BACKGROUND AND PURPOSE:Recently, surgeons have used an expanded endonasal surgical approach (EENS) to access skull base lesions not previously accessible by minimally invasive techniques. Reconstruction of the large skull base defects created during EENS is necessary to prevent postoperative CSF leaks. A vascular pedicle nasoseptal mucoperiosteal flap based on the nasoseptal artery, (Hadad-Bassagasteguy flap) is becoming a common reconstructive technique. The purpose of this study was to review the expected MR imaging appearance of these flaps and to discuss variations in the appearance that may suggest potential flap failure.
Introduction: Dissecting aneurysms in the communicating segment of the internal carotid artery (ICA) is uncommon. Clinical evidence to support the use of endovascular treatment for dissecting aneurysms in the communicating segment of ICA has not been established. Patient concerns: A 48-year-old woman presented with complaints of sudden headaches with nausea and vomiting. Computed Tomography Head taken in another hospital showed subarachnoid hemorrhage. Diagnoses: Digital Subtraction Angiography examination of the head showed ruptured dissecting aneurysm in the communicating segment of ICA. Interventions: The patient underwent stent-assisted aneurysm embolization and acute thromboembolic complication occurred intra-operatively. Tirofiban was injected through the microcatheter and a Percutaneous Transluminal Angioplasty (PTA) balloon catheter was inserted in the stent. Following the treatment, a repeat digital subtraction angiography showed no aneurysm development and the right middle cerebral artery was unobstructed. The right ICA was observed for 30 minutes, and it remained patent. Outcomes: Seven hours after the procedure, the patient became drowsy, the right limb was paralyzed, and her speech was slurred. Magnetic resonance angiography and 3D time of flight showed severe stenosis of the right middle cerebral artery and anti-platelet drug was administered. At seven-month follow-up, the patient showed residual mild motor dysfunction of right hand and leg. Conclusion: For ruptured dissecting aneurysm in the communicating segment of ICA, endovascular treatment may be a suitable treatment. But there is a risk of acute thromboembolic complication during and after the procedure and hence requires careful monitoring.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.