Onyx embolization in distal dissecting posterior inferior cerebellar artery aneurysms.

Publication Title

J Neurointerv Surg

Authors

Ajit S Puri
Francesco Massari
Samuel Y Hou, Division of Neuroimaging and Intervention (NII), Department of Radiology and New England Center for Stroke Research, University of Massachusetts, Worcester, Massachusetts, USA.Follow
Juan Diego Lozano
Mary Howk
Mary Perras
Christopher Brooks
Matthew J Gounis
Peter Kan
Ajay K Wakhloo

Document Type

Article

Publication Date

5-1-2016

Keywords

Aged; Aged, 80 and over; Aneurysm, Dissecting; Cerebellum; Cerebral Angiography; Dimethyl Sulfoxide; Embolization, Therapeutic; Female; Follow-Up Studies; Humans; Intracranial Aneurysm; Male; Middle Aged; Polyvinyls; Retrospective Studies

Abstract

BACKGROUND: Dissecting aneurysms located along the distal segments of the posterior inferior cerebellar artery (PICA) are extremely rare, accounting for only 0.5-0.7% of all intracranial aneurysms. Treatment of these aneurysms is challenging, both surgically and endovascularly. We present our preliminary experience and clinical data utilizing Onyx as an embolization agent in the treatment of these lesions with proximal parent artery preservation.

METHODS: 7 consecutive ruptured peripheral PICA aneurysms, in 7 patients, were treated with superselective Onyx embolization at our institutions. According to the anatomical classification of Lister et al, these aneurysms were located in the lateral medullary segment (n=1), tonsillomedullary segment (n=1), and the telovelotonsillary segment (n=5) of the PICA. Technical feasibility, procedure related complications, angiographic results, follow-up diagnostic imaging, and clinical outcome were evaluated.

RESULTS: In all cases, endovascular treatment was successful, with complete occlusion of the aneurysm with proximal parent artery preservation at the final postprocedural angiogram. Procedure related complications were not observed. One patient with a poor clinical condition at admission died during the initial hospital stay due to extensive subarachnoid and intraventricular hemorrhage. No rebleeding or recanalization was noted during follow-up. Two patients had a residual moderate to severe disability at follow-up. Favorable outcomes, with no or mild disability, were observed in four of the surviving patients.

CONCLUSIONS: Angiographic, diagnostic imaging, and clinical results of our small series indicate that Onyx embolization of dissecting distal PICA aneurysms with parent artery preservation is an effective option with acceptable morbidity and mortality rate, in those cases in which surgical clipping or endovascular coiling of the aneurysmal sac is not suitable.

Clinical Institute

Neurosciences (Brain & Spine)

Specialty/Research Institute

Neurosciences

Comments

Samuel Hou is affiliated with Providence St. Joseph Health.