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Carotid-Cavernous Fistula

Report of 32 Surgically Treated Cases and Suggestions for Definitive Operation

W. B. Hamby

Primary Ligation Subsequent Ligations Cure Improvement Failure Death Totals II III IC 24–33(2) 26–28(2) 4–5–15–27(7) 30–35–36 11 (Time) 4 (1) 1 CC-EC 30(1) 1 35 (1) 5 (1) 36 (1) 3 CC 36 (1) 1 27 (1) 1 IC-EC 16 (1) 1 IC-CC 1 (1) 1 1 (1) 1 Contralat. CC-IC-EC 1 (1) 1  Total (13 patients) 8 3 10 1 22 Symbols as in Table 1

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Joachim K. Krauss and Fritz Mundinger

of 1 Andy, 1962 4 pall med, IC, SR EC 4 of 4 1 of 1 2 of 4 Yasargil, 1962 ‡ 3 pall med, or VL, IC EC 3 of 3 NA NA Spiegel, et al. , 1963 1 SN EC 1 of 1 NA NA Gioino, et al. , 1966 5 pall med, or VL, SR chem 5 of 5 3 of 3 3 of 5 Cooper, 1969 † ‡ 9 (4 + 5) pall med, or VL, SR chem NA ‡ NA ‡ NA ‡ Mundinger, et al. , 1970 ‡ 11 pall med, or VL, ZI EC NA 7 of 11 NA Tsubokawa & Moriyasu, 1975 2 pall lat EC 2 of 2 2 of 2 NA Kandel, 1982

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Alexander P. Marston, Jeffrey T. Jacob, Matthew L. Carlson, Bruce E. Pollock, Colin L. W. Driscoll and Michael J. Link

.76–5.27; 2.34–5.80) Treated as EC 59   Decrease & stable 50 2.08 (1.59–3.17; 1.10–10.64) 0.009   Increase 9 3.26 (2.76–5.27; 2.34–5.80) IC 9   Decrease 2 1.13, 3.15 * NE   Stable 7 1.85 (1.59–3.93; 1.21–5.04) ICEC † 15   Decrease 6 2.03 (1.69–4.02; 1.59–5.29) NE   Stable 7 2.75 (1.74–6.34; 1.30–10.64)   Increase 2 2.34, 5.27 * NE = not evaluated; Pts = patients. * The growth values (in mm/yr) are shown for the 2 patients in the group. No other statistical analysis was performed in these groups due to the small sample size. † Arrow signifies conversion from IC to EC. No

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Fengping Zhu, Yi Qian, Bin Xu, Yuxiang Gu, Kaavya Karunanithi, Wei Zhu, Liang Chen, Ying Mao and Michael K. Morgan

angiograms. MMD is thus regarded as a unique and dynamic cerebrovascular disease involving vascular flow from the IC to the external carotid (EC) system (which can develop transdural arterial recruitment), with the degree of involvement varying with the stages of MMD. 6 Insufficiency of this IC-EC conversion system may result in cerebral ischemia, as well as intracranial hemorrhage from aneurysm development in the collateral vascular networks, both of which contribute to the clinical presentation of MMD. Surgical revascularization by extracranial-intracranial bypass is

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Meng Zhao, Xiaofeng Deng, Dong Zhang, Shuo Wang, Yan Zhang, Rong Wang and Jizong Zhao

complications were significantly associated with worse outcomes at discharge, although this effect seem to be diminished in follow-up. The cerebral vascular supply of MMD is characterized by a dynamic transitional state of conversion of the internal carotid system to the external carotid system (IC-EC conversion). 11 , 40 Revascularization is employed for treatment of MMD to complement the “IC-EC conversion” and thus prevent secondary events. Surgical complications of MMD include both neurological (postoperative cerebral infarction and CHS) and nonneurological complications

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Miki Fujimura, Takeshi Funaki, Kiyohiro Houkin, Jun C. Takahashi, Satoshi Kuroda, Yasutake Tomata, Teiji Tominaga and Susumu Miyamoto

surgery in adult moyamoya disease . Stroke 45 : 3025 – 3031 , 2014 10.1161/STROKEAHA.114.005624 25184359 3 Fujimura M , Tominaga T : Current status of revascularization surgery for moyamoya disease: special consideration for its ‘internal carotid-external carotid (IC-EC) conversion’ as the physiological reorganization system . Tohoku J Exp Med 236 : 45 – 53 , 2015 10.1620/tjem.236.45 25971859 4 Fujimura M , Tominaga T : Lessons learned from moyamoya disease: outcome of direct/indirect revascularization surgery for 150 affected hemispheres . Neurol

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Wataru Yanagihara, Kohei Chida, Masakazu Kobayashi, Yoshitaka Kubo, Kenji Yoshida, Kazunori Terasaki and Kuniaki Ogasawara

‘internal carotid-external carotid (IC-EC) conversion’ as the physiological reorganization system . Tohoku J Exp Med 236 : 45 – 53 , 2015 10.1620/tjem.236.45 25971859 9 Fushimi Y , Okada T , Takagi Y , Funaki T , Takahashi JC , Miyamoto S , : Voxel based analysis of surgical revascularization for moyamoya disease: pre- and postoperative SPECT studies . PLoS One 11 : e0148925 , 2016 10.1371/journal.pone.0148925 26867219 10 Grubb RL Jr , Derdeyn CP , Fritsch SM , Carpenter DA , Yundt KD , Videen TO , : Importance of

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Wataru Yanagihara, Kohei Chida, Masakazu Kobayashi, Yoshitaka Kubo, Kenji Yoshida, Kazunori Terasaki and Kuniaki Ogasawara

hemorrhage after superficial temporal artery-middle cerebral artery anastomosis in a patient with moyamoya disease: possible involvement of cerebral hyperperfusion and increased vascular permeability . Surg Neurol 71 : 223 – 227 , 2009 8 Fujimura M , Tominaga T : Current status of revascularization surgery for moyamoya disease: special consideration for its ‘internal carotid-external carotid (IC-EC) conversion’ as the physiological reorganization system . Tohoku J Exp Med 236 : 45 – 53 , 2015 9 Fushimi Y , Okada T , Takagi Y , Funaki T , Takahashi

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Melissa A. LoPresti, Visish M. Srinivasan, Robert Y. North, Vijay M. Ravindra, Jeremiah Johnson, Jan-Karl Burkhardt, Sandi K. Lam and Peter Kan

Direct bypass has been used to salvage failed endovascular treatment; however, little is known of the reversed role of endovascular management for failed bypass.

The authors report the case of a 7-year-old patient who underwent a superficial temporal artery to middle cerebral artery (STA-MCA) bypass for treatment of a giant MCA aneurysm and describe the role of endovascular rescue in this case. Post-bypass catheter angiogram showed occlusion of the proximal extracranial STA donor with patent anastomosis, possibly due to STA dissection. A self-expanding Neuroform Atlas stent was deployed across the dissection flap, and follow-up images showed revascularization of the STA with good MCA runoff.

This case demonstrates that direct extracranial-intracranial bypass failure can infrequently originate from the STA donor vessel and that superselective angiogram can be useful for identification and treatment in such cases. With more advanced endovascular techniques the tide has turned in the treatment of complex cerebrovascular cases, with this case being an early example of successful rescue stenting for endovascular management of a failed donor after STA-MCA bypass.

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Melissa A. LoPresti, Visish M. Srinivasan, Robert Y. North, Vijay M. Ravindra, Jeremiah Johnson, Jan-Karl Burkhardt, Sandi K. Lam and Peter Kan

Direct bypass has been used to salvage failed endovascular treatment; however, little is known of the reversed role of endovascular management for failed bypass.

The authors report the case of a 7-year-old patient who underwent a superficial temporal artery to middle cerebral artery (STA-MCA) bypass for treatment of a giant MCA aneurysm and describe the role of endovascular rescue in this case. Post-bypass catheter angiogram showed occlusion of the proximal extracranial STA donor with patent anastomosis, possibly due to STA dissection. A self-expanding Neuroform Atlas stent was deployed across the dissection flap, and follow-up images showed revascularization of the STA with good MCA runoff.

This case demonstrates that direct extracranial-intracranial bypass failure can infrequently originate from the STA donor vessel and that superselective angiogram can be useful for identification and treatment in such cases. With more advanced endovascular techniques the tide has turned in the treatment of complex cerebrovascular cases, with this case being an early example of successful rescue stenting for endovascular management of a failed donor after STA-MCA bypass.