World Neurosurg
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Triplicate A2 segment of the anterior cerebral artery is a rare anatomical variant (1%-3% prevalence) that which is thought to result mainly from persistence of the embryonic median artery of the corpus callosum. We sought to determine whether the triple-A2 variant is specifically associated with anterior communicating artery (ACoA) aneurysm. ⋯ Compared with the normal population, patients with ACoA aneurysms deemed to require treatment have a significantly higher likelihood of having triplicate A2 segment. Knowledge of this anatomical variation is of critical importance in planning and executing endovascular and microsurgical treatment of ACoA aneurysms.
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Pneumorrhachis refers to air within the spinal canal and is most commonly associated with traumatic spinal injuries or spine surgery. A link between pneumorrhachis and certain pulmonary diseases, such as asthma, has also been demonstrated in the literature; however, there are no previous reports of pneumorrhachis secondary to vaping-induced lung injury. ⋯ The emerging condition of vaping-induced lung injury may place patients at risk for serious complications of extrapulmonary air including pneumorrhachis. To our knowledge, this is the first report of pneumorrhachis secondary to vaping-induced lung injury.
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In-stent thrombosis is a potentially dangerous complication of flow diversion for cerebral aneurysms. The optimal management strategy for such thrombosis is not known. Here we present a case of acute ischemic stroke caused by occlusion of a Pipeline Embolization Device (PED) construct placed 18 months earlier for treatment of a fusiform middle cerebral artery aneurysm. This was successfully treated with mechanical thrombectomy with good neurologic outcome. ⋯ Mechanical thrombectomy with a stent retriever and aspiration is a therapeutic option for treatment of delayed thrombosis of a flow-diverting stent.
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Case Reports
Cavernous sinus dural arteriovenous fistula with an enhanced lesion in the brainstem mimicking a malignant tumor.
Cavernous sinus (CS) dural arteriovenous fistula (dAVF) with an enhanced lesion in the brainstem is rare, and an enhanced lesion in the brainstem might be indicative of irreversibility. ⋯ DAVFs with RLVD should be mentioned as a differential diagnosis of enhanced lesions in the brainstem. Transvenous embolization with selective coil embolization of RLVD was effective for the treatment of CS-dAVF, and a unilateral enhanced brainstem lesion may be reversible.
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Reports of cerebral aneurysm and aneurysm rupture during pregnancy are rare in the literature. Aneurysms might rupture and cause intracranial hemorrhage during or after pregnancy. Aneurysmal subarachnoid hemorrhage during pregnancy presents a challenge regarding treatment and management. No institution has reported a large patient population or experience in managing this condition during pregnancy in the literature. Owing to the limited number of cases, there are no available treatment guidelines, and treatment is usually based on a case-by-case approach. ⋯ We present our experience in the management of aneurysmal subarachnoid hemorrhage during pregnancy and maternal and fetal outcomes of this rare disease. More cases and multicenter studies are needed to develop standardized management of this disease.