RECURRENT SUBARACHNOID HEMORRHAGE CAUSED BY A DE NOVO BASILAR TIP ANEURYSM DEVELOPING WITHIN 8 WEEKS AFTER CLIPPING OF A RUPTURED ANTERIOR COMMUNICATING ARTERY ANEURYSM

Neurosurgery ◽  
2008 ◽  
Vol 62 (1) ◽  
pp. E259-E260 ◽  
Author(s):  
Karl-Michael Schebesch ◽  
Christian Doenitz ◽  
Roland Zoephel ◽  
Thomas Finkenzeller ◽  
Alexander T. Brawanski
Keyword(s):  
Subarachnoid Hemorrhage ◽  
De Novo ◽  
Case Reports ◽  
Rapid Development ◽  
Transcranial Doppler Sonography ◽  
Artery Aneurysm ◽  
Posterior Circulation ◽  
Anterior Communicating Artery ◽  
Anterior Circulation ◽  
De Novo Aneurysm

Abstract OBJECTIVE Well-documented case reports of the rapid formation and rupture of de novo aneurysms of the posterior circulation are rare. CLINICAL PRESENTATION We report a patient with subarachnoid hemorrhage caused by an aneurysm of the anterior communicating artery that was clipped consecutively. Forty-four days after the initial subarachnoid hemorrhage, the patient experienced a second subarachnoid hemorrhage after the rupture of a newly grown aneurysm of the basilar tip. Between the two hemorrhages, transcranial Doppler sonography and neuroimaging revealed a fulminant generalized vasospasm. INTERVENTION To our knowledge, this is the first report of the rapid development and rupture of a de novo aneurysm of the posterior circulation after the rupture of an initial aneurysm of the anterior circulation. CONCLUSION We review the pertinent literature and discuss possible reasons for the development and rupture of this second aneurysm.

scholarly journals An Analysis of Intracranial Aneurysms Presenting with Subarachnoid Haemorrhage in Manipal Teaching Hospital Pokhara

2018 ◽  
Vol 8 (1) ◽  
pp. 20-24
Author(s):  
Balgopal Karmacharya ◽  
Nikunja Yogi
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Teaching Hospital ◽  
Intracranial Aneurysms ◽  
Artery Aneurysm ◽  
Anterior Communicating Artery ◽  
High Morbidity ◽  
Anterior Circulation ◽  
Cross Sectional ◽  
Female Ratio ◽  
Spontaneous Subarachnoid Hemorrhage

Introduction: Rupture of intracranial aneurysms is the most common cause for spontaneous subarachnoid hemorrhage. It is a devastating stroke with high morbidity and mortality. This study was done to determine the frequency, location and size of aneurysms in patients presenting with spontaneous subarachnoid hemorrhage.Methods: This prospective cross sectional observational study was conducted in the Neurosurgery Unit of Manipal Teaching Hospital from January 2012 to June 2016. All patients who presented with spontaneous subarachnoid hemorrhage and had a positive angiography of brain were included in the study.Results: There were 39 patients who had positive angiographic results. Male: female ratio was 1:2.25. Mean age was 55.79 years. Nine patients had more than one aneurysms. More than 50% of patients were of age group 50-70 years. Anterior circulation aneurysms were found in 90% of patients. Anterior communicating artery was the commonest location of aneurysms. Most of the aneurysms had neck size less than 4 mm.Conclusion: Anterior communicating artery aneurysm was the commonest location of ruptured aneurysms.  23.07% of patients had multiple aneurysms. 

Terson sign:

2020 ◽  
Vol 2 (1) ◽  
pp. 38-43
Author(s):  
Luiz Severo Bem Junior ◽  
Gustavo De Souza Andrade ◽  
Joao Ribeiro Memória Júnior ◽  
Hildo Rocha Cirne de Azevedo Filho
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Early Recognition ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Case Reports ◽  
Clinical Status ◽  
Vitreous Hemorrhage ◽  
Anterior Communicating Artery ◽  
Inclusion Criteria ◽  
Relationship Of ◽  
The Relationship

Terson's sign (TS) is classically defined as vitreous hemorrhage associated with subarachnoid hemorrhage of aneurysmal origin, being an important predictor of severity, indicating greater morbidity and mortality when compared to patients without the sign. The objective of this study is to review the relationship of Terson syndrome/Terson sign with the prognosis of aneurysmal subarachnoid hemorrhage. A search for original articles, research and case reports was performed on the PubMed, Scielo, Cochrane and ScienceDirect platform, with the following descriptors: Terson sign and subarachnoid hemorrhage. Retrospective, prospective articles and case reports published in the last 5 years and which were in accordance with the established objective and inclusion criteria were selected. Ten (10) articles were selected, in which the available results show an unfavorable prognostic relationship of TS and subarachnoid hemorrhage, because these patients had a worse clinical status assessed on the Glasgow scales ≤ 8, Hunt & Hess > III, Fisher > 3, in addition to intracranial hypertension and location of the aneurysm in the anterior communicating artery complex. The early recognition of this condition described by Albert Terson in 1900 brought an important contribution to neurosurgery, being recognized until nowadays.

Beware of Nihilism: Favorable Outcome despite Poor Admission Status in Posterior Circulation Aneurysms after Aneurysmal Subarachnoid Hemorrhage

2021 ◽  
Author(s):  
Nina Brawanski ◽  
Sepide Kashefiolasl ◽  
Sae-Yeon Won ◽  
Joachim Berkefeld ◽  
Elke Hattingen ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Mortality Rate ◽  
Cerebral Artery ◽  
Coil Embolization ◽  
Posterior Inferior Cerebellar Artery ◽  
Posterior Circulation ◽  
Anterior Circulation ◽  
Ruptured Aneurysms ◽  
Admission Status ◽  
Posterior Circulation Aneurysms

Abstract Objective As shown in a previous study, aneurysm location seems to influence prognosis in patients with subarachnoid hemorrhage (SAH). We compared patients with ruptured aneurysms of anterior and posterior circulation, undergoing coil embolization, concerning differences in outcome and prognostic factors. Methods Patients with SAH were entered into a prospectively collected database. We retrospectively identified 307 patients with aneurysms of the anterior circulation (anterior cerebral artery, carotid bifurcation, and middle cerebral artery) and 244 patients with aneurysms of the posterior circulation (aneurysms of the basilar artery, posterior inferior cerebellar artery, posterior communicating artery and posterior cerebral artery). All patients underwent coil embolization. The outcome was assessed using the modified Rankin Scale (mRS; favorable [mRS 0–2] vs. unfavorable [mRS 3–6]) 6 months after SAH. Results In interventionally treated aneurysms of the anterior and posterior circulation, statistically significant risk factors for poor outcome were worse admission status and severe cerebral vasospasm. If compared with patients with ruptured aneurysms of the anterior circulation, patients with aneurysms of the posterior circulation had a significantly poorer admission status, and suffered significantly more often from an early hydrocephalus. Nonetheless, there were no differences in outcome or mortality rate between the two patient groups. Conclusion Patients with a ruptured aneurysm of the posterior circulation suffer more often from an early hydrocephalus and have a significantly worse admission status, possibly related to the untreated hydrocephalus. Nonetheless, the outcome and the mortality rate were comparable between ruptured anterior and posterior circulation aneurysms, treated by coil embolisation. Therefore, despite the poorer admission status of patients with ruptured posterior circulation aneurysms, treatment of these patients should be considered.

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.

Subarachnoid hemorrhage due to de novo dissecting vertebral artery aneurysm in a patient with Guillain‐Barré syndrome

2019 ◽  
Vol 7 (6) ◽  
pp. 341-343
Author(s):  
Takamichi Hijikata ◽  
Eiichi Baba ◽  
Kazutaka Shirokane ◽  
Atsushi Tsuchiya ◽  
Motohiro Nomura
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Vertebral Artery ◽  
De Novo ◽  
Artery Aneurysm ◽  
Guillain Barre Syndrome ◽  
Guillain Barré Syndrome ◽  
Guillain Barré

Transcirculation Silk Vista Baby-assisted coiling in half-T configuration for the treatment of posterior communicating artery aneurysms associated with a fetal posterior circulation: An alternative flow diversion strategy

2020 ◽  
pp. 159101992096188
Author(s):  
Mario Martínez-Galdámez ◽  
Miguel Schüller-Arteaga ◽  
Jorge Galván-Fernández ◽  
Vladimir Kalousek ◽  
Ezequiel Petra ◽  
...  
Keyword(s):  
Flow Diverter ◽  
Posterior Circulation ◽  
Flow Diversion ◽  
Anterior Communicating Artery ◽  
Anterior Circulation ◽  
Low Profile ◽  
Specific Subgroup ◽  
Flow Diverter Devices ◽  
Profile Flow ◽  
Incomplete Occlusion

Flow diverter devices have become a routine first-line option for treatment of an increasing population of intracranial aneurysms at many neurovascular centers.  Despite the promising results of flow diverter stents on anterior circulation, incomplete occlusion on the presence of fetal posterior circulation has been described on several reports.  Here we describe a novel technical alternative to conventional flow diversion approach for this specific subgroup of aneurysms using the low-profile flow diverter, Silk Vista Baby. The device was selectively placed into the fetal type posterior cerebral artery in half-T configuration for the treatment of a posterior communicating aneurysm using a transcirculation approach through the anterior communicating artery. This represents a useful and effective technique and should be considered when encountering the above-described situation.

De Novo Aneurysm Formation Following Carotid Ligation: Case Report and Review of the Literature

Neurosurgery ◽  
1989 ◽  
Vol 24 (1) ◽  
pp. 88-92 ◽  
Author(s):  
Gregg N. Dyste ◽  
David W. Beck
Keyword(s):  
Case Report ◽  
Subarachnoid Hemorrhage ◽  
Carotid Artery ◽  
De Novo ◽  
Review Of The Literature ◽  
Pertinent Literature ◽  
Carotid Siphon ◽  
Aneurysm Formation ◽  
Carotid Ligation ◽  
De Novo Aneurysm

Abstract The authors report a patient with an aneurysm of the carotid siphon who underwent ligation of the cervical carotid artery. Six years after this procedure, the patient suffered a subarachnoid hemorrhage from an apparent de novo aneurysm. Pertinent literature is reviewed to determine the incidence of this occurrence, and congenital arteriosclerotic and hemodynamic factors causing aneurysm enlargement are discussed.

scholarly journals Subarachnoid Hemorrhage from Intracranial Dissecting Aneurysms of the Anterior Circulation —Two Case Reports—

1999 ◽  
Vol 39 (6) ◽  
pp. 442-446 ◽  
Author(s):  
Hiroyuki HASHIMOTO ◽  
Jun-ichi IIDA ◽  
Yasushi SHIN ◽  
Yasuo HIRONAKA ◽  
Toshisuke SAKAKI
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Case Reports ◽  
Anterior Circulation ◽  
Dissecting Aneurysms

Eyelid approach to the anterior cranial base

2008 ◽  
Vol 109 (2) ◽  
pp. 341-346 ◽  
Author(s):  
Norberto Andaluz ◽  
Alberto Romano ◽  
Likith V. Reddy ◽  
Mario Zuccarello
Keyword(s):  
Minimally Invasive ◽  
Skull Base ◽  
Artery Aneurysm ◽  
Anterior Cranial Fossa ◽  
Anterior Communicating Artery ◽  
Surgical Morbidity ◽  
Anterior Circulation ◽  
Unruptured Aneurysms ◽  
Anterior Cranial Base ◽  
Cranial Fossa

Skull base approaches play a fundamental role in modern neurosurgery by reducing surgical morbidity. Increasing experience has allowed surgeons to perform minimally invasive approaches without straying from the premises of skull base surgery. The eyelid approach has evolved from the orbitopterional osteotomy into a more effective and targeted approach to disease of the anterior cranial fossa. In this technique, after an incision is made on the supratarsal fold, the orbicularis oculi muscle is incised, and a myocutaneous flap composed of the elements of the anterior lamella is elevated. Subperiosteal dissection is used to expose the superior and lateral walls of the orbit, the superior and lateral orbital rim, and the frontosphenoidal suture. A MacCarty bur hole is drilled, and a frontal osteotomy is fashioned medial to the supraorbital notch and extending through the orbital roof back toward the orbital half of the MacCarty bur hole, exposing the frontobasal brain. A conventional microsurgical technique is used to treat tumors and aneurysms of the anterior cranial fossa under the operative microscope. Five patients were treated for unruptured aneurysms of the anterior circulation (3 anterior communicating artery aneurysms, 1 ophthalmic artery aneurysm, and 1 posterior communicating artery aneurysm) using the eyelid approach. The mean aneurysm size was 5 mm, and all aneurysms were approached from the right side. Three tumors in the anterior fossa (2 suprasellar pituitary adenomas and 1 craniopharyngioma) were also excised using this approach. There was no surgical morbidity. Three months after surgery all patients presented excellent cosmetic results. The eyelid approach may be considered as an effective, cosmetically beneficial, and minimally invasive skull base approach to selected aneurysms and tumors of the anterior circulation.

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