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Unice T, Naidoo P, Hiralal P, Naidoo Y, Pillay S. Multiple fusiform and saccular aneurysms in a person living with Human Immunodeficiency Virus. SAGE Open Med Case Rep 2023; 11:2050313X231211048. [PMID: 38022860 PMCID: PMC10656792 DOI: 10.1177/2050313x231211048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 10/12/2023] [Indexed: 12/01/2023] Open
Abstract
Cerebral aneurysms secondary to human immunodeficiency virus vasculopathy are a diagnosis by exclusion and its mechanism is unknown. We report on a 21-year-old male with human immunodeficiency virus infection and suboptimal virological control, despite highly active antiretroviral therapy. An incidental discovery of multiple cerebral aneurysms occurred in this patient, who initially presented with signs of disorientation, acute psychosis, and a history of blunt cranial trauma. A non-contrasted computerized tomography scan of the encephalon showed no intracranial hemorrhage but multiple cerebral (saccular and fusiform) aneurysms. Subsequently, a non-urgent computerized tomography angiogram of the cerebral vasculature corroborated the existence of multiple cerebral aneurysms. Despite investigation, no secondary etiological factors for the aneurysmal condition were identified. The multitude of cerebral aneurysms was consequently ascribed to human immunodeficiency virus-associated vasculopathy. The patient was managed conservatively. At discharge, he was lucid and apsychotic. A unique aspect of the case is the presence of both fusiform and saccular cerebral aneurysms.
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Affiliation(s)
- Talia Unice
- King Edward VIII Hospital, Durban, Kzn, South Africa
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2
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Yamano A, Matsuda M, Hosoo H, Ishikawa E. Disappearance of a Ruptured Feeding Artery Fusiform Aneurysm After the Resection of a Large Subependymoma: A Case Report. Cureus 2023; 15:e48873. [PMID: 38106698 PMCID: PMC10724701 DOI: 10.7759/cureus.48873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2023] [Indexed: 12/19/2023] Open
Abstract
Aneurysm formation on the tumor-feeding artery is rare, and its treatment strategies are not yet settled. We herein report the case of a 49-year-old female with a large subependymoma in the left lateral ventricle presenting remote intracerebral hemorrhage at the left posterior cingulate gyrus. Digital subtraction angiography (DSA) revealed the presence of a 5.5 mm fusiform tumor-feeding artery aneurysm on the left parieto-occipital branch of the posterior cerebral artery, considered to be the source of the hemorrhage. Three months after total tumor resection, the aneurysm subsequently disappeared on the follow-up angiography. Subependymomas are generally known as tumors with low vascularity and seldom present with symptoms such as intracerebral hemorrhage. From the subsequent disappearance of the aneurysm after the complete tumor resection, the pathophysiological cause of the aneurysm formation is assumed to be flow-related hemodynamic vessel wall stress of the feeding artery. Tumor resection alone may be a favorable first treatment strategy to avoid unnecessary brain damage since subsequent disappearance of the aneurysm can be expected. The coexistence of feeding artery aneurysms should be kept in mind, especially in cases with remote hemorrhage.
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Affiliation(s)
- Akinari Yamano
- Department of Neurosurgery, Institute of Medicine, University of Tsukuba, Tsukuba, JPN
| | - Masahide Matsuda
- Department of Neurosurgery, Institute of Medicine, University of Tsukuba, Tsukuba, JPN
| | - Hisayuki Hosoo
- Department of Neurosurgery, Institute of Medicine, University of Tsukuba, Tsukuba, JPN
| | - Eiichi Ishikawa
- Department of Neurosurgery, Institute of Medicine, University of Tsukuba, Tsukuba, JPN
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Wang PW, Chung MH, Feng SW, Liao HC, Wu YC, Hueng DY, Yang YJ, Ju DT. Corrigendum: Case report: Ruptured internal carotid artery fusiform aneurysm mimicking pituitary apoplexy after stereotactic radiosurgery. Front Neurol 2023; 14:1301436. [PMID: 37885476 PMCID: PMC10598380 DOI: 10.3389/fneur.2023.1301436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 09/28/2023] [Indexed: 10/28/2023] Open
Abstract
[This corrects the article DOI: 10.3389/fneur.2023.1219372.].
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Affiliation(s)
- Peng Wei Wang
- Department of Surgery, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan
- Department of Neurological Surgery, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan
| | - Ming Hsuan Chung
- Department of Neurological Surgery, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan
| | - Shao Wei Feng
- Department of Neurological Surgery, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan
| | - Hsiang Chih Liao
- Department of Neurological Surgery, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan
| | - Yi Chieh Wu
- Department of Neurological Surgery, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan
| | - Dueng Yuan Hueng
- Department of Neurological Surgery, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan
| | - Yun Ju Yang
- Department of Neurological Surgery, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan
| | - Da Tong Ju
- Department of Neurological Surgery, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan
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Wang PW, Chung MH, Feng SW, Liao HC, Wu YC, Hueng DY, Yang YJ, Ju DT. Case report: Ruptured internal carotid artery fusiform aneurysm mimicking pituitary apoplexy after stereotactic radiosurgery. Front Neurol 2023; 14:1219372. [PMID: 37602248 PMCID: PMC10437111 DOI: 10.3389/fneur.2023.1219372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 07/10/2023] [Indexed: 08/22/2023] Open
Abstract
Pituitary adenomas are benign tumors of the anterior pituitary gland for which surgery or pharmacological treatment is the primary treatment. When initial treatment fails, radiation therapy should be considered. There are several case reports demonstrating radiation-induced vascular injury. We report an adult patient who presented with headache and diplopia for 6 months and a sellar tumor with optic chiasm compression. The patient received transnasal surgery, and the tumor was partially removed, which demonstrated adenoma. Stereotactic radiosurgery (SRS) was arranged. However, owing to progressive tumor growth, the patient received further transnasal surgery and stereotactic radiosurgery (SRS). After 14 years, the patient reported the sudden onset of headache and diplopia, and a ruptured fusiform aneurysm from the left internal carotid artery with pituitary apoplexy was diagnosed. The patient received transarterial embolization of the aneurysm. There were no complications after embolization, and this patient was ambulatory on discharge with blindness in the left eye and cranial nerve palsies. Aneurysm formation may be a complication of SRS, and it may occur after several years. Further research is needed to investigate the pathogenesis of radiosurgery and the development of cerebral aneurysms.
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Affiliation(s)
- Peng Wei Wang
- Department of Surgery, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan
- Department of Neurological Surgery, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan
| | - Ming Hsuan Chung
- Department of Neurological Surgery, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan
| | - Shao Wei Feng
- Department of Neurological Surgery, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan
| | - Hsiang Chih Liao
- Department of Neurological Surgery, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan
| | - Yi Chieh Wu
- Department of Neurological Surgery, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan
| | - Dueng Yuan Hueng
- Department of Neurological Surgery, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan
| | - Yun Ju Yang
- Department of Neurological Surgery, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan
| | - Da Tong Ju
- Department of Neurological Surgery, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan
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He P, Li Z, Jiang H. Hemifacial spasm caused by unruptured fusiform vertebral aneurysm treated with endovascular coil embolization: a case report. Front Neurol 2023; 14:1203751. [PMID: 37560448 PMCID: PMC10407084 DOI: 10.3389/fneur.2023.1203751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 07/04/2023] [Indexed: 08/11/2023] Open
Abstract
Hemifacial spasm due to fusiform aneurysm of the vertebral artery is extremely rare. The lateral spread response (LSR) is routinely used to monitor hemifacial spasms during microvascular decompression to predict the degree of postoperative remission of hemifacial spasm. We report a case of hemifacial spasm caused by an unruptured fusiform vertebral aneurysm treated with intravascular intervention and monitoring of LSR. A 59-year-old man was admitted to the hospital with a left facial spasm that gradually worsened for 1 year. Preoperative cerebrovascular angiography indicated fusiform aneurysms in the intracranial segment of the left vertebral artery close to the left facial nerve. The patient underwent parent artery occlusion and aneurysm embolization, and LSR was monitored intraoperatively. After intraoperative aneurysm embolization, LSR disappeared immediately. The postoperative review of cerebrovascular angiography indicated that the parent artery and aneurysm were embolized successfully, and the patient's left facial spasm was relieved after surgery. Hemifacial spasm caused by the vertebral artery fusiform aneurysm can be safely and effectively treated by parent artery occlusion and aneurysm embolization. Meanwhile, intraoperative LSR monitoring can be used to predict postoperative efficacy.
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Affiliation(s)
- Pengchen He
- Department of Neurosurgery, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, Sichuan, China
| | - Zongping Li
- Department of Neurosurgery, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, Sichuan, China
| | - Han Jiang
- Department of Rehabilitation Therapy, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, Sichuan, China
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Coxon AT, Huguenard AL, Chatterjee AR, Dacey RG. A challenging case of recurrent and progressive fusiform anterior circulation intracranial aneurysms: illustrative case. J Neurosurg Case Lessons 2023; 5:CASE22497. [PMID: 36794734 PMCID: PMC10550598 DOI: 10.3171/case22497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 12/09/2022] [Indexed: 02/17/2023]
Abstract
BACKGROUND Intracranial fusiform aneurysms are circumferential dilations of cerebral arteries that can lead to complications including ischemic stroke due to vessel occlusion, subarachnoid hemorrhage, or intracerebral hemorrhage. Treatment options for fusiform aneurysms have expanded significantly in recent years. Microsurgical treatment options include proximal and distal surgical occlusion and microsurgical trapping of the aneurysm, usually in association with high-flow bypass procedures. Endovascular treatment options include the placement of coils and/or flow diverters. OBSERVATIONS Here the authors report a case of aggressive surveillance and treatment of a man with multiple progressive, recurrent, and de novo fusiform aneurysms of the left anterior cerebral circulation over 16 years. Because the long-term course of his treatment coincided with the recent expansion of endovascular treatment options, he underwent every type of treatment listed above. LESSONS This case demonstrates the wide range of therapeutic options for fusiform aneurysms and how the treatment model for these lesions has evolved.
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Affiliation(s)
| | | | - Arindam R. Chatterjee
- Departments of Neurosurgery
- Radiology, and
- Neurology, Washington University, St. Louis, Missouri
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Dmytriw AA, Alrashed A, Enriquez-Marulanda A, Medhi G, Mendes Pereira V. Unruptured Intradural Posterior Circulation Dissecting/ Fusiform Aneurysms Natural History and Treatment Outcome. Interv Neuroradiol 2023; 29:56-62. [PMID: 34935531 PMCID: PMC9893235 DOI: 10.1177/15910199211068673] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 12/01/2021] [Accepted: 12/06/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The natural history and outcome of unruptured posterior circulation dissecting fusiform aneurysms is not fully understood. These have a high risk of morbidity and mortality, not only due to natural history but also due to the challenging and controversial treatment approaches currently available compared to other types of intracranial aneurysms. METHODS We performed a retrospective study of a prospectively collected aneurysm database at a quaternary neurovascular hospital. We included consecutive patients with unruptured intradural vertebrobasilar dissecting aneurysms between January 2000 and July 2016 who were followed to 2020. Description of baseline, procedural, and outcomes data was performed. Comparisons of patient who had aneurysm rupture on follow-up, increase in 2 or more points of mRS in follow-up and progression of the aneurysm was performed. RESULTS Seventy patients with 78 fusiform posterior circulation aneurysms were identified. Thirty-nine (55.7%) patients were male with a mean age of 51.7 years (SD ± 17.6). When multiple, aneurysms were more likely to be fusiform (60%) than saccular (40.0%). Baseline diameter (measured on CTA/MRA/DSA), length as well as symptomatic presentation were significantly higher in aneurysms which grew over time. Coronary disease, diabetes and growth were associated an >2 increase in mRS. Diabetes as well as initial symptomatic presentation were associated with rupture. CONCLUSIONS Unruptured dissecting/fusiform aneurysm are associated with a considerable rate of rupture during follow-up. Growth is associated with morbidity even in the absence of rupture. Initial large size, coronary disease, diabetes, and to a lesser extent female gender may merit closer follow-up and/or prophylactic treatment.
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Affiliation(s)
- Adam Andrew Dmytriw
- St Michael's Hospital, Divisions of Neurosurgery and Therapeutic Neuroradiology,
Toronto, ON, Canada
- Neurosurgical Service, Beth Israel Deaconess Medical
Center, Harvard Medical School, Boston, MA, USA
| | - Abdullah Alrashed
- St Michael's Hospital, Divisions of Neurosurgery and Therapeutic Neuroradiology,
Toronto, ON, Canada
| | - Alejandro Enriquez-Marulanda
- St Michael's Hospital, Divisions of Neurosurgery and Therapeutic Neuroradiology,
Toronto, ON, Canada
- Neurosurgical Service, Beth Israel Deaconess Medical
Center, Harvard Medical School, Boston, MA, USA
| | - Gorky Medhi
- St Michael's Hospital, Divisions of Neurosurgery and Therapeutic Neuroradiology,
Toronto, ON, Canada
| | - Vitor Mendes Pereira
- St Michael's Hospital, Divisions of Neurosurgery and Therapeutic Neuroradiology,
Toronto, ON, Canada
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8
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Kyle K, Maher M, Achhra AC, Venna N. Contrasting Cases of HIV Vasculopathy Associated Fusiform Aneurysms. Neurohospitalist 2023; 13:69-73. [PMID: 36531848 PMCID: PMC9755620 DOI: 10.1177/19418744221122863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background Human Immunodeficiency Virus (HIV) vasculopathy encompasses the development of aneurysms, stenosis and vessel occlusions. Intracranial fusiform aneurysms in Human Immunodeficiency Virus (HIV) were originally described in children; however, HIV-associated aneurysms are increasingly recognized in adults. Purpose: We present two cases to highlight the spectrum of severity and outline instructive clinical courses. Results Case one is a 52-year-old woman with HIV, Acquired Immunodeficiency Syndrome (AIDS)-defining progressive multifocal leukoencephalopathy (PML) and an 18 years course of cerebral aneurysms, aneurysm thrombosis and the development of right middle cerebral artery (MCA) moyamoya pattern collaterals. Case two is a 55-year-old man with AIDS-defining cerebral toxoplasmosis, complicated by IRIS and anterior and posterior circulation fusiform aneurysm formation. Conclusions: The combination of both fusiform abnormalities and Moyamoya, discussed in our first case has not been previously described. In comparison, our second case actually demonstrated improvement in vasculopathy after nine-months of antiretroviral therapy (ART) adherence.
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Affiliation(s)
- Kevin Kyle
- Department of Neurology, Comprehensive Neurology Division, Massachusetts General Hospital, Boston, MA, USA
| | - Mary Maher
- Department of Radiology, Hospital of the University of Pennsylvania, Pennsylvania, PA, USA
| | - Amit C. Achhra
- Infectious Diseases Division, Yale New Haven Hospital, New Haven, CT, USA
| | - Nagagopal Venna
- Department of Neurology, Neuroimmunology and Neuro-Infectious Disease Division, Massachusetts General Hospital, Boston, MA, USA
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Roh J, Baik SK, Yeom JA, Na JY, Lee SW. Successful management of bilateral internal carotid artery fusiform giant aneurysms in a patient with intimal fibroplasia using multiple flow diverters: With long-term imaging follow up. Interv Neuroradiol 2022; 28:508-514. [PMID: 34647490 PMCID: PMC9511623 DOI: 10.1177/15910199211049129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 08/12/2021] [Accepted: 09/01/2021] [Indexed: 11/17/2022] Open
Abstract
The authors report a rare case of sequentially developed bilateral internal carotid artery (ICA) fusiform giant aneurysms in a patient with pathologically confirmed intimal fibroplasia. Both ICA fusiform aneurysms were treated with multiple flow diverter insertion and were well-managed over the past 5.5 years of follow-up. The development of aneurysms in this rare disease entity appears to be a lifelong process based on the authors' observations in serial angiographic follow-up studies. Reconstruction therapy using flow-diverting stents in this unique condition may be a safe and effective treatment modality.
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Affiliation(s)
- Jieun Roh
- Department of Radiology, Pusan National University Yangsan Hospital, Yangsan-si, Kyoungsangnam-do, South Korea
| | - Seung Kug Baik
- Department of Radiology, Pusan National University Yangsan Hospital, Yangsan-si, Kyoungsangnam-do, South Korea
| | - Jeong A Yeom
- Department of Radiology, Pusan National University Yangsan Hospital, Yangsan-si, Kyoungsangnam-do, South Korea
| | - Joo-Young Na
- Department of Pathology, Pusan National University Yangsan Hospital, Yangsan-si, Kyoungsangnam-do, South Korea
| | - Sang-Won Lee
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan-si, Kyoungsangnam-do, South Korea
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Rinaldo L, Oushy S, Lanzino G. Combined deconstructive and reconstructive treatment of a giant vertebrobasilar fenestration aneurysm. Neurosurg Focus Video 2022; 7:V7. [PMID: 36425263 PMCID: PMC9664490 DOI: 10.3171/2022.7.focvid2256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 07/11/2022] [Indexed: 06/16/2023]
Abstract
Aneurysms associated with a vertebrobasilar fenestration are rare lesions and can grow to a giant size, presenting significant therapeutic challenges. Endovascular treatment of these aneurysms has traditionally been with coiling; however, flow diverter placement within the fenestration arms has recently proven to be a viable treatment strategy. The authors present a case of a giant vertebrobasilar fenestration aneurysm in a patient presenting with a cranial nerve VI palsy. The lesion was treated by using a combination of flow diverter placement and vertebral artery sacrifice. The nuances of flow diversion therapy for these aneurysms and the management of intra- and postoperative complications are discussed. The video can be found here: https://stream.cadmore.media/r10.3171/2022.7.FOCVID2256.
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Affiliation(s)
| | | | - Giuseppe Lanzino
- Departments of Neurosurgery and
- Radiology, Mayo Clinic, Rochester, Minnesota
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Peng F, Fu M, Xia J, Niu H, Liu L, Feng X, Xu P, Bai X, Li Z, Chen J, Tong X, He X, Xu B, Chen X, Liu H, Sui B, Duan Y, Li R, Liu A. Quantification of aneurysm wall enhancement in intracranial fusiform aneurysms and related predictors based on high-resolution magnetic resonance imaging: a validation study. Ther Adv Neurol Disord 2022; 15:17562864221105342. [PMID: 35847373 PMCID: PMC9280813 DOI: 10.1177/17562864221105342] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 05/18/2022] [Indexed: 11/18/2022] Open
Abstract
Background: Aneurysm wall enhancement (AWE) in high-resolution magnetic resonance imaging (HR-MRI) has emerged as a new imaging biomarker of intracranial aneurysm instability. Objective: To determine a standard method of AWE quantification for predicting fusiform intracranial aneurysms (FIAs) stability by comparing the sensitivity of each parameter in identifying symptomatic FIAs. The predictors of AWE and FIA types were also identified. Methods: We retrospectively analyzed consecutive fusiform aneurysm patients who underwent HR-MRI from two centers. The aneurysm-to-pituitary stalk contrast ratio (CRstalk), aneurysm enhancement ratio, and aneurysm enhancement index were extracted, and their sensitivities in discriminating aneurysm symptoms were compared using the receiver-operating characteristic curve. Morphological parameters of fusiform aneurysm were extracted based on 3D vessel model. Uni- and multivariate analyses of related predictors for AWE, CRstalk, and FIA types were performed, respectively. Results: Overall, 117 patients (mean age, 53.3 ± 11.7 years; male, 75.2%) with 117 FIAs underwent HR-MRI were included. CRstalk with the maximum signal intensity (CRstalk-max) had the highest sensitivity in identifying symptomatic FIAs with an area under the curve value (0.697) and a cut-off value of 0.90. The independent predictors of AWE were aneurysm symptoms [(odds ratio) OR = 3.754, p = 0.003], aspirin use (OR = 0.248, p = 0.037), and the maximum diameter of the cross-section (OR = 1.171, p = 0.043). The independent predictors of CRstalk-max were aneurysm symptoms (OR = 1.289, p = 0.003) and posterior circulation aneurysm (OR = 1.314, p = 0.001). Transitional-type showed higher rates of hypertension and mural thrombus over both dolichoectatic- and fusiform-type FIAs. Conclusion: CRstalk-max may be the most reliable parameter to quantify AWE to distinguish symptomatic FIAs. It also has the potential to identify unstable FIAs. Several factors contribute to the complex pathophysiology of FIAs and need further validation in a larger cohort.
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Affiliation(s)
- Fei Peng
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Mingzhu Fu
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University, Beijing, China
| | - Jiaxiang Xia
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Hao Niu
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Lang Liu
- Department of Neurosurgery, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Xin Feng
- Neurosurgery Center, Department of Cerebrovascular Surgery, Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Peng Xu
- Department of Neurosurgery, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
| | - Xiaoyan Bai
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhiye Li
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jigang Chen
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Xin Tong
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Xiaoxin He
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Boya Xu
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Xuge Chen
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Hongyi Liu
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Binbin Sui
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yonghong Duan
- Department of Neurosurgery, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
| | - Rui Li
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University, Beijing, China
| | - Aihua Liu
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, No. 119, South 4th Ring West Road, Fengtai District, Beijing 100070, China
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12
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Narsinh KH, Narsinh K, McCoy DB, Sun Z, Halabi C, Meisel K, Tihan T, Chaganti K, Amans MR, Halbach VV, Higashida RT, Hetts SW, Dowd CF, Winkler EA, Abla AA, Nowakowski TJ, Cooke DL. Endovascular Biopsy of Vertebrobasilar Aneurysm in Patient With Polyarteritis Nodosa. Front Neurol 2021; 12:697105. [PMID: 34887823 PMCID: PMC8650719 DOI: 10.3389/fneur.2021.697105] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 10/08/2021] [Indexed: 12/15/2022] Open
Abstract
Background and Purpose: The management of unruptured intracranial aneurysms remains controversial. The decisions to treat are heavily informed by estimated risk of bleeding. However, these estimates are imprecise, and better methods for stratifying the risk or tailoring treatment strategy are badly needed. Here, we demonstrate an initial proof-of-principle concept for endovascular biopsy to identify the key molecular pathways and gene expression changes associated with aneurysm formation. We couple this technique with single cell RNA sequencing (scRNAseq) to develop a roadmap of the pathogenic changes of a dolichoectatic vertebrobasilar aneurysm in a patient with polyarteritis nodosa. Methods: Endovascular biopsy and fluorescence activated cell sorting was used to isolate the viable endothelial cells (ECs) using the established techniques. A single cell RNA sequencing (scRNAseq) was then performed on 24 aneurysmal ECs and 23 patient-matched non-aneurysmal ECs. An integrated panel of bioinformatic tools was applied to determine the differential gene expression, enriched signaling pathways, and cell subpopulations hypothesized to drive disease pathogenesis. Results: We identify a subset of 7 (29%) aneurysm-specific ECs with a distinct gene expression signature not found in the patient-matched control ECs. A gene set enrichment analysis identified these ECs to have increased the expression of genes regulating the leukocyte-endothelial cell adhesion, major histocompatibility complex (MHC) class I, T cell receptor recycling, tumor necrosis factor alpha (TNFα) response, and interferon gamma signaling. A histopathologic analysis of a different intracranial aneurysm that was later resected yielded a diagnosis of polyarteritis nodosa and positive staining for TNFα. Conclusions: We demonstrate feasibility of applying scRNAseq to the endovascular biopsy samples and identify a subpopulation of ECs associated with cerebral aneurysm in polyarteritis nodosa. Endovascular biopsy may be a safe method for deriving insight into the disease pathogenesis and tailoring the personalized treatment approaches to intracranial aneurysms.
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Affiliation(s)
- Kazim H Narsinh
- Division of Interventional Neuroradiology, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
| | - Kamileh Narsinh
- Division of Interventional Neuroradiology, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
| | - David B McCoy
- Division of Interventional Neuroradiology, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
| | - Zhengda Sun
- Division of Interventional Neuroradiology, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
| | - Cathra Halabi
- Division of Neurovascular Neurology, Department of Neurology, University of California, San Francisco, San Francisco, CA, United States.,Weill Institute for Neuroscience, University of California, San Francisco, San Francisco, CA, United States
| | - Karl Meisel
- Division of Neurovascular Neurology, Department of Neurology, University of California, San Francisco, San Francisco, CA, United States
| | - Tarik Tihan
- Division of Neuropathology, Department of Pathology, University of California, San Francisco, San Francisco, CA, United States
| | - Krishna Chaganti
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Matthew R Amans
- Division of Interventional Neuroradiology, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
| | - Van V Halbach
- Division of Interventional Neuroradiology, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
| | - Randall T Higashida
- Division of Interventional Neuroradiology, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
| | - Steven W Hetts
- Division of Interventional Neuroradiology, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
| | - Christopher F Dowd
- Division of Interventional Neuroradiology, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
| | - Ethan A Winkler
- Cerebrovascular Disorders Program, Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Adib A Abla
- Cerebrovascular Disorders Program, Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Tomasz J Nowakowski
- Department of Anatomy, Chan Zuckerberg Biohub, University of California, San Francisco, San Francisco, CA, United States
| | - Daniel L Cooke
- Division of Interventional Neuroradiology, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
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13
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Izumo T, Fujimoto T, Morofuji Y, Tateishi Y, Matsuo T. Partial Clipping Occlusion Including Rupture Point Is an Effective Strategy for Ruptured Giant Fusiform Basilar Artery Aneurysm: A Technical Case Report. Front Neurol 2021; 12:743654. [PMID: 34659100 PMCID: PMC8516352 DOI: 10.3389/fneur.2021.743654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 09/06/2021] [Indexed: 11/13/2022] Open
Abstract
Treatment of fusiform basilar artery aneurysms is still challenging today. The authors present a case of a patient with a ruptured giant fusiform basilar artery aneurysm successfully treated by clipping occlusion of the rupture point. A 62-year-old man suddenly fell into a coma due to subarachnoid hemorrhage (SAH) with a ruptured giant fusiform basilar artery aneurysm with a bleb on the right shoulder. We considered treating the lesion with stent-assisted coil embolization because of the aneurysm's shape, but we had to give up because stents were off-label in the acute phase SAH in our country. Instead, we successfully performed clipping surgery to partially occlude the aneurysm, including the rupture point via the anterior transpetrosal approach. His postoperative course was uneventful, without rerupture of the aneurysm, and his conscious level tended to improve. The postoperative imaging studies showed no complications and disappearance of the rupture point of the aneurysm. Although direct surgery for the giant fusiform basilar artery aneurysms is one of the challenging operations, it is an essential and highly effective treatment as a last resort for complex aneurysms if other treatments are not available.
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Affiliation(s)
- Tsuyoshi Izumo
- Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Takashi Fujimoto
- Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Yoichi Morofuji
- Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Yohei Tateishi
- Department of Clinical Neuroscience and Neurology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Takayuki Matsuo
- Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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14
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Tsunoda S, Inoue T. Microsurgical Treatment Strategy of Vertebral Artery Fusiform Aneurysm-From the Standpoint of Hemodynamic Integrity and Perforator Preservation. Front Neurol 2021; 12:728176. [PMID: 34616354 PMCID: PMC8488355 DOI: 10.3389/fneur.2021.728176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 08/10/2021] [Indexed: 11/13/2022] Open
Abstract
During treatment of vertebral artery (VA) fusiform aneurysms, it is critical to preserve peripheral perforators and anterograde blood flow of the VA and to reduce hemodynamic load to the contralateral VA. Even in the era of endovascular treatment, there are still many benefits to using microsurgical treatments with appropriate clip application and preservation of the perforators around the aneurysm, in conjunction with various bypass techniques. The ideal microsurgical technique involves reconstructive clipping that obliterates the aneurysm but preserves anterograde blood flow of the VA, followed by isolation of the aneurysm and VA reconstruction. If these two methods are unavailable, proximal clipping of the aneurysm combined with flow-augmentation bypass to the distal branch can be considered as an alternative surgical management. We discuss the microsurgical treatment of unruptured VA fusiform aneurysms in our surgical cases on the basis of a review of the current literature.
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Affiliation(s)
- Sho Tsunoda
- Department of Neurosurgery, NTT Medical Center Tokyo, Tokyo, Japan
| | - Tomohiro Inoue
- Department of Neurosurgery, NTT Medical Center Tokyo, Tokyo, Japan
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15
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Brummund D, Chang A, Azimi-Ghomi O, Diaz B, Sendzischew H. Superficial Temporal Artery True Fusiform Aneurysm With Several Lateral Feeding Vessels. Cureus 2021; 13:e13973. [PMID: 33880302 PMCID: PMC8052991 DOI: 10.7759/cureus.13973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
A 49-year-old man flight attendant with a past medical history of Roux-en-Y bypass and massive weight loss 18 months prior was referred for surgical management of a superficial temporal artery aneurysm. Imaging confirmed the diagnosis. Intraoperatively a 1 cm fusiform aneurysm was identified with numerous feeding side branch vessels. The aneurysm was suture ligated and excised in toto with pathologic analysis showing involvement of all vessel layers. This case highlights a rare true aneurysm of the superficial temporal artery and aberrant anatomy of multiple side branches feeding the aneurysm and complicating dissection and excision.
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Affiliation(s)
- Dieter Brummund
- Department of General Surgery, Aventura Hospital and Medical Center, Aventura, USA
| | - Angela Chang
- Department of Anesthesiology, Aventura Hospital and Medical Center, Aventura, USA
| | - Obteene Azimi-Ghomi
- Department of General Surgery, Aventura Hospital and Medical Center, Aventura, USA
| | - Brandon Diaz
- Department of General Surgery, Aventura Hospital and Medical Center, Aventura, USA
| | - Harry Sendzischew
- Department of General Surgery, Mount Sinai Medical Center, Miami Beach, USA
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16
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Church EW, Bigder MG, Sussman ES, Gummidipundi SE, Han SS, Heit JJ, Do HM, Dodd RL, Marks MP, Steinberg GK. Treatment of posterior circulation fusiform aneurysms. J Neurosurg 2020; 134:1894-1900. [PMID: 32707547 DOI: 10.3171/2020.4.jns192838] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 04/27/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Perforator arteries, the absence of an aneurysm discrete neck, and the often-extensive nature of posterior circulation fusiform aneurysms present treatment challenges. There have been advances in microsurgical and endovascular approaches, including flow diversion, and the authors sought to review these treatments in a long-term series at their neurovascular referral center. METHODS The authors performed a retrospective chart review from 1990 to 2018. Primary outcomes were modified Rankin Scale (mRS) scores and Glasgow Outcome Scale (GOS) scores at follow-up. The authors also examined neurological complication rates. Using regression techniques, they reviewed independent and dependent variables, including presenting features, aneurysm location and size, surgical approach, and pretreatment and posttreatment thrombosis. RESULTS Eighty-four patients met the inclusion criteria. Their mean age was 53 years, and 49 (58%) were female. Forty-one (49%) patients presented with subarachnoid hemorrhage. Aneurysms were located on the vertebral artery (VA) or posterior inferior cerebellar artery (PICA) in 50 (60%) patients, basilar artery (BA) or vertebrobasilar junction (VBJ) in 22 (26%), and posterior cerebral artery (PCA) in 12 (14%). Thirty-one (37%) patients were treated with microsurgical and 53 (63%) with endovascular approaches. Six aneurysms were treated with endovascular flow diversion. The authors found moderate disability or better (mRS score ≤ 3) in 85% of the patients at a mean 14-month follow-up. The GOS score was ≥ 4 in 82% of the patients. The overall neurological complication rate was 12%. In the regression analysis, patients with VA or PICA aneurysms had better functional outcomes than the other groups (p < 0.001). Endovascular strategies were associated with better outcomes for BA-VBJ aneurysms (p < 0.01), but microsurgery was associated with better outcomes for VA-PICA and PCA aneurysms (p < 0.05). There were no other significant associations between patient, aneurysm characteristics, or treatment features and neurological complications (p > 0.05). Patients treated with flow diversion had more complications than those who underwent other endovascular and microsurgical strategies, but the difference was not significant in regression models. CONCLUSIONS Posterior circulation fusiform aneurysms remain a challenging aneurysm subtype, but an interdisciplinary treatment approach can result in good outcomes. While flow diversion is a useful addition to the armamentarium, traditional endovascular and microsurgical techniques continue to offer effective options.
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Affiliation(s)
| | | | | | - Santosh E Gummidipundi
- 3Quantitative Sciences Unit, Stanford University School of Medicine, Stanford, California
| | - Summer S Han
- Departments of1Neurosurgery and.,3Quantitative Sciences Unit, Stanford University School of Medicine, Stanford, California
| | - Jeremy J Heit
- Departments of1Neurosurgery and.,2Radiology, and Stanford Stroke Center; and
| | - Huy M Do
- Departments of1Neurosurgery and.,2Radiology, and Stanford Stroke Center; and
| | - Robert L Dodd
- Departments of1Neurosurgery and.,2Radiology, and Stanford Stroke Center; and
| | - Michael P Marks
- Departments of1Neurosurgery and.,2Radiology, and Stanford Stroke Center; and
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17
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Wenger TL, Bly RA, Wu N, Albert CM, Park J, Shieh J, Chenbhanich J, Heike CL, Adam MP, Chang I, Sun A, Miller DE, Beck AE, Gupta D, Boos MD, Zackai EH, Everman D, Ganapathi S, Wilson M, Christodoulou J, Zarate YA, Curry C, Li D, Guimier A, Amiel J, Hakonarson H, Webster R, Bhoj EJ, Perkins JA, Dahl JP, Dobyns WB. Activating variants in PDGFRB result in a spectrum of disorders responsive to imatinib monotherapy. Am J Med Genet A 2020; 182:1576-1591. [PMID: 32500973 DOI: 10.1002/ajmg.a.61615] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 03/25/2020] [Accepted: 04/20/2020] [Indexed: 11/09/2022]
Abstract
More than 50 individuals with activating variants in the receptor tyrosine kinase PDGFRB have been reported, separated based on clinical features into solitary myofibromas, infantile myofibromatosis, Penttinen syndrome with premature aging and osteopenia, Kosaki overgrowth syndrome, and fusiform aneurysms. Despite their descriptions as distinct clinical entities, review of previous reports demonstrates substantial phenotypic overlap. We present a case series of 12 patients with activating variants in PDGFRB and review of the literature. We describe five patients with PDGFRB activating variants whose clinical features overlap multiple diagnostic entities. Seven additional patients from a large family had variable expressivity and late-onset disease, including adult onset features and two individuals with sudden death. Three patients were treated with imatinib and had robust and rapid response, including the first two reported infants with multicentric myofibromas treated with imatinib monotherapy and one with a recurrent p.Val665Ala (Penttinen) variant. Along with previously reported individuals, our cohort suggests infants and young children had few abnormal features, while older individuals had multiple additional features, several of which appeared to worsen with advancing age. Our analysis supports a diagnostic entity of a spectrum disorders due to activating variants in PDGFRB. Differences in reported phenotypes can be dramatic and correlate with advancing age, genotype, and to mosaicism in some individuals.
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Affiliation(s)
- Tara L Wenger
- Division of Genetic Medicine, University of Washington, Seattle, Washington, USA
| | - Randall A Bly
- Department of Otolaryngology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Natalie Wu
- Division of Hematology/Oncology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Catherine M Albert
- Division of Hematology/Oncology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Julie Park
- Division of Hematology/Oncology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Joseph Shieh
- Division of Medical Genetics, Benioff Children's Hospital and Institute for Human Genetics, University of California San Francisco, San Francisco, California, USA
| | - Jirat Chenbhanich
- Division of Medical Genetics, Benioff Children's Hospital and Institute for Human Genetics, University of California San Francisco, San Francisco, California, USA
| | - Carrie L Heike
- Division of Craniofacial Medicine, Seattle Children's Hospital, Seattle, Washington, USA
| | - Margaret P Adam
- Division of Genetic Medicine, University of Washington, Seattle, Washington, USA
| | - Irene Chang
- Division of Genetic Medicine, University of Washington, Seattle, Washington, USA
| | - Angela Sun
- Division of Genetic Medicine, University of Washington, Seattle, Washington, USA
| | - Danny E Miller
- Division of Genetic Medicine, University of Washington, Seattle, Washington, USA
| | - Anita E Beck
- Division of Genetic Medicine, University of Washington, Seattle, Washington, USA
| | - Deepti Gupta
- Division of Dermatology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Markus D Boos
- Division of Dermatology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Elaine H Zackai
- Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - David Everman
- Greenwood Genetics Center, Greenville, South Carolina, USA
| | - Shireen Ganapathi
- Division of Hematology/Oncology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Meredith Wilson
- Department of Clinical Genetics, Sydney Children's Hospitals Network-Westmead, University of Sydney, Sydney, New South Wales, Australia.,Division of Genetic Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - John Christodoulou
- Murdoch Children's Research Institute, Parkville, Department of Paediatrics, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
| | - Yuri A Zarate
- Section of Genetics and Metabolism, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Cynthia Curry
- Division of Medical Genetics, Benioff Children's Hospital and Institute for Human Genetics, University of California San Francisco, San Francisco, California, USA
| | - Dong Li
- Center for Applied Genomics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Anne Guimier
- Département de Génétique, Hôpital Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris (AP-HP), Paris, France
| | - Jeanne Amiel
- Département de Génétique, Hôpital Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris (AP-HP), Paris, France
| | - Hakon Hakonarson
- Center for Applied Genomics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Richard Webster
- Department of Neurology, Sydney Children's Hospital Network, Westmead, New South Wales, Australia
| | - Elizabeth J Bhoj
- Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Center for Applied Genomics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jonathan A Perkins
- Department of Otolaryngology, Seattle Children's Hospital, Seattle, Washington, USA
| | - John P Dahl
- Department of Otolaryngology, Seattle Children's Hospital, Seattle, Washington, USA
| | - William B Dobyns
- Division of Genetic Medicine, University of Washington, Seattle, Washington, USA
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18
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Avery MB, Alaqeel A, Bromley AB, Chen YX, Wong JH, Eesa M, Mitha AP. A refined experimental model of fusiform aneurysms in a rabbit carotid artery. J Neurosurg 2019; 131:88-95. [PMID: 30052160 DOI: 10.3171/2018.2.jns173168] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 02/22/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Reliable animal models are an important aspect of translational research, especially for relatively uncommon clinical entities such as fusiform aneurysms. While several animal models exist, very few are tailored to cerebral fusiform aneurysms, which have unique attributes compared to abdominal fusiform aneurysms. The authors aimed to build from previous models to create a cerebral fusiform aneurysm model that is simple to use and reliable. METHODS Twelve female New Zealand White rabbits were assigned to 3 groups: group E, elastase only; group C, CaCl2 only; group EC, elastase + CaCl2. All rabbits underwent surgical exposure of the right common carotid artery (CCA) and 20 minutes of peri-carotid incubation with their respective chemicals. Angiography was performed 6 weeks later for arterial dilation measurements, with 50% increase in diameter being defined as fusiform aneurysm formation. The arterial segments, along with the contralateral CCAs, were harvested and assessed histologically for wall component measurements and elastin semiquantification. A separate rabbit underwent aneurysm creation per the group EC protocol and was treated with an endovascular flow-diversion device. RESULTS All of the group EC rabbits developed fusiform aneurysms (mean dilation of 88%), while none of the group E or group C rabbits developed aneurysms (p = 0.001). Histological analysis revealed increased internal elastic lamina fragmentation in the group EC aneurysms, which also had less tunica intima hyperplasia. All aneurysms exhibited thinning of the tunica media and reduction in elastin content. The use of an endovascular flow-diverting stent was successful, with complete parent vessel remodeling, as expected, 4 weeks after deployment. CONCLUSIONS The peri-arterial application of combined elastase and CaCl2 to the CCA appears sufficient to reliably produce fusiform aneurysms after 6 weeks. Exposure to elastase or CaCl2 individually appears insufficient, despite the observed histological changes to the arterial wall. The proposed fusiform aneurysm model is able to accommodate endovascular devices, simulating the tortuous pathway experienced in using such devices in human cerebral aneurysms and thus is a satisfactory model to use in translational research.
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Affiliation(s)
- Michael B Avery
- 1Department of Neurosciences.,2Neuroscience Graduate Program
| | | | | | | | - John H Wong
- 1Department of Neurosciences.,5Department of Radiology, and.,6Hotchkiss Brain Institute, University of Calgary, Alberta, Canada
| | - Muneer Eesa
- 1Department of Neurosciences.,5Department of Radiology, and
| | - Alim P Mitha
- 1Department of Neurosciences.,5Department of Radiology, and.,6Hotchkiss Brain Institute, University of Calgary, Alberta, Canada
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19
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Chihi M, Gembruch O, Darkwah Oppong M, Chen B, Dinger TF, Barthel L, Pierscianek D, Wrede KH, Özkan N, Sure U, Jabbarli R. Intracranial aneurysms in patients with tuberous sclerosis complex: a systematic review. J Neurosurg Pediatr 2019; 24:174-183. [PMID: 31075764 DOI: 10.3171/2019.2.peds18661] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 02/22/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Tuberous sclerosis complex (TSC) is a rare multisystem genetic disease. Arterial wall developmental disorders, such as aneurysms, in association with TSC have been well described for extracranial vasculature. The characteristics of intracranial aneurysms (IAs) in TSC have not previously been addressed in the literature. This systematic review was performed to identify and assess the distinct characteristics of IAs in patients with TSC. METHODS The authors searched PubMed, Scopus, and Web of Science for publications describing cases of TSC and IA reported before August 7, 2018. They also report 2 cases of IAs in TSC patients treated at their own institution. RESULTS Thirty-three TSC patients with a total of 42 IAs were included in this review. Three individuals presented with subarachnoid hemorrhage. The IAs were large or giant in 57.1% and fusiform in 45.2% of the cases. Most of the IAs (61.9%, 26 of 42) originated from the internal carotid artery. There was a higher prevalence of pediatric cases (66.7%) and male patients (63.6%, 21 of 32 individuals with known sex) among the collected series. CONCLUSIONS TSC patients with IAs are characterized with a higher proportion of large/giant and fusiform IAs and young age, suggesting rapid aneurysmal growth. Furthermore, there is a distinct location pattern of IAs and an inverse sex ratio than in the healthy population. Large population-based patient registers are required to improve the understanding of epidemiology and pathophysiology of IA formation in TSC.
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20
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Beer-Furlan A, Dasenbrock HH, Joshi KC, Chen M. Endovascular management of basilar artery occlusion secondary to fusiform aneurysm with intraluminal thrombus. Neurosurg Focus 2019; 46:V2. [PMID: 30611176 DOI: 10.3171/2019.1.focusvid.18468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 09/18/2018] [Indexed: 11/06/2022]
Abstract
Acute basilar artery occlusion is one of the most devastating subtypes of ischemic stroke with an extremely high morbidity and mortality rate. The most common causes include embolism, large-artery atherosclerosis, penetrating small-artery disease, and arterial dissection. The heart and vertebral arteries are the main source of emboli in embolic basilar occlusions. The authors present an uncommon acute basilar occlusion secondary to a fusiform aneurysm with intraluminal thrombus. The patient underwent a mechanical thrombectomy with successful recanalization, but persistent intraluminal thrombus. The authors discuss the management dilemma and describe their choice for placement of flow diverter stents.The video can be found here: https://youtu.be/XzBdgxJPSWQ.
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21
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Santillan A, Knopman J, Patsalides A, Pierre Gobin Y. Delayed intracranial aneurysm formation after cardiac myxoma resection: Report of two cases and review of the literature. Interv Neuroradiol 2018; 25:177-181. [PMID: 30394840 DOI: 10.1177/1591019918808026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Myxomas are slowly growing benign neoplasms and represent the most common tumor of the heart. Embolism from cardiac myxoma occurs in 30-45% of patients and in at least half of the cases cerebral arteries are affected leading mainly to embolic ischemic strokes and rarely to delayed intracranial aneurysm formation. We present two cases with delayed intracranial aneurysmal formation 14 years and 18 years after cardiac myxoma resection. To the best of our knowledge these two cases represent the longest time interval between aneurysm detection after complete cardiac myxoma resection with no recurrence confirmed by transesophageal echocardiogram. Our study also provides the longest clinical and radiological follow-up on this type of lesion.
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Affiliation(s)
- Alejandro Santillan
- Division of Interventional Neuroradiology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, USA
| | - Jared Knopman
- Division of Interventional Neuroradiology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, USA
| | - Athos Patsalides
- Division of Interventional Neuroradiology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, USA
| | - Y Pierre Gobin
- Division of Interventional Neuroradiology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, USA
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22
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Tahir R, Asmaro KP, Haider S, Kole M. Ruptured Distal Superior Cerebellar Artery Dissecting Aneurysm Treated with a Flow-diverting Device: Case Report and Review of Literature. Cureus 2018; 10:e2918. [PMID: 30186723 PMCID: PMC6122669 DOI: 10.7759/cureus.2918] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Distal fusiform aneurysms of the superior cerebellar artery (SCA) are rare and present several challenges to clinicians, especially when ruptured. While several treatment options are available, including surgical clipping and endovascular coiling, numerous challenges still remain due to the presence of vital neighboring neurovascular structures. In addition, the complications that arise due to the compromise of brainstem perforators make these aneurysms difficult to treat. This case report demonstrates the successful treatment of a ruptured fusiform aneurysm of the SCA with a flow-diverting device. We also conducted a literature review of the use of flow-diverting devices for treating such aneurysms. When choosing a treatment modality for a ruptured aneurysm, clinicians must consider both the patient-specific variables as well as aneurysm morphology. Treatment options including microsurgical clipping, endovascular coiling, and flow diversion carry risks. Therefore, the clinician must decide which option best fits each situation.
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Affiliation(s)
- Rizwan Tahir
- Neurological Surgery, Henry Ford Hospital, Detroit, USA
| | | | - Sameah Haider
- Neurological Surgery, Henry Ford Hospital, Detroit, USA
| | - Max Kole
- Neurosurgery, Henry Ford Hospital, detroit, USA
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23
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Ekuma ME, Goto T, Hanaoka Y, Kanaya K, Horiuchi T, Hongo K, Ohaegbulam SC. Unilateral isolated hypoglossal nerve palsy due to pathologically adherent PICA fusiform aneurysm - A case report. Surg Neurol Int 2017; 8:114. [PMID: 28680733 PMCID: PMC5482208 DOI: 10.4103/sni.sni_279_16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 03/21/2017] [Indexed: 12/02/2022] Open
Abstract
Background: Isolated hypoglossal nerve palsy due to mechanical compression by a vascular lesion is rare. Case Description: We report the case of a 72-year-old man who presented with a 4-year history of swallowing disturbance and subsequently progressively worsening left-sided tongue atrophy. He was referred to our department by a neurologist due a magnetic resonance imaging detected left vertebral artery compression of the medulla. Neurological examination was unremarkable except for left hypoglossal nerve dysfunction, which presented as left-sided atrophy and impaired movement of the tongue. Three-dimensional computed tomography angiography showed proximal left posterior inferior cerebellar artery (PICA) origin fusiform aneurysm. Microvascular decompression was done through a left transcondylar fossa approach. Intraoperative findings were thickened arachnoid around the lower cranial nerves, fusiform aneurysm of the left PICA at its origin from the left vertebral artery which was severely adherent to and compressing the left hypoglossal nerve rootlets. Conclusion: The PICA has a very close relationship to the hypoglossal nerve, and its fusiform dilatation could cause isolated hypoglossal nerve dysfunction. Pathological adhesions between hypoglossal rootlets and the PICA aneurysm wall could be a possible contributor in the development and progression of hypoglossal nerve palsy.
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Affiliation(s)
- Mike E Ekuma
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan.,Memfys Hospital for Neurosurgery, Enugu, Nigeria
| | - Tetsuya Goto
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yoshiki Hanaoka
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Kohei Kanaya
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Tetsuyoshi Horiuchi
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Kazuhiro Hongo
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
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24
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Abstract
Fenestrated vertebrobasilar junction aneurysms are rare vascular lesions. Microsurgical intervention is extremely difficult due to the complex anatomy in the vicinity of these aneurysms. Endovascular neurosurgery appears to be safe and should be considered as the first modality of treatment. This case study details the treatment of an unruptured fusiform fenestrated vertebrobasilar junction aneurysm with endovascular occlusion with stent-assisted coiling. The optimal angiographic exposure and selective microcatheterization of the aneurysm were challenging due to the patient’s body habitus, and the aneurysm was large with one dominant fenestrated limb.
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Affiliation(s)
| | | | - Alex Tai
- Neurosurgery, Medstar Georgetown University Hospital
| | - Ai-Hsi Liu
- Neurointerventional Radiology, Medstar Washington Hospital Center
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25
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Jelodar S, Shirani M, Tavallaii A, Ketabchi M, Alimohamadi M. Bilateral Fusiform Aneurysms of the Internal Carotid Arteries Presenting with Subarachnoid Hemorrhage. J Stroke Cerebrovasc Dis 2017; 26:e111-e113. [PMID: 28433386 DOI: 10.1016/j.jstrokecerebrovasdis.2017.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 03/13/2017] [Accepted: 03/21/2017] [Indexed: 11/16/2022] Open
Abstract
Fusiform aneurysms of cerebral arteries are less prevalent than saccular aneurysms and are rarely associated with subarachnoid hemorrhage (SAH). In this article, we report SAH due to a rare case of bilateral fusiform aneurysm of the supraclinoid segment of the internal carotid arteries (ICAs) (C4 segment of the ICA).
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Affiliation(s)
- Sina Jelodar
- Brain and Spinal Cord Injury Research Center (BASIR), Neuroscience Institute, Tehran University of Medical Sciences (TUMS), Tehran, Iran; Department of Neurosurgery, Sina Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Mohammad Shirani
- Brain and Spinal Cord Injury Research Center (BASIR), Neuroscience Institute, Tehran University of Medical Sciences (TUMS), Tehran, Iran; Department of Neurosurgery, Sina Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Amin Tavallaii
- Department of Neurosurgery, Sina Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Mehdi Ketabchi
- Department of Neurosurgery, Sina Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Maysam Alimohamadi
- Brain and Spinal Cord Injury Research Center (BASIR), Neuroscience Institute, Tehran University of Medical Sciences (TUMS), Tehran, Iran; Department of Neurosurgery, Sina Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran.
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26
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Gupta M, Cheung VJ, Abraham P, Wali AR, Santiago-Dieppa DR, Gabel BC, Almansouri A, Pannell JS, Khalessi AA. Low-profile Visualized Intraluminal Support Junior Device for the Treatment of Intracranial Aneurysms. Cureus 2017; 9:e1037. [PMID: 28357169 PMCID: PMC5356986 DOI: 10.7759/cureus.1037] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective: Early case series suggest that the recently introduced Low-profile Visualized Intraluminal Support Junior (LVIS Jr.) device (MicroVention-Terumo, Inc., Tustin, CA) may be used to treat wide-necked aneurysms that would otherwise require treatment with intrasaccular devices or open surgery. We report our single-center experience utilizing LVIS Jr. to treat intracranial aneurysms involving 1.8-2.5 mm parent arteries. Methods: We retrospectively reviewed records of patients treated with the LVIS Jr. device for intracranial aneurysms at a single center. A total of 21 aneurysms were treated in 18 patients. Aneurysms were 2-25 mm in diameter; one was ruptured, while three had recurred after previous rupture and treatment. Lesions were distributed across the anterior (n=12) and posterior (n=9) circulations. Three were fusiform morphology. Results: Stent deployment was successful in 100% of cases with no immediate complications. Seventeen aneurysms were treated with stent-assisted coil embolization resulting in immediate complete occlusion in 94% of cases. Two fusiform aneurysms arising from the posterior circulation were further treated with elective clip ligation after delayed expansion and recurrence; no lesions required further endovascular treatment. Four aneurysms were treated by flow diversion with stand-alone LVIS Jr. stent, and complete occlusion was achieved in three cases. Small foci of delayed ischemic injury were noted in two patients in the setting of antiplatelet medication noncompliance. No in-stent stenosis, migration, hemorrhage, or permanent deficits were observed. Good functional outcome based on the modified Rankin Scale score (mRS ≤ 2) was achieved in 100% of cases. Conclusion: Our midterm results suggest that the LVIS Jr. stent may be used for a variety of intracranial aneurysms involving small parent arteries (1.8-2.5 mm) with complete angiographic occlusion, parent vessel preservation, and functional clinical outcomes. This off-label expansion would increase the number of aneurysms amenable to endovascular treatment. Future studies may build upon our experiences with flow diversion and treatment of complex or multiple lesions.
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Affiliation(s)
- Mihir Gupta
- Department of Neurosurgery, University of California, San Diego
| | | | - Peter Abraham
- Department of Neurosurgery, University of California, San Diego
| | - Arvin R Wali
- Department of Neurosurgery, University of California, San Diego
| | | | - Brandon C Gabel
- Department of Neurosurgery, University of California, San Diego
| | | | - J Scott Pannell
- Department of Neurosurgery, University of California, San Diego
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27
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de Andrade GC, Alves HP, Clímaco V, Pereira E, Lesczynsky A, Frudit ME. Two-stage reconstructive overlapping stent LEO+ and SILK for treatment of intracranial circumferential fusiform aneurysms in the posterior circulation. Interv Neuroradiol 2016; 22:516-23. [PMID: 27402799 DOI: 10.1177/1591019916656475] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 06/02/2016] [Indexed: 11/16/2022] Open
Abstract
Intracranial circumferential fusiform aneurysms of the posterior circulation involving arterial branches or perforating vessels are difficult to treat. This article shows an endovascular reconstruction technique not yet described, using a telescoping self-expandable stent (LEO+) and flow-diverter device (SILK) at different surgical times. Two patients with circumferential fusiform aneurysm, one being an aneurysm of the segments P2 and P3 of the posterior cerebral artery, diagnosed after a headache, and the other a partially thrombosed aneurysm of the lower basilar artery, diagnosed following ischemia of the brain stem. Endovascular treatment was performed by means of a vascular reconstruction technique that used at different surgical times: overlapping; a telescoped self-expandable stent, LEO+; and a flow-diverter device, SILK. Angiographic control was carried out at 6 and 12 months, to evaluate arterial patency, flow maintenance in the arterial branches and perforating vessels, and thrombosis of the aneurysm. The combined use at different surgical times of the self-expandable stent and flow-diverter device was technically successful in both patients. There were no complications during the procedure, nor in the long-term follow-up with full arterial vascular reconstruction, maintenance of cerebral perfusion and complete aneurysm occlusion at the 6- and 12-month angiographic follow-up. There was no aneurysm recanalization nor intra-stent stenosis. Circumferential fusiform aneurysm of the posterior circulation involving arterial branches or perforating vessels to the brain stem may be treated with this arterial reconstruction technique at different surgical times, using the self-expandable stent called LEO+ and the flow-diverter device SILK, minimizing the risk of complications and failure of the endovascular technique, with the potential for arterial reconstruction with thrombosis of the aneurysmatic sac, as well as flow maintenance in the eloquent arteries, in this type of cerebral aneurysm.
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Affiliation(s)
- Guilherme Cabral de Andrade
- Integrated Center of Neurology and Neurosurgery (CINN), Maringa, Brazil Department of Neurointervention, Paraná Hospital, Maringa, Brazil
| | - Helvercio P Alves
- Integrated Center of Neurology and Neurosurgery (CINN), Maringa, Brazil Department of Neurointervention, Paraná Hospital, Maringa, Brazil
| | - Valter Clímaco
- Integrated Center of Neurology and Neurosurgery (CINN), Maringa, Brazil
| | - Eduardo Pereira
- Integrated Center of Neurology and Neurosurgery (CINN), Maringa, Brazil
| | | | - Michel E Frudit
- Federal University of São Paulo (UNIFESP), São Paulo, Brazil
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28
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J-O'Shanahan A, Noda K, Tsuboi T, Ota N, Kamiyama H, Tokuda S, Tanikawa R. Radical surgical treatment for recurrent giant fusiform thrombosed vertebral artery aneurysm previously coiled. Surg Neurol Int 2016; 7:S237-42. [PMID: 27127714 PMCID: PMC4828954 DOI: 10.4103/2152-7806.179581] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Accepted: 01/28/2016] [Indexed: 11/29/2022] Open
Abstract
Background: Fusiform aneurysms are rare (<1%) and the underlying pathophysiology is not well known. Endovascular coiling is the standard of treatment; however, a surgical procedure with vascular reconstruction by excluding the pathological segment of the vessel and restoring the blood flow, seems to be the most effective and definitive treatment. Case Description: We report a patient who presented a fusiform vertebral artery aneurysm previously coiled which developed a giant enlargement and a new contralateral fusiform aneurysm. Hemodynamic changes resulting in the formation of contralateral aneurysm might be the result of aneurysm occlusion without revascularization. In addition, continued blood flow to the aneurysmal wall through the vasa vasorum might result in aneurysm recanalization or regrowth. In order to account for these possible sources of complications, we performed a vascular reconstruction with high and low flow bypasses after trapping the aneurysm. Conclusions: We hypothesize that, in this and similar cases, surgical vascular reconstruction should be the first and definitive treatment under experienced cerebrovascular surgeons.
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Affiliation(s)
- Aruma J-O'Shanahan
- Department of Neurosurgery, University Hospital Dr. Negrín, Gran Canaria, Canary Islands, Spain
| | - Kosumo Noda
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Hokkaido, Japan
| | - Toshiyuki Tsuboi
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Hokkaido, Japan
| | - Nakao Ota
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Hokkaido, Japan
| | - Hiroyasu Kamiyama
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Hokkaido, Japan
| | - Sadahisa Tokuda
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Hokkaido, Japan
| | - Rokuya Tanikawa
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Hokkaido, Japan
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29
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Pabaney AH, Mazaris PA, Kole MK, Reinard KA. Endovascular management of fusiform aneurysm of anterior temporal artery: Technical report. Surg Neurol Int 2015; 6:119. [PMID: 26290771 PMCID: PMC4521225 DOI: 10.4103/2152-7806.161239] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Accepted: 05/27/2015] [Indexed: 11/09/2022] Open
Abstract
Background: The treatment of a rare, nontraumatic, fusiform aneurysm of the anterior temporal artery (ATA) via endovascular techniques is presented, and procedural nuances are highlighted. Methods: We performed a retrospective chart review and collected demographic and clinical data on the patient presented here; procedural details were extracted from operative notes. Results: Following successful balloon test occlusion (BTO) of the ATA, complete coil embolization of the ATA, and its associated fusiform aneurysm was performed. Postprocedurally, the patient did not suffer any adverse neurological sequelae. Conclusion: Selective BTO of intracranial branch vessels is safe, technically feasible, and could serve as a useful technical tool in the treatment of complex, fusiform intracranial aneurysms.
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Affiliation(s)
| | - Paul A Mazaris
- Department of Neurosurgery, Hartford Hospital, Hartford, CT, USA
| | - Max K Kole
- Department of Neurosurgery, Henry Ford Hospital, Detroit, MI, USA
| | - Kevin A Reinard
- Department of Neurosurgery, Henry Ford Hospital, Detroit, MI, USA
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30
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Abstract
Aneurysms of the posterior cerebral artery (PCA) are a distinct pathological entity and are surgically challenging. Fusiform aneurysms involving the PCA are quite rare and scarcely reported in the literature. In this video, we demonstrate the utility of the subtemporal approach to surgically reconstruct an unruptured, fusiform aneurysm of the left PCA, located at the junction of P3 and P4 segments. Curved clips were used to reconstruct the aneurysm such that flow was maintained in the parent vessel as well as distal branches. Postoperatively, the patient remained neurologically intact. The video can be found here: http://youtu.be/l7yzUPsaMc4.
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Affiliation(s)
- Ghaus M Malik
- Department of Neurological Surgery, Henry Ford Hospital, Detroit, Michigan
| | - Aqueel H Pabaney
- Department of Neurological Surgery, Henry Ford Hospital, Detroit, Michigan
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31
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Kochi R, Endo H, Fujimura M, Sato K, Sugiyama SI, Osawa SI, Tominaga T. Outflow Occlusion with Occipital Artery-Posterior Inferior Cerebellar Artery Bypass for Growing Vertebral Artery Fusiform Aneurysm with Ischemic Onset: A Case Report. J Stroke Cerebrovasc Dis 2015; 24:e223-6. [PMID: 25979424 DOI: 10.1016/j.jstrokecerebrovasdis.2015.04.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 03/21/2015] [Accepted: 04/14/2015] [Indexed: 11/29/2022] Open
Abstract
Surgical treatments should be considered for vertebral artery fusiform aneurysms, which become symptomatic due to cerebral ischemia or mass effect. Ischemic complication is one of the major problems after surgical or endovascular trapping, which is associated with unfavorable outcomes. The authors present a case with growing vertebral artery (VA) fusiform aneurysm with ischemic onset successfully treated with outflow occlusion with occipital artery-posterior inferior cerebellar artery (OA-PICA) bypass. A 50-year-old woman presented with left PICA territory infarction. Left vertebral angiography (VAG) showed occlusion of the left VA at the proximal V4 segment. Right VAG revealed that the distal part of the left V4 segment with fusiform aneurysmal dilatation was reconstituted through vertebrobasilar junction, and the left PICA was the outlet of the blood flow from the fusiform aneurysm. Although the patient was treated conservatively, enlargement of the left VA fusiform aneurysm was observed 8 months after the initial presentation. Considering the potential risks for future stroke or bleeding, we performed clip occlusion of the origin of the left PICA, which could achieve outflow occlusion of the fusiform aneurysm with preservation of the perforators arising around the aneurysm. We created OA-PICA anastomosis for revascularization of the distal PICA. The postoperative course was uneventful, and the postoperative right VAG revealed occlusion of the fusiform aneurysm. Outflow occlusion instead of trapping is an effective surgical option for VA fusiform aneurysm to achieve obliterate the aneurysm with preservation of the perforator at the blind end.
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Affiliation(s)
- Ryuzaburo Kochi
- Department of Neurosurgery, Kohnan Hospital, Sendai, Japan; Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hidenori Endo
- Department of Neurosurgery, Kohnan Hospital, Sendai, Japan.
| | - Miki Fujimura
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kenichi Sato
- Department of Neuroendovascular Therapy, Kohnan Hospital, Sendai, Japan
| | | | | | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
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32
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Saliou G, Sacho RH, Power S, Kostynskyy A, Willinsky RA, Tymianski M, terBrugge KG, Rawal S, Krings T. Natural history and management of basilar trunk artery aneurysms. Stroke 2015; 46:948-53. [PMID: 25712945 DOI: 10.1161/strokeaha.114.006909] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Basilar trunk aneurysms (BTAs), defined as aneurysms distal to the basilar origin and proximal to the origin of the superior cerebellar artery, are rare and challenging to manage. We describe the natural history and management in a consecutive series of BTAs. METHODS Between 2000 and 2013, 2522 patients with 3238 aneurysms were referred to our institution for aneurysm management. A retrospective review of this database was conducted to identify all patients with BTAs. RESULTS In total, 52 patients had a BTA. Mean age was 56 (SD±18) years. Median clinical follow-up was 33 (interquartile range, 8-86) months, and imaging follow-up was 26 (interquartile range, 2-80.5) months. BTAs were classified into 4 causal subtypes: acute dissecting aneurysms, segmental fusiform ectasia, mural bleeding ectasia, and saccular aneurysms. Multiple aneurysms were more frequently noticed among the 13 saccular aneurysms when compared with overall population (P=0.021). There was preponderance of segmental ectasia or mural bleeding ectasia (P=0.045) in patients presenting with transit ischemic attack/stroke or mass effect. Six patients with segmental and 4 with mural bleeding ectasia demonstrated increasing size of their aneurysm, with 2 having subarachnoid hemorrhage caused by aneurysm rupture. None of the fusiform aneurysms that remained stable bled. CONCLUSIONS BTAs natural histories may differ depending on subtype of aneurysm. Saccular aneurysms likely represent an underlying predisposition to aneurysm development because more than half of these cases were associated with multiple intracranial aneurysms. Intervention should be considered in segmental ectasia and chronic dissecting aneurysms, which demonstrate increase in size over time as there is an increased risk of subarachnoid hemorrhage.
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Affiliation(s)
- Guillaume Saliou
- From the Department of Neuroradiology, Hôpital Bicêtre, Le Kremlin Bicetre, France (G.S.); and Division of Neuroradiology, Department of Medical Imaging (G.S., R.H.S., S.P., A.K., R.A.W., K.G.t., S.R., T.K.) and Division of Neurosurgery (M.T.), Toronto Western Hospital, Toronto, Ontario, Canada.
| | - Raphael H Sacho
- From the Department of Neuroradiology, Hôpital Bicêtre, Le Kremlin Bicetre, France (G.S.); and Division of Neuroradiology, Department of Medical Imaging (G.S., R.H.S., S.P., A.K., R.A.W., K.G.t., S.R., T.K.) and Division of Neurosurgery (M.T.), Toronto Western Hospital, Toronto, Ontario, Canada
| | - Sarah Power
- From the Department of Neuroradiology, Hôpital Bicêtre, Le Kremlin Bicetre, France (G.S.); and Division of Neuroradiology, Department of Medical Imaging (G.S., R.H.S., S.P., A.K., R.A.W., K.G.t., S.R., T.K.) and Division of Neurosurgery (M.T.), Toronto Western Hospital, Toronto, Ontario, Canada
| | - Alex Kostynskyy
- From the Department of Neuroradiology, Hôpital Bicêtre, Le Kremlin Bicetre, France (G.S.); and Division of Neuroradiology, Department of Medical Imaging (G.S., R.H.S., S.P., A.K., R.A.W., K.G.t., S.R., T.K.) and Division of Neurosurgery (M.T.), Toronto Western Hospital, Toronto, Ontario, Canada
| | - Robert A Willinsky
- From the Department of Neuroradiology, Hôpital Bicêtre, Le Kremlin Bicetre, France (G.S.); and Division of Neuroradiology, Department of Medical Imaging (G.S., R.H.S., S.P., A.K., R.A.W., K.G.t., S.R., T.K.) and Division of Neurosurgery (M.T.), Toronto Western Hospital, Toronto, Ontario, Canada
| | - Michael Tymianski
- From the Department of Neuroradiology, Hôpital Bicêtre, Le Kremlin Bicetre, France (G.S.); and Division of Neuroradiology, Department of Medical Imaging (G.S., R.H.S., S.P., A.K., R.A.W., K.G.t., S.R., T.K.) and Division of Neurosurgery (M.T.), Toronto Western Hospital, Toronto, Ontario, Canada
| | - Karel G terBrugge
- From the Department of Neuroradiology, Hôpital Bicêtre, Le Kremlin Bicetre, France (G.S.); and Division of Neuroradiology, Department of Medical Imaging (G.S., R.H.S., S.P., A.K., R.A.W., K.G.t., S.R., T.K.) and Division of Neurosurgery (M.T.), Toronto Western Hospital, Toronto, Ontario, Canada
| | - Sapna Rawal
- From the Department of Neuroradiology, Hôpital Bicêtre, Le Kremlin Bicetre, France (G.S.); and Division of Neuroradiology, Department of Medical Imaging (G.S., R.H.S., S.P., A.K., R.A.W., K.G.t., S.R., T.K.) and Division of Neurosurgery (M.T.), Toronto Western Hospital, Toronto, Ontario, Canada
| | - Timo Krings
- From the Department of Neuroradiology, Hôpital Bicêtre, Le Kremlin Bicetre, France (G.S.); and Division of Neuroradiology, Department of Medical Imaging (G.S., R.H.S., S.P., A.K., R.A.W., K.G.t., S.R., T.K.) and Division of Neurosurgery (M.T.), Toronto Western Hospital, Toronto, Ontario, Canada
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Kinoshita M, Kida S, Hasegawa M, Yamashita J, Nomura M. Pathological examination of a ruptured fusiform aneurysm of the middle cerebral artery. Surg Neurol Int 2014; 5:S465-8. [PMID: 25422790 PMCID: PMC4235114 DOI: 10.4103/2152-7806.143722] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 08/26/2014] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Little is known about the pathogenesis and clinical course of fusiform compared with saccular aneurysms. The case of a ruptured fusiform aneurysm accompanied by dissection at the M2 portion of the middle cerebral artery (MCA) is reported, along with pathological findings. CASE DESCRIPTION A 41-year-old female presenting with subarachnoid hemorrhage was revealed to have a ruptured fusiform aneurysm at the M2 portion of the right MCA on angiography. She was treated with superficial temporal artery-MCA anastomosis and trapping of the aneurysm. The aneurysm consisted of a whitish fusiform dilatation with a thickened wall of the MCA and two red protrusions on it. Pathological examinations revealed disruption and fragmentation of the internal elastic lamina and intimal thickening in the fusiform lesion. There were two aneurysmal protrusions on the main fusiform dilatation. In one protruded lesion, a dissection of the intima was observed. CONCLUSION We propose that a dissection and saccular aneurysm additionally developed on the wall of a preexisting segmental ectasia of the MCA in our case. In this report, we discuss the etiology of fusiform aneurysms of the MCA.
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Affiliation(s)
- Masashi Kinoshita
- Department of Neurosurgery, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Shinya Kida
- Department of Neurosurgery, Fukui Prefectural Hospital, Fukui, Japan
| | - Mitsuhiro Hasegawa
- Department of Neurosurgery, Fujita Health University School of Medicine, Nagoya, Japan
| | - Junkoh Yamashita
- Department of Neurosurgery, Asanogawa General Hospital, Kanazawa, Japan
| | - Motohiro Nomura
- Department of Neurosurgery, Yokohama Sakae Kyosai Hospital, Yokohama, Japan
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34
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Sacho RH, Saliou G, Kostynskyy A, Menezes R, Tymianski M, Krings T, Radovanovic I, Terbrugge K, Rinkel GJE, Willinsky R. Natural history and outcome after treatment of unruptured intradural fusiform aneurysms. Stroke 2014; 45:3251-6. [PMID: 25205312 DOI: 10.1161/strokeaha.114.006292] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Management of unruptured fusiform intracranial aneurysms is controversial because of the paucity of natural history data. We studied their natural history and outcome after treatment. METHODS We reviewed our neurovascular database from January 2000 to October 2013. Inclusion criteria were unruptured, intradural fusiform aneurysms with a diameter of <2.5 cm. Criteria were developed to define atherosclerotic aneurysms. For outcome assessment, we used the modified Ranking Scale and aneurysm measurements on serial imaging. Mann-Whittney (continuous) and Fisher exact (categorical) tests were used for risk factor analysis. RESULTS For nonatherosclerotic aneurysms (96 patients; 193 person-years follow-up), 1 patient died (rupture) during follow-up (mortality, 0.51% per year) and 8 patients (10%) showed aneurysm progression (risk, 1.6% per year). Risk factors for progression were maximum diameter (>7 mm; odds ratio, 12; 95% confidence interval, 1.4-104) and symptomatic clinical presentation (odds ratio, 16; 95% confidence interval, 3.1-81.4). Of the 23 treated patients, 3 had died (mortality, 12.5%) and 3 had serious disability (modified Ranking Scale, ≥3; 12.5%). For the atherosclerotic aneurysms (25 patients; 97 person-years follow-up), 5 had died (mortality, 5.2% per year) and 13 of 20 (65%) had aneurysm progression (risk, 12% per year). When compared with patients with nonatherosclerotic aneurysms, case fatality (odds ratio, 19.2; 95% confidence interval, 2.1-172) and aneurysm progression (odds ratio, 17.8; 95% confidence interval, 5.3-56) were higher. CONCLUSIONS Nonatherosclerotic fusiform intradural aneurysms have a low risk of adverse outcome within the first few years after diagnosis and remain stable unless symptomatic on presentation or >7 mm in maximum diameter. High risks of treatment should be balanced against this benign natural history. Atherosclerotic aneurysms have a worse natural history and may represent a different disease entity.
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Affiliation(s)
- Raphael H Sacho
- From the Departments of Interventional Neuroradiology (R.H.S., G.S., A.K., R.M., T.K., K.T., R.W.) and Neurosurgery (R.H.S., M.T., I.R.), University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada; and Department of Neurology and Neurosurgery, University Medical Centre Utrecht, Utrecht, The Netherlands (G.J.E.R.).
| | - Guillaume Saliou
- From the Departments of Interventional Neuroradiology (R.H.S., G.S., A.K., R.M., T.K., K.T., R.W.) and Neurosurgery (R.H.S., M.T., I.R.), University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada; and Department of Neurology and Neurosurgery, University Medical Centre Utrecht, Utrecht, The Netherlands (G.J.E.R.)
| | - Alex Kostynskyy
- From the Departments of Interventional Neuroradiology (R.H.S., G.S., A.K., R.M., T.K., K.T., R.W.) and Neurosurgery (R.H.S., M.T., I.R.), University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada; and Department of Neurology and Neurosurgery, University Medical Centre Utrecht, Utrecht, The Netherlands (G.J.E.R.)
| | - Ravi Menezes
- From the Departments of Interventional Neuroradiology (R.H.S., G.S., A.K., R.M., T.K., K.T., R.W.) and Neurosurgery (R.H.S., M.T., I.R.), University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada; and Department of Neurology and Neurosurgery, University Medical Centre Utrecht, Utrecht, The Netherlands (G.J.E.R.)
| | - Michael Tymianski
- From the Departments of Interventional Neuroradiology (R.H.S., G.S., A.K., R.M., T.K., K.T., R.W.) and Neurosurgery (R.H.S., M.T., I.R.), University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada; and Department of Neurology and Neurosurgery, University Medical Centre Utrecht, Utrecht, The Netherlands (G.J.E.R.)
| | - Timo Krings
- From the Departments of Interventional Neuroradiology (R.H.S., G.S., A.K., R.M., T.K., K.T., R.W.) and Neurosurgery (R.H.S., M.T., I.R.), University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada; and Department of Neurology and Neurosurgery, University Medical Centre Utrecht, Utrecht, The Netherlands (G.J.E.R.)
| | - Ivan Radovanovic
- From the Departments of Interventional Neuroradiology (R.H.S., G.S., A.K., R.M., T.K., K.T., R.W.) and Neurosurgery (R.H.S., M.T., I.R.), University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada; and Department of Neurology and Neurosurgery, University Medical Centre Utrecht, Utrecht, The Netherlands (G.J.E.R.)
| | - Karel Terbrugge
- From the Departments of Interventional Neuroradiology (R.H.S., G.S., A.K., R.M., T.K., K.T., R.W.) and Neurosurgery (R.H.S., M.T., I.R.), University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada; and Department of Neurology and Neurosurgery, University Medical Centre Utrecht, Utrecht, The Netherlands (G.J.E.R.)
| | - Gabriel J E Rinkel
- From the Departments of Interventional Neuroradiology (R.H.S., G.S., A.K., R.M., T.K., K.T., R.W.) and Neurosurgery (R.H.S., M.T., I.R.), University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada; and Department of Neurology and Neurosurgery, University Medical Centre Utrecht, Utrecht, The Netherlands (G.J.E.R.)
| | - Robert Willinsky
- From the Departments of Interventional Neuroradiology (R.H.S., G.S., A.K., R.M., T.K., K.T., R.W.) and Neurosurgery (R.H.S., M.T., I.R.), University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada; and Department of Neurology and Neurosurgery, University Medical Centre Utrecht, Utrecht, The Netherlands (G.J.E.R.)
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Alurkar A, Karanam LSP, Oak S, Nayak S. Endovascular treatment of fusiform A2 aneurysm with parent artery occlusion. Surg Neurol Int 2014; 5:S199-202. [PMID: 25184100 PMCID: PMC4138823 DOI: 10.4103/2152-7806.137752] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 06/03/2014] [Indexed: 11/29/2022] Open
Abstract
Background: A2 aneurysms are rare with a reported incidence of <1% of the intracranial aneurysms. These aneurysms are located between the anterior communicating artery and genu of the corpus callosum. Fusiform aneurysms in this location are even rarer and we present one such case of fusiform A2 aneurysm treated with endovascular technique. Case Description: In this report, we present a case of ruptured fusiform A2 or proximal pericallosal artery aneurysm in a middle-aged female who presented with subarachnoid hemorrhage. She subsequently underwent endovascular parent artery occlusion, and post-procedure angiogram showed good pial collaterals filling the distal territory. She developed transient lower limb weakness which improved over the next 24 h with supportive inotrope management to maintain adequate cerebral flow. Conclusion: We report a rare unique case of ruptured fusiform proximal pericallosal artery aneurysm. Endovascular treatment of this type of aneurysm is a feasible method and can be considered as an effective alternative to surgical technique.
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Affiliation(s)
- Anand Alurkar
- Department of Neurointervention, King Edward Memorial Hospital, Pune, Maharashtra, India
| | | | - Sagar Oak
- Department of Neurointervention, King Edward Memorial Hospital, Pune, Maharashtra, India
| | - Suresh Nayak
- Department of Neurointervention, King Edward Memorial Hospital, Pune, Maharashtra, India
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Abstract
Cardiac tumors are an uncommon cause for neurologic disease, but if undiagnosed can be associated with devastating neurologic consequences. Primary cardiac tumors, both benign and neoplastic, and metastatic tumors occur. Primary cardiac tumors are more likely to be associated with neurologic embolic complications. Metastatic cardiac tumors are more likely to be associated with valvular distraction, arrhythmia, diminished cardiac output and indirect neurological dysfunction. Primary and metastatic cardiac tumors may result in cerebral metastatic disease. Atrial myxoma, a benign primary cardiac tumor, is the most common cardiac tumor associated with neurologic disease, and most commonly causes cerebral embolization and stroke. The use of thrombolytic therapy for these strokes is controversial. Additionally, delayed manifestations, including aneurysm formation and intracranial hemorrhage, are possible. Aneurysm formation has been described as occurring after removal of the primary tumor. The availability of noninvasive cardiac imaging has significantly helped decrease the neurologic morbidity of cardiac tumors and has led to frequent successful intervention.
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Affiliation(s)
- David Roeltgen
- Cape Physicians Associates, Cape May Court House, NJ, USA.
| | - Chelsea S Kidwell
- Department of Neurology, Georgetown University Medical Center, Washington, DC, USA
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Baran B, Kornafel O, Guziński M, Sąsiadek M. Dolichoectasia of the circle of Willis arteries and fusiform aneurysm of basilar artery - case report and review of the literature. Pol J Radiol 2012; 77:54-9. [PMID: 22844310 PMCID: PMC3403802 DOI: 10.12659/pjr.882971] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Accepted: 03/21/2012] [Indexed: 12/01/2022] Open
Abstract
Background: Dolichoectasia of intracranial arteries is a rare arteriopathy characterized by elongation and widening of the arteries and disturbance of the laminar blood flow. It involves mostly vertebral and basilar arteries. In advanced cases, formation of a fusiform aneurysm is possible. Case Report: A sixty-four-year-old female with hypertension was admitted to the hospital with severe non-systemic vertigo and dysarthria, which had lasted for a couple of weeks. Imaging of the brain revealed dolichoectasia of arteries of the circle of Willis coexisting with a fusiform aneurysm of the basilar artery. Conclusions: Intracranial arterial dolichoectasia may be asymptomatic for a long time. However, in many cases it leads to neurological symptoms associated with haemodynamic disturbance (due to unstable wall clots) and mass effect caused by the widened vessel.
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Affiliation(s)
- Bogusława Baran
- Department of General and Interventional Radiology and Neuroradiology, Wrocław Medical University, Wrocław, Poland
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Alurkar A, Karanam LSP, Nayak S, Oak S. Endovascular management of fusiform superior cerebellar artery aneurysms: a series of three cases with review of literature. J Clin Imaging Sci 2012; 2:47. [PMID: 22919561 PMCID: PMC3424817 DOI: 10.4103/2156-7514.99181] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Accepted: 06/25/2012] [Indexed: 11/10/2022] Open
Abstract
Distal superior cerebellar artery (SCA) aneurysms are rare. Fusiform aneurysms of SCA are rarer and more challenging to treat. Parent artery occlusion by endovascular coiling is the treatment option for these cases. Presence of good collateral circulation and paucity of perforators from S1 and S2 segments makes this a feasible option. From 2007 to 2010, we treated three patients (two men and one woman between the ages of 42 to 64 years) with distal fusiform SCA aneurysms using endovascular coiling. All the patients presented with symptoms of rupture and were treated in the acute phase. Informed and written high-risk consent was given by all patients prior to the procedure. Successful angiographic and clinical outcome was achieved in all three patients. Endovascular treatment of fusiform SCA aneurysms with coils is a safe and feasible option in the management of this rare entity.
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Affiliation(s)
- Anand Alurkar
- Department of Neurointervention, King Edward Memorial Hospital, Pune, Maharashtra, India
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Jaworska K, Dołowy J, Kuśmierska M, Kuniej T, Jaźwiec P. Multiple fusiform cerebral aneurysms - case report. Pol J Radiol 2012; 77:50-3. [PMID: 22802866 PMCID: PMC3389952 DOI: 10.12659/pjr.882581] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Accepted: 01/19/2012] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND A true aneurysym is a dilation of arterial lumen as a consequence of congenital or acquired abnormalities leading to a reduction of mechanical resistance of vascular wall, most commonly caused by its defected structure in the form of absence or weakening of the muscular and/or elastic layer. From the pathophysiological point of view, cerebral aneurysms can be classified as 'saccular' - most commonly occurring, and 'other types', including fusiform/dolichoectatic, dissecting, serpentine, posttraumatic, mycotic and giant aneurysms with or without intra-aneurysmal thrombosis. CASE REPORT We present a rare case of a patient with multiple fusiform dilations of cerebral vessels and giant fusiform aneurysm in supraclinoid segment of the internal carotid artery. The patient presented to hospital because of sudden, severe vertigo with nausea, impaired balance and disturbed vision. Vascular anomalies were detected on CT scanning without contrast. The diagnostic work-up was complemented by CT angiography, MRI and cerebral angiography. CONCLUSIONS Aneurysm located within the intracranial arteries is one of the most common vascular defects of the brain. The number, size and location of aneurysms are highly variable. Aneurysms can have either supra- or infratentorial location, affecting a single or multiple arteries within one or both brain hemispheres. There is often a correlation between the location of the aneurysm and its etiology, as in case of so-called mirror-image aneurysms. Symmetrically located aneurysms may indicate a defect in vascular structure. Asymmetric location, as in the patient described above, is more likely due to acquired causes, mainly atherosclerosis, but also septic emboli or blood disorders.
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Affiliation(s)
- Katarzyna Jaworska
- Department of Medical Radiology and Diagnostic Imaging, 4 Military Clinical Hospital with the Polyclinic in Wrocław, Wrocław, Poland
| | - Joanna Dołowy
- Department of Medical Radiology and Diagnostic Imaging, 4 Military Clinical Hospital with the Polyclinic in Wrocław, Wrocław, Poland
| | - Małgorzata Kuśmierska
- Department of Medical Radiology and Diagnostic Imaging, 4 Military Clinical Hospital with the Polyclinic in Wrocław, Wrocław, Poland
| | - Tomasz Kuniej
- Department of Medical Radiology and Diagnostic Imaging, 4 Military Clinical Hospital with the Polyclinic in Wrocław, Wrocław, Poland
| | - Przemysław Jaźwiec
- Department of Medical Radiology and Diagnostic Imaging, 4 Military Clinical Hospital with the Polyclinic in Wrocław, Wrocław, Poland
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Lodi YM, Latorre JG, El-Zammar Z, Swarnkar A, Gordon V, Whapham J, Malek A, Fessler RD. Single Stage versus Multi-staged Stent-assisted Endovascular Repair of Intracranial Aneurysms. J Vasc Interv Neurol 2011; 4:24-28. [PMID: 22518268 PMCID: PMC3317279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Stent-assisted coiling of intracranial aneurysms is performed either as a single-stage or a multi-staged procedure. The objective of our study is to compare the complications between the in single-stage versus the multi-staged stent-assisted coiling of intracranial aneurysm. METHODS From January 2003 to January 2010, consecutive patients treated with intracranial stent for aneurysms were prospectively enrolled. Patients' demographics including cerebrovascular risk factors, aneurysms size and locations were collected. Technical and clinical complications as well as outcomes were measured. Data were analyzed retrospectively using SPSS software version 11.5. RESULTS 87 patients (87 aneurysms) with a mean of 51.2 ± 13.6 years were treated with 90 intracranial (Neuroform 74, Enterprise 16) stents, single-stage 37 (42.5%) and multi-staged 50 (57.5%). Eight adverse events were observed without any mortality, 6 of which were in the single-stage group-rupture of aneurysm in 2, and thrombo-embolic events in 4. Both rupture occurred in basilar artery bifurcation aneurysms, required ventriculostomy and resuscitations. In single-stage, asymptomatic intra-operative stent thrombosis developed in one, symptomatic stent thrombosis in one on day 14, transient ischemic attack on day 6 and immediate post operative stroke in one. Only two minor strokes were observed in the multi-staged group, one on post-procedure day 7 and other on day 60. Majority of the patients had good outcomes including those with events. CONCLUSION Our study revealed that single-stage stent-coiling technique is associated with a higher rate of complications than multistaged procedure. Therefore, staging the procedure may be an option whenever possible.
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Affiliation(s)
- YM Lodi
- Address Correspondence to: Yahia M Lodi MD, Upstate Medical University, SUNY 750 E Adams Street, Syracuse, NY 13210, Tel: 315-464-5014, Fax: 315-464-5015, E-mail:
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