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.

Prevalence of cerebral aneurysms in patients with persistent primitive trigeminal artery

1999 ◽  
Vol 90 (5) ◽  
pp. 865-867 ◽  
Author(s):  
Harry J. Cloft ◽  
Nasser Razack ◽  
David F. Kallmes
Keyword(s):  
Intracranial Aneurysms ◽  
Case Reports ◽  
Cerebral Aneurysms ◽  
Trigeminal Artery ◽  
Content Type ◽  
Persistent Primitive Trigeminal Artery ◽  
Unbiased Manner ◽  
Primitive Trigeminal Artery ◽  
Fine Print ◽  
Saccular Aneurysms

Object. The aim of this study was to determine the prevalence of cerebral saccular aneurysms in patients with persistent primitive trigeminal artery (PPTA). The prevalence of cerebral saccular aneurysms in patients with PPTA previously has been reported to be 14 to 32%, but this rate range is unreliable because it is based on collections of published case reports rather than a series of patients chosen in an unbiased manner.Methods. The authors retrospectively evaluated their own series of 34 patients with PPTA to determine the prevalence of cerebral aneurysms in this population. The prevalence of intracranial aneurysms in patients with PPTA was approximately 3% (95% confidence interval 0–9%).Conclusions. The prevalence of intracranial aneurysms in patients with PPTA is no greater than the prevalence of intracranial aneurysms in the general population.

Sizes of ruptured and unruptured aneurysms in relation to their sites and the ages of patients

2002 ◽  
Vol 96 (1) ◽  
pp. 64-70 ◽  
Author(s):  
Bryce Weir ◽  
Lew Disney ◽  
Theodore Karrison
Keyword(s):  
Cerebral Artery ◽  
Patient Age ◽  
Content Type ◽  
Unruptured Aneurysms ◽  
Ruptured Aneurysms ◽  
Patient Âgé ◽  
Risk Of Rupture ◽  
Mean Size ◽  
The Mean ◽  
Fine Print

Object. The authors explore the risk of rupture in aneurysms categorized by size. Methods. A computerized database of 945 patients with aneurysms treated between 1967 and 1987 was retrospectively established. All available clinical and radiological studies were abstracted. Because of the recent interest in the size of intracranial aneurysms in relation to their likelihood of rupture, the database was searched with respect to this parameter. In 390 patients representing 41% of all cases, aneurysms were measured by neuroradiologists at the time of diagnosis. In 78% of the 945 patients there was only one aneurysm, and of the 507 aneurysms that were measured, 60% were solitary. Of all patients, 86% had ruptured aneurysms. The average age of all patients was 47 years, and for those with ruptured aneurysms it was 46 years. Of the ruptured aneurysms, 77% were 10 mm or smaller, compared with 85% of the unruptured aneurysms. It was found that 40.3% of the ruptured aneurysms were on the anterior cerebral artery or anterior communicating artery, compared with 13% of the unruptured aneurysms. None of the cavernous internal carotid artery (ICA) aneurysms were ruptured and 65% of the ophthalmic artery (OphA) aneurysms were. Of the unruptured aneurysms, 15% were located in the cavernous ICA or the OphA. Of the ruptured aneurysms, 29% were on the middle cerebral artery, compared with 36% of the unruptured aneurysms. The mean size of ruptured and unruptured aneurysms showed no statistically significant increase with patient age, although the difference in size between the ruptured and unruptured aneurysms decreased with increasing age. The mean size of all ruptured aneurysms (10.8 mm) was significantly larger than the mean size of all unruptured aneurysms (7.8 mm, p < 0.001); the median sizes were 10 mm and 5 mm, respectively. The size of ruptured aneurysms in patients who died in the hospital was significantly larger than those in the patients who survived (12 mm compared with 9.9 mm, p = 0.004). Symptomatic unruptured aneurysms were significantly larger than incidental unruptured aneurysms (14.6 mm compared with 6.9 mm, p = 0.032), which were, in turn, larger than aneurysms that were unruptured and part of a multiple aneurysm constellation. Both ruptured and unruptured aneurysms were larger in male than in female patients, but not significantly. Conclusions. Site and patient age, as well as lesion size, may affect the chance of rupture.

Surgical management of unruptured intracranial aneurysms

1994 ◽  
Vol 80 (3) ◽  
pp. 440-446 ◽  
Author(s):  
Robert A. Solomon ◽  
Matthew E. Fink ◽  
John Pile-Spellman
Keyword(s):  
Surgical Management ◽  
Intracranial Aneurysms ◽  
Clinical Decision Making ◽  
Mass Effect ◽  
Endovascular Embolization ◽  
Surgical Morbidity ◽  
Content Type ◽  
Unruptured Aneurysms ◽  
Unruptured Intracranial Aneurysms ◽  
Fine Print

✓ The surgical management of patients with unruptured intracranial aneurysms continues to be controversial. The criteria for withholding treatment or choosing between endovascular embolization and conventional microsurgery are not well delineated. The present study analyzes the morbidity and mortality that can be expected with modern surgical management of unruptured aneurysms, and therefore serves as a point of reference for clinical decision-making in this group of patients. A total of 202 consecutive operations for attempted clipping of unruptured intracranial aneurysms are reported. Subarachnoid hemorrhage from another aneurysm was the most common presentation (55 cases). Thirty-seven patients presented with headache, 36 with mass effect from the aneurysm, and 19 with embolic events; 11 aneurysms were associated with an arteriovenous malformation, 10 caused seizures, and 34 were incidental findings. Excellent or good outcome was achieved in 100% of patients with aneurysms less than 10 mm in diameter, 95% with aneurysms 11 to 25 mm, and 79% with aneurysms greater than 25 mm. Except for giant basilar aneurysms, size (and not location) of the aneurysm was the key predictor of risk for surgical morbidity. These data may be useful when discussing with patients the risk:benefit ratio of choosing between conservative management, endovascular embolization, and microsurgical clipping.

Prevalence of asymptomatic incidental aneurysms: review of 4568 arteriograms

2002 ◽  
Vol 96 (1) ◽  
pp. 43-49 ◽  
Author(s):  
H. Richard Winn ◽  
John A. Jane ◽  
James Taylor ◽  
Donald Kaiser ◽  
Gavin W. Britz
Keyword(s):  
Prevalence Rate ◽  
Cerebral Aneurysms ◽  
Anterior Circulation ◽  
Content Type ◽  
Unruptured Aneurysms ◽  
Incidental Aneurysms ◽  
Unruptured Cerebral Aneurysms ◽  
The University ◽  
Yearly Rate ◽  
Fine Print

Object. The prevalence of unruptured cerebral aneurysms is unknown, but is estimated to be as high as 5%. The goal of this study was to determine the prevalence of asymptomatic incidental aneurysms. Methods. The authors studied all cerebral arteriography reports produced at a single institution, the University of Virginia, between April 1969 and January 1980. A review of 3684 arteriograms demonstrated 24 cases of asymptomatic aneurysms, yielding a prevalence rate of 0.65%. The majority (67%) of the 24 patients harboring unruptured aneurysms were women. More than 90% of the unruptured aneurysms were located in the anterior circulation and in locations similar to those found in patients with ruptured aneurysms. Nearly 80% of the aneurysms were smaller than 1 cm in their greatest diameter. The frequency of asymmetrical unruptured aneurysms (0.6–1.5%) was constant throughout all relevant age ranges (35–84 years). Conclusions. While keeping in mind appropriate caveats in extrapolating from these data, the prevalence rate of asymptomatic unruptured aneurysms found in the present study allows an estimation of the yearly rate of rupture of these lesions. The authors suggest that this yearly rate of rupture falls within the range of 1 to 2%.

The size of intracranial saccular aneurysms

1970 ◽  
Vol 33 (4) ◽  
pp. 422-427 ◽  
Author(s):  
William F. McCormick ◽  
Gaston J. Acosta-Rua
Keyword(s):  
Intracranial Aneurysms ◽  
Autopsy Material ◽  
Autopsy Study ◽  
Content Type ◽  
Unruptured Aneurysms ◽  
Age And Sex ◽  
Fine Print ◽  
Saccular Aneurysms

✓ An autopsy study was made of the size of 191 saccular intracranial aneurysms (54 ruptured, 137 unruptured). Variations with age and sex, and ruptured and unruptured state were recorded and analyzed. Measurements on unfixed, unruptured aneurysms inflated by perfusion under 70 mm Hg pressure indicated that the size of aneurysms as generally determined in autopsy material is deceptively low.

Intracranial cavernous angioma: presentation and management

1986 ◽  
Vol 64 (5) ◽  
pp. 720-723 ◽  
Author(s):  
Patricio Tagle ◽  
Isidro Huete ◽  
Jorge Méndez ◽  
Sergio del Villar
Keyword(s):  
Cerebellopontine Angle ◽  
Unusual Case ◽  
Clinical Presentation ◽  
Ct Scanning ◽  
Cavernous Angioma ◽  
Mass Effect ◽  
Ct Scans ◽  
Content Type ◽  
Neurological Signs ◽  
Fine Print

✓ Thirteen cases of cerebral cavernous angiomas are reported, and their radiological and pathological features are reviewed. The clinical presentation was variable: 53.8% of patients had seizures, 30.8% intracerebral hemorrhage, and 15.4% focal neurological signs, including one unusual case that presented as a cerebellopontine angle tumor. The computerized tomography (CT) scans were abnormal in all cases. Angiography was positive only when there was mass effect due to associated hematoma. Surgery was performed in 12 cases with good results. The prognosis of the 13 cases was favorable, with no mortality in this series. These data suggest that the combination of a recent seizure disorder with a hyperdense intracerebral nodule on the CT scanning should alert the neurosurgeon to the possibility of a cavernous angioma.

Intracranial tuberculoma and the CT scan

1986 ◽  
Vol 64 (4) ◽  
pp. 568-574 ◽  
Author(s):  
Umesh S. Vengsarkar ◽  
Ramkrishna Prasad Pisipaty ◽  
Bharat Parekh ◽  
Venilal G. Panchal ◽  
Manohar N. Shetty
Keyword(s):  
Ct Scanning ◽  
Mass Effect ◽  
Ct Scans ◽  
Complete Disappearance ◽  
Antituberculous Therapy ◽  
Content Type ◽  
Diagnosis And Management ◽  
Intracranial Tuberculoma ◽  
Serial Ct ◽  
Fine Print

✓ Computerized tomography (CT) has greatly influenced the diagnosis and management of intracranial tuberculomas and has helped us to formulate guidelines for the management of these lesions. Solid and ringenhancing lesions seen on CT scans are diagnostic of tuberculoma if supported by other clinical and ancillary criteria. Conservative management of intracranial tuberculoma is usually indicated because serial CT scans have shown complete disappearance of these lesions with antituberculous therapy. Only lesions associated with raised intracranial pressure and CT evidence of a mass effect should be considered for surgery. Nonresponse to antituberculous therapy, as judged by serial CT scanning, should raise doubts regarding the diagnosis of a tuberculomatous lesion, and therefore such lesions should be subjected to surgery and histopathological confirmation. Representative clinical cases illustrating the principles of diagnosis and management of intracranial tuberculoma with the help of CT scanning are briefly described and discussed.

Intraoperative factors associated with surgical outcome in patients with unruptured cerebral aneurysms: the experience of a single surgeon

2003 ◽  
Vol 99 (3) ◽  
pp. 452-457 ◽  
Author(s):  
Arthur A. Grigorian ◽  
Alvin Marcovici ◽  
Eugene S. Flamm
Keyword(s):  
Cerebral Artery ◽  
Cerebral Aneurysms ◽  
Predictive Tool ◽  
Content Type ◽  
Unruptured Aneurysms ◽  
Aneurysm Neck ◽  
Unruptured Cerebral Aneurysms ◽  
Unexpected Outcomes ◽  
Expected Outcomes ◽  
Fine Print

Object. Some well-known predictors of clinical outcomes in patients with ruptured aneurysms are not useful for forecasting outcome in patients with unruptured aneurysms. The goal of this study was to analyze outcomes in patients harboring unruptured cerebral aneurysms in different locations and to create a predictive tool for assessing both favorable outcome and morbidity in a large series of unruptured aneurysms. Methods. The authors analyzed data from 387 patients with nonruptured intracranial cerebral aneurysms who underwent surgery for clip placement. Intraoperative data were reviewed and seven factors that might influence outcomes were identified. These included the following: 1) aneurysm size larger than 10 mm; 2) presence of a broad aneurysm neck; 3) presence of plaque calcification near the aneurysm neck; 4) application of clips to more than one aneurysm during the same surgery; 5) temporary occlusion; 6) multiple clip applications and repositioning; and 7) use of multiple clips. The entire group of patients with unruptured aneurysms was divided into two subgroups on the basis of outcome. Each patient was subsequently assessed to formulate the factor accumulation index (FAI), the sum of different factors observed in a given patient. The subgroup of patients with expected outcomes was composed of 312 patients, whereas the subgroup of unexpected outcomes consisted of 31 patients. Depending on the anatomical locations of the aneurysms, the combined mortality—morbidity rate ranged from 5.7 to 25%, with the best results for patients harboring ophthalmic artery aneurysms and the worst results for those with vertebrobasilar system (VBS) aneurysms. The majority of patients with expected outcomes who harbored aneurysms of the middle cerebral artery, the internal carotid artery, and the VBS had a lower FAI, whereas the majority of patients with unexpected outcomes had a higher FAI. Conclusions. It is possible to predict outcomes in patients with unruptured cerebral artery aneurysms by calculating the FAI. The rate of postoperative morbidity increases with the FAI within the range of three to four factors.

A cervical dural arteriovenous fistula in a patient presenting with radiculopathy

1996 ◽  
Vol 84 (1) ◽  
pp. 119-123 ◽  
Author(s):  
Michihiro Kohno ◽  
Hiroshi Takahashi ◽  
Katsuhisa Ide ◽  
Buichi Ishijima ◽  
Katsuhiro Yamada ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Ct Scanning ◽  
Mass Effect ◽  
Preoperative Embolization ◽  
Venous Plexus ◽  
Content Type ◽  
Embolization Therapy ◽  
Dynamic Ct Scanning ◽  
Fine Print

✓ A 51-year-old man presenting with radiculopathy with a rare cervical dural arteriovenous fistula (AVF) is reported. Angiography revealed that the cervical dural AVF was fed mainly by the left C-3 and C-4 radicular arteries and drained into the internal vertebral venous plexus with no communication with intradural structures. The dural AVF was treated surgically after embolization therapy. Although the AVF showed mass effect on computerized tomography (CT) scanning, abnormal vessels, which were suspected to drain the AVF, were observed intraoperatively to compress the left C-4 and C-5 nerve root sleeves. After resection of these abnormal epidural vessels, monoparesis of the left proximal upper extremity was markedly improved. In this patient, dynamic CT scanning was useful in the initial diagnosis, and the preoperative embolization therapy was very effective.

Cerebral aneurysms following radiotherapy for medulloblastoma

1989 ◽  
Vol 70 (4) ◽  
pp. 545-550 ◽  
Author(s):  
Peter J. Benson ◽  
Joo Ho Sung
Keyword(s):  
Cerebral Arteries ◽  
Cerebral Aneurysms ◽  
Content Type ◽  
Histological Features ◽  
Autopsy Examination ◽  
Cerebellar Medulloblastoma ◽  
Radiation Induced ◽  
The Brain ◽  
Fine Print ◽  
Saccular Aneurysms

✓ Three patients, two males and one female aged 21, 14, and 31 years, respectively, developed cerebral saccular aneurysms several years after undergoing radiotherapy for cerebellar medulloblastoma at 2, 5, and 14 years of age, respectively. Following surgery, all three received combined cobalt-60 irradiation and intrathecal colloidal radioactive gold (198Au) therapy, and died from rupture of the aneurysm 19, 9, and 17 years after the radiotherapy, respectively. Autopsy examination revealed no recurrence of the medulloblastoma, but widespread radiation-induced vasculopathy was found at the base of the brain and in the spinal cord, and saccular aneurysms arose from the posterior cerebral arteries at the basal cistern or choroidal fissure. The aneurysms differed from the ordinary saccular aneurysms of congenital type in their location and histological features. Their locations corresponded to the areas where intrathecally administered colloidal 198Au is likely to pool, and they originated directly from a segment of the artery rather than from a branching site as in congenital saccular aneurysms. It is, therefore, concluded that the aneurysms in these three patients were most likely radiation-induced.

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