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Robert F. Spetzler - One of the best experts on this subject based on the ideXlab platform.
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anterior temporal Artery to Posterior Cerebral Artery bypass for revascularization of the Posterior circulation an anatomical study
Journal of Clinical Neuroscience, 2018Co-Authors: Kaan Yağmurlu, Feres Chaddadneto, Orhun Mete Cevik, Baran Bozkurt, Evgenii Belykh, Hugo Leonardo Dorianetto, Mark C. Preul, Yashar M S Kalani, Andrew W Grande, Robert F. SpetzlerAbstract:Abstract We describe a novel intracranial-to-intracranial bypass technique between the anterior temporal Artery and the Posterior Cerebral Artery for revascularization of the Posterior circulation. Four formalin-fixed human heads were examined to demonstrate the detailed anatomy of the middle Cerebral Artery and the Posterior Cerebral Artery, and to illustrate the step-by-step bypass procedure. The anterior temporal Artery, a branch of the middle Cerebral Artery, can be anastomosed to the P2 segment of the Posterior Cerebral Artery as an alternative to extracranial bypass donor segments for treatment of complex aneurysms requiring revascularization. The anastomosis of the anterior temporal Artery as a pedicled donor to the Posterior Cerebral Artery provides a shorter graft, due to its close anatomical position to the Posterior Cerebral Artery, for Posterior circulation revascularization.
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internal carotid Artery to Posterior Cerebral Artery bypass for revascularization of the brainstem
Journal of Clinical Neuroscience, 2016Co-Authors: Yashar M S Kalani, Robert F. SpetzlerAbstract:Abstract We describe a novel bypass technique used to revascularize the brainstem by anastomosing the internal carotid Artery (ICA) to the Posterior Cerebral Artery (PCA) using a radial Artery graft, effectively creating a functional alternative to the Posterior communicating Artery. A 72-year-old male patient presented with rapidly progressive neurological symptoms attributable to brainstem compression; imaging showed a giant, fusiform, partially thrombosed, vertebrobasilar Artery aneurysm. An Alcock’s test revealed no significant collateral circulation from the Posterior communicating arteries. To revascularize the top of the basilar Artery, we performed an ICA-to-PCA bypass using a radial Artery interposition graft. Specifically, we used the radial Artery graft to connect the supraclinoid ICA to the P2 segment of the PCA. The basilar Artery was subsequently occluded during the same operation by placing a clip below the superior cerebellar arteries. Although the bypass remained patent, the patient suffered an acute thrombosis of the aneurysm, resulting in fatal pontine infarction.
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treatment of distal Posterior Cerebral Artery aneurysms a critical appraisal of the occipital Artery to Posterior Cerebral Artery bypass
Neurosurgery, 2010Co-Authors: Steve W Chang, Cameron G Mcdougall, Adib A Abla, Udaya K Kakarla, Eric Sauvageau, Shervin R Dashti, Peter Nakaji, Joseph M Zabramski, Felipe C Albuquerque, Robert F. SpetzlerAbstract:OBJECTIVE: This is the largest contemporary series of distal Posterior Cerebral Artery (PCA) aneurysms treated by use of endovascular coiling and stenting as well as surgical clipping, clip wrapping, and bypass techniques. We propose a new treatment paradigm. METHODS: The location, size, type of aneurysm, clinical presentation, treatment, complications, and outcomes associated with 34 distal PCA aneurysms in 33 patients (15 females, 18 males; mean age, 44 years) were reviewed retrospectively. RESULTS: The most common presenting symptom was headache in 19 (58%) followed by contralateral weakness or numbness in 6 (18%) and visual changes in 4 (12%). Eight aneurysms were giant. Of the remaining 26 aneurysms, 17 were fusiform/dissecting, 5 were saccular, and 4 were mycotic. Treatment was primarily endovascular in 22 patients, 12 of whom also had a concomitant surgical bypass procedure. Nine patients underwent microsurgical clipping, and 3 underwent combined treatment of clipping and coiling and/or stenting. There were no significant differences in outcomes between the groups (P=.078). The recurrence rate in patients undergoing coiling was 22% and 0% in patients undergoing clipping. Fourteen aneurysms (41%) involved treatment with an occipital Artery-to-PCA bypass or an onlay graft. Compared with their preoperative status, these patients had significantly worse outcomes than those without a bypass (P=.013). CONCLUSION: Bypass techniques for the treatment of distal PCA aneurysms are associated with a higher rate of complications than once thought. In our new treatment paradigm, bypass is a last resort and reserved for patients in whom balloon-test occlusion fails, who refuse parent-vessel sacrifice, and who cannot undergo primary stenting with coiling or clip wrapping.
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distal Posterior Cerebral Artery revascularization in multimodality management of complex peripheral Posterior Cerebral Artery aneurysms technical case report
Neurosurgery, 1998Co-Authors: A G Vishteh, Kris A Smith, Cameron G Mcdougall, Robert F. SpetzlerAbstract:UNLABELLED: OBJECTIVES AND IMPORTANCE: Although controversial, revascularization of the distal Posterior Cerebral Artery (PCA) may become necessary in treating complex PCA aneurysms before proximal parent vessel sacrifice. The revascularization of the distal PCA territories of two patients with peripheral PCA aneurysms is presented. CLINICAL PRESENTATIONS: One patient had an aneurysm of the P2-P3 segment and failed a selective P2 balloon occlusion test by developing homonymous hemianopia before planned parent vessel sacrifice. The other patient with a giant P2 segment aneurysm presented with visual field deficits. TECHNIQUE: The distal segment of PCA was revascularized before the aneurysms were trapped by surgical clipping or coil occlusion of the distal P2 segment, proximal to the aneurysms. In both cases, the occipital Artery was used as the "donor" vessel. Temporary occlusion times were 22 and 20 minutes, respectively. Both grafts were patent on postoperative angiography, and both patients had full visual fields at the time of their follow-up examinations. CONCLUSION: De novo distal P2 sacrifice, advocated for treating peripheral PCA aneurysms, leads to visual field deficits in some patients. Revascularization of the distal segment of the PCA, less technically demanding than bypass to other PCA segments, preserves blood flow, thus sparing vision in this subset of patients.
Adib A Abla - One of the best experts on this subject based on the ideXlab platform.
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y stent technique for treatment of wide necked Posterior communicating Artery aneurysm associated with fetal Posterior Cerebral Artery technical report
World Neurosurgery, 2020Co-Authors: Daniel M S Raper, Caleb W Rutledge, Ethan A Winkler, Adib A AblaAbstract:Background Despite a variety of technologies that are available for treatment of complex intracranial aneurysms, certain anatomic configurations remain challenging to address endovascularly. Case Description A patient was found to have an incidental 12 mm × 11 mm × 10 mm, wide-necked right Posterior communicating Artery aneurysm with a fetal origin of the Posterior Cerebral Artery arising directly from the aneurysm dome. After multidisciplinary discussion, a staged endovascular treatment approach was undertaken in 2 stages. First, a Y-stent construct using 2 overlapping Neuroform Atlas stents was placed into the M1 and fetal Posterior Cerebral Artery segments. Two months later, after endothelialization of the stent construct, coil embolization of the aneurysm was performed. The patient tolerated both stages of the procedure well and was discharged the following day in each case. She remained neurologically intact, and at follow-up 5 months later had no evidence of residual or recurrent aneurysm. Conclusions This case illustrates a number of important considerations in the management approach for wide-necked intracranial aneurysms.
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treatment of distal Posterior Cerebral Artery aneurysms a critical appraisal of the occipital Artery to Posterior Cerebral Artery bypass
Neurosurgery, 2010Co-Authors: Steve W Chang, Cameron G Mcdougall, Adib A Abla, Udaya K Kakarla, Eric Sauvageau, Shervin R Dashti, Peter Nakaji, Joseph M Zabramski, Felipe C Albuquerque, Robert F. SpetzlerAbstract:OBJECTIVE: This is the largest contemporary series of distal Posterior Cerebral Artery (PCA) aneurysms treated by use of endovascular coiling and stenting as well as surgical clipping, clip wrapping, and bypass techniques. We propose a new treatment paradigm. METHODS: The location, size, type of aneurysm, clinical presentation, treatment, complications, and outcomes associated with 34 distal PCA aneurysms in 33 patients (15 females, 18 males; mean age, 44 years) were reviewed retrospectively. RESULTS: The most common presenting symptom was headache in 19 (58%) followed by contralateral weakness or numbness in 6 (18%) and visual changes in 4 (12%). Eight aneurysms were giant. Of the remaining 26 aneurysms, 17 were fusiform/dissecting, 5 were saccular, and 4 were mycotic. Treatment was primarily endovascular in 22 patients, 12 of whom also had a concomitant surgical bypass procedure. Nine patients underwent microsurgical clipping, and 3 underwent combined treatment of clipping and coiling and/or stenting. There were no significant differences in outcomes between the groups (P=.078). The recurrence rate in patients undergoing coiling was 22% and 0% in patients undergoing clipping. Fourteen aneurysms (41%) involved treatment with an occipital Artery-to-PCA bypass or an onlay graft. Compared with their preoperative status, these patients had significantly worse outcomes than those without a bypass (P=.013). CONCLUSION: Bypass techniques for the treatment of distal PCA aneurysms are associated with a higher rate of complications than once thought. In our new treatment paradigm, bypass is a last resort and reserved for patients in whom balloon-test occlusion fails, who refuse parent-vessel sacrifice, and who cannot undergo primary stenting with coiling or clip wrapping.
Michael T Lawton - One of the best experts on this subject based on the ideXlab platform.
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superior cerebellar Artery Posterior Cerebral Artery bypass in situ bypass for Posterior Cerebral Artery revascularization
Journal of Neurosurgery, 2013Co-Authors: Ana Rodriguezhernandez, Christina Huang, Michael T LawtonAbstract:Iatrogenic pseudoaneurysms are rare but serious complications of transsphenoidal surgery, and an iatrogenic pseudoaneurysm of the Posterior Cerebral Artery (PCA) has been reported just once in the literature. The authors encountered such a case with a new P1 segment PCA pseudoaneurysm after endoscopic transsphenoidal resection of a pituitary adenoma. The aneurysm proved ideal for a novel intracranial–intracranial bypass in which the superior cerebellar Artery (SCA) was used as an in situ donor Artery to revascularize the recipient P2 segment. The bypass allowed aneurysm trapping without causing ischemic stroke or neurological morbidity. This case represents the first reported surgical treatment of an iatrogenic PCA pseudoaneurysm. Endovascular occlusion with coils was an option, but dolichoectatic morphology requires sacrifice of the P1 segment, with associated risks to the thalamoperforators and circumflex perforators. The SCA-PCA bypass was ideal because of low-flow demands. Like other in situ bypasses,...
Joel K Levy - One of the best experts on this subject based on the ideXlab platform.
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ego syntonic alien hand syndrome after right Posterior Cerebral Artery stroke
Archives of Physical Medicine and Rehabilitation, 1999Co-Authors: Kevin N Groom, Wing Ng, George C Kevorkian, Joel K LevyAbstract:The alien hand syndrome classically consists of involuntary movements accompanied by a feeling of foreignness and personification of the affected limb. Autocriticism, in which patients criticize and express astonished frustration with the behavior of the autonomous limb, is a commonly noted feature. Most cases of alien hand are associated with lesions of the supplementary motor areas of the frontal lobes, the corpus callosum, or both. The authors report on a 79-year-old man who sustained a right Posterior Cerebral Artery distribution infarction and developed alien hand syndrome in the absence of callosal involvement. Also unique is that the patient perceived the alien hand as acceptable and positive, not hostile and repugnant. This case suggests not only that the neuroanatomic regions responsible for alien hand syndrome may require re-examination, but also that its definition may need expansion.
A Thron - One of the best experts on this subject based on the ideXlab platform.
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the hyperdense Posterior Cerebral Artery sign a computed tomography marker of acute ischemia in the Posterior Cerebral Artery territory
Stroke, 2006Co-Authors: Timo Krings, Dagmar Noelchen, Michael Mull, Klaus Willmes, Ingo G Meister, Peter C Reinacher, Rudolf Toepper, A ThronAbstract:Background and Purpose— In the anterior circulation, the hyperdense middle Cerebral Artery (MCA) sign is a well-established marker for early ischemia. Similarly, the hyperdense basilar Artery sign or the MCA “dot” sign may be a diagnostic clue for basilar Artery or distal MCA branch thrombosis. The purpose of this study was to define the hyperdense Posterior Cerebral Artery (PCA) sign and determine its incidence, diagnostic value, and reliability as a marker for ischemia in the territory of the PCA. Methods— Cranial computed tomographies (CCTs) of 48 patients with proven acute ischemia (<12 hours) in the PCA territory were compared by 3 independent and blinded readers to the CCTs of 86 age-matched patients without PCA infarction. Using follow-up imaging, the correlation of the hyperdense PCA (HPCA) with infarct size, thalamic infarction, and bleeding were investigated. Results— An HPCA was found in 35.4% of all patients with PCA infarction, typically within the ambient cistern, with a specificity of 95.4%. The thalamus was affected significantly more often ( P =0.009) and the size of the infarct was significantly more often large than medium ( P =0.018) or small ( P <0.001) when an HPCA was present. Hemorrhagic transformation tended to occur more often when the HPCA was present. Conclusions— An HPCA was detected in more than one third of all patients with PCA ischemia, suiting the incidence of the hyperdense MCA. Based on our results, this sign may not only be helpful in the early diagnosis of PCA infarction but might also act as a prognostic marker in acute PCA territory ischemic stroke.
