No abstract

Objective:The objectives of treating dural arteriovenous fistula (dAVF) are to achieve complete occlusion of the arteriovenous (AV) shunt and restoration of anterograde venous flow. We report a patient with complex dAVF who was managed by double overinflated balloon protection of the torcula and percutaneous transluminal angioplasty (PTA) for the occluded venous sinus. Case Presentation:A 62-year-old woman was admitted with gradually worsening nausea and vomiting, as well as progressive memory disturbance and left hemiparesis. Head MRI/MRA demonstrated a dAVF involving the region from the right sigmoid sinus (SS) to transverse sinus (TS) along with occlusion of the left TS and right proximal SS. There was associated dilatation of the right TS, torcula, and superior sagittal sinus (SSS). The intracranial venous circulation was impaired, with venous reflux draining into the deep cerebral veins as well as the cortical veins. Transarterial embolization (TAE) and transvenous embolization (TVE) were performed with double overinflated balloon protection of the torcula, and shunt flow was completely abolished. The occluded sinus was recanalized by PTA. Her symptoms gradually improved after treatment. Conclusion:In this patient, double overinflated balloon protection was effective for maintaining the torcula.

Objectives?In microvascular decompression (MVD) for hemifacial spasm (HFS), the patient is placed in the lateral or park-bench position that is complicated and uncomfortable for anesthesiologists, nurses, and even the patient. Careless retraction of the cerebellum by a spatula could be the major cause of surgical complications. In our method, a patient is laid supine avoiding the complicated positioning. The subfloccular approach from a small cranial window sited on the more lateral and basal side of the occipital cranium enables the surgeon to reach all the segments of the facial nerve root without a spatula. We introduce our surgical procedures in detail along with our excellent results. Methods?A total of 100 consecutive patients experiencing primary HFS were operated on with MVD by a single surgeon in our institution from August 2012 to April 2014. Results?Overall, 94 patients showed the complete disappearance or a satisfactory alleviation of HFS. De novo neurologic deficits were not encountered after surgery including hearing impairment. In 47 cases, multiple offending vessels were observed in multiple possible affected sites in addition to the root entry/exit zone. Conclusions?We believe this approach is superior for the safe and precise decompression of any part of the facial nerve root.

Cavernous sinus (CS) dural arteriovenous fistulas (AVF), which are most common in middle-aged females, present with benign symptoms such as exophthalmos, chemosis, and orbital bruit. Benign CS dural AVF without cortical venous drainage (CVD) have the rare potential for development of CVD with neurological symptoms, even without treatment. On the other hand, aggressive type AVF with CVD can cause more aggressive symptoms such as cerebral hemorrhage. As symptoms are highly related to the drainage pattern, it is important to understand the anatomy of the CS itself, shunt point, and draining vein when treating the lesion. In general, the drainage route is gradually diminished by thrombosis and compartmentalization within the CS according to progression of the angiographical stage. At the restrictive stage, the disease is usually treated by endovascular treatment, particularly transvenous embolization. Keywords▶ cavernous sinus, dural arteriovenous fistula, general aspects, natural history This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives International License.

• Abstract • Objective: Infection associated with coil embolization of cerebral aneurysm is very rare. We describe a case of brain abscess formation following coil embolization of a cavernous carotid artery giant aneurysm. Case presentation: This 59-year-old man complained of double vision due to a left cavernous carotid artery giant aneurysm. Embolization of the aneurysm using platinum coils was performed. However, the patient presented double vision again 1 year later. MRI showed brain abscess in the left temporal lobe, which appeared continuous with the aneurysm. His neurological condition rapidly deteriorated despite administration of antibiotic drugs. After additional aneurysm embolization and parent artery occlusion, brain abscess was surgically treated. Under the microsurgical view, the brain abscess directly connected the aneurysm and platinum coils were detected through a perforated wall of the aneurysm. Without removal of the coil, infection was completely resolved. Conclusion:Coil infection of cerebral aneurysm should be noted, however it is very rare.•