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Intracranial Fusiform aneurysm

Saleem I Abdulrauf, Peter Vuong, Ritesh Patel, Raghu Sampath, Ahmed M Ashour, Lauren M Germany, Jonathon Lebovitz, Colt Brunson, Yuvraj Nijjar, J Kyle Dryden, Maheen Q Khan, Mihaela G Stefan, Evan Wiley, Ryan T Cleary, Connor Reis, Jodi Walsh, Paula Buchanan
OBJECTIVE Risk of ischemia during aneurysm surgery is significantly related to temporary clipping time and final clipping that might incorporate a perforator. In this study, the authors attempted to assess the potential added benefit to patient outcomes of "awake" neurological testing when compared with standard neurophysiological testing performed under general anesthesia. The procedure is performed after the induction of conscious sedation, and for the neurological testing, the patient is fully awake. METHODS The authors conducted an institutional review board-approved prospective study of clipping unruptured intracranial aneurysms (UIAs) in 30 consecutive adult patients who underwent awake clipping...
October 21, 2016: Journal of Neurosurgery
M Barburoglu, A Arat
BACKGROUND AND PURPOSE: There is very limited data concerning utilization of flow diverters in children. Our aim is to report results for the treatment of complex intracranial aneurysms and carotid cavernous fistulas by using flow diverters in children. MATERIALS AND METHODS: Retrospective review of children (17 years of age or younger) treated with flow diverters between May 2011 and July 2014 was performed. Clinical and laboratory data and angiographic findings were extracted...
October 20, 2016: AJNR. American Journal of Neuroradiology
Jay Vachhani, Christopher Nickele, Lucas Elijovich, Paul Klimo, Adam S Arthur
Intracranial flow diversion has gained increasing popularity since the approval of the Pipeline Embolization Device (PED). Although it is only approved for use in adult patients, the PED has been used to treat aneurysms in pediatric patients. We present the first reported case of the use of a PED in a pediatric patient to treat an unusual fusiform distal anterior cerebral artery aneurysm. A 12-year-old female presented with new onset seizures and was found to have an incidental distal left anterior cerebral artery aneurysm...
September 29, 2016: World Neurosurgery
Seung Chai Jung, Ho Sung Kim, Choong-Gon Choi, Sang Joon Kim, Sun U Kwon, Dong-Wha Kang, Jong S Kim
PURPOSE: The aim of this article is to present high-resolution magnetic resonance imaging (HR-MRI) findings of chronic stage spontaneous and unruptured intracranial artery dissection (ICAD). MATERIAL AND METHODS: From March 2012 to April 2016 a total of 29 patients (15 male and14 female, age range 37-68 years) with chronic stage spontaneous and unruptured ICAD (vertebral artery 27, posterior inferior cerebellar artery 1 and middle cerebral artery 1) were retrospectively enrolled...
September 27, 2016: Clinical Neuroradiology
Hyoung Soo Byoun, Hyeong Joong Yi, Kyu Sun Choi, Hyoung Joon Chun, Yong Ko, Koang Hum Bak
OBJECTIVE: Subarachnoid hemorrhage (SAH) caused by rupture of an internal carotid artery (ICA) or vertebral artery (VA) dissecting aneuryesm is rare. Various treatment strategies have been used for ruptured intracranial dissections. The purpose of this study is to compare the clinical and angiographic characteristics and outcomes of endovascular treatment for ruptured dissecting aneurysms of the intracranial ICA and VA. METHODS: The authors retrospectively reviewed a series of patients with SAH caused by ruptured intracranial ICA and VA dissecting aneurysms from March 2009 to April 2014...
September 2016: Journal of Korean Neurosurgical Society
Xianli Lv, Huijian Ge, Hengwei Jin, Hongwei He, Chuhan Jiang, Youxiang Li
BACKGROUND AND PURPOSE: Endovascular treatment of unruptured posterior circulation intracranial aneurysms (UPCIAs) is limited in the International Study of Unruptured Intracranial Aneurysms (ISUIA). The aim of this study is to evaluate the periprocedural morbidity, mortality, and midterm clinical and angiographic follow-ups of endovascular treatment of UPCIAs. MATERIALS AND METHODS: Retrospective analysis of all patients treated in a 2-year period (89 patients: 10-78 years of age, mean: 45...
July 2016: Annals of Indian Academy of Neurology
Erol Akgul, Hasan Bilen Onan, Suha Akpinar, Huseyin Tugsan Balli, Erol Huseyin Aksungur
OBJECTIVE: The Derivo embolization device (DED) is a new nitinol flow diverter stent manufactured for the treatment of intracranial aneurysms. In this study, we evaluated the safety and efficacy of the DED in the treatment of intracranial aneurysms and present the short- and mid-term results. METHODS: We treated 34 aneurysms using 26 devices in 24 patients with wide-necked, mostly medium-sized, and fusiform aneurysms. Fourteen of the patients included in the study were females and the other 10 were males...
August 8, 2016: World Neurosurgery
Valeria Onofrj, Maria Cortes, Donatella Tampieri
Intracranial dissecting aneurysms have been frequently reported to present with fairly challenging and time-variable imaging findings that can be mostly explained by the pathological mechanisms that underline the dissection. We present two cases of spontaneous dissecting aneurysm of the supraclinoid ICA, both clinically presenting with SAH, but characterized by different progression of clinical symptoms and imaging. However, in both cases an outpouch and a mild fusiform dilation of the supraclinoid ICA was present in the initial CTA performed after the occurrence of symptoms...
August 10, 2016: Interventional Neuroradiology
Ashish Kulhari, Sunil Manjila, Gagandeep Singh, Kunal Kumar, Robert W Tarr, Nicholas Bambakidis
The authors present a unique case of intracranial lipoma in the interpeduncular cistern associated with proximal P1 segment fenestration. This patient is a 20-year-old male with extensive psychiatric history and complaints of recent auditory hallucinations. Cranial magnetic resonance imaging (MRI) (T1, T2, and FLAIR) showed a hyperintense lesion in the left aspect of interpeduncular cistern with a prominent flow void within the hyperintense lesion suggestive of a combined vascular-lipomatous lesion. Computed tomography (CT) angiography showed a high-riding large tortuous P1 segment on the left side with proximal fenestration, the ectatic posteromedial limb harboring a fusiform dilated segment...
June 2016: Journal of Vascular and Interventional Neurology
Guilherme Cabral de Andrade, Helvercio P Alves, Valter Clímaco, Eduardo Pereira, Alexandre Lesczynsky, Michel E Frudit
Intracranial circumferential fusiform aneurysms of the posterior circulation involving arterial branches or perforating vessels are difficult to treat. This article shows an endovascular reconstruction technique not yet described, using a telescoping self-expandable stent (LEO+) and flow-diverter device (SILK) at different surgical times. Two patients with circumferential fusiform aneurysm, one being an aneurysm of the segments P2 and P3 of the posterior cerebral artery, diagnosed after a headache, and the other a partially thrombosed aneurysm of the lower basilar artery, diagnosed following ischemia of the brain stem...
October 2016: Interventional Neuroradiology
Sayal Parag, Zafar Arif, Rajaraman Chittoor
BACKGROUND: Radiotherapy-related intracranial aneurysms are a recognized but rare phenomenon and often present following rupture leading to subarachnoid hemorrhage. Treatment poses a particular dilemma and both endovascular, and surgical approaches have been used with varied success. We present the case of a radiotherapy-related aneurysm treated conservatively with a favorable outcome. CASE DESCRIPTION: A 37-year-old man was diagnosed with a left temporal lobe mass for which he underwent an uneventful craniotomy and debulking...
2016: Surgical Neurology International
Fawaz Al-Mufti, Krishna Amuluru, Chirag D Gandhi, Charles J Prestigiacomo
Endovascular treatment of intracranial aneurysms with complex morphologies such as giant, wide-necked, or fusiform aneurysms is challenging. Stent-assisted coiling and balloon-assisted coiling are alternative techniques to treat such complex aneurysms, but studies have shown less-than-expected efficacy, as suggested by their high rate of recanalization. The management of complex aneurysms via microsurgery or conventional neuroendovascular strategies has traditionally been poor. However, over the last few years, flow-diverting stents (FDS) have revolutionized the treatment of such aneurysms...
July 2016: Neurotherapeutics: the Journal of the American Society for Experimental NeuroTherapeutics
Peng Qi, Daming Wang, Jiachun Liu, Lijun Wang, Jun Lu
OBJECTIVE: To explore the feasibility, safety and efficacy of endovascular reconstructive treatment by multiple overlapping stents with or without coils. METHODS: Totally 17 patients of vertebrobasilar fusiform aneurysms treated by multiple overlapping stents with or without coils between September 2011 and September 2015 in Department of Neurosurgery, Beijing Hospital were retrospectively reviewed. There were 15 male and 2 female patients with mean age of (47±13) years...
May 1, 2016: Zhonghua Wai Ke za Zhi [Chinese Journal of Surgery]
Goran Mrak, Kresimir Sasa Duric, Jakob Nemir
BACKGROUND: Ischemic stroke is a well-described but less frequent consequence of ruptured or unruptured intracranial aneurysms. To date, the optimal form of treatment for patients with a thrombosed cerebral aneurysm has not yet been well-defined. CASE DESCRIPTION: Here, we report a case of a 68-year-old female patient presenting with cerebral stroke. Five days poststroke multislice computed tomography (MSCT) and MSCT angiography were performed for the evaluation of clinical deterioration, showing a left M2 middle cerebral artery (MCA) bifurcation aneurysm and subarachnoid hemorrhage...
2016: Surgical Neurology International
W Brinjikji, G Lanzino, H J Cloft, A H Siddiqui, E Boccardi, S Cekirge, D Fiorella, R Hanel, P Jabbour, E Levy, D Lopes, P Lylyk, I Szikora, D F Kallmes
BACKGROUND AND PURPOSE: Risk factors for acute ischemic stroke following flow-diverter treatment of intracranial aneurysms are poorly understood. Using the International Retrospective Study of Pipeline Embolization Device (IntrePED) registry, we studied demographic, aneurysm, and procedural characteristics associated with postoperative acute ischemic stroke following Pipeline Embolization Device (PED) treatment. MATERIALS AND METHODS: We identified patients in the IntrePED registry with post-PED-treatment acute ischemic stroke...
September 2016: AJNR. American Journal of Neuroradiology
Guillaume Marzolf, Marcela Sabou, Béatrice Lannes, François Cotton, David Meyronet, Damien Galanaud, Jean-Philippe Cottier, Sylvie Grand, Hubert Desal, Julie Kreutz, Maleka Schenck, Nicolas Meyer, Francis Schneider, Jean-Louis Dietemann, Meriam Koob, Raoul Herbrecht, Stéphane Kremer
Cerebral aspergillosis is associated with a significant morbidity and mortality rate. The imaging data present different patterns and no full consensus exists on typical imaging characteristics of the cerebral lesions. We reviewed MRI findings in 21 patients with cerebral aspergillosis and correlated them to the immune status of the patients and to neuropathological findings when tissue was available. The lesions were characterized by their number, topography, and MRI signal. Dissemination to the brain resulted from direct spread from paranasal sinuses in 8 patients, 6 of them being immunocompetent...
2016: PloS One
Alejandro Tomasello, Nicolas Romero, Sonia Aixut, Maria A Miquel, Juan M Macho, Carlos Castaño, Pilar Coscojuela, Miguel Lemus, Lucia Aja, Luis San Roman, Jordi Blasco, Alex Rovira
UNLABELLED: Flow diverters represent a useful tool in the treatment of fusiform aneurysms and wide-neck saccular aneurysms which until the advent of this technology were problematic to treat. Pipeline™ Embolization Device (PED) has been described in several series showing high rates of occlusion and being relatively safe. OBJECTIVE: Shows the experience in four different neurointerventional centres in Barcelona with the PED (Covidien) between February 2010 and October 2013...
May 2016: Neurological Research
Jun Wang, Xin-Feng Liu, Bao-Min Li, Sheng Li, Xiang-Yu Cao, Yong-Ping Liang, Ai-Li Ge, Hui-Min Feng
OBJECTIVE Large vertebrobasilar fusiform aneurysms (VFAs) represent a small subset of intracranial aneurysms and are often among the most difficult to treat. Current surgical and endovascular techniques fail to achieve a complete or acceptable result because of complications, including late-onset basilar artery thrombosis and perforator infarction. The parallel-stent placement technique was established in the authors' department, and this study reports the application of this technique in the treatment of unruptured VFAs...
March 25, 2016: Journal of Neurosurgery
S T Kim, W Brinjikji, D F Kallmes
BACKGROUND AND PURPOSE: Few studies have examined the prevalence of intracranial aneurysms in connective tissue diseases such as Marfan syndrome, Ehlers-Danlos syndrome, neurofibromatosis type 1, and Loeys-Dietz syndrome. We studied the prevalence of intracranial aneurysms and other intracranial neurovascular pathologies such as arteriovenous malformations and intracranial dissections, in these 4 patient populations. MATERIALS AND METHODS: We retrospectively reviewed all patients who had a clinical diagnosis of Marfan syndrome, Ehlers-Danlos syndrome, neurofibromatosis type 1, or Loeys-Dietz syndrome who underwent MRA, CTA, and/or DSA imaging of the intracranial circulation between January 1, 2005, and January 31, 2015...
August 2016: AJNR. American Journal of Neuroradiology
Yingming Amy Chen, Brian J Drake, Albert Ho Yuen Chiu, Thomas R Marotta
The pipeline embolization device (PED) is a well recognized treatment for intracranial aneurysms. However, uncertainty remains regarding its effects on flow alteration, which is particularly highlighted by persistently perfused aneurysmal remnants and non-regressing, non-perfused aneurysmal masses. Here we present a 68-year-old woman with an incidental giant fusiform right paraophthalmic aneurysm electively treated with a PED. After lowering her antiplatelet therapy to promote aneurysm thrombosis, she was found to have a progressively enlarging perfused aneurysmal remnant...
March 9, 2016: Journal of Neurointerventional Surgery
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