Key Clinical MessageBlood blister‐like aneurysms of the supraclinoid portion of the internal carotid artery are rare, fragile, and thin‐walled lesions with a higher rate of rebleeding. Our case underwent a hybrid procedure combining direct surgical and endovascular approach.

Background Spinal intradural (subdural and subarachnoid) hematoma following percutaneous kyphoplasty is an extremely rare complication. In this report, we describe a case of subarachnoid hemorrhage with delayed paralysis after kyphoplasty and review the literature on similar cases to describe the complications of kyphoplasty and vertebroplasty (VP). Case Description An 80-year-old man underwent percutaneous kyphoplasty at a local hospital an osteoporotic vertebral fracture (OVF) at the T12 and L1 level. On the second day after kyphoplasty for T12 OVF, he developed paralysis of the lower limbs. At his initial visit to our clinic, he had a complete loss of sensation below T11 and complete paralysis of both lower extremities. Thoracolumbar magnetic resonance imaging revealed an intradural hematoma on the ventral side of the spinal cord, in the spinal canal from T5 to T12, compressing the spinal cord. Thoracolumbar computed tomography showed a fracture line in the medial cortex of the right pedicle at T12 and a tract from the spinal canal to the vertebral body. An emergency posterior decompression from T11 to L1 was performed. A small hole was found on the right side of the pedicle at T12, and tear of the nerve and subarachnoid hematoma were observed in the vicinity of the T11 nerve root. The subarachnoid hematomas were removed. Postoperatively, the neurological symptoms improved rapidly. Eventually, he was able to walk and was transferred for rehabilitation. Conclusions Percutaneous surgery through the pedicle might cause hematoma and bone cement leakage into the spinal canal. This can be a serious complication: hence prevention is important.

Bow hunter’s syndrome is an ischemic manifestation of vertebrobasilar artery (VA) insufficiency due to stenosis or occlusion of the contralateral VA at the bony elements of the atlas and axis during neck rotation. In early reports, VA stenosis at the craniovertebral junction was the main cause, but later, symptoms due to VA occlusion at the middle and lower cervical vertebrae were also included in this pathology. Although the confirmed diagnosis is usually determined by dynamic digital subtraction angiography (DSA), we have experienced a method of minimally invasive MR angiogram (MRA) that provides the same diagnostic value as DSA and would like to present it here. The patient was a 61-year-old man who had been visiting the outpatient clinic for cervical spondylosis due to neck pain for 9 months. When he rotated his neck to the left side, dizziness and syncope appeared. Initial MRA in the neutral position did not show any steno-occlusive changes in the vertebrobasilar artery. In our hospital, repeated MRA with the neck rotated 45 degrees to the left demonstrated ipsilateral left VA severe stenosis. Subsequent DSA showed the same findings, with occlusion of the left VA. CT of the cervical spine revealed a ventral C3/4 osteophyte within the foramen. Based on these findings, instability at the C3-4 during head rotation was considered the cause of the vertebrobasilar insufficiency. The patient underwent anterior discectomy and fusion (ACDF) at the C3/4 level using a cylindrical titanium cage. Immediately after the surgery, the patient’s symptoms improved dramatically and did not appear even when the neck were fully rotated to the left. More than 5 years have passed since the surgery, and the patient is still in good health.

No abstract

Objective:We report the case of a patient who presented with a subarachnoid hemorrhage as an initial symptom and who underwent parent artery occlusion of the internal carotid artery while maintaining the anterior circulation through the posterior circulation using a stent to treat an anterior-wall aneurysm of the internal carotid artery. Case Presentation:The patient was a 54-year-old female who was brought to our hospital by ambulance with symptoms of headache and vomiting. A cephalic CT scan revealed a subarachnoid hemorrhage. DSA led to a diagnosis of a right internal carotid artery dissection. A balloon occlusion test (BOT) was conducted 2 days after admission, and endovascular treatment was performed 3 days after admission. An Enterprise vascular reconstruction device (VRD) was inserted into the right middle cerebral artery via the posterior communicating artery through the posterior cerebral artery, and a parent artery occlusion, which incorporated the rupture site, was performed proximal to the stent. Conclusion:The number of patients for whom this procedure is indicated is limited, but it may facilitate safe treatment at the distal end of a parent artery occlusion while maintaining the anterior circulation.Keywords▶ anterior-wall aneurysm of the internal carotid artery, subarachnoid hemorrhage, parent artery occlusion, Enterprise vascular reconstruction device