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Dittapong Songsaeng, Sasikhan Geibprasert, Karel G. ter Brugge, Robert Willinsky, Michael Tymianski and Timo Krings

Object

The goal was to investigate whether morphological features of aneurysms can be identified that determine initial success and recurrence rates of coiled aneurysms of the basilar artery tip, the posterior communicating artery (PCoA), and the anterior communicating artery.

Methods

The authors evaluated 202 aneurysms in connection with their pretreatment morphological features including size, neck-to-dome ratio, angulation of the aneurysm in relation to the parent artery, orientation of the aneurysm dome, and associated anatomical variations. The mean follow-up was 19 months (range 6–96 months) after endovascular coil occlusion. Using multivariate logistic regression, probabilities for initial complete occlusion and long-term stability of the treatment were calculated.

Results

Recanalization occurred in 49 of 202 cases. Favorable factors for long-term stability included small aneurysms with small necks. However, additional factors related to local hemodynamic forces could be identified for the different aneurysm locations, which may influence initial success rates and long-term stability of aneurysm treatment with endovascular coiling. These factors were a medial dome orientation and a symmetrical disposition of both A1 segments (for the anterior communicating artery), a posteroinferior dome orientation and a small-size PCoA (for the PCoA), and a cranial symmetrical fusion (for the basilar artery tip).

Conclusions

A detailed pretreatment analysis of morphological features of aneurysms may help to determine those aneurysms that are more prone to recurrence, which could add to the treatment decision and the follow-up algorithm.

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Kittipong Srivatanakul, Dittapong Songsaeng, Augustin Ozanne, Frédérique Toulgoat and Pierre Lasjaunias

The authors describe 4 cases of syringomyelia-associated spinal cord arteriovenous malformation (AVM). All cases were managed with embolization of the AVM. Treatments were aimed to stabilize the AVM itself and not directed toward the syrinx. In 3 of the 4 cases the syringomyelia resolved after treatment. Reports concerning AVM as a cause of syringomyelia is very scarce and lacks posttreatment clinical information. In light of the clinical course and imaging findings, the authors propose a theory that venous hypertension in the spinal cord is the trigger for the development of syringomyelia, which may reverse after AVM treatment.

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Dittapong Songsaeng, Kittipong Srivatanakul, Timo Krings, Sasikhan Geibprasert, Augustin Ozanne and Pierre Lasjaunias

Object

The purpose of this study is to analyze the clinical presentation, morphological characteristics, angio-architecture, and outcome of vertebrobasilar dissection (VBD) in the pediatric population.

Methods

The authors retrospectively reviewed 29 consecutive cases involving children younger than 16 years of age who were diagnosed with symptomatic VBDs. Data were gathered with respect to the patient's age, sex, clinical history, associated underlying disease, and symptoms (headache, vertigo) as well as the location of the dissection and the imaging appearance.

Results

The patients' mean age was 8.24 years (range 2 months–15 years). There was an overall 3:1 male predominance, although among children older than 8 years, girls and boys were similarly affected. Hemorrhagic dissections occurred in 10 of 29 cases. In nonhemorrhagic dissections, stroke occurred in 16 cases, with the most common presenting symptoms being headaches and vertigo; in the other 3 cases, mass effect due to a chronic dissecting aneurysm was present. In 7 children an underlying vessel wall disease was found. The location of the dissection was extradural in 11 cases and intradural in the remainder. There was no preference with respect to side. The basilar artery was affected in 9 patients.

Conclusions

The imaging appearance and clinical presentation of symptomatic VBDs in the pediatric population differs from that in adults. Boys are more often affected, especially at younger ages, and hemorrhagic presentation is more common, presumably owing to the fact that the basilar artery is more commonly involved. Depending on the pathogenetic mechanism underlying the dissection, different clinical symptoms will evolve, necessitating individually tailored treatment.