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Heo YJ, Yang KH, Jung SC, Park JC, Lee DH. "Two-coil technique" for embolization of small internal carotid artery aneurysms incorporating the origin of the anterior choroidal artery. Interv Neuroradiol 2016; 22:396-401. [PMID: 26888963 DOI: 10.1177/1591019916632368] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 01/21/2016] [Indexed: 11/16/2022] Open
Abstract
PURPOSE The purpose of this article is to evaluate the efficacy, safety and stability of the "two-coil technique." MATERIALS AND METHODS We evaluated a single-center experience by using a two-coil technique, which is a variation of the multiple-microcatheter technique in the treatment of a small internal carotid artery aneurysm with its sac incorporated with the origin of the anterior choroidal artery. Six consecutive patients with small ICA aneurysms with its sac incorporated with origin of the anterior choroidal artery and treated with the two-coil technique were included in this study. We finished the embolization with only two coils introduced via two different microcatheters without any other device assistance in all cases. Embolization status was determined at immediate postoperative and follow-up angiography after six months. RESULTS The two-coil technique was technically successful in five of six cases; one case was converted to surgical clipping because of persistent occlusion of the anterior choroidal artery after several attempts. On follow-up study, all five cases showed stable occlusion status without recanalization or residual aneurysm. CONCLUSIONS The two-coil technique has potential to be used for coiling small aneurysms, particularly where there is an important branch incorporated into the sac or neck of the aneurysm.
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Affiliation(s)
- Young Jin Heo
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Korea Department of Radiology, Busan Paik Hospital, Inje University, Korea
| | - Ku Hyun Yang
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Korea
| | - Sung Chul Jung
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Korea
| | - Jung Cheol Park
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Korea
| | - Deok Hee Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Korea
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Motoyama Y, Tanaka Y, Gurung P, Nakagawa I, Park YS, Nakase H. A simple bracing technique to correct kinking of arterial branches to avoid ischemic sequelae during neurovascular surgery. Surg Neurol Int 2016; 7:8. [PMID: 26862447 PMCID: PMC4743273 DOI: 10.4103/2152-7806.174602] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2015] [Accepted: 10/22/2015] [Indexed: 11/30/2022] Open
Abstract
Background: During microscopic procedures for neurovascular disease, we sometimes encounter kinking of arterial branches resulting in ischemic sequelae. A simple and useful technique that involves inserting a small, ball-like prosthesis made of oxidized cellulose or shredded Teflon with fibrin glue that corrects the arterial branch kinking and avoids subsequent compromise is reported. Methods: Between January and December 2014, three patients developed arterial kinking during microscopic procedures, including two in the caudal loop of the posterior inferior cerebellar artery during microvascular decompression for glossopharyngeal neuralgia and one in a branch of the middle cerebral artery (MCA) during clipping for an unruptured MCA aneurysm. Blood flow insufficiency was confirmed by microvascular Doppler ultrasonography (MDU) and indocyanine green (ICG) videoangiography. The prosthesis, which was made of shredded Teflon in two cases and oxidized cellulose in one case, was inserted into the crotch of the kinked arteries to correct the kinking of the arteries and restore the proper vascular shape and normal blood flow. Results: The small, ball-shaped prosthesis corrected the kinked arteries and maintained the proper shape, which was confirmed by ICG videoangiography and MDU during the operation and three-dimensional computerized tomography angiography postoperatively. Postoperatively, the patients did not manifest any ischemic sequelae related to the kinked arteries. Conclusion: The insertion of prostheses with fibrin glue into the crotch of a kinked artery for repair is considered a simple and useful method for correcting a kinked artery that avoids ischemic sequelae.
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Affiliation(s)
- Yasushi Motoyama
- Department of Neurosurgery, Nara Medical University, Kashihara, Japan
| | - Yoshitaka Tanaka
- Department of Neurosurgery, Nara Medical University, Kashihara, Japan
| | | | - Ichiro Nakagawa
- Department of Neurosurgery, Nara Medical University, Kashihara, Japan
| | - Young-Soo Park
- Department of Neurosurgery, Nara Medical University, Kashihara, Japan
| | - Hiroyuki Nakase
- Department of Neurosurgery, Nara Medical University, Kashihara, Japan
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353
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Suzuki Y, Watanabe A, Wakui K, Horiuchi T, Hongo K. Results of Clipping Surgery for Aneurysmal Subarachnoid Hemorrhage in Elderly Patients Aged 90 or Older. Acta Neurochir Suppl 2016; 123:13-16. [PMID: 27637623 DOI: 10.1007/978-3-319-29887-0_2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND The number of elderly patients with aneurysmal subarachnoid hemorrhage (SAH) is increasing. Although advanced age is one of the recognized risk factors for poor outcome, conservative treatment for aneurysmal subarachnoid hemorrhage cannot provide satisfactory outcome in elderly patients. The aim of this study is to assess the outcome in patients aged 90 or older, for whom ruptured aneurysms were treated by clipping. METHODS We retrospectively reviewed the medical records of non-traumatic SAH patients who were hospitalized at the Chiba Neurosurgical Clinic between 2004 and 2013. Of the 702 patients, 8 patients (1.1 %) were aged 90 or older. Of them, four underwent clipping surgery and the other four died or were managed conservatively. Their preoperative conditions were evaluated with the World Federation of Neurosurgical Societies Grading Scale of SAH, and the Fisher classification was used to assess the bleeding severity. The location of the ruptured aneurysm was determined by three-dimensional computed tomographic angiography or cerebral angiography. The Glasgow Outcome Scale evaluation was assigned at discharge. RESULTS Four patients (four female, all WFNS grade 1), aged 90 or older, underwent clipping surgery. Fisher classification was three in two patients and four in the other two. Location of the ruptured aneurysm was internal carotid artery in two, anterior communicating artery in one, and posterior inferior cerebellar artery in one patient. Two of these four patients had a favorable outcome. CONCLUSIONS We propose that advanced age alone does not exclude suitable surgical clipping in patients with aneurysmal rupture in the tenth decade of life.
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Affiliation(s)
- Yota Suzuki
- Department of Neurosurgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | | | | | - Tetsuyoshi Horiuchi
- Department of Neurosurgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan.
| | - Kazuhiro Hongo
- Department of Neurosurgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
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354
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Abstract
BACKGROUND During surgery for cerebral aneurysm, revascularization techniques are occasionally needed to (1) treat an aneurysm (trapping or flow alteration); (2) preserve blood flow during temporary parent artery occlusion (insurance); and (3) repair accidentally injured vessels (troubleshooting). Herein we present our surgical case experiences. METHODS Revascularization modalities were employed in 33 (7.6 %) of 452 cases of surgically treated aneurysms. The aneurysm locations and associated required bypass procedures were: (1) 7 middle cerebral artery (MCA) aneurysms with 7 superficial temporal artery (STA)-MCA bypass procedures; (2) 10 internal carotid artery (ICA) aneurysms with 9 high-flow and 1 STA-MCA procedures; (3) 10 vertebro-basilar artery aneurysms with 2 high-flow, 6 occipital artery (OA)-posterior ICA, and 1 STA-superior cerebellar artery (SCA) procedures; (4) 1 posterior cerebral artery (PCA) aneurysm with OA-PCA bypass; and (5) 5 anterior cerebral artery aneurysms with 4 A3-A3 and 1 A3-STA-A3 procedure. Curative bypasses for aneurysmal treatment, temporary bypasses, and troubleshooting procedures were performed in 25, 3, and 5 cases, respectively. RESULTS Among the 26 aneurysms treated via curative bypass, 16 aneurysms that were trapped or clipped using revascularization techniques had better outcomes (no aneurysmal rupture and 1 perforator infarction), whereas among the 10 aneurysms that could not be trapped or clipped and were thereby treated via flow alteration (e.g., bypass plus proximal artery clipping), 2 developed symptomatic infarction and 2 exhibited aneurysmal rupture after partial thrombosis. Patients whose bypass procedures were used for temporary parent artery occlusion (insurance) or troubleshooting had no complications. CONCLUSION Complex aneurysm clipping or trapping using bypass techniques yielded good results. In particular, perforator vessel ischemia still requires resolution. Flow alteration techniques leading to aneurismal thrombosis carried the risks of ischemic and hemorrhagic complications when applied to intracranial aneurysms. Bypasses for temporary use or troubleshooting were quite effective.
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355
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Abstract
Predictors for cerebral infarction, an important cause of poor outcome after aneurysmal subarachnoid hemorrhage (SAH), were examined. This study used data from the Prospective Registry of Subarachnoid Aneurysms Treatment (PRESAT) cohort, which included 579 patients whose ruptured aneurysms were treated with either clipping or coiling within 12 days of onset. Patient, clinical, radiographic, and treatment variables associated with cerebral infarction were determined. Ruptured aneurysms were clipped in 282 patients and coiled in 297 patients. Cerebral infarction occurred in 162 patients (28.0 %): 101 patients by cerebral vasospasm, 34 patients by clipping, and 33 patients by coiling. Univariate analyses showed that significant factors associated with cerebral infarction development were Fisher computed tomography (CT) group 3 on admission, premature aneurysm rupture during clipping procedure, cerebrospinal fluid drainage, symptomatic vasospasm, endovascular treatment for vasospasm, and shunt-dependent hydrocephalus. Multivariable logistic regression analyses showed that cerebral infarction was significantly associated with Fisher CT group 3 on admission, larger aneurysm dome size, ruptured posterior circulation aneurysms, premature aneurysm rupture during clipping procedure, symptomatic vasospasm, and infection, while endovascular treatment for vasospasm significantly decreased the development of cerebral infarction. The most important potentially treatable factor associated with cerebral infarction was symptomatic vasospasm.
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Affiliation(s)
- Kenji Kanamaru
- Department of Neurosurgery, Suzuka Kaisei Hospital, Suzuka, Japan
| | - Hidenori Suzuki
- Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan.
| | - Waro Taki
- Department of Neurosurgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
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356
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Robba C, Bacigaluppi S, Bragazzi NL, Bilotta F, Sekhon MS, Bertuetti R, Ercole A, Bertuccio A, Czosnyka M, Matta B. Aneurysmal Subarachnoid Hemorrhage in Pregnancy-Case Series, Review, and Pooled Data Analysis. World Neurosurg 2015; 88:383-398. [PMID: 26724616 DOI: 10.1016/j.wneu.2015.12.027] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 12/01/2015] [Accepted: 12/03/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Aneurysmal subarachnoid hemorrhage (aSAH) during pregnancy represents an important cause of maternal and fetal morbidity and mortality. Approaches to diagnostics and treatment are still controversial, and there are only a limited number of cases described in the literature. Our study examines the management of aSAH in pregnant patients, creating a case series by combining patients from our hospital records with those from the limited available literature. METHODS Data collected from Addenbrooke's Hospital records and cases published between January 1995 and January 2015 were studied. Chi-square test, exact Fisher's test, and chi-square test for trend were used for analyzing categorical data, while the t-test and Mann-Whitney-Wilcoxon test were used for continuous data. RESULTS Fifty-two patients were included. The mean age was 31.47 ± 5.80, and most patients were in their third trimester. A univariate pooled data analysis suggested that the maternal outcome may depend on the mother's age, mother's Hunt and Hess scale score, Glasgow Coma Scale at arrival, treatment modality for the aneurysm, mode, and timing of delivery. However, at the multivariate analysis only the presence of general complications resulted in a significant impact on maternal outcome. CONCLUSIONS Ruptured aneurysms in pregnant patients with aSAH may be safely secured in a timely manner. The diagnostic and treatment strategy for each of these patients should consider peculiar maternal and obstetric factors and requires a multidisciplinary assessment involving obstetrics, neurosurgeons, and intensivists. Considering the observed statistical power of our series, our findings should be taken with caution and should be supported by further systematic data collection.
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Affiliation(s)
- Chiara Robba
- Neurosciences Critical Care Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom.
| | - Susanna Bacigaluppi
- Department of Neurosurgery, Galliera Hospital, University of Genova, Genova, Italy
| | | | - Federico Bilotta
- Department of Anaesthesiology, University of Rome "La Sapienza", Rome, Italy
| | - Mypinder S Sekhon
- Department of Medicine, Division of Critical Care Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Rita Bertuetti
- Neurosciences Critical Care Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Ari Ercole
- Neurosciences Critical Care Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Alessandro Bertuccio
- Department of Neurosurgery, St. George's Hospital, University of London, London, United Kingdom
| | - Marek Czosnyka
- Division of Neurosurgery, Brain Physics Laboratory, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Basil Matta
- Neurosciences Critical Care Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
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357
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Czorlich P, Sauvigny T, Ricklefs F, Kluge S, Vettorazzi E, Regelsberger J, Westphal M, Schmidt NO. The simplified acute physiology score II to predict hospital mortality in aneurysmal subarachnoid hemorrhage. Acta Neurochir (Wien) 2015; 157:2051-9. [PMID: 26467798 DOI: 10.1007/s00701-015-2605-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 10/05/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Early prediction of increased morbidity and mortality in aneurysmal subarachnoid hemorrhage (aSAH) remains crucial to improving patient management. Most prediction models lack external validation and focus on disease-specific items without considering physiological parameters and the past medical history. The aim was to assess the validity of the established Simplified Acute Physiology Score II (SAPS-II) in an aSAH cohort for the prediction of hospital mortality and to identify additional physiological and clinical predictors. METHODS The predictive value of SAPS-II for hospital mortality was assessed in a retrospective analysis of 263 consecutive patients with aSAH. Additional physiological and clinical parameters including the past medical history were analyzed by forward selection multivariate analysis to identify independent predictors of hospital mortality and to improve the prediction model. RESULTS The SAPS-II predicted hospital mortality with an area under the curve (AUC) of 0.834 with an odds ratio (OR) of 1.097 [95 % confidence interval 1.067-1.128) for each additional point. Forward selection multivariate analysis identified the Glasgow Coma Scale score (P < 0.001), history of chronic headache (P = 0.01) and medication with anticoagulants (P = 0.04) as independent predictors of hospital mortality. Adding these parameters to the SAPS-II, the AUC increased to 0.86. CONCLUSION This study validates the predictive accuracy of SAPS-II for hospital mortality in aSAH patients. Additional parameters from the past medical history increase its predictive power. From a practical viewpoint, SAPS-II alone already represents a sufficient and powerful score to predict hospital mortality at an early time point and may help to improve patient management.
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Affiliation(s)
- Patrick Czorlich
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Thomas Sauvigny
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Franz Ricklefs
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Stefan Kluge
- Department of Intensive Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Eik Vettorazzi
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jan Regelsberger
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Manfred Westphal
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Nils Ole Schmidt
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
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358
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Nair P, Chong BW, Indahlastari A, Lindsay J, DeJeu D, Parthasarathy V, Ryan J, Babiker H, Workman C, Gonzalez LF, Frakes D. Hemodynamic characterization of geometric cerebral aneurysm templates. J Biomech 2015; 49:2118-2126. [PMID: 26654674 DOI: 10.1016/j.jbiomech.2015.11.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 11/13/2015] [Indexed: 10/22/2022]
Abstract
Hemodynamics are currently considered to a lesser degree than geometry in clinical practices for evaluating cerebral aneurysm (CA) risk and planning CA treatment. This study establishes fundamental relationships between three clinically recognized CA geometric factors and four clinically relevant hemodynamic responses. The goal of the study is to develop a more combined geometric/hemodynamic basis for informing clinical decisions. Flows within eight idealized template geometries were simulated using computational fluid dynamics and measured using particle image velocimetry under both steady and pulsatile flow conditions. The geometric factor main effects were then analyzed to quantify contributions made by the geometric factors (aneurysmal dome size (DS), dome-to-neck ratio (DNR), and parent-vessel contact angle (PV-CA)) to effects on the hemodynamic responses (aneurysmal and neck-plane root-mean-square velocity magnitude (Vrms), aneurysmal wall shear stress (WSS), and cross-neck flow (CNF)). Two anatomical aneurysm models were also examined to investigate how well the idealized findings would translate to more realistic CA geometries. DNR made the greatest contributions to effects on hemodynamics including a 75.05% contribution to aneurysmal Vrms and greater than 35% contributions to all responses. DS made the next greatest contributions, including a 43.94% contribution to CNF and greater than 20% contributions to all responses. PV-CA and several factor interactions also made contributions of greater than 10%. The anatomical aneurysm models and the most similar idealized templates demonstrated consistent hemodynamic response patterns. This study demonstrates how individual geometric factors, and combinations thereof, influence CA hemodynamics. Bridging the gap between geometry and flow in this quantitative yet practical way may have potential to improve CA evaluation and treatment criteria. Agreement among results from idealized and anatomical models further supports the potential for a template-based approach to play a useful role in clinical practice.
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Affiliation(s)
- Priya Nair
- School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ, United States.
| | - Brian W Chong
- School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ, United States; Mayo Clinic Hospital, Phoenix, AZ, United States
| | - Aprinda Indahlastari
- School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ, United States
| | - James Lindsay
- School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ, United States
| | - David DeJeu
- School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ, United States
| | - Varsha Parthasarathy
- School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ, United States
| | - Justin Ryan
- School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ, United States
| | | | - Christopher Workman
- School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ, United States
| | - L Fernando Gonzalez
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC, United States
| | - David Frakes
- School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ, United States; School of Electrical, Computer and Energy Engineering, Arizona State University, Tempe, AZ, United States
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359
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Maruta Y, Fujii M, Imoto H, Nomura S, Tanaka N, Inamura A, Sadahiro H, Oka F, Goto H, Shirao S, Ideguchi M, Yoneda H, Suehiro E, Koizumi H, Ishihara H, Suzuki M. Strategies and Pitfalls of Motor-Evoked Potential Monitoring during Supratentorial Aneurysm Surgery. J Stroke Cerebrovasc Dis 2015; 25:484-95. [PMID: 26639401 DOI: 10.1016/j.jstrokecerebrovasdis.2015.10.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 09/28/2015] [Accepted: 10/26/2015] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The aims of this study were to reveal the strategies and pitfalls of motor-evoked potential (MEP) monitoring methods during supratentorial aneurysm surgery, and to discuss the drawbacks and advantages of each method by reviewing our experiences. METHODS Intraoperative MEP monitoring was performed in 250 patients. Results from 4 monitoring techniques using combinations of 2 stimulation sites and 2 recording sites were analyzed retrospectively. RESULTS MEP was recorded successfully in 243 patients (97.2%). Direct cortical stimulation (DCS)-spinal recorded MEP (sMEP) was used in 134 patients, DCS-muscle recorded MEP (mMEP) in 97, transcranial electrical stimulation (TES)-mMEP in 11 and TES-sMEP in 1. TES-mMEP during closure of the skull was used in 21 patients. DCS-mMEP was able to detect waveforms from upper and/or lower limb muscles. Alternatively, DCS-sMEP (direct [D]-wave) could accurately estimate amplitude changes. A novel "early warning sign" indicating ischemia was found in 21 patients, which started with a transiently increased amplitude of D-wave and then decreased after proximal interruption of major arteries. False-negative findings in MEP monitoring in 2 patients were caused by a blood insufficiency in the lenticulostriate artery and by a TES-sMEP recording, respectively. CONCLUSIONS The results of this study suggest that to perform accurate MEP monitoring, DCS-mMEP or DCS-sMEP recording should be used as the situation demands, with combined use of TES-mMEP recording during closure of the skull. DCS-sMEP is recommended for accurate analysis of waveforms. We also propose a novel "early warning sign" of blood insufficiency in the D-wave.
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Affiliation(s)
- Yuichi Maruta
- Department of Neurosurgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan.
| | - Masami Fujii
- Department of Neurosurgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Hirochika Imoto
- Department of Neurosurgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Sadahiro Nomura
- Department of Neurosurgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Nobuhiro Tanaka
- Department of Neurosurgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Akinori Inamura
- Department of Neurosurgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Hirokazu Sadahiro
- Department of Neurosurgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Fumiaki Oka
- Department of Neurosurgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Hisaharu Goto
- Department of Neurosurgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Satoshi Shirao
- Department of Neurosurgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Makoto Ideguchi
- Department of Neurosurgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Hiroshi Yoneda
- Department of Neurosurgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Eiichi Suehiro
- Department of Neurosurgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Hiroyasu Koizumi
- Department of Neurosurgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Hideyuki Ishihara
- Department of Neurosurgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Michiyasu Suzuki
- Department of Neurosurgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
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360
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Chen J, Yang L, Chen Y, Zhang G, Fan Z. Controlled release of osteopontin and interleukin-10 from modified endovascular coil promote cerebral aneurysm healing. J Neurol Sci 2015; 360:13-7. [PMID: 26723964 DOI: 10.1016/j.jns.2015.11.037] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 11/15/2015] [Accepted: 11/19/2015] [Indexed: 01/30/2023]
Abstract
Cerebral aneurysm is a bulging of the artery inside the brain that results from a weakened or thin area of the artery wall. Ruptured cerebral aneurysm could lead to serious brain damage or even death, thus the proper treatment is essential. Compared with the conventional microsurgical clipping approach, the endovascular coiling treatment has many advantages, however, with a major disadvantage of high recurrence rate. One way to lower the recurrence rate, which has been tried since one decade ago, is to modify the coil to be bioactive and releasing biological molecules to stimulate tissue ingrowth and aneurysm healing. We have identified three candidates including osteopontin (OPN), IL-10 and matrix metallopeptidase 9 (MMP-9) from previous studies and generated platinum coils coated with these proteins in the carrier of poly-DL-lactic glycolic acid (PLGA). We were interested to know whether coils coated with OPN, IL-10 and MMP-9 were able to promote aneurysm healing and we have tested it in the rat carotid aneurysm model. We found that OPN and IL-10 coated coils had shown significant improvement in tissue ingrowth while MMP-9 coated coils failed to enhance tissue ingrowth compared with the control group. Our studies suggested the possible application of OPN and IL-10 coated coils in aneurysm treatment to overcome the recurrence.
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Affiliation(s)
- Jingyi Chen
- Department of Neurosurgery, The Hospital of Gaoyi County, Shijiazhuang 050000, China.
| | - Lijun Yang
- Department of Neurosurgery, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China
| | - Yan Chen
- Department of Neurosurgery, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China
| | - Gengshen Zhang
- Department of Neurosurgery, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China
| | - Zheneng Fan
- Department of Neurosurgery, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China
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361
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Baeesa SS, Bakhaidar M, Almekhlafi MA, Madani TA. Human Immunodeficiency Virus-Associated Cerebral Aneurysmal Vasculopathy: A Systematic Review. World Neurosurg 2015; 87:220-9. [PMID: 26615788 DOI: 10.1016/j.wneu.2015.11.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 11/08/2015] [Accepted: 11/12/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Human immunodeficiency virus (HIV)-associated cerebral aneurysmal vasculopathy is a rare complication of HIV affecting pediatric and adult patients and has been the subject of many case reports and case series. METHODS We performed a systematic literature search of PubMed, EMBASE, Scopus, Web of Science, Science Direct, and Google Scholar up to April 10, 2015. Our inclusion criteria encompassed all reported original case series and reports of HIV-associated cerebral aneurysms diagnosed radiologically. We analyzed the clinical characteristics and management of the reported cases. RESULTS We identified 61 patients reported in the literature (45 pediatric and 16 adult patients). The median age was 9.8 years for pediatric patients and 36.5 years for adult patients. Weakness was the most common presenting symptom in adult and pediatric patients. The most common affected artery was the middle cerebral artery. Approximately 87.2% of pediatric patients and 42.9% of adult patients were on antiretroviral therapy (ART) at presentation. The mortality rate was 60% and 35.7% among pediatric and adult patients, respectively. The optimal management is not well established. Variable response to ART was reported with possible survival benefits when ART was initiated early. CONCLUSIONS HIV-associated cerebral aneurysmal arteriopathy is associated with high mortality. The optimal management is not well established, but early initiation of ART may improve the survival rate.
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Affiliation(s)
- Saleh S Baeesa
- Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
| | - Mohamad Bakhaidar
- Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mohammed A Almekhlafi
- Department of Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Tariq A Madani
- Department of Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
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362
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Zhou G, Zhu YQ, Su M, Gao KD, Li MH. Flow-Diverting Devices versus Coil Embolization for Intracranial Aneurysms: A Systematic Literature Review and Meta-analysis. World Neurosurg 2015; 88:640-645. [PMID: 26585732 DOI: 10.1016/j.wneu.2015.11.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Revised: 11/04/2015] [Accepted: 11/05/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To review the literature on flow-diverting device (FDD) treatments for intracranial aneurysms (IAs) and to compare the safety and efficacy of FDDs with coil embolization treatment (CET) for IAs using a meta-analysis of published studies. METHODS A systematic electronic search was conducted of PubMed, Springer Link, EBSCO, and the Cochrane Database on all accessible published articles through September 2015. Abstracts, full-text manuscripts, and the reference lists of retrieved articles were analyzed. Studies that explicitly compared FDD and CET approaches to the treatment of IAs were included. Odds ratios (ORs) and 95% CIs were calculated for the complete occlusion rate and the morbidity rate using a random-effects model. RESULTS Nine studies were included in the analysis, containing retrospectively collected data for 863 patients. FDD treatment showed a significantly higher complete occlusion rate than CET (OR = 3.13; 95% confidence interval [CI], 2.11-4.65) and the subgroup of stent-assisted coiling did (OR = 2.08; 95% CI, 1.34-3.24). FDDs did not achieve a significantly lower overall morbidity rate compared with CET (OR = 0.87; 95% CI, 0.45-1.69) or the SAC (stent-assisted coiling) subgroup (OR = 0.86; 95% CI, 0.33-2.26), and our results did not show a significant difference in mortality between the two techniques. CONCLUSIONS FDD treatment of IAs yielded satisfactory results in complete occlusion rate compared with CET. The FDD procedure is feasible and has no significant difference in morbidity risk. Despite the findings reported herein, further validation with well-designed, multicenter randomized controlled trials is needed.
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Affiliation(s)
- Geng Zhou
- Department of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yue-Qi Zhu
- Department of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Ming Su
- Shandong Academy Of Chinese Medicine, Lixia, Jinan, China
| | - Kai-Di Gao
- School of Nursing, Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China
| | - Ming-Hua Li
- Department of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
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363
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Sousa Nanji L, Melo TP, Canhão P, Fonseca AC, Ferro JM. Subarachnoid Haemorrhage and Sports. Cerebrovasc Dis Extra 2015; 5:146-51. [PMID: 26648972 PMCID: PMC4662293 DOI: 10.1159/000441395] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Accepted: 09/29/2015] [Indexed: 12/28/2022] Open
Abstract
Background Some cases of subarachnoid haemorrhage (SAH) have been associated with vigorous physical activity, including sports. Our research aimed to describe the association between SAH and sports and to identify the types of sports that were more frequently found as precipitating factors in a tertiary single-centre SAH register. Methods We retrieved information from a prospectively collected SAH registry and reviewed discharge notes of acute SAH patients admitted to the Stroke Unit of Hospital de Santa Maria, Lisbon, between 1995 and 2014. Results Out of 738 patients included in the analysis, 424 (57.5%) cases of SAH were preceded by physical activity. Nine cases (1.2%) were associated with sports, namely running (2 cases), aerobics (2 cases), cycling, body balance, dance, surf and windsurf. Patients with SAH while practicing sports were younger than controls (average age 43.1 vs. 57.0 years; p = 0.007). In 1 patient, there was a report of trauma to the neck. Patients in the sports group only had Hunt and Hess scale grades 1 (11.1%) or 2 (88.9%) at admission, while patients in the control group had a wider distribution in severity. Conclusions Our findings indicate that SAH precipitated by sports is not very frequent and is uncommonly related to trauma. Patients who suffered SAH associated with sports were younger and apparently had a milder clinical presentation.
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Affiliation(s)
| | - Teresa P Melo
- Faculty of Medicine, University of Lisbon, Lisbon, Portugal ; Neurology/Stroke Unit, Department of Neurosciences, Hospital de Santa Maria, Lisbon, Portugal
| | - Patrícia Canhão
- Faculty of Medicine, University of Lisbon, Lisbon, Portugal ; Neurology/Stroke Unit, Department of Neurosciences, Hospital de Santa Maria, Lisbon, Portugal
| | - Ana Catarina Fonseca
- Faculty of Medicine, University of Lisbon, Lisbon, Portugal ; Neurology/Stroke Unit, Department of Neurosciences, Hospital de Santa Maria, Lisbon, Portugal
| | - José Manuel Ferro
- Faculty of Medicine, University of Lisbon, Lisbon, Portugal ; Neurology/Stroke Unit, Department of Neurosciences, Hospital de Santa Maria, Lisbon, Portugal
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364
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Lee SH, Jang JH, Kim KH, Kim YZ. Stent-assisted Coil Embolization of Petrous ICA in a Teenager with Neurofibromatosis. J Cerebrovasc Endovasc Neurosurg 2015; 17:252-6. [PMID: 26523261 PMCID: PMC4626351 DOI: 10.7461/jcen.2015.17.3.252] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 08/17/2015] [Accepted: 09/09/2015] [Indexed: 11/23/2022] Open
Abstract
We herein report on a patient with a cerebral aneurysm located at the petrous portion of the internal carotid artery (ICA). An 18-year-old male, previously diagnosed with neurofibromatosis, was referred to our emergency service complaining of severe headache, pulsatile tinnitus, nausea, and vomiting which occurred suddenly. Neuro-radiological studies including computed tomography and magnetic resonance imaging of the cerebral artery showed a large aneurysm arising from the petrous segment of the left ICA. He was treated with a neuro-interventional technique such as intra-arterial stenting and coil embolization for the aneurysm. Several days after the interventional treatment, his symptoms were resolved gradually except for a mild headache. Symptomatic unruptured aneurysm at the petrous portion of the ICA is rare, and our patient was treated successfully using a neuro-intervention technique. Therefore, we describe a case of a petrous aneurysm treated with endovascular coils without compromising the ICA flow, and review the literature.
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Affiliation(s)
- Sang Hyuk Lee
- Department of Neurosurgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Ji Hwan Jang
- Department of Neurosurgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Kyu Hong Kim
- Department of Neurosurgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Young Zoon Kim
- Department of Neurosurgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
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365
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Kim HJ, Lee SW, Lee TH, Kim YS. Huge Intramural Hematoma in a Thrombosed Middle Cerebral Artery Aneurysm: A Case Report. J Cerebrovasc Endovasc Neurosurg 2015; 17:234-8. [PMID: 26523258 PMCID: PMC4626348 DOI: 10.7461/jcen.2015.17.3.234] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 07/16/2015] [Accepted: 09/10/2015] [Indexed: 11/23/2022] Open
Abstract
We describe a case of a huge intramural hematoma in a thrombosed middle cerebral artery aneurysm. A 47-year-old female patient with liver cirrhosis and thrombocytopenia presented to the neurosurgical unit with a 5-day history of headache and cognitive dysfunction. Magnetic resonance imaging and computed tomography of the brain showed a thrombosed aneurysm located in the right middle cerebral artery with a posteriorly located huge intramural hematoma mimicking an intracerebral hematoma. Imaging studies and cerebrospinal fluid analysis showed no evidence of subarachnoid hemorrhage. Angiography showed a partially thrombosed aneurysm at the origin of the right anterior temporal artery and an incidental aneurysm at the bifurcation of the right middle cerebral artery. Both aneurysms were embolized by coiling. After embolization, the thrombosed aneurysmal sac and intramural hematoma had decreased in size 4 days later and almost completely disappeared 8 months later. This is the first reported case of a nondissecting, nonfusiform aneurysm with a huge intramural hematoma, unlike that of a dissecting aneurysm.
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Affiliation(s)
- Hak Jin Kim
- Department of Radiology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Sang Won Lee
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Tae Hong Lee
- Department of Radiology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Young Soo Kim
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
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366
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Inoue T, Shimizu H, Fujimura M, Sato K, Endo H, Niizuma K, Sakata H, Tominaga T. Risk factors for meningitis after craniotomy in patients with subarachnoid hemorrhage due to anterior circulation aneurysms rupture. Clin Neurol Neurosurg. 2015;139:302-306. [PMID: 26562195 DOI: 10.1016/j.clineuro.2015.10.029] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 10/20/2015] [Accepted: 10/22/2015] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Postoperative meningitis is a serious complication occurring after neurosurgical interventions. However, few investigations have focused specifically on the risk factors that predispose patients to meningitis after major craniotomy. This study identified the risk factors for postoperative meningitis after neurovascular surgery, and investigated the relationship between postoperative meningitis and clinical outcome. PATIENTS AND METHODS A total of 148 consecutive patients with subarachnoid hemorrhage (SAH) who underwent clipping surgery through a pterional approach within 72 h between January 2007 and September 2011 were retrospectively analyzed. The treatment strategy of our hospital for patients with SAH was based on the findings of digital subtraction angiography in the acute phase. Coil embolization was firstly considered, and clipping through craniotomy if indicated was performed as soon as possible. Prophylactic antibiotics were administered before beginning craniotomy and for at least 3 days after. Hydrocortisone was used to prevent hyponatremia if allowed by the medical condition of the patient. Intrathecal administration of nicardipine hydrochloride was given if required for vasospasm treatment. Meningitis was clinically diagnosed from the blood samplings and cerebrospinal fluid (CSF) examinations. Data were collected from the electronic and paper charts. The status of modified Rankin scale (mRS) 0-2 at discharge was defined as favorable outcome. RESULTS A total of 14 patients (9.5%) had meningitis during this study period. Symptomatic vasospasm was detected in 33 patients (22.3%), and 12 patients (8.1%) had permanent neurological deficits caused by vasospasm. Overall, 109 patients (73.6%) had favorable outcome. The longer duration of drainage placement, presence of CSF leakage, and intrathecal administration of vasodilatory agent showed significantly higher incidence of postoperative meningitis in univariate analysis (p=0.0093, 0.0017, and 0.0090, respectively). The proportion of favorable outcome patients at discharge (mRS 0-2) was significantly lower in patients with postoperative meningitis (35.7%) than in patients without it (77.6%) (p=0.0004). The duration of in-hospital stay was significantly longer in patients with postoperative meningitis (median 58.5, range 28-115 days) than in patients without it (median 38.5, range 19-149 days) (p<0.001). Multivariate logistic regression analysis showed that only presence of CSF leakage was associated with postoperative meningitis (p=0.0299). CONCLUSION Meningitis after surgery is still a serious complication that requires preventative intervention. The clinical outcome of patients with postoperative meningitis after neurovascular surgery is not still satisfactory.
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Peng Z, Tian D, Wang H, Kong DK, Zhang S, Liu B, Deng G, Xu Z, Wu L, Ji B, Wang L, Cai Q, Li M, Wang J, Zhang A, Chen Q. Epistaxis and pituitary apoplexy due to ruptured internal carotid artery aneurysm embedded within pituitary adenoma. Int J Clin Exp Pathol 2015; 8:14189-14197. [PMID: 26823732 PMCID: PMC4713518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Accepted: 10/23/2015] [Indexed: 06/05/2023]
Abstract
Epistaxis due to ruptured internal carotid artery (ICA) aneurysm embedded within a pituitary adenoma (PA) has seldom been reported in the literature. Here we want to elaborate the incidence, mechanisms, clinical manifestations, and treatment strategy for this condition. The first survived case of a patient with epistaxis and pituitary apoplexy due to ruptured aneurysm embedded within PA was reported and the literature was reviewed. A 53-year-old male patient presented to our institution with sudden onset epistaxis and progressive vision loss. Neurological examination revealed bilateral ptosis and dilated unresponsive pupils. A CT scan showed a large mass in the pituitary fossa with bony erosion. MRI revealed a large pituitary tumor and abnormal signal intensity in the tumor. No aneurysm was noted during the pre-operative MR angiography. Abundant arterial bleeding suddenly occurred during urgent transsphenoidal surgery. Digital subtraction angiography confirmed the presence of a 14 mm unexpected saccular aneurysm of right ICA in the cavernous sinus with the dome protruding into the sella turcica. Balloon test occlusion of the right ICA was undertaken and permanent occlusion was performed. The patient recovered well and received bromocriptine and thyroid hormone replacement therapy during the follow-up period. At 14-month followup, the patient had no neurological deficits, no features of ischaemia relating to the right ICA therapeutic occlusion. Our case indicated that epistaxis and pituitary apoplexy could be due to the rupture of an ICA aneurysm embedded in a PA. Clinical suspicion should remain high when evaluating any case of epistaxis and pituitary apoplexy. Optimal treatment should take into consideration individual features of the tumor, aneurysm, and patient. Making the correct diagnosis as well as identifying an appropriate management strategy is critical in the care of such patients.
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Affiliation(s)
- Zesheng Peng
- Department of Neurosurgery, Renmin Hospital of Wuhan UniversityWuhan, Hubei Province, China
| | - Daofeng Tian
- Department of Neurosurgery, Renmin Hospital of Wuhan UniversityWuhan, Hubei Province, China
| | - Hongliu Wang
- Department of Neurosurgery, The Second People’s Hospital of Jingzhou CityJingzhou, Hubei Province, China
| | | | - Shenqi Zhang
- Department of Neurosurgery, Renmin Hospital of Wuhan UniversityWuhan, Hubei Province, China
| | - Baohui Liu
- Department of Neurosurgery, Renmin Hospital of Wuhan UniversityWuhan, Hubei Province, China
| | - Gang Deng
- Department of Neurosurgery, Renmin Hospital of Wuhan UniversityWuhan, Hubei Province, China
| | - Zhou Xu
- Department of Neurosurgery, Renmin Hospital of Wuhan UniversityWuhan, Hubei Province, China
| | - Liquan Wu
- Department of Neurosurgery, Renmin Hospital of Wuhan UniversityWuhan, Hubei Province, China
| | - Baowei Ji
- Department of Neurosurgery, Renmin Hospital of Wuhan UniversityWuhan, Hubei Province, China
| | - Long Wang
- Department of Neurosurgery, Renmin Hospital of Wuhan UniversityWuhan, Hubei Province, China
| | - Qiang Cai
- Department of Neurosurgery, Renmin Hospital of Wuhan UniversityWuhan, Hubei Province, China
| | - Mingchang Li
- Department of Neurosurgery, Renmin Hospital of Wuhan UniversityWuhan, Hubei Province, China
| | - Junmin Wang
- Department of Neurosurgery, Renmin Hospital of Wuhan UniversityWuhan, Hubei Province, China
| | - Aimin Zhang
- Department of Neurosurgery, Renmin Hospital of Wuhan UniversityWuhan, Hubei Province, China
| | - Qianxue Chen
- Department of Neurosurgery, Renmin Hospital of Wuhan UniversityWuhan, Hubei Province, China
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Lorentzen AO, Nome T, Bakke SJ, Scheie D, Stenset V, Aamodt AH. Cerebral foreign body reaction after carotid aneurysm stenting. Interv Neuroradiol 2015; 22:53-7. [PMID: 26510943 DOI: 10.1177/1591019915609171] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 08/09/2015] [Indexed: 11/15/2022] Open
Abstract
Flow diverter stents are new important tools in the treatment of large, giant, or wide-necked aneurysms. Their delivery and positioning may be difficult due to vessel tortuosity. Common adverse events include intracranial hemorrhage and ischemic stroke, which usually occurs within the same day, or the next few days after the procedure. We present a case where we encountered an unusual intracerebral complication several months after endovascular treatment of a large left internal carotid artery aneurysm, and where brain biopsy revealed foreign body reaction to hydrophilic polymer fragments distally to the stent site. Although previously described, embolization of polymer material from intravascular equipment is rare. We could not identify any other biopsy verified case in the literature, with this particular presentation of intracerebral polymer embolization--a multifocal inflammation spread out through the white matter of one hemisphere without hemorrhage or ischemic changes.
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Affiliation(s)
- Anastasia Orlova Lorentzen
- Department of Radiology, Østfold Hospital Trust HF, Norway Department of Neurology, Oslo University Hospital, Rikshospitalet, Norway
| | - Terje Nome
- Department of Neuroradiology, Oslo University Hospital, Rikshospitalet, Norway
| | - Søren Jacob Bakke
- Department of Neuroradiology, Oslo University Hospital, Rikshospitalet, Norway
| | - David Scheie
- Department of Pathology, Rigshospitalet, Copenhagen, Denmark
| | - Vidar Stenset
- Department of Neurosurgery, Oslo University Hospital, Rikshospitalet, Norway
| | - Anne Hege Aamodt
- Department of Neurology, Oslo University Hospital, Rikshospitalet, Norway
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369
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Ikeda H, Ishii A, Kikuchi T, Ando M, Chihara H, Arai D, Hattori E, Miyamoto S. Delayed aneurysm rupture due to residual blood flow at the inflow zone of the intracranial paraclinoid internal carotid aneurysm treated with the Pipeline embolization device: Histopathological investigation. Interv Neuroradiol 2015; 21:674-83. [PMID: 26500232 DOI: 10.1177/1591019915609121] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 05/30/2015] [Indexed: 11/17/2022] Open
Abstract
Cerebral aneurysm rupture is a serious complication that can occur after flow diverter (FD) placement, but the underlying mechanisms remain unclear. We encountered a case in which direct stress on the aneurysm wall caused by residual blood flow at the inflow zone near the neck during the process of thrombosis after FD placement appeared associated with aneurysm rupture. The patient was a 67-year-old woman with progressive optic nerve compression symptoms caused by a large intracranial paraclinoid internal carotid aneurysm. The patient had undergone treatment with a Pipeline embolization device (PED) with satisfactory adherence between the PED and vessel wall. Surgery was completed without complications, and optic nerve compression symptoms improved immediately after treatment. Postoperative clinical course was satisfactory, but the patient suddenly died 34 days postoperatively. Autopsy confirmed the presence of subarachnoid hemorrhage caused by rupture of the internal carotid aneurysm that had been treated with PED. Although the majority of the aneurysm lumen including the outflow zone was thrombosed, a non-thrombosed area was observed at the inflow zone. Perforation was evident in the aneurysm wall at the inflow zone near the neck, and this particular area of aneurysm wall was not covered in thrombus. Macrophage infiltration was not seen on immunohistochemical studies of the aneurysm wall near the perforation. A hemodynamically unstable period during the process of complete thrombosis of the aneurysm lumen after FD placement may be suggested, and blood pressure management and appropriate management with antiplatelet therapy may be important.
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Affiliation(s)
- Hiroyuki Ikeda
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Japan
| | - Akira Ishii
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Japan
| | - Takayuki Kikuchi
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Japan
| | - Mitsushige Ando
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Japan
| | - Hideo Chihara
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Japan
| | - Daisuke Arai
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Japan
| | - Etsuko Hattori
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Japan
| | - Susumu Miyamoto
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Japan
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370
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Durst CR, Hixson HR, Schmitt P, Gingras JM, Crowley RW. Endovascular Treatment of a Fusiform Aneurysm at the M3-M4 Junction of the Middle Cerebral Artery Using the Pipeline Embolization Device. World Neurosurg 2015; 86:511.e1-4. [PMID: 26485414 DOI: 10.1016/j.wneu.2015.10.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 10/06/2015] [Accepted: 10/07/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Peripheral fusiform cerebral aneurysms remain difficult to treat. Current surgical approaches to the treatment of fusiform aneurysms include wrapping, clip occlusion or vessel reconstruction without parent vessel sacrifice, and aneurysm trapping with or without bypass, although these may carry high morbidity (36%). Classic endovascular approaches to the treatment of peripheral aneurysms include selective or parent artery occlusion, which imparts the risk of distal infarction. It may be possible to use a flow diversion device off label to treat the aneurysm and preserve flow to the distal territory. CASE DESCRIPTION After a presyncopal event, a patient was found to have an unruptured fusiform aneurysm at the junction of the M3 and M4 segments of the right middle cerebral artery. After initiating dual antiplatelet therapy, the aneurysm was successfully treated with a Pipeline embolization device. Three months after treatment, the aneurysm has completely thrombosed, the parent artery remains widely patent, and the patient remains at her neurologic baseline. CONCLUSIONS Flow diversion devices may provide the neurointerventional surgeon with an opportunity to treat fusiform peripheral aneurysms and preserve flow to the distal territory.
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Affiliation(s)
- Christopher R Durst
- Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia, USA
| | - H Robert Hixson
- Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Paul Schmitt
- Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Jean M Gingras
- Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia, USA
| | - R Webster Crowley
- Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia, USA.
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371
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Nabaweesi-Batuka J, Kitunguu PK, Kiboi JG. Pattern of Cerebral Aneurysms in a Kenyan Population as Seen at an Urban Hospital. World Neurosurg 2015; 87:255-65. [PMID: 26456068 DOI: 10.1016/j.wneu.2015.09.061] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 09/08/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Intracranial aneurysms constitute a significant part of the caseload for any neurosurgical service. Despite the occurrence of intracranial aneurysms and the availability of advanced diagnostic tools and management options, there is a paucity of published data concerning aneurysm patterns in Kenya. METHODS This was a combined retrospective and prospective quantitative descriptive study. Following ethical approval, all patients with cerebral aneurysms seen on computed tomography angiography who presented at Nairobi Hospital between May 2010 and June 2014 were included. A standardized questionnaire was used to collect data on patient characteristics, indications for imaging, and radiologic findings. Analysis was carried out SPSS for Windows version 15.0. RESULTS The study included 121 patients with a female (71.9%) predominance; most (30.58%) of the patients were aged 50-59 years. There were 151 aneurysms observed, with 85.95% of patients having solitary aneurysms and 14.05% having multiple aneurysms; 82.1% of the aneurysms were located in the anterior circulation. Mean aneurysm size was 6.92 mm, mean neck diameter was 2.79 mm, and the range of diameter/neck ratio was 1-11.88 (mean 1.16). The rate of subarachnoid bleeding displayed an exponential increase with aneurysms 3 mm in size and appeared to plateau thereafter despite increasing aneurysm size. Most (78.8%) of the observed anterior communicating artery aneurysms were ruptured. CONCLUSIONS Most patients were postmenopausal women, who had a higher rate of aneurysms with an elevated risk of rupture for small aneurysms; this suggests that clinicians need to be more vigilant and have a higher index of suspicion in such patients with subtle clinical signs. This study revealed a pattern of aneurysms in accord with previous reports and is expected to serve as a basis for further research on aneurysm management, outcome, and prognostic indicators in the Kenyan population.
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Affiliation(s)
| | | | - Julius G Kiboi
- Department of Surgery, University of Nairobi, Nairobi, Kenya
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372
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Wang S, Li J, Wang C, Yang X, Mu S, Wang W. Hemodynamics investigation for a giant aneurysm treated by a flow diverter implantation. Biomed Mater Eng 2015; 26 Suppl 1:S225-31. [PMID: 26406006 DOI: 10.3233/bme-151309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Flow diverter is a kind of stent-like devices with higher metal coverage rate, and it is deployed endovascularly to treat cerebral aneurysms, especially to treat giant aneurysms. However, there exist some arguments about its safety and efficacy. Hemodynamics is considered to play very important role during the initiation, growth and rupture of cerebral aneurysms. In this study, the models of a giant cerebral aneurysm involved a small branch at the aneurysmal sac before and after flow diverter implantation were constructed by virtual deployment, the blood flows in the models were simulated by computational fluid dynamics method. Analyzing the variations of the hemodynamics, the following conclusions were summarized. The flow diverter is very effective device to occlude the aneurysm, the flow rate at the small branch was rarely changed when the flow diverter deployed and the flow diverter.
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Affiliation(s)
- Shengzhang Wang
- Department of Mechanics and Engineering Science, Fudan University, 220 Handan Road, Shanghai 200433, China
| | - Jianjun Li
- Department of Mechanics and Engineering Science, Fudan University, 220 Handan Road, Shanghai 200433, China
| | - Chao Wang
- Beijing Neurosurgery Institute, 6 Tiantan Xili, Beijing 100050, China
| | - Xinjian Yang
- Beijing Neurosurgery Institute, 6 Tiantan Xili, Beijing 100050, China
| | - Shiqing Mu
- Beijing Neurosurgery Institute, 6 Tiantan Xili, Beijing 100050, China
| | - Wuqing Wang
- Department of Dermatology, Minghang District Central Hospital, 170 Xinsong Road, Shanghai 201199, China
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373
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Jin GL, Yuan ZG. Mini-arteriotomy to remove misplaced Gugliemi detachable coils: case report and technical note. Int J Clin Exp Med 2015; 8:16772-16777. [PMID: 26629219 PMCID: PMC4659107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 09/06/2015] [Indexed: 06/05/2023]
Abstract
Coil-related thromboembolic complications due to misplacement of coils in embolization of the intracranial aneurysms might result in severe neurological deficits. We describe an unusual case of a ruptured posterior communicating artery (PcomA) aneurysm in a woman who underwent a Mini-Arteriotomy to rescue error embolism in the left middle cerebral artery (MCA). This surgical procedure might be considered as an alternative route in selected patients with coil-related thromboembolic complications. This novel technology gives us a simple and practical method to remedy the misplacement of coils in a wide region of the cerebral vascular after interventional treatment.
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Affiliation(s)
- Guo-Liang Jin
- Department of Neurosurgery, Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University China
| | - Zi-Gang Yuan
- Department of Neurosurgery, Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University China
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374
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Inagawa T. Risk Factors for Cerebral Vasospasm Following Aneurysmal Subarachnoid Hemorrhage: A Review of the Literature. World Neurosurg 2016; 85:56-76. [PMID: 26342775 DOI: 10.1016/j.wneu.2015.08.052] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 08/17/2015] [Accepted: 08/18/2015] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To examine the literature on risk factors for cerebral vasospasm (CV), one of the most serious complications following aneurysmal subarachnoid hemorrhage (SAH), with special reference to the definition of CV. METHODS Using standard search engines, including PubMed, the medical literature on risk factors for CV after SAH was reviewed, and the best definition representative of CV was searched. RESULTS Severe SAH evident on computed tomography scan was the only consistent risk factor for CV after SAH. Effects of risk factors on CV, including age, clinical grade, rebleeding, intraventricular or intracerebral hemorrhage on computed tomography scan, acute hydrocephalus, aneurysm site and size, leukocytosis, interleukin-6 level, and cardiac abnormalities, appeared to be associated with the severity of SAH rather than each having a direct effect. Cigarette smoking, hypertension, and left ventricular hypertrophy on electrocardiogram were associated with CV without any relationship to SAH severity. With regard to parameters representative of CV, the grade of angiographic vasospasm (i.e., the degree of arterial narrowing evident on angiography) was the most adequate. Nevertheless, few reports on the risk factors associated with angiographic vasospasm grade have been reported to date. CONCLUSIONS Severe SAH evident on computed tomography scan appears to be a definite risk factor for CV after SAH, followed by cigarette smoking, hypertension, and left ventricular hypertrophy on electrocardiogram. To understand the pathogenesis of CV, further studies on the relationships between risk factors, especially factors not related to the severity of SAH, and angiographic vasospasm grade are necessary.
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375
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Murai Y, Ishisaka E, Tsukiyama A, Matano F, Morita A. Internal Carotid Artery Aneurysm Anomalously Originating from the Posterior Communicating Artery. World Neurosurg 2015; 84:2078.e9-11. [PMID: 26325211 DOI: 10.1016/j.wneu.2015.08.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Revised: 08/21/2015] [Accepted: 08/22/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND We report a case of an internal carotid artery (ICA) aneurysm anomalously originating from the posterior communicating artery (PComA). CASE DESCRIPTION Preoperative radiologic findings revealed a paraclinoid carotid artery aneurysm at the level of the distal dural ring. Because of the low rupture risk, there are no treatment indications for small paraclinoid or ICA-superior hypophyseal artery unruptured aneurysms. In this case, because of the patient's age and the irregular shape of the aneurysm, treatment was considered necessary. Intraoperative findings using microscopic and endoscopic angiography showed that the aneurysm originated from the proximal branched PComA. The PComA originated from the same level as the ophthalmic artery, and the superior hypophyseal artery originated from the distal side of the PComA. CONCLUSIONS According to numerous reports, small incidental paraclinoid aneurysms have a lower risk of rupture and growth than PComA aneurysms. Preoperative radiologic examination of unruptured small aneurysms was performed using magnetic resonance angiography and three-dimensional computed tomography angiography. Because the ability of magnetic resonance angiography and three-dimensional computed tomography angiography to detect small branches of the ICA is inferior to digital subtraction angiography, the location of an unruptured ICA aneurysm should be evaluated with other diagnostic modalities besides magnetic resonance angiography and three-dimensional computed tomography angiography.
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Affiliation(s)
- Yasuo Murai
- Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan.
| | - Eitaro Ishisaka
- Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan
| | - Atsushi Tsukiyama
- Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan
| | - Fumihiro Matano
- Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan
| | - Akio Morita
- Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan
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376
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Abstract
Cerebrospinal vascular malformations are a group of anomalies affecting the arterial wall, the capillary arteriovenous interface, or the venous and lymphatic structures. Heritability and family studies allow identification of mutations in single genes associated with rare familial conditions causing cerebral or spinal vascular malformations, as is the case in hemorrhagic hereditary telangiectasia diseases. This article reviews the genetic and epigenetic influences increasingly reported in recent years as causal factors or triggers involved in the formation and growth of cerebromedullary vascular malformations.
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Affiliation(s)
- Hortensia Alvarez
- Interventional Neuroradiology, UNC at Chapel Hill, Chapel Hill, NC 27516, USA
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377
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Abstract
Cerebral aneurysms are well known to be associated with cardiac myxomas. The mechanism of cerebral aneurysm formation remains to be elucidated. Embolization of tumor particles in the vessel wall has been proposed as the likely mechanism for aneurysm formation. Recent reports suggest interleukin-6 (IL-6) may play a role as well. We describe a patient who presented with subarachnoid hemorrhage secondary to ruptured right middle cerebral artery (MCA) aneurysm and unruptured left MCA aneurysm. Subsequently, the patient was found to have an atrial myxoma and persistently elevated serum IL-6 levels. Transcranial Doppler monitoring showed multiple emboli in the right MCA vascular territory on day 1 after surgery but no recurrent embolization during the next 2 weeks on repeated tests. Elevated IL-6 levels were noted both on day 1 and on day 30. Our findings provide evidence that IL-6 elevation and not tumor embolization is likely the culprit for aneurysm formation in some patients with atrial myxoma.
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Affiliation(s)
- Nnadozie Ezerioha
- College of Medicine, Medical University of South Carolina, Charleston, S.C., USA
| | - Wuwei Feng
- College of Medicine, Medical University of South Carolina, Charleston, S.C., USA
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378
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Fang C, Liu CS, Xiao YP, Zhao M, Zhang JM, Li MH, Zhu YQ. Using a covered stent for large cerebral aneurysms treated with stent-assisted coiling. Interv Neuroradiol 2015; 21:317-24. [PMID: 25972387 DOI: 10.1177/1591019915581993] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE The purpose of this article is to evaluate the efficacy and safety of covered stent implantation for large intracranial aneurysms treated with stent-assisted coiling. MATERIALS AND METHODS Seven patients with a cerebral aneurysm were selected for this study. The aneurysms were located at the cavernous segment of the internal carotid artery in three cases, the supraclinoid segment in two and the vertebrobasilar junction in one. Aneurysm diameter was 10-25 mm. Mass effect symptoms occurred in six patients, epistaxis in one and subarachnoid hemorrhage in one. All patients underwent endovascular reconstruction with stent-assisted coiling and a covered stent. Five had undergone conventional endovascular embolization with stent-assisted coiling three to six months previously; the covered stent was then navigated through the existing stent and deployed to cover the aneurysm neck. In two cases, the covered stent was deployed after stent-assisted coiling in a single procedure. RESULTS Angiography showed that all aneurysms were excluded from the circulation and parent arteries were preserved. No technical adverse events occurred. At the one- to two-year follow-up, complete resolution of clinical symptom had occurred in six patients and partial resolution in one. No recurrent aneurysm filling and no hemodynamic stenosis was observed. CONCLUSION Endovascular reconstruction combining a covered stent with stent-assisted coiling could be an effective and safe strategy for the treatment of large cerebral aneurysms.
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Affiliation(s)
- Chun Fang
- Department of Neurosurgery, the Second Affiliated Hospital, Medical School of Zhe Jiang University, China Department of Neuro-Interventional Radiology, Shanghai East Hospital, Medical School of Tong Ji University, China
| | - Chuan-Sen Liu
- Department of Neuro-Interventional Radiology, Shanghai East Hospital, Medical School of Tong Ji University, China
| | - Ya-Ping Xiao
- Department of Neuro-Interventional Radiology, Shanghai East Hospital, Medical School of Tong Ji University, China
| | - Mei Zhao
- Department of Neuro-Interventional Radiology, Shanghai East Hospital, Medical School of Tong Ji University, China
| | - Jian-Min Zhang
- Department of Neurosurgery, the Second Affiliated Hospital, Medical School of Zhe Jiang University, China
| | - Ming-Hua Li
- The Sixth Affiliated People's Hospital, Medical School of Shanghai Jiao Tong University, China
| | - Yue-Qi Zhu
- The Sixth Affiliated People's Hospital, Medical School of Shanghai Jiao Tong University, China
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379
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Heiferman DM, Somasundaram A, Alvarado AJ, Zanation AM, Pittman AL, Germanwala AV. The endonasal approach for treatment of cerebral aneurysms: A critical review of the literature. Clin Neurol Neurosurg 2015; 134:91-7. [PMID: 25974398 DOI: 10.1016/j.clineuro.2015.04.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 04/25/2015] [Indexed: 10/23/2022]
Abstract
The last two decades of neurosurgery have seen flourishing use of the endonasal approach for the treatment of skull base tumors. Safe and effective resections of neoplasms requiring intracranial arterial dissection have been performed using this technique. Recently, there have been a growing number of case reports describing the use of the endonasal approach to surgically clip cerebral aneurysms. We review the use of these approaches in intracranial aneurysm clipping and analyze its advantages, limitations, and consider future directions. Three major electronic databases were queried using relevant search terms. Pertinent case studies of unruptured and ruptured aneurysms were considered. Data from included studies were analyzed. 8 case studies describing 9 aneurysms (4 ruptured and 5 unruptured) treated by the endonasal approach met inclusion criteria. All studies note the ability to gain proximal and distal control and successful aneurysm obliteration was obtained for 8 of 9 aneurysms. 1 intraoperative rupture occurred and was controlled, and delayed complications of cerebrospinal fluid leak, vasospasm, and hydrocephalus occurred in 1, 1, and 2 patients, respectively. Described limitations of this technique include aneurysm orientation and location, the need for lower profile technology, and challenges with handling intraoperative rupture. The endonasal approach for clipping of intracranial aneurysms can be an effective approach in only very select cases as demonstrated clinically and through cadaveric exploration. Further investigation with lower profile clip technology and additional studies need to be performed. Options of alternative therapy, limitations of this approach, and team experience must first be considered.
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Affiliation(s)
- Daniel M Heiferman
- Department of Neurological Surgery, Loyola University School of Medicine, Maywood, USA
| | - Aravind Somasundaram
- Department of Neurological Surgery, Loyola University School of Medicine, Maywood, USA
| | | | - Adam M Zanation
- Department of Otolaryngology, University of North Carolina School of Medicine, Chapel Hill, USA
| | - Amy L Pittman
- Department of Otolaryngology, Loyola University School of Medicine, Maywood, USA
| | - Anand V Germanwala
- Department of Neurological Surgery, Loyola University School of Medicine, Maywood, USA; Edward Hines, Jr. VA Medical Center, Hines, USA.
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380
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Chen SH, Grandhi R, Deibert CP, Jovin TG, Gardner PA, Ducruet AF. Coil herniation following intra-arterial verapamil infusion for the treatment of cerebral vasospasm: Case report and literature review. Interv Neuroradiol 2015; 21:184-7. [PMID: 25934655 DOI: 10.1177/1591019915581990] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Complications associated with intra-arterial infusion of vasodilator agents for the treatment of vasospasm associated with a ruptured cerebral aneurysm are extremely rare. We present the case of a patient who developed left lower extremity monoplegia following intra-arterial infusion of verapamil for treatment of diffuse cerebral vasospasm, 6 days after initially undergoing treatment of a ruptured right A1-2 junction aneurysm. A repeat angiogram following this intra-arterial vasodilator treatment demonstrated a coil loop which had herniated into the right A2 artery. Herein, we describe a previously unreported complication which occurred following intra-arterial pharmacologic vasospasm treatment, review the existing literature, and suggest potential causes and treatment options.
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Affiliation(s)
| | - Ramesh Grandhi
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, USA
| | - Christopher P Deibert
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, USA
| | - Tudor G Jovin
- Department of Neurology, University of Pittsburgh Medical Center; Pittsburgh, USA
| | - Paul A Gardner
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, USA
| | - Andrew F Ducruet
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, USA
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381
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Lehto H, Niemelä M, Kivisaari R, Laakso A, Jahromi BR, Hijazy F, Andrade-Barazarte H, Dashti R, Hernesniemi J. Intracranial Vertebral Artery Aneurysms: Clinical Features and Outcome of 190 Patients. World Neurosurg 2015; 84:380-9. [PMID: 25828051 DOI: 10.1016/j.wneu.2015.03.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Revised: 03/17/2015] [Accepted: 03/18/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Vertebral artery (VA) aneurysms comprise approximately one-third of posterior circulation aneurysms. They are morphologically variable, and located critically close to the cranial nerves and the brainstem. We aim to represent the characteristics of these aneurysms and their treatment, and to analyze the outcome. METHODS We reviewed retrospectively 9709 patients with intracranial aneurysms. Of these, we included 190 with aneurysms at the VA or VA-posterior inferior cerebellar artery junction. These patients were treated in the Department of Neurosurgery, Helsinki, Finland, between 1934 and 2011. RESULTS The 190 patients had 193 VA aneurysms, among which 131 (68%) were ruptured. The VA aneurysm caused a mass effect in 7 and ischemia in 2 patients. Compared to 4387 patients with a ruptured aneurysm in other locations, those with a VA aneurysm were older, their aneurysms were more often fusiform, and more often caused intraventricular hemorrhages. Among surgically treated aneurysms, clipping was the treatment in 91 (88%) saccular and 11 (50%) fusiform aneurysms. Treatment was endovascular in 13 (9%), and multimodal in 6 (4%) aneurysms. Within a year after aneurysm diagnosis, 53 (28%) patients died. Among the survivors, 104 (93%) returned to an independent or to their previous state of life; only 2 (2%) were unable to return home. CONCLUSIONS Microsurgery is a feasible treatment for VA aneurysms, although cranial nerve deficits are more common than in endovascular surgery. Despite the challenge of an often severe hemorrhage, of challenging morphology, and risk for laryngeal palsy, most patients surviving the initial stage return to normalcy.
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Affiliation(s)
- Hanna Lehto
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland.
| | - Mika Niemelä
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Riku Kivisaari
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Aki Laakso
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Behnam Rezai Jahromi
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Ferzat Hijazy
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | | | - Reza Dashti
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Juha Hernesniemi
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
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382
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Yamaguchi R, Tanaka G, Liu H, Ujiie H. Repression of wall shear stress inside cerebral aneurysm at bifurcation of anterior cerebral artery by stents. Heart Vessels 2015; 31:622-7. [PMID: 25813684 DOI: 10.1007/s00380-015-0665-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 03/20/2015] [Indexed: 10/23/2022]
Abstract
The effect of a simple bare metal stent on repression of wall shear stress inside a model cerebral aneurysm was experimentally investigated by two-dimensional particle image velocimetry in vitro. The flow model simulated a cerebral aneurysm induced at the apex of bifurcation between the anterior cerebral artery and the anterior communicating artery. Wall shear stress was investigated using both stented and non-stented models to assess the simple stent characteristics. The flow behavior inside the stented aneurysm sac was unusual and wall shear stress was much smaller inside the aneurysm sac. Stent placement effectively repressed the temporal and spatial variations and the magnitude of wall shear stress. Hence, there is an effective possibility that would retard the progress of cerebral aneurysms by even simple stent.
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Affiliation(s)
- Ryuhei Yamaguchi
- Graduate School of Engineering, Chiba University, 1-33 Yayoicho, Inage-ku, Chiba, 263-8522, Japan.
| | - Gaku Tanaka
- Graduate School of Engineering, Chiba University, 1-33 Yayoicho, Inage-ku, Chiba, 263-8522, Japan
| | - Hao Liu
- Graduate School of Engineering, Chiba University, 1-33 Yayoicho, Inage-ku, Chiba, 263-8522, Japan
| | - Hiroshi Ujiie
- Department of Neurosurgery, Tokyo Rosai Hospital, 4-13-21 Oomori, Ohta-ku, Tokyo, 337-8570, Japan
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383
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Jahromi BR, Niemelä M, Hernesniemi J. Should I Treat or Should I Not? World Neurosurg 2015; 83:1034-5. [PMID: 25681594 DOI: 10.1016/j.wneu.2015.01.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 01/27/2015] [Indexed: 11/23/2022]
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384
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Mulholland C, Spetzler RF. A Symphony Deconstructed. World Neurosurg 2015; 83:1024-5. [PMID: 25659808 DOI: 10.1016/j.wneu.2015.01.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 01/27/2015] [Indexed: 11/25/2022]
Affiliation(s)
- Celene Mulholland
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Robert F Spetzler
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
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385
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Shin KM, Ahn JH, Kim IS, Lee JY, Kang SS, Hong SJ, Chung HM, Lee HJ. The efficacy of pre-warming on reducing intraprocedural hypothermia in endovascular coiling of cerebral aneurysms. BMC Anesthesiol 2015; 15:8. [PMID: 25670919 PMCID: PMC4322559 DOI: 10.1186/1471-2253-15-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 01/13/2015] [Indexed: 11/10/2022] Open
Abstract
Background The anesthetic management of patients undergoing endovascular treatment of cerebral aneurysms in the interventional neuroradiology suite can be challenged by hypothermia because of low ambient temperature for operating and maintaining its equipments. We evaluated the efficacy of skin surface warming prior to induction of anesthesia to prevent the decrease in core temperature and reduce the incidence of hypothermia. Methods Seventy-two patients were randomized to pre-warmed and control group. The patients in pre-warmed group were warmed 30 minutes before induction with a forced-air warming blanket set at 38°C. Pre-induction tympanic temperature (Tpre) was measured using an infrared tympanic thermometer and core temperature was measured at the esophagus immediately after intubation (T0) and recorded at 20 minutes intervals (T20, T40, T60, T80, T100, and T120). The number of patients who became hypothermic at each time was recorded. Results Tpre in the control and pre-warmed group were 36.4 ± 0.4°C and 36.6 ± 0.3°C, whereas T0 were 36.5 ± 0.4°C and 36.6 ± 0.2°C. Core temperatures in the pre-warmed group were significantly higher than the control group at T20, T40, T60, T80, T100, and T120 (P < 0.001). Compared to T0, core temperatures at each time were significantly lower in both two groups (P = 0.007 at T20 in pre-warmed group, P < 0.001 at the other times in both groups). The incidence of hypothermia was significantly lower in the pre-warmed group than the control group from T20 to T120 (P = 0.002 at T20, P < 0.001 at the other times). Conclusion Pre-warming for 30 minutes at 38°C did not modify the trends of the temperature decrease seen in the INR suite. It just slightly elevated the beginning post intubation base temperature. The rate of decrease was similar from T20 to T120. However, pre-warming considerably reduced the risk of intraprocedural hypothermia. Trial registration Clinical Research Information Service (CRiS) Identifier: KCT0001320. Registered December 19th, 2014.
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Affiliation(s)
- Keun Man Shin
- Department of Anesthesiology and Pain Medicine, Kangdong Sacred Heart Hospital, Hallym University Medical Center, 150, Sungan-ro, Gangdong-gu, Seoul, 134-701 South Korea
| | - Jung Hwan Ahn
- Department of Emergency Medicine, Bundang Jesaeng General Hospital, Seongnam, South Korea
| | - Il Seok Kim
- Department of Anesthesiology and Pain Medicine, Kangdong Sacred Heart Hospital, Hallym University Medical Center, 150, Sungan-ro, Gangdong-gu, Seoul, 134-701 South Korea
| | - Jong Young Lee
- Department of Neurosurgery, Kangdong Sacred Heart Hospital, Hallym University Medical Center, Seoul, South Korea
| | - Sang Soo Kang
- Department of Anesthesiology and Pain Medicine, Kangdong Sacred Heart Hospital, Hallym University Medical Center, 150, Sungan-ro, Gangdong-gu, Seoul, 134-701 South Korea
| | - Sung Jun Hong
- Department of Anesthesiology and Pain Medicine, Kangdong Sacred Heart Hospital, Hallym University Medical Center, 150, Sungan-ro, Gangdong-gu, Seoul, 134-701 South Korea
| | - Hyun Mo Chung
- Department of Anesthesiology and Pain Medicine, Kangdong Sacred Heart Hospital, Hallym University Medical Center, 150, Sungan-ro, Gangdong-gu, Seoul, 134-701 South Korea
| | - Hee Jae Lee
- Department of Pharmacology, School of Medicine, Kangwon National University, Chuncheon, South Korea
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386
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Sánchez-Vicente JL, Frau-Aguilera L, Sánchez-Vicente P, Herrador-Montiel A, Rueda-Rueda T, Castilla-Lázpita A, Romera-Piñero A, Medina-Tapia A. [Macular atrophy in Terson's syndrome]. ACTA ACUST UNITED AC 2014; 90:26-9. [PMID: 25443182 DOI: 10.1016/j.oftal.2014.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Revised: 01/31/2014] [Accepted: 02/09/2014] [Indexed: 10/24/2022]
Abstract
CASE REPORT The case is presented on a 63-year-old patient with Terson's syndrome who complained of loss of visual acuity. The optical coherence tomography showed macular atrophy. DISCUSSION The patient developed macular atrophy probably secondary to macular hemorrhage caused by the rupture of a cerebral aneurysm.
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Affiliation(s)
- J L Sánchez-Vicente
- Unidad de Gestión Clínica de Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - L Frau-Aguilera
- Unidad de Gestión Clínica de Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, España.
| | | | - A Herrador-Montiel
- Servicio de Oftalmología, Hospital Universitario Reina Sofía, Córdoba, España
| | - T Rueda-Rueda
- Unidad de Gestión Clínica de Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, España
| | | | - A Romera-Piñero
- Unidad de Gestión Clínica de Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - A Medina-Tapia
- Unidad de Gestión Clínica de Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, España
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387
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Park J. Superciliary keyhole approach for unruptured anterior circulation aneurysms: surgical technique, indications, and contraindications. J Korean Neurosurg Soc 2014; 56:371-4. [PMID: 25535512 PMCID: PMC4272993 DOI: 10.3340/jkns.2014.56.5.371] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 08/14/2014] [Accepted: 10/05/2014] [Indexed: 11/27/2022] Open
Abstract
Neurosurgeons have been trying to reduce surgical invasiveness by applying minimally invasive keyhole approaches. Therefore, this paper clarifies the detailed surgical technique, its limitations, proper indications, and contraindications for a superciliary keyhole approach as a minimally invasive modification of a pterional approach. Successful superciliary keyhole surgery for unruptured aneurysms requires an understanding of the limitations and the use of special surgical techniques. Essentially, this means the effective selection of surgical indications, usage of the appropriate surgical instruments with a tubular shaft, and refined surgical techniques, including straightforward access to the aneurysm, clean surgical dissection, and the application of clips with an appropriate configuration. A superciliary keyhole approach allows unruptured anterior circulation aneurysms to be clipped safely, rapidly, and less invasively on the basis of appropriate surgical indications.
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Affiliation(s)
- Jaechan Park
- Department of Neurosurgery, Research Center for Neurosurgical Robotic Systems, Kyungpook National University, Daegu, Korea
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388
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Lang SS, Sanborn MR, Ju C, Premjee A, Stein SC, Smith MJ. Hydrocephalus after subarachnoid hemorrhage: A meta-analytic comparison of aneurysm treatments. World J Meta-Anal 2014; 2:171-178. [DOI: 10.13105/wjma.v2.i4.171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 05/27/2014] [Accepted: 08/29/2014] [Indexed: 02/05/2023] Open
Abstract
AIM: To compare two treatments for ruptured cerebral aneurysm with reference to the relative risk of developing hydrocephalus.
METHODS: We reviewed the English language literature on the risk of developing hydrocephalus after aneurysm treatment. Data were divided by type of study (randomized controlled trial, cohort trial, nonrandomized comparison, prospectively- and retrospectively-collected observational study). They were also divided by type of aneurysm treatment (microvascular - clipping, or endovascular - coiling). Additional predictive variables collected for each publication were average age, gender distribution, measures of hemorrhage volume and subarachnoid hemorrhage severity, aneurysm locations, time to treatment, duration of follow-up and date of publication. We employed meta-analysis to calculate pooled risk ratios of developing hydrocephalus in cases receiving aneurysm clipping vs those receiving coiling. Meta-regression was used to correct pooled results for covariates.
RESULTS: Because indications for the two treatments are different, there is little clinical equipoise for treating most cases. The single randomized, controlled trial dealt with a small subset of ruptured aneurysms. Neither this nor pooled values from other studies which compared the two treatments had the power to demonstrate significant differences between the two treatments. Nor was there an apparent difference when observational data were meta-analytically pooled. However, when meta-regression was used to correct for predictive variables known to differ between the two treatment groups, a highly-significant difference appeared. Coiling is used more commonly in older, sicker patients with aneurysms in certain locations. These cases are more likely to develop hydrocephalus. When corrected for these covariates, the risk of hydrocephalus was found to be significantly lower in coiled vs clipped cases (P = 0.014).
CONCLUSION: Pooled observational data were necessary to demonstrate that coiling ruptured cerebral aneurysms is associated with a lower risk of developing hydrocephalus than is clipping.
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389
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Munarriz PM, Castaño-Leon AM, Cepeda S, Campollo J, Alén JF, Lagares A. Endovascular treatment of a true posterior communicating artery aneurysm. Surg Neurol Int 2014; 5:S447-50. [PMID: 25422786 PMCID: PMC4235117 DOI: 10.4103/2152-7806.143273] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Accepted: 08/22/2014] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Posterior communicating artery (PCoA) aneurysms are most commonly located at the junction of the internal carotid artery and the PCoA. "True" PCoA aneurysms, which originate from the PCoA itself, are rarely encountered. Most previously reported cases were treated surgically mainly before the endovascular option became available. CASE DESCRIPTION A 53-year-old male presented with sudden onset of right hemiparesis and aphasia. Left middle cerebral artery stroke was diagnosed. Further studies revealed a 3 mm left PCoA aneurysm arising from the PCoA itself, attached to neither the internal carotid artery nor the posterior cerebral artery. Endovascular treatment was performed and the aneurysm was coiled completely. CONCLUSION Technical advances in endovascular interventional technology have permitted an additional approach to these lesions. The possible endovascular significance of the treatment of true PCoA aneurysms is discussed.
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Affiliation(s)
- Pablo M Munarriz
- Department of Neurosurgery, "12 de Octubre" University Hospital, Complutense University of Madrid, Madrid, Spain
| | - Ana M Castaño-Leon
- Department of Neurosurgery, "12 de Octubre" University Hospital, Complutense University of Madrid, Madrid, Spain
| | - Santiago Cepeda
- Department of Neurosurgery, "12 de Octubre" University Hospital, Complutense University of Madrid, Madrid, Spain
| | - Jorge Campollo
- Division of Neuroradiology, "12 de Octubre" University Hospital, Complutense University of Madrid, Madrid, Spain
| | - Jose F Alén
- Department of Neurosurgery, "12 de Octubre" University Hospital, Complutense University of Madrid, Madrid, Spain ; Division of Neuroradiology, "12 de Octubre" University Hospital, Complutense University of Madrid, Madrid, Spain
| | - Alfonso Lagares
- Department of Neurosurgery, "12 de Octubre" University Hospital, Complutense University of Madrid, Madrid, Spain
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390
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Zhao J, Lin X, He C, Yang GY, Ling F. Study of cerebral aneurysms in a modified rat model: from real-time imaging to histological analysis. J Clin Neurosci 2014; 22:373-7. [PMID: 25443088 DOI: 10.1016/j.jocn.2014.05.044] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 05/08/2014] [Accepted: 05/10/2014] [Indexed: 11/19/2022]
Abstract
Cerebral aneurysm (CA) is a life-threatening condition with a pathogenesis that remains unclear. Previous hypotheses have primarily been based on in vitro examinations of animal models. Therefore, we attempted to observe CA in living rats and to establish a multi-level evaluation system. The rat model was produced by deoxycorticosterone-acetate (DOCA; Sigma Aldrich, St. Louis, MO, USA) induced hypertension and a single injection of elastase into the basal cistern. The animals were assessed 35 days later. At the endpoint, we induced well-developed CA in 41.7% of the surviving rats. Using synchrotron radiation angiography (SRA), we observed the experimental aneurysms and their surrounding arteries dynamically in the living model. Further anatomical and histological analyses demonstrated the typical degenerative changes of the mural structure and a major infiltration of macrophages into the aneurysmal wall. In conclusion, we visualised well-developed experimental CA in living rats using SRA and demonstrated the associated degenerative histological changes and macrophage involvement; thus, we have provided an effective model for the study of dynamic multi-level changes associated with CA in a rat model.
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Affiliation(s)
- Jingjing Zhao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing 100054, China
| | - Xiaojie Lin
- Med-X Research Institute and School of Biomedical Engineering, Shanghai Jiao Tong University, Xuhui District, Shanghai, China
| | - Chuan He
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing 100054, China
| | - Guo-Yuan Yang
- Med-X Research Institute and School of Biomedical Engineering, Shanghai Jiao Tong University, Xuhui District, Shanghai, China
| | - Feng Ling
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing 100054, China.
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391
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Li S, Tian Y, Huang X, Zhang Y, Wang D, Wei H, Dong J, Jiang R, Zhang J. Intravenous transfusion of endothelial colony-forming cells attenuates vascular degeneration after cerebral aneurysm induction. Brain Res 2014; 1593:65-75. [PMID: 25316629 DOI: 10.1016/j.brainres.2014.09.077] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 07/28/2014] [Accepted: 09/04/2014] [Indexed: 11/29/2022]
Abstract
Cerebral aneurysm (CA) rupture is a major cause of subarachnoid hemorrhage with high morbidity and mortality. Using an animal model, we examined the potential of endothelial colony-forming cells (ECFCs) transfusion on vascular degeneration after CA induction and underlying mechanisms. CA was induced in the right anterior cerebral artery-olfactory artery (ACA/OA) bifurcations in Sprague-Dawley rats with or without ECFCs transfusion. The degeneration of internal elastic lamina (IEL), media thickness and CA size were evaluated. Expression of matrix metalloproteinase-2 and 9 (MMP-2 and 9), tissue inhibitor of metalloproteinase-1 (TIMP-1), macrophage chemoattractant protein-1 (MCP-1), vascular cell adhesion molecule-1 (VCAM-1), nuclear factor κB (NF-κB), endothelial nitric oxide synthase (eNOS), B-cell leukemia/lymphoma-2 (Bcl-2), and inducible nitric oxide synthase (iNOS) were analyzed by quantitative real-time polymerase chain reaction. The macrophages infiltration and apoptosis of smooth muscle cells (SMCs) were examined immunohistologically. Rats in CA+ECFCs transfusion group showed a notable reduction in IEL degeneration, media thinning and CA size compared with those in CA+saline group. ECFCs transfusion inhibited the MMP-driven wall destruction by downregulating MMP-2, MMP-9 expression and upregulating TIMP-1. ECFCs transfusion dramatically decreased VCAM-1 and NF-κB expression, increased eNOS expression and caused no change in MCP-1 expression, which was accompanied by reduced macrophages infiltration. Moreover, ECFCs transfusion reversed downregulation of Bcl-2 expression and upregulation of iNOS expression, and decreased SMCs apoptosis. Collectively, these findings suggest that ECFCs transfusion confers protection against degeneration of aneurysmal wall by inhibiting inflammatory cascades and SMCs apoptosis.
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Affiliation(s)
- Shengjie Li
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin 300052, China; Tianjin Neurological Institute, Tianjin 300052, China; Key Laboratory of Post-trauma Neuro-repair and Regeneration in Central Nervous System, Ministry of Education, Tianjin 300052, China; Tianjin Key Laboratory of Injuries, Variations and Regeneration of Nervous System, Tianjin 300052, China
| | - Ye Tian
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin 300052, China; Tianjin Neurological Institute, Tianjin 300052, China; Key Laboratory of Post-trauma Neuro-repair and Regeneration in Central Nervous System, Ministry of Education, Tianjin 300052, China; Tianjin Key Laboratory of Injuries, Variations and Regeneration of Nervous System, Tianjin 300052, China
| | - Xintao Huang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin 300052, China; Tianjin Neurological Institute, Tianjin 300052, China; Key Laboratory of Post-trauma Neuro-repair and Regeneration in Central Nervous System, Ministry of Education, Tianjin 300052, China; Tianjin Key Laboratory of Injuries, Variations and Regeneration of Nervous System, Tianjin 300052, China
| | - Yongqiang Zhang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin 300052, China; Tianjin Neurological Institute, Tianjin 300052, China; Key Laboratory of Post-trauma Neuro-repair and Regeneration in Central Nervous System, Ministry of Education, Tianjin 300052, China; Tianjin Key Laboratory of Injuries, Variations and Regeneration of Nervous System, Tianjin 300052, China
| | - Dehui Wang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin 300052, China; Tianjin Neurological Institute, Tianjin 300052, China; Key Laboratory of Post-trauma Neuro-repair and Regeneration in Central Nervous System, Ministry of Education, Tianjin 300052, China; Tianjin Key Laboratory of Injuries, Variations and Regeneration of Nervous System, Tianjin 300052, China
| | - Huijie Wei
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin 300052, China; Tianjin Neurological Institute, Tianjin 300052, China; Key Laboratory of Post-trauma Neuro-repair and Regeneration in Central Nervous System, Ministry of Education, Tianjin 300052, China; Tianjin Key Laboratory of Injuries, Variations and Regeneration of Nervous System, Tianjin 300052, China
| | - Jingfei Dong
- Puget Sound Blood Research Institute, 1551 Eastlake Ave E, Seattle, WA 98102, USA
| | - Rongcai Jiang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin 300052, China; Tianjin Neurological Institute, Tianjin 300052, China; Key Laboratory of Post-trauma Neuro-repair and Regeneration in Central Nervous System, Ministry of Education, Tianjin 300052, China; Tianjin Key Laboratory of Injuries, Variations and Regeneration of Nervous System, Tianjin 300052, China.
| | - Jianning Zhang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin 300052, China; Tianjin Neurological Institute, Tianjin 300052, China; Key Laboratory of Post-trauma Neuro-repair and Regeneration in Central Nervous System, Ministry of Education, Tianjin 300052, China; Tianjin Key Laboratory of Injuries, Variations and Regeneration of Nervous System, Tianjin 300052, China.
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392
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Suzuki M, Umeoka K, Kominami S, Morita A. Successful treatment of a ruptured flow-related aneurysm in a patient with hemangioblastoma: Case report and review of literature. Surg Neurol Int 2014; 5:S430-3. [PMID: 25324977 PMCID: PMC4199150 DOI: 10.4103/2152-7806.141887] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 07/29/2014] [Indexed: 11/30/2022] Open
Abstract
Background: No cerebral aneurysms on the feeder associated with hemangioblastomas that ruptured before resection have been reported. We report a patient with a ruptured flow-related aneurysm associated with cerebellar hemangioblastoma and a tumor feeder treated simultaneously by a single procedure of embolization using N-butyl cyanoacrylate before tumor removal. Case Description: A 36-year-old female with a cerebellar tumor was admitted to our institute. Four days later, she suffered a massive subarachnoid hemorrhage mainly in the posterior fossa. Left vertebral angiograms showed an aneurysm on the feeding artery, posterior inferior cerebellar artery. Both the aneurysm and its main feeder were simultaneously treated by a single procedure of embolization using N-butyl cyanoacrylate. Their complete obliteration was confirmed angiographically. Four days after the procedure, we removed the tumor and the embolized aneurysm. The pathological diagnosis was hemangioblastoma and flow-related ruptured aneurysm. Conclusion: Cerebral angiography should be performed to rule out vascular abnormalities such as cerebral aneurysms adjacent to the tumor in patients with hemangioblastoma who present with intracranial hemorrhage. We emphasize the usefulness of embolization with N-butyl cyanoacrylate for hemangioblastoma with ruptured feeder aneurysm, by which the aneurysm and the feeder could be simultaneously embolized.
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Affiliation(s)
- Masanori Suzuki
- Department of Neurosurgery, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, Japan
| | - Katsuya Umeoka
- Department of Neurosurgery, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, Japan
| | - Shushi Kominami
- Department of Neurosurgery, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, Japan
| | - Akio Morita
- Department of Neurosurgery, Nippon Medical School Hospital, 1-1-5, Sendagi, Bunkyoku, Tokyo, Japan
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393
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Wong GKC, Lam SW, Chan SSM, Lai M, Tse PPP, Mok V, Poon WS, Wong A. Neuropsychiatric disturbance after aneurysmal subarachnoid hemorrhage. J Clin Neurosci 2014; 21:1695-8. [PMID: 24929862 DOI: 10.1016/j.jocn.2014.02.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 02/23/2014] [Indexed: 11/25/2022]
Abstract
Although aneurysmal subarachnoid hemorrhage (aSAH) accounts for only 3-5% of all strokes, a high degree of morbidity has been reported in this relatively young subset of patients. Neuropsychiatric disturbance has often been neglected in these reports. We aimed to investigate the pattern and pathological factors of chronic neuropsychiatric disturbance in aSAH patients. This cross-sectional observational four-center study was carried out in Hong Kong. Neuropsychiatric outcome (Neuropsychiatric Inventory Chinese Version [CNPI]) assessments were conducted cross-sectionally 1-4 years after ictus. Pathological factors considered were early brain injury as assessed by admission World Federation of Neurosurgical Societies grade, aneurysm treatment (clipping versus coiling), delayed cerebral infarction, and chronic hydrocephalus. One hundred and three aSAH patients' spouses or caregivers completed the CNPI. Forty-two (41%) patients were reported to have one or more domain(s) of neuropsychiatric disturbance. Common neuropsychiatric disturbance domains included agitation/aggression, depression, apathy/indifference, irritability/lability, and appetite/eating disturbance. Chronic neuropsychiatric disturbance was associated with presence of chronic hydrocephalus. A subscore consisting of the five commonly affected domains seems to be a suitable tool for aSAH patients and should be further validated and replicated in future studies.
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Affiliation(s)
- George Kwok Chu Wong
- Division of Neurosurgery, Department of Surgery, 4/F Clinical Science Building, Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong Special Administrative Region.
| | - Sandy Wai Lam
- Division of Neurosurgery, Department of Surgery, 4/F Clinical Science Building, Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong Special Administrative Region
| | - Sandra S M Chan
- Department of Psychiatry, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Mary Lai
- Division of Neurosurgery, Department of Surgery, 4/F Clinical Science Building, Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong Special Administrative Region
| | - Patty P P Tse
- Division of Neurosurgery, Department of Surgery, 4/F Clinical Science Building, Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong Special Administrative Region
| | - Vincent Mok
- Division of Neurology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Wai Sang Poon
- Division of Neurosurgery, Department of Surgery, 4/F Clinical Science Building, Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong Special Administrative Region
| | - Adrian Wong
- Department of Psychological Studies, The Hong Kong Institute of Education, Tai Po, New Territories, Hong Kong Special Administrative Region
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394
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Khan SA, Berger M, Agrawal A, Huang M, Karikari I, Nimjee SM, Zomorodi AR, McDonagh DL. Rapid ventricular pacing assisted hypotension in the management of sudden intraoperative hemorrhage during cerebral aneurysm clipping. Asian J Neurosurg 2014; 9:33-5. [PMID: 24891888 PMCID: PMC4038864 DOI: 10.4103/1793-5482.131066] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Sudden intraoperative hemorrhage during intracranial aneurysm surgery from vascular injury or aneurysmal rupture has been known to dramatically increase the associated morbidity and mortality. We describe the first reported use of rapid ventricular pacing (RVP) assisted hypotension to control sudden intraoperative hemorrhage during intracranial aneurysm surgery where temporary arterial occlusion was not achievable.
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Affiliation(s)
- Shariq Ali Khan
- Department of Anesthesiology, Duke University Medical Centre, Durham, North Carolina, USA ; Department of Anaesthesiology, Singapore General Hospital, Singapore
| | - Miles Berger
- Department of Anesthesiology, Duke University Medical Centre, Durham, North Carolina, USA
| | - Abhishek Agrawal
- Department of Surgery (Neurosurgery) and Radiology, Duke University Medical Centre, Durham, North Carolina, USA
| | - Mary Huang
- Department of Surgery (Neurosurgery), Duke University Medical Centre, Durham, North Carolina, USA
| | - Isaac Karikari
- Department of Surgery (Neurosurgery), Duke University Medical Centre, Durham, North Carolina, USA
| | - Shahid M Nimjee
- Department of Surgery (Neurosurgery) and Radiology, Duke University Medical Centre, Durham, North Carolina, USA
| | - Ali R Zomorodi
- Department of Surgery (Neurosurgery) and Radiology, Duke University Medical Centre, Durham, North Carolina, USA
| | - David L McDonagh
- Department of Anesthesiology, Duke University Medical Centre, Durham, North Carolina, USA
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395
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Abstract
Background: Prototyping of cerebral vasculature models through stereolithographic methods have the ability to accurately depict the 3D structures of complicated aneurysms with high accuracy. We describe the method to manufacture such a model and review some of its uses in the context of treatment planning, research, and surgical training. Methods: We prospectively used the data from the rotational angiography of a 40-year-old female who presented with an unruptured right paraclinoid aneurysm. The 3D virtual model was then converted to a physical life-sized model. Results: The model constructed was shown to be a very accurate depiction of the aneurysm and its associated vasculature. It was found to be useful, among other things, for surgical training and as a patient education tool. Conclusion: With improving and more widespread printing options, these models have the potential to become an important part of research and training modalities.
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Affiliation(s)
- Imad S Khan
- J.B. Marshall Laboratory for Neurovascular Therapeutics, NH, USA ; Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Patrick D Kelly
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Robert J Singer
- J.B. Marshall Laboratory for Neurovascular Therapeutics, NH, USA ; Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
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396
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Choi JY, Cha SH, Cho WH, Ko JK. Communicating hydrocephalus accompanied by arachnoid cyst in aneurismal subarachnoid hemorrhage. J Cerebrovasc Endovasc Neurosurg 2013; 15:311-5. [PMID: 24729958 PMCID: PMC3983532 DOI: 10.7461/jcen.2013.15.4.311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Revised: 10/17/2013] [Accepted: 10/31/2013] [Indexed: 11/23/2022] Open
Abstract
The authors describe a case of communicating hydrocephalus accompanied by an arachnoid cyst in an aneurismal subarachnoid hemorrhage. A 69-year-old female was referred to our clinic due to the sudden onset of a headache. A head computed tomography scan demonstrated an arachnoid cyst in the right middle fossa with a mass effect and diffuse subarachnoid hemorrhage. Digital subtraction angiography then revealed a left internal carotid-posterior communicating artery aneurysm. The neck of the aneurysm was clipped successfully and the post-operative period was uneventful. However, two months after discharge, the patient reported that her mental status had declined over previous weeks. A cranial computed tomography scan revealed an interval increase in the size of the ventricle and arachnoid cyst causing a midline shift. Simultaneous navigation guided ventriculoperitoneal shunt and cystoperitoneal shunt placement resulted in remarkable radiological and clinical improvements.
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Affiliation(s)
- Jae Young Choi
- Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Seung Heon Cha
- Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Won Ho Cho
- Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Jun Kyeung Ko
- Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital, Busan, Korea
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397
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Guo J, Chen Q, Miao H, Feng H, Zhu G, Chen Z. True posterior communicating artery aneurysms with or without increased flow dynamical stress: report of three cases. Clin Neurol Neurosurg 2013; 116:93-5. [PMID: 24275337 DOI: 10.1016/j.clineuro.2013.10.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Revised: 10/17/2013] [Accepted: 10/27/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Jing Guo
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
| | - Qianwei Chen
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
| | - Hongping Miao
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
| | - Hua Feng
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
| | - Gang Zhu
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
| | - Zhi Chen
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University, Chongqing 400038, China.
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398
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Sorkin GC, Jaleel N, Mokin M, Dumont TM, Eller JL, Siddiqui AH. Ruptured mycotic cerebral aneurysm development from pseudoocclusion due to septic embolism. Surg Neurol Int 2013; 4:144. [PMID: 24340226 PMCID: PMC3841922 DOI: 10.4103/2152-7806.121109] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Accepted: 10/03/2013] [Indexed: 12/04/2022] Open
Abstract
Background: Cerebral mycotic aneurysms are rare sequelae of systemic infections that can cause profound morbidity and mortality with rupture. Direct bacterial extension and vessel integrity compromise from septic emboli have been implicated as mechanisms for formation of these lesions. We report the 5-day development of a ruptured mycotic aneurysm arising from a septic embolism that caused a focal M1 pseudoocclusion. Case Description: A 14-year-old girl developed acute left-sided hemiparesis while hospitalized for subacute bacterial endocarditis that was found after she presented with a 2-week history of fever, myalgia, shortness of breath, and lethargy. Mitral valve vegetations were confirmed in the setting of hemophilus bacteremia. Brain magnetic resonance (MR) imaging and angiography confirmed middle cerebral artery infarct with focal pseudoocclusion of the distal M1 segment. Given that further middle cerebral artery territory was at risk, a trial of heparin was attempted for revascularization but required discontinuation owing to hemorrhagic conversion. Decline of the patient's mental status necessitated craniectomy for decompression. Postoperatively, her mental status improved with residual left hemiparesis. On the third postoperative day (5 days after MR angiography), the patient's neurologic condition acutely declined, with development of right-sided mydriasis. Computed tomography (CT) angiography revealed a ruptured 19 × 16 mm pseudoaneurysm arising from the M1 site of the previous occlusion. Emergent coiling of aneurysm and parent vessel followed by hematoma evacuation ensued. At discharge, the patient had residual left hemiparesis but intact speech and cognition. Conclusion: Focal occlusions due to septic emboli should be considered high-risk for mycotic aneurysm formation, prompting aggressive monitoring with neuroimaging and treatment when indicated.
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Affiliation(s)
- Grant C Sorkin
- Department of Neurosurgery, School of Medicine and Biomedical Sciences, Buffalo, New York, USA ; Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, New York, USA
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399
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Maradni A, Khoshnevisan A, Mousavi SH, Emamirazavi SH, Noruzijavidan A. Role of matrix metalloproteinases (MMPs) and MMP inhibitors on intracranial aneurysms: a review article. Med J Islam Repub Iran 2013; 27:249-54. [PMID: 24926188 PMCID: PMC4011417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Revised: 04/04/2013] [Accepted: 04/20/2013] [Indexed: 11/04/2022] Open
Abstract
Cerebrovascular disease is one of the leading causes of death in the world, and about one-fourth of cerebrovasculardeaths are due to ruptured cerebral aneurysms (CA). Hence it is important to find a way to reduce aneurysmformation and its subsequent morbidity and mortality. Proteolytic activity capable of lysing gelatin hasbeen shown to be increased in aneurysm tissue and expression of plasmin, membrane-type matrix metalloproteinase-1(MT1-MMP), and matrix metalloproteinase-2 (MMP-2) in aneurysmal wall is more than what we observein normal cerebral arteries. MMP inhibitors such as doxycycline and statins may prohibit aneurysm formationand growth. MMPs are important in tissue remodeling associated with various physiological and pathologicalprocesses such as morphogenesis, angiogenesis, apoptosis and tissue repair. In this article we review therole of MMPs and MMP inhibitors in formation of aneurysm.
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Affiliation(s)
- Azam Maradni
- 1General practitioner, Brain and spinal injury repair research center (BASIR), Tehran University of Medical Sciences, Tehran, Iran.
| | - Alireza Khoshnevisan
- 2Assistant Professor, Department of Neurosurgery, Brain and spinal injury repair research center, Tehran University of medical sciences, Tehran, Iran.
| | - Seyed Hamzeh Mousavi
- 3Assistant of Surgery, Department of Surgery, Tehran University of Medical Sciences, Tehran, Iran.
| | - Seyed Hasan Emamirazavi
- 4Professor, Department of Surgery, Brain and spinal injury repair research center (BASIR), Tehran University of Medical Sciences, Tehran, Iran.
| | - Abbas Noruzijavidan
- 5Assistant Professor, Brain and spinal injury repair research center, Tehran University of Medical Sciences, Tehran, Iran.
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400
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Delgado F, Saiz A, Hilario A, Murias E, San Román Manzanera L, Lagares Gomez-Abascal A, Gabarrós A, González García A. [Neuroimaging follow-up of cerebral aneurysms treated with endovascular techniques]. Radiologia 2013; 56:118-28. [PMID: 24144295 DOI: 10.1016/j.rx.2013.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Revised: 06/25/2013] [Accepted: 06/25/2013] [Indexed: 11/25/2022]
Abstract
There are no specific recommendations in clinical guidelines about the best time, imaging tests, or intervals for following up patients with intracranial aneurysms treated with endovascular techniques. We reviewed the literature, using the following keywords to search in the main medical databases: cerebral aneurysm, coils, endovascular procedure, and follow-up. Within the Cerebrovascular Disease Group of the Spanish Society of Neuroradiology, we aimed to propose recommendations and an orientative protocol based on the scientific evidence for using neuroimaging to monitor intracranial aneurysms that have been treated with endovascular techniques. We aimed to specify the most appropriate neuroimaging techniques, the interval, the time of follow-up, and the best approach to defining the imaging findings, with the ultimate goal of improving clinical outcomes while optimizing and rationalizing the use of available resources.
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Affiliation(s)
- F Delgado
- Sección de Neurorradiología, Servicio de Radiodiagnóstico, Hospital Reina Sofia, Córdoba, España
| | - A Saiz
- Sección de Neurorradiología, Servicio de Radiodiagnóstico, Hospital Universitario Central de Asturias, Oviedo, España
| | - A Hilario
- Sección de Neurorradiología, Servicio de Radiodiagnóstico, Hospital 12 de Octubre, Madrid, España
| | - E Murias
- Sección de Neurorradiología, Servicio de Radiodiagnóstico, Hospital Universitario Central de Asturias, Oviedo, España
| | - L San Román Manzanera
- Sección de Neurorradiología, Servicio de Radiodiagnóstico, Hospital Clinic, Barcelona, España
| | | | - A Gabarrós
- Servicio Neurocirugía, Hospital de Bellvitge, Barcelona, España
| | - A González García
- Sección de Neurorradiología, Servicio de Radiodiagnóstico, Hospital Universitario Virgen del Rocío, Sevilla, España.
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