Outcomes of multidisciplinary treatment for posterior cerebral artery aneurysms

Yong Bae Kim, Jae Whan Lee, Seung Kon Huh, Byung Moon Kim, Dong Jun Kim

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Objective Posterior cerebral artery (PCA) aneurysms are rare and often challenging to manage. Since Drake's historical report regarding PCA aneurysms, there has been limited additional information on recent advancements in either microsurgical or endovascular tools. We report a series of 25 consecutive cases and attempt to extrapolate useful information for managing PCA aneurysms. Methods A total of 25 cases of PCA aneurysm that were treated either by microsurgical or endovascular methods were selected and retrospectively reviewed. The clinical data, radiographic findings, and outcomes associated with the treatment modality were analysed. Results The case series included 13 women and 12 men with a mean age of 52 years, ranging from 11 to 75 years. Fourteen aneurysms were ruptured, 7 aneurysms caused a direct mass effect, and the remaining 4 aneurysms were found incidentally. Most aneurysms were located in the P1 through P2A segment of the PCA (19 aneurysms, 76%). Seven aneurysms (28%) were large-giant in size (>20 mm), 4 of which had a thrombosed sac. Microsurgical treatment was the primary treatment in 15 aneurysms, including 9 successful direct clip ligations, 3 aneurysms that were surgically trapped without a bypass, and 2 wrapped aneurysms. One giant thrombosed aneurysm was incompletely clipped; subsequently, the large remnant was coil-embolised. Endovascular coil embolisation was performed for 6 aneurysms, stent-assisted coil embolisation was performed for 2 aneurysms, and 2 aneurysms were treated by endovascular occlusion of the parent artery. Permanent deficits acquired after treatment included limb weakness, palsy of the third cranial nerve, and hemianopsia in 5 cases (20%). There was no mortality. Overall, 22 patients (88%) showed favourable clinical outcomes according to the modified Rankin Scale Score (≤2) at the mean clinical follow-up period of 43.2 months (range: 2-130 months). Conclusions The present case series suggests that treating PCA aneurysms with microsurgical or endovascular options can achieve a comparable outcome when a judicious decision is made. Endovascular treatment had excellent anatomical and clinical outcomes for non-mass compressing, non-giant, saccular aneurysms. Given the propensity for the large-giant, dysplastic nature of PCA aneurysms to develop in younger patients, microsurgical competence should be maintained. Along with careful evaluation of the anatomic collaterals over the PCA territory, therapeutic parent artery sacrifice may be an appropriate option without adding bypass.

Original languageEnglish
Pages (from-to)2062-2068
Number of pages7
JournalClinical Neurology and Neurosurgery
Volume115
Issue number10
DOIs
Publication statusPublished - 2013 Oct 1

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Intracranial Aneurysm
Aneurysm
Thrombosis
Therapeutics
Arteries
Oculomotor Nerve
Posterior Cerebral Artery
Hemianopsia
Ruptured Aneurysm
Surgical Instruments
Paralysis
Mental Competency
Stents
Ligation
Extremities

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

Cite this

Kim, Yong Bae ; Lee, Jae Whan ; Huh, Seung Kon ; Kim, Byung Moon ; Kim, Dong Jun. / Outcomes of multidisciplinary treatment for posterior cerebral artery aneurysms. In: Clinical Neurology and Neurosurgery. 2013 ; Vol. 115, No. 10. pp. 2062-2068.
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title = "Outcomes of multidisciplinary treatment for posterior cerebral artery aneurysms",
abstract = "Objective Posterior cerebral artery (PCA) aneurysms are rare and often challenging to manage. Since Drake's historical report regarding PCA aneurysms, there has been limited additional information on recent advancements in either microsurgical or endovascular tools. We report a series of 25 consecutive cases and attempt to extrapolate useful information for managing PCA aneurysms. Methods A total of 25 cases of PCA aneurysm that were treated either by microsurgical or endovascular methods were selected and retrospectively reviewed. The clinical data, radiographic findings, and outcomes associated with the treatment modality were analysed. Results The case series included 13 women and 12 men with a mean age of 52 years, ranging from 11 to 75 years. Fourteen aneurysms were ruptured, 7 aneurysms caused a direct mass effect, and the remaining 4 aneurysms were found incidentally. Most aneurysms were located in the P1 through P2A segment of the PCA (19 aneurysms, 76{\%}). Seven aneurysms (28{\%}) were large-giant in size (>20 mm), 4 of which had a thrombosed sac. Microsurgical treatment was the primary treatment in 15 aneurysms, including 9 successful direct clip ligations, 3 aneurysms that were surgically trapped without a bypass, and 2 wrapped aneurysms. One giant thrombosed aneurysm was incompletely clipped; subsequently, the large remnant was coil-embolised. Endovascular coil embolisation was performed for 6 aneurysms, stent-assisted coil embolisation was performed for 2 aneurysms, and 2 aneurysms were treated by endovascular occlusion of the parent artery. Permanent deficits acquired after treatment included limb weakness, palsy of the third cranial nerve, and hemianopsia in 5 cases (20{\%}). There was no mortality. Overall, 22 patients (88{\%}) showed favourable clinical outcomes according to the modified Rankin Scale Score (≤2) at the mean clinical follow-up period of 43.2 months (range: 2-130 months). Conclusions The present case series suggests that treating PCA aneurysms with microsurgical or endovascular options can achieve a comparable outcome when a judicious decision is made. Endovascular treatment had excellent anatomical and clinical outcomes for non-mass compressing, non-giant, saccular aneurysms. Given the propensity for the large-giant, dysplastic nature of PCA aneurysms to develop in younger patients, microsurgical competence should be maintained. Along with careful evaluation of the anatomic collaterals over the PCA territory, therapeutic parent artery sacrifice may be an appropriate option without adding bypass.",
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Outcomes of multidisciplinary treatment for posterior cerebral artery aneurysms. / Kim, Yong Bae; Lee, Jae Whan; Huh, Seung Kon; Kim, Byung Moon; Kim, Dong Jun.

In: Clinical Neurology and Neurosurgery, Vol. 115, No. 10, 01.10.2013, p. 2062-2068.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Outcomes of multidisciplinary treatment for posterior cerebral artery aneurysms

AU - Kim, Yong Bae

AU - Lee, Jae Whan

AU - Huh, Seung Kon

AU - Kim, Byung Moon

AU - Kim, Dong Jun

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N2 - Objective Posterior cerebral artery (PCA) aneurysms are rare and often challenging to manage. Since Drake's historical report regarding PCA aneurysms, there has been limited additional information on recent advancements in either microsurgical or endovascular tools. We report a series of 25 consecutive cases and attempt to extrapolate useful information for managing PCA aneurysms. Methods A total of 25 cases of PCA aneurysm that were treated either by microsurgical or endovascular methods were selected and retrospectively reviewed. The clinical data, radiographic findings, and outcomes associated with the treatment modality were analysed. Results The case series included 13 women and 12 men with a mean age of 52 years, ranging from 11 to 75 years. Fourteen aneurysms were ruptured, 7 aneurysms caused a direct mass effect, and the remaining 4 aneurysms were found incidentally. Most aneurysms were located in the P1 through P2A segment of the PCA (19 aneurysms, 76%). Seven aneurysms (28%) were large-giant in size (>20 mm), 4 of which had a thrombosed sac. Microsurgical treatment was the primary treatment in 15 aneurysms, including 9 successful direct clip ligations, 3 aneurysms that were surgically trapped without a bypass, and 2 wrapped aneurysms. One giant thrombosed aneurysm was incompletely clipped; subsequently, the large remnant was coil-embolised. Endovascular coil embolisation was performed for 6 aneurysms, stent-assisted coil embolisation was performed for 2 aneurysms, and 2 aneurysms were treated by endovascular occlusion of the parent artery. Permanent deficits acquired after treatment included limb weakness, palsy of the third cranial nerve, and hemianopsia in 5 cases (20%). There was no mortality. Overall, 22 patients (88%) showed favourable clinical outcomes according to the modified Rankin Scale Score (≤2) at the mean clinical follow-up period of 43.2 months (range: 2-130 months). Conclusions The present case series suggests that treating PCA aneurysms with microsurgical or endovascular options can achieve a comparable outcome when a judicious decision is made. Endovascular treatment had excellent anatomical and clinical outcomes for non-mass compressing, non-giant, saccular aneurysms. Given the propensity for the large-giant, dysplastic nature of PCA aneurysms to develop in younger patients, microsurgical competence should be maintained. Along with careful evaluation of the anatomic collaterals over the PCA territory, therapeutic parent artery sacrifice may be an appropriate option without adding bypass.

AB - Objective Posterior cerebral artery (PCA) aneurysms are rare and often challenging to manage. Since Drake's historical report regarding PCA aneurysms, there has been limited additional information on recent advancements in either microsurgical or endovascular tools. We report a series of 25 consecutive cases and attempt to extrapolate useful information for managing PCA aneurysms. Methods A total of 25 cases of PCA aneurysm that were treated either by microsurgical or endovascular methods were selected and retrospectively reviewed. The clinical data, radiographic findings, and outcomes associated with the treatment modality were analysed. Results The case series included 13 women and 12 men with a mean age of 52 years, ranging from 11 to 75 years. Fourteen aneurysms were ruptured, 7 aneurysms caused a direct mass effect, and the remaining 4 aneurysms were found incidentally. Most aneurysms were located in the P1 through P2A segment of the PCA (19 aneurysms, 76%). Seven aneurysms (28%) were large-giant in size (>20 mm), 4 of which had a thrombosed sac. Microsurgical treatment was the primary treatment in 15 aneurysms, including 9 successful direct clip ligations, 3 aneurysms that were surgically trapped without a bypass, and 2 wrapped aneurysms. One giant thrombosed aneurysm was incompletely clipped; subsequently, the large remnant was coil-embolised. Endovascular coil embolisation was performed for 6 aneurysms, stent-assisted coil embolisation was performed for 2 aneurysms, and 2 aneurysms were treated by endovascular occlusion of the parent artery. Permanent deficits acquired after treatment included limb weakness, palsy of the third cranial nerve, and hemianopsia in 5 cases (20%). There was no mortality. Overall, 22 patients (88%) showed favourable clinical outcomes according to the modified Rankin Scale Score (≤2) at the mean clinical follow-up period of 43.2 months (range: 2-130 months). Conclusions The present case series suggests that treating PCA aneurysms with microsurgical or endovascular options can achieve a comparable outcome when a judicious decision is made. Endovascular treatment had excellent anatomical and clinical outcomes for non-mass compressing, non-giant, saccular aneurysms. Given the propensity for the large-giant, dysplastic nature of PCA aneurysms to develop in younger patients, microsurgical competence should be maintained. Along with careful evaluation of the anatomic collaterals over the PCA territory, therapeutic parent artery sacrifice may be an appropriate option without adding bypass.

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