1
|
Khanafer A, Henkes H, Cohen J, Albiña-Palmarola P, Gomori JM, Forsting M, von Gottberg P. Endovascular treatment of distal anterior cerebral artery aneurysms using flow modulation devices: mid- and long-term results from a two-center study. Front Neurol 2024; 15:1368612. [PMID: 38529030 PMCID: PMC10962386 DOI: 10.3389/fneur.2024.1368612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 02/28/2024] [Indexed: 03/27/2024] Open
Abstract
Purpose Flow-diverter (FD) stents have become an established treatment for intracranial aneurysms in recent years, but their use for aneurysms in distal cerebral vessels with small carrier vessel diameters remains controversial. This study describes the method and mid- and long-term outcomes of FD treatment of distal anterior cerebral artery aneurysms (DACAAs) at two neurointerventional centers, to elucidate this topic and provide more in-depth data. Methods Data for all patients at two neurointerventional centers who were treated with FDs for DACAAs in the pericallosal and supracallosal segment of the anterior cerebral artery were retrospectively analyzed. Data on periprocedural complications, and short-, mid- and long-term follow-up findings were recorded. Results Forty-one patients were eligible for inclusion in the study. Three FD models were used, one of which had an anti-thrombotic coating. Two periprocedural complications (5%) occurred but did not cause a change in the mRS. In the long-term follow-up, at 29 months and beyond, 83% of assessable patients showed complete occlusion of the aneurysms without new neurological deficits. Conclusion FDs are a safe and effective treatment approach for DACAAs. This study indicated a low risk of complications, and high closure rates in short-, mid- and long-term follow-up.
Collapse
Affiliation(s)
- Ali Khanafer
- Neuroradiologische Klinik, Klinikum Stuttgart, Stuttgart, Germany
| | - Hans Henkes
- Neuroradiologische Klinik, Klinikum Stuttgart, Stuttgart, Germany
- Medizinische Fakultät, Universität Duisburg-Essen, Essen, Germany
| | - Jose Cohen
- Department of Neurosurgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Pablo Albiña-Palmarola
- Neuroradiologische Klinik, Klinikum Stuttgart, Stuttgart, Germany
- Medizinische Fakultät, Universität Duisburg-Essen, Essen, Germany
| | - John Moshe Gomori
- Department of Radiology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Michael Forsting
- Medizinische Fakultät, Universität Duisburg-Essen, Essen, Germany
| | | |
Collapse
|
2
|
Ozgıray E, Husemoglu B, Cınar C, Bolat E, Akınturk N, Bıceroglu H, Kızmazoglu C. The Effect of Preoperative Three Dimensional Modeling and Simulation on Outcome of Intracranial Aneursym Surgery. J Korean Neurosurg Soc 2024; 67:166-176. [PMID: 37709549 PMCID: PMC10924900 DOI: 10.3340/jkns.2023.0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 08/31/2023] [Accepted: 09/08/2023] [Indexed: 09/16/2023] Open
Abstract
OBJECTIVE Three-dimensional (3D) printing in vascular surgery is trending and is useful for the visualisation of intracranial aneurysms for both surgeons and trainees. The 3D models give the surgeon time to practice before hand and plan the surgery accordingly. The aim of this study was to examine the effect of preoperative planning with 3D printing models of aneurysms in terms of surgical time and patient outcomes. METHODS Forty patients were prospectively enrolled in this study and divided into two groups : groups I and II. In group I, only the angiograms were studied before surgery. Solid 3D modelling was performed only for group II before the operation and was studied accordingly. All surgeries were performed by the same senior vascular neurosurgeon. Demographic data, surgical data, both preoperative and postoperative modified Rankin scale (mRS) scores, and Glasgow outcome scores (GOS) were evaluated. RESULTS The average time of surgery was shorter in group II, and the difference was statistically significant between the two groups (p<0.001). However, no major differences were found for the GOS, hospitalisation time, or mRS. CONCLUSION This study is the first prospective study of the utility of 3D aneurysm models. We show that 3D models are useful in surgery preparation. In the near future, these models will be used widely to educate trainees and pre-plan surgical options for senior surgeons.
Collapse
Affiliation(s)
- Erkin Ozgıray
- Department of Neurosurgery, Ege University School of Medicine, Izmir, Turkey
| | - Bugra Husemoglu
- Department of Biomechanics, Dokuz Eylül University Health Science Institution, Izmir, Turkey
| | - Celal Cınar
- Department of Radiology, Ege University School of Medicine, Izmir, Turkey
| | - Elif Bolat
- Department of Neurosurgery, Ege University School of Medicine, Izmir, Turkey
| | - Nevhis Akınturk
- Department of Neurosurgery, Ege University School of Medicine, Izmir, Turkey
| | - Huseyin Bıceroglu
- Department of Neurosurgery, Ege University School of Medicine, Izmir, Turkey
| | - Ceren Kızmazoglu
- Department of Neurosurgery, Dokuz Eylül University School of Medicine, Izmir, Turkey
| |
Collapse
|
3
|
Cazzaniga J, Jara C, Ruxmohan S, Quinonez J. Brain Imaging Modalities for Cavernous Sinus Pathology With Migraine Features: A Case Report. Cureus 2024; 16:e55146. [PMID: 38558706 PMCID: PMC10979712 DOI: 10.7759/cureus.55146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 02/28/2024] [Indexed: 04/04/2024] Open
Abstract
This case report delves into the unusual presentation of a 38-year-old female with a history of migraines, who initially presented with a severe right-sided headache and changes in vision in her right eye, which gradually improved. Although she had consulted with an eye specialist for these issues, she did not receive targeted treatment. This case underscores the necessity of vigilant evaluation and early intervention in a patient with seemingly benign symptoms, thereby highlighting the potential gravity of underlying conditions such as aneurysms. Our analysis and description of this case provide insights for clinicians to consider comprehensive assessment and to explore less common etiologies, resulting in improved patient outcomes.
Collapse
Affiliation(s)
- Juliana Cazzaniga
- Medical School, Florida International University, Herbert Wertheim College of Medicine, Miami, USA
| | - Cesar Jara
- Neurology, Larkin Community Hospital Palm Springs Campus, Hialeah, USA
| | - Samir Ruxmohan
- Neurocritical Care, University of Texas (UT) Southwestern Medical Center, Dallas, USA
| | - Jonathan Quinonez
- Osteopathic Medicine/Neurology, Larkin Community Hospital Palm Springs Campus, Hialeah, USA
- Addiction Medicine, Brandon Regional Hospital, Brandon, USA
| |
Collapse
|
4
|
Gómez-Amador JL, Tovar-Romero LA, Castillo-Matus A, Marian-Magaña R, Aragón-Arreola JF, Sangrador-Deitos MV, Hernández-Hernández A, López-Valencia G, Guinto-Nishimura GY, Ríos-Zermeño J. Intra-aneurysmatic thrombectomy in a distal anterior cerebral artery aneurysm. J Cerebrovasc Endovasc Neurosurg 2023; 25:462-467. [PMID: 38192188 PMCID: PMC10774688 DOI: 10.7461/jcen.2023.e2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 04/19/2023] [Accepted: 04/20/2023] [Indexed: 01/10/2024] Open
Abstract
Thrombectomy procedures following intra-aneurysmatic lesions are extremely rare, and few cases have been reported. This article describes a microsurgical intra-aneurysmatic thrombectomy (MIaT) for a distal anterior cerebral artery (DACA) aneurysm. We present the case of a 48-year-old female that was admitted to the emergency room, showing neurologic deterioration with focal deficits. A computed tomography angiography (CTA) scan revealed an aneurysm located in the distal segment of the left anterior cerebral artery. During the surgical procedure, after clipping, a wellformed clot was visualized through the aneurysm's wall obstructing the left DACA flow. We proceeded to open the aneurysm's dome to remove the thrombus and clip the aneurysm neck, re-establishing the flow of the left DACA. Intra-aneurysmatic thrombosis can occur as a complication during clipping, obstructing the distal flow of vital arteries and causing fatal results in the patient's postoperative status. MIaT is a good technique for restoring the flow of the affected vessel and allows a secure aneurysm clipping after thrombus removal.
Collapse
Affiliation(s)
- Juan Luis Gómez-Amador
- Department of Neurosurgery, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | | | - Andrea Castillo-Matus
- Department of Neurosurgery, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Ricardo Marian-Magaña
- Department of Neurosurgery, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | | | | | - Alan Hernández-Hernández
- Department of Neurosurgery, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Germán López-Valencia
- Department of Neurosurgery, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | | | - Jorge Ríos-Zermeño
- Department of Neurosurgery, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| |
Collapse
|
5
|
Singh DK, Sharma PK, Singh AK, Chand VK. Ruptured mirror DACA aneurysm: A rare case report and review of literature. J Cerebrovasc Endovasc Neurosurg 2023; 25:340-346. [PMID: 36647234 PMCID: PMC10555628 DOI: 10.7461/jcen.2023.e2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 10/16/2022] [Accepted: 11/07/2022] [Indexed: 01/18/2023] Open
Abstract
Bilateral distal anterior cerebral artery (DACA) aneurysms also called "kissing aneurysms" or "mirror aneurysm" are extremely rare, accounting for only 0.2% of all intracranial aneurysms. There have only been a few examples of mirror DACA aneurysms reported in the literature. Here, we report a rare case of mirror DACA aneurysm in a middle aged female with its successful clipping. Patient was admitted with severe headache and altered sensorium. Computed tomography (CT) head was suggestive of anterior inter-hemispheric hematoma. Digital subtraction angiography (DSA) was done which was suggestive of two distal anterior cerebral artery aneurysms located at same anatomical position. It was treated through microsurgical clipping. Mirror image DACA aneurysms are rare occurrence. All patients with ruptured DACA aneurysms should have angiography with 3D reconstruction studies. This aids in determining the aneurysm's morphology and planning treatment accordingly.
Collapse
Affiliation(s)
- Deepak Kumar Singh
- Department of Neurosurgery, DR. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
| | - Prevesh Kumar Sharma
- Department of Neurosurgery, DR. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
| | - Arun Kumar Singh
- Department of Neurosurgery, DR. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
| | - Vipin Kumar Chand
- Department of Neurosurgery, DR. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
| |
Collapse
|
6
|
Doron O, McLellan R, Vranic JE, Regenhardt RW, Stapleton CJ, Patel AB. FRED Jr stent for acute flow diversion in ruptured cerebral aneurysms arising from small-caliber vessels: a clinical case series. Neurosurg Focus 2023; 54:E6. [PMID: 37127034 DOI: 10.3171/2023.2.focus22645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 02/13/2023] [Indexed: 05/03/2023]
Abstract
OBJECTIVE Treatment of ruptured aneurysms arising from small-caliber (< 2.5 mm) or distal vessels beyond the circle of Willis is considered challenging with all treatment modalities. Recently, the Flow Re-Direction Endoluminal Device Junior (FRED Jr) stent, designed for flow diversion in small arteries, was approved in the United States for the treatment of nonruptured aneurysms. Here, the authors report their experience using this device in the setting of subarachnoid hemorrhage (SAH). METHODS Clinical and radiological records of patients sustaining SAH treated with a FRED Jr stent between June 2020 and October 2022 were reviewed. Treatment course, including antiplatelet therapy, external ventricular drain (EVD) management, and vasospasm, and clinical outcomes were analyzed. Angiographic results were assessed according to the O'Kelly-Marotta (OKM) grading scale. RESULTS Nine patients at a median age of 62 (range 27-75) years were included. The median Hunt and Hess grade was II (IQR I) and the median modified Fisher grade was 4 (IQR 1). Aneurysm morphology types included saccular (6 patients), blister (1 patient), and dissecting (2 patients), and the aneurysms were located at the anterior communicating artery complex (n = 3) at the A2/A3 (n = 3), M2/M3 (n = 1), V4 (n = 1), and P2 (n = 1) arterial segments. All stents were deployed successfully with no intraprocedural complications. Postoperatively, no rebleeding events were encountered. Vasospasm therapy was initiated in 6 patients, and no symptomatic EVD-related hematomas were observed. Postoperative ischemic events were encountered in 2 patients. The median 3-month modified Rankin Scale score was 2 (IQR 1) for the 7 surviving patients, and 3-month radiographic follow-up revealed OKM grade D in 4 of 7 patients. CONCLUSIONS Flow diversion using the FRED Jr stent is feasible as a potential treatment strategy for acutely ruptured aneurysms arising from small-caliber vessels. The complication profile reported in this series is comparable to those of historical microsurgical cohorts, and effective protection was conferred by this treatment modality. Therefore, our small cohort provides a glimpse into a new tool for successfully achieving acute flow diversion for this subset of difficult-to-treat aneurysms.
Collapse
|
7
|
Menon G, Srinivasan S, Pai A, Hegde A. Mini anterior interhemispheric approach for A3 segment distal anterior cerebral artery aneurysms. Clin Neurol Neurosurg 2023; 226:107598. [PMID: 36706678 DOI: 10.1016/j.clineuro.2023.107598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 12/28/2022] [Accepted: 01/15/2023] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Aneurysms of the A3 segment of the distal anterior cerebral artery (DACA), in relation to the genu of the corpus callosum, are specific sub-group which pose unique surgical challenges due to their discrete anatomical location. We describe a mini-anterior interhemispheric approach which can be safely utilised to clip these aneurysms rather than the traditional bifrontal approach. METHODS Retrospective analysis of the clinical and radiological data of ruptured DACA-A3 aneurysms operated between 2014 and 2021 at our institute. A curvilinear scalp incision within the hairline followed by raising small, unilateral, free frontal bone flap, avoiding the opening of frontal sinus. Superior sagittal sinus is displaced medially, inter-hemispheric dissection carried out with posterior trajectory and small callosotomy is performed. DACA is skeletonised, proximal control is established, and the A3 aneurysm is dissected and clipped. RESULT Our cohort of 18 patients had a definite female preponderance (F:M::2:1) with mean age of 55.6 years. On admission three patients were categorized as WFNS Grade I, thirteen in Grade II, and two in Grade III for subarachnoid haemorrhage. All the patients had evidence of blood in the interhemispheric fissure; intraparenchymal haemorrhage was seen in seven, with intraventricular haemorrhage in six patients. Within the A3 segment six aneurysms were infragenu (inferior), eight were at the genu (anterior) and four were supragenu (superior). Two (11.1%) elderly patients succumbed post-surgery following ischemic infarcts and associated complications. At the time of follow-up at 3 months of the remaining sixteen (72.2%) patients, thirteen had a good outcome (mRS 0-3) and three (16.7%) had a poor outcome (mRS > 3). CONCLUSION The mini anterior interhemispheric is an effective minimally invasive alternative for A3 segments aneurysms and helps to avoid the complications of the conventional bifrontal interhemispheric approach.
Collapse
Affiliation(s)
- Girish Menon
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher education, Manipal, India
| | - Siddharth Srinivasan
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher education, Manipal, India
| | - Ashwin Pai
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher education, Manipal, India
| | - Ajay Hegde
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher education, Manipal, India.
| |
Collapse
|
8
|
Takeuchi M, Uyama A, Matsumoto T, Tsuto K. Endovascular Treatment for Anterior Communicating Artery Aneurysms. Adv Tech Stand Neurosurg 2022; 44:239-249. [PMID: 35107683 DOI: 10.1007/978-3-030-87649-4_13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Previously, anterior communicating artery aneurysms were considered unsuitable for endovascular treatment. In recent years, however, endovascular treatment has been increasingly performed due to the fact that it is less likely to cause high dysfunction compared to surgery and the treatment has been improved. The International Subarachnoid Aneurysm Trial reported anterior communicating artery aneurysms comprise 45.4% of cerebral aneurysms on which both endovascular treatment and surgery are suitable. The use of the endovascular treatment for anterior communicating artery aneurysms is expected to increase in the future. In this paper, we present cases from our institution based on the characteristics of anterior and distal communicating artery aneurysms, treatment strategies, and treatment indications.
Collapse
Affiliation(s)
- Masataka Takeuchi
- Department of Neurosurgery, Seisho Hospital, Odawara, Kanagawa, Japan.
| | - Atsushi Uyama
- Department of Neurosurgery, Seisho Hospital, Odawara, Kanagawa, Japan
| | - Takashi Matsumoto
- Department of Neurosurgery, Seisho Hospital, Odawara, Kanagawa, Japan
| | - Kazuma Tsuto
- Department of Neurosurgery, Seisho Hospital, Odawara, Kanagawa, Japan
| |
Collapse
|
9
|
Contralateral transradial access for coil embolization of distal anterior cerebral artery aneurysm associated with a steep ipsilateral A1-A2 angle. J Stroke Cerebrovasc Dis 2022; 31:106299. [PMID: 35033987 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 12/25/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE Endovascular treatment of distal anterior cerebral artery aneurysms is commonly addressed via the ipsilateral A1 segment of the anterior cerebral artery. However, when the parent pericallosal artery has a sharp ipsilateral A1-A2 angle, catheterization through the ipsilateral A1 segment can potentially result in vessel injury, catheter kinking, and/or compromised/stagnant anterior cerebral artery flow. Here, we present a case of a distal anterior cerebral artery aneurysm associated with a steep ipsilateral A1-A2 angle treated with contralateral transradial coil embolization. CASE PRESENTATION A 91-year-old woman presented with a ruptured left distal anterior cerebral artery aneurysm at the A3 segment. The parent pericallosal artery had a steep ipsilateral A1-A2 angle. To safely achieve coil embolization of the aneurysm, a contralateral transradial system via the right A1 segment was employed. Although a secondary ipsilateral transradial system was required for contrast injection, aneurysm obliteration was successfully achieved without vessel injury or system instability. CONCLUSION The A1-A2 angle can be a key anatomical factor in the endovascular treatment of distal anterior cerebral artery aneurysms. The contralateral transradial system is a useful treatment option for distal anterior cerebral artery aneurysms associated with sharp ipsilateral A1-A2 angles. However, if the distal anterior cerebral artery aneurysm cannot be clearly visualized through the contralateral system, an ipsilateral system will be required for contrast injection.
Collapse
|
10
|
Hanaoka Y, Koyama JI, Yamazaki D, Fujii Y, Ogiwara T, Horiuchi T. Transradial quadraxial system for coil embolization of distal anterior cerebral artery aneurysms: A radial-first center case series and literature review. J Neuroradiol 2021; 49:169-172. [PMID: 34634296 DOI: 10.1016/j.neurad.2021.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 09/10/2021] [Accepted: 09/10/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE Endovascular treatment is technically challenging as distal anterior cerebral artery (DACA) aneurysms have distal location, small-caliber parent artery, and small size/wide neck. This study evaluated the feasibility and safety of the transradial approach (TRA) with a radial-specific neurointerventional guiding sheath as the first-line technique for DACA aneurysms. METHODS We retrospectively analyzed an institutional database of consecutive patients with DACA aneurysm who underwent coil embolization using TRA. Ten consecutive patients were included in this study. After the radial-specific 6F Simmons guiding sheath (0.088″ inner diameter) was completely engaged into the target common carotid artery, a quadraxial system (6F Simmons guiding sheath/6F intermediate catheter/3.2F intermediate catheter/single microcatheter) was used for embolization. Then, we assessed for procedural success, angiographic outcomes, and procedure-related or vascular access site complications. RESULTS Embolization procedures were conducted using simple coiling in eight and stent-assisted coiling with the trans-cell approach in two patients. The embolization procedure was successful in all patients (n = 10). Moreover, none presented with catheter kinking, parent artery flow stagnation, or system instability during the procedure. Immediate postprocedural angiography revealed complete obliteration in six and residual neck in four patients. Then, eight patients underwent follow-up angiography at a mean of 7.1 months, and none developed recanalization or required retreatment. The postprocedural course was uneventful, and there were no complications. CONCLUSION The transradial quadraxial system had the ability to achieve sufficient stability and kink resistance in DACA aneurysm embolization. Thus, this method was feasible and safe and had a high success rate.
Collapse
Affiliation(s)
- Yoshiki Hanaoka
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan.
| | - Jun-Ichi Koyama
- Neuroendovascular Therapy Center, Shinshu University Hospital, Matsumoto, Japan
| | - Daisuke Yamazaki
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yu Fujii
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Toshihiro Ogiwara
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Tetsuyoshi Horiuchi
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| |
Collapse
|
11
|
Sivakoti S, Chavali P, Nandeesh BN, Konar SK, Mahadevan A. Distal anterior cerebral artery aneurysm with bilateral fetal posterior cerebral arteries and trifurcation of anterior cerebral artery. INDIAN J PATHOL MICR 2021; 63:651-653. [PMID: 33154329 DOI: 10.4103/ijpm.ijpm_1021_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Developmental vascular anomalies of brain are non-modifiable risk factors for the development of aneurysms and are prone for rupture. We report one such association in a 44-year-old gentleman who succumbed to subarachnoid hemorrhage (SAH) secondary to ruptured distal anterior cerebral artery aneurysm associated with vascular anomalies in the anterior and posterior circulation that included trifurcation of anterior cerebral artery and bilateral fetal posterior cerebral arteries. We identified multiple anomalies in circle of Willis that could have contributed to the formation of aneurysm and early rupture. Knowledge of these variations is essential to plan early and optimum management with close follow-up.
Collapse
Affiliation(s)
- Sumitra Sivakoti
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Pooja Chavali
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - B N Nandeesh
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Subhas K Konar
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Anita Mahadevan
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| |
Collapse
|
12
|
Deuschl C, Darkwah Oppong M, Styczen H, Markhardt L, Wrede K, Jabbarli R, Sure U, Radbruch A, Forsting M, Wanke I, Mönninghoff C. Therapy results of pericallosal aneurysms: A retrospective unicenter study. Clin Pract 2020; 10:1257. [PMID: 33014320 PMCID: PMC7512184 DOI: 10.4081/cp.2020.1257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 07/30/2020] [Indexed: 12/27/2022] Open
Abstract
This retrospective study aims to compare treatment results of ruptured and unruptured pericallosal artery aneurysms (PAAs) regarding patient outcome and aneurysm recurrence after endovascular treatment (EVT) and neurosurgical treatment (NT). A total of 67 patients with PAA were admitted to our hospital, 44 patients with subarachnoidal hemorrhage (SAH) due to a ruptured PAA and 23 patients with unruptured PAA. The radiographic features of PAA were collected from pre-treatment digital subtraction angiography. In addition, demographic, clinical and radiographic parameters of all patients were recorded. Outcome was measured based on the modified Rankin scale (mRS) at 6 months after admission (favorable mRS score, 0-2 vs unfavorable mRS score, 3-6). Overall 46 patients underwent EVT and 21 patients NT. Six months after discharge 24 patients with SAH had a favorable outcome (mRS 0-2) and 16 patients an unfavorable outcome (mRS 3-6). Mortality rate of patients with SAH was 9.1% (4/44). Overall aneurysm recurrence was treated in 13 % of patients in the EVT cohort (6/46), whereas patients treated with NT had no recurrence. All patients with unruptured PAA had a favorable outcome. EVT and NT of PAA show comparable good results, although aneurysm recurrence occurs more often after EVT.
Collapse
Affiliation(s)
- Cornelius Deuschl
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | | | - Hanna Styczen
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Lisa Markhardt
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Karsten Wrede
- Clinic for Neurosurgery, University Hospital Essen, Essen, Germany
| | - Ramazan Jabbarli
- Clinic for Neurosurgery, University Hospital Essen, Essen, Germany
| | - Ulrich Sure
- Clinic for Neurosurgery, University Hospital Essen, Essen, Germany
| | - Alexander Radbruch
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Michael Forsting
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Isabel Wanke
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany.,Center for Neuroradiology, Clinic Hirslanden, Zurich, Switzerland
| | - Christoph Mönninghoff
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany.,Clinic for Neuroradiology, Clemenshospital Muenster, Germany
| |
Collapse
|
13
|
Wedge Resection of the Falx to Clip a Distal Anterior Cerebral Artery Aneurysm. World Neurosurg 2020; 141:33-36. [PMID: 32454203 DOI: 10.1016/j.wneu.2020.05.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 05/14/2020] [Accepted: 05/15/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND The unilateral anterior interhemispheric approach has been widely used for distal anterior cerebral artery (DACA) aneurysms. However, there are some drawbacks of this approach because of the narrow operative field, including possible brain traction injury, bridging vein injury, and inadequate exposure of the aneurysm. Here, we report a case of a DACA aneurysm covered by the falx that could not be totally exposed with the unilateral interhemispheric approach. We successfully obtained a wide view with wedge resection of the falx, avoiding excessive brain traction and division of the superior sagittal sinus. CASE DESCRIPTION A 76-year-old woman with a 6-mm unruptured DACA aneurysm underwent a unilateral craniotomy with the anterior interhemispheric approach. In the operative field, the aneurysm was found at the midline, just below the falx. The aneurysm was covered by the falx and could not be completely exposed with the usual brain retraction. Therefore, we performed wedge resection of the falx, thus obtaining sufficient surgical field and totally exposing the aneurysm. We were then able to apply the clip successfully. Postoperative brain computed tomography angiography showed no remnant aneurysm sac or complications of falx resection or brain retraction, such as bleeding or vessel injury. CONCLUSIONS When an aneurysm is located just below the falx and is exposed inadequately, performing wedge resection of the falx can expose the aneurysms adequately for application of the clip.
Collapse
|
14
|
Pericallosal artery aneurysm - Case report, literature review and management outcome. Int J Surg Case Rep 2020; 68:32-35. [PMID: 32113168 PMCID: PMC7044651 DOI: 10.1016/j.ijscr.2020.02.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 02/05/2020] [Accepted: 02/07/2020] [Indexed: 11/25/2022] Open
Abstract
Pericallosal artery aneurysms are rare. They have a higher rupture rate than other anterior circulation intracranial aneurysms. These vascular lesions often present with pericallosal intracerebral hematoma. Surgical approaches to these aneurysms are associated with a high complication rate. Successful management is possible in our low-resource neurosurgical facility.
Introduction Pericallosal artery aneurysms are rare. Very few cases of this vascular anomaly have been published from West Africa. We report the first case of a ruptured pericallosal artery (PCA) aneurysm managed in a Nigerian neurosurgical facility, with the aim to add to the limited documentation on vascular brain lesions in our sub-region. The management outcome of the index patient and a literature review on these unusual aneurysms were also discussed. Case report A middle-aged known hypertensive woman who presented with clinical features of a WFNS grade I subarachnoid hemorrhage (SAH). A plain cranial computerized tomography (CT) scan revealed SAH, a supracallosal intracerebral hematoma and intraventricular hemorrhage. Cranial computerized tomography angiography (CTA) showed a small right pericallosal artery aneurysm, which was treated (with clipping via an interhemispheric approach) in a resource-constrained neurosurgical facility. The patient has remained well over a six-year follow-up period. Discussion PCA aneurysms have a high tendency to bleed compared with other supratentorial intracranial aneurysms in spite of their small size. Microsurgical approach, although difficult, is an effective treatment option for these rare aneurysms. Conclusion Surgical clipping remains a safe and useful treatment option for pericallosal artery aneurysms in a low-resource neurosurgical facility.
Collapse
|
15
|
De Macedo Rodrigues K, Kühn AL, Tamura T, Dabus G, Kan P, Marosfoi MG, Lozano JD, Perras M, Brooks C, Howk MC, Hou SY, Rex DE, Massari F, Gounis MJ, Wakhloo AK, Puri AS. Pipeline Embolization Device for Pericallosal Artery Aneurysms: A Retrospective Single Center Safety and Efficacy Study. Oper Neurosurg (Hagerstown) 2019; 14:351-358. [PMID: 28521024 DOI: 10.1093/ons/opx111] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 04/11/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Pericallosal artery aneurysm treatment may be challenging using traditional endovascular techniques. OBJECTIVE To demonstrate the feasibility, efficacy, and safety of endovascular treatment of pericallosal artery aneurysm using flow diverters. METHODS We performed a retrospective review of our institutional database from July 2013 through July 2016 and identified 7 subjects with a pericallosal artery aneurysm treated with the Pipeline embolization device (ev3 Neurovascular, Medtronic, Dublin, Ireland) and at least 1 follow-up angiogram. Technical feasibility, procedural complication, angiographic results, and clinical outcome were evaluated. RESULTS Placement of the Pipeline embolization device was successful in all cases without evidence of procedural complication. Five out of 7 subjects showed a complete aneurysm occlusion at 6- to 12-mo follow-up angiogram. The 2 subjects with persistent aneurysm filling showed decreased aneurysm sac volume on follow-up angiograms (96% and 60%). There was no evidence of in-implant stenosis or intimal hyperplasia. No thromboembolic or hemorrhagic complications were seen during the follow-up period. Only 1 patient had a transient change in Modified Rankin scale score from baseline as a result of different unrelated procedure. CONCLUSION Our preliminary results demonstrate feasibility of the use of flow diverter stent for treatment of aneurysms of the pericallosal artery with rate of aneurysm occlusion comparable to literature and without evidence of increased procedural or short-term morbidity. A long-term and larger cohort study is needed to validate our findings.
Collapse
Affiliation(s)
- Katyucia De Macedo Rodrigues
- Division of Neuroimaging and Interve-ntion and New England Center for Stroke Research, Department of Radiology, University of Massachusetts, Worcester, Massachusetts
| | - Anna Luisa Kühn
- Division of Neuroimaging and Interve-ntion and New England Center for Stroke Research, Department of Radiology, University of Massachusetts, Worcester, Massachusetts
| | - Takamitsu Tamura
- Division of Neuroimaging and Interve-ntion and New England Center for Stroke Research, Department of Radiology, University of Massachusetts, Worcester, Massachusetts
| | | | - Peter Kan
- Depa-rtment of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Miklos G Marosfoi
- Division of Neuroimaging and Interve-ntion and New England Center for Stroke Research, Department of Radiology, University of Massachusetts, Worcester, Massachusetts
| | - J Diego Lozano
- Division of Neuroimaging and Interve-ntion and New England Center for Stroke Research, Department of Radiology, University of Massachusetts, Worcester, Massachusetts
| | - Mary Perras
- Division of Neuroimaging and Interve-ntion and New England Center for Stroke Research, Department of Radiology, University of Massachusetts, Worcester, Massachusetts
| | - Christopher Brooks
- Division of Neuroimaging and Interve-ntion and New England Center for Stroke Research, Department of Radiology, University of Massachusetts, Worcester, Massachusetts
| | - Mary C Howk
- Division of Neuroimaging and Interve-ntion and New England Center for Stroke Research, Department of Radiology, University of Massachusetts, Worcester, Massachusetts
| | - Samuel Y Hou
- Division of Neuroimaging and Interve-ntion and New England Center for Stroke Research, Department of Radiology, University of Massachusetts, Worcester, Massachusetts
| | - David E Rex
- Division of Neuroimaging and Interve-ntion and New England Center for Stroke Research, Department of Radiology, University of Massachusetts, Worcester, Massachusetts
| | - Francesco Massari
- Division of Neuroimaging and Interve-ntion and New England Center for Stroke Research, Department of Radiology, University of Massachusetts, Worcester, Massachusetts
| | - Matthew J Gounis
- Division of Neuroimaging and Interve-ntion and New England Center for Stroke Research, Department of Radiology, University of Massachusetts, Worcester, Massachusetts
| | - Ajay K Wakhloo
- Division of Neuroimaging and Interve-ntion and New England Center for Stroke Research, Department of Radiology, University of Massachusetts, Worcester, Massachusetts
| | - Ajit S Puri
- Division of Neuroimaging and Interve-ntion and New England Center for Stroke Research, Department of Radiology, University of Massachusetts, Worcester, Massachusetts
| |
Collapse
|
16
|
Current Management of Mirror Distal Anterior Cerebral Artery Aneurysms in Association with Multiple Aneurysms: Case Report with Literature Review. World Neurosurg 2019; 130:324-334. [DOI: 10.1016/j.wneu.2019.07.084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 07/06/2019] [Accepted: 07/08/2019] [Indexed: 11/22/2022]
|
17
|
Abstract
Intracranial aneurysms (IAs) have an estimated incidence of up to 10 % and can lead to serious morbidity and mortality. Because of this, the natural history of IAs has been studied extensively, with rupture rates ranging from 0.5 to 7 %, depending on aneurysm characteristics. The spectrum of presentation of IAs ranges from incidental detection to devastating subarachnoid hemorrhage. Although the gold standard imaging technique is intra-arterial digital subtraction angiography, other modalities such as computed tomography angiography (CTA) and magnetic resonance angiography (MRA) are being increasingly used for screening and treatment planning. Management of these patients depends upon a number of factors including aneurysmal, patient, institutional, and operator factors. The ultimate goal of treating patients with IAs is complete and permanent occlusion of the aneurysm sac in order to eliminate future hemorrhagic risk, while preserving or restoring the patient's neurological function. The most common treatment approaches include microsurgical clipping and endovascular coiling, and multiple studies have compared these two techniques. To date, three large prospective, randomized studies have been done: a study from Finland, International Subarachnoid Aneurysm Trial (ISAT), and the Barrow Ruptured Aneurysm Trial (BRAT). Despite differences in methodology, the results were similar: in patients undergoing coiling, although rates of rebleeding and retreatment are higher, the overall rate of poor outcomes at 12 months was significantly lower. As minimally invasive procedures and devices continue to be refined, endovascular strategies are likely to increase in popularity. However, as long-term outcome studies become available, it is increasingly apparent that they are complementary treatment strategies, with patient selection of critical importance.
Collapse
Affiliation(s)
- Ann Liu
- Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | |
Collapse
|
18
|
Mavridis IN, Kalamatianos T, Koutsarnakis C, Stranjalis G. The Microsurgical Anatomy of the Orbitofrontal Arteries. World Neurosurg 2016; 89:309-19. [PMID: 26875657 DOI: 10.1016/j.wneu.2016.02.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Revised: 02/04/2016] [Accepted: 02/04/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The orbitofrontal (or frontobasal) arteries (OFAs) are the medial (MOFA) and lateral (LOFA) orbitofrontal artery, branches of the anterior and middle cerebral artery, respectively. They supply the orbitofrontal cortex. The purpose of this microscopic cadaveric study was the detailed and precise anatomic identification of the OFAs along their course. METHODS Twenty formalin-fixed, colored latex-injected cadaveric heads were studied with the aid of an operating microscope and microsurgical instrumentation. The anatomy of the OFAs was examined after removing the cerebrum from the cranial vault. Anatomic features of the MOFA and LOFA were investigated and assessed in relation to demographic and anthropometric variables. RESULTS The MOFA supplies approximately 15 branches and LOFA almost 16 branches. The MOFA provides 1 branch to the olfactory bulb and 4 branches to the olfactory tract, and there are approximately 2 MOFA-LOFA anastomoses per hemisphere (novel finding). The MOFA origin is located approximately 7.9 mm anterior to the anterior communicating artery and 4.7 cm posterior to the anterior limit of the gyrus rectus. The LOFA origin is located approximately 11.1 mm from the middle cerebral artery bifurcation. Younger, shorter, and lighter individuals have more MOFA-LOFA anastomoses. Finally, the number of MOFA branches for the olfactory bulb is positively correlated with the number of MOFA branches for the olfactory tract, as well as with the number of MOFA-LOFA anastomoses. CONCLUSIONS The present study provides a detailed description of the OFAs' microsurgical anatomy and can help neurosurgeons to easily identify, manipulate, and preserve these vessels during surgery.
Collapse
Affiliation(s)
- Ioannis N Mavridis
- Athens Microneurosurgery Laboratory, Department of Neurosurgery, University of Athens School of Medicine, Evangelismos Hospital, Athens, Greece.
| | - Theodosis Kalamatianos
- Athens Microneurosurgery Laboratory, Department of Neurosurgery, University of Athens School of Medicine, Evangelismos Hospital, Athens, Greece
| | - Christos Koutsarnakis
- Athens Microneurosurgery Laboratory, Department of Neurosurgery, University of Athens School of Medicine, Evangelismos Hospital, Athens, Greece
| | - George Stranjalis
- Athens Microneurosurgery Laboratory, Department of Neurosurgery, University of Athens School of Medicine, Evangelismos Hospital, Athens, Greece
| |
Collapse
|
19
|
Mavridis IN, Kalamatianos T, Koutsarnakis C, Stranjalis G. Microsurgical Anatomy of the Precuneal Artery: Does It Really Exist? Clarifying an Ambiguous Vessel Under the Microscope. Oper Neurosurg (Hagerstown) 2015; 12:68-76. [PMID: 29506249 DOI: 10.1227/neu.0000000000001082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 09/02/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The ambiguous term precuneal artery (PA) has several synonyms and anatomic definitions. OBJECTIVE To examine the arteries of the precuneus and describe the PA and its branching pattern. We defined the PA as the principal arterial supplier of the precuneus. METHODS Twenty formalin-fixed, colored latex-injected cadaveric heads were studied with the aid of an operating microscope and microsurgical instrumentation. After removal of the cerebrum from the cranial vault, we examined this vessel's anatomy. Anatomic features of the PA were investigated and assessed in relation to demographic and anthropometric variables. RESULTS The PA was always a pericallosal artery branch and, more specifically, the superior internal parietal artery (SIPA) in 86.84%, the inferior internal parietal artery in 2.63%, and their common stem in 10.53% of specimens. Anastomosing interhemispheric branches between the PAs were present in 20% of cases. Compared with the right PA, the left anastomosed nearly 3 times more often with the ipsilateral posterior cerebral artery. The average distance of the PA's origin from the posterior limit of the splenium was shown to be 9.4 mm longer in elderly individuals compared with younger ones. CONCLUSION The term PA complex (rather than PA) can better describe the principal arterial supplier of the precuneus, and the SIPA, inferior internal parietal artery, and their common stem were shown as the 3 contributing arteries, with the SIPA predominating. The average distance of the PA complex origin from the splenium's posterior limit shows significant variation with respect to age.
Collapse
Affiliation(s)
- Ioannis N Mavridis
- Microneurosurgery Laboratory, Department of Neurosurgery, University of Athens School of Medicine, Evangelismos Hospital, Athens, Greece
| | - Theodosis Kalamatianos
- Microneurosurgery Laboratory, Department of Neurosurgery, University of Athens School of Medicine, Evangelismos Hospital, Athens, Greece
| | - Christos Koutsarnakis
- Microneurosurgery Laboratory, Department of Neurosurgery, University of Athens School of Medicine, Evangelismos Hospital, Athens, Greece
| | - George Stranjalis
- Microneurosurgery Laboratory, Department of Neurosurgery, University of Athens School of Medicine, Evangelismos Hospital, Athens, Greece
| |
Collapse
|
20
|
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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 01/27/2015] [Indexed: 11/23/2022]
|
21
|
Massive spontaneous corpus callosal hemorrhage with intraventricular extension. ROMANIAN NEUROSURGERY 2014. [DOI: 10.2478/romneu-2014-0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract
Spontaneous hemorrhage into the corpus callosum with intraventricular extension is uncommon. In the present article we describe a case 60 year female who had massive hemorrhage along the corpus callosum involving genu, body of corpus callosum and extending on ventral as well as dorsal aspect of the corpus callosum with intraventricular extension and areas of hypodensities in the body of the corpus callosum and adjacent cerebral cortex. In this case the subarachnoid and corpus callosal hemorrhage probably resulted from the ruptured aneurysms of the anterior cerebral artery.
Collapse
|
22
|
Abstract
PURPOSE OF REVIEW Unruptured intracranial aneurysms are found commonly in the general public, and more frequently in certain populations. This article focuses on the epidemiology, screening strategies, and management options for patients with unruptured aneurysms. RECENT FINDINGS Recent epidemiologic studies show the overall prevalence of intracranial aneurysms to be approximately 3%, with higher rates seen in familial aneurysm syndromes and in certain medical conditions, such as autosomal dominant polycystic kidney syndrome. Aneurysm treatment may include surgical or endovascular techniques, with increasing utilization of endovascular strategies over time. Increased aneurysm diameter, certain locations, and other anatomical considerations may be associated with higher risks of aneurysm rupture. SUMMARY Given the high morbidity and mortality associated with aneurysm rupture, screening for unruptured aneurysms is generally recommended for high-risk patients (patients who have at least two first-degree relatives with aneurysms, and patients with autosomal dominant polycystic kidney disease). Screening may be considered for other patients (eg, one first-degree relative with aneurysm) after discussion of the risks and benefits of imaging. Following identification of an aneurysm, decisions regarding observation or treatment should be based on patient characteristics, features of the aneurysm, and provider expertise.
Collapse
|
23
|
Rodríguez-Hernández A, Zador Z, Rodríguez-Mena R, Lawton MT. Distal Aneurysms of Intracranial Arteries: Application of Numerical Nomenclature, Predilection for Cerebellar Arteries, and Results of Surgical Management. World Neurosurg 2013; 80:103-12. [DOI: 10.1016/j.wneu.2012.09.010] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Revised: 08/21/2012] [Accepted: 09/14/2012] [Indexed: 10/27/2022]
|
24
|
YAMAZAKI T, SONOBE M, KATO N, KASUYA H, IKEDA G, NAKAMURA K, ITO Y, TSURUTA W, NAKAI Y, MATSUMURA A. Endovascular Coiling as the First Treatment Strategy for Ruptured Pericallosal Artery Aneurysms: Results, Complications, and Follow Up. Neurol Med Chir (Tokyo) 2013; 53:409-17. [PMID: 23803620 DOI: 10.2176/nmc.53.409] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Tomosato YAMAZAKI
- Department of Neurosurgery, National Hospital Organization, Mito Medical Center
| | - Makoto SONOBE
- Department of Neurosurgery, National Hospital Organization, Mito Medical Center
| | - Noriyuki KATO
- Department of Neurosurgery, National Hospital Organization, Mito Medical Center
| | - Hiromichi KASUYA
- Department of Neurosurgery, National Hospital Organization, Mito Medical Center
| | - Go IKEDA
- Department of Neurosurgery, National Hospital Organization, Mito Medical Center
| | | | - Yoshiro ITO
- Department of Neurosurgery, Tsukuba Medical Center Hospital
| | - Wataro TSURUTA
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba
| | - Yasunobu NAKAI
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba
| | - Akira MATSUMURA
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba
| |
Collapse
|