Endovascular Management of a Ruptured Basilar Perforator Artery Aneurysm Associated with a Pontine Arteriovenous Malformation: Case Report and Review of the Literature

Lockwood, Joseph; Scullen, Tyler; Mathkour, Mansour; Kaufmann, Ascher; Medel, Ricky; Dumont, Aaron S.; Amenta, Peter S.

doi:10.1016/j.wneu.2018.05.051

Cited by 5 publications

(5 citation statements)

References 16 publications

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“…The remaining 31 studies were assessed in full text and, after revision of cross references, 24 retrospective case series met our predefined inclusion criteria and were included in the evidence synthesis. Of the 24 included articles, 19 (79%) had a low risk of bias,2–4 8–23 three (12%) had a medium risk of bias,24–26 and two (8%) had a high risk of bias27 28 (see online supplementary table 1).…”

Section: Resultsmentioning

confidence: 99%

A systematic review of non-trunk basilar perforator aneurysms: is it worth chasing the small fish?

Granja

Monteiro

Agnoletto

et al. 2019

J NeuroIntervent Surg

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Background and purposeNon-trunk basilar artery perforator aneurysms (BAPAs) are rare intracranial vascular pathologies that have long been underdiagnosed, under-reported, and under-analyzed. We performed a systematic review of the efficacy and safety endpoints between conservative and active treatment approaches for non-trunk BAPAs.MethodsMajor databases were analyzed for relevant publications between 1995 and 2019. Studies comparing the outcomes between conservative and active treatment approaches such as coiling, stenting, clipping, liquid embolization, and flow diversion were included. Mortality rate, rate of permanent neurological deficit as determined by the modified Rankin Score (mRS), rate of second treatment occurrence, and perioperative complication rate were also assessed.ResultsA total of 24 studies, including 54 patients with 56 non-trunk BAPAs, were included. The mean maximum aneurysm diameter was 2.70 mm (range 1–10). A diagnosis was achieved with the initial DSA in 50.0% (27/54) of the patients. A conservative approach was used in 16 patients while active treatment was used in the other 38. Thirteen of 15 (86.7%) patients in the conservative group and 27/34 (79.4%) in the active treatment group had an mRS score 0–2. A non-significant higher odds of a positive outcome was observed in the conservative group (OR 1.51, 95% CI 0.50 to 4.54). The event-related mortality rate was 3.55% (3/54) with one procedure-related death in the active treatment group.ConclusionsIn patients with non-trunk BAPAs unamenable to active treatment, conservative approaches may result in acceptable functional outcomes and low morbidity. Small sample sizes and under-reporting of outcomes warrant further study.

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Section: Resultsmentioning

confidence: 99%

A systematic review of non-trunk basilar perforator aneurysms: is it worth chasing the small fish?

Granja

Monteiro

Agnoletto

et al. 2019

J NeuroIntervent Surg

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“…In the remaining two, a combination of aneurysm embolization and AVM radiosurgery was used. [28,30,32] In our cases, the aneurysms were both placed at the junction between the BA and a dilated pontine artery. is, further, supports the concept that similar lesions might be flowrelated rather than linked to an intrinsic vessel wall alteration.…”

Section: Discussionmentioning

confidence: 60%

“…Posterior fossa AVMs associated with flow-related aneurysms carry a significantly higher rate of rupture and re-bleeding if compared to the isolated aneurysm counterparts. [ 28 ] When the blood flow increases in the AVM feeding vessel, it predisposes to aneurysm development. This seems to be supported by reports of spontaneous aneurysm disappearance after AVM removal.…”

Section: Discussionmentioning

confidence: 99%

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Ruptured proximal pontine artery aneurysm and association with cerebellopontine angle cistern arterial venous malformation fed by the same artery: A surgical challenge

Gladi,

Di Rienzo,

Fasinella

et al. 2023

Surgical Neurology International

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Background: The coexistence of hyper-inflow aneurysms and cerebellopontine angle cistern (CPAc) arterial venous malformations (AVMs) have been rarely reported and most commonly associated with high risk of bleeding. Case Descriptions: We present two cases of CPAc AVMs admitted for acute subarachnoid hemorrhage from rupture of a parent right pontine artery aneurysm. Admission history, neurology at presentation, pre/post-operative imaging, approach selection, and results are thoroughly reviewed and presented. The acute origin angle of the vessel from the basilar artery made both malformations unsuitable for endovascular treatment. The surgical strategy was differently tailored in the two patients, respectively, using a Le Fort I/transclival and a Kawase approach. The aneurysm was clipped in the first case, and the AVM was excised in the second one, as required by the anatomical context. Aneurysm exclusion and AVM size reduction were obtained in the first case, while complete AVM removal and later aneurysm disappearance were obtained in the second one. A high-flow cerebrospinal fluid leak in the first case was successfully treated by an endoscopic approach. Both patients experienced a satisfactory neurological outcome in the follow-up. Conclusion: Pontine artery aneurysms, especially when associated with CPAc AVMs, represent a surgical challenge, due to their rarity and anatomical peculiarity, which typically requires complex operative approaches. Multimodal preoperative imaging, appropriate timing, and accurate target selection, together with versatile strategies, are the keys to a successful treatment.

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“…Perforator aneurysms are a rare cause of subarachnoid hemorrhage that are challenging to diagnose and treat. The posterior circulation is prone to perforator aneurysms, with reported cases including 57 basilar artery perforator aneurysms, 1-26 3 superior cerebellar artery aneurysms, 22,27,28 and 2 posterior choroidal artery aneurysms. 22,28 Approximately half of perforator aneurysms are diagnosed on the first diagnostic imaging, 29 and described management strategies include open treatment, endovascular treatment, or conservative management.…”

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confidence: 99%

Orbitozygomatic Approach for a Ruptured P1 Perforator Aneurysm: 2-Dimensional Operative Video

Orenday-Barraza,

Jabre,

Venteicher

2023

Operative Neurosurgery

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Endovascular Management of a Ruptured Basilar Perforator Artery Aneurysm Associated with a Pontine Arteriovenous Malformation: Case Report and Review of the Literature

Cited by 5 publications

References 16 publications

A systematic review of non-trunk basilar perforator aneurysms: is it worth chasing the small fish?

A systematic review of non-trunk basilar perforator aneurysms: is it worth chasing the small fish?

Ruptured proximal pontine artery aneurysm and association with cerebellopontine angle cistern arterial venous malformation fed by the same artery: A surgical challenge

Orbitozygomatic Approach for a Ruptured P1 Perforator Aneurysm: 2-Dimensional Operative Video

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