RESUMEN
Background: Dural arteriovenous fistulas (AVFs) are reportedly induced by trauma. We report a rare case of traumatic AVF with a direct shunt from the middle meningeal artery (MMA) to the middle meningeal vein (MMV) and multiple drainage routes after head trauma. The patient was effectively treated with selective coil embolization alone without liquid embolic material. Case Description: A 56-year-old woman was admitted to the emergency department with mild disturbance of consciousness caused by a head contusion after alcohol consumption. She exhibited impaired consciousness with a Glasgow coma scale score of 14 (E4V4M6), complained of headache, and presented with a hemorrhage in the left ear. Computed tomography suggested a skull fracture and cerebral hemorrhage. Magnetic resonance imaging conducted on the 4th day after the injury indicated shunt disease with a feeder in the right MMA. Cerebral angiography on the 7th day suggested a direct shunt from the right MMA to the MMV aligned with the temporal bone fracture line, with multiple drainage route perfusion. Coil embolization was performed on the 14th day to occlude the shunt point selectively. In the final image, the MMA was absent, and the MMV, superior sagittal sinus, or pterygoid plexus was not visible through the shunt. Her symptoms improved, and she was discharged on the 20th day and did not exhibit recurrence at the 1-year follow-up. Conclusion: AVF with a direct shunt from the MMA to MMV after head trauma can be effectively and safely treated with coil embolization alone, despite the need for long-term postoperative follow-up.
RESUMEN
Background: Delayed rupture after flow diverter (FD) placement is a serious complication, and often it leads to death; however, the exact mechanism leading to the rupture remains unclear. Therefore, in this case, study, we report a case of delayed rupture after FD placement and discuss its causes. Case Description: This study presents the case of a 69-year-old female with multiple aneurysms who underwent FD placement with coil embolization for a large intracranial internal carotid artery aneurysm. Postoperatively, the patient had no significant symptoms, and angiography and magnetic resonance imaging revealed decreased intra-aneurysmal blood flow. However, on the 3rd postoperative day, she developed a sudden disturbance of consciousness. Computed tomography revealed a massive subarachnoid hemorrhage, diagnosed as a delayed rupture. We decided to withhold therapy due to her serious condition. Previous studies have suggested that hemodynamic mechanisms can cause delayed aneurysm rupture. Based on the computational fluid dynamics (CFD) of the aneurysm, we suggest that an increase in intra-aneurysmal pressure after FD placement may have caused the delayed rupture. Conclusion: Preoperative CFD analysis may help evaluate the risk of delayed rupture for large aneurysms with a high inflow from the parent vessel.
RESUMEN
Objective: We report the use of a Goose Neck microsnare for cervical internal carotid artery (ICA) occlusion in a patient with dolichoarteriopathy in whom it was difficult to achieve recanalization. Case Presentation: A 65-year-old woman underwent thrombectomy for a tandem lesion of left M1 occlusion and left cervical ICA occlusion. Recanalization of left M1 occlusion was achieved. For left cervical ICA occlusion, we attempted multiple thrombectomy using an existing device, but a hard clot with mobility was caught due to dolichoarteriopathy, which made thrombectomy difficult. Using a Goose Neck microsnare, we were able to capture the thrombus and achieve recanalization. Conclusion: Thrombectomy by capturing the thrombus using a Goose Neck microsnare may be useful for capturing hard clots with mobility when it is difficult to achieve recanalization with existing devices.