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Related Experiment Videos

Surgery for angiographically occult cerebral aneurysms

J J Jafar1, H L Weiner

  • 1Department of Neurosurgery, New York University Medical Center, New York.

Journal of Neurosurgery
|November 1, 1993
PubMed
Summary

For spontaneous subarachnoid hemorrhage (SAH) cases with negative angiograms, exploratory surgery can reveal hidden aneurysms, particularly anterior communicating artery aneurysms, leading to good outcomes.

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Area of Science:

  • Neurosurgery
  • Neuroradiology
  • Vascular Neurology

Background:

  • Spontaneous subarachnoid hemorrhage (SAH) of unknown origin occurs in 15% of cases despite diagnostic angiography.
  • Undetected aneurysms can be the source of bleeding in patients diagnosed with SAH of unknown cause.

Purpose of the Study:

  • To evaluate the efficacy of exploratory surgery in identifying aneurysms in patients with SAH and negative cerebral angiograms.
  • To determine the clinical and radiographic predictors for successful aneurysm detection via surgery.

Main Methods:

  • Retrospective review of six patients with SAH and multiple negative cerebral angiograms who underwent exploratory surgery.
  • Analysis of brain CT findings, Hunt and Hess grades, vasospasm, rebleeding, and surgical outcomes.
  • Correlation of blood distribution on CT with aneurysm location.

Main Results:

  • Five partially thrombosed aneurysms were discovered and successfully clipped in five patients.
  • Anterior communicating artery (ACoA) aneurysms were found in all four patients with interhemispheric fissure blood.
  • A middle cerebral artery aneurysm was found in the patient with sylvian fissure blood.

Conclusions:

  • Exploratory aneurysm surgery is warranted in selected SAH patients with negative angiograms but high clinical/radiographic suspicion.
  • CT-localized blood, especially in the interhemispheric fissure, strongly suggests ACoA aneurysms.
  • Early surgical intervention can lead to excellent outcomes in these challenging cases.

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