Resection of an Embolized Cirsoid Aneurysm With Intracranial Venous Drainage: 2-Dimensional Operative Video

2018 ◽  
Vol 16 (3) ◽  
pp. E94-E94 ◽  
Author(s):  
Daniel M Heiferman ◽  
Hasan R Syed ◽  
Daphne Li ◽  
Brian D Rothstein ◽  
Ali Shaibani ◽  
...  
Keyword(s):  
Surgical Excision ◽  
Venous Drainage ◽  
Vascular Supply ◽  
Endovascular Embolization ◽  
Vascular Lesions ◽  
Definitive Treatment ◽  
Cirsoid Aneurysm ◽  
Institutional Review ◽  
Diagnostic Angiography ◽  
Scalp Lesion

Abstract Cirsoid aneurysms, also known as scalp arteriovenous malformations (AVM), are rare congenital extracranial vascular anomalies that often present as an enlarging pulsatile scalp mass. A 14-yr-old male presented with a pulsatile scalp lesion that was first noticed 3 yr prior and had progressively enlarged. No history of trauma was reported. MRI demonstrated a 4 cm wide and 2 cm tall nidus and catheter angiography was performed to further define the vascular supply and drainage. The patient underwent transvenous endovascular embolization followed by surgical excision via a bicoronal incision, as shown in this operative video. Care was taken to identify, cauterize, and transect feeding vessels from the superficial temporal, supratrochlear, and supraorbital arteries circumferentially to completely devascularize and resect the galeal nidus from overlying scalp tissue and underlying pericranium. Previously unreported in the literature, transosseous emissary veins partially draining the lesion were noted on angiography and were waxed thoroughly during surgery. Six-month follow-up examination demonstrated a well-healed incision without evidence of AVM recurrence. The unique venous drainage of this cirsoid aneurysm highlights the value of diagnostic angiography to fully characterize these rare and complex vascular lesions prior to pursuing definitive treatment.  IRB approval was obtained from the Ann & Robert H. Lurie Children's Hospital of Chicago Institutional Review Board (IRB #2018-1799). The IRB waives the requirement of obtaining informed consent for this study in accordance with 45 CFR 46.116(d).

Surgical Dissection of a Perimedullary Fistula of Conus Medullaris With Long-Term Follow-Up: 2-Dimensional Operative Video

2018 ◽  
Vol 17 (2) ◽  
pp. E59-E59 ◽  
Author(s):  
Thomas J Sorenson ◽  
Giuseppe Lanzino
Keyword(s):  
Surgical Excision ◽  
Vascular Supply ◽  
Conus Medullaris ◽  
Endovascular Embolization ◽  
Neurological Deficits ◽  
Vascular Lesions ◽  
Complete Obliteration ◽  
Long Term Follow Up ◽  
Clinical And Radiological Outcome

Abstract Perimedullary fistulae of the spinal cord are rare vascular lesions that can present with different clinical patterns: hemorrhage, progressive myelopathy due to arterial steal and/or venous congestion, or symptoms due to compression of neural structures by engorged vessels. Treatment consists of surgical excision, endovascular embolization, or a combination of the two. If complete obliteration of the nidus exposes the patient to undue risk of permanent neurological deficits, incomplete obliteration with reduction of the vascular supply is a reasonable compromise to improve clinical symptomatology. Partial devascularization may also alter the natural history by decreasing the risk of further growth and bleeding. In this video we illustrate the case of a patient with a perimedullary fistula of the conus treated with surgical disconnection of the main fistulous component. Partial devascularization resulted in resolution of MRI signal changes and symptoms with documented good clinical and radiological outcome and progressive regression of the residual nidus over six years of follow-up.

scholarly journals Carotid body tumour: an enigma that remains

2019 ◽  
Vol 5 (2) ◽  
pp. 479
Author(s):  
Rachel C. A. Lim ◽  
Jeyasakthy Saniasiaya ◽  
Rohaizam Bin Japar Jaafar ◽  
Zakinah Bt Yahaya ◽  
Iskandar B. Hailani
Keyword(s):  
Carotid Body ◽  
Thromboembolic Event ◽  
Anatomical Variation ◽  
Surgical Excision ◽  
Vascular Supply ◽  
External Carotid Artery ◽  
Definitive Treatment ◽  
External Carotid ◽  
Carotid Body Tumour ◽  
Rare Presentation

<p class="abstract">Carotid body tumour is a form of paraganglioma which arises from the carotid body. This tumour is known for its rich vascular supply mainly contributed by the ascending pharyngeal artery, a branch from external carotid artery. Surgical excision preceded by pre-operatic embolization remains the definitive treatment despite the countless feared complications. We present our experience with a case of carotid body tumour which was embolised prior to surgical excision, unfortunately complicated with a thromboembolic event. This patient was found to have an anatomical variation in the cerebrovascular anatomy known as a fetal posterior cerebral artery which led to a paradoxical PCA infarction post-embolization. We would like to highlight this rare presentation along with its management as there were scarce evidence of this case in the literature.</p>

Unusual clinical manifestations of dural arteriovenous malformations

1986 ◽  
Vol 64 (4) ◽  
pp. 554-558 ◽  
Author(s):  
Fernando Viñuela ◽  
Allan J. Fox ◽  
David M. Pelz ◽  
Charles G. Drake
Keyword(s):  
Arteriovenous Malformations ◽  
Clinical Manifestations ◽  
Signs And Symptoms ◽  
Surgical Excision ◽  
Venous Drainage ◽  
Endovascular Embolization ◽  
External Carotid Artery ◽  
External Carotid ◽  
Content Type ◽  
Visual Disturbances

✓ Fourteen patients had classical angiographic findings of intracranial dural arteriovenous malformations (AVM's). They presented with unusual central neurological signs and symptoms, including visual disturbances, hemiparesis, speech disturbances, gait ataxia, diffuse increased intracranial pressure, and intracranial hemorrhage. In 12 of the 14 patients there was a direct correlation between the clinical presentation and the venous drainage characteristics of the AVM's. The symptoms were probably related to a regional steal phenomenon in two patients. Six patients had direct surgical excision of the dural AVM. Five patients underwent endovascular embolization of the malformation and, in one case, the AVM was removed surgically after embolization. In one patient, the external carotid artery in the neck was ligated. Ten of the 14 patients had substantial clinical improvement or cure. A complete anatomical obliteration of the malformation was obtained in seven cases. None of the patients deteriorated clinically after therapy.

scholarly journals Endovascular transvenous cure for ruptured brain arteriovenous malformations in complex cases with high Spetzler-Martin grades

2015 ◽  
Vol 122 (5) ◽  
pp. 1229-1238 ◽  
Author(s):  
Christina Iosif ◽  
Georges A. C. Mendes ◽  
Suzana Saleme ◽  
Sanita Ponomarjova ◽  
Eduardo Pedrolo Silveira ◽  
...  
Keyword(s):  
Arteriovenous Malformations ◽  
Clinical Status ◽  
Surgical Techniques ◽  
Venous Drainage ◽  
Endovascular Embolization ◽  
Modified Rankin Scale ◽  
Transvenous Embolization ◽  
Scale Scores ◽  
Therapeutic Decision Making ◽  
Brain Avms

OBJECT Ruptured cerebral arteriovenous malformations (AVMs) with deep localization and high Spetzler-Martin grades are associated with considerable challenges regarding nidus eradication treatment. The authors report their experience with curative endovascular transvenous embolization in a series of patients harboring “untreatable” lesions. METHODS Between January 2008 and June 2013, a transvenous endovascular embolization protocol was implemented at the authors' institution for consecutive patients with ruptured brain AVMs that were considered incurable by classic endovascular and surgical techniques. Therapeutic decision making was based on Spetzler-Martin grades, AVM location, type of venous drainage, and angioarchitectural evaluation. Complete exclusion of the nidus was the objective of treatment. RESULTS Twenty patients (10 male and 10 female, mean age 36.7 ± 17.7 years) were included. Initial Spetzler-Martin grades were III–V for 90.0% of the patients. The lesions were deeply seated in 80% and in eloquent locations in 90% of cases. The preprocedural modified Rankin Scale score was 0–2 for 12 of the 20 patients (60.0%), 3 for 2 patients (10.0%), and 4 for 6 patients (30.0%). The postprocedural clinical status was unchanged for all patients. The procedure was technically feasible in all cases. Procedure-related mortality was 0%. Ninety percent of the patients were independent in their everyday lives (modified Rankin Scale Scores 0–2) at the 6-month follow-up. In all cases but one (95%) the embolization was curative, confirmed by selective DSA at 6 months and 18 months postintervention. CONCLUSIONS Single-session endovascular transvenous embolization seems to be a safe and effective curative treatment for patients harboring complex brain AVMs with high Spetzler-Martin grade.

scholarly journals Intraductal Papilloma Without Atypia on Image- Guided Breast Biopsy: Upgrade Rates to Carcinoma at Surgical Excision

Breast Care ◽  
2018 ◽  
Vol 13 (5) ◽  
pp. 364-368 ◽  
Author(s):  
Doris Leithner ◽  
Benjamin Kaltenbach ◽  
Petra Hödl ◽  
Volker Möbus ◽  
Volker Brandenbusch ◽  
...  
Keyword(s):  
Needle Biopsy ◽  
Breast Biopsy ◽  
Ductal Carcinoma ◽  
Statistical Tests ◽  
Menopausal Status ◽  
Surgical Excision ◽  
Lesion Size ◽  
Intraductal Papilloma ◽  
Image Guided ◽  
Institutional Review

Background: The management of intraductal papilloma without atypia (IDP) in breast needle biopsy remains controversial. This study investigates the upgrade rate of IDP to carcinoma and clinical and radiologic features predictive of an upgrade. Methods: Patients with a diagnosis of IDP on image-guided (mammography, ultrasound, magnetic resonance imaging) core needle or vacuum-assisted biopsy and surgical excision of this lesion at a certified breast center between 2007 and 2017 were included in this institutional review board-approved retrospective study. Appropriate statistical tests were performed to assess clinical and radiologic characteristics associated with an upgrade to malignancy at excision. Results: For 60 women with 62 surgically removed IDPs, the upgrade rate to malignancy was 16.1% (10 upgrades, 4 invasive ductal carcinoma, 6 ductal carcinoma in situ). IDPs with upgrade to carcinoma showed a significantly greater distance to the nipple (63.5 vs. 36.8 mm; p = 0.012). No significant associations were found between upgrade to carcinoma and age, menopausal status, lesion size, microcalcifications, BI-RADS descriptors, initial BI-RADS category, and biopsy modality. Conclusion: The upgrade rate at excision for IDPs diagnosed with needle biopsy was higher than expected according to some guideline recommendations. Observation only might not be appropriate for all patients with IDP, particularly for those with peripheral IDP.

scholarly journals Preoperative Cyanoacrylate Embolization of Venous Malformations

2018 ◽  
Vol 02 (01) ◽  
pp. 042-050 ◽  
Author(s):  
Eric Monroe ◽  
Rush Chewning ◽  
Kevin Koo ◽  
Giri Shivaram
Keyword(s):  
Blood Loss ◽  
Surgical Margin ◽  
Surgical Excision ◽  
High Volume ◽  
Definitive Treatment ◽  
Incomplete Resection ◽  
Venous Malformations ◽  
Cyanoacrylate Glue ◽  
Multiple Treatment ◽  
Percutaneous Sclerotherapy

AbstractPercutaneous sclerotherapy and standalone surgical excision have historically been the mainstay of treatment for pediatric venous malformations (VMs). However, both approaches have significant limitations. Sclerotherapy often requires multiple treatment sessions, with each round adding additional procedural and anesthetic risks as well as radiation exposure. Standalone surgical excision of VMs can be complicated by high-volume blood loss, and indistinct lesion margins can lead to incomplete resection, resulting in recurrence. An alternative to these approaches is percutaneous cyanoacrylate glue embolization followed by immediate surgical excision, a single-stage procedure that allows for better surgical margin definition and reduced intraoperative blood loss, potentially leading to more definitive treatment. The authors describe the interventional radiology aspects of this combined procedure, emphasizing materials preparation and embolization technique.

scholarly journals Embolization of a superior sagittal sinus dural arteriovenous fistula under intrasinus balloon protection: A case report

2015 ◽  
Vol 21 (1) ◽  
pp. 94-100 ◽  
Author(s):  
Yongxin Zhang ◽  
Qiang Li ◽  
Qing-hai Huang
Keyword(s):  
Dural Arteriovenous Fistula ◽  
Superior Sagittal Sinus ◽  
Therapeutic Option ◽  
Venous Drainage ◽  
Endovascular Embolization ◽  
Arteriovenous Fistulas ◽  
Sagittal Sinus ◽  
Dural Arteriovenous Fistulas ◽  
Cerebral Venous Drainage ◽  
Balloon Protection

Endovascular embolization has evolved to become the primary therapeutic option for dural arteriovenous fistulas (DAVFs). While guaranteeing complete occlusion of the fistula orifice, the goal of DAVF embolization is also to ensure the patency of normal cerebral venous drainage. This paper describes a case of successful embolization of a complex DAVF in the superior sagittal sinus with a multistaged approach using a combination of transvenous and transarterial tactics. The strategies and techniques are discussed.

scholarly journals Isolated Cor Triatriatum Sinister: A Case Report

2020 ◽  
Vol 18 (1) ◽  
pp. 28-30
Author(s):  
Zanda Grīnberga ◽  
Pauls Sīlis ◽  
Elīna Ligere ◽  
Ingūna Lubaua ◽  
Inta Bergmane ◽  
...  
Keyword(s):  
Left Atrium ◽  
Pulmonary Veins ◽  
Surgical Excision ◽  
Venous Drainage ◽  
Treatment Method ◽  
Cor Triatriatum ◽  
Cardiac Anomaly ◽  
Congenital Cardiac Anomaly ◽  
Cor Triatriatum Sinister ◽  
The Right

SummaryCor triatriatum sinister is a rare congenital cardiac anomaly that has been identified in 0.1% of children with congenital heart disease. It is defined as a fibromuscular membrane that divides the left atrium into two chambers: a superior (proximal) that in most cases receives drainage from the pulmonary veins and an inferior (distal) chamber that communicates with the mitral valve and the left atrium. Cor triatriatum sinister can be an isolated lesion (approximately 25% of cases), but in many cases it is associated with other congenital cardiovascular anomalies, the most common one being – atrial septal defect(3). Symptoms in patients with cor triatriatum sinister are related to obstruction of pulmonary venous drainage, pressure loading of the right side of the heart and congestive cardiac failure. Depending on the severity of the obstruction and presence of associated cardiac anomalies it can be diagnosed at any age. Diagnosis is usually achieved by echocardiography in early infancy. Elective treatment method is surgical excision of the membrane. Here we present a pediatric patient (4 months old) presenting in cardiogenic shock with a successful correction of isolated cor triatriatum sinister. To confirm diagnosis and success of surgical repair, transthoracic and transesophageal echocardiography were used.

scholarly journals Maternal and neonatal consequences in women with severe preeclampsia and patients with HELLP syndrome: a comparative study

2020 ◽  
Vol 11 (4) ◽  
Author(s):  
Ahmed SSA Rashwan
Keyword(s):  
Hellp Syndrome ◽  
Statistical Significance ◽  
Health Hazard ◽  
Severe Preeclampsia ◽  
University Hospital ◽  
Definitive Treatment ◽  
Icu Admission ◽  
Institutional Review ◽  
Elevated Liver Enzymes ◽  
Multiple Drugs

Background: The (HELLP) syndrome is a severe health hazard in pregnancy described by elevated liver enzymes, low platelet count and hemolysis. It happens in 0.4 to 0.7% of all gestations and in 10-12% of cases with severe preeclampsia. Patients and methods: The present study was a prospective observational study that was made at Department of Obstetrics and Gynecology, Kasr Al-Ainy University Hospital, Cairo University, from September 2018 – March 2019. It included One Hundred and Thirty pregnant women diagnosed with hypertension in the current pregnancy complicated with severe preeclampsia, or HELLP Syndrome associated with abdominal ascites, recruited from the attendees of the Obstetric Emergency Department. The study was approved by the local institutional review board of the Faculty of Medicine, Cairo University. All ladies signed an informed consent. Results: There were statistically significant differences between the HELLP group and the severe preeclamptic group regarding maternal ICU admission and the need of multiple drugs to control the blood pressure being less in severe preeclampsia group. The need for ICU admission was much higher in the HELLP group (43.1%) compared to the severe preeclampsia group (9.2%) showing statistical significance (P<0.001). Conclusion: Maternal and neonatal sicknesses are elevated between cases with HELLP syndrome. So, early diagnosis and definitive treatment can be made to enhance maternal and neonatal results.

scholarly journals Nongalenic arteriovenous fistulas: history of treatment and technology

2006 ◽  
Vol 20 (6) ◽  
pp. 1-8 ◽  
Author(s):  
Kristen Upchurch ◽  
Lei Feng ◽  
Gary R. Duckwiler ◽  
John G. Frazee ◽  
Neil A. Martin ◽  
...  
Keyword(s):  
Open Surgery ◽  
Interventional Neuroradiology ◽  
Endovascular Embolization ◽  
High Flow ◽  
Vascular Lesions ◽  
Arteriovenous Fistulas ◽  
The Past ◽  
Technological Developments ◽  
History Of ◽  
Endovascular Technology

✓ Nongalenic cerebral arteriovenous fistulas (AVFs) are uncommon, high-flow vascular lesions first treated by Walter Dandy and his colleagues by using open surgery with ligation of the feeding artery. Due to advances in endovascular technology over the past four decades that make possible the control of high flow in AVFs, treatment has evolved from the sole option of surgery to include the alternative or adjunct option of endovascular embolization. The authors of this review discuss the history of nongalenic AVF treatment, including techniques of both surgery and interventional neuroradiology and the technological developments underlying them.

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