Lenticulostriate Aneurysm Research Articles

Teaching NeuroImage: Lenticulostriate Aneurysm in a Patient With a Remote History of Cranial Radiation Therapy.

Teaching NeuroImage: Lenticulostriate Aneurysm in a Patient With a Remote History of Cranial Radiation Therapy.

Post-thrombolysis rupture of small lenticulostriate aneurysms: A report of 2 consecutive cases

The 2018 American Heart Association/American Stroke Association (AHA/ASA) guidelines stated that the administration of intravenous recombinant tissue-type plasminogen activator (rTPA) for acute ischaemic stroke is probably safe for patients with small (i.e. <10 mm) unruptured intracranial aneurysms. We present 2 cases of small (2 and 5 mm) lenticulostriate artery (LSA) aneurysms which ruptured immediately following rtPA infusion. The ensuing acute intracranial haemorrhages resulted in the death of one patient and severe functional impairment for the other. Given the limited literature available, the natural history of LSA aneurysms is largely unknown. This report suggests that LSA aneurysms, regardless of size, be considered separately from other conventional aneurysms as “high-risk” lesions and a contraindication to thrombolysis.

Surgical treatment of lenticulostriate aneurysms (a case report and literature review)

The study objective is to describe a rare case of putaminal intracerebral hemorrhage (PICH) results from a rupture of the distal lateral lenticulostriate artery (LSA) aneurysm and to summarize currently available information on its diagnosis and treatment.Materials and methods. A 40-year-old female patient was admitted to the N.V. Sklifosovsky Research Institute of Emergency Medicine. Her arterial pressure was 200/110 mm Hg. Brain computed tomography (CT) revealed a 25 сm3 right-sided PICH with a minimal perifocal edema. CT angiography revealed a saccular aneurysm located in the right distal LSA with the dome of 5 mm and the neck of 2 mm. We performed right frontotemporoparietal osteoplastic craniotomy and used the transsylvian transinsular approach to PICH represented by ruptured while we were removing the blood clots. We performed aneurysm trapping and removed the hematoma.Results. This clinical case demonstrates the possibility of successful microsurgical repair of the distal lateral LSA aneurysm rupture. Six months postoperatively, the patient had complete regression of left leg paresis and partial restoration of left hand functions.Conclusion. This case report appears quite interesting since deep intracerebral hematomas of this etiology are extremely rare. An optimal treatment for LSA aneurysms remains a subject of debate due to the small number of patients with this disorder and limited data on it. Patients with fusiform aneurysms require conservative treatment and dynamic follow-up with periodic cerebral angiography. Patients with typical saccular aneurysms or PICH presenting mass effect should undergo surgical treatment.

Correction to: 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association.

Correction to: 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association.

Microsurgical Repair of Ruptured Aneurysms Associated with Moyamoya-Pattern Collateral Vessels of the Middle Cerebral Artery: A Report of Two Cases

Patients with Moyamoya or other intracranial steno-occlusive disease are at risk for developing aneurysms associated with flow through collateral vessels. Because these lesions are rare, the optimal management remains unclear. Here, we describe 2 cases of microsurgical repair of ruptured collateral vessel aneurysms associated with middle cerebral artery (MCA) occlusion. The first patient was a 61-year-old man who presented with right frontal and intraventricular hemorrhage. Angiography revealed chronic right M1 occlusion and a 3-mm spherical lenticulostriate aneurysm. The frontal lobe hematoma was evacuated to reveal the aneurysm, which was safely cauterized and resected by coagulating and dividing the lenticulostriate parent vessel. The procedure was carried out with neuronavigation guidance and intraoperative neuromonitoring. The patient was discharged with no neurologic deficits. The second patient was a 53-year-old woman who presented with subarachnoid and intracerebral hemorrhage. Computed tomography angiogram showed a 2-mm saccular MCA aneurysm. Emergency left decompressive hemicraniectomy and hematoma evacuation were performed. The aneurysm, arising from a small collateral type vessel, was safely clipped without complications. Postoperative angiography revealed absence of the superior MCA trunk with a dense network of collateral vessels at the site of the clipped aneurysm. The patient recovered well and was ambulating independently 6 months postoperatively. No rebleeding occurred in the 2 patients. Our experience suggests that patients with MCA occlusion can harbor associated aneurysms related to flow through collateral vessels and can present with hemorrhage. Microsurgical repair of these aneurysms can be performed safely to prevent rebleeding.

Lenticulostriate aneurysms: a case series and review of the literature

IntroductionAneurysms of lenticulostriate artery (LSA) perforators are uncommon. There are few data on their natural history, and opinions differ on the treatment strategies.ObjectiveWe report a case series and summarize the...

Ruptured, fusiform, distal lenticulostriate aneurysm causing intraventricular haemorrhage in a patient with antiphospholipid-negative Sneddon's syndrome

Sneddon’s syndrome (SS) is a rare, non-inflammatory, occlusive, rterial vasculopathyaffecting small tomediumcalibrearterial vesels and defined by the presence of bluish-purple, lattice-like skin esions known as livedo racemosa in association with ischaemic erebrovascular events. Predominantly affecting women in early iddle age [1]. SS occurs both sporadically and in a familial form nd is often accompanied by hypertension and cardiac valvuopathies [1]. Anti-phospholipid antibodies (aPL) are detected in roundhalf of cases [1] andderangement of clotting factors has also een reported. While abnormalities on cerebral digital subtraction ngiography (DSA) in SS are common and diverse [1,2], intracranial neurysms have not, so far, been recognised as a feature. Aneurysms arising from distal branches of the lenticulostriate rteries are exceedingly rare [3,4]. We report a case of a fusiform, istal lenticulostriate artery aneurysm presenting with intravenricular haemorrhage (IVH) in a patient with SS – the first report of uch an association.

Microsurgical clipping of an unruptured lenticulostriate aneurysm

Aneurysms of the lenticulostriate artery have been associated with hypertension, vasculopathy, tumors, and arteriovenous malformations. Although several cases of microsurgical treatment of ruptured lenticulostriate artery aneurysms have been reported, to our knowledge there is no published case of microsurgical treatment of an unruptured lenticulostriate artery aneurysm. We report a 66-year-old woman with a history of moyamoya disease, previously treated with a right-sided middle cerebral artery-to-superficial temporal artery bypass who presented with an unruptured aneurysm of a lenticulostriate artery. We report successful microsurgical treatment of this rare lesion and discuss the rationale for our treatment strategy.

Efficacy of clip-wrapping in treatment of complex pediatric aneurysms

Pediatric aneurysms (PAs) are distinct from their adult counterparts with respect to typical location, aneurysm type, and known predisposing risk factors. Many strategies have been employed to treat PAs, but although it has been used frequently in adults, clip wrapping in pediatric patients has only been reported once. We present a series of pediatric patients that underwent clip wrapping and discuss this strategy as an effective means of treating unclippable PAs. Pediatric patients with clip-wrapped aneurysms over a 5-year period were retrospectively identified. Clinical presentation, surgical management, and clinical and radiological outcome of the patients were evaluated. Five pediatric patients with aneurysms were treated with clip wrapping during the specified period. Three had traumatic pseudoaneurysms, with two subarachnoid hemorrhages from aneurysm rupture. One patient presented with mycotic pseudoaneurysm rupture causing a large intraparenchymal and subarachnoid hemorrhage. Another patient had a dissecting complex saccular lenticulostriate aneurysm with four perforating vessels arising from the dome. Four patients had good clinical results, with Glasgow Outcome Scale (GOS) scores of 5 after at least 1-year follow-up (mean 24.2); one patient had a GOS score of 5 at discharge, but no additional follow-up. Postoperative neuroimaging demonstrated vessel patency after clip wrapping with no recurrent hemorrhages or increase in aneurysm size; however, one had progressive occlusion of the artery in a delayed fashion and had a small clinical ischemic event from which she fully recovered. Clip wrapping appears to be an effective underutilized technique for treatment of pediatric complex aneurysms that cannot be treated with conventional methods.

Comment on: Surgical revascularization for childhood moyamoya, Child's Nerv Syst 28: 1041–1048, 2012

Dear Editor: I enjoyed the article by Ng and colleagues “Surgical Revascularization for Childhood Moyamoya,” published in Child's Nervous System, volume 28:1041–1048, 2012. The article is a well-written summary of the experience at Great Ormond Street with this entity; I especially liked the comparison tables that the authors provided regarding other series in the literature, along with the time lines of their patients followed up for extended periods—an excellent graphic method for depicting the effect of surgery on control of symptoms in these patients, who appear to have a variable rate of progression of their arteriopathy. I do wish to gently object to the “mortality” figures that are provided in their table for referencing our article published in the Journal of Neurosurgery: Pediatrics, volume 100:142–149, 2004. In that table, the authors state under mortality that two of our patients died. Both of these patients in fact represent long-term deaths, one occurring 5 years after her surgery for moyamoya from the invasive growth of a radiation-induced malignant meningioma and the second patient dying 6 years after surgery from the rupture of an untreatable lenticulostriate aneurysm. The reader might infer from reviewing the table that these patients represented operative deaths, when in fact our series and others in the literature demonstrate a negligible operative mortality rate.

Small but Consequential: A Case of Deep Intracerebral Hemorrhage (ICH) Caused by Distal Lenticulostriate Artery Aneurysm (P05.218)

Objective: To report a rare case of hemorrhage stroke caused by a lenticulostriate aneurysmal rupture missed initially by both multidetector cerebral CT angiography and digital subtraction angiography. Background Intracerebral hemorrhage is the deadliest form of stroke. Cerebral angiography is not routinely performed in typical deep intracranial hemorrhage which is often associated with hypertension. In as many as a third of cases of deep ICH, however, there is a treatable underlying structural lesion. We report a case of lenticulostriate artery aneurysmal rupture-a rare subtype of vascular abnormality-which led to a diagnostically challenging but ultimately treatable case of ICH. Design/Methods: Case report. Results: A 41 year-old female presented with headache, diaphoresis, agitation, and left-sided visual-spatial and limb asomatognosia, and hemiparesis. Cerebral CT scan showed an acute intracerebral hemorrhage approximately 28cc in volume centered near the right superior temporal lobe and centrum semiovale. Multidetector CT angiography performed did not reveal definitive evidence of any vascular abnormality. Cerebral catheter-based angiography was also initially negative. On hospital day 4, the patient had increased headache and somnolence with expansion of her intracerebral hemorrhage. Repeat angiogram demonstrated a 3mm distal lenticulostriate aneurysm which was then surgically clipped. The patient underwent extensive physical rehabilitation and was left with residual left arm greater than leg weakness with otherwise good neurological recovery. Repeat cerebral angiogram 3 months later showed resolution of the aneurysm. Conclusions: This is a rare case of intracerebral hemorrhage caused by rupture of a distal lenticulostriate artery aneurysm. After extensive neuroimaging, an underlying aneurysm was discovered. Patients without history of hypertension, who are under the age of 45, and who have atypical hematoma patterns or expansion of ICH after presentation should undergo neuroimaging for underlying structural lesion. Disclosure: Dr. Cai has nothing to disclose. Dr. Han has received personal compensation for activities with Harvard/MIT Health Sciences and Technology-Beth Israel Deaconess Medical Center in collaboration with Pfizer Inc and Merck & Co. Dr. Chou has nothing to disclose.

Lenticulostriate Brain Aneurysms

Objective Lenticulostriate artery (LSA) aneurysms are rare. Here we present 2 cases of LSA aneurysm, their clinical presentation, diagnosis, surgical treatment, and postoperative follow-up, with a review of the topic. Case Report We report 2 female patients with LSA aneurysms among 194 surgically treated aneurysms in the Santa Paula and São Camilo Hospitals, who underwent the same surgical treatment. The first patient was a 48-year-old, Latin-American woman whose aneurysms were detected incidentally in an angiographic study carried out due to a cavernous sinus thrombosis. Both cerebral angiogram and magnetic angioresonance were performed and showed a left lenticulostriate aneurysm and 2 parasylvian aneurysms. The other case was a 62-year-old, Japanese, hypertensive patient who presented with subarachnoid hemorrhage, Fisher scale 2, and Hunt-Hess classification 2. Her angiogram showed a right LSA, left-middle cerebral artery, and anterior communicating artery aneurysms. No other pathology or infectious etiology was noted. Both patients were treated by opening the sylvian fissure, allowing the visualization of the lenticulostriate vessels and aneurysm clipping. Postoperative angiographies were performed in both cases. During the 2-year follow-up the younger patient remained with just distal right arm paresis and Rankin scale score of 1; the older patient developed normal pressure hydrocephalus, needing peritoneal ventricular drainage. Conclusions LSA aneurysms are uncommon. Subarachnoid hemorrhage and intracranial sinus thrombosis are quite common pathologies; nevertheless, the underlying vascular abnormality is rarely identified. The most common clinical presentation is intraparenchymal hemorrhage. Microsurgical treatment is often the chosen modality of intervention. Elderly people are more likely to develop postoperative complications before and after hospital discharge, which may be associated with microscopic alterations in vessels. They are also at higher risk of more severe vasospasm and the development of hydrocephalus in cases of ruptured aneurysms.

Cerebral aneurysms in children: are we talking about a single pathological entity?

The objective of this article is to highlight the fact that cerebral aneurysms in children are heterogeneous unlike in the adult population. This is a retrospective review of 17 children with intracranial aneurysms who were managed at a single institution from 2004 to 2009. The median age was 12 years (range 10 months-17 years). Sixty-five percent of the aneurysms were saccular and 24% were fusiform. There was one infectious and one distal lenticulostriate aneurysm. Patients with saccular aneurysms were predominantly male and presented more commonly with intracranial hemorrhage (91%). The fusiform aneurysms were dissecting in nature or chronic with intramural thrombus and mass effect. The treatment was dependent upon the type and location of the aneurysm. Pedriatic aneurysms are a heterogeneous group of intracranial arterial diseases with different etiologies, diverse morphology, and dissimilar clinical manifestations.

Partially thrombosed lateral lenticulostriate aneurysm presenting with embolic stroke

Partially thrombosed lateral lenticulostriate aneurysm presenting with embolic stroke

Embolization of an Unruptured Distal Lenticulostriate Aneurysm Associated with Moyamoya Disease

Lenticulostriate aneurysms are rare and usually present with intracranial hemorrhage, limiting understanding of their natural course. We describe an unusual case of an unruptured rapidly growing distal LSA aneurysm in the setting of Moyamoya disease, successfully embolized with n-BCA following functional neurologic testing with amobarbital.

Treatment of ruptured lenticulostriate artery aneurysms

Lenticulostriate artery (LSA) aneurysms are rarely reported in the literature, making management decisions challenging. Conservative, endovascular, and surgical treatments have been described primarily through case reports and reports of individual authors' experiences. The purpose of this study is to report neurological outcomes in a single-institution experience of ruptured lenticulostriate aneurysms treated surgically. The authors have conducted a retrospective review of all cases involving patients with ruptured LSA aneurysms who presented to the Mt. Sinai Hospital neurosurgical service between September 2001 and January 2007. Over 5.4 years, the authors treated 6 patients with 7 LSA aneurysms-6 ruptured and 1 unruptured. The Hunt and Hess grade on admission ranged from I to IV, with subarachnoid hemorrhage in 5 of the 6 patients. Catheter angiography confirmed the presence of the aneurysms, and all patients underwent a pterional craniotomy and clipping or resection of the aneurysm, performed by a single surgeon. Associated risk factors in our series of patients included hypertension, cocaine abuse, and intracranial occlusive disease suggestive of moyamoya disease. Two types of LSA aneurysms were identified. The mean size of the 6 ruptured aneurysms was 3.2 mm. The LSA was preserved in 3 of 6 patients, but LSA preservation did not correlate with development of a postoperative infarct, clinically or radiologically. In patients with ruptured aneurysms, the mean modified Rankin Scale score at discharge was 1.7. The 3 patients in whom the LSA was sacrificed had good outcomes, suggesting that loss of the artery is clinically well tolerated. This case series demonstrates that surgical treatment of ruptured LSA aneurysms can be an appropriate, effective, and safe therapy.

Distal Lenticulostriate Artery Aneurysm Rupture Presenting as Intraparenchymal Hemorrhage: Case Report

Aneurysms involving the distal lenticulostriate artery branches are a rare cause of spontaneous intracerebral hemorrhage. We report a case of ruptured lenticulostriate aneurysm in an otherwise healthy patient and review the literature on this topic. Computed tomography showed a right basal ganglia hemorrhage in a 44-year-old Native American woman with acute left hemiparesis. Cerebral angiography showed a 2-mm aneurysm in a distal lenticulostriate artery branch. A pterional craniotomy was performed on a delayed basis using computed tomographic angiography and frameless stereotactic guidance. The basal ganglia hematoma was evacuated, and the aneurysm was identified and clipped using microsurgical technique. Because the base of the aneurysm involved a portion of the parent vessel wall, it was wrapped with cotton and reinforced with cyanoacrylate glue. The patient did well after surgery and was discharged to home with outpatient rehabilitation on the third postoperative day. Although intraparenchymal hemorrhages are fairly common, the underlying vascular abnormality is rarely identified. Most are related to hypertensive vascular degeneration, rupture of a Charcot-Bouchard aneurysm, or both. When intracerebral hemorrhage occurs in young patients, however, aggressive investigation is warranted to rule out a structural vascular abnormality.

Endovascular Treatment of a Lenticulostriate Artery Aneurysm with N-butyl Cyanoacrylate

Aneurysms arising from lenticulostriate artery branches in moyamoya-type disease are challenging lesions to treat, due to their fragility and deep location. Surgery is difficult and endovascular options may be limited. A 57-year-old woman presented with a right ganglionic parenchymal hemorrhage due to a ruptured lenticulostriate artery aneurysm associated with ipsilateral middle cerebral artery occlusion. The aneurysm and parent feeding artery were occluded using endovascular injection of N-butyl cyanoacrylate. The aneurysm was successfully obliterated and although some glue did enter the more distal middle cerebral artery, there was no change in the patient's neurologic status. In highly selected cases where lenticulostriate aneurysms cannot be directly accessed for surgery or endovascular coiling, obliteration with liquid acrylic glue may be considered as a therapeutic option.