Felipe Padovani Trivelato

Endoscopic choroid plexus cauterization versus ventriculoperitoneal shunt for hydranencephaly and near hydranencephaly: a prospective study.

OBJECTIVETo prospectively evaluate the results of endoscopic choroid plexus cauterization (ECPC) and ventriculoperitoneal shunts (VPSs) in infants with hydranencephaly or near hydranencephaly. METHODSWe prospectively collected clinical data from all untreated hydranencephalic and near hydranencephalic children from October 2006 to March 2008. All patients treated were randomly divided into 2 groups, ECPC or VPS, and submitted to either endoscopic choroid plexus cauterization or ventriculoperitoneal shunt placement. RESULTSSeventeen patients were entered into the study. ECPC was completed in 9 patients; the procedure successfully controlled excessive head circumference and signs of increased intracranial pressure in 8 of these patients (88.8%). One endoscopic procedure in a hydranencephalic child failed after 7 months, resulting in VPS placement. Thus, of the 10 patients randomized to ECPC, 8 were treated successfully by ECPC (80%), and 2 went on to have a VPS. There were no complications related to this method of treatment. Seven children were randomized to the VPS group; and of these, 2 patients (28.5%) required shunt revisions during follow-up. There were no complications related to shunt placement. There was no difference in the success rate between patients randomized to ECPC and VPS, but the ECPC was more economical. CONCLUSIONECPC is an acceptable alternative to VPS for treatment of hydranencephaly and near hydranencephaly. It is a single, definitive, safe, effective, and economical treatment that may avoid the complications of shunting.

Dural arteriovenous fistulas with direct cortical venous drainage treated with Onyx®: a case series

UNLABELLED Dural arteriovenous fistulas (DAVFs) may have aggressive symptoms, especially if there is direct cortical venous drainage. We report our preliminary experience in transarterial embolization of DAVFs with direct cortical venous drainage (CVR) using Onyx. METHOD Nine patients with DAVFs with direct cortical venous drainage were treated: eight type IV and one type III (Cognard). Treatment consisted of transarterial embolization using Onyx-18. Immediate post treatment angiographies, clinical outcome and late follow-up angiographies were studied. RESULTS Complete occlusion of the fistula was achieved in all patients with only one procedure and injection in only one arterial pedicle. On follow-up, eight patients became free from symptoms, one improved and no one deteriorated. Late angiographies showed no evidence of recurrent DAVF. CONCLUSION We recommend that transarterial Onyx embolization of DAVFs with direct cortical venous drainage be considered as a treatment option, while it showed to be feasible, safe and effective.

Preoperative embolization of choroid plexus papilloma with Onyx via the anterior choroidal artery: technical note

IntroductionTotal surgical resection is the treatment of choice for choroid plexus tumors. However, the hypervascular nature of such lesions imposes challenges to the surgical treatment. Preoperative embolization for intracranial tumors has been widely used in an attempt to reduce blood loss, but rarely with choroid plexus tumors.Case reportWe describe the first case of preoperative embolization of choroid plexus papilloma with Onyx via the anterior choroidal artery. The procedure underwent without any complications and surgical treatment was possible with minimal blood loss.DiscussionEmbolization of choroid plexus tumors via anterior choroidal artery is potentially dangerous, but following a meticulous technique, it can be used as a safe and effective preoperative procedure.

Endoscope-controlled microneurosurgery to treat middle fossa epidermoid cysts: technical case report.

OBJECTIVE To present an alternative technique of endoscope-controlled microneurosurgery for the treatment of middle fossa epidermoid cysts. METHODS The three operations described were performed through an approximately 2-cm diameter temporal craniotomy after a straight skin incision was made. Resection was then performed under the magnification of a 30-degree rigid endoscope, which mandated the use of exclusively conventional microsurgical instruments. RESULTS Total resection was accomplished in all three patients with large middle fossa epidermoid cysts through a small temporal corticectomy, without damage to neurovascular structures. CONCLUSION This procedure allowed the association of a smaller craniotomy, better cosmetic results, and minor retraction of the brain to wide resection of the tumor and satisfactory functional outcomes.

Endovascular treatment of a linguofacial trunk pseudoaneurysm after tonsillectomy

1 Medico (Fellow, neurorradiologia intervencionista, Hospital das Clinicas, Universidade Federal de Minas Gerais). 2 Medico (Neurorradiologista intervencionista, Hospital das Clinicas, Universidade Federal de Minas Gerais). 3 Medico (Residente, neurocirurgia, Hospital das Clinicas, Universidade Federal de Minas Gerais). Divisao de Neurorradiologia Intervencionista Hospital das Clinicas Universidade Federal de Minas Gerais Belo Horizonte Minas Gerais Brasil. Endereco para correspondencia: Felipe Padovani Trivelato. Rua Timbiras, no 3616. Barro Preto. Belo Horizonte MG. Brasil. CEP: 30140-062. E-mail: felipepadovani@yahoo.com.br Este artigo foi submetido no SGP (Sistema de Gestao de Publicacoes) do BJORL em 18 de maio de 2012. cod. 9212. Artigo aceito em 6 de outubro de 2012. CASE REPORT Braz J Otorhinolaryngol. 2013;79(4):524.

Endovascular treatment of a traumatic carotid artery aneurysm after endoscopic arachnoid cyst fenestration

Intracranial aneurysms are usually described in the adult population. They are rare in childhood, representing 1–5% of all intracranial aneurysms [5, 7, 10]. Aneurysms in this population exhibit features that differ significantly from those in adults, including a higher incidence of unusual anatomic locations, male predominance, and a higher incidence of uncommon etiologies, such as infection and trauma [4, 5, 7, 9, 10, 14]. Traumatic intracranial aneurysms are rare and constitute less than 1% of all aneurysms in large series [1–3, 9, 11, 12, 14–16, 18]. They may occur as the result of either blunt or penetrating trauma, including iatrogenic neurosurgical procedures [1–4, 11, 12, 14, 15, 18]. Direct surgical repair of intracranial traumatic aneurysms is challenging due to the lack of a true neck or aneurysm wall [1, 4, 13, 15, 16, 18]. The endoscopic management of hydrocephalus and intracranial cysts is a well-established and safe technique, but vascular lesions are potential complications of such interventions [6–8, 12, 15, 17]. We report a case of a traumatic supraclinoid carotid artery aneurysm after endoscopic middle fossa arachnoid cyst treatment that was successfully managed with selective endovascular occlusion. To our knowledge, this is the first report of selective endovascular treatment of a traumatic carotid aneurysm after endoscopic cystocisternostomy.

Venous lesions as a cause of sylvian aqueductal obstruction: case report.

OBJECTIVE The cases of two patients who presented with sylvian aqueductal obstruction caused by venous lesions (an ectatic vein and a developmental venous anomaly, which are uncommon causes of obstructive hydrocephalus) are reported. CLINICAL PRESENTATION A 42-year-old man presented with chronic headache and behavior abnormalities. Magnetic resonance imaging revealed supratentorial ventricular dilation caused by an obstruction of the sylvian aqueduct by a developmental venous anomaly. An 18-year-old man complained of intermittent headaches. The magnetic resonance imaging scan disclosed aqueductal stenosis-type hydrocephalus secondary to an ectatic vein. INTERVENTION Both patients underwent endoscopic third ventriculostomy and recovered well. During the procedures, the aqueductal obstruction by venous elements could be seen clearly. CONCLUSION Venous anomalies may cause obstructive hydrocephalus and can be suspected in cases of chronic and intermittent headaches. Endoscopic third ventriculostomy is an effective treatment.

Endovascular treatment of pulsatile tinnitus associated with transverse sigmoid sinus aneurysms and jugular bulb anomalies

Pulsatile tinnitus of vascular origin may arise in arterial or venous structures. Many authors have reported the association of pulsatile tinnitus with anomalies of dural venous sinuses and the jugular bulb. In such circumstances, mainly concomitantly with disabling tinnitus, endovascular treatment has been successfully employed. We describe here a new case of jugular bulb diverticulum associated with transverse sigmoid sinus stenosis, in a patient presenting with disabling pulsatile tinnitus. She was treated with dural sinus stenting and selective embolization of the diverticulum. In addition, we performed a literature review aiming to identify possible risk factors for developing the symptoms, as well as the safety and results of endovascular treatment.

Transitory Brain Stem Edema Following Successfully Transvenous Embolization of a Posterior Fossa Arteriovenous Malformation

The best management of brain arteriovenous malformations (BAVMs) remains controversial, since the annual risk of hemorrhage must be balanced against the significant morbimortality associated with the treatment [2]. The treatment of BAVMs includes different modalities such as microsurgery, embolization, and radiosurgery, either alone or in combination [1, 8]. regarding endovascular therapy, this is no longer reserved exclusively for preoperative embolization. Instead, it is becoming a curative procedure in an increasing proportion of cases [1, 8]. Technological advances, including the development of softer flow-directed microcatheters and mainly the advent of onyx are responsible for the increase in the cure rates [1, 5, 8, 10]. However, it has also been associated with considerable rates of complications [1, 8]. Although one of the most feared complications is the inadvertent occlusion of the draining veins of the arteriovenous malformation (AVM) before the complete exclusion of the nidus, transvenous approach can be used in very selected cases [1, 5, 9]. We report a case of a ruptured posterior fossa AVM that was successfully treated by transvenous approach. And moreover, a flow-related aneurysm shrinkage occurred in few days without specific treatment. Case Report

Occlusion rates of intracranial aneurysms treated with the Pipeline embolization device: the role of branches arising from the sac

OBJECTIVEThe aim of this study was to compare the clinical and angiographic outcomes of intracranial aneurysms with and without branches arising from the sac after Pipeline embolization device (PED) treatment.METHODSThis retrospective 2-center comparative study included 116 patients with 157 aneurysms that were treated with PEDs. Aneurysms were divided into 2 groups: one group had branches arising from the sac and the other group did not. Study end points included total aneurysm occlusion assessed by angiography at 6 and 12 months, death or stroke, technical complications, in-stent stenosis, patency of covered branches, and transient ischemia.RESULTSOne hundred fifty-one aneurysms (96%) were located in the internal carotid artery. A branch arising from the sac was observed in 26 aneurysms. Complete occlusion was found in 120 of 156 aneurysms at 6 months (76.92% [95% CI 69.71%-82.84%]) and in 136 of 155 aneurysms at 12 months (87.74% [95% CI 81.28%-92.27%]). Total occlusion was more frequently observed in the group without a branch arising from the sac (84% vs 40% at 6 months, p < 0.001; 93.10% vs 60% at 1 year, p < 0.001). There were 4 (3.45% [95% CI 1.11%-9.12%]) cases of death or major stroke. Amaurosis fugax occurred in 3 patients. One patient experienced worsening of mass effect after treatment. No occlusion of branches arising from the aneurysm was observed. In-stent stenosis greater than 50% was observed in 1 case.CONCLUSIONSAneurysms treated with PEDs are less likely to be totally occluded if they have a branch arising from the sac than are aneurysms without these branches.