Search

Objective: Total aneurysm occlusion is crucial for the prevention of rebleeding of a ruptured aneurysm or to avoid rupture of an unruptured lesion. Both surgical and endovascular embolization fail to achieve complete aneurysm occlusion in all the cases. The objective of the study was to establish the safety and efficacy of endovascular treatment for previously clipped residual or recurrent aneurysms.Methods: This was an observational, retrospective study of patients harboring incompletely occluded intracranial aneurysms after clipping who underwent endovascular treatment. Patients were treated using 4 different techniques: (1) simple coiling, (2) balloon remodeling, (3) stent-assisted coiling, and (4) flow diversion. Analyses were performed to identify predictors of total aneurysm occlusion, recanalization and complications.Results: Between May 2010 and September 2018, 70 patients harboring incompletely occluded intracranial aneurysms after clipping met the inclusion criteria in 5 centers. The mean residual aneurysm size was 7.5 mm. Fifty-nine aneurysms were unruptured. Total aneurysm occlusion was achieved in 75.3% of the aneurysms after 1 year. All aneurysms treated with flow diversion revealed complete occlusion according to control angiography. Recanalization was observed in 14.5%. Permanent morbidity and mortality occurred in 2.9% and 1.4% of the patients, respectively.Conclusions: Endovascular treatment of recurrent or residual aneurysms after surgical clipping was safe and efficacious. Flow diversion seems to be associated with better anatomical results. A more rigid study, a larger group of patients, and longterm follow-up are required to provide stronger conclusions about the best approach for residual clipped aneurysms.

Stent infection is extremely rare, especially in stents placed in the internal carotid artery (ICA). Treatment in these cases remains controversial and no consensus has been reached, resulting in high mortality in all cases. We report the case of a 78-year-old man undergoing stent placement in the left ICA who, 20 days later, presented with infection at the stent site and a large pseudoaneurysm. The primary infectious focus was the teeth. The patient was treated with antibiotics and placement of a Casper stent, a dual layer braided metal stent with micro-mesh, intended to determine flow diversion and arterial wall reconstruction. Although the procedure was able to reduce the pseudoaneurysm, the patient eventually died of sepsis. We believe that the use of dual layer stents, with a flow-diverting effect, may be a treatment option in selected cases. However, further studies are needed to confirm this hypothesis.

Objetivo deste estudo: comparar a eficácia do stent de célula fechada com o stent Casper durante angioplastia de carótida com implante de stent (ACS) e dispositivo de proteção cerebral (DPC) distal. Material e Métodos: estudo prospectivo de superioridade randomizado no qual 88 pacientes foram incluídos. Os desfechos primários foram a incidência, número e tamanho de novas lesões cerebrais isquêmicas após ACS sob DPC distal. Os desfechos secundários incluíram acidente vascular cerebral (AVC), ataque isquêmico transitório (AIT) e infarto agudo do miocárdio (IAM). As lesões cerebrais isquêmicas foram avaliadas por uma imagem de ressonância magnética na sequência de difusão (DWI-MR). Os resultados neurológicos foram avaliados por meio do NIHSS e da escala Rankin modificada (mRS). Resultados: Comparado com o stent de célula fechada (n = 47), o stent Casper (n = 41) não resultou em redução significativa na incidência (44,7% versus 39%, p = 0,592), número (1,3 ± 1,8 versus 0,9 ± 1,5; p = 0,444) e tamanho (3,9 ± 5,8 versus 2,8 ± 4,2 mm; p = 0,353) de novas lesões cerebrais isquêmicas na DWI-MR. A taxa global de AVC / AIT / IAM foi (2/88 - 2,3%). Dois AITs ocorreram no período hospitalar, um em cada grupo (1/41 - 2,4% versus 1/47 - 2,1%). Um paciente do grupo-Casper apresentou trombose intra-stent assintomática. Um paciente do grupo-controle apresentou IAM (1/47 - 2,1%) após a alta. Conclusão: O stent Casper não mostrou superioridade na taxa de incidência, número e tamanho de novas lesões cerebrais isquêmicas silenciosas detectadas por DWI-RM quando comparado ao stent célula fechada durante ACS sob DPC distal. Objective: The aim of this trial was to compare the efficacy of closed-cell stents with Casper stents during carotid angioplasty stenting (CAS). Methods: This was a randomized superiority trial in which 88 patients were enrolled. The primary end points were the incidence, number, and size of new ischemic brain lesions after CAS under distal embolic protection devices (EPD). The secondary end points included stroke, transient ischemic attack (TIA) and myocardial infarction (MI). Ischemic brain lesions were assessed by a diffusion-weighted magnetic resonance image (DWI-MR). Neurological outcomes were evaluated by means of the National Institutes of Health scale score (NIHSS) and the modified Rankin scale (mRS). Results: Compared with closed-cell stents (n= 47), Casper stents (n= 41), resulted in no significant reduction in the incidence (44.7% versus 39%, p = 0.592), number (1.3± 1.8 versus 0.9± 1.5, p = 0.444), and size (3.9± 5.8 mm versus 2.8± 4.1mm, p = 0.353) of new ischemic brain lesions. The global rate of stroke/TIA/MI was (2/88, 2.3%). Two TIA occurred during the hospitalization period, one in each group (1/41, 2.4% versus 1/47, 2.1%). One patient of the Casper group had an asymptomatic in-stent thrombosis. One patient of the control group had a MI (1/47, 2.1%) after discharge. Conclusion: The Casper stents did not show superiority in the rate of incidence, number and size of new silent ischemic brain lesions detect by DW-MRI when compared to close cell stents during CAS under distal EPD.

Pseudoaneurysm resulting from the external carotid artery or its branches after trauma to the maxillofacial region is unlikely, even more so, in a patient with von Willebrand disease. This study aimed to report a challenging case of pseudoaneurysm of the buccal artery and inferior alveolar artery due to a mandible fracture in a traumatized patient with undiagnosed von Willebrand disease. This reported case was conducted by a multidisciplinary team, covering the departments of maxillofacial surgery, interventional neuroradiology, neurosurgery, and hematology. From a fracture of the lower jaw and the appropriate course of action, bleeding episodes followed until intervention with embolization therapy. To our knowledge, this is the first case reported in the literature of a patient with those conditions.

BACKGROUND AND PURPOSE: The development of flow diverters has changed the endovascular approach to intracranial aneurysms. On the basis of good results, the indications for flow diverters have expanded to include aneurysms of different shapes, locations, and sizes. The objective of the study was to report on the performance of the Flow Re-Direction Endoluminal Device (FRED) in intracranial aneurysm treatment at early and medium-term follow-up. MATERIALS AND METHODS: This single-arm, multicentric, prospective, observational study assessed aneurysm treatment with the FRED. The primary outcome was complete aneurysm occlusion at 6 and 12 months, and the secondary outcome was to evaluate the safety of the FRED with respect to stroke and death rates. RESULTS: Between June 2016 and August 2018, a total of 100 consecutive patients with 131 aneurysms were treated in 107 procedures. Total occlusion rates were 91% and 95% at 6 and 12 months. There was 1 death, and the total final morbidity rate was 1.8%. The complication rate was 4.6%. CONCLUSIONS: As reported previously, the FRED has proved to be a safe and effective tool, with high occlusion rates. The design of the stent makes it more difficult to perform balloon angioplasty compared with similar devices. A branch arising from the aneurysm sac was found to be a predictor of nonocclusion at 12 months, though larger series are needed to estimate the magnitude of the association.

Purpose We aimed to evaluate the safety and feasibility of the embolization of peripheral arteriovenous malformation (AVM) with non-adhesive liquid agents (NALA) injected by dual-lumen balloons (DLB). Methods We conducted a multicenter retrospective study between January 2017 and June 2019, including patients with peripheral AVM embolized with NALA by DLB. Fourteen patients were included. The AVM classification, technical and clinical success were evaluated, as were nidus size, liquid agent used, volume and time of injection in DLB, complications, follow-up and need of surgical intervention. Results The mean age of the patients was 37±22.5 years (range, 6-82 years). The mean nidus size was 5.2±2.4 cm (range, 3.0-12.0 cm). By Schobinger classification, 11 AVMs were classified in stage 3 and 3 AVMs were classified in stage 2. By Cho's classification, 2 AVMs were in stage II, 4 AVMs were in stage I, 4 AVMs were in stage IIIa and 4 AVMs were in stage IIIb. Onyx was used in 11 patients (78.6%), while Squid, PHIL, and both Onyx and Squid were used in one patient each (7.1%). Seven patients (50%) required one session of embolization, 4 patients (28.6%) required two, 2 patients (14.3%) required three and 1 patient (7.1%) required four sessions. Complete nidus exclusion was achieved in 11 patients (78.6%), optimal clinical response in 12 patients (85.7%). Four patients (28.6%) exhibited minor complications, all controlled. No major complications were seen. Four patients underwent surgical intervention (28.6%). Conclusion The embolization of peripheral AVM with NALA in DLB appears to be safe and feasible, achieving high rates of technical and clinical success.

Context: Dural arteriovenous fistulas (DAVFs) of the cavernous sinus are arteriovenous connections located in the dura mater leaflets of this region. DAVFs usually present with ocular symptoms such as diplopia, conjunctival hyperemia, involvement of cranial nerves III/IV/VI, etc. Trigeminal neuralgia caused by a cavernous DAVF is rare, being reported only three times in the literature. Case report: A 46-year-old female smoker sought care with a complaint of multiple daily episodes of shock-like right temporal headache and facial pain in the V1/V2 dermatomes, of 2 years’ duration. A clinical diagnosis of trigeminal neuralgia was established. Magnetic resonance (MR) imaging of the brain and MR angiography of the cerebral and cervical vessels were both normal. Conservative treatment and balloon compression of the trigeminal ganglion were ineffective. Therefore, we chose to perform an angiography for diagnostic clarification, which demonstrated a DAVF of the right cavernous sinus, fed by branches of the external carotid artery. We decided to catheterize the fistula and complete obliteration was achieved. Soon after the procedure the patient reported pain relief. At 3-month follow-up the patient remained pain free and required no analgesia. Conclusion: Trigeminal neuralgia caused by a cavernous DAVF is rare. The fistula in this case was only diagnosed after an angiography was performed, so clinicians must be aware that not all vascular conditions can be identified non invasively, and that cavernous DAVFs may be an underdiagnosed cause of trigeminal neuralgia.

Background:Moyamoya disease (MMD) is a steno-occlusive cerebral angiopathy. The incidence of intracranial aneurysms (IA) associated with MMD is high (3.4-14.8%) when compared to the general population (1-3%). IA in the middle cerebral artery (MCA) associated with MMD are rare, with only 25 cases described in the literature. Methods:Search on the PubMed platform, in English, with the MeSH terms “Moyamoya Disease”, “Intracranial Aneurysm” and “Middle Cerebral Artery”. There were 151 results, of which 7 were included in the review. Results:Sumi et al. and Larson et al. reported non-ruptured IA of the M1 segment, treated by surgical clipping and wrapping, respectively. Endo et al. chose to clip a ruptured IA in the M1 segment, followed by anastomosis between the superficial temporal artery and the MCA, excluding the IA . Liu et al. reported a non-ruptured MCA IA in a pediatric patient, treated through an encephalo-duro-arterio-synangiosis; the IA was excluded. Peltier et al. performed an indirect revascularization using the multiple bur-hole technique in a pediatric patient with non-ruptured IA in the M1 segment, excluding the IA. Rivera et al. opted for the conservative approach of a ruptured IA in the M1 segment, which was successful. Yan et al. described 19 IA in the MCA associated with the MMD, without specifying the adopted therapeutic. Conclusion:Due to the low number of cases, no recommendation can be made, and treatment should be individualized.

Nasal hemorrhage or epistaxis is a common finding in the emergency department. The causes of epistaxis are varied and can be classified as local, systemic or a combination of both. The aim of this study was to report a case of embolization of branches of the maxillary artery for treatment of epistaxis secondary to facial trauma. A 43-year-old man suffered blunt trauma in the frontonasal area as a result of a bicycle accident. It presented with amnesia, severe epistaxis, panfacial edema and nasal deformity. The patient was hypotensive and hypothermic, with evidence of hemorrhagic intracranial. Orotracheal intubation was performed immediately to protect the airways and prevent aspiration of blood to the lower respiratory tract. The occlusion of the artery was successful and was immediately followed by cessation of oronasal bleeding. The patient was discharged after ten days. Arterial embolization should be the gold-standard treatment, which provides a safe and effective alternative for the control of epistaxis.

A meningomielocele cervical (MMCC) é uma afecção com características embriológicas e anatômicas que a diferencia das meningomieloceles (MMC) que ocorrem nos outros segmentos medulares. O comprometimento neurológico, a abordagem cirúrgica, assim como o prognóstico desse tipo de malformação, são igualmente distintos daqueles observados nos casos de MMC torácica ou lombar. Este relato de caso tem por objetivo salientar os aspectos peculiares dessa afecção e o seu manejo terapêutico.

Os hematomas epidurais espinhais são uma causa rara de disfunção neurológica, estando vários fatores envolvidos na sua etiologia, como trauma, desordens da coagulação, terapia antiplaquetária, malformações arteriovenosas e cirurgia. Os hematomas epidurais espinhais espontâneos (HEEE) representam 0,3% a 0,9% das lesões que ocupam espaço no canal vertebral epidural. Os resultados do tratamento dessa patologia severa dependem fundamentalmente da precisão diagnóstica e do intervalo de tempo entre o início dos sintomas e a descompressão cirúrgica. O HEEE é uma emergência medular rara, com diagnóstico desafiador. Os autores apresentam o relato de dois casos. O primeiro, de uma paciente de 47 anos com quadro clínico de dor forte e súbita interescapular seguida por paraplegia, cujo diagnóstico foi confirmado pela ressonância magnética (RM) da coluna vertebral. A paciente foi tratada com laminectomia descompressiva 36 horas após a instalação da paraplegia, com recuperação funcional completa. O segundo caso, um homem de 60 anos com a mesma sintomatologia dolorosa e paraparesia, com recuperação do déficit neurológico em 10 horas. O tratamento foi conservador, com resolução espontânea confirmada pela RM. Os autores apresentam uma breve revisão da literatura e comentam os aspectos do diagnóstico e do tratamento empregado nessa rara patologia.

Background The safety and efficacy of the first generation of the Pipeline Embolization Device (PED; Medtronic Inc) have been proven in large case series. Ischemic events are one of the most common complications following treatment of aneurysms with flow diverters. The new PED Flex with Shield technology (PED Shield; Medtronic Inc) was introduced to minimize the rate of complications. Objective To evaluate the outcomes of patients harboring aneurysms treated with the PED Shield. Methods This was an observational, prospective, single-arm multicenter study of patients treated with the PED Shield. The primary safety endpoint was the absence of major neurological complications and death. The secondary effectiveness endpoint was angiographic occlusion at 6 and 12 mo. Technical complications were also reported. Results Between November 2017 and December 2018, 151 patients from 7 centers with 182 aneurysms were enrolled. The mean aneurysm size was 7.0 mm; 27 (14.8%) aneurysms were large, and 7 (3.8%) were giant. In 141 of 151 patients (93.4%), the primary endpoint was reached. The overall rate of periprocedural complications was 7.3%. Of the aneurysms, 79.7% met the study's secondary endpoint of complete occlusion at 6 mo and 85.3% at 12 mo. Conclusion The PED Shield is a safe and effective treatment for intracranial aneurysms. The results regarding total occlusion and ischemic complications did not differ from those obtained in case series using previous versions of the PED. Long-term follow-up and comparative studies are required to provide stronger conclusions regarding the reduced thrombogenicity of this device.

The aim of this trial was to compare the efficacy of closed-cell stents with Casper stents during carotid angioplasty stenting (CAS).This was a randomized superiority trial in which 88 patients were enrolled. The primary end points were the incidence, number, and size of new ischemic brain lesions after CAS under distal embolic protection devices (EPD). The secondary end points included stroke, transient ischemic attack (TIA) and myocardial infarction (MI). Ischemic brain lesions were assessed by a diffusion-weighted magnetic resonance image (DW-MRI). Neurological outcomes were evaluated by means of the National Institutes of Health scale score (NIHSS) and the modified Rankin scale (mRS).Compared with closed-cell stents (n = 47), Casper stents (n = 41), resulted in no significant reduction in the incidence (44.7% versus 39%, P = 0.592), number (1.3 ± 1.8 versus 0.9 ± 1.5, p = 0.444), and size (3.9 ± 5.8 mm versus 2.8 ± 4.1 mm, p = 0.353) of new ischemic brain lesions. The global rate of stroke/TIA/MI was (2/88, 2.3%). Two TIA occurred during the hospitalization period, one in each group (1/41, 2.4% vs 1/47, 2.1%). One patient of the Casper group had an asymptomatic in-stent thrombosis. One patient of the control group had a MI (1/47, 2.1%) after discharge.The Casper stents did not show superiority in the rate of incidence, number and size of new silent ischemic brain lesions detect by DW-MRI when compared to close cell stents during CAS under distal EPD.

Background and Purpose- Flow diverter technology improvements are necessary to provide safe and good results and enable the treatment of a larger variety of aneurysms. We report a nationwide experience with the Derivo Embolization Device in the treatment of intracranial aneurysms. Methods- BRAIDED (Brazilian Registry of Aneurysms Assigned to Intervention With the Derivo Embolization Device) is a multicenter, prospective, interventional, single-arm trial of the Derivo Embolization Device for the treatment of intracranial aneurysms. The primary effectiveness end point was total aneurysm occlusion at 6- and 12-month angiographies. The secondary safety end point was the absence of serious adverse events during follow-up. Univariable and multivariable logistic regression was performed to identify predictors of aneurysm persistence, periprocedural complications, and adverse events during follow-up. Results- Between December 2016 and October 2018, 146 patients harboring 183 intracranial aneurysms were treated in 151 interventions at 7 centers. Derivo Embolization Device placement was technically successful in all patients. Most aneurysms (86.9%) were located at the internal carotid artery, and the mean diameter was 6.7 mm. At 6 months, 113 of 140 (80.7%) aneurysms met the study's primary end point, and 74 of 83 (89.2%) met the study's primary end point at 12 months. Saccular morphology of the aneurysm (odds ratio, 5.66; 95% CI, 1.01-31.77) and the presence of a branch arising from the sac (odds ratio, 6.36; 95% CI, 2.11-22.36) predicted persistence. A long duration of follow-up (odds ratio, 0.86; 95% CI, 0.78-0.95) predicted total occlusion. Of the 146 enrolled patients, 138 (94.5%) were treated without serious adverse events during follow-up. In the multivariable analysis, aneurysms located at a sidewall were less likely to experience these events than those located at bifurcations (odds ratio, 0.07; 95% CI, 0.01-0.51). Conclusions- The Derivo Embolization Device is a safe and effective treatment for intracranial aneurysms. Clinical Trial Registration- URL: http://plataformabrasil.saude.gov.br/login.jsf. Unique identifier: CAAE 77089717.7.1001.5125.

Background and Purpose— Flow diverter technology improvements are necessary to provide safe and good results and enable the treatment of a larger variety of aneurysms. We report a nationwide experience with the Derivo Embolization Device in the treatment of intracranial aneurysms. Methods— BRAIDED (Brazilian Registry of Aneurysms Assigned to Intervention With the Derivo Embolization Device) is a multicenter, prospective, interventional, single-arm trial of the Derivo Embolization Device for the treatment of intracranial aneurysms. The primary effectiveness end point was total aneurysm occlusion at 6- and 12-month angiographies. The secondary safety end point was the absence of serious adverse events during follow-up. Univariable and multivariable logistic regression was performed to identify predictors of aneurysm persistence, periprocedural complications, and adverse events during follow-up. Results— Between December 2016 and October 2018, 146 patients harboring 183 intracranial aneurysms were treated in 151 interventions at 7 centers. Derivo Embolization Device placement was technically successful in all patients. Most aneurysms (86.9%) were located at the internal carotid artery, and the mean diameter was 6.7 mm. At 6 months, 113 of 140 (80.7%) aneurysms met the study’s primary end point, and 74 of 83 (89.2%) met the study’s primary end point at 12 months. Saccular morphology of the aneurysm (odds ratio, 5.66; 95% CI, 1.01–31.77) and the presence of a branch arising from the sac (odds ratio, 6.36; 95% CI, 2.11–22.36) predicted persistence. A long duration of follow-up (odds ratio, 0.86; 95% CI, 0.78–0.95) predicted total occlusion. Of the 146 enrolled patients, 138 (94.5%) were treated without serious adverse events during follow-up. In the multivariable analysis, aneurysms located at a sidewall were less likely to experience these events than those located at bifurcations (odds ratio, 0.07; 95% CI, 0.01–0.51). Conclusions— The Derivo Embolization Device is a safe and effective treatment for intracranial aneurysms. Clinical Trial Registration— URL: http://plataformabrasil.saude.gov.br/login.jsf . Unique identifier: CAAE 77089717.7.1001.5125.

The femoral approach has been considered the preferred technique for the endovascular treatment of intracranial aneurysms. Occasionally, aneurysms are not amenable to the standard femoral approach. We describe four cases of basilar artery aneurysm that were treated by the direct vertebral artery access of V1 at the cervical region. The direct vertebral artery access technique can provide an alternative route in selected cases for the treatment of basilar artery aneurysms.

Resume Introduction Les anevrysmes de l’artere cerebrale moyenne (ACM) presentent souvent une particularite anatomique jugee jadis non favorable au traitement endovasculaire ce qui a souvent amene a leur clipage chirurgical. L’etude ISAT, bien qu’elle concerne les anevrysmes rompus, a compare les risques de l’embolisation a ceux du clipage chirurgical seulement lorsque les deux techniques etaient envisageables. Or, les idees recues par certains operateurs endovasculaires quant a l’impossibilite de l’embolisation, a reduit considerablement le nombre d’anevrysmes de l’ACM integres dans cette etude. Nous rapportons notre experience dans le traitement endovasculaire des anevrysmes de l’ACM non rompus et nous la comparons aux resultats de la bibliographie neurochirurgicale. Patients et Methodes Cette etude retrospective concerne les patients porteurs d’anevrysmes de l’ACM non rompus qui ont ete traites dans notre service entre Novembre 1998 et Decembre 2003. Une imagerie rotationelle a ete realisee dans tous les cas afin de determiner precisement les rapports entre l’anevrysme et son artere porteuse. En fin de procedures et aux controles angiographiques ulterieurs, le degre de l’occlusion du sac anevrysmal a ete estime selon la classification de Raymond. L’etat neurologique a ete evalue selon l’echelle de Rankin et reevalue a chaque hospitalisation pour controle arteriographique. Resultats 84 patients consecutifs porteurs de 100 anevrysmes non rompus de l’ACM sont rapportes. 90 anevrysmes ont pu etre traites par voie endovasculaire. 9 anevrysmes (9 %) ont ete confies au traitement chirurgical, d’emblee apres la visualisation de l’imagerie 3D (6 cas) ou apres echec de l’embolisation (3 cas). Compte tenu la configuration tres complexe de l’anevrysme, nous n’avons retenu aucun traitement invasif dans un cas. 4 anevrysmes geants ont ete traites par l’occlusion de l’axe porteur et 86 anevrysmes ont ete traites selectivement. La technique de remodelage au ballonnet a ete utilisee dans 50 cas (58,1 %). 8 patients (8,9 %) ont presente un deficit neurologique suite au traitement. Dans 6 cas (6,7 %) le deficit etait transitoire et dans 2 cas (2,2 %) permanent. Aucune mortalite n’a ete relevee dans cette serie. Des 86 anevrysmes selectivement traites, 75 (87,2 %) appartenaient aux groupes A et B de la classification de Raymond. 71 anevrysmes (82,5 %) traites ont ete controles entre 3 et 58 mois avec une moyenne de 19,6 mois. La recanalisation a ete observee dans 18 cas (25,3 %). Dans 7 cas (9,8 %) elle etait majeure et a necessite un retraitement. Aucune complication neurologique n’a ete relevee au decours des procedures de retraitement. Conclusion Les etudes multicentriques comparatives entre le traitement endovasculaire et la chirurgie d’ouverture (ISAT, ISUIA) rapportees ces dernieres annees ont oriente notre strategie face au traitement des anevrysmes intracrâniens. L’embolisation est a considerer en premiere intention lorsque les deux techniques, endovasculaire et chirurgicale, sont envisageables. Nous rapportons la faisabilite du traitement endovasculaire des anevrysmes de l’ACM jadis considere comme inenvisageable. L’imagerie tridimensionnelle per therapeutique et la maitrise de la technique de remodelage par ballonnet nous ont ete d’un apport fondamental dans la gestion de ces anevrysmes.

OBJECTIVE: The Brazilian public health system determines a quantity of coils allowed to treat a cerebral aneurysm. The goal of this paper was to determine the number of coils necessary to treat an aneurysm based on size. METHODS: All patients harboring an aneurysm treated by endovascular approach between 1999 and 2003 were reviewed. RESULTS: There were 952 aneurysms included. Mean diameter sac was 8.2 mm with 7.9 coils per aneurysm. Out of 462 small aneurysms, mean size was 4.8 mm, with 4.6 coils/aneurysm used. A total of 315 medium aneurysms were treated, mean size was 8.6 mm, with 8.2 coils. Out of 135 large, mean size was 17 mm, with 16.1 coils. Forty giant aneurysms were treated with a mean size of 32 mm and 28.7 coils. CONCLUSIONS: We propose size as a reference to predict the number of coils necessary to treat each aneurysm: one coil for each millimeter of diameter. OBJETIVO: O sistema público brasileiro determina uma quantidade limitada de molas permitida para o tratamento endovascular dos aneurismas cerebrais. O objetivo deste trabalho foi determinar a quantidade de molas necessária para tratar um aneurisma usando tamanho como referência. MÉTODO: Foram revisados todos os pacientes com aneurismas embolizados entre 1999 e 2003. RESULTADOS: No total, 952 aneurismas foram analisados. O diâmetro médio foi de 8,2 mm, com 7,9 molas usadas por aneurisma. Do total, 462 aneurismas eram pequenos, com tamanho médio de 4,8 mm e 4,6 molas/aneurisma. Foram tratados 315 aneurismas médios, com tamanho médio de 8,6 mm e 8,2 molas/aneurisma. Dentre os 135 aneurismas grandes, o tamanho foi de 17 mm, com 16,1 molas/aneurisma. Foram tratados 40 aneurismas gigantes, com média de 32 mm e 28,7 molas/aneurisma. CONCLUSÃO: Propomos que se utilize o tamanho do aneurisma como referência para prever o número de molas necessário para embolização: uma mola para cada milímetro de tamanho do saco aneurismático.

Primary central nervous system lymphoma (PCNSL) is a form of extranodal non-Hodgkin’s lymphoma, which occurs in the brain, leptomeninges, spinal cord, or eyes. PCNSL is an uncommon intracranial neoplasm, particularly in the immunocompetent patient population. An immunosuppressive state is the unique established risk factor for PCNSL, and the HIV-related primary lymphoma is 3600-fold more common compared with the general population. This tumor constitutes 0.3–1.5% of all intracranial neoplasm in patients without AIDS1 […] Primary central nervous system lymphoma in an [...]

Objectifs Nous rapportons une serie de 77 patients ayant beneficie dans notre service du placement d’un stent intracrânien non auto expansible. Materiels et methodes Entre Juin 1998 et Decembre 2003, ces patients ont beneficie du placement d’un stent intracrânien pour le traitement d’anevrysmes sacculaires a large collets, d’anevrysmes fusiformes ou de dissection, de fistules carotido-caverneuses directes ou de stenoses atheromateuses. Les anevrysmes, souvent de grand volume, se sont manifestes par un effet compressif dans 18 cas, une rupture dans 19 cas, un accident ischemique transitoire dans 2 cas et etaient de decouverte fortuite dans 20 cas. Un scanner crânien a ete realise apres chaque procedure. Resultats Le stent a ete place pour retablir la paroi arterielle dans le cadre d’anevrysmes a larges collets dans 59 cas ou de fistules carotido-caverneuses directes dans 2 cas. Il a ete utilise pour angioplastie de stenose atheromateuse dans 16 cas. Il a ete deploye avec succes dans 71 procedures. Les complications etaient d’origine ischemique dans 7 cas (5 patients ont presente un deficit transitoire, 1 patient un deficit persistant et 1 patient est decede d’une migration embolique) ou d’origine hemorragique dans 8 cas (sans consequences cliniques dans 2 cas, un score Rankin 3 dans 2 cas, un score Rankin 4 dans 2 cas et 2 patients sont decedes). Conclusion Reserve a des situations inhabituelles, bien que les risques des procedures soient majores lors de son utilisation, le stent non auto expansible offre des avantages techniques actuellement inaccessibles aux stents auto expansibles.

Objectifs Nous rapportons une serie de 8 embolisations de paragangliomes de la tete et du cou realisees par ponction directe et injection de colle acrylique (Glubran2*). Nous insistons sur l’interet de la scopie soustraite en biplan dans la prevention des complications jadis rapportees dans la litterature. Materiels et methodes Entre Avril 2002 et Septembre 2003, huit patients porteurs de paragangliome ont beneficie dans notre service d’une embolisation preoperatoire. Il s’agissait de 2 tumeurs du corps carotidien, de 2 tumeurs du nerf vague et de 4 paragangliomes jugulaires. Les ponctions directes faites sous « road mapping ». Resultats La devascularisation tumorale totale a ete prouvee angiographiquement dans tous les cas de glomus carotidiens ou vagaux. Elle etait intentionnellement subtotale dans les glomus jugulaires afin d’eviter les risques de migration de l’embole vers les pedicules intracrâniens. Aucune complication thromboembolique ou hemorragique n’a ete constatee sur le controle angiographique ou scanographique final. L’examen clinique apres embolisation a toujours ete superposable a celui d’avant la procedure. La resection chirurgicale a ete jugee totale par le chirurgien dans tous les cas sauf un. Dans un cas de glomus jugulaire, la chirurgie s’est compliquee d’une paralysie du VII et dans un autre cas elle s’est compliquee d’un faux anevrysme carotidien qui a ete occlus par voie endovasculaire sans consequence clinique. Conclusion Cette technique offre des avantages difficilement accessibles a l’embolisation particulaire par voie endo-arterielle. L’amelioration de la scopie soustraite en biplan instantane nous permet de reduire significativement les risques de la procedure.

This study was designed in an attempt to identify the risk factors that could be significantly associated with angiographic recurrences after selective endovascular treatment of aneurysms with inert platinum coils. A retrospective analysis of all patients with selective endovascular coil occlusion of intracranial aneurysms was prospectively collected from 1999 to 2003. There were 455 aneurysms treated with inert platinum coils and followed by digital subtraction angiography. Angiographic results were classified according Roy and Raymond's classification. Recurrences were subjectively divided into minor and major. The most significant predictors for angiographic recurrences were determined by ANOVAs logistic regression, Cochran-Mantel-Haenszel test, Fisher exact probability. Short-term (4.3±1.4 months) follow-up angiograms were available in 377 aneurysms, middle-term (14.1±4.0 months) in 327 and long-term (37.4±11.5 months) in 180. Recurrences were found in 26.8% of treated aneurysms with a mean of 21±15.7 months of follow-up. Major recurrences needing retreatment were present in 8.8% during a mean period follow-up of 17.9±12.29 months after the initial endovascular treatment. One patient (0.2%) experienced a bleed during the follow-up period. Recurrences after endovascular treatment of aneurysms with inert platinum coils are frequent, but hemorrhages are unusual. Single aneurysm, ruptured aneurysm, neck greater than 4 mm and time of follow-up were risk factors for recurrence after endovascular treatment. The retreatment of recurrent aneurysm decreases the risk of major recurrences 9.8 times. Long-term angiogram monitoring is necessary for the population with significant recurrence predictors.