Flow diversion in proximal superior cerebellar artery aneurysms: Systematic review of clinical outcomes and exploratory hemodynamic analysis.

Flow diverters (FDs) are emerging as a treatment strategy for superior cerebellar artery aneurysms (SCAs) despite the limited data on their efficacy and safety. This study evaluated flow diversion (FD) treatment for proximal SCA aneurysms through a single center analysis, systematic review of the literature, and exploratory computational fluid dynamics (CFDs) simulations. Retrospective review of patients with proximal SCA aneurysms treated with FDs at our neurovascular service between 2013 and 2024. We then conducted a systematic review of the literature using the EMBASE, PubMed, and Web of Science to identify patients with SCA aneurysms treated with FD. Data extracted from these studies included demographics, aneurysm characteristics, treatment, and outcomes. Thereafter, a steady-state CFD simulations using a porous-media representation of the implanted device were performed to qualitatively explore hemodynamic differences when the device distally landed in the ipsilateral versus contralateral posterior cerebral artery relative to the aneurysm. Our literature search identified 13 proximal aneurysms from 6 eligible studies; combined with 5 institutional cases, a total of 18 aneurysms were analyzed. Among these, 16 (88.9%) of the aneurysms were saccular, with a mean size of 6.5 mm (range: 2.2-22) and treated with PED (84.6%) and SILK (15.4%) devices. At a mean of 16.1 months (range: 4-53) angiographic evaluation indicated that 72.2% (13/18) achieved complete or near-complete occlusion, with no long-term neurological deficits. Exploratory CFD analysis suggested greater modeled reductions in aneurysm WSS, kinetic energy, and inflow when stent deployment was simulated ipsilateral to the aneurysm. FD is a reported treatment for proximal SCA aneurysms, and can be technically performed in selected cases. However, further studies with larger cohorts and extended follow-up are needed to evaluate long-term efficacy, functional outcomes, and potential delayed complications.