Transvenous embolization of intracranial dural arteriovenous shunts through occluded venous segments: experience in 51 Patients.

BACKGROUND AND PURPOSE: DAVFs with cortical venous reflux carry a high risk of morbidity and mortality. Endovascular treatment options include transarterial embolization with a liquid embolic agent or transvenous access with occlusion of the involved venous segment, which may prove difficult if the venous access route is thrombosed. The aim of this article is to describe the technique and results of the transvenous approach via thrombosed venous segments for occlusion of DAVFs. MATERIALS AND METHODS: Our study was a retrospective analysis of 51 patients treated with a transvenous approach through an occluded sinus that was reopened by gentle rotational advancement of a 0.035-inch guidewire, which opened a path for a subsequently inserted microcatheter. RESULTS: Of 607 patients with DAVFs, the transvenous reopening technique was attempted in 62 patients in 65 sessions and was successful in 51 patients and 53 sessions. Immediate occlusion was seen in 42 patients; on follow-up, occlusion was seen in 49 patients, whereas 2 patients had reduced flow without cortical venous reflux. No permanent procedure-related morbidity was noted. CONCLUSIONS: The reopening technique to gain access to isolated venous pouches or the cavernous sinus for the treatment of DAVFs is a safe and effective treatment, which should be considered if transarterial approaches fail or are anticipated to result only in an incomplete anatomic cure.

Endovascular management in children with vein of Galen aneurysmal malformation.

BACKGROUND: A vein of Galen aneurysmal malformation (VGAM) is a relatively rare vascular malformation, often resulting in high morbidity and mortality. While surgical arterial clipping has been reported for decades, results in the literature have recently favored endovascular treatment. METHODS: During a 10-year period, all children who were diagnosed with VGAM were included in our follow-up study. Clinical and radiological records of 5 consecutive patients were reviewed. RESULTS: 5 children (4 infants and 1 child) who suffered from symptoms caused by VGAM were treated by means of transarterial embolization with N-butyl cyanoacrylate (NBCA) alone. Their age at the time of diagnosis ranged from 4 months to 3 years. 4 of the 5 patients presented with macrocranium, and 3 of those 4 patients were infants. The fifth patient presented with seizures. None of the patients presented with hemorrhage. 2 of the 5 VGAM patients were classified as the mural type, while the others 3 were of the choroidal type. Both mural type patients achieved total obliteration of lesions with good outcomes. One of the remaining 3 patients exhibited autistic behavior during late follow-up, whereas the other 2 had good outcomes. 2 patients suffered from asymptomatic ruptured arterial feeders during embolization, which were treated immediately with glue embolization. CONCLUSION: Our purpose in treating a patient with VGAM is to achieve normal brain development using minimally invasive interventions. Our treatment strategies were influenced by each patient's clinical status, their ages, and varying radiographic features. We achieved considerable successful in treating our patients by means of transarterial embolization alone.

Multiple symptomatic cerebral arteriovenous malformations in a patient with HIV.

This brief case report describes an unusual presumed association of chronic HIV infection with multiple cerebral arteriovenous malformations. An adult male patient presented with recurrent spontaneous brain intracranial hemorrhages and neurologic deficits requiring surgical evacuation. The diagnosis was delayed because of lack of a high index of suspicion of this unexpected and previously unrecognized association.

Trigeminal fistula treated by combined transvenous and transarterial embolisation.

Trigeminal cavernous fistulae are rare, compared to other types of carotid-cavernous fistulae with only about 17 examples previously reported in English literature. The aetiology can be either post-traumatic or spontaneous, and in the latter group either due to a ruptured trigeminal aneurysm or postulated intrinsic weakness of the artery itself. The treatment goal is to close the fistula while preserving the parent artery and this can be done either by surgical or endovascular methods. We present a 35-year-old woman with a spontaneous trigeminal fistula treated by combined trans-venous and trans-arterial embolisation.

Clinical course and angioarchitecture of cerebrofacial arteriovenous metameric syndromes. Three demonstrative cases and literature review.

SUMMARY: Bonnet-Dechaume-Blanc or Wyburn-Mason disease has been considered a rare condition and mysterious disease for the last century. It was recently introduced as a spectrum of disease expression of cerebrofacial vascular structures related by the same neural crest origin, named "Cerebrofacial Arteriovenous Malformations Syndrome" (CAMS) by JJ Bhattacharya.We illustrate the special observations of reported cases in the literature and our three demonstrative cases of CAMS in terms of natural history including progressive appearance of the AVMs, clinical presentation, angioarchitecture, clinical risk of retinal AVMs, AVMs along the optic pathways, intracranial AVMs and proper investigation in the suspicious case.

Ruptured anterior spinal artery aneurysm associated with coarctation of aorta. Case report and literature review.

SUMMARY: A 39-year-old man presented with acute headache and neck pain, followed by quadriparesis and quadriparesthesia, accompanied by urinary and bowel incontinence. Lumbar puncture showed subarachnoid haemorrhage. Angiogram via a right axillary approach revealed severe coarctation of the aorta, between the left common carotid artery and left subclavian artery. Multiple collateral circulation including an enlarged anterior spinal arterial axis bridging the stenosed arch provided collateral circulation to the abdominal aorta. A small lobulated aneurysm was seen at the radiculomedullary-anterior spinal artery junction from the right ascending cervical artery. This patient underwent successful surgical clipping of the aneurysm. Pathogenesis of the spinal arterial aneurysm associated with coarctation of the aorta is likely to result from the haemodynamic stress from collateral circulation through the anterior spinal axis rather than segmental arterial disease or angiodysplastic disease. Aneurysms of the spinal artery are rare but can be unusually found in association with SCAVMs, coarctation of aorta, Klippel-Trenaunay syndrome or more rarely with aortic arch interruption.