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Fisher WAM, David CA. Combined Open Surgical and Endovascular Management of a Giant Posterior Cerebral Artery Aneurysm: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2024:01787389-990000000-01077. [PMID: 38442485 DOI: 10.1227/ons.0000000000001115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 01/10/2024] [Indexed: 03/07/2024] Open
Abstract
A 17-year-old female patient presented with worsening intractable headaches which were initially diagnosed as migraine headaches. The patient's headaches were refractory to medical management and continued to worsen in both severity and frequency. Computed tomography angiography and digital subtraction angiography demonstrated a giant posterior cerebral artery aneurysm with contributions from the internal carotid artery through the posterior communicating artery. During the surgical planning period, the patient continued to have worsening headaches, intractable nausea, vomiting, left upper extremity weakness, and associated visual obfuscations. Repeated angiography revealed spontaneous thrombosis of the posterior communicating artery contribution with additional sudden onset hemianopsia on balloon test occlusion of the posterior cerebral artery, prompting urgent surgical intervention. A right subtemporal approach was used for a superficial temporal artery to posterior cerebral artery bypass, followed by coil occlusion of the aneurysm inlet at the posterior cerebral artery on postoperative day 1. The patient consented to the procedure. Postoperative angiography demonstrated successful superficial temporal artery to posterior cerebral artery anastomosis with occluded posterior cerebral artery after coiling. At 1-year follow-up, the patient remained neurologically intact with a patent bypass and regression of the trapped aneurysm. We present this case to demonstrate the successful management of a complex posterior cerebral artery aneurysm with both surgical bypass and endovascular parent artery coil occlusion.1-6.
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Affiliation(s)
- Wilson A M Fisher
- Department of Neurosurgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Carlos A David
- Department of Neurosurgery, University of North Carolina, Chapel Hill, North Carolina, USA
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2
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Hong CE, Oh HS, Bae JW, Kim KM, Yoo DH, Kang HS, Cho YD. Endovascular Treatment in Precommunicating Segment Aneurysms of Posterior Cerebral Artery. World Neurosurg 2024; 182:e602-e610. [PMID: 38056626 DOI: 10.1016/j.wneu.2023.11.156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 11/30/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND Precommunicating (P1) segment aneurysms of the posterior cerebral artery are rare, with few studies reported to date. Herein, we address the clinical and radiologic outcomes of their endovascular treatment. METHODS For this study, we retrieved prospectively collected data on 35 consecutive patients with 37 P1 aneurysms, analyzing the clinical ramifications and morphologic outcomes of treatment. All subjects received endovascular interventions between January 2001 and October 2021. RESULTS There were 16 aneurysms (43.2%) of P1 segment sidewalls and 21 (56.8%) at P1/posterior communicating artery junctions. Five (13.5%) were fusiform, and 14 (37.8%) were ruptured. In 14 patients (40%), 16 aneurysms (43%) were associated with intracranial arterial occlusive disease of the anterior circulation. Selective coiling was undertaken in 34 aneurysms (91.9%), using single (n = 24) or double (n = 4) microcatheters, microcatheter protection (n = 2), or stents (n = 4); and trapping was done in 3 (8.1%). No procedure-related morbidity or mortality resulted. Excluding the trapped lesions, angiographic follow-up of 29 aneurysms obtained >6 months after embolization (mean, 12.4 month) revealed stable occlusion in 21 (72.4%), with some recanalization in the other 8 (minor: 3/29, 10.4%; major: 5/29, 17.2%). CONCLUSIONS Aneurysms of P1 segment (vs. other locations) are strongly associated with intracranial arterial occlusive disease of the anterior circulation and thus are likely flow related. Endovascular treatment of such lesions seems safe and efficacious, despite the array of technical strategies that their distinctive anatomic configurations impose.
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Affiliation(s)
- Chang-Eui Hong
- Department of Neurosurgery, Veterans Health Service Medical Center, Seoul, Korea
| | - Han San Oh
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jin Woo Bae
- Department of Neurosurgery, Inha University Hospital, Incheon, Korea
| | - Kang Min Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Dong Hyun Yoo
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun-Seung Kang
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Young Dae Cho
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
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Pettersson SD, Khorasanizadeh M, Maglinger B, Garcia A, Wang SJ, Taussky P, Ogilvy CS. Trends in the Age of Patients Treated for Unruptured Intracranial Aneurysms from 1990 to 2020. World Neurosurg 2023; 178:233-240.e13. [PMID: 37562685 DOI: 10.1016/j.wneu.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND The decision for treatment for unruptured intracranial aneurysms (UIAs) is often difficult. Innovation in endovascular devices have improved the benefit-to-risk profile especially for elderly patients; however, the treatment guidelines from the past decade often recommend conservative management. It is unknown how these changes have affected the overall age of the patients selected for treatment. Herein, we aimed to study potential changes in the average age of the patients that are being treated over time. METHODS A systematic search of the literature was performed to identify all studies describing the age of the UIAs that were treated by any modality. Scatter diagrams with trend lines were used to plot the age of the patients treated over time and assess the presence of a potential significant trend via statistical correlation tests. RESULTS A total of 280 studies including 83,437 UIAs treated between 1987 and 2021 met all eligibility criteria and were entered in the analysis. Mean age of the patients was 55.5 years, and 70.7% were female. There was a significant increasing trend in the age of the treated patients over time (Spearman r: 0.250; P < 0.001), with a 1-year increase in the average age of the treated patients every 5 years since 1987. CONCLUSIONS The present study indicates that based on the treated UIA patient data published in the literature, older UIAs are being treated over time. This trend is likely driven by safer treatments while suggesting that re-evaluation of certain UIA treatment decision scores may be of great interest.
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Affiliation(s)
- Samuel D Pettersson
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - MirHojjat Khorasanizadeh
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Benton Maglinger
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Alfonso Garcia
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - S Jennifer Wang
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Philipp Taussky
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Christopher S Ogilvy
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
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4
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Kimura T, Hong S, Irie K, Ichi S. A partially thrombosed aneurysm mimicking an intraventricular tumor. Acta Neurol Belg 2023:10.1007/s13760-023-02378-9. [PMID: 37749483 DOI: 10.1007/s13760-023-02378-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 08/30/2023] [Indexed: 09/27/2023]
Affiliation(s)
- Toshikazu Kimura
- Department of Neurosurgery, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan.
| | - Sukwoo Hong
- Department of Neurosurgery, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan
- Mayo Clinic, Rochester, Minnesota, USA
| | - Koreaki Irie
- Department of Neurosurgery, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan
| | - Shunsuke Ichi
- Department of Neurosurgery, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan
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Yoshinaga T, Fukumoto H, Kawano D, Kobayashi H, Fukuda K, Morishita T, Inoue T, Abe H. Case report: isolated trochlear nerve palsy associated with posterior cerebral artery aneurysm. Acta Neurochir (Wien) 2023; 165:1027-1030. [PMID: 36864353 DOI: 10.1007/s00701-023-05530-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 02/15/2023] [Indexed: 03/04/2023]
Abstract
We describe a case of isolated trochlear nerve palsy caused by an unruptured posterior cerebral artery (PCA) aneurysm in an 82-year-old male who consulted an ophthalmologist after developing diplopia. Magnetic resonance angiography showed a left PCA aneurysm in the ambient cistern, and T2WI showed an aneurysm compressing the left trochlear nerve to the cerebellar tentorium. Digital subtraction angiography revealed that the lesion was located between the left P2a segment. We attributed this isolated trochlear palsy to left PCA unruptured aneurysm pressure. Thus, we performed stent-assisted coil embolization. The aneurysm was obliterated, and trochlear nerve palsy improved completely.
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Affiliation(s)
- Taisuke Yoshinaga
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Hironori Fukumoto
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.
| | - Dai Kawano
- Department of Neurosurgery, Fukuoka University Hospital, Fukuoka, Japan
| | | | - Kenji Fukuda
- Department of Neurosurgery, Hakujuji Hospital, Fukuoka, Japan
| | - Takashi Morishita
- Department of Neurosurgery, Fukuoka University Hospital, Fukuoka, Japan
| | - Tooru Inoue
- Department of Neurosurgery, Hakujuji Hospital, Fukuoka, Japan
| | - Hiroshi Abe
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
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Vargová L, Vymazalová K, Jarošová I, Mařík I, Horáčková L, Trampota F, Rebay-Salisbury K, Rendl B, Kanz F, Zlámalová D. A case of congenital multiple epiphyseal dysplasia from the Late Migration Period graveyard in Drnholec (Czech Republic). Int J Paleopathol 2023; 40:33-40. [PMID: 36455429 DOI: 10.1016/j.ijpp.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 10/19/2022] [Accepted: 11/13/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE To contribute to differential diagnosis of multiple epiphyseal dysplasia (MED) in archeological and clinical contexts. MATERIALS A skeleton of a 30- to 45-year-old male (grave no. 806) from the Late Migration Period graveyard in Drnholec-Pod sýpkou (Czech Republic), radio-carbon dated to AD 492-530. METHODS Morphological and metric analyses. RESULTS Significant pathological changes were noted on ossa coxae and proximal ends of the femora, which appear similar to changes associated with Legg-Calvé-Perthes disease. X-ray examination made it possible to rule out pseudoachondroplasia, rickets and metabolic bone diseases. CONCLUSIONS The finding was evaluated as a probable case of congenital multiple epiphyseal dysplasia. SIGNIFICANCE This case will contribute to the construction of estimates of the occurrence of this disease in historical populations and can be instructive for diagnostics in current medical practice. LIMITATIONS The final diagnosis is limited by the lack of genetic analysis. SUGGESTION FOR THE FUTURE RESEARCH Further clarification leading to diagnosis will benefit from genetic analysis and evaluation of skeletal remains throughout Europe.
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Affiliation(s)
- Lenka Vargová
- Research Group of Medical Anthropology and Clinical Anatomy, Department of Anatomy, Faculty of Medicine, Masaryk University, Kamenice 3, 625 00 Brno, Czech Republic.
| | - Kateřina Vymazalová
- Research Group of Medical Anthropology and Clinical Anatomy, Department of Anatomy, Faculty of Medicine, Masaryk University, Kamenice 3, 625 00 Brno, Czech Republic.
| | | | - Ivo Mařík
- Faculty of Health Care Studies, West Bohemia University, Pilsen Ambulant & Centre for Defects of Locomotor Apparatus, Olšanská 7, 130 00 Praha 3, Czech Republic.
| | - Ladislava Horáčková
- Department of Kinesiology, Faculty of Sports Studies, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic.
| | - František Trampota
- Regional Museum in Mikulov, Zámek 1/4, 692 01 Mikulov, Czech Republic; Department of Archaeology and Museology, Faculty of Arts, Masaryk University, Arna Nováka 1, 602 00 Brno, Czech Republic; Institute of Archaeology of the Czech Academy of Sciences, Letenská 4, 118 01, Prague, Czech Republic.
| | - Katharina Rebay-Salisbury
- Austrian Archaeological Institute, Austrian Academy of Sciences, Hollandstraße 11-13, 1020 Vienna, Austria.
| | - Barbara Rendl
- Unit of Forensic Anthropology, Medical University of Vienna, Center for Forensic Medicine, Sensengasse 2, 1090 Vienna, Austria.
| | - Fabian Kanz
- Unit of Forensic Anthropology, Medical University of Vienna, Center for Forensic Medicine, Sensengasse 2, 1090 Vienna, Austria.
| | - Denisa Zlámalová
- Department of Archaeology and Museology, Faculty of Arts, Masaryk University, Arne Nováka 1, 602 00 Brno, Czech Republic.
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Essibayi MA, Oushy SH, Keser Z, Lanzino G. Natural history and management of posterior cerebral artery aneurysms: a systematic review and meta-analysis of individual patient data. Neurosurg Rev 2022. [PMID: 36222943 DOI: 10.1007/s10143-022-01867-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 07/26/2022] [Accepted: 09/15/2022] [Indexed: 10/17/2022]
Abstract
We conducted a comprehensive review and meta-analysis to investigate clinical, radiographic characteristics, and treatment outcomes of posterior cerebral artery aneurysms (PCAA). We systematically reviewed English-language articles investigating available treatments (parent artery occlusion (PAO), microsurgery, reconstructive endovascular (rEVT), and conservative treatments) for PCAA and analyzed the based on aneurysm morphology and rupture status. Six-hundred-eighty-five patients with 698 PCAA were identified from 59 studies. Overall, 371 (54.2%) aneurysms were ruptured, 325 (49%) were saccular, and 342 (51%) were non-saccular aneurysms. The mean age of the saccular was lower (40 years) than non-saccular aneurysm group (50 years) (P < .05). In ruptured PCAA, favorable clinical outcomes were comparable between the treatment groups except for patients treated conservatively, which had lower rates of favorable clinical outcomes (35.6%) and higher mortality (55.7%) (P < .0001). Ruptured aneurysms treated with rEVT (22.6%) had the highest recanalization rates compared to PAO (9.2%, P = 0.0001) and microsurgery (3.8%, P = 0.005). In unruptured PCAA, clinical outcomes were similar; higher complication rates were noted in microsurgery (40.4%, P = 0.026) and PAO (21.5%, P = 0.015) compared to rEVT (13.2%), which had higher recanalization rates (15.6%, P < .0001). The rates of subsequent stroke following PAO were 21.8% for unruptured and 32.3% for ruptured PCAA (P = 0.078). Ruptured PCAA portend worse prognosis and typically require an intervention to achieve better outcome whereas the benefit of an intervention in unruptured PCAA is much less clear. rEVT is promising for PCAA management with a good clinical and safety profile but more recurrence compared to PAO and microsurgery.
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Tang H, Shang C, Zhang G, Zuo Q, Zhang X, Xu F, Xu Y, Zhao R, Huang Q, Li Q, Liu J. Braided stents assisted coiling for endovascular management of posterior cerebral artery aneurysms: a preliminary mid-term experience. Neuroradiology 2022; 64:1847-1856. [PMID: 35441874 DOI: 10.1007/s00234-022-02956-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 04/10/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Posterior cerebral artery (PCA) aneurysms are rare. This study is to evaluate the preliminary experience of braided stents applied in PCA aneurysms treatment. METHODS Angiographic and clinical data of 28 PCA patients treated with braided stents from July 2016 and September 2020 were retrospectively analyzed. RESULTS A total of 28 PCA aneurysms were enrolled. 22 (78.6%) aneurysms were dissecting aneurysms, while 6 (21.4%) aneurysms were saccular aneurysms. Thirty-five braided stents were implanted with dual stents implanted in 7 cases. Immediate angiographic results show that Raymond class I was obtained in 13 patients (46.4%), Raymond class II was obtained in 4 patients (14.3%), and Raymond class III was obtained in 11 patients (39.3%). Perioperative hemorrhagic events occurred in 1 patient (3.6%). Twenty-four patients (85.7%) received angiographic follow-up, and the mean follow-up time was 11.2 ± 4.9 months. Two patients (8.3%) were confirmed with IA neck recurrence, and 3 patients (12.5%) were confirmed asymptomatic parent artery occlusion (PAO). The other 19 patients were confirmed promoted occlusion with 18 Raymond class I (75%) and 1 Raymond class II (4.2%). Twenty-seven patients (96.4%) received clinical follow-up, and the mean follow-up time was 32.2 ± 13.5 months. One patient (3.7%) confirmed the death event 2 weeks after discharge. The other 27 patients (96.3%) got favorable clinical outcomes with an mRS score of 0-2. CONCLUSIONS Braided stent-assisted coiling with a high occlusion rate and relatively low complication rate provides an alternative strategy in treating PCA aneurysms. Long-term outcomes need further randomized study with larger case numbers.
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Affiliation(s)
- Haishuang Tang
- Department of Neurosurgery, Changhai Hospital, Navy Military Medical University, Shanghai, 200433, People's Republic of China.,Naval Medical Center of PLA, Navy Military Medical University, Shanghai, 200050, People's Republic of China
| | - Chenghao Shang
- Department of Neurosurgery, Changhai Hospital, Navy Military Medical University, Shanghai, 200433, People's Republic of China
| | - Guanghao Zhang
- Department of Neurosurgery, Changhai Hospital, Navy Military Medical University, Shanghai, 200433, People's Republic of China
| | - Qiao Zuo
- Department of Neurosurgery, Changhai Hospital, Navy Military Medical University, Shanghai, 200433, People's Republic of China
| | - Xiaoxi Zhang
- Department of Neurosurgery, Changhai Hospital, Navy Military Medical University, Shanghai, 200433, People's Republic of China
| | - Fengfeng Xu
- Naval Medical Center of PLA, Navy Military Medical University, Shanghai, 200050, People's Republic of China
| | - Yi Xu
- Department of Neurosurgery, Changhai Hospital, Navy Military Medical University, Shanghai, 200433, People's Republic of China
| | - Rui Zhao
- Department of Neurosurgery, Changhai Hospital, Navy Military Medical University, Shanghai, 200433, People's Republic of China
| | - Qinghai Huang
- Department of Neurosurgery, Changhai Hospital, Navy Military Medical University, Shanghai, 200433, People's Republic of China
| | - Qiang Li
- Department of Neurosurgery, Changhai Hospital, Navy Military Medical University, Shanghai, 200433, People's Republic of China.
| | - Jianmin Liu
- Department of Neurosurgery, Changhai Hospital, Navy Military Medical University, Shanghai, 200433, People's Republic of China
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Choque-Velasquez J, Colasanti R, Muhammad S, Chioffi F, Hernesniemi J. Vascular Lesions of the Pineal Region: A Comprehensive Review of the Therapeutic Options. World Neurosurg 2022; 159:298-313. [PMID: 35255631 DOI: 10.1016/j.wneu.2021.09.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 09/12/2021] [Accepted: 09/13/2021] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Vascular lesions of the pineal region comprise aneurysms of the pineal region, arteriovenous malformations, cavernous malformations, and vein of Galen malformations. In the present report, we have offered an extensive review of each vascular pineal region lesion. METHODS We performed an extensive literature review, focusing on the current therapeutic options available for the different vascular lesions of the pineal region. RESULTS Vascular lesions of the pineal region are rare. Microneurosurgery remains a valid treatment of cavernomas, arteriovenous malformations, and aneurysms. Endovascular treatments seem to be the first option for the vein of Galen malformations, followed by microneurosurgery. Radiosurgery seems beneficial for small-size arteriovenous malformations. Complex and large vascular lesions will require a combination of multiple treatments. CONCLUSIONS Vascular lesions of the pineal region are complex, uncommon diseases. Thus, definitive therapeutic modalities for these lesions require further research.
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Affiliation(s)
- Joham Choque-Velasquez
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Department of Neurosurgery, University Hospital Düsseldorf, Düsseldorf, Germany.
| | - Roberto Colasanti
- Department of Neurosurgery, Umberto I General Hospital, Università Politecnica delle Marche, Ancona, Italy; Department of Neurosurgery, Padua University Hospital, Padua, Italy
| | - Sajjad Muhammad
- Department of Neurosurgery, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Franco Chioffi
- Department of Neurosurgery, Padua University Hospital, Padua, Italy
| | - Juha Hernesniemi
- Juha Hernesniemi International Center for Neurosurgery, Henan Provincial People's Hospital, Zhengzhou, China
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Mitsuhashi T, Oishi H, Makino K, Tokugawa J, Fuse A, Hishii M. Stent-Assisted Coil Embolization for Acute Ruptured Dissecting Aneurysm at the P2 Segment of the Posterior Cerebral Artery: A Case Report. J Neuroendovasc Ther 2021; 16:157-162. [PMID: 37502277 PMCID: PMC10370781 DOI: 10.5797/jnet.cr.2021-0054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 06/08/2021] [Indexed: 07/29/2023]
Abstract
Objective We report a case of ruptured posterior cerebral artery (PCA) dissecting aneurysm treated with stent-assisted coil embolization in the acute phase of ruptured aneurysm. Case Presentation A 60-year-old woman presented with sudden onset of severe headache followed by unconsciousness. CT showed severe subarachnoid hemorrhage. Digital subtraction angiography showed a dissecting aneurysm at the P2 segment of the right PCA. Stent-assisted coil embolization was performed for the ruptured dissecting aneurysm. Since thrombus was observed in the stent, ozagrel was administered intravenously, and the thrombus gradually disappeared during the follow-up period. She was discharged without neurological deficit. Conclusion Parent artery occlusion is widely performed for acute ruptured PCA dissecting aneurysm, but reconstruction with stent-assisted coiling is considered to be an effective therapeutic strategy.
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Affiliation(s)
- Takashi Mitsuhashi
- Department of Neurosurgery, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Hidenori Oishi
- Department of Neurosurgery, Faculty of Medicine, Juntendo University, Tokyo, Japan
- Department of Neuroendovascular Therapy, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Kensaku Makino
- Department of Neurosurgery, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Joji Tokugawa
- Department of Neurosurgery, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Atsuhito Fuse
- Department of Neurology, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Makoto Hishii
- Department of Neurosurgery, Juntendo University Nerima Hospital, Tokyo, Japan
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11
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Murumkar V, Peer S, Saini J, Arvinda HR. Endovascular management of dissecting posterior cerebral artery aneurysm associated with persistent hypoglossal artery: A case report. J Vasc Bras 2021; 20:e20200142. [PMID: 34394204 PMCID: PMC8336981 DOI: 10.1590/1677-5449.200142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 11/18/2020] [Indexed: 11/22/2022] Open
Abstract
Persistent embryological connections between the anterior and posterior circulations are rare entities. Persistent hypoglossal artery is the second most common persistent carotid-basilar anastomosis. As it is often associated with hypoplasia of vertebral arteries, it poses a challenge during endovascular interventions. We present a case of a 32-year-old woman who presented with occipital headache of four weeks’ duration. Magnetic Resonance Angiography showed hypoplastic vertebral arteries with a persistent hypoglossal artery arising from the cervical segment of the left internal carotid artery and supplying the entire posterior circulation, associated with a dissecting aneurysm of the right posterior cerebral artery. Endovascular parent vessel occlusion was performed for the dissecting posterior cerebral artery aneurysm by navigating the guide catheter, microwire, and microcatheter through the persistent hypoglossal artery because the vertebral arteries were hypoplastic. Post-intervention, the patient did not develop any neurological deficit and was discharged in a stable condition.
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Affiliation(s)
- Vivek Murumkar
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Sameer Peer
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Jitender Saini
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Hanumanthapura Ramalingaiah Arvinda
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
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Kishi F, Kayama R, Kimura S, Yagi R, Ogawa D, Yamada K, Taniguchi H. Intra-Aneurysmal Coil Embolization of a Ruptured Distal Posterior Inferior Temporal Artery Aneurysm: A Case Report. J Neuroendovasc Ther 2021; 16:152-156. [PMID: 37502278 PMCID: PMC10370779 DOI: 10.5797/jnet.cr.2021-0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 06/07/2021] [Indexed: 07/29/2023]
Abstract
Objective We report a case of a ruptured aneurysm at the posterior inferior temporal artery (PITA) of the posterior cerebral artery (PCA) treated by intra-aneurysmal coil embolization. Case Presentation A 93-year-old man presented with disturbance of consciousness. Angiography revealed a 3-mm aneurysm in the distal PITA of the left PCA. He was diagnosed with subarachnoid hemorrhage and intracerebral hemorrhage due to a ruptured aneurysm. This aneurysm was occluded by intra-aneurysmal coil embolization with preservation of the PITA. Conclusion Distal PITA aneurysm of the PCA is rare. Complete occlusion and preservation of the parent artery were achieved by intra-aneurysmal coil embolization, which may be an effective therapeutic option for such aneurysms.
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Affiliation(s)
- Fumihisa Kishi
- Department of Neurosurgery, Yagi Neurosurgical Hospital, Osaka, Osaka, Japan
| | - Ryo Kayama
- Department of Neurosurgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Seigo Kimura
- Department of Neurosurgery, Yagi Neurosurgical Hospital, Osaka, Osaka, Japan
| | - Ryokichi Yagi
- Department of Neurosurgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Daiji Ogawa
- Department of Neurosurgery, Yagi Neurosurgical Hospital, Osaka, Osaka, Japan
| | - Keiichi Yamada
- Department of Neurosurgery, Yagi Neurosurgical Hospital, Osaka, Osaka, Japan
| | - Hirokatsu Taniguchi
- Department of Neurosurgery, Yagi Neurosurgical Hospital, Osaka, Osaka, Japan
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Kikuta Y, Yamaguchi K, Ishikawa T, Funatsu T, Okada Y, Kawamata T. Selection of approach and bypass for fetal-type posterior cerebral artery aneurysm: illustrative cases. Journal of Neurosurgery: Case Lessons 2021; 1:CASE21240. [PMID: 35855078 PMCID: PMC9245774 DOI: 10.3171/case21240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 04/29/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Unlike in aneurysms of the adult-type posterior cerebral artery (PCA), in aneurysms of the fetal-type PCA, parent artery occlusion (PAO) results in vascular insufficiency and major ischemic strokes. Preservation or reconstruction of fetal-type PCAs is necessary to prevent these complications. Furthermore, it is necessary to select an appropriate bypass method and approach for revascularization of the PCA. OBSERVATIONS The authors report 2 cases of aneurysms of fetal-type PCAs that were successfully treated with PAO with revascularization. A 38-year-old man with a large unruptured right PCA aneurysm at the postcommunicating (P2) segment underwent trapping with superficial temporal artery–PCA bypass via the anterior temporal and subtemporal approaches. In addition, a 45-year-old woman with a left PCA aneurysm at the quadrigeminal (P3)–cortical (P4) segments resulting in subarachnoid hemorrhage underwent proximal clipping of the P3 segment via the occipital interhemispheric approach with an occipital artery–PCA bypass. Although she had perforator infarction, major ischemic stroke was prevented, and aneurysm occlusion was accomplished in both cases. LESSONS Aneurysms of fetal-type PCAs pose a risk of ischemia due to PAO. The combined use of bypass and revascularization should be considered to prevent major ischemic stroke after occlusion of the fetal-type PCA. However, perforator infarction is a concern.
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Affiliation(s)
- Yoshichika Kikuta
- Department of Neurosurgery, Tokyo Women’s Medical University, Tokyo, Japan
| | - Koji Yamaguchi
- Department of Neurosurgery, Tokyo Women’s Medical University, Tokyo, Japan
| | - Tatsuya Ishikawa
- Department of Neurosurgery, Tokyo Women’s Medical University, Tokyo, Japan
| | - Takayuki Funatsu
- Department of Neurosurgery, Tokyo Women’s Medical University, Tokyo, Japan
| | - Yoshikazu Okada
- Department of Neurosurgery, Tokyo Women’s Medical University, Tokyo, Japan
| | - Takakazu Kawamata
- Department of Neurosurgery, Tokyo Women’s Medical University, Tokyo, Japan
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Bojanowski MW, El Hage G, Chaalala C, Mercier P. How I do it: lateral supra-cerebellar infra-tentorial approach for P2-P3 junction cerebral aneurysms. Acta Neurochir (Wien) 2020; 162:2767-72. [PMID: 32918194 DOI: 10.1007/s00701-020-04566-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 09/02/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND P2-P3 junction aneurysms are challenging to treat surgically because of their frequent complex morphology and their location deep in close proximity to the midbrain. The sub-temporal route requires significant retraction of the temporal lobe in addition to potential injury to the vein of Labbe. We describe the technique for treating such aneurysms via a lateral supra-cerebellar infra-tentorial (LSCIT) approach, which eliminates manipulation of the temporal lobe. METHOD Cadaveric dissection provided comprehensive understanding of relevant anatomy. Intraoperative video shows clipping of the aneurysm using a LSCIT approach. CONCLUSION LSCIT approach allows safe clipping of P2-P3 aneurysms with minimal brain manipulation.
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Xue G, Tang H, Liu P, Zuo Q, Yang P, Zhou Y, Li Q, Fang Y, Huang Q, Hong B, Xu Y, Zhao R, Liu J. Safety and Long-term Efficacy of Stent-assisted Coiling for the Treatment of Complex Posterior Cerebral Artery Aneurysms. Clin Neuroradiol 2019; 31:89-97. [PMID: 31418047 DOI: 10.1007/s00062-019-00825-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 07/22/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To evaluate the safety and long-term efficacy of stent-assisted coiling for the treatment of complex posterior cerebral artery (PCA) aneurysms. METHODS Angiographic and clinical data of 23 patients harboring 23 complex PCA aneurysms treated with stent-assisted coiling from March 2010 to March 2017 were retrospectively reviewed. RESULTS In this study 8 (34.8%) aneurysms were located at the P1 segment, 7 (30.4%) at the junction of P1 and P2 segments (P1-2), and 8 (34.8%) at the P2 segment. The aneurysms were ruptured in 7 cases (30.4%). Thirteen were dissecting in nature, while the other 10 were classical saccular aneurysms. Of the patients, 5 (21.7%) had of history of recent head trauma, immediate angiographic results were Raymond class I in 5 (21.7%) cases, Raymond class II in 8 (34.8%), and Raymond class III in 10 (43.5%). Perioperative complications occurred in one case with occlusion of the PA due to acute in-stent thrombosis without any neurologic deficit at discharge. The last angiographic follow-up (mean 18.7 months) results demonstrated complete aneurysmal occlusion in 20 (87.0%) cases, PA occlusion in 1 (4.3%) and recurrence in 2 (8.7%). Of the two patients with aneurysm recurrence, one was treated by PA occlusion, and the other was treated with two overlapping stents. Clinical follow-up (mean 58.3 months) was available for all 23 patients, 22 (95.7%) patients had good neurologic outcomes (mRS score 0-2), and 1 (4.3%) patient died 7 months after the procedure for unknown reasons. CONCLUSION Stent-assisted coiling for the treatment of complex PCA aneurysms is safe and durable with a relatively low rate of complication and a relatively high rate of complete occlusion at long-term follow-up and is a promising alternative strategy for the reconstruction of the PCA.
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Affiliation(s)
- Gaici Xue
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, 168 Changhai Road, 200433, Shanghai, China
| | - Haishuang Tang
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, 168 Changhai Road, 200433, Shanghai, China
| | - Peng Liu
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, 168 Changhai Road, 200433, Shanghai, China
| | - Qiao Zuo
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, 168 Changhai Road, 200433, Shanghai, China
| | - Pengfei Yang
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, 168 Changhai Road, 200433, Shanghai, China
| | - Yu Zhou
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, 168 Changhai Road, 200433, Shanghai, China
| | - Qiang Li
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, 168 Changhai Road, 200433, Shanghai, China
| | - Yibin Fang
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, 168 Changhai Road, 200433, Shanghai, China
| | - Qinghai Huang
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, 168 Changhai Road, 200433, Shanghai, China
| | - Bo Hong
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, 168 Changhai Road, 200433, Shanghai, China
| | - Yi Xu
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, 168 Changhai Road, 200433, Shanghai, China
| | - Rui Zhao
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, 168 Changhai Road, 200433, Shanghai, China.
| | - Jianmin Liu
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, 168 Changhai Road, 200433, Shanghai, China.
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Zhang J, Shi X, Liu F, Sun Y, Qian H, Zhou Z. Serpentine aneurysm of the posterior cerebral artery treated by internal maxillary artery bypass followed by parent artery occlusion: a case report and literature review. Acta Neurochir (Wien) 2019; 161:1183-9. [PMID: 30968180 DOI: 10.1007/s00701-019-03902-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 03/28/2019] [Indexed: 10/27/2022]
Abstract
Serpentine aneurysms of the posterior cerebral artery (PCA) treated by the internal maxillary artery (IMA) bypass are rare. Here, the authors report the case of a 34-year-old male patient who presented with a half-year history of gradual severe headache and right-sided limb monoparesis and paresthesia lasting for 1 week. Preoperative angiograms showed a serpentine aneurysm in the left distal PCA, which was treated with internal maxillary artery-radial artery-posterior cerebral artery (IMA-RA-PCA) bypass followed by parent artery occlusion (PAO). The postoperative course was uneventful; radiological images revealed that the aneurysm disappeared, and there was good graft patency and excellent perfusion of the distal PCA territories. To the authors' knowledge, this is the first and only case of distal PCA serpentine aneurysm to be treated by IMA-RA-PCA bypass followed by proximal PAO. These findings suggest that IMA bypass surgery is a good and feasible treatment option for serpentine aneurysms of the PCA that can preserve the parent artery. Moreover, the anatomic segments of the PCA and different treatment options available for PCA serpentine aneurysms are also discussed in this study.
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17
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Kalamatianos T, Mavridis IN, Karakosta E, Drosos E, Skandalakis GP, Kalyvas A, Piagkou M, Koutsarnakis C, Stranjalis G. The Parieto-Occipital Artery Revisited: A Microsurgical Anatomic Study. World Neurosurg 2019; 126:e1130-e1139. [PMID: 30880193 DOI: 10.1016/j.wneu.2019.02.215] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 02/23/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND The parieto-occipital artery (PoA) is the terminal posterior cerebral artery branch, which typically runs in the parieto-occipital sulcus. Previous studies have highlighted variation in the PoA origin and branching pattern and their clinical implications. Nevertheless, PoA anastomoses have not been systematically investigated. The present study aimed to assess whether putative variation in PoA origin and its branching as well as anastomotic pattern is associated with differences in demographic/anthropometric variables. METHODS In 15 cadaveric heads, PoA anatomic features were quantified and assessed in relation to demographic/anthropometric variables. RESULTS The mean distance of PoA origin from the posterior limit of the splenium and the occipital pole (OP) is 3.1 and 53.1 mm, respectively. The latter is significantly longer in taller individuals. The PoA supplies a mean of 10.5 and 9.1 branches to the precuneus and cuneus, respectively. PoA anastomoses primarily involve the precuneal artery complex (PAc) and the calcarine artery. The analysis indicated significant, positive correlations between the distance of PoA origin from the OP and the number of PoA anastomoses and between the number of PoA precuneal and cuneal branches. CONCLUSIONS Although the PoA invariably supplies the precuneus and almost always the cuneus, its direct contribution to the former seems inferior to PAc. Nevertheless, the PoA frequently shows putative collateral supply networks to the precuneus and cuneus via anastomoses with the PAc and calcarine artery, respectively. The distance between PoA origin and OP varies with an individual's height; the frequency of intrahemispheric PoA anastomoses varies with its site of origin.
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Affiliation(s)
- Theodosis Kalamatianos
- Athens Microneurosurgery Laboratory, Department of Neurosurgery, Evangelismos Hospital, Athens, Greece.
| | - Ioannis N Mavridis
- Athens Microneurosurgery Laboratory, Department of Neurosurgery, Evangelismos Hospital, Athens, Greece
| | - Eleni Karakosta
- Athens Microneurosurgery Laboratory, Department of Neurosurgery, Evangelismos Hospital, Athens, Greece
| | - Evangelos Drosos
- Athens Microneurosurgery Laboratory, Department of Neurosurgery, Evangelismos Hospital, Athens, Greece
| | - Georgios P Skandalakis
- Athens Microneurosurgery Laboratory, Department of Neurosurgery, Evangelismos Hospital, Athens, Greece
| | - Aristotelis Kalyvas
- Athens Microneurosurgery Laboratory, Department of Neurosurgery, Evangelismos Hospital, Athens, Greece
| | - Maria Piagkou
- Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Christos Koutsarnakis
- Athens Microneurosurgery Laboratory, Department of Neurosurgery, Evangelismos Hospital, Athens, Greece
| | - George Stranjalis
- Athens Microneurosurgery Laboratory, Department of Neurosurgery, Evangelismos Hospital, Athens, Greece
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18
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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 2018; 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] [What about the content of this article? (0)] [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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Welling LC, Figueiredo EG, Nakaji P, Welling MS, Schafranski MD, Teixeira MJ, Spetzler RF, Preul MC. Less is more: Parahippocampal resection or endoscopic assistance in ambient cistern surgery? Qualitative and quantitative assessment of subtemporal approach. J Clin Neurosci 2018; 53:203-8. [PMID: 29685409 DOI: 10.1016/j.jocn.2018.04.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 04/09/2018] [Indexed: 11/20/2022]
Abstract
The ambient cistern is an arachnoid complex that extends from the crural cistern to lateral border of cerebral colliculi. The subtemporal approach has been recognized as the best access to reach pathologies in the ambient cistern, however many disadvantages exist. The present work aims to analyze quantitatively the area of exposure provided by the subtemporal access. The objective is to evaluate if there are advantages of using the neuroendoscope in conventional subtemporal access when compared to the subtemporal access with resection of the parahippocampal gyrus. A subtemporal approach was performed in six brain hemispheres. Qualitative and quantitative analyses were made. The linear exposition of the vascular structures and the surgical exposure area were evaluated. The linear exposure to the posterior cerebral artery was 5.95 for subtemporal access (ST) and 13.6 for subtemporal access with resection of the parahippocampal gyrus (STh) (p = 0.019). The total exposure area was 104.8 mm2 for ST and 210.5 for STh (p = 0.0001). Regarding endoscope assistance the medial area, ST was 81.0 mm2, and STend was 176.2 mm2 (p = 0.038). For the total area of exposure, we obtained a value of 210.5 mm2 for ST and a value of 391.3 mm2 for STend (p = 0.041). In conventional subtemporal access, the use of the neuroendoscopes avoids the need for resection of the parahippocampal gyrus for better visualization of the ambient cistern structures.
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Huang Z, Zhang D, Chen Y, Wang Y, Chen W, Huang Z. Treatment of the recanalization of maxillary and mandibular arteriovenous malformations in children. Oral Surg Oral Med Oral Pathol Oral Radiol 2016; 122:530-536. [PMID: 27601351 DOI: 10.1016/j.oooo.2016.06.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Revised: 05/09/2016] [Accepted: 06/17/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE This study reviewed our experience in treating the recanalization of maxillary and mandibular arteriovenous malformations in children. STUDY DESIGN Four patients with maxillary or mandibular arteriovenous malformations (AVMs) were included in this study. All the patients had undergone multidisciplinary treatment of AVM at least 26 months before our review, including superselective intra-arterial embolization combined with bone wax packing. Computed tomographic angiography and digital subtraction angiography were performed to confirm the presence of recanalization. Superselective intra-arterial embolization combined with bone wax packing and tooth extractions were performed in the patients with recanalization. RESULTS After confirmation of the recanalization of AVM by digital subtraction angiography, the patients were treated with superselective intra-arterial embolization combined with bone wax packing and tooth extractions (if necessary). All the patients were followed up for 5 to 14 months, with an average of 9.5 months. The outcome for all patients was good, and no patient complained of pulsatile sensation or hemorrhage after treatment. CONCLUSIONS In the treatment for recanalization of maxillary and mandibular AVMs, reapplication of the superselective intra-arterial embolization, combined with bone wax packing, remains necessary.
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Affiliation(s)
- Zixian Huang
- Resident, Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Daming Zhang
- Resident, Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yaoting Chen
- Resident, Department of Interventional Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Youyuan Wang
- Associate Professor, Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Weiliang Chen
- Professor, Department Head, Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Zhiquan Huang
- Associate Professor, Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.
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