PMC9282821_01
The initial CT angiography before the treatment showing bilateral fusiform type VADAs (a), and magnification (b). Arrowhead indicates left VADA, empty arrowhead right VADA, and arrow internal meatus. VADA: Vertebral artery dissecting aneurysm.
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F1
In 2014, she was referred to our hospital and diagnosed bilateral fusiform type VADAs by computed tomographic angiography [Figures 1a and b].
Pre- and post-treatment 3D multifusion images of HFS due to VADA. (a) Pretreatment 3D FSE MR cisternogram showing the NVC at the RExZ. The left facial nerve was directly compressed by the VADA. (b) Pretreatment 3D multifusion image of the time-of-flight MR angiography and fast spin-echo MR cisternography, same viewpoint as a. Arrowhead indicates the NVC. Arrows indicate CN-VII (facial nerve); CN-VIII, (vestibulocochlear nerve); VADA (An); VA. (c) Pretreatment 3D time-of-flight MR angiogram, same viewpoint as a, showing VADA. The dotted line indicates the running course of the left VA. (d) Pre- and post-treatment 3D multifusion image of the MR cisternogram, same viewpoint as a and e, showing the restoration form of the facial nerve after the second treatment through stentinstent placement. The curved arrow indicates the movement of the facial nerve. (e) Posttreatment 3D image of the MR cisternogram, same viewpoint as a, showing the elimination of NVC at the RExZ after the second treatment through stent-in-stent placement. (f) Posttreatment 3D multifusion image of silent MR angiogram and MR cisternogram, same viewpoint as a, showing the elimination of the NVC. (g) Posttreatment 3D silent MR angiogram, same viewpoint as a, showing the diminished size of the stented VADA. The dotted line indicates the running course of the left VA. (h) 3D multifusion images of (c) and (g). The curved arrow indicates the displacement of the left VA. HFS: Hemifacial spasm, MR: Magnetic resonance, VADA: Vertebral artery dissecting aneurysm, VA: VADA: Vertebral artery, RExZ: Root exit zone, NVC: Neurovascular contact.
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F2
Pretreatment 3D multifusion imaging of time-of-flight MR angiography and fast spin-echo MR cisternography was performed, which identified NVC at the root exit zone (RExZ) of the left facial nerve by the VADA [Figure 2].
Digital angiography of the left VADA of the first endovascular treatment. (a) The left VADA before treatment. (b) Posttreatment with enterprise stent placement. VADA: Vertebral artery dissecting aneurysm.
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F3
Enterprise 2 VRD 4/30 was placed in the left VA [Figures 3a and b].
Digital angiography before the second treatment showing reduction of VADA, but appearance of a de novo aneurysm at the proximal end of the stent (a and b), after the second treatment using additional LVIS stent and coil (c). Note the running course of the parent VA was changed after the treatment. VADA: Vertebral artery dissecting aneurysm.
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F4
August 2016, the right VADA was successfully treated with a stent-assisted coil. At this time, the left VADA reduced size, but a small de novo aneurysm was observed at the proximal end of the stent [Figures 4a-c].
Stereotactic images (a and b) showing locations of two stents in the left VA after first and second treatments. White arrows indicate the proximal and distal ends of VRD (Enterprise 2 VRD 4/30) of the first treatment, and green arrows LVIS (additional stent-in-stent with LVIS-4.5/18) of the second treatment. VADA: Vertebral artery dissecting aneurysm.
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F5
Axium PRIME 3/6 was used for coiling of the de novo aneurysm [Figures 5a and b].