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Yokoyama H, Nishihori M, Izumi T, Goto S, Kurimoto M, Kato M, Kanamori F, Uda K, Yokoyama K, Araki Y, Saito R. Ruptured Middle Cerebral Artery Aneurysm in an Infant: Case Report and Literature Review. NMC Case Rep J 2023; 10:177-183. [PMID: 37465251 PMCID: PMC10351959 DOI: 10.2176/jns-nmc.2022-0369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 03/27/2023] [Indexed: 07/20/2023] Open
Abstract
Intracranial aneurysms (IA) in infants are reportedly rare at 0.5% to 4.5% of all aneurysms. Furthermore, subarachnoid hemorrhage in infants younger than three months are even rarer as it has been reported in approximately 20 cases only till date. A 3-month-old infant with seizures and impaired consciousness was admitted to our hospital. Three-dimensional computed tomography angiography (3D-CTA) revealed a dissecting aneurysm with a maximum diameter of 13 mm in the right M2. Internal trapping using detachable coil were successfully performed, following which he was discharged without significant neurological deficit after one month of onset. Thus, we have reported a rare case of a large ruptured dissecting IA in a 3-month-old infant, in the right middle cerebral artery (MCA), successfully treated with an endovascular therapy, along with a literature review.
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Affiliation(s)
- Hayato Yokoyama
- Department of Neurosurgery, Nagoya University of Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Masahiro Nishihori
- Department of Neurosurgery, Nagoya University of Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Takashi Izumi
- Department of Neurosurgery, Nagoya University of Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Shunsaku Goto
- Department of Neurosurgery, Nagoya University of Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Michihiro Kurimoto
- Department of Neurosurgery, Aichi Children's Health and Medical Center, Obu, Aichi, Japan
| | - Mihoko Kato
- Department of Neurosurgery, Aichi Children's Health and Medical Center, Obu, Aichi, Japan
| | - Fumiaki Kanamori
- Department of Neurosurgery, Nagoya University of Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Kenji Uda
- Department of Neurosurgery, Nagoya University of Graduate School of Medicine, Nagoya, Aichi, Japan
- Department of Neurosurgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Aichi, Japan
| | - Kinya Yokoyama
- Department of Neurosurgery, Nagoya University of Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Yoshio Araki
- Department of Neurosurgery, Nagoya University of Graduate School of Medicine, Nagoya, Aichi, Japan
- Department of Neurosurgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Aichi, Japan
| | - Ryuta Saito
- Department of Neurosurgery, Nagoya University of Graduate School of Medicine, Nagoya, Aichi, Japan
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Massa DS, Montivero NA, Ciraolo CA, Medina SAP. Saccular intracranial neonatal aneurysm. Childs Nerv Syst 2023; 39:541-546. [PMID: 35941231 DOI: 10.1007/s00381-022-05640-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 08/02/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Neonatal cerebral aneurysms are very rare condition and distinct from those of the adults. CASE REPORT We reported a 14-day-old male neonate who presented subarachnoid hemorrhage due to a ruptured anterior cerebral artery saccular aneurysm. In addition, we present a review of the relevant literature. CONCLUSION Intracranial hemorrhage due to cerebral aneurysm rupture in a newborn is an uncommon diagnosis, but it must be unequivocally excluded.
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Affiliation(s)
- Daniela S Massa
- Pediatrics Neurosurgical Department, Hospital Italiano de Buenos Aires, Peron, 4190-Buenos, Aires, Argentina.
| | - Nicolás A Montivero
- Pediatrics Neurosurgical Department, Hospital Italiano de Buenos Aires, Peron, 4190-Buenos, Aires, Argentina
| | - Carlos A Ciraolo
- Pediatrics Neurosurgical Department, Hospital Italiano de Buenos Aires, Peron, 4190-Buenos, Aires, Argentina
| | - Santiago A Portillo Medina
- Pediatrics Neurosurgical Department, Hospital Italiano de Buenos Aires, Peron, 4190-Buenos, Aires, Argentina
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Saraf R, Garg T, Parvathi S. Endovascular Therapy in Paediatric Dissecting Intracranial Aneurysm: A Case Report. Neurol India 2021; 69:748-750. [PMID: 34169882 DOI: 10.4103/0028-3886.317236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The incidence of cerebral aneurysms is rare in children, and it has to be definitively ruled out in all cases of intracranial bleed even if there is associated history of trauma. We report a case of 11-month-old girl who presented with intracranial bleed after a history of minor trauma whose diagnosis of an intracranial aneurysm was initially missed which later led to a rebleed. It was managed emergently with endovascular coiling and the patient showed incredible recovery in the post-operative period.
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Affiliation(s)
- Rashmi Saraf
- Division of Interventional Neuroradiology, Department of Radiology, KEM Hospital, Mumbai, Maharashtra, India
| | - Tushar Garg
- Division of Interventional Neuroradiology, Department of Radiology, KEM Hospital, Mumbai, Maharashtra, India
| | - Shakthi Parvathi
- Division of Interventional Neuroradiology, Medical Trust Hospital, Kochi, Kerala, India
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Goia A, Garrido E, Lefebvre M, Langlois O, Derrey S, Papagiannaki C, Gilard V. Ruptured Intracranial Aneurysm in a Neonate: Case Report and Review of the Literature. World Neurosurg 2020; 140:219-223. [PMID: 32407915 DOI: 10.1016/j.wneu.2020.05.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/01/2020] [Accepted: 05/02/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Intracranial aneurysms (IAs) are exceptional in neonates accounting for less than 2% of all IAs occurring during the first decade of life. Little is known about this pathology in this specific population. Because of its scarcity and this specific age at onset, the treatment of IA in neonates is challenging. We describe a rare case of aneurysmal subarachnoid hemorrhage in a neonate and review the current literature. CASE DESCRIPTION A 21-day-old boy was admitted for hypotonia, vomiting, and seizures. Computed tomography scan revealed a subarachnoid hemorrhage in the sylvian fissure, a frontoparietal subdural hematoma, a left middle cerebral artery (MCA) aneurysm with a diameter of 11 mm, and an infarct of the MCA frontal region. He was successfully treated with endovascular coiling, neuroprotection, and antiepileptic drugs. Immediate postoperative magnetic resonance imaging showed a good aneurysm occlusion without any further ischemia. The outcome was favorable with extubation at day 10. At follow-up, the child experienced normal psychomotor development with no motor deficit. CONCLUSIONS Ruptured IAs in neonates are rare. Subarachnoid hemorrhage is the most common presentation. Intracranial aneurysms are frequently larger than 10 mm and located on the MCA. The treatment could be surgical or endovascular depending on the characteristics of the aneurysm. There is no recommendation concerning the prevention or treatment of vasospasm in neonates.
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Affiliation(s)
- Alice Goia
- Department of Neurosurgery, Rouen University Hospital, Rouen, France
| | - Elisabeth Garrido
- Department of Neurosurgery, Rouen University Hospital, Rouen, France
| | - Margaux Lefebvre
- Department of Interventional Neuroradiology, Rouen University Hospital, Rouen, France
| | - Olivier Langlois
- Department of Neurosurgery, Rouen University Hospital, Rouen, France
| | - Stéphane Derrey
- Department of Neurosurgery, Rouen University Hospital, Rouen, France
| | - Chrysanthi Papagiannaki
- Department of Interventional Neuroradiology, Rouen University Hospital, Rouen, France; University of Limoges CNRS XLIM UMR 7252, Limoges, France
| | - Vianney Gilard
- Department of Neurosurgery, Rouen University Hospital, Rouen, France; Department of Interventional Neuroradiology, Rouen University Hospital, Rouen, France; University of Limoges CNRS XLIM UMR 7252, Limoges, France; Laboratory of Microvascular Endothelium and Neonate Brain Lesions, Normandie University, UNIROUEN, INSERM U1245, Rouen, France.
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Ruptured intracranial aneurysm in a neonate. J Clin Neurosci 2020. [DOI: 10.1016/j.jocn.2019.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Radiologic Characteristics and High Risk of Seizures in Infants with Ruptured Intracranial Aneurysms: Case Report and Review of the Literature. World Neurosurg 2018; 118:e772-e777. [PMID: 30026150 DOI: 10.1016/j.wneu.2018.07.049] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 07/04/2018] [Accepted: 07/05/2018] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To evaluate the parameters related to the high risk of preoperative seizures in infants (1 year or younger) with ruptured intracranial aneurysms. METHODS Infants with ruptured intracranial aneurysms treated at our institution from January 2012 to January 2018 were retrospectively analyzed. Seventeen similar cases of infant patients with seizures reported in published studies were reviewed. RESULTS The mean age of the 7 infant patients treated at our institution was 4.1 ± 3.3 months (range, 28 days to 11 months), with 2 male and 5 female subjects. One patient (14.3%) had an internal carotid artery aneurysm with subarachnoid hemorrhage, and the remaining 6 patients (85.7%) had middle cerebral artery (MCA) aneurysms in the distal arterial region with lobe hemorrhage. Five of the 7 infants (71.4%) had seizures, 4 of whom (4/5, 80.0%) had MCA distal arterial aneurysms with lobe hemorrhage. Management was successful for all patients with aneurysm clipping or resection surgery, and one patient experienced postoperative seizures. Of the 17 reviewed cases of infant patients with seizures, 10 patients (58.8%) exhibited the typical distal arterial aneurysm with lobe hemorrhaging, and 6 (60%) of them had aneurysms in MCA. CONCLUSIONS Infant patients with ruptured intracranial aneurysms have a high risk of preoperative seizures. The typical radiologic finding of distal arterial aneurysm with lobe hemorrhage was frequently observed in the MCA, and it might be related to the high risk of preoperative seizures in this population. Microsurgical techniques effectively control postoperative seizures in infants with ruptured intracranial aneurysms.
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Mohotti JE, Carter NS, Zhang VJW, Lai LT, Xenos C, Asadi H, Chandra RV. Neonatal intracranial aneurysms: case report and review of the literature. J Neurosurg Pediatr 2018; 21:471-477. [PMID: 29498602 DOI: 10.3171/2017.10.peds17226] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Intracranial aneurysms in the neonate, presenting in the first 4 weeks of life, are exceedingly rare. They appear to have characteristics, including presentation and location, that vary from those found in adults. The authors present a case of a 28-day-old neonate with a ruptured distal middle cerebral artery (MCA) aneurysm. Initial noninvasive imaging with transfontanelle ultrasound and CT confirmed intraparenchymal and subarachnoid hemorrhage. Contrast-enhanced MRI revealed a 14-mm ruptured fusiform MCA aneurysm that was not identified on time-of-flight magnetic resonance angiography (MRA). Microsurgical treatment was performed with partial neurological recovery. A comprehensive review of the literature from 1949 to 2017 revealed a total of 40 aneurysms in 37 neonates, including the present case. The most common presenting symptom was seizure. Although subarachnoid hemorrhage was the most common form of hemorrhage, 40% had intraparenchymal hemorrhage. The median aneurysm size was 10 mm (range 2-30 mm) and the most common location was the MCA, with two-thirds of cases involving the distal intracranial vasculature. Over the last 10 years, there has been a trend of increasing noninvasive diagnosis of ruptured cerebral aneurysms in neonates, with CT angiography and contrast-enhanced MRI being the most useful diagnostic modalities. The use of contrast-enhanced MRI may improve sensitivity over time-of-flight MRA. Microsurgical treatment was the most common treatment modality overall, with increased use of endovascular treatment in the last decade. Most patients underwent microsurgical vessel ligation or endovascular parent vessel occlusion. There were high rates of neurological recovery after microsurgical or endovascular treatment, particularly for patients with distal aneurysms.
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Affiliation(s)
| | - Nicole S Carter
- 2Faculty of Medicine, Nursing, and Health Sciences, Monash University.,3Neurointerventional Service, Monash Imaging, Monash Health
| | | | - Leon T Lai
- 1Department of Neurosurgery.,2Faculty of Medicine, Nursing, and Health Sciences, Monash University.,4Monash Neurovascular Institute, Melbourne; and
| | | | - Hamed Asadi
- 3Neurointerventional Service, Monash Imaging, Monash Health.,5Neurointerventional Service, Department of Radiology, Austin Health.,6School of Medicine, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Ronil V Chandra
- 2Faculty of Medicine, Nursing, and Health Sciences, Monash University.,2Faculty of Medicine, Nursing, and Health Sciences, Monash University
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Ghali MGZ, Srinivasan VM, Cherian J, Kim L, Siddiqui A, Aziz-Sultan MA, Froehler M, Wakhloo A, Sauvageau E, Rai A, Chen SR, Johnson J, Lam SK, Kan P. Pediatric Intracranial Aneurysms: Considerations and Recommendations for Follow-Up Imaging. World Neurosurg 2017; 109:418-431. [PMID: 28986225 DOI: 10.1016/j.wneu.2017.09.150] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 09/20/2017] [Accepted: 09/21/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Pediatric intracranial aneurysms (IAs) are rare. Compared with adult IAs, they are more commonly giant, fusiform, or dissecting. Treatment often proves more complex, and recurrence rate and de novo aneurysmogenesis incidence are higher. A consensus regarding the most appropriate algorithm for following pediatric IAs is lacking. METHODS We sought to generate recommendations based on the reported experience in the literature with pediatric IAs through a thorough review of the PubMed database, discussion with experienced neurointerventionalists, and our own experience. RESULTS Digital subtraction angiography (DSA) was utilized immediately post-operatively for microsurgically-clipped and endovascularly-treated IAs, at 6-12 months postoperatively for endovascularly-treated IAs, and in cases of aneurysmal recurrence or de novo aneurysmogenesis discovered by non-invasive imaging modalities. Computed tomographic angiography was the preferred imaging modality for long-term follow-up of microsurgically clipped IAs. Magnetic resonance angiography (MRA) was the preferred modality for following IAs that were untreated, endovascularly-treated, or microsurgically-treated in a manner other than clipping. CONCLUSIONS We propose incidental untreated IAs to be followed by magnetic resonance angiography without contrast enhancement. Follow-up modality and interval for treated pediatric IAs is determined by initial aneurysmal complexity, treatment modality, and degree of posttreatment obliteration. Recurrence or de novo aneurysmogenesis requiring treatment should be followed by digital subtraction angiography and appropriate retreatment. Computed tomography angiography is preferred for clipped IAs, whereas contrast-enhanced magnetic resonance angiography is preferred for lesions treated endovascularly with coil embolization and lesions treated microsurgically in a manner other than clipping.
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Affiliation(s)
- Michael George Zaki Ghali
- Department of Neurosurgery, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA; Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | | | - Jacob Cherian
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Louis Kim
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Adnan Siddiqui
- Department of Neurosurgery, University at Buffalo, Buffalo, New York, USA
| | - M Ali Aziz-Sultan
- Vascular and Endovascular Neurosurgery, Department of Neurosurgery, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Michael Froehler
- Department of Neurology, Vanderbilt School of Medicine, Nashville, Tennessee, USA
| | - Ajay Wakhloo
- Department of Radiology, University of Massachusetts, Worcester, Massachusetts, USA
| | - Eric Sauvageau
- Baptist Neurological Institute, Lyerly Neurosurgery, Jacksonville, Florida, USA
| | - Ansaar Rai
- Department of Interventional Neuroradiology, West Virginia University, Morgantown, West Virginia, USA
| | - Stephen R Chen
- Department of Radiology, Baylor College of Medicine, Houston, Texas, USA
| | - Jeremiah Johnson
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Sandi K Lam
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Peter Kan
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA.
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Hidalgo J, Dickerson JC, Burnsed B, Luqman A, Shiflett JM. Middle cerebral artery aneurysm rupture in a neonate with interrupted aortic arch: case report. Childs Nerv Syst 2017; 33:999-1003. [PMID: 28251324 DOI: 10.1007/s00381-017-3365-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 02/09/2017] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Arterial cerebral aneurysms in the neonatal population are rare, and while the association of interrupted aortic arch and intracranial aneurysm has been reported in the adult and pediatric population (three cases each), to date, it has not been reported in the neonate. CASE REPORT We report the case of a 26-day-old girl who presented with a generalized seizure 2 weeks after undergoing congenital heart surgery. Head CT revealed diffuse SAH with a 1.7 × 2.9-cm frontal intra-parenchymal hematoma with subdural extension producing 3 mm of midline shift. CTA evidenced a 2-mm left MCA bifurcation aneurysm, and the patient was taken to the operating room for clipping. Twenty-four-hour post-operative head CT showed ventriculomegaly and an EVD was placed. It was removed 4 days later without the need for permanent CSF diversion, and after this, her hospital stay was uneventful and she was discharged home. At 25 months of age, she was meeting developmental milestones. At this time, she underwent further heart surgery and expired shortly thereafter due to cardiomyopathy. CONCLUSION Here, we report the successful treatment of a ruptured neonatal aneurysm, and the first known case associated with interrupted aortic arch. Given the time and presentation, this patient likely illustrates the role of hemodynamic factors in the rupture of neonatal aneurysms. In reviewing all of the reported cases of neonatal aneurysms, promptly securing the aneurysm by either open clipping, parent vessel occlusion, or endovascular coiling is strongly preferable to no surgical intervention.
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Affiliation(s)
- Joaquin Hidalgo
- Department of Neurological Surgery, University of Mississippi Medical Center, Batson's Children Hospital, 2500 N State St, Jackson, MS, 39216, USA.
| | - James Charles Dickerson
- Department of Neurological Surgery, University of Mississippi Medical Center, Batson's Children Hospital, 2500 N State St, Jackson, MS, 39216, USA
| | - Brandon Burnsed
- Department of Neurological Surgery, University of Mississippi Medical Center, Batson's Children Hospital, 2500 N State St, Jackson, MS, 39216, USA
| | - Ali Luqman
- Department of Neurological Surgery, University of Mississippi Medical Center, Batson's Children Hospital, 2500 N State St, Jackson, MS, 39216, USA
| | - James Mason Shiflett
- Department of Neurological Surgery, University of Mississippi Medical Center, Batson's Children Hospital, 2500 N State St, Jackson, MS, 39216, USA
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Yatomi K, Oishi H, Yamamoto M, Suga Y, Nonaka S, Yoshida K, Arai H. Radiological changes in infantile dissecting anterior communicating artery aneurysm treated endovascularly. A case report and five-year follow-up. Interv Neuroradiol 2014; 20:796-803. [PMID: 25496693 DOI: 10.15274/inr-2014-10093] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 05/31/2014] [Indexed: 11/12/2022] Open
Abstract
Intracranial aneurysms are extremely rare in infants, and to our knowledge only seven infants treated for ruptured spontaneous dissecting aneurysms have been reported. Good outcomes have been achieved with endovascular treatment of infantile aneurysm. We the endovascular treatment of a one-month-old girl for ruptured dissecting aneurysm located in the anterior communicating artery, and the unique radiological changes that were observed during the perioperative and follow-up periods. These changes suggest that blood coagulation and fibrinolytic response play a part in the repair and healing processes of dissecting aneurysms. Careful neuroradiological surveys are needed for pediatric dissecting aneurysms treated endovascularly.
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Affiliation(s)
- Kenji Yatomi
- Departments of Neurosurgery, Juntendo University School of Medicine; Tokyo, Japan -
| | - Hidenori Oishi
- Departments of Neurosurgery and Neuroendovascular Therapy, Juntendo University School of Medicine; Tokyo, Japan
| | - Munetaka Yamamoto
- Departments of Neurosurgery, Juntendo University School of Medicine; Tokyo, Japan
| | - Yasuo Suga
- Departments of Neurosurgery, Juntendo University School of Medicine; Tokyo, Japan
| | - Senshu Nonaka
- Departments of Neurosurgery, Juntendo University School of Medicine; Tokyo, Japan
| | - Kensaku Yoshida
- Department of Neurosurgery, Tokyo Metropolitan Hiroo Hospital; Tokyo, Japan
| | - Hajime Arai
- Departments of Neurosurgery, Juntendo University School of Medicine; Tokyo, Japan
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Anichini G, Passacantilli E, Lenzi J, Guidetti G, Santoro A. Dissecting aneurysm of the middle cerebral artery treated with heparin infusion in a 6-year-old child; neurological recovery with delayed spontaneous thrombosis: case illustration and literature review. Neurol Sci 2011; 33:313-6. [DOI: 10.1007/s10072-011-0704-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2011] [Accepted: 07/05/2011] [Indexed: 12/26/2022]
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