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Far Lateral Approach (Transcondylar, Transtubercular) for Bypass and Trapping of a Ruptured, Dissecting PICA Aneurysm
Aneurysms of the posterior circulation pose a unique challenge due to higher rupture rates, higher recurrence rates following endovascular treatment, and extended open cranial base approaches required to reach the ventrally located brainstem circulation. While endovascular therapy has made tremendou...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Georg Thieme Verlag KG
2021
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7935842/ https://www.ncbi.nlm.nih.gov/pubmed/33717815 http://dx.doi.org/10.1055/s-0040-1701237 |
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author | Venteicher, Andrew S. Goldschmidt, Ezequiel Gardner, Paul A. |
author_facet | Venteicher, Andrew S. Goldschmidt, Ezequiel Gardner, Paul A. |
author_sort | Venteicher, Andrew S. |
collection | PubMed |
description | Aneurysms of the posterior circulation pose a unique challenge due to higher rupture rates, higher recurrence rates following endovascular treatment, and extended open cranial base approaches required to reach the ventrally located brainstem circulation. While endovascular therapy has made tremendous strides in successful treatment for most posterior circulation aneurysms, open microscopic approaches remain essential in specific circumstances. Here, we present a case of a patient who presented with acute, severe headache, and sixth nerve palsies, and who was found to have hydrocephalus and a dissecting aneurysm at the anterolateral medullary segment of the posterior inferior cerebellar artery (PICA). Interestingly, this patient had a history of alpha-1 antitrypsin deficiency that has been linked with spontaneous aortic and cervical arterial dissections. The fusiform geometry of the dissecting aneurysm was deemed suboptimal for endovascular treatment, so an open microsurgical approach for occipital artery to PICA bypass and aneurysm trapping was planned. Because this patient had cerebral edema in the setting of a ruptured aneurysm and hydrocephalus, a far lateral craniotomy combined with drilling of the occipital condyle and jugular tubercle was critical to enhance exposure of the first segment of the PICA and to minimize brain retraction. In this video, we highlight the key steps and nuances for harvest of the occipital artery, achieving control of the extracranial vertebral artery, performing the transcondylar and transtubercular far lateral approach, and bypass with trapping technique for these challenging posterior circulation aneurysms. The link to the video can be found at: https://youtu.be/dqgblwX6t0Q . |
format | Online Article Text |
id | pubmed-7935842 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Georg Thieme Verlag KG |
record_format | MEDLINE/PubMed |
spelling | pubmed-79358422021-08-17 Far Lateral Approach (Transcondylar, Transtubercular) for Bypass and Trapping of a Ruptured, Dissecting PICA Aneurysm Venteicher, Andrew S. Goldschmidt, Ezequiel Gardner, Paul A. J Neurol Surg B Skull Base Aneurysms of the posterior circulation pose a unique challenge due to higher rupture rates, higher recurrence rates following endovascular treatment, and extended open cranial base approaches required to reach the ventrally located brainstem circulation. While endovascular therapy has made tremendous strides in successful treatment for most posterior circulation aneurysms, open microscopic approaches remain essential in specific circumstances. Here, we present a case of a patient who presented with acute, severe headache, and sixth nerve palsies, and who was found to have hydrocephalus and a dissecting aneurysm at the anterolateral medullary segment of the posterior inferior cerebellar artery (PICA). Interestingly, this patient had a history of alpha-1 antitrypsin deficiency that has been linked with spontaneous aortic and cervical arterial dissections. The fusiform geometry of the dissecting aneurysm was deemed suboptimal for endovascular treatment, so an open microsurgical approach for occipital artery to PICA bypass and aneurysm trapping was planned. Because this patient had cerebral edema in the setting of a ruptured aneurysm and hydrocephalus, a far lateral craniotomy combined with drilling of the occipital condyle and jugular tubercle was critical to enhance exposure of the first segment of the PICA and to minimize brain retraction. In this video, we highlight the key steps and nuances for harvest of the occipital artery, achieving control of the extracranial vertebral artery, performing the transcondylar and transtubercular far lateral approach, and bypass with trapping technique for these challenging posterior circulation aneurysms. The link to the video can be found at: https://youtu.be/dqgblwX6t0Q . Georg Thieme Verlag KG 2021-02 2020-07-01 /pmc/articles/PMC7935842/ /pubmed/33717815 http://dx.doi.org/10.1055/s-0040-1701237 Text en The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ) https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License, which permits unrestricted reproduction and distribution, for non-commercial purposes only; and use and reproduction, but not distribution, of adapted material for non-commercial purposes only, provided the original work is properly cited. |
spellingShingle | Venteicher, Andrew S. Goldschmidt, Ezequiel Gardner, Paul A. Far Lateral Approach (Transcondylar, Transtubercular) for Bypass and Trapping of a Ruptured, Dissecting PICA Aneurysm |
title | Far Lateral Approach (Transcondylar, Transtubercular) for Bypass and Trapping of a Ruptured, Dissecting PICA Aneurysm |
title_full | Far Lateral Approach (Transcondylar, Transtubercular) for Bypass and Trapping of a Ruptured, Dissecting PICA Aneurysm |
title_fullStr | Far Lateral Approach (Transcondylar, Transtubercular) for Bypass and Trapping of a Ruptured, Dissecting PICA Aneurysm |
title_full_unstemmed | Far Lateral Approach (Transcondylar, Transtubercular) for Bypass and Trapping of a Ruptured, Dissecting PICA Aneurysm |
title_short | Far Lateral Approach (Transcondylar, Transtubercular) for Bypass and Trapping of a Ruptured, Dissecting PICA Aneurysm |
title_sort | far lateral approach (transcondylar, transtubercular) for bypass and trapping of a ruptured, dissecting pica aneurysm |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7935842/ https://www.ncbi.nlm.nih.gov/pubmed/33717815 http://dx.doi.org/10.1055/s-0040-1701237 |
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