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1.
No Shinkei Geka ; 48(12): 1177-1182, 2020 Dec.
Artigo em Japonês | MEDLINE | ID: mdl-33353881

RESUMO

Positional vertebral artery occlusion(PVAO)is a mechanical occlusion of the extracranial vertebral artery(VA)due to physiological movement of the head and neck. However, only a few cases of mechanical VA compression due to routine flexion-extension of the neck have been reported. We present a unique case of PVAO due to neck extension with an occipital condylar spur. A 78-year-old man was admitted to our hospital for sudden onset of right hemiparesis and dysarthria. Magnetic resonance imaging(MRI)revealed bilateral occipital and cerebellar infarctions and vessel occlusion extending from the VA to the basilar artery. Mechanic thrombectomy resulted in partial recanalization. Computed tomography angiography(CTA)performed the next day showed spontaneously recanalized left VA with some wall irregularity. CTA in the neck-extended position revealed a severely compressed left VA in its V3 segment, which was attributed to the left occipital condylar spur with degenerative changes of the condyle-C1 facet. Cervical MRI also showed a pseudotumor from the lower clivus to the odontoid process that indicated mechanical stress on the occipitocervical ligaments. An occiput to C2 fusion was performed to stabilize and avoid dynamic vascular compression. Postoperative CTA revealed no evidence of restricted flow with flexion or extension movements of the neck. It should be noted that physiological head and neck movements accompanied by condylar degenerative changes could be a cause of vertebrobasilar insufficiency.


Assuntos
Artéria Vertebral , Insuficiência Vertebrobasilar , Idoso , Humanos , Imagem por Ressonância Magnética , Masculino , Pescoço , Osso Occipital/diagnóstico por imagem , Osso Occipital/cirurgia , Artéria Vertebral/diagnóstico por imagem , Artéria Vertebral/cirurgia , Insuficiência Vertebrobasilar/diagnóstico por imagem , Insuficiência Vertebrobasilar/etiologia , Insuficiência Vertebrobasilar/cirurgia
2.
Zhonghua Wai Ke Za Zhi ; 58(12): 909-917, 2020 Dec 01.
Artigo em Chinês | MEDLINE | ID: mdl-33249808

RESUMO

Objective: To examine the clinical efficacy of endovascular treatment on symptomatic occlusion of intracranial vertebral artery (ICVA) in early non-acute stage. Methods: Nine consecutive patients who presented with aggressive ischemic events in the early non-acute stage of ICVA occlusion from January 2014 to December 2019 and received endovascular treatment at Department of Neurosurgery, Peking University First Hospital were retrospectively reviewed.There were 7 males and 2 females, aged 63.4 years old(range: 52 to 72 years).The average preoperative modified Rankin scale(mRS) was 4.3(range: 4 to 5), the National Institute of Health stroke scale(NIHSS) was 12.3(range: 8 to 18). Among them, 2 patients received a single stage endovascular treatment, and the other 7 patients received staged endovascular treatment.The strategy of staged treatment was as follows: firstly, the occlusion part was passed through by a micro-guidewire and dilated with balloons to maintain the blood flow above Thrombolysis In Cerebral Infarction grade 2b. Then, the intravascular large load thrombus was eliminated by the fibrinolytic system and strengthened antiplatelet drugs. After that, a second stage of angioplasty with stenting was performed on the severe residual stenosis part.The complications and the recanalization rate were collected, and the National NIHSS and mRS after endovascular treatment and in follow-up period were recorded. Results: In the 2 cases received single stage endovascular treatment, although revascularization was achieved lastly, one patient suffered embolus translocation and the other suffered re-occlusion after mechanical thrombectomy during the operation, respectively.Technical success was achieved in 6 of the 7 patients received staged endovascular treatment.On discharge, the average NIHSS scores was 5.7(range: 3 to 4) of the patients. Three months after operation,the average mRS was 1.6(range:0 to 3) and it was 0.9(range: 0 to 2) at the latest follow-up, which were better than preoperative status. Conclusions: Staged endovascular treatment might be a safe, efficient, viable option in carefully selected patients with symptomatic ICVA occlusion in early non-acute stage. It needs to be confirmed by further investigation, preferably in a large controlled setting.


Assuntos
Arteriopatias Oclusivas/cirurgia , Procedimentos Endovasculares , Doenças Arteriais Intracranianas/cirurgia , Artéria Vertebral/cirurgia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Stents , Resultado do Tratamento
3.
Ann Ital Chir ; 91: 273-276, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32877380

RESUMO

CASE REPORT: A 64-year-old woman presented to our emergency department during the outbreak of the covid-19 emergency in Italy with syncope, anosmia, mild dyspnoea and atypical chest and dorsal pain. A chest CT scan showed an acute type B aortic dissection (ATBAD) and bilateral lung involvement with ground-glass opacity, compatible with interstitial pneumonia. Nasopharyngeal swabs resulted positive for SARS-CoV-2. For the persistence of chest pain, despite the analgesic therapy, we decided to treat her with a TEVAR. Patient's chest and back pain resolved during the first few days after the procedure. No surgical or respiratory complications occurred and the patient was discharged 14 days after surgery. DISCUSSION: By performing the operation under local anesthesia, it was possible to limit both the staff inside the operatory room and droplet/aerosol release. Since we had to perform the operation in a hemodynamics room, thanks to the limited extension of the endoprosthesis and the good caliber of the right vertebral artery we were able to reduce the risk of spinal cord ischemia despite the lack of a revascularization of the left subclavian artery. CONCLUSIONS: A minimally invasive total endovascular approach allows, through local anesthesia and percutaneous access, to avoid surgical cut down and orotracheal intubation. This, combined with a defined management protocol for infected patients, seems to be a reasonable way to perform endovascular aortic procedures in urgent setting, even in a SARSCoV- 2 positive patient. KEY WORDS: COVID-19, Dissection, TEVAR.


Assuntos
Aneurisma Dissecante/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Betacoronavirus/isolamento & purificação , Implante de Prótese Vascular/métodos , Infecções por Coronavirus/prevenção & controle , Procedimentos Endovasculares/métodos , Controle de Infecções/métodos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Anestesia Local , Aneurisma Dissecante/complicações , Antibioticoprofilaxia , Anticoagulantes/uso terapêutico , Antivirais/uso terapêutico , Aneurisma da Aorta Torácica/complicações , Contraindicações de Procedimentos , Infecções por Coronavirus/complicações , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/transmissão , Darunavir/uso terapêutico , Diabetes Mellitus Tipo 2/complicações , Quimioterapia Combinada , Enoxaparina/uso terapêutico , Feminino , Humanos , Hidroxicloroquina/uso terapêutico , Complicações Intraoperatórias/prevenção & controle , Intubação Intratraqueal/efeitos adversos , Pessoa de Meia-Idade , Nasofaringe/virologia , Salas Cirúrgicas , Isolamento de Pacientes , Pneumonia Viral/complicações , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/transmissão , Ritonavir/uso terapêutico , Isquemia do Cordão Espinal/prevenção & controle , Artéria Vertebral/cirurgia
4.
World Neurosurg ; 141: 137-141, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32497848

RESUMO

BACKGROUND: Vertebral angioma is a tumor defined as an abnormality of vascular tissue development. It usually has an asymptomatic behavior, being present in 10%-12% of autopsies and imaging studies. CASE DESCRIPTION: A 70-year-old man consulted because of a long history of low back pain. Imaging studies were compatible with vertebral angioma at T12; we decided to perform a minimally invasive surgical procedure, such as kyphoplasty. During surgery, there was a sharp decrease in pulmonary saturation, and the patient underwent a computed tomography scan evaluation confirming a left hemothorax due to segmental branch vascular injury at T12. Given the patient's poor medical condition and the complexity of an emergent open procedure in the thoracic spine, we decided to undertake a minimally invasive endovascular coil placement to repair the vascular injury. Due to a favorable outcome, we discharged the patient after 72 hours of surveillance. CONCLUSIONS: Even in the case of a complication to occur, we should always consider a minimally invasive solution to solve the problem because patients undergoing these procedures correspond to elderly patients with poor medical conditions or comorbidities.


Assuntos
Procedimentos Endovasculares/métodos , Hemangioma/cirurgia , Cifoplastia/efeitos adversos , Complicações Pós-Operatórias/cirurgia , Neoplasias da Coluna Vertebral/cirurgia , Artéria Vertebral/lesões , Idoso , Prótese Vascular , Humanos , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Complicações Pós-Operatórias/etiologia , Artéria Vertebral/cirurgia
5.
World Neurosurg ; 142: 176-178, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32585380

RESUMO

BACKGROUND: Intracranial mycotic aneurysms are uncommon. They can occur due to extravascular extension or intravascular seeding of the vessel wall. They often result in subarachnoid hemorrhage with poor prognosis. We present a rare case of subarachnoid hemorrhage due to vertebral artery dissection with aproximal anterior inferior cerebellar artery (AICA)-posterior inferior cerebellar artery common trunk mycotic aneurysm after an episode of bacterial meningitis. CASE DESCRIPTION: A 66-year-old male with history of 2 episodes of culture-negative bacterial meningitis presented with a Hunt and Hess grade II, Fisher grade III subarachnoid hemorrhage. Catheter angiography showed a right-sided intracranial vertebral artery (VA) dissection and a fusiform AICA-posterior inferior cerebellar artery trunk aneurysm. The patient underwent an endovascular occlusion of the VA dissecting aneurysm followed by an occipital artery to AICA bypass with trapping of the aneurysm. The patient developed a left-sided numbness and weakness after the coiling procedure due to anteromedian medullary stroke (occlusion of the right anterior spinal artery). The patient's magnetic resonance imaging 3 weeks before the aneurysm rupture and during the second episode of meningitis showed new enhancement of both vertebral arteries with a mild reduction in the right VA caliber. At 6 weeks' follow-up the patient was off the ventilator but had a modified Rankin Scale score of 5. CONCLUSIONS: Bacterial meningitis can lead to inflammatory injury of the intracranial vessels with resultant aneurysm formation. New enhancement of the vessel wall indicates that patients are at risk of developing mycotic aneurysms; therefore close observation with repeated vascular imaging is necessary.


Assuntos
Aneurisma Infectado/cirurgia , Aneurisma Roto/cirurgia , Cerebelo/irrigação sanguínea , Cerebelo/cirurgia , Aneurisma Intracraniano/cirurgia , Idoso , Aneurisma Infectado/complicações , Aneurisma Infectado/diagnóstico por imagem , Aneurisma Roto/complicações , Aneurisma Roto/diagnóstico por imagem , Cerebelo/diagnóstico por imagem , Humanos , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/diagnóstico por imagem , Masculino , Resultado do Tratamento , Artéria Vertebral/diagnóstico por imagem , Artéria Vertebral/cirurgia
6.
J Neurointerv Surg ; 12(8): 777-782, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32546632

RESUMO

BACKGROUND: Ruptured aneurysms of the intracranial vertebral artery (VA) or posterior inferior cerebellar artery (PICA) are challenging to treat as they are often dissecting aneurysms necessitating direct sacrifice of the diseased segment, which is thought to carry high morbidity due to brainstem and cerebellar stroke. However, relatively few studies evaluating outcomes following VA or proximal PICA sacrifice exist. We sought to determine the efficacy and outcomes of endovascular VA/PICA sacrifice. METHODS: A retrospective series of ruptured VA/PICA aneurysms treated by endovascular sacrifice of the VA (including the PICA origin) or proximal PICA is reviewed. Collected data included demographic, radiologic, clinical, and disability information. RESULTS: Twenty-one patients were identified. Median age was 57 years (IQR 11); 15 were female. The Hunt and Hess grade was mostly 3 and 4 (18/21). Seven cases (33%) involved VA-V4 at the PICA take-off, and 14 cases (67%) involved the PICA exclusively. For VA pathology, V4 was sacrificed in all cases, while for PICA pathology, sacrificed segments included anterior medullary (4/14), lateral medullary (7/14), and tonsillomedullary (3/14) segments. Four patients went to hospice (19%). Twelve patients (57%) had evidence of stroke on follow-up imaging: cerebellar (8), medullary (1), and both (3). One patient required suboccipital decompression for brainstem compression. No aneurysm re-rupture occurred. Median discharge modified Rankin Scale score was 2.0 (IQR 2), which decreased to 1.0 (IQR 1) at median follow-up of 6.5 months (IQR 23). CONCLUSIONS: Endovascular sacrifice of V4 or PICA aneurysms may carry less morbidity than previously thought, and is a viable alternative for poor surgical candidates or those with good collateral perfusion.


Assuntos
Aneurisma Roto/cirurgia , Cerebelo/irrigação sanguínea , Cerebelo/cirurgia , Aneurisma Intracraniano/cirurgia , Idoso , Procedimentos Endovasculares , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Acidente Vascular Cerebral/cirurgia , Artéria Vertebral/cirurgia
7.
No Shinkei Geka ; 48(5): 429-434, 2020 May.
Artigo em Japonês | MEDLINE | ID: mdl-32434954

RESUMO

Microvascular decompression(MVD)is an effective treatment for hemifacial spasm and trigeminal neuralgia. However, there are few reports regarding its use with abducens nerve palsy. Here, we report the case of a 77-year-old male who presented with diplopia and was admitted to our facility for right abducens nerve palsy. MRI constructive interference in steady-state(CISS)showed that the right anterior inferior cerebellar artery(AICA)was curved in a posterior-superior direction at the beginning of the region of origin, causing compression of the root exit zone of the right abducens nerve. In addition, MRI showed an unruptured fusiform aneurysm(5.3mm×7.1mm)of the vertebral artery(VA)involving the posterior inferior cerebellar artery(PICA). However it was not related to abducens nerve paralysis. The aneurysm was successfully treated with an occipital artery-posterior inferior cerebellar artery(OA-PICA)bypass and clipping of the proximal VA and PICA origin. The position of the offending artery was moved using a Teflon® felt fibrin glue and the retrosigmoid transcondylar fossa approach. The patient recovered from abducens nerve paralysis with no new neurological deficit. We emphasize the importance of choosing an appropriate approach as this increases the possibility of treating abducens nerve paralysis in a timely manner.


Assuntos
Doenças do Nervo Abducente , Espasmo Hemifacial/cirurgia , Cirurgia de Descompressão Microvascular , Nervo Abducente , Idoso , Artéria Basilar , Humanos , Masculino , Artéria Vertebral/cirurgia
8.
J Clin Neurosci ; 78: 397-399, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32402613

RESUMO

We report the case of a patient with an anterior ischemic stroke due to tandem occlusion of the left M2 segment and ipsilateral internal carotid artery (ICA), with concomitant severe stenosis of the ipsilateral external carotid artery (ECA) and contralateral ICA, and moderate stenosis of the left vertebral artery (VA); as thrombectomy was not possible, stenting of the right ICA was performed. Two days after significant recovery, the patient showed neurological deterioration when in upright position, and brain magnetic resonance imaging confirmed decreased cerebral blood flow on the left hemisphere. Stenting of the left ECA and balloon angioplasty of the ipsilateral VA were performed in order to increase collateral flow, with an almost complete resolution of symptoms. This case highlights the importance of assessing the collateralization pattern when an ICA occlusion is present, and the potential need to revascularize an ipsilateral stenotic ECA.


Assuntos
Doenças das Artérias Carótidas/terapia , Artéria Carótida Interna/patologia , Estenose das Carótidas/cirurgia , Stents/efeitos adversos , Angioplastia com Balão/métodos , Artéria Carótida Interna/cirurgia , Circulação Cerebrovascular , Circulação Colateral/fisiologia , Humanos , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/fisiopatologia , Artéria Vertebral/cirurgia
10.
J Clin Ultrasound ; 48(6): 362-366, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32274812

RESUMO

Although ultrasonographically-guided carotid interventions without contrast medium have been reported in the literature, we found no report regarding stenting of the vertebral artery origin for treatment of stenosis. Here, we report the case of an iodine-allergic patient in whom a stenosis at the origin of the vertebral artery was successfully treated with ultrasonographically-guided stent placement without contrast medium. B-mode longitudinal images were monitored during the insertion of the embolism-protection device, when positioning the stent, and for the evaluation of the stent opening. This technique can be an alternative option in selected patients, especially those allergic to the contrast medium.


Assuntos
Stents , Artéria Vertebral/diagnóstico por imagem , Artéria Vertebral/cirurgia , Idoso , Angioplastia com Balão/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Ultrassonografia/métodos
11.
World Neurosurg ; 139: 101-105, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32305617

RESUMO

BACKGROUND: Transradial access (TRA) has recently gained traction as the preferred approach in a variety of neurointerventions after studies have demonstrated equivalent outcomes with fewer complications than transfemoral access (TFA). However, multiple access sites are occasionally necessary when simultaneous selective catheterization of 2 vessels is required. We present the first cases detailing bilateral TRA for complex posterior circulation interventions. CASE DESCRIPTIONS: All neuroendovascular cases in which bilateral TRA was obtained at the University of Miami/Jackson Health System were reviewed. Two patients, each with complex left vertebral artery aneurysms, were identified. In each case, bilateral TRA was chosen because 1) left vertebral artery catheterization via right TRA can be technically challenging; 2) simultaneous catheterization of both vertebral arteries was felt to be necessary; 3) prior angiograms had demonstrated that the subclavian arteries would provide the most direct, anatomically feasible access route; and 4) the primary surgeon preferred to avoid TFA. Right TRA and left distal transradial access via the anatomic snuffbox were obtained in both cases to allow both arms to sit on the operator side of the table. Neither patient experienced any perioperative complications. CONCLUSIONS: Bilateral TRA can be an effective method for catheterizing both vertebral arteries during complex posterior circulation interventions and obviates the need for TFA when multiple arterial access sites are required. Furthermore, distal transradial access allows the left hand to remain more anatomically neutral while being positioned on the right side of the table so that both access sites remain ergonomically favorable for the interventionalist.


Assuntos
Aneurisma Dissecante/cirurgia , Procedimentos Endovasculares/métodos , Aneurisma Intracraniano/cirurgia , Procedimentos Neurocirúrgicos/métodos , Artéria Radial , Artéria Vertebral/cirurgia , Adulto , Aneurisma Dissecante/diagnóstico por imagem , Angiografia Cerebral , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Imageamento Tridimensional , Aneurisma Intracraniano/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Artéria Vertebral/diagnóstico por imagem
12.
Ann Vasc Surg ; 67: 566.e11-566.e15, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32335248

RESUMO

The endovascular repair of subclavian aneurysms or pseudoaneurysms is now widely adopted. However, controversies still prevail in the management of dominant vertebral arteries originating close to aneurysms, as coverage of the vertebral artery might be complicated by either endoleaks or ischemic events. Here, we present a rare case of multiple aneurysmal lesions involving the right subclavian artery and bilateral internal carotid arteries treated by way of a total endovascular method using parallel stent grafts for the simultaneous exclusion of a subclavian artery pseudoaneurysm and flow preservation of the adjacent vertebral artery. To the best of our knowledge, this is the first study to report the use of this technique for the endovascular repair of juxta-vertebral subclavian artery pseudoaneurysms.


Assuntos
Falso Aneurisma/cirurgia , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Procedimentos Endovasculares/instrumentação , Stents , Artéria Subclávia/cirurgia , Artéria Vertebral/cirurgia , Adulto , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/fisiopatologia , Humanos , Masculino , Desenho de Prótese , Fluxo Sanguíneo Regional , Artéria Subclávia/diagnóstico por imagem , Artéria Subclávia/fisiopatologia , Resultado do Tratamento , Artéria Vertebral/diagnóstico por imagem , Artéria Vertebral/fisiopatologia
13.
J Clin Neurosci ; 78: 403-405, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32336640

RESUMO

One of the treatment options for long segment common carotid artery (CCA) occlusion is bypass surgery with different combinations of donors and receipts. Using vertebral artery (VA) as the donor for CCA occlusion was uncommonly reported. The reported cases were using jump graft to connect V3 segment of VA to either CCA or ICA. We describe our patient using V2 segment as the donor for VA-CCA bypass as treatment for CCA occlusion. Our patient was a 51 years old gentleman with Marfan syndrome and had multiple operations that included total arch replacement. He presented with sudden onset of spontaneous right frontal subarachnoid haemorrhage and repeated episodes of TIA with left upper limb numbness. CTA showed occluded right CCA and anastomosis between branches from subclavian artery and occipital artery. CT perfusion showed hypoperfusion of right hemisphere. To avoid damaging the anastomosis at subclavian artery and occipital artery, we decided for V2-RAG (radial artery graft)-CCA bypass. It was done by exposing the V2 segment at C4/5 level, performing end-to-side anastomoses at V2-RAG and RAG-CCA junctions where the RAG was underneath the internal jugular vein. Patient had no new deficits after surgery and no more TIAs. CTA performed one week after surgery showed patent RAG. In conclusion, using V2 for VA-CCA bypass is technically feasible and may have theoretical advantages over using V3. V2-CCA bypass is an option for CCA occlusion in very selected patients.


Assuntos
Anastomose Cirúrgica , Doenças das Artérias Carótidas/cirurgia , Trombose das Artérias Carótidas/terapia , Artéria Carótida Primitiva/cirurgia , Artéria Vertebral/cirurgia , Revascularização Cerebral , Humanos , Ataque Isquêmico Transitório , Masculino , Síndrome de Marfan/terapia , Pessoa de Meia-Idade , Artéria Radial/cirurgia , Artéria Radial/transplante , Hemorragia Subaracnóidea , Trombose/cirurgia , Procedimentos Cirúrgicos Vasculares
14.
World Neurosurg ; 139: e601-e607, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32330623

RESUMO

OBJECTIVE: Tumors of the cervical spine often encase 1 or both vertebral arteries (VA), presenting the treating surgeon with the dilemma of whether to sacrifice or skeletonize the artery. We propose an algorithm for VA management in surgeries for cervical neoplasms METHODS: A retrospective review was carried out of 67 patients undergoing resection of cervical spine tumors with VA involvement. Patients were categorized by tumor origin (primary vs. metastatic) and degree of circumferential VA involvement: 1) abutment only; 2) <180° circumferential involvement; 3) >180° circumferential involvement without complete encasement; or 4) complete encasement. RESULTS: Twelve patients (18%) underwent VA sacrifice, whereas 55 (82%) underwent VA skeletonization. Compared with 11/30 patients with primary tumors (37%), only 1/37 patients (3%) with metastatic disease underwent VA sacrifice (P < 0.01). This patient had invasion of the V2 arterial wall, requiring VA sacrifice. Odds of VA sacrifice also increased with increasing circumferential involvement (P < 0.01). No patients with simple abutment or 0°-180° circumferential involvement underwent sacrifice, whereas 6 of 10 (60%) with 180°-359° involvement and 6 of 29 (21%) with complete encasement underwent VA sacrifice. Of the 27 patients with ≥180° involvement, the reasons for preserving the VA were metastatic disease at the time of treatment (n = 18), a compromised contralateral VA (n = 7), vertebrobasilar junction aplasia (n = 1), and presence of a radiculomedullary artery at the affected level (n = 1). CONCLUSIONS: Primary tumor disease and >180° of circumferential VA involvement should be considered as indications for intraoperative sacrifice of the VA pending preoperative angiographic evaluation for contraindications.


Assuntos
Vértebras Cervicais/cirurgia , Procedimentos Neurocirúrgicos/métodos , Neoplasias da Coluna Vertebral/cirurgia , Artéria Vertebral/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Angiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Estudos Retrospectivos , Neoplasias da Coluna Vertebral/secundário , Resultado do Tratamento , Adulto Jovem
15.
World Neurosurg ; 141: 437-438.e1, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32311570

RESUMO

A patient presented with progressive ischemic stroke and received mechanical thrombectomy with a Solitaire FR device 29 days after stroke onset. The occluded V4 segment of the left vertebral artery showed a double rail sign on angiography, which indicated that the occlusion might have been caused by embolism instead of stenosis. The mechanical thrombectomy procedure was a 1-pass success and the patient was functionally independent with a modified Rankin Scale score of 1 at 3-month follow-up. The appearance of the vascular wall (double rail sign) of the occluded cerebral vascular segment on angiography may be a significant feature to identify the character of the occlusion even a long time after onset, which is important when planning further endovascular therapy in patients with ischemic stroke.


Assuntos
Isquemia Encefálica/cirurgia , Stents/efeitos adversos , Trombectomia , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/etiologia , Constrição Patológica/etiologia , Constrição Patológica/cirurgia , Cabeça/cirurgia , Humanos , Anamnese/métodos , Trombectomia/efeitos adversos , Trombectomia/métodos , Artéria Vertebral/cirurgia
16.
World Neurosurg ; 138: e539-e550, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32156594

RESUMO

BACKGROUND AND IMPORTANCE: Unclippable vertebral artery aneurysms (UVAs) are difficult to treat with direct clipping, especially in cases involving the origin of the posterior inferior cerebellar artery (PICA). Bypass with trapping is the common procedure used for these conditions. The authors used the blind-alley formation technique, which is a simpler method than trapping and can avoid some complications. OBJECTIVES: To report 7 cases of UVA with PICA involvement treated with blind-alley formation and occipital artery (OA)-PICA bypass as well as their surgical outcomes and complications and to describe the operative techniques. RESULTS: Seven patients with UVA and PICA involvement underwent OA-PICA bypass and blind-alley formation (occlusions of the PICA origin and vertebral artery proximal to the aneurysm). Vertebral artery dissecting aneurysms and fusiform atherosclerotic vertebral artery aneurysms were detected in 6 patients and 1 patient, respectively. All patients presented with subarachnoid hemorrhage, and 71.4% of them were classified into the poor-grade group. Good bypass patency and complete aneurysm obliteration were achieved in all cases. Six aneurysms (85.7%) were completely obliterated according to computed tomography angiography performed immediately postoperatively. Another aneurysm was 50% and 100% thrombosed immediately and at 7 days after the operation, respectively. Surgical complications were found in 1 patient (14.3%) who had postoperative diparesis with dysphagia. Three patients (42.9%) achieved a Glasgow Outcome Score of 4 or 5 one month after the operation. CONCLUSIONS: Blind-alley formation and OA-PICA bypass are simple, safe, and effective for the treatment of patients with UVA with PICA involvement.


Assuntos
Cerebelo/irrigação sanguínea , Revascularização Cerebral/métodos , Dissecação da Artéria Vertebral/cirurgia , Artéria Vertebral/cirurgia , Adulto , Idoso , Cerebelo/diagnóstico por imagem , Cerebelo/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Artéria Vertebral/diagnóstico por imagem , Dissecação da Artéria Vertebral/diagnóstico por imagem
17.
AANA J ; 88(1): 49-58, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32008618

RESUMO

Traumatic aortic rupture (TAR) is a highly fatal injury mechanism resulting from blunt deceleration forces against the descending aorta. The mechanism of TAR is directly attributed to the aorta suffering damage by indirect shearing forces. The descending aorta remains fixed to the posterior chest wall, while the heart and ascending aorta are exerted forward, thus causing the intimal tear. A characteristic triad presents as increased blood pressure in the upper extremities, decreased blood pressure in the lower extremities, and a widened mediastinum on radiography. Early recognition of signs and symptoms of the mechanism of injury is key to initiating early damage control surgery and ultimately decreasing morbidity and mortality. This case report describes the intraoperative management of an elderly female patient with TAR following a motor vehicle collision in a remote location in rural Pennsylvania.


Assuntos
Acidentes de Trânsito , Aorta Torácica/lesões , Ruptura Aórtica/diagnóstico , Lesões do Pescoço/complicações , Artéria Vertebral/lesões , Ferimentos não Penetrantes/complicações , Idoso , Aorta Torácica/cirurgia , Ruptura Aórtica/complicações , Ruptura Aórtica/diagnóstico por imagem , Ruptura Aórtica/cirurgia , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Escala de Gravidade do Ferimento , Lesões do Pescoço/enfermagem , Enfermeiras Anestesistas , Artéria Vertebral/cirurgia , Ferimentos não Penetrantes/enfermagem
19.
Neurosurgery ; 87(2): 383-393, 2020 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-32022238

RESUMO

BACKGROUND: Parent vessel sacrifice (PVS) has been a traditional way of treating complex aneurysms of the intradural vertebral artery (VA). Flow diversion (FD) has emerged as an alternative reconstructive option. OBJECTIVE: To compare the long-term clinical and radiographic outcomes of intradural VA aneurysms following PVS or FD. METHODS: We retrospectively reviewed and evaluated 43 consecutive patients between 2009 and 2018 with ruptured and unruptured intradural VA aneurysms treated by PVS or FD. Medical records including clinical and radiological details were reviewed. RESULTS: A total of 43 intradural VA aneurysms were treated during this period. In the 14 PVS patients, the mean follow-up was 19.5 mo, and 71.4% of cases achieved modified Rankin scale (mRS) ≤2 at the last follow-up. A total of 86.5% of cases achieved complete occlusion. There was a 14.3% (2 cases) mortality rate, 14.3% (2 cases) postoperative ischemic complication rate, and 0% postoperative hemorrhaging rate. Retreatment was required in 1 case (7.1%). In the 29 FD patients, the mean follow-up was 21.8 mo, and 89.7% of cases achieved mRS ≤2 at the final follow-up. There was a 3.2% (1 case) mortality rate, 19.4% (6 cases) of postoperative ischemic complications, and 6.5% (2 cases) of postoperative hemorrhagic complications. Complete occlusion was seen in 86.5% patients. No cases required retreatment. Mortality and complication rates were not significantly different between PVS and PED (Pipeline Embolization Device) groups. CONCLUSION: PVS was associated with comparable intraprocedural complications for VA aneurysms as compared to FD in the largest multicenter study to date. Both procedures have good long-term clinical and radiological outcomes.


Assuntos
Procedimentos Endovasculares/métodos , Aneurisma Intracraniano/cirurgia , Resultado do Tratamento , Artéria Vertebral/cirurgia , Adulto , Prótese Vascular , Estudos de Coortes , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Retratamento , Estudos Retrospectivos , Artéria Vertebral/patologia
20.
World Neurosurg ; 137: 126-129, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32032788

RESUMO

BACKGROUND: Intraoperative confirmation of the vascular anatomy and blood flow contributes to the safety of the surgery for perimedullary arteriovenous fistulas (PAVF). However, because the PAVF at the craniocervical junction (CCJ) is mainly located on the ventral spinal cord surface, it is difficult to observe the entire pathology by a conventional surgical approach. To achieve increased viewing angle and visualization of real time blood flow, we introduced endoscope-integrated fluorescein video angiography in the treatment for PAVF at the CCJ for the first time. CASE DESCRIPTION: A 63-year-old man presented with subarachnoid hemorrhage due to rupture of PAVF at the CCJ, fed by both the right C1 radiculomedullary artery and the anterior spinal artery (ASA). Suboccipital craniotomy and C1 hemilaminotomy was performed and microscopic observation revealed partial anatomy of the PAVF covered by subarachnoid clots on the ventrolateral surface at the right C1 nerve root level. However, pathology ventral to the C1 nerve root was obscure and an endoscope-integrated fluorescein video angiography was introduced, which clearly demonstrated the PAVF components and the ASA. CONCLUSIONS: According to these findings, the PAVF was coagulated and the ASA was preserved. Endoscope-integrated fluorescein video angiography allowed to visualize its real-time blood flow, leading to a safe and reliable treatment.


Assuntos
Fístula Arteriovenosa/cirurgia , Malformações Vasculares do Sistema Nervoso Central/cirurgia , Vértebras Cervicais/cirurgia , Hemorragia Subaracnóidea/cirurgia , Fístula Arteriovenosa/diagnóstico , Angiofluoresceinografia/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Neuroendoscopia , Medula Espinal/cirurgia , Hemorragia Subaracnóidea/diagnóstico , Artéria Vertebral/cirurgia
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