Aneurismas intracranianos múltiplos

Lynch, José Carlos; Andrade, Ricardo Alves de

doi:10.1590/S0004-282X1992000100004

Resumos

Os aneurismas múltiplos correspondem de 15 a 31% dos aneurismas cerebrais. Em nosso material encontramos 19,4% de aneurismas múltiplos. Trinta e oito pacientes foram incluídos neste estudo e totalizaram 89 aneurismas e 4 infundíbulos. Em 71,0% dos casos foram encontrados 2 aneurismas; em 18,4%, 3 aneurismas; e em 10,4%, 4 ou 5 aneurismas. As artérias carótida, comunicante anterior, comunicante posterior e cerebral média foram os sítios mais frequentes dessas lesões. Observamos nítido predomínio do sexo feminino (2,45:1). A média de idade foi 47 anos, com os extremos variando entre 16 e 72 anos. A hemorragia subaracnóidea foi a mais comum das formas de expressão clínica (86,8%). A mortalidade cirúrgica nesta série foi de 3,5%, o que nos leva a concluir que pacientes com aneurismas múltiplos devem ser submetidos a tratamento microcirúrgico para isolar da circulação os aneurismas que, rompendo, podem colocar em risco a vida dos pacientes.

aneurisma intracraniano; aneurismas múltiplos; cirurgia

Thirty eight patients with multiple intracranial aneurysms were studied. They correspond to 19.4% of all aneurysms treated over a twelve year period in the Servidores do Estado Hospital. 89 aneurysms and 4 infundibuli were detected. In 71.0% of the patients, two aneurysms were found; in 18.4%, three aneurysms; and in 10.4%, 4 or 5 aneurysms were observed. Twenty-seven patients were women and 11 men, ranging in age from 16 to 72 (average 47 years old). Subarachnoid hemorrhage was found in 36 patients (86.8%). The operative mortality in this series was 3.5%. We concluded that patients with multiple intracranial aneurysms should have all aneurysms, that can bleed, clipped through standard micro-neurosurgery technics.

intracranial aneurysm; multiple aneurysms; surgery

José Carlos Lynch^I; Ricardo Alves de Andrade^II

^IChefe de Serviço. Serviço de Neurocirurgia do Hospital dos Servidores do Estado, RJ

^IIChefe da Clínica. Serviço de Neurocirurgia do Hospital dos Servidores do Estado, RJ

RESUMO

Os aneurismas múltiplos correspondem de 15 a 31% dos aneurismas cerebrais. Em nosso material encontramos 19,4% de aneurismas múltiplos. Trinta e oito pacientes foram incluídos neste estudo e totalizaram 89 aneurismas e 4 infundíbulos. Em 71,0% dos casos foram encontrados 2 aneurismas; em 18,4%, 3 aneurismas; e em 10,4%, 4 ou 5 aneurismas. As artérias carótida, comunicante anterior, comunicante posterior e cerebral média foram os sítios mais frequentes dessas lesões. Observamos nítido predomínio do sexo feminino (2,45:1). A média de idade foi 47 anos, com os extremos variando entre 16 e 72 anos. A hemorragia subaracnóidea foi a mais comum das formas de expressão clínica (86,8%). A mortalidade cirúrgica nesta série foi de 3,5%, o que nos leva a concluir que pacientes com aneurismas múltiplos devem ser submetidos a tratamento microcirúrgico para isolar da circulação os aneurismas que, rompendo, podem colocar em risco a vida dos pacientes.

Palavras chave: aneurisma intracraniano, aneurismas múltiplos, cirurgia.

SUMMARY

Thirty eight patients with multiple intracranial aneurysms were studied. They correspond to 19.4% of all aneurysms treated over a twelve year period in the Servidores do Estado Hospital. 89 aneurysms and 4 infundibuli were detected. In 71.0% of the patients, two aneurysms were found; in 18.4%, three aneurysms; and in 10.4%, 4 or 5 aneurysms were observed. Twenty-seven patients were women and 11 men, ranging in age from 16 to 72 (average 47 years old). Subarachnoid hemorrhage was found in 36 patients (86.8%). The operative mortality in this series was 3.5%. We concluded that patients with multiple intracranial aneurysms should have all aneurysms, that can bleed, clipped through standard micro-neurosurgery technics.

Key words: intracranial aneurysm, multiple aneurysms, surgery.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Dr. José Carlos Lynch Rua Jardim Botânico 700/318 - 22461 Rio de Janeiro RJ - Brasil

1. Af Bjorkesten G, Troup H. Multiple intracranial arterial aneurysms. Acta Chir Scand 1960, 118:387-391.
2. Almaani WS, Richardson AE. Multiple intracranial aneurysms: identifying the ruptured lesion. Surg Neurol 1978, 9:303-305.
3. Bassett RC. Multiple cerebral aneurysm: case report. J Neurosurg 1951, 8:132-134.
4. Bigelow NH. Multiple intracranial arterial aneurysms. Arch Neurol Psychiat 1955, 73:76-99.
5. Brisman R. Treatment of multiple and asymptomatic aneurysms. In Schmidek HH, Sweet WH (eds): Operative Neurosurgical Techniques, Indications, Methods and Results. Ed 2. Orlando: Grune & Straton, 1988, p 1003-1007.
6. Crawford T. Some observations on the pathogenesis and natural history of intracranial aneurysms.' J Neurol Neurosurg Psychiat 1959, 22:259-266.
7. Drake CF, Girvin JP. The surgical treatment of subarachnoid hemorrhage with multiple aneurysm. In Morley TP (ed): Current Controversies in Neurosurgery. Philadelphia: Saunders, 1976, p 274-278.
8. DuBoulay GH. Some observations on the natural history intracranial aneurysms. Br J Radiol 1965, 38:721-757.
9. Hacker RJ, Krall JM, Fox JL. In Fox JL (ed): Intracranial Aneurysms. New York: Springer, 1983, Vol 1, p 19-62.
10. Hashimoto N, Handa H. The size of cerebral aneurysm in relation to repeated rupture. Surg Neurol 1983, 19:107-111.
11. Heiskanen O. Multiple intracranial arterial aneurysms. Acta Neurol Scand 1965, 41:356-382.
12. Heiskanen O, Marttila I. Risk of rupture of a second aneurysms in patients with multiple aneurysms J Neurosurg 1970, 32:295-298.
13. Jane JA, Winn HR, Richardson AE. The natural history of intracranial aneurysms: rebleeding rates during the acute and long term period and implication for surgical management. Clin Neurosurg 1976, 24:176-184.
14. Kassel NF, Torner JC. Size of intracranial aneurysms. Neurosurgery 1983, 3:291-297.
15. Locksley HB. Natural history of subarachnoid hemorrhage, intracranial aneurysms and arteriovenous malformations: based on 6368 cases in the cooperative study. In Saws AL, Paret GE, Locksley HB, Nishioka H (eds): Intracranial Aneurysms and Subarachnoid Hemorrhage, A Cooperative Study. Philadelphia: Lippincott, 1969, 37-108.
16. McKissock W, Richardson A, Walsh L, Owen E. Multiple intracranial aneurysms. Lancet 1964, 1:623-626.
17. Milenkovic Z, Gopic H, Antovic P, Jovicic V, Petrovic B. Contralateral pterional approach to a carotid ophthalmic aneurysm ruptured at surgery: ciase report. J Neurosurg 1982, 57:823-825.
18. Mount LA, Brisman R. Treatment of multiple intracranial aneurysms: symptomatic and asymptomatic. Clin Neurosurg 1974, 21:166-170.
19. Moyes PD. Surgical treatment of multiple aneurysms and of incidentally-discovered unruptured aneurysms. J Neurosurg 1971, 35:291-295.
20. Nakao S, Kikughi H, Takahashi N. Successful clipping of carotid-ophthalmic aneurysms through a contralateral pterional approach: report of two cases. J Neurosurg 1981, 54:532-536.
21 Nehls DC, Flom RA, Carter LP, Spetzler RF. Multiple intracranial aneurysms: determining the site of rupture. J Neurosurg 1985, 63:342-348.
22. Ojemann RG. Management of the unruptured intracranial aneurysm. N Engl Med 1981, 304:725-726.
23. Oliveira E, Ribas GC, Yamashita M, Lourenzi M, Marino R Jr. Abordagem fronto--temporo-esfenoidal para a clipagem de aneurismas múltiplos localizados ipsi e contra-lateralmente. Apresentado no 16ş Congresso Brasileiro de Neurocirurgia. Rio de Janeiro, agosto, 1986.
24. Paterson A, Bond MR. Treatment of multiple intracranial arterial aneurysms. Lancet 1973, 1:1302-1304.
25. Poppen JL, Fager CA. Multiple intracranial aneurysms. J Neurosurg 1959, 16:581-589.
26. Salazar JL. Surgical treatment of asymptomatic and incidental intracranial aneurysms. J Neurosurg 1980, 53:20-21.
27. Samson DS, Hodosh RM, Clark WK. Surgical management of unruptured asymptomatic aneurysms. J Neurosurg 1977, 46:731-734.
28. Sekhar LN, Heros RC. Origin, growth and rupture of saccular aneurysms: a review. Neurosurgery 1981, 8:248-260.
29. Vadja J, Juhasz J, Pasztor E, Nyary I. Contralateral approach to bilateral and ophthalmic aneurysms. Neurosurgery 1988, 22:662-668.
30. Wiebers DO, Whisnant JP, Sundt TM, O'Fallon WM. The significance of unruptured intracranial saccular aneurysms. J Neurosurg 1987, 66:23-29.
31. Wirth FP, Laws ER Jr, Piepgras D, Scott R, Surgical treatment of incidental intracranial aneurysms. Neurosurgery, 1983, 12:507-511.
32. Wood EH. Angiographic identification of the ruptured lesion in patients with multiple cerebral aneurysms. J Neurosurg 1964, 21:182-198.
33. Yamada K, Hayakawa T, Oku Y, Maeda Y, TJshio Y, Yoshimine T, Kawai R. Contralateral pterional approach for carotid-ophthalmic aneurysm: usefulness of high resolution metrizamide or blood computed tomographic cisternography. Neurosurgery 1984, 15:5-8.
34. Yasargil MG. Microsurgery Applied to Neurosurgery. Stuttgart: Georg Thieme, 1969.

Aneurismas intracranianos múltiplos

Multiple intracranial aneurysms

Datas de Publicação

Publicação nesta coleção
22 Fev 2011
Data do Fascículo
Mar 1992

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Af Bjorkesten G, Troup H. Multiple intracranial arterial aneurysms. Acta Chir Scand 1960, 118:387-391.

[2] 2. Almaani WS, Richardson AE. Multiple intracranial aneurysms: identifying the ruptured lesion. Surg Neurol 1978, 9:303-305.

[3] 3. Bassett RC. Multiple cerebral aneurysm: case report. J Neurosurg 1951, 8:132-134.

[4] 4. Bigelow NH. Multiple intracranial arterial aneurysms. Arch Neurol Psychiat 1955, 73:76-99.

[5] 5. Brisman R. Treatment of multiple and asymptomatic aneurysms. In Schmidek HH, Sweet WH (eds): Operative Neurosurgical Techniques, Indications, Methods and Results. Ed 2. Orlando: Grune & Straton, 1988, p 1003-1007.

[6] 6. Crawford T. Some observations on the pathogenesis and natural history of intracranial aneurysms.' J Neurol Neurosurg Psychiat 1959, 22:259-266.

[7] 7. Drake CF, Girvin JP. The surgical treatment of subarachnoid hemorrhage with multiple aneurysm. In Morley TP (ed): Current Controversies in Neurosurgery. Philadelphia: Saunders, 1976, p 274-278.

[8] 8. DuBoulay GH. Some observations on the natural history intracranial aneurysms. Br J Radiol 1965, 38:721-757.

[9] 9. Hacker RJ, Krall JM, Fox JL. In Fox JL (ed): Intracranial Aneurysms. New York: Springer, 1983, Vol 1, p 19-62.

[10] 10. Hashimoto N, Handa H. The size of cerebral aneurysm in relation to repeated rupture. Surg Neurol 1983, 19:107-111.

[11] 11. Heiskanen O. Multiple intracranial arterial aneurysms. Acta Neurol Scand 1965, 41:356-382.

[12] 12. Heiskanen O, Marttila I. Risk of rupture of a second aneurysms in patients with multiple aneurysms J Neurosurg 1970, 32:295-298.

[13] 13. Jane JA, Winn HR, Richardson AE. The natural history of intracranial aneurysms: rebleeding rates during the acute and long term period and implication for surgical management. Clin Neurosurg 1976, 24:176-184.

[14] 14. Kassel NF, Torner JC. Size of intracranial aneurysms. Neurosurgery 1983, 3:291-297.

[15] 15. Locksley HB. Natural history of subarachnoid hemorrhage, intracranial aneurysms and arteriovenous malformations: based on 6368 cases in the cooperative study. In Saws AL, Paret GE, Locksley HB, Nishioka H (eds): Intracranial Aneurysms and Subarachnoid Hemorrhage, A Cooperative Study. Philadelphia: Lippincott, 1969, 37-108.

[16] 16. McKissock W, Richardson A, Walsh L, Owen E. Multiple intracranial aneurysms. Lancet 1964, 1:623-626.

[17] 17. Milenkovic Z, Gopic H, Antovic P, Jovicic V, Petrovic B. Contralateral pterional approach to a carotid ophthalmic aneurysm ruptured at surgery: ciase report. J Neurosurg 1982, 57:823-825.

[18] 18. Mount LA, Brisman R. Treatment of multiple intracranial aneurysms: symptomatic and asymptomatic. Clin Neurosurg 1974, 21:166-170.

[19] 19. Moyes PD. Surgical treatment of multiple aneurysms and of incidentally-discovered unruptured aneurysms. J Neurosurg 1971, 35:291-295.

[20] 20. Nakao S, Kikughi H, Takahashi N. Successful clipping of carotid-ophthalmic aneurysms through a contralateral pterional approach: report of two cases. J Neurosurg 1981, 54:532-536.

[21] 21 Nehls DC, Flom RA, Carter LP, Spetzler RF. Multiple intracranial aneurysms: determining the site of rupture. J Neurosurg 1985, 63:342-348.

[22] 22. Ojemann RG. Management of the unruptured intracranial aneurysm. N Engl Med 1981, 304:725-726.

[23] 23. Oliveira E, Ribas GC, Yamashita M, Lourenzi M, Marino R Jr. Abordagem fronto--temporo-esfenoidal para a clipagem de aneurismas múltiplos localizados ipsi e contra-lateralmente. Apresentado no 16ş Congresso Brasileiro de Neurocirurgia. Rio de Janeiro, agosto, 1986.

[24] 24. Paterson A, Bond MR. Treatment of multiple intracranial arterial aneurysms. Lancet 1973, 1:1302-1304.

[25] 25. Poppen JL, Fager CA. Multiple intracranial aneurysms. J Neurosurg 1959, 16:581-589.

[26] 26. Salazar JL. Surgical treatment of asymptomatic and incidental intracranial aneurysms. J Neurosurg 1980, 53:20-21.

[27] 27. Samson DS, Hodosh RM, Clark WK. Surgical management of unruptured asymptomatic aneurysms. J Neurosurg 1977, 46:731-734.

[28] 28. Sekhar LN, Heros RC. Origin, growth and rupture of saccular aneurysms: a review. Neurosurgery 1981, 8:248-260.

[29] 29. Vadja J, Juhasz J, Pasztor E, Nyary I. Contralateral approach to bilateral and ophthalmic aneurysms. Neurosurgery 1988, 22:662-668.

[30] 30. Wiebers DO, Whisnant JP, Sundt TM, O'Fallon WM. The significance of unruptured intracranial saccular aneurysms. J Neurosurg 1987, 66:23-29.

[31] 31. Wirth FP, Laws ER Jr, Piepgras D, Scott R, Surgical treatment of incidental intracranial aneurysms. Neurosurgery, 1983, 12:507-511.

[32] 32. Wood EH. Angiographic identification of the ruptured lesion in patients with multiple cerebral aneurysms. J Neurosurg 1964, 21:182-198.

[33] 33. Yamada K, Hayakawa T, Oku Y, Maeda Y, TJshio Y, Yoshimine T, Kawai R. Contralateral pterional approach for carotid-ophthalmic aneurysm: usefulness of high resolution metrizamide or blood computed tomographic cisternography. Neurosurgery 1984, 15:5-8.

[34] 34. Yasargil MG. Microsurgery Applied to Neurosurgery. Stuttgart: Georg Thieme, 1969.