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Blood blisterlike aneurysms of the internal carotid artery

Masamitsu Abe, Kazuo Tabuchi, Hiroaki Yokoyama, and Akira Uchino

Object. An aneurysm arising from the anterior wall of the internal carotid artery (ICA) is a poorly understood entity. A small hemispherical bulge from the anterior wall of the ICA, which is called a “blood blisterlike aneurysm” (BBA), may be confused with a tiny berry aneurysm although the clinical features are distinctly different. This paper summarizes the clinical course of patients with this lesion to clarify the nature of the BBA.

Methods. Six patients with BBAs who presented with subarachnoid hemorrhage (SAH) are described. In all patients, the initial angiogram obtained soon after SAH showed only a small bulge from the anterior wall of the ICA. In three of the six patients this bulge had progressed to a saccular appearance within a few weeks. The wall of the lesion was so thin and fragile that the aneurysm ruptured at the base during clipping or within a few hours after clipping in two patients.

Conclusions. From the authors' experience, as well as a review of the literature, which includes an autopsy study of similar cases, it is inferred that these lesions are focal wall defects covered only with thin fibrous tissue and that they are therefore not true aneurysms. Direct clipping often causes laceration of the lesion, whereas complete wrapping or clipping after wrapping is effective, but may fail to prevent growth of the aneurysm. Endovascular occlusion of the cervical ICA with or without bypass surgery, which is less risky than direct surgery, is another option.

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Aneurysm of a persistent primitive olfactory artery

Case report

Takehisa Tsuji, Masamitsu Abe, and Kazuo Tabuchi

✓ A ruptured anterior cerebral artery (ACA) aneurysm is reported in a patient in whom an anomalous ACA arose from the internal carotid artery at the bifurcation. The aberrant artery coursed anteriorly along the ipsilateral olfactory tract and made a hairpin turn posterior to the olfactory bulb, supplying the circulation of the ACA. Persistence of the primitive olfactory artery is suggested as an embryological origin of this vascular anomaly.

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Blister or Berry Aneurysm

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Blood-Blister-Like Aneurysms

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Blisterlike Aneurysms

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Spontaneous resolution of multiple hemangiomas of the brain

Case report

Masamitsu Abe, Kazuo Tabuchi, Masashi Takagi, Shunichi Matsumoto, Tatsuro Shimokama, and Takashi Kishikawa

✓ A case of multiple intracerebral hemangiomas is reported. The lesions were angiographically hypervascular and accompanied by marked perifocal brain edema. After removal of the main lesion and postoperative steroid administration, the rest of the lesions resolved spontaneously. Histologically, the lesion was composed of capillaries and fibromyxoid stroma. The distinctive clinical, radiological and histological features of this lesion are discussed in contrast to several other types of intracranial vascular tumors.

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Capillary hemangioma of the central nervous system

Masamitsu Abe, Kazuo Tabuchi, Shin Tanaka, Akira Hodozuka, Katsuzo Kunishio, Naohiko Kubo, and Yukimasa Nishimura

Object. Capillary hemangiomas are benign tumors or tumorlike lesions that originate from blood vessels and have rarely been reported to develop in the brain or spinal cord. The authors summarize the clinical and histological features of capillary hemangiomas of the central nervous system (CNS).

Methods. The clinical features, imaging characteristics, and outcomes in 10 patients with CNS capillary hemangiomas were reviewed. Histological studies included immunostaining with CD31, α-smooth muscle actin, vascular endothelial growth factor, and Ki-67 antigen. Three patients with lesions in the brain presented with symptoms of increased intracranial pressure or seizures. Seven patients with lesions in the spinal cord presented with progressive sensorimotor disturbances of the lower limbs. Computerized tomography and magnetic resonance imaging demonstrated well-defined, enhancing lesions associated with marked perifocal edema. Angiography demonstrated hypervascular lesions, which have not recurred after resection. In two cases, multiple satellite lesions resolved after the systemic administration of steroid drugs or interferon-α. Histologically, all lesions were consistent with findings of capillary hemangioma of the skin or soft tissues. The CNS lesions differed significantly from other vascular neoplasms, such as hemangioendotheliomas, hemangiopericytomas, and hemangioblastomas.

Conclusions. Capillary hemangiomas of the CNS are benign lesions that can be surgically removed and cured without adjuvant therapy.