[Paraspinal arteriovenous malformations with perimedullary venous drainage]. / Malformations artérioveineuses paraspinales à drainage veineux épidural.

Symptoms of chronic myelopathy in cases of paraspinal arteriovenous malformations are most often related to perimedullary venous drainage. Here, we report on three cases of such malformations that have unique epidural venous drainage. These thoracolumbar lesions manifested as isolated back pain (in two cases) and S1 lumboradicular pain (in one case). MRI presented evidence to suggest a diagnosis of these rare conditions, based on signs of vertebral erosion, signal loss (flow void) on T1- and T2-weighted imaging, and partial enhancement after gadolinium injection, with no signs of congestive myelopathy. Spinal angiography confirmed the presence of a paraspinal fistula and, at the same time, allowed treatment by intra-arterial onyx injection.

[Acutely ruptured intracranial aneurysms treated with GDC coils. Results from a single center over a period of 5 years]. / Traitement endovasculaire des anévrysmes rompus a la phase aiguë. Résultat d'une étude prospective monocentrique. Pronostic à court terme.

PURPOSE: We prospectively reviewed the clinical results of acutely ruptured cerebral aneurysms treated with GDC over a 5 year period, in order to characterize death and dependency factors. METHODS: Between 1997 and 2002, 229 patients (254 aneurysms treated, 140 females, 89 males; mean age: 51 years) with aneurysmal subarachnoid hemorrhage were treated with GDC (Boston Scientific Neurovascular, Fremont, CA) once the anatomical conditions of feasibility had been achieved. Over 90% of the aneurysms treated (mean size: 5,8 mm) were located in the anterior circulation. The anterior communicating artery complex (87 cases), the posterior aspect of the internal carotid artery (65 cases), and the middle cerebral artery (49 cases) were most commonly treated. RESULTS: At the end of the initial hospitalization period, 14 patients (6.1%) died. Major procedural complications were associated with perforation of the aneurysmal sac in 9 patients (3.9%), thromboembolic events in 10 patients (4.3%) which resulted in 2 deaths (0.8%) and permanent neurologic morbidity in 7 patients (3%). The univariate analysis demonstrated no correlation between death and time-to-treatment, the topography of the aneurysm, or the occurrence of treatment related complications. The results of the logistical regression model demonstrated that the clinical score upon entry, and the occurrence of delayed ischemia were the only independent factors correlated with patient death. The prognostic factors affecting the degree of sequellae identified by the logistical regression model were the clinical score upon admission, age, treatment related complications, and pulmonary complications. CONCLUSIONS: Endovascular treatment of ruptured anterior circulation aneurysms with GDC, including MCA aneurysms, is associated with low morbidity and allows good overall outcomes in patients with subarachnoid hemorrhage. A better understanding of dependency factors associated with endovascular coiling will foster further technical advances in order to improve the treatment of small and medium sized ruptured aneurysms.