scholarly journals Successful rescue treatment of right posterior inferior cerebellar artery (PICA) vascular stasis with tirofiban following endovascular coil implantation

2021 ◽  
Vol 14 (1) ◽  
pp. e238120
Author(s):  
Christopher Houle ◽  
Varun Reddy
Keyword(s):  
Hospital Stay ◽  
Continuous Infusion ◽  
Posterior Inferior Cerebellar Artery ◽  
Neurological Deficits ◽  
Antiplatelet Treatment ◽  
Fixed Rate ◽  
Rescue Treatment ◽  
Cerebellar Artery

This report describes a patient who developed intraprocedural vascular stasis immediately following elective endovascular coil emboliation. Urgent antiplatelet treatment with the GpIIb/IIIa agent tirofiban was used. It was infused intra-arterially during the procedure, followed by a fixed rate intravenous continuous infusion, and successfully restored normal circulation. There were no reports of further bleeding or haemodynamic compromise during the hospital stay. The patient’s condition returned to baseline and he was discharged the following day with no neurological deficits.

scholarly journals Spontaneous Vertebral Artery Dissection Presenting with Crescendo TIAs and Headache

2019 ◽  
pp. 1-6
Author(s):  
Dr. Nosakhare I Idehen ◽  
Dr. Mohammed Awad
Keyword(s):  
Vertebral Artery ◽  
Posterior Inferior Cerebellar Artery ◽  
Vertebral Artery Dissection ◽  
Symptomatic Improvement ◽  
Neurological Deficits ◽  
Artery Dissection ◽  
Neurological Sequelae ◽  
Cerebellar Artery ◽  
Ct Brain

We present the case of a man in his thirties who had attended the emergency department with complaint of a distressing headache and associated intermittent facial droop with occasional slurred speech. The patient’s symptoms were bizarre in their nature as they were random, not sustained and he had long intervals when he was asymptomatic and was his normal self. During the course of admission his symptoms evolved resulting in neurological deficits which were more sustained, prompting the need for further imaging beyond the initial plain CT brain which showed no abnormality. This led to the diagnosis of vertebral artery dissection (VAD) complicated with an ischaemic stroke in the posterior inferior cerebellar artery distribution (PICA) on MRI/MRA. Dual anti-platelet treatment was commenced with the patient attaining gradual symptomatic improvement prior to discharge. He has reported some degree of neurological sequelae which he described as intermittent poor coordination on follow up visit in clinic after discharge.

Foramen magnum syndrome caused by a giant aneurysm of the posterior inferior cerebral artery

1978 ◽  
Vol 48 (4) ◽  
pp. 639-641 ◽  
Author(s):  
Donald Judice ◽  
Edward S. Connolly
Keyword(s):  
Cerebral Artery ◽  
Posterior Inferior Cerebellar Artery ◽  
Giant Aneurysm ◽  
Foramen Magnum ◽  
Neurological Deficits ◽  
Content Type ◽  
Cerebellar Artery ◽  
Fine Print

✓ The authors present a case of giant aneurysm of the posterior inferior cerebellar artery. It was successfully excised with reversal of neurological deficits.

POSTERIOR INFERIOR CEREBELLAR ARTERY ORIGIN THROMBOSIS WITH ANEURYSM OF COLLATERALIZED POSTERIOR MENINGEAL ARTERY PRESENTING AS SUBARACHNOID HEMORRHAGE

Neurosurgery ◽  
2009 ◽  
Vol 65 (4) ◽  
pp. E818-E819 ◽  
Author(s):  
Steven W. Chang ◽  
Udaya K. Kakarla ◽  
Giriraj K. Sharma ◽  
Robert F. Spetzler
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Posterior Inferior Cerebellar Artery ◽  
Lateral Approach ◽  
Neurological Deficits ◽  
Collateral Flow ◽  
Collateral Branch ◽  
Cerebellar Artery ◽  
Far Lateral Approach ◽  
Posterior Meningeal Artery ◽  
Meningeal Artery

Abstract OBJECTIVE This is the first report of a ruptured aneurysm involving a collateral branch to the posterior inferior cerebellar artery (PICA) in a patient who had a subarachnoid hemorrhage. CLINICAL PRESENTATION A 56-year-old man initially presented with a subarachnoid hemorrhage and underwent 2 catheter-based 4-vessel angiograms with negative results. A delayed angiogram 4 weeks later revealed a dissecting aneurysm of the posterior meningeal artery, a branch of the vertebral artery. INTERVENTION A 3-dimensional reconstruction of the vertebral angiogram showed proximal occlusion of the proximal left PICA and distal filling via a collateral branch from the posterior meningeal artery. A far-lateral approach was used for this patient. The aneurysm was found along the course of the collateral posterior meningeal artery and was clipped successfully. CONCLUSION Aneurysms involving collateral branches of the PICA are rare. It is important to recognize such collateral flow preoperatively because inadvertent sacrifice of these vessels during a surgical approach could lead to stroke and neurological deficits of the PICA territory.

scholarly journals Endoscopic endonasal approach for clipping of a PICA aneurysm

2020 ◽  
Vol 2 (2) ◽  
pp. V14
Author(s):  
Ezequiel Goldschmidt ◽  
Philippe Lavigne ◽  
Carl Snyderman ◽  
Paul A. Gardner
Keyword(s):  
Posterior Inferior Cerebellar Artery ◽  
Cranial Nerves ◽  
Neurological Deficits ◽  
Csf Leak ◽  
Open Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal ◽  
Posthemorrhagic Hydrocephalus ◽  
Cerebellar Artery ◽  
Lower Cranial Nerves

This video depicts the case of a 59-year-old woman that presented to the emergency department with the worst headache of her life. CT showed subarachnoid hemorrhage and digital subtraction angiogram demonstrated a right-side posterior inferior cerebellar artery (PICA) aneurysm. Given the medial and ventral position of the aneurysm, deep to the lower cranial nerves, which obviated distal control from an open approach, and the absence of an endovascular option able to reliably preserve the PICA, an endonasal approach was offered. A far medial approach was performed, and the aneurysm was successfully clipped. The patient developed a postoperative CSF leak with persistent posthemorrhagic hydrocephalus treated with reexploration and an eventual ventriculoperitoneal shunt. The patient was discharged without neurological deficits.The video can be found here: https://youtu.be/_9hsM2CaMow.

Surgical treatment for vertebral artery–posterior inferior cerebellar artery aneurysms: special reference to the importance of the cerebellomedullary fissure dissection

2013 ◽  
Vol 118 (2) ◽  
pp. 460-464 ◽  
Author(s):  
Masatou Kawashima ◽  
Yukinori Takase ◽  
Toshio Matsushima
Keyword(s):  
Vertebral Artery ◽  
Posterior Inferior Cerebellar Artery ◽  
Neurological Deficits ◽  
Lateral Part ◽  
Microsurgical Anatomy ◽  
Aneurysm Surgery ◽  
Lesion Side ◽  
Cerebellar Artery ◽  
Cerebellomedullary Fissure ◽  
Pica Aneurysms

Object The cerebellomedullary fissure (CMF) is a space between the cerebellum and the medulla oblongata, which often adhere to each other. The purpose of the present study was to demonstrate the importance of the unilateral CMF dissection for clipping vertebral artery (VA)–posterior inferior cerebellar artery (PICA) aneurysms. Methods Five adult cadaveric specimens were studied after colored silicone was infused into the arteries and veins. The microsurgical anatomy of the CMF and the trans-CMF approach for VA-PICA aneurysm surgery were examined in stepwise dissections. In addition, 6 patients underwent surgery for VA-PICA saccular aneurysms (2 ruptured and 4 unruptured aneurysms) via posterolateral approaches, with wide opening of the unilateral CMF to obtain good visualization and a wide working space in the lateral part of the cerebellomedullary cistern. Clinical data including neurological and radiological findings and patient outcomes were analyzed in all 6 cases. Results In all cases, the aneurysm was successfully clipped and no permanent neurological deficits remained. The wide opening of the unilateral CMF on the lesion side made it possible to retract the inferolateral part of the cerebellum easily, provided a wide operative field in the cerebellomedullary cistern, and enabled successful clip placement without difficulty. Conclusions For safe and effective VA-PICA aneurysm surgery, it is very important to dissect the CMF on the lesion side as well as to remove the lateral part of the foramen magnum. Direct clip placement is very safe and useful in cases involving VA-PICA aneurysms.

scholarly journals Retrosigmoid Approach for Resecting a Giant Lateral Pontine Ependymoma: Two-Dimensional Operative Video

2020 ◽  
Author(s):  
Hongxiang Wang ◽  
Yong Yan ◽  
Tao Xu ◽  
Juxiang Chen
Keyword(s):  
Brain Stem ◽  
Posterior Inferior Cerebellar Artery ◽  
Cranial Nerves ◽  
Retrosigmoid Approach ◽  
Gross Total Resection ◽  
Neurological Deficits ◽  
Ependymal Cells ◽  
Total Resection ◽  
Petrosal Vein ◽  
Cerebellar Artery

AbstractEpendymoma is one of the most common pediatric tumors in central nervous system, for which gross total resection has been the most favorable prognostic factor.1 2 However, surgery of ependymomas located in brain stem is significantly challenging. This video demonstrates the microsurgical removal of an ependymoma originating from ependymal cells of the lateral recess of fourth ventricle via retrosigmoid approach in an 11-year-old female. The patient presented with a 6-month history of continues headache and vomiting. On examination, she had a walking instability and an emaciated body. Neuroimaging revealed a right lateral pontine lesion extending to the cerebellopontine angle region. The patient underwent a suboccipital craniotomy, followed by excellent exposure for the tumor. Petrosal vein encased by the tumor mass and close adhesion of the tumor and the initial segments of facial and acoustic nerves adjoined brain stem could be seen operatively. While preserving trigeminal nerve, facial and acoustic nerves, posterior cranial nerves, anterior inferior cerebellar artery, labyrinth artery, posterior inferior cerebellar artery, and petrosal vein, gross total resection was achieved under the careful operation along arachnoid spaces together with intratumoral decompression. The patient tolerated the procedure well without any neurological deficits. Histological examination confirmed the tumor as an ependymoma (WHO II). The cytology measurement of the cerebrospinal fluid did not find any tumor cells. Postoperative computed tomography and magnetic resonance imaging scan depicted complete resection of the tumor, and adjuvant radiotherapy was recommended. She remained symptom-free without any evidence of recurrence during the follow-up period of 1 year. Informed consent was obtained from the patient.The link to the video can be found at: https://youtu.be/sZ9GhUeltwc.

Endovascular Management of Intracranial Vertebral Artery Dissection: Technical Nuances for the Preservation of Posterior Inferior Cerebellar Artery and Basilar Artery

2020 ◽  
Vol 19 (3) ◽  
pp. 241-248
Author(s):  
Gaurav Gupta ◽  
Donna A Eckstein ◽  
Vinayak Narayan ◽  
Fareed Jumah ◽  
Anthony A DePalma ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Vertebral Artery ◽  
Basilar Artery ◽  
Posterior Inferior Cerebellar Artery ◽  
Vertebral Artery Dissection ◽  
Treatment Method ◽  
Neurological Deficits ◽  
Artery Dissection ◽  
Treatment Technique ◽  
Cerebellar Artery

Abstract BACKGROUND The treatment of intracranial vertebral artery dissection (VAD) can be challenging. OBJECTIVE To evaluate the clinical presentation, endovascular treatment techniques, and prognostic outcome of patients diagnosed with intracranial VAD at our institution. METHODS A retrospective analysis of 35 patients who were diagnosed with VAD at our institution over 17-yr period (2001-2017) is presented. A total of 27 patients with a total of 30 affected arteries underwent endovascular treatment, and their outcome was evaluated. RESULTS Of the 35 total patients with VAD, 15 presented with headache, 12 with focal neurological deficits, 2 with neck pain, 2 with dizziness, 1 with syncope, and 3 after trauma. Of the 30 dissected arteries, 18 were treated with deconstruction and 12 were treated with stent reconstruction. Treatment method was determined by the dominance of the affected artery and location relative to the ipsilateral posterior inferior cerebellar artery (PICA) and the basilar artery. Deconstructive techniques were utilized in all cases of hypoplastic artery dissection and the majority of codominant artery dissections, whereas reconstruction was performed on the majority of dominant artery dissections. Rupture did not impact treatment technique. Four patients demonstrated post-treatment infarcts, and another 1 patient died because of intraparenchymal bleed. The remaining 22 patients demonstrated favorable clinical outcome. None of the patients developed recanalization or needed retreatment till the last follow-up. CONCLUSION This study suggests that endovascular treatment of intracranial VAD with deconstruction or stent reconstruction based on the patients anatomy, particularly vessel dominance and location with respect to PICA, is feasible and effective though the revascularization procedures still has its role in selected cases.

Descending Branch of the Lateral Circumflex Femoral Artery Graft for Posterior Inferior Cerebellar Artery Revascularization

2018 ◽  
Vol 15 (3) ◽  
pp. 285-291 ◽  
Author(s):  
Ben A Strickland ◽  
Joshua Bakhsheshian ◽  
Robert C Rennert ◽  
Vance L Fredrickson ◽  
Jordan Lam ◽  
...  
Keyword(s):  
Femoral Artery ◽  
Posterior Inferior Cerebellar Artery ◽  
Neurological Deficits ◽  
Arterial Graft ◽  
Lateral Circumflex Femoral Artery ◽  
Institutional Review ◽  
Circumflex Femoral Artery ◽  
Bypass Patency ◽  
Cerebellar Artery ◽  
Lateral Circumflex Femoral

Abstract BACKGROUND Posterior inferior cerebellar artery (PICA) revascularization can be achieved with relative ease when a contralateral PICA is present. However, without a contralateral PICA, identification of a suitable vessel alternative can be challenging due to a size mismatch. OBJECTIVE To propose the descending branch of the lateral circumflex femoral artery (DLCFA) to be an acceptable, if not preferred, arterial graft for PICA revascularization. METHODS Data from patients who underwent PICA revascularization with DLCFA grafts were obtained from an institutional review board-approved prospectively maintained database with informed consent from the patients. RESULTS Three patients, all presenting with ruptured aneurysms, were treated with PICA revascularization using the DLCFA. All cases achieved bypass patency and no ischemic events occurred during the bypass procedures. Graft spasm occurred in 2 patients. Two patients that presented with neurological deficits achieved excellent neurological outcomes and 1 suffered an anterior spinal artery stroke during a repeat endovascular treatment 1 wk after revascularization. CONCLUSION The DLCFA is favorable for PICA revascularization when a contralateral PICA is not a viable option.

Occipital artery to p3 segment of posterior inferior cerebellar artery bypass in treating a complex fusiform aneurysm

2020 ◽  
Vol 13 (6) ◽  
pp. e235023
Author(s):  
Peyton L Nisson ◽  
Michael A McNamara ◽  
Xiaolong Wang ◽  
Xinmin Ding
Keyword(s):  
Case Report ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Posterior Inferior Cerebellar Artery ◽  
Dissecting Aneurysm ◽  
Neurological Deficits ◽  
Endovascular Coiling ◽  
Occipital Artery ◽  
Cerebellar Artery ◽  
Arterial Bypass Graft

We provide a case report of a 58-year-old man who presented with a ruptured fusiform dissecting aneurysm located at the junction of the vertebral artery and posterior inferior cerebellar artery (PICA). Due to the lesion’s complexity, a two-step approach was planned for revascularisation of PICA using the occipital artery (OA) prior to coiling embolisation. An end-to-side OA–PICA bypass was performed with implantation at the caudal loop of the p3 PICA segment. Fifteen days after the procedure, the aneurysm underwent stent-assisted coiling for successful obliteration of the aneurysm. The patient tolerated this procedure well and now at 1.5 years of follow-up remains free from any neurological deficits (modified Rankin Score 0). This case report illustrates one of the unique scenarios where both the vascular territory involved and morphological features of the aneurysm prohibited the use of more conventional means, necessitating the use of an arterial bypass graft for successful treatment of this lesion. As open vascular surgery is becoming less common in the age of endovascular coiling, our article uniquely reports on the combined use of both endovascular and microsurgical techniques to treat a complex aneurysm of the posterior circulation.

Reimplantation Bypass Using One Limb of a Double-Origin Posterior–Inferior Cerebellar Artery for Treatment of a Ruptured, Fusiform PICA Aneurysm

2020 ◽  
Author(s):  
Fabio Frisoli ◽  
Joshua S. Catapano ◽  
Stefan Koester ◽  
Gabriella Paisan ◽  
Michael Lang ◽  
...  
Keyword(s):  
Posterior Inferior Cerebellar Artery ◽  
Cerebellar Artery ◽  
Double Origin
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