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Surgical treatment of pial cerebellar arteriovenous fistulas with aneurysm of the main feeder artery
No full textBACKGROUND: Intracranial pial arteriovenous fistulas (pAVFs) are rare vascular lesions only recently considered distinct from arteriovenous malformations. Conservative management was associated with a high mortality rate. The abnormality of the lesion arises from its high-flow nature. The authors present a case of a cerebellar pAVF associated with aneurysms of the main feeding artery that was surgically treated. CASE DESCRIPTION: A 54-year-old woman was referred to us after an attack of severe headache and vomiting. Computerized tomography scan visualized a hematoma of the fourth ventricle. Digital subtraction angiography (DSA) revealed a cerebellar pAVF mainly fed by the right posteroinferior cerebellar artery (PICA) and with drainage into one of the superior cerebellar veins. The PICA presented a saccular aneurysm on its fourth segment and a fusiform dilatation on its third segment. The patient underwent surgical operation via a midline suboccipital craniotomy. The fusiform dilatation was wrapped and the saccular aneurysm was clipped. The most fistulous connections were closed. The draining vein at the level of torcular herophili was closed by application of a clip. Control DSA demonstrated exclusion of both the aneurysms and the fistula from the circulation. At 1-year follow-up, the patient was neurologically intact. CONCLUSIONS: The association of a cerebellar pAVF and an aneurysm is rare. Surgical treatment of multiple-channel arteriovenous fistulas by closure of venous varix should guarantee the exclusion from the circulation and avoid recruitment of new arterial connections and recurrence. Attention must be paid to normal venous channels draining into the varix
LONG SAPHENOUS-VEIN GRAFTS FOR EXTRACRANIAL AND INTRACRANIAL INTERNAL CAROTID ANEURYSM AMENABLE NEITHER TO CLIPPING NOR TO ENDOVASCULAR TREATMENT
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Bypass combined with embolization via a venous graft in a patient with giant aneurysm in the posterior comunicanting artery and bilateral idiopathic occlusion of the internal carotid artery in the neck
No full textThe Guglielmi Detachable Coil "Crescent" in the Endovascular Treatment of Peripheral Brain Aneurysms: Technical Case Report
No full textBrain AVMs: An Endovascular, Surgical, and Radiosurgical Update
Full text linkBrain arteriovenous malformations (bAVMs) are complex vascular lesions. Despite multiple studies, several classifications, and a great interest of the scientific community, case selection in AVM patients remains challenging. During the last few years, tremendous advancements widened therapeutic options and improved outcomes spreading indications for patients harboring lesions deemed inoperable in the past. Anatomical and biological case specific features, and natural history with a focus on presenting symptoms should be evaluated case by case and always kept in mind while planning a therapeutic management for a bAVMs. A multidisciplinary approach is strongly recommended when dealing with bAVMs and should involve physicians expertise in this kind of challenging lesions. The goal of this paper is to provide a focused review of the most recent acquisitions and therapeutic strategies regarding surgical, endovascular, and radiosurgical treatment
Dissecting aneurysm of the middle cerebral artery treated with heparin infusion in a 6-year-old child; neurological recovery with delayed spontaneous thrombosis: case illustration and literature review
No full textAneurysms in the pediatric population are a rare pathology with specific features which requires a deep knowledge of their pathogenesis for the best therapeutic choice; the authors report their experience with a patient presenting aneurysm of the middle cerebral artery (MCA) associated with proximal stenosis of the vessel. A six-year-old girl came to our observation after sudden onset of headache and left hemiparesis. Angio-MRI and angio-CT scan showed a right MCA dissecting aneurysms associated with proximal stenosis of the vessel. Patient started a therapy with low molecular weight heparin (LMWH), replaced, 15 days later, with acetyl-salicylic acid (ASA). Patient showed a rapid and almost complete neurological recovery, despite several radiological exams confirmed a complete occlusion of the right MCA. As many other authors noted, dissecting aneurysms in the pediatric population are probably due to a defect of the entire arterial wall. Combination of stenosis, turbulence and partial thrombosis of the aneurysm led to a complete occlusion of artery involved, leading to the formation of collateral circles. In our case, complete thrombosis was probably delayed with anticoagulant therapy and the progressive reinforcement of collateral circles lead to the patient's neurological recovery
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
The only case of mycotic aneurysm of the PICA: Clinical-radiological remarks and review of literature
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