Intracranial arterial aneurysms / by Walter E. Dandy.

  • Walter Dandy
Date:
1944
Catalogue details

Licence: In copyright

Credit: Intracranial arterial aneurysms / by Walter E. Dandy. Source: Wellcome Collection.

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    of the circle were based on Fawcett and Blackford (see above) and his broad interpretation of Windle, who remarks that “usually there was a slight anastomosis in the interpeduncular space between small twigs passing from basilar and carotid arteries,” in his 13 per cent of absence of one or both posterior communicating arteries. Saphir (1935) reviewed the literature and suggested that de¬ fects in the circle ot Willis may be responsible for cerebral soften¬ ing and hemorrhage. He reported two autopsy cases of softening which, no occlusive lesions being found, he accounted for by the existence of heart failure and cerebral arteriosclerosis plus marked in- terruptive defects ol the posterior communicating branches. Fetterman and Moran (1911), interested by Saphir’s report, examined 200 consecutive brains, 09 per cent of which were mental hospital patients of a high average age (59 years) and found that 23 per cent showed absent or “thread like” posterior communicat¬ ing arteries on one or both sides. Cerebral softening had occurred in 30 per cent ol the total number of specimens, and, “excluding those in which the softening was due to demonstrable occlusive le¬ sions and trauma, there was a definitely higher incidence of soften¬ ing among the group showing deficiency of the circle (32 per cent) than in those without such anomalies (23 per cent).” Howe (1903) reported a case of ligation of the common carotid for lymphosarcoma in the neck with a resulting hemiplegia. Autopsy revealed that the anterior communicating artery was absent and that both posterior communicating arteries were reduced to im¬ pervious threads. Vaviations With Aneurysms For purposes of comparison it is unfortunate that there are so few illustrated or fully described cases with aneurysms available. Photographs seldom show the true relative size of all the significant arteries. However, 28 from the literature are shown in tracings in Figure 34 and summarized in Figure 33, G. It is obvious from the authors’ text that a number of these were illustrated because of the defective circle, and small or absent vessels occurred in al¬ most 50 per cent. Note the absent or impervious posterior communi¬ cating connection in the following cases of Figure 34: Cases 5 (Jacques, 1926), 6 (Berger, 1923), 7 (Beadles, 1907), 9 (Chase, 1932), 13 (McDonald and Korb, 1940), 16 and 17 (Dial and
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