Clinical Effect of Surgical Reconstruction of Extracranial Vertebral Artery / 中国医学科学院学报

Objective To evaluate the effect of surgical reconstruction of extracranial vertebral artery and to summarize the experience. Methods The clinical data of 15 patients undergoing surgical reconstruction of extracranial vertebral artery from September 2018 to June 2022 were collected.The operation methods,operation duration,intraoperative blood loss,operation complications,and relief of symptoms were retrospectively analyzed. Results Eleven patients underwent vertebral artery (V1 segment) to common carotid artery transposition,two patients underwent endarterectomy of V1 segment,two patients underwent V3 segment to external carotid artery bypass or transposition.The operation duration,intraoperative blood loss,and blocking time of common carotid artery varied within 120-340 min,50-300 ml,and 12-25 min,with the medians of 240 min,100 ml,and 16 min,respectively.There was no cardiac accident,cerebral hyperperfusion syndrome,cerebral hemorrhage or lymphatic leakage during the perioperative period.One patient suffered from cerebral infarction and three patients suffered from incomplete Horner's syndrome after the operation.During the follow-up (4-45 months,median of 26 months),there was no anastomotic stenosis,new cerebral infarction or cerebral ischemia. Conclusion Surgical reconstruction of extracranial vertebral artery is safe and effective,and individualized reconstruction strategy should be adopted according to different conditions.

The far-lateral craniotomy: tips and tricks / A craniotomia extremo-lateral: dicas e truques

This article intends to describe in a didactical and practical manner the suboccipital far-lateral craniotomy. This is then basically a descriptive text, divided according to the main stages involved in this procedure, and that describes with details how the authors currently perform this craniotomy.

O presente artigo visa descrever de forma didática e prática a realização da craniotomia suboccipital extremo-lateral. Trata-se, portanto, de um texto fundamentalmente descritivo, dividido conforme as principais etapas da realização dessa craniotomia, e que descreve com detalhes a técnica com que o presente grupo de autores evolutivamente veio a realizá-la.

Use of Self-Expanding Stents for the Treatment of Vertebral Artery Ostial Stenosis: a Single Center Experience

OBJECTIVE: To evaluate our early experience using self-expanding stents to treat atherosclerotic vertebral artery ostial stenosis (VAOS), with respect to technical feasibility and clinical and imaging follow-up results. MATERIALS AND METHODS: A total of 20 lesions in 20 patients underwent stenting of the VAOS using a self-expanding stent (Precise RX; Cordis Neurovascular, Miami Lakes, FL). Two patients were asymptomatic. We analyzed the technical success rate, causes of technical failure, occurrence of any vascular or neurological event, and the occurrence of any neurological abnormality or in-stent restenosis (ISR) seen on follow-up. The imaging follow-up was performed with Doppler ultrasound (DUS) as a primary screening modality. RESULTS: One instance of technical failure was caused by failure of the guidewire passage. The stent diameter was 5 mm, and post-stenting balloon dilatations were necessary in all cases. Stent misplacement requiring placement of an additional stent occurred in four cases. Following a 14.8 month average clinical follow-up time, two patients showed anterior circulation ischemia, which was not attributed to the VAOS we treated. Following a 13.7 month average DUS follow-up, five patients showed a mild degree of diffuse or focal intimal thickening in the stent lumen; however, none of the stenosis showed luminal loss of more than 50% and no stent fracture was noted. CONCLUSION: The use of self-expanding stents for treating VAOS was technically feasible and helped to improve artery patency during our limited follow-up interval.

Surgical approaches for radical resection of cervical Spine lesions: analytical review and surgical experience with correlation to the vertebral artery. A retrospective study

The management cervical spine lesions, with spinal cord compression and vertebral artery involvement, are problematic both in terms of obtaining adequate resection and stabilisation and ensuring neurovascular compromise. Cervical spine approaches for total resection of the underlying pathology and reconstruction even in a staged operation are still a matter of challenge. Twelve patients with Non traumatic, non spondylotic cervical spine disorders were managed in this study. The cardinal presentation was neck and arm pain with progressive cervical myelopathy. All patients had plain x-rays of cervical spine, cervical spine CT scan MRI. The angiogram was performed to both vertebral arteries when the pathology is in proximity to the vertebral artery. When tumour blush with feeders was evident; endovascular embolisation to minimize intraoperative bleeding was also considered. A single approach or combined anterior and posterior cervical approaches for corpectomy and cage with plate fixation and then posterior fixation for gross total resection of the lesion was considered as indicated. All cases made a good neurological recovery and had no neural or vascular complication. Two patients had superficial wound infection that recovered well. Three patients died; two of them died of their primary malignancy and one died from pulmonary embolism. On the long term follow up, there was no recurrence of the disease or surgical failure of the instrumentation. This report documents a safe and reliable way to deal with non spondylotic, non traumatic cervical spine lesions with preservation of the vertebral arteries in a retrospective manner

Anatomia do sulco da artéria vertebral / Vertebral artery groove anatomy

INTRODUÇÃO: Diversas técnicas cirúrgicas têm sido realizadas na região craniocervical devido a diversas patologias. Durante o acesso cirúrgico a essa região existe um risco potencial de lesão iatrogênica da artéria vertebral, relacionado ao acesso lateral amplo e à avaliação inadequada da anatomia local. Variações no trajeto da artéria vertebral ocasionam maior risco de lesão vascular. O estudo pré-operatório por imagem da anatomia da artéria vertebral e do seu sulco tem sido realizado para aumentar a segurança cirúrgica. OBJETIVO: Estudar a morfometria da artéria vertebral no atlas através da tomografia computadorizada do sulco da artéria vertebral (SAV) em 30 atlas isolados de cadáveres. MATERIAIS E MÉTODOS: O SAV e suas relações com a linha média foram avaliados através de oito medidas lineares e duas angulares, bilateralmente. A média, valor máximo e mínimo, e desvio padrão foram calculados para cada parâmetro. RESULTADOS: O SAV apresentou uma maior largura e maior espessura do lado esquerdo (p<0,05) CONCLUSÃO: os nossos dados sugerem que a dissecção posterior e superior do arco posterior devem permanecer a uma distância lateral de 11,2mm e 7,4mm da linha média para que haja segurança no procedimento.

INTRODUCTION: Several surgical techniques have been carried through in the skull-cervical region due to various pathologies. During the surgical access to this region, a potential risk of iatrogenic injury of the vertebral artery exists, related to extended lateral access and the inadequate evaluation of the local anatomy. Variations in the groove of the vertebral artery lead to a greater risk of vascular injury during surgery. Preoperative image study of the vertebral artery anatomy and its groove has been realized to enhance surgical safety. OBJECTIVE: to study the morphometry of atlas vertebral artery on computed tomography scan images of the vertebral artery groove (VAG) in 30 dry atlas. METHODS: VAG and its relationship with the midline were evaluated through eight linear and two angular measures, bilaterally. The average, maximum and minimum values, and standard deviation were calculated for each parameter. RESULTS: VAG has shown to be wider and thicker on the left side (p<0,05). CONCLUSION: our data suggest that the posterior and superior dissection of the posterior arch must be made at lateral distance of 11,2mm and 7,4mm to the midline in order to provide safety during the procedure.

Arteritis de Takayasu: informe de un caso con compromiso supraaórtico y tratamiento quirúrgico / Takayasu's arteritis: report of a case with supraaortic compromise and surgical treatment

La arteritis de Takayasu es una vasculitis inflamatoria crónica de grandes vasos. Fue descrita por primera vez por el oftalmólogo japonés Nikito Takayasu, en el año 1908. Presentamos un caso de arteritis de Takayasu, diagnosticada clínicamente de acuerdo a los criterios del American College of Rheumatology de 1990. Se trata de una paciente de 23 años que ingresa al Hospital Regional de Talca por un accidente vascular encefálico hemisférico y sintomatología de robo subclavio. Se realiza un angio TAC que muestra compromiso severo (oclusión total) del tercio medio y distal del tronco braquiocefálico, carótida común derecha e inicio de la subclavia derecha. Además, este examen demuestra un flujo retrógrado en la arteria vertebral derecha, compatible con el síndrome de robo subclavio. Se decide corregir la oclusión subclavia mediante angioplastía, sin éxito tanto en el abordaje anterogrado como retrógrado. Finalmente se opta por un bypass protésico (politetrafluoroetileno expandido) desde la carótida común izquierda a la subclavia derecha a través de un túnel subcutáneo en la cara anterior del cuello.

Takayasu's arteritis is a chronic inflammatory vasculitis of large vessels. It was first identified by Japanese ophthalmologist Nikito Takayasu, in 1908. A case of Takayasu's arteritis is presented, clinically diagnosed according to the criteria of the American College of Rheumatology of 1990. This is a 23 year oíd patient, entering Talca's Regional Hospital for a stroke, also presenting symptoms of subclavian steal. An angio CT was made, showing severe commitment (total occlusion) in the middle and distal third of the brachiocephalic trunk, right common carotid and the beginning of right subclavian artery. In addition, this test shows retrograde flow on the right vertebral artery, compatible with the subclavian steal syndrome. It was decided to correct the subclavian occiusion through angioplasty, without success, in both the anterograde and retrograde approach; finally opting for a prosthetic bypass (expanded polytetrafluoroethylene) from left common carotid to right subclavian artery through a tunnel of the subcutaneous front of the neck.

Arteria vertebral extracraneal-porción distal. Aspectos anatómicos de su abordaje quirúrgico / Extracranial vertebral artery-distal portion. Anatomical aspects of its surgical approach

La demostración reciente de la eficacia en el manejo quirúrgico de la porción distal de la arteria vertebral extracreneal provee una alternativa para muchas patologías que afectan esta porción. El tratamiento quirúrgico es el manejo de elección en enfermedad arteriosclerótica, así como en algunas otras condiciones estructurales. Presentamos una técnica quirúrgica, la cual es segura y eficaz en el alivio de la sintomatología, haciéndose énfasis en los aspectos anatómicos.

Anatomía quirúrgica de la arteria vertebral, segmento distal intradural / Surgical anatomy of the vertebral artery, distal and intradural

La anatomía quirúrgica microvascular de las arterias vertebral (distal e intradural), póstero-cerebelosa inferior y de la unión vértebro-basilar es muy variable, por lo que es muy importante delinear algunas guías para la cirugía de aneurismas de estas localizaciones. La arteria vertebral izquierda es dominante, llevando un mayor aporte sanguíneo que la del lado derecho, ocasionando mayor incidencia de aneurismas de ese lado, con una mayor incidencia en mujeres (2:1). Revisamos la antatomía quirúrgica microvascular teniendo en mente el abordaje dorsolateral suboccipita ampliado. Palabras claves: anatomía quirúrgica, anatomía microvascular,arteria vertebral, arteria póstero-cerebelosa inferior, unión vértebro-basilar

Pseudoaneurisma de artéria vertebral: relato de caso clínico / False aneurysm of the vertebral artery: report of a case

Os autores apresentam um caso de pseudoaneurisma da artéria vertebral, pós-trauma, em paciente de 12 anos. O trauma da artéria vertebral é incomum e ocorre em menos de 10 por cento dos traumas vasculares da cabeça e do pescoço, segundo a literatura. O propósito deste relato de caso é chamar a atençao para o diagnóstico arteriográfico, onde devemos estudar também a circulaçao intracraniana, da qual dependerá a escolha do melhor tratamento cirúrgico.

Abordagem transcondilar lateral extrema aos tumores da porçäo anterior da transiçäo occipito-cervical / The extreme lateral transcondylar approach to tumors of the anterior portion of the craniocervical junction

Os tumores localizados ao nível da transiçäo occipito-cervical em posiçäo ventral à medula cervical alta e à medula oblonga säo de difícil abordagem e remoçäo. Essas lesöes têm sido mais comumente tratadas por uma via anterior transoral ou por uma via postero-lateral suboccipital, ambas com as desvantagens sobrepujando as vantagens. Para contornar essas dificuldades, recentemente, foi idealizada uma via cirúrgica alternativa para essa regiäo: a abordagem transcondilar lateral extrema. Contudo, as informaçöes nem sempre claras ou completas contidas nas publicaçöes sobre esta abordagem, a tornam um procedimento de alta complexidade para a maioria dos neurocirurgiöes. A despeito de treinamento laboratorial prévio, encontramos inúmeras dificuldades durante a realizaçäo de 8 dessas abordagens à transiçäo da técnica e de estimular sua maior utilizaçäo, decidimos descrever em detalhes os aspectos anatômicos e técnicos desta via de acesso, com algumas pequenas modificaçöes, enfatizando os pontos críticos para sia realizaçäo adequada

Diagnóstico y tratamiento de la insuficiencia vertebrobasilar de origen extracraneano / Diagnosis and treatment of vertebrobasilar insufficiency of extracraneanal origen

Se presentan 100 casos de insuficiencia vertebrobasilar extracraneana reunidas en un lapso de 25 años por los autores. Se señala que el vértigo y los trastornos en el equilibrio son los síntomas más constantes que se observan en esta patología así como su importancia en el diagnóstico diferencial con las enfermedades del oído. Se reportan buenos resultados (96 por ciento) obtenidos con el empleo de diferentes procedimientos quirúrgicos utilizados en el tratamiento de esta patología.

Cirugía de los troncos supraaórticos por síntomas vertebrobasilares / Surgery of supraaortic main vessels with vertebrobasilar symptoms

Se presenta la experiencia en cirugía de los troncos supraaórticos por síntomas vertebrobasilares. desde julio de 1983 a julio de 1987. La serie está constituída por 24 pacientes. El 83,3% ( 20 pacientes ) quedaron libre de síntomas; de los 4 pacientes sintomáticos, 2 de ellos tienen lesiones que deberían ser corregidas. La morbilidad general fué de 20,8%, sin mortallidad operatoria