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Mitsuhashi D, Okada T, Sato K, Yajima N, Aiba T. Unique image findings around "kissing" distal anterior cerebral artery aneurysms in addition to perianeurysmal edema: A case report. Surg Neurol Int 2023; 14:181. [PMID: 37292395 PMCID: PMC10246312 DOI: 10.25259/sni_109_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 04/30/2023] [Indexed: 06/10/2023] Open
Abstract
Background Some aneurysms cause edema formation in the surrounding brain parenchyma and are thought to reflect various phenomena occurring in the aneurysm. Some authors highlighted perianeurysmal edema (PAE) as a finding that indicates higher risk of rupture of the aneurysm. On the other hand, there are no reports of image changes in the surrounding brain parenchyma of aneurysm other than edema formation. Case Description We describe a 63-year-old man with unique signal change in the surrounding brain parenchyma of "kissing" distal anterior cerebral artery aneurysms completely different from PAE. The large and partially thrombosed aneurysm presented well-defined signal change surrounding brain parenchyma in addition to PAE. Intraoperative findings revealed the signal change as a space of retaining serous fluid. Drain the fluid and clipping was made for the both anterior cerebral artery aneurysms. The postoperative course was uneventful and his headache was improved the day after the surgery. The perianeurysmal signal change was also disappeared immediately after the surgery except for the PAE. Conclusion This case demonstrates a rare phenomenon of signal change around the aneurysm, and there is a possibility that the unique finding exists as an early manifestation of intracerebral hematoma associated with aneurysm rupture.
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Affiliation(s)
- Daiju Mitsuhashi
- Department of Neurosurgery, Brain Research Institute, Niigata University, Shibata, Niigata, Japan
- Department of Neurosurgery, Niigata Prefectural Shibata Hospital, Shibata, Niigata, Japan
| | - Takuya Okada
- Department of Neurosurgery, Brain Research Institute, Niigata University, Shibata, Niigata, Japan
| | - Keisuke Sato
- Department of Neurosurgery, Niigata Prefectural Shibata Hospital, Shibata, Niigata, Japan
| | - Naoki Yajima
- Department of Neurosurgery, Niigata Prefectural Shibata Hospital, Shibata, Niigata, Japan
| | - Toyotaka Aiba
- Department of Neurosurgery, Niigata Prefectural Shibata Hospital, Shibata, Niigata, Japan
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Chao Z, Peng L, Ling L, Xiaosong L, Gengshen Z, Lei Z, Tangkai, Xiaomeng L, Xiaoliang W, Jianliang W. Evaluation of theTherapeutic Effect of the Hybrid Operation on Patients with Aneurysms Associated with Cerebral Arteriovenous Malformations with different Redekop Classifications. J Stroke Cerebrovasc Dis 2022; 31:106514. [PMID: 35671655 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 03/18/2022] [Accepted: 04/04/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Intracranial aneurysms associated with cerebral arteriovenous malformations (AVMs) are a rare condition in the clinic, and treatment is very difficult due to their particular anatomical features. We present our experience in the treatment of intracranial aneurysms with AVMs and evaluate the effectiveness and safety of endovascular treatment combined with microsurgical resection (the hybrid operation). METHODS This was a single-center retrospective study in our neurosurgical department from January 2015 to January 2021. We collected clinical data from 48 patients with intracranial aneurysms associated with AVMs and categorized them according to Redekop classifications according to the results of cerebral imaging examination to compare the therapeutic effects of endovascular embolization and the hybrid operation. RESULTS Compared to nonaneurysmal AVMs, intracranial aneurysms with AVMs more often presented with intracranial hemorrhage (P<0.05). Massive hematoma and severe neurological impairment were more often found in patients with intracranial aneurysms with AVMs (P<0.05). For flow-related aneurysms, the hybrid surgery had a higher one-stage cure rate than endovascular embolization alone (P<0.05). Both treatment methods had similar effects on intranidal aneurysms (P>0.05). There were no significant differences in prognostic indicators between the two treatments. However, the recurrence rate of AVMs with proximal flow-related aneurysms was lower in patients who underwent the hybrid operation (P<0.05). CONCLUSION The hybrid operation was safe and effective for patients with intracranial aneurysms associated with AVMs. For flow-related aneurysms, the one-stage cure rate was higher and the recurrence rate was lower with the hybrid operation than with endovascular embolization alone.
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Affiliation(s)
- Zhang Chao
- Department of Neurosurgery, The second hospital of Hebei medical university, 215 HepingXi Rd, Shijiazhuang, Hebei 050000, China
| | - Li Peng
- 89 DongGang Rd. Department of Neurosurgery, The first hospital of Hebei medical university, Shijiazhuang, Hebei 050000, China
| | - Liu Ling
- Department of Neurosurgery, The second hospital of Hebei medical university, 215 HepingXi Rd, Shijiazhuang, Hebei 050000, China
| | - Liu Xiaosong
- East department of Neurosurgery, The second hospital of Hebei medical university, 80 Huanghe Rd, Shijiazhuang, Hebei 050000, China
| | - Zhang Gengshen
- East department of Neurosurgery, The second hospital of Hebei medical university, 80 Huanghe Rd, Shijiazhuang, Hebei 050000, China
| | - Zhao Lei
- East department of Neurosurgery, The second hospital of Hebei medical university, 80 Huanghe Rd, Shijiazhuang, Hebei 050000, China
| | - Tangkai
- East department of Neurosurgery, The second hospital of Hebei medical university, 80 Huanghe Rd, Shijiazhuang, Hebei 050000, China
| | - Liu Xiaomeng
- East department of Neurosurgery, The second hospital of Hebei medical university, 80 Huanghe Rd, Shijiazhuang, Hebei 050000, China
| | - Wang Xiaoliang
- East department of Neurosurgery, The second hospital of Hebei medical university, 80 Huanghe Rd, Shijiazhuang, Hebei 050000, China
| | - Wu Jianliang
- Department of Neurosurgery, The second hospital of Hebei medical university, 215 HepingXi Rd, Shijiazhuang, Hebei 050000, China.
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Rashad S, Endo T, Ogawa Y, Sato K, Endo H, Matsumoto Y, Takahashi A, Tominaga T. Stereotactic radiosurgery as a feasible treatment for intramedullary spinal arteriovenous malformations: a single-center observation. Neurosurg Rev 2016; 40:259-266. [PMID: 27270299 DOI: 10.1007/s10143-016-0758-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 05/26/2016] [Accepted: 05/31/2016] [Indexed: 11/29/2022]
Abstract
Spinal cord intramedullary arteriovenous malformations are rare. For patients suffering from either hemorrhage or myelopathy, surgical or endovascular interventions are indicated. However, complete eradication of the nidus is often difficult because of its intramedullary location and complex angioarchitecture. In this report, we evaluate the feasibility and safety of stereotactic radiosurgery as a treatment modality for intramedullary spinal arteriovenous malformations (AVMs). Between 2010 and 2014, we performed stereotactic radiosurgery to treat four patients with intramedullary AVM and one with spinal arteriovenous metameric syndrome (one woman and four men; age range, 31-66 years). Three patients presented with myelopathy, and two suffered hemorrhages. Nidi were located in the cervical (three cases) and thoracic (two cases) spinal cord regions. Based on the angioarchitecture, surgery and endovascular embolization were indicated. When both modalities were deemed hazardous, radiosurgery using CyberKnife™ was offered. Radiation using marginal doses of 18 Gy was administered in three fractions. The mean follow-up period was 37.2 months (range, 16-62 months). After treatment, two of the three patients with myelopathy experienced either improvement or stabilization of their symptoms and one experienced worsening of dysesthesia. In two patients with hemorrhage, symptoms improved in one and remained stable in the other. No further hemorrhagic episodes were evident during follow-up. Follow-up angiograms showed marked shrinkage of the nidus located in the thoracic spinal cord in one case and angiographic stabilization in the others. As a treatment modality for intramedullary AVMs, CyberKnife™ is safe and can be considered when surgery or endovascular therapy is not indicated. To determine optimum radiation doses and protocols for treating spinal AVMs, further studies with more patients and long-term follow-up are required.
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Affiliation(s)
- Sherif Rashad
- Department of Neurosurgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryo Aoba, Sendai, 980-8574, Japan
| | - Toshiki Endo
- Department of Neurosurgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryo Aoba, Sendai, 980-8574, Japan.
| | | | - Kenichi Sato
- Department of Neuroendovascular Therapy, Kohnan Hospital, Sendai, Japan
| | - Hidenori Endo
- Department of Neurosurgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryo Aoba, Sendai, 980-8574, Japan
| | - Yasushi Matsumoto
- Department of Neuroendovascular Therapy, Kohnan Hospital, Sendai, Japan
| | - Akira Takahashi
- Department of Neuroendovascular Therapy, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Teiji Tominaga
- Department of Neurosurgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryo Aoba, Sendai, 980-8574, Japan
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Disappearance of a Ruptured Distal Flow–Related Aneurysm after Arteriovenous Malformation Nidal Embolization. World Neurosurg 2015; 84:1496.e1-6. [DOI: 10.1016/j.wneu.2015.05.065] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 05/26/2015] [Accepted: 05/28/2015] [Indexed: 11/24/2022]
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Narisawa A, Endo T, Sato K, Watanabe M, Takahashi A, Tominaga T. Spinal dural arteriovenous shunt presenting with intramedullary hemorrhage: case report. J Neurosurg Spine 2014; 20:322-6. [PMID: 24409983 DOI: 10.3171/2013.12.spine12163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The authors report on a 49-year-old man with a thoracic spinal dural arteriovenous shunt (dAVS) in which rupture of a varix caused intramedullary hemorrhage. In the literature, patients with a thoracic dAVS predominantly present with congestive myelopathy; however, the patient featured in this report presented without increased deep tendon reflexes or muscle weakness, but instead with intermittent stabbing chest pain and paresthesia. Magnetic resonance images and angiograms demonstrated tortuous enlargement and the formation of a varix-like structure of the draining veins, features compatible with those of high-flow angiopathy. Recognition of this phenomenon is important in thoracic dAVS because intramedullary hemorrhage dramatically degrades outcome. A high index of clinical suspicion can prevent a similar case of thoracic dAVS from progressing to intramedullary hemorrhage.
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Navratil O, Lehecka M, Juran V, Mrlian A, Boudny J, Smrcka M. Giant intranidal aneurysm associated with the arteriovenous malformation. Clin Neurol Neurosurg 2011; 113:813-5. [PMID: 21908100 DOI: 10.1016/j.clineuro.2011.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2010] [Revised: 07/10/2011] [Accepted: 08/14/2011] [Indexed: 10/17/2022]
Affiliation(s)
- Ondrej Navratil
- Department of Neurosurgery, Masaryk University and University Hospital, Brno, Czech Republic.
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Yu JL, Yang S, Luo Q, Wang HL, Wang B, Qu YY, Xu K. Endovascular treatment of intracranial ruptured aneurysms associated with arteriovenous malformations: a clinical analysis of 14 hemorrhagic cases. Interv Neuroradiol 2011; 17:78-86. [PMID: 21561563 DOI: 10.1177/159101991101700113] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Accepted: 12/24/2010] [Indexed: 11/16/2022] Open
Abstract
This study investigated and summarized endovascular therapeutic strategies for intracranial ruptured aneurysms associated with arteriovenous malformations (AVMs). Between June 2005 and June 2009, we identified 16 aneurysms in 14 hemorrhagic cases of intracranial AVM using digital subtraction angiography (DSA). Of the 16 aneurysms, 14 were ruptured and two were unruptured. Aneurysms were classified as types I to IV, and were treated. Aneurysm treatment was followed by AVM treatment via various therapies, including embolization, gamma knife radiotherapy, or follow-up and observation to reduce the risk of aneurysm rupture or intracranial hemorrhage. Over a follow-up period ranging from six months to one year, none of the patients had aneurysm ruptures or intracranial hemorrhage. Most (13/14) patients had a Glasgow Outcome Scale (GOS) score of 5, and one patient had a score of 4. Sixteen aneurysms were treated successfully, as confirmed by DSA examination, and no AVMs re-grew. Clinical therapeutic strategies for intracranial ruptured aneurysms associated with AVMs should include aneurysm treatment first to reduce the risk of rupture and intracranial hemorrhage, eventually leading to a better prognosis.
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Affiliation(s)
- J-L Yu
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, Jilin Province, China
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Hiu T, Tsutsumi K, Kitagawa N, Hayashi K, Ujifuku K, Yasunaga A, Suyama K, Nagata I. Progressive perianeurysmal edema preceding the rupture of a small basilar artery aneurysm. Clin Neurol Neurosurg 2008; 111:216-9. [PMID: 19058909 DOI: 10.1016/j.clineuro.2008.10.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2008] [Revised: 09/29/2008] [Accepted: 10/03/2008] [Indexed: 11/28/2022]
Abstract
We herein report the first case of progressive perianeurysmal edema preceding the rupture of a small saccular aneurysm, without any intervention or intraluminal thrombosis. A 71-year-old woman was incidentally noted to have a cerebral aneurysm (5mm in diameter) at the lower basilar artery. Twelve months later, magnetic resonance (MR) imaging showed a T2-elongated area around a dome of the aneurysm buried in the brain stem, suggesting perianeurysmal edema formation. Interestingly, the edema progressed with the formation of a bleb, in addition to an increase in size of the aneurysm over the following 3-year period. The aneurysm eventually ruptured as a brain stem hemorrhage without any subarachnoid clots 3 days after the final check-up with MR imaging, by which a significant increase of edema formation with an increase in size of the aneurysm and a marked expansion of the bleb was observed. These findings raise the possibility that bleb formation and an enlargement of a small cerebral aneurysm might also be associated with perianeurysmal edema and a subsequent aneurysmal rupture. In addition to the pulsatile flow and/or compression from the expanded aneurysm, local inflammation in the aneurysm wall may play an important role in such edema formation.
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Affiliation(s)
- Takeshi Hiu
- Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
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