• Title/Summary/Keyword: Posterior Inferior Cerebellar artery

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Coil Embolization of Ruptured Proximal Posterior Inferior Cerebellar Artery Aneurysm with Contralateral Retrograde Approach for LVIS Jr. Intraluminal Support Deployment

  • Kim, Dong Sub;Sung, Jae Hoon;Lee, Dong Hoon;Yi, Ho Jun
    • Journal of Cerebrovascular and Endovascular Neurosurgery
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    • v.20 no.4
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    • pp.235-240
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    • 2018
  • The safety and feasibility of simple coil embolization and stent deployment for the treatment of posterior inferior cerebellar artery (PICA) aneurysms, as well as their radiologic and clinical results, have not been adequately understood. Especially, if dissecting aneurysm of proximal PICA is associated with small caliber PICA and stenosis of ipsilateral vertebral artery orifice (VAO), endovascular coiling with saving of PICA is not always easy. This 64-year-old man presented with subarachnoid hemorrhage due to a ruptured dissecting aneurysm of left proximal PICA. The aneurysm was irregularly fusiform in nature with a shallow PICA orifice (1.4 mm) and narrow caliber (0.9-1.5 mm). Moreover, the ipsilateral VAO showed severe stenosis (1.8 mm). We performed bifemoral puncture and chose additional route from right vertebral artery to left vertebrobasilar junction for retrograde approach and deployment of LVIS Jr. intraluminal support at proximal PICA. And then, the antegrade approach and coiling of aneurysm was done. Despite of transient thrombus of PICA, the aneurysm was successfully secured with preservation of whole PICA course. For preservation of narrow PICA with ipsilateral VAO stenosis, the contralateral approach and deployment of LVIS Jr. intraluminal support may be considered.

Detachable Coil Embolization for Saccular Posterior Inferior Cerebellar Artery Aneurysms

  • Jeon, Su-Gi;Kwon, Do-Hoon;Ahn, Jae-Sung;Kwun, Byung-Duk;Choi, Choong-Gon;Jin, Sung-Chul
    • Journal of Korean Neurosurgical Society
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    • v.46 no.3
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    • pp.221-225
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    • 2009
  • Objective : Surgical treatment of posterior inferior cerebellar artery (PICA) aneurysms is challenging due to limited surgical accessibility. Endovascular approach has a benefit of avoiding direct injury to the brainstem or lower cranial nerves. Therefore, it has recently been considered an alternative or primary modality for PICA aneurysms. We retrospectively assessed outcomes following detachable coil embolization of saccular PICA aneurysms. Methods : From February 1997 to December 2007, we performed endovascular procedures to treat 15 patients with 15 PICA aneurysms. Fourteen patients with 14 PICA aneurysms morphology of which was saccular were reviewed retrospectively. Twelve patients had ruptured aneurysms. The aneurysms arose from the PICA origin site (n=12), the PICA lateral medullary segment (n=1), or the PICA tonsilomedullary segment (n=1). Results : Complete aneurysm occlusion was achieved in 10 patients, residual neck in 3, and residual sac in one. Radiological follow-up was performed in 7 patients with mean duration of 34.7 months (range, 1-97 months) and showed stable or complete occlusion in 6 patients. There were no rebleeding or retreatment after endovascular treatment. Thromboembolism was the only procedure-related complication (n=4 ; 28.6%). Asymptomatic PICA infarction occurred in two patients and symptomatic PICA infarction in two elderly patients with poor clinical grade. Of these procedural PICA infarction cases, 1 symptomatic PICA infarction patient developed ventriculitis and septic shock leading to death. The clinical outcome was good in 10 patients (71.4%). Conclusions : In the present study, detachable coil embolization has shown as an efficient modality for PICA saccular aneurysms challenging indications of microsurgery. However, thromboembolic complications should be considered, especially in poor clinical elderly patients with ruptured aneurysms.

The Analysis of Cerebral Aneurysm's Prone position Using Computed Tomography Equipment (전산화단층촬영장치를 이용한 뇌동맥류의 호발부위 분석)

  • Lee, Seon-Tae;Lim, Jong-Soo;Park, Jeong-Kyu
    • Journal of Digital Contents Society
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    • v.12 no.3
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    • pp.271-277
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    • 2011
  • This research studied 249 patients who has an aneurysm and went through computerized CT angiography at S University Hospital in Northern Kyung-sang area from October 1st 2008 to September 30th 2010, and the results are the following. Among total 249 of research objects, 159 women (63.9%) showed higher distribution than 90 men (36.1%) The order of the distribution of aneurysm classified by blood vessel is the following. Posterior communicating artery 34.9% as the highest, internal carotid artery 21.7%, middle cerebral artery of 15.7%, anterior communicating artery 14.5%, posterior cerebral artery and posterior cerebral artery channel 3.6% each, anterior cerebral artery and vertebral artery 2.4% each, and posterior inferior cerebellar artery 1.2%. As a result of analysis of distribution of aneurysm classified by gender, there was no case of posterior cerebral artery and posterior cerebral artery channel among men, and there was no case of posterior inferior cerebellar artery among women. Distribution of aneurysm classified by vessel according to gender showed no statistic significance. (p<0.05). And distribution of aneurysm classified by vessel according to the age, showed no statistic significance. (p>0.05), After applying post analysis to understand the group with age difference, the significance was the highest among the group of 61-70, (4.21), and the group of the age under 30 was the lowest. (2.0) There was statistic significance on the distribution of aneurysm classified by vessel according to the season. (p<0.05). After applying post-analysis in order to understand the groups with difference between seasons, it was found that fall was the highest (4.55) and spring was the lowest. (2.50)

Antegrade Recanalization of Parent Artery after Internal Trapping of Ruptured Vertebral Artery Dissecting Aneurysm

  • Ihn, Yon-Kwon;Sung, Jae-Hoon;Byun, Je-Hoon
    • Journal of Korean Neurosurgical Society
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    • v.51 no.5
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    • pp.301-304
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    • 2012
  • We report a patient with a ruptured vertebral artery (VA) dissecting aneurysm that was treated by internal trapping of the aneurysm and parent artery using detachable coils with subsequent antegrade recanalization of occluded vertebral artery during the follow-up period. A 38-year-old man was admitted with a ruptured right VA dissecting aneurysm just distal to origin of right posterior inferior cerebellar artery. The dissected segment of the VA was occluded by coil embolization. The 14 months follow-up angiography showed that dissected aneurysm was completely occluded, but the parent artery was recanalized in an antegrade fashion. Based on this unique case, the authors suggest that careful angiographic follow-up of dissecting aneurysm is required, even in patients successfully treated with endovascular occlusion of the affected artery and aneurysm.

Management of a ruptured posterior inferior cerebellar artery (PICA) aneurysm with end-to-end in situ bypass: Case report

  • Livio Pereira de Macedo;Delson Culembe Baptista-Andre;rlindo Ugulino-Netto;Kaue Franke;Pierre Vansant Oliveira Eugenio;Auricelio Batista Cezar-Junior;Igor Vilela Faquini;Eduardo Vieira de Carvalho-Junior;Nivaldo S. Almeida;Hildo Rocha Cirne Azevedo-Filho
    • Journal of Cerebrovascular and Endovascular Neurosurgery
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    • v.26 no.2
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    • pp.216-222
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    • 2024
  • Dissecting posterior inferior cerebellar artery (PICA) aneurysms are uncommon lesions. Their anatomy and the location of the dissection are variable, however, they usually occurs at the origin of the PICA. Dissecting PICA aneurysms generally have non-vascular morphology involving an entire segment of the artery and cannot be cut. Nevertheless, the detection of these vascular lesions has increased latterly, so it is necessary to recognize it and take the appropriate management modalities for these injuries. In this report, we describe a case of a 73-year-old male patient, who presented a history of severe headache, associated with neck stiffness, nausea, vomiting, dizziness, hypoactivity, mental confusion, and walking difficulty. Radiographic investigation with brain computed tomography (CT) showed mild bleeding in a pre-medullary and pre-pontine cistern, and cerebral angiogram showed a dissecting PICA aneurysm. Despite being a challenging treatment, microsurgery management was the chosen modality. It was performed an end-to-end anastomosis between the p2/p3 segments, showing to be effective with good clinical and radiographic outcomes. We discussed an unusual case, reviewing the current literature on clinical presentations, the angiographic characteristics of the dissecting aneurysms of PICA, and evaluating the clinical and angiographic results of patients undergoing microsurgical treatment.

Bioglue-Coated Teflon Sling Technique in Microvascular Decompression for Hemifacial Spasm Involving the Vertebral Artery

  • Lee, Seong Ho;Park, Jae Sung;Ahn, Young Hwan
    • Journal of Korean Neurosurgical Society
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    • v.59 no.5
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    • pp.505-511
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    • 2016
  • Objective : Microvascular decompression (MVD) for hemifacial spasm (HFS) involving the vertebral artery (VA) can be technically challenging. We investigated the therapeutic effects of a bioglue-coated Teflon sling technique on the VA during MVD in 42 cases. Methods : A bioglue-coated Teflon sling was crafted by the surgeon and applied to patients in whom neurovascular compression was caused by the VA. The radiologic data, intra-operative findings with detailed introduction of the procedure, and the clinical outcomes of each patient were reviewed and analyzed. Results : The 42 patients included in the analysis consisted of 22 females and 20 males, with an average follow-up duration of 76 months (range 24-132 months). Intraoperative investigation revealed that an artery other than the VA was responsible for the neurovascular compression in all cases : posterior inferior cerebellar artery (PICA) in 23 patients (54.7%) and anterior inferior cerebellar artery (AICA) in 11 patients (26.2%). All patients became symptom-free after MVD. Neither recurrence nor postoperative neurological deficit was noted during the 2-year follow-up, except in one patient who developed permanent deafness. Cerebrospinal fluid (CSF) leak occurred in three patients, and one required dural repair. Conclusion : Transposition of the VA using a bioglue-coated Teflon sling is a safe and effective surgical technique for HFS involving the VA. A future prospective study to compare clinical outcomes between groups with and without use of this novel technique is required.

A Case of Lateral Medullary Infarction after Endovascular Trapping of the Vertebral Artery Dissecting Aneurysm

  • Cho, In-Yang;Hwang, Sung-Kyun
    • Journal of Korean Neurosurgical Society
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    • v.51 no.3
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    • pp.160-163
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    • 2012
  • We report an unusual case of lateral medullary infarction after successful embolization of the vertebral artery dissecting aneurysm (VADA). A 49-year-old man who had no noteworthy previous medical history was admitted to our hospital with a severe headache. Computed tomography (CT) revealed a subarachnoid hemorrhage, located in the basal cistern and posterior fossa. Cerebral angiography showed a VADA, that did not involve the origin of the posterior inferior cerebellar artery (PICA). We treated this aneurysm via endovascular trapping of the vertebral artery distal to the PICA. After operation, CT revealed post-hemorrhagic hydrocephalus, which we resolved with a permanent ventriculoperitoneal shunt procedure. Postoperatively, the patient experienced transient mild hoarsness and dysphagia. Magnetic resonance image (MRI) showed a small infarction in the right side of the medulla. The patient recovered well, though he still had some residual symptom of dysphagia at discharge. Such an event is uncommon but can be a major clinical concern. Further investigation to reveal risk factors and/or causative mechanisms for the medullary infarction after successful endovascular trapping of the VADA are sorely needed, to minimize such a complication.

High-Resolution Contrast-Enhanced 3D-Spoiled Gradient-Recalled Imaging for Evaluation of Intracranial Vertebral Artery and Posterior Inferior Cerebellar Artery in Lateral Medullary Infarction (고해상도 조영증강 삼차원 회손기울기 회상 영상을 이용한 측면연수경색 환자의 두개내 척추동맥 및 뒤아래소뇌동맥 평가)

  • Yoon, Youngno;Ahn, Sung Jun;Suh, Sang Hyun;Park, Ah Young;Chung, Tae-Sub
    • Investigative Magnetic Resonance Imaging
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    • v.18 no.1
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    • pp.17-24
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    • 2014
  • Purpose : To determine whether high-resolution contrast-enhanced three dimensional imaging with spoiled gradient-recalled sequence (HR-CE 3D-SPGR) plays a meaningful role in the assessment of intracranial vertebral artery (ICVA) and posterior inferior cerebellar artery (PICA) in lateral medullary infarction (LMI). Materials and Methods: Twenty-five patients confirmed with LMI were retrospectively enrolled with approval by the IRB of our institute, and 3T MRI with HR-CE 3D-SPGR and contrast-enhanced magnetic resonance angiography (CE-MRA) were performed. Two radiologists who were blinded to clinical information and other brain MR images including diffusion weighted image independently evaluated arterial lesions in ICVA and PICA. The demographic characteristics, the area of LMI and cerebellar involvement were analyzed and compared between patients with arterial lesion in ICVA only and patients with arterial lesions in both ICVA and PICA on HR-CE 3D-SPGR. Results: Twenty-two of twenty-five LMI patients had arterial lesions in ICVA or PICA on HR-CE 3D SPGR. However twelve arterial lesions in PICA were not shown on CE-MRA. Concurrent cerebellar involvement appeared more in LMI patients with arterial lesion in ICVA and PICA than those with arterial lesion in ICVA alone (p = 0.069). Conclusion: HR-CE 3D-SPGR can help evaluate arterial lesions in ICVA and PICA for LMI patients.

Size and Location of Ruptured Intracranial Aneurysms

  • Jeong, Young-Gyun;Jung, Yong-Tae;Kim, Moo-Seong;Eun, Choong-Ki;Jang, Sang-Hwan
    • Journal of Korean Neurosurgical Society
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    • v.45 no.1
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    • pp.11-15
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    • 2009
  • Objective : The aim of study was to review our patient population to determine whether there is a critical aneurysm size at which the incidence of rupture increases and whether there is a correlation between aneurysm size and location. Methods : We reviewed charts and radiological findings (computed tomography (CT) scans, angiograms, CT angiography, magnetic resonance angiography) for all patients operated on for intracranial aneurysms in our hospital between September 2002 and May 2004. Of the 336 aneurysms that were reviewed, measurements were obtained from angiograms for 239 ruptured aneurysms by a neuroradiologist at the time of diagnosis in our hospital. Results : There were 115 male and 221 female patients assessed in this study. The locations of aneurysms were the middle cerebral artery (MCA, 61), anterior communicating artery (ACoA, 66), posterior communicating artery (PCoA, 52), the top of the basilar artery (15), internal carotid artery (ICA) including the cavernous portion (13), anterior choroidal artery (AChA, 7), A1 segment of the anterior cerebral artery (3), A2 segment of the anterior cerebral artery (11), posterior inferior cerebellar artery (PICA, 8), superior cerebellar artery (SCA, 2), P2 segment of the posterior cerebral artery (1), and the vertebral artery (2). The mean diameter of aneurysms was $5.47{\pm}2.536\;mm$ in anterior cerebral artery (ACA), $6.84{\pm}3.941\;mm$ in ICA, $7.09{\pm}3.652\;mm$ in MCA and $6.21{\pm}3.697\;mm$ in vertebrobasilar artery. The ACA aneurysms were smaller than the MCA aneurysms. Aneurysms less than 6 mm in diameter included 37 (60.65%) in patients with aneurysms in the MCA, 43 (65.15%) in patients with aneurysms in the ACoA and 29 (55.76%) in patients with aneurysms in the PCoA. Conclusion : Ruptured aneurysms in the ACA were smaller than those in the MCA. The most prevalent aneurysm size was 3-6 mm in the MCA (55.73%), 3-6 mm in the ACoA (57.57%) and 4-6 mm in the PCoA (42.30%). The more prevalent size of the aneurysm to treat may differ in accordance with the location of the aneurysm.

Multimodal Treatment for Complex Intracranial Aneurysms : Clinical Research

  • Jin, Sung-Chul;Kwon, Do-Hoon;Song, Young;Kim, Hyun-Jung;Ahn, Jae-Seung;Kwun, Byung-Duk
    • Journal of Korean Neurosurgical Society
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    • v.44 no.5
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    • pp.314-319
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    • 2008
  • Objective: For patients with giant or dissecting aneurysm, multimodal treatment consisting extracranial-intracranial bypass surgery plus clip or coil for parent artery occlusion may be necessary. In this study, the safety and efficacy of multimodal treatment in 15 patients with complex aneurysms were evaluated retrospectively. Methods: From January 1995 to June 2007, the authors treated 15 complex aneurysms that were unable to be clipped or coiled. Among them, nine patitents had unruptured aneurysms and 6 had ruptured aneurysms. Aneurysms were located in the internal cerebral artery (ICA) in 11 patients (4 in the dorsal wall. 4 in the terminal ICA, 1 in the paraclinoid, and 2 in the cavernous ICA), in the middle cerebral artery (MCA) in 2, and in the posterior circulation in two patients Results: Fifteen patients with complex aneurysms were treated with bypass surgery previously. Thirteen patients were treated with external carotid middle cerebral artery (ECA-MCA) anastomosis, and one patient with superficial temporal to posterior cerebral artery (STA-PCA) and another patient with occipital artery to posterior inferior cerebellar artery (OA-PICA) anastomosis. Parent artery occlusion was then performed with a clip in 9 patients, with a coil in 4, with balloon plus coil in one patient. All 15 aneurysms were successfully treated with clip or coil combined with bypass surgery. Follow-up angiograms showed good patency of anastomotic site in 10 out of 11 patients, and perfusion study showed sufficient perfusion in 6 out of 9 patients. Conclusion: These findings indicate that for patients with complex aneurysms, clip or coil for parent vessel occlusion with additive bypass surgery can successfully exclude the aneurysm from the neurovascular circulatory system.