Rupture of De Novo Anterior Communicating Artery Aneurysm 8 Days after the Clipping of Ruptured Middle Cerebral Artery Aneurysm

Rapidly developed de novo aneurysm is very rare. We present a rapidly developed and ruptured de novo anterior communicating aneurysm 8 days after the rupture of another aneurysm. This de novo aneurysm was not apparent in the initial 3-dimensional computed tomography and digital subtraction angiography. We reviewed the literature and discussed possible mechanisms for the development of this de novo aneurysm.

Development of 'De novo' Aneurysm after Therapeutic Carotid Occlusion

Carotid occlusion is an inevitable therapeutic modality for the treatment of complex aneurysms such as giant, traumatic, and intracavernous aneurysms. Late complications of carotid occlusion include 'de novo' aneurysm formation at a distant site because of hemodynamic changes in the circle of Willis. We report a case of de novo aneurysm in a vessel that appeared to be normal on initial angiography. The patient developed an anterior communicating artery aneurysm and marked growth of a basilar bifurcation aneurysm 9 years after trapping of the left internal carotid artery for the treatment of a ruptured large saccular aneurysm involving ophthalmic and cavernous segments. We propose that patients who undergo therapeutic carotid occlusion should be periodically followed by magnetic resonance angiography or computed tomographic angiography to evaluate the possibility of de novo aneurysm formation; this advice is in line with previous reports.

A Clinical Analysis of Twelve Cases of Ruptured Cerebral De Novo Aneurysms

Formation of cerebral de novo aneurysms (CDNA) is rare, and the pathogenesis remains obscure. In this study, we investigated the factors that contribute to the formation of CDNA and suggest guidelines for following patients treated for cerebral aneurysms. We retrospectively reviewed 2,887 patients treated for intracranial aneurysm at our institute from January of 1976 to December of 2005. Of those patients, 12 were readmitted due to recurrent rupture of CDNA, which was demonstrated by cerebral angiography. We assessed clinical characteristics, such as gender, size and site of rupture, past history, and the time to CDNA rupture. Of the 12 patients, 11 were female and 1 was male, with a mean age at rupture of the first aneurysm of 44.7 years (range: 30-69 years). The mean time between the first episode of subarachnoid hemorrhage (SAH) and the second was 8.9 years (range: 1.0-16.7 years). The most common site of ruptured CDNA was the internal carotid artery (5 patients, 41.7%), followed by basilar artery bifurcation (3 patients, 25.0%). In the remaining 4 patients, rupture occurred in the anterior communicating, middle cerebral, anterior cerebral (A1), or posterior cerebral (P1) arteries. In 5 cases (41.7%), the CDNA occurred contralateral to the initial aneurysm. Eleven patients (91.7%) had a past history of arterial hypertension. There was no history of habitual smoking or alcohol abuse in any of the patients. Eight patients underwent clipping for CDNA and three patients were treated with coiling. One patient who had multiple aneurysms was treated with clipping following intra-aneurysmal coiling. Assessment according to the Glasgow Outcome Scale (GOS) of the patients after the treatment was good in 10 cases (83.3%) and fair in 2 cases (16.7%). Although formation of CDNA after successful treatment of initial aneurysm is rare, several factors may contribute to recurrence. In our study, female patients with a history of arterial hypertension were at higher risk for ruptured CDNA. We recommend follow-up imaging studies every five years after treatment of the initial aneurysm, especially in women and those with a history of arterial hypertension.

Role of Three-dimensional Computed Tomography Angiography in the Follow-up of Patients with Aneurysm Clips

OBJECTIVE: The purpose of this study is to assess the usefulness of three-dimensional computed tomography angiography (3D-CTA) as a postoperative follow-up examination after intracranial aneurysms have been clipped. METHODS: Between January 2002 and June 2005, 522 consecutive patients received treatment for intracranial aneurysms. A retrospective analysis of 310 patients with postoperative 3D-CTAs was performed to evaluate aneurysmal remnants and de novo aneurysms. This study was conducted in 271 patients with at least immediate and 6-month routine 3D-CTAs for postoperative clipped aneurysm and 39 patients with 3D-CTAs for clipped aneurysm before 2002 when there was no 3D-CTA in our hospital. RESULTS: Eight patients had abnormal CT angiographic findings. Aneurysm remnants were revealed in 4 patients and de novo aneurysms were discovered in 5 patients. Two patients were found at the postoperative 6-month 3D-CTA performed routinely. In 1 patient, the aneurysm was demonstrated on the way to the examination of syncope. In 2 patients, the author recommended 3D-CTA although there was no symptom because the patients had visited our institute long time ago (5.1, 4.5 years). Of the 8 patients, 2 remnants and 1 de novo aneurysm were treated by endovascular treatment. Three de novo aneurysms at the middle cerebral artery and 1 pericallosal artery aneurysm were treated by direct clipping because these aneurysms were not suitable for the endovascular treatment in point of anatomical configuration. One patient with both remnant and de novo aneurysm was treated conservatively. CONCLUSION: 3D-CTA is an available, non-invasive diagnostic tool for the postoperative follow-up examination of aneurysmal state in patients after clipping.

Intracranial "De Novo" Aneurysms: Case Report

There are numerous theories of pathophysiology in intracranial aneurysm, but currently accepted hypothesis was congenital defect of medial layer of vascular wall and the major developing factor was hemodynamics. Almost physicians were belived that treatment of intracranial aneurysm was completely through clipping of aneurysmal neck. But many reports were emphasized newly deloped intracranial(De Novo) aneurysm after clipping of initially identified intracranial aneurysm. The authors have same experienced of 2 cases intracranial "Do Novo" aneurysms. We are stress there were never completed treatment of aneurysm that clipping of initially identified intracranial aneurysm and should be attention to "De Novo" aneurysm.