Page 49 - WNS 2022 E-Program Booklet

Initial experience with Pipeline embolization of intracranial pseudoaneu-
rysms in pediatric patients
Karol P. Budohoski, FRCS(SN), PhD Department of Neurosurgery, Clinical
Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
Objective: Flow-diverting devices have been used successfully for the treat-
ment of complex intracranial vascular injuries in adults, but the role of these
devices in treating iatrogenic and traumatic intracranial vascular injuries in chil-
dren remains unclear. The authors present their experience using the Pipeline
Embolization Device (PED) for treating intracranial pseudoaneurysms in chil-
dren.
Methods: This single-center retrospective cohort study included pediatric pa-
tients with traumatic and iatrogenic injuries to the intracranial vasculature that
were treated with the PED between 2015 and 2021. Demographic data, indica-
tions for treatment, number and sizes of PEDs used, and follow-up imaging and
clinical outcomes were analyzed.
Results: Six patients with a median age of 12 years (range 7–16) underwent
PED placement to treat intracranial pseudoaneurysms. There were 3 patients
with hemorrhagic presentation, 2 with ischemia, and 1 in whom a growing pseu-
doaneurysm was found on angiography. Injured vessels included the anterior
cerebral artery (n=2), the supraclinoid internal carotid artery (ICA, n=2), the
cavernous ICA (n=1), and the distal cervical ICA (n=1). All 6 pseudoaneurysms
were successfully treated with PED deployment. One patient required retreat-
ment with a second PED within a week because of concern for a growing pseu-
doaneurysm. One patient experienced parent vessel occlusion without neuro-
logical sequelae.
Conclusions: Use of the PED is feasible for the management of iatrogenic and
traumatic pseudoaneurysms of the intracranial vasculature in children, even in
the setting of hemorrhagic presentation.

Carotid Cavernous Fistulas

Arjun Pendharkar MD, Stanford University
Carotid-cavernous fistulas (CCF) serve as a benchmark pathology for cerebro-
vascular disease encapsulating the full breadth of clinical, radiographic and
angiographic features of high and low flow arteriovenous shunting. Whether it
be traumatic or acquired etiology, these abnormal connections between the
internal and external carotid arteries and the cavernous sinus provide an oppor-
tunity to study the often-unseen vascular anatomy of the anterior and middle
cranial fossa, as well as the entire spectrum of microsurgical and endovascular
approaches to cure. Techniques include constructive, reconstructive, and de-
constructive options using endovascular and microsurgical techniques, all of
which are highlighted in this presentation.

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