Background/Objectives: Endovascular embolization is an effective treatment option for cerebral arteriovenous malformation (AVM) and dural arteriovenous fistulas (DAVFs). The objective of this study was to assess the safety and efficacy of Menox^TM in patients with cranial dural arteriovenous fistulas. Methods: From January 2021 to January 2023, 19 patients with intracranial DAVFs underwent embolization procedures. All patients were treated by embolization with Menox^TM or/and in combination with other embolization products such as Onyx (Covidien, Irvine, California), PHIL (MicroVention, Tustin, California), and Squid (Balt Extrusion, Montmorency, France). Treatment approaches were selected depending on the anatomical location of the fistula. Patients were monitored and followed-up for 12 months. Results: The patients’ mean age was 56.26 ± 16.49 years. Of these 19 patients, 58% (n = 11) were treated with the Menox^TM liquid embolizing agent (LEA) alone or in combination with different LEAs, while n = 7 were treated with other LEAs and 1 patient was treated solely with coils. Complete occlusion of DAVFs with Menox^TM and other agents was evident in 68.4% (n = 13/19) of patients. Complete occlusion (100%) was observed in the sinus rectus, transverse sinus, and diploic veins of the orbital roof, while complete occlusion was observed in 50% of falcotentorial patients and 60% of superior sagittal sinus patients. The lowest rate of complete fistula obliteration was observed in the dural carotid cavernous fistula (CCF) group (25%). An intra-procedural adverse event occurred in one patient. No other post-procedural adverse events were noted. Furthermore, in patients treated with Menox^TM, total occlusion was achieved in 72.7% (n = 8) of patients, whereas the non-Menox^TM group had 62.5% (n = 5) of patients with 100% occlusion and 37.5% (n = 3) of patients with subtotal occlusion. Conclusions: Outcomes using Menox^TM alone and in combination with other agents were effective, and it is safe for the treatment of dural arteriovenous fistulas.

Stents have become very important devices in the treatment of intracranial aneurysms. Flow diverters as high metal coverage stents are developed for hemodynamic treatment of challenging intracranial aneurysms. High level of metal coverage can also be achieved by implementing regular stents telescopically one in another. We present the case of a patient successfully treated for giant aneurysm of basilar artery bifurcation by a “Stent-within-a-Stent” technique. After stent implantation, coil embolization was performed using multiple-sized platinum helical coils. Control angiography performed at the end of the procedure revealed aneurysm occlusion. After 3 years, the patient is fully neurologically recovered, without pyramidal deficit, independently active and able to work.

Introduction: Very few studies address meningeal artery (MMA) histology, including some features of epidural hematomas (EDH). Materials and Methods: We microscopically analyzed 238 slices from ten MMA specimens. In addition, 61 patients with EDH were enrolled and examined. Both analyses were retrospective. Results: MMA analysis showed a larger subendothelial space and reduced media and adventitial coat, the latter continuous with the two dural parts (periosteal and meningeal layers). The 61 patients had an average age of 42.1 years. The EDH averaged 28.8 mm in diameter, but it did not affect outcomes (p=0.626). Vault bone fracture was seen in 95.1% of patients. An incidental fall was the most frequent cause (68.5%). Coma was present in 35.0%, whilst the Glasgow Coma Scale (GCS) on admission averaged 12. EDH was associated with other intracranial hemorrhages (19.7%), including subdural (9.8%), subarachnoid (4.9%), intracerebral (1.7%), or combinations thereof. Following EDH surgical evacuation, some patients had certain neurological or psychological disorders (19.7%). The mortality rate was 14%, especially in patients manifesting early neurologic symptoms (p=0.034). Conclusion: The MMA is well protected due to its structure and dural support. However, a strong head impact, especially associated with a bony fracture, leads to MMA rupture and a dural laceration resulting in EDH. The latter can be accompanied by neurological signs, as well as a mortality rate of 14%, which mainly depends on early neurological manifestation or coma occurrence.