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Lefevre E, Fawaz R, Premat K, Lenck S, Shotar E, Degos V, Kalamarides M, Boch AL, Carpentier A, Clarençon F, Nouet A. Delayed traumatic intracranial aneurysms: literature review and case series. Neurosurg Rev 2024; 47:355. [PMID: 39060452 DOI: 10.1007/s10143-024-02586-8] [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: 03/05/2024] [Revised: 05/16/2024] [Accepted: 07/08/2024] [Indexed: 07/28/2024]
Abstract
Traumatic intracranial aneurysm (TICA) is a rare and aggressive pathology that requires prompt treatment. Nevertheless, early vascular imaging following head trauma may yield falsely negative results, underscoring the importance of subsequent imaging within the first week to detect delayed TICAs. This study aims to report our experience with delayed TICAs and highlight the clinical importance of repeated angiographic screening for delayed TICAs. In this retrospective analysis, we evaluated patients managed for a TICA at a tertiary care teaching institution over the last decade. Additionally, we conducted a systematic review of the literature, following the PRISMA guidelines, on previously reported TICAs, focusing on the time lag between the injury and diagnosis. Twelve delayed TICAs were diagnosed in 9 patients. The median time interval from injury to diagnosis was 2 days (IQR: 1-22 days), and from diagnosis to treatment was 2 days (IQR: 0-9 days). The average duration of radiological follow-up was 28 ± 38 months. At the final follow-up, four patients exhibited favorable neurological outcomes, while the remainder had adverse outcomes. The mortality rate was 22%. Literature reviews identified 112 patients with 114 TICAs, showcasing a median diagnostic delay post-injury of 15 days (IQR: 6-44 days), with 73% diagnosed beyond the first week post-injury. The median time until aneurysm rupture was 9 days (IQR: 3-24 days). Our findings demonstrate acceptable outcomes following TICA treatment and highlight the vital role of repeated vascular imaging after an initial negative computed tomography or digital subtraction angiography in excluding delayed TICAs.
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Affiliation(s)
- Etienne Lefevre
- Department of Neurosurgery, Pitié-Salpêtrière University Hospital, 47-83 Boulevard de l'hôpital, Paris, 75013, France.
- Sorbonne University, Paris, France.
| | - Rayan Fawaz
- Department of Neurosurgery, Pitié-Salpêtrière University Hospital, 47-83 Boulevard de l'hôpital, Paris, 75013, France
| | - Kevin Premat
- Sorbonne University, Paris, France
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Stéphanie Lenck
- Sorbonne University, Paris, France
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Eimad Shotar
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
- Sorbonne Université, INSERM, Institut de la vision, Paris, France
| | - Vincent Degos
- Sorbonne University, Paris, France
- Department of Anesthesia and Intensive Care, Sorbonne University, Pitié- Salpêtrière Hospital, APHP, DMU DREAM, GRC 29, Paris, France
| | - Michel Kalamarides
- Department of Neurosurgery, Pitié-Salpêtrière University Hospital, 47-83 Boulevard de l'hôpital, Paris, 75013, France
- Sorbonne University, Paris, France
| | - Anne-Laure Boch
- Department of Neurosurgery, Pitié-Salpêtrière University Hospital, 47-83 Boulevard de l'hôpital, Paris, 75013, France
- Sorbonne University, Paris, France
| | - Alexandre Carpentier
- Department of Neurosurgery, Pitié-Salpêtrière University Hospital, 47-83 Boulevard de l'hôpital, Paris, 75013, France
- Sorbonne University, Paris, France
| | - Frédéric Clarençon
- Sorbonne University, Paris, France
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Aurélien Nouet
- Department of Neurosurgery, Pitié-Salpêtrière University Hospital, 47-83 Boulevard de l'hôpital, Paris, 75013, France
- Sorbonne University, Paris, France
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Sugii M, Okada K, Ikeda S, Hara Y, Yokobori S. Clinical features and risk factors for delayed rupture of traumatic cerebral aneurysm: A case series. Acute Med Surg 2024; 11:e70000. [PMID: 39175960 PMCID: PMC11339465 DOI: 10.1002/ams2.70000] [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: 04/25/2024] [Revised: 07/05/2024] [Accepted: 08/11/2024] [Indexed: 08/24/2024] Open
Abstract
Background Traumatic cerebral aneurysms (TA) are a subset of traumatic cerebrovascular injury (TCVI). Misdiagnosis of TA can be fatal. To investigate factors that predict TA formation and the optimal timing for searching, we present four suspected cases of delayed TA rupture during hospitalization. Case Presentation Medical records of head injury cases to have delayed TA rupture during hospitalization between April 2021 and March 2022 were retrospectively reviewed. Of the four patients included, only one met the TCVI screening criteria. All the patients had acute subdural hematoma (ASDH) on arrival; two had delayed expansion of the traumatic subarachnoid hemorrhage (tSAH) on repeat imaging. All the patients received anticoagulants. Ruptured TA occurred between days 5 and 11. Three patients died during hospitalization. Conclusion It is advisable to suspect TA when imaging studies show ASDH on admission and intracranial hematoma expansion during hospitalization. We suggest TA screening around day 5.
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Affiliation(s)
- Masataka Sugii
- Nippon Medical School Chiba Hokusoh HospitalChibaJapan
- Department of Emergency and Critical Care MedicineNippon Medical School HospitalTokyoJapan
| | - Kazuhiro Okada
- Nippon Medical School Chiba Hokusoh HospitalChibaJapan
- Department of Emergency and Critical Care MedicineNippon Medical School HospitalTokyoJapan
| | - Shimpei Ikeda
- Nippon Medical School Chiba Hokusoh HospitalChibaJapan
- Department of Emergency and Critical Care MedicineNippon Medical School HospitalTokyoJapan
| | - Yoshiaki Hara
- Nippon Medical School Chiba Hokusoh HospitalChibaJapan
- Department of Emergency and Critical Care MedicineNippon Medical School HospitalTokyoJapan
| | - Shoji Yokobori
- Nippon Medical School Chiba Hokusoh HospitalChibaJapan
- Department of Emergency and Critical Care MedicineNippon Medical School HospitalTokyoJapan
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Yamada K, Morimoto T, Fujimoto K, Nishioka T, Tokunaga H. Traumatic intracranial aneurysm in a distal posterior cerebral artery: A case report and literature review. Surg Neurol Int 2023; 14:428. [PMID: 38213445 PMCID: PMC10783693 DOI: 10.25259/sni_752_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: 09/11/2023] [Accepted: 11/18/2023] [Indexed: 01/13/2024] Open
Abstract
Background Traumatic intracranial aneurysms (TICAs) are rare and known to rupture easily and have a high mortality rate. Case Description An 87-year-old male patient with no neurological deficits presented to our hospital after head trauma. Computed tomography (CT) revealed a tentorial acute subdural hematoma (ASDH). The patient was managed conservatively and discharged home six days after hospitalization. Two days later, the patient returned with a severe headache. CT showed that the ASDH had enlarged and extended from the tentorium to the convexity. CT angiography and digital subtraction angiography revealed a pseudoaneurysm in a branch of the left posterior inferior temporal artery. The patient was diagnosed with an enlarged ASDH due to a ruptured TICA that arose from the P3 segment. We performed endovascular intervention with parent artery occlusion (PAO) using n-butyl-2-cyanoacrylate (NBCA). The parent artery was accessed through the left posterior communicating artery because left vertebral angiography revealed an aplastic left P1 segment. After navigating the microcatheter near the aneurysm, we injected 33% NBCA into the parent artery. The pseudoaneurysm disappeared after injection. The patient was discharged on hospital day 25 despite persistent delirium. Conclusion This is the first report of a TICA arising from the P3 segment that was treated with PAO using NBCA. TICAs are rare; however, a TICA must be considered when an enlarged hematoma caused by head injury is detected.
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Affiliation(s)
- Kengo Yamada
- Department of Neurosurgery, Nara City Hospital, , Nara, Japan
| | | | - Kenta Fujimoto
- Department of Neurosurgery, Nara Prefecture General Medical Center, Nara, Japan
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Fuga M, Tanaka T, Nogami R, Tachi R, Teshigawara A, Ishibashi T, Hasegawa Y, Murayama Y. Delayed Tentorial Subdural Hematoma Caused by Traumatic Posterior Cerebral Artery Aneurysm: A Case Report and Literature Review. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e933771. [PMID: 34797819 PMCID: PMC8611473 DOI: 10.12659/ajcr.933771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Subdural hematoma (SDH) caused by traumatic intracranial aneurysm (TICA) is rare. TICAs are known to rupture easily, resulting in a high morbidity and mortality rate. Therefore, accurate diagnosis and treatment are crucial for preserving life. We describe a case of delayed SDH in the setting of posterior cerebral artery (PCA) aneurysm. CASE REPORT A 42-year-old man presented with sustained head injury from a traffic accident, and was being followed-up conservatively for traumatic SDH and subarachnoid hemorrhage. Three weeks after the head trauma, the patient developed a sudden deterioration of mental status and disorientation. Computed tomography revealed de novo SDH at the cerebellar tentorium. Computed tomography angiography and magnetic resonance imaging demonstrated TICA in the PCA. The patient was diagnosed with SDH due to a ruptured PCA aneurysm at the quadrigeminal segment. To avoid SDH growth due to re-rupture of the aneurysm, parent artery occlusion was subsequently performed with no complications. The patient was discharged home 2 months after endovascular treatment, with moderate disability. Follow-up angiography 2 years after the operation showed no recanalization, and the patient had returned to work. CONCLUSIONS TICA in the PCA can cause tentorial SDH with or without the presence of subarachnoid hemorrhage. Routine cerebrovascular assessment is crucial for head trauma with hematoma adjacent to the cerebellar tentorium. Parent artery occlusion via an endovascular procedure is an alternative treatment for TICA in the PCA that is less invasive than other approaches.
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Affiliation(s)
- Michiyasu Fuga
- Department of Neurosurgery, Jikei University School of Medicine, Kashiwa Hospital, Chiba, Japan
| | - Toshihide Tanaka
- Department of Neurosurgery, Jikei University School of Medicine, Kashiwa Hospital, Chiba, Japan
| | - Ryo Nogami
- Department of Neurosurgery, Jikei University School of Medicine, Kashiwa Hospital, Chiba, Japan
| | - Rintaro Tachi
- Department of Neurosurgery, Jikei University School of Medicine, Kashiwa Hospital, Chiba, Japan
| | - Akihiko Teshigawara
- Department of Neurosurgery, Jikei University School of Medicine, Kashiwa Hospital, Chiba, Japan
| | - Toshihiro Ishibashi
- Department of Neurosurgery, Jikei University School of Medicine, Tokyo, Japan
| | - Yuzuru Hasegawa
- Department of Neurosurgery, Jikei University School of Medicine, Kashiwa Hospital, Chiba, Japan
| | - Yuichi Murayama
- Department of Neurosurgery, Jikei University School of Medicine, Tokyo, Japan
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Chiba F, Inokuchi G, Makino Y, Torimitsu S, Motomura A, Yamaguchi R, Hashimoto M, Hoshioka Y, Nasgasawa S, Sakuma A, Yajima D, Saito H, Iwase H. Postmortem angiography revealing traumatic rupture of the intracranial internal carotid artery. Int J Legal Med 2017; 132:589-592. [PMID: 29197939 DOI: 10.1007/s00414-017-1752-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 11/23/2017] [Indexed: 10/18/2022]
Abstract
Diagnosis of traumatic subarachnoid hemorrhage (SAH), although relatively rare, is important in forensic medicine. It is mostly associated with rupture of the vertebrobasilar artery. Traumatic aneurysm of the intracranial part of the internal carotid artery (ICA) is also rare but has been reported in several studies. It is thought that the intracranial ICA is injured by blunt force to the head, neck, and chest. However, traumatic SAH with fatal acute course resulting from rupture of the ICA is especially uncommon: only two fatal cases without an associated aneurysm have been reported in the English-language literature. Although detecting the arterial lesion is required to make a precise diagnosis, this is sometimes impossible by macroscopic examination at autopsy or by investigation after formalin-fixation according to the position of the lesion. We report a rare case of fatal traumatic SAH associated with intracranial ICA rupture. Postmortem computed tomography angiography was useful to confirm the lesion.
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Affiliation(s)
- Fumiko Chiba
- Department of Forensic Medicine, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8654, Japan. .,Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba Prefecture, 260-8670, Japan.
| | - Go Inokuchi
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba Prefecture, 260-8670, Japan
| | - Yohsuke Makino
- Department of Forensic Medicine, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8654, Japan
| | - Suguru Torimitsu
- Department of Forensic Medicine, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8654, Japan
| | - Ayumi Motomura
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba Prefecture, 260-8670, Japan
| | - Rutsuko Yamaguchi
- Department of Forensic Medicine, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8654, Japan
| | - Mari Hashimoto
- Department of Forensic Medicine, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8654, Japan
| | - Yumi Hoshioka
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba Prefecture, 260-8670, Japan
| | - Sayaka Nasgasawa
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba Prefecture, 260-8670, Japan
| | - Ayaka Sakuma
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba Prefecture, 260-8670, Japan
| | - Daisuke Yajima
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba Prefecture, 260-8670, Japan
| | - Hisako Saito
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba Prefecture, 260-8670, Japan
| | - Hirotaro Iwase
- Department of Forensic Medicine, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8654, Japan
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Kobata H. Diagnosis and Treatment of Traumatic Cerebrovascular Injury: Pitfalls in the Management of Neurotrauma. Neurol Med Chir (Tokyo) 2017; 57:410-417. [PMID: 28674346 PMCID: PMC5566700 DOI: 10.2176/nmc.oa.2017-0056] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Traumatic cerebrovascular injury (TCVI) is an uncommon clinical entity in traumatic brain injury (TBI), yet it may cause devastating brain injury with high morbidity and mortality. Early recognition and prioritized strategic treatment are of paramount importance. A total of 1966 TBI patients admitted between 1999 and 2015 in our tertiary critical care center were reviewed. Screening of TCVI was based on the Guidelines for the Management of Severe Head Injury in Japan. TCVI was confirmed in 33 (1.7%) patients; 29 blunt and 4 penetrating injuries. The primary location of the injury included 16 cervical, 6 craniofacial, and 11 intracranial lesions. On arrival, 15 patients presented with hemorrhage, 5 of these arrived in shock status with massive hemorrhage. Ten presented with ischemic symptoms. Sixteen patients underwent surgical or endovascular intervention, 13 of whom required immediate treatment upon arrival. Surgical procedures included clipping or trapping for traumatic aneurysms, superficial temporal artery - middle cerebral artery bypass, carotid endarterectomy, and direct suture of the injured vessels. Endovascular intervention was undertaken in 7 patients; embolization with Gelfoam (Pharmacia and Upjohn Company, Kalamazoo, MI, USA) or coil for 6 hemorrhagic lesions and stent placement for 1 lesion causing ischemia. Patients’ outcome assessed by the Glasgow Outcome Scale at 3 months were good recovery in 8, moderate disability in 3, severe disability in 9, persistent vegetative state in 1, and death in 12, respectively. In order to rescue potentially salvageable TCVI patients, neurosurgeons in charge should be aware of TCVI and master basic skills of cerebrovascular surgical and endovascular procedures to utilize in an emergency setting.
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Affiliation(s)
- Hitoshi Kobata
- Department of Neurosurgery, Osaka Mishima Emergency Critical Care Center
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7
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Nakamura H, Fujinaka T, Tasaki O, Yoshimine T. Delayed massive epistaxis from traumatic intracranial aneurysm after blunt facial injury. Acute Med Surg 2016; 4:131-134. [PMID: 29123850 PMCID: PMC5667291 DOI: 10.1002/ams2.239] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 07/29/2016] [Indexed: 12/15/2022] Open
Abstract
Cases Traumatic intracranial aneurysm following blunt head injury is uncommon but can be induced by extension of skull base fracture and causes unexpected hemorrhagic complications. We present two cases of traumatic intracranial aneurysm in the paraclinoid area that was revealed by delayed massive epistaxis. Lack of initial neurological deficits omitted screening for cerebrovascular injury. Outcome Internal trapping was carried out using endovascular techniques in both cases, with extracranial-intracranial bypass in one case. No recurrent bleeding occurred in either case. Conclusion To prevent unexpected delayed life-threatening hemorrhagic accidents, careful assessment of skull-base fracture is prerequisite, even in cases of mild facial injury.
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Affiliation(s)
- Hajime Nakamura
- Department of NeurosurgeryOsaka University Graduate School of MedicineOsakaJapan
| | | | - Osamu Tasaki
- Department of Emergency MedicineUnit of Clinical MedicineNagasaki University Graduate School of Biomedical SciencesNagasakiJapan
| | - Toshiki Yoshimine
- Division of Clinical NeuroengineeringGlobal Center for Medical Engineering and InformaticsOsaka UniversityOsakaJapan
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Nazari P, Kasliwal MK, Wewel JT, Dua SG, Chen M. Delayed Intracerebral Hemorrhage from a Pseudoaneurysm Following a Depressed Skull Fracture. Neurointervention 2016; 11:42-5. [PMID: 26958412 PMCID: PMC4781916 DOI: 10.5469/neuroint.2016.11.1.42] [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] [Received: 11/21/2015] [Accepted: 01/20/2016] [Indexed: 11/24/2022] Open
Abstract
A 26-year-old male presented with delayed intracerebral hemorrhage from a ruptured distal middle cerebral artery pseudoaneurysm that followed a compound depressed skull fracture from years ago. The brain protrusion through the skull defect likely resulted in stretching and subsequent tearing of the arterial wall resulting in the pseudoaneurysm formation. No prior report of such a clinical occurrence exists in the literature. We highlight an unusual but treatable cause for intracerebral hemorrhage following surgery for traumatic brain injury.
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Affiliation(s)
- Pouya Nazari
- Department of Neurosurgery, RUSH University Medical Center, Chicago, IL-60612, USA
| | - Manish K Kasliwal
- Department of Neurosurgery, RUSH University Medical Center, Chicago, IL-60612, USA
| | - Joshua T Wewel
- Department of Neurosurgery, RUSH University Medical Center, Chicago, IL-60612, USA
| | - Sumeet G Dua
- Department of Radiology, RUSH University Medical Center, Chicago, IL-60612, USA
| | - Michael Chen
- Department of Neurosurgery, RUSH University Medical Center, Chicago, IL-60612, USA
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Surgical repair of lacerated anterior cerebral artery presented with massive intracerebral hemorrhage. J Craniofac Surg 2016; 26:e270-2. [PMID: 25915668 DOI: 10.1097/scs.0000000000001330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE AND IMPORTANCE Traumatic intracranial aneurysms present diagnostic and therapeutic challenges. Owing to their fragile nature, endovascular intervention has become the first-line treatment; however, direct surgery has an advantage in certain cases. CLINICAL PRESENTATION A 34-year-old man in coma was admitted after a motor vehicle accident. Brain computed tomographic scans revealed deep bifrontal, left intraventricular, and subarachnoid hemorrhages. Three-dimensional computed tomographic angiography and digital subtraction angiography revealed an aneurysm arising from the left pericallosal artery. INTERVENTION A massive intracerebral hematoma prompted us to perform emergency surgical intervention. We immediately removed the hematoma and extirpated the aneurysm. After hematoma evacuation via the interhemispheric approach, a pulsating red sphere projecting from the pericallosal artery, with no obvious solid wall or neck, was encountered. While retracting the frontal lobe, it suddenly ruptured. Under temporary trapping of the parent artery, the point of bleeding was identified. No aneurysm wall or fibrous tissue was present, whereas a 1.5-mm laceration was observed at the pericallosal artery close to its branching point. The laceration was sutured with 10-0 nylon. Postoperative digital subtraction angiography confirmed patency of the pericallosal artery. CONCLUSIONS Although recent technologic advances of intravascular surgery have enabled successful treatment of traumatic pseudoaneurysms, open surgical intervention still has some advantages of providing definitive hemostasis, allowing for parent artery reconstruction, and facilitating mass reduction. The case in the current study was quite unusual in that angiographic aneurysm had disrupted easily, leaving arterial laceration. This finding implies the probability of unavoidable parent artery occlusion when endovascular treatment is applied.
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Han JH, Koh EJ, Choi HY, Park JS, Lee JM. Visualization of a Traumatic Pseudoaneurysm at Internal Carotid Artery Bifurcation due to Blunt Head Injury: A Case Report. Korean J Neurotrauma 2014; 10:126-9. [PMID: 27169047 PMCID: PMC4852601 DOI: 10.13004/kjnt.2014.10.2.126] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 08/28/2014] [Accepted: 08/29/2014] [Indexed: 12/02/2022] Open
Abstract
Traumatic intracranial pseudoaneurysms occurring after blunt head injuries are rare. We report an unusual case of subarachnoid hemorrhage (SAH) caused by rupturing of the traumatic pseudoaneurysm of the internal carotid artery (ICA) bifurcation that resulted from a non-penetrating injury. In a patient with severe headache and SAH in the right sylvian cistern, which developed within 7 days after a blunt-force head injury, a trans-femoral cerebral angiogram (TFCA) showed aneurysmal sac which was insufficient to confirm the pseudoaneurysm. We obtained a multi-slab image of three dimensional time of flight (TOF) of magnetic resonance angiography (MRA). The source image of the gadolinium-enhanced MRA revealed an intimal flap within the intracranial ICA bifurcation, providing a clue for the diagnosis of a dissecting pseudoaneurysm at the ICA bifurcation due to blunt head trauma. We performed direct aneurysmal neck clipping, without neurological deficit. A follow-up TFCA did not show either aneurysm sac or luminal narrowing. We suggest that in the patient with a history of blunt head injury with SAH following shortly, multi-slab image of 3D TOF MRA can give visualization of the presence of a pseudoaneurysm.
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Affiliation(s)
- Ju-Hee Han
- Department of Neurosurgery, Chonbuk National University Medical School-Hospital, Jeonju, Korea
| | - Eun-Jeong Koh
- Department of Neurosurgery, Chonbuk National University Medical School-Hospital, Jeonju, Korea
| | - Ha-Young Choi
- Department of Neurosurgery, Chonbuk National University Medical School-Hospital, Jeonju, Korea
| | - Jung-Soo Park
- Department of Neurosurgery, Chonbuk National University Medical School-Hospital, Jeonju, Korea
| | - Jong-Myong Lee
- Department of Neurosurgery, Chonbuk National University Medical School-Hospital, Jeonju, Korea
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11
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Du Y, Han Z, Zheng S, Wu T, Yin W. Delayed Massive Traumatic Hematoma in the Corpus Callosum: Two Case Reports with Literature Review. NMC Case Rep J 2014; 1:37-41. [PMID: 28663951 PMCID: PMC5364943 DOI: 10.2176/nmccrj.2013-0087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 01/21/2014] [Indexed: 11/20/2022] Open
Abstract
A delayed massive traumatic hematoma in the corpus callosum is extremely rare. We report two cases with a delayed massive callosal hematoma caused by blunt head trauma. A massive callosal hematoma was diagnosed by computed tomography (CT) 2 weeks after a minor head injury in a 29-year-old man. A similar but larger hematoma developed 12 hours post-trauma with acute onset of consciousness disturbance in a 39-year-old man. Emergency CT angiography revealed no vascular pathologies in either case. The first patient was managed conservatively and recovered, whereas the second patient was treated surgically and died. The literature was reviewed regarding the possible mechanism of production of these lesions following head injury and therapeutic considerations are discussed.
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Affiliation(s)
- Yanli Du
- School of Medical Technology and Nursing, Shenzhen Polytechnic, Shenzhen, P.R. China
| | - Zongli Han
- Department of Neurosurgery, Peking University Shenzhen Hospital, Shenzhen, P.R. China
| | - Siyang Zheng
- Department of Neurosurgery, Peking University Shenzhen Hospital, Shenzhen, P.R. China
| | - Tao Wu
- Department of Neurosurgery, Peking University Shenzhen Hospital, Shenzhen, P.R. China
| | - Wei Yin
- Department of Neurosurgery, Peking University Shenzhen Hospital, Shenzhen, P.R. China
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12
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Fatal subarachnoid hemorrhage following traumatic rupture of the internal carotid artery. Leg Med (Tokyo) 2012; 14:328-30. [DOI: 10.1016/j.legalmed.2012.06.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Revised: 06/15/2012] [Accepted: 06/18/2012] [Indexed: 11/18/2022]
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13
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Kikkawa Y, Natori Y, Sasaki T. Delayed post-traumatic pseudoaneurysmal formation of the intracranial ophthalmic artery after closed head injury. Case report. Neurol Med Chir (Tokyo) 2012; 52:41-3. [PMID: 22278026 DOI: 10.2176/nmc.52.41] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 42-year-old male presented with a rare case of delayed aneurysmal formation of the intracranial ophthalmic artery after closed head injury manifesting as subarachnoid hemorrhage. Initial magnetic resonance angiography revealed no aneurysmal formation, but angiography 7 days after the injury demonstrated an intracranial ophthalmic artery aneurysm. Follow-up computed tomography angiography demonstrated enlargement of the aneurysm. The aneurysm was successfully treated by surgical resection. Histological examination revealed that the aneurysm was a pseudoaneurysm. Traumatic intracranial aneurysm (TICA) is rare and usually occurs in the peripheral arteries of the cerebral circulation or the basal portion of the internal carotid artery. The present case shows that failure to demonstrate an aneurysm on the initial angiography in the acute stage does not exclude the presence of traumatic aneurysm. This case clearly shows the time course of development of a TICA of the ophthalmic artery after closed head injury.
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Affiliation(s)
- Yuichiro Kikkawa
- Department of Neurosurgery, Graduate School of Medical Science, Kyushu University, Fukuoka, Japan.
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Trapping with high-flow bypass for a traumatic giant pseudoaneurysm of the supraclinoid carotid artery in an adolescent: case report. Childs Nerv Syst 2011; 27:681-4. [PMID: 21279362 DOI: 10.1007/s00381-011-1397-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Accepted: 01/13/2011] [Indexed: 10/18/2022]
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Ohba S, Kuroshima Y, Mayanagi K, Inamasu J, Saito R, Nakamura Y, Ichikizaki K. Traumatic aneurysm of the supraclinoid internal carotid artery-case report-. Neurol Med Chir (Tokyo) 2009; 49:587-9. [PMID: 20035133 DOI: 10.2176/nmc.49.587] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 23-year-old male was admitted after a motor vehicle accident with acute epidural hematoma, diffuse subarachnoid hemorrhage (SAH) in the basal cistern, and fractures at the anterior cranial base. Angiography revealed an aneurysm of the right supraclinoid internal carotid artery (ICA). His consciousness suddenly worsened on the 23rd day. Expansion of the SAH in the basal cistern and two hump aneurysms were detected. He underwent endovascular embolization of these aneurysms and the right ICA with Guglielmi detachable coil. Traumatic aneurysms are difficult to diagnose in the early period after injury and are associated with a high mortality. Endovascular treatments for traumatic aneurysms have lower mortality rate, and can be performed under local anesthesia.
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Affiliation(s)
- Shigeo Ohba
- Department of Neurosurgery, Ashikaga Red Cross Hospital, Ashikaga, Tochigi, Japan.
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Posters. Interv Neuroradiol 2007. [DOI: 10.1177/15910199070130s210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Horiuchi T, Nakagawa F, Miyatake M, Iwashita T, Tanaka Y, Hongo K. Traumatic middle cerebral artery aneurysm: case report and review of the literature. Neurosurg Rev 2007; 30:263-7; discussion 267. [PMID: 17440757 DOI: 10.1007/s10143-007-0073-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2006] [Revised: 03/06/2007] [Accepted: 03/07/2007] [Indexed: 10/23/2022]
Abstract
Traumatic intracranial aneurysms are rare. A case of traumatic middle cerebral artery aneurysm was presented. A 66-year-old man sustained a severe head injury in a bicycle accident. Serial computed tomography and angiography showed the delayed intracerebral hemorrhage caused by the traumatic middle cerebral artery aneurysm. The aneurysm was trapped and removed. Histological examination clearly revealed the pseudoaneurysm. Traumatic middle cerebral aneurysms were reviewed.
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Murakami M, Kakita K, Hosokawa Y. Ruptured traumatic aneurysm after trivial injury mimicking acute spontaneous subdural hematoma--case report-. Neurol Med Chir (Tokyo) 2003; 43:130-3. [PMID: 12699120 DOI: 10.2176/nmc.43.130] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 75-year-old man suffered acute subdural hematoma shortly after trivial head trauma. Thirteen hours after a trivial brow to the occipital region, caused by contact with a mat, he suddenly deteriorated to the level of a Glasgow Coma Scale score of 6. Computed tomography demonstrated an acute subdural hematoma on the left and angiography revealed an aneurysm of the distal middle cerebral artery. An emergent craniotomy disclosed no skull fracture and exposed a thick subdural hematoma with no brain contusions. After evacuation of the hematoma, an aneurysm was found on the distal portion of posterior temporal artery, which was compatible with the angiographical findings. The neck of aneurysm was so fragile that neck clipping could not be successfully performed. Therefore, the aneurysm was extirpated, and the bleeding site coagulated with oxidized cellulose reinforcement. Histological examination of the aneurysm indicated a pseudoaneurysm during the early phase of clot formation. The acute subdural hematoma resulted from rupture of this pseudoaneurysm which was formed shortly after the minor head trauma. Rupture of a pseudoaneurysm caused by trivial trauma might be one of the origins for so-called acute "spontaneous" subdural hematoma.
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Affiliation(s)
- Mamoru Murakami
- Department of Neurosurgery, Kyoto First Red Cross Hospital, Kyoto, Japan.
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