Subarachnoid hemorrhage caused by a fungal aneurysm of the vertebral artery as a complication of intracranial aneurysm clipping

1990 ◽  
Vol 73 (6) ◽  
pp. 962-964 ◽  
Author(s):  
Wolfgang Peter Piotrowski ◽  
Peter Pilz ◽  
I-Hsing Chuang
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Intracranial Aneurysm ◽  
Fungal Infection ◽  
Vertebral Artery ◽  
Immunosuppressive Therapy ◽  
Intracranial Aneurysms ◽  
Content Type ◽  
Aneurysm Clipping ◽  
Long Period ◽  
Fine Print

✓ Intracranial aneurysms are an uncommon manifestation of fungal infection. A case is described in which the formation of an aneurysm followed an intracranial intraoperative Aspergillus infection attributable to a long period of preoperative antibiotic medication and immunosuppressive therapy with steroids.

Regrowth of aneurysm sacs from residual neck following aneurysm clipping

1989 ◽  
Vol 70 (4) ◽  
pp. 556-560 ◽  
Author(s):  
Teresa Lin ◽  
Allan J. Fox ◽  
Charles G. Drake
Keyword(s):  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Recurrent Hemorrhage ◽  
Content Type ◽  
Complete Occlusion ◽  
Aneurysm Neck ◽  
Aneurysm Clipping ◽  
Long Period ◽  
Aneurysm Occlusion ◽  
Fine Print

✓ It is recognized that incomplet treatment of an aneurysm may result in recurrent hemorrhage with serious or fatal consequences. For this reason, patients treated at the authors' institution in whom a large portion of the aneurysm neck or sac remained after application of a clip or ligature have been subjected to reoperation. However, 1- to 2-mm residual necks seen in postoperative angiography have been thought to pose little risk. Some cases of aneurysms recurring from a narrow residual neck after clipping have been reported, and a few instances of recurrent aneurysm have been described after apparently complete occlusion of the neck (as observed angiographically or in the surgeon's judgment). In recent years, a surprising number of cases have been presented in which this seemingly unimportant remnant of the neck dilated over a long period to become a dangerous aneurysm. This finding stresses the importance of complete aneurysm occlusion and of postoperative angiography for the recognition of a residual aneurysm neck. This should be important not only in aneurysm clipping but also in the endovascular treatment of intracranial aneurysms with detachable balloons.

Surgical experiences with giant intracranial aneurysms

1984 ◽  
Vol 61 (6) ◽  
pp. 1009-1028 ◽  
Author(s):  
Lindsay Symon ◽  
Janos Vajda
Keyword(s):  
Blood Pressure ◽  
Subarachnoid Hemorrhage ◽  
Mortality Rate ◽  
Intracranial Aneurysms ◽  
Visual Loss ◽  
Considerable Improvement ◽  
Brain Circulation ◽  
Content Type ◽  
Space Occupying Lesion ◽  
Fine Print

✓ A series of 35 patients with 36 giant aneurysms is presented. Thirteen patients presented following subarachnoid hemorrhage (SAH) and 22 with evidence of a space-occupying lesion without recent SAH. The preferred technique of temporary trapping of the aneurysm, evacuation of the contained thrombus, and occlusion of the neck by a suitable clip is described. The danger of attempted ligation in atheromatous vessels is stressed. Intraoperatively, blood pressure was adjusted to keep the general brain circulation within autoregulatory limits. Direct occlusion of the aneurysm was possible in over 80% of the cases. The mortality rate was 8% in 36 operations. Six percent of patients had a poor result. Considerable improvement in visual loss was evident in six of seven patients in whom this was a presenting feature, and in four of seven with disturbed eye movements.

Deliberate basilar or vertebral artery occlusion in the treatment of intracranial aneurysms

1993 ◽  
Vol 79 (2) ◽  
pp. 161-173 ◽  
Author(s):  
Gary K. Steinberg ◽  
Charles G. Drake ◽  
Sydney J. Peerless
Keyword(s):  
Clinical Outcome ◽  
Vertebral Artery ◽  
Brain Stem ◽  
Intracranial Aneurysms ◽  
Artery Occlusion ◽  
Neurological Deterioration ◽  
Content Type ◽  
Vertebrobasilar Junction ◽  
Aneurysm Thrombosis ◽  
Fine Print

✓ Deliberate occlusion of the basilar or vertebral arteries was performed in 201 patients with intracranial aneurysms, where the aneurysmal neck could not be clipped directly. The aneurysms arose from the basilar apex in 83 cases, the basilar trunk in 46, the vertebrobasilar junction in 35, and the vertebral artery in 37; 87% of the aneurysms were classified as giant lesions (> 2.5 cm). There were 85 upper basilar occlusions, 41 lower basilar occlusions, 29 bilateral vertebral occlusions, and 48 unilateral vertebral artery occlusions. The clinical follow-up period varied from 1 to 23 years, with a mean of 9.5 years. Overall long-term results were excellent in 68% of the patients, good in 5%, and poor in 3%; 24% died. Clinical outcome varied according to aneurysm site; excellent or good results were achieved in 64% of the patients with basilar apex, 76% with basilar trunk, 74% with vertebrobasilar junction, and 87% with vertebral artery aneurysms. Clinical outcome also varied depending on preoperative grade: 86% of the patients with an excellent presenting grade achieved excellent results. The size of the posterior communicating arteries was a good predictor of tolerance to basilar artery occlusion (p < 0.05). Successful aneurysm thrombosis was achieved in 78% of the patients. The neurological status in 26 patients (13%) deteriorated due to vertebrobasilar ischemia occurring within the 1st postoperative week, and thrombosis or embolism was implicated much more frequently than hemodynamic insufficiency. Subarachnoid hemorrhage (SAH) in 14 patients, vasospasm in five patients, and surgical trauma in seven patients accounted for additional morbidity in the 1st month following operation; however, many of these patients ultimately made an excellent recovery. Late vertebrobasilar ischemic complications or neurological deterioration from persistent mass effect occurred in 4% of patients with successful aneurysm thrombosis 6 weeks to 18 months after arterial ligation. Among the 43 patients with incompletely thrombosed aneurysms, 67% developed early or late neurological deterioration from SAH, progressive brain-stem compression, or brain-stem stroke, with 86% of the complications proving fatal.

Intracranial aneurysm in infancy

1977 ◽  
Vol 46 (6) ◽  
pp. 832-834 ◽  
Author(s):  
Robert J. Morelli ◽  
Frederick Laubscher
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Surgical Treatment ◽  
Intracranial Aneurysm ◽  
Anterior Cerebral Artery ◽  
Content Type ◽  
Long Term Follow Up ◽  
Surgical Cure ◽  
Fine Print

✓ Angiography demonstrated an aneurysm of the left anterior cerebral artery in a 4-month-old baby who was admitted for subarachnoid hemorrhage. A surgical cure with long-term follow-up course was achieved. Clinical and pathogenetic aspects are presented. The rarity of such lesions in childhood and their successful surgical treatment are discussed briefly.

Pseudoaneurysm of the extracranial vertebral artery

1987 ◽  
Vol 67 (6) ◽  
pp. 935-939 ◽  
Author(s):  
Karl Detwiler ◽  
John C. Godersky ◽  
Lindell Gentry
Keyword(s):  
Soft Tissue ◽  
Vertebral Artery ◽  
Intracranial Aneurysms ◽  
Balloon Occlusion ◽  
Artery Pseudoaneurysm ◽  
Content Type ◽  
Unusual Association ◽  
Associated Symptoms ◽  
Extracranial Vertebral Artery ◽  
Fine Print

✓ The unusual association of a giant extracranial vertebral artery pseudoaneurysm, intracranial aneurysms, and extracranial carotid occlusion in a woman with neurofibromatosis is presented. Pain as a result of expansion of the mass in the soft tissue of the neck led to her seeking evaluation. Herniation of the mass intraspinally between the occiput and C-1 resulted in myelopathy. Following balloon occlusion of the vertebral artery, the mass and associated symptoms resolved without the need for direct resection. The salient features of these unusually associated problems are discussed.

Multiple intracranial aneurysms in sickle cell anemia

1985 ◽  
Vol 62 (3) ◽  
pp. 430-434 ◽  
Author(s):  
M. Chris Overby ◽  
Allen S. Rothman
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Sickle Cell ◽  
Sickle Cell Anemia ◽  
Intracranial Aneurysms ◽  
Neurological Complications ◽  
Review Of The Literature ◽  
Hemoglobin S ◽  
Content Type ◽  
Multiple Intracranial Aneurysms ◽  
Fine Print

✓ Neurological complications of sickle cell anemia occur in 18% to 29% of patients with homozygous hemoglobin S disease. A review of the literature yielded reports of two cases, both treated conservatively, of multiple intracranial aneurysms occurring in patients with sickle cell anemia. The authors report two cases of subarachnoid hemorrhage secondary to multiple intracranial aneurysms in patients with sickle cell anemia. One of the two patients underwent three craniotomies for ablation of six intracranial aneurysms. The techniques used in the treatment of these patients are presented.

Intracranial vertebral artery dissection with subarachnoid hemorrhage: clinical characteristics and outcomes in conservatively treated patients

2004 ◽  
Vol 101 (1) ◽  
pp. 25-30 ◽  
Author(s):  
Masaru Yamada ◽  
Takao Kitahara ◽  
Akira Kurata ◽  
Kiyotaka Fujii ◽  
Yoshio Miyasaka
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Conservative Treatment ◽  
Vertebral Artery ◽  
Vertebral Artery Dissection ◽  
Delayed Diagnosis ◽  
Acute Stage ◽  
Artery Dissection ◽  
Content Type ◽  
String Structure ◽  
Fine Print

Object. Intracranial vertebral artery (VA) dissection with subarachnoid hemorrhage is notorious for frequent rebleeding and a poor prognosis. Nevertheless, some patients survive with a good final outcome. The factors associated with the prognosis of this disease are not fully understood and appropriate treatment strategies continue to be debated. The authors retrospectively evaluated the clinical features of conservatively treated patients to elucidate the relationship between the clinical and angiographic characteristics of the disease and final outcomes. Methods. This study includes 24 patients who were treated by conservative methods between 1990 and 2000. Conservative treatment was chosen because of delayed diagnosis, poor clinical condition, or anatomical features such as bilateral lesions and contralateral VA hypoplasia. Of nine patients with an admission Hunt and Kosnik Grade I or II, eight had good outcomes (mean follow-up period 8 years and 4 months). All 15 patients with Grade III, IV, or V died and in 10 of these the cause of death was rebleeding. Among the 24 patients, 14 suffered a total of 35 rebleeding episodes; in 10 (71.4%) of these 14 patients rebleeding occurred within 6 hours and in 13 (93%) within 24 hours. Compared with the survivors, there was a female preponderance (0.022) among patients who died. These patients also had significantly shorter intervals between onset and hospital admission (p = 0.0067), a higher admission Hunt and Kosnik grade (p = 0.0001), a higher incidence of prehospitalization (p = 0.0296) and postadmission (p = 0.0029) rebleeding episodes, and a higher incidence of angiographically confirmed pearl-and-string structure of the lesion (p = 0.0049). Conclusions. In our series of preselected patients, poor admission neurological grade, rebleeding episode(s), and lesions with a pearl-and-string structure were predictive of poor outcomes. Our findings indicate that patients with these characteristics may be candidates for aggressive attempts to prevent rebleeding during the acute stage. Patients without these characteristics may be good candidates for conservative treatment, especially those who survive the acute phase without rebleeding.

Super giant globoid intracranial aneurysm in an infant

1980 ◽  
Vol 53 (3) ◽  
pp. 411-416 ◽  
Author(s):  
Enrique C. G. Ventureyra ◽  
Sin H. Choo ◽  
Brien G. Benoit
Keyword(s):  
Intracranial Aneurysm ◽  
Cerebral Angiography ◽  
Intracranial Aneurysms ◽  
Posterior Cerebral Artery ◽  
Uneventful Recovery ◽  
Baby Girl ◽  
Content Type ◽  
Two Stages ◽  
Arterial Aneurysms ◽  
Fine Print

✓ The incidence of intracranial aneurysms in infancy is less than 1%. Intracranial arterial aneurysms are very rare in patients under 1 year of age. This 6-month-old baby girl presented with progressive macrocephaly and anemia. Computerized tomography and cerebral angiography demonstrated a giant globoid aneurysm, 8 × 9 cm in size, arising from an anomalous posterior cerebral artery. The aneurysm was successfully clipped and excised in two stages. The child made an uneventful recovery. The congenital nature of the aneurysm is discussed, and the literature concerning intracranial aneurysms in patients under 1 year of age is reviewed.

Subarachnoid hemorrhage from intracranial dissecting aneurysm

1984 ◽  
Vol 60 (2) ◽  
pp. 325-334 ◽  
Author(s):  
Allan H. Friedman ◽  
Charles G. Drake
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Vertebral Artery ◽  
Arterial Occlusion ◽  
Dissecting Aneurysm ◽  
Content Type ◽  
Vertebrobasilar Circulation ◽  
Intracranial Dissecting Aneurysm ◽  
Fine Print

✓ Rupture of an intracranial dissecting aneurysm is a rare but dangerous event. The authors' experience with 14 cases of these lesions on the vertebrobasilar circulation suggests that these aneurysms have typical angiographic silhouettes and that, at least in the vertebral artery, they are treatable by proximal arterial occlusion.

Long-term prognosis in surgically treated intracranial aneurysms

1981 ◽  
Vol 54 (1) ◽  
pp. 26-34 ◽  
Author(s):  
Lydia Artiola i Fortuny ◽  
Luis Prieto-Valiente
Keyword(s):  
Mortality Rate ◽  
Intracranial Aneurysm ◽  
Intracranial Aneurysms ◽  
Advanced Age ◽  
Content Type ◽  
Long Term Prognosis ◽  
Neurological State ◽  
Fine Print

✓ A series of 265 consecutive cases of intracranial aneurysm were reviewed to assess mortality and its causes. Preoperative and postoperative factors were considered in isolation and in combination. The mortality rate was 20%. Postoperative generalized vasospasm was found to be the major cause of mortality. Advanced age, hypertension, and a poor neurological state at operation were associated with poor results. The study emphasizes the importance of considering variables in combination rather than singly in the assessment of prognosis.

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