1
|
Wakuta N, Yoshioka T, Irie Y, Tsugu H, Abe H. Ruptured distal anterior inferior cerebellar artery aneurysm years after stereotactic radiosurgery for vestibular schwannoma: A case report and literature review. Surg Neurol Int 2024; 15:213. [PMID: 38974544 PMCID: PMC11225523 DOI: 10.25259/sni_285_2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 05/31/2024] [Indexed: 07/09/2024] Open
Abstract
Background Aneurysmal formation after stereotactic radiosurgery (SRS) for vestibular schwannoma (VS) is a rare complication. Its characteristics and the best treatment strategies remain controversial, and the clinical course is especially unknown because reported aneurysms are first incidentally detected, or aneurysmal rupture occurs suddenly, and they are treated immediately. Case Description A 68-year-old man who underwent SRS for VS 20 years ago presented with subarachnoid hemorrhage (SAH) due to rupture of a radiation-induced fusiform anterior inferior cerebellar artery aneurysm. He was treated with parent artery occlusion, resulting in a modified Rankin scale grade 2. This report illustrates the first case of detected aneurysm formation before rupture with retrospective magnetic resonance imaging evaluation. Conclusion We describe the possible risk of rapid progression and rupture of aneurysms, focusing on the interval from SRS to aneurysmal formation. The period of formation of SRS-induced aneurysms is suspected to vary from years to decades regardless of radiation doses; however, aneurysms estimated as pseudoaneurysms have an extremely high risk of rupture within a few years, even when small in size. If aneurysms are discovered unruptured, there are some advantages in not only the prevention of poor prognosis due to SAH but also in the availability of optional therapeutic strategies using revascularization. Long-term annual follow-up, including vessel examination, is warranted not only to assess tumor status but also for early detection of any vascular lesions.
Collapse
Affiliation(s)
- Naoki Wakuta
- Department of Neurosurgery, Fukuoka Red Cross Hospital, Fukuoka, Japan
| | - Tsutomu Yoshioka
- Department of Neurosurgery, Fukuoka Red Cross Hospital, Fukuoka, Japan
| | - Yukino Irie
- Department of Neurosurgery, Fukuoka Red Cross Hospital, Fukuoka, Japan
| | - Hitoshi Tsugu
- Department of Neurosurgery, Fukuoka Red Cross Hospital, Fukuoka, Japan
| | - Hiroshi Abe
- Department of Neurosurgery Fukuoka University Hospital, School of Medicine, Fukuoka University, Fukuoka, Japan
| |
Collapse
|
2
|
Hirayama A, Sunaga A, Yokota K, Shigematsu H, Sorimachi T. Ruptured aneurysm in collateral arteries with blood-flow impairment of posterior inferior cerebellar artery: a report of three cases. Acta Neurochir (Wien) 2024; 166:184. [PMID: 38639801 DOI: 10.1007/s00701-024-06071-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 04/04/2024] [Indexed: 04/20/2024]
Abstract
Herein, we report three cases of cerebellar hemorrhage due to a ruptured small aneurysm located on a collateral artery compensating for one or more stenotic or occluded major cerebellar arteries. In each case, endovascular distant parent artery occlusion of both the collateral artery and aneurysm was performed to prevent rebleeding. A ruptured small aneurysm in a collateral artery may be observed in patients with hemorrhage in an atypical cerebellar region, especially in cases of stenosis or occlusion of the vertebral artery or posterior inferior cerebellar artery. Thus, cerebral angiography is recommended to rule out collateral artery aneurysm.
Collapse
Affiliation(s)
- Akihiro Hirayama
- Department of Neurosurgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan.
| | - Azusa Sunaga
- Department of Neurosurgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Kazuma Yokota
- Department of Neurosurgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Hideaki Shigematsu
- Department of Neurosurgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Takatoshi Sorimachi
- Department of Neurosurgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| |
Collapse
|
3
|
Tsurumaki N, Suzuki M, Izumi S, Hojo M. Rupture of a bronchial artery pseudoaneurysm after radiotherapy. BMJ Case Rep 2024; 17:e259825. [PMID: 38471708 PMCID: PMC10936474 DOI: 10.1136/bcr-2024-259825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024] Open
Affiliation(s)
- Nozomu Tsurumaki
- Respiratory Medicine, National Center for Global Health and Medicine Hospital, Shinjuku-ku, Japan
| | - Manabu Suzuki
- Respiratory Medicine, National Center for Global Health and Medicine Hospital, Shinjuku-ku, Japan
| | - Shinyu Izumi
- Respiratory Medicine, National Center for Global Health and Medicine Hospital, Shinjuku-ku, Japan
| | - Masayuki Hojo
- Respiratory Medicine, National Center for Global Health and Medicine Hospital, Shinjuku-ku, Japan
| |
Collapse
|
4
|
Yamashiro K, Sadato A, Hasegawa M, Wakako A, Omi T, Nakagawa M, Kuroda M, Hirose Y. Radiation-induced anterior inferior cerebellar artery pseudoaneurysm after stereotactic radiosurgery for vestibular schwannoma: features observed by direct surgery. Br J Neurosurg 2023; 37:1675-1679. [PMID: 34148476 DOI: 10.1080/02688697.2021.1940856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 06/07/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND In vestibular schwannoma (VS) patients treated with stereotactic radiosurgery (SRS), radiation-induced pseudoaneurysm is a rare long-term complication. To the best of our knowledge, there has been only one report of direct surgery in ruptured cases, and the optimal strategy for direct surgery is yet to be clarified. This case report describes a case of ruptured VS-related SRS-induced pseudoaneurysm that was successfully treated by direct surgery. CASE PRESENTATION A 57-year -old man underwent SRS for VS, and the tumour was well controlled after the SRS. Nine years after the SRS, however, he developed subarachnoid haemorrhage, and a SRS-induced distal anterior inferior cerebellar artery aneurysm was detected on the surface of the tumour. During the trapping surgery, the aneurysm was embedded in the tumour, and it was difficult to separate the aneurysm and tumour. Besides, the facial nerve and tumour restricted exposure of the parent artery. The parent artery proximal to the aneurysm could only be exposed by resecting caudal part of the tumour. The aneurysm was trapped with permanent clips and it was pathologically diagnosed as pseudoaneurysm. CONCLUSION It was suggested that the VS-related SRS-induced pseudoaneurysm is tightly adhered with surrounding structures and exposure of the parent artery could be limited due to the tumour and facial nerve. In this case report, we describe detailed intraoperative findings that will be useful for developing strategies for trapping surgery in future.
Collapse
Affiliation(s)
- Kei Yamashiro
- Department of Neurosurgery, Fujita Health University Okazaki Medical Center, Okazaki, Japan
- Department of Neurosurgery, Fujita Health University, Toyoake, Japan
| | - Akiyo Sadato
- Department of Neurosurgery, Fujita Health University Okazaki Medical Center, Okazaki, Japan
- Department of Neurosurgery, Fujita Health University, Toyoake, Japan
| | | | - Akira Wakako
- Department of Neurosurgery, Fujita Health University Okazaki Medical Center, Okazaki, Japan
- Department of Neurosurgery, Fujita Health University, Toyoake, Japan
| | - Tatsuo Omi
- Department of Neurosurgery, Fujita Health University Okazaki Medical Center, Okazaki, Japan
- Department of Neurosurgery, Fujita Health University, Toyoake, Japan
| | - Mitsuru Nakagawa
- Department of Diagnostic Pathology, Fujita Health University Okazaki Medical Center, Okazaki, Japan
| | - Makoto Kuroda
- Department of Diagnostic Pathology, Fujita Health University Okazaki Medical Center, Okazaki, Japan
| | - Yuichi Hirose
- Department of Neurosurgery, Fujita Health University, Toyoake, Japan
| |
Collapse
|
5
|
Lu D, Ping H, Wei C, Fang W, Zhang Y, Wu Y, Xue Y, Wang B, Qu Y, Zhao T. Unruptured anterior Inferior cerebellar artery aneurysm following stereotactic irradiation for vestibular schwannoma: Case report and literature review. Front Surg 2023; 10:1082265. [PMID: 36843988 PMCID: PMC9949606 DOI: 10.3389/fsurg.2023.1082265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 01/16/2023] [Indexed: 02/11/2023] Open
Abstract
Background The clinical features and therapeutic measures of vestibular schwannoma (VS) radiation-related aneurysm (RRA) have not been well described. We reported the first VS RRA case admitted for acute anterior inferior cerebella artery (AICA) ischemic symptoms. Literature was reviewed to present the research fruits about VS RRAs, and some therapeutic advices were given. Materials and methods A 54-year-old woman who had undergone GKS 10 years previously for a right VS was admitted to our hospital in 2018 because of sudden onset of severe vertigo and vomiting, accompanied with unsteady gait. During tumor resection, a dissecting aneurysm arose from the main trunk of AICA was encountered accidently within the tumor. The aneurysm was successfully treated with direct clip ligation, sparing the parent vessel. Data about this case were combined with those of other 11 radiation-related AICA aneurysm cases retrieved from the current literature. The following parameters were evaluated: Age, Sex, Diagnostic method, Location of aneurysm, Age of radiotherapy (Years)/Latency, Rupture, x-ray dosage, Type of radiotherapy, History of surgical resection of VS, Aneurysm Type, Morphology, Number, Treatment, Operative complications, Sequela, Outcome. VS RRAs mainly occurred in women (75%) with a median age of 62.5 years and were mainly located on AICA. Ruptured aneurysms accounted for 75.0% of the total cases. This paper reported the first VS case admitted with acute AICA ischemic symptoms. Cases with sacciform-like, irregular and fusiform-shaped aneurysms accounted for 50.0%, 25.0% and 25.0% of the total, respectively. After surgical treatment, 75.0% patients recovered, except for 3 patients who developed new ischemic consequence. Conclusion Patients should be informed of the risk of RRAs after receiving radiotherapy for VS. In these patients, RRAs should be suspected when subarachnoid hemorrhage or AICA ischemic symptoms occurred. Active intervention should be conducted considering the high instability and bleeding rate of VS RRAs.
Collapse
Affiliation(s)
| | | | | | - Wei Fang
- Department of Neurosurgery, The Second Affiliated Hospital, Air Force Military Medical University, Xi’an, China
| | - Yunze Zhang
- Department of Neurosurgery, The Second Affiliated Hospital, Air Force Military Medical University, Xi’an, China
| | - Yingxi Wu
- Department of Neurosurgery, The Second Affiliated Hospital, Air Force Military Medical University, Xi’an, China
| | - Yafei Xue
- Department of Neurosurgery, The Second Affiliated Hospital, Air Force Military Medical University, Xi’an, China
| | - Bao Wang
- Correspondence: Tianzhi Zhao Yan Qu Bao Wang
| | - Yan Qu
- Correspondence: Tianzhi Zhao Yan Qu Bao Wang
| | | |
Collapse
|
6
|
Hong CE, Cho YD, Yoo DH, Bae JW, Oh HS, Kang HS. Gamma knife radiosurgery-induced intracranial aneurysms: A case series and literature review. J Neuroradiol 2023; 50:36-39. [PMID: 36243170 DOI: 10.1016/j.neurad.2022.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 10/08/2022] [Accepted: 10/11/2022] [Indexed: 01/07/2023]
Affiliation(s)
- Chang-Eui Hong
- Department of Neurosurgery, Veterans Health Service Medical Center, Seoul, Korea
| | - Young Dae Cho
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
| | - Dong Hyun Yoo
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jin Woo Bae
- Department of Neurosurgery, Inha University Hospital, Incheon, Korea
| | - Han San Oh
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun-Seung Kang
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| |
Collapse
|
7
|
Frisoli FA, Catapano JS, Sheehy JP, Benner D, Srinivasan VM, Lawton MT. Occipital Artery to a3 Bypass and Distal Occlusion of an a2 Aneurysm: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2022; 22:e218-e219. [PMID: 35239521 DOI: 10.1227/ons.0000000000000121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 11/03/2021] [Indexed: 11/19/2022] Open
Affiliation(s)
- Fabio A Frisoli
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | | | | | | | | | | |
Collapse
|
8
|
Kimura S, Yagi R, Kishi F, Ogawa D, Yamada K, Taniguchi H, Wanibuchi M. Subarachnoid hemorrhage due to ruptured cerebral aneurysm at the distal part of anterior inferior cerebellar artery-posterior inferior cerebellar artery variant after γ-knife irradiation. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2022.101533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
9
|
Swain S. Vascular loop of anterior inferior cerebellar artery causing disabling tinnitus, vertigo, and hearing loss - A review. MATRIX SCIENCE MEDICA 2022. [DOI: 10.4103/mtsm.mtsm_21_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
10
|
Kawashima M, Hasegawa H, Shin M, Shinya Y, Katano A, Saito N. Outcomes of stereotactic radiosurgery in young adults with vestibular schwannomas. J Neurooncol 2021; 154:93-100. [PMID: 34241770 DOI: 10.1007/s11060-021-03803-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 07/01/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Vestibular schwannomas (VSs) are comparatively rare in younger patients, and stereotactic radiosurgery (SRS) outcome data are limited. We aimed to evaluate long-term SRS outcomes concerning sporadic VSs in patients aged ≤ 40 years. METHODS Of 383 patients with VS who had undergone SRS at our institution between 1990 and 2017, we retrospectively compared younger and older patients' tumor control and radiation-induced complication rates using case-control propensity score (PS) matching. RESULTS The mean follow-up was 83 and 92 months in older and younger patients, respectively. Compared with older patients, younger patients were more likely to have a history of resection (20% vs. 39%, p = 0.006) and be treated with higher marginal doses (median, 12 Gy vs. 14 Gy; p = 0.014). Cumulative 5- and 10-year tumor control rates were higher in older patients (97.7% and 93.9%, respectively) than in younger patients (90.2% and 85.4%, respectively, p = 0.024). After PS matching, younger patients' cumulative tumor control rates (93.6%, 85.4%, and 85.4% at 5, 10, and 15 years, respectively) were similar to those of older patients (p = 0.411). No significant between-cohort differences in hearing preservation rates or other cranial nerve complications were observed. Two younger patients had malignant tumors several years post-SRS, with one patient having confirmed histological transformation. CONCLUSIONS SRS is equally effective for younger and older patients. Complications other than hearing deterioration are uncommon. However, malignant transformation is possible, and long-term post-SRS surveillance MRI is important. These data are useful for decision-making involving young adults with VSs.
Collapse
Affiliation(s)
- Mariko Kawashima
- Department of Neurosurgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Hirotaka Hasegawa
- Department of Neurosurgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Masahiro Shin
- Department of Neurosurgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yuki Shinya
- Department of Neurosurgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Atsuto Katano
- Department of Radiology, The University of Tokyo Hospital, Tokyo, Japan
| | - Nobuhito Saito
- Department of Neurosurgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| |
Collapse
|
11
|
Huang C, Qin S, Huang W, Yu Y. Anterior Inferior Cerebellar Aneurysm Treated by Aneurysm Resection and Intracranial Artery Anastomosis in situ: A Case Report and Literature Review. Front Surg 2021; 8:669433. [PMID: 34113645 PMCID: PMC8185168 DOI: 10.3389/fsurg.2021.669433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 04/13/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Anterior inferior cerebellar artery (AICA) aneurysms are relatively rare in clinical practice, accounting for <1% of all intracranial arteries. After the diagnosis and location are confirmed by angiography, magnetic resonance, and other imaging examinations, interventional, or surgical treatment is often used, but some complex aneurysms require reconstructive surgery. Case Description: An 8-year-old male child was admitted to the hospital due to sudden disturbance of consciousness for 2 weeks. The head CT showed hematocele in the ventricular system with subarachnoid hemorrhage in the basilar cistern and annular cistern. On admission, he was conscious, answered correctly, had a soft neck, limb muscle strength was normal, and had no cranial nerves or nervous system abnormalities. A preoperative examination showed the right side of the anterior distal arteries class under the circular wide neck aneurysm, the distal anterior inferior cerebellar artery supplying a wide range of blood to the cerebellum, the ipsilateral posterior inferior cerebellar artery absent, and the aneurysm close to the VII, VIII nerves. The aneurysm was successfully treated by aneurysm resection and intracranial artery anastomosis in situ of a2 AICA-a2 AICA. Conclusions: AICA aneurysms are relatively rare; in this case, a complex wide-necked aneurysm was successfully treated by aneurysm resection and anastomosis in situ of a2 AICA-a2 AICA. This case can provide a reference for the surgical treatment of complex anterior cerebellar aneurysms.
Collapse
Affiliation(s)
- Chaojue Huang
- Department of Neurosurgery, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Shixing Qin
- Department of Neurosurgery, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Wei Huang
- Department of Neurosurgery, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yongjia Yu
- Department of Neurosurgery, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| |
Collapse
|
12
|
Long-term Outcomes of Gamma Knife Radiosurgery for Treating Vestibular Schwannoma With a Lower Prescription Dose of 12 Gy Compared With Higher Dose Treatment. Otol Neurotol 2021; 41:e1314-e1320. [PMID: 33492807 DOI: 10.1097/mao.0000000000002885] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Gamma knife radiosurgery (GKRS) is commonly used to treat vestibular schwannomas (VSs). The risk of complications from GKRS decreases at lower doses, but it is unknown if long-term tumor control is negatively affected by dose reduction. STUDY DESIGN This was a retrospective case review and analysis of patient data. SETTING Tertiary referral center. PATIENTS Patients with VSs who underwent GKRS between 1990 and 2007 at the authors' institution. INTERVENTION(S) The subjects were divided into two cohorts based on the prescribed doses of radiation received: a 12 Gy cohort (96 patients) with a follow-up period of 124 months and a >12 Gy cohort (118 patients) with a follow-up period of 143 months. MAIN OUTCOME MEASURES Tumor control rates at 10 to 15 years, frequency of facial and trigeminal nerve complications, and hearing function. RESULTS The 10 to 15-year tumor control rates were 95% in the 12 Gy cohort and 88% in the > 12 Gy cohort, but the differences were not significant. Compared with the >12 Gy cohort, facial and trigeminal nerve deficits occurred significantly less frequently in the 12 Gy cohort, with the 10-year cumulative, permanent deficit-free rates being 2% and 0%, respectively. Multivariate analyses revealed that treatment doses exceeding 12 Gy were associated with a significantly higher risk for cranial nerve deficits. The percentage of subjects retaining pure-tone average ≤ 50 dB at the final follow-up did not significantly differ between the cohorts (12 Gy cohort, 30% and >12 Gy cohort, 33%; p = 0.823). CONCLUSIONS Dose reduction to 12 Gy for GKRS to treat VSs decreased facial and trigeminal nerve complications without worsening tumor control rates.
Collapse
|
13
|
Keser N, Elshamy W, Chen X, Velioglu M, Is M, Xu Y, Eroksuz M, Ermutlu I, Huryol C, Jian R, Ates O. Challenges in Using the Posterior Inferior Cerebellar Artery for Revascularization of the Anterior Inferior Cerebellar Artery: A Microsurgical Anatomic Study. World Neurosurg 2021; 150:e591-e599. [PMID: 33753318 DOI: 10.1016/j.wneu.2021.03.067] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 03/12/2021] [Accepted: 03/13/2021] [Indexed: 01/27/2023]
Abstract
BACKGROUND A bypass is usually required to prevent ischemia during the treatment of anterior inferior cerebellar artery (AICA) aneurysms. The intracranial (IC)-to-IC bypass provides several advantages over the extracranial-to-IC bypass in the posterior fossa. However, there are only 2 case reports about AICA revascularization with the posterior inferior cerebellar artery (PICA). We aimed to investigate the microsurgical anatomical challenges for PICA to AICA anastomosis. METHODS Ten cadaveric heads injected with colored silicone were inspected on both sides using a lateral transcondylar approach. After the donor and recipient arteries were examined from the posterior side, neurovascular contents of the posterior fossa were excised and the origin, course, and variations of both arteries were investigated from the anterior view. The diameters of the AICA and PICA segments and the intersegment distance were measured. RESULTS PICA variations and posteromedial origins from the vertebral artery were identified in 8 of the 20 right and 6 of the 20 left sides, and the first segment of the PICA was not present in 7 sides. Furthermore, in 18 sides, the PICA was trapped between the lower cranial nerves and dentate ligaments. Therefore the donor artery could not be brought closer than 1 cm to the recipient artery in 19 sides. Moreover, AICA variations were identified in 6 sides, and in 12 sides, the diameter of the recipient artery was <1 mm. CONCLUSIONS The mostly PICA-related issues made PICA-to-AICA anastomosis unfeasible in all cadaveric heads included in the study.
Collapse
Affiliation(s)
- Nese Keser
- Department of Neurosurgery, University of Health Sciences, Istanbul Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey.
| | - Walid Elshamy
- Ain Shams University Faculty of Medicine, Department of Neurosurgery, Cairo, Egypt
| | - Xinpu Chen
- Zhengzhou University School of Medicine, Department of Neurosurgery, Zhengzhou, China
| | - Murat Velioglu
- Department of Radiology, University of Health Sciences, Istanbul Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Merih Is
- Retired Neurosurgeon, Department of Neurosurgery, University of Health Sciences, Istanbul, Turkey
| | - Yinfu Xu
- The Second People's Hospital of Liaocheng Shandong University, Department of Neurosurgery, Liaocheng Shandong, China
| | - Melih Eroksuz
- Marmara University School of Medicine, Institute of Neurological Sciences, Department of Neurosurgery, Istanbul, Turkey
| | - Ilcim Ermutlu
- Department of Neurosurgery, University of Health Sciences, Istanbul Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Cagin Huryol
- Bakirkoy Dr Sadi Konuk Training and Research Hospital, Department of Radiology, Istanbul, Turkey
| | - Ruan Jian
- Chongqing University Cancer Hospital, Department of Neurosurgery, Chongqing, China
| | - Ozkan Ates
- Koc University School of Medicine Hospital, Department of Neurosurgery, Istanbul, Turkey
| |
Collapse
|
14
|
Zheng Y, Lu Z, Shen J, Xu F. Intracranial Pseudoaneurysms: Evaluation and Management. Front Neurol 2020; 11:582. [PMID: 32733358 PMCID: PMC7358534 DOI: 10.3389/fneur.2020.00582] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 05/20/2020] [Indexed: 12/04/2022] Open
Abstract
Intracranial pseudoaneurysms account for about 1% of intracranial aneurysms with a high mortality. The natural history of intracranial pseudoaneurysm is not well-understood, and its management remains controversial. This review provides an overview of the etiology, pathophysiology, clinical presentation, imaging, and management of intracranial pseudoaneurysms. Especially, this article emphasizes the factors that should be considered for the most appropriate management strategy based on the risks and benefits of each treatment option.
Collapse
Affiliation(s)
- Yongtao Zheng
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical School, Fudan University, Shanghai, China
| | - Zheng Lu
- Department of Neurosurgery, Hai'an People's Hospital, Nantong, China
| | - Jianguo Shen
- Department of Neurosurgery, Second Affiliated Hospital of Jiaxiang University, Jiaxing, China
| | - Feng Xu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical School, Fudan University, Shanghai, China.,Department of Neurosurgery, Kashgar Prefecture Second People's Hospital, Kashgar, China
| |
Collapse
|
15
|
The Iatrogenic Development of an Anterior Cerebral Artery Pseudoaneurysm during Lamina Terminalis Fenestration-Genesis, Diagnosis and Therapy: Lessons Learned. Brain Sci 2020; 10:brainsci10060357. [PMID: 32526835 PMCID: PMC7349859 DOI: 10.3390/brainsci10060357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 05/31/2020] [Accepted: 06/05/2020] [Indexed: 11/29/2022] Open
Abstract
Intracranial pseudoaneurysms (PSA) are scarcely presented in the literature. We describe the case of an intracranial PSA on the right anterior cerebral artery, which developed during the complicated surgical treatment of a ruptured right middle cerebral aneurysm. The pseudoaneurysm grew over time and was co-incidentally diagnosed 3 months after the original surgery. The PSA was successfully treated by coiling. In cases of vascular injuries during complicated brain surgery, the timely and careful radiological diagnosis of such a lesion is necessary to allow its fast and proper treatment and thus prevent the patient from potential risks.
Collapse
|
16
|
Hasegawa T, Kato T, Naito T, Tanei T, Ishii K, Tsukamoto E, Okada K. Long-Term Outcomes of Sporadic Vestibular Schwannomas Treated with Recent Stereotactic Radiosurgery Techniques. Int J Radiat Oncol Biol Phys 2020; 108:725-733. [PMID: 32473897 DOI: 10.1016/j.ijrobp.2020.05.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 05/18/2020] [Accepted: 05/18/2020] [Indexed: 11/18/2022]
Abstract
PURPOSE Vestibular schwannomas (VSs) are benign; thus, understanding long-term tumor control and late adverse radiation effects of stereotactic radiosurgery (SRS) through current radiosurgical techniques is important to inform treatment decisions. Our aim was to clarify long-term tumor control rates and incidence of late adverse radiation effects in patients with VSs followed for 5 years or longer after SRS. METHODS AND MATERIALS Altogether, 615 patients with VSs (excluding neurofibromatosis type 2 and partially treated tumors) followed for 5 years or longer after SRS using recent radiosurgical techniques were evaluated. All patients were treated at a margin dose of less than 14 Gy. All tumors were classified into 4 categories: type A (intracanalicular tumor, 87 patients [14%]), type B (cerebellopontine angle [CPA] tumor, 325 patients [53%]), type C (CPA tumor compressing the brain stem, 138 patients [22%]), and type D (CPA tumor compressing the brain stem with a deviation of the fourth ventricle, 65 patients [11%]). Median tumor volume was 2.0 cm3 and median marginal dose was 12 Gy. RESULTS Median follow-up period was 158 months. Actuarial 5-, 10-, and 15-year or longer local control (LC) rates were 93%, 91%, and 89%, respectively. Tumor type (P < .001, hazard ratio 2.389) and number of prior surgeries (P = .007, hazard ratio 1.698) were significant for LC. Depending on the tumor type, the actuarial 10-year LC rates were 100%, 93%, 88%, and 70% in type A, B, C, and D tumors, respectively. No patient developed persistent facial palsy. Twenty patients (3.3%) developed delayed cysts. One patient developed malignant transformation (0.2%). CONCLUSIONS SRS is a safe and effective treatment for VSs in the long term, excluding VSs compressing the brain stem with a deviation of the fourth ventricle. Delayed cysts such as cyst formation, enlarged preexisting cysts or extratumoral cysts, and malignant transformation should be considered possible causes of long-term treatment failures.
Collapse
Affiliation(s)
- Toshinori Hasegawa
- Department of Neurosurgery, Gamma Knife Center, Komaki City Hospital, Komaki, Japan.
| | - Takenori Kato
- Department of Neurosurgery, Gamma Knife Center, Komaki City Hospital, Komaki, Japan
| | - Takehiro Naito
- Department of Neurosurgery, Gamma Knife Center, Komaki City Hospital, Komaki, Japan
| | - Takafumi Tanei
- Department of Neurosurgery, Gamma Knife Center, Komaki City Hospital, Komaki, Japan
| | - Kazuki Ishii
- Department of Neurosurgery, Gamma Knife Center, Komaki City Hospital, Komaki, Japan
| | - Eisuke Tsukamoto
- Department of Neurosurgery, Gamma Knife Center, Komaki City Hospital, Komaki, Japan
| | - Kou Okada
- Department of Neurosurgery, Gamma Knife Center, Komaki City Hospital, Komaki, Japan
| |
Collapse
|
17
|
Surgical Anatomy of the Donor Arteries for Extracranial-Intracranial Bypass Surgery: An Anatomic and Radiologic Study. World Neurosurg 2020; 136:e447-e459. [DOI: 10.1016/j.wneu.2020.01.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 01/06/2020] [Indexed: 11/21/2022]
|
18
|
Baranoski JF, Przybylowski CJ, Mascitelli JR, Lang MJ, Lawton MT. Anterior Inferior Cerebellar Artery Bypasses: The 7-Bypass Framework Applied to Ischemia and Aneurysms in the Cerebellopontine Angle. Oper Neurosurg (Hagerstown) 2019; 19:165-174. [DOI: 10.1093/ons/opz347] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 08/24/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Aneurysms of the anterior inferior cerebellar artery (AICA) are rare. Primary clip reconstruction of these lesions is a challenge because of the limited surgical exposure and frequent nonsaccular aneurysm morphology. Endovascular treatment options exist, but outcomes are equivalent to those for open surgery. Historically, AICA aneurysms not amenable to clipping or primary coiling have been treated with parent vessel sacrifice.
OBJECTIVE
To determine whether an AICA revascularization strategy would afford for the safe treatment of AICA aneurysms and other posterior circulation pathologies without compromising perfusion of the AICA territories.
METHODS
We describe a series of AICA bypasses to treat 4 AICA aneurysms and 3 vertebral artery/AICA occlusions.
RESULTS
We used 7 types of bypasses to revascularize the AICA territory. Bypass types included extracranial-to-intracranial (EC-IC) bypass without an interpositional graft, EC-IC with an interpositional graft, in situ bypass, reanastomosis, reimplantation, intracranial-to-intracranial bypass with interpositional graft, and combination bypasses. In particular, we performed the following 7 bypasses: OA-a3 AICA, OA-RAG-a3 AICA, p3 PICA-a3 AICA, a2 AICA reanastomosis, V4 VA-a3 AICA, V3 VA-SVG-a3 AICA, and a combined OA-a3 AICA bypass and p3 PICA reanastomosis. AICA revascularization allows for the safe treatment of AICA aneurysms and other posterior circulation pathologies without compromising perfusion of the AICA territories.
CONCLUSION
All 7 AICA bypasses are feasible for application to AICA aneurysms and ischemic disease. Our experience with the 7-bypass framework demonstrates the utility of the framework as a decision-making tool and the breadth of bypass innovation possible in this anatomically challenging region.
Collapse
Affiliation(s)
- Jacob F Baranoski
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Colin J Przybylowski
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Justin R Mascitelli
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Michael J Lang
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Michael T Lawton
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| |
Collapse
|
19
|
Revascularization of the Anterior Inferior Cerebellar Artery Using Extracranial and Intracranial Donors: A Morphometric Cadaveric Study. World Neurosurg 2019; 127:e768-e778. [DOI: 10.1016/j.wneu.2019.03.260] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 03/25/2019] [Indexed: 11/20/2022]
|
20
|
Vigo V, Dones F, Di Bonaventura R, Barakat D, McDermott MW, Abla AA, Rubio RR. Middle Meningeal Artery to Premeatal Anterior Inferior Cerebellar Artery Bypass via Anterior Petrosectomy: An Anatomic Feasibility Study. World Neurosurg 2019; 123:e536-e542. [DOI: 10.1016/j.wneu.2018.11.207] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 11/21/2018] [Accepted: 11/22/2018] [Indexed: 10/27/2022]
|