Fenestration of the middle cerebral artery and aneurysm at the site of the fenestration.

The authors report the case of a patient who presented a ruptured aneurysm of the anterior communicating artery and an unruptured aneurysm of the middle cerebral artery arising at the site of a fenestration of the MCA. The fenestration was undiagnosed on the preoperative angiogram but discovered during the surgery carried out for clipping of the aneurysms. In the literature, cases of fenestration of the MCA are sporadically reported and are incidental findings; an aneurysm may be associated on an artery other than the fenestrated MCA; an aneurysm arising at the site of the MCA fenestration is a very rare occurrence.     

Mathematical model of the rupture mechanism of intracranial saccular aneurysms through daughter aneurysm formation and growth

OBJECTIVES: Daughter aneurysms have been strongly associated with saccular aneurysm rupture. We constructed a mathematical model to help explain this association as a possible hemodynamic mechanism for intracranial saccular aneurysm rupture. METHODS: Our model is based on the assumption that when an aneurysm reaches a state of imminent rupture, the weakest area of the aneurysm wall responds passively to a surge of intra-aneurysmal pressure by forming a daughter aneurysm that will be the site of the eventual rupture. The daughter and parent aneurysms were assumed to be spherical. Using mathematical modeling, the growth of the daughter aneurysm was observed. To obtain the change in tensile stress in the daughter aneurysm wall under constant pressure and changing geometry, the Law of Laplace was applied to the parent and the daughter aneurysms. RESULTS: The model reveals that the stress factor, i.e. tensile stress in the daughter aneurysm wall relative to the wall strength (rupture point), is dependent on two geometric parameters: the orifice factor (mu), which represents the relative size of the daughter aneurysm orifice radius to the parent aneurysm radius; and the aspect ratio (lambda), which represents the height-to-orifice ratio of the daughter aneurysm. As the daughter aneurysm develops, the stress factor first decreases to protect against rupture. Minimal stress is attained at an aspect ratio (lambda) of 0.577 regardless of the orifice factor. This is a relatively stable state. Further growth of the daughter aneurysm results in an increase of stress above the minimum, eventually leading to rupture at a stress factor of 1. A smaller orifice factor mu allows this aneurysm to grow to a higher aspect ratio lambda before rupture. DISCUSSION: Daughter aneurysm formation is a likely path to aneurysm rupture. The formation of a daughter aneurysm temporarily decreases the tensile stress within a parent aneurysm in which rupture is imminent, indicating a temporary protective role of daughter aneurysm development. Aneurysms harboring daughter aneurysms are at a more advanced stage of development, hence at a greater risk for rupture. The severity of the rupture risk can be estimated on the basis of daughter aneurysm geometry; aspect ratio lambda > 0.577 indicates a greater risk of rupture. Furthermore, daughter aneurysms with larger orifices are associated with a greater risk of rupture.     

Fenestration of the middle cerebral artery and aneurysm at the site of the fenestration

Abstract

The authors report the case of a patient who presented a ruptured aneurysm of the anterior communicating artery and an unruptured aneurysm of the middle cerebral artery arising at the site of a fenestration of the MCA. The fenestration was undiagnosed on the preoperative angiogram but discovered during the surgery carried out for clipping of the aneurysms. In the literature, cases of fenestration of the MCA are sporadically reported and are incidental findings; an aneurysm may be associated on an artery other than the fenestrated MCA; an aneurysm arising at the site of the MCA fenestration is a very rare occurrence.     

颅内动脉瘤三维计算机血流动力学数值模拟与术中对照分析

目的 利用三维计算机血流动力学数值模拟技术,数字化地显示动脉瘤及其载瘤动脉的血流速度、轨迹、剪切力等多项参数,结合显微动脉瘤夹闭术中对动脉瘤壁的观察,对动脉瘤破口位置的观察进行对比分析,探讨动脉瘤破口的血流动力学特征和动脉瘤破裂的机制.方法 选取资料完整的动脉瘤患者14例,在三维CTA图像基础上,利用本课题组自写程序及美国Ansys公司的ICEM,美国Fluent公司的Fluent 6.02等,对动脉瘤进行三维计算机血流动力学数值模拟,得出动脉瘤剪切力分布特点,结合动脉瘤夹闭术中所见进行对比分析.结果 根据分析结果我们将患者分为两组.A组:破裂口位于动脉瘤侧壁(10例),模拟结果显示动脉瘤中有涡流产生,破裂口处剪切力在8.5959～10.8419 pascal之间,平均剪切力为9.0704 pascal.B组:破裂口位于动脉瘤底部(4例),模拟结果显示动脉瘤内均无典型涡流,破口处剪切力在0.6983～0.9744 pascal,平均剪切力为0.8364pascal.从A、B两组动脉瘤特点可知,破裂口位于侧壁的动脉瘤内有涡流存在,破口处剪切力较大;破裂口位于底部的动脉瘤内无典型涡流,破裂口处剪切力较小.结论 强剪切力和弱剪切力均与动脉瘤的破裂有关,有助于解释动脉瘤破裂的机制.

Abstract：

Objective With the cranial aneurysm's 3D - computational hemodynamics numerical simulation, we can get the cranial aneurysms and its's mother arteries' blood flow rate, path and wall shearing stress and so on. Taking use of the contrast analysis of the hemodynamics result and the findings in operation,we can try to find the hemodynamic character and the mechanism of the rupture on the aneurysm.Method We choose 14 aneurysm patients with complete clinical data. With the 3D - CTA image, we take use of self - program, American Ansys - ICEM and Fluent6. 02 softwares to simulate blood flow in the aneurysm. Finally we got the wall shearing stress distribution on the aneurysm, and contrastedly analyzed the results and the findings in operation. Result According to the analysis result, we can divide the patients into two groups. Group A:the rapture locates on the side wall of the aneurysm( 10 cases). The simulation results show there is turbulent flow in this kind of aneurysm. The wall shearing stress of the rupture is between 8. 5959 ～ 10. 8419 pascal,and the average is 9. 0704 pascal. Group B:The rupture locates on the tip of the aneurysm (4 cases ). The simulation results show there is no turbulent flow in this kind of aneurysm. The wall shearing stress of the rupture is between 0. 6983 ～ 0. 9744 pascal, and the average is 0. 8364 pascal. According to the character of group A and B,there is turbulent flow in the aneurysm with the rupture on the side wall ,and the wall shearing stress of the rupture is larger. There is no turbulent flow in the aneurysm with the rupture on the tip,and the wall shearing stress of the rupture is smaller. Conclusions If the wall shearing stress is too high or too low,it will cause the rupture of the aneurysm. The deduction helps to explain the mechanism of the aneurysm's rupture.     

Results of the surgical treatment of patients with single aneurysms of the middle cerebral artery

Results are presented of surgical treatment of patients with isolated aneurysms on the middle cerebral artery on the basis of the material of the Department of Neurosurgery, Medical Academy in Warsaw in the years 1975-1981. The material included 161 surgically treated patients out of 179 treated in this time period for diagnosed isolated aneurysm of this artery. The frequency of this aneurysm was 23.2% in this material. The operative mortality was 8.9%, and the results were very good and good in 85.7% of cases. The number of past bleedings from the aneurysm, the clinical state of the patients, the timing of the operation, presence of intracerebral haematoma, intraoperative rupture of the aneurysm and postoperative vasospasm were factors having a significant unfavourable influence on the early postoperative results. Vasospasm was the most frequent postoperative complication observed in 15.2% of cases. The clinical state of the patient and the mode of aneurysm management had a statistically significant effect on the late results of surgical treatment. In 6 cases (6.1%) subarachnoid bleeding appeared after the operation and in 5 of them aneurysm wall had to be strengthened (wrapping).     

Paraclinoid aneurysms of the internal carotid artery: hydraulic simulation study on their locations and shape of the carotid siphon

Hemodynamics of paraclinoid aneurysms were investigated focusing on the effects of their locations and shape of the carotid siphon. A transparent silicon model of the carotid siphon was constructed and a model aneurysm was attached to the outside of the curvature at three different sites. Glycerol solution was perfused into the model, and the half-life of the dye injected into the aneurysm was calculated as an index of the stagnant flow. Values of half-life changed significantly depending on the aneurysmal location and the siphon angle. When the siphon angle was 0 degree where C2 and C4 segments were parallel to each other, the half-life value was the lowest in the C2-C3 junction aneurysm, highest in the C3 segment aneurysm and intermediate in the C2 segment aneurysm. While the C2-C3 junction aneurysm maintained low values regardless of the angle, the C3 segment aneurysm values decreased and C2 segment aneurysm values increased with increases in the angle. These changes of half-life occur because the point at which the faster moving fluid component strikes the curved wall changes according to the siphon angle. These results are considered useful to determine the surgical indications, treatment modalities and post-surgical management of the aneurysms.     

弹力酶诱导的兔囊状动脉瘤早期形态学研究

目的研究猪胰弹力酶诱导的兔囊状动脉瘤的早期形态学及病理学变化特征.方法使用35只新西兰大白兔制作猪胰弹力酶诱导的囊性动脉瘤模型后,在第3、7、14、21、30天通过静脉血管造影观察动脉瘤模型的形态学动态变化特征及动脉瘤管腔内形态变化特征.结果静脉血管造影显示:术后第3、7、14、21天平均瘤颈、瘤高及瘤宽不断增大;术后第30天瘤颈、瘤高及瘤宽无明显增大.整体标本观察可见术后3d瘤腔内主要为血栓填充;术后7d瘤腔内血栓减少,瘤腔顶部血栓出现完整纤维膜;术后14～30d,瘤腔顶部血栓逐渐机化.结论猪胰弹力酶诱导的兔动脉瘤腔内最初主要为血栓填充,随后血栓逐渐机化,瘤腔不断增大,在21d左右形态趋于稳定.     

颅内动脉瘤破裂出血后假性动脉瘤形成的实验和临床研究

目的探讨颅内动脉瘤破裂出血后在其破口周围可以形成假性动脉瘤,对其应早期诊断尽快治疗,防止再出血,提高治愈率,降低死残率。方法通过用兔建立的假性动脉瘤与真性动脉瘤合并假性动脉瘤的动物模型,探讨假性动脉瘤形成的机理,并结合临床在治疗颅内动脉瘤破裂出血早期、DSA造影影像分析及GDC血管内栓塞动脉瘤时所见的情况进行分析。结果用创伤与显微外科相结合的方法,可以成功建立假性动脉瘤,其形成过程分为动脉瘤破裂出血期、假性动脉瘤形成前期、假性动脉瘤形成期及假性动脉瘤增大破裂出血期四个阶段。颅内动脉瘤破裂出血早期行DSA血管造影时可见其影像形态不规则呈哑铃状、双腔与瘤囊顶鼓出小泡等表现,血管内栓塞治疗可见(1)GDC只能进入靠近载瘤动脉的瘤腔,并将其栓塞,完全不进入远离载瘤动脉的瘤腔,栓塞后透视下见未充填GDC的瘤腔内有造影剂滞留,栓塞后造影见动脉瘤完全闭塞,随访造影见动脉瘤完全消失;(2)GDC完全填塞靠近载瘤动脉的瘤腔,部分填塞远离载瘤动脉的瘤腔,栓塞后造影见动脉瘤完全消失,随访造影动脉瘤消失;(3)GDC将靠近与远离载瘤动脉的两个瘤腔完全填塞,栓塞后造影见动脉瘤完全闭塞,随访造影见动脉瘤消失。结论颅内动脉瘤破裂出血后,在其破口周围可以形成假性动脉瘤,对伴有假性动脉瘤的颅内     

颅内动脉瘤夹闭术中荧光造影"假阴性"原因探讨

目的 探讨吲哚菁绿荧光血管造影在颅内动脉瘤夹闭术中"假阴性"的原因及处理措施.方法 回顾分析2008年11月-2011年10月7例颅内动脉瘤夹闭术中吲哚菁绿荧光血管造影"阴性"患者手术治疗经过,分析术中吲哚菁绿荧光血管造影在显示动脉瘤夹闭完全性方面的局限性及应对原则.结果 7例患者均于术中吲哚菁绿荧光血管造影显示"阴性".但在剪开或刺破动脉瘤瘤体后出现少量渗血.经迅速清理瘤颈渗血并调整动脉瘤瘤夹位置,渗血消失.结论 吲哚菁绿荧光血管造影是术中监测动脉瘤是否夹闭完全的重要方法.但具有一定局限性,瘤颈较宽、瘤颈血栓形成或血管壁粥样硬化,以及蛛网膜分离不完全等情况均可能导致"假阴性"结果.因此,对于术中夹闭动脉瘤后吲哚菁绿荧光血管造影"阴性"的患者,仍需配合其他监测方法,进一步确认动脉瘤夹闭情况.     

Paraclinoid aneurysms of the internal carotid artery: Hydraulic simulation study on their locations and shape of the carotid siphon

Abstract

Hemodynamics of paraclinoid aneurysms were investigated focusing on the effects of their locations and shape of the carotid siphon. A transparent silicon model of the carotid siphon was constructed and a model aneurysm was attached to the outside of the curvature at three different sites. Glycerol solution was perfused into the model, and the half-life of the dye injected into the aneurysm was calculated as an index of the stagnant flow. Values of half-life changed significantly depending on the aneurysmal location and the siphon angle. When the siphon angle was 0° where C2 and C4 segments were parallel to each other, the half-life value was the lowest in the C2-C3 junction aneurysm, highest in the C3 segment aneurysm and intermediate in the C2 segment aneurysm. While the C2-C3 junction aneurysm maintained low values regardless of the angle, the C3 segment aneurysm values decreased and C2 segment aneurysm values increased with increases in the angle. These changes of half-life occur because the point at which the faster moving fluid component strikes the curved wall changes according to the siphon angle. These results are considered useful to determine the surgical indications, treatment modalities and post-surgical management of the aneurysms. [Neurol Res 1999; 21: 733-736]     

A case of dissecting aneurysm of the basilar artery extended from the top of the basilar artery to the proximal part]

A rare case of the dissecting aneurysm of the basilar artery is reported. A 48-year-old man was admitted to our hospital because of a sudden onset comatose state. An hour later he recovered consciousness with the residual disturbance of the vertical ocular movement. Computed tomogram on second day revealed low density lesions in the medial part of the bilateral thalamus, and the mesencephalic tegmentum and the cerebellar peduncle on the left side. Cerebral angiograms on the same day and 13th day showed a double lumen sign of the basilar artery and slight extension of the dissecting aneurysm, respectively. However, the cerebral angiogram 6 months after the onset revealed a little bit shrinkage of the aneurysm. The patient was treated conservatively and is in good condition with slight limitation of the downward gaze 10 months after the onset. We reviewed the clinical sign, cerebral angiogram, treatment and prognosis of the dissecting aneurysm of the basilar artery.     

介入栓塞治疗不同直径颅内动脉瘤的临床效果观察

目的 观察介入栓塞治疗对不同直径颅内动脉瘤的临床效果及安全性。方法 回顾性分析本院在2015年8月-2017年1月收治的87例颅内未破裂动脉瘤患者的临床资料,根据动脉瘤直径不同分为小型动脉瘤组(瘤体直径≤3 mm)41例,中大型动脉瘤组46例,均行介入栓塞治疗; 比较2组患者栓塞效果、并发症、复发率及预后。结果 术后6个月小型动脉瘤组完全栓塞率为100%,中大型动脉瘤组完全栓塞率为91.30%(42/46),动脉瘤瘤颈残留3例(6.52%),动脉瘤腔残留1例(2.17%),2组比较无明显差异(P>0.05); 小型动脉瘤组单纯弹簧圈栓塞16例,支架辅助弹簧圈栓塞25例,中大型动脉瘤组单纯弹簧圈栓塞23例,支架辅助弹簧圈栓塞18例,球囊辅助弹簧圈栓塞5例,2组比较也无明显差异(P>0.05); 小型动脉瘤组并发症发生率较中大型动脉瘤组低(7.32% vs 15.22%),但无明显差异(P>0.05); 术后6个月小型动脉瘤组无复发病例,中大型动脉瘤组复发率为8.69%(4/46),2组比较也无明显差异(P>0.05); 术后30 d,小型动脉瘤组GCS预后评分中恢复良好例数明显多于中大型动脉瘤组(87.80% vs 58.69%),2组比较有明显差异(P<0.05)。结论 介入栓塞治疗对不同直径的颅内动脉瘤均具有较好的疗效,但小型动脉瘤预后较好。     

遗传性结缔组织病与颅内动脉瘤发生与破裂相关研究进展

颅内动脉瘤发生及破裂机制复杂,可能涉及多种环境因素与遗传因素的相互作用。颅内动脉瘤的发生发展与结缔组织病具有相关性,罹患遗传性结缔组织病的患者合并颅内动脉瘤等多种脑血管病的风险明显增加,这些遗传性结缔组织病的某些关联基因突变与颅内动脉瘤的发生发展密切相关。本文重点综述常见颅内动脉瘤相关遗传性结缔组织病及其关联基因位点。     

Coexistence of aneurysmal subarachnoid haemorrhage and pituitary apoplexy: Case report and review of the literature.

A case of aneurysmal subarachnoid haemorrhage with associated haemorrhagic infarction of a growth hormone secreting pituitary macroadenoma is presented. The subarachnoid haemorrhage was not identifiable on CT, but was apparent on MRI. Angiography revealed a 7mm right posterior communicating aneurysm, a 3mm left A1 segment anterior cerebral aneurysm, and vasospasm. Surgery was performed through a right pterional/subfrontal approach, clipping both aneurysms and debulking the tumour. The left A1 aneurysm was the site of subarachnoid haemorrhage. There was evidence of haemorrhagic infarction of the pituitary tumour. Although rupture of an aneurysm into a pituitary tumour has been previously reported, this is the first case reported of aneurysmal subarachnoid haemorrhage with coexisting pituitary apoplexy where the aneurysm had not bled directly into the pituitary tumour. The literature regarding the association between pituitary tumours and aneurysm is reviewed.     

Hemodynamic assessment of the development and rupture of intracranial aneurysms using computational simulations

Intracranial aneurysms manifest themselves as sacculations within a weakened region of the vessel wall and pose substantial neurological risks upon rupture. A primary factor in the development and rupture stages of an aneurysm is hemodynamics and its degrading effects on the aneurysm wall. Wall dynamics and hemodynamics within a fully developed aneurysm were investigated using computational simulation techniques. To study wall dynamics, the aneurysm was modeled as a thin spherical shell with linearly elastic and plastic (viscoelastic) wall behavior. The sensitivity of this model to the biophysical parameters which describe it will assist in the quantitative assessment of factors predisposing to aneurysm rupture and subarachnoid hemorrhage. Flow dynamics simulations were performed for spherical aneurysms with rigid walls. We observed the development and motion of an annular vortex within the lateral sacculation. We also simulated a ruptured aneurysm by placing a tear near the neck of the aneurysm. Flow patterns showed blood flowing out during the initial stages of the flow, but displayed an inflow of blood soon thereafter; as the internal pressure dropped. These results are substantiated by the clinical observations that turbulent flow is observed within the aneurysm as evidenced by reduced bruits. [Neuro Res 1995; 17: 426-434]     

Giant aneurysm of the distal portion of the posterior inferior cerebellar artery

The authors report a case of a giant aneurysm of the distal portion of the posterior inferior cerebellar artery presenting the classical picture of a tumor of the posterior fossa. CT scan of a giant aneurysm reveals the clear margin and high density area of aneurysm wall, and the homogeneous and high density area of the organized thrombus in a cavity of the aneurysm.     

Clinical analysis of the mechanism of oculomotor nerve palsy caused by unruptured internal carotid artery posterior communicating artery aneurysm]

We analyzed the clinical course of eight female patients of oculomotor nerve palsy due to unruptured internal artery posterior (IC-PC) communicating artery aneurysm in order to speculate on the mechanism of aneurysmal rupture. Seven of the eight patients had preceding headache or ophthalmalgia, three of them deteriorated oculomotor nerve palsy and one showed worsening of ophthalmalgia. These deteriorations occurred between three to seven days after the first clinical symptom appeared. Neck clipping of aneurysm was performed for all eight patients. These aneurysms were profiled except for one patient whose aneurysm ruptured before operation. None of these seven patients had subarachnoid hemorrhage in the operative field. The patients who showed clinical deterioration had fragile aneurysm wall, wall with bleb, and one aneurysm showed minor blood leakage during operative manipulation. In the four patients who did not show clinical deterioration, aneurysm attached oculomotor nerve, these aneurysm walls were arteriosclerotic and we could not find the fragile portion during operation. Repeated minor bleeding near the oculomotor nerve or direct aneurysmal compression are the main causes of oculomotor nerve palsy with unruptured IC-PC aneurysm. Adhesion or stimulation of aneurysm on the upper border of cavernous sinus cause the headache or ophthalmalgia and these deteriorations are thought to occur gradually. However, these deteriorations occur more rapidly than ever thought and reflect acute aneurysmal growth and its direct affect on the oculomotor nerve. IC-PC aneurysm is the only aneurysm we can observe its aneurysmal growth by its unique clinical presentation. From this study, we conclude that the deterioration of oculomotor nerve palsy, preceding headache or ophthalmalgia reflects rapid growth of unruptured IC-PC aneurysm. We neurosurgeons consider it to be an urgent rupture period and should introduce surgical management to prevent its rupture and the devastating consequence of subarachnoid hemorrhage.     

三维数值模拟颅内分叉部动脉瘤及血流动力学分析****☆

背景：已知血流动力学因素在动脉瘤的发生、发展和破裂中起重要作用。 目的：以三维计算机数值模拟观察颅内分叉部动脉瘤的血流动力学特性。 设计、时间及地点：三维数值模拟试验，于2008-07在北京神经外科研究所血管内治疗实验室进行。 对象：选择2008-04/07首都医科大学附属北京天坛医院神经介入科住院患者2例。病例1，女，37岁，血管造影示左侧前交通动脉瘤（共面的分叉部动脉瘤），右侧大脑前动脉A1段不显影。病例2，女，61岁，血管造影示基底动脉顶端动脉瘤（不共面的分叉部动脉瘤）。 方法：利用临床三维血管造影图像建立动脉瘤数值模型，并在GE公司的专用工作站进行三维重建。调整重建后的血管图像，并对其进行重新切片。然后运行Matlab 7.0软件及自写程序，逐渐生成动脉瘤的STL文件。导入网格生成软件，生成动脉瘤的三维网格。定义边界条件及提取血压波后，应用Fluent软件进行动脉瘤数值模拟。 主要观察指标：动脉瘤流入道、流出道、瘤顶部的血流速度、动压及壁面切应力。 结果：两个分叉部动脉瘤流入道的血流速度、动压及壁面切应力均最高，瘤顶部最低，与流出道相比较差异有显著性意义 （P < 0.05）；但共面的分叉部动脉瘤瘤顶部的动压较高，平均动压为(62.385 3±35.076 5) Pa；不共面的分叉部动脉瘤瘤顶部壁面切应力较低，平均壁面切应力为(0.220 7±0.071 6) Pa。 结论：瘤内动压在共面的分叉部动脉瘤破裂因素中起主要作用，而壁面切应力不足是不共面分叉部动脉瘤破裂的主要原因。     

介入栓塞与开颅瘤颈夹闭术治疗颅内动脉瘤的术前评估研究

目的评估介入栓塞与开颅瘤颈夹闭术治疗颅内动脉瘤的术前相关危险因素。方法回顾性分析颅内动脉瘤患者120例,根据手术方式分为开颅夹闭组及介入栓塞组各60例;记录术前相关影响因素及术后恢复情况,分析比较性别、年龄、Fisher分级、Hunt-Hess分级、动脉瘤部位、动脉瘤长轴与颈宽比(AR)、高血压及高血糖等术前影响因素对开颅夹闭术和血管内介入栓塞术治疗颅内动脉瘤疗效的影响。结果年龄是手术治疗的影响因素,60岁以上患者预后明显差于60岁以下患者(P0.05);Fisher分级中Ⅰ、Ⅱ级患者的预后明显优于Ⅲ、Ⅳ级患者(P0.05);Hunt-Hess分级越高,预后效果越差,但开颅夹闭术与介入栓塞术2组比较无明显差异(P0.05);动脉瘤的部位对预后有显著影响(P0.05),动脉瘤长颈和瘤颈比值(AR)对介入栓塞术组影响较大(P0.05),随着AR值增大采用介入栓塞术的疗效明显好转(P0.05);高血压及高血糖对介入栓塞术治疗的影响较小(P0.05);不同年龄对临时阻断载瘤动脉时间的耐受能力不同,导致其预后疗效有显著差异(P0.05)。结论年龄、Fisher分级、Hunt-Hess分级及动脉瘤部位是颅内动脉瘤患者开颅夹闭术和血管介入栓塞术术后疗效的共同影响因素。     

Traumatic aneurysm of the peripheral cerebral artery]

Two cases of traumatic aneurysm of peripheral cerebral artery were reported. Case 1. A 6-year-old girl was severely injured on her head by automobile accident. Plain skull films showed depressed fracture in the left frontal region. Left common carotid angiogram 25 days after the injury revealed small aneurysm of a cortical branch of the anterior cerebral artery. Cranioplasty and removal of the aneurysm was performed. Postoperative course of this patient was uneventful. Case 2. A 4-year-old girl fell downstaris and struck her left temporal region. On admission, she was unconscious and plain skull films showed multiple linear fractures. No aneurysm was demonstrated in the right common carotid angiogram immediately after the head trauma. Since her general condition gradually improved, she discharged 23 days after the head trauma. 63 days after the injury, she developed sudden onset of severe headache, vomiting, and status epilepticus. Right common carotid angiogram showed a large aneurysm arising from a branch of right pericallosal artery at the free edge of the falx. Parent artery of the aneurysm was clipped. Postoperatively, the patient made uneventful recovery. 60 reported cases of traumatic aneurysm of peripheral cerebral artery were reviewed and analyzed in etiology, diagnosis, clinical course, treatment and pathogenesis.