Peripheral intracranial aneurysms: management challenges in 60 consecutive cases

Clinical article

View More View Less
  • National Brain Aneurysm Center, St. Joseph's Hospital, St. Paul, Minnesota
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
Print or Print + Online Sign in

Object

The authors report the management and outcomes of 55 patients with 60 intracranial aneurysms arising distal to the major branch points of the circle of Willis and vertebrobasilar system.

Methods

Between July 1997 and December 2006, the authors' neurovascular service treated 2021 intracranial aneurysms in 1850 patients. The database was reviewed retrospectively to identify peripherally located intracranial aneurysms. Aneurysms that were mycotic and aneurysms that were associated with either an arteriovenous malformation or an atrial myxoma were excluded from review.

Results

The authors encountered 60 peripheral intracranial aneurysms in 55 patients. There were 42 small, 7 large, and 11 giant lesions. Forty-one (68%) were unruptured, and 19 (32%) had bled. Fifty-three aneurysms were treated surgically by using direct clip reconstruction in 26, trapping or proximal occlusion with distal revascularization in 21, excision with end-to-end anastomosis in 3, and circumferential wrap/clip reconstruction in 3. Coils were used to treat 6 aneurysms, and 1 was treated by endovascular parent artery occlusion. Overall, 49 patients had good outcomes, 4 were left with new neurological deficits, and 2 died.

Conclusions

Peripherally situated intracranial aneurysms are rare lesions that present unique management challenges. Despite the fact that in the authors' experience these lesions were rarely treatable with simple clipping of the aneurysm neck or endovascular coil occlusion, preservation of the parent artery was possible in most cases, and the majority of patients had a good outcome.

Abbreviations used in this paper:

ACA = anterior cerebral artery; AICA = anterior inferior cerebellar artery; MCA = middle cerebral artery; OA = occipital artery; PCA = posterior cerebral artery; PICA = posterior inferior cerebellar artery; SAH = subarachnoid hemorrhage; SCA = superior cerebellar artery; STA = superficial temporal artery.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
  • 1

    Ali MJ, , Bendok BR, , Tawk RG, , Getch CC, & Batjer HH: Trapping and revascularization for a dissecting aneurysm of the proximal posteroinferior cerebellar artery: technical case report and review of the literature. Neurosurgery 51:258262, 2002

    • Search Google Scholar
    • Export Citation
  • 2

    Anson JA, , Lawton MT, & Spetzler RF: Characteristics and surgical treatment of dolichoectatic and fusiform aneurysms. J Neurosurg 84:185193, 1996

    • Search Google Scholar
    • Export Citation
  • 3

    Biondi A, , Jean B, , Vivas E, , Le Jean L, , Boch AL, & Chiras J, et al.: Giant and large peripheral cerebral aneurysms: etiopathologic considerations, endovascular treatment, and long-term follow-up. AJNR Am J Neuroradiol 27:16851692, 2006

    • Search Google Scholar
    • Export Citation
  • 4

    Chapot R, , Houdart E, , Saint-Maurice JP, , Aymard A, , Mounayer C, & Lot G, et al.: Endovascular treatment of cerebral mycotic aneurysms. Radiology 222:389396, 2002

    • Search Google Scholar
    • Export Citation
  • 5

    Chun JY, , Smith W, , Halbach VV, , Higashida RT, , Wilson CB, & Lawton MT: Current multimodality management of infectious intracranial aneurysms. Neurosurgery 48:12031214, 2001

    • Search Google Scholar
    • Export Citation
  • 6

    Cloft HJ, , Kallmes DF, , Jensen ME, , Lanzino G, & Dion JE: Endovascular treatment of ruptured, peripheral cerebral aneurysms: parent artery occlusion with short Guglielmi detachable coils. AJNR Am J Neuroradiol 20:308310, 1999

    • Search Google Scholar
    • Export Citation
  • 7

    Day AL, , Gaposchkin CG, , Yu CJ, , Rivet DJ, & Dacey RG Jr: Spontaneous fusiform middle cerebral artery aneurysms: characteristics and a proposed mechanism of formation. J Neurosurg 99:228240, 2003

    • Search Google Scholar
    • Export Citation
  • 8

    Drake CG, & Peerless SJ: Giant fusiform intracranial aneurysms: review of 120 patients treated surgically from 1965 to 1992. J Neurosurg 87:141162, 1997

    • Search Google Scholar
    • Export Citation
  • 9

    Dolenc V: Treatment of fusiform aneurysms of the peripheral cerebral arteries. Report of two cases. J Neurosurg 49:272277, 1978

  • 10

    Eckard DA, , O'Boynick PL, , McPherson CM, , Eckard VR, , Han P, & Arnold P, et al.: Coil occlusion of the parent artery for treatment of symptomatic peripheral intracranial aneurysms. AJNR Am J Neuroradiol 21:137142, 2000

    • Search Google Scholar
    • Export Citation
  • 11

    Fujimura M, , Nishijima M, , Midorikawa H, , Umezawa K, , Hayashi T, & Kaimori M: Fatal rupture following intra-aneurysmal embolization for the distal posterior inferior cerebellar artery aneurysm with parent artery preservation. Clin Neurol Neurosurg 105:117120, 2003

    • Search Google Scholar
    • Export Citation
  • 12

    Hallacq P, , Piotin M, & Moret J: Endovascular occlusion of the posterior cerebral artery for the treatment of p2 segment aneurysms: retrospective review of a 10-year series. AJNR Am J Neuroradiol 23:11281136, 2002

    • Search Google Scholar
    • Export Citation
  • 13

    Hodes JE, , Aymard A, , Gobin YP, , Rufenacht D, , Bien S, & Reizine D, et al.: Endovascular occlusion of intracranial vessels for curative treatment of unclippable aneurysms: report of 16 cases. J Neurosurg 75:694701, 1991

    • Search Google Scholar
    • Export Citation
  • 14

    Jean WC, , Walski-Easton S, & Nussbaum ES: Multiple intracranial aneurysms as a delayed complication of atrial myxoma: case report. Neurosurgery 49:200203, 2001

    • Search Google Scholar
    • Export Citation
  • 15

    Kanou Y, , Arita K, , Kurisu K, , Ikawa F, , Eguchi K, & Monden S, et al.: Dissecting aneurysm of the peripheral posterior inferior cerebellar artery. Acta Neurochir (Wien) 142:11511156, 2000

    • Search Google Scholar
    • Export Citation
  • 16

    Lazinski D, , Willinsky RA, , TerBrugge K, & Montanera W: Dissecting aneurysms of the posterior cerebral artery: angioarchitecture and a review of the literature. Neuroradiology 42:128133, 2000

    • Search Google Scholar
    • Export Citation
  • 17

    Lewis SB, , Chang DJ, , Peace DA, , Lafrentz PJ, & Day AL: Distal posterior inferior cerebellar artery aneurysms: clinical features and management. J Neurosurg 97:756766, 2002

    • Search Google Scholar
    • Export Citation
  • 18

    Lubicz B, , Leclerc X, , Gauvrit JY, , Lejeune JP, & Pruvo JP: Endovascular treatment of peripheral cerebellar artery aneurysms. AJNR Am J Neuroradiol 24:12081213, 2003

    • Search Google Scholar
    • Export Citation
  • 19

    Mawad ME, & Klucznik RP: Giant serpentine aneurysms: radiographic features and endovascular treatment. AJNR Am J Neuroradiol 16:10531060, 1995

    • Search Google Scholar
    • Export Citation
  • 20

    Mizutani T, , Kojima H, & Asamoto S: Healing process for cerebral dissecting aneurysms presenting with subarachnoid hemorrhage. Neurosurgery 54:342348, 2004

    • Search Google Scholar
    • Export Citation
  • 21

    Mizutani T, , Kojima H, , Asamoto S, & Miki Y: Pathological mechanism and three-dimensional structure of cerebral dissecting aneurysms. J Neurosurg 94:712717, 2001

    • Search Google Scholar
    • Export Citation
  • 22

    Mizutani T, , Miki Y, , Kojima H, & Suzuki H: Proposed classification of nonatherosclerotic cerebral fusiform and dissecting aneurysms. Neurosurgery 45:253260, 1999

    • Search Google Scholar
    • Export Citation
  • 23

    Nakasu S, , Kaneko M, & Matsuda M: Cerebral aneurysms associated with Behcet's disease: a case report. J Neurol Neurosurg Psychiatry 70:682684, 2001

    • Search Google Scholar
    • Export Citation
  • 24

    Nakatomi H, , Segawa H, , Kurata A, , Shiokawa Y, , Nagata K, & Kamiyama H, et al.: Clinicopathological study of intracranial fusiform and dolichoectatic aneurysms: insight on the mechanism of growth. Stroke 31:896900, 2000

    • Search Google Scholar
    • Export Citation
  • 25

    Nussbaum ES, , Madison MT, , Myers ME, , Goddard J, & Janjua TM: Dissecting aneurysms of the posterior inferior cerebellar artery. J Neurosurg 109:2327, 2008

    • Search Google Scholar
    • Export Citation
  • 26

    Nussbaum ES, , Mendez A, , Camarata P, & Sebring LA: Surgical management of fusiform aneurysms of the peripheral posteroinferior cerebellar artery. Neurosurgery 53:831834, 2003

    • Search Google Scholar
    • Export Citation
  • 27

    Olmsted WW, & McGee TP: The pathogenesis of peripheral aneurysms of the central nervous system: a subject review from the AFIP. Radiology 123:661666, 1977

    • Search Google Scholar
    • Export Citation
  • 28

    Oran I, , Memis A, , Parildar M, & Yunten N: Multiple intracranial aneurysms in polyarteritis nodosa: MRI and angiography. Neuroradiology 41:436439, 1999

    • Search Google Scholar
    • Export Citation
  • 29

    Ross IB, , Weill A, , Piotin M, & Moret J: Endovascular treatment of distally located giant aneurysms. Neurosurgery 47:11471153, 2000

  • 30

    Sakaki T, , Morimoto T, & Utsumi S: Cerebral transmural angiitis and ruptured cerebral aneurysm in patients with systemic lupus erythematosus. Neurochirurgia (Stuttg) 33:132135, 1990

    • Search Google Scholar
    • Export Citation
  • 31

    Sanai N, , Quinones-Hinojosa A, , Gupta NM, , Perry V, , Sun PP, & Wilson CB, et al.: Pediatric intracranial aneurysms: durability of treatment following microsurgical and endovascular management. J Neurosurg 104:8289, 2006

    • Search Google Scholar
    • Export Citation
  • 32

    Sciubba DM, , Gallia GL, , Recinos P, , Garonzik IM, & Clatterbuck RE: Intracranial aneurysm following radiation therapy during childhood for a brain tumor. J Neurosurg 105:2 Suppl 134139, 2006

    • Search Google Scholar
    • Export Citation
  • 33

    Seoane ER, , Tedeschi H, , de Oliveira E, , Siqueira MG, , Calderon GA, & Rhoton AL Jr: Management strategies for posterior cerebral artery aneurysms: a proposed new surgical classification. Acta Neurochir (Wien) 139:325331, 1997

    • Search Google Scholar
    • Export Citation
  • 34

    Terasaka S, , Sawamura Y, , Kamiyama H, & Fukushima T: Surgical approaches for the treatment of aneurysms on the P2 segment of the posterior cerebral artery. Neurosurgery 47:359364, 2000

    • Search Google Scholar
    • Export Citation
  • 35

    Vishteh AG, , Smith KA, , McDougall CG, & Spetzler RF: Distal posterior cerebral artery revascularization in multimodality management of complex peripheral posterior cerebral artery aneurysms: technical case report. Neurosurgery 43:166170, 1998

    • Search Google Scholar
    • Export Citation
  • 36

    Yamamoto I, , Tsugane R, , Ohya M, , Sato O, , Ogura K, & Hara M: Peripheral aneurysms of the posterior inferior cerebellar artery. Neurosurgery 15:839845, 1984

    • Search Google Scholar
    • Export Citation
  • 37

    Yamaura I, , Tani E, , Yokota M, , Nakano A, , Fukami M, & Kaba K, et al.: endovascular treatment of ruptured dissecting aneurysms aimed at occlusion of the dissected site by using Guglielmi detachable coils. J Neurosurg 90:853856, 1999

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 644 155 19
Full Text Views 235 29 4
PDF Downloads 140 30 5
EPUB Downloads 0 0 0