Selective endovascular treatment of a traumatic basilar aneurysm after endoscopic third ventriculostomy.

A 4-year-old girl suffered intraventricular and subarachnoid hemorrhage during endoscopic third ventriculostomy. Cerebral angiography revealed a traumatic basilar aneurysm secondary to basilar artery injury. The aneurysm was treated with selective endovascular embolization using Guglielmi detachable coils. We review some therapeutic features of traumatic basilar aneurysms after endoscopic third ventriculostomy and describe the feasibility of endovascular selective therapy to manage these lesions successfully.

Endoarterial management of dural arteriovenous malformations with isolated sinus using Onyx-18: technical case report.

OBJECTIVE: Anatomic and clinical cure of dural arteriovenous malformations (DAVM) with isolated sinus is difficult to achieve by endovascular means without previous surgical exposure. We propose a new management technique using a new liquid embolic agent (ethylene-vinyl alcohol copolymer [Onyx-18]; ev3 Inc., Plymouth, MN) via an endoarterial approach that would avoid surgical craniotomy. BACKGROUND: Data of three consecutive patients with a DAVM with isolated sinus treated at our department between January 2005 and June 2005 are described. Procedures performed under general anesthesia consist of an arterial approach whereby a microcatheter is navigated via a meningeal feeder to the DAVM. Onyx-18, which diffuses under aqueous conditions, is then delivered, mechanically filling the isolated sinus and ultimately treating it. RESULTS: The patients included two men and one woman aged 69, 71, and 64 years, respectively. All patients were classified as Merland Type IV. Two patients presented with DAVMs involving the transverse-sigmoid sinus, and one patient presented with a DAVM involving the superior sagittal sinus with an isolated venous collector. All three fistulae were treated with transarterial embolization, using Onyx-18, through the filling of the pathological sinus via the anterior meningeal artery branch of the ophthalmic artery (DAVM at the superior sagittal sinus), and the other two patients were treated by means of the petrosquamous branch of the middle meningeal artery (DAVM at the transverse-sigmoid sinus). Postoperative digital subtraction angiography confirmed the elimination of the DAVMs in all three patients. The follow-up study ranging from 3 to 12 months (average, 7.5 mo) revealed no recurrence, and all of the patients had clinical improvement and recovered to their full activities. CONCLUSION: DAVMs with isolated sinus and retrograde venous drainage to the cortical system are aggressive vascular lesions that can be treated by transarterial embolization using Onyx-18. This procedure allowed us to achieve an anatomic and clinical cure in the three patients consecutively treated without the need for surgical exposure of the compromised sinus.

Do leptomeningeal venous drainage and dysplastic venous dilation predict hemorrhage in dural arteriovenous fistula?

BACKGROUND: The objective of this study was to correlate the presence of leptomeningeal venous drainage and dysplastic venous dilation with the risk of intracranial hemorrhage in DAVFs. METHODS: The subjects for this research were composed of 93 patients with DAVFs who were studied retrospectively with regard to therapeutic success and failure, who had undergone either neurosurgery or embolization or a combination of both methods, and whose disease was located in the cavernous sinus, the superior sagittal sinus, or the transverse-sigmoid sinus of the anterior fossa or of the tentorium. Also among these study subjects were patients who had had angiography done in at least 6 cranial vessels (external and internal carotid and vertebral arteries) before and after treatment and who had a minimum follow-up of 3 months. Cases of leptomeningeal venous drainage and dysplastic venous dilation and their associations with intracranial hemorrhage were ascertained for all the 93 case patients included in the study. RESULTS: The presence of leptomeningeal drainage (P = .0002) and that of dysplastic venous dilation (P = .036) increased the risk of intracranial hemorrhage in case patients for DAVFs of the 5 regions. CONCLUSION: There is a statistical significance between risk of intracranial hemorrhage in DAVFs and the presence of leptomeningeal drainage and dysplastic venous dilation.

Analysis of the best therapeutic alternative for intracranial dural arteriovenous malformations.

The material for this research consisted of 93 patients with dural arteriovenous malformations (DAVMs) who were studied retrospectively with regards to therapeutic success and failure, who had undergone either neurosurgery, or embolization or a combination of both methods and whose disease was located in the cavernous sinus, the superior sagittal sinus, the transverse-sigmoid sinus of the anterior fossa and the tentorium. Thus, it was possible to arrive at the following conclusions: treatment of the DAVMs must be indicated, jointly, by an interventionist neuroradiologist and a neurosurgeon; DAVMs of the transverse-sigmoid sinus were better treated when a combination of both methods was used; DAVMs of the tentorium were also better treated with a combined method; the endovascular method ensured only a 50% chance of therapeutic success for DAVMs of the superior sagittal sinus; DAVMs of the cavernous sinus are better treated when the endovascular method was used with a transvenous approach, relative to the transarterial approach.

Analysis of the best therapeutic alternative for intracranial dural arteriovenous malformations

O material utilizado consistiu de 93 pacientes portadores de malformações arteriovenosas durais (MAVDs) estudados retrospectivamente em relação ao sucesso e ao fracasso terapêutico submetidos aos métodos neurocirúrgico ou endovascular ou, ainda, combinação entre ambos, em que a doença se localizou nas regiões do seio cavernoso, do seio sagital superior, do seio transverso-sigmóide, da fossa anterior e do tentório. As conclusões foram as seguintes: o tratamento das MAVDs deve ser indicado pelo neurorradiologista intervencionista e pelo neurocirurgião, conjuntamente; as MAVDs do seio transverso-sigmóide foram melhor tratadas através do método combinado; as MAVDs do tentório foram melhor tratadas através do método combinado; as MAVDs do seio sagital superior tratadas por método endovascular asseguraram apenas 50% de sucesso terapêutico; as MAVDs do seio cavernoso são melhor tratadas por método endovascular empregando-se a via transvenosa quando comparadas com a via transarterial.

Malformação arteriovenosa dural do seio transverso-sigmóide causando neuralgia trigeminal / Transverse-sigmoid sinus dural arteriovenous malformation presenting as trigeminal neuralgia

Os autores relatam um caso raro de malformação arteriovenosa dural (MAVD) do seio transverso-sigmóide esquerdo, causando neuralgia do trigêmeo. O paciente foi submetido a cirurgia para esqueletização do seio transversosigmóide com ressecção dos dois terços distais do seio transverso e dos dois terços proximais do seio sigmóide. O procedimento cirúrgico foi suficiente para proporcionar a cura angiográfica e clínica, com um seguimento de oito meses. Foi realizada uma completa revisão bibliográfica encontrando-se apenas cinco casos descritos de pacientes com MAVD e neuralgia trigeminal.

The authors report a rare case of transverse-sigmoid dural arteriovenousmalformation (DAVM) presenting as trigeminal neuralgia in the distribution of left V3. The patient was treated surgically by the sinus skeletonization technique with the resection of the distal 2/3 of the transverse sinus and the proximal 2/3 of the sigmoid sinus. Clinical and angiographic cure was achieved in our patient with a folow-up of 8 months. Furthermore, a thorough review of the English language literature was carried out, compiling only five cases of trigeminal neuralgia due to DAVM.

Anatomia microcirúrgica do corpo da fissura coroidéia para acesso ao III ventrículo / Microsurgical anatomy of the body of the choroidal fissure to approach the third ventricle

Os autores apresentam o estudo da anatomia microcirúrgica do corpo da fissura coroidéia, baseado na dissecçao de 10 encéfalos humanos com auxílio de microscópio cirúrgico. As distância médias encontradas entre a físsura coroidéia e as seguintes estruturas foram, respectivamente, de: aderência intertalâmica, 12,8 mm; assoalho do terceiro ventrículo, 19,2 mm; comissura anterior, 16,0 mm; comissura posterior, 20,4 mm. Esses achados foram analisados e correlacionados com aspectos neurocirúrgicos da abordagem da regiao do corpo da físsura coroidéia ao III ventrículo.

Tratamento cirúrgico das fístulas liquóricas da base craniana anterior / Treatment of cerebrospinal fluid fistulae of the anterior base

Foram estudados, retrospectivamente, 22 pacientes portadores de fístula liquórica da base craniana anterior (FLBCA), tratados no período entre 1987 e 1993. O estudo levou em consideraçäo aspectos referentes à etiologia, apresentaçäo clínica, exames radiológicos, técnica cirúrgica e resultados do tratamento. A utilizaçäo da tomografia computadorizada craniana com cisternografia e identificaçäo do sítio exato da fístula revelou-se fator fundamental no sucesso do tratamento. A via intradural, para correçäo das FLBCA situadas na regiäo da lâmina crivosa e/ou plano esfenoidal, deve ser preferida pois possibilita a preservaçäo do olfato.