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Background The Pipeline Embolization Device (PED) has been increasingly used for the treatment of posterior circulation aneurysms. The purpose of the present study was to examine the clinical and angiographic outcomes of patients with vertebrobasilar aneurysms treated with the PED. Methods We performed a retrospective review of vertebrobasilar aneurysms treated with the PED at 4 high-volume neurovascular centers. Patient, aneurysm, and procedural data were collected, including perioperative and delayed complications. Aneurysm occlusion on follow-up imaging studies was defined as complete (100%), near-complete (>90%), or incomplete ( Results The cohort included 35 patients with 37 vertebrobasilar aneurysms who underwent 36 treatment sessions. Of the 35 patients, 10 were men (29%), and the mean patient age was 54.1 years (range, 32–75). Eight patients (23%) underwent urgent treatment because of a ruptured aneurysm (n = 6), brainstem perforator stroke (n = 1), or post-traumatic pseudoaneurysm (n = 1). Of the 37 aneurysms, 22 arose from the vertebral artery (59%) and 15 from the basilar artery (41%). Also, 19 were saccular aneurysms (51%), with a mean size of 7.7 mm (range, 1.7–38.0); 17 were fusiform aneurysms (46%), with a mean size of 11.0 mm (range, 4.3–34); and 1 was a 2.9-mm blister aneurysm. The overall procedural complication rate was 14% (5 of 36), including 3 neurologically symptomatic complications. At a mean follow-up period of 14 months (range, 3–59), 24 of 34 aneurysms (71%) were completely occluded and 29 of 34 (85%) were completely or near-completely occluded. Conclusion Our results show that Pipeline embolization of vertebrobasilar aneurysms is associated with acceptable occlusion and complication rates.

BACKGROUND It is known that a “dissociated motor loss” of the deltoid muscle can occur with disconcerting frequency after cervical spine surgery. The etiology of this entity is in question. We conducted an anatomic study to identify anatomic factors that might predispose C5 to injury. METHODS We studied 128 dorsal cervical nerves and root ganglion/ventral root complexes in 10 adult cadavers. At each cervical level the following data were recorded: number of rootlets, range of width of rootlets, length of DREZ, cranial angles of the superior and inferior rootlets with the spinal cord, length of the superior and inferior rootlets, dimensions of the foramina, dimensions of the dorsal root, dimensions of the dorsal root ganglion (DRG)/ventral root (VR) complex, and the blood supply to the DRG. The histology at the site of compression was also examined. Statistical analysis was conducted using the single factor-repeated measures analysis of variance. RESULTS We found that, 1) the C5 superior dorsal rootlets angle less inferiorly from the cervical cord than the other dorsal cervical roots ( p = 0.001), 2) the majority of the DRG/VR complexes from C3 to C6 were compressed by the vertebral artery (73%), 3) the C5 DRG/VR complex was compressed to the greatest extent (77.6%, p = 0.3519), and 4) the ganglionic artery was more frequent at C4, C5, and C6. CONCLUSION To our knowledge, the second finding has not been reported previously. The first and third findings may help explain why C5 is more vulnerable to injury.