Sphenopalatine ganglion stimulation for vasospasm after experimental subarachnoid hemorrhage

Object Sphenopalatine ganglion stimulation activates perivascular vasodilatory nerves in the ipsilateral anterior circle of Willis. This experiment tested whether stimulation of the ganglion could reverse vasospasm and improve cerebral perfusion after subarachnoid hemorrhage (SAH) in monkeys. Methods Thirteen cynomolgus monkeys underwent baseline angiography followed by creation of SAH by placement of autologous blood against the right intradural internal carotid artery, the middle cerebral artery (MCA), and the anterior cerebral artery. Seven days later, angiography was repeated, and the right sphenopalatine ganglion was exposed microsurgically. Angiography was repeated 15 minutes after exposure of the ganglion. The ganglion was stimulated electrically 3 times, and angiography was repeated during and 15 and 30 minutes after stimulation. Cerebral blood flow (CBF) was monitored using laser Doppler flowmetry, and intracranial pressure (ICP) was measured throughout. The protocol was repeated again. Evans blue was injected and the animals were killed. The brains were removed for analysis of water and Evans blue content and histology. Results Subarachnoid hemorrhage was associated with significant vasospasm of the ipsilateral major cerebral arteries (23% ± 10% to 39% ± 4%; p < 0.05, paired t-tests). Exposure of the ganglion and sham stimulation had no significant effects on arterial diameters, ICP, or CBF (4 monkeys, ANOVA and paired t-tests). Sphenopalatine ganglion stimulation dilated the ipsilateral extracranial and intracranial internal carotid artery, MCA, and anterior cerebral artery compared with the contralateral arteries (9 monkeys, 7% ± 9% to 15% ± 19%; p < 0.05, ANOVA). There was a significant increase in ipsilateral CBF. Stimulation had no effect on ICP or brain histology. Brain water content did not increase but Evans blue content was significantly elevated in the MCA territory of the stimulated hemisphere. Conclusions Sphenopalatine ganglion stimulation decreased vasospasm and increased CBF after SAH in monkeys. This was associated with opening of the blood-brain barrier.

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Competitive flow diversion of multiple P1 aneurysms: proposed classification

BMJ Case Reports ◽

10.1136/bcr-2019-015581 ◽

2020 ◽

Vol 13 (6) ◽

pp. e015581

Author(s):

Mark Alexander MacLean ◽

Thien J Huynh ◽

Matthias Helge Schmidt ◽

Vitor M Pereira ◽

Adrienne Weeks

Keyword(s):

Subarachnoid Hemorrhage ◽

Carotid Artery ◽

Internal Carotid Artery ◽

Cerebral Artery ◽

Internal Carotid ◽

Posterior Cerebral Artery ◽

Flow Diversion ◽

Endovascular Coiling ◽

Ruptured Aneurysms ◽

The Right

We report the case of a patient with subarachnoid hemorrhage and three aneurysms arising from the posterior communicating artery (Pcomm)-P1 complex, treated with endovascular coiling and competitive flow diversion. The largest and likely ruptured Pcomm aneurysm was treated with traditional coiling. Two smaller potentially ruptured aneurysms arose from the distal right posterior cerebral artery (PCA) P1 segment. After a failed attempt to treat with conventional flow diversion across the PCA-P1 segment, the P1 aneurysms were successfully treated with competitive flow diversion distal to the PCA-P1 segment from Pcomm to the P2 segment. Over 12 months, competitive flow diversion redirected flow to the right PCA territory via the internal carotid artery-Pcomm-P2, reducing the size of the PCA-P1 segment and obliterating the P1 aneurysms. Competitive flow diversion treatment should be considered for aneurysms occurring at the circle of Willis when traditional methods are not feasible. Herein, we introduce a novel classification for competitive flow diversion treatment.

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Republished: Competitive flow diversion of multiple P1 aneurysms: proposed classification

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2019-015581.rep ◽

2020 ◽

Vol 12 (9) ◽

pp. e7-e7

Author(s):

Mark Alexander MacLean ◽

Thien J Huynh ◽

Matthias Helge Schmidt ◽

Vitor M Pereira ◽

Adrienne Weeks

Keyword(s):

Subarachnoid Hemorrhage ◽

Carotid Artery ◽

Internal Carotid Artery ◽

Cerebral Artery ◽

Internal Carotid ◽

Posterior Cerebral Artery ◽

Flow Diversion ◽

Endovascular Coiling ◽

Ruptured Aneurysms ◽

The Right

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1679 An Unusual Case of Hypoplastic Internal Carotid Artery with Segmental Aplasia of The Anterior Cerebral Artery: A Case Report and Systematic Literature Review

British Journal of Surgery ◽

10.1093/bjs/znab259.661 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

H Whitley ◽

P Skalicky ◽

J Malik ◽

F Charvat ◽

V Benes ◽

...

Keyword(s):

Carotid Artery ◽

Literature Review ◽

Internal Carotid Artery ◽

Cerebral Artery ◽

Unusual Case ◽

Clinical Decision Making ◽

Internal Carotid ◽

Anterior Cerebral Artery ◽

Ct Angiogram ◽

The Right

Abstract Aim Hypoplasia of the internal carotid artery (ICA) is a rare morphological variant with potential implications in disease and clinical decision-making. We describe an unusual case of ICA hypoplasia in a 50-year-old female who presented with an acute episode of vertigo. CT angiogram showed an unusually short common carotid artery (CCA) on the right side, hypoplasia of the right ICA, and agenesis of the A1 segment of the right anterior cerebral artery (ACA). We provide a short review of the available literature. Method The literature review was performed according to PRISMA guidelines. Three databases (Pubmed, Web of Science, and Ovid) were searched using the terms “ICA” and “Hypoplasia”. Case reports published in English in the last 10 years were considered eligible for inclusion. Reports of acquired ICA hypoplasia or ICA agenesis were excluded. Results Our systematic literature search revealed that 19 cases of congenital ICA hypoplasia have been reported in the last 10 years. Of these, 14 were unilateral hypoplasia, including nine cases in which the anomaly was on the left, and five cases in which the anomaly was on the right. Two cases had additional aplasias; one with aplasia of the ACOM and another with aplasia of segment C6 of the ICA. Conclusions We conclude that ICA hypoplasia remains a rare anomaly, despite the increasing incidence due to the availability of imaging technology. Clinicians should be aware of these variations, as they are frequently associated with haemodynamic changes, aneurysms, and fenestrations. Such variations have important implications for planning angiographic and surgical approaches.

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Carotid-Anterior Cerebral Artery Anastomosis with Aneurysm: Case Report and Review of the Literature

Neurosurgery ◽

10.1227/00006123-198811000-00021 ◽

1988 ◽

Vol 23 (5) ◽

pp. 654-658 ◽

Cited By ~ 17

Author(s):

Genya Odake

Keyword(s):

Case Report ◽

Subarachnoid Hemorrhage ◽

Carotid Artery ◽

Internal Carotid Artery ◽

Cerebral Artery ◽

Internal Carotid ◽

Anterior Cerebral Artery ◽

Common Trunk ◽

Review Of The Literature ◽

Proximal Internal Carotid Artery

Abstract A ruptured aneurysm at the origin of the bilateral pericallosal arteries with an anomalous anterior cerebral artery was found in a 56-year-old man. The abnormal solitary anterior cerebral artery arose from the intracranial proximal internal carotid artery, passed underneath the ipsilateral optic nerve, and turned upward at the midline as a common trunk of the bilateral pericallosal arteries. Subarachnoid hemorrhage recurred 15 days postoperatively, and the patient did poorly. The 20 published cases of this rare anomaly (an infraoptic course of the anterior cerebral artery with a low bifurcation of the internal carotid artery) are reviewed. This anomaly should be referred to by the descriptive term “carotid-anterior cerebral artery anastomosis.” It is frequently associated with aneurysms.

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A case of segmental arterial mediolysis with subarachnoid hemorrhage due to anterior cerebral artery dissection followed by internal carotid artery dissection

Surgical Neurology International ◽

10.25259/sni_138_2021 ◽

2021 ◽

Vol 12 ◽

pp. 240

Author(s):

Shoji Yasuda ◽

Kodai Uematsu ◽

Kentaro Yamashita ◽

Tatsuya Kuroda ◽

Satoru Murase ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Carotid Artery ◽

Internal Carotid Artery ◽

Cerebral Artery ◽

Internal Carotid ◽

Anterior Cerebral Artery ◽

Mesenteric Arteries ◽

Artery Dissection ◽

Symptom Improvement ◽

Segmental Arterial Mediolysis

Background: Segmental arterial mediolysis (SAM) causes subarachnoid hemorrhage (SAH) due to intracranial aneurysm rupture and arterial dissection. We encountered a case of SAM-related SAH due to ruptured dissection of the A1 segment of the anterior cerebral artery concomitant with internal carotid artery (ICA) dissection. Case Description: A 53-year-old man presented with SAH due to a ruptured right A1 dissecting aneurysm. The aneurysm was trapped; however, 7 days after the onset of SAH, he experienced right hemiparesis and aphasia. Angiography showed left ICA dissection; urgent carotid artery stenting was performed, leading to symptom improvement. Abdominal computed tomography angiography showed aneurysms of the celiac and superior mesenteric arteries. He was diagnosed with SAM based on clinical, imaging, and laboratory findings. Conclusion: In the acute phase of SAM-related SAH, cerebral ischemia could occur due to both cerebral vasospasm and intracranial or cervical artery dissection.

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Abstract 1122‐000187: Acute Stroke, Subarachnoid Hemorrhage, VZV vasculopathy, and Carotid Dissection: An Interesting Case

Stroke: Vascular and Interventional Neurology ◽

10.1161/svin.01.suppl_1.000187 ◽

2021 ◽

Vol 1 (S1) ◽

Author(s):

Hashaam Arshad ◽

Zhenhua Gui ◽

Dakota Owens ◽

Binod Wagle ◽

Charles Donohoe

Keyword(s):

Subarachnoid Hemorrhage ◽

Carotid Artery ◽

Internal Carotid Artery ◽

Lumbar Puncture ◽

Internal Carotid ◽

Acute Encephalopathy ◽

Igg Antibody ◽

Cerebral Angiogram ◽

Ct Angiogram ◽

The Right

Introduction : A 51‐year‐old lady with a past medical history of Essential Hypertension, Hypothyroidism, prior Herpes Zoster infection 8 weeks ago was admitted with complaints of abdominal pain, bilateral flank pain, and restlessness. Her initial workup was significant for hyponatremia and hypokalemia. On the 3rd day of admission, she developed acute hypoxemic respiratory failure which led to intubation. At that time, CTA Chest was not done but CT Chest revealed prominent mucous plugging with left side glass ground opacities, Ultrasound of lower extremities revealed right common femoral vein DVT which led to concerns that she may have suffered from Pulmonary Embolism and led to starting Heparin drip. On the 6th day of admission, she developed Acute Encephalopathy, MRI Brain revealed acute infarcts in bilateral cerebral cortices and cerebella, CT Angiogram Head showed acute subarachnoid hemorrhage in the high posterior right parietal lobe, stenosis of the right high cervical internal carotid artery, and irregular, the appearance of the arterial vasculature throughout and CT Angiogram Neck abrupt change in caliber of the right ICA, 1.5 cm distal to the bifurcation with markedly severe narrowing of the majority of the extracranial right ICA throughout its course. A cerebral Angiogram was done which showed diffuse tandem segments of tandem cervical and intracranial portions of the right internal carotid artery and she was given nitroglycerin was administered as a therapeutic intervention. Lumbar Puncture showed WBC 2, RBC 7, Protein 162, Glucose 64, VZV PCR was negative, CSF VZV IgG Antibody positive at 303 IV (>165 IV indicative of current or past infection). Serum VZV IgG Antibody was positive at >4000 IV. Infectious Diseases were consulted after Lumbar Puncture, they initially started Acyclovir but once the Serum VZV IgG Antibody came back much higher than Serum VZV IgG Antibody levels, their assessment was that VZV vasculitis is unlikely and Acyclovir was discontinued. Eventually, the case was discussed at Neuroradiology which led to us getting a repeat MRA Neck without contrast which showed a concentric T1 and T2 hyperintensity along with a small and irregular caliber right cervical ICA consistent with dissection. She eventually completed a 21‐day course of Nimodipine due to underlying Subarachnoid Hemorrhage. Methods : NA Results : NA Conclusions : Our case demonstrates how it can become difficult to ascertain the etiology of stroke in certain patients. Our patient presented with multiple non‐specific symptoms initially and it was later on due to her Acute Encephalopathy that her Strokes and Subarachnoid Hemorrhage were discovered. It is still difficult to pinpoint whether the cause of strokes was dissection or VZV infection. Lumbar Puncture remains an essential tool to complete work up on uncommon etiologies of stroke.

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Bilateral Internal Carotid to Anterior Cerebral Artery Anastomosis with Anterior Communicating Artery Aneurysm: Technical Case Report

Operative Neurosurgery ◽

10.1227/01.neu.0000176852.33587.e9 ◽

2005 ◽

Vol 57 (suppl_4) ◽

pp. ONS-E400-ONS-E400 ◽

Cited By ~ 2

Author(s):

Kaya Kılıç ◽

Metin Orakdöğen ◽

Aram Bakırcı ◽

Zafer Berkman

Keyword(s):

Case Report ◽

Magnetic Resonance ◽

Magnetic Resonance Angiography ◽

Carotid Artery ◽

Internal Carotid Artery ◽

Cerebral Artery ◽

Internal Carotid ◽

Anterior Cerebral Artery ◽

Artery Aneurysm ◽

Anterior Communicating Artery

Abstract OBJECTIVE AND IMPORTANCE: The present case report is the first one to report a bilateral anastomotic artery between the internal carotid artery and the anterior communicating artery in the presence of a bilateral A1 segment, fenestrated anterior communicating artery (AComA), and associated aneurysm of the AComA, which was discovered by magnetic resonance angiography and treated surgically. CLINICAL PRESENTATION: A 38-year-old man who was previously in good health experienced a sudden onset of nuchal headache, vomiting, and confusion. Computed tomography revealed a subarachnoid hemorrhage. Magnetic resonance angiography and four-vessel angiography documented an aneurysm of the AComA and two anastomotic vessels of common origin with the ophthalmic artery, between the internal carotid artery and AComA. INTERVENTION: A fenestrated clip, introduced by a left pterional craniotomy, leaving in its loop the left A1 segment, sparing the perforating and hypothalamic arteries, excluded the aneurysm. CONCLUSION: The postoperative course was uneventful, with complete recovery. Follow-up angiograms documented the successful exclusion of the aneurysm. Defining this particular internal carotid-anterior cerebral artery anastomosis as an infraoptic anterior cerebral artery is not appropriate because there is already an A1 segment in its habitual localization. Therefore, it is also thought that, embryologically, this anomaly is not a misplaced A1 segment but the persistence of an embryological vessel such as the variation of the primitive prechiasmatic arterial anastomosis. The favorable outcome for our patient suggests that surgical treatment may be appropriate for many patients with this anomaly because it provides a complete and definitive occlusion of the aneurysm.

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Critical neurovascular brain anatomy

The Neurosurgeon's Handbook ◽

10.1093/med/9780198570677.003.0390 ◽

2010 ◽

pp. 504-517

Author(s):

George Samandouras

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Basilar Artery ◽

Internal Carotid ◽

Anterior Cerebral Artery ◽

Brain Anatomy ◽

Vertebral Arteries ◽

System P

Chapter 9.1 covers critical neurovascular brain anatomy, including internal carotid artery, the middle cerebral artery, the anterior cerebral artery, the vertebral arteries (VAs), the basilar artery (BA), and the venous system.

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Origins and Pathways of Cerebrovascular Vasoactive Intestinal Polypeptide-Positive Nerves in Rat

Journal of Cerebral Blood Flow & Metabolism ◽

10.1038/jcbfm.1988.117 ◽

1988 ◽

Vol 8 (5) ◽

pp. 697-712 ◽

Cited By ~ 182

Author(s):

Norihiro Suzuki ◽

Jan Erik Hardebo ◽

Christer Owman

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Vasoactive Intestinal Polypeptide ◽

Basilar Artery ◽

Internal Carotid ◽

Sphenopalatine Ganglion ◽

Cerebral Blood Vessels ◽

Carotid Canal

In order to clarify the origins and pathways of vasoactive intestinal polypeptide (VlP)-containing nerve fibers in cerebral blood vessels of rat, denervation experiments and retrograde axonal tracing methods (true blue) were used. Numerous VIP-positive nerve cells were recognized in the sphenopalatine ganglion and in a mini-ganglion (internal carotid mini-ganglion) located on the internal carotid artery in the carotid canal, where the parasympathetic greater superficial petrosal nerve is joined by the sympathetic fibers from the internal carotid nerve, to form the Vidian nerve. VIP fiber bridges in the greater deep petrosal nerve and the internal carotid nerve reached the wall of the internal carotid artery. Two weeks after bilateral removal of the sphenopalatine ganglion or sectioning of the structures in the ethmoidal foramen, VIP fibers in the anterior part of the circle of Willis completely disappeared. Very few remained in the middle cerebral artery, the posterior cerebral artery, and rostral two-thirds of the basilar artery, whereas they remained in the caudal one-third of the basilar artery, the vertebral artery, and intracranial and carotid canal segments of the internal carotid artery. One week after application of true blue to the middle cerebral artery, dye accumulated in the ganglion cells in the sphenopalatine, otic and internal carotid mini-ganglion; some of the cells were positive for VIP. The results show that the VIP nerves in rat cerebral blood vessels originate: (a) in the sphenopalatine, and otic ganglion to innervate the circle of Willis and its branches from anterior and caudally and (b) from the internal carotid mini-ganglion to innervate the internal carotid artery at the level of the carotid canal and to some extent its intracranial extensions.

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