scholarly journals Spontaneous Disappearance of an Intracranial Aneurysm After Subarachnoid Hemorrhage

1992 ◽  
Vol 19 (3) ◽  
pp. 389-391 ◽  
Author(s):  
Mark G. Hamilton ◽  
Oliver N.R. Dold
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Intracranial Aneurysm ◽  
Cerebral Aneurysms ◽  
Artery Aneurysm ◽  
Anterior Communicating Artery ◽  
Complete Disappearance ◽  
Slow Recovery ◽  
Spontaneous Thrombosis ◽  
Grade 5 ◽  
Spontaneous Disappearance

ABSTRACT:Spontaneous disappearance of an intracranial aneurysm after subarachnoid hemorrhage is an uncommon event and usually associated with severe cerebral vasospasm, giant aneurysms or the use of antifibrinolytics. We present a young woman who suffered a grade 5 subarachnoid hemorrhage with severe vasospasm caused by a small anterior communicating artery aneurysm. The patient underwent a slow recovery and two years later requested surgery. Angiography demonstrated complete disappearance of the aneurysm. The neurosurgeon should be aware that spontaneous thrombosis of cerebral aneurysms can occur and ensure that angiography is repeated when surgery is significantly delayed.

STENT REMODELING TECHNIQUE FOR COILING OF RUPTURED WIDE-NECK CEREBRAL ANEURYSMS: CASE REPORT

Neurosurgery ◽  
2009 ◽  
Vol 65 (5) ◽  
pp. E1007-E1008 ◽  
Author(s):  
Demetrius K. Lopes ◽  
Kalani Wells
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cerebral Aneurysms ◽  
Artery Aneurysm ◽  
Anterior Communicating Artery ◽  
Parent Vessel ◽  
Aneurysm Neck ◽  
Acute Subarachnoid Hemorrhage ◽  
The Right ◽  
Wide Neck ◽  
Cordis Corporation

Abstract OBJECTIVE To describe a novel stent remodeling technique for the coiling of ruptured wide-neck cerebral aneurysms. CLINICAL PRESENTATION A 46-year-old man presented with acute subarachnoid hemorrhage (Hunt and Hess grade IV), intracerebral hemorrhage, and hydrocephalus. Cerebral angiography revealed a wide-neck small anterior communicating artery aneurysm. Conventional coiling was not successful because of coil instability and compromise of the dominant anterior cerebral artery. TECHNIQUE A 6-French shuttle sheath (Cook Medical, Indianapolis, IN) was advanced from a right femoral approach into the right common carotid artery. To protect the parent vessel during coiling without compromising blood flow, a Prowler Select Plus catheter (Cordis Corporation, Bridgewater, NJ) was navigated across the aneurysm neck. Subsequently, an Enterprise stent (22-mm length; Cordis Corporation) was partially deployed across the aneurysm's wide neck. It was very important to watch the distal markers of the stent and lock the stent delivery wire to the Prowler Select Plus with a hemostatic valve once the stent was halfway deployed. This maneuver was essential to prevent further deployment of the stent. The SL-10 microcatheter and Synchro 14 wire (Boston Scientific, Natick, MA) were carefully navigated to the aneurysm passing through the partially deployed stent. Coils were then delivered to the aneurysm using the stent as a scaffold. After coiling, the SL-10 microcatheter was removed and the stent was recaptured into the Prowler Select Plus catheter. During the recapture, there was initial resistance. This was easily overcome after deploying the stent a little more before resheathing. During the procedure, the patient received 2000 U of heparin after the first coil was detached in the aneurysm. CONCLUSION The stent remodeling technique is a novel endovascular technique that can be used to treat ruptured wide-neck aneurysms and maintain patency of parent vessels, avoiding the use of antiplatelet therapy in acute subarachnoid hemorrhage.

Multiple ruptured cerebral aneurysms in a child with Takayasu arteritis

2008 ◽  
Vol 1 (1) ◽  
pp. 83-87 ◽  
Author(s):  
Suresh N. Magge ◽  
H. Isaac Chen ◽  
Michael F. Stiefel ◽  
Linda Ernst ◽  
Ann Marie Cahill ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cerebral Aneurysm ◽  
Takayasu Arteritis ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Cerebral Aneurysms ◽  
Artery Aneurysm ◽  
Anterior Communicating Artery ◽  
Rare Presentation ◽  
Anterior Communicating Artery Aneurysm ◽  
Clip Application

✓The authors report the case of an 18-month-old girl who presented with a ruptured anterior communicating artery aneurysm, and who was later diagnosed with Takayasu arteritis. Her initial aneurysm was successfully treated with clip application. However, over a 6-month period she had multiple ruptures from new and rapidly recurring aneurysms adjacent to the clips. These aneurysms were treated with repeated craniotomy and clip application and then with endovascular coil placement. Aneurysmal subarachnoid hemorrhage is a rare presentation of Takayasu arteritis. To the authors' knowledge, this is the youngest reported patient with Takayasu arteritis to present with a ruptured cerebral aneurysm.

Cyanosis and Clipping: Noninfectious Aneurysm in a Patient with 22q11.2 Deletion Syndrome

2021 ◽  
pp. 1-5
Author(s):  
Bhanu Jayanand Sudhir ◽  
Sanjay Honavalli Murali ◽  
Jaypalsinh Gohil ◽  
Rajalakshmi Poyuran ◽  
Manikantan Sethuraman ◽  
...  
Keyword(s):  
Heart Disease ◽  
Cerebral Aneurysms ◽  
Artery Aneurysm ◽  
22Q11.2 Deletion Syndrome ◽  
Neurological Deficits ◽  
Deletion Syndrome ◽  
Anterior Communicating Artery ◽  
Cyanotic Heart Disease ◽  
22Q11.2 Deletion ◽  
Congenital Cyanotic Heart Disease

Noninfectious cerebral aneurysms are rare in patients with congenital cyanotic heart disease. We present a patient with DiGeorge/velocardiofacial syndrome with a complex congenital cyanotic heart disease with a ruptured anterior communicating artery aneurysm. The 10-year-old child was managed by surgical clipping of the aneurysm. Surgical challenges included prominent veins in the Sylvian fissure, difficulty in differentiating arterial and venous bleed, and anesthetic risks. The patient recovered without any neurological deficits. This is the first report of a patient with 22q11.2 deletion syndrome, with a noninfectious cerebral aneurysm.

Surgery for angiographically occult cerebral aneurysms

1993 ◽  
Vol 79 (5) ◽  
pp. 674-679 ◽  
Author(s):  
Jafar J. Jafar ◽  
Howard L. Weiner
Keyword(s):  
Cerebral Aneurysms ◽  
Artery Aneurysm ◽  
Sylvian Fissure ◽  
Ct Scans ◽  
Anterior Communicating Artery ◽  
Content Type ◽  
Excellent Outcome ◽  
Interpeduncular Cistern ◽  
Spontaneous Subarachnoid Hemorrhage ◽  
Exploratory Surgery

✓ In 15% of patients with spontaneous subarachnoid hemorrhage (SAH), the source of bleeding cannot be determined despite repeated cerebral angiography. However, some patients diagnosed as having “SAH of unknown cause” actually harbor undetected aneurysms. The authors report six patients with SAH who, despite multiple negative cerebral angiograms, underwent exploratory surgery due to a high clinical and radiographic suspicion for the presence of an aneurysm. Brain computerized tomography (CT) scans revealed blood located mainly in the basal frontal interhemispheric fissure in four patients, in the sylvian fissure in one patient, and in the interpeduncular cistern in one patient. The patients were evaluated as Hunt and Hess Grades I to III, and had undergone at least two high-quality cerebral angiograms that did not reveal an aneurysm. Vasospasm was visualized in two patients. Three patients rebled while in the hospital. Exploratory surgery was performed at an average of 12 days post-SAH. Five aneurysms were discovered at surgery and were successfully clipped. All four patients with interhemispheric blood were found to have an anterior communicating artery (ACoA) aneurysm. The patient with blood in the sylvian fissure was found to have a middle cerebral artery aneurysm. These aneurysms were partially thrombosed. No aneurysm was detected in the patient with interpeduncular SAH, despite extensive basilar artery exploration. Five patients had an excellent outcome and one patient developed diabetes insipidus. These results show that exploratory aneurysm surgery is warranted, despite repeated negative cerebral angiograms, if the patient manifests the classical signs of SAH with CT scans localizing blood to a specific cerebral blood vessel (particularly the ACoA) and if a second SAH is documented at the same site.

Saccular Intracranial Aneurysm Disease

Neurosurgery ◽  
2010 ◽  
Vol 66 (4) ◽  
pp. 631-638 ◽  
Author(s):  
Terhi Huttunen ◽  
Mikael von und zu Fraunberg ◽  
Juhana Frösen ◽  
Martin Lehecka ◽  
Gerard Tromp ◽  
...  
Keyword(s):  
Risk Factors ◽  
Subarachnoid Hemorrhage ◽  
Intracranial Aneurysm ◽  
Anterior Communicating Artery ◽  
Sporadic Group ◽  
Site Distribution ◽  
Median Diameter ◽  
Age And Sex ◽  
Eastern Finland ◽  
First Admission

Abstract OBJECTIVE Finnish saccular intracranial aneurysm (sIA) disease associates to 2q33, 8q11, and 9p21 loci and links to 19q13, Xp22, and kallikrein cluster in sIA families. Detailed phenotyping of familial and sporadic sIA disease is required for fine mapping of the Finnish sIA disease. METHODS Eastern Finland, which is particularly isolated genetically, is served by Kuopio University Hospital's Department of Neurosurgery. We studied the site and size distribution of unruptured and ruptured sIAs in correlation to age and sex in 316 familial and 1454 sporadic sIA patients on first admission from 1993 to 2007. RESULTS The familial and sporadic aneurysmic subarachnoid hemorrhage patients had slightly different median ages (46 vs 51 years in men; 50 vs 57 years in women), different proportion of males (50% vs 42%), equal median diameter of ruptured sIAs (7 mm vs 7 mm) with no correlation to age, and equally unruptured sIAs (30% vs 28%). The unruptured sIAs were most frequent at the middle cerebral artery (MCA) bifurcation (44% vs 39%) and the anterior communicating artery (12% vs 13%), in contrast to the ruptured sIAs at the anterior communicating artery (37% vs 29%) and MCA bifurcation (29% vs 29%). The size of unruptured sIAs increased by age in the sporadic group. CONCLUSION The MCA bifurcation was most prone to develop unruptured sIAs, suggesting that MCA branching during the embryonic period might be involved. The different site distribution of ruptured and unruptured sIAs suggests different etiologies for sIA formation and rupture. The lack of correlation of size and age at rupture (exposure to risk factors) suggests that the size at rupture is more dependent on hemodynamic stress.

scholarly journals Hemodynamic Consideration of Intracranial Aneurysm

2017 ◽  
Vol 3 (4) ◽  
pp. 229-236
Author(s):  
Hiroshi Ujiie ◽  
Chie Shinohara ◽  
Yoshinori Tamano ◽  
Kouichi Katou ◽  
Akira Teramoto
Keyword(s):  
Fluid Dynamics ◽  
Blood Flow ◽  
Intracranial Aneurysm ◽  
Middle Cerebral Artery ◽  
Internal Carotid ◽  
Cerebral Aneurysms ◽  
Anterior Communicating Artery ◽  
Great Care ◽  
Wall Strength ◽  
Surgical Manipulation

We reviewed basic considerations in fluid dynamics of cerebral aneurysms and applied these in surgery on the three most common types: internal carotid-posterior communicating artery, middle cerebral artery, and anterior communicating artery. It was found that aneurysmal initiation and growth do not occur at symmetric bifurcations. As blood flow always obeys the law of inertia, jet flow into the aneurysm will disperse along the wall; assuming the aneurysmal wall strength is even, the shape of the aneurysm becomes round or oval. When neurosurgeons encounter an aneurysm that is not round or oval, the wall may be fragile and requires great care during surgical manipulation.

Use of spiral computerized tomography angiography in patients with subarachnoid hemorrhage in whom subtraction angiography did not reveal cerebral aneurysms

2000 ◽  
Vol 92 (2) ◽  
pp. 278-283 ◽  
Author(s):  
Hiroyuki Hashimoto ◽  
Jun-Ichi Iida ◽  
Yasuo Hironaka ◽  
Masato Okada ◽  
Toshisuke Sakaki
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Ct Angiography ◽  
Cerebral Aneurysms ◽  
Spiral Ct ◽  
The Other ◽  
Anterior Communicating Artery ◽  
Content Type ◽  
Spiral Ct Angiography ◽  
Spiral Computerized Tomography ◽  
Fine Print

Object. Patients with subarachnoid hemorrhage (SAH) in whom angiography does not demonstrate diagnostic findings sometimes suffer recurrent disease and actually harbor undetected cerebral aneurysms. The management strategy for such cases remains controversial, but technological advances in spiral computerized tomography (CT) angiography are changing the picture. The purpose of this prospective study was to examine how spiral CT angiography can contribute to the detection of cerebral aneurysms that cannot be visualized on angiography.Methods. In 134 consecutive patients with SAH, a prospective search for the source of bleeding was performed using digital subtraction (DS) and spiral CT angiography. In 21 patients in whom initial DS angiography yielded no diagnostic findings, spiral CT angiography was performed within 3 days. Patients in whom CT angiography provided no diagnostic results underwent second and third DS angiography sessions after approximately 2 weeks and 6 months, respectively.Six patients with perimesencephalic SAH were included in the 21 cases. Six of the other 15 patients had small cerebral aneurysms detectable by spiral CT angiography, five involving the anterior communicating artery and one the middle cerebral artery. Two patients in whom initial angiograms did not demonstrate diagnostic findings proved to have a ruptured dissecting aneurysm of the vertebral artery; in one case this was revealed at autopsy and in the other during the second DS angiography session. A third DS angiography session revealed no diagnostic results in 13 patients.Conclusions. Spiral CT angiography was useful in the detection of cerebral aneurysms in patients with SAH in whom angiography revealed no diagnostic findings. Anterior communicating artery aneurysms are generally well hidden in these types of SAH cases. A repeated angiography session was warranted in patients with nonperimesencephalic SAH and in whom initial angiography revealed no diagnostic findings, although a third session was thought to be superfluous.

scholarly journals Transcirculation Pipeline embolization device deployment: a rescue technique

2017 ◽  
Vol 42 (6) ◽  
pp. E13 ◽  
Author(s):  
Edison P. Valle-Giler ◽  
Elias Atallah ◽  
Stavropoula Tjoumakaris ◽  
Robert H. Rosenwasser ◽  
Pascal Jabbour
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Cerebral Aneurysms ◽  
Artery Aneurysm ◽  
Carotid Artery Dissection ◽  
Artery Dissection ◽  
Anterior Communicating Artery ◽  
Pipeline Embolization Device ◽  
Contralateral Internal Carotid Artery

The Pipeline embolization device (PED) has become a very important tool in the treatment of nonruptured cerebral aneurysms. However, a patient’s difficult anatomy or vascular stenosis may affect the device delivery. The purpose of this article was to describe an alternate technique for PED deployment when ipsilateral anatomy is not amenable for catheter navigation.A 44-year-old woman with a symptomatic 6-mm right superior hypophyseal artery aneurysm and a known history of right internal carotid artery dissection presented for PED treatment of her aneurysm. An angiogram showed persistence of the arterial dissection with luminal stenosis after 6 months of dual antiplatelet treatment. The contralateral internal carotid artery was catheterized and the PED was deployed via a transcirculation approach, using the anterior communicating artery. Transcirculation deployment of a PED is a viable option when ipsilateral anatomy is difficult or contraindicated for this treatment.

Acute Spinal Epidural Hematoma and Cranial Interdural Hematoma Due to a Rupture of a Posterior Communicating Artery Aneurysm: Case Report

Neurosurgery ◽  
2011 ◽  
Vol 69 (4) ◽  
pp. E1000-E1004 ◽  
Author(s):  
Andrea Bartoli ◽  
Marc Kotowski ◽  
Vitor Mendes Pereira ◽  
Karl Schaller
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Epidural Hematoma ◽  
Clinical Presentation ◽  
Artery Aneurysm ◽  
Posterior Communicating Artery ◽  
Spinal Epidural Hematoma ◽  
Anterior Communicating Artery ◽  
Posterior Communicating Artery Aneurysm ◽  
The Right ◽  
Spinal Epidural

Abstract BACKGROUND AND IMPORTANCE: We describe an unusual presentation of a ruptured aneurysm of the posterior communicating artery with an acute intracranial hematoma between the dural layers associated with an acute spinal epidural hematoma descending to L1. CLINICAL PRESENTATION: A 35-year-old woman presented 3 hours after ictus with a postcoital headache, neck stiffness, and bilateral abducens cranial nerve palsy. No other neurological deficits were present. Clinically, she had a subarachnoid hemorrhage World Federation of Neurosurgical Societies grade 1. CT scan demonstrates an acute subdural hematoma, extending from the right parasellar region, around the clivus, tentorium, and falx. Angio-CT showed a posterior communicating artery aneurysm and an anterior communicating artery aneurysm and an extension of the hematoma to the cervical spine. This justified a spinal and cerebral MRI that confirmed an extension of the hematoma to the epidural space at the cervical, thoracic, and lumbar levels. Three-dimensional digital subtraction angiography confirmed aneurysms on the right posterior communicating artery and on the anterior communicating artery. Both aneurysms were completely occluded by coiling. With reference to the concept of the cranial subdural compartment described in studies conducted using an electron microscope, this group of hematomas was classified as interdural. CONCLUSION: Ruptured aneurysm of the posterior communicating artery may cause cranial acute interdural hematoma with a typical subarachnoid hemorrhage clinical presentation, and it rarely can extend to spinal epidural space.

scholarly journals The role of anatomical anomalies in anterior communicating artery aneurysm rupture

2013 ◽  
Vol 19 (3) ◽  
pp. 147-153
Author(s):  
Cr.P Dimitriu ◽  
C. Ionescu ◽  
P. Bordei ◽  
I. Bulbuc
Keyword(s):  
Cerebral Artery ◽  
Anterior Cerebral Artery ◽  
Cerebral Aneurysms ◽  
Artery Aneurysm ◽  
Aneurysm Rupture ◽  
Circle Of Willis ◽  
Control Group ◽  
Anterior Communicating Artery ◽  
Aneurysm Size ◽  
Proper Patient Selection

Abstract Background and purpose:limited data exist to guide proper patient selection for preventive treatment of unruptured cerebral aneurysms. Cerebral aneurysms have been associated with anomalies of arterial segments that are forming the brain arterial circle of Willis but whether this association is also related to aneurysm rupture is not known. The occurrence of cerebral aneurysm rupture when a circle of Willis anomaly was present or absent was compared. Material and methods: we have performed this study on a number of 312 cases, of which 87 were dissections, 22 dissection followed by plastic injection, 135 magnetic resonance angiography (MRA), 75 computer tomography angiography (CTA), 40 digital subtraction angiographies (DSA), 30 in vivo (intraoperatory) observation. Brain vascular imaging was reviewed for aneurysm size, morphology and presence of anterior cerebral artery anomalies. Results: we divided the study group in 2 cohorts, one control group of 272 cases, in which we have study the anatomical variants occurrence and aneurysm occurrence in general population and another included 45 patients admitted thru emergency room for subarachnoid hemorrhage, of those 38 were ruptured aneurysm of anterior communicating artery (ACoA). Mean aneurysm size was 8.9 mm. An anterior cerebral artery anomaly was identified in 31 cases (81.5%). Multivariate analysis revealed a higher risk of aneurysm rupture when an anterior cerebral artery was present. Conclusions: this study shows that anterior cerebral artery anomalies are more commonly found in ruptured as opposed to unruptured ACoA aneurysms. The presence of an ACA anomaly may be an important characteristic for selecting patients for preventive aneurysm treatment.

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