This supplement of the Acta Neurochirurgica is dedicated to professor Helge Nornes on the occasion of his retirement. Helge Nornes started his neurosurgical training in Oslo in 1965. In 1980 he was offered the neurosurgical chair of Bern, Switzerland, where he stayed until 1983 when his old university called him ...

Although many reports have described the rebleeding risk of the ruptured aneurysm in already hospitalized patients, there are only a few reports that have addressed the incidence of rebleeding in these patients before hospitalization. To improve the prognosis of patients with a ruptured intracranial aneurysm, it seems very important to ...

The caudal intercarotid artery was investigated in 6 species of Equidae family and in lowland tapir of Tapiridae family. It was found that this artery connects bilateral intracranial segments of the internal carotid artery. It is located in the cavernous and intercavernous sinuses, caudal to the hypophysis. This artery being ...

Intracerebral haemorrhage may occur several hours after intracranial surgery. The exact mechanism by which this occurs is still unclear, although prolonged brain retraction is considered to be the most responsible factor. In these delayed postoperative haematoma cases, serial angiography has never been performed. We performed angiographic evaluation in such 12 ...

BACKGROUND: Traumatic intracranial aneurysms (TICAs) may develop following gunshot injuries to the head. Management of these lesions often combines various aspects of microneurosurgical and endovascular techniques to safely repair or obliterate vessel defects. METHODS: We reviewed our experience over the last 18 years and identified five cases of intracranial aneurysms ...

BACKGROUND: The management of unruptured intracranial aneurysms requires knowledge of the natural history of these lesions and the risks of repairing them. METHODS: A total of 2621 patients at 53 participating centers in the United States, Canada, and Europe were enrolled in the study, which had retrospective and prospective components. ...

Two patients with known intracranial aneurysms (ICA) received electroconvulsive therapy (ECT). The first patient received ECT 4 years after the clipping of a right middle cerebral artery aneurysm. Treatment with esmolol failed to completely prevent an increase in blood pressure, but she did well nonetheless. The second patient underwent clipping ...

OBJECTIVE: This study was designed to elucidate the requirements for angiographic evaluation in blunt head injuries, the timing of angiography, and the selection of appropriate therapeutic approaches. METHODS: Twelve cases of traumatic aneurysms (TAs) in the intracranial carotid tree were analyzed in this study. Neurological examination results, computed tomographic scans, ...

OBJECT: Isolated polycystic liver disease, that is, polycystic liver disease without kidney cysts, is an entity distinct from polycystic kidney disease. It is not known whether patients with isolated polycystic liver disease are at an increased risk for developing intracranial aneurysms, similar to patients with polycystic kidney disease. The authors ...

This paper introduces a different visualization method which we call "virtual cisternoscopy" using 3D MRA data sets. Virtual cisternoscopy uses well known tools, such as perspective volume rendering (pVR), fly-through techniques, and interactive visualization and combines them to a new approach featuring motion to resolve spatial relationships of intracranial vessels ...

The authors describe the use of a microanastomotic device to perform intracranial end-to-end vascular anastomoses. Direct end-to-end anastomosis was performed between the superficial temporal artery and branches of the middle cerebral artery (MCA) in three patients. Two patients had moyamoya disease, with severe proximal MCA disease, and one suffered an ...

BACKGROUND AND OBJECTIVE: In families with two or more relatives with subarachnoid hemorrhage (SAH), other first-degree relatives have an increased risk of SAH. We studied the presence of unruptured intracranial aneurysms in 125 members of 23 families with familial SAH, defined as two or more affected first-degree relatives, in a ...

The different interventional neuroradiological procedures are continually developing. New fields such as fibrinolytic therapy or intracranial stent treatment of vascular stenosis have become the object of interest. The analysis of the results of intravascular procedures has become more refined, with a critical evaluation of the quality of results and complication ...

OBJECTIVES: A retrospective study was carried out on 13 patients with intracranial dural arteriovenous fistulas (DAVFs) who presented with isolated or associated signs of intracranial hypertension. METHODS: Nine patients presented with symptoms of intracranial hypertension at the time of diagnosis. Ocular fundoscopy available in 12 patients showed bilateral papilloedema in ...

To clarify the mechanism leading to the development and rupture of intracranial aneurysms, tensile strength and viscoelastic parameters of 22 human saccular aneurysms were investigated. Meridional and circumferential strips from the thin and the thick part of the aneurysm sack and 18 control strips from the basilar artery of 8 ...

BACKGROUND AND PURPOSE: Subarachnoid hemorrhage from intracranial aneurysm rupture produces a severe form of stroke. Extracellular matrix remodeling is associated with cerebral aneurysms and may play a role in the formation or rupture of these lesions. We previously reported a 3-fold increase in a 72-kDa serum gelatinase in a subgroup ...

OBJECTIVE: Few published studies have focused specifically on the unique management issues encountered in treating patients with arteriovenous malformations (AVMs) and associated intracranial aneurysms. The primary objective of this study was to retrospectively review the clinical and radiographic features of these patients. METHODS: Medical records of all patients seen at ...

The application of different color-coding techniques in transcranial color-coded duplex sonography (TCCD) was assessed for detection and measurement of the size of intracranial aneurysms. Thirty-two consecutively examined patients with 36 angiographically verified cerebral aneurysms underwent TCCD with color Doppler flow imaging (CDFI), power Doppler imaging (PDI), and both methods with ...

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. ...

OBJECTIVE: Risk factors that predispose to the formation of multiple intracranial aneurysms, which are present in up to 34% of patients with intracranial aneurysms, are not well defined. In this study, we examined the association between known risk factors for cerebrovascular disease and presence of multiple intracranial aneurysms. METHODS: We ...

Vasa vasorum are adventitial vessels that play a role in pathogenesis of atherosclerosis, aneurysm, vasculitides, and graft vascular disease. The existence of vasa vasorum in human intracranial arteries is not yet well defined. The specific aims of this study are to determine whether the human intracranial arteries have vasa vasorum, ...

OBJECTIVES: This report describes successful anaesthesia and electroconvulsive therapy (ECT) in a patient with an unruptured basilar artery aneurysm. ECT is associated with a hyperdynamic state characterised by arterial hypertension, tachycardia, and considerably increased cerebral blood flow rate and velocity. These responses pose an increased risk for subarachnoid haemorrhage when ...

An extremely rare case with multiple meningiomas and multiple aneurysms is reported. This 48 year-old female had her meningiomas at the convexity and along the sphenoid wing, and intracranial aneurysms at the basilar tip, left middle cerebral artery bifurcation, and left pericallosal artery. All of them were shown by preoperative ...

INTRODUCTION: Transcranial color Doppler sonography permits the accurate assessment of intracranial arteries. The latest Doppler units, using the color and power techniques, can show even very small flow volumes (1 x 1 mm). Low frequency (2-2.5 MHz) and very focused transducers are used in transcranial color Doppler. The skull is ...

OBJECT: The authors sought to determine whether the increased pulsatility of aneurysms, compared with normal intracranial arteries, on color "power" transcranial Doppler (TCD) ultrasound was due to a true change in aneurysm size and whether aneurysm dimensions change with intracranial pressure (ICP). METHODS: The authors studied nine patients who had ...

METHODS: Three patients with Borrelia burgdorferi infection and intracranial aneurysms are described. RESULTS: All three patients had neurological symptoms. Perivascular and vasculitic lymphocytic inflammation were detected in the brain biopsy specimen of one patient. The aneurysm was located in the internal carotid arteries in two patients and in the basilar ...

PURPOSE: To provide a practical review of the ophthalmologic manifestations of intracranial vascular abnormalities. METHODS: We reviewed ocular manifestations of the most common intracranial vascular abnormalities: intracranial aneurysms, carotid-cavernous fistulas, arteriovenous malformations, and cavernous malformations. RESULTS: Unruptured aneurysms can compress the third cranial nerve and the anterior visual pathways. Ruptured ...

We describe a 53-year-old mother and a her 34-year-old son who suffered from spontaneous subarachnoid hemorrhage (SAH) and/or intracerebral hemorrhage due to a ruptured intracranial aneurysm. Diagnosis of the intracranial aneurysm was made by CT scan of the brain, and cerebral angiography. These two cases received surgical intervention and returned ...

This study assessed the observer variability for measurement of intracranial aneurysmal size visualized on color "power" Transcranial Doppler Ultrasound (TCD). Patients with recent subarachnoid hemorrhage underwent color "power" TCD blind to angiography. Identified aneurysms were measured from the frozen image (in real time or from video tape) using the trackball ...

There is no accepted hypothesis explaining the mechanism of growth and the subsequent rupture of intracranial aneurysms. Both congenital and acquired factors are believed to contribute to the formation and development of intracranial aneurysms. Apoptosis, commonly observed under a wide range of physiological conditions, occurs in the various pathological situations ...

OBJECTIVE: Some intracranial aneurysms may not be operable by conventional neurosurgery due to their location or morphology. Cardiopulmonary bypass (CPB) and deep hypothermic circulatory arrest renders surgery of these complex aneurysms possible. Brain temperatures can be measured directly in this setting. METHODS: Eight patients with complex intracranial aneurysms were operated ...

BACKGROUND AND PURPOSE: Knowledge of the natural history of stenoses due to intracranial atherosclerosis may be useful for evaluating possible treatments such as angioplasty. METHODS: We retrospectively reviewed records over a 7-year period to identify patients with intracranial atherosclerotic stenoses and serial angiograms. Quantitative measurements of stenoses were made in ...

A 20-year-old national serviceman with acute lymphoblastic leukaemia, developed a large left parieto-occipital haemorrhage 7 days after completion of induction chemotherapy. Severe hypofibrinogenemia had been noted while he was receiving L-asparaginase. The haemorrhage could not be attributed to thrombocytopenia, disseminated intravascular coagulopathy, arterio-venous malformation, berry aneurysm or leukaemic infiltration because ...

PURPOSE: Our goal was to evaluate the utility of subtraction three-dimensional CT angiography for the detection of intracranial aneurysms. METHODS: Thirty-six patients with intracranial aneurysms were examined using newly devised controlled-orbit helical scanning and conventional angiography. Three-dimensional CT angiograms and subtraction 3-D CT angiograms were compared with conventional angiograms for ...

Proposed generator sites for the N18 component of the somatosensory evoked potential (SEP) range in location from the medulla to the thalamus. Additional knowledge regarding the generators of the N18 will be important in interpreting the results of intra-operative monitoring during skull base surgery and providing the surgeon more specific ...

Major intracranial vessels can be damaged during tumor resection. With the availability of refined microvascular techniques, direct repair or by-pass of the damaged segment is possible. These methods, however, often require temporary occlusion of the offending vessel, can result in a less than optimal angiographic result, and are difficult to ...

A normotensive, non-smoking 41-year-old female with a history of generalized seizures from the age of 4 years presented with a left middle cerebral artery (MCA) fusiform aneurysm and an ipsilateral frontal lobe cavernous hemangioma. Surgical exploration demonstrated that the fusiform aneurysm-like lesion was a dolichoectatic MCA with no arteriosclerotic change. ...

We review our experience with 27 cases of pulmonary and meningeal cryptococcosis at the University Hospital, (Kuala Lumpar, Malaysia) where this is the most common cause of adult meningitis in patients without debilitating illnesses. Of the 27 cases analysed, six presented primarily with pulmonary symptomatology which usually were mainly cough, ...

Summary: A 12-year-old boy with recessive polycystic kidney disease and congenital hepatic failure, presented intracranial subarachnoid haemorrhage, due to the rupture of a laterobasilar tip aneurysm. In addition, he presented a left-sided middle cerebral unruptured aneurysm demonstrated during the screening procedure. Our patient is a boy, like most children with ...

This case report describes sudden death in a young boy resulting from an undiagnosed saccular intracranial aneurysm located at the right posterior cerebral artery. It is suggested that the rupture might have been provoked by xylometazolin aerosol, which can increase blood pressure.

OBJECTIVE: Familial intracranial aneurysms are more common than has been appreciated, but systematic autopsy studies of affected individuals have not been reported. We reviewed the autopsy findings of a group of patients with familial aneurysms to elucidate the nature of the putative underlying arteriopathy. METHODS: Using a computerized diagnostic index, ...

Although the majority of infectious (bacterial) intracranial aneurysms occur in patients with subacute bacterial endocarditis, septic cerebral embolization and infectious intracranial aneurysm formation can also occur in immunocompromised patients. We report the case of ruptured bacterial aneurysm occurring in a 19 years old man immunocompromised by vigorously treated acute lymphoblastic ...

Previous studies suggest that nitric oxide (NO) is involved in headaches induced by i.v. infusion of the vasodilator and NO donor glyceryl trinitrate (GTN) in healthy subjects. Extending these studies to sufferers of migraine without aura, it was found that migraineurs experienced a stronger headache than non-migraineurs. In addition, most ...

Vein of Galen aneurysmal malformation (VGAM) is a rare, intracranial vascular anomaly that, until recently, has usually been diagnosed postnatally. Today, however, with the advances in high-resolution ultrasonography and colour Doppler, prenatal diagnosis is relatively easy. Due to novel intravascular embolization techniques, the prognosis of neonates with VGAM has markedly ...

OBJECTIVE: Marfan's syndrome is a heritable connective tissue disorder that has been associated with intracranial aneurysms. However, the prevalence of intracranial aneurysms in Marfan's syndrome is unknown and pathological studies of affected vessels have not been reported. We therefore examined the neuropathological findings in a group of patients with Marfan's ...

OBJECTIVE: Generalized disruption of arterial wall morphological changes in patients harboring cerebral aneurysms has been documented; however, little is known regarding the pathogenesis of these changes. To explore the role of the elastolytic gelatinase, matrix metalloproteinase-9 (MMP-9), levels of this enzyme in the wall of intracranial aneurysms were compared with ...

This article reports a method for reliable intraoperative monitoring of blood flow velocities in the basal cerebral arteries during clipping of intracerebral aneurysms. Transcranial color-coded duplex sonography provides practical integration of transcranial Doppler technology with real-time imaging capabilities through the intact human skull. With a computerized sonography system equipped with ...

Moyamoya syndrome is characterized by the reticulated collateralization of the intracranial vasculature distal to an occlusion of proximal intracranial vessels. In the present study this pathology was visualized in 2 patients, aged 29 and 32 years, using transcranial color Doppler imaging (TCDI). Digital subtraction angiography in both patients revealed stenosis ...

A 35-year-old woman developed symptoms consistent with intracranial venous sinus occlusions that were demonstrated by MR angiography. After a few weeks of anticoagulant therapy, she became paraplegic due to haemorrhages in the caudal spinal canal. A decompressive laminectomy did not improve her neurological deficits. Up to this point, we assumed ...

STUDY OBJECTIVES: To determine the risk factors and frequency of intracranial hemorrhage among patients undergoing thrombolysis for pulmonary embolism. DESIGN: A retrospective descriptive and controlled analysis. SETTING: Hospitalized patients at centers in the United States, Canada, and Italy. PATIENTS: All had evidence of pulmonary embolism on perfusion scans or angiography. ...