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  • Author or Editor: Neal F. Kassell x
  • Journal of Neurosurgery: Pediatrics x
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Endovascular treatment of a fusiform basilar artery aneurysm using multiple “in-stent stents”

Technical note

R. Webster Crowley, Avery J. Evans, Neal F. Kassell, Mary E. Jensen, and Aaron S. Dumont

Fusiform aneurysms of the basilar artery present difficult challenges for the treating physician. On one hand, these aneurysms are difficult and dangerous to treat. On the other, the relatively high rupture rate, risk of thromboemboli, and the frequent presence of mass effect on the brainstem often demand treatment rather than observation. While conservative treatment may be reasonable in an elderly patient, the relative resiliency and the larger lifetime cumulative risks of pediatric patients are compelling arguments for treatment. With the advancement of endovascular techniques some of these lesions have become treatable without the high morbidity and mortality rates associated with open surgical treatment, albeit with risks of their own. The authors present the case of a fusiform aneurysm arising from a severely tortuous basilar artery in a 22-month-old boy. The aneurysm was successfully treated using flow diversion by placing multiple intracranial stents without coil embolization. This allowed for thrombosis of the aneurysm and resolution of the mass effect on the brainstem without compromising blood flow to the brainstem.

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Combined surgical/endovascular treatment of a complex dural arteriovenous fistula in 21-month-old

Technical note

R. Webster Crowley, Avery J. Evans, Mary E. Jensen, Neal F. Kassell, and Aaron S. Dumont

The treatment of intracranial dural arteriovenous fistulas (AVF) has progressed considerably over the past few decades. With the introduction of new embolic materials and refinement of endovascular techniques, lesions that in the past may have required extensive surgery, or were considered untreatable, have increasingly become curable. Despite improvements in technology, not every condition is amenable to an endovascular treatment, including those patients with preexisting vascular abnormalities that preclude an endovascular approach. In these cases, the patient may be left with suboptimal treatment options with higher associated risks. The authors here report on the treatment of a dural AVF in a pediatric patient in whom prior procedures rendered his cerebrovascular anatomy unnavigable using traditional endovascular techniques. To circumvent these vascular abnormalities the patient underwent combined surgical/endovascular treatment that included surgical exposure and cannulation of the cervical carotid artery, as well as simultaneous femoral artery access, with subsequent successful transarterial embolization of the dural AVF.