Review of treatment modalities and clinical outcome of giant saccular posterior cerebral artery aneurysms
Introduction: Giant saccular posterior cerebral artery (PCA) aneurysms are rare lesions carrying significant morbidity due to mass effect and present therapeutic challenges, mainly due to the challenging approach required for aneurysm obliteration. Research question: To review treatment modalities a...
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Elsevier
2025-01-01
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| Series: | Brain and Spine |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2772529425001286 |
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| author | Andreas Theofanopoulos Rajiv Kumar Khajuria Dilaware Khan Lucas Troude Ben Waldau Katharina Faust Sajjad Muhammad |
| author_facet | Andreas Theofanopoulos Rajiv Kumar Khajuria Dilaware Khan Lucas Troude Ben Waldau Katharina Faust Sajjad Muhammad |
| author_sort | Andreas Theofanopoulos |
| collection | DOAJ |
| description | Introduction: Giant saccular posterior cerebral artery (PCA) aneurysms are rare lesions carrying significant morbidity due to mass effect and present therapeutic challenges, mainly due to the challenging approach required for aneurysm obliteration. Research question: To review treatment modalities and outcomes of patients harboring giant (>2.5 cm) PCA saccular aneurysms distal to the basilar bifurcation. Materials and methods: A systematic literature review through PubMed and Scopus to identify cases of giant saccular PCA aneurysms treated either microsurgically or endovascularly. Patients’ demographics, aneurysm size, preoperative and postoperative neurologic status, clinical outcomes and follow-up information were retrieved. Results: Data from 33 studies including 55 patients were obtained. Mean patient age was 34.35 years. Mean maximum aneurysm diameter was 38.48 mm. Presentation was aneurysm rupture in 30.9 %, headache in 23.6 %, hemiparesis or tetraparesis in 12.7 %, hemianopsia in 10.9 % and hydrocephalus in 5.5 %. At least 30.9 % had significant brainstem compression. Treatment was endovascular in 23.6 %, microsurgical in 67.3 % and combined in 9.1 %. Debulking to reduce mass effect was required in 32.4 %. Preoperative mRS ranged from 1 to 5. A favorable outcome (mRS 0–2) was reported on 92.7 % of cases. Death rate was 3.6 %. The PCA was sacrificed in 40 % of the patients without severe neurologic morbidity. Follow-up ranged from 1 week to 11 years. Discussion and conclusion: Giant PCA aneurysms are amenable to both treatment modalities. PCA sacrifice may be required and is often well tolerated, presumably due to the rich collateral supply. Mass effect may necessitate debulking. PCA bypass may be required, but carries significant morbidity. |
| format | Article |
| id | doaj-art-20184cb91d0147ffa7b42c5438d2d453 |
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| language | English |
| publishDate | 2025-01-01 |
| publisher | Elsevier |
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| series | Brain and Spine |
| spelling | doaj-art-20184cb91d0147ffa7b42c5438d2d4532025-07-09T04:33:01ZengElsevierBrain and Spine2772-52942025-01-015104309Review of treatment modalities and clinical outcome of giant saccular posterior cerebral artery aneurysmsAndreas Theofanopoulos0Rajiv Kumar Khajuria1Dilaware Khan2Lucas Troude3Ben Waldau4Katharina Faust5Sajjad Muhammad6Department of Neurosurgery, University Hospital of Patras, Patras, GreeceDepartment of Neurosurgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, GermanyDepartment of Neurosurgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, GermanyDepartment of Neurosurgery, North University Hospital Marseille, APHM-AMU, Marseille, France; Department of Neurosurgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, GermanyDepartment of Neurological Surgery, UC Davis Medical Center, Sacramento, CA, USADepartment of Neurosurgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, GermanyDepartment of Neurosurgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany; Corresponding author. Department of Neurosurgery, University Hospital Duesseldorf, Germany Mooren Str. 5, 40225, Düsseldorf, Germany.Introduction: Giant saccular posterior cerebral artery (PCA) aneurysms are rare lesions carrying significant morbidity due to mass effect and present therapeutic challenges, mainly due to the challenging approach required for aneurysm obliteration. Research question: To review treatment modalities and outcomes of patients harboring giant (>2.5 cm) PCA saccular aneurysms distal to the basilar bifurcation. Materials and methods: A systematic literature review through PubMed and Scopus to identify cases of giant saccular PCA aneurysms treated either microsurgically or endovascularly. Patients’ demographics, aneurysm size, preoperative and postoperative neurologic status, clinical outcomes and follow-up information were retrieved. Results: Data from 33 studies including 55 patients were obtained. Mean patient age was 34.35 years. Mean maximum aneurysm diameter was 38.48 mm. Presentation was aneurysm rupture in 30.9 %, headache in 23.6 %, hemiparesis or tetraparesis in 12.7 %, hemianopsia in 10.9 % and hydrocephalus in 5.5 %. At least 30.9 % had significant brainstem compression. Treatment was endovascular in 23.6 %, microsurgical in 67.3 % and combined in 9.1 %. Debulking to reduce mass effect was required in 32.4 %. Preoperative mRS ranged from 1 to 5. A favorable outcome (mRS 0–2) was reported on 92.7 % of cases. Death rate was 3.6 %. The PCA was sacrificed in 40 % of the patients without severe neurologic morbidity. Follow-up ranged from 1 week to 11 years. Discussion and conclusion: Giant PCA aneurysms are amenable to both treatment modalities. PCA sacrifice may be required and is often well tolerated, presumably due to the rich collateral supply. Mass effect may necessitate debulking. PCA bypass may be required, but carries significant morbidity.http://www.sciencedirect.com/science/article/pii/S2772529425001286Giant PCA aneurysmEndovascular treatmentSurgical treatmentOutcome |
| spellingShingle | Andreas Theofanopoulos Rajiv Kumar Khajuria Dilaware Khan Lucas Troude Ben Waldau Katharina Faust Sajjad Muhammad Review of treatment modalities and clinical outcome of giant saccular posterior cerebral artery aneurysms Brain and Spine Giant PCA aneurysm Endovascular treatment Surgical treatment Outcome |
| title | Review of treatment modalities and clinical outcome of giant saccular posterior cerebral artery aneurysms |
| title_full | Review of treatment modalities and clinical outcome of giant saccular posterior cerebral artery aneurysms |
| title_fullStr | Review of treatment modalities and clinical outcome of giant saccular posterior cerebral artery aneurysms |
| title_full_unstemmed | Review of treatment modalities and clinical outcome of giant saccular posterior cerebral artery aneurysms |
| title_short | Review of treatment modalities and clinical outcome of giant saccular posterior cerebral artery aneurysms |
| title_sort | review of treatment modalities and clinical outcome of giant saccular posterior cerebral artery aneurysms |
| topic | Giant PCA aneurysm Endovascular treatment Surgical treatment Outcome |
| url | http://www.sciencedirect.com/science/article/pii/S2772529425001286 |
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