S. Chemate, K. Chandrasekar, C. Ganesh, C. Govindaraju, M. Balamurugan
When two or more adjacent intracranial aneurysms, arise from the same or different arteries, with separate origins and partially adherent walls, they are referred to as 'kissing aneurysms'. These are rare aneurysms. Among different locations of kissing aneurysms reported in the literature, kissing aneurysms of bilateral distal anterior cerebral arteries (DACAs), two different aneurysms situated symmetrically on opposite DACA are very rare. A 69-year-old woman with multiple comorbidities was admitted with anterior interhemispheric bleed. Magnetic resonance angiography and digital subtraction angiography (DSA) showed ruptured bilateral DACA aneurysms in mirror position to each other forming a Mickey mouse head appearance. The patient was managed surgically by craniotomy and clipping of both aneurysms. Kissing aneurysms of bilateral DACA aneurysms are very rare. DSA is essential to be useful for pre-operative diagnosis and planning. The basic principle of securing the parent artery proximally and clipping the neck after meticulous dissection should be followed.
{"title":"‘Mickey mouse head aneurysms’ – Kissing aneurysms of the distal anterior cerebral artery: A case report and review of literature","authors":"S. Chemate, K. Chandrasekar, C. Ganesh, C. Govindaraju, M. Balamurugan","doi":"10.4103/jcvs.jcvs_9_20","DOIUrl":"https://doi.org/10.4103/jcvs.jcvs_9_20","url":null,"abstract":"When two or more adjacent intracranial aneurysms, arise from the same or different arteries, with separate origins and partially adherent walls, they are referred to as 'kissing aneurysms'. These are rare aneurysms. Among different locations of kissing aneurysms reported in the literature, kissing aneurysms of bilateral distal anterior cerebral arteries (DACAs), two different aneurysms situated symmetrically on opposite DACA are very rare. A 69-year-old woman with multiple comorbidities was admitted with anterior interhemispheric bleed. Magnetic resonance angiography and digital subtraction angiography (DSA) showed ruptured bilateral DACA aneurysms in mirror position to each other forming a Mickey mouse head appearance. The patient was managed surgically by craniotomy and clipping of both aneurysms. Kissing aneurysms of bilateral DACA aneurysms are very rare. DSA is essential to be useful for pre-operative diagnosis and planning. The basic principle of securing the parent artery proximally and clipping the neck after meticulous dissection should be followed.","PeriodicalId":218723,"journal":{"name":"Journal of Cerebrovascular Sciences","volume":"109 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124830762","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}
Chronic subdural hematoma (cSDH) is a common cranial neurosurgical condition with morbidity and mortality ranging from 2% to 5%. Conventional treatment includes conservative and surgical evacuation. Minimally invasive middle meningeal artery (MMA) embolisation is emerging as a potential treatment option. We report our case successfully managed by MMA embolization and review the literature. cSDH development and progression is related to the cycle of chronic inflammation and angiogenesis following the original hemorrhage due to trivial trauma. Due to growth factor, stimulation-initiating angiogenesis leading to growth of leaky blood vessels causing microhaemorrhages resulting in the progressive enlargement of subdural collection as the physiologic absorption capability is outpaced by the rate of collection. Strategies for the management of cSDH are aimed at interrupting the vicious cycle of its development and tilting the balance toward reabsorption of haemorrhage. Conservative management, medical treatment and surgical treatments are conventional treatment options with surgical evacuation considered as the gold standard option. However, challenges include recurrence and reversal of anti-platelets and anti-coagulants and its associated risk of ischaemic complications. cSDH being a pathology of meninges deriving blood the dura causing microhaemorrhages, it is prudent to seal off the vessels to tilt the balance towards resorption. MMA embolisation as a treatment option has been used with significant published data. It may be used as a stand-alone therapy in minimally symptomatic patients. Technical success rate is high both with polyviny alcohol and liquid embolic agents. Recurrence rate is consistently low in spite of significant patients having antiplatelets and anti-coagulants on board. It eliminates the ischemic complication due to stoppage of antiplatelets and anticoagulants. MMA embolization is also emerging as an adjunct to surgically evacuated cSDH that is considered high risk for recurrence.
{"title":"Middle meningeal artery embolization in the management of chronic subdural haematoma: A case report and review of literature","authors":"S. Paramasivam, Harihara Sudan","doi":"10.4103/jcvs.jcvs_7_20","DOIUrl":"https://doi.org/10.4103/jcvs.jcvs_7_20","url":null,"abstract":"Chronic subdural hematoma (cSDH) is a common cranial neurosurgical condition with morbidity and mortality ranging from 2% to 5%. Conventional treatment includes conservative and surgical evacuation. Minimally invasive middle meningeal artery (MMA) embolisation is emerging as a potential treatment option. We report our case successfully managed by MMA embolization and review the literature. cSDH development and progression is related to the cycle of chronic inflammation and angiogenesis following the original hemorrhage due to trivial trauma. Due to growth factor, stimulation-initiating angiogenesis leading to growth of leaky blood vessels causing microhaemorrhages resulting in the progressive enlargement of subdural collection as the physiologic absorption capability is outpaced by the rate of collection. Strategies for the management of cSDH are aimed at interrupting the vicious cycle of its development and tilting the balance toward reabsorption of haemorrhage. Conservative management, medical treatment and surgical treatments are conventional treatment options with surgical evacuation considered as the gold standard option. However, challenges include recurrence and reversal of anti-platelets and anti-coagulants and its associated risk of ischaemic complications. cSDH being a pathology of meninges deriving blood the dura causing microhaemorrhages, it is prudent to seal off the vessels to tilt the balance towards resorption. MMA embolisation as a treatment option has been used with significant published data. It may be used as a stand-alone therapy in minimally symptomatic patients. Technical success rate is high both with polyviny alcohol and liquid embolic agents. Recurrence rate is consistently low in spite of significant patients having antiplatelets and anti-coagulants on board. It eliminates the ischemic complication due to stoppage of antiplatelets and anticoagulants. MMA embolization is also emerging as an adjunct to surgically evacuated cSDH that is considered high risk for recurrence.","PeriodicalId":218723,"journal":{"name":"Journal of Cerebrovascular Sciences","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123577592","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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