Incidental Medium-Sized Basilar Tip Aneurysm

2019 ◽  
pp. 109-118
Author(s):  
Ethan A. Winkler ◽  
W. Caleb Rutledge ◽  
Alex Lu ◽  
Adib A. Abla
Keyword(s):  
Open Surgery ◽  
Posterior Circulation ◽  
Endovascular Management ◽  
Unruptured Aneurysms ◽  
Microsurgical Clipping ◽  
Wide Range ◽  
Posterior Circulation Aneurysms ◽  
History Of ◽  
Management Techniques ◽  
Basilar Tip Aneurysm

Abstract: Posterior circulation aneurysms, including those in the basilar tip location, are commonly seen in neurosurgical practice. They represent about 10% of aneurysms. Although posterior circulation aneurysms are often treated via endovascular means, microsurgical clipping of basilar tip aneurysms is still occasionally indicated. A thorough understanding of the natural history of unruptured aneurysms in all locations is needed to drive proper management, and the higher rupture risk of posterior circulation aneurysms must be considered. Endovascular management techniques for these aneurysms now employ a wide range of strategies to achieve complete occlusion. For those treated with open surgery, careful patient selection and excellent microsurgical technique are essential for effective treatment.

Microsurgical clipping of an unruptured basilar apex aneurysm

2015 ◽  
Vol 38 (videosuppl1) ◽  
pp. Video10 ◽  
Author(s):  
M. Yashar S. Kalani ◽  
Mark E. Oppenlander ◽  
Michael Levitt ◽  
Sam Safavi-Abbasi ◽  
Robert F. Spetzler ◽  
...  
Keyword(s):  
Dual Therapy ◽  
Posterior Circulation ◽  
Clinical Equipoise ◽  
Endovascular Technique ◽  
Link Type ◽  
Microsurgical Clipping ◽  
Posterior Circulation Aneurysms ◽  
Basilar Tip Aneurysm

Unruptured posterior circulation aneurysms pose a treatment challenge. Although data supports the use of endovascular technique for select ruptured cases, in unruptured cases, there may be clinical equipoise. Furthermore, wide-necked basilar apex aneurysms commonly require the use of stents and placement of patients on dual therapy. We present a case of a healthy 50-year-old woman with an incidental basilar tip aneurysm treated via an orbitozygomatic craniotomy. This video highlights the steps of dynamic retraction, which is retraction without placement of permanent rigid retraction system, and the added maneuverability afforded by the use of the mouthpiece on the microscope.The video can be found here: http://youtu.be/jVfC6CCXdZY.

Clinical and Radiographic Outcome in the Management of Posterior Circulation Aneurysms by Use of Direct Surgical or Endovascular Techniques

Neurosurgery ◽  
2002 ◽  
Vol 51 (1) ◽  
pp. 14-22 ◽  
Author(s):  
Christopher S. Ogilvy ◽  
Brian L. Hoh ◽  
Robert J. Singer ◽  
Christopher M. Putman
Keyword(s):  
Surgical Treatment ◽  
High Risk ◽  
Endovascular Treatment ◽  
Posterior Circulation ◽  
Endovascular Coiling ◽  
High Morbidity ◽  
Surgical Clipping ◽  
Fisher Grade ◽  
Posterior Circulation Aneurysms ◽  
History Of

Abstract OBJECTIVE Posterior circulation aneurysms can be difficult lesions to treat surgically, and they have potential for high morbidity and mortality, particularly in elderly patients or those in poor neurological condition. In an effort to improve outcomes, our combined neurosurgical and neuroendovascular unit has used both surgical clipping and endovascular coiling techniques to treat posterior circulation aneurysms. Patients considered at high risk for surgery were managed with endovascular treatment. METHODS From 1990 to 1998, 197 posterior circulation aneurysms in 189 patients were treated in our combined neurovascular unit. Of these aneurysms, 128 were ruptured, 63 were unruptured, and 6 had a distant history of rupture in patients who came to our center for delayed or repeat treatment. A total of 132 aneurysms were treated with surgical clipping (85 ruptured, 46 unruptured, and 1 with distant history of rupture) and 65 aneurysms were treated with endovascular coiling (43 ruptured, 17 unruptured, and 5 with distant history of rupture). Dissecting aneurysms of the vertebral or posteroinferior cerebellar arteries or aneurysms treated with proximal (Hunterian) occlusion were excluded from this analysis. Surgical risk was assessed using a previously described system (Massachusetts General Hospital [MGH] grade), which incorporates age, Hunt and Hess grade, size of lesion, and Fisher grade. RESULTS Overall clinical outcomes at 1 year of follow-up were 77.2% excellent or good, 10.2% fair, 4.1% poor, and 8.6% dead. Surgical treatment resulted in 95.6% complete aneurysm occlusion and 4.4% with residual aneurysm after surgical treatment, whereas endovascular treatment resulted in 32.3% complete occlusion, 26.2% with residual aneurysm, and 41.5% with partial occlusion. In most cases, however, treatment with Guglielmi detachable coils (Boston Scientific/Target, Fremont, CA) was performed for palliation rather than complete radiographic occlusion. Outcome was closely associated with MGH grade with either treatment modality. Excellent/good outcomes were achieved in 96, 92.3, 82.9, 46.2, and 0% of surgically treated patients with MGH Grades of 0, 1, 2, 3, and 4, respectively. In comparison, excellent/good outcomes were achieved in 100, 84.2, 61.9, 0, and 50% of endovascularly treated patients with MGH Grades of 0, 1, 2, 3, and 4, respectively. CONCLUSION A combined surgical and endovascular approach to posterior circulation aneurysms can achieve good outcomes in high-risk surgical patients treated by use of coiling techniques.

Extracranial Carotid-Vertebral Bypass for Endovascular Access to Complex Posterior Circulation Aneurysms

Neurosurgery ◽  
2011 ◽  
Vol 70 (5) ◽  
pp. 1296-1304 ◽  
Author(s):  
Markus Chwajol ◽  
Troy A. Munson ◽  
Ali Alaraj ◽  
Fady T. Charbel ◽  
Victor A. Aletich ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Endovascular Embolization ◽  
Posterior Circulation ◽  
Vein Grafts ◽  
Posterior Circulation Aneurysms ◽  
Basilar Tip Aneurysm ◽  
Vessel Tortuosity ◽  
Novel Strategy ◽  
Vertebral Dissection ◽  
Extracranial Bypass

Abstract BACKGROUND: Endovascular embolization is a desirable treatment option for complex posterior circulation aneurysms, particularly recurrent aneurysms or those in difficult-to-access surgical locations. However, endovascular access is occasionally prohibited by proximal vertebral artery (VA) occlusion or vessel tortuosity. One strategy in such instances involves creation of an extracranial bypass conduit to the distal VA. OBJECTIVE: To describe a novel strategy to allow for endovascular treatment of aneurysms at high risk for direct surgery. METHODS: Three cases of carotid-VA bypass performed to provide endovascular access to posterior circulation aneurysms were identified. The clinical indications, radiographic characteristics, operative technique, and outcomes were reviewed. RESULTS: Indications for bypass were previously clipped recurrent basilar tip aneurysm, previously coiled midbasilar aneurysm with compaction requiring stent placement, and distal intracranial VA aneurysm with iatrogenic vertebral dissection/occlusion after initial coil attempt. In all cases, routine endovascular access for primary or stent-assisted coiling was prohibited by VA tortuosity. Bypass with the use of interposition saphenous vein grafts was successfully performed to the C1-C2 region of the V2 segment without complications. The bypass was followed by successful endovascular treatment in all cases 2 to 6 weeks after surgery. In 1 patient, 2 recurrent treatments through the graft were subsequently performed for coil compaction. CONCLUSION: Extracranial carotid-VA bypass can be a valuable tool in the management of complex posterior circulation aneurysms. It is a safe and efficacious technique providing a conduit for repeated access to the posterior circulation in patients with otherwise prohibitive vertebral anatomy.

scholarly journals Clip ligation of contralateral P1 aneurysm: extending the working depth of microsurgery along the skull base

2015 ◽  
Vol 38 (videosuppl1) ◽  
pp. Video8
Author(s):  
Karishma Vijay Rupani ◽  
Aaron A. Cohen-Gadol
Keyword(s):  
Artery Aneurysm ◽  
Posterior Circulation ◽  
Posterior Communicating Artery ◽  
Unruptured Aneurysms ◽  
Working Space ◽  
Left Posterior ◽  
Posterior Circulation Aneurysms ◽  
Microsurgical Techniques ◽  
Posterior Communicating Artery Aneurysm ◽  
Small Aneurysms

Clip ligation of posterior circulation aneurysms can be challenging because of limited operative working space and angles. Certain proximal posterior cerebral (P1) aneurysms are especially challenging because of their locations within the lateral anterior interpeduncular fossa.We present a 52-year-old woman who had previously undergone coil embolization of a ruptured right-sided posterior communicating artery aneurysm. She also had two other small aneurysms (left posterior communicating artery and right P1 aneurysms). She underwent clip ligation of the latter two unruptured aneurysms through a left-sided pterional craniotomy. The microsurgical techniques to clip ligate a contralateral P1 aneurysm are discussed in the video.The video can be found here: http://youtu.be/YBE7FcFGlpQ.

Enlargement of small, asymptomatic, unruptured intracranial aneurysms in patients with no history of subarachnoid hemorrhage: the different factors related to the growth of single and multiple aneurysms

2013 ◽  
Vol 119 (1) ◽  
pp. 190-197 ◽  
Author(s):  
Aichi Chien ◽  
Feng Liang ◽  
James Sayre ◽  
Noriko Salamon ◽  
Pablo Villablanca ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intracranial Aneurysms ◽  
Posterior Circulation ◽  
Unruptured Aneurysms ◽  
Multiple Aneurysms ◽  
Unruptured Intracranial Aneurysms ◽  
History Of ◽  
Aneurysm Growth ◽  
Small Aneurysms

Object This study was performed to investigate the risk factors related to the growth of small, asymptomatic, unruptured aneurysms in patients with no history of subarachnoid hemorrhage (SAH). Methods Between January 2005 and December 2010, a total of 508 patients in whom unruptured intracranial aneurysms were diagnosed at the University of California, Los Angeles medical center did not receive treatment to prevent rupture. Of these, 235 patients with no history of SAH who had asymptomatic, small, unruptured aneurysms (< 7 mm) were monitored with 3D CT angiography images. Follow-up images of the lesions were used to measure aneurysm size changes. Patient medical history, family history of SAH, aneurysm size, and location were studied to find the risk factors associated with small aneurysm growth. Results A total of 319 small aneurysms were included, with follow-up durations of 29.2 ± 20.6 months. Forty-two aneurysms increased in size during the follow-up; 5 aneurysms grew to become ≥ 7 mm within 38.2 ± 18.3 months. A trend of higher growth rates was found in single aneurysms than in multiple aneurysms (p = 0.07). A history of stroke was the only factor associated with single aneurysm growth (p = 0.03). The number of aneurysms (p = 0.011), number of aneurysms located within the posterior circulation (p = 0.030), and patient history of transient ischemic attack (p = 0.044) were related to multiple aneurysm growth. Conclusions Multiple small aneurysms are more likely to grow, and multiple aneurysms located in the posterior circulation may require additional attention. Although single aneurysms have a lower risk of growth, a trend of higher growth rates in single aneurysms was found.

Treatment of Posterior Circulation Aneurysms With the Pipeline Embolization Device

Neurosurgery ◽  
2013 ◽  
Vol 72 (6) ◽  
pp. 833-889 ◽  
Author(s):  
Nohra Chalouhi ◽  
Stavropoula Tjoumakaris ◽  
Aaron S. Dumont ◽  
L. Fernando Gonzalez ◽  
Ciro Randazzo ◽  
...  
Keyword(s):  
Posterior Circulation ◽  
Patient Treatment ◽  
Pipeline Embolization Device ◽  
Unruptured Aneurysms ◽  
Aneurysm Size ◽  
Procedural Complications ◽  
Posterior Circulation Aneurysms ◽  
Vertebrobasilar Junction ◽  
Aneurysm Occlusion

Abstract BACKGROUND: Treatment of complex intracranial aneurysms with the pipeline embolization device (PED) has become common practice in neurovascular centers. Very few studies have assessed the safety and efficacy of PED treatment for posterior circulation aneurysms. OBJECTIVE: To retrospectively present our experience with use of the PED in the posterior circulation. METHODS: A total of 7 patients harboring 7 posterior circulation aneurysms were treated with the PED at our institution between November 2011 and July 2012. RESULTS: Aneurysm size was 14.1 mm on average. All patients had unruptured aneurysms. Three aneurysms arose from the vertebral artery, 2 from the basilar artery, and 2 from the vertebrobasilar junction. A single stent was used in 4 patients, 2 stents in 2 patients, and 3 stents in 1 patient. Treatment was successful in all 7 patients. No procedural complications or perforator infarcts were noted in the series. No patient experienced new neurological symptoms related to PED treatment during the follow-up period. Angiographic follow-up was available for 6 patients at a mean time point of 5.5 months. Follow-up angiography showed 100% aneurysm occlusion in 3 patients, marked decrease in aneurysm size in 2 patients, and no change in 1 patient. CONCLUSION: In our initial experience, it appears that PED treatment in select patients with vertebrobasilar aneurysms may have a reasonable safety-efficacy profile. Larger studies are needed to confirm our findings.

Storia naturale degli aneurismi “large-giant”

2003 ◽  
Vol 16 (1) ◽  
pp. 135-137 ◽  
Author(s):  
A. Pasqualin
Keyword(s):  
Preliminary Analysis ◽  
Mass Effect ◽  
Posterior Circulation ◽  
Cooperative Study ◽  
Anterior Circulation ◽  
Giant Aneurysms ◽  
Posterior Circulation Aneurysms ◽  
History Of ◽  
Haemorrhage Rate ◽  
Progressive Enlargement

The natural history of large (20–25 mm) and giant (> 25 mm) intracranial aneurysms is still undefined. Most frequently giant aneurysms present with haemorrhage (45% of cases) or symptoms of expanding mass lesion (39% of cases), rarely with ischemic deficits (5% of cases) or epilepsy (2% of cases). Endoluminar thrombosis is present in 48% of large and 73% of giant aneurysms (according to the Italian Cooperative Study of 1988) and constitutes a dynamic process, with possible evolution to: a) sudden mass effect, b) progressive enlargement of the aneurysm, or c) complete spontaneous occlusion; moreover, endoluminar thrombosis does not prevent haemorrhage. According to the ISUIA Study (1998), the risk of haemorrhage for intact aneurysms is highest for aneurysms larger than 25 mm, especially if located on the posterior communicating artery or in the posterior circulation. From a more recent and still preliminary analysis of the ISUIA Study, the five-year haemorrhage rate is roughly 40% for giant anterior circulation and 50% for giant posterior circulation aneurysms.

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

Neurosurgery ◽  
2011 ◽  
Vol 68 (3) ◽  
pp. 820-830 ◽  
Author(s):  
Felipe C Albuquerque ◽  
L Fernando Gonzalez ◽  
Yin C Hu ◽  
C Benjamin Newman ◽  
Cameron G McDougall
Keyword(s):  
Vertebral Artery ◽  
Posterior Inferior Cerebellar Artery ◽  
Cerebral Aneurysms ◽  
Posterior Circulation ◽  
Alternative Pathways ◽  
Complex Aneurysms ◽  
Cerebellar Artery ◽  
Kissing Balloon Technique ◽  
Posterior Circulation Aneurysms ◽  
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 (&gt;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.

Group Experiences and Individual Differences in Stuttering

2019 ◽  
Vol 62 (12) ◽  
pp. 4335-4350 ◽  
Author(s):  
Seth E. Tichenor ◽  
J. Scott Yaruss
Keyword(s):  
Individual Differences ◽  
Support Groups ◽  
Support Group ◽  
Affective States ◽  
Life Outcomes ◽  
Self Help ◽  
Wide Range ◽  
Group Experiences ◽  
History Of ◽  
Adults Who Stutter

Purpose This study explored group experiences and individual differences in the behaviors, thoughts, and feelings perceived by adults who stutter. Respondents' goals when speaking and prior participation in self-help/support groups were used to predict individual differences in reported behaviors, thoughts, and feelings. Method In this study, 502 adults who stutter completed a survey examining their behaviors, thoughts, and feelings in and around moments of stuttering. Data were analyzed to determine distributions of group and individual experiences. Results Speakers reported experiencing a wide range of both overt behaviors (e.g., repetitions) and covert behaviors (e.g., remaining silent, choosing not to speak). Having the goal of not stuttering when speaking was significantly associated with more covert behaviors and more negative cognitive and affective states, whereas a history of self-help/support group participation was significantly associated with a decreased probability of these behaviors and states. Conclusion Data from this survey suggest that participating in self-help/support groups and having a goal of communicating freely (as opposed to trying not to stutter) are associated with less negative life outcomes due to stuttering. Results further indicate that the behaviors, thoughts, and experiences most commonly reported by speakers may not be those that are most readily observed by listeners.

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