Abstract:
:The craniocervical junction (CCJ) functions within a complicated regional anatomy necessary to protect and support vital neurovascular structures. In select instances, vascular pathology can be attributed to this complicated interplay of motion and structure found within this narrow space. The authors report 3 cases of complex vascular pathology related to motion at the CCJ and detail the management of these cases. Two cases involved posterior circulation vascular compression syndromes, and one case involved a vascular anomaly and its relation to aneurysm formation and rupture. The patient in Case 1 was a 66-year-old man with a history of syncopal episodes resulting from the bilateral vertebral artery becoming occluded when he rotated his head. Successful microsurgical decompression at the skull base resulted in patent bilateral vertebral artery V3 segments upon head movement in all directions. The patient in Case 2 was a 53-year-old woman who underwent elective resection of a right temporal meningioma and who experienced postoperative drowsiness, dysphagia, and mild right-arm ataxia. Subsequent MRI demonstrated bilateral posterior inferior cerebel-lar artery (PICA) strokes. Cerebral angiography showed a single PICA, of extradural origin, supplying both cerebellar hemispheres. The PICA exhibited dynamic extradural compression when the patient rotated her head; the bilateral PICA strokes were due to head rotation during surgical positioning. In Case 3, a 37-year-old woman found unconscious in her home had diffuse subarachnoid hemorrhage and evidence of a right PICA aneurysm. A right far-lateral craniectomy was performed for aneurysm clipping, and she was found to have a dissecting aneurysm with an associated PICA originating extradurally. There was a shearing phenomenon of the extradural PICA along the dura of the foramen magnum, and this microtraumatic stress imposed on the vessel resulted in a dissecting aneurysm. This series of complex and unusual cases highlights the authors' understanding of vascular pathology of the CCJ and its management.
journal_name
Neurosurg Focusjournal_title
Neurosurgical focusauthors
Ravindra VM,Neil JA,Mazur MD,Park MS,Couldwell WT,Taussky Pdoi
10.3171/2015.1.FOCUS14826subject
Has Abstractpub_date
2015-04-01 00:00:00pages
E6issue
4issn
1092-0684journal_volume
38pub_type
杂志文章,评审abstract:OBJECT:Minimally invasive lumbar discectomy is a refinement of the standard open microsurgical discectomy technique. Proponents of the minimally invasive technique suggest that it improves patient outcome, shortens hospital stay, and decreases hospital costs. Despite these claims there is little support in the literatu...
journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
doi:10.3171/FOC/2008/25/8/E20
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journal_title:Neurosurgical focus
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journal_title:Neurosurgical focus
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pub_type: 杂志文章,评审
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journal_title:Neurosurgical focus
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doi:10.3171/foc.1999.7.2.3
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journal_title:Neurosurgical focus
pub_type: 杂志文章
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pub_type: 传,历史文章,杂志文章
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journal_title:Neurosurgical focus
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journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
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