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Advances in the Management of Intracranial Aneurysms

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Clinical Neurology".

Deadline for manuscript submissions: closed (20 September 2025) | Viewed by 451

Special Issue Editors


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Guest Editor
Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA
Interests: cerebral aneurysm; cerebrovascular disease; intracranial surgery; neurosurgery

E-Mail Website
Guest Editor
Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA
Interests: cerebrovascular disease; intracranial surgery; spinal cord injury; neurosurgery

E-Mail Website
Guest Editor
Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA
Interests: cerebrovascular disease; endovascular neurosurgery; intracranial surgery; neurooncology

Special Issue Information

Dear Colleagues,

The management of complex intracranial aneurysms oftentimes requires a combination of complex endovascular and open vascular techniques in order to provide patients with definitive treatment. From staging treatments to combining endovascular intervention with open surgery, the decision-making required is complex and necessitates comprehensive, multidisciplinary training to ensure long-term, durable outcomes. The dome protection of ruptured aneurysms in acute settings followed by delayed flow diversion or clip ligation, open surgery for recurrent endovascularly-treated aneurysms and upfront cerebral bypass combined with endovascular treatment are some of the nuanced decisions necessary in the modern era of cerebrovascular surgeries. In this Special Issue, we welcome authors to submit papers that highlight the multidiscipilnary techniques needed to treat complex intracranial aneurysms and the nuances considered to improve patient outcomes.

Prof. Dr. Robert H. Rosenwasser
Dr. Nikolaos Mouchtouris
Dr. Elias Atallah
Guest Editors

Manuscript Submission Information

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Keywords

  • cerebral aneurysm
  • endovascular
  • open vascular
  • flow diversion
  • cerebral bypass
  • stent-assisted coiling

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Published Papers (1 paper)

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Research

15 pages, 1479 KB  
Article
Choice of Treatment Modality and Validity of Direct Surgery for Complex Posterior Inferior Cerebellar Artery-Related Aneurysms
by Fumihiro Hamada, Hitoshi Fukuda, Naoki Fukui, Yusuke Ueba, Motonobu Nonaka, Mitsuhiro Takemura, Namito Kida and Tetsuya Ueba
J. Clin. Med. 2025, 14(23), 8270; https://doi.org/10.3390/jcm14238270 - 21 Nov 2025
Abstract
Background/Objectives: Complex aneurysms of the posterior inferior cerebellar artery (PICA) remain challenging because of their deep location, variable morphology, and proximity to critical neurovascular structures. Although endovascular therapy is preferred, its feasibility is limited in wide-necked, fusiform, or dissecting lesions. We describe our [...] Read more.
Background/Objectives: Complex aneurysms of the posterior inferior cerebellar artery (PICA) remain challenging because of their deep location, variable morphology, and proximity to critical neurovascular structures. Although endovascular therapy is preferred, its feasibility is limited in wide-necked, fusiform, or dissecting lesions. We describe our tertiary referral hospital single-center experience with tailored microsurgical and endovascular strategies—emphasizing occipital artery–PICA (OA-PICA) bypass, transcondylar fossa craniotomy, and cerebellomedullary fissure opening—and analyze perioperative factors that influence outcome. Methods: All consecutive patients treated for PICA origin or distal-PICA aneurysms between January 2021 and April 2025 were retrospectively reviewed. Demographics, aneurysm characteristics, procedure type, antithrombotic regimen, complications, diffusion-weighted MRI findings, and 3-month modified Rankin Scale scores were collected. Results: Twelve aneurysms (mean age 61.4 ± 15.2 years; 8 women) were treated: trapping + OA-PICA bypass in 5, direct clipping in 2, flow diverter in 1, endovascular parent artery occlusion in 2, coil embolization in 1, and a hybrid bypass-plus-coil strategy in 1. Two cases were ruptured aneurysms. Perioperative aspirin was used in 2/5 bypass cases; heparin was added in one hybrid case. Asymptomatic PICA-territory infarcts occurred in the three bypasses performed without antiplatelet therapy (one with intra-anastomotic thrombus). No leaks or subcutaneous collections of cerebrospinal fluid were encountered, and no graft occlusions were observed. At 3 months, 9/12 patients achieved a good outcome (mRS 0–2); among them, only one patient with subarachnoid hemorrhage (SAH) experienced postoperative worsening of the mRS. Two cranial nerve palsies (one permanent, one transient) and one wound site hematoma (heparin-associated) resolved without sequelae. Conclusions: Meticulous operative planning allows safe treatment of complex PICA aneurysms. Perioperative aspirin appears beneficial for OA-PICA bypass, whereas perioperative heparin increases bleeding risk. Individualized selection of endovascular, microsurgical, or combined strategies yields favorable early neurological outcomes in this demanding subset of cerebrovascular disease. Full article
(This article belongs to the Special Issue Advances in the Management of Intracranial Aneurysms)
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