Mirror image distal anterior cerebral artery aneurysms treated with coil embolization. a report of two cases and literature review

Mirror image aneurysms of the distal anterior cerebral arteries (DACA) are rare. To the best of our knowledge this is the first case report of two patients with mirror image DACA aneurysms treated successfully with coil embolization. The association of aneurysms with anatomic variants has been extensively reported. We may speculate that the remnants of the failed regression of the supreme anterior communicating artery could lead to an increase in stress across their territorial bifurcation, leading to the development of mirror image DACA aneurysms. We found the endovascular treatment of mirror image DACA aneurysms to be feasible and effective. If possible, we suggest the treatment of both aneurysms in one procedure.

The use of Onyx in different types of intracranial dural arteriovenous fistula

BACKGROUND AND PURPOSE

Recently some series have been published about the use of Onyx for the treatment of DAFVs with satisfactory results. Our aim was to describe the treatment of different types of intracranial DAVFs with transcatheter injection of Onyx through an arterial approach.

MATERIALS AND METHODS

At the Department of Interventional Neuroradiology, Hospital Lariboisière Paris, between January 2005 and January 2010, we treated 44 DAVFs in 42 patients. All patients were initially treated by arterial injection of Onyx. The average patient age was 56 years (range, 27-86 years), and there were 17 women and 25 men treated.

RESULTS

A total of 58 arterial pedicles were catheterized, with the middle meningeal artery representing the most common site (n = 38). The average time of injection was 30 minutes (range, 15-60 minutes), and the average amount of Onyx was 2.5 mL (range, 0.6-6.5 mL). Of the 20 fistulas with direct venous drainage into a dural sinus (types I and II), we achieved the preservation of the sinus in 7 patients. Of the 44 fistulas embolized, 8 required a second embolization treatment and 1 fistula required a third treatment. In 9 cases, a complementary treatment was performed via transvenous embolization with coils and/or open surgery. Early complications were observed in 6 patients: Four had nerve injury (facial palsy, n = 2, and neuralgia, n = 2), and 2 had complications related to extension of venous thrombosis postembolization. All 6 patients had partial or complete resolution of these symptoms.

CONCLUSIONS

The treatment of DAVFs by intracranial arterial injection of Onyx is safe, and, in most cases, results in the occlusion of the arterial venous shunt. In DAVFs with direct sinus drainage, sinus preservation was only possible in 7 of 20 patients (35%).