Reconstruction of intracranial vertebral artery with radial artery and occipital artery grafts for fusiform intracranial vertebral aneurysm not amenable to endovascular treatment: technical note

Kubota, Hisashi; Tanikawa, Rokuya; Katsuno, Makoto; Noda, Kosumo; Maeda, Shiro; Yabuuchi, Tomonari; Izumi, Naoto; Bulsara, Ketan R.; Hashimoto, Masaaki

doi:10.1007/s00701-013-1715-z

Cited by 18 publications

(12 citation statements)

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“…The TCFA can provide a more lateral and inferiorly placed operative field than the suboccipital approach. [5][6][7] As a part of this approach, during the drilling of the condylar fossa and the jugular tubercle, surgeons always encounter PCEVs. Although there is no report of an SS or internal jugular vein occlusion caused by inadequate manipulation of the PCEVs while performing the TCFA, such a possibility, and the resulting severe complications, cannot be ruled out.…”

Section: Anatomic Importance Of the Pcevs For The Tcfamentioning

confidence: 99%

“…he transcondylar fossa approach (TCFA) 1,2 is a variation of the transcondylar approach 3,4 for treating vertebral artery (VA) aneurysms (ie, clipping, trapping, or reconstructing the VA). [5][6][7] This approach is also effective for performing microvascular decompression (MVD) for hypoglossal neuralgia or compression of the ABBREVIATIONS: ACEV, anterior condylar emissary vein; CT, computed tomography; CTV, CT venography; JB, jugular bulb; MS, marginal sinus; MVD, microvascular decompression; OS, occipital sinus; PCC, posterior condylar canal; PCEV, posterior condylar emissary vein; PICA, posterior inferior cerebellar artery; RAG, radial artery graft; SCS, suboccipital cavernous sinus; SS, sigmoid sinus; TCFA, transcondylar fossa approach; VA, vertebral artery; 3-D, three dimensional Supplemental digital content is available for this article at operativeneurosurgery-online.com. medulla oblongata, [8][9][10] and for some tumors located in the cerebellopontine angle or the foramen magnum.…”

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Surgical Microanatomy of the Posterior Condylar Emissary Vein and its Anatomical Variations for the Transcondylar Fossa Approach

Ota¹,

Tanikawa²,

Yoshikane³

et al. 2017

Operative Surg.

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Section: Anatomic Importance Of the Pcevs For The Tcfamentioning

confidence: 99%

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confidence: 99%

Surgical Microanatomy of the Posterior Condylar Emissary Vein and its Anatomical Variations for the Transcondylar Fossa Approach

Ota¹,

Tanikawa²,

Yoshikane³

et al. 2017

Operative Surg.

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“…Finally, if one side of the bilateral VADAs is treated by VA reconstruction, the treatment of the contralateral VADA is only parent artery occlusion, which is known to provide reliable outcomes. 10,12,22,34 Vascular reconstruction of the VA, 20,21 such as V 3 -RAG-V 4 anastomosis as the initial operation, is the most useful microsurgical method of treating bilateral VADAs. Favor-able outcomes can be achieved if performed by a skilled neurosurgeon.…”

Section: Discussionmentioning

confidence: 99%

“…Concurrently, there has been a decline in open surgery for VADAs because of the difficulty of treating these aneurysms. However, recent technical and instrumental improvements for vascular reconstruction, 17,20,21,41 as well as advances in skull base techniques, 14,15,26,27 have again made open surgery a viable option for treating these complex aneurysms. This study describes the surgical strategy for the radical treatment of bilateral VADAs using bypass surgery.…”

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Radical treatment for bilateral vertebral artery dissecting aneurysms by reconstruction of the vertebral artery

Ota¹,

Tanikawa²,

Eda³

et al. 2016

JNS

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OBJECTIVE Bilateral vertebral artery dissecting aneurysms (VADAs) have a poor prognosis because progressive enlargement of the aneurysms compresses the brainstem or causes subarachnoid hemorrhage. The trapping of 1 vertebral artery (VA) places increased hemodynamic stress on the contralateral VA and may lead to enlargement and rupture. Therefore, management strategies are controversial. This study describes a radical treatment for bilateral VADAs using bypass surgery. METHODS Seven patients with bilateral VADAs were included. Three patients were treated by trapping of 1 VA via coiling or clipping at another hospital; the previously treated VA in 1 patient and the contralateral untreated VA in 2 patients subsequently enlarged. The other 4 patients presented without previous intervention and progressive enlargement of the aneurysms. RESULTS The post-coil embolization patients underwent V-posterior cerebral artery (PCA) bypass and trapping. The other 4 patients underwent VA reconstruction via V-V or V-V bypass, with contralateral trapping on a separate day in 3 patients and observation in 1 patient. Perioperative complications included 1 case of cerebrospinal fluid leakage for which the patient required an additional operation, 1 case of dysphagia and facial palsy due to sigmoid sinus thrombosis, and 1 case of dysphagia. The long-term outcomes of these patients were favorable. CONCLUSIONS Patients with bilateral VADAs require treatment on both sides. If VA trapping is performed first, the treatment options for the other side are limited to V-PCA bypass and trapping. This procedure is effective; however, it is also invasive and technically difficult. In cases of bilateral VADAs in which it is feasible to reconstruct 1 side, the best approach is to begin by reconstructing the VA that appears technically easiest, followed by trapping of the contralateral VADA. This strategy allows enough time to suture vessels because contralateral reverse flow is maintained.

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“…Surgical procedures are the most curative and definitive treatments. [ 2 9 24 26 34 45 48 49 50 53 ] A good outcome depends on the presence of adequate collateral circulation and the preoperative clinical grade. [ 9 34 48 ] The location of the aneurysm and the expertise of the surgeon also influence the success rate.…”

Section: Discussionmentioning

confidence: 99%

Radical surgical treatment for recurrent giant fusiform thrombosed vertebral artery aneurysm previously coiled

et al. 2016

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Background:Fusiform aneurysms are rare (<1%) and the underlying pathophysiology is not well known. Endovascular coiling is the standard of treatment; however, a surgical procedure with vascular reconstruction by excluding the pathological segment of the vessel and restoring the blood flow, seems to be the most effective and definitive treatment.Case Description:We report a patient who presented a fusiform vertebral artery aneurysm previously coiled which developed a giant enlargement and a new contralateral fusiform aneurysm. Hemodynamic changes resulting in the formation of contralateral aneurysm might be the result of aneurysm occlusion without revascularization. In addition, continued blood flow to the aneurysmal wall through the vasa vasorum might result in aneurysm recanalization or regrowth. In order to account for these possible sources of complications, we performed a vascular reconstruction with high and low flow bypasses after trapping the aneurysm.Conclusions:We hypothesize that, in this and similar cases, surgical vascular reconstruction should be the first and definitive treatment under experienced cerebrovascular surgeons.

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Reconstruction of intracranial vertebral artery with radial artery and occipital artery grafts for fusiform intracranial vertebral aneurysm not amenable to endovascular treatment: technical note

Abstract: Complex cerebral artery bypass techniques are essential in the armamentarium of cerebrovascular for the treatment of complex lesions not amenable to endovascular therapy.

Cited by 18 publications

References 8 publications

Surgical Microanatomy of the Posterior Condylar Emissary Vein and its Anatomical Variations for the Transcondylar Fossa Approach

Surgical Microanatomy of the Posterior Condylar Emissary Vein and its Anatomical Variations for the Transcondylar Fossa Approach

Radical treatment for bilateral vertebral artery dissecting aneurysms by reconstruction of the vertebral artery

Radical surgical treatment for recurrent giant fusiform thrombosed vertebral artery aneurysm previously coiled

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