OBJECTIVE: Sinus pericranii (SP) is a rare vascular malformation characterized by abnormal communication between the extracranial and intracranial venous systems, usually involving the superior sagittal sinus (SSS) and occasionally, the transverse sinus. CASE REPORT: A 28-year-old man was presented with a round, fluctuant, nonpulsatile scalp mass in the frontal area near the midline, the size of which changed, depending on his head position. Magnetic resonance imaging showed an extracranial vein extending through a bony defect in the vertex of the skull and draining into the superior portion of the sagittal sinus. RESULTS: The lesion was completely removed by surgery. The presence of vascular endothelium in the pathologic specimen suggests a congenital or spontaneous origin. CONCLUSION: SP is a rare vascular malformation that requires surgical or endovascular treatment for the prevention of life-threatening complications.
Adult ; Endothelium, Vascular ; Head ; Humans ; Magnetic Resonance Imaging ; Scalp ; Sinus Pericranii ; Skull ; Superior Sagittal Sinus ; Vascular Malformations ; Veins

OBJECTIVE: A dural arteriovenous fistula (DAVF) of the anterior cranial fossa is rare. We report a case of a DAVF of the anterior cranial fossa which was treated surgically, following endovascular treatment failure. METHODS & RESULTS: The subject was a 53-year-old male with a headache caused by a hematoma in the right frontal lobe. A vascular abnormality of the anterior cranial fossa was suspected on brain computed tomographic angiography. The subsequent transfemoral cerebral angiography revealed that the AVF of the anterior cranial fossa was mainly fed by the left anterior ethmoidal artery. Endovascular therapy using N-butyl cyanoacrylate was attempted. However, the procedure failed to occlude the fistula due to the existing feeding artery (the right anterior ethmoidal artery). Consequently, a surgical approach was undertaken and the lesion was successfully obliterated. CONCLUSION: We report a rare case of an intracerebral hematoma caused by a DAVF, which was successfully managed surgically following, endovascular treatment failure.
Angiography ; Arteries ; Arteriovenous Fistula ; Brain ; Central Nervous System Vascular Malformations ; Cerebral Angiography ; Cerebral Hemorrhage ; Cranial Fossa, Anterior ; Cyanoacrylates ; Fistula ; Frontal Lobe ; Headache ; Hematoma ; Humans ; Male ; Middle Aged ; Treatment Failure

We report three cases of a novel balloon remodelling technique across the anterior communicating artery (ACoA) through simultaneous bilateral internal carotid angiography. In all three cases, simultaneous bilateral carotid angiography for balloon-assisted coil embolisation of anterior communicating artery aneurysms (ACoAA) provided improved anatomical detail and resulted in effective and safe procedures compared to typical unilateral angiography.
Aneurysm ; Angiography ; Arteries ; Intracranial Aneurysm ; Neck

Moyamoya disease is a rare idiopathic cerebrovascular disease which is known to cause ischemic or hemorrhagic strokes in association with progressive stenosis of intracranial major arteries and subsequent formation of fragile collateral vessels. In this review, we have provided an update on the epidemiology, pathophysiology, clinical presentation, diagnosis, treatment and prognosis of moyamoya disease.
Arteries ; Constriction, Pathologic ; Moyamoya Disease ; Prognosis ; Stroke

OBJECTIVE: Cranial nerve dysfunction is common after endovascular treatment of a cavernous sinus dural arteriovenous fistula and sometimes this symptom persists. We reviewed the treatment outcomes of the patients with cavernous sinus dural arteriovenous fistula and who were treated with endovascular technique, and we analyzed the characteristics of those patients who had cranial nerve palsy after treatment. METHODS: Between May 2003 and July 2010, 25 patients were treated by an endovascular technique at our institution. Their medical records were reviewed and we analyzed their data, including the clinical presentation, the neurological deficits, the radiographic features and the treatment outcomes. RESULTS: In our series, a total of 25 patients (28 cases) received endovascular treatment. There were four male patients and twenty one female patients with an age range of 26-78 years (mean age : 57.4 years). Complete occlusion was observed in nineteen cases (67.9%) and 5 cases (17.9%) showed near complete occlusion. Additional procedures were required for four cases with fistulas that were partially occluded by previous treatment. Twenty four patients (96%) showed improved symptoms during the follow up and only one patient suffered from persistent symptoms. Procedure-related complications were observed in 2 cases. New cranial nerve palsy was observed in four patients (16%) and two patients experienced aggravation of their existing cranial nerve palsy. One of them had persistent deficits at the final follow up. CONCLUSION: Sufficient occlusion and avoidance of over-compaction of coils are important to prevent cranial nerve palsy when performing endovascular treatment of cavernous sinus dural arteriovenous fistulas.
Cavernous Sinus ; Caves ; Central Nervous System Vascular Malformations ; Cranial Nerve Diseases ; Cranial Nerves ; Endovascular Procedures ; Female ; Fistula ; Follow-Up Studies ; Humans ; Male ; Medical Records ; Retrospective Studies

OBJECTIVE: This study is aimed to describe our experience with performing hemicraniectomy for treating patients with malignant cerebral infarction. This study also aimed at describing the difference between our experience and that of the published articles. METHODS: Ten patients who had anterior circulation territory cerebral infarction underwent decompressive hemicraniectomy for treating their life threatening brain swelling between August 2004 and October 2007. We retrospectively analyzed the patients' medical records and radiological films and we described the patients' clinical and radiological details. The outcomes were measured according to the case fatality rate at 2 weeks and the modified Rankin scale (mRS) at 9 months. We compared our institution's outcomes with the pooled analysis result of three randomized controlled trials (DESTINY, DECIMAL, HAMLET trial). RESULTS: Nine men and one woman were included in this study. Their mean age was 61.5 +/- 11.9 years, and the mean National Institute of Health Stroke Scale (NIHSS) score on admission was 17.3 +/- 6.0. Five patients died within 2 weeks after operation. Four patients had a mRS of 5 and one had a mRS of 4 at 9 months. Our series included elder patients (mean difference : 9.9~18.3 years) who had a low NIHSS score on admission (mean difference : -4.8~-6.8) as compared to that of the pooled analysis group. Our series revealed a higher proportion of an unfavorable outcome (mRS > or = 4) compared to that of the pooled analysis results (p=0.01). No patient in our series would have been eligible, according to the inclusion criteria, for inclusion in the pooled analysis studies. CONCLUSION: We think that the higher proportion of an unfavorable outcome in our series was a consequence of the elder age of our patients.
Brain Edema ; Cerebral Infarction ; Female ; Humans ; Male ; Medical Records ; Retrospective Studies ; Stroke

OBJECTIVE: The objective of this study was to determine whether postoperative conventional angiography conducted during the early stage after aneurysm clipping is useful in patients with ruptured aneurysm. METHODS: Between May 2008 and November 2009, 57 patients who presented with ruptured cerebral aneurysms were treated with surgical clipping. Among them, a consecutive series of 45 patients who underwent postoperative angiography was analyzed retrospectively. Parameters of the postoperative angiography were categorized as incomplete clippings, vasospasms, vascular compromises, or other aneurysms. RESULTS: The average age of the patients was 49.2 years and ranged from 18 to 72 years. The average timing of the postoperative angiography after the onset of hemorrhage was 11.1 (+/- 5.6) days. Complete aneurysm closure was achieved in 43 (95%) patients. A neck remnant aneurysm was discovered in two patients and a fundus remnant was revealed in one patient. Twelve (27%) patients showed angiographic vasospasms and seven needed angioplasty. Four cases (9%) revealed either parent artery stenosis or branch occlusions, and two of them (4%) were clinically significant. Two cases showed aneurysms at another location, one of which was a ruptured aneurysm. Overall, 21 (47%) patients exhibited significant findings on the postoperative angiography. CONCLUSIONS: Our retrospective analysis revealed that postoperative angiography might be valuable in patients with ruptured aneurysms, especially in the acute stage, in order to determine the presence of vasospasms, incomplete clippings, vascular compromises, or other aneurysms that were missed at the initial cerebral angiography.
Aneurysm ; Aneurysm, Ruptured ; Angiography ; Angioplasty ; Arteries ; Cerebral Angiography ; Constriction, Pathologic ; Hemorrhage ; Humans ; Intracranial Aneurysm ; Neck ; Parents ; Retrospective Studies ; Subarachnoid Hemorrhage ; Surgical Instruments

OBJECTIVE: Fusiform and dissecting aneurysms cannot be treated with conventional clipping or coiling surgery. Various methods are used for treating these aneurysms, including proximal occlusion of the parent artery or trapping the aneurysms with or without cerebral revascularization. We report here on our experience with treating unclippable and uncoilable aneurysms and we present the clinical and angiographic outcomes. METHODS: Nine patients with unclippable and uncoilable aneurysms were managed during a 5 year period at our institution. We retrospectively reviewed all the patients with aneurysms and who underwent multimodal techniques. The mean age of the 9 patients was 56.5 years. The mean clinical follow-up period was 28.1 months. Six patients presented with subarachnoid hemorrhage and 2 had diplopia. Of these patients, 3 had aneurysms arising from the posterior inferior cerebellar artery (PICA), 2 had vertebral artery (VA) aneurysms, 2 had internal carotid artery aneurysms and 2 had middle cerebral artery aneurysms. Eight aneurysms were fusiform and 1 was a giant saccular aneurysm. RESULTS: The treatment included surgical trapping with bypass in 4 patients, endovascular trapping with bypass in 4 patients and vein graft bypass in 1 patient. Among the bypass surgeries, high-flow bypass was performed for a giant internal cerebral artery (ICA) aneurysm. Trapping of the aneurysms with coil and occipital artery (OA)-PICA bypass were performed for 2 VA aneurysms of the PICA origin. There was no recurrent bleeding or ischemic symptoms during the follow-up periods. CONCLUSION: The cerebral bypass technique is a useful, safe for the treatment of dissecting and otherwise unclippable/uncoilable aneurysms.
Aneurysm ; Aneurysm, Dissecting ; Arteries ; Carotid Artery, Internal ; Cerebral Arteries ; Cerebral Revascularization ; Diplopia ; Follow-Up Studies ; Hemorrhage ; Humans ; Intracranial Aneurysm ; Parents ; Pica ; Retrospective Studies ; Subarachnoid Hemorrhage ; Transplants ; Veins ; Vertebral Artery

OBJECTIVE: Delayed cerebral ischemia due to vasospasm after aneurysmal subarachnoid hemorrhage (SAH) is a leading cause of morbidity and mortality. Recent reports have confirmed that intra-arterial infusion of calcium-channel blockers, which are widely used to counteract vasospasm, is effective for treating SAH with a low risk of complications. Here we report on our experience with intra-arterial nicardipine angioplasty in a consecutive series of 32 patients with SAH. METHODS: This retrospective review evaluated a series of 32 consecutive patients with symptomatic vasospasm that was treated with intra-arterial nicardipine. The patients included in the study were diagnosed with aneurysmal SAH between January 2007 and February 2011. All the patients underwent microsurgical clipping or endovascular coiling. Angioplasty using intra-arterial nicardipine was performed in those patients who were refractory to medical therapy such as triple H therapy. RESULTS: The 32 patients underwent a total of 55 procedures. The total amount of nicardipine used in each angioplasty procedure did not exceed 12 mg, with a maximum dose of 3 mg for each vessel. The Glasgow Coma Scale (GCS) score improved in all patients with an average improvement of 2.4 (range : 1~5). During angioplasty, there were no complications such as thromboembolic events and/or acute transitory spasm. The clinical results were evaluated using the modified Rankin Scale (mRS). Good outcomes (mRS 0~2) were determined in 19 (63.3%) of the 30 patients. The 11 patients (36.7%) with poor outcomes initially had a high Hunt and Hess grade (III or IV) or they had intra-operative complications (mRS: 3~6). CONCLUSION: Our study results support the effectiveness and safety of low-dose nicardipine when performing intra-arterial angioplasty for the treatment of vasospasm after aneurysmal SAH.
Aneurysm ; Angioplasty ; Brain Ischemia ; Glasgow Coma Scale ; Glycosaminoglycans ; Humans ; Infusions, Intra-Arterial ; Nicardipine ; Retrospective Studies ; Spasm ; Subarachnoid Hemorrhage

OBJECTIVE: Extracranial carotid artery aneurysm is a rare vascular disease. In this study, we present our experience with extracranial carotid artery aneurysm and we review the related articles with addressing different treatment options and their results. METHODS: Between 2003 and 2011, 11 patients (mean age : 52.7 years) were diagnosed to harbor extracranial carotid artery aneurysms. Five patients underwent various surgeries and 2 patients were treated by endovascular methods. Four patients were managed conservatively. RESULTS: There were no perioperative/periprocedural mortality or morbidity related to the treatment of extracranial carotid artery aneurysms. During follow-up (mean follow-up : 39.3 months), 1 patient died of an unrelated cause and 2 other patients underwent stenting and/or angioplasty due to asymptomatic progressive stenosis of the treated site. CONCLUSION: Aneurysm can be treated with low periprocedural risk by utilizing various therapeutic modalities. Long-term follow-up is mandatory to check for stenosis around the treatment site.
Aneurysm ; Angioplasty ; Carotid Arteries ; Constriction, Pathologic ; Follow-Up Studies ; Humans ; Stents ; Vascular Diseases