Ahead of Print: Surgery for Complex Basilar Aneurysms

Background: Giant aneurysms of the vertebral and basilar arteries are formidable lesions to treat.

Objective: To evaluate the long-term outcomes of patients with vertebrobasilar aneurysms treated with extracranial-intracranial (EC-IC) bypass and flow reduction.

Methods: We retrospectively reviewed a prospective database of aneurysms cases treated between December 1993 and August 2011.

Ahead of Print: Extracranial Carotid-Vertebral Bypass for Endovascular Access to Complex Posterior Circulation Aneurysms

Background: Endovascular embolization is a desirable treatment option for complex posterior circulation aneurysms, particularly recurrent aneurysms or those in difficult to access surgical locations.However, endovascular access is occasionally prohibited by proximal vertebral artery (VA) occlusion or vessel tortuosity.One strategy in such instances involves creation of an extracranial bypass conduit to the distal VA.

Objective: To describe a novel strategy to allow for endovascular treatment of aneurysms at high risk for direct surgery.

Methods: Three cases of carotid-VA bypass performed to provide endovascular access to posterior circulation aneurysms were identified. The clinical indications, radiographic characteristics, operative technique and outcomes were reviewed.

Ahead of Print: Bilateral Vertebral Dissecting Aneurysms

Background: Optimal management of bilateral vertebral artery dissecting aneurysms (bi-VDA) causing subarachnoid hemorrhage (SAH) remains unclear.

Objective: To investigate the treatment methods and outcomes of bi-VDA causing SAH.

Methods: Seven patients were endovascularly treated for bi-VDA causing SAH. Treatment methods and outcomes were retrospectively evaluated.

Ahead of Print: Flow Diverter Stent for Ruptured Intracranial Dissecting Aneurysm of Vertebral Artery

Background: The treatment of ruptured dissecting aneurysms of the intracranial vertebral artery (VA) with parent vessel preservation is a challenge for neurosurgeons and interventional neuroradiologists.

Objective: To propose an indication of flow diversion treatment for the reconstruction of a dissecting VA with acute subarachnoid haemorrhage (SAH).

Methods: 2 male patients transferred after acute SAH and dissecting aneurysm on the V4 segment of the dominant VA. An occlusion test was not performed because of their poor clinical state. A flow diverter stent (FDS) represented by the Pipeline embolization device (PED) was suggested to both patients.

Ahead of Print: Long-Term Angiographic and Clinical Outcome Following Stenting by Flow Reversal Technique for Chronic Occlusions Older Than 3 Months of the Cervical Carotid or Vertebral Artery

Full article access for Neurosurgery subscribers at Neurosurgery-Online.com.

BACKGROUND: Long-term angiographic and clinical outcome following stenting by flow reversal technique (FRT) for chronic occlusions (COs) of the cervical internal carotid artery (ICA) or vertebral artery (VA) is unknown.

OBJECTIVE: The aim of our retrospective study was to investigate the feasibility, safety and long-term outcome of stenting by FRT for COs of the cervical ICA or VA.

METHODS: Included for analysis were patients (1) who underwent stenting for CO older than 3 months of the ICA or VA by FRT, and (2) who finished at least one-year follow-up angiographic and clinical investigation. Criteria of stenting for CO in the ICA or VA were patients (1) who experienced minor strokes, a transient ischemic attack, or transient symptoms probably due to hemodynamic compromise or insufficiency, (2) with angiographic complete occlusion of the ICA or VA, and (3) with occlusion limited in the cervical area of the affected artery.