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Hayashi T, Endo H, Kanoke A, Kawaguchi T, Tominaga T. Bypass surgery for ruptured dissecting aneurysms of the proximal posterior cerebral artery: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2022; 4:CASE22341. [PMID: 36461837 PMCID: PMC9552679 DOI: 10.3171/case22341] [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: 08/09/2022] [Accepted: 08/29/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Posterior cerebral artery (PCA) dissecting aneurysms commonly occur in the proximal PCA and are considered rare. The treatment of proximal PCA dissecting aneurysms is challenging because of the existence of perforators supplying the vital neural structures. Recently, endovascular intervention has been used; however, concerns for ischemic or hemorrhagic complications exist. OBSERVATIONS A 54-year-old woman presented with subarachnoid hemorrhage due to dissecting aneurysm rupture at the P1-P2 junction of the PCA. The thalamoperforating artery (TPA) and medial posterior choroidal artery (MPchA) originated from the proximal end and the distal end of the aneurysm, respectively. Additionally, the posterior communicating artery (PcomA) connected with the dissected segment. To preserve these perforators, we performed surgical trapping combined with superficial temporal artery (STA) PCA anastomosis. Clips were applied for trapping the proximal and distal end of the aneurysm, with preservation of the TPA and MPchA origin. PcomA was left open for blood flow preservation to the perforators directly arising from the aneurysm. The postoperative course was uneventful, and the patient was discharged. LESSONS Surgical trapping using STA-PCA bypass could be a treatment of choice for proximal PCA dissecting aneurysms, considering its potential for cure and prevention of ischemic complications.
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Affiliation(s)
- Tetsuya Hayashi
- Department of Neurosurgery, Kohnan Hospital, Sendai, Miyagi, Japan
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan; and
| | - Hidenori Endo
- Department of Neurosurgery, Kohnan Hospital, Sendai, Miyagi, Japan
- Division of Advanced Cerebrovascular Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Atsushi Kanoke
- Department of Neurosurgery, Kohnan Hospital, Sendai, Miyagi, Japan
| | | | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan; and
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Sun N, Yang XY, Zhao Y, Zhang QJ, Ma X, Wei ZN, Li MQ. Treatment of pediatric intracranial dissecting aneurysm with clipping and angioplasty, and next-generation sequencing analysis: A case report and literature review. World J Clin Cases 2021; 9:1103-1110. [PMID: 33644173 PMCID: PMC7896649 DOI: 10.12998/wjcc.v9.i5.1103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 12/11/2020] [Accepted: 12/23/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Large intracranial dissecting aneurysm (IDA) in the anterior cerebral circulation is rare in children. There has been no consensus on the diagnosis and treatment for IDA in children.
CASE SUMMARY We report a 3-year-old boy with a large ruptured IDA in the right middle cerebral artery (16 mm × 14 mm). The IDA was successfully managed with clipping and angioplasty. Next-generation sequencing of the blood sample followed by bioinformatics analysis suggested that the rs78977446 variant of the ADAMTS13 gene is a risk for pediatric IDA. Three years after surgery, the boy was develop-mentally normal.
CONCLUSION Clipping and angioplasty are effective treatments for ruptured IDA in the anterior cerebral circulation. ADAMTS13 rs78977446 is a risk factor for pediatric IDA.
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Affiliation(s)
- Ning Sun
- Department of Neurosurgery, Tianjin Children's Hospital/Tianjin University Children's Hospital, Tianjin 300134, China
| | - Xin-Yu Yang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Yan Zhao
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Qing-Jiang Zhang
- Department of Neurosurgery, Tianjin Children's Hospital/Tianjin University Children's Hospital, Tianjin 300134, China
| | - Xiao Ma
- Department of Neurosurgery, Tianjin Children's Hospital/Tianjin University Children's Hospital, Tianjin 300134, China
| | - Zhong-Nan Wei
- Department of Neurosurgery, Tianjin Children's Hospital/Tianjin University Children's Hospital, Tianjin 300134, China
| | - Meng-Qi Li
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin 300052, China
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Wang Y, Zhao C, Hao X, Wang C, Wang Z. Endovascular interventional therapy and classification of vertebral artery dissecting aneurysms. Exp Ther Med 2014; 8:1409-1415. [PMID: 25289031 PMCID: PMC4186359 DOI: 10.3892/etm.2014.1961] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Accepted: 07/23/2014] [Indexed: 12/28/2022] Open
Abstract
The current study aimed to summarise the clinical features and classifications of vertebral artery dissecting aneurysms (VADAs) to optimise strategies for endovascular interventional therapy. The clinical features and results of 31 inpatients with VADA were retrospectively analysed. The aneurysms were classified according to their location and association between the aneurysm and posterior inferior cerebellar artery (PICA), and into subtypes according to the developmental state of the contralateral vertebral artery. Different endovascular interventional therapy strategies were selected for each classification. Three types of aneurysm with two subtypes each were identified. An aneurysm located distally to the PICA was termed type I (10/31 patients). Aneurysms with a contralateral vertebral artery were denoted as subtype a (type Ia, 6/31 patients) and aneurysms with hypoplasia of the contralateral vertebral artery were denoted as subtype b (type Ib, 4/31 patients). An aneurysm located at the origin of the PICA was termed type II (13/31 patients), with seven cases classified as IIa and six cases as IIb. An aneurysm located proximally to the PICA was termed type III (8/31 patients), with five cases classified as IIIa and three cases as IIIb. Among the 31 patients, 18 received stent-assisted coiling, two received coiling, 10 received coiling with parent artery occlusion and one patient received conservative treatment. Among the 31 patients with VADA, 21 were occluded completely, nine were partially occluded and one was not occluded. One patient developed a coma following coiling; however, the other 30 patients recovered well. Thus, the classification of an aneurysm based on its location and the developmental state of the contralateral vertebral arteries appears to be an effective and safe approach for the selection of appropriate endovascular interventional therapy strategies.
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Affiliation(s)
- Yihua Wang
- Department of Neurosurgery, Qilu Hospital of Shandong University, Qingdao, Shandong 266000, P.R. China ; Department of Neurosurgery, The Second Hospital of Shandong University, Jinan, Shandong 250033, P.R. China
| | - Cuiping Zhao
- Department of Neurology, Qilu Hospital of Shandong University, Qingdao, Shandong 266000, P.R. China
| | - Xiaoguang Hao
- Department of Neurosurgery, Qilu Hospital of Shandong University, Qingdao, Shandong 266000, P.R. China ; Department of Neurosurgery, The Second Hospital of Shandong University, Jinan, Shandong 250033, P.R. China
| | - Chengwei Wang
- Department of Neurosurgery, The Second Hospital of Shandong University, Jinan, Shandong 250033, P.R. China
| | - Zhigang Wang
- Department of Neurosurgery, Qilu Hospital of Shandong University, Qingdao, Shandong 266000, P.R. China ; Department of Neurosurgery, The Second Hospital of Shandong University, Jinan, Shandong 250033, P.R. China
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Strianese D, Napoli M, Russo C, D'Errico A, Scotti N, Puoti G, Bonavolontà G, Tranfa F, Briganti F. Coexistence of cavernous hemangioma and other vascular malformations of the orbit. A report of three cases. Neuroradiol J 2014; 27:223-31. [PMID: 24750713 DOI: 10.15274/nrj-2014-10016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Accepted: 01/09/2014] [Indexed: 11/12/2022] Open
Abstract
Coexistence of orbital cavernous hemangioma and other vascular malformations is unusual and few cases have been reported. We describe the clinical and radiological features of three cases of orbital cavernous hemangiomas associated with other vascular malformations, selected reviewing a series of 181 cases of cavernous hemangiomas. All patients were males (age ranging from 43 to 67 years) without vascular systemic disorders and/or a clinical syndrome. They experienced slow progressive exophthalmos. One of them developed acute pulsatile proptosis (case 2), while another experienced slow progressive diplopia (case 3). In one case vascular lesions were bilateral (case 3) and in two patients two different lesions coexisted in the same orbit (cases 1 and 2). All patients underwent surgical excision, which was partial in two cases. Two patients had cavernous hemangiomas in association with a venous malformation (a varix in case 1 and a lymphangioma in case 2), while in the other ones (case 3) cavernous hemangioma was associated with a low-flow arteriovenous malformation. No patient denied visual impairment postoperatively. Few cases of orbital cavernous hemangiomas coexisting with other vascular malformations have been reported in the literature. This entity seems to be an association of different variants of orbital vascular malformations, presenting with a wide spectrum of clinical forms and probably with the same pathogenesis.
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Affiliation(s)
- Diego Strianese
- Department of Neurosciences and Reproductive Sciences, "Federico II" University; Naples, Italy -
| | - Manuela Napoli
- Department of Advanced Biomedical Sciences, "Federico II" University; Naples, Italy
| | - Carmela Russo
- Department of Advanced Biomedical Sciences, "Federico II" University; Naples, Italy
| | - Arianna D'Errico
- Department of Advanced Biomedical Sciences, "Federico II" University; Naples, Italy
| | - Nadia Scotti
- Department of Pediatrics, "Federico II" University; Naples, Italy
| | - Gianfranco Puoti
- I Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Naples, Italy
| | - Giulio Bonavolontà
- Department of Neurosciences and Reproductive Sciences, "Federico II" University; Naples, Italy
| | - Fausto Tranfa
- Department of Neurosciences and Reproductive Sciences, "Federico II" University; Naples, Italy
| | - Francesco Briganti
- Department of Advanced Biomedical Sciences, "Federico II" University; Naples, Italy
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Briganti F, Caranci F, Leone G, Napoli M, Cicala D, Briganti G, Tranfa F, Bonavolontà G. Endovascular occlusion of dural cavernous fistulas through a superior ophthalmic vein approach. Neuroradiol J 2013; 26:565-72. [PMID: 24199817 DOI: 10.1177/197140091302600510] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 09/04/2013] [Indexed: 11/15/2022] Open
Abstract
Dural cavernous fistulas are low-flow vascular malformations with usually benign clinical course and a high rate of spontaneous resolution. Cases with symptom progression must be treated with an endovascular approach by arterial or venous route. We report 30 patients with dural cavernous fistulas treated by coil embolization using surgical exposure and retrograde catheterization of the superior ophthalmic vein (SOV). The procedure resulted in closure of the fistula without other endovascular treatments in all 30 patients and clinical remission or improvement in 20 and eight patients, respectively. Embolization via a SOV approach is a safe and easy endovascular procedure, particularly indicated for dural cavernous fistulas with exclusive or prevalent internal carotid artery feeders and anterior venous drainage.
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Briganti F, Leone G, Panagiotopoulos K, Marseglia M, Mariniello G, Napoli M, Caranci F. Endovascular treatment of cerebral aneurysms using the hydrocoil embolic system. Neuroradiol J 2013; 26:420-7. [PMID: 24007730 PMCID: PMC4202812 DOI: 10.1177/197140091302600407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 07/05/2013] [Indexed: 11/16/2022] Open
Abstract
HydroCoils are platinum helical coils coated with a layer of hydrophilic acrylic polymer (hydrogel), which on contact with blood causes disentanglement of polymer chains and expansion. We retrospectively reviewed a series of 29 patients harboring 29 cerebral aneurysms treated with the Hydrocoil Embolic System in the period 2004-2005, discussing the results of endovascular procedures in terms of safety and efficacy. The immediate post-procedure angiographic control demonstrated complete aneurysm occlusion in 21 cases (72.4%), near-complete occlusion in seven cases (24.1%), whereas in one case (3.4%) there was a procedure failure with major perfusion of the sac. Five patients (17.2%) experienced thromboembolic complications, including an asymptomatic lacunar stroke of the head of the caudate nucleus, a thalamic infarct following hypotension secondary to pulmonary edema, temporal ischemia secondary to vasospasm and a small right occipital ischemic lesion. Only one patient (3.4%) suffered a major ischemic accident. No other procedure-related complication occurred. Three-month follow-up control with MR angiography and 12-month follow-up angiography demonstrated no recurrence of aneurysms. Overall, after a mean follow-up of 12 months, the clinical outcome was good recovery in 26 patients (89.6%), moderate disability in three patients (10.3%) and no vegetative status or death. Our HydroCoil series supports the safety and midterm durability of hydrogel-coated aneurysm coils in the treatment of cerebral aneurysms.
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Affiliation(s)
- F Briganti
- Department of Diagnostic Imaging, University of Naples; Naples, Italy -
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Briganti F, Marseglia M, Leone G, Briganti G, Piccolo D, Napoli M, Caranci F. Endovascular treatment of a small aneurysm of the superior cerebellar artery with a flow-diverter device. A case report. Neuroradiol J 2013; 26:327-31. [PMID: 23859291 DOI: 10.1177/197140091302600313] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Accepted: 05/10/2013] [Indexed: 11/16/2022] Open
Abstract
We describe the case of a 62-year-old woman who presented with a small fusiform left superior cerebellar artery (SCA) aneurysm. Aneurysms located on the SCA are uncommon and their presentation, natural history and clinical management are poorly understood. Reports on the endovascular or surgical management of SCA aneurysms are rare and usually incorporated in clinical series of basilar artery or posterior circulation aneurysms. The patient was treated by delivery of a flow-diverter Pipeline Embolization Device (PED - Chestnut Medical/ev3) at the origin of vessel. She had no procedural complications and the aneurysm volume was reduced. This paper presents additional evidence to literature reports suggesting that the new endovascular flow-diverter devices are an effective and well-tolerated treatment for complex aneurysms. Our review contributes data on the incidence of recurrence as a measure of long-term efficacy of this therapeutic approach.
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Affiliation(s)
- F Briganti
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
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Briganti F, Tedeschi E, Leone G, Marseglia M, Cicala D, Giamundo M, Napoli M, Caranci F. Endovascular treatment of vertebro-vertebral arteriovenous fistula. A report of three cases and literature review. Neuroradiol J 2013; 26:339-46. [PMID: 23859293 DOI: 10.1177/197140091302600315] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Accepted: 06/02/2013] [Indexed: 11/16/2022] Open
Abstract
This report describes endovascular approaches for occlusion of vertebro-vertebral arteriovenous fistula (VV-AVF) in a series of three cases and a review of the literature. Complete neuroimaging assessment, including CT, MR and DSA was performed in three patients (two female, one male) with VV-AVF. Based on DSA findings, the VV-AVF were occluded by endovascular positioning of detachable balloons (case 1), coils (case 2), or a combination of both (case 3) with parent artery patency in two out of three cases. In this small series, endovascular techniques for occlusion of VV-AVF were safe and effective methods of treatment. To date, there are no guidelines on the best treatment for VV-AVF. Detachable balloons, endovascular coiling, combined embolization procedures could all be considered well-tolerated treatments.
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Affiliation(s)
- F Briganti
- Department of Diagnostic Imaging, University of Naples, Naples, Italy.
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