Browsing by Subject "Vertebral artery"

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  • Hafez, Ahmad; Ibrahim, Tarik F.; Raj, Rahul; Antinheimo, Jussi; Siironen, Jari; Hernesniemi, Juha (2016)
    BACKGROUND: Most of the physician's attention during spinal surgery, when using wires and screws, is toward the avoidance of injuries of critical structures (nerves and vessels). When such wires are broken during surgery, the most important point is to take them out safely or, if it is impossible, to leaf them in secure place and follow the patient closely. Migrations of broken Kirschner wire (K-wire) are well known in literature; however, to the best of our knowledge, migration of a fractured K-wire during anterior atlantoaxial fixation of cervical spine has not been reported in the literature. CASE DESCRIPTION: We report a case in which a fractured K-wire was imbedded in the lateral mass of C1 for 3 years and then migrated to endanger the dominant right vertebral artery. By using posterior approach and drilling right part of posterior arch of C1, we manage to secure the vertebral artery. The broken K-wire was extracted successfully. In our case, with optimal follow-up, the burred wire inside hard bone was moved in delayed fashion to come out of the bone, grooving the dominant vertebral artery. CONCLUSIONS: Our recommendation is to inspect the K-wire before using it and to try retrieve as much as possible when removing it.
  • Lehto, Hanna; Niemela, Mika; Kivisaari, Riku; Laakso, Aki; Jahromi, Behnam Rezai; Hijazy, Ferzat; Andrade-Barazarte, Hugo; Dashti, Reza; Hernesniemi, Juha (2015)
    BACKGROUND: Vertebral artery (VA) aneurysms comprise approximately one-third of posterior circulation aneurysms. They are morphologically variable, and located critically close to the cranial nerves and the brainstem. We aim to represent the characteristics of these aneurysms and their treatment, and to analyze the outcome. METHODS: We reviewed retrospectively 9709 patients with intracranial aneurysms. Of these, we included 190 with aneurysms at the VA or VA posterior inferior cerebellar artery junction. The patients were treated in the Department of Neurosurgery, Helsinki, Finland, between 1934 and 2011. RESULTS: The 190 patients had 193 VA aneurysms, among which 131 (68%) were ruptured, The VA aneurysm caused a mass effect in 7 and ischemia in 2 patients. Compared to 4387 patients with a ruptured aneurysm in other locations, those with a VA aneurysm were older, their aneurysms were more often fusiform, and more often caused intraventricular hemorrhages. Among surgically treated aneurysms, clipping was the treatment in 91 (88%) saccular and 11 (50%) fusiform aneurysms. Treatment was endovascular in 13 (9%), and multimodal in 6 (4%) aneurysms, Within a year after aneurysm diagnosis, 53 (28%) patients died. Among the survivors, 104 (93%) returned to an independent or to their previous state of life; only 2 (2%) were unable to return home. CONCLUSIONS: Microsurgery is a feasible treatment for VA aneurysms, although cranial nerve deficits are more common than in endovascular surgery. Despite the challenge of an often severe hemorrhage, of challenging morphology, and risk for laryngeal palsy, most patients surviving the initial stage return to normalcy.