Posterior Circulation Aneurysms: A Critical Appraisal of a Surgical Series in Endovascular Era

Posterior Circulation ◽

Cerebellar Artery ◽

Average Patient ◽

The Mean

AbstractThe advent of the endovascular era has apparently decreased the role of microneurosurgery for many of the posterior circulation aneurysms. This study consists of a critical appraisal of a retrospective surgical series regarding posterior circulation aneurysms, targeted to define whether microneurosurgery still has a role for some of these. In 28 years, 157 aneurysms were surgically treated, 98 of which ruptured. The Average patient age was 56.7 ± 14.2 years, while in hemorrhagic cases, the mean Hunt-Hess score was 2.17 ± 0.8. Basilar tip, vertebral artery and proximal posterior inferior cerebellar artery were the most frequently involved sites. The treatment consisted of 128 clippings, 19 trappings, 7 wrappings, and 3 bypasses. A total exclusion was achieved in 88.5% of the aneurysms. An average follow-up of 67.1 ± 61.3 months proved no recurrences. The best results were observed in patients <65 years old who harbored small-to-regular aneurysms of the basilar tip, distal cerebellar arteries, or vertebral artery.Clipping proved to be a definitive and durable treatment for a large part of posterior circulation aneurysms, whereas bypass allows for treating aneurysms not amenable for coiling, stenting, or clipping. The present study confirms that microneurosurgery continues to have a paramount role within neurovascular pathology.

Pipeline embolization device for the treatment of vertebral artery aneurysms: the fate of covered branch vessels

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2015-012040 ◽

2015 ◽

Vol 8 (10) ◽

pp. 1041-1047 ◽

Cited By ~ 43

Author(s):

Marcus D Mazur ◽

Craig Kilburg ◽

Victor Wang ◽

Philipp Taussky

Keyword(s):

Vertebral Artery ◽

Vessel Wall ◽

Posterior Circulation ◽

Pipeline Embolization Device ◽

Safety And Efficacy ◽

Cerebellar Artery ◽

Flow Through ◽

Flow Diverting Stent

IntroductionPreliminary studies suggest that flow-diverting stents may be suitable for the treatment of aneurysms of the posterior circulation. The safety and efficacy of using flow-diverting stents for vertebral artery (VA) aneurysms is not well defined.ObjectiveTo examine the fate of covering the posterior inferior cerebellar artery (PICA) in patients undergoing placement of a flow-diverting stent for VA aneurysm.MethodsConsecutive patients who underwent placement of a Pipeline Embolization Device (PED) for treatment of an aneurysm of the V4 segment of the VA between April 2012 and June 2015 at our institution were retrospectively evaluated. Angiograms were reviewed to determine the patency of the PICA when the vessel origin was covered by the PED.Results11 patients with VA aneurysms who underwent treatment with the PED were identified. In each case the device covered the origin of the PICA. Follow-up angiography in eight patients demonstrated thrombosis of the aneurysm with patency of the PICA.ConclusionsFlow-diverting stents can be used for the treatment of VA aneurysms. When appropriately sized to the vessel wall and positioned in the VA, the device may cover the origin of the PICA without impairing flow through the branching artery.

Coiling Using Dual Microcatheter Technique—A Novel Approach

Indian Journal of Neurosurgery ◽

10.1055/s-0041-1730875 ◽

2022 ◽

Author(s):

Arvind Kumar ◽

Swarup Sohan Gandhi ◽

Ashok Gandhi ◽

Trilochan Srivastav ◽

Devendra Purohit

Keyword(s):

Vertebral Artery ◽

Posterior Circulation ◽

Left Vertebral Artery ◽

Aneurysm Neck ◽

Novel Technique ◽

Novel Approach ◽

Cerebellar Artery ◽

Flow Through

AbstractPosterior circulation aneurysms are difficult to treat, and if an incorporated artery is arising from the neck of aneurysm, management becomes much more challenging. Here, we are describing a novel technique used to treat a patient with a large, wide-necked left vertebral artery (VA)-posterior inferior cerebellar artery (PICA) junctional aneurysm. PICA seems to be arising from the aneurysm neck, but the aneurysm neck was not very clearly defined. So, we placed a second microcatheter into PICA, which not only allowed the coils to be placed in the aneurysm, without disrupting the flow through PICA but also helpful in assessing the aneurysmal occlusion. This technique allowed coils to be placed successfully without compromising flow through PICA.

Is Vertebral Artery and Posterior Inferior Cerebellar Artery Dominance a Risk Factor for Thromboembolism During Coil Embolization of Unruptured Posterior Circulation Aneurysms?

World Neurosurgery ◽

10.1016/j.wneu.2020.03.065 ◽

2020 ◽

Vol 138 ◽

pp. e743-e748

Author(s):

Wonsoo Son ◽

Dong-Hun Kang

Keyword(s):

Risk Factor ◽

Vertebral Artery ◽

Coil Embolization ◽

Posterior Circulation ◽

Cerebellar Artery ◽

Posterior Circulation Aneurysms

Transcirculation Endovascular Treatment of Complex Cerebral Aneurysms: Technical Considerations and Preliminary Results

Neurosurgery ◽

10.1227/neu.0b013e3182077f17 ◽

2011 ◽

Vol 68 (3) ◽

pp. 820-830 ◽

Cited By ~ 29

Author(s):

Felipe C Albuquerque ◽

L Fernando Gonzalez ◽

Yin C Hu ◽

C Benjamin Newman ◽

Cameron G McDougall

Keyword(s):

Vertebral Artery ◽

Cerebral Aneurysms ◽

Posterior Circulation ◽

Alternative Pathways ◽

Complex Aneurysms ◽

Cerebellar Artery ◽

Kissing Balloon Technique ◽

History Of

Abstract BACKGROUND: Unfavorable anatomy can preclude embolization of intracranial aneurysms. Transcirculation techniques, in which a catheter is navigated from one side of the brain to the other or from the anterior to the posterior circulation, are alternative pathways for primary or balloon- or stent-assisted coiling. OBJECTIVE: We report the largest experience in coil embolization of aneurysms using transcirculation techniques. METHODS: We reviewed our endovascular database from 2006 to 2009 and identified 18 patients who had aneurysms treated with transcirculation techniques. RESULTS: Eight patients had anterior and 10 had posterior circulation aneurysms. Overall, 8 patients were treated with stent-assisted coiling and 9 with balloon-assisted coiling, including 1 patient treated with a “kissing balloon” technique. Of the 9 patients treated with balloon-assistance, 1 also was stented at the conclusion of aneurysm coiling. One patient with a left fourth vertebral artery (V4) aneurysm was treated with coiling alone via a bilateral vertebral artery (VA) approach. In 14 patients, the anterior communicating and posterior communicating arteries were used as conduits. In 4 patients, both VAs were traversed to treat 2 V4 aneurysms and 2 posterior inferior cerebellar artery aneurysms. One patient died as a result of treatment and was the only permanent complication (5.6%). Complete or near-complete (>95%) embolization was achieved in all patients. CONCLUSION: Transcirculation techniques are effective pathways for embolization of complex aneurysms. Although technically challenging, these techniques are associated with an acceptably low rate of complications when compared to the natural history of the treated lesion.

Hemifacial Spasm: Endoscopic Vascular Decompression

Otolaryngology ◽

10.1016/s0194-5998(97)70118-9 ◽

1997 ◽

Vol 117 (4) ◽

pp. 308-314 ◽

Cited By ~ 32

Author(s):

J. Magnan ◽

F. Caces ◽

P. Locatelli ◽

A. Chays

Keyword(s):

Hemifacial Spasm ◽

Marked Improvement ◽

Cerebellopontine Angle ◽

Endoscopic Examination ◽

Anterior Inferior Cerebellar Artery ◽

Cerebellar Artery ◽

The Mean ◽

Vascular Decompression

Sixty patients with primitive hemifacial spasm were treated by means of a minimally invasive retrosigmoid approach in which endoscopic and microsurgical procedures were combined. Intraoperative endoscopic examination of the cerebellopontine angle showed that for 56 of the patients vessel-nerve conflict was the cause of hemifacial spasm. The most common offending vessel was the posterior inferior cerebellar artery (39 patients), next was the vertebral artery (23 patients), and last was the anterior inferior cerebellar artery (16 patients). Nineteen of the patients had multiple offending vascular loops. In one patient, another cause of hemifacial spasm was an epidermoid tumor of the cerebellopontine angle. For three patients, it was not possible to determine the exact cause of the facial disorder. Follow-up information was reviewed for 54 of 60 patients; the mean follow-up period was 14 months. Fifty of the patients were in the vessel-nerve conflict group. Forty of the 50 were free of symptoms, and four had marked improvement. The overall success rate was 88%, and there was minimal morbidity (no facial palsy, two cases of severe hearing loss).

Endovascular Treatment of Bilateral Intracranial Vertebral Artery Dissecting Aneurysms Presenting With Subarachnoid Hemorrhage

Operative Neurosurgery ◽

10.1227/neu.0b013e31822ed1f0 ◽

2011 ◽

Vol 70 (suppl_1) ◽

pp. ons75-ons81 ◽

Cited By ~ 1

Author(s):

Yong Sam Shin ◽

Byung Moon Kim ◽

Se-Hyuk Kim ◽

Sang Hyun Suh ◽

Chang Woo Ryu ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Endovascular Treatment ◽

Vertebral Artery ◽

Stent Insertion ◽

Treatment Methods ◽

Cerebellar Artery ◽

Endovascular Methods ◽

Dissecting Aneurysms

Abstract BACKGROUND: Optimal management of bilateral vertebral artery dissecting aneurysms (bi-VDAs) causing subarachnoid hemorrhage (SAH) remains unclear. OBJECTIVE: To investigate the treatment methods and outcomes of bi-VDA causing SAH. METHODS: Seven patients were treated endovascularly for bi-VDA causing SAH. Treatment methods and outcomes were evaluated retrospectively. RESULTS: Two patients were treated with 2 overlapping stents for both ruptured and unruptured VDAs, 2 with 2 overlapping stents and coiling for ruptured VDA and with conservative treatment for unruptured VDA, 1 with internal trapping (IT) for ruptured VDA and stent-assisted coiling for unruptured VDA, 1 with IT for ruptured VDA and 2 overlapping stents for unruptured VDA, and 1 with IT for ruptured VDA and a single stent for unruptured VDA. None had rebleeding during follow-up (range, 15-48 months). All patients had favorable outcomes (modified Rankin Scale score, 0-2). On follow-up angiography at 6 to 36 months, 9 treated and 2 untreated VDAs revealed stable or improved state, whereas 3 VDAs in 2 patients showed regrowth. Of the 3 recurring VDAs, 1 was initially treated with IT but recurred owing to retrograde flow to the ipsilateral posterior inferior cerebellar artery (PICA), the second was treated with single stent but enlarged, and the last was treated with 2 overlapping stents and coiling but recurred from the remnant sac harboring the PICA origin. All 3 recurred VDAs were retreated with coiling with or without stent insertion. CONCLUSION: Bilateral VDAs presenting with SAH were safely treated with endovascular methods. However, endovascular treatment may be limited for VDAs with PICA origin involvement.

Spontaneous Vertebral Artery Dissection Presenting with Crescendo TIAs and Headache

Global Journal of Medical Research ◽

10.34257/gjmrkvol19is1pg1 ◽

2019 ◽

pp. 1-6

Author(s):

Dr. Nosakhare I Idehen ◽

Dr. Mohammed Awad

Keyword(s):

Vertebral Artery ◽

Vertebral Artery Dissection ◽

Symptomatic Improvement ◽

Neurological Deficits ◽

Artery Dissection ◽

Neurological Sequelae ◽

Cerebellar Artery ◽

Ct Brain

We present the case of a man in his thirties who had attended the emergency department with complaint of a distressing headache and associated intermittent facial droop with occasional slurred speech. The patient’s symptoms were bizarre in their nature as they were random, not sustained and he had long intervals when he was asymptomatic and was his normal self. During the course of admission his symptoms evolved resulting in neurological deficits which were more sustained, prompting the need for further imaging beyond the initial plain CT brain which showed no abnormality. This led to the diagnosis of vertebral artery dissection (VAD) complicated with an ischaemic stroke in the posterior inferior cerebellar artery distribution (PICA) on MRI/MRA. Dual anti-platelet treatment was commenced with the patient attaining gradual symptomatic improvement prior to discharge. He has reported some degree of neurological sequelae which he described as intermittent poor coordination on follow up visit in clinic after discharge.

Application of covered stent grafts for intracranial vertebral artery dissecting aneurysms

Journal of Neurosurgery ◽

10.3171/2008.3.17470 ◽

2009 ◽

Vol 110 (3) ◽

pp. 418-426 ◽

Cited By ~ 18

Author(s):

Min He ◽

Heng Zhang ◽

Ding Lei ◽

Bo-Yong Mao ◽

Chao You ◽

...

Keyword(s):

Vertebral Artery ◽

Stent Graft ◽

Covered Stent ◽

Stent Grafts ◽

Graft Placement ◽

Cerebellar Artery ◽

Covered Stent Graft ◽

Dissecting Aneurysms

Object Utilization of covered stent grafts in treating neurovascular disorders has been reported, but their efficacy and safety in vertebral artery (VA) dissecting aneurysms needs further investigation. Methods Six cases are presented involving VA dissecting aneurysms that were treated by positioning a covered stent graft. Two aneurysms were located distal to the posterior inferior cerebellar artery, and 4 were located proximal to the posterior inferior cerebellar artery. Aspirin as well as ticlopidine or clopidogrel were administered after the procedure to prevent stent-related thrombosis. All patients were followed up both angiographically and clinically. Results Five of the 6 patients underwent successful placement of a covered stent graft. The covered stent could not reach the level of the aneurysm in 1 patient with serious vasospasm who died secondary to severe subarachnoid hemorrhage that occurred 3 days later. Patient follow-up ranged from 6 to 14 months (mean 10.4 months), and demonstrated complete stabilization of the obliterated aneurysms, and no obvious intimal hyperplasia. No procedure-related complications such as stenosis or embolization occurred in the 5 patients with successful stent graft placement. Conclusions Although long-term follow-up studies using a greater number of patients is required for further validation of this technique, this preliminary assessment shows that covered stent graft placement is an efficient, safe, and microinvasive technique, and is a promising tool in treating intracranial VA dissecting aneurysms.

Surgical Treatment of Posterior Circulation Aneurysms – Anatomical Study and Surgical Technique

Arquivos Brasileiros de Neurocirurgia Brazilian Neurosurgery ◽

10.1055/s-0038-1639589 ◽

2018 ◽

Vol 37 (01) ◽

pp. 27-37

Author(s):

Vitor Yamaki ◽

Eric Paschoal ◽

Manoel Teixeira ◽

Eberval Figueiredo

Keyword(s):

Surgical Treatment ◽

Cranial Nerves ◽

Posterior Circulation ◽

Surgical Approaches ◽

Superior Cerebellar Artery ◽

Anterior Circulation ◽

Cerebellar Artery ◽

Risk Of Rupture ◽

Posterior Circulation Aneurysms

AbstractPosterior circulation aneurysms represent 10–15% of intracranial aneurysms. The diagnosis is usually secondary to subarachnoid hemorrhage due to its initial asymptomatic presentation and higher risk of rupture compared with aneurysms in the anterior circulation. The surgical treatment of posterior circulation aneurysms is complex and challenging for neurosurgeons because of the particular anatomy of the posterior circulation with its close relation to the brainstem and cranial nerves and also because of the depth and narrowness of the surgical approach. Aneurysms from different locations have specific anatomical relationships and surgical approaches for better visualization and dissection. Therefore, a detailed anatomy knowledge of the posterior circulation is mandatory for an individualized preoperative planning and good neurological and angiographic outcomes. We selected the main aneurysm sites on the posterior circulation, such as: posterior inferior cerebellar artery, basilar trunk, basilar bifurcation, posterior cerebral artery (PCA) and superior cerebellar artery for a detailed description of the relevant anatomy related to aneurysm, and the main surgical approaches for its surgical treatment. Furthermore, we performed a literature review with the most recent outcomes regarding to the surgical treatment of posterior circulation aneurysms.

Embolization of Posterior Circulation Aneurysms with Detachable Coils

Interventional Neuroradiology ◽

10.1177/15910199980040s127 ◽

1998 ◽

Vol 4 (1_suppl) ◽

pp. 127-130 ◽

Cited By ~ 1

Author(s):

K. Kazekawa ◽

T. Fukushima ◽

M. Tomonaga ◽

T. Kawano ◽

T. Kawaguchi ◽

...

Keyword(s):

Posterior Circulation ◽

Superior Cerebellar Artery ◽

Anterior Inferior Cerebellar Artery ◽

Cerebellar Artery ◽

Long Term Follow Up ◽

Detachable Coils ◽

Vertebrobasilar Junction

We evaluated the usefulness of endovascular treatment of posterior circulation aneurysms with GDCs and IDCs, Five cases were treated with IDCs, and 15 cases were treated with GDCs. In this study, 8 aneurysms were identified at the basilar bifurcation, 3 at the P1 segment of the pasterior cerebral artery, 1 at the origin of the superior cerebellar artery, 2 at the vertebrobasilar junction, 1 at the origin of the posterior inferior cerebellar artery, 1 at the distal anterior inferior cerebellar artery, and 4 dissecting aneurysms at the vertebral artery. Thirteen of the aneurysms were small (< 12 mm), 5 were large (13–24 mm), and 2 were giant (> 25 mm). Of the 20 patients, 14 patients returned to their previous occupation. Patients with permanent deficits included 2 patients with infarction caused by thromboembolic complications during the embolization procedure, and 2 with infarction caused by vasospasm. There were 2 deaths. The outcomes of the patients seemed favorable. However, long-term follow-up is necessary to determine the usefulness of detachable coils.