RESUMEN
In a consecutive series of 268 patients harboring saccular aneurysms confirmed by digital subtraction angiography (DSA) all major blood vessels of the brain, 36 patients (13.4%) with multiple aneurysms were identified. Majority of them (around 58%) were between 40 to 60 years of age, around 22% were below 40 years of age, but no was younger than 30 years of age. The asymmetric Willis circle was identified in 26 patients (74.2%) A hypoplastic A1 segment of the anterior cerebral artery was revealed in 10 patients; a combination of the hypoplastic A1 segment and the fetal type of the posterior communicating artery with a hypoplastic P1 segment of the posterior cerebral artery were found in 9 cases, while 7 patients had only the fetal posterior communicating artery. A suggestion was put that the asymmetric circle of Willis, prenatal or acquired in postnatal life is inclined of developing aneurysm (multiple aneurysms) only if there exist a hemodynamic stress in postnatal life producing degenerative lesions of the circle of Willis at the site of the augmented hemodynamic vascular wave.
Asunto(s)
Círculo Arterial Cerebral/patología , Aneurisma Intracraneal/prevención & control , Adulto , Angiografía de Substracción Digital , Angiografía Cerebral , Círculo Arterial Cerebral/anomalías , Círculo Arterial Cerebral/diagnóstico por imagen , Femenino , Humanos , Aneurisma Intracraneal/diagnóstico por imagen , Aneurisma Intracraneal/patología , Masculino , Persona de Mediana EdadRESUMEN
Temporary occlusion of the main artery feeding aneurysm with intraoperative monitoring of somatosensitive evoked potentials was performed in 10 patients: in the majority of them because premature aneurysm rupture, and in 3 patients to facilitate the dissection of the aneurysm and application of a definitive clip. The duration of temporary occlusion was between 5 to 20 minutes. The basic changes of SEP abnormalities were manifested in the prolongation of absolute latencies and the central conduction time. The changes were reversible. One patient died 30 days after the operation from lung infection; the condition of one was unchanged; two patients with mental sequelae had good but long recovery; outcome in one patient was good and in the others it was excellent. Temporary occlusion may not have disastrous consequences, and it can be well tolerated if performed in a reasonable period of time. The SEP monitoring is helpful in the operative management of aneurysms showing early signs of ischaemia.