OBJECTIVE: Describe experience managing intracranial dural arteriovenous fistulas (DAVF) via endovascular embolization utilizing transarterial embolization technique with liquid embolic agents. We illustrate the technical nuance of using dual arterial access for angiographic control runs in complex DAVFs supplied by multiple feeders from two distinct arterial systems.
METHODS: Retrospective analysis of intracranial DAVF embolization as a single treatment technique at our institution from 2013-2023.
RESULTS: Twenty-three patients with intracranial DAVF who underwent endovascular treatment as their initial treatment were included. All embolizations were approached transarterially (TAE) with Onyx (n=19), NBCA (n=2), or combination (n=2). 96% (n=22) of patients had angiographic evidence of complete fistula obliteration after initial embolization. Six DAVF TAEs were performed with dual arterial access for simultaneous embolic delivery and angiographic control intraoperatively. Two patients (2/22) recanalized twice post-procedure, with one of these patients found to have incidental new DAVF at follow-up. Median patient follow-up was 12 months (IQR: 6-36) with median mRS on discharge of 1 and GOS at 3 months of 5.
CONCLUSIONS: In this initial series of patients with DAVF managed by endovascular embolization, the authors found dual-arterial access was feasible, safe, and effective in achieving fistula obliteration. Dual-arterial access conveniently provides simultaneous access for control angiography and embosylate delivery intraoperatively.

BACKGROUND: Intracranial aneurysms are rare in the pediatric age group, especially in neonates. This article presents a novel case of a neonate with a dissected and ruptured giant anterior cerebral artery aneurysm, focusing on diagnosis and endovascular treatment with a review of the literature.
METHODS: A full-term female neonate presented with projectile vomiting, fever, and hyperkinetic movements. Diagnostic workup revealed a giant dissecting and partially thrombosed aneurysm along the anterior cerebral artery. The neonate underwent successful endovascular coil embolization.
RESULTS: The intervention led to the cessation of symptoms, and the patient was discharged and followed with mild hypotonia as the only neurological deficit at 9 months.
CONCLUSIONS: This case highlights the rarity and complexity of diagnosing and treating giant dissected anterior cerebral artery aneurysms in neonates. It underscores the importance of considering intracranial aneurysms in differential diagnosis for neonates with relevant symptoms and suggests endovascular embolization as an effective treatment option.

UNASSIGNED: The ultrasonic surgical aspirator is widely used in intracranial tumor resection as this instrument is considered safe. The advantage of an ultrasonic surgical aspirator is that it does not damage vessels or nerves close to the tumor. Therefore, limited information exists regarding intraoperative arterial injury by the ultrasonic surgical aspirator.
UNASSIGNED: We report two cases. The first case was a 30-year-old woman who underwent surgery for a recurrent craniopharyngioma, and the second was a 50-year-old man who underwent surgery for a meningioma. A craniopharyngioma encased the basilar artery in the former case, and the superior cerebellar artery was encased by a meningioma in the latter. An ultrasonic surgical aspirator was used to resect the tumors in two cases. During surgery, the arteries involved in the tumors were unintentionally injured using an ultrasonic surgical aspirator. Intraoperative hemostasis was achieved for the bleeding from the injured arteries. However, postoperative digital cerebral angiography revealed pseudoaneurysms in the injured arteries. A subarachnoid hemorrhage occurred in the first case. The pseudoaneurysms were managed using endovascular embolization.
UNASSIGNED: Intraoperative arterial injury can occur with the application of an ultrasonic surgical aspirator. Neurosurgeons should be cautious when using ultrasonic surgical aspirators to avoid damaging the arteries involved with the tumor.

Cirsoid aneurysms, formerly identified as arteriovenous malformations (AVMs), represent infrequent vascular anomalies primarily localized within the scalp. These anomalies are typified by the absence of interposing capillaries, giving rise to extensively vascularized, expanded conduits connecting arterial feeders and venous outflows. This report details a case of a 13-year-old male afflicted with a cirsoid aneurysm in the scalp, who presented with swelling on the left frontal region, accompanied by headache and pulsatile sensations. Definitive diagnosis was achieved through radiological and histopathological examinations. Scalp cirsoid aneurysms may either be congenital in nature or arise following traumatic incidents, with clinical manifestations typically surfacing in the third decade of life. Common clinical presentations encompass a palpable, pulsatile subcutaneous mass, throbbing headaches, tinnitus, and cosmetic concerns. Diverse therapeutic strategies, including surgical excision, endovascular embolization, and percutaneous injection of sclerosing agents, can be employed contingent upon the particular characteristics of the lesion.

OBJECTIVE: Cerebral arteriovenous malformations (AVMs) are a challenging pathology in pediatric patients, carrying a high risk of morbidity and mortality. Treatment modalities include resection, endovascular embolization and stereotactic radiosurgery (SRS). There is currently no consensus favoring one modality over another. Timing of multimodal therapy with embolization/SRS and resection is not well explored in the literature. Here we present a series of pediatric AVM patients, with special attention paid to the timing of treatment.
METHODS: Electronic medical records of all pediatric patients (<18 years at treatment) with AVMs treated at our institution were retrospectively reviewed after IRB approval. Demographic information, AVM characteristics, treatment variables and outcomes were recorded.
RESULTS: 27 total patients were included. 21 (77.8%) presented with a ruptured AVM. 6 patients (28.6%) had an GCS of 3 to 10, and underwent treatment within 24 hours of presentation. 10 patients (47.6 %) with a GCS of 12 to 15 were treated between 24 to 120 hours. 5 patients (23.8%) were treated 3 weeks to 14 months after AVM rupture. 96% of our cohort, regardless of rupture status, had mRS of 1-2 at most recent follow-up.
CONCLUSIONS: We present our institution\'s experience with pediatric AVM\'s, focusing on the timing of treatment. Based on our experience, early treatment of AVMs seems to be safe and effective regardless of rupture status.

Renal arteriovenous anomalies are uncommon. They are characterized by an abnormal vascular connection that usually bypasses the capillary bed. Most are acquired arteriovenous fistulas (AVF) while the rest are congenital or idiopathic arteriovenous malformations (AVM). AVF are usually caused by renal interventions, trauma, or neoplastic processes. They can lead to hypertension, heart failure, hematuria, and renal insufficiency. A 69-year-old woman presented with arrhythmia, tachycardia, mild ankle edema, and increasing fatigue. Right kidney color Doppler ultrasound confirmed the presence of a huge AVM with a blood flow of 9 L/minute and a dilated, 35 mm in diameter, right renal vein. Two months later, an attempt to embolize the AVM failed as the Amplatzer™ Vascular Plug II (Abbott Laboratories, Chicago, Illinois, United States) migrated to the pulmonary circulation and was later removed. Complete embolization was achieved by implanting two Amplatzer Vascular Plug IIs, various embolization coils, histoacryl glue, and lipiodol. Control angiography revealed significant stenosis in the right subclavian artery endovascular access, which was managed with BeGraft (Bentley InnoMed GmbH, Hechingen, Germany) and Zilver (Cook Group Incorporated, Bloomington, Indiana, United States) stents. The patient was discharged on the third postoperative day, all her symptoms resolved, and she reported eventual recovery. Three months later, the patient was operated on due to a 40x58 mm pseudoaneurysm at the right femoral access site. Thus, renal AVMs should be included as a potential alternative diagnosis for various symptoms such as hematuria and hypertension resistant to medication. Endovascular embolization is a less-invasive, safer, and more effective option than open surgery but has a risk of complications. Success requires fully occluding the shunted vessel, preventing embolic material migration, and preserving normal arterial branches. It depends on selecting adequate techniques and embolic materials individually, based on etiology and precise vascular anatomy assessment.

Background and Objectives: Aneurysmal subarachnoid hemorrhage (ASAH) is defined as bleeding in the subarachnoid space caused by the rupture of a cerebral aneurysm. About 11% of people who develop ASAH die before receiving medical treatment, and 40% of patients die within four weeks of being admitted to hospital. There are limited data on single-center experiences analyzing intrahospital mortality in ASAH patients treated with an endovascular approach. Given that, we wanted to share our experience and explore the risk factors that influence intrahospital mortality in patients with ruptured intracranial aneurysms treated with endovascular coil embolization. Materials and Methods: Our study was designed as a clinical, observational, retrospective cross-sectional study. It was performed at the Department for Radiology, University Clinical Center Kragujevac in Kragujevac, Serbia. The study inclusion criteria were ≥18 years, admitted within 24 h of symptoms onset, acute SAH diagnosed on CT, aneurysm on DSA, and treated by endovascular coil embolization from January 2014 to December 2018 at our institution. Results: A total of 66 patients were included in the study-48 (72.7%) women and 18 (27.3%) men, and 19.7% of the patients died during hospitalization. After adjustment, the following factors were associated with in-hospital mortality: a delayed ischemic neurological deficit, the presence of blood in the fourth cerebral ventricle, and an elevated urea value after endovascular intervention, increasing the chances of mortality by 16.3, 12, and 12.6 times. Conclusions: Delayed cerebral ischemia and intraventricular hemorrhage on initial head CT scan are strong predictors of intrahospital mortality in ASAH patients. Also, it is important to monitor kidney function and urea levels in ASAH patients, considering that elevated urea values after endovascular aneurysm embolization have been shown to be a significant risk factor for intrahospital mortality.

A 17-year-old girl with a congenital, painless right forehead swelling obstructing her visual field was diagnosed with sinus pericranii. Radiological imaging confirmed extracalvarial arteriovenous malformation with serpentine vessels and bony erosion. Endovascular surgery was chosen for management, highlighting the necessity of considering SP in differential diagnosis for scalp swellings. Despite its rarity, awareness of it is essential to prevent complications from injury, misdiagnosis, or invasive procedures.

OBJECTIVE: Cerebral arteriovenous malformation during pregnancy is rare but lethal disease that usually present with new-onset seizures and headaches mimicking eclampsia. We report a rare case of cerebral arteriovenous malformation with abrupt seizures in the third trimester.
METHODS: A 28-year-old primipara was brought to our emergency department at 32 6/7 weeks of gestation with new-onset acute seizures and hypertension. Owing to neurological deterioration, the patient underwent emergency cesarean delivery. However, 24 h after cesarean delivery and eclampsia treatment, the seizures worsened. Computed tomography and magnetic resonance imaging showed unruptured arteriovenous malformation of the right frontal lobe. Subsequently, intraarterial embolization was performed. The patient was discharged 5 days after surgery without neurological sequelae or obstetric complications.
CONCLUSIONS: This case report highlights the differential diagnoses of sudden new-onset seizures in late pregnancy for obstetricians and emergency medicine physicians. Lethal cerebral diseases, apart from eclampsia, should be considered during pregnancy.

Background: Very small intracranial aneurysms, generally considered to be those 3 mm in diameter or smaller, pose particular technical challenges for endovascular surgeons. For this reason, very small aneurysms have been excluded from many relevant studies. The aim of our research was to establish the risk factors for the occurrence of stroke complications after endovascular embolization of ruptured and unruptured small intracranial aneurysms. Methods: During the period of 2009-2023, our team performed endovascular embolizations of intracranial aneurysms in 1567 patients across four different centers within the territory of Serbia and Montenegro. Within the total number of patients mentioned, aneurysms of less than 4 mm were treated 185 times, with 119 ruptured and 66 unruptured. Results: In the group of 119 patients with ruptured small intracranial aneurysms, 19 (16%) patients had ischemia after the endovascular treatment, 6 (5%) patients had minor neurological deficits, while 13 (10.9%) patients had major neurological deficits, of which 6 (5%) patients died. In the group of 66 patients with unruptured small intracranial aneurysms, 7 (10.6%) patients had ischemia after the endovascular treatment, 5 (7.6%) patients had minor neurological deficits, and 2 (3.03%) had major neurological deficits. Multivariate binary logistic regression showed that the risk factors for the occurrence of ischemia were the patient\'s age, smoking and alcohol consumption. The type of endovascular treatment used also had a statistically significant effect on the development of ischemia. Conclusions: Understanding the influence of possible risk factors for the occurrence of ischemic insult after embolization of small intracranial aneurysms is of great importance. By recognizing them, periprocedural complications can be reduced to a minimum.