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Intraoperative visualization of bilateral thrombosis in the posterior inferior cerebellar artery apparent in the telovelomedullary segment.

Nevzati E, Schatlo B, Fathi AR, Fandino J, Muroi C - Case Rep Neurol Med (2014)

Bottom Line: A 74-year-old woman was admitted to our department on day two of a bilateral PICA thrombosis with developing cerebellar infarction.Her Glasgow Coma Scale score dropped from 15 to 13, and cranial computed tomography revealed compression of the fourth ventricle with consecutive occlusive hydrocephalus.The surgical access may offer surgical therapeutic options in a hyperacute occlusion, such as thromb-/embolectomy or bypass procedures.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Kantonsspital Aarau, Tellstraße, 5001 Aarau, Switzerland.

ABSTRACT
Unilateral posterior inferior cerebellar artery (PICA) thrombosis is frequent. However, bilateral PICA thrombosis is rare. Herein we report about an intraoperative visualization of a bilateral thrombosis of the telovelomedullary segment of the PICA. A 74-year-old woman was admitted to our department on day two of a bilateral PICA thrombosis with developing cerebellar infarction. Her Glasgow Coma Scale score dropped from 15 to 13, and cranial computed tomography revealed compression of the fourth ventricle with consecutive occlusive hydrocephalus. After the insertion of an external ventricular drainage, the patient underwent urgent suboccipital decompressive craniectomy with removal of infarcted cerebellar tonsils, which allowed the bilateral visualization of the thrombosed telovelomedullary segments. The surgical access may offer surgical therapeutic options in a hyperacute occlusion, such as thromb-/embolectomy or bypass procedures.

No MeSH data available.


Related in: MedlinePlus

(a) Intraoperative photograph, showing readily visible bilateral PICAs, after the removal of the tonsils. The arteries were pulseless, rigid, and dark. A seemingly calcified thrombus was visible in left PICA (arrow). The right thrombosed PICA was bluish (double arrow). C indicates cottonoid placed over the remaining occipital bone; C1: remaining parts of the C1 arch; Cr: cranial; Ca: caudal; L: left; R: right; S: suction. (b) Schematic drawing of the PICA. C indicates cerebellum; CaL: caudal loop of the PICA; CrL: cranial loop of the PICA; Hb: hemispheric branch; T: cerebellar tonsils, Ts: telovelomedullary segment; V: vermis; VA: vertebral artery; Vb: vermian branches.
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fig2: (a) Intraoperative photograph, showing readily visible bilateral PICAs, after the removal of the tonsils. The arteries were pulseless, rigid, and dark. A seemingly calcified thrombus was visible in left PICA (arrow). The right thrombosed PICA was bluish (double arrow). C indicates cottonoid placed over the remaining occipital bone; C1: remaining parts of the C1 arch; Cr: cranial; Ca: caudal; L: left; R: right; S: suction. (b) Schematic drawing of the PICA. C indicates cerebellum; CaL: caudal loop of the PICA; CrL: cranial loop of the PICA; Hb: hemispheric branch; T: cerebellar tonsils, Ts: telovelomedullary segment; V: vermis; VA: vertebral artery; Vb: vermian branches.

Mentions: On day two after stroke, the patient was transferred to the neurosurgical department due to incessant vomiting, progressive dysphagia, and a decreased level of consciousness. Accordingly the GCS dropped from 15 to 13. Cranial CT revealed an ischemic cerebellar edema with compression of the fourth ventricle and consecutive occlusive hydrocephalus. After the insertion of an external ventricular drainage (EVD) in the anterior horn of the right ventricle, the patient underwent urgent suboccipital decompressive craniectomy. The surgery was performed in prone position. A paramedian right-sided suboccipital craniectomy—crossing the midline to the contralateral side—was performed, combined with a partial C1 laminectomy. After the opening of the dura, clearly infarcted cerebellar tissue was removed until the space occupying effect was relieved. This procedure allowed a good visualization of the thrombosed bilateral PICA segments (Figure 2).


Intraoperative visualization of bilateral thrombosis in the posterior inferior cerebellar artery apparent in the telovelomedullary segment.

Nevzati E, Schatlo B, Fathi AR, Fandino J, Muroi C - Case Rep Neurol Med (2014)

(a) Intraoperative photograph, showing readily visible bilateral PICAs, after the removal of the tonsils. The arteries were pulseless, rigid, and dark. A seemingly calcified thrombus was visible in left PICA (arrow). The right thrombosed PICA was bluish (double arrow). C indicates cottonoid placed over the remaining occipital bone; C1: remaining parts of the C1 arch; Cr: cranial; Ca: caudal; L: left; R: right; S: suction. (b) Schematic drawing of the PICA. C indicates cerebellum; CaL: caudal loop of the PICA; CrL: cranial loop of the PICA; Hb: hemispheric branch; T: cerebellar tonsils, Ts: telovelomedullary segment; V: vermis; VA: vertebral artery; Vb: vermian branches.
© Copyright Policy - open-access
Related In: Results  -  Collection

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fig2: (a) Intraoperative photograph, showing readily visible bilateral PICAs, after the removal of the tonsils. The arteries were pulseless, rigid, and dark. A seemingly calcified thrombus was visible in left PICA (arrow). The right thrombosed PICA was bluish (double arrow). C indicates cottonoid placed over the remaining occipital bone; C1: remaining parts of the C1 arch; Cr: cranial; Ca: caudal; L: left; R: right; S: suction. (b) Schematic drawing of the PICA. C indicates cerebellum; CaL: caudal loop of the PICA; CrL: cranial loop of the PICA; Hb: hemispheric branch; T: cerebellar tonsils, Ts: telovelomedullary segment; V: vermis; VA: vertebral artery; Vb: vermian branches.
Mentions: On day two after stroke, the patient was transferred to the neurosurgical department due to incessant vomiting, progressive dysphagia, and a decreased level of consciousness. Accordingly the GCS dropped from 15 to 13. Cranial CT revealed an ischemic cerebellar edema with compression of the fourth ventricle and consecutive occlusive hydrocephalus. After the insertion of an external ventricular drainage (EVD) in the anterior horn of the right ventricle, the patient underwent urgent suboccipital decompressive craniectomy. The surgery was performed in prone position. A paramedian right-sided suboccipital craniectomy—crossing the midline to the contralateral side—was performed, combined with a partial C1 laminectomy. After the opening of the dura, clearly infarcted cerebellar tissue was removed until the space occupying effect was relieved. This procedure allowed a good visualization of the thrombosed bilateral PICA segments (Figure 2).

Bottom Line: A 74-year-old woman was admitted to our department on day two of a bilateral PICA thrombosis with developing cerebellar infarction.Her Glasgow Coma Scale score dropped from 15 to 13, and cranial computed tomography revealed compression of the fourth ventricle with consecutive occlusive hydrocephalus.The surgical access may offer surgical therapeutic options in a hyperacute occlusion, such as thromb-/embolectomy or bypass procedures.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Kantonsspital Aarau, Tellstraße, 5001 Aarau, Switzerland.

ABSTRACT
Unilateral posterior inferior cerebellar artery (PICA) thrombosis is frequent. However, bilateral PICA thrombosis is rare. Herein we report about an intraoperative visualization of a bilateral thrombosis of the telovelomedullary segment of the PICA. A 74-year-old woman was admitted to our department on day two of a bilateral PICA thrombosis with developing cerebellar infarction. Her Glasgow Coma Scale score dropped from 15 to 13, and cranial computed tomography revealed compression of the fourth ventricle with consecutive occlusive hydrocephalus. After the insertion of an external ventricular drainage, the patient underwent urgent suboccipital decompressive craniectomy with removal of infarcted cerebellar tonsils, which allowed the bilateral visualization of the thrombosed telovelomedullary segments. The surgical access may offer surgical therapeutic options in a hyperacute occlusion, such as thromb-/embolectomy or bypass procedures.

No MeSH data available.


Related in: MedlinePlus