1
|
Deora H, Nayak N, Dixit P, Vikas V, Rao KVLN, Pruthi N, Srinivas D, Shukla DP, Bhat DI, Malla BR, Devi BI, Somanna S. Surgical Management and Outcomes of Aneurysms of Posterior Inferior Cerebellar Artery: Location-Based Approaches with Review of Literature. J Neurosci Rural Pract 2020; 11:34-43. [PMID: 32269450 PMCID: PMC7138643 DOI: 10.1055/s-0039-3399486] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background
Posterior inferior cerebellar artery (PICA) is a tortuous, variable, and uncommon site for aneurysms. Surgical management of PICA aneurysms involves careful selection of approach based on the location of the aneurysm and meticulous dissection of the neurovascular structures and perforators.
Materials and Methods
We did a retrospective review of all the PICA aneurysms operated at our institute in the past 10 years along with the site, presentation, and approach used for the same. Preoperative World Federation of Neurosurgical Society scores and follow-up modified Rankin scores (mRS) were also evaluated. During the same period, data for intervention cases of PICA aneurysm were also collected with follow-ups for a comparative analysis.
Results
A total of 20 patients with 21 PICA aneurysms were reviewed. All the reviewed cases presented with subarachnoid hemorrhage, and the most common location was the lateral medullary segment and vertebral artery (VA)–PICA junction. Midline approaches were used for distal PICA cases, with far-lateral approach reserved for anterior medullary/VA–PICA junction. No lower cranial nerve palsies were recorded at follow-up. Four cases needed cerebrospinal fluid diversion and two developed cerebellar infarcts. All cases were mRS 0 to 2 at follow-up.
Conclusion
Our series compares well with some of the larger surgical series of PICA aneurysms. This may be due to early referral patterns and early surgery (<24 hours) policy at our institution. Anatomical knowledge of PICA anatomy and sound perioperative management are keys to good outcomes in these cases.
Collapse
Affiliation(s)
- Harsh Deora
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Nitish Nayak
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Priyadarshi Dixit
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - V Vikas
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - K V L Narasinga Rao
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Nupur Pruthi
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Dwarakanath Srinivas
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Dhaval P Shukla
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Dhananjay I Bhat
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Bhaskara Rao Malla
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Bhagvatula Indira Devi
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Sampath Somanna
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| |
Collapse
|
2
|
Kim DS, Sung JH, Lee DH, Yi HJ. Coil Embolization of Ruptured Proximal Posterior Inferior Cerebellar Artery Aneurysm with Contralateral Retrograde Approach for LVIS Jr. Intraluminal Support Deployment. J Cerebrovasc Endovasc Neurosurg 2018; 20:235-240. [PMID: 31745467 PMCID: PMC6851229 DOI: 10.7461/jcen.2018.20.4.235] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 03/30/2017] [Accepted: 09/18/2017] [Indexed: 11/23/2022] Open
Abstract
The safety and feasibility of simple coil embolization and stent deployment for the treatment of posterior inferior cerebellar artery (PICA) aneurysms, as well as their radiologic and clinical results, have not been adequately understood. Especially, if dissecting aneurysm of proximal PICA is associated with small caliber PICA and stenosis of ipsilateral vertebral artery orifice (VAO), endovascular coiling with saving of PICA is not always easy. This 64-year-old man presented with subarachnoid hemorrhage due to a ruptured dissecting aneurysm of left proximal PICA. The aneurysm was irregularly fusiform in nature with a shallow PICA orifice (1.4 mm) and narrow caliber (0.9–1.5 mm). Moreover, the ipsilateral VAO showed severe stenosis (1.8 mm). We performed bifemoral puncture and chose additional route from right vertebral artery to left vertebrobasilar junction for retrograde approach and deployment of LVIS Jr. intraluminal support at proximal PICA. And then, the antegrade approach and coiling of aneurysm was done. Despite of transient thrombus of PICA, the aneurysm was successfully secured with preservation of whole PICA course. For preservation of narrow PICA with ipsilateral VAO stenosis, the contralateral approach and deployment of LVIS Jr. intraluminal support may be considered.
Collapse
Affiliation(s)
- Dong Sub Kim
- Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Jae Hoon Sung
- Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Dong Hoon Lee
- Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Ho Jun Yi
- Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| |
Collapse
|
3
|
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
|
4
|
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
|
5
|
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; 22:129-137. [PMID: 26825074 DOI: 10.1177/1591019915622164if:1.764q4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Accepted: 10/29/2015] [Indexed: 05/27/2023] 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
|
6
|
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
|
7
|
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]
|
8
|
Lehto H, Harati A, Niemelä M, Dashti R, Laakso A, Elsharkawy A, Satopää J, Billon-Grand R, Canato B, Kivisaari R, Hernesniemi J. Distal Posterior Inferior Cerebellar Artery Aneurysms: Clinical Features and Outcome of 80 Patients. World Neurosurg 2014; 82:702-13. [DOI: 10.1016/j.wneu.2014.06.012] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 12/03/2013] [Accepted: 06/09/2014] [Indexed: 11/29/2022]
|
9
|
Alokaili RN, Ahmed ME. Flow-diverter stent for the treatment of a non-origin posterior inferior cerebellar artery aneurysm. A case report. Neuroradiol J 2014; 27:456-60. [PMID: 25196620 DOI: 10.15274/nrj-2014-10061] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 06/12/2014] [Indexed: 11/12/2022] Open
Abstract
We describe the case of a 44-year old man with a ruptured wide-necked non-origin aneurysm of the posterior inferior cerebellar artery successfully treated with placement of a low porosity stent. To our knowledge, there are no cases in the literature of a non-origin posterior inferior cerebellar artery aneurysm treated with a flow-diverter stent.
Collapse
Affiliation(s)
- Riyadh Nasser Alokaili
- Department of Medical Imaging, King AbdulAziz Medical City National Guards Health; Riyadh, Saudi Arabia -
| | - Muhammad Ejaz Ahmed
- Department of Medical Imaging, King AbdulAziz Medical City National Guards Health; Riyadh, Saudi Arabia
| |
Collapse
|
10
|
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
|
11
|
Cho YD, Kang HS, Lee WJ, Kim KM, Kim JE, Han MH. Stent-assisted coil embolization of wide-necked posterior inferior cerebellar artery aneurysms. Neuroradiology 2013; 55:877-82. [PMID: 23568700 DOI: 10.1007/s00234-013-1178-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Accepted: 03/20/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Young Dae Cho
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 28 Yongon-dong, Jongno-gu, Seoul, Korea 110-744
| | | | | | | | | | | |
Collapse
|
12
|
Crowley RW, Albuquerque FC, Ducruet AF, Williamson RW, McDougall CG. Technical Considerations in the Endovascular Management of Aneurysms of the Posterior Inferior Cerebellar Artery. Oper Neurosurg (Hagerstown) 2012; 71:ons204-17; discussion ons217-8. [DOI: 10.1227/neu.0b013e31826920b4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- R Webster Crowley
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ 85013, USA
| | | | | | | | | |
Collapse
|
13
|
Jeon SI, Kwon BJ, Seo DH, Kang HI, Park SC, Choe IS. Bilateral Approach for Stent-assisted Coiling of Posterior Inferior Cerebellar Artery Aneurysms - Two Cases. J Cerebrovasc Endovasc Neurosurg 2012; 14:223-7. [PMID: 23210051 PMCID: PMC3491218 DOI: 10.7461/jcen.2012.14.3.223] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Revised: 07/17/2012] [Accepted: 07/24/2012] [Indexed: 11/23/2022] Open
Abstract
Aneurysms of the posterior inferior cerebellar artery (PICA) are rarely encountered. In particular, due to frequent anatomic complexity and the presence of nearby critical structures, PICA origin aneurysms are difficult to treat. However, recent reports of anecdotal cases using advanced endovascular instruments and skills have made the results of endovascular treatment rather outstanding. PICA preservation is the key to a successful endovascular treatment, based on the premise that a PICA origin aneurysm is well occluded. To secure PICA flow, stenting into the PICA would be the best method, however, it is nearly impossible technically via the ipsilateral vertebral artery (VA) if the PICA arose at an acute angle from the sac. In such a case, a bilateral approach for stent-assisted coiling can be a creative method for achievement of two goals of both aneurysm occlusion and PICA preservation: ipsilateral approach for coil delivery and contralateral cross-over approach for stent delivery via a retrograde smooth path into the PICA.
Collapse
Affiliation(s)
- Se-Il Jeon
- Department of Neurosurgery, Myongji Hospital, Kwandong University College of Medicine, Goyang, Korea
| | | | | | | | | | | |
Collapse
|
14
|
Roh HG, Chun YI, Choi JW, Cho J, Moon WJ, Solander S. Retrograde stent placement for coil embolization of a wide-necked posterior inferior cerebellar artery aneurysm. Korean J Radiol 2012; 13:510-4. [PMID: 22778576 PMCID: PMC3384836 DOI: 10.3348/kjr.2012.13.4.510] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Accepted: 10/18/2011] [Indexed: 11/15/2022] Open
Abstract
Wide-necked aneurysms of the posterior inferior cerebellar artery (PICA) are infrequently encountered in cerebrovascular practice, and endovascular treatment is difficult or impossible even with the use of several neck remodeling techniques. We present the case of a patient with a wide-necked aneurysm of the PICA, which was treated by the retrograde stenting through the contralateral vertebral artery and vertebrobasilar junction with antegrade coil embolization.
Collapse
Affiliation(s)
- Hong Gee Roh
- Department of Radiology, Konkuk University School of Medicine, Seoul 143-729, Korea
| | | | | | | | | | | |
Collapse
|
15
|
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]
|
16
|
Zhang CW, Xie XD, You C, Mao BY, Wang CH, He M, Sun H. Endovascular treatment of traumatic pseudoaneurysm presenting as intractable epistaxis. Korean J Radiol 2010; 11:603-11. [PMID: 21076585 PMCID: PMC2974221 DOI: 10.3348/kjr.2010.11.6.603] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2010] [Accepted: 07/07/2010] [Indexed: 02/05/2023] Open
Abstract
Objective To investigate the clinical efficacy of individual endovascular management for the treatment of different traumatic pseudoaneurysms presenting as intractable epistaxis. Materials and Methods For 14 consecutive patients with traumatic pseudoaneurysm presenting as refractory epistaxes, 15 endovascular procedures were performed. Digital subtraction angiography revealed that the pseudoaneurysms originated from the internal maxillary artery in eight patients; and all were treated with occlusion of the feeding artery. In six cases, they originated from the internal carotid artery (ICA); out of which, two were managed with detachable balloons, two with covered stents, one by means of cavity embolization, and the remaining one with parent artery occlusion. All of these cases were followed up clinically from six to 18 months, with a mean follow up time of ten months; moreover, three cases were also followed with angiography. Results Complete cessation of bleeding was achieved in all the 15 instances (100%) immediately after the endovascular therapies. Of the six patients who suffered from ICA pseudoaneurysms, one presented with a permanent stroke and one had an episode of rebleeding requiring intervention. Conclusion In patients presenting with a history of craniocerebral trauma, traumatic pseudoaneurysm must be considered as a differential diagnosis. Individual endovascular treatment is a relatively safe, plausible, and reliable means of managing traumatic pseudoaneurysms.
Collapse
Affiliation(s)
- Chang wei Zhang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | | | | | | | | | | | | |
Collapse
|