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Vertebrobasilar insufficiency

Part 2: Microsurgical treatment of intracranial vertebrobasilar disease

Leo N. Hopkins, Neil A. Martin, Mark N. Hadley, Robert F. Spetzler, James Budny and L. Philip Carter

✓ Posterior circulation transient ischemic attacks have an associated risk of subsequent infarction of approximately 5% per year. Intracranial vertebrobasilar thrombo-occlusive lesions appear particularly likely to result in repetitive ischemic symptoms and in infarction due to hemodynamic insufficiency. The authors present their experience with 45 patients with symptomatic intracranial vertebrobasilar vascular disease despite maximal medical therapy. The specific operative approaches for intracranial vertebral artery endarterectomy and extracranial to intracranial posterior circulation revascularization procedures are outlined.

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Vertebrobasilar insufficiency

Part 1: Microsurgical treatment of extracranial vertebrobasilar disease

Robert F. Spetzler, Mark N. Hadley, Neil A. Martin, Leo N. Hopkins, L. Philip Carter and James Budny

✓ Extracranial vertebrobasilar artery thrombo-occlusive disease may cause repetitive transient ischemic episodes and, less frequently, brain-stem or cerebellar infarction. This report describes 40 patients who experienced repetitive vertebrobasilar ischemic symptoms despite maximal medical therapy. The natural history, pathogenesis, and treatment options for each causative lesion are reviewed. The operative approaches to symptomatic disease of the proximal vertebral arteries, arterial compression by cervical osteophytes, traumatic lesions of the vertebral arteries, and thrombo-occlusive pathology of the distal extracranial vertebral arteries are outlined. Specific anesthetic and surgical techniques that have proved successful while achieving zero operative mortality and low perioperative morbidity rates are reported.