Fusiform Cerebral Aneurysms Research Articles

Multiple fusiform myxomatous cerebral aneurysms in a patient with Carney complex

Carney complex is a rare autosomal-dominant familial tumor syndrome that involves the triad of myxoma, mucocutaneous pigmentation, and endocrine overactivity. To the best of the authors' knowledge, there are no reports of multiple fusiform aneurysms coinciding with atrial myxoma. The authors report the case of a 38-year-old woman with typical Carney complex who had multiple skin myxomas, endocrine abnormalities, and multiple brownish perioral lesions. Multiple fusiform aneurysms were also discovered after the recurrence of atrial myxoma. During a follow-up period of > 10 years, there have been no angiographic changes in the aneurysms and no progression of symptoms.

Recurrence of myxoma in the left ventricle with concurrent cerebral fusiform aneurysms after previous atrial myxoma surgery

Recurrence of myxoma in the left ventricle with concurrent cerebral fusiform aneurysms after previous atrial myxoma surgery

On the influence of variation in haemodynamic conditions on the generation and growth of cerebral aneurysms and atherogenesis: A computational model

A risk-factor criterion, based on near-wall haemodynamic conditions, for the assessment of vascular pathology risk is developed and tested. This criterion has its foundation on experimentally observed vascular wall responses to oscillatory and swirling wall shear stress patterns and is applied to the results of computational simulations. We test this model on two anatomically accurate vascular segments, where pathologies are either commonplace or have already been developed, i.e. a healthy carotid bifurcation and a cerebral fusiform aneurysm. In the case of the former, the risk-assessment criterion predicts the emergence of atherosclerosis of the same locations that the disease is usually encountered. In the case of the latter, the risk factor shows increased probability for the appearance of secondary, “baby”, aneurysms at certain locations.

Trapping and Vascular Reconstruction for Ruptured Fusiform Aneurysm in the Proximal A1 Segment of the Anterior Cerebral Artery-Case Report-

A 65-year-old woman presented with subarachnoid hemorrhage (SAH). Angiography detected a small bulge in the A1 segment of the right anterior cerebral artery (ACA). The patient was managed conservatively. Ten days after the initial SAH, the patient suffered a second SAH. Cerebral angiography demonstrated a fusiform aneurysm in the right A1 segment and vasospasm in the left A1 segment. The aneurysm of the right A1 segment was trapped and the right superficial temporal artery (STA) was end-to-end anastomosed to the distal portion of the right A1 segment. The patient had no postoperative cerebral ischemic events. Postoperative cerebral angiography revealed that the bypass flow through the right STA perfused the right ACA territories. STA-A1 end-to-end anastomosis can prevent cerebral ischemic events following parent vessel occlusion or microsurgical trapping for fusiform cerebral aneurysms in the A1 segment without sufficient collateral flow to the ipsilateral ACA territory from the contralateral ACA.

Traumatic cerebral aneurysm formation following ventriculoperitoneal shunt insertion

Iatrogenic intracranial aneurysms are rare in children. A 15-year-old girl presented in coma with a fixed dilated left pupil six weeks following removal of a long-standing left-sided ventriculoperitoneal shunt. Computed tomography (CT) and cerebral angiography revealed a left temporoparietal intracerebral haemorrhage with a fusiform distal middle cerebral artery aneurysm. The patient underwent image-guided localisation of the aneurysm to enable evacuation of the haemorrhage and resection of the fusiform aneurysm. A high index of suspicion is required for diagnosis and early treatment to prevent unnecessary morbidity and mortality.

Multiple cerebral aneurysms as delayed complication of left cardiac myxoma: a case report and review

Left cardiac myxoma and also consecutive embolization into the brain is well documented, whereas the association of myxomas with multiple fusiform cerebral aneurysms is rare. We analyze 33 previously reported patients and present a case of a 43-year-old woman with multiple cerebral infarctions 2 years after resection of a recurrent myxoma in the left atrium. Cerebral angiography displayed multiple fusiform aneurysms of several cerebral arteries, including a giant aneurysm of the basilar artery. Serum level of interleukin-6 (IL-6) was highly elevated. The clinical, radiological and pathological features of these aneurysms are summarized. The pathogenesis, including the role of IL-6 in the formation of myxomatous aneurysms, is discussed.

Stenosis of perforating artery in neck clipping of cerebral saccular aneurysm or trapping of fusiform aneurysm: A study in the vascular model

Stenosis of perforating artery, which occurs during neck clipping of cerebral saccular aneurysm or in trapping operation of cerebral fusiform aneurysm, was examined using the chicken ascending aortic artery. In neck clippings, the orifice of the perforating artery became narrow when the aneurysmal clip was applied pointing to the perforating artery which was just in the vicinity of the aneurysmal neck, although its outward appearance did not show the stenosis. When the clip was applied passing beside the perforating artery, the artery was patent. Therefore, the clip should be applied passing beside the perforating artery and not occlude its orifice. In trapping, When the clip was applied parallel to the perforating artery, the intima of the perforating artery was approximated and its vascular lumen became narrow despite its normal outward appearance. On the contrary, when the clip was applied at a right angle to the perforating artery, its orifice was left open. When the fusiform aneurysm is hard and a tiny perforating artery is just in the vicinity of the aneurysm, the trapping clip must be applied at a right angle to the perforating artery.

Cerebral aneurysms in atrial myxoma: a delayed, rare manifestation

Atrial myxomas are the most common primary tumors of the heart. Neurologic involvement usually occurs as a stroke with ischemic episodes. Following excision of cardiac myxomas, delayed neurologic events owing to aneurysms are rare and have not been reported from India. We report an operated case of left atrial myxoma. The patient initially presented with a stroke and 6 months after the surgery, developed multiple intracerebral hemorrhages due to the rupture of fusiform cerebral aneurysms, without recurrence of the cardiac tumor.

Endovascular parent artery occlusion in large-giant or fusiform distal posterior cerebral artery aneurysms.

Posterior cerebral artery aneurysms are amenable to deconstructive surgical treatment because of the rich collateral supply of the distal posterior cerebral artery. This report retrospectively analyses the outcome of endovascular parent artery occlusion for large or fusiform distal posterior cerebral artery aneurysms. Medical records and cerebral angiograms from two endovascular centres were analysed retrospectively. Eight patients with large or fusiform distal posterior cerebral artery (PCA) aneurysms were treated by endovascular occlusion of the segment of the PCA at the site of the aneurysm. Three of those were treated urgently after acute subarachnoid haemorrhage, the remainder had elective treatment. The clinical and angiographic outcomes in seven patients were assessed at 6 to 12 months. A single case of occipital infarction resulting in permanent homonymous hemianopia was the only permanent complication. Of the remaining patients, six made excellent recoveries and one was lost to follow-up. No recurrence or re-bleeding was noted. Endovascular parent artery occlusion may be an alternative to surgical parent artery occlusion in distal PCA aneurysms which are not convenient for selective endovascular treatment or surgical clipping.

Non-Atherosclerotic Fusiform Cerebral Aneurysms

Fusiform cerebral aneurysms are dilatations of the entire circumference of a segment of cerebral artery, usually considered due to atherosclerosis in adults. They are relatively thick-walled and elongated, causing neural compression or ischemia when discovered. We have noted a subset of fusiform cerebral aneurysms that vary from this common description. Out of a series of 472 intracranial aneurysms treated over 11 years, 11 patients between the ages 16 and 67 years (mean age 37) were identified who had discrete fusiform aneurysms unassociated with generalized cerebral atherosclerosis, connective tissue disorder or inflammation. Three presented with hemorrhage, six with neural compression by the aneurysm and two were discovered incidentally. Nine aneurysms were located in the posterior circulation, the other two in the intracranial carotid artery. Their mean length and width were 16.3 and 11 mm, respectively. Three aneurysms contained thrombus. The eight aneurysms that were exposed surgically were partly or substantially thin-walled with normal appearing parent arteries. Eight were treated with proximal occlusion and three were circumferentially "wrapped". Parent artery occlusion caused one death and one mild disability and the remaining patients made good recoveries (follow-up 0.5 - 10 years). There is a subset of cerebral aneurysms with discrete fusiform morphology, apparently unrelated to cerebral atherosclerosis or systemic connective tissue disease, thin-walled in part or whole, more common in the vertebrobasilar system, and possessing a risk of rupture. Treatments currently available include proximal occlusion or aneurysm wrapping", different approaches than neck-clipping or endovascular coiling of side-wall saccular cerebral aneurysms that leave the parent artery intact.

Aneurisma fusiforme de la arteria cerebral media

Introduction. The main objective of the treatment of intracranial aneurysms is to isolate them from the cerebral blood circulation. A fusiform aneurysm, because of its shape, cannot be treated using the usual techniques and usually requires techniques of arterial reconstruction and revascularization using by pass. Currently it is possible to find the vascular territories with the greatest risk of causing neurological defects and where revascularization is necessary. CASE REPORT. A 20 year old man with no previous history of illness who had several transient ischaemic episodes. Emergency laboratory tests, ECG and plain chest Xray were all normal. Imaging investigations showed the presence of a fusiform aneurysm of the anterosuperior division of the right middle cerebral artery. No associated systemic disease was detected. Wada s test showed the vascular territory with the greatest risk of neurological deficit. Extra intra cranial by pass was done from the right superficial temporal artery to the distal portion of the anteriorsuperior branch of this artery. The operation was done using a right pterion approach with dissection of the superficial temporal artery, and the aneurysm, trapping and termino lateral anastomosis. Cerebral protectors and mild hypothermia were used during the operation. The post operative course was uneventful. Anatomo pathological diagnosis was of an atherosclerotic fusiform aneurysm with osseous and chondroid metaplasia. After six months follow up the patient remains asymptomatic. Discussion and conclusions. Treatment of fusiform cerebral aneurysms is complex and usually requires procedures for cerebral revascularization. Correct pre operative evaluation is essential to identify the vascular territory with the greatest risk of causing neurological deficit. Wada s test is useful for this, since it permits selective evaluation of the different vascular territories safely and quickly. High or low flow by pass of these territories prevents cerebral ischaemia and permits the treatment of choice for these aneurysms.

Case of unusual presentation of fusiform aneurysm of the basilar artery

Objective: To describe a case of a fusiform aneurysm of the basilar artery presented as a pontine infarct and 2 days later as a subarachnoid hemorrhage caused by the rupture of the same aneurysm. Design: Case report. Setting: Tertiary-care hospital. Background: Fusiform aneurysm of cerebral vessels is a rare pathology that presents with ischemic stroke, subarachnoid hemorrhage, or mass effect. Ischemia and subarachnoid hemorrhage in the same patient 2 days apart, to our knowledge, was not reported before. Subject: A 55-year-old Hispanic man with history of untreated hypertension and alcohol abuse presented with acute onset of right hemiparesis and dysarthria. On day 2 of his hospital admission, he developed arrythmia and loss of consciousness. The patient expired from cardiac arrest on day 4 of his hospitalization. Initial head computed tomography scan showed dolichoectatic basilar artery and marked calcification of internal carotid arteries (ICA) and middle cerebral arteries (MCA). Brain magnetic resonance imaging showed left upper pons infarct 2 cm in diameter. Magnetic resonance angiography confirmed presence of a fusiform aneurysm of the basilar artery. Head computed tomography scan at the time of clinical deterioration on day 2 of hospital admission showed subarachnoid bleeding and significant brain edema. Autopsy revealed a ruptured basilar artery aneurysm with thrombus in the lumen and left pontine infarct. Microscopic examination of fusiform aneurysm showed atherosclerosis of the aneurysmal wall and attenuation and inflammation at the rupture site. Conclusions: We hypothesize that in our case, pontine infarct had developed because of occlusion of pontine perforators by a thrombus within an aneurysm, and subarachnoid hemorrhage had developed secondary to a rupture of weakened by inflammatory changes aneurysmal wall. We also hypothesize that in our case, ischemic stroke and subsequent subarachnoid hemorrhage may represent different stages of the same process of atherosclerosis and inflammation in an aneurysmal wall confirmed by autopsy. Origin as well as management of fusiform cerebral aneurysms are unclear. Antiplatelet agents and anticoagulation are recommended by some for stroke prophylaxis in patients with unruptured fusiform cerebral aneurysms. Our case shows that caution should be exercised in prescribing anticoagulants or even antiplatelet agents to a patient with fusiform aneurysm of cerebral arteries due to a possibility of rupture of an aneurysm. Randomized prospective study may be necessary to clarify this issue. Copyright © 2001 by National Stroke Association

中大脳動脈Ｓｅｒｐｅｎｔｉｎｅ ａｎｅｕｒｙｓｍの１手術例

We surgically treated a giant thrombosed fusiform middle cerebral aneurysm with dolichoectatic and tortuous (so-called “serpentine”) channel in a 55-year-old male. He showed mass signs progressively for over 4 years. We performed STA-MCA anastomosis and clipping and debulking of the aneurysm. His aphasia worsened and he developed right hemiparesis after operation. The natural history of the giant thrombosed fusiform aneurysms is not well known now. But many of the case will grow worse gradually without aggressive treatment. We recommend earlier diagnosis and earlier treatments for giant fusiform aneurysm.

Wrap-clipping with a Dacron mesh silastic sheet. Technical note.

A technique combining wrapping and clipping using a Silastic sheet coated with Dacron mesh is described for treatment of fusiform or broad-based cerebral aneurysms. This sheet is easily tailored to wrapping the aneurysm base while avoiding involvement of the cranial nerves or branching vessels. The sheet is semitransparent so that the caliber of the newly constructed parent artery is easily adjusted during wrap-clipping. After the aneurysm and the parent artery have been circumferentially wrapped with the sheet, aneurysm clips are applied on the sheet so that the base of the aneurysm is clipped between the two leaves of the sheet. This wrap-clipping technique avoids the risks involved in extracting the aneurysm from the parent artery. The Dacron mesh coating the outer surface and sufficient clip closing pressure are both helpful in preventing the clip blades from sliding. Similar previously reported techniques are reviewed and discussed in detail.

In vivo study of flow pattern at human carotid bifurcation with regard to aneurysm development.

In order to investigate the developmental mechanism of cerebral aneurysms, the in vivo flow pattern around human cervical carotid bifurcations was studied by flow visualization using digital subtraction angiography with an isotonic contrast medium. The blood stream containing the medium impinged on the apex, then proceeded along the walls of the branches. After opacification of the whole lumen around the apex, most of the medium was carried away, while some remained for a few seconds at the carotid sinus. In the internal carotid artery, the blood struck the wall at an oblique angle near the tops of the arterial curvatures. In cases with atheromatous plaque or kinking of the branch, the blood passed through the stenosed segment and moved upstream, indicating turbulence. The study suggests that haemodynamic forces around the apex consist mainly of impingement on the apex and shear stress to the wall at and around the apex. In branches, high shear stress seems to exist. It might be possible that high shear stress causes degenerative changes in the endothelial layer, initiating the formation of saccular and fusiform cerebral aneurysms.

Fusiform posterior cerebral artery aneurysm treated with excision and end-to-end anastomosis

A case of a ruptured fusiform aneurysm of the posterior cerebral artery is reported. The aneurysm was excised and end-to-end anastomosis was carried out between the two ends of the posterior cerebral artery. There is no previous report of a posterior cerebral artery aneurysm treated with this technique. The pertinent literature is reviewed and the significance of this technique in the treatment of unclippable cerebral aneurysms is discussed.

Left Atrial Myxoma with Cerebral Emboli

Infarction of the central nervous system secondary to embolism from left atrial myxoma is a recognized phenomenon. However, myxoma as the source of an embolus may be overlooked if an index of suspicion is not present during the evaluation of the patient with a stroke without a known cause. We present a case report that illustrates some of the pitfalls and characteristic findings present in the evaluation of these patients. The magnetic resonance image of multiple cerebral aneurysms and infarction associated with this condition is presented along with a unique, arteriographically proven resolution of a fusiform cerebral aneurysm after the removal of the cardiac tumor. A review of published case reports suggests that, if the cardiac tumor is recognized and treated quickly, the ultimate prognosis, while uncertain, is usually good. However, because the potential exists for recurrence of the cardiac tumor, for enlargement of the cerebral lesions, or for late development of cerebral lesions, long term follow-up is mandatory and a vigorous work-up must be pursued if the patient again becomes symptomatic or develops central nervous system manifestations for the first time.