Lenticulostriate Artery Aneurysm Research Articles

Rupture of lenticulostriate artery aneurysms

The authors report on 3 rare cases of ruptured lenticulostriate artery (LSA) aneurysms that were heralded by deep cerebral hematomas. The hematomas were unilateral in 2 cases and bilateral in 1; in the bilateral case, only a single LSA aneurysm could be identified on the right side of the brain. Because of their small size (≤ 2 mm), fusiform aspect, and deep location within the brain, all of the aneurysms were treated conservatively. There was no hemorrhage recurrence, and follow-up angiography demonstrated spontaneous thrombosis in 2 of the 3 cases. The clinical course was favorable in 2 of the 3 patients. The course in the patient with the bilateral hematoma was marked by an ischemic event after the initial episode, resulting in an aggravation of deficits. The cause of this second event was uncertain. Because our knowledge about the natural history of LSA aneurysms is incomplete, there is no consensus concerning a therapeutic strategy. The authors' experience in 3 reported cases leads them to think that a conservative approach involving close angiographic monitoring may be proposed as first-line treatment. If the monitored aneurysm then persists or grows in size, its occlusion should be considered. Nonetheless, other studies are needed to further strengthen the legitimacy of this strategy.

A New, More Accurate Classification of Middle Cerebral Artery Aneurysms

Classification of middle cerebral artery (MCA) aneurysms is sometimes difficult because the identification of the main MCA bifurcation, the key for accurate classification of MCA aneurysms, is inconsistent and somewhat subjective. To use the meeting point of the M1 and M2 trunks as an objective, generally accepted, and angiographically evident hallmark for identification of MCA bifurcation and more accurate classification of MCA aneurysms. We reviewed the computed tomographic angiography data of 1009 consecutive patients with 1309 MCA aneurysms. The M2 trunks were followed proximally until their meeting with the M1 trunk at the main MCA bifurcation. The aneurysms were classified according to their relative location: proximal, at, or distal to the MCA bifurcation. The M1 aneurysms were further subgrouped into M1 early cortical branch aneurysms and M1 lenticulostriate artery aneurysms, extending the classic 3-group classification of MCA aneurysms into a 4-group classification. The main MCA bifurcation was the most common location for MCA aneurysms, harboring 829 aneurysms (63%). The 406 M1 aneurysms comprised 242 M1 early cortical branch aneurysms (60%) and 164 M1 lenticulostriate artery aneurysms (40%). We found 106 MCA aneurysms (8%) at the origin of large early frontal branches simulating M2 trunks liable to be misclassified as MCA bifurcation aneurysms. Even though 51% of the 407 ruptured MCA aneurysms were associated with an intracerebral hematoma, this did not affect the classification. Studying MCA angioarchitecture and applying the 4-group classification of MCA aneurysms is practical and facilitates the accurate classification of MCA aneurysms, helping to improve surgical outcome.

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.

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.

Subarachnoid hemorrhage from a ruptured proximal lenticulostriate artery aneurysm

Subarachnoid hemorrhage from a ruptured proximal lenticulostriate artery aneurysm

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.

Embolization of a ruptured lenticulostriate artery aneurysm

Aneurysms arising from the lenticulostriate artery (LSA) are rare. So far, only 23 cases have been reported in the literature (Ahn et al. 2007 [1], Gandhi et al. 2008 [2], Harreld et al. 2010 [3]). Early detection and treatment of these aneurysms is difficult because of their small size, deep location and complex surrounding vasculature. The majority of reported cases were treated surgically, and only two were treated with endovascular embolization (Harreld et al. 2010 [3], Larrazabal et al. 2001 [4]). We present here a case of an LSA aneurysm that was successfully embolized with n-butyl cyanoacrylate (n-BCA) with no recurrence after 1 year of follow-up.

Medial lenticulostriate artery aneurysm presenting with isolated intraventricular hemorrhage

Background:Isolated intraventricular hemorrhage (IVH) secondary to lenticulostriate artery aneurysm rupture is extremely rare. Thus, the diagnostic imaging modalities and therapeutic interventions utilized in the management of such cases are not clearly defined.Case Description:Here we describe a case of isolated or primary IVH (PIVH) in a 71-year-old woman presenting with severe headache. Emergent catheter cerebral angiography, performed after nondiagnostic computed tomography angiography (CTA), revealed the bleeding source to be a 4 × 2.6 mm distal medial lenticulostriate artery aneurysm that ruptured directly into the lateral ventricle. The poorly accessible location of the aneurysm for both endovascular and direct surgical treatment argued for conservative management. A good clinical outcome was obtained with rapid angiographic resolution of the ruptured aneurysm.Conclusion:Thus, lenticulostriate artery aneurysm rupture must be given diagnostic consideration in cases of isolated IVH. Emergent catheter cerebral angiography should be performed in cases such as this when noninvasive imaging is unrevealing. Conservative management may be a reasonable therapeutic option in patients with this kind of aneurysm, and spontaneous resolution can be observed.

Fusiform Lenticulostriate Artery Aneurysm with Subarachnoid Hemorrhage: The Role for Superselective Angiography in Treatment Planning

Aneurysms of the lenticulostriatal perforating arteries are rare and either involve the middle cerebral artery-perforator junction or are located distally in basal ganglia. We describe a rare ruptured fusiform lenticulostriatal perforating artery aneurysm arising from a proximal M2 MCA branch, discerned on superselective microcatheter angiography, presenting solely with subarachnoid hemorrhage (SAH). A 50-year-old previously healthy man presented with diffuse SAH and negative CT angiogram. Cerebral angiogram demonstrated a 2 mm fusiform aneurysm presumably arising from the right lateral lenticulostriate perforator but the exact origin of the perforator was unclear. Superselective angiography was required to precisely delineate the aneurysm and its vessel of origin and directly influenced treatment planning (surgical trapping). Superselective microcatheter angiography provides both an option for endovascular therapy as well as more accurate delineation for surgical planning for these rare aneurysms.

Bilateral lenticulostriate artery aneurysms

Aneurysms of lenticulostriate artery (LSA) have rarely been reported. We present an extremely rare case of bilateral aneurysm of LSA, which spontaneously disappeared. A 59-year-old man presented to us with a decreased level of consciousness. Twice repeated blood culture was negative. Computed tomography (CT) showed bilateral basal ganglia hemorrhage with intraventricular extension and acute hydrocephalus. We performed external ventricular drainage. Cerebral angiograms, on 3 days after the onset, disclosed two aneurysms on the left LSA and one aneurysm on the right LSA. Cerebral angiography after 9 weeks demonstrated complete disappearance of three aneurysms.

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.

MICROSURGICAL AND ANGIOGRAPHIC ANATOMY OF MIDDLE CEREBRAL ARTERY ANEURYSMS

To determine the prevalence of early branch aneurysms, characterize these lesions angiographically and anatomically, and determine their clinical significance. The authors conducted a retrospective review of 125 consecutive patients with a diagnosis of middle cerebral artery (MCA) aneurysm. Eighty-four patients harboring 100 MCA aneurysms were studied; 41 patients were excluded for lack of adequate imaging or for fusiform morphology of the aneurysm. Demographic characteristics including age, side, sex, subarachnoid hemorrhage, intracerebral hematoma, multiple aneurysms, and type of treatment were obtained. The average patient age was 57.3 years (range, 29-79 yr); 69 were women and 15 were men. Fifty-eight were right MCA aneurysms and 42 were left aneurysms. Fourteen patients had multiple MCA aneurysms. Thirty-nine of 100 aneurysms were associated with subarachnoid hemorrhage. Twelve of 100 aneurysms were associated with an intracerebral hematoma. The average aneurysm sizes were 9.1 mm overall (range, 2.0-27.0 mm), 12.3 mm for ruptured aneurysms, and 7.5 mm for unruptured. There were 36 M1 bifurcation aneurysms, 39 early frontal branch aneurysms, 18 early temporal branch aneurysms, four lenticulostriate artery aneurysms, and three trifurcation aneurysms. In our retrospective review, the majority of MCA aneurysms arose along the M1 segment proximal to the M1 bifurcation. Early frontal branch aneurysms were more common than typical M1 segment bifurcation aneurysms. M1 segment aneurysms arising from early frontal and early temporal branches have distinct anatomic features that impact surgical management and outcome. Understanding the relationship between the recurrent lenticulostriate arteries arising from the proximal segments of these early branches and the aneurysm neck should allow surgeons to avoid many postoperative ischemic complications when dealing with these challenging lesions.

Distal lenticulostriate artery aneurysm in deep intracerebral haemorrhage

Aneurysms of the distal lenticulostriate artery (LSA) are rare. Only 16 cases have been reported in the literature. Early detection and treatment of these aneurysms is also difficult because of...

Idiopathic distal lenticulostriate artery aneurysm in a child

The authors describe a rare case of idiopathic distal lenticulostriate artery (LSA) aneurysm in a 5-year-old boy who presented in the emergency department with a sudden onset of headache. Admission computed tomography scans revealed an intracerebral hemorrhage in the left caudate nucleus with intraventricular extension. Angiographic studies demonstrated a left medial LSA aneurysm. The patient underwent a left parasagittal frontal craniotomy, the lateral ventricle was accessed via the anterior transcallosal approach, and the aneurysm was removed after sectioning of the parent vessel. The child left the hospital after 5 days; at that time he was asymptomatic and without motor impairment. The optimum treatment of aneurysms involving small perforating arteries is controversial and depends mainly on the causative factors. The pathogenesis and treatment of these unusual aneurysms are discussed.

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.

A Neurocytoma and an Associated Lenticulostriate Artery Aneurysm Presenting with Intraventricular Hemorrhage: Case Report

A Neurocytoma and an Associated Lenticulostriate Artery Aneurysm Presenting with Intraventricular Hemorrhage: Case Report

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.

O-22-320 - Craniotomy under local anesthesia and monitored conscious sedation for the resection of tumors involving eloquent cortex

Moyamoya disease (MMD) in children was rarely associated with intracranial aneurysms. The purpose of this study was to report the clinical characteristics and long-term surgical outcomes of pediatric intracranial aneurysms accompanied with MMD.Between October 2002 and October 2013, our department treated 9 pediatric MMD patients (aged ≤17 years) with intracranial aneurysms. Clinical and angiographic features, treatment selection, as well as follow-up information were obtained and analyzed. The efficacy of vascularization and the changes of intracranial aneurysms were evaluated with digital subtraction angiography (DSA). We also collected 7 previously published reports to analyze the characteristics of this rare condition.In our series of 9 patients, 7 were male. The mean age was 11 ± 3.4 years (range 5−16). Seven patients presented with intracranial hemorrhage as the initial manifestation, while 2 patients suffered transient ischemic attacks. The most common aneurysm location was the posterior choroidal artery (4, 44.4%). One anterior choroidal artery aneurysm was completely embolized with Onyx (ev3, Irvine, California, USA). One posterior choroidal artery aneurysm failed due to inaccessibility to the parent artery. Bilateral encephalo-duro-arterio-synangiosis (EDAS) surgery was performed for all the children. During the follow-up period of 6.4 ± 2.2 years (range 3−11), spontaneous occlusion of aneurysm was observed in 4 children, including 1 child with middle cerebral artery aneurysm, 1 with lenticulostriate artery aneurysm, and 2 with posterior choroidal artery aneurysm. Good or fair vascularization was observed in all the 9 children with DSA follow-up. No patients suffered intracranial hemorrhage during the follow-up period.The long-term survey showed EDAS surgery could effectively increase the cerebral blood flow and maintain good outcomes in children, which may further result in the disappearance of the intracranial aneurysms and decrease the incidence of recurrent hemorrhage.

Aneurysm of the Lenticulostriate Artery

Four rare cases of aneurysm of the lenticulostriate artery (LSA) are presented. LSA aneurysms were located at the origin in three patients and distally in one. Two cases were of multiple aneurysms, one was associated with hypertensive intracerebral hematoma (putaminal hemorrhage), and the other with moyamoya disease. Two patients were successfully treated by microsurgical procedures. The occurrence of LSA aneurysm suggests that aneurysm formation and growth are accentuated by hemodynamic alteration and stress.