Intracranial Aneurysms: Volume 1

668 Pages·1983·29.58 MB·English

by  John L. Fox M.D. (auth.)

Intracranial
Aneurysms
Vol. I
\J""oo ../ ~'
,ea
n·t
Fig. 5.2. For legend see copyright page.
-.- - ---
,-_. . -'""--- ---
('01
f1·ret
Fig. 7.4. For legend see copyright page.
Intracranial
Aneurysms
Volume I
John L. Fox, M.D.
Professor of Neurosurgery
West Virginia University
School of Medicine
Morgantown, West Virginia
With 177 Illustrations
Springer-Verlag New York Berlin Heidelberg Tokyo
John L. Fox, M.D.
Professor of Neurosurgery
West Virginia University
Medical Center
Morgantown, West Virginia 26506
Fig. 5.2. Right frontolateral view of pituitary stalk (pit) as seen between the optic nerve (2) and the athero
sclerotic internal carotid artery (ica). Critical anterior thalamic perforating arteries pass medially to hypothala
mus and pituitary stalk from internal carotid artery and posterior communicating artery (pca). ara, arachnoid
between optic nerves; pc, posterior clinoid process; 3, oculomotor nerve; tl, temporal lobe; jl, frontal lobe;
ret, retractor; 1, olfactory tract; ha, Heubner's artery. (See Fig. 34.1 for orientation of patient's head.)
Fig. 7.4. Right frontolateral view of internal carotid artery aneurysm (single-crossed arrow) at the take
off of the posterior communicating artery (double-crossed arrow). Aneurysm has been partially electrocoagu
lated to narrow its waist. The dome of the inferolaterally projecting aneurysm is pressing on the medial
edge of the oculomotor nerve (3). ica, internal carotid artery; pc, posterior clinoid process; te, anterior
reflection of tentorial edge approaching anterior clinoid process; tl-ret, temporal lobe retractor; mem, mem
brane of Liliequist (or Key and Retzius); cot, cotton strip; jl-ret, frontal lobe retractor. (See Fig. 34.1 for
orientation of patient's head.)
Library of Congress Cataloging in Publication Data
Fox, John L., 1934-
Intracranial aneurysms.
Includes bibliographies and index.
1. Intracranial aneurysms. 2. Intracranial aneurysms-Surgery.
I. Title. [DNLM: 1. Cerebral aneurysm. WL 355
1609]
RC693.F69 1983 616.8'1 83-834
© 1983 by Springer-Verlag New York Inc.
Softcover reprint of the hardcover 1s t edition 1983
All rights reserved. No part of this book may be translated or reproduced in any form
without written permission from Springer-Verlag, 175 Fifth Avenue, New York, New
York 10010, U.S.A.
The use of general descriptive names, trade names, trademarks, etc., in this publication,
even if the former are not especially identified, is not to be taken as a sign that such
names, as understood by the Trade Marks and Merchandise Marks Act, may accordingly
be used freely by anyone.
987 6 5 4 3 2 1
ISBN-13: 978-1-4612-5439-3 e-ISBN-13: 978-1-4612-5437-9
DOl: 10.1007/978-1-4612-5437-9
Dedicated to our patients
who sought to be made well again
and to our families and colleagues
who gave their time and encouragement
Contents of Volume I
Contents of Vol. II xv
Contents of Vol. III-Appendices xvi
Foreword by A. L. Sahs xvii
Preface xix
List of Contributors xxi
...
Table I Symbols and Abbreviations
XXIII
.
Table II Instrument and Drug Companies
XXIX
1 Historical Aspects of Intracranial Aneurysms 1
Early History 1
The Early 1900s 4
Angiography 6
Early Surgical Advances 7
Vertebrobasilar Aneurysms 7
Bibliography 8
2 The Incidence of Intracranial Aneurysm 15
Bibliography 16
3 Data I 19
Robert J. Hacker, M.D., John M. Krall, Ph.D., and John L. Fox, M.D.
Part 1 General Overview 19
Introduction 19
Materials and Methods 20
Part 2 Single Intracranial Aneurysms Occurring in Adults 21
Introduction 21
Data Base 21
Data Processing 21
Results 22
Discussion 34
x Contents of Volume I
Part 3 Multiple Intracranial Aneurysms Occurring in Adults 36
Introduction 36
Data Base and Data Processing 37
Results 37
Discussion 40
Part 4 Intracranial Aneurysms Occurring in Children 43
Introduction 43
Data Base and Data Processing 43
Results of the Analysis of Single Aneurysm Cases without Associated Conditions 44
Results of the Analysis of Single Aneurysm Cases with Associated Conditions 47
Multiple Aneurysms Occurring in Children 50
Discussion 50
Part 5 Giant Intracranial Aneurysms Occurring in Adults 52
Introduction 52
Results of the Analysis of Adult Giant Single Aneurysms 52
Giant Multiple Aneurysms Occurring in Adults 54
Discussion 55
Part 6 Summary 55
Adult Single Berry Aneurysms 55
Adult Multiple Berry Aneurysms 56
Childhood Aneurysms 57
Adult Giant Aneurysms 57
Bibliography 58
4 Data II 63
Robert J. Hacker, M.D., John M. Krall, Ph.D., and John L. Fox, M.D.
Introduction 63
Tables 64
5 Signs and Symptoms I General 118
Signs and Symptoms 119
Classification and Grading 125
Summary 127
Bibliography 127
6 Signs and Symptoms II Specific 133
Part 1 Specific Aneurysms
Aneurysms of the Internal Carotid Artery and Its Branches 133
Aneurysms of the Middle Cerebral Artery 139
Aneurysms of the Anterior Communicating Artery 139
Aneurysms of the Anterior Cerebral Artery 143
Aneurysms of the Basilar Artery and Its Branches 144
Aneurysms of the Vertebral Artery and Its Branches 148
Contents of Volume I Xl
Part 2 Giant Aneurysms 149
Signs of Sellar/Suprasellar Tumor 150
Bruit 152
Convulsive Seizures 153
Trigeminal Neuralgia 153
Other Findings 153
Bibliography 154
7 Signs and Symptoms III Ophthalmic 163
Cranial Nerves 3, 4, 5, and 6 163
Cranial Nerve 2 171
Summary 178
Bibliography 178
8 Secondary Complications of the Subarachnoid
Hemorrhage 184
Elevated Intracranial Pressure 184
Hydrocephalus 185
Intracranial Hematoma 195
Vasospasm 203
Ischemia and Infarction 203
Fluid and Electrolyte Disorders 204
Rebleeding 204
Epileptic Seizures 204
Gastrointestinal Hemorrhage 205
Pulmonary Edema 206
Electrocardiographic Changes 206
Summary 208
Bibliography 208
9 Vasospasm I Experimental Findings 218
Richard P. White, Ph.D.
Definitions and Background 218
Experimental Designs and Procedures 219
Specific Experimental Findings 222
Some Experimental Therapies in Animals and Humans 237
Summary 238
Bibliography 238
10 Vasospasm II Clinical Considerations 250
Location and Occurrence 251
Signs and Symptoms 252
xii Contents of Volume I
Tests 253
Related Factors 260
Treatment 260
Summary 263
Bibliography 263
11 The Pathology of Intracranial Arterial Aneurysms and their
Complications 272
William E. Stehbens, M.D.
Definitions 272
Fusiform Aneurysms 273
Saccular Arterial Aneurysms 275
Aneurysms of Inflammatory Origin 326
Neoplastic (Oncotic) Aneurysms 331
Traumatic Aneurysms 331
Dissecting Aneurysms 334
Aneurysms of the Spinal Arteries 339
Bibliography 342
12 Etiology and Pathogenesis of Intracranial Berry
Aneurysms 358
William E. Stehbens, M.D.
Distribution of Berry Aneurysms in Nature 359
Anatomic Variations Associated with Berry Aneurysms 362
Persistence of Vestigial Vessels 366
Medial Defects or Raphes 366
Disorders Associated with Berry Aneurysms 372
Early Aneurysm Formation in Man 379
Experimental Arterial Aneurysms 384
Other Theories 388
Bibliography 389
13 Associated Conditions I 396
Intracranial Arteriovenous Malformations 396
Carotid Artery Stenosis 398
Moyamoya Syndrome 400
Brain Neoplasms 402
Aortic Stenosis (Coarctation) 405
Polycystic Kidneys 405
Connective Tissue Diseases 406
Other Disease States 409
Familial Aneurysms 410
Pregnancy 411
Bibliography 413