Shinichiro Kurokawa

Hemifacial spasm due to contralateral aneurysmal compression of the facial nerve successfully treated with endovascular coil embolization: case report.

BACKGROUND AND IMPORTANCE:Hemifacial spasm is usually caused by compression of the facial nerve at the root exit zone (REZ), whereas fusiform aneurysmal compression is extremely rare. The authors describe symptomatic hemifacial spasm caused by a contralateral fusiform aneurysm of the vertebral artery (VA) that was treated by endovascular coil embolization. CLINICAL PRESENTATION:A 55-year-old woman developed left hemifacial spasm that had gradually worsened over a period of 2 years before admission to our hospital. Cerebral angiography showed an elongated right VA fusiform aneurysm near the VA union that inclined toward the left side. The cause of the facial spasm was considered to be compression of the left facial nerve REZ by the aneurysm. Endovascular parent artery embolization including the aneurysm was performed. The hemifacial spasm disappeared within 3 months. CONCLUSION:Hemifacial spasm caused by contralateral VA fusiform aneurysm can be treated by intravascular parent artery occlusion with coil embolization.

Virtual surgical planning for superficial temporal artery to middle cerebral artery bypass using three-dimensional digital subtraction angiography.

ObjectiveTo introduce reliable and minimally invasive virtual surgical planning for superficial temporal artery to middle cerebral artery (STA–MCA) bypass surgery using three-dimensional (3-D) rotational reconstruction digital subtraction angiography (DSA).MethodsTwenty-eight consecutive patients (11 women and 17 men) with cerebrovascular insufficiency due to internal carotid artery (ICA) or middle cerebral artery (MCA) occlusion (n = 16), ICA or MCA stenosis (n = 6), and moyamoya or moyamoya-like disease (n = 6) underwent rotational DSA. Anatomical locations of the appropriate donor branch of the STA, the most suitable recipient of MCA and squamous sutures on the skull surface, were visualized using 3-D reconstruction imaging. Localization of the minicraniotomy, the skin incision on top of the superficial temporal artery branch, and the anastomosis point were accurately determined by virtual surgical planning.ResultsAccording to preoperative assessments, the minimum necessary skin incision and small craniotomy were successfully achieved. The preselected artery was found without additional craniotomy and anastomosed at the putative point in all patients. Perioperative complications did not arise and all bypasses remained patent on follow-up.ConclusionPreoperative 3-D virtual surgical planning assessments are exactly consistent with operative findings. Such assessments avoid unnecessary manipulation and simplify the surgical procedure. This imaging technique is helpful for planning STA–MCA bypass surgery.

Stent Placement for Severe Stenosis of the Left Common Carotid Artery with Internal-to-External Carotid Steal

We report the case of a 64-year-old male with internal carotid artery (ICA)-to-external carotid artery (ECA) steal due to severe stenosis of the common carotid artery (CCA). Left CCA occlusion was initially diagnosed on 3-dimensional time-of-flight magnetic resonance angiography, but digital subtraction angiography revealed severe stenosis of the left CCA and retrograde flow through the left ICA feeding the left ECA. Diverted blood flow from ECA to ICA in cases with occlusion or severe stenosis of the CCA represents a well-known alternative collateral flow pattern called ECA-to-ICA steal. However, collateral flow from ICA to ECA is rarely observed and may be termed ICA-to-ECA steal. We treated CCA stenosis in our patient by carotid artery stenting (CAS) because his CCA stenosis had been gradually progressing since the initial ischaemic attack. Antegrade ICA flow subsequently recovered. To the best of our knowledge, this is the first report of ICA-to-ECA steal normalised by the treatment of CCA stenosis using CAS. i 2014 S. Karger AG, Basel

Direct Surgery for Cerebral Arteriovenous Malformation After Superselective Intravascular Embolization

Embolization is used as a radical therapy, as well as an adjunctive therapy with surgery for cerebral arteriovenous malformations (AVM). Eight patients underwent endovascular embolization and then surgical resection for cerebral AVM. In two cases, although AVM was embolized completely on the digital subtraction angiographical (DSA) evaluation, slight arterial blood filling into the nidus of AVM was observed on the surgical exploration. Postoperative computerized tomography (CT) demonstrated extent infarction area which was seemed secondary to occlusion of feeding arterial trunk due to retrograde thrombosis from nidus, although new neurological deficits were not recognized because of infarction in the non-dominant temporal lobe. In three cases, embolization of AVM was partial, because catheterization into the all feeding arteries was difficult. But, in two cases who had AVM in the right temporal and in the left occipital lobe respectively, surgical removal of AVM was performed completely without excessive hemorrhage. In another case who had AVM in the corpus callosum, although AVM was smoothly removed, the patient died of postoperative pulmonary embolism. In three cases, AVM could not be embolized at all because of impossible catheterization into feeding arteries. Histological findings of removed AVM which was completely embolized angiographically demonstrated that embolus mainly existed in the nidus and draining veins, and existence of blood around the embolus in these vessels. These histological findings and the our intraoperative obseravation of slight arterial blood inflow into the nidus in the angiographically complete embolized AVMs imply that AVM should be removed surgically, even if it is embolized sufficiently. We must not forget that angiographical complete embolization of AVMs may provoke infarction of the normal brain around them, although they can be removed surgically without difficulty by the embolization.