Republished: Resolution of an enlarging subdural haematoma after contralateral middle meningeal artery embolisation

2021 ◽  
pp. neurintsurg-2021-017530.rep
Author(s):  
Caleb Rutledge ◽  
Jacob F Baranoski ◽  
Joshua S Catapano ◽  
Ashutosh P Jadhav ◽  
Felipe C Albuquerque ◽  
...  
Keyword(s):  
Subdural Haematoma ◽  
Mass Effect ◽  
Middle Meningeal Artery ◽  
Embolic Agent ◽  
Head Ct ◽  
Liquid Embolic ◽  
Liquid Embolic Agent ◽  
The Right ◽  
Meningeal Artery

A man in his 50s presented 1 month after an automobile accident with worsening headaches and an enlarging chronic left subdural haematoma (SDH). He underwent left middle meningeal artery (MMA) embolisation. Due to tortuosity at its origin, we were unable to catheterise the MMA distally. Only proximal coil occlusion at the origin was performed. Follow-up interval head CT showed an increase in the size of the SDH with new haemorrhage, worsening mass effect and midline shift. However, he remained neurologically intact. Contralateral embolisation of the right MMA was performed with a liquid embolic agent. His headaches improved, and a follow-up head CT 3 months later showed near-complete resolution of the SDH.

Resolution of an enlarging subdural haematoma after contralateral middle meningeal artery embolisation

2021 ◽  
Vol 14 (4) ◽  
pp. e017530
Author(s):  
Caleb Rutledge ◽  
Jacob F Baranoski ◽  
Joshua S Catapano ◽  
Ashutosh P Jadhav ◽  
Felipe C Albuquerque ◽  
...  
Keyword(s):  
Subdural Haematoma ◽  
Mass Effect ◽  
Middle Meningeal Artery ◽  
Embolic Agent ◽  
Head Ct ◽  
Liquid Embolic ◽  
Liquid Embolic Agent ◽  
The Right ◽  
Meningeal Artery

A man in his 50s presented 1 month after an automobile accident with worsening headaches and an enlarging chronic left subdural haematoma (SDH). He underwent left middle meningeal artery (MMA) embolisation. Due to tortuosity at its origin, we were unable to catheterise the MMA distally. Only proximal coil occlusion at the origin was performed. Follow-up interval head CT showed an increase in the size of the SDH with new haemorrhage, worsening mass effect and midline shift. However, he remained neurologically intact. Contralateral embolisation of the right MMA was performed with a liquid embolic agent. His headaches improved, and a follow-up head CT 3 months later showed near-complete resolution of the SDH.

scholarly journals In Vivo Assessment of Chitosan/β-Glycerophosphate as a New Liquid Embolic Agent

2011 ◽  
Vol 17 (1) ◽  
pp. 87-92 ◽  
Author(s):  
Y. Wang ◽  
N. Xu ◽  
Q. Luo ◽  
Y. Li ◽  
L. Sun ◽  
...  
Keyword(s):  
Renal Arteries ◽  
Embolic Agent ◽  
Inflammatory Reactions ◽  
Complete Occlusion ◽  
Liquid Embolic ◽  
Feasibility Evaluation ◽  
Liquid Embolic Agent ◽  
In Vivo Assessment

We sought to assess the feasibility of using thermosensitive chitosan/β-glycerophosphate for embolotherapy. The renal arteries in nine rabbits were embolized with chitosan/β-glycerophosphate. The animals were studied angiographically and sacrificed at one week (n = 3), four weeks (n = 3), and eight weeks (n = 3) after embolotherapy. Histology was obtained at these three time points. Delivery of chitosan/β-glycerophosphate was successful in all cases. Complete occlusion was achieved in all cases. No recanalization was observed in the follow-up angiograms. No untoward inflammatory reactions were observed in the target renal arteries and infarcted kidneys during the histological examinations. Our preliminary feasibility evaluation in rabbit renal arteries indicates that C/GP is a satisfactory embolization agent.

Transradial embolization of the left middle meningeal artery and accessory middle meningeal artery for treatment of subacute–chronic subdural hematoma

2020 ◽  
Vol 12 (4) ◽  
pp. 436-436 ◽  
Author(s):  
Gary B Rajah ◽  
Michael K Tso ◽  
Rimal Dossani ◽  
Kunal Vakharia ◽  
Adnan H Siddiqui
Keyword(s):  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Mass Effect ◽  
Middle Meningeal Artery ◽  
Vascular Lesion ◽  
External Carotid ◽  
Invasive Treatment ◽  
History Of ◽  
The Right ◽  
Meningeal Artery

This 52-year-old man with no remarkable medical history, no anticoagulation use, and no history of trauma was noted to have a subacute–chronic left subdural hematoma during outpatient headache evaluation. No occult vascular lesion or cross-calvarial supply of the right middle meningeal artery (MMA) to the left side was identified on bilateral selective external carotid injections. Because the patient preferred non-surgical management, we performed a left MMA embolization with Onyx 18 (Medtronic), utilizing a Headway Duo microcatheter (MicroVention) via the transradial route. A 6 French Benchmark (Penumbra) was utilized for transradial support into the left external carotid. The patient was discharged home the same day. Repeat scans from 2 to 6 weeks revealed complete resolution of the subdural hematoma. The patient’s headaches resolved. Transradial MMA embolization for subacute–chronic subdural hematoma represents a minimally invasive treatment option for mass effect and hemorrhage-related symptoms. Tailored embolizations are necessary when >1 meningeal vessel supplies the subdural hematoma.

scholarly journals Traumatic Pseudoaneurysm of the Middle Meningeal Artery with an Arteriovenous Fistula on a Non-Fractured Site

2014 ◽  
Vol 20 (3) ◽  
pp. 352-356 ◽  
Author(s):  
Jung Ho Ko ◽  
Young-Joon Kim
Keyword(s):  
Arteriovenous Fistula ◽  
Distal Part ◽  
Middle Meningeal Artery ◽  
Traumatic Pseudoaneurysm ◽  
Collateral Vessels ◽  
The Right ◽  
Proximal Occlusion ◽  
Pterygoid Plexus ◽  
Meningeal Artery

We describe a rare case of a combined traumatic pseudoaneurysm and arteriovenous fistula (AVF) of the middle meningeal artery (MMA) on a non-fractured site. A 24-year-old man was admitted to our hospital with head trauma. He underwent a craniotomy and removal of an epidural hematoma on the right side. Twenty-five days later, he complained of pulsatile tinnitus on the left non-fractured side. Angiography revealed a markedly dilated proximal MMA with flow shunting to the pterygoid plexus. We performed proximal occlusion on the proximal MMA for the traumatic pseudoaneurysm and the AVF of the MMA using coils. Although immediate angiography showed retrograde contrast filling from the collateral vessels into the distal part of the pseudoaneurysm, follow-up angiography revealed that the lesion had successfully disappeared.

Utilizing dual energy CT to distinguish blood from contrast leakage following middle meningeal artery embolization for chronic subdural hematomas

2021 ◽  
pp. neurintsurg-2020-016953
Author(s):  
Mujtaba Zaki Naveed ◽  
Peter Wang ◽  
Ryan Lee ◽  
Mehdi Taghipour ◽  
Paul Brady
Keyword(s):  
Middle Meningeal Artery ◽  
Dual Energy ◽  
Dual Energy Ct ◽  
Head Ct ◽  
Subdural Hematomas ◽  
Alternative Treatment Option ◽  
Potential Alternative ◽  
Conventional Ct ◽  
Meningeal Artery

BackgroundRecently, middle meningeal artery (MMA) embolization has emerged as a potential alternative treatment option for chronic subdural hematomas (SDH). Imaging following MMA embolization often shows high density material in the subdural space, usually representing contrast leakage through the dura or, less commonly, hemorrhage. These cannot be reliably differentiated on conventional CT. Dual energy CT (DECT) provides the ability to differentiate materials that otherwise appear similar on conventional CT such as blood and iodine.MethodsA retrospective review was conducted to evaluate patients who underwent MMA embolization for SDH between May 2019 and April 2020. Post-procedural head CT performed on an IQon Elite Spectral CT detector-based DECT scanner enabled two-material decomposition to separate iodine from blood. The dual energy reconstructions used included the virtual non-contrast and iodine no-water images.ResultsFour representative illustrative cases were selected to highlight the ability of DECT to characterize new hyperdensity on head CT following MMA embolization as blood, contrast or a combination.ConclusionsDECT allows objective differentiation of contrast leakage from blood following MMA embolization. This technology can obviate the need for additional follow-up scanning and prolonged patient observation, which in turn can result in reduced costs and radiation exposure to patients.

scholarly journals Successful embolisation of pelvic fistulating vessels to the prostate arising after TURP – a rare cause of postoperative bleeding

2020 ◽  
Vol 102 (3) ◽  
pp. e60-e62
Author(s):  
JF Donati-Bourne ◽  
S Morris ◽  
S Nour ◽  
IJ McCafferty ◽  
Y Smith
Keyword(s):  
Postoperative Bleeding ◽  
Embolic Agent ◽  
Standard Management ◽  
Core Skill ◽  
Liquid Embolic ◽  
Prostatic Enlargement ◽  
Internal Iliac ◽  
Liquid Embolic Agent ◽  
The Right ◽  
Pelvic Varices

Transurethral resection of the prostate (TURP) is considered the gold-standard operation to treat lower urinary tract symptoms due to benign prostatic enlargement in men. Postoperative bleeding is a recognised complication and managing it is a core skill required by attending urologists. We report a rare case of postoperative bleeding caused by fistulating vessels to the prostate which developed after TURP. These fistulas arose from the right internal iliac vessels and communicated with pre-existing pelvic varices affecting the right paraprostaticand seminal vesicle tissues. The fistulating vessels were successfully embolised with liquid embolic agent. Surgeons should be aware that persisting haemorrhage can occur post-TURP from the rare presence of fistulating vessels communicating with pelvic varices. Early computed tomography angiographic assessment is warranted in cases where bleeding is prolonged and refractory to standard management in view of timely referral for percutaneous embolisation.

Intrasaccular combination of metallic coils and Onyx liquid embolic agent for the endovascular treatment of cerebral aneurysms

2006 ◽  
Vol 105 (5) ◽  
pp. 706-712 ◽  
Author(s):  
H. Saruhan Cekirge ◽  
Isil Saatci ◽  
Serdar Geyik ◽  
Kivilcim Yavuz ◽  
Halil Öztürk ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Cerebral Aneurysms ◽  
Embolic Agent ◽  
Stent Insertion ◽  
Parent Artery ◽  
Parent Artery Occlusion ◽  
Liquid Embolic ◽  
Liquid Embolic Agent ◽  
Embolic Coils

Object The aim of this study was to report on a novel technique in which metallic embolization coils were combined with the Onyx liquid embolic agent in the aneurysm sac to achieve a more durable result after endovascular treatment. This therapeutic procedure was performed in selected cases in which, based on the authors’ experiences, either coil embolization or Onyx alone would likely have failed. The authors report long-term clinical and angiographic follow-up results in 20 consecutive intracranial aneurysms treated using this combination for defined indications. Methods Twenty aneurysms in 20 patients were treated with a combination of embolic coils and Onyx. Four aneurysms were giant; 13, large; and three, small. This new technique was used when standard Onyx or coil treatment with balloon assistance was determined to involve a higher possibility of recanalization, because either an adjunctive stent insertion could not be performed or the Onyx technique could not be used due to an unsuccessful seal test or intraaneurysm balloon prolapse. In one case, an adjunctive stent was placed before coil placement and Onyx deposition to control the material in the sac of the aneurysm, which had a fusiform neck. All aneurysms were completely occluded after using this technique. No clinical or technical adverse events occurred in any of the cases. Follow-up angiography was performed in all patients: 3-year studies in six patients, 2-year studies in five, and 1-year studies in nine. None of these studies demonstrated aneurysm regrowth or parent artery occlusion. Conclusions The combination of the embolic coils and the Onyx liquid embolic agent provides very durable aneurysm occlusion for defined indications.

The superior ophthalmic vein approach for the treatment of carotid-cavernous fistulas: a novel technique using Onyx

2012 ◽  
Vol 32 (5) ◽  
pp. E13 ◽  
Author(s):  
Nohra Chalouhi ◽  
Aaron S. Dumont ◽  
Stavropoula Tjoumakaris ◽  
L. Fernando Gonzalez ◽  
Jurij R. Bilyk ◽  
...  
Keyword(s):  
Treatment Option ◽  
Primary Treatment ◽  
Embolic Agent ◽  
Superior Ophthalmic Vein ◽  
Type D ◽  
Liquid Embolic ◽  
Complete Obliteration ◽  
Liquid Embolic Agent ◽  
Carotid Cavernous Fistulas

Object Endovascular therapy is the primary treatment option for carotid-cavernous fistulas (CCFs). Operative cannulation of the superior ophthalmic vein (SOV) provides a reasonable alternative route to the cavernous sinus when all transvenous and transarterial approaches have been unsuccessful. The role of the liquid embolic agent Onyx in the management of CCFs has not been well documented, especially when using an SOV approach. The purpose of this study is to assess the safety and efficacy of Onyx embolization of CCFs through a surgical cannulation of the SOV. Methods The authors retrospectively reviewed all patients with CCFs who were treated with Onyx through an SOV approach between April 2009 and April 2011. Traditional endovascular approaches had failed in all patients. Results A total of 10 patients were identified, 1 with a Type A CCF, 5 with a Type B CCF, and 4 with a Type D CCF. All fistulas were embolized in 1 session. Onyx was the sole embolic agent used in 7 cases and was combined with coils in 3 other cases. Complete obliteration was achieved in 8 patients and a significant reduction in fistulous flow was achieved in 2 patients, which later progressed to near-complete occlusion on angiographic follow-up. All patients experienced a complete clinical recovery with excellent cosmetic results and were free from recurrence at their latest clinical follow-up evaluations. Conclusions Onyx embolization is an excellent therapy for CCFs in general, and through an SOV approach in particular. Direct operative cannulation of the SOV followed by Onyx embolization may be the best treatment option in patients with CCFs when all other endovascular approaches have been exhausted.

scholarly journals Endovascular Treatment of Hemifacial Spasm Associated with a Petrosal DAVF Using Transarterial Onyx Embolization

2012 ◽  
Vol 18 (1) ◽  
pp. 69-73 ◽  
Author(s):  
T. Li ◽  
X. Lv ◽  
Z. Wu
Keyword(s):  
Complete Remission ◽  
Facial Nerve ◽  
Endovascular Treatment ◽  
Hemifacial Spasm ◽  
Dural Arteriovenous Fistula ◽  
Middle Meningeal Artery ◽  
Vascular Compression ◽  
The Right ◽  
Meningeal Artery

This paper reports that decompression of the facial nerve by transarterial Onyx embolization may relieve hemifacial spasm (HFS) caused by dilated veins due to a right petrosal dural arteriovenous fistula (DAVF). A 56-year-old man suffered severe chronic right HFS associated with a dilated right petrosal vein lying in the vicinity of the facial nerve. The right petrosal DAVF was reached through the middle meningeal artery using a transfemoral arterial approach and was occluded with Onyx 18 (M.T.I.- ev3, Irvine, CA, USA). There was complete remission of HFS without recurrence after two months of follow-up. This case supports vascular compression in the pathogenesis of HFS and suggests that facial nerve injury caused by a DAVF could be treated with transarterial Onyx embolization.

ENDOVASCULAR TREATMENT OF EXPERIMENTAL ANEURYSMS USING A COMBINATION OF THERMOREVERSIBLE GELATION POLYMER AND PROTECTION DEVICES

Neurosurgery ◽  
2009 ◽  
Vol 65 (3) ◽  
pp. 601-609 ◽  
Author(s):  
Hiroyuki Takao ◽  
Yuichi Murayama ◽  
Ichiro Yuki ◽  
Toshihiro Ishibashi ◽  
Masaki Ebara ◽  
...  
Keyword(s):  
Mechanical Stability ◽  
Side Wall ◽  
Embolic Agent ◽  
Experimental Aneurysm ◽  
Aneurysm Embolization ◽  
Liquid Embolic ◽  
Thermoreversible Gelation ◽  
Liquid Embolic Agent ◽  
Thermoreversible Gelation Polymer

Abstract OBJECTIVE We developed a new liquid embolic agent, an aqueous solution of thermoreversible gelation polymer (TGP) for the treatment of cerebral aneurysms. This polymer solution has the unique characteristics that allow it to solidify at a specific temperature without solvent. We performed an experimental aneurysm embolization using this liquid embolic agent with and without different protective devices to evaluate its technical feasibility for the treatment of aneurysms. METHODS Fourteen side-wall aneurysms were surgically constructed on 14 common carotid arteries of 7 swine. Embolizations were conducted in combination with balloon protection (balloon group, n = 4), microstent protection (stent group, n = 4), and microcoil and microstent protection (stent-coil group, n = 4). Two aneurysms were used as controls. One control aneurysm was not embolized, and the other received control stent placement only. Angiographic follow-up was performed on day 14 and was followed by histopathological evaluation. RESULTS Successful TGP solution delivery was conducted in all cases. Complete aneurysm occlusion was achieved in all cases without TGP migration. Follow-up angiograms demonstrated complete occlusion in the stent and stent-coil groups. A small recurrence was observed in the balloon group. Histopathological findings demonstrated neoendothelialization across the necks of the aneurysms. CONCLUSION Experimental aneurysms were safely embolized using TGP. Further modifications related to mechanical stability and long-term safety evaluation results are necessary before clinical application.

Sign in / Sign up

Export Citation Format

Share Document