Background and Purpose-The role of type of treatment on cerebral vasospasm occurrence after aneurysmal subarachnoid hemorrhage (SAH) has not been studied. Through multivariate analysis we determined the independent prognostic factors of the occurrence of symptomatic vasospasm following aneurysmal SAH in a study cohort of 244 patients undergoing either surgical or endovascular treatment. The prognostic factors of sequelae after aneurysmal SAH were studied as well. Methods-Symptomatic vasospasm was defined as the association of deterioration in a patient's neurological condition between 3 and 14 days after SAH with no other explanation and an increase in mean transcranial Doppler velocities of Ͼ120 cm/s. The prognostic factors were registered on admission and during the intensive care stay. , and secondary brain insults were associated with an increased risk of 6-month sequelae. Conclusions-Age Ͻ50 years, good neurological grade, and hyperglycemia were all associated with an increased risk of cerebral vasospasm whereas treatment was not. This provides a basis for future clinical prospective randomized trials comparing both treatments. Results-Symptomatic

Three-dimensional DSA is valuable for evaluating the potential for EVT, finding a working view, and performing accurate measurements.

EVT provides effective protection against rebleeding. When possible, occlusion with coils at the dissection site is the current method of choice. Another option is parent artery occlusion with balloons, and the use of a stent may preserve vessel permeability in specific cases.

S urgical clipping of MCA aneurysms is usually preferred to EVT. This preference is largely the result of a relatively easy surgical access and unfavorable endovascular approach due to the complex branching pattern of the MCA. As of this writing, no direct comparison between results of endovascular and surgical treatment of MCA aneurysms has been published in the literature, leaving the optimal treatment strategy unclear and choices depending mainly on the practice at the different centers. We therefore considered it important to study procedure-related risks as well as the immediate and midterm angiographic and clinical results after EVT of MCA aneurysms. MethodsFrom October 1992 to October 2001, a total of 940 patients with 1120 cerebral aneurysms were seen in our institute. Of these 940 patients, 202 (21.5%) were found to have MCA aneurysms (a total of 238 [21.3% of all identified aneurysms]). The closing date was chosen to have more than 5 years of follow-up data.Since the first use of detachable coils in our department in October 1992, data pertaining to all patients referred for EVT has been prospectively recorded. These data include: patients' demographic characteristics, mode of presentation, aneurysmal angiographic features, angiographic outcome at immediate post-EVT and follow-up examinations, procedure-related complications, and clinical status, using Hunt and Hess grading (in case of hemorrhage) on admission and GOS scores upon discharge Object. The object of this study was to evaluate the initial and mid-term angiographic and clinical results after endovascular coil occlusion of middle cerebral artery (MCA) aneurysms at the authors' institution.Methods. The authors conducted a retrospective analysis of a consecutive series of 152 MCA aneurysms (73 ruptured) treated by endovascular coiling in 140 patients. Angiographic and clinical data at initial and midterm follow-up as well as procedure-related complications were prospectively registered.Results. At discharge, favorable clinical outcomes (Glasgow Outcome Scale score of 1 or 2) were obtained in 89.3% of patients (125/140). Seven patients (5%) were in a vegetative state or had died. Complications were encountered in association with 11.8% of the procedures (18/152), and most (13/18) involved thromboembolic events (which led to permanent ischemia in 4 cases and death in 1). The overall procedure-related mortality rate was 0.7%, and the rates of permanent and transient morbidity were 2.6 and 2%, respectively. At a mean follow-up duration of 4.3 years there had been 4 cases of rebleeding: early rebleeding occurred during the initial postoperative period in 3 cases and later in 1. Total or subtotal occlusion was obtained in 84.2% of aneurysms (128/152). At follow-up, this satisfactory occlusion persisted in 83.3% of aneurysms (110/132) at 1 year posttreatment, 79.5% (89/112) at 3 years, and 80.2% (73/91) at 5 years.Conclusions. Risks and initial and midterm angiographic and clinical results after endovascular treatment of MCA aneurysms are nearly identi...

The authors have studied the microvascularization of the intracranial dura mater by microradiographic and histologic examination of 73 injected anatomic specimens. There exists a very abundant superficial arterial plexus which also serves to supply the inner table of the cranial vault. This plexus is continuous, even at the walls of the venous sinuses and the dural septa. The arteries are for the most part tortuous. The veins may be satellites of the arteries or, on the contrary, from a plexiform network passing through crevices in the interior of the dural layer. The walls of these veins consist only of an endothelium to be seen within the fibrous layer of the dura. Often, the arteries compress the venous lumen; this dangerous situation probably explains the frequent occurrence of arteriovenous fistulae of the dura mater, known by the name of dural fistulae.