1/13. Guglielmi detachable coil treatment of a partially thrombosed giant basilar artery aneurysm in a child.We report a partially thrombosed giant of the aneurysm basilar artery with prominent mass effect, diagnosed in an 11 year-old child who presented with neurological deficits due to brain stem compression. After the patent portion of the aneurysm was embolised with Guglielmi detachable coils, remarkable clinical improvement occurred. angiography demonstrated complete occlusion of the aneurysm and MRI revealed dramatic shrinkage of the aneurysm at 6-month and 1-year follow-up.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
2/13. Giant aneurysm of the azygos anterior cerebral artery--case report.A 77-year-old female presented with a giant aneurysm of the azygos anterior cerebral artery (ACA) manifesting as acute onset of akinetic mutism caused by enlargement of the aneurysm resulting from rapid thrombus formation within the aneurysmal sac. Thrombus removal to obtain decompression of the aneurysmal bulk and tension was performed before parent artery occlusion to prevent thromboembolic events. The aneurysmal neck was completely clipped with preservation of the parent artery and all branches. This strategy for direct neck clipping of a giant thrombosed distal ACA aneurysm can reduce the possibility of ischemic sequelae.- - - - - - - - - - ranking = 0.4keywords = giant (Clic here for more details about this article) |
3/13. Giant intracranial aneurysm of the anterior communicating artery treated by direct surgical approach. Case report.We report the singular case of an exceptionally large giant communicating artery aneurysm successfully treated with a direct surgical approach. The clinical presentation was a relatively short history of frontal headache. In the pre- and postcontrast CT scans the lesion mimicked an intracranial tumor. At surgery the intraluminal thrombus was partially removed with an ultrasonic surgical aspirator; the decompression allowed the isolation and subsequent temporary dipping of the tracts A1 and A2 of both the anterior cerebral arteries. It was then possible to complete the thrombectomy and to dip the neck of the aneurysm. The report emphasizes the indispensable role of MRI for the accurate diagnosis of giant intracranial aneurysms and the recent improvement of the surgical results concerning this category of aneurysms (mainly related to the present wider availability of technical surgical instrumentation).- - - - - - - - - - ranking = 0.4keywords = giant (Clic here for more details about this article) |
4/13. 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) |
5/13. Focal neurological deficits following spontaneous thrombosis of unruptured giant aneurysms.BACKGROUND: Giant aneurysms (GAs) must be regarded as dynamic lesions with respect to their growth and intraluminal thrombus formation, occasionally giving rise to thromboembolic events. Little is known about spontaneous thrombosis of unruptured GAs leading to focal neurological deficits which can mimic arteriosclerotic, epileptic or neoplastic disease. methods: Three patients (2 men, 27 and 68 years old, and 1 woman, 32 years old) presented with progressive neurological deficits. Neuroradiological studies showed unruptured GAs [two of the middle cerebral artery (MCA), one of the anterior communicating artery] displaying spontaneous near complete intraluminal thrombosis. In one of the cases with a giant MCA aneurysm, acute thrombosis was followed by infarction of the corresponding territory. RESULTS: Partial excision of the intraluminal thrombus was performed in the anterior communicating artery lesion. Wrapping followed by an extracranial-intracranial bypass and stepwise trapping successfully excluded one MCA lesion from circulation. The other MCA aneurysm was treated conservatively. All three patients showed full recovery neurologically after treatment. CONCLUSION: The reported clinical history of three patients who developed rapid focal progressive neurological deterioration following acute spontaneous thrombosis can be attributed to the acute swelling of the aneurysmal mass. Their pattern of consecutive rapid clinical improvement represents a previously undescribed clinical course of unruptured GAs.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
6/13. Complete asymptomatic thrombosis and resorption of a congenital giant intracranial aneurysm.Intracranial aneurysms in infants are rare, but are associated with a high risk of rupture and subarachnoid hemorrhage. The authors report a case of an incidentally diagnosed, probably congenital, asymptomatic giant aneurysm of the posterior communicating artery in a 9-month-old girl, which completely thrombosed following a diagnostic superselective angiography without any neuropathological incident. Follow-up magnetic resonance imaging revealed that the aneurysm decreased further in size and was largely resorbed within 3 years after the initial finding. In single cases the natural history of congenital giant aneurysms may be better than previously assumed.- - - - - - - - - - ranking = 1.2keywords = giant (Clic here for more details about this article) |
7/13. Small aneurysms as a cause of thromboembolic stroke.OBJECTIVE AND IMPORTANCE: A small percentage of patients with intracranial aneurysms present with embolic stroke distal to the site of the aneurysm. thromboembolism typically occurs in large or giant aneurysms where reduction of flow within the aneurysm is thought to increase the possibility of clot formation. Only a few examples are available in the literature of patients with smaller aneurysms who develop embolic infarction distal to the lesion. We have experience with two such patients with an apparent common pathophysiology. CLINICAL PRESENTATION: Patient 1 with a distal left middle cerebral artery infarct was found to have an 18 mm carotid artery bifurcation aneurysm (patient age 49 years). Patient 2 had a 7 mm right middle cerebral artery aneurysm with a small distal embolus (patient age 65 years). At surgery both patients were found to have atherosclerotic disease involving the aneurysm base and parent vessel. In each instance, the aneurysm was opened during temporary vessel occlusion and microendarterectomy was performed. Occlusion of one of the major arterial branches exiting the aneurysm was also present with anterior cerebral artery occlusion in the case of ICA bifurcation lesion and MCA branch occlusion in the case of the MCA aneurysm. Both patients made a good recovery following surgery. CONCLUSION: In small aneurysms with atherosclerotic disease distal thromboembolism may occur. Surgical treatment with microendarterectomy is appropriate to prevent further emboli and potential for subarachnoid hemorrhage. (Fig. 5, Ref. 16.)- - - - - - - - - - ranking = 0.2keywords = giant (Clic here for more details about this article) |
8/13. Surgical strategies for treatment of giant or large intracranial aneurysms: our experience with 139 cases.Giant or large intracranial aneurysms are the vascular neurosurgeon's greatest challenge. At our department, we have treated one hundred and thirty nine patients with giant or large intracranial aneurysms between 1975 and 2001. These included 37 partially thrombosed giant aneurysms. 75 aneurysms were giant (> 2.5 cm) and 64 were large aneurysms (2-2.5 cm). Three-dimensional computed tomography angiograms were performed in patients besides MRI angiography and digital subtraction angiography. These were found to be very valuable in the preoperative assessment of surgical anatomy of the aneurysm with respect to the branch arteries and perforators origin besides knowing the relations to the skull base. With our experience in surgical treatment of these 139 cases, we find that the basic technique is trapping and evacuation and not just clipping of the aneurysm neck but also reconstruction of the artery bearing the aneurysm, especially with wide-necked aneurysms. Use of multiple clipping, tandem clipping or dome clipping as per the intraoperative situation, is very helpful in dealing with giant aneurysms as also is the use of different types of clips like fenestrated clip with straight clip (combination clipping), booster clip, dome clips etc. While selecting surgical strategy for partially thrombosed giant aneurysm, securing the neck is most important. If the neck is too narrow to reconstruct, aneurysmectomy with anastomosis is one of the surgical strategies. An extracranial intracranial bypass should be considered in cases where clipping or parent artery ligation is expected to be associated with compromise of cerebral circulation.- - - - - - - - - - ranking = 1.8keywords = giant (Clic here for more details about this article) |
9/13. Intravascular papillary endothelial hyperplasia in an intracranial thrombosed aneurysm: 3T magnetic resonance imaging and angiographical features.Enhancement of intracranial thrombosed aneurysms is an uncommon finding on magnetic resonance (MR) imaging, and can present diagnostic difficulties and complicate management decisions. We report a 46-year-old man who had an enhancing thrombosed intracranial aneurysm observed on 3T MR imaging. There was angiographical correlation, with follow-up serial MR imaging documenting regression and improvement. Findings are typical for benign intravascular papillary endothelial hyperplasia. Differential diagnoses of giant serpentine intracranial aneurysm and malignant angiosarcoma are discussed.- - - - - - - - - - ranking = 0.2keywords = giant (Clic here for more details about this article) |
10/13. Ruptured de novo thrombotic giant aneurysm induced by ethyl 2-cyanoacrylate: case report.BACKGROUND: A very rare case of a ruptured aneurysm induced by ethyl 2-cyanoacrylate is reported. CASE DESCRIPTION: Six years earlier, this 68-year-old woman had undergone microvascular decompression for trigeminal neuralgia during which the left vertebral artery, which compressed the exit zone of the trigeminal nerve, had been detached and fixed to the dura mater of the petrous bone with ethyl 2-cyanoacrylate. Shortly thereafter she underwent microvascular decompression for left-side facial palsy; again ethyl 2-cyanoacrylate was used. Six years later, she suffered a subarachnoid hemorrhage because of rupture of a new aneurysm of the left vertebral artery. She was referred to our hospital where coil embolization was attempted on the day following the insult. However, the left vertebral artery and the aneurysm could not be occluded completely, and she suddenly died 20 days later from rerupture of the aneurysm. CONCLUSION: This is the first pathologic report of a ruptured de novo aneurysm induced by ethyl 2-cyanoacrylate. We suggest that arterial wall damage by ethyl 2-cyanoacrylate may have contributed to the development of the de novo aneurysm.- - - - - - - - - - ranking = 0.8keywords = giant (Clic here for more details about this article) |
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