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Raygor KP, Caton MT, Tonetti DA, Baker A, Dubnicoff TB, Abla AA. Staged stent-assisted, transcirculatory coiling of partially-thrombosed, mixed saccular and fusiform SCA aneurysm. Interv Neuroradiol 2024; 30:126. [PMID: 35850562 PMCID: PMC10956447 DOI: 10.1177/15910199221108312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/11/2022] [Accepted: 05/27/2022] [Indexed: 11/17/2022] Open
Abstract
SCA aneurysms are rare, making data on their management sparse compared to other posterior circulation aneurysms. While saccular aneurysms at the SCA origin can be treated with primary coiling or surgical clipping, fusiform and distal SCA aneurysms often require endovascular techniques such as stent-assisted coil embolization or parent vessel occlusion. We present a case of a mixed saccular/fusiform SCA aneurysm that underwent staged stent-assisted coil embolization. A right SCA stent was placed in the first stage. Given the acute angle between the BA and the SCA, microcatheter access and stent placement proved challenging. The decision was made to allow the stent to endothelialize and return in a staged fashion to perform a trans-radial, transcirculatory (trans-left PCoA, trans-left PCA) coil embolization. This provided a straight course between the left P1 segment and the right SCA origin, allowing easy microcatheter navigation through the stent and into the aneurysm for coil embolization.
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Affiliation(s)
- Kunal P Raygor
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - M Travis Caton
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Daniel A Tonetti
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Amanda Baker
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Todd B Dubnicoff
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Adib A Abla
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
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Raygor KP, Caton MT, Tonetti DA, Dubnicoff TB, Abla AA. Intermediate-porosity stent for coil-reconstruction of mixed saccular-fusiform basilar trunk aneurysm. Interv Neuroradiol 2024; 30:127. [PMID: 35916413 PMCID: PMC10956458 DOI: 10.1177/15910199221113643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 06/16/2022] [Accepted: 06/27/2022] [Indexed: 11/17/2022] Open
Abstract
Vertebrobasilar junction and basilar trunk aneurysms are extremely difficult to treat, with significant morbidity associated with bypass-trapping procedures. As a result, endovascular techniques including flow diversion and stent-assisted coil embolization have become the mainstay of treatment.1-3 Traditional flow diverters pose risk of occlusion of basilar perforator arteries while traditional stents used as adjuncts for coil-embolization often have high porosity and cannot function as flow diverters. On the other hand, the LVIS stent uniquely provides more porosity than other flow diverters,4,5 allowing patency of perforators while also being amenable to stent-assisted coiling. We present a case of a mixed saccular and fusiform basilar trunk aneurysm that underwent LVIS stent-assisted coil embolization. Using bifemoral access with triaxial systems, one microcatheter was placed in the aneurysm sac and another was used to deploy a stent from the basilar apex into the right vertebral artery. A durable angiographic outcome was observed at 9 months.
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Affiliation(s)
- Kunal P Raygor
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - M Travis Caton
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Daniel A Tonetti
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Todd B Dubnicoff
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Adib A Abla
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
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Rinaldo L, Wilkinson S, Dubnicoff TB, Rubio RR, Abla AA. Transpeduncular Approach for Resection of Ruptured Fourth Ventricular Arteriovenous Malformation. World Neurosurg 2023; 180:69. [PMID: 37714456 DOI: 10.1016/j.wneu.2023.09.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 09/05/2023] [Accepted: 09/07/2023] [Indexed: 09/17/2023]
Abstract
The lateral recess of the fourth ventricle can be challenging to access surgically. We present a case of a previously ruptured arteriovenous malformation (AVM) of the fourth ventricle that was surgically resected via a retrosigmoid craniotomy and transinferior cerebellar peduncular approach. The patient is a 54-year-old female who experienced an intraventricular hemorrhage several months before presentation to our institution. Imaging studies suggested the presence of an AVM located in the right lateral recess of the fourth ventricle. After discussion of all possible treatment options, the patient elected to proceed with surgical resection. To access the lesion, we performed a retrosigmoid craniotomy and entered into the fourth ventricle via s small incision in the inferior cerebellar peduncle. Postoperative imaging demonstrated complete removal of the AVM nidus. Video 1 demonstrates this approach and discusses the anatomic landmarks used to guide resection.
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Affiliation(s)
- Lorenzo Rinaldo
- Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA; Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Sean Wilkinson
- Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA
| | - Todd B Dubnicoff
- Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA
| | - Roberto Rodriguez Rubio
- Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA; Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California, USA; Department of Otolaryngology - Head and Neck Surgery, University of California, San Francisco, California, USA
| | - Adib A Abla
- Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA.
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Raygor KP, Rinaldo L, Dubnicoff TB, Shih T, Chang EF, Abla AA. Awake Craniotomy and Electrocorticography-Guided Extended Lesionectomy of Motor Cortex Cavernoma: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2023; 25:e286. [PMID: 37441797 DOI: 10.1227/ons.0000000000000837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 05/19/2023] [Indexed: 07/15/2023] Open
Affiliation(s)
- Kunal P Raygor
- Department of Neurological Surgery, University of California, San Francisco, California, USA
| | - Lorenzo Rinaldo
- Department of Neurological Surgery, University of California, San Francisco, California, USA
| | - Todd B Dubnicoff
- Department of Neurological Surgery, University of California, San Francisco, California, USA
| | - Tina Shih
- Department of Neurology, University of California, San Francisco, California, USA
| | - Edward F Chang
- Department of Neurological Surgery, University of California, San Francisco, California, USA
| | - Adib A Abla
- Department of Neurological Surgery, University of California, San Francisco, California, USA
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Rinaldo L, Morshed RA, Wilkinson S, Dubnicoff TB, Abla AA. Intradural Anterior Petrosectomy for In Situ Occlusion of Ruptured Trigeminal Nerve Root Entry Zone Arteriovenous Malformation: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2023; 25:e159-e160. [PMID: 37195060 DOI: 10.1227/ons.0000000000000759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 03/16/2023] [Indexed: 05/18/2023] Open
Affiliation(s)
- Lorenzo Rinaldo
- Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Ramin A Morshed
- Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA
| | - Sean Wilkinson
- Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA
| | - Todd B Dubnicoff
- Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA
| | - Adib A Abla
- Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA
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Tonetti DA, Rinaldo L, Raygor KP, Dubnicoff TB, El-Sayed IH, Abla AA. Common Carotid-Greater Saphenous-M2 Bypass for Myoepithelial Carcinoma Encasing the Carotid Artery. World Neurosurg 2023:S1878-8750(23)00731-3. [PMID: 37268186 DOI: 10.1016/j.wneu.2023.05.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 05/24/2023] [Accepted: 05/25/2023] [Indexed: 06/04/2023]
Abstract
Revascularization of the anterior circulation using a high-capacitance graft is sometimes necessary for the treatment of cervical tumors encasing the internal carotid artery (ICA). In this surgical video, we aim to demonstrate the technical nuances of high-flow extra- to intracranial bypass using a saphenous vein graft. The patient is a 23-year-old female who presented with a four-month history of an enlarging left-sided neck mass, dysphagia and 25-lb weight loss. CT and MR imaging demonstrated an enhancing lesion encasing the cervical internal carotid artery (ICA). The patient underwent an open biopsy that established a diagnosis of a myoepithelial carcinoma. The patient was advised to undergo attempted gross total resection, which would require sacrifice of the cervical internal carotid artery. After the patient failed a balloon test-occlusion of the left ICA, it was decided to perform a cervical ICA to middle cerebral artery (MCA) M2 bypass using a saphenous vein graft followed by tumor resection in staged fashion. Post-operative imaging demonstrated complete tumor removal and filling of the left anterior circulation via the saphenous vein graft. This video discusses important pre- and post-operative considerations as well as highlights the technical nuances of this complex procedure. High-flow ICA to MCA bypass using a saphenous vein graft can be employed to facilitate gross total resection of malignant tumors encasing the cervical internal carotid artery.
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Affiliation(s)
- Daniel A Tonetti
- Department of Neurosurgery, Cooper Neurological Institute, Camden, NJ, USA
| | - Lorenzo Rinaldo
- Department of Neurosurgery, University of California San Francisco, San Francisco, CA, USA; Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA
| | - Kunal P Raygor
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Todd B Dubnicoff
- Department of Neurosurgery, University of California San Francisco, San Francisco, CA, USA
| | - Ivan H El-Sayed
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Adib A Abla
- Department of Neurosurgery, University of California San Francisco, San Francisco, CA, USA.
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Raper DMS, Raygor KP, Rutledge C, Dubnicoff TB, Abla AA. Suboccipital craniectomy with bilateral cerebellomedullary fissure dissection for resection of a ruptured tonsillar/vermian AVM occupying the roof of the fourth ventricle in a pregnant patient. Neurosurgical Focus: Video 2021; 4:V6. [PMID: 36284619 PMCID: PMC9542581 DOI: 10.3171/2020.10.focvid2059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 10/20/2020] [Indexed: 11/24/2022]
Abstract
Posterior fossa arteriovenous malformations (AVMs) in pregnant patients can present unique considerations for surgical treatment, including positioning to minimize pressure on the fetus, minimization of radiation exposure, and ethical considerations regarding emergency surgery. This video outlines surgical treatment of a ruptured tonsillar/vermian AVM performed in a staged fashion after emergent suboccipital craniotomy with posterior fossa decompression in the setting of a life-threatening infratentorial hemorrhage. Later, bilateral cerebellomedullary fissure dissection, exposure and dissection of the tela choroidea and inferior medullary velum, and disconnection of arterial feeders from the posterior inferior cerebellar artery (PICA) allowed resection of this AVM occupying the roof of the fourth ventricle. This study was approved by the UCSF Human Research Protection Program IRB no. 18-26938. The video can be found here: https://youtu.be/rTYUGanopUE
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