scholarly journals Outcome of patients of Subarachnoid Hemorrhage due to ruptured anterior communicating artery aneurysm after surgical clipping

2016 ◽  
Vol 11 (4) ◽  
Author(s):  
Anjum Habib Vohra ◽  
Mubasher Ahmed
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Subarachnoid Haemorrhage ◽  
Prospective Study ◽  
Artery Aneurysm ◽  
Anterior Communicating Artery ◽  
Surgical Clipping ◽  
Radiological Investigation ◽  
Female Ratio ◽  
Male To Female ◽  
Grade Iii

This prospective study was done to determine the outcome of subarachnoid haemorrhage (SAH) due to ruptured anterior communicating artery ( a Corn) aneurysm in 8 consecutive patients after craniotomy and clipping of the aneurysm. The study was conducted at Mayo Hospital, Lahore from September 1999 to January 2002. All patients presented with history and examination suggestive of SAH had CT scan brain as first radiological investigation. Patients of SAH were graded clinically according to Hung and Hess scale. After confirmation of diagnosis of SAH, four vessels cerebral angiography was done to localize site of aneurysm in patiens of Hunt and Hess grade I, II and III or after they improved to at least grade III. Craniotomy and clipping of aneursm was done only in patients with Hunt & Hess grade I, II and III. Maximum patients presented during 6th decade i.e., 38%. Male to female ratio was 6:2. Hunt & Hess grade I, II and III was observed in 5,2 and 1 patients respectively. Outcome was assessed according to G lasgow Outcome Scale (GOS). Good outcome was present in 75% patients and moderate disability in 25%.

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. 

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.

scholarly journals Intraoperative Rerupture and Surgical Clipping of a Small Superiorly Projecting Anterior Communicating Artery Aneurysm: 2-Dimensional Operative Video

2020 ◽  
Vol 19 (3) ◽  
pp. E288-E288
Author(s):  
Benjamin K Hendricks ◽  
Robert F Spetzler
Keyword(s):  
Video Recording ◽  
Artery Aneurysm ◽  
Anterior Communicating Artery ◽  
Surgical Clipping ◽  
Institutional Review ◽  
Clip Application ◽  
Interhemispheric Fissure ◽  
Aneurysm Occlusion ◽  
Intraoperative Rupture ◽  
Temporary Clip

Abstract Anterior communicating artery (ACoA) aneurysms are prone to rupture even at smaller sizes. The surgical management of ACoA aneurysms is highly dependent on the spatial orientation of the saccular projection, categorized as inferior, superior, anterior, or posterior. Superior projecting aneurysms constitute approximately one-third of all aneurysms involving the ACoA. These aneurysms commonly project within the interhemispheric fissure; however, if the aneurysm is not high-riding, it can often be approached via a transsylvian trajectory. The patient presented after subarachnoid hemorrhage with a 3-mm superiorly projecting ACoA aneurysm. The lesion was approached via a right modified orbitozygomatic craniotomy with a transsylvian trajectory. The aneurysm reruptured after minimal manipulation of the dome. Mitigation of the intraoperative rupture was achieved through temporary clip application to bilateral A1 vessels. Bipolar coagulation and placement of 2 permanent clips facilitated final aneurysm occlusion. Postoperative imaging demonstrated patent bilateral A2 flow and no residual aneurysm filling. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

scholarly journals Early Rebleeding of Small Anterior Communicating Artery Aneurysm with Presumed Extrusion of Coil Loop to outside the Aneurysmal Wall during Endovascular Treatment

2009 ◽  
Vol 15 (1) ◽  
pp. 103-108 ◽  
Author(s):  
HW Pyun ◽  
DK Hyun ◽  
DH Lee ◽  
SW Park ◽  
MK Lim
Keyword(s):  
Endovascular Treatment ◽  
Coil Embolization ◽  
Artery Aneurysm ◽  
Anterior Communicating Artery ◽  
Surgical Clipping ◽  
Aneurysmal Wall ◽  
Follow Up Study ◽  
Complete Treatment ◽  
Anterior Communicating Aneurysm

Although endovascular treatment has been proved to be as effective as surgical clipping in the prevention of rebleeding of ruptured aneurysm, early rebleeding after coil embolization has seldom been reported. We experienced early re-hemorrhage in two patients of ruptured small anterior communicating artery aneurysms of complete treatment with coil-embolization initially. In both cases what interested us was not early rebleeding itself but how the presumed extrusion of the first part of coil loop beyond aneurysmal wall developed. However, there was no evidence of intraprocedural rupture and moreover complete occlusion with only one or two coils was obtained. Our two patients underwent successful second treatment. We discovered the presumed extruded first part of the coil loop initially was located inside the enlarged aneurysmal sac in retreatment stage. In case of coil embolization of ruptured small anterior communicating aneurysm, the phenomenon we experienced with no evidence of intraprocedural rupture in spite of obvious extrusion of coil loop beyond the aneurysmal wall can be a sign of necessity for early follow-up study including plain radiography to track the change in the presumed extruded coil loop.

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 Traditionally Amputated Uvula amongst Nigerians: Still an Ongoing Practice

2011 ◽  
Vol 2011 ◽  
pp. 1-4 ◽  
Author(s):  
Adeyi A. Adoga ◽  
Tonga L. Nimkur
Keyword(s):  
Hospital Admission ◽  
Health Outcomes ◽  
Prospective Study ◽  
Teaching Hospital ◽  
Traditional Healers ◽  
University Teaching ◽  
Female Ratio ◽  
Throat Pain ◽  
Outpatient Unit ◽  
Male To Female

Traditional healers in Nigeria continue to perform uvulectomy for all throat problems despite the severe complications they present to physicians. It is a hospital-based prospective study done at the outpatient unit of the Department of Otolaryngology, Jos University Teaching Hospital, Jos, Nigeria to determine the prevalence of traditional uvulectomy, highlighting the dangers it portends with suggested ways of providing improved health outcomes for our people. We saw 517 new cases of which 165 (32%) patients aged 2 years to 53 years had their uvulae amputated consisting of 108 (65.5%) males and 57 (34.5%) females giving a male to female ratio of 2 : 1. One hundred and forty two (86.1%) patients had uvulectomy at childhood and 23 (13.9%) in adulthood. The commonest indication was throat pain (, 21.8%). The commonest complication was hemorrhage (, 17.6%). Forty six (27.9%) patients required hospital admission.

scholarly journals Aneurysmal Subarachnoid Haemorrhage After COVID-19 Infection

2020 ◽  
Author(s):  
Sajjad Muhammad ◽  
Soheil Naderi ◽  
Mostafa Ahmadi ◽  
Askar Ghorbani ◽  
Daniel Hänggi
Keyword(s):  
Subarachnoid Haemorrhage ◽  
Systemic Inflammation ◽  
Artery Aneurysm ◽  
Neurological Deficits ◽  
Coagulation System ◽  
Anterior Communicating Artery ◽  
Aneurysmal Subarachnoid Haemorrhage ◽  
Low Oxygen ◽  
First Case ◽  
History Of

Abstract BackgroundSARS-CoV-2 virus infection leads to a severe and dysbalanced inflammatory response with hypercytokinemia and immunodepression. Systemic inflammation due to viral infections can potentially cause vascular damage including disruption of blood-brain barrier (BBB) and alterations in coagulation system that may also lead to cardiovascular and neurovascular events. Here, we report the first case of COVID-19 infection leading to aneurysmal subarachnoid haemorrhage (aSAH). Case DescriptionA 61-year-old woman presented with dyspnea, cough and fever. She was over weight with Body mass-index of 34 and history of hypertension. No history of subarachnoid hemorrhage in the family. She was admitted in ICU due to low oxygen saturation (89%). A chest CT showed typical picture of COVID-19 pneumonia. Oropharyngeal swab with a PCR-based testing was COVID-19 positive. She was prescribed with favipiravir and hydroxychloroquine in Addition to oxygen support. On second day she experienced sudden headache and losst conciousness. A computer tomography (CT) with CT-angiography revealed subarachnoid haemorrhage in basal cisterns from a ruptured anterior communicating artery aneurysm. The aneurysm was clipped microsurgically through a standard pterional approach and the patient was admitted again to intensive care unit for further intensive medical treatment. Post-operative the patient showed slight motor dysphasia. No other neurological deficits.ConclusionAneurysmal subarachnoid haemorrhage secondary to COVID-19 infection might be triggered by systemic inflammation. COVID-19 infection could be one of the risk factors leading to instability and rupture of intracranial aneurysm.

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