scholarly journals Endovascular treatment of a ruptured posterior fossa pure arterial malformation: illustrative case

2021 ◽  
Vol 1 (2) ◽  
Author(s):  
Melissa M. J. Chua ◽  
Saksham Gupta ◽  
Walid Ibn Essayed ◽  
Dustin J. Donnelly ◽  
Habibullah Ziayee ◽  
...  
Keyword(s):  
Vascular Malformations ◽  
Posterior Inferior Cerebellar Artery ◽  
Definitive Treatment ◽  
Illustrative Case ◽  
First Case ◽  
Cerebellar Artery ◽  
History Of ◽  
Endovascular Approach ◽  
Arterial Malformation ◽  
Tomography Scan

BACKGROUNDPure arterial malformations (PAMs) are rare vascular anomalies that are commonly mistaken for other vascular malformations. Because of their purported benign natural history, PAMs are often conservatively managed. The authors report the case of a ruptured PAM leading to subarachnoid hemorrhage (SAH) with intraventricular extension that was treated endovascularly.OBSERVATIONSA 38-year-old man presented with a 1-day history of headaches and nausea. A computed tomography scan demonstrated diffuse SAH with intraventricular extension, and angiography revealed a right posterior inferior cerebellar artery–associated PAM. The PAM was treated with endovascular Onyx embolization.LESSONSTo the authors’ knowledge, only 2 other cases of SAH associated with PAM have been reported. In those 2 cases, surgical clipping was pursued for definitive treatment. Here, the authors report the first case of a ruptured PAM treated using an endovascular approach, showing its feasibility as a treatment option particularly in patients in whom open surgery is too high a risk.

Republished: Subarachnoid hemorrhage then thrombosis of posterior inferior cerebellar artery dissection: is early surgical exploration warranted?

2015 ◽  
Vol 8 (6) ◽  
pp. e22-e22
Author(s):  
Nikita G Alexiades ◽  
Jason A Ellis ◽  
Philip M Meyers ◽  
E Sander Connolly
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Posterior Inferior Cerebellar Artery ◽  
Definitive Treatment ◽  
Artery Dissection ◽  
Acute Thrombosis ◽  
Cerebellar Artery ◽  
History Of ◽  
Diseased Vessel ◽  
Vessel Thrombosis

The natural history of spontaneous cerebral artery dissection and thrombosis remains uncertain. Concurrent subarachnoid hemorrhage further complicates the therapeutic approach. Thus the best strategy for managing patients with acute vessel thrombosis in the setting of subarachnoid hemorrhage is unclear. Here we present a case of spontaneous posterior inferior cerebellar artery dissection presenting with subarachnoid hemorrhage and acute thrombosis. Although the patient was initially managed conservatively, angiographic follow-up demonstrated recanalization of the diseased vessel, necessitating definitive treatment. Thus we propose that angiographic follow-up is necessary in the management of patients with subarachnoid hemorrhage in association with apparent vessel thrombosis.

scholarly journals Case Report: Bow Hunter's Syndrome Caused by Compression of Extracranially Originated Posterior Inferior Cerebellar Artery

2021 ◽  
Vol 12 ◽  
Author(s):  
Noriya Enomoto ◽  
Kenji Yagi ◽  
Shunji Matsubara ◽  
Masaaki Uno
Keyword(s):  
Case Report ◽  
Posterior Inferior Cerebellar Artery ◽  
Head Rotation ◽  
Radiographic Examination ◽  
Posterior Decompression ◽  
First Case ◽  
Cerebellar Artery ◽  
Cervical Approach ◽  
The Right ◽  
Hunter's Syndrome

Bow hunter's syndrome (BHS) is most commonly caused by compression of the vertebral artery (VA). It has not been known to occur due to an extracranially originated posterior inferior cerebellar artery (PICA), the first case of which we present herein. A 71-year-old man presented with reproducible dizziness on leftward head rotation, indicative of BHS. On radiographic examination, the bilateral VAs merged into the basilar artery, and the left VA was predominant. The right PICA originated extracranially from the right VA at the atlas–axis level and ran vertically into the spinal canal. During the head rotation that induced dizziness, the right PICA was occluded, and a VA stenosis was revealed. Occlusion of the PICA was considered to be the primary cause of the dizziness. The patient underwent surgery to decompress the right PICA and VA via a posterior cervical approach. Following surgery, the patient's dizziness disappeared, and the stenotic change at the right VA and PICA improved. The PICA could be a causative artery for BHS when it originates extracranially at the atlas–axis level, and posterior decompression is an effective way to treat it.

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.

Information Freedom and U.S. Foreign Policy: A History

2017 ◽  
Author(s):  
Shawn M. Powers ◽  
Michael Jablonski
Keyword(s):  
Foreign Policy ◽  
American Foreign Policy ◽  
Freedom Of Information ◽  
Illustrative Case ◽  
Underdeveloped Countries ◽  
Communication Structures ◽  
Policy Goals ◽  
First Case ◽  
History Of ◽  
Nineteenth And Twentieth Centuries

This chapter traces the history of U.S. information policy, focusing on four illustrative case studies that reveal a consistent pattern of utilizing a narrative of the freedom of information to bypass state boundaries and sovereignty. After discussing the connection between information and commerce, the chapter considers each case in more detail. The first case examines the U.S. challenge to British communications hegemony in the nineteenth and twentieth centuries; the second explores the view that U.S.-backed ventures to build up underdeveloped countries constituted a policy of creating new markets for U.S. products; the third focuses on the use of international structures such as the International Telecommunications Union and UNESCO by developing countries to assert grievances arising from a misbalance of power in world communication structures; and the fourth case deals with the formation of ICANN as a U.S. policy. This chapter links the debates over international communication to geopolitics, highlighting the various ways international institutions and partnerships are leveraged, selectively, to support American foreign policy goals.

Treatment of aneurysms by excision or trapping with arterial reimplantation or interpositional grafting

1996 ◽  
Vol 85 (1) ◽  
pp. 178-185 ◽  
Author(s):  
Sang Youl Lee ◽  
Laligam N. Sekhar
Keyword(s):  
Superficial Temporal Artery ◽  
Posterior Inferior Cerebellar Artery ◽  
Giant Aneurysm ◽  
Temporal Artery ◽  
Left Vertebral Artery ◽  
Anterior Inferior Cerebellar Artery ◽  
Content Type ◽  
First Case ◽  
Cerebellar Artery ◽  
Fine Print

✓ The authors report three cases of ruptured, large or giant aneurysms that were treated by excision or trapping, followed by revascularization of distal vessels by means of arterial reimplantation or superficial temporal artery interpositional grafting. In the first case, a large serpentine aneurysm arising from the anterior temporal branch of the right middle cerebral artery (MCA) was excised and the distal segment of the anterior temporal artery was reimplanted into one of the branches of the MCA. In the second case, a giant aneurysm, fusiform in shape, arose from the rolandic branch of the MCA. This aneurysm was totally excised and the M3 branch in which it had been contained was reconstructed with an arterial interpositional graft. In the third case the patient, who presented with a subarachnoid hemorrhage, had a dissecting aneurysm that involved the distal portion of the left vertebral artery. In this case the posterior inferior cerebellar artery (PICA) arose from the wall of the aneurysm and coursed onward to supply the brainstem. This aneurysm was managed by trapping and the PICA was reimplanted into the ipsilateral large anterior inferior cerebellar artery. None of the patients suffered a postoperative stroke and all recovered to a good or excellent postoperative condition. These techniques allowed complete isolation of the aneurysm from the normal blood circulation and preserved the blood flow through the distal vessel that came out of the aneurysm. These techniques should be considered as alternatives when traditional means of cerebral revascularization are not feasible.

scholarly journals Case Report: Endovascular Treatment of a Giant Distal PICA Aneurysm in Association With a Cerebellar AVM: A Report on Treatment Considerations and a Literature Review

2020 ◽  
Vol 11 ◽  
Author(s):  
Hassan A. Khayat ◽  
Christine M. Hawkes ◽  
Almunder R. Algird
Keyword(s):  
Posterior Inferior Cerebellar Artery ◽  
Superior Cerebellar Artery ◽  
Management Approach ◽  
Parent Vessel ◽  
Cerebral Angiogram ◽  
First Case ◽  
Cerebellar Artery ◽  
Risk Of Rupture ◽  
The Right ◽  
Pica Aneurysms

Background: Distal posterior inferior cerebellar artery (PICA) aneurysms are uncommon intracranial vascular lesions. The coincidence of these aneurysms and Arteriovenous malformation (AVM) is even more rare. Since 1956, a total of 57 cases of distal PICA aneurysms associated with AVM have been reported with clear and adequate description. None of these reports describe a giant prenidal aneurysm at this particular location. The paucity of natural history data as well as lack of consensus about treatment strategies in such cases present a significant challenge that requires an individualized management approach.Case Description: A 68-year-old male presented with recurrent episodes of nausea and vomiting precipitated by physical exertion and change of head position. An MRI of the brain demonstrated a giant partially thrombosed right posterior inferior cerebellar artery (PICA) aneurysm with mass effect on the floor of the fourth ventricle. A conventional cerebral angiogram revealed a giant (3.1 x 3.1 x 2.8cm) distal right PICA pre-nidal aneurysm with two smaller distal PICA aneurysms. An AVM (Spetzler-Martin Grade 1) supplied by the right PICA as well as the right superior cerebellar artery (SCA) was also identified on cerebral angiography (not seen on an MRI). Endovascular coil embolization with parent vessel sacrifice was performed to occlude the giant aneurysm. Due to the asymptomatic nature, low risk of rupture, and the patient's age, AVM treatment was deferred.Conclusion: This paper presents the first case of a giant PICA aneurysm associated with cerebellar AVM. For PICA aneurysm-AVM complexes, meticulous evaluation of the morphology, associated anatomy, and comparative risk analysis for both lesions are key for treatment planning. Distal PICA aneurysms can be treated safely with parent vessel occlusion, particularly in the case of prenidal aneurysms.

scholarly journals Pure arterial malformation of the posterior inferior cerebellar artery with interspersed adipose tissue: case report

2018 ◽  
Vol 22 (3) ◽  
pp. 261-264 ◽  
Author(s):  
Thomas J. Sorenson ◽  
Waleed Brinjikji ◽  
Kelly D. Flemming ◽  
Giuseppe Lanzino
Keyword(s):  
Adipose Tissue ◽  
Case Report ◽  
Posterior Inferior Cerebellar Artery ◽  
Conclusive Evidence ◽  
Vascular Lesions ◽  
Imaging Studies ◽  
Unique Case ◽  
Arteriovenous Shunting ◽  
Cerebellar Artery ◽  
Arterial Malformation

Incidental vascular lesions are being discovered at an increasing frequency due to widespread noninvasive brain imaging studies. One of these lesions has recently been termed a “pure arterial malformation” (PAM), which is defined as dilated, overlapping, and tortuous arteries forming a mass of arterial loops with a coil-like appearance in the absence of arteriovenous shunting. The pathogenesis of these lesions is not known, but a congenital etiology is suspected. The authors report the case of a 17-year-old female who was found to have a PAM of the posterior inferior cerebellar artery with adipose tissue interspersed within the arterial loops. The authors believe that this abnormal intracranial association between blood vessel and adipose tissue lends further support to the theory that PAMs are the result of a congenital malformation and are therefore safe to manage conservatively given their presumed benign natural history. Far from offering conclusive evidence, this unique case report adds to the growing body of PAM literature and strengthens an increasingly supported congenital theory of genesis.

scholarly journals Endovascular management of a ruptured aneurysm associated with distal PICA fenestration

2019 ◽  
Vol 25 (4) ◽  
pp. 430-433
Author(s):  
Jeyaseelan Nadarajah ◽  
Nishchint Jain ◽  
Leve Joseph Devarajan Sebastian ◽  
SB Gaikwad ◽  
Ajay Garg ◽  
...  
Keyword(s):  
Posterior Inferior Cerebellar Artery ◽  
Complete Recovery ◽  
Ruptured Aneurysm ◽  
Anatomic Variations ◽  
Endovascular Management ◽  
Neurological Sequelae ◽  
Cerebellar Artery ◽  
History Of ◽  
Parallel Channels ◽  
Occipital Headache

Fenestrations are rare but well-known arterial anatomic variations in which a segment of artery divides into two parallel channels that reunite distally. Although fenestrations as such are asymptomatic, they have gained clinical significance because of their association with aneurysms and other intracranial vascular pathologies. Here we present a 35-year-old woman with history of sudden severe occipital headache and vomiting. Imaging revealed a ruptured aneurysm in the distal posterior inferior cerebellar artery arising from one of the limbs of the fenestration. The aneurysm was successfully managed by coiling, and the patient made complete recovery without neurological sequelae.

scholarly journals Treatment of intracranial vertebral artery dissecting aneurysms involving the posterior inferior cerebellar artery origin

2019 ◽  
Vol 10 ◽  
pp. 116 ◽  
Author(s):  
Jason A. Chen ◽  
Matthew C. Garrett ◽  
Anton Mlikotic ◽  
James I. Ausman
Keyword(s):  
Vertebral Artery ◽  
Complex Disease ◽  
Treatment Options ◽  
Posterior Inferior Cerebellar Artery ◽  
Treatment Strategies ◽  
Dissecting Aneurysm ◽  
Parent Artery ◽  
Illustrative Case ◽  
Parent Vessel ◽  
Cerebellar Artery

Background: Vertebral artery dissecting aneurysm (VADA) involving the origin of the posterior inferior cerebellar artery (PICA) is a complex disease entity in which the dual goals of preventing future rebleeding and maintaining perfusion of the lateral medulla must be considered. We present an illustrative case and review the literature surrounding treatment strategies. Case Description: We report a patient presenting with extensive subarachnoid hemorrhage due to rupture of an intracranial VADA involving the PICA origin. After consideration of the patient’s cerebral vasculature and robustness of collaterals, a flow-diverting stent was placed with angiographic resolution of the lesion and maintenance of antegrade PICA flow. Ultimately, the patient experienced a contralateral intraparenchymal hemorrhage leading to death. Review of the literature identified 124 cases of VADA involving the PICA origin described over the past decade. The methods of surgical and endovascular treatment of these cases were reviewed, with particular focus on the rationale of treatment, outcomes, and complications. Conclusion: Numerous treatment options for VADA involving PICA have been reported with different risk and benefit profiles. Flow-diverting stents appear to offer the most favorable balance of securing the aneurysm and avoiding medullary infarction, but the risks and optimal anti-thrombotic treatment strategy are incompletely understood. In select cases, in which the surgical risk is low or in which the anatomy is favorable (e.g., nondominant parent vessel or robust collateral circulation in the involved territories), parent artery trapping with or without microsurgical revascularization can be considered.

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