A Case of Multiple Inflammatory Aneurysms Treated with Multimodality Treatment / 日本心臓血管外科学会雑誌

An 88-year-old woman presented at a local hospital with a left femoral pulsatile mass. CT revealed saccular aneurysms with irregular intima in the descending thoracic aorta, the right common femoral artery and the left superficial femoral artery. They were 60 mm, 30 mm, and 25 mm in diameter, respectively. After referral to our hospital, multiple inflammatory aneurysms were strongly suspected by detailed examinations. Endovascular treatment including thoracic endovascular aortic repair and surgical replacement were performed by two-stage operations. After steroid therapy was started postoperatively, her c-reactive protein (CRP) value decreased. Nevertheless, the thoracic aortic aneurysm enlarged and she died due to hemorrhage. Multiple inflammatory aneurysms are extremely rare. We consider that appropriate steroid therapy and close follow-up are most important.

Single-session Coil Embolization of Multiple Intracranial Aneurysms

OBJECTIVE: There is no clear treatment strategy for the management of multiple intracranial aneurysms because of variable anatomical distribution, difficult identification of the aneurysm ruptured, and poor overall outcomes. The purpose of this study was to assess the efficacy and safety of single-session coil embolization for multiple intracranial aneurysms. METHODS: Between September 2008 and December 2012, 209 aneurysms in 117 patients were treated at our institute. Twenty eight among the 117 patients had multiple aneurysms with a total of 71, and 60 of the 71 aneurysms underwent coil embolization in a single-session. RESULTS: A total of 60 aneurysms were treated with a single-session coil embolization, of which the most frequent locations were in the posterior communicating artery, followed by the middle cerebral artery. Immediate post-embolization angiographies showed total occlusion in 49 (81.7%) aneurysms, remnant neck in 6 (10%), and body-filling in 5 (8.3%). Procedure-related complications had developed in 2 (3.3%) of the 60 embolized aneurysms: an asymptomatic thromboembolic event, and a partial coil protrusion without a subsequent thromboembolic complication. CONCLUSION: With careful evaluation of individual aneurysm characteristics and configuration, multiple intracranial aneurysms previously thought to require multimodality therapy can be safely treated in a single-session coil embolization.

Single-session Coil Embolization of Multiple Intracranial Aneurysms

OBJECTIVE: There is no clear treatment strategy for the management of multiple intracranial aneurysms because of variable anatomical distribution, difficult identification of the aneurysm ruptured, and poor overall outcomes. The purpose of this study was to assess the efficacy and safety of single-session coil embolization for multiple intracranial aneurysms. METHODS: Between September 2008 and December 2012, 209 aneurysms in 117 patients were treated at our institute. Twenty eight among the 117 patients had multiple aneurysms with a total of 71, and 60 of the 71 aneurysms underwent coil embolization in a single-session. RESULTS: A total of 60 aneurysms were treated with a single-session coil embolization, of which the most frequent locations were in the posterior communicating artery, followed by the middle cerebral artery. Immediate post-embolization angiographies showed total occlusion in 49 (81.7%) aneurysms, remnant neck in 6 (10%), and body-filling in 5 (8.3%). Procedure-related complications had developed in 2 (3.3%) of the 60 embolized aneurysms: an asymptomatic thromboembolic event, and a partial coil protrusion without a subsequent thromboembolic complication. CONCLUSION: With careful evaluation of individual aneurysm characteristics and configuration, multiple intracranial aneurysms previously thought to require multimodality therapy can be safely treated in a single-session coil embolization.

Five Aneurysms Arising from the Ipsilateral Internal Carotid Artery : Case Report / 대한뇌혈관외과학회지

Although the incidence of intracranial multiple aneurysms are not low, the occurrence of multiple aneurysms more than three developing on the ipsilateral carotid artery is quite rare. We present a patient with five aneurysms on the left internal carotid artery. Four aneurysms arising from the left internal carotid artery underwent microsurgical clipping and wrapping, and remnant superior hypophyseal artery aneurysm was treated by using coil embolization. Incidence and risk factors for management of multiple aneurysms were investigated with the literature review.

Microcirugía asistida por endoscopia en el clipado de aneurismas gigantes y del segmento carotídeo comunicante posterior / Endoscopic assited microsurgery for clipping of giant aneurysms and carotid portion of posterior communicating aneurysms

Objetivo. Describir la utilidad de la endoscopia en el clipado microquirúrgico de aneurismas cerebrales. Descripción: Paciente de 62 años de edad con diagnóstico de aneurisma gigante de la arteria carótida interna (ICA) asociado amúltiples aneurismas, uno de ellos en el segmento carotídeo comunicante posterior (Pcom). Intervención. Se resolvió el aneurisma gigante carotídeo y el comunicante posterior con técnica microquirúrgica mediante el clipado,y éste último se clipó con la asistencia del endoscopio. Conclusión. En casos con aneurismas de ICA gigantes y aneurismas ICA-PcomA la microcirugía asistida por endoscopia provee acceso a las áreas ocultas al microscopio, permitiendo una apropiada oclusión del cuello aneurismático con preservación de perforantes

Objective. To describe the importance of the aid of the neuroendoscopein the microsurgery of cerebral aneurysms. Description. 62 years old female patient with an internal carotidartery giant aneurysm (ICA) and multiple aneurysms, one of them in the posterior communicant carotid segment (pcom). Intervention. Both of them were treated with microsurgery, and the pcom aneurysm was clipped with the assistance of endoscopy. Conclusion. In cases with giant and pcom aneurysms the endoscope assisted microsurgery is useful, providing good access to hidden fields to microscope, allowing a properlyocclusion and preservation of perforators branches.

An Operative Case of Idiopathic Nonspecific Inflammatory Aneurysms of the Abdominal Aorta / 日本心臓血管外科学会雑誌

We report a case of surgical treatment for idiopathic nonspecific inflammatory aneurysms of the abdominal aorta (AAA) with high-dose steroid therapy. The patient was a 35-year-old man who underwent steroid therapy (30 mg/day prednisolone) for idiopathic nonspecific inflammatory AAA and right common iliac artery aneurysm (CIAA) for 5 months. However, the sizes of the aneurysms were slowly increasing, and they were sacculated types, so surgical replacement was performed. Before the operation we continued to give 30 mg/day prednisolone, because decreasing the medicine made the c-reactive protein (CRP) value rise. Perioperatively the therapy continued, and the postoperative course was uneventful. With appropriate steroid therapy, replacement of idiopathic nonspecific inflammatory aneurysms of the abdominal aorta can be performed. It is also important to follow up the patient from long-term, to monitor for pseudoaneurysms from anastomosis or new aneurysms.

Multiple separated and multi-lobular aneurysms of the anterior communicating artery complex

The anterior communicating artery complex [ACoA] is the most common site of occurrence of intracranial aneurysms, harboring about 30 percent of these lesions. Multiple aneurysms account for 20 percent of all cerebral aneurysms. Multiple aneurysms on the same artery correspond to 2.8 percent of aneurysms, usually found in the internal carotid artery or middle cerebral artery. Multiple aneurysms of the ACoA are very rare and there are only a few cases reported in the literature. In cases of multiple aneurysms of the anterior communicating artery complex, not all lesions may be detected on preoperative radiological studies, due to the complex angio-archiecture around the ACoA. Careful dissection is mandatory to ensure the completeness of aneurysm surgery. Multiple separated and multi-lobular aneurysms of the anterior communicating artery are unusual lesions and should be studied as a special topic. The authors present four cases of these rare aneurysms, namely three multiple separated aneurysms and one multi-lobular aneurysm of the ACoC. Three of these patients presented with subarachnoid hemorrhage [SAH]. There were no familial or arteriovenous malformation.related aneurysms reported in our series. We propose a new classification for this type of aneurysm on the ACoA. The literature is reviewed. The results, physiopathology and management are dis cussed.

Multiple Aneurysms in the Anterior Communicating Artery: Case Report

Multiple aneurysms arising from the same intracranial artery are rare. A few cases of multiple aneurysms of the anterior communicating artery(ACoA) have been reported in the literature. The authors present a 60-year-old female patient who had multiple aneurysms on the ACoA with systemic vasculitis. There were four aneurysms around the ACoA region. Two sizeable aneurysms had completely separated necks on each side of the ACoA. The ruptured larger aneurysm projected in an anteroinferior direction, whereas the unruptured smaller one projected superoposteriorly. Both aneurysms were surgically confirmed and clipped. Two bleb-like microaneurysms, located on ACoA and perforating artery each, were coagulated and reinforced.

Surgical Management of Multiple Aneurysms Including Distal Anterior Cerebral Artery Aneurysms / 대한뇌혈관학회지

OBJECTIVE: The goal of this study is to evaluate the surgical outcome of multiple aneurysms including distal anterior cerebral artery (DACA) aneurysms. MATERIAL AND METHOD: From May 1989 to March 2000, 12 patients with multiple aneurysms including DACA aneurysms, presented with subarachnoid hemorrhage, had been surgically treated. Their medial record and radiological studies were studied retrospectively. Of 12 patients, in 5 patients, all of the aneurysms were clipped through a single craniotomy extended from midline to pterion in one stage, in 5 patients, multiple aneurysms were treated through separate craniotomies in one stage and 2 patients were treated in staged operation. RESULTS: Two patients showed Glasgow Outcome Scale (GOS) 5-4, 2 patients showed GOS 3-2 and 1 patient showed GOS 1 in 5 patients treated through a single craniotomy in one stage, 2 patients showed GOS 5-4 and 3 patients showed GOS 3-2. All patients treated in staged operation showed favorable outcome. CONCLUSION: In surgical management of multiple aneurysms including DACA aneurysms surgery through separate bony windows in two stages seemed to show more favorable outcome.

Proximal(M1 Segment) Middle Cerebral Artery Aneurysms: Clinical Features, Surgical Treatment and Comparison with Middle Cerebral Artery Bifurcation Aneurysms

The authors report a series of 26 patients with proximal(M1) middle cerebral artery aneurysms who underwent surgery. To determine whether M1 aneurysms are especially problematic, these were compared with those at the bifurcation of the middle cerebral artery(MCA). The incidence of M1 aneurysms was 3.0% among 862 patients who underwent surgery for intracranial aneurysms and 13.4% among 194 patients with MCA aneurysms : 166 patients suffered MCA bifurcation aneurysms, and six patients had both types. In M1 aneurysms, there was a greater female preponderance(1 : 2.3), and the incidence of multiple aneurysms(50%) was much higher than in MCA bifurcation aneurysms(1 : 1.2, 26%). Fifteen patients(58%) had ruptured M1 aneurysms, and these ruptured in 3(23%) of 13 patients with multiple aneurysms. Depending on their location, M1 aneurysms were classified into two types : the superior wall type(7 cases), arising at the origin of the lenticulostriate artery, and the inferior wall type(17 cases), arising at the origin of early temporal branches. Fusiform aneurysms occurred in two patients. It was noted, though was not significant statistically, that the superior wall type was more frequently associated with multiple aneurysms(57.1% vs 47.1%), and the inferior wall type was more prone to rupture(70.6% vs 42.9%). In 15 patients with ruptured M1 aneurysms, intracerebral hematomas were seen in only three(20%). This incidence was relatively low, but was similar to the incidence of 22.5%(31/138) with ruptured MCA bifurcation aneurysms. In eleven patients, besides using the medial trans-sylvian approach, we clipped the neck of M1 aneurysms using the superior temporal gyrus approach, generally used for MCA bifurcation aneurysms. Nineteen(73%) of 26 patients made a useful recovery. Two patients, who were grade II preoperatively, became severely disabled(hemiparesis and aphasia, hemiparesis) after surgery. For this to be successful, special attention to the preservation of the lenticulostriate arteries is therefore essential. Comparing the two groups of patients, however(M1 vs MCA bifurcation aneurysms), we found no difference between either preoperative Hunt-Hess grade or surgical outcome(useful recovery, 75% vs 81%).

Multiple Aneurysms of the Anterior Communicating Artery: A Report of Two Cases

The authors report two cases of multiple aneurysms on the anterior communication artery among 141 consecutive cases of cerebral aneurysms treated surgically during last 3 years, and review the literatures.

Association of Brain Tumor with Cerebral Aneurysms

Two cases of association of brain tumor and intracranial aneurysms are reported. One case is association of pituitary adenoma with anterior communicating artery aneurysm. The other is association of acoustic neurinoma with multiple aneurysms and it is exceedingly rare reviewing the available literature. Various pathogenesis for association of brain tumor with cerebral aneurysm have been postulated.