Republished: Spinal arteriovenous malformation without endovascular arterial access: is a combined neurosurgical approach and direct venous puncture an option?

This case report describes a combined neurosurgical and endovascular approach for the treatment of a conus medullaris arteriovenous malformation resulting in considerable improvement in the patient's neurological condition (modified Rankin Scale score 2).

Spinal arteriovenous malformation without endovascular arterial access: is a combined neurosurgical approach and direct venous puncture an option?

This case report describes a combined neurosurgical and endovascular approach for the treatment of a conus medullaris arteriovenous malformation resulting in considerable improvement in the patient's neurological condition (modified Rankin Scale score 2).

Flow diversion treatment of aneurysms of the complex region of the anterior communicating artery: which stent placement strategy should 'I' use? A single center experience.

BACKGROUND: Aneurysms of the anterior communicating artery (ACoA) are difficult to treat with coiling or clipping because of the anatomical variation in this region. Flow diversion represents a feasible treatment, but no consensus exists as to which stent deployment technique is more suitable. METHODS: All patients with ACoA aneurysms treated with flow diverters between April 2014 and November 2018 were retrospectively analyzed. Aneurysm characteristics, follow-up results, and clinical outcome data were recorded, and a new classification comparing the diameters of both A1 segments is proposed: H1=same diameters; H2=<50% difference in diameters; H3= ≥50% difference; and Y=no A1 segment. RESULTS: We analyzed 30 procedures in 30 patients with ACoA aneurysms, including 16 ruptured aneurysms treated with coiling embolization and 4 previously unruptured aneurysms (two Medina and two Woven EndoBridge devices). Adequate aneurysm occlusion occurred in 86.9%; one patient (3.3%) experienced symptomatic ischemic stroke. The global thromboembolic complications for each group were 17.6% (H1), 25% (H2), and 60% (H3). CONCLUSION: Flow diversion treatment in this region is safe, feasible, and effective. The most suitable anatomical configuration for flow diverter treatment seems to be the H1 configuration where the 'I technique' is suitable (from an A1 segment to the ipsilateral A2). There is a tendency that the H3 configuration is not a good indication for flow diverter treatment. However, further studies are needed to evaluate the feasibility of this anatomical classification and the reproducibility of our findings.

Metastatic deaths in retinoblastoma patients treated with intraarterial chemotherapy (ophthalmic artery chemosurgery) worldwide.

BACKGROUND: Ophthalmic artery chemosurgery [OAC, intra-arterial chemotherapy (IAC)] was introduced in 2006 as treatment modality for intraocular retinoblastoma. The purpose of this commentary is to retrospectively review the incidence of metastatic deaths in retinoblastoma patients treated with OAC worldwide over a 10 year period. Retrospective data regarding metastatic deaths was collected from six international retinoblastoma centers (New York City USA, Philadelphia USA, Sao Paulo Brazil, Siena Italy, Lausanne Switzerland and Buenos Aires Argentina). All retinoblastoma patients from these centers (naive and recurrent, unilateral and bilateral) treated with OAC/IAC since 2006 have been included in this study. Data regarding number of patients, number of OAC/IAC infusions, number unilateral and bilateral, number treated for naive disease or salvage and number of metastatic deaths have been assessed. Over a 10-year period of time 1139 patients received OAC/IAC for 4396 infusions. At last follow-up there were only three metastatic deaths (all treated in Buenos Aires). CONCLUSION: The current survey assessed the recorded risk of metastatic deaths in six retinoblastoma centers worldwide in children with retinoblastoma (unilateral or bilateral) treated with OAC/IAC as primary or secondary therapy. Overall, the observed risk for metastatic deaths from retinoblastoma was <1% in OAC/IAC treated children.

Preliminary evaluation of the endovascular treatment of intracranial aneurysms with detachable coils in vigil patients / Avaliação preliminar do tratamento endovascular de aneurismas intracranianos com espirais destacáveis em pacientes no estado de vigília

Endovascular treatment of intracranial aneurysms with coil embolization became the most important therapeutic option with better morbidity and mortality rates and quality of life. Following immobility, patients are treated with general anaesthesia. OBJECTIVE: To test viability of endovascular treatment on wake patients. METHOD: Considering clinical symptoms, psychological characteristics and aneurysmal morphology, four patients with five intracranial aneurysms were selected. RESULTS: Four among five cases were completed with this technique. Patient 1 was partially treated after 75 minutes presenting vesical stress. Patient 2 presented subarachnoid hemorrhage after aneurysmal re-rupture, and the procedure was completed under general anaesthesia. The other three patients presented no intercurrences during the treatment. CONCLUSION: Endovascular treatment on wake patients with intracranial aneurysm can be an alternative to a selected group of patients.

O tratamento endovascular de aneurismas intracranianos com espirais destacáveis estabeleceu-se como principal opção terapêutica na maioria dos pacientes, por menores taxas de morbidade e mortalidade. De forma geral, os pacientes são tratados sob anestesia geral, pela necessidade de imobilidade. OBJETIVO: Avaliar a viabilidade do tratamento endovascular de aneurismas intracranianos em pacientes no estado de vigília. MÉTODO: Cinco aneurismas foram tratados em quatro pacientes selecionados, considerando-se quadro clínico, a intenção de colaboração do paciente e características morfológicas do aneurisma. RESULTADOS: A abordagem proposta foi possível em quatro dos cinco casos. O paciente 1 obteve compactação parcial do aneurisma, pois o tratamento foi interrompido por desconforto vesical. O paciente 2 apresentou hemorragia subaracnóidea por re-ruptura do aneurisma, e o tratamento foi completado no mesmo tempo sob anestesia geral. Nos demais casos, não houve intercorrências. CONCLUSÃO: O tratamento endovascular de aneurismas intracranianos em pacientes no estado de vigília é viável em grupo selecionado de pacientes.

Preliminary evaluation of the endovascular treatment of intracranial aneurysms with detachable coils in vigil patients.

UNLABELLED: Endovascular treatment of intracranial aneurysms with coil embolization became the most important therapeutic option with better morbidity and mortality rates and quality of life. Following immobility, patients are treated with general anaesthesia. OBJECTIVE: To test viability of endovascular treatment on wake patients. METHOD: Considering clinical symptoms, psychological characteristics and aneurysmal morphology, four patients with five intracranial aneurysms were selected. RESULTS: Four among five cases were completed with this technique. Patient 1 was partially treated after 75 minutes presenting vesical stress. Patient 2 presented subarachnoid hemorrhage after aneurysmal re-rupture, and the procedure was completed under general anaesthesia. The other three patients presented no intercurrences during the treatment. CONCLUSION: Endovascular treatment on wake patients with intracranial aneurysm can be an alternative to a selected group of patients.

[Galen vein thrombosis: case report]. / Trombose da veia de Galeno: relato de caso.

Cerebral venous thrombosis (CVT) is a vascular disease with many clinical manifestations and possible etiologies (local, systemic or idiopathic). Galen vein thrombosis (GVT) is a rare cause of CVT and usually it is associated with some vascular malformation. We report a case of a 16 years old female patient with GVT without vascular malformation, but associated with straight sinus thrombosis and venous thalamic infarct. Relevant aspects of the clinical, radiological and laboratory diagnosis of CVT are also discussed.

Trombose da veia de Galeno: relato de caso / Galen vein thrombosis: case report

A trombose venosa cerebral (TVC) é doença vascular com diferentes manifestações clínicas e várias causas possíveis (locais, sistêmicas ou idiopáticas). A trombose da veia de Galeno (TVG) é causa rara de TVC e geralmente está associada a alguma malformação vascular. Relatamos o caso de uma paciente de 16 anos que apresentou TVG sem malformação vascular, porém associada a trombose de seio reto e infarto venoso talâmico. Discutem-se também aspectos importantes do diagnóstico clínico, radiológico e laboratorial da TVC .