scholarly journals Retrosigmoid Clip Anterior Inferior Cerebellar Artery Aneurysm: 2-Dimensional Operative Video

2020 ◽  
Vol 18 (4) ◽  
pp. E111-E111 ◽  
Author(s):  
Benjamin K Hendricks ◽  
Robert F Spetzler
Keyword(s):  
Video Recording ◽  
Artery Aneurysm ◽  
Lateral Approach ◽  
Surgical Approaches ◽  
Anterior Inferior Cerebellar Artery ◽  
Parent Vessel ◽  
Aneurysm Neck ◽  
Institutional Review ◽  
Cerebellar Artery ◽  
Far Lateral Approach

Abstract Aneurysms of the anterior inferior cerebellar artery (AICA) are rare and require a considerate approach to facilitate successful and safe clipping. Surgical approaches vary and are dependent on the relation of the aneurysm to the internal acoustic meatus. An anterior approach should be considered for lesions medial to the meatus. Lesions adjacent to the meatus can be approached via a retrosigmoid or translabyrinthine approach. Lesions lateral to the meatus can be approached via a retrosigmoid or far lateral approach. This patient had a previously ruptured AICA aneurysm in the meatal region for which a retrosigmoid approach was selected. The approach involved locating the AICA distally and tracking it proximally to the origin off the basilar artery. A clip was applied across the aneurysm neck to facilitate occlusion while preserving parent vessel flow. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

Treatment of an Anterior Inferior Cerebellar Artery Aneurysm With Microsurgical Trapping and In Situ Posterior Inferior Cerebellar Artery to Anterior Inferior Cerebellar Artery Bypass: Case Report

2017 ◽  
Vol 15 (4) ◽  
pp. 418-424 ◽  
Author(s):  
Bryan S Lee ◽  
Alex M Witek ◽  
Nina Z Moore ◽  
Mark D Bain
Keyword(s):  
Artery Bypass ◽  
Posterior Inferior Cerebellar Artery ◽  
Significant Risk ◽  
Artery Aneurysm ◽  
Lateral Approach ◽  
Anterior Inferior Cerebellar Artery ◽  
Parent Vessel ◽  
Cerebellar Artery ◽  
Far Lateral Approach

Abstract BACKGROUND Anterior inferior cerebellar artery (AICA) aneurysms are rare lesions whose treatment can involve microsurgical and/or endovascular techniques. Such treatment can be challenging and may carry a significant risk of neurological morbidity. OBJECTIVE To demonstrate a case involving a complex AICA aneurysm that was treated with a unique microsurgical approach involving trapping the aneurysm and performing in Situ bypass from the posterior inferior cerebellar artery (PICA) to the distal AICA. The nuances of AICA aneurysms and revascularization strategies are discussed. METHODS The aneurysm and the distal segments of AICA and PICA were exposed with a retrosigmoid and far lateral approach. A side-to-side anastomosis was performed between the adjacent caudal loops of PICA and AICA. The AICA aneurysm was then treated by trapping the aneurysm-bearing segment of the parent vessel between 2 clips. RESULTS A postoperative angiogram demonstrated a patent PICA-AICA bypass and complete occlusion of the AICA aneurysm. There were no complications, and the patient made an excellent recovery. CONCLUSION The combination of parent vessel sacrifice and bypass remains an excellent option for certain difficult-to-treat aneurysms. This case involving PICA-AICA bypass to treat an AICA aneurysm serves as an example of the neurosurgeon's ability to develop unique solutions that take advantage of individual anatomy.

scholarly journals Modified Orbitozygomatic Craniotomy for a Previously Coiled Anterior Communicating Artery Aneurysm: 2-Dimensional Operative Video

2020 ◽  
Author(s):  
Benjamin K Hendricks ◽  
Robert F Spetzler
Keyword(s):  
Video Recording ◽  
Artery Aneurysm ◽  
Mass Effect ◽  
Optic Chiasm ◽  
Anterior Communicating Artery ◽  
Aneurysm Neck ◽  
Institutional Review Board Approval ◽  
Institutional Review ◽  
Clip Occlusion

Abstract Clip occlusion of previously coiled aneurysms poses unique technical challenges. The coil mass can complicate aneurysm neck access and clip tine approximation. This patient had a previously ruptured anterior communicating artery (ACOM) aneurysm that had been treated with coil embolization. On follow-up evaluation, the patient was found to have a recurrence of the aneurysm, which prompted an orbitozygomatic craniotomy for clip occlusion. The approach provided a favorable view of the aneurysm neck with the coil mass protruding outside the aneurysm dome. Indocyanine green fluoroscopy was used to assist with ideal permanent clip placement along the aneurysm neck. The segment of coils present outside the aneurysm neck was removed to reduce mass effect on the optic chiasm. Postoperative imaging demonstrated aneurysm obliteration. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

scholarly journals Surgical Challenges Associated With Anterior Choroidal Artery Aneurysm Clipping: 2-Dimensional Operative Video

2020 ◽  
Vol 19 (3) ◽  
pp. E289-E289
Author(s):  
Benjamin K Hendricks ◽  
Robert F Spetzler
Keyword(s):  
Video Recording ◽  
Region Of Interest ◽  
Artery Aneurysm ◽  
Anterior Choroidal Artery ◽  
Parent Vessel ◽  
Institutional Review ◽  
Adjacent Structures ◽  
Clip Application ◽  
Anterior Choroidal ◽  
Choroidal Artery

Abstract Surgical treatment of anterior choroidal artery (AChA) aneurysms is challenging because of the constrained operative corridor and limitations imparted by the surrounding rigid structures during the exposure. The AChA most commonly arises as a single branch from the communicating (C7) segment of the internal carotid artery but has 2 to 4 branches in approximately one-third of cases, and aneurysms generally arise from the parent vessel interface with these branches. This patient experienced a sentinel headache 4 d before presenting with subarachnoid hemorrhage. The patient had a large right AChA aneurysm with a unique configuration in which the parent vessel was located anterior to the aneurysm. Endovascular therapy was aborted because there was an AChA branch at the base of the aneurysm. An orbitozygomatic craniotomy was performed that provided transsylvian access to the region of interest. Clip application was challenging because of the close proximity of the branch vessels. Intraoperative indocyanine green evaluation and postoperative angiogram showed patency of the AChA and posterior communicating artery. This video demonstrates the surgical challenge associated with AChA aneurysms because of the proximity of adjacent structures and highlights the importance of meticulous technique during clip application. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

scholarly journals Orbitozygomatic Craniotomy for Clipping a Complex Middle Cerebral Artery Aneurysm: 2-Dimensional Operative Video

2019 ◽  
Vol 18 (2) ◽  
pp. E33-E33
Author(s):  
Benjamin K Hendricks ◽  
Robert F Spetzler
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Video Recording ◽  
Artery Aneurysm ◽  
Sylvian Fissure ◽  
Parent Artery ◽  
Parent Vessel ◽  
Institutional Review ◽  
Vessel Patency ◽  
Mca Aneurysm

Abstract Middle cerebral artery (MCA) aneurysms pose a surgical challenge because of the large caliber of the parent artery and the common need to dissect the sylvian fissure to permit access to the proximal and distal control. The neck of the aneurysm should be generously dissected to permit visualization of any adjacent lenticulostriate perforators. This patient demonstrated a left-sided wide-necked bilobed MCA aneurysm at the M1 bifurcation. The aneurysm was approached using a left orbitozygomatic craniotomy with distal sylvian fissure dissection. A single curved clip was applied for aneurysm occlusion, and postoperative angiography demonstrated aneurysm obliteration with parent vessel patency. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

scholarly journals Orbitozygomatic Craniotomy for Giant Anterior Communicating Artery Aneurysm: 2-Dimensional Operative Video

2019 ◽  
Vol 18 (1) ◽  
pp. E5-E6
Author(s):  
Benjamin K Hendricks ◽  
Robert F Spetzler
Keyword(s):  
Video Recording ◽  
Artery Aneurysm ◽  
Anterior Communicating Artery ◽  
Parent Artery ◽  
Aneurysm Neck ◽  
Anterior Communicating Artery Aneurysm ◽  
Institutional Review Board Approval ◽  
Institutional Review ◽  
Vessel Patency ◽  
Aneurysmal Neck

Abstract Giant intracranial aneurysms pose a significant surgical challenge because of the associated difficulty in achieving adequate visualization of the parent artery and aneurysm neck. This patient had an incidentally identified giant anterior communicating artery aneurysm. An orbitozygomatic craniotomy was performed for aneurysm exposure and aneurysmal neck dissection. Aneurysm dome opening and thrombectomy was performed to debulk the aneurysmal mass, which facilitated subsequent aneurysmal neck visualization. Sequential utilization of temporary clips of the bilateral A1 and bilateral A2 vessels reduced hemorrhage during thrombectomy. Multiple permanent clips were applied along the dissected aneurysm neck to permit occlusion. A small fracture of the aneurysm neck was identified, and cotton was applied with subsequent tamponade utilizing a fenestrated clip to maintain hemostasis. Indocyanine green fluoroscopy was used to verify parent and distant vessel patency. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

Anterior inferior cerebellar artery aneurysm

1983 ◽  
Vol 59 (4) ◽  
pp. 697-702 ◽  
Author(s):  
Akira Nishimoto ◽  
Shunichiro Fujimoto ◽  
Shoji Tsuchimoto ◽  
Yuzo Matsumoto ◽  
Kazuo Tabuchi ◽  
...  
Keyword(s):  
Surgical Procedures ◽  
Cerebellopontine Angle ◽  
Artery Aneurysm ◽  
Anterior Inferior Cerebellar Artery ◽  
Content Type ◽  
Aneurysm Neck ◽  
The Third ◽  
Suboccipital Craniectomy ◽  
Cerebellar Artery ◽  
Fine Print

✓ Three cases of aneurysms of the anterior inferior cerebellar artery are reported. Two of the aneurysms were located in the cerebellopontine angle and one in the ventral portion of the pons. Through a suboccipital craniectomy, neck clipping was perfomed on one aneurysm, neck ligation on another, and coating on the third. A discussion of the surgical procedures and complications includes a review of previous reports.

scholarly journals Far-Lateral Approach for Medullary Cavernous Malformation: 2-Dimensional Operative Video

2019 ◽  
Vol 18 (3) ◽  
pp. E74-E75
Author(s):  
Benjamin K Hendricks ◽  
Robert F Spetzler
Keyword(s):  
Cavernous Malformation ◽  
Video Recording ◽  
Lateral Approach ◽  
Cavernous Malformations ◽  
Institutional Review ◽  
Far Lateral Approach ◽  
Far Lateral ◽  
Caudal Medulla ◽  
High Degree ◽  
Selection Of

Abstract Medullary cavernous malformations are the rarest subtype of brainstem cavernous malformation and are associated with a high degree of morbidity. Selection of surgical candidates is critical, and cases are most favorable when the cavernous malformation abuts the surface of the brainstem. This limits the amount of native tissue transgressed during the resection. This patient had a large cavernous malformation within the caudal medulla eccentric. A right-sided paramedian far-lateral approach was used to access the brainstem. The cavernous malformation was readily apparent along the medullary surface and was dissected away in its entirety. Postoperative imaging confirmed complete resection. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

Orbitozygomatic Approach Clipping of an Anterior Communicating Artery Aneurysm: 2-Dimensional Operative Video

2020 ◽  
Vol 18 (5) ◽  
pp. E160-E160
Author(s):  
Benjamin K Hendricks ◽  
Robert F Spetzler
Keyword(s):  
Video Recording ◽  
Artery Aneurysm ◽  
Optic Chiasm ◽  
Anterior Communicating Artery ◽  
Aneurysm Neck ◽  
Institutional Review ◽  
Orbitozygomatic Approach ◽  
Interhemispheric Fissure ◽  
Aneurysm Occlusion ◽  
Neck Control

Abstract Anterior communicating artery (ACoA) aneurysms can orient rostrally into the interhemispheric fissure or caudally into the optic chiasm. The majority of these aneurysms project into the interhemispheric fissure. This patient had an ACoA aneurysm with a multilobulated appearance, and the primary lobe projected into the interhemispheric fissure. The cisterns were opened sharply via an orbitozygomatic approach to permit proximal, distal, and neck control. A permanent clip was applied across the aneurysm neck and on a small contralateral aneurysm. Postoperative imaging confirmed complete aneurysm occlusion. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

scholarly journals Dual Microcatheter Technique for Coiling of Intracranial Aneurysms: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Muhammad Waqas ◽  
Rimal H Dossani ◽  
Justin M Cappuzzo ◽  
Ashish Sonig ◽  
Alexander B Becker ◽  
...  
Keyword(s):  
Packing Density ◽  
Intracranial Aneurysms ◽  
Treatment Options ◽  
Video Recording ◽  
Artery Aneurysm ◽  
Aneurysm Rupture ◽  
Parent Vessel ◽  
Distal Catheter ◽  
Institutional Review ◽  
Fisher Grade

Abstract Primary coiling of large intracranial aneurysms with complex morphology, such as multiple lobes and a wide neck, is challenging. In these aneurysms, achieving adequate intra-aneurysmal packing density while preventing coil herniation into the parent vessel may be difficult with traditional coiling technique. In the setting of acute aneurysm rupture, alternative treatment options such as stent-assisted coiling or flow diversion may not be feasible due to the need for dual antiplatelets. In this video, we demonstrate the use of a dual microcatheter technique to achieve adequate packing density within a wide-necked, bilobed saccular aneurysm. The patient presented with a ruptured posterior communicating artery aneurysm with Hunt and Hess grade 2 and Fisher grade 4 subarachnoid hemorrhage. A biaxial catheter system was used for primary coiling of the aneurysm. Two .017-inch microcatheters were strategically positioned in the aneurysm lobes. The first coil was deployed through the distal catheter, which created a basket for the second coil to be deployed through the proximal microcatheter. Subsequent simultaneously deployed coils were weaved into each other to form a stable coil mass that prevented coil herniation into the parent vessel. Complete obliteration of the aneurysm was achieved.  The patient gave informed consent for the procedures and video recording. Institutional review board approval was deemed unnecessary.

scholarly journals Contralateral far-lateral approach for clipping of a ruptured vertebral artery–posterior inferior cerebellar artery aneurysm

2008 ◽  
Vol 25 (6) ◽  
pp. E9 ◽  
Author(s):  
Taryn McFadden Bragg ◽  
Edward A. M. Duckworth
Keyword(s):  
Computed Tomography ◽  
Vertebral Artery ◽  
Posterior Inferior Cerebellar Artery ◽  
Artery Aneurysm ◽  
Lateral Approach ◽  
Cerebellar Artery ◽  
Far Lateral Approach ◽  
Far Lateral ◽  
The Right ◽  
Pica Aneurysms

Numerous nuanced approaches have been used to access posterior inferior cerebellar artery (PICA) aneurysms for microsurgical clipping. The authors report the case of a patient with a right vertebral artery (VA)–PICA aneurysm that was reached via a contralateral far-lateral approach. The wide-necked saccular/fusiform aneurysm arose from the lateral aspect of the right V4 segment just proximal to the PICA origin, anterior to the jugular tubercle at the level of the hypoglossal canal. Computed tomography angiograms demonstrated the size and configuration of the aneurysm, and 3D reconstructions revealed the tortuosity of the right VA, defining its location just left of the midline adjacent to the lower clivus. A contralateral far-lateral approach to VA–PICA aneurysms should be considered when aneurysms cross the midline. Computed tomography angiography with volume rendering and interactive software capabilities can help identify the relationship of such an aneurysm to an individual's particular skull base osseous anatomy and is paramount in selecting the optimal microsurgical approach.

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