XXXX : A difficult challenge for microsurgery and endovascular treatment.

@entity1 @entity90 @entity438 @entity73 @entity397 @entity439 @entity1756
INTRODUCTION: @entity438 ( @entity438 ) represent 2 to 9% of @entity438 and their management remains difficult. OBJECTIVE: We aimed to report our experience to evaluate the outcome of @entity1 with @entity397 and unruptured @entity438 , when the treatment modality is decided in a multidisciplinary fashion. MATERIALS AND METHODS: In this retrospective study, we included 28  @entity1 (8  @entity1 and 20  @entity1 ) treated for a @entity438 in our institution between 2002 and 2012, among the 2430  @entity1 who underwent the treatment of an @entity438 in the same period. Fifteen @entity1 harbored a @entity1756 while 13 benefited from a prophylactic treatment. The mean age at diagnosis was 52  years (range 37 to 75  SD:   5) in @entity1 with @entity1756 and 54.2  years (range 35 to 66  SD:   5) in @entity1 with unruptured @entity439 . Endovascular treatment has been performed in 9  @entity1 while 19  @entity1 underwent a microsurgical treatment. Clinical outcome has been assessed using the modified Rankin scale (mRS) at 3  months. Long-term imaging follow-up included a CT angiography at 36  months for clipped @entity439 and @entity90 angiography at 6, 18 and 36  months for coiled @entity439 . RESULTS: The median follow-up was 3.4  years (range 2.8 to 4.2). The mRS was <=2 in all @entity1 with @entity439 . In @entity1 with @entity1756 , the mRS was  <=2 at 3  months in 13  @entity1 (87%). Persistent @entity73 were noted in 8  @entity1 with @entity1756 , 2 of them were considered as possibly related to the treatment. @entity439 has been depicted in 4  @entity1 (at 6  months in 3  @entity1 and 1  year in 1  @entity1 ) requiring further treatment in all cases; all of them had an @entity439 remnant on immediate conventional angiography. No recurrence was noted in @entity1 without remnant on immediate post-treatment angiography. CONCLUSION: Both endovascular and microsurgical treatment are challenged in this location. Multidisciplinary discussion is essential to optimize the management of @entity1 with @entity438 .
