Ruptured intracranial dissecting aneurysms: management considerations with a focus on surgical and endovascular techniques to preserve arterial continuity

Uhl, Eberhard; Schmid-Elsaesser, Robert; Steiger, Hans‐Jakob

doi:10.1007/s00701-003-0122-2

Cited by 49 publications

(49 citation statements)

References 50 publications

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“…As such, definitive treatment usually involves surgical or endovascular trapping or proximal occlusion, with or without extracranial-intracranial bypass. 1,2 In fact, even when an attempt was made to clip-reconstruct the dissected RAH in this patient, our efforts to preserve the vessel were ultimately unsuccessful. This outcome is not very surprising, given the very small caliber of the RAH and the dissecting fusiform nature of the aneurysm.…”

Section: Intracranial Dissectionsmentioning

confidence: 91%

“…Although many cases in the literature have been successfully managed conservatively and have healed spontaneously, early securement of ruptured dissecting aneurysms is generally advocated, given the high risk of early rerupture. [1][2][3][4] Thus, although conservative management in this patient would have been a potential treatment option, neither the treating team nor the patient's family felt comfortable leaving that ruptured dissecting aneurysm unsecured. Unlike saccular aneurysms, dissecting aneurysms are challenging to treat by simple clip ligation or coil embolization, given the lack of a well-defined neck and actual involvement of the parent vessel wall.…”

Section: Intracranial Dissectionsmentioning

confidence: 98%

“…1,2 Dissecting aneurysms most commonly affect the large proximal intracranial vessels, although small distal cerebral vessels may rarely be involved. [1][2][3][4] However, to the best of our knowledge, dissecting aneurysms of the recurrent artery of Heubner (RAH), a large named perforator arising from the anterior cerebral artery (ACA), have not been previously observed. We present an exceptional case of ruptured dissecting aneurysm of the RAH in a patient with osteogenesis imperfecta (OI), an inherited disorder of collagen synthesis.…”

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confidence: 99%

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Dissecting Aneurysm of the Recurrent Artery of Heubner in a Patient With Osteogenesis Imperfecta

Mansfield

Rahme

2015

Can. J. Neurol. Sci.

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Spontaneous intracranial dissections are a rare cause of subarachnoid hemorrhage (SAH), accounting for 2% to 3% of cases. 1,2 Dissecting aneurysms most commonly affect the large proximal intracranial vessels, although small distal cerebral vessels may rarely be involved. [1][2][3][4] However, to the best of our knowledge, dissecting aneurysms of the recurrent artery of Heubner (RAH), a large named perforator arising from the anterior cerebral artery (ACA), have not been previously observed. We present an exceptional case of ruptured dissecting aneurysm of the RAH in a patient with osteogenesis imperfecta (OI), an inherited disorder of collagen synthesis. CASE REPORTA 50-year-old woman was transferred to us for evaluation and management of spontaneous SAH and intraventricular hemorrhage. She had been found unresponsive by her family and was initially seen in an outside hospital, where she was found to have a Glasgow coma score of 5 (decorticate posturing) and was thus intubated. Head computed tomography (CT) scan revealed diffuse cisternal SAH predominating in the anterior interhemispheric fissure and tetraventricular hemorrhage with hydrocephalus ( Figure 1A,B). A right frontal external ventricular drain was placed emergently, revealing an opening pressure of 20 cm of water. Following cerebrospinal fluid diversion, her neurological examination improved slightly, measured by her withdrawing all four extremities to pain.CT angiography was obtained, demonstrating a small fusiform aneurysmal dilation of the well-developed left RAH ( Figure 1C). Cerebral angiography confirmed the presence of a 4 mm × 1.5 mm fusiform aneurysm arising from the proximal portion of the left RAH overlying the A1 segment of the left ACA ( Figure 1D). The A1 vessel was mildly deformed, suggesting that the aneurysm was actually larger in size and had a thrombosed, nonangiographically visible portion ( Figure 1D). Given the "pearl-on-string" appearance of the aneurysm and its atypical location, a dissecting nature was strongly suspected. Moreover, there was angiographic evidence of an old healed dissection of the right internal carotid artery, just proximal to its entrance into the carotid canal, and occlusion of the proximal right vertebral artery at its V1-V2 junction, just proximal to its entrance into the right C6 foramen transversarium, also suggesting an old dissection ( Figure 1E,F). Consideration was given for obtaining a brain magnetic resonance imaging to demonstrate the intramural thrombus and confirm the diagnosis of intracranial dissection. However, given the patient's critical condition and the expectation that magnetic resonance imaging findings would not drastically change our management strategy, this study was not performed in order to avoid delaying definitive treatment.Further questioning of the family revealed that the patient had type I (autosomal dominant) OI, as did roughly 50% of her siblings and children. Interestingly, the patient's mother had died of aneurysmal SAH and one of her maternal aunts had had surgical cli...

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Section: Intracranial Dissectionsmentioning

confidence: 91%

Section: Intracranial Dissectionsmentioning

confidence: 98%

mentioning

confidence: 99%

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Dissecting Aneurysm of the Recurrent Artery of Heubner in a Patient With Osteogenesis Imperfecta

Mansfield

Rahme

2015

Can. J. Neurol. Sci.

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“…Endovascular treatment of intracranial dissection aneurysms has been previously described. However, there has been limited experience on successful treatment of BA dissections complicated by aneurysms with stenting and coil embolization [12][13][14][15][16] . Good outcomes were reported after this procedure in only three cases 9,13 .…”

Section: Fig 2 Mra (A B) and Dsa (C D E) Shows Proximal (White Armentioning

confidence: 99%

Endovascular treatment of a basilar artery dissecting aneurysm

Patroclo

Puglia²,

Leite³

et al. 2007

Arq. Neuro-Psiquiatr.

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-Basilar artery (BA) dissecting aneurysms pose difficulties to treatment because both bleeding and thrombosis can happen in the same patient, clinical course is unpredictable and high morbidity is usual. We report the case of a 37-year-old woman with a BA aneurysm probably caused by arterial dissection, presenting embolic and hemorrhagic complications. The aneurysm was submitted to endovascular treatment with stenting and coil embolization. Clinical and radiological results were excellent and no complications were observed, suggesting that BA stenting and coil embolization may be a safe and effective treatment for this condition.KEY WORDS: basilar artery dissection aneurysm, endovascular treatment, stenting, coil embolization. Tratamento endovascular de aneurisma dissecante da artéria basilarRESUMO -Aneurismas associados a dissecção da artéria basilar (AB) apresentam dificuldades terapêuticas, pois sangramentos e fenômenos trombóticos podem ocorrer no mesmo paciente, seu curso clínico é imprevisível e sua morbidade, alta. Relatamos o caso de uma paciente de 37 anos com aneurisma de artéria basilar provavelmente causado por dissecção arterial, apresentando-se com complicações hemorrágicas e embólicas. O aneurisma foi submetido a tratamento endovascular com colocação de "stent" e embolização com molas. Os resultados clínico e radiológico foram excelentes e nenhuma complicação foi observada, sugerindo que o tratamento dos aneurismas de AB dissecantes com colocação de "stent" e embolização com molas possa ser seguro e eficaz. PALAVRAS-CHAVE: aneurismas associados a dissecção da artéria basilar, tratamento endovascular, embolização com molas, "stent".

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“…Endovascular treatment options include the use of three-dimensional coils, stent placement, balloon remodelling [1][2][3] , the use of liquid embolics 4 , multiple microcatheters 5 and combinations of these approaches. [6][7][8][9] We present two patients with (CT) scan revealed diffuse subarachnoid haemorrhage (SAH) with intraventricular extension and brain oedema. CT angiography displayed a large aneurysm of the origin of posterior communicating artery (PComA), with mural thrombus and a wide neck.…”

Section: Introductionmentioning

confidence: 99%

Migration of Enterprise stent in treatment of intracranial aneurysms: a report of two cases

Pavliša¹,

Ozretić²,

Radoš³

et al. 2009

Radiology and Oncology

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Ruptured intracranial dissecting aneurysms: management considerations with a focus on surgical and endovascular techniques to preserve arterial continuity

Cited by 49 publications

References 50 publications

Dissecting Aneurysm of the Recurrent Artery of Heubner in a Patient With Osteogenesis Imperfecta

Dissecting Aneurysm of the Recurrent Artery of Heubner in a Patient With Osteogenesis Imperfecta

Endovascular treatment of a basilar artery dissecting aneurysm

Migration of Enterprise stent in treatment of intracranial aneurysms: a report of two cases

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