The prospects and pitfalls in the endovascular treatment of moyamoya disease–associated intracranial aneurysms

Hou, Kun; Li, Guichen; Luan, Tengfei; Xu, Kan; Yu, Jinlu

doi:10.1007/s10143-020-01261-y

Cited by 27 publications

(27 citation statements)

References 69 publications

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“…These branches often supply the corpus callosum. The PchA often participates in the choroidal artery system of the posterior ventricle of the brain and can anastomose with the ACA to form a callosal circle ( 7 – 10 ). A case of BAVM mainly supplied by the PchA is illustrated in Figure 4 .…”

Section: Discussionmentioning

confidence: 99%

Imaging Characteristics and Endovascular Treatment of Brain Arteriovenous Malformations Mainly Fed by the Posterior Cerebral Artery

Hou

et al. 2021

Front. Neurol.

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Background: A BAVM that is mainly supplied by the posterior cerebral artery (PCA) lies deeply in the middle of the bilateral posterior hemispheres. Few studies have investigated the imaging characteristics and endovascular treatment (EVT) of brain arteriovenous malformations (BAVMs) in this area.Methods: A retrospective study was performed for patients who were diagnosed with PCA-BAVMs from January 2015 to December 2019. The PCA-BAVMs were divided into type I and type II according to their feeding arteries. Type I PCA-BAVMs were supplied by the posterior choroidal artery (PchA) from the PCA. They could be further subdivided into type Ia and type Ib. Type II PCA-BAVMs were supplied by the temporal or occipital branch from the PCA. They could also be further subdivided into type IIa and IIb. Targeted embolization of the risk factors was the main aim of EVT.Results: Forty-two patients were identified, with age ranging from 6 to 63 years. Twenty-four cases belonged to type I (57.1%, 24/42), including 6 Ia cases and 18 Ib cases. Eighteen cases belonged to type II (42.9%, 18/42), including 7 IIa cases and 11 IIb cases. Immediate complete or nearly complete embolization was achieved in 17 (40.5%, 17/42) cases. Partial embolization was achieved in 25 (59.5%, 25/42) cases. Two (4.8%, 2/42) patients experienced intraoperative or postoperative bleeding. The GOS scores at discharge were 3, 4, and 5 in 2 (4.8%, 2/42), 2 (4.8%, 2/42), and 38 (90.4%, 38/42) cases, respectively. There was no statistical difference between patients in type I and type II groups regarding age, BAVM rupture, SM grade, immediate extent of obliteration, and prognosis. Deep venous drainage was more common in patients of the type I group (P < 0.001).Conclusions: Our classification of the PCA-BAVMs was based on the segmentation of the PCA, which is a reasonable approach and could guide the strategy of EVT. EVT is a reasonable option for the PCA-BAVMs. The main aim of EVT is to secure the weak structures. A targeted EVT aimed at the ruptured part of the BAVM can reduce the risk of early rebleeding.

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Section: Discussionmentioning

confidence: 99%

Imaging Characteristics and Endovascular Treatment of Brain Arteriovenous Malformations Mainly Fed by the Posterior Cerebral Artery

Hou

et al. 2021

Front. Neurol.

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“…Liquid embolic agents include n-butyl cyanoacrylate (NBCA, Histoacryl, Yocan Medical, Toronto, CA) and Onyx [15]. NBCA has a better ability to penetrate the shunt [16]. For example, Koyanagi et al (2016) successfully treated a DAVF in the falcine sinus with the help of NBCA through the MMA [7].…”

Section: Discussionmentioning

confidence: 99%

Endovascular Treatment of Falcine Sinus Dural Arteriovenous Fistula

Piao

Zhao

Yang

et al. 2021

Preprint

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BackgroundDural arteriovenous fistula (DAVF) often occurs in the cavernous sinus, transverse sinus, sigmoid sinus, tentorium, etc. A DAVF in the falcine sinus is extremely rare in adults. DAVF treatment has progressed from microsurgery to endovascular treatment (EVT). At present, the treatment for DAVF in the falcine sinus is mainly EVT. Cases PresentationWe present 2 cases of DAVF in the falcine sinus. In case 1, the patient was a 38-year-old male, and in case 2, the patient was a 35-year-old female; both had sudden onset of cerebral hemorrhage. They underwent CT angiography (CTA) and/or digital subtraction angiography (DSA), which showed a DAVF in the falcine sinus. In case 1, the feeding artery was only the right middle meningeal artery (MMA), which drained to the superior sagittal sinus through the cortical vein. In contrast, in case 2, there were a variety of feeding arteries, including bilateral ophthalmic arteries, the internal maxillary artery and the right MMA, and the DAVF drained through both cortical veins and cerebral deep veins simultaneously. Both were cases of Cognard type IV DAVF. Using Onyx (Medtronic, Irvine, California, USA), both patients underwent complete EVT through the MMA, with a satisfactory therapeutic outcome. ConclusionWe believe that it is highly feasible to use Onyx for DAVFs in the falcine sinus using an arterial approach through the MMA to perform EVT. Nevertheless, due to the limited number of cases, we still need to accumulate additional experience.

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“…MMD is an uncommon cerebrovascular disease characterized by progressive stenosis of the terminal portion of the internal carotid artery and its main branches, which is more popular in East Asian countries [15,16]. Due to the ischemic state in anterior circulation, collateral circulation always forms in patients with MMD [17].…”

Section: Discussionmentioning

confidence: 99%

Angiographic study of the transdural collaterals at the anterior cranial fossa in patients with Moyamoya disease

Hou

Guo

et al. 2020

Int. J. Med. Sci.

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Unlike its parietal, temporal, and occipital counterparts, the frontal lobe has a broad basal surface directly facing the anterior cranial fossa dura mater which could permit establishment of transdural collaterals (TDCs) with the frontal lobe. Studies on the TDCs from the anterior cranial fossa in moyamoya disease (MMD) are scarce and inadequately investigated. A retrospective study of 100 hemispheres in 50 patients who were diagnosed with MMD by catheter angiography between January 2015 and June 2019 was performed in our institution. TDCs through the anterior ethmoid artery (AEA) or posterior ethmoid artery (PEA) were divided into 3 types respectively based on their respective angioarchitecture. Furthermore, we also studied TDCs to the temporal, parietal, and occipital lobes and collaterals from the posterior circulation to the territory of the anterior cerebral artery. TDCs through the AEA and PEA were identified in 89 (89/100, 89%) and 73 (73/100, 73%) of the hemispheres. The vascularization state of the frontal lobe was good in 89 (89/100, 89%) hemispheres. Rete mirabile and TDCs through the PEA were statistically different among patients with different Suzuki stages. No statistical difference was noted in TDCs through the AEA, frontal TDCs from other sources, and the vascularization state of the frontal lobe with regard to different Suzuki stages. TDCs through the AEA and PEA at the anterior cranial fossa play a very important role in compensating the ischemic frontal lobe. The frontal lobe could be well compensated in most of the patients with TDCs at the anterior cranial fossa.

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The prospects and pitfalls in the endovascular treatment of moyamoya disease–associated intracranial aneurysms

Cited by 27 publications

References 69 publications

Imaging Characteristics and Endovascular Treatment of Brain Arteriovenous Malformations Mainly Fed by the Posterior Cerebral Artery

Imaging Characteristics and Endovascular Treatment of Brain Arteriovenous Malformations Mainly Fed by the Posterior Cerebral Artery

Endovascular Treatment of Falcine Sinus Dural Arteriovenous Fistula

Angiographic study of the transdural collaterals at the anterior cranial fossa in patients with Moyamoya disease

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