1/962. Embolic bacterial aneurysm of the basilar artery: case report.A patient with basilar artery rupture caused by a septic embolus originating from a mitral valve vegetation is reported. The pathogenesis, investigation and management of infected cerebral aneurysms are reviewed.- - - - - - - - - - ranking = 1keywords = aneurysm (Clic here for more details about this article) |
2/962. Giant fusiform aneurysm of the middle cerebral artery: successful Hunterian ligation without distal bypass.Giant fusiform aneurysm is a rare vascular lesion which presents difficult management issues. We describe one such aneurysm in a middle cerebral artery branch (M2) that presented with subarachnoid haemorrhage and was managed operatively. Clinical, radiological and pathological presentations, as well as the different treatment options for this type of aneurysm are discussed based on a literature review. A satisfactory results in an M2 giant fusiform aneurysm can be achieved with Hunterian ligation of the parent vessel even when a distal EC-IC bypass is not possible.- - - - - - - - - - ranking = 1.6keywords = aneurysm (Clic here for more details about this article) |
3/962. Surgical treatment of internal carotid artery anterior wall aneurysm with extravasation during angiography--case report.A 54-year-old female presented subarachnoid hemorrhage from an aneurysm arising from the anterior (dorsal) wall of the internal carotid artery (ICA). During four-vessel angiography, an extravasated saccular pooling of contrast medium emerged in the suprasellar area unrelated to any arterial branch. The saccular pooling was visualized in the arterial phase and cleared in the venophase during every contrast medium injection. We suspected that the extravasated pooling was surrounded by hard clot but communicated with the artery. Direct surgery was performed but major premature bleeding occurred during the microsurgical procedure. After temporary clipping, an opening of the anterior (dorsal) wall of the ICA was found without apparent aneurysm wall. The vessel wall was sutured with nylon thread. The total occlusion time of the ICA was about 50 minutes. Follow-up angiography demonstrated good patency of the ICA. About 2 years after the operation, the patient was able to walk with a stick and to communicate freely through speech, although left hemiparesis and left homonymous hemianopsia persisted. The outcome suggests our treatment strategy was not optimal, but suture of the ICA wall is one of the therapeutic choices when premature rupture occurs in the operation.- - - - - - - - - - ranking = 1.2keywords = aneurysm (Clic here for more details about this article) |
4/962. Clinical evaluation of the effect of percutaneous transluminal angioplasty and intra-arterial papaverine infusion for the treatment of vasospasm following aneurysmal subarachnoid hemorrhage.The clinical efficacy of percutaneous transluminal angioplasty and intra-arterial papaverine infusion for treatment of vasospasm following subarachnoid hemorrhage was investigated. Between 1990 and 1993, 84 patients were treated for cerebral vasospasm in National Defense Medical College Hospital. angioplasty was performed for asymptomatic vasospasm in 18 patients and for symptomatic vasospasm in 12 patients. Intra-arterial papaverine infusion was performed for asymptomatic vasospasm in 10 patients and for symptomatic vasospasm in four patients. The other 40 patients were treated with standard conservative therapy including hypervolemic and hypertensive hemodilution. The outcomes of these patients were analyzed using the glasgow outcome scale. The outcome tended to be better for patients treated with angioplasty, but not for those treated with papaverine infusion, than for those treated conservatively. recurrence of vasospasm was more frequent after papaverine infusion than after angioplasty. Undesirable complications such as abrupt development of unconsciousness were experienced during papaverine infusion but not during angioplasty. We conclude that percutaneous transluminal angioplasty is superior to intra-arterial papaverine infusion for prevention and treatment of vasospasm following aneurysmal subarachnoid hemorrhage.- - - - - - - - - - ranking = 1keywords = aneurysm (Clic here for more details about this article) |
5/962. Subtemporal suboccipital transpetrosal transsigmoidal approach to aneurysm of the basilar artery fenestration.The aneurysm arising from the lower third of a basilar artery fenestration is a rare event. The traditional suboccipital or subtentorial transtentorial or transoral approach to this vascular malformation can be problematic. We report the case of a 52-year-old woman who suffered a Grade 4 subarachnoid hemorrhage from an aneurysm located at a fenestration of the proximal third of the basilar artery. This aneurysm was successfully clipped through a left subtemporal suboccipital translabyrinthine transsigmoidal approach. In the aneurysms of the proximal third of the basilar artery the transpetrosal approach with its variants (translabyrinthine and transsigmoidal) related to patient's clinical condition can be useful with undoubted advantages.- - - - - - - - - - ranking = 1.6keywords = aneurysm (Clic here for more details about this article) |
6/962. Bedside-microdialysis for early detection of vasospasm after subarachnoid hemorrhage. Case report and review of the literature.Continuous monitoring of cerebral metabolism would be desirable for early detection of vasospasm in SAH patients. Bedside-microdialysis, a new technique for on-line monitoring of cerebral metabolism, may reflect changes seen in cerebral vasospasm diagnosed by transcranial Doppler sonography (TCD). This report represents the first case of combined TCD monitoring and on-line microdialysis from the brain extracellular fluid in a SAH patient. A 48-year-old woman suffered subarachnoid hemorrhage grade IV according to Hunt and Hess. angiography revealed an aneurysm of the left carotid artery. The aneurysm was clipped 45 hours after bleeding. The microdialysis catheter was inserted after aneurysm clipping into the white matter of the left temporal lobe. Sampling of microdialysates started immediately, analyzing time for glucose, lactate, pyruvate and glutamate was four minutes. Postoperatively, the patient was doing well and microdialysis and TCD parameters remained within normal range. On the third postoperative day a shift to anaerob metabolism (decrease of glucose, increase of lactate and the lactate-pyruvate ratio up to pathological levels) and an increase in glutamate was observed suggesting insufficient cerebral perfusion. The patient progressively deteriorated clinically. Vasospasm was diagnosed by TCD monitoring 36 hours after onset of ischemic changes monitored by microdialysis. After elevation of mean arterial blood pressure, TCD values and metabolic parameters normalized. Interestingly, the pathological changes in on-line microdialysis preceded the typical increase in blood flow velocity by TCD and the clinical deterioration. Our case suggests, that bedside-microdialysis may be useful for early detection of vasospasm and continuous surveillance of treatment and may be a new guide to treat ischemic neurological deficits following SAH.- - - - - - - - - - ranking = 0.6keywords = aneurysm (Clic here for more details about this article) |
7/962. Endovascular treatment of multiple aneurysms involving the posterior intracranial circulation.The results of surgery on multiple intracranial aneurysms tha involve the vertebrobasilar circulation are poor, and associated patient mortality remains high. We describe the endovascular treatment of four patients with mutiple aneurysms that involved the posterior intracrancial circulation. Satisfactory occlusion of all aneurysms was achieved by using electrolytically detachable coils, and all patients had a good clinical recovery. Our early experience suggests that endovascular coil occlusion may be a particularly suitable method for treating this high-risk condition.- - - - - - - - - - ranking = 1.4keywords = aneurysm (Clic here for more details about this article) |
8/962. subarachnoid hemorrhage due to septic embolic infarction in infective endocarditis.During antibiotic therapy, a 56-year-old man with a streptococcus bovis endocarditis developed an infarction of the right middle cerebral artery (MCA). Thirty hours after stroke onset, cranial computed tomography controls demonstrated a secondary subarachnoid hemorrhage, marked in the cistern of the right MCA. The latent period, cerebrospinal fluid analysis, angiographic and pathologic findings favor the assumption of a pyogenic arterial wall necrosis of the MCA due to a septic embolus. This pathomechanism of intracranial hemorrhage in infective endocarditis should be distinguished from a rupture of a mycotic aneurysm.- - - - - - - - - - ranking = 0.2keywords = aneurysm (Clic here for more details about this article) |
9/962. Intraoperative use of nitric oxide during intracranial aneurysm clipping in a patient with acute respiratory distress syndrome.We describe a case of subarachnoid hemorrhage (SAH) complicated by acute respiratory distress syndrome (ARDS) and cerebral vasospasm. Inhaled nitric oxide (NO) was used to improve oxygenation, thereby facilitating cerebral aneurysm clipping.- - - - - - - - - - ranking = 1keywords = aneurysm (Clic here for more details about this article) |
10/962. Resolution of third nerve paresis after endovascular management of aneurysms of the posterior communicating artery.The effect of endovascular treatment on the recovery of neural function in patients with third nerve palsy caused by an aneurysm of the posterior communicating artery is poorly documented. We report three cases in which third nerve paresis resolved completely within 2 to 3 weeks of endovascular occlusion of a posterior communicating artery aneurysm.- - - - - - - - - - ranking = 1.2keywords = aneurysm (Clic here for more details about this article) |
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