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Super-selective balloon test occlusion with electrophysiological monitoring to occlude angiographically invisible posterior communicating artery perforators with unruptured aneurysm

  • Case Report - Vascular Neurosurgery - Aneurysm
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Abstract

Balloon test occlusion (BTO) can predict the ischemic complication risk associated with arterial occlusion. We present a case of an unruptured, broad-necked internal carotid artery-posterior communicating artery (PcomA) aneurysm that was successfully embolized after super-selective BTO of fetal PcomA with electrophysiological monitoring. The proximal portion of the PcomA was internally occluded without causing major neurological deficits, although we observed a small new infarction in the ipsilateral anterior thalamus postoperatively. We recognized small perforators arising from the proximal PcomA during a previous clipping surgery. Super-selective BTO with electrophysiological monitoring could be useful for functional preservation after infarction from angiographically invisible perforators.

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Abbreviations

BTO :

Balloon test occlusion

ICA :

Internal carotid artery

MEPs :

Motor-evoked potentials

PcomA :

Posterior communicating artery

SEPs :

Sensory-evoked potentials

References

  1. Aydin K, Stracke CP, Barburoglu M, Yamac E, Berdikhojayev M, Sencer S, Chapot R (2019) Long-term outcomes of wide-necked intracranial bifurcation aneurysms treated with T-stent-assisted coiling. J Neurosurg 1-10

  2. Endo H, Sato K, Kondo R, Matsumoto Y, Takahashi A, Tominaga T (2012) Tuberothalamic artery infarctions following coil embolization of ruptured posterior communicating artery aneurysms with posterior communicating artery sacrifice. AJNR Am J Neuroradiol 33:500–506

    Article  CAS  Google Scholar 

  3. Hiraishi T, Fukuda M, Oishi M, Nishino K, Shinbo J, Sorimachi T, Ito Y, Fujii Y (2011) Usefulness of motor-evoked potential monitoring during coil embolization of anterior choroidal artery aneurysms: technical reports. Neurol Res 33:360–362

    Article  Google Scholar 

  4. Isozaki M, Arai H, Neishi H, Kitai R, Kikuta KI (2016) Super-selective balloon test occlusion of the posterior communicating artery in the treatment of a posterior cerebral artery fusiform aneurysm: a case report. NMC Case Rep J 3:129–131

    Article  Google Scholar 

  5. Isozaki M, Satow T, Matsushige T, Mori H, Iihara K (2016) Superselective provocative test with propofol using motor-evoked potential monitoring for managing cerebral arteriovenous malformations fed by the anterior choroidal artery. J Stroke Cerebrovasc Dis 25:e153–e157

    Article  Google Scholar 

  6. Kim B, Jeon P, Kim K, Yang N, Kim S, Kim H, Byun H, Jo KI (2016) Endovascular treatment of unruptured ophthalmic artery aneurysms: clinical usefulness of the balloon occlusion test in predicting vision outcomes after coil embolization. J Neurointerv Surg 8:696–701

    Article  Google Scholar 

  7. Lee S, Kim DY, Kim SB, Kim W, Kang MR, Kim HJ, Lee KH, Yoo M, Choi BS, Kim JS, Lee SI, Kim HY, Jin SC (2019) Predictive value of neurophysiologic monitoring during neurovascular intervention for postoperative new neurologic deficits. Neuroradiology 61:207–215

    Article  Google Scholar 

  8. Ma Y, Zhang Y, Jiang J, Li S, Ni T, Liu L, Xue Z, Wu C, Sun Z, Yu X (2019) Application and reliability of the superselective balloon occlusion test in the treatment of complex cerebral artery aneurysms: a report of 12 cases. J Clin Neurosci 64:57–63

    Article  Google Scholar 

  9. Martinez Piñeiro A, Cubells C, Garcia P, Castaño C, Dávalos A, Coll-Canti J (2015) Implementation of intraoperative neurophysiological monitoring during endovascular procedures in the central nervous system. Interv Neurol 3:85–100

    Article  Google Scholar 

  10. Mathis JM, Barr JD, Jungreis CA, Yonas H, Sekhar LN, Vincent D, Pentheny SL, Horton JA (1995) Temporary balloon test occlusion of the internal carotid artery: experience in 500 cases. AJNR Am J Neuroradiol 16:749–754

    CAS  PubMed  PubMed Central  Google Scholar 

  11. Mitsuhashi T, Takeda N, Oishi H, Arai H (2015) Parent artery occlusion for ruptured “true” posterior communicating artery aneurysm. Interv Neuroradiol 21:171–174

    Article  Google Scholar 

  12. Moshayedi P, Giurgiutiu DV, Ducruet AF, Jankowitz BT, Jadhav AP (2018) Provocative testing prior to anterior cerebral artery fusiform aneurysm embolization. Interv Neurol 7:36–41

    Article  Google Scholar 

  13. Nakagawa I, Park H, Kotsugi M, Motoyama Y, Myochin K, Takeshima Y, Matsuda R, Nishimura F, Yamada S, Takatani T, Kichikawa K, Nakase H (2021) Diagnostic impact of monitoring transcranial motor-evoked potentials to prevent ischemic complications during endovascular treatment for intracranial aneurysms. Neurosurg Rev 44:1493–1501

    Article  Google Scholar 

  14. Rinaldo L, Brinjikji W, Cloft H, Lanzino G, Gonzalez LF, Kan P, Castilla LR (2019) Effect of fetal posterior circulation on efficacy of flow diversion for treatment of posterior communicating artery aneurysms: a multi-institutional study. World Neurosurg 127:e1232–e1236

    Article  Google Scholar 

  15. Saeki N, Rhoton AL Jr (1977) Microsurgical anatomy of the upper basilar artery and the posterior circle of Willis. J Neurosurg 46:563–578

    Article  CAS  Google Scholar 

  16. Sattur MG, Welz ME, Bendok BR, Miller JW (2019) Balloon occlusion testing to assess retinal collateral and predict visual outcomes in the management of a fusiform intraorbital ophthalmic artery aneurysm: technical note and literature review. Oper Neurosurg (Hagerstown) 16:60–66

    Article  Google Scholar 

  17. Takahashi S, Goto K, Fukasawa H, Kawata Y, Uemura K, Yaguchi K (1985) Computed tomography of cerebral infarction along the distribution of the basal perforating arteries. Part II: Thalamic arterial group. Radiol 155:119–130

    CAS  Google Scholar 

  18. Wang Q, Chen G, Gu Y, Song D (2011) Provocative tests and parent artery occlusion in the endovascular treatment of distal middle cerebral artery pseudoaneurysms. J Clin Neurosci 18:1741–1743

    Article  CAS  Google Scholar 

  19. Wilent WB, Belyakina O, Korsgaard E, Tjoumakaris SI, Gooch MR, Jabbour P, Rosenwasser R, English JD, Kim W, Tesdahl E, Cohen J, Sestokas AK (2021) Intraoperative vascular complications during 2278 cerebral endovascular procedures with multimodality IONM: relationship between signal change, complication, intervention and postoperative outcome. J Neurointerv Surg 13:378–383

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Neurosurgery, Kyoto Prefectural University of Medicine Graduate School of Medical Science, 465 Kajii-cho, Kawaramachi Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan

    Daisuke Maruyama, Masataka Nanto, Shogo Ogita & Naoya Hashimoto

  2. Department of Neurosurgery, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan

    Daisuke Maruyama, Kengo Kishida, Gaku Fujiwara, Mamoru Murakami & Nobukuni Murakami

Authors
  1. Daisuke Maruyama
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  2. Masataka Nanto
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  3. Shogo Ogita
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  4. Kengo Kishida
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  5. Gaku Fujiwara
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  6. Mamoru Murakami
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  7. Nobukuni Murakami
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  8. Naoya Hashimoto
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Correspondence to Daisuke Maruyama.

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This article is part of the Topical Collection on Vascular Neurosurgery - Aneurysm

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Maruyama, D., Nanto, M., Ogita, S. et al. Super-selective balloon test occlusion with electrophysiological monitoring to occlude angiographically invisible posterior communicating artery perforators with unruptured aneurysm. Acta Neurochir 164, 169–172 (2022). https://doi.org/10.1007/s00701-021-05074-w

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  • DOI: https://doi.org/10.1007/s00701-021-05074-w

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