Many options exist for the treatment of<unk> s. While surgery was the gold-standard treatment in the<unk> st, several less invasive treatment options are popular today. Covered stent Since the<unk>  communicates with an artery through a hole in the arterial wall, a covered stent may be placed endovascularly across this hole to "exclude it," or to prevent it from receiving blood flow from the artery. The covered stent is composed of metal and is covered with polytetrafluoroethylene (PTFE) or another sterile fabric-like material. The covered stent remains in place permanently, and the<unk> , without a continuous flow of arterial blood, then thromboses. Advantages of this technique are that it has a high success rate without the need for an open surgery. Complications include covered stent migration, persistent leakage of blood into the<unk> , fracturing (breaking) of the stent, and infection of the stent or of the arterial insertion site. Ultrasound probe compression Another option for treatment is ultrasound probe compression of the neck of the<unk> . The "neck" of the<unk>  is the narrow<unk> th of blood flow between the artery, through the arterial wall, and into the<unk>  cavity. The artery, neck, and<unk>  are seen on ultrasound. The ultrasound probe can be pushed firmly against the<unk> tient's skin to compress the neck of the<unk>  for usually about 20 minutes. During this time, the blood within the<unk>  clots; after the probe is then removed, the<unk>  will hopefully remain clotted and will not continue to expand. The procedure may be stopped early due to<unk> tient discomfort. It is less successful if the<unk> tient is obese, since there is more fatty tissue between the skin and the neck of the<unk> . It also is less successful if the neck of the<unk>  is wider, since it is less likely to clot off during the period of compression. Finally, it is also much less successful if the<unk> tient is taking aspirin, warfarin (Coumadin), or another anticoagulant, since these would prevent clotting of blood within the<unk> . Advantages are that this is the least invasive method of stopping arterial blood flow into a<unk> . Ultrasound-guided thrombin injection In addition to covered stent placement, another popular, minimally-invasive technique used today is ultrasound-guided thrombin injection. Thrombin (factor IIa in the coagulation cascade) is a clotting factor that converts fibrinogen into fibrin, which then polymerizes to form a blood clot. Under ultrasound guidance, thrombin can be injected directly into a<unk> , causing it to clot. Advantages are that the technique is relatively easy to perform, is successful, and is minimally invasive. One contraindication to this procedure is if there is an arteriovenous fistula (communication between an artery and vein), in addition to the<unk> . This occurs with about 10% of<unk> s. If this is present, thrombin injected into the<unk>  could then enter the venous circulation and possibly lead to distant thrombosis. Surgical ligation (with or without distal bypass) Open surgery may also be performed to remove<unk> s or prevent them from expanding. If the artery is small and "expendable" - the tissues it supplies have adequate collateral blood flow - then the artery supplying the<unk>  may be ligated both proximally and distally to the<unk> . The<unk>  may or may not be removed. If the tissues supplied by the artery do not have sufficient collateral flow (the artery is not expendable), then a vein or synthetic graft would have to be anastomosed proximally and distally to allow for continued blood flow around the<unk> . Advantages are that the technique has been successful in the treatment of<unk> s for many years. However, it is more invasive (a large skin incision is necessary), and there is more postoperative<unk> in and a risk for wound infection. One of the less invasive options may be preferred in a<unk> tient with many comorbidities, who is at high risk for surgery.
Pseudoaneurysm
Duret haemorrhages
Cirsoid aneurysm
Angioma
Splinter hemorrhage
Charcot–Bouchard aneurysm
Dural ectasia
Dural arteriovenous fistula