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Summary:The aim of this study was to determine age-related differences in outcome between clipping and coiling in patients with intracranial aneurysms. We retrospectively analyzed 377 consecutive patients (clipping, 304 cases and coiling, 73 cases) dividing them into four groups based on age as follows: <50 years, 50 to 59 years, 60 to 69 years, and ≥70 years. Outcomes were assessed in the perioperative period and 1 year later. Of the cases with perioperative symptomatic events, 7 (2.3%), including 4 cases (1.3%) of symptomatic ischemic stroke, were treated with clipping and none was treated with coiling. All cases of symptomatic perioperative ischemic stroke after clipping occurred in patients aged 60 years (p = 0.027). Events at 1 year occurred only after clipping in 10 cases (3.3%) and after coiling in none of the cases. Eight of 10 patients had chronic subdural hematoma, and all of them were >60 years old (p = 0.028). Favorable outcome was observed for both clipping and coiling in both age groups. Clipping was related to risks of perioperative ischemic stroke and chronic subdural hematoma within 1 year in patients >60 years of age.

BACKGROUND Unlike in aneurysms of the adult-type posterior cerebral artery (PCA), in aneurysms of the fetal-type PCA, parent artery occlusion (PAO) results in vascular insufficiency and major ischemic strokes. Preservation or reconstruction of fetal-type PCAs is necessary to prevent these complications. Furthermore, it is necessary to select an appropriate bypass method and approach for revascularization of the PCA. OBSERVATIONS The authors report 2 cases of aneurysms of fetal-type PCAs that were successfully treated with PAO with revascularization. A 38-year-old man with a large unruptured right PCA aneurysm at the postcommunicating (P2) segment underwent trapping with superficial temporal artery–PCA bypass via the anterior temporal and subtemporal approaches. In addition, a 45-year-old woman with a left PCA aneurysm at the quadrigeminal (P3)–cortical (P4) segments resulting in subarachnoid hemorrhage underwent proximal clipping of the P3 segment via the occipital interhemispheric approach with an occipital artery–PCA bypass. Although she had perforator infarction, major ischemic stroke was prevented, and aneurysm occlusion was accomplished in both cases. LESSONS Aneurysms of fetal-type PCAs pose a risk of ischemia due to PAO. The combined use of bypass and revascularization should be considered to prevent major ischemic stroke after occlusion of the fetal-type PCA. However, perforator infarction is a concern.