Flow diversion for the treatment of posterior inferior cerebellar artery aneurysms: a novel classification and strategies

Srinivasan, Visish M.; Ghali, Michael George Zaki; Reznik, Oleg E.; Cherian, Jacob; Mokin, Maxim; Dumont, Travis M.; Gaughen, John R.; Grandhi, Ramesh; Puri, Ajit S; Chen, Stephen R.; Johnson, Jeremiah N.; Kan, Peter

doi:10.1136/neurintsurg-2017-013427

Cited by 43 publications

(40 citation statements)

References 34 publications

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“…[18] In three cases of PICA aneurysms treated with FD stents placed wholly within PICA, no patients suffered stroke. [4]…”

Section: Perforator Systemmentioning

confidence: 99%

“…In a previous series, we classified PICA aneurysms according to (1) morphology and (2) location. [4] Saccular and fusiform aneurysms were designated as Types 1 and 2, respectively. Saccular aneurysms involving the PICA–VA junction or those on the proximal 5 mm of PICA were designated as Type 1a and 2a and those located distally as Type 1b and 2b.…”

Section: Perforator Systemmentioning

confidence: 99%

“…[123] Optimization of PICA aneurysm treatment is thus facilitated by an intimate appreciation for these relationships and precise characterization of lesional angioarchitecture. [4]…”

Section: Introductionmentioning

confidence: 99%

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Posteroinferior cerebellar artery aneurysms: Influence of angioanatomy on the safety of flow diversion treatment

et al. 2019

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Several anatomical variables critically influence therapeutic strategies for posteroinferior cerebellar artery (PICA) aneurysms and, specifically, the safety of flow diversion for these lesions. We review the microsurgical anatomy of the PICA, discussing and detailing these considerations in the treatment of aneurysms of this vessel from a theoretical perspective and in light of our previously published clinical results.

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“…[18] In three cases of PICA aneurysms treated with FD stents placed wholly within PICA, no patients suffered stroke. [4]…”

Section: Perforator Systemmentioning

confidence: 99%

Section: Perforator Systemmentioning

confidence: 99%

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Posteroinferior cerebellar artery aneurysms: Influence of angioanatomy on the safety of flow diversion treatment

et al. 2019

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“…The choice of treatment for VA and PICA aneurysms (microsurgical or endovascular surgery) remains controversial. [3,5,21,23,25,26]…”

Section: Introductionmentioning

confidence: 99%

Vertebral artery and posterior inferior cerebellar artery aneurysms: Results of microsurgical treatment of eighty patients

Pilipenko¹,

Eliava²,

Okishev³

et al. 2019

Surgical Neurology International

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Background: The choice of surgical approaches and options for the microsurgical vertebral artery (VA) and posterior inferior cerebellar artery (PICA) aneurysms repair remains controversial. Methods: A retrospective analysis of the clinical, surgical, and angiographic data of 80 patients with VA and PICA aneurysms treated from 2012 to 2018 was performed. Results: The aneurysms were saccular in 50 cases (62.5%) and fusiform in 30 cases (37.5%). The median suboccipital craniotomy was the most common approach (73.8%). Retrosigmoid craniotomy was performed in 25% of patients. There were the following types of microsurgical operations: neck clipping (61.25%), clipping with the artery lumen formation (13.75%), trapping (10%), proximal clipping (5%), and deconstruction with anastomosis (10%). Fifty-seven (71.3%) patients were discharged without worsening of the clinical signs after surgery. The most common postoperative neurological disorder was palsy of IX and X cranial nerve revealed in 14 (17.5%) patients. No fatal outcomes or patients in vegetative state were identified. The complete occlusion of PICA and VA aneurysms according angiography was in 77 (96.3%) cases. Conclusion: Microsurgical treatment is an effective method for VA and PICA aneurysms. The majority of VA and PICA aneurysms do not require complex basal approaches. A thorough preoperative planning, reconstructive clipping techniques, and anastomoses creation, as well as patient selection based on the established algorithms and consultations with endovascular surgeons, may reduce the number of complications and increase the rate of complete microsurgical occlusion in VA and PICA aneurysms.

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“…Appearance of low-profile intracranial stents-both flow diverters and assisting ones-let us use stenting within PICA itself, if the diameter of vessel is appropriate. [4][5][6] During evaluation of any new PICA aneurysm, we should consider an optimal tactics among this wide variety of options, regarding anatomical characteristics of the aneurysm itself, parent arteries, and clinical presentation.…”

mentioning

confidence: 99%

Personalized Approach to the Treatment of Posterior Inferior Cerebellar Artery Aneurysms

Aronov

2020

JNRP

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Flow diversion for the treatment of posterior inferior cerebellar artery aneurysms: a novel classification and strategies

Abstract: The PED may be used successfully to treat select aneurysms of the PICA. We present the first described cases of successful PED treatment of PICA aneurysms with direct placement of the PED in the PICA vessel itself. The proposed classification system aids in that selection.

Cited by 43 publications

References 34 publications

Posteroinferior cerebellar artery aneurysms: Influence of angioanatomy on the safety of flow diversion treatment

Posteroinferior cerebellar artery aneurysms: Influence of angioanatomy on the safety of flow diversion treatment

Vertebral artery and posterior inferior cerebellar artery aneurysms: Results of microsurgical treatment of eighty patients

Personalized Approach to the Treatment of Posterior Inferior Cerebellar Artery Aneurysms

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