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Theodore W. Eller

I ntracranial aneurysms most frequently announce their presence by rupture and subarachnoid hemorrhage or by mass effect upon nearby anatomic structures. Occasionally, they are responsible for transient ischemic events or stroke in the distribution of the parent artery. 1, 4 A case is presented in which magnetic resonance imaging (MRI) aided in the decision to clip an unruptured aneurysm in an elderly individual. Case Report This previously healthy 69-year-old woman suffered a sudden moderate stroke of the right hemisphere and was brought to the

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Aneurysms of the vein of Galen

Experience at The Hospital for Sick Children, Toronto

Harold J. Hoffman, Sylvester Chuang, E. Bruce Hendrick, and Robin P. Humphreys

A lthough Steinheil 54 made initial reference to an aneurysm of the vein of Galen in 1895, the first comprehensive description of the condition and the first attempt at treatment was published in a case report by Jaeger, et al. , in 1937. 26 In 1947, Oscherwitz and Davidoff 40 were the first to approach an aneurysm of the vein of Galen intracranially. Boldrey and Miller 6 in 1949 clipped the posterior cerebral arteries in an attempt to deal with an aneurysm of the vein of Galen. Gold, et al. , 20 firmly established the clinical features of aneurysms

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Rene Tempelhoff, Paul A. Modica, Keith M. Rich, and Robert L. Grubb Jr.

C erebral ischemia during aneurysm surgery continues to be a major cause of morbidity and mortality in the perioperative period. 7 Early recognition and therapy of compromised cerebral perfusion has been shown to be the most important factor in the recovery from cerebral ischemia. 10, 11, 23 Unfortunately, during general anesthesia for aneurysm surgery, cerebral blood flow (CBF) is not routinely monitored. Thus, some patients will awaken from surgery with a new focal neurological deficit due to undetected intraoperative cerebral ischemia from a variety of

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Alexis Victorien Konan, Jean Raymond, and Daniel Roy

S pinal cord arteriovenous malformations (SCAVMs) are most challenging neurovascular lesions. 2, 6, 8–10, 14, 15, 20, 21, 25, 26 The natural history of patients with SCAVMs is poor 1, 2, 6, 13–15, 20, 25, 26, 29 and the risks of surgical or endovascular treatment of lesions involving the anterior spinal artery (ASA) are sometimes prohibitive. 1, 2, 6, 13–15, 20, 25, 26, 29 Aneurysms associated with SCAVMs have been reported as risk factors for hemorrhage. 4, 7, 25 There may be a role for partial treatment of incurable arteriovenous malformations (AVMs) if

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Peter J. Leech, Bryant A. R. Stokes, Trevor Apsimon, and Clive Harper

A n aneurysm of the anterior spinal artery presenting as a mass lesion in the spinal canal is a rare occurrence. When subarachnoid hemorrhage is associated with neurological signs referable to the spinal cord, investigation of the area usually discloses a spinal arteriovenous malformation. 2 When a mass lesion presents alone, the diagnosis of spinal artery aneurysm is not readily brought to mind. Case Report This 25-year-old woman was referred with a 10-week history of back pain located at the T-10 level and radiating in a girdle-like fashion

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Mandy J. Binning and William T. Couldwell

C ranial nerve splitting or infiltration by intracranial aneurysms has been reported in the literature. Typically, this anomaly has been seen with the optic nerve or chiasm and involvement with ophthalmic artery or anterior communicating artery aneurysms. The authors describe the first reported case of a PCA aneurysm arising from a duplicated arterial branch that was found to be splitting the oculomotor nerve. Case Report History, Presentation, and Examination This 63-year-old man experienced the sudden onset of the “worst headache of his

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Fon-Yih Tsuang, I-Chang Su, Jo-Yu Chen, Jing-Er Lee, Dar-Ming Lai, Yong-Kwang Tu, and Kuo-Chuan Wang

A dvancements in imaging modalities have revolutionized the diagnosis of ruptured cerebral aneurysm. In the past, detecting aneurysms generally required the use of DSA, but CTA offers several advantages. It is less time consuming and can be performed immediately after the noncontrast CT diagnosis of spontaneous SAH. In addition, CTA clearly demonstrates the topography of most aneurysms in the presence of an acute hemorrhage. 2 It is therefore helpful in localizing a ruptured aneurysm under emergency conditions and, currently, is often used as the first

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Fredric B. Meyer and Donald A. Muzzi

occlusion is usually reserved for aneurysms that are technically difficult or for those that bleed intraoperatively. Therefore, the six patients in this report are described anecdotally and were not subjected to a randomized prospective study. All the aneurysms, including those of the posterior circulation, were approached and repaired through a pterional craniotomy. A lumbar spinal needle was placed for removal of cerebrospinal fluid to facilitate exposure, obviating the need for mannitol. Prophylactic phenytoin and Decadron (dexamethasone) were utilized routinely. The

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Katsuhiro Kuroda, Hiroyuki Kinouchi, Kazuya Kanemaru, Takuma Wakai, Nobuo Senbokuya, and Toru Horikoshi

I ntraoperative rupture is one of the major complications of surgical clipping of ruptured intracranial aneurysms, which occurs in 17.5% of cases and causes poor outcomes in 21% of occurrences. 5 Various monitoring methods such as endoscopy, Doppler ultrasonography, motor evoked potential monitoring, and intraoperative conventional angiography have been adopted. 1 , 3 , 13 Indocyanine green and fluorescein videoangiography have recently been introduced to intraoperative blood flow monitoring during cerebrovascular surgery. The efficacy of videoangiography

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Guido Guglielmi, Fernando Viñuela, Jacques Dion, and Gary Duckwiler

T he recently published results of the International Cooperative Study on the Timing of Aneurysm Surgery 5, 6 indicate that there is considerable room for improvement in the treatment of this disease. The technique of intra-aneurysmal electrothrombosis via an endovascular approach has been conceived in an attempt to improve the therapeutic management of patients harboring intracranial aneurysms. This technique, the basic electrochemical principles on which it is based, and the results of the preclinical animal experimentation are described in Part 1. 1 An