1
|
Serioli S, Leonel L, Celda MP, Lanzino G, Keser Z. Dissecting and fusiform aneurysms of the superior cerebellar artery: anatomy, clinical presentation, and treatment outcomes. Neurosurg Rev 2024; 47:516. [PMID: 39214870 DOI: 10.1007/s10143-024-02734-0] [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: 06/01/2024] [Revised: 08/15/2024] [Accepted: 08/20/2024] [Indexed: 09/04/2024]
Abstract
The management of superior cerebellar aneurysms is still controversial. Although several techniques are available, the deep localization of the lesion and the limited number of cases increase the complexity of decision-making for optimal treatment. Only a few cases of dissecting and fusiform aneurysms of the superior cerebellar artery (SCA) are described in the literature, many of which are without long follow-ups. The study aims to offer an exhaustive retrospective analysis of patients affected by SCA fusiform and dissecting aneurysms treated at our institution from 2008 to 2023, highlighting outcomes and complications. Moreover, a comprehensive narrative review was performed. A total of seven patients were treated at our institution. After a title and abstract screen, fifty-five papers met the criteria for inclusion in the review. In our case series, conservative treatment was proposed as the first therapeutic option in four cases (57.1%), while endovascular treatment (EVT) was in three cases (42.9%). A good recovery was observed in 66% of patients presenting with subarachnoid hemorrhage (SAH), while every patient without SAH achieved a good clinical outcome. A poor outcome was observed only in one patient with a dissecting aneurysm causing SAH, who also suffered a pontine infarction. In the literature review, conservative treatment was proposed as a first therapeutic option in eleven cases (16.6%), open microsurgical techniques in 19 patients (28.8%), and EVT in 31 patients (46.9%). Fatal outcome was documented in five patients (7.5%), all characterized by the rupture of the vascular lesion, while 6.1% of cases had non-fatal poor outcomes.
Collapse
Affiliation(s)
- Simona Serioli
- Division of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, MN, USA
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Luciano Leonel
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, MN, USA
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Maria Peris Celda
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, MN, USA
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
- Department of Otolaryngology / Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - Giuseppe Lanzino
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Zafer Keser
- Division of Cerebrovascular Disorders and Stroke, Department of Neurology, Mayo Clinic, 200 1St Street SW, Rochester, MN, 55905, USA.
| |
Collapse
|
2
|
Rinaldo L, Abla AA. Trapping and side-to-end superior cerebellar artery to superior cerebellar artery bypass for treatment of fusiform superior cerebellar artery aneurysm. J Clin Neurosci 2023; 118:12-15. [PMID: 37832265 DOI: 10.1016/j.jocn.2023.09.032] [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: 09/04/2023] [Revised: 09/26/2023] [Accepted: 09/30/2023] [Indexed: 10/15/2023]
Abstract
We describe the technical nuances of in-situ bypass for treatment of a fusiform superior cerebellar artery (SCA) aneurysm via surgical trapping and a side-to-end in-situ bypass between duplicated SCAs. Our patient is a 40-year-old male who presented with an incidental aneurysm of the proximal right superior cerebellar artery (SCA). Formal angiography was performed that demonstrated a fusiform morphology of the aneurysm, as well as a duplicated SCA on that side. After extensive counseling, the patient elected to undergo surgical clip reconstruction with possible bypass. A large frontotemporal craniotomy was performed and a combined transsylvian-subtemporal approach to the ventral anterolateral brainstem was performed. After identifying the aneurysm, the tentorium was incised posterior to the insertion of the trochlear nerve to widen the operative field. An end-to-side anastomosis between the duplicated SCAs was performed, followed by trapping of the diseased arterial segment. The patient had an oculomotor nerve palsy post-operatively, however this resolved by his six-month follow-up. In-situ bypass is a viable technique for revascularizing the SCA territory during clip reconstruction of fusiform aneurysms. A duplicated SCA allows for an SCA to SCA bypass. Incising the tentorium can increase visualization of donor and recipient vessels and facilitate performance of the anastomosis.
Collapse
Affiliation(s)
- Lorenzo Rinaldo
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Adib A Abla
- Department of Neurologic Surgery, University of Miami School of Medicine, Miami, FL, USA.
| |
Collapse
|
3
|
Ogura T, Hatano T, Koyanagi M, Kitamura T, Yamada D. Ruptured aneurysms at the distal superior cerebellar artery successfully treated by combining occipital artery-superior cerebellar artery anastomosis and endovascular therapy: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2023; 5:CASE22246. [PMID: 38015026 PMCID: PMC10550605 DOI: 10.3171/case22246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 12/14/2022] [Indexed: 11/29/2023]
Abstract
BACKGROUND Distal superior cerebellar artery (SCA) aneurysms are rare and are treated using various treatment strategies. Treatment often requires parent artery occlusion, which raises concerns regarding the potential risk of ischemia in the distal territory. OBSERVATIONS An 81-year-old woman presented with subarachnoid hemorrhage. Diagnostic cerebral angiography revealed two tiny distal SCA aneurysms. Because significant ischemic damage following parent artery occlusion was concerned, two bypasses between the occipital artery and SCA branches were first performed with the patient in the prone position in a hybrid operating room. Each aneurysm was successively treated in the same position with endovascular internal trapping and intra-aneurysmal embolization. After adequate hemostasis was confirmed, the wound was closed. Both aneurysms were successfully occluded without symptomatic ischemic complications. LESSONS This combined surgical and endovascular approach would be helpful in cases with notable concerns regarding ischemia after sacrificing the parent artery.
Collapse
|
4
|
Uda K, Tanahashi K, Mamiya T, Kanamori F, Yokoyama K, Nishihori M, Izumi T, Araki Y, Saito R. Advantages of petrosectomy for superficial temporal artery to superior cerebellar artery bypass based on three-dimensional distance measurements using cadaver heads. Neurosurg Rev 2021; 45:1617-1624. [PMID: 34735687 PMCID: PMC8976806 DOI: 10.1007/s10143-021-01686-z] [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: 05/31/2021] [Revised: 09/28/2021] [Accepted: 10/26/2021] [Indexed: 11/29/2022]
Abstract
Superficial temporal artery (STA) to superior cerebellar artery (SCA) bypass is usually performed via the subtemporal approach (StA), anterior transpetrosal approach (ApA), or combined petrosal approach (CpA), but no study has yet reported a quantitative comparison of the operative field size provided by each approach, and the optimal approach is unclear. The objective of this study is to establish evidence for selecting the approach by using cadaver heads to measure the three-dimensional distances that represent the operative field size for STA-SCA bypass. Ten sides of 10 cadaver heads were used to perform the four approaches: StA, ApA with and without zygomatic arch osteotomy (ApA-ZO- and ApA-ZO+), and CpA. For each approach, the major-axis length and the minor-axis length at the anastomosis site (La-A and Li-A), the major-axis length and the minor-axis length at the brain surface (La-B and Li-B), the depth from the brain surface to the anastomosis site (Dp), and the operating angles of the major axis and the minor axis (OAa and OAi) were measured. Shallower Dp and wider operating angle were obtained in the order CpA, ApA-ZO+, ApA-ZO-, and StA. In all parameters, ApA-ZO- extended the operative field more than StA. ApA-ZO+ extended La-B and OAa more than ApA-ZO-, whereas it did not contribute to Dp and OAi. CpA significantly decreased Dp, and widened OAa and OAi more than ApA-ZO+. ApA and CpA greatly expanded the operative field compared with StA. These results provide criteria for selecting the optimal approach for STA-SCA bypass in light of an individual surgeon's anastomosis skill level.
Collapse
Affiliation(s)
- Kenji Uda
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho Showa-ku Nagoya, Aichi, 466-8550, Japan.
| | - Kuniaki Tanahashi
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho Showa-ku Nagoya, Aichi, 466-8550, Japan
| | - Takashi Mamiya
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho Showa-ku Nagoya, Aichi, 466-8550, Japan
| | - Fumiaki Kanamori
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho Showa-ku Nagoya, Aichi, 466-8550, Japan
| | - Kinya Yokoyama
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho Showa-ku Nagoya, Aichi, 466-8550, Japan
| | - Masahiro Nishihori
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho Showa-ku Nagoya, Aichi, 466-8550, Japan
| | - Takashi Izumi
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho Showa-ku Nagoya, Aichi, 466-8550, Japan
| | - Yoshio Araki
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho Showa-ku Nagoya, Aichi, 466-8550, Japan
| | - Ryuta Saito
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho Showa-ku Nagoya, Aichi, 466-8550, Japan
| |
Collapse
|
5
|
Distal Parent Vessel Occlusion of 2 Superior Cerebellar Artery Fusiform Aneurysms: Report of 2 Cases and Literature Review. World Neurosurg X 2019; 3:100026. [PMID: 31225519 PMCID: PMC6584478 DOI: 10.1016/j.wnsx.2019.100026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 02/14/2019] [Indexed: 11/22/2022] Open
Abstract
Background Fusiform superior cerebellar artery (SCA) aneurysms are rare, and their management represents a technical challenge. In complex aneurysms, endovascular parent vessel occlusion of the SCA may be a treatment option. Here, we present 2 cases of fusiform SCA aneurysms, 1 ruptured and 1 unruptured, as well as our institution's management with parent vessel occlusion. We also provide a review of the literature. Cases Description Case 1: A 42-year-old male was transferred from an outside hospital with subarachnoid hemorrhage. On admission, the patient had a Glasgow Coma Scale score of 8, a Hunt and Hess grade 4, and a Fisher grade 4. A diagnostic angiogram demonstrated a right SCA fusiform lesion with proximal and distal dilatations of 1.45 mm and 5.35 mm long, respectively, likely representing a single dissecting pseudoaneurysm. The distal dilatation was coiled, resulting in parent vessel occlusion. The patient recovered clinically and was discharged in stable condition. Case 2: A 27-year-old female was transferred from an outside hospital due to a brainstem stroke. A diagnostic angiogram revealed an S2/S3 segment left SCA fusiform lesion, likely representing a dissecting aneurysm. The patient was neurologically intact at admission and managed conservatively. At the 2-month follow-up angiogram, the dissection had extended along the length of the SCA. Consequently, the patient underwent coil embolization of the distal left SCA. At the 6-month follow-up, the vessel remained obliterated and the patient's neurologic status had improved. Conclusions Endovascular coil embolization of fusiform SCA aneurysms offers a reasonable and safe treatment approach.
Collapse
|
6
|
Jeon JB, Oh SY, Hyun DK, Shim YS. Fusiform Superior Cerebellar Artery Aneurysm Treated with Endovascular Treatment. J Cerebrovasc Endovasc Neurosurg 2016; 18:276-280. [PMID: 27847774 PMCID: PMC5104855 DOI: 10.7461/jcen.2016.18.3.276] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 09/05/2016] [Accepted: 09/06/2016] [Indexed: 12/22/2022] Open
Abstract
An aneurysm of the distal superior cerebellar artery (SCA) is a highly rare disease. Fusiform aneurysms of the distal SCA are particularly challenging to treat. Clipping, trapping with or without bypass using microsurgery or endovascular treatment (EVT) were used to treat this condition. We describe the case of fusiform distal SCA aneurysms treated successfully with endovascular coiling with a 3-month follow-up. A 39 year-old male was presented with subarachnoid hemorrhage (SAH) and a 15 mm fusiform aneurysm of the ambient segment of the left distal SCA. EVT for parent artery occlusion and packing of the aneurysm was done. Left sixth nerve palsy appeared after 1 day of EVT. The symptom completely recovered within 1 week of the post-procedural period. No neurological deficit was seen during the clinical 3-month follow-up. EVT of fusiform distal SCA aneurysms with coils is a safe and feasible option to manage this rare condition. However, the treatment options must be carefully selected depending on the neurologic condition, development of collateral circulation, and configuration of the dissection.
Collapse
Affiliation(s)
- Joon Bok Jeon
- Department of Neurosurgery, Inha University School of Medicine and Hospital, Incheon, Korea
| | - Se-Yang Oh
- Department of Neurosurgery, Inha University School of Medicine and Hospital, Incheon, Korea
| | - Dong-Keun Hyun
- Department of Neurosurgery, Inha University School of Medicine and Hospital, Incheon, Korea
| | - Yu Shik Shim
- Department of Neurosurgery, Inha University School of Medicine and Hospital, Incheon, Korea
| |
Collapse
|
7
|
State-of-art in surgical treatment of dissecting posterior circulation intracranial aneurysms. Neurosurg Rev 2016; 41:31-45. [PMID: 27215913 DOI: 10.1007/s10143-016-0749-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 03/17/2016] [Accepted: 04/09/2016] [Indexed: 11/27/2022]
Abstract
Vertebrobasilar (VB) intracranial dissecting aneurysms (IDAs) pose difficult therapeutic issues and are especially among the most difficult to manage surgically. There are, however, some cases where selective aneurysm obliteration by endovascular approach is impossible or is associated with an unacceptable risk of morbidity. This is particularly true when the aneurysm is dissecting, giant, or has a large neck. In such cases, surgical treatment may be the only alternative. Optimal management of these lesions is therefore challenging and treatment decisions have to be made on a case-by-case basis. Ideal treatment should be a complete surgical excision of the lesion; however, this procedure might only be possible after distal and proximal vessel wall occlusion which might not be tolerated by the patient depending on the location of the aneurysm. Therefore, formulation of recommendations concerning the surgical strategy remains still difficult due to inconsistency of surgical outcomes. The literature describing surgical strategy of VB IDAs is varying in quality and content, and many studies deal with only a few patients. In the presented review, the authors summarize the current knowledge on the incidence, pathogenesis, clinical presentation, and diagnostic procedures with special emphasis on surgical treatment of IDAs in posterior circulation.
Collapse
|