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Lara-Olivas JA, Sangrador-Deitos MV, Villalobos-Díaz R, Marian-Magaña R, Gomez-Amador JL. A rare case of a right infratentorial meningioma and a left giant posterior communicating thrombosed aneurysm. Surg Neurol Int 2023; 14:317. [PMID: 37810320 PMCID: PMC10559378 DOI: 10.25259/sni_473_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: 06/04/2023] [Accepted: 08/19/2023] [Indexed: 10/10/2023] Open
Abstract
Background Giant intracranial aneurysms cause symptoms due to mass effect and can mimic other lesions in imaging studies. The coexistence of tumors and aneurysms is relatively rare, with meningiomas being the predominant tumors found in such cases. The relationship between these two entities is complex and represent a neurosurgical challenge. Case Description A 61-year-old woman presented with intermittent headache, vertigo, right peripheral facial palsy, hearing loss, and left hemiparesis. Magnetic resonance imaging revealed two lesions: a supratentorial paraclinoid lesion in the left frontotemporal region and a right infratentorial extra-axial mass, suggestive of a meningioma. The patient underwent a two-staged surgical intervention to address both lesions. Conclusion In this particular case, the lesions were located on different sides and in different cranial compartments, making it even rarer.
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Yuzhe L, Haoyu L, Bo C, Wenyong L, Qing L. Intracranial aneurysms mimicking third ventricular masses: case series and systematic review. Heliyon 2022; 8:e11506. [DOI: 10.1016/j.heliyon.2022.e11506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 07/17/2022] [Accepted: 11/04/2022] [Indexed: 11/15/2022] Open
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3
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Perret CM, Bertani R, W. Koester S, Santa Maria PE, Von Zuben D, Batista S, Schiavini HC, Landeiro JA. A Giant Internal Carotid Bifurcation Aneurysm as a Rare and Dangerous Differential Diagnosis of a Craniopharyngioma. Cureus 2022; 14:e21588. [PMID: 35228946 PMCID: PMC8867713 DOI: 10.7759/cureus.21588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2022] [Indexed: 11/17/2022] Open
Abstract
Craniopharyngiomas are supra/parasellar lesions that often present with general, unspecific symptoms. Similarly, internal carotid artery (ICA) bifurcation giant aneurysms may also produce calcified, heterogeneous, parasellar expansive lesions, posing a relevant differential diagnosis due to their inherently different surgical strategies and risks. We report the case of a 54-year-old female presenting with progressive disorientation and apathetic behavior. CT and MRI reports described a suprasellar heterogenous mass with calcifications associated with an adjacent, laterally located fluid collection suggestive of a craniopharyngioma. During the surgical procedure, perfuse and unexplained arterial bleeding ensued, prompting the surgical team to review a previous contrast-enhanced CT scan. Careful inspection revealed an image suggestive of vascular pathology, with an area of continuous hyperdensity along the right ICA bifurcation. The Sylvian fissure was dissected, and an aneurysmal neck was encountered and successfully clipped. Giant intracranial aneurysms are rare but essential differential diagnoses to be considered during the workup and surgical approach toward parasellar mass lesions. This case illustrates the importance of performing a CT angiogram (CTA) for skull base lesions, even when the size is more suggestive of tumor pathology.
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Thrombosed large distal posterior inferior cerebellar artery aneurysm mimicking an infratentorial ependymoma. Case Rep Neurol Med 2014; 2014:435953. [PMID: 24716019 PMCID: PMC3970360 DOI: 10.1155/2014/435953] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 01/07/2014] [Indexed: 11/17/2022] Open
Abstract
Large or giant intracranial aneurysms can simulate brain tumors clinically and radiologically by virtue of their progressive mass effect. Unlike aneurysms from alternative locations, those arising from the distal posterior inferior cerebellar artery (PICA) are uncommon. We report a patient who experienced progressive hemiparesis with magnetic resonance imaging findings suggestive of an infratentorial ependymoma. Intraoperatively, a thrombosed large aneurysm of the distal PICA was unexpectedly encountered. The aneurysm was clipped and the patient did not develop any permanent neurological deficit. This case illustrates the radiological nuances of large aneurysms and infratentorial ependymomas. Three-dimensional contrast-enhanced magnetic resonance angiography can be falsely negative and the importance of the "target" sign is emphasized. One should be cognizant of this possible diagnosis for patients with midline fourth ventricular lesions in order to reduce surgical risk.
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5
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Nagatani K, Otani N, Seno S, Takeuchi S, Wada K, Mori K. Diagnostic pitfalls associated with a large true posterior communicating artery aneurysm: a case report. Br J Neurosurg 2013; 27:687-9. [PMID: 23458560 DOI: 10.3109/02688697.2013.771727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
True posterior communicating artery (PCoA) aneurysm is an aneurysm that originates from the PCoA, and large or giant true PCoA aneurysms are rare. We report a case of a large true PCoA aneurysm successfully clipped after anterior clinoidectomy and discuss the diagnostic pitfalls associated with this rare clinical entity.
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Affiliation(s)
- Kimihiro Nagatani
- Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama, Japan.
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6
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Velat GJ, Zabramski JM, Nakaji P, Spetzler RF. Surgical management of giant posterior communicating artery aneurysms. Neurosurgery 2012; 71:43-50; discussion 51. [PMID: 22278359 DOI: 10.1227/neu.0b013e31824c05a0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Giant posterior communicating artery (PCoA) aneurysms (> 25 mm) are rare lesions associated with a poor prognosis and high rates of morbidity and mortality. OBJECTIVE To review the clinical results of giant PCoA aneurysms surgically treated at our institution, focusing on operative nuances. METHODS All cases of giant PCoA aneurysms treated surgically at our institution were identified from a prospectively maintained patient database. Patient demographic factors, medical comorbidities, rupture status, neurological presentation, clinical outcomes, and surgical records were critically reviewed. RESULTS From 1989 to 2010, 11 patients (10 women) underwent surgical clipping of giant PCoA aneurysms. Presenting signs and symptoms included cranial nerve palsies, diminished mental status, headache, visual changes, and seizures. Five aneurysms were ruptured on admission. All aneurysms were clipped primarily except 1, which was treated by parent artery sacrifice and extracranial-to-intracranial bypass after intraoperative aneurysm rupture. Perioperative morbidity and mortality rates were 36% (4 of 11) and 18.3% (2 of 11), respectively. Excellent or good clinical outcomes, defined as modified Rankin Scale scores ≤ 2, were achieved in 86% (5 of 6) of patients available for long-term clinical follow-up (mean, 12.5 ± 13.6 months). CONCLUSION Giant PCoA aneurysms are rare vascular lesions that may present with a variety of neurological signs and symptoms. These lesions can be successfully managed surgically with satisfactory morbidity and mortality rates. To the best of our knowledge, this is the largest surgical series of giant PCoA aneurysms published to date.
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Affiliation(s)
- Gregory J Velat
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona 85013, USA
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7
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Castro Castro J, Agulleiro Díaz JP, Villa Fernández JM, Pinzón Millán A. [Anterior cerebral artery aneurism presenting as a third ventricular mass and hydrocephalus. Case report]. Neurocirugia (Astur) 2012; 24:41-6. [PMID: 23098766 DOI: 10.1016/j.neucir.2012.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Accepted: 01/04/2012] [Indexed: 10/27/2022]
Abstract
Aneurysms which appear as third ventricular masses are uncommon; most are giant aneurysms arising from the basilar apex. We present the case of a 67-year-old male who was admitted to hospital with a 4-week history of gait instability, urinary incontinence and progressive visual loss. A cranial computed tomography scan revealed a hyperdense mass in the third ventricle with triventricular dilatation. Cerebral magnetic resonance imaging, magnetic resonance-angiography and conventional angiography identified this lesion as a partially thrombosed aneurysm of the anterior cerebral artery. To our knowledge, this is the first report of an anterior cerebral artery aneurysm with these clinical and radiological features.
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Affiliation(s)
- Julián Castro Castro
- Servicio de Neurocirugía, Complejo Hospitalario Universitario de Ourense, Ourense, España.
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8
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SATO M, NAKAI Y, TAKIGAWA T, TAKANO S, MATSUMURA A. Endoscopic Third Ventriculostomy for Obstructive Hydrocephalus Caused by a Large Upper Basilar Artery Aneurysm After Coil Embolization. Neurol Med Chir (Tokyo) 2012. [DOI: 10.2176/nmc.52.832] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Masayuki SATO
- Department of Neurosurgery, Graduate School of Comprehensive Human Science, University of Tsukuba
| | - Yasunobu NAKAI
- Department of Neurosurgery, Graduate School of Comprehensive Human Science, University of Tsukuba
| | - Tomoji TAKIGAWA
- Department of Neurosurgery, Graduate School of Comprehensive Human Science, University of Tsukuba
| | - Shingo TAKANO
- Department of Neurosurgery, Graduate School of Comprehensive Human Science, University of Tsukuba
| | - Akira MATSUMURA
- Department of Neurosurgery, Graduate School of Comprehensive Human Science, University of Tsukuba
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9
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Principles in Case-Based Aneurysm Treatment: Approaching Complex Lesions Excluded by International Subarachnoid Aneurysm Trial (ISAT) Criteria. World Neurosurg 2011; 75:462-75. [DOI: 10.1016/j.wneu.2010.10.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2010] [Revised: 09/26/2010] [Accepted: 10/04/2010] [Indexed: 11/18/2022]
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10
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Sanli AM, Cekirge S, Sekerci Z. Aneurysm of the distal anterior cerebral artery radiologically mimicking a ventricular mass. J Neurosurg 2010; 114:1061-4. [PMID: 20635851 DOI: 10.3171/2010.6.jns10370] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The ventricular system is a rare localization for intracranial aneurysms. Most ventricular aneurysms arise from a distal branch of the choroidal arteries and a major branch point of the circle of Willis. A 41-year-old-man suffering from dizziness of 2 weeks' duration was admitted to the clinic. On radiological examination, he had a well-circumscribed mass involving the frontal horn of the right lateral ventricle without radiological evidence of a prior or recent hemorrhage. Localization and radiological appearance were not typical of a ventricular mass and did not allow diagnosis. After cerebral angiography, an aneurysm arising from the distal anterior cerebral artery was incidentally found in an intraventricular location. This unruptured aneurysm was successfully treated via the endovascular route. The authors describe the unusual case of a distal anterior cerebral artery aneurysm with a dome extending into the right lateral ventricle, which appears to be the first such case in the literature. Angiography may be helpful to neurosurgeons in avoiding the disastrous complications of a biopsy procedure in such unusual cases.
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Affiliation(s)
- A Metin Sanli
- Department of Neurosurgery, Dιşkapι Yιldιrιm Beyazιt Hospital, Ankara, Turkey.
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11
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Oertel JMK, Mondorf Y, Gaab MR. Endoscopic third ventriculostomy in obstructive hydrocephalus due to giant basilar artery aneurysm. J Neurosurg 2009; 110:14-8. [DOI: 10.3171/2008.7.jns0887] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Obstructive hydrocephalus due to giant basilar artery (BA) aneurysm is a rare finding, and endoscopic treatment has not been reported. Here the authors present their experience with endoscopic third ventriculostomy (ETV) in obstructive hydrocephalus due to giant BA aneurysm. Between December 2000 and March 2007, 3 patients (2 men and 1 woman; age range 32–80 years) underwent an ETV for the treatment of obstructive hydrocephalus caused by a giant BA aneurysm. All 3 patients presented with cephalgia, nausea, vomiting, and a variable decrease in consciousness. An obstructive hydrocephalus caused by a giant BA aneurysm was found in each case as the underlying pathological entity. Intraoperatively, a narrowing of the third ventricle by upward displacement of the tegmentum was found in all 3 patients. A standard ETV was performed and included an inspection of the prepontine cisterns. The endoscopic treatment was successful in all patients with respect to clinical signs and radiological ventricular enlargement. No complications were observed. In all, the endoscopic ventriculostomy was proven to be a successful treatment option in obstructive hydrocephalus even if it is caused by untreated giant BA aneurysm.
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12
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Tsutsumi S, Kondo A, Abe Y, Yasumoto Y, Ito M. Basilar apex aneurysm manifesting as third ventricular mass and obstructive hydrocephalus--case report--. Neurol Med Chir (Tokyo) 2008; 48:451-4. [PMID: 18948679 DOI: 10.2176/nmc.48.451] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 58-year-old male, with a past history of hypertensive thalamic hemorrhage 12 years before, presented with gradually exaggerating gait disturbance, memory disturbance, and urinary incontinence. On admission, he had gait disturbance represented by petit pas and anteropulsion in addition to significant recent memory disturbance. Cranial computed tomography (CT) revealed a hyperdense mass in the third ventricle with triventricular dilation. Cerebral magnetic resonance (MR) imaging and MR angiography identified the third ventricular lesion as saccular basilar apex aneurysm. No other intracranial abnormal intensity contributing to his clinical symptoms was recognized. Cervical MR angiography showed normal findings. Cerebral blood flow (CBF) measurements revealed diffuse CBF reduction in the cerebral hemisphere. The patient underwent coil embolization which accomplished complete aneurysm occlusion. He showed only slight improvement in his gait disturbance after embolization, and CT following embolization revealed persistent ventriculomegaly. Ventriculoperitoneal shunting was carried out. Intraoperative neuroendoscopy demonstrated cerebrospinal fluid (CSF) obstruction caused by the embolized aneurysm at the level of the third ventricle, with normal CSF findings. Postoperatively his gait disturbance and intellectual impairment showed remarkable improvement. Basilar apex aneurysm associated with obstructive hydrocephalus has complex underlying pathology and should be treated by a combination of definitive aneurysm obliteration and CSF diversion.
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Affiliation(s)
- Satoshi Tsutsumi
- Department of Neurological Surgery, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan.
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13
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Lim DH, Jung S, Jung TY, Kim TS. An Unusual Case of a Thrombosed Giant Distal PICA Aneurysm Simulating a Large Cavernous Angioma. J Korean Neurosurg Soc 2008; 43:155-8. [PMID: 19096624 DOI: 10.3340/jkns.2008.43.3.155] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2007] [Accepted: 03/18/2008] [Indexed: 11/27/2022] Open
Abstract
A 64-year-old woman was referred to our hospital with a one-month history of progressive headache. Magnetic resonance imaging (MRI) showed a hemorrhagic mass adjacent to the left inferior cerebellar hemisphere associated with a peripheral rim of signal void. Angiography demonstrated an avascular mass and the provisional diagnosis was a large cavernous angioma in the cerebellum. Intraoperative findings revealed a thrombosed giant aneurysm of the left distal posterior inferior cerebellar artery (PICA). We report an unusual case of a completely thrombosed giant aneurysm simulating a large cavernous angioma in the cerebellum. The cerebellar cisternal location of the mass may be a clue for the pre-operative diagnosis of an aneurysm.
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Affiliation(s)
- Dong-Ho Lim
- Department of Neurosurgery, Chonnam National University, Hwasun Hospital & Medical School, Hwasun, Korea
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14
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Successful treatment of a thrombosed posterior cerebral artery aneurysm causing obstructive hydrocephalus. J Clin Neurosci 2007; 15:199-202. [PMID: 17981037 DOI: 10.1016/j.jocn.2006.04.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2006] [Revised: 04/25/2006] [Accepted: 04/27/2006] [Indexed: 11/20/2022]
Abstract
The authors report a 49-year-old man who presented with obstructive hydrocephalus caused by a thrombosed posterior cerebral artery aneurysm. He underwent an endoscopic third ventriculostomy for the obstructive hydrocephalus followed by endovascular occlusion for the aneurysm. To our knowledge, this is the first report of a thrombosed posterior cerebral artery aneurysm presenting with obstructive hydrocephalus treated by the combination of endoscopic and endovascular techniques.
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15
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Abstract
We report upon two cases of obstructive hydrocephalus produced by giant basilar artery aneurysms. They initially presented with symptoms of increased intracranial pressure, and were managed by a ventriculo-peritoneal (VP) shunt with good symptomatic improvement. With time, however, both showed a gradual deterioration of clinical symptoms due to increased aneurysm size. One, with a basilar tip aneurysm was treated by direct neck-clipping of the aneurysm, and was able to return to work. In the other patient, with a basilar trunk aneurysm, endovascular occlusion of one vertebral artery was attempted in an effort to decrease the aneurysm size, but the aneurysm enlarged precipitating brain stem failure. In conclusion, these cases reveal the risk of the VP shunt, which may induce aneurysmal growth, leading to clinical devastation, and emphasize the importance of definitive treatment for giant cerebral aneurysms whenever possible.
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Affiliation(s)
- Myoung Soo Kim
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
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16
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Santoro A, Passacantilli E, Guidetti G, Dazzi M, Guglielmi G, Cantore G. Bypass combined with embolization via a venous graft in a patient with a giant aneurysm in the posterior communicating artery and bilateral idiopathic occlusion of the internal carotid artery in the neck. J Neurosurg 2002; 96:135-9. [PMID: 11794595 DOI: 10.3171/jns.2002.96.1.0135] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The authors describe the case of a patient with a symptomatic giant aneurysm of the posterior communicating artery (PCoA) associated with bilateral idiopathic occlusion of the internal carotid artery (ICA). The presence of severe tortuosity of the vertebral arteries (VAs), both at their origin from the subclavian artery and at the level of the third segment, impeded navigation of the catheter for embolization of the aneurysm with Guglielmi detachable coils (GDCs). A direct surgical approach was considered to be a high-risk procedure because of the bilateral occlusion of the ICAs and the size of the aneurysm. The following therapeutic strategy was therefore adopted: 1) balloon occlusion test of the left VA; 2) vertebro-vertebral bypass with saphenous vein graft to provide a pathway for subsequent embolization; 3) ICA-left middle cerebral artery bypass to ensure blood flow in the event that embolization resulted in closure of the PCoA; and 4) GDC embolization of the aneurysm via the posterior circulation graft to ensure complete exclusion of the lesion from the arterial circulation and preservation of the PCoA. At 3-month follow-up review the patient did not present with any neurological deficits; at 1-year control examination, magnetic resonance (MR) imaging and MR angiography both confirmed complete exclusion of the aneurysm and patency of the two bypasses.
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Affiliation(s)
- Antonio Santoro
- Dipartimento di Scienze Neurologiche, Neurochirurgia, Rome, Italy.
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17
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Hongo K, Morota N, Watabe T, Isobe M, Nakagawa H. Giant basilar bifurcation aneurysm presenting as a third ventricular mass with unilateral obstructive hydrocephalus: case report. J Clin Neurosci 2001; 8:51-4. [PMID: 11148080 DOI: 10.1054/jocn.2000.0730] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We report a rare case of a non-ruptured basilar bifurcation aneurysm presenting as a third ventricular mass producing unilateral obstructive hydrocephalus. This is the first reported case of its kind. A 70 year old woman presented with a giant basilar bifurcation aneurysm in which the aneurysm protruded into the third ventricle as a mass causing unilateral left hydrocephalus. The patient gradually became disoriented and developed a right hemiparesis and global aphasia. The right vertebral artery was occluded by placing coils intravascularly followed by an endoscopic septostomy. The patient's neurological state dramatically improved immediately. One month after the septostomy, however, the aneurysm ruptured and the patient eventually died. Treatment of the hydrocephalus only was selected instead of direct surgery or an intravascular procedure on the aneurysm, which eventually ruptured. The mechanisms for the unilateral hydrocephalus and the rupture of the aneurysm are described. The treatment strategy for these lesions is also discussed.
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Affiliation(s)
- K Hongo
- Department of Neurological Surgery, Aichi Medical University, Nagakute, Aichi, Japan.
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18
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Watanabe A, Imamura K, Ishii R. Endosaccular aneurysm occlusion with Guglielmi detachable coils for obstructive hydrocephalus caused by a large basilar tip aneurysm. Neurosurg Focus 1999. [DOI: 10.3171/foc.1999.7.4.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The authors present the case of a 60-year-old man with obstructive hydrocephalus caused by a large basilar artery tip aneurysm, in whom direct surgical clipping of the aneurysm neck was considered hazardous. After endosaccular aneurysm occlusion, his symptoms (headache, intellectual impairment, and gait disturbance) and ventricular dilation immediately improved without placement of a ventricular shunt. To the authors' knowledge, this is the first case of its kind treated solely endovascularly.
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19
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Watanabe A, Imamura K, Ishii R. Endosaccular aneurysm occlusion with Guglielmi detachable coils for obstructive hydrocephalus caused by a large basilar tip aneurysm. Case report. J Neurosurg 1999; 91:675-8. [PMID: 10507391 DOI: 10.3171/jns.1999.91.4.0675] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The authors present the case of a 60-year-old man with obstructive hydrocephalus caused by a large basilar artery tip aneurysm, in whom direct surgical clipping of the aneurysm neck was considered hazardous. After endosaccular aneurysm occlusion, his symptoms (headache, intellectual impairment, and gait disturbance) and ventricular dilation immediately improved without placement of a ventricular shunt. To the authors' knowledge, this is the first case of its kind treated solely endovascularly.
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Affiliation(s)
- A Watanabe
- Department of Neurosurgery, Kawasaki Medical School, Okayama, Japan.
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20
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Kawaguchi S, Noguchi H, Yonezawa T, Hoshida T, Morimoto T, Sakaki T. Giant true posterior communicating artery aneurysm. J Stroke Cerebrovasc Dis 1998; 7:259-62. [PMID: 17895094 DOI: 10.1016/s1052-3057(98)80036-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/1997] [Accepted: 01/30/1998] [Indexed: 10/24/2022] Open
Abstract
The case of a giant posterior communicating artery (PCoA) aneurysm is reported in which the clinical presentation was Korsakoff's syndrome. Left carotid angiography revealed a partially thrombosed giant PCoA aneurysm. Three-dimensional computed tomography angiography showed the precise neck of aneurysm and surrounding structures from a multidirectional view. Hypoperfusion of the bilateral frontal, temporal, and medial inferior thalamus was seen on single-photon emission computed tomography. According to previous reports, giant true PCoA aneurysms are rare; in fact, there has been only one report of a giant true PCoA aneurysm. We discuss the radiological characteristics and the clinical presentation of giant true PCoA aneurysms.
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Affiliation(s)
- S Kawaguchi
- Department of Neurosurgery, Nara Medical University, Nara, Japan
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22
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Matsumoto K, Kuriyama M, Tamiya T, Ohmoto T. Direct clip obliteration of a ruptured giant aneurysm of the posterior communicating artery: case report. Neurosurgery 1997; 41:939-42; discussion 942-3. [PMID: 9316057 DOI: 10.1097/00006123-199710000-00032] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE AND IMPORTANCE A review of the literature documents that giant posterior communicating artery (PCoA) aneurysms are rare. To our knowledge, this report is the first to describe a ruptured giant aneurysm arising from a PCoA that was successfully clipped. CLINICAL PRESENTATION A 27-year-old man had a left oculomotor palsy and then suffered a subarachnoid hemorrhage. Cerebral angiography and three-dimensional computed tomographic angiography revealed a giant fusiform aneurysm of the left PCoA. These imaging techniques documented the rapid growth of the aneurysm from a moderate to a giant size in fewer than 3 days. INTERVENTION The patient underwent a left subtemporal craniotomy. The neck was constructed and was successfully clipped, and the PCoA was reconstructed with five sequentially placed fenestrated clips in a tandem fashion. The patient experienced a good recovery. CONCLUSION This report describes the usefulness of three-dimensional computed tomographic angiography in planning the surgical approach to giant aneurysms originating from the PCoA and the use of fenestrated clips to obliterate giant fusiform aneurysms.
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Affiliation(s)
- K Matsumoto
- Department of Neurological Surgery, Okayama University Medical School, Japan
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23
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Koyama S, Kotani A, Sasaki J. Giant basilar artery aneurysm with intramural hemorrhage and then disastrous hemorrhage: case report. Neurosurgery 1996; 39:174-7; discussion 177-8. [PMID: 8805156 DOI: 10.1097/00006123-199607000-00039] [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: 02/02/2023] Open
Abstract
OBJECTIVE AND IMPORTANCE Intracranial giant aneurysms have been considered to grow by recurrence of intramural hemorrhage of the aneurysmal wall. However, it remains uncertain whether rupture of giant aneurysms is brought about by the same mechanism that causes the rupture of smaller saccular aneurysms. It is also unclear whether intramural hemorrhage is correlated with the rupture of giant aneurysms. CLINICAL PRESENTATION A 67-year-old woman was admitted with symptoms of gait disturbance and dementia. Computed tomographic scans revealed a large mass located in the prepontine region and extending into the third ventricle as well as moderate dilatation of the lateral ventricles. Angiography demonstrated a giant basilar tip aneurysm and multiple aneurysms located in the bilateral anterior and middle cerebral arteries. INTERVENTION Ventriculoperitoneal shunting was scheduled, but subarachnoid and intraventricular hemorrhage occurred and the patient died. Computed tomographic scans, performed immediately before the disastrous hemorrhage, displayed intramural hemorrhage in the wall of the giant basilar tip aneurysm. Ventricular drainage was performed, but the patient died. CONCLUSION It seems probable that intramural hemorrhage of the aneurysmal wall may cause both the growth and rupture of intracranial giant aneurysms.
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Affiliation(s)
- S Koyama
- Department of Neurological Surgery, Yokohama Chuou Hospital, Japan
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