Premammillary Artery Infarction after Microsurgical Clipping of Unruptured Posterior Communicating Artery Aneurysm: Risk Factors, Surgical, and Anatomical Considerations

Purpose Posterior communicating artery (PCoA) aneurysm is common and sometimes requires microsurgery; however, as data on premammillary artery (PMA) infarction after clipping is scarce, we retrospectively reviewed cases of post-clipping PMA infarction to analyze incidence, independent risk factors of infarction, and anatomical considerations. Methods Data from 569 consecutive patients who underwent microsurgical clipping for unruptured PCoA aneurysm between January 2008 and December 2020 were included. Patients were categorized into the normal or the PMA infarction group. Statistical analyses and comparisons between the two groups were used to determine the influence of various factors. Results The normal group included 515 patients while the PMA infarction group had 31. The mean length of hospital stay was significantly longer in the PMA infarction group (10.3 ± 9.1 days) than in the normal group (6.5 ± 6.4 days; p < 0.0001). The distribution of Glasgow Outcome Scale (GOS) at discharge was significantly different between the two groups (p ≤ 0.0001) but was not so at 6 months after discharge (p = 0.0568). Multivariate-logistic-regression analysis identified aneurysm size (odds ratio [OR], 1.194; 95% confidence interval [CI], 1.08–1.32; p = 0.0005) and medial direction of aneurysm (OR, 4.615; 95% CI, 1.224–17.406; p = 0.0239) as independent risk factors of post-clipping PMA infarction. Conclusions Surgeons must beware of PMA infarction after clipping of large aneurysms that are medial in direction. Intraoperative verification of the patency of the PCoA and the PMA from various angles using various intraoperative methods can reduce morbidity due to PMA infarction.

Horizontal Stenting via Retrograde Route for Recurrent Ruptured Posterior Communicating Artery Aneurysm after Clipping: A Case Report and Literature Review

Treatment of recurrent ruptured aneurysms incorporating a branch vessel arising from the dome is challenging. Here, we attempted horizontal stent-assisted coil embolisation via a retrograde route from the contralateral internal carotid artery to treat a small ruptured posterior communicating artery aneurysm incorporating a foetal variant posterior cerebral artery after clipping.

Effects of surgical clipping and endovascular embolization on the recovery of oculomotor nerve paralysis caused by posterior communicating artery aneurysm

Background and Objectives: Our study aimed to explore the therapeutic effects of surgical clipping and endovascular embolization on the recovery of oculomotor nerve paralysis (ONP) caused by posterior communicating artery aneurysm (PcomAA). Methods: The clinical data of patients with intracranial PcomAA and ONP were retrospectively analyzed. All patients were treated with surgical clipping or endovascular embolization, then followed up for no less than 12 months. Logistic regression analysis was performed to analyze the potential risk factors influencing ONP recovery. Results: Among 128 patients of ONP caused by PcomAA, 96 patients were treated with surgical clipping and 32 patients with endovascular embolization, respectively. Time from initial ONP onset to complete or partial recovery was 85.3 ± 36.8 days for patients receiving surgical clipping, and 135.7 ± 41.3 days for patients treated with endovascular embolization. The recovery rate was 94 (97.9%) in the surgical clipping group and 22 (68.8%) in the endovascular embolization group, and significant difference was shown between the two groups (P < 0.001). Logistic regression analyses demonstrated that the complete or partial recovery of ONP in the surgical clipping group was significantly better than that in the endovascular embolization group (OR, 5.582; 95%CI, 2.023-15.405; P <0.001). Moreover, time from initial symptom onset to receiving treatment also affect ONP recovery (OR, 0.893; 95% CI, 0.820-0.972; P = 0.009). Conclusion: Surgical clipping was superior to endovascular embolization in the recovery of ONP caused by PcomAA, and patients who received early intervention could result in better ONP recovery.

Scepter-Mini Balloon Assisted Coil Embolization of an Intracranial Arterial Aneurysm in a Child with PHACE Syndrome via a Persistent Trigeminal Artery

Cerebral vascular malformations constitute one of the key abnormalities in children with PHACE syndrome, which is characterized by Plaque like cutaneous hemangiomas, Posterior fossa abnormalities, arterial Cerebrovascular and Eye abnormalities, with or without Sternal clefts (PHACES when sternal clefts are present), and associated midline anomalies. Both moyamoya arteriopathy and intracranial aneurysms have been reported in children with this syndrome. Herein, we report the successful treatment of a growing left posterior-communicating artery aneurysm arising from an aberrant left internal carotid artery (LICA) with balloon assisted coiling (BAC) in a child with PHACE syndrome. We circumvented the limitations posed by the narrow caliber of the proximal LICA, by successfully navigating a coiling microcatheter from the basilar artery into the LICA <i>via</i> a persistent trigeminal artery. BAC was then achieved using a Scepter Mini balloon microcatheter for aneurysm neck remodelling.