Transtentorial Approach for Parahippocampal Gyrus Arteriovenous Malformation Resection: 3-Dimensional Operative Video

2018 ◽  
Vol 16 (3) ◽  
pp. E83-E84 ◽  
Author(s):  
Feres Chaddad-Neto ◽  
Marcos Devanir Silva da Costa ◽  
Ricardo Lourenço Caramanti ◽  
Bruno Lourenço Costa ◽  
Conrado Feisthauer Silveira ◽  
...  
Keyword(s):  
Cerebral Artery ◽  
Posterior Cerebral Artery ◽  
Vascular Anatomy ◽  
Neurological Deficits ◽  
Parahippocampal Gyrus ◽  
3 Dimensional ◽  
Complex Anatomy ◽  
Basal Vein Of Rosenthal ◽  
Anterior Choroidal ◽  
Transtentorial Approach

Abstract Medial temporal basal arteriovenous malformations (AVMs) have complex anatomy. They usually drain to the basal vein of Rosenthal, and arterial feeders can arise from the anterior choroidal artery and its branches, or from the posterior cerebral artery. If the AVM is more posterior in the parahippocampal gyrus, there is a predominance of arterial feeders arising from P2P or P3 segments of the posterior cerebral artery. As posterior AVMs are difficult to reach using anterior approaches, the supracerebellar transtentorial approach provides a direct pathway to the malformation, allowing better visualization and exposure of the vascular anatomy.  In this video, we present a 29-yr-old woman with a left parahippocampal AVM with P2P arterial feeders and Rosenthal basal vein drainage. The patient had three months of moderate headache and two abrupt seizures before admission. Emergency computed tomography showed intraventricular hemorrhage. Magnetic resonance imaging and cerebral angiography revealed an AVM located in the parahippocampal gyrus, posterior to pulvinar thalamus. The patient underwent microsurgical treatment in semi-sitting position using a supracerebellar and infratentorial approach with transtentorial resection. The AVM was completely removed, and the patient recovered without neurological deficits. The authors present a 3-dimensional video of the microsurgical steps required to perform a transtentorial approach for AVM resection in the parahippocampal gyrus.  The patient signed the Institutional Consent Form, which allows the use of his/her images and videos for any type of medical publications in conferences and/or scientific articles.

scholarly journals Microsurgical Treatment of Posterior Cerebral Artery Aneurysm (P2P Segment): Case Report and Review of the Literature

2018 ◽  
Vol 37 (04) ◽  
pp. 343-348
Author(s):  
Lucas Meguins ◽  
Antônio Spotti ◽  
Jean de Oliveira ◽  
Carlos Pereira ◽  
Ronaldo Fernandes ◽  
...  
Keyword(s):  
Case Report ◽  
Cerebral Artery ◽  
Posterior Cerebral Artery ◽  
Artery Aneurysm ◽  
Saccular Aneurysm ◽  
Neurological Deficits ◽  
Uneventful Recovery ◽  
Cerebral Peduncle ◽  
Vast Number ◽  
The Right

Introduction Aneurysms of the posterior cerebral artery (PCA) represent ∼ 1% of all intracranial aneurysms and usually present with subarachnoid hemorrhage. Objective The aim of the present study is to describe the case of an adult man presenting a saccular aneurysm of the right PCA at the posterior half of the postcommunicating (P2P) segment, and to discuss the technical nuances of the approach and of the clipping process. Case Report An investigation of a chronic headache in a 55-year-old man found a saccular aneurysm located just posterior to the most lateral portion of the right cerebral peduncle. A digital subtraction arteriography revealed a 7.8 mm × 5.6 mm × 4.8 mm posterior-medial projecting aneurysm of the right PCA at the P2P segment. A subtemporal approach was performed with partial aspiration of the right parahippocampal gyrus for a better exposure of the vascular structures. A proximal temporary occlusion of the PCA was performed at the anterior half of the postcommunicating P2A segment. The aneurysm was clipped with two semi-curved clips. The patient presented an uneventful recovery and was discharged from the hospital on the third postoperative day without any additional neurological deficits. Conclusion Aneurysms of the PCA are an uncommon vascular disease that challenges the ability of the neurosurgeons due to their many anatomical nuances, to their vast number of perforators, and to the risk of bleeding. However, the operative management of aneurysms of the PCA is technically feasible, safe and effective when performed respecting microsurgical principles.

scholarly journals Early Recognition of Stroke by Confrontation Visual Field Test – Is It Possible?

2020 ◽  
Keyword(s):  
Case Report ◽  
Visual Field ◽  
Cerebral Artery ◽  
Vision Loss ◽  
Posterior Cerebral Artery ◽  
Early Recognition ◽  
Past History ◽  
Neurological Deficits ◽  
Visual Field Defects ◽  
Axial Tomography

Introduction: Visual field loss is often the first sign of lesion of the anterior or posterior visual pathways. Screening for visual field defects should be a part of all routine eye examinations, mainly when neurological lesions are suspected. A confrontation visual field (CVF) test provide a rapid and practical method of visual field assessment, allowing the recognition of major neurological deficits. Materials and Research Methods: To report a case of posterior cerebral artery (PCA) stroke early suspected by CVF test. Case-Report: A 77 year-old male presented to our emergency department with vision blurring complaints and a strange sensation of a vision loss on one side on the left eye (OS), for the previous 15 days. He explained that symptoms initiated after an episode of dizziness followed by lipothymia. He denied diplopia or headaches. Past history revealed hypertension and diabetes as cardiovascular risk factors. The best corrected visual acuity was 20/25 on right eye (OD) and 20/60 on OS and pupillary reflexes were normal. CVF test was performed and showed a decrease on left hemicampus of OS. The biomicroscopy was normal and the fundus examination showed optic nerve edema bilaterally, also documented by Optical Coherence Tomography. Considering the findings and the history, neuroimaging and a neurological observation were requested. Computerized axial tomography revealed a hypodense lesion in right occipital posterior region, with hematic density. He was hospitalized for proper treatment with the diagnosis of posterior cerebral artery ischemic stroke, with further hemorrhagic transformation. Discussion: In acute stroke, visual disorders may form all or part of the initial presentation. Homonymous visual field deficits are well-known almost universal characteristics of PCA ischemia, however, due to the absent of cognitive impairment or speech problems associated to many cases, the diagnosis can be challenging at early stages. Our case-report highlights the importance of using CVF test to an immediate inspection of the peripheral visual field, in order to detect acute major defects, including homonymous deficits, to understand if a further prompt neurological examination is mandatory.

scholarly journals “True Fetal Posterior Cerebral Artery”: Rare Variant Mimics AVM on MRI

Neurographics ◽  
2020 ◽  
Vol 10 (2) ◽  
pp. 71-74
Author(s):  
E.L. Perez ◽  
A. Wang ◽  
P. Meyers
Keyword(s):  
Cerebral Artery ◽  
Posterior Cerebral Artery ◽  
Cerebral Arteries ◽  
Cerebral Vasculature ◽  
Brain Arteriovenous Malformation ◽  
Cross Sectional ◽  
Cross Sectional Imaging ◽  
Anterior Choroidal ◽  
Rare Anatomic Variant ◽  
Choroidal Artery

A “true fetal posterior cerebral artery” is an extremely rare anatomic variant of the cerebral vasculature in which 2 independent posterior cerebral arteries are present; 1 arises from a persistent large primitive anterior choroidal artery and a second arises in the usual fashion. This case report demonstrates this diagnosis made using cerebral angiography in a young woman with nonspecific headaches whose MR imaging brain scan was originally interpreted as a brain arteriovenous malformation or dural arteriovenous fistula. Given the rarity of a true fetal posterior cerebral artery, awareness of this entity may make it discernible on cross-sectional imaging. In addition, it is important to be able to recognize this angiographically because this variant supplies posterior cerebral structures and should not be embolized.

scholarly journals P.189 Unruptured Posterior Cerebral Artery aneurysm causing temporal lobe epilepsy

2021 ◽  
Vol 48 (s3) ◽  
pp. S74-S75
Author(s):  
M Fatehi Hassanabad ◽  
G Redekop ◽  
LS Yefet
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Cerebral Artery ◽  
Rare Case ◽  
Posterior Cerebral Artery ◽  
Cerebral Aneurysms ◽  
Artery Aneurysm ◽  
Parahippocampal Gyrus ◽  
Temporal Lobe Seizures ◽  
Cerebral Artery Aneurysm

Background: Cerebral aneurysms are an unusal cause of epilepsy. To date, several groups have reported temporal lobe seizures caused by aneurysms projecting into the parahippocampal gyrus. Given the low incidence of posterior cerebral artery aneurysms, they are a very rare cause of temporal lobe seizures. Methods: Here, we report a rare case of temporal lobe epilepsy caused by an unruptured aneurysm. We also present a review of the literature yielding two similar cases. Results: A previosuly well 56 year old male presented to a neurologist with symptoms consistent with temporal lobe epilepsy. He was started on carbamzepine and underwent imaging and neuropsychological assessments. An MRI suggested the existance of a 7mm posterior cerebral artery aneurysm arising from the P2 segment of the posterior cerebral artery and projecting into the parahippocampal gyrus. This was also confirmed with CT angiography and the patient elected to have the aneurysm clipped. Conclusions: Temporal lobe epilepsy is an uncommon presentation for unruptured cerebral aneurysms. We report a rare case wherein a laterally pointing PCA aneurysm was buried in the posterior parahippocampal gyrus. This aneurysm had caused perifocal gliosis leading to stereotyped seizures. Post-operatively, the patient has been seizure free.

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