1/13. Spontaneous thrombosis of vein of Galen aneurysmal malformation.Two cases of aneurysmal malformations of the vein of Galen (AVG) with spontaneous thrombosis are reported. Angiogram and MRI before thrombosis demonstrated AVGs with slow arteriovenous shunts and associated stagnation of contrast in the venous sac secondary to severe outflow restriction. Based on these findings, one patient was managed conservatively, and the other underwent placement of a ventriculoperitoneal shunt. Surveillance of the lesions with subsequent MRIs revealed spontaneous thrombosis of the AVGs with excellent clinical outcomes. Proposed mechanisms of spontaneous thrombosis include slow flow shunts, obstruction of the venous outflow or obstruction of the feeding artery. Similar cases in the literature are reviewed with special emphasis on diagnostic tests, symptomatology, mechanisms of thrombosis and therapeutic options.- - - - - - - - - - ranking = 1keywords = aneurysm (Clic here for more details about this article) |
2/13. Management of vein of galen malformations. A review based on five neurosurgically treated cases and literature reports.The high morbidity and mortality associated with the management of vein of Galen aneurysmal malformations (VGAM) continues to pose a tremendous challenge to the neurosurgeon as well as to the attending interventional radiologist. Since 1985, five patients with VGAM have been referred to the neurosurgical unit of the University of Cologne, two neonates, one infant and two adults. Four patients underwent direct operation and two patients received a shunt. The treatment was performed without mortality. A review of the literature reflects no substantial difference between neurosurgical treatment during the last 15 years (mortality 10%) and endovascular treatment (best series mortality 6%).- - - - - - - - - - ranking = 0.2keywords = aneurysm (Clic here for more details about this article) |
3/13. aneurysm originating from the fenestration of the posterior cerebral artery: case report.OBJECTIVE AND IMPORTANCE: A rare case of an aneurysm arising at the fenestration of the P2 segment of the posterior cerebral artery is reported. CLINICAL PRESENTATION: A 37-year-old man presented with severe headache and disturbance of consciousness. Computed tomographic scanning showed diffuse subarachnoid hemorrhage. cerebral angiography revealed an aneurysm at the fenestration of the P2 segment of the right posterior cerebral artery. The aneurysm was located at the middle portion of the lower trunk of the fenestration. An unruptured arteriovenous malformation was incidentally found in the right thalamus. INTERVENTION: A right frontotemporal craniotomy with orbitozygomatic osteotomy was made, and the aneurysm was successfully clipped. One year after the operation, gamma knife surgery was performed for the right thalamic arteriovenous malformation. CONCLUSION: This is the first reported case of an aneurysm originating from the middle portion of a fenestrated posterior cerebral artery.- - - - - - - - - - ranking = 1keywords = aneurysm (Clic here for more details about this article) |
4/13. Potential role of the anterior spinal artery in preventing propagation of thrombus in a therapeutically occluded vertebral artery: angiographic studies before and after endovascular treatment.therapeutic occlusion of the vertebral artery (VA) is one of the treatments for unclippable aneurysms and other lesions, although controversy still surrounds the appropriate site for occlusion to attain selective thrombosis of the lesion while avoiding ischaemic complications. The lower two-thirds of the lateral medulla are supplied by perforating branches of both the VA and the posterior inferior cerebellar artery (pica). However, in patients without a pica or in whom the origin of the pica is low (at or below the foramen magnum), the VA is usually the only source of perforating vessels. We retrospectively studied the results of VA occlusion on such anatomically high-risk patients, and propose a safer procedure. Five high-risk patients underwent therapeutic occlusion of the VA for dissecting aneurysms or arteriovenous fistula. A lateral medullary syndrome developed due to propagation of thrombus after the procedure in two patients in whom angiography did not demonstrate the anterior spinal artery (ASA) within the stump of the VA. Ischaemic signs did not develop in the other three patients, in whom the ASA was visible, and retrograde flow was observed proximal to the origin of the ASA. This suggests that the ASA may play a role in preventing propagation of thrombus in the VA distal to the site of occlusion and supply blood to its perforating arteries in high-risk patients. Angiographic assessment of the ASA may be useful for predicting the likelihood of the lateral medullary syndrome developing with therapeutic occlusion of the VA in patients without a pica or with one whose origin is low.- - - - - - - - - - ranking = 0.4keywords = aneurysm (Clic here for more details about this article) |
5/13. Traumatic lesions of the bilateral middle meningeal arteries--case report.A 44-year-old man presented with traumatic injuries of the bilateral middle meningeal arteries after a traffic accident. Neurological examination found left visual impairment due to left optic nerve injury. Computed tomography demonstrated a small amount of left epidural hemorrhage and bilateral skull fractures. Left external carotid angiography revealed a pseudoaneurysm of the left middle meningeal artery at the sphenoid ridge. Right external carotid angiography demonstrated a dural arteriovenous fistula fed by the right middle meningeal artery colocated with the right frontal convexity fracture. Transarterial embolization of the left middle meningeal artery pseudoaneurysm with four fibered platinum coils and transarterial embolization of the right dural arteriovenous fistula with poly(2-hydroxyethyl methacrylate-co-methyl methacrylate) were performed, resulting in complete obliteration of both lesions. Angiographic cure was obtained and the postoperative course was uneventful.- - - - - - - - - - ranking = 0.4keywords = aneurysm (Clic here for more details about this article) |
6/13. Near-infrared indocyanine green video angiography: a new method for intraoperative assessment of vascular flow.OBJECTIVE: We report our initial clinical experience with a new method for intraoperative blood flow assessment. The purposes of the study were to assess the use of indocyanine green (ICG) video angiography in neurovascular cases, to assess the handling and image quality, to compare the findings with postoperative angiographic results, and to evaluate the clinical value of the method in a preliminary feasibility study. methods: Fourteen patients with aneurysms (n = 12) or spinal (n = 1) or intracranial (n = 1) dural fistulae were included. Before and/or after aneurysm or dural fistula occlusion, ICG (25 mg) was injected intravenously. A near-infrared laser excitation light source (lambda = 780 nm) illuminated the operating field. The intravascular fluorescence of ICG (maximal lambda = 835 nm) was recorded by a nonintensified video camera, with optical filtering to block ambient and laser light for collection of only ICG-induced fluorescence. RESULTS: A total of 21 investigations were performed for 14 patients. For the 17 successful ICG video angiographic investigations, image quality and resolution were excellent, allowing intraoperative real-time assessment of the cerebral circulation. ICG angiographic results could be divided into arterial, capillary, and venous phases, comparable to those observed with digital subtraction angiography. In all cases, the postoperative angiographic results corresponded to the intraoperative ICG video angiographic findings. In three cases, the information provided by intraoperative ICG angiography significantly changed the surgical procedure. CONCLUSION: ICG video angiography is simple and provides real-time information on the patency of arterial and venous vessels of all relevant diameters, including small and perforating arteries (<0.5 mm), and the visible aneurysm sac. It may be a useful adjunct to improve the quality of neurovascular procedures and to document the intraoperative vascular flow.- - - - - - - - - - ranking = 0.6keywords = aneurysm (Clic here for more details about this article) |
7/13. Incidental discovery of a dural arteriovenous fistula in a patient with activated protein c resistance.A dural arteriovenous fistula was discovered incidentally in a 58-year-old man with activated protein c resistance who underwent routine outpatient cerebral angiography for workup of multiple intracranial aneurysms.- - - - - - - - - - ranking = 0.2keywords = aneurysm (Clic here for more details about this article) |
8/13. Combined transvenous and transarterial embolization of a tentorial-incisural dural arteriovenous malformation followed by primary stent placement in the associated stenotic straight sinus. Case report.Dural arteriovenous malformations (AVMs) involving the tentoria-incisura are associated with an aggressive clinical course characterized by subarachnoid and intracranial hemorrhage (ICH). In these lesions, venous outflow obstruction precipitates leptomeningeal venous drainage, resulting in the arterialization of pial veins and the formation of venous aneurysms, both of which are prone to hemorrhage. Stenotic lesions of the dural sinuses also contribute to the development of retrograde leptomeningeal drainage, which is responsible for the aggressive clinical course of the dural AVM. Endovascular approaches are successful in the treatment of these lesions and of any potential venous outflow obstruction caused by stenosis of a dural sinus. The authors report on a patient with a tentorial-incisural dural AVM and an accompanying stenotic venous sinus. A combined transvenous and transarterial embolization procedure was performed, resulting in complete obliteration of the dural AVM, followed by primary stent placement across a stenotic segment of the straight sinus and normalization of venous outflow. The authors conclude that dural AVMs can be treated safely by using a combined transarterial and transvenous approach and that an extensive search for venous outflow obstruction often reveals stenosis of a draining sinus. Consideration should be given to primary stent placement in the stenotic sinus to protect against ICH.- - - - - - - - - - ranking = 0.2keywords = aneurysm (Clic here for more details about this article) |
9/13. Spinal dural arteriovenous fistula and venous aneurysm: an unusual association.OBJECTIVE: Although spinal intradural arteriovenous malformations have frequently been associated with venous aneurysms, spinal dural arteriovenous fistulas typically are not. We describe a case of conus medullaris compression by a large saccular venous aneurysm of a spinal dural arteriovenous fistula. As these lesions are slow-flow arteriovenous shunts, development of a venous aneurysm is an unexpected condition. Pathogenesis of these aneurysms is briefly discussed. methods: A 61-year-old man presented with progressive spastic paraparesis of 1-year duration. Spinal magnetic resonance (MR) suggested abnormal serpiginous vessels and a partially thrombosed aneurysm at the level of conus medullaris. Spinal angiography was performed but some lower thoracal and upper lumbar segments could not be catheterized because of severe atherosclerosis. As a result, vascular anomaly could not be demonstrated angiographically, but surgical exploration was found to be necessary because of positive clinical and MR findings. RESULTS: An arteriovenous fistula that entered the spinal canal beneath the L1 pedicle on the left was identified. It was easily coagulated and cut. The partially thrombosed aneurysm within the conus medullaris was also resected. CONCLUSIONS: Our case illustrates two important points related to patients harboring spinal dural arteriovenous fistulas (AVF): First, clinical suspicion and MR findings are important in diagnosis of these lesions and surgical exploration is indicated despite negative or nondiagnostic angiographic results in such cases. Second, venous aneurysms may be associated with spinal dural AVFs, and although spinal dural AVFs are low-flow lesions, the development of the venous aneurysm is probably a result of high venous pressure.- - - - - - - - - - ranking = 2.4keywords = aneurysm (Clic here for more details about this article) |
10/13. Second-trimester diagnosis of intracranial vascular anomalies in a fetus with subdural hemorrhage.OBJECTIVES: risk factors for intracranial hemorrhage occurring in prenatal life are imperfectly known. A case of prenatal diagnosis of subdural hemorrhage associated with multiple intracranial vascular aneurysms is described. methods: Sonography and magnetic resonance imaging of the fetal head were obtained at 21 weeks' gestation and compared with pathologic findings. RESULTS: Sonography showed a large transonic mass displacing the normal intracranial structures. magnetic resonance imaging demonstrated the hemorrhagic origin of the mass and showed multiple vascular anomalies. Postmortem examination confirmed the compression of the cerebral hemisphere by a blood collection, probably because of bleeding from one of the multiple vascular aneurysms into the subdural space. CONCLUSION: magnetic resonance imaging with the use of single-shot ultrafast sequences may be useful not only in the differential diagnosis of fetal intracranial hemorrhage but also in identifying vascular risk factors.- - - - - - - - - - ranking = 0.4keywords = aneurysm (Clic here for more details about this article) |
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