Hemorrhagic cerebral dissecting aneurysms: surgical treatments and results

Yonekawa, Yasuhiro; Zumofen, Daniel; Imhof, Hans-Georg; Roth, Peter; Khan, Nickalus R.

doi:10.1007/978-3-211-76589-0_12

Cited by 20 publications

(15 citation statements)

References 27 publications

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“…2) In the case of low positioned basilar aneurysms located below the level of the posterior clinoid process, extended transcavernous posterior clinoidectomy is combined. 2,3) With the use of the mentioned procedures, unavailability of subtemporal approach for such ruptured aneurysms in the acute stage with mild to severe grades occupying just more than 50% of admitted SAH patients 1) can be overcome, so possible rerupture of aneurysms during the waiting period can be prevented and perioperative management simplified.…”

Section: Discussionmentioning

confidence: 99%

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Brain Retraction Technique Using Gelatin Sponge in the Subtemporal Approach -Technical Note-

Kashimura

Ogasawara

Kubo

et al. 2008

Neurol. Med. Chir.(Tokyo)

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Wide exposure of lesions during the subtemporal approach often leads to temporal lobe injury caused by excessive retraction. A brain retraction technique using gelatin sponge pieces was developed to minimize intraoperative brain retraction during the subtemporal approach. After aspirating cerebrospinal fluid and slackening the temporal lobe, 2-3 pieces of gelatin sponge are inserted between the dura and surfaces of the anterior and posterior parts of the temporal lobe, then covered with cottonoids. The gelatin sponge pieces expand and thus expose the free margin of the tentorium with minimal brain retraction. This technique was used in 50 patients undergoing clipping for cerebral aneurysms. Although computed tomography indicated minor brain injury caused by retraction in three patients with ruptured aneurysm of the basilar artery bifurcation, no patients experienced new neurological deficits other than transient ipsilateral oculomotor nerve paresis. In conclusion, gelatin sponge, with its innate mechanical characteristics and ease of application, seems to offer an alternative retractor in neurosurgical interventions using the subtemporal approach for patients with unruptured aneurysm or non-severe subarachnoid hemorrhage.

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Section: Discussionmentioning

confidence: 99%

“…2,3) Wide exposure of lesions during the subtemporal approach often leads to temporal lobe injury following excessive retraction. 4-9) Minimal brain retraction thus remains one of the important goals in such an approach.…”

Section: Introductionmentioning

confidence: 99%

Brain Retraction Technique Using Gelatin Sponge in the Subtemporal Approach -Technical Note-

Kashimura

Ogasawara

Kubo

et al. 2008

Neurol. Med. Chir.(Tokyo)

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“…As such, definitive treatment usually involves surgical or endovascular trapping or proximal occlusion, with or without extracranial-intracranial bypass. 1,2 In fact, even when an attempt was made to clip-reconstruct the dissected RAH in this patient, our efforts to preserve the vessel were ultimately unsuccessful. This outcome is not very surprising, given the very small caliber of the RAH and the dissecting fusiform nature of the aneurysm.…”

Section: Intracranial Dissectionsmentioning

confidence: 93%

“…Although many cases in the literature have been successfully managed conservatively and have healed spontaneously, early securement of ruptured dissecting aneurysms is generally advocated, given the high risk of early rerupture. [1][2][3][4] Thus, although conservative management in this patient would have been a potential treatment option, neither the treating team nor the patient's family felt comfortable leaving that ruptured dissecting aneurysm unsecured. Unlike saccular aneurysms, dissecting aneurysms are challenging to treat by simple clip ligation or coil embolization, given the lack of a well-defined neck and actual involvement of the parent vessel wall.…”

Section: Intracranial Dissectionsmentioning

confidence: 98%

“…1,2 Dissecting aneurysms most commonly affect the large proximal intracranial vessels, although small distal cerebral vessels may rarely be involved. [1][2][3][4] However, to the best of our knowledge, dissecting aneurysms of the recurrent artery of Heubner (RAH), a large named perforator arising from the anterior cerebral artery (ACA), have not been previously observed. We present an exceptional case of ruptured dissecting aneurysm of the RAH in a patient with osteogenesis imperfecta (OI), an inherited disorder of collagen synthesis.…”

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confidence: 99%

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Dissecting Aneurysm of the Recurrent Artery of Heubner in a Patient With Osteogenesis Imperfecta

Mansfield

Rahme

2015

Can. J. Neurol. Sci.

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Spontaneous intracranial dissections are a rare cause of subarachnoid hemorrhage (SAH), accounting for 2% to 3% of cases. 1,2 Dissecting aneurysms most commonly affect the large proximal intracranial vessels, although small distal cerebral vessels may rarely be involved. [1][2][3][4] However, to the best of our knowledge, dissecting aneurysms of the recurrent artery of Heubner (RAH), a large named perforator arising from the anterior cerebral artery (ACA), have not been previously observed. We present an exceptional case of ruptured dissecting aneurysm of the RAH in a patient with osteogenesis imperfecta (OI), an inherited disorder of collagen synthesis. CASE REPORTA 50-year-old woman was transferred to us for evaluation and management of spontaneous SAH and intraventricular hemorrhage. She had been found unresponsive by her family and was initially seen in an outside hospital, where she was found to have a Glasgow coma score of 5 (decorticate posturing) and was thus intubated. Head computed tomography (CT) scan revealed diffuse cisternal SAH predominating in the anterior interhemispheric fissure and tetraventricular hemorrhage with hydrocephalus ( Figure 1A,B). A right frontal external ventricular drain was placed emergently, revealing an opening pressure of 20 cm of water. Following cerebrospinal fluid diversion, her neurological examination improved slightly, measured by her withdrawing all four extremities to pain.CT angiography was obtained, demonstrating a small fusiform aneurysmal dilation of the well-developed left RAH ( Figure 1C). Cerebral angiography confirmed the presence of a 4 mm × 1.5 mm fusiform aneurysm arising from the proximal portion of the left RAH overlying the A1 segment of the left ACA ( Figure 1D). The A1 vessel was mildly deformed, suggesting that the aneurysm was actually larger in size and had a thrombosed, nonangiographically visible portion ( Figure 1D). Given the "pearl-on-string" appearance of the aneurysm and its atypical location, a dissecting nature was strongly suspected. Moreover, there was angiographic evidence of an old healed dissection of the right internal carotid artery, just proximal to its entrance into the carotid canal, and occlusion of the proximal right vertebral artery at its V1-V2 junction, just proximal to its entrance into the right C6 foramen transversarium, also suggesting an old dissection ( Figure 1E,F). Consideration was given for obtaining a brain magnetic resonance imaging to demonstrate the intramural thrombus and confirm the diagnosis of intracranial dissection. However, given the patient's critical condition and the expectation that magnetic resonance imaging findings would not drastically change our management strategy, this study was not performed in order to avoid delaying definitive treatment.Further questioning of the family revealed that the patient had type I (autosomal dominant) OI, as did roughly 50% of her siblings and children. Interestingly, the patient's mother had died of aneurysmal SAH and one of her maternal aunts had had surgical cli...

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Brain Revascularization by Extracranial-Intracranial Arterial Bypasses

Yonekawa

2009

Practical Handbook of Neurosurgery

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Hemorrhagic cerebral dissecting aneurysms: surgical treatments and results

Cited by 20 publications

References 27 publications

Brain Retraction Technique Using Gelatin Sponge in the Subtemporal Approach -Technical Note-

Brain Retraction Technique Using Gelatin Sponge in the Subtemporal Approach -Technical Note-

Dissecting Aneurysm of the Recurrent Artery of Heubner in a Patient With Osteogenesis Imperfecta

Brain Revascularization by Extracranial-Intracranial Arterial Bypasses

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