Surgical Management of Fusiform Aneurysms of the Peripheral Posteroinferior Cerebellar Artery

Nussbaum, Eric S.; Méndez, Alejandro; Camarata, Paul J.; Sebring, Leslie A.

doi:10.1227/01.neu.0000084162.29616.43

Cited by 48 publications

(23 citation statements)

References 17 publications

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“…This contrasts with that of patients with saccular aneurysms 36) . Our study confirms previous reports that spontaneous fusiform aneurysms are more often found in younger patients 2,4,6,9,13,19,26,29,31,34,35) and are more frequent in men 6,13,28,35) .…”

supporting

confidence: 92%

“…It is defined as a circumferential arterial dilatation resulting from pathological involvement of the entire artery 2,4,9,28,34) . All aneurysms exhibit a spindle shape when viewed externally 6) .…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, they recommended a proximal occlusion or trapping with or without resection combined with end-to-end anastomosis or EC-IC bypass 3,4,6,[9][10][11][12][13]17,28,31,34,35) . We also experienced one patient who died from rebleeding after clipping of a fusiform aneurysm at A1.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Intracranial Fusiform Aneurysms: It's Pathogenesis, Clinical Characteristics and Managements

Park

Yim

Lee

et al. 2008

J Korean Neurosurg Soc

108

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supporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Intracranial Fusiform Aneurysms: It's Pathogenesis, Clinical Characteristics and Managements

Park

Yim

Lee

et al. 2008

J Korean Neurosurg Soc

108

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“…If flow is diminished too much then complex bypass techniques may need to be used to prevent ischemic complications. 8,14 Treatment of fusiform aneurysms with endovascular flow diversion has been limited to a discussion in small case series or as a subgroup in larger series of all aneurysm types. 2,4,7,17,19,21 In a series by Siddiqui et al, 22 7 patients underwent flow diversion for large or giant fusiform vertebro- basilar aneurysms.…”

Section: Discussionmentioning

confidence: 99%

Endovascular treatment of fusiform cerebral aneurysms with the Pipeline Embolization Device

Monteith

Tsimpas²,

Dumont³

et al. 2014

JNS

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Object. Despite advances in surgical and endovascular techniques, fusiform aneurysms remain a therapeutic challenge. Introduction of flow-diverting stents has revolutionized the treatment of aneurysms with wide necks and of complex morphology. The authors report their experience with the endovascular treatment of fusiform aneurysms using the Pipeline Embolization Device.Methods. A retrospective review of 146 patients with cerebral aneurysms treated with the Pipeline Embolization Device between June 2011 and January 2013 was performed. Twenty-four patients were identified as having fusiform aneurysms. Twenty-four aneurysms in these 24 patients were treated. The mean patient age was 59 years. There were 9 men and 15 women. Angiographic and clinical data (including the modified Rankin Scale [mRS] score) were recorded at the time of treatment and at follow-up. The aneurysms were located in the internal carotid artery in 8 patients (33.3%), middle cerebral artery in 8 patients (33.3%), anterior cerebral artery in 1 patient (4%), and vertebrobasilar circulation in 7 patients (29%). The aneurysms were smaller than 10 mm in 3 patients, 10-25 mm in 16 patients, and larger than 25 mm in 5 patients. The mean largest dimension diameter was 18 mm.Results. Stent deployment was successful in all cases. The minor procedural morbidity was 4% (1 case). Morbidity and mortality related to aneurysm treatment were 4.2% and 4.2%, respectively. The mean mRS scores preoperatively and at clinical follow-up (median 6.0 months, mean 6.9 months) were 0.71 and 1.2, respectively (91.7% presented with an mRS score of 2 or better, and 79.2% had an mRS score of 2 or better at the 6.0-month follow-up). At clinical follow-up, 82.6% of patients were stable or had improved, 13.0% worsened, and 4.2% had died. Twentytwo (91.7%) of 24 patients had follow-up angiography available (mean follow-up time 6.3 months); 59% had excellent angiographic results (> 95% or complete occlusion), 31.8% had complete aneurysm occlusion, 27.3% had greater than 95% aneurysm occlusion, 18.2% had a moderate decrease in size (50%-95%), 4.5% had a minimal decrease in size (< 50%), 13.6% had not changed, and 4.5% had an increase in size.Conclusions. This series demonstrates that endovascular treatment of fusiform cerebral aneurysms with flow diversion was a safe and effective treatment. Procedural complications were low. Long-term morbidity and mortality rates were acceptable given the complex nature of these lesions.

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“…Published surgical series with PICA bypass are small, with 43 total patients and an even split between the occipital artery-to-PICA and IC-IC bypasses (Table 5). [5][6][7][8][9]13,14,19,22,29 PICA-PICA bypass was the most common IC-IC bypass, and only 4 cases of PICA reimplantation were reported. 4,12,20,26 The limited application of IC-IC bypass may be explained by the rarity of dysmorphic PICA aneurysms, but there are other reasons that deserve consideration.…”

Section: Bypass Indicationsmentioning

confidence: 99%

Intracranial-to-intracranial bypass for posterior inferior cerebellar artery aneurysms: options, technical challenges, and results in 35 patients

Abla¹,

McDougall²,

Lawton³

2016

JNS

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I ntracranIal-to-IntracranIal (IC-IC) bypasses are alternatives to traditional extracranial-to-intracranial (EC-IC) bypasses to reanastomose parent arteries, reimplant efferent branches, revascularize efferent branches with in situ donor arteries, and reconstruct bifurcated anatomy with interposition grafts that are entirely intracranial. 25 These bypasses represent an evolution in bypass surgery from using scalp arteries and remote donor sites in the neck toward a more local and reconstructive approach, or, in other words, a more minimally invasive approach to byabbreviatioNs DSA = digital subtraction angiography; EC-IC = extracranial-to-intracranial; IC-IC = intracranial-to-intracranial; mRS = modified Rankin Scale; PICA = posterior inferior cerebellar artery; RAG = radial artery interposition graft; VA = vertebral artery. obJective Intracranial-to-intracranial (IC-IC) bypasses are alternatives to traditional extracranial-to-intracranial (EC-IC) bypasses to reanastomose parent arteries, reimplant efferent branches, revascularize branches with in situ donor arteries, and reconstruct bifurcations with interposition grafts that are entirely intracranial. These bypasses represent an evolution in bypass surgery from using scalp arteries and remote donor sites toward a more local and reconstructive approach. IC-IC bypass can be utilized preferentially when revascularization is needed in the management of complex aneurysms. Experiences using IC-IC bypass, as applied to posterior inferior cerebellar artery (PICA) aneurysms in 35 patients, were reviewed. methods Patients with PICA aneurysms and vertebral artery (VA) aneurysms involving the PICA's origin were identified from a prospectively maintained database of the Vascular Neurosurgery Service, and patients who underwent bypass procedures for PICA revascularization were included. results During a 17-year period in which 129 PICA aneurysms in 125 patients were treated microsurgically, 35 IC-IC bypasses were performed as part of PICA aneurysm management, including in situ p3-p3 PICA-PICA bypass in 11 patients (31%), PICA reimplantation in 9 patients (26%), reanastomosis in 14 patients (40%), and 1 V 3 VA-to-PICA bypass with an interposition graft (3%). All aneurysms were completely or nearly completely obliterated, 94% of bypasses were patent, 77% of patients were improved or unchanged after treatment, and good outcomes (modified Rankin Scale ≤ 2) were observed in 76% of patients. Two patients died expectantly. Ischemic complications were limited to 2 patients in whom the bypasses occluded, and permanent lower cranial nerve morbidity was limited to 3 patients and did not compromise independent function in any of the patients. coNclusioNs PICA aneurysms receive the application of IC-IC bypass better than any other aneurysm, with nearly one-quarter of all PICA aneurysms treated microsurgically at our center requiring bypass without a single EC-IC bypass. The selection of PICA bypass is almost algorithmic: trapped aneurysms at the PICA origin or p1 segment are revasculari...

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Surgical Management of Fusiform Aneurysms of the Peripheral Posteroinferior Cerebellar Artery

Abstract: Fusiform, peripheral PICA aneurysms are rare lesions. Distal revascularization was used in most cases because of the uncertain adequacy of collateral supply. Careful, individualized management allows for a good outcome in the majority of cases.

Cited by 48 publications

References 17 publications

Intracranial Fusiform Aneurysms: It's Pathogenesis, Clinical Characteristics and Managements

Intracranial Fusiform Aneurysms: It's Pathogenesis, Clinical Characteristics and Managements

Endovascular treatment of fusiform cerebral aneurysms with the Pipeline Embolization Device

Intracranial-to-intracranial bypass for posterior inferior cerebellar artery aneurysms: options, technical challenges, and results in 35 patients

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