Dissecting aneurysm confined to the anterior cerebral artery

Dissecting aneurysm confined to the anterior cerebral artery (ACA) is extremely rare. Four patients presented with dissecting aneurysms confined to the ACA, two with cerebral infarctions in the territories of the ACA and two with subarachnoid haemorrhages. The two patients with infarction were treated by conservative therapy with anti-platelet therapy and the two patients with subarachnoid haemorrhage were treated by wrapping surgery in the early period after the ictus. Conservative treatment for patients with infarction and early wrapping surgery for patients with subarachnoid haemorrhage are recommended.     

Dissecting aneurysm of the anterior cerebral artery requiring surgical treatment--case report

A 45-year-old male presented with spontaneous dissecting aneurysm in the anterior cerebral artery manifesting as headache persisting for several days and speech disturbance. Neurological and laboratory examinations showed no abnormalities. Magnetic resonance imaging revealed infarction in the right cingulate gyrus. Angiography revealed occlusion of the right A2. Repeat angiography 8 months later showed a saccular aneurysm had developed. The interhemispheric approach exposed the aneurysm at the junction between the right frontopolar artery and the pericallosal artery. The aneurysm was fusiform due to the right A2 dissection. The aneurysm was trapped and resected. One month after the operation, the patient was discharged without neurological deficits. Cases of dissecting aneurysms in the anterior cerebral artery with ischemic onset are usually treated conservatively. Cases requiring surgery include those due to trauma, growing aneurysms, giant aneurysms, and uncontrolled hypertension. Some dissecting aneurysms of the distal anterior cerebral artery require only resection without bypass surgery.     

Dissecting aneurysm of the anterior cerebral artery with later development of collateral circulation: a case report

Intracranial dissecting aneurysm (DA) is much less frequent than berry aneurysm. Such dissection involves mostly the vertebral and basilar arteries, followed by the internal carotid and middle cerebral arteries. DA of the anterior cerebral artery (ACA) is relatively rare and little is known about its natural Development. Only 23 cases have been reported previously. Our present patient, a 44-year-old man, suddenly developed paresis of the left leg while bathing. Diffusion magnetic resonance imaging indicated an area of high signal intensity in the territory of the ACA. Angiography on day 3 following onset showed a DA involving the left A2 segment. Antiplatelet therapy was administered. Further luminal narrowing in the lesion was demonstrated by repeat angiography on day 17. Occlusion of the distal A2 segment was demonstrated together with sufficient collateral supply on day 41. Symptoms resolved completely. DA of the ACA usually presents with ischemic attacks. Its etiology remains uncertain, and its natural course is unclear. Surgical intervention is recommended for patients with intracranial hemorrhage, while non surgical therapies have achieved good outcomes in ischemic cases.     

Bilateral distal anterior cerebral artery aneurysm associated with supreme anterior cerebral artery: case report]

A 67-year-old woman presented with bilateral distal anterior cerebral artery aneurysms manifesting as consciousness disturbance. Computed tomography revealed subarachnoid hemorrhage in the interhemispheric fissure, right sylvian fissure, and a hematoma in the right frontal lobe and lateral ventricles. Angiography showed bilateral symmetrical aneurysms located on the pericallosal artery at the bifurcation of the callosomarginal artery. The operation was performed on the day the patient was admitted. The aneurysms were clipped via the interhemispheric approach, and the hematoma was aspirated. Operative view demonstrated rupture of the left aneurysm, and supreme anterior cerebral aneurysm. Postoperative angiography showed disappearance of the aneurysms and an intact bilateral anterior cerebral artery. The patient was discharged with mild organic mental syndrome. However, a few days later, she was admitted again with a high fever and died of complications due to sepsis. Pathological view showed clipped aneurysms and the connection of the bilateral distal anterior cerebral artery with the so-called supreme anterior communicating artery.     

主动脉夹层动脉瘤并发脊髓前动脉综合征1例报道

<正>脊髓前动脉综合征(anterior spinal artery syndrome,ASAS)是一种纵向延伸性脊髓缺血性疾病,在神经系统疾病中较为少见,但发病原因众多,症状复杂,临床误诊、漏诊率较高。现将我科收治的1例ASAS进行报道并结合相关文献,对ASAS的病因、临床特征、影像表现、治疗方案及预后进行讨论,以期提高临床医师对此疾病的认识和诊治水平。患者男,47岁,因突发腹痛、右下肢麻木伴活动障碍3h于2019年9月15日入院。患者入院前3h无明显诱因突发剧烈撕裂样腹痛,肚脐偏左明显,腹痛10min后出现     

Dissecting aneurysm of the middle cerebral artery with subarachnoid hemorrhage showing complete occlusion at the M2 portion of the middle cerebral artery on preoperative angiograms: case report

We present a surgical case of a dissecting aneurysm of the middle cerebral artery associated with subarachnoid hemorrhage and intracranial hemorrhage. A 29-year-old man suddenly fell into a comatose state, and was referred to our hospital. CT scan showed diffuse subarachnoid hemorrhage and an intracerebral hematoma with marked midline shift located in the right frontal lobe. The right carotid angiogram revealed complete occlusion at the M2 portion of the middle cerebral artery, but failed to reveal any aneurysms in the rest of the intracranial circulation. We undertook emergent surgery to evacuate the hematoma and to confirm whether it was a dissecting aneurysm or not. After evacuation of the hematoma of the right frontal lobe, the Sylvian fissure was noticed to be widely opened. We detected a large dissecting aneurysm with a dark-purplish wall arising from the right M2 trunk, and we trapped the aneurysm. The postoperative course was uneventful and the patient gradually improved and was discharged without neurological deficits. We presented this case with a review of the literature.     

Dissecting aneurysm of the anterior temporal artery: case report

A 65-year-old woman presented a rare dissecting aneurysm of the anterior temporal artery (ATA) manifesting as headache. Computed tomography and magnetic resonance imaging revealed a mixed-density mass in the horizontal segment of the middle cerebral artery. Emergent angiography demonstrated aneurysmal dilatation and a thrombosed mass in the sylvian fissure. Infectious aneurysm was excluded. She underwent emergent surgery to reduce the risk of repeated infarction and hemorrhage. The distal side of the ATA manifested occlusive changes suggestive of arterial dissection. The proximal side of the ATA was ligated and the lesion was excised. Histological examination confirmed that the aneurysmal dilatation was attributable to arterial dissection due to disruption of the internal elastic lamina. Distal dissecting aneurysms may occur in the absence of infectious disease. We recommend that ruptured distal dissecting aneurysms be treated surgically in the acute stage immediately after detection.     

Two cases of distal anterior cerebral artery aneurysm associated with accessory anterior cerebral artery

An accessory anterior cerebral artery (accessory ACA) is a rare anomalous vessel arising from the anterior communicating artery as a median artery of triplicated ACA. It is considered a large median artery of the corpus callosum and distributes to one or both hemispheres. The cases of an accessory ACA aneurysm are extremely rare; however, we experienced two cases of unruptured aneurysm growing at the distal portion of an accessory ACA. Two females, aged 66 and 67 years, respectively, separately consulted our hospital as a result of chronic headaches. Brain MR angiography and following DSA in the first patient demonstrated a triplicated ACA and an aneurysm located just above the corpus callosum growing from the distal portion of the accessory ACA. MRI and MR angiography in the second patient depicted a triplicated ACA and an aneurysm from the accessory ACA as with the first case. Neck clipping of the aneurysm was performed using an interhemispheric approach in both cases. These aneurysms appeared to present the same intraoperative findings as other unruptured aneurysms growing at the usual positions.     

Dissecting aneurysm of the posterior cerebral artery treated with proximal ligation.

A rare case of a dissecting aneurysm of the P3 segment of the right posterior cerebral artery is presented that seems to have occurred in association with mild head injury. The patient was treated surgically because of repeated intramural hemorrhage and enlargement of the aneurysm. Proximal ligation produced thrombosis of the aneurysm without resulting in infarction in the region of the posterior cerebral artery. The mechanisms of the dissection, diagnosis, and treatment are briefly discussed.     

A case showing the infraoptic course of the anterior cerebral artery associated with anterior cerebral artery aneurysm

A ruptured anterior cerebral artery aneurysm with anomalous right infraoptic course of the anterior cerebral artery (ACA) was reported. A 40-year old male was admitted because of SAH episode, and computerized tomography (CT) on the day of admission revealed hemorrhage in both Sylvian and interhemispheric fissures. Four-vessel angiography was performed on the same day. A saccular aneurysm was demonstrated in the region of the anterior communicating artery (ACoA), and anomalous artery, which originated from the intradural right carotid artery at the level of the right ophthalmic artery was found to be running medially and superiorly. It supplied the bilateral callosomarginal arteries and the unpaired pericallosal artery. The fenestration of the vertebral artery, duplication of bilateral superior cerebellar arteries, and an occipital artery arising from the right internal carotid artery at the C3 level were found. Surgery was performed on the first day of admission, and the anterior interhemispheric approach was selected. The anomalous branch of the right ICA ran beneath the right optic nerve, ascended between the optic nerves, and supplied the ACoA system. The left hypoplastic A1 segment entered the ACoA. However, the right A1 segment could not be found. The aneurysmal neck, situated between the bilateral callosomarginal arteries and the unpaired pericallosal artery, was clipped with Sugitas curved clip. The postoperative course was uneventful and a follow-up angiograph revealed successful obliteration of the aneurysm.     

Endovascular treatment of primitive persistent trigeminal artery aneurysm associated with middle cerebral artery aneurysm

We report the case of a primitive trigeminal artery aneurysm associated with an ipsilateral middle cerebral artery aneurysm. A 64-year-old Caucasian woman suffered from a severe acute headache. A head CT scan displayed subarachnoid hemorrhage and subsequent cerebral angiography showed right, wide-necked persistent trigeminal artery and ipsilateral middle cerebral artery aneurysms. The patient underwent embolization of both aneurysms with Guglielmi detachable coils. The association of a PPTA aneurysm and an ipsilateral MCA aneurysm has not been reported in the English literature.     

Dissecting aneurysm of the posterior cerebral artery: spontaneous resolution

Dissecting aneurysms of the intracranial arteries display vascular pathological features that appear sporadically, generally affecting young adults. The clinical features of this condition may involve both ischemic episodes and hemorrhages. Posterior circulation is affected less than the rest of the intracranial arteries, and it is extremely rare to find the posterior cerebral arteries only affected. Mortality is high in patients where the lesion is located in the posterior intracranial circulation, although dissecting aneurysms limited to the posterior cerebral arteries may, to a certain extent, be benign. We report the case of a young woman with ischemia in the territory of the posterior cerebral artery that occurred subsequent to a dissecting aneurysm that resolved spontaneously to a complete remission, both clinically and as demonstrated by angiography. A review of the literature is made, analyzing the pathogenic, clinical, angiographic, and therapeutic characteristics of such lesions.     

Dissecting aneurysm of the middle cerebral artery: case report

We present a surgical case of a dissecting aneurysm of the right middle cerebral artery associated with subarachnoid hemorrhage and intracranial hemorrhage. A 61-year-old woman with consciousness disturbance and left hemiplegia was referred to our hospital. She had suffered severe headache for a week. CT scan showed a subarachnoid hemorrhage in the right Sylvian fissure and intracranial hemorrhage in the right putamen. The right carotid angiogram revealed string sign in M1 portion and occlusion at M2 lower branch of the right middle cerebral artery. On the 12th day, we undertook surgery to confirm whether it was a dissecting aneurysm or not. In the operation, it was reddish in the M1 portion corresponding to the "string sign" and dark-purplish in the lower M2 portion corresponding to an "aneurysm-like lesion". To prevent bleeding, the arterial wall in the M1 portion was coated using muscle. Though the left hemiplegia was unchanged, the postoperative course was uneventful. The patient was transferred to another hospital and underwent rehabilitation. There has been no reccurrence during the four years since surgery. The middle cerebral artery dissecting aneurysm is extremely rare. We presented this case with review of the literature.     

Repair of a cerebral artery aneurysm in a patient with persistent truncus arteriosus

We describe the anesthetic management of a 19-year-old woman with persistent truncus arteriosus who presented for cerebral artery aneurysm clipping. The anatomy and pathophysiology of persistent truncus arteriosus are reviewed to provide a basis for the choice of anesthetic agents and monitoring devices in this patient. The hazards of induced hypotension in the patient with truncus arteriosus are also discussed.     

Dissecting aneurysms of the anterior cerebral artery and accessory middle cerebral artery. Case report

A 66-year-old woman presented with dissecting aneurysms of the anterior cerebral artery (ACA) and accessory middle cerebral artery (MCA) manifesting as subarachnoid hemorrhage but without radiological evidence of the dissecting aneurysms. Intraoperative observation revealed that the vessel walls were dark purple in color, a typical finding of dissecting aneurysm. The abnormal A1 segment was trapped and the dissecting aneurysm of the accessory MCA was wrapped. In the case of SAH of unknown origin, dissecting aneurysm should always be kept in mind even if the angiogram does not show any abnormal finding. This is the first reported case of dissecting aneurysm of the accessory MCA.     

Giant aneurysm of the distal anterior cerebral artery: associated with an anterior communicating artery aneurysm and a dural arteriovenous fistula.

We describe an unusual case of a giant pericallosal artery aneurysm, producing psychomotor depression from mass effect, associated with a smaller aneurysm of the anterior communicating artery, a dural arteriovenous fistula, and a meningioma. Magnetic resonance imaging (MRI) and cerebral angiography demonstrated the giant aneurysm and the meningioma. Cerebral angiography provided a detailed appreciation of the cerebral circulation, including both aneurysms, the dural arteriovenous fistula, and the potential collateral supply to the involved anterior cerebral distribution. The anterior communicating artery aneurysm was successfully clipped as was the distal anterior cerebral branch supplying the giant aneurysm before its resection. The patient made a full recovery but with persisting, slight dysphasia. We conclude that computed tomography, cerebral angiography, and MRI are of specific value in the assessment of giant aneurysms, but only angiography can provide detailed characterization of the aneurysm and demonstrate other possible cerebrovascular pathology such as multiple aneurysms and arteriovenous fistulas.     

Two cases of persistent primitive artery associated with anterior communicating aneurysm

Two aneurysm patients who have persistent primitive artery are reported. Both patients were admitted to our hospital under the diagnosis of subarachnoid hemorrhage. Carotid angiograms revealed saccular aneurysms in the anterior communicating artery. One case had the right persistent trigeminal and the other had the right persistent hypoglossal artery. Both patients were treated by aneurysmal neck clipping successfully. The incidence of association of persistent primitive trigeminal artery with intracranial vascular disease is 25%, in which 14% of cases have the intracranial aneurysms. Other congenital anomalies of the intracranial artery co-existent with intracranial aneurysm have been considerably reported so far. Our cases might suggest that congenital factors have taken part in the formation of the intracranial aneurysm.     

An aneurysm of the distal anterior cerebral artery with a remarkably anomalous configuration

A case of aneurysm on the distal anterior cerebral artery with a remarkably anomalous configuration was reported. In the present case, the left anterior cerebral artery showed hairpin-like angulation, at the top of which a small saccular aneurysm was noticed. This anomalous anterior cerebral artery seemed to feed the territories of the fronto-orbital artery and the pericallosal artery. Although the incidence of distal anterior cerebral artery aneurysm is low, they are very interesting due to several characteristics. According to the reported cases of distal anterior cerebral artery aneurysms, acute angulation of the parent vessel, at the top of which saccular aneurysm is often noticed, and the hemodynamic stress has been considered to play important roles in aneurysm formation. The findings of the cerebral angiograms and the operation of the present case were demonstrated.