RESUMO
OBJECTIVE: To report the treatment and outcome of traumatic intracranial aneurysm (TICA) cases at the Southwest Hospital, Army Medical University in China. PATIENTS AND METHODS: All patients diagnosed with TICA at our institution from January 1, 1977, to October 31, 2018, and meeting the inclusion/exclusion criteria were included in the study. Cases were reported separately for those diagnosed before 1998 and those after 1998. RESULTS: A total of 25 patients were included in the study. Ten were diagnosed with TICA prior to 1998. Seven of these 10 patients were treated surgically with parent artery sacrificed, including aneurysmectomy, trapping, and bypass. The mean Glasgow Outcome Scale (GOS) score for the 7 patients with surgical treatment was 3.1. Three of the 10 patients died of severe complications, including intracranial infection, delayed bleeding, and deadly injury. After 1998, 15 patients were diagnosed with TICA. Thirteen presented with head trauma and two with iatrogenic TICA following ventricle drainage or sphenoid ridge meningioma resection. Thirteen were treated with endovascular treatment, including coil alone, glue, coil-associated glue, stent alone, stent-assisted coil embolization, one with clipping, and one with conservative treatment. The 13 patients with endovascular treatment achieved a mean GOS score of 4.5. Among the 13 patients, one died from intracranial infection, one suffered recurrence, and one had intraoperative rupture. CONCLUSION: Although the treatment of TICA has traditionally been surgical, endovascular treatment with different techniques, such as endovascular patch, provides a valuable alternative. Currently, the flow diverter is a popular embolization device and may represent another valid treatment option for TICA.
Assuntos
Traumatismos Craniocerebrais/complicações , Procedimentos Endovasculares/métodos , Aneurisma Intracraniano/cirurgia , Procedimentos Neurocirúrgicos/métodos , Acidentes por Quedas , Acidentes de Trânsito , Adolescente , Adulto , Angiografia Digital , Artéria Cerebral Anterior/diagnóstico por imagem , Artéria Cerebral Anterior/lesões , Artéria Cerebral Anterior/cirurgia , Lesões das Artérias Carótidas/diagnóstico por imagem , Lesões das Artérias Carótidas/cirurgia , Artéria Carótida Interna/diagnóstico por imagem , Artéria Carótida Interna/cirurgia , Angiografia Cerebral , Feminino , Escala de Resultado de Glasgow , Humanos , Doença Iatrogênica , Aneurisma Intracraniano/etiologia , Masculino , Artéria Cerebral Média/diagnóstico por imagem , Artéria Cerebral Média/lesões , Artéria Cerebral Média/cirurgia , Procedimentos Neurocirúrgicos/efeitos adversos , Hemorragia Pós-Operatória/epidemiologia , Stents , Instrumentos Cirúrgicos , Adesivos Teciduais/uso terapêutico , Adulto JovemRESUMO
OBJECTIVE: To assess the feasibility of using MicroFil polymer perfusion to detect concomitant saccular aneurysms in an intracranial arterial dolichoectasia (IADE) model in mice, and to report detailed histomorphometric features of these aneurysms. MATERIALS AND METHODS: IADE models were created in C57/BL6 mice via microsurgical injection of 25â mU elastase into the cisterna magna. The cerebral vasculature was perfused with MicroFil polymer and harvested at 1, 3, and 7â days, and 2 and 4â weeks (n=8 for each group). IADE was defined by a tortuosity index >10 combined with a 25% increase in diameter of the A1 segment of the anterior cerebral artery (ACA), internal carotid artery (ICA), or basilar artery compared with the baseline of controls, which received heat-inactivated elastase. Saccular aneurysm occurrence rate, location, and morphological parameters were investigated using macroscopic and microscopic analysis. RESULTS: IADE was present in 95% (36/38) of the subjects, with a mortality rate of 5% (2/40). Fifteen concomitant saccular aneurysms were detected in 8 (21%) of the 38 surviving mice, including 6 at the posterior communicating artery, 1 along the ACA, 2 along the anterior communicating artery complex, 3 along the ICA, and 3 along the middle cerebral artery. Rupture was confirmed in two aneurysms. Histological examination indicated that the aneurysms develop via arterial-wall remodelling, which is characterized by internal elastic lamina disruptions and muscular layer discontinuity in the media. CONCLUSIONS: The proportion of subjects developing saccular aneurysms in addition to IADE in our mouse model is similar to the 15% of patients with IADE who have concomitant saccular aneurysms.
Assuntos
Modelos Animais de Doenças , Aneurisma Intracraniano/patologia , Perfusão/métodos , Elastômeros de Silicone/administração & dosagem , Insuficiência Vertebrobasilar/patologia , Animais , Artéria Cerebral Anterior/patologia , Artéria Cerebral Anterior/cirurgia , Artéria Basilar/patologia , Artéria Basilar/cirurgia , Artéria Carótida Interna/patologia , Artéria Carótida Interna/cirurgia , Feminino , Aneurisma Intracraniano/induzido quimicamente , Aneurisma Intracraniano/cirurgia , Camundongos , Camundongos Endogâmicos C57BL , Artéria Cerebral Média/patologia , Artéria Cerebral Média/cirurgia , Elastase Pancreática/toxicidade , Polímeros/administração & dosagem , Insuficiência Vertebrobasilar/induzido quimicamente , Insuficiência Vertebrobasilar/cirurgiaRESUMO
A hypertensive woman complained of a headache soon after an operation to remove a maxillary cyst. A computed tomogram showed evidence of subarachnoid haemorrhage and on angiogram an aneurysm of an anterior cerebral artery. The aneurysm was treated by clipping and the patient recovered.