scholarly journals Anterior Inferior Cerebellar Aneurysm Treated by Aneurysm Resection and Intracranial Artery Anastomosis in situ: A Case Report and Literature Review

2021 ◽  
Vol 8 ◽  
Author(s):  
Chaojue Huang ◽  
Shixing Qin ◽  
Wei Huang ◽  
Yongjia Yu
Keyword(s):  
Surgical Treatment ◽  
Posterior Inferior Cerebellar Artery ◽  
Cranial Nerves ◽  
Anterior Inferior Cerebellar Artery ◽  
Intracranial Artery ◽  
Disturbance Of Consciousness ◽  
Cerebellar Artery ◽  
Wide Range ◽  
Aneurysm Resection

Background: Anterior inferior cerebellar artery (AICA) aneurysms are relatively rare in clinical practice, accounting for <1% of all intracranial arteries. After the diagnosis and location are confirmed by angiography, magnetic resonance, and other imaging examinations, interventional, or surgical treatment is often used, but some complex aneurysms require reconstructive surgery.Case Description: An 8-year-old male child was admitted to the hospital due to sudden disturbance of consciousness for 2 weeks. The head CT showed hematocele in the ventricular system with subarachnoid hemorrhage in the basilar cistern and annular cistern. On admission, he was conscious, answered correctly, had a soft neck, limb muscle strength was normal, and had no cranial nerves or nervous system abnormalities. A preoperative examination showed the right side of the anterior distal arteries class under the circular wide neck aneurysm, the distal anterior inferior cerebellar artery supplying a wide range of blood to the cerebellum, the ipsilateral posterior inferior cerebellar artery absent, and the aneurysm close to the VII, VIII nerves. The aneurysm was successfully treated by aneurysm resection and intracranial artery anastomosis in situ of a2 AICA-a2 AICA.Conclusions: AICA aneurysms are relatively rare; in this case, a complex wide-necked aneurysm was successfully treated by aneurysm resection and anastomosis in situ of a2 AICA-a2 AICA. This case can provide a reference for the surgical treatment of complex anterior cerebellar aneurysms.

An a3-Anterior Inferior Cerebellar Artery to p3-Posterior Inferior Cerebellar Artery Bypass With Thrombectomy and Trapping of an Anterior Inferior Cerebellar Artery Aneurysm: 3-Dimensional Operative Video

2020 ◽  
Vol 19 (3) ◽  
pp. E311-E312
Author(s):  
Justin R Mascitelli ◽  
Sirin Gandhi ◽  
Jacob F Baranoski ◽  
Michael J Lang ◽  
Michael T Lawton
Keyword(s):  
Artery Bypass ◽  
Posterior Inferior Cerebellar Artery ◽  
Cranial Nerves ◽  
Artery Aneurysm ◽  
Anterior Inferior Cerebellar Artery ◽  
Occipital Artery ◽  
Cerebellar Artery ◽  
Retrograde Filling ◽  
In Situ Bypass

Abstract In situ bypasses to the anterior inferior cerebellar artery (AICA) are unusual because, with only one artery in the cerebellopontine angle (CPA), no natural intracranial donors parallel its course. In rare cases, the posterior inferior cerebellar artery (PICA) may have the tortuosity or redundancy to be mobilized to the AICA to serve as a donor. This video demonstrates this p3 PICA-to-a3 AICA in situ side-to-side bypass. A 75-yr-old woman presented with ataxia and hemiparesis from a large thrombotic right AICA aneurysm compressing the brainstem. Strategy consisted of bypass, trapping, and brainstem decompression. Written informed consent for surgery was obtained from the patient. A hockey-stick incision was made to harvest the occipital artery as a backup donor, but its diminutive caliber precluded its use. The bypass was performed through an extended retrosigmoid craniotomy. The aneurysm was trapped completely and thrombectomized to relieve the pontine mass effect. Indocyanine green videoangiography confirmed patency of the bypass, retrograde filling of the AICA to supply pontine perforators, and no residual aneurysmal filling. This unusual in situ bypass is possible when redundancy of the AICA and PICA allow their approximation in the CPA. The anastomosis is performed lateral to the lower cranial nerves in a relatively open and superficial plane. The extended retrosigmoid approach provides adequate exposure for both the bypass and aneurysm trapping. In situ AICA-PICA bypass enables anterograde and retrograde AICA revascularization with side-to-side anastomosis. The occipital artery-to-AICA bypass and the V3 vertebral artery-to-AICA interpositional bypass are alternatives when intracranial anatomy is unfavorable for this in situ bypass.1–6 Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

Treatment of an Anterior Inferior Cerebellar Artery Aneurysm With Microsurgical Trapping and In Situ Posterior Inferior Cerebellar Artery to Anterior Inferior Cerebellar Artery Bypass: Case Report

2017 ◽  
Vol 15 (4) ◽  
pp. 418-424 ◽  
Author(s):  
Bryan S Lee ◽  
Alex M Witek ◽  
Nina Z Moore ◽  
Mark D Bain
Keyword(s):  
Artery Bypass ◽  
Posterior Inferior Cerebellar Artery ◽  
Significant Risk ◽  
Artery Aneurysm ◽  
Lateral Approach ◽  
Anterior Inferior Cerebellar Artery ◽  
Parent Vessel ◽  
Cerebellar Artery ◽  
Far Lateral Approach

Abstract BACKGROUND Anterior inferior cerebellar artery (AICA) aneurysms are rare lesions whose treatment can involve microsurgical and/or endovascular techniques. Such treatment can be challenging and may carry a significant risk of neurological morbidity. OBJECTIVE To demonstrate a case involving a complex AICA aneurysm that was treated with a unique microsurgical approach involving trapping the aneurysm and performing in Situ bypass from the posterior inferior cerebellar artery (PICA) to the distal AICA. The nuances of AICA aneurysms and revascularization strategies are discussed. METHODS The aneurysm and the distal segments of AICA and PICA were exposed with a retrosigmoid and far lateral approach. A side-to-side anastomosis was performed between the adjacent caudal loops of PICA and AICA. The AICA aneurysm was then treated by trapping the aneurysm-bearing segment of the parent vessel between 2 clips. RESULTS A postoperative angiogram demonstrated a patent PICA-AICA bypass and complete occlusion of the AICA aneurysm. There were no complications, and the patient made an excellent recovery. CONCLUSION The combination of parent vessel sacrifice and bypass remains an excellent option for certain difficult-to-treat aneurysms. This case involving PICA-AICA bypass to treat an AICA aneurysm serves as an example of the neurosurgeon's ability to develop unique solutions that take advantage of individual anatomy.

Microvascular decompression for hemifacial spasm

1991 ◽  
Vol 75 (3) ◽  
pp. 388-392 ◽  
Author(s):  
Shinji Nagahiro ◽  
Akira Takada ◽  
Yasuhiko Matsukado ◽  
Yukitaka Ushio
Keyword(s):  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
Posterior Inferior Cerebellar Artery ◽  
Cranial Nerves ◽  
Anterior Inferior Cerebellar Artery ◽  
Vascular Compression ◽  
Content Type ◽  
Seventh Cranial Nerve ◽  
Cerebellar Artery

✓ To determine the causative factors of unsuccessful microvascular decompression for hemifacial spasm, the follow-up results in 53 patients were assessed retrospectively. The mean follow-up period was 36 months. There were 32 patients who had compression of the seventh cranial nerve ventrocaudally by an anterior inferior cerebellar artery (AICA) or a posterior inferior cerebellar artery. Of these 32 patients, 30 (94%) had excellent postoperative results. Of 14 patients with more severe compression by the vertebral artery, nine (64%) had excellent results, three (21%) had good results, and two (14%) had poor results; in this group, three patients with excellent results experienced transient spasm recurrence. There were seven patients in whom the meatal branch of the AICA coursed between the seventh and eighth cranial nerves and compressed the dorsal aspect of the seventh nerve; this was usually associated with another artery compressing the ventral aspect of the nerve (“sandwich-type” compression). Of these seven patients, five (71%) had poor results including operative failure in one and recurrence of spasm in four. The authors conclude that the clinical outcome was closely related to the patterns of vascular compression.

scholarly journals Surgical Treatment of Posterior Circulation Aneurysms – Anatomical Study and Surgical Technique

2018 ◽  
Vol 37 (01) ◽  
pp. 27-37
Author(s):  
Vitor Yamaki ◽  
Eric Paschoal ◽  
Manoel Teixeira ◽  
Eberval Figueiredo
Keyword(s):  
Surgical Treatment ◽  
Posterior Inferior Cerebellar Artery ◽  
Cranial Nerves ◽  
Posterior Circulation ◽  
Surgical Approaches ◽  
Superior Cerebellar Artery ◽  
Anterior Circulation ◽  
Cerebellar Artery ◽  
Risk Of Rupture ◽  
Posterior Circulation Aneurysms

AbstractPosterior circulation aneurysms represent 10–15% of intracranial aneurysms. The diagnosis is usually secondary to subarachnoid hemorrhage due to its initial asymptomatic presentation and higher risk of rupture compared with aneurysms in the anterior circulation. The surgical treatment of posterior circulation aneurysms is complex and challenging for neurosurgeons because of the particular anatomy of the posterior circulation with its close relation to the brainstem and cranial nerves and also because of the depth and narrowness of the surgical approach. Aneurysms from different locations have specific anatomical relationships and surgical approaches for better visualization and dissection. Therefore, a detailed anatomy knowledge of the posterior circulation is mandatory for an individualized preoperative planning and good neurological and angiographic outcomes. We selected the main aneurysm sites on the posterior circulation, such as: posterior inferior cerebellar artery, basilar trunk, basilar bifurcation, posterior cerebral artery (PCA) and superior cerebellar artery for a detailed description of the relevant anatomy related to aneurysm, and the main surgical approaches for its surgical treatment. Furthermore, we performed a literature review with the most recent outcomes regarding to the surgical treatment of posterior circulation aneurysms.

Right Retrosigmoid Approach for In Situ Occlusion of Brainstem Arteriovenous Malformation Surrounding the Trigeminal Nerve: 3-Dimensional Operative Video

2018 ◽  
Vol 16 (2) ◽  
pp. E42-E42 ◽  
Author(s):  
Roberto Rodriguez Rubio ◽  
Vera Vigo ◽  
Rina Di Bonaventura ◽  
Adib A Abla
Keyword(s):  
Trigeminal Nerve ◽  
Cranial Nerves ◽  
Venous Drainage ◽  
Lateral Position ◽  
Retrosigmoid Approach ◽  
Superior Cerebellar Artery ◽  
Anterior Inferior Cerebellar Artery ◽  
Neurovascular Compression ◽  
Cerebellar Artery

Abstract Arteriovenous malformations (AVMs) of the trigeminal root entry zone are rare and can be associated with neurovascular compression syndromes as well as intracranial hemorrhage.1 They generally have a small nidus located on and around the pial surface of the brainstem; thus, they are feasible for surgery. Nevertheless, they represent a challenge given the vicinity and involvement of cranial nerves and brainstem perforators.2–4 This video demonstrates the case of a 57-yr-old man with new onset of a severe headache without neurological deficit associated with MRI evidence of a vascular malformation around the cisternal right trigeminal nerve. The nerve showed an altered signal on the MRI. Angiography revealed a Spetzler–Martin grade II AVM with a 16-mm nidus supplied by basilar artery perforators, right anterior inferior cerebellar artery, and the superior cerebellar artery (SCA), with drainage into the superior petrosal vein and sigmoid sinus. After an unsuccessful attempted embolization, the patient was referred for and elected microsurgical treatment. With the patient in a lateral position, a right retrosigmoid approach was performed. After cisternal dissection and identification of the nidus, the feeders were occluded by alternating cauterization and clipping to avoid damage to the critical surrounding structures. The AVM in-situ occlusion was carried on without resection, given the involvement of the trigeminal nerve. The intraoperative indocyanine green angiography allowed recognition of the venous drainage and helped to localize and differentiate the feeders from normal perforators. In the immediate postoperative course, the patient suffered from mild numbness with a V2-V3 distribution that progressively improved. Angiography showed no residual AVM.

Hemifacial Spasm: Endoscopic Vascular Decompression

1997 ◽  
Vol 117 (4) ◽  
pp. 308-314 ◽  
Author(s):  
J. Magnan ◽  
F. Caces ◽  
P. Locatelli ◽  
A. Chays
Keyword(s):  
Hemifacial Spasm ◽  
Marked Improvement ◽  
Cerebellopontine Angle ◽  
Posterior Inferior Cerebellar Artery ◽  
Endoscopic Examination ◽  
Anterior Inferior Cerebellar Artery ◽  
Cerebellar Artery ◽  
The Mean ◽  
Vascular Decompression

Sixty patients with primitive hemifacial spasm were treated by means of a minimally invasive retrosigmoid approach in which endoscopic and microsurgical procedures were combined. Intraoperative endoscopic examination of the cerebellopontine angle showed that for 56 of the patients vessel-nerve conflict was the cause of hemifacial spasm. The most common offending vessel was the posterior inferior cerebellar artery (39 patients), next was the vertebral artery (23 patients), and last was the anterior inferior cerebellar artery (16 patients). Nineteen of the patients had multiple offending vascular loops. In one patient, another cause of hemifacial spasm was an epidermoid tumor of the cerebellopontine angle. For three patients, it was not possible to determine the exact cause of the facial disorder. Follow-up information was reviewed for 54 of 60 patients; the mean follow-up period was 14 months. Fifty of the patients were in the vessel-nerve conflict group. Forty of the 50 were free of symptoms, and four had marked improvement. The overall success rate was 88%, and there was minimal morbidity (no facial palsy, two cases of severe hearing loss).

scholarly journals Parent Artery Occlusion for Intracranial Aneurysms

2009 ◽  
Vol 15 (3) ◽  
pp. 309-315 ◽  
Author(s):  
Lishan Cui ◽  
Qiang Peng ◽  
Wenbo Ha ◽  
Dexiang Zhou ◽  
Yang Xu
Keyword(s):  
Cerebral Artery ◽  
Intracranial Aneurysms ◽  
Posterior Inferior Cerebellar Artery ◽  
Cerebral Aneurysms ◽  
Artery Occlusion ◽  
Anterior Inferior Cerebellar Artery ◽  
Parent Artery ◽  
Parent Artery Occlusion ◽  
Cerebellar Artery ◽  
Dissecting Aneurysms

Peripheral cerebral aneurysms are difficult to treat with preservation of the parent arteries. We report the clinical and angiographic outcome of 12 patients with cerebral aneurysms located peripherally. In the past five years, 12 patients, six females and six males, presented at our institution with intracranial aneurysms distal to the circle of Willis and were treated endovascularly. The age of our patients ranged from four to 58 years with a mean age of 37 years. Seven of the 12 patients had subarachnoid and/or intracerebral hemorrhage upon presentation. Two patients with P2 dissecting aneurysms presented with mild hemiparesis and hypoesthesia, one patient with a large dissecting aneurysm complained of headaches and two patients with M3 dissecting aneurysms had mild hemiparesis and hypoesthesia of the right arm. Locations of the aneurysms were as follows: posterior cerebral artery in seven patients, anterior inferior cerebellar artery in two, posterior inferior cerebellar artery in one, middle cerebral artery in two. Twelve patients with peripheral cerebral aneurysms underwent parent artery occlusion (PAO). PAO was performed with detachable coils. No patient developed neurologic deficits. Distally located cerebral aneurysms can be treated with parent artery occlusion when selective embolization of the aneurysmal sac with detachable platinum coils or surgical clipping cannot be achieved.

Revascularization of the Posterior Inferior Cerebellar Artery Using the Occipital Artery: A Cadaveric Study Comparing the p3 and p1 Recipient Sites

2020 ◽  
Vol 19 (2) ◽  
pp. E122-E129 ◽  
Author(s):  
Peyton L Nisson ◽  
Xinmin Ding ◽  
Ali Tayebi Meybodi ◽  
Ryan Palsma ◽  
Arnau Benet ◽  
...  
Keyword(s):  
Posterior Inferior Cerebellar Artery ◽  
Cranial Nerves ◽  
Median Number ◽  
Cerebellar Tonsil ◽  
Occipital Artery ◽  
Recipient Site ◽  
Cerebellar Artery ◽  
Feasible Alternative ◽  
End To End ◽  
Lower Cranial Nerves

Abstract BACKGROUND Revascularization of the posterior inferior cerebellar artery (PICA) is typically performed with the occipital artery (OA) as an extracranial donor. The p3 segment is the most accessible recipient site for OA-PICA bypass at its caudal loop inferior to the cerebellar tonsil, but this site may be absent or hidden due to a high-riding location. OBJECTIVE To test our hypothesis that freeing p1 PICA from its origin, transposing the recipient into a shallower position, and performing OA-p1 PICA bypass with an end-to-end anastomosis would facilitate this bypass. METHODS The OA was harvested, and a far lateral craniotomy was performed in 16 cadaveric specimens. PICA caliber and number of perforators were measured at p1 and p3 segments. OA-p3 PICA end-to-side and OA-p1 PICA end-to-end bypasses were compared. RESULTS OA-p1 PICA bypass with end-to-end anastomosis was performed in 16 specimens; whereas, OA-p3 PICA bypass with end-to-side anastomosis was performed in 11. Mean distance from OA at the occipital groove to the anastomosis site was shorter for p1 than p3 segments (30.2 vs 48.5 mm; P < .001). Median number of perforators on p1 was 1, and on p3, it was 4 (P < .001). CONCLUSION Although most OA-PICA bypasses can be performed using the p3 segment as the recipient site for an end-to-side anastomosis, a more feasible alternative to conventional OA-p3 PICA bypass in cases of high-riding caudal loops or aberrant anatomy is to free the p1 PICA, transpose it away from the lower cranial nerves, and perform an end-to-end OA-p1 PICA bypass instead.

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