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Sakamoto Y, Suzuki O, Fukuoka T, Awaya T, Saito R. Vertebral Artery-Posterior Inferior Cerebellar Artery (PICA) Aneurysm Treated With the PICA-to-PICA Bypass: A Case Report. Cureus 2025; 17:e76863. [PMID: 39897223 PMCID: PMC11787819 DOI: 10.7759/cureus.76863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2025] [Indexed: 02/04/2025] Open
Abstract
Treating vertebral artery-posterior inferior cerebellar artery (VA-PICA) aneurysms poses challenges because of their complex anatomy. Although endovascular treatment is commonly preferred, direct surgery offers better recovery prospects than endovascular surgery aided by bypass techniques. We present a VA-PICA aneurysm case treated with VA internal trapping, using a PICA-to-PICA bypass without direct clipping. A 64-year-old man presented with complaints of severe headache and was diagnosed with a right VA-PICA wide neck aneurysm. The PICA originated from the neck of the aneurysm. We consulted an endovascular surgeon and opted for direct clipping via the transcondylar fossa approach. During surgery, we secured and followed the right VA, identified the PICA origin, and observed the proximal neck of the aneurysm. However, securing the distal VA was challenging because the dissector was inaccessible. Instead of direct clipping, a PICA-to-PICA bypass was selected following internal trapping. After anastomosis, the proximal PICA was occluded, whereas the small perforating artery was preserved. The next day, internal trapping of the right VA was performed. The patient's postoperative course was uneventful, except for mild dysphagia. Head magnetic resonance imaging revealed a small infarction on the right medulla. Three-dimensional computed tomography angiography revealed perfect PICA-to-PICA bypass patency. The patient was subsequently transferred to a rehabilitation hospital. The patient had no neurological symptoms at the six-month follow-up (Modified Rankin Score = 0). The preoperative feasibility of direct clipping of complex PICA aneurysms while preserving PICA is unpredictable. Various bypass methods, including the PICA-to-PICA bypass, are potential treatment options for complicated VA-PICA aneurysms.
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Affiliation(s)
- Yusuke Sakamoto
- Neurosurgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, JPN
| | - Osamu Suzuki
- Neurosurgery, Nagoya Ekisaikai Hospital, Nagoya, JPN
| | | | | | - Ryuta Saito
- Neurosurgery, Nagoya University Hospital, Nagoya, JPN
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Srichawla BS, Garcia-Dominguez MA. Regional dynamic cerebral autoregulation across anterior and posterior circulatory territories: A detailed exploration and its clinical implications. World J Crit Care Med 2024; 13:97149. [PMID: 39655297 PMCID: PMC11577536 DOI: 10.5492/wjccm.v13.i4.97149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 09/24/2024] [Accepted: 10/10/2024] [Indexed: 10/31/2024] Open
Abstract
Cerebral autoregulation (CA) is the mechanism that maintains stable cerebral blood flow (CBF) despite fluctuations in systemic blood pressure, crucial for brain homeostasis. Recent evidence highlights distinct regional variations in CA between the anterior (carotid) and posterior (vertebrobasilar) circulations. Non-invasive neuromonitoring techniques, such as transcranial Doppler, transfer function analysis, and near-infrared spectroscopy, facilitate the dynamic assessment of CBF and autoregulation. Studies indicate a robust autoregulatory capacity in the anterior circulation, characterized by rapid adjustments in vascular resistance. On the contrary, the posterior circulation, mainly supplied by the vertebral arteries, may have a lower autoregulatory capacity. in acute brain injuries such as intracerebral and subarachnoid hemorrhage, and traumatic brain injuries, dynamic CA can be significantly altered in the posterior circulation. Proposed physiological mechanisms of impaired CA in the posterior circulation include: (1) Decreased sympathetic innervation of the vasculature impairing compensatory vasoreactivity; (2) Endothelial dysfunction; (3) Increased cerebral metabolic rate of oxygen consumption within the visual cortex causing CBF-metabolism (i.e., neurovascular) uncoupling; and (4) Impaired blood-brain barrier integrity leading to impaired astrocytic mediated release of vasoactive substances (e.g. nitric oxide, potassium, and calcium ions). Furthermore, more research is needed on the effects of collateral circulation, as well as the circle of Willis variants, such as the fetal-type posterior cerebral artery, on dynamic CA. Improving our understanding of these mechanisms is crucial to improving the diagnosis, prognosis, and management of various cerebrovascular disorders.
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Affiliation(s)
- Bahadar S Srichawla
- Department of Neurology, University of Massachusetts Chan Medical School, Worcester, MA 01655, United States
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Błaszczyk M, Ochwat K, Necka S, Kwiecińska M, Ostrowski P, Bonczar M, Żytkowski A, Walocha J, Mituś J, Koziej M. The Arterial Anatomy of the Cerebellum-A Comprehensive Review. Brain Sci 2024; 14:763. [PMID: 39199457 PMCID: PMC11352334 DOI: 10.3390/brainsci14080763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Revised: 07/15/2024] [Accepted: 07/24/2024] [Indexed: 09/01/2024] Open
Abstract
The cerebellum, a major feature of the hindbrain, lies posterior to the pons and medulla and inferior to the posterior part of the cerebrum. It lies beneath the tentorium cerebelli in the posterior cranial fossa and consists of two lateral hemispheres connected by the vermis. The cerebellum is primarily supplied by three arteries originating from the vertebrobasilar system: the superior cerebellar artery (SCA), the anterior inferior cerebellar artery (AICA), and the posterior inferior cerebellar artery (PICA). However, variations of the cerebellar arteries may occur, such as duplication of the SCA, SCA creating a common trunk with the posterior cerebral artery, triplication of the AICA, and agenesis of PICA, amongst others. Knowledge of the arterial anatomy of the cerebellum is crucial, as inadequate blood supply to this region can result in diminished motor functioning, significantly impacting the quality of life for patients. The present study demonstrated the importance of adequate anatomical knowledge of the arteries supplying the cerebellum. The PubMed and Embase databases were searched to gather articles on the anatomical characteristics and variations of the arterial supply of the cerebellum. It is the most comprehensive and up-to-date review available in the literature. The possible variations of these vessels may be clinically silent or present with clinical symptoms such as neurovascular compression syndromes of the cranial nerves and aneurysms. With a comprehensive understanding of the cerebellar arterial system, physicians can enhance their diagnostic and treatment capabilities, ultimately leading to more effective management of cerebellar vascular-related issues and other neurological deficits.
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Affiliation(s)
- Malwina Błaszczyk
- Department of Anatomy, Jagiellonian University Medical College, Mikołaja Kopernika 12, 33-332 Kraków, Poland (S.N.)
- Youthoria, Youth Research Organization, 30-363 Kraków, Poland
| | - Kajetan Ochwat
- Department of Anatomy, Jagiellonian University Medical College, Mikołaja Kopernika 12, 33-332 Kraków, Poland (S.N.)
- Youthoria, Youth Research Organization, 30-363 Kraków, Poland
| | - Sandra Necka
- Department of Anatomy, Jagiellonian University Medical College, Mikołaja Kopernika 12, 33-332 Kraków, Poland (S.N.)
- Youthoria, Youth Research Organization, 30-363 Kraków, Poland
| | - Maria Kwiecińska
- Department of Anatomy, Jagiellonian University Medical College, Mikołaja Kopernika 12, 33-332 Kraków, Poland (S.N.)
- Youthoria, Youth Research Organization, 30-363 Kraków, Poland
| | - Patryk Ostrowski
- Department of Anatomy, Jagiellonian University Medical College, Mikołaja Kopernika 12, 33-332 Kraków, Poland (S.N.)
- Youthoria, Youth Research Organization, 30-363 Kraków, Poland
| | - Michał Bonczar
- Department of Anatomy, Jagiellonian University Medical College, Mikołaja Kopernika 12, 33-332 Kraków, Poland (S.N.)
- Youthoria, Youth Research Organization, 30-363 Kraków, Poland
| | - Andrzej Żytkowski
- Department of Anatomy, Faculty of Medicine, University of Social Sciences in Lodz, 90-113 Lodz, Poland
| | - Jerzy Walocha
- Department of Anatomy, Jagiellonian University Medical College, Mikołaja Kopernika 12, 33-332 Kraków, Poland (S.N.)
- Youthoria, Youth Research Organization, 30-363 Kraków, Poland
| | - Jerzy Mituś
- Department of Anatomy, Jagiellonian University Medical College, Mikołaja Kopernika 12, 33-332 Kraków, Poland (S.N.)
| | - Mateusz Koziej
- Department of Anatomy, Jagiellonian University Medical College, Mikołaja Kopernika 12, 33-332 Kraków, Poland (S.N.)
- Youthoria, Youth Research Organization, 30-363 Kraków, Poland
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Muthana A, Al-Gertani MR, Ahmed FO, Etaiwi AK, Al-Badri SG, Atallah O, Algabri MH, Ismail M, Hoz SS. Occipital artery: Anatomical variations and neurosurgical applications. Surg Neurol Int 2023; 14:313. [PMID: 37810316 PMCID: PMC10559367 DOI: 10.25259/sni_598_2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 08/18/2023] [Indexed: 10/10/2023] Open
Abstract
Background The occipital artery (OA) is a branch of the external carotid artery. It gives rise to several cutaneous, muscular, and meningeal branches to supply different anatomical areas. The implication of OA in the neurosurgical field is well-established in the literature. Our aim in this study is to draw a complete picture of the anatomical variations and neurosurgical applications of the OA. Methods A literature review was conducted in Google Scholar and PubMed to review the studies discussing OA, its anatomical variation, and neurosurgical applications. Results We identified 29 articles that discuss the anatomical variations and neurosurgical applications of the OA. Certain variables are used to describe the surgical anatomy of OA. We also discussed certain applications of OA and its importance in neurosurgical bypass, embolization, and aneurysms. Conclusion Comprehending the anatomy of the OA is crucial for neurosurgeons to safely and effectively perform procedures such as bypass and embolization. In addition, knowledge of the anatomical variations of the OA can help surgeons anticipate potential challenges and tailor their approach accordingly.
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Affiliation(s)
- Ahmed Muthana
- Department of Neurosurgery, University of Baghdad, College of Medicine, Baghdad, Iraq
| | - Mustafa R. Al-Gertani
- Department of Neurosurgery, University of Mustansiriyah, College of Medicine, Baghdad, Iraq
| | - Fatimah Oday Ahmed
- Department of Neurosurgery, University of Mustansiriyah, College of Medicine, Baghdad, Iraq
| | | | - Sajjad G. Al-Badri
- Department of Neurosurgery, University of Baghdad, College of Medicine, Baghdad, Iraq
| | - Oday Atallah
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - Mostafa H. Algabri
- Department of Neurosurgery, University of Baghdad, College of Medicine, Baghdad, Iraq
| | - Mustafa Ismail
- Department of Neurosurgery, Neurosurgery Teaching Hospital, Baghdad, Iraq
| | - Samer S. Hoz
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
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Jung J, Jeong D. A comparison study of vessel twisting by different microsurgical suture techniques in a chicken wing artery side to side bypass training model. J Cerebrovasc Endovasc Neurosurg 2023; 25:260-266. [PMID: 37188332 PMCID: PMC10555616 DOI: 10.7461/jcen.2023.e2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 04/17/2023] [Accepted: 04/18/2023] [Indexed: 05/17/2023] Open
Abstract
OBJECTIVE Microvascular anastomosis, particularly side-to-side (STS) bypass, is a complex surgical procedure. While several suture techniques exist, none of them is superior to the others. We assessed the association between various STS bypass techniques and vessel twisting using chicken wing training models. METHODS Three suture techniques were compared over an anterior wall suture procedure. The unidirectional continuous suture (UCS) group used a downward "right-to-left" continuous suture. The reverse continuous suture (RCS) group used a downward "left-to-right" continuous suture. The interrupted suture (IS) group used the standard interrupted suture. The number of samples in each of the three groups was 30 (n=90). We compared the incidence of vessel twisting and rotation angles across groups. RESULTS Vessel twisting occurred in 96.7%, 56.7%, and 0% of the cases in the UCS, IS, and RCS groups, respectively. The incidence of vessel twisting differed significantly in all 3 groups (p<0.001), with an apparent trend (p=0.002). The mean rotation angles were 201˚±90.6˚, 102˚±107.6˚, and 0˚ in the UCS, IS, and RCS groups, respectively, which were significantly different (p<0.001). On excluding cases without twisting, the rotation angles of twisted vessels in the UCS and IS groups were 207.9˚±83.7˚ and 180˚±77.9˚, respectively, which yielded a significant difference between these groups (p<0.001). CONCLUSIONS We found that the incidence and trend of vessel twisting differed significantly across suture techniques. The RCS technique may aid in preventing vessel twisting in the STS bypass procedure.
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Affiliation(s)
- Junho Jung
- Department of Neurosurgery, Hallym University Dongtan Sacred Heart Hospital, Hwasung, Korea
| | - Donghwan Jeong
- Department of Neurosurgery, Danwon Hospital, Ansan, Korea
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Zhang M, Wu X, Gao K, Huang L, Wang X, Tong X. External carotid artery-radial artery graft-posterior cerebral artery bypass for complex vertebrobasilar aneurysms: efficacy and analysis of outcome in a single center. Neurosurg Rev 2023; 46:192. [PMID: 37540310 DOI: 10.1007/s10143-023-02101-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 07/21/2023] [Accepted: 07/28/2023] [Indexed: 08/05/2023]
Abstract
The purpose of this research was to demonstrate the effectiveness and clinical outcome of an external carotid artery-radial artery graft-posterior cerebral artery (ECA-RAG-PCA) bypass in the treatment of complex vertebrobasilar artery aneurysms (VBANs) in a single-center retrospective study. An ECA-RAG-PCA bypass may be a last and very important option in the treatment of complex VBANs when conventional surgical clipping or endovascular interventions fail to achieve the desired outcome. This study retrospectively analyzed the clinical presentation, case characteristics, aneurysm location, size and morphology, choice of surgical strategy, complications, clinical follow-up, and prognosis of the patients enrolled. The data involved were analyzed by the appropriate statistical methods. A total of 24 patients with complex VBANs who met the criteria were included in this study. Eighteen (75.0%) were male and the mean age was 54.1 ± 8.83 years. The aneurysms were located in the vertebral artery, the basilar artery, and in the vertebrobasilar artery with simultaneous involvement. All patients underwent ECA-RAG-PCA bypass surgery via an extended middle cranial fossa approach, with 8 (33.3%) undergoing ECA-RAG-PCA bypass only, 3 (12.5%) undergoing ECA-RAG-PCA bypass combined with aneurysm partial trapping, and 12 (50.0%) undergoing ECA-RAG-PCA bypass combined with proximal occlusion of the parent artery. The average clinical follow-up was 22.0 ± 13.35 months. The patency rate of the high-flow bypass was 100%. At the final follow-up, 15 (62.5%) patients had complete occlusion of the aneurysm, 7 (29.2%) patients had subtotal occlusion of the aneurysm, and 2 (8.3%) patients had stable aneurysms. The rate of complete and subtotal occlusion of the aneurysm at the final follow-up was 91.7%. The clinical prognosis was good in 21 (87.5%) patients and no procedure-related deaths occurred. Analysis of the good and poor prognosis groups revealed a statistically significant difference in aneurysm size (P = 0.034, t-test). Combining the results of this study and the clinical experience of our center, we propose a surgical algorithm and strategy for the treatment of complex VBANs.The technical approach of ECA-RAG-PCA bypass for complex VBANs remains important, even in an era of rapid advances in endovascular intervention. When conventional surgical clipping or endovascular intervention has failed, an ECA-RAG-PCA bypass plays a role that cannot be abandoned and is a very important treatment option of last resort.
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Affiliation(s)
- Meng Zhang
- School of Medicine, Nankai University, 94 Weijin Road, 300071, Tianjin, China
| | - Xiangchen Wu
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China
| | - Kaiming Gao
- School of Medicine, Nankai University, Huanhu Hospital Affiliated to Nankai University, Tianjin Huanhu Hospital, No. 6, Jizhao Road, Jinnan District, Tianjin, China
| | - Litian Huang
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China
| | - Xingdong Wang
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China
| | - Xiaoguang Tong
- School of Medicine, Nankai University, 94 Weijin Road, 300071, Tianjin, China.
- School of Medicine, Nankai University, Huanhu Hospital Affiliated to Nankai University, Tianjin Huanhu Hospital, No. 6, Jizhao Road, Jinnan District, Tianjin, China.
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Cohen MA, Evins AI, Pinheiro L, Nonaka M, Xia JJ, Stieg PE, Bernardo A. Quantitative analysis of external carotid artery bypass donor vessels by recipient and approach. J Clin Neurosci 2023; 114:110-119. [PMID: 37390774 DOI: 10.1016/j.jocn.2023.06.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/05/2023] [Accepted: 06/24/2023] [Indexed: 07/02/2023]
Abstract
INTRODUCTION Utilization an in-situ pedicle of the external carotid artery (ECA) as an arterial donor can allow for the successful augmentation or replacement of flow to a large vascular territory. We propose a mathematical model for quantitatively analyzing and grading the suitability of donor and recipient bypass vessels based on a set of anatomical and surgical variables in order to predict which pair has the greatest possibility for success. Using this method, we analyze all of the potential donor-recipient pairs for each ECA donor vessel-including the superficial temporal (STA), middle meningeal (MMA), and occipital (OA) arteries. METHODS The ECA pedicles were dissected in frontotemporal, middle fossa, subtemporal, retrosigmoid, far lateral, suboccipital, supracerebellar, and occipital transtentorial approaches. For each approach, every potential donor-recipient pair was identified, and donor length and diameter were measured as well as depth of field, angle of exposure, ease of proximal control, maneuverability, and length and diameter of the recipient segment. Anastomotic pair scores were determined by adding the weighted donor and recipient. RESULTS The best overall anastomotic pairs were OA-vertebral artery (V3, 17.1) and STA-insular (M2, 16.3) and STA-sylvian (M3, 15.9) segments of the middle cerebral artery. Other strong anastomotic combinations were OA- telovelotonsillar (15) and OA- tonsilomedullary (14.9) segments of the posterior inferior cerebellar artery, and MMA-lateral pontomesencephalic segment of the superior cerebellar artery (14.2). CONCLUSIONS This novel model for anastamotic pair scoring can serve as a useful clinical tool for selecting the optimal donor, recipient, and approach combination that can help facilitate a successful bypass.
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Affiliation(s)
- Michael A Cohen
- Department of Neurological Surgery, Weill Cornell Medicine / NewYork-Presbyterian Hospital, New York, New York, USA; Northern Light Neurosurgery and Spine, Bangor, ME, USA
| | - Alexander I Evins
- Department of Neurological Surgery, Weill Cornell Medicine / NewYork-Presbyterian Hospital, New York, New York, USA
| | - Leon Pinheiro
- Department of Neurological Surgery, Weill Cornell Medicine / NewYork-Presbyterian Hospital, New York, New York, USA; Department of Neurology, Psychology and Psychiatry, Division of Neurosurgery, Botucatu Medical School-UNESP São Paulo State University, Botucatu, São Paulo, Brazil
| | - Motonobu Nonaka
- Department of Neurological Surgery, Weill Cornell Medicine / NewYork-Presbyterian Hospital, New York, New York, USA; Department of Neurosurgery, Kochi University Hospital, Kochi, Japan
| | - Jimmy J Xia
- Department of Neurological Surgery, Weill Cornell Medicine / NewYork-Presbyterian Hospital, New York, New York, USA; Department of Radiology, Weill Cornell Medicine / NewYork-Presbyterian Hospital, New York, New York, USA
| | - Philip E Stieg
- Department of Neurological Surgery, Weill Cornell Medicine / NewYork-Presbyterian Hospital, New York, New York, USA
| | - Antonio Bernardo
- Department of Neurological Surgery, Weill Cornell Medicine / NewYork-Presbyterian Hospital, New York, New York, USA.
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SAKAMOTO Y, MAEDA K, TAKEMOTO M, CHOO J, IKEZAWA M, FUJITA O, SAGO F, SOMIYA D, IKEDA A. A Case of Proximal Posterior Inferior Cerebellar Artery (PICA) Aneurysm Treated with PICA-to-PICA Bypass and Trapping Surgery: Comparison with Occipital Artery-PICA Bypass. NMC Case Rep J 2022; 9:129-133. [PMID: 35756187 PMCID: PMC9217146 DOI: 10.2176/jns-nmc.2022-0028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 03/23/2022] [Indexed: 11/28/2022] Open
Abstract
Posterior inferior cerebellar artery (PICA) aneurysms often require cerebral vascular reconstruction for surgical treatment because of their characteristic morphology. Despite its potential complications, the occipital artery-to-posterior inferior cerebellar artery (OA-PICA) bypass is a typical treatment because of its versatility. Although a few cases of intracranial-to-intracranial bypass have been reported, this type of vascular reconstruction is only regarded as an alternative to the OA-PICA bypass because of the uncertainty of bypass feasibility and potential risk of ischemic complications. In this article, we report a case of proximal PICA ruptured aneurysm that was treated with a PICA-to-PICA (PICA-PICA) bypass. A 79-year-old man presented with a chief complaint of sudden, severe headache and disturbances in consciousness. Radiological examination revealed a right proximal PICA fusiform aneurysm. The patient had many systemic disorders such as microscopic polyangiitis and steroid-induced diabetes mellitus that could have caused wound dehiscence and cerebrospinal fluid (CSF) leakage. We performed the PICA-PICA bypass and trapping surgery rather than the OA-PICA bypass to avoid skin problems and CSF leakage. The postoperative course was uneventful, and the patient was discharged on day 64 without any neurological disorders. In comparison with the OA-PICA bypass, the PICA-PICA bypass is less likely to cause CSF leakage and skin complications, although it carries the risk of specific ischemic complications and requires advanced surgical techniques. For some patients with systemic disorders, the PICA-PICA bypass could be an optimal treatment option for proximal fusiform PICA aneurysms rather than as an alternative to the OA-PICA bypass.
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Affiliation(s)
- Yusuke SAKAMOTO
- Department of Neurosurgery, Japan Community Health Care Organization Chukyo Hospital
| | - Kenko MAEDA
- Department of Neurosurgery, Japan Community Health Care Organization Chukyo Hospital
| | - Masaya TAKEMOTO
- Department of Neurosurgery, Japan Community Health Care Organization Chukyo Hospital
| | - Jungsu CHOO
- Department of Neurosurgery, Japan Community Health Care Organization Chukyo Hospital
| | - Mizuka IKEZAWA
- Department of Neurosurgery, Japan Community Health Care Organization Chukyo Hospital
| | - Ohju FUJITA
- Department of Neurosurgery, Japan Community Health Care Organization Chukyo Hospital
| | - Fumihiro SAGO
- Department of Neurosurgery, Japan Community Health Care Organization Chukyo Hospital
| | - Daiki SOMIYA
- Department of Neurosurgery, Japan Community Health Care Organization Chukyo Hospital
| | - Akira IKEDA
- Department of Neurosurgery, Japan Community Health Care Organization Chukyo Hospital
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Zakaria J, Gonzalez SM, Serrone JC. Destructive strategies in treating cerebrovascular pathology: Review and treatment algorithm. Rev Neurol (Paris) 2022; 178:1031-1040. [PMID: 36137828 DOI: 10.1016/j.neurol.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 05/27/2022] [Accepted: 06/08/2022] [Indexed: 12/14/2022]
Abstract
The goal of cerebrovascular pathology treatment is most often to angiographically eradicate a lesion with the lowest probability of morbidity. Destructive strategies using parent vessel occlusion are less commonly considered in the modern era. We review principles of parent vessel occlusion for treatment of cerebrovascular pathology and select cases to demonstrate these principles. Many common cerebrovascular conditions have been safely and effectively treated with destructive strategies including intracranial aneurysms, traumatic craniocervical vascular injuries, and oncologic indications such as carotid blowout. Avoiding procedural morbidity in these procedures involves assessment of collaterals distal to a planned parent vessel occlusion, determination of this arterial segment's eloquence, prevention of distal migration of endovascular devices or thrombus, and prevention of stump emboli. An algorithm for case selection and method of destructive technique versus a reconstructive approach can be used. Destructive strategies for treating cerebrovascular pathology are still relevant and can be applied safely in appropriately selected cases.
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Affiliation(s)
- J Zakaria
- Loyola University Health System, Department of Neurosurgery, Maywood, IL, United States
| | - S-M Gonzalez
- Loyola Stritch School of Medicine, Maywood, IL, United States
| | - J C Serrone
- Loyola University Health System, Department of Neurosurgery, Maywood, IL, United States; Loyola Stritch School of Medicine, Maywood, IL, United States; Edward Hines Jr., VA Hospital, Department of Neurosurgery, Hines, IL, United States.
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10
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Nguyen VN, Parikh KA, Motiwala M, Erin Miller L, Barats M, Milton C, Khan NR. Surgical techniques and indications for treatment of adult moyamoya disease. Front Surg 2022; 9:966430. [PMID: 36061058 PMCID: PMC9437590 DOI: 10.3389/fsurg.2022.966430] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 07/29/2022] [Indexed: 11/17/2022] Open
Abstract
Moyamoya disease (MMD) is a chronic, progressive cerebrovascular disease involving the occlusion or stenosis of the terminal portion of the internal carotid artery (ICA) and the proximal anterior and middle cerebral arteries. Adults with MMD have been shown to progressively accumulate neurological and cognitive deficits without treatment, with a mortality rate double that of pediatric patients with MMD. Surgical intervention is the mainstay of treatment to prevent disease progression and improve clinical outcomes. Several different types of bypasses can be utilized for revascularization in MMD, including indirect, direct, and combined forms of extracranial-to-intracranial (EC-IC) bypass. Overall, the choice of appropriate technique requires consideration of the age of the patient, preoperative hemodynamics, neurologic status, and territories most at risk and in need of revascularization. Here, we will review the indications and surgical techniques for the treatment of adult MMD. Step-by-step instructions for performing several bypass variants with technical pearls are discussed.
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Affiliation(s)
- Vincent N. Nguyen
- Department of Neurological Surgery, University of Tennessee College of Medicine, Memphis, TN, United States
| | - Kara A. Parikh
- Department of Neurological Surgery, University of Tennessee College of Medicine, Memphis, TN, United States
| | - Mustafa Motiwala
- Department of Neurological Surgery, University of Tennessee College of Medicine, Memphis, TN, United States
| | - L. Erin Miller
- Department of Neurological Surgery, University of Tennessee College of Medicine, Memphis, TN, United States
| | - Michael Barats
- Department of Neurological Surgery, University of Tennessee College of Medicine, Memphis, TN, United States
| | - Camille Milton
- Department of Neurological Surgery, University of Tennessee College of Medicine, Memphis, TN, United States
| | - Nickalus R. Khan
- Department of Neurological Surgery, University of Tennessee College of Medicine, Memphis, TN, United States
- Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Institute, Memphis, TN, United States
- Correspondence: Nickalus Khan
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Luan T, Yu J. Anatomical features of the occipital artery on CTA and differences between patients with/without stenosis and occlusion of the internal carotid artery. MEDICINE INTERNATIONAL 2021; 2:3. [PMID: 36700153 PMCID: PMC9829191 DOI: 10.3892/mi.2021.28] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 12/28/2021] [Indexed: 01/28/2023]
Abstract
The understanding of the basic anatomy of the occipital artery (OA) is crucial, and computed tomography angiography is an effective tool for this purpose. In the present study, a comparison between healthy subjects and patients with internal carotid artery (ICA) stenosis and occlusion was made. The following parameters were measured: Age, sex, diameters and lengths of the OA in different locations, distance from the edge of the foramen magnum to the OA and the distance from the midline to the OA at the level of the superior nuchal line. A total of 205 participants who met the inclusion criteria were selected for further investigation. In addition, 50 healthy subjects (100 sides, left and/or right) were selected as the control group. A total of 155 patients (180 sides, left and/or right) were selected as the stenosis and occlusion groups, including the mild and moderate ICA stenosis group (50 sides, left and/or right), severe ICA stenosis group (80 sides, left and/or right) and the ICA occlusion group (50 sides, left and right). General information, measured parameters and statistical analysis results are provided for these groups. No significant differences were observed in the anatomical parameters of the OA among these groups. Thus, in addition to providing anatomical data, the present study demonstrates that stenosis and the occlusion of the ICA do not significantly alter the anatomy of the OA.
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Affiliation(s)
- Tengfei Luan
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Jinlu Yu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China,Correspondence to: Dr Jinlu Yu, Department of Neurosurgery, The First Hospital of Jilin University, 1 Xinmin Avenue, Changchun, Jilin 130021, P.R. China ;
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12
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Uda K, Tanahashi K, Mamiya T, Kanamori F, Yokoyama K, Nishihori M, Izumi T, Araki Y, Saito R. Advantages of petrosectomy for superficial temporal artery to superior cerebellar artery bypass based on three-dimensional distance measurements using cadaver heads. Neurosurg Rev 2021; 45:1617-1624. [PMID: 34735687 PMCID: PMC8976806 DOI: 10.1007/s10143-021-01686-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 09/28/2021] [Accepted: 10/26/2021] [Indexed: 11/29/2022]
Abstract
Superficial temporal artery (STA) to superior cerebellar artery (SCA) bypass is usually performed via the subtemporal approach (StA), anterior transpetrosal approach (ApA), or combined petrosal approach (CpA), but no study has yet reported a quantitative comparison of the operative field size provided by each approach, and the optimal approach is unclear. The objective of this study is to establish evidence for selecting the approach by using cadaver heads to measure the three-dimensional distances that represent the operative field size for STA-SCA bypass. Ten sides of 10 cadaver heads were used to perform the four approaches: StA, ApA with and without zygomatic arch osteotomy (ApA-ZO- and ApA-ZO+), and CpA. For each approach, the major-axis length and the minor-axis length at the anastomosis site (La-A and Li-A), the major-axis length and the minor-axis length at the brain surface (La-B and Li-B), the depth from the brain surface to the anastomosis site (Dp), and the operating angles of the major axis and the minor axis (OAa and OAi) were measured. Shallower Dp and wider operating angle were obtained in the order CpA, ApA-ZO+, ApA-ZO-, and StA. In all parameters, ApA-ZO- extended the operative field more than StA. ApA-ZO+ extended La-B and OAa more than ApA-ZO-, whereas it did not contribute to Dp and OAi. CpA significantly decreased Dp, and widened OAa and OAi more than ApA-ZO+. ApA and CpA greatly expanded the operative field compared with StA. These results provide criteria for selecting the optimal approach for STA-SCA bypass in light of an individual surgeon's anastomosis skill level.
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Affiliation(s)
- Kenji Uda
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho Showa-ku Nagoya, Aichi, 466-8550, Japan.
| | - Kuniaki Tanahashi
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho Showa-ku Nagoya, Aichi, 466-8550, Japan
| | - Takashi Mamiya
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho Showa-ku Nagoya, Aichi, 466-8550, Japan
| | - Fumiaki Kanamori
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho Showa-ku Nagoya, Aichi, 466-8550, Japan
| | - Kinya Yokoyama
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho Showa-ku Nagoya, Aichi, 466-8550, Japan
| | - Masahiro Nishihori
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho Showa-ku Nagoya, Aichi, 466-8550, Japan
| | - Takashi Izumi
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho Showa-ku Nagoya, Aichi, 466-8550, Japan
| | - Yoshio Araki
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho Showa-ku Nagoya, Aichi, 466-8550, Japan
| | - Ryuta Saito
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho Showa-ku Nagoya, Aichi, 466-8550, Japan
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13
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Morphologic characterization of the superior cerebellar artery. A direct anatomic study. TRANSLATIONAL RESEARCH IN ANATOMY 2021. [DOI: 10.1016/j.tria.2021.100150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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14
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Longatti P, Fiorindi A, Marton E, Sala F, Feletti A. Where the central canal begins: endoscopic in vivo description. J Neurosurg 2021; 136:895-904. [PMID: 34388726 DOI: 10.3171/2020.12.jns203649] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 12/30/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Although evidence and descriptions of the central canal (CC) along the medulla oblongata and the spinal cord have been provided by several anatomical and radiological studies, a clear picture and assessment of the opening of the CC, or apertura canalis centralis (ACC), into the fourth ventricle is lacking, due to its submillimetric size and hidden position in the calamus scriptorius. METHODS The authors reviewed all of their cases in which patients underwent ventricular transaqueductal flexible endoscopic procedures and selected 44 cases in which an inspection of the region of the calamus scriptorius had been performed and was suitable for study inclusion. Patients were divided into different groups, based on the presence or absence of a chronic pathological process involving the fourth ventricle. In each case, the visual appearance of the opening of the CC of the ACC was classified as no evidence (A0), indirect evidence (A1), or clear evidence (A2). Morphometric measurements were inferred from surrounding structures and the size of surgical tools visible in the field. RESULTS The opening of the CC could be clearly observed in all cases (A1 4.5%, A2 95.5%). In normal cases, a lanceolate shape along the median sulcus was most frequently found, with an average size of 600 × 250 µm that became rounded and smaller in size in cases of hydrocephalus. The distance between the caudal margin of the ACC and the obex was about 1.8 mm in normal cases, 2.1 mm in cases of obstructive hydrocephalus, and 1 mm in cases of normal pressure hydrocephalus. The two wings of the area postrema, variable in size and shape, were sited just caudal to the opening. CONCLUSIONS A flexible scope inserted through the cerebral aqueduct can approach the hidden calamus scriptorius like a pen fits into an inkpot. With this privileged viewpoint, the authors provide for the first time, to their knowledge, a clear and novel vision of the opening of the CC in the fourth ventricle, along with the precise location of this tiny structure compared to other anatomical landmarks in the inferior triangle.
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Affiliation(s)
| | | | - Elisabetta Marton
- 3Neurosurgical Department, Treviso Regional Hospital-University of Padova, Treviso; and
| | - Francesco Sala
- 4Department of Neurosciences, Biomedicine, and Movement Sciences, Institute of Neurosurgery, University of Verona, Italy
| | - Alberto Feletti
- 4Department of Neurosciences, Biomedicine, and Movement Sciences, Institute of Neurosurgery, University of Verona, Italy
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15
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Imahori T, Yamamoto Y, Miura S, Higashino M, Sugihara M, Mizobe T, Aihara H, Hosoda K, Tanaka K, Sasayama T, Kohmura E. Ruptured vertebral artery dissecting aneurysms involving a dominant posterior inferior cerebellar artery origin: A preferred indication for bypass surgery in clinical practice. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2020.100999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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16
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Otawa M, Izumi T, Nishihori M, Tsukada T, Oshima R, Kawaguchi T, Goto S, Ikezawa M, Elisabeth Kropp A, Araki Y, Yokoyama K, Uda K, Wakabayashi T. A case of internal trapping to a thrombosed giant rapidly growing aneurysm at the posterior cerebral artery. NAGOYA JOURNAL OF MEDICAL SCIENCE 2020; 82:557-566. [PMID: 33132439 PMCID: PMC7548258 DOI: 10.18999/nagjms.82.3.557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We describe a case of internal trapping including the vasa vasorum for a thrombosed giant rapidly growing posterior cerebral artery aneurysm and performing a detailed analysis. A 48-year-old woman was followed up in our hospital for a thrombosed large posterior cerebral artery aneurysm located in the P2 segment. She initially presented after experiencing a sudden headache on two occasions. Head computed tomography and magnetic resonance imaging indicated a larger aneurysm than before. Digital subtraction angiography with balloon occlusion test was assessed, and internal trapping was sequentially conducted. We detected that the vasa vasorum originated from the posterior temporal artery. Therefore, we embolized the posterior temporal artery including the vasa vasorum using N-butyl-2-cyanoacrylate and Lipiodol. Next, the anterior temporal artery was embolized with N-butyl-2-cyanoacrylate and Lipiodol, posterior temporal artery P3 segment and the aneurysm and finally the proximal P2 segment were embolized with coils. Final vertebral and internal carotid angiography showed complete obliteration of the aneurysm. On the day after the procedure her paresis worsened and she developed left upper quadrantanopia, however was finally discharged with no hemiparesis. We reported a case of a rapidly growing thrombosed giant posterior cerebral artery aneurysm treated by parent artery occlusion including the vasa vasorum with detailed image analysis.
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Affiliation(s)
- Masato Otawa
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takashi Izumi
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masahiro Nishihori
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tetsuya Tsukada
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Ryosuke Oshima
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tomomi Kawaguchi
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shunsaku Goto
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Mizuka Ikezawa
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Asuka Elisabeth Kropp
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshio Araki
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kinya Yokoyama
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kenji Uda
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toshihiko Wakabayashi
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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17
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Fiaschi P, Scala M, Piatelli G, Tortora D, Secci F, Cama A, Pavanello M. Limits and pitfalls of indirect revascularization in moyamoya disease and syndrome. Neurosurg Rev 2020; 44:1877-1887. [PMID: 32959193 PMCID: PMC8338852 DOI: 10.1007/s10143-020-01393-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 08/11/2020] [Accepted: 09/15/2020] [Indexed: 11/28/2022]
Abstract
Moyamoya vasculopathy is a rare chronic cerebrovascular disorder characterized by the stenosis of the terminal branches of the internal carotid arteries and the proximal tracts of anterior and middle cerebral arteries. Although surgical revascularization does not significantly change the underlying pathogenic mechanisms, it plays a pivotal role in the management of affected individuals, allowing to decrease the risk of ischemic and hemorrhagic complications. Surgical approaches may be direct (extracranial-intracranial bypass), indirect, or a combination of the two. Several indirect techniques classifiable according to the tissue (muscle, periosteum, galea, dura mater, and extracranial tissues) or vessel (artery) used as a source of blood supply are currently available. In this study, we reviewed the pertinent literature and analyzed the advantages, disadvantages, and pitfalls of the most relevant indirect revascularization techniques. We discussed the technical aspects and the therapeutical implications of each procedure, providing a current state-of-the-art overview on the limits and pitfalls of indirect revascularization in the treatment of moyamoya vasculopathy.
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Affiliation(s)
- Pietro Fiaschi
- Department of Neurosurgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Marcello Scala
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy. .,Department of Neurosurgery, IRCCS Istituto Giannina Gaslini, Via Gerolamo Gaslini, Genoa, Italy.
| | - Gianluca Piatelli
- Department of Neurosurgery, IRCCS Istituto Giannina Gaslini, Via Gerolamo Gaslini, Genoa, Italy
| | - Domenico Tortora
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Francesca Secci
- Department of Neurosurgery, IRCCS Istituto Giannina Gaslini, Via Gerolamo Gaslini, Genoa, Italy
| | - Armando Cama
- Department of Neurosurgery, IRCCS Istituto Giannina Gaslini, Via Gerolamo Gaslini, Genoa, Italy
| | - Marco Pavanello
- Department of Neurosurgery, IRCCS Istituto Giannina Gaslini, Via Gerolamo Gaslini, Genoa, Italy
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18
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Nisson PL, Ding X, Tayebi Meybodi A, Palsma R, Benet A, Lawton MT. Revascularization of the Posterior Inferior Cerebellar Artery Using the Occipital Artery: A Cadaveric Study Comparing the p3 and p1 Recipient Sites. Oper Neurosurg (Hagerstown) 2020; 19:E122-E129. [PMID: 32107553 DOI: 10.1093/ons/opaa023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 01/01/2020] [Indexed: 12/19/2022] Open
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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Affiliation(s)
- Peyton L Nisson
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.,Department of Neurosurgery, Cedar Sinai, Beverly Hills, California
| | - Xinmin Ding
- ShanXi Province People's Hospital, Yinze District, Taiyuan, China
| | - Ali Tayebi Meybodi
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Ryan Palsma
- College of Medicine, University of Arizona, Tucson, Arizona
| | - Arnau Benet
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Michael T Lawton
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
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19
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Ballesteros LE, Forero PL, Estupiñan HY. Morphologic characterization of the anterior inferior cerebellar artery: a direct anatomic study. Neurol Res 2020; 42:828-834. [PMID: 32584208 DOI: 10.1080/01616412.2020.1785743] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE An adequate knowledge of the anterior inferior cerebellar artery (AICA) is oriented to the morphological sciences, clinical management and surgical planning of the posterior fossa. We aimed to determine the morphology of AICA in a sample from Colombian population. METHOD We studied 92 AICA from fresh cadavers. For each specimen, the vertebral arteries were injected with 100 cc of semi-synthetic resin (a mixture of Palatal E210® BASF 80 cc and Styrene 20 cc) dyed with mineral red. The biometrics and morphological variables of AICA were registered. RESULTS AICA originated at 9.9 ± 3.2 mm from the vertebrobasilar junction. In 12 samples (8.1%), we observed a common trunk between AICA and posterior inferior cerebellar artery, which presented a caliber of 1.56 ± 0.23 mm and a length of 11.3 Â ± 3. 53 mm. In 80 (51.3%) specimens, AICA was originated from the proximal segment of basilar artery, while in 76 (48.7%) of them emerged from the medium segment. The AICA bifurcation distance from its origin was less than 20 mm in 20.5% of cases; between 20 and 40 mm in 62.3%. In its trajectory, AICA passed ventral to the facial nerve in 85 samples (53.2%), dorsal to the facial nerve in 68 samples (43.6%) and between the roots in 5 samples (3.2%). CONCLUSIONS The origin of the AICA from the proximal segment of the basilar artery is confirmed in this study, which disagrees with reports that point out its origin in the middle segment.
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Affiliation(s)
- L E Ballesteros
- Department of Basic Sciences, Medicine School, Universidad Industrial De Santander , Bucaramanga, Colombia
| | - P L Forero
- Department of Pathology, Medicine School, Universidad Industrial De Santander , Bucaramanga, Colombia.,Forensic pathology, National Institute of Legal Medicine and Forensic Sciences , Bucaramanga, Colombia
| | - H Y Estupiñan
- Department of Basic Sciences, Medicine School, Universidad Industrial De Santander , Bucaramanga, Colombia
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20
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Hatano Y, Ota N, Noda K, Okada Y, Suzuki Y, Fukuyama S, Tanada S, Hashimoto A, Kondo T, Miyazaki T, Kinoshita Y, Kamiyama H, Tokuda S, Tanikawa R. Surgical microanatomy of the occipital artery for suboccipital muscle dissection and intracranial artery reconstruction. Surg Neurol Int 2019; 10:127. [PMID: 31528463 PMCID: PMC6744747 DOI: 10.25259/sni-16-2019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 05/01/2019] [Indexed: 11/23/2022] Open
Abstract
Background: The occipital artery (OA) is an important donor artery for posterior fossa revascularization. Harvesting the OA is difficult in comparison to the superficial temporal artery because the OA runs between suboccipital muscles. Anatomical knowledge of the suboccipital muscles and OA is essential for harvesting the OA during elevation of the splenius capitis muscle (SPL) for reconstruction of the posterior inferior cerebellar artery. We analyzed the running pattern of the OA and its anatomic variations using preoperative and intraoperative findings. Methods: From April 2012 to March 2018, we surgically treated 162 patients with suboccipital muscle dissection by OA dissection using the lateral suboccipital approach. The running pattern and relationship between the suboccipital muscles and OA were retrospectively analyzed using the operation video and preoperative enhanced computed tomography (CT) images. The anatomic variation in the running pattern of the OA was classified into two types: lateral type, running lateral to the muscle and medial type, running medial to the longissimus capitis muscle (LNG). Results: The medial pattern was observed in 107 (66%) patients and the lateral pattern in 54 (33.3%); 1 (0.6%) patient had the OA running between the LNGs. Conclusion: Preoperative CT is effective in determining the running course of the OA, which is important for safely harvesting the OA during SPL elevation. There is a risk of causing OA injury in patients with the lateral pattern. This is the first report showing that the OA rarely runs in between the LNGs.
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Affiliation(s)
- Yuto Hatano
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Higashi-ku, Sapporo, Hokkaido, Japan
| | - Nakao Ota
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Higashi-ku, Sapporo, Hokkaido, Japan
| | - Kosumo Noda
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Higashi-ku, Sapporo, Hokkaido, Japan
| | - Yasuaki Okada
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Higashi-ku, Sapporo, Hokkaido, Japan
| | - Yosuke Suzuki
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Higashi-ku, Sapporo, Hokkaido, Japan
| | - Shusei Fukuyama
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Higashi-ku, Sapporo, Hokkaido, Japan
| | - Shuichi Tanada
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Higashi-ku, Sapporo, Hokkaido, Japan
| | - Atsumu Hashimoto
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Higashi-ku, Sapporo, Hokkaido, Japan
| | - Tomomasa Kondo
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Higashi-ku, Sapporo, Hokkaido, Japan
| | - Takanori Miyazaki
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Higashi-ku, Sapporo, Hokkaido, Japan
| | - Yu Kinoshita
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Higashi-ku, Sapporo, Hokkaido, Japan
| | - Hiroyasu Kamiyama
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Higashi-ku, Sapporo, Hokkaido, Japan
| | - Sadahisa Tokuda
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Higashi-ku, Sapporo, Hokkaido, Japan
| | - Rokuya Tanikawa
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Higashi-ku, Sapporo, Hokkaido, Japan
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21
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Guo Y, Chen H, Chen X, Yu J. Clinical importance of the occipital artery in vascular lesions: A review of the literature. Neuroradiol J 2019; 32:366-375. [PMID: 31188082 DOI: 10.1177/1971400919857245] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The occipital artery (OA) is a critical artery in vascular lesions. However, a comprehensive review of the importance of the OA is currently lacking. In this study, we used the PubMed database to perform a review of the literature on the OA to increase our understanding of its role in vascular lesions. We also provided our typical cases to illustrate the importance of the OA. The OA has several variations. For example, it may arise from the internal carotid artery or anastomose with the vertebral artery. Therefore, the OA may provide a crucial collateral vascular supply source and should be preserved in these cases. The OA is a good donor artery. Consequently, it is used in extra- to intracranial bypasses for moyamoya disease (MMD) or aneurysms. The OA can be involved in dural arteriovenous fistula (DAVF) and is a feasible artery for the embolisation of DAVF. True aneurysms and pseudoaneurysms can occur in the OA; surgical resection and embolisation are the effective treatment approaches. Direct high-flow AVF can occur in the OA; embolisation treatment is a good option in such cases. The OA can also be involved in MMD and brain arteriovenous malformation (AVM) by forming transdural collaterals. For a patient in the prone position, if occipital and suboccipital craniotomies are performed, the OA can also be used for intraoperative angiography. In brief, the OA is a very important artery in vascular lesions.
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Affiliation(s)
- Yunbao Guo
- Department of Neurosurgery, The First Hospital of Jilin University, PR China
| | - Hao Chen
- Department of Neurosurgery, The First Hospital of Jilin University, PR China
| | - Xuan Chen
- Department of Neurosurgery, The First Hospital of Jilin University, PR China
| | - Jinlu Yu
- Department of Neurosurgery, The First Hospital of Jilin University, PR China
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22
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Mascitelli JR, Gandhi S, Tayebi Meybodi A, Lawton MT. The oculomotor-tentorial triangle. Part 2: a microsurgical workspace for vascular lesions in the crural and ambient cisterns. J Neurosurg 2019; 130:1435-1445. [PMID: 29957110 DOI: 10.3171/2018.2.jns173141] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 02/16/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Pathology in the region of the basilar quadrifurcation, anterolateral midbrain, medial tentorium, and interpeduncular and ambient cisterns may be accessed anteriorly via an orbitozygomatic (OZ) craniotomy. In Part 1 of this series, the authors explored the anatomy of the oculomotor-tentorial triangle (OTT). In Part 2, the versatility of the OTT as a surgical workspace for treating vascular pathology is demonstrated. METHODS Sixty patients with 61 vascular pathologies treated within or via the OTT from 1998 to 2017 by the senior author were retrospectively reviewed. Patients were grouped together based on pathology/surgical procedure and included 1) aneurysms (n = 19); 2) posterior cerebral artery (PCA)/superior cerebellar artery (SCA) bypasses (n = 24); 3) brainstem cavernous malformations (CMs; n = 14); and 4) tentorial region dural arteriovenous fistulas (dAVFs; n = 4). The majority of patients were approached via an OZ craniotomy, wide sylvian fissure split, and temporal lobe mobilization to widen the OTT. RESULTS Aneurysm locations included the P1-P2 junction (n = 7), P2A segment (n = 9), P2/3 (n = 2), and basilar quadrification (n = 1). Aneurysm treatments included clip reconstruction (n = 12), wrapping (n = 3), proximal occlusion (n = 2), and trapping with (n = 1) or without (n = 1) bypass. Pathologies in the bypass group included vertebrobasilar insufficiency (VBI; n = 3) and aneurysms of the basilar trunk (n = 13), basilar apex (n = 4), P1 PCA (n = 2), and s1 SCA (n = 2). Bypasses included M2 middle cerebral artery (MCA)-radial artery graft (RAG)-P2 PCA (n = 8), M2 MCA-saphenous vein graft (SVG)-P2 PCA (n = 3), superficial temporal artery (STA)-P2 PCA (n = 5) or STA-s1 SCA (n = 3), s1 SCA-P2 PCA (n = 1), V3 vertebral artery (VA)-RAG-s1 SCA (n = 1), V3 VA-SVG-P2 PCA (n = 1), anterior temporal artery-s1 SCA (n = 1), and external carotid artery (ECA)-SVG-s1 SCA (n = 1). CMs were located in the midbrain (n = 10) or pontomesencephalic junction (n = 4). dAVFs drained into the tentorial, superior petrosal, cavernous, and sphenobasal sinuses. High rates of aneurysm occlusion (79%), bypass patency (100%), complete CM resection (86%), and dAVF obliteration (100%) were obtained. The overall rate of permanent oculomotor nerve palsy was 8.3%. The majority of patients in the aneurysm (94%), CM (93%), and dAVF (100%) groups had stable or improved modified Rankin Scale scores. CONCLUSIONS The OTT is an important anatomical triangle and surgical workspace for vascular lesions in and around the crural and ambient cisterns. The OTT can be used to approach a wide variety of vascular pathologies in the region of the basilar quadrifurcation and anterolateral midbrain.
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Rennert RC, Ravina K, Strickland BA, Bakhsheshian J, Carey J, Russin JJ. Radial Artery Fascial Flow-Through Free Flap for Complex Cerebral Revascularization: Technical Notes and Long-Term Neurologic and Radiographic Outcomes. Oper Neurosurg (Hagerstown) 2019; 16:424-434. [PMID: 29920593 DOI: 10.1093/ons/opy124] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 04/20/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Surgical innovation is critical for the management of challenging cerebrovascular pathology. Flow-through free flaps are versatile composite grafts that combine viable tissue with a revascularization source. Neurosurgical experience with these flaps is limited. OBJECTIVE To provide an in-depth technical description of the radial artery fascial (and fasciocutaneous) flow-through free flap (RAFF and RAFCF, respectively) for complex cerebral revascularizations. METHODS An Institutional Review Board-approved, prospective database was retrospectively reviewed to identify patients that underwent extracranial-to-intracranial cerebral bypass with a RAFF or RAFCF. Patient demographics, underlying pathology, surgical treatment, complications, and outcomes were recorded. RESULTS A total of 4 patients were treated with RAFFs or RAFCFs (average age 40 ± 8.8 yr). Two patients with progressive moyamoya disease involving multiple vascular territories with predominantly anterior cerebral artery (ACA) symptoms and flow alterations underwent combined direct ACA and indirect middle cerebral artery (MCA) bypass with a RAFF. The third patient with moyamoya disease and concomitant proximal fusiform aneurysms requiring internal carotid artery sacrifice underwent dual direct ACA and MCA bypass and indirect MCA revascularization with posterior tibial artery and RAFF grafts. The fourth patient with a large MCA bifurcation aneurysm and recurrent wound complications underwent a direct MCA bypass and complex wound reconstruction using a RAFCF. Good neurologic outcomes (Glasgow Outcomes Scale score ≥4 at discharge) were achieved in all patients. There were no perioperative surgical complications, and graft patency was confirmed on long-term follow-up. CONCLUSION The RAFF and RAFCF are versatile grafts for complex cerebral revascularizations.
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Affiliation(s)
- Robert C Rennert
- Department of Neurological Surgery, University of California San Diego, San Diego, California
| | - Kristine Ravina
- Neurorestoration Center, Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Ben A Strickland
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Joshua Bakhsheshian
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Joseph Carey
- Department of Plastic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Jonathan J Russin
- Neurorestoration Center, Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
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Dai K, Song Z, Gao Y, Zheng J, Liu Z. Occipital artery to upper posterior circulation bypass through the presigmoid approach in revascularization of the posterior circulation: An anatomical study. J Clin Neurosci 2019; 63:209-212. [PMID: 30738739 DOI: 10.1016/j.jocn.2019.01.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 11/13/2018] [Accepted: 01/18/2019] [Indexed: 11/30/2022]
Abstract
We describe a novel extracranial (EC)-to-intracranial (IC) bypass technique between the occipital artery and upper posterior circulation (UPC) for revascularization of the posterior circulation through the presigmoid approach. Five formalin-fixed human heads were examined to demonstrate the detailed anatomy of the occipital artery and UPC and illustrate the step-by-step bypass procedure. The occipital artery, a branch of the external carotid artery, can be anastomosed to the P2/P3 segment of the posterior cerebral artery and S1/S2 segments of the superior cerebellar artery as an alternative to EC bypass donor segments for treatment of affection requiring revascularization. Presigmoid approach for the anastomosis of the occipital artery to the UPC provides a shorter distance, due to resection of some bones.
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Affiliation(s)
- Kefang Dai
- Department of Neurosurgery, Xingtai Third Hospital, Xingtai, Hebei, China
| | - Zhijun Song
- Department of Neurosurgery, Xingtai Third Hospital, Xingtai, Hebei, China
| | - Yikuan Gao
- Department of Neurosurgery, Central Hospital of Yongzhou, Yongzhou, China
| | - Jun Zheng
- Department of Neurosurgery, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zhenlin Liu
- Department of Neurosurgery, Affiliated Hospital of Logistics University of Chinese People's Armed Police Forces, Tianjin 30052, China.
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25
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Matsushima T, Matsushima K, Kobayashi S, Lister JR, Morcos JJ. The microneurosurgical anatomy legacy of Albert L. Rhoton Jr., MD: an analysis of transition and evolution over 50 years. J Neurosurg 2018; 129:1331-1341. [PMID: 29393756 DOI: 10.3171/2017.7.jns17517] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 07/13/2017] [Indexed: 11/06/2022]
Abstract
The authors chronologically categorized the 160 original articles written by Dr. Rhoton and his fellows to show why they selected their themes and how they carried out their projects. The authors note that as neurosurgery progresses and new techniques and approaches are developed, accurate and safe treatment will depend upon continued clarification of microsurgical anatomy.
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Affiliation(s)
- Toshio Matsushima
- 1International University of Health and Welfare
- 2Neuroscience Center, Fukuoka Sanno Hospital, Fukuoka
| | - Ken Matsushima
- 3Department of Neurosurgery, Tokyo Medical University, Tokyo
| | - Shigeaki Kobayashi
- 4Medical Research and Education Center, Aizawa Hospital, Matsumoto, Japan
| | - J Richard Lister
- 5Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville; and
| | - Jacques J Morcos
- 6Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida
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26
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Wang L, Cai L, Qian H, Tanikawa R, Lawton M, Shi X. The re-anastomosis end-to-end bypass technique: a comprehensive review of the technical characteristics and surgical experience. Neurosurg Rev 2018; 42:619-629. [PMID: 30255374 DOI: 10.1007/s10143-018-1036-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 09/04/2018] [Accepted: 09/18/2018] [Indexed: 11/24/2022]
Abstract
Re-anastomosis end-to-end bypass is a straightforward subtype of intracranial-intracranial reconstruction technique that has been utilized to treat complex aneurysms and skull base tumors. This simple technique involves connecting the cut ends of an afferent and efferent artery under added tension after excising the lesion. The current study aims to provide a detailed description of the technical pitfalls, ideal anatomical sites and indications, and clinical outcomes for intracranial complex disorders. A literature search was performed using the terms "intracranial-intracranial bypass," "re-anastomosis bypass," "reconstructive bypass," "end-to-end bypass," and "end-to-end anastomosis" to identify pertinent articles. Articles involving end-to-end re-anastomosis combined with other bypass methods were excluded. Computer-tablet-drawn illustrations of this technique are provided to enhance comprehension. Eighty-six patients who met our search and inclusion criteria were identified between 1978 and the present. However, comprehensive descriptions of medical records and neuroimaging were available in only 41 cases (40 complex aneurysms and a skull base tumor). Of 40 reported cases of complex cerebral aneurysms treated by this technique, the overall rate of full recovery without complication is 87.5% (35/40). Meanwhile, all aneurysms were completely eliminated from the circulation, with 92.5% of bypasses being patent. End-to-end re-anastomosis remains a simple modality in the microsurgical bypass armamentarium. Safe and effective surgical outcomes can be achieved in select cases that rarely involve perforators or branches.
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Affiliation(s)
- Long Wang
- Department of Neurosurgery, SanBo Brain Hospital, Capital Medical University, No. 50, Yikesong Rd, Haidian District, Beijing, 100093, China. .,Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan. .,Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA.
| | - Li Cai
- Department of Neurosurgery, The First Affiliated Hospital of University of South China, Hengyang, China.,Arkansas Neuroscience Institute, St. Vincent Hospital, Little Rock, AR, USA
| | - Hai Qian
- Department of Neurosurgery, SanBo Brain Hospital, Capital Medical University, No. 50, Yikesong Rd, Haidian District, Beijing, 100093, China
| | - Rokuya Tanikawa
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Michael Lawton
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Xiang'en Shi
- Department of Neurosurgery, SanBo Brain Hospital, Capital Medical University, No. 50, Yikesong Rd, Haidian District, Beijing, 100093, China.
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27
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Strickland BA, Bakhsheshian J, Rennert RC, Fredrickson VL, Lam J, Amar A, Mack W, Carey J, Russin JJ. Descending Branch of the Lateral Circumflex Femoral Artery Graft for Posterior Inferior Cerebellar Artery Revascularization. Oper Neurosurg (Hagerstown) 2018; 15:285-291. [PMID: 30125010 DOI: 10.1093/ons/opx241] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 02/07/2018] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Posterior inferior cerebellar artery (PICA) revascularization can be achieved with relative ease when a contralateral PICA is present. However, without a contralateral PICA, identification of a suitable vessel alternative can be challenging due to a size mismatch. OBJECTIVE To propose the descending branch of the lateral circumflex femoral artery (DLCFA) to be an acceptable, if not preferred, arterial graft for PICA revascularization. METHODS Data from patients who underwent PICA revascularization with DLCFA grafts were obtained from an institutional review board-approved prospectively maintained database with informed consent from the patients. RESULTS Three patients, all presenting with ruptured aneurysms, were treated with PICA revascularization using the DLCFA. All cases achieved bypass patency and no ischemic events occurred during the bypass procedures. Graft spasm occurred in 2 patients. Two patients that presented with neurological deficits achieved excellent neurological outcomes and 1 suffered an anterior spinal artery stroke during a repeat endovascular treatment 1 wk after revascularization. CONCLUSION The DLCFA is favorable for PICA revascularization when a contralateral PICA is not a viable option.
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Affiliation(s)
- Ben A Strickland
- Department of Neurosurgery The Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Joshua Bakhsheshian
- Department of Neurosurgery The Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Robert C Rennert
- Department of Neurosurgery, The University of California San Diego, San Diego, California
| | - Vance L Fredrickson
- Department of Neurosurgery The Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Jordan Lam
- Department of Neurosurgery The Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Arun Amar
- Department of Neurosurgery The Keck School of Medicine of the University of Southern California, Los Angeles, California.,Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - William Mack
- Department of Neurosurgery The Keck School of Medicine of the University of Southern California, Los Angeles, California.,Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Joseph Carey
- Department of Plastic Surgery, The Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Jonathan J Russin
- Department of Neurosurgery The Keck School of Medicine of the University of Southern California, Los Angeles, California.,Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, California
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28
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Wang L, Cai L, Qian H, Lawton MT, Shi X. The In Situ Side-To-Side Bypass Technique: A Comprehensive Review of the Technical Characteristics, Current Anastomosis Approaches, and Surgical Experience. World Neurosurg 2018; 115:357-372. [DOI: 10.1016/j.wneu.2018.04.173] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 04/21/2018] [Accepted: 04/23/2018] [Indexed: 12/18/2022]
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29
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Lee BC, Lin YH, Lee CW, Liu HM, Huang A. Prediction of Borderzone Infarction by CTA in Patients Undergoing Carotid Embolization for Carotid Blowout. AJNR Am J Neuroradiol 2018; 39:1280-1285. [PMID: 29773563 DOI: 10.3174/ajnr.a5672] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 03/24/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND PURPOSE Permanent common carotid artery and/or ICA occlusion is an effective treatment for carotid blowout syndrome. Besides postoperative thromboembolic infarction, permanent common carotid artery and/or ICA occlusion may cause borderzone infarction when the collateral flow to the deprived brain territory is inadequate. In this study, we aimed to test the predictive value of CTA for post-permanent common carotid artery and/or ICA occlusion borderzone infarction in patients with carotid blowout syndrome. MATERIALS AND METHODS In this retrospective study, we included 31 patients undergoing unilateral permanent common carotid artery and/or ICA occlusion for carotid blowout syndrome between May 2009 and December 2016. The vascular diameter of the circle of Willis was evaluated using preprocedural CTA, and the risk of borderzone infarction was graded as very high risk, high risk, intermediate risk, low risk, and very low risk. RESULTS The performance of readers' consensus on CTA for predicting borderzone infarction was excellent, with an area under receiver operating characteristic curve of 0.938 (95% confidence interval, 0.85-1.00). We defined very high risk, high risk, and intermediate risk as positive for borderzone infarction, the sensitivity, specificity, positive predictive value, and negative predictive value of CTA for borderzone infarction were 100% (7/7), 62.5% (15/24), 43.8% (7/16), and 100% (15/15), respectively. The interobserver reliability was excellent (κ = 0.807). No significant difference in the receiver operating characteristic curves was found between the 2 readers (P = .114). CONCLUSIONS CTA can be used to predict borderzone infarction after permanent common carotid artery and/or ICA occlusion by measuring the collateral vessels of the circle of Willis.
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Affiliation(s)
- B-C Lee
- From the Department of Medical Imaging (B.-C.L., Y.-H.L., C.-W.L.), National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Y-H Lin
- From the Department of Medical Imaging (B.-C.L., Y.-H.L., C.-W.L.), National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - C-W Lee
- From the Department of Medical Imaging (B.-C.L., Y.-H.L., C.-W.L.), National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - H-M Liu
- Department of Radiology (H.-M.L.), Fu-Jen Catholic University Hospital, New Taipei, Taiwan
| | - A Huang
- Research Center for Adaptive Data Analysis (A.H.), National Central University, Jhongli, Taiwan
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30
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Willaert W, Tozzi F, Van Herzeele I, D’Herde K, Pattyn P. Systematic review of surgical training on reperfused human cadavers. Acta Chir Belg 2018; 118:141-151. [PMID: 29653497 DOI: 10.1080/00015458.2017.1407099] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND The role of reperfused human cadavers in surgical training has not been established. METHODS Reports describing reperfused human cadaver models in terms of simulated surgeries, the use of tools to assess technical competency and skills transfer to patients, cadaver status and reperfusion techniques were included. RESULTS Thirty-five reports were included. Most participants practised vascular (n = 27), flap (n = 6) and trauma (n = 4) procedures. Training progression was evaluated objectively in only two studies. In two publications, flap techniques were practised on cadavers and repeated successfully in patients. Eighteen studies employed whole bodies. Fresh and embalmed cadavers were both used in 17 publications. Most embalmed cadavers were formalin-fixed (n = 10), resulting in stiffness. Few trainings were offered on soft Thiel-embalmed cadavers (n = 5). Only arteries were reperfused in 20 studies, while in 13 publications, the arteries and veins were filled. Arteries and/or veins were mostly pressurized (n = 21) and arterial flow was generated in 14 studies. CONCLUSIONS Various reperfused human cadaver models exist, enabling practise of mainly vascular procedures. Preservation method determines the level of simulation fidelity. Thorough evaluation of these models as surgical training tools and transfer effectiveness is still lacking.
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Affiliation(s)
- Wouter Willaert
- Department of Gastrointestinal Surgery, Ghent University Hospital, Ghent, Belgium
| | - Francesca Tozzi
- Department of Gastrointestinal Surgery, Ghent University Hospital, Ghent, Belgium
| | - Isabelle Van Herzeele
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Katharina D’Herde
- Department of Basic Medical Sciences, Ghent University Hospital, Ghent, Belgium
| | - Piet Pattyn
- Department of Gastrointestinal Surgery, Ghent University Hospital, Ghent, Belgium
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31
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Hokari M, Asaoka K, Shimbo D, Uchida K, Itamoto K. Superficial Temporal Artery–Superior Cerebellar Artery Bypass with Anterior Petrosectomy. World Neurosurg 2018; 114:179-186. [DOI: 10.1016/j.wneu.2018.03.118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 03/16/2018] [Accepted: 03/16/2018] [Indexed: 11/24/2022]
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32
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Keser N, Avci E, Soylemez B, Karatas D, Baskaya MK. Occipital Artery and Its Segments in Vertebral Artery Revascularization Surgery: A Microsurgical Anatomic Study. World Neurosurg 2018; 112:e534-e539. [DOI: 10.1016/j.wneu.2018.01.073] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Revised: 01/08/2018] [Accepted: 01/11/2018] [Indexed: 10/18/2022]
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33
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Yağmurlu K, Kalani MYS, Chaddad-Neto F, Cevik OM, Bozkurt B, Belykh E, Doria-Netto HL, Grande AW, Preul MC, Spetzler RF. Anterior temporal artery to posterior cerebral artery bypass for revascularization of the posterior circulation: An anatomical study. J Clin Neurosci 2018; 47:337-340. [DOI: 10.1016/j.jocn.2017.10.047] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 10/11/2017] [Indexed: 10/18/2022]
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Tayebi Meybodi A, Benet A, Lawton MT. The V 3 segment of the vertebral artery as a robust donor for intracranial-to-intracranial interpositional bypasses: technique and application in 5 patients. J Neurosurg 2017; 129:691-701. [PMID: 28984522 DOI: 10.3171/2017.4.jns163195] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The V3 segment of the vertebral artery (VA) has been studied in various clinical scenarios, such as in tumors of the craniovertebral junction and dissecting aneurysms. However, its use as a donor artery in cerebral revascularization procedures has not been extensively studied. In this report, the authors summarize their clinical experience in cerebral revascularization procedures using the V3 segment as a donor. A brief anatomical description of the relevant techniques is also provided.
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35
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Hanakita S, Lenck S, Labidi M, Watanabe K, Bresson D, Froelich S. The Occipital Artery as an Alternative Donor for Low-Flow Bypass to Anterior Circulation After Internal Carotid Artery Occlusion Failure prior to Exenteration for an Atypical Cavernous Sinus Meningioma. World Neurosurg 2017; 109:10-17. [PMID: 28887285 DOI: 10.1016/j.wneu.2017.08.181] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 08/27/2017] [Accepted: 08/28/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND In skull base tumors involving the cavernous sinus, indications for aggressive resection are sparse and must be carefully examined because of their invasiveness. With careful evaluation, techniques including internal carotid artery sacrifice with or without extracranial-intracranial bypass may still be an option in some cases. Moreover, previous surgery with the sacrifice of potential donor vessels requires adjusting the revascularization strategy. We describe an occipital artery-middle cerebral artery bypass before skull base tumor resection. CASE DESCRIPTION A 47-year-old woman with a recurrent cavernous sinus meningioma was referred to our department. Because of tumor recurrence after radiotherapy and its rapid progression, radical resection, including part of the cavernous sinus, was planned. A balloon test occlusion was performed and showed good tolerance. An endovascular internal carotid artery occlusion was performed. The patient eventually experienced motor deficits and aphasia after surgery. Therefore, bypass surgery using an occipital artery-middle cerebral artery anastomosis was performed. The patient showed no exacerbation of symptoms after bypass surgery and subsequently underwent tumor resection. CONCLUSIONS The reliability of balloon test occlusion in the management of giant aneurysms may not be similarly applicable to skull base tumors. If hypoperfusion symptoms occur after occlusion of the internal carotid artery, a surgical revascularization procedure should be considered because of the risk of ischemic stroke following tumor resection. For patients whose superficial temporal artery is not available, the occipital artery can be a valuable alternative donor for low-flow bypass.
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Affiliation(s)
- Shunya Hanakita
- Department of Neurosurgery, Lariboisière Hospital, University of Paris Diderot, Paris, France
| | - Stéphanie Lenck
- Department of Neuroradiology, Lariboisière Hospital, University of Paris Diderot, Paris, France
| | - Moujahed Labidi
- Department of Neurosurgery, Lariboisière Hospital, University of Paris Diderot, Paris, France
| | - Kentaro Watanabe
- Department of Neurosurgery, Lariboisière Hospital, University of Paris Diderot, Paris, France
| | - Damien Bresson
- Department of Neurosurgery, Lariboisière Hospital, University of Paris Diderot, Paris, France
| | - Sébastien Froelich
- Department of Neurosurgery, Lariboisière Hospital, University of Paris Diderot, Paris, France.
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Matsushima K, Matsuo S, Komune N, Kohno M, Lister JR. Variations of Occipital Artery-Posterior Inferior Cerebellar Artery Bypass: Anatomic Consideration. Oper Neurosurg (Hagerstown) 2017; 14:563-571. [DOI: 10.1093/ons/opx152] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 05/31/2017] [Indexed: 11/15/2022] Open
Abstract
Abstract
BACKGROUND
Advances in diagnosis of posterior inferior cerebellar artery (PICA) aneurysms have revealed the high frequency of distal and/or dissecting PICA aneurysms. Surgical treatment of such aneurysms often requires revascularization of the PICA including but not limited to its caudal loop.
OBJECTIVE
To examine the microsurgical anatomy involved in occipital artery (OA)-PICA anastomosis at various anatomic segments of the PICA.
METHODS
Twenty-eight PICAs in 15 cadaveric heads were examined with the operating microscope to take morphometric measurements and explore the specific anatomy of bypass procedures.
RESULTS
OA bypass to the p2, p3, p4, or p5 segment was feasible with a recipient vessel of sufficient diameter. The loop wandering near the jugular foramen in the p2 segment provided sufficient length without requiring cauterization of any perforating arteries to the brainstem. Wide dissection of the cerebellomedullary fissure provided sufficient exposure for the examination of some p3 segments and all p4 segments hidden by the tonsil. OA-p5 bypass was placed at the main trunk before the bifurcation in 5 hemispheres and at the larger hemispheric trunk in others.
CONCLUSION
Understanding the possible variations of OA-PICA bypass may enable revascularization of the appropriate portion of the PICA when the parent artery must be occluded. A detailed anatomic understanding of each segment clarifies important technical nuances for the bypass on each segment. Dissection of the cerebellomedullary fissure helps to achieve sufficient exposure for the bypass procedures on most of the segments.
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Affiliation(s)
- Ken Matsushima
- Lillian S. Wells Department of Neuro-logical Surgery, University of Florida, Gainesville, Florida
- Department of Neurosurgery, Tokyo Medical University, Tokyo, Japan
| | - Satoshi Matsuo
- Lillian S. Wells Department of Neuro-logical Surgery, University of Florida, Gainesville, Florida
| | - Noritaka Komune
- Lillian S. Wells Department of Neuro-logical Surgery, University of Florida, Gainesville, Florida
| | - Michihiro Kohno
- Department of Neurosurgery, Tokyo Medical University, Tokyo, Japan
| | - J Richard Lister
- Lillian S. Wells Department of Neuro-logical Surgery, University of Florida, Gainesville, Florida
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37
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Kobayashi S, Morita A. The History of Neuroscience and Neurosurgery in Japan. ACTA ACUST UNITED AC 2017. [DOI: 10.17795/inj867] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Shigeaki Kobayashi
- Medical Research and Education Center, Stroke and Brain Center, Aizawa Hospital, Matsumoto , Japan
| | - Akio Morita
- Medical Research and Education Center, Stroke and Brain Center, Aizawa Hospital, Matsumoto , Japan
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Abe H, Miki K, Kobayashi H, Ogata T, Iwaasa M, Matsushima T, Inoue T. Unilateral Trans-cerebellomedullary Fissure Approach for Occipital Artery to Posterior Inferior Cerebellar Artery Bypass during Aneurysmal Surgery. Neurol Med Chir (Tokyo) 2017; 57:284-291. [PMID: 28484132 PMCID: PMC5495960 DOI: 10.2176/nmc.oa.2016-0319] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Occipital artery (OA) to the posterior inferior cerebellar artery (PICA) bypass is indispensable for the management of complex aneurysms of the PICA that cannot be reconstructed with surgical clipping or coil embolization. Although OA-PICA bypass is a comparatively standard procedure, the bypass is difficult to perform in some cases because of the location and situation of the PICA. We describe the usefulness of the unilateral trans-cerebellomedullary fissure (CMF) approach for OA-PICA bypass. Thirty patients with aneurysms in the vertebral artery (VA) or PICA were treated using OA-PICA bypasses between 2010 and 2015. Among them, the unilateral trans-CMF approach was used for OA-PICA anastomosis in 13 patients. The surgical procedures performed on and the medical records of all the patients were retrospectively reviewed. The unilateral trans-CMF approach was performed for two reasons depending on the PICA location or situation: either because the caudal loop could not be used as a recipient artery because of arterial dissection (3 patients) or because the tonsillo-medullary segment that was located in the upper part of the CMF did not have a caudal loop that was large enough (10 patients). The trans-CMF approach provided a good operative field for the OA-PICA bypass and the anastomosis were successfully performed in all patients. When the recipient artery was located in the upper part of the CMF, the unilateral trans-cerebello-medullary fissure approach provided a sufficient operative field for OA-PICA anastomosis.
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Affiliation(s)
- Hiroshi Abe
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University
| | - Koichi Miki
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University
| | | | - Toshiyasu Ogata
- Department of Neurology, Faculty of Medicine, Fukuoka University
| | | | | | - Tooru Inoue
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University
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Tailored Double-Barrel Bypass Surgery Using an Occipital Artery Graft for Unstable Intracranial Vascular Occlusive Disease. World Neurosurg 2017; 101:813.e5-813.e9. [DOI: 10.1016/j.wneu.2017.03.043] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 03/08/2017] [Accepted: 03/09/2017] [Indexed: 11/17/2022]
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Cho KC, Kim YB, Suh SH, Joo JY, Hong CK. Multidisciplinary management for the treatment of proximal posterior inferior cerebellar artery aneurysms. Neurol Res 2017; 39:403-413. [DOI: 10.1080/01616412.2017.1298691] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Kwang-Chun Cho
- Department of Neurosurgery, College of Medicine, Yonsei University, Gangnam Severance Hospital, Seoul, South Korea
| | - Yong Bae Kim
- Department of Neurosurgery, College of Medicine, Yonsei University, Gangnam Severance Hospital, Seoul, South Korea
| | - Sang Hyun Suh
- Department of Radiology, College of Medicine, Yonsei University, Gangnam Severance Hospital, Seoul, South Korea
| | - Jin Yang Joo
- Department of Neurosurgery, College of Medicine, Yonsei University, Gangnam Severance Hospital, Seoul, South Korea
| | - Chang-Ki Hong
- Department of Neurosurgery, College of Medicine, Yonsei University, Gangnam Severance Hospital, Seoul, South Korea
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Evaluation of a Traumatic Vertebral Artery Occlusion. World Neurosurg 2017; 101:815.e13-815.e17. [PMID: 28254602 DOI: 10.1016/j.wneu.2017.02.089] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 02/17/2017] [Accepted: 02/18/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND Penetrating neck injury occurs in 5%-10% of all trauma cases and carries a significant burden of morbidity and mortality (15%). We describe the evaluation and management of a 25-year-old man shot in the neck with occlusion of the left vertebral artery from its origin to C6. This is a case report in which medical data were analyzed retrospectively with institutional review board approval. CASE DESCRIPTION Neurologic examination revealed paresthesias and dysesthesias in a left C8 dermatomal distribution. Computed tomography angiography of the neck demonstrated no opacification of the left vertebral artery from its origin to C6. Magnetic resonance imaging of the cervical spine revealed an acute infarct in the left cerebellum. A cerebral angiogram highlighted hemodynamic compromise, and the patient was felt to be at significant risk of further cerebral infarction. Augmenting flow to the posterior circulation would mitigate that risk. The patient was taken to the operating room for a transposition of the vertebral artery to the common carotid artery. CONCLUSIONS The patient presented with silent cerebellar infarction due to a vertebral artery injury and impending vertebrobasilar insufficiency. This case demonstrates clinical evaluation of the posterior circulation and treatment with a bypass technique through mobilization of the vertebral artery from the boney vertebral foramen with anastomosis to the common carotid.
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Fukuda H, Evins AI, Iwasaki K, Hattori I, Murao K, Kurosaki Y, Chin M, Stieg PE, Yamagata S, Bernardo A. The role of alternative anastomosis sites in occipital artery–posterior inferior cerebellar artery bypass in the absence of the caudal loop using the far-lateral approach. J Neurosurg 2017; 126:634-644. [DOI: 10.3171/2015.11.jns151385] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
Occipital artery–posterior inferior cerebellar artery (OA-PICA) bypass is a technically challenging procedure for posterior fossa revascularization. The caudal loop of the PICA is considered the optimal site for OA-PICA anastomosis, however its absence can increase the technical difficulty associated with this procedure. The use of the far-lateral approach for accessing alternative anastomosis sites in OA-PICA bypass in patients with absent or unavailable caudal loops of PICA is evaluated.
METHODS
A morphometric analysis of OA-PICA bypass with anastomosis on each segment of the PICA was performed on 5 cadaveric specimens through the conventional midline foramen magnum and far-lateral approaches. The difficulty level associated with anastomoses at each segment was qualitatively assessed in each approach for exposure and maneuverability by multiple surgeons. A series of 8 patients who underwent OA-PICA bypass for hemodynamic ischemia or ruptured dissecting posterior fossa aneurysms are additionally reviewed and described, and the clinical significance of the caudal loop of PICA is discussed.
RESULTS
Anastomosis on the caudal loop could be performed more superficially than on any other segment (p < 0.001). A far-lateral approach up to the medial border of the posterior condylar canal provided a 13.5 ± 2.2–mm wider corridor than the conventional midline foramen magnum approach, facilitating access to alternative anastomosis sites. The far-lateral approach was successfully used for OA-PICA bypass in 3 clinical cases whose caudal loops were absent, whereas the midline foramen magnum approach provided sufficient exposure for caudal loop bypass in the remaining 5 cases.
CONCLUSIONS
The absence of the caudal loop of the PICA is a major contributing factor to the technical difficulty of OA-PICA bypass. The far-lateral approach is a useful surgical option for OA-PICA bypass when the caudal loop of the PICA is unavailable.
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Affiliation(s)
- Hitoshi Fukuda
- 1Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Alexander I. Evins
- 2Department of Neurological Surgery, Weill Cornell Medical College, New York, New York
| | - Koichi Iwasaki
- 3Department of Neurosurgery, Himeji Medical Center, Himeji, Hyogo, Japan; and
| | - Itaro Hattori
- 3Department of Neurosurgery, Himeji Medical Center, Himeji, Hyogo, Japan; and
| | - Kenichi Murao
- 4Department of Neurosurgery, Shiroyama Hospital, Habikino, Osaka, Japan
| | - Yoshitaka Kurosaki
- 1Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Masaki Chin
- 1Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Philip E. Stieg
- 2Department of Neurological Surgery, Weill Cornell Medical College, New York, New York
| | - Sen Yamagata
- 1Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Antonio Bernardo
- 2Department of Neurological Surgery, Weill Cornell Medical College, New York, New York
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Kimura H, Taniguchi M, Koyama J, Fujimoto Y, Hosoda K, Kohmura E. Minimum Transpetrosal Retrolabyrinthine Approach for Revascularization of Posterior Cerebral Artery: Operative Nuance. Oper Neurosurg (Hagerstown) 2016; 12:112-118. [PMID: 29506089 DOI: 10.1227/neu.0000000000001064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 08/22/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Revascularization of the posterior cerebral artery (PCA) can be essential for treating complex cerebral aneurysms in the posterior circulation, and it is considered technically challenging. To help decrease the difficulty of this technique, we developed the minimum transpetrosal approach (MTPA). OBJECTIVE The technical nuances of the MTPA were innovated by cadaver head dissections and an actual clinical case. METHODS Four sides of the formalin-fixed cadaver heads were used to investigate if the posterior cerebral artery could be exposed with this minimum retraction of the temporal lobe in the subtemporal approach and the MTPA. By using the MTPA, 1 patient harboring a ruptured PCA aneurysm underwent superficial temporal artery-PCA anastomosis followed by isolation of the aneurysm. RESULTS In the cadaver head dissections, we noticed that the PCAs were difficult to expose with gentle retraction of the temporal lobe in the subtemporal approach. By performing an additional retrolabyrinthine mastoidectomy, performed as the MTPA, all 4 PCAs were easily exposed in the 4 wide surgical fields. The maximum widths of the surgical fields above and below the PCA could be successfully measured in 2 cases, which were 13.3 mm and 11.2 mm, respectively (mean, 12.3 mm). Additionally, in the actual live surgery using MTPA, the PCAs were relative easy to expose with a surgical field wide enough to perform PCA bypass, which was performed without complication. CONCLUSION The MTPA may be the most favorable approach for PCA bypass that can be performed easily with minimal temporal lobe retraction.
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Affiliation(s)
- Hidehito Kimura
- Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masaaki Taniguchi
- Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Junji Koyama
- Department of Neurosurgery, Toyooka Public Hospital, Toyooka, Japan
| | - Yousuke Fujimoto
- Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kohkichi Hosoda
- Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Eiji Kohmura
- Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Japan
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Esposito G, Burkhardt JK, Bozinov O, Regli L. Indocyanine green videoangiography for the identification of superficial temporal artery branches in EC-IC bypass surgery. Acta Neurochir (Wien) 2016; 158:565-70. [PMID: 26783025 DOI: 10.1007/s00701-016-2703-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 01/06/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Superficial temporal artery-to-middle cerebral artery (STA-MCA) bypass remains an essential tool for managing complex cerebrovascular conditions. A crucial surgical step is the identification and safe dissection of the bypass donor artery. If the frontal branch of the STA is used, a curvilinear fronto-temporal scalp flap generally allows for a clean dissection from the underside of the scalp flap. This dissection is sometimes tedious, since the frontal branch is not always easily visible and due to variability of its anatomy. With this article, we report on the feasibility and effectiveness of a simple indocyanine green videoangiography (ICG-VA)-assisted technique for the identification of the STA branches from the underside of a fronto-temporal scalp flap in bypass surgery. METHODS The technique is based on the analysis of the difference in timing of filling of scalp vessels illuminated via ICG-VA from the underside of a scalp flap. Three illustrative cases are reported. RESULTS ICG-VA permitted the correct identification and safe dissection of the donor vessels (STA branches) in all three patients. There were no complications due to the ICG-VA. CONCLUSIONS This technique allows reliable visualization of the STA and its branches at once before microsurgical dissection. The information provided by ICG-VA enables precise mapping and preparation of the STA. The simplicity and safety of this technique make it an effective tool for intraoperative identification of the STA and its branches.
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Affiliation(s)
- Giuseppe Esposito
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland, Frauenklinikstrasse 10, 8091.
| | - Jan-Karl Burkhardt
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland, Frauenklinikstrasse 10, 8091.
| | - Oliver Bozinov
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland, Frauenklinikstrasse 10, 8091.
| | - Luca Regli
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland, Frauenklinikstrasse 10, 8091.
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Sosa P, Dujovny M, Onyekachi I, Sockwell N, Cremaschi F, Savastano LE. Microvascular anatomy of the cerebellar parafloccular perforating space. J Neurosurg 2016; 124:440-9. [DOI: 10.3171/2015.2.jns142693] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT
The cerebellopontine angle is a common site for tumor growth and vascular pathologies requiring surgical manipulations that jeopardize cranial nerve integrity and cerebellar and brainstem perfusion. To date, a detailed study of vessels perforating the cisternal surface of the middle cerebellar peduncle—namely, the paraflocculus or parafloccular perforating space—has yet to be published. In this report, the perforating vessels of the anterior inferior cerebellar artery (AICA) in the parafloccular space, or on the cisternal surface of the middle cerebellar peduncle, are described to elucidate their relevance pertaining to microsurgery and the different pathologies that occur at the cerebellopontine angle.
METHODS
Fourteen cadaveric cerebellopontine cisterns (CPCs) were studied. Anatomical dissections and analysis of the perforating arteries of the AICA and posterior inferior cerebellar artery at the parafloccular space were recorded using direct visualization by surgical microscope, optical histology, and scanning electron microscope. A comprehensive review of the English-language and Spanish-language literature was also performed, and findings related to anatomy, histology, physiology, neurology, neuroradiology, microsurgery, and endovascular surgery pertaining to the cerebellar flocculus or parafloccular spaces are summarized.
RESULTS
A total of 298 perforating arteries were found in the dissected specimens, with a minimum of 15 to a maximum of 26 vessels per parafloccular perforating space. The average outer diameter of the cisternal portion of the perforating arteries was 0.11 ± 0.042 mm (mean ± SD) and the average length was 2.84 ± 1.2 mm. Detailed schematics and the surgical anatomy of the perforating vessels at the CPC and their clinical relevance are reported.
CONCLUSIONS
The parafloccular space is a key entry point for many perforating vessels toward the middle cerebellar peduncle and lateral brainstem, and it must be respected and protected during surgical approaches to the cerebellopontine angle.
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Affiliation(s)
- Pablo Sosa
- 1Department of Neuroscience, Clinical and Surgical Neurology, School of Medicine, National University of Cuyo, Mendoza, Argentina
| | - Manuel Dujovny
- 2Departments of Neurosurgery and Electrical Engineering, Wayne State University, Detroit; and
| | - Ibe Onyekachi
- 2Departments of Neurosurgery and Electrical Engineering, Wayne State University, Detroit; and
| | - Noressia Sockwell
- 2Departments of Neurosurgery and Electrical Engineering, Wayne State University, Detroit; and
| | - Fabián Cremaschi
- 1Department of Neuroscience, Clinical and Surgical Neurology, School of Medicine, National University of Cuyo, Mendoza, Argentina
| | - Luis E. Savastano
- 3Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
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Technical Description of the Medial and Lateral Anterior Temporal Approach for the Treatment of Complex Proximal Posterior Cerebral Artery Aneurysms. World Neurosurg 2016; 86:490-6. [DOI: 10.1016/j.wneu.2015.09.068] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 09/17/2015] [Accepted: 09/19/2015] [Indexed: 11/22/2022]
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Lee SH, Choi SK. In Situ Intersegmental Anastomosis within a Single Artery for Treatment of an Aneurysm at the Posterior Inferior Cerebellar Artery: Closing Omega Bypass. J Korean Neurosurg Soc 2015; 58:467-70. [PMID: 26713148 PMCID: PMC4688317 DOI: 10.3340/jkns.2015.58.5.467] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Revised: 09/21/2014] [Accepted: 09/23/2014] [Indexed: 11/27/2022] Open
Abstract
A 74-year-old patient was diagnosed with a subarachnoid hemorrhage suspected from a dissecting aneurysm located at the lateral medullary segment of the posterior inferior cerebellar artery (PICA). Because perforators to the medulla arose both proximal and distal to the dissecting segment, revascularization for distal flow was essential. However, several previously reported methods for anastomosis, such as an occipital artery-PICA bypass or resection with PICA end-to-end anastomosis could not be used. Ultimately, we performed an in situ side-to-side anastomosis of the proximal loop of the PICA with distal caudal loops within a single artery, as a "closing omega," followed by trapping of the dissected segment. The aneurysm was obliterated successfully, with intact patency of the revascularized PICA.
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Affiliation(s)
- Sung Ho Lee
- Department of Neurosurgery, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Seok Keun Choi
- Department of Neurosurgery, College of Medicine, Kyung Hee University, Seoul, Korea
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Takanari K, Araki Y, Okamoto S, Sato H, Yagi S, Toriyama K, Yokoyama K, Murotani K, Matsui S, Wakabayashi T, Kamei Y. Operative wound-related complications after cranial revascularization surgeries. J Neurosurg 2015; 123:1145-50. [DOI: 10.3171/2014.12.jns132602] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT
Intracranial revascularization surgeries are an effective treatment for moyamoya disease and other intracranial vascular obliterative diseases. However, in some cases, wound-related complications develop after surgery. Although the incidence of wound complication is supposed to be higher than that with a usual craniotomy, this complication has rarely been the focus of studies in the literature that report the outcomes of revascularization surgeries. Here, the relationship between intracranial revascularization surgeries and their complications is statistically assessed.
METHODS
Between October 2004 and February 2010, 71 patients were treated using cerebral revascularization surgeries on 98 sides of the head. The relationship between wound complications and operative technique was retrospectively assessed. Multivariate logistic regression analysis was performed to identify the risk factors of wound complication, including operative technique, age, sex, diabetes mellitus (DM), hypertension, hyperlipidemia, and smoking history.
RESULTS
In total, there were 21 (21.4%) operative wound complications. Of these 21 complications, there were 14 (66.7%) minor complications and 7 (33.3%) major complications. No statistically significant relationship was found between wound complications and any surgical procedure. A trend toward severer complications was demonstrated for the procedures that used both STA branches (“double” procedures) in comparison with the procedures that used only 1 STA branch (“single” procedures, p = 0.016, Cochran-Armitage trend test). Multivariate logistic regression analysis also revealed that double procedures demonstrated a significantly higher incidence of wound complications than single procedures (OR 3.087, p = 0.048). DM was found to be a risk factor for wound complication (OR 9.42, p = 0.02), but age, sex, hypertension, and hyperlipidemia were not associated with the incidence of complications. Even though the blood supply to the scalp is abundant due to 5 arteriovenous systems, sometimes cutaneous necrosis develops after intracranial revascularization surgeries. The galeal blood supply is thought to be crucial for preventing wound-related complications. Special care is also thought to be required for DM patients.
CONCLUSIONS
Revascularization surgeries seemed to demonstrate a higher risk of wound-related complications. Double-type procedures, which use both branches of the STA, and a history of DM were found to be risk factors for wound-related complications. Attention should be paid to the design of the galeal incision and vessel harvest line. Also, special attention should be paid to patients with DM.
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Affiliation(s)
| | | | | | | | | | | | | | - Kenta Murotani
- 4Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya, Japan
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Sejkorová A, Cihlář F, Hejčl A, Lodin J, Vachata P, Sameš M. Microsurgery and endovascular treatment of posterior inferior cerebellar artery aneurysms. Neurosurg Rev 2015; 39:159-68; discussion 168. [DOI: 10.1007/s10143-015-0659-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Revised: 05/01/2015] [Accepted: 06/27/2015] [Indexed: 11/28/2022]
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50
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Britz GW, Agarwal V, Mihlon F, Ramanathan D, Agrawal A, Nimjee SM, Kaylie D. Radial Artery Bypass for Intractable Vertebrobasilar Insufficiency: Case Series and Review of the Literature. World Neurosurg 2015; 85:106-13. [PMID: 26284960 DOI: 10.1016/j.wneu.2015.08.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Revised: 08/03/2015] [Accepted: 08/04/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Vertebrobasilar insufficiency resulting from embolism, atherosclerosis, or arterial dissection has long been a challenge for successful management and outcomes. The main treatment options include medical therapy, angioplasty and stenting, and surgical revascularization. Unlike cardiac or peripheral vascular revascularization, large randomized trials with cerebrorevascularization have not revealed favorable outcomes. In patients who have failed maximal medical therapy, and having persistent debilitating symptomology, cerebral revascularization may still be a viable option. METHODS We report 3 patients who presented with symptoms of vertebrobasilar ischemia. The diagnosis was verified by computerized tomographic arteriography and digital subtraction angiography. RESULTS These patients subsequently underwent revascularization with a radial artery graft. We also present a comprehensive review of the literature of treatment for vertebrobasilar insufficiency. CONCLUSIONS Surgical revascularization should be considered in the posterior circulation in the rare subset of patients with VBI, who remain symptomatic despite having a protracted course of maximal medical therapy with large- and medium-sized vessel occlusions and poor collateral circulation.
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Affiliation(s)
- Gavin W Britz
- Department of Neurosurgery, Methodist Hospital, Houston, Texas, USA.
| | - Vijay Agarwal
- Division of Neurosurgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Frank Mihlon
- Division of Neurosurgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | | | - Abhishek Agrawal
- Division of Neurosurgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Shahid M Nimjee
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - David Kaylie
- Division of Neurosurgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
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