RT Journal Article
SR Electronic
T1 Microsurgical treatment of posterior inferior cerebellar aneurysms based on angioarchitecture supplemented by high-resolution vessel wall MRI: a case series report
JF Stroke and Vascular Neurology
JO Stroke Vasc Neurol
FD BMJ Publishing Group Ltd
SP 337
OP 344
DO 10.1136/svn-2021-001115
VO 7
IS 4
A1 Yang, Zixiao
A1 Song, Jianping
A1 Quan, Kai
A1 Li, Peiliang
A1 An, Qingzhu
A1 Shi, Yuan
A1 Liu, Peixi
A1 Yu, Guo
A1 Tian, Yanlong
A1 Zhou, Liangfu
A1 Zhu, Wei
YR 2022
UL http://svn.bmj.com/content/7/4/337.abstract
AB Background Surgical treatment of posterior inferior cerebellar artery (PICA) aneurysms is challenging because many are nonsaccular and atherosclerotic. We report our tailored approach to PICA aneurysms, which is based on angioarchitecture supplemented by high-resolution vessel wall MRI (HR-VW MRI) findings.Methods From March 2010 to September 2020, 27 patients with 29 PICA aneurysms underwent surgical treatment in our institution. Since October 2016, HR-VW MRI has been used for aneurysmal wall assessment. Clinical characteristics, radiological data and surgical outcomes were analysed.Results Nineteen proximal PICA aneurysms (vertebral artery (VA), P1, P2 and P3) were treated using the far-lateral approach. Ten distal PICA aneurysms (P4, P5) were treated using the suboccipital midline approach. Direct clipping or clip reconstruction was achieved in 19 aneurysms. Ten were trapped in conjunction with extracranial–intracranial or intracranial–intracranial bypass, including three occipital artery-PICA reimplantations, three PICA-VA reimplantations, two PICA-PICA side-to-side anastomoses, one PICA-PICA reimplantation and one PICA-PICA reanastomosis. All aneurysms were eventually completely obliterated and all bypasses remained patent. At the last follow-up, 26 patients (96.2%) achieved a good outcome (modified Rankin Scale score <3). Eight patients underwent HR-VW MRI. Among these, the six aneurysms with focal wall enhancement required bypass and the two with negative enhancement were successfully clipped.Conclusion PICA aneurysms have a higher frequency of complex features such as large or giant size and fusiform or dissecting morphology. Favourable outcomes were achieved with individualised microsurgical strategies based on angioarchitecture. HR-VW MRI may be used as a promising technique to predict aneurysmal atherosclerosis.Data are available on reasonable request. Individual participant data will be available. Individual participant data that underlie the results reported in this article, after deidentification (text, tables, figures and appendices) will be shared. Other documents including study protocol, statistical analysis plan will be available immediately following publication with no end date to researchers who provide a methodologically sound proposal. The documents were available to achieve aims in the approved proposal. Proposals should be directed to drzhuwei@fudan.edu.cn. To gain access, data requestors will need to sign a data access agreement.