Background:Esotropia is a common concern in pediatric ophthalmology consultations.While most cases stem from strabismus,it is crucial for physicians to differentiate atypical features that might indicate underlying or...Background:Esotropia is a common concern in pediatric ophthalmology consultations.While most cases stem from strabismus,it is crucial for physicians to differentiate atypical features that might indicate underlying organic causes,such as VI nerve palsy,hinting at the presence of intracranial spaceoccupying lesions.Although the occurrence of cerebral aneurysms in children is rare,they can have severe consequences.Case Description:Here,we described an extremely rare case of giant basilar fusiform aneurysm measuring 4.0 cm×3.9 cm×3.9 cm in an otherwise healthy 8-year-old child,and analyzed its atypical features that suggested an intracranial etiology.We further described an endovascular approach,performed by interventional radiologists,and discussed its advantages over the conventional neurosurgery.The patient continued to be followed by our multidisciplinary team.He had a stable post-operative course and made an excellent recovery neurologically.At the 1-year follow-up,he was orthophoria with excellent vision and stereopsis.Conclusions:To our knowledge,this is the first pediatric case in Canada where a giant intracranial aneurysm was treated endovascularly.The salient red flags—progressive incomitant esotropia and diplopia,the presence of myopia(rather than hyperopia),nystagmus and abnormal saccadic movements—should be astutely recognized by clinicians as intracranial giant aneurysms carry a poor prognosis.A multidisciplinary approach is essential for the management of such cases.展开更多
Objective:To investigate morphological risk factors of basilar aneurysm rupture based on computer tomography angiography(CTA)parameters.Materials and methods:The clinical and CTA data of 43 patients with basilar aneur...Objective:To investigate morphological risk factors of basilar aneurysm rupture based on computer tomography angiography(CTA)parameters.Materials and methods:The clinical and CTA data of 43 patients with basilar aneurysm admitted to Shaanxi Provincial People's Hospital from January 2015 to July 2023 were analyzed.The patients were divided into“ruptured group”and“unruptured group,”and the morphological parameters of aneurysms were measured.The general data and morphological parameters between the two groups were statistically analyzed.Logistic regression was used to analyzed statistically significant parameters,and the receiver operating characteristic curve was drawn to evaluate its diagnostic effectiveness.Results:Irregular aneurysms were more likely to rupture than regular aneurysms(χ^(2)=13.971,P<0.05).The maximum diameter(4.92[3.37-6.94]mm),length-width ratio(1.31[1.14-1.55]),height(4.08[2.71-5.34]mm),aspect ratio(0.99[0.84-1.45]),and inflow angle(133.63±11.21°)of aneurysms in the ruptured group were larger than the unruptured group,and the differences were statistically significant(P<0.05).Binary logistic regression showed that aneurysm shape(OR=39.347,P=0.021),length-width ratio(OR=313.062,P=0.033),and inflow angle(OR=1.156,P=0.004)were independent risk factors for rupture.The area under the curve were 0.809,0.842.and 0.894,respectively.Conclusion:Aneurysm shape,aspect ratio,and blood flow incidence angle are independent risk factors for basilar aneurysm rupture,which means that they can be used to predict the risk of rupture to a certain extent.展开更多
Basilar artery fenestration is a rare anatomical variation resulting from the failed fusion of the two vertebral arteries during embryonic life. In order of frequency, it is the second most common location of vascular...Basilar artery fenestration is a rare anatomical variation resulting from the failed fusion of the two vertebral arteries during embryonic life. In order of frequency, it is the second most common location of vascular fenestrations after the anterior communicating artery. Vertebrobasilar junction aneurysms are uncommon but often associated with basilar artery fenestration. We report the case of a fenestrated vertebrobasilar junction saccular aneurysm in a 57-year-old woman. The diagnosis was incidentally made on CT angiography which found the anatomical variant and the aneurysm. The radiological features illustrating this association are detailed here and a brief discussion of its pathogenesis and management was made. Vertebrobasilar junction aneurysms are rare and their presence should suggest an associated basilar fenestration.展开更多
Objective and Importance—Vertebrobasilar artery aneurysms can be very challenging to treat and are preferentially dealt with using endovascular tech-niques, since they are associated with lower risk than surgical cli...Objective and Importance—Vertebrobasilar artery aneurysms can be very challenging to treat and are preferentially dealt with using endovascular tech-niques, since they are associated with lower risk than surgical clipping. Small aneurysms located on perfo-rating arteries can pose problems though, as their dimensions may not be favorable for coiling and leave the endovascular surgeon without many options. We present a basilar perforating artery aneurysm that was successfully embolized using a stent-within-stent technique. Clinical Presentation—A 47 year old fe-male presented with a Hunt-Hess 3, Fisher Grade-3 subarachnoid hemorrhage with blood in the pre-pontine cistern. Initial imaging (CT angiogram and digital subtraction angiography) did not reveal an aneurysm. Follow-up angiography on post-bleed day eight demonstrated a three-millimeter basilar perforating artery aneurysm. After an unsuccessful coiling attempt a closed-cell stent-within-stent tech-nique was used to divert flow away from the aneu-rysm neck to induce aneurysm thrombosis. Interven-tion (or Technique)—Multiple attempts were made to access and stabilize a microcatheter in the small basilar perforator artery aneurysm in order to de-liver coils for endovascular embolization;this could not be done safely. Therefore a closed-cell 4.5 × 22 mm Enterprise stent (Cordis Neurovascular, Inc., Miami Lakes, Florida) was deployed in the basilar artery across the origin of the perforator aneurysm in order for the stent tines to divert flow away from the aneurysm neck and induce thrombosis. Persistant brisk flow within the aneurysm continued however, and a second closedcell 4.5 × 22 mm Enterprise stent was placed within the first one to increase the stent metal surface area across the aneurysm neck to further reduce flow into the aneurysm. Subsequently, angiography demonstrated stagnant blood flow in the aneurysm dome and the aneurysm spontaneously thrombosed, sparing all associated vessels. Conclu-sion—Stent-within-stent technique should be consid-ered as a possible endovascular treatment option for small side-wall and perforator artery aneurysms that can’t be safely treated with coils or embolic agents.展开更多
A giant basilar artery aneurysm of young woman with endocrine disturbance was misdiagnosed as a large pituitary adenoma and treated surgically via a trans-sphenoidal approach was planned. But the neurosurgery was fina...A giant basilar artery aneurysm of young woman with endocrine disturbance was misdiagnosed as a large pituitary adenoma and treated surgically via a trans-sphenoidal approach was planned. But the neurosurgery was finally aborted because of massive bleeding during the procedure. One year later,a cerebral angiography confirmed this basilar artery aneurysm was obviously regressed and then endovascular coiling was successfully performed. No neurological complication occurred post-procedure and the endocrine dysfunction symptom was obviously improved.展开更多
Background:Treatment of giant basilar aneurysms is extremely challenging, especially recurrences after previous coiling.Case presentation:A 20-year-old male was referred for a recurrent giant proximal basilar aneurysm...Background:Treatment of giant basilar aneurysms is extremely challenging, especially recurrences after previous coiling.Case presentation:A 20-year-old male was referred for a recurrent giant proximal basilar aneurysm 3 months after coiling, with headache, blurred vision, and brainstem compression symptoms. Angiography showed that the previously placed coils were compacted within the caudal portion of the 43 mm × 31 mm aneurysm, with spontaneous occlusion of the right vertebral artery and absence of the posterior communicating arteries. The diameter of the aneurismal neck, the afferent and efferent arteries was 6 mm, 3.5 mm and 4.1 mm, respectively. A balloon-expandable covered-stent of 3.5 mm × 10 mm was selected, matching the above 3 measurements;and deployed precisely across the aneurismal neck, immediately creating the'sub-complete reconstruction with intentional endoleak distal to aneurismal neck'. Subsequently, 2 self-expanding 4.5 mm × 37 mm stents were telescopically implanted within the covered-stent to adjust the angulation of the proximal basilar artery. After the procedure, the patient's symptoms gradually disappeared. Catheter angiography at 18 days, 3 months and 15 months demonstrated complete aneurismal exclusion from the patent vertebrobasilar artery, with dramatic elimination of aneurismal volume and reconfiguration of the compacted coils. The patient was asymptomatic at 15-month follow-up.Conclusions:Sub-complete reconstruction with intentional endoleak distal to aneurismal neck can be safely achieved after implantation of a covered-stent and conventional stents in the case of a recurrent post-coiling proximal giant basilar aneurysm, with complete vascular reconstruction subsequently.展开更多
Initiation, growth, and rupture of cerebral aneurysms are caused by hemodynamic factors. It is extensively accepted that the cerebral aneurysm wall is assumed to be rigid using computational fluid dynamics (CFD). Furt...Initiation, growth, and rupture of cerebral aneurysms are caused by hemodynamic factors. It is extensively accepted that the cerebral aneurysm wall is assumed to be rigid using computational fluid dynamics (CFD). Furthermore, fluid-structure interactions have been recently applied for simulation of an elastic cerebral aneurysm model. Herein, we examined cerebral aneurysm hemodynamics in a realistic moving boundary deformation model based on 4-dimensional computed tomographic angiography (4D-CTA) obtained by high time-resolution using numerical simulation. The aneurysm of the realistic moving deformation model based on 4D-CTA at each phase was constructed. The effect of small wall deformation on hemodynamic characteristics might be interested. So, four hemodynamic factors (wall shear stress, wall shear stress divergence, oscillatory shear index and residual residence time) were determined from the numerical simulation, and their behaviors were assessed in the basilar bifurcation aneurysm.展开更多
Basilar tip aneurysms account for 5% - 8% of all intracranial aneurysms. They are known to rupture more frequently than aneurysms in other locations. Surgical clipping of basilar apex aneurysms however challenging;rem...Basilar tip aneurysms account for 5% - 8% of all intracranial aneurysms. They are known to rupture more frequently than aneurysms in other locations. Surgical clipping of basilar apex aneurysms however challenging;remains the treatment of choice in Ivory Coast due in part, to multiple technical barriers. A 60-year-old right-handed patient presented to our Neurosurgical Unit in February 2nd 2013 after a sudden onset of altered consciousness. Neurological examination revealed both an upper motor neuron and meningeal syndromes with a Glasgow Coma Scale of 12. Brain NECT scan and a subsequent brain CT angiography showed a subarachnoid haemorrhage and a 3.8 mm (height) × 5.2 mm (width) basilar tip aneurysm respectively. Surgical clipping of the aneurysm was indicated but due to multiple technical barriers, surgery was delayed and the patient underwent surgery after the critical vasospasm period. The patient developed a hospital acquired pneumonia after surgery and was successfully treated with antibiotics. Since her discharge, she has been asymptomatic. We sought to report this case of a basilar apex aneurysm successfully occluded with non-ferromagnetic SUGITA clips and to share our experience of clipping these lesions through the frontotemporal approach. The patient was informed that non identifying information from the case would be submitted for publication, and she provided consent.展开更多
文摘Background:Esotropia is a common concern in pediatric ophthalmology consultations.While most cases stem from strabismus,it is crucial for physicians to differentiate atypical features that might indicate underlying organic causes,such as VI nerve palsy,hinting at the presence of intracranial spaceoccupying lesions.Although the occurrence of cerebral aneurysms in children is rare,they can have severe consequences.Case Description:Here,we described an extremely rare case of giant basilar fusiform aneurysm measuring 4.0 cm×3.9 cm×3.9 cm in an otherwise healthy 8-year-old child,and analyzed its atypical features that suggested an intracranial etiology.We further described an endovascular approach,performed by interventional radiologists,and discussed its advantages over the conventional neurosurgery.The patient continued to be followed by our multidisciplinary team.He had a stable post-operative course and made an excellent recovery neurologically.At the 1-year follow-up,he was orthophoria with excellent vision and stereopsis.Conclusions:To our knowledge,this is the first pediatric case in Canada where a giant intracranial aneurysm was treated endovascularly.The salient red flags—progressive incomitant esotropia and diplopia,the presence of myopia(rather than hyperopia),nystagmus and abnormal saccadic movements—should be astutely recognized by clinicians as intracranial giant aneurysms carry a poor prognosis.A multidisciplinary approach is essential for the management of such cases.
文摘Objective:To investigate morphological risk factors of basilar aneurysm rupture based on computer tomography angiography(CTA)parameters.Materials and methods:The clinical and CTA data of 43 patients with basilar aneurysm admitted to Shaanxi Provincial People's Hospital from January 2015 to July 2023 were analyzed.The patients were divided into“ruptured group”and“unruptured group,”and the morphological parameters of aneurysms were measured.The general data and morphological parameters between the two groups were statistically analyzed.Logistic regression was used to analyzed statistically significant parameters,and the receiver operating characteristic curve was drawn to evaluate its diagnostic effectiveness.Results:Irregular aneurysms were more likely to rupture than regular aneurysms(χ^(2)=13.971,P<0.05).The maximum diameter(4.92[3.37-6.94]mm),length-width ratio(1.31[1.14-1.55]),height(4.08[2.71-5.34]mm),aspect ratio(0.99[0.84-1.45]),and inflow angle(133.63±11.21°)of aneurysms in the ruptured group were larger than the unruptured group,and the differences were statistically significant(P<0.05).Binary logistic regression showed that aneurysm shape(OR=39.347,P=0.021),length-width ratio(OR=313.062,P=0.033),and inflow angle(OR=1.156,P=0.004)were independent risk factors for rupture.The area under the curve were 0.809,0.842.and 0.894,respectively.Conclusion:Aneurysm shape,aspect ratio,and blood flow incidence angle are independent risk factors for basilar aneurysm rupture,which means that they can be used to predict the risk of rupture to a certain extent.
文摘Basilar artery fenestration is a rare anatomical variation resulting from the failed fusion of the two vertebral arteries during embryonic life. In order of frequency, it is the second most common location of vascular fenestrations after the anterior communicating artery. Vertebrobasilar junction aneurysms are uncommon but often associated with basilar artery fenestration. We report the case of a fenestrated vertebrobasilar junction saccular aneurysm in a 57-year-old woman. The diagnosis was incidentally made on CT angiography which found the anatomical variant and the aneurysm. The radiological features illustrating this association are detailed here and a brief discussion of its pathogenesis and management was made. Vertebrobasilar junction aneurysms are rare and their presence should suggest an associated basilar fenestration.
文摘Objective and Importance—Vertebrobasilar artery aneurysms can be very challenging to treat and are preferentially dealt with using endovascular tech-niques, since they are associated with lower risk than surgical clipping. Small aneurysms located on perfo-rating arteries can pose problems though, as their dimensions may not be favorable for coiling and leave the endovascular surgeon without many options. We present a basilar perforating artery aneurysm that was successfully embolized using a stent-within-stent technique. Clinical Presentation—A 47 year old fe-male presented with a Hunt-Hess 3, Fisher Grade-3 subarachnoid hemorrhage with blood in the pre-pontine cistern. Initial imaging (CT angiogram and digital subtraction angiography) did not reveal an aneurysm. Follow-up angiography on post-bleed day eight demonstrated a three-millimeter basilar perforating artery aneurysm. After an unsuccessful coiling attempt a closed-cell stent-within-stent tech-nique was used to divert flow away from the aneu-rysm neck to induce aneurysm thrombosis. Interven-tion (or Technique)—Multiple attempts were made to access and stabilize a microcatheter in the small basilar perforator artery aneurysm in order to de-liver coils for endovascular embolization;this could not be done safely. Therefore a closed-cell 4.5 × 22 mm Enterprise stent (Cordis Neurovascular, Inc., Miami Lakes, Florida) was deployed in the basilar artery across the origin of the perforator aneurysm in order for the stent tines to divert flow away from the aneurysm neck and induce thrombosis. Persistant brisk flow within the aneurysm continued however, and a second closedcell 4.5 × 22 mm Enterprise stent was placed within the first one to increase the stent metal surface area across the aneurysm neck to further reduce flow into the aneurysm. Subsequently, angiography demonstrated stagnant blood flow in the aneurysm dome and the aneurysm spontaneously thrombosed, sparing all associated vessels. Conclu-sion—Stent-within-stent technique should be consid-ered as a possible endovascular treatment option for small side-wall and perforator artery aneurysms that can’t be safely treated with coils or embolic agents.
文摘A giant basilar artery aneurysm of young woman with endocrine disturbance was misdiagnosed as a large pituitary adenoma and treated surgically via a trans-sphenoidal approach was planned. But the neurosurgery was finally aborted because of massive bleeding during the procedure. One year later,a cerebral angiography confirmed this basilar artery aneurysm was obviously regressed and then endovascular coiling was successfully performed. No neurological complication occurred post-procedure and the endocrine dysfunction symptom was obviously improved.
基金This study was founded by National Key Basic Research Program of China (973 program)(grant 2013CB733805)%Program of National Natural Science Foundation of China (grant No.81070925 and 81,471,767) to Weijian Jiang
文摘Background:Treatment of giant basilar aneurysms is extremely challenging, especially recurrences after previous coiling.Case presentation:A 20-year-old male was referred for a recurrent giant proximal basilar aneurysm 3 months after coiling, with headache, blurred vision, and brainstem compression symptoms. Angiography showed that the previously placed coils were compacted within the caudal portion of the 43 mm × 31 mm aneurysm, with spontaneous occlusion of the right vertebral artery and absence of the posterior communicating arteries. The diameter of the aneurismal neck, the afferent and efferent arteries was 6 mm, 3.5 mm and 4.1 mm, respectively. A balloon-expandable covered-stent of 3.5 mm × 10 mm was selected, matching the above 3 measurements;and deployed precisely across the aneurismal neck, immediately creating the'sub-complete reconstruction with intentional endoleak distal to aneurismal neck'. Subsequently, 2 self-expanding 4.5 mm × 37 mm stents were telescopically implanted within the covered-stent to adjust the angulation of the proximal basilar artery. After the procedure, the patient's symptoms gradually disappeared. Catheter angiography at 18 days, 3 months and 15 months demonstrated complete aneurismal exclusion from the patent vertebrobasilar artery, with dramatic elimination of aneurismal volume and reconfiguration of the compacted coils. The patient was asymptomatic at 15-month follow-up.Conclusions:Sub-complete reconstruction with intentional endoleak distal to aneurismal neck can be safely achieved after implantation of a covered-stent and conventional stents in the case of a recurrent post-coiling proximal giant basilar aneurysm, with complete vascular reconstruction subsequently.
文摘Initiation, growth, and rupture of cerebral aneurysms are caused by hemodynamic factors. It is extensively accepted that the cerebral aneurysm wall is assumed to be rigid using computational fluid dynamics (CFD). Furthermore, fluid-structure interactions have been recently applied for simulation of an elastic cerebral aneurysm model. Herein, we examined cerebral aneurysm hemodynamics in a realistic moving boundary deformation model based on 4-dimensional computed tomographic angiography (4D-CTA) obtained by high time-resolution using numerical simulation. The aneurysm of the realistic moving deformation model based on 4D-CTA at each phase was constructed. The effect of small wall deformation on hemodynamic characteristics might be interested. So, four hemodynamic factors (wall shear stress, wall shear stress divergence, oscillatory shear index and residual residence time) were determined from the numerical simulation, and their behaviors were assessed in the basilar bifurcation aneurysm.
文摘Basilar tip aneurysms account for 5% - 8% of all intracranial aneurysms. They are known to rupture more frequently than aneurysms in other locations. Surgical clipping of basilar apex aneurysms however challenging;remains the treatment of choice in Ivory Coast due in part, to multiple technical barriers. A 60-year-old right-handed patient presented to our Neurosurgical Unit in February 2nd 2013 after a sudden onset of altered consciousness. Neurological examination revealed both an upper motor neuron and meningeal syndromes with a Glasgow Coma Scale of 12. Brain NECT scan and a subsequent brain CT angiography showed a subarachnoid haemorrhage and a 3.8 mm (height) × 5.2 mm (width) basilar tip aneurysm respectively. Surgical clipping of the aneurysm was indicated but due to multiple technical barriers, surgery was delayed and the patient underwent surgery after the critical vasospasm period. The patient developed a hospital acquired pneumonia after surgery and was successfully treated with antibiotics. Since her discharge, she has been asymptomatic. We sought to report this case of a basilar apex aneurysm successfully occluded with non-ferromagnetic SUGITA clips and to share our experience of clipping these lesions through the frontotemporal approach. The patient was informed that non identifying information from the case would be submitted for publication, and she provided consent.
