Microneurosurgical Management of Posterior Communicating Artery Aneurysm: A Contemporary Series from Helsinki

Thiarawat, Peeraphong; Jahromi, Behnam Rezai; Kozyrev, Danil A.; Intarakhao, Patcharin; Teo, Mario; Choque-Velasquez, Joham; Hernesniemi, Juha

doi:10.1016/j.wneu.2017.02.033

Cited by 14 publications

(14 citation statements)

References 33 publications

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“…[ 22 23 ] However, the relationship between a fetal type of PCoA and risk of rupture is poorly documented. It is often argued that the fetal type is prone to IA formation and is likely to cause rupture risk;[ 20 24 ] this study showed that with respect to ruptured SIAs, the nonfetal type of PCoA was associated with rupture. Cebral et al .…”

Section: Discussionmentioning

confidence: 68%

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Clinical and morphological characteristics of ruptured small (<5 mm) posterior communicating artery aneurysms

et al. 2021

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Context: Small intracranial aneurysms (IAs) are considered to have a low risk of rupture; however, in clinical practice, we often encounter patients with subarachnoid hemorrhage (SAH) due to rupture of small IAs. Aims: This study aims to clarify the clinical and morphological characteristics of ruptured small IA, focusing on posterior communicating artery (PCoA) aneurysms as a prone site. Settings and Design: We retrospectively reviewed 102 consecutive patients with SAH due to ruptured PCoA aneurysm who underwent microsurgical or endovascular aneurysm repair between April 2013 and March 2018. Subjects and Methods: All PCoA aneurysms were diagnosed using three-dimensional rotation angiography or three-dimensional computed tomography angiography. Information regarding the following clinical characteristics was collected: age, sex, past medical history, current smoking, antithrombotic therapy, multiplicity, hydrocephalus, intracerebral hemorrhage, intraventricular hemorrhage, and World Federation of Neurosurgical Societies (WFNS) Grade on admission. Statistical Analysis Used: We analyzed factors of ruptured small IA, focusing on PCoA aneurysms using univariate and multivariate regression analyses. Results: Univariate and multivariate analyses revealed that low aspect ratio (AR) (odds ratio [OR] = 0.33, P = 0.01) and nonfetal type of PCoA (OR = 0.31, P = 0.02) might be independent characteristics of ruptured small PCoA aneurysms. However, age, sex, past medical history, WFNS grade, and treatment outcome were not different between the small and nonsmall PCoA aneurysms. The aneurysm size was not associated to the selection of treatment, proportion of complications, and treatment outcome. Conclusions: In cases of ruptured PCoA aneurysms, low AR and nonfetal type of PCoA might be associated with rupture of small aneurysms.

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Section: Discussionmentioning

confidence: 68%

“…[ 17 18 19 ] Thus, a higher AR seems to reflect a lower intra-aneurysmal blood flow and subsequently a higher risk of rupture, and the same applies to SIA. [ 14 20 ]…”

Section: Discussionmentioning

confidence: 99%

Clinical and morphological characteristics of ruptured small (<5 mm) posterior communicating artery aneurysms

et al. 2021

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“…At this point, to allow visualization of the PCOMM it was necessary to do a proximal opening of the Sylvian fissure, to reveal the carotid-oculomotor window (CoW). As previously reported, 3 temporal lobe retraction should be avoided to prevent aneurysm rupture. Pilot clipping with a 9 mm straight clip was performed (►Fig.…”

Section: Surgical Techniquementioning

confidence: 64%

“…1 Compromise of a fetaltype posterior communicating artery (PCOMM) or its perforators by surgical clipping could result in posterior circulation infarction and neurological morbidity. 2,3 The technical considerations in the treatment of a patient with a PCOMM aneurysm with lateral projection and a fetal-type PCOMM artery are presented.…”

Section: Introductionmentioning

confidence: 99%

Surgery of a Posterior Communicating Artery Aneurysm with Fetal-Type Circulation

et al. 2018

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Inadvertent occlusion of a fetal-type posterior communicating artery in aneurysm surgery could result in posterior circulation infarction and neurological morbidity. The case of a patient with an unruptured posterior communicating artery aneurysm with lateral projection and a fetal-type posterior communicating artery is presented. The utility of the carotid-oculomotor window as a surgical corridor to safely find the fetal-type posterior communicating artery is discussed.

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“…Previous studies on the treatment of ruptured PCoA aneurysms have mainly reported a moderate number of lacunar infarctions (5%) and severe bleeding or delayed cerebral vasospasm-related neurological complications (7%), but only two ICA or MCA occlusions have been documented by the previously largest study and none by the other studies. 9,33,37,39 We also saw occlusive treatment-related infarctions among initially good-grade patients. These complications occurred throughout the follow-up period.…”

Section: Resultsmentioning

confidence: 87%

Riskier-than-expected occlusive treatment of ruptured posterior communicating artery aneurysms: treatment and outcome of 620 consecutive patients

Huhtakangas¹,

Lehečka²,

Lehto³

et al. 2019

Journal of Neurosurgery

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OBJECTIVEOcclusive treatment of posterior communicating artery (PCoA) aneurysms has been seen as a fairly uncomplicated procedure. The objective here was to determine the radiological and clinical outcome of patients after PCoA aneurysm rupture and treatment and to evaluate the risk factors for impaired outcome.METHODSIn a retrospective clinical follow-up study, data were collected from 620 consecutive patients who had been treated for ruptured PCoA aneurysms at a single center between 1980 and 2014. The follow-up was a minimum of 1 year after treatment or until death.RESULTSOf the 620 patients, 83% were treated with microsurgical clipping, 8% with endovascular coiling, 2% with the two procedures combined, 1% with indirect surgical methods, and 6% with conservative methods. The most common procedural complications were treatment-related brain infarctions (15%). The occurrence of artery occlusions (10% microsurgical, 8% endovascular) was higher than expected. Most patients made a good recovery at 1 year after aneurysmal subarachnoid hemorrhage (modified Rankin Scale [mRS] score 0–2: 386 patients [62%]). A fairly small proportion of patients were left severely disabled (mRS score 4–5: 27 patients [4%]). Among all patients, 20% died during the 1st year. Independent risk factors for an unfavorable outcome, according to the multivariable analysis, were poor preoperative clinical condition, intracerebral or subdural hematoma due to aneurysm rupture, age over 65 years, artery occlusion on postoperative angiography, occlusive treatment–related ischemia, delayed cerebral vasospasm, and hydrocephalus requiring a shunt.CONCLUSIONSEven though most patients made a good recovery after PCoA aneurysm rupture and treatment during the 1st year, the occlusive treatment–related complications were higher than expected and caused morbidity even among initially good-grade patients. Occlusive treatment of ruptured PCoA aneurysms seems to be a high-risk procedure, even in a high-volume neurovascular center.

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Microneurosurgical Management of Posterior Communicating Artery Aneurysm: A Contemporary Series from Helsinki

Cited by 14 publications

References 33 publications

Clinical and morphological characteristics of ruptured small (<5 mm) posterior communicating artery aneurysms

Clinical and morphological characteristics of ruptured small (<5 mm) posterior communicating artery aneurysms

Surgery of a Posterior Communicating Artery Aneurysm with Fetal-Type Circulation

Riskier-than-expected occlusive treatment of ruptured posterior communicating artery aneurysms: treatment and outcome of 620 consecutive patients

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