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  • Superior Cerebellar Artery Aneurysms as Dissidents in Posterior Circulation; Role of Microsurgery in Endovascular Era With Comparative Outcome Analysis

    Final Number:
    1118

    Authors:
    Devi Prasad Patra MS M.CH. M.D. MRCS; Shyamal C Bir MD PhD; Tanmoy Kumar Maiti Mch; Anil Nanda MD FACS

    Study Design:
    Other

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2016 Annual Meeting

    Introduction: Superior cerebellar artery (SCA) aneurysms are considered to be grueling surgical lesions owing to narrow operative corridors and proximity to critical cranial nerves. Accordingly, endovascular treatment has always been weighed as more safe and effective than microsurgical clipping. We retrospectively analyzed and compared the outcome of our patients with SCA aneurysms treated with endovascular coiling and microsurgical clipping.

    Methods: Between June 2000 and August 2015, 10 patients with SCA aneurysms underwent microsurgical (n = 4) or endovascular (n = 6) treatment. The decision of surgery versus endovascular treatment was based on the aneurysm morphology and clinical grade etc. The Glasgow outcome scale (GOS) and the modified Rankin’s scale (mRS) were used to grade their postoperative neurological status at discharge and 6 months, respectively.

    Results: Majority (90%) of patients were in good grade (WFNS 1&2) at presentation. The average size of the aneurysm was 7.6mm. The transylvian subtemporal approach was used for surgery. 3 patients developed vasospasm (2 in coiling arm, 1 in surgery arm); one patient with hydrocephalus underwent ventriculo-periotoneal shunt followed by coiling. There was no mortality. At discharge all patients from coiling arm had a GOS of 4 or 5 except the patient who presented in poor grade (GOS-3). All patients from surgery arm had GOS 4-5. Similarly at 6 months follow-up, 90% patients had mRS of 0–2. Univariate analysis showed no significant difference in outcome in both treatment arms (p=0.44). Follow up angiogram at 6 months showed complete obliteration of the aneurysm in all surgically treated patients. One patient from coiling arm had a small residual which is stable on serial observation.

    Conclusions: SCA aneurysms are rare and unlike other posterior circulation aneurysms are amenable to surgical treatment owing to lack of major perforators in vicinity to the aneurysm neck. Microsurgery and endovascular coiling both are viable primary treatment options with comparable clinical as well as radiological outcomes.

    Patient Care: Endovascular treatment is considered as gold standard for posterior circulation aneurysms. Microsurgical treatment can be considered as a primary treatment option in properly selected patients of superior cerebellar artery aneurysms with comparable outcome

    Learning Objectives: 1. Superior cerebellar artery (SCA) aneurysms are considered to be grueling surgical lesions owing to narrow operative corridors and proximity to critical cranial nerves. 2. SCA aneurysms are rare and unlike other posterior circulation aneurysms are amenable to surgical treatment owing to lack of major perforators in vicinity to the aneurysm neck. 3. Microsurgery and endovascular coiling both are viable primary treatment options with comparable clinical as well as radiological outcomes.

    References: 1. Jin SC, Park ES, Kwon do H, Ahn JS, Kwun BD, Kim CJ, Choi CG. Endovascular and microsurgical treatment of superior cerebellar artery aneurysms. J Cerebrovasc Endovasc Neurosurg. 2012 Mar;14(1):29-36. 2. Sanai N, Tarapore P, Lee AC, Lawton MT. The current role of microsurgery for posterior circulation aneurysms: a selective approach in the endovascular era. Neurosurgery. 2008 Jun;62(6):1236-49; discussion 1249-53.

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