Mauricio Jory - Academia.edu (original) (raw)
Papers by Mauricio Jory
Arquivos Brasileiros de Neurocirurgia, Sep 28, 2022
Idiopathic intracranial hypertension (IIH) is a disease characterized by an increase in the openi... more Idiopathic intracranial hypertension (IIH) is a disease characterized by an increase in the opening pressure of the cerebrospinal fluid (CSF) associated with symptoms of elevated intracranial pressure (ICP). The condition is more prevalent in women and typically managed clinically. Surgical treatment is reserved for select refractory cases. The wellestablished surgical procedures for the management of IIH are CSF shunting and fenestration of the optic nerve sheath. These procedures, however, are associated with high rates of complication and recurrence. More recently, venous sinus angioplasty with stents has been employed in cases with documented narrowing of the sigmoid-transverse sinuses. This technique is associated with a significant reduction in the venous pressure gradient at the stenosis site, alleviating the symptoms of intracranial hypertension. We report a case of a previously healthy 12-year-old patient who presented with 10-day history of headaches, blurring of vision, nausea and vomiting, which evolved with worsening of the visual acuity and papilledema. Imaging scans disclosed stenosis of the right transverse and sigmoid sinuses. The patient underwent stenting of the stenotic venous segments and showed good evolution, with significant clinical improvement within 24 hours of the procedure. Resumo A hipertensão intracraniana idiopática (HII) é uma doença caracterizada pelo aumento da pressão de abertura do líquido cefalorraquidiano associado a sintomas de aumento da pressão intracraniana. É mais frequente em mulheres, sendo habitualmente tratada
Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery
Idiopathic intracranial hypertension (IIH) is a disease characterized by an increase in the openi... more Idiopathic intracranial hypertension (IIH) is a disease characterized by an increase in the opening pressure of the cerebrospinal fluid (CSF) associated with symptoms of elevated intracranial pressure (ICP). The condition is more prevalent in women and typically managed clinically. Surgical treatment is reserved for select refractory cases. The well-established surgical procedures for the management of IIH are CSF shunting and fenestration of the optic nerve sheath. These procedures, however, are associated with high rates of complication and recurrence.More recently, venous sinus angioplasty with stents has been employed in cases with documented narrowing of the sigmoid-transverse sinuses. This technique is associated with a significant reduction in the venous pressure gradient at the stenosis site, alleviating the symptoms of intracranial hypertension.We report a case of a previously healthy 12-year-old patient who presented with 10-day history of headaches, blurring of vision, na...
Interventional Neuroradiology, Sep 1, 2011
The trigeminal artery is an anastomosis between the embryonic precursors of the vertebrobasilar a... more The trigeminal artery is an anastomosis between the embryonic precursors of the vertebrobasilar and carotid systems, and may persist into adult life. The association of the persistent primitive trigeminal artery (PTA) with cerebral aneurysm is well documented in the literature and, in general, aneurysms are located in the anterior circulation. We describe a patient who presented with a panencephalic Fisher III subarachnoid hemorrhage due to rupture of an intracranial aneurysm. Digital arteriography showed a saccular aneurysm in the middle third of the basilar artery, adjacent to the junction with a persistent trigeminal artery. She was submitted to endovascular treatment with embolization of the basilar artery aneurysm with coils. Aneurysms at the PTA junction with the basilar artery are rare. This paper describes a case of PTA associated with an aneurysm in the basilar artery at PTA junction and briefly reviews the literature.
Revista do Colégio Brasileiro de Cirurgiões, Feb 1, 2017
Objective: to evaluate the endovascular treatment of vascular lesions of the cavernous segment of... more Objective: to evaluate the endovascular treatment of vascular lesions of the cavernous segment of the internal carotidartery (ICA) performed at our institution. Methods: we conducted a descriptive, retrospective and prospective study of patients with aneurysms of the cavernous portion of the ICA or with direct carotid-cavernous fistulas (dCCF) undergoing endovascular treatment. Results: we included 26 patients with intracavernous aneurysms and ten with dCCF. All aneurysms were treated with ICA occlusion. Those with dCCF were treated with occlusion in seven cases and with selective fistula occlusion in the remaining three. There was improvement of pain and ocular proptosis in all patients with dCCF. In patients with intracavernous aneurysms, the incidence of retro-orbital pain fell from 84.6% to 30.8% after treatment. The endovascular treatment decreased the dysfunction of affected cranial nerves in both groups, especially the oculomotor one. Conclusion: the endovascular treatment significantly improved the symptoms in the patients studied, especially those related to pain and oculomotor nerve dysfunction.
Surgical Neurology International, 2016
Background: The surgical treatment of complex intracranial aneurysms (CIAs) represents a signific... more Background: The surgical treatment of complex intracranial aneurysms (CIAs) represents a significant challenge to the skill and expertise of the neurosurgeon. The natural history of complex cerebrovascular lesions is especially unfavorable because of the pressure effect on adjacent areas, the risk of embolism in the presence of intraluminal thrombi, and the possibility of hemorrhage through leakage or rupture of the aneurysm. The surgical strategy must be customized for each case in order to maximize the treatment effectiveness and the safety of the patient. Case Description: A 68-year-old woman presented with a 10-month history of atypical headaches but no other neurological symptoms. Computed tomography scan and digital subtraction angiography revealed an unruptured saccular aneurysm on the M1 segment of the right middle cerebral artery. The lesion was 21 mm in length in its largest diameter and with an undefined neck (extensive involvement of the walls of the afferent vessel). Craniotomy was performed in order to expose the lesion and allow microsurgical dissection of the neck of the aneurysm and its adjacent structures. A balloon catheter was navigated via the internal carotid artery to a position alongside the aneurysm neck. With the balloon fully inflated, the aneurysm was punctured and drained, and a guide clip was located at the neck of the aneurysm. Additional clips were applied using a similar procedure to ensure the exclusion of the aneurysm. Conclusion: The patient recovered without complications and complete occlusion of the CIA was confirmed on follow-up angiography. A modified Rankin score of 0 was attributed to the patient 6 months after treatment. A multidisciplinary perspective is important in planning and executing the treatment of CIAs.
Jornal Brasileiro de Neurocirurgia, Mar 24, 2018
Tratamento endovascular de fístula arteriovenosa dural intracraniana através de punção direta do ... more Tratamento endovascular de fístula arteriovenosa dural intracraniana através de punção direta do seio transverso-Nota técnica e revisão da literatura Tratamento endovascular de fístula arteriovenosa dural intracraniana através de punção direta do seio transverso-Nota técnica e revisão da literatura Endovascular treatment of intracranial dural arteriovenous fistula by direct puncture of transverse sinus-Technical note and literature review
Arquivos Brasileiros de Neurocirurgia, Mar 1, 2013
Os pseudoaneurismas traumáticos da artéria meníngea média (AMM) representam lesões raras, corresp... more Os pseudoaneurismas traumáticos da artéria meníngea média (AMM) representam lesões raras, correspondendo a menos de 1% dos aneurismas intracranianos. Em geral, estão associados à fratura craniana temporal que cruza o trajeto da AMM. O hematoma extradural (HED) é a apresentação mais comum desse tipo de lesão, podendo apresentar elevada morbimortalidade na maioria dos casos. O diagnóstico dos pseudoaneurismas da AMM pode ser realizado por angiorressonância, angiotomografia e, principalmente, por arteriografia cerebral. Após a confirmação de sua existência, o tratamento é mandatório e deve ser realizado precocemente, por causa do risco potencial de ruptura. Esse tratamento pode ser realizado por craniotomia e coagulação da artéria meníngea média, ou por via endovascular com oclusão do aneurisma. Apresentamos neste relato o caso de paciente vítima de traumatismo craniano atendido em nosso serviço. Os exames de imagem iniciais mostravam fratura temporal, associada à contusão hemorrágica adjacente. O paciente foi submetido à angiografia cerebral, sendo diagnosticado um pseudoaneurisma na artéria meníngea média. Ele foi submetido a procedimento endovascular para embolização do aneurisma, tendo evoluído satisfatoriamente.
Arquivos Médicos dos Hospitais e da Faculdade de Ciências Médicas da Santa Casa de São Paulo, Dec 10, 2018
Introduction: Blood blister-like (BBAs) aneurysms are rare cerebrovascular lesions for which the ... more Introduction: Blood blister-like (BBAs) aneurysms are rare cerebrovascular lesions for which the endovascular treatment methods are reviewed here. The reported pathogenesis varies, and hemodynamic stress, arterial dissection, and arteriosclerotic ulceration have all been described. The excessive fragility of BBAs and their parent vessels, can make microsurgical clipping technically difficult. Surgical treatment is associated with high rates of complications, morbidity, and mortality. The approach to the treatment of BBAs in recent times has shifted from microsurgical treatment to endovascular treatment, thanks to ongoing innovations in regard to endovascular techniques and devices. Method: The authors performed a review of available endovascular techniques used for blood blister-like aneurysms treatment. The Pubmed database was used as source search introducing "blood blister-like aneurysm" and "blister aneurysms" as keywords. The most relevant articles and those that focused on endovascular treatment techniques were selected. Discussion: Endovascular interventional techniques have evolved as an effective treatment for intracranial aneurysms. Considerable interest has emerged regarding the use of endovascular approaches to treat BBAs. In some studies, endovascular treatment of BBAs was associated with high rates of complete occlusion and good mid-to long-term neurological outcomes. Various endovascular techniques have been applied to treat BBAs, such as coil embolization, stenting, stent-assisted coiling and flow-diverting stents. Conclusion: From the available endovascular techniques, flow-diverting stents appears to be the safest and most effective treatment modality, with a higher rate of complete occlusion of an aneurysm and a lower rate of retreatment. The development of novel flow-diverting stents with decreased thrombogenic properties, may represents a key step forward and increases the potential for flow diversion becoming the gold standard for endovascular treatment of BBAs.
Neurocirugía, Jun 1, 2011
The de novo aneurysms are the formation of new aneurysms in a location previously observed to be ... more The de novo aneurysms are the formation of new aneurysms in a location previously observed to be normal by a cerebral angiography or direct microsurgical exploration. In this report, we present a review of the theme and describe a case of a ruptured de novo basilar tip aneurysm in a patient previously treated with carotid occlusion for a giant intracavernous aneurysm and microsurgical clipping of contralateral posterior communicating artery aneurysm. KEY WORDS. Basilar artery, De novo aneurysm, Subarachnoid hemorrhage Aneurisma de novo del topo basilar. Descripción de un caso y revisión de la literatura Resumen Se llaman aneurismas de novo a la formación de aneurismas en una región previamente normal, observado y documentado por una angiografía cerebral o por la exploración microquirúrgica directa. En este trabajo, se presenta una revisión de la literatura sobre el tema y la descripción de un caso de ruptura de un aneurisma de novo en la arteria basilar en un paciente que previamente fue tratado con la oclusión de la arteria carótida para el tratamiento de un aneurisma gigante intracavernoso de un lado y el clipaje microquirúrgico de un aneurisma en la arteria comunicante posterior contralateral. PALABRAS CLAVE. Arteria basilar. Aneurisma de novo. Hemorragia subaracnóidea.
Revista Da Associacao Medica Brasileira, Feb 1, 2016
Carotid cavernous fistulas (CCFs) are abnormal connections between the carotid artery and the cav... more Carotid cavernous fistulas (CCFs) are abnormal connections between the carotid artery and the cavernous sinus. They are considered direct when there is a direct connection between the internal carotid artery and the cavernous sinus. These cases are generally traumatic. Direct CCFs are high-flow lesions, possibly related to intracranial bleeding, visual loss, corneal exposure or even fatal epistaxis. Treatment of such lesions is, thus, always recommended. The ideal treatment for direct CCF is to exclude the fistula from circulation, preserving the carotid flow. This can be attained using diverse endovascular techniques. The objective of the present article is to review the current techniques for treatment of direct CCFs, with special attention to the currently available endovascular treatment options.
Surgical Neurology International, 2020
Background: Angioplasty using a carotid stent is a treatment modality for carotid stenosis, with ... more Background: Angioplasty using a carotid stent is a treatment modality for carotid stenosis, with results similar to those obtained with endarterectomy, as demonstrated by important studies. The increasing use of this procedure has also led to a larger number of reports of complications, stent fractures among those. Stent fracture is a rare manifestation and hence needs further studying so that its actual prevalence can be determined, as well as its associated risk factors and proper clinical management. The current study reports the case of a patient who had previously undergone angioplasty with a carotid stent and, after an automobile accident, presented with a stent fracture and distal embolization of fragments thereof with neurological manifestation. Case Description: A male patient, 40 years old, presented with a history of previously stent carotid angioplasty. He had been involved in an automobile accident and suffered a stent fracture with distal fragment migration. As he was ...
Surgical neurology international, 2016
The surgical treatment of complex intracranial aneurysms (CIAs) represents a significant challeng... more The surgical treatment of complex intracranial aneurysms (CIAs) represents a significant challenge to the skill and expertise of the neurosurgeon. The natural history of complex cerebrovascular lesions is especially unfavorable because of the pressure effect on adjacent areas, the risk of embolism in the presence of intraluminal thrombi, and the possibility of hemorrhage through leakage or rupture of the aneurysm. The surgical strategy must be customized for each case in order to maximize the treatment effectiveness and the safety of the patient. A 68-year-old woman presented with a 10-month history of atypical headaches but no other neurological symptoms. Computed tomography scan and digital subtraction angiography revealed an unruptured saccular aneurysm on the M1 segment of the right middle cerebral artery. The lesion was 21 mm in length in its largest diameter and with an undefined neck (extensive involvement of the walls of the afferent vessel). Craniotomy was performed in orde...
Revista da Associacao Medica Brasileira (1992), 2016
Carotid cavernous fistulas (CCFs) are abnormal connections between the carotid artery and the cav... more Carotid cavernous fistulas (CCFs) are abnormal connections between the carotid artery and the cavernous sinus. They are considered direct when there is a direct connection between the internal carotid artery and the cavernous sinus. These cases are generally traumatic. Direct CCFs are high-flow lesions, possibly related to intracranial bleeding, visual loss, corneal exposure or even fatal epistaxis. Treatment of such lesions is, thus, always recommended. The ideal treatment for direct CCF is to exclude the fistula from circulation, preserving the carotid flow. This can be attained using diverse endovascular techniques. The objective of the present article is to review the current techniques for treatment of direct CCFs, with special attention to the currently available endovascular treatment options.
Neurosurgery, 2009
OBJECTIVE A giant fusiform aneurysm in the posterior cerebral artery (PCA) is rare, as is fenestr... more OBJECTIVE A giant fusiform aneurysm in the posterior cerebral artery (PCA) is rare, as is fenestration of the PCA and basilar apex variation. We describe the angiographic and surgical findings of a giant fusiform aneurysm in the P1–P2 PCA segment associated with PCA bilateral fenestration and superior cerebellar artery double origin. CLINICAL PRESENTATION A 26-year-old woman presented with a 2-month history of visual blurring. Digital subtraction angiography showed a giant (2.5 cm) fusiform PCA aneurysm in the right P1–P2 segment. The 3-dimensional view showed a caudal fusion pattern from the upper portion of the basilar artery associated with a bilateral long fenestration of the P1 and P2 segments and superior cerebellar artery double origin. INTERVENTION Surgical trapping of the right P1–P2 segment, including the posterior communicating artery, was performed by a pretemporal approach. Angiograms performed 3 and 13 months after surgery showed complete aneurysm exclusion, and the PC...
min - Minimally Invasive Neurosurgery, 2011
Arteriovenous fistulas (AVF) are rare vascular lesions of the brain that differ from arteriovenou... more Arteriovenous fistulas (AVF) are rare vascular lesions of the brain that differ from arteriovenous malformations as they present a direct connection between artery and vein, without interposition of the nidus. They are fed by one or more arterial branches, with a single draining vein. Clinically they can be revealed through cerebral hemorrhage, convulsive crisis, neurological deficit, heart failure in neonates and infants, headache, bruit, or intracranial hypertension symptoms. A 30-year-old patient was found unconscious on a public street, presenting a generalized tonic-clonic convulsive crisis. At admission, she presented with ocular proptosis, conjunctival hyperemia and bilateral jugular turgescence. The cranial computed tomography showed diffuse subarachnoid hemorrhage, and the cerebral angiography evidenced a giant intracranial pial AVF with high flow supplied by 2 branches of the left anterior cerebral artery.The patient underwent endovascular treatment in 2 sessions, using a mixture of histoacryl and lipiodol for complete occlusion of the lesion. She was discharged after a month, alert, devoid of motor deficit, and the ocular proptosis and the conjunctival hyperemia had decreased. AVFs are rare vascular lesions that require prompt treatment. The endovascular treatment must be considered, especially when the lesions are deep and the risks of neurological deficit associated with the surgery are high. Endoscopic intervention represents an effective and safe option for the treatment of this type of lesion.
Arquivos de Neuro-Psiquiatria, 2008
Arquivos Brasileiros de Neurocirurgia, Sep 28, 2022
Idiopathic intracranial hypertension (IIH) is a disease characterized by an increase in the openi... more Idiopathic intracranial hypertension (IIH) is a disease characterized by an increase in the opening pressure of the cerebrospinal fluid (CSF) associated with symptoms of elevated intracranial pressure (ICP). The condition is more prevalent in women and typically managed clinically. Surgical treatment is reserved for select refractory cases. The wellestablished surgical procedures for the management of IIH are CSF shunting and fenestration of the optic nerve sheath. These procedures, however, are associated with high rates of complication and recurrence. More recently, venous sinus angioplasty with stents has been employed in cases with documented narrowing of the sigmoid-transverse sinuses. This technique is associated with a significant reduction in the venous pressure gradient at the stenosis site, alleviating the symptoms of intracranial hypertension. We report a case of a previously healthy 12-year-old patient who presented with 10-day history of headaches, blurring of vision, nausea and vomiting, which evolved with worsening of the visual acuity and papilledema. Imaging scans disclosed stenosis of the right transverse and sigmoid sinuses. The patient underwent stenting of the stenotic venous segments and showed good evolution, with significant clinical improvement within 24 hours of the procedure. Resumo A hipertensão intracraniana idiopática (HII) é uma doença caracterizada pelo aumento da pressão de abertura do líquido cefalorraquidiano associado a sintomas de aumento da pressão intracraniana. É mais frequente em mulheres, sendo habitualmente tratada
Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery
Idiopathic intracranial hypertension (IIH) is a disease characterized by an increase in the openi... more Idiopathic intracranial hypertension (IIH) is a disease characterized by an increase in the opening pressure of the cerebrospinal fluid (CSF) associated with symptoms of elevated intracranial pressure (ICP). The condition is more prevalent in women and typically managed clinically. Surgical treatment is reserved for select refractory cases. The well-established surgical procedures for the management of IIH are CSF shunting and fenestration of the optic nerve sheath. These procedures, however, are associated with high rates of complication and recurrence.More recently, venous sinus angioplasty with stents has been employed in cases with documented narrowing of the sigmoid-transverse sinuses. This technique is associated with a significant reduction in the venous pressure gradient at the stenosis site, alleviating the symptoms of intracranial hypertension.We report a case of a previously healthy 12-year-old patient who presented with 10-day history of headaches, blurring of vision, na...
Interventional Neuroradiology, Sep 1, 2011
The trigeminal artery is an anastomosis between the embryonic precursors of the vertebrobasilar a... more The trigeminal artery is an anastomosis between the embryonic precursors of the vertebrobasilar and carotid systems, and may persist into adult life. The association of the persistent primitive trigeminal artery (PTA) with cerebral aneurysm is well documented in the literature and, in general, aneurysms are located in the anterior circulation. We describe a patient who presented with a panencephalic Fisher III subarachnoid hemorrhage due to rupture of an intracranial aneurysm. Digital arteriography showed a saccular aneurysm in the middle third of the basilar artery, adjacent to the junction with a persistent trigeminal artery. She was submitted to endovascular treatment with embolization of the basilar artery aneurysm with coils. Aneurysms at the PTA junction with the basilar artery are rare. This paper describes a case of PTA associated with an aneurysm in the basilar artery at PTA junction and briefly reviews the literature.
Revista do Colégio Brasileiro de Cirurgiões, Feb 1, 2017
Objective: to evaluate the endovascular treatment of vascular lesions of the cavernous segment of... more Objective: to evaluate the endovascular treatment of vascular lesions of the cavernous segment of the internal carotidartery (ICA) performed at our institution. Methods: we conducted a descriptive, retrospective and prospective study of patients with aneurysms of the cavernous portion of the ICA or with direct carotid-cavernous fistulas (dCCF) undergoing endovascular treatment. Results: we included 26 patients with intracavernous aneurysms and ten with dCCF. All aneurysms were treated with ICA occlusion. Those with dCCF were treated with occlusion in seven cases and with selective fistula occlusion in the remaining three. There was improvement of pain and ocular proptosis in all patients with dCCF. In patients with intracavernous aneurysms, the incidence of retro-orbital pain fell from 84.6% to 30.8% after treatment. The endovascular treatment decreased the dysfunction of affected cranial nerves in both groups, especially the oculomotor one. Conclusion: the endovascular treatment significantly improved the symptoms in the patients studied, especially those related to pain and oculomotor nerve dysfunction.
Surgical Neurology International, 2016
Background: The surgical treatment of complex intracranial aneurysms (CIAs) represents a signific... more Background: The surgical treatment of complex intracranial aneurysms (CIAs) represents a significant challenge to the skill and expertise of the neurosurgeon. The natural history of complex cerebrovascular lesions is especially unfavorable because of the pressure effect on adjacent areas, the risk of embolism in the presence of intraluminal thrombi, and the possibility of hemorrhage through leakage or rupture of the aneurysm. The surgical strategy must be customized for each case in order to maximize the treatment effectiveness and the safety of the patient. Case Description: A 68-year-old woman presented with a 10-month history of atypical headaches but no other neurological symptoms. Computed tomography scan and digital subtraction angiography revealed an unruptured saccular aneurysm on the M1 segment of the right middle cerebral artery. The lesion was 21 mm in length in its largest diameter and with an undefined neck (extensive involvement of the walls of the afferent vessel). Craniotomy was performed in order to expose the lesion and allow microsurgical dissection of the neck of the aneurysm and its adjacent structures. A balloon catheter was navigated via the internal carotid artery to a position alongside the aneurysm neck. With the balloon fully inflated, the aneurysm was punctured and drained, and a guide clip was located at the neck of the aneurysm. Additional clips were applied using a similar procedure to ensure the exclusion of the aneurysm. Conclusion: The patient recovered without complications and complete occlusion of the CIA was confirmed on follow-up angiography. A modified Rankin score of 0 was attributed to the patient 6 months after treatment. A multidisciplinary perspective is important in planning and executing the treatment of CIAs.
Jornal Brasileiro de Neurocirurgia, Mar 24, 2018
Tratamento endovascular de fístula arteriovenosa dural intracraniana através de punção direta do ... more Tratamento endovascular de fístula arteriovenosa dural intracraniana através de punção direta do seio transverso-Nota técnica e revisão da literatura Tratamento endovascular de fístula arteriovenosa dural intracraniana através de punção direta do seio transverso-Nota técnica e revisão da literatura Endovascular treatment of intracranial dural arteriovenous fistula by direct puncture of transverse sinus-Technical note and literature review
Arquivos Brasileiros de Neurocirurgia, Mar 1, 2013
Os pseudoaneurismas traumáticos da artéria meníngea média (AMM) representam lesões raras, corresp... more Os pseudoaneurismas traumáticos da artéria meníngea média (AMM) representam lesões raras, correspondendo a menos de 1% dos aneurismas intracranianos. Em geral, estão associados à fratura craniana temporal que cruza o trajeto da AMM. O hematoma extradural (HED) é a apresentação mais comum desse tipo de lesão, podendo apresentar elevada morbimortalidade na maioria dos casos. O diagnóstico dos pseudoaneurismas da AMM pode ser realizado por angiorressonância, angiotomografia e, principalmente, por arteriografia cerebral. Após a confirmação de sua existência, o tratamento é mandatório e deve ser realizado precocemente, por causa do risco potencial de ruptura. Esse tratamento pode ser realizado por craniotomia e coagulação da artéria meníngea média, ou por via endovascular com oclusão do aneurisma. Apresentamos neste relato o caso de paciente vítima de traumatismo craniano atendido em nosso serviço. Os exames de imagem iniciais mostravam fratura temporal, associada à contusão hemorrágica adjacente. O paciente foi submetido à angiografia cerebral, sendo diagnosticado um pseudoaneurisma na artéria meníngea média. Ele foi submetido a procedimento endovascular para embolização do aneurisma, tendo evoluído satisfatoriamente.
Arquivos Médicos dos Hospitais e da Faculdade de Ciências Médicas da Santa Casa de São Paulo, Dec 10, 2018
Introduction: Blood blister-like (BBAs) aneurysms are rare cerebrovascular lesions for which the ... more Introduction: Blood blister-like (BBAs) aneurysms are rare cerebrovascular lesions for which the endovascular treatment methods are reviewed here. The reported pathogenesis varies, and hemodynamic stress, arterial dissection, and arteriosclerotic ulceration have all been described. The excessive fragility of BBAs and their parent vessels, can make microsurgical clipping technically difficult. Surgical treatment is associated with high rates of complications, morbidity, and mortality. The approach to the treatment of BBAs in recent times has shifted from microsurgical treatment to endovascular treatment, thanks to ongoing innovations in regard to endovascular techniques and devices. Method: The authors performed a review of available endovascular techniques used for blood blister-like aneurysms treatment. The Pubmed database was used as source search introducing "blood blister-like aneurysm" and "blister aneurysms" as keywords. The most relevant articles and those that focused on endovascular treatment techniques were selected. Discussion: Endovascular interventional techniques have evolved as an effective treatment for intracranial aneurysms. Considerable interest has emerged regarding the use of endovascular approaches to treat BBAs. In some studies, endovascular treatment of BBAs was associated with high rates of complete occlusion and good mid-to long-term neurological outcomes. Various endovascular techniques have been applied to treat BBAs, such as coil embolization, stenting, stent-assisted coiling and flow-diverting stents. Conclusion: From the available endovascular techniques, flow-diverting stents appears to be the safest and most effective treatment modality, with a higher rate of complete occlusion of an aneurysm and a lower rate of retreatment. The development of novel flow-diverting stents with decreased thrombogenic properties, may represents a key step forward and increases the potential for flow diversion becoming the gold standard for endovascular treatment of BBAs.
Neurocirugía, Jun 1, 2011
The de novo aneurysms are the formation of new aneurysms in a location previously observed to be ... more The de novo aneurysms are the formation of new aneurysms in a location previously observed to be normal by a cerebral angiography or direct microsurgical exploration. In this report, we present a review of the theme and describe a case of a ruptured de novo basilar tip aneurysm in a patient previously treated with carotid occlusion for a giant intracavernous aneurysm and microsurgical clipping of contralateral posterior communicating artery aneurysm. KEY WORDS. Basilar artery, De novo aneurysm, Subarachnoid hemorrhage Aneurisma de novo del topo basilar. Descripción de un caso y revisión de la literatura Resumen Se llaman aneurismas de novo a la formación de aneurismas en una región previamente normal, observado y documentado por una angiografía cerebral o por la exploración microquirúrgica directa. En este trabajo, se presenta una revisión de la literatura sobre el tema y la descripción de un caso de ruptura de un aneurisma de novo en la arteria basilar en un paciente que previamente fue tratado con la oclusión de la arteria carótida para el tratamiento de un aneurisma gigante intracavernoso de un lado y el clipaje microquirúrgico de un aneurisma en la arteria comunicante posterior contralateral. PALABRAS CLAVE. Arteria basilar. Aneurisma de novo. Hemorragia subaracnóidea.
Revista Da Associacao Medica Brasileira, Feb 1, 2016
Carotid cavernous fistulas (CCFs) are abnormal connections between the carotid artery and the cav... more Carotid cavernous fistulas (CCFs) are abnormal connections between the carotid artery and the cavernous sinus. They are considered direct when there is a direct connection between the internal carotid artery and the cavernous sinus. These cases are generally traumatic. Direct CCFs are high-flow lesions, possibly related to intracranial bleeding, visual loss, corneal exposure or even fatal epistaxis. Treatment of such lesions is, thus, always recommended. The ideal treatment for direct CCF is to exclude the fistula from circulation, preserving the carotid flow. This can be attained using diverse endovascular techniques. The objective of the present article is to review the current techniques for treatment of direct CCFs, with special attention to the currently available endovascular treatment options.
Surgical Neurology International, 2020
Background: Angioplasty using a carotid stent is a treatment modality for carotid stenosis, with ... more Background: Angioplasty using a carotid stent is a treatment modality for carotid stenosis, with results similar to those obtained with endarterectomy, as demonstrated by important studies. The increasing use of this procedure has also led to a larger number of reports of complications, stent fractures among those. Stent fracture is a rare manifestation and hence needs further studying so that its actual prevalence can be determined, as well as its associated risk factors and proper clinical management. The current study reports the case of a patient who had previously undergone angioplasty with a carotid stent and, after an automobile accident, presented with a stent fracture and distal embolization of fragments thereof with neurological manifestation. Case Description: A male patient, 40 years old, presented with a history of previously stent carotid angioplasty. He had been involved in an automobile accident and suffered a stent fracture with distal fragment migration. As he was ...
Surgical neurology international, 2016
The surgical treatment of complex intracranial aneurysms (CIAs) represents a significant challeng... more The surgical treatment of complex intracranial aneurysms (CIAs) represents a significant challenge to the skill and expertise of the neurosurgeon. The natural history of complex cerebrovascular lesions is especially unfavorable because of the pressure effect on adjacent areas, the risk of embolism in the presence of intraluminal thrombi, and the possibility of hemorrhage through leakage or rupture of the aneurysm. The surgical strategy must be customized for each case in order to maximize the treatment effectiveness and the safety of the patient. A 68-year-old woman presented with a 10-month history of atypical headaches but no other neurological symptoms. Computed tomography scan and digital subtraction angiography revealed an unruptured saccular aneurysm on the M1 segment of the right middle cerebral artery. The lesion was 21 mm in length in its largest diameter and with an undefined neck (extensive involvement of the walls of the afferent vessel). Craniotomy was performed in orde...
Revista da Associacao Medica Brasileira (1992), 2016
Carotid cavernous fistulas (CCFs) are abnormal connections between the carotid artery and the cav... more Carotid cavernous fistulas (CCFs) are abnormal connections between the carotid artery and the cavernous sinus. They are considered direct when there is a direct connection between the internal carotid artery and the cavernous sinus. These cases are generally traumatic. Direct CCFs are high-flow lesions, possibly related to intracranial bleeding, visual loss, corneal exposure or even fatal epistaxis. Treatment of such lesions is, thus, always recommended. The ideal treatment for direct CCF is to exclude the fistula from circulation, preserving the carotid flow. This can be attained using diverse endovascular techniques. The objective of the present article is to review the current techniques for treatment of direct CCFs, with special attention to the currently available endovascular treatment options.
Neurosurgery, 2009
OBJECTIVE A giant fusiform aneurysm in the posterior cerebral artery (PCA) is rare, as is fenestr... more OBJECTIVE A giant fusiform aneurysm in the posterior cerebral artery (PCA) is rare, as is fenestration of the PCA and basilar apex variation. We describe the angiographic and surgical findings of a giant fusiform aneurysm in the P1–P2 PCA segment associated with PCA bilateral fenestration and superior cerebellar artery double origin. CLINICAL PRESENTATION A 26-year-old woman presented with a 2-month history of visual blurring. Digital subtraction angiography showed a giant (2.5 cm) fusiform PCA aneurysm in the right P1–P2 segment. The 3-dimensional view showed a caudal fusion pattern from the upper portion of the basilar artery associated with a bilateral long fenestration of the P1 and P2 segments and superior cerebellar artery double origin. INTERVENTION Surgical trapping of the right P1–P2 segment, including the posterior communicating artery, was performed by a pretemporal approach. Angiograms performed 3 and 13 months after surgery showed complete aneurysm exclusion, and the PC...
min - Minimally Invasive Neurosurgery, 2011
Arteriovenous fistulas (AVF) are rare vascular lesions of the brain that differ from arteriovenou... more Arteriovenous fistulas (AVF) are rare vascular lesions of the brain that differ from arteriovenous malformations as they present a direct connection between artery and vein, without interposition of the nidus. They are fed by one or more arterial branches, with a single draining vein. Clinically they can be revealed through cerebral hemorrhage, convulsive crisis, neurological deficit, heart failure in neonates and infants, headache, bruit, or intracranial hypertension symptoms. A 30-year-old patient was found unconscious on a public street, presenting a generalized tonic-clonic convulsive crisis. At admission, she presented with ocular proptosis, conjunctival hyperemia and bilateral jugular turgescence. The cranial computed tomography showed diffuse subarachnoid hemorrhage, and the cerebral angiography evidenced a giant intracranial pial AVF with high flow supplied by 2 branches of the left anterior cerebral artery.The patient underwent endovascular treatment in 2 sessions, using a mixture of histoacryl and lipiodol for complete occlusion of the lesion. She was discharged after a month, alert, devoid of motor deficit, and the ocular proptosis and the conjunctival hyperemia had decreased. AVFs are rare vascular lesions that require prompt treatment. The endovascular treatment must be considered, especially when the lesions are deep and the risks of neurological deficit associated with the surgery are high. Endoscopic intervention represents an effective and safe option for the treatment of this type of lesion.
Arquivos de Neuro-Psiquiatria, 2008