The variation in which the posterior inferior cerebellar artery arises from the hypoglossal branch of the ascending pharyngeal artery is thought to be related to the remnant of the primitive hypoglossal artery, and is referred to as a primitive hypoglossal artery variant. Cases in which the posterior inferior cerebellar artery arises from the jugular branch of the ascending pharyngeal artery are extremely rare. The authors present a case of a 50-year-old male with vertebral artery dissection who had this extremely rare variation bilaterally. The patient also had several rare variations of the intracranial vessels. This posterior inferior cerebellar artery arising from the jugular branch of the ascending pharyngeal artery may have developed due to the anastomosis between the meningeal and the pial vessels of the posterior fossa. Alternatively, an unknown primitive anastomotic artery may have passed through the jugular foramen. Genetic factors may play an important role in the presence of this anomalous vessel.
We report the usefulness of the adjunctive technique using a 3.4-Fr TACTICS catheter, which is a distal access catheter (DAC) for coil embolization. Methods: Patients who underwent coil embolization with an adjunctive technique using a TACTICS catheter between October 2018 and May 2019 were retrospectively analyzed. Results: In all, 64 aneurysms in 51 patients were treated. Among them, 18 aneurysms in 15 patients (4 ruptured aneurysms and 14 unruptured aneurysms) required an adjunctive technique using a TACTICS catheter. The methods of embolization were the double catheter technique (DCT) for five aneurysms, stent-assisted coiling (SAT) for seven, DCT + SAC for one, and balloon-assisted technique (BAT) for five aneurysms. Aneurysms were located in the anterior communicating artery (Acom A) in three cases, distal anterior cerebral artery (dACA) in one, middle cerebral artery (MCA) in five, internal carotid artery (ICA) in six, basilar artery (BA) in one, and vertebral artery (VA) in two cases. It was easy to access distal intracranial vessels using the TACTICS catheter. In all cases, guiding of the microcatheter, coiling, and stent placement were improved. There were no complications associated with using the TACTICS catheter. Conclusion: Compared with conventional DACs, distal intracranial vessels were more easily accessed using the TACTICS catheter. A TACTICS catheter is useful because DCT and SAC require sufficient operability of the microcatheter. Keywords▶ TACTICS, adjunctive technique, coil embolization This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives International License.
The Miyako Islands (with a population of approximately 50,000) are located in southwestern Japan, with a subtropical oceanic climate. This isolated location permitted a retrospective population-based epidemiological study of subarachnoid hemorrhage. We retrospectively enrolled 110 consecutive patients from 2010 to 2019 using the subarachnoid hemorrhage database at Okinawa Miyako Hospital, which is the only local facility with neurosurgeons. We calculated the incidence of subarachnoid hemorrhage standardized to the entire Japanese population. The seasonal distribution of subarachnoid hemorrhage onset and patients' epidemiological characteristics were also investigated. The standardized annual incidence of subarachnoid hemorrhage was 21.4 per 100,000 population, as reported previously in Japan. The patients' mean age was 62.1 ± 15.4 years, and women constituted 60.9%. Anterior communicating artery aneurysms were most common. The endovascular treatment for ruptured aneurysms was increasing as standard levels in Japan. The rates of symptomatic vasospasm and secondary hydrocephalus requiring additional neurosurgical treatment were 2.7% and 19.1%, respectively. The mortality rate was 23.6%. The percentage of patients with a modified Rankin scale score of 0-2 at discharge was 55.5%. There were no differences in the frequency of subarachnoid hemorrhage associated with seasonal distribution or climatic factors. The incidence, baseline characteristics, and clinical outcomes of subarachnoid hemorrhage in the Miyako Islands were similar to those in other regions of Japan. There are preferable epidemiological backgrounds for further practical clinical research.
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