Extracranial internal carotid fibromuscular dysplasia associated with successfully treated hyperacute cerebral infarction

Fibromuscular dysplasia [FMD] is a segmental non-atheromatous and non-inflammatory stenosing angiopathy of unknown cause and the cervico-cephalic [cc] FMD is relatively uncommon. The big majority of the ccFMD patients are Caucasians and there have been several reports in Japan up to the present, the greatest number of which were associated with intracranial aneurysms or discovered post-mortem. The association with cerebral infarction has been rarely described in Japanese patients. We report a case of hyperacute cerebral ischemia caused by embolism, originating in the internal carotid artery. We performed super-selective thrombolysis of a middle cerebral artery embolic ooclusion by a microcatheter with excellent result. Although ccFMD can be associated with a range of vascular pathology and cerebral ischemia is only one of the possibilities, it should be considered as a cause in these young patients where there is no evidence of other embolic sources. Early intervention in these cases can prevent ischemic brain damage

Experience with anterior petrosal approach for aneurysms of mid-basilar artery

Anterior petrosal approach [Kawase's approach] is an established technique for the management of basilar artery aneurysms arising near the origin of anterior inferior cerebellar artery [Ba-AICA], however the extent of petrosectomy may vary from patient to patient. Authors report their experience with Kawase's approach for the management of these aneurysms in 5 patients. During the last 10 years, anterior petrosal approach was used to clip aneurysms of Ba-AICA junction in five patients, who were not suitable for endovascular therapy. Both ruptured and unruptured aneurysms were included in this series. Successful clipping could be achieved in all but one patient. In this patient with a large aneurysm and complex morphology, residual filling was noted in the postoperative angiogram. Postoperatively one patient developed hemiparesis and transient sixth nerve palsy. There was no operative mortality in this series. For patients with small Ba-AICA shoulder aneurysms, where clipping is preferred method of treatment, sufficient exposure is achieved through Kawase approach, however minor variation may be required while resecting the petrous bone