158
Surg Neurol 1992;37:158
Letters to the Editor
To the Editor: Dr. Francois Aldrich [1] finds it remarkable that there should be a carotid-ophthalmic aneurysm that is anterior or dorsal in the proximal internal carotid artery, and hence unrelated to any arterial junction. This is not really so rare, in general, as Dr. Aldrich opines. Perhaps the most well known is an aneurysm of the basilar artery at the locus of the embryonic trigeminal artery; that is, there are a number of aneurysms at the loci of embryonic vessels that disappear during development. I called attention to these in an article in 1951 [4], but credit for the concept goes probably to Dorcus Hager (Padget), the artist-embryologist who wrote the chapter (and illustrated it) on development of intracranial arteries in Dandy's book [2] on intracranial arterial aneurysms. Her amplification of this material is to be found in her monograph [3] on the development of cranial arteries in the human embryo, listed under her married name of Padget. She also later wrote a similar beautifully illustrated work on development of the veins. Oscar Sugar, M.D.
San Diego, California References i. Aldrich F. Anterior (dorsal) paraclinoid aneurysm: case report. Surg Neurol 1991;35:374-6. 2. Dandy WE. lntracranial arterial aneurysms. Ithaca, NY: Comstock, 1944. 3. Padget DH. The development of the cranial arteries in the human embryo. Contrib Carnegie lnst 1948;32:205-6I. 4. SugarO. Path°l°gicalanat°myandangi°graphy°fintracranialvascularan°malies. J Neurosurg 1951;8:3-22.
To the Editor: In "Autopsy study of unruptured incidental intracranial aneurysms" by Inagawa and Hirano (Surgical Neurology 1990; 34:361-5) there were 84 patients with 102 unruptured aneurysms in 10,259 autopsies. Especially noteworthy was the higher incidence of unruptured aneurysms in patients aged 60 years or more. This raised a question of the possibility that this result was skewed by the age distribution of the autopsied patients. As suggested, I wrote to Dr. Harry M. Zimmerman, professor of pathology, emeritus, of the Albert Einstein College of Medicine, for information on the search for the aneurysms at the Montefiore Medical Center. Dr. Zimmerman wrote back after he had reviewed the cases that had been reported by Inagawa and Hirano, noting that 9630 of the
© 1992 by Elsevier Science Publishing Co., Inc.
postmortem examinations were done in the years when he was chairman of the department at Montefiore. The search was a prospective study, which he believes avoided missing these vascular lesions, which are so often overlooked in "routine" examinations of the brain unless a specific search is made. This was pointed out to me many years ago by Percival Bailey, who examined and cut the brains of all autopsies done at the University of Illinois Hospital in the years after 1940, when he had moved from the University of Chicago. After my residency in neurological surgery was finished, I continued that process when he was away, and in the interim between his leaving the University of Illinois to be director of research at the Illinois Psychiatric Institute in the late 1950s and the arrival of Dr. Orville Bailey to become neuropathologist at the University of Illinois in 1959. The statistical incidence of occurrence of unruptured aneurysms in the various decades as reported by Inagawa and Hirano gives a preponderance to the age span 6 0 - 6 9 years, 29 aneurysms, compared with the next highest number, 18, for the decade of the 70s. However, the number of autopies was also greatest for the decade of the 60s (2663) compared with 2290 autopsies for the decade 70-79, and 1868 for the 50s. Dr. Zimmerman points our that for most of the years covered by these autopsies the hospital preferentially admitted patients in older age groups, even after the name was changed from the Montefiore Hospital for Chronic Diseases to tile Montefiore Medical Center. Of the 102 aneurysms in this series, the greatest number were on the middle cerebral artery (37); internal carotid loci were found in 29, and there were 28 aneurysms of the anterior communicating artery region. This contrasts with the sites for 133 ruptured aneurysms given by the same authors in their earlier paper (Surgical Neurology 1990; 33:117-23); 53 (40%) were on the internal carotid artery, 40 (30%,) on the anterior communicating artery, and 28 (21%) on the middle cerebral artery. The remaining 10 were in lesser numbers in other places. One might deduce that the unruptured aneurysms of the middle cerebral artery found in the large autopsied series might be the ones left over after those on the other common loci had bled--and hence could not be in the larger autopsy study of unruptured aneurysms. Whether there are other factors inducing increased aneurysm incidence with age, such as hypertensive cardiovascular disease, remains speculative. Oscar Sugar, M.D.
San Diego, California
0090-3019/92/$5.00
Surg Neurol 1992;37:158
Letters to the Editor
To the Editor: Dr. Francois Aldrich [1] finds it remarkable that there should be a carotid-ophthalmic aneurysm that is anterior or dorsal in the proximal internal carotid artery, and hence unrelated to any arterial junction. This is not really so rare, in general, as Dr. Aldrich opines. Perhaps the most well known is an aneurysm of the basilar artery at the locus of the embryonic trigeminal artery; that is, there are a number of aneurysms at the loci of embryonic vessels that disappear during development. I called attention to these in an article in 1951 [4], but credit for the concept goes probably to Dorcus Hager (Padget), the artist-embryologist who wrote the chapter (and illustrated it) on development of intracranial arteries in Dandy's book [2] on intracranial arterial aneurysms. Her amplification of this material is to be found in her monograph [3] on the development of cranial arteries in the human embryo, listed under her married name of Padget. She also later wrote a similar beautifully illustrated work on development of the veins. Oscar Sugar, M.D.
San Diego, California References i. Aldrich F. Anterior (dorsal) paraclinoid aneurysm: case report. Surg Neurol 1991;35:374-6. 2. Dandy WE. lntracranial arterial aneurysms. Ithaca, NY: Comstock, 1944. 3. Padget DH. The development of the cranial arteries in the human embryo. Contrib Carnegie lnst 1948;32:205-6I. 4. SugarO. Path°l°gicalanat°myandangi°graphy°fintracranialvascularan°malies. J Neurosurg 1951;8:3-22.
To the Editor: In "Autopsy study of unruptured incidental intracranial aneurysms" by Inagawa and Hirano (Surgical Neurology 1990; 34:361-5) there were 84 patients with 102 unruptured aneurysms in 10,259 autopsies. Especially noteworthy was the higher incidence of unruptured aneurysms in patients aged 60 years or more. This raised a question of the possibility that this result was skewed by the age distribution of the autopsied patients. As suggested, I wrote to Dr. Harry M. Zimmerman, professor of pathology, emeritus, of the Albert Einstein College of Medicine, for information on the search for the aneurysms at the Montefiore Medical Center. Dr. Zimmerman wrote back after he had reviewed the cases that had been reported by Inagawa and Hirano, noting that 9630 of the
© 1992 by Elsevier Science Publishing Co., Inc.
postmortem examinations were done in the years when he was chairman of the department at Montefiore. The search was a prospective study, which he believes avoided missing these vascular lesions, which are so often overlooked in "routine" examinations of the brain unless a specific search is made. This was pointed out to me many years ago by Percival Bailey, who examined and cut the brains of all autopsies done at the University of Illinois Hospital in the years after 1940, when he had moved from the University of Chicago. After my residency in neurological surgery was finished, I continued that process when he was away, and in the interim between his leaving the University of Illinois to be director of research at the Illinois Psychiatric Institute in the late 1950s and the arrival of Dr. Orville Bailey to become neuropathologist at the University of Illinois in 1959. The statistical incidence of occurrence of unruptured aneurysms in the various decades as reported by Inagawa and Hirano gives a preponderance to the age span 6 0 - 6 9 years, 29 aneurysms, compared with the next highest number, 18, for the decade of the 70s. However, the number of autopies was also greatest for the decade of the 60s (2663) compared with 2290 autopsies for the decade 70-79, and 1868 for the 50s. Dr. Zimmerman points our that for most of the years covered by these autopsies the hospital preferentially admitted patients in older age groups, even after the name was changed from the Montefiore Hospital for Chronic Diseases to tile Montefiore Medical Center. Of the 102 aneurysms in this series, the greatest number were on the middle cerebral artery (37); internal carotid loci were found in 29, and there were 28 aneurysms of the anterior communicating artery region. This contrasts with the sites for 133 ruptured aneurysms given by the same authors in their earlier paper (Surgical Neurology 1990; 33:117-23); 53 (40%) were on the internal carotid artery, 40 (30%,) on the anterior communicating artery, and 28 (21%) on the middle cerebral artery. The remaining 10 were in lesser numbers in other places. One might deduce that the unruptured aneurysms of the middle cerebral artery found in the large autopsied series might be the ones left over after those on the other common loci had bled--and hence could not be in the larger autopsy study of unruptured aneurysms. Whether there are other factors inducing increased aneurysm incidence with age, such as hypertensive cardiovascular disease, remains speculative. Oscar Sugar, M.D.
San Diego, California
0090-3019/92/$5.00
