J Korean Neurosurg Soc.  2023 Jul;66(4):418-425. 10.3340/jkns.2022.0259.

Added Predictive Values of Proton Density Magnetic Resonance Imaging on Posterior Communicating Artery Aneurysms and Surrounding Soft Tissues with Simple Classification

• Yoon S
• Kim MJ
• Han HJ
• Park KY
• Chung J
• Kim YB

• KMID: 2543533
• DOI: http://doi.org/10.3340/jkns.2022.0259

Abstract

Objective
: Deciphering the anatomy of posterior communicating artery (PCoA) aneurysms in relation to surrounding structures is essential to determine adjuvant surgical procedures. However, it is difficult to predict surgical structures through preoperative imaging studies. We aimed to present anatomical structures using preoperative high-resolution three-dimensional proton densityweighted turbo spin-echo magnetic resonance (PDMR) imaging with simple classification.
Methods
: From January 2020 to April 2022, 30 patients underwent PDMR before microsurgical clipping for unruptured PCoA aneurysms in a single tertiary institute. We retrospectively reviewed the radiographic images and operative data of these patients. The structural relationship described by PDMR and intraoperative findings were compared. Subsequently, we classified aneurysms into two groups and analyzed the rate of adjuvant surgical procedures and contact with the surrounding structures.
Results
: Correlations between preoperative PDMR predictions and actual intraoperative findings for PCoA aneurysm contact to the oculomotor nerve, temporal uncus, and anterior petroclinoid fold (APCF) reported a diagnostic accuracy of 0.90, 0.87, and 0.90, respectively. In 12 patients (40.0%), an aneurysm dome was located on the plane of the oculomotor triangle and was classified as the infratentorial type. Compared to the supratentorial type PCoA aneurysm, adjuvant procedures were required more frequently (66.7% vs. 22.2%, p=0.024) for infratentorial type PCoA aneurysm clipping.
Conclusion
: Preoperative PCoA aneurysm categorization using PDMR can be helpful for predicting surgical complexity and planning of microsurgical clipping.

Keyword

Aneurysm; Cerebral revascularization; Angiography; Magnetic resonance imaging

Figure

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  Fig. 1. A : Aneurysm (asterisk) located under the level of the APCF (white arrowhead). B : Laterally deviated oculomotor nerve (white arrow) with PCoA aneurysm of the affected side, contralateral normal oculomotor triangle (white triangle). Intraoperative photography, (C) PCoA aneurysm under the APCF (black dashed line) and (D) oculomotor nerve (black arrow) adjacent to PCoA aneurysm and concomitant anterior choroidal aneurysm. APCF : anterior petroclinoid fold, PCoA : posterior communicating artery

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  Fig. 2. A : Coronal section of Rt. posterior communicating artery aneurysm on PDMR; aneurysm contact with temporal uncus (black arrow) and the APCF (white arrow) are indicated. Oculomotor nerve (white arrowhead). Intraoperative photographs, (B) thick adhesion of aneurysm to temporal uncus (black arrow), and (C) after subpial dissection of aneurysm from temporal uncus, adhesion to the APCF is noted. (D) After resection of the APCF to free the aneurysm, the oculomotor nerve (white arrow) below the APCF was noted. Rt. : right, PDMR : proton density-weighted turbo spin-echo magnetic resonance, APCF : anterior petroclinoid fold.

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  Fig. 3. A and B : Lt. PCoA aneurysm (asterisk) caught between APCF and temporal uncus is shown on PDMR coronal and axial planes. Intraoperative photography, (C) Lt. PCoA aneurysms are caught between the APCF (white dashed line) and temporal uncus (T). Lt. : left, PCoA : posterior communicating artery, APCF : anterior petroclinoid fold, PDMR : proton density-weighted turbo spin-echo magnetic resonance.

Reference

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