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Intracranial artery to artery spontaneous revascularization in a child

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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.

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Authors and Affiliations

  1. Pediatric Neuroradiology, Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, M5G 1H4, Canada

    Prakash Muthusami, Charles Raybaud & Manohar M Shroff

  2. Division of Neuroradiology and Neurosurgery, University of Toronto, Toronto Western Hospital and University Health Network, Toronto, ON, Canada

    Timo Krings

  3. Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada

    Peter Dirks

  4. Division of Neurosurgery, Department of Surgery, The Hospital for Sick Children, Toronto, ON, Canada

    Peter Dirks

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  1. Prakash Muthusami
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  2. Timo Krings
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  5. Manohar M Shroff
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Correspondence to Prakash Muthusami.

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Muthusami, P., Krings, T., Raybaud, C. et al. Intracranial artery to artery spontaneous revascularization in a child. Childs Nerv Syst 33, 2035–2038 (2017). https://doi.org/10.1007/s00381-017-3498-7

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  • DOI: https://doi.org/10.1007/s00381-017-3498-7

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