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Surgical Treatment of Large and Giant Anterior Cerebral Artery Aneurysms in the Endovascular Era: Analysis of Large Clinical Series. World Neurosurg 2022; 165:e298-e310. [PMID: 35714949 DOI: 10.1016/j.wneu.2022.06.036] [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: 05/28/2022] [Accepted: 06/07/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Analysis of results of surgical treatment of 112 patients with large and giant anterior cerebral artery (ACA) aneurysms. METHODS This is the largest clinical series of large and giant ACA aneurysms ever reported. Retrospective analysis of medical charts, radiographic studies, and intraoperative videos was performed. Univariate and multivariate analysis of relations among 3 types of outcomes (complete aneurysm occlusion, ischemic complications, and clinical outcomes) and predicting factors was performed. RESULTS Most aneurysms were communicant (84.8%). Aneurysms of the A1 segment and distal segments (A2-A5) were encountered rarely. Complete aneurysm occlusion (class I) was shown in 95 cases (90.5%). In 4 patients, only exploration and wrapping were performed because of severe atherosclerosis and chronic intraluminal thrombi. Partial occlusion (class III) was shown in 2 patients, and neck residual (class II) in 4 patients. Cerebral ischemia developed in 29 patients postoperatively. Occlusion or injury of the A1 segment and anterior communicating artery perforators and recurrent branch of Heubner were the most common reason for ischemic complications. At follow-up, 97 patients (86.6%) had favorable outcomes. Ten patients (8.9%) had unfavorable outcomes because of postoperative complications. CONCLUSIONS Microsurgery provides effective and relatively safe occlusion of complex ACA aneurysms. Direct clipping can be applied in most cases independent of their precise location. In certain cases, alternative methods can be safely used. According to multivariate analysis, giant aneurysm size, aneurysm-related mass effect, involvement of large arterial branches in the aneurysm wall, and intraoperative complications were significant predicting factors for ischemic complications.
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Holl M, Rasch ML, Becker L, Keller AL, Schultze-Rhonhof L, Ruoff F, Templin M, Keller S, Neis F, Keßler F, Andress J, Bachmann C, Krämer B, Schenke-Layland K, Brucker SY, Marzi J, Weiss M. Cell Type-Specific Anti-Adhesion Properties of Peritoneal Cell Treatment with Plasma-Activated Media (PAM). Biomedicines 2022; 10:biomedicines10040927. [PMID: 35453677 PMCID: PMC9032174 DOI: 10.3390/biomedicines10040927] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/08/2022] [Accepted: 04/12/2022] [Indexed: 11/16/2022] Open
Abstract
Postoperative abdominal adhesions are responsible for serious clinical disorders. Administration of plasma-activated media (PAM) to cell type-specific modulated proliferation and protein biosynthesis is a promising therapeutic strategy to prevent pathological cell responses in the context of wound healing disorders. We analyzed PAM as a therapeutic option based on cell type-specific anti-adhesive responses. Primary human peritoneal fibroblasts and mesothelial cells were isolated, characterized and exposed to different PAM dosages. Cell type-specific PAM effects on different cell components were identified by contact- and marker-independent Raman imaging, followed by thorough validation by specific molecular biological methods. The investigation revealed cell type-specific molecular responses after PAM treatment, including significant cell growth retardation in peritoneal fibroblasts due to transient DNA damage, cell cycle arrest and apoptosis. We identified a therapeutic dose window wherein specifically pro-adhesive peritoneal fibroblasts were targeted, whereas peritoneal mesothelial cells retained their anti-adhesive potential of epithelial wound closure. Finally, we demonstrate that PAM treatment of peritoneal fibroblasts reduced the expression and secretion of pro-adhesive cytokines and extracellular matrix proteins. Altogether, we provide insights into biochemical PAM mechanisms which lead to cell type-specific pro-therapeutic cell responses. This may open the door for the prevention of pro-adhesive clinical disorders.
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Affiliation(s)
- Myriam Holl
- Department of Women’s Health Tübingen, Eberhard Karls University Tübingen, 72076 Tübingen, Germany; (M.H.); (M.-L.R.); (L.S.-R.); (F.N.); (F.K.); (J.A.); (C.B.); (B.K.); (S.Y.B.)
- NMI Natural and Medical Sciences Institute, University Tübingen, 72770 Reutlingen, Germany; (A.-L.K.); (F.R.); (M.T.); (S.K.); (K.S.-L.); (J.M.)
| | - Marie-Lena Rasch
- Department of Women’s Health Tübingen, Eberhard Karls University Tübingen, 72076 Tübingen, Germany; (M.H.); (M.-L.R.); (L.S.-R.); (F.N.); (F.K.); (J.A.); (C.B.); (B.K.); (S.Y.B.)
- NMI Natural and Medical Sciences Institute, University Tübingen, 72770 Reutlingen, Germany; (A.-L.K.); (F.R.); (M.T.); (S.K.); (K.S.-L.); (J.M.)
| | - Lucas Becker
- Institute of Biomedical Engineering, Eberhard Karls University Tübingen, 72076 Tübingen, Germany;
- Cluster of Excellence iFIT (EXC 2180) “Image-Guided and Functionally Instructed Tumor Therapies”, Eberhard Karls University, 72076 Tübingen, Germany
| | - Anna-Lena Keller
- NMI Natural and Medical Sciences Institute, University Tübingen, 72770 Reutlingen, Germany; (A.-L.K.); (F.R.); (M.T.); (S.K.); (K.S.-L.); (J.M.)
| | - Laura Schultze-Rhonhof
- Department of Women’s Health Tübingen, Eberhard Karls University Tübingen, 72076 Tübingen, Germany; (M.H.); (M.-L.R.); (L.S.-R.); (F.N.); (F.K.); (J.A.); (C.B.); (B.K.); (S.Y.B.)
- NMI Natural and Medical Sciences Institute, University Tübingen, 72770 Reutlingen, Germany; (A.-L.K.); (F.R.); (M.T.); (S.K.); (K.S.-L.); (J.M.)
| | - Felix Ruoff
- NMI Natural and Medical Sciences Institute, University Tübingen, 72770 Reutlingen, Germany; (A.-L.K.); (F.R.); (M.T.); (S.K.); (K.S.-L.); (J.M.)
| | - Markus Templin
- NMI Natural and Medical Sciences Institute, University Tübingen, 72770 Reutlingen, Germany; (A.-L.K.); (F.R.); (M.T.); (S.K.); (K.S.-L.); (J.M.)
| | - Silke Keller
- NMI Natural and Medical Sciences Institute, University Tübingen, 72770 Reutlingen, Germany; (A.-L.K.); (F.R.); (M.T.); (S.K.); (K.S.-L.); (J.M.)
| | - Felix Neis
- Department of Women’s Health Tübingen, Eberhard Karls University Tübingen, 72076 Tübingen, Germany; (M.H.); (M.-L.R.); (L.S.-R.); (F.N.); (F.K.); (J.A.); (C.B.); (B.K.); (S.Y.B.)
| | - Franziska Keßler
- Department of Women’s Health Tübingen, Eberhard Karls University Tübingen, 72076 Tübingen, Germany; (M.H.); (M.-L.R.); (L.S.-R.); (F.N.); (F.K.); (J.A.); (C.B.); (B.K.); (S.Y.B.)
| | - Jürgen Andress
- Department of Women’s Health Tübingen, Eberhard Karls University Tübingen, 72076 Tübingen, Germany; (M.H.); (M.-L.R.); (L.S.-R.); (F.N.); (F.K.); (J.A.); (C.B.); (B.K.); (S.Y.B.)
| | - Cornelia Bachmann
- Department of Women’s Health Tübingen, Eberhard Karls University Tübingen, 72076 Tübingen, Germany; (M.H.); (M.-L.R.); (L.S.-R.); (F.N.); (F.K.); (J.A.); (C.B.); (B.K.); (S.Y.B.)
| | - Bernhard Krämer
- Department of Women’s Health Tübingen, Eberhard Karls University Tübingen, 72076 Tübingen, Germany; (M.H.); (M.-L.R.); (L.S.-R.); (F.N.); (F.K.); (J.A.); (C.B.); (B.K.); (S.Y.B.)
| | - Katja Schenke-Layland
- NMI Natural and Medical Sciences Institute, University Tübingen, 72770 Reutlingen, Germany; (A.-L.K.); (F.R.); (M.T.); (S.K.); (K.S.-L.); (J.M.)
- Institute of Biomedical Engineering, Eberhard Karls University Tübingen, 72076 Tübingen, Germany;
- Cluster of Excellence iFIT (EXC 2180) “Image-Guided and Functionally Instructed Tumor Therapies”, Eberhard Karls University, 72076 Tübingen, Germany
- Department of Medicine/Cardiology, University of California, Los Angeles (UCLA), Los Angeles, CA 90095, USA
| | - Sara Y. Brucker
- Department of Women’s Health Tübingen, Eberhard Karls University Tübingen, 72076 Tübingen, Germany; (M.H.); (M.-L.R.); (L.S.-R.); (F.N.); (F.K.); (J.A.); (C.B.); (B.K.); (S.Y.B.)
| | - Julia Marzi
- NMI Natural and Medical Sciences Institute, University Tübingen, 72770 Reutlingen, Germany; (A.-L.K.); (F.R.); (M.T.); (S.K.); (K.S.-L.); (J.M.)
- Institute of Biomedical Engineering, Eberhard Karls University Tübingen, 72076 Tübingen, Germany;
- Cluster of Excellence iFIT (EXC 2180) “Image-Guided and Functionally Instructed Tumor Therapies”, Eberhard Karls University, 72076 Tübingen, Germany
| | - Martin Weiss
- Department of Women’s Health Tübingen, Eberhard Karls University Tübingen, 72076 Tübingen, Germany; (M.H.); (M.-L.R.); (L.S.-R.); (F.N.); (F.K.); (J.A.); (C.B.); (B.K.); (S.Y.B.)
- NMI Natural and Medical Sciences Institute, University Tübingen, 72770 Reutlingen, Germany; (A.-L.K.); (F.R.); (M.T.); (S.K.); (K.S.-L.); (J.M.)
- Correspondence:
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Xu K, Yu T, Guo Y, Yu J. Study and Therapeutic Progress on Intracranial Serpentine Aneurysms. Int J Med Sci 2016; 13:432-9. [PMID: 27279792 PMCID: PMC4893557 DOI: 10.7150/ijms.14934] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 05/08/2016] [Indexed: 12/23/2022] Open
Abstract
An intracranial serpentine aneurysm (SA) is a clinically rare entity, and very few multi-case studies on SA have been published. The present study reviewed the relevant literature available on PubMed. The studied information included the formation mechanism and natural history of SA as well as its clinical manifestation, imaging characteristics, and current treatments. After reviewing the literature, we conclude that intracranial SA can be managed surgically and by endovascular embolization, but the degree of blood flow in normal brain tissue distal to the SA must be evaluated. A balloon occlusion test (BOT) or cross compression test is recommended for this evaluation. If the collateral circulation is sufficiently compensatory, direct excision or embolization can be performed. However, if the compensatory collateral circulation is poor, a bypass surgery is necessary. Satisfactory results can be achieved in the majority of SA patients after treatment. However, the size of the aneurysm may increase in some patients after endovascular treatment. Special attention should be paid to cases exhibiting a significant mass effect to avoid subsequent SA excision due to an intolerable mass effect. Satisfactory results can be achieved with careful treatment of SA.
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Affiliation(s)
- Kan Xu
- 1. Department of Neurosurgery, First Hospital of Jilin University, Changchun, 130021, P.R. China
| | - Tiecheng Yu
- 2. Department of Orthopedics, First Hospital of Jilin University, Changchun, 130021, P.R. China
| | - Yunbao Guo
- 1. Department of Neurosurgery, First Hospital of Jilin University, Changchun, 130021, P.R. China
| | - Jinlu Yu
- 1. Department of Neurosurgery, First Hospital of Jilin University, Changchun, 130021, P.R. China
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