Prevention of Rebleeding after Operation for Subarachnoid Hemorrhage of Unknown Cause

Neurosurgery ◽  
1985 ◽  
Vol 17 (6) ◽  
pp. 942-946 ◽  
Author(s):  
Noboru Sakai ◽  
Hiromu Yamada ◽  
Takashi Ando ◽  
Yasuaki Nishimura
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Surgical Treatment ◽  
Arterial Wall ◽  
Internal Carotid ◽  
Cerebral Arteries ◽  
Anterior Communicating Artery ◽  
Computed Tomographic ◽  
Follow Up Study ◽  
Computed Tomographic Scan

Abstract This study is presented to promote prophylactic operation to prevent rebleeding after subarachnoid hemorrhage (SAH) of unknown cause. Twenty-two cases of nontraumatic SAH of unknown cause of a total of 254 cases of SAH treated during a 5-year period (1980-1984) were available for this study. A follow-up study (4 to 61 months after treatment; median, 43 months) revealed a 4.5% mortality rate. Four patients chosen from among the 22 SAH cases underwent prophylactic operation. The decision to operate was based on repeated angiography showing regional cerebral vasospasm corresponding to a limited hyperdense area on the computed tomographic scan at the time of the onset of SAH. Microsurgery revealed a minute protrusion (less than 2 mm in diameter) or thinning of the arterial wall with old hematoma of the surrounding brain in all 4 cases, and treatment required only coating of the abnormal site. All 4 patients are now fully recovered. Frequently, abnormal changes of such cerebral arteries as the anterior communicating artery, the internal carotid artery (C-1 and C-2), and the middle cerebral artery (M-1) may occur. Therefore, the authors emphasize the necessity of surgical treatment for specific cases of SAH with an unknown cause.

scholarly journals Endovascular Exclusion of the Anterior Communicating Artery with Flow-Diverter Stents as an Emergency Treatment for Blister-Like Intracranial Aneurysms

2013 ◽  
Vol 19 (4) ◽  
pp. 471-478 ◽  
Author(s):  
Aymeric Rouchaud ◽  
Suzana Saleme ◽  
Benjamin Gory ◽  
David Ayoub ◽  
Charbel Mounayer
Keyword(s):  
Emergency Treatment ◽  
Arterial Wall ◽  
Therapeutic Option ◽  
Cerebral Arteries ◽  
Flow Diverter ◽  
Anterior Communicating Artery ◽  
Aneurysm Wall ◽  
Complete Exclusion ◽  
Small Aneurysms

Blood blister-like aneurysms (BLAs) are rare lesions, associated with diffuse subarachnoid hemorrhage (SAH). BLAs tend to rebleed quickly after first bleeding and must be treated as an emergency. Acute treatment is challenging using surgical and endovascular approaches due to the fragile aneurysm wall and small sac. Flow-diverter stents (FDSs) may offer a new option for the treatment of difficult small aneurysms. We describe a case of a ruptured BLA on the anterior communicating artery (AComA) treated in the acute phase of SAH by endovascular exclusion of the AComA with deployment of two FDSs in the A1/A2 junctions of both anterior cerebral arteries (ACAs). A 61-year-old man was admitted for diffuse SAH with a focal interhemispheric hematoma. Angiography revealed multiple arterial wall irregularities on the AComA and both ACAs. We performed an endovascular shunt of the AComA by deploying two FDSs in both A1/A2 junctions. Immediate control injections confirmed flow diversion in the A1/A2 segments of the ACAs with decreased blood flow in the AComA. The patient's course in hospital was uneventful. A three-month follow-up angiogram confirmed complete exclusion of the aneurysms, complete exclusion of the AComA, and patency of the two ACAs without any persistent arterial wall irregularity. Endovascular bypass using an FDS for a ruptured BLA has never been described. It establishes a new therapeutic option despite the need for antiplatelet therapy. Endovascular AComA exclusion using an FDS may be a solution when no other treatment is available for a ruptured BLA.

Recurrence of a Vertebral Artery Dissecting Pseudoaneurysm after Successful Stent-supported Coil Embolization: Case Report

Neurosurgery ◽  
2003 ◽  
Vol 53 (3) ◽  
pp. 754-761 ◽  
Author(s):  
Christopher I. MacKay ◽  
Patrick P. Han ◽  
Felipe C. Albuquerque ◽  
Cameron G. McDougall
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Neck Pain ◽  
Vertebral Artery ◽  
Coil Embolization ◽  
Artery Aneurysm ◽  
Left Vertebral Artery ◽  
Parent Vessel ◽  
Computed Tomographic ◽  
Computed Tomographic Scan

Abstract OBJECTIVE AND IMPORTANCE Dissecting aneurysms of the intracranial vertebral artery are increasingly recognized as a cause of subarachnoid hemorrhage. We present a case involving technical success of the stent-supported coil embolization but with recurrence of the dissecting pseudoaneurysm of the intracranial vertebral artery. The implications for the endovascular management of ruptured dissecting pseudoaneurysms of the intracranial vertebral artery are discussed. CLINICAL PRESENTATION A 36-year-old man with a remote history of head injury had recovered functionally to the point of independent living. He experienced the spontaneous onset of severe head and neck pain, which progressed rapidly to obtundation. A computed tomographic scan of the head revealed subarachnoid hemorrhage centered in the posterior fossa. The patient underwent cerebral angiography, which revealed dilation of the distal left vertebral artery consistent with a dissecting pseudoaneurysm. INTERVENTION Transfemoral access was achieved under general anesthesia, and two overlapping stents (3 mm in diameter and 14 mm long) were placed to cover the entire dissected segment. Follow-up angiography of the left vertebral artery showed the placement of the stents across the neck of the aneurysm; coil placement was satisfactory, with no residual aneurysm filling. Approximately 6 weeks after the patient's initial presentation, he developed the sudden onset of severe neck pain. A computed tomographic scan showed no subarachnoid hemorrhage, but computed tomographic angiography revealed that the previously treated left vertebral artery aneurysm had recurred. Angiography confirmed a recurrent pseudoaneurysm around the previously placed Guglielmi detachable coils. A test balloon occlusion was performed for 30 minutes. The patient's neurological examination was stable throughout the test occlusion period. Guglielmi detachable coil embolization of the left vertebral artery was then performed, sacrificing the artery at the level of the dissection. After the procedure was completed, no new neurological deficits occurred. On the second day after the procedure, the patient was discharged from the hospital. He was alert, oriented, and able to walk. CONCLUSION We appreciate the value of preserving a parent vessel when a dissecting pseudoaneurysm of the intracranial vertebral artery ruptures in patients with inadequate collateral blood flow, in patients with disease involving the contralateral vertebral artery, or in patients with both. However, our case represents a cautionary note that patients treated in this fashion require close clinical follow-up. We suggest that parent vessel occlusion be considered the first option for treatment in patients who will tolerate sacrifice of the parent vessel along its diseased segment. In the future, covered stent technology may resolve this dilemma for many of these patients.

Cerebral Infarction and Release of Platelet Thromboxane after Subarachnoid Hemorrhage

Neurosurgery ◽  
1990 ◽  
Vol 27 (6) ◽  
pp. 929-935 ◽  
Author(s):  
Seppo Juvela
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cerebral Infarction ◽  
Adenosine Diphosphate ◽  
Thromboxane B2 ◽  
Intracerebral Hematoma ◽  
Computed Tomographic ◽  
Computed Tomographic Scan ◽  
Aggregation Of Platelets ◽  
Platelet Thromboxane

Abstract Platelet aggregation induced by adenosine diphosphate and the release of thromboxane B2 were studied in 68 patients with subarachnoid hemorrhage during the second week after the hemorrhage, when delayed ischemic deterioration most often occurs. Follow-up computed tomographic scans were performed later than 1 month after subarachnoid hemorrhage to reveal permanent hypodense areas consistent with cerebral infarction. Occurrence of hypodense lesions on the follow-up computed tomographic scan was significantly associated with the presence of delayed ischemic deterioration (DID) (P<0.01). Patients with subcortical or cortical cerebral infarctions due to DID released more platelet thromboxane B2 than those with no evidence of a hypodense lesion on the computed tomographic scan (P<0.05). Hypodense areas caused by an intracerebral hematoma or small, deep-seated infarcts due to DID were not associated with significantly elevated release of thromboxane B2, but the lacunar type infarcts were associated with increased aggregation of platelets. The results suggest that augmented platelet function may be involved in the pathogenesis of cerebral infarction due to DID.

Primary Treatment of a Blister-like Aneurysm with an Encircling Clip Graft: Technical Case Report

2006 ◽  
Vol 59 (suppl_1) ◽  
pp. ONS-E168-ONS-E168 ◽  
Author(s):  
Raymond F. Sekula ◽  
David B. Cohen ◽  
Matthew R. Quigley ◽  
Peter J. Jannetta
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Current Practice ◽  
Internal Carotid ◽  
Primary Treatment ◽  
Sudden Onset ◽  
Cerebral Angiogram ◽  
Computed Tomographic

Abstract OBJECTIVE: Blister-like aneurysms at nonbranching sites in the supraclinoid portion of the internal carotid artery are a rare but important cause of subarachnoid hemorrhage. We report a case of subarachnoid hemorrhage caused by a ruptured blister-type aneurysm, review the pertinent literature, and hope to remind readers of the wisdom of the use of an encircling clip as the primary treatment of these challenging lesions. CLINICAL PRESENTATION: A 41-year-old woman presented with sudden onset of headache. An admission computed tomographic (CT) scan revealed thick and diffuse subarachnoid hemorrhage involving primarily the carotid cistern and the proximal left sylvian fissure. A cerebral angiogram was initially interpreted as absent for aneurysm, but a follow-up angiogram performed 1 week later confirmed an enlarging aneurysm. INTERVENTION: A craniotomy with placement of an encircling clip graft around a blister-like aneurysm was performed. CONCLUSION: Although Sundt advocated the encircling clip graft for the blister-type aneurysm almost 40 years ago, use of an encircling clip graft in the treatment of blister-like aneurysms of the supraclinoid portion of the internal carotid artery seems to be reserved as a secondary or “rescue” measure in current practice. Neurosurgeons must familiarize themselves with this distinct entity (the blister-type aneurysm), recognize the possible risks associated with parallel clipping, and consider the use of an encircling clip graft as the primary treatment.

BLISTER-LIKE ANEURYSMS OF THE ANTERIOR COMMUNICATING ARTERY

Neurosurgery ◽  
2008 ◽  
Vol 62 (4) ◽  
pp. 807-811 ◽  
Author(s):  
Norberto Andaluz ◽  
Mario Zuccarello
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Digital Subtraction Angiography ◽  
Internal Carotid ◽  
Computed Tomographic Angiography ◽  
Anterior Communicating Artery ◽  
Digital Subtraction ◽  
Computed Tomographic ◽  
Tomographic Angiography

Abstract OBJECTIVE Blood blister-like aneurysms are small hemispherical bulges from the dorsomedial wall of the internal carotid artery that resemble berry aneurysms but differ in their clinical and surgical features. On the basis of our literature review, blister-like aneurysms have been reported to occur only at nonbranching sites of the dorsomedial internal carotid artery. In this report on our series of five patients, we describe blister-like aneurysms of the anterior communicating artery (AComA) and discuss important diagnostic and therapeutic aspects unique to them. METHODS In our retrospective review of 719 patients with nontraumatic subarachnoid hemorrhage admitted to our service from 1998 to 2003, 181 (25.17%) patients harbored AComA aneurysms. Five (2.76%) patients (four women, one man) had blister-like aneurysms that were recognized at the time of surgery. RESULTS Initial digital subtraction angiography was diagnostic in only one patient. A second digital subtraction angiogram was diagnostic in one patient but failed to reveal an aneurysm in the remaining three patients; these were eventually diagnosed by computed tomographic angiography. All aneurysms were clipped. At the time of surgery, the aneurysms arose from the horizontal portion of the AComA without any involvement of the branches of the anterior cerebral artery. All presented as blister-like aneurysms that were thin-walled and lacking a surgical neck. On dissection, two of the lesions ruptured. All lesions were treated with straight fenestrated clips through the A1–AComA junction, thus remodeling the AComA. No delayed rupture was noted at the time of the last follow-up evaluation. At the time of discharge, outcomes were good in two patients, fair in two, and poor in the remaining patient. CONCLUSION Blister-like aneurysms constitute technically challenging lesions that may occur at the AComA. Computed tomographic angiography is valuable in diagnosis. Blister-like aneurysms should be suspected when digital subtraction angiography findings are negative for subarachnoid hemorrhage.

scholarly journals A long-term (4- to 12-year) follow-up study of surgical treatment of lumbar spinal stenosis

2000 ◽  
Vol 9 (6) ◽  
pp. 563-570 ◽  
Author(s):  
M. Cornefjord ◽  
G. Byröd ◽  
H. Brisby ◽  
B. Rydevik
Keyword(s):  
Surgical Treatment ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Follow Up Study ◽  
Lumbar Spinal

Evaluation of Vasospasm after Subarachnoid Hemorrhage by Use of Multislice Computed Tomographic Angiography

Neurosurgery ◽  
2002 ◽  
Vol 51 (4) ◽  
pp. 939-943 ◽  
Author(s):  
Yasunari Otawara ◽  
Kuniaki Ogasawara ◽  
Akira Ogawa ◽  
Makoto Sasaki ◽  
Kei Takahashi
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cerebral Vasospasm ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Cerebral Arteries ◽  
Computed Tomographic Angiography ◽  
Computed Tomographic ◽  
Tomography System ◽  
Middle Cerebral Arteries ◽  
Multislice Images ◽  
Tomographic Angiography

Abstract OBJECTIVE Multislice computed tomographic angiography (CTA) can provide clearer vascular images, even of the peripheral arteries, than conventional CTA. Multislice CTA was compared with digital subtraction angiography (DSA) for the detection of cerebral vasospasm in patients with acute aneurysmal subarachnoid hemorrhage (SAH) to analyze whether multislice CTA can replace DSA in the detection of vasospasm after SAH. METHODS Within 72 hours after the onset of symptoms, multislice CTA and DSA were performed in 20 patients with SAH. Multislice CTA and DSA were repeated on Day 7 to assess cerebral vasospasm. Regions of interest were established in the proximal and distal segments of the anterior and middle cerebral arteries on both multislice CTA and DSA images, and the agreement between the severity of vasospasm on multislice CTA and DSA images was statistically compared. The multislice Aquilon computed tomography system (Toshiba, Inc., Tokyo, Japan) used the following parameters: 1 mm collimation and 3.5 mm per rotation table increment (pitch, 3.5). RESULTS The degree of vasospasm as revealed by multislice CTA correlated significantly with the degree of vasospasm revealed by DSA (P < 0.0001). The agreement between the severity of vasospasm on multislice images obtained via CTA and DSA in the overall, proximal, and distal segments of the cerebral arteries was 91.6, 90.8, and 92.3%, respectively. CONCLUSION Multislice CTA can detect angiographic vasospasm after SAH with accuracy equal to that of DSA.

Changing prognosis of primary intracerebral hemorrhage: results of a clinical and computed tomographic follow-up study of 104 patients.

Stroke ◽  
1988 ◽  
Vol 19 (2) ◽  
pp. 192-195 ◽  
Author(s):  
C Fieschi ◽  
A Carolei ◽  
M Fiorelli ◽  
C Argentino ◽  
L Bozzao ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Computed Tomographic ◽  
Follow Up Study

An analysis of follow-up results of 1000 intracranial saccular aneurysms with definitive surgical treatment

1979 ◽  
Vol 50 (2) ◽  
pp. 152-157 ◽  
Author(s):  
Takashi Yoshimoto ◽  
Keita Uchida ◽  
Uichi Kaneko ◽  
Takamasa Kayama ◽  
Jiro Suzuki
Keyword(s):  
Surgical Treatment ◽  
Postoperative Results ◽  
Content Type ◽  
Poor Condition ◽  
Follow Up Study ◽  
Normal Life ◽  
Definitive Surgery ◽  
Fine Print ◽  
Saccular Aneurysms

✓ The authors report a follow-up review of 1000 cases of intracranial definitive surgery for saccular aneurysms. The prognosis for such surgical cases is discussed. Postoperative results at least 6 months after discharge from the hospital were analyzed in 876 (93.3%) of the 939 surviving patients. The longest follow-up period was 14 years and 5 months, with an average of 3 years and 7 months. At the time of discharge, there were 543 excellent results, 186 good, 117 fair, 93 poor, and 61 deaths. The chief findings were as follows: 1) Most of the patients determined as “excellent” or “good” at discharge were able to return to normal life; most of the deaths or instances of worsened condition found in the follow-up study were due to new lesions. 2) Fully 62% of the cases determined as “fair” at discharge were found in an improved state at the follow-up study, having returned to normal life. 3) Only 19% of cases determined as “poor” at discharge had improved to the point where a return to normal life was possible, the majority having died or remaining in poor condition.

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