Double Aneurysms Research Articles

Incidental Postmortem Diagnosis of Anterior Communicating Artery Aneurysm After Successful Treatment of Double Aneurysms of the Superior Cerebellar and Paraclinoid Internal Carotid Arteries

Intracranial aneurysm diagnosis uses several tools, of which digital subtraction angiography is still the gold standard. Computed tomography angiography is widely used for its specificity and sensibility. The 3D slicer software is an interesting diagnosis tool that provides high-quality 3D modeling. It facilitates diagnosis and improves aneurysm assessment. However, it is still not approved for clinical tasks. We present a case of a woman treated for a ruptured paraclinoid and superior cerebellar artery aneurysms, and who succumbed to a post-procedural rebleeding. During a research routine, we realized a computed tomography angiography-based 3D slicer modeling that detected an incidental anterior communicating artery aneurysm. This case illustrates an unusual association of two rare intracranial aneurysm locations and the usefulness of the 3D slicer modeling tool in the diagnosis of intracranial aneurysms. Through this report, we recommend using this tool worldwide for clinical tasks.

The role of MicroRNA as a potential diagnostic and prognostic biomarker for cerebral aneurysms.

To identify the dysregulated functional miRNAs, miRNA-16, miRNA-143, and miRNA-200 as potential biomarkers of cerebral aneurysms(CAs) to aid in diagnosis and prognosis. This is a prospective case-control study conducted among patients with CA. All patients' computed tomography angiography (CTA) and interventional angiogram were assessed and studied. The miRNAs were isolated and quantified from peripheral blood samples and the expression profiling was done using TaqMan chemistry on Real-Time PCR. A total of 37 samples were included. Three cases had double aneurysms and 10 cases presented with aneurysmal rupture. miRNA-16, miRNA-143, and miRNA-200 were upregulated with an absolute fold-change of >8 in the CA group in comparison to controls (p<0.05). miRNA-200 showed double expression in patients with single aneurysm. A statically significant increase was observed in the expression of miRNA-143 in patients who had an aneurysmal rupture with p<0.05. Diabetic patients showed an obvious increase in miRNA-200 (13.03 folds) and miRNA-16 (26.82 folds) expression. Also, there was a notable elevation in miRNA-16, miRNA-143, and miRNA-200 in patients who had hypertension in comparison to those who did not. miRNA-16, miRNA-143, and miRNA-200 showed statically significant higher expression among cases with cerebral aneurysms in comparison to controls. Thus, these preliminary results of miRNAs biomarkers are promising future tool to be used for aneurysmal screening.

The complementary multimodal treatment of recalcitrant cerebral aneurysms

Background: The main treatment of cerebral aneurysms is direct surgical clipping or endovascular coil embolization. However, some cerebral aneurysms that we reviewed in the literature are still not susceptible to a single treatment approach. These aneurysms can be referred to as complex aneurysms.&#x0D; Objective: We aim to report these aneurysms and share our clinical experience with their treatment and diagnosis.&#x0D; Methods: All cases of cerebral aneurysms treated in New York University and in Mansoura University from 2010-2021 were retrospectively reviewed.&#x0D; Results: 18 patients with 21 cerebral aneurysms were treated by combined surgical and endovascular modalities. Aneurysms associated with arteriovenous malformations (AVMs) in 3 patients, associated with vasospasm in 7 patients, and 3 patients had double aneurysms. A total of 18 patients with aneurysms were treated with combined endovascular and microsurgical therapy. Early angiogram (&lt; 1 week) revealed; complete obliteration of 19 aneurysms (90%) out of a total of 21 aneurysms, residual filling was observed in 2 aneurysms (10%). Late radiological follow up (&gt; 3 months- 2 years) revealed; a stable residual filling in one and the other case underwent retreatment.&#x0D; Conclusions: The recalcitrant or complex cerebral aneurysms can be better referred to as diseases rather than lesions as many clinical and anatomical factors make their treatment difficult. Endovascular and microsurgery could be complementary to each other and create a multimodal approach for treating them.

The Combined Pterionally Interhemispheric Approach as a Solution of Double Aneurysms in the Area of Anterior Communicating Artery and Interhemispheric Haematoma and Hemocephalus

The Combined Pterionally Interhemispheric Approach as a Solution of Double Aneurysms in the Area of Anterior Communicating Artery and Interhemispheric Haematoma and Hemocephalus

The Combined Pterionally Interhemispheric Approach as a Solution of Double Aneurysms in the Area of Anterior Communicating Artery and Interhemispheric Haematoma and Hemocephalus

The Combined Pterionally Interhemispheric Approach as a Solution of Double Aneurysms in the Area of Anterior Communicating Artery and Interhemispheric Haematoma and Hemocephalus

Management of a double basilar tip aneurysm

Complex basilar tip aneurysms are still challenging to secure with coils or stent-assisted coiling. Double aneurysms at the basilar bifurcation and the basilar artery-superior cerebellar artery are a rare particular situation that usually requires more appropriate treatment. This case reports details of our experience with a double basilar tip aneurysm treated in two steps by coiling repair and stent-assisted coiling.

Karmaşık Bir Hastada Üç Renal Arteri İçeren ve Çift Anevrizma ile Komplike Olan Yaygın Ateromazi

Karmaşık Bir Hastada Üç Renal Arteri İçeren ve Çift Anevrizma ile Komplike Olan Yaygın Ateromazi

State of the Union in Open Neurovascular Training

The evolution of minimally invasive endovascular approaches and training paradigms has reduced open neurovascular case exposure for neurosurgical residents. There are no published estimates of open neurovascular case volumes during residency or Committee on Advanced Subspecialty Training (CAST) accredited fellowships. Case volumes from residency programs submitting data for CAST accredited fellowship applications were collected and analyzed. The study period covered the academic years of 2013-2016. Case index volumes were calculated to provide an estimate of total volume of cases each trainee participated in a given year. The case index volume was defined as the total volume of cases per year divided by the total training complement. Over the study period, institutional data from 46 programs were available. Of those programs, 9 programs had CAST accredited open cerebrovascular fellowships. Across all 46 programs, the median number of vascular cases was 246 (interquartile range [IQR]: 148-340), whereas the median number of open vascular cases was 105 (IQR: 67-152). The median number of open aneurysm cases among programs with CAST cerebrovascular fellowships was 80 (IQR: 54-103) and among programs without CAST cerebrovascular fellowships was 34 (IQR: 24-63). The median open aneurysm case index volume for trainees at programs with and without CAST cerebrovascular fellowships was 23 (IQR: 14-29) and 19 (IQR: 11-24). Strong neurovascular training can be obtained through dedication and planning. Completion of a CAST accredited cerebrovascular fellowship will often more than double aneurysm case exposure of trainees.

Unusual Representation of a Common Iliac Artery Double Aneurysm

This case discusses an unusual representation of a 3.1-cm double aneurysm of the right common iliac artery with an ectatic distal abdominal aorta. The patient was a 64-year-old asymptomatic male who participated in a routine ultrasound screening at his church. On the basis of the findings, a full ultrasound study was ordered and conducted at the request of his primary physician. The patient's history included smoking cessation in 1975. He currently had hypertension and hyperlipidemia. He was physically active and ran 40 miles per week until developing right Achilles tendonitis. Because of this injury, the patient biked daily. The patient's medications included atenolol and daily vitamins. The ultrasound findings revealed two aneurysms of the right common iliac artery. Both areas were fusiform and measured 3.1 and 2.9 cm, respectively. The dilation extended to the right internal iliac artery. The left common iliac was mildly dilated and kinked to the left. There was mild enlargement of the distal abdominal aorta measuring 3.4 cm by ultrasound and 3.1 cm by computed tomography angiogram. There is no evidence of internal thrombus. Usually asymptomatic, iliac artery aneurysms can be lethal if large (above 3.0 cm) and undetected. With appropriate, timely intervention the aneurysm can be safely repaired before rupture. Various aneurysm treatment options include conventional open abdominal surgery or endovascular stent graft placement with coil embolization. This patient discussed options with the vascular surgeon and was scheduled to have a cardiac catheterization with right internal iliac coil embolization. Staging of the endovascular graft was planned to follow. This case presents the uncommon finding of a large iliac artery aneurysm. This patient's disease was made more unusual by the presence of two distinct aneurysms present within the same vessel. It further reinforces the common practice of fully examining patients with aneurismal disease bilaterally and over multiple levels as a significant portion of patients have multilevel disease.

Treatment of Complex Aorta Diseases by Multilayer Stents

Purpose: The aim of our study was to evaluate the role of multilayer stents (MLS) in the therapeutic arsenal of complex aortic pathologies for frail patients combining several comorbidities that are initially objected to the conventional surgical treatment. Materials and methods: Since March 2012, we conducted a monocentric prospective study on a series of 41 procedures, performed on 41 aortic lesion locations in 38 patients treated with multilayer stents. The series was divided into four groups. The first group included 21 cases: 20 thoracoabdominal aneurysms and one aneurysm of the entire descending thoracic aorta. The second group included 7 cases of juxta/infra renal aneurysms, the third group included 5 cases of false aneurysms and the fourth group included 8 cases of aortic dissecting hematoma (first subgroup: 6 cases) or extended dissections (second subgroupe: 2 cases).Three patients were treated during the same operation for a double aneurysm location (thoracic and abdominal in 2 cases and aortic arch and thoracic aorta in the 3rd case). Results: The series included 25 men and 13 women with an average age of 63 years (40-84 years). The procedures were performed under local anesthesia in 3 cases, loco regional in 19 cases and general anesthesia in 16 cases. The average hospital stay was 7 days (4-14 days).The technical placement of the MLS was successful for the 41 procedures. No paraplegia, no stroke and no mesenteric ischemia occurred. Three complications related to the surgical approach were treated surgically with success. Two patients had post-operative renal failure for which one required dialysis. The 30-day mortality in relation to the aneurysm was 3% (one case of rupture in the first postoperative day) and unrelated to the aneurysm 3% (one case of massive myocardial infarction after the procedure). For an average follow up of 12 months (1-20 months) mortality unrelated to the aneurysm was 25% (9 deaths) and 0% in relation to the aneurysm. Among the 38 remaining aortic lesions treated and followed, the aneurismal sac was not feeded in 14 cases (63%) with 6 out of 20 cases in group 1(30%), 3 out of 6 cases in group 2(50%), 3 out of 4 cases in group 3 (75%) and finally 2 out of 6 cases in the first subgroup of group 4 (33%). The aneurismal sac is not feeded in 19 cases (50 %), including 14 out of 20 cases in group 1 (70%), 2 out of 6 cases in group 2 (33%), 1 out of 4 cases in the group 3(25%) and 2 out of 6 cases in the first subgroup of group 4 (33%). Two cases of extensive dissections treated remained stable without aneurismal changes. Three cases are recent: 1 out of 6 cases in group 2 (17%) and 2 out of 6 (33%) in the first subgroup of group 4 (33%). Visceral arteries and supraaortic trunks remained patent in all the 38 cases. Conclusion: MLS may be an option treatment for dissections and complex aortic aneurysms in frail patients with high surgical risk. Our results showed that better results are obtained for false aneurysms and true aortic aneurysms without involvement of significant side branches.

Surgical Strategy for Complex Anterior Cerebral Artery Aneurysms: Retrospective Case Series and Literature Review

Giant, or complex, aneurysms of the anterior cerebral artery (ACA) are rare, but their surgical treatment is important. The authors describe their experiences with bypasses for complex ACA aneurysms and discuss the new classification of ACA bypasses, the concept of using bypasses for insurance during the approach to the aneurysm, and simplifying the surgical algorithms for these complex ACA aneurysms. Over a 19-year period, 7 cases of complex ACA aneurysm were treated with bypasses and reviewed retrospectively. The bypasses were classified into 4 groups according to donor blood flow: internal carotid artery-ACA, external carotid artery-ACA, communicating bypass, and reconstruction bypass of the ipsilateral postcommunicating ACA. The cases included 1 precommunicating aneurysm, 3 communicating aneurysms, 2 postcommunicating aneurysms, and 1 double aneurysm (communicating and postcommunicating). The types of bypass included 1 internal carotid artery-ACA, 6 communicating bypasses, 3 external carotid artery-ACAs, and 2 reconstruction bypass of the postcommunicating ACA. Postoperative modified Rankin Scale scores were 0 (6 cases) and 3 (1 case of a communicating aneurysm with complicated memory disturbance because of infarction). One case revealed asymptomatic infarction. Surgical treatment of complex ACA aneurysms requires knowledge of a variety of bypass techniques. Although the type of bypass should be selected according to patient-specific anatomy and the neurosurgeon's preference, the new classification of bypass-specified ACA aneurysms may alter the way surgeons think about ACA bypasses, and in combination with the concept of the protective bypass, can be used to establish a comprehensive algorithm for each type of complex ACA aneurysm.

Trapping and Extra-intracranial Bypass for Double Giant Aneurysms in Series with Progressive Stroke Symptomatology

Trapping and Extra-intracranial Bypass for Double Giant Aneurysms in Series with Progressive Stroke Symptomatology

Bilobulated paraclinoid aneurysm mimics double aneurysms: A comparison of endovascular coiling and surgical clipping treatments

This report presents two cases of subarachnoid hemorrhage caused by rupture of paraclinoid aneurysms. Both aneurysms presented a bilobulated appearance upon image study. Both cases were treated successfully, the first with surgical clipping and the second with endovascular coiling. The special bilobulated feature of paraclinoid aneurysm in this particular anatomic location suggests its close relationship with the carotid dural ring. This relationship caused varying degrees of difficulty in both coiling and clipping the aneurysm. We compared the limitations and advantages of both treatments, and suggest that surgical clipping may be the treatment of choice in this region.

Preliminary Computational Hemodynamics Study of Double Aortic Aneurysms under Multistage Surgical Procedures: An Idealised Model Study

Double aortic aneurysm (DAA) falls under the category of multiple aortic aneurysms. Repair is generally done through staged surgery due to low invasiveness. In this approach, one aneurysm is cured per operation. Therefore, two operations are required for DAA. However, post-first-surgery rupture cases have been reported. Although the problems involved with managing staged surgery have been discussed for more than 30 years, investigation from a hemodynamic perspective has not been attempted. Hence, this is the first computational fluid dynamics approach to the DAA problem. Three idealized geometries were prepared: presurgery, thoracic aortic aneurysm (TAA) cured, and abdominal aortic aneurysm (AAA) cured. By applying identical boundary conditions for flow rate and pressure, the Navier-Stokes equation and continuity equations were solved under the Newtonian fluid assumption. Average pressure in TAA was increased by AAA repair. On the other hand, average pressure in AAA was decreased after TAA repair. Average wall shear stress was decreased at the peak in post-first-surgery models. However, the wave profile of TAA average wall shear stress was changed in the late systole phase after AAA repair. Since the average wall shear stress in the post-first-surgery models decreased and pressure at TAA after AAA repair increased, the TAA might be treated first to prevent rupture.

Stent-assisted Coiling of Complex Intracranial Aneurysms

Objective: To discuss the indications, technical details, and safety of endovascular treatment of complex intracranial aneurysms using coiling in combination with stent-assisted remodeling of the parent artery. Methods: Forty-one consecutive patients with complex intracranial aneurysms were treated with stent-assisted coiling. Three patients had double aneurysms that were located within 5mm. Nine patients had giant wide-necked aneurysms. Two patients had neck remnants at 2 years after the initial coiling. One patient had recurrent aneurysm at 3 years after the initial coiling. Twenty-six patients had acutely ruptured aneurysms. Neuroform, LEO and SolitaireAB stents, and Matrix, Orbit coils were used. Results: All endovascular procedures were performed uneventfully. There were no complications. Postoperative angiography showed complete dense packing (95% to 100%) in all aneurysms, except 2 giant aneurysms, which had subtotal embolization. In patients with acutely ruptured aneurysms, there was no intrastent thrombosis or stenosis of the stent lumen. Twenty-one patients underwent angiography at 3 to 6 months postoperatively. All of them showed a good outcome, except that one giant aneurysm showed a slight residual filling inside the sac. Discussion: Stent-assisted remodeling of the parent artery in combination with various types of coils can increase the cure rate of intracranial complex aneurysms. In patients with acutely ruptured aneurysms, antiplatelet drugs should be weighed against the risks of possible open surgeries. Although we have not encountered complications in our emergent cases without using antiplatelet drugs, we should still be cautious when deploying stent without anticoagulation treatment.

Surgical management of double aneurysms

A 47 year old lady presented with features of spontaneous Intracerebral Haemorrhage (ICH). CT scan showed a right frontal hematoma with diffuse Subarachnoid Haemorrhage (SAH). Digital Subtraction Angiography (DSA) revealed Descending Anterior Cerebral Artery (DACA) and Middle Cerebral Artery (MCA) aneurysms. Managed with hematoma, evaluation and aneurysm clipping, she made a good recovery.

Ocular Symptomatology, Management, and Clinical Outcome of a Giant Intracranial Aneurysm

Giant aneurysms of the anterior intracranial circulation are rare, slowly progressive vascular abnormalities, often presenting with neuro-ophthalmological symptoms before they rupture. This is a case of a 55-year-old woman with a double aneurysm of the anterior intracranial circulation, part of which was giant, diagnosed exclusively on the basis of ocular manifestations. We also describe successful management of the case throughout a long follow-up period.

A case of double inflammatory aneurysms in the thoracic and abdominal aorta repaired simultaneously.

A 54-year-old male who had been experiencing a high fever for a month was admitted to a local hospital for examination. Computed tomography revealed saccular aneurysms in the descending thoracic aorta and infrarenal abdominal aorta. The walls of the aneurysms were thickened and enhanced by intravenous contrast which suggested the inflammatory change. He was transferred to this hospital and underwent graft replacement of both the descending thoracic aorta and the abdominal aorta simultaneously. Simultaneous surgery should be considered in patients presenting with multiple inflammatory aneurysms, since inflammatory aneurysms have a risk of demonstrating rapid enlargement.

Unusual Representation of a Common Iliac Artery Double Aneurysm

This case discusses an unusual representation of a 3.1-cm double aneurysm of the right common iliac artery with an ectatic distal abdominal aorta. The patient was a 64-year-old asymptomatic male who participated in a routine ultrasound screening at his church. On the basis of the findings, a full ultrasound study was ordered and conducted at the request of his primary physician. The patient's history included smoking cessation in 1975. He currently had hypertension and hyperlipidemia. He was physically active and ran 40 miles per week until developing right Achilles tendonitis. Because of this injury, the patient biked daily. The patient's medications included atenolol and daily vitamins. The ultrasound findings revealed two aneurysms of the right common iliac artery. Both areas were fusiform and measured 3.1 and 2.9 cm, respectively. The dilation extended to the right internal iliac artery. The left common iliac was mildly dilated and kinked to the left. There was mild enlargement of the distal abdominal aorta measuring 3.4 cm by ultrasound and 3.1 cm by computed tomography angiogram. There is no evidence of internal thrombus. Usually asymptomatic, iliac artery aneurysms can be lethal if large (above 3.0 cm) and undetected. With appropriate, timely intervention the aneurysm can be safely repaired before rupture. Various aneurysm treatment options include conventional open abdominal surgery or endovascular stent graft placement with coil embolization. This patient discussed options with the vascular surgeon and was scheduled to have a cardiac catheterization with right internal iliac coil embolization. Staging of the endovascular graft was planned to follow. This case presents the uncommon finding of a large iliac artery aneurysm. This patient's disease was made more unusual by the presence of two distinct aneurysms present within the same vessel. It further reinforces the common practice of fully examining patients with aneurismal disease bilaterally and over multiple levels as a significant portion of patients have multilevel disease.

Multiple aneurysms of the anterior communicating artery: radiological and surgical difficulties

Multiple aneurysms of the anterior communicating artery (ACoA) occur rarely and have not been well investigated previously. The authors report on a consecutive series of six patients who each harbored multiple ACoA aneurysms. The radiological and surgical difficulties encountered in treating these complex and uncommon aneurysms are described and the pertinent literature is reviewed. Between October 1996 and August 2003, the authors surgically treated 146 patients with ACoA aneurysms. Six (4.1%) of these patients harbored multiple aneurysms of the ACoA. Four of these patients were men and two were women; their ages ranged from 36 to 72 years. Five patients had two aneurysms and one patient had three. All underwent surgery performed using the pterional approach. The clinical presentations, angiograms, intraoperative difficulties, and surgical results were retrospectively analyzed. All patients had premorbid hypertension. In two cases, the aneurysms were initially misdiagnosed as a single complex aneurysm based on routine cerebral angiograms, but special angiographic views demonstrated double aneurysms. In one case, multiple ACoA aneurysms could be identified using three-dimensional (3D) computerized tomography (CT) angiography. The size of the ACoA aneurysms ranged from 3 to 12 mm (mean 5.3 mm). A total of 13 ACoA aneurysms were successfully occluded in the six patients. Four patients were discharged in good condition, and two patients died. Although multiple ACoA aneurysms are quite rare, the following points should be kept in mind. (1) In bilobular ACoA aneurysms, special angiographic projections and 3D CT angiography or 3D digital subtraction angiography should also be performed to obtain a correct diagnosis. The differentiation of two aneurysms from a bilobular aneurysm during the preoperative period is important for surgical planning. (2) Angiographically, detection of the ruptured aneurysm is often difficult. (3) Resection of the gyrus rectus is necessary to obtain a good operative exposure. 4) Clip selection and sequencing are important. Straight clips with short blades should be preferred to avoid narrowing of the surgeon's view and a collision between the clips.