Unusual persistent primitive trigeminal artery with a superior duplicated basilar system.

A 67-year-old patient who presented with a right cerebellar hemorrhage underwent vascular workup for suspicion of underlying vascular anomalies. A diagnostic cerebral angiogram demonstrated a duplicated basilar system fed solely by a persistent primitive trigeminal artery. The findings proved to be incidental and unrelated to the patient's hemorrhage. These developmental abnormalities are consistent with embryological development.

Transverse Sinus Dural Arteriovenous Fistula Presenting with Acute Hydrocephalus from Cerebellar Venous Engorgement Resolving with Endovascular Treatment.

A 77-year-old woman presented with a several week history of progressively worsening nausea and vomiting and a sudden change in mental status. She was found to have hydrocephalus with transependymal flow. Angiography revealed a Cognard class IIb/Borden class II transverse sinus dural arteriovenous fistula. Cerebellar venous engorgement causing posterior fossa mass effect was thought to be the cause of her hydrocephalus. Treatment involved transarterial embolization resulting in angiographic cure. Following treatment she had resolution of nausea and vomiting, and her ventriculostomy was discontinued without need for shunting. Six-month follow-up magnetic resonance imaging indicated no sign of hydrocephalus and significantly improved posterior fossa congestion.

Endovascular approach and technique for treatment of transverse-sigmoid dural arteriovenous fistula with cortical reflux: the importance of venous sinus sacrifice.

BACKGROUND: Treatment of dural arteriovenous fistula involving the transverse-sigmoid region with cortical reflux is complex and treatment options may require sacrifice of the fistulous segment of the sinus. OBJECTIVE: To review our results in this subset of patients and describe current endovascular decision-making and approaches. METHODS: We reviewed cases of endovascular sinus sacrifice for dural fistulas at our institution from 2007 to 2012. Demographic, decision-making, technical and outcome data were collected. RESULTS: Seven patients were identified who underwent endovascular sinus sacrifice for treatment of dural fistula during this 4-year period. Determination of the fistulous sinus segment was based on the pattern of cortical drainage. Endovascular access to the sinus was achieved by transarterial, transvenous or via open surgery in one case. Complete cure of the target fistula was obtained in all cases. One patient had transient post-procedure headache. There were no hemorrhages, new neurological deficits or signs of increased intracranial pressure. Six of the seven patients had angiographic follow-up at least 6 months after treatment with no recurrence. CONCLUSIONS: Fistulas of the transverse-sigmoid sinuses with cortical reflux may require sacrifice of the parent sinus for cure. Defining the fistulous segment and occluding this segment deliberately, completely and precisely is essential for cure. Several modalities and approaches can be used to achieve this. For properly selected patients, cure of the lesions can be achieved with this method with low risk of morbidity.