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Robert H. Wilkins, James A. Alexander and Guy L. Odom

the 72 patients who had not had a subarachnoid hemorrhage or an intracranial infection (including eight patients with unruptured intracranial aneurysms). Intracranial spasm was also noted in association with active meningitis or subdural empyema. Three of the four patients with these types of infections showed spasm, whereas no spasm was seen in the arteriograms of the seven patients with encapsulated brain abscesses. The following case is illustrative. Case 1 A 55-year-old Negro man was discovered to have a right maxillary tooth abscess on June 10, 1967

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Christopher B. T. Adams, Michael R. Fearnside and Sean A. O'Laoire

arterial blood pressure, 10, 18 and these were also carefully measured. This study was carried out between April, 1976, and May, 1977, during which time 48 patients with subarachnoid hemorrhage (SAH) due to an intracranial aneurysm were treated in the Radcliffe Infirmary, Oxford. In addition, two patients with unruptured intracranial aneurysms underwent surgery, one because of temporal lobe epilepsy and the other patient, who harbored multiple aneurysms, for clipping of an unruptured aneurysm in an elective procedure. Of these 50 patients, cannulation of the STA was

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Jose Luis Salazar

report deals with 38 unruptured intracranial aneurysms ( Table 1 ). These aneurysms were found in 29 patients from a consecutive series of 78 patients, with a total of 106 aneurysms operated on by the author between 1972 and 1978. TABLE 1 Summary of 38 unruptured aneurysms in 29 patients Location of Aneurysm Asymptomatic Incidental Total internal carotid artery 11 10 21 basilar artery 1 2 3 anterior communicating artery 1 2 3 middle cerebral artery 4 2 6 internal carotid

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Polycystic kidney disease and intracranial aneurysms

Early angiographic diagnosis and early operation for the unruptured aneurysm

Toshimitsu Wakabayashi, Shigekiyo Fujita, Yoshiro Ohbora, Tohru Suyama, Norihiko Tamaki and Satoshi Matsumoto

aneurysms. Although the value of early diagnosis and early operation has been recognized, there have been very few series emphasizing the necessity of cerebral angiography for detecting unruptured intracranial aneurysms in patients with PKD. 4, 10 Furthermore, there has been no report of the use of angiography in the diagnosis of unruptured aneurysms in PKD patients. We have recently performed four-vessel angiography in a series of 17 patients with PKD so as to detect unruptured intracranial aneurysms. This paper presents our findings. Clinical Material and Methods

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The long-term outcome in patients with multiple aneurysms

Incidence of late hemorrhage and implications for treatment of incidental aneurysms

H. Richard Winn, Waled S. Almaani, Sarah L. Berga, John A. Jane and Alan E. Richardson

suggested by others 5, 15, 19 in multiple-aneurysm patients who had only one aneurysm treated. In addition, the percentage of the population suffering a rupture of an intact aneurysm is comparable to that found by Wiebers, et al. , 29 who studied the natural history of unruptured intracranial aneurysms in 65 patients followed for an average of 8.2 years. Eight of their 65 patients (12.3%) suffered a subsequent hemorrhage during the first decade after the initial bleed. The present study has an almost identical follow-up period (8.1 years), during which at least three

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Laligam N. Sekhar and Jack F. Wasserman

microphone. Brain-Tumor Patients Recordings from three patients with glial brain neoplasms were negative. Patients without Intracranial Vascular Lesions Recordings were made in six patients in whom intracranial vascular lesions had been angiographically proven to be obliterated by operation or balloon occlusion, and in one patient who had a normal arteriogram but who was suspected of having an unruptured intracranial aneurysm on the basis of computerized tomography scanning. These seven patients were considered to represent the control group, and no

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Ralph G. Dacey Jr., David Pitkethly and H. Richard Winn

T he appropriate treatment for unruptured intracranial aneurysms has not been determined. 1, 4, 5 It has been suggested that unruptured cerebral aneurysms bleed at a rate of approximately 2% per year. 6 Hence, a younger patient who harbors an asymptomatic lesion may have a greater cumulative risk of suffering a subarachnoid hemorrhage at some point during his or her life than an older patient. 1 The possibility of a relatively smaller cumulative risk of hemorrhage for older patients has led some neurosurgeons to recommend nonoperative treatment of

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Chemotherapy October 1986 65 4 10.3171/jns.1986.65.4.0574 Infinite needs: finite resources The Honorable Richard D. Lamm October 1986 65 4 435 438 10.3171/jns.1986.65.4.0435 Saphenous vein bypass grafts for giant aneurysms and intracranial occlusive disease Thoralf M. Sundt Jr. David G. Piepgras W. Richard Marsh Nicolee C. Fode October 1986 65 4 439 450 10.3171/jns.1986.65.4.0439 Risks of surgery for unruptured intracranial aneurysms Olli Heiskanen October 1986 65 4 451 453 10.3171/jns.1986.65.4.0451 Study of

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Olli Heiskanen

treatment of asymptomatic and incidental intracranial aneurysms. J Neurosurg 53: 20–21, 1980 8. Samson DS , Hodosh RM , Clark WK : Surgical management of unruptured asymptomatic aneurysms. J Neurosurg 46 : 731 – 734 , 1977 Samson DS, Hodosh RM, Clark WK: Surgical management of unruptured asymptomatic aneurysms. J Neurosurg 46: 731–734, 1977 9. Wiebers DO , Whisnant JP , O'Fallon WM : The natural history of unruptured intracranial aneurysms. N Engl J Med 304 : 696 – 698 , 1981

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David O. Wiebers, Jack P. Whisnant, Thoralf M. Sundt Jr. and W. Michael O'Fallon

M Anagement of patients with unruptured intracranial aneurysms remains controversial. This is at least partly the result of the relatively limited data available regarding the natural history of unruptured aneurysms. Zacks, et al. , 22 gathered data on 10 patients with untreated, fortuitously discovered intracranial aneurysms over a follow-up period of 7 weeks to 7½ years. None of the patients had intracranial hemorrhages, but only two were followed for 5 years or more after diagnosis or until death. None of the aneurysms exceeded 10 mm in diameter. Locksley