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Stephen L. Nutik

T he paraclinoid CA 6, 8 gives rise to a number of different types of aneurysms. An important differentiating feature of these aneurysms is their direction of projection as they appear on angiograms. The projection is inferior for the ventral paraclinoid aneurysm, 12, 15 inferomedial for the SHA (carotid cave) aneurysm, 9, 12, 20 superomedial for the OphA aneurysm, 4, 20 and superior for anterior CA and blister-like aneurysms. 1, 2, 7, 11, 16 A single case of a paraclinoid aneurysm that projected laterally was described by Korosue and Heros in 1992. 10

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Oncotic aneurysm

Case report

Fredric A. Helmer

T he classical features of subarachnoid and intracerebral hemorrhage associated with brain tumors have been reported by others. 2, 4 This is believed to be the first recorded instance of a true cerebral aneurysm associated with and caused by a metastatic tumor. In this instance, it is apparent that aneurysmal rupture heralded the symptomatic presence of a previously silent metastatic tumor. Case Report A 32-year-old woman was brought to the emergency room on February 13, 1970, after having suffered a brief loss of consciousness. She had experienced

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Toshisuke Sakaki, Kazuhiko Kinugawa, Tatsuo Tanigake, Seiji Miyamoto, Kikuo Kyoi and Shozaburo Utsumi

A n embolus from an aneurysm may narrow or obstruct a cerebral artery transiently or permanently and cause neurological symptoms of ischemic origin. Taptas and Katsiotis 10 presented such a possibility in 1968. These authors suggested that a cause of hemiplegia after subarachnoid hemorrhage might be arterial embolism from the aneurysm. Only eight cases of cerebral embolism in intracranial aneurysms have been published since then. 2, 3, 7–9 In this paper we report four new cases and discuss the method of treatment of these aneurysms. Case Reports Case

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Hiroyuki Kinouchi, Kazuo Mizoi, Yoshihide Nagamine, Noritaka Yanagida, Shigeki Mikawa, Akira Suzuki, Toshio Sasajima and Takashi Yoshimoto

T he portion of the proximal intradural ICA adjacent to the anterior clinoid process is called the paraclinoid segment. 12 Aneurysms of the paraclinoid segment are usually located in the intradural space and their rupture will cause SAH. Some paraclinoid aneurysms, however, are considered unclippable or surgical treatment results in disastrous outcomes due to the location of the aneurysm. 13, 18 Therefore, the classification of these aneurysms according to the origin of their necks or their relationships with anatomical landmarks is particularly important to

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Stephen L. Nutik

V entral paraclinoid carotid artery aneurysms have been described as a distinct type of aneurysm having an intradural neck and a partially intracavernous fundus. 5 On lateral angiography, the aneurysms are seen to originate from the ventral surface of the carotid artery with the proximal aspect of the neck at about the level of the ophthalmic artery and the distal aspect of the neck proximal to the origin of the posterior communicating artery. They project straight downward or a little medially on the frontal view. At surgery, they are partially hidden by the

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Shoichiro Kawaguchi, Toshisuke Sakaki, Shuzo Okuno, Yoshitomo Uchiyama and Toshikazu Nishioka

S accular aneurysms usually occur at major bifurcations on the circle of Willis or the large arteries that arise from it; 10 saccular aneurysms on the peripheral OphA are rare. In this paper we describe two peripheral OphA aneurysms that arose away from the origin of this artery. We also review the literature on these lesions and discuss the mechanism of aneurysm development from the perspective of OphA hemodynamics. The OphA hemodynamics were evaluated using CDF velocimetry imaging. Case Reports Case 1 This 26-year-old woman experienced episodic

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Jiro Suzuki and Takehide Onuma

C ases of cerebral aneurysm associated with arteriovenous malformation (AVM) are fairly rare, and questions remain with regard to etiology and treatment. Between 1959 and 1975, we have treated 140 cases of AVM (excluding cases of dural AVM), among which nine patients were found to harbor cerebral aneurysms as well. All but one patient with a deep—seated AVM were cured by total extirpation of the AVM during a radical operation on the aneurysm. During surgery, 500 to 1000 cc of 20% mannitol solution was administered intravenously under normotensive and

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Howard Yonas, Sue Patre and Robert J. White

D uring the past decade, the prognosis of patients with cerebral aneurysms has steadily improved due to advances in the medical 6, 9, 11 and surgical management 12, 14 of this disorder. Despite this progress, aneurysms of the posterior fossa, and especially those arising along the basilar artery midline axis, continue to pose challenges to the neurosurgeon. We are reporting our experience with an aneurysm that arose in conjunction with an anomalous anterior spinal artery. This anatomical relationship has not, to our knowledge, been reported before

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Prithvi Narayan, Michael J. Workman and Daniel L. Barrow

A neurysms of the LSA are uncommon. Their causes include hypertension, moyamoya disease, infection, systemic lupus erythematosis, and flow-related saccular aneurysms. Treatment of these aneurysms is extremely difficult because of their small size, location, and angioarchitecture. Treatment, when feasible, has been surgical obliteration. Endovascular treatment with platinum coils 12 or N -butyl cyanoacrylate 8 has been reported. The angioarchitecture of the aneurysm described in this report precluded treatment with endovascular methods. In this report we

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Pierluigi Longatti, Donatella Sgubin and Francesco Di Paola

S ubarachnoid hemorrhage due to spinal vessel lesions is infrequently encountered in clinical practice, and the most common cause is bleeding from a spinal cord AVM or an intraspinal tumor. 1 Spinal SAH due to the rupture of spinal artery aneurysms is extremely rare ( Table 1 ). 21 , 25 In the present paper we report a case of acute spinal SAH due to the rupture of multiple aneurysms of the anterior spinal artery and review the relevant literature. TABLE 1 Reported cases of spinal artery aneurysms * Authors & Year