Embolization of Posterior Circulation Aneurysms with Detachable Coils

1998 ◽  
Vol 4 (1_suppl) ◽  
pp. 127-130 ◽  
Author(s):  
K. Kazekawa ◽  
T. Fukushima ◽  
M. Tomonaga ◽  
T. Kawano ◽  
T. Kawaguchi ◽  
...  
Keyword(s):  
Posterior Inferior Cerebellar Artery ◽  
Posterior Circulation ◽  
Superior Cerebellar Artery ◽  
Anterior Inferior Cerebellar Artery ◽  
Cerebellar Artery ◽  
Long Term Follow Up ◽  
Detachable Coils ◽  
Posterior Circulation Aneurysms ◽  
Vertebrobasilar Junction

We evaluated the usefulness of endovascular treatment of posterior circulation aneurysms with GDCs and IDCs, Five cases were treated with IDCs, and 15 cases were treated with GDCs. In this study, 8 aneurysms were identified at the basilar bifurcation, 3 at the P1 segment of the pasterior cerebral artery, 1 at the origin of the superior cerebellar artery, 2 at the vertebrobasilar junction, 1 at the origin of the posterior inferior cerebellar artery, 1 at the distal anterior inferior cerebellar artery, and 4 dissecting aneurysms at the vertebral artery. Thirteen of the aneurysms were small (< 12 mm), 5 were large (13–24 mm), and 2 were giant (> 25 mm). Of the 20 patients, 14 patients returned to their previous occupation. Patients with permanent deficits included 2 patients with infarction caused by thromboembolic complications during the embolization procedure, and 2 with infarction caused by vasospasm. There were 2 deaths. The outcomes of the patients seemed favorable. However, long-term follow-up is necessary to determine the usefulness of detachable coils.

Microsurgical Reconstruction of the Posterior Circulation

1984 ◽  
Vol 92 (1) ◽  
pp. 102-108 ◽  
Author(s):  
James I. Ausman ◽  
Fernando G. Diaz
Keyword(s):  
Posterior Inferior Cerebellar Artery ◽  
Superior Cerebellar Artery ◽  
Anterior Inferior Cerebellar Artery ◽  
Occipital Artery ◽  
Vertebrobasilar Insufficiency ◽  
Surgical Morbidity ◽  
Microsurgical Reconstruction ◽  
Cerebellar Artery ◽  
Vertebrobasilar Junction

Thirty-four patients with vertebrobasilar Insufficiency (VBI) were evaluated between 1974 and 1982. Twenty-two presented with transient VBI and 12 with residual strokes. The frequency of preoperative symptoms varied from once or twice a month to multiple daily events. Four patients with high-grade vertebral stenosis were treated by local vertebral endarterectomy at the C1 level. Seven patients underwent an anastomosis of the occipital artery to the posterior inferior cerebellar artery for distal vertebral basilar junction stenosis or occlusion. Three patients underwent anastomosis of the occipital artery to the anterior inferior cerebellar artery for vertebral basilar junction occlusion. Twenty patients underwent anastomosis of the superficial temporal to the superior cerebellar artery for distal vertebrobasilar junction stenosis or occlusion or midbasilar occlusive lesions. In 26 of 27 patients (95%), the anastomoses were patent. Two patients died, one from congestive heart failure and one from a brain stem infarct. Immediate complications included meningitis, CSF leaks, temporal lobe swelling, and seizures. Although the early surgical morbidity is high, it is only transient. Twenty-six patients have had complete resolution of their symptoms, and three have minor residual dizziness. Long-term morbidity has been limited to a patient with residual Wallenberg's syndrome secondary to the surgical occlusion of the vertebral artery, a patient who remained in a locked-in syndrome as before surgery, and a patient who developed Brown-Séquard syndrome. No further VBI symptoms occurred in one patient who died 4 years after surgery of a myocardial infarction. We believe the surgical approach to the vertebrobasilar area is feasible and can lead to the ultimate recovery of most patients.

scholarly journals Posterior circulation aneurysms: A 10-year institutional analysis

2012 ◽  
Vol 01 (02) ◽  
pp. 119-123
Author(s):  
Saurabh Sharma ◽  
Ansari Abuzer ◽  
Ashish Suri ◽  
Shailesh Gaikwad ◽  
N.K. Mishra ◽  
...  
Keyword(s):  
Posterior Inferior Cerebellar Artery ◽  
Posterior Circulation ◽  
Superior Cerebellar Artery ◽  
Anterior Inferior Cerebellar Artery ◽  
Poor Grade ◽  
Cranial Nerve Palsies ◽  
Cerebellar Artery ◽  
Posterior Circulation Aneurysms ◽  
Grade Ii ◽  
Multimodality Approach

Abstract Aneurysms are uncommon and challenging to manage. A retrospective study was designed to report 53 patients who are treated from June 2002 to June 2011. The mean age at presentation was 46.34 ± 13.67 years (males, 26). Clinical features included subarachnoid hemorrhage (median Hunt and Hess Grade II, n = 42), cranial nerve palsies (9), hydrocephalus (5), and incidentally diagnosed (5). Locations included superior cerebellar artery (3), posterior cerebral artery (2), basilar trunk (4), vertebral (8), anterior inferior cerebellar artery (AICA) (5), posterior inferior cerebellar artery (PICA) (13), vertebrobasilar junction (6), and basilar top (13). Management included both endovascular intervention (26) and surgery (19), and both (2). Five patients presented as poor grade and underwent only extraventricular drain placement while one patient had thrombosed aneurysm and was managed conservatively. Mortality was 26.4% (n = 14) and morbidity included vasospasm (10), meningitis (2), pseudomeningocele (2), pneumonitis (2), and myocardial infarction (1). Posterior circulation aneurysms are highly challenging. They require the multimodality approach, and decision regarding surgery or embolization has to be individualized.

Abstract 12: Buenos Aires Experience With Flow Diverter in our First 1000 Patients Safety, Efficacy and Long Term Follow-up

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Javier Lundquist ◽  
Angel Ferrario ◽  
Rosana Ceratto ◽  
Esteban Scrivano ◽  
Jorge Chudyk ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Previous Treatment ◽  
Mass Effect ◽  
Flow Diverter ◽  
Superior Cerebellar Artery ◽  
Anterior Inferior Cerebellar Artery ◽  
Cerebellar Artery ◽  
Long Term Follow Up

Background: Hemodynamic flow is one of the major factors in the progression and rupture of intracranial aneurysms (IA). Flow diverter devices (FD) reduce blood flow in the aneurysm sac, allow gradual stagnation, thrombosis and neointimal remodeling while maintain outflow in the side branches and perforators. Objectives: We present our experience and long-term follow-up on endovascular reconstruction of complexes IA using flow diverter device. Particularly we analyze our experience with (Pipeline endovascular device) PED. Methods: Since March 2006 to July 2015, 1000 patients (pt) with IA were treated with FD or FD/coils. Of this group 633 pt were with PED, 113 Surpass (SNEG), 111 P64, 78 Cardiatis, 40 WEB and others 25. Angiographic follow-up was performed at 3, 6, 12 months and yearly until 8 y Fup. An inclusion criteria was unfavorable anatomy for coil, dome to neck ratio ≥ 2, Neck ≥ 4 mm and recurrence following previous treatment. Results: We treated 633 Pt with 704 IA with 932 PED. (77 % female); mean age 55 y (range 7-88). History of SAH was present in 18,5%; 81,5% were unruptured IA; mass effect in 125 pt; incidental IA 96 pts; headache 77 pts, others 23 pts. Large/giant IA were present in 51,2%, and wide neck (>4mm) 65%. The technical success was 98,4%. Occlusion rate at 1yr was 90 % and 8 yr 100 %, without recurrences. Peri-procedural (30 days) morbi-mortality rate was 5.9%: 2.7% had definitive neurologic defects; death rate was 3.2%. Conclusion: Endovascular treatment of complex IA with FD is a safe, effective and stable procedure, with an acceptable morbi-mortality rate. Abbreviations: AICA, anterior inferior cerebellar artery • BA, basilar artery • DSA, digital subtraction angiography • IA, intracranial aneurysm • ICA, internal carotid artery • MRA, MR angiography • PcomA, posterior communicating artery • PED, Pipeline • SNEG, Surpass •Embolization Device • SAH, subarachnoid hemorrhage • SCA, superior cerebellar artery

scholarly journals Surgical Treatment of Posterior Circulation Aneurysms – Anatomical Study and Surgical Technique

2018 ◽  
Vol 37 (01) ◽  
pp. 27-37
Author(s):  
Vitor Yamaki ◽  
Eric Paschoal ◽  
Manoel Teixeira ◽  
Eberval Figueiredo
Keyword(s):  
Surgical Treatment ◽  
Posterior Inferior Cerebellar Artery ◽  
Cranial Nerves ◽  
Posterior Circulation ◽  
Surgical Approaches ◽  
Superior Cerebellar Artery ◽  
Anterior Circulation ◽  
Cerebellar Artery ◽  
Risk Of Rupture ◽  
Posterior Circulation Aneurysms

AbstractPosterior circulation aneurysms represent 10–15% of intracranial aneurysms. The diagnosis is usually secondary to subarachnoid hemorrhage due to its initial asymptomatic presentation and higher risk of rupture compared with aneurysms in the anterior circulation. The surgical treatment of posterior circulation aneurysms is complex and challenging for neurosurgeons because of the particular anatomy of the posterior circulation with its close relation to the brainstem and cranial nerves and also because of the depth and narrowness of the surgical approach. Aneurysms from different locations have specific anatomical relationships and surgical approaches for better visualization and dissection. Therefore, a detailed anatomy knowledge of the posterior circulation is mandatory for an individualized preoperative planning and good neurological and angiographic outcomes. We selected the main aneurysm sites on the posterior circulation, such as: posterior inferior cerebellar artery, basilar trunk, basilar bifurcation, posterior cerebral artery (PCA) and superior cerebellar artery for a detailed description of the relevant anatomy related to aneurysm, and the main surgical approaches for its surgical treatment. Furthermore, we performed a literature review with the most recent outcomes regarding to the surgical treatment of posterior circulation aneurysms.

Skull base approaches to the basilar artery

2005 ◽  
Vol 19 (2) ◽  
pp. 1-12 ◽  
Author(s):  
L. Fernando Gonzalez ◽  
Sepideh Amin-Hanjani ◽  
Nicholas C. Bambakidis ◽  
Robert F. Spetzler
Keyword(s):  
Skull Base ◽  
Basilar Artery ◽  
Posterior Inferior Cerebellar Artery ◽  
Free Edge ◽  
Posterior Circulation ◽  
Surgical Instruments ◽  
Petrous Apex ◽  
Superior Cerebellar Artery ◽  
Anterior Inferior Cerebellar Artery ◽  
Cerebellar Artery

Posterior circulation lesions constitute approximately 10% of all intracranial aneurysms. Their distribution includes the basilar artery (BA) bifurcation, superior cerebellar artery, posterior inferior cerebellar artery, and anterior inferior cerebellar artery. The specific features of a patient's aneurysm and superb anatomical knowledge help the surgeon to choose the most appropriate approach and to tailor it to the patient's situation. The main principle that must be applied is maximization of bone resection. This allows the surgeon to work within a wider corridor, which facilitates the use of surgical instruments and minimizes retraction of the brain. The management of aneurysms within the posterior circulation requires expertise in skull base and vascular surgery. Endovascular treatments have become increasingly important, but in this paper the authors focus on the surgical management of these difficult aneurysms. The paper is divided into three parts: the first section is a brief review of the anatomy of the BA; the second part is a review of the techniques associated with the management of posterior fossa aneurysms; and in the third section the authors describe the different approaches, their nuances and indications based on the location of the aneurysm, and its relationship to the surrounding bone (especially the clivus, dorsum sellae, and the free edge of the petrous apex).

Cardiac standstill for cerebral aneurysms in 103 patients: an update on the experience at the Barrow Neurological Institute

2011 ◽  
Vol 114 (3) ◽  
pp. 877-884 ◽  
Author(s):  
Francisco A. Ponce ◽  
Robert F. Spetzler ◽  
Patrick P. Han ◽  
Scott D. Wait ◽  
Brendan D. Killory ◽  
...  
Keyword(s):  
Circulatory Arrest ◽  
Deep Hypothermic Circulatory Arrest ◽  
Hypothermic Circulatory Arrest ◽  
Posterior Circulation ◽  
Superior Cerebellar Artery ◽  
Small Subset ◽  
Long Term Follow Up ◽  
Posterior Circulation Aneurysms

Object The aim of this study was to clarify the surgical indications, risks, and long-term clinical outcomes associated with the use of deep hypothermic circulatory arrest for the surgical treatment of intracranial aneurysms. Methods The authors retrospectively reviewed 105 deep hypothermic circulatory arrest procedures performed in 103 patients (64 females and 39 males, with a mean age of 44.8 years) to treat 104 separate aneurysms. Patients' clinical histories, radiographs, and operative reports were evaluated. There were 97 posterior circulation aneurysms: at the basilar apex in 60 patients, midbasilar artery in 21, vertebrobasilar junction in 11, superior cerebellar artery in 4, and posterior cerebral artery in 1. Seven patients harbored anterior circulation aneurysms. Two additional patients harbored nonaneurysmal lesions. Results Perioperatively, 14 patients (14%) died. Five patients (5%) were lost to late follow-up. At a mean long-term follow-up of 9.7 years, 65 patients (63%) had the same or a better status after surgical intervention, 10 (10%) were worse, and 9 (9%) had died. There were 19 cases (18%) of permanent or severe complications. The combined rate of permanent treatment-related morbidity and mortality was 32%. The mean late follow-up Glasgow Outcome Scale score was 4, and the annual hemorrhage rate after microsurgical clipping during cardiac standstill was 0.5%/year. Ninety-two percent of patients required no further treatment of their aneurysm at the long-term follow-up. Conclusions Cardiac standstill remains an important treatment option for a small subset of complex and giant posterior circulation aneurysms. Compared with the natural history of the disease, the risk associated with this procedure is acceptable.

scholarly journals Re-Growth of a Posterior Inferior Cerebellar Artery Aneurysm after Resection of the Associated Posterior Fossa Arteriovenous Malformation

2014 ◽  
Vol 20 (1) ◽  
pp. 61-66 ◽  
Author(s):  
Hosam Al-Jehani ◽  
Donatella Tampieri ◽  
Maria Cortes ◽  
Denis Melançon
Keyword(s):  
Arteriovenous Malformation ◽  
Posterior Fossa ◽  
Posterior Inferior Cerebellar Artery ◽  
Artery Aneurysm ◽  
Endovascular Coiling ◽  
Cerebellar Artery ◽  
Long Term Follow Up ◽  
Glue Embolization

Arteriovenous malformation (AVM)-related aneurysms have been described in the literature. Their behavior varies based on their location in relation to and the activity of the shunting through the index AVM. The intuitive expectation supported by numerous reports is that these aneurysms should regress if the AVM is excluded from the circulation. We describe a case of 46-year-old man who presented with a posterior fossa AVM with an aneurysm on the posterior inferior cerebellar artery feeding the AVM. The nidus of the AVM was successfully excluded by glue embolization, with initial regression of the PICA aneurysm on serial imaging. Five years after the endovascular treatment, the aneurysm showed significant re-growth necessitating endovascular coiling. This case presents the re-growth of an AVM-related aneurysm and emphasizes the importance of long-term follow-up of such aneurysms even if the AVM is completely excluded.

scholarly journals Application of flow coils to occlude distal vertebrobasilar aneurysms

2020 ◽  
Vol 32 (2) ◽  
pp. 58-66
Author(s):  
D.V. Shchehlov ◽  
O.E. Svyrydiuk ◽  
I.M. Bortnik ◽  
O.A. Pastushyn ◽  
Ya.E. Kudelskyi ◽  
...  
Keyword(s):  
Cerebral Angiography ◽  
Clinical Status ◽  
Posterior Inferior Cerebellar Artery ◽  
Artery Aneurysm ◽  
Superior Cerebellar Artery ◽  
Coordination Disorders ◽  
Cerebellar Artery ◽  
Detachable Coils ◽  
Scientific Practical

Objective ‒ to improve the quality of treatment and endovascular occlusion techniques in case of distal vertebrobasilar (VB) aneurysms with implementation of flow coils usage.Materials and methods. Retrospective analysis of 4 patients (3 women and 1 man, mean age 53.5 years) with VB aneurysms in a 2-year period treated in Scientific-Practical Center of Endovascular Neuroradiology NAMS of Ukraine. Pretreatment clinical status was recorded from the patient files, any new neurologic symptoms after the treatment were recorded. Clinical outcome of the patients was established from the patient files. We describe the case of distal superior cerebellar artery aneurysm, 3 cases of posterior inferior cerebellar artery neurysms treated successfully with flow coils with 3-month follow-up at least. All patients underwent cerebral angiography with transfemoral access. Subsequently, coiling of the most distal to the aneurysm segment of the artery was performed.Results. All patients presented with subarachnoid hemorrhage with vestibulo-atactic disorder, diplopia in the case of an aneurysm of the superior cerebellar artery. Endovascular deconstructive occlusion of the aneurysm was performed, according to the data of cerebral angiography, anatomy of the involved artery. In postprocedure Reversible neurological decline in one patient after performing deconstructive occlusion was observed, the symptom completely recovered within 2 weeks of the post-procedural period. Three patients noted the regression of static-coordination disorders in the first 5 days after surgery. No cases of extravasation during coiling and recanalization of the artery during the control examination were observed.Conclusions. Aneurysms of posterior inferior cerebellar artery and superior cerebellar artery are rare. Technical availability to reach the distal to the aneurysm segment of the artery is the key of successful procedure. In comparison with general microcatheters used to insert detachable coils, A microcatheter that is congruent to flow coils is a better navigated in a flow and has lower risk of damaging the artery wall because its physical properties. When the favorable positioning of the tip of the microcatheter is achieved, the flow coils effectively and in a controlled manner occlude the eligible segment of the artery.

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 Vertigo in Cerebrovascular Diseases

2012 ◽  
Vol 4 (1) ◽  
pp. 46-53
Author(s):  
Rahul T Chakor ◽  
Nishikant Eklare
Keyword(s):  
Cerebrovascular Disease ◽  
Sinus Thrombosis ◽  
Cerebrovascular Disorders ◽  
Posterior Inferior Cerebellar Artery ◽  
Cerebrovascular Diseases ◽  
Superior Cerebellar Artery ◽  
Anterior Inferior Cerebellar Artery ◽  
Vestibular Cortex ◽  
Delay In Diagnosis ◽  
Cerebellar Artery

ABSTRACT Background Vertigo as a symptom of cerebrovascular disease is relatively uncommon. All types of cerebrovascular diseases namely ischemia, infarction, hemorrhage can produce vertigo. Since, cerebrovascular disease is an emergency prompt recognition and treatment is necessary to prevent neurologic deficit and death. Among cerebrovascular diseases vertebrobasilar territory strokes commonly present with vertigo. Since, the term vertigo is used nonspecifically by patients this may lead to delay in diagnosis of these strokes. This article reviews the epidemiology of vertigo in cerebrovascular diseases and the various stroke syndromes associated with vertigo. Summary Cerebrovascular diseases in the vertebrobasilar territory have vertigo, imbalance, dizziness in addition to other symptoms and signs. Posterior inferior cerebellar artery, anterior inferior cerebellar artery, superior cerebellar artery and basilar artery territory strokes can present with true vertigo. A high index of suspicion of stroke in patients with vertigo and risk factors for stroke is essential. Other vascular causes of vertigo are small cerebellar hemorrhage, vestibular cortex stroke, rotational vertebral artery syndrome, transverse/sigmoid sinus thrombosis and vestibular paroxysmia. Conclusion Cerebrovascular disorders are estimated to account for 3 to 4% of patients with vertigo or dizziness. Early detection and treatment is necessary to prevent disability and death in these cases of vascular vertigo. How to cite this article Chakor RT, Eklare N. Vertigo in Cerebrovascular diseases. Int J Otorhinolaryngol Clin 2012;4(1):46-53.

Sign in / Sign up

Export Citation Format

Share Document