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Outcomes of multidisciplinary treatment for posterior cerebral artery aneurysms

 Yong Bae Kim  ;  Jae Whan Lee  ;  Seung-Kon Huh  ;  Byung Moon Kim  ;  Dong Jun Kim 
 CLINICAL NEUROLOGY AND NEUROSURGERY, Vol.115(10) : 2062-2068, 2013 
Journal Title
Issue Date
Adolescent ; Adult ; Aged ; Cerebral Angiography ; Child ; Embolization, Therapeutic ; Female ; Follow-Up Studies ; Humans ; Intracranial Aneurysm/surgery ; Intracranial Aneurysm/therapy* ; Magnetic Resonance Angiography ; Male ; Microsurgery ; Middle Aged ; Neurosurgical Procedures ; Patient Care Team ; Posterior Cerebral Artery* ; Retrospective Studies ; Treatment Outcome ; Young Adult
Cerebral aneurysm ; Coil embolisation ; Microsurgery ; Parent artery occlusion ; Posterior cerebral artery
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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1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Neurosurgery (신경외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Dong Joon(김동준) ORCID logo https://orcid.org/0000-0002-7035-087X
Kim, Byung Moon(김병문) ORCID logo https://orcid.org/0000-0001-8593-6841
Kim, Yong Bae(김용배) ORCID logo https://orcid.org/0000-0003-2262-7157
Lee, Jae Whan(이재환)
Huh, Seung Kon(허승곤)
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