2.Traumatic Entrapment of the Vertebrobasilar Junction Due to a Longitudinal Clival Fracture: A Case Report.
Joon CHO ; Chang Taek MOON ; Hyun Seung KANG ; Woo Jin CHOE ; Sang Keun CHANG ; Young Cho KOH ; Hong Gee ROH
Journal of Korean Medical Science 2008;23(4):747-751
Vertebrobasilar junction entrapment due to a clivus fracture is a rare clinical observation. The present case report describes a 54-yr-old man who sustained a major craniofacial injury. The patient displayed a stuporous mental state (Glasgow Coma Scale [GCS]=8) and left hemiparesis (Grade 3). The initial computed tomography (CT) scan revealed a right subdural hemorrhage in the frontotemporal region, with a midline shift and longitudinal clival fracture. A decompressive craniectomy with removal of the hematoma was performed. Two days after surgery, a follow-up CT scan showed cerebellar and brain stem infarction, and a CT angiogram revealed occlusion of the left vertebral artery and entrapment of vertebrobasilar junction by the clival fracture. A decompressive suboccipital craniectomy was performed and the patient gradually recovered. This appears to be a rare case of traumatic vertebrobasilar junction entrapment due to a longitudinal clival fracture, including a cerebellar infarction caused by a left vertebral artery occlusion. A literature review is provided.
Basilar Artery/*injuries
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Humans
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Male
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Middle Aged
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Skull Fractures/*complications/radiography
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Tomography, X-Ray Computed
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Vertebral Artery/*injuries
4.Bilateral Paramedian Thalamic Contrast Enhancement on CT after Intra-arterial Thrombolysis.
Woong YOON ; Jeong Jin SEO ; Heoung Keun KANG
Korean Journal of Radiology 2005;6(1):41-43
A 58-year-old woman presented with an acute embolic occlusion of the distal basilar artery. She underwent angioplasty and intra-arterial thrombolysis. Angiography performed after recanalization revealed a single perforating thalamic artery. A nonenhanced CT scan carried out immediately after the procedure revealed hyperdense lesions in the bilateral paramedian portions of the thalami, which disappeared on the 24-hour follow-up CT scan. Three months later, the patient improved to functional independence, but had some memory dysfunction and vertical gaze palsy. This case suggests that contrast enhancement or extravasation can occur in the thalamus after intra-arterial thrombolysis performed to recanalize a basilar artery occlusion.
Angioplasty
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Basilar Artery/*radiography
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Contrast Media
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Female
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Humans
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Intracranial Embolism and Thrombosis/*radiography/*therapy
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Middle Aged
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Thalamus/*blood supply
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Thrombolytic Therapy
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*Tomography, X-Ray Computed
5.Endovascular Treatment of the Huge Dissecting Aneurysms Involving the Basilar Artery by the Internal Trapping Technique: Technical Note.
Shi-Qing MU ; Xin-Jian YANG ; You-Xiang LI ; Chu-Han JIANG ; Zhong-Xue WU
Chinese Medical Journal 2015;128(14):1916-1921
BACKGROUNDThe endovascular strategy of the huge dissecting aneurysms involving the basilar artery (BA) is controversial and challenging. This study was to investigate the clinical and angiographic outcomes of the treatment of the huge dissecting aneurysms involving the BA by the internal trapping (IT) technique.
METHODSWe retrospectively studied 15 patients with the huge dissecting aneurysms involving the BA treated by the IT technique between September 2005 and September 2014 in Department of Interventional Neuroradiology of Beijing Tiantan Hospital. Clinical and angiographic data were reviewed and evaluated.
RESULTSAll patients were treated by the IT technique. That meant the dissecting artery and aneurysm segments were completed occlusion. After the procedure, the angiography demonstrated that all the dissecting artery and aneurysm segments were completed occlusion. Follow-up angiography was performed at 3-6 months or 12-18 months after the endovascular treatment (median 8 months), 14 patients had a good recovery. Re-canalization occurred in one patient whose aneurysm involved in bilateral vertebral arteries and the two third of the middle-lower BA. After the second treatment, the patient died by the ventricular tachycardia.
CONCLUSIONSThe IT technique is a technically feasible and safe alternative for the treatment of BA dissecting aneurysms, but it is not necessarily the safest or most definitive treatment modality. The ideal treatment of the huge dissecting aneurysms involving the BA remains debatable and must be investigated on a case-by-case basis.
Adolescent ; Adult ; Aneurysm, Dissecting ; diagnostic imaging ; therapy ; Basilar Artery ; diagnostic imaging ; Female ; Humans ; Intracranial Aneurysm ; diagnostic imaging ; therapy ; Male ; Middle Aged ; Radiography ; Retrospective Studies ; Treatment Outcome ; Young Adult