scholarly journals Treatment of Ruptured Saccular Aneurysms of the Fenestrated Vertebrobasilar Junction with Balloon Remodeling Technique

2013 ◽  
Vol 19 (3) ◽  
pp. 289-298 ◽  
Author(s):  
Vivek Gupta ◽  
Chirag K Ahuja ◽  
N Khandelwal ◽  
Ajay Kumar ◽  
S K Gupta
Keyword(s):  
Anatomic Variation ◽  
Common Occurrence ◽  
Ruptured Aneurysms ◽  
Aneurysm Formation ◽  
Vertebrobasilar Junction ◽  
Intracranial Arteries ◽  
Saccular Aneurysms

Fenestration of the intracranial arteries is a relatively common occurrence. This anatomic variation may predispose to aneurysm formation at certain sites. Treatment of such aneurysms is difficult as it may occlude one of the limbs of fenestration with resultant deficit. Thus, preservation of both the limbs with adequate exclusion of the aneurysm from the circulation should be the aim of any treatment. We describe a series of four cases of ruptured aneurysms arising from a fenestrated vertebrobasilar junction treated with endovascular balloon remodeling technique.

Mathematical model of the rupture mechanism of intracranial saccular aneurysms through daughter aneurysm formation and growth

2005 ◽  
Vol 27 (5) ◽  
pp. 459-465 ◽  
Author(s):  
Hui Meng ◽  
Yixiang Feng ◽  
Scott H. Woodward ◽  
Bernard R. Bendok ◽  
Ricardo A. Hanel ◽  
...  
Keyword(s):  
Mathematical Model ◽  
Aneurysm Formation ◽  
Rupture Mechanism ◽  
Saccular Aneurysms

High incidence of ICA anterior wall aneurysms in patients with an anomalous origin of the ophthalmic artery: possible relevance to the pathogenesis of aneurysm formation

2014 ◽  
Vol 120 (1) ◽  
pp. 93-98 ◽  
Author(s):  
Masahiro Indo ◽  
Soichi Oya ◽  
Michihiro Tanaka ◽  
Toru Matsui
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Ophthalmic Artery ◽  
Internal Carotid ◽  
Medical Center ◽  
Anterior Wall ◽  
Dissecting Aneurysm ◽  
Anomalous Origin ◽  
Aneurysm Formation ◽  
Saccular Aneurysms

Object Surgery for aneurysms at the anterior wall of the internal carotid artery (ICA), which are also referred to as ICA anterior wall aneurysms, is often challenging. A treatment strategy needs to be determined according to the pathology of the aneurysm—namely, whether the aneurysm is a saccular aneurysm with firm neck walls that would tolerate clipping or coiling, a dissecting aneurysm, or a blood blister–like aneurysm. However, it is not always possible to properly evaluate the condition of the aneurysm before surgery solely based on angiographic findings. Methods The authors focused on the location of the ophthalmic artery (OA) in determining the pathology of ICA anterior wall aneurysms. Between January 2006 and December 2012, diagnostic cerebral angiography, for any reason, was performed on 1643 ICAs in 855 patients at Saitama Medical Center. The authors also investigated the relationship between the origin of the OA and the incidence of ICA anterior wall aneurysms. The pathogenesis was also evaluated for each aneurysm based on findings from both angiography and open surgery to identify any correlation between the location where the OA originated and the conditions of the aneurysm walls. Results Among 1643 ICAs, 31 arteries (1.89%) were accompanied by an anomalous origin of the OA, including 26 OAs originating from the C3 portion, 3 originating from the C4 portion, and 2 originating from the anterior cerebral artery. The incidence of an anomalous origin of the OA had no relationship to age, sex, or side. Internal carotid artery anterior wall aneurysms were observed in 16 (0.97%) of 1643 ICAs. Female patients had a significantly higher risk of having ICA anterior wall aneurysms (p = 0.026). The risk of ICA anterior wall aneurysm formation was approximately 50 times higher in patients with an anomalous origin of the OA (25.8% [8 of 31]) than in those with a normal OA (0.5% [8 of 1612], p < 0.0001). Based on angiographic classifications, saccular aneurysms were significantly more common in patients with an anomalous origin of the OA than in those with a normal OA (p = 0.041). Ten of 16 patients with ICA anterior wall aneurysms underwent craniotomies. Based on the intraoperative findings, all 6 aneurysms with normal OAs were dissecting or blood blister–like aneurysms, not saccular aneurysms. Conclusions There was a close relationship between the location of the OA origin and the predisposition to ICA anterior wall aneurysms. Developmental failure of the OA and subsequent weakness of the vessel wall might account for this phenomenon, as previously reported regarding other aneurysms related to the anomalous development of parent arteries. The data also appear to indicate that ICA anterior wall aneurysms in patients with an anomalous origin of the OA tend to be saccular aneurysms with normal neck walls. These findings provide critical information in determining therapeutic strategies for ICA anterior wall aneurysms.

Association of Hemodynamic Factors With Intracranial Aneurysm Formation and Rupture

Neurosurgery ◽  
2015 ◽  
Vol 78 (4) ◽  
pp. 510-520 ◽  
Author(s):  
Anil Can ◽  
Rose Du
Keyword(s):  
Intracranial Aneurysms ◽  
Meta Analysis ◽  
Unruptured Aneurysms ◽  
Ruptured Aneurysms ◽  
Aneurysm Formation ◽  
Positive Correlations ◽  
Mean Differences ◽  
Shear Area ◽  
Dynamics Models ◽  
Low Shear

Abstract BACKGROUND: Recent evidence suggests a link between the magnitude and distribution of hemodynamic factors and the formation and rupture of intracranial aneurysms. However, there are many conflicting results. OBJECTIVE: To quantify the effect of hemodynamic factors on aneurysm formation and their association with ruptured aneurysms. METHODS: We performed a systematic review and meta-analysis through October 2014. Analysis of the effects of hemodynamic factors on aneurysm formation was performed by pooling the results of studies that compared geometrical models of intracranial aneurysms and “preaneurysm” models where the aneurysm was artificially removed. Furthermore, we calculated pooled standardized mean differences between ruptured and unruptured aneurysms to quantify the association of hemodynamic factors with ruptured aneurysms. Standard PRISMA guidelines were followed. RESULTS: The hemodynamic factors that showed high positive correlations with location of aneurysm formation were high wall shear stress (WSS) and high gradient oscillatory number, with pooled proportions of 78.8% and 85.7%, respectively. Positive correlations were largely seen in bifurcation aneurysms, whereas negative correlations were seen in sidewall aneurysms. Mean and normalized WSS were significantly lower and low shear area significantly higher in ruptured aneurysms. CONCLUSION: Pooled analyses of computational fluid dynamics models suggest that an increase in WSS and gradient oscillatory number may contribute to aneurysm formation, whereas low WSS is associated with ruptured aneurysms. The location of the aneurysm at the bifurcation or sidewall may influence the correlation of these hemodynamic factors.

Aneurysms at a Temporopolar Artery Origin from the Internal Carotid Artery: Report of Two Cases

Neurosurgery ◽  
2003 ◽  
Vol 52 (5) ◽  
pp. 1221-1253
Author(s):  
Hatem Alkadhi ◽  
Bernhard Schuknecht ◽  
Hans-Georg Imhof ◽  
Yasuhiro Yonekawa
Keyword(s):  
Computed Tomography ◽  
Subarachnoid Hemorrhage ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Clinical Presentation ◽  
Anatomic Variation ◽  
Sudden Onset ◽  
Ruptured Aneurysms ◽  
Supraclinoid Internal Carotid Artery

Abstract OBJECTIVE AND IMPORTANCE Origination of the temporopolar artery (TPA) from the supraclinoid internal carotid artery (ICA) represents a rare anatomic variation, and the presence of aneurysms at this uncommon site has never before been reported. CLINICAL PRESENTATION Two patients presented with a sudden onset of headaches and meningism. Computed tomography demonstrated diffuse subarachnoid hemorrhage in both cases. Cerebral angiography revealed ruptured aneurysms originating at a TPA origin from the ICA. INTERVENTION The patients were surgically treated, and the aneurysms were successfully clipped. For technical reasons, the TPA was sacrificed in both cases. CONCLUSION These are the first reported cases of aneurysms originating at the TPA origin from the ICA. Awareness of the existence of this variation is necessary, particularly for the management of superior wall aneurysms of the ICA.

Image-Based CFD Modelling of Hemodynamic Factors in Aneurysm Formation Using a Novel Approach for Digital Removal of Saccular Aneurysms

2009 ◽  
Author(s):  
Matthew D. Ford ◽  
Yiemeng Hoi ◽  
Marina Piccinelli ◽  
Luca Antiga ◽  
David A. Steinman
Keyword(s):  
A Priori ◽  
Patient Specific ◽  
Cfd Modelling ◽  
Specific Location ◽  
Hemodynamic Forces ◽  
Aneurysm Formation ◽  
Novel Approach ◽  
Saccular Aneurysms

Although local hemodynamic forces are widely believed to play a role in aneurysm pathogenesis, the hemodynamic mechanisms have not been confirmed in a prospective manner. Ideally, one would identify the patient-specific vessel that is prone to aneurysm formation and follow it longitudinally to investigate the associated aneurysm formation factors or mechanisms. However, such studies are not practical in humans, and so the knowledge to predict aneurysm formation at a specific location, a priori, is not available.

Comparison of the Elastic Properties of Human Intracranial Arteries and Aneurysms

1972 ◽  
Vol 50 (4) ◽  
pp. 328-332 ◽  
Author(s):  
Susan Scott ◽  
Gary G. Ferguson ◽  
Margot R. Roach
Keyword(s):  
Elastic Properties ◽  
High Pressures ◽  
Static Pressure ◽  
Cerebral Arteries ◽  
Major Change ◽  
Initial Part ◽  
Histological Studies ◽  
Intracranial Arteries ◽  
Saccular Aneurysms

Static pressure–volume curves were done on seven intracranial saccular aneurysms and 16 major cerebral arteries from human autopsies. The aneurysms were much less distensible than the arteries. The major change was in the initial or elastin part of the curve (elastance of 6 ± 5 S.D. × 105 dynes/cm per 100% elongation in the artery compared to 13.5 ± 5 × 105 dynes/cm per 100% elongation for the aneurysm; p < 0.005). This agrees well with histological studies which show that elastin is decreased and fragmented in aneurysms.As the aneurysm enlarges, its wall must become thinner. This change, coupled with the loss of distensibility, makes it more prone to rupture. Obviously the larger the aneurysm, the thinner the wall (if the volume of tissue remains constant), and the greater the risk of rupture.The distensibility of major cerebral arteries could be dramatically decreased by two or three runs to pressures of 200 mm Hg. The elastance of the initial part of the curve changed from 2 ± 1 × 105 dynes/cm per 100%; elongation to 8 ± 1 × 105 dynes/cm per 100% elongation (different at p < 0.001). The final elastance was altered less significantly (42 ± 6 × 105 dynes/cm per 100% elongation to 82 ± 28 × 105 dynes/cm per 100% elongation; p < 0.01). This shift in distensibility was accompanied by a significant increase in diameter of the artery. High pressures appear able to break the single elastin layer of cerebral arteries.

Cross-Flow at Anterior Communicating Artery and Implication in Cerebral Aneurysm Formation

2009 ◽  
Author(s):  
Liang-Der Jou ◽  
Michel E. Mawad
Keyword(s):  
Cerebral Aneurysm ◽  
Cerebral Artery ◽  
Anterior Cerebral Artery ◽  
Cross Flow ◽  
Lateral Flow ◽  
Anterior Communicating Artery ◽  
Ruptured Aneurysms ◽  
Aneurysm Formation ◽  
The Right

The anterior communication artery (ACOM) connects the right and left anterior cerebral artery and establishes contra-lateral flow, permiting perfusion of brain at both sides. While the artery itself is very short in length and small in size, 35% of ruptured aneurysms are found to form at the ACOM [1] and these aneurysms also rupture when they are small [2].

Intracranial aneurysms in sickle cell anemia: clinical and imaging findings

2015 ◽  
Vol 8 (4) ◽  
pp. 434-440 ◽  
Author(s):  
S Ali Nabavizadeh ◽  
Arastoo Vossough ◽  
Rebecca N Ichord ◽  
Janet Kwiatkowski ◽  
Bryan A Pukenas ◽  
...  
Keyword(s):  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Artery Aneurysm ◽  
Adult Patients ◽  
Imaging Findings ◽  
Cell Disease ◽  
Anterior Circulation ◽  
Multiple Aneurysms ◽  
Ruptured Aneurysms ◽  
Aneurysm Formation

BackgroundCerebral aneurysm formation is one of the cerebrovascular complications of sickle cell disease.ObjectiveTo report the clinical and imaging findings of intracerebral aneurysms and their treatment in pediatric and adult patients with sickle cell disease.MethodsReview of clinical data via chart abstraction and radiologic features at the University of Pennsylvania and Children's Hospital of Philadelphia from 2000 to 2014 and review of the literature since 1942.ResultsNineteen patients with aneurysms (2.7%) were found in 709 imaged patients, including 1.2% of imaged children and 10.8% of adults. A total of 44 aneurysms were detected (52.6% with multiple aneurysms, overall 2.3 per patient), 35 (79.5%) in the anterior circulation and 9 in the posterior circulation (20.4%). Thirty-eight unruptured aneurysms ranging in size from 2 to 6 mm and six ruptured aneurysms ranging in size from 3 to 9 mm in diameter were found. Of the patients with ruptured aneurysms, two were treated by stent-assisted coiling, two by clipping, and one patient with coiling. In the group without a rupture, one patient was treated by coil embolization and one patient with a peripheral middle cerebral artery aneurysm was treated by aneurysmectomy. Three pediatric patients with a previously normal MR angiogram demonstrated new aneurysm formation during the study.ConclusionsAdult patients with sickle cell disease have a high prevalence of aneurysm formation. Both pediatric and adult patients with sickle cell disease tend to develop multiple aneurysms with frequent involvement of atypical locations, in both anterior and posterior circulations.

scholarly journals Surgical Treatment of Ruptured Aneurysms around the Vertebrobasilar Junction : Indications and Our Use of the Conventional Approach

1998 ◽  
Vol 7 (4) ◽  
pp. 209-216
Author(s):  
Mitsuo Sato ◽  
Tomoyoshi Oikawa ◽  
Satoshi Taira ◽  
Masato Matsumoto ◽  
Namio Kodama
Keyword(s):  
Surgical Treatment ◽  
Conventional Approach ◽  
Ruptured Aneurysms ◽  
Vertebrobasilar Junction

scholarly journals Risk of de novo aneurysm formation in patients with a prior diagnosis of ruptured or unruptured aneurysm: systematic review and meta-analysis

2019 ◽  
Vol 131 (1) ◽  
pp. 14-24 ◽  
Author(s):  
Enrico Giordan ◽  
Giuseppe Lanzino ◽  
Leonardo Rangel-Castilla ◽  
Mohammad Hassan Murad ◽  
Waleed Brinjikji
Keyword(s):  
Systematic Review ◽  
Time Course ◽  
De Novo ◽  
Meta Analysis ◽  
Incidence Density ◽  
Ruptured Aneurysms ◽  
Aneurysm Formation ◽  
Significant Difference ◽  
De Novo Aneurysm

OBJECTIVEDe novo aneurysms are rare entities periodically discovered during follow-up imaging. Little is known regarding the frequency with which these lesions form or the time course. This systematic review and meta-analysis was undertaken to estimate the incidence of de novo aneurysms and to determine risk factors for aneurysm formation.METHODSThe authors searched multiple databases for studies of patients with unruptured and ruptured aneurysms describing the rate of de novo aneurysm formation. The primary outcome was incidence of de novo aneurysm formation. A meta-analysis was performed using a random-effects model. The authors examined the associations of multiple aneurysms, prior subarachnoid hemorrhage, smoking, sex, age at presentation, and hypertension with de novo aneurysm formation.RESULTSThe meta-analysis included 14,968 aneurysm patients who received imaging follow-up from 35 studies. The overall incidence of de novo aneurysm formation was 2% (95% CI 2%–3%) over a mean follow-up time of 8.3 years. The estimated incidence density was 0.3%/patient-year. There was no statistically significant difference in rates of de novo aneurysm formation between patients who had ruptured aneurysms and those with unruptured aneurysms. In 8 studies, 11.2% of de novo aneurysms were found in patients with ≤ 5 years of follow-up and 88.8% were found at > 5 years. The mean time to rupture for de novo aneurysms was 10 years.CONCLUSIONSThis systematic review demonstrates that formation of de novo aneurysms is rare. Overall, routine screening for de novo aneurysms is likely to be of low yield and could be performed at time intervals of at least 5 to 10 years.

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