Marco Túlio Salles Rezende

Dural arteriovenous fistula of the lesser sphenoid wing region treated with Onyx: technical note

A 45-year-old man presented with acute right orbital pain and right-sided headache. Magnetic resonance imaging (MRI) and cerebral angiography revealed a dural arteriovenous fistula (DAVF) of the lesser sphenoid wing region. The lesion was endovascularly treated by transarterial embolization with Onyx (ethyl vinyl alcohol; Micro Therapeutics, Irvine, Calif.). We review some anatomical and therapeutic features involving DAVFs of this region and describe the feasibility of the use of Onyx in the treatment of these lesions.

Hyperperfusion Syndrome After Stenting for Intracranial Vertebral Stenosis

Background and Purpose— Hyperperfusion syndrome is a rare but well-described complication after endarterectomy or stenting in the carotid circulation. Summary of Case— A 66-year-old man who had vertebrobasilar insufficiency refractory to medical treatment because of an intracranial right side vertebral stenosis was referred to our institution for endovascular treatment. Stenting was performed, and after 24 hours, he became extremely agitated, and this was followed by a period of apathy without focal neurological deficits. MRI showed bilateral thalamic hemorrhage. Conclusion— To our knowledge, this is the first report of hyperperfusion syndrome with hemorrhagic presentation after intracranial vertebral artery stenting.

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.

Endoarterial management of dural arteriovenous malformations with isolated sinus using Onyx-18: technical case report.

OBJECTIVE Anatomic and clinical cure of dural arteriovenous malformations (DAVM) with isolated sinus is difficult to achieve by endovascular means without previous surgical exposure. We propose a new management technique using a new liquid embolic agent (ethylene-vinyl alcohol copolymer [Onyx-18]; ev3 Inc., Plymouth, MN) via an endoarterial approach that would avoid surgical craniotomy. BACKGROUND Data of three consecutive patients with a DAVM with isolated sinus treated at our department between January 2005 and June 2005 are described. Procedures performed under general anesthesia consist of an arterial approach whereby a microcatheter is navigated via a meningeal feeder to the DAVM. Onyx-18, which diffuses under aqueous conditions, is then delivered, mechanically filling the isolated sinus and ultimately treating it. RESULTS The patients included two men and one woman aged 69, 71, and 64 years, respectively. All patients were classified as Merland Type IV. Two patients presented with DAVMs involving the transverse-sigmoid sinus, and one patient presented with a DAVM involving the superior sagittal sinus with an isolated venous collector. All three fistulae were treated with transarterial embolization, using Onyx-18, through the filling of the pathological sinus via the anterior meningeal artery branch of the ophthalmic artery (DAVM at the superior sagittal sinus), and the other two patients were treated by means of the petrosquamous branch of the middle meningeal artery (DAVM at the transverse-sigmoid sinus). Postoperative digital subtraction angiography confirmed the elimination of the DAVMs in all three patients. The follow-up study ranging from 3 to 12 months (average, 7.5 mo) revealed no recurrence, and all of the patients had clinical improvement and recovered to their full activities. CONCLUSION DAVMs with isolated sinus and retrograde venous drainage to the cortical system are aggressive vascular lesions that can be treated by transarterial embolization using Onyx-18. This procedure allowed us to achieve an anatomic and clinical cure in the three patients consecutively treated without the need for surgical exposure of the compromised sinus.

Selective endovascular treatment of a traumatic basilar aneurysm after endoscopic third ventriculostomy

A 4-year-old girl suffered intraventricular and subarachnoid hemorrhage during endoscopic third ventriculostomy. Cerebral angiography revealed a traumatic basilar aneurysm secondary to basilar artery injury. The aneurysm was treated with selective endovascular embolization using Guglielmi detachable coils. We review some therapeutic features of traumatic basilar aneurysms after endoscopic third ventriculostomy and describe the feasibility of endovascular selective therapy to manage these lesions successfully.

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.

Number of coils necessary to treat cerebral aneurysms according to each size group: a study based on a series of 952 embolized aneurysms

OBJECTIVE The Brazilian public health system determines a quantity of coils allowed to treat a cerebral aneurysm. The goal of this paper was to determine the number of coils necessary to treat an aneurysm based on size. METHODS All patients harboring an aneurysm treated by endovascular approach between 1999 and 2003 were reviewed. RESULTS There were 952 aneurysms included. Mean diameter sac was 8.2 mm with 7.9 coils per aneurysm. Out of 462 small aneurysms, mean size was 4.8 mm, with 4.6 coils/aneurysm used. A total of 315 medium aneurysms were treated, mean size was 8.6 mm, with 8.2 coils. Out of 135 large, mean size was 17 mm, with 16.1 coils. Forty giant aneurysms were treated with a mean size of 32 mm and 28.7 coils. CONCLUSIONS We propose size as a reference to predict the number of coils necessary to treat each aneurysm: one coil for each millimeter of diameter.

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.

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.