Treatment of Cerebral Vasospasm in an Infant Using a Modified Dotter Technique

Journal of Cerebrovascular and Endovascular Neurosurgery
Brian M SnellingEric C Peterson

Abstract

An 8-month old female presented with spontaneous subarachnoid hemorrhage and was treated successfully with endovascular coil embolization of the ruptured aneurysm. Transcranial Doppler ultrasound performed four days later demonstrated middle cerebral artery (MCA) velocities greater than 350 cm/sec on the right and greater than 200 cm/sec on the left, despite medical management. The patient demonstrated no focal neurological deficits, though examination was limited by our patient's sedation and intubation. Angiography revealed severe vasospasm of the supraclinoid internal carotid and MCA territories, bilaterally. The vasospasm was refractory to the administration of intra-arterial verapamil. Balloon angioplasty was attempted, but the device could not be advanced safely due to the small size of the patient's vessels and the stiffness of the device. A microcatheter (0.0165" diameter) was advanced over a J-shaped soft microwire (0.014" diameter) to perform mechanical angioplasty in the internal carotid artery and MCA vessels bilaterally. Dramatic improvement was seen angiographically and on transcranial Doppler, and no complications were seen.

References

Jan 1, 1984·Journal of Neurosurgery·R AaslidH Nornes
Jun 1, 1983·Journal of Neurosurgery·J R Ostergaard, B Voldby
May 17, 2001·Journal of Neurosurgery·F ProustP Fréger
Apr 1, 1965·Radiology·C T DOTTER, M P JUDKINS

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Citations

Apr 21, 2021·Child's Nervous System : ChNS : Official Journal of the International Society for Pediatric Neurosurgery·Elisabeth GarridoVianney Gilard
Jul 11, 2021·Child's Nervous System : ChNS : Official Journal of the International Society for Pediatric Neurosurgery·Anne MilletGuillaume Mortamet

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Methods Mentioned

BETA
percutaneous transluminal angioplasty
dissection

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