OBJECTIVETo investigate the administration of far-lateral approach in lesions located anterior or anterolateral to brain stem and upper cervical spinal cord.

METHODSTwenty-three patients underwent far lateral approach, including 12 retrocondylar approach, 5 partial transcondylar approach, 3 transfacetal and partial transcondylar approach, 2 transtubercular approach and 1 complete transcondylar approach.

RESULTSTotal tumor removal was achieved in 15 patients, subtotal removal in 5 patients, 3 vertibral artery aneurysms were clipped successfully, 3 patients were given occipitalcervical fusion. There was no operative mortality. The most frequent complications were lower cranial nerve deficit, CSF leakage, injury to vertibral artery, and ischemia of brain stem, cerebellum or spinal cord. No patient presented clinical instability of the occipitocervical junction after surgery.

CONCLUSIONSThe far-lateral approach is an ideal approach to structures located ventral to cranial-cervicle junction. But some of the surgical steps are technically difficult and carry some degree of risk. The choice of approach depends on the pathological feature and degree of exposure required for effective surgical treatment. Bone removal should be quantified for individual lesion. The approach may be limited to less aggressive steps, while still achieving significant exposure and surgical space.

Adolescent ; Adult ; Aneurysm ; surgery ; Basilar Artery ; surgery ; Brain Neoplasms ; pathology ; surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Microsurgery ; Middle Aged ; Neurosurgical Procedures ; methods ; Treatment Outcome ; Vertebral Artery ; surgery

Arteriovenous fistulas of the extracranial vertebral artery are rare. The authors report a case of a spontaneous arteriovenous fistula of the extracranial vertebral artery presenting as an osteolytic lesion at the body of the axis. The patient presented with headache and posterior neck pain. The fistula was obliterated by an endovascular trapping.
Adult ; Arteriovenous Fistula/*pathology/surgery ; Axis/*pathology ; Case Report ; Follow-Up Studies ; Human ; Male ; Osteolysis/pathology ; Support, Non-U.S. Gov't ; Vertebral Artery/*pathology/surgery

PURPOSE: Pathogenesis and treatment of spontaneous dissecting aneurysm of the intracranial vertebral artery (VA) remain controversial. This study was designed to provide management strategies and to improve management outcome in patients with these aneurysms. MATERIALA AND METHODS: Among a total of 1,990 patients treated for intracranial aneurysms from February 1992 to June 2005, 28 patients (1.4%) were treated either by surgery (8 patients) or neurointervention (20 patients) for spontaneous dissecting aneurysms of the intracranial VA. Twenty-two patients had ruptured aneurysms. We analyzed indications of surgery or neurointervention for each case, and assessed the management outcome at a 6-month follow-up. RESULTS: For selection of therapeutic options, patients were initially evaluated as possible candidates for neurointervention using the following criteria: 1) poor clinical grade; 2) advanced age; 3) medical illness; 4) unruptured aneurysm; 5) equal or larger opposite VA; 6) anticipated surgical difficulty due to a deep location of the VA-posterior inferior cerebellar artery (PICA) junction. Surgery was considered for patients with: 1) high-risk aneurysms (large or irregular shaped); 2) smaller opposite VA; 3) failed neurointervention; or 4) dissection involving the PICA. Management outcomes were favorable in 25 patients (89.3%). Causes of unfavorable outcome in the remaining 3 patients were the initial insult in 2 patients, and medical complications in one patient. CONCLUSION: Ruptured aneurysms must be treated to prevent rebleeding. For unruptured aneurysms, follow-up angiography would be necessary to detect growth of the aneurysm. Treatment modality should be selected according to the clinical characteristics of each patient and close collaboration between neurosurgeons and neurointerventionists is essential.
Adult ; Aged ; Aneurysm, Dissecting/*pathology/surgery/therapy ; Aneurysm, Ruptured/pathology/surgery/therapy ; Female ; Follow-Up Studies ; Humans ; Intracranial Aneurysm/*pathology/surgery/therapy ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome ; Vertebral Artery/*pathology/surgery

OBJECTIVETo investigate the clinical outcomes of the posterior C1,2 screw-rod combined with C2 unilateral translaminar screw and contralateral pedicle screw fixation and autogenous bicortical iliac crest graft fusion in treating upper cervical instability with vertebral artery variations.

METHODSFrom June 2008 to December 2012, the clinical data of 12 patients with upper cervical instability underwent C1 lateral mass screws-C2 unilateral laminar and contralateral pedicle screws fixation combined with autogenous bicortical iliac crest graft fusion were analyzed retrospectively. There were 8 males and 4 females with a mean age of 47.5 years (ranged, 16 to 77 years). Patients suffered from occipitocervical activity limitation of motion with pain or not, VAS was 0-7 points with an average of (3.50 +/- 2.71) points. Unilateral vertebral artery hypoplasia was demonstrated by vertebral arteriography (VAG) or CTA in all patients. Cervical X-ray and CT scans were done within 7 days after surgery in order to confirm internal fixation position. Internal fixation loosening and breakage, reduction losing, bone fusion ratio were observed during follow-up.

RESULTSNo nerves and vertebral artery injuries occurred during operation. Cervical pain obviously decreased and VAS was (0.92 +/- 0.90) points. Cervical alignment of 12 patients had well-recovered by X-ray while Atlantoaxial ventral lamina cortex of 1 case was encroached by CT scan without neurological symptom. All patients were followed up for 6 months to 3 years, no internal fixation loosening and breakage, reduction losing were found. All patients obtained bone fusion in 6-12 months after operation.

CONCLUSIONPosterior C1 lateral mass screws-C2 unilateral laminar and contralateral pedicle screws fixation combined with autogenous bicortical iliac crest graft fusion can achieve biomechanical stability and raise the successful rate of bone fusion, while avoiding the risk of vertebral artery injury and overcoming the insufficient of bone fusion during bilateral laminar screws placement as well. Posterior C1 lateral mass screws fixation is a safe and effective additional method in treating upper cervical instability with vertebral artery variations.

Adolescent ; Adult ; Aged ; Bone Screws ; Cervical Vertebrae ; surgery ; Female ; Humans ; Internal Fixators ; Joint Instability ; surgery ; Male ; Middle Aged ; Tomography, X-Ray Computed ; Vertebral Artery ; pathology

OBJECTIVETo explore the feasibility, safety and efficacy of endovascular reconstructive treatment by multiple overlapping stents with or without coils.

METHODSTotally 17 patients of vertebrobasilar fusiform aneurysms treated by multiple overlapping stents with or without coils between September 2011 and September 2015 in Department of Neurosurgery, Beijing Hospital were retrospectively reviewed. There were 15 male and 2 female patients with mean age of (47±13) years. Clinical manifestations included subarachnoid hemorrhage in 5 patients, cerebral ischemia or infarction in the posterior circulation in 5 patients, mass effect accompanied with brainstem infarction in 1 patients, headache or dizziness in 4, and incidental findings in 2 patients. Aneurysm located in intracranial vertebral artery in 11 patients, vertebrobasilar junction in 2 patients, and basilar trunk in 4 patients. Mean aneurysmal size was 18.5 mm×8.0 mm(length×width).

RESULTSSole stenting with overlapping stents was performed in 8 patients, and overlapping stents with coils was applied in 9 patients. Post-procedural hemorrhage occurred in a patient with a giant basilar trunk fusiform aneurysm and led to death. The 16 surviving patients were clinically followed up for a mean of 21.1 months. One patient had a modified Rankin score of 4, and the other patients had a good recovery. Among 15 patients with a mean angiographic follow-up of 8.6 months, 9 patients had their aneurysms further thrombosed, 3 patients were stable, and 3 patients with a recurred aneurysm. Final complete occlusion was achieved in 7 patients.

CONCLUSIONReconstructive treatment by overlapping stents with or without coils is feasible and relative safe in vertebrobasilar fusiform aneurysms.

Adult ; Endovascular Procedures ; Female ; Humans ; Intracranial Aneurysm ; surgery ; Male ; Middle Aged ; Retrospective Studies ; Stents ; Subarachnoid Hemorrhage ; surgery ; Treatment Outcome ; Vertebral Artery ; pathology

A 61-year-old female presented with 4 years history of left-sided hemifacial spasm. Head MRI and angiography indicated left vertebral artery dissecting aneurysm which compressed ipsilateral cranial nerves Ⅶ and Ⅷ. Microvascular decompression was performed. The dissecting aneurysm was pushed apart and the distal part of the parent artery was adhered to the dura on the petrosum. The compressed nerves were totally decompressed. The symptom of facial spasm was completely resolved immediately after surgery and did not recur during 6 months of follow up.
Cerebral Angiography ; Facial Nerve ; pathology ; Female ; Hemifacial Spasm ; surgery ; Humans ; Magnetic Resonance Imaging ; Microvascular Decompression Surgery ; Middle Aged ; Nerve Compression Syndromes ; diagnosis ; etiology ; surgery ; Vertebral Artery Dissection ; diagnostic imaging ; surgery ; Vestibulocochlear Nerve ; pathology