The treatment of intracranial aneurysms by injection with a tissue adhesive

Endovascular therapy for intracranial aneurysms: a historical and present status review

Beginning in the 1960s, neurosurgeons and radiologists have made attempts to treat intracranial aneurysms using nonclip techniques. The evolution of such therapy has included acrylics, metallic particles, balloons, electric current, and nondetachable and detachable coils. This article will chronologically review these various techniques and the papers that reported their results so that the reader can understand how endovascular therapy developed and the position it currently holds in the treatment of intracranial aneurysms.

Endovascular treatment of a distal aneurysm of the superior cerebellar artery by intra-aneurysmal injection of glue

SUMMARY

Aneurysms in the distal cerebellar arteries are rare events. They are associated with a poor prognosis, as surgery or embolisation with Guglielmi detachable coils (GDCs) is very difficult. The ability to treat them surgically depends on the location of the aneurysm, but surgery is considered difficult and is associated with a high morbidity/mortality rate. Embolisation with GDCs may be difficult or impossible because of the distal location of the aneurysm or the unfavourable ratio between the size of the aneurysm and the size of the parent vessel. We report our experience in one case treated with intra-aneurysmal injection of glue. The aneurysm, located in the distal right superior cerebellar artery, was catheterized with a flow-guided microcatheter, and glue was slowly injected into the aneurysmal sac. The treatment resulted in total occlusion of the aneurysm with preservation of the parent artery.

Stereotactic angiographic localization as an adjunct to surgery of cerebral mycotic aneurysms: case report and review of the literature

Less than 10% of all aneurysms affecting the arterial cerebral circulation are mycotic in nature. They occur in the setting of bacterial endocarditis and are the cause of considerable morbidity and mortality of affected patients. In selected cases surgery may play a curative role in the treatment plan. These aneurysms frequently arise in distal arterial branches, and their localization during surgery may at times prove laborious. We report the case of a mycotic aneurysm of a distal branch of the anterior cerebral artery surgically treated with the help of angiographic stereotactic localization. Stereotaxy should thus be regarded as a pertinent adjunct in selected cases of surgical treatment of distal mycotic cerebral aneurysms.

Embolization of cerebral aneurysms with a liquid embolus, EVAL mixture: report of three cases

Embolization of three surgically difficult cerebral aneurysms was performed using our newly developed non-adhesive embolic material, EVAL mixture (ethylene vinyl alcohol copolymer). Conventional embolic materials such as detachable balloons or microcoils were not used because of a large or irregular aneurysmal neck. After temporary occlusion of the parent artery with a superselective balloon catheter, the EVAL mixture was slowly injected through a microcatheter placed in the aneurysm or parent artery. The locations of the aneurysms were anterior communicating artery, basilar artery-posterior cerebral artery and basilar artery-anterior inferior cerebellar artery (BA-AICA). One aneurysmal occlusion and 2 parent artery occlusions were performed. Patients had no persistent deficits. The patient with the BA-AICA aneurysm associated with an arteriovenous malformation died of rupture of the residual AVM due to haemodynamic change 2 weeks after embolization. In selected and limited cases, embolization of surgically difficult cerebral aneurysms using EVAL mixture was more effective and safer than embolization using conventional embolic materials such as balloons and microcoils.

Occlusion of experimental artery aneurysms by intrasaccular injection of fibrin sealant

Aneurysms were produced by grafting a vein pouch onto the cervical carotid artery of rabbits following the removal of an elliptical piece of the arterial wall. The diameter of the opening was 3-4 mm and the maximum height 8 mm. Through direct puncture of the aneurysm a clot of the fibrin sealant Tissucol was injected into the aneurysm. The sequential morphological changes were studied by light microscopy. One case was examined after 3 weeks by scanning electron microscopy. Complete resorption of the fibrin sealant was observed. The aneurysm cavity was filled with a dense connective tissue covered by a layer of newly formed endothelial cells.

Experimental aneurysms in the rabbit: occlusion by intrasaccular injection of fibrin sealant

Experimental aneurysms of the carotid artery were produced using the microsurgical technique of grafting a venous sack onto the artery in the neck of rabbits after the removal of an elliptical piece of arterial wall. Twenty-five aneurysms were occluded with the fibrin sealant Tissucol. Microscopic examination showed complete resorption of the fibrin clot and the formation of dense granulation tissue within the aneurysm, which was covered with a layer of endothelial cells after 2 weeks. The results are only tentative and require further experimental studies.

The histotoxicity of cyanoacrylates. A selective review

Cyanoacrylates, a group of rapidly polymerizing adhesives, have found widespread uses in oral and general surgery as well as surgical subspecialties, for example as hemostatic and anastomotic agents. They have been utilized most recently as materials for embolotherapy of complex cerebral and extra-cerebral vascular anomalies. The histopathology that results from their deposition in human tissues is thus an important consideration, and the subject of this review. Particular attention is given to the fate of cyanoacrylates in cerebral lesions after iatrogenic embolization procedures. The apparent toxicity of these plastics on blood vessel walls is discussed in relation to experimental observations. It is imperative that clinicians who use this group of substances evaluate their potential functions in the light of the pathologic findings.

Arteriovenous malformations of the brain: a teratologic challenge

Congenital arteriovenous malformations of the brain are lesions which are well-known to neurologists and neurosurgeons but are puzzling to teratologists because they occur sporadically and are unassociated with congenital malformations outside the central nervous system. They are recommended to teratologists as a field of etiologic and pathogenetic research.