Giant pericallosal artery aneurysm: case report and review of the literature

Pericallosal artery aneurysms comprise 5% of all intracranial saccular aneurysms and are usually small. Giant cerebral aneurysms mostly occur in major arteries. To date, 12 cases of giant pericallosal artery aneurysm have been reported in the literature. An unusual giant thrombosed pericallosal artery aneurysm is reported here. A 65-year-old female presented with headache and personality changes. Computed tomography, magnetic resonance imaging, and cerebral angiography revealed a right-sided giant thrombosed pericallosal artery aneurysm. The patient was operated via an anterior interhemispheric approach and the neck of the aneurysm was successfully clipped. The postoperative period was uneventful. This rare lesion is one of few cases presented in the literature in which neuroradiologic and neuropathologic evaluation was completely performed and the neck of the aneurysm was clipped. Received: 14 November 2000 / Accepted: 4 January 2000     

Traumatic middle cerebral artery aneurysm: case report and review of the literature

Traumatic intracranial aneurysms are rare. A case of traumatic middle cerebral artery aneurysm was presented. A 66-year-old man sustained a severe head injury in a bicycle accident. Serial computed tomography and angiography showed the delayed intracerebral hemorrhage caused by the traumatic middle cerebral artery aneurysm. The aneurysm was trapped and removed. Histological examination clearly revealed the pseudoaneurysm. Traumatic middle cerebral aneurysms were reviewed.     

Aneurysm of distal anterior cerebral artery associated with azygos anterior cerebral artery

Summary An aneurysm arising from the distal anterior cerebral artery distal to the bifurcation of the azygos anterior cerebral artery is reported. A review of the literature emphasizes the rarity of this lesion.     

'Mirror image' distal anterior cerebral artery aneurysms. A case report of two patients with review of literature

Summary.  We report two cases of patients with bilateral `mirror image' or `kissing' aneurysms at the distal anterior cerebral arteries who presented with subarachnoid haemorrhage and frontal intracerebral haematoma. Published online September 2, 2002 Correspondence: Mr. J. Sousa, Staff Village, Royal Preston Hospital, Sharoe green Lane, Preston, PR2 9HT.     

Etiological factors and surgical treatment of pericallosal aneurysm

In spite of the belief that pericallosal bifurcation is the predilectional site for aneurysm, only a few reports have so far been available. Since 1963 nine cases of such aneurysms have been encountered at the Yamaguchi University Hospital. All aneurysms located on so-called pericallosal bifurcation at the genu of the corpus callosum. Seven aneurysms were saccular and two were fusiform. Multiple aneurysms were found in one case, while another case had a combined arteriovenous malformation at the periphery of the aneurysm. In one case, the internal carotid artery on the opposite side was occluded. Seven of the 9 patients were treated surgically. Ligation of the afferent artery was performed in the case with combined arteriovenous anomaly. Direct attack to the aneurysm was safely done in the remaining 6 cases through interhemispheric approach, neck clipping in 3 cases and adhesive coating in 3. Postoperative results were excellent in all cases but one, in which postoperative meningitis developed. In view of the disastrous outcome of pericallosal aneurysm when left alone, we believe that the direct surgical attack is the treatment of choice. Fortunately, an aneurysm at this site can be handled easier and safer than deep seated aneurysms in connection with Willis's circle, since it can be approached by interhemispheric route.     

Giant fusiform aneurysm in middle cerebral artery branches: a report of two cases and a review of the literature

Summary Giant fusiform aneurysm (2.5 cm in length or more) is an unusual pathological entity typically described involving the main trunks of cerebral arteries and, rarely, cerebral artery branches. We are presenting two cases of middle cerebral artery branch giant fusiform aneurysm, one surgically and the other conservatively treated. We were unable to find in the literature reports of similar aneurysms at the same location. Clinical and pathological aspects, radiological findings, and treatment are discussed.     

Spontaneous dissecting aneurysms of anterior and middle cerebral artery associated with brain infarction: a case report and review of the literature

BACKGROUND

Intracranial dissecting aneurysms have been reported with increasing frequency and are recognized as a common cause of stroke. In some reviews and case reports, attempts have been made to compare the outcomes of surgical and medical treatments. However, the appropriate management of dissecting aneurysms in the anterior circulation remains controversial, especially in patients who also manifest cerebral infarction.

CASE DESCRIPTION

A 45-year-old male was diagnosed as having a dissecting aneurysm of the right middle cerebral artery (MCA) with cerebral infarction. In the course of conservative treatment, he developed a new cerebral infarction in the territory of the right anterior cerebral artery (ACA). Repeat cerebral angiograms revealed an increase in the aneurysmal dilatation of the right M2 and the appearance of a segmental dilatation of the right A2. He continued to be treated conservatively and his course was satisfactory. On subsequent angiograms, we observed resolution of the right A2 dissection and no further progression of the dilatation of the right M2.

CONCLUSION

This is the first reported case of simultaneous idiopathic dissecting aneurysms of different major arterial branches in the anterior circulation. Our review of the literature disclosed 36 and 23 cases, respectively, of dissecting aneurysms of the ACA and MCA. Many previously reported patients with these dissecting aneurysms involving subarachnoid hemorrhage (SAH) underwent surgery, which resulted in better outcome. More than half of the patients with ACA and MCA dissecting aneurysms had cerebral infarction. All ACA dissecting aneurysms involving ischemia occurred in the A2 region. The outcomes of both surgical and conservative management were equally satisfactory. On the other hand, in patients with MCA dissecting aneurysms, the area of ischemia frequently involved the M1 region; in these patients, conservative treatment resulted in poor outcomes. Therefore, revascularization distal to the compromised artery should be considered in patients with MCA-dissecting aneurysms who have ischemia. Careful interpretation of serial angiograms and/or magnetic resonance (MR) images is necessary because of the possibility of disease progression. If the aneurysmal size increases or there is progression of ischemic symptoms in the course of conservative treatment, surgery must be urgently evaluated.     

Aneurysm of an azygos anterior cerebral artery: report of two cases and review of the literature

Aneurysm of an azygos anterior cerebral artery is rare. Two cases are presented. In case 2, the coexistence of arachnoid cyst with this aneurysm is reported. Literature is reviewed.     

Ruptured aneurysm at the choroidal branch of the posterior inferior cerebellar artery: a case report and review of the literature

BACKGROUND: The authors present a rare case of a ruptured aneurysm at the choroidal branch of the posterior inferior cerebellar artery (PICA). CASE DESCRIPTION: A 77-year-old female was admitted to our institute because of sudden onset of severe headache and vomiting. Radiologic examination revealed intraventricular hemorrhage caused by rupture of the aneurysm at the choroidal branch of the PICA. The fusiform aneurysm was resected after ligation via a midline suboccipital approach. CONCLUSIONS: The conclusions drawn from this experience and a review of the literature include the following: (1) the aneurysm at the branch of the PICA is frequently associated with anomalies of the vascular structure, particularly in hypoplasty of the contralateral PICA; (2) hemodynamic stress is speculated to be a causative factor of these lesions; (3) cases with hypoplasty of the contralateral PICA have the possibility of developing nonmycotic peripheral aneurysms at the branch of the PICA; (4) these aneurysms should be managed immediately because of the high risk of rebleeding.     

颈内动脉瘤合并锁骨下动脉瘤1例

患者女,45岁,7天前突然头痛、头晕伴恶心呕吐,既往健康。查体：生命体征平稳。头颅CT平扫双侧裂池、前纵裂略高密度影。DSA（图1～4）：右侧颈内动脉前床突段向后侧方囊状膨突动脉瘤10mm×9mm,可见附壁血栓,外缘不规则。左侧锁骨下动脉、椎动脉开口远端可见向上前方囊状膨突动脉瘤7．0mm×4．2mm,外缘光滑。     

Thrombosis of an idiopathic saccular azygos aneurysm

We report a case of a large saccular idiopathic aneurysm of the azygos vein which was discovered totally thrombosed at operation. To our knowledge, such a case of thrombosis occurring in this exceptional aneurysm location has never been previously reported.     

Infraoptic anterior cerebral artery: review,report of two cases and an anatomical classification

Introduction  Infraoptic course of the pre-communicating anterior cerebral artery (A1) is a rare anomaly. In total, there are 42 examples reported in the literature. We report two further patients. The first had an intradural cerebral aneurysm at the low bifurcation of an internal carotid artery (ICA) with bilateral infraoptic course of A1. The second had right infraoptic course of A1 with associated left parietal cerebral arteriovenous malformation and is the first report of such an association. Discussion and conclusion  Overall, 59% of the examples were associated with cerebral aneurysms. Different terminology such as carotid–anterior cerebral artery anastomosis and infraoptic anterior cerebral artery has been used. Having analyzed the reports of infraoptic A1, we found the vascular configurations of the A1 could be better described by classifying them into four types. Such a classification can facilitate analysis of the embryogenesis explanation for this anomaly and the pathogenesis of the associated aneurysms. Besides, such a classification also has some practical implications.     

Aneurysmal embolization of a blisterlike aneurysm of the internal carotid artery: a case report and review of the literature

BACKGROUND: Little is known regarding the optimal management of a ruptured blisterlike aneurysm of the ICA. Because of the high risk for intraoperative bleeding, direct surgical treatments of these fragile lesions have generally been associated with a poor outcome. We herein report a very rare case of a ruptured blisterlike aneurysm that was successfully treated with coil embolization in the late period. CASE DESCRIPTION: The patient was 21 years old when he had a Hunt and Hess grade IV subarachnoid hemorrhage. At the time of the hemorrhage, 3D-CTA demonstrated a minimal aneurysmal enlargement located in the left C2 portion of the ICA. Because of his poor neurological condition and the risk for a premature rupture during early surgery, delayed surgery was thus scheduled. Cerebral angiography, 13 days later, revealed the shape and size of the aneurysm to have changed in form from a blisterlike aneurysm to a saccular-type one. Initially, we planned to treat the aneurysm by trapping with bypass surgery on the 15th day. However, we instead performed coil embolization on the 19th day because a thick thrombus was found to cover the aneurysm at the time of surgery on the 15th day. CONCLUSION: This is the first report of a ruptured blisterlike aneurysm that was successfully treated with coil embolization in the late period of a subarachnoid hemorrhage after operative confirmation of thrombus formation around the aneurysm. Our findings suggest that coil embolization in the late period appears to be an effective option in the management of selective cases of ruptured blisterlike aneurysms.     

Treatment of splenic artery aneurysm after distal splenorenal shunt. A case report

A patient with splenic artery aneurysm which developed after creation of selective distal spleno-renal shunt for hepatic cirrhosis and portal hypertension was presented. Three months after operation, an aneurysm of the splenic artery with a diameter of about 20 mm was detected. This aneurysm reached 4 cm three months later, and a resection was carried out. An arterial continuity was established by means of end-to-end anastomosis of the sectioned arterial ends. Because the flow through the splenic artery was about 60% of the total flow of the selective distal spleno-renal shunt, it is important to maintain continuity in order to avoid thrombosis of the shunt.     

Giant right coronary artery aneurysm in the setting of the acute coronary syndrome: A case report

Giant right coronary artery (RCA) aneurysm is a rare coronary artery pathology. We describe a 45-year-old gentleman who presented with unstable angina of recent onset. Diagnostic workup including chest computed tomography angiography and left heart catheterization demonstrated three-vessel coronary artery disease with giant proximal RCA aneurysm. In the view of the severity of the coronary artery disease and the risk of rupture associated with the giant RCA aneurysm and the clinical presentation, the patient was successfully treated by coronary artery bypass surgery. During this procedure, the RCA aneurysm was ligated at both inflow and outflow. The patient recovered well and was discharged home.     

Ruptured anterior spinal artery aneurysm: a case report

BACKGROUND

Spinal artery aneurysms are rare, and are usually found in association with arteriovenous malformations or coarctation of the aorta.

CASE REPORT

A 42-year-old man with a ruptured anterior spinal artery aneurysm is presented here. He experienced subarachnoid hemorrhage, which was confirmed by computed tomography. Magnetic resonance imaging revealed an aneurysm in front of the upper part of the medulla. Angiography demonstrated bilateral vertebral artery occlusion. Distal vertebral arteries and the basilar artery were perfused via the dilated anterior spinal artery, which originates in the right subclavian artery. The aneurysm was located at the distal part of the anterior spinal artery, and was successfully clipped through a lateral suboccipital craniotomy 2 months after bleeding from the aneurysm. After rehabilitation, the patient was able to walk with no apparent neurologic deficit.

CONCLUSIONS

This case suggests that the anterior spinal artery as a collateral route after bilateral vertebral arery occlusion is under hemodynamic stress, resulting in aneurysm formation and rupture.     

Preoperative angiographical prediction of the necessity to removal of the anterior clinoid process in internal carotid-posterior communicating artery aneurysm surgery

Summary During the last 10 years, we had to resect the anterior clinoid process (ACP) before applying the clip in three of the 70 patients with internal carotid-posterior communicating artery (ICPCom) aneurysms. To reveal the angiographic characteristics in these three patients, we measured the following parameters on carotid angiograms in all 70 patients: 1) the angle between the midline of the skull and the axis of the C 1 segment of the internal carotid artery (ICA) on A-P view (angle A), 2) the angle between the axes of the C1 and C2 segments of the ICA on A-P view (angle B), and 3) the distance between the posterior wall of the carotid knee and the proximal aneurysmal neck on lateral view (distance d). The common angiographic features of these three patients were as follows: 1) angle A was larger than 60 degrees, 2) angle B was less than 90 degrees, 3) distance d was less than 10mm, and 4) the posterior communicating artery was of the foetal type.The present results suggest that preoperative angiogram can predict whether or not the ACP should be removed during ICPCom aneurysm surgery.     

Giant aneurysm of an azygos anterior cerebral artery: report of two cases and review of the literature

The authors present two cases of a largely thrombosed giant aneurysm of an azygos anterior cerebral artery. An aneurysm of an azygos artery is rare, and a giant aneurysm in this location is extremely rare.