Vertebral artery section for treating arterial compression of the medulla oblongata

1993 ◽  
Vol 79 (1) ◽  
pp. 116-118 ◽  
Author(s):  
Kazuhiro Hongo ◽  
Shigeaki Kobayashi ◽  
Masanobu Hokama ◽  
Kenichiro Sugita
Keyword(s):  
Vertebral Artery ◽  
Medulla Oblongata ◽  
Pyramidal Tract ◽  
Posterior Inferior Cerebellar Artery ◽  
Term Effect ◽  
Left Vertebral Artery ◽  
Content Type ◽  
Long Term Effect ◽  
Cerebellar Artery

✓ A case of a 30-year-old man who showed progressive pyramidal tract signs caused by compression of the left vertebral artery is presented. Initial decompression of the vertebral artery by placing a piece of sponge between the artery and medulla had no long-term effect. The left vertebral artery distal to the origin of the posterior inferior cerebellar artery was then sectioned, decompressing the medulla oblongata. The patient's symptoms improved postoperatively. This is the first reported case of brain-stem compression by an elongated vertebral artery treated by sectioning of the artery.

Combined surgical and endovascular treatment of a giant vertebral artery aneurysm in a child

1994 ◽  
Vol 81 (2) ◽  
pp. 304-307 ◽  
Author(s):  
Mazen H. Khayata ◽  
Robert F. Spetzler ◽  
Jan J. A. Mooy ◽  
James M. Herman ◽  
Harold L. Rekate
Keyword(s):  
Vertebral Artery ◽  
Posterior Inferior Cerebellar Artery ◽  
Artery Aneurysm ◽  
Mass Effect ◽  
Left Vertebral Artery ◽  
Parent Artery ◽  
Content Type ◽  
Cerebellar Artery ◽  
Coil Occlusion ◽  
Surgical Bypass

✓ The case is presented of a 5-year-old child who suffered a subarachnoid hemorrhage from a giant left vertebral artery-posterior inferior cerebellar artery (PICA) aneurysm. Initial treatment consisted of surgical occlusion of the parent vertebral artery combined with a PICA-to-PICA bypass. Because of persistent filling of the aneurysm, the left PICA was occluded at its takeoff from the aneurysm. Endovascular coil occlusion of the aneurysm and the distal left vertebral artery enabled complete elimination of the aneurysm. Follow-up magnetic resonance imaging and arteriography performed 6 months postoperatively showed persistent occlusion and elimination of the mass effect. Combined surgical bypass and endovascular occlusion of the parent artery may be a useful adjunct in the management of these aneurysms.

Fatal traumatic vertebral artery aneurysm rupture

1998 ◽  
Vol 89 (5) ◽  
pp. 822-824 ◽  
Author(s):  
Ramesh L. Sahjpaul ◽  
Muwaffak M. Abdulhak ◽  
Charles G. Drake ◽  
Robert R. Hammond
Keyword(s):  
Vertebral Artery ◽  
Head Trauma ◽  
Posterior Inferior Cerebellar Artery ◽  
Artery Aneurysm ◽  
Aneurysm Rupture ◽  
Left Vertebral Artery ◽  
Content Type ◽  
Brainstem Reflex ◽  
Cerebellar Artery ◽  
Posterior Circulation Aneurysm

✓ The authors present the case of a 34-year-old man struck over the left mastoid region by a hockey puck, who suffered a fatal rupture of a left vertebral artery berry aneurysm. He became apneic within seconds of the injury and had no brainstem reflex within minutes. The postmortem examination showed massive subarachnoid hemorrhage in the posterior fossa and the remnants of a berry aneurysm near the intradural origin of the left vertebral artery, 11 mm proximal to the posterior inferior cerebellar artery. Rupture of a saccular aneurysm as a result of head trauma is rare. This is the first reported case of a posterior circulation aneurysm rupture as a result of head trauma.

Microvascular anatomy of the anterior surface of the medulla oblongata and olive

1995 ◽  
Vol 82 (1) ◽  
pp. 97-105 ◽  
Author(s):  
Ziya C. Akar ◽  
Manuel Dujovny ◽  
Estrella Gómez-Tortosa ◽  
Konstantin V. Slavin ◽  
James I. Ausman
Keyword(s):  
Vertebral Artery ◽  
Medulla Oblongata ◽  
Posterior Inferior Cerebellar Artery ◽  
Arterial Supply ◽  
Anterior Spinal Artery ◽  
Anterior Surface ◽  
Posterior Aspect ◽  
Content Type ◽  
Cerebellar Artery ◽  
Fine Print

✓ The arterial supply and the microanatomy of the anterior surface of the medulla oblongata and olive were studied in 11 cadaveric specimens, with investigation of the size, course, and length of the arteries. Two distinct anatomical entities divide the vascular supply in this region: 1) the pyramid, which is the anterior surface of the medulla; and 2) the olive, which is adjacent to the lateral aspect of the pyramid. Primary vascularization of the pyramid was via small branches of the anterior spinal artery, a branch of the vertebral artery. Minute perforators from the anterior spinal artery were found in all specimens. Arterial supply to the olive varied by location: its anterior aspect was primarily supplied by the anterior spinal artery; the upper portion of the posterior aspect of the olive was supplied by the vertebral artery, the anterior inferior cerebellar artery, and the basilar artery; and the middle and lower portions of the posterior aspect were fed by the vertebral artery and posterior inferior cerebellar artery. These arteries supplied the medulla through the small branches directed toward the olive. The authors observed a wide anastomotic net connecting the small arteries in this area. These patterns of microvascular supply of the pyramid and olive may deepen the understanding of clinical and pathological conditions resulting from arterial occlusion. The existence of an anastomotic net may account for the rare incidence of medullary infarction in the olive region.

scholarly journals Direct puncture of the V3 segment of the vertebral artery in acute basilar artery stroke: an alternative approach in desperate circumstances

2019 ◽  
Vol 12 (8) ◽  
pp. e231335 ◽  
Author(s):  
Sean Thomas O’Reilly ◽  
Ian Rennie ◽  
Jim McIlmoyle ◽  
Graham Smyth
Keyword(s):  
Vertebral Artery ◽  
Basilar Artery ◽  
Posterior Inferior Cerebellar Artery ◽  
Left Vertebral Artery ◽  
Basilar Artery Thrombosis ◽  
Direct Puncture ◽  
Alternative Approach ◽  
Cerebellar Artery ◽  
First Pass ◽  
The Right

A patient in his mid-40s presented with acute basilar artery thrombosis 7 hours postsymptom onset. Initial attempts to perform mechanical thrombectomy (MT) via the femoral and radial arterial approaches were unsuccessful as the left vertebral artery (VA) was occluded at its origin and the right VA terminated in the posterior inferior cerebellar artery territory, without contribution to the basilar system. MT was thus performed following ultrasound-guided direct arterial puncture of the left VA in its V3 segment, with antegrade advancement of a 4 French radial access sheath. First pass thrombolyisis in cerebral infarction (TICI) 3 recanalisation achieved with a 6 mm Solitaire stent retriever and concurrent aspiration on the 4 French sheath. Vertebral closure achieved with manual compression.

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.

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.

Anastomosis Between the Ascending Pharyngeal Artery and the Posterior Inferior Cerebellar Artery Through the Jugular Foramen

2015 ◽  
Vol 12 (2) ◽  
pp. 163-167
Author(s):  
Khaled Effendi ◽  
Elsa Magro ◽  
Jean-Christophe Gentric ◽  
Tim E Darsaut ◽  
Jean Raymond ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Posterior Inferior Cerebellar Artery ◽  
Jugular Foramen ◽  
Left Vertebral Artery ◽  
Cadaveric Specimen ◽  
3 Dimensional ◽  
Ascending Pharyngeal Artery ◽  
Cerebellar Artery ◽  
Direct Anastomosis ◽  
Posterior Division

Abstract BACKGROUND The ascending pharyngeal artery (APA) may, in very rare cases, supply the posterior inferior cerebellar artery (PICA). In reported cases, when such is the case, the ipsilateral vertebral artery (VA) does not supply the PICA, and most of the time it is hypoplastic. OBJECTIVE To describe a unique cadaveric observation of a direct anastomosis between the posterior division (neuromeningeal) of the jugular branch of the APA and the PICA, where the PICA is also supplied by a normal-size VA. METHODS A direct connection between the APA and the PICA was examined in a cadaveric specimen using a 3-dimensional endoscope and a surgical microscope. RESULTS The enlarged jugular branch of the posterior division of the APA entered intracranially via the jugular foramen in its pars vascularis. It then connected directly with the lateral medullary segment of the PICA. The first segment of the PICA originated from a left vertebral artery of normal size and continued its normal course beyond the junction with the jugular branch of the APA. CONCLUSION Both the VA and the jugular branch of the APA may simultaneously supply the PICA territory. Recognition of this anatomic variant is relevant when planning surgical or endovascular treatments.

Microsurgical anatomy of the extracranial—extradural origin of the posterior inferior cerebellar artery

1999 ◽  
Vol 91 (4) ◽  
pp. 645-652 ◽  
Author(s):  
Andrew D. Fine ◽  
Alberto Cardoso ◽  
Albert L. Rhoton
Keyword(s):  
Soft Tissue ◽  
Vertebral Artery ◽  
Posterior Inferior Cerebellar Artery ◽  
Microsurgical Anatomy ◽  
Content Type ◽  
The Third ◽  
Cerebellar Artery ◽  
The Common ◽  
Bone Anomalies ◽  
Fine Print

Object. The authors describe the microsurgical anatomy of the posterior inferior cerebellar artery (PICA) with an extradural origin and discuss its importance as a common variation.Methods. The microsurgical anatomy of paired PICAs with an extradural origin were examined.Conclusions. Five to 20% of PICAs have an extradural origin. In the case described, both PICAs arose extradurally from the third segment of the vertebral artery (VA). Both origins were less than 1 cm proximal to the site at which the VA penetrated the dura, and neither PICA gave rise to extradural branches. Extradurally, the PICAs coursed parallel to the VA and the C-1 nerve and the three structures penetrated the dura together. Intradurally, the PICAs remained lateral and posterior to the brainstem, whereas, in the common PICA configuration, the first segment of the PICA courses anterior to the medulla. Neither PICA sent branches to the anterior brainstem, which is commonly found in PICAs with an intradural origin. There were no soft-tissue or bone anomalies.

Sign in / Sign up

Export Citation Format

Share Document