1
|
Librata PN, Sani AF, Kurniawan D, Hamdan M, Nugraha P. Hemifacial spasm caused by tortuous vertebrobasilar artery: a case report. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2022. [DOI: 10.1186/s41983-022-00488-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Hemifacial spasm is a rare movement disorder. Prevalence estimates worldwide was 14.5 per 100,000 women and 7.4 per 100,000 men. Hemifacial spasm generally caused by compression of blood vessels at the root entry zone of the facial nerve in the brainstem, tortuous anteroinferior cerebellar artery (AICA) and posteroinferior cerebellar artery (PICA). Direct compression by vertebrobasilar dolichoectasia (VBD) with coincidence cavernoma is extremely rare.
Case report
A 50-year-old woman with right hemifacial spasm for 1 year, with a history of hypertension for 10 years, did not take medication regularly. MRI MRA was performed showing suspicious dolichoectasia in the vertebrobasilar artery and cavernoma in the left basal ganglia. Then digital subtraction angiography was performed, it was found that the tortuous vertebrobasilar junction artery with a curve to the right caused right hemifacial spasm.
Conclusion
Vascular imaging examination is important to do to find the cause of hemifacial spasm suspected to be due to vascular causes. The finding of two types of intracranial vascular malformations should be explored further. Therefore, the selection of therapy and management becomes more appropriate.
Collapse
|
2
|
Lu X, Fang X, Huang Y, Zhou P, Wang Z, Brinjikji W, Chen G. Cerebral Revascularization for the Management of Symptomatic Pure Arterial Malformations. Front Neurol 2022; 12:755312. [PMID: 34975720 PMCID: PMC8716448 DOI: 10.3389/fneur.2021.755312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 11/18/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Pure arterial malformations (PAMs) are extremely rare abnormalities defined as dilated, overlapping, and tortuous arteries with a coil-like appearance in the absence of venous components. Over the last half century, only seven published reports have described cases of patients with PAMs who received treatment. Methods: Here, we report two cases of women with PAMs who received surgical treatment, and we present a systematic review of the literature. We searched the PubMed, Embase, Web of Science, and Medline databases (up until October 1, 2021) for relevant publications. We performed independent-sample t-tests and Fisher's exact tests to compare continuous and categorical characteristics among the available cases. Results: Our first patient was a 43-year-old woman with PAM of the left internal carotid artery (ICA), who received an ICA-radial artery (RA)-M2 bypass. Post-operative digital subtraction angiography (DSA) revealed the disappearance of the left ICA PAM without ischemic events during follow-up. The second patient was a 53-year-old woman with PAMs of the right ICA and posterior cerebral artery. The P1 lesion was treated by proximal occlusion combined with a superficial temporal artery-P2 bypass. During the 12-month follow-up period, the size of the PAMs decreased significantly as indicated by the post-operative DSA showing the absence of hemorrhages. Our systematic review, which includes 56 PAMs, shows that the reported PAMs were more common in the anterior circulation (33/56, 58.9%) than in the posterior circulation (11/56, 19.7%). Bilateral PAMs were more likely to affect bilateral anterior cerebral arteries (ACA) (ACAbilateral vs. ACAunilateral: 63.6 vs. 26.2%, p = 0.02). In addition, PAMs involving the anterior circulation were likely to affect multiple arteries (anteriormulti vs. posteriormulti: 30.3 vs. 0%, p = 0.038). Conclusion: We found very few reports on treated PAMs; further studies with large sample sizes and long follow-up periods are required to explore the appropriate treatment strategy for PAMs.
Collapse
Affiliation(s)
- Xiaocheng Lu
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xinggen Fang
- Department of Neurosurgery, Wannan Medical College, Yijishan Hospital, Wuhu, China
| | - Yabo Huang
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Peng Zhou
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhong Wang
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Waleed Brinjikji
- Departments of Radiology, Mayo Clinic, Rochester, MN, United States.,Departments of Neurosurgery, Mayo Clinic, Rochester, MN, United States
| | - Gang Chen
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| |
Collapse
|
3
|
Iwaki K, Arimura K, Nishimura A, Iihara K. Decompression surgery for pure arterial malformations in a 15 year old with acute, progressive visual impairment: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2021; 1:CASE2037. [PMID: 36131587 PMCID: PMC9628099 DOI: 10.3171/case2037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 10/22/2020] [Indexed: 06/15/2023]
Abstract
BACKGROUND The authors document the first case of pure arterial malformations (PAMs) of the posterior communicating artery (PCoA), which were successfully treated with microsurgical clipping of the main body of the PAMs. PAMs are defined as dilated, overlapping, and tortuous arteries with a coil-like appearance and/or a mass of arterial loops without any associated venous component. Although PAMs usually have a benign history and are often incidental findings, this case presented with acute progression of visual field impairment. OBSERVATIONS Because the patient's right optic tract was affected by the loop of PAMs of the PCoA, the authors performed microsurgical clipping of the main body of the PAMs using endoscopy, which ceased the progression of symptoms without any complications. LESSONS There have been several reports of PAMs receiving surgical treatment for accompanying lesions. However, in this case, the lesion to the main body of PAMs was the cause of visual field impairment and was successfully treated with microsurgical clipping.
Collapse
Affiliation(s)
- Katsuma Iwaki
- Department of Neurosurgery, Kyushu University, Higashi-ku, Fukuoka, Japan; and
| | - Koichi Arimura
- Department of Neurosurgery, Kyushu University, Higashi-ku, Fukuoka, Japan; and
| | - Ataru Nishimura
- Department of Neurosurgery, Kyushu University, Higashi-ku, Fukuoka, Japan; and
| | - Koji Iihara
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita-city, Osaka, Japan
| |
Collapse
|
4
|
Liu TY, Xu N, Wan Z, Zhang ZM, Xu JJ, Meng H, Wang HL. Diagnosis and treatment of pure arterial malformation: Three case reports and literature review. Medicine (Baltimore) 2020; 99:e20229. [PMID: 32481296 PMCID: PMC7249948 DOI: 10.1097/md.0000000000020229] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
RATIONALE The incidence of pure arterial malformations is relatively low, and few cases have been reported. Only 2 cases with pure arterial malformation have been reported to receive surgery or endovascular treatment. PATIENT CONCERNS We report 3 cases and review the relevant literatures. The head examinations of the patients suggested the presence of high-density shadows in front of the pons and midbrain, the dilation of the supraclinoid segment of the right internal carotid artery, and moyamoya in the left brain with an aneurysm-like expansion located on the left posterior communicating artery respectively. After admission, head digital subtraction angiography (DSA) was performed. DIAGNOSES Digital subtraction angiography (DSA) for these 3 patients showed that the left posterior communicating artery, the supraclinoid segment of the right internal carotid artery, and the left posterior communicating artery appeared dilated, tortuous, and spirally elongated. In addition, the lesions in the latter 2 patients were accompanied with local aneurysmal changes. INTERVENTIONS Two patients were given conservative treatment, and another patient was given endovascular treatment. A head DSA was reviewed 6 months after therapy. OUTCOMES The prognosis status of the 3 patients was good. Two patients in the conservative treatment group showed no changes in the lesions on head DSA examination. The DSA examination of the third patient indicated that the vascular remodeling of the diseased vessels was good, the blood vessels were unobstructed, and the aneurysms had disappeared. LESSONS Pure arterial malformations mostly occur in young women and may involve any blood vessels in the brain. It can be accompanied with local aneurysms and calcification. The patients are often given conservative treatment but need to be reviewed regularly. However, it is beneficial to give endovascular treatment to the patients with local aneurysms.
Collapse
|
5
|
Rathore L, Yamada Y, Kawase T, Kato Y, Senapati SB. A 5-Year Follow-up of Intracranial Arterial Dolichoectasia: A Case Report and Review of Literature. Asian J Neurosurg 2019; 14:1302-1307. [PMID: 31903384 PMCID: PMC6896615 DOI: 10.4103/ajns.ajns_282_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A patient with multiple dolichoectasia of the intracranial cerebral artery was followed sequentially with clinical and radiological progression of disease in the past 5 years. The patient was treated in multiple stages in the past 5 years with the endovascular and microsurgical clipping method. The maximum diameter of each major intracranial artery segment was recorded and compared in the follow-up year. The progression in size of the dolichoectatic segment was observed in spite of surgical intervention. In review diagnostic criteria, etiopathogenesis and treatment options have been discussed.
Collapse
Affiliation(s)
- Lavlesh Rathore
- Department of Neurosurgery, Shri Balaji Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Yashiro Yamada
- Department of Neurosurgery, Banbuntane Hotokukai Hospital, Fujita Health University, Nagoya, Japan
| | - Tsukasa Kawase
- Department of Neurosurgery, Banbuntane Hotokukai Hospital, Fujita Health University, Nagoya, Japan
| | - Yoko Kato
- Department of Neurosurgery, Banbuntane Hotokukai Hospital, Fujita Health University, Nagoya, Japan
| | | |
Collapse
|
6
|
Yue H, Ling W, Hanmin C, Yibo O, Po Z, Dongsheng G, Lanzino G. Progressive Pure Arterial Malformations of the Anterior Cerebral Artery. World Neurosurg 2019; 131:e52-e64. [PMID: 31295621 DOI: 10.1016/j.wneu.2019.07.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 06/29/2019] [Accepted: 07/01/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Pure arterial malformations (PAMs) are rare intracranial vascular anomalies. As recently reported, PAMs have a benign natural history and can be treated conservatively. However, their etiology, natural history, and treatment have not yet been fully elucidated. METHODS We present a rare case of the progression of a PAM involving the anterior cerebral artery. Magnetic resonance imaging showed a mass located in the suprasellar region associated with obstructive hydrocephalus. Digital subtraction angiography showed evolution of the arterial anomaly with progression compared with the studies 3 years earlier. Surgical trapping of the parent artery with electrophysiological monitoring was performed. Combined with previous data, the clinical features and therapeutic strategies for this unusual entity are discussed. RESULTS The patient recovered uneventfully after surgery. Postoperative digital subtraction angiography confirmed complete obliteration of the lesion. Axial computed tomography also showed shrinkage of the aneurysm, with improvement of the hydrocephalus. Our review of the reported data showed only 4 patients with a definite or probable PAM who had undergone surgery. To the best of our knowledge, the present case represents the first report of changes in the vascular architecture of a PAM during the follow-up period. CONCLUSION Whether the aneurysmal component of PAMs merits invasive treatment has remained controversial. The findings from our case raises the possibility of evolution for some patients with PAMs and stresses the importance of scheduled follow-up noninvasive imaging studies to rule out progression of these nosological entities, especially PAMs with an "aneurysm-like" component.
Collapse
Affiliation(s)
- He Yue
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Wang Ling
- Department of Operating Room, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Chen Hanmin
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Ou Yibo
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Zhang Po
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Guo Dongsheng
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.
| | - Giuseppe Lanzino
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
7
|
Brinjikji W, Cloft HJ, Flemming KD, Comelli S, Lanzino G. Pure arterial malformations. J Neurosurg 2018; 129:91-99. [DOI: 10.3171/2017.2.jns1744] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVEOver the last half century, there have been isolated case reports of purely arterial malformations. In this study, the authors report a consecutive series of patients with pure arterial malformations, emphasizing the clinical and radiological features of these lesions.METHODSPure arterial malformations were defined as dilated, overlapping, and tortuous arteries with a coil-like appearance and/or a mass of arterial loops without any associated venous component. Demographic characteristics of the patients, cardiovascular risk factors, presentation, radiological characteristics, and follow-up data were collected. Primary outcomes were new neurological symptoms including disability, stroke, and hemorrhage.RESULTSTwelve patients meeting the criteria were identified. Ten patients were female (83.3%) and 2 were male (16.6%). Their mean age at diagnosis was 26.2 ± 11.6 years. The most common imaging indication was headache (7 patients [58.3%]). In 3 cases the pure arterial malformation involved the anterior cerebral arteries (25.0%); in 4 cases the posterior communicating artery/posterior cerebral artery (33.3%); in 2 cases the middle cerebral artery (16.6%); and in 1 case each, the superior cerebellar artery, basilar artery/anterior inferior cerebellar artery, and posterior inferior cerebellar artery. The mean maximum diameter of the malformations was 7.2 ± 5.0 mm (range 3–16 mm). Four lesions had focal aneurysms associated with the pure arterial malformation, and 5 were partially calcified. In no cases was there associated intracranial hemorrhage or infarction. One patient underwent treatment for the pure arterial malformation. All 12 patients had follow-up (mean 29 months, median 19 months), and there were no cases of disability, stroke, or hemorrhage.CONCLUSIONSPure arterial malformations are rare lesions that are often detected incidentally and probably have a benign natural history. These lesions can affect any of the intracranial arteries and are likely best managed conservatively.
Collapse
Affiliation(s)
| | | | | | - Simone Comelli
- 4Radiologia e Neuroradiologia Interventistica, Ospedale San Giovanni Bosco, Turin, Italy
| | | |
Collapse
|
8
|
Del Brutto VJ, Ortiz JG, Biller J. Intracranial Arterial Dolichoectasia. Front Neurol 2017; 8:344. [PMID: 28769872 PMCID: PMC5511833 DOI: 10.3389/fneur.2017.00344] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 07/03/2017] [Indexed: 11/13/2022] Open
Abstract
An increased diameter (ectasis) and/or long and tortuous course (dolichosis) of at least one cerebral artery define intracranial arterial dolichoectasia (IADE). IADE could be detected incidentally or may give rise to an array of neurological complications including ischemic stroke, intracranial hemorrhage, or compression of surrounding neural structures. The basilar artery is preferentially affected and has been studied in more detail, mainly due to the presence of accepted diagnostic criteria proposed by Smoker and colleagues in 1986 (1). Criteria for the diagnoses of dolichoectasia in other cerebral arteries have been suggested. However, they lack validation across studies. The prevalence of IADE is approximately 0.08–6.5% in the general population, while in patients with stroke, the prevalence ranges from 3 to 17%. Variations among case series depend on the characteristics of the studied population, diagnostic tests used, and diagnostic criteria applied. In rare instances, an underlying hereditary condition, connective tissue disorder, or infection predispose to the development of IADE. However, most cases are sporadic and associated with traditional vascular risk factors including advanced age, male gender, and arterial hypertension. The link between this dilative arteriopathy and other vascular abnormalities, such as abdominal aortic aneurysm, coronary artery ectasia, and cerebral small vessel disease, suggests the underlying diffuse vascular process. Further understanding is needed on the physiopathology of IADE and how to prevent its progression and clinical complications.
Collapse
Affiliation(s)
- Victor J Del Brutto
- Department of Neurology, Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
| | - Jorge G Ortiz
- Department of Neurology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, United States
| | - José Biller
- Department of Neurology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, United States
| |
Collapse
|
9
|
Abstract
Intracranial dolichoectasia is an angiopathy characterized by dilation, elongation, and tortuosity of the cerebral arteries. It most frequently involves the vertebrobasilar arteries and carotid arteries, whereas a more peripheral location involving the anterior and the middle cerebral arteries (MCAs) is less frequent. We present a male patient with MCA dolichoectasia with radiologic follow-up for 3 years, and no ischemia or intracranial bleeding occurred after the antiplatelet therapy. From the reported case series of MCA dolichoectasia, we suggest that surgical procedure should not be adopted unless accompanied by aneurysm located at dolichoectatic MCA. Moreover, anticoagulation or antiplatelet therapy could be a good treatment of option to prevent ischemic events.
Collapse
|
10
|
|