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Specific Treatment of Intracranial Aneurysms

Experiences with 143 Surgically Treated Patients

James L. Poppen

they are fusiform or pedunculated. ANEURYSMS ARISING FROM THE ANTERIOR COMMUNICATING ARTERY Aneurysms of the anterior communicating artery present a particular problem. Unfortunately, the anterior communicating artery is an arterial communication, of only a few mm. in length, between the two anterior cerebral arteries. An aneurysm of any size involves the entire length of the artery. Here again, the aneurysm usually arises from the junction of either anterior cerebral artery with the anterior communicating artery ( Fig. 21, a and b ). Arteriography

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Gösta Norlén and Alec S. Barnum

cases of anterior communicating artery aneurysm showed multiplicity. It is now generally conceded that angiography early after an episode of hemorrhage does not essentially increase the morbidity, and the shortness of the interval from the acute episode should not influence performance of this examination. Our 2 patients who were worse after angiography had it performed 1½ weeks and 8 weeks respectively after the last episode of bleeding. Secondly, it is imperative to establish the exact state of the collateral circulation between the hemispheres and to exclude

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Carl J. Graf

were associated with hematomas. All 3 patients with this combination died. One aneurysm was trapped; the patient with this lesion expired. The aneurysmal neck was clipped in 2 patients, in one of which a reinforcement procedure was accomplished. One patient had clips applied to both anterior cerebral arteries and 3 had clipping of the anterior cerebral artery proximal to the aneurysm. Only 1 of these last 3 patients recovered. In this group of 7 cases, 6 (86 per cent) of the patients died. Anterior Communicating Artery Aneurysms The anterior communicating

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E. H. Botterell, W. M. Lougheed, J. W. Scott and S. L. Vandewater

of anterior cerebral and anterior communicating arteries. Aneurysm clipped 39 days after second haemorrhage: hypothermia. Recovery. Feb. 5, 1955 . A.N., B.99890, a man aged 52, was admitted. Subarachnoid haemorrhage had occurred in March 1952, and on Jan. 2, 1955. In neither instance was consciousness impaired and there was no neurological deficit. Chronic rheumatic heart disease was present with mitral stenosis and probably also associated aortic insufficiency. Congestive heart failure was not present. The electrocardiogram showed auricular fibrillation. His

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Guy L. Odom, Barnes Woodhall, George T. Tindall and J. R. Jackson

weeks, and 9 days, respectively, in the 3 patients whose aneurysms did not show a change in size. B. Anterior communicating artery aneurysms. The results in this small group were less consistent ( Table 2 ). The average interval between carotid ligation and repeated arteriography was 9.2 months. The aneurysm was considerably smaller in 2 patients; not visualized in 1 patient (bilateral carotid arteriogram done on follow-up study); and larger in 2 patients ( Fig. 6 ). There was no correlation between the late change in size of the aneurysm and the “immediate

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Ernest H. Wood

near the origin of the ophthalmic artery, while others originated at the root of the anterior choroidal artery. Aneurysms at the bifurcation of the internal carotid artery are listed separately. A very small number of patients with an aneurysm of the transverse portion of the anterior cerebral artery proximal to the anterior communicating artery were listed with the group with aneurysm of the anterior communicating artery. Aneurysms of the anterior cerebral artery listed separately were those occurring distal to the anterior communicating artery. TABLE 1

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Albert W. Cook, Donald M. Dooley and E. Jefferson Browder

up to the site of the aneurysm. Two aids in deciding when this area has been reached are identification of the beginning of obliteration of subarachnoid space around the anterior cerebral artery (the result of previous hemorrhage), and the estimation of the length of the anterior cerebral artery afforded by angiography. Just proximal to an anterior communicating artery aneurysm, the opposite anterior cerebral artery is usually only a few millimeters away from the medial portion of the aneurysm. In fact, anatomical distortions from hemorrhage may place all these

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Intracranial Aneurysm in Late Pregnancy

Report of a Successful Operation Utilizing Hypothermia

Lycurgus M. Davey, Joseph A. Fiorito and Frederick W. Hehre

has been marked by severe differences of opinion. We are reporting the case of a symptomatic, but apparently unruptured, anterior communicating artery aneurysm in a woman who had definitive and successful aneurysmal surgery in the 8th month of pregnancy, which 3 weeks later ended with the normal delivery of a normal child. Case Report This 27-year-old pregnant housewife was admitted to the Grace-New Haven Community Hospital on May 28, 1963, with a chief complaint of sudden severe headaches. First Admission. On April 18, 1963, she suffered an abrupt

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J. Lawrence Pool and Robert P. Colton

A-1 portion of the anterior cerebral artery, which are distributed to the anterior hypothalamus, septal region, and adjacent structures of the brain can be visualized so well that injury to them can be avoided during the surgical treatment of anterior communicating artery aneurysms ( Fig. 4 ). 3. Changes in the circulation of small partly transparent vessels can be observed during some procedures. We have occasionally noted, for example, circulatory slowing with clumping of red cells within some of the small semi-transparent arteries of the optic chiasm

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F. Miles Skultety and Hiro Nishioka

histologically. Case #2238 A 56-year-old male was reported to have a ruptured anterior communicating artery aneurysm. The aneurysm was clipped at its neck and obliterated. Fifteen months later the patient rebled. He was readmitted for four-vessel angiography which revealed no other aneurysm. The aneurysm previously clipped remained obliterated by angiography. At the last follow-up 32 months after the operation the patient was confined in a mental institution. Case #5020 A 47-year-old male had a ruptured anterior communicating artery aneurysm which filled