World Neurosurg
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Review Case Reports
Endovascular Retrieval of Migrated Coil within the Distal Middle Cerebral Artery Using Stentriever Device.
Displacement of endovascular coils during endovascular embolization of an intracranial aneurysm is a potentially life-threatening complication. Several methods for coil retrieval have been described, including the use of microsnares and microforceps retrieval devices. With the recent surge of stentriever implementation in the treatment of ischemic stroke, some operators are now using such devices in the retrieval of migrated coils. We present a case of a balloon-assisted coil embolization of a communicating segment internal carotid artery aneurysm, complicated by coil migration far distally into the middle cerebral artery, which was retrieved successfully with a stentriever. To the best of our knowledge, this is the furthest migration of a coil to be successfully retrieved with a stentriever. We review conservative and invasive management of displaced coils and the technical advantages of stentrievers over retrieval devices. ⋯ In certain situations, a stentriever does not mandate complete ensnaring of the target to be retrieved and thus need not always be deployed distal to a migrated coil mass to be successful. Due to the mechanical advantage of strut-engagement, stentrievers can afford to be positioned in relatively suboptimal positions, and this is especially useful in cases involving tortuous and small distal vessels (<2 mm diameter).
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Review Case Reports
Multiple Extradural Spinal Meningiomas in a Patient with Acquired Immunodeficiency Syndrome: Case Report and Literature Review.
Purely extradural spinal meningiomas are uncommon. Due to their typical location in the neural foramen, they are often mistaken for schwannomas, neurofibromas, and epidural metastases. In addition, comorbid conditions such as immunodeficiency may obscure the diagnosis. We present a case of extradural spinal meningiomas in a patient with human immunodeficiency virus (HIV). This is the first reported case of multiple extradural spinal meningiomas in 2 separate regions of the spine. ⋯ Our experience with this 40-year-old male with AIDS who presented with radicular symptoms due to multiple purely extradural meningiomas underscores the importance of considering meningioma as a possible diagnosis in patients with tumors of the neural foramina. In addition, a wide differential diagnosis should be made for patients with spinal lesions and history of HIV, including illnesses that are related to immunodeficiency and those that are not.
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Review Case Reports
A Rare Case of Malignant Craniopharyngioma Reactive to Adjunctive Stereotactic Radiotherapy and Chemotherapy: Case Report and Literature Review.
Malignant craniopharyngioma or anaplastic craniopharyngioma was first reported in 1987 by Akachi and colleagues. It has malignant clinical and histological features, remarkably rapid progression, atypical pathology like squamous cell carcinoma, and a poor prognosis. To date, 17 cases of malignant craniopharyngioma have been reported, most of which were secondary malignant tumors. In classic benign craniopharyngioma, adjunctive treatment after gross total removal is not necessary, but in cases of malignant tumors, adjunctive treatment is important. ⋯ Adjunctive gamma knife stereotactic radiosurgery and chemotherapy for malignant craniopharyngioma affects follow-up strategies, we propose the need for a revision to the World Health Organization classification regarding the evaluation of malignant craniopharyngioma.
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Review Case Reports
Clipping of a Pediatric Pial Arteriovenous Fistula Located at Basilar Artery Tip Using a Hybrid Trapping-Evacuation Technique.
Intracranial pial arteriovenous fistulas (PAVFs) are rare cerebrovascular lesions with high mortality rates. We report a rare case of pediatric PAVF at the basilar artery tip and its treatment with surgical clipping aided by a trapping-evacuation technique in a hybrid operating room. ⋯ The successful obliteration of the lesion is reported. In addition, a brief review of literature comparing endovascular embolization, surgical disconnection, and hybrid technique for treatment of PAVF is included.
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Review Case Reports
Fatal Subarachnoid Hemorrhage from an Aneurysm of a Persistent Primitive Hypoglossal Artery: Case Series and Literature Overview.
Persistent carotid-basilar connections have a prevalence of 0.14%. Recognizing such persistent fetal anastomoses between the carotid and the vertebrobasilar circulation is of great importance because they are reportedly associated with an increased prevalence of intracranial aneurysms. ⋯ Although uncommon, it is important to recognize persistent carotid-basilar connections, since they have a considerable hemodynamic impact on the posterior cerebral circulation via the carotid system. A critical reduction in the carotid blood flow will, therefore, have ischemic consequences in the posterior cerebral territories. In addition, such connections might be associated with anomalies of the vessel wall and be predisposed to aneurysm formation. The endovascular neurointerventionalist, as well as the vascular and skull base neurosurgeon, need to be aware of their anatomy and variations.