Endovascular treatment of a ruptured aneurysm at a very rare location. Distal azygos anterior cerebral artery.

SUMMARY: We describe a patient with a small ruptured azygos anterior cerebral artery aneurysm located at a non-bifurcation distal site on the artery treated successfully with simple coiling.

Fusiform aneurysms detected 5 years after removal of an atrial myxoma.

Neurological signs frequently accompany atrial myxomas. Association of multiple cerebral aneurysms in patients with atrial myxomas are less common than embolic infarctions. The development of aneurysms years after the cardiac tumor removal is rare, and few MR images have been reported to date. A case of multiple peripheral fusiform aneurysms detected 5 years after tumor resection is presented in this report, together with MR images and CT and angiographic images.

Intraparenchymal meningioma originating from underlying meningioangiomatosis. Case report and review of the literature.

The authors present the case of a 20-year-old woman with right-sided temporal intraparenchymal meningioma originating from underlying meningioangiomatosis. The patient manifested temporal-type seizures as the initial symptom. She had no stigmata of neurofibromatosis Type 2. Neuroradiological studies revealed an intraaxial, contrast-enhancing lesion in the right temporal lobe. After gross-total removal of the tumor, histological examination revealed a transitional meningioma with surrounding neural parenchyma and features of meningioangiomatosis. Although there were no signs of anaplasia, necrosis, or increased mitosis, tumor islands were observed in the adjacent neuropil. The rare association of meningioangiomatosis and meningioma is discussed, along with radiological and surgical findings.

Endovascular coil embolization of residual or recurrent aneurysms after surgical clipping.

PURPOSE: Treatment of residual or recurrent aneurysms after surgical clipping is a challenge and most surgeons prefer to avoid a second surgical attempt. We present treatment of 4 residual or recurrent aneurysms after surgical clipping with electrolytically detachable coils. MATERIAL AND METHODS: In 3 of 4 patients, recurrent aneurysms were diagnosed with angiography 2 months, 5 years and 14 years after surgery, although the domes of the aneurysms were opened following clipping during the surgery. In the 4th patient, an early postoperative angiogram revealed filling of a residual aneurysm secondary to the incomplete neck clipping. Guglielmi detachable coils were used to occlude the residual or recurrent aneurysm. RESULTS: The endovascular approach was successful in all patients and the control angiograms showed complete obliteration of the aneurysms with no recanalization. CONCLUSION: The endovascular approach is a good treatment option for patients in whom complete obliteration of the aneurysm cannot be achieved by surgical clipping. Opening of the aneurysm sac after clipping does not necessarily preclude aneurysm regrowth from a neck remnant proximal to the clip.

Guglielmi detachable coil treatment of a partially thrombosed giant basilar artery aneurysm in a child.

We report a partially thrombosed giant of the aneurysm basilar artery with prominent mass effect, diagnosed in an 11 year-old child who presented with neurological deficits due to brain stem compression. After the patent portion of the aneurysm was embolised with Guglielmi detachable coils, remarkable clinical improvement occurred. Angiography demonstrated complete occlusion of the aneurysm and MRI revealed dramatic shrinkage of the aneurysm at 6-month and 1-year follow-up.

Bilateral cavernous carotid artery aneurysms in a 4-year-old child: endovascular treatment with mechanically detachable coils.

We present a 4-year-old child who suffered bilateral third nerve palsies secondary to bilateral giant saccular cavernous carotid artery aneurysms. Endovascular treatment was performed by means of direct endosaccular aneurysm occlusion on the right side and parent vessel occlusion on the left, using mechanically detachable coils. No complication occurred during or after the procedure. The bilateral third nerve palsies resolved over 3 months. Follow-up angiography at 1 year is presented.

Interlocking detachable coil occlusion in the endovascular treatment of intracranial aneurysms: preliminary results.

PURPOSE: To present our preliminary experience with the recently developed interlocking detachable coils in the treatment of intracranial aneurysms. METHODS: Two aneurysms of the basilar tip, two of the internal carotid artery, and one of the posterior inferior cerebellar artery were treated by an endovascular technique using interlocking detachable coils. Three of the patients had undergone unsuccessful surgical clipping. Three-month and 1-year control angiograms were obtained. RESULTS: In all patients but one, who had an aneurysm of the internal carotid artery, the aneurysmal sac was occluded with preservation of the parent artery and did not show recanalization on the follow-up control angiograms. In the other patient who had a wide-necked aneurysm of the internal carotid artery, the sac could not be totally obliterated and showed contrast filling in the neck remnant at 3-month angiography. None of the patients experienced neurologic deficit after treatment. CONCLUSION: Because they are soft and retrievable, interlocking detachable coils, with their immediate coil release design, may provide an alternative to surgery in the future treatment of endovascular aneurysms.

Placement of mechanically detachable spiral coils in the endovascular treatment of intracranial aneurysms. Work in progress.

PURPOSE: To determine the usefulness of mechanically detachable spiral tungsten coils (MDSs) in the endovascular, endosaccular occlusion of intracranial aneurysms. MATERIALS AND METHODS: Anterior communicating artery aneurysms shown at angiography in two patients and a basilar tip aneurysm shown in one patient were treated with MDSs. RESULTS: In the basilar artery aneurysm, eight coils were delivered. Two additional coils were placed at 3 months because of filling of the residual aneurysm neck. Angiography at 1 year showed no recanalization. The smaller aneurysm in the anterior communicating artery was totally occluded by a single coil. Angiography at 6 months showed no recanalization. The other aneurysm was occluded by two coils, with a small amount of residual filling. A third coil was withdrawn before detachment. The patient had aspiration pneumonia and electrolyte imbalance, but he was in stable condition 3 weeks later and was discharged. CONCLUSION: The pliable, soft, retrievable MDS system provides instantaneous release of a spiral coil.

Retrieval of an embolization coil from the internal carotid artery using the Amplatz microsnare retrieval system.

An unusual case of unintentional release of an embolization coil into the proximal internal carotid artery is reported. The coil migrated and lodged distally in the petrous portion of the internal carotid artery during initial removal attempts using a regular nitinol loop snare. The coil was retrieved with the Amplatz Nitinol Microsnare system.

[Echography of the parotid gland]. / L'échographie de la parotide.

Ultrasound is the first choice imaging modality for the evaluation of parotid lesions because of its simplicity and its sensitivity which is as high as that of a CT scan. It can differentiate between benign and malignant tumors. However MRI is necessary for the exploration of the deep lobe, regional spread and a better histopathologic differentiation.

[Lipoma of the parotid gland. Apropos of a case]. / Lipome de la parotide. A propos d'un cas.

Lipoma of the parotid gland is a rather rare tumor (2-3% of all tumors of the gland). Comparative imaging of a case of parotid lipoma by computed tomography, sonography and magnetic resonance is presented.

[Parotid metastases: value of imaging. Review of the literature, apropos of 4 cases]. / Métastases parotidiennes: intérêt de l'imagerie. Revue de la littérature, a propos de 4 cas.

Parotid gland is a very unusual site of metastasis. Four proven cases are described. The tumor was occult in three cases out of four. In one case, an extra neck primitive tumor was suspected. Two kinds of metastases are described: firstly, metastases within the salivary gland with look like pleomorphic adenoma and are secondary to hematogenous spread; secondly, lymph node metastasis (two cases). Their diagnosis appear easier as they are not usually completely surrounded by parenchyma. They can reveal either occult head and neck tumor or visceral tumor.

Mandibular nerve: MR versus CT about 10 proved unusual tumors.

10 patients with symptoms of mandibular neuralgia formed the basis of this study. They were studied by both enhanced CT and MRI. MRI, better than CT, easily permits distinction between intrinsic and extrinsic lesions and detects involvement of the cavernous sinus and meninges. Moreover, because of its multiplanar imaging capability, and ability to portray exquisite anatomic details and characteristic tissue signal intensity, MRI is helpful in the evaluation of tumor involvement for biopsy and preoperative planning for these deep tumours.