Postoperative brachial artery entrapment associated with pediatric supracondylar fracture of the humerus: a case report

Secondary Benefits of Microsurgical Intervention on the Vertebral Artery (V1 Segment) for Refractory Vertebrobasilar Insufficiency: Alleviation of Parkinsonism-Like Symptoms

OBJECTIVE

The objective of this study was to investigate the outcomes of microneurosurgical interventions on V1 segment of the vertebral artery in patients with refractory vertebrobasilar insufficiency (VBI) due to dolicoarteriopathy and external compressions and to assess the secondary benefits of Parkinsonism-like symptoms.

METHODS

Retrospective analysis encompassed 101 patients treated for vertebral artery dolicoarteriopathy or compression-related refractory VBI from 2016 to 2023. Of these, 16 patients exhibited drug-resistant Parkinsonism-like symptoms. The diagnostic evaluation included cerebral computed tomography/magnetic resonance angiography or digital subtraction angiography and brain computed tomography or magnetic resonance perfusion studies, corroborated by preoperative and 6- and 12-month postoperative Movement Disorder Society-Unified Parkinson's Disease Rating Scale Part 3 assessments. Data were analyzed through Turkey's "E-nabız" system, employing Stata16 for statistical scrutiny.

RESULTS

A significant reduction in Movement Disorder Society-Unified Parkinson's Disease Rating Scale scores was observed (preoperative: 26.75±10.91; 6 months: 23.09±9.24; 12 months: 22.5±8.73; P < 0.001). Postoperative follow-up denoted that 43.7% of patients ceased medication and 50% reduced antiparkinsonian drugs. The microneurosurgical approach resulted in complete remission of VBI-related symptoms in 84.6% of patients, with the rest showing partial or marked improvement. At 6 months postoperation, perfusion studies revealed posterior border zone or cerebellar perfusion enhancements in 81% (13 out of 16) of patients, with full symptom resolution, while the remaining 19% (3 out of 16) showed partial perfusion and clinical improvements, particularly in regions supplied by the posterior cerebellar artery or posterior inferior cerebellar artery. The absence of operative mortality and minimal transient morbidities underscored the procedure's safety.

CONCLUSIONS

Microneurosurgery for vertebral artery anomalies in refractory VBI patients, particularly those with concomitant parkinsonian-like syndromes, has demonstrated potential in symptom remission and medication reduction.

Anomalous Brachial Artery Bifurcations Can Be at Increased Risk for Entrapment in Pediatric Supracondylar Humerus Fractures, but Do Not Alter Practice Guidelines

Limb-threatening events arising subsequent to fixation of pediatric supracondylar humerus (SCH) fractures are infrequent. We experienced an untoward pulseless hand in a 9-year-old boy subsequent to reduction and fixation of a SCH fracture with unremarkable preoperative neurovascular examination. A dilemma persists in consideration of parameters to assess limb perfusion from an array of investigations. Recently, clinical practice guidelines in the management of pediatric SCH have been established based on appropriate use criteria and in compliance, we undertook vascular exploration. We observed a variant of high brachial artery bifurcation entrapped in the fracture site. The injuries were appropriately managed without complications and had excellent outcomes in a follow-up period of 11 months. This index case report of a preexisting brachial artery bifurcation variant associating a limb-threatening event in postoperative period also highlights the effective utility of the current practice guidelines in management of pediatric SCH fractures.