1/41. A giant dissecting aneurysm mimicking serpentine aneurysm angiographically. Case report and review of the literature.Intracranial dissecting and giant serpentine aneurysms are rare vascular anomalies. Their precise cause has not yet been completely clarified, and the radiological appearance of such lesions can be different in each case according to the effect of hemodynamic stress on a pathologic vessel wall. For berry aneurysms, available evidence overwhelmingly favors their causation by hemodynamically induced degenerative vascular disease and there is an obvious need to determine the hemodynamic parameters most likely to induce the precursor atrophic lesions. In this study, a case of a giant dissecting aneurysm angiographically mimicking serpentine aneurysm of the right ophthalmic artery is reported and the relevant literature is reviewed to investigate the pathological characteristics and pathogenesis of this lesion. In the present case, radiological investigation of the lesion suggested a serpentine aneurysm, but the diagnosis was corrected to dissecting aneurysm subsequent to the pathological examination of the resected aneurysm. A giant dissecting aneurysm angiographically mimicking serpentine aneurysm and developing as the result of a circumferential dissection located between the internal elastic lamina and media is of particular interest when the etiology of these aneurysms is considered. To our knowledge this is the first report on intracranial dissecting aneurysm mimicking serpentine aneurysm angiographically. Our case illustrates the importance of careful serial section studies for a better understanding of the vascular pathology underlying the processes involved in intracranial serpentine aneurysms. We conclude that serpentine, dissecting and berry aneurysms may all arise by way of similar pathophysiological mechanisms.- - - - - - - - - - ranking = 1keywords = berry (Clic here for more details about this article) |
2/41. Systemic lupus erythematosus, berry aneurysm and subarachnoid haemorrhage.A 57-year-old woman with SLE and subarachnoid haemorrhage is described. The aetiology of the haemorrhage was a saccular aneurysm. The literature is reviewed.- - - - - - - - - - ranking = 2keywords = berry (Clic here for more details about this article) |
3/41. subarachnoid hemorrhage from intracranial dissecting aneurysms of the anterior circulation. Two case reports.Two rare cases of intracranial dissecting aneurysms of the anterior circulation associated with subarachnoid hemorrhage (SAH) are described. A 56-year-old female presented with a dissecting aneurysm in the proximal segment of the left middle cerebral artery. Proximal occlusion of the affected artery and a superficial temporal artery-middle cerebral artery anastomosis were performed, but the outcome was poor. A 61-year-old male presented with a dissecting aneurysm in the proximal segment of the left anterior cerebral artery. Clipping was enhanced by a piece of fascia lata, allowing patency of the affected artery with a satisfactory outcome. Dissecting aneurysm of the carotid system should be considered in a patient with SAH but no evidence of berry aneurysm.- - - - - - - - - - ranking = 0.5keywords = berry (Clic here for more details about this article) |
4/41. Middle meningeal artery aneurysm associated with meningioma.The aneurysms of the middle meningeal artery are extremely rare. 30 pseudoaneurysms of the middle meningeal artery (MMA) are reported in literature. These are post-traumatic lesions different from the true aneurysms that have a different origin. In fact they can be associated with arteriovenous malformations, Paget's disease and tumors; nevertheless in some cases the genesis remains unknown. Sometimes the berry aneurysm of MMA can cause non traumatic extradural hematomas. The association meningioma-aneurysm of the middle meningeal artery is extremely rare: only a case has been signalled till now in literature. In our case the patient was a 69 year-old woman admitted in our department following an epileptic seizure. Neuroradiological studies (post-contrast CT and RM) showed a meningioma of the right pterion. A preoperative angiography evidenciated a big blush from the afferences of meningioma by the middle meningeal artery and, proximally a small berry aneurysm of this artery. Selective embolization of the tumor and the aneurysm was performed preoperatively with polyvinyl particles and straight platinum coils. A craniotomy a surgical resection of the meningioma were performed. The role of the endovascular treatment in the management of these lesions is underlined to decrease the risks of morbidity.- - - - - - - - - - ranking = 1keywords = berry (Clic here for more details about this article) |
5/41. New method for obliterative treatment of an anterior wall aneurysm in the internal carotid artery: encircling silicone sheet clip procedure--technical case report.OBJECTIVE AND IMPORTANCE: Aneurysms on the anterior surface of the internal carotid artery (ICA) have been shown to be somewhat different from ordinary berry aneurysms because they are rather small, grow rapidly in a short time, and easily lead to rupture, especially during surgery. The most difficult problem is that this type of aneurysm cannot be eliminated easily by an ordinary clipping procedure without causing apparent arterial stenosis or occlusion. CLINICAL PRESENTATION: A 52-year-old man experienced a subarachnoid hemorrhage because of a ruptured aneurysm located on the anterior surface of the ICA. The tiny aneurysmal body, which was covered with a layer of brain tissue, was successfully exposed. The ICA seemed to be atherosclerotic, and the aneurysmal portion was solitary and had a reddish color. TECHNIQUE: A large silicone sheet encircling clip (Vascwrap; Mizuho Ikakogyo Co., Ltd., tokyo, japan) was selected for this patient. The proximal margin of the silicone sheet was incised with a V-shaped cut, and the middle part of the sheet, which covered the diagonal part of the ICA, was trimmed to make it shorter. The blade of the fenestrated clip was applied to obliterate the aneurysm and was attached to the normal arterial wall together with this modified Vascwrap sheet to create a small space between the normal arterial wall and the surrounding Vascwrap sheet. Then tiny pieces of Teflon fiber (E.I. duPont de Nemours and Co., Wilmington, DE) was inserted from both margins, and the whole Vascwrap sheet was sealed with fibrin glue to ensure good adhesion. CONCLUSION: This method seemed adequate in treating this difficult aneurysm without causing postoperative regrowth or occlusion of the patient's ICA.- - - - - - - - - - ranking = 0.5keywords = berry (Clic here for more details about this article) |
6/41. Is the rupture of cerebral berry aneurysms influenced by the perianeurysmal environment?PURPOSE: To evaluate contact between cerebral berry aneurysms and the perianeurysmal environment and to study the influence this contact has on aneurysm rupture. MATERIALS AND methods: In a series of 76 consecutive patients, pre- and post-contrast CT images of 87 aneurysms were evaluated. aneurysm locations were identified and aneurysms were divided into two different groups depending on whether they had ruptured or not. Contact between aneurysms and the perianeurysmal environment was studied when present, and considered to be balanced or unbalanced according to symmetry of contact and type of contact interface, i.e. with bone, dura, etc. RESULTS: rupture occurred in 47 aneurysms at an average maximum dome size of 7.4 mm. There was contact with elements of the perianeurysmal environment in 38 (81%) of ruptured cases and no evidence of contact in 7 (15%). The nature of contact was unclear in 2 (4%) ruptured aneurysms. In the aneurysms with contact, the nature of contact was unbalanced in 34 (72%) and balanced in 4 (9%). Unbalanced aneurysms ruptured at significantly smaller sizes (average: 7.7 mm) than balanced aneurysms (average: 11.4 mm). Seven aneurysms of small size (3.3-6.9 mm, average: 4.8 mm) were found to have ruptured, despite the fact that they were too small to exhibit contact with the perianeurysmal environment. In 40 unruptured aneurysms (average size: 6.3 mm), contact with the perianeurysmal environment was found in 15 aneurysms, for which balanced contact was found in 11 (27.5%) and unbalanced contact in 4 (10%), and no contact in 25 (62.5%). The average size of the aneurysms without contact (3.7 mm) was significantly smaller than that with balanced contact (10.3 mm) or with unbalanced contact (11.3 mm). CONCLUSION: Aneurysms exhibit contact with their perianeurysmal environment as soon as they reach a size that exceeds their allowance given by the local subarachnoid space. The contact with the environment was found to be an additional determinant parameter in the evolution of cerebral berry aneurysms and their risk to rupture.- - - - - - - - - - ranking = 3keywords = berry (Clic here for more details about this article) |
7/41. Subclinoid aneurysms.OBJECT: This study was undertaken to analyze the features that define subclinoid aneurysms. methods: Five cases of laterally directed carotid artery (CA) aneurysms adjacent to the anterior clinoid process (ACP) were identified in a series of approximately 1400 surgically treated aneurysms. These cases were selected because the aneurysms had the same features as the only previously described "subclinoid" aneurysm. The angiographic and anatomical features of the five cases were analyzed. CONCLUSIONS: Subclinoid aneurysms are a unique group of congenital berry aneurysms. They originate from the lateral surface of the CA adjacent to the ACP. They are partially or completely hidden from view at surgery by the ACP and are partially or completely proximal to the distal dural ring of the CA. The proximal neck of these lesions is located at the same level of the CA cut perpendicular to its axis of blood flow as the origin of the ophthalmic artery (OphA), but they do not originate at that or any other branch of the CA. They can only be definitively differentiated from OphA, anterior paraclinoid, and blister-like aneurysms at surgery.- - - - - - - - - - ranking = 0.5keywords = berry (Clic here for more details about this article) |
8/41. Cerebral berry aneurysms in identical twins: a case report.A pair of identical twins in whom cerebral berry aneurysms were found is reported. One presented with epilepsy, and the aneurysm was discovered incidentally. The other presented with a spontaneous bleed, which was fatal.- - - - - - - - - - ranking = 2.5keywords = berry (Clic here for more details about this article) |
9/41. Why are aneurysms of the posterior inferior cerebellar artery so unique? Clinical experience and review of the literature.BACKGROUND: Aneurysms of the posterior inferior cerebellar artery (pica) are rare lesions. The anatomical behaviour of the artery itself is complex and characterised by a multitude of variations. The same holds true for the aneurysms discovered there. Dissecting aneurysms can be found from the pica origin to the distal artery berry. They have a wider range of clinical and radiographical presentations and their surgical treatment requires more than one standard approach. methods: We encountered 14 patients with pica aneurysms within two surgical series of a total of 1345 cerebral aneurysm patients (1 %). In this patient group of the last 27 years only 3 of the 14 were distal aneurysms ("true" pica aneurysms) RESULTS: The 14 patients harboured 15 aneurysms (9 right-sided and 6 left-sided). The female/male ratio of the patients was 9/5, the mean age 52.7 years. 13 of them had sustained an SAH. 7/14 patients were hypertensive, in 10 patients at least one of putative cerebrovascular risk factors was found. From the 15 aneurysms treated, 11 were typical berry aneurysms, 4 dissecting aneurysms. The aneurysms ranged in size from 5 to 20 mm (mean 9.1). 11 aneurysms were located within the anterior medullary segment, 1 in the tonsillomedullary and 2 in the telovelomedullary segments. All patients were surgically treated, 10 in a semi-sitting position via a suboccipital craniotomy, 4 in the prone position. 13 aneurysms were clipped, two were treated differently. Two patients died due to their bad preoperative clinical status. CONCLUSIONS: The clinical, radiographical and surgical approaches to pica aneurysms still represent a challenge.- - - - - - - - - - ranking = 1keywords = berry (Clic here for more details about this article) |
10/41. Extracranial vertebral and carotid dissection occurring in the course of subarachnoid hemorrhage.The pathogenesis of both intracranial aneurysms and spontaneous cervical artery dissection may be related to an underlying vasculopathy. Seven cases of spontaneous cervical artery dissection in the course of ruptured berry aneurysms are reported here.- - - - - - - - - - ranking = 0.5keywords = berry (Clic here for more details about this article) |
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