A Case of a Perianeurysmal Cyst Following Stent-Assisted Coil Embolization of an Unruptured Vertebral Artery Aneurysm.

Objective: To report the rare case of a patient with a perianeurysmal cyst following stent-assisted coil embolization of an unruptured vertebral artery aneurysm. Case Presentation: A 63-year-old woman underwent stent-assisted coil embolization for an unruptured vertebral artery aneurysm embedded in the brainstem (pons). Complete occlusion of the aneurysm was successfully achieved. However, subsequent magnetic resonance imaging (MRI) conducted 8 months after the procedure showed perilesional edematous changes surrounding the aneurysm, and at 20 months, cyst formation was observed in the vicinity of the aneurysm. Progressive enlargement of the cyst eventually led to the development of paralysis and dysphagia, necessitating cyst fenestration surgery. Although postoperative reduction in the cyst size was achieved, the patient experienced complications in the form of aspiration pneumonia and bacterial meningitis, which resulted in a life-threatening condition. Conclusion: Aneurysms embedded in the brain parenchyma should be carefully followed up, recognizing the risk of perianeurysmal cyst formation after coil embolization.

Cervical radiculopathy secondary to vertebral artery dissection: clinical features and outcomes.

PURPOSE: Cervical radiculopathy due to various mechanical causes is commonly seen, however, cervical vertebral artery dissection (cVAD)-related radiculopathy is very rare with poorly characterized clinical outcomes. Thus, we conducted a systematic review of published literature and reported an institutional case to provide a better illustration of this rare entity. METHODS: We systematically reviewed the PubMed literature and queried the clinical database at our center for cVAD-related radiculopathy. We described the baseline characteristics of patients with cVAD-related radiculopathy, the involved segment, diagnostic approach and treatment options. RESULT: 14 previously published studies met the inclusion criteria and along with the case we identified in our center, our study included 17 patients total (median age: 35 years, 9 females). C5 was the most commonly affected root and ipsilateral shoulder/arm pain along with shoulder abduction weakness was most common presentation. Antiplatelet or anticoagulant therapy was the treatment of choice. Most cases managed conservatively (82%). Majority of the cases (92%) had either complete or partial resolution of their symptoms. CONCLUSION: Despite its limitations, this study show that cVAD related radiculopathy is a relatively benign entity with excellent clinical outcomes when managed medically.

Treatment of Extracranial Vertebral Artery Aneurysm with Flow Diversion.

BACKGROUND: Aneurysms of the extracranial vertebral artery are rare, and the treatment options are not standardized. We present a case of an extracranial vertebral artery aneurysm treated with flow diversion. CASE DESCRIPTION: In a 72-year-old woman, computed tomography angiography demonstrated a right extracranial vertebral artery aneurysm. The saccular aneurysm (7.9 × 6.6 mm) was demonstrated on digital subtraction angiography at the V3 segment of the right vertebral artery. A Pipeline embolization device was placed in the diseased parent artery. The patency of the Pipeline embolization device was confirmed at 12-month follow-up. CONCLUSIONS: Flow diversion is a simple and promising treatment option for a V3 segment aneurysm. Postoperative asymptomatic partial in-stent stenosis is tolerable.

Subarachnoid Hemorrhage from Vertebral Arteriovenous Fistula without Perimedullary Drainage: Rare Stroke Hemorrhagic Event in a Patient of Neurofibromatosis Type 1.

Vertebral arteriovenous fistula (VAVF), which can cause subarachnoid hemorrhage (SAH) when having a perimedurally drainage, has been reported as a rare vascular abnormality in patients with neurofibromatosis type 1 (NF-1). In addition, extracranial vertebral aneurysm (EVAn) coexisting with VAVF and NF-1 is considered rare, and further complication with SAH is extremely rare in patients. There is only one reported case of NF-1 complicated with SAH from VAVF with an EVAn. Here, we present a case of a middle-aged patient with NF-1. The VAVF accompanied by an EVAn was detected with an episode of SAH. The VAVF with an EVAn in our case was accompanied with an epidural varix, lacking of perimedullary drainage, which could be a cause for SAH. We speculate the mechanism of SAH from the VAVF with an EVAn lacking of perimedurally drainage, focusing on hemodynamic stress of the VAVF and the tissue fragility related to NF-1.

Clinical Analysis and Surgical Treatment of Vertebral Aneurysm

Aneurysms of the vertebral artery are relatively uncommon. Diagnois and treatment of such condition aneurysm has a potentially higher degree of technical difficulty. We retrospectively analyzed the clinical features and therapentic outcomes of 12 consecutive patients with vertebral aneurysms that we have encountered during the last 11 years. Most of these aneurysms occured in females (9 of 12). Eight patients presented as classic subarachnoid hemorrhage, three were diagnosed incidentally, and the other one patient had fusiform aneurysm presented with mass effect. Among the 12, there were 7 saccular aneurysms, 2 fusiform aneurysms, and 3 dissecting aneurysms. Eight of these were located at the origin of the posterior inferior cerebellar artery(PICA), two were at the junction of the vertebral and basilar arteries, and two were at the distal portion of PICA. Direct neck clipping was performed in 8 patients and proximal ligation of the vertebral artery was done in 4 patients due to the impossibility of direct neck clipping. Eleven of them experienced no major morbidity. However, one patient with fusiform aneurysm treated by vertebral artery clipping developed right cerebellar hemispheric infarction. Unfortunately this patient died 10 months after surgery due to lung abscess related to Behcet's disease.