scholarly journals Interpositional carotid artery bypass strategies in the surgical management of aneurysms and tumors of the skull base

2003 ◽  
Vol 14 (3) ◽  
pp. 1-6 ◽  
Author(s):  
James K. Liu ◽  
William T. Couldwell
Keyword(s):  
Carotid Artery ◽  
Skull Base ◽  
Surgical Management ◽  
Artery Bypass ◽  
Skull Base Tumors ◽  
Parent Vessel ◽  
Vessel Occlusion ◽  
Vein Grafts ◽  
Complex Aneurysms ◽  
Parent Vessel Occlusion

Cerebral revascularization is an important component in the surgical management of complex skull base tumors and aneurysms. Patients who harbor complex aneurysms that cannot be clipped directly and in whom parent vessel occlusion cannot be tolerated may require cerebrovascular bypass surgery. In cases in which skull base tumors encase the carotid artery (CA) and a resection is desired, a cerebrovascular bypass may be necessary in planned CA occlusion or sacrifice. In this review the authors discuss options for performing high-flow anterograde interposition CA bypass for lesions of the skull base. The authors review three important bypass techniques involving saphenous vein grafts: the cervical-to-petrous internal carotid artery (ICA), petrous-to-supraclinoid ICA, and cervical-to-supraclinoid ICA bypass. These revascularization techniques are important tools in the surgical treatment of complex aneurysms and tumors of the skull base and cavernous sinus.

Parent vessel occlusion after Pipeline embolization of cerebral aneurysms of the anterior circulation

2017 ◽  
Vol 127 (6) ◽  
pp. 1333-1341 ◽  
Author(s):  
Matthew B. Potts ◽  
Maksim Shapiro ◽  
Daniel W. Zumofen ◽  
Eytan Raz ◽  
Erez Nossek ◽  
...  
Keyword(s):  
Antiplatelet Therapy ◽  
Parent Artery ◽  
Parent Vessel ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Complex Aneurysms ◽  
Aneurysm Size ◽  
Parent Vessel Occlusion ◽  
Anterior Circulation Aneurysms

OBJECTIVEThe Pipeline Embolization Device (PED) is now a well-established option for the treatment of giant or complex aneurysms, especially those arising from the anterior circulation. Considering the purpose of such treatment is to maintain patency of the parent vessel, postembolization occlusion of the parent artery can be regarded as an untoward outcome. Antiplatelet therapy in the posttreatment period is therefore required to minimize such events. Here, the authors present a series of patients with anterior circulation aneurysms treated with the PED who subsequently experienced parent vessel occlusion (PVO).METHODSThe authors performed a retrospective review of all anterior circulation aneurysms consecutively treated at a single institution with the PED through 2014, identifying those with PVO on follow-up imaging. Aneurysm size and location, number of PEDs used, and follow-up digital subtraction angiography results were recorded. When available, pre- and postembolization platelet function testing results were also recorded.RESULTSAmong 256 patients with anterior circulation aneurysms treated with the PED, the authors identified 8 who developed PVO after embolization. The mean aneurysm size in this cohort was 22.3 mm, and the number of PEDs used per case ranged from 2 to 10. Six patients were found to have asymptomatic PVO discovered incidentally on routine follow-up imaging between 6 months and 3 years postembolization, 3 of whom had documented “delayed” PVO with prior postembolization angiograms confirming aneurysm occlusion and a patent parent vessel at an earlier time. Two additional patients experienced symptomatic PVO, one of which was associated with early discontinuation of antiplatelet therapy.CONCLUSIONSIn this large series of anterior circulation aneurysms, the authors report a low incidence of symptomatic PVO, complicating premature discontinuation of postembolization antiplatelet or anticoagulation therapy. Beyond the subacute period, asymptomatic PVO was more common, particularly among complex fusiform or very large–necked aneurysms, highlighting an important phenomenon with the use of PED for the treatment of anterior circulation aneurysms, and suggesting that extended periods of antiplatelet coverage may be required in select complex aneurysms.

Submandibular-Infratemporal Carotid Artery Bypass for Skull Base Tumors and Giant Aneurysms

Skull Base ◽  
2007 ◽  
Vol 16 (S 1) ◽  
Author(s):  
James Liu ◽  
Amin Amini ◽  
Peter Kan ◽  
William Couldwell
Keyword(s):  
Carotid Artery ◽  
Skull Base ◽  
Artery Bypass ◽  
Skull Base Tumors ◽  
Giant Aneurysms

scholarly journals Successful Endovascular Management of Intra-meatal Anterior Inferior Cerebellar Artery–Posterior Inferior Cerebellar Artery Variant Aneurysm

2018 ◽  
Vol 02 (01) ◽  
pp. 059-061
Author(s):  
Vikram Bohra ◽  
Romnesh DeSouza ◽  
Vikram Huded
Keyword(s):  
Surgical Management ◽  
Case Reports ◽  
Posterior Inferior Cerebellar Artery ◽  
Common Trunk ◽  
Anterior Inferior Cerebellar Artery ◽  
Parent Vessel ◽  
Vessel Occlusion ◽  
Unsuccessful Attempt ◽  
Cerebellar Artery ◽  
Parent Vessel Occlusion

AbstractAnterior inferior cerebellar artery–posterior inferior cerebellar artery (AICA-PICA) variant or common trunk is seen frequently in vertebral angiograms as PICA is found to be hypoplastic or absent in approximately 20 to 25% of patients. There have been very few case reports of aneurysm arising in AICA-PICA variant. Intrameatal AICA aneurysms are also rare, with no reports involving AICA-PICA variant till date. Neurosurgical approach and clipping have been proposed as first-line treatment option for intrameatal AICA aneurysms. The authors report a case of a young woman presenting with subarachnoid hemorrhage, found to have a right AICA-PICA variant aneurysm in intrameatal location. The patient underwent coiling with parent vessel occlusion after an unsuccessful attempt at surgical management of the same. She recovered without any postprocedure complication. This case report highlights the fact that endovascular approach can be used to manage distal AICA/AICA-PICA variant or intrameatal aneurysm with added advantage of avoiding the postprocedure complications associated with surgical management of the same.

Traumatic dissecting pathology of posterior cerebral artery: a report of two cases—aneurysm and pial arteriovenous fistula

2021 ◽  
Vol 14 (5) ◽  
pp. e237722
Author(s):  
Vignesh Selvamurugan ◽  
Surya Nandan Prasad ◽  
Vivek Singh ◽  
Zafar Neyaz
Keyword(s):  
Arteriovenous Fistula ◽  
Cerebral Artery ◽  
Road Traffic ◽  
Posterior Cerebral Artery ◽  
Case Reports ◽  
Dissecting Aneurysm ◽  
Parent Vessel ◽  
Vessel Occlusion ◽  
Parent Vessel Occlusion ◽  
Pial Arteriovenous Fistula

We present two cases of 17-year-old man and 10-year-old boy presenting with subarachnoid haemorrhage and a history of road traffic accident. One patient had dissecting aneurysm of the posterior cerebral artery (PCA), and the other patient had partially thrombosed aneurysm on CT angiography. On digital subtraction angiography of the second patient, there was formation of PCA pontomesencephalic vein pial arteriovenous fistula (PAVF). Both the patients underwent endovascular treatment: stent-assisted coiling for aneurysm and coiling with parent vessel occlusion for PAVF. There were no procedural complications. Follow-up angiography showed no residual aneurysm or fistula. Trauma is one of the recognised causes of dissection, and intracranial dissections can present as stenotic lesions, aneurysms or fistulas, depending on the pathology. Traumatic dissecting PCA aneurysm has been reported in only two case reports previously, and post-traumatic PAVF in PCA has not been reported.

Outcomes in Surgical Management of Sinonasal/Skull Base Tumors: A Single Comprehensive Cancer Center Experience

2021 ◽  
Author(s):  
Dauren Adilbay ◽  
Cristina Valero ◽  
Conall Fitzgerald ◽  
Avery Yuan ◽  
Ximena Mimica ◽  
...  
Keyword(s):  
Skull Base ◽  
Surgical Management ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Skull Base Tumors

scholarly journals Flow diversion in the treatment of aneurysms: a randomized care trial and registry

2017 ◽  
Vol 127 (3) ◽  
pp. 454-462 ◽  
Author(s):  
Jean Raymond ◽  
Jean-Christophe Gentric ◽  
Tim E. Darsaut ◽  
Daniela Iancu ◽  
Miguel Chagnon ◽  
...  
Keyword(s):  
Standard Treatment ◽  
Flow Diversion ◽  
Parent Vessel ◽  
Management Options ◽  
Vessel Occlusion ◽  
Clinical Trial Registration ◽  
Safety Outcome ◽  
Standard Management ◽  
Efficacy Outcome ◽  
Parent Vessel Occlusion

OBJECTIVEThe Flow Diversion in the Treatment of Intracranial Aneurysm Trial (FIAT) was designed to guide the clinical use of flow diversion, an innovative method to treat intracranial aneurysms, within a care trial and to study safety and efficacy.METHODSFIAT, conducted in 3 Canadian hospitals, proposed randomized allocation to flow diversion or standard management options (observation, coil embolization, parent vessel occlusion, or clip placement), and a registry of non-randomized patients treated with flow diversion. The primary safety outcome was death or dependency (modified Rankin Scale score > 2) at 3 months, to be determined for all patients who received flow diversion at any time. The primary efficacy outcome was angiographic occlusion at 3–12 months combined with an independent clinical outcome.RESULTSOf 112 participating patients recruited between May 2, 2011, and February 25, 2015, 78 were randomized (39 in each arm), and 34 received flow diversion within the registry. The study was halted due to safety concerns. Twelve (16%) of 75 patients (95% CI 8.9%–26.7%) who were allocated to or received flow diversion at any time were dead (n = 8) or dependent (n = 4) at 3 months or more, crossing a predefined safety boundary. Death or dependency occurred in 5 (13.2%) of 38 patients randomly allocated and treated by flow diversion (95% CI 5.0%–28.9%) and in 5 (12.8%) of 39 patients allocated to standard treatment (95% CI 4.8%–28.2%). Efficacy was below expectations of the trial hypothesis: 16 (42.1%) of 38 patients (95% CI 26.7%–59.1%) randomly allocated to flow diversion failed to reach the primary outcome, as compared with 14 (35.9%) of 39 patients allocated to standard treatment (95% CI 21.7%–52.9%).CONCLUSIONSFlow diversion was not as safe and effective as hypothesized. More randomized trials are needed to determine the role of flow diversion in the management of aneurysms.Clinical trial registration no.: NCT01349582 (clinicaltrials.gov)

scholarly journals pCONUS for Distal Artery Protection During Complex Aneurysm Treatment by Endovascular Parent Vessel Occlusion—A Technical Nuance

2020 ◽  
Author(s):  
Victoria Hellstern ◽  
Marta Aguilar-Pérez ◽  
Maike Dukiewicz ◽  
Gottlieb Maier ◽  
Hansjörg Bäzner ◽  
...  
Keyword(s):  
Parent Vessel ◽  
Vessel Occlusion ◽  
Complex Aneurysm ◽  
Aneurysm Treatment ◽  
Parent Vessel Occlusion ◽  
Distal Artery
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