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Eric L. Zager, Ellen G. Shaver, Robert W. Hurst, and Eugene S. Flamm

A neurysms of the distal segment of the AICA are rare. Patients with these aneurysms may present acutely with SAH or with symptoms of a mass lesion in the CPA, including hearing loss, vertigo, tinnitus, facial weakness, diplopia, ataxia, or altered facial sensation. In this paper we describe four patients with distal AICA aneurysms that were managed at a single institution. Two patients presented with SAH, and two were evaluated for hearing loss, vertigo, and gait instability. The aneurysms were demonstrated in each case on MR imaging and/or cerebral

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Olivier Heck, René Anxionnat, Jean-Christophe Lacour, Anne-Laure Derelle, Xavier Ducrocq, Sébastien Richard, and Serge Bracard

R upture of a lenticulostriate artery (LSA) aneurysm is a rare cause of deep intracerebral hemorrhage. 22 The natural history of LSA aneurysm rupture and, in particular, the risk of hemorrhage recurrence are poorly understood. Several cases of spontaneous involution free of hemorrhage recurrence have been described in the literature. 12 , 13 , 22 The surgical or endovascular treatment of these aneurysms is possible but is difficult and risky because the lesions are located deep in the brain and close to sensitive cerebral tissues. 11 , 43 There is thus

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Atsuya Akabane, Hidefumi Jokura, Kuniaki Ogasawara, Kou Takahashi, Kazuyuki Sugai, Akira Ogawa, and Takashi Yoshimoto

I ntracranial bleeding is the biggest threat in patients with AVMs. Intranidal aneurysm is recognized as one of the major risk factors for such bleeding, 11 and its presence may influence treatment strategy. For incidental small AVMs with no neurological deficit, radiosurgery can be a powerful treatment option. For AVMs with intranidal aneurysms, on the other hand, the possibility of more aggressive treatment should be considered, including surgery, given the high risk of intracranial bleeding during the latent period after radiosurgery. We report on a

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Randall T. Higashida, Van V. Halbach, Leslie D. Cahan, Grant B. Hieshima, and Yoshifumi Konishi

I ntravascular detachable balloon embolization therapy for neurovascular lesions was first described by Serbinenko in 1974. 26 At that time, occlusion of vessels was utilized diagnostically to assess collateral blood flow and also to treat certain vascular malformations. With the further development of intravascular detachable balloon technology, permanent solidification agents, and high-resolution real-time digital subtraction angiography, it is possible to treat complex intracranial aneurysms from a transvascular approach in selected cases. The procedure is

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Mark J. Kupersmith, Robert Hurst, Alejandro Berenstein, In Sup Choi, Jafar Jafar, and Joseph Ransohoff

S pontaneous or developmental aneurysms arising from the cavernous segment of the internal carotid artery (ICA) are rarely associated with life-threatening complications. Early studies emphasized this knowledge when considering treatment. 2, 6, 7, 13 Typically, patients harboring these lesions present with painful ophthalmoplegia or symptoms referable to another cerebral aneurysm and, less commonly, with signs of a spontaneous carotid-cavernous fistula. 1, 2, 6, 8, 9, 12, 14, 20 The ophthalmoplegia can have a gradually progressive or explosive onset. If the

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Neill E. F. Cartlidge and David A. Shaw

T he association of hypopituitarism with intracranial aneurysm is well recognized. Bramwell 2 in 1887 described two patients with clinical features that in retrospect were suggestive of pituitary deficiency and who at autopsy were found to have large aneurysms of the internal carotid artery. Subsequent reports of aneurysms simulating pituitary tumors were fully reviewed by White and Ballantine 8 in 1961. Their series numbered 35 in all, and two later reviews by Van't Hoff, et al., 6 and Kahana, et al., 5 included five similar cases. A single case report

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Vini G. Khurana, David G. Piepgras, and Jack P. Whisnant

A pproximately 5% of all aneurysms are giant aneurysms, which by definition measure 25 mm or more in diameter. 27 Approximately 25% of giant aneurysms present clinically with subarachnoid hemorhage (SAH). 18, 19 Wiebers, et al., 30 suggested that unruptured giant and near-giant aneurysms have a higher probability of subsequent rupture than smaller ones. Thrombosis of the lesion, which may be extensive in giant aneurysms, does not preclude rupture. 12, 22 Although the incidence of rebleeding from smaller aneurysms has been studied extensively, 5, 8, 9, 14, 15

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Carlos A. David, A. Giancarlo Vishteh, Robert F. Spetzler, Michael Lemole, Michael T. Lawton, and Shahram Partovi

P ostoperative angiography is routinely used to evaluate patients who have undergone surgical obliteration of an aneurysm. It provides information on the results of clipping, the presence of residual unclipped aneurysm, other unclipped aneurysms, and the occlusion of major vessels. Apart from this initial evaluation, however, few surgeons pursue late angiographic follow-up review in patients surgically treated for aneurysms. Increasingly, the need for late outcome data related to various treatments has become apparent. In particular, the long-term efficacy of

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Toshisuke Sakaki, Toshikazu Takeshima, Masao Tominaga, Hiroshi Hashimoto, and Shoichiro Kawaguchi

A lthough it has been recognized that incomplete treatment of an aneurysm may result in recurrent hemorrhage with serious or fatal consequences, 1–4 1- to 2-mm residual aneurysmal necks have been thought to pose little risk. We have found reports of several cases of aneurysms recurring from a residual neck following aneurysm clipping 5–7 or from the same arterial segment at which the aneurysm initially arose in spite of complete disappearance on postoperative angiography. 4 Between 1975 and 1992, 2211 patients underwent aneurysmal neck clipping at the Nara

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Maksim Shapiro, Tibor Becske, and Peter K. Nelson

T he Pipeline Embolization Device (PED) has been in use since 2007. In 2011, the PED received FDA clearance for use in the US, based on results of the Pipeline for Uncoilable or Failed Aneurysms (PUFS) 1 trial, reporting 86.8% aneurysm occlusion at 12-month follow-up angiography among a cohort of large, wide-neck aneurysms of the internal carotid artery (ICA). The worldwide experience has since been characterized by device utilization in a more varied aneurysm population, 7 and by the overall trend toward limiting the number of implanted devices per case