PMID- 30261396
OWN - NLM
STAT- MEDLINE
DCOM- 20190102
LR  - 20191210
IS  - 1878-8769 (Electronic)
IS  - 1878-8750 (Linking)
VI  - 121
DP  - 2019 Jan
TI  - Challenging Anterior Inferior Cerebellar Artery in Retrosigmoid Vestibular 
      Schwannoma Removal.
PG  - e370-e378
LID - S1878-8750(18)32157-0 [pii]
LID - 10.1016/j.wneu.2018.09.111 [doi]
AB  - OBJECTIVE: Referring to the anterior inferior cerebellar artery (AICA) traversing 
      a cerebellopontine angle tumor during retrosigmoid vestibular schwannoma (VS) 
      removal as a challenging AICA (c-AICA), we describe incidence, anatomic 
      characteristics, mechanism of development of c-AICA, and surgical techniques used 
      to remove VS while preserving the AICA. METHODS: Review of surgical records and 
      videos of 150 patients who underwent retrosigmoid VS removal revealed 10 patients 
      (7%) with c-AICAs. Retrospective analysis of these 10 patients was performed. 
      RESULTS: Surgical findings classified c-AICAs as c-AICAs with subarcuate artery 
      (SAA) and c-AICAs without SAA. In c-AICAs with SAA (7/10), the SAA had an 
      anchoring effect in the development of the c-AICA. The most challenging c-AICAs 
      (i.e., c-AICAs reaching the porus acusticus, entering the internal auditory 
      canal, and adhering to the dura) were associated with short cisternal SAAs (4/7). 
      We preserved the most challenging c-AICA with the surrounding dura by drilling 
      the posterior wall to preserve the posterior wall dura. AICAs adhering to the 
      porus acusticus dura were not associated with long cisternal SAAs. Sacrificing 
      the SAA caused no neurologic deficits. c-AICAs were preserved in all patients, 
      and tumors were removed with no complications related to AICAs. CONCLUSIONS: 
      c-AICAs occur more often than expected. The anatomy of the SAA is related to the 
      development and characteristics of c-AICAs. Although preserving a c-AICA is 
      challenging and necessitates a complex dissecting technique, understanding of 
      anatomic characteristics and appropriate surgical management of c-AICAs enable VS 
      removal while preserving the AICA.
CI  - Copyright (c) 2018 Elsevier Inc. All rights reserved.
FAU - Yamakami, Iwao
AU  - Yamakami I
AD  - Department of Neurosurgery, Seikei-kai Chiba Medical Center, Chiba, Japan; 
      Department of Neurosurgery, Chiba Central Medical Center, Chiba, Japan. 
      Electronic address: yamakami@seikeikai-cmc.jp.
FAU - Kubota, Shunsuke
AU  - Kubota S
AD  - Department of Neurosurgery, Seikei-kai Chiba Medical Center, Chiba, Japan.
FAU - Higuchi, Yoshinori
AU  - Higuchi Y
AD  - Department of Neurosurgery, Chiba University Postgraduate School of Medicine, 
      Chiba, Japan.
FAU - Ito, Seiro
AU  - Ito S
AD  - Department of Neurosurgery, Chiba Rosai Hospital, Ichihara, Japan.
LA  - eng
PT  - Journal Article
DEP - 20180925
PL  - United States
TA  - World Neurosurg
JT  - World neurosurgery
JID - 101528275
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Anterior Commissure, Brain/*surgery
MH  - Basilar Artery/*surgery
MH  - Cerebellopontine Angle/diagnostic imaging/*surgery
MH  - Databases, Factual/statistics & numerical data
MH  - Female
MH  - Humans
MH  - Magnetic Resonance Angiography
MH  - Male
MH  - Middle Aged
MH  - Neuroma, Acoustic/diagnostic imaging/*surgery
MH  - Neurosurgical Procedures/*methods
MH  - Retrospective Studies
MH  - Treatment Outcome
MH  - Young Adult
OTO - NOTNLM
OT  - Anterior inferior cerebellar artery
OT  - Cerebellopontine angle
OT  - Complication
OT  - Tumor removal
OT  - Vestibular schwannoma
EDAT- 2018/09/28 06:00
MHDA- 2019/01/03 06:00
CRDT- 2018/09/28 06:00
PHST- 2018/07/03 00:00 [received]
PHST- 2018/09/12 00:00 [revised]
PHST- 2018/09/15 00:00 [accepted]
PHST- 2018/09/28 06:00 [pubmed]
PHST- 2019/01/03 06:00 [medline]
PHST- 2018/09/28 06:00 [entrez]
AID - S1878-8750(18)32157-0 [pii]
AID - 10.1016/j.wneu.2018.09.111 [doi]
PST - ppublish
SO  - World Neurosurg. 2019 Jan;121:e370-e378. doi: 10.1016/j.wneu.2018.09.111. Epub 
      2018 Sep 25.