Parent vessel occlusion for treatment of cerebral aneurysms: Is there still an indication? A series of 17 patients Nishant Ganesh Kumar d, ⁎, Travis R. Ladner d , Imad S. Kahn e , Scott L. Zuckerman d , Christopher B. Baker a,c , Marybess Skaletsky a , Deborah Cushing a , Matthew R. Sanborn a , J Mocco f , Robert D. Ecker a,b a Maine Medical Center, Neuroscience Institute, Portland, Maine, USA b Maine Medical Center, Department of Surgery, Portland, ME, USA c Maine Medical Center, Department of Radiology, Portland, ME, USA d Vanderbilt University Medical Center, Department of Neurosurgery, Nashville, Tenessee, USA e Dartmouth Hitchcock Medical Center, Department of Neurosurgery, Hanover, New Hampshire, USA f Mt. Sinai Medical Center, Department of Neurosurgery, New York, New York, USA abstract article info Article history: Received 11 June 2016 Received in revised form 27 October 2016 Accepted 22 November 2016 Available online 23 November 2016 Introduction/purpose: Flow diversion has allowed cerebrovascular neurosurgeons and neurointerventionalists to treat complex, large aneurysms, previously treated with trapping, bypass, and/or parent vessel sacrifice. Howev- er, a minority of aneurysms remain that cannot be treated endovascularly, and microsurgical treatment is too dangerous. However, balloon test occlusion (macro and micro), micro WADA testing, ICG, intra-angiography and intra-operative monitoring are all available to clinically test the hypothesis that vessel sacrifice is safe. We describe a dual-institution series of aneurysms successfully treated with parent vessel occlusion (PVO). Materials/methods: Prospectively collected databases of all endovascular and open cerebrovascular cases per- formed at Maine Medical Center and Vanderbilt University Medical Center from 2011 to 2013 were screened for patients treated with primary vessel sacrifice. A total of 817 patients were screened and 17 patients were identified who underwent parent vessel sacrifice as primary treatment. Results: All 17 patients primarily treated with PVO are described below. Nine patients presented with SAH, and 3/ 17 involved anterior circulation. Complete occlusion was achieved in 15/17 patients. In the remaining 2 patients, significant reduction in the aneurysm occurred. Modified Rankin Score (mRS) of 0, signifying complete indepen- dence, was achieved for 16/17 patients. One patient died due to an extracranial process. Conclusions: Parent vessel sacrifice remains a viable and durable solution in select ruptured and unruptured in- tracranial aneurysms. Many adjuncts are available to aid in the decision making. In this small series, patients nat- urally divided into vertebral dissecting aneurysms, giant aneurysms and small distal aneurysms. Outcomes were favorable in this highly selected group. © 2016 Elsevier B.V. All rights reserved. Keywords: Aneurysm Balloon test occlusion Parent vessel occlusion Giant aneurysm 1. Introduction Parent vessel occlusion (PVO) is a traditional method for treating an- eurysms that are not amenable to direct coiling/clipping or particularly complex saccular or fusiform aneurysms. It has been successfully implemented in the treatment of aneurysms involving the vertebrobasilar junction [1–4], posterior cerebral artery [5–7] and pe- ripheral cerebral aneurysms [8,9] when adequate collateral flow is pres- ent. Flow diverters have introduced another class of treatment options for these complex aneurysms that historically would have undergone trapping, parent vessel sacrifice, or bypass. However, PVO still remains a viable option. There are many well-established diagnostic modalities to determine feasibility of PVO, including intra-operative monitoring, balloon test occlusion (BTO), and Wada testing. These can aid in patient selection to ensure that PVO, if indicated, is safe. Therefore, interventionalists and neurosurgeons should keep PVO in their arma- mentarium of treatment options. Here we review the experiences of two centers using PVO as a favorable solution in a select group of pa- tients with intracranial aneurysms. Journal of the Neurological Sciences 372 (2017) 250–255 Abbreviations: AICA, Anterior Inferior Cerebellar Artery; AVM, Arterial-venous Malformation; BTO, Balloon test occlusion; ICA, Internal Carotid Artery; ICG, Indocyanine green; MMC, Maine Medical Center; MCA, Middle Cerebral Artery; mRS, Modified Rankin Score; NBCA, n-butyl cyanoacrylate; PVO, Parent Vessel Occlusion; PICA, Posterior inferior cerebellar artery; SAH, Subarachnoid hemorrhage; SCA, Superior Cerebellar Artery and Vanderbilt University Medical Center (VUMC). ⁎ Corresponding author at: Vanderbilt University School of Medicine, Medical Center North T-4224, Nashville, TN 37212, USA. E-mail address: nishant.ganesh.kumar@vanderbilt.edu (N. Ganesh Kumar). http://dx.doi.org/10.1016/j.jns.2016.11.057 0022-510X/© 2016 Elsevier B.V. All rights reserved. Contents lists available at ScienceDirect Journal of the Neurological Sciences journal homepage: www.elsevier.com/locate/jns