scholarly journals Microsurgical Clipping of a Posterior Inferior Cerebellar Artery Aneurysm Following Failed Pipeline Stent

Cureus ◽  
2021 ◽  
Author(s):  
Rishi Suresh ◽  
Amanda V Jenson ◽  
Gavin Britz
Keyword(s):  
Posterior Inferior Cerebellar Artery ◽  
Artery Aneurysm ◽  
Microsurgical Clipping ◽  
Cerebellar Artery ◽  
Pipeline Stent

scholarly journals Far Lateral Approach for Clipping of a Posterior Inferior Cerebellar Artery Aneurysm

2019 ◽  
Vol 80 (S 04) ◽  
pp. S343-S343
Author(s):  
Jaafar Basma ◽  
Vincent N. Nguyen ◽  
William M. Mangham ◽  
Nickalus R. Khan ◽  
Jeffrey Sorenson ◽  
...  
Keyword(s):  
Hypoglossal Nerve ◽  
Posterior Inferior Cerebellar Artery ◽  
Artery Aneurysm ◽  
Lateral Approach ◽  
Microsurgical Anatomy ◽  
Microsurgical Clipping ◽  
Cerebellar Artery ◽  
Far Lateral Approach ◽  
Far Lateral ◽  
Clip Occlusion

Abstract Objectives To describe a far lateral approach for microsurgical clipping of a ruptured posterior inferior cerebellar artery (PICA) aneurysm involving the hypoglossal nerve, with emphasis on the microsurgical anatomy, and technique. Design A far lateral craniotomy is performed in the lateral decubitus position and the transverse and sigmoid sinuses were exposed. After opening the dura, sutures are placed to allow gentle mobilization of the sinuses. The ipsilateral cerebellar tonsil is mobilized and the PICA is followed to its junction with the vertebral artery. Hypoglossal nerve rootlets are draped over the dome of the aneurysm. Mobilization of the PICA and the hypoglossal nerve away from the lateral medulla allows microsurgical clipping of the aneurysm neck. Photographs of the region are borrowed from Dr Rhoton's laboratory to illustrate the microsurgical anatomy. Participants The senior authors performed the surgery. The video was edited by Drs. V.N. and J.B. Chart review and literature review were performed by Drs. W.M. and J.B. Outcome Measures Outcome was assessed with successful clip occlusion and postoperative neurological function. Results There was complete clip occlusion of the PICA aneurysm with no postoperative neurological deficits. The patient was discharged home after an uneventful hospital course. Conclusion The far lateral approach provides an adequate corridor to the ventrolateral brainstem for microsurgical treatment of PICA aneurysms. An adequate understanding of the relevant microsurgical anatomy is the key to safe and effective clipping in this region.The link to the video can be found at: https://youtu.be/yhjKRIG5H74.

Microsurgical Clipping of Ruptured Distal Posterior Inferior Cerebellar Artery Aneurysm: 3-Dimensional Operative Video

2018 ◽  
Vol 16 (2) ◽  
pp. E48-E49
Author(s):  
Ricardo Chmelnitsky Wainberg ◽  
Marcos Devanir Silva da Costa ◽  
Yair A Ugalde Hernández ◽  
Ricardo Lourenço Caramanti ◽  
César Augusto Ferreira Alves Filho ◽  
...  
Keyword(s):  
Case Reports ◽  
Posterior Inferior Cerebellar Artery ◽  
Case Series ◽  
Artery Aneurysm ◽  
Close Relation ◽  
Cerebellar Tonsil ◽  
3 Dimensional ◽  
Suboccipital Craniotomy ◽  
Microsurgical Clipping ◽  
Cerebellar Artery

Abstract The distal posterior inferior cerebellar artery (PICA) is a rare site of aneurysm formation. Only small case series and case reports regarding surgical treatment are found in the literature. The PICA is divided into 5 segments (anterior medullary, lateral medullary, tonsilomedullary, telovelotonsillary, and cortical), and the distal ones represent the most complex, due to anatomic variations. We present a case of a 69-yr-old female patient who has suffered from a sudden and intense occipital headache, associated with nausea and vomiting. CT scan showed intraventricular hemorrhage, and further investigation with MRI and MR Angiography revealed a small distal PICA aneurysm, at the superior part of the medial aspect of the left cerebellar tonsil. Digital angiography has demonstrated the aneurysm at the tonsilomedullary segment of the PICA. In this 3-dimensional video, the authors show the microsurgical clipping of a saccular distal PICA aneurysm in the close relation to a choroidal branch, performed by median suboccipital craniotomy. Step-by-step of the dissection, relevant surrounding anatomy and aneurysm clipping is demonstrated. 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 Persistent hypoglossal artery aneurysm: Case report and qualitative systematic review

2018 ◽  
Vol 25 (2) ◽  
pp. 164-171
Author(s):  
George H Tse ◽  
Andrew Martin ◽  
Richard A Dyde ◽  
Stuart C Coley
Keyword(s):  
Systematic Review ◽  
Posterior Inferior Cerebellar Artery ◽  
Artery Aneurysm ◽  
Endovascular Coiling ◽  
Persistent Hypoglossal Artery ◽  
Randomised Study ◽  
Hypoglossal Artery ◽  
Qualitative Systematic Review ◽  
Cerebellar Artery ◽  
Patient Reported

A persistent hypoglossal artery was first described in 1889 and is one of the more common anatomical variations arising from aberration in normal development. Endovascular coiling has been recognised as a robust treatment for acutely ruptured intracranial arterial aneurysms, although specific data regarding an aneurysm arising from a persistent hypoglossal artery is lacking due to the low incidence. Here we report both the oldest patient reported to be treated with a persistent hypoglossal artery-associated aneurysm and also explicitly report endovascular treatment of a persistent hypoglossal artery aneurysm arising at the posterior inferior cerebellar artery origin. Qualitative systematic review of the available medical literature demonstrates limited evidence regarding treatment of persistent hypoglossal artery-associated aneurysms with the majority being carried out via open surgery. Ruptured posterior inferior cerebellar artery aneurysm arising from a persistent hypoglossal artery can be successfully and safely treated by endovascular therapy via the persistent hypoglossal artery. Randomised study of this situation is unlikely to be feasible; however, qualitative review of the literature reveals six such aneurysms that have been treated surgically, and this case appears to be the first via an endovascular means.

Challenges in the Management of a Ruptured Bihemispheric Posterior Inferior Cerebellar Artery Aneurysm

2019 ◽  
Vol 122 ◽  
pp. 317-321 ◽  
Author(s):  
Chin Lik Tan ◽  
Gopinathan Anil ◽  
Tseng Tsai Yeo ◽  
Ning Chou
Keyword(s):  
Posterior Inferior Cerebellar Artery ◽  
Artery Aneurysm ◽  
Cerebellar Artery

Rupture of previously documented small asymptomatic saccular intracranial aneurysms

1992 ◽  
Vol 76 (6) ◽  
pp. 1019-1024 ◽  
Author(s):  
Wouter I. Schievink ◽  
David G. Piepgras ◽  
Fremont P. Wirth
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Intracranial Aneurysms ◽  
Posterior Inferior Cerebellar Artery ◽  
Artery Aneurysm ◽  
Careful Consideration ◽  
Middle Cerebral Artery Aneurysm ◽  
Internal Carotid Artery Aneurysm ◽  
Cerebellar Artery ◽  
Cerebral Artery Aneurysm

✓ In a recent study from the Mayo Clinic on the natural history of intact saccular intracranial aneurysms, none of the aneurysms smaller than 10 mm in diameter ruptured. It was concluded that these aneurysms carry a negligible risk for future hemorrhage and that surgery for their repair could not be recommended. These findings and recommendations have been the subject of much controversy. The authors report three patients with previously documented asymptomatic intact saccular intracranial aneurysms smaller than 5 mm in diameter that subsequently ruptured. In Case 1, a 70-year-old man bled from a 4-mm middle cerebral artery aneurysm that had been discovered incidentally 2½ years previously during evaluation of cerebral ischemic symptoms. A 10-mm internal carotid artery aneurysm and a contralateral 4-mm middle cerebral artery aneurysm had not ruptured. Case 2 was that of a 66-year-old woman who bled from a 4-mm pericallosal aneurysm that had been present 9½ years previously when she suffered subarachnoid hemorrhage (SAH) from a 7 × 9-mm posterior inferior cerebellar artery aneurysm. Although the pericallosal aneurysm had not enlarged in the intervening years, a daughter aneurysm had developed. The third patient was a 45-year-old woman who bled from a 4- to 5-mm posterior inferior cerebellar artery aneurysm that had measured approximately 2 mm on an angiogram obtained 4 years previously; at that time she had suffered SAH due to rupture of a 5 × 12-mm posterior communicating artery aneurysm. These cases show that small asymptomatic intact saccular intracranial aneurysms are not innocuous and that careful consideration must be given to their surgical repair and long-term follow-up study.

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