1
|
Nounaka Y, Murai Y, Shirokane K, Matano F, Koketsu K, Nakae R, Watanabe A, Mizunari T, Morita A. Spontaneous middle cerebral artery dissection: a series of six cases and literature review. Neurosurg Rev 2023; 46:229. [PMID: 37676338 DOI: 10.1007/s10143-023-02139-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 08/28/2023] [Accepted: 09/01/2023] [Indexed: 09/08/2023]
Abstract
Middle cerebral artery (MCA) dissection is rare, and various clinical presentations, including hemorrhage, ischemia, or comorbidities, and the changes in imaging findings over time hinder treatment decisions. The European Stroke Organization guidelines exclude MCA dissection. Few cases have been reported with no review of the relevant literature. Therefore, we reviewed the relevant literature and our own experience with non-traumatic MCA dissection cases to determine appropriate treatment strategies. At our institution and affiliated institutions, we encountered six cases of MCA dissection-five with infarction and one with hemorrhage. Two patients underwent revascularization, and one underwent an aneurysmectomy. We reviewed English and Japanese articles in PubMed and Medical Journal Web and summarized the results based on the relationships among age, sex, location, the presence of an aneurysm, the presence of angiography, history, treatment, and mode of onset. The clinical course, changes in imaging, treatment strategies, and prognosis were discussed. Eighty cases were included in the review. Cerebral aneurysms were more common distal to the M2 area (p = 0.00) and were correlated with hemorrhage (p < 0.001). Most hemorrhagic cases with aneurysms were treated surgically, while ischemic cases were treated with antithrombotic agents, and both had a similar neurological prognosis. There were some cases of rebleeding after antithrombotic therapy, especially in older adults.Surgical treatment is recommended in cases of hemorrhage and confirmed aneurysms, particularly for lesions distal to the M2 area. Patients with aneurysm-associated ischemia should be followed up, and antithrombotic treatment should be considered with particular care in older adults.
Collapse
Affiliation(s)
- Yohei Nounaka
- Department of Neurological Surgery, Nippon Medical School Hospital, Tokyo, 113-8603, Japan.
| | - Yasuo Murai
- Department of Neurological Surgery, Nippon Medical School Hospital, Tokyo, 113-8603, Japan
| | - Kazutaka Shirokane
- Department of Neurological Surgery, Nippon Medical School Hospital, Tokyo, 113-8603, Japan
| | - Fumihiro Matano
- Department of Neurological Surgery, Nippon Medical School Hospital, Tokyo, 113-8603, Japan
| | - Kenta Koketsu
- Department of Neurological Surgery, Nippon Medical School Chibahokuso Hospital, Chiba, Japan
| | - Ryuta Nakae
- Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital, Tokyo, Japan
| | - Akira Watanabe
- Department of Neurological Surgery, Tokyo Kyosai Hospital, Tokyo, Japan
| | - Takayuki Mizunari
- Department of Neurological Surgery, Nippon Medical School Chibahokuso Hospital, Chiba, Japan
| | - Akio Morita
- Department of Neurological Surgery, Nippon Medical School Hospital, Tokyo, 113-8603, Japan
| |
Collapse
|
2
|
Asaithambi G, Saravanapavan P, Rastogi V, Khan S, Bidari S, Khanna AY, Ganti L, Qureshi AI, Hedna VS. Isolated middle cerebral artery dissection: a systematic review. Int J Emerg Med 2015; 7:44. [PMID: 25593617 PMCID: PMC4272800 DOI: 10.1186/s12245-014-0044-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 11/12/2014] [Indexed: 11/10/2022] Open
Abstract
Acute stroke can be missed in the emergency department, particularly in younger patients and in those with more vague symptoms such as headache or dizziness. Cervicocephalic dissections are one group of etiologies for acute stroke in the young. While cervicocephalic dissections are not uncommon in clinical practice, isolated middle cerebral artery dissection (MCAD) has been rarely reported as a cause for stroke. We sought to review the clinical implications and pathophysiology of an isolated MCAD. We searched the medical literature for isolated MCAD in clinical stroke patients using MEDLINE, HighWire, and Google Scholar databases from 1966 to 2013 using the keywords 'middle cerebral artery dissection,' 'intracerebral artery dissection,' and 'middle cerebral artery dissection stroke.' We reviewed cases to learn various characteristics of isolated MCAD. A total of 61 cases (62.3% male, mean age 44.16 ± 19.17 years) were reviewed from 54 publications. Most cases were reported from Asian countries (78.7%). Ischemic strokes were more common than hemorrhagic strokes (68.9%). Digital subtraction angiography was the most common imaging modality used to diagnose isolated MCAD (75.4%). Surgery was the preferred form of therapeutic intervention (39.3%). Males (n = 27/48, p = 0.0008) and those who presented with only ischemic syndromes (n = 22/48, p = 0.0009) had significantly higher rates of favorable outcome. Isolated MCAD is a rare disease that can contribute to the stroke burden of young patients. Further studies are needed to better characterize optimal treatment strategies and define outcomes for this rare condition.
Collapse
Affiliation(s)
- Ganesh Asaithambi
- Department of Neurology, University of Florida College of Medicine, HSC Box 100236, Gainesville, FL 32610 USA
| | - Pradeepan Saravanapavan
- Department of Neurology, University of Florida College of Medicine, HSC Box 100236, Gainesville, FL 32610 USA
| | - Vaibhav Rastogi
- Department of Neurology, University of Florida College of Medicine, HSC Box 100236, Gainesville, FL 32610 USA
| | - Sheema Khan
- Department of Neurology, University of Florida College of Medicine, HSC Box 100236, Gainesville, FL 32610 USA
| | - Sharatchandra Bidari
- Department of Radiology, University of Florida College of Medicine, Gainesville, FL 32610 USA
| | - Anna Y Khanna
- Department of Neurology, University of Florida College of Medicine, HSC Box 100236, Gainesville, FL 32610 USA
| | - Latha Ganti
- North Florida South Georgia Veterans Affairs Medical Center, 1601 Archer Road, Gainesville, FL 32610 USA
| | - Adnan I Qureshi
- Zeenat Qureshi Stroke Institute, 519 2nd St N, St Cloud, MN 56303 USA
| | | |
Collapse
|
3
|
Kinoshita M, Kida S, Hasegawa M, Yamashita J, Nomura M. Pathological examination of a ruptured fusiform aneurysm of the middle cerebral artery. Surg Neurol Int 2014; 5:S465-8. [PMID: 25422790 PMCID: PMC4235114 DOI: 10.4103/2152-7806.143722] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 08/26/2014] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Little is known about the pathogenesis and clinical course of fusiform compared with saccular aneurysms. The case of a ruptured fusiform aneurysm accompanied by dissection at the M2 portion of the middle cerebral artery (MCA) is reported, along with pathological findings. CASE DESCRIPTION A 41-year-old female presenting with subarachnoid hemorrhage was revealed to have a ruptured fusiform aneurysm at the M2 portion of the right MCA on angiography. She was treated with superficial temporal artery-MCA anastomosis and trapping of the aneurysm. The aneurysm consisted of a whitish fusiform dilatation with a thickened wall of the MCA and two red protrusions on it. Pathological examinations revealed disruption and fragmentation of the internal elastic lamina and intimal thickening in the fusiform lesion. There were two aneurysmal protrusions on the main fusiform dilatation. In one protruded lesion, a dissection of the intima was observed. CONCLUSION We propose that a dissection and saccular aneurysm additionally developed on the wall of a preexisting segmental ectasia of the MCA in our case. In this report, we discuss the etiology of fusiform aneurysms of the MCA.
Collapse
Affiliation(s)
- Masashi Kinoshita
- Department of Neurosurgery, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Shinya Kida
- Department of Neurosurgery, Fukui Prefectural Hospital, Fukui, Japan
| | - Mitsuhiro Hasegawa
- Department of Neurosurgery, Fujita Health University School of Medicine, Nagoya, Japan
| | - Junkoh Yamashita
- Department of Neurosurgery, Asanogawa General Hospital, Kanazawa, Japan
| | - Motohiro Nomura
- Department of Neurosurgery, Yokohama Sakae Kyosai Hospital, Yokohama, Japan
| |
Collapse
|
4
|
Rao VY, Shah KB, Bollo RJ, Mawad ME, Whitehead WE, Curry DJ, Dauser RC, Luerssen TG, Jea A. Management of ruptured dissecting intracranial aneurysms in infants: report of four cases and review of the literature. Childs Nerv Syst 2013; 29:685-91. [PMID: 23014950 DOI: 10.1007/s00381-012-1924-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Accepted: 09/05/2012] [Indexed: 11/24/2022]
Abstract
BACKGROUND Intracranial cerebral aneurysms in the pediatric population are infrequent, and those occurring in infants less than 1 year old are extremely rare. Of intracranial aneurysms in children, dissecting aneurysms are the most common type seen. While spontaneous dissecting aneurysms usually present with ischemia, hemorrhage can also occur. METHODS A retrospective review of our patients revealed that from July 1, 2007 to June 30, 2012, four infants were treated for ruptured distal dissecting intracranial aneurysms at Texas Children's Hospital. Mycotic aneurysms and collagen vascular disorder were excluded in all four cases. All patients presented in our series presented with subarachnoid hemorrhage, and three had intraventricular hemorrhage. All patients underwent conventional catheter angiography for diagnosis. All patients in this series were managed in the acute or subacute period with surgical or endovascular trapping without distal bypass procedures. All four patients tolerated sacrifice of the parent vessels feeding these distal aneurysms well. CASE REPORT AND REVIEW OF LITERATURE We describe the presentation and management of these rare cases and then review the current literature on the management of these dissecting aneurysms in infants.
Collapse
Affiliation(s)
- Vikas Y Rao
- Division of Pediatric Neurosurgery, Texas Children's Hospital, 6621 Fannin Street, CCC 1230.01, 12th Floor, Houston, TX 77030, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
5
|
Chuang MJ, Lu CH, Cheng MH. Management of middle cerebral artery dissecting aneurysm. Asian J Surg 2012; 35:42-8. [PMID: 22726563 DOI: 10.1016/j.asjsur.2012.04.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Accepted: 04/15/2011] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Dissecting aneurysms of the intracranial carotid circulation were previously thought to occur primarily in young people presenting with cerebral infarction caused by arterial stenosis and occlusion. The appropriate management of dissecting aneurysms in the anterior circulation remains controversial, especially in patients who also present with cerebral infarction. However, recent studies have reported better outcomes for patients with middle cerebral artery (MCA) dissecting aneurysms involving surgically treated subarachnoid hemorrhage (SAH). The purpose of this study is to describe a case of spontaneous SAH from rupture of a dissecting aneurysm in the M2 segment observed in a 79-year-old man with no sign of an ischemic neurological deficit, and also to review the clinical and radiological features of cases reported since 1990. METHODS Our review of the literature identified 24 cases of MCA dissecting aneurysms after 1990. RESULTS Of the patients in these cases, 15 (63%) presented with pure bleeding and 7 (29%) with ischemia, and two were detected incidentally. Our review also found that the outcome of patients presenting with pure bleeding differed from those with ischemia. Patients with an MCA dissecting aneurysm who presented with pure bleeding showed better outcomes if they had surgery than if they did not. In contrast, the appropriate management of patients with a dissecting aneurysm who present with ischemia remains controversial. CONCLUSION Our review found that the clinical course of patients presenting with ischemia differed from that of patients presenting with pure bleeding. Most of the patients with ischemia underwent progressive deterioration. However, while the outcome for patients with ischemia treated surgically was relatively good, it remained poor compared to the outcome for patients who had been bleeding.
Collapse
Affiliation(s)
- Ming-Jung Chuang
- Department of Neurosurgery, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | | | | |
Collapse
|
6
|
Umeoka K, Shirokane K, Mizunari T, Kobayashi S, Teramoto A. Dissecting aneurysm of the anterior temporal artery: case report. Neurol Med Chir (Tokyo) 2012; 51:777-80. [PMID: 22123481 DOI: 10.2176/nmc.51.777] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Katsuya Umeoka
- Department of Neurosurgery, Nippon Medical School Chiba Hokusoh Hospital, Inzai, Chiba.
| | | | | | | | | |
Collapse
|
7
|
Yadav RR, Kumar A, Somani R, Phadke RV. Spontaneous resolution in dissecting aneurysms of the distal middle cerebral artery. Neuroradiol J 2011; 24:899-906. [PMID: 24059895 DOI: 10.1177/197140091102400613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Accepted: 09/16/2011] [Indexed: 11/17/2022] Open
Abstract
Spontaneous resolution of intracranial aneurysms is a rare phenomenon. We describe two cases of ruptured distal middle cerebral artery branch aneurysms associated with initial neurological deficit. Follow-up angiography showed complete resolution of the aneurysms.
Collapse
Affiliation(s)
- R R Yadav
- Department of Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences; Lucknow, India -
| | | | | | | |
Collapse
|
8
|
Fulkerson DH, Voorhies JM, Payner TD, Leipzig TJ, Horner TG, Redelman K, Cohen-Gadol AA. Middle cerebral artery aneurysms in children: case series and review. J Neurosurg Pediatr 2011; 8:79-89. [PMID: 21721893 DOI: 10.3171/2011.4.peds10583] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECT Pediatric intracranial aneurysms are rare lesions that differ from their adult counterparts. Aneurysms involving the middle cerebral artery (MCA) are particularly challenging to treat in children, as they are often fusiform and cannot undergo direct clipping alone. The authors recently treated a patient with a heavily calcified, dysplastic, left-sided MCA aneurysm. The present study was performed to evaluate the authors' previous operative and follow-up experience with these difficult lesions. METHODS The authors performed a review of a prospectively maintained database of all aneurysms treated at Methodist Hospital in Indianapolis, Indiana, from January 1990 through November 2010. Relevant operative notes, clinical charts, and radiological reports were reviewed for all patients 18 years of age or younger. RESULTS A total of 2949 patients with aneurysms were treated over the study period, including 28 children (0.95%). Seven children harbored MCA aneurysms. Five of these 7 aneurysms (71.4%) were fusiform. Two patients were treated with direct clipping, 2 underwent parent vessel occlusion without bypass, and 3 underwent aneurysm trapping with extracranial-intracranial vessel bypass. Long-term follow-up data were available in 6 cases. All 6 patients had a 1-year follow-up Glasgow Outcome Scale score of 5. Long-term radiological follow-up was available in 4 patients. One patient required a reoperation for a recurrent aneurysm 4 years after the initial surgery. CONCLUSIONS Middle cerebral artery aneurysms in children are often fusiform, giant, and incorporate the origins of proximal artery branches. Direct clipping may not be possible; trapping of the lesion may be required. Children seem to tolerate surgical trapping with or without bypass extremely well. Aggressive therapy of these rare lesions in children is warranted, as even patients presenting with a poor clinical grade may have excellent outcomes. Long-term surveillance imaging is necessary because of the risk of aneurysm recurrence.
Collapse
Affiliation(s)
- Daniel H Fulkerson
- Department of Neurosurgery, Indiana University School of Medicine, Goodman Campbell Brain and Spine, Indianapolis, Indiana 46202-5200, USA.
| | | | | | | | | | | | | |
Collapse
|
9
|
Peron S, Jimenez-Roldán L, Cicuendez M, Millán JM, Ricoy JR, Lobato RD, Alday R, Alén JF, Lagares A. Ruptured dissecting cerebral aneurysms in young people: report of three cases. Acta Neurochir (Wien) 2010; 152:1511-7. [PMID: 20490577 DOI: 10.1007/s00701-010-0688-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2010] [Accepted: 05/05/2010] [Indexed: 10/19/2022]
Abstract
Intracranial arterial aneurysms in the pediatric population are rare. Among these, dissecting aneurysms are the most frequent, followed by saccular, infectious, and posttraumatic. It is widely known that aneurysmal rupture is uncommon in the first two decades of life. Spontaneous dissecting aneurysms (SDAs) of the middle cerebral artery (MCA) affecting young individuals most frequently present as occlusive syndrome with ischemia, although bleeding and subarachnoid hemorrhage can also occur. Between March 2006 and January 2008, three young patients (20 months, 8 and 20 years old) were surgically treated for MCA SDA in the Neurosurgical Department of "12 de Octubre" Hospital of Madrid. These patients showed hemorrhage as primary radiological finding, and all of them underwent surgical operation. Aneurysms were always treated by trapping, with aneurysmectomy in one case, but no distal extra-intracranial (EC-IC) bypass was performed. In two cases, the histological examination of the aneurysm's wall evidenced signs of subintimal dissection with widespread disruption of the internal elastic lamina and media with neointima formation and intramural hemorrhage. Although bleeding is an uncommon presenting sign of SDAs, they should be suspected in young people showing hemorrhage at CT scan. Early surgical treatment and, if possible, preoperative neuroimaging evaluation of intracranial vessels should be performed to reduce the mortality in these patients despite a higher postoperative morbidity. From a technical point of view, surgical trapping of the aneurysm seems to be a reasonable treatment strategy especially in an emergency basis. However, whenever possible, an EC-IC bypass could help diminish the ischemic morbidity associated with these aneurysms.
Collapse
|
10
|
Park SH, Yim MB, Lee CY, Kim E, Son EI. Intracranial Fusiform Aneurysms: It's Pathogenesis, Clinical Characteristics and Managements. J Korean Neurosurg Soc 2008; 44:116-23. [PMID: 19096660 DOI: 10.3340/jkns.2008.44.3.116] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2008] [Accepted: 08/10/2008] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE The objective of this study is to investigate clinical characteristics, management methods and possible causes of intracranial fusiform aneurysm. METHODS Out of a series of 2,458 intracranial aneurysms treated surgically or endovascularly, 22 patients were identified who had discrete fusiform aneurysms. Clinical presentations, locations, treatment methods and possible causes of these aneurysms were analyzed. RESULTS Ten patients of fusiform aneurysm were presented with hemorrhage, 5 patients with dizziness with/without headache, 4 with ischemic neurologic deficit, and 1 with 6th nerve palsy from mass effect of aneurysm. Two aneurysms were discovered incidentally. Seventeen aneurysms were located in the anterior circulation, other five in the posterior circulation. The most frequent site of fusiform aneurysm was a middle cerebral artery. The aneurysms were treated with clip, and/or wrapping in 7, resection with/without extracranial-intracranial (EC-IC) bypass in 6, proximal occlusion with coils with/without EC-IC bypass in 5, EC-IC bypass only in 1 and conservative treatment in 3 patient. We obtained good outcome in 20 out of 22 patients. The possible causes of fusiform aneurysms were regard as dissection in 16, atherosclerosis in 4 and collagen disease or uncertain in 2 cases. CONCLUSION There is a subset of cerebral aneurysms with discrete fusiform morphology. Although the dissection or injury of internal elastic lamina of the cerebral vessel is proposed as the underlying cause for most of fusiform aneurysm, more study about pathogenesis of these lesions is required.
Collapse
Affiliation(s)
- Seong-Ho Park
- Department of Neurosurgery, Keimyung University, School of Medicine, Daegu, Korea
| | | | | | | | | |
Collapse
|
11
|
Yonekawa Y, Zumofen D, Imhof HG, Roth P, Khan N. Hemorrhagic cerebral dissecting aneurysms: surgical treatments and results. ACTA NEUROCHIRURGICA. SUPPLEMENT 2008; 103:61-69. [PMID: 18496947 DOI: 10.1007/978-3-211-76589-0_12] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
INTRODUCTION Cerebral dissecting aneurysms are an increasingly recognized etiology of subarachnoid hemorrhage SAH and cerebral stroke. Hemorrhagic dissecting aneurysms of the anterior circulation have been considered to be somewhat different to those of the posterior circulation not only in terms of their pathophysiology, but also in terms of their management. Herewith our series of hemorrhagic dissecting aneurysms of the internal carotid artery ICA, vertebral artery VA, basilar artery BA and some of those of distal cerebral arteries is presented and compared to the series reported in the literature. Therapeutic consideration in the light of our experiences emphasizing the significance of aneurysm entrapment in combination with bypass surgery is presented. MATERIAL AND METHODS During the last 13 years over 1000 patients with cerebral aneurysms were treated surgically in our department. Hemorrhagic dissecting aneurysms were diagnosed in 26 patients. Diagnosis was based on neuroradiological findings as well as intraoperative findings. All patients underwent surgical intervention. Clinical findings of these patients were analysed retrospectively. Follow-up outcomes were evaluated according to the Glasgow Outcome Scale GOS at 3 months after treatments. RESULTS Location of 26 dissecting aneurysms was: ICA 11 cases (42%), VA 9 cases (35%), BA 3 cases, MCA 2 cases and PCA (P1 segment) one case. Primary surgical treatments were performed on day 3.7 of SAH on average. Clinical manifestation of dissecting aneurysms of the ICA and their outcome was more severe compared with those of the VA (p < 0.01): WNFS grade 3.1 vs 2.4 and GOS score 3.4 vs 4.3. As a conventional neck clipping procedure was problematic or impossible (aneurysm recurrence after clipping, premature rupture at the time of exposure or clipping), entrapment (or proximal ligation) plus EC-IC bypass procedure was the most frequent final definitive method of surgical treatment (9/26 35%: ICA 6/11, VA 1/9 and MCA 2/2) followed by proximal ligation or trapping only 7/26, neck clipping 7/26 and coating 4/26. CONCLUSIONS Hemorrhagic dissecting aneurysms still remain problematic in their diagnosis and treatment. One has to be aware of the diagnostic possibility of dissecting aneurysms as an etiology of SAH. Neurosurgeons have to be prepared to be able to manage complex surgical situations also by the use of EC-IC bypass, as its combination with entrapment procedure can be the final treatment of choice. Less invasive endovascular technique is in evolution but its availability and superiority are still to be settled.
Collapse
Affiliation(s)
- Y Yonekawa
- Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland.
| | | | | | | | | |
Collapse
|
12
|
Leach JCD, Mitchell PJ, Siu K. Subarachnoid haemorrhage due to a dissecting aneurysm of the anterior cerebral artery: a case report. J Clin Neurosci 2007; 11:334-7. [PMID: 14975436 DOI: 10.1016/s0967-5868(03)00165-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2003] [Accepted: 05/23/2003] [Indexed: 10/26/2022]
Abstract
Dissecting aneurysms of the intracranial carotid circulation are becoming increasingly recognised as a cause of subarachnoid haemorrhage. We present a case where SAH caused by anterior cerebral artery dissection was diagnosed on a repeat angiogram and successfully treated by surgical trapping. Diagnosis may be difficult as angiographic signs may be subtle and variable. Accurate diagnosis and prompt treatment is important, as the re-bleed rate is high.
Collapse
Affiliation(s)
- J C D Leach
- Department of Neurosurgery, The Royal Melbourne Hospital, Melbourne, Vic., Australia
| | | | | |
Collapse
|
13
|
Szatmary Z, Boukobza M, Vahedi K, Stapf C, Houdart E, Bousser MG. Orgasmic headache and middle cerebral artery dissection. J Neurol Neurosurg Psychiatry 2006; 77:693-4. [PMID: 16614038 PMCID: PMC2117461 DOI: 10.1136/jnnp.2005.082719] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2005] [Revised: 12/21/2005] [Accepted: 12/21/2005] [Indexed: 11/04/2022]
Abstract
A patient with a 20 year history of primary orgasmic headache is described who, after suffering an unusually severe episode of orgasmic headache was found to have a middle cerebral artery dissection. This unusual association of primary and secondary orgasmic headache emphasises the need for a thorough diagnostic examination when the orgasmic headache differs from that of previous episodes or is associated with neurological symptoms.
Collapse
Affiliation(s)
- Z Szatmary
- Department of Neurology and Neuroradiology, Hôpital Lariboisière, 2 rue Ambroise Paré cedex 10, Paris, France.
| | | | | | | | | | | |
Collapse
|
14
|
Liu HM, Lai DM, Tu YK, Wang YH. Aneurysms in Twig-Like Middle Cerebral Artery. Cerebrovasc Dis 2005; 20:1-5. [PMID: 15925875 DOI: 10.1159/000086119] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2004] [Accepted: 02/23/2005] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND We report a vascular abnormality of the middle cerebral artery (MCA) that has not been described in the literature before. METHODS Two patients (1 male and 1 female; age 44 and 67 years, respectively) were found to have a vascular abnormality in which the main trunk of the MCA had a twig-like form. Both patients presented with intracranial hemorrhage. RESULTS In these 2 patients, the abnormality was seen before the genu of the MCA. They had an intracranial hemorrhage due to an associated aneurysm inside the twigs. The twig appeared to be a network between the bifurcation of internal carotid artery and insular segment of MCA, and it was different from the collateral circulation due to acquired occlusion or moyamoya disease. CONCLUSION This new type of vascular lesion of the MCA is not benign. It appears to be associated with the occurrence of an aneurysm, an important clinical aspect.
Collapse
Affiliation(s)
- Hon-Man Liu
- Department of Radiology, Division of Neurosurgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
| | | | | | | |
Collapse
|