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Wang MX, Nie QB. Giant cavernous aneurysms occluded by aneurysmal thrombosis, calcification, parent artery occlusion: A case report and review of literature. World J Clin Cases 2024; 12:2822-2830. [PMID: 38899288 PMCID: PMC11185339 DOI: 10.12998/wjcc.v12.i16.2822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/26/2024] [Accepted: 03/13/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Patients with giant intracranial aneurysms (GIAs) are at a high risk of rupture, morbidity, and mortality even after surgical or endovascular treatment. We described a case of a spontaneously occluded GIA secondary to gradual growth of the GIA, continuously progressed aneurysmal thrombosis, complete aneurysmal calcification and complete occlusion of the parent artery-the right internal carotid artery (RICA). CASE SUMMARY A 72-year-old female patient complained of sudden pain in her right eye upon admission to our hospital. She had been diagnosed with a GIA [30 mm (axial) × 38 mm (coronal) × 28 mm (sagittal)] containing an aneurysmal thrombus located in the cavernous sinus segment of RICA diagnosed by magnetic resonance imaging (MRI), enhanced MRI, and magnetic resonance angiography more than 14 years ago. Later, with slow growth of the cavernous carotid GIA, aneurysmal thrombosis progressed continuously, spontaneous occlusion of the RICA, complete aneurysmal calcification, and occlusion of the GIA occurred gradually. She had no history of subarachnoid hemorrhage but missed the chance for endovascular therapy at an early stage. As a result, she was left with severe permanent sequelae from the injuries to the right cranial nerves II, III, IV, V1/V2, and VI. CONCLUSION The risk of rupture of the cavernous carotid GIAs was relatively low and possibly further be reduced by the stasis flow and spontaneous occlusion of the parent artery internal carotid artery (ICA) induced by the mass effect of the cavernous carotid GIAs and the extremely rare aneurysmal calcification. However, nowadays, it is advisable to recommend early endovascular treatment for the cavernous carotid GIAs to prevent injuries to the surrounding intracranial nerves and occlusion of the ICA, mainly caused by the mass effect of the cavernous carotid GIAs.
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Affiliation(s)
- Ming-Xi Wang
- School of Medicine, Huaqiao University, Xiamen 361021, Fujian Province, China
| | - Qing-Bin Nie
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing 100853, China
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Jha VC, Jain R, Sinha VS, Kumar N, Verma G, Dhage N. Spontaneous thrombosis and calcification of giant cavernous carotid artery aneurysm: A rare case and management insights. Surg Neurol Int 2024; 15:98. [PMID: 38628510 PMCID: PMC11021061 DOI: 10.25259/sni_805_2023] [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: 09/26/2023] [Accepted: 02/19/2024] [Indexed: 04/19/2024] Open
Abstract
Background Giant cavernous carotid artery aneurysms (>25 mm) are rare (3-5%), with some prone to spontaneous thrombosis (10-20% complete). We present a unique case of one of the largest aneurysms spontaneously thrombosing and calcifying. Case Description A 57-year-old with persistent right-sided headaches had a substantial hyperdense mass in the right middle cranial fossa, eroding petrous bone. Magnetic resonance imaging and digital subtraction angiography revealed a giant cavernous segment fusiform aneurysm of the right internal carotid artery (ICA) with spontaneous thrombosis and distal ICA occlusion. Collateral circulation maintains the cerebral blood supply. Despite anatomical challenges, conservative management was chosen due to the patient's stability. Conclusion This case highlights the complex interplay between thrombosed giant aneurysms and affected vessels, with unique features such as cross-flow, calcification, and bone erosion. We advocate conservative management for stable cases, supported by literature, emphasizing vigilant follow-up. This expands the spectrum of aneurysm presentations and encourages further research into their dynamics.
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Affiliation(s)
- Vikas Chandra Jha
- Department of Neurosurgery, All India Institute of Medical Sciences, Patna, Bihar, India
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3
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Abousedu YA, Saleem A, Alenezi S, Bosnjakovic P, Lazovic L, Alsheikh TM. Spontaneous thrombosis of a giant cavernous-carotid aneurysm with simultaneous ipsilateral complete parent artery occlusion: a rare phenomenon and review of the literature. Arch Clin Cases 2023; 10:21-28. [PMID: 36814678 PMCID: PMC9940282 DOI: 10.22551/2023.38.1001.10234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
Cavernous-carotid artery (CCA) aneurysms represent about 3-5% of all intracranial aneurysms. Spontaneous thrombosis of a CCA aneurysm with simultaneous occlusion of its parent vessel is an extremely rare phenomenon with few reported cases in the literature offering different management strategies. A 54-year-old Asian female presented with a one day-history of painless left eye conjunctival injection, proptosis, and features of cavernous sinus syndrome (cranial nerve III, IV, V1, V2, and VI palsies). Imaging revealed a giant thrombosed CCA aneurysm measuring 3.6cmx3.4cm with complete thrombosis of the left cervical internal carotid artery (ICA) and adequate collaterals from the anterior and posterior communicating artery and branches of the left external carotid artery. Management was conservative with antiplatelet therapy and close clinical-radiological follow-ups. The outcome was satisfactory. Data in the literature on this condition is limited due to its exceedingly rare occurrence. The majority of patients do well via a conservative approach and surgery is rarely indicated. For clinically stable patients, especially those with adequate collateral circulation and tolerance to Balloon Test Occlusion, we advocate for a conservative approach and initiation of anti-platelet therapy to treat these patients. Emphasis is needed on close serial clinical-radiological surveillance in these cases to monitor the propagation of the thrombus as well as the development of new and/or enlarging pre-existing aneurysms in the contralateral ICA circulation.
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Affiliation(s)
- Yousef A.I. Abousedu
- Department of Neurosurgery, Ibn Sina Hospital, Ministry of Health, Kuwait City, Kuwait,Corresponding Author: Yousef A. I. Abousedu. Department of Neurosurgery, Ibn Sina Hospital, Ministry of Health, Kuwait City, PO Box: 25427 Safat 13115 Kuwait.
| | - Athary Saleem
- Department of Neurosurgery, Ibn Sina Hospital, Ministry of Health, Kuwait City, Kuwait
| | - Saqer Alenezi
- Department of Neurosurgery, Ibn Sina Hospital, Ministry of Health, Kuwait City, Kuwait
| | - Petar Bosnjakovic
- Medical Imaging Department, Ibn Sina Hospital, Ministry of Health, Kuwait City, Kuwait
| | - Lazar Lazovic
- Medical Imaging Department, Ibn Sina Hospital, Ministry of Health, Kuwait City, Kuwait
| | - Tarik M. Alsheikh
- Department of Neurosurgery, Ibn Sina Hospital, Ministry of Health, Kuwait City, Kuwait
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4
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Kamogawa M, Koide T, Kikuchi R, Nakamura A, Tagawa A, Miyazaki H. A Case of Wallenberg's Syndrome Presenting with Spontaneous Thrombosis of a Vertebral Artery Aneurysm. J Stroke Cerebrovasc Dis 2020; 29:104492. [DOI: 10.1016/j.jstrokecerebrovasdis.2019.104492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 10/03/2019] [Accepted: 10/21/2019] [Indexed: 10/25/2022] Open
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Darkwah Oppong M, Jabbarli R, Radbruch A, Sure U, Dammann P. Blind Date with an Aneurysm: Acute M1 Middle Cerebral Artery Thrombus with Native Computed Tomography Scan Suggesting Aneurysm Rupture. World Neurosurg 2019; 132:103-105. [PMID: 31493595 DOI: 10.1016/j.wneu.2019.08.206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 08/24/2019] [Accepted: 08/26/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND We present a case of a concurrent rupture of a middle cerebral artery (MCA) aneurysm and thrombosis of the associated vessel. CASE DESCRIPTION A male patient presented with acute onset of hemiparesis and nuchal pain. A computed tomography scan revealed a right sided frontotemporal intracerebral hemorrhage and a basal subarachnoid hemorrhage. Owing to obliteration of the M1 segment of the MCA, no aneurysm was visible on digital subtraction angiography. Because of otherwise typical imaging for a subarachnoid hemorrhage, surgical exploration of the MCA was performed. During surgery, a thrombosed MCA bifurcation aneurysm was identified, clipped, and subsequently, endovascular (partly) recanalization of the MCA was performed. CONCLUSIONS In extremely rare cases of aneurysm rupture and subsequent thrombosis of the associated vessel, a 2-stage approach seems to be feasible. In the present case, initial surgical securing of the aneurysm followed by endovascular recanalization of the occluded vessel provided good results.
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Affiliation(s)
- Marvin Darkwah Oppong
- Department of Neurosurgery, University Hospital, University of Duisburg-Essen, Essen, Germany.
| | - Ramazan Jabbarli
- Department of Neurosurgery, University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Alexander Radbruch
- Institute for Diagnostic and Interventional Radiology, University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Ulrich Sure
- Department of Neurosurgery, University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Philipp Dammann
- Department of Neurosurgery, University Hospital, University of Duisburg-Essen, Essen, Germany
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6
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Extracranial–Intracranial High-Flow Bypass for Giant Ruptured Paraclinoid Aneurysm with Concomitant Bilateral Internal Carotid Artery Stenotic Dissection. World Neurosurg 2018; 117:265-270. [DOI: 10.1016/j.wneu.2018.06.101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 06/13/2018] [Accepted: 06/14/2018] [Indexed: 12/26/2022]
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7
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Das KK, Singh G, Pandey S, Bhaisora KS, Jaiswal A, Behari S. Completely Thrombosed Giant Intracranial Aneurysm with Spontaneous Thrombosis of the Parent Artery: Is It Nature's Divine Intervention and a Self-Cure? World Neurosurg 2018; 118:132-138. [PMID: 30026148 DOI: 10.1016/j.wneu.2018.07.072] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 07/05/2018] [Accepted: 07/07/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Although partial thrombosis is common with intracranial aneurysms, complete aneurysmal thrombosis is extremely rare. An even rarer and seldom reported phenomenon is the spontaneous complete occlusion of the parent artery in the presence of a thrombosed aneurysm. Given the unclear natural history of this phenomenon, therapeutic decision making may be rather difficult. Here we report a case of right cavernous carotid artery aneurysm with spontaneous right internal carotid artery (ICA) thrombosis in a 45-year-old man. CASE DESCRIPTION Our patient presented almost 1 month after an episode of sudden-onset severe holocranial headache associated with vomiting that had resolved completely within 2 days. He was neurologically intact at the time of presentation. A computed tomography (CT) scan done at the time of ictus showed a rounded hyperdensity with the epicenter at the right parasellar region along with nonvisualization of the ipsilateral ICA on CT angiography. Magnetic resonance imaging (MRI) suggested a diagnosis of a completely thrombosed right cavernous segment ICA aneurysm. Intra-arterial angiography confirmed a complete ipsilateral ICA thrombosis and a good arterial cross-flow from the left side to the bilateral anterior and middle cerebral artery territories. We started the patient on oral aspirin and a close clinicoradiologic follow-up after having decided against any active intervention. CONCLUSIONS Spontaneous thrombosis of an intracranial aneurysm and the parent artery is rare, with only a few cases reported in the literature. In the absence of symptoms and adequate collateral circulation, these patients are perhaps best managed conservatively.
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Affiliation(s)
- Kuntal Kanti Das
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
| | - Gagandeep Singh
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Satyadeo Pandey
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Kamlesh Singh Bhaisora
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Awadhesh Jaiswal
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Sanjay Behari
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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8
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Sastri SB, Sadasiva N, Pandey P. Giant cavernous carotid aneurysm with spontaneous ipsilateral ICA occlusion: Report of 2 cases and review of literature. J Neurosci Rural Pract 2013; 4:S113-6. [PMID: 24174776 PMCID: PMC3808038 DOI: 10.4103/0976-3147.116439] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Giant aneurysms of the cavernous carotid artery are rare entities which present predominantly with features of compression of the adjacent neural structures, most commonly the III, IV, VI and V cranial nerves. Historically, treatment options included occlusion of the feeding vessel, direct surgery on the aneurysm, bypass procedures and in recent times, the use of endovascular devices. While intramural thrombus formation is commonly seen in giant aneurysms, we present 2 cases of giant cavernous aneurysms which on evaluation were found to have spontaneous occlusion of the feeding internal carotid artery secondary to thrombus formation, and review the available literature regarding the same.
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9
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Sillero RDO, Sillero Filho VJ, Zimmermann GPM. Rare case of carotid artery occlusion due to thrombosis of a giant cerebral aneurysm: the role of cerebral revascularization. ARQUIVOS DE NEURO-PSIQUIATRIA 2012; 70:159-61. [PMID: 22311227 DOI: 10.1590/s0004-282x2012000200020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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10
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Baldawa SS, Pendharkar H, Menon GR, Nair SR. Case report: Thrombosed giant cavernous carotid artery aneurysm secondary to cervical internal carotid artery dissection: An unusual entity. Indian J Radiol Imaging 2011; 21:225-7. [PMID: 22013300 PMCID: PMC3190497 DOI: 10.4103/0971-3026.85373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Spontaneous thrombosis of a giant intracranial aneurysm with parent artery occlusion is known. The exact mechanism is however unclear and various theories have been proposed. We present an unusual case of an angiographically documented cervical internal carotid artery (ICA) dissection, which led to total occlusion of the ICA distal to the dissected site, with acute cessation of forward blood flow. This resulted in acute upstream thrombosis of the giant cavernous carotid artery aneurysm and an acute cavernous sinus syndrome-like presentation.
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Affiliation(s)
- Sachin S Baldawa
- Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
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11
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DATE I. Symptomatic Unruptured Cerebral Aneurysms: Features and Surgical Outcome. Neurol Med Chir (Tokyo) 2010; 50:788-99. [DOI: 10.2176/nmc.50.788] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Isao DATE
- Department of Neurological Surgery, Okayama University Graduate School of Medicine
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12
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Songsaeng D, Srivatanakul K, Toulgoat F, Saliou G, Ozanne A, Lasjaunias P. Repair process in spontaneous intradural dissecting aneurysms in children: report of eight patients and review of the literature. Childs Nerv Syst 2009; 25:55-62. [PMID: 18712397 DOI: 10.1007/s00381-008-0698-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2008] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The objective of this study is to present a series of eight pediatric patients (less than 16 years old) with complete spontaneous thrombosis of spontaneous intradural dissecting aneurysms. MATERIAL AND METHODS Since 1989, eight consecutive patients in whom the cerebral aneurysms (four in middle cerebral arteries, one in posterior cerebral artery, three in basilar arteries) were found complete spontaneous thrombosis on follow-up MRI/MRA or conventional angiography. Patient histories and angiographic features were retrospectively reviewed. RESULTS Complete thrombosis of aneurysms in between first few days to 7 months was found in eight out of 1,587 patients (0.5%) in this recent series. Aneurysm repair was related to multivariate processes. Headache (50%), vomiting, and hemiplegia (37.5%) were common presenting symptoms. Partial or total resolution of the symptoms in a few months was often seen. Associated parent artery occlusions (50%) were also observed. CONCLUSION Spontaneous resolution of intradural dissecting aneurysm with or without parent artery occlusion is not uncommon even in the pediatric population. Aneurysm repair is a dynamic and multifaceted entity. Mural hematoma appears to be the most important factor promoting thrombosis and healing of the dissecting intracranial aneurysms.
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Affiliation(s)
- Dittapong Songsaeng
- Service de Neuroradiologie Diagnostique Thérapeutique, Hôpital de Bicêtre-Université Paris-sud Orsay, 78 rue du Général Leclerc, 94275, Le Kremlin-Bicêtre, France.
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Nanda A, Vannemreddy PSSV. Cerebral Ischemia as a Presenting Feature of Intracranial Aneurysms: A Negative Prognostic Indicator in the Management of Aneurysms. Neurosurgery 2006; 58:831-7; discussion 831-7. [PMID: 16639316 DOI: 10.1227/01.neu.0000209643.66807.80] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Cerebral ischemia (stroke) can be a presenting clinical feature of intracranial aneurysms and may herald poor prognosis. METHODS A retrospective review of admissions for aneurysms over a 6-year period revealed that 12 patients (5%) had stroke or stroke-like presentations among 236 patients with intracranial aneurysms. Patient demographics, characteristics of aneurysms, and management were analyzed. RESULTS Of 12 patients reviewed, nine had anterior circulation aneurysms. Two patients presented with subarachnoid hemorrhage and 10 with unruptured aneurysms. Eleven patients had stroke at the time of presentation, and five had a previous history of transient ischemic attacks. Ten patients had hypertension and eight were active smokers. The mean size of 10 aneurysms was 11.8 mm. Surgical extirpation of the aneurysms was performed in all cases. Four cases revealed thrombus in the aneurysm and one was atherosclerotic. The 6-month outcome was good in seven patients (58%) and fair in four patients (33%). One patient died. This outcome was significantly worse (P < 0.01) compared to that of good grade aneurysms in our database. Hypertension was a significant indicator of poor outcome (P < 0.02). CONCLUSION Ischemic episodes as a presenting feature of intracranial aneurysms could be indicators of poor prognosis. Routine evaluation of stroke patients for aneurysms may help in early diagnosis. In addition, surgical obliteration of aneurysms could prevent subsequent strokes and neurological deficits.
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Affiliation(s)
- Anil Nanda
- Department of Neurosurgery, Louisiana State University Health Sciences Center in Shreveport, Shreveport, Louisiana 71130-3932, USA.
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Herzig R, Bogousslavsky J, Maeder P, Maeder-Ingvar M, Reichhart M, Urbano LA, Leemann B. Intracranial arterial and arteriovenous malformations presenting with infarction. Lausanne Stroke Registry study*. Eur J Neurol 2005; 12:93-102. [PMID: 15679696 DOI: 10.1111/j.1468-1331.2004.00954.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Cerebral aneurysms and arteriovenous malformations (AVMs) are well-known sources of intracranial hemorrhage, but can also manifest as other clinical symptoms or remain clinically asymptomatic. The aim was to document and analyze cases of aneurysm or AVM with brain infarction. Survey on 4804 stroke patients treated at the Department of Neurology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland between 1978 and 2000 using the Lausanne Stroke Registry. Twenty patients presented with cerebral aneurysm and 21 with cerebral AVM. Hemorrhage was present in 100% of the AVM and in 75% of the aneurysm patients; in one (5%) of the remaining aneurysm patients, aneurysm and infarction were located in different territories. Infarction associated with Sylvian artery aneurysm was found in three (15%), vertebrobasilar ischemia because of fusiform left vertebral artery aneurysm in one (5%), and dural fistula draining to the distal transversal and left sigmoid sinus associated with a stroke in the territory of the left anterior inferior cerebellar artery in one patient. Ischemic stroke is infrequent, but important, complication in unruptured intracranial aneurysms and AVMs. The early recognition and therapy of these vascular malformations in selected patients can avoid a major neurological deficit or death caused by their rupture.
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Affiliation(s)
- R Herzig
- Department of Neurology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
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15
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Gondim J, Schops M, Ferreira E. Hypopituitarism and amenorrhea- galactorrhea syndrome caused by thrombosis of both internal carotid artery and giant intrasellar aneurysm: case report. ARQUIVOS DE NEURO-PSIQUIATRIA 2004; 62:158-61. [PMID: 15122453 DOI: 10.1590/s0004-282x2004000100029] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Giant intra and parasellar aneurysm with a spontaneous thrombosis of internal carotid artery is rare. We report the case of a 34 years old woman presenting a unique giant sellar and parasellar aneurysm associated with hypopituitarism and amenorrhea-galactorrhea syndrome. Computed tomographic scans and magnetic resonance images were suggestive of a sellar tumor with a cystic component. Digital cerebral angiography showed spontaneous thrombosis of a intrasellar and parasellar carotid artery aneurysm and left internal carotid artery in the neck. A transseptal endoscopic biopsy was done and confirmed a thrombosed aneurysm. No other surgical treatment was required in this patient but permanent endocrinological treatment was necessary.
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Affiliation(s)
- Jackson Gondim
- Department of Neuroendocrinology, Fortaleza General Hospital, Fortaleza, CE, and Department of Neurosurgery, Federal University of São Paulo, SP, Brasil.
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Kurokawa R, Kuroshima Y, Yoshida K, Kawase T. Spontaneous thrombosis of intracavernous internal carotid artery aneurysm and parent artery occlusion in patients with positive balloon test occlusion--two case reports. Neurol Med Chir (Tokyo) 2001; 41:436-41. [PMID: 11593970 DOI: 10.2176/nmc.41.436] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Two patients with giant intracavernous internal carotid artery (ICA) aneurysms were intolerant to balloon test occlusion of the ICA, and later developed spontaneous thrombosis of the aneurysm and the parent ICA without ischemic sequelae. Case 1: A 60-year-old female with a giant right intracavernous ICA aneurysm presented with right abducens nerve paresis. An unsuccessful extracranial-to-intracranial bypass graft operation was complicated by transient postoperative ophthalmoplegia. The patient did not tolerate balloon test occlusion of the right ICA after attempted bypass surgery, and was treated conservatively. The patient presented with acute onset of headache 3 years later. Case 2: A 50-year-old female with a giant right intracavernous ICA aneurysm presented with right abducens nerve paresis. The patient was managed conservatively after a positive balloon test occlusion of the right ICA. The patient suffered transient hypopituitarism and acute onset of headache 2 years later. Spontaneous thrombosis of the aneurysms and occlusion of the parent ICA were found in both patients. Neither had major hemispheric infarcts, but the first patient had asymptomatic infarcts, which were presumed to be thromboembolic in nature. Patients with intracavernous ICA aneurysms who have positive balloon test occlusions appear to develop tolerance to spontaneous and gradual occlusion of the ICA without significant sequelae. However, these patients have an increased risk of developing embolic infarctions. The role for anticoagulation and repeat hemodynamic tests remains unclear.
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Affiliation(s)
- R Kurokawa
- Department of Neurosurgery, Keio University School of Medicine, Tokyo
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17
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Enam SA, Malik GM. Association of cerebral arteriovenous malformations and spontaneous occlusion of major feeding arteries: clinical and therapeutic implications. Neurosurgery 1999; 45:1105-11; discussion 1111-2. [PMID: 10549926 DOI: 10.1097/00006123-199911000-00018] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE The spontaneous occlusion of a cerebral arteriovenous malformation (AVM) occurs rarely. Occlusion of a parent artery feeding the AVM is even more rare, and its incidence is unknown. We undertook this study to determine the incidence of occlusion of a major artery feeding an AVM and to recommend a management strategy for such an AVM. METHODS We identified AVMs associated with an occluded artery by performing a retrospective angiographic analysis of 500 patients with AVMs who presented to Henry Ford Hospital from 1976 to 1998. RESULTS A review of the angiograms revealed that 7 (1.4%) of 500 patients with an AVM had occlusion of one or more major arteries feeding the nidus. In four patients, an internal carotid artery and its bifurcation were occluded; in two patients, the M1 segment of the middle cerebral artery was occluded, and in one patient, a vertebral artery was occluded. Pial collaterals and/or a moyamoya pattern of anastomoses developed in all patients, with the exception of one who had vertebral artery occlusion. Five patients underwent definitive treatment: one received radiosurgery, and four underwent surgical excision. One of the surgically treated patients died of complications from excessive blood loss and coagulopathy, but the other three had no postoperative complications. CONCLUSION The occlusion of a major artery feeding an AVM occurs rarely (1.4%). These AVMs are moderate to large in size (>3 cm). To prevent collateral flow-related complications of cortical "steal" and hemorrhage, as well as the usual risk of hemorrhage from the AVM itself, surgical management should be considered for these AVMs.
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Affiliation(s)
- S A Enam
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan 48202, USA
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18
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Morioka T, Nishio S, Kimura Y, Kohno S, Kashimura S, Fukui M. Rupture of a giant middle cerebral aneurysm after blunt head injury. J Clin Neurosci 1999; 6:175-7. [DOI: 10.1016/s0967-5868(99)90092-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/1996] [Accepted: 12/17/1996] [Indexed: 10/26/2022]
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19
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Cantore G, Santoro A, Da Pian R. Spontaneous occlusion of supraclinoid aneurysms after the creation of extra-intracranial bypasses using long grafts: report of two cases. Neurosurgery 1999; 44:216-9; discussion 219-20. [PMID: 9894985 DOI: 10.1097/00006123-199901000-00132] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE We describe two cases of giant supraclinoid aneurysms, treated by means of saphenous vein grafting between the external carotid artery and the middle cerebral artery, which unexpectedly spontaneously occluded. CLINICAL PRESENTATION Two patients presented with subarachnoid hemorrhage and headache, respectively. In the first case, angiography showed an aneurysm of the right internal carotid artery (ICA), which had been treated by clipping. Repeat angiography showed a giant aneurysm of the right ICA, the formation of which was probably caused by sliding of the clip that had been applied during the previous operation. The patient was operated on again, but it was impossible to exclude the aneurysm because no clear neck could be identified. In the second case, magnetic resonance imaging and cerebral angiography showed a large, partially thrombosed aneurysm of the supraclinoid segment of the left ICA. TECHNIQUE In view of the patients' ages and the statuses of compensatory circulation, each patient underwent cerebral revascularization with a long saphenous vein graft placed between one branch of the middle cerebral artery and the external carotid artery, in anticipation of subsequent endovascular treatment of the aneurysm and/or closure of the ICA in the neck. Postoperative angiography demonstrated spontaneous occlusion of the aneurysms. CONCLUSION Thrombosis of an aneurysm may occur spontaneously or after explorative surgery. However, it should be remembered that spontaneous occlusion of an aneurysm may be induced or favored by hemodynamic vascular alterations that take place inside the aneurysm after a high-flow extra-intracranial bypass has been created.
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Affiliation(s)
- G Cantore
- Department of Neurological Sciences, Rome University La Sapienza, Italy
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20
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Lee KC, Joo JY, Lee KS, Shin YS. Recanalization of completely thrombosed giant aneurysm: case report. SURGICAL NEUROLOGY 1999; 51:94-8. [PMID: 9952130 DOI: 10.1016/s0090-3019(97)00346-7] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Spontaneous recanalization in a completely thrombosed giant aneurysm is a very rare condition. CASE DESCRIPTION An 18-year-old woman presented with a serpentine variety giant aneurysm of the posterior cerebral artery, in which spontaneous recanalization of a completely thrombosed lumen was demonstrated on magnetic resonance imaging and angiography. The patient was treated by trapping of the parent artery and aneurysmectomy. CONCLUSION This case will provide insight into the potential for spontaneous recanalization in completely thrombosed giant aneurysms.
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Affiliation(s)
- K C Lee
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea
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21
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Kraus GE, Herman JM, Marciano F, Spetzler RF. Ruptured giant aneurysm of an occluded middle cerebral artery in a severe-grade patient: case report. Neurosurgery 1995; 36:169-71; discussion 171-2. [PMID: 7708154 DOI: 10.1227/00006123-199501000-00022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
A 27-year-old woman presented with a ruptured giant aneurysm of the right middle cerebral artery, occlusion of the artery distal to the aneurysm, and an intraparenchymal hematoma. Before emergent surgery, her condition deteriorated to a Glasgow Coma Scale score of 4 and a Hunt and Hess grade of V. Electroencephalographic response on the right, initially absent, was present toward the end of the surgery. Postoperative angiography demonstrated good filling of the previously occluded distal middle cerebral artery. The simultaneous occurrence of hemorrhage from a giant intracranial aneurysm and occlusion of the parent artery is extremely rare, and this is the first case we found in the literature in which the patient survived. The treatment strategy and outcome are discussed.
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Affiliation(s)
- G E Kraus
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
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22
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Ruptured Giant Aneurysm of an Occluded Middle Cerebral Artery in a Severe-grade Patient. Neurosurgery 1995. [DOI: 10.1097/00006123-199501000-00022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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23
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Atkinson JL, Lane JI, Colbassani HJ, Llewellyn DM. Spontaneous thrombosis of posterior cerebral artery aneurysm with angiographic reappearance. Case report. J Neurosurg 1993; 79:434-7. [PMID: 8360742 DOI: 10.3171/jns.1993.79.3.0434] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The case is presented of a 23-year-old man suffering ischemic brain infarction from spontaneous thrombosis of a left posterior cerebral artery P1-P2 junction aneurysm. Vasospasm and/or partial parent vessel occlusion were documented by magnetic resonance (MR) imaging and angiography. Repeat cerebral angiography and MR imaging 3 months later revealed patency of the posterior cerebral artery and luminal filling of a 1-cm fusiform aneurysm, which was successfully trapped at surgery.
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Affiliation(s)
- J L Atkinson
- Department of Neurological Surgery, Naval Hospital Oakland, California
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