Reimplantation Bypass Using One Limb of a Double-Origin Posterior Inferior Cerebellar Artery for Treatment of a Ruptured Fusiform Aneurysm: Case Report

2020 ◽  
Vol 19 (3) ◽  
pp. E314-E319 ◽  
Author(s):  
Michael J Lang ◽  
Joshua S Catapano ◽  
Gabriella M Paisan ◽  
Stefan W Koester ◽  
Tyler S Cole ◽  
...  
Keyword(s):  
Case Report ◽  
Scale Score ◽  
Clinical Presentation ◽  
Posterior Inferior Cerebellar Artery ◽  
Pica Pica ◽  
Fisher Grade ◽  
Cerebellar Artery ◽  
Pica Aneurysms ◽  
Double Origin ◽  
Variant Anatomy

Abstract BACKGROUND AND IMPORTANCE Posterior inferior cerebellar artery (PICA) aneurysms are uncommon, and aneurysms associated with anatomical PICA variants are even rarer. Although often treated endovascularly, aneurysms associated with anatomical PICA variants may not be suitable for endovascular intervention because of the risk of compromise of brainstem perforators and may be more amenable to open techniques. This case report describes the successful treatment of an aneurysm associated with a double-origin PICA (DOPICA) by distally reimplanting one of the PICA limbs. CLINICAL PRESENTATION A 78-yr-old man with a Hunt-Hess grade III, Fisher grade IV subarachnoid hemorrhage secondary to a ruptured distal right PICA aneurysm associated with a DOPICA was treated with PICA-PICA bypass and trapping of the aneurysm. This is the first reported case in the literature of successful bypass of a DOPICA-associated aneurysm. Radiographically, the bypass remained patent with successful obliteration of the aneurysm, and at discharge from the hospital, the patient had a Glasgow Coma Scale score of 15 and modified Rankin Scale score of 3. CONCLUSION This case demonstrates a novel reimplantation bypass for a ruptured aneurysm that exploits this rare variant anatomy of a DOPICA.

Surgical Treatment of a Double Origin Posterior Inferior Cerebellar Artery Aneurysm and Insights From Embryology: Case Report and Literature Review

2017 ◽  
Vol 13 (3) ◽  
pp. E8-E12 ◽  
Author(s):  
Michael A. Silva ◽  
Alfred P. See ◽  
Mohammad A. Aziz-Sultan ◽  
Nirav J. Patel
Keyword(s):  
Case Report ◽  
Surgical Treatment ◽  
Clinical Presentation ◽  
Posterior Inferior Cerebellar Artery ◽  
Artery Aneurysm ◽  
Cerebellar Artery ◽  
Flow Through ◽  
Open Surgical Treatment ◽  
Double Origin ◽  
Insight Into

Abstract BACKGROUND AND IMPORTANCE: Aneurysms affecting double origin (DO) posterior inferior cerebellar artery (PICA) variants are rare. Most reports describe endovascular occlusion of the affected branch to treat the aneurysm, but we describe a patient in which open surgical sacrifice of 1 branch resulted in insufficient perfusion. This case and our review of PICA embryology provide insight into treatment of aneurysms affecting duplicated intracranial vessels. CLINICAL PRESENTATION: We report the only case of open surgical treatment of an aneurysm affecting a leg of a DOPICA. A 42-year-old woman presenting with the worst headache of her life was found to have a DOPICA aneurysm and initially treated by trapping the aneurysm. Intraoperative indocyanine green imaging revealed insufficient perfusion through the caudal branch, which was remediated by end-to-end anastomosis to preserve flow through both origins. The patient made a full recovery. CONCLUSION: Treating a DOPICA aneurysm by sacrificing 1 of the origins is not possible for all patients. This first report of open surgical treatment of a DOPICA leg aneurysm suggests that 1 or both branches may be required for sufficient perfusion, and the unique embryology of DOPICA development suggests a possible mechanism.

scholarly journals Treating a Ruptured Fusiform Aneurysm of the Posterior Inferior Cerebellar Artery (PICA) using PICA-PICA Anastomosis combined with Trapping: A Case Report

2010 ◽  
Vol 19 (5) ◽  
pp. 420-424
Author(s):  
Kenta Aso ◽  
Yoshitaka Kubo ◽  
Shunsuke Kakino ◽  
Hiroshi Kashimura ◽  
Atsushi Sugawara ◽  
...  
Keyword(s):  
Case Report ◽  
Posterior Inferior Cerebellar Artery ◽  
Fusiform Aneurysm ◽  
Pica Pica ◽  
Cerebellar Artery

Double Origin of the Posterior Inferior Cerebellar Artery: Anatomic Case Report

2019 ◽  
Vol 124 ◽  
pp. 110-115 ◽  
Author(s):  
Ali Tayebi Meybodi ◽  
Leandro Borba Moreira ◽  
Xiaochun Zhao ◽  
Michael T. Lawton ◽  
Mark C. Preul
Keyword(s):  
Case Report ◽  
Posterior Inferior Cerebellar Artery ◽  
Cerebellar Artery ◽  
Double Origin

Endovascular Surgery for Proximal Posterior Inferior Cerebellar Artery Aneurysms: An Analysis of Glasgow Outcome Score by Hunt-Hess Grades

Neurosurgery ◽  
2006 ◽  
Vol 58 (4) ◽  
pp. 619-625 ◽  
Author(s):  
Robert A. Mericle ◽  
Adam S. Reig ◽  
Matthew V. Burry ◽  
Eric Eskioglu ◽  
Christopher S. Firment ◽  
...  
Keyword(s):  
Posterior Inferior Cerebellar Artery ◽  
Endovascular Surgery ◽  
Glasgow Outcome Score ◽  
Clinical Grade ◽  
Outcome Score ◽  
Fisher Grade ◽  
Cerebellar Artery ◽  
Pica Aneurysms ◽  
Angiographic Result

Abstract OBJECTIVE: Proximal posterior inferior cerebellar artery (PICA) aneurysms represent a subset of posterior circulation aneurysms that can be routinely treated with either clipping or coiling. The literature contains limited numbers of patients with proximal PICA aneurysms treated with endovascular surgery. We report our experience with endovascular surgery of proximal PICA aneurysms with emphasis on patients with poor Hunt-Hess grades. METHODS: We reviewed 31 consecutive patients with proximal PICA aneurysms who were treated with endovascular surgery. The following data were analyzed: age, sex, size of aneurysm, Hunt-Hess grade at presentation, Fisher grade at presentation, angiographic result after embolization, complications, number of days hospitalized, duration of follow-up, angiographic follow-up results, and Glasgow Outcome Score at follow-up. RESULTS: Excellent angiographic occlusion was achieved in 30 of 31 (97%) patients. Clinical follow-up with Glasgow Outcome Score was performed on every patient an average of 10 months later. Twenty-one of 31 (68%) patients had good outcomes (Glasgow Outcome Score I or II) at follow-up. Of the patients who presented with a favorable clinical grade (Hunt-Hess 0–III), 13 of 15 (87%) had good outcomes at follow-up. Of the patients who presented with a poor clinical grade (Hunt-Hess Grade IV or higher), 8 of 16 (50%) had good outcomes at follow-up. CONCLUSION: This series demonstrates the safety and efficacy of endovascular surgery for proximal PICA aneurysms. Many patients with poor Hunt-Hess grades from ruptured PICA aneurysms ultimately had a good outcome. This could be secondary to early, aggressive treatment of hydrocephalus and the minimally invasive nature of the endovascular approach.

scholarly journals Use of the Coupler Microanastomotic Device for the Treatment of a Distal Posterior Inferior Cerebellar Artery Aneurysm Via Excision and End-to-End Anastomosis—A Case Report

2020 ◽  
Vol 1 (2) ◽  
Author(s):  
Oded Goren ◽  
Raghuram Sampath ◽  
Akshal S Patel ◽  
Christoph J Griessenauer ◽  
Clemens M Schirmer ◽  
...  
Keyword(s):  
Case Report ◽  
Intracranial Aneurysms ◽  
Clinical Presentation ◽  
Posterior Inferior Cerebellar Artery ◽  
Artery Aneurysm ◽  
Parent Vessel ◽  
First Case ◽  
Cerebellar Artery ◽  
End To End ◽  
Coupler Device

ABSTRACT BACKGROUND AND IMPORTANCE The Coupler microanastomotic device (Medical Companies Alliance, Birmingham, Alabama) aims at facilitating safe and efficient end-to-end reconstruction of the native vessel ends following resection of intracranial aneurysms. CLINICAL PRESENTATION We report the first case of the Coupler device used to treat a ruptured posterior inferior cerebellar artery (PICA) aneurysm. Following aneurysmal trapping and excision, the native parent vessel ends were connected in an end-to-end fashion. CONCLUSION The microanastomotic Coupler device is an acceptable option for end-to-end anastomosis and was successfully applied in the management of a ruptured fusiform PICA aneurysm.

scholarly journals Endovascular treatment for aneurysm on double origin of the posterior inferior cerebellar artery: Case report

Nosotchu ◽  
2008 ◽  
Vol 30 (3) ◽  
pp. 521-525 ◽  
Author(s):  
Kentaro Horiguchi ◽  
Eiichi Kobayashi ◽  
Takashi Saegusa ◽  
Yoshinori Ozawa ◽  
Naokatsu Saeki
Keyword(s):  
Case Report ◽  
Endovascular Treatment ◽  
Posterior Inferior Cerebellar Artery ◽  
Cerebellar Artery ◽  
Double Origin

Decision Making in Surgery for Nonsaccular Posterior Inferior Cerebellar Artery Aneurysms With Special Reference to Intraoperative Assessment of Collateral Blood Flow and Neurophysiological Function

2017 ◽  
Vol 14 (4) ◽  
pp. 422-431 ◽  
Author(s):  
Alessandro Narducci ◽  
Ran Xu ◽  
Peter Vajkoczy
Keyword(s):  
Posterior Inferior Cerebellar Artery ◽  
Neurophysiological Monitoring ◽  
Occipital Artery ◽  
Pica Pica ◽  
Endovascular Techniques ◽  
Vessel Occlusion ◽  
Cerebellar Artery ◽  
Pica Aneurysms ◽  
Intraoperative Test ◽  
Time Assessment

Abstract BACKGROUND Posterior inferior cerebellar artery (PICA) aneurysms represent a challenging pathology. PICA sacrifice is often necessary, due to the high proportion of nonsaccular aneurysms that can be found in this location. Several treatments are available, but the infrequency of these aneurysms and the increasing number of endovascular techniques have limited the development of a standardized algorithm for cases in which open surgery is indicated. OBJECTIVE We present our series of nonsaccular PICA aneurysms, in the attempt to define an algorithm for their surgical management. METHODS We retrospectively reviewed the operation database, identifying patients harboring nonsaccular PICA aneurysms who were surgically treated at our institution from 2007 to 2016. RESULTS During a 9-yr period, 17 patients harboring 18 nonsaccular PICA aneurysms were surgically treated at our institution. Fourteen (7.7%) aneurysms were located within the proximal PICA (including those located at the vertebral artery–PICA junction), and 4 were located distally. We performed PICA revascularization in 8 (57.1%) cases of proximal aneurysms (n = 4, PICA–PICA bypass; n = 4, occipital artery–PICA bypass). We based our decision whether to perform bypass on intraoperative test occlusion with indocyanine green (ICG) videoangiography and neurophysiological monitoring. In no cases, bypass was necessary for distal aneurysms. CONCLUSION For nonsaccular PICA aneurysms, in which vessel occlusion is often necessary, it is possible to adopt a selective use of revascularization techniques. Intraoperative occlusion test with ICG videoangiography and neurophysiological monitoring provides reliable indications, allowing real-time assessment of collateral circulation.

scholarly journals Isolated abducens nerve palsy associated with subarachnoid hemorrhage: a localizing sign of ruptured posterior inferior cerebellar artery aneurysms

2018 ◽  
Vol 128 (6) ◽  
pp. 1830-1838 ◽  
Author(s):  
Jan-Karl Burkhardt ◽  
Ethan A. Winkler ◽  
George F. Lasker ◽  
John K. Yue ◽  
Michael T. Lawton
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cranial Nerve ◽  
Posterior Inferior Cerebellar Artery ◽  
Artery Aneurysm ◽  
Abducens Nerve ◽  
Dorello’S Canal ◽  
Ruptured Aneurysms ◽  
Fisher Grade ◽  
Cerebellar Artery ◽  
Pica Aneurysms

OBJECTIVECompressive cranial nerve syndromes can be useful bedside clues to the diagnosis of an enlarging intracranial aneurysm and can also guide subsequent evaluation, as with an acute oculomotor nerve (cranial nerve [CN] III) palsy that is presumed to be a posterior communicating artery aneurysm and a surgical emergency until proven otherwise. The CN VI has a short cisternal segment from the pontomedullary sulcus to Dorello’s canal, remote from most PICA aneurysms but in the hemodynamic pathway of a rupturing PICA aneurysm that projects toward Dorello’s canal. The authors describe a cranial nerve syndrome for posterior inferior cerebellar artery (PICA) aneurysms that associates subarachnoid hemorrhage (SAH) and an isolated abducens nerve (CN VI) palsy.METHODSClinical and radiological data from 106 surgical patients with PICA aneurysms (66 ruptured and 40 unruptured) were retrospectively reviewed. Data from a group of 174 patients with other aneurysmal SAH (aSAH) were analyzed in a similar manner to control for nonspecific effects of SAH. Univariate statistical analysis compared incidence and risk factors associated with CN VI palsy in subarachnoid hemorrhage.RESULTSOverall, 13 (4.6%) of 280 patients had CN VI palsy at presentation, and all of them had ruptured aneurysms (representing 13 [5.4%] of the 240 cases of ruptured aneurysms). CN VI palsies were observed in 12 patients with ruptured PICA aneurysms (12/66 [18.1%]) and 1 patient with other aSAH (1/174 [0.1%], p < 0.0001). PICA aneurysm location in ruptured aneurysms was an independent predictor for CN VI palsy on multivariate analysis (p = 0.001). PICA aneurysm size was not significantly different in patients with or without CN VI palsy (average size 4.4 mm and 5.2 mm, respectively). Within the PICA aneurysm cohort, modified Fisher grade (p = 0.011) and presence of a thick cisternal SAH (modified Fisher Grades 3 and 4) (p = 0.003) were predictors of CN VI palsy. In all patients with ruptured PICA aneurysms and CN VI palsy, dome projection and presumed direction of rupture were directed toward the ipsilateral and/or contralateral Dorello’s canal, in agreement with laterality of the CN palsy. In patients with bilateral CN VI palsies, a medial projection with extensive subarachnoid blood was observed near bilateral canals.CONCLUSIONSThis study establishes a localizing connection between an isolated CN VI palsy, SAH, and an underlying ruptured PICA aneurysm. CN VI palsy is an important clinical sign in aSAH and when present on initial clinical presentation may be assumed to be due to ruptured PICA aneurysms until proven otherwise. The deficit may be ipsilateral, contralateral, or bilateral and is determined by the direction of the aneurysm dome projection and extent of subarachnoid bleeding toward Dorello’s canal, rather than by direct compression.

scholarly journals Ten years of experience in endovascular treatment of ruptured aneurysms of the posterior inferior cerebellar artery

2016 ◽  
Vol 22 (2) ◽  
pp. 129-137 ◽  
Author(s):  
Robert Juszkat ◽  
Paweł Kram ◽  
Katarzyna Stanisławska ◽  
Roman Jankowski ◽  
Bogumiła Stachowska-Tomczak ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Clinical Presentation ◽  
Posterior Inferior Cerebellar Artery ◽  
Years Of Experience ◽  
Endovascular Stents ◽  
Ruptured Aneurysms ◽  
Ruptured Intracranial Aneurysm ◽  
Cerebellar Artery ◽  
Pica Aneurysms

Background The aim of this study is to present our 10 years of experience in endovascular treatment of ruptured posterior inferior cerebellar artery (PICA) saccular aneurysms and to compare clinical presentation and outcome after endovascular treatment between patients with PICA aneurysms and patients with aneurysms in different locations. Methods and findings Out of 932 patients with a ruptured intracranial aneurysm treated endovascularly in our institution, 38 aneurysms were located at the posterior inferior cerebellar artery. Clinical presentation, mean aneurysm diameter and outcome of the therapy in this group were compared with the same for ruptured aneurysms in other locations. Patients discharged with favourable outcomes were checked angiographically in the follow-up period. Thirty-four patients with ruptured PICA aneurysms were treated by selective endovascular coiling. Two patients with wide-necked aneurysms had endovascular stents implanted. In two cases, the parent vessel was occluded due to failure to catheterise the target aneurysm. The evaluated variables did not differ significantly between two groups, but significantly more ruptured aneurysms in the PICA group were under 6 mm in diameter. 29.4% of controlled aneurysms needed additional reembolisation in the follow-up period. Conclusions Clinical presentation, extension of subarachnoid haemorrhage and outcome after endovascular treatment did not differ significantly between patients with ruptured aneurysms located on the PICA and patients with aneurysms located elsewhere intracranially. Endovascular treatment is an effective method of therapy in patients with ruptured PICA aneurysms. In our experience, even when sacrificing of the PICA is required, the results of treatment are favourable.

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