No abstract

Basilar artery fenestration aneurysms are rare and complex lesions. Endovascular treatment appears to be safe and efficient. The detailed understanding of the aneurysm morphology and its relation to the fenestration is strongly recommended to treatment planning. Further studies are necessary to validate the utility of the proposed classification and treatment strategy.

BACKGROUND AND PURPOSE:The use of Onyx in the treatment of intracranial AVMs has increased the cure rate of endovascular embolization compared with the use of liquid adhesive agents. Inadvertent occlusion of the draining veins before the complete exclusion of the nidus constitutes a major risk of bleeding. We report a case series using the technique of double simultaneous arterial catheterization as an approach to achieve the complete exclusion of the nidus before reaching the venous drainage, through a more controlled hemodynamic filling.

SUMMARY:Embolization of head and neck hypervascular tumors is a well-established therapeutic technique. Preoperative embolization reduces intraoperative blood loss, shortens the length of surgery, and decreases surgical morbility and mortality. This study assesses the safety and efficacy of preoperative embolization of meningiomas fed by the OPH by using Onyx liquid embolic agent.ABBREVIATIONS: ACA ϭ anterior cerebral artery; DSA ϭ digital subtraction angiography; MMA ϭ middle meningeal artery; OPH ϭ ophthalmic artery, PVA ϭ polyvinyl alcohol. Preoperative embolization of meningiomas can reduce surgical blood loss, shorten operation length, reduce the risk of damage to surrounding structures, and increase the likelihood of complete tumor resection.1-11 Embolization becomes especially important when meningiomas are located at the skull base, because of the difficulties of bleeding management in this region. 2,11,12 The blood supply of meningiomas usually arises from branches of the external carotid artery, except in cases of anterior and middle skull base tumors. In these cases, hypervascularized tumors are often fed by internal carotid artery branches, such as the OPH. [2][3][4][5][12][13][14][15] In this situation, the benefits of preoperative embolization must be weighed against the risk of complications, as an inadvertent interruption of blood flow to the central retinal artery may lead to retinal ischemia and visual compromise. 1,8,[13][14][15][16] The preoperative embolization of meningiomas supplied by the OPH requires superselective catheterization and the most distal placement of the microcatheter as possible, aiming to protect the central retinal artery of any reflux. There are several embolic materials, such as PVA particles, spheres, and glue, that were widely used in the literature. 3,4,6,[14][15][16][17][18] However, these embolic agents are usually injected by using guide-dependent microcatheters that are known to have limited distal reach.Liquid embolic agent reflux into the OPH could lead to inadvertent occlusion of the central retinal artery. 3,[14][15][16][17][18] This article reports our experiences with the preoperative embolization of meningiomas fed by OPH branches by using Onyx (ev3, Irvine, California). This endovascular approach with Onyx was proposed as an alternative strategy for a more controlled embolization, aiming to reduce the risks of visual impairment caused by central retinal artery occlusion. Materials and MethodsFrom February 2008 to January 2010, 5 patients with untreated intracranial meningiomas fed mainly by OPH branches underwent preoperative embolization with Onyx-18 at our institution. There were 2 men and 3 women, with a mean age of 56 with an SD of 11.11 years (median, 53.3 years; range, 46 -74 years).Clinical presentation included headache in 3 patients, confusion in 3, anosmia in 1 patient, decreased visual acuity in 1 patient, and epilepsy in 1 patient. No patient had appendicular deficits. All patients underwent a CT scan, MR imaging, and DSA. Hypervascular blush ...

Arteriovenous fistulae of the cavernous sinus are rare and difficult to diagnose. They are classified into dural cavernous sinus fistulae or direct carotid-cavernous fistulae. Despite the similarity of symptoms between both types, a precise diagnosis is essential since the treatment is specific for each type of fistula. Imaging findings are remarkably similar in both dural cavernous sinus fistulae and carotid-cavernous fistulae, but it is possible to differentiate one type from the other. Amongst the available imaging methods (Doppler ultrasonography, computed tomography, magnetic resonance imaging and digital subtraction angiography), angiography is considered the gold standard for the diagnosis and classification of cavernous sinus arteriovenous fistulae. The present essay is aimed at didactically presenting the classification and imaging findings of cavernous sinus arteriovenous fistulae.