Healing Process for Cerebral Dissecting Aneurysms Presenting with Subarachnoid Hemorrhage

Abstract OBJECTIVE This was a pathological study to investigate the healing process for cerebral dissecting aneurysms presenting with subarachnoid hemorrhage (SAH). METHODS Thirteen dissecting aneurysms that presented with SAH were obtained from 13 patients. Nine aneurysms arose from the vertebral artery, two arose from the anterior cerebral artery, one arose from the internal carotid artery, and one arose from the superior cerebellar artery. Eight aneurysm specimens were collected during autopsy and five were resected during surgery (trapping with or without bypass). The period between the onset of SAH and the time of specimen collection ranged from 6 hours to 35 days. All 13 aneurysms were pathologically examined with immunohistochemical staining, with a focus on the chronological healing process after SAH. RESULTS All dissecting aneurysms were generated with sudden widespread disruption of the internal elastic lamina and media. The healing process occurred with neointimal proliferation. The neointima, consisting mainly of newly synthesized smooth muscle cells and collagen fibers, extended from the disrupted ends of the media proper forward to the ruptured portion. CONCLUSION It is assumed that the healing process, with neointimal proliferation, begins after 1 week and may not be complete even after 1 month, depending on the extent of the wall injury.

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Fusiform vertebral artery aneurysms as a cause of dissecting aneurysms

Journal of Neurosurgery ◽

10.3171/jns.1999.91.1.0139 ◽

1999 ◽

Vol 91 (1) ◽

pp. 139-144 ◽

Cited By ~ 40

Author(s):

Toshihiro Yasui ◽

Masaki Komiyama ◽

Misao Nishikawa ◽

Hideki Nakajima ◽

Yasutsugu Kobayashi ◽

...

Keyword(s):

Posterior Inferior Cerebellar Artery ◽

Internal Elastic Lamina ◽

Content Type ◽

Pathological Characteristics ◽

Vertebral Arteries ◽

Cerebellar Artery ◽

The Media ◽

Dissecting Aneurysms ◽

Elastic Lamina

✓ Two autopsy cases of angiographically determined fusiform aneurysms of the vertebral arteries (VAs) are reported and the appropriate literature is reviewed to investigate the pathological characteristics of both fusiform and dissecting VA aneurysms and the pathogenesis of dissecting aneurysms. One patient had suffered a subarachnoid hemorrhage (SAH) due to dissection of a previously documented incidental fusiform aneurysm. The other patient had harbored incidental fusiform aneurysms coexistent with a ruptured aneurysm of the posterior inferior cerebellar artery. The location and pathological features of the aneurysms were similar in the two cases. The aneurysms in both cases displayed intimal thickening, disruption of the internal elastic lamina, and degeneration of the media. A mural hemorrhage and patchy calcification were also found in the case that included SAH. Based on their pathological investigation of these two cases and a review of reported cases, the authors propose that incidental fusiform aneurysms in the VAs are characterized by weakness in the internal elastic lamina and, therefore, have the potential to become dissecting aneurysms, resulting in a fatal prognosis. This suggests that long-term control of blood pressure is mandatory in patients with incidental fusiform aneurysms in the VAs.

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Endovascular Treatment of Bilateral Intracranial Vertebral Artery Dissecting Aneurysms Presenting With Subarachnoid Hemorrhage

Operative Neurosurgery ◽

10.1227/neu.0b013e31822ed1f0 ◽

2011 ◽

Vol 70 (suppl_1) ◽

pp. ons75-ons81 ◽

Cited By ~ 1

Author(s):

Yong Sam Shin ◽

Byung Moon Kim ◽

Se-Hyuk Kim ◽

Sang Hyun Suh ◽

Chang Woo Ryu ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Endovascular Treatment ◽

Vertebral Artery ◽

Posterior Inferior Cerebellar Artery ◽

Stent Insertion ◽

Treatment Methods ◽

Cerebellar Artery ◽

Endovascular Methods ◽

Dissecting Aneurysms

Abstract BACKGROUND: Optimal management of bilateral vertebral artery dissecting aneurysms (bi-VDAs) causing subarachnoid hemorrhage (SAH) remains unclear. OBJECTIVE: To investigate the treatment methods and outcomes of bi-VDA causing SAH. METHODS: Seven patients were treated endovascularly for bi-VDA causing SAH. Treatment methods and outcomes were evaluated retrospectively. RESULTS: Two patients were treated with 2 overlapping stents for both ruptured and unruptured VDAs, 2 with 2 overlapping stents and coiling for ruptured VDA and with conservative treatment for unruptured VDA, 1 with internal trapping (IT) for ruptured VDA and stent-assisted coiling for unruptured VDA, 1 with IT for ruptured VDA and 2 overlapping stents for unruptured VDA, and 1 with IT for ruptured VDA and a single stent for unruptured VDA. None had rebleeding during follow-up (range, 15-48 months). All patients had favorable outcomes (modified Rankin Scale score, 0-2). On follow-up angiography at 6 to 36 months, 9 treated and 2 untreated VDAs revealed stable or improved state, whereas 3 VDAs in 2 patients showed regrowth. Of the 3 recurring VDAs, 1 was initially treated with IT but recurred owing to retrograde flow to the ipsilateral posterior inferior cerebellar artery (PICA), the second was treated with single stent but enlarged, and the last was treated with 2 overlapping stents and coiling but recurred from the remnant sac harboring the PICA origin. All 3 recurred VDAs were retreated with coiling with or without stent insertion. CONCLUSION: Bilateral VDAs presenting with SAH were safely treated with endovascular methods. However, endovascular treatment may be limited for VDAs with PICA origin involvement.

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Subarachnoid Hemorrhage from Vertebral Artery Dissecting Aneurysms Involving the Origin of the Posteroinferior Cerebellar Artery: Report of Two Cases and Review of the Literature

Neurosurgery ◽

10.1093/neurosurgery/46.1.196 ◽

2000 ◽

Vol 46 (1) ◽

pp. 196-200 ◽

Cited By ~ 26

Author(s):

Toshihiro Yasui ◽

Masaki Komiyama ◽

Misao Nishikawa ◽

Hideki Nakajima

Keyword(s):

Subarachnoid Hemorrhage ◽

Vertebral Artery ◽

Review Of The Literature ◽

Cerebellar Artery ◽

Dissecting Aneurysms

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Treatment of Dissecting Vertebral Aneurysm

Interventional Neuroradiology ◽

10.1177/15910199010070s123 ◽

2001 ◽

Vol 7 (1_suppl) ◽

pp. 155-160 ◽

Cited By ~ 1

Author(s):

Y. Kai ◽

J. Hamada ◽

M. Morioka ◽

T. Todaka ◽

T. Mizuno ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Posterior Inferior Cerebellar Artery ◽

Dissecting Aneurysm ◽

The Other ◽

Cerebellar Artery ◽

Retrograde Filling ◽

Angiographic Evidence ◽

Vertebral Aneurysm ◽

Proximal Occlusion ◽

Dissecting Aneurysms

We report 17 patients with dissecting aneurysm of the vertebral artery (VA) who were treated by direct surgery (n=8) or interventional surgery (n=9). Eight patients presented with subarachnoid hemorrhage (SAH) and nine with ischemia. Ten patients were treated by trapping of the aneurysm that was occlusion of the VA on both sides of aneurysm (direct surgery, n=2; interventional surgery, n=8). The other seven patients were treated by ligation of the VA proximal to the aneurysm (direct surgery, n=6; interventional surgery, n=1). Two patients underwent transposition of the posterior inferior cerebellar artery (PICA). In 15 patients, there were no major complications. Two patients who had been treated by proximal occlusion of the VA developed rebleeding and ischemia due to persistent retrograde filling of the dissecting site. We suggest that angiographic evidence of retrograde filling of the dissecting site should have been considered as an indication for trapping. Trapping of VA dissecting aneurysms is easier and safer by interventional surgery than by direct surgery.

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Acute surgery for a case of superior vermian arteriovenous malformation producing raised venous pressure coexisting with basilar-superior cerebellar artery aneurysm presenting subarachnoid hemorrhage; Case report

Surgical Neurology International ◽

10.25259/sni_500_2020 ◽

2021 ◽

Vol 12 ◽

pp. 23

Author(s):

Sho Tsunoda ◽

Tomohiro Inoue ◽

Akihiro Shimoi ◽

Atsuya Akabane

Keyword(s):

Subarachnoid Hemorrhage ◽

Arteriovenous Malformation ◽

Cerebral Vasospasm ◽

Acute Phase ◽

Venous Pressure ◽

Artery Aneurysm ◽

Superior Cerebellar Artery ◽

Oculomotor Palsy ◽

Acute Surgery ◽

Cerebellar Artery

Background: Superior vermian subtype of arteriovenous malformation (AVM) coexisting with proximal feeder aneurysm on basilar-superior cerebellar artery (BA-SCA) junction is an extremely rare situation. We experienced a case of this rare entity presenting with subarachnoid hemorrhage (SAH), and herein, introduce the outline and clinical features of this experience together with the actual surgical video. Case Description: A 54-year-old man SAH patient with severe headache, disturbance of consciousness, and left oculomotor palsy was urgently admitted to our hospital. Imaging examination demonstrated superior vermian AVM with BA-SCA aneurysm, and both lesions were treated through two different approaches (left pterional craniotomy in conjunction with zygomectomy, and left posterior interhemispheric occipital transtentorial approach) in acute phase of SAH. Both lesions were completely disappeared postoperatively and the patient’s postoperative course was favorable, without symptomatic cerebral vasospasm. Although slight oculomotor palsy remained, the patient recovered well and was transferred to a rehabilitation hospital for further improvement. Conclusion: In the cases of AVM coexisting with proximal feeder aneurysm, presenting with SAH, disorders of intracranial venous return associated with an AVM can be a vital hindrance to managing cerebral vasospasm; therefore, treating both lesions in the acute phase may lead to good outcomes.

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Abstract T P171: Impaired Brachial Flow-mediated Dilatation in Patients With Symptomatic Nontraumatic Intracranial Arterial Dissections

Stroke ◽

10.1161/str.45.suppl_1.tp171 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Tomonori Iwata ◽

Takahisa Mori ◽

Yuichi Miyazaki ◽

Yuhei Tanno ◽

Shigen Kasakura ◽

...

Keyword(s):

Endothelial Function ◽

Ankle Brachial Index ◽

Superior Cerebellar Artery ◽

Internal Elastic Lamina ◽

Cerebellar Artery ◽

Atherosclerotic Change ◽

Flow Mediated Dilatation ◽

Intracranial Arteries ◽

Atherosclerotic Risk Factors ◽

Elastic Lamina

Background: Non-traumatic intracranial arterial dissections (IADs) are characterized by the sudden disruption of the internal elastic lamina in intracranial arteries. It is still unknown why IADs occurs. There are few reports concerned with relationship between the endothelial function and IADs. Purpose: The purpose of our retrospective study was to investigate whether or not patients with nontraumatic IADs had normal endothelial function. Methods: Included for retrospective analysis were patients with symptomatic nontraumatic IADs (1) who were admitted to our institution from 2012 to 2013 and (2) who underwent an endothelial function test during hospitalization. Headache patients admitted to outpatient clinic were selected as a control matched for sex and age. The endothelial function was assessed using flow-mediated dilatation (FMD). We investigated ankle brachial index (ABI) and pulse wave velocity (PWV) to determine the degree of atherosclerosis. Patients’ characteristics, brachial FMD, ABI and PVW were assessed in two groups. Results: During study periods, there were 14 patients (median age 45.5 years, IQR 38-53.5 years) with nontraumatic IADs. Fourteen patients of the control had median age of 47 years (IQR: 44-53.5 years). The locations of IADs were the vertebral artery (n=10), the internal carotid artery (n=3) and the superior cerebellar artery (n=1). Between two groups, there were no significant differences of clinical features, atherosclerotic risk factors, ABI and PWV except FMD, indicating that most of them did not suffer from atherosclerosis. However, FMD in IADs was significantly lower than in control (4.85 vs. 7.4, p<0.01) Conclusion: ur results suggest that the endothelial function of intracranial arteries might be impaired in patients with symptomatic nontraumatic IADs in spite of no atherosclerotic change.

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The Endovascular Management of Superior Cerebellar Artery Aneurysms

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/s0317167100002833 ◽

2004 ◽

Vol 31 (1) ◽

pp. 53-57 ◽

Cited By ~ 18

Author(s):

Charles Haw ◽

Robert Willinsky ◽

Ronit Agid ◽

Karel TerBrugge

Keyword(s):

Subarachnoid Hemorrhage ◽

Cerebral Aneurysms ◽

The Other ◽

Superior Cerebellar Artery ◽

Poor Grade ◽

Cerebellar Artery ◽

Clinical Series ◽

Recovery Management ◽

Endovascular Coils

Background:Superior cerebellar artery aneurysms are rare. We present a clinical series of twelve of these aneurysms that were treated exclusively with endovascular coils.Method:A retrospective analysis of a prospectively collected database of cerebral aneurysms treated with coil embolization was performed. Clinical notes and radiological images were reviewed.Results:Twelve superior cerebellar artery aneurysms were treated in eleven patients between 1992 and 2001. Seven patients presented with subarachnoid hemorrhage, two with neurologic deficit, and two had asymptomatic aneurysms. Coiling resulted in complete aneurysm obliteration in six patients and incomplete obliteration in the other six. No subsequent hemorrhage occurred with follow-up between 6 and 119 months (mean follow-up 50 months). Procedural morbidity was one superior cerebellar artery infarct with good recovery. Management morbidity was one middle cerebral artery embolus during a follow-up angiogram that required thrombolysis with a good clinical result. Nine out of 11 patients on follow-up were performing at Glasgow Outcome Scale (GOS) 5. One patient with GOS 3 presented with a poor grade subarachnoid hemorrhage and the other patient with GOS 4 presented with a parenchymal hemorrhage due to an arteriovenous malformation.Conclusion:Endovascular treatment of superior cerebellar artery aneurysms is an effective treatment strategy with low morbidity.

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The Superior Cerebellar Artery Aneurysm: A Posterior Circulation Aneurysm with Favorable Microsurgical Outcomes

Neurosurgery ◽

10.1093/neuros/nyw111 ◽

2017 ◽

Vol 80 (6) ◽

pp. 908-916 ◽

Cited By ~ 10

Author(s):

Ana Rodríguez-Hernández ◽

Brian P. Walcott ◽

Harjus Birk ◽

Michael T. Lawton

Keyword(s):

Subarachnoid Hemorrhage ◽

Surgical Techniques ◽

Artery Aneurysm ◽

Posterior Circulation ◽

Superior Cerebellar Artery ◽

Microsurgical Clipping ◽

Cerebellar Artery ◽

Neurological Morbidity ◽

Scale Scores ◽

Permanent Morbidity

Abstract BACKGROUND: Superior cerebellar artery (SCA) aneurysms are usually grouped with aneurysms that arise from the upper basilar artery or more broadly, the posterior circulation. However, the SCA aneurysm has distinctive anatomy that facilitates safe surgical management, notably few associated perforating arteries, and excellent exposure in the carotid-oculomotor triangle. OBJECTIVE: To demonstrate the outcomes of patients treated with microsurgery in a continuous surgical series. METHODS: Sixty-two patients harboring 63 SCA aneurysms were retrospectively reviewed from a prospectively maintained database, focusing on clinical characteristics, surgical techniques, and clinical outcomes. RESULTS: Of 31 patients (49%) presenting with subarachnoid hemorrhage, the SCA aneurysm was the source in 16 (25%). Thirty-three aneurysms were complex (52%) and 43 patients (59%) had multiple aneurysms. Fifty-seven SCA aneurysms (90.5%) were clipped and 5 were bypassed/trapped or wrapped. Complete angiographic occlusion was achieved in 91.7%. Permanent neurological morbidity occurred in 3 patients and 3 patients that presented in coma after subarachnoid hemorrhage died. All patients with “simple” aneurysms and without subarachnoid hemorrhage had improved or unchanged modified Rankin scale scores. Overall, outcomes were stable or improved in 82.5% of patients. CONCLUSION: SCA aneurysms are favorable for microsurgical clipping with low rates of permanent morbidity and mortality. Microsurgery should be considered alongside endovascular techniques as a treatment option in many patients.

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Dissecting aneurysm of the distal superior cerebellar artery – Case report and assessment of endovascular treatment

Arquivos Brasileiros de Neurocirurgia Brazilian Neurosurgery ◽

10.1055/s-0038-1626000 ◽

2013 ◽

Vol 32 (02) ◽

pp. 118-121

Author(s):

Arquimedes Cavalcante Cardoso ◽

Eduardo Leitão de Almeida Lima ◽

Thiago Mendes Barbosa

Keyword(s):

Case Report ◽

Surgical Treatment ◽

Endovascular Therapy ◽

Distal Portion ◽

Endovascular Embolization ◽

Dissecting Aneurysm ◽

Superior Cerebellar Artery ◽

Cerebellar Artery ◽

Type Of Injury ◽

Dissecting Aneurysms

AbstractDissecting aneurysms located in peripheral regions of the cerebellar arteries are rare, and few cases have been described in the literature. Surgical treatment of these lesions may become difficult due to its relatively inaccessible location. Thus, the approach of these aneurysms through endovascular therapy may be an alternative treatment. We described a case of ruptured dissecting aneurysm located in the distal portion of the superior cerebellar artery, which was treated with endovascular embolization. We also discuss the results of endovascular therapy for this type of injury.

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