Intracranial mycotic aneurysms of extravascular origin

1972 ◽  
Vol 36 (5) ◽  
pp. 552-559 ◽  
Author(s):  
Charas Suwanwela ◽  
Nitaya Suwanwela ◽  
Srisakul Charuchinda ◽  
Chaturaporn Hongsaprabhas
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cavernous Sinus ◽  
Internal Carotid ◽  
Cerebral Arteries ◽  
Content Type ◽  
Mycotic Aneurysms ◽  
Fine Print

✓ Six patients with intracranial mycotic aneurysms of extravascular origin are reported. Four had aneurysms of the intracavernous portion of the internal carotid artery associated with thrombophlebitis of the cavernous sinus, and two had aneurysms of the cerebral arteries associated with meningitis. An aneurysm of this type may rupture, producing subarachnoid hemorrhage, or it may become thrombosed and decrease in size or spontaneously disappear. In some patients it may persist and develop calcification in the wall.

Subarachnoid hemorrhage possibly caused by a saccular carotid artery aneurysm within the cavernous sinus

1990 ◽  
Vol 73 (2) ◽  
pp. 301-304 ◽  
Author(s):  
Tatsuya Nishioka ◽  
Akinori Kondo ◽  
Ikuhiro Aoyama ◽  
Kiyoshi Nin ◽  
Jun Takahashi
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cavernous Sinus ◽  
Surgical Approach ◽  
Internal Carotid ◽  
Artery Aneurysm ◽  
Content Type ◽  
Carotid Artery Aneurysm ◽  
Fine Print

✓ Aneurysms arising from the intracavernous portion of the internal carotid artery very rarely rupture. A patient is presented in whom rupture of an aneurysm wholly within the cavernous sinus caused a subarachnoid hemorrhage. The aneurysm was successfully clipped via a direct surgical approach. The possible mechanism by which subarachnoid hemorrhage occurred is briefly discussed.

Treatment of bilateral spontaneous dural carotid-cavernous fistulas by coils and sclerotherapy

1987 ◽  
Vol 66 (3) ◽  
pp. 468-470 ◽  
Author(s):  
Patrick Courtheoux ◽  
Daniel Labbe ◽  
Christian Hamel ◽  
Pierre-Joel Lecoq ◽  
Marcio Jahara ◽  
...  
Keyword(s):  
Intraocular Pressure ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cavernous Sinus ◽  
Internal Carotid ◽  
Superior Ophthalmic Vein ◽  
Content Type ◽  
Steel Coils ◽  
Carotid Cavernous Fistulas ◽  
Fine Print

✓ A case of bilateral spontaneous carotid-cavernous fistulas producing increased intraocular pressure is reported. The fistulas lay between the meningeal branches of the internal carotid artery (ICA) and the cavernous sinus, but the ICA itself was not involved. Successful treatment was accomplished by the introduction of steel coils and a sclerotic liquid into the cavernous sinus via the distal superior ophthalmic vein.

Mycotic aneurysms of the internal carotid artery

1976 ◽  
Vol 44 (1) ◽  
pp. 105-108 ◽  
Author(s):  
Satoshi Shibuya ◽  
Seishi Igarashi ◽  
Tadashi Amo ◽  
Hideo Sato ◽  
Taro Fukumitsu
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Clinical Features ◽  
Internal Carotid ◽  
Rapid Development ◽  
Content Type ◽  
Mycotic Aneurysms ◽  
Fine Print

✓ The authors report a case with two mycotic aneurysms in the cavernous portion of the internal carotid artery, presumably secondary to a transient bacteremia from pneumonia. The strikingly rapid development of the aneurysms was demonstrated by angiography. Painful total ophthalmoplegia and exophthalmos were the main clinical features.

Surgical alternatives in the treatment of cavernous sinus aneurysms

1989 ◽  
Vol 71 (6) ◽  
pp. 846-853 ◽  
Author(s):  
Fernando G. Diaz ◽  
Sam Ohaegbulam ◽  
Manuel Dujovny ◽  
James I. Ausman
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cavernous Sinus ◽  
Visual Loss ◽  
Internal Carotid ◽  
Content Type ◽  
Group 3 ◽  
Group 2 ◽  
Fine Print ◽  
Group 1

✓ Direct surgery on aneurysms in the cavernous sinus is a formidable technical procedure. The intimate relationship of the intracavernous carotid artery to the venous structures and to the cranial nerves make surgical access difficult at best. Thirty-two of 356 aneurysm patients presented with symptomatic aneurysms originating from the intracavernous internal carotid artery. Twenty-one patients had aneurysms contained entirely within the cavernous sinus, and in 11 others the aneurysms arose within the cavernous sinus and extended into the subarachnoid space. Of the purely intracavernous aneurysms there were five small aneurysms (< 25 mm) and 16 giant (≥ 25 mm) aneurysms. Fifteen patients with purely intracavernous lesions had a superior orbital fissure syndrome, and six had a variety of other symptoms. Of 11 patients with subarachnoid extension, five had a subarachnoid hemorrhage (Grade I or II), five had ipsilateral visual loss, and one had periorbital pain. The aneurysms were treated as follows: Group 1 received progressive ligation of the internal carotid artery in the neck with a Selverstone clamp and a surface superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis (purely intracavernous in nine, and with subarachnoid extension in one); Group 2 underwent trapping of the internal carotid artery and a deep STA-MCA anastomosis (purely intracavernous in seven); and Group 3 had direct clipping of the aneurysm (purely intracavernous in five, and with subarachnoid extension in 10). The cavernous sinus was entered directly through its roof by a pterional craniotomy with radical removal of the optic canal, lesser sphenoid wing, and lateral and superior orbital walls. Proximal control of the internal carotid artery was obtained through a cervical incision. Two patients in Group 1 developed transient neurological deficits, which resolved. Two patients in Group 2 developed a cerebral infarction, one of whom died; in both of these patients, the anastomosis was completed after the internal carotid artery occlusion. Two patients in Group 3 progressed from marked visual loss to blindness of the same side, and one developed an intraventricular hemorrhage during induction of anesthesia and died without surgery. It is proposed that a direct approach to symptomatic aneurysms in the cavernous sinus is the best initial alternative. When this approach is not feasible, a trapping procedure preceded by a high-flow extracranial-intracranial anastomosis may be considered. Although the authors have been able to clip aneurysms of various sizes, this has not been possible in all patients. Further work is needed in this area.

Some observations on aneurysms of the proximal internal carotid artery

1979 ◽  
Vol 51 (2) ◽  
pp. 151-154 ◽  
Author(s):  
Jonathan Punt
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Ophthalmic Artery ◽  
Internal Carotid ◽  
Content Type ◽  
Multiple Aneurysms ◽  
Proximal Internal Carotid Artery ◽  
High Incidence ◽  
Fine Print

✓ The author reports on 41 aneurysms of the proximal internal carotid artery (PICA) demonstrated in 36 patients with subarachnoid hemorrhage. The patients included a striking preponderance of women, and there was a high incidence of multiple aneurysms. In cases with multiple aneurysms the PICA aneurysm was usually found incidentally, a more distal aneurysm on the internal carotid artery being the source of hemorrhage. An infundibulum at the origin of a posterior communicating artery was unusually common in these patients. The origin of the ophthalmic artery is proposed as the angiographic landmark of the level at which the internal carotid artery penetrates the dura mater.

The minor leak preceding subarachnoid hemorrhage

1987 ◽  
Vol 66 (1) ◽  
pp. 35-39 ◽  
Author(s):  
Richard Leblanc
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Lumbar Puncture ◽  
Computerized Tomography ◽  
Internal Carotid ◽  
Artery Aneurysm ◽  
Content Type ◽  
A Minor ◽  
Fine Print

✓ Thirty-four of 87 consecutive patients with subarachnoid hemorrhage from a cerebral aneurysm had a premonitory minor leak. There were 12 men and 22 women, aged 25 to 73 years (mean 44.4 years). Twenty-two had a small and 12 had a large aneurysm located on the internal carotid artery (17 cases), anterior communicating artery (10 cases), middle cerebral artery (five cases), and pericallosal artery (two cases). Fifty-two percent of patients with a minor leak from an internal carotid artery aneurysm had ipsilateral, hemicranial, hemifacial, or periorbital pain. Half of the patients initially saw a physician, but in no case was the correct diagnosis made. Twenty-five patients had a major rupture within 24 hours to 4 weeks after findings suggesting a minor leak, with a mortality rate of 53%. Nine other patients were diagnosed by lumbar puncture or computerized tomography (CT) scanning after initial misdiagnosis and were operated on, without mortality, before a major rupture could occur. The CT scans were negative in 55% of patients with a minor leak, but lumbar puncture, when performed, was always positive. A minor leak prior to major aneurysmal rupture is a common occurrence and, if unrecognized, is associated with a high mortality. Computerized tomography scanning is unreliable in diagnosing this event, and lumbar puncture is the examination of choice once intracranial hypertension has been ruled out.

The superior wall of the cavernous sinus: a microanatomical study

1994 ◽  
Vol 81 (6) ◽  
pp. 914-920 ◽  
Author(s):  
Felix Umansky ◽  
Alberto Valarezo ◽  
Josef Elidan
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cavernous Sinus ◽  
Internal Carotid ◽  
Deep Layer ◽  
Lateral Wall ◽  
Anterior Clinoid Process ◽  
Content Type ◽  
Carotid Canal ◽  
Fine Print

✓ The superior wall of the cavernous sinus was studied in 30 specimens obtained from 15 cadaver heads fixed in formalin. Trapezoidal in shape, the superior wall of cavernous sinus is limited laterally by the anterior petroclinoid ligament, medially by the dura of the diaphragma sellae, anteriorly by the endosteal dura of the carotid canal, and posteriorly by the posterior petroclinoid ligament. An interclinoid ligament bisects the wall, dividing it into two triangles: the carotid trigone anteromedially and the oculomotor trigone posterolaterally. Similar to the lateral wall of the cavernous sinus, the superior wall is formed by two layers: a smooth superficial dural layer and a thin, less defined deep layer. In the area of the carotid trigone, both layers separate to wrap the anterior clinoid process. The removal of this process will reveal a “clinoid space” medial to which the internal carotid artery can be identified. This clinoid segment of the artery, still extracavernous, is surrounded by two fibrous rings: a distal ring formed by fibers of the superficial dural layer and a proximal ring related to the deep dural layer. Below the proximal ring, the internal carotid artery becomes intracavernous; above the distal ring, the artery is continuous with its supraclinoid segment. The complex dural anatomy of the superior wall, its fibrous rings, and the clinoid space in relation to a superior surgical approach to the cavernous sinus are discussed.

Enlarged anterior spinal artery as collateral circulation

1974 ◽  
Vol 41 (3) ◽  
pp. 356-359 ◽  
Author(s):  
Jun Karasawa ◽  
Haruhiko Kikuchi ◽  
Seiji Furuse ◽  
Toshisuke Sakaki ◽  
Yasumasa Makita
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Collateral Circulation ◽  
Internal Carotid ◽  
Vascular Malformations ◽  
Anterior Spinal Artery ◽  
Left Internal Carotid Artery ◽  
Content Type ◽  
Vertebral Arteries ◽  
Fine Print

✓The authors report and discuss two cases in which collateral circulation could be angiographically demonstrated passing through the anterior spinal artery. Case 1 proved to have occlusions of the left internal carotid artery and both vertebral arteries. The basilar artery was visualized via the anterior spinal, the primitive trigeminal, and primitive otic arteries. The presence of multiple vascular malformations and an abnormal anterior spinal artery suggested that the latter had been functioning as collateral circulation since an embryonic stage. In Case 2, both internal carotids and both vertebral arteries were occluded by arteriosclerotic changes. It was assumed that the deleted anterior spinal artery visualized angiographically had developed into a collateral circulation with increasing age.

Patient presentation, angiographic features, and treatment of strangulation-induced dissection of the internal carotid artery

2000 ◽  
Vol 92 (3) ◽  
pp. 481-487 ◽  
Author(s):  
Adel M. Malek ◽  
Randall T. Higashida ◽  
Van V. Halbach ◽  
Christopher F. Dowd ◽  
Constantine C. Phatouros ◽  
...  
Keyword(s):  
Domestic Violence ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Stent Placement ◽  
Internal Carotid ◽  
Artery Dissection ◽  
Percutaneous Angioplasty ◽  
Consistent Finding ◽  
Content Type ◽  
Fine Print

✓ Domestic violence leading to strangulation by an abusive spouse can cause carotid artery dissection. This phenomenon is rare and has been described in only three previous instances. The authors present their management strategies in three additional cases.Three young women aged 24 to 43 years were victims of manual strangulation committed by their spouses 3 months to 1 year before presentation. Two of the patients suffered delayed cerebral infarctions before presentation and angiography demonstrated focal, mirror-image severe residual stenoses in the high-cervical internal carotid artery (ICA), which were characteristic of a healed chronic dissection; there was no evidence of fibromuscular dysplasia. One of these patients underwent unilateral percutaneous angioplasty with stent placement, and the other underwent bilateral percutaneous angioplasty. Both patients have recovered from their strokes and remain clinically stable at 8 and 20 months posttreatment, respectively. The third patient presented with bilateral ischemic frontal watershed infarctions resulting from an occluded left ICA and a severely narrowed right ICA. Given the extent of the established infarctions, this case was managed with a long-term regimen of anticoagulation medications, and the patient remains neurologically impaired.These cases illustrate the susceptibility of the manually compressed ICA to traumatic injury as a result of domestic violence. They identify bilateral symmetrical ICA dissection as a consistent finding and the real danger of delayed stroke as a consequence of strangulation. Endovascular therapy in which percutaneous angioplasty and/or stent placement are used can be useful in treating residual focal stenoses to improve cerebral perfusion and to lower the risk of embolic or ischemic stroke.

Carotid paraclinoid aneurysms with intradural origin and intracavernous location

1978 ◽  
Vol 48 (4) ◽  
pp. 526-533 ◽  
Author(s):  
Stephen Nutik
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Precise Definition ◽  
Separate Entity ◽  
Content Type ◽  
Paraclinoid Aneurysms ◽  
Planning Treatment ◽  
Definition Of ◽  
Fine Print

✓ Five cases of a congenital berry aneurysm of the internal carotid artery with origin partially intradural and fundus mainly intracavernous are presented. Angiography does not allow a precise definition of the amount of aneurysm that is intradural, a fact of importance when planning treatment of these cases. However, the angiographic features are characteristic of the type and suggest that these aneurysms be grouped together as a separate entity.

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