Laterocavernous sinus dural arteriovenous fistulas (DAVFs) are rare and not always accessible transvenously due to their angioarchitecture. We report a case of non-sinus-type laterocavernous sinus DAVF treated by endovascular transarterial venous coil embolization.Case Presentation: A 78-year-old woman was admitted to our hospital with loss of consciousness, right hemiparesis, and motor aphasia. CT demonstrated intracerebral hematoma in the left frontal lobe and subarachnoid hemorrhage. On CTA and MRA, a DAVF was found in the left laterocavernous sinus region associated with the accessory meningeal artery (AMA) and draining directly into the superficial middle cerebral vein. The diagnosis was confirmed by DSA, which revealed a DAVF fed by the large and straight AMA and the internal carotid artery's meningohypophyseal trunk.Endovascular transarterial venous coil embolization was performed through the AMA. A microcatheter was advanced beyond the shunt point into the origin of the draining vein, and coils were placed in the venous and arterial sides of the fistula. The fistula was completely occluded, and 15-month follow-up angiography demonstrated stable obliteration of the fistula. Conclusion:Transarterial venous coil embolization may be a treatment option for non-sinus-type laterocavernous sinus DAVF with a large fistula size and a large and straight feeding artery.Keywords▶ middle fossa dural arteriovenous fistula, sphenoid wing, transarterial venous embolization, coil, endovascular therapy

Objective: We report a case wherein coil embolization with an intention to preserve the hemispheric branches was performed to treat a ruptured saccular aneurysm in the distal posterior inferior cerebellar artery (PICA) during the acute period. The considerations that led to the selection of the endovascular treatment are discussed. Case Presentation:The patient was an 87-year-old woman who presented with subarachnoid hemorrhage. After considering the patient's age and the severity of her condition, intra-aneurysmal coil embolization was performed to treat a saccular aneurysm in the left telovelotonsillar segment. The parent artery was preserved, and no postoperative complications were noted. Conclusion:Either parent artery embolization or intra-aneurysmal embolization should be selected as the endoscopic treatment methodology for de novo saccular aneurysms located in the PICA, except for those in the vertebral artery bifurcation area. The treatment selection should be based on careful evaluation of the aneurysm size, parent artery diameter, and aneurysm site.

We report a patient in whom overlapping stent placement with coil embolization was useful for treating a ruptured basilar artery (BA) dissecting aneurysm with rapid enlargement. Case Presentation: A 50-year-old female presented with subarachnoid hemorrhage (SAH). On evaluation, a fusiform dilatation of the BA was noted, suggesting a dissecting aneurysm. Rapid enlargement of the aneurysmal dilatation was observed between days 9 and 16. On day 18, overlapping stent placement was performed in the dilated BA, and the aneurysmal dilatation was roughly embolized using coils. No neurologic deficit was observed in the postoperatively, and the patient was discharged with modified Rankin Scale (mRS) 0. Follow-up DSA at 8 months after the procedure showed the complete obliteration of the aneurysm with the remodeling of the BA. During the 29-month follow-up, there has been no recurrence. Conclusion: Overlapping stent placement for a dissecting BA aneurysm was effective treatment leading to favorable vascular remodeling.

We report a patient with normal imaging findings at the onset of preceding headache who developed subarachnoid hemorrhage (SAH) due to intracranial vertebral artery dissection 7 days later.Case Presentation: A 51-year-old woman with a history of chronic headache visited our emergency outpatient department with a complaint of mild to moderate right nuchal pain. CT, MRA, and MRI (diffusion-weighted image, T2-weighted image, FLAIR, MR cisternography, and basi-parallel anatomical scanning) were normal. Seven days later, she was admitted to our hospital with sudden disturbance of consciousness. CT revealed SAH and CTA demonstrated dilatation of the right vertebral artery (VA). The dilated lesion with an intimal flap on the right VA proximal to the posterior inferior cerebellar artery was confirmed on DSA. The dilated lesion and the proximal VA were occluded endovascularly using coils. The condition of the patient improved gradually, and she was transferred to the rehabilitation hospital on day 45 with a modified Rankin Scale score of 2. Conclusion:The clinical course of the presented case, although rare, should be kept in mind in daily clinical practice.