Cerebral abscess after neuro-vascular embolization: Own experience and review of the literature

Vein of Galen aneurysmal malformation associated with brain abscess: A computed tomography case report

Vein of Galen malformation (VGM) is a rare congenital, uncommon intracerebral vascular anomaly rarely complicated with the development of brain abscess as secondary to primary infection or after endovascular treatment. We report a very rare finding of a vein of Galen aneurysm associated with a large brain abscess at the time of diagnosis. A 12-year-old boy with a high-grade fever, severe headache, and recurrent episodes of convulsions came into the radiology department of Kassala Advanced Diagnostic Center. On a Siemens 16-slice scanner, brain non-contrast enhanced computed tomography (NECT) and contrast enhanced CT (CECT) was used to determine the source of the acute headache and convulsions which revealed a right frontal peripherally enhancing cystic lesion measuring 5.7 × 4.7 × 5.3 cm2 surrounded by massive vasogenic edema causing mass effect with midline shift to the left side by 1.5 cm suggestive of brain abscess. There is evidence of another avidly enhancing lesion seen within the third ventricle continuous with a straight sinus surrounded by extensive vascular loops consistent with an aneurysm of the vein of Galen, it was causing compression of the cerebral aqueduct with upstream mild hydrocephalus with dilated both lateral ventricles. Late presentation, diagnosis, and treatment also lead to an increase in the morbidities and mortalities of such case conditions. Urgent intervention should be considered for better outcomes.

The impact of refined nursing intervention on neurological function recovery and prognosis improvement in patients undergoing intracranial aneurysm intervention

BACKGROUND

This study aims to explore the application of refined nursing intervention in patients undergoing unruptured intracranial aneurysm intervention, evaluating its impact on neurological function recovery and prognosis improvement.

METHODS

Patients diagnosed with intracranial aneurysms and undergoing treatment at our hospital from February 2022 to June 2023 were included in this study. After applying complete inclusion and exclusion criteria to ensure sample representativeness, a total of 92 patients were enrolled. Using a randomization method, patients were divided into an observation group and a control group. The control group received routine nursing care, while the observation group received refined nursing intervention. Nursing effects were compared between the two groups, and statistical analysis was conducted using appropriate methods, with content analysis summarizing the results.

RESULTS

The observation group, post-intervention, exhibited significantly improved Neurological Function Deficit (NFD) scores compared to the control group (p = 0.023). Additionally, the observation group showed higher proportions of Grade V patients in the Glasgow Outcome Scale (GOS) post-intervention (p = 0.031). Moreover, Fugl Meyer Assessment (FMA) scores for motor function were notably higher in the observation group than the control group (p = 0.003). The observation group also reported lower headache intensity and fewer adverse outcomes than the control group (p = 0.018, 0.038).

CONCLUSION

Refined nursing intervention in patients undergoing intracranial aneurysm intervention demonstrates better outcomes in terms of neurological function recovery and prognosis improvement. It reduces uncertainty in nursing practices, effectively enhancing nursing outcomes, and warrants clinical application and promotion.

Middle meningeal artery embolization without surgical evacuation for chronic subdural hematoma: a single-center experience of 209 cases

Background

Middle meningeal artery (MMA) embolization is a minimally invasive treatment option for new and recurrent chronic subdural hematomas (cSDH).

Objective

To examine the safety and efficacy profile of MMA embolization without surgical evacuation for cSDH patients.

Methods

A single-center retrospective study of patients with cSDHs treated by MMA embolization was undertaken. Patient demographics, hematoma characteristics, procedural details, and clinical and radiological outcomes were collected. The primary outcome was the need for retreatment, and the secondary outcomes were at least a 50% reduction in the maximum width of cSDH on the last CT imaging, complications, and an improvement in the modified Rankin scale (mRS) score. All results were presented as descriptive statistics.

Results

A total of 209 MMA embolizations were successfully performed on 144 patients. Polyvinyl alcohol particles were the primary embolization agent in all procedures. Of the total of 206 cSDH, the median maximum width at pre-intervention and last follow-up were 12 and 3 mm, respectively, and the median reduction percentage was 77.5%, with a >50% improvement observed in 72.8% at the last follow-up imaging. A total of 13.8% of patients needed retreatment for recurrent, refractory, or symptomatic hematomas after embolization. The mRS score improved in 71 (49.3%) patients. Of 144 patients, 4 (2.8%) experienced complications related to the procedure, and 12 (8.4%) died during follow-up due to causes unrelated to the MMA embolization procedures.

Conclusion

This study supports the fact that MMA embolization without surgical evacuation is a safe and effective minimally invasive option for the treatment of cSDHs.

Epidural empyema following nBCA embolization of the middle meningeal artery for the treatment of a chronic subdural hematoma

Chronic subdural hematomas (CSDHs) are a common neurosurgical disease for which middle meningeal artery (MMA) embolization is emerging as an attractive and efficacious endovascular treatment modality. We present the first known case of a Streptococcus intermedius epidural abscess that resulted following MMA embolization for a left-sided CSDH that required evacuation and washout through a craniotomy. Intracranial infections can be a potentially devastating complication from MMA embolization in this patient population.

Cerebral abscess secondary to embolization of arteriovenous malformation: A case report and literature review

Background:

Infectious complications of the central nervous system secondary to endovascular procedures have rarely been reported. However, the number of complications has grown exponentially owing to the popularization of these procedures. The success rate of these procedures varies with the pathology, the patient, and surgical performance. Although brain abscesses have been extensively reported, their presence after endovascular procedures has not been described in detail in the literature. We present a case of brain abscess induced by embolization of an arteriovenous malformation (AVM), discuss the main indications, techniques, procedural complications, and review the associated literature.

Case Description:

A 13-year-old boy presented to us with a history of hemorrhagic stroke secondary to a cerebral AVM rupture. He underwent incomplete AVM resection (2014), with subsequent incomplete embolization (2017), and permanence of the endovenous catheter as a procedural complication. Physical examination revealed purulent exudate through the cervical surgical wound. We performed cervicotomy to remove the catheter but had no success in removing the intracranial material segment. The patient was subsequently diagnosed with a brain abscess (2018) and treated with antibiotics. Our team performed resection of the residual AVM, abscess, and the catheter-associated with the region.

Conclusion:

The patient showed significant clinical improvement after surgical resection of the malformation. No residual lesions were observed in the imaging examinations. Further, we reviewed the literature to find other cases of similar complications and their association with the endovascular procedure. We did not find complications in patients younger than the one presented in this case. Factors such as incomplete embolisation increase the risk of unfavourable outcomes.

Sphenoid sinusitis complicated by extensive septic thrombosis after coiling of a ruptured intracranial aneurism

We report here the case of a 40-year-old man who presented with sphenoid sinusitis complicated by jugular and cerebral venous thrombosis and intracranial infection 6 weeks after coiling of an anterior choroidal artery aneurysm. The pathogeny of this unusual and severe complication is discussed.

Cerebral Abscess After Onyx Embolization of an Arteriovenous Malformation

BACKGROUND

Endovascular embolization is being increasingly used to treat cerebral arteriovenous malformations. Common complications associated with embolization include intracranial hemorrhage and ischemic stroke; intracranial infections seldomly occur and are even less frequently reported. Although abscess formation after embolization is exceedingly rare, it is a serious condition that warrants immediate attention.

CASE DESCRIPTION

This 53-year-old male with a ruptured left temporal-occipital arteriovenous malformation. He underwent uncomplicated 2-stage embolization with Onyx and was discharged. Five weeks after embolization, he returned to the hospital with worsening aphasia and contralateral hemiparesis, and a cerebral abscess was detected at the site of embolization. Bacterial cultures were positive for Escherichia coli, and he was treated successfully with surgical excision of the abscess and Onyx material, followed by long-term antibiotics.

CONCLUSIONS

Although rare, formation of an intracranial abscess after endovascular embolization is a potential complication in the treatment of arteriovenous malformations.

Brain Abscesses After Endovascular Embolization of a Brain Arteriovenous Malformation with Squid

BACKGROUND

The use of nonadhesive liquid embolic agents (NALEAs) has gained great popularity in the treatment of brain vascular malformations, with a lower rate of local complications than surgery. However, we describe the formation of brain abscesses after endovascular treatment of a brain arteriovenous malformation (bAVM) and how important removal of the NALEAs was in the treatment of these abscesses.

CASE DESCRIPTION

A 68-year-old man presented with seizures after being treated for an unruptured bAVM using Squid (Emboflu), an NALEA. Radiologic imaging revealed brain lesions suspicious of abscesses around the previously treated bAVM. A surgical excision of the bAVM and the embolized material was performed as was drainage of the brain abscesses. Bacterial cultures were positive for Enterococcus faecalis, and the patient left the hospital with an appropriate antibiotic regimen without new deficits.

CONCLUSIONS

This is the first reported case of a bAVM treated with Squid complicated with brain abscesses, a rare but very serious complication. This complication should be treated not only using antibiotherapy but with complete safe removal of the embolic material.

Cerebral Abscess Following Endovascular Treatment of Aneurysm: Report of 2 Cases and Review of the Literature

INTRODUCTION

Endovascular treatment is growing in popularity globally as an important treatment option for intracranial aneurysms. Cerebral infection as a complication of endovascular treatment of aneurysms is sufficiently rare that only 6 isolated cerebral abscess cases have been reported thus far.

CASE REPORT

In this report, we present 2 cerebral abscesses from 3 institutions, which developed after coil embolization of anterior communicating artery and middle cerebral artery aneurysms.

CONCLUSION

This report was written to discuss the possible mechanisms underlying cerebral abscess after endovascular treatment of aneurysms and to suggest potential treatment and prevention methods.

Cerebral abscesses after endovascular coiling of a paraophthalmic aneurysm: Case report and review of the literature

Background:

Intracranial infections are a rare complication of therapeutic neuroendovascular procedures.

Case Description:

We present a case of a 72-year-old female with multiple unilateral cerebral hemisphere abscesses after endovascular embolization of a right paraophthalmic aneurysm and also provide a comprehensive review of the literature on cerebral abscesses following neurovascular embolization.

Conclusion:

Infection following coil embolization of cerebral aneurysm is rare. However, it is likely to increase in the setting of increased used of neuroendovascular techniques in the future. Therefore, we suggest that extreme care is taken to ensure proper asepsis during embolization, and a high index of suspicion is maintained in patients with predisposing characteristics (large hemorrhage, ischemia, recurrent endovascular procedures, right-to-left shunt, and concomitant infection). Given the fact that the majority of abscesses occurred in patients who have had ruptured aneurysms, we suggest consideration is given to prophylactic intraprocedural intravenous antibiotics use as seen with open aneurysm treatment.