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Koh DH, Choi HC, Shin HS, Baek HJ, Koh EH, Park MJ, Choi DS. Endovascular Treatment of Traumatic Vascular Injuries in the Head and Neck Region. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:269. [PMID: 38399556 PMCID: PMC10890514 DOI: 10.3390/medicina60020269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/01/2024] [Accepted: 02/01/2024] [Indexed: 02/25/2024]
Abstract
Background and Objectives: Traumatic vascular injuries of the head and neck pose significant treatment challenges due to the complex anatomy, diverse clinical presentation, and mostly emergent nature. Endovascular treatment increasingly complements traditional surgical approaches. This study aimed to report our 10-year experience in treating traumatic vascular injuries of the head and neck with endovascular therapy and to determine the effectiveness of endovascular treatment. Materials and Methods: A retrospective analysis of 21 patients treated for head and neck vascular injuries between May 2011 and April 2021 was performed. Patients' medical histories, clinical presentations, imaging findings, treatment materials, and clinical outcomes were reviewed. Treatments included stenting, coil embolization, and other endovascular techniques focused on hemostasis and preservation of the parent vessel. Results: The most common injuries involved the internal maxillary artery branches (n = 11), followed by the common or internal carotid artery (n = 6), vertebral artery (n = 3), and others. Endovascular treatment achieved successful hemostasis in all but one case. In five of six carotid artery injuries and two of three vertebral artery injuries, we achieved successful hemostasis while preserving the parent vessel using covered and bare stents, respectively. Conclusions: Endovascular therapy might be a useful treatment modality for traumatic vascular injuries in the head and neck region, offering efficacy, safety, and a minimally invasive approach.
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Affiliation(s)
- Dong Hyun Koh
- Department of Medicine, Gyeongsang National University College of Medicine, 816-15 Jinju-daero, Jinju 52727, Republic of Korea; (D.H.K.); (H.J.B.); (E.H.K.)
- Department of Radiology, Gyeongsang National University Hospital, 79 Gangnam-ro, Jinju 52727, Republic of Korea; (H.C.C.); (H.S.S.)
| | - Ho Cheol Choi
- Department of Radiology, Gyeongsang National University Hospital, 79 Gangnam-ro, Jinju 52727, Republic of Korea; (H.C.C.); (H.S.S.)
| | - Hwa Seon Shin
- Department of Radiology, Gyeongsang National University Hospital, 79 Gangnam-ro, Jinju 52727, Republic of Korea; (H.C.C.); (H.S.S.)
| | - Hye Jin Baek
- Department of Medicine, Gyeongsang National University College of Medicine, 816-15 Jinju-daero, Jinju 52727, Republic of Korea; (D.H.K.); (H.J.B.); (E.H.K.)
- Department of Radiology, Gyeongsang National University Changwon Hospital, 11 Samjeongja-ro, Seongsan-gu, Changwon 51472, Republic of Korea
| | - Eun Ha Koh
- Department of Medicine, Gyeongsang National University College of Medicine, 816-15 Jinju-daero, Jinju 52727, Republic of Korea; (D.H.K.); (H.J.B.); (E.H.K.)
- Gyeongsang Institute of Medical Science, Gyeongsang National University College of Medicine, 816-15 Jinju-daero, Jinju 52727, Republic of Korea
| | - Mi Jung Park
- Department of Medicine, Gyeongsang National University College of Medicine, 816-15 Jinju-daero, Jinju 52727, Republic of Korea; (D.H.K.); (H.J.B.); (E.H.K.)
- Department of Radiology, Gyeongsang National University Hospital, 79 Gangnam-ro, Jinju 52727, Republic of Korea; (H.C.C.); (H.S.S.)
| | - Dae Seob Choi
- Department of Medicine, Gyeongsang National University College of Medicine, 816-15 Jinju-daero, Jinju 52727, Republic of Korea; (D.H.K.); (H.J.B.); (E.H.K.)
- Department of Radiology, Gyeongsang National University Hospital, 79 Gangnam-ro, Jinju 52727, Republic of Korea; (H.C.C.); (H.S.S.)
- Gyeongsang Institute of Medical Science, Gyeongsang National University College of Medicine, 816-15 Jinju-daero, Jinju 52727, Republic of Korea
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Reyes Soto G, Ovalle Torres CS, Perez Terrazas J, Honda Partida K, Rosario Rosario A, Campero A, Baldoncini M, Ramirez MDJE, Montemurro N. Multiple Myeloma Treatment Challenges: A Case Report of Vertebral Artery Pseudoaneurysm Complicating Occipitocervical Arthrodesis and a Review of the Literature. Cureus 2023; 15:e49716. [PMID: 38161862 PMCID: PMC10757504 DOI: 10.7759/cureus.49716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2023] [Indexed: 01/03/2024] Open
Abstract
Multiple myeloma is a hematological neoplasm that frequently affects the spinal column. Less than a fifth of this vertebral involvement corresponds to the cervical spine and cranio-cervical junction. When there is instability or neurological involvement due to compression or deformity, approaches for anterior decompression and occipitocervical stabilization are required. The correct managment of vertebral artery aneurysm associated with occipitocervical arthrodesis requires extensive knowledge of anatomy and pathology. We present a case of a vertebral pseudoaneurysm that occurred late after the resection of a C1-C2 vertebral body multiple myeloma lesion managed with endonasal endoscopic approach and posterior occipitocervical arthrodesis as well as a systematic review of the related literature. The patient recovered well, without major neurological deficits.
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Affiliation(s)
- Gervith Reyes Soto
- Neuroscience Unit, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, MEX
| | | | - Jorge Perez Terrazas
- Spine Surgery, National Autonomous University of Mexico (UNAM) Hospital General de Mexico, Mexico City, MEX
| | - Kaori Honda Partida
- Spine Surgery, National Autonomous University of Mexico (UNAM) Hospital General de Mexico, Mexico City, MEX
| | | | | | - Matias Baldoncini
- Neurosurgery, School of Medicine, University of Buenos Aires, Buenos Aires, ARG
- Neurosurgery, San Fernando Hospital, Buenos Aires, ARG
| | | | - Nicola Montemurro
- Neurosurgery, Azienda Ospedaliera Universitaria Pisana (AOUP) University of Pisa, Pisa, ITA
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Panther E, Lucke-Wold B, Laurent D, Osorno-Cruz C, Mehkri Y, Turner R, Polifka A, Koch M, Hoh B, Chalouhi N. Treatment of Dissecting Vertebral Pseudoaneurysms: A Single-Center Experience. ANNALS OF NEUROLOGY AND NEUROSCIENCE 2022; 1:1002. [PMID: 36468934 PMCID: PMC9717722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Background Dissecting vertebral artery pseudoaneurysms represent a unique clinical challenge with careful appreciation for location of the posterior inferior cerebellar artery. Limited data is available in terms of outcomes regarding the various treatment modalities. Methods 11 patients with dissecting pseudoaneurysms were identified from 2013-2021. Pseudoaneurysm size and morphology, clinical presentation, and treatment approach was collected. Success of treatment was recorded based on post-operative imaging as well as documented overall patient outcomes. Three primary treatment modalities emerged: coil embolization, stent assisted coiling, and flow diversion. Results Of the 11 patients, 5 were female and 6 were male with an age from 36 to 69.7. 7 had ruptured pseudoaneurysms at time of treatment. Size of pseudoaneurysm ranged from 3 to 6 mm. 8 were on the right and 3 were on the left vertebral artery. 8 were proximal to PICA and 3 were distal. Co-dominance of vertebral filling was seen in 5 patients, 5 with dominance through right vertebral artery, and 1 with dominance through left vertebral artery. Variability existed in treatment approaches with 4 patients undergoing coil occlusion, 5 patients undergoing flow diversion stenting, and 2 patients undergoing flow diversion stenting with jailed coiling. 1 patient had enlargement of pseudoaneurysm while inpatient and required a second flow diversion device. 1 patient had two flow diversion devices placed initially at time of treatment due to morphology of PA. 6 patients had repeat angiograms between 6 to 9 months with complete occlusion. 3 had CTA or MRA with complete occlusion for those that had flow diversion, they were transitioned from aspirin and clopidogrel to aspirin monotherapy after first repeat angiogram. 6 patients required shunt placement for hydrocephalus. 1 patient died prior to discharge due to sepsis. 2 patients died post discharge: 1 with myocardial infarction and the 2nd due to urosepsis.Dissecting vertebral pseudoaneurysm has high morbidity and mortality if rupture occurs. Location of PICA origin influences treatment approach. Patients with poor Hunt/Hess scores upon arrival had increased risk for systemic infection and mortality.
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Affiliation(s)
- E Panther
- Department of Neurosurgery, University of Florida, Gainesville
| | - B Lucke-Wold
- Department of Neurosurgery, University of Florida, Gainesville
| | - D Laurent
- Department of Neurosurgery, University of Florida, Gainesville
| | - C Osorno-Cruz
- Department of Neurosurgery, University of Iowa, Des Moines
| | - Y Mehkri
- Department of Neurosurgery, University of Florida, Gainesville
| | - R Turner
- Department of Neurosurgery, West Virginia University, Morgantown
| | - A Polifka
- Department of Neurosurgery, University of Florida, Gainesville
| | - M Koch
- Department of Neurosurgery, University of Florida, Gainesville
| | - B Hoh
- Department of Neurosurgery, University of Florida, Gainesville
| | - N Chalouhi
- Department of Neurosurgery, University of Florida, Gainesville
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