Pediatric cerebral aneurysms

2001 ◽  
Vol 94 (5) ◽  
pp. 733-739 ◽  
Author(s):  
François Proust ◽  
Patrick Toussaint ◽  
José Garniéri ◽  
Didier Hannequin ◽  
Daniel Legars ◽  
...  
Keyword(s):  
Adult Population ◽  
Clinical Status ◽  
Cerebral Aneurysms ◽  
Giant Aneurysm ◽  
Distal Portion ◽  
Anterior Communicating Artery ◽  
Content Type ◽  
Delay In Diagnosis ◽  
Specific Distribution ◽  
Fine Print

Object. The exceptional pediatric aneurysm can be distinguished from its adult counterpart by its location and size; however patient outcomes remain difficult to evaluate based on the published literature. Methods. Twenty-two children, all consecutively treated in three neurosurgery departments, were included in this study. Each patient's preoperative status was determined according to the Hunt and Hess classification. Routine computerized tomography scanning and angiography were performed in all children on the 10th postoperative day. Each patient's clinical status was evaluated 2 to 10 years postoperatively by applying the Glasgow Outcome Scale (GOS). Twenty-one children presented with a subarachnoid hemorrhage (SAH) and one child harbored an asymptomatic giant aneurysm. Thirteen patients were in good preoperative grade (Hunt and Hess Grades I to III) and eight in poor preoperative grade (Hunt and Hess Grade IV or V). The symptomatic aneurysms were located on the internal carotid artery bifurcation (36.4%); middle cerebral artery (36.4%), half of which were found on the distal portion; anterior communicating artery (18.2%); and within the vertebrobasilar system (9.1%). A giant aneurysm was observed in 14% of patients. Overall outcome was favorable (GOS Score 5) in 14 children (63.6%) and death occurred in five (22.7%). Causes of unfavorable outcome included the initial SAH in four children, a complication in procedure in three children, and edema in one child. Conclusions. Pediatric aneurysms have a specific distribution unlike that of aneurysms in the adult population. The incidence of giant aneurysms and outcomes were similar to those in the adult population. The major cause of poor outcome was the initial SAH, in particular, the high proportion of rebleeding possibly due to a delay in diagnosis.

Bifrontal interhemispheric approach to aneurysms of the anterior communicating artery

1986 ◽  
Vol 64 (2) ◽  
pp. 183-190 ◽  
Author(s):  
Jiro Suzuki ◽  
Kazuo Mizoi ◽  
Takashi Yoshimoto
Keyword(s):  
Cerebral Arteries ◽  
Distal Portion ◽  
Anterior Communicating Artery ◽  
Content Type ◽  
Interhemispheric Approach ◽  
Interhemispheric Fissure ◽  
Early Operations ◽  
Temporary Clip ◽  
Fine Print

✓ The authors review their experience with the bifrontal interhemispheric approach in 603 cases of single anterior communicating artery (ACoA) aneurysms and describe the operative technique. With this approach, the olfactory tracts are dissected, and both A1 segments of the anterior cerebral arteries are identified subfrontally. The interhemispheric fissure is then dissected and A2segments are followed from the distal portion toward the ACoA complex. Following the administration of a combination of mannitol, vitamin E, and dexamethasone, a temporary clip is placed on at least the dominant A1 segment prior to dissection of the aneurysm itself. Once the aneurysm has been completely freed from the surrounding structures, the neck is ligated and clipped. If the aneurysm ruptures during surgery, temporary clips are placed on both A1 and A2 segments bilaterally and the operation proceeds in a completely dry field. With this method, it is possible to occlude any of the intracranial vessels for up to 40 minutes within 100 minutes of drug administration. To prevent the possibility of rerupture and the development of vasospasm in the period before aneurysm surgery, the authors have adopted a policy of performing ultra-early operations within 48 hours of the onset of symptoms. Among the 257 cases operated on during the 9 years since 1975, one-fifth have been operated on within 48 hours of rupture, and the in-hospital mortality rate has been only 4.3% (11 cases). Follow-up studies have shown that 87% of the 246 surviving patients have returned to useful lives.

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.

Experimental induction of cerebral aneurysms in monkeys

1987 ◽  
Vol 67 (6) ◽  
pp. 903-905 ◽  
Author(s):  
Nobuo Hashimoto ◽  
Choegon Kim ◽  
Haruhiko Kikuchi ◽  
Masayuki Kojima ◽  
Yoo Kang ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid ◽  
Cerebral Aneurysms ◽  
Anterior Communicating Artery ◽  
Experimental Hypertension ◽  
Content Type ◽  
Experimental Induction ◽  
The Common ◽  
The Brain ◽  
Fine Print

✓ Saccular cerebral aneurysms were successfully induced in two monkeys treated with ligation of the common carotid artery, experimental hypertension, and β-aminopropionitrile feeding. The cerebral aneurysms developed on the large arteries at the base of the brain, such as the anterior communicating artery and the internal carotid artery at the origin of the posterior communicating artery. Because of the similarity of the monkey to man as a species, the present results strongly suggest the significance of postnatal aggravating factors in the development of cerebral aneurysms in man.

Postoperative intracranial pressure in patients operated on for cerebral aneurysms following subarachnoid hemorrhage

1981 ◽  
Vol 54 (6) ◽  
pp. 726-732 ◽  
Author(s):  
Andrew H. Kaye ◽  
David Brownbill
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Intracranial Pressure ◽  
Postoperative Period ◽  
Cerebral Aneurysms ◽  
Anterior Communicating Artery ◽  
Antifibrinolytic Agents ◽  
Content Type ◽  
Plateau Waves ◽  
Arterial Vasospasm ◽  
Fine Print

✓ The postoperative intracranial pressure (ICP) in 36 patients operated on for cerebral aneurysm following subarachnoid hemorrhage was studied. Not only was the baseline ICP significantly lower in patients whose outcome was assessed as “good” as compared with those patients with a worse outcome at 1 month after surgery, but also the height of the plateau waves and B-waves was significantly less in the patients who did well. The baseline ICP and the height of the B-wave formation were unrelated to the position of the aneurysm. Plateau waves were marginally significantly higher in aneurysms of the anterior communicating artery complex. Neither preoperative hypertension nor the use of antifibrinolytic agents made any difference to postoperative ICP. In patients with cerebral arterial vasospasm found preoperatively on the angiograms, the ICP tended to be lower in the postoperative period than in those without spasm.

Magnetic resonance angiographic evidence of sex-linked variations in the circle of Willis and the occurrence of cerebral aneurysms

2002 ◽  
Vol 96 (4) ◽  
pp. 697-703 ◽  
Author(s):  
Toru Horikoshi ◽  
Iwao Akiyama ◽  
Zentaro Yamagata ◽  
Masao Sugita ◽  
Hideaki Nukui
Keyword(s):  
Magnetic Resonance ◽  
Cerebral Aneurysms ◽  
Type A ◽  
Anatomical Variations ◽  
Circle Of Willis ◽  
Anterior Communicating Artery ◽  
Content Type ◽  
Ordinary Type ◽  
Male Patients ◽  
Fine Print

Object. In this study the authors investigated the relationship between variations in the circle of Willis observed on magnetic resonance (MR) angiograms and locations of cerebral aneurysms, and evaluated the risk of aneurysm formation. Methods. One hundred thirty-one patients with cerebral aneurysms were retrospectively selected from a series of 4518 patients who underwent MR angiography at one neurosurgical institute. Variations in the anatomy of the circle of Willis were simply classified into Type A, in which there was no visualization of a unilateral A1 segment, and Type P, in which there was a fetal type of posterior cerebral artery that was continuously delineated from the internal carotid artery (ICA) through the posterior communicating artery. All other variations in the circle of Willis were defined as Type O (ordinary type of variations). An additional 440 patients who did not harbor cerebral aneurysms were randomly selected for a comparison. Anterior communicating artery aneurysms were significantly related to the Type A anatomy and ICA aneurysms to Type P anatomy. Male patients who did not harbor aneurysms tended to have Type A anatomy, whereas women had a significantly greater incidence of Type P. Conclusions. This sex-linked difference in anatomical variations may be correlated to the well-known sex-linked difference in aneurysm distribution.

Prospective analysis of aneurysm treatment in a series of 103 consecutive patients when endovascular embolization is considered the first option

2000 ◽  
Vol 93 (2) ◽  
pp. 175-182 ◽  
Author(s):  
Christian Raftopoulos ◽  
Pierre Mathurin ◽  
Dutcho Boscherini ◽  
Rudolf F. Billa ◽  
Michel Van Boven ◽  
...  
Keyword(s):  
Coil Embolization ◽  
Clinical Status ◽  
Cerebral Aneurysms ◽  
Endovascular Embolization ◽  
Surgical Clipping ◽  
Anterior Circulation ◽  
Content Type ◽  
Group A ◽  
Group B ◽  
Fine Print

Object. The aim of this study was to evaluate prospectively the results of treating cerebral aneurysms with coil embolization (CE) or with surgical clipping when CE was considered the first option.Methods. Whenever an aneurysm was to be treated, CE was first considered by our neurovascular team. Surgical clipping was reserved for cases excluded from CE or cases in which CE failed. The study consisted of 103 consecutive patients with 132 aneurysms, of which 127 were treated. Coil embolization was performed using Guglielmi detachable coils, and surgery was performed using Zeppelin clips. Three groups were defined: Group A consisted of 64 aneurysms that were treated by CE (neck/sac ratio < 1:3); Group B, 63 aneurysms that were surgically clipped; and Group C, 12 aneurysms that failed to be satisfactorily (≥ 95%) embolized and were subsequently clipped. The percentages of residual aneurysm were 31.2% in Group A, 1.6% in Group B, and 0% in Group C. The percentages of patients with poor Glasgow Outcome Scale (GOS) scores (GOS Scores 1–3) were 13.3% in Group A, 6.1% in Group B, and 8.3% in Group C. The percentages of poor outcome (GOS Scores 1–3) in patients with good clinical status before treatment were 10.7% in Group A, 0% in Group B, and 8.3% in Group C.Conclusions. Even with preselection, CE remains associated with a significant number of treatment failures and poor outcomes, even in patients with good preoperative clinical status. Surgical clipping can offer better results than CE, even for more complex aneurysms of the anterior circulation, especially for those involving the middle cerebral artery cases. However, because CE can be effective and causes less stress and invasiveness for the patient, it should be considered first in aneurysms strictly selected by a neurovascular team.

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.

Occlusion of an “accessory” distal anterior cerebral artery during treatment of anterior communicating artery aneurysms

1991 ◽  
Vol 74 (1) ◽  
pp. 133-135 ◽  
Author(s):  
Kevin Gibbons ◽  
Leo N. Hopkins ◽  
Roberto C. Heros
Keyword(s):  
Cerebral Artery ◽  
Anterior Cerebral Artery ◽  
Anterior Communicating Artery ◽  
Case Histories ◽  
Content Type ◽  
Anterior Communicating Artery Aneurysms ◽  
Artery Segment ◽  
Distal Anterior Cerebral Artery ◽  
Clip Occlusion ◽  
Fine Print

✓ Two cases are presented in which clip occlusion of a third distal anterior cerebral artery segment occurred during treatment of anterior communicating artery aneurysms. Case histories, angiograms, operative descriptions, and postmortem findings are presented. The incidence of this anomalous vessel is reviewed. Preoperative and intraoperative vigilance in determining the presence of this anomaly prior to clip placement is emphasized.

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.

Stereotaxic occlusion of 22 consecutive anterior communicating artery aneurysms

1980 ◽  
Vol 52 (6) ◽  
pp. 790-793 ◽  
Author(s):  
John F. Alksne ◽  
Randall W. Smith
Keyword(s):  
Anterior Communicating Artery ◽  
Content Type ◽  
Anterior Communicating Artery Aneurysms ◽  
Fine Print

✓ The authors review 22 consecutive cases of anterior communicating artery aneurysms treated by stereotaxic iron-acrylic occlusion. There was no mortality and no rebleeding in this series. The morbidity was low, and 16 of the 22 patients have returned to work. The patients whose aneurysms could be treated transsphenoidally enjoyed the best outcome.

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