Prakash Muthusami1, Timo Krings2, Charles Raybaud3, Peter Dirks4,5, Manohar M Shroff3. 1. Pediatric Neuroradiology, Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, M5G 1H4, Canada. prakash.muthusami@sickkids.ca. 2. Division of Neuroradiology and Neurosurgery, University of Toronto, Toronto Western Hospital and University Health Network, Toronto, ON, Canada. 3. Pediatric Neuroradiology, Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, M5G 1H4, Canada. 4. Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada. 5. Division of Neurosurgery, Department of Surgery, The Hospital for Sick Children, Toronto, ON, Canada.
Abstract
INTRODUCTION: Intracranial artery-to-artery antegrade revascularization is a poorly recognized entity, more so when it involves main stem arteries. The etiology, appearance, and significance of this condition are not described in the literature. CASE PRESENTATION: We describe a case of spontaneous revascularization of a chronically occluded middle cerebral arterial branch by collaterals from the proximal segment reconstituting distal flow, mimicking a brain arteriovenous malformation in a 9-year old boy. We discuss the nature of these channels, presumed to be related to artery to artery collaterals that are either dilated adventitial vasa vasorum, or, more likely, leptomeningeal collaterals that are hypertrophied in response to cerebral demand. We review the literature regarding intracerebral vasa vasorum and leptomeningeal collaterals including their imaging. CONCLUSION: Recognizing the tortuous channels associated with this type of vascular abnormality as normal vessels reconsituting distal flow may prevent unnecessary and potentially dangerous treatments.
INTRODUCTION: Intracranial artery-to-artery antegrade revascularization is a poorly recognized entity, more so when it involves main stem arteries. The etiology, appearance, and significance of this condition are not described in the literature. CASE PRESENTATION: We describe a case of spontaneous revascularization of a chronically occluded middle cerebral arterial branch by collaterals from the proximal segment reconstituting distal flow, mimicking a brain arteriovenous malformation in a 9-year old boy. We discuss the nature of these channels, presumed to be related to artery to artery collaterals that are either dilated adventitial vasa vasorum, or, more likely, leptomeningeal collaterals that are hypertrophied in response to cerebral demand. We review the literature regarding intracerebral vasa vasorum and leptomeningeal collaterals including their imaging. CONCLUSION: Recognizing the tortuous channels associated with this type of vascular abnormality as normal vessels reconsituting distal flow may prevent unnecessary and potentially dangerous treatments.
Authors: H T Ozgur; T Kent Walsh; A Masaryk; J F Seeger; W Williams; E Krupinski; M Melgar; E Labadie Journal: AJNR Am J Neuroradiol Date: 2001-05 Impact factor: 3.825