Transient neurological deficits secondary to saccular vertebrobasilar aneurysms

1984 ◽  
Vol 60 (2) ◽  
pp. 410-413 ◽  
Author(s):  
Abe Steinberger ◽  
S. Ramaiah Ganti ◽  
James G. McMurtry ◽  
Sadek K. Hilal
Keyword(s):  
Posterior Circulation ◽  
Neurological Deficits ◽  
Transient Ischemic Attacks ◽  
Anterior Circulation ◽  
Content Type ◽  
Vertebrobasilar Artery ◽  
Posterior Circulation Aneurysm ◽  
Vertebrobasilar Aneurysms ◽  
Possible Cause ◽  
Fine Print

✓ Aneurysms have rarely been implicated as a possible cause of transient neurological deficits, and most reports of this phenomenon describe aneurysms in the anterior circulation. There is only one previous report of a saccular posterior circulation aneurysm associated with transient ischemic attacks. The authors document two cases of giant saccular vertebrobasilar artery aneurysms associated with transient neurological deficits.

Surgical treatment of unruptured aneurysms of the posterior circulation

1990 ◽  
Vol 73 (2) ◽  
pp. 165-173 ◽  
Author(s):  
Beverly J. Rice ◽  
Sydney J. Peerless ◽  
Charles G. Drake
Keyword(s):  
Surgical Treatment ◽  
Posterior Circulation ◽  
Alternative Methods ◽  
Surgical Morbidity ◽  
Systemic Complications ◽  
Content Type ◽  
Unruptured Aneurysms ◽  
Posterior Circulation Aneurysm ◽  
Vertebrobasilar Aneurysms ◽  
Fine Print

✓ With the ever-increasing number of intact aneurysms revealed by modern imaging, the options for their management are assuming great importance. While some knowledge has emerged as to their natural history and the results of surgical treatment of those in the anterior circulation, little information has been published concerning unruptured aneurysms arising from the posterior circulation. The authors report their experience since 1971 with 167 patients operated on for 179 unruptured vertebrobasilar aneurysms up to 25 mm in diameter. Overall, 160 aneurysms were treated by direct clip obliteration, while 19 were managed by alternative methods. Fifty-three patients (32%) had solitary aneurysms and the other 114 patients (68%) had multiple aneurysms or an associated arteriovenous malformation, which were commonly treated concurrently. Many of these coexisting vascular anomalies had ruptured in the recent or remote past, adding to the complexity of management and interpretation of specific surgical results related to the intact posterior circulation aneurysm. There were 78 documented postoperative complications including 23 systemic complications, seven postoperative hematomas, six brain injuries from retraction, five cases of aseptic meningitis, three instances of seizures, three wound infections, and three patients with hydrocephalus. Multiple complications occurred in 23 patients. Seventy-one of the patients with these untoward events recovered, without disability, with time or treatment. There were only six poor results and one death in the series, resulting in a 4.2% combined morbidity/mortality rate. However, since two of these poor outcomes and the single death were attributable to a coexisting aneurysm, the actual surgical morbidity related specifically to the posterior circulation aneurysm was only 2.4%. This experience suggests that non-giant, intact vertebrobasilar aneurysms can be obliterated surgically at a very low risk, and this treatment should eliminate the greater lifetime risk related to an unsecured aneurysm.

Stent-assisted angioplasty of intracranial vertebrobasilar atherosclerosis: an initial experience

2000 ◽  
Vol 92 (5) ◽  
pp. 771-778 ◽  
Author(s):  
Peter A. Rasmussen ◽  
John Perl ◽  
John D. Barr ◽  
Georges Z. Markarian ◽  
Irene Katzan ◽  
...  
Keyword(s):  
Alternative Therapy ◽  
Signs And Symptoms ◽  
Antiplatelet Agents ◽  
Posterior Circulation ◽  
Occlusive Disease ◽  
Stent Insertion ◽  
Initial Experience ◽  
Content Type ◽  
Vertebrobasilar Artery ◽  
Fine Print

Object. Patients with intracranial vertebrobasilar artery (VBA) atherosclerotic occlusive disease have few therapeutic options. Unfortunately, VBA transient ischemic attacks (TIAs) herald a lethal or devastating event within 5 years in 25 to 30% of patients. The authors report their initial experience with eight patients in whom medically refractory TIAs secondary to intracranial posterior circulation atherosclerotic occlusive lesions were treated with stent-assisted angioplasty.Methods. Eight patients (six men), ranging in age from 43 to 77 years, experienced signs and symptoms of VBA insufficiency despite combination therapy with warfarin and antiplatelet agents. Angiographic studies revealed severe distal vertebral (four patients), proximal basilar (one patient), or proximal and midbasilar stenoses (three patients). Aspirin and clopidogrel were administered for 3 days before primary angioplasty and stent placement, and this regimen was maintained by the patients on discharge. Patients underwent heparinization during the procedure and were given a bolus and 12-hour infusion of abciximab. A neurologist specializing in stroke evaluated all patients before and after the procedure.The VBAs in all patients were successfully revascularized with 7 to 28% residual stenosis. Six patients experienced no neurological complications. One patient died the evening of the procedure due to a massive subarachnoid hemorrhage. Two patients had groin hematomas, one developed congestive heart failure, and one had transient encephalopathy. All surviving patients are asymptomatic up to 8 months postoperatively.Conclusions. Although primary intracranial VBA angioplasty with stent insertion is technically feasible, complications associated with the procedure can be life threatening. As experience is gained with this procedure, it may be offered routinely as an alternative therapy to patients with medically refractory posterior circulation occlusive disease that may develop into catastrophic VBA insufficiency.

Treatment of moyamoya disease with STA-MCA anastomosis

1978 ◽  
Vol 49 (5) ◽  
pp. 679-688 ◽  
Author(s):  
Jun Karasawa ◽  
Haruhiko Kikuchi ◽  
Seiji Furuse ◽  
Junichiro Kawamura ◽  
Toshisuke Sakaki
Keyword(s):  
Cerebrovascular Disease ◽  
Effective Treatment ◽  
Moyamoya Disease ◽  
Neurological Deficits ◽  
Unknown Etiology ◽  
Transient Ischemic Attacks ◽  
Content Type ◽  
Fine Print ◽  
Temporal Middle

✓ Moyamoya disease is a chronic occlusive cerebrovascular disease of unknown etiology for which no effective treatment has been found. The authors report the results of 23 superficial temporal-middle cerebral artery (STA-MCA) anastomoses and seven encephalomyosynangioses, performed on 13 cases with moyamoya disease and on four additional atypical cases. There were 10 children and seven adults in this study. The follow-up period ranged from 1 year and 4 months to 4 years and 1 month postoperatively; nine patients had excellent results, five good, and one fair; two patients were unchanged. The anastomotic procedure was most effective for transient ischemic attacks, reversible ischemic neurological deficits, and even minor or moderate neurological symptoms. The STA-MCA anastomosis appears to be an effective treatment for moyamoya disease.

The poor prognosis of ruptured intracranial aneurysms of the posterior circulation

1995 ◽  
Vol 82 (5) ◽  
pp. 791-795 ◽  
Author(s):  
Wouter I. Schievink ◽  
Eelco F. M. Wijdicks ◽  
David G. Piepgras ◽  
Chu-Pin Chu ◽  
W. Michael O'Fallon ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Initial Period ◽  
Posterior Circulation ◽  
Medical Record Linkage ◽  
Anterior Circulation ◽  
Content Type ◽  
Clinical Series ◽  
Posterior Circulation Aneurysms ◽  
Fine Print

✓ The first 48 hours after aneurysmal subarachnoid hemorrhage are critical in determining final outcome. However, most patients who die during this initial period are not included in hospital-based studies. We investigated the occurrence of subarachnoid hemorrhage in a population-based study to evaluate possible predictors of poor outcome. All patients diagnosed with aneurysmal subarachnoid hemorrhage between 1955 and 1984 were selected for analysis of mortality in the first 30 days using the medical record—linkage system employed for epidemiological studies in Rochester, Minnesota. One hundred and thirty-six patients were identified. The mean age of these 99 women and 37 men was 55 years. Rates for survival to 48 hours were 32% for the 19 patients with posterior circulation aneurysms, 77% for the 87 patients with anterior circulation aneurysms, and 70% for the 30 patients with a presumed aneurysm (p < 0.0001). Rates for survival to 30 days were 11%, 57%, and 53%, respectively, in these three patient groups (p < 0.0001). Clinical grade on admission to the hospital, the main variable predictive of death within 48 hours, was significantly worse in patients with posterior circulation aneurysms than in others (p < 0.0001). The prognosis of ruptured posterior circulation aneurysms is poor. The high early mortality explains why posterior circulation aneurysms are uncommon in most clinical series of patients with subarachnoid hemorrhage. The management of incidentally discovered intact posterior circulation aneurysms may be influenced by these findings.

Disabling cerebral transient ischemic attacks

1991 ◽  
Vol 75 (6) ◽  
pp. 891-901 ◽  
Author(s):  
Patrick W. McCormick ◽  
Frank J. Tomecek ◽  
Jean McKinney ◽  
James I. Ausman
Keyword(s):  
Cerebral Artery ◽  
Artery Bypass ◽  
Superficial Temporal Artery ◽  
Neurological Dysfunction ◽  
Initial Slope ◽  
Vertebrobasilar Insufficiency ◽  
Transient Ischemic Attacks ◽  
Anterior Circulation ◽  
Content Type ◽  
Fine Print

✓ The surgical management of an emerging clinical entity, namely disabling transient cerebral ischemic attacks, is described. A series of 19 patients treated in a 2-year period (12 with anterior circulation dysfunction and seven with posterior insufficiency) met the following criteria: 1) stereotypical recurrent episodes of transient neurological dysfunction related to the anterior or posterior circulation distribution; 2) failure of maximum medical therapy to control the transient neurological dysfunction; 3) four-vessel cerebral angiography demonstrating an isolated vascular territory corresponding to patient symptoms; 4) inhalation xenon cerebral blood flow studies with at least three of eight probe-pairs showing significant asymmetries in the initial slope index, localizing an area of relative oligemia to the symptomatic hemisphere (anterior circulation only); and 5) severe restriction of lifestyle due to transient ischemic attacks (TIA's). Seventeen patients underwent surgical bypass therapy: deep sylvian superficial temporal artery (STA)-middle cerebral artery (MCA) bypass in nine; surface STA-MCA bypass in three: STA-superior cerebellar artery bypass in three; STA-posterior cerebral artery bypass in one; and aorta-carotid artery bypass in one. There was one perioperative death and four perioperative strokes (two ipsilateral and two contralateral to the operated side). The average follow-up period was 14 months. Of the 16 surviving surgically treated patients, 13 (81%) have had an excellent to good outcome with complete resolution of TIA's and minimal neurological deficits. Three patients had a poor outcome with either a significant persistent neurological deficit or continued TIA's. The two patients not treated surgically continue to have vertebrobasilar insufficiency episodes while receiving oral anticoagulation medication. The overall mortality rate (5.5%) and stroke morbidity rate (22.2%) of surgical therapy for disabling TIA's are high in this neurologically unstable group of patients, but are associated with an 81 % excellent to good response. Although the natural history of disabling TIA's is not known, these patients present with significant to total disability due to their symptoms. It is concluded that disabling TIA's respond to surgical revascularization and may represent an indication for cerebral revascularization surgery.

Study of the posterior circulation in moyamoya disease

1984 ◽  
Vol 61 (6) ◽  
pp. 1032-1037 ◽  
Author(s):  
Susumu Miyamoto ◽  
Haruhiko Kikuchi ◽  
Jun Karasawa ◽  
Izumi Nagata ◽  
Toshio Ikota ◽  
...  
Keyword(s):  
Computerized Tomography ◽  
Moyamoya Disease ◽  
Cerebral Angiography ◽  
Posterior Circulation ◽  
Vascular Network ◽  
Anterior Circulation ◽  
Content Type ◽  
Vertebrobasilar System ◽  
Fine Print

✓ Eighty-two cases of cerebrovascular moyamoya disease were studied by cerebral angiography and computerized tomography. Occlusive lesions were demonstrated not only in the anterior circulation but also in the posterior circulation, and they were associated with the development of an abnormal vascular network (moyamoya vessels). Although occlusive lesions do occur in the vertebrobasilar system, the vertebrobasilar system also acts as a source of collateral channels to the anterior circulation in this disease.

Ruptured giant intracranial aneurysms. Part II. A retrospective analysis of timing and outcome of surgical treatment

1998 ◽  
Vol 88 (3) ◽  
pp. 430-435 ◽  
Author(s):  
David G. Piepgras ◽  
Vini G. Khurana ◽  
Jack P. Whisnant
Keyword(s):  
Surgical Treatment ◽  
Mortality Rate ◽  
Mayo Clinic ◽  
Intracranial Aneurysms ◽  
Posterior Circulation ◽  
Anterior Circulation ◽  
Content Type ◽  
Medical Centers ◽  
Giant Intracranial Aneurysms ◽  
Fine Print

Object. This retrospective study was made to determine the relationship between surgical timing and outcome in all patients with ruptured giant intracranial aneurysms undergoing surgical treatment at the Mayo Clinic between 1973 and 1996. Methods. The authors studied 109 patients, 102 of whom were referred from other medical centers. The ruptured giant aneurysms were 25 to 60 mm in diameter. One hundred five of the patients survived the rupturing of the aneurysm to undergo operation, with direct surgery possible in 84% of cases. Excluding delayed referrals, the average time to surgery after admission to the Mayo Clinic was approximately 4 to 5 days. Patients admitted earlier tended to be in poorer condition, often undergoing earlier operation. On average, surgical treatment was administered later for patients with ruptured aneurysms of the posterior circulation than for those with aneurysms in the anterior circulation. Temporary occlusion of the parent vessel was necessary in 67% of direct procedures, with an average occlusion time of 15 minutes. Among surgically treated patients, a favorable outcome was achieved in 72% harboring ruptured anterior circulation aneurysms and in 78% with ruptured posterior circulation lesions. Conclusions. The overall management mortality rate was 21.1%, and the mortality rate for surgical management was 8.6%. The authors believe that because of the technical difficulties and risk of rebleeding associated with ruptured giant intracranial aneurysms, timely referral to and well-planned treatment at medical centers specializing in management of these lesions are essential to effect a more favorable outcome.

Vertebrobasilar insufficiency

1987 ◽  
Vol 66 (5) ◽  
pp. 662-674 ◽  
Author(s):  
Leo N. Hopkins ◽  
Neil A. Martin ◽  
Mark N. Hadley ◽  
Robert F. Spetzler ◽  
James Budny ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Vascular Disease ◽  
Medical Therapy ◽  
Posterior Circulation ◽  
Vertebrobasilar Insufficiency ◽  
Transient Ischemic Attacks ◽  
Content Type ◽  
Maximal Medical Therapy ◽  
Revascularization Procedures ◽  
Fine Print

✓ Posterior circulation transient ischemic attacks have an associated risk of subsequent infarction of approximately 5% per year. Intracranial vertebrobasilar thrombo-occlusive lesions appear particularly likely to result in repetitive ischemic symptoms and in infarction due to hemodynamic insufficiency. The authors present their experience with 45 patients with symptomatic intracranial vertebrobasilar vascular disease despite maximal medical therapy. The specific operative approaches for intracranial vertebral artery endarterectomy and extracranial to intracranial posterior circulation revascularization procedures are outlined.

Retrolabyrinthine transsigmoid approach to basilar trunk and vertebrobasilar artery junction aneurysms

1988 ◽  
Vol 69 (3) ◽  
pp. 461-466 ◽  
Author(s):  
Steven L. Giannotta ◽  
Dennis R. Maceri
Keyword(s):  
Brain Stem ◽  
Shallow Depth ◽  
Content Type ◽  
Vertebrobasilar Artery ◽  
Vertebrobasilar Aneurysms ◽  
Fine Print

✓ A retrolabyrinthine transsigmoid approach was employed successfully in three patients with vertebrobasilar aneurysms. The major benefits of this technique include a relatively shallow depth of exposure, lack of brain stem retraction, and simplicity as compared to traditional and some recently proposed methods. All three patients have returned to their previous activities.

Treatment of cerebral vasospasm with intra-arterial papaverine

1992 ◽  
Vol 77 (6) ◽  
pp. 848-852 ◽  
Author(s):  
Neal F. Kassell ◽  
Gregory Helm ◽  
Nathan Simmons ◽  
C. Douglas Phillips ◽  
Wayne S. Cail
Keyword(s):  
Cerebral Vasospasm ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Cerebral Arteries ◽  
Posterior Circulation ◽  
Neurological Deficits ◽  
Arterial Infusion ◽  
Content Type ◽  
Repeat Angiography ◽  
Safe Dose ◽  
Fine Print

✓ Cerebral vasospasm continues to be the leading treatable cause of morbidity and mortality following aneurysmal subarachnoid hemorrhage. In this preliminary anecdotal series of 12 patients who were candidates for balloon angioplasty, vasospasm was treated instead with intra-arterial papaverine. Eight patients had marked angiographic reversal of the arterial narrowing following papaverine infusion, four of whom showed dramatic reversal of profound neurological deficits. Two patients deteriorated clinically 5 days after the initially successful papaverine infusions. In both, repeat angiography demonstrated severe recurrent vasospasm, which was partially reversed with a second intra-arterial papaverine treatment. Two patients developed focal neurological deficits during papaverine infusion, which resolved spontaneously over several hours after cessation of the intra-arterial infusion. Arterial narrowing in the posterior circulation and middle cerebral artery distribution appeared to be more responsive to papaverine infusion than was spasm in the anterior cerebral arteries. The infusion of 300 mg of papaverine over 1 hour seemed to be an adequate and safe dose to effect these angiographic and clinical improvements.

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