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Surg Neurol Int 2021 8;12:149. Epub 2021 Apr 8.

Department of Neurosurgery, Sapporo Teishinkai Hospital, Higashi-ku, Sapporo, Japan.

Background: Vertebral artery (VA) to middle cerebral artery (MCA) bypass is a rarely selected technique because a complex expanded dissection is required, and often, a better donor artery than VA exists. A good indication for VA-MCA bypass is the treatment of head-and-neck malignancies with the sacrifice of the internal carotid artery (ICA) or for carotid artery rupture.

Methods: A 23-year-old man with epipharyngeal carcinoma, treated by ligating the carotid artery with a VAMCA bypass before chemoradiotherapy, was reported. Read More

Morphologie 2021 May 1. Epub 2021 May 1.

Department of Anatomy, Christian Medical College, Vellore, Tamil Nadu, 632002, India.

Introduction: The temporal bone contains structures related to hearing and balance, and is a valuable learning resource for medical students and trainee surgeons. The middle ear and inner ear are difficult to demonstrate by cadaveric dissection as the structures are closely contained in a small space in the dense temporal bone. Consequently, the teaching and learning of the ear are largely relegated to virtual and theoretical images, and models, which has resulted in a knowledge gap in medical students and prospective surgeons. Read More

Oper Neurosurg (Hagerstown) 2021 May 3. Epub 2021 May 3.

Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.

Microsurgical resection of craniopharyngiomas poses significant challenges, which are amplified with tumors in the retrochiasmatic location and larger size. Traditional pterional trans-sylvian, subfrontal translamia terminalis, or interhemispheric approaches provide narrow surgical corridors with obstructed visualization of the tumor by the prefixed chiasm and slit optic carotid window.1-5 The superior extension of the tumor compressing the hypothalamus and third ventricle are likewise inaccessible. Read More

J Vasc Surg 2021 Apr 30. Epub 2021 Apr 30.

Vascular Surgery Unit, First Department of Propedeutic Surgery, National and Kapodistrian University of Athens, Hippocration Hospital, Athens, Greece.

Introduction: ExtraCranial Carotid artery Aneurysms (ECCAs) are rare, although they are associated with a high stroke and mortality risk if untreated. This review aims to compare major outcomes between open and endovascular repair of ECCAs.

Methods: We systematically searched PubMed, Embase, Scopus, and the Cochrane Library for clinical studies published online up to September 2020 that evaluated major outcomes after both open and endovascular repair of ECCAs. Read More

Oper Neurosurg (Hagerstown) 2021 Apr 30. Epub 2021 Apr 30.

Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.

Chordoma is not a benign disease. It grows invasively, has a high rate of local recurrence, metastasizes, and seeds in the surgical field.1 Thus, chordoma should be treated aggressively with radical resection that includes the soft tissue mass and the involved surrounding bone that contains islands of chordoma. Read More

Oper Neurosurg (Hagerstown) 2021 Apr 29. Epub 2021 Apr 29.

Neurosciences Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.

Giant paraclinoid aneurysm remains a treatment challenge because of their complex anatomy and surgical difficulties stems frequently from a calcified or atherosclerotic aneurysmal neck and compression of the optic pathways.1-9 To improve exposure, facilitate the dissection of the aneurysm, assure vascular control, reduce brain retraction and temporary occlusion time, and enable simultaneous treatment of possible associated aneurysms, we combined the cranio-orbital zygomatic (COZ) approach9 with endovascular balloon occlusion of the internal carotid artery (ICA) and suction decompression of the aneurysm.4 The patient is a 50-yr-old female who presented with headache and hemianopsia. Read More

Brain Sci 2021 Apr 19;11(4). Epub 2021 Apr 19.

Department of Neurosurgery, Asenjo Neurosurgical Institute, Santiago 7500691, Chile.

The study of cerebrovascular anatomy can be difficult and may take time due to its intrinsic complexity. However, it can also be difficult for the following reasons: the excessive description of neuroanatomy making articles hard to read, the unclear clinical application of what is written, the use of simplified or intricate schematic drawings that are not always appropriate for effective teaching, the poor quality of neuroanatomy dissections and the use of unusual views of figures that are not strictly related to the most frequent neuroimages to be interpreted in daily practice. Because of this, we designed an article that incorporates original and accurate anatomical dissections in an attempt to improve its comprehensibility. Read More

Ann Vasc Surg 2021 Apr 26. Epub 2021 Apr 26.

APHM, Timone Hospital, Department of Vascular Surgery, 13005, Marseille, France.

We report the case of a 57-year-old woman diagnosed with an asymptomatic chronic type B aortic dissection. The maximum aortic diameter was 70 mm in the proximal descending thoracic aorta. The entry tear was located at the aortic isthmus, and the proximal neck included all of the supra-aortic trunks. Read More

Eur J Radiol 2021 Apr 14;139:109723. Epub 2021 Apr 14.

Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yishan Road, Shanghai, 200233, China. Electronic address:

Purpose: To compare the extent of arterial wall damage when SR and CA were used for treatment of AIS models to evaluate their efficacy and safety.

Methods: A thrombin-induced thrombus was pre-injected into the right distal external carotid-maxillary artery (ECMA) in 12 dogs to create an acute thrombus occlusion model and were randomly divided into the SR group (n = 6; received SR treatment) and CA group (n = 6; received CA treatment). Device safety was also assessed by five passages through the normal left ECMA using each device. Read More

Neurol India 2021 Mar-Apr;69(2):478-479

Department of Neurology, Military Hospital of Tunis, Monfleury, Tunis, Tunisia.

Background: Cervical artery dissections are not exceptional in the pediatric population. Typically, it affects the internal carotid artery or the vertebral artery. To our knowledge, this is the first case of common carotid artery (CCA) dissection in a child. Read More

Multimed Man Cardiothorac Surg 2021 04 21;2021. Epub 2021 Apr 21.

Department of Cardiothoracic surgery, St. Antonius Hospital, Nieuwegein, The Netherlands.

To create an optimal landing zone (zone 2) in the aortic arch for concomitant or subsequent thoracic endovascular aortic repair of aortic diseases (aneurysm, dissection), surgeons frequently need to debranch the supra-aortic vessels. We present in this video tutorial an alternative to our video tutorial for surgical debranching of the left subclavian artery in which we used a central approach. When the proximal left subclavian artery is dissected or shows dense adhesions around its proximal, centrally located section, it can be helpful to stretch this bypass to the infraclavicular part of the left subclavian artery. Read More

Multimed Man Cardiothorac Surg 2021 04 21;2021. Epub 2021 Apr 21.

Department of Cardiothoracic surgery, St. Antonius Hospital, Nieuwegein, The Netherlands.

To create an optimal landing zone (zone 2) in the aortic arch for concomitant or subsequent thoracic endovascular aortic repair of aortic diseases (aneurysm, dissection), surgeons frequently need to debranch the supra-aortic vessels. We present a surgical debranching of the left subclavian artery by performing a centrally located bypass from the left common carotid artery to the left subclavian artery. Read More

Multimed Man Cardiothorac Surg 2021 04 21;2021. Epub 2021 Apr 21.

Department of Cardiothoracic surgery, St. Antonius Hospital, Nieuwegein, The Netherlands.

To create an optimal landing zone (zone 2) in the aortic arch for concomitant or subsequent thoracic endovascular aortic repair of aortic diseases (aneurysm, dissection), surgeons frequently need to debranch the supra-aortic vessels. In this video tutorial, we present an alternative to our 2 other video tutorials for surgical debranching of the left subclavian artery (link; link). Depending on patient-specific characteristics, surgical preference and local experience, the surgeon chooses the approach. Read More

Cureus 2021 Mar 22;13(3):e14035. Epub 2021 Mar 22.

Internal Medicine, University of Central Florida College of Medicine, Ocala, USA.

Internal carotid artery dissection (ICAD) is a known but uncommon cause of ischemic stroke among young and middle-aged patients. A common presentation includes ipsilateral headache, unilateral oculosympathetic palsy (partial Horner syndrome), or ischemic stroke but some reported cases present with less common manifestations, such as lower cranial nerve syndrome (IX, X, XI, XII). However, third cranial nerve palsy is an extremely rare presentation of ICAD. Read More

Acta Neurol Belg 2021 Apr 23. Epub 2021 Apr 23.

Department of Neurology, Cerrahpasa School of Medicine, İstanbul University, Istanbul, Turkey.

Headache is a common symptom of cervical artery dissections (CAD). Sometimes, it can be the only symptom and mimic migraine. We aimed to investigate headache characteristics and previous history of migraine in CAD patients, and to compare headache features between patients with internal carotid artery dissection (ICAD) and vertebral artery dissection (VAD). Read More

Clin Appl Thromb Hemost 2021 Jan-Dec;27:10760296211002274

Department of Neurology, Comprehensive Stroke Center Program, Cedars-Sinai Medical Center, Los Angeles, CA, USA.

The purpose of this article is to address several challenging questions in the management of young patients (those age 60 and under) who present with ischemic stroke. Do genetic thrombophilic states, strongly associated with venous thrombosis, independently cause arterial events in adults? Should cases of patent foramen ovale be closed with mechanical devices in patients with cryptogenic stroke? What are the optimal treatments for cerebral vein thrombosis, carotid artery dissection, and antiphospholipid syndrome and are DOACs acceptable treatment for these indications? What is the mechanism underlying large vessel stroke in patients with COVID-19? This is a narrative review. We searched PubMed and Embase and American College of physicians Journal club database for English language articles since 2000 looking mainly at randomized clinical trials, Meta analyses, Cochran reviews as well as some research articles viewed to be cutting edge regarding anticoagulation and cerebrovascular disease. Read More

J Vasc Surg 2021 Apr 15. Epub 2021 Apr 15.

Aortic Center, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Université Paris Saclay, France.

Purpose: To evaluate the outcomes of total endovascular aortic arch repair using three-vessel inner branch stent-grafts for aneurysms and chronic dissections.

Methods: We reviewed the clinical data and outcomes of consecutive patients treated by total endovascular aortic arch repair at eight academic centers using three-vessel inner branch stent-grafts (William Cook Europe, Bjaeverskov, Denmark) between 2016 to 2019. All patients received three vessel designs with two antegrade and one retrograde inner branch, which was used to incorporate the innominate (IA), left common carotid (LCCA) and left subclavian arteries (LSA). Read More

J Clin Neurosci 2021 May 1;87:26-28. Epub 2021 Mar 1.

Department of Radiology, Liv Hospital, Yuksek Ihtisas University, Kavaklidere Avenue Bestekar Road No:8, Cankaya, Ankara 06680, Turkey.

The "Corona Virus Disease 2019 (COVID-19)", caused by severe acute respiratory coronavirus 2 (SARS-CoV-2), progressed rapidly since its first outbreak, and quickly developed into a pandemic. Although COVID-19 mostly presents with respiratory symptoms, researchers have started reporting neurologic manifestations such as cerebrovascular diseases in patients, with COVID-19 as the pandemic has progressed. Herein, we report a case of 38-year-old female patient identified with a left common carotid artery dissection, with COVID-19. Read More

Oper Neurosurg (Hagerstown) 2021 Apr 16. Epub 2021 Apr 16.

Far East Neurosurgical Institute, Sapporo Teishinkai Hospital, Sapporo, Japan.

Despite technological advances in endovascular therapy, surgical clipping of paraclinoid aneurysms remains an indispensable treatment option and has an acceptable profile risk. Intraoperative monitoring of motor and somatosensory evoked potentials has proven to be an effective tool in predicting and preventing postoperative motor deficits during aneurysm clipping.1,2 We describe the case of a 61-yr-old Japanese woman with a history of hypertension and smoking. Read More

Oper Neurosurg (Hagerstown) 2021 Apr 16. Epub 2021 Apr 16.

Department of Neurosurgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan.

Background: The inferior petroclival vein (IPV) courses along the extracranial surface of the petroclival fissure. It is occasionally involved in vascular diseases and has recently been used for vascular access to the cavernous sinus. However, detailed descriptions of its anatomy are currently lacking. Read More

J Med Case Rep 2021 Apr 15;15(1):168. Epub 2021 Apr 15.

Division of Vascular Surgery and Endovascular Therapy, Rutgers Robert Wood Johnson School of Medicine, One Robert Wood Johnson Place, MEB 541, New Brunswick, NJ, 08901, USA.

Background: Thoracic endovascular aortic repair (TEVAR) is the gold standard for surgical management of descending thoracic aortic pathology. Depending on the anatomy, TEVAR often requires deployment across the origin of the left subclavian artery (LSA) to obtain a proximal seal, thus potentially compromising perfusion to the left upper extremity (LUE). However, in most patients this is generally well tolerated without revascularization due to collateralization from the left vertebral artery (LVA). Read More

Int J Med Sci 2021 3;18(9):2017-2022. Epub 2021 Mar 3.

Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.

Blood blister-like aneurysms (BBAs) are rare and usually appear at nonbranching sites in the supraclinoid portion of the internal carotid artery (ICA). Because it is difficult to obtain histological specimens of the aneurysm wall and because experimental models are challenging to establish, the pathogenesis of BBAs remains uncertain. In this paper, we reviewed the diagnostic, radiological, and pathophysiological characteristics of patients with BBAs. Read More

Am J Case Rep 2021 Apr 12;22:e930291. Epub 2021 Apr 12.

University of Nevada, Reno School of Medicine, Reno, NV, USA.

BACKGROUND National guidelines and consensus statements suggest a 24-hour window for endovascular recanalization in patients presenting with acute ischemic stroke due to large-vessel occlusion. However, the safety and efficacy of extending the window for intervention remains to be definitively established. CASE REPORT A healthy 26-year-old woman presented with headache, left-sided hemiplegia, and rightward gaze palsy 2 days after a minor trauma. Read More

Angiol Sosud Khir 2021 ;27(1):65-71

Scientific Research Laboratory of Surgery for Cardiac Defects and Ischaemic Heart Disease, National Medical Research Centre named after V.A. Almazov under the RF Ministry of Public Health, Saint Petersburg, Russia.

Presented herein is a clinical case report concerning successful simultaneous surgical treatment of a female patient with a complication after transcatheter treatment for chronic dissection of the descending portion of the thoracic aorta. The woman was subjected to elective transcatheter isolation of chronic dissection of the descending thoracic aorta using a stent graft with complete coverage of the zone of the origin of the left subclavian artery. Repeat control imaging studies several months after the intervention revealed residual blood flow through the false channel, directed retrogradely from the distal edge of the stent graft to the left subclavian artery. Read More

Cureus 2021 Mar 1;13(3):e13640. Epub 2021 Mar 1.

Anesthesiology, Westchester Medical Center, Valhalla, USA.

An alarming and distressing delayed inflammatory response to Coronavirus Disease 2019 (COVID-19) has emerged in children and adolescents, a population previously thought to have been largely spared by this global pandemic. In April 2020, clinicians in the United Kingdom identified eight cases of previously healthy children testing positive for current or recent infection with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) presenting with Kawasaki disease-like features. From April 16 to May 4, 2020, New York City reported that 15 patients aged 2-15 years were hospitalized with a similar multisystem inflammatory syndrome, many requiring intensive care unit (ICU) admission. Read More

Surg Oncol 2021 Apr 1;37:101555. Epub 2021 Apr 1.

The Department of Vascular Surgery, Sant'Anna Hospital, Catanzaro, Italy.

Background: Carotid body tumor (CBT) is a slow-growing tumor arising from the carotid body, a chemoceptor organ lying behind the carotid artery bifurcation. Although rarely, metastases can occur distally through the hematogenous route and through the lymphatic route.to the cervical lymphnodes. Read More

Asian Cardiovasc Thorac Ann 2021 Apr 4:2184923211008074. Epub 2021 Apr 4.

Regional Vascular Unit, University Hospital of Wales, Cardiff, UK.

Introduction: Thoracic endovascular aortic repair (TEVAR) has become an accepted treatment for thoracic aortic disease. However, the principal complications relate to coverage of the thoracic aortic wall and deliberate occlusion of aortic branches over a potentially long segment. Complications include risk of stroke, spinal cord ischaemia (SCI) and arterial insufficiency to the left arm (left arm ischaemia (LAI)). Read More

Vascular 2021 Apr 4:17085381211002735. Epub 2021 Apr 4.

Department of Surgery, Yale School of Medicine, Connecticut, New Haven, CT, USA.

Objectives: We present a case in which a 44-year-old female smoker with a complex medical and surgical history presented with acute upper limb ischemia.

Methods: The patient was diagnosed with thoracic outlet syndrome causing symptomatic thrombosis of an aberrant right subclavian artery associated with diverticulum of Kommerell. The patient had history of extensive surgeries and radiation in the right chest with fibrotic changes, so surgical dissection in the area was associated with significant risk of nerve injury. Read More

Am J Med 2021 Mar 31. Epub 2021 Mar 31.

Department of Radiology, General Hospital of Serres, Serres, Greece.

Gen Thorac Cardiovasc Surg 2021 Apr 2. Epub 2021 Apr 2.

Department of Cardiac Surgery, Aichi Medical University Hospital, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan.

Objectives: Acute type A aortic dissection complicated with brain ischemia is associated with significantly higher mortality risks. Even if rescued with central aortic repair, some patients develop permanent postoperative neurological deficiency postoperatively. We recently introduced direct common carotid artery perfusion for acute type A aortic dissection involving the common carotid artery. Read More