scholarly journals Delayed Onset Cranial Nerve Palsies After Endovascular Coil Embolization of Direct Carotid-Cavernous Fistulas

2018 ◽  
Vol 38 (2) ◽  
pp. 156-159 ◽  
Author(s):  
Alaa Bou Ghannam ◽  
Prem S. Subramanian
Keyword(s):  
Coil Embolization ◽  
Cranial Nerve ◽  
Delayed Onset ◽  
Cranial Nerve Palsies ◽  
Endovascular Coil Embolization ◽  
Carotid Cavernous Fistulas

scholarly journals Intraprocedural Angiographic CT as a Valuable Tool in the Course of Endovascular Treatment of Direct Sinus Cavernous Fistulas

2012 ◽  
Vol 18 (3) ◽  
pp. 326-332 ◽  
Author(s):  
P. Gölitz ◽  
T. Struffert ◽  
M. Arc Saake ◽  
F. Knossalla ◽  
A. Doerfler
Keyword(s):  
Endovascular Treatment ◽  
Coil Embolization ◽  
Parent Artery ◽  
Angiographic Ct ◽  
Complex Anatomy ◽  
Procedural Complications ◽  
Endovascular Coil Embolization ◽  
Contrast Medium Injection ◽  
Carotid Cavernous Fistulas ◽  
Coil Migration

This investigation aimed to demonstrate the potential of intraprocedural angiographic CT in monitoring complex endovascular coil embolization of direct carotid cavernous fistulas. Angiographic CT was performed as a dual rotational 5 s run with intraarterial contrast medium injection in two patients during endovascular coil embolization of direct carotid cavernous fistulas. Intraprocedural angiographic CT was considered helpful if conventional 2D series were not conclusive concerning coil position or if a precise delineation of the parent artery was impossible due to a complex anatomy or overlying coil material. During postprocessing multiplanar reformatted and dual volume images of angiographic CT were reconstructed. Angiographic CT turned out to be superior in the intraprocedural visualization of accidental coil migration into the parent artery where conventional 2D-DSA series failed to reliably detect coil protrusion. The delineation of coil protrusion by angiographic CT allowed immediate correct coil repositioning to prevent parent artery compromising. Angiographic CT can function as a valuable intraprocedurally feasible tool during complex coil embolizations of direct carotid cavernous fistulas. It allows the precise visualization of the cerebral vasculature and any accidental coil protrusion can be determined accurately in cases where conventional 2D-DSA series are unclear or compromised. Thus angiographic CT might contribute substantially to reduce procedural complications and to increase safety in the management of endovascular treatment of direct carotid cavernous fistulas.

scholarly journals Relationship between Focal Inflammation and Symptom Exacerbation after Endovascular Coil Embolization for Symptomatic Intracranial Aneurysms

2008 ◽  
Vol 14 (2) ◽  
pp. 179-184
Author(s):  
S. Suzuki ◽  
A. Kurata ◽  
K. Iwamoto ◽  
M. Yamada ◽  
J. Niki ◽  
...  
Keyword(s):  
Coil Embolization ◽  
Cranial Nerve ◽  
Anticoagulation Therapy ◽  
Unruptured Aneurysms ◽  
Anti Platelet Therapy ◽  
Symptom Exacerbation ◽  
Endovascular Coil Embolization ◽  
Inflammatory Drugs ◽  
Continuous Injection

As endovascular surgery (EVS) of symptomatic unruptured aneurysms can result in symptom exacerbation due to intra-aneurysmal thrombosis or lump formation by coils, this treatment remains controversial. We present five women ranging in age from 58 to 76 years (mean 65.6 years) who suffered post-EVS symptom exacerbation attributable to local inflammation. The aneurysms measured from 8 to 25 mm (mean 19 mm) and were located at the cavernous portion in four patients and at the origin of the ophthalmic artery in one. All underwent endosaccular embolization under local anesthesia. Immediately after embolization, 24 h anticoagulation therapy was started via the continuous injection of heparin; they also received anti-platelet therapy. At one to three days post-EVS, all five patients manifested worsening of their cranial nerve symptoms. In three other patients the symptoms were improved after EVS. We posit that inflammation induced by coil embolization may worsen cranial nerve symptoms transiently. Our findings suggest that post-EVS follow-up is necessary and that patients exhibiting an inflammatory reaction be treated with anti-inflammatory drugs.

scholarly journals Spinal Cord Infarction is an Unusual Complication of Intracranial Neuroendovascular Intervention

2013 ◽  
Vol 19 (4) ◽  
pp. 500-505 ◽  
Author(s):  
Noriaki Matsubara ◽  
Shigeru Miyachi ◽  
Takeshi Okamaoto ◽  
Takashi Izumi ◽  
Takumi Asai ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Coil Embolization ◽  
Cranial Nerve ◽  
Cervical Spinal Cord ◽  
Posterior Circulation ◽  
Spinal Cord Infarction ◽  
Unusual Complication ◽  
Flow Restriction ◽  
Catheter Technique ◽  
Endovascular Coil Embolization

Spinal cord infarction is an unusual complication of intracranial neuroendovascular intervention. The authors report on two cases involving spinal cord infarction after endovascular coil embolization for large basilar-tip aneurysms. Each aneurysm was sufficiently embolized by the stent/balloon combination-assisted technique or double catheter technique. However, postoperatively, patients presented neurological symptoms without cranial nerve manifestation. MRI revealed multiple infarctions at the cervical spinal cord. In both cases, larger-sized guiding catheters were used for an adjunctive technique. Therefore, guiding catheters had been wedged in the vertebral artery (VA). The wedge of the VA and flow restriction may have caused thromboemboli and/or hemodynamic insufficiency of the spinal branches from the VA (radiculomedullary artery), resulting in spinal cord infarction. Spinal cord infarction should be taken into consideration as a complication of endovascular intervention for lesions of the posterior circulation.

Transvenous Coil Embolization of an Intraorbital Arteriovenous Fistula

Neurosurgery ◽  
2012 ◽  
Vol 72 (1) ◽  
pp. E130-E134 ◽  
Author(s):  
Richard W. Williamson ◽  
Andrew F. Ducruet ◽  
R. Webster Crowley ◽  
Cameron G. McDougall ◽  
Felipe C. Albuquerque
Keyword(s):  
Coil Embolization ◽  
Ophthalmic Artery ◽  
Vascular Malformations ◽  
Transarterial Embolization ◽  
Rare Type ◽  
Arteriovenous Fistulas ◽  
Ocular Symptoms ◽  
Detachable Coils ◽  
Endovascular Coil Embolization ◽  
Carotid Cavernous Fistulas

Abstract BACKGROUND AND IMPORTANCE: Purely intraorbital arteriovenous fistulas (AVFs), which are rare vascular malformations that clinically mimic carotid-cavernous fistulas (CCFs), involve a fistula from the ophthalmic artery to 1 of the draining ophthalmic veins. We describe a case of an intraorbital AVF treated with transvenous endovascular coil embolization via the inferior petrosal sinus (IPS) route and review the literature on this rare entity. CLINICAL PRESENTATION: An 81-year-old woman sought treatment after 7 days of progressive left-sided visual acuity loss, chemosis, and lateral rectus palsy. Magnetic resonance imaging demonstrated dilated vascularity in the left orbit raising suspicions for a CCF. Cerebral angiography showed a purely intraorbital AVF with a fistula between the left ophthalmic artery and superior ophthalmic vein (SOV). Transvenous selective catheterization of the fistula was performed by successfully navigating the ipsilateral IPS to the cavernous sinus and SOV. The fistula was then embolized using detachable coils. The patient was discharged the next day. Three weeks after embolization, her ocular symptoms and findings had resolved. CONCLUSION: Intraorbital AVFs are a rare type of AVF that can be treated by direct surgical ligation, transarterial embolization, or transvenous embolization. We successfully navigated the IPS, which is frequently stenotic or occluded secondary to chronically increased fistulous drainage, and utilized this route to embolize the fistula with detachable coils.

Isolated contralateral abducens palsy in direct carotid-cavernous fistula

2020 ◽  
Vol 13 (12) ◽  
pp. e238746
Author(s):  
Chirag Jain ◽  
Aditi Mehta ◽  
Vikas Bhatia ◽  
Pankaj Gupta
Keyword(s):  
Cranial Nerve ◽  
Close Association ◽  
Cranial Nerves ◽  
Closed Head Injury ◽  
Abducens Nerve ◽  
Abducens Palsy ◽  
Carotid Cavernous Fistula ◽  
Cavernous Fistula ◽  
Cranial Nerve Palsies ◽  
Carotid Cavernous Fistulas

Post-traumatic direct carotid-cavernous fistulas may develop in patients with a closed head injury. The classical presentation is the Dandy’s triad—chemosis, pulsatile proptosis and orbital bruit. Associated findings may include orbital pain, dilated episcleral corkscrew vessels, vision deficit and cranial nerve palsies. Cranial nerves—oculomotor (III), trochlear (IV), ophthalmic (V1), and maxillary (V2) divisions of trigeminal and the abducens (VI) lie in close association of the cavernous sinus. Abducens nerve (VI) lies close to the intracavernous internal carotid artery, within the substance of the sinus and is hence easily susceptible to vascular insult. The two sinuses connect across the midline and communicate freely with each other. Back pressure changes can present with the same sided or bilateral cranial nerve palsies. We report a rare association of a long-standing left-sided carotid-cavernous fistula with right eye abduction deficit and contralateral abducens palsy.

Delayed-Onset Cranial Nerve Palsy After Transvenous Embolization of Indirect Carotid Cavernous Fistulas

2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Arthur Wang ◽  
Van V. Halbach ◽  
Christopher F. Dowd ◽  
Matthew D. Alexander ◽  
Danial K. Hallam ◽  
...  
Keyword(s):  
Cranial Nerve ◽  
Cranial Nerve Palsy ◽  
Nerve Palsy ◽  
Transvenous Embolization ◽  
Delayed Onset ◽  
Carotid Cavernous Fistulas

Pseudobulbar Palsy after Posterior Fossa Operation in Children

Neurosurgery ◽  
1984 ◽  
Vol 15 (5) ◽  
pp. 707-709 ◽  
Author(s):  
Jeffrey H. Wisoff ◽  
Fred J. Epstein
Keyword(s):  
Posterior Fossa ◽  
Cranial Nerve ◽  
Operative Technique ◽  
Pseudobulbar Palsy ◽  
Delayed Onset ◽  
Cranial Nerve Palsies ◽  
Cerebellar Peduncles ◽  
Ventricular Tumors ◽  
Posterior Fossa Operation

Abstract The authors describe their experience with an unusual postoperative syndrome of pseudobulbar palsy occurring a few days after the extirpation of large midline vermian/4th ventricular tumors in children. The patients had a delayed onset of supranuclear cranial nerve palsies associated with emotional incontinence and lability that resolved over several weeks to months. It is postulated that retraction pressure on the medial cerebellum and split vermis is the operative insult responsible for edema that subsequently tracked along fiber pathways in the middle and superior cerebellar peduncles into the upper pons and midbrain. Modifications of operative technique to eliminate the need for retraction are presented.

Combination of microsurgery and Gamma Knife surgery for the treatment of intracranial chondrosarcomas

2006 ◽  
Vol 105 (Supplement) ◽  
pp. 18-25 ◽  
Author(s):  
Petter Förander ◽  
Tiit Rähn ◽  
Lars Kihlström ◽  
Elfar Ulfarsson ◽  
Tiit Mathiesen
Keyword(s):  
Gamma Knife ◽  
Cranial Nerve ◽  
Residual Tumor ◽  
Local Tumor Control ◽  
Gamma Knife Surgery ◽  
Long Term Results ◽  
Tumor Control ◽  
Low Grade ◽  
Cranial Nerve Palsies ◽  
Tumor Volume Reduction

ObjectIntracranial chondrosarcomas have a high risk of recurrence after surgery. This retrospective study of patients with intracranial chondrosarcoma was conducted to determine the long-term results of microsurgery followed by Gamma Knife surgery (GKS) for residual tumor or recurrence.MethodsThe authors treated nine patients whose median age was 36 years. Seven patients had low-grade chondrosarcomas (LGCSs), whereas mesenchymal chondrosarcomas (MCSs) were diagnosed in two. Radiosurgery was performed in eight patients, whereas one patient declined further surgical intervention and tumor-volume reduction necessary for the GKS.The patients were followed up for 15 to 173 months (median 108 months) after diagnosis and 3 to 166 months (median 88 months) after GKS. Seven patients had residual tumor tissue after microsurgery, and two operations appeared radical. In the two latter cases, tumors recurred after 25 and 45 months. Thus, definite tumor control was not achieved after surgery alone in any patient, whereas the addition of radiosurgery allowed tumor control in all six patients with LGCSs. Two of these patients experienced an initial tumor regrowth after GKS; in both cases the recurrences were outside the prescribed radiation field. The patients underwent repeated GKS, and subsequent tumor control was observed. An MCS was diagnosed in the remaining two patients. Complications after microsurgery included diplopia, facial numbness, and paresis. After GKS, one patient had radiation necrosis, which required microsurgery, and two patients had new cranial nerve palsies.Conclusions Tumor control after microsurgery alone was not achieved in any patient, whereas adjuvant radiosurgery provided local tumor control in six of eight GKS-treated patients. Tumor control was not achieved in the two patients with MCS. Similar to other treatments for intracranial chondrosarcoma, morbidity after micro- and radiosurgical combination therapy was high and included severe cranial nerve palsies.

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