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Wu Y. Letter to the editor: "Endovascular treatment of mycotic aneurysms: An update meta-analysis". Clin Neurol Neurosurg 2024; 246:108559. [PMID: 39293265 DOI: 10.1016/j.clineuro.2024.108559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2024] [Revised: 08/31/2024] [Accepted: 09/15/2024] [Indexed: 09/20/2024]
Affiliation(s)
- Yuxi Wu
- Department of Neurosurgery, People's Hospital of Dongxihu District, Wuhan, Hubei 430040, China.
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Shen Y, Hu F, Wu L, Nie H. Concomitant rapidly growing aneurysm of intracavernous carotid artery and cavernous sinus thrombosis: Case report and review of the literature. Medicine (Baltimore) 2024; 103:e39022. [PMID: 39058832 PMCID: PMC11272256 DOI: 10.1097/md.0000000000039022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 07/01/2024] [Indexed: 07/28/2024] Open
Abstract
RATIONALE Intracavernous infectious aneurysm (ICIA), represents a rare entity that is always described in the form of case reports in the literature. The coexistence of ICIA and cavernous sinus thrombosis (CST) is extremely rare and poorly understood. PATIENT CONCERNS A 53-year-old female patient presented to our hospital with headache, nausea and fatigue for 3 weeks. She complained of blurry vision and drooping eyelids before admission. Neurological examination revealed bilateral decreased visual acuity, limitation of extraocular movements and decreased sensation of forehead. Brain magnetic resonance imaging (MRI) showed mixed signal intensities in both cavernous sinuses and expansion of right superior ophthalmic vein, suggesting the formation of CST. One month later, computed tomography angiography (CTA) confirmed a large aneurysm was attached to the left intracavernous carotid artery (ICCA). DIAGNOESE This patient was diagnosed with ICIA and CST. INTERVENTIONS She was administered with intravenous meropenem and vancomycin and subcutaneous injection of low molecular heparin for 4 weeks. OUTCOMES One month later, her extraocular movement had significantly improved, without ptosis and conjunctival congestion. At 1-year follow-up, her ophthalmoplegia fully recovered. Fortunately, such large aneurysm did not rupture in spite of slight broadening. LESSONS The coexistence of ICIA and CST is extremely rare. Contiguous infection from adjacent tissues is the foremost cause of ICIA. A repeated angiographic examination is recommended under enough anti-infective treatment due to the characteristics of rapid emergence and fast growth of infectious aneurysms.
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Affiliation(s)
- Yaoyao Shen
- Department of Neurology, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi Province, China
- Department of Neurology, Xiangya Hospital, Central South University, Jiangxi, National Regional Center for Neurological Diseases, Nanchang, Jiangxi Province, China
| | - Fan Hu
- Department of Neurology, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi Province, China
- Department of Neurology, Xiangya Hospital, Central South University, Jiangxi, National Regional Center for Neurological Diseases, Nanchang, Jiangxi Province, China
| | - Lingfeng Wu
- Department of Neurology, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi Province, China
- Department of Neurology, Xiangya Hospital, Central South University, Jiangxi, National Regional Center for Neurological Diseases, Nanchang, Jiangxi Province, China
| | - Hongbing Nie
- Department of Neurology, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi Province, China
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Batista S, Oliveira LDB, Filho JAA, Abreu LV, Andreão FF, Palavani LB, Bertani R, Alves Filho CAF, de Oliveira Braga F, Machado EAT, da Mata Pereira PJ, Filho PN, Pereira VM. Endovascular treatment of mycotic aneurysms: An update meta-analysis. Clin Neurol Neurosurg 2024; 236:108068. [PMID: 38064880 DOI: 10.1016/j.clineuro.2023.108068] [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: 07/26/2023] [Revised: 11/20/2023] [Accepted: 11/22/2023] [Indexed: 02/04/2024]
Abstract
INTRODUCTION Intracranial mycotic or infectious aneurysms result from the infection of arterial walls, most caused by bacterial or fungal organisms. These infections can weaken the arterial wall, leading to the formation of an aneurysm, a localized dilation, or a bulge. The management can be conservative mainly based on antibiotics or invasive methods such as clipping or endovascular treatment. PURPOSE We performed a systematic review and meta-analysis of the current literature on endovascular treatment of mycotic aneurysms, analyzing the safety and efficacy associated with this procedure. METHODS We systematically searched on PUBMED, Cochrane Library, Embase, and Web of Science databases. Our search strategy was carefully crafted to conduct a thorough investigation of the topic, utilizing a comprehensive combination of relevant keywords. This meta-analysis included all studies that reported endovascular treatment of mycotic aneurysms. To minimize the risk of bias, studies with fewer than four patients, studies where the main outcome was not found, and studies with no clear differentiation between microsurgical and endovascular treatment were excluded. RESULTS In a comprehensive analysis of 134 patients, it was observed that all except one patient received antibiotics as part of their treatment. Among the patients, 56% (a total of 51 out of 90 patients) underwent cardiac surgery. Additionally, three patients required a craniotomy following endovascular treatment. 12 patients experienced morbidity related to the procedures performed, indicating complications arising from the interventions. Furthermore, four aneurysms experienced rebleeding while treatment. A pooled analysis of the endovascular treatment of the mycotic aneurysm revealed a good level of technical success, achieving a 100% success rate in 12 out of 14 studies (97-100%; CI 95%; I2 = 0%), as illustrated in Fig. 2. Similarly, the aneurysm occlusion rate demonstrated a notable efficacy, with a success rate of 97% observed in 12 out of 14 studies (97-100%; CI 95%; I2 = 0%), as depicted in Fig. 3. CONCLUSION The results strongly support the efficacy of endovascular treatment in achieving technical success, complete aneurysm occlusion, and favorable neurological outcomes. Additionally, the notably low incidence of complications and procedure-related mortality reaffirms the safety and benefits associated with this intervention.
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Affiliation(s)
- Sávio Batista
- Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - José Alberto Almeida Filho
- Department of Neurosurgery, Hospital Municipal Miguel Couto, Rio de Janeiro, Brazil; Department of Endovascular Neurosurgery, Paulo Niemeyer State Brain Institute, Rio de Janeiro, Brazil
| | - Lívia Viviani Abreu
- Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Filipi Fim Andreão
- Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Lucca B Palavani
- Faculty of Medicine, Max Planck University Center, Indaiatuba, SP, Brazil.
| | | | - Cesar A F Alves Filho
- Department of Endovascular Neurosurgery, Paulo Niemeyer State Brain Institute, Rio de Janeiro, Brazil
| | - Fausto de Oliveira Braga
- Department of Endovascular Neurosurgery, Paulo Niemeyer State Brain Institute, Rio de Janeiro, Brazil
| | - Elias A T Machado
- Department of Endovascular Neurosurgery, Paulo Niemeyer State Brain Institute, Rio de Janeiro, Brazil
| | | | - Paulo Niemeyer Filho
- Department of Neurosurgery, Paulo Niemeyer State Brain Institute, Rio de Janeiro, Brazil
| | - Vitor Mendes Pereira
- Division of Neuroradiology, Department of Medical Imaging and Division of Neurosurgery, Department of Surgery, University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada
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Alouda N, Alshammari NH, Alomar KS, Shami I, Alobaid AO. A misdiagnosed aneurysm of the petrous internal carotid artery: A case report. Int J Surg Case Rep 2023; 110:108671. [PMID: 37634430 PMCID: PMC10509807 DOI: 10.1016/j.ijscr.2023.108671] [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: 08/01/2023] [Revised: 08/11/2023] [Accepted: 08/11/2023] [Indexed: 08/29/2023] Open
Abstract
INTRODUCTION An aneurysm is characterized by the weakening of the arterial wall, which leads to a bulge that can be filled with blood. Aneurysms of the petrous portion of the internal carotid artery are rare and predominantly detected incidentally. This is a report of multiple misdiagnoses of an aneurysm of the petrous segment of the internal carotid artery (ICA) that highlights its imaging-based diagnosis and risk of mortality. PRESENTATION OF CASE A 60-year-old woman with chronic kidney disease and a history of stroke presented with left ear discharge, decreased hearing, and non-pulsatile tinnitus that had persisted for four months. Clinical examination showed wet tympanic membrane perforation, and imaging revealed an ill-defined infiltrative mass involving the left petrous apex initially misdiagnosed as glomus jugulare. Diagnostic computed tomography (CT) angiography revealed a left aneurysm in the petrous part of the ICA, which was successfully treated with interventional radiology. Follow-up was planned for infectious diseases and internal medicine, but she was lost to follow-up by the otolaryngology department. DISCUSSION Aneurysms in the petrous portion of the ICA are rare and usually asymptomatic. However, their clinical manifestations vary, and they have various differential diagnoses. CT and magnetic resonance imaging are essential for diagnosis, and CT angiography is the gold standard. CONCLUSION Diagnosing petrous ICA aneurysms requires a high level of suspicion and CT angiography. Their clinical presentations vary from asymptomatic to severe. Case-specific management and endovascular treatment yield positive neurological outcomes.
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Affiliation(s)
- Nada Alouda
- Department of Otolaryngology-Head & Neck Surgery, King Saud University Medical City, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
| | - Nouf H Alshammari
- Department of Otolaryngology-Head & Neck Surgery, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Khalid Suwayyid Alomar
- Department of Otolaryngology-Head & Neck Surgery, King Saud University Medical City, College of Medicine, King Saud University, Riyadh, Saudi Arabia; King Abdullah Ear Specialist Center (KAESC), College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ibrahim Shami
- Department of Otolaryngology-Head & Neck Surgery, Main Hospital, King Fahad Medical City, P.O. Box. 59046, Riyadh 11525, Saudi Arabia
| | - Abdullah Omar Alobaid
- Department of Neurosurgery, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
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5
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Sursal T, Clare K, Feldstein E, Ogulnick J, Nolan B, Karimov Z, Nazarenko A, Ye L, Bornovski Y, Wong S, Goldberg J, Mayer SA, Bauerschmidt A, El Khoury MY, Al-Jehani H, Gandhi CD, Al-Mufti F. Significant increase in mortality and risk of acute ischemic stroke in infective endocarditis patients with subarachnoid hemorrhage secondary to mycotic aneurysms. J Neurol Sci 2023; 451:120670. [PMID: 37392505 DOI: 10.1016/j.jns.2023.120670] [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: 10/03/2022] [Revised: 04/13/2023] [Accepted: 05/01/2023] [Indexed: 07/03/2023]
Abstract
Infective Endocarditis (IE) patients are known to have a variety of complications with one of the rarest, but serious being cerebral mycotic aneurysm, which can result in subarachnoid hemorrhage (SAH). Using the National In-Patient Sample database, we sought to determine the rate of acute ischemic stroke (AIS) and outcomes in IE- patients with and without SAH. In total, we identified 82,844 IE-patients from 2010 to 2016, of which 641 had a concurrent diagnosis of SAH. IE patients with SAH had a more complicated course, higher mortality rate (OR 4.65 CI 95% 3.9-5.5, P < 0.001), and worse outcomes. This patient population also had a significantly higher rate of AIS (OR 6.3 CI 95% 5.4-7.4, P < 0.001). Overall, 41.5% of IE-patients with SAH had AIS during their hospitalization as compared to 10.1% of IE only patients. IE-patients with SAH were more likely to undergo endovascular treatment (3.6%) with 0.8% of the IE patients with AIS undergoing mechanical thrombectomy. While IE-patients are at risk for various complications, our study suggests a significant increase in the mortality and risk of AIS in those with SAH.
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Affiliation(s)
- Tolga Sursal
- Brain and Spine Institute at Westchester Medical Center, Valhalla, NY 10595, USA
| | - Kevin Clare
- New York Medical College School of Medicine, Valhalla, NY 10595, USA
| | - Eric Feldstein
- Brain and Spine Institute at Westchester Medical Center, Valhalla, NY 10595, USA
| | - Jonathan Ogulnick
- New York Medical College School of Medicine, Valhalla, NY 10595, USA
| | - Bridget Nolan
- New York Medical College School of Medicine, Valhalla, NY 10595, USA
| | - Zafar Karimov
- New York Medical College School of Medicine, Valhalla, NY 10595, USA
| | - Andrew Nazarenko
- New York Medical College School of Medicine, Valhalla, NY 10595, USA
| | - Linda Ye
- New York Medical College School of Medicine, Valhalla, NY 10595, USA
| | - Yarden Bornovski
- Brain and Spine Institute at Westchester Medical Center, Valhalla, NY 10595, USA
| | - Serena Wong
- Brain and Spine Institute at Westchester Medical Center, Valhalla, NY 10595, USA
| | - Joshua Goldberg
- Section of Cardiothoracic Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY 10595, USA
| | - Stephan A Mayer
- Brain and Spine Institute at Westchester Medical Center, Valhalla, NY 10595, USA
| | - Andrew Bauerschmidt
- Brain and Spine Institute at Westchester Medical Center, Valhalla, NY 10595, USA
| | - Marc Y El Khoury
- Department of Medicine, Division of Infectious Diseases, Westchester Medical Center, New York Medical College School of Medicine, Valhalla, NY 10595, USA
| | - Hosam Al-Jehani
- Neurosurgery, Imam Abdulrahman Bin Faisal University King Fahd Hospital of the University, Alkhobar, Saudi Arabia
| | - Chirag D Gandhi
- Brain and Spine Institute at Westchester Medical Center, Valhalla, NY 10595, USA; New York Medical College School of Medicine, Valhalla, NY 10595, USA
| | - Fawaz Al-Mufti
- Brain and Spine Institute at Westchester Medical Center, Valhalla, NY 10595, USA; New York Medical College School of Medicine, Valhalla, NY 10595, USA.
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6
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Alawieh AM, Dimisko L, Newman S, Grossberg JA, Cawley CM, Pradilla G, Samuels O, Barrow DL, Howard BM. Management and Long-Term Outcomes of Patients With Infectious Intracranial Aneurysms. Neurosurgery 2023; 92:515-523. [PMID: 36700696 PMCID: PMC10158861 DOI: 10.1227/neu.0000000000002235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 09/13/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Infectious intracranial aneurysms (IIAs) are rare complications of infective endocarditis (IE). Data on management and long-term outcomes remain limited. OBJECTIVE To retrospectively study long-term outcomes of IIAs in patients treated medically or surgically. METHODS Adult cases of IE and/or IIAs admitted to Emory or Grady Healthcare Systems between May 2015 and May 2020 were reviewed for demographic, clinical, and radiographic variables for up to 2 years. Primary outcome measure was 2-year survival. RESULTS Among 1714 cases of IE, intracerebral hemorrhage occurred in 322 patients and IIAs in 17 patients. The presence of IIAs in IE was associated with higher odds of disposition to hospice/death (odds ratio = 6.9). Including non-IE patients, 24 patients had 38 IIAs mainly involving the distal middle cerebral artery and 16 were ruptured on admission. IIAs were predominantly treated with antibiotics as the primary approach. Open microsurgery was the primary approach for 5 aneurysms and was used as salvage in 7 IIAs. Endovascular management was the primary approach for 2 IIAs and used as salvage for 5 IIAs with antibiotic failure. Medical management had high rate of treatment failure (15/31) which predominantly occurred within 2 weeks of onset. The 2-year survival in this cohort was 70% (17/24). CONCLUSION IIAs are rare complications of IE with a poor prognosis. Patients treated with antibiotics have higher risk of treatment failure requiring salvage surgical or endovascular intervention. Medical treatment failure occurred mostly within 2 weeks of onset and had a negative prognostic value emphasizing the need for close follow-up and early surgical or endovascular management.
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Affiliation(s)
| | | | - Sarah Newman
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jonathan A. Grossberg
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - C. Michael Cawley
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Gustavo Pradilla
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Owen Samuels
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Daniel L. Barrow
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Brian M. Howard
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
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7
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Kashkoush A, El-Abtah ME, Achey R, Hussain MS, Toth G, Moore NZ, Bain M. Flow Diversion as Destination Treatment of Intracranial Mycotic Aneurysms: A Retrospective Case Series. Oper Neurosurg (Hagerstown) 2023; 24:492-498. [PMID: 36715979 DOI: 10.1227/ons.0000000000000593] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 10/21/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Mycotic aneurysms represent a rare type of intracranial aneurysm. Treatment options usually consist of coiling, clipping, or liquid embolization. Data regarding outcomes after flow diversion of mycotic aneurysms are sparse. OBJECTIVE To present a single-center case series regarding our experience with FD as definitive treatment for ruptured mycotic aneurysms initially treated with coil embolization. METHODS We retrospectively reviewed a prospectively maintained database of all cerebrovascular procedures performed at a single institution between 2017 and 2021 for cases that used FD for the management of intracranial mycotic aneurysms. Prospectively collected data included patient demographics, medical history, rupture status, aneurysm morphology, aneurysm location, and periprocedural complications. The main outcomes included neurological examination and radiographic occlusion rate on cerebral digital subtraction angiography. RESULTS Three patients with 4 ruptured mycotic aneurysms that were initially treated with coil embolization were identified that required retreatment. The aneurysms were located along the middle cerebral artery bifurcation (n = 2), posterior cerebral artery P1/2 junction (n = 1), and basilar artery apex (n = 1), which all demonstrated recurrence after initial coil embolization. Successful retreatment using flow diverting stents was performed in all 3 patients. At the last angiographic follow-up, all aneurysms demonstrated complete occlusion. No patients suffered new periprocedural complications or neurological deficits after FD. CONCLUSION Flow-diverting stents may be an effective treatment option for intracranial mycotic aneurysms that are refractory to previous endovascular coiling. Future studies are warranted to establish the associated long-term safety and clinical efficacy.
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Affiliation(s)
- Ahmed Kashkoush
- Department of Neurological Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mohamed E El-Abtah
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Rebecca Achey
- Department of Neurological Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Gabor Toth
- Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Nina Z Moore
- Department of Neurological Surgery, Cleveland Clinic, Cleveland, Ohio, USA.,Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mark Bain
- Department of Neurological Surgery, Cleveland Clinic, Cleveland, Ohio, USA.,Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
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8
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Kiwan R, Son M, Mayich M, Boulton M, Pandey S, Sharma M. Ruptured intracranial infectious aneurysms: Single Canadian center experience. Surg Neurol Int 2022; 13:185. [PMID: 35673652 PMCID: PMC9168302 DOI: 10.25259/sni_69_2022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 03/30/2022] [Indexed: 11/04/2022] Open
Abstract
Background:
Ruptured intracranial infected aneurysms (IIAs) are relatively rare, but they portend high mortality. To the best of our knowledge, there is no Canadian case series on IIA, as well there is a relative paucity of international published experiences. Our purpose is to share the experience of a single Canadian tertiary center in managing ruptured IIA and to conduct a systematic review.
Methods:
We did a retrospective case review series of adult patients with ruptured IIA treated at our institution. Second, we conducted a systematic review of the literature on ruptured IIA between 2011 and 2021 inclusive.
Results:
At our institution, of a total eight cases with ruptured IIA, four were treated endovascularly and two by surgical bypass. For the systematic review, we included nine noncomparative studies with a total of 509 patients (318 males) and at least 437 ruptured IIA aneurysms. Favorable outcome was specified for 63.3% of patients (n = 57). Regarding ruptured IIA, favorable clinical outcome was described in 59.3% (n = 16).
Conclusion:
This study highlights a single Canadian tertiary center experience in the management of IIA and compares it to the global trends of the past 10 years in a systematic review.
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Affiliation(s)
- Ruba Kiwan
- Department of Medical Imaging, Northern Ontario School of Medicine, Sudbury,
| | - Maksim Son
- Department of Clinical Neurological Sciences, University of Western Ontario, London, Canada
| | - Michael Mayich
- Department of Medical Imaging, University of Western Ontario, London, Canada
| | - Melfort Boulton
- Department of Clinical Neurological Sciences, University of Western Ontario, London, Canada
| | - Sachin Pandey
- Department of Medical Imaging, University of Western Ontario, London, Canada
| | - Manas Sharma
- Department of Medical Imaging, University of Western Ontario, London, Canada
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Akimoto K, Yanaka K, Nakamura K, Takeda H, Saura M, Takada M, Hosoo H, Matsumaru Y, Ishikawa E. Simultaneous intracerebral and subarachnoid hemorrhages caused by multiple infectious intracranial aneurysms treated endovascularly and by microsurgical clipping: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2022; 3:CASE21685. [PMID: 36130552 PMCID: PMC9379754 DOI: 10.3171/case21685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 01/04/2022] [Indexed: 12/04/2022]
Abstract
BACKGROUND Infected intracranial aneurysms are relatively rare but tend to occur in multiple locations. Establishing an optimal treatment strategy for multiple ruptured aneurysms is often challenging, especially when simultaneous ruptures occur in different locations. We report a case of simultaneous intracerebral and subarachnoid hemorrhages caused by the rupture of multiple infected intracranial aneurysms. OBSERVATIONS A 23-year-old male with a 2-week history of chronic fever presented with sudden onset of severe headache and visual disturbance. Computed tomography showed intracerebral hemorrhage in the right occipital lobe and subarachnoid hemorrhage in the area of the left Sylvian fissure. Further investigation documented Staphylococcus bacteremia, verrucae on the mitral valve, and aneurysms arising from the right posterior cerebral artery (PCA) and the left middle cerebral artery (MCA). A larger aneurysm arising from the PCA was successfully occluded endovascularly, but subsequent endovascular occlusion of the MCA aneurysm was unsuccessful because some important branches were observed extending from the aneurysm. The left MCA aneurysm was then obliterated by angioplastic clipping via left pterional craniotomy. The patient showed a favorable neurological recovery after treatment. LESSONS In such complex cases of infectious aneurysms, the method and timing of treatment need to be carefully determined based on the medical condition.
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Affiliation(s)
- Ken Akimoto
- Department of Neurosurgery, Tsukuba Memorial Hospital, Tsukuba, Ibaraki, Japan; and
| | - Kiyoyuki Yanaka
- Department of Neurosurgery, Tsukuba Memorial Hospital, Tsukuba, Ibaraki, Japan; and
| | - Kazuhiro Nakamura
- Department of Neurosurgery, Tsukuba Memorial Hospital, Tsukuba, Ibaraki, Japan; and
| | - Hayato Takeda
- Department of Neurosurgery, Tsukuba Memorial Hospital, Tsukuba, Ibaraki, Japan; and
| | - Minami Saura
- Department of Neurosurgery, Tsukuba Memorial Hospital, Tsukuba, Ibaraki, Japan; and
| | - Maya Takada
- Department of Neurosurgery, Tsukuba Memorial Hospital, Tsukuba, Ibaraki, Japan; and
| | | | | | - Eiichi Ishikawa
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
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10
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Lai PMR, Caragher S, Patel NJ, Du R, Ali Aziz-Sultan M. Safety Profile and Factors Associated With Good Outcome for Endovascularly Treated Infectious Intracranial Aneurysms. Neurosurgery 2022; 90:233-239. [PMID: 34995237 DOI: 10.1227/neu.0000000000001785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 09/13/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Infectious intracranial aneurysms (IIAs), or mycotic aneurysms, are infectious inflammatory lesions that can cause devastating neurological damage or death. Recent systemic reviews have suggested endovascular treatment to be efficacious for IIA management. OBJECTIVE To compare the safety profile of different endovascular methods for treating ruptured and unruptured IIAs and factors associated with good clinical and radiographic outcomes. METHODS We conducted a retrospective single study of endovascularly treated ruptured and unruptured IIAs between 2003 and 2019. Univariate and multivariate analyses were used to study patient presentation, endovascular treatments used, and clinical and radiographic outcomes. RESULTS Thirty-eight patients with ruptured (n = 20) and unruptured (n = 18) IIAs treated with endovascular methods were included. One patient required retreatment after aneurysm recanalization, and 2 patients demonstrated new infarcts after embolization. There was no postprocedural radiographic hemorrhage or infarct and no difference in clinical and radiographic outcomes comparing treatment modality. Hypertension was associated with ruptured IIA status and worse clinical outcome at 6 mo (odds ratio: 0.03 [95% confidence interval: 0.002-0.52]). CONCLUSION In this study, the largest single-center series to date, we showed that endovascular intervention is a safe and effective strategy for both ruptured and unruptured IIAs. Hypertension was associated with ruptured status and worse clinical outcome. Procedures are generally well-tolerated and safe, with good outcomes for patients.
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Affiliation(s)
- Pui Man Rosalind Lai
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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11
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Serrano F, Guédon A, Saint-Maurice JP, Labeyrie MA, Civelli V, Eliezer M, Houdart E. Endovascular treatment of infectious intracranial aneurysms complicating infective endocarditis: a series of 31 patients with 55 aneurysms. Neuroradiology 2021; 64:353-360. [PMID: 34459945 DOI: 10.1007/s00234-021-02798-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 08/25/2021] [Indexed: 12/13/2022]
Abstract
PURPOSE Endovascular treatment (EVT) has become a major option in management of infectious intracranial aneurysms (IIAs) complicating infective endocarditis. We report a retrospective, single-center series of consecutive patients with IIAs treated by EVT. METHODS Patients were included from January 2009 to July 2020. IIAs were diagnosed on DSA. Each patient underwent a neurological assessment before and after EVT and was followed up by imaging within 15 days of EVT. Safety was assessed on the evolution of NIHSS score. A minor stroke was defined as a worsening of NIHSS < 4 points. Efficacy was defined as the absence of hemorrhagic event during cardiac surgery and the exclusion of the IIA on control imaging. RESULTS Sixty-two IIAs (30 ruptured) were diagnosed in 31 patients. Fifty-six IIAs were diagnosed on the first DSA and 6 on the early control exploration. EVT was achieved in 55 IIAs by parent artery occlusion with glue in 52 distal IIAs and coils in 3 proximal IIAs. IIAs were located in 90.9% of cases on a fourth-division branch of a cerebral artery. The neurological examination remained unchanged in 29 patients (93.5%), and 2 patients suffered minor stroke. EVT was performed before cardiac surgery in 20/22 patients. All treated IIAs were excluded on follow-up imaging. No hemorrhage was observed during cardiac surgery or in the aftermath. Seven (11.3%) unruptured IIAs were not embolized. CONCLUSION EVT of IIAs by occlusion of the parent artery is effective in preventing rupture and carries no significant neurological risk.
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Affiliation(s)
- Fabiola Serrano
- Department of Neuroradiology, Lariboisière Hospital, 2, rue Ambroise Paré, 75010, Paris, France
| | - Alexis Guédon
- Department of Neuroradiology, Lariboisière Hospital, 2, rue Ambroise Paré, 75010, Paris, France. .,University of Paris, Paris, France.
| | | | - Marc-Antoine Labeyrie
- Department of Neuroradiology, Lariboisière Hospital, 2, rue Ambroise Paré, 75010, Paris, France
| | - Vittorio Civelli
- Department of Neuroradiology, Lariboisière Hospital, 2, rue Ambroise Paré, 75010, Paris, France
| | - Michael Eliezer
- Department of Neuroradiology, Lariboisière Hospital, 2, rue Ambroise Paré, 75010, Paris, France
| | - Emmanuel Houdart
- Department of Neuroradiology, Lariboisière Hospital, 2, rue Ambroise Paré, 75010, Paris, France.,University of Paris, Paris, France
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Kalousek V, Sajko T, Splavski B, Rotim K, Jurilj M, Čulo B, Rotim A. CURRENT ENDOVASCULAR MANAGEMENT OF INFECTED DISTAL BRANCH INTRACRANIAL ANEURYSMS: A CASE REPORT AND INSIGHT INTO THE LITERATURE. Acta Clin Croat 2021; 59:754-760. [PMID: 34285448 PMCID: PMC8253077 DOI: 10.20471/acc.2020.59.04.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 11/20/2020] [Indexed: 11/24/2022] Open
Abstract
Infected intracranial aneurysms are a rare type of inflammatory vascular lesions that occur due to infection of intracranial arterial wall. Brain aneurysms of distal arterial branches are equally rare and frequently multiple, including those situated at the peripheral middle cerebral artery segments. Although both types represent a small percentage of all intracranial aneurysms, they may bring about high mortality in case of rupture. The management of such aneurysms includes conservative treatment with broad-spectrum antibiotics, and microsurgical or endovascular treatment, which is gaining more prominence for both asymptomatic and ruptured aneurysms. Herein, we present a case of a 61-year-old male patient with a history of cardiac infective disease and multiple bilateral aneurysms of infected distal branch middle cerebral arteries, discussing the efficacy of available endovascular treatment modalities and reviewing the literature. In conclusion, selective endovascular coiling is a preferable method in the current management of distal branch infected ruptured intracranial aneurysms, which may bring a favorable outcome.
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Affiliation(s)
| | - Tomislav Sajko
- 1Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3University of Applied Health Sciences, Zagreb, Croatia; 4Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 5Josip Juraj Strossmayer University of Osijek, Faculty of Dental Medicine and Health, Osijek, Croatia; 6Department of Neurosurgery, Dubrava University Hospital, Zagreb, Croatia
| | - Bruno Splavski
- 1Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3University of Applied Health Sciences, Zagreb, Croatia; 4Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 5Josip Juraj Strossmayer University of Osijek, Faculty of Dental Medicine and Health, Osijek, Croatia; 6Department of Neurosurgery, Dubrava University Hospital, Zagreb, Croatia
| | - Krešimir Rotim
- 1Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3University of Applied Health Sciences, Zagreb, Croatia; 4Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 5Josip Juraj Strossmayer University of Osijek, Faculty of Dental Medicine and Health, Osijek, Croatia; 6Department of Neurosurgery, Dubrava University Hospital, Zagreb, Croatia
| | - Mia Jurilj
- 1Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3University of Applied Health Sciences, Zagreb, Croatia; 4Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 5Josip Juraj Strossmayer University of Osijek, Faculty of Dental Medicine and Health, Osijek, Croatia; 6Department of Neurosurgery, Dubrava University Hospital, Zagreb, Croatia
| | - Branimir Čulo
- 1Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3University of Applied Health Sciences, Zagreb, Croatia; 4Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 5Josip Juraj Strossmayer University of Osijek, Faculty of Dental Medicine and Health, Osijek, Croatia; 6Department of Neurosurgery, Dubrava University Hospital, Zagreb, Croatia
| | - Ante Rotim
- 1Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3University of Applied Health Sciences, Zagreb, Croatia; 4Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 5Josip Juraj Strossmayer University of Osijek, Faculty of Dental Medicine and Health, Osijek, Croatia; 6Department of Neurosurgery, Dubrava University Hospital, Zagreb, Croatia
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13
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Rotim K, Splavski B, Kalousek V, Jurilj M, Sajko T. ENDOVASCULAR MANAGEMENT OF INTRACRANIAL ANEURYSMS ON DISTAL ARTERIAL BRANCHES: ILLUSTRATIVE CASE SERIES AND LITERATURE RETROSPECTION. Acta Clin Croat 2020; 59:712-720. [PMID: 34285442 PMCID: PMC8253063 DOI: 10.20471/acc.2020.59.04.18] [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: 10/07/2020] [Accepted: 11/09/2020] [Indexed: 12/17/2022] Open
Abstract
Intracranial aneurysms located on distal arterial branches are sporadic and scarce. They account for 2%-7% of the middle cerebral artery and 0.7%-2.3% of the posterior cerebral artery aneurysms, where they mainly arise distally from the P2-related sites. Such aneurysms usually remain asymptomatic prior to rupture, making their diagnosis and management really demanding. Endovascular treatment comprising of different neurointerventional techniques is becoming the most operational up-to-date routine to approach distal cerebral branch aneurysms. In this single-institution case series, endovascular selective coiling and/or parent vessel occlusion resulted in successful and total aneurysmal exclusion from cerebral circulation, which brought good recovery. Hereby, we present an illustrative case series of distal arterial branch intracranial aneurysms, discussing their possible etiology and various endovascular management modalities. We also provide a literature retrospection concerned with this rare entity. In conclusion, due to their predisposition for rupture, distal branch intracranial aneurysms should be treated early and aggressively. We do believe that endovascular selective coil occlusion is the management method of choice, while parent vessel occlusion (with liquid embolics) is optimal when aneurysmal coiling cannot be achieved, or when distal cortical territory is well vascularized by strong collateral cerebral circulation.
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Affiliation(s)
| | - Bruno Splavski
- 1Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2University of Applied Health Sciences, Zagreb, Croatia; 3Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 4Josip Juraj Strossmayer University of Osijek, Faculty of Dental Medicine and Health, Osijek, Croatia; 5Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Vladimir Kalousek
- 1Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2University of Applied Health Sciences, Zagreb, Croatia; 3Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 4Josip Juraj Strossmayer University of Osijek, Faculty of Dental Medicine and Health, Osijek, Croatia; 5Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Mia Jurilj
- 1Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2University of Applied Health Sciences, Zagreb, Croatia; 3Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 4Josip Juraj Strossmayer University of Osijek, Faculty of Dental Medicine and Health, Osijek, Croatia; 5Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Tomislav Sajko
- 1Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2University of Applied Health Sciences, Zagreb, Croatia; 3Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 4Josip Juraj Strossmayer University of Osijek, Faculty of Dental Medicine and Health, Osijek, Croatia; 5Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
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Wang X, Chen G, Li M, Liang J, Guo H, Song G, Bao Y. Rapid formation and rupture of an infectious basilar artery aneurysm from meningitis following suprasellar region meningioma removal: a case report. BMC Neurol 2020; 20:94. [PMID: 32171270 PMCID: PMC7071631 DOI: 10.1186/s12883-020-01673-9] [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: 08/16/2019] [Accepted: 03/03/2020] [Indexed: 12/05/2022] Open
Abstract
Background Infectious basilar artery (BA) aneurysm has been occasionally reported to be generated from meningitis following transcranial operation. However, infectious BA aneurysm formed by intracranial infection after endoscopic endonasal operation has never been reported. Case presentation A 53-year-old man who was diagnosed with suprasellar region meningioma received tumor removal via endoscopic endonasal approach. After operation he developed cerebrospinal fluid (CSF) leak and intracranial infection. The patient ultimately recovered from infection after anti-infective therapy, but a large fusiform BA aneurysm was still formed and ruptured in a short time. Interventional and surgical measures were impossible due to the complicated shape and location of aneurysm and state of his endangerment, therefore, conservative anti-infective therapy was adopted as the only feasible method. Unfortunately, the aneurysm did not disappear and the patient finally died from repeating subarachnoid hemorrhage (SAH). Conclusion Though extremely rare, it was emphasized that infectious aneurysm can be formed at any stage after transnasal surgery, even when the meningitis is cured. Because of the treatment difficulty and poor prognosis, it was recommended that thorough examination should be timely performed for suspicious patient to make correct diagnosis and avoid fatal SAH.
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Affiliation(s)
- Xu Wang
- Department of Skull Base Surgery Center, Department of Neurosurgery, XuanWu Hospital, Capital Medical University, Beijing, China
| | - Ge Chen
- Department of Skull Base Surgery Center, Department of Neurosurgery, XuanWu Hospital, Capital Medical University, Beijing, China
| | - Mingchu Li
- Department of Skull Base Surgery Center, Department of Neurosurgery, XuanWu Hospital, Capital Medical University, Beijing, China
| | - Jiantao Liang
- Department of Skull Base Surgery Center, Department of Neurosurgery, XuanWu Hospital, Capital Medical University, Beijing, China
| | - Hongchuan Guo
- Department of Skull Base Surgery Center, Department of Neurosurgery, XuanWu Hospital, Capital Medical University, Beijing, China
| | - Gang Song
- Department of Skull Base Surgery Center, Department of Neurosurgery, XuanWu Hospital, Capital Medical University, Beijing, China
| | - Yuhai Bao
- Department of Skull Base Surgery Center, Department of Neurosurgery, XuanWu Hospital, Capital Medical University, Beijing, China.
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Ando K, Hasegawa H, Kikuchi B, Saito S, On J, Shibuya K, Fujii Y. Treatment Strategies for Infectious Intracranial Aneurysms: Report of Three Cases and Review of the Literature. Neurol Med Chir (Tokyo) 2019; 59:344-350. [PMID: 31270285 PMCID: PMC6753255 DOI: 10.2176/nmc.oa.2019-0051] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We retrospectively reviewed the cases of three patients with infectious intracranial aneurysms (IIAs), and discuss the indications for surgical and endovascular treatments. We treated two men and one woman with a total of six aneurysms. The mean age was 43.3 years, ranging from 36 to 51 years. One patient presented initially with an intraparenchymal hemorrhage, one with mass effect, and the other one had four aneurysms (one causing subarachnoid hemorrhages and the other causing delayed intraparenchymal hemorrhages). The average size of all aneurysms was 12.2 mm (range, 2–50 mm). They were preferentially located in the distal posterior cerebral artery, and then, in the middle cerebral artery. All cases were caused by infective endocarditis. We selected endovascular treatments for five aneurysms and treated all but one within 24 h from detection. One aneurysm was treated by combined therapy with endovascular intervention and surgery. After treatment, none of the IIAs presented angiographical recurrence or re-bleeding. If feasible, endovascular treatment is probably the first choice, but a combined surgical and endovascular approach should be considered if surgery or endovascular treatment alone are not feasible. The method of treatment should be individualized. For cases with high risk of aneurysm rupture, treatment should be performed as soon as possible.
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Affiliation(s)
- Kazuhiro Ando
- Department of Neurosurgery, Brain Research Institute, Niigata University
| | - Hitoshi Hasegawa
- Department of Neurosurgery, Brain Research Institute, Niigata University
| | - Bumpei Kikuchi
- Department of Neurosurgery, Brain Research Institute, Niigata University
| | - Shoji Saito
- Department of Neurosurgery, Brain Research Institute, Niigata University
| | - Jotaro On
- Department of Neurosurgery, Brain Research Institute, Niigata University
| | - Kohei Shibuya
- Department of Neurosurgery, Brain Research Institute, Niigata University
| | - Yukihiko Fujii
- Department of Neurosurgery, Brain Research Institute, Niigata University
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Ares WJ, Tonetti DA, Greene S, Sharma MS, Xavier F, Jankowitz BT, Jadhav A. Pipeline Embolization of an Infectious Basilar Artery Aneurysm in a 2-Year-Old Child: Case Report, Discussion of the Literature and Perioperative Considerations. Oper Neurosurg (Hagerstown) 2019; 17:E224-E228. [DOI: 10.1093/ons/opz002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 01/11/2019] [Indexed: 11/13/2022] Open
Abstract
AbstractBACKGROUND AND IMPORTANCEFlow diversion of intracranial aneurysms has been rarely described in the pediatric population. Here we discuss the technical and perioperative complexities inherent in the flow diversion of an infectious basilar apex aneurysm in a 2-yr-old child with significant medical comorbidities.CLINICAL PRESENTATIONFollowing judicious oral administration of dual anti-platelet agents and intra-arterial administration of calcium channel blockers to treat vasospasm, standard endovascular procedures were used to place a flow diverting stent across the neck of a rapidly enlarging infectious aneurysm of the basilar apex.Following the uncomplicated procedure, the patient demonstrated progressive thrombosis of the previously noted basilar apex aneurysm over a 3-mo period. The patient was therefore felt to be safe to proceed with, and eventually underwent, uncomplicated orthotopic heart transplant.CONCLUSIONFlow diversion of complex intracranial aneurysms in pediatric patients with significant medical comorbidities is feasible and safe; however, considerations have to be made in the pre- and perioperative care of these patients given the propensity for low-weight and complicated systemic disease processes.
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Affiliation(s)
- William J Ares
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Daniel A Tonetti
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Stephanie Greene
- Department of Neurological Surgery, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Mahesh S Sharma
- Division of Pediatric Cardiothoracic Surgery, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Frederico Xavier
- Division of Pediatric Hematology/Oncology, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Brian T Jankowitz
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Ashutosh Jadhav
- Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Alawieh A, Chaudry MI, Turner RD, Turk AS, Spiotta AM. Infectious intracranial aneurysms: a systematic review of epidemiology, management, and outcomes. J Neurointerv Surg 2018; 10:708-716. [DOI: 10.1136/neurintsurg-2017-013603] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 01/16/2018] [Accepted: 01/24/2018] [Indexed: 12/27/2022]
Abstract
Infectious intracranial aneurysms (IIAs) are a rare cerebrovascular complication of systemic infections induced by microbial infiltration and degradation of the arterial vessel wall. Studies on the epidemiology and management of IIAs are limited to case reports and retrospective single-center studies, and report a large variability in epidemiological features, management, and outcomes due to the limited sample size. We conducted a systematic review of all published papers on IIAs in the English literature using MEDLINE and SCOPUS database from January 1950 to June 2017. A total of 288 publications describing 1191 patients with IIA (1398 aneurysms) were included and reviewed for epidemiological features, disease features, treatment and outcome. All patients were merged into a single cohort and summary data are presented. The majority of reported IIAs are distally located, relatively small (<5 mm), involve the anterior circulation, are associated with a relatively high rate of rupture, and demonstrate a propensity to multiplicity of aneurysms. Sensitive diagnosis of IIAs requires digital subtraction angiography and not CT angiography or MR angiography. Treatment of ruptured, symptomatic, or enlarging IIAs has evolved over the last 50 years. Endovascular therapy is associated with a high success rate and low morbidity compared with microsurgical and medical management. A treatment algorithm for the management of patients with IIA in various contexts is proposed and the need for prospective multicenter studies is emphasized.
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Resuscitative Endovascular Balloon Occlusion of the Aorta: Principles, Initial Clinical Experience, and Considerations for the Anesthesiologist. Anesth Analg 2017; 125:884-890. [PMID: 28598924 DOI: 10.1213/ane.0000000000002150] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an endovascular technique that allows for temporary occlusion of the aorta in patients with severe, life-threatening, trauma-induced noncompressible hemorrhage arising below the diaphragm. REBOA utilizes a transfemoral balloon catheter inserted in a retrograde fashion into the aorta to provide inflow control and support blood pressure until definitive hemostasis can be achieved. Initial retrospective and registry clinical data in the trauma surgical literature demonstrate improvement in systolic blood pressure with balloon inflation and improved survival compared to open aortic cross-clamping via resuscitative thoracotomy. However, there are no significant reports of anesthetic implications and perioperative management in this challenging cohort. In this narrative, we review the principles, technique, and logistics of REBOA deployment, as well as initial clinical outcome data from our level-1 American College of Surgeons-verified trauma center. For anesthesiologists who may not yet be familiar with REBOA, we make several suggestions and recommendations for intraoperative management based on extrapolation from these initial surgical-based reports, opinions from a team with increasing experience, and translated experience from emergency aortic vascular surgical procedures. Further prospective data will be necessary to conclusively guide anesthetic management, especially as potential complications and implications for global organ function, including cerebral and renal, are recognized and described.
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Champeaux C, Walker N, Derwin J, Grivas A. Successful delayed coiling of a ruptured growing distal posterior cerebral artery mycotic aneurysm. Neurochirurgie 2017; 63:17-20. [DOI: 10.1016/j.neuchi.2016.10.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 08/24/2016] [Accepted: 10/23/2016] [Indexed: 10/20/2022]
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