Disappearing saccular intracranial aneurysms: do they really disappear?

Early reappearance of disappeared ruptured small aneurysm with concomitant vertebral artery dissection

Thrombosis of a previously ruptured intracranial aneurysm is a frequent event and it most commonly occurs in large or giant aneurysms. We present a dynamic short-term follow-up and management of thrombosis in a ruptured small posterior inferior cerebellar artery aneurysm with concomitant vertebral artery dissection (VAD). Clinical and radiological follow-up findings and reviewed literature on thrombosis of small ruptured aneurysms are the focus of this presentation. Early reappearance of a disappeared ruptured small cerebral aneurysm with a concomitant VAD may be attributed to the controlled ovarian hyperstimulation phase of in vitro fertilization and prolonged use of oral contraceptive pills.

Spontaneous Regression of Aneurysm Remnant after Incomplete Surgical Clipping in a Patient with Ruptured Cerebral Aneurysm

Cases of spontaneous regression of cerebral aneurysm remnant after incomplete surgical clipping have been rarely reported. This paper reports the regression of an aneurysm remnant after incomplete surgical clipping during postsurgical follow-up. A 50-year-old male presented with subarachnoid hemorrhage because of rupture of an anterior communicating artery aneurysm. An emergency clipping of the aneurysm was performed. A cerebral angiography, which was performed two weeks postoperatively, revealed an aneurysm remnant. The patient refused additional treatment and was discharged without apparent neurological deficit. One-year follow up cerebral angiography demonstrated a partially regressed aneurysm remnant.

Growth and subsequent disappearance of a ruptured small saccular intracranial aneurysm: A morphometric and flow-dynamic analysis

The growth of a ruptured small saccular aneurysm has rarely been documented. Also rare are reports of spontaneous thrombosis of ruptured small intracranial saccular aneurysms. However, there are no reported instances of ruptured small saccular aneurysms that have demonstrated an increase in size after rupture, subsequently thrombosed and disappeared from circulation. We report one such aneurysm in a patient who presented with subarachnoid hemorrhage from a ruptured small saccular aneurysm of the anterior communicating artery. The possible reasons for the initial growth and subsequent thrombosis of the aneurysm from morphometric and flow dynamic points of view are discussed.

Spontaneous Occluded Anterior Communicating Artery Aneurysm during Coil Embolization Treated with One Coil Insertion into Remaining Stump

Spontaneous thrombosis of a ruptured aneurysm during coil embolization is a rare event, and some reports on recanalization of a spontaneous occluded ruptured aneurysm have been published. We report on a case of a 54-year-old male who presented with a subarachnoid hemorrhage due to rupture of a small aneurysm of the anterior communicating artery (ACoA). Cerebral angiography confirmed the presence of the ACoA aneurysm, but, during coil embolization, the aneurysm was near completely occluded with a remaining small neck. A small coil was inserted into the remaining stump of the neck to prevent recanalization, and the angiographic result at 1 year after coil embolization showed complete obliteration of the aneurysm.

Thrombosis and recanalization of small saccular cerebral aneurysm : two case reports and a suggestion for possible mechanism

Reports of thrombosis and recanalization of cerebral aneurysm are rare. We report two cases of small, saccular aneurysms in which spontaneous thrombosis had occurred during the preparation for endovascular coiling. Also, we review reported cases and propose the presumed pathogenesis.

Repair process in spontaneous intradural dissecting aneurysms in children: report of eight patients and review of the literature

OBJECTIVE

The objective of this study is to present a series of eight pediatric patients (less than 16 years old) with complete spontaneous thrombosis of spontaneous intradural dissecting aneurysms.

MATERIAL AND METHODS

Since 1989, eight consecutive patients in whom the cerebral aneurysms (four in middle cerebral arteries, one in posterior cerebral artery, three in basilar arteries) were found complete spontaneous thrombosis on follow-up MRI/MRA or conventional angiography. Patient histories and angiographic features were retrospectively reviewed.

RESULTS

Complete thrombosis of aneurysms in between first few days to 7 months was found in eight out of 1,587 patients (0.5%) in this recent series. Aneurysm repair was related to multivariate processes. Headache (50%), vomiting, and hemiplegia (37.5%) were common presenting symptoms. Partial or total resolution of the symptoms in a few months was often seen. Associated parent artery occlusions (50%) were also observed.

CONCLUSION

Spontaneous resolution of intradural dissecting aneurysm with or without parent artery occlusion is not uncommon even in the pediatric population. Aneurysm repair is a dynamic and multifaceted entity. Mural hematoma appears to be the most important factor promoting thrombosis and healing of the dissecting intracranial aneurysms.