scholarly journals Novel Models for Identification of the Ruptured Aneurysm in Patients with Subarachnoid Hemorrhage with Multiple Aneurysms

2019 ◽  
Author(s):  
H. Rajabzadeh-Oghaz ◽  
J. Wang ◽  
N. Varble ◽  
S.-I. Sugiyama ◽  
A. Shimizu ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Ruptured Aneurysm ◽  
Multiple Aneurysms

scholarly journals Single-stage clipping with bifrontal and bilateral frontotemporal craniotomies for subarachnoid hemorrhage with multiple cerebral aneurysms using Sugita head holding system: A case report

2020 ◽  
Vol 11 ◽  
pp. 76
Author(s):  
Masahito Katsuki ◽  
Naomichi Wada ◽  
Yasunaga Yamamoto
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cerebral Artery ◽  
Treatment Strategies ◽  
Cerebral Aneurysms ◽  
Single Stage ◽  
Ruptured Aneurysm ◽  
Left Middle Cerebral Artery ◽  
Multiple Aneurysms ◽  
Single Fixation ◽  
The Right

Background: Subarachnoid hemorrhage with multiple aneurysms is very challenging because it is difficult to identify the ruptured aneurysm. We could not identify the ruptured aneurysm preoperatively, so we decided to treat all of the aneurysms as a single-stage surgery. Case Description: A 79-year-old woman was diagnosed with subarachnoid hemorrhage with multiple cerebral aneurysms at the right distal anterior cerebral artery, left middle cerebral artery, and right internal carotid artery- posterior communicating artery bifurcation. We could not identify the ruptured aneurysm preoperatively. We fixed her head using the Sugita head holding system (Mizuho Co., Ltd., Tokyo) and performed clipping for each aneurysm with bifrontal craniotomy and bilateral frontotemporal craniotomy as a single-stage operation. The last aneurysm seemed ruptured, and clipping for all the aneurysms was successful. She was discharged with a good postoperative course. The Sugita head holding system allowed turning the head of the patient toward the right and left with single fixation, leading to this single-stage operation. Conclusion: Several methods for identifying a ruptured aneurysm from multiple aneurysms have been reported, but under limited medical resources, this procedure would be one of the treatment strategies.

Accuracy in Identifying the Source of Subarachnoid Hemorrhage in the Setting of Multiple Intracranial Aneurysms

Neurosurgery ◽  
2017 ◽  
Vol 83 (1) ◽  
pp. 62-68 ◽  
Author(s):  
Jennifer L Orning ◽  
Sophia F Shakur ◽  
Ali Alaraj ◽  
Mandana Behbahani ◽  
Fady T Charbel ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Subarachnoid Hemorrhage ◽  
Cerebral Aneurysms ◽  
Endovascular Embolization ◽  
Ruptured Aneurysm ◽  
Multiple Aneurysms ◽  
Microsurgical Clipping ◽  
Computed Tomography Scans ◽  
Rupture Site

Abstract BACKGROUND Subarachnoid hemorrhage cases with multiple cerebral aneurysms frequently demonstrate a hemorrhage pattern that does not definitively delineate the source aneurysm. In these cases, rupture site is ascertained from angiographic features of the aneurysm such as size, morphology, and location. OBJECTIVE To examine the frequency with which such features lead to misidentification of the ruptured aneurysm. METHODS : Records of patients who underwent surgical clipping of a ruptured aneurysm at our institution between 2004 and 2014 and had multiple aneurysms were retrospectively reviewed. A blinded neuroendovascular surgeon provided the rupture source based on the initial head computed tomography scans and digital subtraction angiography images. Operative reports were then assessed to confirm or refute the imaging-based determination of the rupture source. RESULTS One hundred fifty-one patients had multiple aneurysms. Seventy-one patients had definitive hemorrhage patterns on initial computed tomography scans and 80 patients had nondefinitive hemorrhage patterns. Thirteen (16.2%) of the cases with nondefinitive hemorrhage patterns had discordance between the imaging-based determination of the rupture source and intraoperative findings of the true ruptured aneurysm, yielding an imperfect positive predictive value of 83.8%. Of all multiple aneurysm cases with subarachnoid hemorrhage treated by surgical or endovascular means at our institution, 4.3% (13 of 303) were misidentified. CONCLUSION Morphological features cannot reliably be used to determine rupture site in cases with nondefinitive subarachnoid hemorrhage patterns. Microsurgical clipping, confirming obliteration of the ruptured lesion, may be preferentially indicated in these patients unless, alternatively, all lesions can be contemporaneously and safely treated with endovascular embolization.

Demographic and clinical predictors of multiple intracranial aneurysms in patients with subarachnoid hemorrhage

2018 ◽  
Vol 128 (4) ◽  
pp. 961-968 ◽  
Author(s):  
Michael M. McDowell ◽  
Yin Zhao ◽  
Christopher P. Kellner ◽  
Sunjay M. Barton ◽  
Eric Sussman ◽  
...  
Keyword(s):  
Risk Factors ◽  
Subarachnoid Hemorrhage ◽  
Intracranial Aneurysms ◽  
Posterior Circulation ◽  
Smoking History ◽  
Relative Risk Ratio ◽  
Base Case ◽  
Black Race ◽  
Multiple Aneurysms ◽  
Female Sex

OBJECTIVEPathophysiological differences that underlie the development and subsequent growth of multiple aneurysms may exist. In this study, the authors assessed the factors associated with the occurrence of multiple aneurysms in patients presenting with aneurysmal subarachnoid hemorrhage (SAH).METHODSConsecutive patients presenting with aneurysmal SAH between 1996 and 2012 were prospectively enrolled in the Subarachnoid Hemorrhage Outcome Project. Patients harboring 1, 2, or 3 or more aneurysms were stratified into groups, and the clinical and radiological characteristics of each group were compared using multivariate logistic regression.RESULTSOf 1277 patients with ruptured intracranial aneurysms, 890 had 1 aneurysm, 267 had 2 aneurysms, and 120 had 3 or more aneurysms. On multinomial regression using the single-aneurysm cohort as base case, risk factors for patients presenting with 2 aneurysms were female sex (relative risk ratio [RRR] 1.80, p < 0.001), higher body mass index (BMI) (RRR 1.02, p = 0.003), more years of smoking (RRR = 1.01, p = 0.004), and black race (RRR 1.83, p = 0.001). The risk factors for patients presenting with 3 or more aneurysms were female sex (RRR 3.10, p < 0.001), higher BMI (RRR 1.03, p < 0.001), aneurysm in the posterior circulation (RRR 2.59, p < 0.001), and black race (RRR 2.15, p = 0.001). Female sex, longer smoking history, aneurysms in the posterior circulation, BMI, and black race were independently associated with the development of multiple aneurysms in our adjusted multivariate multinomial model.CONCLUSIONSSignificant demographic and clinical differences are found between patients presenting with single and multiple aneurysms in the setting of aneurysmal SAH. These predictors of multiple aneurysms likely reflect a predisposition toward inflammation and endothelial injury.

scholarly journals Multiple aneurysms on the subarcuate artery arising from the anterior inferior cerebellar artery in a patient with a Borden type I transverse-sigmoid dural arteriovenous fistula manifesting as subarachnoid hemorrhage: A case report

2018 ◽  
Vol 25 (1) ◽  
pp. 90-96 ◽  
Author(s):  
Tomoaki Suzuki ◽  
Kouichirou Okamoto ◽  
Nobuyuki Genkai ◽  
Yasushi Ito ◽  
Hiroshi Abe
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Anterior Inferior Cerebellar Artery ◽  
Type I ◽  
Feeding Artery ◽  
Multiple Aneurysms ◽  
Arteriovenous Shunts ◽  
Cerebellar Artery ◽  
Subarcuate Artery

Background Peripheral anterior inferior cerebellar artery (AICA) aneurysms are rare and commonly associated with vascular malformations, such as cerebellar arteriovenous malformations (AVMs). We present a case wherein multiple AICA feeding aneurysms on the subarcuate artery as a feeding artery of a Borden type I transverse-sigmoid dural arteriovenous fistula (dAVF) manifested as subarachnoid hemorrhage. Case description A 67-year-old woman presented with acute severe headache. Brain computed tomography (CT) demonstrated subarachnoid hemorrhage mainly in the posterior fossa. A transverse-sigmoid dAVF was detected on magnetic resonance angiography (MRA) and three-dimensional-CT angiography (3D-CTA), with no cortical venous reflex. The patient underwent conventional angiography, which showed multiple aneurysms on a small branch of the AICA, feeding a transverse-sigmoid dAVF (Borden type I). The AICA aneurysms seemed flow dependent and ruptured owing to high-flow arteriovenous shunts through the dAVF. Based on the source images of the MRA, the small artery arising from the AICA was considered the subarcuate artery, and it was confirmed on 3D-CTA after the artery was successfully embolized with Onyx without any complications. Multiple aneurysms on the subarcuate artery are extremely rare, and the artery has not been identified as a feeding artery of the transverse-sigmoid dAVF. Conclusion A rare case of multiple ruptured aneurysms on the subarcuate artery was reported in a patient with a Borden type I dAVF at the transverse-sigmoid sinuses manifesting as subarachnoid hemorrhage. Onyx embolization of the parent artery occlusion was feasible and useful in treating this type of feeding artery aneurysm of the AICA with a dAVF.

Arteriovenous Malformation Associated with Multiple Aneurysms in the Posterior Fossa: A Case Report with a Review of the Literature

Neurosurgery ◽  
1987 ◽  
Vol 21 (3) ◽  
pp. 387-391 ◽  
Author(s):  
J. Noterman ◽  
P. Georges ◽  
J. Brotchi
Keyword(s):  
Case Report ◽  
Subarachnoid Hemorrhage ◽  
Arteriovenous Malformation ◽  
Posterior Fossa ◽  
The Other ◽  
Review Of The Literature ◽  
Multiple Aneurysms ◽  
One Stage ◽  
Cerebellar Artery

Abstract The association of two aneurysms on the distal posteroinferior cerebellar artery with an arteriovenous malformation fed by the same artery is reported. A one-stage operation was performed. The other cases in the literature are analyzed with particular regard to the origin of the subarachnoid hemorrhage and the location of the aneurysms.

Acute Spontaneous Thrombosis and Recanalization of a Ruptured Aneurysm With Subarachnoid Hemorrhage

2012 ◽  
Vol 22 (4) ◽  
pp. 249-252
Author(s):  
Makoto Goda ◽  
Takeshi Kubo ◽  
Akira Yamada ◽  
Tsuyoshi Shimomura ◽  
Eiji Abe ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Ruptured Aneurysm ◽  
Spontaneous Thrombosis

Aneurysmal Rupture without Subarachnoid Hemorrhage: Case Series and Literature Review

Neurosurgery ◽  
2005 ◽  
Vol 57 (2) ◽  
pp. 225-229 ◽  
Author(s):  
Quoc-Anh Thai ◽  
Shaan M. Raza ◽  
Gustavo Pradilla ◽  
Rafael J. Tamargo
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cerebral Artery ◽  
Case Series ◽  
Ct Imaging ◽  
Ruptured Aneurysm ◽  
Subdural Hemorrhage ◽  
Aneurysmal Rupture ◽  
Computed Tomographic ◽  
Ruptured Aneurysms ◽  
Medical Institutions

ABSTRACT OBJECTIVE: Although an aneurysmal rupture typically presents on computed tomographic (CT) imaging as only subarachnoid hemorrhage (SAH), it may be associated with intraparenchymal hemorrhage (IPH), intraventricular hemorrhage (IVH), or subdural hemorrhage. On rare occasions, however, an aneurysmal rupture may present with IPH or IVH without SAH. METHODS: The Division of Cerebrovascular Neurosurgery at The Johns Hopkins Medical Institutions maintains a prospective database of all patients treated for intracranial aneurysms at this institution since 1991. Using this database, we identified patients with ruptured aneurysms who presented with IPH or IVH in the absence of SAH on CT imaging. RESULTS: Eight hundred twenty-two patients with radiographically documented ruptured aneurysms were admitted from January 1991 through June 2004. Of these, nine patients presented with IPH only, three with IPH and IVH, and one with IVH only, for a total of 13 cases. There were seven posterior communicating artery, four middle cerebral artery, one basilar apex, and one posterior cerebral artery aneurysms. The incidence of aneurysmal rupture with IPH and/or IVH without SAH is 1.6% CONCLUSION: Initial presentation of a ruptured aneurysm without SAH is rare and may have a multifactorial cause attributable to the timing of CT imaging, physiological parameters, or location of the aneurysm. Patients presenting with a head CT scan revealing IPH in the temporal lobe or with IVH should be considered for an urgent workup of a ruptured aneurysm, even in the absence of diffuse SAH.

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