different hospitals to create models of aneurysm rupture that are valid across hospital populations.
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Tanabe J, Ishikawa T, Moroi J, Sakata Y, Hadeishi H. Impact of Right-Sided Aneurysm, Rupture Status, and Size of Aneurysm on Perforator Infarction Following Microsurgical Clipping of Posterior Communicating Artery Aneurysms with a Distal Transsylvian Approach. World Neurosurg 2018; 111:e905-e911. [DOI: 10.1016/j.wneu.2018.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 12/28/2017] [Accepted: 01/03/2018] [Indexed: 11/16/2022]
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Kocur D, Przybyłko N, Bażowski P, Baron J. Rupture during coiling of intracranial aneurysms: Predictors and clinical outcome. Clin Neurol Neurosurg 2018; 165:81-87. [PMID: 29331871 DOI: 10.1016/j.clineuro.2018.01.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Revised: 01/03/2018] [Accepted: 01/07/2018] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The intraprocedural aneurysm rupture (IPR) is one of the most feared adverse effect associated with the coil embolization therapy. The aim of the study was to identify predisposing factors for IPR, as well as to define patient groups with worse clinical outcome following IPR. PATIENTS AND METHODS From February 2008 to March 2015, 273 consecutive patients were treated at our institution via endovascular coil embolization. Patient medical records were reviewed with emphasis on procedure description, potential risk factors and clinical outcomes related to IPR. The IPR occurred in 14 (5.13%) cases. Multivariate logistic regression models were used to determine independent predictors of IPR. Clinical outcome was analyzed using the Glasgow Outcome Scale (GOS). RESULTS Multivariate analysis showed that aneurysm location at posterior communicating artery is an independent risk factor for IPR (p = 0.035; OR 3.5; 95%CI 1.09-11.26). The frequencies of favorable disability (GOS 4-5), severe disability (GOS 2-3), and mortality (GOS 1) between patients with IPR and without IPR were significantly different in the general study population (p < 0.001, p < 0.001 and p = 0.023, respectively) and in patients with previously unruptured aneurysms (p < 0.001, p = 0.006 and p = 0.003, respectively) but not in patients with previously ruptured aneurysms (p = 0.187, p = 0.089 and p = 1.0, respectively). CONCLUSION Posterior communicating artery aneurysm location is an independent predictor for IPR. IPR is associated with a significant clinical deterioration in a subgroup of patients with previously unruptured aneurysms, but not in patients with ruptured aneurysms.
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Affiliation(s)
- Damian Kocur
- Medical University of Silesia, School of Medicine in Katowice, Department of Neurosurgery, Katowice, Poland.
| | - Nikodem Przybyłko
- Medical University of Silesia, School of Medicine in Katowice, Department of Neurosurgery, Katowice, Poland
| | - Piotr Bażowski
- Medical University of Silesia, School of Medicine in Katowice, Department of Neurosurgery, Katowice, Poland
| | - Jan Baron
- Medical University of Silesia, School of Medicine in Katowice, Department of Radiology and Nuclear Medicine, Katowice, Poland
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Abstract
BACKGROUND Temporary parent vessel clip occlusion in aneurysm surgery is not always practical or feasible. Adenosine-induced transient cardiac arrest may serve as an alternative. METHODS All patients who underwent microsurgical clipping of intracranial aneurysms under adenosine-induced asystole performed by the author between September 2011 and July 2014 were retrospectively reviewed. RESULTS A total of 16 craniotomies were performed and 16 aneurysms were clipped under adenosine-induced asystole (in 8 basilar arteries, 7 internal carotid arteries, and 1 middle cerebral artery) in 14 patients (8 females, 6 males). Seven cases were elective and 7 were performed after subarachnoid hemorrhage. The patients' mean age was 54 years (range, 39-70 years). The indications for adenosine use were proximal control in narrow surgical corridors in 11 cases, aneurysm softening in 4 cases, and aneurysm rupture in 1 case. A single dose was used in 12 patients; 2 patients had multiple boluses. The median (range) total dose was 30 (18-60) mg. Adenosine induced bradycardia with concomitant arterial hypotension in all patients and the majority also had asystole for 5-15 s. Transient cardiac arrhythmias were noted in 1 patient (atrial fibrillation in need of electroconversion after two boluses). CONCLUSION Nine clinical scenarios were identified in which adenosine-induced temporary cardiac arrest and deep hypotension was an effective adjunct to temporary clipping during the microsurgical clipping of intracranial aneurysms.
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Affiliation(s)
- Torstein R Meling
- Department of Neurosurgery, Oslo University Hospital-Rikshospitalet, Oslo, Norway.
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
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Kamide T, Burkhardt JK, Tabani H, Safaee MM, Lawton MT. Preoperative Prediction of the Necessity for Anterior Clinoidectomy During Microsurgical Clipping of Ruptured Posterior Communicating Artery Aneurysms. World Neurosurg 2018; 109:e493-e501. [DOI: 10.1016/j.wneu.2017.10.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 09/30/2017] [Accepted: 10/03/2017] [Indexed: 12/31/2022]
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Matsuo S, Komune N, Tsuchimochi R, Kai Y, Matsumoto K, Haga S, Inoue T. The Microsurgical Relationships between Internal Carotid-Posterior Communicating Artery Aneurysms and the Skull Base. J Neurol Surg B Skull Base 2017; 79:427-436. [PMID: 30210969 DOI: 10.1055/s-0037-1615804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Accepted: 11/19/2017] [Indexed: 10/18/2022] Open
Abstract
Objective This study aimed to review the anatomical and clinical characteristics of internal carotid-posterior communicating artery (IC-PC) aneurysms, especially those located close to the skull base. Methods The microsurgical anatomy around the posterior communicating artery (PComA) was examined in a dry skull and five formalin-fixed human cadaveric heads. The clinical characteristics of 37 patients with 39 IC-PC aneurysms, who were treated microsurgically between April 2008 and July 2016, were retrospectively reviewed. Results The anterior clinoid process (ACP), as well as the anterior petroclinoidal dural fold (APF), which forms part of the oculomotor triangle, are closely related to the origin of the PComA. Among the 39 IC-PC aneurysms, anterior clinoidectomy was performed on 4 (10.3%) and a partial resection of the APF was performed on 2 (5.1%). Both of these aneurysms projected inferior to the tentorium, or at least part of the aneurysm's dome was inferior to the tentorium. Conclusion Proximally located IC-PC aneurysms have an especially close relationship with the ACP and APF. We should be familiar with the anatomical relationship between IC-PC aneurysms and the structures of the skull base to avoid hazardous complications.
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Affiliation(s)
- Satoshi Matsuo
- Department of Neurosurgery, Kyushu Central Hospital, Fukuoka, Japan.,Department of Neurosurgery, Clinical Research Institute, Kyushu Medical Center, National Hospital Organization, Fukuoka, Japan
| | - Noritaka Komune
- Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | | | - Yasutoshi Kai
- Department of Neurosurgery, Iizuka Hospital, Fukuoka, Japan
| | - Kenichi Matsumoto
- Department of Neurosurgery, Saga Medical Center Koseikan, Saga, Japan
| | - Sei Haga
- Department of Neurosurgery, Kyushu Rosai Hospital, Fukuoka, Japan
| | - Takuya Inoue
- Department of Neurosurgery, Kyushu Central Hospital, Fukuoka, Japan
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Suvatha A, Kandi SM, Bhat DI, Rao N, Vazhayil V, Kasturirangan CG. Apolipoprotein E polymorphism and the risk of aneurysmal subarachnoid hemorrhage in a South Indian population. Cell Mol Biol Lett 2017; 22:25. [PMID: 29213291 PMCID: PMC5708094 DOI: 10.1186/s11658-017-0059-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 11/21/2017] [Indexed: 12/16/2022] Open
Abstract
Background The rupture of a brain aneurysm causes bleeding in the subarachnoid space. This is known as aneurysmal subarachnoid hemorrhage (aSAH). We evaluated the association of apolipoprotein E (APOE) polymorphism and the risk of aSAH in a South Indian population. Methods The study was performed on 200 subjects with aSAH and 253 healthy control subjects. Blood samples (5 ml) were used to isolate DNA and genotyping was performed for rs7412 and rs429358 using a Taqman allelic discrimination assay. Statistical software R.3.0.11 was used to statistically analyze the data and a p value < 0.05 was considered as statistically significant. Results We found a significant association with the risk of aSAH in ε3/ ε4 genetic model (OR = 1.91, 95% CI = 1.16-3.14, p = 0.01). However, in the other genetic models and allele frequency, there was no significant association with the risk of aSAH. In subtyping, we found a significant association of ε2 allele frequency with posterior communicating artery (PCOM) aneurysm (OR = 3.59, 95% CI = 1.11-11.64, p = 0.03). Conclusion Our results suggest that APOE polymorphism has an influence on the risk of aSAH in this South Indian population, specifically in the PCOM subtype.
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Affiliation(s)
- Arati Suvatha
- Department of Human Genetics, National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka 560029 India
| | - Sibin Madathan Kandi
- Department of Human Genetics, National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka 560029 India
| | - Dhananjaya Ishwara Bhat
- Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences, Bangalore, 560029 India
| | - Narasinga Rao
- Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences, Bangalore, 560029 India
| | - Vikas Vazhayil
- Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences, Bangalore, 560029 India
| | - Chetan Ghati Kasturirangan
- Department of Human Genetics, National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka 560029 India
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Mochizuki Y, Kawashima A, Yamaguch K, Okada Y. Thrombosed Giant "True" Posterior Communicating Artery Aneurysm Treated by Trapping and Thrombectomy. Asian J Neurosurg 2017; 12:757-759. [PMID: 29114304 PMCID: PMC5652116 DOI: 10.4103/1793-5482.215757] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Giant “true” posterior communicating artery (PCOM) aneurysms are rare and the best surgical treatment for them is unclear. We present a case of 85-year-old woman with this type of lesion, 35 mm in diameter, successfully treated by trapping and thrombectomy via pterional approach without complications. There were no perforating arteries originating from the aneurysmal wall. The patient had an uneventful postoperative course. The key for successful treatment for such lesions is preservation of perforators, as trapping may result in ischemic complications. However, our case indicates that trapping and thrombectomy might have relatively low risks for development of such complications, supposing that the thrombosis within the giant “true” PCOM aneurysm induced spontaneous obliteration of perforators, arising from the aneurysmal dome, and that collateral flow from the posterior cerebral artery already compensated the corresponding territories.
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Affiliation(s)
- Yuichi Mochizuki
- Department of Neurosurgery, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - Akitsugu Kawashima
- Department of Neurosurgery, Yachiyo Medical Center, Neurological Institute, Tokyo Women's Medical University, Yachiyo-shi, Chiba, Japan
| | - Koji Yamaguch
- Department of Neurosurgery, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - Yoshikazu Okada
- Department of Neurosurgery, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
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Bender MT, Wendt H, Monarch T, Lin LM, Jiang B, Huang J, Coon AL, Tamargo RJ, Colby GP. Shifting Treatment Paradigms for Ruptured Aneurysms from Open Surgery to Endovascular Therapy Over 25 Years. World Neurosurg 2017; 106:919-924. [DOI: 10.1016/j.wneu.2017.07.074] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 07/12/2017] [Accepted: 07/13/2017] [Indexed: 12/11/2022]
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Chung BJ, Doddasomayajula R, Mut F, Detmer F, Pritz MB, Hamzei-Sichani F, Brinjikji W, Kallmes DF, Jimenez CM, Putman CM, Cebral JR. Angioarchitectures and Hemodynamic Characteristics of Posterior Communicating Artery Aneurysms and Their Association with Rupture Status. AJNR Am J Neuroradiol 2017; 38:2111-2118. [PMID: 28860212 DOI: 10.3174/ajnr.a5358] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 06/09/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Intracranial aneurysms originating at the posterior communicating artery are known to have high rupture risk compared with other locations. We tested the hypothesis that different angioarchitectures (ie, branch point configuration) of posterior communicating artery aneurysms are associated with aneurysm hemodynamics, which in turn predisposes aneurysms to rupture. MATERIALS AND METHODS A total of 313 posterior communicating artery aneurysms (145 ruptured, 168 unruptured) were studied with image-based computational fluid dynamics. Aneurysms were classified into different angioarchitecture types depending on the location of the aneurysm with respect to parent artery bifurcation. Hemodynamic characteristics were compared between ruptured and unruptured aneurysms, as well as among aneurysms with different angioarchitectures. RESULTS Angioarchitecture was associated with rupture (P = .003). Ruptured aneurysms had higher, more concentrated, and more oscillatory wall shear stress distributions (maximum wall shear stress, P < .001; shear concentration index, P < .001; mean oscillatory shear index, P < .001), stronger and more concentrated inflow jets (represented as Q, P = .01; inflow concentration index, P < .001), and more complex and unstable flow patterns (vortex core length, P < .001; proper orthogonal decomposition entropy, P < .001) compared with unruptured aneurysms. These adverse conditions were more common in aneurysms with bifurcation-type angioarchitectures compared with those with lateral or sidewall angioarchitectures. Interestingly, ruptured aneurysms also had lower normalized mean wall shear stress (P = .02) and minimum wall shear stress (P = .002) than unruptured aneurysms. CONCLUSIONS High-flow intrasaccular hemodynamic characteristics, commonly found in bifurcation-type angioarchitectures, are associated with the posterior communicating artery aneurysm rupture status. These characteristics include strong and concentrated inflow jets, concentrated regions of elevated wall shear stress, oscillatory wall shear stress, lower normalized wall shear stress, and complex and unstable flow patterns.
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Affiliation(s)
- B J Chung
- From the Bioengineering Department (B.J.C., R.D., F.M., F.D., M.B.P., J.R.C.), George Mason University, Fairfax, Virginia
| | - R Doddasomayajula
- From the Bioengineering Department (B.J.C., R.D., F.M., F.D., M.B.P., J.R.C.), George Mason University, Fairfax, Virginia
| | - F Mut
- From the Bioengineering Department (B.J.C., R.D., F.M., F.D., M.B.P., J.R.C.), George Mason University, Fairfax, Virginia
| | - F Detmer
- From the Bioengineering Department (B.J.C., R.D., F.M., F.D., M.B.P., J.R.C.), George Mason University, Fairfax, Virginia
| | - M B Pritz
- From the Bioengineering Department (B.J.C., R.D., F.M., F.D., M.B.P., J.R.C.), George Mason University, Fairfax, Virginia
| | - F Hamzei-Sichani
- Department of Neurosurgery (F.H.-S.), Mt. Sinai Medical Center, New York, New York
| | - W Brinjikji
- Department of Radiology (W.B., D.F.K.), Mayo Clinic, Rochester, Minnesota
| | - D F Kallmes
- Department of Radiology (W.B., D.F.K.), Mayo Clinic, Rochester, Minnesota
| | - C M Jimenez
- Neurosurgery Department (C.M.J.), University of Antioquia, Medellín, Colombia
| | - C M Putman
- Interventional Neuroradiology Unit (C.M.P.), Inova Fairfax Hospital, Falls Church, Virginia
| | - J R Cebral
- From the Bioengineering Department (B.J.C., R.D., F.M., F.D., M.B.P., J.R.C.), George Mason University, Fairfax, Virginia
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Meling TR, Romundstad L, Niemi G, Narum J, Eide PK, Sorteberg AG, Sorteberg WA. Adenosine-assisted clipping of intracranial aneurysms. Neurosurg Rev 2017; 41:585-592. [DOI: 10.1007/s10143-017-0896-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 07/24/2017] [Accepted: 08/10/2017] [Indexed: 11/25/2022]
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Ros de San Pedro J. Posterior communicating artery aneurysms causing facial pain: A comprehensive review. Clin Neurol Neurosurg 2017; 160:59-68. [PMID: 28686948 DOI: 10.1016/j.clineuro.2017.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Revised: 06/08/2017] [Accepted: 06/11/2017] [Indexed: 10/19/2022]
Abstract
Posterior communicating aneurysms are commonly associated with oculomotor nerve palsy. However, trigeminal nerve involvement among these aneurysms is a rare event with no previous analysis. In order to describe the main features of posterior communicating aneurysms causing trigeminal neuralgia (TGN-PComAAs) eight cases (six from the literature plus two more illustrative cases) were included in the present series. All cases were thoroughly studied in order to collect their epidemiological, radiological, clinical, therapeutic, pathogenic, and outcome data. The mean age at diagnosis was 57 years. Gender distribution showed a female predominance (M-to-F ratio 3:5), while side distribution showed a slight left dominance (62%). The aneurysms mean size was 24.7mm (range: 7-40mm). In 7 cases (87.5%) the PComAA was reported to project posteriorly, associated with cavernous sinus extension/compression in two of them and posterior fossa extension in three. No case presented with hemorrhage. Facial pain was the clinical onset in all eight cases, which was reported as an atypical TGN (continuous with exacerbating fits) in 87.5%. Trigger points were absent in all cases but one (87.5%). The most frequent anatomical distribution of the pain was V2 alone (n=3), followed by V1-2 (n=2) and V1-2-3 (n=2). Three different mechanisms for trigeminal neuralgia were observed, namely, cavernous sinus compression (n=4), direct trigeminal root compression (n=3), and oculomotor nerve compression (n=1). Three different treatment options were performed: surgery (n=6), trigeminal thermo-rhizotomy (n=1) and medical management (n=1). According to the Barrow Neurological Institute (BNI) score the pain control after main treatment was I (no pain with no medication) in 7 cases (87.5%). The average modified Rankin scale (mRS) score was 1. In sum, TGN-PComAAs are infrequent lesions characterized by large size and posterior-medial-inferior projection. They mainly cause atypical TGN, most commonly involving the first and second trigeminal distributions (V1-V2). Surgical aneurysmal clipping has been the most frequent treatment option for these aneurysms, providing good neurological results in a vast majority and complete trigeminal pain relief in all cases.
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Affiliation(s)
- Javier Ros de San Pedro
- Regional Service of Neurosurgery, Hospital Clínico Universitario Virgen de la Arrixaca, Crta. Madrid-Cartagena, sn, 30120, El Palmar, Murcia, Spain.
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Reduced Efficacy of the Pipeline Embolization Device in the Treatment of Posterior Communicating Region Aneurysms with Fetal Posterior Cerebral Artery Configuration. Neurosurgery 2017; 82:695-700. [DOI: 10.1093/neuros/nyx293] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 05/02/2017] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND
Aneurysms at the origin of the posterior communicating artery (PcommA) have been demonstrated to be effectively treated with the pipeline embolization device (PED). Much less is known about the efficacy of the PED for aneurysms associated with a fetal posterior cerebral artery (fPCA) variant.
OBJECTIVE
To study PED treatment efficacy of PcommA aneurysms, including fPCA aneurysms.
METHODS
A prospectively maintained university database of aneurysm patients treated with the PED was retrospectively reviewed. Demographics, treatment details, and imaging were reviewed for all PcommA and fPCA aneurysms.
RESULTS
Out of a total of 285 patients treated with PED, 50 patients (mean age 57.5 ± 12.2 yr, 42 females) with unruptured PcommA (9 fPCA) aneurysms were identified. Mean follow-up duration was 14.0 ± 11.6 mo (48 patients). Roy-Raymond class I occlusion on follow-up magnetic resonance or catheter angiography (mean time 11.7 ± 6.8 mo) was achieved in 30 patients (62.5%), class II occlusion in 11 patients (22.9%) and class III occlusion in 7 patients (14.5%). The PcommA was occluded in 56% of patients without any clinical symptoms. No deaths or permanent neurological complications occurred. In fPCA aneurysms, class I occlusion was seen in 1 patient, class 2 occlusion in 2 patients, and class III occlusion in 6 patients. Multivariate analysis revealed an independent association between incomplete occlusion and fPCA configuration (OR 73.65; 95% CI: 5.84-929.13; P = .001).
CONCLUSION
The PED is a safe and effective treatment for PcommA aneurysms, although fetal anatomy should increase consideration of traditional endovascular techniques or surgical clipping.
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Zheng F, Dong Y, Xia P, Mpotsaris A, Stavrinou P, Brinker G, Goldbrunner R, Krischek B. Is clipping better than coiling in the treatment of patients with oculomotor nerve palsies induced by posterior communicating artery aneurysms? A systematic review and meta-analysis. Clin Neurol Neurosurg 2017; 153:20-26. [DOI: 10.1016/j.clineuro.2016.11.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 11/27/2016] [Accepted: 11/28/2016] [Indexed: 10/20/2022]
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Daou B, Valle-Giler EP, Chalouhi N, Starke RM, Tjoumakaris S, Hasan D, Rosenwasser RH, Hebert R, Jabbour P. Patency of the posterior communicating artery following treatment with the Pipeline Embolization Device. J Neurosurg 2017; 126:564-569. [DOI: 10.3171/2016.2.jns152544] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
The Pipeline Embolization Device (PED) has become an effective treatment strategy for some cerebral aneurysms. Concerns regarding the patency of branch arteries have been raised. The objective of this study was to assess the patency of the posterior communicating artery (PCoA) following treatment of PCoA aneurysms using the PED.
METHODS
All patients with PCoA aneurysms treated with the PED who had angiographic follow-up were retrospectively identified. The patency of the PCoA at follow-up was evaluated by 2 authors who were not involved in the intervention. Univariate and multivariate analyses were performed to identify factors associated with the following: 1) PCoA patency versus no or diminished flow, and 2) PCoA patency and diminished flow versus PCoA occlusion.
RESULTS
Thirty patients with an angiographic follow-up of 6 months were included. Aneurysm obliteration was achieved in 25 patients (83.3%). The PCoA was patent in 7 patients (23.3%), had diminished flow in 7 patients (23.3%), and was occluded in 16 patients (53.3%). In the univariate analysis of outcome, there was a trend for aneurysms with incomplete occlusion, aneurysms not previously treated, those with presence of a fetal PCoA, and those with an artery coming from the aneurysm to have higher odds of the PCoA remaining patent. In univariate and multivariate analyses of factors associated with outcome, fetal PCoA and presence of an artery coming from the aneurysm were associated with the PCoA remaining open with or without diminished flow. No patients had symptoms related to PCoA occlusion.
CONCLUSIONS
Occlusion and diminished flow through the PCoA is common following PED treatment of PCoA aneurysms. However, it is clinically insignificant in most cases.
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Affiliation(s)
- Badih Daou
- 1Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
| | - Edison P. Valle-Giler
- 1Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
| | - Nohra Chalouhi
- 1Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
| | - Robert M. Starke
- 2Department of Neurological Surgery, University of Virginia Health Sciences Center, Charlottesville, Virginia; and
| | - Stavropoula Tjoumakaris
- 1Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
| | - David Hasan
- 3Department of Neurological Surgery, University of Iowa, Iowa City, Iowa
| | - Robert H. Rosenwasser
- 1Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
| | - Ryan Hebert
- 1Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
| | - Pascal Jabbour
- 1Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
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71
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Legatt AD, Laarakker AS, Nakhla JP, Nasser R, Altschul DJ. Somatosensory evoked potential monitoring detection of carotid compression during ACDF surgery in a patient with a vascularly isolated hemisphere. J Neurosurg Spine 2016; 25:566-571. [PMID: 27285667 DOI: 10.3171/2016.4.spine151481] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The authors report herein a case of anterior cervical discectomy and fusion (ACDF) surgery in which findings on somatosensory evoked potential (SSEP) monitoring led to the correction of carotid artery compression in a patient with a vascularly isolated hemisphere (no significant collateral blood vessels to the carotid artery territory). The amplitude of the cortical SSEP component to left ulnar nerve stimulation progressively decreased in multiple runs, but there were no changes in the cervicomedullary SSEP component to the same stimulus. When the lateral (right-sided) retractor was removed, the cortical SSEP component returned to baseline. The retraction was then intermittently relaxed during the rest of the operation, and the patient suffered no neurological morbidity. Magnetic resonance angiography demonstrated a vascularly isolated right hemisphere. During anterior cervical spine surgery, carotid artery compression by the retractor can cause hemispheric ischemia and infarction in patients with inadequate collateral circulation. The primary purpose of SSEP monitoring during ACDF surgery is to detect compromise of the dorsal column somatosensory pathways within the cervical spinal cord, but intraoperative SSEP monitoring can also detect hemispheric ischemia. Concurrent recording of cervicomedullary SSEPs can help differentiate cortical SSEP changes due to hemispheric ischemia from those due to compromise of the dorsal column pathways. If there are adverse changes in the cortical SSEPs but no changes in the cervicomedullary SSEPs, the possibility of hemispheric ischemia due to carotid artery compression by the retractor should be considered.
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Affiliation(s)
| | - Avra S Laarakker
- Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Jonathan P Nakhla
- Neurosurgery, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, New York; and
| | - Rani Nasser
- Neurosurgery, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, New York; and
| | - David J Altschul
- Neurosurgery, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, New York; and
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Labeyrie PE, Gory B, Huguet N, Grenier C, Ditac G, Sadeh-Gonik U, Riva R, Turjman F. Carotid siphon morphology: Is it associated with posterior communicating aneurysms? Interv Neuroradiol 2016; 22:378-82. [PMID: 27012777 DOI: 10.1177/1591019916637344] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 02/14/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND PURPOSE Posterior communicating artery (PComA) aneurysm seems to behave uniquely compared with other intracranial aneurysms at different locations. The association between the morphology of the carotid siphon and PComA aneurysms is not well known. This study aimed to investigate whether the anatomical characteristics of the carotid siphon are associated with the formation and rupture of PComA aneurysms. METHODS One hundred and thirty-two patients were retrospectively reviewed in a monocentric case-control study. Sixty-seven consecutive patients with PComA aneurysms were included in the case group, and 65 patients with anterior circulation aneurysm situated in other intracranial locations were included in the control group, matched by age and sex. Morphological characteristics of the carotid siphon were analyzed using angiography images. A univariate analysis was used to investigate the association between the morphological characteristics and the formation of PComA aneurysms. Furthermore, a subgroup analysis within the case group compared ruptured and non-ruptured PComA aneurysms. RESULTS Patients with PComA aneurysm had a significantly (1.31 ± 0.70 vs. 0.82 ± 0.46; P < 0.001) larger PComA. No association was observed between the morphological characteristics of the carotid siphon and the presence of a PComA aneurysm. Likewise, subgroup analysis showed no significant association between morphological characteristics of the carotid siphon and aneurysm rupture. CONCLUSIONS This case-control study shows that the carotid siphon morphology seems not to be related to PComA aneurysm formation or rupture.
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Affiliation(s)
- Paul-Emile Labeyrie
- Department of Interventional Neuroradiology, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France
| | - Benjamin Gory
- Department of Interventional Neuroradiology, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France
| | - Nazyad Huguet
- Department of Interventional Neuroradiology, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France
| | - Charlotte Grenier
- Department of Interventional Neuroradiology, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France
| | - Geoffroy Ditac
- Department of Interventional Neuroradiology, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France
| | - Udi Sadeh-Gonik
- Department of Interventional Neuroradiology, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France
| | - Roberto Riva
- Department of Interventional Neuroradiology, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France
| | - Francis Turjman
- Department of Interventional Neuroradiology, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France
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73
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Failure of the Pipeline Embolization Device in Posterior Communicating Artery Aneurysms Associated with a Fetal Posterior Cerebral Artery. Case Rep Vasc Med 2016; 2016:4691275. [PMID: 27069709 PMCID: PMC4812271 DOI: 10.1155/2016/4691275] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 01/21/2016] [Accepted: 02/28/2016] [Indexed: 12/13/2022] Open
Abstract
The pipeline embolization device has emerged as an important endovascular option. This is in part due to safety, efficacy, and possibly the ability to shorten the operative time considerably. With this new technology, some limitations are emerging as experience accumulates. We report three cases of posterior communicating (PCOM) artery aneurysms associated with fetal posterior cerebral artery where pipeline embolization was unsuccessful in obliterating the aneurysms. PCOM artery aneurysms associated with a fetal PCA should be managed either by microsurgical clipping or coiling when feasible.
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74
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Yang ZG, Liu J, Ge J, Li ZF, Tian CO, Han J, Zhao R, Hong B. A novel proximal end stenting technique for assisting embolization of a complex true posterior communicating aneurysm. J Clin Neurosci 2016; 28:148-51. [PMID: 26906925 DOI: 10.1016/j.jocn.2015.09.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 09/14/2015] [Accepted: 09/19/2015] [Indexed: 11/17/2022]
Abstract
Stent-assisted coiling has been widely used for endovascular treatment in recent years with satisfying clinical outcomes. The implantation of a stent using the regular approach, however, may not be safe or effective for certain aneurysms with complex structures. In this study, we report a novel stenting technique utilizing the proximal end of the stent for assisting embolization of a wide-neck irregular true posterior communicating aneurysm. This new method is a potential treatment strategy for wide-neck aneurysms located at the origin of a tortuous and thin vessel.
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Affiliation(s)
- Zhi-Gang Yang
- Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai 200433, China
| | - Jianmin Liu
- Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai 200433, China
| | - Jiajia Ge
- Siemens Ltd. China, Healthcare Sector, Angiography & Interventional X-ray Systems, China
| | - Zi-Fu Li
- Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai 200433, China
| | - Chun-Ou Tian
- Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai 200433, China
| | - Jingfeng Han
- Siemens Ltd. China, Healthcare Sector, Angiography & Interventional X-ray Systems, China
| | - Rui Zhao
- Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai 200433, China
| | - Bo Hong
- Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai 200433, China.
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75
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Morphological and Hemodynamic Discriminators for Rupture Status in Posterior Communicating Artery Aneurysms. PLoS One 2016; 11:e0149906. [PMID: 26910518 PMCID: PMC4766191 DOI: 10.1371/journal.pone.0149906] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Accepted: 02/05/2016] [Indexed: 11/19/2022] Open
Abstract
Background and Purpose The conflicting findings of previous morphological and hemodynamic studies on intracranial aneurysm rupture may be caused by the relatively small sample sizes and the variation in location of the patient-specific aneurysm models. We aimed to determine the discriminators for aneurysm rupture status by focusing on only posterior communicating artery (PCoA) aneurysms. Materials and Methods In 129 PCoA aneurysms (85 ruptured, 44 unruptured), clinical, morphological and hemodynamic characteristics were compared between the ruptured and unruptured cases. Multivariate logistic regression analysis was performed to determine the discriminators for rupture status of PCoA aneurysms. Results While univariate analyses showed that the size of aneurysm dome, aspect ratio (AR), size ratio (SR), dome-to-neck ratio (DN), inflow angle (IA), normalized wall shear stress (NWSS) and percentage of low wall shear stress area (LSA) were significantly associated with PCoA aneurysm rupture status. With multivariate analyses, significance was only retained for higher IA (OR = 1.539, p < 0.001) and LSA (OR = 1.393, p = 0.041). Conclusions Hemodynamics and morphology were related to rupture status of intracranial aneurysms. Higher IA and LSA were identified as discriminators for rupture status of PCoA aneurysms.
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76
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Lv N, Feng Z, Wang C, Cao W, Fang Y, Karmonik C, Liu J, Huang Q. Morphological Risk Factors for Rupture of Small (<7 mm) Posterior Communicating Artery Aneurysms. World Neurosurg 2015; 87:311-5. [PMID: 26724608 DOI: 10.1016/j.wneu.2015.12.055] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 12/14/2015] [Accepted: 12/16/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND The management of small, unruptured intracranial aneurysms is still controversial. Given the distinctive natural history of aneurysm at different locations, location-specific analysis might be a reasonable approach. This study aimed to investigate morphological discriminators for rupture status by focusing on only posterior communicating artery (PcomA) aneurysms smaller than 7 mm. METHODS In 108 small PcomA aneurysms (68 ruptured, 40 unruptured), clinical and morphological characteristics were compared between the ruptured and unruptured groups. Multivariate logistic regression analysis was performed to determine the independent predictors for the rupture status of small PcomA aneurysms. RESULTS None of the clinical characteristics were significantly different between the ruptured and unruptured groups (P > 0.05). The ruptured group revealed a significantly larger size (P = 0.009), aspect ratio (P = 0.009), size ratio (P = 0.002), dome-to-neck ratio (P = 0.002), inflow angle (P < 0.001), and proportion of bleb formation (P = 0.039). Bottleneck factor (P = 0.154), diameter of PcomA (P = 0.302), and fetal-type PcomA (P = 0.832) showed no significance. With multivariate analyses, size ratio (P = 0.012) and inflow angle (P = 0.001) were shown to be independently associated with the rupture status of small PcomA aneurysms. CONCLUSIONS Morphological characteristics were closely related with the rupture status of small PcomA aneurysms. Size ratio and inflow angle were independent risk factors for rupture and might be useful in clinical risk stratification of small PcomA aneurysms.
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Affiliation(s)
- Nan Lv
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Zhengzhe Feng
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Chi Wang
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Wei Cao
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Yibin Fang
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Christof Karmonik
- Cerebrovascular Center, Department of Neurosurgery, Houston Methodist, Houston, Texas, USA
| | - Jianmin Liu
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Qinghai Huang
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China.
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77
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Lv N, Yu Y, Xu J, Karmonik C, Liu J, Huang Q. Hemodynamic and morphological characteristics of unruptured posterior communicating artery aneurysms with oculomotor nerve palsy. J Neurosurg 2015; 125:264-8. [PMID: 26636379 DOI: 10.3171/2015.6.jns15267] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Unruptured posterior communicating artery (PCoA) aneurysms with oculomotor nerve palsy (ONP) have a very high risk of rupture. This study investigated the hemodynamic and morphological characteristics of intracranial aneurysms with high rupture risk by analyzing PCoA aneurysms with ONP. METHODS Fourteen unruptured PCoA aneurysms with ONP, 33 ruptured PCoA aneurysms, and 21 asymptomatic unruptured PCoA aneurysms were included in this study. The clinical, morphological, and hemodynamic characteristics were compared among the different groups. RESULTS The clinical characteristics did not differ among the 3 groups (p > 0.05), whereas the morphological and hemodynamic analyses showed that size, aspect ratio, size ratio, undulation index, nonsphericity index, ellipticity index, normalized wall shear stress (WSS), and percentage of low WSS area differed significantly (p < 0.05) among the 3 groups. Furthermore, multiple comparisons revealed that these parameters differed significantly between the ONP group and the asymptomatic unruptured group and between the ruptured group and the asymptomatic unruptured group, except for size, which differed significantly only between the ONP group and the asymptomatic unruptured group (p = 0.0005). No morphological or hemodynamic parameters differed between the ONP group and the ruptured group. CONCLUSIONS Unruptured PCoA aneurysms with ONP demonstrated a distinctive morphological-hemodynamic pattern that was significantly different compared with asymptomatic unruptured PCoA aneurysms and was similar to ruptured PCoA aneurysms. The larger size, more irregular shape, and lower WSS might be related to the high rupture risk of PCoA aneurysms.
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Affiliation(s)
- Nan Lv
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China; and
| | - Ying Yu
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China; and
| | - Jinyu Xu
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China; and
| | - Christof Karmonik
- Cerebrovascular Center, Department of Neurosurgery, Houston Methodist, Houston, Texas
| | - Jianmin Liu
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China; and
| | - Qinghai Huang
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China; and
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Fukuda H, Hayashi K, Yoshino K, Koyama T, Lo B, Kurosaki Y, Yamagata S. Impact of Aneurysm Projection on Intraoperative Complications During Surgical Clipping of Ruptured Posterior Communicating Artery Aneurysms. Neurosurgery 2015; 78:381-90; discussion 390. [DOI: 10.1227/neu.0000000000001131] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND:
Surgical clipping of ruptured posterior communicating artery (PCoA) aneurysms is a well-established procedure to date. However, preoperative factors associated with procedure-related risk require further elucidation.
OBJECTIVE:
To investigate the impact of the direction of aneurysm projection on the incidence of procedure-related complications during surgical clipping of ruptured PCoA aneurysms.
METHODS:
A total of 65 patients with ruptured PCoA aneurysms who underwent surgical clipping were retrospectively analyzed from a single-center, prospective, observational cohort database in this study. The aneurysms were categorized into lateral and posterior projection groups, depending on direction of the dome. Characteristics and operative findings of each projection group were identified. We also evaluated any correlation of aneurysm projection with the incidence of procedure-related complications.
RESULTS:
Patients with ruptured PCoA aneurysms with posterior projection more likely presented with good-admission-grade subarachnoid hemorrhage (P = .01, χ2 test) and were less to also have intracerebral hematoma (P = .01). These aneurysms were found to be associated with higher incidence of intraoperative rupture (P = .02), complex clipping with fenestrated clips (P = .02), and dense adherence to PCoA or its perforators (P = .04) by univariate analysis. Aneurysms with posterior projection were also correlated with procedure-related complications, including postoperative cerebral infarction or hematoma formation (odds ratio, 5.87; 95% confidence interval, 1.11-31.1; P = .04) by multivariable analysis.
CONCLUSION:
Ruptured PCoA aneurysms with posterior projection carried a higher risk of procedure-related complications of surgical clipping than those with lateral projection.
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Affiliation(s)
- Hitoshi Fukuda
- Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Okayama Japan
| | - Kosuke Hayashi
- Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Okayama Japan
| | - Kumiko Yoshino
- Department of Radiology, Kurashiki Central Hospital, Kurashiki, Okayama Japan
| | - Takashi Koyama
- Department of Radiology, Kurashiki Central Hospital, Kurashiki, Okayama Japan
| | - Benjamin Lo
- Department of Neurosurgery, Montreal Neurological Institute and Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Yoshitaka Kurosaki
- Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Okayama Japan
| | - Sen Yamagata
- Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Okayama Japan
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79
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Ahmed O, Kalakoti P, Menger R, Brown B, Zhang S, Guthikonda B, Cuellar H. Accuracy of CT angiography in detection of blood supply dominance of posterior cerebral artery in patients with posterior communicating artery aneurysm. Neuroradiol J 2015; 28:598-603. [PMID: 26515748 DOI: 10.1177/1971400915615082] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND PURPOSE The use of computed tomography angiography (CTA) as the sole vascular imaging study for preoperative planning for clipping of aneurysms is well described in the literature. CTA is widely available, provides quick acquisition, has low morbidity, and low cost. In this study, we describe the accuracy of CTA in determining the blood supply dominance in comparison to standard digital subtraction angiography. MATERIALS AND METHODS Sixty-six patients, with both CTAs and angiograms, were reviewed by two independent neuroradiologists. The posterior cerebral artery was determined to have dominant supply from the posterior communicating artery if it was of similar size to the P2 segment and the P1 segment was smaller by approximately 50%. If the posterior communicating artery and P1 segment were the same size, it was considered to have a dual supply. If P1 and P2 segments were the same caliber and the posterior communicating artery was smaller by 50%, it was deemed to have posterior circulation dominance. RESULTS Based on the findings of our reviewers, CTA had a sensitivity and specificity of 69% and 96%, respectively, in predicting the presence of a fetal PCA. The positive predictive value was found to be 82% while a negative predictive value was estimated as 93%. A small-caliber P1 segment and large-caliber posterior communicating artery led to inaccurate interpretations of the CTAs. CONCLUSION This study shows that one cannot accurately predict blood supply dominance of the posterior cerebral artery. Knowledge of the blood flow dominance is essential when clipping a posterior communicating artery aneurysm to avoid compromise in posterior circulation.
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Affiliation(s)
- Osama Ahmed
- Louisiana State University Health Science Center, USA
| | | | | | | | - Shihao Zhang
- Louisiana State University Health Science Center, USA
| | | | - Hugo Cuellar
- Louisiana State University Health Science Center, USA
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80
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Sherpa LD, Barreiro TJ. A Headache You Don't Want to Miss. Headache 2015; 55:1256-8. [PMID: 26466965 DOI: 10.1111/head.12629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Lakpa Diku Sherpa
- Internal Medicine PGY3, St. Elizabeth Health Center (Mercy Health), Youngstown, OH, USA
| | - Timothy J Barreiro
- Pulmonary Health & Research Center, St. Elizabeth Health Center (Mercy Health), Youngstown, OH, USA
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81
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Tsang ACO, Fung AMY, Tsang FCP, Leung GKK, Lee R, Lui WM. Failure of Flow Diverter Treatment of Intracranial Aneurysms Related to the Fetal-type Posterior Communicating Artery. Neurointervention 2015; 10:60-6. [PMID: 26389008 PMCID: PMC4571555 DOI: 10.5469/neuroint.2015.10.2.60] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 06/01/2015] [Indexed: 11/24/2022] Open
Abstract
Purpose The pipeline embolization device (PED) is a flow diverter that has shown promise in the treatment of intracranial aneurysms. Close to one-fifth of aneurysms, however, fail to occlude after PED placement. This study aims to identify anatomical features and clinicopathologic factors that may predispose failed aneurysm occlusion with the PED. Materials and Methods We retrospectively reviewed all anterior circulation unruptured saccular aneurysms treated with the PED in a single-center. The primary outcome measure was angiographic occlusion. Anatomical features and potential predictors, including gender, aneurysm location, size, height, aspect ratio, neck width, prior treatment and the number of PED, were studied using binary logistic regression. Results 29 anterior circulation unruptured saccular aneurysms with a mean size of 6.99 mm treated with the PED in a single center were retrospectively studied. The overall occlusion rate was 79.3% after a mean follow-up of 9.2 months. Four aneurysms were related to the fetal-type posterior communicating artery (PComA), and all were refractory to flow diverter treatment. Female gender was significantly associated with a higher occlusion rate. We present the anatomical features and propose possible pathophysiological mechanisms of these PComA aneurysms that failed flow diverter treatment. Conclusion A PComA aneurysm with persistent fetal-type circulation appears to be particularly refractory to flow diverter treatment, especially when the aneurysm incorporates a significant portion of the PComA. Our experience suggested that flow diverting stents alone may not be the ideal treatment for this subgroup of aneurysms, and alternative modalities should be considered. Female patients were found to have a significantly higher rate of treatment success.
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Affiliation(s)
- Anderson Chun On Tsang
- Division of Neurosurgery, Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Arthur Man Yuen Fung
- Division of Neurosurgery, Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Frederick Chun Pong Tsang
- Division of Neurosurgery, Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Gilberto Ka Kit Leung
- Division of Neurosurgery, Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Raymand Lee
- Department of Radiology, Queen Mary Hospital, Hong Kong
| | - Wai Man Lui
- Division of Neurosurgery, Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
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82
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Zhang Y, Jing L, Liu J, Li C, Fan J, Wang S, Li H, Yang X. Clinical, morphological, and hemodynamic independent characteristic factors for rupture of posterior communicating artery aneurysms. J Neurointerv Surg 2015; 8:808-12. [PMID: 26253110 DOI: 10.1136/neurintsurg-2015-011865] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Accepted: 07/22/2015] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To identify clinical, morphological, and hemodynamic independent characteristic factors that discriminate posterior communicating artery (PCoA) aneurysm rupture status. METHODS 173 patients with single PCoA aneurysms (108 ruptured, 65 unruptured) between January 2012 and June 2014 were retrospectively collected. Patient-specific models based on their three-dimensional digital subtraction angiography images were constructed and analyzed by a computational fluid dynamic method. All variables were analyzed by univariate analysis and multivariate logistic regression analysis. RESULTS Two clinical factors (younger age and atherosclerosis), three morphological factors (higher aspect ratio, bifurcation type, and irregular shape), and six hemodynamic factors (lower mean and minimum wall shear stress, higher oscillatory shear index, a greater portion of area under low wall shear stress, unstable and complex flow pattern) were significantly associated with PCoA aneurysm rupture. Independent factors characterizing the rupture status were identified as age (OR 0.956, p=0.015), irregular shape (OR 6.709, p<0.001), and minimum wall shear stress (OR 0.001, p=0.038). CONCLUSIONS We combined clinical, morphological, and hemodynamic characteristics analysis and found the three strongest independent factors for PCoA aneurysm rupture were younger age, irregular shape, and low minimum wall shear stress. This may be useful for guiding risk assessments and subsequent treatment decisions for PCoA aneurysms.
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Affiliation(s)
- Ying Zhang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Linkai Jing
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jian Liu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chuanhui Li
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jixing Fan
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shengzhang Wang
- Department of Mechanics and Engineering Science, Fudan University, Shanghai, China
| | - Haiyun Li
- Department of Biomedical Engineering, Capital Medical University, Beijing, China
| | - Xinjian Yang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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83
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Mitsuhashi T, Takeda N, Oishi H, Arai H. Parent artery occlusion for ruptured "true" posterior communicating artery aneurysm. Interv Neuroradiol 2015; 21:171-4. [PMID: 25953771 DOI: 10.1177/1591019915583000] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A case of a patient with a ruptured true posterior communicating artery (PCoA) aneurysm is reported, who had been managed by early endovascular parent artery occlusion with coils. The small blister aneurysm was located at the proximal PCoA itself and directed superiorly. Postoperative course was uneventful. During 1-month follow-up, the patient recovered well and could care for herself. Aneurysms of the PCoA itself are very rare. As reported to date, surgical procedures would favor microsurgical clipping over endovascular coil embolization. Endovascular treatment may be a good alternative to surgical trapping for true PCoA blister aneurysm.
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Affiliation(s)
- Takashi Mitsuhashi
- Department of Neurosurgery, Tamananbu Chiiki Hospital, Tokyo, Japan Department of Neurosurgery, Juntendo University, Faculty of Medicine, Tokyo, Japan
| | - Nobuaki Takeda
- Department of Neurosurgery, Juntendo University, Faculty of Medicine, Tokyo, Japan Department of Neurosurgery, Kichijojiminami Hospital, Tokyo, Japan
| | - Hidenori Oishi
- Department of Neurosurgery and Neuroendovasular Therapy, Juntendo University, Faculty of Medicine, Tokyo, Japan
| | - Hajime Arai
- Department of Neurosurgery, Juntendo University, Faculty of Medicine, Tokyo, Japan
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84
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Tan H, Huang G, Zhang T, Liu J, Li Z, Wang Z. A Retrospective Comparison of the Influence of Surgical Clipping and Endovascular Embolization on Recovery of Oculomotor Nerve Palsy in Patients With Posterior Communicating Artery Aneurysms. Neurosurgery 2015; 76:687-94; discussion 694. [DOI: 10.1227/neu.0000000000000703] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Abstract
BACKGROUND:
Oculomotor nerve palsy (ONP) is a common symptom of posterior communicating artery aneurysms (PcomAAs). Surgical clipping and endovascular embolization are used to treat PcomAAs with ONP.
OBJECTIVE:
To analyze the impact of these 2 techniques on recovery of ONP caused by PcomAAs.
METHODS:
The clinical data for 176 patients with intracranial PcomAAs with ONP admitted to the Department of Neurosurgery, Sichuan Provincial People's Hospital, between June 2008 and May 2013 who undergone surgical clipping or endovascular embolization were studied retrospectively. The 2 treatment groups were compared with respect to age, sex, aneurysm size, levels of hypertension and hyperlipidemia, preadmission ONP duration, subarachnoid hemorrhage (SAH), complete ONP, postoperative recovery time from ONP symptoms, and degree of recovery. The follow-up duration was a minimum of 12 months. Multivariate Cox regression was used for analysis.
RESULTS:
A total of 132 patients were treated by surgical clipping, and 44 were treated by endovascular embolization. Significant differences were found in postoperative recovery time (83.87 ± 34.70 days for clipping and 137.45 ± 44.94 days for embolization, P < .001) and recovery rates (130 [98.5%] for clipping and 30 [68.2%] for embolization, P < .001). The period between ONP onset and admission was associated with recovery. Postoperative complications included significant cerebral vasospasms (6 in the clipping group and 2 in the embolization group) and hydrocephalus (16 in the clipping group and 9 in the embolization group).
CONCLUSION:
Simultaneous elimination of 2 injury mechanisms, compression and pulsation, when treating the oculomotor nerve by surgical clipping may be more advantageous than endovascular embolization to treat ONP caused by PcomAA.
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Affiliation(s)
- Haibin Tan
- Department of Neurosurgery, Sichuan Academy of Medical Science & Sichuan Provincial People's Hospital, Chengdu, Sichuan Province, China
| | - Guangfu Huang
- Department of Neurosurgery, Sichuan Academy of Medical Science & Sichuan Provincial People's Hospital, Chengdu, Sichuan Province, China
| | - Tian Zhang
- Department of Neurosurgery, Sichuan Academy of Medical Science & Sichuan Provincial People's Hospital, Chengdu, Sichuan Province, China
| | - Jinping Liu
- Department of Neurosurgery, Sichuan Academy of Medical Science & Sichuan Provincial People's Hospital, Chengdu, Sichuan Province, China
| | - Zhili Li
- Department of Neurosurgery, Sichuan Academy of Medical Science & Sichuan Provincial People's Hospital, Chengdu, Sichuan Province, China
| | - Zhenyu Wang
- Department of Neurosurgery, Sichuan Academy of Medical Science & Sichuan Provincial People's Hospital, Chengdu, Sichuan Province, China
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85
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Abstract
Endovascular management of intracranial aneurysms has advanced significantly over the last couple decades and continues to evolve, including aneurysms within the subgroup of supraclinoid internal carotid artery (ophthalmic, superior hypophyseal, posterior communicating, anterior choroidal, dorsal wall/blister, and carotid terminus).
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86
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Single-centre comparison of procedural complications, clinical outcome, and angiographic follow-up between coiling and stent-assisted coiling for posterior communicating artery aneurysms. J Clin Neurosci 2014; 21:2140-4. [DOI: 10.1016/j.jocn.2014.03.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2013] [Revised: 03/26/2014] [Accepted: 03/29/2014] [Indexed: 11/17/2022]
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87
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Munarriz PM, Castaño-Leon AM, Cepeda S, Campollo J, Alén JF, Lagares A. Endovascular treatment of a true posterior communicating artery aneurysm. Surg Neurol Int 2014; 5:S447-50. [PMID: 25422786 PMCID: PMC4235117 DOI: 10.4103/2152-7806.143273] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Accepted: 08/22/2014] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Posterior communicating artery (PCoA) aneurysms are most commonly located at the junction of the internal carotid artery and the PCoA. "True" PCoA aneurysms, which originate from the PCoA itself, are rarely encountered. Most previously reported cases were treated surgically mainly before the endovascular option became available. CASE DESCRIPTION A 53-year-old male presented with sudden onset of right hemiparesis and aphasia. Left middle cerebral artery stroke was diagnosed. Further studies revealed a 3 mm left PCoA aneurysm arising from the PCoA itself, attached to neither the internal carotid artery nor the posterior cerebral artery. Endovascular treatment was performed and the aneurysm was coiled completely. CONCLUSION Technical advances in endovascular interventional technology have permitted an additional approach to these lesions. The possible endovascular significance of the treatment of true PCoA aneurysms is discussed.
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Affiliation(s)
- Pablo M Munarriz
- Department of Neurosurgery, "12 de Octubre" University Hospital, Complutense University of Madrid, Madrid, Spain
| | - Ana M Castaño-Leon
- Department of Neurosurgery, "12 de Octubre" University Hospital, Complutense University of Madrid, Madrid, Spain
| | - Santiago Cepeda
- Department of Neurosurgery, "12 de Octubre" University Hospital, Complutense University of Madrid, Madrid, Spain
| | - Jorge Campollo
- Division of Neuroradiology, "12 de Octubre" University Hospital, Complutense University of Madrid, Madrid, Spain
| | - Jose F Alén
- Department of Neurosurgery, "12 de Octubre" University Hospital, Complutense University of Madrid, Madrid, Spain ; Division of Neuroradiology, "12 de Octubre" University Hospital, Complutense University of Madrid, Madrid, Spain
| | - Alfonso Lagares
- Department of Neurosurgery, "12 de Octubre" University Hospital, Complutense University of Madrid, Madrid, Spain
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88
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Affiliation(s)
- Donald Mebust
- Emergency Physician at the San Diego Medical Center in CA. E-mail:
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89
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Cho YD, Jung SC, Kim CH, Ahn JH, Kang HS, Kim JE, Han MH. Posterior Communicating Artery Compromise in Coil Embolization of Posterior Communicating Artery Aneurysms. Clin Neuroradiol 2014; 25:275-9. [PMID: 24794767 DOI: 10.1007/s00062-014-0308-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Accepted: 04/17/2014] [Indexed: 11/26/2022]
Abstract
PURPOSE Whether the posterior communicating artery (PcomA) can be safely compromised during endovascular treatment of a PcomA aneurysm is a matter of debate. Here we present clinical and radiologic outcomes, given this scenario. METHODS From data prospectively accrued between January 2004 and December 2012, records of 44 patients harboring 46 PcomA aneurysms were retrieved. All had suffered PcomA compromise in the course of endovascular coil embolization. Patients/aneurysms were stratified into those with complete (Group A) and incomplete (Group B) compromise depending on the degree of PcomA flow limitation documented by postembolization ipsilateral internal carotid artery angiography. Clinical and radiologic outcomes were accordingly assessed. RESULTS All affected vessels were hypoplastic PcomA variants (PcomA/P1 ratio, ≤ 1.0), with exception of a single dominant PcomA (PcomA/P1 ratio, 1.1). In Group A (23 patients, 23 aneurysms), no PcomA compromise-related infarction was evident, whereas in Group B (21 patients, 23 aneurysms), two ischemic events occurred. One patient suffered thalamic infarction, although patency of the PcomA was adequate in a follow-up angiogram, and another experienced a transient ischemic attack. CONCLUSION Our findings suggest that obstructed flow in hypoplastic PcomA variants during coil embolization of PcomA aneurysms carries no major consequence. However, incomplete compromise of the PcomA may be a source of delayed thromboembolic infarction.
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Affiliation(s)
- Y D Cho
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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90
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Matsukawa H, Fujii M, Akaike G, Uemura A, Takahashi O, Niimi Y, Shinoda M. Morphological and clinical risk factors for posterior communicating artery aneurysm rupture. J Neurosurg 2013; 120:104-10. [PMID: 24160476 DOI: 10.3171/2013.9.jns13921] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Recent studies have shown that posterior circulation aneurysms, specifically posterior communicating artery (PCoA) aneurysms, are more likely to rupture than other aneurysms. To date, few studies have investigated the factors contributing to PCoA aneurysm rupture. The authors aimed to identify morphological and clinical characteristics predisposing to PCoA aneurysm rupture. METHODS The authors retrospectively reviewed 134 consecutive patients with PCoA aneurysms managed at their facility between July 2003 and December 2012. The authors divided patients into groups of those with aneurysmal rupture (n = 39) and without aneurysmal rupture (n = 95) and compared morphological and clinical characteristics. Morphological characteristics were mainly evaluated by 3D CT angiography and included diameter of arteries (anterior cerebral artery, middle cerebral artery, and internal carotid artery), size of the aneurysm, dome-to-neck ratio, neck direction of the aneurysmal dome around the PCoA (medial, lateral, superior, inferior, and posterior), aneurysm bleb formation, whether the PCoA was fetal type, and the existence of other intracranial unruptured aneurysm(s). RESULTS Patients with ruptured PCoA aneurysms were significantly younger (a higher proportion were < 60 years of age) and a significantly higher proportion of patients with ruptured PCoA aneurysms showed a lateral direction of the aneurysmal dome around the PCoA, had bleb formation, and the aneurysm was > 7 mm in diameter and/or the dome-to-neck ratio was > 2.0. Multivariate logistic regression analysis showed age < 60 years (OR 4.3, p = 0.011), history of hypertension (OR 5.1, p = 0.008), lateral direction of the aneurysmal dome around the PCoA (OR 6.7, p = 0.0001), and bleb formation (OR 11, p < 0.0001) to be significantly associated with PCoA aneurysm rupture. CONCLUSIONS The present results demonstrated that lateral projection of a PCoA aneurysm may be related to rupture.
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91
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Zhao R, Shen J, Huang QH, Nie JH, Xu Y, Hong B, Yang PF, Zhao WY, Liu JM. Endovascular treatment of ruptured tiny, wide-necked posterior communicating artery aneurysms using a modified stent-assisted coiling technique. J Clin Neurosci 2013; 20:1377-81. [PMID: 23890412 DOI: 10.1016/j.jocn.2012.12.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Revised: 11/25/2012] [Accepted: 12/01/2012] [Indexed: 11/19/2022]
Abstract
The endovascular treatment of patients with tiny, wide-necked aneurysms is technically challenging, due to the small volume for microcatheterization and coil stabilization inside the aneurysm sac. We performed a retrospective study to evaluate the feasibility, effectiveness, and safety of stent-assisted embolization for patients with ruptured, tiny, wide-necked posterior communicating artery (PcomA) aneurysms. Between January 2007 and August 2011, 17 tiny, wide-necked PcomA aneurysms that had ruptured were treated at our institution using a modified stent-assisted technique, with delivery of the first coil inside the aneurysm followed by placement of a self-expanding stent via a second microcatheter. All patients were treated successfully using this modified stent-assisted coiling technique. Initial results showed aneurysm occlusion of Raymond Class 1 in 10 patients, Class 2 in four patients, and Class 3 in three patients. The angiographic follow-up results for 13 patients (mean, 12.5 months) showed that all aneurysms remained stable or improved, without any in-stent stenosis or recurrence. Of the other four patients, three refused angiography for economic or personal reasons, and one was lost in follow-up. Clinical follow-up of 16 patients for a mean of 23.8 months showed no death or rebleeding. These results imply that endovascular treatment of ruptured tiny, wide-necked PcomA aneurysms using our modified stent-assisted coiling technique is safe and feasible. This technique improves the long-term outcomes of these aneurysms by increasing the packing density and diverting the intra-aneurysmal blood flow.
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Affiliation(s)
- Rui Zhao
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai 200433, China
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92
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Almeida-Pérez R, Espinosa-García H, Alcalá-Cerra G, de la Rosa-Manjarréz G, Orozco-Gómez F. [Endovascular coiling of a «true» posterior communicating artery aneurysm]. Neurocirugia (Astur) 2013; 25:90-3. [PMID: 23831341 DOI: 10.1016/j.neucir.2013.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Accepted: 05/19/2013] [Indexed: 10/26/2022]
Abstract
True posterior communicating artery aneurysms originate exclusively from the wall of this artery and should be differentiated from aneurysms of the posterior communicating segment of the distal carotid artery. As these lesions are rare, their anatomical relationships have been poorly described; likewise, reports concerning their endovascular treatment are extremely rare and the technical aspects poorly detailed. A case of a patient with a true aneurysm of the left posterior communicating artery treated by endovascular coiling is presented. A literature review was also conducted to illustrate the anatomical and technical details relevant to achieving its successful treatment.
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Affiliation(s)
- Rafael Almeida-Pérez
- Sección de Neurocirugía, Universidad de Cartagena, Cartagena de Indias, Colombia; Servicio de Neurocirugía Endovascular y Neurorradiología Intervencionista, Neurodinamia S.A., Cartagena de Indias, Colombia
| | - Héctor Espinosa-García
- Servicio de Neurocirugía Endovascular y Neurorradiología Intervencionista, Neurodinamia S.A., Cartagena de Indias, Colombia
| | - Gabriel Alcalá-Cerra
- Sección de Neurocirugía, Universidad de Cartagena, Cartagena de Indias, Colombia; Grupo de Investigación en Ciencias de la Salud y Neurociencias (CISNEURO), Cartagena de Indias, Colombia.
| | - Ginna de la Rosa-Manjarréz
- Servicio de Neurocirugía Endovascular y Neurorradiología Intervencionista, Neurodinamia S.A., Cartagena de Indias, Colombia
| | - Fernando Orozco-Gómez
- Servicio de Neurocirugía Endovascular y Neurorradiología Intervencionista, Neurodinamia S.A., Cartagena de Indias, Colombia
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93
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Cho YD, Lee WJ, Kim KM, Kang HS, Kim JE, Han MH. Stent-assisted coil embolization of posterior communicating artery aneurysms. AJNR Am J Neuroradiol 2013; 34:2171-6. [PMID: 23660292 DOI: 10.3174/ajnr.a3541] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND PURPOSE Use of protective stents may not be effective in coil embolization of wide-neck aneurysms involving the posterior communicating artery. Successful implementation depends on the caliber of the vessel, its angle of origin, and the manner in which its orifice is incorporated into the aneurysm. Presented here are the results (clinical and radiographic) of coil embolization in aneurysms of the ICA-posterior communicating artery junction, variably aided by stents. The primary focus is angiographic configurations that impact stent placement. MATERIALS AND METHODS From a prospective data repository, we retrieved records of 32 consecutive patients with 33 posterior communicating artery aneurysms, all of which were treated by stent-assisted coil embolization between June 2008 and August 2012. Outcomes were analyzed in terms of aneurysm configuration and clinical status. RESULTS Stents were positioned entirely in the ICA (n = 26), from the ICA to the posterior communicating artery (n = 2), in the posterior communicating artery only (n = 3), and retrograde from the posterior communicating artery to the ICA terminus (n = 2). Procedure-related complications occurred in 3 patients (9.1%), but only 1 (3.0%) had mild neurologic sequelae (Glasgow Outcome Score 4). Using coil embolization, we achieved successful occlusion in 24 aneurysms (72.7%), and in 9 others, subtotal occlusion was conferred. During a mean follow-up of 15.7 ± 10.7 months, imaging of 27 aneurysms documented stable occlusion in 19 (70.4%), whereas angiography of 15 aneurysms (39.5%) disclosed 2 instances of in-stent stenosis (13.3%) and a solitary occurrence of stent migration (6.7%). CONCLUSIONS In posterior communicating artery aneurysms, stent protection during coil embolization is feasible by adjusting the procedural strategy to accommodate differing configurations of the aneurysm and its vascular source.
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Cho YD, Kim KM, Lee WJ, Kang HS, Kim JE, Han MH. Retrograde stenting through the posterior cerebral artery in coil embolization of the posterior communicating artery aneurysm. Neuroradiology 2013; 55:733-9. [DOI: 10.1007/s00234-013-1163-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Accepted: 02/27/2013] [Indexed: 10/27/2022]
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Kuzmik GA, Bulsara KR. Microsurgical clipping of true posterior communicating artery aneurysms. Acta Neurochir (Wien) 2012; 154:1707-10. [PMID: 22832978 DOI: 10.1007/s00701-012-1435-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Accepted: 06/20/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND "True" posterior communicating artery (PCOM) aneurysms are rare variants in which the aneurysm arises solely from the PCOM rather than the junction of the internal carotid artery and the PCOM. METHODS It is critical to note that for true PCOM aneurysms, the neck arises distal to the origin of the PCOM and therefore lies in what is traditionally an intra-operative blind spot. The PCOM must be followed posteriorly to visualise the aneurysm neck for microsurgical clipping. CONCLUSIONS A thorough pre-operative understanding of this unique anatomy is essential in minimising morbidity associated with microsurgical clipping of this aneurysm configuration.
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Sanai N, Caldwell N, Englot DJ, Lawton MT. Advanced Technical Skills Are Required for Microsurgical Clipping of Posterior Communicating Artery Aneurysms in the Endovascular Era. Neurosurgery 2012; 71:285-94; discussion 294-5. [DOI: 10.1227/neu.0b013e318256c3eb] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Abstract
BACKGROUND:
Many neurosurgeons feel competent clipping posterior communicating artery (PCoA) aneurysms and include this lesion in their practice. However, endovascular therapy removes simple aneurysms that would have been easiest to clip with the best results. What remains are aneurysms with complex anatomy and technical challenges that are not well described.
OBJECTIVE:
A contemporary surgical series with PCoA aneurysms is reviewed to define the patients, microsurgical techniques, and outcomes in current practice.
METHODS:
A total of 218 patients had 218 PCoA aneurysms that were treated microsurgically during an 11-year period. Complexities influencing aneurysm management included (1) large/giant size; (2) fetal posterior cerebral artery; (3) previous coiling; (4) anterior clinoidectomy; (5) adherence of the anterior choroidal artery (AChA); (6) intraoperative aneurysm rupture; (7) complex clipping; and (8) atherosclerotic calcification.
RESULTS:
Simple PCoA aneurysms were encountered in 113 patients (51.8%) and complex aneurysms in 105 (48.2%). Adherent AChA (13.8%) and intraoperative rupture (11.5%) were the most common complexities. Simple aneurysms had favorable outcomes in 86.6% of patients, whereas aneurysms with 1 or multiple complexities had favorable outcomes in 78.2% and 75.0%, respectively. Intraoperative rupture (P < .01), large/giant size (P = .04), and complex clipping (P = .05) were associated with increased neurological worsening.
CONCLUSION:
Because endovascular therapy alters the surgical population, neurosurgeons should recalibrate their expectations with this once straightforward aneurysm. The current mix of PCoA aneurysms requires advanced techniques including clinoidectomy, AChA microdissection, complex clipping, and facility with intraoperative rupture. Microsurgery is recommended for recurrent aneurysms after coiling, complex branches, aneurysms causing oculomotor nerve palsy, multiple aneurysms, and patients with hematomas.
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Affiliation(s)
- Nader Sanai
- Division of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona
| | - Nolan Caldwell
- Department of Neurological Surgery, University of California at San Francisco, San Francisco, California
| | - Dario J. Englot
- Department of Neurological Surgery, University of California at San Francisco, San Francisco, California
| | - Michael T. Lawton
- Department of Neurological Surgery, University of California at San Francisco, San Francisco, California
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Scholtes F, Martin D. Strategical implications of aneurysmal cranial nerve compression. Neurochirurgie 2012; 58:146-55. [DOI: 10.1016/j.neuchi.2012.02.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Accepted: 02/27/2012] [Indexed: 12/17/2022]
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98
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