Cerebral aspergillosis

✓ A mycotic basilar artery aneurysm, in which Aspergillus was identified histologically, was found to be the cause of a massive subarachnoid hemorrhage in a 75-year-old man who suffered from hereditary hemorrhagic telangiectasia; there was no evidence of intracranial involvement by the latter disorder.

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Selective extradural anterior clinoidectomy for supra- and parasellar processes

Journal of Neurosurgery ◽

10.3171/jns.1997.87.4.0636 ◽

1997 ◽

Vol 87 (4) ◽

pp. 636-642 ◽

Cited By ~ 97

Author(s):

Yasuhiro Yonekawa ◽

Nobuyoshi Ogata ◽

Hans-Georg Imhof ◽

Magnus Olivecrona ◽

Kevin Strommer ◽

...

Keyword(s):

Optic Nerve ◽

Basilar Artery ◽

Artery Aneurysm ◽

Anterior Clinoid Process ◽

Content Type ◽

Cerebrospinal Fluid Rhinorrhea ◽

Anterior Clinoidectomy ◽

Basilar Artery Aneurysm ◽

Sphenoid Ridge ◽

Fine Print

✓ Removal of the anterior clinoid process (ACP) facilitates radical removal of tumors or radical neck clipping of aneurysms in the supra- and parasellar regions by providing a wide operative exposure of the internal carotid artery (ICA) and the optic nerve and by reducing the need for brain retraction. Over a period of 3 years, anterior clinoidectomy was performed in 40 patients, 30 of whom harbored aneurysms (18 of the ICA and 13 of the basilar artery [one patient had two aneurysms]) and 10 of whom had tumors (four large pituitary tumors, four craniopharyngiomas, and two sphenoid ridge meningiomas). The ACP was removed extradurally in 31 cases and intradurally in nine cases. Extradural clinoidectomy was performed in all cases of pituitary adenoma and craniopharyngioma and in most cases of basilar artery aneurysm. Intradural clinoidectomy was performed in two cases of ICA—ophthalmic artery aneurysm, two cases of ICA—posterior communicating artery aneurysm, two cases of ICA cavernous aneurysm, one case of basilar artery aneurysm, and two cases of sphenoid ridge meningioma. The outcome was satisfactory in all patients, except for one patient who underwent clipping of a basilar tip aneurysm and suffered a thalamic and midbrain infarction. Three patients who underwent extradural clinoidectomy suffered a postoperative diminution of visual acuity or a visual field defect on the side of the clinoidectomy. These deficits may have been caused either by drilling of the ACP or by other operative manipulation of the optic nerve. Cerebrospinal fluid rhinorrhea, which required reoperation, occurred in one patient. The authors' experience suggests that the extradural technique of ACP removal is easier and less time consuming than the intradural one and provides better operative exposure. It can be used routinely in treating lesions in the supra- and parasellar regions.

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Endovascular occlusion of intracranial vessels for curative treatment of unclippable aneurysms: report of 16 cases

Journal of Neurosurgery ◽

10.3171/jns.1991.75.5.0694 ◽

1991 ◽

Vol 75 (5) ◽

pp. 694-701 ◽

Cited By ~ 81

Author(s):

Jonathan E. Hodes ◽

Armand Aymard ◽

Y. Pierre Gobin ◽

Daniel Rüfenacht ◽

Siegfried Bien ◽

...

Keyword(s):

Blood Flow ◽

Cerebral Blood Flow ◽

Cerebral Artery ◽

Basilar Artery ◽

Posterior Inferior Cerebellar Artery ◽

Artery Aneurysm ◽

Neurological Deficits ◽

Parent Vessel ◽

Content Type ◽

Fine Print

✓ Among 121 intracerebral aneurysms presenting at one institution between 1984 and 1989, 16 were treated by endovascular means. All 16 lesions were intradural and intracranial, and had failed either surgical or endovascular attempts at selective exclusion with parent vessel preservation. The lesions included four giant middle cerebral artery (MCA) aneurysms, one giant anterior communicating artery aneurysm, six giant posterior cerebral artery aneurysms, one posterior inferior cerebellar artery aneurysm, one giant mid-basilar artery aneurysm, two giant fusiform basilar artery aneurysms, and one dissecting vertebral artery aneurysm. One of the 16 patients failed an MCA test occlusion and was approached surgically after attempted endovascular selective occlusion. Treatment involved pretreatment evaluation of cerebral blood flow followed by a preliminary parent vessel test occlusion under neuroleptic analgesia with vigilant neurological monitoring. If the test occlusion was tolerated, it was immediately followed by permanent occlusion of the parent vessel with either detachable or nondetachable balloon or coils. The follow-up period ranged from 1 to 8 years. Excellent outcomes were obtained in 12 cases with complete angiographic obliteration of the aneurysm and no new neurological deficits and/or improvement of the pre-embolization symptoms. Four patients died: two related to the procedure, one secondary to rupture of another untreated aneurysm, and the fourth from a postoperative MCA thrombosis after having failed endovascular test occlusion. The angiographic, clinical, and cerebral blood flow criteria for occlusion tolerance are discussed.

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Adenosine-induced transient asystole for management of a basilar artery aneurysm

Journal of Neurosurgery ◽

10.3171/jns.1999.91.4.0687 ◽

1999 ◽

Vol 91 (4) ◽

pp. 687-690 ◽

Cited By ~ 53

Author(s):

Michael W. Groff ◽

David C. Adams ◽

Ronald A. Kahn ◽

Uday M. Kumbar ◽

Bo-Yi Yang ◽

...

Keyword(s):

Basilar Artery ◽

Circulatory Arrest ◽

Artery Aneurysm ◽

Deep Hypothermic Circulatory Arrest ◽

Aneurysm Surgery ◽

Content Type ◽

Basilar Artery Aneurysm ◽

Profound Hypotension ◽

Definition Of ◽

Temporary Clipping

✓ Advances in anesthetic and surgical management, such as induced deep hypothermic circulatory arrest and application of temporary clips, have improved outcome for patients with basilar artery aneurysms. Nonetheless, these techniques are associated with significant risks. The authors report a case in which three transient periods of cardiac asystole were induced during basilar artery aneurysm surgery. Adenosine-induced asystole facilitated the safe clipping of the aneurysm by producing consistent periods of profound hypotension and collapse of the aneurysm without the need for temporary clipping. This technique provided unencumbered identification of perforating arteries, precise definition of the local anatomy, and an ideal environment for the safe placement of the aneurysm clip.

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Simulation of the surgical manipulation involved in clipping a basilar artery aneurysm: concepts of virtual clipping

Journal of Neurosurgery ◽

10.3171/jns.2000.93.2.0355 ◽

2000 ◽

Vol 93 (2) ◽

pp. 355-360 ◽

Cited By ~ 16

Author(s):

Toru Koyama ◽

Kazuhiro Hongo ◽

Yuichiro Tanaka ◽

Shigeaki Kobayashi

Keyword(s):

Cerebral Aneurysm ◽

Basilar Artery ◽

Morphological Changes ◽

Three Dimensional ◽

Artery Aneurysm ◽

Content Type ◽

Aneurysm Clip ◽

Transsylvian Approach ◽

Surgical Manipulation ◽

Fine Print

✓ Despite recent advances in three-dimensional imaging based on a voxel-rendering method, these techniques do not simulate the morphological changes that occur during surgery. The authors' goal was to develop a computer-graphics model to simulate the manipulation that occurs during surgery when clipping a cerebral aneurysm.The authors developed an application program to interpolate the contours of models of an artery and an aneurysm clip. The center of displacement was determined inside the arterial model. The directions of displacement were changed to simulate saccular and broad-neck aneurysms, and the intensity of displacement was calculated by using a cosine-based formula. The morphological changes in a saccular aneurysm that may occur during clipping were calculated in x, y, and z coordinates by using sine- and cosine-based formulas. Clip movement was integrated with the aneurysm model, thus simulating the manipulation used during clipping of a cerebral aneurysm. Surgery performed to clip a basilar artery (BA) aneurysm via the transsylvian approach was simulated, in which displacement of the internal carotid artery and clipping of the BA aneurysm were necessary. The movements of an aneurysm clip and clip applicator were designed to represent those occurring when a surgeon actually manipulates a BA aneurysm.The authors have named this methodological tool “virtual clipping.” Use of this tool would assist the preoperative choice of clipping style and selection of the best clip.

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Intravascular balloon embolization of a large mid-basilar artery aneurysm

Journal of Neurosurgery ◽

10.3171/jns.1987.66.1.0124 ◽

1987 ◽

Vol 66 (1) ◽

pp. 124-127 ◽

Cited By ~ 17

Author(s):

Grant B. Hieshima ◽

Randall T. Higashida ◽

Joseph Wapenski ◽

Van V. Halbach ◽

John R. Bentson

Keyword(s):

Basilar Artery ◽

Artery Aneurysm ◽

Heparin Therapy ◽

Content Type ◽

Surgical Methods ◽

Basilar Artery Aneurysm ◽

Balloon Embolization ◽

Embolization Procedure ◽

Multiple Episodes

✓ A patient who presented with multiple episodes of subarachnoid hemorrhage was diagnosed as having a large mid-basilar artery aneurysm that had no definable surgical neck. Balloon embolization was performed utilizing two detachable silicone balloons to occlude the mid-basilar artery and the aneurysm. The procedure was carried out with the patient fully awake and alert. One day after the procedure, the patient developed pontine and cerebellar ischemia which completely resolved after 5 days on heparin therapy. A follow-up angiogram performed immediately after the procedure and at 3 months demonstrated complete occlusion of the mid-basilar artery and the aneurysm. The patient was intact neurologically upon discharge 5 days after the embolization procedure and has since resumed his normal activities. Balloon embolization therapy may offer some advantages over surgical methods for the treatment of such therapeutically challenging aneurysms.

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Transoral transclival clipping of anterior inferior cerebellar artery aneurysm using new rotating applier

Journal of Neurosurgery ◽

10.3171/jns.1991.75.3.0483 ◽

1991 ◽

Vol 75 (3) ◽

pp. 483-485 ◽

Cited By ~ 36

Author(s):

H. Alan Crockard ◽

Turgut Koksel ◽

Nigel Watkin

Keyword(s):

Basilar Artery ◽

Artery Aneurysm ◽

Transoral Surgery ◽

Anterior Inferior Cerebellar Artery ◽

Content Type ◽

Aneurysm Clip ◽

Dural Closure ◽

Cerebellar Artery ◽

Fine Print

✓ A large, partly calcified aneurysm buried in the pons and arising from the junction of the basilar artery and the anterior inferior cerebellar artery was successfully occluded using a variangle aneurysm clip with a new rotating pistol-grip applier which allowed transoral access. The authors believe that the new applier, used in association with the current techniques for dural closure, allows for safe transoral surgery for basilar aneurysms.

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An approach to a basilar aneurysm above the bifurcation of the internal carotid artery

Journal of Neurosurgery ◽

10.3171/jns.1983.59.6.1082 ◽

1983 ◽

Vol 59 (6) ◽

pp. 1082-1084 ◽

Cited By ~ 15

Author(s):

Shigeaki Kobayashi ◽

Kenichiro Sugita ◽

Fukuo Nakagawa

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Internal Carotid ◽

Artery Aneurysm ◽

Carotid Bifurcation ◽

Content Type ◽

Temporal Lobes ◽

Basilar Artery Aneurysm ◽

Perforating Arteries ◽

Fine Print

✓ The authors report a case of a basilar artery aneurysm approached by the transsylvian route; the aneurysm was successfully clipped through the space distal to the carotid bifurcation and between the frontal and temporal lobes. This approach is useful when the internal carotid artery is short, sclerotic, and difficult to mobilize. Special care should be taken when retracting perforating arteries and the posterior communicating artery.

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