scholarly journals CPA Epidermoid Cyst with Rare Anatomic Variant: Anterior Inferior Cerebellar Artery Embedded in the Subarcuate Fossa: Operative Video and Technical Nuances

2018 ◽  
Vol 80 (S 03) ◽  
pp. S323-S324
Author(s):  
Carlos Candanedo ◽  
Sergey Spektor
Keyword(s):  
Trigeminal Neuralgia ◽  
Epidermoid Cyst ◽  
Abducens Nerve ◽  
Residual Tumor ◽  
Benign Tumors ◽  
Anterior Inferior Cerebellar Artery ◽  
Surgical Removal ◽  
Anatomical Variant ◽  
Cerebellar Artery ◽  
Subarcuate Artery

Intracranial epidermoid cysts are considered benign tumors with a good general prognosis; however, their radical removal, including tumor capsule, is associated with significant morbidity, especially when the capsule is attached to neurovascular structures. We show an operative video describing main steps and surgical nuances in the resection of a large right cerebellopontine angle (CPA) epidermoid cyst in a 42-year-old male patient who presented with intractable trigeminal neuralgia. Craniectomy was performed to exposure the transverse-sigmoid sinus junction. A mold for a polymethylmethacrylate (PMMA) bone flap was built before opening the dura to avoid potentially neurotoxic effects on the cerebellum. The video illustrates the management of the rare anatomical variant of the anterior inferior cerebellar artery (AICA). Its loop was embedded in the dura, covering the subarcuate fossa where it gives off the subarcuate artery. Near total removal of the epidermoid cyst was achieved, leaving only a tiny capsule remnant adhering to the abducens nerve. Postoperatively the patient's trigeminal neuralgia was fully relieved and medications were discontinued. The patient's hearing was preserved per audiometry at the preoperative level (Gardner–Robertson II). Postoperative magnetic resonance imaging (MRI) revealed no signs of residual tumor. In this case, it was not possible to obtain optimal surgical exposure of the CPA without handling a rare anatomical anomaly of the AICA in the dura of the subarcuate fossa, which demanded coagulation and transection of the subarcuate artery and transposition of AICA with the dural cuff. This manipulation enabled optimal surgical removal of the epidermoid and didn't cause any neurological deficit.The link to the video can be found at: https://youtu.be/lLZqBHlu-uA.

scholarly journals Percutaneous radiofrequency treatment of the gasserian ganglion for trigeminal neuralgia complicated by trochlear nerve palsy: a case report

2021 ◽  
pp. rapm-2020-102285
Author(s):  
Pascal SH Smulders ◽  
Michel AMB Terheggen ◽  
José W Geurts ◽  
Jan Willem Kallewaard
Keyword(s):  
Trigeminal Neuralgia ◽  
Cranial Nerve ◽  
Facial Pain ◽  
Anatomical Variations ◽  
Anterior Inferior Cerebellar Artery ◽  
Gasserian Ganglion ◽  
Radiofrequency Treatment ◽  
Experienced Pain ◽  
Cerebellar Artery ◽  
Trochlear Nerve Palsy

BackgroundTrigeminal neuralgia (TN) has the highest incidence of disorders causing facial pain. TN is provoked by benign stimuli, like shaving, leading to severe, short-lasting pain. Patients are initially treated using antiepileptic drugs; however, multiple invasive options are available when conservative treatment proves insufficient. Percutaneous radiofrequency treatment of the trigeminal, or gasserian, ganglion (RF-G) is a procedure regularly used in refractory patients with comorbidities. RF-G involves complex needle maneuvering to perform selective radiofrequency heat treatment of the affected divisions. We present a unique case of cranial nerve 4 (CN4) paralysis after RF-G.Case presentationA male patient in his 60s presented with sharp left-sided facial pain and was diagnosed with TN, attributed to the maxillary and mandibular divisions. MRI showed a vascular loop of the anterior inferior cerebellar artery without interference of the trigeminal complex. The patient opted for RF-G after inadequate conservative therapy. The procedure was performed by an experienced pain physician and guided by live fluoroscopy. The patient was discharged without problems but examined the following day for double vision. Postprocedural MRI showed enhanced signaling between the trigeminal complex and the brainstem. Palsy of CN4 was identified by a neurologist, and spontaneous recovery followed 5 months after the procedure.ConclusionsMention of postprocedural diplopia in guidelines is brief, and the exact incidence remains unknown. Different mechanisms for cranial nerve (CN) palsy have been postulated: incorrect technique, anatomical variations, and secondary heat injury. We observed postprocedural hemorrhage and hypothesized that bleeding might be a contributing factor in injury of CNs after RF-G.

Early results of surgery in patients with nonfunctioning pituitary adenoma and analysis of the risk of tumor recurrence

2008 ◽  
Vol 108 (3) ◽  
pp. 525-532 ◽  
Author(s):  
Marco Losa ◽  
Pietro Mortini ◽  
Raffaella Barzaghi ◽  
Paolo Ribotto ◽  
Maria Rosa Terreni ◽  
...  
Keyword(s):  
Tumor Recurrence ◽  
Postoperative Radiotherapy ◽  
Residual Tumor ◽  
Benign Tumors ◽  
Surgical Removal ◽  
Tumor Diameter ◽  
Tumor Removal ◽  
Early Results ◽  
Results Of Surgery

Object Nonfunctioning pituitary adenomas (NFPAs) are benign tumors of the pituitary gland that typically cause visual and/or hormonal dysfunction. Surgery is the treatment of choice, but patients remain at risk for tumor recurrence for several years afterwards. The authors evaluate the early results of surgery and the long-term risk of tumor recurrence in patients with NFPAs. Methods Between 1990 and 2005, 491 previously untreated patients with NFPA underwent surgery at the Università Vita-Salute. Determinations of recurrence or growth of the residual tumor tissue during the follow-up period were based on neuroradiological criteria. Results Residual tumor after surgery was detected in 173 patients (36.4%). Multivariate analysis showed that invasion of the cavernous sinus, maximum tumor diameter, and absence of tumor apoplexy were associated with an unfavorable surgical outcome. At least 2 sets of follow-up neuroimaging studies were obtained in 436 patients (median follow-up 53 months). Tumors recurred in 83 patients (19.0%). When tumor removal appeared complete, younger age at surgery was associated with a risk of tumor recurrence. In patients with incomplete tumor removal, adjunctive postoperative radiotherapy had a marked protective effect against growth of residual tumor. Conclusions Complete surgical removal of NFPAs can be safely achieved in > 50% of cases. Visual symptoms and, less frequently, pituitary function may improve after surgery. However, tumor can recur in patients after apparently complete surgical removal. In patients with incomplete tumor removal, radiation therapy is the most effective adjuvant therapy for preventing residual tumor growth.

scholarly journals Multiple aneurysms on the subarcuate artery arising from the anterior inferior cerebellar artery in a patient with a Borden type I transverse-sigmoid dural arteriovenous fistula manifesting as subarachnoid hemorrhage: A case report

2018 ◽  
Vol 25 (1) ◽  
pp. 90-96 ◽  
Author(s):  
Tomoaki Suzuki ◽  
Kouichirou Okamoto ◽  
Nobuyuki Genkai ◽  
Yasushi Ito ◽  
Hiroshi Abe
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Anterior Inferior Cerebellar Artery ◽  
Type I ◽  
Feeding Artery ◽  
Multiple Aneurysms ◽  
Arteriovenous Shunts ◽  
Cerebellar Artery ◽  
Subarcuate Artery

Background Peripheral anterior inferior cerebellar artery (AICA) aneurysms are rare and commonly associated with vascular malformations, such as cerebellar arteriovenous malformations (AVMs). We present a case wherein multiple AICA feeding aneurysms on the subarcuate artery as a feeding artery of a Borden type I transverse-sigmoid dural arteriovenous fistula (dAVF) manifested as subarachnoid hemorrhage. Case description A 67-year-old woman presented with acute severe headache. Brain computed tomography (CT) demonstrated subarachnoid hemorrhage mainly in the posterior fossa. A transverse-sigmoid dAVF was detected on magnetic resonance angiography (MRA) and three-dimensional-CT angiography (3D-CTA), with no cortical venous reflex. The patient underwent conventional angiography, which showed multiple aneurysms on a small branch of the AICA, feeding a transverse-sigmoid dAVF (Borden type I). The AICA aneurysms seemed flow dependent and ruptured owing to high-flow arteriovenous shunts through the dAVF. Based on the source images of the MRA, the small artery arising from the AICA was considered the subarcuate artery, and it was confirmed on 3D-CTA after the artery was successfully embolized with Onyx without any complications. Multiple aneurysms on the subarcuate artery are extremely rare, and the artery has not been identified as a feeding artery of the transverse-sigmoid dAVF. Conclusion A rare case of multiple ruptured aneurysms on the subarcuate artery was reported in a patient with a Borden type I dAVF at the transverse-sigmoid sinuses manifesting as subarachnoid hemorrhage. Onyx embolization of the parent artery occlusion was feasible and useful in treating this type of feeding artery aneurysm of the AICA with a dAVF.

Trigeminal Neuralgia Due to Anterior Inferior Cerebellar Artery Loop: A Case Report

2009 ◽  
Vol 24 (8) ◽  
pp. 989-990
Author(s):  
Roshan Koul ◽  
Amna Alfutaisi ◽  
Rajeev Jain ◽  
Faisal Alzri
Keyword(s):  
Case Report ◽  
Trigeminal Neuralgia ◽  
Anterior Inferior Cerebellar Artery ◽  
Cerebellar Artery

scholarly journals Microvascular Decompression by Interposition Method for Treatment of Trigeminal Neuralgia Due to Vertebrobasilar Dolichoectasia: A Retrospective Single-Center Study

2021 ◽  
Author(s):  
Feng Yu ◽  
Jia Yin ◽  
Pei-gang Lu ◽  
Zhen-yu Zhao ◽  
Yong-qiang Zhang ◽  
...  
Keyword(s):  
Trigeminal Neuralgia ◽  
Microvascular Decompression ◽  
Long Term Results ◽  
Superior Cerebellar Artery ◽  
Anterior Inferior Cerebellar Artery ◽  
Symptom Duration ◽  
Free Survival ◽  
Kaplan Meier ◽  
Vertebrobasilar Dolichoectasia ◽  
Cerebellar Artery

Abstract Trigeminal neuralgia (TN) due to vertebrobasilar dolichoectasia (VBD) is a rare disease that can be challenging to treat. The objectives of this study are to investigate the characteristics of patients with TN due to VBD and to analyze the efficacy of microvascular decompression (MVD) by the interposition method for treatment of the condition. From 2010 till 2020, the data of 30 patients with TN due to VBD who were treated with MVD by the interposition method were analyzed retrospectively. The characteristics of the patients were compared with those of patients with non-VBD TN (n = 815). Kaplan–Meier survival analysis was performed to determine pain-free survival. The 30 patients (21 males, 9 females; mean age, 63.03 years) accounted for 3.55% of all patients with TN during the study period. In 30 patients, the offending vessel was the basilar artery (BA) in 1 patient, the vertebral artery (VA) in 6 patients, the VA plus the superior cerebellar artery (SCA) in 6 patients, the VA plus the anterior inferior cerebellar artery (AICA) in 12 patients, and the VA+SCA+AICA in 5 patients. Compared to non-VBD TN patients, those with TN due to VBD were significantly more likely to be male, to have TN of the left side, and to have hypertension (all P < 0.001). Mean age at surgery (P = 0.057) and symptom duration (P = 0.308) were comparable between the two groups. All 30 patients had immediate relief of facial pain after MVD and could stop medication. There were no postoperative complications. Over mean follow-up of 76.67 months, 3 patients had recurrence. The mean duration of pain-free survival was 70.77 months. In conclusions, TN due to VBD appears to be more likely in males, in those with hypertension, and to involve the left side. The interposition method performed by experienced and skilled neurosurgeons is a safe and effective treatment for TN due to VBD. Further studies are needed to analyze the associated long-term results and the pain recurrence rate among this special population.

scholarly journals Microvascular Decompression for Trigeminal Neuralgia: Our Experiences at Bir Hospital

2017 ◽  
Vol 14 (2) ◽  
pp. 3-7
Author(s):  
Gopal R Sharma ◽  
Rajiv Jha ◽  
Prakash Poudel ◽  
Dhrub R Adhikari ◽  
Prakash Bista
Keyword(s):  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Medical Treatment ◽  
Treatment Options ◽  
Superior Cerebellar Artery ◽  
Anterior Inferior Cerebellar Artery ◽  
Recurrent Pain ◽  
Cerebellar Artery

Trigeminal neuralgia (TGN) is a very peculiar disease, mostly characterized by unilateral paroxysmal facial pain, often described by patient as ‘one of the worst pain in my life’. This condition is also known as ‘Tic Douloureus’. The annual incidence of TN is about 4.7/100000 population, male and female are equally affected. The diagnosis is usually made by history, clinical fi ndings and cranial imaging is required to rule out compressing vascular loop, organic lesions and Multiple Sclerosis (MS) at Trigeminal nerve (TN). Treatment of TGN ranged from medical to surgical intervention. Between September 2007 and April 2015, 20 patients underwent micro vascular decompression (MVD) of TN for TGN who were refractory to medical treatment at department of Neurosurgery, Bir Hospital. All decompressions were performed using operating microscope. Follow up period ranged from 22 months to 8 years.There were 9 males and 11 females and age ranged from 30-70 years. The neuralgic pain was localized on right side in 13 patients and left on 7 patients. Pain distribution was on V3 (mandibular branch) dermatome in 11, V2( Maxillary branch ) in 4, V2-3 in 2 and V1- 2-3 in 3 patients respectively. On intraoperative fi ndings TN was compressed by superior cerebellar artery ( SCA ) in 8, tumors in 4, unidentifi ed vessels in 3, veins in 2, anterior inferior cerebellar artery ( AICA ) in 1 and no cause was found in 2 patients. 7 patients suffered postoperative complications which included hyposthesia in 3, pseudomeningocele in 3 and meningitis in 1. There was no mortality in this series. 20 patients felt pain relief immediately after procedure and 1 patients came after 3 years with recurrent pain requiring second surgery. In conclusion, MVD for TGN in younger patients who are refractory to medical treatment is one of the best treatment options which is safe and long term pain relief is achieved in majority of cases.Nepal Journal of Neuroscience, Vol. 14, No. 2,  2017 Page:11-15

scholarly journals A Classification for the Anterior Inferior Cerebellar Artery—Subarcuate Artery Complex Based on the Embryological Development

2019 ◽  
Vol 81 (05) ◽  
pp. 536-545
Author(s):  
Jorge Rasmussen ◽  
Pedro Plou ◽  
Álvaro Campero ◽  
Pablo Ajler
Keyword(s):  
Cerebellopontine Angle ◽  
Anterior Inferior Cerebellar Artery ◽  
Embryological Development ◽  
Constructive Interference ◽  
State Sequence ◽  
Cerebellar Artery ◽  
Surgical Field ◽  
Grade 3 ◽  
Subarcuate Artery ◽  
Petromastoid Canal

Objective To hierarchize the anterior inferior cerebellar artery (AICA)–subarcuate artery (SAA) complex's variations in the surgical field. Background The AICA's “subarcuate loop” (SL) presents multiple variations, closely related to the SAA. AICA-SAA complex's variations may represent major issues in cerebellopontine angle (CPA) surgery. As the spectrum of configurations is originated during the development, a systematized classification was proposed based on the interaction between the petrosal bone and the AICA in the embryonic period. Methods The variations were defined as follow: Grade 0: free, purely cisternal AICA, unidentifiable or absent SAA; Grade 1: purely cisternal AICA, loose SL, SAA > 3 mm; Grade 2: AICA near the subarcuate fossa, pronounced SL, SAA <3 mm; Grade 3: “duralized” AICA, unidentifiable SAA, or included in the petromastoid canal (PMC); and Grade 4: intraosseous AICA, unidentifiable SAA, or included in the PMC. The classification was applied to a series of patients assessed by magnetic resonance constructive interference in steady state sequence. Surgical examples were also provided. Results Eighty-four patients were evaluated, including 161 CPA. The proportions found in the gradation remained within the range of previous publications (Grade 0: 42.2%; Grade 1: 11.2%; Grade 2: 35.4%; Grade 3: 10.6%; and Grade 4: 0.6%). Moreover, the degrees of the classification were related to the complexity of the anatomical relationships and, therefore, to the difficulty of the maneuvers required to overcome them. Conclusion The proposed AICA-SAA complex classification allowed to distinguish and objectify pre- and intraoperatively the spectrum of variations, to thoroughly plan the required actions and instrumentation.

Isolated trigeminal neuralgia secondary to distal anterior inferior cerebellar artery aneurysm

1996 ◽  
Vol 19 (1) ◽  
pp. 43-46 ◽  
Author(s):  
Faruk İldan ◽  
Alp I. Göçer ◽  
Hüseyin Bağdatoğlu ◽  
Ziya Uzuneyüpoğlu ◽  
Metin Tuna ◽  
...  
Keyword(s):  
Trigeminal Neuralgia ◽  
Artery Aneurysm ◽  
Anterior Inferior Cerebellar Artery ◽  
Cerebellar Artery

Abstract 1122‐000148: Rare Anterior Inferior Cerebellar Artery Origin of Middle Meningeal Artery

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Samer Abdul Kareem ◽  
Arsalan Anwar ◽  
Nicholas Liaw ◽  
Mustafa Kareem ◽  
Osama Zaidat
Keyword(s):  
Posterior Inferior Cerebellar Artery ◽  
Middle Meningeal Artery ◽  
External Carotid ◽  
Anterior Inferior Cerebellar Artery ◽  
Subdural Hemorrhage ◽  
Maxillary Artery ◽  
Term Care ◽  
Anatomical Variant ◽  
Cerebellar Artery ◽  
Meningeal Artery

Introduction : Middle meningeal artery (MMA) anatomy has very important surgical implications during endovascular and open based skull procedures. Various anatomical origins have been identified in the literature besides its most common origin as the largest branch of the maxillary artery. It runs parallel and close contact of the lateral skull face therefore during trauma to this area is prone to rupture resulting in subdural hemorrhage(SDH). In our case report, we present its peculiar origin from anterior inferior cerebellar artery which has never been reported before. The origin of MMA may reflects the risk involved with embolization therapy for chronic SDH. Methods : A case of MMA originated form AICA. A literature review was conducted of reports of MMA origins. Results : A 35‐year‐old male with a history of alcohol abuse presented to the ED after falling down from the stairs. In the ED, the patient had multiple episodes of seizures along with respiratory distress therefore was intubated due to concern of airway protection. CT head showed bilateral SDH. Patient underwent diagnostic angiogram for possible bilateral embolization of MMA. During the procedure, the left MMA origin was seen from the AICA whereas the right MMA arising from the external carotid artery. Embolization of the left MMA was aborted. Patient remained intubated and was later transferred to a long term care facility. Conclusions : In the last 80 years, the anatomy of the MMA has been part of the discussion of various literature. Seeger et.al, highlighted the embryological changes manifested as anastomosis between Sphenomaxillary artery and lateral pontine artery resulting in origin of MMA from Basilar artery along with absence of foramen spinosum. Since 1973, multiple literature highlighted the origin of MMA including the lacrimal artery, ICA, ascending pharyngeal artery, opthalmic and occipital arteries. Recently, In 2011 Kuruvuilla et.al showed the origin of MMA from posterior inferior cerebellar artery. MMA clinical significance can be seen in multiple diseases. Older populations with chronic subdural hematomas, embolization of MMA has shown to be a less invasive and cost effective procedure. In patients with anterior and middle cranial fossa meningiomas embolization of MMA has been a crucial part of management. Similarly, understanding of its anatomy is also important while treating MMA aneurysm or pseudoaneurysms. In our case, the origin of middle meningeal artery from AICA has been significant as it supplies the posterior fossa structures and was not reported in the literature before, hence the procedure was aborted. This anatomical variant has shown us a new light upon embryological evolution and has helped us widen the horizons of our approach towards brain vasculature. This finding will help the future Interventionists to develop new ways of embolization of the MMA and understanding its anatomy.

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