Giant intracranial aneurysm. Case report

Giant thrombosed aneurysm of the vertebral artery in childhood: an extremely rare case

In childhood, a significant proportion of giant aneurysms usually occur at the vertebrobasilary system. Nonetheless, giant totally thrombosed aneurysm which only involves the vertebral portion of the vertebrobasilary system is very rare. Up to this time, in childhood, a few giant aneurysm originating from vertebral artery have been reported, and to our knowledge only one case was reported to be totally thrombosed. The enlargement tendency of totally thrombosed aneurysms and management of these cases are still controversial. Thus, diagnosis and follow-up of cases where a radical approach could not be performed require a multi-modality radiologic approach. In this study, we reported a case of angiographically occult giant thrombosed vertebral artery aneurysm, which is extremely rare, and discussed the importance of CT and MRI in evaluation of these patients before surgical treatment.

Giant global intracranial aneurysm in an infant

Images

The angiographic and scintigraphic picture of dolichoectasia of the anterior cerebral artery

This report concerns a case of dolichoectasia of the anterior cerebral artery. The authors present the angiographic and scintigraphic pictures. The clinical symptoms were connected with ischaemia in the region supplying by the anterior cerebral artery and seemed to indicate expanding process.

Computer tomographic features of giant intracranial aneurysms

Five cases of giant intracranial aneurysm are reported, all of which presented as intracranial mass lesions. All five aneurysms were visualised by CT scanning as well as angiography. Their CT scan appearances may be sufficiently characteristic to be distinguished from other mass lesions. The poor prognosis when untreated is emphasised, and the results of treatment by carotid ligation discussed.

Direct surgical treatment of giant intracranial aneurysms

The author has operated on 40 patients with giant intracranial aneurysms, using various surgical approaches. Giant aneurysms predominated in females (3:1) and were most common in the age group 30 to 60 years. Patients presented with subarachnoid hemorrhage (17), visual disturbance (18), chronic headache (14), transient or progressive hemispheric deficit (6), seizure (2), dementia (2), and cerebrospinal fluid rhinorrhea (1). Giant aneurysms were located at the carotid artery (25), the basovertebral artery (8), the anterior communicating artery (5), and the middle cerebral artery (2). Eight of 40 patients had one or more other aneurysms and/or associated arteriovenous malformations. Aneurysms were treated with intramural thrombosis (21), neck occlusion (7), trapping (10), proximal parent artery ligation (1), and aneurysmorrhaphy (1). After as much as 8 years of follow-up, 32 patients (80%) showed complete or marked improvement in signs and symptoms; two patients (5%) had a poor recovery. There were six surgical mortalities (15%). Giant aneurysms can be treated with respectable results if the surgeon selects the technique best suited to the particular aneurysm. In general, neck occlusion, trapping, and aneurysmorrhaphy are best for giant aneurysms of the anterior circulation, and intramural thrombosis is best for those of the posterior circulation. Extra- and intracranial vascular anastomotic techniques are also of value. For success, a flexible approach is essential.

Giant thrombosed aneurysm associated with an arteriovenous malformation. Case report

The authors describe a case of giant anterior cerebral artery aneurysm associated with an anatomically related arteriovenous malformation (AVM). The aneurysm was almost completely thrombosed and was resected along with the AVM.

[Giant aneurysm of the middle cerebral artery. Report of a case]

A case of giant aneurysm of the middle artery with the size of 12,0 x 8,0 x 6,0 cm is reported. Some aspects of the treatment of such aneurysm are considered. As far as we know this is the largest intracranial aneurysm ever recorded.

Giant serpentine aneurysm. Report of two cases

The authors describe two cases of giant middle cerebral artery aneurysms presenting as mass lesions. Angiograms in each case revealed a distinctive serpentine vascular channel surrounded by an avascular area causing a "mass effect." Both lesions were resected in toto with excellent clinical results. Similar lesions in the literature are noted and the pathophysiology and origin of this group of aneurysms are discussed.

Giant intracranial aneurysm associated with Marfan's syndrome. Case report

The authors describe a giant intracranial internal carotid aneurysm in a patient with Marfan's syndrome. Treatment consisted of internal carotid ligation with subsequent thrombosis of the lesion. The patient's course was complicated by carotid arterial dissection and possible laminar thrombosis within the aneurysm increasing the size of the lesion. Three clinical syndromes, Marfan's, Ehlers-Danlos, and pseudoxanthoma esasticum, are discussed. The literature is reviewed with reference to the hazards of treatment of vascular pathology in patients with these connective tissue disorders.