Distal anterior cerebral artery aneurysms are rare, comprising approximately 6% of all intracranial aneurysms. These aneurysms tend to be smaller in size, broad-based, associated with additional aneurysms and at arterial branching sites, which can make both diagnosis and treatment difficult. Here we report a case of a 63-year-old female who presented with headache and perioral paresthesia determined to be Hunt & Hess scale grade 1. Computed tomography angiography discovered a medium-sized left A2 trunk saccular aneurysm. Intraoperatively 2 additional small blister type aneurysms not noted on initial computed tomography were discovered and treated via clipping and wrapping, respectively. Postoperatively a cerebral angiogram revealed an additional small right A2 trunk broad-based aneurysm. Preoperative evaluation of cerebral vasculature with a cerebral angiogram or high-resolution digital subtraction angiography is essential as multiple aneurysms are commonly associated with anterior cerebral artery aneurysms. The patient was successfully treated without any operative or postoperative complications and has remained symptom-free at 1 year follow up.
Purpose: To evaluate safety and efficacy of CT-guided cryoablation of renal neoplasms and identify factors predictive of clinical success. Materials and Methods: A retrospective analysis was undertaken of patients treated with CT-guided cryoablation between December 2008 and August 2013 at a single center. Chart and image review was performed to evaluate technical success and adverse events for the procedure as well as survival and freedom from recurrence on follow up. In addition, multivariable analysis was performed to identify predictors of clinical success, including CT volumetric analysis of the lesion and ice-ball using Tera-Recon 3D reconstruction software. Results: Ninety-six renal neoplasms in 89 consecutive patients (55 male, mean age 67 years) were enrolled in the study. The mean lesion diameter was 2.73 cm (range 1-6.5 cm), with a mean lesion volume of 14.6 cm 3. The mean number of probes required for treatment was 2.74. 52 lesions demonstrated medullary involvement (54.1%). Hydrodissection was required in 13 lesions (14%) due to proximity of bowel loops.Technical success was achieved in 95 of the 96 lesions (99%). Major bleeding occurred in 3 patients requiring transfusions. There was a single 30-day mortality not directly related to complications from the procedure.Mean follow-up was 13 months (range 1-48 months). Local recurrence was noted in 3 of 89 patients (3.4%) while secondary lesions in the contralateral kidney were seen in two patients (2.2%).The mean ratio of iceball volume to lesion volume at the index procedure was 1.22 in patients with recurrent lesions and 2.07 in patients without recurrences (p ¼ 0.028). None of the other analyzed variables yielded significant findings Conclusion: Percutaneous CT-guided cryoablation is a safe and effective procedure for the treatment of renal neoplasms. An ice-ball to lesion volumetric ratio of o 1.5 may be indicative of potential future recurrence.
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