Abstract
A 51-year-old female patient underwent a MRI/MRA examination as workup for non-specific, occasional discomfort. Small incidental aneurysms of both middle cerebral arteries (MCAs) were found in December 2012 and in June 2013. A diagnostic DSA in November 2013 showed four intradural aneurysms: #1 a fusiform dilatation of the inferior trunk of the right MCA, #2 an aneurysm of the superior trunk of the right MCA with a 4 mm neck width and 3 mm depth and a small daughter aneurysm, #3 a small aneurysm of the left MCA/M1 segment at the origin of the second temporal branch with a fundus diameter of 3 mm, and #4 an aneurysm of the left vertebral artery (VA)/V4 segment at the origin of the left posterior inferior cerebellar artery (PICA) with a fundus diameter of 2 mm. The two right-sided MCA aneurysms were surgically clipped. The aneurysms on the left M1 segment and on the left PICA were treated by flow diversion (p64). Due to the small caliber of the parent arteries (the second temporal branch of the left MCA and the left PICA), the flow diverters were implanted in the adjacent main arteries (the left M1 segment and the left V4 segment), covering the orifice of the branching vessel rather than the entire neck of the aneurysm. Both aneurysms regressed completely during the following months. The treatment of intracranial aneurysms using the slipstream effect of flow diverters is the main topic of this chapter.
This is a preview of subscription content, log in via an institution to check access.
References
Berg P, Iosif C, Ponsonnard S, Yardin C, Janiga G, Mounayer C. Endothelialization of over- and undersized flow-diverter stents at covered vessel side branches: an in vivo and in silico study. J Biomech. 2016;49(1):4–12. https://doi.org/10.1016/j.jbiomech.2015.10.047.
Bhogal P, Martinez R, Gansladt O, Bäzner H, Henkes H, Aguilar M. Management of unruptured saccular aneurysms of the M1 segment with flow diversion: a single centre experience. Clin Neuroradiol. 2016;11:1–8.
Briganti F, Delehaye L, Leone G, Sicignano C, Buono G, Marseglia M, Caranci F, Tortora F, Maiuri F. Flow diverter device for the treatment of small middle cerebral artery aneurysms. J Neurointerv Surg. 2016;8(3):287–94. https://doi.org/10.1136/neurintsurg-2014-011460.
Cagnazzo F, Mantilla D, Lefevre PH, Dargazanli C, Gascou G, Costalat V. Treatment of middle cerebral artery aneurysms with flow-diverter stents: a systematic review and meta-analysis. AJNR Am J Neuroradiol. 2017;38(12):2289–94. https://doi.org/10.3174/ajnr.A5388.
Cebral JR, Raschi M, Mut F, Ding YH, Dai D, Kadirvel R, Kallmes D. Analysis of flow changes in side branches jailed by flow diverters in rabbit models. Int J Numer Method Biomed Eng. 2014;30(10):988–99. https://doi.org/10.1002/cnm.2640.
Chalouhi N, Zanaty M, Whiting A, Yang S, Tjoumakaris S, Hasan D, Starke RM, Hann S, Hammer C, Kung D, Rosenwasser R, Jabbour P. Safety and efficacy of the Pipeline Embolization Device in 100 small intracranial aneurysms. J Neurosurg. 2015;122(6):1498–502. https://doi.org/10.3171/2014.12.JNS14411.
Sonobe M, Yamazaki T, Yonekura M, Kikuchi H. Small unruptured intracranial aneurysm verification study: SUAVe study, Japan. Stroke. 2010;41(9):1969–77. https://doi.org/10.1161/STROKEAHA.110.585059.
Srinivasan VM, Ghali MGZ, Reznik OE, Cherian J, Mokin M, Dumont TM, Gaughen JR, Grandhi R, Puri AS, Chen SR, Johnson JN, Kan P. Flow diversion for the treatment of posterior inferior cerebellar artery aneurysms: a novel classification and strategies. J Neurointerv Surg. 2017. pii: neurintsurg-2017-013427. https://doi.org/10.1136/neurintsurg-2017-013427.
Topcuoglu OM, Akgul E, Daglioglu E, Topcuoglu ED, Peker A, Akmangit I, Belen D, Arat A. Flow diversion in middle cerebral artery aneurysms: is it really an all-purpose treatment? World Neurosurg. 2016;87:317–27. https://doi.org/10.1016/j.wneu.2015.11.073.
UCAS Japan Investigators, Morita A, Kirino T, Hashi K, Aoki N, Fukuhara S, Hashimoto N, Nakayama T, Sakai M, Teramoto A, Tominari S, Yoshimoto T. The natural course of unruptured cerebral aneurysms in a Japanese cohort. N Engl J Med. 2012;366(26):2474–82. https://doi.org/10.1056/NEJMoa1113260.
Wajnberg E, Silva TS, Johnson AK, Lopes DK. Progressive deconstruction: a novel aneurysm treatment using the pipeline embolization device for competitive flow diversion: case report. Neurosurgery. 2014;10(Suppl 1):E161-6; discussion E166. https://doi.org/10.1227/NEU.0000000000000029.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2018 Springer International Publishing AG, part of Springer Nature
About this entry
Cite this entry
Aguilar Pérez, M., AlMatter, M., Ganslandt, O., Henkes, H. (2018). Posterior Inferior Cerebellar Artery Aneurysm: Multiple Incidental Aneurysms of Both MCAs and the Left Vertebral Artery, Surgical Clipping of two Right MCA Aneurysms, and Flow Diversion Using the Slipstream Effect of the Left PICA and Left M1 Aneurysm. In: Henkes, H., Lylyk, P., Ganslandt, O. (eds) The Aneurysm Casebook. Springer, Cham. https://doi.org/10.1007/978-3-319-70267-4_37-1
Download citation
DOI: https://doi.org/10.1007/978-3-319-70267-4_37-1
Received:
Accepted:
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-70267-4
Online ISBN: 978-3-319-70267-4
eBook Packages: Springer Reference MedicineReference Module Medicine