Multiple Aneurysms on the Same Bifurcation Site of the Middle Cerebral Artery

Multiple aneurysms at the same cerebral arterial branching site are rare, and have been mainly described in a few case reports in comparison with other intracranial multiple aneurysms. Most reported locations of the same artery where multiple aneurysms developed were internal carotid artery and anterior communicating artery. We experienced a very rare case of multiple aneurysms arising at the same bifurcation site of the middle cerebral artery. Only one case like this has been reported previously in the literature. We discussed the preoperative diagnosis and surgical management of such condition.

Multiple Aneurysms of the Distal Anterior Cerebral Artery: Case Report

Saccular aneurysms of the distal anterior cerebral artery are relatively rare, ranging from 1.5 to 9.2% of all intracranial aneurysms. A 61-year old woman presented with headache and nuchal rigidity. Cerebral angiographic image demonstrated multiple aneurysms of the distal anterior cerebral artery. We report a case of multiple aneurysms of the distal anterior cerebral artery without other vascular anomalies.

One Stage Operation of Triple Aneurysms: Case Report

In the multiple aneurysm cases of the conservatively treated patients in the cooperative study and in Suzuki's personal series, three aneurysm comprised 15 percent in the multiple aneurysm. Posterior circulation aneurysms is about 15 percent of all intracranial aneurysm. When an aneurysm on the anterior circulation is found, the chance of a secondary aneurysm on the posterior circulation is between 3 and 5 percent. Authors experienced a case of large basilar tip aneurysm projected superiorly and posteriorly accompanied with right middle cerebral artery and right anterior choroidal artery aneurysm. This case was difficult one because of the importance of the perforating vessels in large aneurysm at the basilar fiburcation and the existence of the perforating vessels in large aneurysm at the basilar fiburcation and the existence of another two aneurysms. Through the right pterional approach, three aneurysm were clipped in one stage operation successfully, but the large basilar tip aneurysm was clipped partially because both PCA arose from the aneurysm.

2 Cases of Bacterial Intracranial Aneurysm

The authors experienced 2 cases of bacterial intracranial aneurysm, the mortality of which has been reported to by very high and the management of which is controversial. Some authors have recommended observation with serial angiography during antimicrobial therapy and surgery for aneurysms that enlarge or remain patent. Others have argued for promt surgical removal. Bothof our patients had multiple aneurysms and were treated with appropriate, high-dose antibiotics, but intracerebral homorrhage(ICH) occurred during antibiotiecs treatment in both cases and they underwnet emergent operation, but both died.

Microsurgical Treatment of Distal Anterior Cerebral Artery Aneurysm

Between Jan. 1983 and Dec. 1990, 17 Patients with distal anterior cerebral artery(DACA) aneurysms were admitted to our institute and underwent microsurgical neck clipping of their aneurysms. This group comprised 3.7% of the 437 aneurysms managed surgically during this period. There were 11 females and 6 males. The mean age was 48.5 years. Most of DACA aneurysms were located at the genu portion of the anterior cerebral artery. Three cases were at the proximal protion of A2 close to the anterior communicating artery. Two cases were at the dista pericallosal artery and distal callosomarginal artery. Eight patients had additional vascular anomalies documented by angiography such as multiple aneurysms, azygos DACA and duplication of DACA. Direct neck clipping was possible in all cases through the interhemispheric approach or the frontotemporal approach according to the location. For the interhemispheric apporach preoperative evaluation of the exact location and direction of the aneurysms on the angiogram was important for operative planning. The surgical outcome was good or excellent without any neurological deficits in 17 of the cases. Operative management, clinical features and incidence of vascular anomalies associated with DACA aneurysms are discussed.

Basilar Bifurcation Aneurysm Associated with Carotid-Ophthalmic Aneurysm: A Case Report

The report of basilar bifurcation aneurysm accompanying carotid-ophthalmic aneurysm is extremely rare and some technical dexterity must be needed on surgical treatment for each of two aneurysms. Authors report a case of basilar top aneurysm accompanied with a carotid- ophthalmic aneurysm clipped successfully in one stage operation with review of literatures concerning basilar bifurcation aneurysm, carotid-ophthalmic aneurysm and multiple aneurysms.

Multiple Aneurysm-Which One Ruptured?

Brain Computerized Tomography(CT) and cerebral angiography were reviewed in thirty-six patients with multiple intracranial aneurysms(22.5%) among the 160 consecutive surgical cases of intracranial aneurysms. The prevalent sites of multiple aneurysms were the middle cerebral artery(37.0%), posterior communicating artery(22.2%), and internal carotid artery(14.8%) in sequence. However, the vertebrobasilar system(83.3%), anterior communicating artery(63.6%), and posterior communicating artery(50.0%) had higher probability of rupture than internal carotid artery(8.3%) or middle cerebral artery(33.3%). Based on CT and angiographic information, the site of rupture can be predicted with a high degree of reliability. These factors were the presence of localized hemorrhage on CT, focal vasospasm, size and irregularity of aneurysms, and relative hyperplasia of parent artery.

Surgical Treatment of Unruptured Cerebral Aneurysms

The authors report their experience with 73 cases of unruptured cerebral aneurysms in a consecutive series of intracranial microsurgery for 380 cerebral aneurysms in 307 patients from September, 1975 through March, 1984. Multiple, symptomatic, and incidental aneurysms are included in this group of 73 unruptured aneurysms. There was no mortality among fifty nine of these cases who had surgery. The only morbidity was due to massive postoperative vasospasm in a patient with multiple aneurysms, that developed on the site of ruptured aneurysm. Discussed in this report are characteristics of three categories of unruptured cerebral aneurysm patients and the principles of the management of unruptured aneurysms. In conclusion, all symptomatic unruptured aneurysms should be clipped immediately upon definite diagnosis, while decision for the operation of multiple unruptured aneurysms and aneurysms detected incidentally should be made with discretion by the surgeon.