1/89. rupture mechanism of a thrombosed slow-growing giant aneurysm of the vertebral artery--case report.A 76-year-old male developed left hemiparesis in July 1991. The diagnosis was thrombosed giant vertebral artery aneurysm. He showed progressive symptoms and signs of brainstem compression, but refused surgery and was followed up without treatment. He died of rupture of the aneurysm and underwent autopsy in March 1995. Histological examination of the aneurysm revealed fresh clot in the aneurysmal lumen, old thrombus surrounding the aneurysmal lumen, and more recent hemorrhage between the old thrombus and the inner aneurysmal wall. The most important histological feature was the many clefts containing fresh blood clots in the old thrombus near the wall of the distal neck. These clefts were not lined with endothelial cells, and seemed to connect the lumen of the parent artery with the most peripheral fresh hemorrhage. However, the diameter of each of these clefts is apparently not large enough to transmit the blood pressure of the parent artery. Simple dissection of the aneurysmal wall by blood flow in the lumen through many clefts in the old thrombus of the distal neck may be involved in the growth and rupture of thrombosed giant aneurysms of the vertebral artery.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
2/89. aneurysm retreatment after Guglielmi detachable coil and nondetachable coil embolization: report of nine cases and review of the literature.OBJECTIVE: Guglielmi detachable coil embolization of cerebral aneurysms is becoming increasingly used to manage certain intracranial lesions based on aneurysm geometry, patient condition, and patient and surgeon preferences. aneurysm recurrences or incomplete initial treatments are not uncommon, making repeat treatment necessary using either surgical or endovascular techniques. methods: Between January 1993 and June 1998, 1025 cerebral aneurysms were managed by the authors at a single hospital. One hundred twenty-four of these lesions were treated using Guglielmi detachable coils, and one was managed with nondetachable coils. During the follow-up period, eight patients who underwent embolization at our institution and one who underwent embolization elsewhere received repeat treatment. Five were approached surgically, and four underwent re-embolization. All charts and films were reviewed retrospectively to determine patient outcome and clinical success. RESULTS: No patient in the subgroup of this clinical study suffered a permanent complication from initial aneurysm coiling, no episodes of subsequent bleeding occurred, and no complications resulted from any subsequent therapies. The anatomic results were excellent, and all aneurysms were totally or near totally obliterated. CONCLUSION: Subtotal initial coil embolization of aneurysms can be managed safely using a variety of surgical and endovascular techniques. Our approach to this predicament, lessons we have learned, and a review of the literature are herein discussed.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
3/89. Application of a rigid endoscope to the microsurgical management of 54 cerebral aneurysms: results in 48 patients.OBJECT: To enhance visual confirmation of regional anatomy, endoscopy was introduced during microsurgery for cerebral aneurysms. The risks and benefits are analyzed in the present study. methods: The endoscopic technique was used during microsurgery for 54 aneurysms in 48 patients. Forty-three aneurysms were located in the anterior circulation and 11 were in the posterior circulation. Thirty-eight aneurysms (70.4%) had not ruptured. All ruptured aneurysms in the present series produced Hunt and Hess Grade I or II subarachnoid hemorrhage. After initial exposure achieved with the aid of a microscope, the rigid endoscope was introduced to confirm the regional anatomy, including the aneurysm neck and adjacent structures. The necks of 43 aneurysms were clipped using microscopic control or simultaneous microscopic/endoscopic control. After clipping, the positions of the clip and nearby structures were inspected using the endoscope. Use of the neuroendoscope provided useful information that further clarified the regional anatomy in 44 cases (81.5%) either before or after neck clipping. In nine cases (16.7%), these details were available only with the use of the endoscope. In five cases (9.3%), the surgeons reapplied the clip on the basis of endoscopic information obtained after the initial clipping. There were two cases in which surgical complications were possibly related to the endoscopic procedures (one patient with asymptomatic cerebral contusion and another with transient oculomotor palsy). CONCLUSIONS: It is the authors' impression that the use of the endoscope in the microsurgical management of cerebral aneurysms enhanced the safety and reliability of the surgery. However, there is a prerequisite for the surgeon to be familiar with this instrumentation and fully prepared for the risks and inconveniences of endoscopic procedures.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
4/89. arteriovenous fistula with associated aneurysms coexisting with dural arteriovenous malformation of the anterior inferior falx. Case report and review of the literature.This 24-year-old man presented with an unusual case of a high-flow arteriovenous fistula (AVF). This lesion was similar to giant AVFs in children that have been previously described in the literature. In patients in whom abnormalities of the vein of Galen have been excluded and in whom presentation occurs after 20 years of age, a diagnosis of congenital AVF is quite unusual. The fistula in this case originated in an enlarged callosomarginal artery and drained into the superior sagittal sinus via a saccular vascular abnormality. Two giant aneurysmal dilations of the fistula were present. In an associated finding, a small falcine dural arteriovenous malformation (AVM) was also present. Arterial supply to the AVM arose from both external carotid arteries and the left vertebral artery, with drainage through an aberrant vein in the region of the inferior sagittal sinus into the vein of Galen. craniotomy with exposure and trapping of the AVF was performed, with subsequent radiosurgical (linear accelerator) treatment of the dural AVM. Through this combination of microsurgical trapping of the AVF and radiotherapy of the dural AVM, an excellent clinical outcome was achieved.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
5/89. Growing blood clot mimicking an aneurysm on postoperative computerized tomography and magnetic resonance imaging studies. Case report and review of the literature.The authors describe the case of a 15-year-old boy who underwent resection of a large left temporal tumor. During a normal postoperative course, computerized tomography (CT) scanning demonstrated a spherically hyperdense structure near the internal carotid artery, enlarging on a control CT scan. A suspected false aneurysm was confirmed on magnetic resonance imaging; angiographic studies were negative. The authors believed they were dealing with a thrombosed false aneurysm and they performed operative revision. Intraoperatively the "aneurysm" could be dissected off the internal carotid artery and no lesion of the arterial wall was obvious. Histological findings showed a fresh blood clot. This case demonstrates that a blood clot may mimic an aneurysm on CT and magnetic resonance studies, which has not been described earlier. The origin of the blood clot remains unclear.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
6/89. Screening for cerebral aneurysm in patients with polycystic liver disease.BACKGROUND: Polycystic liver disease (PCLD) is an autosomal dominant disease characterized by multiple macrocystic lesions throughout the liver. The association between PCLD and cerebral aneurysm is well documented, and approximately 20% of patients with PCLD have demonstrable cerebral aneurysms at autopsy. The prevalence reported from autopsy series, however, may not reflect the true prevalence in patients with PCLD. We undertook this study to evaluate the prevalence and diagnosis of cerebral aneurysms in screening cerebral studies in patients with PCLD. methods: patients were identified by searching the hepatobiliary surgical service data base and hospital medical records. Hospital charts were reviewed to confirm presence of PCLD and to identify screening studies for cerebral aneurysms. RESULTS: Ten patients with PCLD received screening studies of the cerebral vasculature during a 10 1/2-year period. One patient was found to have an asymptomatic cerebral aneurysm. A 45-year-old woman with no other significant medical history was referred for evaluation of PCLD. Screening magnetic resonance angiography (MRA) revealed a 5 mm aneurysm extending anteriorly near the origin of the right ophthalmic artery, without evidence of rupture. cerebral angiography confirmed these findings, and the aneurysm was clipped. CONCLUSIONS: Because cerebral aneurysms can be an important source of morbidity and mortality in PCLD, we recommend screening by MRA or by computed tomographic angiography (CTA) of the cerebral vasculature in all patients who have PCLD.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
7/89. Intracranial stent placement to trap an extruded coil during endovascular aneurysm treatment: technical note.OBJECTIVE: The development of low profile, navigable stents has expanded the range of intracranial neuroendovascular procedures. We report a unique case of endovascular stent placement to trap a partially extruded Guglielmi detachable coil (GDC) during treatment of an internal carotid artery (ICA) cavernous segment aneurysm. methods: A 49-year-old woman presented for endovascular coiling of a left superior hypophyseal artery aneurysm. Previously, a contralateral mirror lesion had been treated by stent-assisted coiling. heparin was administered to maintain an activated coagulation time of greater than 250 seconds, and a guide catheter was placed in the cervical ICA. A microcatheter was advanced into the aneurysm over a microguidewire. A GDC-10, 3-dimension, 6 x 20-mm coil was placed within the aneurysm, forming a stable basket. Three additional GDCs were placed with near-complete obliteration of the aneurysm. Attempted placement of a fifth coil caused partial prolapse of a previously placed coil into the cavernous ICA. We decided to place a stent rather than to snare the extruded coil because the extruded coil was integral to the aneurysm coil mass. A 3.5x8-mm balloon-expandable stent was placed across the aneurysm orifice, trapping the extruded coil between the stent and ICA. RESULTS: Digital subtraction angiography documented patency of the ICA lumen. The patient remains neurologically intact and awaits 3-month follow-up cerebral angiography. CONCLUSION: Trapping of an extruded intraaneurysmal coil via stent placement obviated the need for coil removal and avoided the risk of coil mass manipulation. The use of a stent to displace extruded coils and reconstitute a "normal" lumen is an excellent addition to our endovascular armamentarium.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
8/89. Postpartum dissecting aneurysm of the superior cerebellar artery--case report.A 37-year-old female with toxemia of pregnancy suffered sudden headache and loss of consciousness on the day following a cesarean delivery. Computed tomography revealed subarachnoid hemorrhage (SAH). Vertebral angiography revealed a fusiform dilatation near the origin of the right superior cerebellar artery (SCA) with distal luminal narrowing. She underwent surgery within 24 hours of the ictus. A SAH clot was carefully removed from the prepontine cistern, and subadventitial discoloration was seen in the wall of the right SCA just distal to the aneurysmal protuberance (rupture site). The dissecting aneurysm was treated with body clipping by directly clipping the rupture site and with additional wrapping of the proximal SCA, including the aneurysmal protuberance and discolored site. The postoperative clinical course was uneventful. Postoperative angiography revealed complete obliteration of the aneurysm and patency of the SCA. Therapeutic intervention should be considered for patients with ruptured dissecting aneurysm who present with recurrent SAH.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
9/89. Ruptured vertebral artery-posterior inferior cerebellar artery aneurysm associated with facial nerve paresis successfully treated with interlocking detachable coils--case report.An 81-year-old female presented with severe headache. Computed tomography revealed subarachnoid hemorrhage. She developed right facial nerve paresis on the next day. Angiography revealed a right vertebral artery-posterior inferior cerebellar artery aneurysm. The aneurysm was successfully occluded with interlocking detachable coils (IDCs) on the 7th day. Magnetic resonance (MR) imaging 1 month after IDC placement showed partially thrombosed aneurysm near the internal acoustic meatus. Ten months after the ictus, MR imaging revealed marked resolution of the intra-aneurysmal thrombus and reduction of the aneurysm size. Her facial nerve function gradually recovered during this period. Her facial nerve paresis was probably caused by acute stretching of the facial nerve by the ruptured aneurysm that was in direct contact with the nerve. Intra-aneurysmal thrombosis using coils can reduce aneurysm size and alleviate cranial nerve symptoms.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
10/89. Antegrade recanalization of completely embolized internal carotid artery after treatment of a giant intracavernous aneurysm: a case report.BACKGROUND: Parent artery occlusion is one of the traditional methods of treatment for unclippable aneurysms. However, parent artery occlusion may not result in permanent exclusion of the aneurysm from the systemic circulation. We present a case of cerebral aneurysm treated by proximal embolization of the parent artery, which recanalized during the follow-up period. CASE DESCRIPTION: A 69-year-old woman presented with a right blepharoptosis and diplopia. A large aneurysm arising from the cavernous portion of the right internal carotid artery was found and endovascularly excluded from the cerebral circulation by proximal internal carotid artery occlusion with balloons. Eleven days after treatment, occlusion of the parent artery and obliteration of the aneurysm were angiographically confirmed. However, the parent artery was found to be recanalized with nearly total obliteration of the aneurysm at the follow-up 6 months after treatment. CONCLUSION: Angiography suggested that recanalization took place through the vaso vasorum. We believe that recanalization was induced by marginal cerebral blood flow in the ipsilateral hemisphere.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
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