Distal Posterior Cerebral Artery Revascularization in Multimodality Management of Complex Peripheral Posterior Cerebral Artery Aneurysms: Technical Case Report

Distal Posterior Cerebral Artery Revascularization in Multimodality Management of Complex... AbstractOBJECTIVES AND IMPORTANCE:Although controversial, revascularization of the distal posterior cerebral artery (PCA) may become necessary in treating complex PCA aneurysms before proximal parent vessel sacrifice. The revascularization of the distal PCA territories of two patients with peripheral PCA aneurysms is presented.CLINICAL PRESENTATIONS:One patient had an aneurysm of the P2-P3 segment and failed a selective P2 balloon occlusion test by developing homonymous hemianopia before planned parent vessel sacrifice. The other patient with a giant P2 segment aneurysm presented with visual field deficits.TECHNIQUE:The distal segment of PCA was revascularized before the aneurysms were trapped by surgical clipping or coil occlusion of the distal P2 segment, proximal to the aneurysms. In both cases, the occipital artery was used as the "donor" vessel. Temporary occlusion times were 22 and 20 minutes, respectively. Both grafts were patent on postoperative angiography, and both patients had full visual fields at the time of their follow-up examinations.CONCLUSION:De novo distal P2 sacrifice, advocated for treating peripheral PCA aneurysms, leads to visual field deficits in some patients. Revascularization of the distal segment of the PCA, less technically demanding than bypass to other PCA segments, preserves blood flow, thus sparing vision in this subset of patients. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Neurosurgery Oxford University Press

Distal Posterior Cerebral Artery Revascularization in Multimodality Management of Complex Peripheral Posterior Cerebral Artery Aneurysms: Technical Case Report

Distal Posterior Cerebral Artery Revascularization in Multimodality Management of Complex Peripheral Posterior Cerebral Artery Aneurysms: Technical Case Report

T E C H N IC A L C A SE REPO RTS riods of temporary occlusion. These Distal Posterior Cerebral Artery proximal PCA bypasses, however, are not a consideration when treating more Revascularization in M ultimodality peripherally located PCA aneurysms. We present our experience with a by­ Management of Com plex Peripheral pass to a distal PCA branch as an ad­ junct to simple parent vessel sacrifice in Posterior Cerebral Artery Aneurysms: the m anagem ent of complex peripheral PCA aneurysms. Despite the small cali­ Technical Case Report ber of these distal PCA branches, this procedure is technically less demanding than bypasses performed to proximal PCA segments. No such bypass with A. Giancarlo Vishteh, M.D., Kris A. Smith, M.D., angiographic docum entation of graft Cameron G. M cDougall, M.D., Robert F. Spetzler, M.D. patency has been previously reported. D ivision of Neurological Surgery, Barrow Neurological Institute, Mercy Healthcare Arizona, Phoenix, Arizona CASE REPORTS Patient 1 O BJECTIV ES A N D IM PO RTAN CE: Although controversial, revascularization A 45-year-old w om an was treated at of the distal posterior cerebral artery (PCA) may become necessary in an outside institution with a chief com­ treating complex PCA aneurysms before proximal parent vessel sacrifice. plaint of headaches. Contrast-enhanced The revascularization of the distal PCA territories of two patients with computed tomography (Fig. 1A) re­ peripheral PCA aneurysms is presented. vealed an enhancing mass in the left C L IN IC A L PRESEN TATIO N S: One patient had an aneurysm of the P2-P3 quadrigem inal/am bient cisterns. Four- segment and failed a selective P2 balloon occlusion test by developing vessel cerebral angiography revealed a left fetal-origin PCA with a P 2 -P 3 junc­ homonymous hemianopia before planned parent vessel sacrifice. The tion aneurysm. The patient's headaches other patient with a giant P2 segment aneurysm presented with visual were managed...
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Publisher
Congress of Neurological Surgeons
Copyright
© Published by Oxford University Press.
ISSN
0148-396X
eISSN
1524-4040
D.O.I.
10.1097/00006123-199807000-00114
Publisher site
See Article on Publisher Site

Abstract

AbstractOBJECTIVES AND IMPORTANCE:Although controversial, revascularization of the distal posterior cerebral artery (PCA) may become necessary in treating complex PCA aneurysms before proximal parent vessel sacrifice. The revascularization of the distal PCA territories of two patients with peripheral PCA aneurysms is presented.CLINICAL PRESENTATIONS:One patient had an aneurysm of the P2-P3 segment and failed a selective P2 balloon occlusion test by developing homonymous hemianopia before planned parent vessel sacrifice. The other patient with a giant P2 segment aneurysm presented with visual field deficits.TECHNIQUE:The distal segment of PCA was revascularized before the aneurysms were trapped by surgical clipping or coil occlusion of the distal P2 segment, proximal to the aneurysms. In both cases, the occipital artery was used as the "donor" vessel. Temporary occlusion times were 22 and 20 minutes, respectively. Both grafts were patent on postoperative angiography, and both patients had full visual fields at the time of their follow-up examinations.CONCLUSION:De novo distal P2 sacrifice, advocated for treating peripheral PCA aneurysms, leads to visual field deficits in some patients. Revascularization of the distal segment of the PCA, less technically demanding than bypass to other PCA segments, preserves blood flow, thus sparing vision in this subset of patients.

Journal

NeurosurgeryOxford University Press

Published: Jul 1, 1998

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