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cerebral dissecting aneurysm

Virendra R Desai, Alejandro L Rosas, Gavin W Britz
Cerebral aneurysms have a high mortality rate when ruptured. Endovascular techniques have improved substantially in treating this pathology. However, surgical clip ligation remains the preferred option for some aneurysms. Various techniques are used intraoperatively to assist the surgeon in dissecting the aneurysmal dome free of surrounding tissue and placing a clip around the neck safely and effectively so that no nearby perforating vessels are affected and no residual remains. These techniques include temporary clip ligation, endovascular balloon occlusion and cardiac standstill...
December 2017: Stroke and Vascular Neurology
Tomohiko Ozaki, Takeo Nishida, Yuya Fujita, Haruhiko Kishima, Manabu Kinoshita
Ruptured dissecting aneurysms located at the middle cerebral artery (MCA) are rare, and its standard treatment has not been defined. Furthermore, lenticulostriate artery involvement in the dissecting segment makes the treatment extremely difficult, and no previous reports have described successful treatment for such conditions. We herein report the case of a 74-year-old woman who presented with sudden severe headache from subarachnoid hemorrhage due to dissection in the proximal M1 segment of left MCA involving LSA...
February 27, 2018: World Neurosurgery
Jong Young Lee, Jong-Hwa Park, Hong Jun Jeon, Dae Young Yoon, Seoung Woo Park, Byung Moon Cho
PURPOSE: A complicated course of the femoral route for neurointervention can prevent approaching the target. Thus, we determined whether transcervical access in the hybrid angiosuite is applicable and beneficial in real practice. METHODS: From January 2014 to March 2017, this approach was used in 17 of 453 (3.75%) cases: 11 cerebral aneurysms (4 ruptured, 7 unruptured), 4 acute occlusions of the large cerebral artery, 1 proximal internal carotid artery (ICA) stenosis, and 1 direct carotid cavernous fistula (CCF)...
March 1, 2018: Neuroradiology
Raluca Pascalau, Vlad Adrian Padurean, Dana BARTOș, Adrian BARTOș, Bianca Aurora Szabo
AIM: Anatomical variants of the circle of Willis are diverse and frequent and, although they are not a direct cause of cerebrovascular diseases, they are risk factors for impaired collateral perfusion and wall shear stress. This study aimed to correlate the anatomical variants with their effects on the hemodynamic and geometrical parameters responsible for the pathogenesis of neurological diseases. MATERIAL AND METHODS: The circle of Willis and the proximal segments of the main arteries were dissected and measured on ten formalin-fixed human brains...
February 7, 2018: Turkish Neurosurgery
Takashi Matsueda, Yuki Ikeno, Koki Yokawa, Yojiro Koda, Soichiro Henmi, Takeshi Inoue, Hiroshi Tanaka, Yutaka Okita
OBJECTIVES: We present our experience with one-stage replacement of thoracic aneurysm from the ascending aorta to the thoracoabdominal aorta. PATIENTS AND METHODS: Fourteen patients (10 male and 4 female; mean age 53.6 ± 12.4 years) with extended thoracic aortic aneurysms underwent graft replacement. The pathology of the diseased aorta was chronic aortic dissection in 13 patients and intraoperative retrograde aortic dissection in 1 patient. Five patients had Marfan syndrome...
February 2018: Journal of Thoracic and Cardiovascular Surgery
Sivashanmugam Dhandapani, Sushant Kumar Sahoo
BACKGROUND: Minimally invasive approach to distal anterior cerebral artery (DACA) aneurysms could not gain much acceptance due to the difficulties associated with conventional frontal paramedian approach. The more proximal basal interhemispheric approach however necessitated extensive dissection of soft tissues. We describe a minimally invasive median supraorbital keyhole craniotomy with basal interhemispheric approach for clipping a ruptured DACA aneurysm. METHODS: A 62-year-old patient presented with subarachnoid hemorrhage...
February 1, 2018: World Neurosurgery
Shigeru Oya, Issei Kiko, Kenichiro Suyama, Takanori Suzuki, Kuniatsu Yamamoto, Hidetoshi Mochida, Saburo Watanabe, Hideharu Karasawa
We report the case of a ruptured dissecting aneurysm in an infant. A 2-year-old boy suffered sudden headache and nausea. CT scan revealed a subarachnoid hemorrhage, and digital subtraction angiography(DSA)revealed a dissecting aneurysm(3.9mm)at a branch of the right middle cerebral artery(MCA). Eight days after onset, carotid angiography revealed enlargement of the aneurysm(up to 6.8 mm). Right frontotemporal craniotomy and aneurysm trapping with STA-MCA bypass was performed. Two years and two months later, the aneurysm recurred as assessed by magnetic resonance angiography(MRA)...
January 2018: No Shinkei Geka. Neurological Surgery
Puyuan Zhao, Deyuan Zhu, Wanling Wen, Yu Zhou, Yibin Fang, Qiang Li, Rui Zhao, Bo Hong, Yi Xu, Jianmin Liu, Qinghai Huang
OBJECTIVES: This study sought to evaluate the safety and efficacy of endovascular treatment of middle cerebral artery dissecting aneurysms(MCADAs). METHOD: Fourteen patients with MCADAs received endovascular treatment between July 2009 and April 2016. MCADAs were identified by virtue of their unique radiographic features on cerebral angiography. Baseline characteristics, angiographic features, angiographic and clinical outcomes were analyzed retrospectively. RESULTS: All fourteen MCADAs (including 6 ruptured and 8 unruptured) were successfully treated with the endovascular approach...
January 16, 2018: World Neurosurgery
Ryohei Matsuura, Yasushi Tsutsumi, Osamu Monta, Hisazumi Uenaka, Kenji Tanaka, Takaaki Samura, Hirokazu Ohashi
BACKGROUND: The long-term effects of some surgical treatment procedures of arch replacement for aortic dissection or aortic aneurysm are unknown. CASE PRESENTATION: The present study reports the case of a 68-year-old man admitted to our hospital for aortic arch anastomotic pseudoaneurysm with concomitant aortic root enlargement and coronary artery stenosis. Eleven years ago, at the age of 56 years, he underwent total arch replacement with island reconstruction for chronic aortic dissection...
January 15, 2018: Journal of Cardiothoracic Surgery
Imanda M E Alons, Ben F J Goudsmit, Korne Jellema, Marianne A A van Walderveen, Marieke J H Wermer, Ale Algra
BACKGROUND: Patients with acute severe headache, normal neurological examination, and a normal noncontrast head computed tomography (NCCT) may still have subarachnoid hemorrhage, cerebral venous thrombosis (CVT), cervical arterial dissection, or reversible cerebral vasoconstriction syndrome (RCVS). Computed tomography angiography (CTA) is used increasingly in the emergency department for evaluating this, but its added value remains controversial. METHODS: We retrospectively collected data on the diagnostic yield of CTA in patients with acute severe headache, normal neurological examination, and normal NCCT who received additional CTA in the acute phase in 2 secondary referral centers for vascular neurology...
December 23, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Gianfranco Filippone, Giovanni Caruana, Claudia Calia, Violetta Moscaritolo, Vincenzo Argano
INTRODUCTION: Aortic intramural hematoma (IMH) is described as "dissection without intimal tear" due to rupture of vasa vasorum, which results in bleeding within the tunica media in the absence of intimal disruption or blood flow communication. The aim of our study is to validate perioperative evidence of intimal entry tear in patients with IMH and to suggest that this entity may represent a part of a disease and not a separate disease. PRESENTATION OF CASES: We report two patients admitted to our institution with sudden onset thoracic pain...
December 12, 2017: International Journal of Surgery Case Reports
Yutaka Fukushima, Tomohiro Takaki, Shinichiro Yoshino, Katsuyuki Hirakawa, Tooru Inoue
A 71-year-old woman presented with a sudden onset of headache and vomiting. Computed tomography(CT)showed diffuse subarachnoid hemorrhage(SAH)that was more severe on the right side. Three-dimensional CT angiography and right carotid angiography(CAG)demonstrated 2-mm microaneurysms at the middle cerebral artery(MCA)bifurcation and anterior communicating artery, with slight narrowing and dilatation of the M2 inferior trunk. Each microaneurysm was smooth, making it difficult to identify the bleeding source. Thus, surgery was postponed at the acute stage, and further investigation was planned...
December 2017: No Shinkei Geka. Neurological Surgery
Hidetoshi Matsukawa, Hiroyasu Kamiyama, Takanori Miyazaki, Yu Kinoshita, Kosumo Noda, Nakao Ota, Norihiro Saito, Rihee Takeda, Sadahisa Tokuda, Rokuya Tanikawa
BACKGROUND: Anterior cerebral artery aneurysms (ACAs) are characterized by higher rupture rate and small size at rupture. It was revealed that the aneurysm-to-vessel size ratio, and not the absolute size, might predict the risk of rupture in small unruptured intracranial aneurysms.The present study aimed to investigate the relationship between a size ratio and outcome in patients with unruptured non-dissecting ACA aneurysms (UNDAs). METHODS: Consecutive 187 patients with 12 A1 (6...
December 16, 2017: World Neurosurgery
V V Shlomin, M L Gordeev, D A Zverev, E A Shloĭdo, V E Uspenskiĭ, E D Zvereva, P B Bondarenko, P D Puzdriak
The authors share herein their experience with hybrid surgical treatment of 21 patients presenting with lesions of the aortic arch and descending thoracic aorta. Aortic pathology included dissection of the thoracoabdominal aorta (n=15), a sacciform aneurysm of the aortic arch (n=5), and a spindle-shaped aneurysm of the distal portions of the aortic arch (n=1). The first stage consisted of the following operations: transposition of the left subclavian artery into the left common carotid artery (n=9; 42.8%), partial debranching (n=11; 52...
2017: Angiologii︠a︡ i Sosudistai︠a︡ Khirurgii︠a︡, Angiology and Vascular Surgery
Hiroyuki Toi, Nobuhisa Matsushita, Yukari Ogawa, Keita Kinoshita, Kohei Satoh, Hiroki Takai, Satoshi Hirai, Keijiro Hara, Shunji Matsubara, Masaaki Uno
Indocyanine green (ICG) emits fluorescence in the far-red domain under light excitation. ICG video angiography (ICG-VA) has been established as a useful method to evaluate blood flow in the operative field. We report the usefulness of ICG-VA for Sylvian fissure dissection in patients with subarachnoid hemorrhage (SAH). Subjects comprised 7 patients who underwent ICG-VA before opening the Sylvian fissure during neck clipping for ruptured cerebral aneurysm. We observed contrasted Sylvian veins before opening the Sylvian fissure using surgical microscopes...
February 15, 2018: Neurologia Medico-chirurgica
Kotaro Oshio, Tetsuya Ikeda, Takashi Matsumori, Daisuke Wakui, Hidemichi Ito, Hiroshi Takasuna, Yuichiro Tanaka
Pure fusiform aneurysms without dissection are considered to have a low risk of rupture. Furthermore, aneurysm wall with atherosclerotic change tends to be less susceptible to rupture. We present a rare case of multiple atherosclerotic fusiform aneurysms associated with repeated subarachnoid hemorrhage(SAH)during a 9-year observation period. A 34-year-old woman was admitted to our hospital because of SAH. SAH with a temporal hematoma due to a fusiform aneurysm of the right middle cerebral artery(MCA)was detected using computed tomography(CT)...
November 2017: No Shinkei Geka. Neurological Surgery
Giovanni Vitale, Giacomo Talenti, Joseph Gabrieli, Giacomo Cester, Alessandro Della Puppa, Francesco Causin
During aneurysm clipping, ischemic complications may occur and require a rescue treatment, usually surgical. We present two such cases that required urgent rescue treatment, performed through an endovascular route. Our first case presented with a non-ruptured right posterior inferior cerebellar artery (PICA) aneurysm. After permanent clip positioning, occlusion of the PICA occurred. An unsuccessful attempt of clip repositioning was performed. We therefore positioned a stent obtaining complete flow restoration...
November 16, 2017: BMJ Case Reports
Ihtesham A Qureshi, Gustavo J Rodriguez, Tatiana Chacon-Quesada, Gavito-Higuera Jose, Salvador Cruz-Flores, Alberto Maud
Background  There have been studies trying to characterize Fibromuscular Dysplasia (FMD); however, most of them are based in mainly non-Hispanic sample. The objective of this study is to better understand the epidemiology and clinical characteristics of craniocervical FMD in the Hispanic population. Methods  We retrospectively reviewed the cerebral angiograms performed in our center in a period of 3.5 years under any indication looking for angiographic patterns of FMD. Exclusion criteria consisted of cases in which the first angiogram was done when the patients were younger than 18 years...
December 2017: International Journal of Angiology: Official Publication of the International College of Angiology, Inc
Takahiro Yamazato, Tetsu Nakamura, Noriyuki Abe, Koki Yokawa, Yuki Ikeno, Yojiro Koda, Soichiro Henmi, Hidekazu Nakai, Yasuko Gotake, Takashi Matsueda, Takeshi Inoue, Hiroshi Tanaka, Yoshihiro Kakeji, Yutaka Okita
OBJECTIVE: To present a surgical strategy for aortoesophageal fistula (AEF). METHODS: From October 1999 to May 2017, 27 patients with AEF were treated at Kobe University Hospital. After 9 patients with malignancies or fish bone penetration were excluded, 18 patients who had AEF secondary to aortic lesions were investigated. The mean age was 67.2 ± 10.4 years, and the male/female ratio was 16:2. Twelve patients had a nondissection thoracic aneurysm, and 6 patients had a chronic aortic dissection...
January 2018: Journal of Thoracic and Cardiovascular Surgery
Bradley A Gross, Daniel A Tonetti, Gregory M Weiner, David M Panczykowski, William J Ares, Cynthia L Kenmuir, Ashutosh P Jadhav, Tudor G Jovin, Brian T Jankowitz
Introduction: Balloon angioplasty can be a requisite approach for the treatment of symptomatic and/or severe vasospasm. Dual-lumen microcatheter balloons have multiple potential advantages for this indication including accommodating a 0.014-inch wire and the potential to deliver superselective vasodilators directly via the microcatheter prior to angioplasty. Methods: The authors reviewed a 3-year institutional experience with the Scepter XC balloon (Microvention, Tustin, CA, USA) in the treatment of postaneurysmal subarachnoid hemorrhage vasospasm, focusing on treatment methods, angiographic, and clinical results...
October 2017: Interventional Neurology
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