Therapeutic Occlusion of the Vertebral Artery for Unclippable Vertebral Aneurysm: Relationship between Site of Occlusion and Clinical Outcome

Neurosurgery ◽  
1984 ◽  
Vol 15 (6) ◽  
pp. 834-838 ◽  
Author(s):  
Kazuo Yamada ◽  
Toru Hayakawa ◽  
Yukitaka Ushio ◽  
Yoshikazu Yukitaka ◽  
Kentaro Koshino ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Clinical Outcome ◽  
Vertebral Artery ◽  
Neurological Deficit ◽  
Posterior Inferior Cerebellar Artery ◽  
Cerebellar Artery ◽  
Vertebral Aneurysm ◽  
Therapeutic Occlusion

Abstract Six cases of unclippable vertebral aneurysms were treated by therapeutic occlusion of the proximal vertebral artery. In three cases, the vertebral artery was clipped proximal to the posterior inferior cerebellar artery (PICA), and all of these patients had a postoperative embolic complication or a fatal subarachnoid hemorrhage. In two cases, the vertebral artery was clipped distal to the PICA and in one case the PICA was absent and the vertebral artery was clipped proximal to the aneurysm. All three of these patients did well without any neurological deficit, Possible mechanisms of the complications are discussed, and the importance of not clipping the PICA is stressed.

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

2011 ◽  
Vol 70 (suppl_1) ◽  
pp. ons75-ons81 ◽  
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 ◽  
Posterior Inferior Cerebellar 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.

scholarly journals Treatment of Dissecting Vertebral Aneurysm

2001 ◽  
Vol 7 (1_suppl) ◽  
pp. 155-160 ◽  
Author(s):  
Y. Kai ◽  
J. Hamada ◽  
M. Morioka ◽  
T. Todaka ◽  
T. Mizuno ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Posterior Inferior Cerebellar Artery ◽  
Dissecting Aneurysm ◽  
The Other ◽  
Cerebellar Artery ◽  
Retrograde Filling ◽  
Angiographic Evidence ◽  
Vertebral Aneurysm ◽  
Proximal Occlusion ◽  
Dissecting Aneurysms

We report 17 patients with dissecting aneurysm of the vertebral artery (VA) who were treated by direct surgery (n=8) or interventional surgery (n=9). Eight patients presented with subarachnoid hemorrhage (SAH) and nine with ischemia. Ten patients were treated by trapping of the aneurysm that was occlusion of the VA on both sides of aneurysm (direct surgery, n=2; interventional surgery, n=8). The other seven patients were treated by ligation of the VA proximal to the aneurysm (direct surgery, n=6; interventional surgery, n=1). Two patients underwent transposition of the posterior inferior cerebellar artery (PICA). In 15 patients, there were no major complications. Two patients who had been treated by proximal occlusion of the VA developed rebleeding and ischemia due to persistent retrograde filling of the dissecting site. We suggest that angiographic evidence of retrograde filling of the dissecting site should have been considered as an indication for trapping. Trapping of VA dissecting aneurysms is easier and safer by interventional surgery than by direct surgery.

Republished: Delayed subarachnoid hemorrhage 7 years after cerebellar infarction from traumatic vertebral artery dissection

2016 ◽  
Vol 9 (4) ◽  
pp. e9-e9
Author(s):  
Michael A Silva ◽  
Alfred P See ◽  
Priyank Khandelwal ◽  
Nirav J Patel ◽  
Mohammad Ali Aziz-Sultan
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Vertebral Artery ◽  
Posterior Inferior Cerebellar Artery ◽  
Vertebral Artery Dissection ◽  
Artery Dissection ◽  
Cerebellar Infarction ◽  
Radiographic Evidence ◽  
Vessel Injury ◽  
Cerebellar Artery ◽  
The Right

Vertebral artery dissection (VAD) is an important cause of ischemic stroke and subarachnoid hemorrhage (SAH). Dissections presenting with ischemia rarely cause SAH after more than a few hours, especially without radiographic evidence of pseudoaneurysm. We successfully treated a patient for persistent vessel injury presenting with SAH 7 years after presenting with extracranial subocclusive dissection of the right vertebral artery and an associated right posterior inferior cerebellar artery stroke. This is one of only three reported cases of delayed SAH occurring more than 2 weeks after an initial ischemic presentation of a VAD, and the only one without radiographic evidence of pseudoaneurysm at standard follow-up duration.

Posterior inferior to posterior inferior cerebellar artery anastomosis combined with trapping for vertebral artery aneurysm

1990 ◽  
Vol 73 (3) ◽  
pp. 462-465 ◽  
Author(s):  
James I. Ausman ◽  
Fernando G. Diaz ◽  
Sean Mullan ◽  
Randy Gehring ◽  
Balaji Sadasivan ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Posterior Inferior Cerebellar Artery ◽  
Artery Aneurysm ◽  
Artery Ligation ◽  
Content Type ◽  
Cerebellar Artery ◽  
Vertebrobasilar Junction ◽  
Vertebral Aneurysm ◽  
The Right ◽  
Fine Print

✓ A case is presented in which a giant intracranial vertebral artery aneurysm gave rise to an associated ipsilateral posterior inferior cerebellar artery (PICA) from its waist. Proximal vertebral artery ligation at C-1 was achieved. The aneurysm filled from the opposite vertebrobasilar junction. Direct intracranial trapping of the right vertebral aneurysm was followed by successful anastomosis of the proximally sectioned right PICA to the adjacent left PICA in an end-to-end fashion.

scholarly journals Subarachnoid Hemorrhage Due to Ruptured Intracranial Aneurysm Arising from a Vertebral Artery-Bihemispheric Posterior Inferior Cerebellar Artery Bifurcation

2017 ◽  
Vol 08 (04) ◽  
pp. 654-656 ◽  
Author(s):  
Yasushi Ogasawara ◽  
Hiroshi Kashimura ◽  
Kenta Aso ◽  
Hiroaki Saura
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Vertebral Artery ◽  
Posterior Inferior Cerebellar Artery ◽  
Three Dimensional ◽  
Distal Portion ◽  
Ruptured Intracranial Aneurysm ◽  
Cerebellar Artery ◽  
Complications Of Surgery ◽  
Subsequent Loss ◽  
The Right

ABSTRACTAlthough the anatomy of the posterior inferior cerebellar artery (PICA) is highly variable, a solitary PICA supplying both hemispheres of the cerebellum is rare. A 76-year-old woman presented with severe headache and subsequent loss of consciousness and was admitted to our hospital. Initial computed tomography showed subarachnoid hemorrhage. Three-dimensional digital subtraction angiography revealed a saccular aneurysm arising from the right vertebral artery (VA)-PICA bifurcation. The PICA branching from the right VA was enlarged, tortuous, and crossed the midline to supply both cerebellar hemispheres. This right PICA was interpreted as a bihemispheric PICA. Recognizing this variant preoperatively could help prevent complications of surgery. Careful follow-up studies are necessary in cases with bihemispheric PICA to monitor for the development of aneurysm at the junction between the bihemispheric PICA and the VA or the distal portion of the bihemispheric PICA.

Posterior Inferior Cerebellar Artery/Vertebral Artery Subarachnoid Hemorrhage: A Comparison of Saccular vs Dissecting Aneurysms

Neurosurgery ◽  
2017 ◽  
Vol 82 (1) ◽  
pp. 93-98 ◽  
Author(s):  
Mitchell T Foster ◽  
Amit Herwadkar ◽  
Hiren C Patel
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Length Of Stay ◽  
Vertebral Artery ◽  
Cox Regression ◽  
Posterior Inferior Cerebellar Artery ◽  
Nasogastric Feeding ◽  
Cox Regression Analysis ◽  
Vp Shunt ◽  
Poor Grade ◽  
Cerebellar Artery

Abstract BACKGROUND Two distinct categories of aneurysms are described in relation to the posterior inferior cerebellar artery (PICA) and vertebral artery (VA): saccular (SA) and dissecting (DA) types. This distinction is often unrecognized because abnormalities here are uncommon and most studies are small. OBJECTIVE To determine if there are any differences in the clinical presentation, in-hospital course, or outcomes in patients with DA vs SA of the PICA or VA. METHODS Thirty-eight patients with a VA or PICA aneurysm were identified from a departmental subarachnoid hemorrhage database and categorized into DA or SA types. Prospectively collected demographic and outcome data (length of stay, discharge Glasgow Outcome Score) were supplemented by abstracting records for procedural data (extraventricular drain [EVD], ventriculoperitoneal [VP] shunt, tracheostomy, and nasogastric feeding). Univariate, binary logistic regression, and Cox regression analysis was used to compare patients with SA vs DA. RESULTS Three aneurysms related to arteriovenous malformation were excluded. Five patients were conservatively managed. Of the 30 treated cases, more patients with a DA presented in poor grade (6/13 vs 2/17 SA; P = .035). More DA patients required an EVD (85% vs 29%; P = .003), VP shunt (54% vs 6%; P = .003), tracheostomy (46% vs 6%; P < .01), and nasogastric feeding (85% vs 35%; P = .007). The median length of stay (41 vs 17 d, P < .001) was longer, and the age and injury severity adjusted odds of discharge home were significantly lower in the DA group (P = .008). Thirty-day mortality was not significantly different (23% of DA vs 24% of SA; P = .2). CONCLUSION The presentation, clinical course, and outcomes differ in patients with DA vs SA of the PICA and VA.

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