RESUMEN
The focus of this case report is to technically describe a noninvasive diagnostic evaluation of bow Hunter's syndrome using a dynamic computed tomography angiography protocol and discuss its advantages. In addition, we aimed to exemplify the quality of the study by presenting images of a 3D-printed model generated to help plan the surgical treatment for the patient. The dynamic computed tomography angiography protocol consisted of a first image acquisition with the patient in the anatomic position of the head and neck. This was followed by a second acquisition with the head and neck rotated to the side that triggered the symptoms, with technical parameters similar to the first acquisition. The acquired images were used to print a 3D model to better depict the findings for the surgical team. The dynamic computed tomography angiography protocol developed in this study helped visualize the vertebrobasilar arterial anatomy, detect vertebral artery stenosis produced by head and neck rotation, depict the structure responsible for artery stenosis (e.g., bony structure or membranes), and study possible complications of the disease (e.g., posterior cerebral circulation infarction). Additionally, the 3D-printed model better illustrated the findings of stenosis, aiding in surgical planning. In conclusion, dynamic computed tomography angiography for the evaluation of bow Hunter's syndrome is a feasible noninvasive technique that can be used as an alternative to traditional diagnostic methods.
Asunto(s)
Angiografía por Tomografía Computarizada , Insuficiencia Vertebrobasilar , Humanos , Angiografía por Tomografía Computarizada/métodos , Insuficiencia Vertebrobasilar/diagnóstico por imagen , Insuficiencia Vertebrobasilar/cirugía , Masculino , Arteria Vertebral/diagnóstico por imagen , Imagenología Tridimensional/métodos , Impresión TridimensionalRESUMEN
Bow Hunter's syndrome is a rare cause of posterior circulation ischemia, produced by the mechanical and reversible occlusion of the vertebral artery during cephalic rotation. Diagnosis requires clinical suspicion and careful inspection of images with three-dimensional reconstruction. The study of choice is dynamic digital subtraction angiography (DSA). Treatment alternatives are: medical, surgical or endovascular. We report the case of an 8-year-old boy with recurrent infarctions of the posterior circulation secondary to the dissection of the vertebral artery, in association with an occipital bone spur. Dynamic DSA was negative. Conservative initial management was elected with cervical immobilization and anticoagulation, but due to persistence of symptoms, surgical decompression was decided. The patient did not repeat symptoms postoperatively and returned to his usual life. This is the first case reported to our knowledge of a surgical pediatric patient with asymptomatic atypical compression of VA secondary to BHS, whose dynamic angiography was negative, suggesting an alternative mechanism of the syndrome.
Asunto(s)
Mucopolisacaridosis II , Insuficiencia Vertebrobasilar , Masculino , Humanos , Niño , Insuficiencia Vertebrobasilar/diagnóstico por imagen , Insuficiencia Vertebrobasilar/etiología , Insuficiencia Vertebrobasilar/cirugía , Mucopolisacaridosis II/complicaciones , Arteria Vertebral/diagnóstico por imagen , Arteria Vertebral/cirugía , Descompresión Quirúrgica/métodos , Angiografía de Substracción DigitalRESUMEN
PURPOSE: To review the literature, analyze and discuss diagnostic and treatment options for the Bowhunter Syndrome. A clinical case of idiopathic rotatory C1-C2 subluxation causing dynamic vertebral artery occlusion is presented. METHODS: Literature review between 1960 and 2019, discussion of diagnostic methods and treatment options. Description of diagnostic and treatment methods in the aforementioned case. RESULTS: We present a patient with dynamic left vertebral artery occlusion associated with idiopathic rotatory C1-C2 subluxation. A dynamic Angio-CT showed rotatory C1-C2 subluxation with significant flow reduction at the left vertebral artery at the exit of the C2 transverse foramen until the V3 segment when the head rotated towards the right. Due to clinical and radiological worsening in the following months, posterior C1-C2 arthrodesis was performed, with the disappearance of the symptoms. There are 193 cases reported with dynamic vertebral artery occlusion, but in only two, the etiology was primary rotational atlantoaxial instability. The most prevalent etiology was degenerative. CONCLUSION: Rotatory vertebral artery occlusion is a rare condition presented mostly in adults, aged 50-70 years. Vertebrobasilar insufficiency is triggered by the rotation of the head to the contralateral side of the dominant vertebral artery. Dynamic subtraction angiography is considered the diagnostic gold-standard method, but dynamic Angio-CT scan, Angio-MRI, or Doppler ultrasonography are less invasive options. The treatment options are conservative or surgical. Endovascular surgery is another option in specific cases.
Asunto(s)
Luxaciones Articulares , Mucopolisacaridosis II , Insuficiencia Vertebrobasilar , Adulto , Humanos , Rotación , Arteria Vertebral/diagnóstico por imagen , Arteria Vertebral/cirugía , Insuficiencia Vertebrobasilar/diagnóstico por imagen , Insuficiencia Vertebrobasilar/etiología , Insuficiencia Vertebrobasilar/cirugíaRESUMEN
BACKGROUND: Acute basilar artery occlusion is a devastating life-threatening condition. Early recanalization is the therapeutic goal in patients with acute ischemic stroke. Despite the high rates of recanalization achieved with modern devices for basilar occlusions, many patients have had poor clinical outcomes. This study aimed to assess the predictors of good and poor outcomes among patients with basilar artery occlusion treated with thrombectomy. METHODS: A consecutive registry of 80 patients was included in this retrospective study. The primary end point was to access variables associated with neurologic outcomes defined by a modified Rankin Scale (mRS) score of 0-2, symptomatic intracranial hemorrhage (sICH), and mortality at 3 months follow-up. RESULTS: Recanalization was achieved in 86.2%, and the sICH rate was 8.7%. A good neurologic outcome (mRS score 0-2) was observed in 26.2% and a moderate outcome (mRS score 0-3) in 32.5% of patients. The mortality was 38.7% at 3 months follow-up. CONCLUSIONS: After thrombectomy for posterior circulation strokes, young patients, V4-proximal basilar occlusion, (high) baseline posterior circulation Alberta Stroke Program Early CT Score, and complete recanalization were independent predictors of good neurologic outcomes. Failure to recanalize was strongly related to sICH and mortality. In addition, diabetes, atrial fibrillation, and baseline National Institutes of Health Stroke Scale scores ≥10 had an independent association with mortality. This study contributes to the knowledge required to optimize recanalization treatments for posterior circulation strokes and may help to improve future clinical studies.
Asunto(s)
Isquemia Encefálica/cirugía , Hemorragias Intracraneales/cirugía , Accidente Cerebrovascular/cirugía , Trombectomía , Insuficiencia Vertebrobasilar/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Arteriopatías Oclusivas/etiología , Arteriopatías Oclusivas/cirugía , Isquemia Encefálica/etiología , Brasil , Procedimientos Endovasculares/métodos , Femenino , Humanos , Hemorragias Intracraneales/etiología , Masculino , Persona de Mediana Edad , Sistema de Registros , Factores de Riesgo , Trombectomía/efectos adversos , Trombectomía/métodos , Resultado del TratamientoRESUMEN
This report describes a solution for a restenosis and for the fracture of a stent in the vertebral artery in a patient suffering from vertebrobasilar symptoms. Angiography demonstrates restenosis of a vertebral stent as well as its fracture and migration into the subclavian artery. This complication was managed percutaneously by passing a guide wire through the fractured stent. Pre-dilatation and kissing balloon techniques were applied in both the vertebral and subclavian arteries to modify the stent's dimensions and shape it into the form of a "ring." Postprocedural angiography demonstrated an excellent final result with the assistance of StentBoost visualization. Control angiography at six months also utilized StentBoost imaging and confirmed the patency of the bifurcation and that the stent was not displaced.
Asunto(s)
Falla de Prótesis , Stents/efectos adversos , Insuficiencia Vertebrobasilar/cirugía , Anciano , Femenino , Migración de Cuerpo Extraño , Humanos , Recurrencia , Arteria Subclavia , Procedimientos Quirúrgicos Vasculares/métodosRESUMEN
Herein a case is described of a 54-years old patient, HIV negative, with cerebro-vascular disease by basilar artery thrombosis secondary to meningovascular neurosyphilis. Neurosyphilis is the impairment at any stage of the central nervous system by Treponema pallidum subspecies pallidum and includes asymptomatic and symptomatic forms of infection. The presentation can take many forms, depending on the location and extent of tissue damage. The currently recommended treatment is crystalline penicillin, 4 million units every 4 hours for 14 days.
Asunto(s)
Meningitis/etiología , Neurosífilis/complicaciones , Trombosis/etiología , Vasculitis/etiología , Insuficiencia Vertebrobasilar/etiología , Alcoholismo/complicaciones , Antibacterianos/uso terapéutico , Terapia Combinada , Disartria/etiología , Urgencias Médicas , Procedimientos Endovasculares , Seronegatividad para VIH , Humanos , Hipertensión/complicaciones , Imagen por Resonancia Magnética , Masculino , Meningitis/tratamiento farmacológico , Persona de Mediana Edad , Neurosífilis/tratamiento farmacológico , Paresia/etiología , Penicilina G/uso terapéutico , Stents , Trombectomía , Trombosis/diagnóstico por imagen , Trombosis/tratamiento farmacológico , Trombosis/cirugía , Tomografía Computarizada por Rayos X , Vasculitis/tratamiento farmacológico , Insuficiencia Vertebrobasilar/diagnóstico , Insuficiencia Vertebrobasilar/diagnóstico por imagen , Insuficiencia Vertebrobasilar/cirugíaRESUMEN
Se presenta el caso clínico de un paciente de 54 años, negativo para VIH, con enfermedad cerebrovascular por trombosis de la arteria basilar, secundaria a neurosífilis meningovascular. La neurosífilis es el compromiso del sistema nervioso central por Treponema pallidum subespecie pallidum en cualquier estadio de la entidad e incluye las formas asintomáticas y sintomáticas de la infección; sus formas de presentación son diversas y dependen de la localización y la extensión de las lesiones. La recomendación actual es el tratamiento con 4 millones de unidades de penicilina cristalina cada 4 horas por 14 días.
Herein a case is described of a 54-years old patient, HIV negative, with cerebro-vascular disease by basilar artery thrombosis secondary to meningovascular neurosyphilis. Neurosyphilis is the impairment at any stage of the central nervous system by Treponema pallidum subspecies pallidum and includes asymptomatic and symptomatic forms of infection. The presentation can take many forms, depending on the location and extent of tissue damage. The currently recommended treatment is crystalline penicillin, 4 million units every 4 hours for 14 days.
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Meningitis/etiología , Neurosífilis/complicaciones , Trombosis/etiología , Vasculitis/etiología , Insuficiencia Vertebrobasilar/etiología , Alcoholismo/complicaciones , Antibacterianos/uso terapéutico , Terapia Combinada , Disartria/etiología , Urgencias Médicas , Procedimientos Endovasculares , Seronegatividad para VIH , Hipertensión/complicaciones , Imagen por Resonancia Magnética , Meningitis/tratamiento farmacológico , Neurosífilis/tratamiento farmacológico , Paresia/etiología , Penicilina G/uso terapéutico , Stents , Trombectomía , Tomografía Computarizada por Rayos X , Trombosis/tratamiento farmacológico , Trombosis , Trombosis/cirugía , Vasculitis/tratamiento farmacológico , Insuficiencia Vertebrobasilar/diagnóstico , Insuficiencia Vertebrobasilar , Insuficiencia Vertebrobasilar/cirugíaAsunto(s)
Arteria Basilar/anomalías , Tronco Encefálico , Descompresión Quirúrgica , Enfermedades del Nervio Trigémino/etiología , Insuficiencia Vertebrobasilar/cirugía , Angiografía Coronaria/métodos , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Síndrome , Tomografía Computarizada por Rayos X , Enfermedades del Nervio Trigémino/cirugía , Neuralgia del Trigémino/diagnóstico , Insuficiencia Vertebrobasilar/complicacionesAsunto(s)
Humanos , Masculino , Persona de Mediana Edad , Tronco Encefálico , Arteria Basilar/anomalías , Descompresión Quirúrgica , Enfermedades del Nervio Trigémino/etiología , Insuficiencia Vertebrobasilar/cirugía , Angiografía Coronaria/métodos , Imagen por Resonancia Magnética , Síndrome , Tomografía Computarizada por Rayos X , Enfermedades del Nervio Trigémino/cirugía , Neuralgia del Trigémino/diagnóstico , Insuficiencia Vertebrobasilar/complicacionesRESUMEN
Our purpose is to report a case of trigeminal neuralgia caused by vertebrobasilar dolichoectasia treated with microvascular decompression. A 63-year-old man sought treatment for a recurrent lancinating left facial pain in V2 and V3 trigeminal territories. The computed tomography angiography revealed a mechanical compression of the left trigeminal nerve due to vertebrobasilar dolichoectasia. The patient was submitted to a left suboccipital craniotomy. Shredded Teflon was introduced in the conflicting neurovascular area, achieving a satisfactory decompression. The patients pain resolved immediately. Vertebrobasilar dolichoectasia is a rare cause of trigeminal neuralgia and a successful outcome can be achieved with microvascular decompression.
Asunto(s)
Descompresión Quirúrgica/métodos , Nervio Trigémino , Neuralgia del Trigémino/etiología , Insuficiencia Vertebrobasilar/complicaciones , Insuficiencia Vertebrobasilar/cirugía , Angiografía Coronaria , Humanos , Masculino , Persona de Mediana Edad , Politetrafluoroetileno/uso terapéutico , Recurrencia , Tomografía Computarizada por Rayos X , Nervio Trigémino/cirugía , Neuralgia del Trigémino/cirugía , Insuficiencia Vertebrobasilar/diagnóstico por imagenRESUMEN
O objetivo desse estudo é relatar um caso de neuralgia trigeminal causado por dolicoectasia vertebrobasilar tratado com descompressão microvascular. Um homem (63 anos) consultou por neuralgia trigeminal recorrente na hemiface esquerda (territórios V2 e V3). A angiotomografia cerebral revelou compressão mecânica do nervo trigêmio esquerdo devido à dolicoectasia vertebrobasilar. O paciente foi submetido à craniotomia suboccipital esquerda. Introduziu-se Teflon® na área de conflito neurovascular, obtendo-se uma descompressão satisfatória. O paciente apresentou remissão da dor imediatamente. A dolicoectasia vertebrobasilar é uma causa rara de neuralgia trigeminal e uma excelente evolução pode ser alcançada com a descompressão microvascular.
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Descompresión Quirúrgica/métodos , Nervio Trigémino , Neuralgia del Trigémino/etiología , Insuficiencia Vertebrobasilar/complicaciones , Insuficiencia Vertebrobasilar/cirugía , Angiografía Coronaria , Politetrafluoroetileno/uso terapéutico , Recurrencia , Tomografía Computarizada por Rayos X , Nervio Trigémino/cirugía , Neuralgia del Trigémino/cirugía , Insuficiencia VertebrobasilarAsunto(s)
Humanos , Revascularización Cerebral/métodos , Trastornos Cerebrovasculares/cirugía , Ataque Isquémico Transitorio/cirugía , Endarterectomía Carotidea/normas , Estenosis Carotídea/cirugía , Trombosis de las Arterias Carótidas/diagnóstico , Isquemia Encefálica/cirugía , Anestesia , Revascularización Cerebral/historia , Revascularización Cerebral/mortalidad , Trastornos Cerebrovasculares/epidemiología , Enfermedades de las Arterias Carótidas/cirugía , Endarterectomía Carotidea/métodos , Estenosis Carotídea/diagnóstico , Trombosis de las Arterias Carótidas/cirugía , Arterias Carótidas/anatomía & histología , Arterias Carótidas/cirugía , Circulación Cerebrovascular , Insuficiencia Vertebrobasilar/cirugía , Isquemia Encefálica/fisiopatología , Prótesis Vascular , Complicaciones Posoperatorias , Guías de Práctica Clínica como Asunto , Recurrencia , Aneurisma/cirugía , Arteria Vertebral/anatomía & histología , Arteria Vertebral/cirugía , Pronóstico , Tronco Braquiocefálico/anatomía & histología , Tronco Braquiocefálico/cirugíaAsunto(s)
Humanos , Anestesia , Isquemia Encefálica/cirugía , Trombosis de las Arterias Carótidas/diagnóstico , Trastornos Cerebrovasculares/cirugía , Endarterectomía Carotidea/normas , Estenosis Carotídea/cirugía , Ataque Isquémico Transitorio/cirugía , Revascularización Cerebral/métodos , Aneurisma/cirugía , Arterias Carótidas/anatomía & histología , Arterias Carótidas/cirugía , Prótesis Vascular , Isquemia Encefálica/fisiopatología , Enfermedades de las Arterias Carótidas/cirugía , Trombosis de las Arterias Carótidas/cirugía , Circulación Cerebrovascular , Trastornos Cerebrovasculares/epidemiología , Endarterectomía Carotidea , Estenosis Carotídea/diagnóstico , Guías de Práctica Clínica como Asunto , Complicaciones Posoperatorias , Pronóstico , Recurrencia , Revascularización Cerebral/historia , Revascularización Cerebral/mortalidad , Tronco Braquiocefálico/anatomía & histología , Tronco Braquiocefálico/cirugía , Arteria Vertebral/anatomía & histología , Arteria Vertebral/cirugía , Insuficiencia Vertebrobasilar/cirugíaRESUMEN
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.