Treatment of Wide-Necked Bifurcation Aneurysms : Initial Results with the pCANvas Neck Bridging Device.

BACKGROUND: Recently, numerous devices dedicated to the treatment of wide-necked aneurysms have become available. We present our initial experience with the pCANvas device and present the technical success rate, clinical outcome and immediate angiographic occlusion rates. OBJECTIVE: We sought to determine the efficacy of flow with the pCANvas for the treatment of unruptured intracranial aneurysms. METHODS: We performed a retrospective review of our prospectively collected data to identify patients treated with the pCANvas device between February 2015 and February 2017. The patient demographics, aneurysm characteristics, immediate and delayed clinical and radiographic follow-up data were recorded. RESULTS: We identified 17 patients (13 female) treated only with the pCANvas device. The average age of the patients was 60.5 ± 13.3 years (range 25-75 years). The average dome width was 7.6 ± 3.2 mm (range 3-15.8 mm), dome height 7.1 ± 3.2 mm (range 3-12.9 mm) and neck width 5.4 ± 3.2 (range 3-16.3 mm). The average aspect ratio was 1.5 ± 0.8 (range 0.6-3.7). At the end of the procedure 15 aneurysms continued complete filling of the aneurysm (Raymond Roy Classification[RRC] 3) with 2 aneurysms showing only filling of the neck of the aneurysm (RRC 2). Early follow-up angiography was available for 16 patients and at this stage 11 aneurysms showed persistent and complete filling of the aneurysm (RRC 3), 5 aneurysms showed complete occlusion of the aneurysm (RRC 1) and 7 aneurysms underwent repeat treatment with coiling. CONCLUSION: The early results on the use of the pCANvas are promising; however, longer term follow-up and larger studies are required.

Endovascular occlusion of pial arteriovenous macrofistulae, using pCANvas1 and adenosine-induced asystole to control nBCA injection.

Background In large-caliber pial macrofistulae (pMF), the combination of high blood flow velocity and large efferent artery diameter makes control over the endovascular vessel occlusion difficult and may result in the inadvertent venous passage of occlusive devices or embolic agents. Case descriptions Patient 1: A 27-year-old man presented with headache and ataxia. An infratentorial pMF supplied by both superior cerebellar arteries with venous ectasia was found. The first treatment attempt using balloons and coils failed since the position of either device could not be controlled because of a distal diameter of the feeding artery of 8 mm. In a second session a pCANvas1 (phenox) was deployed at the level of the arteriovenous connection and adenosine-induced asystole allowed the controlled injection of nBCA/Lipiodol with partial occlusion of the pMF. A remaining arteriovenous shunt was occluded under asystole in a third session. The procedures were well tolerated, the patient returned to normal and DSA confirmed the occlusion of the fistula. Patient 2: A 13-year-old boy with hereditary hemorrhagic teleangiectasia presented with an intracerebral hemorrhage from an aneurysm of the left MCA. Twelve weeks after the aneurysm treatment a feeding MCA branch (diameter 4.5 mm) of a right frontal pMF was catheterized. The macrofistula was occluded by deployment of a pCANvas1, followed by the injection of nBCAl/Lipiodol under adenosine-induced asystole. Conclusion pCANvas1 and adenosine-induced asystole allow a controlled injection of nBCA/Lipiodol for the endovascular occlusion of high-flow pMF without venous passage of the embolic agent.

[Magnetic resonance of brain involvement in progressive facial hemiatrophy (Romberg's disease). Reconsideration of a syndrome]. / Ressonância magnética do envolvimento cerebral na hemiatrofia facial progressiva (doença de Romberg). Reconsideração de uma síndrome.

UNLABELLED: Progressive facial hemiatrophy (PFH) is a sporadic disease of unclear etiology, characterized by shrinking and deformation of one side of the face. Reports and interpretations of CNS involvement in PFH, as deduced from the occurrence of seizures in some patients and documented by pneumoencephalography and CT findings in small series of patients, are contradictory. We examined three female patients with PFH, one with partial epilepsy, with the view to gaining further insight into the pathogenesis of the disease. METHODS: Routine MR examinations of the head and face were performed. RESULTS: Only the patient with epilepsy showed pathological findings, confined to the cerebral hemisphere homolateral to the facial hemiatrophy, and including monoventricular enlargement, meningo-cortical dysmorphia and white matter changes. CONCLUSIONS: The MR morphology, and corresponding neuroradiological and histopathological findings disclosed by a review of the literature, indicate that homolateral hemiatrophy is a typical finding for a subgroup of PFH patients, but do not support the model of a simple or nutritive atrophic process. We reconsider chronic localized meningo-encephalitis with vascular involvement as possible underlying cause of the occasional brain involvement in PFH.

Ressonância magnética do envolvimento cerebral na hemiotrofia facial progressiva (doença de Romberg): reconsideraçäo de uma síndrome / Magnetic resonance of brain involvement in progressive facial hemiatrophy (Romberg's disease): reconsideration of a syndrome

A hemiatrofia facial progressiva (HFP) é doença esporádica de etiologia näo esclarecida, caracterizada por progressiva atrofia e deformaçäo de um dos lados da face. Os relatos e interpretaçöes de comprometimento do sistema nervoso central HFP, conforme deduzido pela ocorrência de crises epilépticas em alguns pacientes e pela documentaçäo por pneumencefalografia e CT em pequenas séries de pacientes, säo contraditórios. Examinamos tres pacientes do sexo feminino com HFP, uma com epilepsia, com o objetivo de obter mais informaçöes sobre patogênese da doença. Métodos: Realizamos exames de ressonância magnética nuclear (RMN) de rotina da cabeça e face. Resultados: Apenas a paciente com epilepsia apresentou achados patológicos no cérebro. Estes eram confinados ao hemisfério homolateral à hemiatrofia facial: dilataçäo monoventricular, dismorfismo maningo-cortical e alteraçöes na substância branca. Conclusöes: As alteraçöes morfológicas verificadas à RMN assim como os achados neurorradiológicos e histopatológicos mostrados em revisäo da literatura indicaram que a hemiatrofia homolateral é achado típico para um subgrupo de pacientes com HFP, mas näo indica um modelo de simples processo atrófico. Reconsideramos a possibilidade de uma meningoencefalite crônica com acometimento vascular como possível causa do ocasional envolvimento cerebral na HFP