Risk Assessment of Hemorrhage of Posterior Inferior Cerebellar Artery Aneurysms in Posterior Fossa Arteriovenous Malformations

2017 ◽  
Vol 14 (4) ◽  
pp. 359-366 ◽  
Author(s):  
Alice L Hung ◽  
Wuyang Yang ◽  
Maria Braileanu ◽  
Tomas Garzon-Muvdi ◽  
Justin M Caplan ◽  
...  
Keyword(s):  
Treatment Outcomes ◽  
Posterior Fossa ◽  
Arteriovenous Malformations ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Posterior Inferior Cerebellar Artery ◽  
Aneurysm Rupture ◽  
Acute Hydrocephalus ◽  
Increased Risk ◽  
Cerebellar Artery ◽  
Risk Of Rupture

Abstract BACKGROUND Posterior fossa arteriovenous malformations (AVMs) are associated with increased risk of rupture and severe consequences from such rupture. The hemorrhagic risk of prenidal aneurysms (anr) on the posterior inferior cerebellar artery (PICA) may exceed that of the AVM in posterior fossa AVMs fed by PICA (PICA-AVM). OBJECTIVE To characterize the relative risks of aneurysm and AVM hemorrhage in patients with posterior fossa AVMs. METHODS We retrospectively reviewed patients diagnosed with AVM. Patients with posterior fossa AVMs were divided into 3 groups: PICA-AVM with prenidal aneurysm (PICA-AVM-anr group), PICA-AVM without prenidal aneurysm (PICA-AVM group), and AVMs without PICA feeder with/without aneurysm (AVM-only group). Patient and lesion characteristics and treatment outcomes were compared. ANOVA and chi squared tests were used for statistical analyses. RESULTS Our cohort included 85 patients. Mean age was 45.3 ± 18.1 yr, with 43(50.6%) female patients. Fifty-one patients (60.0%) had hemorrhagic presentation, and 27 (31.8%) experienced acute hydrocephalus. Patients in the PICA-AVM-anr group (n = 11) were more likely to present with aneurysmal subarachnoid hemorrhage (SAH; P = .005) and less likely to have AVM rupture (P < .001). Ten (90.9%) patients presented with hemorrhage, 6 (60.0%) of which resulted from aneurysm rupture. Of these 6, 5 (83.3%) had acute hydrocephalus. No patients with AVM rupture had hydrocephalus. Eight (72.7%) received aneurysm treatment prior to AVM treatment. There were no significant differences in post-treatment outcomes dependent on treatment order. CONCLUSION In addition to relatively higher risk of AVM rupture from infratentorial location and prenidal aneurysm, a higher risk of aneurysm rupture rather than AVM rupture was observed in patients with PICA-AVM-anr complex.

Associated Aneurysms in Infratentorial Arteriovenous Malformations: Role of Aneurysm Size and Comparison with Supratentorial Lesions

2016 ◽  
Vol 41 (5-6) ◽  
pp. 219-225 ◽  
Author(s):  
Klaus-Peter Stein ◽  
Isabel Wanke ◽  
Michael Forsting ◽  
Neriman Oezkan ◽  
Bernd-Otto Huetter ◽  
...  
Keyword(s):  
Posterior Fossa ◽  
Intracranial Hemorrhage ◽  
Arteriovenous Malformations ◽  
Posterior Inferior Cerebellar Artery ◽  
Aneurysm Rupture ◽  
Special Focus ◽  
Aneurysm Size ◽  
Common Location ◽  
Mean Size ◽  
The Mean

Background: The natural history and treatment of brain arteriovenous malformations (AVMs) is the object of ongoing debates and discussions. To capture the entirety of these complex lesions, associated vascular pathologies, such as associated aneurysms (AAs), have to be implemented in future risk stratification models, as they are believed to represent additional risk factors for intracranial hemorrhage. The present study aims to determine AA characteristics in posterior fossa AVMs and to compare with AAs accompanying supratentorial AVMs, with special focus on aneurysm size. Methods: Patients with cerebral AVMs, treated in our department between 1990 and 2013, were analyzed retrospectively. Only patients with flow-related AAs of the feeding arteries were evaluated. Thus, patients harboring intranidal, venous or remote aneurysms were excluded. Results: Of 485 patients with cerebral AVM, 76 patients harbored an AVM of the posterior fossa. Among those, 22 individuals exhibited a total of 35 AAs (n = 8 patients with multiple AAs). Most common location of AAs was the posterior inferior cerebellar artery (n = 20, 57%) and mean AA diameter was 7.9 mm (SD 5.5). In the subgroup of patients with a single AA, mean aneurysm size in posterior fossa AVMs was with 7.8 mm (SD 6.0; range 2-25 mm) significantly larger than the mean size of AAs with supratentorial AVMs (4.8 mm, SD 3.0; range 2-20 mm; p = 0.048). Intracranial hemorrhage was found in 18 of 22 patients (82%) with infratentorial AVMs, and of these, 11 patients suffered from aneurysm rupture. In 14 patients bearing a single AA, 8 (57%) had sustained hemorrhage from aneurysm rupture. The mean diameter of AAs was as supposed in the ruptured group with 9.8 mm (SD 6.9; range 4-25 mm) significantly larger than in the unruptured AA group exhibiting a mean of 5.0 mm (SD 3.3; range 2-10 mm; p = 0.038). Patients with posterior fossa AVMs and AAs were significantly older as compared to those patients with supratentorial lesions (57.1, SD 12.6 vs. 45.8 years, SD 15.9 years; p = 0.004), which was also evident in the subgroup of patients with single AAs (55.2, SD 11.7 vs. 45.8 years, SD 14.9 years; p = 0.038). Conclusions: AAs of posterior fossa AVMs are larger in diameter than aneurysms accompanying supratentorial AVMs. AA size influences risk for hemorrhage, which, together with the high number of hemorrhagic events in posterior fossa AVMs, justifies treating these pathologies. The higher age of patients with AVMs of the posterior fossa might be one reason for larger AAs in this cohort, when compared to patients with supratentorial AVMs and AAs.

scholarly journals Risk Factors for Cerebral Aneurysm Rupture in Mongolia

2021 ◽  
Author(s):  
Matthias Bechstein ◽  
Amarjargal Gansukh ◽  
Boldbat Regzengombo ◽  
Oyun Byambajav ◽  
Lukas Meyer ◽  
...  
Keyword(s):  
Risk Factors ◽  
Medical History ◽  
Cerebral Aneurysm ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Imaging Modality ◽  
Treatment Options ◽  
Time Estimation ◽  
Developed Countries ◽  
Aneurysm Rupture ◽  
Risk Of Rupture

Abstract Purpose Identification of country-specific demographic, medical, lifestyle, and geoenvironmental risk factors for cerebral aneurysm rupture in the developing Asian country of Mongolia. First-time estimation of the crude national incidence of aneurysmal subarachnoid hemorrhage (aSAH). Methods A retrospective analysis of all intracranial digital subtraction angiographies (DSA) acquired in Mongolia during the 2‑year period 2016–2017 (1714 examinations) was performed. During this period, DSA was used as primary diagnostic imaging modality for acute severe neurological symptoms in the sole hospital nationwide dedicated to neurological patients. The catchment area of the hospital included the whole country. Patients with incidental and ruptured aneurysms were reviewed with respect to their medical history and living conditions. The data was used to install a Mongolian aneurysm registry. Results The estimated annual crude incidence of cerebral aneurysm rupture was 6.71 for the country of Mongolia and 14.53 per 100,000 persons for the capital region of Ulaanbaatar. Risk factors common in developed countries also applied for the Mongolian population: A medical history of hypertension, smoking or the presence of multiple aneurysms led to a higher relative risk of rupture. In contrast, female gender was not associated with a higher risk in this national cohort. Males pursuing a traditional nomadic living may exhibit a specifically high risk of rupture. Conclusion Disease management of over 200 individuals/year with aSAH constitutes a socioeconomic burden in Mongolia. Efforts to raise awareness of the risk factors hypertension and smoking among the Mongolian population are desirable. Measures to improve the nationwide availability of modern neurovascular treatment options are currently under consideration.

scholarly journals The role of alternative anastomosis sites in occipital artery–posterior inferior cerebellar artery bypass in the absence of the caudal loop using the far-lateral approach

2017 ◽  
Vol 126 (2) ◽  
pp. 634-644 ◽  
Author(s):  
Hitoshi Fukuda ◽  
Alexander I. Evins ◽  
Koichi Iwasaki ◽  
Itaro Hattori ◽  
Kenichi Murao ◽  
...  
Keyword(s):  
Posterior Fossa ◽  
Posterior Inferior Cerebellar Artery ◽  
Technical Difficulty ◽  
Foramen Magnum ◽  
Lateral Approach ◽  
Difficulty Level ◽  
Occipital Artery ◽  
Cerebellar Artery ◽  
Far Lateral Approach ◽  
Far Lateral

OBJECTIVE Occipital artery–posterior inferior cerebellar artery (OA-PICA) bypass is a technically challenging procedure for posterior fossa revascularization. The caudal loop of the PICA is considered the optimal site for OA-PICA anastomosis, however its absence can increase the technical difficulty associated with this procedure. The use of the far-lateral approach for accessing alternative anastomosis sites in OA-PICA bypass in patients with absent or unavailable caudal loops of PICA is evaluated. METHODS A morphometric analysis of OA-PICA bypass with anastomosis on each segment of the PICA was performed on 5 cadaveric specimens through the conventional midline foramen magnum and far-lateral approaches. The difficulty level associated with anastomoses at each segment was qualitatively assessed in each approach for exposure and maneuverability by multiple surgeons. A series of 8 patients who underwent OA-PICA bypass for hemodynamic ischemia or ruptured dissecting posterior fossa aneurysms are additionally reviewed and described, and the clinical significance of the caudal loop of PICA is discussed. RESULTS Anastomosis on the caudal loop could be performed more superficially than on any other segment (p < 0.001). A far-lateral approach up to the medial border of the posterior condylar canal provided a 13.5 ± 2.2–mm wider corridor than the conventional midline foramen magnum approach, facilitating access to alternative anastomosis sites. The far-lateral approach was successfully used for OA-PICA bypass in 3 clinical cases whose caudal loops were absent, whereas the midline foramen magnum approach provided sufficient exposure for caudal loop bypass in the remaining 5 cases. CONCLUSIONS The absence of the caudal loop of the PICA is a major contributing factor to the technical difficulty of OA-PICA bypass. The far-lateral approach is a useful surgical option for OA-PICA bypass when the caudal loop of the PICA is unavailable.

scholarly journals PHASES Score for Prediction of Intracranial Aneurysm Growth

Stroke ◽  
2015 ◽  
Vol 46 (5) ◽  
pp. 1221-1226 ◽  
Author(s):  
Daan Backes ◽  
Mervyn D.I. Vergouwen ◽  
Andreas T. Tiel Groenestege ◽  
A. Stijntje E. Bor ◽  
Birgitta K. Velthuis ◽  
...  
Keyword(s):  
Intracranial Aneurysm ◽  
Cox Regression ◽  
Continuous Variable ◽  
Aneurysm Rupture ◽  
Hazard Ratios ◽  
Unruptured Intracranial Aneurysms ◽  
Increased Risk ◽  
Risk Of Rupture ◽  
Aneurysm Growth

Background and Purpose— Growth of an intracranial aneurysm occurs in around 10% of patients at 2-year follow-up imaging and may be associated with aneurysm rupture. We investigated whether PHASES, a score providing absolute risks of aneurysm rupture based on 6 easily retrievable risk factors, also predicts aneurysm growth. Methods— In a multicenter cohort of patients with unruptured intracranial aneurysms and follow-up imaging with computed tomography angiography or magnetic resonance angiography, we performed univariable and multivariable Cox regression analyses for the predictors of the PHASES score at baseline, with aneurysm growth as outcome. We calculated hazard ratios and corresponding 95% confidence intervals (CI), with the PHASES score as continuous variable and after division into quartiles. Results— We included 557 patients with 734 unruptured aneurysms. Eighty-nine (12%) aneurysms in 87 patients showed growth during a median follow-up of 2.7 patient-years (range 0.5–10.8). Per point increase in PHASES score, hazard ratio for aneurysm growth was 1.32 (95% CI, 1.22–1.43). With the lowest quartile of the PHASES score (0–1) as reference, hazard ratios were for the second (PHASES 2–3) 1.07 (95% CI, 0.49–2.32), the third (PHASES 4) 2.29 (95% CI, 1.05–4.95), and the fourth quartile (PHASES 5–14) 2.85 (95% CI, 1.43–5.67). Conclusions— Higher PHASES scores were associated with an increased risk of aneurysm growth. Because higher PHASES scores also predict aneurysm rupture, our findings suggest that aneurysm growth can be used as surrogate outcome measure of aneurysm rupture in follow-up studies on risk prediction or interventions aimed to reduce the risk of rupture.

scholarly journals Re-Growth of a Posterior Inferior Cerebellar Artery Aneurysm after Resection of the Associated Posterior Fossa Arteriovenous Malformation

2014 ◽  
Vol 20 (1) ◽  
pp. 61-66 ◽  
Author(s):  
Hosam Al-Jehani ◽  
Donatella Tampieri ◽  
Maria Cortes ◽  
Denis Melançon
Keyword(s):  
Arteriovenous Malformation ◽  
Posterior Fossa ◽  
Posterior Inferior Cerebellar Artery ◽  
Artery Aneurysm ◽  
Endovascular Coiling ◽  
Cerebellar Artery ◽  
Long Term Follow Up ◽  
Glue Embolization

Arteriovenous malformation (AVM)-related aneurysms have been described in the literature. Their behavior varies based on their location in relation to and the activity of the shunting through the index AVM. The intuitive expectation supported by numerous reports is that these aneurysms should regress if the AVM is excluded from the circulation. We describe a case of 46-year-old man who presented with a posterior fossa AVM with an aneurysm on the posterior inferior cerebellar artery feeding the AVM. The nidus of the AVM was successfully excluded by glue embolization, with initial regression of the PICA aneurysm on serial imaging. Five years after the endovascular treatment, the aneurysm showed significant re-growth necessitating endovascular coiling. This case presents the re-growth of an AVM-related aneurysm and emphasizes the importance of long-term follow-up of such aneurysms even if the AVM is completely excluded.

Abstract WP94: Emphysema: A Potential Risk Factor for Ruptured Cerebral and Aortic Aneurysms

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Ali Mahta ◽  
Alexander E Merkler ◽  
Michael E Reznik ◽  
Hooman Kamel
Keyword(s):  
Risk Factors ◽  
Aortic Aneurysm ◽  
Cox Regression ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Predictor Variable ◽  
Incidence Rates ◽  
Aneurysm Rupture ◽  
Aortic Aneurysms ◽  
Ruptured Aortic Aneurysm ◽  
Increased Risk

Background: Whether emphysema is associated with the development and rupture of cerebral and abdominal aortic aneurysms is unclear. Methods and Materials: We performed a retrospective cohort study using outpatient and impatient claims data from a nationally representative 5% sample of Medicare beneficiaries > 66 years of age. Our predictor variable was emphysema and our outcome was a hospitalization for aneurysmal subarachnoid hemorrhage (SAH) or ruptured aortic aneurysm. All predictors and outcomes were defined using previously reported International Classification of Diseases, 9 th Revision, Clinical Modification ( ICD-9-CM ) diagnosis code algorithms. Survival statistics were used to calculate incidence rates and Cox regression was used to measure the association between emphysema and outcomes while adjusting for demographics and previously reported risk factors for aneurysm rupture: hypertension, diabetes, and tobacco and alcohol use. Results: We identified 133,337 patients with emphysema and 1,484,760 patients without emphysema. Over a mean follow-up period of 4.3 (+/-1.9) years, we identified 5,396 cases of aneurysm rupture, 477 of which occurred in patients with emphysema. The annual incidence of aneurysm rupture was 159 (95% confidence interval [CI], 146-174) per 100,000 in patients with emphysema and 74 (95% CI, 72-76) per 100,000 in patients without emphysema. After adjusting for demographics and other risk factors, emphysema was independently associated with aneurysm rupture (hazard ratio [HR], 1.6; 95% CI, 1.4-1.8). In secondary analyses, emphysema was associated with both aneurysmal SAH (HR, 1.4; 95% CI, 1.2-1.6) and ruptured aortic aneurysm (HR, 2.1; 95% CI, 1.7-2.5). Conclusion: Patients with emphysema faced an increased risk of developing SAH and aortic aneurysm rupture. This finding is consistent with the hypothesis that protease/anti-protease imbalance, which is seen in emphysema, may play a role in vessel wall weakening and the development and rupture of aneurysms.

Angiographic differentiation between Dandy-Walker cyst and arachnoid cyst of the posterior fossa in newborn infants and children

1973 ◽  
Vol 38 (3) ◽  
pp. 298-308 ◽  
Author(s):  
Emanuele La Torre ◽  
Aldo Fortuna ◽  
Emanuele Occhipinti
Keyword(s):  
Posterior Fossa ◽  
Arachnoid Cyst ◽  
Posterior Inferior Cerebellar Artery ◽  
Newborn Infants ◽  
Infants And Children ◽  
Arachnoid Cysts ◽  
Content Type ◽  
Dural Sinuses ◽  
Cerebellar Artery ◽  
Fine Print

✓ Elevation of the tentorium and its dural sinuses, originally considered a diagnostic sign of Dandy-Walker cyst, may also occur in arachnoid cysts of the posterior fossa. Differentiation between these two lesions may be achieved angiographically by the evaluation of the posterior inferior cerebellar artery and its vermian branch, and of the inferior vermian vein. All these vessels are displaced forward and upward by an arachnoid cyst, while in the Dandy-Walker cyst the posterior inferior cerebellar artery is miniature and the vermian branch and the inferior vermian vein are absent.

scholarly journals Surgical Treatment of Posterior Circulation Aneurysms – Anatomical Study and Surgical Technique

2018 ◽  
Vol 37 (01) ◽  
pp. 27-37
Author(s):  
Vitor Yamaki ◽  
Eric Paschoal ◽  
Manoel Teixeira ◽  
Eberval Figueiredo
Keyword(s):  
Surgical Treatment ◽  
Posterior Inferior Cerebellar Artery ◽  
Cranial Nerves ◽  
Posterior Circulation ◽  
Surgical Approaches ◽  
Superior Cerebellar Artery ◽  
Anterior Circulation ◽  
Cerebellar Artery ◽  
Risk Of Rupture ◽  
Posterior Circulation Aneurysms

AbstractPosterior circulation aneurysms represent 10–15% of intracranial aneurysms. The diagnosis is usually secondary to subarachnoid hemorrhage due to its initial asymptomatic presentation and higher risk of rupture compared with aneurysms in the anterior circulation. The surgical treatment of posterior circulation aneurysms is complex and challenging for neurosurgeons because of the particular anatomy of the posterior circulation with its close relation to the brainstem and cranial nerves and also because of the depth and narrowness of the surgical approach. Aneurysms from different locations have specific anatomical relationships and surgical approaches for better visualization and dissection. Therefore, a detailed anatomy knowledge of the posterior circulation is mandatory for an individualized preoperative planning and good neurological and angiographic outcomes. We selected the main aneurysm sites on the posterior circulation, such as: posterior inferior cerebellar artery, basilar trunk, basilar bifurcation, posterior cerebral artery (PCA) and superior cerebellar artery for a detailed description of the relevant anatomy related to aneurysm, and the main surgical approaches for its surgical treatment. Furthermore, we performed a literature review with the most recent outcomes regarding to the surgical treatment of posterior circulation aneurysms.

scholarly journals Case Report: Endovascular Treatment of a Giant Distal PICA Aneurysm in Association With a Cerebellar AVM: A Report on Treatment Considerations and a Literature Review

2020 ◽  
Vol 11 ◽  
Author(s):  
Hassan A. Khayat ◽  
Christine M. Hawkes ◽  
Almunder R. Algird
Keyword(s):  
Posterior Inferior Cerebellar Artery ◽  
Superior Cerebellar Artery ◽  
Management Approach ◽  
Parent Vessel ◽  
Cerebral Angiogram ◽  
First Case ◽  
Cerebellar Artery ◽  
Risk Of Rupture ◽  
The Right ◽  
Pica Aneurysms

Background: Distal posterior inferior cerebellar artery (PICA) aneurysms are uncommon intracranial vascular lesions. The coincidence of these aneurysms and Arteriovenous malformation (AVM) is even more rare. Since 1956, a total of 57 cases of distal PICA aneurysms associated with AVM have been reported with clear and adequate description. None of these reports describe a giant prenidal aneurysm at this particular location. The paucity of natural history data as well as lack of consensus about treatment strategies in such cases present a significant challenge that requires an individualized management approach.Case Description: A 68-year-old male presented with recurrent episodes of nausea and vomiting precipitated by physical exertion and change of head position. An MRI of the brain demonstrated a giant partially thrombosed right posterior inferior cerebellar artery (PICA) aneurysm with mass effect on the floor of the fourth ventricle. A conventional cerebral angiogram revealed a giant (3.1 x 3.1 x 2.8cm) distal right PICA pre-nidal aneurysm with two smaller distal PICA aneurysms. An AVM (Spetzler-Martin Grade 1) supplied by the right PICA as well as the right superior cerebellar artery (SCA) was also identified on cerebral angiography (not seen on an MRI). Endovascular coil embolization with parent vessel sacrifice was performed to occlude the giant aneurysm. Due to the asymptomatic nature, low risk of rupture, and the patient's age, AVM treatment was deferred.Conclusion: This paper presents the first case of a giant PICA aneurysm associated with cerebellar AVM. For PICA aneurysm-AVM complexes, meticulous evaluation of the morphology, associated anatomy, and comparative risk analysis for both lesions are key for treatment planning. Distal PICA aneurysms can be treated safely with parent vessel occlusion, particularly in the case of prenidal aneurysms.

scholarly journals Association between posterior fossa arteriovenous malformations and prenidal aneurysm rupture: potential impact on management

2014 ◽  
Vol 37 (3) ◽  
pp. E4 ◽  
Author(s):  
Evgueni Kouznetsov ◽  
Alain Weill ◽  
Jimmy S. Ghostine ◽  
Jean-Christophe Gentric ◽  
Jean Raymond ◽  
...  
Keyword(s):  
Posterior Fossa ◽  
Arteriovenous Malformations ◽  
Case Series ◽  
Aneurysm Rupture ◽  
Modified Rankin Scale ◽  
Feeding Artery ◽  
Potential Impact ◽  
Arterial Aneurysms ◽  
Lost To Follow Up

Object In patients with posterior fossa arteriovenous malformations (AVMs) who present with hemorrhage, feeding artery aneurysms are often the source of bleeding. The aim of this study was to evaluate the relative proportions of cases of infra- and supratentorial AVMs in which patients presented with prenidal aneurysm rupture. The management and outcome of 9 cases of posterior fossa AVMs associated with prenidal aneurysm rupture are presented. Methods The authors retrospectively reviewed 233 consecutive AVM cases involving patients treated at their institution between April 2001 and August 2012. Patients with a prenidal aneurysm as the cause of the hemorrhage were identified. The frequencies of prenidal aneurysm-related ruptures were compared in cases of supra- and infratentorial AVMs. Management and clinical outcome (modified Rankin Scale [mRS] score) of patients with posterior fossa AVMs treated for ruptured prenidal aneurysms were recorded. Results Of 233 AVMs, 25 (11%) were in the posterior fossa, and in 22 (88%) of these cases, the patients presented with hemorrhage, including 9 patients (41%) who presented with hemorrhage due to prenidal aneurysm rupture. Of 208 patients with supratentorial AVMs, 107 (51%) presented with hemorrhage, including 5 patients (4.7%) in whom the hemorrhage was associated with a prenidal aneurysm (p < 0.01). All 9 patients with posterior fossa AVMs and prenidal aneurysm rupture were treated with early embolization of the offending aneurysm. There was no early rebleeding or clinical complication related to this approach. At the end of follow-up (mean 46.8 months), 2 patients had an mRS score of 0, 1 had a score of 1, 3 had a score of 2, 2 patients were dead (mRS score of 6), and 1 patient was lost to follow-up. Conclusions Posterior fossa AVM hemorrhages are frequently associated with prenidal arterial aneurysms. Urgent endovascular treatment of the aneurysm was effective in this case series.

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