Piyush Thombare, Viraj Nadkarni, S. Balasubramaniam
A 52-year-old female diagnosed to harbour a non-functioning pituitary adenoma underwent trans-sphenoidal excision of the tumour. On the 8th post-operative day, the patient developed severe headaches and had an episode of generalised convulsion. Post-ictally, the patient was drowsy, irritable, apahasic and developed right-sided hemiparesis. Computed tomography of the brain revealed a left parietal venous infarct. Magnetic resonance venography confirmed thrombosis of the straight sinus, left transverse sinus, left sigmoid sinus, left internal jugular vein and cortical veins in the left high parietal region. The patient's thrombophilia profile was positive only for heterozygous Factor V Leiden mutation. The patient was treated conservatively with anticonvulsants and low-molecular-weight heparin. The patient recovered completely within a week and was discharged. Cerebral venous sinus thrombosis (CVST) has been rarely reported in the post-operative period following trans-sphenoidal surgery for pituitary adenoma. Early diagnosis and treatment of CVST is necessary for a favourable outcome.
{"title":"Cerebral venous sinus thrombosis following trans-sphenoidal excision of pituitary adenoma: A case report","authors":"Piyush Thombare, Viraj Nadkarni, S. Balasubramaniam","doi":"10.4103/jcvs.jcvs_13_21","DOIUrl":"https://doi.org/10.4103/jcvs.jcvs_13_21","url":null,"abstract":"A 52-year-old female diagnosed to harbour a non-functioning pituitary adenoma underwent trans-sphenoidal excision of the tumour. On the 8th post-operative day, the patient developed severe headaches and had an episode of generalised convulsion. Post-ictally, the patient was drowsy, irritable, apahasic and developed right-sided hemiparesis. Computed tomography of the brain revealed a left parietal venous infarct. Magnetic resonance venography confirmed thrombosis of the straight sinus, left transverse sinus, left sigmoid sinus, left internal jugular vein and cortical veins in the left high parietal region. The patient's thrombophilia profile was positive only for heterozygous Factor V Leiden mutation. The patient was treated conservatively with anticonvulsants and low-molecular-weight heparin. The patient recovered completely within a week and was discharged. Cerebral venous sinus thrombosis (CVST) has been rarely reported in the post-operative period following trans-sphenoidal surgery for pituitary adenoma. Early diagnosis and treatment of CVST is necessary for a favourable outcome.","PeriodicalId":218723,"journal":{"name":"Journal of Cerebrovascular Sciences","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128424218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Adapt and adopt: Remote delivery of healthcare in neurosurgical practice","authors":"J. Dil","doi":"10.4103/jcvs.jcvs_19_21","DOIUrl":"https://doi.org/10.4103/jcvs.jcvs_19_21","url":null,"abstract":"","PeriodicalId":218723,"journal":{"name":"Journal of Cerebrovascular Sciences","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134015344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
K. Giridharan, Sudhakshina Nathan, S. Patil, B. Mangaleswaran
Aneurysms of the Middle cerebral artery (MCA) are more common at the bifurcation. Distal MCA aneurysm in M2, M3 and M4 segments are rare. Here, we discuss an incidental distal M2 segment aneurysm and its management along with a brief literature review. Fifty-one-year-old male, presented to us with a history of the giddiness of 1-week duration. During the evaluation for giddiness, his computed tomography (CT) brain plain showed a small well-defined hyperdense rounded lesion in the left Sylvian fissure. CT angiogram was done and it showed a saccular aneurysm measuring 7.7 mm × 7.3 mm and had a narrow neck of 1.5 mm arising from the distal M2 segment of MCA. The aneurysm was directed superiorly in the distal MCA. Digital subtraction angiogram showed a 6.4 mm × 6.9 mm distal M2 segment bilobed aneurysm with a neck of 3.8 mm and projecting superiorly. Surgical clipping of the aneurysm was done. Perioperative period was uneventful and the patient is doing well at 3 months follow-up. Review of the literature showed that the incidence of distal MCA aneurysm was low. Intra-operative CT angiogram, neuro-navigation, indocyanine green video angiography (ICGV) are some of the useful tools in improving outcomes in surgical clipping of these aneurysms. Distal MCA aneurysms are less frequently encountered. Surgical clipping is the treatment of choice in these cases. Challenge arises in localising these aneurysms and adjuncts such as intraoperative CT angiogram, neuro-navigation, ICGV can be useful to overcome that challenge.
大脑中动脉(MCA)的动脉瘤在分叉处更为常见。中动脉远端动脉瘤在M2, M3和M4段是罕见的。在这里，我们讨论偶发的远端M2段动脉瘤及其处理，并简要回顾文献。男性，51岁，有眩晕病史，持续1周。在评估眩晕时，他的计算机断层扫描(CT)显示左侧脑裂有一个小而清晰的高密度圆形病变。CT血管造影显示一囊状动脉瘤，尺寸为7.7 mm × 7.3 mm，颈狭窄1.5 mm，起源于MCA远端M2段。动脉瘤位于MCA远端。数字减影血管造影显示远端M2段双叶动脉瘤6.4 mm × 6.9 mm，颈部3.8 mm，上突。手术切除了动脉瘤。围手术期顺利，随访3个月，患者恢复良好。回顾文献显示，MCA远端动脉瘤的发生率很低。术中CT血管造影、神经导航、吲吲吲胺绿视频血管造影(ICGV)是改善手术切除这些动脉瘤效果的一些有用工具。远端MCA动脉瘤较少见。在这些情况下，手术夹是治疗的选择。在定位这些动脉瘤和辅助物时出现的挑战，如术中CT血管造影、神经导航、ICGV可用于克服这一挑战。
{"title":"Incidental unruptured aneurysm of the distal M2 segment: Case report and review of literature","authors":"K. Giridharan, Sudhakshina Nathan, S. Patil, B. Mangaleswaran","doi":"10.4103/jcvs.jcvs_10_21","DOIUrl":"https://doi.org/10.4103/jcvs.jcvs_10_21","url":null,"abstract":"Aneurysms of the Middle cerebral artery (MCA) are more common at the bifurcation. Distal MCA aneurysm in M2, M3 and M4 segments are rare. Here, we discuss an incidental distal M2 segment aneurysm and its management along with a brief literature review. Fifty-one-year-old male, presented to us with a history of the giddiness of 1-week duration. During the evaluation for giddiness, his computed tomography (CT) brain plain showed a small well-defined hyperdense rounded lesion in the left Sylvian fissure. CT angiogram was done and it showed a saccular aneurysm measuring 7.7 mm × 7.3 mm and had a narrow neck of 1.5 mm arising from the distal M2 segment of MCA. The aneurysm was directed superiorly in the distal MCA. Digital subtraction angiogram showed a 6.4 mm × 6.9 mm distal M2 segment bilobed aneurysm with a neck of 3.8 mm and projecting superiorly. Surgical clipping of the aneurysm was done. Perioperative period was uneventful and the patient is doing well at 3 months follow-up. Review of the literature showed that the incidence of distal MCA aneurysm was low. Intra-operative CT angiogram, neuro-navigation, indocyanine green video angiography (ICGV) are some of the useful tools in improving outcomes in surgical clipping of these aneurysms. Distal MCA aneurysms are less frequently encountered. Surgical clipping is the treatment of choice in these cases. Challenge arises in localising these aneurysms and adjuncts such as intraoperative CT angiogram, neuro-navigation, ICGV can be useful to overcome that challenge.","PeriodicalId":218723,"journal":{"name":"Journal of Cerebrovascular Sciences","volume":"13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127733778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Arterio-venous malformations (AVMs) are anomalous shunts between the arterial and venous systems, acting as a major risk factor for intra-cerebral haemorrhage, seen in 38%–71% of patients harbouring the pathology. Current techniques in the management of AVMs include observation, microsurgery, embolisation and radiosurgery, or combination therapy. AVMs are classically categorised based on the Spetzler-Martin grading and it is generally accepted that Grades I and II are best managed by microsurgical resection. To discuss the technique of astute visual inspection of AVM malformations on the operating table in microsurgical management of AVMs, and the surgical importance and significance of the valuable inferences derived from this routine. It is of utmost importance to visually distinguish between the arterial and venous ends of the nidus, and this can be effectively accomplished through eyeballing techniques by looking at the appearance of the vessels and noticing its colour, thickness, and underlying blood; and the variations in the turgor pressure of the nidus with changes in compression of the arterial and venous ends. It is equally important to visually identify the safe and effective plane to approach the target lesion by identifying the gliotic plane, the discoloured vertex of the underlying haematoma, or the widened subarachnoid spaces. Microsurgical resection is a definite mode of treatment of intra-cranial AVMs and flawless execution of surgery is vital. Eyeballing techniques must be aimed at correctly identifying the nature of the lesion and creating a mind-map before setting out to manipulate the AVM. A good initial visual inspection and survey is a crucial measure of safety and efficiency in AVM surgery.
{"title":"Visual techniques in microsurgery for intra-cranial arteriovenous malformations","authors":"Sumeet Narang, J. Dil, A. Raja","doi":"10.4103/jcvs.jcvs_18_21","DOIUrl":"https://doi.org/10.4103/jcvs.jcvs_18_21","url":null,"abstract":"Arterio-venous malformations (AVMs) are anomalous shunts between the arterial and venous systems, acting as a major risk factor for intra-cerebral haemorrhage, seen in 38%–71% of patients harbouring the pathology. Current techniques in the management of AVMs include observation, microsurgery, embolisation and radiosurgery, or combination therapy. AVMs are classically categorised based on the Spetzler-Martin grading and it is generally accepted that Grades I and II are best managed by microsurgical resection. To discuss the technique of astute visual inspection of AVM malformations on the operating table in microsurgical management of AVMs, and the surgical importance and significance of the valuable inferences derived from this routine. It is of utmost importance to visually distinguish between the arterial and venous ends of the nidus, and this can be effectively accomplished through eyeballing techniques by looking at the appearance of the vessels and noticing its colour, thickness, and underlying blood; and the variations in the turgor pressure of the nidus with changes in compression of the arterial and venous ends. It is equally important to visually identify the safe and effective plane to approach the target lesion by identifying the gliotic plane, the discoloured vertex of the underlying haematoma, or the widened subarachnoid spaces. Microsurgical resection is a definite mode of treatment of intra-cranial AVMs and flawless execution of surgery is vital. Eyeballing techniques must be aimed at correctly identifying the nature of the lesion and creating a mind-map before setting out to manipulate the AVM. A good initial visual inspection and survey is a crucial measure of safety and efficiency in AVM surgery.","PeriodicalId":218723,"journal":{"name":"Journal of Cerebrovascular Sciences","volume":"32 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129528297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
K. Kannan, Madhavi Karri, Balakrishnan Ramasamy, Aleesha Ummer
Context: Posterior cerebral artery (PCA) derives its blood supply from the vertebrobasilar system. However, in 10% of the population, they get blood supply from the internal carotid artery via a posterior communicating artery. This variant is called as fetal type of PCA (fPCA). Whether fPCA is an anatomical variant or a predisposing factor for a cerebrovascular event remains an enigma. Aims: The aim is to assess if fPCA is associated with increased risk of ischaemic stroke or other vascular anomalies. Settings and Design: It is a retrospective cross-sectional observational study. Subjects and Methods: Patients who underwent MR or CT angiography, over 5 years for various neurological illnesses were screened for fPCA. Those patients were assessed for vascular anomalies and ischaemic stroke. Statistical Analysis Used: Chi-square in the Statistical Package for the Social Sciences v23. Results: On analysis of 250 patients, five had aneurysms; three had AV malformation, one with Fenestration and one with vascular loop. And 51% were found to have an ischaemic stroke, in which 34% had large vessel disease, 41% had lacunar infarct, 7% had a cardioembolic stroke and 18% had an embolic stroke of unknown source with predominantly middle cerebral artery territory infarct (55%). Among 127 patients with ischaemic stroke, 45% had infarcts ipsilateral to fPCA vs 28% on the opposite side of fPCA. Conclusions: We conclude that patients with fPCA had increased risk of MCA infarct probably due to poor collaterals from posterior circulation and fPCA is not associated with increased risk of aneurysms or AV malformations.
{"title":"Is foetal variant of posterior cerebral artery a risk factor for ischemic stroke?","authors":"K. Kannan, Madhavi Karri, Balakrishnan Ramasamy, Aleesha Ummer","doi":"10.4103/jcvs.jcvs_7_21","DOIUrl":"https://doi.org/10.4103/jcvs.jcvs_7_21","url":null,"abstract":"Context: Posterior cerebral artery (PCA) derives its blood supply from the vertebrobasilar system. However, in 10% of the population, they get blood supply from the internal carotid artery via a posterior communicating artery. This variant is called as fetal type of PCA (fPCA). Whether fPCA is an anatomical variant or a predisposing factor for a cerebrovascular event remains an enigma. Aims: The aim is to assess if fPCA is associated with increased risk of ischaemic stroke or other vascular anomalies. Settings and Design: It is a retrospective cross-sectional observational study. Subjects and Methods: Patients who underwent MR or CT angiography, over 5 years for various neurological illnesses were screened for fPCA. Those patients were assessed for vascular anomalies and ischaemic stroke. Statistical Analysis Used: Chi-square in the Statistical Package for the Social Sciences v23. Results: On analysis of 250 patients, five had aneurysms; three had AV malformation, one with Fenestration and one with vascular loop. And 51% were found to have an ischaemic stroke, in which 34% had large vessel disease, 41% had lacunar infarct, 7% had a cardioembolic stroke and 18% had an embolic stroke of unknown source with predominantly middle cerebral artery territory infarct (55%). Among 127 patients with ischaemic stroke, 45% had infarcts ipsilateral to fPCA vs 28% on the opposite side of fPCA. Conclusions: We conclude that patients with fPCA had increased risk of MCA infarct probably due to poor collaterals from posterior circulation and fPCA is not associated with increased risk of aneurysms or AV malformations.","PeriodicalId":218723,"journal":{"name":"Journal of Cerebrovascular Sciences","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134414808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A 52-year-old woman had subarachnoid haemorrhage due to an aneurysm at a fenestration of the vertebrobasilar artery junction. The fenestration and aneurysm filled by the dominant left vertebral artery (VA). The left VA had a tight stenosis at its origin from the left subclavian artery. The patient underwent a stent-assisted coiling of the aneurysm after balloon dilatation of the proximal stenosis. The management of this unusual and rare entity is discussed. The relevant literature on the subject is presented.
{"title":"Endovascular treatment of a saccular aneurysm associated with fenestrated basilar artery and proximal stenosis of vertebral artery origin - A treatment challenge","authors":"Himanshu Patel, B. Pandurang, T. Nadkarni","doi":"10.4103/jcvs.jcvs_28_20","DOIUrl":"https://doi.org/10.4103/jcvs.jcvs_28_20","url":null,"abstract":"A 52-year-old woman had subarachnoid haemorrhage due to an aneurysm at a fenestration of the vertebrobasilar artery junction. The fenestration and aneurysm filled by the dominant left vertebral artery (VA). The left VA had a tight stenosis at its origin from the left subclavian artery. The patient underwent a stent-assisted coiling of the aneurysm after balloon dilatation of the proximal stenosis. The management of this unusual and rare entity is discussed. The relevant literature on the subject is presented.","PeriodicalId":218723,"journal":{"name":"Journal of Cerebrovascular Sciences","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131015925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Shyam Krishnan, Pulak Nigam, G. Menon, M. Vasudevan
Proximal A1 segment aneurysms are technically challenging aneurysms that require careful and meticulous adherence to surgical principles for optimising the outcomes. They usually present with rupture and headache and visual symptoms are uncommon due to the optic nerve not being in proximity to the aneurysm. Important, delicate perforators arise from the segment and their preservation is the key to a good surgical outcome.
{"title":"Proximal A1 segment aneurysm presenting with visual symptoms: A case report","authors":"Shyam Krishnan, Pulak Nigam, G. Menon, M. Vasudevan","doi":"10.4103/jcvs.jcvs_15_21","DOIUrl":"https://doi.org/10.4103/jcvs.jcvs_15_21","url":null,"abstract":"Proximal A1 segment aneurysms are technically challenging aneurysms that require careful and meticulous adherence to surgical principles for optimising the outcomes. They usually present with rupture and headache and visual symptoms are uncommon due to the optic nerve not being in proximity to the aneurysm. Important, delicate perforators arise from the segment and their preservation is the key to a good surgical outcome.","PeriodicalId":218723,"journal":{"name":"Journal of Cerebrovascular Sciences","volume":"19 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115427224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abhishek Katyal, B. Anil Kumar, Shaam Bodeliwala, A. Jagetia, A. Srivastava
Perimedullary arteriovenous fistulas are uncommon vascular malformations particularly if they involve the craniovertebral junction. The complexity of the angioarchitecture of these lesions poses a further diagnostic challenge. Moreover, the therapeutic management is controversial and can include observation alone, endovascular occlusion, or surgical exclusion, depending on both patient and the angiographic characteristics of the lesion.
{"title":"Cranio-vertebral junction arteriovenous fistula presenting with subarachnoid haemorrhage: A case report","authors":"Abhishek Katyal, B. Anil Kumar, Shaam Bodeliwala, A. Jagetia, A. Srivastava","doi":"10.4103/jcvs.jcvs_6_21","DOIUrl":"https://doi.org/10.4103/jcvs.jcvs_6_21","url":null,"abstract":"Perimedullary arteriovenous fistulas are uncommon vascular malformations particularly if they involve the craniovertebral junction. The complexity of the angioarchitecture of these lesions poses a further diagnostic challenge. Moreover, the therapeutic management is controversial and can include observation alone, endovascular occlusion, or surgical exclusion, depending on both patient and the angiographic characteristics of the lesion.","PeriodicalId":218723,"journal":{"name":"Journal of Cerebrovascular Sciences","volume":"136 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123251880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
V. Muralidharan, Mario Travali, T. Cavallaro, L. Tomarchio, Gabriele Corsale, Federica Cosentino, M. Politi, C. Cristaudo
Background: Aneurysms with neck diameter >4 mm or dome to neck ratio <2 are wide-neck aneurysms. Balloons and stents are used to assist in coiling the wide-neck aneurysms, but these are associated with increased intra-procedure and peri-procedure risk in ruptured aneurysms. Microcatheter-assisted coiling (MAC) is an alternative salvage technique in these situations which is under reported. Materials and Methods: We describe our experience in a cohort of 16 patients with ruptured wide neck aneurysm treated with MAC technique. Our primary objective of intervention in acute setting was to secure the aneurysm to prevent rebleed. Results: Anterior communicating artery aneurysm was the most common (56.3%) followed by middle cerebral artery bifurcation aneurysm (18.8%), paraclinoid aneurysm (12.5%), posterior communicating artery aneurysm (6.3%) and basilar tip aneurysm (6.3%). Mean greatest dimension of dome and neck were 8.9 mm and 4.6 mm, respectively. Mean neck to dome ratio was 1.8. Fisher grade 3 and grade 4 subarachnoid haemorrhage (SAH) were observed in 56.3% and 43.7% patients, respectively. Immediate post-procedure digital subtraction angiography (DSA) showed Raymond Roy grade 1, grade 2 and grade 3 embolisation in 62.5%, 33.3% and 6.7% patients, respectively. No distal embolus, vessel occlusion, vessel perforation or aneurysm rupture was observed. Immediate post-procedure DSA showed good distal flow in all patients. Infarct was observed at 24 and 48 hours respectively, in two patients with Fisher Grade 3 SAH. Conclusion: Ruptured wide neck aneurysms can be embolised with complete preservation of branching vessel and distal flow. Total occlusion can be achieved in 2/3rd of patients.
背景:颈直径> 4mm或圆颈比<2的动脉瘤为宽颈动脉瘤。球囊和支架用于辅助盘绕宽颈动脉瘤，但这增加了术中和术中动脉瘤破裂的风险。微导管辅助盘绕(MAC)是一种可替代的抢救技术，但目前尚未报道。材料和方法:我们描述了我们对16例宽颈动脉瘤破裂患者采用MAC技术治疗的经验。我们的主要目的是在紧急情况下进行干预，以确保动脉瘤的安全，防止再出血。结果:以前交通动脉瘤最为常见(56.3%)，其次为大脑中动脉分叉动脉瘤(18.8%)、类旁动脉瘤(12.5%)、后交通动脉瘤(6.3%)和颅底尖端动脉瘤(6.3%)。脑顶和颈的平均最大尺寸分别为8.9 mm和4.6 mm。平均颈圆比为1.8。Fisher 3级和4级蛛网膜下腔出血(SAH)分别占56.3%和43.7%。术后立即数字减影血管造影(DSA)显示，62.5%、33.3%和6.7%的患者分别出现了Raymond Roy 1级、2级和3级栓塞。未见远端栓子、血管闭塞、血管穿孔或动脉瘤破裂。术后立即DSA显示所有患者远端血流良好。2例Fisher 3级SAH患者分别在24小时和48小时观察到梗死。结论:在保留分支血管和远端血流的情况下，可以对破裂的宽颈动脉瘤进行栓塞。2/3的患者完全闭塞。
{"title":"Micro-catheter assisted coiling (MAC): A mid-path between simple and assisted coiling techniques in treating ruptured wide neck aneurysms and immediate post procedure outcomes","authors":"V. Muralidharan, Mario Travali, T. Cavallaro, L. Tomarchio, Gabriele Corsale, Federica Cosentino, M. Politi, C. Cristaudo","doi":"10.4103/jcvs.jcvs_4_21","DOIUrl":"https://doi.org/10.4103/jcvs.jcvs_4_21","url":null,"abstract":"Background: Aneurysms with neck diameter >4 mm or dome to neck ratio <2 are wide-neck aneurysms. Balloons and stents are used to assist in coiling the wide-neck aneurysms, but these are associated with increased intra-procedure and peri-procedure risk in ruptured aneurysms. Microcatheter-assisted coiling (MAC) is an alternative salvage technique in these situations which is under reported. Materials and Methods: We describe our experience in a cohort of 16 patients with ruptured wide neck aneurysm treated with MAC technique. Our primary objective of intervention in acute setting was to secure the aneurysm to prevent rebleed. Results: Anterior communicating artery aneurysm was the most common (56.3%) followed by middle cerebral artery bifurcation aneurysm (18.8%), paraclinoid aneurysm (12.5%), posterior communicating artery aneurysm (6.3%) and basilar tip aneurysm (6.3%). Mean greatest dimension of dome and neck were 8.9 mm and 4.6 mm, respectively. Mean neck to dome ratio was 1.8. Fisher grade 3 and grade 4 subarachnoid haemorrhage (SAH) were observed in 56.3% and 43.7% patients, respectively. Immediate post-procedure digital subtraction angiography (DSA) showed Raymond Roy grade 1, grade 2 and grade 3 embolisation in 62.5%, 33.3% and 6.7% patients, respectively. No distal embolus, vessel occlusion, vessel perforation or aneurysm rupture was observed. Immediate post-procedure DSA showed good distal flow in all patients. Infarct was observed at 24 and 48 hours respectively, in two patients with Fisher Grade 3 SAH. Conclusion: Ruptured wide neck aneurysms can be embolised with complete preservation of branching vessel and distal flow. Total occlusion can be achieved in 2/3rd of patients.","PeriodicalId":218723,"journal":{"name":"Journal of Cerebrovascular Sciences","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128615989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Chemate, Joy Vargese, P. Chatterjee, G. Nathan, M. Balamurugan
Carotid-cavernous fistula (CCF) is an abnormal vascular connection between the carotid artery and the cavernous sinus. There are various classifications based on haemodynamic, aetiology or anatomically. Haemodynamic classification is based on whether the fistula is high or low flow. Etiologically, it can be secondary to trauma or can develop spontaneously due to pre-existing aneurysm or medical conditions predisposing to arterial wall defects. Bilateral CCFs are very rare. We present two cases of bilateral CCF – one secondary to trauma and other occurred spontaneously. Both the patients presented with the signs of raised intraocular pressure – decreased vision, chemosis, proptosis and ophthalmoplegia. Magnetic resonance imaging and digital subtraction angiography confirmed a bilateral CCF. Both the patients underwent two settings of endovascular embolisation procedures, and complete embolisation of bilateral CCF was achieved. Available literature is unclear about the aetiology of bilateral CCF, technique of endovascular embolisation and the prognosis of bilateral CCF. In our both the cases, we were able to achieve complete embolisation in two settings.
{"title":"Bilateral carotid-cavernous sinus fistula: Case reports and review of the literature","authors":"S. Chemate, Joy Vargese, P. Chatterjee, G. Nathan, M. Balamurugan","doi":"10.4103/jcvs.jcvs_11_21","DOIUrl":"https://doi.org/10.4103/jcvs.jcvs_11_21","url":null,"abstract":"Carotid-cavernous fistula (CCF) is an abnormal vascular connection between the carotid artery and the cavernous sinus. There are various classifications based on haemodynamic, aetiology or anatomically. Haemodynamic classification is based on whether the fistula is high or low flow. Etiologically, it can be secondary to trauma or can develop spontaneously due to pre-existing aneurysm or medical conditions predisposing to arterial wall defects. Bilateral CCFs are very rare. We present two cases of bilateral CCF – one secondary to trauma and other occurred spontaneously. Both the patients presented with the signs of raised intraocular pressure – decreased vision, chemosis, proptosis and ophthalmoplegia. Magnetic resonance imaging and digital subtraction angiography confirmed a bilateral CCF. Both the patients underwent two settings of endovascular embolisation procedures, and complete embolisation of bilateral CCF was achieved. Available literature is unclear about the aetiology of bilateral CCF, technique of endovascular embolisation and the prognosis of bilateral CCF. In our both the cases, we were able to achieve complete embolisation in two settings.","PeriodicalId":218723,"journal":{"name":"Journal of Cerebrovascular Sciences","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116124470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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