scholarly journals Aneurysm of the Fenestrated Basilar Artery: Case Report and Literature Review

2017 ◽  
Vol 36 (04) ◽  
pp. 225-229
Author(s):  
Linoel Valsechi ◽  
Lucas Meguins ◽  
Isabela Maia ◽  
Adil Fares ◽  
Diogo Taffarel ◽  
...  
Keyword(s):  
Case Report ◽  
Endovascular Treatment ◽  
Basilar Artery ◽  
Cranial Nerve ◽  
Three Dimensional ◽  
Vascular Diseases ◽  
Sixth Cranial Nerve ◽  
3D Angiography ◽  
Complex Anatomy ◽  
First Choice

Introduction Aneurysms of the vertebrobasilar junction are rare, but when present, they are often associated with fenestration of the basilar artery. Frequently, the endovascular treatment is the first choice due to the complex anatomy of the posterior fossa, which represents a challenge for the open surgical treatment alternative. Case Report A 47-year-old man was admitted to the emergency unit with headache, diplopia, neck pain and mental confusion. The neurological exam showed: score of 15 in the Glasgow coma scale (GCS), no motor or sensitivity deficit, palsy of the left sixth cranial nerve and Hunt-Hess grade III. The computed tomography (CT) scan showed subarachnoid hemorrhage (Fisher III) and hydrocephalus. The patient was submitted to ventricular-peritoneal shunt. A diagnostic angiography was performed with 3D reconstruction, which showed evidence of fenestration of the basilar artery associated with aneurysm in the right vertebrobasilar portion. An aneurysm coil embolization was performed without complications. The patient was discharged 19 days later maintaining diplopia, with paralysis of the left sixth cranial nerve, but without any other complaints or neurological symptoms. Discussion Fenestration of the basilar artery occurs due to failure of fusion of the longitudinal neural arteries in the embryonic period, and it is associated with the formation of aneurysms. The endovascular treatment is the first choice and several techniques are described, including simple coiling, balloon remodeling, stent-assisted coiling, liquid embolic agents and flow diversion devices. The three-dimensional rotational angiography (3DRA) is an extremely helpful tool when planning the best treatment course. Conclusion Fenestrated basilar artery aneurysms are rare and complex vascular diseases and their treatment improved with the advent of the 3D angiography and the development of the endovascular techniques.

Endovascular Treatment for Vertebrobasilar Artery Tandem Occlusion Beyond 24 Hours From Onset of Stroke—Case Report

2020 ◽  
Vol 55 (1) ◽  
pp. 77-80
Author(s):  
Takashi Mizowaki ◽  
Atsushi Fujita ◽  
Satoshi Inoue ◽  
Eiji Kurihara
Keyword(s):  
Case Report ◽  
Endovascular Treatment ◽  
Basilar Artery ◽  
Percutaneous Transluminal Angioplasty ◽  
Transluminal Angioplasty ◽  
Postoperative Course ◽  
Ischemic Change ◽  
Vertebrobasilar Artery ◽  
Tandem Occlusion ◽  
Percutaneous Transluminal

We report a case in which endovascular treatment (EVT) was performed for vertebral and basilar artery (VA and BA) tandem occlusion beyond 24 hours from onset of stroke. A 78-year-old man was admitted to our institution with dysarthria and disturbance of gait. MRI revealed occlusion of the BA with acute ischemic change in bilateral cerebellum and brain stem. At 36 hours after onset and 30 hours after administration, EVT was performed because of deteriorating neurological symptom. Successful revascularization was achieved with percutaneous transluminal angioplasty for VA and thrombectomy for BA occlusion. The neurological symptoms were improved in postoperative course.

scholarly journals Isolated sixth cranial nerve palsy as the presenting symptom of a rapidly expanding ACTH positive pituitary adenoma: a case report

2011 ◽  
Vol 11 (1) ◽  
Author(s):  
Norman Saffra ◽  
Elizabeth Kaplow ◽  
Irina Mikolaenko ◽  
Alice Kim ◽  
Benjamin Rubin ◽  
...  
Keyword(s):  
Case Report ◽  
Pituitary Adenoma ◽  
Cranial Nerve ◽  
Cranial Nerve Palsy ◽  
Nerve Palsy ◽  
Sixth Cranial Nerve ◽  
Sixth Cranial Nerve Palsy

Endovascular Treatment of Unruptured Vertebro-basilar Aneurysms

1999 ◽  
Vol 5 (1_suppl) ◽  
pp. 83-88 ◽  
Author(s):  
S. Miyachi ◽  
M. Negoro ◽  
T. Okamoto ◽  
O. Suzuki ◽  
J. Yoshida
Keyword(s):  
Surgical Treatment ◽  
Endovascular Treatment ◽  
Vertebral Artery ◽  
Basilar Artery ◽  
Cranial Nerve ◽  
Perioperative Management ◽  
Nerve Injuries ◽  
The Past ◽  
Complications Of Surgery ◽  
Cranial Nerve Injuries

We reviewed 201 unruptured vertebro-basilar aneurysms encountered at our institute and 35 affiliated hospitals over the past 8 years. Of these, 106 aneurysms in 103 patients were treated with surgical or endovascular approaches: 43 aneurysms, surgically with clipping or wrapping; and 63 endovascularly with embolization. Outcome was excellent or good in 87 patients (84.5%). Among 24 patients with 36 complications, 16 had unfavorable outcomes including five deaths. Twelve patients (27.9%) with surgical treatment and two (3.3%) with endovascular treatment had unfavorable results because of treatment-related complications. Two patients with surgical treatment had complications related to perioperative management. Vascular occlusive complications were likeliest to occur in surgically treated basilar artery aneurysms (41%). Among surgically treated aneurysms the vertebral artery site was relatively associated with cranial nerve injuries. Complications numbered 36, occurring in 24 patients and 54% of complications affected outcome. Overall morbidity and mortality of surgical treatment were 18.6% and 7.0%, respectively, while those of endovascular treatment were 5.0% and 3.3%. In conclusion, complications of surgery tend to be serious and affect outcome, and endovascular treatment is safer than surgical for vertebro-basilar aneurysms. Embolizations are particularly advantageous for patients who are poor surgical risks.

scholarly journals Magnetic resonance imaging of the cranial nerves in congenital, traumatic, and vascular diseases: a pictorial essay

2021 ◽  
Vol 54 (3) ◽  
pp. 185-192 ◽  
Author(s):  
Mariana Dalaqua ◽  
Felipe Barjud Pereira do Nascimento ◽  
Larissa Kaori Miura ◽  
Fabiano Reis ◽  
Márcio Ricardo Taveira Garcia ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Cranial Nerves ◽  
Three Dimensional ◽  
Vascular Diseases ◽  
Resonance Imaging ◽  
Complex Anatomy ◽  
Contrast Enhanced ◽  
Pictorial Essay ◽  
The Brain

Abstract The cranial nerves, which represent extensions of the functional structures of the brain, traverse the head and neck. They are connected to various cranial structures and are associated with several diseases. An in-depth understanding of their complex anatomy and normal imaging appearance allows the examiner to identify and characterize abnormalities with greater precision. One important tool for evaluating the cranial nerves is contrast-enhanced magnetic resonance imaging, especially three-dimensional steady-state free precession sequences, which provide high soft-tissue and spatial resolution, despite the slenderness of the nerves. In most cases, imaging findings are nonspecific. Therefore, to narrow the differential diagnosis, it is necessary to take a full patient anamnesis, perform a focused physical examination and order laboratory tests. In this pictorial essay we review, illustrate and discuss, from a pathophysiological perspective, congenital, traumatic, and vascular diseases of the cranial nerves.

Sixth cranial nerve palsy secondary to compression by dolichoectatic vertebrobasilar artery

2020 ◽  
Vol 13 (7) ◽  
pp. e234949
Author(s):  
Trishal Jeeva-Patel ◽  
Edward A Margolin ◽  
Daniel Mandell
Keyword(s):  
Cranial Nerve ◽  
Nerve Palsy ◽  
High Spatial Resolution ◽  
Cranial Nerves ◽  
Three Dimensional ◽  
Sixth Cranial Nerve ◽  
Vertebrobasilar Artery ◽  
Cranial Nerve Palsies ◽  
Mri Sequences ◽  
Sixth Nerve

Dolichoectasia refers to distinct elongation, dilatation and tortuosity of an artery. We present a rare well-illustrated case of dolichoectatic vertebrobasilar artery compressing the cisternal portion of the sixth cranial nerve resulting in chronic sixth nerve palsy. High spatial resolution, three-dimensional, heavily T2-weighted MRI sequences are uniquely positioned to assess the cranial nerves especially in their cisternal and canalicular portions and need to be performed for all patients with non-resolving cranial nerve palsies. Dolichoectatic vessels can be the cause of neurovascular conflict and cause non-resolving oculomotor palsies.

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