1/301. Large and giant middle to lower basilar trunk aneurysms treated by surgical and interventional neuroradiological methods.Treatment of large and giant aneurysms of the basilar artery remains difficult and controversial. Three large or giant aneurysms of the lower basilar artery were treated with a combination of surgical and interventional neuroradiological procedures. All patients underwent the balloon occlusion test with hypotensive challenge (blood pressure reduced to 70% of the control value). The third patient did not tolerate the test. In the first patient, both vertebral arteries were occluded through a craniotomy. In the second patient, both the aneurysm and the basilar artery were occluded by detached balloons. In the third patient, one vertebral artery was occluded by surgical clipping and the other by detached helical coils and fiber coils. In spite of anti-coagulation and anti-platelet therapy, postoperative thrombotic or embolic ischemia occurred in the second and third patients. Fibrinolytic therapy promptly corrected the ischemic symptoms, but the second patient developed hemorrhagic complications at the craniotomy area 2 hours later. At follow-up examination, the first patient had only 8th cranial nerve paresis, the second patient who had a hemorrhagic complication was bed-ridden, and the third patient had no deficit. Interventional occlusion requires a longer segment of the parent artery compared to surgical occlusion of the parent artery and might cause occlusion of the perforating arteries. However, selected use of various coils can occlude only a short segment of the parent artery. Thus, the postoperative management of thromboembolic ischemia after the occlusion of the parent artery is easier using the interventional technique.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
2/301. Compression of the visual pathway by anterior cerebral artery aneurysm.Visual failure is an uncommon presenting symptom of an intracranial aneurysm. It is even more uncommon in aneurysms arising from the anterior cerebral artery (ACA). We presented 2 patients with an aneurysm of the A1 segment of the anterior cerebral artery causing visual field defects. One patient presented with a complete homonymous hemianopia due to compression of the optic tract by a giant aneurysm of the proximal left A1 segment. The second patient had an almost complete unilateral anopia caused by compression of the optic nerve and chiasm by an aneurysm of the distal part of the A1 segment with a small chiasmatic hemorrhage and ventricular rupture.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
3/301. Intrameatal aneurysm successfully treated by meatal loop trapping--case report.A 77-year-old female presented with a rare intrameatal aneurysm manifesting as sudden onset of headache, hearing loss, tinnitus, and vertigo associated with subarachnoid hemorrhage. Meatal loop trapping was performed. After surgery, the patient's functions recovered almost completely, probably because of the preservation of the 7th and 8th cranial nerves and the presence of effective collaterals in the area supplied by the anterior inferior cerebellar artery.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
4/301. Does the tuberous sclerosis complex include intracranial aneurysms? A case report with a review of the literature.BACKGROUND: tuberous sclerosis is a protean, genetically determined disease that may involve any organ or tissue and lead to a great number of symptoms and clinical features. OBJECTIVE: diagnosis can be very difficult in cases with incomplete manifestations (formes fruste) lacking the classic signs of the disease. MATERIALS AND methods: We report a case fulfilling the diagnostic criteria for tuberous sclerosis (shagreen patches, hypomelanotic macules, renal cysts and angiomyolipomas, and "migration tracts" in the cerebral white matter) in association with a giant intracranial aneurysm, but lacking mental retardation, epilepsy and facial angiofibroma. RESULTS: Fourteen other cases of tuberous sclerosis and intracranial aneurysms, all but one without any clear sign of polycystic kidney disease, were found in the literature. CONCLUSION: We suggest that vascular dysplasias in general and aneurysms (mainly intracranial) in particular can be added to the other non-primary diagnostic features for the clinical diagnosis of tuberous sclerosis.- - - - - - - - - - ranking = 0.0013503328651061keywords = organ (Clic here for more details about this article) |
5/301. Resolution of third nerve paresis after endovascular management of aneurysms of the posterior communicating artery.The effect of endovascular treatment on the recovery of neural function in patients with third nerve palsy caused by an aneurysm of the posterior communicating artery is poorly documented. We report three cases in which third nerve paresis resolved completely within 2 to 3 weeks of endovascular occlusion of a posterior communicating artery aneurysm.- - - - - - - - - - ranking = 6keywords = nerve (Clic here for more details about this article) |
6/301. Long-term outcome of surgical treatment of intracavernous giant aneurysms.A number of approaches have been proposed for the treatment of intracavernous giant aneurysms. In the present study, we have analyzed long-term surgical outcome of 27 consecutive cases of our experience. All the cases were unruptured and symptomatic, showing symptoms such as extraocular movement disorder or visual disturbances. Thirteen cases were male and 14 cases were female. The age of the patients ranged between 11 and 75 years (average 52.2 years) and follow-up periods were between 1 and 20 years (average 7.7 years). abducens nerve was distributed in 20 cases, oculomotor nerve in 12 cases, optic nerve in six cases, trigeminal nerve in six cases, and trochlear nerve in five cases. In addition to conventional angiography, three-dimensional computed tomographic angiography, balloon test occlusion (BTO), slow injection angiography, aneurysmography, and single photon emission computed tomography with BTO were used to determine a method of treatment. Therapeutic modalities of the present series were as follows: four cases were unoperated, common carotid artery ligation was performed in eight cases, internal carotid artery (IC) ligation in three cases, IC ligation plus superficial temporal artery (STA)--middle cerebral artery (MCA) anastomosis in four cases, IC ligation plus high flow vein bypass in three cases, IC trapping plus STA-MCA anastomosis in three cases, and direct clipping in two cases. Although two cases showed early and late ischemic complications, other cases demonstrated improvement of cranial nerve dysfunction relatively soon after surgical treatment and long-term outcome was generally good. It is concluded that good long-term surgical outcome is obtained for intracavernous giant aneurysms by selecting adequate surgical treatment based upon careful preoperative evaluation of these aneurysms using sophisticated diagnostic methods.- - - - - - - - - - ranking = 6keywords = nerve (Clic here for more details about this article) |
7/301. Direct surgery of basilar trunk and vertebrobasilar junction aneurysms via the combined transpetrosal approach.Surgical access to aneurysms of the basilar trunk and vertebrobasilar junction is hampered by their direct proximity of these lesions to highly vulnerable neural structures like the brain stem and cranial nerves, as well by the bony structure of the petrous bone blocking the direct surgical approach to these aneurysms. Only recently lateral approaches directed through parts of the petrous bone have been reported for surgery of basilar trunk and vertebrobasilar junction aneurysms like the anterior transpetrosal, the retrolabyrinthine transsigmoid, as well as the combined supra-infratentorial posterior transpetrosal approach. As experience in the use of this approach is limited in the neurosurgical literature we present our surgical experiences in 11 patients with basilar trunk and vertebrobasilar junction aneurysms, operated on using the supra-infratentorial posterior transpetrosal approach. In 10 patients, including one patient with a giant partially thrombosed basilar trunk aneurysm, direct clipping of the aneurysm via the transpetrosal route was possible. In one patient with a giant vertebrobasilar junction aneurysm, the completely calcified aneurysm sac was resected after occlusion of the vertebral artery. Of the whole series, one patient died and in three patients postoperative accentuation of preexisting cranial nerve deficits occurred. Except transient cerebrospinal fluid leak in two patients, the postoperative course was uneventful in the remaining patients. Postoperative angiography demonstrated complete aneurysm clipping in ten patients and relief of preoperative brain stem compression in the patient with the giant vertebrobasilar junction aneurysm. It is concluded, that the supra-infratentorial posterior transpetrosal approach allows excellent access to the basilar artery trunk and vertebrobasilar junction and can be considered the approach of choice to selected aneurysms located in this area.- - - - - - - - - - ranking = 2keywords = nerve (Clic here for more details about this article) |
8/301. Tissue response of a small saccular aneurysm after incomplete occlusion with a Guglielmi detachable coil.A 49-year-old woman had a small saccular aneurysm that was incompletely occluded with a Guglielmi detachable coil (GDC). She died from rupture of another aneurysm 42 days after the treatment. autopsy for the embolized aneurysm revealed no neoendothelium at the aneurysmal neck, but an organized thrombus was observed limited to the periphery of the aneurysmal lumen. Although isolation of the aneurysm was not apparent, loose embolization with this method may help to reinforce the aneurysmal wall.- - - - - - - - - - ranking = 0.0013503328651061keywords = organ (Clic here for more details about this article) |
9/301. A case of ocular neuromyotonia with tonic pupil.A 48-year old woman with hypertension experienced painful oculomotor nerve palsy. After surgery for a giant aneurysm of the internal carotid artery in the cavernous sinus, phasic constrictions of the pupil developed. Two years later, this phenomenon disappeared and was replaced by intermittent involuntary cyclic spasms elevating the ptosed lid. These cyclic lid movements were not elicited with any eye movement or by increased accommodation. The pupil now manifested the pharmacologic features of a tonic pupil. The explanation for this unique case of ocular neuromyotonia is based on a misdirection phenomenon, possibly caused by ephaptic transmission.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
10/301. Aggravation of brainstem symptoms caused by a large superior cerebellar artery aneurysm after embolization by Guglielmi detachable coils--case report.An 81-year-old male presented with right oculomotor nerve paresis and left hemiparesis caused by a mass effect of a large superior cerebellar artery aneurysm. Endovascular treatment was performed using Guglielmi detachable coils. The patient subsequently suffered aggravation of the mass effect 3 weeks after the embolization. Bilateral vertebral artery occlusion was performed, which decreased the cerebral edema surrounding the aneurysm, but his neurological symptoms did not improve. Parent artery occlusion is recommended as the first choice of treatment for an unclippable large or giant aneurysm causing a mass effect on the brainstem.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
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