Surgical resection of brainstem cavernous malformations (BCMs) is a high-risk procedure and can be challenging to the neurosurgeon. Lateral surgical routes are becoming increasingly used to approach ventrolaterally brainstem cavernoma. Surgical approach decision depends on the location of the cavernoma in the brainstem and a possible association with brainstem developmental venous anomalies (DVAs). DVA can affect the formation and clinical course of cavernous malformation (CM). CMs related to DVAs tend to have more aggressive behavior than isolated CM. In cases of DVAs associated with hemorrhage, CMs are most often the site of bleeding rather than DVAs themselves. In this case report, we present a 24-year-old woman with a pontomedullary CM and associated dorsally located DVA. BCM was operated through a far lateral suboccipital craniotomy. Brainstem entry point was at inferior olive with extension to the pontomedullary sulcus. This approach should be preferred as a safe surgical exposure to the central and paramedian pontomedullary cavernoma, especially in the cases with associated intraparenchymal brainstem DVA. Such surgical exposure allows preservation of the concomitant brainstem DVA.
Dealing only with the ruptured paraclinoid aneurysm, without taking care of the underlying cerebral ischemia owing to concomitant extracranial ICA dissection, could be an insufficient approach for treatment. In the presented case of a giant ruptured paraclinoid aneurysm and coexistence of severe bilateral ICA dissecting stenosis, trapping with matching the bypass flow was the proper solution for managing simultaneously with the aneurysm and the cerebral ischemia from the left side. Anticoagulants and antiplatelets were applied safely to treat the right internal CAD.
OBJECTIVE: The purpose of the present research was to evaluate the morphometric characteristics of ruptured and unruptured aneurysms in series of surgically treated patients with multiple intracranial aneurysms. According to the findings the differences between ruptured and unruptured aneurysms were analyzed in patients with subarachnoid hemorrhage and multiple intracranial aneurysms. METHODS: Sixty eight patients with 174 multiple aneurysms and clinical presentation of aneurismal subarachnoid hemorrhage were treated in two hospitals in Sofia, Bulgaria between 1991 and 2010. The ruptured aneurysm was identified from preoperative studies (head computed tomography, digital subtraction angiography, computed tomography angiography) and it was proved during the surgical procedure. The preoperative angiograms were used to perform measurements of morphometric characteristics of ruptured and unruptured cerebral aneurysms. We used univariable logistic regression analysis to obtain odds ratios. Cochran-Mantel-Haenszel test for dependence was performed to obtain adjusted odds ratio and P value for dependence. RESULTS: In 16 (23.53%) patients, the ruptured aneurysm was not the largest one. The calculated odds ratios with 95% confidence intervals revealed strong association with rupture for the aneurysm size ≥ 7.5 mm, aneurysm location at anterior communicating-anterior cerebral artery complex, irregular aneurysm shape and angle of inclination. The average value of the angle of inclination was 153.06° ± 21.16 for the ruptured aneurysms and 106.78° ± 29.50. After performing a test for dependence and adjustment for aneurysm size and location, size ratio, irregular shape, terminal aneurysm type and aneurysm inclination angle were strongly associated with aneurysm rupture. CONCLUSION: The only independent significant determinant for aneurysm rupture besides aneurysm size and location was aneurysm inclination angle (P < 0.05).
OBJECTIVE: The purpose of this study was to assess the usefulness of MDCT (multidetector computed tomography) angiography as a routine follow-up examination of surgically treated patients with multiple intracranial aneurysms. METHODS: Thirty seven patients with a total of 92 multiple intracranial aneurysms underwent MDCT angiography to evaluate residual aneurysm remnants and de novo aneurysm formation. The mean period between aneurysm surgery and MDCT angiography examination was 8.9 years. The investigations were assessed by an experienced radiologists and neurosurgeons. RESULTS: Eight patients (21.6%) showed abnormal findings on follow-up MDCT angiography: aneurysm remnants (5.4%) and de novo formed aneurysms (18.9%). Three of them were operated: one for reposition of the placed clips and two were treated by direct clipping of de novo formed aneurysm. Two patients were suitable for endovascular treatment. CONCLUSION: MDCT angiography is an useful routine examination for long-term follow-up of surgically treated patients with multiple intracranial aneurysms.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.