Embolization of a peripheral cerebral aneurysm associated with intracranial major artery occlusion through a transdural anastomotic artery: Case report

A peripheral cerebral aneurysm is known to develop at collateral vessels as a result of hemodynamic stress by the occlusion of the intracranial major arteries. We report a case of successful embolization of a ruptured aneurysm through a transdural anastomotic artery. The aneurysm formed at the developed collateral vessel from the meningeal branch of the occipital artery (OA) to the posterior pericallosal artery. A 59-year-old man presented with acute-onset headache, and computed tomography revealed subarachnoid hemorrhage and intracerebral hemorrhage at the splenium of the corpus callosum with intraventricular hemorrhage. Digital subtraction angiography demonstrated a ruptured aneurysm located at a transdural anastomotic artery from the right OA to the posterior pericallosal artery. The patient underwent endovascular treatment for the aneurysm through the transdural anastomotic artery with a coil and n-butyl-2-cyanoacrylate. Because it was impossible to navigate a microcatheter to the aneurysm through the right anterior cerebral artery because of the occlusion of its proximal portion, it was advanced through the transdural anastomosis from the right OA. The aneurysm was completely occluded without complications. Endovascular embolization is a useful treatment option for a peripheral cerebral aneurysm developed at a collateral vessel with intracranial major artery occlusion.

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“Craniotomy Within Craniotomy” Technique for Safe Resection of an Intracranial Arteriovenous Malformation With Frontal Bony Erosion: 2-Dimensional Operative Video

Operative Neurosurgery ◽

10.1093/ons/opab312 ◽

2021 ◽

Author(s):

MirHojjat Khorasanizadeh ◽

Kristine Ravina ◽

Aristotelis Filippidis ◽

Christopher S Ogilvy

Keyword(s):

Surgical Resection ◽

Endovascular Embolization ◽

Acute Onset ◽

Bone Flap ◽

Intracranial Arteriovenous Malformation ◽

Excessive Bleeding ◽

Left Hand ◽

The Right ◽

Venous Varix

Abstract Surgical resection is one option in the treatment of large high-grade brain arteriovenous malformations (AVMs). Resection of AVMs with skull-eroding components can be challenging due to the risk of excessive bleeding from these components during craniotomy and bone flap removal. We present a case of a 25-yr-old woman who presented with an acute onset right-sided frontal headache. She was found to have a large, frontal Spetzler-Martin grade IV AVM with an associated dural AVM. The AVM had caused focal erosions of the right frontal bone by a venous varix traversing the region of the calvarial defect. An elective staged endovascular embolization followed by surgical resection was recommended considering the patient's young age and the large size of the AVM located in a noneloquent area. Given the high risk of intraoperative hemorrhage during the craniotomy portion of the procedure, a “craniotomy within craniotomy” approach was planned. During this approach, a small rectangle of bone, including the portion eroded by the venous varix, was left in place, while the larger bone flap surrounding it was removed for an initial approach to the AVM. The small bony piece was safely removed at later stages of resection once the arterial feeders had been reasonably obliterated. Immediate postoperative catheter angiogram demonstrated good filling of the intracranial vascular territories with no residual AVM. The patient developed mild left facial and left hand weakness postoperatively, which resolved after 2 wk of follow-up. The patient remained neurologically intact on further follow-up.

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Acute Basilar Artery Occlusion Presenting With Convulsive Movements: A Systematic Review

Frontiers in Neurology ◽

10.3389/fneur.2021.803618 ◽

2022 ◽

Vol 12 ◽

Author(s):

Dan Zhang ◽

Yigang Chen ◽

Yonggang Hao ◽

Xingyue Hu ◽

Xudong He

Keyword(s):

Basilar Artery ◽

Reperfusion Therapy ◽

Artery Occlusion ◽

Acute Onset ◽

Basilar Artery Occlusion ◽

Institutional Review ◽

Initial Symptoms ◽

Convulsive Seizures ◽

The Right ◽

Vessel Dissection

Background and Purpose: Convulsive seizures related to posterior circulation stroke are considered rare. However, some patients with acute basilar artery occlusion (BAO) can present with convulsive movements. Misdiagnosed as seizures may delay the reperfusion therapy for acute BAO. In this study, we have summarized the clinical features and possible mechanisms of BAO presenting with convulsive movements.Methods: We performed an Institutional Review Board-approved institutional database query from 2015 to 2020 and a literature search of the online database PubMed. Clinical data were collected and analyzed.Results: In total, 14 patients with acute BAO presented with convulsions. There were 10 men and 4 women, with a mean age of 53 (range, 23–77) years. All of these patients had different degrees of impaired consciousness (100.0%, 14/14). Convulsive movements were the initial symptoms in 78.6% (11/14) of patients. Further, 64.3% (9/14) of patients presented with paralysis or cranial nerve abnormalities, and 85.7% (12/14) of patients were treated with reperfusion therapy (thrombolysis, 35.7% [5/14]; endovascular thrombectomy, 64.3% [9/14]). The BAO etiology and mechanism were related to embolism, vessel dissections, and severe stenosis of the right vertebral artery in 57.1% (8/14), 21.4% (3/14), and 7.1% (1/14) of patients, respectively; they were undefined in 14.3% (2/14) of patients. Moreover, 42.9% (6/14) of patients had a 90-day modified Rankin Scale score of 0–2, and the mortality rate was 21.4% (3/14).Conclusions: Acute BAO, especially that related to embolism or vessel dissection, may present with convulsive movements. Acute BAO is a devastating, but treatable disease if diagnosed in time. Considering the possibility of BAO is important when dealing with patients presenting with acute-onset convulsive movements. Prompt diagnosis and reperfusion therapy may help achieve a better prognosis.

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Iatrogenic Rupture of a Cerebral Aneurysm on the Feeding Artery of an Arteriovenous Malformation

Interventional Neuroradiology ◽

10.1177/159101990000600210 ◽

2000 ◽

Vol 6 (2) ◽

pp. 141-145

Author(s):

R. Guzman ◽

L. Remonda ◽

K.O. Lövblad ◽

A. Barth ◽

G. Schroth

Keyword(s):

Arteriovenous Malformation ◽

Endovascular Treatment ◽

Cerebral Aneurysm ◽

Acute Onset ◽

Ruptured Aneurysm ◽

Feeding Artery ◽

Detachable Coil ◽

Guglielmi Detachable Coil

We present the case of a patient with acute onset of headache who showed a flow-related acutely ruptured aneurysm on the feeding artery of an AVM in the angiogram. Rerupture of the aneurysm occurred during angiography after endovascular treatment with a Guglielmi detachable coil. The possible mechanisms leading to rupture of the aneurysm are discussed.

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Two Distally Located Right SCA Aneurysms: Endovascular Treatment by Parent Artery Occlusion with GDC Coils and N-BCA Injection

Interventional Neuroradiology ◽

10.1177/159101990300900209 ◽

2003 ◽

Vol 9 (2) ◽

pp. 193-198 ◽

Cited By ~ 1

Author(s):

M. Szajner ◽

K. Obszaska ◽

A. Nestorowicz ◽

M. Szczerbo-Trojanowska

Keyword(s):

Artery Occlusion ◽

Endovascular Embolization ◽

Superior Cerebellar Artery ◽

Parent Artery ◽

Parent Artery Occlusion ◽

Cerebellar Artery ◽

Peripheral Aneurysms ◽

Embolic Materials ◽

The Right ◽

Wide Neck

Peripheral aneurysms of the superior cerebellar artery are considered difficult to treat surgically and endovascularly because of their inaccessibility. Parent artery occlusion is therefore frequently the preferred method. Embolic materials previously reported in this situation are either GDC coils or a polymerizing agent (n-BCA). We report a patient with two distally located, wide-neck aneurysms of the right superior cerebellar artery who presented with hemorrhage and was treated by endovascular embolization of the parent artery using a combination of GDC coils and n-BCA.

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Adaptation of the cerebrocortical circulation to carotid artery occlusion involves blood flow redistribution between cortical regions and is independent of eNOS

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.00197.2016 ◽

2016 ◽

Vol 311 (4) ◽

pp. H972-H980 ◽

Cited By ~ 3

Author(s):

Andreas Polycarpou ◽

László Hricisák ◽

András Iring ◽

Daniel Safar ◽

Éva Ruisanchez ◽

...

Keyword(s):

Blood Flow ◽

Carotid Artery ◽

Blood Supply ◽

Right Hemisphere ◽

Temporal Cortex ◽

Artery Occlusion ◽

Carotid Artery Occlusion ◽

Laser Speckle ◽

Collateral Vessels ◽

The Right

Cerebral circulation is secured by feed-forward and feed-back control pathways to maintain and eventually reestablish the optimal oxygen and nutrient supply of neurons in case of disturbances of the cardiovascular system. Using the high temporal and spatial resolution of laser-speckle imaging we aimed to analyze the pattern of cerebrocortical blood flow (CoBF) changes after unilateral (left) carotid artery occlusion (CAO) in anesthetized mice to evaluate the contribution of macrovascular (circle of Willis) vs. pial collateral vessels as well as that of endothelial nitric oxide synthase (eNOS) to the cerebrovascular adaptation to CAO. In wild-type mice CoBF reduction in the left temporal cortex started immediately after CAO, reaching its maximum (−26%) at 5–10 s. Thereafter, CoBF recovered close to the preocclusion level within 30 s indicating the activation of feed-back pathway(s). Interestingly, the frontoparietal cerebrocortical regions also showed CoBF reduction in the left (−17–19%) but not in the right hemisphere, although these brain areas receive their blood supply from the common azygos anterior cerebral artery in mice. In eNOS-deficient animals the acute CoBF reduction after CAO was unaltered, and the recovery was even accelerated compared with controls. These results indicate that 1) the Willis circle alone is not sufficient to provide an immediate compensation for the loss of one carotid artery, 2) pial collaterals attenuate the ischemia of the temporal cortex ipsilateral to CAO at the expense of the blood supply of the frontoparietal region, and 3) eNOS, surprisingly, does not play an important role in this CoBF redistribution.

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Two-stage surgical treatment of subarachnoid and paryhymatous blood effects with the use of endovascular embolization of damaged aneurysm

The Journal of V. N. Karazin Kharkiv National University, Series "Medicine" ◽

10.26565/2313-6693-2019-37-06 ◽

2019 ◽

Keyword(s):

Surgical Treatment ◽

Subarachnoid Haemorrhage ◽

Cerebral Aneurysm ◽

Endovascular Embolization ◽

Neurological Deficits ◽

Ruptured Aneurysm ◽

Motor Deficit ◽

Intracerebral Hematoma ◽

Subsequent Removal ◽

Two Stage

Introduction. Aneurysmal subarachnoid hemorrhage (SAH) is complicated by concomitant intracerebral hemorrhage (IUD) with a frequency of 4% to 42.5%. More than 80% of patients die in conservative therapy, and when removing only hematomas without occlusion of an aneurysm, the mortality rate reaches 75%. Objectives. The aim of the study was the optimization of treatment of aneurysmatic subarachnoid haemorrhage complicated by the formation of intracerebral hematoma. Materials and methods. The analysis of the results of surgical treatment of 101 patients in the acute period of cerebral aneurysm rupture was performed. The first group of observations in which the surgical treatment was limited to endovascular occlusion of cerebral aneurysms. In the second group of observations, multi-stage surgical treatment was performed - endovascular embolization of cerebral aneurysm with subsequent removal of parenchymal hematoma for 24–48 hours. Results. In most cases, surgical treatment was limited to endovascular embolization of the ruptured aneurysm. In 3 observations, multistage surgical treatment was performed - endovascular embolization of cerebral aneurysm with subsequent removal of intracerebral hematoma. In two cases, positive dynamics with a regression of neurological deficits in the postoperative period was noted. In one observation, partial regression of motor deficit. Conclusions. Two - stage surgical treatment of subarachnoid haemorrhage with intracerebral hematoma the use of endovascular embolization of the ruptured aneurysm and subsequent evacuation of hematoma is effective and can be used in cases where there is a technical possibility of occlusion of the aneurysm s and the compensated state of the patient.

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Endovascular Treatment of Giant P1/P2 Aneurysm by Direct Puncture of the Vertebral Artery

Interventional Neuroradiology ◽

10.1177/159101990300900405 ◽

2003 ◽

Vol 9 (4) ◽

pp. 359-365 ◽

Cited By ~ 3

Author(s):

M. Szajner ◽

K. Obsza_Ska ◽

A. Nestorowicz ◽

M. Szczerbo-Trojanowska ◽

T. Trojanowski

Keyword(s):

Vertebral Artery ◽

Artery Occlusion ◽

Endovascular Embolization ◽

Seldinger Technique ◽

Parent Artery ◽

Direct Puncture ◽

Femoral Approach ◽

Parent Artery Occlusion ◽

Transbrachial Approach ◽

The Right

Vascular access is usually achieved through a femoral arterial puncture using a modified Seldinger technique. However, selective catheterization of the great cerebral vessels by femoral approach fails completely when the vessel is tortuous or atheromatous. In case of posterior vascular circulation aneurysms, transbrachial approach or direct puncture of the vertebral artery (VA) is an alternative. The aneurysms of the posterior cerebral artery (PCA) are reported to be rare. Due to unfavorable anatomic location, the PCA aneurysms are difficult to reach during surgical procedure. Endovascular embolization is at present considered to be more effective and safer treatment of the PCA aneurysms arising from different segments, offering a viable alternative to the surgical approach. We report the case of the giant left PCA aneurysm, located at the junction of P1/P2 segments, successfully treated by parent artery occlusion achieved after the direct puncture of the right VA which was used because both VAs were tortuous, irregular and their ostia were not accessible by femoral approach. According to different authors, parent artery occlusion appears to be safe in the treatment of P2 segment aneurysms, whatever the location of the occlusion. In our case we decided to perform this kind of treatment believing it was the only possible one.

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Renal Infarction and Pulmonary Embolism in Patient with Myelodysplastic

Health Sciences ◽

10.15342/hs.1.182 ◽

2020 ◽

Vol 1 (1) ◽

Author(s):

Mounia Bendari ◽

Nouama Bouanani ◽

Mohamed Amine Khalfaoui ◽

Maryam Ahnach ◽

Aziza Laaraj ◽

...

Keyword(s):

Pulmonary Embolism ◽

Myeloproliferative Neoplasms ◽

Bone Biopsy ◽

Bone Marrow Aspiration ◽

Myeloproliferative Disorders ◽

Acute Onset ◽

International Prognostic Scoring System ◽

Renal Infarction ◽

The Right ◽

Enhanced Computed Tomography

The myelodysplastic syndrome-myeloproliferative neoplasms (MDS/MPNs) are defined by a group of heterogeneous hematological malignancies resulting from stem cell−driven clonal growth of pathological hematopoietic progenitors and ineffective hematopoiesis, they are characterized concomitant myelodysplastic and myeloproliferative signs. Myelodysplastic/myeloproliferative disorders have been considered to have a higher risk of thrombus formation.We report a rare case about a 64 years old Moroccan woman, experienced renal infarction (RI) associated with pulmonary embolism as a complication of a myelodysplastic/myeloproliferative disorder.The patient complained of acute-onset severe left flank pain, a contrast-enhanced computed tomography (CT) of the chest and abdomen revealed RI by a large wedge-shaped defect in the right kidney with pulmonary embolism.Biological exam showed deep anemia, the bone marrow aspiration found myelodysplasia.the bone biopsy showed signs of myeloproliferatif disease. The karyotype was normal, BCR-ABL, JAK2, CALR mutations were absents, and MPL mutation was positive. The International Prognostic Scoring System (IPSS-R) was 0, and the patient was included to the low risk group.Anticoagulation therapy was initiated with heparin to treat RI and pulmonary embolism. Three months later, pulmonary embolism had resolved without the appearance of additional peripheral infarction.This case emphasizes the need to consider myelodysplastic/myeloproliferative disorders as a cause of infraction renal and pulmonary embolism.

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Omental Infarction: A Case Treated with Laparoscopic Surgery

10.31487/j.ijscr.2019.02.03 ◽

2019 ◽

pp. 1-3

Author(s):

Bertrand Ng ◽

Arafat Yasser

Keyword(s):

Diabetes Mellitus ◽

Laparoscopic Surgery ◽

Hospital Stay ◽

Acute Cholecystitis ◽

Inflammatory Markers ◽

Acute Onset ◽

Laparoscopy Surgery ◽

History Of ◽

Background History ◽

The Right

Omental infarct is a rare cause of an acute abdomen that arises from an interruption of blood supply to the omentum. Here, we present a case of omental infarct in a 67-year-old gentleman with background history of diabetes mellitus who present unusually with a severe acute onset right hypochondrium pain. Examination revealed that he was tender to touch at the right and was having localized guarding. His inflammatory markers were normal. He was successfully treated with laparoscopy surgery and he was subsequently discharged the following day. Omental infarct cases with right hypochondrium pain can sometimes mimicked acute cholecystitis and management includes laparoscopic surgery which can hasten symptoms resolution and reduces hospital stay, however recommendation for surgery has to be balanced with anesthetics risk and complication of the surgery itself.

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Right frontotemporal craniotomy for ECA-to-MCA direct and indirect bypass and occipital artery indirect bypass to the posterior circulation: case report

Journal of Neurosurgery Pediatrics ◽

10.3171/2020.7.peds20181 ◽

2020 ◽

pp. 1-5

Author(s):

Mitchell W. Couldwell ◽

Samuel Cheshier ◽

Philipp Taussky ◽

Vance Mortimer ◽

William T. Couldwell

Keyword(s):

Case Report ◽

Pediatric Patients ◽

Posterior Circulation ◽

Occipital Artery ◽

Transient Ischemic Attacks ◽

Collateral Vessel ◽

Suboccipital Craniotomy ◽

Uncommon Disease ◽

Indirect Revascularization ◽

The Brain

Moyamoya is an uncommon disease that presents with stenoocclusion of the major vasculature at the base of the brain and associated collateral vessel formation. Many pediatric patients with moyamoya present with transient ischemic attacks or complete occlusions. The authors report the case of a 9-year-old girl who presented with posterior fossa hemorrhage and was treated with an emergency suboccipital craniotomy for evacuation. After emergency surgery, an angiogram was performed, and the patient was diagnosed with moyamoya disease. Six months later, the patient was treated for moyamoya using direct and indirect revascularization; after surgery there was excellent vascularization in both regions of the bypass and no further progression of moyamoya changes. This case illustrates a rare example of intracerebral hemorrhage associated with moyamoya changes in the posterior vascularization in a pediatric patient and subsequent use of direct and indirect revascularization to reduce the risk of future hemorrhage and moyamoya progression.

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