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Seven Intracranial Aneurysms in One Patient: Treatment and Review of Literature.

Ahmed O, Kalakoti P, Hefner M, Cuellar H, Guthikonda B - J Cerebrovasc Endovasc Neurosurg (2015)

Bottom Line: Initial workup showed a subarachnoid hemorrhage in the right Sylvian fissure.Further angiographic workup showed 7 intracranial aneurysms (left and right middle cerebral artery bifurcation, right middle cerebral artery, anterior communicating artery, left posterior communicating artery, right posterior inferior cerebellar artery, and left superior cerebellar artery).The need for anti-platelet agents for endovascular treatment of the posterior circulation aneurysms and clinical presentation warranted surgical clipping of the anterior circulation aneurysms prior to endovascular therapy.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, LA, USA.

ABSTRACT
Before the advent of endovascular coiling, patients with multiple intracranial aneurysms were treated with surgical clipping; however, with the advancements in endovascular technology, intracranial aneurysms can be treated with surgical clipping and/or endovascular coiling. We describe a case of subarachnoid hemorrhage in a patient with 7 intracranial aneurysms. A 45-year-old female developed a sudden headache and left sided hemiparesis. Initial workup showed a subarachnoid hemorrhage in the right Sylvian fissure. Further angiographic workup showed 7 intracranial aneurysms (left and right middle cerebral artery bifurcation, right middle cerebral artery, anterior communicating artery, left posterior communicating artery, right posterior inferior cerebellar artery, and left superior cerebellar artery). The patient underwent two craniotomies for surgical clipping of the anterior circulation aneurysms and endovascular stent-assisted coils for the posterior circulation aneurysms. The need for anti-platelet agents for endovascular treatment of the posterior circulation aneurysms and clinical presentation warranted surgical clipping of the anterior circulation aneurysms prior to endovascular therapy. We describe a case report and decision making for a patient with multiple intracranial aneurysms treated with surgical clipping and endovascular coiling.

No MeSH data available.


Related in: MedlinePlus

CT head without contrast showing a hyperdensity in the right Sylvian fissure.
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Figure 1: CT head without contrast showing a hyperdensity in the right Sylvian fissure.

Mentions: A CT scan showed a subarachnoid hemorrhage (SAH) located in the right Sylvian fissure (Fig. 1). CT angiogram demonstrated concomitant multiple intracranial aneurysms. Digital subtraction angiography (DSA) showed a total of 7 intracranial aneurysms (Fig. 2, 3, 4, 5, 6, 7, 8). The angiogram showed right middle cerebral artery (M1) and middle cerebral artery (MCA) bifurcation aneurysm, left MCA bifurcation aneurysm, left posterior communicating artery (PCOM) aneurysm, anterior communicating artery (ACOM) aneurysm (filling from both the right and left carotid injections), left superior cerebellar artery (SCA) and a right posterior inferior cerebellar artery (PICA) aneurysm.


Seven Intracranial Aneurysms in One Patient: Treatment and Review of Literature.

Ahmed O, Kalakoti P, Hefner M, Cuellar H, Guthikonda B - J Cerebrovasc Endovasc Neurosurg (2015)

CT head without contrast showing a hyperdensity in the right Sylvian fissure.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4495085&req=5

Figure 1: CT head without contrast showing a hyperdensity in the right Sylvian fissure.
Mentions: A CT scan showed a subarachnoid hemorrhage (SAH) located in the right Sylvian fissure (Fig. 1). CT angiogram demonstrated concomitant multiple intracranial aneurysms. Digital subtraction angiography (DSA) showed a total of 7 intracranial aneurysms (Fig. 2, 3, 4, 5, 6, 7, 8). The angiogram showed right middle cerebral artery (M1) and middle cerebral artery (MCA) bifurcation aneurysm, left MCA bifurcation aneurysm, left posterior communicating artery (PCOM) aneurysm, anterior communicating artery (ACOM) aneurysm (filling from both the right and left carotid injections), left superior cerebellar artery (SCA) and a right posterior inferior cerebellar artery (PICA) aneurysm.

Bottom Line: Initial workup showed a subarachnoid hemorrhage in the right Sylvian fissure.Further angiographic workup showed 7 intracranial aneurysms (left and right middle cerebral artery bifurcation, right middle cerebral artery, anterior communicating artery, left posterior communicating artery, right posterior inferior cerebellar artery, and left superior cerebellar artery).The need for anti-platelet agents for endovascular treatment of the posterior circulation aneurysms and clinical presentation warranted surgical clipping of the anterior circulation aneurysms prior to endovascular therapy.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, LA, USA.

ABSTRACT
Before the advent of endovascular coiling, patients with multiple intracranial aneurysms were treated with surgical clipping; however, with the advancements in endovascular technology, intracranial aneurysms can be treated with surgical clipping and/or endovascular coiling. We describe a case of subarachnoid hemorrhage in a patient with 7 intracranial aneurysms. A 45-year-old female developed a sudden headache and left sided hemiparesis. Initial workup showed a subarachnoid hemorrhage in the right Sylvian fissure. Further angiographic workup showed 7 intracranial aneurysms (left and right middle cerebral artery bifurcation, right middle cerebral artery, anterior communicating artery, left posterior communicating artery, right posterior inferior cerebellar artery, and left superior cerebellar artery). The patient underwent two craniotomies for surgical clipping of the anterior circulation aneurysms and endovascular stent-assisted coils for the posterior circulation aneurysms. The need for anti-platelet agents for endovascular treatment of the posterior circulation aneurysms and clinical presentation warranted surgical clipping of the anterior circulation aneurysms prior to endovascular therapy. We describe a case report and decision making for a patient with multiple intracranial aneurysms treated with surgical clipping and endovascular coiling.

No MeSH data available.


Related in: MedlinePlus