Cerebral aneurysms in childhood and adolescence

1989 ◽  
Vol 70 (3) ◽  
pp. 420-425 ◽  
Author(s):  
Fredric B. Meyer ◽  
Thoralf M. Sundt ◽  
Nicolee C. Fode ◽  
Michael K. Morgan ◽  
Glen S. Forbes ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Vascular Malformations ◽  
Cerebral Aneurysms ◽  
Mass Effect ◽  
Posterior Circulation ◽  
Childhood And Adolescence ◽  
Postoperative Results ◽  
Content Type ◽  
Presenting Symptoms ◽  
Fine Print

✓ In this study, 24 aneurysms occurring in 23 patients under the age of 18 years (mean 12 years) are analyzed. The male:female ratio was 2.8:1, and the youngest patient was 3 months old. Mycotic lesions and those associated with other vascular malformations were excluded. Forty-two percent of the aneurysms were located in the posterior circulation, and 54% were giant aneurysms. Presenting symptoms included subarachnoid hemorrhage in 13 and mass effect in 11. Several of these aneurysms were documented to rapidly increase in size over a 3-month to 2-year period of observation. All aneurysms were surgically treated: direct clipping was performed in 14; trapping with bypass in four; trapping alone in four; and direct excision with end-to-end anastomosis in two. The postoperative results were excellent in 21 aneurysms (87%), good in two (8%), and poor in one. The pathogenesis of cerebral aneurysms is reviewed.

Comparison between perimesencephalic nonaneurysmal subarachnoid hemorrhage and subarachnoid hemorrhage caused by posterior circulation aneurysms

2003 ◽  
Vol 98 (3) ◽  
pp. 529-535 ◽  
Author(s):  
Jose F. Alén ◽  
Alfonso Lagares ◽  
Ramiro D. Lobato ◽  
Pedro A. Gómez ◽  
Juan J. Rivas ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cerebral Aneurysms ◽  
Clinical Syndrome ◽  
Posterior Circulation ◽  
Ct Scans ◽  
World Federation ◽  
Content Type ◽  
Unenhanced Ct ◽  
Posterior Circulation Aneurysms ◽  
Fine Print

Object. Some authors have questioned the need to perform cerebral angiography in patients presenting with a benign clinical picture and a perimesencephalic pattern of subarachnoid hemorrhage (SAH) on initial computerized tomography (CT) scans, because the low probability of finding an aneurysm does not justify exposing patients to the risks of angiography. It has been stated, however, that ruptured posterior circulation aneurysms may present with a perimesencephalic SAH pattern in up to 10% of cases. The aim of the present study was twofold: to define the frequency of the perimesencephalic SAH pattern in the setting of ruptured posterior fossa aneurysms, and to determine whether this clinical syndrome and pattern of bleeding could be reliably and definitely distinguished from that of aneurysmal SAH. Methods. Twenty-eight patients with ruptured posterior circulation aneurysms and 44 with nonaneurysmal perimesencephalic SAH were selected from a series of 408 consecutive patients with spontaneous SAH admitted to the authors' institution. The admission unenhanced CT scans were evaluated by a neuroradiologist in a blinded fashion and classified as revealing a perimesencephalic SAH or a nonperimesencephalic pattern of bleeding. Of the 28 patients with posterior circulation aneurysms, five whose grade was I according to the World Federation of Neurosurgical Societies scale were classified as having a perimesencephalic SAH pattern on the initial CT scan. The data show that the likelihood of finding an aneurysm on angiographic studies obtained in a patient with a perimesencephalic SAH pattern is 8.9%. Conversely, ruptured aneurysms of the posterior circulation present with an early perimesencephalic SAH pattern in 16.6% of cases. Conclusions. This study supports the impression that there is no completely sensitive and specific CT pattern for a nonaneurysmal SAH. In addition, the authors believe that there is no specific clinical syndrome that can differentiate patients who have a perimesencephalic SAH pattern caused by an aneurysm from those without aneurysms. Digital subtraction angiography continues to be the gold standard for the diagnosis of cerebral aneurysms and should be performed even in patients who have the characteristic perimesencephalic SAH pattern on admission CT scans.

Use of spiral computerized tomography angiography in patients with subarachnoid hemorrhage in whom subtraction angiography did not reveal cerebral aneurysms

2000 ◽  
Vol 92 (2) ◽  
pp. 278-283 ◽  
Author(s):  
Hiroyuki Hashimoto ◽  
Jun-Ichi Iida ◽  
Yasuo Hironaka ◽  
Masato Okada ◽  
Toshisuke Sakaki
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Ct Angiography ◽  
Cerebral Aneurysms ◽  
Spiral Ct ◽  
The Other ◽  
Anterior Communicating Artery ◽  
Content Type ◽  
Spiral Ct Angiography ◽  
Spiral Computerized Tomography ◽  
Fine Print

Object. Patients with subarachnoid hemorrhage (SAH) in whom angiography does not demonstrate diagnostic findings sometimes suffer recurrent disease and actually harbor undetected cerebral aneurysms. The management strategy for such cases remains controversial, but technological advances in spiral computerized tomography (CT) angiography are changing the picture. The purpose of this prospective study was to examine how spiral CT angiography can contribute to the detection of cerebral aneurysms that cannot be visualized on angiography.Methods. In 134 consecutive patients with SAH, a prospective search for the source of bleeding was performed using digital subtraction (DS) and spiral CT angiography. In 21 patients in whom initial DS angiography yielded no diagnostic findings, spiral CT angiography was performed within 3 days. Patients in whom CT angiography provided no diagnostic results underwent second and third DS angiography sessions after approximately 2 weeks and 6 months, respectively.Six patients with perimesencephalic SAH were included in the 21 cases. Six of the other 15 patients had small cerebral aneurysms detectable by spiral CT angiography, five involving the anterior communicating artery and one the middle cerebral artery. Two patients in whom initial angiograms did not demonstrate diagnostic findings proved to have a ruptured dissecting aneurysm of the vertebral artery; in one case this was revealed at autopsy and in the other during the second DS angiography session. A third DS angiography session revealed no diagnostic results in 13 patients.Conclusions. Spiral CT angiography was useful in the detection of cerebral aneurysms in patients with SAH in whom angiography revealed no diagnostic findings. Anterior communicating artery aneurysms are generally well hidden in these types of SAH cases. A repeated angiography session was warranted in patients with nonperimesencephalic SAH and in whom initial angiography revealed no diagnostic findings, although a third session was thought to be superfluous.

Reoperative management of intracranial aneurysms

1995 ◽  
Vol 83 (3) ◽  
pp. 387-393 ◽  
Author(s):  
Steven L. Giannotta ◽  
N. Scott Litofsky
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Operative Procedure ◽  
Technical Difficulty ◽  
Mass Effect ◽  
Time Interval ◽  
Anterior Circulation ◽  
Content Type ◽  
Coating Agents ◽  
Intraoperative Rupture ◽  
Fine Print

✓ Nineteen patients underwent 20 operative procedures for the treatment of recurrent or residual aneurysms. There were 13 small, three large, and four giant lesions; with one exception, all were in the anterior circulation. Five individuals presented with recurrent subarachnoid hemorrhage, six were referred for symptoms of mass effect, and nine were known to have had inadequate treatment at the time of the initial operative procedure. The average time interval from initial treatment to either recurrent subarachnoid hemorrhage or compressive effects was 10.5 and 9.75 years, respectively. No deaths resulted from the reoperative procedures. Two patients suffered moderate disability and one had severe disability. Malpositioned or slipped clips, intraoperative rupture, and inadequate exposure were responsible for 75% of the initial operative failures. The technical difficulty of the reoperative procedure correlated with the length of time between initial and reoperative treatment, the presence of clips and coating agents, and the complexity of the lesion. A classification scheme for preoperative planning and case selection is proposed based on the technical adjuncts required for reoperative aneurysm procedures.

Pituitary adenomas in childhood and adolescence

1994 ◽  
Vol 80 (2) ◽  
pp. 209-216 ◽  
Author(s):  
Michael D. Partington ◽  
Dudley H. Davis ◽  
Edward R. Laws ◽  
Bernd W. Scheithauer
Keyword(s):  
Pituitary Adenomas ◽  
Remission Rate ◽  
Endocrine Function ◽  
Childhood And Adolescence ◽  
Age Group ◽  
Content Type ◽  
Presenting Symptoms ◽  
Acth Secreting ◽  
Fine Print

✓ Pituitary adenomas are uncommon in childhood. Between 1975 and 1988, 36 patients underwent trans-sphenoidal resection at the Mayo Clinic before their 17th birthday. Fifteen (41.7%) had prolactin (PRL)-secreting tumors, 16 (44.4%) had adrenocorticotropic hormone (ACTH)-secreting tumors (including two patients with Nelson-Salassa syndrome), and three (8.3%) had tumors secreting growth hormone (GH); two patients (5.6%) had clinically nonfunctioning tumors. Of the 36 patients, 21 (58.3%) were girls, and girls predominated in every group except that with ACTH-secreting tumors, where they accounted for only 37.5% of the patients. The average age at the time of surgery was 14.7 ± 2.2 years, the youngest patient being 7.3 years old. The ACTH-secreting tumors were associated with an earlier onset of symptoms than the other tumor types: six (37.5%) of 16 patients became symptomatic before 10 years of age, compared with two (10.0%) of the 20 other patients. Presenting symptoms primarily reflected endocrine dysfunction, with neurological presentation (visual field deficits) occurring in only two patients. There were no deaths in this patient group. Significant operative morbidity included steroid-induced psychosis in one patient and diabetes insipidus in three, which resolved in two. Plurihormonal tumors, broadly defined as tumors producing more than one hormone, were common, comprising five (36%) of 14 PRL-secreting tumors, all three GH-secreting tumors, and one of two clinically nonfunctioning tumors, or 25.7% overall. Macroadenomas accounted for 89% of plurihormonal tumors. Long-term follow-up review (median > 5 years) revealed good control of PRL-secreting tumors (although five of 15 patients had received postoperative radiotherapy), contrasted with a 25% late recurrence rate for ACTH-secreting tumors, which had an 80% initial remission rate. The majority of patients had good endocrine function, including reproductive function. It is concluded that: 1) although pediatric pituitary adenomas occur primarily in adolescence, Cushing's disease is found at any age; 2) transsphenoidal surgery is feasible and safe in this age group; 3) plurihormonal tumors occur more frequently in the pediatric age group than in adults; and 4) long-term control rates in PRL- and ACTH-secreting tumors are probably similar to those seen in adults.

Encapsulated intracerebral hematomas: a defined entity

1993 ◽  
Vol 78 (5) ◽  
pp. 829-833 ◽  
Author(s):  
José M. Roda ◽  
Fernando Carceller ◽  
Antonio Pérez-Higueras ◽  
Carmen Morales
Keyword(s):  
Vascular Malformation ◽  
Vascular Malformations ◽  
Young Patients ◽  
Mass Effect ◽  
Magnetic Resonance Images ◽  
Intracerebral Hematoma ◽  
Content Type ◽  
Male Predominance ◽  
Perifocal Edema ◽  
Fine Print

✓ Encapsulated intracerebral hematoma is an interesting and not widely appreciated entity. It can be defined as an intraparenchymal hematoma found in normotensive patients, usually caused by histologically confirmed vascular malformations, characterized by a gradual clinical onset, and presenting a well-defined capsule at operation. One case is presented and 25 previously reported cases are reviewed, all reflecting the above-mentioned characteristics. The hematomas reviewed here occurred in relatively young patients with a mean age of 35 years and a clear male predominance (19 males, seven females). A ring of contrast enhancement around a lesion of variable density, usually with mass effect and perifocal edema, is the most relevant feature on computerized tomography. Findings on magnetic resonance images are described for the first time in the reported case. A vascular malformation was the most frequent cause found on histological examination (12 of the 26 total cases). No proven cause was found in the remaining 14 cases, although a small vascular malformation, destroyed or thrombosed after rupturing and bleeding, is the most likely etiology in these patients.

The poor prognosis of ruptured intracranial aneurysms of the posterior circulation

1995 ◽  
Vol 82 (5) ◽  
pp. 791-795 ◽  
Author(s):  
Wouter I. Schievink ◽  
Eelco F. M. Wijdicks ◽  
David G. Piepgras ◽  
Chu-Pin Chu ◽  
W. Michael O'Fallon ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Initial Period ◽  
Posterior Circulation ◽  
Medical Record Linkage ◽  
Anterior Circulation ◽  
Content Type ◽  
Clinical Series ◽  
Posterior Circulation Aneurysms ◽  
Fine Print

✓ The first 48 hours after aneurysmal subarachnoid hemorrhage are critical in determining final outcome. However, most patients who die during this initial period are not included in hospital-based studies. We investigated the occurrence of subarachnoid hemorrhage in a population-based study to evaluate possible predictors of poor outcome. All patients diagnosed with aneurysmal subarachnoid hemorrhage between 1955 and 1984 were selected for analysis of mortality in the first 30 days using the medical record—linkage system employed for epidemiological studies in Rochester, Minnesota. One hundred and thirty-six patients were identified. The mean age of these 99 women and 37 men was 55 years. Rates for survival to 48 hours were 32% for the 19 patients with posterior circulation aneurysms, 77% for the 87 patients with anterior circulation aneurysms, and 70% for the 30 patients with a presumed aneurysm (p < 0.0001). Rates for survival to 30 days were 11%, 57%, and 53%, respectively, in these three patient groups (p < 0.0001). Clinical grade on admission to the hospital, the main variable predictive of death within 48 hours, was significantly worse in patients with posterior circulation aneurysms than in others (p < 0.0001). The prognosis of ruptured posterior circulation aneurysms is poor. The high early mortality explains why posterior circulation aneurysms are uncommon in most clinical series of patients with subarachnoid hemorrhage. The management of incidentally discovered intact posterior circulation aneurysms may be influenced by these findings.

Rare cause of subarachnoid hemorrhage: spinal meningeal carcinomatosis

2005 ◽  
Vol 2 (1) ◽  
pp. 79-82 ◽  
Author(s):  
Servet Inci ◽  
Gokhan Bozkurt ◽  
Salih Gulsen ◽  
Pinar Firat ◽  
Tuncalp Ozgen
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Vascular Malformations ◽  
Spinal Metastases ◽  
Rare Condition ◽  
Spinal Tumor ◽  
Meningeal Carcinomatosis ◽  
Spinal Tumors ◽  
Content Type ◽  
Metastatic Spinal Tumor ◽  
Fine Print

✓Subarachnoid hemorrhage (SAH) of spinal origin is a rare entity accounting for approximately 1% of all cases of SAH. Its most frequent causes are trauma and vascular malformations. Although primary spinal tumors, especially ependymomas, are also relatively common causes, SAH secondary to a metastatic spinal tumor arising from outside the central nervous system is an extremely rare condition; only one case has been reported in the literature. The authors present a case of spinal meningeal carcinomatosis secondary to cutaneous malignant melanoma in which the patient presented with only symptoms of SAH. Although very rare, this case underscores several factors. 1) Spinal SAH due to spinal metastases should be considered in the differential diagnosis of patients with previously known malignancy. 2) Spinal SAH may manifest without paraparesis or sensory deficit. 3) Magnetic resonance imaging of the spinal cord may be important to determine the source of SAH in patients in whom four-vessel cerebral angiography demonstrates no abnormal findings.

Risk of rupture from incidental cerebral aneurysms

2000 ◽  
Vol 93 (4) ◽  
pp. 550-553 ◽  
Author(s):  
Kazuo Tsutsumi ◽  
Keisuke Ueki ◽  
Akio Morita ◽  
Takaaki Kirino
Keyword(s):  
Risk Estimation ◽  
Cerebral Aneurysms ◽  
Ct Scanning ◽  
Mass Effect ◽  
Sudden Onset ◽  
Content Type ◽  
Unruptured Aneurysms ◽  
Risk Of Rupture ◽  
Fine Print ◽  
Saccular Aneurysms

Object. Controversy still exists about the risk estimation for rupture of untreated saccular aneurysms presenting for causes other than subarachnoid hemorrhage (SAH). The object of this study was to address this issue.Methods. Between January 1976 and December 1997 in the Aizu Chuou Hospital, 62 patients underwent observation for more than 6 months for saccular, nonthrombotic, noncalcified unruptured aneurysms at locations not related to the cavernous sinus, which were detected in cerebral angiography studies performed for causes other than SAH. Clinical follow-up data in those 62 patients were reviewed to identify the risk of SAH.All patients were followed until July 1998, with the observation period ranging from 6 months to 17 years (mean 4.3 years). Seven patients (11.3%) developed SAH confirmed on computerized tomography (CT) scanning at a mean interval of 4.8 years, six of whom died and one of whom recovered with a major deficit. In addition, one patient died of the mass effect of the aneurysm, and another after sudden onset of headache and vomiting. The 5- and 10-year cumulative risks of CT-confirmed SAH calculated by the Kaplan—Meier method were 7.5% and 22.1%, respectively, for total cases, 33.5% and 55.9%, respectively, for large (> 10 mm) aneurysms, and 4.5% and 13.9%, respectively, for small (< 10 mm) aneurysms.Conclusions. Although based on a relatively small, single-institution series, our data indicated that the risk of rupture from incidental, intradural, saccular aneurysms was higher than previously reported, and may support preventive surgical treatment of incidental aneurysms, considering the fatality rate of SAH.

Endovascular occlusion of vertebral arteries in the treatment of unclippable vertebrobasilar aneurysms

1991 ◽  
Vol 74 (3) ◽  
pp. 393-398 ◽  
Author(s):  
Armand Aymard ◽  
Y. Pierre Gobin ◽  
Jonathan E. Hodes ◽  
Siegfried Bien ◽  
Daniel Rüfenacht ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Vertebral Artery ◽  
Mass Effect ◽  
Content Type ◽  
Vertebral Arteries ◽  
Endovascular Occlusion ◽  
Vertebrobasilar Circulation ◽  
Partial Thrombosis ◽  
Vertebrobasilar Aneurysms ◽  
Fine Print

✓ Twenty-one patients with aneurysms of the vertebrobasilar circulation underwent unilateral or bilateral endovascular occlusion of the vertebral artery. Six patients presented with subarachnoid hemorrhage (SAH), 10 with mass effect, four with mass effect and SAH, and one with ischemic symptoms. Thirteen patients had good outcomes with complete clinical and angiographic cure. Six patients had partial thrombosis of their aneurysms. There was one death and one treatment failure. One patient suffered transient stroke. It is concluded that endovascular occlusion of the vertebral artery following test occlusion is a safe and effective treatment for proximal aneurysms of the vertebrobasilar circulation.

Use of a new aneurysm clip with an inverted-spring mechanism to facilitate visual control during clip application

1995 ◽  
Vol 82 (5) ◽  
pp. 898-899 ◽  
Author(s):  
Axel Perneczky ◽  
Georg Fries
Keyword(s):  
Cerebral Aneurysms ◽  
Senior Author ◽  
Visual Control ◽  
Posterior Circulation ◽  
Content Type ◽  
Aneurysm Clip ◽  
Adjacent Structures ◽  
Clip Application ◽  
Spring Mechanism ◽  
Fine Print

✓ When operating on deep-seated cerebral aneurysms, the surgeon's visual control of clip application may be impaired by the clip holder unless adjacent structures are retracted. To improve visual control and reduce the necessity for retraction, the senior author (A.P.) developed a new concept: an aneurysm clip with an inverted-spring mechanism. The clip has two jaws that point away from the clip blades. The jaws of the clip holder articulate with the inner side of the clip jaws. By distending the jaws of the clip holder the blades of the clip are opened and vice versa. Thus the visual field increases while the clip application is proceeding. This instrumentation is useful, especially in cases of deep-seated aneurysms arising from the posterior circulation and in multiple aneurysms. In these latter cases even lesions located contralaterally could be reached with good visual control.

Sign in / Sign up

Export Citation Format

Share Document