A Cadaveric Study of Palmaris Longus Muscle

Background: Aim: To assess the palmaris longus muscle.Methods:40 formalin fixed cadavers of both genders were included. Routine dissection of the upper limb was carried following the Cunnigham抯 Manual of Practical Anatomy. During the dissection of the anterior compartment of forearm, the Palmaris longus muscle was identified & carefully dissected.Results:Out of 40 cadavers, 22 were of males and 18 were of females. Morphology of Palmaris longus found to be normal in 18, agenesis in 6, fusiform in 4, hybrid in 6, bifurcated tendon in 5 and fleshy in 1 case. A significant difference was observed (P< 0.05).Conclusions:Surgeon must be aware of the variations of palmaris longus muscle. Morphology of Palmaris longus found to be normal, agenesis, fusiform, hybrid, bifurcated tendon and fleshy.

The etiology and treatment of craniopharyngioma with aneurysm / 中国医师进修杂志

Objective:To explore the etiology and treatment of craniopharyngioma with aneurysm.Methods:Seven cases of craniopharyngioma with aneurysm from March 2014 to October 2019 treated in Sanbo Brain Hospital, Capital Medical University were retrospectively analyzed. Among the 7 patients, there were 5 males and 2 females. There were 4 cases of recurrent craniopharyngiomas, 1 case of primary tumor and 2 cases of non-recurrence tumor. Three patients with blood blister-like aneurysms were treated with microsurgical suture after craniopharyngioma resection. Among the three cases with internal carotid artery fusiform aneurysm, 1 case underwent craniopharyngioma resection after internal maxillary artery-radial artery-middle cerebral artery bypass and isolation of the aneurysm; 1 case only underwent internal maxillary artery-radial artery-middle cerebral artery bypass and isolation of the aneurysm for non-recurrence tumor; 1 case underwent craniopharyngioma resection and dynamic observation of aneurysm. One case with a cystic aneurysm of the middle cerebral artery was clipped and the craniopharyngioma did not relapse.Results:All patients had no serious postoperative complications. During the follow-up period, there was no recurrence of craniopharyngioma, no recurrence of treated aneurysms, and the stability of aneurysms was observed.Conclusions:Inflammatory stimulation of craniopharyngioma cystic fluid and operation itself are the important reasons for the occurrence of aneurysms after craniopharyngioma surgery. Choosing appropriate surgical methods can complete the removal of craniopharyngioma and the treatment of aneurysms at one time.

Remodelado Histológico en Aneurismas Fusiformes en Ratas Wistar tratadas con Wrapping de Algodón y Politetrafluoroetileno / Histological Remodeling in Fusiform Aneurysms in Wistar Rats Treated with Cotton Wrapping and Polytetrafluoroethylene

Intoducción: El tratamiento microquirúrgico para los aneurismas intracraneales es el clipado, sin embargo, algunos aneurismas deben ser resueltos mediante wrapping. El objetivo del trabajo es analizar los cambios histológicos en aneurismas fusiformes en ratas luego del wrapping con algodón natural y politetrafluoroetileno. Materiales y Método: Se trabajó con 12 Ratas Wistar divididas en 3 grupos. Luego de la anestesia se expusieron ambas arterias carótidas comunes, realizándose un aneurisma fusiforme en cada vaso. Se realizó wrapping a las carótidas derechas, grupo 1 con membrana de politetrafluoroetileno, grupo 2 con algodón natural y grupo 3 empleándo combinación de ambos materiales. Los animales fueron sacrificados a los 45 días postoperatorios, para luego procesar las muestras y análisis histológico vascular. Resultados: En el grupo 1 no se evidenciaron modificaciones estructurales, en el grupo 2 se destacó la presencia de células gigantes multinucleadas, inflamación, con infiltrado linfoplasmocitario. En el grupo 3 fue similar al grupo 2 con el agregado de metaplasia condroide y calcificaciones en capa media. Las arterias carotidas izquierdas (control) no presentaron cambios histológicos y a nivel muscular, aumento del tejido conectivo entre las fibras musculares y fibroblastos en el grupo 2. Discusión: Existen publicaciones sobre la técnica de wrapping con materiales autólogos o heterólogos. Sin embargo, no existen análisis experimentales de los efectos microestructurales producidos en las arterias tras la creación y tratamiento de un aneurisma fusiforme. Conclusiones: La combinación más efectiva para reforzar la pared del aneurisma y evitar la reacción inflamatoria circundante es la utilización de algodón natural y politetrafluoroetileno

Intoduction: The microsurgical treatment for intracranial aneurysms is clipping, however, some aneurysms must be resolved by wrapping. The objective of the work is to analyze the histological changes in fusiforms aneurysms in rats after wrapping with natural cotton and polytetrafluoroethylene. Materials and Method: We worked with 12 Wistar rats divided into 3 groups. After anesthesia, both common carotid arteries were exposed, making a fusiform aneurysm in each vessel. Right carotid wrapping was performed, group 1 with a polytetrafluoroethylene membrane, group 2 with natural cotton, and group 3 using a combination of both materials. The animals were sacrificed 45 days after surgery, to process the specimens and vascular histological analysis. Results: In group 1 there were no structural modifications, in group 2 the presence of multinucleated giant cells, inflammation, with lymphoplasmacytic infiltrate stood out. In group 3 it was similar to group 2 with the addition of chondroid metaplasia and calcifications in the middle layer. The left carotid arteries (control) did not present histological changes and at the muscle level, increased connective tissue between muscle fibers and fibroblasts in group 2. Discussion: There are publications on the wrapping technique with autologous or heterologous materials. However, there are no experimental analyzes of the microstructural effects produced in the arteries after the creation and treatment of a fusiform aneurysm. Conclusions: The most effective combination to reinforce the wall of the aneurysm and avoid the surrounding inflammatory reaction is the use of natural cotton and polytetrafluoroethylene

Morphology of plantaris longus with special reference to its clinical importance

Background: Plantaris is small fusiform muscle, with its long, slender tendon. Actually it’s a vestigial muscle inhuman beings hence its rupture does not result in any significant loss of function. Muscle tear associated withbleeding and swelling leads to a posterior compartment syndrome. It can mimic other serious conditions likeDVT, ruptured baker’s cyst and calf neoplasms.The present study aims to find out the various patterns of proximal and distal attachment of plantaris muscle,which will help the clinician deciding in diagnosis and the plastic & orthopaedic surgeons for different types ofreconstructive surgeries.Materials and Methods: Forty-eight limbs from 24 embalmed cadavers of known sex(male) & age (40-75 years)were dissected in the department of anatomy of Lady Harding medical college, New Delhi during 2016-2017.Plantaris muscle identified with its proximal and distal attachment. Length of muscle belly & tendon wererecorded.Result: In the present study out of 48 limbs specimens, Plantaris muscle was absent in 12.5%. Its proximalattachment to lateral supracondylar ridges observed in 29% & with lateral head of gastrocnemius muscle &fibrous capsule in 58.3%. Its distal attachment deep to tendocalcaneus was noted in 25% and superficial totendocalcaneus in 62.4%. Length of muscle belly was 7- 9 cm in 37% and tendon length was 34- 36cm in 37.5%.Conclusion: The Morphological aspects of the attachment of plantaris play a significant role in the Pathologiesassociated with Calf & knee region. Their exact attachment is importance for reconstructive surgeries to therepair of ankle joint injury and flexor tendon replacement in hand.

Thrombosed Fusiform Dilatation of Persistent Median Artery with Normal Median Nerve

Carpal tunnel syndrome can be produced by abnormal mass effect due to trauma, ganglion cysts, various soft tissue tumors, musculotendinous variants, and aberrant vascular structures. Persistent median artery is one of the causes of the carpal tunnel syndrome. Thrombosed persistent median artery usually accompanies the anomaly of the median nerve and causes a sudden onset of severe pain and paresthesia. In contrast to previous literature, we report the rare case of gradual onset and mild symptom of a 53-year-old man with a thrombosed persistent median artery but without anomaly of the median nerve and abnormal finding of electrophysiologic study.

Characteristics and Clinical Course of Fusiform Middle Cerebral Artery Aneurysms According to Location, Size, and Configuration

OBJECTIVE: To analyze the angiographic features and clinical course, including treatment outcomes and the natural course, of fusiform middle cerebral artery aneurysms (FMCAAs) according to their location, size, and configuration.METHODS: We reviewed the literature on adult cases of FMCAAs published from 1980 to 2018; from 25 papers, 112 FMCAA cases, for which the location, size, and configuration could be identified, were included in this study. Additionally, 33 FMCAA cases in our hospital were included, from which 16 were assigned to the observation group. Thus, a total of 145 adult FMCAA cases were included. We classified the FMCAAs according to their location (l-type 1, beginning from prebifurcation; l-type 2, beginning from bifurcation; l-type 3, beginning from postbifurcation), size (small, <10 mm; large, ≥10 mm; giant, ≥25 mm), and configuration (c-type 1, classic dissecting aneurysm; c-type 2, segmental ectasia; c-type 3, dolichoectatic dissecting aneurysm).RESULTS: The c-type 3 was more commonly diagnosed with ischemic symptoms (31.8%) than hemorrhage (13.6%), while 40.9% were found accidentally. In contrast, c-type 2 was more commonly diagnosed with hemorrhagic symptoms (14.9%) than ischemic symptoms (10.6%), and 72.3% were accidentally discovered. According to location, ischemic symptoms and hemorrhage were the most frequent symptoms in l-type 1 (28.6%) and l-type 3 (34.6%), respectively. Most of l-type 2 FMCAAs were found incidentally (68.4%). Based on the size of FMCAAs, only 11.1% of small aneurysms were found to be hemorrhagic, while 18.9% and 26.0% of large and giant aneurysms were hemorrhagic, respectively. Although four aneurysms of the 16 FMCAAs in the observation group increased in size and one aneurysm decreased in size during the observation period, no rupture was seen in any case and there were no significant predictors of aneurysm enlargement. Of 104 FMCAAs treated, 14 cases (13.5%) were aggravated than before surgery and all the aggravated cases were l-type 1.CONCLUSION: While ischemic symptoms occurred more frequently in l-type 1 and c-type 3, hemorrhagic rather than ischemic symptoms occurred more frequently in l-type 3 and c-type 2. In case of l-type 1 FMCAAs, more caution is required in determining the treatment due to the relatively high complication rate.

Characteristics and Clinical Course of Fusiform Middle Cerebral Artery Aneurysms According to Location, Size, and Configuration

OBJECTIVE: To analyze the angiographic features and clinical course, including treatment outcomes and the natural course, of fusiform middle cerebral artery aneurysms (FMCAAs) according to their location, size, and configuration. METHODS: We reviewed the literature on adult cases of FMCAAs published from 1980 to 2018; from 25 papers, 112 FMCAA cases, for which the location, size, and configuration could be identified, were included in this study. Additionally, 33 FMCAA cases in our hospital were included, from which 16 were assigned to the observation group. Thus, a total of 145 adult FMCAA cases were included. We classified the FMCAAs according to their location (l-type 1, beginning from prebifurcation; l-type 2, beginning from bifurcation; l-type 3, beginning from postbifurcation), size (small, <10 mm; large, ≥10 mm; giant, ≥25 mm), and configuration (c-type 1, classic dissecting aneurysm; c-type 2, segmental ectasia; c-type 3, dolichoectatic dissecting aneurysm). RESULTS: The c-type 3 was more commonly diagnosed with ischemic symptoms (31.8%) than hemorrhage (13.6%), while 40.9% were found accidentally. In contrast, c-type 2 was more commonly diagnosed with hemorrhagic symptoms (14.9%) than ischemic symptoms (10.6%), and 72.3% were accidentally discovered. According to location, ischemic symptoms and hemorrhage were the most frequent symptoms in l-type 1 (28.6%) and l-type 3 (34.6%), respectively. Most of l-type 2 FMCAAs were found incidentally (68.4%). Based on the size of FMCAAs, only 11.1% of small aneurysms were found to be hemorrhagic, while 18.9% and 26.0% of large and giant aneurysms were hemorrhagic, respectively. Although four aneurysms of the 16 FMCAAs in the observation group increased in size and one aneurysm decreased in size during the observation period, no rupture was seen in any case and there were no significant predictors of aneurysm enlargement. Of 104 FMCAAs treated, 14 cases (13.5%) were aggravated than before surgery and all the aggravated cases were l-type 1. CONCLUSION: While ischemic symptoms occurred more frequently in l-type 1 and c-type 3, hemorrhagic rather than ischemic symptoms occurred more frequently in l-type 3 and c-type 2. In case of l-type 1 FMCAAs, more caution is required in determining the treatment due to the relatively high complication rate.

Endovascular reconstruction for ruptured and unruptured vertebral artery fusiform aneurysms / 中国脑血管病杂志

Objective To investigate the safety and efficacy of endovascular reconstruction for ruptured and unruptured vertebral artery fusiform aneurysms (VAFAs).Methods The clinical,imaging and follow-up data of 26 consecutive patients with VAFA treated with endovascular reconstruction at the Department of Neurosurgery,Beijing Hospital between October 2009 and September 2017 were analyzed retrospectively.Results (1) Twenty-six patients had 26 VAFAs.Their age ranged from 38 to 69 years old.Nine patients had ruptured aneurysms and 17 had unruptured aneurysms.The diameter of the aneurysms ranged from 5 to 12 mm.The success rate of reconstruction technology was 100％.(2)In 9 patients of the rupture group,8 were embolized by stent-assisted coils,1 was treated with stent-assisted coil embolization alone.Five patients were treated with multiple-stent reconstruction and 4 were treated with stent reconstruction alone.Of the 17 patients in the unrupture group,13 were treated with stent-assisted embolization and 4 were treated with stent implantation alone;7 were treated with multiple-stent reconstruction,and 10 were treated with stent reconstruction alone.No perioperative complications occurred.(3) The patients were followed up for 8.0-97.5 months with a median time of 39.5 months.No new cerebral infarction or cerebral hemorrhage occurred.The patients with good prognosis (the modified Rankin scale scale 0-2) was 100％.Twenty-two patients were followed up for 3.5 to 34.0 months with a median time of 10.3 months.Fourteen patients (63.6％) were cured,4 (18.2％) were stable or improved,and 4 (18.2％) had recurrence;Five of 8 patients were cured in the rupture group;9 of 14 were cured in the unrupture group.There were 2 cases of relapse in each of the two groups.Conclusions Endovascular reconstruction for ruptured and unruptured VAFAs is clinically feasible and the safety is higher.The efficacy of mid-term and long-term follow-up is better.The recurrence rate of ruptured VAFAs has an increasing trend,and close follow-up is required after procedure.

Application value of the fusiform tube stomach in the digestive tract reconstruction after thoracoscopic and laparoscopic radical resection of esophageal carcinoma / 中华消化外科杂志

Objective To explore the application value of the fusiform tube stomach in the digestive tract reconstruction after thoracoscopic and laparoscopic radical resection of esophageal carcinoma.Methods The retrospective cohort study was conducted.The clinicopathological data of 96 patients with thoracic esophageal cancer who were admitted to the First Affiliated Hospital of Zhengzhou University between November 2016 and May 2017 were collected.All the patients underwent thoracoscopic and laparoscopic radical resection of esophageal carcinoma,45 using thin tubular stomach and 51 using fusiform tube stomach for digestive tract reconstruction were respectively allocated into the tubular stomach group and fusiform stomach group.Observation indicators:(1) intra-and post-operative situations;(2) postoperative complications;(3) detection of gastric hemodynamics;(4) follow-up situations.Follow-up using outpatient examination and telephone interview was performed to detect patients' survival up to November 2017.Measurement data with normal distribution were represented as-x±s and comparison between groups was analyzed using the t test.Measurement data with skewed distribution were described as M (range) and comparison between groups was analyzed using the rank sum test.Ordinal data and categorical variables were respectively done using the independent-sample Wilcoxon rank-sum test and chi-square test.Paired experimental data were analyzed by the Friedman test and Wilcoxon test.Results (1) Intra-and post-operative situations:96 patients underwent successful thoracoscopic and laparoscopic radical resection of esophageal carcinoma.The number of closers,time of postoperative mediastinal tube removal,thoracic stomach anteroposterior diameter by postoperative CT examination,number of slices at maximal width of thoracic stomach by postoperative CT examination and duration of hospital stay were respectively 4 (range,3-5),14 days (range,11-45 days),28.35 mm (range,9.96-75.70 mm),0.56 (range,0.33-2.13),16 days (range,12-62 days) in the tubular stomach group and 4 (range,2-4),12 days (range,10-16 days),45.80 mm (range,17.36-89.77 mm),1.10 (range,0.47-2.15),14 days (range,12-61 days) in the fusiform stomach group,with statistically significant differences between groups (Z=4.525,4.240,-3.796,-4.604,2.154,P＜0.05).(2) Postoperative complications:cases with postoperative cervical anastomotic fistula,thoracic gastric fistula,grading Ⅰ-Ⅱ and Ⅲ-Ⅳ of Clavien-Dindo classification were respectively 4,5,32,13 in the tubular stomach group (1 with a combination cervical anastomotic fistula and thoracic gastric fistula) and 0,0,47,4 in the fusiform stomach group,with statistically significant differences between groups (x2 =9.937,7.266,P＜0.05).Patients with complications were improved by symptomatic treatment.(3) Detection of gastric hemodynamics:hemodynamic values of gastric antrum,gastric body and gastric fundus that was detected by non-contact laser Doppler line imaging were respectively 314 PU (range,294-320 PU),252 PU (range,242-259 PU),206 PU (range,194-223 PU) in self-control status of 7 patients and 295 PU (range,277-314 PU),255 PU (range,244-267 PU),219 PU (range,199-233 PU) in tubular stomach model and 277 PU (range,263-300 PU),216 PU (range,201-235 PU),199 PU (range,176-207 PU) in fusiform stomach model,with statistically significant differences among groups (x2 =10.286,14.000,10.286,P＜0.05).There were statistically significant differences in the hemodynamic values of gastric antrum,gastric body and gastric fundus between self-control status and fusiform stomach model (Z=-2.028,-2.384,-2.197,P＜0.05),between self-control status and tubular stomach model (Z =-2.371,-2.371,-2.201,P＜0.05) and between fusiform stomach model and tubular stomach model (Z =-2.201,-2.366,-2.366,P＜0.05).(4) Follow-up situations:among 96 patients,90 were followed up for 6-12 months,with a median time of 8 months.During the follow-up,1 patient in the tubular stomach group died of tumor recurrrence,and no patient died in the fusiform stomach group,with no statistically significant difference between groups (x2 =1.264,P ＞ 0.05).Conclusion Compared with the thin tubular stomach,the fusiform tube stomach can reduce the incidences of postoperative fistula and pulmonary complications and shorten duration of hospital stay after the thoracoscopic and laparoscopic radical resection of esophageal carcinoma,and hemodynamics of the fusiform tube stomach is superior to that of thin tubular stomach.

Ideographic Alexia without Involvement of the Fusiform Gyrus in a Korean Stroke Patient: A Serial Functional Magnetic Resonance Imaging Study

BACKGROUND: Korean orthography is composed of Hanja (ideograms) and Hangul (phonograms). Based on previous studies, the fusiform gyrus has been associated with ideogram reading. We examine serial functional magnetic resonance imaging (fMRI) images in a patient exhibiting dissociation of Hanja and Hangul reading to identify brain areas associated with Hanja reading. CASE REPORT: fMRI were taken of a 63-year-old man showing profound Hanja alexia with normal Hangul reading after an acute stroke involving the left frontal and parietal lobes, who later spontaneously recovered his Hanja reading ability. Scans were taken while performing Hanja and Hangul reading tasks on three occasions. As a result, in spite of having profound Hanja alexia, partial activation of the fusiform gyrus was observed on the first fMRI. Serial fMRI scans showed activation of the bilateral middle frontal gyri that increased in parallel with the patient's recovery of Hanja reading. CONCLUSIONS: The frontal lobe, not only fusiform gyrus, may play role in reading Hanja, although more evidence is needed.

Serpentine Cavernous Aneurysm Presented with Visual Symptoms Improved by Endovascular Coil Trapping

This report describes a case of a serpentine fusiform aneurysm of the internal carotid artery in a patient who presented with visual disturbances. The serpentine aneurysm was treated successfully by coil trapping and occlusion of the parent artery, accompanied by balloon dilation. Nine months post-operatively, the patient's visual acuity had improved considerably.

Dual Stent-Assisted Coil Embolization for Fusiform Aneurysm Arising From Persistent Trigeminal Artery / 신경중재치료의학

Aneurysms of the persistent trigeminal artery (PTA) trunk are exceptionally rare and have a high risk for rupture. Dual stent placement through each internal carotid and basilar artery for endovascular coil embolization of a fusiform aneurysm arising from the PTA has not been described in the literature. A 44-year-old female with a history of chronic headache was identified to have a fusiform aneurysm arising from medially coursing adult type, Saltzman type 3 PTA trunk. Sacrifice of the PTA trunk inclusive of the aneurysm was performed with dual stent placement through each basilar and internal carotid artery across their respective junctions with the PTA. Six-month follow-up angiography showed complete occlusion of the PTA and the aneurysm. The patient's symptoms resolved. Our case demonstrated that the sacrifice of an adult type, Saltzman type 3 PTA inclusive of an associated fusiform aneurysm is feasible with dual stent-assisted coil embolization.

Focal Caroli’s Disease Presenting as Fusiform Dilatation of Intrahepatic Biliary Radicles.

Background Caroli's disease is a rare congenital disorder characterized by segmental, non obstructive, cystic dilatation of intra hepatic bile ducts. It belongs to the spectrum of fibropolycystic liver disease which results from in utero malformation of ductal plate. Two forms of this disorder have been described, the less common 'Pure' form involves only the large intrahepatic bile ducts and the more 'complex' form is associated with congenital hepatic fibrosis (CHF), and is known as Caroli's Syndrome. Case A young female presented with features of cholangitis and in addition to all the routine investigations, non invasive imaging in the form of ultrasonography, computed tomography and magnetic resonance imaging was done. Diagnosis Final diagnosis of focal Caroli's disease with cholangitis was made on clinical and imaging findings. Treatment Conservative treatment was given and patient referred to gastro surgery department for partial hepatectomy. Conclusion An early recognition of Caroli's disease with non invasive imaging can bring down the morbidity.

Binocular rivalry estimated objectively under face awareness and fusiform correlation analysis / 军事医学

Objective To study binocular rivalry (BR)objectively and the correlation between fusiform face area (FFA)and visual cortex.Methods Six subjects participated in this study,with one eye presented a normal face expres-sion picture flickered at 8.57 Hz,while the other presented a fearful face flickered at 12 Hz or 15 Hz,respectively.Electro-encephalogram(EEG)was recorded during this process.Steady state visual evoked potential(SSVEP)evoked by two flick-ering rates was analyzed by time-frequency analysis of short time fourier transformation(STFT).The time index of BR was estimated and the correlation coefficient between FFA and visual cortex compared.Results The total average time was (411.6 ±73.8)ms for the left eye and (547.6 ±126.7)ms for the right eye.The switch rate of the two groups was not different,but the left FFA was more sensitive than the right FFA in process of the fearful face.Neither side of FFA had any frequency preference to the flickered fearful face.Conclusion SSVEP can be used as a frequency tag of BR or as a tool to evaluate visual sensation under BR objectively.SSVEP combined with BR can be used in research of neural mechanisms of visual awareness.

Multiple overlapping stents combined with coils for the treatment of intracranial fusiform aneurysms:clinical technique and therapeutic results / 介入放射学杂志

Objective To investigate the safety and feasibility of multiple overlapping stents combined with coils in treating intracranial fusiform aneurysms, and to evaluate its therapeutic efficacy. Methods During the period from Aug. 2012 to Aug. 2013, three patients with intracranial fusiform aneurysm were admitted to authors’ hospital. The diagnosis was confirmed by CT angiography and whole cerebral angiography. Multiple overlapping stents combined with coils was carried out in all the three patients. All the patients were followed up and the clinical results were analyzed. Results Multiple overlapping stents combined with coils was successfully accomplished in all the three patients. Greater part of the aneurysmal cavity was occluded, and immediately after the procedure obvious blood whirling in the aneurysmal sac was seen. A total of 7 stents and 17 coils were used in treating the three patients. No aneurysm rupture or thrombosis occurred. The patients were followed up for 3 - 8 months. In one case the headache disappeared in 8 months, no dysneuria was detected, and angiography showed that the aneurysmal sac disappeared and the parent artery was patent. In another patient the headache disappeared in 3 months, and the angiography showed that the aneurysmal cavity had slight visualization and the parent artery was patent. The remaining patient was asymptomatic at 3-month follow-up. Conclusion For the treatment of intracranial fusiform aneurysms, multiple overlapping stents combined with coils is clinically feasible and safe with excellent short-term efficacy although its long-term results need to be further studied. (J Intervent Radiol, 2014, 23: 277-280).

Treatment for Giant Fusiform Aneurysm Located in the Cavernous Segment of the Internal Carotid Artery Using the Pipeline Embolization Device

The pipeline embolization device (PED) is a new endovascular device for treatment of complex, fusiform and wide-neck intracranial aneurysms. The main mechanism of this stent is to divert the flow in the parent artery with reduction of inflow in the aneurysm leading to thrombosis. We treated a 40-year-old woman who had left facial pain and orbit discomfort. Angiography showed a giant fusiform aneurysm located in the cavernous segment of the left internal carotid artery. A PED was successfully deployed across the aneurysm. The procedure and post-procedural course were uneventful. After 3 months, angiography showed complete obliteration of the aneurysm with good patency of the branching vessels originating from the deployed segment. The patient's symptoms improved completely without complications.

Inducing common carotid fusiform aneurysms in rabbit with the porcine pancreatic elastase extravascular digestion method / 中国脑血管病杂志

Objective To investigate the feasibility and effectiveness of inducing rabbit common carotid fusiform aneurysms via the common carotid extravascular digestion method. Methods Sixteen New Zealand white rabbits were randomly assigned into either an experiment group ( n=12 ) or a control group (n=4). Porcine pancreatic elastase 80-400 U were used to incubate and digest 2 to 4 cm segment of artery distal to the origin of right common carotid artery. One week after modeling,intravenous angiography was performed and the length and width of fusiform dilatation of common carotid artery were measured. The fusiform dilated artery was examined with hematoxylin and eosin staining and the vascular morphological changes were observed with scanning electron microscope. Isotonic saline solution was used to incubate common carotid arteries of the 4 New Zealand white rabbits in the control group. After one week,the same method was used to observe the lumen of common carotid artery and intimal changes. Results After the digestion of common carotid artery adventitia,the angiography of 12 New Zealand white rabbits of the experimental group revealed fusiform dilatation of common carotid artery of the 10 model rabbits. The widest diameter of the fusiform artery was 3. 70 ± 0. 32 mm;two rabbits had common carotid artery occlusion. Compared with the control group,the right common carotid artery diameter enlarged significantly in the experimental group (1. 80 ± 0. 16 mm,P<0. 01). The HE staining showed that the lumen widened, adventitia and media reduced. Scanning electron microscope showed intimal inflammatory injury and thrombus attachment. Conclusion Using porcine pancreatic elastase to digest the adventitia of common carotid artery can make fusiform dilatation of common carotid artery in rabbits. Using this method may effectively induce a model of fusiform aneurysm,and it has certain feasibility.

Treatment of a Ruptured Vertebrobasilar Fusiform Aneurysm Using Pipeline Embolization Device

Treatment options of ruptured vertebrobasilar fusiform aneurysms (VFA) are limited and often carry significant mortality and morbidity. We report the use of Pipeline Embolization Device (PED) to successfully treat a patient with a ruptured vertebrobasilar fusiform aneurysm (VFA) who presented with subarachnoid hemorrhage (SAH). A 73 year-old man with a history of cardiac stent placement seven days earlier presented with Hunt-Hess II SAH. He was taking aspirin and clopidogrel. Computed tomography angiogram revealed a large vertebrobasilar fusiform aneurysm. Microsurgical treatment options are technically challenging and carry high risk. He underwent endovascular treatment of the ruptured VFA using overlapping PEDs. Five PEDs were placed in a telescoping fashion to reconstruct the affected portions of the left vertebral and basilar arteries. An additional 2-mm blister aneurysm in the right vertebral artery was also discovered during the conventional cerebral angiography and was treated with one additional PED. The patient remained neurologically intact after the procedure. He was continued on aspirin and clopidogrel. Follow-up magnetic resonance imaging at three months demonstrated patency of the stents without any evidence of ischemic change. Follow-up conventional cerebral angiogram at six months demonstrated thrombosis of the VFA and reconstruction of the vertebrobasilar system. The patient remained clinically well. An endovascular approach using PEDs can be a safe and effective treatment option for ruptured VFA in selected cases.

Cerebral Achromatopsia After Posterior Cerebral Artery Infarction

Cerebral achromatopsia, which refers to a loss of color vision, is a rare complication of posterior circulation stroke. We report two patients who presented with achromatopsia and dyschromatopsia (incomplete form of achromatopsia) respectively after acute posterior cerebral artery infarction. Lingual and fusiform gyri within the occipito-temporal area are known to be responsible for color perception.

Fusiform Aneurysm on the Basilar Artery Trunk Treated with Intra-Aneurysmal Embolization with Parent Vessel Occlusion after Complete Preoperative Occlusion Test

Fusiform aneurysms on the basilar artery (BA) trunk are rare. The microsurgical management of these aneurysms is difficult because of their deep location, dense collection of vital cranial nerves, and perforating arteries to the brain stem. Endovascular treatment is relatively easier and safer compared with microsurgical treatment. Selective occlusion of the aneurysmal sac with preservation of the parent artery is the endovascular treatment of choice. But, some cases, particularly giant or fusiform aneurysms, are unsuitable for selective sac occlusion. Therefore, endovascular coiling of the aneurysm with parent vessel occlusion is an alternative treatment option. In this situation, it is important to determine whether a patient can tolerate parent vessel occlusion without developing neurological deficits. We report a rare case of fusiform aneurysms in the BA trunk. An 18-year-old female suffered a headache for 2 weeks. Computed tomography and magnetic resonance image revealed a fusiform aneurysm of the lower basilar artery trunk. Digital subtraction angiography revealed a 7.1x11.0 mm-sized fusiform aneurysm located between vertebrovasilar junction and the anterior inferior cerebellar arteries. We had good clinical result using endovascular coiling of unruptured fusiform aneurysm on the lower BA trunk with parent vessel occlusion after confirming the tolerance of the patient by balloon test occlusion with induced hypotension and accompanied by neurophysiologic monitoring, transcranial Doppler and single photon emission computed tomography. In this study, we discuss the importance of preoperative meticulous studies for avoidance of delayed neurological deficit in the patient with fusiform aneurysm on lower basilar trunk.