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Joseph V. McDonald

W hile migraine is a common ailment, afflicting perhaps 5% of children and 15% or more of adults, it is rarely associated with permanent neurological deficits, even when focal symptoms such as hemiparesis or hemianopsia accompany an attack. Migraine in the distribution of the basilar artery is one of its less common forms, and it was this variety that afflicted the patient who is the subject of this report. Case Report This 40-year-old woman was admitted to the hospital on March 3, 1982, because of severe occipital headache and deep stupor

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Yuhei Yoshimoto, Katsumi Hoya, Yoshihiro Tanaka, and Takanori Uchida

configuration in most patients at short intervals from presentation, which clearly indicated the dynamic nature of these dissections. Basilar artery dissection as well as VA dissection often presents with SAH, with rebleeding and consequent death being frequent. In the present series, one patient suffered from catastrophic rebleeding due to distal extension of the dissection and de novo aneurysm formation. Early treatment seems essential for improving prognosis in these patients. A typical VA dissection can be treated relatively safely with either surgical or endovasucular

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Arvind Ahuja, Lee R. Guterman, and Leo N. Hopkins

P ercutaneous transluminal angioplasty is being used successfully to treat atherosclerosis of the coronary, subclavian, vertebral, and peripheral arteries. However, there are few reports on the use of this procedure to treat disease of the basilar artery because of the technological limitations involved and the initially discouraging results. 5, 9, 10 We present a symptomatic case of atherosclerotic basilar artery stenosis treated successfully by angioplasty with a dilatation catheter system. This investigational system, * unlike earlier devices, employs a

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Michael K. Morgan and Michael T. Biggs

S urgical endeavors to ameliorate deficiencies of the posterior intracranial circulation can be divided into direct procedures on the offending pathology 1, 8, 15 and bypass procedures. 2–5, 7, 9, 11–16 For the most part, these procedures have been performed to treat complications of atheromatous disease. Due to difficulty with access, the presence of important perforating arteries, the site of pathology, and the time required for cross clamping, direct surgery on the upper basilar artery has not been deemed a reasonable choice for occlusive disease when

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Kenichiro Sugita, Shigeaki Kobayashi, Toshiki Takemae, Tsuyoshi Tada, and Yuichiro Tanaka

T he direct surgical approach to an aneurysm on the basilar artery trunk is one of the most difficult operations to perform. The aneurysms are located in a deep, narrow region surrounded by critical structures, namely the pons and cranial nerves. Four routes of approach to the lesion have been reported in the literature: pterional, subtemporal, transoral, and suboccipital. We have operated on 10 cases with basilar trunk aneurysms, using a pterional transsylvian approach in one case and a subtemporal technique in nine cases. A discussion of the surgical

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Surgical treatment of basilar artery aneurysms

Elective circulatory arrest with thoracotomy in 12 cases

James G. McMurtry III, Edgar M. Housepian, Frederick O. Bowman Jr., and Richard S. Matteo

S ince our initial reports of the successful treatment of an aneurysm of the basilar artery using elective circulatory arrest via thoracotomy, 11, 13 we have operated on 12 additional cases. Changes in the technique, indications for its use, and a review of the cases are presented. Technique The patients are premedicated with combinations of secobarbital, 100 mg; meperidine hydrochloride, 50 mg; scopolamine, 0.4 to 0.6 mg; or atropine, 0.5 to 0.6 mg. The patients are placed in the supine position with the nondominant side of the head up and a small

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Kenichiro Sugita, Shigeaki Kobayashi, Akira Shintani, and Naomi Mutsuga

S urgical treatment of aneurysms of the basilar artery has been one of the most difficult procedures, even in the era of the operating microscope. 3, 16, 17 While many papers have reported on operative techniques and their results on aneurysms of the anterior portion of the circle of Willis, only a small number of papers have been published on aneurysms of the basilar artery. We are reporting on our surgical technique and operative results in 32 cases of basilar artery aneurysms performed under an operating microscope. Summary of Cases Clinical

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Chhabi Bhushan, Fred J. Hodges, and John Posey

injection, lateral projection. A large left posterior inferior cerebellar artery (PICA) is clearly shown arising proximal to the aneurysm. The right anterior inferior cerebellar artery fills from the basilar artery. Note the posterior displacement of the retromedullary portion of the PICA. Fig. 3. Preoperative angiography, anteroposterior projection, of the left (left) and right (right) vertebral arteries. Fig. 4. Preoperative angiography, lateral views. Left: Left internal carotid injection. Right: Right internal carotid injection

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Grant B. Hieshima, Randall T. Higashida, Joseph Wapenski, Van V. Halbach, Leslie Cahan, and John R. Bentson

-section of the basilar artery from a recent subarachnoid hemorrhage (SAH). In order for us to treat the aneurysm, an angioplasty procedure to dilate the vessel had to be performed. Once this was accomplished, the same balloon could then be passed into the aneurysm and detached. This is the first reported case of intravascular balloon embolization of an aneurysm arising from the distal segment of the basilar artery with simultaneous angioplasty of the mid-segment of the basilar artery for treatment of vasospasm in a fully awake patient. Case Report This 42-year

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Samuel P. W. Black and Linda E. Ansbacher

T he treatment of saccular aneurysm associated with segmental duplication (also called “fenestration”) of the basilar artery is a recent advance. Reports of the arteriographic appearance of this anomaly and the management of its aneurysmal component date only from 1976. 1, 3–7, 9, 10 Basilar artery fenestration found at autopsy, without an attendant aneurysm, has a longer history, 2, 11 but the only morphological study of the condition appears to be that of Crompton. 2 He said: “Histological examination of these fenestrations has revealed a defect in the