Pericallosal Artery Aneurysm Research Articles

Giant aneurysm of the distal anterior cerebral artery: Associated with an anterior communicating artery aneurysm and a dural arteriovenous fistula

We describe an unusual case of a giant pericallosal artery aneurysm, producing psychomotor depression from mass effect, associated with a smaller aneurysm of the anterior communicating artery, a dural arteriovenous fistula, and a meningioma. Magnetic resonance imaging (MRI) and cerebral angiography demonstrated the giant aneurysm and the meningioma. Cerebral angiography provided a detailed appreciation of the cerebral circulation, including both aneurysms, the dural arteriovenous fistula, and the potential collateral supply to the involved anterior cerebral distribution. The anterior communicating artery aneurysm was successfully clipped as was the distal anterior cerebral branch supplying the giant aneurysm before its resection. The patient made a full recovery but with persisting, slight dysphasia. We conclude that computed tomography, cerebral angiography, and MRI are of specific value in the assessment of giant aneurysms, but only angiography can provide detailed characterization of the aneurysm and demonstrate other possible cerebrovascular pathology such as multiple aneurysms and arteriovenous fistulas.

The Quantitative Description of Action Disorganisation after Brain Damage: A Case Study

Abstract This paper outlines a theoretical approach to the study of action in simple, routine activities, along with a coding system for describing and analysing performance. The approach is exemplified through a single case study involving a patient who developed a profound action disorder following rupture of a pericallosal artery aneurysm and concomitant anterior cerebral artery spasm. The Action Coding System provides a detailed, quantitative picture of this patient's action disorder as it was manifested in two routine tasks and as it recovered over time. Discussion focuses on the cognitive organisation and processing of simple, everyday tasks and suggests how disruption of performance may ensue when intentional control of action is compromised.

多発脳動脈瘤の治療方針

The authors reviewed surgical results of 618 surgically treated patients with intracranial aneurysms. Multiple aneurysms were observed in 106 (20%) patients. In cases of multiple aneurysms, their policy has been to treat all aneurysms, ruptured and unruptured, in a one-stage operation whenever possible. All aneurysms of 92 patients were treated in one-stage operations. Eighty three (90%) patients improved or remained stationary, 6 (7%) deteriorated, 3 (3%) died postoperatively. The cause of deterioration or death were due to cerebral vasospasm, primary brain damage or surgical procedure for ruptured aneurysms. No significant difference was found in comparing the rupture site of the aneurysm or the timing of the operation in each preoperative clinical grade. Furthermore, all patients were classified into three groups according to the location of the aneurysms. Sixty-two patients had unilateral aneurysms including aneurysms in the midline, i.e. anterior communicating artery aneurysms, distal basilar artery aneurysms and/or bilateral pericallosal artery aneurysms (unilateral group), and 30 patients had bilateral aneurysms (bilateral group). Morbidity and mortality in unilateral group was 6% and 3%, while in bilateral group, 7%, 3% respectively. No significant difference was observed in the bilateral group compared with the unilateral group, and surgical results of each group appeared to be satisfactory. Neither death nor deterioration was found attributable to operative procedure when unruptured aneurysms were added to the surgery for ruptured aneurysms in a one-stage operation. These surgical results for 92 cases were similar to the results in the rest of the 526 cases. Based on these results, the one-stage operation is recommended, whenever possible, for patients with multiple aneurysms, even if bilateral craniotomy is needed.

動脈瘤処置後に再出血または再増大を示した症例について

During the last 17 years, we have had 15 cases of aneurysmal regrowth or rebleeding after direct surgical treatment. In this paper, we have divided the cases into five groups according to the cause of rebleeding or regrowth, and have discussed some of the problems in each group.Group 1: Incomplete clipping or wrapping; eight casesMost of the cases in this group had undergone initial operation more than ten years before, and incomplete obliteration of the aneurysms was attributable largely to immaturity of technical skill. Most of the recent cases had anterior communicating or internal carotid artery aneurysms, the necks of which were unusually broad and did not easily accept a clip or a combination of clips. Based on the length of interval after operation, recurrent hemorrhage was divided into early (5 to 15 days after initial operation) and late (5 to 16 years) rebleeding. Early rebleeding appeared to occur when the“responsible”or“ruptured”bleb escaped clipping. In late rebleeding it was assumed that incompletely clipped necks took some time to develop an aneurysmal sac and eventually to rupture.Group 2: Mycotic aneurysm; 1 caseMycotic aneurysms often occur multiply in a single case and, for this reason, four-vessel study is mandatory to prevent recurrent hemorrhage.Group 3: Traumatic aneurysm; 1 case Two traumatic aneurysms occurred in a single case after operation for a large pericallosal artery aneurysm. Avulsion of small cortical branches from the pericallosal artery during the initial operation was responsible for these aneurysms, which bled soon after the initial operation. Use of an encircling clip should be considered whenever a tear of the arterial wall appears to be large enough to produce a postoperative traumatic aneurysm.Group 4: Aneurysmal development at a site other than the original; 3 cases We retrospectively and precisely reviewed initial angiograms in this group and discovered that small aneurysms had already been present in the initial angiograms. These aneurysms grew larger and evetually bled after periods of 2 to 11 years. From these experiences we believe that incidental small aneurysms discovered in SAH patients should be clipped, if there is a clippable neck, at the earliest possible chance after the initial operation.Group 5: Regrowth and rebleeding after complete clipping.; 2 casesIn some rare cases we found that a portion of the aneurysmsmal neck was very thin and this portion also involved the wall of the parent artery. In these cases convetional clipping of the aneurysmal neck dose not always ensure against regrowth or rebleeding of the original aneurysm. Application of an encircling clip or clip placement involving a portion of the parent artery, should be considered in such cases.

Clinical - radiological correlates in intracerebral hematomas due to aneurysmal rupture.

In this series of intracerebral hematomas from aneurysmal rupture, gathered from several neurosurgical services, certain morphological features were studied in detail. Patients with very large hematomas tended to have poor neurological grades on admission to hospital and their immediate discharge outlook was correspondingly poor. Ruptured middle cerebral and pericallosal artery aneurysms were relatively common causes of intracerebral hematomas. Patients with temporal lobe hematoma did relatively well; those with parietal hematoma did poorly. The larger the hematoma the less chance there was of developing cerebral vasospasm but the more likely was pre-operative brain herniation. The survival was more closely linked to size and location of the hematoma than to the location of aneurysm or the degree of midline shift.