1/372. Posterior inferior cerebellar artery aneurysms associated with posterior fossa arteriovenous malformation: report of five cases and literature review.BACKGROUND: The association of posterior inferior cerebellar artery (pica) aneurysms with posterior fossa arteriovenous malformation (AVM) is uncommon. Over the past 3 years, five patients with this condition were treated at this institution. A review of the clinical history of these and other reported cases has illuminated common threads in the presentation, treatment, and outcome of these lesions. methods: The findings of 27 patients (5 from our institution and 22 from the medical literature) with pica aneurysms associated with AVMs were reviewed. RESULTS: Eighty-four percent of individuals presented with sub-arachnoid hemorrhage (SAH); 89% of these episodes resulted from aneurysm rupture documented by either intraoperative inspection or autopsy. All aneurysms were located on a feeding artery to the AVM, and 81% originated from distal portions of pica. The majority of patients presented with Hunt & Hess grade I SAH; all patients who presented with hemorrhage were treated surgically. Surgical strategy was directed both to secure the aneurysm and to resect the AVM during the course of a single procedure. Although four individuals either died on admission or in the perioperative period, overall outcome was excellent or good in 82% of patients. CONCLUSIONS: pica aneurysms associated with AVMs most often involve the distal segments of the artery. patients usually present with SAH secondary to aneurysmal rupture. Surgical clipping of the aneurysm and excision of the AVM is possible in a single procedure with minimal morbidity. overall prognosis is favorable in 80% of the cases.- - - - - - - - - - ranking = 1keywords = artery (Clic here for more details about this article) |
2/372. Tentorial dural arteriovenous fistula obliterated using the petrosal approach.BACKGROUND: Tentorial dural arteriovenous fistulas (AVFs) are uncommon lesions usually treated surgically using a subtemporal exposure with division of the tentorium. This exposure requires significant retraction of the temporal lobe and has the possibility of significant arterialized venous bleeding if a draining vein is accidentally cut during division of the tentorium. skull base surgical techniques may provide alternate approaches for the surgical treatment of tentorial dural AVFs. methods: A tentorial dural arteriovenous fistula supplied by the tentorial artery and drained by the petrosal vein was exposed and obliterated using the petrosal (subtemporal-presigmoid) approach. RESULTS: The petrosal approach allowed the exposure and division of the superior petrosal sinus and tentorium with direct visualization of the supratentorial and the infratentorial compartments, avoiding accidental damage to the draining veins. The dural fistula was easily obliterated after its venous drainage was interrupted and the tentorial artery occluded. CONCLUSIONS: Tentorial dural AVFs can be safely treated with interruption of the venous drainage. The exposure can be enhanced with a petrosal approach, decreasing the possibility of uncontrolled bleeding during the procedure.- - - - - - - - - - ranking = 0.28571428571429keywords = artery (Clic here for more details about this article) |
3/372. popliteal artery occlusion as a late complication of liquid acrylate embolization for cerebral vascular malformation.Occlusion of arteriovenous malformations of the brain (BAVMs) by means of an endovascular approach with liquid acrylate glue is an established treatment modality. The specific hazards of this procedure are related to the central nervous system. In the case of unexpectedly rapid polymerization of the cyanoacrylate glue and adhesion of the delivering microcatheter to the BAVM, severing the catheter at the site of vascular access is considered an acceptable and safe management. We present a unique complication related to this technique that has not been described yet. Fragmentation and migration of the microcatheter, originally left in place, had caused popliteal artery occlusion, which required saphenous vein interposition, in a 25-year-old man. Suggestions for avoiding this complication are discussed.- - - - - - - - - - ranking = 0.71428571428571keywords = artery (Clic here for more details about this article) |
4/372. Ruptured aneurysm of the orbitofrontal artery associated with dural arteriovenous malformation in the anterior cranial fossa--case report.A 27-year-old male presented with a rare association of a ruptured orbitofrontal artery aneurysm and a dural arteriovenous malformation (DAVM) fed by both ethmoidal arteries, manifestation as severe headache, nausea, and vomiting. Computed tomography revealed a hematoma within the right frontal lobe and diffuse subarachnoid hemorrhage. The aneurysm was clipped successfully and the hematoma was evacuated. After an uneventful postoperative course, the patient was referred for gamma knife radiosurgery to treat the DAVM. In this case, the DAVM was asymptomatic and pathogenetically unrelated to the aneurysm, which demanded urgent treatment.- - - - - - - - - - ranking = 0.71428571428571keywords = artery (Clic here for more details about this article) |
5/372. adenosine-induced cardiac pause for endovascular embolization of cerebral arteriovenous malformations: technical case report.OBJECTIVE: Extremely high flow through arteriovenous malformations (AVMs) may limit the safety and effectiveness of endovascular glue therapy. To achieve a more controlled deposition of glue, we used transient but profound systemic hypotension afforded by an intravenously administered bolus of adenosine to induce rapidly reversible high-degree atrioventricular block. methods AND CASE REPORT: A patient with a large high-flow occipital AVM fed primarily by the posterior cerebral artery underwent n-butyl cyanoacrylate glue embolization. nitroprusside-induced systemic hypotension did not adequately reduce flow through the nidus, as determined by contrast injection in the feeding artery. In a dose-escalation fashion, boluses of adenosine were administered to optimize the dose and verify that there was no flow reversal in the AVM and no other unexpected hemodynamic abnormalities by arterial pressure measurements and transcranial Doppler monitoring of the posterior cerebral artery feeding the AVM. Thereafter, 64 mg of adenosine was rapidly injected as a bolus to provide 10 to 15 seconds of systemic hypotension (approximately 20 mm Hg). Although there were conducted beats and some residual forward flow through the AVM during this time, the mean systemic and feeding artery pressures were roughly similar and remained relatively constant. A slow controlled injection of n-butyl cyanoacrylate glue was then performed, with excellent filling of the nidus. CONCLUSION: adenosine-induced cardiac pause may be a viable method of partial flow arrest in the treatment of cerebral AVMs. Safe, deep, and complete embolization with a permanent agent may increase the likelihood of endovascular therapy's being curative or may further improve the safety of microsurgical resection.- - - - - - - - - - ranking = 0.57142857142857keywords = artery (Clic here for more details about this article) |
6/372. Dural arteriovenous malformation in the anterior cranial fossa.Two cases of dural arteriovenous malformation (AVM) at the base of the anterior cranial fossa are described. In both cases an intracerebral hematoma following the rupture of the AVM was the first indication of the disease. In one case, the malformation was supplied both by the anterior ethmoidal artery and frontopolar artery draining into the superior sagittal sinus. In the second case, the right anterior ethmoidal artery with draining veins into the superior sagittal sinus and sphenoparietal sinus was the feeding vessel. Surgical evacuation of the hematoma and excision of the malformation was performed on both patients. The typical clinical signs and radiological findings are described. A review of the pertinent literature is given.- - - - - - - - - - ranking = 0.42857142857143keywords = artery (Clic here for more details about this article) |
7/372. arteriovenous fistula with associated aneurysms coexisting with dural arteriovenous malformation of the anterior inferior falx. Case report and review of the literature.This 24-year-old man presented with an unusual case of a high-flow arteriovenous fistula (AVF). This lesion was similar to giant AVFs in children that have been previously described in the literature. In patients in whom abnormalities of the vein of Galen have been excluded and in whom presentation occurs after 20 years of age, a diagnosis of congenital AVF is quite unusual. The fistula in this case originated in an enlarged callosomarginal artery and drained into the superior sagittal sinus via a saccular vascular abnormality. Two giant aneurysmal dilations of the fistula were present. In an associated finding, a small falcine dural arteriovenous malformation (AVM) was also present. Arterial supply to the AVM arose from both external carotid arteries and the left vertebral artery, with drainage through an aberrant vein in the region of the inferior sagittal sinus into the vein of Galen. craniotomy with exposure and trapping of the AVF was performed, with subsequent radiosurgical (linear accelerator) treatment of the dural AVM. Through this combination of microsurgical trapping of the AVF and radiotherapy of the dural AVM, an excellent clinical outcome was achieved.- - - - - - - - - - ranking = 0.76315574820101keywords = carotid, artery (Clic here for more details about this article) |
8/372. Cerebral angioma and aneurysm of the cervical internal carotid artery.A case of internal carotid artery aneurysm in association with a congenital cerebral arterio-venous malformation is described. The carotid artery aneurysm was resected with primary anastomosis of the redundant artery, with satisfactory recovery.- - - - - - - - - - ranking = 6.4235880309708keywords = carotid, carotid artery, artery (Clic here for more details about this article) |
9/372. association of cerebral arteriovenous malformations and spontaneous occlusion of major feeding arteries: clinical and therapeutic implications.OBJECTIVE: The spontaneous occlusion of a cerebral arteriovenous malformation (AVM) occurs rarely. Occlusion of a parent artery feeding the AVM is even more rare, and its incidence is unknown. We undertook this study to determine the incidence of occlusion of a major artery feeding an AVM and to recommend a management strategy for such an AVM. methods: We identified AVMs associated with an occluded artery by performing a retrospective angiographic analysis of 500 patients with AVMs who presented to Henry Ford Hospital from 1976 to 1998. RESULTS: A review of the angiograms revealed that 7 (1.4%) of 500 patients with an AVM had occlusion of one or more major arteries feeding the nidus. In four patients, an internal carotid artery and its bifurcation were occluded; in two patients, the M1 segment of the middle cerebral artery was occluded, and in one patient, a vertebral artery was occluded. Pial collaterals and/or a moyamoya pattern of anastomoses developed in all patients, with the exception of one who had vertebral artery occlusion. Five patients underwent definitive treatment: one received radiosurgery, and four underwent surgical excision. One of the surgically treated patients died of complications from excessive blood loss and coagulopathy, but the other three had no postoperative complications. CONCLUSION: The occlusion of a major artery feeding an AVM occurs rarely (1.4%). These AVMs are moderate to large in size (>3 cm). To prevent collateral flow-related complications of cortical "steal" and hemorrhage, as well as the usual risk of hemorrhage from the AVM itself, surgical management should be considered for these AVMs.- - - - - - - - - - ranking = 2.0467884813523keywords = carotid, carotid artery, artery (Clic here for more details about this article) |
10/372. Carotid rete mirabile presenting subarachnoid haemorrhage. Report Of two cases.Carotid rete mirabile (CRM) consists of arterial channels between the internal and external carotid arteries in some lower mammals. It is a very rare pathological condition in humans. We report two patients who presented with clinical signs of subarachnoid haemorrhage (SAH). Their sudden-onset SAH was thought to have been due to rupture of cerebral aneurysms, however, angiograms revealed an abnormal vascular network around the cavernous sinus. To our knowledge, 2 of 7 reported patients with CRM presented with SAH, however, only one of these patients had a probable cerebral aneurysm. We suggest that in patients with CRM, the rupture of anastomosing vessels be a probable cause of SAH.- - - - - - - - - - ranking = 0.47744146248673keywords = carotid (Clic here for more details about this article) |
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