1/51. 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 = giant (Clic here for more details about this article) |
2/51. Treatment and results of partially thrombosed giant aneurysms.Partially thrombosed giant aneurysms are one of the most difficult diseases in the neurosurgical field. We have had 18 of these cases namely, three in vertebral artery, four in basilar artery, four in internal carotid artery, five in middle cerebral artery, and two in anterior communicating artery. Nine aneurysms were clipped, two aneurysms were removed with anastomosis, two cases were treated interventionally, and five cases were treated conservatively because of serpentine and fusiform types of aneurysms in internal carotid artery bifurcation. These conservatively treated patients died due to infarction. When surgery is selected in the thrombosed giant aneurysms, the approach is the most important to secure the neck. Three-dimensional computed tomography angiography was useful to plan the strategy for surgery. If the neck is big enough for placement of a clip, arterial reconstruction is the choice. The reconstruction must be done including an adequate size of the artery because of the thick wall. If the aneurysm neck is too small to reconstruct, aneurysmectomy with anastomosis is one of the choices.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
3/51. Acute deterioration from thrombosis and rerupture of a giant intracranial aneurysm.The authors describe a patient with an unusual clinicopathologic picture of giant aneurysmal hemorrhage followed by sudden deterioration due to acute intra-aneurysmal thrombosis and fatal rebleeding. This patient underscores the poor natural history associated with this devastating disease and serves to highlight the dangers inherent in the delayed treatment of these life-threatening lesions.- - - - - - - - - - ranking = 0.83333333333333keywords = giant (Clic here for more details about this article) |
4/51. Aggravation of brainstem symptoms caused by a large superior cerebellar artery aneurysm after embolization by Guglielmi detachable coils--case report.An 81-year-old male presented with right oculomotor nerve paresis and left hemiparesis caused by a mass effect of a large superior cerebellar artery aneurysm. Endovascular treatment was performed using Guglielmi detachable coils. The patient subsequently suffered aggravation of the mass effect 3 weeks after the embolization. Bilateral vertebral artery occlusion was performed, which decreased the cerebral edema surrounding the aneurysm, but his neurological symptoms did not improve. Parent artery occlusion is recommended as the first choice of treatment for an unclippable large or giant aneurysm causing a mass effect on the brainstem.- - - - - - - - - - ranking = 0.16666666666667keywords = giant (Clic here for more details about this article) |
5/51. Thrombosed giant middle cerebral aneurysms.Two giant thrombosed aneurysms of the middle cerebral artery are reported with a review of the pertinent literature. A tortuous channel through the thrombus results in an unusual and characteristic angiogram. Mechanisms involved in the formation of this lesion are discussed.- - - - - - - - - - ranking = 0.83333333333333keywords = giant (Clic here for more details about this article) |
6/51. thrombosis of a giant aneurysm after extracranial-intracranial bypass.A patient presenting with a giant, fusiform middle cerebral artery aneurysm underwent extracranial to intracranial bypass grafting before permanent occlusion of the aneurysm. The patient was to return 4 months later for endovascular treatment. Arteriography obtained before obliteration revealed complete aneurysmal thrombosis. No further treatment was deemed necessary. Factors predisposing to thrombosis are discussed.- - - - - - - - - - ranking = 0.83333333333333keywords = giant (Clic here for more details about this article) |
7/51. Giant thrombus trapped in foramen ovale with pulmonary embolus and stroke.We describe the case of a young man who, while he was in coma because of a traffic accident, had first a pulmonary embolus and immediately afterwards had a systemic (cerebral) embolus. A transesophageal echocardiographic image revealed a giant thrombi trapped in foramen ovale protruding in right and left ventricles, diagnosing, thus, a paradoxical embolism. The relationship between patent foramen ovale and pulmonary embolism has been reported in some series. Elevated right-chamber pressure caused by pulmonary hypertension could favor the establishment of a right-to-left shunt, causing, in some cases, paradoxical embolisms. We review the clinical implications.- - - - - - - - - - ranking = 0.16666666666667keywords = giant (Clic here for more details about this article) |
8/51. Magnetic resonance demonstration of the effect of carotid artery ligation for a giant internal carotid artery aneurysm: case report.ligation of the carotid artery remains an accepted treatment for unclippable giant carotid artery aneurysms. Post-operative evaluation is commonly made subsequently by CT scan and angiography, the latter involving an invasive procedure. This paper describes the magnetic resonance (MR) appearance of a traumatic giant terminal carotid artery aneurysm treated by common carotid ligation. MR appears to be the imaging technique of choice for follow-up of giant aneurysms of the terminal carotid artery treated by carotid ligation, the accuracy of delineation of the aneurysm and its content surpassing that of the CT scan.- - - - - - - - - - ranking = 1.1666666666667keywords = giant (Clic here for more details about this article) |
9/51. growth of totally thrombosed giant aneurysm within the posterior cranial fossa. Diagnostic and therapeutic considerations.We report a case in which growth of a totally thrombosed giant aneurysm of the posterior cranial fossa was demonstrated by computed tomography (CT) scans repeated after 4 years. A magnetic resonance (MR) image demonstrated an onion-skin-like, laminated structure within a calcified wall. The laminated structure had developed around an old thrombosis, without any communication to the flowing blood. It showed intensities indicating recent clots, revealing that the giant aneurysm had grown by recurrent intramural hemorrhage rather than by intraluminal accumulation of thrombotic materials. This case illustrates that totally thrombosed giant aneurysms still have the potential of growth.- - - - - - - - - - ranking = 1.1666666666667keywords = giant (Clic here for more details about this article) |
10/51. Giant middle cerebral aneurysm presenting as hemiathetosis in a child and its spontaneous thrombosis.A 10-year-old girl presented with a 6-week history of gradually increasing, abnormal movements and weakness of the right upper and lower limbs. There were no features of raised intracranial pressure. Computed tomography scan and magnetic resonance imaging (MRI) of the brain showed the features of a partially thrombosed giant middle cerebral artery aneurysm, located deep in the left lentiform region and compressing the basal ganglia and the mesencephalon. The angiogram confirmed the aneurysm and its origin from the main trunk of the artery with occlusion of all the branches. A direct approach was unsuitable for the treatment of the aneurysm, so an embolization procedure to occlude the neck of the aneurysm was considered. During the waiting period, the patient improved and became asymptomatic. Follow-up MRI showed complete thrombosis of the aneurysm and eventually, reduction in its size and mass effect. The hemiathetosis may have been the result of direct pressure on the basal ganglia by the aneurysm. The spontaneous intra-aneurysmal thrombosis may have been due to the massive size of the aneurysm and its narrow neck.- - - - - - - - - - ranking = 0.16666666666667keywords = giant (Clic here for more details about this article) |
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