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Rodriguez-Calienes A, Borjas-Calderón NF, Vivanco-Suarez J, Zila-Velasque JP, Chavez-Malpartida SS, Terry F, Grados-Espinoza P, Saal-Zapata G. Endovascular Treatment and Microsurgical Clipping for the Management of Paraclinoid Intracranial Aneurysms: A Systematic Review and Meta-Analysis. World Neurosurg 2023; 178:e489-e509. [PMID: 37516140 DOI: 10.1016/j.wneu.2023.07.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 07/31/2023]
Abstract
OBJECTIVE We aimed to compare the efficacy and safety of microsurgical clipping versus endovascular treatment (EVT) for paraclinoid aneurysms. METHODS A systematic search for studies including patients with paraclinoid aneurysms treated with a microsurgical or endovascular technique was conducted in 6 databases from inception to February 2022. Efficacy outcomes included complete angiographic occlusion at last follow-up, favorable functional outcome, and recurrence of the aneurysm. For safety, we assessed a composite of intraoperative and postoperative complications. Data were pooled using a random-effects model. RESULTS A total of 95 studies including 6711 patients, 3029 in the surgical group and 3682 in the EVT group were found. Pooled rates of complete occlusion were 94% (95% CI 91%-96%; I2 = 0%) in the surgical group and 69% (95% CI 63%-74%; I2 = 79%) in the EVT group, respectively. The favorable functional outcome rate was 86% (95% CI 76%-92%; I2 = 72%) with surgical treatment and 95% (95% CI 92%-97%; I2 = 61%) with EVT. The rate of aneurysm recurrence with surgical treatment was 1% (95% CI 0%-4%; I2 = 0%) and 12% (95% CI 9%-16%; I2 = 57%) with EVT. The composite safety outcome rate in the surgical group was 24% (95% CI 18%-30%; I2 = 90%) and 10% (95% CI 8%-13%; I2 = 71%) in the EVT group. CONCLUSIONS Our findings suggest that microsurgical clipping seems to have a higher efficacy than EVT in terms of angiographic occlusion and aneurysm recurrence; however, EVT seems to be safer in terms of intraoperative and postoperative complications. Considering the heterogeneity and low-level evidence of the data available, further prospective randomized studies are warranted to confirm our findings.
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Affiliation(s)
- Aaron Rodriguez-Calienes
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA; Neuroscience, Clinical Effectiveness and Public Health Research Group, Universidad Científica del Sur, Lima, Peru.
| | - Nagheli Fernanda Borjas-Calderón
- Facultad de Medicina Humana, Universidad de San Martín de Porres, Lima, Peru; Grupo Estudiantil de Investigación en Neurociencias, Sociedad de Estudiantes de Medicina de la Universidad de San Martín de Porres, Lima, Peru; Abdulrauf University of Neurosurgery, Simi Valley, California, USA
| | - Juan Vivanco-Suarez
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - J Pierre Zila-Velasque
- Universidad Nacional Daniel Alcides Carrión, Facultad de Medicina Humana, Pasco, Peru; Red Latinoamericana de Medicina en la Altitud e Investigación (REDLAMAI), Pasco, Peru
| | - Sandra S Chavez-Malpartida
- Universidad Nacional Mayor de San Marcos, Lima, Peru; Red de Eficacia Clínica y Sanitaria, REDECS, Lima, Peru
| | - Fernando Terry
- Department of Neurosurgery, Clínica Internacional, Lima, Peru
| | - Pamela Grados-Espinoza
- Universidad Nacional Daniel Alcides Carrión, Facultad de Medicina Humana, Pasco, Peru; Red Latinoamericana de Medicina en la Altitud e Investigación (REDLAMAI), Pasco, Peru
| | - Giancarlo Saal-Zapata
- Department of Neurosurgery, Endovascular Neurosurgery Service, Hospital Nacional Guillermo Almenara Irigoyen-EsSalud, Lima, Peru; Departament of Neurosurgery, Clinica Angloamericana, Lima, Peru
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Kawajiri S, Isozaki M, Komori O, Yamada S, Higashino Y, Yamauchi T, Akazawa A, Kidoguchi M, Yomo M, Kodera T, Arishma H, Awara K, Inatani M, Kikuta K. Visual Evoked Potential Can Predict Deterioration of Visual Function After Direct Clipping of Paraclinoid Aneurysm With Anterior Clinoidectomy. Neurosurgery 2023; 92:1276-1286. [PMID: 36757317 DOI: 10.1227/neu.0000000000002363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 11/14/2022] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND The role of visual evoked potential (VEP) in direct clipping of the paraclinoid internal carotid artery (ICA) aneurysm remains uncertain. OBJECTIVE To examine whether intraoperative neuromonitoring with VEP can predict deterioration of visual function after direct clipping of the paraclinoid ICA aneurysm with anterior clinoidectomy. METHODS Among consecutive 274 patients with unruptured cerebral aneurysm, we enrolled 25 patients with paraclinoid ICA aneurysm treated by direct clipping after anterior clinoidectomy with intraoperative neuromonitoring with VEP in this study. We evaluated the visual acuity loss (VAL) and visual field loss (VFL) before surgery, 1 month after surgery, and at the final follow-up. RESULTS The VAL at 1 month after surgery (VAL1M) and VAL at the final follow-up (Final VAL) were significantly related to the reduction rate of VEP amplitude at the end of surgery (RedEnd%), more than 76.5%, and the maximal reduction rate of VEP amplitude during surgery (MaxRed%), more than 66.7% to 70%. The VFL at 1 month after surgery (VFL1M) and the VFL at the final follow-up (Final VFL) were significantly related to MaxRed% more than 60.7%. CONCLUSION VAL1M, Final VAL, VFL1M, and Final VFL could be significantly predicted by the value of RedEnd% and MaxRed% in direct clipping of Al-Rodhan group Ia, Ib, and II paraclinoid ICA aneurysms with anterior clinoidectomy.
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Affiliation(s)
- Satoshi Kawajiri
- Department of Neurosurgery, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Makoto Isozaki
- Department of Neurosurgery, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Osamu Komori
- Department of Computer and Information Science, Faculty of Science and Technology, Seikei University, Tokyo, Japan
| | - Shinsuke Yamada
- Department of Neurosurgery, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Yorhifumi Higashino
- Department of Neurosurgery, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Takahiro Yamauchi
- Department of Neurosurgery, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Ayumi Akazawa
- Department of Neurosurgery, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Masamune Kidoguchi
- Department of Neurosurgery, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Munetaka Yomo
- Department of Neurosurgery, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Toshiaki Kodera
- Department of Neurosurgery, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Hidetaka Arishma
- Department of Neurosurgery, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Kousuke Awara
- Department of Neurosurgery, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Masaru Inatani
- Department of Ophthalmology, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Kenichiro Kikuta
- Department of Neurosurgery, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
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White TG, Krush M, Prashant G, Shah K, Katz JM, Link T, Woo HH, Dehdashti AR. Comparative outcomes of the treatment of unruptured paraophthalmic aneurysms in the era of flow diversion. Br J Neurosurg 2023:1-7. [PMID: 37161776 DOI: 10.1080/02688697.2023.2210220] [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: 05/11/2023]
Abstract
BACKGROUND Paraophthalmic aneurysms present a challenge to surgeons and their ideal management remains up for debate. We studied recent outcomes of these lesions in a single center. METHODS A retrospective chart review of all patients undergoing treatment for paraophthalmic aneurysms from 2017-2019 was performed. Factors including patient demographics, aneurysm characteristics, treatment modality, radiographic treatment outcome, clinical outcome, and length of stay were collected, and bivariate analysis was performed. RESULTS In total 84.5% (82/97) of aneurysms were treated endovascularly and 15.5% (15/97) surgically. In the surgery cohort, there were three transient perioperative complications (20%) and one minor postoperative complication (6.7%). Complete aneurysm occlusion or near complete (<2mm residual) was achieved in 100% (15/15). All but one patient had mRS ≤1 at the last follow-up. In the endovascular group, 78.1% (64/82) underwent flow diversion alone. Endovascular treatment was associated with a 4.9% (4/82) rate of periprocedural complications: 3 transient events, and 1 death, and a 3.7% (3/82) rate of delayed complications: 2 transient vision changes, and one death. Rate of total occlusion was 87.8% (72/82). 76 patients (92.7%) had mRS ≤1 at the last follow-up. Length of stay was significantly shorter in the endovascular group (3.4 days vs. 7.0 days) [p < 0.001]. CONCLUSIONS This series demonstrates similar safety to previously reported series as well as the efficacy of both surgical clipping and endovascular embolization of paraophthalmic aneurysms. Rate of complications and treatment efficacy were similar in both groups although this represents a single institution series not generalizable to all centers.
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Affiliation(s)
- Timothy G White
- Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra Northwell, NY, USA
| | - Morgan Krush
- Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra Northwell, NY, USA
| | - Giyarpuram Prashant
- Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra Northwell, NY, USA
| | - Kevin Shah
- Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra Northwell, NY, USA
| | - Jeffrey M Katz
- Department of Neurology, Donald and Barbara Zucker School of Medicine at Hofstra Northwell, NY, USA
- Department of Radiology, Donald and Barbara Zucker School of Medicine at Hofstra Northwell, NY, USA
| | - Thomas Link
- Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra Northwell, NY, USA
| | - Henry H Woo
- Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra Northwell, NY, USA
| | - Amir R Dehdashti
- Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra Northwell, NY, USA
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Luzzi S, Giotta Lucifero A, Baldoncini M, Campero A, Galzio R, Lawton MT. Optic Foraminotomy versus Anterior Clinoidectomy for Small Superior-Projecting Paraclinoid Aneurysms: Visual and Angiographic Outcome Evaluation. World Neurosurg 2023; 170:e612-e621. [PMID: 36410704 DOI: 10.1016/j.wneu.2022.11.081] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 11/17/2022] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Optic foraminotomy (OF) has been recently proposed as an alternative to anterior clinoidectomy (AC) for selected types of paraclinoid aneurysms. In this study, OF and AC were compared for small superior-projecting paraclinoid aneurysms assuming visual and angiographic results as outcome measures. Indications for OF are also discussed. METHODS Data of patients who underwent surgery for a paraclinoid aneurysm in the last 10 years were collected across 3 tertiary hospitals. Small to regular-size and superior projecting aneurysms were sorted. Multiple and complex aneurysms were excluded. Records of patients who went through OF were compared with those of patients who underwent AC. Neurologic outcome was reported as a modified Rankin Scale. Aneurysm complete occlusion rate and rate of approach-related worsened vision were selected as outcome measures of efficacy and safety, respectively, of the OF versus AC. Unpaired t test and χ2 test were used for numerical and categorical variables, respectively. A P value less than 0.05 was considered statistically significant. RESULTS OF and AC groups involved 18 and 25 patients, respectively. Complication rate, overall neurologic outcome, rate of approach-related worsened vision, and complete occlusion rate did not differ between the groups. The average follow-up was 51 ± 34 and 60 ± 41 months in the OF and AC groups, respectively. CONCLUSIONS Compared to AC, OF did not show either a higher rate of approach-related worsened vision or a lower aneurysm complete occlusion rate. OF can be considered a valid alternative to the AC for small superior-projecting dorsal ICA wall paraclinoid aneurysms.
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Affiliation(s)
- Sabino Luzzi
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy; Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | - Alice Giotta Lucifero
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Matias Baldoncini
- Department of Neurological Surgery, San Fernando Hospital, Buenos Aires, Argentina; Laboratory of Microsurgical Neuroanatomy, School of Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | - Alvaro Campero
- Department of Neurological Surgery, Padilla Hospital, Tucumán, Argentina
| | - Renato Galzio
- Neurosurgery Unit, Maria Cecilia Hospital, Cotignola, Italy
| | - Michael T Lawton
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
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5
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Zhou HJ, Wang XY, Zhan RY, Zheng JS, Yu JB, Zheng XJ. Clipping Ophthalmic Segment Artery Aneurysms Using a Modified Subdural Dolenc Approach: Classification and Experience Sharing. Oper Neurosurg (Hagerstown) 2022; 23:154-163. [PMID: 35838455 DOI: 10.1227/ons.0000000000000262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 03/03/2022] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Ophthalmic segment artery aneurysms (OSAs) are difficult to clip; therefore, improvement of the surgical method is of great significance to the prevention of complications, and the classification of the aneurysms is essential to formulate a reasonable surgical plan. OBJECTIVE To explore the strategies and effects of surgery for OSAs using a modified subdural Dolenc approach. METHODS The clinical data of 38 patients (12 men and 26 women, aged 48-73 years) with OSA were analyzed retrospectively. A total of 44 aneurysms were identified, 40 of which were OSAs. The 40 aneurysms were divided into types Ia1 (n = 2), Ia2 (n = 2), Ib (n = 6), IIa (n = 4), IIb (n = 4), IIIa (n = 0), IIIb (n = 4), IIIc (n = 16), and IV (n = 2) based on preoperative images. Thirty-nine OSAs were operated successfully through pterional craniotomy combined with the modified subdural Dolenc approach, and 1 aneurysm was clipped through the contralateral approach. Clinical outcomes were evaluated using the Glasgow Outcome Scale (GOS). RESULTS Thirty-nine OSAs were clipped, and one was wrapped. Visual dysfunction, headache, and dizziness improved after the operation in 18 patients. One patient had new visual impairment, and there were no deaths. At discharge, the GOS score was 5 in 36 cases, 4 in 1 case, and 3 in 1 case. Thirty-seven patients had a GOS score of 5, and 1 patient had a score of 3 at 6 months after the operation. CONCLUSION The modified subdural Dolenc approach (Zheng approach) for clipping OSAs may be associated with less trauma and good postoperative outcomes.
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Affiliation(s)
- Heng-Jun Zhou
- Department of Neurosurgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
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Xu C, Wu P, Sun B, Xu S, Luo B, Yang X, Shi H. Incomplete occlusion and visual symptoms of peri-ophthalmic aneurysm after treatment with a pipeline embolization device: a multi-center cohort study. Acta Neurochir (Wien) 2022; 164:2191-2202. [PMID: 35554695 DOI: 10.1007/s00701-022-05239-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 05/05/2022] [Indexed: 11/01/2022]
Abstract
OBJECTIVE Peri-ophthalmic aneurysm is a special type of aneurysm. We assessed the relationship between ophthalmic artery (OA) origin and aneurysm and examined the effect of a pipeline embolization device (PED, Covidien/Medtronic) with or without coils on aneurysm occlusion rate and visual outcomes. METHODS We retrospectively analyzed 194 peri-ophthalmic aneurysms in 189 patients among 1171 patients treated with a PED in a Chinese post-market multi-center registry study from November 2014 to October 2019. Peri-ophthalmic aneurysms were defined as carotid-ophthalmic segment aneurysms arising from the internal carotid artery dorsal wall at, or distal to, the OA origin, with a superior or superomedial projection. The relationship between OA origin and the aneurysm was classified as follows: type A, OA originating separate from the aneurysm; type B, OA originating from the aneurysm neck or dome. Patients with aneurysm were divided into the PED-only group and the PED + coils group according to treatment. RESULTS The median follow-up time was 6.8 months (range, 5.3-20.2 months). There were 163 occluded aneurysms (84%) and 31 aneurysms with incomplete occlusion (16%). A multivariate analysis showed that type B aneurysm was a risk factor for incomplete occlusion in the PED-only group (odds ratio [OR] 4.854, 95% confidence interval [CI] 1.878-12.548, P = 0.001). Visual symptoms at final follow-up correlated with preoperative visual symptoms (OR 22.777, 95% CI 3.115-166.555, P = 0.002). CONCLUSIONS Type B aneurysm is associated with a lower occlusion rate after PED-only treatment. Patients with preoperative visual symptoms should be treated promptly to avoid permanent visual symptoms.
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7
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Catapano JS, Koester SW, Srinivasan VM, Labib MA, Majmundar N, Nguyen CL, Rutledge C, Cole TS, Baranoski JF, Ducruet AF, Albuquerque FC, Spetzler RF, Lawton MT. A comparative propensity-adjusted analysis of microsurgical versus endovascular treatment of unruptured ophthalmic artery aneurysms. J Neurosurg 2022; 136:1245-1250. [PMID: 34653974 DOI: 10.3171/2021.5.jns211149] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 05/21/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Ophthalmic artery (OA) aneurysms are surgically challenging lesions that are now mostly treated using endovascular procedures. However, in specialized tertiary care centers with experienced neurosurgeons, controversy remains regarding the optimal treatment of these lesions. This study used propensity adjustment to compare microsurgical and endovascular treatment of unruptured OA aneurysms in experienced tertiary and quaternary settings. METHODS The authors retrospectively reviewed the medical records of all patients who underwent microsurgical treatment of an unruptured OA aneurysm at the University of California, San Francisco, from 1997 to 2017 and either microsurgical or endovascular treatment at Barrow Neurological Institute from 2011 to 2019. Patients were categorized into two cohorts for comparison: those who underwent open microsurgical clipping, and those who underwent endovascular flow diversion or coil embolization. Outcomes included neurological or visual outcomes, residual or recurrent aneurysms, retreatment, and severe complications. RESULTS A total of 345 procedures were analyzed: 247 open microsurgical clipping procedures (72%) and 98 endovascular procedures (28%). Of the 98 endovascular procedures, 16 (16%) were treated with primary coil embolization and 82 (84%) with flow diversion. After propensity adjustment, microsurgical treatment was associated with higher odds of a visual deficit (OR 8.5, 95% CI 1.1-64.9, p = 0.04) but lower odds of residual aneurysm (OR 0.06, 95% CI 0.01-0.28, p < 0.001) or retreatment (OR 0.12, 95% CI 0.02-0.58, p = 0.008) than endovascular therapy. No difference was found between the two cohorts with regard to worse modified Rankin Scale score, modified Rankin Scale score greater than 2, or severe complications. CONCLUSIONS Compared with endovascular therapy, microsurgical clipping of unruptured OA aneurysms is associated with a higher rate of visual deficits but a lower rate of residual and recurrent aneurysms. In centers experienced with both open microsurgical and endovascular treatment of these lesions, the treatment choice should be based on patient preference and aneurysm morphology.
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Affiliation(s)
- Joshua S Catapano
- 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | | | - Visish M Srinivasan
- 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - Mohamed A Labib
- 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - Neil Majmundar
- 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - Candice L Nguyen
- 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - Caleb Rutledge
- 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - Tyler S Cole
- 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - Jacob F Baranoski
- 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - Andrew F Ducruet
- 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - Felipe C Albuquerque
- 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - Robert F Spetzler
- 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - Michael T Lawton
- 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
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Paraclinoid aneurysms: Outcome analysis and technical remarks of a microsurgical series. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2021.101373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Kamide T, Burkhardt JK, Tabani H, Safaee M, Lawton MT. Microsurgical Clipping Techniques and Outcomes for Paraclinoid Internal Carotid Artery Aneurysms. Oper Neurosurg (Hagerstown) 2021; 18:183-192. [PMID: 31515556 DOI: 10.1093/ons/opz157] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 01/21/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Microsurgical clipping of paraclinoid aneurysms presents unique technical challenges because of the anatomical complexity of the paraclinoid region. OBJECTIVE To analyze microsurgical clipping techniques, complications, and outcomes associated with paraclinoid aneurysms, with a focus on clip selection and clipping technique according to aneurysm location. METHODS From 1997 to 2016, 231 unruptured paraclinoid aneurysms from 216 patients were treated using microsurgical clipping. We retrospectively reviewed patient records to analyze clinical outcomes. RESULTS A total of 80 aneurysms (34.6%) were treated with simple clipping. Among them, fenestrated clips were used with superior hypophyseal artery (SHA) aneurysms, but curved clips were used with most other aneurysms. A total of 151 aneurysms (65.6%) were treated using multiple clips, including tandem clipping for ophthalmic artery (OphA) aneurysms, tandem angled-fenestrated clipping for SHA and ventral carotid aneurysms, stacked clipping for dorsal carotid aneurysms, and various techniques for clinoidal segment/carotid cave aneurysms. Postoperative angiography was performed in 214 aneurysms (92.6%), and complete obliteration was confirmed in 195 aneurysms (91.1%). Using the modified Rankin Scale (mRS), overall functional outcome was good (mRS 0-2) in 99.6% of patients, although 30 cases (13.0%) showed new postoperative visual deficits. CONCLUSION Surgical clipping of paraclinoid aneurysms is an excellent treatment modality with good clinical outcomes and acceptable complication rates, particularly in centers with large experience in the microsurgical management of cerebrovascular disorders. Appropriate clip selection and clipping techniques are required to perform complete and safe clipping.
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Affiliation(s)
- Tomoya Kamide
- Department of Neurological Surgery, University of California, San Francisco, California.,Department of Neurosurgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Jan-Karl Burkhardt
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Halima Tabani
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Michael Safaee
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Michael T Lawton
- Department of Neurological Surgery, University of California, San Francisco, California.,Department of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona
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10
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Chaddad-Neto F, da Costa MDS, Santos B, Caramanti RL, Costa BL, Doria-Netto HL, Figueiredo EG. Reproducibility of a new classification of the anterior clinoid process of the sphenoid bone. Surg Neurol Int 2020; 11:281. [PMID: 33033643 PMCID: PMC7538961 DOI: 10.25259/sni_133_2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 07/08/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Pneumatization of the anterior clinoid process (ACP) affects paraclinoid region surgery, this anatomical variation occurs in 6.6-27.7% of individuals, making its preoperative recognition essential given the need for correction based on the anatomy of the pneumatized process. This study was conducted to evaluate the reproducibility of an optic strut-based ACP pneumatization classification by presenting radiological examinations to a group of surgeons. METHODS Thirty cranial computer tomography (CT) scans performed from 2013 to 2014 were selected for analysis by neurosurgery residents and neurosurgeons. The evaluators received Google Forms with questionnaires on each scan, DICOM files to be manipulated in the Horos software for multiplanar reconstruction, and a collection of slides demonstrating the steps for classifying each type of ACP pneumatization. Interobserver agreement was calculated by the Fleiss kappa test. RESULTS Thirty CT scans were analyzed by 37 evaluators, of whom 20 were neurosurgery residents and 17 were neurosurgeons. The overall reproducibility of the ACP pneumatization classification showed a Fleiss kappa index of 0.49 (95% confidence interval: 0.49-0.50). The interobserver agreement indices for the residents and neurosurgeons were 0.52 (0.51-0.53) and 0.49 (0.48-0.50), respectively, and the difference was statistically significant (P < 0.00001). CONCLUSION The optic strut-based classification of ACP pneumatization showed acceptable concordance. Minor differences were observed in the agreement between the residents and neurosurgeons. These differences could be explained by the residents' presumably higher familiarity with multiplanar reconstruction software.
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Affiliation(s)
| | | | - Bruno Santos
- Department of Neurosurgery, Universidade Federal de São Paulo
| | | | - Bruno Lourenco Costa
- Department of Neurosurgery, Centro Hospitalar Tondela-Viseu, EPE, Viseu, Portugal
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Kutty RK, Kumar A, Yamada Y, Kawase T, Tanaka R, Miyatani K, Higashiguchi S, Ravishankar V, Takizawa K, Kato Y. Visual Outcomes after Surgery for Paraclinoid Aneurysms: A Fujita Experience. Asian J Neurosurg 2020; 15:363-369. [PMID: 32656133 PMCID: PMC7335145 DOI: 10.4103/ajns.ajns_39_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 02/06/2020] [Accepted: 02/25/2020] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION The surgical strategies for clipping of paraclinoid aneurysms are diverse. These aneurysms are unique in their location, as they closely abut the anterior clinoid process (ACP) and the optic nerve. The ultimate goal of clipping encompasses the exposure of neck of the aneurysm which is seldom complete without the manipulation of optic nerve and the ACP. This manipulation may result in disturbances of vision postoperatively. We analyze our results of visual outcomes in the surgery for paraclinoid aneurysms in this retrospective study. MATERIALS AND METHODS All patients with paraclinoid aneurysms who underwent surgery from June 2014 to June 2019 were included in the study. Surgical procedure was uniform in all patients which included anterior clinoidectomy and clipping of aneurysms as per the Bantane protocol. Glasgow Outcome Scale as well as vision was assessed at discharge and at 1 month and 6 months. RESULTS There were 77 cases of paraclinoid aneurysms operated during the abovementioned period. All patients had no symptoms related to vision preoperatively. Visual deterioration was noted in two patients. All patients were discharged with a good outcome on the Glasgow Outcome Scale. CONCLUSION Paraclinoid aneurysm has a good outcome when treated with surgery. The visual deterioration following surgery can be minimized with extradural anterior clinoidectomy and careful handling of the vessels and nerve.
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Affiliation(s)
- Raja K. Kutty
- Department of Neurosurgery, Government Medical College, Trivandrum, Kerala, India
| | - Ambuj Kumar
- Department of Neurosurgery, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India
| | - Yasuhiro Yamada
- Department of Neurosurgery, Banbuntane Hotokukai Hospital, Fujita Health University, Otobashi, Nagoya, Japan
| | - Tsukosa Kawase
- Department of Neurosurgery, Banbuntane Hotokukai Hospital, Fujita Health University, Otobashi, Nagoya, Japan
| | - Riki Tanaka
- Department of Neurosurgery, Banbuntane Hotokukai Hospital, Fujita Health University, Otobashi, Nagoya, Japan
| | - Kyosuke Miyatani
- Department of Neurosurgery, Banbuntane Hotokukai Hospital, Otobashi, Nagoya, Japan
| | - Saeko Higashiguchi
- Department of Neurosurgery, Banbuntane Hotokukai Hospital, Otobashi, Nagoya, Japan
| | - Vigneswar Ravishankar
- Department of Neurosurgery, Institute of Neurosciences and Spinal Disorders, MGM Healthcare, Chennai, Tamil Nadu, India
| | - Katsumi Takizawa
- Department of Neurosurgery, Japanese Red Cross Asahikawa Hospital, Asahikawa, Hokkaido, Japan
| | - Yoko Kato
- Department of Neurosurgery, Banbuntane Hotokukai Hospital, Otobashi, Nagoya, Japan
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Otani N, Mori K, Wada K, Tomiyama A, Toyooka T, Takeuchi S, Nakao Y, Yamamoto T, Arai H. Limited Indications for Clipping Surgery of Paraclinoid Aneurysm Based on Long-Term Visual Morbidity. World Neurosurg 2019; 134:e153-e161. [PMID: 31629143 DOI: 10.1016/j.wneu.2019.09.147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 09/26/2019] [Accepted: 09/27/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Clipping of paraclinoid aneurysm is still challenging because of poor visual morbidity. The extradural temporopolar approach was applied to clip paraclinoid aneurysms, with the expectation of reducing visual morbidity. Factors related to poor visual morbidity were evaluated, to assess the results for clipping of paraclinoid aneurysms. METHODS A series of 40 unruptured paraclinoid aneurysms in 38 patients were clipped via extradural temporopolar approach. Preoperative and postoperative states of visual cognitive function and radiological outcomes were investigated. Aneurysms were classified into dorsal type or non-dorsal type, and small (<9 mm) or not-small (≥9 mm), respectively, to identify factors correlated with visual morbidity. RESULTS Complete clipping rate was 90.0% without any recurrence (mean: 5.2 years). Visual morbidity was unexpectedly high at 28.9%, including 2.7% of blindness immediately after the operation, and 23.7% and 2.7% at the final examination (mean: 3.6 years). Multivariate analysis showed aneurysm size was significantly correlated with worse visual outcome. Visual morbidity was 13.3% and 11.1% for dorsal and the non-dorsal small aneurysms, respectively, and all these cases showed visual field defect limited to the nasal quadrant without decreased visual acuity. In contrast, the non-dorsal not-small aneurysms showed significantly worse visual morbidity (60%) with decreased visual acuity. CONCLUSIONS Clipping via extradural temporopolar approach can achieve durable treatment for small unruptured paraclinoid aneurysms with acceptable visual morbidity. Visual morbidity of the not-small non-dorsal type, however, was poor. The indications for clipping of paraclinoid aneurysm should be limited to small aneurysms, especially the dorsal type in young patients.
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Affiliation(s)
- Naoki Otani
- Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama, Japan.
| | - Kentaro Mori
- Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama, Japan; Department of Neurosurgery, Tokyo General Hospital, Tokyo, Japan
| | - Kojiro Wada
- Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Arata Tomiyama
- Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Terushige Toyooka
- Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Satoru Takeuchi
- Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Yasuaki Nakao
- Department of Neurosurgery, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan
| | - Takuji Yamamoto
- Department of Neurosurgery, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan
| | - Hajime Arai
- Department of Neurosurgery, Juntendo University Hospital, Tokyo, Japan
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Silva MA, See AP, Khandelwal P, Mahapatra A, Frerichs KU, Du R, Patel NJ, Aziz-Sultan MA. Comparison of flow diversion with clipping and coiling for the treatment of paraclinoid aneurysms in 115 patients. J Neurosurg 2019; 130:1505-1512. [PMID: 29932380 DOI: 10.3171/2018.1.jns171774] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 01/10/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Paraclinoid aneurysms represent approximately 5% of intracranial aneurysms (Drake et al. [1968]). Visual impairment, which occurs in 16%-40% of patients, is among the most common presentations of these aneurysms (Day [1990], Lai and Morgan [2013], Sahlein et al. [2015], and Silva et al. [2017]). Flow-diverting stents, such as the Pipeline Embolization Device (PED), are increasingly used to treat these aneurysms, in part because of their theoretical reduction of mass effect (Fiorella et al. [2009]). Limited data on paraclinoid aneurysms treated with a PED exist, and few studies have compared outcomes of patients after PED placement with those of patients after clipping or coiling. METHODS The authors performed a retrospective analysis of 115 patients with an aneurysm of the cavernous to ophthalmic segments of the internal carotid artery treated with clipping, coiling, or PED deployment between January 2011 and March 2017. Postoperative complications were defined as new neurological deficit, aneurysm rupture, recanalization, or other any operative complication that required reintervention. RESULTS A total of 125 paraclinoid aneurysms in 115 patients were treated, including 70 with PED placement, 23 with coiling, and 32 with clipping. Eighteen (14%) aneurysms were ruptured. The mean aneurysm size was 8.2 mm, and the mean follow-up duration was 18.4 months. Most aneurysms were discovered incidentally, but visual impairment, which occurred in 21 (18%) patients, was the most common presenting symptom. Among these patients, 15 (71%) experienced improvement in their visual symptoms after treatment, including 14 (93%) of these 15 patients who were treated with PED deployment. Complete angiographic occlusion was achieved in 89% of the patients. Complications were seen in 17 (15%) patients, including 10 (16%) after PED placement, 2 (9%) after coiling, and 5 (17%) after clipping. Patients with incomplete aneurysm occlusion had a higher rate of procedural complications than those with complete occlusion (p = 0.02). The rate of postoperative visual improvement was significantly higher among patients treated with PED deployment than in those treated with coiling (p = 0.01). The significant predictors of procedural complications were incomplete occlusion (p = 0.03), hypertension, (p = 0.04), and diabetes (p = 0.03). CONCLUSIONS In a large series in which patient outcomes after treatment of paraclinoid aneurysms were compared, the authors found a high rate of aneurysm occlusion and a comparable rate of procedural complications among patients treated with PED placement compared with the rates among those who underwent clipping or coiling. For patients who presented with visual symptoms, those treated with PED placement had the highest rate of visual improvement. The results of this study suggest that the PED is an effective and safe modality for treating paraclinoid aneurysms, especially for patients who present with visual symptoms.
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Affiliation(s)
- Michael A Silva
- 1Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts; and
| | - Alfred P See
- 1Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts; and
| | - Priyank Khandelwal
- 2Department of Neurology, University of Miami/Jackson Health System, Miami, Florida
| | - Ashutosh Mahapatra
- 2Department of Neurology, University of Miami/Jackson Health System, Miami, Florida
| | - Kai U Frerichs
- 1Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts; and
| | - Rose Du
- 1Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts; and
| | - Nirav J Patel
- 1Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts; and
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Kamide T, Tabani H, Safaee MM, Burkhardt JK, Lawton MT. Microsurgical clipping of ophthalmic artery aneurysms: surgical results and visual outcomes with 208 aneurysms. J Neurosurg 2018; 129:1511-1521. [PMID: 29372879 DOI: 10.3171/2017.7.jns17673] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 07/14/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVEWhile most paraclinoid aneurysms can be clipped with excellent results, new postoperative visual deficits are a concern. New technology, including flow diverters, has increased the popularity of endovascular therapy. However, endovascular treatment of paraclinoid aneurysms is not without procedural risks, is associated with higher rates of incomplete aneurysm occlusion and recurrence, and may not address optic nerve compression symptoms that surgical debulking can. The increasing endovascular management of paraclinoid aneurysms should be justified by comparisons to surgical benchmarks. The authors, therefore, undertook this study to define patient, visual, and aneurysm outcomes in the most common type of paraclinoid aneurysm: ophthalmic artery (OphA) aneurysms.METHODSResults from microsurgical clipping of 208 OphA aneurysms in 198 patients were retrospectively reviewed. Patient demographics, aneurysm morphology (size, calcification, etc.), clinical characteristics, and patient outcomes were recorded and analyzed.RESULTSDespite 20% of these aneurysms being large or giant in size, complete aneurysm occlusion was accomplished in 91% of 208 cases, with OphA patency preserved in 99.5%. The aneurysm recurrence rate was 3.1% and the retreatment rate was 0%. Good outcomes (modified Rankin Scale score 0-2) were observed in 96.2% of patients overall and in all 156 patients with unruptured aneurysms. New visual field defects (hemianopsia or quadrantanopsia) were observed in 8 patients (3.8%), decreased visual acuity in 5 (2.4%), and monocular blindness in 9 (4.3%). Vision improved in 9 (52.9%) of the 17 patients with preoperative visual deficits.CONCLUSIONSThe most important risk associated with clipping OphA aneurysms is a new visual deficit. Meticulous microsurgical technique is necessary during anterior clinoidectomy, aneurysm dissection, and clip application to optimize visual outcomes, and aggressive medical management postoperatively might potentially decrease the incidence of delayed visual deficits. As the results of endovascular therapy and specifically flow diverters become known, they warrant comparison with these surgical benchmarks to determine best practices.
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Affiliation(s)
- Tomoya Kamide
- 1Department of Neurological Surgery, University of California, San Francisco, California; and
| | - Halima Tabani
- 1Department of Neurological Surgery, University of California, San Francisco, California; and
| | - Michael M Safaee
- 1Department of Neurological Surgery, University of California, San Francisco, California; and
| | - Jan-Karl Burkhardt
- 1Department of Neurological Surgery, University of California, San Francisco, California; and
| | - Michael T Lawton
- 1Department of Neurological Surgery, University of California, San Francisco, California; and
- 2Department of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital & Medical Center, Phoenix, Arizona
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15
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Chen R, Guo R, Wen D, You C, Ma L. Entire Orifice Blocking-Assisted Microsurgical Treatment: Clipping of Intracranial Giant Wide-Neck Paraclinoid Aneurysms. World Neurosurg 2018; 114:e861-e868. [PMID: 29572174 DOI: 10.1016/j.wneu.2018.03.101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 03/12/2018] [Accepted: 03/14/2018] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Giant wide-neck paraclinoid aneurysms remain a formidable challenge for neurosurgeons due to the brisk retrograde blood flow during surgical clipping. Theoretically, Entire orifice blockade (EOB) by placing a longitudinal intracarotid balloon catheter across the aneurysm neck could achieve a good vascular control in treating cerebral aneurysms, but related studies have been scarce. The aim of this study was to evaluate the safety and efficiency of the EOB-assisted microsurgical technique for treating giant wide-neck paraclinoid aneurysms. METHODS Clinical data and treatment summaries of patients with giant wide-neck paraclinoid aneurysms who underwent EOB-assisted microsurgical clipping were retrospectively reviewed. RESULTS A total of 26 patients were analyzed. All but 3 patients harbored unruptured aneurysms. The mean largest diameter of the aneurysms was 26.8±2.0 mm, and the mean neck size was 12.5±2.4 mm. All lesions were successfully clipped without residual aneurysms. Post-operative images revealed no major branch occlusion due to thromboembolic complications. Four patients presented neurologic deficits caused by vasospasm, 3 of which were completely resolved by postoperative treatment. At a mean follow-up time of 1.86 ± 0.95 years (range, 0.5-3.5 years), none of the patients died, and 96.2% (n = 25) of the patients had favorable clinical outcomes with modified Rankin Scale values of 0-2. CONCLUSIONS For patients with giant wide-neck paraclinoid aneurysms, EOB-assisted microsurgical clipping is a safe and useful procedure for obtaining vascular control, for softening and shrinking the aneurysm sac and for providing a wide and clean operative field that allows the clip to be effectively placed.
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Affiliation(s)
- Ruiqi Chen
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Rui Guo
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Dingke Wen
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chao You
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Lu Ma
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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Griessenauer CJ, Piske RL, Baccin CE, Pereira BJA, Reddy AS, Thomas AJ, Abud TG, Ogilvy CS. Flow Diverters for Treatment of 160 Ophthalmic Segment Aneurysms: Evaluation of Safety and Efficacy in a Multicenter Cohort. Neurosurgery 2018; 80:726-732. [PMID: 28327931 DOI: 10.1093/neuros/nyw110] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 07/04/2016] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Treatment of ophthalmic segment aneurysms (OSA) remains challenging. Flow diverter stents (FDS) have evolved as a promising endovascular treatment option for aneurysms of the internal carotid artery and are associated with high occlusion rates and a favorable morbidity and mortality profile. OBJECTIVE To determine safety and efficacy of FDS for OSA in a large, multicenter cohort. METHODS A retrospective analysis of prospectively maintained databases of 127 consecutive patients harboring 160 OSA treated with FDS was performed. Aneurysms were classified based on location and morphology. Follow-up with digital subtraction angiography (DSA) was performed 6 to 18 months after treatment. RESULTS Follow-up DSA was available for 101 (63.1%) aneurysms with a mean follow-up of 18 months. Complete occlusion was observed in 90 aneurysms (89.1%), near-complete occlusion (>95%) in 3 (3%), and incomplete occlusion (<95%) in 8 aneurysms (7.9%). One aneurysm was retreated with another FDS (0.9%). No risk factors for incomplete occlusion were identified. The OA was occluded at the latest follow-up in 6 cases (7.1%). Permanent morbidity occurred in 4 patients (3.1%), and there was no mortality related to the FDS procedure. CONCLUSION Treatment of OSA with FDS was found to be safe and effective. The retreatment rate was extremely low and aneurysms that occluded did not reanalyze.
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Affiliation(s)
- Christoph J Griessenauer
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Ronie L Piske
- Hospital Beneficência Portuguesa de São Paulo, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Carlos E Baccin
- Hospital Beneficência Portuguesa de São Paulo, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Benedito J A Pereira
- Hospital Beneficência Portuguesa de São Paulo, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Arra S Reddy
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.,Department of Radiology, Edward Hines Jr. Veterans Affairs Hospital, Chicago, Illinois
| | - Ajith J Thomas
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Thiago G Abud
- Hospital Beneficência Portuguesa de São Paulo, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Christopher S Ogilvy
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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Kamide T, Burkhardt JK, Tabani H, Safaee MM, Lawton MT. Preoperative Prediction of the Necessity for Anterior Clinoidectomy During Microsurgical Clipping of Ruptured Posterior Communicating Artery Aneurysms. World Neurosurg 2018; 109:e493-e501. [DOI: 10.1016/j.wneu.2017.10.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 09/30/2017] [Accepted: 10/03/2017] [Indexed: 12/31/2022]
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Asaid M, O'Neill AH, Bervini D, Chandra RV, Lai LT. Unruptured Paraclinoid Aneurysm Treatment Effects on Visual Function: Systematic Review and Meta-analysis. World Neurosurg 2017; 106:322-330. [PMID: 28669879 DOI: 10.1016/j.wneu.2017.06.135] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Revised: 06/22/2017] [Accepted: 06/24/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Postoperative visual outcomes following repair of unruptured paraclinoid aneurysms (UPAs) are not well defined. We aim to investigate the influence of treatment modality on visual function. METHODS A systematic literature analysis using the Ovid Medline and EMBASE databases was performed, encompassing English language studies (published between 1996 and 2016) reporting treatment outcomes for UPAs. Rates of visual morbidity (new, permanent postoperative deficit, worsening preoperative deficit); angiographic (occlusion, recurrence, retreatment) and clinical outcomes (death, disability, post-treatment subarachnoid hemorrhage) were recorded. Random effects meta-analysis was performed. RESULTS Twenty-eight studies reported visual outcomes, with data for 1013 endovascular and 691 microsurgical patients. In patients with normal vision undergoing elective repair of UPAs, rates of postoperative visual morbidity were higher following microsurgical (10.8%; 95% confidence interval [CI] 8.5-13.7) than endovascular (2.0%; 95% CI 1.2-3.2) interventions, P < 0.001. In those presenting with preoperative visual impairment, surgery was associated with a modest advantage in visual recovery compared with endovascular therapies (65.2% vs. 48.9%, P < 0.03). There were no differences in visual morbidity following treatment with any of the endovascular modalities. Meta-analysis of comparative studies suggested a trend toward poor visual (ES = 0.42; 95% CI 0.08-2.09) and clinical outcomes (ES = 0.57; 95% CI 0.07-4.44) following microsurgery and a trend toward angiographic recurrence (ES = 2.52; 95% CI 0.80-7.90) and retreatment (ES = 1.62; 95% CI 0.46-5.67) after endovascular interventions. CONCLUSION In patients with normal vision undergoing repairs for UPAs, there is a positive correlation between visual outcomes and endovascular treatments. When visual compromise is present, surgery provided modest advantage in visual recovery. However, definitive conclusions were not possible due to data heterogeneity.
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Affiliation(s)
- Mina Asaid
- Department of Neurosurgery, Monash Health, Melbourne, Australia
| | - Anthea H O'Neill
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia; Monash Neurovascular Institute, Melbourne, Australia
| | - David Bervini
- Department of Neurosurgery, University Hospital Inselspital and University of Bern, Bern, Switzerland
| | - Ronil V Chandra
- Department of Surgery, Monash University, Melbourne, Australia; Interventional Neuroradiology Unit, Monash Imaging, Monash Health, Melbourne, Australia; Monash Neurovascular Institute, Melbourne, Australia
| | - Leon T Lai
- Department of Neurosurgery, Monash Health, Melbourne, Australia; Department of Surgery, Monash University, Melbourne, Australia; Monash Neurovascular Institute, Melbourne, Australia.
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Abstract
BACKGROUND Intracranial saccular aneurysms are acquired lesions that often present with neuro-ophthalmologic symptoms and signs. Recent advances in neurosurgical techniques, endovascular treatments, and neurocritical care have improved the optimal management of symptomatic unruptured aneurysms, but whether the chosen treatment has an impact on neuro-ophthalmologic outcomes remains debated. EVIDENCE ACQUISITION A review of the literature focused on neuro-ophthalmic manifestations and treatment of intracranial aneurysms with specific relevance to neuro-ophthalmologic outcomes was conducted using Ovid MEDLINE and EMBASE databases. Cavernous sinus aneurysms were not included in this review. RESULTS Surgical clipping vs endovascular coiling for aneurysms causing third nerve palsies was compared in 13 retrospective studies representing 447 patients. Complete recovery was achieved in 78% of surgical patients compared with 44% of patients treated with endovascular coiling. However, the complication rate, hospital costs, and days spent in intensive care were reported as higher in surgically treated patients. Retrospective reviews of surgical clipping and endovascular coiling for all ocular motor nerve palsies (third, fourth, or sixth cranial nerves) revealed similar results of complete resolution in 76% and 49%, respectively. Improvement in visual deficits related to aneurysmal compression of the anterior visual pathways was also better among patients treated with clipping than with coiling. The time to treatment from onset of visual symptoms was a predictive factor of visual recovery in several studies. Few reports have specifically assessed the improvement of visual deficits after treatment with flow diverters. CONCLUSIONS Decisions regarding the choice of therapy for intracranial aneurysms causing neuro-ophthalmologic signs ideally should be made at high-volume centers with access to both surgical and endovascular treatments. The status of the patient, location of the aneurysm, and experience of the treating physicians are important factors to consider. Although a higher rate of visual recovery was reported with neurosurgical clipping, this must be weighed against the potentially longer intensive care stays and increased early morbidity.
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Silva MA, See AP, Dasenbrock HH, Patel NJ, Aziz-Sultan MA. Vision outcomes in patients with paraclinoid aneurysms treated with clipping, coiling, or flow diversion: a systematic review and meta-analysis. Neurosurg Focus 2017; 42:E15. [DOI: 10.3171/2017.3.focus1718] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVEPatients with paraclinoid aneurysms commonly present with visual impairment. They have traditionally been treated with clipping or coiling, but flow diversion (FD) has recently been introduced as an alternative treatment modality. Although there is still initial aneurysm thrombosis, FD is hypothesized to reduce mass effect, which may decompress the optic nerve when treating patients with visually symptomatic paraclinoid aneurysms. The authors performed a meta-analysis to compare vision outcomes following clipping, coiling, or FD of paraclinoid aneurysms in patients who presented with visual impairment.METHODSA systematic literature review was performed using the PubMed and Web of Science databases. Studies published in English between 1980 and 2016 were included if they reported preoperative and postoperative visual function in at least 5 patients with visually symptomatic paraclinoid aneurysms (cavernous segment through ophthalmic segment) treated with clipping, coiling, or FD. Neuroophthalmological assessment was used when reported, but subjective patient reports or objective visual examination findings were also acceptable.RESULTSThirty-nine studies that included a total of 2458 patients (520 of whom presented with visual symptoms) met the inclusion criteria, including 307 visually symptomatic cases treated with clipping (mean follow-up 26 months), 149 treated with coiling (mean follow-up 17 months), and 64 treated with FD (mean follow-up 11 months). Postoperative vision in these patients was classified as improved, unchanged, or worsened compared with preoperative vision. A pooled analysis showed preoperative visual symptoms in 38% (95% CI 28%–50%) of patients with paraclinoid aneurysms. The authors found that vision improved in 58% (95% CI 48%–68%) of patients after clipping, 49% (95% CI 38%–59%) after coiling, and 71% (95% CI 55%–84%) after FD. Vision worsened in 11% (95% CI 7%–17%) of patients after clipping, 9% (95% CI 2%–18%) after coiling, and 5% (95% CI 0%–20%) after FD. New visual deficits were found in patients with intact baseline vision at a rate of 1% (95% CI 0%–3%) for clipping, 0% (95% CI 0%–2%) for coiling, and 0% (95% CI 0%–2%) for FD.CONCLUSIONSTo the authors’ knowledge, this is the first meta-analysis to assess vision outcomes after treatment for paraclinoid aneurysms. The authors found that 38% of patients with these aneurysms presented with visual impairment. These data also demonstrated a high rate of visual improvement after FD without a significant difference in the rate of worsened vision or iatrogenic visual impairment compared with clipping and coiling. These findings suggest that FD is an effective option for treatment of visually symptomatic paraclinoid aneurysms.
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The incidence of and risk factors for ischemic complications after microsurgical clipping of unruptured middle cerebral artery aneurysms and the efficacy of intraoperative monitoring of somatosensory evoked potentials: A retrospective study. Clin Neurol Neurosurg 2016; 151:128-135. [DOI: 10.1016/j.clineuro.2016.10.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 10/11/2016] [Accepted: 10/13/2016] [Indexed: 11/16/2022]
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Pahl FH, de Oliveira MF, Brock RS, Lucio JEDC, Rotta JM. Surgical clipping is still a good choice for the treatment of paraclinoid aneurysms. ARQUIVOS DE NEURO-PSIQUIATRIA 2016; 74:314-9. [PMID: 27097005 DOI: 10.1590/0004-282x20150215] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 11/26/2015] [Indexed: 12/26/2022]
Abstract
UNLABELLED Paraclinoid aneurysms are lesions located adjacent to the clinoid and ophthalmic segments of the internal carotid artery. In recent years, flow diverter stents have been introduced as a better endovascular technique for treatment of these aneurysms. METHOD From 2009 to 2014, a total of 43 paraclinoid aneurysms in 43 patients were surgically clipped. We retrospectively reviewed the records of these patients to analyze clinical outcomes. RESULTS Twenty-six aneurysms (60.5%) were ophthalmic artery aneurysms, while 17 were superior hypophyseal artery aneurysms (39.5%). The extradural approach to the clinoid process was used to clip these aneurysms. One hundred percent of aneurysms were clipped (complete exclusion in 100% on follow-up angiography). The length of follow-up ranged from 1 to 60 months (mean, 29.82 months). CONCLUSION Surgical clipping continues to be a good option for the treatment of paraclinoid aneurysms.
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Affiliation(s)
- Felix Hendrik Pahl
- Departamento de Neurocirurgia, Hospital do Servidor Público Estadual de São Paulo, IAMSPE, Sao Paulo, SP, Brazil
| | | | - Roger Schmidt Brock
- Departamento de Neurocirurgia, Hospital Sirio Libanês, Sao Paulo, SP, Brazil
| | | | - José Marcus Rotta
- Departamento de Neurocirurgia, Hospital do Servidor Público Estadual de São Paulo, IAMSPE, Sao Paulo, SP, Brazil
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23
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Burrows AM, Brinjikji W, Puffer RC, Cloft H, Kallmes DF, Lanzino G. Flow Diversion for Ophthalmic Artery Aneurysms. AJNR Am J Neuroradiol 2016; 37:1866-1869. [PMID: 27256849 DOI: 10.3174/ajnr.a4835] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 03/23/2016] [Indexed: 12/29/2022]
Abstract
Endovascular treatments of ophthalmic segment aneurysms are commonly used but visual outcomes remain a concern. We performed a retrospective review of patients with carotid-ophthalmic aneurysms treated with flow diversion from June 2009 to June 2015. The following outcomes were studied through chart review: visual outcomes, complications, postoperative stroke and intraparenchymal hemorrhage, and clinical outcomes. Angiographic outcomes were studied with angiography and MRA at 6 months, 1 year, and 3 years. We evaluated 50 carotid-ophthalmic aneurysms in 48 patients, among whom 44 patients with 46 aneurysms underwent treatment. The mean clinical follow-up was 29 ± 22 months (range, 0-65 months). There were no permanent adverse visual outcomes. There was 1 death because of late intraparenchymal hemorrhage (2.2%). Six-month angiography showed complete occlusion in 24 of 37 patients (64.9%), and 3-year angiography results showed occlusion in 24 of 25 patients (96%). In conclusion, flow diversion is a safe and effective treatment for carotid-ophthalmic aneurysms in carefully selected patients. The risk of adverse visual outcomes is low, and most aneurysms progress to complete occlusion.
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Affiliation(s)
- A M Burrows
- From the Departments of Neurologic Surgery (A.M.B., R.C.P., G.L.)
| | - W Brinjikji
- Radiology (W.B., H.C., D.F.K., G.L.), Mayo Clinic, Rochester, Minnesota.
| | - R C Puffer
- From the Departments of Neurologic Surgery (A.M.B., R.C.P., G.L.)
| | - H Cloft
- Radiology (W.B., H.C., D.F.K., G.L.), Mayo Clinic, Rochester, Minnesota
| | - D F Kallmes
- Radiology (W.B., H.C., D.F.K., G.L.), Mayo Clinic, Rochester, Minnesota
| | - G Lanzino
- From the Departments of Neurologic Surgery (A.M.B., R.C.P., G.L.)
- Radiology (W.B., H.C., D.F.K., G.L.), Mayo Clinic, Rochester, Minnesota
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24
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da Costa MDS, de Oliveira Santos BF, de Araujo Paz D, Rodrigues TP, Abdala N, Centeno RS, Cavalheiro S, Lawton MT, Chaddad-Neto F. Anatomical Variations of the Anterior Clinoid Process. Oper Neurosurg (Hagerstown) 2016; 12:289-297. [DOI: 10.1227/neu.0000000000001138] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 10/04/2015] [Indexed: 12/14/2022] Open
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25
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Ophthalmic segment of internal carotid artery aneurysm mimicking normal tension glaucoma. Int Ophthalmol 2016; 36:907-914. [PMID: 26911718 DOI: 10.1007/s10792-016-0206-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 02/16/2016] [Indexed: 10/22/2022]
Abstract
A 41-year-old caucasian male was referred to the Glaucoma clinic at our tertiary referral centre with a diagnosis of normal tension glaucoma after the finding of increased bilateral asymmetrical cup/disc ratios, with normal intraocular pressures. On examination, the authors confirmed the presence of bilateral reduced optic disc rims alongside a left pale residual rim, and a further discovered a positive dyschromatopsia with a bilateral visual field alteration. The left visual field showed a relative scotoma confined to the vertical midline. After initiating investigation for suspected glaucoma, the authors ordered a magnetic resonance imaging that evidenced an internal carotid aneurysm along the ophthalmic segment, stretching across the optic chiasm with a major involvement of the left optic nerve and partial involvement of the right optic nerve. Aneurysm embolisation was performed with complete resolution of signs and symptoms achieved 5 months post-operatively. Despite glaucoma being the most frequent condition causing optic disc atrophy and visual field loss, it is not the only cause. Any atypical visual field defect not in keeping with a glaucomatous field loss should be further investigated. The ophthalmologist should thoroughly assess all signs that could lead to different diagnosis.
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26
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Predictive Factors for the Occurrence of Visual and Ischemic Complications After Open Surgery for Paraclinoid Aneurysms of the Internal Carotid Artery. ACTA NEUROCHIRURGICA SUPPLEMENT 2016; 123:41-9. [DOI: 10.1007/978-3-319-29887-0_6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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27
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Outcome After Surgical Treatment of Paraclinoid Carotid Aneurysms. ACTA NEUROCHIRURGICA SUPPLEMENT 2016; 123:33-9. [DOI: 10.1007/978-3-319-29887-0_5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
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28
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Zanaty M, Chalouhi N, Barros G, Schwartz EW, Saigh MP, Starke RM, Whiting A, Tjoumakaris SI, Hasan D, Rosenwasser RH, Jabbour P. Flow-diversion for ophthalmic segment aneurysms. Neurosurgery 2015; 76:286-9; discussion 289-90. [PMID: 25584955 DOI: 10.1227/neu.0000000000000607] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The use of flow-diversion to treat ophthalmic segment aneurysms (OSA) has not been well evaluated. OBJECTIVE To assess the visual outcomes, the obliteration rate, and the need for retreatment of OSA treated by the pipeline embolization device (PED). METHODS Patients who underwent treatment with PED for OSA from 2009 to 2014 were selected and retrospectively reviewed. Patient's age, sex, mode of presentation, and aneurysm size were recorded. The complication rates, the need for retreatment (due to recurrence of the aneurysm or worsening symptoms), the aneurysm occlusion rates, the evolution of visual symptoms, and the evolution of headache/retro-orbital pain were registered. RESULTS Forty-one patients harboring 44 OSA treated by flow-diversion were identified. Females constituted 87.80% (37/41) of the cohort. The mean age was 59.16 ± 12.54 years. At final angiographic follow-up, 77.27% (34/44) had complete occlusion, 6.81% (3/44) had near-complete occlusion, and 15.90% (7/44) had incomplete occlusion. Of the 22 symptomatic OSA, complete resolution or significant improvement was noted in 72.72% (16/22), while worsening of symptoms occurred in 4.54% (1/22). Five patients out of 22 (22.72%; 5/22) had no significant changes in their symptoms. The complication rate was 2.27% (1/44). The mortality rate was 0%. CONCLUSION The low complication rate, the high obliteration rate, and the high rate of improvement in the visual symptoms make flow-diversion an appealing option for the treatment of OSA.
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Affiliation(s)
- Mario Zanaty
- *Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania; ‡Department of Neurosurgery, University of Virginia, Charlottesville, Virginia; §Department of Neurosurgery, Carver College of Medicine, University of Iowa, Iowa City, Iowa
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29
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Zhu Y, Pan J, Shen J, Liu C, Fan Z, Shen Y, Wen L, Tong Y, Zhan R. Clinical and Radiological Outcomes After Treatment of Unruptured Paraophthalmic Internal Carotid Artery Aneurysms: a Comparative and Pooled Analysis of Single-Center Experiences. World Neurosurg 2015. [PMID: 26210711 DOI: 10.1016/j.wneu.2015.07.036] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Unruptured paraophthalmic aneurysms present unique challenges, and the ideal management remains unknown. METHODS We performed a pooled analysis of single-center experiences to compare the risks and effectiveness involving patients with unruptured paraophthalmic aneurysms treated with clipping, coiling alone, stent-assisted coiling, and flow-diversion. The MEDLINE database was searched and thirty-three series (including our institutional experience) were included. RESULTS Clipping caused more intracranial hemorrhage (ICH) and neurologic complications (NCs) than coiling alone (ICH: odds ratio [OR] = 3.058, P = 0.013; NC: OR = 5.809, P < 0.001), stent-assisted coiling (ICH: P = 0.018; NC: OR = 7.367, P < 0.001), and flow-diversion (ICH: P = 0.006; NC: OR = 16.954, P < 0.001). Clipping also caused more unfavorable visual outcomes than both coiling alone (OR = 3.037, P = 0.001) and stent-assisted coiling (OR = 6.055, P = 0.005). Clipping resulted in a lower reoperation rate than coiling alone in large/giant aneurysm group, which approached statistical significance (OR = 0.133, P = 0.057). Clipping, stent-assisted coiling, and flow-diversion all showed higher occlusion rates compared with coiling alone (OR [clipping vs. coiling alone] = 2.852, P ≤ 0.001; OR [coiling alone vs. stent-assisted coiling] = 0.302, P = 0.003; OR [coiling alone vs. flow-diversion] = 0.400, P = 0.013). Flow-diversion showed comparative complication rate, clinical outcomes, and angiographic result compared with stent-assisted coiling. No significant differences were found among all 4 treatment modalities on mortality and poor outcome. CONCLUSIONS Endovascular therapies have benefits over surgical clipping in terms of fewer intracranial hemorrhage complications, fewer NCs, and lower unfavorable visual outcome rate. Flow diversion showed comparative safety and effectiveness to stent-assisted coiling, and they both achieved better radiologic results than coiling alone. Further validation by randomized cohort studies is still needed to provide robust evidence.
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Jang EW, Kim YB, Chung J, Suh SH, Hong CK, Joo JY. Clinical Risk Factors Affecting Procedure-Related Major Neurological Complications in Unruptured Intracranial Aneurysms. Yonsei Med J 2015; 56:987-92. [PMID: 26069121 PMCID: PMC4479867 DOI: 10.3349/ymj.2015.56.4.987] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE The operative risk and natural history rupture risk for the treatment of unruptured intracranial aneurysms (UIAs) should be evaluated. The purpose of this study was to report our experience with treating UIAs and to outline clinical risk factors associated with procedure-related major neurological complications. MATERIALS AND METHODS We treated 1158 UIAs in 998 patients over the last 14 years. All patients underwent operation performed by a single microvascular surgeon and two interventionists at a single institution. Patient factors, aneurysm factors, and clinical outcomes were analyzed in relation to procedure-related complications. RESULTS The total complication rate was 22 (2.2%) out of 998 patients. Among them, complications developed in 14 (2.3%) out of 612 patients who underwent microsurgery and in 8 (2.1%) out of 386 patients who underwent endovascular procedures. One patient died due to intraoperative rupture during an endovascular procedure. The procedure-related complication was highly correlated with age (p=0.004), hypertension (p=0.002), and history of ischemic stroke (p<0.001) in univariate analysis. The multivariate analysis revealed previous history of ischemic stroke (p=0.001) to be strongly correlated with procedure-related complications. CONCLUSION A history of ischemic stroke was strongly correlated with procedure-related major neurological complications when treating UIAs. Accordingly, patients with UIAs who have a previous history of ischemic stroke might be at risk of procedure-related major neurological complications.
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Affiliation(s)
- E-Wook Jang
- Department of Neurosurgery, Cerebrovascular Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Bae Kim
- Department of Neurosurgery, Cerebrovascular Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Joonho Chung
- Department of Neurosurgery, Cerebrovascular Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.; Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Hyun Suh
- Department of Radiology, Cerebrovascular Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Chang-Ki Hong
- Department of Neurosurgery, Cerebrovascular Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.; Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, Korea
| | - Jin-Yang Joo
- Department of Neurosurgery, Cerebrovascular Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
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31
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Hokari M, Isobe M, Imai T, Chiba Y, Iwamoto N, Isu T. The impact of atherosclerotic factors on cerebral aneurysm is location dependent: aneurysms in stroke patients and healthy controls. J Stroke Cerebrovasc Dis 2014; 23:2301-7. [PMID: 25156785 DOI: 10.1016/j.jstrokecerebrovasdis.2014.04.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 04/04/2014] [Accepted: 04/07/2014] [Indexed: 12/14/2022] Open
Abstract
Previous studies have indicated that cerebrovascular diseases (CVDs) seem to increase the occurrence of unruptured intracranial aneurysms (UIAs). However, this maybe explained by the fact that CVDs and UIAs share common risk factors, such as hypertension (HT) and smoking. To clarify the impact of atherosclerotic risk factors on cerebral aneurysmal formation, we explored the incidence of UIAs and their locations in healthy controls and patients with CVD, who frequently have atherosclerotic risk factors. This study included consecutive 283 asymptomatic healthy adults and 173 acute stroke patients, from patients diagnosed with acute cerebral hemorrhage or cerebral infarction and admitted to our hospital. The incidence, maximum diameter, and location of UIAs were evaluated, and we also investigated the following factors: age, gender, current smoking, HT, diabetes mellitus (DM), and dyslipidemia. UIAs were found in 19 of the total 456 subjects (4.2%), 11 of 283 healthy subjects (3.9%), and 8 of 173 stroke patients (4.6%). These differences are not statically significant. The incidence of middle cerebral artery (MCA) aneurysms was significantly higher in the CVD patients than in the healthy controls (P = .03), and the incidence of paraclinoid aneurysms was significantly higher in the healthy controls than in the CVD patients (P = .03). Moreover, higher incidences of HTs and CVDs in the MCA aneurysms than in the other locations of UIAs were observed. These results indicate that the impact of atherosclerotic factors on cerebral aneurysmal formation depends on their location and that there is a stronger impact on MCA aneurysms than on paraclinoid aneurysms.
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Affiliation(s)
- Masaaki Hokari
- Department of Neurosurgery, Kushiro Rousai Hospital, Sapporo, Japan.
| | - Masanori Isobe
- Department of Neurosurgery, Kushiro Rousai Hospital, Sapporo, Japan
| | - Tetsuaki Imai
- Department of Neurosurgery, Kushiro Rousai Hospital, Sapporo, Japan
| | - Yasuhiro Chiba
- Department of Neurosurgery, Kushiro Rousai Hospital, Sapporo, Japan
| | - Naotaka Iwamoto
- Department of Neurosurgery, Kushiro Rousai Hospital, Sapporo, Japan
| | - Toyohiko Isu
- Department of Neurosurgery, Kushiro Rousai Hospital, Sapporo, Japan
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