Traumatic Aneurysm of the Callosomarginal Artery-Cortical Artery Junction from Penetrating Injury by Scissors

Traumatic intracranial aneurysms (TICAs) are rare and are associated with high rates of morbidity and mortality. TICAs usually result from head injuries caused by traffic accidents, industrial accidents, or gunshots. We report a traumatic aneurysm of the callosomarginal artery-cortical artery junction arising from a penetrating injury by scissors. A 51-year-old woman was admitted to our hospital after suffering a penetrating injury caused by scissors. Computed tomography (CT) and CT-angiography demonstrated a right orbital roof fracture, subarachnoid hemorrhage, frontal lobe hemorrhage, intraventricular hemorrhage, and a traumatic aneurysm of the right callosomarginal artery-cortical artery junction. We trapped the traumatic aneurysm and repositioned a galeal flap. Postoperative CT showed a small infarction in the left frontal lobe. Follow-up angiography two months later showed no residual aneurysm. We suggest that an aggressive surgical intervention be performed whenever TICA is diagnosed.

Bony Protuberances on the Anterior and Posterior Clinoid Processes Lead to Traumatic Internal Carotid Artery Aneurysm Following Craniofacial Injury

Traumatic intracranial aneurysms are rare, comprising 1% or less of all cerebral aneurysms. The majority of these aneurysms arise at the skull base or in the distal anterior and middle cerebral arteries or their branches following direct mural injury or acceleration-induced shearing force. We present a 50-year-old patient in whom subarachnoid hemorrhage (SAH) was developed as a result of traumatic aneurysm rupture after a closed craniofacial injury. Through careful evaluation of the three-dimensional computed tomography and conventional angiographies, the possible mechanism of the traumatic internal carotid artery trunk aneurysm is correlated with a hit injury by the bony protuberances on the anterior and posterior clinoid processes. This traumatic aneurysm was successfully obliterated with clipping and wrapping technique. The possibility of a traumatic intracranial aneurysm should be considered when patient with SAH demonstrates bony protuberances on the clinoid process as a traumatic aneurysm may result from mechanical injury by the sharp bony edges.

Pseudoaneurisma postraumático de aorta torácica descendente: caso clínico, hospital regional Doctor Teodoro Maldonado Carbo / Post-traumatic descending thoracic aorta pseudoaeurysm: clinical case, Regional Hospital Doctor Teodoro Maldonado Carbo

Paciente masculino, 36 años de edad, que acude a consulta externa del servicio de cardiología para valoración prequirúrgica, declarándose asintomático cardiovascular; en antecedentes personales, refirió trauma cerrado de tórax de nueve años de evolución. Como hallazgo radiológico, en estándar de tórax, se observa dilatación de aorta descendente y cayado, compatible con diagnóstico de aneurisma aórtico. Se confirma mediante TAC simple de tórax, ecocardiografía, angiorresonancia y aortografía. Los aneurismas de aorta torácica representan menos de 10 de los aneurismas aórticos, los de tipo postraumáticos son menos frecuentes dentro de este grupo y pueden desarrollarse en el ligamento arterioso por delante de la arteria subclavia izquierda. Se hace revisión sobre esta patología.

Male, 36 years old, who came to the Cardiology Outpatient Service for pre-surgery valuation, declaring being without cardiovascular symptoms. In his medical history there is a nine years of evolution chest closed trauma. As a radiological finding, in a chest radiography we can see dilatation of stab and descending aorta suitable with a diagnosis of aortic aneurysm. It is confirmed by simple chest TAC, echocardiography, magnetic resonance imaging angiography and aortography. The thoracic aorta aneurysms represents less than 10 of aortic aneurysms. The post-traumatic type are the less frequent into this group and they can develope in the arterious ligament in front of the left subclavian artery. There is a revision about this pathology.

Endovascualr Treatment for Traumatic Giant Pseudoaneurysm of Internal Carotid Artery

Traumatic pseudoaneurysms of the cavernous portion of the internal carotid artery(ICA) presenting with epistaxis are uncommon and potentially lethal complication of head injury. Because the onset of delayed bleeding from the time of injury is variable, prompt diagnosis and treatment of cavernous ICA pseudoaneurysm is important. A patient with a giant traumatic pseudoaneurysm of the left ICA presented with massive epistaxis 5 months after a head trauma. This patient was treated with occlusion of the opening of pseudoaneurysm and ICA by a detachable balloon and fibered coils.

Endovascualr Treatment for Traumatic Giant Pseudoaneurysm of Internal Carotid Artery

Traumatic pseudoaneurysms of the cavernous portion of the internal carotid artery(ICA) presenting with epistaxis are uncommon and potentially lethal complication of head injury. Because the onset of delayed bleeding from the time of injury is variable, prompt diagnosis and treatment of cavernous ICA pseudoaneurysm is important. A patient with a giant traumatic pseudoaneurysm of the left ICA presented with massive epistaxis 5 months after a head trauma. This patient was treated with occlusion of the opening of pseudoaneurysm and ICA by a detachable balloon and fibered coils.

Surgical Management of Pseudoaneurysm

OBJECTIVES: Surgical experiences of pseudoaneurysms such as traumatic, mycotic and ill-defined unknown causes of aneurysms are rare. The authors have studied the results of surgical management from such cases in our series. PATIENTS AND METHOD: In the last 17 years, 1320 patients with cerebrovascular aneurysms were managed surgically. Among these, 16 patients showed the pseudoaneurysms. The authors analyzed retrospectively the clinical characteristics, treatment methods, management outcomes and problems in the managements. RESULTS: There were 6 patients with traumatic aneurysm, 4 mycotic aneurysms and 6 ill-defined unknown causes of aneurysm. The sites of traumatic aneurysms were cavernous portion of the internal carotid artery(n=3), distal portion of the anterior cerebral artery (n=2) and vertebral artery(VA: n=1). Good outcomes in 5 cases could be obtained by extracranial - intracranial bypass followed by parent vessel occlusion or resection of aneurysm followed by re-anast-omosis of parent vessel. The sites of mycotic aneurysm were peripheral portions of middle cerebral artery(MCA: n=3) and posterior cerebral artery(PCA: n=1). The outcomes of the patients with a mycotic aneurysm were relatively poor. It was partially due to the development of new aneurysm after treatment in one. The sites of ill-defined unknown causes of aneurysm were extracranial carotid artery(n=3), V2 portion of the VA(n=1), peripheral portion of the PCA (n=1) and MCA(n=1). Good outcome in all cases could be obtained by resection of aneurysm with or without saphenous vein graft. CONCLUSION: For the treatments of cerebrovascular pseudoaneurysm, combinations of aggressive medical, endovascular and surgical managements seem mandatory. Insertion of stent for a extracranial carotid artery aneurysm and coiling for a peripheral mycotic aneurysm can be option in future.

Traumatic Aneurysm of the Pericallosal artery

Traumatic intracranial aneurysms are rare, compromising less than 1% of intracranial aneurysms. The case of 20-year-old man suffered from delayed frontal intracerebral hematoma, subarachnoid hemorrhage and intraventricular hemorrhage from traumatic pericallosal aneurysm 12 days after head injury is presented. Traumatic pericallosal artery aneurysm is always near the falcine edge, is unrelated to arterial branching point. Sudden movement of brain and artery causes vessel wall injury against the stationary edge of the falx. Because of high mortality rate of ruptured traumatic aneurysm, clinical suspicion must be focused on the prompt diagnostic work-up and early treatment.

Management of Traumatic Cerebral Aneurysms / 대한뇌혈관학회지

Owing to their rarity and the preferential use of CT scanning in the evaluation of trauma cases, the diagnosis of traumatic aneurysms is usually missed. Because the lesion are mostly false aneurysm resulting from injury to all vascular layer, about 90% of this lesion bleed within first 3 weeks after trauma and one-half of the patients who experience this bleeding die; therefore, early diagnosis and treatment are the most essential. The diagnosis requires a high index of suspicion and subsequent angiography. The diagnosis needs to be entertained in any patient who deteriorates by delayed cerebral hemorrhage in the period after severe closed or penetrating head injury. Angiographically, traumatic aneurysms usually have poorly defined necks, are not usually at bifurcation sites, are irregular shaped, and have delayed filling and emptying of sac. Traumatic aneurysm tend to increase in size, therefore immediate surgical exclusion is recommended. Current alternative treatment of traumatic aneurysms involves occlusion of the main artery through the use of endovascular techniques, with either detachable balloons or GDC. In intolerable case to occlusion test, it need EC-IC bypass surgery before occlusion. Surgery is a treatment of choice for traumatic aneurysms in distal locations. The outcome seems to depend on severity of the initial head injury.

Traumatic Aneurysm of the Posterior Inferior Cerebellar Artery

Traumatic intracranial aneurysm is a rare complication of severe head injury. Compared with traumatic aneurysm involving the supraclinoid portion of the internal carotid, distal anterior cerebral, and middle cerebral artery, traumatic aneurysm located in the posterior fossa is extremely rare. The authors present a case of traumatic aneurysm involving the posterior inferior cerebellar artery after a severe closed head injury. The patient presented with intraventricular hemorrhage, but there was no evidence of skull fracture. Cerebral angiography revealed a large aneurysm located in the posterior inferior cerebellar artery; repeated angiography demonstrated an enlarged aneurysm following sudden clinical deterioration fifteen days after initial trauma. The PICA was embolized with a tungsten and platinum coil and far lateral suboccipital craniectomy was performed for decompression. Pathologic findings of the resected aneurysm were compatible with a pseudoaneurysm.

Traumatic Intracranial Aneurysms: Report of Six Cases

Six cases of traumatic intracranial aneurysms are presented, two located on the internal carotid artery, two on the anterior cerebral artery, one on the middle cerebral artery, and one on the middle meningeal artery. Three of the 6 cases were associated with skull fracture. Five cases were treated:two by clipping, two by trapping and one by excision & coagulation of the lesion. Due to increasing use of brain CT to substitute angiogram during the initial surveys of head injury patients, traumatic aneurysms are often overlooked and the diagnosis delayed. Since the clinical course of traumatic aneurysm is variable and its high mortality rate, immediate cerebral angiography & early proper treatment are recommended whenever clinical suspicion of traumatic aneurysm is aroused or/and delayed neurological deterioration is detected after head injury. In this study, the authors tried to find out the clues for early diagnosis of traumatic intracranial aneurysms.

Traumatic Aneurysm in an Infant: Case Report

We report a case of traumatic aneurysm in a 50-day old male infant arising from the peripheral portion of right middle cerebral artery. The infant had suffered a major head injury with an iron bar before coming to the hospital. On admission he presented with generalized tonic-clonic seizure 15 days after the head trauma. Computed tomography(CT) scan demonstrated a round, mixed-density hematoma in the right temporoparietal cortex. During operation, an aneurysm was found within the hematoma under the operating microscope, and the aneurysm was assumed to be of traumatic origin. The aneurysm arising from the peripheral right middle cerebral artery was ligated and cauterized, and the hematoma was evacuated. After the operation, the infant had no incidence of any seizure attack nor any focal neurologic deficit. The incidence pathogenesis, clinical diagnosis, and treatment of traumatic aneurysm is discussed together with a review of the literature.

Traumatic Intracranial Aneurysms

Five cases of traumatic intracranial aneurysm were presented. All of them were located at the cavernous segment of the internal carotid artery. These lesions were associated with basal skull fracture. Four cases were presented with massive epistaxis, and two of them required transfusion. All cases were treated successfully:four by detachable balloon occlusion of the proximal internal carotid artery and one by trapping of the lesion at the internal carotid artery. Because the mortality rate of ruptured traumatic aneurysm if high, clinical suspicion must be focused on prompt diagnostic work-up and early treatment.

One Case of Traumatic Pericallosal Artery Aneurysm: A Case Report

Traumatic aneurysm is known to be very rare vascular disease. The authors experienced one case of traumatic aneurysm that occured on pericallosal artery after closed head injury. Traumatic aneurysm was suspected by enlarged traumatic ICH on the corpus callosum in brain CT scan and presence of signal voiding at the center of the hematoma in brain MRI scan and then confirmed by transfermoral carotid angiography. Clipped neck of this traumatic aneurysm successfully via interhemispheric approach, we report a case of traumatic pericallosal artery aneurysm with review of literatures.

Four Cases of Traumatic Aneurysm in the Brances of External Carotid Artery: Report of 4 Cases

We report four cases of traumatic aneurysm in the branches of external carotid artery and reviewed other cases from the literature in view of their clinical feature and management.

Traumatic Aneurysm in the Posterior Cranial Fossa: Case Report

The traumatic intracranial aneurysm within the posterior cranial fossa is extremely rare. The case of a 18-year-old boy who developed an saccular aneurysm lately in the posterior fossa after a blunt head injury is reported. Repeated follow-up angiography demonstrated an saccular aneurysm at the junction of vertebral artery and posterior inferior cerebellar artery. Early brain MRI disclosed neither aneurysm nor mass. Late brain MRI revealed a partially thrombosed saccular aneurysm at the cerebello pontine angle. Follow-up MRI and angiography is recommended if traumatic aneurysm is suspected.

Traumatic Aneurysm of Peripheral Cerebral Artery: A Case Report

No abstract available.

Traumatic Aneurysms Developing During Aneurysm Surgery

We present two cases of traumatic aneurysms developing during aneurysmal surgery. The aneurysms were clipped without difficulty in both anterior communicating aneurysmal cases. To prevent the vasospasm, bypervolemic theraphy was begun and hypertension was induced postoperatively. The postoperative rebleeding occured within two weeks after initial aneurymal clipping in both cases. New aneursms developed near the clipped anterior communicating aneruysms ; A1 in one case, A2 in the other case. Minor arterial injury was considered to be the main cause of theses new aneurysmal formation and the hemodynamic stress induced by hypertension and hypervolemic therapy might contribute to the development of new aneurysms.

Traumatic Aneurysms Developing During Aneurysm Surgery

We present two cases of traumatic aneurysms developing during aneurysmal surgery. The aneurysms were clipped without difficulty in both anterior communicating aneurysmal cases. To prevent the vasospasm, bypervolemic theraphy was begun and hypertension was induced postoperatively. The postoperative rebleeding occured within two weeks after initial aneurymal clipping in both cases. New aneursms developed near the clipped anterior communicating aneruysms ; A1 in one case, A2 in the other case. Minor arterial injury was considered to be the main cause of theses new aneurysmal formation and the hemodynamic stress induced by hypertension and hypervolemic therapy might contribute to the development of new aneurysms.

Two Cases of Traumatic Pericallosal Artery Aneurysm: A Case Report

Two patients with traumatic aneurysm were children below 10 years and the aneurysmal sac located at the peripheral branch o f the anterior cerebral artey. One of the traumatic aneurysm had been found by rupture of aneurysmal sac during medical treatment under the impression of traumatic cerebral hemorrhage. The other had been found during disabiliy evaluation with unruptured status. In the latter case, traumatic aneurysm was suspected by the small sized enhancing lesion below the falx cerebri in Brain CT scan and confirmed by transfemoral carotid angiography. We clipped neck of these traumatic aneurysm successfully. So. we report these two cases of traumatic aneurysms with review of the literatures.

Massive Epistaxis from Carotid Artery Injuries Associated with Blunt Head Trauma: Report of 2 Cases

Two cases of massive epistaxis following nonpenetrating head injury are reported. A 23-year-old man was referred to us because of massive epistaxis and binocular blindness which developed about two months after a head injury. Carotid angiography demonstrated a intracavernous carotid aneurysm protruding into the ethmoid and sphenoid sinuses, and occlusion of the supraclinoid part of contralateral carotid artery. CT scan demonstrated a large hyperdense mass extending into the parasellar area, the ethmoid and sphenoid sinuses, and both orbits with destruction of bony structures. Treatment was delayed because the patient developed typhoid fever and sepsis, he died about six months after a head injury from a severe cerebral infarction due to internal carotid artery occlusion. A 34-year-old man, involved in a car accident, was admitted in semicomatose state. Over the next 72 hr he become more alert but he had massive epistaxis 11 day later which required blood transfusions. Carotid angiography revealed a false aneurysm of the distal part of the internal maxillary artery. About 30 days later, the false aneurysm occluded by embolization with Gelfoam. The patient recovered uneventfully from these procedures.