Odontogenic Pain as the Principal Presentation of Vertebral Artery Pseudoaneurysm; a Case Report

Dissection of the vertebral artery is an important but rare cause of cerebrovascular accidents. Here we report a 48-year-old man with toothache since 4 days before who presented to the emergency department with neck pain and final diagnosis of dissecting right vertebral artery pseudoaneurysm. To our knowledge, this maybe the first report of odontogenic pain as the first manifestation of vertebral artery pseudoaneurysm in the literatures

Ten-year follow-up of giant basilar aneurysm treated by sole stenting technique: a case report

<p>Abstract</p> <p>Introduction</p> <p>The sole stenting technique has emerged as a new tool for the management of intracranial aneurysms. However, several concerns have emerged about the long-term behavior of intracranial stents, particularly their safety and efficacy.</p> <p>Case presentation</p> <p>We present the first case of an intracranial aneurysm intentionally treated with the sole stenting technique. After ten years of clinical and imaging follow-up, the lesion has healed and no intrastent stenosis is observed.</p> <p>Several issues concerning this technique are discussed. For instance, the modification of the angle and intra-aneurysmal thrombosis may account as positive effects; negative outcomes include in-stent thrombosis or stenosis.</p> <p>Conclusions</p> <p>This case report, involving a long clinical and imaging follow-up, provides an example of the effectiveness, safety, durability and simplicity of the sole stenting technique in the management of intracranial aneurysms.</p

Roles and rules of Syngo iFLOW in neuroendovascular procedures

The authors present 2 patients who underwent neuroendovascular procedures in syngo iFLOW produced that use the dynamic of fluid in several types of intracranial pathologies. As part of a combined CT/angiography suite, iFLOW offered the major advantage of immediate detection or exclusion of intracranial complication without patient transfer. The study of fluid dynamics constitutes a cornerstone for the evaluation of various intracranial vascular pathologies. These applications include the isolation of cerebral aneurysms by embolization and clipping, embolisation of malformations, as well the evaluation of vasooclussive diseases. The emergence of techniques such as syngo iFLOW, which give a comprehensive picture of angiography, constitute a element that can to contribute to the decision of conduct clinics. Siemens has developed a novel based system which is able to reconstruct in achieving angiography techniques colors define intracranial flow characteristics in a single image. With this technique, is possible to obtain a comprehensive picture of cerebral angiography

Vein of Galen malformation: What to do when vascular access is not feasible?

Background: The vein of Galen aneurysmal malformation (GVAM) is a rare congenital vascular lesion, with high morbidity and mortality without treatment, endovascular management is the best alternative available today.Aim: The purpose of this work is to report the case of a female patient with imaginological and angiographical diagnosis of GVAM, which was difficult for endovascular managent alone, due to this was decided an alternative endovascular direct access guided by stereotactic assistance.Case report: We report the case of an infant with imaging and angiographic diagnosis of GVAM, with absence of the vein access through classical embolization could be done, complicating and making difficult for endovascular management alone, hence was decided an alternative endovascular direct access guided by stereotactic assistance, ensuring total embolization of the lesion with coils. The patient progressed satisfactorily.Discussion: VGAM generally represents only 1% or less of total cerebral vascular malformations, but in pediatrics may be as high as 30%. The malformation is occupying the subarachnoid space of the velum interpositum and the quadrigeminal cistern. It is characterized by the presence of the vein embryonic precursor of the vein of Galen, and abnormal arterial shunts from arteries normally developed but extremely dilated. Mortality rate is high in these patients without treatment, developing hydrocephalus and cerebral complications related to the occupying mass that could drive to epilepsy, serious cognitive sequelae, intracerebral emorrhage and death within the possibilities. Heart failure is often a common complication. To our knowledge this is the first report of the use of stereotactic assistance in the endovascular therapeutic management of VGAM.Conclusions: In cases where clasical venous access cannot be achieved as in the case we report, further technical assistance can be obtained with stereotactic guidance, making easier the procedure, remembering that without therapy, VGAM result in life-threatening hydrocephalus and/or intracranial hemorrhage, rapidly driving to death

Endovascular remodeling of tortuous cervical segments of the internal carotid artery that hinder the management of complex intracranial aneurysms

Introduction: Severe tortuosity of the cervical segment of the internal carotid artery (ICA) may hamper the navigation of intravascular devices for the management of complex intracranial aneurysms and even conventional techniques of ICA access can fail. In a group of selected cases, we analyzed the efficacy and safety of carotid stenting to straighten the Severe tortuosity for direct navigation of the devices. Methods: A case series of 16 patients harboring 18 intracranial aneurysms with a difficult endovascular approach because of a cervical ICA with Severe tortuosity were prospectively recruited at our institution from January 2005 to December 2007. When traditional means of correction could not surmount this obstacle, an overlap stenting with a distal-to-proximal technique was used to overcome the Severe tortuosity. The efficacy of the procedure was defined as the ability to reach and be able to treat the target lesion with a smooth navigation of the endovascular devices. Safety was documented by procedure-related complications. Results: The straightening of the vessel by the stent helped to overcome pitfalls, making possible an obstacle-free navigation of the endovascular devices to the target lesion in all cases. In 5 cases with severe or double kinking, a distal transfer of the curve beyond the stent was observed, without impact on the efficacy of the procedure. One case of periprocedural related technical complication occurred with a permanent stroke. During the follow-up period (22.7 ± 8.4 months) no case of stent-related stroke or severe hyperplasia was observed. Conclusions: Carotid stenting is an available option when a cervical ICA with Severe tortuosity hampers a smooth catheterization of the intracranial circulation, in carefully selected cases. It allows a relatively safe and free navigation and/or deployment of additional endovascular devices needed for the treatment of complex intracranial aneurysms

Intra-arterial chemotherapy for retinoblastoma: A practical review

The use of chemotherapy for retinoblastoma constitutes a promising treatment strategy. Retinoblastoma is the most common eye cancer in the childhood.. Treatment depends on the laterality, intraocular location and tumor extension. Radiation therapy became an important element in the management of this type of injury risk of extraocular secondary tumor development. Eye salvage is mandatory when vision preserved. The current neuroendovascular techniques constitute a therapeutic tool for these tumors. We present a practical review of current concepts in the management of these tumors

Extracranial internal carotid artery aneurysm: Case illustration

Extracranial internal carotid artery aneurysms (EICAA) are uncommon lesion. These aneurysms can be classified as true or false aneurysms, atherosclerotic, dysplastic, infectious, posttraumatic and iatrogenic aneurysms. The most common presentation is central neurologic dysfunction, either a stroke or a transient ischemic attack. The rupture of these aneurysms can lead to severely impairment and can affect the quality of life of the patients or even may lead to death. Management of these lesions is required in most cases to prevent complications, however there is no treatment guideline or expert consensus for the management. We present a case of an unusual EICAA, associated with kinking of the affected vessel and review the literature

Indications and practical application of strategies in the endovascular management of intracranial aneurysms

The occlusion of intracranial aneurysms is more successful and stable by properly planning the approach and application of endovascular techniques. The next step is a relentless analysis of the different indications of endovascular treatment, tailoring a strategy suitable for the specific case, and making more rational choices for the management of aneurysms. Indications and strategies according to the analysis of the aneurysmal complex are given, as well as pros and cons of the endovascular technique according to different anatomical locations. &nbsp; &nbsp; &nbsp; &nbsp

When flow diverters fail: Short review and a case illustration of a device failure

The ultimate aims of treatment of the intracranial aneurysms are reconstruction the vessel wall and correcting the hemodynamic disturbance. A flow diverter (FD) is a stent placed inside lumen of the parent artery with aim to blood flow reduction into the aneurysms sac to the extent of almost stagnation leading to gradual onset of progressive thrombosis and neointimal lining of arterial wall remodeling to maintain blood outflow into perforators the side and branches. Flow diverter is considered as an effective treatment for fusiform, wide-necked, large and giant intracranial unruptured aneurysms. However, FD implantation may also be associated with growth and rupture of residual aneurysms. The most frequent complication of endovascular aneurysms management is thromboembolic events and less common are intra and postoperative hemorrhagic aneurysmal rupture. Authors report a case where a lack of operation of the device as illustration is presented to demonstrate the shortcomings of this new type of devices