Aneurismas do segmento intracavernoso da artéria carotida interna

Foram estudados 22 pacientes portadores de aneurismas do segmento intracavernoso da arteria carotida interna. Ocorreu predominancia do sexo feminino em relacao ao sexo masculino numa proporcao de 4,5:1. Os sintomas predominantes foram cefaleia (59,1%) e compressao de nervos cranianos adjacentes (VI, III, V, IV). O VI nervo foi o mais frequentemente acometido (68,2%), seguido do III nervo (45,5%). Estes achados apresentaram significancia pela analise estatistica. O diagnostico foi firmado pela TC ou RM de cranio e pela angiografia cerebral por subtracao digital. Todos os pacientes foram submetidos ao teste de oclusao da arteria carotida interna com balao. O tratamento realizado foi a oclusao proximal da arteria carotida interna utilizando-se baloes destacaveis. O impacto do tratamento evidenciou-se pela melhora da sintomatologia na grande maioria dos pacientes. Ocorreram complicacoes em 2 casos, sendo uma temporaria e a outra definitiva. Os pacientes foram submetidos a controles por RM de cranio a partir do 3° mes pos-embolizacao que demonstrou trombose dos aneurismas em todos os casos e diminuicao das dimensoes dos aneurismas na maioria dos pacientes. A revisao da literatura e os achados do autor permitiram concluir que a oclusao proximal da arteria carotida interna foi eficaz no tratamento dos aneurismas intracavernosos.BV UNIFESP: Teses e dissertaçõe

Endovascular treatment of brain arteriovenous malformations less than 25 mm in diameter

Foram encaminhados para tratamento endovascular 70 pacientes portadores de 71 malformacoes arteriovenosas cerebrais (MAV) medindo menos que 25 mm no periodo de setembro de 1996 a junho de 2000. Trinta e seis pacientes foram tratados no Servico de Neurorradiologia Diagnostica e Terapeutica do Groupe Hospitalier Pitie-Salpetriere (Paris - Franca) no periodo de setembro de 1996 a setembro de 1998 e 34 pacientes foram tratados na Disciplina de Neurocirurgia da UNIFESP/EPM no periodo de setembro de 1996 a junho de 2000. A idade dos pacientes variou entre 4 e 73 anos (media de 30,3 anos), com discreta predominancia do sexo masculino (54 por cento). O sintoma mais frequente foi hemorragia cerebral, acometendo 63,4 por cento dos pacientes, seguido de cefaleia em 15,5 por cento e epilepsia em 9,8 por cento dos pacientes. O diagnostico foi realizado atraves de tomografia e/ou ressonancia magnetica do cranio e confirmado pela angiografia por subtracao digital. Aplicando-se a classificacao de SPETZLER & MARTIN (1986), 35,2 por cento das MAV eram de grau 1; 31,0 por cento de grau 2 e 33,8 por cento de grau 3. As MAV de grau 3 apresentaram hemorragias em numero significantemente maior que as de graus 1 e 2. Todos os pacientes foram tratados por cateterismo femoral sob anestesia geral utilizando-se, na maioria das vezes, microcateteres guiados pelo fluxo e histoacrylr como material embolico em todos os casos. O resultado do tratamento demonstrou oclusao total das MAV em 78,9 por cento dos casos e em 91,1 por cento daqueles que haviam sofrido hemorragia cerebral. O numero de pediculos arteriais envolvidos na irrigacao das MAV foi determinante no sucesso do tratamento. Nas MAV irrigadas por 1 ou 2 pediculos arteriais, a oclusao total foi atingida em numero significantemente mais elevado do que nas MAV com maior numero de pediculos nutrientes. A escala de SPETZLER & MARTIN (1986) nao foi preditiva do sucesso da embolizacaoo, pois nao observamos diferencas quanto a oclusao alcancada entre os graus das MAV e as complicacoes ocorridas tambem nao se correlacionaram com o grau das MAV nessa escala...(au)BV UNIFESP: Teses e dissertaçõe

Endovascular treatment of intracavernous carotid aneurysm with hyperprolactinaemia

A 42-year-old woman presented with headache, galactorrhoea, marked hyperprolactinemia and normal neurologic examination.CT MR and MR-angiography showed an intracavernous carotid artery aneurysm with minimal displacement of the pituitary stalk. Treatment by embolisation using GDC coils allowed exclusion of the aneurysm.Galactorrhoea resolved and serum prolactin levels fell to normal after eight months. Followup MR showed absence of the aneurysm, although the discrete mass effect persisted, suggesting that hyperprolactinaemia was due to pulsatility.Univ Sao Paulo, Serv Intervent Radiol, Heart & Radiol Inst, Sao Paulo, BrazilUniv Fed Sao Paulo, CAPES, Neurosurg Serv, Sao Paulo, BrazilHosp NS Lourdes, Serv Intervent Neuroradiol, Sao Paulo, BrazilUniv Fed Sao Paulo, CAPES, Neurosurg Serv, Sao Paulo, BrazilWeb of Scienc

Intracranial vascular lesions associated with small epidural hematomas

OBJECTIVE: We studied the angiographic findings in patients with small epidural hematomas and cranial fractures crossing over the trajectory of the middle meningeal artery and its branches. Additionally, the Occurrence of traumatic vascular lesions and their clinical relevance and treatment are discussed. METHODS: A consecutive analysis was performed for 24 patients who harbored small epidural hematomas in middle meningeal artery topography associated with cranial fractures. Computed tomographic scans and plain x-ray studies were used to diagnose linear cranial fractures. Patients with large epidural hematomas or associated traumatic lesions were excluded from the study. Selective ipsilateral external carotid angiograms were obtained, and an endovascular procedure was performed if any vascular injury was evidenced. RESULTS: In all patients with cranial fractures crossing over the middle meningeal artery and its branches, some kind of vascular lesion was seen. Two types of findings were noted: active extravasation of the contrast medium (71%) and pseudoaneurysms (29%). Early filling of diploic vessels was found in 8.3% of fractures concomitantly with active extravasation. Embolization was performed in all patients. No additional enlargement of the epidural hematoma was observed, and the postoperative period was uneventful. CONCLUSION: This study shows that pseudoaneurysms and active extravasation of contrast are common findings in this subset of patients. Although the natural history of these lesions is still poorly understood, additional investigation with ipsilateral external carotid angiography may be recommended, considering the potentially catastrophic consequences of late rupture

Spinal arteriovenous malformation without endovascular arterial access: is a combined neurosurgical approach and direct venous puncture an option?

This case report describes a combined neurosurgical and endovascular approach for the treatment of a conus medullaris arteriovenous malformation resulting in considerable improvement in the patient’s neurological condition (modified Rankin Scale score 2)

Global impact of COVID-19 on stroke care.

BACKGROUND: The COVID-19 pandemic led to profound changes in the organization of health care systems worldwide. AIMS: We sought to measure the global impact of the COVID-19 pandemic on the volumes for mechanical thrombectomy, stroke, and intracranial hemorrhage hospitalizations over a three-month period at the height of the pandemic (1 March-31 May 2020) compared with two control three-month periods (immediately preceding and one year prior). METHODS: Retrospective, observational, international study, across 6 continents, 40 countries, and 187 comprehensive stroke centers. The diagnoses were identified by their ICD-10 codes and/or classifications in stroke databases at participating centers. RESULTS: The hospitalization volumes for any stroke, intracranial hemorrhage, and mechanical thrombectomy were 26,699, 4002, and 5191 in the three months immediately before versus 21,576, 3540, and 4533 during the first three pandemic months, representing declines of 19.2% (95%CI, -19.7 to -18.7), 11.5% (95%CI, -12.6 to -10.6), and 12.7% (95%CI, -13.6 to -11.8), respectively. The decreases were noted across centers with high, mid, and low COVID-19 hospitalization burden, and also across high, mid, and low volume stroke/mechanical thrombectomy centers. High-volume COVID-19 centers (-20.5%) had greater declines in mechanical thrombectomy volumes than mid- (-10.1%) and low-volume (-8.7%) centers (p \u3c 0.0001). There was a 1.5% stroke rate across 54,366 COVID-19 hospitalizations. SARS-CoV-2 infection was noted in 3.9% (784/20,250) of all stroke admissions. CONCLUSION: The COVID-19 pandemic was associated with a global decline in the volume of overall stroke hospitalizations, mechanical thrombectomy procedures, and intracranial hemorrhage admission volumes. Despite geographic variations, these volume reductions were observed regardless of COVID-19 hospitalization burden and pre-pandemic stroke/mechanical thrombectomy volumes