Microsurgical Findings of Pial Arterial Feeders in Intracranial Dural Arteriovenous Fistulae: A Case Series

2020 ◽  
Author(s):  
Michinari Okamoto ◽  
Taku Sugiyama ◽  
Naoki Nakayama ◽  
Satoshi Ushikoshi ◽  
Ken Kazumata ◽  
...  
Keyword(s):  
Cerebral Artery ◽  
Case Series ◽  
Venous Drainage ◽  
Transverse Sinus ◽  
Endovascular Embolization ◽  
Superior Cerebellar Artery ◽  
Cerebellar Artery ◽  
Cortical Venous Drainage ◽  
Intracranial Dural Arteriovenous Fistulae ◽  
System 1

Abstract BACKGROUND Pial arterial feeders in an intracranial dural arteriovenous fistula (dAVF) are risk factors for both ischemic and hemorrhagic complications during endovascular embolization. Microsurgery in dAVF with pial arterial feeders has rarely been reported. OBJECTIVE To assess our original experience with microsurgery for dAVF with pial arterial feeders by investigating surgical findings and outcomes. METHODS In 40 patients with intracranial dAVF who underwent microsurgery, we found 8 patients who had pial arterial feeders. A retrospective review was conducted. RESULTS The locations of the dAVFs were as follows: tentorium, 2 patients; Galenic system, 1; straight sinus, 1; torcula, 1; transverse sinus, 1; ethmoid, 1; and convexity, 1. Preoperative angiography revealed that the pial arterial feeders originated from the middle cerebral artery in 2 patients, the anterior cerebral artery in 1, the posterior cerebral artery in 2, and the posterior medial choroidal artery in 1. Of note, in 2 patients (6.7%), feeders from the superior cerebellar artery were determined to be angiographically occult during preoperative examination and were detected through careful intraoperative observation and arachnoid dissection. In 5 cases, the additional obliteration of the pial arterial feeders and/or more distal cortical venous drainers after the simple disconnection of proximal cortical drainers was necessary to cure the dAVF. Finally, all shunts were cured with only 1 minor complication. CONCLUSION Although microsurgical results were acceptable, the surgeon should be aware of the presence of pial arterial feeders even after the simple disconnection of cortical venous drainage. Angiographically occult feeders may also exist.

scholarly journals Staged transarterial endovascular embolization of a malignant dural arteriovenous fistula using Onyx and n-butyl cyanoacrylate

2019 ◽  
Vol 46 (Suppl_2) ◽  
pp. V1
Author(s):  
Silvia Gesheva ◽  
William T. Couldwell ◽  
Vance Mortimer ◽  
Philipp Taussky ◽  
Ramesh Grandhi
Keyword(s):  
Arteriovenous Malformations ◽  
Dural Arteriovenous Fistula ◽  
Transarterial Embolization ◽  
Venous Drainage ◽  
Transverse Sinus ◽  
Endovascular Embolization ◽  
Intracranial Arteriovenous Malformations ◽  
Dural Venous Sinus ◽  
Cortical Venous Drainage ◽  
Primary Modality

Dural arteriovenous fistulae (dAVFs) are vascular anomalies formed by abnormal connections between branches of dural arteries and dural veins or dural venous sinus(es). These pathologic shunts constitute 10%–15% of all intracranial arteriovenous malformations. The hallmark of malignant dAVFs is the presence of cortical venous drainage, a finding that increases the likelihood of nonhemorrhagic neurologic deficit, intracranial hemorrhage, and mortality if left unaddressed. Endovascular approaches have become the primary modality for the treatment of dAVFs. The authors present a case of staged endovascular transarterial embolization of a malignant dAVF running parallel to the left transverse sinus in a patient with headaches and pulsatile tinnitus. The fistula was completely treated using Onyx and n-butyl cyanoacrylate.The video can be found here: https://youtu.be/GSAto_wlC3I.

scholarly journals Microsurgical treatment of intracranial dural arteriovenous fistulas. Case series and review of the literature

2020 ◽  
Vol 31 (1) ◽  
pp. 34-41
Author(s):  
D.V. Shchehlov ◽  
M.S. Gudym ◽  
O.E. Svyrydiuk ◽  
M.B. Vyval
Keyword(s):  
Clinical Symptoms ◽  
Case Series ◽  
Venous Drainage ◽  
Middle Cranial Fossa ◽  
Transverse Sinus ◽  
Endovascular Embolization ◽  
Microsurgical Treatment ◽  
Arteriovenous Fistulas ◽  
Surgical Methods ◽  
Dural Arteriovenous Fistulas

Objective ‒ to evaluate peculiarities and results of microsurgical treatment of intracranial dural arteriovenous fistulas (DAVF).Materials and methods. A retrospective analysis of microsurgical treatment of 7 patients with DAVF (4 (57. 1%) women and 3 (42.9 %) men, average age ‒ 43.4 years), who were hospitalized and surgically treated at the SO «Scientific-practical Center of endovascular neuroradiology NAMS of Ukraine» from 2016 to 2020, was made. DAVF was drained into the superior sugittal sinus in 4 (57.1 %) patients, transverse and sigmoid sinuses in 2 (28.6 %) cases, in the middle cranial fossa in 1 (14.3 %). According to the Cognard classification there were 3 (42.9 %) DAVFs belong to type IIb, 2 (28.6 %) ‒ to type IIa + b, 1 (14.3 %) DAVF ‒ to type II, 1 (14.3 %) DAVF ‒ to type IV.Results. In 3 (42.9 %) patients were primarily treated with endovascular method. Follow up studies revealed a recurrence of the disease, and microsurgical disconnection was performed. In 4 (57.1 %) cases, endovascular access to superficial DAVF was risky due to anatomical features, and microsurgery was preferred. In all patients, surgical treatment aimed the disconnecting of the shunt. In 1 (14.3 %) case of DAVF the transverse sinus was ligated. In all cases angiographic confirmation of the DAVFs exclusion was performed. In the postoperative period, there was no evidence of an increasing of clinical symptoms. All patients with pulsatile tinnitus and headache noted their regression after surgery.Conclusions. Considering the efficacy of modern endovascular techniques, microsurgery of DAVF has been indicated in cases where endovascular embolization has proven to be no-n-efficient or technically impossible. Among surgical methods of DAVF treatment, there are disconnection of the meningeal arteries directly at the site of the fistula, resection of the abnormal dura mater with feeding vessels, ligation and intersections of the injured venous sinus, skeletonization of the sinus with the feeding dural vessels. Treatment should be performed in all cases of DAVF with cortical venous drainage and progressive symptoms of the disease. The choice of optimal treatment should be made in a multidisciplinary manner, and all possible methods should be taken into consideration.

scholarly journals Tentorial Incision vs. Retraction of the Tentorial Edge during the Subtemporal Approach: Anatomical Comparison in Cadaveric Dissections and Retrospective Clinical Case Series

2018 ◽  
Vol 80 (05) ◽  
pp. 441-448
Author(s):  
E. Archavlis ◽  
L. Serrano ◽  
F. Ringel ◽  
S. R. Kantelhardt
Keyword(s):  
Case Series ◽  
Free Edge ◽  
Superior Cerebellar Artery ◽  
Fast Method ◽  
Subtemporal Approach ◽  
Cerebellar Artery ◽  
Significant Difference ◽  
Suture Group ◽  
Group A ◽  
Group B

Abstract Objective The aim of this study was to compare tentorial incision (group A) versus retraction and tack up suture (group B) of the tentorial edge during the subtemporal approach for surgery in the high basilar region. Design 24 cadaveric dissections and 4 clinical cases of aneurysms of the high basilar region are presented. Assessment included visibility and operability afforded by either tentorial incision creating a dural flap (group A) or retraction of the tentorial edge and tethering with a suture (group B). Four patients, two with superior cerebellar artery aneurysms and two with proximal posterior cerebral artery aneurysms were treated with each approach. Results In the quantitative evaluations, we found no significant difference in the exposure of the posterior cerebral, superior cerebellar, and perforant arteries as well as surgical working area provided by either approach. However, tentorial incision allowed a significantly greater exposure of the basilar artery and the fourth cranial nerve (both p < 0.001). Concerning operability, tentorial incision provided no objective advantage for direct clipping of the high basilar region (groups A vs. B, p > 0.05). Subjectively, clipping of the high basilar segment was feasible using tentorial tethering only. Conclusion Retraction of the free edge of the tentorium downward by tethering with a suture is simple and fast method for exposure of aneurysms in the high basilar region when the pathology does not require a proximal control. In our data the rather more invasive and time consuming tentorial incision provided an additional objectified advantage only for placement of a proximal temporary clip.

LVIS Blue as a low porosity stent and coil adjuvant

2018 ◽  
Vol 10 (7) ◽  
pp. 682-686 ◽  
Author(s):  
Matthew J Koch ◽  
Christopher J Stapleton ◽  
Scott B Raymond ◽  
Susan Williams ◽  
Thabele M Leslie-Mazwi ◽  
...  
Keyword(s):  
Coil Embolization ◽  
Intracranial Aneurysms ◽  
Posterior Inferior Cerebellar Artery ◽  
Endovascular Embolization ◽  
Superior Cerebellar Artery ◽  
Anterior Communicating Artery ◽  
Aneurysm Neck ◽  
Proximal Internal Carotid Artery ◽  
Cerebellar Artery

IntroductionThe LVIS Blue is an FDA-approved stent with 28% metallic coverage that is indicated for use in conjunction with coil embolization for the treatment of intracranial aneurysms. Given a porosity similar to approved flow diverters and higher than currently available intracranial stents, we sought to evaluate the effectiveness of this device for the treatment of intracranial aneurysms.MethodsWe performed an observational single-center study to evaluate initial occlusion and occlusion at 6-month follow-up for patients treated with the LVIS Blue in conjunction with coil embolization at our institution using the modified Raymond–Roy classification (mRRC), where mRRC 1 indicates complete embolization, mRRC 2 persistent opacification of the aneurysm neck, mRRC 3a filling of the aneurysm dome within coil interstices, and mRRC 3b filling of the aneurysm dome.ResultsSixteen aneurysms were treated with the LVIS Blue device in conjunction with coil embolization with 6-month angiographic follow-up. Aneurysms were treated throughout the intracranial circulation: five proximal internal carotid artery (ICA) (ophthalmic or communicating segments), two superior cerebellar artery, two ICA terminus, two anterior communicating artery, two distal middle cerebral artery, one posterior inferior cerebellar artery, and two basilar tip aneurysms. Post-procedurally, there was one mRRC 1 closure, five mRRC 2 closures, and 10 mRRC 3a or 3b occlusion. At follow-up, all the mRRC 1 and mRRC 3a closures, 85% of the mRRC 3b closures and 75% of the mRRC 2 closures were stable or improved to an mRRC 1 or 2 at follow-up.ConclusionsThe LVIS Blue represents a safe option as a coil adjunct for endovascular embolization within both the proximal and distal anterior and posterior circulation.

Revascularization and Aneurysm Surgery

Neurosurgery ◽  
2014 ◽  
Vol 74 (5) ◽  
pp. 482-498 ◽  
Author(s):  
M. Yashar S. Kalani ◽  
Wyatt Ramey ◽  
Felipe C. Albuquerque ◽  
Cameron G. McDougall ◽  
Peter Nakaji ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Cerebral Artery ◽  
Superficial Temporal Artery ◽  
Posterior Inferior Cerebellar Artery ◽  
Superior Cerebellar Artery ◽  
External Carotid ◽  
Occipital Artery ◽  
Aneurysm Surgery ◽  
Cerebellar Artery

Abstract BACKGROUND: Given advances in endovascular technique, the indications for revascularization in aneurysm surgery have declined. OBJECTIVE: We sought to define indications, outline technical strategies, and evaluate the outcomes of patients treated with bypass in the endovascular era. METHODS: We retrospectively reviewed all aneurysms treated between September 2006 and February 2013. RESULTS: We identified 54 consecutive patients (16 males and 39 females) with 56 aneurysms. Aneurysms were located along the cervical internal carotid artery (ICA) (n = 1), petrous/cavernous ICA (n = 1), cavernous ICA (n = 16), supraclinoid ICA (n = 7), posterior communicating artery (n = 2), anterior cerebral artery (n = 4), middle cerebral artery (MCA) (n = 13), posterior cerebral artery (PCA) (n = 3), posterior inferior cerebellar artery (n = 4), and vertebrobasilar arteries (n = 5). Revascularization was performed with superficial temporal artery (STA) to MCA bypass (n = 25), STA to superior cerebellar artery (SCA) (n = 3), STA to PCA (n = 1), STA-SCA/STA-PCA (n = 1), occipital artery (OA) to PCA (n = 2), external carotid artery/ICA to MCA (n = 15), OA to MCA (n = 1), OA to posterior inferior cerebellar artery (n = 1), and in situ bypasses (n = 8). At a mean clinical follow-up of 18.5 months, 45 patients (81.8%) had a good outcome (Glasgow Outcome Scale 4 or 5). There were 7 cases of mortality (12.7%) and an additional 9 cases of morbidity (15.8%). At a mean angiographic follow-up of 17.8 months, 14 bypasses were occluded. Excluding the 7 cases of mortality, the majority of aneurysms (n = 42) were obliterated. We identified 7 cases of residual aneurysm and recurrence in 6 patients at follow-up. CONCLUSION: Given current limitations with existing treatments, cerebral revascularization remains an essential technique for aneurysm surgery.

GIANT FUSIFORM ANEURYSM ARISING FROM FENESTRATED POSTERIOR CEREBRAL ARTERY AND BASILAR TIP VARIATION

Neurosurgery ◽  
2009 ◽  
Vol 64 (3) ◽  
pp. E564-E565 ◽  
Author(s):  
Marco A. Zanini ◽  
Vitor M. Pereira ◽  
Mauricio Jory ◽  
José G.M.P. Caldas
Keyword(s):  
Cerebral Artery ◽  
Posterior Cerebral Artery ◽  
Superior Cerebellar Artery ◽  
Fusiform Aneurysm ◽  
Parent Vessel ◽  
Vessel Occlusion ◽  
Cerebellar Artery ◽  
Parent Vessel Occlusion ◽  
The Right ◽  
Double Origin

Abstract OBJECTIVE A giant fusiform aneurysm in the posterior cerebral artery (PCA) is rare, as is fenestration of the PCA and basilar apex variation. We describe the angiographic and surgical findings of a giant fusiform aneurysm in the P1–P2 PCA segment associated with PCA bilateral fenestration and superior cerebellar artery double origin. CLINICAL PRESENTATION A 26-year-old woman presented with a 2-month history of visual blurring. Digital subtraction angiography showed a giant (2.5 cm) fusiform PCA aneurysm in the right P1–P2 segment. The 3-dimensional view showed a caudal fusion pattern from the upper portion of the basilar artery associated with a bilateral long fenestration of the P1 and P2 segments and superior cerebellar artery double origin. INTERVENTION Surgical trapping of the right P1–P2 segment, including the posterior communicating artery, was performed by a pretemporal approach. Angiograms performed 3 and 13 months after surgery showed complete aneurysm exclusion, and the PCA was permeated and filled the PCA territory. Clinical follow-up at 14 months showed the patient with no deficits and a return to normal life. CONCLUSION To our knowledge, this is the first report of a giant fusiform aneurysm of the PCA associated with P1–P2 segment fenestration and other variations of the basilar apex (bilateral superior cerebellar artery duplication and caudal fusion). Comprehension of the embryology and anatomy of the PCA and its related vessels and branches is fundamental to the decision-making process for a PCA aneurysm, especially when parent vessel occlusion is planned.

scholarly journals Interhemispheric transcallosal transforaminal approach for decompression of a giant superior cerebellar artery thrombosed aneurysm: Three-dimensional operative video

2020 ◽  
Vol 11 ◽  
pp. 84
Author(s):  
Juan Leonardo Serrato-Avila ◽  
Marcos Devanir Silva Da Costa ◽  
Michel Eli Frudit ◽  
Juan Pablo Carrasco-Hernandez ◽  
Sebastián Aníbal Alejandro ◽  
...  
Keyword(s):  
Cranial Nerves ◽  
Giant Aneurysm ◽  
Mass Effect ◽  
Endovascular Embolization ◽  
Surgical Anatomy ◽  
Vasa Vasorum ◽  
Superior Cerebellar Artery ◽  
Transforaminal Approach ◽  
Flow Diverter Stent ◽  
Cerebellar Artery

Background: Giant brain aneurysms account for approximately 5% of all intracranial aneurysms, often presenting with intraluminal thrombosis that causes a mass effect in surrounding neural structures. Although its exact growing mechanism remains unknown, they have to be treated. Despite the most recent advances in neurosurgical fields, the best treatment modality remains unknown and surgery of giant superior cerebellar artery (SCA) aneurysms still is a challenge even for the most experienced neurosurgeons, due to their deep location, surrounding perforating vessels, and intraluminal thrombosis. Case Description: In this video, we present the case of a 65-year-old woman with progressive hemiparesis and paresis of low cranial nerves. The symptoms were caused by a giant aneurysm located in the origin of the SCA. Despite endovascular embolization of the aneurysm and placement of a flow diverter stent, the aneurysm increased in size causing symptoms progression. In that scenario, we decided to perform a microsurgical decompression of the aneurysm thrombus and coagulation of the vasa vasorum, to reduce the mass effect and prevent the aneurysm from keep growing. Conclusion: Through an extensive description of the surgical anatomy, we illustrate an interhemispheric transcallosal transforaminal approach, with the removal of anterior thalamic tubercle to widely expose the aneurysm dome. The surgery was successfully performed, and the patient symptoms improved. The patient signed the Institutional Consent Form, which allows the use of her images and videos for any type of medical publications in conferences and/or scientific articles.

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