scholarly journals Traumatic cervical vertebral artery aneurysm associated with suicidal stabs

2021 ◽  
Vol 12 ◽  
pp. 452
Author(s):  
Senshu Nonaka ◽  
Hidenori Oishi ◽  
Satoshi Tsutsumi ◽  
Hisato Ishii
Keyword(s):  
Vertebral Artery ◽  
Attempted Suicide ◽  
Artery Aneurysm ◽  
Neurological Deficits ◽  
Lateral Neck ◽  
Venous Plexus ◽  
Penetrating Injuries ◽  
Presurgical Evaluation ◽  
Arteriovenous Shunts ◽  
The Right

Background: Cervical vertebral artery (VA) aneurysm occasionally develops in association with penetrating injury. However, its treatment strategy is not yet determined. Case Description: A 50-year-old woman with bipolar disorder attempted suicide by stabbing herself in the lateral neck. At presentation, focal neurological deficits were not observed. Spinal computed tomography (CT) showed unclear delineation of the VA in the right C4/5 intervertebral foramen. CT performed 7 days later identified an aneurysm of the right VA at C4/5, with abnormal arteriovenous shunts between the aneurysm and paravertebral venous plexus. The patient underwent coil embolization of the VA segment involving the aneurysm on the same day that was complicated by cerebellar ataxia due to procedure-associated infarction. Conclusion: Traumatic VA aneurysms associated with penetrating injuries should be carefully managed with a detailed presurgical evaluation of the relevant cranial and spinal structures.

scholarly journals Trapping and Thrombectomy of Giant Thrombosed Vertebral Artery Aneurysm via Bilateral Subocciptal Approach – Technical Note

2020 ◽  
Vol 2 (2) ◽  
pp. 66-70
Author(s):  
Pritam Gurung ◽  
Yoshihiro Kuga ◽  
Yuji Kodama ◽  
Katsushi Taomoto ◽  
Hideyuki Ohnishi
Keyword(s):  
Vertebral Artery ◽  
Artery Aneurysm ◽  
Giant Aneurysm ◽  
Distal Portion ◽  
Technical Note ◽  
Neurological Deficits ◽  
Occipital Artery ◽  
Parent Artery ◽  
The Right ◽  
Suboccipital Approach

Background: Giant aneurysms arising from the vertebral artery (VA) are rare; they represent 4% to 6% of all intracranial giant aneurysm. The natural history of thrombosed aneurysms is extremely poor. Most such lesions progressively enlarge and result in irreversible progression of neurological deficits and fatal sequelae through resultant compression of the brainstem. We present the clinical experience of giant thrombosed vertebral artery aneurysm successfully treated via a bilateral suboccipital approach. A 62 –year-old woman presented with slight dysarthria and ataxia for one year. Neurological examination showed right lateral gaze nystagmus, bilateral absent corneal reflex, absent gag reflex, bilateral dysdiadochokinesia, poor right finger nose test, and slightly poor tandem gait. MRI showed a 27 mm giant thrombosed left VA aneurysm with brain stem compression. We performed trapping of the aneurysm and thrombectomy through a bilateral suboccipital approach. First, the distal portion was clipped from the left side. Next, the proximal portion was approached from the right side. Thrombectomy was performed and after shrinkage of the aneurysm, the clips were applied involving some part of the aneurysm just distal to PICA. Conclusion: The optimum treatment for aneurysm of this type is thought to be complete obliteration of the parent artery with trapping and thrombectomy to decompress the brainstem. Sometimes if PICA could not be preserved Occipital artery (OA)-PICA bypass should be considered.

scholarly journals Ruptured Bilateral Pericallosal Artery Aneurysm in Mirror Position: Case Report

2018 ◽  
Vol 37 (03) ◽  
pp. 263-266
Author(s):  
Lucas Meguins ◽  
Linoel Valsechi ◽  
Ronaldo Fernandes ◽  
Dionei Morais ◽  
Antonio Spotti
Keyword(s):  
Case Report ◽  
Subarachnoid Hemorrhage ◽  
External Ventricular Drain ◽  
Artery Aneurysm ◽  
Operative Management ◽  
Neurological Deficits ◽  
Pericallosal Artery ◽  
Digital Subtraction Arteriography ◽  
The Many ◽  
The Right

Introduction Pericallosal artery (PA) aneurysms represent 2 to 9% of all intracranial aneurysms, and their management remains difficult. Objective The aim of the present study is to describe the case of an adult woman with subarachnoid hemorrhage and bilateral PA aneurysm in mirror position. Case Report A 46-year-old woman was referred to our institution 20 days after a sudden severe headache. She informed that she was treating her arterial hypertension irregularly, and consumed ∼ 20 cigarettes/day. The patient was neurologically intact at admission. A non-contrast computed tomography (CT) on the first day of the onset of the symptoms revealed hydrocephaly and subarachnoid hemorrhage (Fisher III). An angio-CT/digital subtraction arteriography showed bilateral PA aneurysms in mirror position. The patient was successfully treated with surgery via the right interhemispheric approach (because the surgeon is right-handed); the surgeon performed the proximal control with temporary clipping, and introduced an external ventricular drain at the end of the surgery. The patient was discharged on the fourth postoperative day without any additional neurological deficits or ventricular shunts. Conclusion Ruptured PA aneurysm is a surgically challenging aneurysm due to the many anatomical nuances and risk of rebleeding. However, the operative management of ruptured bilateral PA aneurysms is feasible and effective.

scholarly journals Microsurgical Treatment of Posterior Cerebral Artery Aneurysm (P2P Segment): Case Report and Review of the Literature

2018 ◽  
Vol 37 (04) ◽  
pp. 343-348
Author(s):  
Lucas Meguins ◽  
Antônio Spotti ◽  
Jean de Oliveira ◽  
Carlos Pereira ◽  
Ronaldo Fernandes ◽  
...  
Keyword(s):  
Case Report ◽  
Cerebral Artery ◽  
Posterior Cerebral Artery ◽  
Artery Aneurysm ◽  
Saccular Aneurysm ◽  
Neurological Deficits ◽  
Uneventful Recovery ◽  
Cerebral Peduncle ◽  
Vast Number ◽  
The Right

Introduction Aneurysms of the posterior cerebral artery (PCA) represent ∼ 1% of all intracranial aneurysms and usually present with subarachnoid hemorrhage. Objective The aim of the present study is to describe the case of an adult man presenting a saccular aneurysm of the right PCA at the posterior half of the postcommunicating (P2P) segment, and to discuss the technical nuances of the approach and of the clipping process. Case Report An investigation of a chronic headache in a 55-year-old man found a saccular aneurysm located just posterior to the most lateral portion of the right cerebral peduncle. A digital subtraction arteriography revealed a 7.8 mm × 5.6 mm × 4.8 mm posterior-medial projecting aneurysm of the right PCA at the P2P segment. A subtemporal approach was performed with partial aspiration of the right parahippocampal gyrus for a better exposure of the vascular structures. A proximal temporary occlusion of the PCA was performed at the anterior half of the postcommunicating P2A segment. The aneurysm was clipped with two semi-curved clips. The patient presented an uneventful recovery and was discharged from the hospital on the third postoperative day without any additional neurological deficits. Conclusion Aneurysms of the PCA are an uncommon vascular disease that challenges the ability of the neurosurgeons due to their many anatomical nuances, to their vast number of perforators, and to the risk of bleeding. However, the operative management of aneurysms of the PCA is technically feasible, safe and effective when performed respecting microsurgical principles.

scholarly journals Neurosurgery (Neuro Interventional)

2015 ◽  
Vol 42 (S1) ◽  
pp. S43-S44
Author(s):  
JJ Shankar ◽  
L Hodgson
Keyword(s):  
Vertebral Artery ◽  
Retrospective Analysis ◽  
Posterior Inferior Cerebellar Artery ◽  
Artery Aneurysm ◽  
The Third ◽  
Cerebellar Artery ◽  
Incomplete Coverage ◽  
Negative Findings ◽  
The Right

Purpose: CTA is becoming the frontline modality to reveal aneurysms in patients with SAH. However, in about 20% of SAH patients no aneurysm is found. In these cases, intra-arterial DSA is still performed. Our aim was to evaluate whether negative findings on CTA can reliably exclude aneurysms in patients with acute SAH. Materials and Method: We conducted a retrospective analysis of all DSA performed from August 2010 to July 2014 in patients with various indications. We selected patient who presented with SAH and had a negative CTA. Findings of the CTA were compared with DSA. Results: 857 DSA were performed during the study period. 51(5.95%) patients with SAH and negative findings on CTA who underwent subsequent DSA were identified. Of these, only 3(5.9%) of patients had positive findings on the DSA. One patient had a posterior inferior cerebellar artery aneurysm on the DSA, not seen on CTA due to the incomplete coverage of the head. Second patient’ CTA did not show any evidence of aneurysm. DSA showed suspicious dissection of the right vertebral artery, potentially iatrogenic. The third patient’s DSA showed suspicious tiny protuberance from left ICA, possibly infundibulum. Conclusion: In patients with SAH, negative CTA findings are reliable in ruling out aneurysms in any pattern of SAH on CT.

scholarly journals Transoral Penetrating Knife Injury in the Oral, Maxillofacial Region: A Case Report

2019 ◽  
Vol 3 (1) ◽  
pp. s-0039-1694003
Author(s):  
Lukas B. Seifert ◽  
Philipp Thönissen ◽  
Anna M. Teiler ◽  
Christoph Nau ◽  
Axel Thalhammer ◽  
...  
Keyword(s):  
Case Report ◽  
Vertebral Artery ◽  
Multidisciplinary Approach ◽  
Balloon Catheter ◽  
Cerebellar Infarction ◽  
Soft Tissue Reconstruction ◽  
Penetrating Injuries ◽  
Maxillofacial Region ◽  
Interventional Angiography ◽  
The Right

Penetrating injuries are a rare yet complex variety of oral and maxillofacial trauma and often require a multidisciplinary approach to treatment. The primary survey is always the first step in trauma management prior to proceeding with further evaluation and treatment. The following case report discusses the clinical strategy for a rare transoral and trans-spinal penetrating injury. A 42-year-old man presented with a penetrating metal injury through the oral cavity. A computed tomography scan revealed a 12.8-cm-long knife penetrating through the tongue, floor of the mouth, and hypopharynx reaching the spinal cord in close proximity to the right vertebral artery. The patient did not present with any neurological malfunctions. An emergency tracheotomy was performed for airway protection. A balloon catheter was inserted into the right vertebral artery using interventional angiography to prevent massive bleeding prior to extraction. The knife was then surgically removed, and soft tissue reconstruction was performed without major bleeding. Postoperative magnetic resonance imaging angiography showed no bleeding of the right vertebral artery, but there was mild cerebellar infarction. Early isolated paresis of the right arm returned to nearly normal function within 1 week. This case demonstrates that complex penetrating injuries of the oral and maxillofacial region require a structured and multidisciplinary approach to prevent further side effects and obtain an ideal clinical outcome.

scholarly journals VARIATIONS OF FORAMEN TRANSVERSARIUM IN ATLAS VERTEBRAE : A MORPHOLOGICAL STUDY WITH ITS CLINICAL SIGNIFICANCE

2015 ◽  
Vol 05 (02) ◽  
pp. 080-083 ◽  
Author(s):  
Qudusia Sultana ◽  
Ramakrishna Avadhani ◽  
Varalakshmi KL ◽  
Shariff MH ◽  
Keyword(s):  
Vertebral Artery ◽  
Clinical Significance ◽  
Morphological Study ◽  
Posterior Arch ◽  
Neck Injuries ◽  
Venous Plexus ◽  
Cerebrovascular Accidents ◽  
Cervical Injuries ◽  
The Right

Abstract Introduction: The second part of the vertebral artery along with vertebral venous plexus and sympathetic plexus traverses through vicinity of foramen transversarium of atlas. Derangement of these structures in their course may be seen due to deformities, narrowing and presence of osteophytes in foramen transversarium. Methods: Two hundred foramen transversarium of 100 atlas vertebrae were grossly studied for their variations. Results: Out of hundred atlas vertebrae examined, we found that all the vertebrae had foramina transversaria. Absence of costal element was noticed in five atlas vertebrae. 2 of the vertebrae showed incomplete unilateral foramen transversarium, 3 vertebrae showed bilateral incomplete foramen, In 1 vertebra along with normal foramen transversarium, complete retroarticular foramen was observed on the left side and incomplete retroarticular foramen observed on the right side of the posterior arch.4 vertebrae showed incomplete retroarticular foramen. Conclusion: The increasing incidence of neck injuries and related syndromes necessitates the study of bony variations of the atlas vertebra and its transverse foramina. Due to the incomplete formation of the foramen transversarium the second part of vertebral artery is prone to be damaged easily during posterior cervical injuries and Surgeries. The bony bridges embracing the vertebral artery may be responsible for vertigo and cerebrovascular accidents hence the knowledge of such variations is important for Physicians, Otirhinolaryngologists, neurologists ,Orthopaedicians and Radiologists.

Treatment of Extracranial and Intracranial Aneurysms and Arteriovenous Fistulae Using Stent Grafts

Neurosurgery ◽  
2004 ◽  
Vol 55 (3) ◽  
pp. 631-639 ◽  
Author(s):  
Stephan Felber ◽  
Hans Henkes ◽  
Werner Weber ◽  
Elina Miloslavski ◽  
Stefan Brew ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Stent Graft ◽  
Internal Carotid ◽  
Artery Aneurysm ◽  
Giant Aneurysm ◽  
Dissecting Aneurysm ◽  
Neurological Deficits ◽  
Stent Grafts ◽  
Arteriovenous Fistulae ◽  
Vessel Dissection

Abstract OBJECTIVE: Treatment of 11 patients with aneurysms or arteriovenous fistulae of the craniocervical arteries with stent grafts. METHODS: Peripheral stent grafts were deployed in two extracranial internal carotid arteries. Coronary stent grafts were used to treat two giant aneurysms, five direct carotid-cavernous fistulae, one vertebrojugular fistula, and two dissecting aneurysms of the vertebral artery (V2 and V4). RESULTS: Stent grafts were used successfully in two extracranial internal carotid and two extracranial vertebral arteries, one dissecting aneurysm of the intracranial vertebral artery, one giant aneurysm and one pseudoaneurysm of the cavernous internal carotid artery, and five direct carotid-cavernous sinus fistulae. Angiographic follow-up examinations (available in nine patients; obtained at 3 mo to 5 yr; average, 24 mo) revealed normal vessel caliber, and the stent grafts in all 9 of 11 initial patients were patent. There was a recurrent saccular aneurysm adjacent to the stent graft in the patient with the intracranial vertebral artery aneurysm. The following five complications were encountered: transient hemiparesis (n = 2), increased hemiparesis, post-procedural management-related fatality, and ICA dissection. In six patients, stent graft deployment was accomplished without any technical or clinical complication. There were no permanent neurological deficits consequent to stent graft placement. CONCLUSION: Stent grafts are a useful tool for the endovascular treatment of head and neck aneurysms and direct arteriovenous fistulae in selected patients. The major disadvantage of the currently available stent grafts is their lack of mechanical flexibility. Maneuvering stent grafts in the intracranial arteries carries the risk of iatrogenic vessel dissection and may require supportive measures and protection of the target site by conventional stents.

An unusual case of a giant extracranial vertebral artery aneurysm

Vascular ◽  
2019 ◽  
Vol 27 (4) ◽  
pp. 427-429 ◽  
Author(s):  
Abd Elaziz A Suliman ◽  
Hytham KS Hamid ◽  
Salwa O Mekki
Keyword(s):  
Vertebral Artery ◽  
Symptomatic Relief ◽  
Artery Aneurysm ◽  
Giant Aneurysm ◽  
Mass Effect ◽  
Posterior Neck ◽  
Post Traumatic ◽  
Extracranial Vertebral Artery ◽  
The Right ◽  
Significant Mass Effect

Objective Extracranial vertebral artery (VA) aneurysms are rare and are often post-traumatic secondary to penetrating or blunt injuries. Primary extracranial VA aneurysms are far less common. Most of these lesions are located in the proximal (V1) and middle (V2) segments of the VA. Method We report an extremely rare case of a giant aneurysm of the extracranial vertebral artery in a 50-year-old woman who presented with a right posterior neck swelling, headache and pain at the site of the mass. Angiography confirmed aneurysm of V3 segment of the right VA. Treatment included ligation of the artery and aneurysmectomy. Result Magnetic resonance angiography at 12 months showed obliterated proximal segment of the right VA with no obvious flow distally. Conclusion Aneurysms of the extracranial VA are clinically relevant because of the associated risks of rupture and distal embolization. For patients with rupture, pending rupture or a significant mass effect due to a giant lesion, surgery is the treatment modality of choice to attain symptomatic relief.

scholarly journals Combined microsurgical PICA-PICA bypass and endovascular parent artery occlusion for a ruptured dissecting vertebral artery aneurysm

2015 ◽  
Vol 38 (videosuppl1) ◽  
pp. Video3 ◽  
Author(s):  
Robert M. Starke ◽  
Dale Ding ◽  
Christopher R. Durst ◽  
R. Webster Crowley ◽  
Kenneth C. Liu
Keyword(s):  
Vertebral Artery ◽  
Posterior Inferior Cerebellar Artery ◽  
Artery Aneurysm ◽  
Distal Portion ◽  
Artery Occlusion ◽  
Parent Artery ◽  
Treatment Technique ◽  
Pica Pica ◽  
Parent Artery Occlusion ◽  
The Right

Dissecting vertebral artery (VA) aneurysms are difficult to obliterate when the parent artery cannot be safely occluded. In this video, we demonstrate a combined microsurgical and endovascular treatment technique for a ruptured, dissecting VA aneurysm incorporating the origin of the posterior inferior cerebellar artery (PICA). We first performed a PICA-PICA side-to-side bypass to preserve flow through the right PICA. An endovascular approach was then utilized to embolize the proximal portion of the aneurysm from the right VA and the distal portion of the aneurysm from the left VA.The video can be found here: http://youtu.be/dkkKsX2BiJI.

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