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Background: Pure fusiform aneurysms of the anterior communicating artery (AcomA) are rare. We report a unique case of a patient with an AComA fusiform aneurysm in the setting of several unusual cranial neurocristopathies, including a hypoplastic internal carotid artery (ICA), persistent craniopharyngeal canal, transsphenoidal encephalocele, and ectopic, duplicated pituitary gland. We also review the literature on cranial base neurocristopathies and AComA fusiform aneurysms., Case Description: This 46-year-old patient had a history of short stature, osteoporosis, obesity, cleft lip, decreased libido, congenital left eye blindness, headaches, and chronic nasal congestion. Magnetic resonance imaging revealed a 25 × 25 × 33 mm heterogenous soft tissue mass with an ectopic pituitary gland extending transsphenoidally and a duplicated pituitary stalk. A hormone panel revealed undetectable insulin-like growth factor 1 and growth hormone, central hypogonadism, and elevated prolactin. Before presentation, computed tomography angiography (CTA) had revealed a congenitally hypoplastic right ICA and 4.7 × 10.7 mm fusiform aneurysm of the AComA. Digital subtraction angiography confirmed stable morphology after 9 years. Nonoperative management of aneurysm and cephalocele was elected, with repeat CTA in 1 year., Conclusions: This case provides evidence that inherent arterial wall defects can contribute to fusiform aneurysm formation in the AComA. We propose that small AComA fusiform aneurysms without sclerotic or symptomatic features can be safely observed by describing the longest reported conservative management for this type of aneurysm. A high degree of suspicion for cerebrovascular anomalies should be maintained in patients who present with cranial neurocristopathy., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Many disorders can cause aneurysm and/or dissection of the cerebral arteries, including fibromuscular dysplasia (FMD), connective tissue disorders, cerebral vasculitis, infection, and vascular malformations. Arterial fenestration is a rare congenital finding that can also cause aneurysms, and can rarely dissect and bleed. Treatment of aneurysm and dissection with subarachnoid hemorrhage can be very complicated, and requires case-by-case analysis of the risks and benefits of antithrombotic therapy. To the authors' knowledge, no case of double fenestration of the basilar artery has been reported. This report presents a case of concurring vertebral artery dissection and double fenestration of the basilar artery with aneurysm. The fenestration and FMD are considered possible main contributing causes of this presentation. A literature review of cerebrovascular fenestration and FMD is provided and the relationship between the 2 is considered. Lastly, the use of antithrombotic therapy in the setting of subarachnoid hemorrhage, dissection, and stent placement is discussed., (Copyright © 2013 Elsevier Inc. All rights reserved.)

We narrate the case of a term baby who presented at 30 h of age in congestive cardiac failure due to vein of Galen aneurysmal malformation. A successful interventional radiology embolisation of the feeding vessels to the aneurysm was performed on day 5. Twenty hours following the procedure, the baby developed significant intraventricular haemorrhage with extension into the brain parenchyma; care was reoriented on day 7 of life after discussion with the parents. Vein of Galen aneurysmal malformation is a rare congenital vascular malformation. It usually manifests in the newborn period with high-output cardiac failure. The death rate is higher in those who present early in the neonatal period. The management of this condition requires a multidisciplinary approach.

We describe the case of a 23-year old man, who is himself a student of human medicine and who performed, thanks to his knowledge gained during his studies, a presumptive diagnosis of the Ehlers-Danlos-syndrome on himself. This fact was previously underdiagnosed by several physicians, who were consulted due to the manifestation of symptoms.

A 47-year-old man presented with abdominal pain, neck stiffness, severe transient hypertension and unusually dark urine. Cerebrospinal fluid investigations and angiography confirmed the diagnosis of a subarachnoid haemorrhage. Porphyrin studies on the patient and his family demonstrated that the family has acute intermittent porphyria. This is the second case report of an acute hepatic porphyria presenting with a subarachnoid haemorrhage. Acute transient hypertension during the attack of porphyria caused the rupture of an intracranial arterial aneurysm.

Aneurysms of the vein of Galen (AVG) represent less than 1% of all intracranial arteriovenous malformations. Two cases of prenatal diagnosis made by color Doppler ultrasonography at 32 weeks of gestation are reported. Both cases presented with antenatal mild cardiomegaly and both developed severe cardiac failure in the neonatal period. Embolization was unsuccessful and both infants died. These cases highlight the need for a careful evaluation of the time and mode of delivery; embolization must be performed after a fully informed decision.

Basilar artery "fenestration" is the result of a failed fusion of the bilateral longitudinal neural arteries and can be associated with a saccular aneurysm, which typically arises at the proximal juncture of the unfused segment. "Kissing" aneurysms at this site, i.e. two aneurysms arising from the proximal junction of the unfused segment of the basilar artery pointing anteriorly and posteriorly are reported to be exceedingly rare. We present three patients with this rare condition, all of them being treated by endovascular techniques.

Vein of Galen aneurysm is a rare pathology, representing less than 1% of intracranial vascular malformations. We report on a 65-year-old man who experienced a generalized tonic-clonic seizure. Brain imaging showed a large calcified expanding mass in the pineal region, confirming the diagnosis of a vein of Galen aneurysm. Because of the spontaneous thrombosis of the malformation, there was no need for microsurgical or endovascular treatment and he has been regularly followed since that.

Vein of Galen aneurysmal malformations (VGAM) are characterized by multiple arteriovenous connections draining into a markedly enlarged median draining vein. This ectatic vein is not the vein of Galen, but its embryonic precursor, the median prosencephalic vein of Markowski. During normal development, the posterior portion of the median prosencephalic vein persists as the vein of Galen, while its anterior portion regresses in parallel with the formation of the internal cerebral veins (ICV). It has been traditionally thought that, in children with a VGAM, the deep venous system does not connect to and, a fortiori, does not drain into the ectatic median prosencephalic vein/vein of Galen. This report describes a case of successfully treated VGAM in which the drainage of an ICV into the vein of Galen was only demonstrated by follow-up MR imaging and venography. The potential implications of this finding for the management of VGAMs are discussed.

Vein of Galen aneurysmal malformations (VGAMs) are rare congenital vascular malformations and excessive arteriovenous shunt causes intractable congestive high-output heart failure in the neonate. We report a case of successful staged transcatheter embolizations for a neonate with congestive heart failure and pulmonary hypertension (PH). Heart failure was dramatically relieved as the staged procedure progressed. Although transcatheter embolizations is essential for the treatment, inhaled nitric oxide (iNO) was helpful as a bridge treatment to reduce right-to-left shunt before the initial emergency embolization. Endovascular embolization is a less invasive therapy than open cranial surgery and allows hemodynamic stability. Perioperative iNO can be used to manage PH in VGAMs.

Neonatal intracranial aneurysms are rare. The authors report the case of a 4-week-old girl who presented with left-eye ptosis and proptosis. Computerized tomography scanning and magnetic resonance imaging demonstrated a mass involving the left cavernous sinus and middle cranial fossa. Cerebral angiography revealed a large complex left cavernous carotid artery (CA) aneurysm. The patient underwent endovascular treatment in which detachable coils and N-butyl cyanoacrylate glue were used to achieve complete obliteration of the aneurysm. To the authors' knowledge, this is the first reported neonatal intracranial aneurysm originating from the cavernous CA and treated endovascularly. The authors review the literature on neonatal intracranial aneurysms.

We report the case of a large fusiform aneurysm of the anterior cerebral artery in a 3-month-old girl presenting with generalized seizures and complicated by a cardiorespiratory arrest needing resuscitation. The native cerebral CT scan revealed a diffuse subarachnoid hemorrhage (Fischer III grade); CT angiography showed an aneurysm of the distal A1 segment of the anterior cerebral artery (ACA). Successful treatment was achieved through surgical trapping of the aneurysm and sacrifice of the distal A1 segment. A histological study of the aneurysmal wall revealed the absence of elastic fibers in an otherwise fibromuscular media and showed no signs of previous hemorrhage. Intracranial aneurysms of the ACA are very rare in the early stage of life and their pathogenesis is not clear. This case is of interest as the location and shape of the aneurysm, the absence of relevant familial and medical history, and the histopathological findings raise the hypothesis of a congenital origin. It further describes the value of CT angiography for studying aneurysms in the very young.

Purpose: Investigation of the sites of intracranial aneurysms and incidence of associated congenital variations or anomalies., Materials and Methods: One hundred and ninety cerebral angiography examinations that were positive for aneurysm were evaluated retrospectively. Fourteen cases with vasospasm were excluded and the remaining 176 patients were assessed for the location of the aneurysm and co-incidental vascular variations and/or anomalies. There were two observers in the study, one of whom was an experienced vascular radiologist., Results: The most frequent locations of aneurysms were the supraclinoid internal carotid artery (32%, n=74), anterior communicating artery (30%, n=68), and middle cerebral artery bifurcation (23%, n=52). Twenty-eight patients (17%) had multiple aneurysms. Ninety-one (52%) patients had a vascular anomaly or variation. Hypoplasia or agenesis of A1 segment of the anterior cerebral artery was found in 48 patients, an azygous anterior cerebral artery in 1, a frontoorbital artery in 1, a duplicated middle cerebral artery in 1, early bifurcation of the middle cerebral artery in 9, persistent fetal origin of the posterior cerebral artery in 26, fenestration of P1 segment of posterior cerebral artery in 1, agenesis of P1 segment of posterior cerebral artery in 1, fenestration of vertebral artery in 1, double trunk visualization of superior cerebellar artery in 2 patients., Conclusion: Due to an increased hemodynamic stress, congenital anomalies of the intracranial arteries predispose to the formation of saccular aneurysms. Nomalies such as A1 hypoplasia or agenesis, azygous anterior cerebral artery, accessory middle cerebral artery and persistent trigeminal artery are detected more frequently in patients with cerebral aneurysms compared to the normal population. The location of aneurysms and the frequency of arterial variations and anomalies in this study correlated well with data found in previous studies.

We report the case of a term newborn with vein of Galen aneurysm. No antenatal diagnosis was done. The infant was admitted secondary to cardiac failure, with cardiomegaly and pulmonary hypertension. Physical examination was remarkable for acrocyanosis, microcephaly, cranial bruit, bilateral neck swelling, coarse breath sounds, and a hyperdynamic precordium with continuous murmur. Head ultrasound demonstrated a large, midline venous structure. Computed tomographic scan confirmed vein of Galen malformation.

Basilar artery (BA) aplasia when unaccompanied by a primitive carotid-vertebrobasilar anastomosis is exceedingly rare. The association of BA aplasia with two aneurysms on the dominant posterior communicating artery (PCoA) has not been previously reported. This 40-year-old man presented in a state of drowsiness and responded to simple commands only after being coaxed. He had complete left cranial third nerve palsy, right hemiparesis, and persisting signs of meningeal irritation. A computerized tomography (CT) scan revealed subarachnoid and intraventricular hemorrhage. An angiogram revealed BA aplasia. The right PCoA followed a sinuous course with multiple loops and provided the dominant supply to the posterior circulation. This vessel harbored two aneurysms, one at the origin of the PCoA from the internal carotid artery and the other at the looping segment just proximal to the brainstem. The left PCoA was extremely thin. The pterional transsylvian approach was used to clip the two aneurysms on the PCoA. The hemodynamic changes produced by the BA aplasia may have produced alterations in the cerebral vasculature leading to aneurysm formation and consequent subarachnoid hemorrhage.

As far as the prognosis is concerned, it is important to diagnose the exact type of congenital cystic adenomatoid malformation (CCAM) in order to exclude associated anomalies, as well as the risk of development of malignancies in later life. The frequency of associated malformations of CCAM type 4 is unknown. We report a 4-month-old boy with CCAM type 4 and aneurysmal malformation of the vein of Galen (AVG). Although AVG is the most frequent arteriovenous malformation during childhood, this is the first case report, to our knowledge, of CCAM type 4 in association with an anomaly. In addition, we speculate that the relation between CCAM type 4 and AVG appears to be more likely a possibly related association rather than a rare coincidence, as both malformations develop at the same stages of embryonic life, and pathogenetically, apoptosis play a significant role in both entities. However, further studies are needed to validate this speculation placing emphasis on the association of the two anomalies, otherwise a rare coincidence cannot be excluded.

Background: Fenestration of vertebrobasilar junction is a rare congenital anomaly and often associated with aneurysm formation. We describe five cases of vertebrobasilar junction aneurysms in four patients associated with fenestration, which were treated with endovascular coil occlusion using Guglielmi detachable coils (GDCs). The importance of preoperative computed tomography (CT) angiography to understand the complex anatomy of fenestration and aneurysm is emphasized., Case Reports: Three patients presented with subarachnoid hemorrhage and one patient presented with headache only. Among 3 patients with subarachnoid hemorrhage, 1 patient was referred for endovascular coil occlusion after clipping of ruptured distal ACA aneurysm. A six-French guiding catheter was placed in the left vertebral artery via right femoral artery, except for 1 patient who had two vertebrobasilar junction aneurysms with complex anatomic relationship, accessed bilaterally. Five vertebrobasilar junction aneurysms with fenestration were treated with endovascular coil occlusion using GDCs. Postoperative angiography demonstrated successful occlusion of aneurysmal sac with preservation of basilar artery., Conclusions: Vertebrobasilar junction aneurysms are frequently associated with fenestrations. In addition to vertebral angiography on both sides, CT angiography may be a valuable tool for better understanding of complex anatomy of aneurysms associated with fenestration. The surgically difficult aneurysms such as vertebrobasilar junction aneurysm with fenestration can be successfully treated with GDCs.

An arteriovenous fistula (AVF) is an abnormal connection between an artery and a vein, whereby the interconnecting capillary network is missing. Such a malformation frequently occurs in the deep midline regions of the brain, and the subsequent increased flow into the draining vein of Galen substantially dilates in an aneurysmal manner. Congenital forms of the aneurysmal dilatation of the vein of Galen (AVG) often lead to death in the neonatal period, predominantly due to cardiac failure caused by the increased venous inflow as a consequence of the intracerebral arteriovenous shunting. In the presented case a male baby suffered from a rare combination of a cerebral AVF and an atrial septal defect (ASD). He was born at week 38 of pregnancy and subsequently developed tachydyspnoe. Ultrasound (US) and CT scans revealed a large bilateral AVF with dilated basal venous sinuses, hydrocephalus and brain atrophy. In the heart, severe right ventricular hypertrophy, patent ductus arteriosus and an ASD were detectable by US. Neurosurgical consultation rejected the possibility of an operative treatment due to size and localization of the lesion and the existing irreversible brain damage. The child died because of cardiac failure 6 days after birth. Autopsy examination in the brain demonstrated a large conglomerate of dilated blood vessels predominantly in the midline and left occipital lobe, edema and hydrocephalus. In the heart, the ASD detected by US proved to be an ostium secundum-type lesion. Histologically, the conglomerate of vessels revealed features of an AVF and matched the characteristics of AVG. Consequences of chronic ischemic brain injury were also present, with ferruginated neurons suggesting intrauterine damage caused by a congenital AVF. Based on data in the literature, we assume that the left-to-right shunt due to increased venous influx into the heart caused not only cardiomegaly, but may have also interfered with the normal development of the atrial septum leading to an ASD, contributing to the rapid progression of the cardiac failure.

We applied computational fluid dynamic (CFD) analysis on the numerical grid of a 3D rotational digital subtraction angiogram obtained in a 22-year-old male patient, with an accidentally discovered vein of Galen malformation associated with single feeder aneurysm, to understand the flow pattern through the two aneurysms and improve our general understanding of hemodynamic characteristics of this variety of fusiform aneurysm. This technical note provides a good example of the application of CFD to 3D digital subtraction angiography for studying the flow pattern in patients with cerebrovascular disease.

Intracranial aneurysms in infants are rare, but are associated with a high risk of rupture and subarachnoid hemorrhage. The authors report a case of an incidentally diagnosed, probably congenital, asymptomatic giant aneurysm of the posterior communicating artery in a 9-month-old girl, which completely thrombosed following a diagnostic superselective angiography without any neuropathological incident. Follow-up magnetic resonance imaging revealed that the aneurysm decreased further in size and was largely resorbed within 3 years after the initial finding. In single cases the natural history of congenital giant aneurysms may be better than previously assumed.

Background and Purpose: Neonates with vein of Galen aneurysmal malformations (VGAMs) presenting with cardiac failure have high morbidity and mortality, and outcomes are significantly better in those presenting in later childhood. Neurologic outcomes in survivors are perceived to be uniformly poor, which may lead to the neonate being denied treatment. We assessed outcomes of modern neonatal intensive care and endovascular embolization in a consecutive series of such neonates presenting with cardiac failure., Methods: Between 1996 and 1998, five infants (three male, two female) were diagnosed with symptomatic VGAMs in the first week of life, four of whom had intractable, high-output cardiac failure and underwent initial endovascular treatment. There were 15 endovascular procedures and one neurosurgical clipping in these five patients. Transarterial and transvenous routes were required, using multiple embolic agents. We emphasized the use of sonographically guided, percutaneous transtorcular-venous-access, moveable-core guidewire as an embolic agent; routine MR imaging; and MR angiography., Results: Immediate outcomes included control of cardiac failure with normal neurologic function in four (80%) patients and one (20%) death from intractable cardiac failure. On follow-up examination, three (60%) infants showed no evidence of neurologic abnormality or cardiac failure; one (20%) infant showed moderate developmental delay. Two have had no further shunting on angiography, one has minimal flow, and one is awaiting follow-up imaging., Conclusion: Endovascular therapy with modern neuroanesthetic and neurointensive care can provide good outcomes even in the highest-risk neonates with VGAMs and cardiac failure. If medical management of cardiac failure fails, and there is no evidence of gross cerebral parenchymal damage on imaging, urgent endovascular treatment is feasible and can reduce the almost-100% mortality otherwise expected, without invariably severe morbidity. Use of multiple embolization strategies in multiple stages usually is necessary in these patients, and novel approaches and embolic agents may be necessary.

We report a case of basal subarachnoid hemorrhage in a child. The etiology of this lesion was difficult to diagnose. The patient was a 9-year-old boy. He sustained minor head injury followed by loss of consciousness and cardiopulmonary arrest. He was brought to our emergency room by ambulance. On arrival, he presented with cardiopulmonary arrest and deep comatose state. Basal subarachnoid hemorrhage was revealed on CAT scan. 3D-CTA documented two bulging portions: one was at the junction between the left vertebral artery and the left posterior inferior cerebellar artery. The other one was shown at the basilar artery. He died on the 7th hospital day. The autopsy revealed a laceration of the left vertebral artery. Microscopically, the wall around the laceration showed a defect in the internal elastic membrane and a decrease of smooth muscle cells with moderate fibrosis in the tunica media. These findings were compatible with the structure of a congenital aneurysm. Hence, the patient was strongly suspected to have had a congenital aneurysm whose rupture was triggered by minor head injury.

In neonates, aneurysm of the vein of Galen often masquerades as cyanotic congenital heart disease. We report 4 cases of neonates presenting with malformation of the vein of Galen at our insititution. An increased awareness of this entity seems warranted.

We describe a case of aneurysm of the vein of Galen (AVG), which was diagnosed by intrauterine US, MRI and MRA. The baby girl was born at 35 weeks' gestation. She had severe clinical symptoms at birth and died at 29 h of age from intractable congestive heart failure. Intrauterine US detected an intracranial aneurysm and cardiomegaly due to excessive arteriovenous shunting. Intrauterine MRI (SSFSE) confirmed the diagnosis of AVG, and intrauterine MRA (2D-TOF) successfully demonstrated the anatomical structure of the AVG. MRA may be a useful additional sequence to evaluate AVG, and 2D-TOF is thought to be an appropriate technique for scanning fetal AVG.

We present a follow-up study on a 5-year-old boy who was born with vein of Galen aneurysmal malformation (VGAM) accompanied by extreme cardiovascular distress. He was successfully treated by the staged endovascular technique during the neonatal stage. Postoperative angiographic study confirmed complete occlusion of the VGAM and the establishment of normal brain perfusion. At 5 years of age, the child is growing normally without neurological deficits or developmental retardation. We suggest that the restoration of normal brain perfusion in neonates with VGAM can cause normal brain development., (Copyright 2000 S. Karger AG, Basel)

A 5-year-old boy with macrocephaly and mental retardation was referred for radiologic evaluation. After cranial CT and MR imaging, the diagnosis of mural type vein of Galen aneurysmal malformation was established by angiography. Two weeks later, preembolization angiography revealed complete thrombosis of the malformation. Although it is a very rare event, vein of Galen aneurysmal malformation may spontaneously thrombose following diagnostic angiography. Possible effects of contrast media on thrombosis were discussed.

Vein of Galen aneurysmal malformations (VGAMs) are rarely seen intracranial congenital vascular malformations with extremely complex vascular architectures. We present two newborns with an unclear intracranial mass being discovered in routine intrauterine ultrasonography. Magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) identified these lesions as VGAMs. Besides conventional MRA analysis, "virtual cisternoscopy"-a special kind of virtual endoscopy combining perspective volume rendering and motion-was applied to assess the intracranial vasculature. One newborn was treated by means of interventional neuroradiology with coiling of the median prosencephalic vein. The clinical outcome in this case was excellent. The other will undergo interventional therapy shortly.

The authors reported the surgical experience of two cases of vein of Galen aneurysmal malformation in the newborn, whose congestive high-output cardiac failure was intractable. Along with the intensive care to clinical manifestations of the heart failure, multi-staged feeder clipping was carried out to decrease the high-flow shunt of the malformation. As stages going on, heart failure was relieved gradually and cathecolamines were weaned. Although certain retardation became apparent in both cases, they are showing satisfactory development in the long-term follow up. By the recent advancement of the embolization technique, the embolization appears to have already taken place the treatment of choice for this malformation. According to the neonatal evaluation score of Lasjaunias, the embolization would no longer be recommendation in neonates, whose general condition scored less than eight points. The authors believe, based on our two cases, that multi-staged feeder clipping is one of the effective modality of treatment in neonates of the vein of Galen aneurysmal malformation with severe multiorgan failure.

We studied three patients with aneurysmal malformations of the vein of Galen: all underwent embolisation followed by MRI and conventional angiography; two also underwent postembolisation magnetic resonance angiography (MRA). MRI was performed before treatment in two patients, MRA in only one, diagnosed prenatally. Two patients had normal appearances on follow-up MR studies and were completely cured by embolisation. However, the last patient, after two embolisations, despite the stabilisation of the clinical condition, underwent surgery and died. We think MRI is mandatory before endoarterial treatment, to assess the conditions of the brain. Angiography is mandatory only at the time of endovascular treatment, while MRA and MRI have a role in follow-up. Endoarterial embolisation remains the treatment of choice, and surgery is not advisable.

This article reviews the current understanding of genetic factors involved in the development of intracranial aneurysms. Of the large number of heritable connective tissue disorders that have been associated with intracranial aneurysms, three are discussed in detail: autosomal dominant polycystic kidney disease, Ehlers-Danlos syndrome type IV, and alpha 1-antitrypsin deficiency. The author reviews the familial occurrence of intracranial aneurysms, which is found in about one-fifth of patients with aneurysm subarachnoid hemorrhage. Guidelines are provided for the evaluation of patients with familial intracranial aneurysms and screening of their relatives.

A ten month old unconscious boy with hemiplegia (Hunt and Hess IV) was first admitted to a district hospital without a CT scanner or a neurosurgical service (Glasgow-Coma-Score 4, no pathological pupillary signs). Therefore, he was transferred to the Pediatric Department of the University Hospital the same night. An emergency CT scan that night showed intracerebral and subarachnoid hemorrhage with enlarged ventricle (Fisher grade 5). Angiography was not available within reasonable time. Thus in the stage of progressively increasing clinical deterioration, still without pupillary signs, an external ventricular drain-age was placed. Immediately after reduction of the cerebrospinal fluid volume, arterial hypertension was noticed--the right pupil was mydriatic and fixed. Without further apparative diagnosis an emergency craniotomy was performed for decompression under the suspicion of a secondary hemorrhage due to a rerupture of a middle cerebral artery aneurysm. A bleeding aneurysm of the right middle cerebral artery was found and clipped. A mass transfusion was necessary and a pulmonary air embolism occurred. The infant died in tabula. The histological specimens revealed disruption of the internal elastic membrane of both MCA. This emphasizes a congenital nature of the aneurysm. We conclude that cerebral arterial aneurysms have to be considered in the differential diagnosis of stroke-like symptoms in infancy and early childhood, although the incidence of reported cases is less than one case per year. Since no valid screening parameter is available, diagnosis is often made only after rupture of the aneurysm. This causes problems for emergency management. Infants and children with stroke or stroke-like symptoms should immediately be transferred to a hospital with a neurosurgical unit.

We report the case of a 29-year-old woman in whom a saccular aneurysm of the distal anterior cerebral artery developed following head trauma due to a car accident. She was semicomatose on admission but had no lateralizing motor signs. Reflexes were symmetrical, with bilateral extensor toe sign. X-ray of the skull showed no fracture but CT scans demonstrated a large frontal hematoma and interhemispheric bleeding. Initial cerebral angiography performed within 12 hours of trauma showed a small protrusion on the pericallosal portion of the left pericallosal artery with no branching point nearby. Angiography was repeated on the 9th day after admission and confirmed the presence of a saccular aneurysm of the pericallosal artery, which had been visible as a small protrusion on the initial angiogram. Traumatic aneurysm was suspected and successful neck clipping of the aneurysm was performed on the 14th day. Preoperative CT and angiographic findings could not rule out a congenital aneurysm but the histological study of the specimen confirmed that it was a traumatic false aneurysm. We discussed the diagnosis and the etiology of posttraumatic aneurysm.

Purpose: To report the comprehensive superselective angiographic characteristics of aneurysms associated with cerebral arteriovenous malformations., Method: One hundred consecutive patients referred for cerebral arteriovenous malformation embolization underwent preembolization superselective angiography. Superselective angiograms were obtained after microcatheterization of arteriovenous malformation pedicles, and assessed for number and location of aneurysms related to the malformation. A chi 2 test was conducted to correlate these parameters with the onset of intracranial hemorrhage., Results: Aneurysms were demonstrated in 58 of 100 patients. Single aneurysms were found in 24 patients and multiple aneurysms in 34. Presence and number of aneurysms were found to correlate significantly with a clinical presentation of hemorrhage., Conclusion: Superselective angiography was found to be of paramount importance in elucidating the precise and detailed angioarchitecture of brain arteriovenous malformations.

Dural arteriovenous malformations (dAVMs) are uncommon lesions that constitute about 12% of all the arteriovenous malformations. Depending on the location and the hemodynamics of the lesion, bruit, focal neurological deficit, and visual symptoms represent the more common presentation modalities. Although uncommon, intracranial hemorrhage can occur. In the present study, we report six patients with dural arteriovenous malformation that presented with intracranial hemorrhage. In five cases the hemorrhage was intraparenchymal (localized to the parietooccipital area in three), while it was confined to the subarachnoid space in the remaining one. The dAVM involved the transverse sinus in three cases, was based along the tentorial incisura in two, and was at the level of the torcular Herophili in one. Leptomeningeal drainage was present in all the cases. Aneurysmal dilatation of the draining vein(s) was identified in three. Sinus stenosis/occlusion was identified in two of the four patients with a dAVM draining into a major dural sinus. Four patients underwent pre-operative embolization, and all patients had surgical resection of their lesions. Anatomical cure, as defined by absence of any residual dAVM on postoperative angiogram, was achieved in all six patients. We conclude that several findings such as leptomeningeal drainage, location outside a major venous sinus, variceal dilatation, sinus stenosis/occlusion increase the risk of bleeding and are frequently observed in those dAVMs that present with intracranial hemorrhage. Recognition of these angiographic features is critical in planning a therapeutic approach tailored to the characteristics of the individual case. When these angiographic findings are present, prompt and definitive treatment is mandatory.(ABSTRACT TRUNCATED AT 250 WORDS)

Brain aneurysms are generally subdivided into so-called congenital and acquired (atherosclerotic, embolic and others). This classification does not reflect the reality as more than twenty brain aneurysms of different origin are already known. The classification suggested by the author is grounded on two interconnected features--etiology and pathogenesis--and uses also the term "bifurcation-hemodynamic aneurysms" (instead of so-called congenital aneurysms). This term reflects current understanding of aneurysm etiology and allows one to overcome the psychological barrier which prevented to create a rational classification.

A rare case of systemic multiple aneurysms located in the extracranial internal carotid artery, intracranial vertebral artery, and intraperitonial arteries is described. A 56-year-old woman was referred to our hospital with suspected rupture of an aneurysm of the right extracranial internal carotid artery. Digital subtraction angiography demonstrated a giant aneurysm in the right extracranial internal carotid artery and an aneurysm of fusiform type of the left intracranial vertebral artery. The extracranial carotid artery aneurysm was successfully resected, with end-to-end anastomosis of the internal carotid artery, preserving the cranial nerves. Five days later, an aneurysm of the left hepatic artery ruptured unexpectedly and was treated with emergency surgery. Other aneurysms in the liver and spleen were identified on postoperative celiac angiography. The patient subsequently underwent an operation for a left intracranial vertebral artery aneurysm by proximal clipping.

The authors demonstrate a patient with fenestration of the anterior cerebral artery. The fenestration is in the horizontal portion of the anterior cerebral artery (A1). Its embryonic origin and clinical importance arouse discussion. The paper reviews the literature on the subject.

In this paper, the major theories on the formation and growth of saccular aneurysms are reviewed on the basis of previous clinical, pathological and experimental studies. Which is the critical layer is still the focus of debate. Current ideas can be summarized as follows: most researchers think that disruption of the internal elastic lamina is an essential requirement for the creation of saccular aneurysms because it is this layer that provides most of the strength to the arterial wall, especially in cerebral arteries. Degeneration of this layer is a constant feature of all saccular aneurysms. A coexisting medial defect and haemodynamic stress at an apex may aggravate degeneration at that point. Hypertension does not seem to be the major factor in some aneurysm patients, but it may facilitate the formation and growth of saccular aneurysms. An atheroma is often associated with saccular aneurysms, but its effect on this pathological process is still unknown. Other factors are discussed concisely. Previous experimental methods and their results pertaining to the formation and growth of this type of aneurysm are also reviewed. A reproducible animal model is still required to allow various theories to be tested.

The occurrence of intracranial aneurysms in the pediatric population is a rare phenomenon. An unusual case of aneurysmal dilatation of both petrous and cavernous carotid arteries and the vertebral-basilar junction in a child is presented. The underlying etiology, natural history, and possible modes of management are reviewed and discussed.

Neuroradiologic and neuropathologic findings on neonatal aneurysmal dilation of the vein of Galen are reported. Doppler echocardiography revealed a diastolic reversed Doppler signal, which suggested the presence of a cerebral arteriovenous fistula. Cerebral ultrasonography with intravenous injection of contrast medium was useful in the diagnosis. Digital subtraction cerebral angiography clearly demonstrated both the feeding and draining vessels and the aneurysmal dilation of the vein of Galen, although it failed to detect the abnormal vascular channels. Pathologic and histopathologic findings demonstrated intimal thickening of the abnormal vascular channels, which could produce higher vascular resistance and result in the detection failure with digital subtraction angiography.