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Adib A. Abla, Cameron M. McDougall, Jonathan D. Breshears, and Michael T. Lawton

single EC-IC bypass. All aneurysms were completely or nearly completely obliterated, 94% of bypasses were patent, 77% of patients were improved or unchanged after treatment, and good outcomes (mRS ≤ 2) were observed in 76% of patients. Ischemic complications were limited to 2 patients in whom bypasses were occluded, and permanent lower cranial nerve morbidity was limited to 3 patients, none of which compromised independent function. We found that IC-IC bypasses match the spectrum of aneurysm pathology in this region, and intracranial donor arteries spare the

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Robert J. Morelli and Frederick Laubscher

vomiting for the first 2 weeks without evidence of communicating hydrocephalus. Thereafter, hydration and nutritional status were easily maintained. Within 1 month postoperatively, the child's position on the growth and development curves for age and sex had been regained. Follow-up examinations have resulted in no further evidence of congenital anomaly, no evidence of neurological deficit, and no surgical complications. Discussion The rarity of intracranial aneurysms in infancy is documented by all observers in the field. Matson 8 reports intracranial aneurysms

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Jamie E. Clarke, Evan Luther, Brooke Oppenhuizen, Jessica D. Leuchter, John Ragheb, Toba N. Niazi, and Shelly Wang

I ntracranial aneurysms in the pediatric population account for less than 5% of all cerebral aneurysms and, as such, their etiology, presentation, and natural history remain poorly understood. 1–6 Although previous studies have attempted to elucidate the etiology and presenting symptomatology of pediatric aneurysms, contemporary evaluations of these lesions remain limited. 7–9 Many modifiable risk factors of intracranial aneurysm formation do not pertain to infants. Additionally, the challenges in infantile intracranial aneurysm treatment, and the

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Intracranial aneurysms

Age, sex, blood pressure, and multiplicity in an unselected series of patients

Russell J. Andrews and Peter K. Spiegel

deviations range 12 to 15. The Cooperative Study (COOP) includes 4880 patients with first SAH only. Mean ages are computed from Cooperative Study, p. 39, Table 50. 24 TABLE 2 Site distribution and sex ratio in cases with one intracranial aneurysm * Factor ICA ACA MCA PCA % of total  DHMC (150 patients) 29 43 16 11  COOP (2672 patients) 41 34 20 5 sex ratio (F:M)  DHMC 65:35 35:65 58:42 75:25  COOP 69:31 43:57 59:41 51

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Ronald Brisman and Kazem Abbassioun

S everal factors suggest a hereditary basis for some intracranial aneurysms. The occurrence of familial aggregates of intracranial aneurysms is rare but well documented. 1–4, 7, 8, 10, 11, 18, 19, 23, 27, 29 The inherited condition of polycystic kidneys is associated with an increased incidence of intracranial aneurysms. 6 The familial occurrence of intracranial aneurysms has been described in association with hereditary connective tissue disorders (Ehlers-Danlos syndrome and pseudo-xanthoma elasticum). 11 The following six cases of intracranial aneurysm

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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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John L. Fox

I n 1980, we reported on a family with 13 siblings, among whom six were known to have intracranial aneurysms. 1 Two of the siblings had been operated on previously (in 1955 and 1965) after a subarachnoid hemorrhage (SAH), and were left hemiplegic. Another died at our institution in 1977 from an SAH. Eight of the remaining 10 siblings then underwent elective angiography. Three of these were discovered to have intracranial aneurysms, all of which were successfully clipped. Two of the siblings refused elective angiography. One of the latter two siblings is the

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Andrés M. Lozano and Richard Leblanc

I ntracranial aneurysms occur with an incidence of 1.2% to 7.8%, 35, 37 and cause an estimated 28,000 cases of subarachnoid hemorrhage (SAH) annually in North America. 31 Although they are common lesions with grave sequelae, little is known of their pathogenesis. Two hypotheses to explain the etiology of intracranial aneurysms have been proposed. The first contends that aneurysms arise from inborn defects in the arterial wall, 17 and the second proposes that they develop in response to atherosclerosis and hypertension. It seems possible that acquired

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Familial intracranial aneurysms

Six cases among 13 siblings

John L. Fox and Jehoon P. Ko

T here are numerous reports of familial aneurysms. The vast majority of these cases with proven aneurysms have occurred as pairs; 1 more than two in a family is rare. However, Beumont, 4 Hashimoto, 8 Jefferson, 9 and Sakai, et al. , 13 have described families, each with three siblings harboring intracranial aneurysms. Edelsohn, et al. , 1 have reported a family in which four of eight siblings were proven to have cerebral aneurysms. We are reporting a unique family history in which six siblings are known to have aneurysms, five are known to have normal

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Dwight Parkinson and Michael West

T rauma to intracranial arteries is not rare when one considers the incidence of intracranial hematomas that complicate head injuries. Excluding carotid-cavernous fistulas, however, traumatic saccular aneurysms and arteriovenous fistulas are distinctly uncommon. There are few more than 100 cases recorded in the world literature. 1–10, 12–18, 20–37, 39–47, 50–62, 64–69, 71–73 That intracranial aneurysms may occur after trauma to the intracranial arteries has been shown experimentally and confirmed at pathology. 34, 70 In 1891, Bollinger 11 suggested that