Giant carotid-ophthalmic artery aneurysms: direct clipping utilizing the “trapping-evacuation” technique

1991 ◽  
Vol 74 (4) ◽  
pp. 567-572 ◽  
Author(s):  
Norihiko Tamaki ◽  
Shigekuni Kim ◽  
Kazumasa Ehara ◽  
Masahiro Asada ◽  
Katsuzo Fujita ◽  
...  
Keyword(s):  
Anterior Part ◽  
Giant Aneurysm ◽  
Postoperative Outcome ◽  
Balloon Occlusion ◽  
External Carotid ◽  
Anterior Clinoid Process ◽  
Content Type ◽  
Aneurysm Neck ◽  
Balloon Occlusion Test ◽  
Fine Print

✓ The authors have devised a “trapping-evacuation” technique to facilitate direct clipping of giant aneurysms in the paraophthalmic region of the internal carotid artery (ICA). The giant aneurysm is collapsed by first trapping the aneurysm by temporary occlusion of the cervical common carotid and external carotid arteries, along with temporary clipping of the intracranial ICA distal to the aneurysm. Thereafter, intra-aneurysmal blood is simultaneously aspirated through a catheter placed in the cervical ICA. Exposure of the proximal end of the aneurysm neck is mandatory for successful clipping. This is accomplished by extensive unroofing of the optic canal, removal of the anterior clinoid process, opening of the anterior part of the cavernous sinus, and exposure of the most proximal intradural (C2) and genu (C3) portions of the ICA. Four cases of giant aneuryms of the paraophthalmic ICA were successfully treated by this technique and the postoperative outcome was good in all cases. Preoperative magnetic resonance imaging for evaluation of the anatomical details, balloon occlusion test of the ICA, and intraoperative measurement of cortical blood flow were important to the success of the operation. Intraoperative digital subtraction angiography via the catheter placed in the cervical ICA was useful in confirming successful clipping.

Enlargement of basilar artery aneurysms following balloon occlusion — “water-hammer effect”

1991 ◽  
Vol 75 (6) ◽  
pp. 963-968 ◽  
Author(s):  
Eddie S. K. Kwan ◽  
Carl B. Heilman ◽  
William A. Shucart ◽  
Richard P. Klucznik
Keyword(s):  
Basilar Artery ◽  
Water Hammer ◽  
Balloon Occlusion ◽  
Successful Therapy ◽  
Content Type ◽  
Aneurysm Neck ◽  
Water Hammer Effect ◽  
Fine Print

✓ Two patients with distal basilar aneurysms were treated with intra-aneurysmal balloon occlusion. After apparently successful therapy, follow-up angiograms demonstrated aneurysm enlargement with balloon migration distally in the sac. Geometric mismatch between the base of the balloons and the aneurysm neck together with transmitted pulsation through the 2-hydroxyl-ethylmethacrylate (HEMA)-filled balloon directly contributed to aneurysm enlargement. In this report, the authors discuss the problems of progressive aneurysm enlargement due to a “water-hammer effect” and the possibility of hemorrhage following subtotal occlusion.

Proximal intracranial internal carotid artery branches: prevalence and importance for balloon occlusion test

2005 ◽  
Vol 102 (1) ◽  
pp. 45-52 ◽  
Author(s):  
Jason W. Allen ◽  
Anthony J. G. Alastra ◽  
Peter K. Nelson
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Skull Base ◽  
Internal Carotid ◽  
Balloon Occlusion ◽  
Content Type ◽  
Occlusion Test ◽  
Balloon Occlusion Test ◽  
The Right ◽  
Fine Print

Object. The aim of this study was to determine the prevalence of angiographically identifiable skull base arterial branches that potentially serve as collateral conduits during a balloon occlusion test (BOT) of the internal carotid artery (ICA). The authors posited that neurological deficits in patients who had previously tolerated the occlusion test may be attributable to an unrecognized collateral support through these channels (operant during proximal ICA BOT) when permanent ICA occlusion was performed more distally. Methods. In 481 cases (962 ICAs), cerebral angiograms obtained during routine Wada testing were retrospectively reviewed. Two hundred sixty-one patients had at least one angiographically identifiable ICA branch; 109 patients had two or more branches. A meningohypophyseal branch of the cavernous ICA was identified on the right side in 108 patients and on the left in 122. A vidian artery originated from the petrous portion of the ICA on the right side in 58 patients and on the left in 85. The inferolateral trunk revealed itself as a branch of the cavernous ICA on the right side in 17 patients and on the left in 33. A caroticotympanic artery arose from a left cavernous ICA. A persistent trigeminal artery was situated on the right side in two patients and on the left in three. More than half of the patients had angiographically identifiable and perhaps hemodynamically significant skull base branches of the ICA, and approximately one quarter had more than one identifiable branch. Conclusions. The authors recommend that patients be screened during angiography studies performed prior to BOT in branches of the proximal intracranial ICA and that the site of BOT be moved distally if such branches are identified.

Saphenous vein graft bypass of the cavernous internal carotid artery

1990 ◽  
Vol 72 (1) ◽  
pp. 35-41 ◽  
Author(s):  
Laligam N. Sekhar ◽  
Chandra N. Sen ◽  
Hae Dong Jho
Keyword(s):  
Saphenous Vein ◽  
Vein Graft ◽  
Internal Carotid ◽  
Saphenous Vein Graft ◽  
Balloon Occlusion ◽  
Neurological Deficits ◽  
Content Type ◽  
Occlusion Test ◽  
Balloon Occlusion Test ◽  
Fine Print

✓ Saphenous vein graft reconstruction was performed from the petrous to the supraclinoid internal carotid artery (ICA) to replace the cavernous ICA in six patients during direct intracavernous operations. Four of these patients had intracavernous neoplasms with invasion of the ICA and two had intracavernous ICA aneurysms that could not be clipped or occluded with intraluminal balloons. All but one patient had evidence of poor collateral flow reserve in a balloon occlusion test of the ICA. The superficial temporal artery was not present in four patients, was minuscule in one, and was damaged during the initial dissection in another, making it unsuitable for superficial temporal-to-middle cerebral artery branch anastomosis. Blood flow within the graft could not be established intraoperatively in one patient (who had excellent collateral circulation) due to the small size of the vein (3 mm). In all others, the grafts were patent on follow-up arteriography and transcranial Doppler studies. Three patients who had severe reduction of cerebral blood flow during test occlusion of the ICA exhibited temporary hemispheric neurological deficits postoperatively; the deficits were related to the duration of temporary ICA occlusion. All three recovered completely without evidence of infarction on computerized tomography (CT). One patient who clinically could not tolerate the balloon occlusion test of the ICA also had temporary neurological deficits with good recovery but showed evidence of border-zone infarction on CT scans. The present role of saphenous vein graft bypass of the cavernous ICA is discussed.

Treatment of carotid-cavernous sinus fistulas using a superior ophthalmic vein approach

1995 ◽  
Vol 83 (5) ◽  
pp. 838-842 ◽  
Author(s):  
Neil R. Miller ◽  
Lee H. Monsein ◽  
Gerard M. Debrun ◽  
Rafael J. Tamargo ◽  
Haring J. W. Nauta
Keyword(s):  
Cavernous Sinus ◽  
Intraoperative Complications ◽  
Balloon Catheter ◽  
Balloon Occlusion ◽  
External Carotid ◽  
Superior Ophthalmic Vein ◽  
Content Type ◽  
Transvenous Approach ◽  
Symptoms And Signs ◽  
Fine Print

✓ The authors describe the method and results of treatment of 12 consecutive patients with carotid-cavernous sinus fistulas (CCFs). Treatment was by embolization via a transvenous approach through the superior ophthalmic vein (SOV). The CCFs (two direct and 10 dural) had previously been treated unsuccessfully or, for mechanical reasons, could not be treated by the standard techniques of endoarterial balloon occlusion, particle or glue embolization of feeding vessels from one or both external carotid arteries, or transvenous occlusion of the fistula via the ipsilateral inferior petrosal sinus. All 12 patients were successfully treated either by advancement of a detachable balloon catheter through the ipsilateral SOV into the cavernous sinus with subsequent inflation and detachment of the balloon (11 patients) or by introduction of multiple thrombogenic coils into the fistula via the ipsilateral SOV (one patient). All patients had complete resolution of symptoms and signs after successful occlusion of the CCF. There were no intraoperative complications; however, one patient required postoperative embolization of a residual posteriorly draining fistula via the ipsilateral external carotid artery, and another developed a persistent abducens nerve paresis that eventually required surgical correction. Ten (83.3%) of the 12 patients underwent cerebral angiography 3 to 6 months after surgery, and none showed evidence of a recurrent fistula. Similarly, none of the 12 patients developed recurrent symptoms and signs suggesting recurrence of the fistula during a follow-up period that ranged from 6 months to 10 years (mean 64 months). It is concluded that the transvenous approach to the cavernous sinus through the SOV is a safe and effective treatment of both direct and dural CCFs that are not amenable to transarterial or other transvenous approaches.

Radiometric analysis of paraclinoid carotid artery aneurysms

2002 ◽  
Vol 96 (4) ◽  
pp. 649-653 ◽  
Author(s):  
Yuichiro Tanaka ◽  
Kazuhiro Hongo ◽  
Tsuyoshi Tada ◽  
Hisashi Nagashima ◽  
Tetsuyoshi Horiuchi ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Horizontal Line ◽  
Anterior Clinoid Process ◽  
Content Type ◽  
Aneurysm Neck ◽  
Radiometric Analysis ◽  
Paraclinoid Aneurysms ◽  
The Mean ◽  
Fine Print

Object. Classification of paraclinoid carotid artery (CA) aneurysms based on their associated branching arteries has been confusing because superior hypophyseal arteries (SHAs) are too fine to appear opacified on cerebral angiograms. The authors performed a retrospective radiometric analysis of surgically treated paraclinoid aneurysms to elucidate their angiographic and anatomical characteristics. Methods. A retrospective analysis was made of 85 intradural paraclinoid aneurysms in which the presence or absence of branching arteries had been determined at the time of surgical clipping. The lesions were classified as supraclinoid, clinoid, and infraclinoid aneurysms based on their relation to the anterior clinoid process on lateral angiograms of the CA. The direction of the aneurysms were measured according to angles formed between the medial portion of the horizontal line crossing the aneurysm sac and the center of the aneurysm neck on anteroposterior angiograms. Branching arteries were associated with 68 aneurysms, of which 28 were ophthalmic artery (OphA) lesions (32.9%) and 40 were SHA ones (47.1%); associated branching arteries were absent in 17 aneurysms (20%). Twenty-five aneurysms (29.4%) were located at the supraclinoidal level, 46 (54.1%) at the clinoidal, and 14 (16.5%) at the infraclinoidal. The majority of aneurysms identified at the supraclinoidal level were OphA lesions (44%) or those unassociated with branching arteries (48%), with mean directions of 57° or 67°, respectively. At the clinoidal level, the mean directions of aneurysms were 76° in six lesions unassociated with branching arteries (13%), 43° in 16 OphA lesions (35%), and −11° in 24 SHA ones (52%). All aneurysms at the infraclinoidal level arose at the origin of the SHAs, with a mean direction of −29°, and most of these were embedded in the carotid cave. Conclusions. Aneurysms arising from the SHA can be distinguished from those not located at an arterial division by cerebral angiography, because SHA lesions are usually located at the medial or inferomedial wall of the internal carotid artery at the clinoidal or infraclinoidal level. Their distribution correlates well with the reported distribution of SHA origins. The carotid cave aneurysm is a kind of SHA lesion that originates at the most proximal intradural CA.

Intraoperative endovascular treatment as an adjunct to microsurgical clipping of paraclinoid aneurysms

2000 ◽  
Vol 93 (4) ◽  
pp. 554-560 ◽  
Author(s):  
Puay-Yong Ng ◽  
Daniel Huddle ◽  
Murat Gunel ◽  
Issam A. Awad
Keyword(s):  
Balloon Catheter ◽  
Balloon Occlusion ◽  
Endovascular Procedure ◽  
Intraoperative Angiography ◽  
Content Type ◽  
Aneurysm Neck ◽  
Microsurgical Clipping ◽  
Paraclinoid Aneurysms ◽  
Dural Opening ◽  
Fine Print

Object. The endovascular procedure can provide proximal control, suction decompression, and prompt intraoperative angiography during microsurgical clipping of aneurysms of the paraclinoid segment of the internal carotid artery (ICA). The authors assess the safety and feasibility of this method in 24 consecutive cases.Methods. Frontotemporal craniotomy and radical pterionectomy were performed with the patient's head immobilized in a radiolucent frame while femoral artery catheterizaton was achieved. Before dural opening, a balloon catheter with a coaxial lumen was positioned and tested in the ICA, after which microsurgical exposure was completed, including intradural clinoid drilling and optic canal decompression. Trapping of the lesion was achieved by inflating the balloon and placing a temporary clip beyond the aneurysm neck. The catheter was gently aspirated to achieve suction decompression and to facilitate clip application. Intraoperative digital subtraction angiography was then performed.Twenty-two aneurysms were larger than 10 mm, and 11 of them were giant. Six patients presented with subarachnoid hemorrhage and nine with visual symptoms. Balloon occlusion and suction decompression were performed in 16 cases (67%), and proximal control alone in 1 case. Intraoperative angiography was performed in every case. Subsequent clip readjustment was necessary in seven cases, including three cases of residual aneurysm filling and four of ICA compromise. Complete aneurysm obliteration was achieved in 20 cases, and greater than 90% obliteration in 22. One major infarct likely related to catheter thromboembolism was found. There were no instances of visual deterioration or other complications attributable to the endovascular procedure.Conclusions. The endovascular method allows safe and reliable proximal control, suction decompression, and intraoperative angiography in microsurgical treatment of large paraclinoid aneurysms.

High-flow bypass using the nonocclusive excimer laser—assisted end-to-side anastomosis of the external carotid artery to the P1 segment of the posterior cerebral artery via the sylvian route

1998 ◽  
Vol 88 (5) ◽  
pp. 925-927 ◽  
Author(s):  
Cornelis A. F. Tulleken ◽  
Albert van der Zwan ◽  
Willem Jan van Rooij ◽  
Lino Moreira Pereira Ramos
Keyword(s):  
Carotid Artery ◽  
Excimer Laser ◽  
Cerebral Artery ◽  
Posterior Cerebral Artery ◽  
Giant Aneurysm ◽  
External Carotid Artery ◽  
Balloon Occlusion ◽  
External Carotid ◽  
Content Type ◽  
Grafting Procedure

✓ In a patient with a giant aneurysm of the basilar artery trunk, a vein graft was interposed between the external carotid artery in the neck and the P1 segment of the posterior cerebral artery. Balloon occlusion of both vertebral arteries was performed 3 days later. The sylvian route was used for the grafting procedure and the connection to the posterior cerebral artery was made by using the excimer laser—assisted nonocclusive anastomosis technique.

Giant aneurysm of anterior ethmoidal artery presenting with intracranial hemorrhage

1994 ◽  
Vol 81 (6) ◽  
pp. 934-936 ◽  
Author(s):  
Alok Ranjan ◽  
Thomas Joseph
Keyword(s):  
Intracranial Hemorrhage ◽  
Giant Aneurysm ◽  
Postoperative Recovery ◽  
Vascular Lesions ◽  
Feeding Artery ◽  
Neck Stiffness ◽  
Content Type ◽  
Ethmoidal Artery ◽  
Anterior Ethmoidal Artery ◽  
Fine Print

✓ This forty-five-year-old woman presented with a history suggestive of an intracranial hemorrhage. Clinical examination indicated mild right pyramidal signs and neck stiffness. Computerized tomography demonstrated contrast enhancement in the region of a left frontal intraparenchymal hematoma with an adjacent subdural hematoma. Angiography revealed the presence of a giant aneurysm on the left anterior ethmoidal artery. Surgical evacuation of the hematoma with excision of the aneurysm and coagulation of the feeding artery was achieved. Postoperative recovery was uneventful. Vascular lesions of the anterior ethmoidal artery and the rarity of a giant aneurysm at this site are discussed.

Arteriovenous malformations in the posterior fossa

1977 ◽  
Vol 47 (1) ◽  
pp. 50-56 ◽  
Author(s):  
Hiroshi Matsumura ◽  
Yasumasa Makita ◽  
Kuniyuki Someda ◽  
Akinori Kondo
Keyword(s):  
Arteriovenous Malformation ◽  
Brain Stem ◽  
Posterior Fossa ◽  
Arteriovenous Malformations ◽  
Cerebellopontine Angle ◽  
Anterior Part ◽  
Content Type ◽  
The Brain ◽  
Fine Print

✓ We have operated on 12 of 14 cases of arteriovenous malformation (AVM) in the posterior fossa since 1968, with one death. The lesions were in the cerebellum in 10 cases (three anteromedial, one central, three lateral, and three posteromedial), and in the cerebellopontine angle in two; in two cases the lesions were directly related to the brain stem. The AVM's in the anterior part of the cerebellum were operated on through a transtentorial occipital approach.

Surgical management of spinal cord hemangioblastomas in patients with von Hippel—Lindau disease

2003 ◽  
Vol 98 (1) ◽  
pp. 106-116 ◽  
Author(s):  
Russell R. Lonser ◽  
Robert J. Weil ◽  
John E. Wanebo ◽  
Hetty L. Devroom ◽  
Edward H. Oldfield
Keyword(s):  
Spinal Cord ◽  
Surgical Management ◽  
Postoperative Outcome ◽  
Tumor Location ◽  
Neurological Dysfunction ◽  
Autosomal Dominant Disorder ◽  
Content Type ◽  
Von Hippel Lindau ◽  
Vhl Disease ◽  
Fine Print

Object. Von Hippel—Lindau (VHL) disease is an autosomal-dominant disorder frequently associated with hemangioblastomas of the spinal cord. Because of the slow progression, protean nature, and high frequency of multiple spinal hemangioblastomas associated with VHL disease, the surgical management of these lesions is complex. Because prior reports have not identified the factors that predict which patients with spinal cord hemangioblastomas need surgery or what outcomes of this procedure should be expected, the authors have reviewed a series of patients with VHL disease who underwent resection of spinal hemangioblastomas at a single institution to identify features that might guide surgical management of these patients. Methods. Forty-four consecutive patients with VHL disease (26 men and 18 women) who underwent 55 operations with resection of 86 spinal cord hemangioblastomas (mean age at surgery 34 years; range 20–58 years) at the National Institutes of Health were included in this study (mean clinical follow up 44 months). Patient examination, review of hospital charts, operative findings, and magnetic resonance imaging studies were used to analyze surgical management and its outcome. To evaluate the clinical course, clinical grades were assigned to patients before and after surgery. Preoperative neurological status, tumor size, and tumor location were predictive of postoperative outcome. Patients with no or minimal preoperative neurological dysfunction, with lesions smaller than 500 mm3, and with dorsal lesions were more likely to have no or minimal neurological impairment. Syrinx resolution was the result of tumor removal and was not influenced by whether the syrinx cavity was entered. Conclusions. Spinal cord hemangioblastomas can be safely removed in the majority of patients with VHL disease. Generally in these patients, hemangioblastomas of the spinal cord should be removed when they produce symptoms or signs.

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