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).

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.

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.

scholarly journals Revascularization of the upper posterior circulation with the anterior temporal artery: an anatomical feasibility study

2018 ◽  
Vol 129 (1) ◽  
pp. 121-127 ◽  
Author(s):  
Ali Tayebi Meybodi ◽  
Michael T. Lawton ◽  
Dylan Griswold ◽  
Pooneh Mokhtari ◽  
Andre Payman ◽  
...  
Keyword(s):  
Basilar Artery ◽  
Posterior Cerebral Artery ◽  
Temporal Artery ◽  
Posterior Circulation ◽  
Superior Cerebellar Artery ◽  
Middle Temporal ◽  
Cerebellar Artery ◽  
Orbitozygomatic Approach ◽  
Basal Cisterns

OBJECTIVEIn various disease processes, including unclippable aneurysms, a bypass to the upper posterior circulation (UPC) including the superior cerebellar artery (SCA) and posterior cerebral artery (PCA) may be needed. Various revascularization options exist, but the role of intracranial (IC) donors has not been scrutinized. The objective of this study was to evaluate the anatomical feasibility of utilizing the anterior temporal artery (ATA) for revascularization of the UPC.METHODSATA-SCA and ATA-PCA bypasses were performed on 14 cadaver specimens. After performing an orbitozygomatic craniotomy and opening the basal cisterns, the ATA was divided at the M3-M4 junction and mobilized to the crural cistern to complete an end-to-side bypass to the SCA and PCA. The length of the recipient artery between the anastomosis and origin was measured.RESULTSSeventeen ATAs were found. Successful anastomosis was performed in 14 (82%) of the ATAs. The anastomosis point on the PCA was 14.2 mm from its origin on the basilar artery. The SCA anastomosis point was 10.1 mm from its origin. Three ATAs did not reach the UPC region due to a common opercular origin with the middle temporal artery. The ATA-SCA bypass was also applied to the management of an incompletely coiled SCA aneurysm.CONCLUSIONSThe ATA is a promising IC donor for UPC revascularization. The ATA is exposed en route to the proximal SCA and PCA through the pterional-orbitozygomatic approach. Also, the end-to-side anastomosis provides an efficient and straightforward bypass without the need to harvest a graft or perform multiple or difficult anastomoses.

Resolving Occlusive Lesions of the Basilar Artery

Neurosurgery ◽  
1985 ◽  
Vol 17 (5) ◽  
pp. 811-814 ◽  
Author(s):  
John R. Little ◽  
Anthony J. Furlan
Keyword(s):  
Basilar Artery ◽  
Artery Bypass ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Posterior Circulation ◽  
The Other ◽  
Superior Cerebellar Artery ◽  
Cerebellar Artery ◽  
Basilar Artery Stenosis ◽  
Occlusive Lesion

Abstract Progression of severe basilar artery stenosis to occlusion is a well-recognized phenomenon, but regression of a severe basilar artery atherothrombotic lesion has not been described previously. In this report, two patients with a symptomatic severe basilar artery occlusive lesion showed substantial angiographic improvement after 3 months of anticoagulation in one case and 4 months after superficial temporal artery to superior cerebellar artery bypass in the other case. The findings in these cases indicate that clinical improvement in similar cases may reflect recanalization of a basilar artery occlusive lesion. The uncertain natural history and potential for regression of symptomatic basilar artery atherothormbosis make us hesitant to recommend posterior circulation revascularization immediately after such lesions are first demonstrated angiographically.

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.

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.

scholarly journals STMO-02 Efficacy of preoperative embolization for hemangioblastoma

2020 ◽  
Vol 2 (Supplement_3) ◽  
pp. ii9-ii10
Author(s):  
Takeshi Hiu ◽  
Kousuke Hirayama ◽  
Shiro Baba ◽  
Kenta Ujifuku ◽  
Koichi Yoshida ◽  
...  
Keyword(s):  
Blood Loss ◽  
Cerebral Infarction ◽  
Transarterial Embolization ◽  
Posterior Inferior Cerebellar Artery ◽  
Superior Cerebellar Artery ◽  
Anterior Inferior Cerebellar Artery ◽  
Preoperative Embolization ◽  
Cerebellar Hemangioblastoma ◽  
Cerebellar Artery ◽  
Hemorrhagic Complications

Abstract Introduction: Preoperative transarterial embolization (TAE) for hemangioblastoma carries a risk of cerebral infarction and hemorrhagic complications, and its safety and efficacy are controversial. Method: Twenty-two cases of hemangioblastoma (cerebellar: 18 cases, medulla oblongata: 3 cases, spinal cord: 1 case) treated via direct surgery in our hospital from 2007 to 2020 were enrolled. Results: Preoperative TAE was performed in 6 cases of cerebellar hemangioblastoma (1 bilateral case) and 1 case of spinal hemangioblastoma. The cerebellar hemangioblastoma feeders were only superior cerebellar artery (SCA) in 3 cases, SCA/anterior inferior cerebellar artery (AICA)/posterior inferior cerebellar artery (PICA) in 2 cases, AICA/PICA in 1 case, and single drainer in 5 cases. Tumors were ≥30 mm in all cases (25 mm on 1 side in bilateral cases), and solid or nodular lesions were located on the upper surface of the cerebellum. Cerebellar edema was severe in five cases with hydrocephalus. TAE was performed under local anesthesia in all cases, using a coil alone in two cases and liquid or particle embolization material in five cases. The day before direct surgery, TAE was performed in four cases, one of which underwent emergency decompression due to severe cerebellar edema. Three cases were intentionally embolized on the day of direct surgery. The median blood loss during direct surgery was 100 ml. Although cerebral infarction was observed in all cases, there were no cases of brain stem infarction or hemorrhagic complications. The Modified Rankin Scale at discharge was 0 in 2 cases, 1 in 3 cases, 3 in 1 case, and 4 in 1 case. Discussion/Conclusion: Preoperative TAE for hemangioblastoma reduced the blood loss for direct surgery. Same-day TAE avoided neurological deficit due to cerebral infarction and cerebellar edema. To prevent severe infarction, guiding the microcatheter to the vicinity of the tumor bed is important.

Segmental anatomy of cerebellar arteries: a proposed nomenclature

2011 ◽  
Vol 115 (2) ◽  
pp. 387-397 ◽  
Author(s):  
Ana Rodríguez-Hernández ◽  
Albert L. Rhoton ◽  
Michael T. Lawton
Keyword(s):  
Cerebral Arteries ◽  
Posterior Inferior Cerebellar Artery ◽  
Superior Cerebellar Artery ◽  
Anterior Inferior Cerebellar Artery ◽  
Microsurgical Anatomy ◽  
Numbering System ◽  
Segmental Anatomy ◽  
Cerebellar Artery ◽  
Intracranial Arteries

Object The conceptual division of intracranial arteries into segments provides a better understanding of their courses and a useful working vocabulary. Segmental anatomy of cerebral arteries is commonly cited by a numerical nomenclature, but an analogous nomenclature for cerebellar arteries has not been described. In this report, the microsurgical anatomy of the cerebellar arteries is reviewed, and a numbering system for cerebellar arteries is proposed. Methods Cerebellar arteries were designated by the first letter of the artery's name in lowercase letters, distinguishing them from cerebral arteries with the same first letter of the artery's name. Segmental anatomy was numbered in ascending order from proximal to distal segments. Results The superior cerebellar artery was divided into 4 segments: s1, anterior pontomesencephalic segment; s2, lateral pontomesencephalic segment; s3, cerebellomesencephalic segment; and s4, cortical segment. The anterior inferior cerebellar artery was divided into 4 segments: a1, anterior pontine segment; a2, lateral pontine segment; a3, flocculopeduncular segment; and a4, cortical segment. The posterior inferior cerebellar artery was divided into 5 segments: p1, anterior medullary segment; p2, lateral medullary segment; p3, tonsillomedullary segment; p4, telovelotonsillar segment; and p5, cortical segment. Conclusions The proposed nomenclature for segmental anatomy of cerebellar artery complements established nomenclature for segmental anatomy of cerebral arteries. This nomenclature is simple, easy to learn, and practical. The nomenclature localizes distal cerebellar artery aneurysms and also localizes an anastomosis or describes a graft's connections to donor and recipient arteries. These applications of the proposed nomenclature with cerebellar arteries mimic the applications of the established nomenclature with cerebral arteries.

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.

Acute Treatment of Ruptured Fusiform Posterior Circulation Posterior Cerebral, Superior Cerebellar, and Posterior Inferior Cerebellar Artery Aneurysms With FRED Flow Diverter: Report of 5 Cases

2018 ◽  
Vol 16 (5) ◽  
pp. 549-556 ◽  
Author(s):  
Dan Laukka ◽  
Riitta Rautio ◽  
Melissa Rahi ◽  
Jaakko Rinne
Keyword(s):  
Treatment Time ◽  
Brain Infarction ◽  
Treatment Options ◽  
Posterior Inferior Cerebellar Artery ◽  
Flow Diverter ◽  
External Ventricular Drainage ◽  
Posterior Circulation ◽  
Superior Cerebellar Artery ◽  
Technical Success Rate ◽  
Cerebellar Artery

Abstract BACKGROUND Flow diverter (FD) treatment of ruptured fusiform posterior cerebral artery (PCA), posterior inferior cerebellar artery (PICA), and superior cerebellar artery (SCA) aneurysms are limited to single reports. OBJECTIVE To study the safety and efficacy of FD treatment for ruptured fusiform aneurysms of the PCA, SCA, and PICA. METHODS Five patients with ruptured posterior circulation fusiform aneurysms and treated with a Flow-Redirection Endoluminal Device (FRED/FRED Jr; Microvention, Tustin, California) stent in the acute phase of subarachnoid hemorrhage between 2013 and 2016 were included and reviewed retrospectively. RESULTS Two aneurysms located on the PICA, 2 on PCA, and 1 on the SCA. Mean treatment time with FD was 5.8 d (range, 0-11 d) from ictus. The technical success rate was 100%. On admission 2 patients were Hunt and Hess grade 1, 2 patients grade 3, and 1 patient grade 4. At discharge, 4 patients (80%) were independent (modified Ranking Scale (mRS) ≤2) and 1 patient had severe disability (mRS 4). None of the patients had aneurysmal rebleeding. All 5 aneurysms were completely occluded on angiographic follow-up (range, 3-22 mo). One patient had permanent intraprocedural in stent thrombosis and brain infarction. One patient had spontaneous nonaneurysmal intracerebral hemorrhage 1 mo after FD treatment. External ventricular drainage was inserted in 3 patients and ventriculoperitoneal shunt in 2 patients without hemorrhagic complications despite dual antiplatelet therapy. CONCLUSION FD could be considered as a treatment option for ruptured fusiform aneurysms located on PCA, PICA, or SCA when other treatment options are challenging.

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