Basilar Artery Occlusion Following C1 Lateral Mass Fracture Managed by Mechanical and Pharmacological Thrombolysis

Sugrue, Patrick A.; Hage, Ziad A.; Surdell, Daniel L.; Foroohar, Mina; Liu, John; Bendok, Bernard R.

doi:10.1007/s12028-008-9159-7

Cited by 13 publications

(10 citation statements)

References 39 publications

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“…41 It will be possible to reach the three portions of the AICA feasibly, and enhanced visualization will decrease potential damage to the BA. 42 Endoscopic approaches for clipping aneurysms are a recent development, and prospective studies are needed to determine long-term effectiveness.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Endonasal Transclival Approach versus Dual Transorbital Port Technique for Clip Application to the Posterior Circulation: A Cadaveric Anatomical and Cerebral Circulation Simulation Study

et al. 2016

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Simulation training offers a useful opportunity to appreciate vascular anatomy and develop the technical expertise required to clip intracranial aneurysms of the posterior circulation. In cadavers, a comparison was made between the endoscopic transclival approach (ETA) alone and a combined multiportal approach using the ETA and a transorbital precaruncular approach (TOPA) to evaluate degrees of freedom, angles of visualization, and ergonomics of aneurysm clip application to the posterior circulation depending on basilar apex position relative to the posterior clinoids. ETA alone provided improved access to the posterior circulation when the basilar apex was high riding compared with the posterior clinoids. ETA + TOPA provided a significantly improved functional working area for instruments and visualization of the posterior circulation for a midlevel basilar apex. A single-shaft clip applier provided improved visualization and space for instruments. Proximal and distal vascular control and feasibility of aneurysmal clipping were demonstrated. TOPA is a medial orbital approach to the central skull base; a transorbital neuroendoscopic surgery approach. This anatomical simulation provides surgical teams an alternative to the ETA approach alone to address posterior circulation aneurysms, and a means to preoperatively prepare for intraoperative anatomical and surgical instrumentation challenges.

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Section: Discussionmentioning

confidence: 99%

Endoscopic Endonasal Transclival Approach versus Dual Transorbital Port Technique for Clip Application to the Posterior Circulation: A Cadaveric Anatomical and Cerebral Circulation Simulation Study

et al. 2016

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“…Traumatic vertebral artery dissection is one of the most common causes of acute BAO in young patients and should be suspected in patients presenting with cervical pain with or without headache and neurological deterioration. 20 Rarer causes which are more specific to the posterior circulation include cervical spine or skull base fracture, cervical instability, 21,22 arteritis, meningitis, aneurysms, hereditary arteriopathies, and neurosyphilis. 23 Behcet vasculitis more commonly involves the posterior circulation.…”

Section: Mechanisms For Baosmentioning

confidence: 99%

Basilar Occlusion Syndromes

Demel

Broderick

2015

The Neurohospitalist

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Basilar artery occlusions (BAOs) are a subset of posterior circulation strokes. Particular issues relevant to BAOs include variable and stuttering symptoms at onset resulting in delays in diagnosis, high morbidity and mortality, and uncertain best management. Despite better imaging techniques, diagnosis, and therefore treatment, is often delayed. We will present the most common signs and symptoms of posterior circulation strokes. Data on optimal treatment strategies are gathered from multiple case series, registries, and one randomized trial, which was stopped early. Possible etiologies of BAOs, acute, and subacute treatment strategies and special topics in neuroimaging of the posterior fossa are discussed. This review may be helpful to neurohospitalists who are managing patients with acute stroke as well as emergency room physicians and neurologists.

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“…A case of local intra-arterial thrombolysis in a moribund patient with TVAI and clot that occluded the entire right vertebral artery as far as the basilar tip reports successful outcome, with the patient returning to employment [45]. The current experience with thrombolysis is limited and its use is currently as a last resort in patients with a large demonstrable intravascular clot and poor neurological condition [46,47]. As experience of the technique increases, it may be possible to develop a list of radiological findings predictive of effective thrombolysis.…”

Section: Conventional Treatment Of Tvaimentioning

confidence: 99%

Blunt traumatic vertebral artery injury: a clinical review

et al. 2011

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Blunt traumatic vertebral injury (TVAI) is frequently associated with head and neck injury and is being detected with increasing frequency due to improved imaging of the trauma patient. In a few cases, it can lead to potentially fatal posterior circulation ischaemia There is debate in the literature regarding whether TVAI should be actively screened for and, if so, how. Management of TVAI may be conservative, medical (antiplatelet agents or anticoagulation), endovascular or open surgery. We review the literature concerning the mechanisms and presentation of TVAI following blunt injury and the current screening recommendations. Management strategies proposed are based on the radiological grade and clinical severity of TVAI, where high-grade symptomatic injuries and highgrade injuries in patients where anticoagulation is contraindicated are treated endovascularly and asymptomatic or low-grade injuries are managed with anticoagulation where it is not contraindicated. Follow-up is via CT angiography to assess for resolution of the injury.

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Basilar Artery Occlusion Following C1 Lateral Mass Fracture Managed by Mechanical and Pharmacological Thrombolysis

Cited by 13 publications

References 39 publications

Endoscopic Endonasal Transclival Approach versus Dual Transorbital Port Technique for Clip Application to the Posterior Circulation: A Cadaveric Anatomical and Cerebral Circulation Simulation Study

Endoscopic Endonasal Transclival Approach versus Dual Transorbital Port Technique for Clip Application to the Posterior Circulation: A Cadaveric Anatomical and Cerebral Circulation Simulation Study

Basilar Occlusion Syndromes

Blunt traumatic vertebral artery injury: a clinical review

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