We describe a case of an unruptured basilar top aneurysm that was associated with early rupture after incomplete coiling. A 62-year-old woman with a history of several small infarctions has undergone coiling of unruptured basilar top aneurysm. Two weeks after initial coiling the patient presented with Hunt and Hess grade IV subarachnoid hemorrhage consistent with a ruptured basilar top aneurysm. Repeat angiography revealed a rupture of recanalized basilar top aneurysm. Second embolization with additional coils resulted in complete occlusion. However, her neurological status was not improved afterward and she was transferred to department of rehabilitation one month after hemorrhage with comatous state. To our knowledge, this is the first case of fatal early rupture after coiling of unruptured aneurysm. It has been speculated that coiling could cause injury to aneurysmal wall and facilitate rupture.
Aneurysm* ; Angiography ; Female ; Hemorrhage ; Humans ; Infarction ; Intracranial Aneurysm ; Middle Aged ; Rehabilitation ; Rupture* ; Subarachnoid Hemorrhage

OBJECTIVE: The anatomy of middle cerebral artery (MCA) bifurcation aneurysms has been noted to be unfavorable for endovascular treatment. Our purpose was to analyze the clinical and angiographic results of coiling of the MCA bifurcation aneurysms. METHODS: From January 2004 to April 2007, 26 patients harboring 29 MCA bifurcation aneurysms were treated with coils. Of these patients, 16 had subarachnoid hemorrhages (SAH). The bleeding source was a ruptured MCA bifurcation aneurysm in 11 patients and a ruptured aneurysm in a different location in 5 patients, respectively. Treatment-related complications, clinical outcomes, and postprocedural and follow-up angiography results were retrospectively evaluated. RESULTS: 29 MCA bifurcation aneurysms (11 ruptured, 18 unruptured) were occluded with coils in 26 patients. Occlusion was complete for 24 (82.8%) of the 29 aneurysms, incomplete for 3 (10.3%), and partial for 2 (6.9%) aneurysms. Procedural complications included thromboembolism in 6, a small nonocclusive thrombus formation in 1, and intraprocedural aneurysmal rupture in 1. All of symptomatic complications were thromboembolic events that occurred 3 patients with unruptured aneurysm and they discharged with moderate disability state. Follow-up angiograms were available on 16 patients with 18 aneurysms and 1 patient with an initial complete occlusion had a slight neck recanalization. CONCLUSION: Coiling of MCA bifurcation aneurysm could be achieved without treatment-induced neurologic deficit in 88.5% (23/26) of the patients while at the same time obtaining favorable anatomic results. Improvements in device technology and technique will certainly greatly increase the safety of coiling of MCA bifurcation aneurysm, widening its indications.
Aneurysm ; Aneurysm, Ruptured ; Angiography ; Follow-Up Studies ; Hemorrhage ; Humans ; Intracranial Aneurysm ; Middle Cerebral Artery ; Neck ; Neurologic Manifestations ; Retrospective Studies ; Rupture ; Subarachnoid Hemorrhage ; Thromboembolism ; Thrombosis

OBJECTIVE: Vasospasm of cerebral vessels remains a major source of morbidity and mortality after an aneurysmal subarachnoid hemorrhage (SAH). The purpose of this study was to evaluate the safety and efficacy of transluminal balloon angioplasty (TBA) for SAH-induced vasospasm. METHODS: Eleven patients with an angiographically confirmed significant vasospasm (>50% vessel narrowing and clinical deterioration) were studied. A total of 54 vessel segments with significant vasospasm were treated by TBA. Digital subtraction angiography was used to confirm the presence of vasospasm, and TBA was performed to dilate vasospastic arteries. Medical and angiographic reports were reviewed to determine technical efficacy and for procedural complications. RESULTS: TBA using Hyper-Glide or Hyper-Form balloons (MicroTherapeutics, Irvine, CA) was successfully accomplished in 88.9% vasospastic segments (48 of 54), namely, in the distal internal carotid artery (100%, n=7), the middle cerebral artery (100%), including the M1 (n=10), M2 (n=10), and M3 segments (n=4), in the vertebral artery (100%, n=2), basilar artery (100%, n=1), and in the anterior cerebral artery (ACA), including the A1 (66%), A2 (66%), and A3 segments (100%). Vessel diameters significantly increased after TBA. There were no cases of vessel rupture or thromboembolic complications. GCS at one day after TBA showed an improvement in all patients except one. CONCLUSION: This study suggests that TBA using Hyper-Glide or Hyper-Form balloons is a safe and effective treatment for subarachnoid hemorrhage-induced cerebral vasospasm.
Aneurysm ; Angiography, Digital Subtraction ; Angioplasty, Balloon ; Anterior Cerebral Artery ; Arteries ; Basilar Artery ; Carotid Artery, Internal ; Endovascular Procedures ; Glycosaminoglycans ; Humans ; Middle Cerebral Artery ; Rupture ; Subarachnoid Hemorrhage ; Vasospasm, Intracranial ; Vertebral Artery

OBJECTIVE: The authors evaluate the usefulness, results, and technical problem of endovascular treatment of cerebral aneurysms with Guglielmi detachable coil(GDC). METHODS: Forty patients with 31 ruptured and 11 unruptured aneurysms were treated with GDC embolization. Twenty-four aneurysms were located in the anterior circulation and 18 in the posterior circulation. Aneurysms size was categorized small(n=31) or large(n=11) and neck size was categorized narrow(n=30) or wide(n=12). We statistically analyzed occlusion rate according to the location, rupture, size, and neck size of aneurysms, and investigated the procedure-related complications and clinical outcomes. RESULTS: GDC treatment of aneursyms was successful in 40 aneurysms of 39 patients(95.2%). Total occlusion was achieved in 24(60.0%) cases, subtotal occlusion in 12(30%), and incomplete occlusion in 4(10.0%). Each total occlusion rate was 69.0% in small-sized, 36.4% in large-sized, 69.0% in narrow-necked, and 36.4% in wide-necked aneurysms. Location and rupture of aneurysms did not influence occlusion rate. The technical complications included 4 thromboembolisms, 3 parent artery occlusions, and 1 perforation of aneurysm. Procedure-related morbidity and mortality were 10.3% and 2.6%. 3 subtotally or incompletely embolized aneurysms in posterior circulation rebled during the follow-up period. CONCLUSION: The results of this study indicate that endovascular GDC treatment is an appropriate therapeutic alternative in cerebral aneurysms. However, the rebleeding by aneurysmal recanalization or regrowth is a major limitation of GDC treatment. Follow-up angiography and further technical improvement are mandatory to overcome rebleeding.
Aneurysm ; Angiography ; Arteries ; Follow-Up Studies ; Humans ; Intracranial Aneurysm* ; Mortality ; Neck ; Parents ; Retrospective Studies* ; Rupture ; Thromboembolism

PURPOSE: It is important to differentiate malignant from benign lesions of intraocular masses in choosing therapeutic plan. Biopsy of intraocular tumor is not recommended due to the risk of visual damage. We evaluated the usefulness of F-18-FDG PET imaging in diagnosing intraocular neoplasms. MATERIALS AND METHODS: F-l8-FDG PET scan was performed in 13 patients (15 lesions) suspected to have malignant intraocular tumors. There were 3 benign lesions (retinal detachment, choroidal effusion and hemorrhage) and 10 patients with 12 malignant lesions (3 melanomas, 7 retinoblastomas and 2 metastatic cancers). Regional eye images (256*256 and 128*128 matrices) were obtained with or without attenuation correction. Whole body scan was also performed in eight patients (3 benign and 6 malignant lesions). RESULTS: All malignant lesions were visualized while all benign lesions were not visualized. The mean peak standardized uptake value (SUV) of malignant lesions was 2.64+/-0.57 g/ml. There was no correlations between peak SUV and tumor volume. Two large malignant lesions (>1000 mm3 ) showed hot uptake on whole body scan. But two medium-sized lesions (100-l000 mm3) looked faint and two small (<100 mm3) lesions were not visualized. The images reconstructed with 256*256 matrix showed lesions more clearly than those with 128X128 matrix. CONCLUSION: F-18-FDG PET scan is highly sensitivity in detecting malignant intraocular tumor. For the evaluation of small-sized intraocular lesions, whole body scan is not appropriate because of low sensitivity. A regional scan with sufficient acquisition time is recommended for that purpose. Image reconstruction in matrix size of 256*256 produced clearer images than the ones in 128X128, but it does not affect the diagnostic sensitivity.
Biopsy ; Choroid ; Diagnosis* ; Humans ; Image Processing, Computer-Assisted ; Melanoma ; Orbital Neoplasms ; Positron-Emission Tomography ; Retinoblastoma ; Tumor Burden ; Whole Body Imaging

A 59-year-old female presented with progressive right proptosis, chemosis and ocular pain. An imaging work-up including conventional catheter angiography showed a right-sided dural arteriovenous fistula of the cavernous sinus, which drained into the right superior petrosal sinus, right superior ophthalmic vein, and right inferior ophthalmic vein, and cortical venous reflux was seen via the right petrosal vein in the right posterior fossa. After failure of transvenous embolization, the patient underwent Gamma Knife radiosurgery (GKRS). At one month after GKRS, she developed increasing ocular pain and occipital headache. Repeat angiography showed partial obliteration of the fistula and loss of drainage via the superior and inferior ophthalmic veins with severe congestion, resulting in slow flow around the right cerebellar hemisphere. Prompt transarterial embolization relieved the patient's ocular symptoms and headache. We report on a case of paradoxical exacerbation of symptoms resulting from obstruction of the venous outflow after GKRS for treatment of a dural arteriovenous fistula of the cavernous sinus.
Angiography ; Catheters ; Cavernous Sinus* ; Central Nervous System Vascular Malformations* ; Drainage ; Estrogens, Conjugated (USP) ; Exophthalmos ; Female ; Fistula ; Headache ; Humans ; Middle Aged ; Radiosurgery* ; Veins

Endovascular embolization is being increasingly used to treat intracranial arteriovenous malformations (AVMs). However, we experienced two patients with retained microcatheters after AVM embolization using Onyx.
Arteriovenous Malformations ; Humans ; Intracranial Arteriovenous Malformations

A 57-year-old man presented with a 2-day history of left oculomotor palsy. Digital subtraction angiography revealed a pseudoaneurysm of the left cavernous internal carotid artery (ICA) measuring 37x32 mm. The pseudoaneurysm was treated with a balloon expandable graft-stent to occlude the aneurysmal neck and preserve the parent artery. A post-procedure angiogram confirmed normal patency of the ICA and complete sealing of the aneurysmal neck with no opacification of the sac. After the procedure, the oculomotor palsy improved gradually, and had completely resolved 3 months after the procedure. A graft-stent can be an effective treatment for a pseudoaneurysm of the cavernous ICA with preservation of the parent artery.
Aneurysm ; Aneurysm, False ; Angiography, Digital Subtraction ; Arteries ; Carotid Artery, Internal ; Caves ; Humans ; Middle Aged ; Neck ; Paralysis ; Parents

A 31-year-old man presented with right hemiparesis, and magnetic resonance imaging revealed a small infarct at left basal ganglia. Digital subtraction angiography showed left cervical internal carotid artery (ICA) occlusion and severe stenosis of the ipsilateral external carotid artery (ECA) with collateral cerebral circulation fed by ECAs. Based on the results of a functional evaluation of cerebral blood flow, we performed preventive ECA angioplasty and stenting for advanced ECA stenosis to ensure sufficient blood flow to the superficial temporal artery. Eight weeks later, superficial temporal artery to middle cerebral artery (STA-MCA) anastomosis was performed. His postoperative course was uneventful and no additional transient ischemic attacks have occurred. To our knowledge, this is the first report of preventive angioplasty and stenting for advanced narrowing of an ECA before STA-MCA anastomosis for ipsilateral ICA occlusion.
Adult ; Angiography, Digital Subtraction ; Angioplasty ; Basal Ganglia ; Carotid Artery, External ; Carotid Artery, Internal ; Constriction, Pathologic ; Dietary Sucrose ; Humans ; Ischemic Attack, Transient ; Magnetic Resonance Imaging ; Middle Cerebral Artery ; Paresis ; Stents ; Temporal Arteries

Thalamoperforating artery aneurysms are rarely reported in the literature. We report an extremely rare case of ruptured distal anterior thalamoperforating artery aneurysm which was treated by endovascular obliteration in a patient with occlusion of both the internal carotid arteries (ICAs) : A 72-year-old woman presented with severe headache and loss of consciousness. Initial level of consciousness at the time of admission was drowsy and the Glasgow Coma Scale score was 14. Brain computed tomography (CT) scan was performed which revealed intracerebral hemorrhage in right basal ganglia, subarachnoid hemorrhage, and intraventricular hemorrhage. The location of the aneurysm was identified as within the globus pallidus on CT angiogram. Conventional cerebral angiogram demonstrated occlusion of both the ICAs just distal to the fetal type of posterior communicating artery and the aneurysm was arising from right anterior thalamoperforating artery (ATPA). A microcatheter was navigated into ATPA and the ATPA proximal to aneurysm was embolized with 20% glue. Post-procedural ICA angiogram demonstrated no contrast filling of the aneurysm sac. The patient was discharged without any neurologic deficit. Endovascular treatment of ATPA aneurysm is probably a more feasible and safe treatment modality than surgical clipping because of the deep seated location of aneurysm and the possibility of brain retraction injury during surgical operation.
Adhesives ; Aged ; Aneurysm ; Arteries ; Basal Ganglia ; Brain ; Carotid Artery, Internal ; Cerebral Hemorrhage ; Consciousness ; Female ; Glasgow Coma Scale ; Globus Pallidus ; Headache ; Hemorrhage ; Humans ; Neurologic Manifestations ; Subarachnoid Hemorrhage ; Surgical Instruments ; Unconsciousness