Giant Basilar Artery Aneurysm Involving the Origin of Bilateral Posterior Cerebral and Superior Cerebellar Arteries: Neck Reconstruction with pCONus-Assisted Coiling

Signorelli, Francesco; Sturiale, Carmelo Lucio; Rocca, Giuseppe La; Albanese, Alessio; D’Argento, Francesco; Mattogno, Pier Paolo; Puca, Alfredo; Visocchi, Massimiliano; Marchese, Enrico; Pedicelli, Alessandro

doi:10.1007/978-3-319-39546-3_20

Cited by 11 publications

(3 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This theory was not confirmed by Pérez et al [8] in their in vitro study. On the other hand, there are similar reports of complete aneurysm occlusions assisted with a pCONus stent, which showed residual aneurysm perfusion and aneurysm enlargement in the follow-up DSA [9,10]. Aneurysm size (≥ 10 mm) and incomplete initial occlusion are two major predictive factors of aneurysm recanalisation, and after first intervention both were present in our patient when the first SAH occurred but not in the second case of SAH [11-13].…”

Section: Discussionsupporting

confidence: 78%

Repeating enlargement, recanalisations, and subarachnoid haemorrhages after middle cerebral artery aneurysm embolisation using pCONus stent and coils – a case report

et al. 2019

View full text Add to dashboard Cite

Purpose Large and wide-necked bifurcation aneurysms remain technically challenging to treat by the endovascular approach. Several endovascular strategies have been established in recent years for treating wide-necked bifurcation aneurysms, such as balloon-assisted coiling, stent-assisted coiling, waffle cone technique (WCT), and intrasaccular flow disruptors. Case report A 64-year-old woman was diagnosed with three intracranial aneurysms of the right and left middle cerebral artery and right internal carotid artery. She was qualified for endovascular treatment of the left middle cerebral artery (LMCA) aneurysm because it posed the greatest risk of rupture. Due to complicated morphology, a pCONus stent and coils were chosen for treatment. Three months later the right middle cerebral artery aneurysm was embolised and the woman was scheduled for second-stage treatment of the LMCA aneurysm. One week before the planned admission the woman was diagnosed with subarachnoid haemorrhage (SAH) in the region of the previously treated LMCA aneurysm, and the second-stage treatment was conducted with a good result. The woman was discharged in improved condition. Three months later the woman was once again admitted with SAH – an enlarged LMCA aneurysm was observed and immediate third-stage embolisation was performed, but due to complications of SAH the woman eventually died. Conclusions On the basis of the presented case we would like to emphasise the importance of sufficient initial coil packing and frequent control of neck region of the aneurysm for the long-term stability and safety after pCONus-assisted coiling of intracranial aneurysms.

show abstract

Section: Discussionsupporting

confidence: 78%

Repeating enlargement, recanalisations, and subarachnoid haemorrhages after middle cerebral artery aneurysm embolisation using pCONus stent and coils – a case report

et al. 2019

View full text Add to dashboard Cite

show abstract

“…The theoretical alternatives to the use of a combination of Medina and coils would have included a WEB device (Pierot et al 2017) or a pCONus-assisted coil occlusion (Signorelli et al 2017) with the need for dual platelet function inhibition.…”

Section: Discussionmentioning

confidence: 99%

Superior Cerebellar Artery Aneurysm: Spontaneous SAH, Occlusion of a Mid-sized, Wide-Necked Superior Cerebellar Artery Aneurysm with a Medina Device and Coils; Subsequent Coil Compaction, Treated with Flow Diversion Using a p64

Kalman¹,

AlMatter²,

Pérez³

et al. 2018

The Aneurysm Casebook

View full text Add to dashboard Cite

A 64-year-old male patient was brought to the referring hospital after an acute onset of a paresis of his right arm and a motoric aphasia without headache. Assuming an ischemic stroke, an MRI/MRA was performed, followed by a CT examination. These revealed a massive subarachnoid hemorrhage (SAH) from a mid-sized, wide-necked aneurysm at the origin of the left superior cerebellar artery (SCA). The aneurysm and in particular the rupture site were occluded with a Medina device (Medtronic) and conventional coils. The patient recovered well from the SAH. DSA 3 months after this treatment showed some coil compaction adjacent to the aneurysm neck. A second follow-up DSA 6 months after the initial treatment showed an increase of the aneurysm reperfusion, which was considered to be a sign of unstable aneurysm occlusion. To reduce the hemodynamic impact on the aneurysm remnant and to allow for a remodeling of the left SCA, a p64 (phenox) flow diverter was implanted from the left posterior cerebral artery (PCA) to the distal basilar artery (BA). This procedure was again well tolerated. A follow-up DSA examination 9.5 months after the first and 3 months after the second treatment showed decreased aneurysm reperfusion and an incomplete remodeling of the proximal segment of the left SCA. The management of wide-necked, ruptured aneurysms using Medina and secondary extrasaccular flow diversion is the main topic of this chapter.

show abstract

“…52,53 Endovascular treatment, including simple coiling or stent-assisted coiling, has been found to be effective and safe in small case series and isolated case reports. 16,18,54,55 Recently, one group reported on the use of a woven endobridge device to treat JB diverticulum/aneurysms. 54 Care has to be exercised when placing stents across the JB.…”

Section: Treatment and Outcomesmentioning

confidence: 99%

Venous Causes of Pulsatile Tinnitus: Clinical Presentation, Clinical and Radiographic Evaluation, Pathogenesis, and Endovascular Treatments: A Literature Review

Essibayi¹,

Oushy²,

Lanzino³

et al. 2021

Neurosurg.

View full text Add to dashboard Cite

Tinnitus is an abnormal perception of a sound without external stimulation. Venous pulsatile tinnitus (VPT) is a specific form of tinnitus characterized by an objective and often subjective bruit that occurs as a result of localized venous abnormalities. Clinical evaluation relies on sound quality, duration, and precipitating factors. Idiopathic intracranial hypertension (IIH) and transverse sinus stenosis (TSS) are among the most common causes of VPT. Other causes include sigmoid sinus wall abnormalities (SSWAs), jugular vein anomalies (JVAs), and emissary veins anomalies. These anomalies can be detected on magnetic resonance imaging, magnetic resonance angiography/magnetic resonance venography, and high-resolution temporal bone computed tomography. The pathogenesis behind the VPT includes turbulent blood flow as a result of luminal stenosis or abnormal dilation, amplification of internal sound due to temporal bone defects, and abnormal position of the venous sinus system structures adjacent to the bony structures of the auditive apparatus. Based on these theories, different interventional treatment modalities can be applied to treat the underlying causes. Endovascular treatments have shown high efficacy and safety among those treatments which include stenting of the lateral sinus stenosis in IIH and TSS, coiling of the SSWA and JVA, and embolization of emissary veins anomalies. Further studies are needed to understand the natural history of these anomalies and the efficacy of treatments of VPT, which—unlike other types of tinnitus—can be cured with proper treatment.

show abstract

Giant Basilar Artery Aneurysm Involving the Origin of Bilateral Posterior Cerebral and Superior Cerebellar Arteries: Neck Reconstruction with pCONus-Assisted Coiling

Cited by 11 publications

References 22 publications

Repeating enlargement, recanalisations, and subarachnoid haemorrhages after middle cerebral artery aneurysm embolisation using pCONus stent and coils – a case report

Repeating enlargement, recanalisations, and subarachnoid haemorrhages after middle cerebral artery aneurysm embolisation using pCONus stent and coils – a case report

Superior Cerebellar Artery Aneurysm: Spontaneous SAH, Occlusion of a Mid-sized, Wide-Necked Superior Cerebellar Artery Aneurysm with a Medina Device and Coils; Subsequent Coil Compaction, Treated with Flow Diversion Using a p64

Venous Causes of Pulsatile Tinnitus: Clinical Presentation, Clinical and Radiographic Evaluation, Pathogenesis, and Endovascular Treatments: A Literature Review

Contact Info

Product

Resources

About