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Murai Y, Shirokane K, Kitamura T, Tateyama K, Matano F, Mizunari T, Morita A. Petrous Internal Carotid Artery Aneurysm: A Systematic Review. J NIPPON MED SCH 2020; 87:172-183. [DOI: 10.1272/jnms.jnms.2020_87-407] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Yasuo Murai
- Department of Neurological Surgery, Nippon Medical School Hospital
| | | | - Takao Kitamura
- Department of Neurological Surgery, Nippon Medical School Hospital
| | - Kojiro Tateyama
- Department of Neurological Surgery, Nippon Medical School Hospital
| | - Fumihiro Matano
- Department of Neurological Surgery, Nippon Medical School Hospital
| | - Takayuki Mizunari
- Department of Neurosurgery, Nippon Medical School Chiba Hokusoh Hospital
| | - Akio Morita
- Department of Neurological Surgery, Nippon Medical School Hospital
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2
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Ghali MGZ, Binning M. Flow Diversion for the Treatment of Petrous Internal Carotid Artery Aneurysms. Asian J Neurosurg 2019; 14:1058-1062. [PMID: 31903340 PMCID: PMC6896609 DOI: 10.4103/ajns.ajns_119_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Petrous internal carotid artery (ICA) aneurysms are rare and pose a unique management dilemma. They are most commonly fusiform. They are difficult to treat surgically and typically not amenable to selective aneurysmal obliteration. The advent of flow diverters, such as the Pipeline endovascular device, has offered a new approach to these historically challenging lesions. The unique utility of flow diversion in treatment of petrous ICA aneurysms is reviewed and discussed.
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Affiliation(s)
| | - Mandy Binning
- Department of Neurosurgery, Hahnemann University Hospital, Philadelphia, PA, USA
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3
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Kim SM, Kim CH, Lee CY. Petrous Carotid Aneurysm Causing Pulsatile Tinnitus: Case Report and Review of the Literature. J Cerebrovasc Endovasc Neurosurg 2018; 20:35-39. [PMID: 30370238 PMCID: PMC6196136 DOI: 10.7461/jcen.2018.20.1.35] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 09/21/2017] [Accepted: 01/07/2018] [Indexed: 12/18/2022] Open
Abstract
We present the case of a patient who developed pulsatile tinnitus that was found to be associated with a petrous carotid aneurysm. The aneurysm was successfully obliterated using stent-assisted coiling, after which the patient was symptom-free. Although aneurysms arising from the petrous segment of the internal carotid artery are rare, this pathology must be considered as a causative factor in patients with pulsatile tinnitus. Endovascular treatment appears to have been successful in resolving the symptoms associated with this pathology.
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Affiliation(s)
- Seong-Mook Kim
- Department of Neurosurgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Chang-Hyun Kim
- Department of Neurosurgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Chang-Young Lee
- Department of Neurosurgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
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4
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Yu LB, Zhang D, Yang SH, Zhao JZ. Surgical management of giant intrapetrous internal carotid aneurysm presenting with coil exposure after endovascular treatment. Neurosurg Rev 2018; 41:891-894. [DOI: 10.1007/s10143-018-0964-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 02/28/2018] [Accepted: 03/07/2018] [Indexed: 11/28/2022]
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Mazur MD, Taussky P, Park MS, Couldwell WT. Contemporary endovascular and open aneurysm treatment in the era of flow diversion. J Neurol Neurosurg Psychiatry 2018; 89:277-286. [PMID: 29025918 DOI: 10.1136/jnnp-2016-314477] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 08/23/2017] [Accepted: 09/05/2017] [Indexed: 11/03/2022]
Abstract
Clinical outcomes have improved considerably over the last decade for patients with ruptured and unruptured aneurysms. Modern endovascular techniques, such as flow diversion, are associated with high aneurysm occlusion rates and have become a popular treatment modality for many types of aneurysms. However, the safety and effectiveness of flow diversion has not yet been established in trials comparing it with traditional aneurysm treatments. Moreover, there are some types of aneurysms that may not be appropriate for endovascular coiling, such as wide-necked aneurysms located at branch points of major vessels, large saccular aneurysms with multiple efferent arteries, dolichoectatic aneurysms, large aneurysms with mass effect, when there are technical complications with endovascular treatment, when patients cannot tolerate or have contraindications to antiplatelet therapy or in the setting of a subarachnoid haemorrhage. For these cases, open cerebrovascular surgery remains important. This review provides a discussion on the current trends and evidence for both flow diversion and open cerebrovascular surgery for complex aneurysms that may not be suitable for coiling. We emphasise a continued important role for surgical treatment in certain situations.
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Affiliation(s)
- Marcus D Mazur
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake, Utah, USA
| | - Philipp Taussky
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake, Utah, USA
| | - Min S Park
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake, Utah, USA
| | - William T Couldwell
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake, Utah, USA
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Couldwell WT, Taussky P, Sivakumar W. Submandibular High-Flow Bypass in the Treatment of Skull Base Lesions. Neurosurgery 2012; 71:645-50; discussion 650-1. [DOI: 10.1227/neu.0b013e318260fedd] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND:
Cerebral bypass surgery remains an integral part of the treatment of complex skull base tumors and unclippable aneurysms.
OBJECTIVE:
The authors retrospectively analyzed a single-surgeon experience using a high-flow submandibular–infratemporal saphenous vein graft bypass technique after carotid artery sacrifice in the resection of complex skull base tumors and carotid isolation in unclippable aneurysms.
METHODS:
Data on indications, surgical technique, bypass patency, complications, and outcome were collected for patients treated with adjunctive submandibular high-flow bypass for skull base lesions.
RESULTS:
Eleven patients (age range, 13-77 years) were treated for various skull base lesions: 4 patients were treated for skull base tumors with resection of the internal carotid artery (ICA), 6 were treated for aneurysms not amenable to clipping, and one was treated for invasive Mucor infection. With the use of a saphenous vein graft, a high-flow bypass was created from the high cervical ICA or external carotid artery to ICA or middle cerebral artery by means of a submandibular–infratemporal route. Postoperative angiography indicated bypass patency in 10 of 11 patients. There was no operative mortality. Follow-up of up to 12 years (mean, 56 months) was achieved.
CONCLUSION:
Direct high-flow submandibular–infratemporal interpositional saphenous vein bypass graft is an effective and durable technique for the treatment of complex skull base lesions where ICA revascularization is indicated.
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Affiliation(s)
| | - Philipp Taussky
- Department of Neurosurgery, University of Utah, Salt Lake City, Utah
| | - Walavan Sivakumar
- Department of Neurosurgery, University of Utah, Salt Lake City, Utah
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Bilateral giant cavernous carotid artery aneurysms in a child with juvenile Paget's disease. World Neurosurg 2010; 73:691-3. [PMID: 20934158 DOI: 10.1016/j.wneu.2010.01.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2009] [Accepted: 02/14/2010] [Indexed: 11/24/2022]
Abstract
BACKGROUND Juvenile Paget disease (JPD) is a rare genetic bone disorder, also affecting the immune and vascular systems. We describe the first ever case of JPD associated with bilateral giant cavernous carotid artery aneurysms in a child. CASE DESCRIPTION A child with known JPD presented with left abducens nerve palsy and a computed tomographic angiogram revealed bilateral giant cavernous carotid artery aneurysms. He underwent a left-sided superficial temporal artery to middle cerebral artery bypass and endovascular carotid artery occlusion, followed by an identical procedure on the right side 3 months later and made an event-free recovery without any new neurological deficits. CONCLUSIONS This previously unreported association poses the question of determining the optimal management strategy for such cases. The pathophysiology and clinical features of JPD are discussed, with special emphasis on the management of giant cavernous carotid aneurysms in this subgroup of individuals.
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Hayden MG, Lee M, Guzman R, Steinberg GK. The evolution of cerebral revascularization surgery. Neurosurg Focus 2009; 26:E17. [DOI: 10.3171/2009.3.focus0931] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Among the relatively few surgeons to be awarded the Nobel Prize was Alexis Carrel, a French surgeon and pioneer in revascularization surgery at the turn of the 20th century. The authors trace the humble beginnings of cerebral revascularization surgery through to the major developments that helped shape the modern practice of cerebral bypass surgery. They discuss the cornerstone studies in the development of this technique, including the Extracranial/Intracranial Bypass Study initiated in 1977. Recent innovations, including modern techniques to monitor cerebral blood flow, microanastomosis techniques, and ongoing trials that play an important role in the evolution of this field are also evaluated.
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Krayenbühl N, Khan N, Cesnulis E, Imhof HG, Yonekawa Y. Emergency extra-intracranial bypass surgery in the treatment of cerebral aneurysms. CHANGING ASPECTS IN STROKE SURGERY: ANEURYSMS, DISSECTIONS, MOYAMOYA ANGIOPATHY AND EC-IC BYPASS 2008; 103:93-101. [DOI: 10.1007/978-3-211-76589-0_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Alaraj A, Ashley WW, Charbel FT, Amin-Hanjani S. The superficial temporal artery trunk as a donor vessel in cerebral revascularization: benefits and pitfalls. Neurosurg Focus 2008; 24:E7. [DOI: 10.3171/foc/2008/24/2/e7] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
The superficial temporal artery (STA) is the mainstay of donor vessels for extracranial–intracranial bypass in cerebral revascularization. However, the typically used STA anterior or posterior branch is not always adequate in its flow-carrying capacity. In this report the authors describe the use of the STA trunk at the level of the zygoma as an alternative donor and highlight the benefits and pitfalls of this revascularization option.
Methods
The authors reviewed the cases of 4 patients in whom the STA trunk was used as a donor site for anastomosis of a short interposition vein graft. The graft was implanted into the middle cerebral artery to trap a cartoid aneurysm in 2 patients, and the posterior cerebral artery for vertebrobasilar insufficiency in the other 2. Discrepancies in size between the interposition vein and STA trunk were compensated for by a beveled end-to-end anastomosis or by implanting the STA trunk into the vein graft in an end-to-side fashion.
Results
Intraoperative flow measurements confirmed the significantly higher flow-carrying capacity of the STA trunk (54–100 ml/minute) compared with its branches (10–28 ml/minute). The STA trunk interposition graft has several advantages compared with an interposition graft to the cervical carotid, including a shorter graft and no need for a neck incision. However, in the setting of ruptured aneurysm trapping, with the risk of subsequent vasospasm, it is a poor conduit for endovascular therapies.
Conclusions
The STA trunk is a valuable donor option for cerebral revascularization, but should be avoided in the setting of subarachnoid hemorrhage.
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Kan P, Liu JK, Couldwell WT. Giant fusiform aneurysm in an adolescent with PHACES syndrome treated with a high-flow external carotid artery-M3 bypass. Case report and review of the literature. J Neurosurg 2007; 106:495-500. [PMID: 17566409 DOI: 10.3171/ped.2007.106.6.495] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The acronym PHACES describes a rare neurocutaneous syndrome that comprises posterior fossa malformations, facial hemangiomas, arterial anomalies, coarctation of the aorta and cardiac defects, eye abnormalities, and sternal defects. Facial hemangiomas constitute the hallmark of this disorder. Giant intracranial aneurysms have not been previously reported in the literature as manifestations of PHACES syndrome and can present difficult therapeutic challenges. The authors describe a unique case of a 13-year-old adolescent boy with an incomplete phenotypic expression of PHACES syndrome who harbored diffuse cerebral angiodysplasia and a giant fusiform internal carotid artery (ICA) aneurysm extending from the distal cavernous segment to the supraclinoid segment. The aneurysm was successfully treated with a high-flow saphenous vein graft bypass from the external carotid artery to the distal middle cerebral artery followed by proximal ICA occlusion. This case represents a unique vascular manifestation of PHACES syndrome that required a complex management strategy. The authors review the literature on this rare disorder and emphasize the importance of considering the diagnosis of PHACES syndrome in child with a facial hemangioma.
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Affiliation(s)
- Peter Kan
- Department of Neurosurgery, University of Utah School of Medicine, Salt Lake City, Utah 84132, USA
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Couldwell WT, Liu JK, Amini A, Kan P. Submandibular-Infratemporal Interpositional Carotid Artery Bypass for Cranial Base Tumors and Giant Aneurysms. Oper Neurosurg (Hagerstown) 2006; 59:ONS353-9; discussion ONS359-60. [PMID: 17041504 DOI: 10.1227/01.neu.0000233661.59065.46] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Abstract
OBJECTIVE:
Cerebral revascularization is an important strategy in the surgical management of some complex cranial base tumors and unclippable aneurysms. A high-flow bypass may be necessary in planned carotid occlusion or sacrifice. The cervical-to-supraclinoid internal carotid artery bypass or cervical carotid-to-middle cerebral artery bypass are useful procedures to bypass lesions at the base of the cranium. We describe technical modifications of the submandibular-infratemporal interpositional saphenous vein (or radial artery) graft bypass technique specifically designed to avoid removal of the zygoma.
METHODS:
The saphenous vein or radial artery interpositional graft is tunneled through a burr hole created in the floor of the middle fossa via a submandibular-infratemporal route avoiding removal of zygoma and attachments of the masseter or temporalis muscles.
RESULTS:
The technique is demonstrated in one patient with removal of a malignant cavernous sinus tumor and in another patient with an unclippable giant carotid bifurcation aneurysm.
CONCLUSION:
The advantages of this approach include preservation of the facial anatomy and creation of a short and safe route for passage of the saphenous vein or radial artery graft.
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Affiliation(s)
- William T Couldwell
- Department of Neurosurgery, University of Utah School of Medicine, Salt Lake City, Utah 84132, USA.
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Liu JK, Gottfried ON, Amini A, Couldwell WT. Aneurysms of the petrous internal carotid artery: anatomy, origins, and treatment. Neurosurg Focus 2004; 17:E13. [PMID: 15633978 DOI: 10.3171/foc.2004.17.5.13] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Aneurysms arising in the petrous segment of the internal carotid artery (ICA) are rare. Although the causes of petrous ICA aneurysms remain unclear, traumatic, infectious, and congenital origins have been implicated in their development. These lesions can be detected incidentally on routine neuroimaging. Patients can also present with a wide spectrum of signs and symptoms, including cranial nerve palsies, Horner syndrome, pulsatile tinnitus, epistaxis, and otorrhagia. The treatment of petrous ICA aneurysms remains challenging. Treatment options include close observation, endovascular therapies, and surgical trapping with or without revascularization. Management dilemmas exist, particularly for incidental lesions found in asymptomatic patients. The authors review the literature and discuss the anatomy of the petrous ICA as well as the pathophysiological features of aneurysms arising in this region, and they propose a management paradigm with current treatment options.
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Affiliation(s)
- James K Liu
- Department of Neurological Surgery, University of Utah Health Sciences Center, Salt Lake City, Utah 84132, USA
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Liu JK, Kan P, Karwande SV, Couldwell WT. Conduits for cerebrovascular bypass and lessons learned from the cardiovascular experience. Neurosurg Focus 2003. [DOI: 10.3171/foc.2003.14.3.4] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Direct cerebral revascularization is an important procedure in the treatment of certain complex aneurysms and skull base tumors when acute sacrifice of the internal carotid artery is required. It likely remains an appropriate treatment in a small subgroup of patients with cerebral ischemia refractory to maximal medical management. Similar to cardiovascular surgery, the choice of a graft conduit is critical for a successful outcome. The standard conduits are interposition vein grafts (usually the greater saphenous vein), free arterial grafts (radial artery), and pedicled arterial grafts (superficial temporal artery). The goal of this review is to summarize the conduits commonly used in cerebral revascularization with emphasis on their patency rates and flow characteristics. Comparisons are made with similar data available in the cardiovascular literature.
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Liu JK, Couldwell WT. Interpositional carotid artery bypass strategies in the surgical management of aneurysms and tumors of the skull base. Neurosurg Focus 2003. [DOI: 10.3171/foc.2003.14.3.3] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Cerebral revascularization is an important component in the surgical management of complex skull base tumors and aneurysms. Patients who harbor complex aneurysms that cannot be clipped directly and in whom parent vessel occlusion cannot be tolerated may require cerebrovascular bypass surgery. In cases in which skull base tumors encase the carotid artery (CA) and a resection is desired, a cerebrovascular bypass may be necessary in planned CA occlusion or sacrifice. In this review the authors discuss options for performing high-flow anterograde interposition CA bypass for lesions of the skull base. The authors review three important bypass techniques involving saphenous vein grafts: the cervical-to-petrous internal carotid artery (ICA), petrous-to-supraclinoid ICA, and cervical-to-supraclinoid ICA bypass. These revascularization techniques are important tools in the surgical treatment of complex aneurysms and tumors of the skull base and cavernous sinus.
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