Long-term follow-up showed that EVT, especially tVE, is an efficient and safe treatment for CS-dAVF. It resulted in the eventual disappearance of shunt flow. Residual shunt without major retrograde flow or cortical venous reflux can be monitored without additional treatment.

Aneurysms located at the distal portion of the anterior inferior cerebellar artery (AICA) are rare, and their clinical features are not fully understood. We report the clinical features and management of nine distal AICA aneurysms in nine patients treated during the past decade at Kagoshima University Hospital and affiliated hospitals. Our series includes seven women and two men. Of their nine aneurysms, eight were ruptured and one was unruptured; six were saccular and three were dissecting aneurysms. The most prevalent location was the meatal loop (n = 5) followed by the postmeatal (n = 3) and premeatal segment (n = 1) of the AICA, suggesting hemodynamic stress as an etiology of these distal AICA aneurysms. Of the nine patients, five presented with angiographic features suggestive of increased hemodynamic stress to the AICA and the common trunk of the posterior inferior cerebellar artery, with vertebral artery stenosis, marked laterality, and a primitive hypoglossal artery. We addressed eight aneurysms (eight patients) surgically; one aneurysm in one patient disappeared in the course of 3 months without surgical treatment. Of the eight surgically treated aneurysms, seven were ruptured and one was unruptured, five were clipped via lateral suboccipital craniotomy, two were trapped via lateral suboccipital craniotomy, and one was embolized. Good outcomes were obtained in six of the eight patients who underwent operation (75 %). We consider increased hemodynamic stress attributable to anatomic variations in the AICA and related posterior circulation to be the predominant contributor to the development of distal AICA aneurysms. Direct clipping and trapping yielded favorable outcomes in our series.

Fenestration of the middle cerebral artery detected after thrombectomy: case report

We report a patient with acute-phase cerebral embolism related to Trousseau's syndrome (TS) in whom thrombectomy was performed, and white thrombi were captured. Case Presentation: The patient was a 65-year-old female. Sudden-onset dizziness and progressive consciousness disorder were noted. Diagnostic imaging led to a diagnosis of occlusion of the basilar artery (BA). In the acute phase, thrombectomy was performed, and white thrombi were captured, differing from standard-type embolism. After surgery, the symptoms rapidly reduced, but systemic investigation suggested advanced gastric cancer as an etiologic factor for embolism. Subsequently, embolism recurred, and the patient died of hemorrhagic cerebral infarction 31 days after onset. Conclusion: If a white thrombus is captured during thrombectomy, TS should be differentiated as an etiologic factor.