Ruptured giant intracranial aneurysms. Part I. A study of rebleeding

1998 ◽  
Vol 88 (3) ◽  
pp. 425-429 ◽  
Author(s):  
Vini G. Khurana ◽  
David G. Piepgras ◽  
Jack P. Whisnant
Keyword(s):  
Mayo Clinic ◽  
Intracranial Aneurysms ◽  
Management Strategies ◽  
Giant Aneurysm ◽  
Cumulative Frequency ◽  
Content Type ◽  
Giant Aneurysms ◽  
Giant Intracranial Aneurysms ◽  
Intracranial Circulation ◽  
Fine Print

Object. The present study was conducted to estimate the frequency and timing of rebleeding after initial subarachnoid hemorrhage (SAH) from ruptured giant aneurysms. Methods. The authors reviewed records of 109 patients who suffered an initial SAH from a giant aneurysm and were treated at the Mayo Clinic between 1973 and 1996. They represented 25% of patients with giant intracranial aneurysms seen at this institution during that 23-year period. Seven of the patients were residents of Rochester, Minnesota, and the rest were referred from other institutions. The aneurysms ranged from 25 to 60 mm in diameter, and 74% were located on arteries of the anterior intracranial circulation. The cumulative frequency of rebleeding at 14 days after admission was 18.4%. Cerebrospinal fluid drainage, cerebral angiography, and delayed aneurysm recurrence were implicated in rebleeding in some of the patients. Rebleeding was not precluded by intraaneurysm thrombosis. Among those who suffered recurrent SAH at the Mayo Clinic, 33% died in the hospital. Conclusions. Rebleeding from giant aneurysms occurs at a rate comparable to that associated with smaller aneurysms, a finding that should be considered in management strategies.

scholarly journals Ruptured giant intracranial aneurysms. Part I. A study of rebleeding

1998 ◽  
Vol 4 (1) ◽  
pp. E1 ◽  
Author(s):  
Vini G. Khurana ◽  
David G. Piepgras ◽  
Jack P. Whisnant
Keyword(s):  
Cerebrospinal Fluid ◽  
Mayo Clinic ◽  
Intracranial Aneurysms ◽  
Management Strategies ◽  
Giant Aneurysm ◽  
Cumulative Frequency ◽  
Cerebrospinal Fluid Drainage ◽  
Giant Aneurysms ◽  
Giant Intracranial Aneurysms ◽  
Intracranial Circulation

Object The present study was conducted to estimate the frequency and timing of rebleeding after initial subarachnoid hemorrhage (SAH) from ruptured giant aneurysms. Methods The authors reviewed records of 109 patients who suffered an initial SAH from a giant aneurysm and were treated at the Mayo Clinic between 1973 and 1996. They represented 25% of patients with giant intracranial aneurysms seen at this institution during that 23-year period. Seven of the patients were residents of Rochester, Minnesota, and the rest were referred from other institutions. The aneurysms ranged from 25 to 60 mm in diameter, and 74% were located on arteries of the anterior intracranial circulation. The cumulative frequency of rebleeding at 14 days after admission was 18.4%. Cerebrospinal fluid drainage, cerebral angiography, and delayed aneurysm recurrence were implicated in rebleeding in some of the patients. Rebleeding was not precluded by intraaneurysm thrombosis. Among those who suffered recurrent SAH at the Mayo Clinic, 33% died in the hospital. Conclusions Rebleeding from giant aneurysms occurs at a rate comparable to that associated with smaller aneurysms, a finding that should be considered in management strategies.

Direct surgical treatment of giant intracranial aneurysms

1979 ◽  
Vol 51 (6) ◽  
pp. 743-756 ◽  
Author(s):  
Yoshio Hosobuchi
Keyword(s):  
Intracranial Aneurysms ◽  
Surgical Approaches ◽  
Anterior Communicating Artery ◽  
Parent Artery ◽  
Anterior Circulation ◽  
Artery Ligation ◽  
Content Type ◽  
Giant Aneurysms ◽  
Giant Intracranial Aneurysms ◽  
Fine Print

✓ The author has operated on 40 patients with giant intracranial aneurysms, using various surgical approaches. Giant aneurysms predominated in females (3:1) and were most common in the age group 30 to 60 years. Patients presented with subarachnoid hemorrhage (17), visual disturbance (18), chronic headache (14), transient or progressive hemispheric deficit (6), seizure (2), dementia (2), and cerebrospinal fluid rhinorrhea (1). Giant aneurysms were located at the carotid artery (25), the basovertebral artery (8), the anterior communicating artery (5), and the middle cerebral artery (2). Eight of 40 patients had one or more other aneurysms and/or associated arteriovenous malformations. Aneurysms were treated with intramural thrombosis (21), neck occlusion (7), trapping (10), proximal parent artery ligation (1), and aneurysmorrhaphy (1). After as much as 8 years of follow-up, 32 patients (80%) showed complete or marked improvement in signs and symptoms; two patients (5%) had a poor recovery. There were six surgical mortalities (15%). Giant aneurysms can be treated with respectable results if the surgeon selects the technique best suited to the particular aneurysm. In general, neck occlusion, trapping, and aneurysmorrhaphy are best for giant aneurysms of the anterior circulation, and intramural thrombosis is best for those of the posterior circulation. Extra- and intracranial vascular anastomotic techniques are also of value. For success, a flexible approach is essential.

Ruptured giant intracranial aneurysms. Part II. A retrospective analysis of timing and outcome of surgical treatment

1998 ◽  
Vol 88 (3) ◽  
pp. 430-435 ◽  
Author(s):  
David G. Piepgras ◽  
Vini G. Khurana ◽  
Jack P. Whisnant
Keyword(s):  
Surgical Treatment ◽  
Mortality Rate ◽  
Mayo Clinic ◽  
Intracranial Aneurysms ◽  
Posterior Circulation ◽  
Anterior Circulation ◽  
Content Type ◽  
Medical Centers ◽  
Giant Intracranial Aneurysms ◽  
Fine Print

Object. This retrospective study was made to determine the relationship between surgical timing and outcome in all patients with ruptured giant intracranial aneurysms undergoing surgical treatment at the Mayo Clinic between 1973 and 1996. Methods. The authors studied 109 patients, 102 of whom were referred from other medical centers. The ruptured giant aneurysms were 25 to 60 mm in diameter. One hundred five of the patients survived the rupturing of the aneurysm to undergo operation, with direct surgery possible in 84% of cases. Excluding delayed referrals, the average time to surgery after admission to the Mayo Clinic was approximately 4 to 5 days. Patients admitted earlier tended to be in poorer condition, often undergoing earlier operation. On average, surgical treatment was administered later for patients with ruptured aneurysms of the posterior circulation than for those with aneurysms in the anterior circulation. Temporary occlusion of the parent vessel was necessary in 67% of direct procedures, with an average occlusion time of 15 minutes. Among surgically treated patients, a favorable outcome was achieved in 72% harboring ruptured anterior circulation aneurysms and in 78% with ruptured posterior circulation lesions. Conclusions. The overall management mortality rate was 21.1%, and the mortality rate for surgical management was 8.6%. The authors believe that because of the technical difficulties and risk of rebleeding associated with ruptured giant intracranial aneurysms, timely referral to and well-planned treatment at medical centers specializing in management of these lesions are essential to effect a more favorable outcome.

Platelet interaction within giant intracranial aneurysms

1982 ◽  
Vol 56 (1) ◽  
pp. 53-61 ◽  
Author(s):  
Garnette R. Sutherland ◽  
Martin E. King ◽  
S. J. Peerless ◽  
William C. Vezina ◽  
G. William Brown ◽  
...  
Keyword(s):  
Platelet Aggregation ◽  
Intracranial Aneurysms ◽  
Blood Pool ◽  
Mean Value ◽  
Neurological Deficits ◽  
Content Type ◽  
Dual Isotope ◽  
Giant Intracranial Aneurysms ◽  
Platelet Deposition ◽  
Fine Print

✓ Turbulence within intracranial aneurysms may result in tearing of the aneurysmal wall, exposing the subendothelial matrix to circulating platelets. In this study, platelet interaction in giant intracranial aneurysms was evaluated by a dual-isotope technique employing 111In-labeled platelets and 99mTc-labeled red blood cells. The use of two isotopes allows the subtraction of the blood pool and the calculation of the ratio indium deposited:indium blood pool (In(D)/In(BP)). A ratio greater than zero indicates platelet deposition within the aneurysm. Thirteen patients were evaluated in this way, with platelet deposition demonstrated in six. In these six patients, the ratio In(D)/In(BP) was found to be significantly elevated, with a mean value of 0.96 ± 0.65. Three of these six patients had symptoms of recurrent transient neurological deficits; one of these three suffered a complete stroke following documentation of platelet deposition. In this case, the aneurysm was obtained at surgery and was found to contain intraluminal platelet aggregation when viewed by scanning electron microscopy. In the remaining seven patients, the ratio In(D)/In(BP) was found not to be significantly elevated (mean −0.03 ± 0.06), indicating the absence of active platelet deposition. Two of these patients had prior symptoms of cerebral ischemia; one of these was found to have an ulcer in the ipsilateral internal carotid artery which was probably responsible for thromboembolic events to the hemisphere. The authors conclude that platelet aggregation occurs more frequently than previously recognized in giant intracranial aneurysms, and their data substantiate the hypothesis that platelet metabolic products or thrombi originating from a large aneurysm may embolize to distal cerebral vessels.

Surgical approach to giant intracranial aneurysms

1979 ◽  
Vol 51 (6) ◽  
pp. 731-742 ◽  
Author(s):  
Thoralf M. Sundt ◽  
David G. Piepgras
Keyword(s):  
Cerebral Artery ◽  
Intracranial Aneurysms ◽  
Circulatory Arrest ◽  
Mass Effect ◽  
Apparent Difference ◽  
Flow Measurements ◽  
Content Type ◽  
Giant Aneurysms ◽  
Giant Intracranial Aneurysms ◽  
Blood Flow Measurements

✓ The authors report experience with the surgical management of 80 giant intracranial aneurysms (> 2.5cm in diameter) during a 10-year period in which they performed 594 operations for aneurysms. The overall incidence of giant aneurysms was 13% but varied according to location: 20% of aneurysms of the internal carotid artery (ICA); 13% of middle cerebral artery (MCA) aneurysms; 1% of anterior cerebral artery (ACA) aneurysms; 15% of aneurysms of the basilar artery caput (BAC); and 18% of vertebrobasilar trunk(VB) aneurysms. Twenty-five patients had a subarachnoid hemorrhage (SAH), 49 had mass effect from the aneurysm, and six had ischemic events. There was no apparent difference in results related to the presence or absence of an SAH. Poor results were attributable to the operation except in the two cases of ACA aneurysm in which preexisting dementia persisted. Mortality was 4% and morbidity was 14%, varying from a combined low morbidity-mortality of 8% for ICA lesions to a high of 50% for BAC aneurysms. During the period of the study, different techniques were developed in an attempt to lower the risks of surgery.Ultimately ICA aneurysms were monitored with cerebral blood flow measurements and electroencephalography before and after temporary ICA ligation, then approached following resection of the anterior clinoid or treated with bypass in combination with ICA ligation. Aneurysms of the MCA were either opened during temporary MCA occlusion or resected in combination with a bypass procedure. Bypass grafts and circulatory arrest with extracorporeal circulation may have a role in giant aneurysms of the posterior circulation.

Preliminary report of a hollow-centered balloon for intravascular occlusion of intracranial aneurysms or arteriovenous fistulas

1980 ◽  
Vol 53 (2) ◽  
pp. 262-265 ◽  
Author(s):  
Milton D. Heifetz ◽  
Grant B. Hieshima ◽  
C. Mark Mehringer
Keyword(s):  
Arteriovenous Fistula ◽  
Preliminary Report ◽  
Intracranial Aneurysms ◽  
Giant Aneurysm ◽  
Parent Artery ◽  
Content Type ◽  
Arteriovenous Fistulas ◽  
Preliminary Study ◽  
Intravascular Occlusion ◽  
Fine Print

✓ A doughnut-shaped balloon has been designed that can be inserted intravascularly by catheter to occlude the orifice of an intracranial berry or giant aneurysm or arteriovenous fistula. The blood in the parent artery can continue to flow uninterrupted through the hole in the balloon. In a preliminary study, an arteriovenous fistula was successfully obliterated in a dog. The technique for placing the balloon is described.

Thrombosed growing giant aneurysms of the vertebral artery: growth mechanism and management

1995 ◽  
Vol 82 (5) ◽  
pp. 796-801 ◽  
Author(s):  
Shinji Nagahiro ◽  
Akira Takada ◽  
Satoshi Goto ◽  
Yutaka Kai ◽  
Yukitaka Ushio
Keyword(s):  
Vertebral Artery ◽  
Giant Aneurysm ◽  
Pathological Examination ◽  
Intimal Thickening ◽  
Resonance Imaging ◽  
Endothelial Lining ◽  
Content Type ◽  
Giant Aneurysms ◽  
Vascular Channels ◽  
Fine Print

✓ Results in three patients with thrombosed giant aneurysms of the vertebral artery are reported. Each of the aneurysms presented as a mass lesion. On postcontrast computerized tomography and magnetic resonance imaging, each aneurysm demonstrated a patent lumen and intrathrombotic vascular channels. Two patients died and were autopsied, and the other patient was successfully treated. Pathological examination revealed that the aneurysms had staged clots, an open lumen, intrathrombotic channels with endothelial lining, and aneurysmal walls with intimal thickening. The authors suggest that the development of the intrathrombotic capillary channels may be an important factor in the growth of thrombosed giant aneurysm of the vertebral artery. Trapping of the aneurysm followed by aneurysmectomy appears to be the best treatment for this type of aneurysm.

Giant aneurysm of the pericallosal artery

1982 ◽  
Vol 57 (4) ◽  
pp. 566-569 ◽  
Author(s):  
Eugenio Pozzati ◽  
Giacomo Nuzzo ◽  
Giulio Gaist
Keyword(s):  
Computerized Tomography ◽  
Giant Aneurysm ◽  
Content Type ◽  
Giant Aneurysms ◽  
Pericallosal Artery ◽  
Initial Symptoms ◽  
Neurological Presentation ◽  
Fine Print

✓ A case is reported of a thrombosed giant aneurysm of the pericallosal artery. Neurological presentation was attributable to the acute swelling of the aneurysmal mass after rapid and massive intraluminal thrombosis. This case demonstrates that initial symptoms in giant aneurysms may be related to the thrombotic events within the enlarged sac. The computerized tomography characteristics of this case are reported and discussed.

Cerebral angiography during operation for intracranial aneurysms and arteriovenous malformations

1971 ◽  
Vol 34 (5) ◽  
pp. 706-708 ◽  
Author(s):  
Martin L. Lazar ◽  
Clark C. Watts ◽  
Bassett Kilgore ◽  
Kemp Clark
Keyword(s):  
Cerebral Angiography ◽  
Arteriovenous Malformations ◽  
Intracranial Aneurysms ◽  
Operative Procedure ◽  
Superficial Temporal Artery ◽  
Technical Problem ◽  
Temporal Artery ◽  
Content Type ◽  
Actual Operation ◽  
Fine Print

✓ Angiography during the operative procedure is desirable, but is often difficult because of the problem of maintaining a needle or cannula in an artery for long periods of time. Cannulation of the superficial temporal artery avoids this technical problem. The artery is easily found, cannulation is simple, and obliteration of the artery is of no consequence. Cerebral angiography then provides a means for prompt evaluation of the surgical procedure at any time during the actual operation.

Giant aneurysm of anterior ethmoidal artery presenting with intracranial hemorrhage

1994 ◽  
Vol 81 (6) ◽  
pp. 934-936 ◽  
Author(s):  
Alok Ranjan ◽  
Thomas Joseph
Keyword(s):  
Intracranial Hemorrhage ◽  
Giant Aneurysm ◽  
Postoperative Recovery ◽  
Vascular Lesions ◽  
Feeding Artery ◽  
Neck Stiffness ◽  
Content Type ◽  
Ethmoidal Artery ◽  
Anterior Ethmoidal Artery ◽  
Fine Print

✓ This forty-five-year-old woman presented with a history suggestive of an intracranial hemorrhage. Clinical examination indicated mild right pyramidal signs and neck stiffness. Computerized tomography demonstrated contrast enhancement in the region of a left frontal intraparenchymal hematoma with an adjacent subdural hematoma. Angiography revealed the presence of a giant aneurysm on the left anterior ethmoidal artery. Surgical evacuation of the hematoma with excision of the aneurysm and coagulation of the feeding artery was achieved. Postoperative recovery was uneventful. Vascular lesions of the anterior ethmoidal artery and the rarity of a giant aneurysm at this site are discussed.

Sign in / Sign up

Export Citation Format

Share Document