1/34. The use of cardiopulmonary bypass with profound hypothermia and circulatory arrest during the surgical treatment of giant intracranial aneurysms.The surgical treatment of giant intracranial aneurysms can be aided by using cardiopulmonary bypass to provide hypotension under hypothermic conditions. Cardiopulmonary techniques need to be modified to deal with the problems that arise during this type of neurosurgery.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
2/34. rupture of a giant posterior inferior cerebellar artery aneurysm in an infant following a ventriculoperitoneal shunt--Case report.A 4-month-old female child presented with a huge posterior fossa mass lesion and severe hydrocephalus. Six hours after a ventriculoperitoneal shunt procedure, her condition worsened and she died. autopsy showed extensive intracranial hemorrhage due to rupture of a posterior inferior cerebellar artery aneurysm. The probable causes of the rupture of the aneurysm were mechanical effects or changes in cerebral blood flow.- - - - - - - - - - ranking = 0.8keywords = giant (Clic here for more details about this article) |
3/34. cerebral phaeohyphomycosis caused by a dematiaceous scopulariopsis species.This report describes a rapidly fatal case of cerebral phaeohyphomycosis in a 33-year-old immunocompetent male. The infection presented as a single large lesion in the deep white matter of one temporal lobe, which was then removed surgically. Histologic features observed in the lobectomy specimen were characterized by perivascular sleeves of mononuclear cells accompanied by hemorrhages. These were reminiscent of acute hemorrhagic leukoencephalitis except for the presence of rare fungal organisms and sparse multinucleated giant cells similar to those occurring in AIDS. During the four days following surgery, a large focus of cerebritis with massive invasion of fungi developed in each centrum semiovale around the ventriculostomy sites. Fungal culture of the brain obtained at autopsy grew an organism consistent with a scopulariopsis species.- - - - - - - - - - ranking = 0.2keywords = giant (Clic here for more details about this article) |
4/34. Evolution of incidentally-discovered fusiform aneurysms of the vertebrobasilar arterial system: neuroimaging features suggesting progressive aneurysm growth.This study investigated the natural history and biological behavior of incidental fusiform aneurysms in four patients with incidental fusiform aneurysms of the vertebrobasilar arterial system who had been followed up for more than 3 years (mean 3.5 years). Two lesions remained the same size, and two lesions gradually grew. angiography showed the non-growing fusiform aneurysms as a circumferentially or unilaterally fusiform dilatation of a short segment of the vertebral artery with smooth walls and a steep slope of the dilatation, and the growing fusiform aneurysms as unilaterally fusiform involving a long segment of the vertebral artery or basilar artery with irregular walls and a gentle slope of dilatation. Magnetic resonance (MR) imaging demonstrated the non-growing fusiform aneurysms as a signal-void area, and the growing fusiform aneurysms as high and intermediate signals in addition to the normal flow void. The heterogeneous MR intensities probably correspond to turbulent flow, laminar flow, thrombosis, or intramural hematoma. Differentiation of growing and non-growing fusiform aneurysms is very difficult at the initial diagnosis. However, enlargement of the fusiform aneurysms is consistent with hemorrhage into the aneurysmal wall, which is confirmed by MR imaging. Fusiform aneurysms with the characteristics of the growing aneurysms cannot be overlooked because of the potential to develop into giant fusiform aneurysms which are very difficult to manage therapeutically.- - - - - - - - - - ranking = 0.2keywords = giant (Clic here for more details about this article) |
5/34. Giant cavernous malformation of the occipital lobe.A 15-year-old boy who developed severe headaches and an incomplete homonymous hemianopia was found to have a large, well-circumscribed, multilobulated intracranial mass in the contralateral occipital lobe. The initial impression was that of a low-grade glioma or a vascular malformation. When the lesion increased in size and complexity, concern arose about the possibility of a malignant glioma. Upon craniotomy, it proved to be a giant cerebral cavernous malformation. This case is remarkable in that most cavernous malformations do not become symptomatic before the third decade of life and rarely attain such a large size.- - - - - - - - - - ranking = 0.2keywords = giant (Clic here for more details about this article) |
6/34. Supergiant anterior circulation aneurysms.Six cases of very large anterior circulation intracranial aneurysms are presented. Aneurysms of 53-84 mm in three female and two male adults and a 40 mm lesion in a seven week infant were successfully excised. Three patients tolerated trial intraluminal balloon occlusion preoperatively and underwent subsequent parent artery ligation and aneurysmectomy with gratifying outcome. Three patients failed to tolerate trial occlusion and underwent prophylactic saphenous vein bypass grafts from the common carotid artery to the middle cerebral (MCA) prior to aneurysmectomy. In two of these (a 72 mm MCA and a 84 mm petrous carotid aneurysm), severe brain swelling after successful bypass procedures necessitated emergency craniotomy for aneurysmectomy and decompression. One of these never recovered and died one month later. In both cases in which malignant brain swelling followed bypass, preoperative CT and MR revealed significant hemispheric oedema and shift. Both patients had presented with signs of increased intracranial pressure and global mentational difficulties. Supergiant intracranial aneurysms pose major therapeutic risks, alternative therapeutic avenues must be addressed.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
7/34. Endovascular treatment of posterior circulation aneurysms by electrothrombosis using electrically detachable coils.In a multicenter study, 120 patients with intracranial aneurysms presenting a high surgical risk were treated using electrolytically detachable coils and electrothrombosis via an endovascular approach. The results of treatment in patients with posterior fossa aneurysms (42 patients with 43 aneurysms) are presented. The most frequent clinical presentation was subarachnoid hemorrhage (24 cases). The clinical follow-up periods ranged from 1 week to 18 months. Complete aneurysm occlusion was obtained in 13 of 16 aneurysms with a small neck and in four of 26 wide-necked aneurysms. A 70% to 98% thrombosis of the aneurysm was achieved in 22 of 26 aneurysms with a wide neck and in three of 16 small-necked aneurysms. One aneurysm could not be treated due to a technical complication. Two cases required postprocedural surgical clipping of a residual aneurysm. One patient (originally in Hunt and Hess Grade V) experienced procedural rupture of the aneurysm requiring an emergency parent artery occlusion. He eventually died 5 days later. Another patient (originally in Grade IV) had coil migration and posterior cerebral artery territory ischemia. A third patient developed a permanent neurological deficit (hemianopsia) after complete occlusion of a wide-necked basilar bifurcation aneurysm. One patient, harboring an inoperable giant basilar bifurcation aneurysm, died from aneurysm bleeding 18 months after partial occlusion. overall morbidity and mortality rates related to treatment were 4.8% (two cases) and 2.4% (one case), respectively (2.6% and 0% if considering only patients in Hunt and Hess Grades I, II, and III). It is suggested that this technique is a viable alternative in the management of patients with posterior fossa aneurysms associated with high surgical risk. Longer angiographic and clinical follow-up study is necessary to determine the long-term efficacy of this recently developed endovascular occlusion technique. Close postoperative angiographic and clinical monitoring of patients with wide-necked subtotally occluded aneurysms is mandatory to check for potential aneurysmal recanalization, regrowth, and rupture.- - - - - - - - - - ranking = 0.2keywords = giant (Clic here for more details about this article) |
8/34. Intracerebral hemorrhage from a middle meningeal arteriovenous fistula with a giant venous varix.A patient with a congenital arteriovenous fistula between the middle meningeal artery and a cortical vein with a giant venous varix is described. The patient presented with an intracerebral hemorrhage that had been evacuated. Permanent cure of the fistula was achieved without morbidity by embolization with Ivalon particles.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
9/34. Fatal giant pediatric intracranial cavernous angioma.Cavernous angioma is a benign vascular lesion that may occur in the central nervous system. The symptoms of raised intracranial pressure or consciousness alteration are usually related to acute hemorrhage. A previously healthy four-year-old girl was admitted with sudden loss of consciousness, vomiting and clonic seizures. Her Glasgow coma score (GCS) was 7 at presentation (5 m 1v 1e). anisocoria and mydriasis were present on the right. Computerized tomography revealed a giant spherical, hyperdense intraaxial left frontoparietal lesion. The findings of surrounding vasogenic edema and compression of the adjacent lateral ventricle were seen on computerized tomography (CT). She was taken to operation and the mass was grossly excised. The GCS remained unchanged. A diagnosis of brain death was made. A cavernous hemangioma was diagnosed with pathologic examination. In conclusion, a cavernous angioma may occasionally follow a rapid and fatal course by causing gross hemorrhage in the pediatric age group. Early recognition by CT or magnetic resonance imaging (MRI) and prompt surgical evacuation are necessary.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
10/34. Sporadic cerebral amyloid angiopathy with giant cell reaction.We report a case of intracerebral hemorrhages due to sporadic cerebral amyloid angiopathy in a 43-year-old male with a luxuriant giant cell reaction. The amyloid was resistant to potassium permanganate-sulfuric acid oxidation and reacted with an antiserum to synthetic beta-protein. The distribution and histologic characteristics of the multinucleated giant cell reaction suggest that it represents a foreign-body reaction rather than giant cell arteritis.- - - - - - - - - - ranking = 1.4keywords = giant (Clic here for more details about this article) |
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