Therapeutic occlusion of the vertebral artery using a new penumbra occlusion device system and ruby coils (penumbra): A technical note

Total uncinate process resection or uncinectomy is often required in the setting of severe foraminal stenosis or cervical kyphosis correction. The proximity of the uncus to the vertebral artery, nerve root, and spinal cord makes this a challenging undertaking. Use of a high-speed burr or ultrasonic bone dissector can be associated with direct injury to the vertebral artery and thermal injury to the surrounding structures. The use of an osteotome is a safe and efficient method of uncinectomy. Here the authors describe their technique, which is illustrated with an intraoperative video.

Download Full-text

First experience of combined penumbra occlusion device (POD) associated to pc-400 coils in carotid artery sacrifice: Efficacy, safety and technical note

Journal of Neuroradiology ◽

10.1016/j.neurad.2016.01.097 ◽

2016 ◽

Vol 43 (2) ◽

pp. 111

Author(s):

Gaultier Marnat ◽

Jérôme Berge ◽

Xavier Barreau ◽

Patrice Menegon ◽

Florent Gariel ◽

...

Keyword(s):

Carotid Artery ◽

Technical Note ◽

Occlusion Device

Download Full-text

Anchoring Method for Hemifacial Spasm Associated with Vertebral Artery: Technical Note

Neurosurgery ◽

10.1097/00006123-199912000-00048 ◽

1999 ◽

Vol 45 (6) ◽

pp. 1487-1491 ◽

Cited By ~ 28

Author(s):

Kazuhiko Kyoshima ◽

Atsushi Watanabe ◽

Yasuyuki Toba ◽

Junpei Nitta ◽

Shinsuke Muraoka ◽

...

Keyword(s):

Vertebral Artery ◽

Hemifacial Spasm ◽

Technical Note

Download Full-text

Microvascular Compressicaude by Slinging a Tortuous Vertebrobasilar Artery to the Petrous Dura in Hemifacial Spasm: Technical Note

Arquivos Brasileiros de Neurocirurgia Brazilian Neurosurgery ◽

10.1055/s-0038-1675764 ◽

2018 ◽

Vol 37 (04) ◽

pp. 352-361

Author(s):

Forhad Chowdhury ◽

Mohammod Haque ◽

Jalal Rumi ◽

Monir Reza

Keyword(s):

Vertebral Artery ◽

Free Flap ◽

Hemifacial Spasm ◽

Technical Note ◽

Taxi Driver ◽

Treatment Technique ◽

Entry Zone ◽

Temporal Fascia ◽

Vertebrobasilar Artery ◽

The Brain

Objective In cases of hemifacial spasm caused by a tortuous vertebrobasilar artery (TVBA), the traditional treatment technique involves Teflon (polytetrafluoroethylene), which can be ineffective and fraught with recurrence and neurological complications. In such cases, there are various techniques of arteriopexy using adhesive compositions, ‘suspending loops’ made of synthetic materials, dural or fascial flaps, surgical sutures passed around or through the vascular adventitia, as well as fenestrated aneurysmal clips. In the present paper, we describe a new technique of slinging the vertebral artery (VA) to the petrous dura for microvascular decompression (MVD) in a patient with hemifacial spasm caused by a TVBA. Method A 50-year-old taxi driver presented with a left-sided severe hemifacial spasm. A magnetic resonance imaging (MRI) scan of the brain showed a large tortuous left-sided vertebral artery impinging and compressing the exit/entry zone of the 7th and 8th nerve complex. After a craniotomy, a TVBA was found impinging and compressing the entry zone of the 7th and 8th nerve complex. Arachnoid bands attaching the artery to the nerve complex and the pons were released by sharp microdissection. Through the upper part of the incision, a 2.5 × 1 cm temporal fascia free flap was harvested. After the fixation of the free flap, a 6–0 prolene suture was passed through its length several times using the traditional Bengali sewing and stitching techniques to make embroidered quilts called Nakshi katha. The ‘prolenated’ fascia was passed around the compressing portion of the VA. Both ends of the fascia were brought together and stitched to the posterior petrous dura to keep the TVBA away from the 7th and 8th nerves and the pons. Result The patient had no hemifacial spasm immediately after the recovery from the anesthesia. A postoperative MRI of the brain showed that the VA was away from the entry zone of the 7th and 8th nerves. Conclusion The ‘prolenated’ temporal fascia slinging technique may be a very good option of MVD in cases in which the causative vessel is a TVBA.

Download Full-text

In Vivo Retrieval of a Trapped Merci Embolectomy Device: Technical Case Report

Operative Neurosurgery ◽

10.1227/01.neu.0000383748.34118.d3 ◽

2010 ◽

Vol 67 (3) ◽

pp. onsE304-onsE304 ◽

Cited By ~ 1

Author(s):

Ajeet Gordhan ◽

John Soliman

Keyword(s):

Vertebral Artery ◽

Conformational Changes ◽

Basilar Artery ◽

Technical Note ◽

Vessel Injury ◽

Artery Segment ◽

In Vitro Assessment ◽

Artery Flow

Abstract BACKGROUND AND IMPORTANCE: This technical note describes a complication related to the use of the Merci embolectomy device not previously reported. The device can induce critical flow limitation within an accessed vessel because of a combination of vasospasm and anatomic conformational changes. Furthermore, this can limit the safe removal of the device from intracranial vasculature. We present a novel rescue technique that can be used to safely retrieve the entrapped Merci device without inciting localized vessel injury. CLINICAL PRESENTATION: A 51-year-old male with embolic occlusion of the distal basilar artery and dissection-related occlusion of the left cervical vertebral underwent mechanical thrombolysis. Flow-limiting vasospasm and/or anatomic conformational changes/ telescoping of the intracranial right vertebral artery segment was induced during deployment with subsequent entrapment of the device. Reclamation of the entrapped device was performed by initially removing the Merci microcatheter. The entrapped and fixated device was then resheathed into a 4F slip catheter within the intracranial vertebral artery. The Merci device and the slip catheter were then removed. Right vertebral and proximal basilar artery flow was reestablished after removal of the Merci device. Successful clot extraction was thereafter performed using a microsnare. CONCLUSION: In vitro assessment of the device has demonstrated its propensity to induce vasospasm. In vivo entrapment of the device has not been previously reported. Successful retrieval can be achieved if the Merci device becomes entrapped and fixated. This may be an important consideration as increased utilization of the device occurs.

Download Full-text