Intraventricular hemorrhage due to aneurysms of the distal posterior inferior cerebellar artery

1985 ◽  
Vol 62 (5) ◽  
pp. 772-775 ◽  
Author(s):  
Hwa-Shain Yeh ◽  
Thomas A. Tomsick ◽  
John M. Tew
Keyword(s):  
Fourth Ventricle ◽  
Intraventricular Hemorrhage ◽  
Surgical Repair ◽  
Posterior Inferior Cerebellar Artery ◽  
Content Type ◽  
Lateral Recess ◽  
Cerebellar Artery ◽  
Subarachnoid Blood ◽  
Basal Cisterns ◽  
Fine Print

✓ Three cases of ruptured aneurysm of the distal posterior inferior cerebellar artery (PICA) presenting with isolated intraventricular hematoma are reported. All of the aneurysms originated from the lateral medullary segment of the PICA and ruptured into the lateral recess of the fourth ventricle. The diagnosis of distal PICA aneurysm should be considered if isolated intraventricular hematoma is found without obvious parenchymal hemorrhage or subarachnoid blood in the basal cisterns. Complete vertebral arteriography is a requisite for the recognition of this condition. The outcome in patients with these aneurysms should be good if surgical repair is performed before rebleeding occurs.

Transcerebellomedullary fissure approach with special reference to the methods of dissecting the fissure

2001 ◽  
Vol 94 (2) ◽  
pp. 257-264 ◽  
Author(s):  
Toshio Matsushima ◽  
Tooru Inoue ◽  
Takanori Inamura ◽  
Yoshihiro Natori ◽  
Kiyonobu Ikezaki ◽  
...  
Keyword(s):  
Fourth Ventricle ◽  
Posterior Margin ◽  
Lateral Wall ◽  
Microsurgical Anatomy ◽  
Optimal Method ◽  
Content Type ◽  
Lateral Recess ◽  
Tela Choroidea ◽  
Opening Method ◽  
Fine Print

Object. The purpose of the present study was to refine the transcerebellomedullary fissure approach to the fourth ventricle and to clarify the optimal method of dissecting the fissure to obtain an appropriate operative view without splitting the inferior vermis. Methods. The authors studied the microsurgical anatomy by using formalin-fixed specimens to determine the most appropriate method of dissecting the cerebellomedullary fissure. While dissecting the spaces around the tonsils and making incisions in the ventricle roof, the procedures used to expose each ventricle wall were studied. Based on their findings, the authors adopted the best approach for use in 19 cases of fourth ventricle tumor. The fissure was further separated into two slit spaces on each side: namely the uvulotonsillar and medullotonsillar spaces. The floor of the fissure was composed of the tela choroidea, inferior medullary velum, and lateral recess, which form the ventricle roof. In this approach, the authors first dissected the spaces around the tonsils and then incised the taenia with or without the posterior margin of the lateral recess. These precise dissections allowed for easy retraction of the tonsil(s) and uvula and provided a sufficient view of the ventricle wall such that the deep aqueductal region and the lateral region around the lateral recess could be seen without splitting the vermis. The dissecting method could be divided into three different types, including extensive (aqueduct), lateral wall, and lateral recess, depending on the location of the ventricle wall and the extent of surgical exposure required. Conclusions. When the fissure is appropriately and completely opened, the approach provides a sufficient operative view without splitting the vermis. Two key principles of this opening method are sufficient dissection of the spaces around the tonsil(s) and an incision of the appropriate portions of the ventricle roof. The taenia(e) with or without the posterior margin of the lateral recess(es) should be incised.

Balloon occlusion of a spontaneous fistula of the posterior inferior cerebellar artery

1983 ◽  
Vol 58 (2) ◽  
pp. 287-290 ◽  
Author(s):  
Fernando Viñuela ◽  
Allan J. Fox ◽  
Shinichi Kan ◽  
Charles G. Drake
Keyword(s):  
Arteriovenous Fistula ◽  
Posterior Inferior Cerebellar Artery ◽  
Mass Effect ◽  
Balloon Occlusion ◽  
Cerebellar Syndrome ◽  
Detachable Balloon ◽  
Content Type ◽  
Cerebellar Artery ◽  
Fistula Site ◽  
Fine Print

✓ A case is reported of a large spontaneous right posterior inferior cerebellar artery fistula in which the patient presented with a right cerebellopontine (CP) angle and right cerebellar syndrome. The patient was successfully treated by balloon occlusion at the fistula site. The location of the arteriovenous fistula, the mass effect of its enlarged draining veins on the cerebellum and CP angle structures, and the simple therapeutic endovascular occlusion with a detachable balloon make this case unique.

Treatment of aneurysms by excision or trapping with arterial reimplantation or interpositional grafting

1996 ◽  
Vol 85 (1) ◽  
pp. 178-185 ◽  
Author(s):  
Sang Youl Lee ◽  
Laligam N. Sekhar
Keyword(s):  
Superficial Temporal Artery ◽  
Posterior Inferior Cerebellar Artery ◽  
Giant Aneurysm ◽  
Temporal Artery ◽  
Left Vertebral Artery ◽  
Anterior Inferior Cerebellar Artery ◽  
Content Type ◽  
First Case ◽  
Cerebellar Artery ◽  
Fine Print

✓ The authors report three cases of ruptured, large or giant aneurysms that were treated by excision or trapping, followed by revascularization of distal vessels by means of arterial reimplantation or superficial temporal artery interpositional grafting. In the first case, a large serpentine aneurysm arising from the anterior temporal branch of the right middle cerebral artery (MCA) was excised and the distal segment of the anterior temporal artery was reimplanted into one of the branches of the MCA. In the second case, a giant aneurysm, fusiform in shape, arose from the rolandic branch of the MCA. This aneurysm was totally excised and the M3 branch in which it had been contained was reconstructed with an arterial interpositional graft. In the third case the patient, who presented with a subarachnoid hemorrhage, had a dissecting aneurysm that involved the distal portion of the left vertebral artery. In this case the posterior inferior cerebellar artery (PICA) arose from the wall of the aneurysm and coursed onward to supply the brainstem. This aneurysm was managed by trapping and the PICA was reimplanted into the ipsilateral large anterior inferior cerebellar artery. None of the patients suffered a postoperative stroke and all recovered to a good or excellent postoperative condition. These techniques allowed complete isolation of the aneurysm from the normal blood circulation and preserved the blood flow through the distal vessel that came out of the aneurysm. These techniques should be considered as alternatives when traditional means of cerebral revascularization are not feasible.

Ruptured aneurysm on a double origin of the posterior inferior cerebellar artery: a pathological entity in an anatomical variation

2002 ◽  
Vol 96 (1) ◽  
pp. 127-131 ◽  
Author(s):  
Anne Pasco ◽  
Francine Thouveny ◽  
Xavier Papon ◽  
Jean-Yves Tanguy ◽  
Philippe Mercier ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Anatomical Variation ◽  
Posterior Inferior Cerebellar Artery ◽  
Anatomical Variations ◽  
Content Type ◽  
Small Branch ◽  
Cerebellar Artery ◽  
Fourth Segment ◽  
Double Origin ◽  
Fine Print

✓ The posterior inferior cerebellar artery (PICA) is known to be very variable, and some of its anatomical variations can explain ischemic complications that occur during endovascular treatment of aneurysms. The authors report two cases of anatomical variation of the PICA that they have called its double origin, one of which gave rise to an aneurysm. The first patient was a 36-year-old man who presented with a subarachnoid hemorrhage related to the rupture of a PICA aneurysm. The aneurysm was treated by the endovascular route. Selective and superselective studies showed that the PICA origin was low on the fourth segment of the vertebral artery (VA). The aneurysm was located on an anastomosis between the PICA and a small upper arterial branch originating from the VA. Embolization was performed through the small branch with no problem, but a lateral medullary infarct followed, probably due to occlusion of the perforating vessels. The same anatomical variation was incidentally discovered in the second patient. To the authors' knowledge, neither this anatomical variation of the PICA nor the aneurysm's topography have been previously described angiographically. This highlights the role of angiography in pretreatment evaluation of aneurysms especially when perforating vessels or small accessory branches that are poorly visualized on angiographic studies are concerned, as in the territory of the PICA. Anatomy is sometimes unpredictable, and the surgeon must be very careful when confronted with these variations because they are potentially dangerous for endovascular treatment.

Cerebral revascularization performed using posterior inferior cerebellar artery—posterior inferior cerebellar artery bypass

2002 ◽  
Vol 97 (1) ◽  
pp. 219-223 ◽  
Author(s):  
G. Michael Lemole ◽  
Jeffrey Henn ◽  
Sam Javedan ◽  
Vivek Deshmukh ◽  
Robert F. Spetzler
Keyword(s):  
Artery Bypass ◽  
Posterior Inferior Cerebellar Artery ◽  
Surgical Techniques ◽  
Cerebral Revascularization ◽  
Pica Pica ◽  
Content Type ◽  
Cerebellar Artery ◽  
In Situ Bypass ◽  
Fine Print

✓ Cerebral revascularization is often required for the surgical treatment of complex intracranial aneurysms. In certain anatomical locations, vascular anatomy and redundancy make in situ bypass possible. The authors present four patients who underwent revascularization performed using the rarely reported posterior inferior cerebellar artery (PICA)—PICA in situ bypass after their aneurysms had been trapped. At Barrow Neurological Institute, between 1991 and the present, four male patients underwent PICA—PICA bypasses to treat aneurysms involving the vertebral artery, the PICA, or both. The mean age of these patients was 34 years (range 5–49 years). Follow-up studies revealed patent bypasses and no evidence of infarction. Patient outcomes were excellent or good. Multiple surgical techniques have been described for revascularization of at-risk cerebral territories. Often, the blood supply must be derived from extracranial sources through a mobilized pedicle or interposited graft. Certain anatomical locations such as the vertebrobasilar junction, the anterior circle of Willis, and the middle cerebral artery bifurcation are amenable to in situ bypass because there is vessel redundancy or proximity to the contralateral analogous vessel. The advantages of an in situ bypass include one suture line, a short bypass distance, and a close match with the caliber of the recipient graft. Although technically challenging, this technique can be successful and should be considered for appropriate candidates.

Surgery on a saccular vertebral artery—posterior inferior cerebellar artery aneurysm via the transcondylar fossa (supracondylar transjugular tubercle) approach or the transcondylar approach: surgical results and indications for using two different lateral skull base approaches

2001 ◽  
Vol 95 (2) ◽  
pp. 268-274 ◽  
Author(s):  
Toshio Matsushima ◽  
Koichiro Matsukado ◽  
Yoshihiro Natori ◽  
Takanori Inamura ◽  
Tsutomu Hitotsumatsu ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Skull Base ◽  
Posterior Inferior Cerebellar Artery ◽  
Surgical Results ◽  
Content Type ◽  
Hypoglossal Canal ◽  
Transcondylar Approach ◽  
Lateral Skull Base ◽  
Cerebellar Artery ◽  
Fine Print

Object. The authors report on the surgical results they achieved in caring for patients with vertebral artery—posterior inferior cerebellar artery (VA—PICA) saccular aneurysms that were treated via either the transcondylar fossa (supracondylar transjugular tubercle) approach or the transcondylar approach. In this report they clarify the characteristics of and differences between these two lateral skull base approaches. They also present the techniques they used in performing the transcondylar fossa approach, especially the maneuver used to remove the jugular tubercle extradurally without injuring the atlantooccipital joint. Methods. Eight patients underwent surgery for VA—PICA saccular aneurysms (six ruptured and two unruptured ones) during which one of the two approaches was performed. Clinical data including neurological and radiological findings and reports of the operative procedures were analyzed. The Glasgow Outcome Scale was used to estimate the activities of daily living experienced by the patients. In all cases the aneurysm was successfully clipped and no permanent neurological deficits remained, except for one case of severe vasospasm. In seven of the eight patients, the transcondylar fossa approach provided a sufficient operative field for clipping the aneurysm without difficulty. In the remaining patient, in whom the aneurysm was located at the midline on the clivus at the level of the hypoglossal canal, the aneurysm could not be found by using the transcondylar fossa approach; thus, the route was changed to the transcondylar approach, and clipping was performed below the hypoglossal nerve rootlets. Conclusions. Both approaches offer excellent visualization and a wide working field, with ready access to the lesion. This remarkably reduces the risk of development of postoperative deficits. These approaches should be used properly: the transcondylar fossa approach is indicated for aneurysms located above the hypoglossal canal and the transcondylar approach is indicated for those located below it.

Rupture of posterior inferior cerebellar artery aneurysm into the subarachnoid space during angiography

1975 ◽  
Vol 42 (4) ◽  
pp. 469-472 ◽  
Author(s):  
Amil James Gerlock
Keyword(s):  
Subarachnoid Space ◽  
Posterior Inferior Cerebellar Artery ◽  
Artery Aneurysm ◽  
Content Type ◽  
Aneurysmal Rupture ◽  
Cerebellar Artery ◽  
Fine Print

✓ The author reports a case of angiographically-demonstrated aneurysmal rupture, and reviews related reports.

Angiographic differentiation between Dandy-Walker cyst and arachnoid cyst of the posterior fossa in newborn infants and children

1973 ◽  
Vol 38 (3) ◽  
pp. 298-308 ◽  
Author(s):  
Emanuele La Torre ◽  
Aldo Fortuna ◽  
Emanuele Occhipinti
Keyword(s):  
Posterior Fossa ◽  
Arachnoid Cyst ◽  
Posterior Inferior Cerebellar Artery ◽  
Newborn Infants ◽  
Infants And Children ◽  
Arachnoid Cysts ◽  
Content Type ◽  
Dural Sinuses ◽  
Cerebellar Artery ◽  
Fine Print

✓ Elevation of the tentorium and its dural sinuses, originally considered a diagnostic sign of Dandy-Walker cyst, may also occur in arachnoid cysts of the posterior fossa. Differentiation between these two lesions may be achieved angiographically by the evaluation of the posterior inferior cerebellar artery and its vermian branch, and of the inferior vermian vein. All these vessels are displaced forward and upward by an arachnoid cyst, while in the Dandy-Walker cyst the posterior inferior cerebellar artery is miniature and the vermian branch and the inferior vermian vein are absent.

Foramen magnum syndrome caused by a giant aneurysm of the posterior inferior cerebral artery

1978 ◽  
Vol 48 (4) ◽  
pp. 639-641 ◽  
Author(s):  
Donald Judice ◽  
Edward S. Connolly
Keyword(s):  
Cerebral Artery ◽  
Posterior Inferior Cerebellar Artery ◽  
Giant Aneurysm ◽  
Foramen Magnum ◽  
Neurological Deficits ◽  
Content Type ◽  
Cerebellar Artery ◽  
Fine Print

✓ The authors present a case of giant aneurysm of the posterior inferior cerebellar artery. It was successfully excised with reversal of neurological deficits.

Aneurysms of the posterior inferior cerebellar artery

1983 ◽  
Vol 58 (3) ◽  
pp. 381-387 ◽  
Author(s):  
Rroger J. Hudgins ◽  
Arthur L. Day ◽  
Ronald G. Quisling ◽  
Albert L. Rhoton ◽  
George W. Sypert ◽  
...  
Keyword(s):  
Posterior Inferior Cerebellar Artery ◽  
Vascular Anomaly ◽  
Foramen Magnum ◽  
Parent Vessel ◽  
Content Type ◽  
Aneurysm Neck ◽  
Suboccipital Craniectomy ◽  
Cerebellar Artery ◽  
Pica Aneurysms ◽  
Fine Print

✓ The clinical and anatomical features of 21 surgically treated saccular aneurysms of the posterior inferior cerebellar artery (PICA) are analyzed. Seventeen of these lesions originated from the PICA-vertebral junction, and four arose from distal PICA branching sites. Twelve lesions arose from the left PICA, nine were right-sided, and all were small (less than 12.5 mm). Most of these aneurysms occurred in females (16 of 21) and presented as classic subarachnoid hemorrhage. The lack of specific focal deficits prevented an accurate pre-angiographic determination of aneurysm location in most instances. Clinically significant vasospasm and aneurysm multiplicity occurred with approximately equal frequency as at other locations. The angiographic and surgical features of these lesions are determined by the course of the vertebral artery and PICA; that is, they occur at branching sites and at curves in the parent vessel, and point in the direction in which flow would have continued if the curve at the aneurysm's origin had not been present. Aneurysms at the PICA-vertebral junction usually occur at least 1 cm above the foramen magnum level, arise distal to the PICA origin in the angle between the two vessels, and are best approached by a paramedian incision with the patient in the lateral recumbent position. Isolated clipping of the aneurysm neck is essential in this instance, as trapping may compromise vital perforating arteries of the brain stem. More distal (retromedullary) PICA aneurysms are sometimes associated with another vascular anomaly (two cases in this series), and are best handled through a bilateral suboccipital craniectomy. Clipping of the neck is the preferred treatment, but trapping is usually safe, if necessary.

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