1/53. Direct surgery of basilar trunk and vertebrobasilar junction aneurysms via the combined transpetrosal approach.Surgical access to aneurysms of the basilar trunk and vertebrobasilar junction is hampered by their direct proximity of these lesions to highly vulnerable neural structures like the brain stem and cranial nerves, as well by the bony structure of the petrous bone blocking the direct surgical approach to these aneurysms. Only recently lateral approaches directed through parts of the petrous bone have been reported for surgery of basilar trunk and vertebrobasilar junction aneurysms like the anterior transpetrosal, the retrolabyrinthine transsigmoid, as well as the combined supra-infratentorial posterior transpetrosal approach. As experience in the use of this approach is limited in the neurosurgical literature we present our surgical experiences in 11 patients with basilar trunk and vertebrobasilar junction aneurysms, operated on using the supra-infratentorial posterior transpetrosal approach. In 10 patients, including one patient with a giant partially thrombosed basilar trunk aneurysm, direct clipping of the aneurysm via the transpetrosal route was possible. In one patient with a giant vertebrobasilar junction aneurysm, the completely calcified aneurysm sac was resected after occlusion of the vertebral artery. Of the whole series, one patient died and in three patients postoperative accentuation of preexisting cranial nerve deficits occurred. Except transient cerebrospinal fluid leak in two patients, the postoperative course was uneventful in the remaining patients. Postoperative angiography demonstrated complete aneurysm clipping in ten patients and relief of preoperative brain stem compression in the patient with the giant vertebrobasilar junction aneurysm. It is concluded, that the supra-infratentorial posterior transpetrosal approach allows excellent access to the basilar artery trunk and vertebrobasilar junction and can be considered the approach of choice to selected aneurysms located in this area.- - - - - - - - - - ranking = 1keywords = compression (Clic here for more details about this article) |
2/53. Bow hunter's stroke associated with an aberrant course of the vertebral artery--case report.A 53-year-old male presented with repeated vertebrobasilar insufficiency on turning the head to the left. Angiography revealed severe stenosis of the dominant right vertebral artery at the atlantoaxial level in this position. decompression surgery for the affected vertebral artery at the transverse foramen of the atlas was planned. However, surgery revealed an aberrant course of the artery, turning at the orifice of the transverse foramen of the atlas and perforating the dura at the occipitoatlantal level after passing through the bony canal of the atlas. Therefore, decompression was performed at the bony canal, which was the contributing site, and the symptoms improved. Bow hunter's stroke may be caused by atlantoaxial arterial anomalies, so accurate preoperative evaluation of the region is necessary to avoid anatomical confusion at surgery.- - - - - - - - - - ranking = 2keywords = compression (Clic here for more details about this article) |
3/53. Spontaneous vertebral arteriovenous fistula--case report.A 57-year-old male presented with a rare case of spontaneous vertebral arteriovenous fistula manifesting as radiculopathy of the right arm, subsequently associated with pulsating tinnitus and vascular bruit in the nape. He had a past history of chiropractic-induced vertebrobasilar infarction. Angiography showed a simple and direct fistula between the third segment of the right vertebral artery and the epidural veins at the C-1 level, where the artery runs backward above the arch of the C-1 just proximal to the penetration of the dura. The fistula was successfully obliterated by coil embolization, resulting in rapid improvement of the signs and symptoms. Mechanical compression to the nerve roots by the engorged epidural veins with arterial pressure was considered to be the major cause of radiculopathy. vertebral artery dissection induced by chiropractic manipulation is most likely responsible for the development of the fistula.- - - - - - - - - - ranking = 1keywords = compression (Clic here for more details about this article) |
4/53. Rotational compression of the vertebral artery at the point of dural penetration. Case report.vertebrobasilar insufficiency (VBI) due to vertebral artery (VA) compression occurs in a significant number of patients. Rotational compression of the VA usually occurs below C-2, where the artery is pinched during head rotation, leading to thrombus formation and subsequent cerebellar infarction. Although this problem has been reported to occur at the atlantooccipital levels, a review of the literature revealed no published cases of VA compression at the point of dural penetration, which is located above the atlantooccipital membrane. The authors report the case of a 30-year-old woman who presented with signs and symptoms of VBI. Dynamic angiography demonstrated left-sided VA compression at the site at which dural penetration had occurred, proximal to the posterior inferior cerebellar artery. Surgical decompression of the left VA at the point of dural penetration relieved the symptoms, and postoperative dynamic angiography demonstrated complete resolution of the positional compression of the left VA. Because of these findings, an additional possible location for rotational compression of the VA is described, namely, the point of dural penetration. The authors suggest a method of surgically treating rotational VA compression at this site.- - - - - - - - - - ranking = 12keywords = compression (Clic here for more details about this article) |
5/53. hydrocephalus caused by dolichoectatic basilar artery. Case report.The authors report a rare case of dolichoectatic basilar artery causing hydrocephalus by direct compression of foramen of Monro, documented by brain CT scan and MRI angiography, treated by positioning a biventriculo-peritoneal shunt. Pathogenesis, diagnostic difficulty and treatment are discussed.- - - - - - - - - - ranking = 1keywords = compression (Clic here for more details about this article) |
6/53. Masking of vertebral artery dissection by severe trauma to the cervical spine.STUDY DESIGN: A prospective case study was performed. OBJECTIVES: To illustrate the association of cervical trauma with vertebral artery dissection, and to propose a diagnostic and therapeutic algorithm for suspected traumatic vertebral artery dissection. SUMMARY OF BACKGROUND DATA: vertebral artery dissection is a recognized but underdiagnosed complication of trauma to the cervical spine. Symptoms of spinal cord injury, however, may obscure those of vertebral artery dissection, presumably causing gross underdiagnosis of this complication. methods: All patients with vertebral artery dissection admitted to the authors' facility between 1992 and 1997 were screened for cervical trauma. RESULTS: This article presents four patients with severe trauma to the cervical spine, defined as luxation, subluxation, or fracture, in whom symptoms of vertebral artery dissection developed after a delay ranging from several hours to weeks. The traumatic vertebral artery dissection typically was located at the site of vertebral injury or cranial to it. One patient with fracture of the odontoid process survived symptom free without ischemic brain infarctions. Another patient survived with traumatic quadriplegia in addition to large cerebellar and posterior cerebral artery infarctions. Two patients died as a result of fulminant vertebrobasilar infarctions, both with only moderate impairment from the primary spinal cord injury. CONCLUSIONS: Early signs of vertebral artery dissection include head and neck pain, often localized to the site of intimal disruption, which may be disguised by the signs of the spinal injury. Early Doppler ultrasound and duplex sonography as a noninvasive screening method should be performed for patients with severe trauma to the cervical spine. In cases of vertebral artery dissection, immediate anticoagulation should be initiated. Traumatologists should be aware of this complication in evaluating patients with severe trauma of the cervical spine, and also for a variety of forensic reasons.- - - - - - - - - - ranking = 0.02895726368243keywords = fracture (Clic here for more details about this article) |
7/53. Cochlear vertebral entrapment syndrome: a case report.The authors describe a patient with isolated involvement of vestibulocochlear nerve by a huge vascular loop from vertebral dolichoectasia. No other neurological deficit was found except for unilateral hearing loss. Abnormal brainstem auditory evoked potential study indicated a retrocochlear lesion. The brain computed tomography (CT) and magnetic resonance imaging (MRI) studies demonstrated an abnormally enhanced vascular lesion impinged on the left porus acusticus with a displacement of the brainstem to the right. There was no infarction in the brainstem. A cerebral angiography demonstrated a megadolichoectatic horizontal loop at the intracranial portion of the left vertebral artery. There was no thrombus or atherosclerosis in the vertebrobasilar system. A mechanical compression by a vascular loop is the only possible pathogenesis for hearing loss. The authors diagnose this condition as cochlear vertebral entrapment syndrome.- - - - - - - - - - ranking = 1keywords = compression (Clic here for more details about this article) |
8/53. Cervicomedullary junction compression caused by vertebral artery dolichoectasia and requiring surgical treatment. Case report.A case of progressive brainstem syndrome secondary to vertebral artery (VA) dolichoectasia is reported. The patient presented with partial bilateral abduction paralysis, which progressed to quadriparesis, ataxia, and areflexia. The initial diagnosis was stroke, but because of the patient's deterioration, a diagnosis of Miller-Fisher syndrome was made. Neuroimages obtained at that time revealed an ectatic left VA with minimal cervicomedullary compression. The patient continued to deteriorate despite medical management. Follow-up imaging demonstrated worsened cervicomedullary compression. An emergency posterior fossa neurovascular decompression was performed using a Gore-Tex sling and resulted in mild neurological improvement. This case emphasizes that early recognition and surgical intervention to prevent progressive neurological sequelae are crucial in symptomatic VA dolichoectasia.- - - - - - - - - - ranking = 7keywords = compression (Clic here for more details about this article) |
9/53. Bow hunter stroke caused by cervical disc herniation. Case report.Bow hunter stroke, which is characterized by transient vertebrobasilar ischemia brought on by head turning, is an unusual condition usually caused by structural abnormalities at the craniocervical junction. The authors present a case in which compression of the left vertebral artery (VA) at the C4-5 level was caused by a laterally herniated intervertebral disc. A 56-year-old man presented with a 6-month history of dizziness and syncope when he turned his head 45 degrees or more to the left. Transcranial Doppler (TCD) ultrasonography demonstrated decreased blood flow through the left VA, and angiography revealed an occlusion of the left VA at the C4-5 level, both when the patient turned his head to the left. Via an anterior cervical approach, the VA canal was unroofed through the transverse foramina to decompress the left VA at C4-5; intraoperatively, the left VA was found to be compressed by a laterally herniated cervical disc fragment. To the best of the authors' knowledge this is the first report of a laterally herniated cervical disc causing bow hunter stroke. The use of TCD may be of value in the diagnosis and management of the disorder, and herniated cervical disc must be included in the roster of potential causes for this rare disease.- - - - - - - - - - ranking = 1keywords = compression (Clic here for more details about this article) |
10/53. Anterior decompression of the atlantoaxial vertebral artery to treat bow hunter's stroke: technical case report.OBJECTIVE AND IMPORTANCE: Bow hunter's stroke is a symptomatic vertebrobasilar insufficiency caused by stenosis or occlusion of the vertebral artery at the C1C2 level with head rotation. No case of anterior decompression of the vertebral artery for surgical treatment of bow hunter's stroke has been reported. CLINICAL PRESENTATION: A 47-year-old male patient presented with repeated episodes of unconsciousness caused by turning his head approximately 40 degrees to the right; he recovered consciousness within approximately 10 seconds after his head was returned to the neutral position. Angiography revealed an occluded right vertebral artery and temporary occlusion of the left vertebral artery, at the level of the C2 transverse foramen, when the patient's head was turned approximately 40 degrees to the right. INTERVENTION: Anterior decompression of the left vertebral artery at the transverse foramen of the axis was performed. Postoperative angiography demonstrated sufficient flow in the left vertebral artery even when the neck was rotated. CONCLUSION: The patient was discharged without neurological deficits. We demonstrate that simple surgical untethering of the vertebral artery at the transverse foramen of the axis is an effective method of treatment that avoids the limitation of head rotation. The advantage of this procedure is that it does not result in postoperative restriction of the patient's neck movements. The anterior approach, with decompression of the transverse foramen of the axis, in the present case provided adequate exposure of the vertebral artery and resulted in a satisfactory outcome.- - - - - - - - - - ranking = 7keywords = compression (Clic here for more details about this article) |
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