Recanalization of completely thrombosed non-giant saccular aneurysm mimicking as de novo aneurysm

Falxuplication, a Novel Method for Wrap-Clipping a Fusiform Aneurysm: Technical Note

BACKGROUND

Various techniques have been used for wrap-clipping a ruptured, fusiform intracranial aneurysm; however, there is no available literature on use of the falx cerebri for wrap-clipping. We present a review of the literature, with an illustrative case, of a ruptured fusiform pericallosal artery aneurysm firmly attached to the lower edge of the falx cerebri and not amenable to endovascular intervention.

METHODS

Although the firm attachment between the inferior falx and the fusiform aneurysm was maintained, a section of the lower thinner part of the falx cerebri firmly attached to the aneurysm was dissected and wrapped around the fusiform aneurysm, and then stabilized with a fenestrated clip. We chose a segment slightly longer than the length of the fusiform aneurysm to avoid pre- and post-wrap-clipping stenosis.

RESULTS

Postprocedure, except for a small area of numbness on the left distal anterolateral left leg, the patient was neurologically intact and remained neurologically intact at a 12-month follow-up.

CONCLUSIONS

An inferior thin segment of the falx cerebri can be used for wrap-clipping of ruptured fusiform anterior cerebral artery aneurysms. Furthermore, the inferior falx can be wrapped around the attached fusiform anterior cerebral artery aneurysm without compromising flow, offering a safe solution in these unusually complex cases.

Delayed Rebleeding of Cerebral Aneurysm Misdiagnosed as Traumatic Subarachnoid Hemorrhage

An intracranial saccular aneurysm is uncommonly diagnosed in a patient with closed head trauma. We herein present a patient with delayed rebleeding of a cerebral aneurysm misdiagnosed as traumatic subarachnoid hemorrhage (SAH). A 26-year-old female visited our emergency department because of headache after a motorcycle accident. Brain computed tomography (CT) showed a right-side dominant SAH in Sylvian fissure. Although traumatic SAH was strongly suggested because of the history of head trauma, we performed a CT angiogram to exclude any vascular abnormalities. The CT angiogram showed no vascular abnormality. She was discharged after conservative treatment. One day after discharge, she returned to the emergency department because of mental deterioration. Brain CT showed diffuse SAH, which was dominant in the right Sylvian fissure. The CT angiogram revealed a right middle cerebral artery bifurcation aneurysm. During operation, a non-traumatic true saccular aneurysm was found. The patient recovered fully after successful clipping of the aneurysm and was discharged without neurologic deficit.

Normal findings on a CT angiogram do not always exclude aneurysmal SAH. Follow-up vascular study should be considered in trauma patients who are highly suspicious of aneurysmal rupture.

Spontaneous Occluded Anterior Communicating Artery Aneurysm during Coil Embolization Treated with One Coil Insertion into Remaining Stump

Spontaneous thrombosis of a ruptured aneurysm during coil embolization is a rare event, and some reports on recanalization of a spontaneous occluded ruptured aneurysm have been published. We report on a case of a 54-year-old male who presented with a subarachnoid hemorrhage due to rupture of a small aneurysm of the anterior communicating artery (ACoA). Cerebral angiography confirmed the presence of the ACoA aneurysm, but, during coil embolization, the aneurysm was near completely occluded with a remaining small neck. A small coil was inserted into the remaining stump of the neck to prevent recanalization, and the angiographic result at 1 year after coil embolization showed complete obliteration of the aneurysm.

Spontaneous resolution in dissecting aneurysms of the distal middle cerebral artery

Spontaneous resolution of intracranial aneurysms is a rare phenomenon. We describe two cases of ruptured distal middle cerebral artery branch aneurysms associated with initial neurological deficit. Follow-up angiography showed complete resolution of the aneurysms.