1/956. Giant fusiform aneurysm of the middle cerebral artery: successful Hunterian ligation without distal bypass.Giant fusiform aneurysm is a rare vascular lesion which presents difficult management issues. We describe one such aneurysm in a middle cerebral artery branch (M2) that presented with subarachnoid haemorrhage and was managed operatively. Clinical, radiological and pathological presentations, as well as the different treatment options for this type of aneurysm are discussed based on a literature review. A satisfactory results in an M2 giant fusiform aneurysm can be achieved with Hunterian ligation of the parent vessel even when a distal EC-IC bypass is not possible.- - - - - - - - - - ranking = 1keywords = subarachnoid haemorrhage, subarachnoid, haemorrhage (Clic here for more details about this article) |
2/956. Intra-arterial infusion of fasudil hydrochloride for treating vasospasm following subarachnoid haemorrhage.In this pilot study we treated cerebral vasospasm in patients with subarachnoid haemorrhage to assess intra-arterial fasudil hydrochloride. We analysed effects of intra-arterial infusion on angiographically evident cerebral vasospasm in 10 patients including 3 with symptoms of vasospasm. Over 10 to 30 min 15 to 60 mg was administered via the proximal internal carotid artery or vertebral artery following standard angiography, without superselective techniques. A total of 24 arterial territories (21 internal carotid, 3 vertebral) were treated. Angiographic improvement of vasospasm was demonstrated in 16 arterial territories (local dilation in 2, diffuse dilation in 14) in 9 patients. In 2 symptomatic patients, intra-arterial fasudil hydrochloride was associated with resolution of symptoms without sequelae. In the third symptomatic patient the benefit of fasudil hydrochloride was only temporary, and a large cerebral infarction occurred. All asymptomatic patients showed no progression of angiographic to symptomatic vasospasm after treatment with intra-arterial fasudil hydrochloride. No adverse effect was encountered.- - - - - - - - - - ranking = 5keywords = subarachnoid haemorrhage, subarachnoid, haemorrhage (Clic here for more details about this article) |
3/956. Clinical evaluation of the effect of percutaneous transluminal angioplasty and intra-arterial papaverine infusion for the treatment of vasospasm following aneurysmal subarachnoid hemorrhage.The clinical efficacy of percutaneous transluminal angioplasty and intra-arterial papaverine infusion for treatment of vasospasm following subarachnoid hemorrhage was investigated. Between 1990 and 1993, 84 patients were treated for cerebral vasospasm in National Defense Medical College Hospital. angioplasty was performed for asymptomatic vasospasm in 18 patients and for symptomatic vasospasm in 12 patients. Intra-arterial papaverine infusion was performed for asymptomatic vasospasm in 10 patients and for symptomatic vasospasm in four patients. The other 40 patients were treated with standard conservative therapy including hypervolemic and hypertensive hemodilution. The outcomes of these patients were analyzed using the glasgow outcome scale. The outcome tended to be better for patients treated with angioplasty, but not for those treated with papaverine infusion, than for those treated conservatively. recurrence of vasospasm was more frequent after papaverine infusion than after angioplasty. Undesirable complications such as abrupt development of unconsciousness were experienced during papaverine infusion but not during angioplasty. We conclude that percutaneous transluminal angioplasty is superior to intra-arterial papaverine infusion for prevention and treatment of vasospasm following aneurysmal subarachnoid hemorrhage.- - - - - - - - - - ranking = 0.99641907313862keywords = subarachnoid (Clic here for more details about this article) |
4/956. Subtemporal suboccipital transpetrosal transsigmoidal approach to aneurysm of the basilar artery fenestration.The aneurysm arising from the lower third of a basilar artery fenestration is a rare event. The traditional suboccipital or subtentorial transtentorial or transoral approach to this vascular malformation can be problematic. We report the case of a 52-year-old woman who suffered a Grade 4 subarachnoid hemorrhage from an aneurysm located at a fenestration of the proximal third of the basilar artery. This aneurysm was successfully clipped through a left subtemporal suboccipital translabyrinthine transsigmoidal approach. In the aneurysms of the proximal third of the basilar artery the transpetrosal approach with its variants (translabyrinthine and transsigmoidal) related to patient's clinical condition can be useful with undoubted advantages.- - - - - - - - - - ranking = 0.1660698455231keywords = subarachnoid (Clic here for more details about this article) |
5/956. Ruptured aneurysm of the orbitofrontal artery associated with dural arteriovenous malformation in the anterior cranial fossa--case report.A 27-year-old male presented with a rare association of a ruptured orbitofrontal artery aneurysm and a dural arteriovenous malformation (DAVM) fed by both ethmoidal arteries, manifestation as severe headache, nausea, and vomiting. Computed tomography revealed a hematoma within the right frontal lobe and diffuse subarachnoid hemorrhage. The aneurysm was clipped successfully and the hematoma was evacuated. After an uneventful postoperative course, the patient was referred for gamma knife radiosurgery to treat the DAVM. In this case, the DAVM was asymptomatic and pathogenetically unrelated to the aneurysm, which demanded urgent treatment.- - - - - - - - - - ranking = 0.1660698455231keywords = subarachnoid (Clic here for more details about this article) |
6/956. 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 = 0.1660698455231keywords = subarachnoid (Clic here for more details about this article) |
7/956. 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 = 0.33213969104621keywords = subarachnoid (Clic here for more details about this article) |
8/956. Intraoperative use of nitric oxide during intracranial aneurysm clipping in a patient with acute respiratory distress syndrome.We describe a case of subarachnoid hemorrhage (SAH) complicated by acute respiratory distress syndrome (ARDS) and cerebral vasospasm. Inhaled nitric oxide (NO) was used to improve oxygenation, thereby facilitating cerebral aneurysm clipping.- - - - - - - - - - ranking = 0.1660698455231keywords = subarachnoid (Clic here for more details about this article) |
9/956. Nonaneurysmal thunderclap headache with diffuse, multifocal, segmental, and reversible vasospasm.OBJECTIVE: To highlight the clinical profiles and angiographic findings of two patients with recurrent thunderclap headache (TCH) without subarachnoid hemorrhage (SAH) and to present modified diagnostic criteria for this unusual syndrome. BACKGROUND: TCH may be a benign recurrent headache disorder or it may represent a serious underlying process such as SAH or venous sinus thrombosis. The pathophysiology of this disorder in the absence of underlying pathology is not well understood and its potential angiographic features are not well appreciated. methods: Two case descriptions with illustrative angiography. RESULTS: Both cases demonstrated the potential for reversible intracranial vasospasm without intracranial aneurysm or SAH and a benign clinical outcome. CONCLUSIONS: Primary TCH has a distinctive clinical and angiographic profile and must be distinguished from central nervous system vasculitis and SAH.- - - - - - - - - - ranking = 0.1660698455231keywords = subarachnoid (Clic here for more details about this article) |
10/956. Coiling of recurrent and residual cerebral aneurysms after unsuccessful clipping.We treated four patients with 3 recurrent and 1 residual aneurysm after surgical clipping by using Guglielmi detachable coils (GDCs). Three subjects presented after a second subarachnoid hemorrhage (SAH) occurring between 10 and 25 years after the first bleeding. Early postoperative angiography of the fourth patient showed an incompletely clipped aneurysm. In three poor grade patients we observed one good outcome, one fair result and one death due to the sequelae of SAH. One good grade patient remained in excellent condition postoperatively. Three aneurysms were totally occluded and in one a more than 90% occlusion was achieved with GDCs. We consider the treatment with GDC a viable alternative to reoperation in all patients with recurrent or residual aneurysms following failed attempt at surgical obliteration.- - - - - - - - - - ranking = 0.1660698455231keywords = subarachnoid (Clic here for more details about this article) |
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