Iatrogenic false aneurysm caused by surgery of a traumatic intracranial false aneurysm

A superficial temporal artery (STA) false aneurysm caused by surgery of a traumatic intracranial false aneurysm is reported. A 28-year-old man underwent craniotomy for aneurysm clipping 20 days after traumatic head injury. At surgery the aneurysm was a false aneurysm due to its avulsion from the parent artery without a real neck. A "clip wrapping" technique was used to repair the deficit on the parent artery. On postoperative Day 25, repeat digital subtraction angiogram (DSA) revealed a new right STA aneurysm, which was not apparent in the preoperative DSA. We feel that this aneurysm might have probably resulted from the iatrogenic injury to the STA during the initial surgery as the location of aneurysm was at the initial craniotomy site. The pathophysiology, etiology, surgical treatment and preventive measures of false aneurysms have been discussed.     

MR imaging of giant intracranial aneurysm.

We reviewed the clinical features and findings of magnetic resonance imaging (MRI) in 17 cases of giant intracranial aneurysm (GIA). All were confirmed by digital subtraction angiography (DSA). Seven were non-thrombosed and 10 were partially thrombosed.All thrombosed parts showed no enhancement. The majority of the lumen showed good enhancement in the post-contrast study (89%). About 80% of the partially thrombosed aneurysms had an onion skin appearance on non-contrast T1WI. On T2WI about 80% of partially thrombosed aneurysms had a low signal inside the thrombus or its wall from the susceptibility effect of blood elements such as haemosiderin. Flow void sign was noted in 88% on non-contrast T1WI and T2WI. Flow artifacts along the phase-encoding direction from the lumen of the aneurysm were noted in 41% of non-contrast T1WI, 56% of contrast-enhanced T1WI, and 29% of T2WI.Non-enhancement inside the thrombus and an onion skin appearance were important signs of thrombosis of the aneurysm. Flow artifacts along the phase-encoding direction from the lumen of the aneurysm provided an important clue of a patent lumen inside an aneurysm. The following signs provided clues to the diagnosis of patency lumen instead of thrombosis with high sensitivity and specificity: flow void sign on noncontrast T1WI (sensitivity 88%, specificity 100%), enhancement on contrast-enhanced T1WI (sensitivity 89%, specificity 100%), presence of either flow void sign or enhancement on contrast-enhanced T1WI (sensitivity 100%, specificity 100%).     

颅内动脉瘤破裂出血后假性动脉瘤的影像学特征及血管内栓塞治疗

目的 探讨颅内动脉瘤破裂出血后存其破口周围所形成的假性动脉瘤与真性动脉瘤复合体的影像学特征及血管内治疗方法，并客观评价其治疗效果：方法 对44例破裂性动脉瘤采用CT及DSA等影像学检查；并对这种真性与假性动脉瘤复合体采用电解可脱性弹簧圈进行动脉瘤囊内栓塞。结果 44个破裂性动脉瘤均在其破口周围形成假性动脉瘤，按DSA的影像表现将其分为三型：其中A型9例，B型23例，C型12例：44个动脉瘤均被成功栓塞，其中真性动脉瘤腔100％闭塞者37个．95％闭塞者5个，90％闭塞者2个；9例A型与23例B型假性动脉瘤腔均未行弹簧圈填塞，12例C型中10例仅用弹簧圈疏松填塞假性动脉瘤腔，另2例用3D—GDC仅栓塞真性动脉瘤腔部分。术中并发症：动脉瘤破裂1例，脑血管痉孪2例，脑梗搴1例。术后1例复发者经二次补充填塞GDC治愈。其治疗结果根据Glasgow预后评分：Ⅰ级40例，Ⅱ级2例，Ⅲ级1例，全组死亡1例。术后随访3—60个月均无再出血。结论 颅内动脉瘤破裂出血后住破口周围可以形成假性动脉瘤，其特征在DSA影像上可表现为三种类型；对这种真性与假性动脉瘤复合体采用电解可脱性弹簧圈进行血管内囊内栓塞疗效可靠。     

Closed cervicocranial trauma, "false aneurysm" of the internal carotid artery and brain infarction

A 17-year-old man developed acute hemiparesis 6 months after a motor cycle accident. In the accident he had a closed trauma on the contralateral side of the head and the neck, with multiple bone fractures. Aortocervical angiography, performed after the infarction, revealed a 2.5 cm long aneurysmatic dilatation in the internal carotid artery, the presumably source of embolic infarction. This and the 24 other cases gathered from the literature support the notion that closed neck trauma may create "false aneurysm" which again may cause neurological deficits.     

Spontaneous dissecting aneurysm of the internal carotid artery. Magnetic resonance imaging

A man underwent Magnetic Resonance Imaging (MRI) of the left carotid artery 11 days after a spontaneous dissection of this vessel. T1 weighed images were obtained in the frontal and axial planes. There was a hyperintense lesion expanding the arterial wall due to the hematoma. The image of the lumen was narrowed. These findings corresponded to the angiographic abnormalities. In this case MRI was able to diagnose specifically and non invasively carotid artery dissections. Its sensitivity remains to be evaluated.     

A false traumatic giant aneurysm of the supraclinoid carotid artery. A case report and review of the literature

Abstract

A patient presented with left hemiparesis and facial palsy developed 20 days after a traffic accident A computerized tomography (CT) scan revealed right suprasellar mass lesion. A repeated CT scan revealed a growing mass. Carotid angiogram demonstrated a giant aneurysm of the supraclinoid internal carotid artery (ICA) with no distal filling. Formation of the aneurysm was thought to be due to an overstretching or torsion of the artery or tearing of the ICA by nearby prominent bony structure since no basal skull fracture was detected in the plain skull film or CT scans. The aneurysm was treated by intracranial trapping of the ICA. We present this patient’s findings and review previously reported cases in the literature. [Neurol Res 1996; 18: 135–139]     

Mycotic intracavernous carotid aneurysm.

Intracavernous carotid mycotic aneurysms are rare and management is dictated by clinical presentation. This case involved a patient presenting with a symptomatic expanding proximal internal carotid artery aneurysm treated with antibiotics and balloon occlusion but with thromboembolic complications resulting in a fatal outcome. Points of discussion include difficulties faced in reaching a diagnosis, management options for mycotic aneurysms and the rationale in this case for choosing endovascular rather than surgical treatment. The use and limitations of trial balloon occlusion are discussed as well as complications of vessel occlusion, in particular thromboembolism. Also discussed is the importance of surveillance imaging and the impact of sepsis on overall management.     

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