Acta neurochirurgica
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Acta neurochirurgica · Jan 1999
Intra-operative premature rupture of the cerebral aneurysms. Analysis of the causes and management.
The causes and management of intra-operative premature rupture are analysed and discussed. During the past 6 years, the authors, performed 398 consecutive direct surgical interventions for ruptured cerebral aneurysms. Intra-operative premature rupture is defined as a rupture which occurs before the securing of the parent arteries or the neck of the aneurysm and is out of control, at least temporarily. ⋯ The double suction technique and primary haemostasis using a small piece of cotton or temporary clip resulted in good outcome even in cases with premature rupture. However, very early premature rupture also occurred although its incidence was extremely rare. The removal of part of the brain can secure the working space but the outcome was poor.
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Acta neurochirurgica · Jan 1999
Case ReportsEndovascular stent placement for cervical internal carotid artery aneurysm causing cerebral embolism: usefulness of neuroradiological evaluation.
We present a case of a cervical internal carotid artery aneurysm that caused cerebral embolism. This lesion was supposed to be a dissecting aneurysm due to blunt neck injury. ⋯ Intravascular ultrasound imaging was also useful for evaluation of the satisfactory stent deployment and identification of the neck of the aneurysm. We discuss effectiveness of endovascular stenting for cervical internal carotid artery aneurysm with intramural thrombus and the usefulness of a combination of the neuroradiological imaging before, during and after the interventional procedure.
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Acta neurochirurgica · Jan 1999
Long-term prognosis of haemangioblastoma of the CNS: impact of von Hippel-Lindau disease.
The aim was to assess the frequency of von Hippel-Lindau disease (VHL) and the long-term prognosis of VHL and non-VHL patients among 110 consecutive patients with haemangioblastoma (HB) of the CNS treated between 1953 and 1993 at one neurosurgical unit. To reveal VHL manifestations we performed a detailed clinical and radiological examination (neuraxis and abdomen) (61/110), VHL-gene mutation analysis (40/110), and collection of all available clinical, imaging, operative and autopsy data from the hospitals involved. All patients were followed-up with a median of 14 years (excluding 14 operative deaths), and no patient was lost to follow-up. ⋯ Recurrence of the HB in patients whose primary operation was considered radical developed in four of the 10 VHL patients at a median of 19 years, and in nine of the 74 non-VHL patients at a median of 11 years. The median length of life of all VHL and non-VHL patients was 46 and 63 years, respectively. In VHL, RCC and HBs were equal causes of death.
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Acta neurochirurgica · Jan 1999
Interdisciplinary management results in 100 patients with ruptured and unruptured posterior circulation aneurysms.
The authors report on a series of 100 posterior circulation aneurysms managed by surgical and endovascular procedures. The series consisted of 41 elective admissions more than 14 days after SAH or for unruptured aneurysms and 59 acute admissions after subarachnoid haemorrhage (SAH). In this first interdisciplinary series after the introduction of electrolytically detachable coils, surgical clipping was maintained as treatment of choice in good grade patients while endovascular therapy was primarily offered for patients in poor clinical grade or if the aneurysm was judged difficult to be accessed surgically. ⋯ Size and shape do not appear to be a primary factor to favour one or the other modality. The hope that endovascular therapy improves the prognosis of poor grade patients with posterior circulation aneurysms probably has been overstated. The good results of endovascular treatment with small narrow-necked aneurysms on proximal arteries of the posterior circulation, as seen in the present series and as reported in the accumulating literature, suggest that in future surgical and endovascular treatment should be considered as alternatives in these special cases while in large and broad-necked aneurysms surgery should be considered first.
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Acta neurochirurgica · Jan 1999
Case ReportsRuptured aneurysm at the trunk of the accessory middle cerebral artery.
We present a 32-year-old woman with intracranial haemorrhage due to rupture of a saccular aneurysm arising from the trunk of an accessory middle cerebral artery. This is the first report of an aneurysm arising distally to the anomalous vessel's origin from the A1 segment of the anterior cerebral artery.