Cargando…
Surgical removal using V3-radial artery graft-V4 bypass and occipital artery-posterior inferior cerebellar artery bypass for a giant thrombosed aneurysm of vertebral artery compressing brain stem: Case report
BACKGROUND: Giant thrombosed vertebral artery aneurysms (GTVAs) are difficult disease to treat. Here, we are reporting a case of GTVA successfully treated with excluding the pathological segment and restoring the anterograde blood flow of the parent artery, highlighting the reliable surgical procedu...
Autores principales: | , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Scientific Scholar
2019
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6884950/ https://www.ncbi.nlm.nih.gov/pubmed/31819814 http://dx.doi.org/10.25259/SNI_385_2019 |
_version_ | 1783474656668286976 |
---|---|
author | Tsunoda, Sho Inoue, Tomohiro Naemura, Kazuaki Akabane, Atsuya |
author_facet | Tsunoda, Sho Inoue, Tomohiro Naemura, Kazuaki Akabane, Atsuya |
author_sort | Tsunoda, Sho |
collection | PubMed |
description | BACKGROUND: Giant thrombosed vertebral artery aneurysms (GTVAs) are difficult disease to treat. Here, we are reporting a case of GTVA successfully treated with excluding the pathological segment and restoring the anterograde blood flow of the parent artery, highlighting the reliable surgical procedure. CASE DESCRIPTION: A 55-year-old man with a left GTVA complained of right hemiparesis (manual muscle testing 4/5) represented by hand clumsiness and gait disturbance, in addition to severe left-sided dysesthesia, was referred to our hospital. The posterior inferior cerebellar artery (PICA) was incorporated into the GTVA segment, and the contralateral vertebral artery showed atherosclerotic change. Thus, we decided to treat the aneurysm with aneurysm trapping and thrombectomy, in conjunction with V3-radial artery graft (RAG)-V4 bypass and occipital artery (OA)-PICA bypass through a suboccipital transcondylar approach. The distal end of the dilated segment was meandering and deflecting outwardly to the vicinity of the internal auditory canal and was stretched in an axial direction. Thus, the V4 stump can be transposed to the triangle space made by the medulla, lower cranial nerves, and sigmoid sinus, and we could perform a safe and reliable anastomosis through the corridor. After the surgery, the compression of the brain stem was released, and right hemiparesis was improved completely after rehabilitation. The patient was discharged with a modified Rankin Scale score of 1. CONCLUSION: Trapping of the aneurysm and thrombectomy are the most radical treatment for GTVA, and if possible, reconstruction of anterograde blood flow with V3-RAG-V4 bypass and OA-PICA bypass is desirable. |
format | Online Article Text |
id | pubmed-6884950 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Scientific Scholar |
record_format | MEDLINE/PubMed |
spelling | pubmed-68849502019-12-09 Surgical removal using V3-radial artery graft-V4 bypass and occipital artery-posterior inferior cerebellar artery bypass for a giant thrombosed aneurysm of vertebral artery compressing brain stem: Case report Tsunoda, Sho Inoue, Tomohiro Naemura, Kazuaki Akabane, Atsuya Surg Neurol Int Case Report BACKGROUND: Giant thrombosed vertebral artery aneurysms (GTVAs) are difficult disease to treat. Here, we are reporting a case of GTVA successfully treated with excluding the pathological segment and restoring the anterograde blood flow of the parent artery, highlighting the reliable surgical procedure. CASE DESCRIPTION: A 55-year-old man with a left GTVA complained of right hemiparesis (manual muscle testing 4/5) represented by hand clumsiness and gait disturbance, in addition to severe left-sided dysesthesia, was referred to our hospital. The posterior inferior cerebellar artery (PICA) was incorporated into the GTVA segment, and the contralateral vertebral artery showed atherosclerotic change. Thus, we decided to treat the aneurysm with aneurysm trapping and thrombectomy, in conjunction with V3-radial artery graft (RAG)-V4 bypass and occipital artery (OA)-PICA bypass through a suboccipital transcondylar approach. The distal end of the dilated segment was meandering and deflecting outwardly to the vicinity of the internal auditory canal and was stretched in an axial direction. Thus, the V4 stump can be transposed to the triangle space made by the medulla, lower cranial nerves, and sigmoid sinus, and we could perform a safe and reliable anastomosis through the corridor. After the surgery, the compression of the brain stem was released, and right hemiparesis was improved completely after rehabilitation. The patient was discharged with a modified Rankin Scale score of 1. CONCLUSION: Trapping of the aneurysm and thrombectomy are the most radical treatment for GTVA, and if possible, reconstruction of anterograde blood flow with V3-RAG-V4 bypass and OA-PICA bypass is desirable. Scientific Scholar 2019-11-15 /pmc/articles/PMC6884950/ /pubmed/31819814 http://dx.doi.org/10.25259/SNI_385_2019 Text en Copyright: © 2019 Surgical Neurology International http://creativecommons.org/licenses/by-nc-sa/4.0 This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms. |
spellingShingle | Case Report Tsunoda, Sho Inoue, Tomohiro Naemura, Kazuaki Akabane, Atsuya Surgical removal using V3-radial artery graft-V4 bypass and occipital artery-posterior inferior cerebellar artery bypass for a giant thrombosed aneurysm of vertebral artery compressing brain stem: Case report |
title | Surgical removal using V3-radial artery graft-V4 bypass and occipital artery-posterior inferior cerebellar artery bypass for a giant thrombosed aneurysm of vertebral artery compressing brain stem: Case report |
title_full | Surgical removal using V3-radial artery graft-V4 bypass and occipital artery-posterior inferior cerebellar artery bypass for a giant thrombosed aneurysm of vertebral artery compressing brain stem: Case report |
title_fullStr | Surgical removal using V3-radial artery graft-V4 bypass and occipital artery-posterior inferior cerebellar artery bypass for a giant thrombosed aneurysm of vertebral artery compressing brain stem: Case report |
title_full_unstemmed | Surgical removal using V3-radial artery graft-V4 bypass and occipital artery-posterior inferior cerebellar artery bypass for a giant thrombosed aneurysm of vertebral artery compressing brain stem: Case report |
title_short | Surgical removal using V3-radial artery graft-V4 bypass and occipital artery-posterior inferior cerebellar artery bypass for a giant thrombosed aneurysm of vertebral artery compressing brain stem: Case report |
title_sort | surgical removal using v3-radial artery graft-v4 bypass and occipital artery-posterior inferior cerebellar artery bypass for a giant thrombosed aneurysm of vertebral artery compressing brain stem: case report |
topic | Case Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6884950/ https://www.ncbi.nlm.nih.gov/pubmed/31819814 http://dx.doi.org/10.25259/SNI_385_2019 |
work_keys_str_mv | AT tsunodasho surgicalremovalusingv3radialarterygraftv4bypassandoccipitalarteryposteriorinferiorcerebellararterybypassforagiantthrombosedaneurysmofvertebralarterycompressingbrainstemcasereport AT inouetomohiro surgicalremovalusingv3radialarterygraftv4bypassandoccipitalarteryposteriorinferiorcerebellararterybypassforagiantthrombosedaneurysmofvertebralarterycompressingbrainstemcasereport AT naemurakazuaki surgicalremovalusingv3radialarterygraftv4bypassandoccipitalarteryposteriorinferiorcerebellararterybypassforagiantthrombosedaneurysmofvertebralarterycompressingbrainstemcasereport AT akabaneatsuya surgicalremovalusingv3radialarterygraftv4bypassandoccipitalarteryposteriorinferiorcerebellararterybypassforagiantthrombosedaneurysmofvertebralarterycompressingbrainstemcasereport |