Symptomatic arterial luminal narrowing presenting months after subarachnoid hemorrhage and aneurysm clipping

Douglas Kondziolka M.D.1, Mark Bernstein M.D., F.R.C.S.(C)1, S. M. Spiegel M.D., F.R.C.P.(C)1, and Karel ter Brugge M.D., F.R.C.P.(C)1
View More View Less
  • 1 Divisions of Neurosurgery and Neuroradiology, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
Print or Print + Online

✓ The authors describe three cases of clinical cerebral ischemia associated with angiographic evidence of cerebral arterial luminal narrowing presenting 7, 14, and 52 weeks after subarachnoid hemorrhage (SAH) and aneurysm clipping. Delayed vasospasm, in its usual time setting 1 or 2 weeks after hemorrhage, did not occur symptomatically in these patients. No evidence for aneurysm clip migration or rebleed was present. All patients responded favorably to volume expansion and elevation of blood pressure. This unusual occurrence of a very delayed vasospasm may further the understanding of the vasospastic process. The symptomatic onset of arterial luminal narrowing months after SAH may suggest that a proliferative vasculopathy more accurately explains the observed vessel narrowing, rather than conventional active constriction of vascular smooth muscle.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
  • 1.

    Ammar A: Tissue compatibility of different intracranial implant materials: in-vivo and in-vitro studies. Acta Neurochir 72:4559, 1984 Ammar A: Tissue compatibility of different intracranial implant materials: in-vivo and in-vitro studies. Acta Neurochir 72:45–59, 1984

    • Search Google Scholar
    • Export Citation
  • 2.

    Anderson RE, , Bowron AM, & Sundt TM Jr: Biocompatibility analysis of the Sundt-Kees booster clip and the Drake aneurysm clip. Technical note. J Neurosurg 63:980984, 1985 Anderson RE, Bowron AM, Sundt TM Jr: Biocompatibility analysis of the Sundt-Kees booster clip and the Drake aneurysm clip. Technical note. J Neurosurg 63:980–984, 1985

    • Search Google Scholar
    • Export Citation
  • 3.

    Ausman JI, , Diaz FG, & Malik GM, et al: Current management of cerebral aneurysm: is it based on facts or myths? Surg Neurol 24:625635, 1985 Ausman JI, Diaz FG, Malik GM, et al: Current management of cerebral aneurysm: is it based on facts or myths? Surg Neurol 24:625–635, 1985

    • Search Google Scholar
    • Export Citation
  • 4.

    Batjer H, & Samson D: Use of extracranial-intracranial bypass in the management of symptomatic vasospasm. Neurosurgery 19:235246, 1986 Batjer H, Samson D: Use of extracranial-intracranial bypass in the management of symptomatic vasospasm. Neurosurgery 19:235–246, 1986

    • Search Google Scholar
    • Export Citation
  • 5.

    Conway LW, & McDonald LW: Structural changes of the intradural arteries following subarachnoid hemorrhage. J Neurosurg 37:715723, 1972 Conway LW, McDonald LW: Structural changes of the intradural arteries following subarachnoid hemorrhage. J Neurosurg 37:715–723, 1972

    • Search Google Scholar
    • Export Citation
  • 6.

    Dodson RF, , Tagashira Y, & Chu LWF: Acute ultrastructural changes in the middle cerebral artery due to the injury and ischemia of surgical clamping. Can J Neurol Sci 3:2327, 1976 Dodson RF, Tagashira Y, Chu LWF: Acute ultrastructural changes in the middle cerebral artery due to the injury and ischemia of surgical clamping. Can J Neurol Sci 3:23–27, 1976

    • Search Google Scholar
    • Export Citation
  • 7.

    Dujovny M, , Kossovsky N, & Kossowsky R, et al: Vascular clips: an historical and biomechanical perspective, in Fein JM, & Flamm ES (eds): Cerebrovascular Surgery. New York: Springer-Verlag, 1985, Vol 3:9971046 Dujovny M, Kossovsky N, Kossowsky R, et al: Vascular clips: an historical and biomechanical perspective, in Fein JM, Flamm ES (eds): Cerebrovascular Surgery. New York: Springer-Verlag, 1985, Vol 3, pp 997–1046

    • Search Google Scholar
    • Export Citation
  • 8.

    Dujovny M, , Kossowsky R, & Kossovsky N: Aneurysm clips. Neurosurgery 15:607, 1984 (Letter) Dujovny M, Kossowsky R, Kossovsky N: Aneurysm clips. Neurosurgery 15:607, 1984 (Letter)

    • Search Google Scholar
    • Export Citation
  • 9.

    Dujovny M, , Osgood CP, & Barrionuevo PJ, et al: SEM evaluation of endothelial damage following temporary middle cerebral artery occlusion in dogs. J Neurosurg 48:4248, 1978 Dujovny M, Osgood CP, Barrionuevo PJ, et al: SEM evaluation of endothelial damage following temporary middle cerebral artery occlusion in dogs. J Neurosurg 48:42–48, 1978

    • Search Google Scholar
    • Export Citation
  • 10.

    Ebina K, , Iwabuchi T, & Suzuki S: Histological change in permanently clipped or ligated cerebral arterial wall. Part II: autopsy cases of aneurysmal neck clipping. Acta Neurochir 66:2342, 1982 Ebina K, Iwabuchi T, Suzuki S: Histological change in permanently clipped or ligated cerebral arterial wall. Part II: autopsy cases of aneurysmal neck clipping. Acta Neurochir 66:23–42, 1982

    • Search Google Scholar
    • Export Citation
  • 11.

    Fein JM, , Dujovny M, & Kossovsky N: Angiographic demonstration of postoperative cortical artery stenosis induced by Biemer temporary clips. Neurosurgery 13:520522, 1983 Fein JM, Dujovny M, Kossovsky N: Angiographic demonstration of postoperative cortical artery stenosis induced by Biemer temporary clips. Neurosurgery 13:520–522, 1983

    • Search Google Scholar
    • Export Citation
  • 12.

    Fisher CM, , Kistler JP, & Davis JM: Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning. Neurosurgery 6:19, 1980 Fisher CM, Kistler JP, Davis JM: Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning. Neurosurgery 6:1–9, 1980

    • Search Google Scholar
    • Export Citation
  • 13.

    Fox JL, & Ko JP: Cerebral vasospasm: a clinical observation. Surg Neurol 10:269275, 1978 Fox JL, Ko JP: Cerebral vasospasm: a clinical observation. Surg Neurol 10:269–275, 1978

    • Search Google Scholar
    • Export Citation
  • 14.

    Gertz SD, , Rennels ML, & Forbes MS, et al: Endothelial cell damage by temporary arterial occlusion with surgical clips. Study of the clip site by scanning and transmission electron microscopy. J Neurosurg 45:514519, 1976 Gertz SD, Rennels ML, Forbes MS, et al: Endothelial cell damage by temporary arterial occlusion with surgical clips. Study of the clip site by scanning and transmission electron microscopy. J Neurosurg 45:514–519, 1976

    • Search Google Scholar
    • Export Citation
  • 15.

    Grady MS, , Cooper GW, & Kassell NF, et al: Profound cerebral vasospasm without radiological evidence of subarachnoid hemorrhage: case report. Neurosurgery 18:653659, 1986 Grady MS, Cooper GW, Kassell NF, et al: Profound cerebral vasospasm without radiological evidence of subarachnoid hemorrhage: case report. Neurosurgery 18:653–659, 1986

    • Search Google Scholar
    • Export Citation
  • 16.

    Hughes JT, & Schianchi PM: Cerebral artery spasm. A histological study at necropsy of the blood vessels in cases of subarachnoid hemorrhage. J Neurosurg 48:515525, 1978 Hughes JT, Schianchi PM: Cerebral artery spasm. A histological study at necropsy of the blood vessels in cases of subarachnoid hemorrhage. J Neurosurg 48:515–525, 1978

    • Search Google Scholar
    • Export Citation
  • 17.

    Kassell NF, , Peerless SJ, & Durward QJ, et al: Treatment of ischemic deficits from vasospasm with intravascular volume expansion and induced arterial hypertension. Neurosurgery 11:337343, 1982 Kassell NF, Peerless SJ, Durward QJ, et al: Treatment of ischemic deficits from vasospasm with intravascular volume expansion and induced arterial hypertension. Neurosurgery 11:337–343, 1982

    • Search Google Scholar
    • Export Citation
  • 18.

    Mayfield FH, & Kees G Jr: A brief history of the development of the Mayfield clip. Technical note. J Neurosurg 35:97100, 1971 Mayfield FH, Kees G Jr: A brief history of the development of the Mayfield clip. Technical note. J Neurosurg 35:97–100, 1971

    • Search Google Scholar
    • Export Citation
  • 19.

    McFadden JT: Metallurgical principles in neurosurgery. J Neurosurg 31:373385, 1969 McFadden JT: Metallurgical principles in neurosurgery. J Neurosurg 31:373–385, 1969

    • Search Google Scholar
    • Export Citation
  • 20.

    Mizukami M, , Kawase T, & Usami T, et al: Prevention of vasospasm by early operation with removal of subarachnoid blood. Neurosurgery 10:301307, 1982 Mizukami M, Kawase T, Usami T, et al: Prevention of vasospasm by early operation with removal of subarachnoid blood. Neurosurgery 10:301–307, 1982

    • Search Google Scholar
    • Export Citation
  • 21.

    Mohsen F, , Pomonis S, & Illingworth R: Prediction of delayed cerebral ischemia after subarachnoid hemorrhage by computed tomography. J Neurol Neurosurg Psychiatry 47:11971202, 1984 Mohsen F, Pomonis S, Illingworth R: Prediction of delayed cerebral ischemia after subarachnoid hemorrhage by computed tomography. J Neurol Neurosurg Psychiatry 47:1197–1202, 1984

    • Search Google Scholar
    • Export Citation
  • 22.

    Muizelaar JP, & Becker DP: Induced hypertension for the treatment of cerebral ischemia after subarachnoid hemorrhage. Direct effect of cerebral blood flow. Surg Neurol 25:317325, 1986 Muizelaar JP, Becker DP: Induced hypertension for the treatment of cerebral ischemia after subarachnoid hemorrhage. Direct effect of cerebral blood flow. Surg Neurol 25:317–325, 1986

    • Search Google Scholar
    • Export Citation
  • 23.

    Richling B, , Griesmayr G, & Lametschwandtner A, et al: Endothelial lesions after temporary clipping. A comparative study. J Neurosurg 51:654661, 1979 Richling B, Griesmayr G, Lametschwandtner A, et al: Endothelial lesions after temporary clipping. A comparative study. J Neurosurg 51:654–661, 1979

    • Search Google Scholar
    • Export Citation
  • 24.

    Ritchie WL, , Weir B, & Overton TR: Experimental subarachnoid hemorrhage in the cynomolgus monkey: evaluation of treatment with hypertension, volume expansion and ventilation. Neurosurgery 6:5762, 1980 Ritchie WL, Weir B, Overton TR: Experimental subarachnoid hemorrhage in the cynomolgus monkey: evaluation of treatment with hypertension, volume expansion and ventilation. Neurosurgery 6:57–62, 1980

    • Search Google Scholar
    • Export Citation
  • 25.

    Säveland H, , Ljunggren B, & Brandt L, et al: Delayed ischemic deterioration in patients with early aneurysm operation and intravenous nimodipine. Neurosurgery 18:146150, 1986 Säveland H, Ljunggren B, Brandt L, et al: Delayed ischemic deterioration in patients with early aneurysm operation and intravenous nimodipine. Neurosurgery 18:146–150, 1986

    • Search Google Scholar
    • Export Citation
  • 26.

    Simeone FA, , Ryan KG, & Cotter JR: Prolonged experimental cerebral vasospasm. J Neurosurg 29:357366, 1968 Simeone FA, Ryan KG, Cotter JR: Prolonged experimental cerebral vasospasm. J Neurosurg 29:357–366, 1968

    • Search Google Scholar
    • Export Citation
  • 27.

    Taneda M: Effect of early operation for ruptured aneurysms on prevention of delayed ischemic symptoms. J Neurosurg 57:622628, 1982 Taneda M: Effect of early operation for ruptured aneurysms on prevention of delayed ischemic symptoms. J Neurosurg 57:622–628, 1982

    • Search Google Scholar
    • Export Citation
  • 28.

    Weir B, , Grace M, & Hansen J, et al: Time course of vasospasm in man. J Neurosurg 48:173178, 1978 Weir B, Grace M, Hansen J, et al: Time course of vasospasm in man. J Neurosurg 48:173–178, 1978

    • Search Google Scholar
    • Export Citation
  • 29.

    Yamamoto I, , Hara M, & Ogura K, et al: Early operation for ruptured intracranial aneurysms: comparative study with computed tomography. Neurosurgery 12:169174, 1983 Yamamoto I, Hara M, Ogura K, et al: Early operation for ruptured intracranial aneurysms: comparative study with computed tomography. Neurosurgery 12:169–174, 1983

    • Search Google Scholar
    • Export Citation
  • 30.

    Zabramski JM, , Spetzler RF, & Bonstelle C: Chronic cerebral vasospasm: effect of volume and timing of hemorrhage in a canine model. Neurosurgery 18:16, 1986 Zabramski JM, Spetzler RF, Bonstelle C: Chronic cerebral vasospasm: effect of volume and timing of hemorrhage in a canine model. Neurosurgery 18:1–6, 1986

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 307 45 6
Full Text Views 136 1 0
PDF Downloads 109 1 1
EPUB Downloads 0 0 0