Aneurysms of Distal Posterior Inferior Cerebellar Artery

Objective

Aneurysms are very rarely encountered in the distal posterior inferior cerebellar artery (PICA). The authors experienced 5 cases with a distal PICA aneurysm among 368 cases of intracranial aneurysms during the period from January 2003 to January 2008. Here, the authors describe their clinical and surgical experiences and include a review of the relevant literature.

Methods

Using radiologic findings and charts, we retrospectively reviewed the surgical results of 5 cases with a distal PICA aneurysm treated from January 2003 to January 2008.

Results

The current five cases were composed of four cases of ''Good'' and one case of ''Fair''. No postoperative complications occurred other than a ventriculo-peritoneal shunt due to hydrocephalus in Case 2. In all five cases, treatment was successful without neurological deficit.

Conclusion

Surgical outcome of PICA aneurysms have been reported to be excellent because the amount of intraparenchymal injury is limited. More clinical experience, microsurgical technique developments, and endovascular surgery advancements are certain to improve treatment outcomes.     

Surgical Treatment of Giant Serpentine Aneurysm of A2-A3 Segment Distal Anterior Cerebral Artery : Technical Case Report

Objective

To report our surgical experience using in situ end-to-side bypass for giant serpentine distal anterior cerebral artery aneurysm, unsuitable for microsurgical clipping.

Methods

A 49-year-old woman presented with headache and intermittent loss of consciousness. The brain computed tomography scan revealed a partially calcified mass in the interhemispheric fissure. On cerebral angiography, that was giant (30×18 mm sized), serpentine aneurysm originating from the A2 to A3 segment of the distal anterior cerebral artery (DACA). The aneurysm was trapped with clips, and the right A3 segment to left A3 segment of DACA, end-to-side in situ bypass was performed. Surgical result was favorable, with no newly developed ischemic event in the acute recovery period. Postoperative angiography showed total occlusion of the aneurysm and good patency, with preserved distal flow.

Conclusion

Giant fusiform aneurysms of the DACA are extremely rare and can be particularly challenging to treat. End-to-side A3 : A3 bypass with aneurysm trapping could be a treatment modality for these locations.     

Neuroform Stent-Assisted Coil Embolization of a Ruptured A1 Segment Anterior Cerebral Artery Aneurysm

We report a case of a 71-year-old woman who presented with a ruptured wide-necked proximal anterior cerebral artery (ACA) aneurysm that was successfully embolized using Neuroform stent-assisted coiling.     

Three-Dimensional Angiographic Demonstration of Plexiform Fenestrations of the Proximal Anterior Cerebral Artery Associated with a Ruptured Aneurysm

A rare case of ruptured aneurysm associated with multiple A₁ fenestrations resembling plexiform network was demonstrated by 3D angiography. A 56-year-old female presented with a ruptured aneurysm in the A₂ segment of the left distal anterior cerebral artery associated with the right A₁ fenestration. The ruptured aneurysm was occluded with surgical neck clipping via interhemispheric approach without neurological deficit. Plexiform fenestrations of the right distal A₁, opposite side to the left ruptured A₂ aneurysm, were clearly visible on postoperative 3D angiography. Our case may strongly support the theory described by Paget, namely that a remnant of the plexiform anastomosis between the primitive olfactory artery and A₁ segment is the source of such fenestration.     

锁孔入路治疗破裂的前循环动脉瘤

目的探究锁孔入路治疗破裂的前循环动脉瘤的显微技术和治疗效果。方法通过眉弓眶上和翼点锁孔入路治疗前循环动脉瘤36例,包括前交通动脉瘤13例,后交通动脉瘤16例,大脑中动脉分叉处动脉瘤7例。手术均为发病后1～3d进行。结果术中动脉瘤显露良好,36例均成功夹闭,其中2例动脉瘤术中破裂出血。29例恢复良好,6例轻残,1例死亡。结论锁孔入路可显著减小手术损伤及手术并发症。完善的术前准备和设计,熟练的手术操作技术,良好的术中配合是手术成功的保证。     

Successful Obliteration of Unclippable Large and Giant Middle Cerebral Artery Aneurysms Following Extracranial-Intracranial Bypass and Distal Clip Application

Large to giant middle cerebral artery aneurysm is a challenging disease, especially when incorporating important perforating arteries. Surgical risk increases by perforator infarction and anatomical complexity. In this clinical setting, extensive consideration of surgical options is needed. The two cases described here were unruptured and had rather stable wall. Because of their large and giant size, hardness and incorporated arteries, it was not affordable to isolate them by means of clipping or trapping. The procedure as the alternative to conventional treatment modalities, extracranial-intracranial bypass followed by clipping of only the efferent artery successfully treated the aneurysms.     

Solitary Ruptured Aneurysm of the Spinal Artery of Adamkiewicz with Subarachnoid Hemorrhage

Spinal subarachnoid hemorrhage (SAH) due to solitary spinal aneurysm is extremely rare. A 45-year-old female patient visited the emergency department with severe headache and back pain. Imaging studies showed cerebral SAH in parietal lobe and spinal SAH in thoracolumbar level. Spinal angiography revealed a small pearl and string-like aneurysm of the Adamkiewicz artery at the T12 level. One month after onset, her back pain aggravated, and follow-up imaging study showed arachnoiditis. Two months after onset, her symptoms improved, and follow-up imaging study showed resolution of SAH. The present case of spinal SAH due to rupture of dissecting aneurysm of the Adamkiewicz artery underwent subsequent spontaneous resolution, indicating that the wait-and-see strategy may provide adequate treatment option.     

大脑前动脉A2段构型对左侧翼点入路夹闭前交通动脉瘤的影响

目的比较左侧优势血供的不同空间构型前交通动脉瘤开颅夹闭手术过程、效果及术中暴露情况,并探讨与之相关的手术适应证。方法回顾性分析山西医科大学第二医院2013年1月-2021年12月连续收治的确诊为左侧优势血供前交通动脉瘤,且进行了动脉瘤开颅夹闭手术的患者资料。根据大脑前动脉A2段的走行方向与冠状面的位置关系,将动脉瘤分为4型：大脑前动脉与冠状面夹角＜22.5°为水平型;大脑前动脉与矢状面夹角＜22.5°为纵向型;右侧大脑前动脉在前且与冠状面夹角112.5°～157.5°为右前左后型;左侧大脑前动脉在前且与冠状面夹角22.5°～67.5°为右后左前型。分别比较水平型组和纵向型组,右前左后型组和右后左前型组间的基线资料、进行左侧翼点入路夹闭手术的时间、夹闭方式（简单夹闭或复杂夹闭）、夹闭效果（是否完全夹闭）、术后3个月和1年动脉瘤是否复发、术后1年GCS评分等指标。结果研究共纳入50例患者,其中水平型8例,纵向型12例,右前左后型16例,右后左前型14例。水平型组与纵向型组各项指标差异均无统计学意义。右前左后型组与右后左前型组术前基线资料差异无统计学意义,右前左后型组的手术时间短于右后左前型组（85.1±19.2?min?vs.?102.1±57.5?min,P=0.032）,2组术后动脉瘤复发率、预后差异无统计学意义。结论右前左后型前交通动脉瘤的手术时间短于右后左前型,但预后方面与右后左前型无显著差异;水平型与纵向型前交通动脉瘤的手术和预后指标无显著差异。     

Rupture of De Novo Anterior Communicating Artery Aneurysm 8 Days after the Clipping of Ruptured Middle Cerebral Artery Aneurysm

Rapidly developed de novo aneurysm is very rare. We present a rapidly developed and ruptured de novo anterior communicating aneurysm 8 days after the rupture of another aneurysm. This de novo aneurysm was not apparent in the initial 3-dimensional computed tomography and digital subtraction angiography. We reviewed the literature and discussed possible mechanisms for the development of this de novo aneurysm.     

翼点与纵裂联合入路手术治疗大脑前动脉-胼周动脉瘤

目的探讨翼点联合纵裂入路手术治疗大脑前动脉-胼周动脉瘤的临床效果。方法回顾性分析20例行翼点联合纵裂入路手术治疗的大脑前动脉-胼周动脉瘤患者的临床资料。结果20例患者均恢复良好,手术后平均住院时间18天。无术中动脉瘤破裂,无手术死亡,未发生神经系统并发症。出院时GOS预后评分均为良好。结论应用翼点联合纵裂入路手术治疗大脑前动脉-胼周动脉瘤,可获得满意的临床效果。     

Slowly Recovering Isolated Bilateral Abducens Nerve Palsy after Embolization of Ruptured Anterior Communicating Artery Aneurysm

Bilateral abducens nerve palsy related to ruptured aneurysm of the anterior communicating artery (ACoA) has only been reported in four patients. Three cases were treated by surgical clipping. No report has described the clinical course of the isolated bilateral abducens nerve palsy following ruptured ACoA aneurysm obliterated with coil. A 32-year-old man was transferred to our institution after three days of diplopia, dizziness and headache after the onset of a 5-minute generalized tonic-clonic seizure. Computed tomographic angiography revealed an aneurysm of the ACoA. Magnetic resonance imaging showed focal intraventricular hemorrhage without brain stem abnormalities including infarction or space-occupying lesion. Endovascular coil embolization was conducted to obliterate an aneurysmal sac followed by lumbar cerebrospinal fluid (CSF) drainage. Bilateral paresis of abducens nerve completely recovered 9 weeks after ictus. In conclusion, isolated bilateral abducens nerve palsy associated with ruptured ACoA aneurysm may be resolved successfully by coil embolization and lumbar CSF drainage without directly relieving cerebrospinal fluid pressure by opening Lillequist''s membrane and prepontine cistern.     

Cerebral Dissecting Aneurysms in Patients with Essential Thrombocythemia

The etiologies of intracranial artery dissection are various, the exogenous as well as inherited connective tissue disorders. We report on a patient who presented with diffuse subarachnoid hemorrhage who had been suffered from essential thrombocythemia. He was diagnosed to multiple dissecting aneurysms of left superior cerebellar artery, left posterior inferior cerebellar artery and right pericallosal artery and treated with endovascular coil embolization.     

Saccular Aneurysm of the Azygos Anterior Cerebral Artery: Three Case Reports

The azygos anterior cerebral artery, a rare anomaly in the circle of Willis in which only a single vessel supplies the medial aspects of both anterior cerebral hemispheres, is closely associated with saccular aneurysms. We present three cases of azygos anterior cerebral artery aneurysms among the 781 cerebral aneurysms surgically treated at our institution in an 11-year period. These three cases all involved elderly women who presented with subarachnoid hemorrhage. Conventional cerebral angiography and CT angiography revealed small saccular aneurysms at the distal ends of the azygos anterior cerebral arteries. These aneurysms were clipped successfully using a bifrontal interhemispheric approach. Hence, the pathogenesis of these particular aneurysms relating to hemodynamic change, associated anomalies, and surgical pitfalls is discussed with review of literature.     

经小翼点入路夹闭大脑中动脉分叉部动脉瘤

目的探讨经小翼点入路(MPT)夹闭大脑中动脉分叉部动脉瘤(MbifA)的效果及策略。方法回顾性分析41例2010至2015年经MPT夹闭MbifA患者的临床资料。结果41例经MPT夹闭MbifA后,瘤颈残余1例,术后并发症5例,血管痉挛1例;无颞肌、面神经功能障碍。GOS评分:出院时恢复良好(GOS 4~5分)32例,恢复不良(GOS2~3分)9例,死亡(GOS 1分)0例。远期随访:恢复良好35/41例(85%),恢复不良6/41例(15%),脑积水6例;无复发及再出血病例。结论经MPT夹闭MbifA安全、有效,损伤小、操作快,适合作为常见MbifA夹闭手术入路。     

A Large Ruptured Anterior Communicating Artery Aneurysm Presenting with Bitemporal Hemianopsia

Anterior communicating artery (ACoA) aneurysms sometimes present with visual symptoms when they rupture or directly compress the optic nerve. Giant or large ACoA aneurysms producing bitemporal hemianopsia are extremely rare. Here we present an unusual case of bitemporal hemianopsia caused by a large intracranial aneurysm of the ACoA. A 41-year-old woman was admitted to our neurosurgical department with a sudden-onset bursting headache and visual impairment. On admission, her vision was decreased to finger counting at 30 cm in the left eye and 50 cm in the right eye, and a severe bitemporal hemianopsia was demonstrated on visual field testing. A brain computed tomography scan revealed a subarachnoid hemorrhage at the basal cistern, and conventional cerebral catheter angiography of the left internal carotid artery demonstrated an 18×8 mm dumbbell-shaped aneurysm at the ACoA. Microscopic aneurysmal clipping was performed. An ACoA aneurysm can produce visual field defects by compressing the optic chiasm or nerves. We emphasize that it is important to diagnose an aneurysm through cerebrovascular study to prevent confusing it with pituitary apoplexy.     

颅内破裂微小动脉瘤介入栓塞术临床疗效和安全性研究

目的探讨介入栓塞颅内破裂微小动脉瘤的技术要点,评价其临床疗效和安全性。方法回顾性分析2014年4月-2016年10月云浮市人民医院因微小颅内动脉瘤破裂致蛛网膜下腔出血而行介入栓塞治疗患者的临床资料,评价栓塞治疗的临床疗效、手术并发症及患者预后情况。结果研究共纳入23例微小颅内动脉瘤破裂患者,均在全身麻醉下采用弹簧圈栓塞治疗,其中17例采用单纯弹簧圈栓塞,6例采用支架辅助治疗。致密栓塞19例(82.61%),4例(17.39%)瘤颈残余。所有患者载瘤动脉均通畅,术中无动脉瘤破裂出血,1例(4.35%)术中发生载瘤动脉狭窄闭塞,置入支架后载瘤动脉恢复通畅。术后6~30个月DSA随访均无再出血。1例(4.35%)瘤颈残余患者1年后出现瘤颈部动脉瘤复发,给予支架辅助栓塞治疗。23例患者术后6个月时改良Rankin量表(modified Rankin Scale,mRS)评分0分共21例,2分有2例。结论介入栓塞技术治疗颅内破裂微小动脉瘤是一种安全、有效的治疗手段,术后治疗效果良好。     

Spontaneous Anterior Cerebral Artery Dissection Presenting with Simultaneous Subarachnoid Hemorrhage and Cerebral Infarction in a Patient with Multiple Extracranial Arterial Dissections

Simultaneous subarachnoid hemorrhage and infarction is a quite rare presentation in a patient with a spontaneous dissecting aneurysm of the anterior cerebral artery. Identifying relevant radiographic features and serial angiographic surveillance as well as mode of clinical manifestation, either hemorrhage or infarction, could sufficiently determine appropriate treatment. Enlargement of ruptured aneurysm and progressing arterial stenosis around the aneurysm indicates impending risk of subsequent stroke. In this setting, prompt treatment with stent-assisted endovascular embolization can be a reliable alternative to direct surgery. When multiple arterial dissections are coexistent, management strategy often became complicated. However, satisfactory clinical results can be obtained by acknowledging responsible arterial site with careful radiographic inspection and antiplatelet medication.