Endovascular treatment of a ruptured pure arterial malformation and associated dysplastic middle cerebral artery dissecting aneurysm: illustrative case

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dc.contributor.authorMarlow, Christineen
dc.contributor.authorCuoco, Joshua A.en
dc.contributor.authorRavina, Kristineen
dc.contributor.authorSloboda, Cole A.en
dc.contributor.authorEntwistle, John J.en
dc.date.accessioned2023-12-04T14:33:44Zen
dc.date.available2023-12-04T14:33:44Zen
dc.date.issued2023-05-22en
dc.description.abstractBACKGROUND Pure arterial malformations are characterized as unique cerebrovascular lesions with a dilated, coil-like appearance and tortuous arteries without early venous drainage. Historically, these lesions have been described as incidental findings with a benign natural history. However, pure arterial malformations can rarely demonstrate radiographic progression and develop associated focal aneurysms with an unclear risk of rupture. Whether radiographic progression of these lesions or the presence of an associated aneurysm warrants treatment remains controversial. OBSERVATIONS A 58-year-old male presented with sudden-onset left hemiparesis. Computed tomography revealed a large, acute, right frontotemporoparietal intraparenchymal hemorrhage with underlying irregular curvilinear calcifications. Diagnostic cerebral angiography revealed a dysplastic right middle cerebral artery dissecting aneurysm along the M2 segment associated with a pure arterial malformation, which was treated with endovascular flow diversion in a delayed fashion. LESSONS Pure arterial malformations with associated focal aneurysms may not exhibit a benign natural history as once thought. Intervention should be considered for ruptured pure arterial malformations to mitigate the risk of rerupture. Asymptomatic patients with a pure arterial malformation with an associated aneurysm should at least be followed closely with interval radiographic imaging to evaluate for malformation progression or changes in aneurysmal morphology.en
dc.description.versionPublished versionen
dc.format.mimetypeapplication/pdfen
dc.identifier.doihttps://doi.org/10.3171/CASE23150en
dc.identifier.eissn2694-1902en
dc.identifier.issn2694-1902en
dc.identifier.issue21en
dc.identifier.otherPMC10550645en
dc.identifier.otherCASE23150 (PII)en
dc.identifier.pmid37218731en
dc.identifier.urihttps://hdl.handle.net/10919/116717en
dc.identifier.volume5en
dc.language.isoenen
dc.publisherJournal of Neurosurgery Publishing Groupen
dc.relation.urihttps://www.ncbi.nlm.nih.gov/pubmed/37218731en
dc.rightsCreative Commons Attribution-NonCommercial-NoDerivatives 4.0 Internationalen
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/4.0/en
dc.subjectaneurysmen
dc.subjectcerebrovascularen
dc.subjectendovascularen
dc.subjectpure arterial malformationen
dc.subjectvascular lesionen
dc.subjectvascular malformationen
dc.titleEndovascular treatment of a ruptured pure arterial malformation and associated dysplastic middle cerebral artery dissecting aneurysm: illustrative caseen
dc.title.serialJournal of Neurosurgery: Case Lessonsen
dc.typeArticle - Refereeden
dc.type.dcmitypeTexten
dc.type.otherJournal Articleen
dcterms.dateAccepted2023-04-24en
pubs.organisational-group/Virginia Techen
pubs.organisational-group/Virginia Tech/VT Carilion School of Medicineen
pubs.organisational-group/Virginia Tech/VT Carilion School of Medicine/Surgeryen
pubs.organisational-group/Virginia Tech/VT Carilion School of Medicine/Surgery/Neurosurgeryen

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