Table Of ContentCase-Based Interventional Neuroradiology
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Case-Based Interventional Neuroradiology
Timo Krings, MD, PhD, FRCP (C)
Professor, Department of Medical Imaging, University of Toronto
Division of Neuroradiology, Toronto Western Hospital
Toronto, Canada
Professor, Department for Neuroradiology
University Hospital of the Technical University RWTH
Aachen, Germany
Practicien Attaché, Service de Neuroradiologie Diagnostique et Thérapeutique
CHU Le-Kremlin-Bicetre
Paris, France
Sasikhan Geibprasert, MD
Staff Neurointerventionalist, Department of Radiology
Ramathibodi Hospital
Mahidol University
Bangkok, Thailand
Fellow, Department of Diagnostic Imaging
Hospital for Sick Children
University of Toronto
Toronto, Canada
Karel G. ter Brugge, MD, FRCP (C)
The David Braley and Nancy Gordon Chair in Interventional Neuroradiology,
University of Toronto
Professor, Department of Medical Imaging and Surgery, University of Toronto
Head, Division of Neuroradiology, Toronto Western Hospital
Toronto, Canada
Thieme
New York • Stuttgart
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Library of Congress Cataloging-in-Publication Data
Krings, Timo.
Case-based interventional neuroradiology / Timo Krings, Sasikhan Geibprasert, Karel G. ter
Brugge.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-1-60406-373-8 (alk. paper)
1. Nervous system—Interventional radiology—Case studies. I. Geibprasert, Sasikhan. II. Brugge, K. G.
ter (Karel G. ter) III. Title.
[DNLM: 1. Cerebrovascular Disorders—radiotherapy—Case Reports. 2. Central Nervous System—
blood supply—Case Reports. 3. Radiology, Interventional—methods—Case Reports. WL 355]
RD594.15.K75 2011
616.8'04754—dc22
2010029281
Copyright © 2011 by Thieme Medical Publishers, Inc. This book, including all parts thereof, is legally
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ISBN 978-1-60406-373-8
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To our teachers
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CONTENTS
Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi
Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii
Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xv
PART I
Aneurysms and Subarachnoid Hemorrhage
CASE 1 Embolization of a Ruptured Basilar Tip Aneurysm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
CASE 2 Embolization of a Ruptured Anterior Communicating Artery Aneurysm . . . . . . . . . . . . . . . . 8
CASE 3 Multiple Aneurysms in a Patient with Subarachnoid Hemorrhage . . . . . . . . . . . . . . . . . . . . 13
CASE 4 Management of an Unruptured Internal Carotid Artery Aneurysm . . . . . . . . . . . . . . . . . . . 19
CASE 5 Balloon-Assisted Embolization of a Ruptured Wide-Necked Anterior Communicating
Artery Aneurysm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
CASE 6 S tent-Assisted Embolization of a Wide-Necked Recurrent Posterior Communicating
Artery Aneurysm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
CASE 7 M anagement of Complications during Aneurysm Coiling: Proximal Mechanically
Induced Vasospasm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
CASE 8 M anagement of Complications during Aneurysm Coiling: Periprocedural
Aneurysm Rupture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
CASE 9 M anagement of Complications during Aneurysm Coiling: Periprocedural Thrombus
Formation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
CASE 10 Management of Subarachnoid Hemorrhage-Induced Vasospasm . . . . . . . . . . . . . . . . . . . . 55
CASE 11 Management of Giant “Partially Thrombosed” Aneurysms . . . . . . . . . . . . . . . . . . . . . . . . . 62
CASE 12 Embolization of a Dissecting Vertebral Artery Aneurysm . . . . . . . . . . . . . . . . . . . . . . . . . . . 70
CASE 13 Embolization of a Dissecting Distal Anterior Inferior Cerebellar Artery Aneurysm . . . . . . 77
CASE 14 Embolization of an Infectious Distal Middle Cerebral Artery Aneurysm . . . . . . . . . . . . . . . 83
PART II
Brain Arteriovenous Malformations
CASE 15 Arterial Embolization of an Unruptured Pial Arteriovenous Malformation . . . . . . . . . . . . . 89
CASE 16 Partial Targeted Embolization of an Unruptured Pial Arteriovenous Malformation . . . . . . 95
CASE 17 Pre-radiosurgical Embolization of an Unruptured Pial Arteriovenous Malformation . . . . 101
CASE 18 E mbolization of an Acutely Ruptured Arteriovenous Malformation with
Intranidal Aneurysm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
CASE 19 Management of Hydrocephalus in an Unruptured Pial Arteriovenous Malformation . . . 116
CASE 20 Embolization of a Pial Fistulous Arteriovenous Malformation . . . . . . . . . . . . . . . . . . . . . . 121
CASE 21 Partial Embolization of a Choroidal Fistulous Arteriovenous Malformation . . . . . . . . . . . 125
CASE 22 Embolization of a Microshunt into a Developmental Venous Anomaly . . . . . . . . . . . . . . 131
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PART III
Cranial Dural Arteriovenous Shunts
CASE 23 Arterial Embolization of a Lateral Epidural Type of Dural Arteriovenous Fistula . . . . . . . 137
CASE 24 Arterial Embolization of an Ethmoidal Dural Arteriovenous Fistula . . . . . . . . . . . . . . . . . . 143
CASE 25 Transarterial Embolization of a Transverse Sinus Dural Arteriovenous Fistula . . . . . . . . . 148
CASE 26 Transvenous Embolization of a Transverse Sinus Dural Arteriovenous Fistula . . . . . . . . . 154
CASE 27 T ransvenous Embolization through Thrombosed Dural Sinus of an Aggressive
Transverse Sinus Dural Arteriovenous Fistula at the Level of an Isolated Dural Sinus . . . 160
CASE 28 Transvenous Embolization of a Condylar Confl uence Dural Arteriovenous Fistula . . . . . 166
CASE 29 Transvenous Embolization of a Cavernous Sinus Dural Arteriovenous Fistula . . . . . . . . . 172
CASE 30 Multiple Dural Arteriovenous Fistulae . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 178
PART IV
Head and Neck Vascular Lesions
CASE 31 Transarterial Embolization of a Mandibular Arteriovenous Fistula . . . . . . . . . . . . . . . . . . . 183
CASE 32 C ombined Direct Puncture and Transarterial Embolization of a Scalp Arteriovenous
Malformation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187
CASE 33 P ercutaneous Puncture of a Facial Venous Vascular Malformation with
Injection of Bleomycin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 192
CASE 34 Percutaneous Puncture of a Facial Venous Malformation with Injection of Alcohol . . . . 196
CASE 35 Transarterial Particle Embolization of a Facial Hemangioma . . . . . . . . . . . . . . . . . . . . . . . 201
PART V
Tumors
CASE 36 Preoperative Transarterial Particle Embolization of a Meningioma . . . . . . . . . . . . . . . . . . 207
CASE 37 Preoperative Transarterial Particle Embolization of a Juvenile Angiofi broma . . . . . . . . . . 213
CASE 38 Preoperative Embolization of a Carotid Body Tumor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 218
CASE 39 Preoperative Embolization of a Recurrent Temporal Paraganglioma . . . . . . . . . . . . . . . . . 225
CASE 40 Preoperative Transarterial Embolization of a Spinal Hemangioblastoma . . . . . . . . . . . . . 231
CASE 41 Preoperative Embolization of a Hypervascular Vertebral Body Metastasis . . . . . . . . . . . . 237
PART VI
Trauma
CASE 42 Balloon Embolization of a Traumatic Carotid-Cavernous Fistula . . . . . . . . . . . . . . . . . . . . 243
CASE 43 Coil Embolization of a Traumatic Carotid-Cavernous Fistula . . . . . . . . . . . . . . . . . . . . . . . 249
CASE 44 Carotid Artery Blowout . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 254
CASE 45 B alloon Occlusion Test of a Traumatic Internal Carotid Artery Aneurysm Treated by
Internal Carotid Artery Sacrifi ce with Detachable Balloons . . . . . . . . . . . . . . . . . . . . . . . . 259
CASE 46 Transarterial Particle Embolization for Epistaxis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 265
PART VII
Stroke
CASE 47 Intra-arterial rtPA Thrombolysis in Acute Ischemic Stroke . . . . . . . . . . . . . . . . . . . . . . . . . 271
CASE 48 Mechanical Thrombolysis in Acute Stroke with an Aspiration Device . . . . . . . . . . . . . . . . 278
CASE 49 Mechanical Thrombectomy in Acute Stroke with a Retrievable Stent . . . . . . . . . . . . . . . 285
CASE 50 Stent-Assisted Angioplasty of a Symptomatic Extracranial Internal Carotid
Artery Stenosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 291
CASE 51 Stenting of a Symptomatic Post-surgical Internal Carotid Artery Stenosis . . . . . . . . . . . . 297
CASE 52 Intracranial Revascularization with a Self-Expandable Stent . . . . . . . . . . . . . . . . . . . . . . . . 305
CASE 53 Balloon-Mounted Intracranial Stenting of a High-Grade Vertebral Artery Stenosis . . . . . 312
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CASE 54 Subclavian Steal Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 320
CASE 55 Direct Thrombolysis of Cerebral Venous Sinus Thrombosis . . . . . . . . . . . . . . . . . . . . . . . . 325
PART VIII
Pediatric Vascular Interventions
CASE 56 Transarterial Embolization of a Vein of Galen Aneurysmal Malformation . . . . . . . . . . . . . 331
CASE 57 Embolization of a Pial Arteriovenous Fistula in a Patient with Hereditary
Hemorrhagic Telangiectasia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 338
CASE 58 Management of Pediatric Cerebral Aneurysm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 344
CASE 59 Transarterial Embolization of a Dural Sinus Malformation . . . . . . . . . . . . . . . . . . . . . . . . . 349
PART IX
Spine Vascular Interventions
CASE 60 Spinal Dural Arteriovenous Fistulae: Successful Arterial Embolization . . . . . . . . . . . . . . . 357
CASE 61 Spinal Dural Arteriovenous Fistulae: Unsuccessful Arterial Embolization . . . . . . . . . . . . . 364
CASE 62 S pinal Arteriovenous Malformation of the Fistulous Type: Treatment with Liquid
Embolic Material . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 369
CASE 63 Spinal Arteriovenous Malformation of the Fistulous Type: Treatment with Coils . . . . . . 375
CASE 64 S pinal Arteriovenous Malformation of the Glomerular or Nidus Type: Treatment with
Liquid Embolic Material . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 381
CASE 65 Balloon Embolization of a Vertebrovertebral Fistula . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 388
PART X
Spine Percutaneous Interventions
CASE 66 Fluoroscopy-Guided Percutaneous Vertebral Biopsy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 393
CASE 67 Percutaneous Vertebroplasty in Osteoporotic Vertebral Compression Fracture . . . . . . . 398
CASE 68 Balloon-Assisted Kyphoplasty in Osteoporotic Vertebral Compression Fracture . . . . . . . 406
CASE 69 Multilevel Kyphoplasty in Multiple Myeloma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 414
CASE 70 Radiofrequency Kyphoplasty in an Osteoporotic Vertebral Compression Fracture . . . . . 420
CASE 71 Radiofrequency Kyphoplasty in Multiple Myeloma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 426
CASE 72 Intra-articular Facet Joint Block . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 431
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 435
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