Isolated intracranial mass lesion near the foramen of Luschka: An unusual presentation of granulomatosis with polyangiitis

Granulomatosis with polyangiitis (GPA) is an antineutrophil cytoplasmic antibody-associated granulomatous vasculitis. The main central nervous system manifestations of GPA are patchy meningitis, cranial neuropathies, and vasculitis of the cerebral arteries. However, we report the first case of an intracranial mass lesion near the foramen of Luschka. A 68-year-old female with a history of breast cancer and GPA developed dizziness and diplopia. Head magnetic resonance imaging (MRI) revealed an isolated mass lesion near the right foramen of Luschka. The lesion was enhanced on gadolinium-enhanced MRI, and a T2 high-intensity area suspected of edema was found around the lesion. We performed a resection via craniotomy, and the histopathological findings were consistent with GPA. Cyclophosphamide pulse therapy with corticosteroid was markedly effective and reduced the intracranial mass lesion. When a brain tumor is detected in patients with GPA, a granulomatous lesion should be considered as differential diagnosis, and surgical biopsy is essential for definitive diagnosis for early stage treatment

Evaluation of bleeding risk in dural arteriovenous fistula using susceptibility-weighted imaging: A case report

Susceptibility weighted imaging (SWI) is a new imaging modality for the detailed depiction of cerebral venous hemodynamics. We report a case of a dural arteriovenous fistula (dAVF) in which a symptomatic intracranial hemorrhage occurred at the lesion site where previously performed SWI showed marked hypointensity. Previous reports about SWI findings in patients with dAVF have focused on their correlations with angiography and there has been no report mentioning the direct relationship of SWI finding and the risk of dAVF bleeding. This case shows the possibility that SWI might be useful for estimating the bleeding risk

Transarterial embolization with n-butyl-2-cyanoacrylate for a ruptured aneurysm at the artery of Davidoff and Schechter

The artery of Davidoff and Schechter (ADS) is mostly identified in pathological conditions such as dural arteriovenous fistulas and brain tumors. Herein, we report a rare case of a ruptured aneurysm of the ADS, which was one of the feeders of a falcotentorial dural arteriovenous fistula. We performed endovascular embolization of the aneurysm and parent artery using n-butyl-2-cyanoacrylate. Complete occlusion of the fistula was achieved by another feeder after the acute phase. To our best knowledge, only a few reports on embolization of ruptured ADS aneurysms exist. Furthermore, this is the first report on the embolization of a ruptured ADS aneurysm using n-butyl-2-cyanoacrylate. This case highlights that endovascular n-butyl-2-cyanoacrylate embolization could be a useful treatment for a ruptured ADS aneurysm

Long‐Term Stability of Patients Undergoing Endovascular Parent Artery Occlusion of Their Intracranial Artery

Background Although endovascular parent artery occlusion (PAO) of the intracranial artery is a well‐established treatment option, the long‐term stability of cerebral blood flow remains a concern. This study aimed to evaluate the long‐term clinical and radiological outcomes of patients who underwent PAO. Methods The patients who underwent endovascular PAO of their internal carotid or vertebral artery (VA) between April 2011 and March 2022 were included in this observational study. Information about patient characteristics, details of the endovascular treatment, and clinical and radiological follow‐up were collected. Results The study included a total of 104 cases (average age, 52.9±12.6 years old; men, 73 [70.2%] cases; 95 [91.3%] VA PAO cases) from 8 centers. Most cases were performed in an emergency condition, such as ruptured VA dissecting aneurysm (73 cases [70.2%]). PAO was successful in all cases. Early stroke (within 30 days) occurred in 33 (31.7%) cases (31 cases in VA PAO and 2 cases in internal carotid PAO) with ischemic stroke (29 cases) comprising the largest group. Clinical follow‐up over 1 month was available in 85 cases. During an average follow‐up period of 45.8±25.8 months, 1 case of VA PAO experienced a stroke without functional deterioration. Imaging follow‐up was performed in 75 cases. Recanalization of the occluded VA was observed in 2 cases. The remaining image change was contralateral VA stenosis after VA PAO. The incidence of clinical and radiological events was 1.2% and 1.1% per patient‐year, respectively. Conclusion Once the patients surpass the acute phase after PAO, their mid‐ to long‐term course was stable. The risk of late stroke or de novo aneurysm formation was lower than expected in the literature, and the direct comparison to novel reconstructive techniques is warranted in future studies. Clinical Trial Registration information: https://www.umin.ac.jp/ctr/index.html, trial ID: UMIN000045160