1/127. Surgical treatment of internal carotid artery anterior wall aneurysm with extravasation during angiography--case report.A 54-year-old female presented subarachnoid hemorrhage from an aneurysm arising from the anterior (dorsal) wall of the internal carotid artery (ICA). During four-vessel angiography, an extravasated saccular pooling of contrast medium emerged in the suprasellar area unrelated to any arterial branch. The saccular pooling was visualized in the arterial phase and cleared in the venophase during every contrast medium injection. We suspected that the extravasated pooling was surrounded by hard clot but communicated with the artery. Direct surgery was performed but major premature bleeding occurred during the microsurgical procedure. After temporary clipping, an opening of the anterior (dorsal) wall of the ICA was found without apparent aneurysm wall. The vessel wall was sutured with nylon thread. The total occlusion time of the ICA was about 50 minutes. Follow-up angiography demonstrated good patency of the ICA. About 2 years after the operation, the patient was able to walk with a stick and to communicate freely through speech, although left hemiparesis and left homonymous hemianopsia persisted. The outcome suggests our treatment strategy was not optimal, but suture of the ICA wall is one of the therapeutic choices when premature rupture occurs in the operation.- - - - - - - - - - ranking = 1keywords = subarachnoid (Clic here for more details about this article) |
2/127. De novo formation of familial cerebral aneurysms: case report.OBJECTIVES: The factors regulating the formation and growth of cerebral aneurysms are poorly understood. We report the case of a patient whose grandfather had a cerebral aneurysm and who developed numerous de novo aneurysms of varying size 9 years after the treatment of a first aneurysm. This observation sheds light on the cause and growth of cerebral aneurysms in familial cases that may be pertinent to sporadic cases. CLINICAL PRESENTATION: A 58-year-old man was admitted to the Montreal Neurological Institute in 1956 for an ultimately fatal, autopsy-proven, ruptured internal carotid artery aneurysm. His granddaughter was first admitted to the same institution in 1984 after suffering a subarachnoid hemorrhage from a ruptured right terminal internal carotid artery aneurysm that was successfully treated. Four-vessel cerebral angiography did not reveal other aneurysms. The granddaughter was readmitted to the hospital 9 years later after a new, lumbar puncture-proven subarachnoid hemorrhage occurred. cerebral angiography demonstrated that the previously clipped aneurysm did not fill. However, five new aneurysms were present. INTERVENTION: An anterior communicating artery aneurysm, thought to be the one that bled, was surgically clipped, and a large right posterior communicating artery aneurysm was coiled endovascularly. The remaining, smaller aneurysms were left untreated. CONCLUSION: The appearance of five new aneurysms during a 9-year interval suggests that there may be a genetic factor operating in the development of cerebral aneurysms in families and that this may produce a more widespread cerebral arteriopathy than is generally appreciated. patients with treated cerebral aneurysms from families in which two or more individuals have cerebral aneurysms, and perhaps their first and second degree relatives who have had negative angiograms, should be considered for periodic follow-up cerebrovascular imaging to rule out the subsequent development of de novo aneurysms.- - - - - - - - - - ranking = 2keywords = subarachnoid (Clic here for more details about this article) |
3/127. Carotid ligation for carotid aneurysms.Thirty patients with subarachnoid haemorrhage due to rupture of a carotid aneurysm were treated by ligation of the common carotid artery. Two patients died as a result of the procedure, two patients developed persisting hemisphere deficit. Eight of the ten patients who developed cerebral ischemia after the operation were operated within ten days after the bleeding. At present out aim is to guide the patient safely through the first ten days after his haemorrhage and perform ligation at the end of the second week. After a follow up period of 1-8 years recurrent haemorrhage did not occur. Common carotid ligation, preferably with control of carotid artery end pressure, cerebral blood-flow and EEG is considered to be a valuable method to treat ruptured intracranial carotid aneurysm.- - - - - - - - - - ranking = 6.0819095655987keywords = subarachnoid haemorrhage, subarachnoid, haemorrhage (Clic here for more details about this article) |
4/127. Simultaneous subarachnoid hemorrhage and carotid cavernous fistula after rupture of a paraclinoid aneurysm during balloon-assisted coil embolization.We describe an iatrogenic perforation of a paraclinoid aneurysm during balloon-assisted coil embolization that resulted in simultaneous subarachnoid contrast extravasation and a carotid cavernous fistula. The causative factors specifically related to the balloon-assisted method that led to aneurysm rupture are discussed as well as strategies for dealing with this complication.- - - - - - - - - - ranking = 5keywords = subarachnoid (Clic here for more details about this article) |
5/127. Distal internal carotid artery pseudoaneurysms: technique and pitfalls of surgical management: two technical case reports.OBJECTIVE AND IMPORTANCE: Small, irregular aneurysms of the internal carotid artery (ICA) that are not related to arterial divisions are rare and have characteristics similar to pseudoaneurysms: they do not appear to have well-formed sacs, they are surrounded by clot, and they avulse readily. We report two patients whose treatment demonstrates the surgical technique and important points concerning the management of distal ICA pseudoaneurysms. CLINICAL PRESENTATION: Both patients presented with diffuse subarachnoid hemorrhage. The initial angiographic results were unremarkable in each case. A week after presentation, however, a growing outpouching in the distal ICA was seen. INTERVENTION: At surgery, the aneurysms were found to be on the medial wall of the ICA and were not related to arterial divisions. Quantitative blood flow measurements of the efferent vessels at risk (ICA, M1 and A1 segments) were obtained using a perivascular microflowprobe before and after clipping. In each patient, the aneurysm avulsed entirely during clip application, despite careful placement of the clip parallel to the parent vessel. An encircling clip was then used. Pathological sectioning of the aneurysms revealed loose connective tissue and/or clot with no defined aneurysmal sac. CONCLUSION: Aneurysms of the distal ICA that are not related to arterial divisions are difficult to visualize on angiograms immediately after subarachnoid hemorrhage. They are frail, avulse easily, and may be pseudoaneurysms, necessitating the use of encircling clips. The base of the aneurysm or clot must be trimmed to prevent it from buckling inside the clip sleeve and compromising the ICA lumen. Measuring distal blood flow quantitatively provides valuable information about the patency of the ICA inside the metallic sleeve, since this segment cannot be demonstrated with angiography.- - - - - - - - - - ranking = 2keywords = subarachnoid (Clic here for more details about this article) |
6/127. Tracheocarotid artery fistula infected with methicillin-resistant staphylococcus aureus.Massive life-threatening haemorrhage from a fistula between the trachea and a major blood vessel of the neck is a rare complication of the tracheostomy procedure, well-recognized by anaesthetists and otolaryngologists. Although the lesion is likely to be encountered at autopsy, it is not described in histopathological literature. The possible causes are discussed together with the macroscopic and microscopic appearances of the lesion. Suitable procedures for its identification and for obtaining appropriate histopathological blocks are suggested. Presence of methicillin-resistant staphylococcus aureus (MRSA) has not been documented before and might have contributed to the genesis of the fistula in this case.- - - - - - - - - - ranking = 0.19981021186006keywords = haemorrhage (Clic here for more details about this article) |
7/127. Dural waisting as a sign of subarachnoid extension of cavernous carotid aneurysms: a follow-up case report.OBJECTIVE: Even when augmented by CT and MRI, it can be difficult on angiography to predict which intracavernous carotid artery aneurysms (ICCAA) have subarachnoid extension and therefore pose a higher risk of subarachnoid hemorrhage. Previously we reported a case of an ICCAA, which on angiogram had a focal tapering of the dome that we termed a "waist." At surgery this lesion was found to have subarachnoid extension. We postulated that this dural "waisting" on the arteriogram was a predictor of subarachnoid extension. Herein we report a second case of an ICCAA with the angiographic appearance of a waist that was also confirmed to have subarachnoid extension at surgery, thereby strengthening our original hypothesis. CLINICAL PRESENTATION: A 40-year-old woman presented with a 3-month history of bitemporal headache, diplopia, and a left sixth nerve palsy. MRI showed a lesion in the vicinity of the left cavernous carotid sinus and an arteriogram confirmed the presence of a large cavernous carotid aneurysm. As in the previous case, the aneurysm fundus was indented, creating a waist on the aneurysm dome. INTERVENTION: After passing a trial balloon occlusion of the involved carotid artery, the patient was brought to the operating room for lesion trapping. The aneurysm fundus was seen to extend beyond the falciform ligament and with subsequent dissection, the neck of the aneurysm was seen to incorporate the carotid artery distal to the ophthalmic artery. The aneurysm was trapped by ligating the internal carotid artery in the neck and by placing a clip on the intracranial carotid proximal to the posterior communicating artery. CONCLUSION: The presence of subarachnoid extension of an ICCAA can be difficult to elucidate on an arteriogram. This is an additional case in which a focal narrowing or "waisting" of the aneurysm dome seen on an angiogram served as a marker of subarachnoid extension.- - - - - - - - - - ranking = 11keywords = subarachnoid (Clic here for more details about this article) |
8/127. Cerebral aneurysm associated with an anomalous hyperplastic anterior choroidal artery.An unruptured internal carotid artery (ICA) aneurysm arising at the origin of a hyperplastic anomalous AchoA was identified together with a second unruptured middle cerebral artery aneurysm during angiography performed to investigate a striatal and intraventricular haemorrhage in a 55-years-old woman. The anomalous hyperplastic AchoA supplied the left temporal and occipital lobes, and the aneurysm arose proximal to its origin. The patient underwent clipping of the aneurysms, and intra-operative observation revealed that several perforating branches arose directly from the ICA between the AchoA and the ICA bifurcation.- - - - - - - - - - ranking = 0.19981021186006keywords = haemorrhage (Clic here for more details about this article) |
9/127. Transient cardiac standstill induced by adenosine in the management of intraoperative aneurysmal rupture: technical case report.OBJECTIVE AND IMPORTANCE: Intraoperative aneurysmal rupture represents a potentially catastrophic event. We describe the use of an intravenous adenosine bolus to induce transient cardiac asystole to control a severe intraoperative aneurysmal rupture. This treatment resulted in a brief period of severe hypotension, which enabled successful clipping of the aneurysm. CLINICAL PRESENTATION: A 55-year-old man was referred to our institution 7 days after experiencing a mild subarachnoid hemorrhage from a fusiform, multilobulated aneurysm of the anterior communicating artery. The patient was found to have multiple additional fusiform aneurysms as well as a large parietal arteriovenous malformation. INTERVENTION: A craniotomy was performed to clip the aneurysm, but surgical dissection was complicated by premature rebleeding that could not be controlled satisfactorily with tamponade or temporary arterial occlusion. Infusion of adenosine resulted in the rapid onset of profound hypotension, allowing for safe completion of the dissection and clipping of the aneurysm with a good outcome. There were no complications identified in relation to the use of adenosine. CONCLUSION: In the setting of severe intraoperative aneurysmal rupture, intravenous adenosine represents a potential means of achieving a near-immediate profound decrease in the blood pressure that may allow for safe completion of the dissection and aneurysm clipping.- - - - - - - - - - ranking = 1keywords = subarachnoid (Clic here for more details about this article) |
10/127. Sarcomatous transformation of a prolactinoma associated with development of a fatal internal carotid artery pseudoaneurysm--case report.A 21-year-old female with a 5-year history of prolactinoma was referred to our hospital because of cerebrospinal fluid leakage and meningitis immediately following a third transsphenoidal operation for a rapidly growing tumor. Histological examination of the tumor removed at the second transsphenoidal operation found atypical epithelial and sarcomatous components. Administration of bromocriptine, radiotherapy, and chemotherapy were initiated. Emergent craniotomy was required for rapid regrowth of the tumor. Histological examination found predominant sarcomatous components. Tumor growth was difficult to control. The patient died of subarachnoid hemorrhage due to rupture of a pseudoaneurysm involving the C1 portion of the right internal carotid artery. Pituitary adenoma rarely shows malignant transformation. In this case, prolactinoma underwent malignant change to sarcoma. Development of the pseudoaneurysm may have resulted from surgical manipulation, radiotherapy, or tumor invasion.- - - - - - - - - - ranking = 1keywords = subarachnoid (Clic here for more details about this article) |
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