1
|
Zhao Y, Yu X, Li D, He J, Li Y, Zhang B, Zhang N, Wang Q, Yan C. Intracranial vasculopathy: an important organ damage in young adult patients with late-onset Pompe disease. Orphanet J Rare Dis 2024; 19:267. [PMID: 39010129 PMCID: PMC11250947 DOI: 10.1186/s13023-024-03282-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 07/03/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND Late-onset Pompe disease (LOPD) is mainly characterized by progressive limb-girdle muscle weakness and respiratory impairment, whereas stroke and cerebrovascular abnormalities have been insufficiently studied in LOPD. This study aimed to evaluate the frequency and pattern of intracranial artery and brain parenchyma abnormalities in LOPD patients. RESULTS Neuroimaging data from 30 Chinese adult LOPD patients were collected from our center. Seven patients (7/30) had acute cerebral infarction or hemorrhage. Brain magnetic resonance angiography (MRA) or computed tomography angiography (CTA) revealed artery abnormalities in 23 patients (23/30). Dilative arteriopathy was found in 19 patients (19/30), with vertebrobasilar dolichoectasia found in 17 patients and dilatation of the anterior circulation arteries found in 8 patients. The maximum diameter of the basilar artery was correlated with disease duration (p < 0.05). In addition, aneurysms (7/30) and fenestrations (3/30) were discovered. There were 14 patients with arterial stenosis (14/30), and both anterior and posterior circulation involvement occurred in 9 patients (9/14). Stenosis and dilative arteriopathy simultaneously occurred in 10 patients (10/30). White matter hyperintensities were present in 13 patients (13/28). Microbleeds, predominantly located in the cerebellum and brainstem, were detected in 7 patients (7/22) via susceptibility-weighted imaging. CONCLUSIONS Intracranial vasculopathy involving both large arteries and small vessels is an important organ damage in LOPD patients. LOPD should be considered a key differential diagnosis in young adults with cryptogenic stroke, and a series of imaging evaluations of the brain and intracranial blood vessels is recommended as a routine workup in adult LOPD patients.
Collapse
Affiliation(s)
- Yuying Zhao
- Research Institute of Neuromuscular and Neurodegenerative Diseases and Department of Neurology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
| | - Xiaolin Yu
- Department of Geriatric Medicine, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
| | - Duoling Li
- Research Institute of Neuromuscular and Neurodegenerative Diseases and Department of Neurology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
| | - Jingzhen He
- Department of Radiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
| | - Yuzhi Li
- Department of Neurology, Jining NO.1 People's Hospital, Jining, 272002, China
| | - Bin Zhang
- Department of Neurology, Liaocheng People's Hospital, Liaocheng, 252000, China
| | - Na Zhang
- Research Institute of Neuromuscular and Neurodegenerative Diseases and Department of Neurology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
| | - Qian Wang
- Department of Radiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China.
| | - Chuanzhu Yan
- Research Institute of Neuromuscular and Neurodegenerative Diseases and Department of Neurology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China.
- Mitochondrial Medicine Laboratory, Qilu Hospital (Qingdao), Shandong University, Qingdao, 266035, China.
- Brain Science Research Institute, Shandong University, Jinan, 250012, China.
| |
Collapse
|
2
|
Essibayi MA, Srinivasan VM, Madriñán-Navia HJ, Park MT, Scherschinski L, Catapano JS, Rhodenhiser EG, Graffeo CS, Ducruet AF, Albuquerque FC, Lawton MT. Management of basilar fenestration aneurysms: a systematic review with an illustrative case report. J Neurointerv Surg 2023; 16:24-30. [PMID: 36564200 DOI: 10.1136/jnis-2022-019728] [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: 10/06/2022] [Accepted: 12/14/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND Basilar artery (BA) fenestration aneurysm (BAFA) is a rare phenomenon commonly accompanying other aneurysms. Treatment is challenging, and few cases have been reported. This review investigated the management outcomes of BAFAs. METHODS Publication databases were searched to identify studies evaluating outcomes of endovascular treatment (EVT) and microsurgical treatment of BAFAs from inception through 2021. Outcomes (clinical, angiographic, postoperative complications, and retreatment rates) were collected and analyzed. The authors present their case of a patient treated for a BAFA. RESULTS Including the authors' case, 184 patients with 209 BAFAs were reported in 68 studies. Most patients (130/175; 74.3%) presented with ruptured aneurysms, most commonly involving the proximal segment of the BA. Most BAFAs were small (52/103, 50.5%) and saccular (119/143, 83.2%). Most patients underwent EVT (143/184, 77.7%); the rest underwent microsurgery. Postoperative complications after EVT occurred in 10 (8.3%) of 120 patients, with 4 of the 10 experiencing strokes. At clinical follow-up, most EVT patients (74/86, 86.0%) showed good outcomes; 3.9% (2/51) had died. Most aneurysms managed with EVT (56/73, 76.7%) showed complete occlusion at follow-up; 7.3% (8/109) were retreated. Postoperative complications occurred in 62.2% (23/37) of microsurgical patients; 5 (21.7%) of the 23 experienced strokes. All patients showed good clinical outcomes at follow-up. Most aneurysms (22/28, 78.6%) treated microsurgically showed complete occlusion at angiographic follow-up, with no retreatment required. CONCLUSION BAFAs are often symptomatic; thus, treatment is challenging. By the 2000s, treatment had moved from microsurgical to endovascular modalities, with good clinical and angiographic outcomes.
Collapse
Affiliation(s)
- Muhammed Amir Essibayi
- Department of Neurosurgery, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Visish M Srinivasan
- Department of Neurosurgery, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Humberto José Madriñán-Navia
- Department of Neurosurgery, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
- Department of Neurosurgery, Center for Research and Training in Neurosurgery, Hospital Universitario de la Samaritana, Bogotá, Colombia
| | - Marian T Park
- Department of Neurosurgery, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Lea Scherschinski
- Department of Neurosurgery, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Joshua S Catapano
- Department of Neurosurgery, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Emmajane G Rhodenhiser
- Department of Neurosurgery, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Christopher S Graffeo
- Department of Neurosurgery, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Andrew F Ducruet
- Department of Neurosurgery, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Felipe C Albuquerque
- Department of Neurosurgery, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Michael T Lawton
- Department of Neurosurgery, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| |
Collapse
|
3
|
Catalano M, Crimi L, Belfiore G, Grippaldi D, David E, Spatola C, Cristaudo C, Foti PV, Palmucci S, Basile A. Congenital and acquired anomalies of the basilar artery: A pictorial essay. Neuroradiol J 2023:19714009231177412. [PMID: 37210636 DOI: 10.1177/19714009231177412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2023] Open
Abstract
INTRODUCTION The basilar artery is one of the two cases in our body where an arterial vessel is formed by the union of two others - the vertebral arteries. It provides vascular supply to essential structures for the main vital functions; the posterior cerebral arteries originate from it as terminal branches, and form part of the anastomotic circle of Willis. IMAGING FINDINGS Congenital and acquired anomalies of the basilar trunk are described. We provide a schematic and detailed representation of normal anatomical variants - mainly represented by the fenestrated basilar artery or the persistence of carotid-basilar anastomosis; course anomalies are also illustrated, with reference to neuro-vascular conflicts and dolichoectasia. Among congenital anomalies, this pictorial review also shows the variants of the basilar origin, such as in the case of basilar trunk arising from only one of the two vertebral arteries, and the calibre changes - which are represented by aneurysm and hypoplasia. The latter appears to be a risk factor for posterior circulation stroke, when associated with a bilateral posterior foetal variant.Among the acquired forms, this pictorial essay describes some clinical cases of dissections, non-congenital aneurysms, thrombosis and tumour with vascular encasing or compression of basilar artery. CONCLUSION CT angiography and MRI allow us to study the posterior intracranial circulation in detail, providing useful pre-treatment information. Therefore, knowledge of congenital or acquired anomalies of the basilar artery is essential for radiologists, neuroradiologists and neurosurgeons.
Collapse
Affiliation(s)
- Marco Catalano
- Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia", University Hospital Policlinico "G. Rodolico-San Marco", Italy
| | - Luca Crimi
- Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia", University Hospital Policlinico "G. Rodolico-San Marco", Italy
| | - Giuseppe Belfiore
- Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia", University Hospital Policlinico "G. Rodolico-San Marco", Italy
| | - Daniele Grippaldi
- Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia", University Hospital Policlinico "G. Rodolico-San Marco", Italy
| | - Emanuele David
- Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia", University Hospital Policlinico "G. Rodolico-San Marco", Italy
| | - Corrado Spatola
- Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia", University Hospital Policlinico "G. Rodolico-San Marco", Italy
| | - Concetto Cristaudo
- UOC Neuroradiologia, Azienda Ospedaliera per L'Emergenza Cannizzaro, Italy
| | - Pietro Valerio Foti
- Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia", University Hospital Policlinico "G. Rodolico-San Marco", Italy
| | - Stefano Palmucci
- Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia", University Hospital Policlinico "G. Rodolico-San Marco", Italy
| | - Antonio Basile
- Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia", University Hospital Policlinico "G. Rodolico-San Marco", Italy
| |
Collapse
|
4
|
Lei C, De Stefano FA, Heskett C, Fry L, Brake A, Le K, Peterson J, Ebersole K. A review of the top 100 most influential articles on basilar artery aneurysms. Neurosurg Rev 2023; 46:108. [PMID: 37148412 DOI: 10.1007/s10143-023-02022-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 03/17/2023] [Accepted: 05/01/2023] [Indexed: 05/08/2023]
Abstract
Basilar artery aneurysms account for approximately 5% of all intracranial aneurysms. This bibliometric analysis summarizes the most-cited articles on basilar artery aneurysms and highlights the contributing articles to today's evidence-based practice. In the execution of this bibliometric-based review article, the Scopus database was used to perform a title-specific, keyword-based search for all publications until August 2022. The keyword "basilar artery aneurysm" or "basilar aneurysm" was used. Our results were arranged in descending order based on the article's citation count. The 100 most cited articles were selected for analysis. Parameters included the following: title, citation count, citations per year, authors, specialty of first author, institution, country of origin, publishing journal, Source Normalized Impact Per Paper (SNIP), and Hirsch index. The keyword-based search showed that 699 articles were published between 1888 and 2022. The top 100 articles were published between 1961 and 2019. The top 100 most cited articles collected a total of 8869 citations with an average of 89 citations per paper. The rate of self-citations accounted for an average of 4.85% of the total number of citations. The bibliometric analysis provides a quantitative overview of how medical topics and interventions are analyzed in academic medicine. In the present study, we evaluated the global trends in basilar artery aneurysms by finding the top 100 most cited papers.
Collapse
Affiliation(s)
- Catherine Lei
- University of Kansas School of Medicine, Kansas City, KS, USA.
| | - Frank A De Stefano
- Department of Neurological Surgery, University of Kansas Medical Center, Kansas City, KS, USA
| | - Cody Heskett
- University of Kansas School of Medicine, Kansas City, KS, USA
| | - Lane Fry
- University of Kansas School of Medicine, Kansas City, KS, USA
| | - Aaron Brake
- University of Kansas School of Medicine, Kansas City, KS, USA
| | - Kevin Le
- University of Kansas School of Medicine, Kansas City, KS, USA
| | - Jeremy Peterson
- Department of Neurological Surgery, University of Kansas Medical Center, Kansas City, KS, USA
| | - Koji Ebersole
- Department of Neurological Surgery, University of Kansas Medical Center, Kansas City, KS, USA
| |
Collapse
|
5
|
Kloth C, Häckl F. 79-jährige Patientin mit Zufallsbefund der A. basilaris. Dtsch Med Wochenschr 2022; 147:1145-1146. [DOI: 10.1055/a-1843-0603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Affiliation(s)
- Christopher Kloth
- Klinik für Diagnostische und Interventionelle Radiologie, Uniklinikum Ulm
- Praxis für Radiologie und Strahlentherapie, Lindau (Bodensee)
| | - Franz Häckl
- Praxis für Radiologie und Strahlentherapie, Lindau (Bodensee)
| |
Collapse
|
6
|
Tsantili AR, Karampelias V, Samolis A, Chrysikos D, Antonopoulos I, Spanidis Y, Protogerou V, Troupis T. Anatomical variations of human vertebral and basilar arteries: A current review of the literature. Morphologie 2022; 107:169-175. [PMID: 35907771 DOI: 10.1016/j.morpho.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 07/14/2022] [Accepted: 07/15/2022] [Indexed: 11/18/2022]
Abstract
The vertebral artery originates from the subclavian artery and is divided into four segments (V1-V4). In its intracranial segment (V4), the two vertebral arteries join to form the basilar artery, an unpaired medium-sized artery. However, apart from this typical description, several anatomical variations may occur in the human body. Although in some cases such variations may be asymptomatic, they may be also associated with several pathological conditions, neurological complications, surgical complications, and increased risk of developing vascular diseases. Therefore, it is crucial to obtain sufficient information on the anatomy and variants of both arteries to prevent such complications and ensure the safe completion of surgical and radiological treatments. For this reason, we reviewed studies published up to January 2022 concerning the reported variations of the vertebral artery and basilar artery regarding their origin, course, length, and diameter. We believe that the thorough presentation of these variations would help surgeons worldwide during their daily clinical and surgical practice.
Collapse
Affiliation(s)
- A R Tsantili
- Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - V Karampelias
- Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece; School of Medicine, University of Patras, Patras, Greece
| | - A Samolis
- Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - D Chrysikos
- Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - I Antonopoulos
- Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Y Spanidis
- School of Medicine, University of Patras, Patras, Greece
| | - V Protogerou
- Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - T Troupis
- Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
| |
Collapse
|
7
|
Matsuo A, Hiu T, Otsuka H, Miyazaki A, Haraguchi W, Kawahara I, Ono T, Izumo T, Matsuo T, Tsutsumi K. Endovascular treatment of an aneurysm arising from the minor limb of an upper basilar artery fenestration: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2022; 4:CASE22180. [PMID: 36046266 PMCID: PMC9329865 DOI: 10.3171/case22180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 06/15/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND
An aneurysm arising in an upper basilar artery (BA) fenestration is extremely rare. The authors reported a case involving successful endovascular treatment of an aneurysm arising from the minor limb of an upper BA fenestration.
OBSERVATIONS
A 65-year-old woman presented with an incidentally detected upper BA aneurysm arising from the minor limb of an upper BA fenestration. The irregularly shaped aneurysm was 6.0 × 2.7 mm in diameter, and the minor limb had several perforators. The aneurysm was nearly completely occluded with a catheter-assisted technique. The authors preserved both limbs of the BA fenestration. The postoperative course was uneventful, and the patient had an excellent clinical course with no neurological deficits or aneurysmal recanalization.
LESSONS
The case is the first report of an unruptured aneurysm arising at the minor limb of an upper BA fenestration. In this case, the authors preserved the minor limb with endovascular treatment. The authors believe catheter-assisted coil embolization to be a feasible endovascular technique in such cases.
Collapse
Affiliation(s)
- Ayaka Matsuo
- Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan; and
| | - Takeshi Hiu
- Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan; and
| | | | - Atsushi Miyazaki
- Radiology, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | | | | | | | - Tsuyoshi Izumo
- Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan; and
| | - Takayuki Matsuo
- Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan; and
| | | |
Collapse
|
8
|
Sousa JA, Cruz LR, Almendra L, Sargento-Freitas J. Recanalisation of an occluded fenestrated branch of a basilar artery. BMJ Case Rep 2022; 15:e249086. [PMID: 35379685 PMCID: PMC8981357 DOI: 10.1136/bcr-2022-249086] [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] [Accepted: 03/21/2022] [Indexed: 11/03/2022] Open
Affiliation(s)
- João André Sousa
- Neurology, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
| | - Luis Rito Cruz
- Serviço de Imagem Médica, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - Luciano Almendra
- Neurology, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
| | | |
Collapse
|
9
|
Tong X, Dong J, Zhou G, Zhang X, Wang A, Ji Z, Jiao L, Mei Y, Chen D. Hemodynamic effects of size and location of basilar artery fenestrations associated to pathological implications. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2021; 37:e3507. [PMID: 34184422 DOI: 10.1002/cnm.3507] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 06/07/2021] [Accepted: 06/24/2021] [Indexed: 06/13/2023]
Abstract
Fenestration is a rare congenital abnormality that refers to a segmental duplication of arteries. It is still not clear about the role of fenestrations in the etiology and pathological evolution of vascular diseases. This study aims to investigate the hemodynamic influence brought by various sizes and locations of fenestration in basilar artery models. A series presumptive fenestration models were established based on a normal basilar artery model with various sizes and locations. Identical boundary conditions were utilized in the computational fluid dynamics simulations and different flow patterns in the fenestration and bifurcation regions were comprehensively analyzed. Wall shear stress (WSS)-related parameters such as oscillatory shear index (OSI) and aneurysm formation index (AFI) were computed and compared. The value of WSS on fenestration increased by the fenestration's tortuosity, and nearly-circular fenestration suffered higher WSS than narrow-strips one. Also, high OSI and low AFI value mainly occurred in the bifurcation region, indicating a high level of turbulence and high risk of aneurysm formation. The location of fenestration mainly changed the impact force of blood flow on the bifurcation and the disorder characteristics of blood flow, while the size of fenestration changed the WSS distribution on the proximal inner wall and bifurcation region of fenestration. In summary, the nearly-circular fenestration should be stratified carefully which may results in a high risk inducing unfavorable vascular wall remodeling.
Collapse
Affiliation(s)
- Xinyu Tong
- School of Life Science, Beijing Institute of Technology, Beijing, China
| | - Jia Dong
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Department of Interventional Neuroradiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Guojing Zhou
- School of Life Science, Beijing Institute of Technology, Beijing, China
| | - Xuyang Zhang
- School of Life Science, Beijing Institute of Technology, Beijing, China
| | - Ancong Wang
- School of Life Science, Beijing Institute of Technology, Beijing, China
| | - Zhi Ji
- The High School Affiliated to Renmin University of China, Beijing, China
| | - Liqun Jiao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Department of Interventional Neuroradiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yuqian Mei
- School of Life Science, Beijing Institute of Technology, Beijing, China
- Heilongjiang Key Laboratory of Anti-fibrosis Biotherapy, Mudanjiang Medical University, Mudanjiang, China
| | - Duanduan Chen
- School of Life Science, Beijing Institute of Technology, Beijing, China
| |
Collapse
|
10
|
Kheyreddin AS, Kaftanov AN, Yakovlev SB, Eliava SS, Arustamyan SR, Mikeladze KG. [Surgical treatment of vertebral artery confluence aneurysms]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2021; 85:45-52. [PMID: 34156206 DOI: 10.17116/neiro20218503145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Aneurysms of vertebral artery confluence and proximal parts of basilar artery are extremely rare. They are usually combined with proximal fenestration of basilar artery. No timely surgical treatment of these aneurysms is associated with high risk of adverse outcomes, and their treatment is a challenge for neurosurgeons. MATERIAL AND METHODS We analyzed postoperative outcomes in 17 patients with 21 aneurysms of vertebral artery confluence and proximal parts of basilar artery. RESULTS Six patients with 10 aneurysms underwent microsurgical resection, 11 patients with 11 aneurysms - endovascular procedure. Persistent postoperative deterioration was observed in 5 (29.4%) patients: severe neurological symptoms (GOS grade 3) in 1 case (5.9%), minor bulbar disorders in 4 cases (23.53%). There were no lethal outcomes. CONCLUSION According to our own and literature data, aneurysms of vertebral artery confluence are extremely rare. The risk of rupture of these aneurysms is extremely high. Endovascular approach is preferred in these patients. Microsurgical procedure is an acceptable alternative if endovascular surgery is impossible.
Collapse
Affiliation(s)
- A S Kheyreddin
- Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia
| | - A N Kaftanov
- Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia
| | - S B Yakovlev
- Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia
| | - Sh Sh Eliava
- Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia
| | - S R Arustamyan
- Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia
| | - K G Mikeladze
- Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia
| |
Collapse
|
11
|
Small JE, Macey MB, Wakhloo AK, Sehgal S. CTA Evaluation of Basilar Septations: An Entity Better Characterized as Aberrant Basilar Fenestrations. AJNR Am J Neuroradiol 2021; 42:701-707. [PMID: 33602748 DOI: 10.3174/ajnr.a7008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 11/05/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE A basilar artery intraluminal septation is an exceedingly rarely reported, presumed congenital abnormality. In our clinical practice, we have occasionally noticed an intraluminal band within the inferior aspect of the basilar artery on CTA. Furthermore, we have noticed, at times, the presence of a punctate calcification associated with this finding. We hypothesized that what previous studies have called "basilar septations" in fact represent miniature and thus aberrant basilar fenestrations. MATERIALS AND METHODS We retrospectively reviewed CTA studies obtained between January 1, 2017, and August 31, 2019. Identified intraluminal basilar abnormalities were classified as either basilar septations or basilar fenestrations. Association with other posterior circulation abnormalities was documented. RESULTS A total of 3509 studies were examined. A basilar intraluminal abnormality was evident in 80 patients (2.3%). Of these 80 patients, 59 were classified as having a basilar fenestration (1.7%) and 21 were classified as having basilar septations (0.6%). Associated calcification was evident in 3 of the basilar fenestration cases and 13 of the basilar septation cases. CONCLUSIONS Basilar septations most likely represent and should be referred to as aberrant basilar fenestrations. They should be interpreted as benign congenital incidental findings and should not be misinterpreted as focal dissections or arterial webs. Important variations in the morphology of aberrant basilar fenestrations exist, including areas of thinning, varying thickness, and nodularity. Therefore, when associated with calcification or nodularity, aberrant basilar fenestrations should not be confused with focal intraluminal thrombi or calcified or noncalcified emboli.
Collapse
Affiliation(s)
- J E Small
- From the Department of Neuroradiology (J.E.S., M.B.M.)
| | - M B Macey
- From the Department of Neuroradiology (J.E.S., M.B.M.)
| | - A K Wakhloo
- Interventional Interventional Neuroradiology (A.K.W.)
| | - S Sehgal
- Neurology (S.S.), Lahey Hospital and Medical Center, Burlington, Massachusetts
| |
Collapse
|
12
|
Drijkoningen T, van den Wijngaard I, Ghariq E. Ruptured Bilobed Basilar Artery Fenestration Aneurysm Treated with a WEB Device. JOURNAL OF NEUROENDOVASCULAR THERAPY 2021; 15:695-699. [PMID: 37502374 PMCID: PMC10370566 DOI: 10.5797/jnet.tn.2020-0182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 01/05/2021] [Indexed: 07/29/2023]
Abstract
Objective To describe the technique of using a Woven Endo Bridge (WEB) device to treat a ruptured bilobed blister-like aneurysm (BLA) at the basilar artery (BA) fenestration. Case Presentation A previously healthy 66-year-old female presented at the emergency room with subarachnoid hemorrhage (SAH), centered around the brainstem. Unenhanced CT and CT angiography showed a BLA of a basilar fenestration limb. The angiogram confirmed the diagnosis. A WEB device was chosen to treat this rare and challenging aneurysm. Conclusion In this article, we describe the successful endovascular treatment of a SAH patient with a ruptured BLA at the basilar artery fenestration using a WEB device. And an overview of treatment options is provided.
Collapse
Affiliation(s)
- Tessa Drijkoningen
- Radiology Department, Haaglanden Medisch Centrum, Den Haag, The Netherlands
| | | | - Elyas Ghariq
- Radiology Department, Haaglanden Medisch Centrum, Den Haag, The Netherlands
| |
Collapse
|
13
|
Kawano A, Masutani S, Inui A, Honma H, Igarashi T, Tsuneoka H, Sakamoto W, Sakurai Y, Dembo T, Imanaka K. Basilar Artery Dissection Complicated with Infective Endocarditis. Int Heart J 2021; 62:216-219. [PMID: 33455990 DOI: 10.1536/ihj.20-474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A 14 year-old boy developed infective endocarditis of the mitral valve caused by Methicillin-sensitive Staphylococcus aureus and became comatose. Isolated basilar artery dissection was initially observed on the 3rd day by magnetic resonance imaging (MRI), ie, it did not exist on day 1. He underwent successful urgent mitral valve repair on the 5th day because of highly mobile vegetations and a newly emerged brain infarction under optimal antibiotic administration. Postoperatively, he recovered well and the basilar artery dissection was found to have recovered on an MRI on the 25th day without any specific intervention. This clinical course indicated that intracranial artery dissection may occur as a complication of infective endocarditis and supports the importance of the careful evaluation of brain MRI in patients with infective endocarditis.
Collapse
Affiliation(s)
- Akiko Kawano
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University
| | - Satoshi Masutani
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University
| | - Akitoshi Inui
- Department of Cardiovascular Surgery, Saitama Medical Center, Saitama Medical University
| | | | | | | | - Wataru Sakamoto
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University
| | - Yoshio Sakurai
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University
| | - Tomohisa Dembo
- Department of Neurology, Saitama Medical Center, Saitama Medical University
| | - Kazuhito Imanaka
- Department of Cardiovascular Surgery, Saitama Medical Center, Saitama Medical University
| |
Collapse
|
14
|
Schmidt RF, Sweid A, Chalouhi N, Avery MB, Sajja KC, Al-Saiegh F, Weinberg JH, Asada A, Joffe D, Zarzour HK, Gooch MR, Rosenwasser RH, Jabbour PM, Tjoumakaris SI. Endovascular Management of Complex Fenestration-Associated Aneurysms: A Single-Institution Retrospective Study and Review of Existing Techniques. World Neurosurg 2020; 146:e607-e617. [PMID: 33130285 DOI: 10.1016/j.wneu.2020.10.131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 10/24/2020] [Accepted: 10/26/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND Aneurysms associated with fenestrations of intracranial arteries are exceptionally rare findings. Management strategies for these aneurysms are not well-defined, especially regarding endovascular treatment. We sought to investigate the strategies and feasibility of endovascular treatment approaches for various fenestration-associated intracranial aneurysms. METHODS We performed a retrospective chart review of 2000 aneurysms treated endovascularly, identifying 8 aneurysms located at arterial fenestrations. The technical details and procedural outcomes were reviewed to identify common management approaches, technical nuances, and treatment outcomes. RESULTS There were 3 (37.5%) aneurysms associated with fenestrations of the basilar artery or vertebrobasilar junction. All 3 were successfully treated with a previously undescribed coil-assisted flow-diversion technique, resulting in complete obliteration. Three (37.5%) aneurysms were associated with fenestrations of the anterior communicating artery. Of those, 2 were successfully treated with stent-assisted coil embolization and 1 with coil embolization alone. One (12.5%) aneurysm was associated with a fenestration of the paraclinoid internal carotid artery and 1 (12.5%) aneurysm found was at the takeoff of the posterior inferior cerebellar artery at a fenestration of the vertebral artery. Both were successfully treated with coil-assisted flow diversion. There were no permanent procedural complications. Major considerations for endovascular management of these aneurysms were the dominance of fenestration trunks, aneurysms arising from the fenestration apex or a fenestration limb, amenability to flow diversion, and anticipation of vascular remodeling. CONCLUSIONS Fenestration-associated aneurysms are very rare. We have identified common factors to help guide decision-making for endovascular approaches and demonstrate successful aneurysm treatment using these methods.
Collapse
Affiliation(s)
- Richard F Schmidt
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
| | - Ahmad Sweid
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Nohra Chalouhi
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Michael B Avery
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Kalyan C Sajja
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Fadi Al-Saiegh
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Joshua H Weinberg
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Ashlee Asada
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Daniel Joffe
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Hekmat K Zarzour
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - M Reid Gooch
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Robert H Rosenwasser
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Pascal M Jabbour
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | |
Collapse
|
15
|
Liu H, Hong J, Wang S, Wei L. Anterior communicating artery complex fenestration combined with tandem aneurysm: a case report and literature review. Medicine (Baltimore) 2020; 99:e20013. [PMID: 32384459 PMCID: PMC7220171 DOI: 10.1097/md.0000000000020013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Clinically, anterior communicating artery complex fenestration combined with fenestration-related aneurysms is rare, and combination of this condition with tandem aneurysms is even rarer. PATIENT CONCERNS A case of a 43-year-old man with spontaneous subarachnoid hemorrhage. DIAGNOSIS A computed tomography angiography examination revealed a fenestrated anterior communicating artery complex combined with 2 aneurysms. Then, a digital subtraction angiography examination was performed to further determine the diagnosis, which showed a complex anatomical structure of the local tissue. After the aneurysms ruptured, they were partially wrapped by a hematoma and compressed, which increased the difficulty of surgery. INTERVENTIONS An endovascular interventional therapy method was chosen, and a simple coil was successfully inserted through the blood vessel into the tandem aneurysms to maintain the integrity of the anatomical structure. OUTCOMES The patient recovered well postoperatively. An imaging review after the operation did not show the aneurysms, and the upper and lower branches were patent. CONCLUSION Therefore, endovascular treatment is an appropriate choice for arterial fenestration combined with tandem aneurysms, once the aneurysms have ruptured.
Collapse
Affiliation(s)
- Haibing Liu
- Department of Neurosurgery, Fuzong Clinical Medical College of Fujian Medical University, 900th Hospital
| | - Jingfang Hong
- Department of Neurosurgery, 900th Hospital, Dongfang Hospital, Xiamen University, Fuzhou, P.R. China
| | - Shousen Wang
- Department of Neurosurgery, Fuzong Clinical Medical College of Fujian Medical University, 900th Hospital
| | - Liangfeng Wei
- Department of Neurosurgery, Fuzong Clinical Medical College of Fujian Medical University, 900th Hospital
| |
Collapse
|
16
|
Wang F, Wang X, Li X, Zheng H, Zhang Z. A case of multiple Vertebrobasilar artery fenestration misdiagnosed as vertebral artery dissection. BMC Neurol 2020; 20:63. [PMID: 32079531 PMCID: PMC7033924 DOI: 10.1186/s12883-020-01642-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 02/12/2020] [Indexed: 11/10/2022] Open
Abstract
Background Fenestration of vertebra-basilar artery is an uncommon congenital vascular anomaly, which is identified by incidental findings on imaging in patients presented without related symptoms or in patients with intracerebral hemorrhage secondary to concomitant artery aneurysm or arteriovenous malformations. Yet, cases of fenestration being misdiagnosed as cerebral artery dissection have never been reported. Case presentation We present a patient of 66-year-old female with acute onset of dizziness after chiropractic manipulation of the neck. Neck computed tomography angiography (CTA) showed ‘double lumen’ sign and ‘intimal flap’ of the V1 segment of the vertebral artery, which led to the initial diagnosis of vertebral artery dissection (VAD). However, vertebral artery fenestration at V1 segment was eventually identified by multi-directional digital subtraction angiography (DSA). Interestingly, concomitant vertebral fenestration at V3 segment, basilar fenestration and basilar artery tip aneurysm was also revealed by DSA. Conclusion The triple fenestration at vertebrobasilar artery with basilar tip artery aneurysm is extremely rare, and the fenestration at the V1 segment of vertebral artery was easily misdiagnosed as VAD due to the similar imaging morphology.
Collapse
Affiliation(s)
- Feng Wang
- Department of Neurology, Seventh People's Hospital of Shanghai, University of Traditional Chinese Medicine, Shanghai, China
| | - Xiaokai Wang
- Department of Neurology, She Country Hospital, Hebei, China
| | - Xiaohua Li
- Department of Neurology, She Country Hospital, Hebei, China
| | - Huifeng Zheng
- Department of Neurology, She Country Hospital, Hebei, China
| | - Zhiyong Zhang
- Department of Neurology, China-Japan Friendship Hospital, Beijing, China.
| |
Collapse
|
17
|
Abstract
RATIONALE Fenestration of the basilar artery is most common in the proximal portion near the vertebrobasilar artery junction. Conversely, fenestration of the middle and distal portions of the basilar artery is not common, and fenestration of the basilar artery with an aneurysm is even less common. PATIENT CONCERNS This study reports the case of a 37-year-old woman with basilar artery fenestration malformation and an aneurysm at the mid-distal junction; her symptoms included sudden headaches with nausea and vomiting. DIAGNOSES Head digital subtraction angiography showed fenestration at the junction of the middle and upper portions of the basilar artery associated with an aneurysm, and spontaneous pseudoaneurysm formation could not be excluded. INTERVENTIONS The patient underwent stent-assisted fenestration and channel occlusion. OUTCOMES Five months later, no abnormalities were found by head magnetic resonance imaging. The stents were well positioned, and no occluded branches or aneurysms were present. LESSONS For mid-distal basilar artery fenestration malformation with an aneurysm, occlusion of the lesion channel is relatively safe when there are no perforating vessels in the fenestration channel and the lesion channel is a nondominant channel. Overall, more attention should be paid to the possibility of pseudoaneurysm formation in the diagnosis and treatment of this type of aneurysm.
Collapse
|
18
|
Liu L, Zhang XB, Lu S, Liu ZJ, Zhu XJ. Plaque Distribution of Basilar Artery Fenestration by 3D High-Resolution MR Vessel Wall Imaging. Cell Transplant 2019; 28:851-855. [PMID: 30983405 PMCID: PMC6719492 DOI: 10.1177/0963689719843813] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
The association between fenestrations and neurovascular pathology is not well defined. The morphology of vessel wall plays an important role in the development of neurovascular pathology. We sought to explore the plaque distribution around basilar artery fenestration (BAF) by three-dimensional high-resolution MR vessel wall imaging (3D HRMRI). Patients with BAF on 3D HRMRI images were enrolled. All cross-sectional slices of basilar arteries were assessed and categorized based on the location of fenestration as proximal segment, in-bifurcation segment, and distal segment. Furthermore, plaques in the in-bifurcation segment were classified according to their orientation being centered on the lateral, interior, dorsal, or ventral wall of the vessel. In all, 12 cases with BAF involving 661 cross-sectional image slices in entire basilar arteries were included. Plaques were found in 190 image slices, with the distribution of 41 slices in the proximal segment, 144 slices in the in-bifurcation segment and 67 slices in the distal segment. Plaques were found more frequently in the proximal and in-bifurcation segments than in the distal segment (P < 0.001), but there was no statistical difference between the proximal and in-bifurcation segment (P = 0.11). In the in-bifurcation segment, plaques were more frequently located at the lateral (50.0%) than other interior (16.0%), dorsal (21.0%), and ventral (13.0%) wall (P < 0.001).Plaques of BAF tend to locate in the proximal and in-bifurcation segments, especially at the lateral wall of the in-bifurcation segment.
Collapse
Affiliation(s)
- Lei Liu
- 1 Department of Neurology, China-Japan Friendship Hospital, Beijing, China
| | - Xue-Bin Zhang
- 2 Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| | - Shuo Lu
- 1 Department of Neurology, China-Japan Friendship Hospital, Beijing, China
| | - Zun-Jing Liu
- 1 Department of Neurology, China-Japan Friendship Hospital, Beijing, China
| | - Xian-Jin Zhu
- 2 Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| |
Collapse
|
19
|
Kalamatianos T, Mavridis IN, Karakosta E, Drosos E, Skandalakis GP, Kalyvas A, Piagkou M, Koutsarnakis C, Stranjalis G. The Parieto-Occipital Artery Revisited: A Microsurgical Anatomic Study. World Neurosurg 2019; 126:e1130-e1139. [PMID: 30880193 DOI: 10.1016/j.wneu.2019.02.215] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 02/23/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND The parieto-occipital artery (PoA) is the terminal posterior cerebral artery branch, which typically runs in the parieto-occipital sulcus. Previous studies have highlighted variation in the PoA origin and branching pattern and their clinical implications. Nevertheless, PoA anastomoses have not been systematically investigated. The present study aimed to assess whether putative variation in PoA origin and its branching as well as anastomotic pattern is associated with differences in demographic/anthropometric variables. METHODS In 15 cadaveric heads, PoA anatomic features were quantified and assessed in relation to demographic/anthropometric variables. RESULTS The mean distance of PoA origin from the posterior limit of the splenium and the occipital pole (OP) is 3.1 and 53.1 mm, respectively. The latter is significantly longer in taller individuals. The PoA supplies a mean of 10.5 and 9.1 branches to the precuneus and cuneus, respectively. PoA anastomoses primarily involve the precuneal artery complex (PAc) and the calcarine artery. The analysis indicated significant, positive correlations between the distance of PoA origin from the OP and the number of PoA anastomoses and between the number of PoA precuneal and cuneal branches. CONCLUSIONS Although the PoA invariably supplies the precuneus and almost always the cuneus, its direct contribution to the former seems inferior to PAc. Nevertheless, the PoA frequently shows putative collateral supply networks to the precuneus and cuneus via anastomoses with the PAc and calcarine artery, respectively. The distance between PoA origin and OP varies with an individual's height; the frequency of intrahemispheric PoA anastomoses varies with its site of origin.
Collapse
Affiliation(s)
- Theodosis Kalamatianos
- Athens Microneurosurgery Laboratory, Department of Neurosurgery, Evangelismos Hospital, Athens, Greece.
| | - Ioannis N Mavridis
- Athens Microneurosurgery Laboratory, Department of Neurosurgery, Evangelismos Hospital, Athens, Greece
| | - Eleni Karakosta
- Athens Microneurosurgery Laboratory, Department of Neurosurgery, Evangelismos Hospital, Athens, Greece
| | - Evangelos Drosos
- Athens Microneurosurgery Laboratory, Department of Neurosurgery, Evangelismos Hospital, Athens, Greece
| | - Georgios P Skandalakis
- Athens Microneurosurgery Laboratory, Department of Neurosurgery, Evangelismos Hospital, Athens, Greece
| | - Aristotelis Kalyvas
- Athens Microneurosurgery Laboratory, Department of Neurosurgery, Evangelismos Hospital, Athens, Greece
| | - Maria Piagkou
- Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Christos Koutsarnakis
- Athens Microneurosurgery Laboratory, Department of Neurosurgery, Evangelismos Hospital, Athens, Greece
| | - George Stranjalis
- Athens Microneurosurgery Laboratory, Department of Neurosurgery, Evangelismos Hospital, Athens, Greece
| |
Collapse
|
20
|
Meinel TR, Pult F, Gralla J, Arnold M, Bassetti C, Jung S. Successful endovascular recanalization of a partially occluded basilar artery fenestration. Interv Neuroradiol 2018; 25:44-46. [PMID: 30092730 DOI: 10.1177/1591019918793340] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A 76-year-old man with a history of arterial hypertension, obstructive sleep apnea, dyslipidemia, family history of cardiovascular events, prestroke and overweight presented 90 minutes after acute onset of right-sided sensorimotor hemiparesis, hemiataxia and dysarthria (National Institutes of Health Stroke Scale (NIHSS) 9/42). Magnetic resonance imaging (MRI) revealed a pontine ischemia and MR angiography showed a thrombus in the middle to distal portion of the basilar artery. Owing to the location, an occlusion of one lumen of a fenestrated basilar artery was suspected. Fearing the risk of peripheral dislocation, intravenous thrombolysis was withheld after an interdisciplinary discussion and direct endovascular thrombectomy (Solitaire stent retriever) was successfully performed by passing the stent retriever specifically through the affected lumen and between the thrombus and the vascular wall, which would normally be avoided. Angiography after complete reperfusion (Thrombolysis in Cerebral Infarction grade 3) confirmed a fenestration in the middle to distal portion of the basilar artery where the thrombus was initially located (blue and green arrow). Follow-up MRI after 24 hours showed only minimal ischemic damage in the left pontine area, and the patient was discharged home with ambulatory physiotherapy for residual minimal gait disturbance (NIHSS 0).
Collapse
Affiliation(s)
- Thomas Raphael Meinel
- 1 Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Frauke Pult
- 2 University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jan Gralla
- 2 University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marcel Arnold
- 1 Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Claudio Bassetti
- 1 Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Simon Jung
- 1 Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| |
Collapse
|
21
|
Guo X, Gao L, Shi Z, Liu D, Wang Y, Sun Z, Chen Y, Chen W, Yang Y. Intracranial Arterial Fenestration and Risk of Aneurysm: A Systematic Review and Meta-Analysis. World Neurosurg 2018; 115:e592-e598. [PMID: 29702312 DOI: 10.1016/j.wneu.2018.04.106] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 04/14/2018] [Accepted: 04/16/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Previous studies have been inconsistent regarding risk for intracranial aneurysm related to intracranial arterial fenestration. We conducted a meta-analysis to examine the association between intracranial arterial fenestration and risk of aneurysm. METHODS We performed a systematic review of PubMed and Embase through August 2017 for potentially relevant articles. Summary odds ratios with 95% confidence intervals were pooled using a random-effects model. RESULTS Of 446 articles found, 7 were selected for meta-analysis. Pooled odds ratios revealed an increased risk of aneurysm owing to fenestration of 1.50 (95% confidence interval, 0.61-3.71; P = 0.38). Subgroup analyses based on the population presenting with various indications suggested that pooled odds ratios indicated a significant increase in risk for aneurysm of 2.43 (95% confidence interval, 1.04-5.69; P = 0.04). CONCLUSIONS Our findings indicate that intracranial arterial fenestration may be associated with increased risk for aneurysm formation.
Collapse
Affiliation(s)
- Xiang Guo
- Department of Medical Imaging, the Affiliated Hospital of Jining Medical University, Jining, China
| | - Lingyun Gao
- Department of Medical Imaging, the Affiliated Hospital of Jining Medical University, Jining, China
| | - Zhitao Shi
- Department of Medical Imaging, the Affiliated Hospital of Jining Medical University, Jining, China
| | - Deguo Liu
- Department of Medical Imaging, the Affiliated Hospital of Jining Medical University, Jining, China
| | - Yuhong Wang
- Department of Medical Imaging, the Affiliated Hospital of Jining Medical University, Jining, China
| | - Zhanguo Sun
- Department of Medical Imaging, the Affiliated Hospital of Jining Medical University, Jining, China
| | - Yueqin Chen
- Department of Medical Imaging, the Affiliated Hospital of Jining Medical University, Jining, China.
| | - Weijian Chen
- Department of Medical Imaging, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yunjun Yang
- Department of Medical Imaging, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| |
Collapse
|
22
|
O'Hare M, Hoxworth J, O'Carroll C. Fenestration of the Basilar Artery With Associated Aneurysm-A Case Report. Headache 2016; 56:1671-1672. [DOI: 10.1111/head.12972] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 06/14/2016] [Accepted: 07/19/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Meabh O'Hare
- Department of Neurology; Stanford CA USA
- Department of Neurology; Mayo Clinic; Scottsdale AZ USA
| | | | | |
Collapse
|
23
|
Montagnese F, Granata F, Musumeci O, Rodolico C, Mondello S, Barca E, Cucinotta M, Ciranni A, Longo M, Toscano A. Intracranial arterial abnormalities in patients with late onset Pompe disease (LOPD). J Inherit Metab Dis 2016; 39:391-398. [PMID: 26830551 DOI: 10.1007/s10545-015-9913-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 12/22/2015] [Accepted: 12/23/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND OBJECTIVES Pompe disease is a rare metabolic disorder due to lysosomal alpha-glucosidase (GAA) deficiency. It is considered as a multi-systemic disease since, although glycogen accumulation is largely prominent in heart, skeletal and respiratory muscles, other organs can also be affected. As regards the vascular system, few reports have documented cerebrovascular malformations in Pompe patients. The aim of this study was to define the presence and type of intracranial arterial abnormalities in a cohort of late onset Pompe disease (LOPD) patients. METHODS We have studied 21 LOPD patients with cerebral CT angiography (CTA), using maximum intensity projection and volume rendering technique for 3D-image reconstruction. RESULTS We found intracranial arterial abnormalities in 13/21 patients (62 %), of whom: 2/21 patients (9.5 %) showed an unruptured intracranial aneurysm (respectively 2 and 4 mm), 10/21 (47 %) had a vertebrobasilar dolichoectasia (VBD) and 1/21 a basilar artery fenestration. Signs of lacunar encephalopathy (insular, capsular and frontal subcortical lesions) were detected in 13/21 patients (62 %) and this correlated with the presence of respiratory impairment (p = 0.017). CONCLUSIONS These findings differ from what has been previously observed in healthy, aged-matched populations and confirm that cerebral arteries abnormalities, mainly involving the posterior circle, are not so rare in LOPD patients and are often accompanied by a lacunar encephalopathy that might represent a hypoxic-ischemic origin. A CTA or an MRA is recommended, in LOPD patients, for early detection of cerebrovascular malformations as they could lead to life-threatening events such as sub-arachnoid haemorrhage or brainstem compression.
Collapse
Affiliation(s)
- Federica Montagnese
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
| | - Francesca Granata
- Department of Radiological Sciences, University of Messina, Messina, Italy
| | - Olimpia Musumeci
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Carmelo Rodolico
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Stefania Mondello
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Emanuele Barca
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Maria Cucinotta
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Anna Ciranni
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Marcello Longo
- Department of Radiological Sciences, University of Messina, Messina, Italy
| | - Antonio Toscano
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| |
Collapse
|
24
|
Park WB, Sung JH, Huh J, Cho CB, Yang SH, Kim IS, Hong JT, Lee SW. Double Stent Assist Coiling of Ruptured Large Saccular Aneurysm in Proximal Basilar Artery Fenestration. J Cerebrovasc Endovasc Neurosurg 2015; 17:227-33. [PMID: 26523257 PMCID: PMC4626347 DOI: 10.7461/jcen.2015.17.3.227] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 08/24/2015] [Accepted: 09/10/2015] [Indexed: 11/23/2022] Open
Abstract
Basilar artery fenestration is infrequent and even rarer in association with a large aneurysm. With proximity to brain stem and vital perforators, endovascular coiling can be considered first. If the large ruptured aneurysm with a wide neck originated from fenestra of the proximal basilar artery and the fenestration loop has branches of posterior circulation, therapeutic consideration should be thorough and fractionized. We report endovascular therapeutic details for a case of a ruptured large saccular aneurysm in proximal basilar artery fenestration.
Collapse
Affiliation(s)
- Woong Bae Park
- Cerebrovascular center, Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
| | - Jae Hoon Sung
- Cerebrovascular center, Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
| | - Joon Huh
- Cerebrovascular center, Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
| | - Chul Bum Cho
- Cerebrovascular center, Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
| | - Seung Ho Yang
- Cerebrovascular center, Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
| | - Il Sup Kim
- Cerebrovascular center, Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
| | - Jae Taek Hong
- Cerebrovascular center, Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
| | - Sang Won Lee
- Cerebrovascular center, Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
| |
Collapse
|
25
|
Toth G, Hui F, Bain M. Fenestra Obscura: Flow Diverter Reconstruction of a Complex Vertebrobasilar Aneurysm Through an Obscured Fenestration Limb: Technical Case Report. Oper Neurosurg (Hagerstown) 2015; 12:E95-E100. [DOI: 10.1227/neu.0000000000000996] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Accepted: 07/20/2015] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND AND IMPORTANCE
Basilar fenestration aneurysms are rare, challenging intracranial vascular lesions with atypical anatomy. The posterior circulation represents a difficult therapeutic dilemma because of the close proximity of crucial life-sustaining brainstem structures. The use of flow diverter technology has been very limited in posterior circulation vessels.
CLINICAL PRESENTATION
We present the case of a 49-year-old female patient, who was diagnosed with a symptomatic large vertebrobasilar junction aneurysm, which was initially thought to be a proximal basilar dilatation. The aneurysm was later verified to arise from the proximal end of a basilar fenestration, distended by the aneurysm fundus. The small-caliber fenestration limbs were the only connection to the distal basilar artery, but were stretched laterally and concealed by the aneurysm fundus. This complex lesion was successfully treated by flow diverter deployment through one of the fenestration limbs, followed by coiling of the aneurysm fundus, and sacrificing the contralateral vertebral artery. A 6-month follow-up angiogram showed remodeling of the basilar artery and complete occlusion of the aneurysm with good clinical outcome. Careful diagnostic workup, multidisciplinary discussions, and the innovative use of versatile endovascular technology were crucial to achieve an optimal result in this case.
CONCLUSION
This is the first report of a successful basilar artery reconstruction for the treatment of a large atypical vertebrobasilar junction fenestration aneurysm by deployment of a flow diverter device directly in a small, obscured fenestration limb.
Collapse
Affiliation(s)
- Gabor Toth
- Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio
| | - Ferdinand Hui
- Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio
| | - Mark Bain
- Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio
| |
Collapse
|
26
|
van Rooij SBT, Bechan RS, Peluso JP, Sluzewski M, van Rooij WJ. Fenestrations of intracranial arteries. AJNR Am J Neuroradiol 2015; 36:1167-70. [PMID: 25655871 DOI: 10.3174/ajnr.a4236] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 12/01/2014] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Few data are available on the frequency and location distribution of fenestrations of intracranial arteries. We used 3D rotational angiography of all intracranial arteries in a cohort of 179 patients with suspected intracranial aneurysms to assess the prevalence and location of fenestrations and the relation of fenestrations to aneurysms. MATERIALS AND METHODS Of 179 patients with subarachnoid hemorrhage admitted between March 2013 and June 2014, 140 had 3D rotational angiography of all cerebral vessels. The presence and location of aneurysms and fenestrations were assessed. In patients with both aneurysms and fenestrations, we classified the relation of the location of the aneurysm as remote from the fenestration or on the fenestration. RESULTS In 140 patients, 210 aneurysms were present. In 33 of 140 patients (24%; 95% confidence interval, 17.2%-31.3%), 45 fenestrations were detected with the following locations: anterior communicating artery in 31 (69%), A1 segment of the anterior cerebral artery in 4 (9%), middle cerebral artery in 4 (9%), basilar artery in 4 (9%), vertebral artery in 1 (2%), and anterior inferior cerebellar artery in 1 (2%). Of 56 patients with anterior communicating artery aneurysms, 14 had a fenestration on the anterior communicating artery complex. The remaining 31 fenestrations had no anatomic relation to aneurysms. In 140 patients with 210 aneurysms, 14 aneurysms (7%) were located on a fenestration and 196 were not. CONCLUSIONS In patients with a suspected ruptured aneurysm, fenestrations of intracranial arteries were detected in 24% (33 of 140). Most fenestrations were located on the anterior communicating artery. Of 45 fenestrations, 14 (31%) were related to an aneurysm.
Collapse
Affiliation(s)
- S B T van Rooij
- From the Department of Radiology (S.B.T.v.R.), Medisch Centrum Alkmaar, Alkmaar, the Netherlands
| | - R S Bechan
- Department of Radiology (R.S.B., J.P.P., M.S., W.J.v.R.), St. Elisabeth Ziekenhuis, Tilburg, the Netherlands
| | - J P Peluso
- Department of Radiology (R.S.B., J.P.P., M.S., W.J.v.R.), St. Elisabeth Ziekenhuis, Tilburg, the Netherlands
| | - M Sluzewski
- Department of Radiology (R.S.B., J.P.P., M.S., W.J.v.R.), St. Elisabeth Ziekenhuis, Tilburg, the Netherlands
| | - W J van Rooij
- Department of Radiology (R.S.B., J.P.P., M.S., W.J.v.R.), St. Elisabeth Ziekenhuis, Tilburg, the Netherlands.
| |
Collapse
|
27
|
Lee H, Yang K, Choi IJ, Lee JH. The ileocolic vein passing through the ring-shaped part of ileocolic artery. Surg Radiol Anat 2014; 37:1005-7. [DOI: 10.1007/s00276-014-1408-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 12/17/2014] [Indexed: 11/24/2022]
|