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Yokoya S, Oka H, Shiomi N, Hino A, Fujimoto M. Aneurysm of Distal Medial Lenticulostriate Artery: Report of 2 Cases. World Neurosurg 2020; 143:219-222. [PMID: 32750519 DOI: 10.1016/j.wneu.2020.07.178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/24/2020] [Accepted: 07/26/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Aneurysms originating from the distal portion of the lenticulostriate artery (LSA) are uncommon. Distal medial LSA (MLSA) aneurysms are particularly uncommon when compared with distal lateral LSA aneurysms, and their clinical features are unclear. Here, we present 2 patients with aneurysms of the distal MLSA who exhibited hemorrhages of the caudate nucleus and intraventricular region (intraventricular hemorrhage [IVH]). CASE DESCRIPTION Patient 1 is a 50-year-old woman who was admitted to our hospital because of a hemorrhage in the left caudate nucleus and ventricles. She underwent external ventricular drainage (EVD). Cerebral angiography (CAG) performed on hospital day 24 showed an aneurysm located in the distal portion of the MLSA; however, CAG performed on admission revealed no abnormal vessels. We excised the aneurysm using a transcallosal-transventricular approach. Patient 2 is an 88-year-old woman who was admitted to our hospital with a right caudate nucleus hematoma and a dense IVH. She underwent emergent EVD. CAG demonstrated a 2.5-mm aneurysm in the distal MLSA, and a 6-mm aneurysm which originated from the right horizontal portion of the anterior cerebral artery (A1)-MLSA bifurcation aneurysm. We performed direct clipping of the A1-MLSA bifurcation aneurysm with proximal ligation of the distal MLSA aneurysm. CONCLUSIONS We should consider the possibility of a ruptured distal MLSA aneurysm when diagnosing a patient with IVH-with or without a caudate nucleus hematoma. Repeated imaging evaluations may be necessary to find the lesion.
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Affiliation(s)
- Shigeomi Yokoya
- Department of Neurosurgery, Saiseikai Shiga Hospital, Imperial Gift Foundation Inc., Ritto, Shiga, Japan.
| | - Hideki Oka
- Department of Neurosurgery, Saiseikai Shiga Hospital, Imperial Gift Foundation Inc., Ritto, Shiga, Japan
| | - Naoto Shiomi
- Department of Neurosurgery, Saiseikai Shiga Hospital, Imperial Gift Foundation Inc., Ritto, Shiga, Japan
| | - Akihiko Hino
- Department of Neurosurgery, Saiseikai Shiga Hospital, Imperial Gift Foundation Inc., Ritto, Shiga, Japan
| | - Masahito Fujimoto
- Department of Neurosurgery, Saiseikai Shiga Hospital, Imperial Gift Foundation Inc., Ritto, Shiga, Japan
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Yamano A, Nakamura K, Onuma K, Sato M, Matsumaru Y, Yanaka K, Ishikawa E, Matsumura A. A Patient with a Distal Medial Lenticulostriate Artery Aneurysm and Intraventricular Hemorrhage Treated by Endovascular Treatment. JOURNAL OF NEUROENDOVASCULAR THERAPY 2020; 14:400-405. [PMID: 37501665 PMCID: PMC10370906 DOI: 10.5797/jnet.cr.2019-0083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 05/02/2020] [Indexed: 07/29/2023]
Abstract
Objective A patient with a ruptured distal medial lenticulostriate artery (mLSA) aneurysm presenting with intraventricular hemorrhage was successfully treated using endovascular treatment. Case Presentation A 60-year-old woman presented with impaired consciousness. Radiological examination revealed intraventricular hemorrhage caused by a rupture of a distal mLSA aneurysm. Using endovascular technique, approaching contralaterally through the anterior communicating artery (AComA), complete occlusion of the aneurysm was achieved by N-butyl-2-cyanoacrylate (NBCA) injection. The postoperative course was uneventful. Conclusion Intraventricular aneurysms at a distal site of the perforating arteries are rare. Although there have been reports on patients with distal mLSA aneurysms treated by open surgery or conservative therapy, endovascular therapy should also be considered as a treatment option.
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Affiliation(s)
- Akinari Yamano
- Department of Neurosurgery, Tsukuba Memorial Hospital, Tsukuba, Ibaraki, Japan
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Kazuhiro Nakamura
- Department of Neurosurgery, Tsukuba Memorial Hospital, Tsukuba, Ibaraki, Japan
| | - Kuniyuki Onuma
- Department of Neurosurgery, Tsukuba Memorial Hospital, Tsukuba, Ibaraki, Japan
| | - Masayuki Sato
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
- Division of Stroke Prevention and Treatment, Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Yuji Matsumaru
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
- Division of Stroke Prevention and Treatment, Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Kiyoyuki Yanaka
- Department of Neurosurgery, Tsukuba Memorial Hospital, Tsukuba, Ibaraki, Japan
| | - Eiichi Ishikawa
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Akira Matsumura
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
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Massive intracranial bleeding due to the rupture of a rare spontaneous pseudoaneurysm of the middle cerebral artery in a pediatric patient: case report with clinical, radiological, and pathologic findings. Forensic Sci Med Pathol 2019; 15:474-480. [PMID: 31218656 DOI: 10.1007/s12024-019-00122-5] [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] [Accepted: 05/02/2019] [Indexed: 10/26/2022]
Abstract
Intracranial pseudoaneurysm (IPA) is a rare but likely underdiagnosed cause of intracranial hemorrhage, which accounts for just 1-6% of all intracranial aneurysms. Spontaneous IPAs are exceptionally rare, and their etiology and features are not well defined. Herein, we report a case of a pediatric patient who died from massive intracranial bleeding due to the rupture of a spontaneous IPA after undergoing multiple radiological studies and neurosurgical operations. At the postmortem examination of the brain, a giant size pseudoaneurysm of the right middle cerebral artery was observed. Microscopic examination demonstrated variable wall thickness and dense fibrosis focally in the vessel wall with disruption of the media structure together with a loss and fragmentation of the elastic laminae, loss of organization of smooth muscle cells in the media, and multifocal areas of hemorrhage throughout the vessel wall, as well as direct evidence of wall dissection. Since IPAs without any traumatic or infective history are extremely uncommon, further pathologic studies should be performed to clarify spontaneous pseudoaneurysm etiology.
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Chaohui L, Chuan H, Hongqi Z. Embolization of Ruptured Distal Lenticulostriate Artery Aneurysms. World Neurosurg 2018; 118:e147-e154. [DOI: 10.1016/j.wneu.2018.06.143] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 06/15/2018] [Accepted: 06/16/2018] [Indexed: 12/01/2022]
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Nomura M, Baba E, Shirokane K, Tsuchiya A. Aneurysm of lenticulostriate artery in a patient presenting with hemorrhage in the caudate nucleus and lateral ventricle-delayed appearance and spontaneous resolution. Surg Neurol Int 2018; 9:192. [PMID: 30294496 PMCID: PMC6169348 DOI: 10.4103/sni.sni_126_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 08/02/2018] [Indexed: 12/03/2022] Open
Abstract
Background: An aneurysm of distal lenticulostriate artery is very rare. The natural course and management of this rare aneurysm are not clear. Case Description: An 81-year-old woman developed consciousness disturbance. Computed tomography revealed hemorrhage in the right caudate nucleus and lateral ventricles. Three-dimensional computed tomographic angiography demonstrated only an aneurysm at the basilar artery. On angiography, on the sixth day, an aneurysm at the right lenticulostriate artery was demonstrated. Then, the aneurysm disappeared on three-dimensional computed tomographic angiography on the 15th day. Subsequent radiological examinations revealed no vascular anomaly in the right lenticulostriate artery. Conclusion: An aneurysm at this location can show dynamic changes based on radiological findings. Close radiological observation is necessary.
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Affiliation(s)
- Motohiro Nomura
- Department of Neurosurgery, Kanto Rosai Hospital, Kawasaki, Japan
| | - Eiichi Baba
- Department of Neurosurgery, Kanto Rosai Hospital, Kawasaki, Japan
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Sato Y, Ando K, Kawaguchi M, Kakinuma K. Successful Resection of a Growing Distal Medial Lenticulostriate Artery Pseudoaneurysm Presenting with Isolated Intraventricular Hemorrhage. J Stroke Cerebrovasc Dis 2017; 26:e206-e209. [PMID: 28826583 DOI: 10.1016/j.jstrokecerebrovasdis.2017.07.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 07/09/2017] [Accepted: 07/23/2017] [Indexed: 10/19/2022] Open
Abstract
INTRODUCTION Distal medial lenticulostriate artery (LSA) aneurysms associated with isolated intraventricular hemorrhage (IVH) are extremely rare. We report a very rare case of the isolated IVH due to the rupture of the distal medial LSA pseudoaneurysm that was not visible at the initial angiography but later emerged and grew. CASE REPORT A 61-year-old woman with a history of hypertension had sudden onset of severe headache and mild consciousness disturbance. The computed tomography scan revealed the IVH, but the initial angiographies showed no evidence of aneurysm. The follow-up magnetic resonance imaging revealed that an intraventricular mass, arising from the right distal medial LSA, emerged and grew into the right anterior horn. Considering the risk of rebleeding, we resected the mass lesion via the transsulcal transventricular approach. The postoperative imaging showed complete obliteration of the mass lesion. Histopathological analysis indicated the pseudoaneurysm. The patient was discharged without any neurological deficit. CONCLUSIONS The careful and repetitive follow-up imaging should be done in the cases with isolated IVH even if the initial image evaluations are unrevealing. The transsulcal transventricular approach can be the most minimally invasive surgical option for intraventricular lesion.
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Affiliation(s)
- Yosuke Sato
- Department of Neurosurgery, Cerebrovascular Center, Niigata Rosai Hospital, Japan Organization of Occupational Health and Safety, Niigata, Japan.
| | - Kazuhiro Ando
- Department of Neurosurgery, Cerebrovascular Center, Niigata Rosai Hospital, Japan Organization of Occupational Health and Safety, Niigata, Japan
| | - Makoto Kawaguchi
- Division of Diagnostic Pathology, Niigata Rosai Hospital, Japan Organization of Occupational Health and Safety, Niigata, Japan
| | - Kenichi Kakinuma
- Department of Neurosurgery, Cerebrovascular Center, Niigata Rosai Hospital, Japan Organization of Occupational Health and Safety, Niigata, Japan
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Turan N, Butler S, Larson TC, Mason A. Nontraumatic, posterior circulation pseudoaneurysm of the basilar artery summit with complete spontaneous resolution: Case report and literature review. Surg Neurol Int 2017; 8:50. [PMID: 28480112 PMCID: PMC5402333 DOI: 10.4103/sni.sni_452_16] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 01/23/2017] [Indexed: 12/02/2022] Open
Abstract
Background: Intracranial pseudoaneurysms are rare vascular defects of arterial walls that are classically the result of traumatic injury, iatrogenic causes, or infection. Idiopathic pseudoaneurysms are seen even less frequently and are often related to atherosclerosis. Pseudoaneurysms are most commonly found along the distal wall of the internal carotid artery, however, can occur at any location in the cerebrovascular circulation. Treatment of these arterial defects is often challenging due to their frail nature. Case Description: A 61-year-old male with a history of hypertension presented with a severe, atypical headache without history of trauma. Computed tomography (CT) and computed tomography angiography (CTA) demonstrated diffuse subarachnoid hemorrhage. Imaging demonstrated a 3.5 mm pseudoaneurysm projecting distally from the basilar artery at the apex. Repeated imaging (CTA, digital subtraction angiography) demonstrated decreased size and flow associated within the aneurysm over the following 2 weeks; as such, the patient was managed conservatively. The patient was discharged in neurologically intact condition when imaging at 14 days confirmed complete and spontaneous resolution of the pseudoaneurysm. Conclusion: Idiopathic pseudoaneurysms that are commonly associated with atherosclerosis are most commonly managed surgically or endovascularly. Conservative approach may be considered in a select group of patients that exhibit decreased size and/or flow within the aneurysm in repeated imaging; spontaneous resolution was seen in the present case.
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Affiliation(s)
- Nefize Turan
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia
| | - Shannon Butler
- Faculty of Health, University of Canberra, Canberra, Australia
| | - Theodore C Larson
- Department of Neurosciences, Centura Health Physician Group Neuroscience and Spine, Lakewood, Colorado, USA
| | - Alexander Mason
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia
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