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Ruptured venous aneurysm of cervicomedullary junction.

Aggarwal A, Salunke P, Futane S, Mathuriya SN, Kumar A, Mukherjee KK, Radotra BD - Surg Neurol Int (2014)

Bottom Line: During surgery, a saccular pliable structure approx. 1.5 × 1 cm was found in the subarachnoid space that was clipped and excised.The possible etiologies remain an unnoticed head trauma or a congenital vessel wall abnormality.Surgically clipping and excision remains the treatment of choice for such lesion.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, PGIMER, Chandigarh, India.

ABSTRACT

Background: Ruptured venous aneurysm is often seen with arterio-venous malformation (AVM) or developmental venous anomaly (DVA). However, isolated venous aneurysm is unusual.

Case description: We present a case of ruptured venous aneurysm that presented with subarachnoid hemorrhage (SAH) and intraventricular hemorrhage (IVH). Digital substraction angiography (DSA) revealed a saccular contrast filling pouch in the left lateral aspect of cervicomedullary junction (CMJ). Endovascular intervention was not a viable option. During surgery, a saccular pliable structure approx. 1.5 × 1 cm was found in the subarachnoid space that was clipped and excised. There were no arterial feeders, no evidence of surrounding AVM, and no dilated perimedullary vein.

Conclusion: This is perhaps the first reported case of ruptured venous aneurysm (without associated AVM) of CMJ, which was successfully managed surgically. The possible etiologies remain an unnoticed head trauma or a congenital vessel wall abnormality. Surgically clipping and excision remains the treatment of choice for such lesion.

No MeSH data available.


Related in: MedlinePlus

Intraoperative images showing: (a) a large pliable vascular lesion (marked with star), (b) dissection being done to identify the neck, (c) the feeding vein (dialated) being skeletonized and (d) aneurysm clip applied at the feeding vein. Aneurysm partially (hidden from view) marked with a star
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Figure 2: Intraoperative images showing: (a) a large pliable vascular lesion (marked with star), (b) dissection being done to identify the neck, (c) the feeding vein (dialated) being skeletonized and (d) aneurysm clip applied at the feeding vein. Aneurysm partially (hidden from view) marked with a star

Mentions: Patient was operated through a midline suboccipital craniectomy with excision of posterior arch of atlas. Dura was opened in Y shape. There was no apparent dural AVM. There was evidence of old subarachnoid blood with presence of thick subarachnoid adhesions. A saccular pliable structure approx. 1.5 × 1cm was found in the subarachnoid space. Its color was indicative of venous blood. Careful dissection revealed the attachment/neck of the aneurysm with a vein. There were no arterial feeders, or evidence of surrounding AVM or dilated perimedullary vein. This aneurysm was clipped and excised [Figure 2a–d]. Gross examination revealed a thin walled vascular structure with no arterial ostia. There was a thrombus present. HPR revealed a single layer of fibromuscular tissue lined [Figure 3a] by a flat endothelium. There were no signs of sclerosis or inflammation. There was no muscle layer [Figure 3b and c]. Patient was discharged on 5th postoperative day. Postoperative DSA did not show any aneurysm/AVM. On the last follow up at 5 months after surgery, the patient has no focal deficits and has joined work.


Ruptured venous aneurysm of cervicomedullary junction.

Aggarwal A, Salunke P, Futane S, Mathuriya SN, Kumar A, Mukherjee KK, Radotra BD - Surg Neurol Int (2014)

Intraoperative images showing: (a) a large pliable vascular lesion (marked with star), (b) dissection being done to identify the neck, (c) the feeding vein (dialated) being skeletonized and (d) aneurysm clip applied at the feeding vein. Aneurysm partially (hidden from view) marked with a star
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3927081&req=5

Figure 2: Intraoperative images showing: (a) a large pliable vascular lesion (marked with star), (b) dissection being done to identify the neck, (c) the feeding vein (dialated) being skeletonized and (d) aneurysm clip applied at the feeding vein. Aneurysm partially (hidden from view) marked with a star
Mentions: Patient was operated through a midline suboccipital craniectomy with excision of posterior arch of atlas. Dura was opened in Y shape. There was no apparent dural AVM. There was evidence of old subarachnoid blood with presence of thick subarachnoid adhesions. A saccular pliable structure approx. 1.5 × 1cm was found in the subarachnoid space. Its color was indicative of venous blood. Careful dissection revealed the attachment/neck of the aneurysm with a vein. There were no arterial feeders, or evidence of surrounding AVM or dilated perimedullary vein. This aneurysm was clipped and excised [Figure 2a–d]. Gross examination revealed a thin walled vascular structure with no arterial ostia. There was a thrombus present. HPR revealed a single layer of fibromuscular tissue lined [Figure 3a] by a flat endothelium. There were no signs of sclerosis or inflammation. There was no muscle layer [Figure 3b and c]. Patient was discharged on 5th postoperative day. Postoperative DSA did not show any aneurysm/AVM. On the last follow up at 5 months after surgery, the patient has no focal deficits and has joined work.

Bottom Line: During surgery, a saccular pliable structure approx. 1.5 × 1 cm was found in the subarachnoid space that was clipped and excised.The possible etiologies remain an unnoticed head trauma or a congenital vessel wall abnormality.Surgically clipping and excision remains the treatment of choice for such lesion.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, PGIMER, Chandigarh, India.

ABSTRACT

Background: Ruptured venous aneurysm is often seen with arterio-venous malformation (AVM) or developmental venous anomaly (DVA). However, isolated venous aneurysm is unusual.

Case description: We present a case of ruptured venous aneurysm that presented with subarachnoid hemorrhage (SAH) and intraventricular hemorrhage (IVH). Digital substraction angiography (DSA) revealed a saccular contrast filling pouch in the left lateral aspect of cervicomedullary junction (CMJ). Endovascular intervention was not a viable option. During surgery, a saccular pliable structure approx. 1.5 × 1 cm was found in the subarachnoid space that was clipped and excised. There were no arterial feeders, no evidence of surrounding AVM, and no dilated perimedullary vein.

Conclusion: This is perhaps the first reported case of ruptured venous aneurysm (without associated AVM) of CMJ, which was successfully managed surgically. The possible etiologies remain an unnoticed head trauma or a congenital vessel wall abnormality. Surgically clipping and excision remains the treatment of choice for such lesion.

No MeSH data available.


Related in: MedlinePlus