Therapeutic dilemmas regarding giant aneurysms of the intracranial vertebral artery causing medulla oblongata compression

Hou, Kun; Qu, Lai; Yu, Jinlu

doi:10.1177/19714009211042881

Cited by 3 publications

(3 citation statements)

References 49 publications

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“…Another disadvantage of the PICA-PICA bypass is the possibility of damaging the contralateral PICA. In addition, prolonged clamping or bypass occlusion may endanger the bilateral PICA, resulting in irreversible ischemic complications in the bilateral cerebellum [11].Furthermore, the PICA-PICA bypass has a disadvantage in that it requires an entirely different anastomotic procedure than the super cial temporal artery (STA)-middle cerebral artery (MCA) bypass, which is unfamiliar to most neurosurgeons [16]. The technique also necessitates suturing in a deeper lumen, making this anastomosis technically challenging [2].…”

Section: Discussionmentioning

confidence: 99%

Occipital artery-posterior inferior cerebellar artery bypass: a cadaveric feasibility study

Yuan

Wang

Han

et al. 2023

Preprint

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Pupose: To demonstrate that the occipital artery(OA)-p1 posterior inferior cerebellar artery(PICA) bypass can be an alternative for complex posterior circulation aneurysms. Methods: A far-lateral approach to craniotomy was performed on 10 adult head and neck specimens(a total of 20 sides occipital artery), and the OA was obtained 'in-line.' Its length, diameter, and the number of p1/p2 and p3 segmental perforators were determined, and the relationship between caudal loop and cerebellar tonsil position was also assessed. The distance between the PICA’s origin and the cranial nerve XI (CN XI), the buffer length above the CN XI after dissection, the OA length required to complete the OA-p1/p3 PICA bypass, and the p1 and p3 segment diameters were all measured. Results: All specimens underwent OA-p1 PICA end-to-end bypass, 15 sides underwent OA-p3 PICA end-to-side bypass, and the other bypass protocols were less common. The buffer length above the CN XI after dissection, the distance between the PICA’s origin and the CN XI, and the first perforator were all of sufficient length. The direct length of the OA needed to complete the OA-p1 PICA end-to-end bypass was significantly less than the available length and the OA-p3 PICA end-to-side bypass, with the OA matching the p1 segment diameter. The number of p1 perforators was less than that of p3, and the OA diameter was equal to that of the p1 segment. Conclusion: OA-p1 PICA end-to-end bypass is a feasible alternative in cases which p3 segment has high caudal loops or anatomic anomalies.

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Section: Discussionmentioning

confidence: 99%

Occipital artery-posterior inferior cerebellar artery bypass: a cadaveric feasibility study

Yuan

Wang

Han

et al. 2023

Preprint

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“…Another disadvantage of the PICA-PICA bypass is the possibility of damaging the contralateral PICA. In addition, prolonged clamping or bypass occlusion may endanger the bilateral PICA, resulting in irreversible ischemic complications in the bilateral cerebellum [ 13 ]. Furthermore, the PICA-PICA bypass has a disadvantage in that it requires an entirely different anastomotic procedure than the superficial temporal artery (STA)-middle cerebral artery (MCA) bypass, which is unfamiliar to most neurosurgeons [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

Occipital artery-posterior inferior cerebellar artery bypass: a cadaveric feasibility study

et al. 2023

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Purpose To demonstrate that occipital artery (OA)-p1 posterior inferior cerebellar artery (PICA) bypass can be an alternative for complex posterior circulation aneurysms. Methods A far-lateral approach to craniotomy was performed on 20 cadaveric specimens, and the OA was obtained 'in-line.' Its length, diameter, and the number of p1/p2 and p3 segmental perforators were determined, and the relationship between the caudal loop and cerebellar tonsil position was also assessed. The distance between the PICA’s origin and the cranial nerve XI (CN XI), the buffer length above the CN XI after dissection, the OA length required to complete the OA-p1/p3 PICA bypass, and the p1 and p3 segment diameters were all measured. A bypass training practical scale (TSIO) was used to evaluate the quality of the anastomosis. Results All specimens underwent OA-p1 PICA end-to-end bypass and had favorable results for the TSIO score, 15 sides underwent OA-p3 PICA end-to-side bypass, and the other bypass protocols were less common. The buffer length above the CN XI after dissection, the distance between the PICA’s origin and the CN XI, and the first perforator were all of sufficient length. The direct length of the OA needed to complete the OA-p1 PICA end-to-end bypass was significantly less than the available length and the OA-p3 PICA end-to-side bypass, with the OA matching the p1 segment diameter. The number of p1 perforators was less than that of p3, and the OA diameter was equal to that of the p1 segment. Conclusion OA-p1 PICA end-to-end bypass is a feasible alternative in cases in which p3 segment has high caudal loops or anatomic anomalies.

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“…For large and giant intracranial aneurysms, after EVT, the aneurysms can enlarge due to thrombosis, and an occupying effect can occur or become aggravated ( 69 ). In a report by Wang et al, 22 symptomatic patients with VBD underwent EVT; of them, 13 (54.2%, 13/24) presented with compressive symptoms, and 7 (54%, 7/13) died from severe progressive brainstem compression ( 62 ).…”

Section: Evt Prognosis and Complicationsmentioning

confidence: 99%

Prospects and Dilemmas of Endovascular Treatment for Vertebrobasilar Dolichoectasia

Wang¹,

Yu²

2022

Front. Neurol.

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Vertebrobasilar dolichoectasia (VBD) is characterized by significant expansion, elongation, and tortuosity of the basilar artery and vertebral artery. Certain highly selected cases of VBD can require intervention. Recent advances in endovascular treatment (EVT) have renewed hope for patients with VBD. However, which cases of VBD can benefit from EVT still needs to be determined. Currently, little is known regarding this matter. Therefore, we performed a review of the literature from a PubMed search and cataloged our experience regarding the classification and natural history of VBD and the prospects, prognosis and complications of EVT. The findings can be summarized as follows: for asymptomatic VBD, “wait and see” or medical management may be a reasonable strategy. EVT may only be effective in certain patients. For saccular aneurysms in VBD, especially ruptured aneurysms, EVT is reasonable. For fusiform aneurysms in VBD, EVT can carry high complication rates and should be recommended with caution. For stenting reconstruction in VBD, the effect is uncertain. For the future of EVT of VBD, randomized controlled trials and the development of neurointerventional products are worth pursuing, but EVT in VBD still has a long way to go.

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Therapeutic dilemmas regarding giant aneurysms of the intracranial vertebral artery causing medulla oblongata compression

Cited by 3 publications

References 49 publications

Occipital artery-posterior inferior cerebellar artery bypass: a cadaveric feasibility study

Occipital artery-posterior inferior cerebellar artery bypass: a cadaveric feasibility study

Occipital artery-posterior inferior cerebellar artery bypass: a cadaveric feasibility study

Prospects and Dilemmas of Endovascular Treatment for Vertebrobasilar Dolichoectasia

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