Giant cavernous aneurysms occluded by aneurysmal thrombosis,calcification,parent artery occlusion:A case report and review of literature

BACKGROUND Patients with giant intracranial aneurysms(GIAs)are at a high risk of rupture,morbidity,and mortality even after surgical or endovascular treatment.We described a case of a spontaneously occluded GIA secondary to gradual growth of the GIA,continuously progressed aneurysmal thrombosis,complete aneurysmal calcification and complete occlusion of the parent artery-the right internal carotid artery(RICA).CASE SUMMARY A 72-year-old female patient complained of sudden pain in her right eye upon admission to our hospital.She had been diagnosed with a GIA[30 mm(axial)×38 mm(coronal)×28 mm(sagittal)]containing an aneurysmal thrombus located in the cavernous sinus segment of RICA diagnosed by magnetic resonance imaging(MRI),enhanced MRI,and magnetic resonance angiography more than 14 years ago.Later,with slow growth of the cavernous carotid GIA,aneurysmal thrombosis progressed continuously,spontaneous occlusion of the RICA,complete aneurysmal calcification,and occlusion of the GIA occurred gradually.She had no history of subarachnoid hemorrhage but missed the chance for endovascular therapy at an early stage.As a result,she was left with severe permanent sequelae from the injuries to the right cranial nerves Ⅱ,Ⅲ,Ⅳ,V1/V2,and Ⅴ.CONCLUSION The risk of rupture of the cavernous carotid GIAs was relatively low and possibly further be reduced by the stasis flow and spontaneous occlusion of the parent artery internal carotid artery(ICA)induced by the mass effect of the cavernous carotid GIAs and the extremely rare aneurysmal calcification.However,nowadays,it is advisable to recommend early endovascular treatment for the cavernous carotid GIAs to prevent injuries to the surrounding intracranial nerves and occlusion of the ICA,mainly caused by the mass effect of the cavernous carotid GIAs.

Unusual Presentation of Heart Failure Secondary to Ruptured Aneurysmal Sinus of Valsalva: A Case Report

Sinus of Valsalva Aneurysm (SOVA) arises from an abnormal dilation of the aortic root, leading to enlargement between the aortic annulus and the sinotubular junction. Although often presenting without symptoms, these aneurysms bear the potential for life-threatening complications, primarily from the looming risk of rupture. We present the case of a 42-year-old Malay gentleman with a history of bilateral pedal edema and dyspnea on exertion who was diagnosed with a ruptured sinus of Valsalva aneurysm. The patient underwent successful surgical repair of the aneurysm, leading to symptomatic improvement and favorable outcomes. This case highlights the importance of early diagnosis and prompt surgical intervention in managing this uncommon condition.

Whole-brain CT Perfusion at Admission and During Delayed Time-window Detects the Delayed Cerebral Ischemia in Patients with Aneurysmal Subarachnoid Hemorrhage

Objective To evaluate the utility of computed tomography perfusion(CTP)both at admission and during delayed cerebral ischemia time-window(DCITW)in the detection of delayed cerebral ischemia(DCI)and the change in CTP parameters from admission to DCITW following aneurysmal subarachnoid hemorrhage.Methods Eighty patients underwent CTP at admission and during DCITW.The mean and extreme values of all CTP parameters at admission and during DCITW were compared between the DCI group and non-DCI group,and comparisons were also made between admission and DCITW within each group.The qualitative color-coded perfusion maps were recorded.Finally,the relationship between CTP parameters and DCI was assessed by receiver operating characteristic(ROC)analyses.Results With the exception of cerebral blood volume(P=0.295,admission;P=0.682,DCITW),there were significant differences in the mean quantitative CTP parameters between DCI and non-DCI patients both at admission and during DCITW.In the DCI group,the extreme parameters were significantly different between admission and DCITW.The DCI group also showed a deteriorative trend in the qualitative color-coded perfusion maps.For the detection of DCI,mean transit time to the center of the impulse response function(Tmax)at admission and mean time to start(TTS)during DCITW had the largest area under curve(AUC),0.698 and 0.789,respectively.Conclusion Whole-brain CTP can predict the occurrence of DCI at admission and diagnose DCI during DCITW.The extreme quantitative parameters and qualitative color-coded perfusion maps can better reflect the perfusion changes of patients with DCI from admission to DCITW.

Sclerotherapy as a primary or salvage procedure for aneurysmal bone cysts:A single-center experience

BACKGROUND Aneurysmal bone cysts(ABC)are benign cystic bone tumors of an osteolytic and locally aggressive nature.As an alternative to the primary treatment of choice,which consists of curettage with bone grafting,alternative treatment methods with promising results have been described.At our department,we have,in recent years,used percutaneous sclerotherapy with polidocanol.The objective of this study was to identify the healing rate and safety of sclerotherapy with polidocanol.AIM To identify the efficacy and safety of sclerotherapy with polidocanol in primary and recurrent ABC.METHODS Twenty-two consecutive patients(median age 12.5 years;range 1-27)with 23 ABCs treated with sclerotherapy with polidocanol from 2016-2021 were included retrospectively.Eleven patients(48%)had undergone different forms of previous treatment with recurrence.Under general anesthesia and fluoroscopic guidance,repeated percutaneous injections of 4mg polidocanol/kg body weight were performed.Through review of the electronic medical records,the following were identified:healing and recurrence rate,number of treatments,gender,age,comorbidity,location of the tumor and side effects/complications,as well as any previous surgery for ABC.The median length of radiographic follow-up was 19.5 mo.RESULTS All ABCs except one(96%)showed healing or stable disease after a median of 4(range 1-8)injections.Complete clinical and radiographic healing was observed in 16 cysts(70%),while partial radiographic healing with resolution of pain was seen in 6 cases(26%)and considered as stable disease.The cyst that failed to heal had previously undergone curettage twice with recurrence.One patient with a large pelvic ABC experienced,right after two injections,a sudden drop in blood pressure,which could quickly be reversed.One patient with a juxtaphyseal ABC in the femoral neck showed a minor limb length discrepancy because of deformity.Beyond that,no complications were observed.CONCLUSION Percutaneous sclerotherapy with polidocanol appears to be a safe alternative for treatment of aneurysmal bone cysts.In our series of both primary and recurrent cysts,it showed the ability to achieve healing or stable disease in 22 of 23 cases(96%).Further studies are needed to decide if this provides a long-lasting effect.

Surgery for fibrous dysplasia associated with aneurysmal-bone-cystlike changes in right proximal femur:A case report

BACKGROUND Fibrous dysplasia associated with aneurysmal bone cyst(ABC)-like changes in the right proximal femur has a low incidence.It is considered more difficult to make early diagnosis than for single fibrous dysplasia.CASE SUMMARY A 14-year-old woman was admitted because of persistent pain in the right hip and abnormal gait over the previous 2 mo.She had no history of present or past illness.Preoperative photography,enhanced computed tomography,and magnetic resonance imaging showed ground-glass appearance with cortical scalloping and expansion of the right proximal femur and femoral neck.Pathological examination by preoperative puncture biopsy revealed fibrous dysplasia of the right proximal femur.The patient was diagnosed with fibrous dysplasia based on medical history,physical examination,and results of laboratory,imaging and pathological examinations.According to final pathological examination,the patient was diagnosed with fibrous dysplasia of the right proximal femur associated with ABC.Curettage and allograft along with fixation of compression screws was performed for fibrous dysplasia associated with ABClike changes.No obvious allograft absorption,loosening of fixation,or secondary fracture were observed during 6-months’follow-up with re-examination by plain radiography and computed tomography.Fibrous dysplasia associated with ABClike changes in the right proximal femur has a low incidence and early diagnosis is considered more difficult than for single fibrous dysplasia.CONCLUSION We report a cases of fibrous dysplasia associated with ABC-like changes in the right proximal femur treated with curettage and allograft along with hip compression screws.

Giant Aneurysmal Bone Cyst of the Right Femur about a Case

Aneurysmal bone cyst (ABC) is a rare bone tumor accounting for 1% - 4% of benign bone tumors. Its etiopathogenesis remains unknown. The main site is the metaphysis of the long bones. ABC occurs almost exclusively in young people, with a slight female predominance. We report an exceptional case of ABC of the femur with involvement of the right hip in a 16-year-old girl in the Medical Imaging Department of Pr Bocar Sidy Sall Hospital of Kati (Mali). We will discuss the clinical and radiological aspects of this pathology. Observation: Mrs N C., aged 16, was referred to the orthopaedic-traumatology department for an X-ray of the right thigh, indicated as having a large, disabling thigh. Clinical examination revealed a large thigh measuring 890 mm in circumference, compared with 300 mm on the contralateral side. Radiographically, the femur showed a blown appearance, with the cortex thinned and broken in places. Exceptionally, the lesion affected the entire femur. On CT scan, we found a voluminous fluid collection occupying the entire right femur, including the right femoral head and homolateral ischium. The cortex was interrupted in places, and the adjacent soft tissues were thinned or laminated, but not infiltrated. Histology revealed haemorrhagic and inflammatory elements compatible with the diagnosis of ABC. Conclusion: ABC is a tumor entity that is often difficult to diagnose. Medical imaging, topographical distribution and histology form an indissociable whole to establish a diagnosis of certainty.

A prospective cohort study on serum A20 as a prognostic biomarker of aneurysmal subarachnoid hemorrhage

BACKGROUND:A20 may be a neuroprotective factor.Herein,we aimed to investigate whether serum A20 levels were associated with disease severity,delayed cerebral ischemia(DCI),and outcome after aneurysmal subarachnoid hemorrhage(aSAH).METHODS:In this prospective cohort study containing 112 aSAH patients and 112 controls,serum A20 levels were quantified.At 90 d poststroke,Modified Rankin Scale(MRS) scores≥3 were defined as a poor outcome.All correlations and associations were assessed using multivariate analysis.RESULTS:Compared with controls,there was a significant elevation of serum A20 levels in patients(median 123.7 pg/mL vs.25.8 pg/mL;P<0.001).Serum A20 levels were independently correlated with Hunt-Hess scores(β 9.854;95% confidence interval [95% CI] 2.481-17.227,P=0.009) and modified Fisher scores(β 10.349,95% CI 1.273-19.424,P=0.026).Independent associations were found between serum A20 levels and poor outcome(odds ratio [OR] 1.015,95%CI 1.000-1.031,P=0.047) and DCI(OR 1.018,95% CI 1.001-1.035,P=0.042).Areas under the curve for predicting poor outcome and DCI were 0.771(95% CI 0.682-0.845) and 0.777(95% CI 0.688-0.850),respectively.Serum A20 levels ≥128.15 pg/mL predicted poor outcome,with a sensitivity of 73.9% and specificity of 74.2%,and A20 levels ≥160.55 pg/mL distinguished the risk of DCI with65.5% sensitivity and 89.2% specificity.Its ability to predict poor outcome and DCI was similar to those of Hunt-Hess scores and modified Fisher scores(both P>0.05).CONCLUSION:Enhanced serum A20 levels are significantly associated with stroke severity and poor clinical outcome after aSAH,implying that serum A20 may be a potential prognostic biomarker for aSAH.

Serum Gamma-glutamyl Transferase Levels Predict Functional Outcomes after Aneurysmal Subarachnoid Hemorrhage

Objective We aim to explore the potential association between serum gamma-glutamyl transferase levels and functional outcome after aneurysmal subarachnoid hemorrhage in a Chinese population. Methods A total of 386 aneurysmal subarachnoid hemorrhage patients were included in the study from September 2007 to February 2015. Baseline serum gamma-glutamyl transferase levels and 6-month follow-up functional outcomes were determined. A poor outcome was defined as a modified ranking scale score of ≥ 3. The multivariable logistic model was used to analyze the relationship between serum gamma-glutamyl transferase and clinical outcomes after aneurysmal subarachnoid hemorrhage. Results The adjusted poor outcome rates of patients with gamma-glutamyl transferase levels of 〈 30 U/L, 30-50 U/L and ≥ 50 U/L were 16.7%, 19.6%, and 34.4%, respectively （P 〈 0.01）. The age-sex and multivariable adjusted odds ratios （95% confidence intervals） of poor prognosis comparing the top group （≥ 50 U/L） with the lowest group （〈 30 U/L） were 5.76 （2.74-12.13）, 6.64 （2.05-21.52）, and 6.36 （1.92-21.02）. A significant linear trend existed between gamma-glutamyl transferase level and aneurysmal subarachnoid hemorrhage prognosis. This association was also observed among nondrinkers. Conclusion Patients with higher gamma-glutamyl transferase levels were more likely to have a poor prognosis. Serum gamma-glutamyl transferase can be considered to be an independent predictor of functional outcomes after aneurysmal subarachnoid hemorrhage.

D-dimer may predict poor outcomes in patients with aneurysmal subarachnoid hemorrhage: a retrospective study

Serum biomarkers may play a reliable role in predicting the outcomes of patients with aneurysmal subarachnoid hemorrhage. This study retrospectively analyzed the relationship between serum biomarkers on admission and outcomes in patients with aneurysmal subarachnoid hemorrhage. We recruited 146 patients with aneurysmal subarachnoid hemorrhage who were treated in Renmin Hospital of Wuhan University of China between 1 May 2014 and 30 March 2016. There were 57 males and 89 females included and average age of included patients was 57.03 years old. Serum samples were taken immediately on admission（within 48 hours after initial hemorrhage） and the levels of serum biomarkers were detected. Baseline information, complications, and outcomes at 6 months were recorded. Univariate and multivariate logistic regression analyses were used to explore the relationship between biomarkers and clinical outcomes. Receiver operating characteristic curves were obtained to investigate the possibility of the biomarkers predicting prognosis. Of the 146 patients, 102 patients achieved good outcomes and 44 patients had poor outcomes. Univariate and multivariate analyses showed that high World Federation of Neurosurgical Societies grade, high serum D-dimer levels, and high neurological complications were significantly associated with poor outcomes. Receiver operating characteristic curves verified that D-dimer levels were associated with poor outcomes. D-dimer levels strongly correlated with neurological complications. In conclusion, we suggest that D-dimer levels are a good independent prognostic factor for poor outcomes in patients with aneurysmal subarachnoid hemorrhage.

Serial lumbar puncture reduces cerebrospinal fluid (CSF) infection during removal of hemorrhagic CSF in aneurysmal subarachnoid hemorrhage after endovascular coiling

The present study aimed to compare the complications and clinical outcomes of serial lumbar puncture（LP） and lumbar cerebrospinal fluid（CSF） drainage（LD） of patients with aneurysmal subarachnoid hemorrhage and provide more evidence to guide clinical management.In this retrospective study,41 and 39 aneurysmal subarachnoid hemorrhage patients were enrolled in the LP and LD group,respectively.Clinical outcomes,including CSF infection,intracerebral hemorrhage,vasospasm,hydrocephalus,death,length of stay,duration of drainage and the Glasgow Outcome Scale score were compared between the two groups.By comparing with the LP group,the LD group showed a significantly higher rate of CSF infection（P= 0.029） and shorter duration of drainage（P〈 0.001）.Both groups displayed similar rates of vasospasm,hydrocephalus,intracerebral hemorrhage,the Glasgow Outcome Scale score one month after endovascular coiling and length of stay（P〉 0.05,respectively）.In conclusion,both LD and serial LP are effective methods in the treatment of aneurysmal subarachnoid hemorrhage; besides,serial LP can reduce the incidence of CSF infection in draining hemorrhagic CSF in aneurysmal subarachnoid hemorrhage after endovascular coiling.

Aneurysmal Fibrous Histiocytoma:Clinicopathology Analysis of 30 Cases of a Rare Variant of Cutaneous Fibrohistiocytoma

Aneurysmal fibrous histiocytoma is often clinically misdiagnosed.In this study,we put forward an insight on how to help diagnose this disease clinically.A retrospective chart review was performed on all patients diagnosed with aneuiysmal fibrous histiocytoma from 2007 to 2017 in the Department of Dermatology,Union Hospital,China,and all clinical data were collected from the hospital archives.From a total of 418 patients diagnosed with cutaneous fibrous histiocytoma,only 30 patients were confirmed to have aneurysmal fibrous histiocytoma out of which only 2 patients were clinically diagnosed with aneurysmal fibrous histiocytoma.The remaining 28 patients were diagnosed with various types of vascular tumors although pathology classified them as having aneurysmal fibrous histiocytoma.Among the 30 patients,9 were male and 21 were female.There were following age groups:13-19(mean 16,n=4),20-29(mean 26.25,n=8),30-39(mean 33,n=7),40-49(mean 44,n=4),50-59(mean 56.75,n=4)5 60 and above(mean 61,n=3).Tumors were present on the head,neck,back,waist,hips and upper and lower extremities.After complete excision,there was no recurrence and no complications.Histologically,lesions showed the typical pseudoangiomatoid spaces without endothelial lining and infiltration of fibrohistiocytes in hemosiderotic pigmentation.It was suggested that although the prognosis of aneurysmal fibrous histiocytoma is good,accurate diagnosis is paramount to avoid clinical misdiagnosis and subsequent complications.

Influence of Clip Locations on Intraaneurysmal Flow Dynamics in Patient-specific Anterior Communicating Aneurysm Models with Different Aneurysmal Angle

To improve aneurysm treatment,this study examined the influence of clip locations on hemodynamic factors in patient-specific anterior communicating artery(ACoA)aneurysms with different aneurysmal angle.We proposed a simplified classification of ACoA aneurysms using aneurysmal angle,defined by the angle of pivot of the aneurysmal dome and the virtual two-dimensional plane created by both proximal A2 segments of anterior cerebral artery(ACA).ACoA aneurysms with three different aneurysmal angles,which are 15°,80°and 120°,were analyzed in our study.In this work,we obtained hemodynamics before and after clipping surgery with three clip locations based on clinical clipping strategies in three ACoA aneurysms with different aneurysm angles.Results showed that local high pressure occurs at impingement region of the ACoA aneurysm before clipping and new impingement region close to the clipping location after clipping treatment.For clipping the aneurysm with aneurysmal angle 15°and a wide neck,wall shear stress(WSS)distribution is more uniform when the clipping angle of two clips close to 180°comparing with other two angles.In addition,for clipping the aneurysm with aneurysmal angle 80°and 120°,local high pressure appears on new impingement region and high WSS distributes around the clipping location when the clip plane is normal to the direction of inflow of aneurysm from the dominance of A1 segment of ACA.Hence,we should avoid the impingement of inflow from the A1 segment and choose a favorable clipping location for the fastness of clip.The results of our study could preoperatively give a useful information to the decision of surgical plan.

Tenascin-C in aneurysmal subarachnoid hemorrhage: deleterious or protective?

Subarachnoid hemorrhage（SAH）caused by the rupture of a cerebral aneurysm is a well-known devastating cerebrovascular disease.Post-SAH brain is vulnerable,associated with early brain injury（EBI;Suzuki,2015）.

A Case Report of Multiple Aneurysmal Bone Cysts

A 30-year old male patient, admitted in our hospital for a fracture of the upper end of the left humerus in February, 2006, received treatment with curettage of the lesion in combination with an autologous bone graft from the right ilium plus internal fixation. A post-operative pathological examination indicated that there was a simple bone cyst in the area of the fracture, with a satisfactory postoperative recovery.

Recurrent aneurysmal bone cyst of talus resulted in tibiotalocalcaneal arthrodesis

Aneurysmal bone cyst(ABC), a locally benign aggressive lytic lesion of either primary or secondary origin, seldom involves the talus. Herein, we present a 25-year-old man with recurrent ABC of the talus after curettage and bone grafting, which was managed by total resection followed by filling the defect using fibular graft and finally tibiotalocalcaneal arthrodesis due to articular surface involvement. At 18 mo postoperatively, no recurrence was detected. Arthrodesis might be a good option in cases with recurrent ABC of the talus especially with articular surface involvement.

Cognitive and functional status after vein of Galen aneurysmal malformation endovascular occlusion

AIM:To study the clinical outcomes of treating vein of Galen aneurysmal malformations(VGAM),we assessed our patient cohort using standardized cognitive and functional measures.METHODS:A retrospective review of patients with VGAM treated by a single practitioner between 2003 and 2009 was performed for this study.In addition to routine clinical assessment,all patients were evaluated for cognitive and functional impairment using validated measures including the Neurobehavioral Rating ScaleRevised,the Bicêtre outcome score,and the Barthel index.RESULTS:Five patients underwent combined transarterial and transvenous embolization of their VGAM during the study period.VGAMs were classified based on angioarchitecture as either choroidal(1/5) or mural(4/5) according to the classification scheme of Lasjaunias.In total,13 embolization procedures were performed consisting of 1 to 3 treatment stages per patient.Complete or near complete occlusion was achieved in 4 patients,while subtotal occlusion was achieved in 1 patient.During follow-up(median 62.6 mo),all patients were either unchanged or cognitively and neurologically intact.CONCLUSION:VGAM can be safely and effectively treated by staged transarterial and transvenous embolization.Using this strategy,excellent long-term cognitive and functional outcomes can be achieved.

Clinic Pathological Study of Aneurysmal Fibrous Histiocytoma

Aneurysmal fibrous histiocytoma (AFH) is a rare variant of benign fibrous histiocytoma (FH), Characterized by blood-filled spaces within the fibrohistiocytic tumor. AFH has a higher recurrence rate than FH. The diagnosis of AFH is often problematic due to its overlapping morphological features with other skin tumors. The diagnosis of AFH depends on histological features and immunohistochemistry. The aim of this study is to understand the clinical and histopathological diagnostic criteria for AFH.

Aneurysmal Bone Cyst of Talus: A Rare Case

Aneurysmal bone cyst is a benign locally aggressive lytic lesion usually involving metaphyseal regions of long tubular bones. It rarely involves talus. It can be primary or secondary in origin. We reported the imaging findings in a case of a 23-year-old male patient with complaints of pain and swelling around left ankle joint one year ago which turned out to be aneurysmal bone cyst on histopathology.

Effectiveness and Influencing Factors of Comprehensive Rehabilitation Therapy in Patients with Aneurysmal Subarachnoid Hemorrhage

This study aimed to determine the effectiveness of comprehensive rehabilitation for patients with aneurysmal subarachnoid hemorrhage (aSAH) and to explore the factors influencing the prognosis of rehabilitation. This was a retrospective study. Twenty-five patients with aSAH were treated with physical therapy, occupational therapy, speech therapy, cognitive therapy, music therapy, Chinese acupuncture, hyperbaric oxygen, and transcranial magnetic stimulation. The general data of all patients were collected, and the functional scores at admission were compared with those at discharge. The Mini Mental State Examination, Fugl-Meyer Assessment Scale (FMAS) for motor and balance assessment, Holden Functional Ambulation Classification (FAC), modified Rankin Scale, National Institute of Health Stroke Scale, Modified Barthel Index for activities of daily living (ADL), and Glasgow Outcome Scale were significantly improved among 25 patients with aSAH after 1 month of comprehensive rehabilitation training. Hydrocephalus was an independent factor of the ability to perform ADLs (odds ratio, 0.29;95% confidence interval, 2.03. 3.15;p = 0.000). The improvement of ADLs in aSAH patients was not related to sex, surgical method, aneurysm location, age, or smoking status. Comprehensive and professional rehabilitation is effective for the cognition, movement, walking, ADLs, and functional prognosis of patients with aSAH, while early hydrocephalus may be a risk factor for poor ADLs.

Treatment of Unicameral and Aneurysmal Bone Cysts by Minimally Invasive Percutaneous Injection of Grafton DBF Putty Using the Kyphon Cement Delivery System

Background: Simple Unicameral and Aneurysmal Bone Cysts are benign lesions that may heal spontaneously especially after fracture which may be the first symptom. However, often size increases causing pain, and complications of fractures can severely compromise the patient. Aim: The results in a series of cases treated minimally invasive using a new device for the application of allogenic bone material appear highly promising and shall be presented. Patients and Methods: Eight consecutive patients with symptomatic Unicameral Bone Cysts (UBC) were treated by percutaneous instillation of Grafton? DBF Putty (demineralised allogenic bone containing fibers) mixed with autologous bone marrow using the Kyphon? Cement Delivery System (Medtronic), which allows the injection of this high viscosity paste by controlled high pressure. Five patients with Aneurysmal Bone Cysts (ABC) were treated accordingly after inactivation by Aethoxysclerol 3% and lacking bone formation. Using this approach a high rate of bone regeneration was observed in these patients at 8 months to 5 years follow-up (f/u). Conclusion: The presented technique of a minimally invasive biologic treatment led to highly satisfying results using the Grafton? DBF Putty with its higher potential for bone regeneration than demineralized bone matrix not containing fibres (DBM).