This study is aimed to analyze the clinical outcomes of endovascular treatments for patients with intracranial vertebral artery dissecting aneurysms.Clinical data of 32 patients with vertebral artery dissecting aneurysms who underwent endovascular procedures in the Department of Neurosurgery of our University from January 2016 to December 2019 were retrospectively analyzed. Nine cases were treated with endovascular occlusion; 23 cases received reconstructive treatment, including 20 cases of stent combined with coil embolization, and 3 cases of stent implantation. The angiography taken at 3-22 months after surgery was reviewed.The endovascular treatments for all 32 cases were successful. Thirty-one cases had no postoperative complications during index hospital. Mid-term follow-up showed that: 27 cases (84%) had embolism; 5 cases (16%) had recurrence, of which 4 cases were treated again with endovascular procedures followed with no further complications and no recurrence, and 1 case received closely monitor but no reoperation. During an average follow-up of 10.5 months, except for one case that was self-discharged due to end-stage brainstem compression and respiratory failure, the rest of the patients were in stable conditions without bleeding or infarction.Endovascular treatment of intracranial vertebral artery dissecting aneurysms is safe and effective. Recurrent vertebral artery dissecting aneurysms can be treated with endovascular reoperations with satisfactory outcomes.
Abstract Background Moyamoya disease (MMD) is a cerebrovascular disorder characterized by progressive unilateral or bilateral stenosis of the distal internal carotid artery. As hemodynamic features in MMD patients alter, the comorbidity of intracranial aneurysm (IA) is sometimes observed clinically. We aim to investigate clinical characteristics and therapeutic strategies for the comorbidity of Moyamoya disease with intracranial aneurysms (MMD-IA). Methods A total of 13 MMD-IA patients were recruited in this study and were manifested to be intracranial hemorrhage. We reviewed the surgical technique notes for all patients. Results According to the locations of an aneurysm, MMD-IA could be divided into several categories: (1) MMD-IA at a circle of Willis—aneurysms usually located at the trunk of Willis circle; (2) MMD-IA at collateral anastomosis—aneurysms located at the distal end of collateral anastomosis; and (3) MMA-IA at basal ganglia region. In this report, aneurysms in 10 patients located at Willis circle, 2 at the pericallosal artery, and 1 at the basal ganglia region. Among them, endovascular embolism was performed among 5 patients. Aneurysm clipping was conducted among 7 patients. A patient with an aneurysm at the basal ganglia region just accepted revascularization treatment. All the treatments were successful. Follow-up studies, ranging from 6 to 24 months, demonstrated all patients received satisfactory curative effects. Conclusion Diverse clinical presentations could be observed among MMD-IA patients. Individualized neurosurgical treatments should be chosen according to the locations of the aneurysm.
Objective To investigate the therapeutic effect of the fourth ventricle tumors through lateral wall type of the transcerebellomedullary fissure approach under endoscope.Methods Clinical data of 14 cases with the fourth ventricle lesions were analyzed retrospectively.All the patients were treated by lateral wall type of the transcerebellomedullary fissure approach surgery.The endoscope was used if the lesions develop to the aqueduct and hard to be exposed.Both neurophysiological monitoring and intraoperative ultrasound were used regularly.Results Tumors were totally removed in 12 cases,subtotally in 1,and partially in 1.All the patients were diagnosed in postoperative histopathology,including 4 medulloblastoma,three epidermoid cyst,two ependymoma,two hemangioblastoma,one meningioma,one cavernous hemangioma and 1 astrocytoma.Hypopnea occurred immediate after operation in 1 patient.Ventilatory support was performed by Ventilator,and the respiration was restored 1 day later.Normal cerebrospinal fluid circulation was return in all cases.Neither aggravation of preoperative symptoms nor nuclei injury related complication had been found.The follow-up interval between 3 months to 28 months,one patient was dead with unexplained,and 1 medulloblastoma patient was relapse.Conclusion Lateral wall type of the transeerebellomedullary fissure approach,under endoscope,combined with the usage of neurophysiological monitoring and intraoperative ultrasound,can degrade the surgical related complications such as facial palsy and amblyacousia.
Key words:
Fourth ventricle; Cerebellomedullary fissure approach; Posterior inferior cerebellar artery; Endoscope; Neurophysiological monitoring
Background: Intracranial vertebral artery dissection aneurysms (VADAs) may cause acute ischemia or hemorrhage and the urgent endovascular treatment is needed. Although the majority of patients obtained a good functional outcome after surgery, the surprising finding was a bad quality of life (QOL) in the follow-up. The purpose of this study was to evaluate clinical efficacy and to analyze contributing factors of QOL after reconstructive endovascular therapy for acute intracranial VADAs. Methods: In this prospective study, 33 consecutive VADAs patients with subarachnoid hemorrhage were recruited in comparison to 37 VADAs patients with posterior circulation cerebral ischemia. All VADAs patients were treated using reconstructive strategy. The clinical, radiological, neurological and cognitive data, as well as QOL was performed at admission and six months after surgery. Stoke Specific Quality of Life (SS-QOL) was done for patients with good functional outcome (modified Ranking Scale (mRS) scoring 0-2) for subgroup analysis. Predictors for QOL at follow-up were analyzed by regression model. Results: Immediate angiography after surgery showed 57 (81.4%) patients were complete obliteration and 13 (18.6%) patients were partial obliteration in VADAs. Three (4.3%) cases suffered from perioperative complications, which contained 2 cases of stent thrombosis in hemorrhagic group and 1 case of posterior inferior cerebellar artery occlusion in ischemic group. Of 25 (75.8%) patients in hemorrhagic group and 30 (81.1%) patients in ischemic group had a favorable outcome (mRS scoring 0-2) in 6 months follow-up. Follow-up angiography displayed that 1 case of recurrence occurred separately in both group. 15 of 33 hemorrhagic patients (45.5%) and 19 of 37 ischemic patients (51.4%) rated QOL at follow-up as bad (SS-QOL score ≤ 3.9) despite of good function outcome. Severity of neurological disorder and impaired neurocognition at baseline in VADAs patients are proved to be independent predictors for decline of QOL according to regression analysis. Conclusion: Reconstructive endovascular therapy for acute intracranial VADAs is a safe and effective method with a low complication rate. VADAs lead to impaired QOL at 6 months follow-up attributed to multiple factors. The study demonstrated that neurological and cognitive status at baseline of significant importance for the QOL after VADAs.
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