Connection Between a Dural Artery and a Dural Vein in a Dural Arteriovenous Fistula of the Cranial Vault : Case Report

A 41-year-old man presented with consciousness disturbance and right hemiparesis. Computed tomography showed a hematoma in the frontal lobe. Left carotid angiography showed a dural arteriovenous fistula (AVF) located in the cranial vault, supplied by the left middle meningeal artery, and drained directly into the cortical vein adjacent to the superior sagittal sinus. Emergency decompressive craniectomy and evacuation of the intracerebral hematoma were performed. A red vein was found on the cortex but the location of the arteriovenous shunt was not clear due to severe brain swelling. Two months later, cranioplasty was performed and a part of the dura mater, expected to have been affected by the dural AVF, was resected. Histological examination disclosed thickening of the intima of the middle meningeal artery and a few small veins around this artery. The fistula was clearly demonstrated between the dural artery and the dural vein. The non-sinal type of dural AVF may originate in similar arteriovenous connections to the sinal type

Endovascular Treatment of Unusual Multiple Aneurysms of the Internal Carotid Artery-Posterior Communicating Artery Complex

A 79-year-old female presented with subarachnoid hemorrhage due to rupture of a rare true posterior communicating artery(PCoA)aneurysm and with poor general condition. Endovascular therapy was performed in the chronic stage. Right carotid angiography just before embolization demonstrated unusual multiple aneurysms of the internal carotid artery(ICA)-PCoA complex. Superselective an-giography and aneurysmography using microcatheter revealed two separate aneurysms arising from the PCoA and the ICA-PCoA junction. Endosaccular embolization using Guglielmi detachable coils (GDCs)was successfully performed for both aneurysms and complete occlusions were achieved with the PCoA fully patent. Embolization with GDCs is a good alternative to surgical clipping for PCoA aneurysm after careful evaluation of superselective angiography

Vidian Artery as a Collateral Channel Between the External and Occluded Internal Carotid Arteries : Case Report

A 68-year-old man presented with occlusion of the internal carotid artery (ICA) manifesting as a 6-month history of progressive sensory and motor disturbance of the left lower limb. Angiography clearly demonstrated a collateral arterial network between the ICA and external carotid artery (ECA) through the vidian artery, a small branch of both the ICA and ECA. The vidian artery may form an unusual but important ECA-ICA collateral pathway in patients with occlusive lesion of the ICA

Supratentorial Dynamic Computed Tomography for the Diagnosis of Vertebrobasilar Ischemic Stroke

Dynamic computed tomography (CT) is an established method for the evaluation of per fusion in acute ischemic stroke, but is not frequently used to assess infratentorial ischemia. Eleven patients with vertebrobasilar ischemia underwent dynamic CT on admission and/or during the follow-up period. The time of appearance (TA) and time to peak (TTP) were mapped and differences in TA (ΔTA) and TTP (ΔTTP) between the bilateral middle cerebral artery and posterior cerebral artery (PGA) territories were calculated. Conventional angiography and brain imaging including CT and magnetic resonance imaging were also performed. The TA and TTP maps obtained within 48 hours after onset exhibited time delay in eight of nine patients in the bilateral PGA territories. ΔTA and ΔTTP were greater in patients with stenosis or occlusion of the bilateral vertebral arteries or the basilar artery, and in patients without collateral circulation via the posterior communicating arteries than in control subjects. Furthermore, TA and TTP normalized dramatically in patients with recanalization of the arteries. ΔTA and ΔTTP were also normalized. ΔTA and ΔTTP were negatively correlated with the time from onset to examination. Dynamic CT can provide important information in patients with vertebrobasilar ischemic stroke, and may allow the diagnosis of acute ischemia and monitoring of the course