合并动眼神经麻痹的颈内动脉后交通动脉段动脉瘤血管内治疗及预后分析

目的探讨合并动眼神经麻痹（oculomotor nerve palsy,ONP）的颈内动脉后交通动脉段动脉瘤的不同血管内治疗方式的恢复情况差异及影响因素。 方法回顾性分析我院2011至2018年收治的35例合并动眼神经麻痹的颈内动脉后交通动脉段动脉瘤并经血管内治疗的病例。随访观察术后动眼神经麻痹的恢复情况,分析不同治疗方式ONP恢复情况的差异性,分析术后数字减影血管造影（digital subtraction angiography,DSA）即刻评价的栓塞与否及程度对ONP恢复的差异性,分析ONP恢复与否与年龄、动眼神经麻痹程度、蛛网膜下腔出血（subarachnoid hemorrhage,SAH）、动脉瘤大小、自发病至接受治疗的时长的关系。 结果35例后交通动脉瘤患者,动眼神经麻痹完全恢复25例（71.4%）,部分恢复6例（17.1%）,未缓解4例（11.4%）;不同的血管内治疗方式,ONP的恢复没有统计学差异（P=1.00）;术后DSA即刻评价的栓塞与否及程度对ONP恢复的存在统计学差异（P<0.01）,单纯支架治疗和致密栓塞后动眼神经功能恢复得更好;年龄、ONP程度、动脉瘤大小、是否SAH、治疗时间均不是ONP恢复的影响因素（P>0.05）。 结论不同治疗方式患者的ONP恢复状态没有差异;术后即刻评价的致密栓塞及单纯支架置入,相较部分栓塞及栓塞后瘤腔显影,动眼神经恢复更好。     

血管内栓塞治疗后交通动脉动脉瘤性动眼神经麻痹临床效果及预后因素分析

目的探讨并分析经血管内栓塞治疗后交通动脉（posterior communicating artery，PComA）动脉瘤性动眼神经麻痹（oculomotor nerve palsy，ONP）的临床效果和预后影响因素。 方法回顾性分析2010年4月至2018年10月期间，在我科接受血管内栓塞治疗的57例PComA动脉瘤性ONP患者的临床资料及随访资料。按其术后恢复程度分为治愈（完全恢复）组和非治愈（部分恢复+未恢复）组，分析比较两组患者的相关资料。 结果57例患者中，42例完全恢复，13例部分恢复，2例未恢复，治愈组与非治愈组在术前麻痹程度（73.8% vs 26.7%，P=0.002）以及是否伴有蛛网膜下腔出血（54.8% vs 20%，P=0.033）差别具有统计学意义。 结论血管内栓塞治疗可促进PComA动脉瘤性ONP患者症状恢复，术前麻痹程度较轻以及伴有蛛网膜下腔出血的ONP患者经血管内栓塞治疗后症状更容易恢复。     

Recovery of oculomotor nerve palsy after endovascular treatment of ruptured posterior communicating artery aneurysm

Purpose

Oculomotor nerve palsy (ONP) may result from Posterior communicating artery (Pcom) aneurysms. Endovascular treatment of ruptured Pcom aneurysms generally is a safe procedure, but the effect of this therapy on ONP is incompletely elucidated. This retrospective study evaluates outcomes of ONP after endovascular treatment for ruptured Pcom aneurysm and with the intention to clarify predictors of recovery.

Methods

From May 2010 to October 2015, 210 patients with Pcom aneurysms underwent endovascular treatment at our institution. Among them, 34 patients with ruptured aneurysms and either complete or incomplete ONP were identified. The outcomes and predictors of ONP recovery were analyzed.

Results

At the last available clinical follow-up, ONP resolution was complete in 21 (61.8%) patients and incomplete in 8 (23.5%) patients. The mean resolution time after embolization was 24.5 days. Five patients showed no signs of ONP recovery. In no case was an initial incomplete ONP observed to worsen. There was a statistically insignificant trend toward complete recovery among patients with initial incomplete ONP (OR = 4.17; 95% CI, 0.75–23.18; P = 0.103).

Conclusion

Endovascular treatment appears to be an effective treatment modality for ruptured Pcom aneurysm and related ONP. The initial incomplete ONP might encourage complete ONP recovery after endovascular treatment.

     

后交通动脉动脉瘤伴动眼神经麻痹的形态学危险因素分析

【摘要】 目的 从形态学角度分析未破裂后交通动脉（PComA）动脉瘤引起动眼神经麻痹（ONP）的危险因素。方法 回顾性分析2010年1月至2018年10月经脑血管造影确诊的71例单发未破裂PComA动脉瘤患者临床资料。根据临床症状,分为ONP组（n=31）和非ONP组（n=40）。根据动脉瘤形态学特征,采用单因素和多因素logistic回归分析,确定PComA动脉瘤引起ONP的形态学危险因素。结果 单因素分析显示,两组患者动脉瘤瘤颈宽度（P=0.046）、瘤顶指向（P=0.005）、有无子囊（P=0.002）差异均有统计学意义;多因素logistic回归分析显示,瘤颈宽度≤3.8 mm（OR=5.437,P=0.008）、瘤顶指向后外下（OR=5.953,P=0.003）、有子囊（OR=5.356,P=0.014）是ONP发生的独立危险因素。 结论 动脉瘤瘤颈宽度≤3.8 mm、瘤顶指向后外下、存在子囊,可能是PComA动脉瘤引起ONP的形态学危险因素。     

MRI of the facial nerve in idiopathic facial palsy

The purpose of this prospective study was to define the enhancement pattern of the facial nerve in idiopathic facial paralysis (Bell's palsy) on magnetic resonance (MR) imaging with routine doses of gadolinium-DTPA (0.1 mmol/kg). Using 0.5T imager, 24 patients were examined with a mean interval time of 13.7 days between the onset of symptoms and the MR examination. Contralateral asymptomatic facial nerves constituted the control group and five of the normal facial nerves (20.8%) showed enhancement confined to the geniculate ganglion. Hence, contrast enhancement limited to the geniculate ganglion in the abnormal facial nerve (3 of 24) was referred to as equivocal. Not encountered in any of the normal facial nerves, enhancement of other segments alone or associated with geniculate ganglion enhancement was considered to be abnormal and noted in 70.8% of the symptomatic facial nerves. The most frequently enhancing segments were the geniculate ganglion and the distal intracanalicular segment. Correspondence to: I. Saatçi     

Incidental aneurysm of the superior cerebellar and non-visualized posterior inferior cerebellar artery: a diagnostic trap

Summary The authors report a case of two aneurysms in the posterior fossa, one of which was first visualized on follow-up arteriography. The mechanism of non-vasualization and re-appearance of the aneurysm is discussed.     

An unusual case of facial nerve palsy following soccer related minor head injury

A 16 year old amateur soccer player sustained a minor head injury while contesting a ball in the air. He was unconscious for two minutes and remained “dizzy” for about an hour. After two days he developed a profound left lower motor neurone facial nerve palsy. He was found to have a complex fracture of the left petrous temporal bone, with fluid in the left middle ear and left mastoid. Treatment was conservative with oral steroids and oral co‐amoxiclav and a left myringotomy to decompress his middle ear. The spectrum of aetiology, presentation, and prognosis for facial nerve injuries is discussed.     

未破裂后交通动脉瘤致动眼神经麻痹血管内治疗疗效分析

目的探讨未破裂后交通动脉瘤（PComA）致动眼神经麻痹（OMNP）血管内治疗疗效。方法对11例伴有OMNP的PComA患者的治疗时机、治疗方式与动眼神经功能恢复的关系进行分析。结果治疗后动眼神经功能全部恢复10例（90.9%）,部分恢复1例（9.1%）,其恢复状况与治疗时机、麻痹程度密切相关。结论血管内栓塞未破裂PComA可有效恢复其致OMNP,但神经功能的恢复取决于麻痹程度和早期手术时机。     

Persistent primitive trigeminal artery associated to aneurysm of the posterior communicating artery: a case report

We report the case of a patient that presented with an intense headache caused by a subarachnoid hemorrhage. Magnetic resonance angiography demonstrated the existence of an aneurysm of the left posterior communicating artery, as well as of a persistent primitive trigeminal artery.     

Unusual MR features in a case of completely thrornbosed giant aneurysm of the posterior cerebral artery

An unusual case of completely thmmbosed giant aneurysm of the left posterior arebrsl artery, ohowing much morc lors of signal on T2-wdghtcd imagca compared with T2*-wdghtcd imagea in the periphuy d the thrombus ie pnmted. pocuible mcchadam of this preferential dgml loss on T2- weighted images is discussed.     

Abducens nerve palsy in a congenital anomalous neurovascular development of the sixth cranial nerve and anterior inferior cerebellar artery: A case report

Abducens nerve palsy is a common ocular motor paralysis with a broad set of etiopathogenetic causes. Magnetic resonance imaging is a key diagnostic technique to investigate organic causes of sixth nerve palsy, as it allows a detailed representation of the course of the nerve, particularly in its intracisternal tract. Anatomical variants of the sixth cranial nerve comprise duplications and fenestrations in various traits. Anatomical variants of cerebellar arteries have also been described. We report the case of a patient with abducens nerve palsy presumably related to a neurovascular conflict due to a peculiar anatomical variant, which consists in a cerebellar artery passing through the intracisternal duplication of the abducens nerve.     

Mediastinal mass and tracheal compression due to an aneurysm of a systemic-to-pulmonary collateral artery in a patient with pseudotruncus arteriosus

A patient with pseudotruncus arteriosus who presented with a large mediastinal mass due to a systemic to pulmonary collateral artery aneurysm is reported. This aneurysm caused tracheal compression with resulting dyspnea and postobstructive pneumonitis, which are unusual presenting features in these patients. The differential diagnosis for a mediastinal mass arising in a patient with pseudotruncus arteriosus, or any other patient with possible systemic-to-pulmonary collateral arteries, should include aneurysm.     

Demonstration of the Adamkiewicz artery in patients with descending or thoracoabdominal aortic aneurysm: optimization of contrast-medium application for 64-detector-row CT angiography

Our aim was to prospectively investigate the contrast agent concentration and the infusion rate to obtain optimal images of the Adamkiewicz artery by 64-row MDCT. Eighty patients were divided into four groups based on the following protocol: A, 100 mL of 300 mg I/mL at 5.0 mL/s; B, 100 mL of 350 mg I/mL at 5.0 mL/s; C, 100 mL of 300 mg I/mL at 3.5 mL/s; D, 100 mL of 350 mg I/mL at 3.5 mL/s. Quantitative evaluation was performed by calculating mean aortic attenuation value from T5 to L3 level. Visual evaluation of the Adamkiewicz artery was also performed. In a quantitative evaluation, the rapid injection (A, 473.4 ± 82.6 HU; B, 506.7 ± 71.9 HU) was significantly superior to the slow injection (C, 371.3 ± 65.1 HU; D, 391.5 ± 60.8 HU). In a visual evaluation, the Adamkiewicz artery was assessable in 15 of 20 (75%), 16 of 20 (80%), 9 of 20 (45%), and 10 of 20 (50%) patients in groups A, B, C, and D, respectively. The injection protocol of 1.75 g iodine/s provides both the adequate aortic attenuation of more than 450 HU to assess the Adamkiewicz artery and the best visualization of the Adamkiewicz artery in 64-row MDCT.     

“Dural tail” adjacent to a giant posterior cerebral artery aneurysm: case report and review of the literature

The “dural tail” sign on gadolinium (Gd-DTPA)-enhanced MRI has been described in association with meningiomas. Various series with histopathological correlation have shown that in some cases there is tumour invasion into the dura mater, but in the majority of cases it represents a hypervascular, non-neoplastic reaction. While this sign was originally thought to be specific for meningioma, subsequent case reports have described the presence of a dural tail in other intra- and extra-axial lesions. We present a patient with a giant aneurysm arising from the P2 segment of the right posterior cerebral artery, adjacent to the tentorium, with a prominent dural tail on Gd-DTPA-enhanced MRI. In this location, differentiation of an aneurysm from a meningioma was critical. Received: 24 September 1996 Accepted: 7 October 1996     

Treatment of massive posterior epistaxis by detachable coil embolization of a cavernous internal carotid artery aneurysm

We present a case of massive posterior epistaxis caused by a cavernous internal carotid artery aneurysm. This lesion was treated with endovascular placement of electrolytically detachable platinum embolization coils. The treatment resulted in cessation of epistaxis until the patient's death 3 months following embolization. We discuss aspects of using these above coils for this condition.     

A multi-center, comparative, phase 3 study to determine the efficacy of gadofosveset-enhanced magnetic resonance angiography for evaluation of renal artery disease

PURPOSE: To determine prospectively the safety and efficacy of the blood-pool contrast agent gadofosveset trisodium in renal artery magnetic resonance angiography (MRA). MATERIALS AND METHODS: Gadofosveset (0.03 mmol/kg) was administered to adult patients with known or suspected renal arterial disease in a multi-center phase 3 single dose study. The drug binds reversibly to albumin, prolonging the blood residence time, and allowing collection of images in the first-pass and steady-state phases. The combination of these images was compared to non-contrast MRA, using catheter X-ray angiography (XRA) as the standard of reference (SOR). All MRA images were collected at 1.5 T in one imaging session for direct comparison, and XRA within 30 days. Sensitivity, specificity, and accuracy for diagnosing significant disease (stenosis > or =50%) were calculated for MRA using three independent blinded readers. Patient safety was monitored for 72-96 h. RESULTS: A total of 145 patients at 18 centers were enrolled and received gadofosveset; the 127 with complete efficacy data entered the primary efficacy analysis. Gadofosveset-enhanced MRA led to significant improvement (p<0.01) in sensitivity (+25%, +26%, +42%), specificity (+23%, +25%, +29%), and accuracy (+23%, +28%, +29%) over non-enhanced MRA for the three readers. The rate of uninterpretable examinations decreased from 30% to less than 2%. There were no serious adverse events, and the most common adverse events were nausea, pruritis, and headache (8% each). No significant trends in clinical chemistry parameters, nor significant changes in serum creatinine, were found following administration of gadofosveset. CONCLUSION: In patients with known or suspected renal arterial disease, multi-phase gadofosveset-enhanced MRA significantly improves sensitivity, specificity, and accuracy versus non-enhanced MRA. Gadofosveset was safe and well tolerated in this patient population.     

Giant aneurysm of the right internal carotid artery in an 8-month-old child presenting with a persistent red eye

SummaryChildhood intracranial aneurysms are a rare entity. Diagnosis of intracranial aneurysms in infancy may be difficult because of their infrequency and confusing clinical presentation. Findings with routine radiographic methods may be misleading and difficult to interpret. This case report entails a giant aneurysm arising from the right internal carotid artery (RICA) in an 8-month-old child.     

MR demonstration of a giant cavernous carotid aneurysm with occlusion of the contralateral intracranial carotid artery: an unusual complication of cavernous sinus thrombosis

We present an unusual combination of vascular complications of cavernous sinus thrombosis in a 7-year-old girl. MRI and MR angiography showed occlusion of the intracranial portion of the left internal carotid artery and a contralateral giant cavernous carotid aneurysm. This combination of vascular findings may influence the management in such cases. Received: 1 April 1997 Accepted: 13 August 1997     

Diagnosis of splanchnic artery aneurysms and pseudoaneurysms, with special reference to contrast enhanced 3D magnetic resonance angiography: a review

Splanchnic artery aneurysms are rare. In the past, conventional angiography was the only way to detect them, but today non-invasive techniques are available. Breath-hold contrast-enhanced 3D magnetic resonance angiography has become a routine examination for evaluation of the aorta and its visceral branches. In this article, we briefly discuss the technical aspects of 3D contrast-enhanced magnetic resonance angiography and illustrate various splanchnic artery aneurysms-pseudoaneurysms with their main characteristics.