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.

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.

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.

scholarly journals Rupture of a Large Vertebral Artery Aneurysm following Proximal Occlusion

2005 ◽  
Vol 11 (1) ◽  
pp. 51-58 ◽  
Author(s):  
S. Iwabuchi ◽  
T. Yokouchi ◽  
H. Kimura ◽  
M. Ueda ◽  
H. Samejima
Keyword(s):  
Vertebral Artery ◽  
Posterior Inferior Cerebellar Artery ◽  
Artery Aneurysm ◽  
Neck Region ◽  
Aneurysm Rupture ◽  
Left Vertebral Artery ◽  
Partial Filling ◽  
Vertebrobasilar Junction ◽  
Large Aneurysm ◽  
Proximal Occlusion

Proximal occlusion of the vertebral artery is regarded as a safe and effective method of treating aneurysms of the vertebral artery or the vertebrobasilar junction unsuitable for treatment by neck clipping. Complications known to develop after this procedure include ischemic lesions of the perforators and other areas. There are only a limited number of reports on early rupture of aneurysm following proximal occlusion of the vertebral artery for the treatment of unruptured aneurysm. We recently encountered a case of large aneurysm of the vertebral artery identified after detection of brainstem compression. This patient underwent proximal occlusion of the vertebral artery with a coil and developed a fatal rupture of the aneurysm ten days after proximal occlusion. The patient was a 72-year-old woman who had complained of dysphagia and unsteadiness for several years. An approximately 20 mm diameter aneurysm was detected in her left vertebral artery. She underwent endovascular treatment, that is, her left vertebral artery was occluded with coils at a point proximal to the aneurysm. Her initial post-procedure course was uneventful. However, she suddenly developed right-side hemiparesis nine days after procedure. At that time, CT scan suggested sudden thrombosis of the aneurysm. Right vertebral angiography revealed a small part of the aneurysm. She was treated conservatively. Ten days after the procedure, she suffered massive subarachnoid haemorrhage. Both the present case and past reports suggest that proximal occlusion of the vertebral artery is effective in treating relatively large aneurysms unsuitable for treatment by neck clipping or trapping. However, when the bifurcation of the posterior inferior cerebellar artery (PICA) is distal to the occluded point in cases where the PICA bifurcates from the aneurysm or the neck region, blood supply to the aneurysm may persist because anterograde blood flow to the PICA may be preserved. Therefore, clinicians must consider the possibility of aneurysm rupture after proximal occlusion in the following cases: 1) when the aneurysm is large or giant, but non-thrombosed; 2) when thrombosis occurs soon after the procedure; 3) when postoperative angiography shows partial filling of the aneurysm with contrast agent through the contralateral vertebral artery of basilar artery or the cervical muscle branches.

Reconstruction of the posterior inferior cerebellar artery in the treatment of giant aneurysms

1996 ◽  
Vol 85 (3) ◽  
pp. 496-499 ◽  
Author(s):  
Jun-Ichiro Hamada ◽  
Shinji Nagahiro ◽  
Chikara Mimata ◽  
Takayuki Kaku ◽  
Yukitaka Ushio
Keyword(s):  
Vertebral Artery ◽  
Fourth Ventricle ◽  
Posterior Inferior Cerebellar Artery ◽  
Artery Aneurysm ◽  
Temporal Artery ◽  
Aneurysm Surgery ◽  
Content Type ◽  
Giant Aneurysms ◽  
Cerebellar Artery ◽  
Normal Blood Flow

✓ Two techniques of revascularizing the posterior inferior cerebellar artery (PICA) during aneurysm surgery are presented. One involves transposition of the PICA to the vertebral artery proximal to the aneurysm using a superior temporal artery (STA) as a graft. This is used in cases in which the PICA has branched off from the wall of the giant vertebral artery aneurysm. The other technique involves end-to-end anastomosis of the PICA after excision of a giant distal PICA aneurysm located at the cranial loop near the roof of the fourth ventricle. The reconstructions of the PICA described here are surgical procedures designed to preserve normal blood flow in the PICA in patients treated for giant aneurysms involving that artery.

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.

Subarachnoid hemorrhage caused by posterior inferior cerebellar artery aneurysm with an anomalous course of the atlantoaxial segment of the vertebral artery

2005 ◽  
Vol 103 (2) ◽  
pp. 356-360 ◽  
Author(s):  
William W. Ashley ◽  
Michael R. Chicoine
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Vertebral Artery ◽  
Anatomical Variation ◽  
Posterior Inferior Cerebellar Artery ◽  
Artery Aneurysm ◽  
Unique Case ◽  
Pertinent Literature ◽  
Content Type ◽  
Cerebellar Artery ◽  
First Time

✓ Various anatomical courses of the vertebral artery (VA) and posterior inferior cerebellar artery (PICA) have been described. The authors present a unique case of a subarachnoid hemorrhage resulting from an aneurysm in a patient with an anatomical variation of the extracranial portion of the VA and cervical origin of the PICA. The surgical implications of this variant are discussed, and the pertinent literature reviewed. Subarachnoid hemorrhage caused by rupture of a PICA aneurysm is reported for the first time in association with a rare variation of the course of the VA.

scholarly journals Neurosurgery (Neuro Interventional)

2015 ◽  
Vol 42 (S1) ◽  
pp. S43-S44
Author(s):  
JJ Shankar ◽  
L Hodgson
Keyword(s):  
Vertebral Artery ◽  
Retrospective Analysis ◽  
Posterior Inferior Cerebellar Artery ◽  
Artery Aneurysm ◽  
The Third ◽  
Cerebellar Artery ◽  
Incomplete Coverage ◽  
Negative Findings ◽  
The Right

Purpose: CTA is becoming the frontline modality to reveal aneurysms in patients with SAH. However, in about 20% of SAH patients no aneurysm is found. In these cases, intra-arterial DSA is still performed. Our aim was to evaluate whether negative findings on CTA can reliably exclude aneurysms in patients with acute SAH. Materials and Method: We conducted a retrospective analysis of all DSA performed from August 2010 to July 2014 in patients with various indications. We selected patient who presented with SAH and had a negative CTA. Findings of the CTA were compared with DSA. Results: 857 DSA were performed during the study period. 51(5.95%) patients with SAH and negative findings on CTA who underwent subsequent DSA were identified. Of these, only 3(5.9%) of patients had positive findings on the DSA. One patient had a posterior inferior cerebellar artery aneurysm on the DSA, not seen on CTA due to the incomplete coverage of the head. Second patient’ CTA did not show any evidence of aneurysm. DSA showed suspicious dissection of the right vertebral artery, potentially iatrogenic. The third patient’s DSA showed suspicious tiny protuberance from left ICA, possibly infundibulum. Conclusion: In patients with SAH, negative CTA findings are reliable in ruling out aneurysms in any pattern of SAH on CT.

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.

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