Successful surgical treatment of giant aneurysm of the basilar artery

1978 ◽  
Vol 49 (1) ◽  
pp. 124-128 ◽  
Author(s):  
Chhabi Bhushan ◽  
Fred J. Hodges ◽  
John Posey
Keyword(s):  
Surgical Treatment ◽  
Vertebral Artery ◽  
Basilar Artery ◽  
Giant Aneurysm ◽  
Artery Ligation ◽  
Content Type ◽  
Fine Print

✓ The authors describe a case of giant aneurysm of the basilar artery successfully treated by bilateral vertebral artery ligation at the sulcus arteriosus of the atlas.

Ligation of the vertebral (unilateral or bilateral) or basilar artery in the treatment of large intracranial aneurysms

1975 ◽  
Vol 43 (3) ◽  
pp. 255-274 ◽  
Author(s):  
Charles G. Drake
Keyword(s):  
Vertebral Artery ◽  
Basilar Artery ◽  
Artery Occlusion ◽  
Collateral Flow ◽  
Patient Death ◽  
Artery Ligation ◽  
Content Type ◽  
Vertebral Artery Occlusion ◽  
Complete Thrombosis ◽  
Fine Print

✓ The author reports the use of vertebral artery ligation, unilateral and bilateral, for the treatment of large vertebral-basilar aneurysms in 14 patients with one delayed death. Extracranial ligation was carried out unilaterally with a Selverstone clamp in three patients. In two, where the aneurysm filled only from one vertebral artery, there was extensive thrombosis within the sac and dramatic clinical improvement after decompression. Extracranial ligation was done bilaterally in three patients, temporarily in two. A 14-year-old boy is well after 5 years but the bilateral vertebrobasilar aneurysm did not undergo extensive thrombosis until both vertebral arteries were occluded at their intracranial entrance above collateral flow. In two others, the clamp had to be reopened on the second artery. In one patient, death from delayed thrombosis of a huge aneurysm and pontine infarction might have been prevented with anticoagulants. In the other, the aneurysm ruptured again fatally 18 months later. Unilateral intracranial occlusion of a vertebral artery was done in eight cases, with no morbidity and complete or nearly complete thrombosis in all but one aneurysm. Seven patients had excellent or good results while one showed little recovery from an existing medullary syndrome. Occlusion of the basilar artery was done in seven cases. In five it was used deliberately as the only treatment, but in two it was forced when an aneurysm burst during dissection. Only two of the patients in the first group and one of the second group have made complete recoveries. The results of vertebral artery occlusion are encouraging and the technique deserves further consideration. Extensive collateral circulation enhances the safety of cervical vertebral artery occlusion but can be of a degree to make the occlusion ineffective. For intracranial occlusion knowledge of the size and distribution of each vertebral artery is essential. Occlusion of the basilar artery is dangerous, although it seems to be effective in producing extensive thrombosis in the aneurysm. It should probably be done under anesthesia only when the artery fills spontaneously from the carotid circulation. Otherwise, even when reasonable posterior communicating arteries are demonstrated, it is best to test occlusion under local anesthesia.

Transluminal angioplasty for atherosclerotic disease of the vertebral and basilar arteries

1993 ◽  
Vol 78 (2) ◽  
pp. 192-198 ◽  
Author(s):  
Randall T. Higashida ◽  
Fong Y. Tsai ◽  
Van V. Halbach ◽  
Christopher F. Dowd ◽  
Tony Smith ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Basilar Artery ◽  
Cerebral Circulation ◽  
Transluminal Angioplasty ◽  
Content Type ◽  
Atherosclerotic Stenosis ◽  
Basilar Arteries ◽  
Posterior Cerebral Circulation ◽  
Fine Print

✓ Transluminal angioplasty for hemodynamically significant stenosis (> 70%) involving the posterior cerebral circulation is now being performed by the authors in selected cases. A total of 42 lesions affecting the vertebral or basilar artery have been successfully treated by percutaneous transluminal angioplasty techniques in 41 patients. The lesions involved the proximal vertebral artery in 34 cases, the distal vertebral artery in five, and the basilar artery in three. Patients were examined clinically at 1 to 3 and 6 to 12 months after angioplasty. Three (7.1%) permanent complications occurred, consisting of stroke in two cases and vessel rupture in one. There were four (9.5%) transient complications (< 30 minutes): two cases of vessel spasm and two of cerebral ischemia. Clinical follow-up examination demonstrated improvement of symptoms in 39 cases (92.9%). Radiographic follow-up studies demonstrated three cases (7.1 %) of restenosis involving the proximal vertebral artery; two were treated by repeat angioplasty without complication, and the third is being followed clinically while the patient remains asymptomatic. In patients with significant atherosclerotic stenosis involving the vertebral or basilar artery territories, transluminal angioplasty may be of significant benefit in alleviating symptoms and improving blood flow to the posterior cerebral circulation.

Microvascular anatomy of foramen caecum medullae oblongatae

1991 ◽  
Vol 75 (2) ◽  
pp. 299-304 ◽  
Author(s):  
Asim Mahmood ◽  
Manuel Dujovny ◽  
Maximo Torche ◽  
Ljubisa Dragovic ◽  
James I. Ausman
Keyword(s):  
Vertebral Artery ◽  
Basilar Artery ◽  
Foramen Magnum ◽  
Left Vertebral Artery ◽  
Anterior Inferior Cerebellar Artery ◽  
Outer Diameter ◽  
Vertebrobasilar Insufficiency ◽  
High Concentration ◽  
Content Type ◽  
Fine Print

✓ The foramen caecum (FC) is a triangular-shaped fossa situated in the midline on the base of the brain stem, at the pontomedullary junction. Although this area is known to have a very high concentration of brainstem perforating vessels, its microvascular anatomy has not been studied in detail. The purpose of this study was to detail the microvasculature of this territory. Twenty unfixed brains were injected with silicone rubber solution and dissected under a microscope equipped with a camera. The origin, course, outer diameter, and branching pattern of the perforators were examined. The total number of perforators found in the 20 brains was 287, with an average (± standard deviation) of 14.35 ± 1.24 perforators per brain (range seven to 28). Their origin was as follows: right vertebral artery in 52 perforators (18.11%); left vertebral artery in 35 (12.19%); basilar artery below the anterior inferior cerebellar artery (AICA) in 139 (48.43%); basilar artery above the AICA in 46 (16.02%); AICA in 10 (3.48%); and anterior spinal artery in five (1.74%). Most of the perforators arose as sub-branches of larger trunks; their average outer diameter was 0.16 ± 0.006 mm while that of trunks was 0.35 ± 0.02 mm. These anatomical data are important for those wishing 1) to study the pathophysiology of vascular insults to this area caused by atheromas, thrombi, and emboli; 2) to plan vertebrobasilar aneurysm surgery; 3) to plan surgery for vertebrobasilar insufficiency; and 4) to study foramen magnum neoplasms.

Surgical reconstruction of the proximal vertebral artery

1984 ◽  
Vol 61 (5) ◽  
pp. 874-881 ◽  
Author(s):  
Fernando G. Diaz ◽  
James I. Ausman ◽  
Raul A. de los Reyes ◽  
Jeffrey Pearce ◽  
Carl Shrontz ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Vertebral Artery ◽  
Subclavian Artery ◽  
Antiplatelet Agents ◽  
Artery Stenosis ◽  
Surgical Reconstruction ◽  
Vertebrobasilar Insufficiency ◽  
Artery Ligation ◽  
Content Type ◽  
Fine Print

✓ The authors have reviewed their experience in the management of 55 patients admitted to Henry Ford Hospital with symptoms of vertebrobasilar insufficiency and associated proximal vertebral artery stenosis or occlusion. In 48 patients, the symptoms occurred as multiple repeated events, five of which resulted in permanent deficits. The remaining seven patients had single events, four of which caused permanent deficit. These patients had been treated unsuccessfully with antiplatelet agents (37 cases) and with anticoagulant drugs (15 cases) before surgery. Most patients had multiple angiographic abnormalities, including bilateral vertebral stenosis in 19 cases, unilateral vertebral stenosis and contralateral occlusion in 18, unilateral vertebral hypoplasia and contralateral stenosis in 10, subclavian artery stenosis with steal in seven, and bilateral vertebral artery occlusion in one case. Posterior communicating arteries could not be demonstrated angiographically in 18 patients. Thirty-four patients had associated stenotic or occlusive lesions of the internal carotid artery. Forty-eight underwent a vertebral-to-carotid artery transposition. Of these, 18 had an associated carotid endarterectomy and seven had a vertebral artery endarterectomy immediately before the transposition. Two patients had saphenous vein grafts, one from the subclavian and one from the common carotid artery to the vertebral artery. Other surgical procedures included vertebral artery ligation in one case, transposition of the vertebral artery to the thyrocervical trunk in two cases and to the subclavian artery in one case, and endarterectomy of the origin of the vertebral artery in one case. All but two patients had complete resolution of their symptoms: one had persistent dizziness and the other had syncopal episodes. Complications included transient Horner's syndrome (30 cases) which became permanent in four cases, vocal cord paralysis (three cases), elevated hemidiaphragm without respiratory difficulty (two cases), and superficial wound infection (one case). There were no deaths. Although the presentation of patients with vertebrobasilar insufficiency is generally characteristic, we believe that a specific diagnosis can be established only by angiographic means. Anticoagulants have been used to alleviate symptoms in some cases but are ineffective in solving the primary hemodynamic problem. Surgical reconstruction of the affected area deserves further evaluation in the management of these patients.

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.

Surgical treatment for aneurysms of the upper basilar artery

1976 ◽  
Vol 44 (5) ◽  
pp. 537-543 ◽  
Author(s):  
Charles B. Wilson ◽  
Hoi Sang U
Keyword(s):  
Surgical Treatment ◽  
Basilar Artery ◽  
Angiographic Study ◽  
Content Type ◽  
Regional Anatomy ◽  
Successful Attack ◽  
Microsurgical Techniques ◽  
Arterial Aneurysms ◽  
Fine Print

✓ Fifteen patients with basilar bifurcation arterial aneurysms were treated surgically and their results presented. The importance of preoperative angiographic study to delineate regional anatomy is emphasized. Developments in neuroanesthesia and microsurgical techniques have made possible the successful attack of these formidable lesions.

Consequence of ligation of the vertebral artery

1972 ◽  
Vol 36 (4) ◽  
pp. 447-450 ◽  
Author(s):  
Akira Shintani ◽  
Nicholas T. Zervas
Keyword(s):  
Carotid Artery ◽  
Vertebral Artery ◽  
Review Of The Literature ◽  
Artery Ligation ◽  
Content Type ◽  
Fine Print

✓ A case requiring ligation of the vertebral artery to treat an aneurysm of that vessel is reported. Review of the literature reveals that vertebral artery ligation is far less hazardous than ligation of the carotid artery as long as the opposite vertebral artery is functioning.

Thrombosed growing giant aneurysms of the vertebral artery: growth mechanism and management

1995 ◽  
Vol 82 (5) ◽  
pp. 796-801 ◽  
Author(s):  
Shinji Nagahiro ◽  
Akira Takada ◽  
Satoshi Goto ◽  
Yutaka Kai ◽  
Yukitaka Ushio
Keyword(s):  
Vertebral Artery ◽  
Giant Aneurysm ◽  
Pathological Examination ◽  
Intimal Thickening ◽  
Resonance Imaging ◽  
Endothelial Lining ◽  
Content Type ◽  
Giant Aneurysms ◽  
Vascular Channels ◽  
Fine Print

✓ Results in three patients with thrombosed giant aneurysms of the vertebral artery are reported. Each of the aneurysms presented as a mass lesion. On postcontrast computerized tomography and magnetic resonance imaging, each aneurysm demonstrated a patent lumen and intrathrombotic vascular channels. Two patients died and were autopsied, and the other patient was successfully treated. Pathological examination revealed that the aneurysms had staged clots, an open lumen, intrathrombotic channels with endothelial lining, and aneurysmal walls with intimal thickening. The authors suggest that the development of the intrathrombotic capillary channels may be an important factor in the growth of thrombosed giant aneurysm of the vertebral artery. Trapping of the aneurysm followed by aneurysmectomy appears to be the best treatment for this type of aneurysm.

Dissecting aneurysm of the vertebral artery

1984 ◽  
Vol 61 (6) ◽  
pp. 1038-1046 ◽  
Author(s):  
Takeyoshi Shimoji ◽  
Kuniaki Bando ◽  
Keiji Nakajima ◽  
Kazufumi Ito
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Surgical Treatment ◽  
Vertebral Artery ◽  
Arterial Wall ◽  
Dissecting Aneurysm ◽  
Content Type ◽  
Venous Phase ◽  
Dissecting Aneurysms ◽  
Angiographic Findings ◽  
Fine Print

✓ Seven cases of dissecting aneurysm of the vertebral artery, all appearing to be of fusiform type, are reported. Clinically, all seven cases initially showed symptoms of subarachnoid hemorrhage; however, three of these were associated with Wallenberg's syndrome. The characteristic angiographic findings in these cases were: 1) retention of contrast medium in the aneurysm; 2) the presence of a true (vertebral artery) and false (arterial wall) lumen in the late arterial and/or venous phase; and 3) irregular arterial narrowing proximal and/or distal to the aneurysm. Autopsy findings of one patient supported the angiographic findings. Recently, reports of fusiform aneurysms associated with subarachnoid hemorrhage have been increasing. As dissecting aneurysms are found in the fusiform group, it is very important to analyze serial angiograms in order to choose a method of surgical treatment.

Evaluation of prostaglandin biosynthetic activity in canine basilar artery following subarachnoid injection of blood

1981 ◽  
Vol 55 (5) ◽  
pp. 771-778 ◽  
Author(s):  
Tomio Sasaki ◽  
Sei-itsu Murota ◽  
Susumu Wakai ◽  
Takao Asano ◽  
Keiji Sano
Keyword(s):  
Arachidonic Acid ◽  
Platelet Aggregation ◽  
Cerebral Artery ◽  
Basilar Artery ◽  
Biosynthetic Activity ◽  
Content Type ◽  
Blood Injection ◽  
Canine Basilar Artery ◽  
Subarachnoid Blood ◽  
Fine Print

✓ Transformation of arachidonic acid into prostaglandins was investigated in the basilar artery by incubating sections of artery with carbon-14-labeled arachidonic acid. Thin-layer radiochromatography revealed that, in normal canine basilar arteries, 14C-arachidonic acid was transformed mainly to 6-ketoprostaglandin (PG)F1α, a spontaneous metabolite of prostacyclin (PGI2). Among other prostaglandins, only a small amount of PGF2α was detected, whereas PGD2, PGE2, and thromboxane B2 were not. Arteries removed on Days 3 and 8 after subarachnoid blood injection showed a prostaglandin synthesis profile similar to that in the normal cerebral artery. In borate-buffered saline (0.1M borate buffer, pH 9.0/0.15M NaCl = 1:9, vol/vol), canine basilar artery produced a PGI2-like substance that inhibited adenosine diphosphate (ADP)-induced platelet aggregation. Its anti-aggregatory activity was completely abolished by acidification. Aspirin likewise inhibited production of the anti-aggregatory substance. From these results, it was concluded that the anti-aggregatory activity was due solely to the production of PGI2 by the arterial specimen. Based on the above results, PGI2 biosynthetic activity in the cerebral artery exposed to subarachnoid blood injection was bioassayed by measuring the inhibitory activity of the incubation product upon ADP-induced platelet aggregation following incubation of the arteries in borate-buffered saline for 5 to 30 minutes at 20°C, using synthetic PGI2-Na as a standard. The synthetic activity of PGI2 in the artery exposed to subarachnoid blood injection had diminished remarkably by Days 3 and 8. This diminution of PGI2 synthesis in the cerebral artery may be involved in the pathogenesis of cerebral vasospasm.

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