1
|
Liu F, Jiang M, Luo J, Cheng B, Wang X, Zhao L, Cheng H. Strategies and outcomes of endovascular treatment of posterior inferior cerebellar artery aneurysms: a single center experience. Neurosurg Rev 2024; 47:351. [PMID: 39046673 DOI: 10.1007/s10143-024-02521-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 04/12/2024] [Accepted: 06/15/2024] [Indexed: 07/25/2024]
Abstract
To explore safe and reliable strategies and outcomes of endovascular procedures in the treatment of posterior inferior cerebellar artery (PICA) aneurysms. Retrospectively reviewed and analyzed the cases of PICA aneurysms that undergone endovascular therapy from July 2017 through January 2022 in our neurosurgical center, as well as outcomes of long-term follow-up. Total 24 cases were enrolled. Majority of the PICA aneurysms (87.5%, 21/24) presented initially with subarachnoid hemorrhage (SAH) and only 3 cases were not ruptured when they were clinically diagnosed as PICA aneurysms. The patients were endovascularly given either aneurysm occlusion with selective coils (12 cases), embolization of aneurysms and parent arteries (7 cases: 3 cases with coils and 4 cases with Onyx liquid embolic agent), or stent-assisted coiling of the aneurysms (5 cases). One patient, who had comorbidity of intracranial hemorrhage and severe cerebral vasospasm, declined further post-surgery therapy, and discharged from the hospital with anticipation of poor outcome. The rest 23 patients were followed up for 3-24 months with a recurrence rate of 17.4% (4/23). Endovascular procedure of embolizing PICA aneurysms with selective coils or stent-assisted coils is feasible, safe, and reliable. Simplified embolization of the aneurysms or occlusion of the parent artery is recommended as the first choice for the ruptured and bleeding PICA aneurysms.
Collapse
Affiliation(s)
- Fei Liu
- Department of Neurosurgery, The First Affiliated Hospital of Anhui Medical University, 218 Jixi, Hefei, Anhui, 230022, PR China
| | - Min Jiang
- Department of Neurosurgery, The First Affiliated Hospital of Anhui Medical University (North District), Hefei, PR China
| | - Jing Luo
- Department of Neurosurgery, The First Affiliated Hospital of Anhui Medical University, 218 Jixi, Hefei, Anhui, 230022, PR China.
| | - Baochun Cheng
- Department of Neurosurgery, The First Affiliated Hospital of Anhui Medical University, 218 Jixi, Hefei, Anhui, 230022, PR China
| | - Xiaojian Wang
- Department of Neurosurgery, The First Affiliated Hospital of Anhui Medical University, 218 Jixi, Hefei, Anhui, 230022, PR China
| | - Liang Zhao
- Department of Neurosurgery, The First Affiliated Hospital of Anhui Medical University, 218 Jixi, Hefei, Anhui, 230022, PR China
| | - Hongwei Cheng
- Department of Neurosurgery, The First Affiliated Hospital of Anhui Medical University, 218 Jixi, Hefei, Anhui, 230022, PR China.
| |
Collapse
|
2
|
Saal-Zapata G, Rodriguez-Calienes A, Malaga M, Velasquez-Rimachi V, Moran C, Bustamante-Paytan D, Pacheco-Barrios N, Pacheco-Barrios K, Alva-Diaz C, Walker M. Microsurgical and endovascular treatment of posterior inferior cerebellar artery aneurysms: a systematic review and meta-analysis. J Neurosurg Sci 2023; 67:638-652. [PMID: 35416457 DOI: 10.23736/s0390-5616.22.05710-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Posterior inferior cerebellar artery (PICA) aneurysms are uncommon vascular lesions of the posterior fossa. In addition to aneurysmal morphology, structural anatomic considerations may confer additional procedural risk, and as a result there is currently no consensus as to whether a surgical or endovascular approach offers greater safety and efficacy for patients. EVIDENCE ACQUISITION We systematically examined peer-reviewed literature describing PICA aneurysm treatment planning from January 2000 to May 2021 using the PRISMA methodology. A meta-analysis of proportions was performed. Certainty of the evidence was assessed using the GRADE approach. EVIDENCE SYNTHESIS Fifty-eight studies including 1673 PICA aneurysms were analyzed. Overall treatment occlusion rate was 97% (95% confidence interval [CI]: 93-100%) for surgery and 85% (95% CI: 78-92%) for endovascular therapy. The recurrence rate was 6% in the endovascular group and 1% for surgery. Overall morbidity and mortality were 16% and 7%, respectively. Intraoperative complications occurred in 9% of the surgical patients. CONCLUSIONS Despite a large body of literature, analysis indicates that 62% of studies had moderate or serious risk of bias, suggesting very-low certainty results. Therefore, treatment via either approach should be determined on a case-by-case basis and according to institutional experience.
Collapse
Affiliation(s)
- Giancarlo Saal-Zapata
- Section of Endovascular Neurosurgery, Department of Neurosurgery, Guillermo Almenara Irigoyen-EsSalud National Hospital, Lima, Peru -
| | - Aaron Rodriguez-Calienes
- Grupo de Investigación Neurociencia, Efectividad Clínica y Salud Pública, Universidad Científica del Sur, Lima, Perú
| | - Marco Malaga
- Red de Eficacia Clínica y Sanitaria (REDECS), Lima, Peru
| | - Victor Velasquez-Rimachi
- Grupo de Investigación Neurociencia, Efectividad Clínica y Salud Pública, Universidad Científica del Sur, Lima, Perú
- Red de Eficacia Clínica y Sanitaria (REDECS), Lima, Peru
| | - Cristian Moran
- Red de Eficacia Clínica y Sanitaria (REDECS), Lima, Peru
- Scientific University of the South, Lima, Peru
| | | | - Niels Pacheco-Barrios
- Red de Eficacia Clínica y Sanitaria (REDECS), Lima, Peru
- Faculty of Human Medicine, San Martin de Porres University, Lima, Peru
| | - Kevin Pacheco-Barrios
- Alberto Hurtado Faculty of Medicine, Cayetano Heredia Peruvian University, Lima, Peru
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Boston, MA, USA
| | - Carlos Alva-Diaz
- Grupo de Investigación Neurociencia, Efectividad Clínica y Salud Pública, Universidad Científica del Sur, Lima, Perú
| | - Melanie Walker
- Research Unit for the Generation and Synthesis of Health Evidence, San Ignacio de Loyola University, Lima, Perú
| |
Collapse
|
3
|
Sriamornrattanakul K, Akharathammachote N, Chonhenchob A, Mongkolratnan A, Niljianskul N, Phoominaonin IS, Ariyaprakai C. Far-lateral approach without C1 laminectomy for microsurgical treatment of vertebral artery and proximal posterior inferior cerebellar artery aneurysms: Experience from 48 patients. World Neurosurg X 2023; 19:100216. [PMID: 37251244 PMCID: PMC10209739 DOI: 10.1016/j.wnsx.2023.100216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 05/10/2023] [Indexed: 05/31/2023] Open
Abstract
Background In the endovascular era, most of vertebral artery (VA) and posterior inferior cerebellar artery (PICA) aneurysms were mainly treated with endovascular procedures. This study aimed to demonstrate the microsurgical treatment via the far-lateral approach without C1 laminectomy and its clinical outcomes. Methods Forty-eight patients with VA and proximal PICA aneurysms treated by microsurgery through the far-lateral approach without C1 laminectomy, between January 2016 and June 2021, were retrospectively evaluated. Results Most patients (87.5%) presented with subarachnoid hemorrhage. Grading at presentation was poor in 41.7%. The rates of VA dissecting aneurysms, saccular aneurysms of the VA-PICA junction, and true PICA saccular aneurysms were 54.2, 18.7, and 14.6%, respectively. All aneurysms were located above the lower margin of the foramen magnum. The far-lateral approach without C1 laminectomy was successfully used in all patients without residual aneurysms. Various surgical strategies were applied depending on the characteristics of the aneurysm. Good outcomes 3 months postoperatively were achieved in 77.1% and 89.3% for the overall and good-grade groups, respectively. Conclusions Microsurgery is a safe and effective treatment of VA and proximal PICA aneurysms. Moreover, the far-lateral approach without C1 laminectomy was adequate and effective for aneurysms located above the lower border of the foramen magnum.
Collapse
|
4
|
Wu B, Huang Z, Liu H, He J, Ju Y, Chen Z, Zhang T, Yi F. Ultra-early endovascular treatment improves prognosis in High grade aneurysmal subarachnoid hemorrhage: A single-center retrospective study. Front Neurol 2022; 13:963624. [PMID: 36034293 PMCID: PMC9413045 DOI: 10.3389/fneur.2022.963624] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 07/20/2022] [Indexed: 11/13/2022] Open
Abstract
Background The long-term survival prognosis of patients with high-grade (Hunt-Hess grade IV–V or World Federation of Neurosurgical Societies grade IV–V) aneurysmal subarachnoid hemorrhage (aSAH) is generally poor, and the association between endovascular treatment timing and the prognosis of high-grade aSAH has not been explored in depth. This retrospective cohort study aimed to determine whether endovascular treatment within 24 h of high-grade aSAH is associated with a better prognosis. Methods We retrospectively analyzed the clinical data of patients with high-grade aSAH who were admitted to our institution between January 2018 and January 2021. The Modified Rankin Scale score was used to assess the 6-month prognosis of patients. Univariate and multivariate logistic regression analyses were used to identify the factors associated with prognosis. The area under the receiver operating characteristic (ROC) curve was used to assess the model's discriminatory ability. Results Eighty-six patients were included in the study. In the multivariate analysis, the timing of endovascular treatment (odds ratio = 7.003 [1.800–27.242], P = 0.005) was an independent risk factor for prognosis. The ROC curve showed that the predictive power of the timing of endovascular treatment was 0.744, the best cut-off value was 12.5 h, and the corresponding sensitivity and specificity were 71.4 and 70.5%, respectively. Hydrocephalus (P = 0.005) and pulmonary infection (P = 0.029) were also associated with prognosis. In addition, cerebrospinal fluid drainage immediately after endovascular treatment had a significant effect on reducing hydrocephalus formation. Conclusions Endovascular therapy within 24 h is feasible and improves the prognosis of patients with high-grade aSAH.
Collapse
Affiliation(s)
- Botao Wu
- Department of Neurosurgery, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
| | - Zhe Huang
- Department of Radiology, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
| | - Huan Liu
- Department of General Surgery, Zhongshan Hospital of Traditional Chinese Medicine, Guangzhou University of Traditional Chinese Medicine, Zhongshan, China
| | - Jiayao He
- Department of Orthopedics, Affiliated Hospital of Chengdu University, Chengdu, China
| | - Yan Ju
- Department of Endocrinology, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
| | - Ziwei Chen
- Department of Neurosurgery, The Third Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
| | - Taiwei Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
| | - Fuxin Yi
- Department of Neurosurgery, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
- *Correspondence: Fuxin Yi
| |
Collapse
|
5
|
Ali AMS, Hannan CJ, Islim AI, Mascitelli JR, Javadpour M. Surgical and Endovascular Treatment of Saccular Posterior Inferior Cerebellar Artery Aneurysms: Systematic Review and Meta-Analysis. World Neurosurg 2022; 162:e168-e177. [PMID: 35257955 DOI: 10.1016/j.wneu.2022.02.103] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 02/24/2022] [Accepted: 02/25/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The optimal treatment modality for saccular aneurysms of the posterior inferior cerebellar artery (PICA) remains unclear. A previous meta-analysis on the topic included a heterogenous study population, limiting the conclusions that can be drawn from its results. The aim of this study was to perform a systematic review and meta-analysis to compare outcomes of microsurgical and endovascular treatment (EVT) of these aneurysms. METHODS A search of 4 online databases was performed for studies describing the management of saccular PICA aneurysms. The primary outcome was complete aneurysm occlusion. Data were also collected on neurologic outcomes, cranial nerve palsies, and requirement for re-treatment. A random effects model was used for calculation of pooled proportions. Our protocol was registered with PROSPERO (CRD42021232784). RESULTS A total of 17 studies were included in the final analysis, reporting the treatment outcomes of 455 aneurysms, with a mean follow-up of 20 months. The pooled occlusion rates were 94.8% (95% confidence interval [CI] 90.6%-97.8%) for surgical treatment and 69.1% (95% CI 55.0%-81.7%) for EVT. Pooled rates of good neurologic outcome (modified Rankin scale score ≤2, Glasgow Outcome Scale score ≥4) at last follow-up were 78.1% (95% CI 67.4%-87.1%) for surgery and 77.6% (95% CI 67.9%-86.0%) for EVT. CONCLUSIONS This meta-analysis demonstrates that in the treatment of saccular PICA aneurysms, microsurgical clipping results in superior angiographic outcomes, similar functional outcomes, but higher rates of lower cranial nerve palsy compared with EVT. Further studies are required to assess the duration and severity of cranial nerve palsies following surgical treatment, and long-term aneurysm occlusion and the requirement for re-intervention following EVT.
Collapse
Affiliation(s)
- Ahmad M S Ali
- The Walton Centre for Neurology and Neurosurgery, Liverpool, England
| | | | | | | | - Mohsen Javadpour
- National Neurosurgical Centre, Beaumont Hospital, Dublin, Ireland; School of Medicine, Trinity College Dublin, Dublin, Ireland; Royal College of Surgeons in Ireland, Dublin, Ireland.
| |
Collapse
|
6
|
Murakami T, Toyota S, Nakagawa K, Hagioka T, Hoshikuma Y, Suematsu T, Shimizu T, Kobayashi M, Taki T. Midline suboccipital approach to a vertebral artery–posterior inferior cerebellar artery aneurysm from the rostral end of the patient using ORBEYE. Surg Neurol Int 2022; 13:87. [PMID: 35399900 PMCID: PMC8986755 DOI: 10.25259/sni_1272_2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 02/11/2022] [Indexed: 02/02/2023] Open
Abstract
Background:
The midline suboccipital approach with the patient in the prone position is safe and effective for clipping vertebral artery–posterior inferior cerebellar artery (VA–PICA) aneurysms. Using a conventional surgical microscope from the rostral end of the patient for this approach without an extreme head-down position requires the surgeon to overhang the visual axis of the microscope and perform surgical manipulations in an uncomfortable posture. We report performing the midline suboccipital approach from the rostral end with slight head-down position using ORBEYE, a new high-definition (4K) three-dimensional exoscope.
Case Description:
A 65-year-old woman was admitted for clipping of a right unruptured VA–PICA aneurysm (maximum diameter, 5mm) located medially and ventral to the hypoglossal canal. After induction of general anesthesia, the patient was placed in the prone position with the head titled slightly downward. A midline suboccipital approach was performed from the rostral end of the patient using ORBEYE. Clipping was safely accomplished in a comfortable posture. No operative complications occurred. Postoperative computed tomography angiography showed complete aneurysmal obstruction.
Conclusion:
Exoscopic surgery using ORBEYE is feasible for a midline suboccipital approach to VA–PICA aneurysms from the rostral end of the patient with the patient in the prone with slight head-down position.
Collapse
|
7
|
Shin HK, Koo HW, Sohn MJ, Park YK. Flow diversion via telescoping stent with Low-profile Visualized Intraluminal Support Junior for treatment of ruptured dissecting aneurysm located at proximal posterior inferior cerebellar artery. J Cerebrovasc Endovasc Neurosurg 2021; 23:130-135. [PMID: 34107595 PMCID: PMC8256025 DOI: 10.7461/jcen.2021.e2020.08.003] [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] [Received: 08/14/2020] [Accepted: 12/03/2020] [Indexed: 11/23/2022] Open
Abstract
Dissecting aneurysm involving the posterior inferior cerebellar artery (PICA) are challenging because of its nature and anatomic relationship to medulla and lower cranial nerve. We introduce a case of ruptured dissecting aneurysm located at the proximal PICA treated with telescoping stents for flow diversion and dissection healing. A 49 years old female visited to the emergency room for ruptured dissecting aneurysm at right proximal PICA. Telescoping stent was deployed along the right vertebral artery to PICA covering the dissecting aneurysm bleb using two Low-profile Visualized Intraluminal Support Jr (LVIS Jr) stents. Three months follow up angiography revealed a disappearance of aneurysm bleb and healing of dissection by parent artery remodeling. Telescoping stent with LVIS Jr may be an effective treatment for dissecting aneurysm with small diameter (<2 mm) parent artery. Convenient navigation and targeted telescoping stent for minimizing metal coverage at perforating arteries are an advantage for this method.
Collapse
Affiliation(s)
- Hee Kwon Shin
- Department of Neurosurgery, Inje University, Ilsan Paik Hospital, Neuroscience & Radiosurgery Hybrid Neurosurgery Research Center, Goyang, Korea
| | - Hae-Won Koo
- Department of Neurosurgery, Inje University, Ilsan Paik Hospital, Neuroscience & Radiosurgery Hybrid Neurosurgery Research Center, Goyang, Korea
| | - Moon-Jun Sohn
- Department of Neurosurgery, Inje University, Ilsan Paik Hospital, Neuroscience & Radiosurgery Hybrid Neurosurgery Research Center, Goyang, Korea
| | - Yung Ki Park
- Department of Neurosurgery, Uijeongbu Eulji Medical Center, Eulji University College of Medicine, Uijeongbu, Korea
| |
Collapse
|
8
|
Lin Q, Ba HJ, Dai JX, Sun J, Lu C, Chen MH, Chen XD, Cai JY. Serum soluble lectin-like oxidized low-density lipoprotein receptor-1 as a biomarker of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage. Brain Behav 2020; 10:e01517. [PMID: 31943892 PMCID: PMC7010573 DOI: 10.1002/brb3.1517] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 11/25/2019] [Accepted: 12/02/2019] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE Delayed cerebral ischemia (DCI) greatly contributes to the high morbidity and mortality of aneurysmal subarachnoid hemorrhage (aSAH) patients. Expression of lectin-like oxidized low-density lipoprotein receptor-1 (LOX-1) was substantially raised in the basilar arterial wall of SAH rabbits. We attempted to ascertain the relationship between serum soluble LOX-1 (sLOX-1) levels and the occurrence of DCI after aSAH. MATERIALS AND METHODS We enrolled 125 aSAH patients and 125 healthy controls. Serum sLOX-1 levels were quantified using commercial enzyme-linked immunosorbent assay kit. The relationship between sLOX-1 levels and DCI was analyzed utilizing the multivariate logistic regression analysis. RESULTS Serum sLOX-1 levels were significantly higher in stroke patients than in controls (median: 1,450.2 vs. 445.7 pg/ml, p < .001). Serum sLOX-1 levels were highly correlated with World Federation of Neurological Surgeons (WFNS) scores, Hunt-Hess scores, and modified Fisher scores (r = .574, .625, and .569, respectively). Forty-two patients (33.6%) experienced DCI. Serum sLOX-1 > 1,450.2 pg/ml, WFNS scores and modified Fisher scores were the independent predictors of DCI. Under receiver operating characteristic curve, serum sLOX-1 levels exhibited a significant discriminatory capability (area under curve 0.825, 95% confidence interval 0.747-0.887). The predictive power of serum sLOX-1 levels was similar to those of WFNS scores and modified Fisher grade (both p > .05). Moreover, serum sLOX-1 levels significantly improved their predictive capability (both p < .05). CONCLUSIONS Serum soluble LOX-1, in positive association with hemorrhagic severity, appears to have the potential to become a promising predictor of DCI after aSAH.
Collapse
Affiliation(s)
- Qun Lin
- Department of Neurosurgery, The Central Hospital of Wenzhou City, Wenzhou, China
| | - Hua-Jun Ba
- Department of Neurosurgery, The Central Hospital of Wenzhou City, Wenzhou, China
| | - Jun-Xia Dai
- Department of Neurosurgery, The Central Hospital of Wenzhou City, Wenzhou, China
| | - Jun Sun
- Department of Neurosurgery, The Central Hospital of Wenzhou City, Wenzhou, China
| | - Chuan Lu
- Department of Neurosurgery, The Central Hospital of Wenzhou City, Wenzhou, China
| | - Mao-Hua Chen
- Department of Neurosurgery, The Central Hospital of Wenzhou City, Wenzhou, China
| | - Xian-Dong Chen
- Department of Neurosurgery, The Central Hospital of Wenzhou City, Wenzhou, China
| | - Jian-Yong Cai
- Department of Neurosurgery, The Central Hospital of Wenzhou City, Wenzhou, China
| |
Collapse
|
9
|
Pilipenko Y, Eliava S, Okishev D, Okisheva E, Spyrou A. Vertebral artery and posterior inferior cerebellar artery aneurysms: Results of microsurgical treatment of eighty patients. Surg Neurol Int 2019; 10:227. [PMID: 31819820 PMCID: PMC6884955 DOI: 10.25259/sni_326_2019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 10/24/2019] [Indexed: 11/04/2022] Open
Abstract
Background The choice of surgical approaches and options for the microsurgical vertebral artery (VA) and posterior inferior cerebellar artery (PICA) aneurysms repair remains controversial. Methods A retrospective analysis of the clinical, surgical, and angiographic data of 80 patients with VA and PICA aneurysms treated from 2012 to 2018 was performed. Results The aneurysms were saccular in 50 cases (62.5%) and fusiform in 30 cases (37.5%). The median suboccipital craniotomy was the most common approach (73.8%). Retrosigmoid craniotomy was performed in 25% of patients. There were the following types of microsurgical operations: neck clipping (61.25%), clipping with the artery lumen formation (13.75%), trapping (10%), proximal clipping (5%), and deconstruction with anastomosis (10%). Fifty-seven (71.3%) patients were discharged without worsening of the clinical signs after surgery. The most common postoperative neurological disorder was palsy of IX and X cranial nerve revealed in 14 (17.5%) patients. No fatal outcomes or patients in vegetative state were identified. The complete occlusion of PICA and VA aneurysms according angiography was in 77 (96.3%) cases. Conclusion Microsurgical treatment is an effective method for VA and PICA aneurysms. The majority of VA and PICA aneurysms do not require complex basal approaches. A thorough preoperative planning, reconstructive clipping techniques, and anastomoses creation, as well as patient selection based on the established algorithms and consultations with endovascular surgeons, may reduce the number of complications and increase the rate of complete microsurgical occlusion in VA and PICA aneurysms.
Collapse
Affiliation(s)
- Yuri Pilipenko
- 3 Department (vascular pathology), Federal State Autonomous Institution "N. N. Burdenko National Medical Research Center of Neurosurgery" of the Ministry of Health of the Russian Federation
| | - Shalva Eliava
- 3 Department (vascular pathology), Federal State Autonomous Institution "N. N. Burdenko National Medical Research Center of Neurosurgery" of the Ministry of Health of the Russian Federation
| | - Dmitry Okishev
- 3 Department (vascular pathology), Federal State Autonomous Institution "N. N. Burdenko National Medical Research Center of Neurosurgery" of the Ministry of Health of the Russian Federation
| | - Elena Okisheva
- Department of Internal Diseases, Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - Andronikos Spyrou
- 3 Department (vascular pathology), Federal State Autonomous Institution "N. N. Burdenko National Medical Research Center of Neurosurgery" of the Ministry of Health of the Russian Federation
| |
Collapse
|
10
|
Serum soluble lectin-like oxidized low-density lipoprotein receptor-1 concentrations and prognosis of aneurysmal subarachnoid hemorrhage. Clin Chim Acta 2019; 500:54-58. [PMID: 31626762 DOI: 10.1016/j.cca.2019.09.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 09/17/2019] [Accepted: 09/18/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Oxidized low-density lipoprotein (ox-LDL) and its receptor, lectin-like ox-LDL receptor-1 (LOX-1) are involved in the pathogenesis of atherosclerosis. Expression of LOX-1 was substantially raised in the basilar arterial wall of subarachnoid hemorrhage (SAH) rabbits. We ascertained the relationship between serum soluble LOX-1 concentrations and functional outcome after human aneurysmal SAH. METHODS We enrolled 94 aneurysmal SAH patients and 94 healthy controls. Serum soluble TOX-1 concentrations were quantified using commercial enzyme-linked immunosorbent assay kit. A poor outcome was defined as Glasgow outcome scale score of 1-3. RESULTS Median values of serum soluble LOX-1 in stroke patients were significantly higher than those in controls (1.5 vs. 0.4 ng/ml, P < 0.001). Thirty patients (31.9%) had a poor outcome at 6 months after stroke. Serum soluble LOX-1 was a strong predictor of poor outcome (OR 5.20, 95% CI 1.25-22.04). Serum soluble LOX-1 concentrations exhibited a significant discriminatory capability (area under curve 0.811, 95% confidence interval 0.717-0.884). The predictive powers of World Federation of Neurological Surgeons grade, Hunt-Hess grade, modified Fisher grade, and serum soluble LOX-1 concentrations were comparable (all P > 0.05). CONCLUSIONS Serum soluble LOX-1 appears to have the potential to become a promising prognostic predictor after human aneurysmal SAH.
Collapse
|
11
|
Eliava SS, Pilipenko YV, Shechtman OD, Kheyreddin AS, Okishev DN, Konovalov AN, Spiru AM, Kisariev SA, Gorozhanin VA, Varyukhina MD. [Microsurgical treatment of aneurysms of vertebral and posterior-lower cerebellar arteries: surgical approaches, exclusion options, treatment results]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2019; 83:5-17. [PMID: 31577266 DOI: 10.17116/neiro2019830415] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aneurysms of vertebral (VA) and posterior inferior cerebellar arteries (PICA) are relatively rare pathologies and account for 3.4% of the total number of intracranial aneurysms. MATERIAL AND METHODS The experience of microsurgical treatment of 67 patients with VA and PICA aneurysms in N.N. Burdenko National Medical Research Center for Neurosurgery of the RF Ministry of Health from 2012 to 2017 is presented. RESULTS Most patients underwent reconstructive microsurgical interventions: clipping of the aneurysm neck in 42 (62.7%) patients and complex clipping with the formation of arterial opening - in 10 (14.9%). Exclusion of the aneurysm together with the carrier artery (trapping, proximal clipping) was performed on 10 (14.9%) patients. In 5 (7.5%) patients, deconstruction of the carrier artery of the aneurysm was performed after creating local anastomoses. The radical exclusion of aneurysms in the studied group was 95.5%. Postoperative dysfunction of the caudal group of cranial nerves was detected in 11 (16.4%) patients. There were no lethal outcomes, or cases with vegetative status outcomes. CONCLUSION Microsurgical intervention is an effective way to treat VA and PICA aneurysms, subject to the principles of patient selection based on existing treatment algorithms as well as adherence to an interdisciplinary approach.
Collapse
Affiliation(s)
| | | | | | | | - D N Okishev
- Burdenko Neurosurgical Center, Moscow, Russia
| | | | - A M Spiru
- Burdenko Neurosurgical Center, Moscow, Russia
| | | | | | | |
Collapse
|
12
|
Starnoni D, Maduri R, Al Taha K, Bervini D, Zumofen DW, Stienen MN, Schatlo B, Fung C, Robert T, Seule MA, Burkhardt JK, Maldaner N, Rothlisberger M, Blackham KA, Marbacher S, D'Alonzo D, Remonda L, Machi P, Gralla J, Bijlenga P, Saliou G, Ballabeni P, Levivier M, Messerer M, Daniel RT. Ruptured PICA aneurysms: presentation and treatment outcomes compared to other posterior circulation aneurysms. A Swiss SOS study. Acta Neurochir (Wien) 2019; 161:1325-1334. [PMID: 31025178 DOI: 10.1007/s00701-019-03894-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 03/25/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND PURPOSE Aneurysms of the posterior inferior cerebellar artery (PICA) are relatively uncommon and evidence is sparse about patients presenting with ruptured PICA aneurysms. We performed an analysis of the Swiss SOS national registry to describe clinical presentation, treatment pattern, and neurological outcome of patients with ruptured PICA aneurysms compared with other ruptured posterior circulation (PC) aneurysms. METHODS This was a retrospective analysis of anonymized data from the Swiss SOS registry (Swiss Study on Aneurysmal Subarachnoid Hemorrhage; 2009-2014). Patients with ruptured PC aneurysms were subdivided into a PICA and non-PICA group. Clinical, radiological, and treatment-related variables were identified, and their impact on the neurological outcome was determined in terms of modified Rankin score at discharge and at 1 year of follow-up for the two groups. RESULTS Data from 1864 aneurysmal subarachnoid hemorrhage patients were reviewed. There were 264 patients with a ruptured PC aneurysm. Seventy-four PICA aneurysms represented 28% of the series; clinical and radiological characteristics at admission were comparable between the PICA and non-PICA group. Surgical treatment was accomplished in 28% of patients in the PICA group and in the 4.8% of patients in the non-PICA group. No statistically significant difference was found between the two groups in terms of complications after treatment. Hydrocephalus requiring definitive shunt was needed in 21.6% of PICA patients (p = 0.6); cranial nerve deficit was present in average a quarter of the patients in both PICA and non-PICA group with no statistical difference (p = 0.3). A more favorable outcome (66.2%) was reported in the PICA group at discharge (p < 0.05) but this difference faded over time with a similar neurological outcome at 1-year follow-up (p = 0.09) between both PICA and non-PICA group. The Kaplan-Meyer estimation showed no significant difference in the mortality rate between both groups (p = 0.08). CONCLUSIONS In the present study, patients with ruptured PICA aneurysms had a favorable neurological outcome in more than two thirds of cases, similar to patients with other ruptured PC aneurysms. Surgical treatment remains a valid option in a third of cases with ruptured PICA aneurysms.
Collapse
Affiliation(s)
- Daniele Starnoni
- Department of Clinical Neurosciences, Service of Neurosurgery, Lausanne University Hospital (CHUV), 46 rue du Bugnon, 1011, Lausanne, Switzerland
| | - Rodolfo Maduri
- Department of Clinical Neurosciences, Service of Neurosurgery, Lausanne University Hospital (CHUV), 46 rue du Bugnon, 1011, Lausanne, Switzerland.
| | - Khalid Al Taha
- Department of Clinical Neurosciences, Service of Neurosurgery, Lausanne University Hospital (CHUV), 46 rue du Bugnon, 1011, Lausanne, Switzerland
| | - David Bervini
- Department of Neurosurgery, Inselspital, University of Bern, Bern, Switzerland
| | - Daniel Walter Zumofen
- Department of Neurosurgery, Basel University Hospital, Basel, Switzerland
- Diagnostic and Interventional Neuroradiology Section, Department of Radiology, Basel University Hospital, Basel, Switzerland
| | - Martin Nikolaus Stienen
- Department of Neurosurgery, University Hospital of Zurich and Clinical Neurosciences Center, University of Zurich, Zurich, Switzerland
| | - Bawarjan Schatlo
- Department of Neurosurgery, University Hospital Göttingen, Göttingen, Germany
| | - Christian Fung
- Department of Neurosurgery, Medical Center, University of Freiburg, Freiburg, Germany
| | - Thomas Robert
- Department of Neurosurgery, Ospedale Civico di Lugano, Lugano, Switzerland
| | - Martin A Seule
- Department of Neurosurgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Jan-Karl Burkhardt
- Department of Neurosurgery, University Hospital of Zurich and Clinical Neurosciences Center, University of Zurich, Zurich, Switzerland
- Department of Neurosurgery, Baylor Medical Center and College of Medicine, Houston, TX, USA
| | - Nicolai Maldaner
- Department of Neurosurgery, University Hospital of Zurich and Clinical Neurosciences Center, University of Zurich, Zurich, Switzerland
| | | | - Kristine A Blackham
- Diagnostic and Interventional Neuroradiology Section, Department of Radiology, Basel University Hospital, Basel, Switzerland
| | - Serge Marbacher
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Donato D'Alonzo
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Luca Remonda
- Department of Radiology, Division of Diagnostic and Interventional Neuroradiology, Kantonsspital Aarau, Aarau, Switzerland
| | - Paolo Machi
- Department of Radiology, Division of Diagnostic and Interventional Neuroradiology, Geneva University Hospital (HUG), Geneva, Switzerland
| | - Jan Gralla
- Department of Radiology, Division of Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Bern, Switzerland
| | - Philippe Bijlenga
- Department of Neurosurgery, Hopitaux Universitaires Genève, Geneva, Switzerland
| | - Guillaume Saliou
- Department of Radiology, Division of Diagnostic and Interventional Neuroradiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Pierluigi Ballabeni
- Lausanne Institute for Clinical Epidemiology and Biostatistics, University Hospital Lausanne (CHUV), Lausanne, Switzerland
- University of Lausanne (UniL), Lausanne, Switzerland
| | - Marc Levivier
- Department of Clinical Neurosciences, Service of Neurosurgery, Lausanne University Hospital (CHUV), 46 rue du Bugnon, 1011, Lausanne, Switzerland
- University of Lausanne (UniL), Lausanne, Switzerland
| | - Mahmoud Messerer
- Department of Clinical Neurosciences, Service of Neurosurgery, Lausanne University Hospital (CHUV), 46 rue du Bugnon, 1011, Lausanne, Switzerland
- University of Lausanne (UniL), Lausanne, Switzerland
| | - Roy Thomas Daniel
- Department of Clinical Neurosciences, Service of Neurosurgery, Lausanne University Hospital (CHUV), 46 rue du Bugnon, 1011, Lausanne, Switzerland
- University of Lausanne (UniL), Lausanne, Switzerland
| |
Collapse
|
13
|
Chen CC, Cheng CT, Hsieh PC, Chen CT, Wu YM, Chang CH, Yi-Chou Wang A. Effects of Posterior Fossa Decompression in Patients with Hunt and Hess Grade 5 Subarachnoid Hemorrhage After Endovascular Trapping of Ruptured Vertebral Artery Dissecting Aneurysms. World Neurosurg 2018; 119:e792-e800. [DOI: 10.1016/j.wneu.2018.07.269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 07/29/2018] [Accepted: 07/30/2018] [Indexed: 10/28/2022]
|
14
|
Kim J, Chang C, Jung YJ. Coil Embolization Results of the Ruptured Proximal Posteriori Inferior Cerebellar Artery Aneurysm: A Single-Center 10 Years' Experience. World Neurosurg 2018; 117:e645-e652. [PMID: 29945000 DOI: 10.1016/j.wneu.2018.06.105] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 06/12/2018] [Accepted: 06/14/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To report a single-center experience with endovascular treatment of ruptured proximal posterior inferior cerebellar artery (PICA) aneurysms. METHODS Between January 2007 and December 2016, among 1403 patients with aneurysmal subarachnoid hemorrhage, 15 with ruptured proximal PICA aneurysms underwent endovascular embolization at our institution. Aneurysmal obliteration with a single microcatheter was performed in 9 patients. Additional microcatheter or stent-assisted coil embolization was performed in 4 patients and parent artery occlusion in 2 patients. RESULTS Immediate angiographic results showed 10 complete occlusions (66.7%, 10/15). Five patients showed incomplete occlusion (remnant neck in 4 patients, remnant aneurysm in 1). Of those, 2 patients experienced recurrence and required conversion to microsurgical clipping. The remaining 2 patients remained in relatively stable condition. Procedure-related complications occurred in 3 patients (20%, with thromboembolic complications in 2 patients and intraprocedural rupture in 1). Clinical outcome was excellent: Glasgow Outcome Score 4 or 5 in 12 of 15 patients (80%). There was no rebleeding during follow-up. CONCLUSIONS Ruptured proximal PICA aneurysms may be effectively treated with endovascular coil embolization. A variety of coil embolization techniques are required to obliterate an aneurysm without parent artery occlusion. Given that recurrence is possible, follow-up is required. Surgical clipping can be performed for recurrence with a relatively low risk of complications, because the aneurysm is unruptured. Coil embolization of a proximal PICA aneurysm in the acute phase can be a good treatment modality with good patient outcomes.
Collapse
Affiliation(s)
- Jonghoon Kim
- Department of Neurosurgery, Yeungnam University Medical Center and Medical School, Namgu, Daegu, South Korea
| | - Chulhoon Chang
- Department of Neurosurgery, Yeungnam University Medical Center and Medical School, Namgu, Daegu, South Korea
| | - Young Jin Jung
- Department of Neurosurgery, Yeungnam University Medical Center and Medical School, Namgu, Daegu, South Korea.
| |
Collapse
|
15
|
Bhogal P, Chudyk J, Bleise C, Lylyk I, Henkes H, Lylyk P. The use of flow diverters to treat aneurysms of the posterior inferior cerebellar artery: Report of three cases. Interv Neuroradiol 2018; 24:489-498. [PMID: 29807446 DOI: 10.1177/1591019918774877] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective The objective of this study was to report our experience on the use of flow diverting stents placed within the posterior inferior cerebellar artery (PICA) as a treatment option for aneurysms of the PICA. Methods Three patients with aneurysms of the PICA, both ruptured and unruptured, underwent treatment of their aneurysms with placement of a single flow diverter in the PICA across the neck of the aneurysm. Adjunctive techniques such as coiling were not used. We present the angiographic and clinical follow-up data. Results The procedure was a technical success in all cases and there were no intraoperative complications. Follow-up data were available for two patients and this showed complete occlusion of the aneurysm with the PICA remaining patent. There was no evidence, either clinical or radiological, of medullary or pontine infarction. One patient died during the follow-up period from an unrelated medical illness (community acquired pneumonia). Conclusion Flow diverters can be successfully placed within the PICA to treat both ruptured and unruptured aneurysms, and they represent an alternative treatment option to endovascular coiling or microscopic neurosurgery.
Collapse
Affiliation(s)
- Pervinder Bhogal
- 1 Clinic for Neuroradiology, Klinikum Stuttgart, Stuttgart, Germany
| | - Jorge Chudyk
- 2 Neuroradiological clinic, Clinica Sagrada Familia, ENERI, Buenos Aires, Argentina
| | - Carlos Bleise
- 2 Neuroradiological clinic, Clinica Sagrada Familia, ENERI, Buenos Aires, Argentina
| | - Ivan Lylyk
- 2 Neuroradiological clinic, Clinica Sagrada Familia, ENERI, Buenos Aires, Argentina
| | - Hans Henkes
- 1 Clinic for Neuroradiology, Klinikum Stuttgart, Stuttgart, Germany.,3 Faculty of Medicine, University Duisburg-Essen, Essen, Germany
| | - Pedro Lylyk
- 2 Neuroradiological clinic, Clinica Sagrada Familia, ENERI, Buenos Aires, Argentina
| |
Collapse
|
16
|
Srinivasan VM, Ghali MGZ, Reznik OE, Cherian J, Mokin M, Dumont TM, Gaughen JR, Grandhi R, Puri AS, Chen SR, Johnson JN, Kan P. Flow diversion for the treatment of posterior inferior cerebellar artery aneurysms: a novel classification and strategies. J Neurointerv Surg 2017; 10:663-668. [DOI: 10.1136/neurintsurg-2017-013427] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 09/21/2017] [Accepted: 09/25/2017] [Indexed: 11/04/2022]
Abstract
BackgroundThe pipeline embolization device (PED) is frequently used in the treatment of anterior circulation aneurysms, especially around the carotid siphon, with generally excellent results. However, treatment of posterior inferior cerebellar artery (PICA) aneurysms with flow diversion (FD) has not been specifically described or discussed. While there are reports of treating PICA aneurysms using placement of FD stents in the vertebral artery, there are no reports of treating these lesions by placement of flow diverting stents in the PICA vessel itself. Due to the unique anatomy and morphology of these aneurysms, it requires special attention. We assessed our multi-institutional experience treating these lesions, including the first reported cases of the PED placed within the PICA.MethodsInstitutional databases of neuroendovascular procedures were reviewed for cases of intracranial aneurysms treated with the PED. Patient and aneurysm data as well as angiographic imaging were reviewed for all cases of PICA aneurysms treated with the PED. PICA aneurysms were defined as aneurysms that involved the PICA. Vertebral aneurysms without disease in the PICA were excluded from the study.Results10 PICA aneurysms were treated during the study period. These were classified based on their morphology and location into two main types and five total subtypes for consideration of treatment with flow diversion. All aneurysms were successfully treated, with 8/10 completely obliterated and 2 with a partial reduction in size. Three patients had the PED placed entirely in the PICA and no patient suffered from a medullary or cerebellar stroke. All PEDs were patent and all patients were independent at the last follow-up.ConclusionsThe PED may be used successfully to treat select aneurysms of the PICA. We present the first described cases of successful PED treatment of PICA aneurysms with direct placement of the PED in the PICA vessel itself. The proposed classification system aids in that selection.
Collapse
Affiliation(s)
| | | | - Oleg E Reznik
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Jacob Cherian
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Maxim Mokin
- Departments of Neurology and Neurosurgery, University of South Florida, Tampa, Florida, USA
| | - Travis M Dumont
- Division of Neurosurgery, University of Arizona, Tucson, Arizona, USA
| | - John R Gaughen
- Sentara Martha Jefferson Medical and Surgical Associates, Charlottesville, Virginia, USA
| | - Ramesh Grandhi
- Department of Neurosurgery, University of Texas at San Antonio, San Antonio, USA
| | - Ajit S Puri
- Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Stephen R Chen
- Department of Radiology, Baylor College of Medicine, Houston, Texas, USA
| | - Jeremiah N Johnson
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Peter Kan
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| |
Collapse
|
17
|
Mascitelli JR, Yaeger K, Wei D, Kellner CP, Oxley TJ, De Leacy RA, Fifi JT, Patel AB, Naidich TP, Bederson JB, Mocco J. Multimodality Treatment of Posterior Inferior Cerebellar Artery Aneurysms. World Neurosurg 2017; 106:493-503. [DOI: 10.1016/j.wneu.2017.07.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Revised: 07/03/2017] [Accepted: 07/06/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Justin R Mascitelli
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
| | - Kurt Yaeger
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Daniel Wei
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Christopher P Kellner
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Thomas J Oxley
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Reade A De Leacy
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Johanna T Fifi
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Aman B Patel
- Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Thomas P Naidich
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Joshua B Bederson
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - J Mocco
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| |
Collapse
|
18
|
Tjahjadi M, Rezai Jahromi B, Serrone J, Nurminen V, Choque-Velasquez J, Kivisaari R, Lehto H, Niemelä M, Hernesniemi J. Simple Lateral Suboccipital Approach and Modification for Vertebral Artery Aneurysms: A Study of 52 Cases Over 10 Years. World Neurosurg 2017; 108:336-346. [PMID: 28899830 DOI: 10.1016/j.wneu.2017.09.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 08/31/2017] [Accepted: 09/02/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Complex skull base approaches are frequently used to treat intracranial vertebral artery (VA) and proximal posterior inferior cerebellar artery (PICA) aneurysms. These complex procedures are associated with higher risk of neurovascular injury. Hence, a less-invasive surgical approach is needed to improve the efficacy and safety of treatment. METHODS A retrospective analysis was conducted on clinical and radiologic data from surgeries in which simple lateral suboccipital and "lateral-enough" approaches were used to clip VA aneurysms in the Department of Neurosurgery at Helsinki University Central Hospital from 2000 to 2009. RESULTS Fifty-two VA or PICA aneurysms were treated using the simple lateral suboccipital approach. Sixteen patients (31%) presented with an unruptured aneurysm, 21 patients (40%) with World Federation of Neurosurgical Societies (WFNS) grade 1-3, and 15 patients (29%) with World Federation of Neurosurgical Societies grade 4-5. The aneurysms were saccular in 48 cases (92%), dissecting in 3 cases (6%), and fusiform in 1 case (2%). The most common aneurysm location was the VA-PICA junction (81%). The mean final modified Rankin Scale score was 2, and in unruptured cases, all patients had favorable clinical outcomes. The main causes of unfavorable outcome were poor preoperative clinical grade (P = 0.002), preoperative intraventricular hemorrhage (P = 0.008), postoperative hydrocephalus (P = 0.003), brain infarction (P = 0.005), and postoperative pneumonia (P < 0.001). CONCLUSIONS We describe a 10-year experience using a simple lateral suboccipital approach and its modification by the senior author (J.H.) to treat VA and proximal PICA aneurysms. Unfavorable outcome was related to the poor preoperative clinical grade, preoperative intraventricular hemorrhage, and postoperative pneumonia.
Collapse
Affiliation(s)
- Mardjono Tjahjadi
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - Behnam Rezai Jahromi
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Joseph Serrone
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ville Nurminen
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Joham Choque-Velasquez
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Riku Kivisaari
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Hanna Lehto
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Mika Niemelä
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Juha Hernesniemi
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| |
Collapse
|
19
|
Song J, Park JE, Chung J, Lim YC, Shin YS. Treatment strategies of ruptured posterior inferior cerebellar artery aneurysm according to its segment. Surg Neurol Int 2017; 8:155. [PMID: 28808604 PMCID: PMC5535566 DOI: 10.4103/sni.sni_132_16] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Accepted: 03/17/2017] [Indexed: 11/30/2022] Open
Abstract
Background: The aim of this study was to evaluate the clinical outcomes between endovascular treatment (EVT) and surgery of the ruptured posterior inferior cerebellar artery (PICA) aneurysms and suggest proper management strategies according to the PICA segment. Methods: We retrospectively analyzed clinical and radiological data of patients with ruptured PICA aneurysms who underwent surgery or EVT from three different institutes. Clinical outcomes were evaluated by mRS. Results: We collected 39 consecutive patients with 39 ruptured PICA aneurysms; 26 patients were with proximal segment aneurysm and 13 patients were with distal. Of the 26 proximal PICA aneurysms, 20 aneurysms were treated with EVT and 6 aneurysms were treated with surgery. EVT seemed to have more favorable clinical outcome (mRS 0–2; mean mRS, 1.75 for EVT vs 3.50 for surgery, P = 0.152). Of the 13 distal PICA aneurysms, 7 aneurysms were treated with EVT and 6 were treated with surgery. Surgery showed more favorable clinical outcome (mean mRS, 2.63 for EVT vs 0.33 for surgery, P = 0.023) and lower procedure-related complication rate (42.9% for EVT vs 0% for surgery, P = 0.046) than EVT. Conclusions: For the treatment of ruptured PICA aneurysms, EVT seemed to have more favorable outcomes for proximal segment, while surgery showed more favorable outcomes for distal segment. Additional experience and follow-up are needed in a larger series to state the efficacy of this strategy.
Collapse
Affiliation(s)
- Jihye Song
- Department of Neurosurgery, Konyang College of Medicine, Konyang University Hospital, Daejeon, Republic of Korea
| | - Jung Eon Park
- Department of Neurosurgery, Hankook Hospital, Cheongju, Republic of Korea
| | - Joonho Chung
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yong Chul Lim
- Department of Neurosurgery, The Ajou University School of Medicine, Ajou University Hospital, Suwon, Republic of Korea
| | - Yong Sam Shin
- Department of Neurosurgery, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| |
Collapse
|
20
|
Seoane P, Kalb S, Clark JC, Rivas JC, Xu DS, Mendes GAC, Preul MC, Zabramski JM, Spetzler RF, Nakaji P. Far-Lateral Approach Without Drilling the Occipital Condyle for Vertebral Artery–Posterior Inferior Cerebellar Artery Aneurysms. Neurosurgery 2017; 81:268-274. [DOI: 10.1093/neuros/nyw136] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 12/15/2016] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND: The far-lateral transcondylar surgical approach is often used to clip vertebral artery (VA) and posterior inferior cerebellar artery (PICA) aneurysms. The role of condyle resection during this approach is controversial.
OBJECTIVE: To evaluate patient outcomes in patients with VA–PICA aneurysms in whom drilling the occipital condyle was not necessary.
METHODS: Between May 2005 and December 2012, a total of 56 consecutive patients with incidental or ruptured VA–PICA aneurysms underwent surgery with a far-lateral approach without condylar resection. Clinical presentation, surgical reports, presurgery and postsurgery radiological examinations, and clinical follow-up reports were assessed. Anatomic aneurysm location was analyzed through angiography or computed tomography angiography. We compared postsurgical Glasgow Outcome Scale scores, modified Rankin Scale scores, and morbidity in 2 groups: those with aneurysms in the anterior medullary segment and those with aneurysms in the lateral medullary segment.
RESULTS: The predominant presentation was subarachnoid hemorrhage in 34 patients (60.7%). Most aneurysms (n = 27 [48.2%]) were located in the lateral medullary segment of the PICA, followed by the anterior medullary segment (n = 25 [44.6%]). Total aneurysm occlusion was achieved in 100% of patients, and bypass techniques were necessary in 3 patients (5.4%). Fifty-two patients (92.8%) had Glasgow Outcome Scale scores of 4 or 5 postsurgery.
CONCLUSIONS: A far-lateral approach that leaves the occipital condyle intact is adequate for treating most patients with VA–PICA aneurysms.
Collapse
Affiliation(s)
- Pablo Seoane
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hos-pital and Medical Center, Phoenix, Arizona
| | - Samuel Kalb
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hos-pital and Medical Center, Phoenix, Arizona
| | - Justin C. Clark
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hos-pital and Medical Center, Phoenix, Arizona
| | - Juan C. Rivas
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hos-pital and Medical Center, Phoenix, Arizona
| | - David S. Xu
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hos-pital and Medical Center, Phoenix, Arizona
| | - George A. C. Mendes
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hos-pital and Medical Center, Phoenix, Arizona
| | - Mark C. Preul
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hos-pital and Medical Center, Phoenix, Arizona
| | - Joseph M. Zabramski
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hos-pital and Medical Center, Phoenix, Arizona
| | - Robert F. Spetzler
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hos-pital and Medical Center, Phoenix, Arizona
| | - Peter Nakaji
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hos-pital and Medical Center, Phoenix, Arizona
| |
Collapse
|
21
|
Cho KC, Kim YB, Suh SH, Joo JY, Hong CK. Multidisciplinary management for the treatment of proximal posterior inferior cerebellar artery aneurysms. Neurol Res 2017; 39:403-413. [DOI: 10.1080/01616412.2017.1298691] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Kwang-Chun Cho
- Department of Neurosurgery, College of Medicine, Yonsei University, Gangnam Severance Hospital, Seoul, South Korea
| | - Yong Bae Kim
- Department of Neurosurgery, College of Medicine, Yonsei University, Gangnam Severance Hospital, Seoul, South Korea
| | - Sang Hyun Suh
- Department of Radiology, College of Medicine, Yonsei University, Gangnam Severance Hospital, Seoul, South Korea
| | - Jin Yang Joo
- Department of Neurosurgery, College of Medicine, Yonsei University, Gangnam Severance Hospital, Seoul, South Korea
| | - Chang-Ki Hong
- Department of Neurosurgery, College of Medicine, Yonsei University, Gangnam Severance Hospital, Seoul, South Korea
| |
Collapse
|
22
|
Safety and efficacy of treatment strategies for posterior inferior cerebellar artery aneurysms: a systematic review and meta-analysis. Acta Neurochir (Wien) 2016; 158:2415-2428. [PMID: 27718027 DOI: 10.1007/s00701-016-2965-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 09/12/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION We conducted a systematic review of the literature to evaluate the safety and efficacy of treatment strategies for PICA aneurysms. METHODS A systematic search of Medline, EMBASE, Scopus, and Web of Science was done for studies published through November 2015. We included studies that described treatment of PICA aneurysms with ≥10 patients. Random-effects meta-analysis was used to pool the following outcomes: complete occlusion, technical success, periprocedural morbidity/mortality, stroke rates, aneurysm recurrence/rebleed, CN palsies rates, and long-term neurological morbidity/mortality. RESULTS We included 29 studies with 796 PICA aneurysms. When considering all ruptured PICA aneurysms, complete occlusion rates were 97.1 % (95 % CI = 94.5-99.0 %) in the surgical group and 84.3 % (95 % CI = 73.8-92.6 %) in the endovascular group. Aneurysm recurrence occurred in 1.4 % (95 % CI = 0.3-3.3 %) after surgery and in 6.9 % (95 % CI = 3.6-10.9 %) after endovascular treatment. Overall neurological morbidity and mortality were 14.4 % (95 % CI = 8.7-21.2 %) and 9.8 % (95 % CI = 5.8-14.8 %) after surgery and 15.1 % (95 % CI = 10.5-20.2 %) and 17.1 % (95 % CI = 11.5-23.7 %) after endovascular treatment, respectively. When considering all unruptured PICA aneurysms, complete occlusion rates were 92.9 % (95 % CI = 79.5-100 %) in the surgical group and 75.7 % (95 % CI = 45.4-97.1 %) in the endovascular group. Overall long-term good neurological outcome rates were 91.5 % (95 % CI = 74.4-100 %) in the surgical series and 93.3 % (95 % CI = 82.7-99.5 %) in the endovascular group. CONCLUSIONS Our meta-analysis demonstrated that both treatment modalities are technically feasible with high rates of technical success and effective with sufficient long-term aneurysm occlusion rates. Our data suggest that surgery is associated with superior angiographic outcomes. While endovascular therapy could be a reasonable first-line treatment option for proximal PICA aneurysms, surgery remains a highly effective first-line choice for distal PICA aneurysms. These findings should be considered when deciding the best therapeutic strategy.
Collapse
|
23
|
Xu F, Hong Y, Zheng Y, Xu Q, Leng B. Endovascular treatment of posterior inferior cerebellar artery aneurysms: a 7-year single-center experience. J Neurointerv Surg 2016; 9:45-51. [DOI: 10.1136/neurintsurg-2016-012489] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Revised: 05/30/2016] [Accepted: 06/01/2016] [Indexed: 11/03/2022]
Abstract
AimTo report our experience with endovascular treatment of posterior inferior cerebellar artery (PICA) aneurysms.MethodsBetween January 2007 and December 2014, 40 patients with 42 PICA aneurysms were treated with endovascular embolization at our institution. Twenty-eight patients had 29 saccular aneurysms and 12 patients had 13 fusiform/dissecting aneurysms. The endovascular modalities were: (1) selective occlusion of the aneurysm with or without stent assistance (n=19); (2) occlusion of the aneurysm and the parent artery (n=22); and (3) occlusion of the aneurysm including the vertebral artery and PICA origin (n=1). Specifically, selective embolization was performed in 93.3% of aneurysms (14/15) proximal to the telovelotonsillary segment.ResultsImmediate angiographic results included 31 complete occlusions (74%), 3 nearly complete occlusions (7%), and 8 incomplete occlusions (19%). Mean follow-up of 20 months in 31 aneurysms showed 27 stable results, 3 further thromoboses, and 1 recurrence. Final results included 27 complete occlusions (87.1%) and 4 incomplete occlusions (12.9%). There were 5 overall procedural-related complications (12.5%), including 1 infarction (2.5%) and 4 intraprocedural ruptures (10.0%). Procedure-related morbidity and morbidity was 5.0% (2/40) and 2.5% (1/40), respectively. Clinical outcome was excellent (Glasgow Outcome Scale 5 in 31 of 33 patients at long-term follow-up).ConclusionsPICA aneurysms may be effectively treated by different endovascular approaches with favorable clinical and radiologic outcomes. Further studies are required to compare the safety and efficacy of endovascular treatment with open surgery.
Collapse
|
24
|
Wang WH, Wang YH, Zheng LL, Li XW, Hao F, Guo D. MicroRNA-29a: A potential biomarker in the development of intracranial aneurysm. J Neurol Sci 2016; 364:84-9. [PMID: 27084222 DOI: 10.1016/j.jns.2016.03.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 02/23/2016] [Accepted: 03/03/2016] [Indexed: 12/01/2022]
Abstract
AIM To identify serum microRNA-29a (miR-29a) level in patients with intracranial aneurysm and its role in the development of intracranial aneurysm (IA). METHODS Case group included 165 IA patients hospitalized in the department of neurosurgery between January 2010 and January 2012 while control group enrolled 220 healthy volunteers. Morning fasting blood samples were collected from peripheral vein. RT-PCR was used for miR-29a detection. Receiver Operating Characteristic (ROC) curve was drawn. Survival curves were drawn for survival analysis with Kaplan-Meier method and Long-rank test was conducted. MiR-29a expression Glasgow Prognosis Score (GOS) was used for prognosis scaling. Multivariate Cox proportional hazards regression analysis was performed for prognosis analysis. Results Cases had significantly higher miR-29a expressions than controls (P<0.05). ROC curve analysis indicated that miR-29a expression in IA had high effectiveness in IA diagnosis. Close associations were identified between miR-29a expression and rupture, Hunt-Hess level and surgical timing (all P<0.05). GOS strongly associated with history of hypertension, aneurysm location, rupture, Hunt-Hess level and miR-29a expression. Patients with low miR-29a expression had longer disease-free survival (DFS) and overall survival (OS) than those with high miR-29a expression (both P<0.05). MiR-29a expression, tumor aneurysm, rupture and Hunt-Hess were risk factors to the prognosis of IA (all P<0.05). CONCLUSION MiR-29a may be closely related to IA development and therefore could be a useful predicator of IA prognosis, providing a new target for IA therapy.
Collapse
Affiliation(s)
- Wei-Hua Wang
- Central Laboratory, Liaocheng People's Hospital, Liaocheng Clinical School of Taishan Medical University, Liaocheng 252000, PR China
| | - Yun-Hua Wang
- Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng Clinical School of Taishan Medical University, Liaocheng 252000, PR China
| | - Li-Li Zheng
- Central Laboratory, Liaocheng People's Hospital, Liaocheng Clinical School of Taishan Medical University, Liaocheng 252000, PR China
| | - Xiao-Wan Li
- Department of Neurology, Liaocheng People's Hospital, Liaocheng Clinical School of Taishan Medical University, Liaocheng 252000, PR China
| | - Fang Hao
- Department of Neurology, Liaocheng People's Hospital, Liaocheng Clinical School of Taishan Medical University, Liaocheng 252000, PR China.
| | - Dong Guo
- Department of Neurology, Liaocheng People's Hospital, Liaocheng Clinical School of Taishan Medical University, Liaocheng 252000, PR China.
| |
Collapse
|
25
|
Juszkat R, Kram P, Stanisławska K, Jankowski R, Stachowska-Tomczak B, Nowak S, Liebert W. Ten years of experience in endovascular treatment of ruptured aneurysms of the posterior inferior cerebellar artery. Interv Neuroradiol 2016; 22:129-37. [PMID: 26825074 DOI: 10.1177/1591019915622164] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Accepted: 10/29/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The aim of this study is to present our 10 years of experience in endovascular treatment of ruptured posterior inferior cerebellar artery (PICA) saccular aneurysms and to compare clinical presentation and outcome after endovascular treatment between patients with PICA aneurysms and patients with aneurysms in different locations. METHODS AND FINDINGS Out of 932 patients with a ruptured intracranial aneurysm treated endovascularly in our institution, 38 aneurysms were located at the posterior inferior cerebellar artery. Clinical presentation, mean aneurysm diameter and outcome of the therapy in this group were compared with the same for ruptured aneurysms in other locations. Patients discharged with favourable outcomes were checked angiographically in the follow-up period. Thirty-four patients with ruptured PICA aneurysms were treated by selective endovascular coiling. Two patients with wide-necked aneurysms had endovascular stents implanted. In two cases, the parent vessel was occluded due to failure to catheterise the target aneurysm. The evaluated variables did not differ significantly between two groups, but significantly more ruptured aneurysms in the PICA group were under 6 mm in diameter. 29.4% of controlled aneurysms needed additional reembolisation in the follow-up period. CONCLUSIONS Clinical presentation, extension of subarachnoid haemorrhage and outcome after endovascular treatment did not differ significantly between patients with ruptured aneurysms located on the PICA and patients with aneurysms located elsewhere intracranially. Endovascular treatment is an effective method of therapy in patients with ruptured PICA aneurysms. In our experience, even when sacrificing of the PICA is required, the results of treatment are favourable.
Collapse
Affiliation(s)
- Robert Juszkat
- Department of General and Interventional Radiology, Poznan University of Medical Sciences, Poland
| | - Paweł Kram
- Department of General and Interventional Radiology, Poznan University of Medical Sciences, Poland
| | - Katarzyna Stanisławska
- Department of General and Interventional Radiology, Poznan University of Medical Sciences, Poland
| | - Roman Jankowski
- Department of Neurosurgery and Neurotraumatology, Poznan University of Medical Sciences, Poland
| | | | - Stanisław Nowak
- Department of Neurosurgery and Neurotraumatology, Poznan University of Medical Sciences, Poland
| | - Włodzimierz Liebert
- Department of Neurosurgery and Neurotraumatology, Poznan University of Medical Sciences, Poland
| |
Collapse
|
26
|
Samaniego EA, Abdo G, Hanel RA, Lima A, Ortega-Gutierrez S, Dabus G. Endovascular treatment of PICA aneurysms with a Low-profile Visualized Intraluminal Support (LVIS Jr) device. J Neurointerv Surg 2015; 8:1030-3. [PMID: 26534868 DOI: 10.1136/neurintsurg-2015-012070] [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: 09/14/2015] [Accepted: 10/12/2015] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To describe the treatment of posterior inferior cerebellar artery (PICA) aneurysms with the Low-profile Visualized Intraluminal Support Device (LVIS Jr) stent. MATERIALS AND METHODS The databases of three institutions were retrospectively reviewed. Patients who underwent endovascular treatment of PICA aneurysms using a reconstructive technique where the LVIS Jr stent was totally or partially deployed into the PICA were included in the analysis. Clinical presentation, aneurysm and PICA sizes, procedural complications, and clinical and angiographic follow-up information was recorded and analyzed. RESULTS Seven patients who underwent endovascular treatment of PICA aneurysms with an LVIS Jr stent were identified. Four aneurysms were treated in the acute phase of subarachnoid hemorrhage (SAH). There were no symptomatic complications. One patient had spasm distal to the stent as a result of mechanical straightening of the vessel. One patient was treated in the acute phase of SAH and required a gycoprotein IIb/IIIa inhibitor after the stent was implanted. This patient needed to be re-treated to complete embolization. All patients had good clinical outcomes (Glasgow Outcome Scale 5). No in-stent stenosis or occlusion was seen on short-term angiographic follow-up and the aneurysms were occluded. CONCLUSIONS This small series suggests that the use of a reconstructive technique with the LVIS Jr stent for the treatment of PICA aneurysms is feasible, safe and effective in the short term.
Collapse
Affiliation(s)
- Edgar A Samaniego
- Division of Interventional Neuroradiology/Endovascular Neurosurgery, Department of Neurology, Neurosurgery and Radiology, University of Iowa, Iowa City, USA Departamento de Neuroradiologia Intervencionista, Hospital Eugenio Espejo, Quito, Ecuador
| | - German Abdo
- Departamento de Neuroradiologia Intervencionista, Hospital Eugenio Espejo, Quito, Ecuador
| | | | - Andrey Lima
- Baptist Neurological Institute, Jacksonville, Florida, USA
| | - Santiago Ortega-Gutierrez
- Division of Interventional Neuroradiology/Endovascular Neurosurgery, Department of Neurology, Neurosurgery and Radiology, University of Iowa, Iowa City, USA
| | - Guilherme Dabus
- Department of NeuroInterventional Surgery, Miami Cardiac & Vascular Institute and Baptist Neuroscience Center, Miami, Florida, USA
| |
Collapse
|
27
|
Williamson RW, Wilson DA, Abla AA, McDougall CG, Nakaji P, Albuquerque FC, Spetzler RF. Clinical characteristics and long-term outcomes in patients with ruptured posterior inferior cerebellar artery aneurysms: a comparative analysis. J Neurosurg 2015; 123:441-5. [DOI: 10.3171/2014.10.jns141079] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT
Subarachnoid hemorrhage (SAH) from ruptured posterior inferior cerebellar artery (PICA) aneurysms is uncommon, and long-term outcome data for patients who have suffered such hemorrhages is lacking. This study investigated in-hospital and long-term clinical data from a prospective cohort of patients with SAH from ruptured PICA aneurysms enrolled in a randomized trial; their outcomes were compared with those of SAH patients who were treated for other types of ruptured intracranial aneurysms. The authors hypothesize that PICA patients fare worse than those with aneurysms in other locations and this difference is related to the high rate of lower cranial nerve dysfunction in PICA patients.
METHODS
The authors analyzed data for 472 patients enrolled in the Barrow Ruptured Aneurysm Trial (BRAT) and retrospectively reviewed vasospasm data not collected prospectively. In the initial cohort, 57 patients were considered angiographically negative for aneurysmal SAH source and did not receive treatment for aneurysms, leaving 415 patients with aneurysmal SAH.
RESULTS
Of 415 patients with aneurysmal SAH, 22 (5.3%) harbored a ruptured PICA aneurysm. Eight of them had dissecting/fusiform-type aneurysms while 14 had saccular-type aneurysms. Nineteen PICA patients were treated with clipping (1 crossover from coiling), 2 were treated with coiling, and 1 died before treatment. When comparing PICA patients to all other aneurysm patients in the study cohort, there were no statistically significant differences in age (mean 57.6 ± 11.8 vs 53.9 ± 11.8 years, p = 0.17), Hunt and Hess grade median III [IQR II–IV] vs III [IQR II–III], p = 0.15), Fisher grade median 3 [IQR 3–3] vs 3 [IQR 3–3], p = 0.53), aneurysm size (mean 6.2 ± 3.0 vs 6.7 ± 4.0 mm, p = 0.55), radiographic vasospasm (53% vs 50%, p = 0.88), or clinical vasospasm (12% vs 23%, p = 0.38). PICA patients were more likely to have a fusiform aneurysm (36% vs 12%, p = 0.004) and had a higher incidence of lower cranial nerve dysfunction and higher rate of tracheostomy/percutaneous endoscopic gastrostomy placement compared with non-PICA patients (50% vs 16%, p < 0.001). PICA patients had a significantly higher incidence of poor outcome at discharge (91% vs 67%, p = 0.017), 1-year follow-up (63% vs 29%, p = 0.002), and 3-year follow-up (63% vs 32%, p = 0.006).
CONCLUSIONS
Patients with ruptured PICA aneurysms had a similar rate of radiographic vasospasm, equivalent admission Fisher grade and Hunt and Hess scores, but poorer clinical outcomes at discharge and at 1- and 3-year follow-up when compared with the rest of the BRAT SAH patients with ruptured aneurysms. The PICA's location at the medulla and the resultant high rate of lower cranial nerve dysfunction may play a role in the poor outcome for these patients. Furthermore, PICA aneurysms were more likely to be fusiform than saccular, compared with non-PICA aneurysms; the complex nature of these aneurysms may also contribute to their poorer outcome.
Collapse
|
28
|
Chen JX, Lai LF, Zheng K, Li GX, He XY, Li LP, Duan CZ. Influencing factors of immediate angiographic results in intracranial aneurysms patients after endovascular treatment. J Neurol 2015; 262:2115-23. [PMID: 26100332 DOI: 10.1007/s00415-015-7824-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Revised: 06/10/2015] [Accepted: 06/11/2015] [Indexed: 11/29/2022]
Abstract
The purpose of this study was to analyze influencing factors associated with immediate angiographic results in intracranial aneurysms patients after endovascular treatment (EVT), providing theoretical evidence and guidance for clinical treatment of intracranial aneurysms. Totally 529 patients met the inclusive criteria, consisting of 338 males and 191 females. Gender; age; history of hypertension, diabetes, and smoking; intracranial atherosclerosis; rupture status, size and location, features of aneurysmal neck, shapes; vasospasm; treatment modality; and degree of aneurysm occlusion were all carefully and completely recorded. All data were investigated in univariate and multivariate logistic regression model to determine whether they were correlated with the degree of aneurysm occlusion. According to aneurysm size, aneurysms were classified as micro-miniature, miniature, and large aneurysms. There were 451 narrow-neck aneurysms and 78 wide-neck aneurysms. Totally 417 were regular and 112 were irregular. And 125 were un-ruptured aneurysms; 404 were ruptured aneurysms. The modalities of treatment were as follows: embolization with coil (n = 415), stent-assisted coil embolization (n = 89), and balloon-assisted coil embolization (n = 25). Univariate analysis showed that aneurysm size, feature of aneurysm neck, shape, and rupture status might affect the immediate occlusion after EVT. Multivariate logistic regression analysis indicated that ruptured aneurysm, tiny aneurysm, and wide-neck aneurysm were independent influencing factors of complete occlusion of intracranial aneurysm. Aneurysm rupture status, size, feature of aneurysmal neck, and shape might be the independent influencing factors of immediate angiographic results in intracranial aneurysm patients after EVT. Un-ruptured, micro-miniature, narrow-neck, and regular-shaped aneurysms were more probable to be occluded completely.
Collapse
Affiliation(s)
- Jia-Xiang Chen
- Department of Neurosurgery, Guangzhou Red Cross Hospital, The Fourth Affiliated Hospital of Jinan University, Guangzhou, People's Republic of China
- Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, No. 253, Industrial Avenue, Haizhu District, Guangzhou, 510282, People's Republic of China
- Key Laboratory on Brain Function Repair and Regeneration of Guangdong, Institute of Neurosurgery, Southern Medical University, Guangzhou, 510200, Guangdong, People's Republic of China
| | - Ling-Feng Lai
- Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, No. 253, Industrial Avenue, Haizhu District, Guangzhou, 510282, People's Republic of China
- Key Laboratory on Brain Function Repair and Regeneration of Guangdong, Institute of Neurosurgery, Southern Medical University, Guangzhou, 510200, Guangdong, People's Republic of China
| | - Kuang Zheng
- Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, No. 253, Industrial Avenue, Haizhu District, Guangzhou, 510282, People's Republic of China
- Key Laboratory on Brain Function Repair and Regeneration of Guangdong, Institute of Neurosurgery, Southern Medical University, Guangzhou, 510200, Guangdong, People's Republic of China
| | - Guo-Xiong Li
- Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, No. 253, Industrial Avenue, Haizhu District, Guangzhou, 510282, People's Republic of China
- Key Laboratory on Brain Function Repair and Regeneration of Guangdong, Institute of Neurosurgery, Southern Medical University, Guangzhou, 510200, Guangdong, People's Republic of China
| | - Xu-Ying He
- Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, No. 253, Industrial Avenue, Haizhu District, Guangzhou, 510282, People's Republic of China
- Key Laboratory on Brain Function Repair and Regeneration of Guangdong, Institute of Neurosurgery, Southern Medical University, Guangzhou, 510200, Guangdong, People's Republic of China
| | - Liang-Ping Li
- Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, No. 253, Industrial Avenue, Haizhu District, Guangzhou, 510282, People's Republic of China
- Key Laboratory on Brain Function Repair and Regeneration of Guangdong, Institute of Neurosurgery, Southern Medical University, Guangzhou, 510200, Guangdong, People's Republic of China
| | - Chuan-Zhi Duan
- Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, No. 253, Industrial Avenue, Haizhu District, Guangzhou, 510282, People's Republic of China.
- Key Laboratory on Brain Function Repair and Regeneration of Guangdong, Institute of Neurosurgery, Southern Medical University, Guangzhou, 510200, Guangdong, People's Republic of China.
| |
Collapse
|
29
|
Polifka AJ, Tjoumakaris SI, Jabbour P, Rosenwasser RH. Endovascular Treatment of Posterior Inferior Cerebellar Artery Aneurysms. World Neurosurg 2015; 83:730-1. [DOI: 10.1016/j.wneu.2015.01.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 01/27/2015] [Indexed: 10/24/2022]
|
30
|
Lehto H, Niemelä M, Kivisaari R, Laakso A, Jahromi BR, Hijazy F, Andrade-Barazarte H, Dashti R, Hernesniemi J. Intracranial Vertebral Artery Aneurysms: Clinical Features and Outcome of 190 Patients. World Neurosurg 2015; 84:380-9. [PMID: 25828051 DOI: 10.1016/j.wneu.2015.03.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Revised: 03/17/2015] [Accepted: 03/18/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Vertebral artery (VA) aneurysms comprise approximately one-third of posterior circulation aneurysms. They are morphologically variable, and located critically close to the cranial nerves and the brainstem. We aim to represent the characteristics of these aneurysms and their treatment, and to analyze the outcome. METHODS We reviewed retrospectively 9709 patients with intracranial aneurysms. Of these, we included 190 with aneurysms at the VA or VA-posterior inferior cerebellar artery junction. These patients were treated in the Department of Neurosurgery, Helsinki, Finland, between 1934 and 2011. RESULTS The 190 patients had 193 VA aneurysms, among which 131 (68%) were ruptured. The VA aneurysm caused a mass effect in 7 and ischemia in 2 patients. Compared to 4387 patients with a ruptured aneurysm in other locations, those with a VA aneurysm were older, their aneurysms were more often fusiform, and more often caused intraventricular hemorrhages. Among surgically treated aneurysms, clipping was the treatment in 91 (88%) saccular and 11 (50%) fusiform aneurysms. Treatment was endovascular in 13 (9%), and multimodal in 6 (4%) aneurysms. Within a year after aneurysm diagnosis, 53 (28%) patients died. Among the survivors, 104 (93%) returned to an independent or to their previous state of life; only 2 (2%) were unable to return home. CONCLUSIONS Microsurgery is a feasible treatment for VA aneurysms, although cranial nerve deficits are more common than in endovascular surgery. Despite the challenge of an often severe hemorrhage, of challenging morphology, and risk for laryngeal palsy, most patients surviving the initial stage return to normalcy.
Collapse
Affiliation(s)
- Hanna Lehto
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland.
| | - Mika Niemelä
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Riku Kivisaari
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Aki Laakso
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Behnam Rezai Jahromi
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Ferzat Hijazy
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | | | - Reza Dashti
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Juha Hernesniemi
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| |
Collapse
|
31
|
Lehto H, Kivisaari R, Niemelä M, Dashti R, Elsharkawy A, Harati A, Satopää J, Koroknay-Pál P, Laakso A, Hernesniemi J. Seventy Aneurysms of the Posterior Inferior Cerebellar Artery: Anatomical Features and Value of Computed Tomography Angiography in Microneurosurgery. World Neurosurg 2014; 82:1106-12. [DOI: 10.1016/j.wneu.2014.03.035] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 12/03/2013] [Accepted: 03/15/2014] [Indexed: 11/30/2022]
|
32
|
Chwajol M, Hage ZA, Amin-Hanjani S, Charbel FT. Extracranial aneurysms of the distal posterior inferior cerebellar artery: Resection and primary reanastomosis as the preferred management approach. Surg Neurol Int 2014; 4:150. [PMID: 24381793 PMCID: PMC3872649 DOI: 10.4103/2152-7806.122005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 10/21/2013] [Indexed: 11/24/2022] Open
Abstract
Background: Extracranial aneurysms of the posterior inferior cerebellar artery (PICA) are rare, with only 22 reported cases in the English literature. For saccular extracranial distal PICA aneurysms not amenable to coiling, a surgically placed clip is not protected by the cranium postoperatively, and can be subject to movement in the mobile cervical region. Furthermore, fusiform or complex aneurysms cannot be clipped primarily. Resection and primary reanastomosis is a useful surgical approach not previously described for these extracranial lesions. Case Description: We report three cases of extracranially located distal PICA aneurysms successfully treated with this surgical strategy at our center. One patient harboring a broad necked saccular aneurysm originally underwent successful primary clipping of the aneurysm but sustained a second subarachnoid hemorrhage (SAH) on postoperative day 25 due to clip dislodgement from vigorous neck movement. The other two patients were found to have fusiform and complex aneurysms, respectively. All three patients were ultimately treated with resection and end-to-end PICA anastomosis, which successfully obliterated their aneurysms. Conclusions: Resection and primary reanastomosis of extracranial distal PICA aneurysms averts the risk of clip dislodgement due to neck movement and/or compression by soft tissues in the upper cervical region. It is a safe and efficacious technique, which we propose as the preferred management strategy for these rare vascular lesions.
Collapse
Affiliation(s)
- Markus Chwajol
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, 60612, USA
| | - Ziad A Hage
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, 60612, USA
| | - Sepideh Amin-Hanjani
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, 60612, USA
| | - Fady T Charbel
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, 60612, USA
| |
Collapse
|
33
|
Chalouhi N, Jabbour P, Starke RM, Tjoumakaris SI, Gonzalez LF, Witte S, Rosenwasser RH, Dumont AS. Endovascular treatment of proximal and distal posterior inferior cerebellar artery aneurysms. J Neurosurg 2013; 118:991-9. [PMID: 23350778 DOI: 10.3171/2012.12.jns121240] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Surgical clipping of posterior inferior cerebellar artery (PICA) aneurysms can be challenging and carries a potentially significant risk of morbidity and mortality. Experience with endovascular therapy has been limited to a few studies. The authors assess the feasibility, safety, and efficacy of endovascular therapy in the largest series of proximal and distal PICA aneurysms to date.
Methods
A total of 76 patients, 54 with proximal and 22 with distal PICA aneurysms, underwent endovascular treatment at Jefferson Hospital for Neuroscience between 2001 and 2011.
Results
Endovascular treatment was successful in 52 patients (96.3%) with proximal aneurysms and 19 patients (86.4%) with distal aneurysms. Treatment consisted of selective aneurysm coiling in 60 patients (84.5%) (including 4 with stent assistance and 4 with balloon assistance) and parent vessel trapping in 11 patients (15.5%). Specifically, a deconstructive procedure was necessary in 9.6% of proximal aneurysms (5 of 52) and 31.6% of distal aneurysms (6 of 19). There were 9 overall procedural complications (12.7%), 6 infarcts (8.5%; 4 occurring after deliberate occlusion of the PICA), and 3 intraprocedural ruptures (4.2%). The rate of procedure-related permanent morbidity was 2.8%. Complete aneurysm occlusion was achieved in 63.4% of patients (45 of 71). One patient (1.4%) treated with selective aneurysm coiling suffered a rehemorrhage on postoperative Day 15. The mean angiographic follow-up time was 17.2 months. Recurrence and re-treatment rates were, respectively, 20% and 17.1% for proximal aneurysms compared with 30.8% and 23.1% for distal aneurysms. Favorable outcomes (moderate, mild, or no disability) at follow-up were seen in 93% of patients with unruptured aneurysms and in 78.7% of those with ruptured aneurysms.
Conclusions
Endovascular therapy is a feasible, safe, and effective treatment in patients with proximal and distal PICA aneurysms, providing excellent patient outcomes and adequate protection against rehemorrhage. The long-term incidence of aneurysm recanalization appears to be high, especially in distal aneurysms, and requires careful angiographic follow-up.
Collapse
Affiliation(s)
- Nohra Chalouhi
- 1Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania; and
| | - Pascal Jabbour
- 1Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania; and
| | - Robert M. Starke
- 1Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania; and
- 2Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Stavropoula I. Tjoumakaris
- 1Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania; and
| | - L. Fernando Gonzalez
- 1Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania; and
| | - Samantha Witte
- 1Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania; and
| | - Robert H. Rosenwasser
- 1Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania; and
| | - Aaron S. Dumont
- 1Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania; and
| |
Collapse
|
34
|
Bacigaluppi S, Bergui M, Crobeddu E, Garbossa D, Ducati A, Fontanella M. Aneurysms of the medullary segments of the posterior-inferior cerebellar artery: considerations on treatment strategy and clinical outcome. Neurol Sci 2012; 34:529-36. [DOI: 10.1007/s10072-012-1095-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2012] [Accepted: 04/11/2012] [Indexed: 11/28/2022]
|
35
|
Zhang P, Liu J, Xu K, Shi Q, Wang Y. Investigation of the endovascularly treated and untreated unruptured vertebrobasilar artery aneurysms. Eur J Radiol 2012; 81:2741-5. [PMID: 22209632 DOI: 10.1016/j.ejrad.2011.11.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Revised: 11/13/2011] [Accepted: 11/15/2011] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE The present study aimed to investigate the endovascular indication with close monitoring of both endovascularly treated and untreated unruptured vertebrobasilar aneurysms. MATERIALS AND METHODS In the past 2 years, 36 patients [7 women and 29 men with a mean age of 48.5 years (range, 13-75 years)] who had 40 unruptured vertebrobasilar artery aneurysms were reviewed. The decision of the endovascular treatment was not randomized. In both endovascularly untreated and treated patients, overall mortality and morbidity corresponding to Glasgow outcome scale (GOS) score III or worse was counted as unruptured aneurysm related event. The ratio of event free was compared between endovascularly treated and untreated patients using Log-rank test. In a univariate analysis, poor outcome was predicted by endovascularly untreated. RESULTS Thirty-six patients were followed with a mean period of 10.7 months (range, 0.7 months-21 months). In untreated cases, new neurological deficits caused by the aneurysm were noted in 2 cases. The annual deterioration rate of the untreated cases was 9.1%. In endovascularly treated cases, there was no mortality and morbidity. There was no SAH in all cases during follow-up period. When ratio of event free was compared, significant advantage of endovascular treatment was noted (X(2)=4.429, P=0.035). CONCLUSIONS The present results indicated that endovascular treatment has a benefit for the unruptured vertebrobasilar artery aneurysms.
Collapse
Affiliation(s)
- Peizhuo Zhang
- Neurosurgery Department, The First Affiliated Hospital of China Medical University, Shenyang, China.
| | | | | | | | | |
Collapse
|
36
|
Kang MS, Kim JH, Kang HI, Moon BG, Lee SJ, Kim JS. Risk Factors Affecting Clinical Outcome of Ruptured Vertebrobasilar Saccular Aneurysms. J Cerebrovasc Endovasc Neurosurg 2012; 14:175-80. [PMID: 23210044 PMCID: PMC3491211 DOI: 10.7461/jcen.2012.14.3.175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Revised: 08/23/2012] [Accepted: 09/04/2012] [Indexed: 11/23/2022] Open
Abstract
Objective Ruptured vertebrobasilar (VB) saccular aneurysm is a difficult lesion to treat, and is associated with high rates of morbidity and mortality. The aim of this study is to investigate the risk factors associated with the clinical outcome of ruptured VB aneurysms. Methods A retrospective review of 29 patients with ruptured VB saccular aneurysms between 2002 and 2010 was conducted between Jan 2002 and Dec 2010. Univariate and multivariate analyses were performed for determination of the statistical significance of the Glasgow Outcome Scale (GOS) at three months, according to age, initial Hunt-Hess grade, the presence of acute hydrocephalus, and treatment modality. Results The study included 24 (82.7%) females and five (17.3%) males, with a mean age of 59 years (range, 22-78 years). Seventeen patients were treated with surgical clipping and 12 patients were treated with endovascular coil embolization. No statistical significance was observed between clinical outcome and treatment modalities (clipping or coiling; p = 0.803). Seventeen (58.6%) patients achieved favorable outcome, defined as GOS score of 4-5, at 3 months. Procedure-related complications occurred in seven patients (24.1%). Results of multivariate analysis indicated that initial Hunt-Hess grade and the presence of acute hydrocephalus were independent predictors of unfavorable outcome, defined as GOS score of 1-3 (Odds ratio (OR) = 8.63, Confidence interval (CI) [95%] 1.11-66.84, p = 0.039 and OR = 36.64, CI [95%] 2.23-599.54, p = 0.012, respectively). Conclusion The present study suggests that the clinical outcomes are related to the initial Hunt-Hess grade and the presence of acute hydrocephalus in ruptured saccular VB aneurysms.
Collapse
Affiliation(s)
- Mun Soo Kang
- Department of Neurosurgery, Eulji Hospital, Eulji University, Seoul, Korea
| | - Jae Hoon Kim
- Department of Neurosurgery, Eulji Hospital, Eulji University, Seoul, Korea
| | - Hee In Kang
- Department of Neurosurgery, Eulji Hospital, Eulji University, Seoul, Korea
| | - Byung Gwan Moon
- Department of Neurosurgery, Eulji Hospital, Eulji University, Seoul, Korea
| | - Seung Jin Lee
- Department of Neurosurgery, Eulji Hospital, Eulji University, Seoul, Korea
| | - Joo Seung Kim
- Department of Neurosurgery, Eulji Hospital, Eulji University, Seoul, Korea
| |
Collapse
|
37
|
Clinical experiences of ruptured posteroinferior cerebellar artery aneurysms and anatomical analysis in the cadaver in a single center of China. Clin Neurol Neurosurg 2011; 114:366-71. [PMID: 22209235 DOI: 10.1016/j.clineuro.2011.11.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2010] [Revised: 08/31/2011] [Accepted: 11/06/2011] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Posteroinferior cerebellar artery (PICA) aneurysms are uncommon and have not been well investigated previously. We report our series of 29 ruptured PICA aneurysms with surgical treatment along with the description of the surgical anatomy of the PICA to the lower cranial nerves in cadaveric specimen. METHODS All patients with ruptured PICA aneurysms who were surgically treated at the First Affiliated Hospital of Soochow University during the period from January 1995 to December 2008 were reviewed retrospectively. Data relating to clinical, radiological, and intraoperative findings were analyzed. Forty formalin-fixed cerebellar hemispheres provided the material for the study of describing the detailed surgical anatomic relationship of the PICA to the lower cranial nerves. RESULTS In our series, ruptured PICA aneurysms reached an incidence of 2.35% of all ruptured intracranial aneurysms. There were 13 aneurysms (44.8%) located in the proximal segment, and 16 (55.2%) located in the distal segment. Of these, 89.7% were saccular, 6.9% fusiform, and 3.4% dissecting aneurysms. Usually, the surgical outcome was influenced by Poor admission grade, the presence of obstructive hydrocephalus and associated distal AVM. In cadaveric specimen, 17.5% of PICAs passed between the glossopharyngeal and vagus nerves, 7.5% between the vagus and accessory nerves, and 62.5% through the rootlets of the accessory nerve. CONCLUSION This report summarizes the presentation and outcome of a large series of 29 patients with ruptured PICA aneurysms, and we conclude that ruptured PICA with surgical treatment usually gets well recovered. The study does, however, also demonstrate that the anatomic relationship of the PICA and lower cranial nerves is somehow variable and irregular. Recognition of the findings in cadaveric dissection is essential in treating lesions of this region.
Collapse
|
38
|
Hong YH, Kim CH, Che GS, Lee SH, Ghang CG, Choi YS. Predicting factors affecting clinical outcomes for saccular aneurysms of posterior inferior cerebellar artery with subarachnoid hemorrhage. J Korean Neurosurg Soc 2011; 50:327-31. [PMID: 22200015 DOI: 10.3340/jkns.2011.50.4.327] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Revised: 10/07/2011] [Accepted: 10/13/2011] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE The aim of this study is to investigate the clinical outcomes of surgery and coiling and analyze the predicting factors affecting the clinical outcomes of ruptured posterior inferior cerebellar artery (PICA) aneurysms. METHODS During the last 15 years, 20 consecutive patients with ruptured PICA aneurysms were treated and these patients were included in this study. The Fisher's exact test was used for the statistical significance of Glasgow Outcome Scale (GOS) according to initial Hunt-Hess (H-H) grade, treatment modalities, and the presence of acute hydrocephalus. RESULTS Eleven (55%) and nine (45%) patients were treated with surgical clipping and endovascular treatment, respectively. Among 20 patients, thirteen (65.0%) patients had good outcomes (GOS 4 or 5). There was the statistical significance between initial poor H-H grade, the presence of acute hydrocephalus and poor GOS. CONCLUSION In our study, we suggest that initial H-H grade and the presence of acute hydrocephalus may affect the clinical outcome rather than treatment modalities in the ruptured PICA aneurysms.
Collapse
Affiliation(s)
- Young-Ho Hong
- Department of Neurosurgery, Cerebro-Vascular Center, Bongseng Memorial Hospital, Busan, Korea
| | | | | | | | | | | |
Collapse
|
39
|
Awe OO, Gonzalez LF, Hasan D, Maltenfort M, Rossenwasser R, Jabbour P. Treatment Outcome of Aneurysmal Subarachnoid Hemorrhage in Patients Aged 70 Years and Older. Neurosurgery 2011; 68:753-8; discussion 758. [DOI: 10.1227/neu.0b013e318207a9fb] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND:
The incidence of subarachnoid hemorrhage is increasing, especially in the elderly as life expectancy increases. Aggressive treatment of aneurysms in the elderly is usually avoided because of a presumed poor prognosis.
OBJECTIVE:
The aim of this study was to assess the outcome of treatment in patients older than 70 years old.
METHODS:
We performed a retrospective chart review of 150 patients aged 70 years and older who were treated at Jefferson Hospital from 2004 to 2009. Data including World Federation of Neurological Surgeons grade and Hunt and Hess classification, specific management components, and treatment outcome on discharge were analyzed.
RESULTS:
One hundred ten patients had aneurysms coiled, 9 patients had aneurysms clipped, 11 patients had aneurysms that were not treated, and 20 patients had no visible aneurysms. Overall, increased World Federation of Neurological Surgeons grades correlated strongly with poor clinical outcome. Statistical tests indicate that patients who died (mean, 78.8, n = 35) or who went into rehabilitation (mean, 76.5, n = 81) were significantly older than patients who were discharged home (mean, 73.1, n = 20). However, day of presentation after initial symptom(s) of subarachnoid hemorrhage and placement of ventriculoperitoneal shunt also influenced clinical outcome. Patients who had a ventriculoperitoneal shunt were more likely to go into rehabilitation than patients who did not, and patients without a ventriculoperitoneal shunt were more likely to die.
CONCLUSION:
Older age should not preclude a patient from aneurysm treatment. Factors such as low Hunt and Hess or World Federation of Neurological Surgeons grades, earlier presentation to the hospital after initial symptoms, early shunting, prompt interventions, and tailored postoperative management can result in favorable clinical outcomes.
Collapse
Affiliation(s)
| | - L Fernando Gonzalez
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - David Hasan
- Department of Neurosurgery, University of Iowa, Iowa City, Iowa
| | - Mitchell Maltenfort
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Robert Rossenwasser
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Pascal Jabbour
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| |
Collapse
|
40
|
Ishikawa M, Kusaka G, Takashima K, Kamochi H, Shinoda S. Clipping of a vertebral artery aneurysm behind the hypoglossal nerve under the monitoring of lower cranial nerves. Clin Neurol Neurosurg 2010; 112:450-3. [DOI: 10.1016/j.clineuro.2010.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2009] [Revised: 01/27/2010] [Accepted: 02/08/2010] [Indexed: 10/19/2022]
|
41
|
Diagnosis and surgical management of extracranial PICA aneurysms presenting through subarachnoid haemorrhage: Case report and review of the literature. Clin Neurol Neurosurg 2009; 111:758-61. [PMID: 19651470 DOI: 10.1016/j.clineuro.2009.05.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2008] [Revised: 03/21/2009] [Accepted: 05/26/2009] [Indexed: 11/21/2022]
|
42
|
Song HH, Won YD, Kim YJ, Kim BS. The endovascular management of saccular posterior inferior cerebellar artery aneurysms. Korean J Radiol 2009; 9:396-400. [PMID: 18838847 PMCID: PMC2627211 DOI: 10.3348/kjr.2008.9.5.396] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Objective The purpose of this retrospective study was to report the outcome of the endovascular treatment of eight patients with eight saccular posterior inferior cerebellar artery (PICA) aneurysms. Materials and Methods Over the last seven years (1999-2006), eight consecutive patients with saccular PICA aneurysms were treated by endovascular methods. Five of the aneurysms were presented with subarachnoid hemorrhaging, whereas three were discovered incidentally. Four of the aneurysms (3 ruptured and 1 incidental) were treated by intrasaccular coiling, whereas the remaining four (1 ruptured and 3 incidental) were treated by vertebral artery (VA) occlusion. Results Of the four aneurysms treated by intrasaccular coiling, three were completely packed with coils and one was partially packed. In three of four patients who underwent vertebral artery occlusions, follow-up digital subtraction angiographies demonstrated thrombosed aneurysms and PICA. No procedure-related morbidity occurred and no re-bleed was encountered during a follow-up examination (mean; 31 months). Conclusion As a result of this study, we found that the endovascular management of saccular PICA aneurysms should be considered as safe and effective.
Collapse
Affiliation(s)
- Ha-Hun Song
- Department of Radiology, Cheju Halla Hospital, Jeju-do, Korea
| | | | | | | |
Collapse
|
43
|
Li XE, Wang YY, Li G, Jia DZ, Liu XH, Gao J, Li XG. Clinical presentation and treatment of distal posterior inferior cerebellar artery aneurysms: report on 5 cases. ACTA ACUST UNITED AC 2008; 70:425-30; discussion 431. [PMID: 18295840 DOI: 10.1016/j.surneu.2007.04.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2006] [Accepted: 04/25/2007] [Indexed: 10/22/2022]
|
44
|
Sanai N, Tarapore P, Lee AC, Lawton MT. THE CURRENT ROLE OF MICROSURGERY FOR POSTERIOR CIRCULATION ANEURYSMS. Neurosurgery 2008; 62:1236-49; discussion 1249-53. [PMID: 18824990 DOI: 10.1227/01.neu.0000333295.59738.de] [Citation(s) in RCA: 121] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Nader Sanai
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | | | | | | |
Collapse
|
45
|
Sanai N, Tarapore P, Lee AC, Lawton MT. THE CURRENT ROLE OF MICROSURGERY FOR POSTERIOR CIRCULATION ANEURYSMS. Neurosurgery 2008. [DOI: 10.1227/01.neu.0000316415.51936.ab] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
46
|
Cellerini M, Mangiafico S, Ammannati F, Ambrosanio G, Muto M, Galasso L, Mennonna P. Ruptured, dissecting posterior inferior cerebellar artery aneurysms: endovascular treatment without parent vessel occlusion. Neuroradiology 2007; 50:315-20. [PMID: 18064445 DOI: 10.1007/s00234-007-0333-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2007] [Accepted: 10/16/2007] [Indexed: 11/30/2022]
|
47
|
Peluso JP, van Rooij WJ, Sluzewski M, Beute GN, Majoie CB. Posterior inferior cerebellar artery aneurysms: incidence, clinical presentation, and outcome of endovascular treatment. AJNR Am J Neuroradiol 2007; 29:86-90. [PMID: 17928380 DOI: 10.3174/ajnr.a0758] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Results of endovascular treatment of PICA aneurysms are not well established. The purpose of this study was to report incidence, clinical presentation, and outcome of endovascular treatment in 46 patients with 47 posterior inferior cerebellar artery (PICA) aneurysms. MATERIALS AND METHODS Of 2169 aneurysms treated between January 1995 and March 2007, 60 were located on the PICA (incidence, 2.8%). Forty-seven proximal PICA aneurysms in 46 patients were treated with endovascular techniques, 37 ruptured (79%) and 10 unruptured (21%). Four patients presented with lower cranial nerve palsies. Mean aneurysm size was 6.8 mm (median, 6 mm; range, 2-32 mm). Forty-three aneurysms were occluded with coils (6 including the PICA origin), and 4 were treated with proximal vertebral artery (VA) occlusion. RESULTS Four aneurysms treated with proximal VA occlusion were not occluded. Procedural rupture occurred in 9 aneurysms leading to death in 2 patients and to permanent disability in 1 patient. One patient developed lateral medullary and cerebellar infarctions after PICA occlusion. Combined mortality and morbidity was 8.6% (4 of 46). Outcome at 6 months in 38 surviving patients was good in 35 and moderate in 3. No hemorrhage occurred during 109 patient-years of follow-up. Symptoms of mass effect resolved in all 4 patients. CONCLUSION In our experience, PICA aneurysms were challenging lesions, prone to procedural rupture. In some instances, endovascular treatment required occlusion of the parent PICA; usually this was well tolerated. In other instances, treatment required occlusion of the VA. Although this was effective in alleviation of symptoms of mass effect, it was not effective in causing thrombosis of the aneurysm.
Collapse
Affiliation(s)
- J P Peluso
- Department of Radiology, St. Elisabeth Ziekenhuis, Tilburg, the Netherlands
| | | | | | | | | |
Collapse
|
48
|
Müller-Forell W, Engelhard K. Neuroimaging for the anesthesiologist. Anesthesiol Clin 2007; 25:413-39, vii-viii. [PMID: 17884702 DOI: 10.1016/j.anclin.2007.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Neuroimaging is essential in the treatment of cerebral nervous system disorders or in patients in the ICU with deterioration of their neurologic function. Leading clinical symptoms are acute neurologic deficits with different stages of hemisymptomatology, primary or progressing loss of consciousness or vigilance deficit, focal or generalized seizures, sometimes combined with an acute respiratory or circulatory insufficiency. The resulting questions can be summarized in those of intracranial space occupying hemorrhage; acute infarction; and signs for reduced cerebral blood flow, cerebrovascular vasospasm, or intracranial mass. Recent evolutions in imaging have contributed to an increase in diagnostic sensitivity and specificity along with reduced side effects. This article illustrates typical and atypical differential diagnoses, with some emphasis on traumatic brain injury.
Collapse
Affiliation(s)
- Wibke Müller-Forell
- Institute of Neuroradiology, Johannes Gutenberg-University of Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany.
| | | |
Collapse
|