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Hamano E, Satow T, Hori T, Takahashi JC, Kataoka H. A Case of Direct Carotid-Cavernous Fistulae Successfully Treated by Bidirectional Double Catheter Technique: A Technical Note. JOURNAL OF NEUROENDOVASCULAR THERAPY 2021; 16:307-312. [PMID: 37501892 PMCID: PMC10370543 DOI: 10.5797/jnet.cr.2021-0052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 08/10/2021] [Indexed: 07/29/2023]
Abstract
Objective Ruptured carotid-cavernous aneurysms (CCAs) are known to result in direct carotid-cavernous fistula (CCF). Although endovascular treatment is recognized as the first-line treatment for direct CCF, obliteration is sometimes difficult because of the high-flow shunt. In this report, we present a case of a direct CCF treated by the combination of transarterial and transvenous approaches. Case Presentation A 57-year-old woman presented with conjunctival chemosis, exophthalmos, and tinnitus. Ophthalmological examination revealed increased intraocular pressure. DSA demonstrated a direct CCF due to a right ruptured CCA with retrograde shunted flow through the superior ophthalmic vein (SOV), superficial middle cerebral vein, basal vein of Rosenthal, and middle temporal vein. Two microcatheters were guided into the shunt segment from the internal carotid artery and SOV. In addition, a balloon catheter was placed at the neck of the aneurysm to assist coiling. Coil embolization for the CCF was performed using two microcatheters in the opposite direction, which enabled compact and tight packing of the shunt segment with only six coils. The CCF was eliminated. Two-year-follow-up MRA revealed no recurrence. Conclusion The bidirectional double catheter technique is a useful approach to obliterate a shunt in a short segment with minimal coils.
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Affiliation(s)
- Eika Hamano
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Tetsu Satow
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Takamitsu Hori
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Jun C Takahashi
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
- Department of Neurosurgery, Kindai University Faculty of Medicine, Osakasayama, Osaka, Japan
| | - Hiroharu Kataoka
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
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Chernov IV, Kutin MA, Kheyreddin AS, Konovalov AN, Shekhtman OD, Eliava SS, Kalinin PL. [Combination of pituitary adenomas and intracranial aneurysms]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2021; 85:94-103. [PMID: 33560625 DOI: 10.17116/neiro20218501194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The combination of intracranial tumors and asymptomatic brain aneurysms is an urgent problem, since it can significantly affect surgical intervention. Aneurysms are common in patients with meningioma, glioma and pituitary adenoma. According to certain authors, combination of aneurysms with pituitary adenomas is 7 times more common than with other tumors. In these cases, a comprehensive examination of the patient and decision-making on surgical strategy are required. This review is devoted to epidemiology, diagnosis and treatment of patients with a combination of pituitary adenomas and intracranial aneurysms detected intraoperatively or at the preoperative stage. The manuscript is illustrated by cases observed at the Burdenko Neurosurgery Center.
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Affiliation(s)
- I V Chernov
- Burdenko Neurosurgery Center, Moscow, Russia
| | - M A Kutin
- Burdenko Neurosurgery Center, Moscow, Russia
| | | | | | | | | | - P L Kalinin
- Burdenko Neurosurgery Center, Moscow, Russia
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Khachatryan T, Khachatryan M, Fanarjyan R, Grigoryan M, Grigorian A. Enlargement of an incidental internal carotid artery aneurysm embedded in pituitary adenoma associated with medical shrinkage of the tumor: Case report. Surg Neurol Int 2018. [PMID: 29527388 PMCID: PMC5838828 DOI: 10.4103/sni.sni_317_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background Currently, transsphenoidal surgery (TSS) is the preferred method for surgical treatment of intrasellar pituitary adenomas. However, it carries some risk of intraoperative arterial injuries, which is mainly attributed to direct iatrogenic rupture of the internal carotid artery (ICA). There is anecdotal evidence suggesting that intracranial aneurysms are coincidentally found significantly more frequently in the setting of pituitary adenomas than when the incidence is compared to other intracranial neoplasms. The exact cause of this discrepancy remains unclear, but it certainly raises concerns about the potential existence of an ICA aneurysm, which might be encountered during TSS and in some cases may cause hemorrhagic complications. Case Description We present a case of a patient who was found to have a growth hormone (GH)-secreting pituitary adenoma and a coexisting cavernous ICA aneurysm which was embedded within the tumor. The patient underwent medical treatment of the adenoma. However, shrinkage of the tumor was associated with enlargement of the observed aneurysm, warranting endovascular intervention. Conclusions This case report is an illustration for physicians to be conscientious about the potential danger posed by the coexistence of an intratumoral aneurysm in the setting of a pituitary adenoma. Special attention should be given to recognition of an intrinsic flow void signal on the presurgical imaging of the tumor, and if observed, magnetic resonance angiography (MRA) should be performed for preoperative planning. If MRA is not performed routinely, detailed review of high-resolution magnetic resonance imaging is recommended to detect any flow artifacts suggestive of an aneurysm.
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Affiliation(s)
| | - Marina Khachatryan
- Department of Neurosurgery, Yerevan State Medical University, Yerevan, Armenia
| | - Ruben Fanarjyan
- Department of Neurosurgery, Yerevan State Medical University, Yerevan, Armenia
| | - Mikayel Grigoryan
- Glendale Adventist Comprehensive Stroke Center, Los Angeles, California, USA
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Guan N, Mu S, Wang L, Huo X, Jiang Y, Lv X, Li Y. Endovascular Treatment of 147 Cases of Cavernous Carotid Aneurysms: A Single-Center Experience. J Stroke Cerebrovasc Dis 2016; 25:1929-35. [PMID: 27185537 DOI: 10.1016/j.jstrokecerebrovasdis.2016.04.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Revised: 03/09/2016] [Accepted: 04/14/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Cavernous carotid aneurysms (CCAs) are characterized by pain and neuro-ophthalmologic deficits. The optimal treatment remains unclear, especially for asymptomatic CCAs. This study investigated the efficacy of endovascular treatment for CCAs in our center. METHODS Data obtained from patients who underwent endovascular treatment for CCAs from July 2011 to July 2014 were reviewed. A retrospective analysis was conducted regarding the general condition, clinical presentation, aneurysm characteristics, therapeutic strategy, and prognosis of CCA patients. RESULTS One hundred forty-seven patients who exhibited 155 CCAs were included, which comprised 46 asymptomatic and 101 symptomatic CCA cases. Forty-eight cases presented with headache, 5 cases presented with subarachnoid hemorrhage, 20 cases presented with diplopia, 38 cases presented with cranial nerve palsy, and 27 cases presented with ischemic stroke. The mean aneurysm sizes were 15.3 ± 12.2 and 8.1 ± 7.1 mm in the symptomatic and asymptomatic groups, respectively. Different treatments were administered: coil occlusion (n = 15), stent/balloon-assisted coil occlusion (n = 123), and parent artery occlusion (PAO) (n = 17). The PAO-treated group exhibited the highest aneurysm occlusion rate. Follow-up data were available for 131 cases, which included 86 symptomatic and 45 asymptomatic cases. There were no deaths. Among the symptomatic patients, 40.7% improved, 58.1% remained stable, and 1.2% worsened; 12 patients exhibited regrowth and 6 patients had repeated endovascular treatment. The asymptomatic patients remained stable, including 5 patients who exhibited regrowth and 2 patients who had repeated endovascular treatment. CONCLUSION Endovascular treatment is safe and effective for CCAs and should be considered in patients with minimal complications, as well as in asymptomatic patients with stable symptoms.
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Affiliation(s)
- Ning Guan
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shiqing Mu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Linyuan Wang
- Department of Periodontics, The Second Affiliated Hospital of Liaoning Medical College, Jinzhou, Liaoning, China
| | - Xiaochuan Huo
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yuhua Jiang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xianli Lv
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Youxiang Li
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
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Baek JW, Kim ST, Lee YS, Jeong YG, Jeong HW, Baek JW, Seo JH. Recurrent Carotid Cavernous Fistula Originating from a Giant Cerebral Aneurysm after Placement of a Covered Stent. J Cerebrovasc Endovasc Neurosurg 2016; 18:306-314. [PMID: 27847780 PMCID: PMC5104861 DOI: 10.7461/jcen.2016.18.3.306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 08/29/2016] [Accepted: 09/09/2016] [Indexed: 11/23/2022] Open
Abstract
We report the case of a recurrent carotid cavernous fistula (CCF) originating from a giant cerebral aneurysm (GCA) after placement of a covered stent. A 47-year-old woman presented with sudden onset of severe headache, and left-sided exophthalmos and ptosis. Cerebral angiography revealed a CCF caused by rupture of a GCA in the cavernous segment of the left internal carotid artery. Two covered stents were placed at the neck of the aneurysm. The neurological symptoms improved at first, but were aggravated in the 6 months following the treatment. Contrast agent endoleak was seen in the distal area of the stent. Even though additional treatments were attempted via an endovascular approach, the CCF could not be cured. However, after trapping the aneurysm using coils and performing superficial temporal artery-middle cerebral artery bypass, the neurological symptoms improved. In cases of recurrent CCF originating from a GCA after placement of a covered stent, it is possible to treat the CCF by endovascular trapping and surgical bypass.
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Affiliation(s)
- Jung Wook Baek
- Department of Neurosurgery, Busan Paik Hospital, Inje University, School of Medicine, Busan, Korea
| | - Sung Tae Kim
- Department of Neurosurgery, Busan Paik Hospital, Inje University, School of Medicine, Busan, Korea
| | - Young Seo Lee
- Department of Neurosurgery, Busan Paik Hospital, Inje University, School of Medicine, Busan, Korea
| | - Young-Gyun Jeong
- Department of Neurosurgery, Busan Paik Hospital, Inje University, School of Medicine, Busan, Korea
| | - Hae Woong Jeong
- Department of Diagnostic Radiology, Busan Paik Hospital, Inje University, School of Medicine, Busan, Korea
| | - Jin Wook Baek
- Department of Diagnostic Radiology, Busan Paik Hospital, Inje University, School of Medicine, Busan, Korea
| | - Jung Hwa Seo
- Department of Neurology, Busan Paik Hospital, Inje University, School of Medicine, Busan, Korea
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Zanaty M, Chalouhi N, Tjoumakaris SI, Hasan D, Rosenwasser RH, Jabbour P. Endovascular treatment of carotid-cavernous fistulas. Neurosurg Clin N Am 2014; 25:551-63. [PMID: 24994090 DOI: 10.1016/j.nec.2014.04.011] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Endovascular management has become the treatment of choice for carotid-cavernous fistulas regardless of the fistula type. The endovascular method offers numerous options that render it capable of treating each fistula type by choosing an adequate technique. This advantage along with the advancement in the field has led to fewer complications with higher success rate.
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Affiliation(s)
- Mario Zanaty
- Department of Neurosurgery, Jefferson Hospital for Neuroscience, Thomas Jefferson University, 909 Walnut Street, Philadelphia, PA 19107, USA
| | - Nohra Chalouhi
- Department of Neurosurgery, Jefferson Hospital for Neuroscience, Thomas Jefferson University, 909 Walnut Street, Philadelphia, PA 19107, USA
| | - Stavropaula I Tjoumakaris
- Department of Neurosurgery, Jefferson Hospital for Neuroscience, Thomas Jefferson University, 909 Walnut Street, Philadelphia, PA 19107, USA
| | - David Hasan
- Department of Neurosurgery, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA
| | - Robert H Rosenwasser
- Department of Neurosurgery, Jefferson Hospital for Neuroscience, Thomas Jefferson University, 909 Walnut Street, Philadelphia, PA 19107, USA
| | - Pascal Jabbour
- Department of Neurosurgery, Jefferson Hospital for Neuroscience, Thomas Jefferson University, 909 Walnut Street, Philadelphia, PA 19107, USA; Division of Neurovascular Surgery and Endovascular Neurosurgery, Department of Neurological Surgery, Thomas Jefferson University Hospital, 909 Walnut Street, 2nd Floor, Philadelphia, PA 19107, USA.
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Yu Y, Huang Q, Xu Y, Hong B, Zhao W, Deng B, Zhang Y, Liu J. Use of onyx for transarterial balloon-assisted embolization of traumatic carotid cavernous fistulas: a report of 23 cases. AJNR Am J Neuroradiol 2012; 33:1305-9. [PMID: 22492567 DOI: 10.3174/ajnr.a2977] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE TCCFs are a common complication following craniofacial trauma and are usually treated by coils or detachable balloons. The use of the liquid embolic agent Onyx as the sole agent for the treatment of TCCFs has been rarely reported. Herein, we summarized the preliminary experience and effectiveness of treating TCCFs with Onyx in 23 patients. MATERIALS AND METHODS From the 36 type A CCFs treated in our department between September 2005 and March 2011, a total of 23 posttraumatic direct CCFs were treated by using Onyx only via transarterial approach. RESULTS Immediate postprocedural angiograms demonstrated complete occlusion in all patients. All the patients underwent a single procedure except 1 with bilateral TCCFs. Up to 24-month clinical and 3-month angiographic follow-ups revealed an ongoing complete occlusion without any complications. CONCLUSIONS In this series, the use of Onyx for the transarterial embolization of TCCFs was feasible and effective. Associated adverse events were rare.
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Affiliation(s)
- Y Yu
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China
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Treatment of High-Flow Carotid Cavernous Fistula Using a Graft Stent: Case Report. Korean J Neurotrauma 2012. [DOI: 10.13004/kjnt.2012.8.1.51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Jin SC, Park H, Kwon DH, Choi CG. Direct carotid cavernous fistula of an adult-type persistent primitive trigeminal artery with multiple vascular variations. J Korean Neurosurg Soc 2011; 49:226-8. [PMID: 21607181 DOI: 10.3340/jkns.2011.49.4.226] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2010] [Revised: 08/12/2010] [Accepted: 03/27/2011] [Indexed: 11/27/2022] Open
Abstract
We report a case of spontaneous right carotid-cavernous fistula (CCF) in a proximal segment of persistent primitive trigeminal artery (PPTA) and combined vascular anomalies such as left duplicated hypoplastic proximal posterior cerebral arteries and a variation of anterior choroidal artery supplying temporal and occipital lobe. A 45-year-old male presented with progressive right exophthalmos, diplopia, and ocular pain. With manual compression of the internal carotid artery, a cerebral angiography revealed a right CCF from a PPTA. Treatment involved the placement of detachable non-fibered and fibered coils, and use of a hyperglide balloon to protect against coil herniation into the internal carotid artery. A final angiograph revealed complete occlusion of PPTA resulted in no contrast filling of CCF.
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Affiliation(s)
- Sung-Chul Jin
- Cerebrovascular Center, Inje University, Haeundae Paik Hospital, Busan, Korea
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Yoon WK, Kim YW, Kim SR, Park IS, Kim SD, Baik MW. Transarterial coil embolization of a carotid-cavernous fistula which occurred during stent angioplasty. Acta Neurochir (Wien) 2009; 151:849-53; discussion 853-4. [PMID: 19415171 DOI: 10.1007/s00701-009-0351-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2008] [Accepted: 10/14/2008] [Indexed: 11/25/2022]
Abstract
Intracranial endovascular procedures are less invasive and relatively safe; however, these procedures do carry a risk of complications, such as thromboembolization, arterial injury, and vessel occlusion. We present a case of carotid-cavernous fistula development secondary to injury of the cavernous segment of the internal carotid artery (ICA) during stent angioplasty and its treatment by transarterial coil embolization. Probable causes of this complication and its treatment method are discussed. To the best of our knowledge, this is the first report of such a case.
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Affiliation(s)
- Won Ki Yoon
- Department of Neurosurgery, Holy Family Hospital, The Catholic University of Korea, Seoul, Korea
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Eddleman CS, Hurley MC, Bendok BR, Batjer HH. Cavernous carotid aneurysms: to treat or not to treat? Neurosurg Focus 2009; 26:E4. [DOI: 10.3171/2009.2.focus0920] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Most cavernous carotid aneurysms (CCAs) are considered benign lesions, most often asymptomatic, and to have a natural history with a low risk of life-threatening complications. However, several conditions may exist in which treatment of these aneurysms should be considered. Several options are currently available regarding the management of CCAs with resultant good outcomes, namely expectant management, luminal preservation strategies with or without addressing the aneurysm directly, and Hunterian strategies with or without revascularization procedures. In this article, we discuss the sometimes difficult decision regarding whether to treat CCAs. We consider the natural history of several types of CCAs, the clinical presentation, the current modalities of CCA management and their outcomes to aid in the management of this heterogeneous group of cerebral aneurysms.
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Affiliation(s)
| | - Michael C. Hurley
- 2Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Bernard R. Bendok
- 1Departments of Neurological Surgery and
- 2Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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