Occult rupture of a giant vertebral artery aneurysm following proximal occlusion and intrasaccular thrombosis. Case report.

The authors describe a unique clinicopathological phenomenon in a patient who presented with an unruptured giant vertebral artery aneurysm and who underwent endovascular proximal occlusion of the parent artery followed, several days later, by surgical trapping of the aneurysm after delayed subarachnoid hemorrhage (SAH). The intraoperative finding of a thrombus extruding from the wall of the aneurysm at a site remote from the origin of the SAH underscores the possibility that occult rupture of an aneurysmal sac can occur in patients with thrombosed giant aneurysms.     

巨大肾动脉瘤血管腔内治疗1例

正患者女,27岁,孕6周,因"妊娠1个月发现右侧腹部搏动性包块"入院。体格检查:血压132/66mmHg,右中腹部触及搏动性包块,右肾动脉听诊区未闻及杂音。实验室检查无异常发现。腹部增强CT:右肾动脉一级分支处可见巨大瘤样扩张,动脉期呈高强化,凸向肾实质外,大小约8.4cm×6.1cm(图1A)。CT诊断:右肾动脉动脉瘤(renal artery aneurysm,RAA)。患者行肾动脉造影:右肾上极可见巨大瘤样扩张,其内血流呈湍流,动脉瘤开口位于右肾动脉主干前段动脉分支,该动脉明显增粗与肾动脉主干相仿(图1B),术中以锥形束CT扫描证实RAA位置及供血动脉。造影后患者行动脉瘤腔内栓塞     

Ruptured extracranial vertebral artery aneurysm associated with neurofibromatosis type 1. Case report

A 31-year-old man presented with a ruptured right extracranial vertebral artery aneurysm associated with neurofibromatosis type 1, manifesting as acute onset of right neck and shoulder pain, and right supraclavicular mass. Three-dimensional computed tomography angiography showed a large aneurysm involving the right extracranial vertebral artery associated with a pseudoaneurysm. The aneurysm was successfully treated by transarterial endovascular trapping with detachable coils. Extracranial vertebral artery aneurysm is rare, but the mortality of ruptured cases is extremely high, so early diagnosis and early treatment are important. The present case shows that endovascular treatment was very effective.     

Treatment of a giant vertebrobasilar artery aneurysm using stent grafts. Case report

This 65-year-old man presented to the authors' institution reporting neck swelling. Stage IIIA Hodgkin disease was diagnosed, and a computed tomography scan of the neck revealed a vertebrobasilar artery aneurysm. His medical history was significant for subarachnoid hemorrhage and coma 2 years earlier. Subsequent digital subtraction angiography demonstrated a giant fusiform vertebrobasilar junction aneurysm with associated basilar artery (BA) fenestration. Endovascular treatment of the giant aneurysm was performed by left vertebral artery (VA) occlusion and placement of two Jo-stent coronary stent grafts from the right VA to the BA. The postprocedure course was uneventful. Follow-up angiography performed 1 week postoperatively demonstrated complete exclusion of the aneurysm. This unique case is described and a review of the relevant literature is presented.     

Hepatic artery aneurysm. Case report

Hepatic artery aneurysms represent about 20% of all visceral aneurysms and 0.01-0.2% of all arterial aneurysms. The authors report on a good risk patient with small infra-renal aortic aneurysm (AAA) and a large hepatic artery aneurysm. An excision and vein grafting of the hepatic artery aneurysm has been performed. The authors made a survey of recent literature concerning hepatic artery aneurysms.     

Angiographically occult spinal dural arteriovenous fistula located using selective computed tomography angiography. Case report

Spinal dural arteriovenous fistula (DAVF) is the most common type of spinal arteriovenous malformation and may cause progressive myelopathy but is usually treatable in the early stages by direct surgery or intravascular embolization. Selective spinal angiography has been the gold standard for diagnosis, but angiographically occult DAVF is not uncommon. A 67-year-old man presented with a 2-year history of progressive paraparesis. Magnetic resonance (MR) imaging demonstrated segmental atrophy of the spinal cord and dilated coronary veins on the dorsal surface of the spinal cord. A DAVF was suspected, but repeated selective angiography failed to demonstrate the fistula. Findings from spoiled gradient echo MR imaging suggested that the draining vein flowed into the dilated venous plexus at the T-9 level. Selective computed tomography (CT) angiography of the right T-9 intercostal artery confirmed the location of the fistula. The authors successfully occluded the draining vein through surgery, and they observed that the fistula was low flow. The patient exhibited improvement in his symptoms, and postoperative MR imaging confirmed closure of the fistula. Selective CT angiography is useful in locating the draining vein of angiographically occult DAVF and therefore minimizing the extent of the surgical procedure.     

Case report of a rare giant left anterior descending coronary artery aneurysm

Giant coronary artery aneurysm (CAA) is a rare condition, reportedly seen in 0.02–0.2％ of patients undergoing coronary angiography. Asymptomatic in most cases, ...     

Giant thrombosed vertebral artery aneurysm managed with extracranial-intracranial bypass surgery and aneurysmectomy. Case report.

A case is presented of a left giant thrombosed vertebral artery aneurysm in a 46-year-old man. The giant thrombosed aneurysm was successfully resected with trapping of the affected artery after right external carotid artery-posterior cerebral artery bypass surgery using a radial arterial graft. The clinical course is reported, and the details of the operative approach and techniques are discussed.     

Unilateral nerve deafness due to rupture of a right vertebral artery aneurysm. Case report

A 49-year-old female with no history of hearing disturbance developed sudden onset of headache and was admitted with no neurological deficits other than mild nuchal rigidity. Computed tomography (CT) showed subarachnoid hemorrhage. Four-vessel cerebral angiography disclosed no aneurysm. A second angiogram obtained on the 14th day showed vasospasm of the bilateral posterior cerebral arteries and right anterior inferior cerebellar artery, but still failed to demonstrate an aneurysm. Following the second angiography, she developed mild disturbance of consciousness and cerebellar ataxia of the right limbs, and repeat CT showed an infarct in the right cerebellar hemisphere. When she regained consciousness a few days later, she was completely deaf on the right side. The third angiography revealed a right vertebral artery dissecting aneurysm. Following clipping of the proximal portion of the right vertebral artery, she did well and was discharged, although right cerebellar ataxia and deafness persisted. Neuro-otological evaluation, including pure-tone audiography, auditory brainstem responses, electrocochleography, and caloric testing, indicated that her deafness resulted from ischemia in the territory of the right internal auditory artery due to vasospasm.     

Hemodynamic analysis of associated extracranial atraumatic vertebral artery aneurysm and arteriovenous fistula. Case report

A case of atraumatic arteriovenous (AV) fistula of the extracranial vertebral artery associated with an atraumatic aneurysm of the contralateral extracranial vertebral artery is reported. The fistulous lesion was excised after distal and proximal ligation of the vessel. Subsequently, the contralateral aneurysm underwent spontaneous dissolution. Seven cases of extracranial vertebral AV fistulae associated with ipsilateral vertebral artery aneurysms (four traumatic and three as part of vascular dysplastic syndromes) have been reported previously.     

Angiographically occult arteriovenous malformation in the septal region--case report.

An occult arteriovenous malformation (AVM) in the septal region occurred in a 14-year-old boy, manifesting as headache and vomiting. Computed tomography showed a high-density mass in the septal region, faintly enhanced postcontrast. Mild hydrocephalus was also seen. Angiography revealed no abnormalities other than hydrocephalic signs. The lesion was totally removed by the transventricular approach after corticotomy of the left frontal lobe. The histological diagnosis was AVM. He was discharged without neurological or endocrinological deficits.     

Hemifacial spasm caused by a spontaneous dissecting aneurysm of the vertebral artery. Case report

The authors describe the first reported case of dissecting aneurysm presenting with hemifacial spasm. The patient was a 58-year-old woman with left hemifacial spasm of 2 years' duration. Cranial nerve examination was otherwise normal and no other clinical symptoms were observed. Vertebral angiography revealed a fusiform enlargement of the left vertebral artery and contrast medium remaining in the intramural false lumen in the venous phase. Microvascular decompression of the facial nerve with wrapping of the aneurysm resulted in complete relief of the hemifacial spasm.     

Spontaneous thrombosis of a giant intracranial aneurysm and ipsilateral internal carotid artery. Case report

Computerized tomography revealed a thrombosed giant intracavernous carotid aneurysm in a man who presented with ophthalmoplegia and headache. Angiography confirmed complete aneurysmal thrombosis and also revealed complete occlusion of the ipsilateral internal carotid artery. Aneurysmotomy and thrombectomy produced substantial reduction in mass effect, with symptomatic improvement. The spontaneous thrombosis of giant intracranial aneurysms is discussed.     

Treatment of a middle cerebral artery giant aneurysm using a covered stent. Case report

The authors report the case of a 60-year-old man harboring a wide-necked giant aneurysm of the M1 segment of the left middle cerebral artery (MCA); his symptoms included transient ischemic attacks characterized by right hemiparesis and aphasia. The aneurysm was treated by placing a covered stent across the orifice of the aneurysm. The 18-month follow-up examination showed a very good outcome, with perfect left MCA patency, no new ischemic lesion, and minor residual aphasia and right hemiparesis. This is the first report in the literature of an MCA aneurysm treated using a covered stent.     

Ipsilateral hyperperfusion after neck clipping of a giant internal carotid artery aneurysm. Case report

A 48-year-old woman exhibited hyperperfusion soon after undergoing a successful clip operation involving multiple clip placement for a giant internal carotid artery (ICA) aneurysm. Intraarterial digital subtraction angiography demonstrated a left paraclinoid giant aneurysm. Multiple clips were placed to obliterate the aneurysm during a 7-minute temporary ICA occlusion. Intraoperative Doppler ultrasound flowmetry showed that the blood flow through the ICA distal to the aneurysm increased from 71.6 ml/minute before clipping to 123.3 ml/minute after. The patient exhibited right hemiparesis and motor aphasia after the operation. Postoperative imaging studies revealed an increase in perfusion and diffuse edema in the left cerebral cortex. The symptoms and diffuse brain edema gradually resolved. In this case, increase in blood flow through the ICA distal to the aneurysm may have played an important role in the circulatory disturbance.     

Posterior inferior to posterior inferior cerebellar artery anastomosis combined with trapping for vertebral artery aneurysm. Case report

A case is presented in which a giant intracranial vertebral artery aneurysm gave rise to an associated ipsilateral posterior inferior cerebellar artery (PICA) from its waist. Proximal vertebral artery ligation at C-1 was achieved. The aneurysm filled from the opposite vertebrobasilar junction. Direct intracranial trapping of the right vertebral aneurysm was followed by successful anastomosis of the proximally sectioned right PICA to the adjacent left PICA in an end-to-end fashion.     

Peripheral superior cerebellar artery aneurysm. Case report

The patient, a 37-year-old female, was hospitalized with a severe headache. Neurological examination on admission revealed no deficits except for neck stiffness and somnolence. Computed tomography showed a subarachnoid hemorrhage, which was especially prominent in the supracerebellar and quadrigeminal cisterns, but demonstrated no ventriculomegaly. Cerebral angiography on admission revealed no apparent abnormalities, but repeat angiography 8 days later disclosed a saccular aneurysm (2 X 3 mm) arising from the hemispheric branch of the left superior cerebellar artery (SCA). Three days after admission, the patient developed cerebellar dysarthria, which was assumed to be due to vasospasm. On the 24th day after admission, the aneurysm was successfully clipped through the infratentorial-supracerebellar approach. The postoperative course was uneventful and the patient was discharged with no neurological deficit. Nineteen other cases of peripheral SCA aneurysm have been reported in the literature. The presence of this type of aneurysm should be considered in patients who are fairly young and have focal neurological signs, such as third or fourth nerve palsy and/or cerebellar dysfunction. The prognosis for such patients is good, except in cases in which the neurological status is poor at the onset.