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Howard J. Senter and Edwin T. Long

C erebrovascular insufficiency of the posterior circulation has been an area of increasing interest during the past few years. Direct attack on extracranial vertebral disease has been limited to those patients who could tolerate vertebral cross-clamping for either endarterectomy, 1 vein grafting, 2 or external carotid to vertebral artery anastomosis. 3, 10 The risk of cross-clamping a solitary vertebral artery with or without angiographically demonstrated flow via the posterior communicating arteries is prohibitively high. 3, 10 We would like to report a

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Akira Shintani and Nicholas T. Zervas

N eurosurgeons occasionally have to consider ligating the vertebral artery (VA) in the course of exploring the posterior cranial fossa for a vascular or neoplastic lesion. This brief report describes such a situation, and reviews the current status of VA ligation. Case Report A 60-year-old woman was admitted to the hospital on November 11, 1965, with vomiting and severe headache of 5 days' duration. Cerebrospinal fluid was grossly bloody with a xanthochromic supernatant. Angiograms demonstrated a saccular aneurysm of the left VA rostral to the posterior

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Douglas J. Quint and Eric M. Spickler

V ertebral artery dissection is usually temporally related to an accidental or intentional traumatic event, but it may also be spontaneous. 3, 9 Prompt accurate diagnosis is important so that appropriate treatment can be instituted. 6, 9 The “gold standard” for diagnosis has been vertebral angiography. 1 Recent work with both spin-echo and gradient refocused echo magnetic resonance (MR) imaging has been successful in characterizing some vascular lesions. 4, 7, 11 We report the MR appearance in two cases of vertebral artery dissection confirmed with

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Steven J. Goldstein

R eports of carotid dissection appear quite regularly in the current medical literature; 4, 8, 12, 13 however, cases of dissecting hematoma of the vertebral artery are rarely encountered. A review of the world literature reveals only eight angiographically or pathologically documented cases of vertebral artery dissecting hematoma. 3, 5, 10, 13, 14, 16–18 In the majority of these cases the involved segment was the distal intradural portion of the vertebral artery. This report describes a patient who presented with posterior fossa ischemia secondary to a

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Karl Detwiler, John C. Godersky and Lindell Gentry

D ue to its relatively protected location, the extracranial vertebral artery in its second and third portions is infrequently injured by penetrating trauma, although it is vulnerable to blunt trauma or rotational injury. Uncommon nontraumatic lesions of the distal extracranial vertebral artery include dissection, arteriovenous fistulae, and aneurysm formation. A case of neurofibromatosis associated with intracranial aneurysms and extracranial carotid artery occlusion, in which the most striking feature was a progressively enlarging distal extracranial

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Mark W. Fox, David G. Piepgras and John D. Bartleson

T emporary occlusion or mechanical compression of the atlantoaxial portion of the vertebral artery (VA) caused by head rotation has been documented during routine cerebral angiography. 1, 2, 5, 7, 10, 11, 15, 16, 19 This occlusion is usually asymptomatic due to sufficient contralateral VA or distal vertebrobasilar system collateral flow. The term “bow hunter's stroke” has been used to describe a syndrome of hemodynamic vertebrobasilar insufficiency induced by forced or voluntary rotational head movements causing intermittent VA compression at the atlantoaxial

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Gayle S. Storey, Michael P. Marks, Michael Dake, Alexander M. Norbash and Gary K. Steinberg

system, 5, 16, 25–27 and in the renal arteries 10, 13, 24 to provide a frame to keep the lumen patent and smooth walled. Stent placement in the cerebrovascular circulation has recently been reported in the treatment of aneurysms and stenoses secondary to internal carotid artery (ICA) dissections and venous occlusive disease involving the major dural sinuses. 18 The use of stents has not been reported in the treatment of atherosclerotic cerebrovascular stenoses. We report stent placement in the vertebral arteries of three patients in whom conventional balloon

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Howard J. Senter and Mohammad Sarwar

T he sparsity of reported cases of dissecting aneurysm of the intracranial carotid and vertebrobasilar system probably does not reflect its true incidence. It is possible that some cases of dissecting intracranial aneurysms are not correctly diagnosed clinically or angiographically. The purpose of the present report is to describe a case of nontraumatic dissecting aneurysm of the vertebral artery, which presented as a stroke with subarachnoid hemorrhage (SAH). The operative and angiographic findings are discussed. Case Report This 45-year

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J. Jeffrey Alexander, Seymour Glagov and Christopher K. Zarins

cranial nerve defects, Horner's syndrome, quadriplegia, and sudden death have been described. 13 This report documents a case of vertebral artery dissection resulting from a traumatic endotracheal intubation. Successful arterial reconstruction of this unusual lesion has, to our knowledge, not been reported previously. Case Report This 38-year-old nurse had a diagnosis of Samter's syndrome: 12 steroid-dependent asthma, nasal polyposis, and acetylsalicylic acid sensitivity. Her prior medical history included multiple nasal polypectomies and a prolonged course of

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Ramesh L. Sahjpaul, Muwaffak M. Abdulhak, Charles G. Drake and Robert R. Hammond

V essels of the posterior circulation give rise to between 10 and 15% of all circle of Willis aneurysms; the vertebral arteries (VAs) give rise to less than 1% of these. Rupture of a saccular aneurysm as a result of head trauma is rare. This is an uncommon source of traumatic subarachnoid hemorrhage (SAH) and one in which the coincidental location of the lesion and the site of the trauma are critical. Case Report This 34-year-old previously healthy man was struck behind the left ear, just below his helmet, by a hockey puck traveling at high speed