Unruptured Intradural Posterior Circulation Dissecting/Fusiform Aneurysms Natural History and Treatment Outcome

Background The natural history and outcome of unruptured posterior circulation dissecting fusiform aneurysms is not fully understood. These have a high risk of morbidity and mortality, not only due to natural history but also due to the challenging and controversial treatment approaches currently available compared to other types of intracranial aneurysms. Methods We performed a retrospective study of a prospectively collected aneurysm database at a quaternary neurovascular hospital. We included consecutive patients with unruptured intradural vertebrobasilar dissecting aneurysms between January 2000 and July 2016 who were followed to 2020. Description of baseline, procedural, and outcomes data was performed. Comparisons of patient who had aneurysm rupture on follow-up, increase in 2 or more points of mRS in follow-up and progression of the aneurysm was performed. Results Seventy patients with 78 fusiform posterior circulation aneurysms were identified. Thirty-nine (55.7%) patients were male with a mean age of 51.7 years (SD ± 17.6). When multiple, aneurysms were more likely to be fusiform (60%) than saccular (40.0%). Baseline diameter (measured on CTA/MRA/DSA), length as well as symptomatic presentation were significantly higher in aneurysms which grew over time. Coronary disease, diabetes and growth were associated an >2 increase in mRS. Diabetes as well as initial symptomatic presentation were associated with rupture. Conclusions Unruptured dissecting/fusiform aneurysm are associated with a considerable rate of rupture during follow-up. Growth is associated with morbidity even in the absence of rupture. Initial large size, coronary disease, diabetes, and to a lesser extent female gender may merit closer follow-up and/or prophylactic treatment.

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Assessing the rate, natural history, and treatment trends of intracranial aneurysms in patients with intracranial dural arteriovenous fistulas: a Consortium for Dural Arteriovenous Fistula Outcomes Research (CONDOR) investigation

Journal of Neurosurgery ◽

10.3171/2021.1.jns202861 ◽

2021 ◽

pp. 1-10

Author(s):

Isaac Josh Abecassis ◽

R. Michael Meyer ◽

Michael R. Levitt ◽

Jason P. Sheehan ◽

Ching-Jen Chen ◽

...

Keyword(s):

Natural History ◽

Arteriovenous Fistula ◽

Outcomes Research ◽

Intracranial Aneurysms ◽

Dural Arteriovenous Fistula ◽

Aneurysm Rupture ◽

External Carotid ◽

Arteriovenous Fistulas ◽

Dural Arteriovenous Fistulas

OBJECTIVE There is a reported elevated risk of cerebral aneurysms in patients with intracranial dural arteriovenous fistulas (dAVFs). However, the natural history, rate of spontaneous regression, and ideal treatment regimen are not well characterized. In this study, the authors aimed to describe the characteristics of patients with dAVFs and intracranial aneurysms and propose a classification system. METHODS The Consortium for Dural Arteriovenous Fistula Outcomes Research (CONDOR) database from 12 centers was retrospectively reviewed. Analysis was performed to compare dAVF patients with (dAVF+ cohort) and without (dAVF-only cohort) concomitant aneurysm. Aneurysms were categorized based on location as a dAVF flow-related aneurysm (FRA) or a dAVF non–flow-related aneurysm (NFRA), with further classification as extra- or intradural. Patients with traumatic pseudoaneurysms or aneurysms with associated arteriovenous malformations were excluded from the analysis. Patient demographics, dAVF anatomical information, aneurysm information, and follow-up data were collected. RESULTS Of the 1077 patients, 1043 were eligible for inclusion, comprising 978 (93.8%) and 65 (6.2%) in the dAVF-only and dAVF+ cohorts, respectively. There were 96 aneurysms in the dAVF+ cohort; 10 patients (1%) harbored 12 FRAs, and 55 patients (5.3%) harbored 84 NFRAs. Dural AVF+ patients had higher rates of smoking (59.3% vs 35.2%, p < 0.001) and illicit drug use (5.8% vs 1.5%, p = 0.02). Sixteen dAVF+ patients (24.6%) presented with aneurysm rupture, which represented 16.7% of the total aneurysms. One patient (1.5%) had aneurysm rupture during follow-up. Patients with dAVF+ were more likely to have a dAVF located in nonconventional locations, less likely to have arterial supply to the dAVF from external carotid artery branches, and more likely to have supply from pial branches. Rates of cortical venous drainage and Borden type distributions were comparable between cohorts. A minority (12.5%) of aneurysms were FRAs. The majority of the aneurysms underwent treatment via either endovascular (36.5%) or microsurgical (15.6%) technique. A small proportion of aneurysms managed conservatively either with or without dAVF treatment spontaneously regressed (6.2%). CONCLUSIONS Patients with dAVF have a similar risk of harboring a concomitant intracranial aneurysm unrelated to the dAVF (5.3%) compared with the general population (approximately 2%–5%) and a rare risk (0.9%) of harboring an FRA. Only 50% of FRAs are intradural. Dural AVF+ patients have differences in dAVF angioarchitecture. A subset of dAVF+ patients harbor FRAs that may regress after dAVF treatment.

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Endovascular treatment of ruptured posterior circulation aneurysms using electrolytically detachable coils

Journal of Neurosurgery ◽

10.3171/jns.1997.87.3.0374 ◽

1997 ◽

Vol 87 (3) ◽

pp. 374-380 ◽

Cited By ~ 90

Author(s):

Douglas A. Nichols ◽

Robert D. Brown ◽

Kent R. Thielen ◽

Fredric B. Meyer ◽

John L. D. Atkinson ◽

...

Keyword(s):

Endovascular Treatment ◽

Balloon Occlusion ◽

Additional Treatment ◽

Posterior Circulation ◽

Parent Artery ◽

Content Type ◽

Detachable Coils ◽

Posterior Circulation Aneurysms ◽

Fine Print

✓ The authors report their experience using electrolytically detachable coils for the treatment of ruptured posterior circulation aneurysms. Twenty-six patients with 28 posterior circulation aneurysms were treated. All patients were referred for endovascular treatment by experienced vascular neurosurgeons. Patients underwent follow-up angiography immediately after treatment, 1 to 6 weeks posttreatment, and 6 months posttreatment. Six-month follow-up angiograms obtained in 19 patients with 20 aneurysms demonstrated that 18 (90%) of the 20 aneurysms were 99 to 100% occluded, one aneurysm (5%) was approximately 90% occluded, and one aneurysm (5%) was approximately 75% occluded. The patient with the aneurysm that was approximately 75% occluded needed additional treatment, consisting of parent artery balloon occlusion, and was considered a treatment failure (3.8% of patients). There was one treatment-associated mortality (3.8%) but no treatment-associated serious neurological or nonneurological morbidity in the patient group. There was no recurrent aneurysm rupture during treatment or during the mean 27-month follow-up period. Endovascular treatment of ruptured posterior circulation aneurysms with electrolytically detachable coils can be accomplished with low morbidity and mortality rates. The primary goal of treatment—preventing recurrent aneurysm—can be achieved over the short term. Endovascular coil occlusion will play an important role in the treatment of ruptured posterior circulation aneurysms, particularly if long-term efficacy in preventing recurrent aneurysm hemorrhage can be documented.

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The safety of Pipeline flow diversion in fusiform vertebrobasilar aneurysms: a consecutive case series with longer-term follow-up from a single US center

Journal of Neurosurgery ◽

10.3171/2015.6.jns1565 ◽

2016 ◽

Vol 125 (1) ◽

pp. 111-119 ◽

Cited By ~ 58

Author(s):

Sabareesh K. Natarajan ◽

Ning Lin ◽

Ashish Sonig ◽

Ansaar T. Rai ◽

Jeffrey S. Carpenter ◽

...

Keyword(s):

Case Series ◽

Dissecting Aneurysm ◽

Posterior Circulation ◽

Flow Diversion ◽

Single Center Experience ◽

Vertebrobasilar Artery ◽

Delayed Hemorrhage ◽

Posterior Circulation Aneurysms ◽

Previously Treated

OBJECT Pessimism exists regarding flow diversion for posterior circulation aneurysms because of reports of perforator territory infarcts and delayed ruptures. The authors report the results of patients who underwent Pipeline Embolization Device (PED) flow diversion using novel strategies for treatment of fusiform posterior circulation aneurysms, and compare these results with those from previously reported series. METHODS The authors conducted a retrospective review of data from consecutive patients with fusiform vertebrobasilar artery aneurysms treated with the PED. RESULTS This review resulted in the identification of 12 such patients (mean [± SD] age 55.1 ± 14.1 years). Eleven patients had symptoms; 1 had a dissecting aneurysm identified on imaging for neck pain. The average aneurysm size was 13.25 ± 4.5 mm. None of the aneurysms were ruptured or previously treated. The average clinical follow-up duration was 22.1 ± 10.7 months and radiological follow-up was 14.5 ± 11.1 months from the index PED treatment. One patient suffered a perforator stroke and had a modified Rankin Scale (mRS) score of 4 at last follow-up. Another patient had a retained stent pusher requiring retrieval via surgical cut-down but recovered to an mRS score of 0 at last follow-up. Eleven (91.7%) of 12 patients recovered to an mRS score of 0 or 1. Two patients had aneurysmal remnants at 7 and 10 months, respectively, after the index PED, which were retreated with PEDs. At last follow-up, all 12 aneurysms were occluded and PEDs were patent. The minimum follow-up duration was 12 months from the index PED treatment; no patient experienced delayed hemorrhage, stroke, or in-stent stenosis. CONCLUSIONS Flow diversion with selective adjunctive techniques is evolving to become a safer treatment option for posterior circulation aneurysms. This is the longest clinical follow-up duration reported for a single-center experience of flow-diversion treatment of these aneurysms.

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Abstract WMP30: Risk Analysis Of Growth And Rupture In Unruptured Intreacranial Aneurysms : Single Institutional Cohort Study

Stroke ◽

10.1161/str.44.suppl_1.awmp30 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Yuichi Murayama ◽

Toshihiro Ishibashi ◽

Hiroyuki Takao ◽

Ichiro Yuki ◽

Hideki Arakawa ◽

...

Keyword(s):

Computed Tomography ◽

Three Dimensional ◽

Aneurysm Rupture ◽

Posterior Circulation ◽

Single Center ◽

Risk Of Rupture ◽

Aneurysm Growth ◽

The Mean ◽

Small Aneurysms

Introduction: Risk of growth and rupture in unruptured intracranial saccular aneurysm (UIA) are still unclear. Hypothesis: Gowth and risk of UIA may be correlated and they were evaluated our single center large cohort. Methods: Between January 2003 and March 2011, a total of 2122 patients with 2756 UIA were referred to our institution. 1403 patients with 2037 UIAs were assigned for conservative management. The mean follow up duration was 6201 aneurysm-years. Bi-annual three-dimensional computed tomography angiography (3D CTA) was performed and aneurysm growth was evaluated using 3D workstation. The aneurysm growth was defined as size increase more than 1mm. Results: During observation, 14.6% aneurysms increased their size. Female and male growth rate were 16% and 11% respectively. 130 patients stopped observation and therapeutic intervention was performed due to increase their size or anxiety. During observation 50 UIAs ruptured resulting in a 0.8% rupture rate per year. Aneurysm growth, IC-pcom aneurysms, posterior circulation, female, and SAH associated multiple aneurysms were risk factor for aneurysm rupture. Growing aneurysm was 10 times higher relative risk of rupture compare to stable aneurysm. No aneurysm demonstrated reduction of their size after rupture. Conclusions: Risk of Aneurysm growth and rupture may be correlated. Risk of rupture of UIAs was similar that was reported before but even small aneurysms can be rupture during observation. Growing UIAs should be considered to treat as soon as possible even in small size.

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Pipeline embolization of posterior circulation aneurysms: a multicenter study of 131 aneurysms

Journal of Neurosurgery ◽

10.3171/2017.9.jns171376 ◽

2019 ◽

Vol 130 (3) ◽

pp. 923-935 ◽

Cited By ~ 18

Author(s):

Christoph J. Griessenauer ◽

Christopher S. Ogilvy ◽

Nimer Adeeb ◽

Adam A. Dmytriw ◽

Paul M. Foreman ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Multicenter Study ◽

Complication Rate ◽

Posterior Circulation ◽

Major Complications ◽

Lower Complication ◽

Posterior Circulation Aneurysms ◽

Occlusion Rate ◽

Dissecting Aneurysms ◽

Saccular Aneurysms

OBJECTIVEFlow diversion for posterior circulation aneurysms performed using the Pipeline embolization device (PED) constitutes an increasingly common off-label use for otherwise untreatable aneurysms. The safety and efficacy of this treatment modality has not been assessed in a multicenter study.METHODSA retrospective review of prospectively maintained databases at 8 academic institutions was performed for the years 2009 to 2016 to identify patients with posterior circulation aneurysms treated with PED placement.RESULTSA total of 129 consecutive patients underwent 129 procedures to treat 131 aneurysms; 29 dissecting, 53 fusiform, and 49 saccular lesions were included. At a median follow-up of 11 months, complete and near-complete occlusion was recorded in 78.1%. Dissecting aneurysms had the highest occlusion rate and fusiform the lowest. Major complications were most frequent in fusiform aneurysms, whereas minor complications occurred most commonly in saccular aneurysms. In patients with saccular aneurysms, clopidogrel responders had a lower complication rate than did clopidogrel nonresponders. The majority of dissecting aneurysms were treated in the immediate or acute phase following subarachnoid hemorrhage, a circumstance that contributed to the highest mortality rate in those aneurysms.CONCLUSIONSIn the largest series to date, fusiform aneurysms were found to have the lowest occlusion rate and the highest frequency of major complications. Dissecting aneurysms, frequently treated in the setting of subarachnoid hemorrhage, occluded most often and had a low complication rate. Saccular aneurysms were associated with predominantly minor complications, particularly in clopidogrel nonresponders.

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Trapped Fourth Ventricle Phenomenon Following Aneurysm Rupture of the Posterior Circulation

Neurosurgery ◽

10.1227/neu.0b013e31822abf95 ◽

2011 ◽

Vol 70 (1) ◽

pp. 253-258 ◽

Cited By ~ 4

Author(s):

Manuel Ferreira ◽

Brian V. Nahed ◽

Maya A. Babu ◽

Brian P. Walcott ◽

Richard G. Ellenbogen ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Fourth Ventricle ◽

Case Series ◽

Aneurysm Rupture ◽

Posterior Circulation ◽

Shunt System ◽

Cerebrospinal Fluid Diversion ◽

Isolated Fourth Ventricle ◽

Posterior Circulation Aneurysms ◽

Trapped Fourth Ventricle

Abstract BACKGROUND AND IMPORTANCE Cerebral ventricular noncommunication has been described in the setting of infection and acutely in the setting of intracranial hemorrhage. We describe the first adult case series of individuals who developed delayed isolated fourth ventricles after rupture of intracranial posterior circulation aneurysms and define treatment modality. CLINICAL PRESENTATION A retrospective review was performed of all patients with aneurysms treated at a single institution from 2005 to 2009. Both microsurgical obliteration and endovascular cases were queried. Of 1044 aneurysms treated in this period, 3 patients were identified who required fourth ventricular shunting, for the treatment of the isolated ventricle. All 3 patients underwent microsurgical clip obliteration of their aneurysms and had subsequent frontal approach ventriculoperitoneal cerebrospinal fluid diversion. These patients had no evidence of infection of the cerebrospinal fluid as measured by serial cultures. Subsequently, all 3 patients presented in a delayed fashion with symptoms attributable to a dilated fourth ventricle and syringomyelia or syringobulbia. Either exploration or percutaneous tapping confirmed the function of the supratentorial shunt. These patients then underwent fourth ventriculoperitoneal cerebrospinal fluid diversion by the use of a low-pressure shunt system. The symptoms attributable to the isolated fourth ventricle resolved rapidly in all 3 patients after shunting. This clinical improvement correlated with the fourth ventricular size. CONCLUSION Isolated fourth ventricle, in an adult, is a rare phenomenon associated with intracranial posterior circulation aneurysm rupture treated with microsurgical clip obliteration. Fourth ventriculoperitoneal cerebrospinal fluid diversion is effective at resolving the symptoms attributed to the trapped ventricle and associated syrinx.

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ENDOVASCULAR COIL EMBOLIZATION OF RUPTURED AND UNRUPTURED POSTERIOR CIRCULATION ANEURYSMS

Neurosurgery ◽

10.1227/01.neu.0000255433.47044.8f ◽

2007 ◽

Vol 60 (4) ◽

pp. 626-637 ◽

Cited By ~ 104

Author(s):

Aditya S. Pandey ◽

Christopher Koebbe ◽

Robert H. Rosenwasser ◽

Erol Veznedaroglu

Keyword(s):

Subarachnoid Hemorrhage ◽

Clinical Outcome ◽

Coil Embolization ◽

Glasgow Outcome Scale ◽

Posterior Circulation ◽

Biologically Active ◽

Cerebellar Artery ◽

Posterior Circulation Aneurysms ◽

Endovascular Coil Embolization

Abstract OBJECTIVE Treatment of posterior circulation aneurysms poses a great technical challenge for the practicing neurosurgeon. The advent of endovascular techniques has made such treatment more feasible. We report our experience with the endovascular management of ruptured and unruptured posterior circulation aneurysms during the past 10 years. METHODS A retrospective analysis was performed on all patients with posterior circulation aneurysms undergoing endovascular treatment at Jefferson Hospital for Neuroscience between July 1995 and December 2005. This yielded 275 patients (67 men and 208 women). The degree of aneurysm occlusion was determined by the operating endovascular neurosurgeon at the time of the procedure. Successful embolization was defined as greater than 95% occlusion of the dome without any coil prolapsing into the parent vessel. Clinical outcome was evaluated using the modified Glasgow Outcome Scale. Clinical follow-up data was obtained for 262 patients (95.3%); the follow-up period ranged from 1 to 94 months (mean, 31.8 mo for procedures performed before 2004 and 13.3 mo for procedures performed during 2004 and 2005). Angiographic follow-up data was obtained for 224 patients (84.8%) for periods ranging from 6 to 94 months (mean, 31.3 mo for procedures performed before 2004 and 13.7 mo for procedures performed during 2004 and 2005). RESULTS Based on the Hunt and Hess grading scale, the patient population included 106 patients (38.5%) with unruptured aneurysms, 43 patients (15.6%) with Grade I aneurysms, 16 patients (5.8%) with Grade II aneurysms, 56 patients (20.5%) with Grade III aneurysms, and 54 patients (19.6%) with Grade IV aneurysms. The locations of the posterior circulation aneurysms included 189 (68.7%) in the basilar apex or posterior cerebral artery, 23 (8.4%) in the basilar trunk/anterior inferior cerebellar artery, 22 (8%) in the superior cerebellar artery, and 41 (14.9%) in the vertebral artery or posterior inferior cerebellar artery. Of the 275 patients, 208 (76%) were women and 67 (24%) were men. The mean age at the time of treatment was 53.9 years (range, 7–90 yr). Of all patients treated, 237 patients (87.8%) had successful embolization (>95% occlusion of the dome). On angiographic follow-up, 55 patients (24.5%) developed recanalization of at least 5%. Retreatment was required in 11 patients (4.9%; 0.01%/patient yr) and rehemorrhage occurred in three patients (1.1%; 0.003%/patient yr). Clinical follow-up was graded using the modified Glasgow Outcome Scale (mGOS) and revealed 229 patients (87.4%) in the mGOS I category, 12 patients (4.6%) in the mGOS II category, eight patients (3%) in the mGOS III category, two patients (0.8%) in the mGOS IV category, and 11 patients (4.2%) were deceased (mGOS V). Clinically significant vasospasm requiring angioplasty occurred in 11 patients (6.5%) with subarachnoid hemorrhage, and 120 patients (71%) with subarachnoid hemorrhage required ventricular shunts. Complications causing clinical morbidity occurred in 14 patients (5.1%) and ranged from postoperative ischemia to recurrent subarachnoid hemorrhage. Of all clinical factors evaluated, Hunt and Hess grade was the strongest predictor of good clinical outcome (P < 0.0001). CONCLUSION Endovascular coil embolization of posterior circulation aneurysms is an effective treatment in the short term but is associated with recurrence, which requires close surveillance, possible retreatment, and can, albeit very rarely, lead to rehemorrhage. Future technological advancements such as the development of biologically active coils will be essential in the permanent obliteration of aneurysms.

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P.111 Large partially thrombosed posterior circulation aneurysms: A treacherous masquerader of benign brain tumors

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2016.212 ◽

2016 ◽

Vol 43 (S2) ◽

pp. S46-S46

Author(s):

N Alizadeh Vakili ◽

A Chiu ◽

B Drake ◽

W Montanera ◽

A Bharatha ◽

...

Keyword(s):

Brain Tumors ◽

Vertebral Artery ◽

Mass Effect ◽

Posterior Circulation ◽

Parent Artery ◽

Facial Weakness ◽

Vp Shunt ◽

Thrombosed Aneurysm ◽

Posterior Circulation Aneurysms

Background: On imaging, thrombosed aneurysms can be mistaken for tumor with potentially disastrous consequences. Methods: We present two cases of aneurysms mimicking tumor. Results:Patient 1 (6 months of left-sided facial weakness): MRI demonstrated a 3.3 cm, T1-isotense, T2-hypertense heterogeneous enhancing mass favored to represent a CPA schwannoma. Biopsy revealed a thrombosed aneurysm. DSA subsequently revealed an area of contrast penetration, treated by parent artery (AICA) obliteration. Two-year follow-up revealed stable occlusion with reduced mass effect. Patient 2 (1 year of headaches): Imaging demonstrated an extra-axial T1-mixed, T2-hyperintense heterogeneously enhancing mass in the left CPA adjacent to the vertebral artery, enlarging from 1.7 cm to 3.2 cm over 2 years. DSA revealed slow, crescentic filling with suggestion of arborisation distally. Patient deteriorated due to mass effect requiring a VP shunt and passed away from SAH 3 months later. Imaging review revealed crescentic filling of the remnant lumen on CE-MRA and signal voids on T2 in both cases, which may suggest the aneurysm diagnosis. However our cases did not have other features such as lamellated thrombus or pulsation artifact. Conclusions: Central contrast enhancement does not necessarily preclude the diagnosis of thrombosed aneurysm. The possibility of revascularization or penetration of contrast through the thrombus in giant aneurysms needs to be considered.

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Cardiac standstill for cerebral aneurysms in 103 patients: an update on the experience at the Barrow Neurological Institute

Journal of Neurosurgery ◽

10.3171/2010.9.jns091178 ◽

2011 ◽

Vol 114 (3) ◽

pp. 877-884 ◽

Cited By ~ 28

Author(s):

Francisco A. Ponce ◽

Robert F. Spetzler ◽

Patrick P. Han ◽

Scott D. Wait ◽

Brendan D. Killory ◽

...

Keyword(s):

Circulatory Arrest ◽

Deep Hypothermic Circulatory Arrest ◽

Hypothermic Circulatory Arrest ◽

Posterior Circulation ◽

Superior Cerebellar Artery ◽

Small Subset ◽

Long Term Follow Up ◽

Posterior Circulation Aneurysms

Object The aim of this study was to clarify the surgical indications, risks, and long-term clinical outcomes associated with the use of deep hypothermic circulatory arrest for the surgical treatment of intracranial aneurysms. Methods The authors retrospectively reviewed 105 deep hypothermic circulatory arrest procedures performed in 103 patients (64 females and 39 males, with a mean age of 44.8 years) to treat 104 separate aneurysms. Patients' clinical histories, radiographs, and operative reports were evaluated. There were 97 posterior circulation aneurysms: at the basilar apex in 60 patients, midbasilar artery in 21, vertebrobasilar junction in 11, superior cerebellar artery in 4, and posterior cerebral artery in 1. Seven patients harbored anterior circulation aneurysms. Two additional patients harbored nonaneurysmal lesions. Results Perioperatively, 14 patients (14%) died. Five patients (5%) were lost to late follow-up. At a mean long-term follow-up of 9.7 years, 65 patients (63%) had the same or a better status after surgical intervention, 10 (10%) were worse, and 9 (9%) had died. There were 19 cases (18%) of permanent or severe complications. The combined rate of permanent treatment-related morbidity and mortality was 32%. The mean late follow-up Glasgow Outcome Scale score was 4, and the annual hemorrhage rate after microsurgical clipping during cardiac standstill was 0.5%/year. Ninety-two percent of patients required no further treatment of their aneurysm at the long-term follow-up. Conclusions Cardiac standstill remains an important treatment option for a small subset of complex and giant posterior circulation aneurysms. Compared with the natural history of the disease, the risk associated with this procedure is acceptable.

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Petrosal approaches to posterior circulation aneurysms

Neurosurgical FOCUS ◽

10.3171/2012.6.focus12131 ◽

2012 ◽

Vol 33 (2) ◽

pp. E9 ◽

Cited By ~ 10

Author(s):

Bradley A. Gross ◽

Daryoush Tavanaiepour ◽

Rose Du ◽

Ossama Al-Mefty ◽

Ian F. Dunn

Keyword(s):

Natural History ◽

Posterior Circulation ◽

Term Outcome ◽

Long Term Outcome ◽

Posterior Circulation Aneurysms ◽

Aneurysm Occlusion

Complex posterior circulation aneurysms are formidable lesions with an abysmal natural history. Their management continues to present a challenge to both endovascular and open microsurgical approaches. Affording an expansive, combined supra- and infratentorial exposure, the petrosal approaches are well suited for these challenging lesions when located along the basilar trunk or at a low-lying basilar apex. This report evaluates the evolution and application of petrosal approaches to these lesions. Excluding transsigmoid, infratentorial, or labyrinth-sacrificing approaches, the authors found 23 reports with 61 posterior circulation aneurysms treated via a petrosal approach. Although early morbidity was not negligible, rates of aneurysm occlusion (95% overall) and long-term outcome were quite laudable in light of the challenge posed by these lesions. Moreover, with accumulating experience with petrosal approaches, rates of complications are likely to wane, as neurosurgeons capitalize on the expansive exposure afforded by these indispensable approaches.

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