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Satoh T, Ichikawa T, Fujii K, Date I. Assessment of morphology and hemodynamics in a surgically clipped neck of a cerebral aneurysm: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2024; 8:CASE24194. [PMID: 39074394 DOI: 10.3171/case24194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 05/23/2024] [Indexed: 07/31/2024]
Abstract
BACKGROUND Silent magnetic resonance angiography reduces metal artifacts, enabling clear visualization of the clipped neck following surgical clipping of cerebral aneurysms. This study aimed to delineate the morphology of the clipped neck complex in cerebral aneurysms using three-dimensional (3D) multifusion imaging of silent magnetic resonance angiography and fast spin echo magnetic resonance cisternography. Additionally, computational fluid dynamics analysis was utilized to evaluate the hemodynamics of the parent vessel at the clipped neck, allowing for a detailed assessment of hemodynamics at the clipped neck. OBSERVATIONS The 3D multifusion image enabled visualization of the orientation and shape of the clip within the clipped neck complex, alongside the morphology of the parent vessel. In the hemodynamic analysis of the parent vessel at the clipped neck, areas of high-intensity magnitude of wall shear stress (WSSm) variation corresponding to the clip's contour, along with significant vector of wall shear stress (WSSv) variation related to vector directionality, were visualized in 3D. The intentional residual neck, coated with muscle grafts, was depicted as an area with low WSSm variation values and high WSSv variation values. LESSONS Three-dimensional multifusion imaging, along with computational fluid dynamics analysis of the parent vessels, facilitated both the morphological and hemodynamic visualization and assessment of the clipped neck complex following neck clipping surgery for cerebral aneurysms. https://thejns.org/doi/10.3171/CASE24194.
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Affiliation(s)
- Toru Satoh
- Department of Neurological Surgery, Ryofukai Satoh Neurosurgical Hospital, Hiroshima, Japan
| | - Tomotsugu Ichikawa
- Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Kentaro Fujii
- Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Isao Date
- Okayama Rosai Hospital, Okayama, Japan
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Satoh T, Sugiu K, Hiramatsu M, Haruma J, Date I. Evaluation of the shrinkage process of a neck remnant after stent-coil treatment of a cerebral aneurysm using silent magnetic resonance angiography and computational fluid dynamics analysis: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2024; 7:CASE24141. [PMID: 38621304 PMCID: PMC11023012 DOI: 10.3171/case24141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 03/13/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND Silent magnetic resonance angiography (MRA) mitigates metal artifacts, facilitating clear visualization of neck remnants after stent and coil embolization of cerebral aneurysms. This study aims to scrutinize hemodynamics at the neck remnant by employing silent MRA and computational fluid dynamics. OBSERVATIONS The authors longitudinally tracked images of a partially thrombosed anterior communicating artery aneurysm's neck remnant, which had been treated with stent-assisted coil embolization, using silent MRA over a decade. Computational fluid dynamics delineated the neck remnant's reduction process, evaluating hemodynamic parameters such as flow rate, wall shear stress magnitude and vector, and streamlines. The neck remnant exhibited diminishing surface area, volume, neck size, dome depth, and aspect ratio. Its reduction correlated with a decline in the flow rate ratio of the remnant dome to the inflow parent artery. Analysis delineated regions within the contracting neck remnant characterized by consistently low average wall shear stress magnitude and variation, accompanied by notable variations in wall shear stress vector directionality. LESSONS Evaluation of neck remnants after stent-coil embolization is possible through silent MRA and computational fluid dynamics. Predicting the neck remnant reduction may be achievable through hemodynamic parameter analysis.
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Affiliation(s)
- Toru Satoh
- Departments of Neurological Surgery, Ryofukai Satoh Neurosurgical Hospital, Hiroshima, Japan
| | - Kenji Sugiu
- Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan; and
| | - Masafumi Hiramatsu
- Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan; and
| | - Jun Haruma
- Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan; and
| | - Isao Date
- Okayama Rosai Hospital, Okayama, Japan
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Vega-Moreno DA, Janković D, Azouz H, Nakipuria M, Kato Y. Dual Microscope Indocyanine Green Video Angiography and Endoscopic Review to Treat Intracranial Aneurysm: A Review of the Literature Regarding a Case. Asian J Neurosurg 2023; 18:701-707. [PMID: 38161615 PMCID: PMC10756820 DOI: 10.1055/s-0043-1775584] [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] [Indexed: 01/03/2024] Open
Abstract
The use of the indocyanine green video angiography (ICG-VA) both endoscope and microscope has become popular in recent decades thanks to the safety, efficacy, and added value that they have provided for cerebrovascular surgery. The dual use of these technologies is considered complementary and has helped cerebrovascular surgeons in decision-making, especially for aneurysm clipping surgery; however, its use has been described for both aneurysm surgery, resection of arteriovenous malformations, or even for bypass surgeries. We conducted a review of the literature with the MeSH terms "microscope indocyanine green video angiography (mICG-VA)," "endoscopic review," AND/OR "intracranial aneurysm." A total of 97 articles that included these terms were selected after a primary review to select a total of 26 articles for the final review. We also present a case to exemplify its use, in which we use both technological tools for the description of the aneurysm, as well as for decision-making at the time of clipping and for reclipping. Both tools, both the use of the endoscope and the mICG-VA, have helped decision-making in neurovascular surgery. A considerable clip replacement rate has been described with the use of these technologies, which has helped to reduce the complications associated with poor clipping. One of the main advantages of their usefulness is that they are tools for intraoperative use, which is why they have shown superiority compared to digital subtraction angiography, which takes longer to use and has a higher risk of complications associated with the contrast medium. On the other hand, a very low rate of complications has been described with the use of the endoscope and mICG-VA, which is why they are considered safe tools to use. In some cases, mention has been made of the use of one or the other technology; however, we consider that its dual use provides more information about the status of the clip, its anatomy, its relationship with other vascular structures, and the complete occlusion of the aneurysm. We consider that the use of both technologies is complementary, so in case of having them both should be used, since both the endoscope and the mICG-VA provide additional and useful information.
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Affiliation(s)
- Daniel Alejandro Vega-Moreno
- Neurosurgery Department, Postgraduate Division, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Dragan Janković
- Neurosurgery Department, University Hospital Mainz, Maguncia, Germany
| | - Heba Azouz
- Neurosurgery Department, Childreńs Cancer Hospital Egypt, Cairo, Egypt
| | | | - Yoko Kato
- Neurosurgery Department, Fujita Health University Banbuntane Hotokukai Hospital, Nagoya, Aichi, Japan
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Bruneau DA, Steinman DA, Valen-Sendstad K. Understanding intracranial aneurysm sounds via high-fidelity fluid-structure-interaction modelling. COMMUNICATIONS MEDICINE 2023; 3:163. [PMID: 37945799 PMCID: PMC10636010 DOI: 10.1038/s43856-023-00396-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 10/26/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Since the 1960s, the origins of intracranial aneurysm bruits and musical murmurs have been debated, with proposed mechanisms ranging from self-excitation (i.e., resonance) by stable pulsatile flow, to vibration caused by unstable (laminar vortex shedding or turbulent) flow. This knowledge gap has impeded the use of intracranial sounds a marker of aneurysm remodelling or rupture risk. New computational techniques now allow us to model these phenomena. METHODS We performed high-fidelity fluid-structure interaction simulations capable of understanding the magnitude and mechanisms of such flow-induced vibrations, under pulsatile flow conditions. Six cases from a previous cohort were used. RESULTS In five cases, underlying flow instabilities present as broad-band, random vibrations, consistent with previously-described bruits, while the sac also exhibits resonance, rocking back and forth in different planes of motion, consistent with previously described musical murmurs. Both types of vibration have amplitudes in the range of 0.1 to 1 μm. The murmurs extend into diastole, after the underlying flow instability has dissipated, and do not exhibit the characteristic repeating frequency harmonics of previously hypothesized vortex-shedding mechanisms. The remaining case with stable pulsatile flow does not vibrate. Spectrograms of the simulated vibrations are consistent with previously reported microphone and Doppler ultrasound recordings. CONCLUSIONS Our results provide a plausible explanation for distinct intracranial aneurysm sounds and characterize the mechanical environment of a vibrating aneurysm wall. Future work should aim to quantify the deleterious effects of these overlooked stimuli on the vascular wall, to determine which changes to the wall makeup are associated with vibration.
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Affiliation(s)
- David A Bruneau
- Department of Mechanical & Industrial Engineering, University of Toronto, Toronto, ON, Canada.
| | - David A Steinman
- Department of Mechanical & Industrial Engineering, University of Toronto, Toronto, ON, Canada
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Tsutsui T, Ikedo T, Kitazawa Y, Otsuka R, Nishiwaki T, Kushi Y, Niwa A, Ozaki S, Hattori EY, Shimonaga K, Hamano E, Yamada K, Imamura H, Mori H, Iihara K, Kataoka H. Impact of Morphological Factors on the Future Growth of Unruptured Posterior Communicating Artery Aneurysms. World Neurosurg 2023; 175:e897-e903. [PMID: 37075892 DOI: 10.1016/j.wneu.2023.04.039] [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: 11/19/2022] [Revised: 04/08/2023] [Accepted: 04/10/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND No previous study has established the factors associated with intracranial aneurysm growth using imaging data obtained before the appearance of morphological changes. Therefore, we investigated the factors related to future aneurysm growth in posterior communicating artery (Pcom) aneurysms. METHODS Using a longitudinal database of intracranial aneurysm cases, we reviewed the findings for consecutive patients with unruptured Pcom aneurysms admitted to our institute from 2012 to 2021. Magnetic resonance images obtained over time were used to evaluate aneurysm growth. Aneurysms showing growth over time (group G) and unchanged aneurysms (group U) were compared in terms of background data and morphological factors. RESULTS 93 Pcom aneurysms (group G: 25 aneurysms, 25%; group U: 68 aneurysms, 75%) were eligible for the present study. Six aneurysm rupture events occurred in group G (24%). Among morphological factors, Pcom diameter (1.2 ± 0.3 mm vs. 0.8 ± 0.7 mm, P < 0.01), bleb formation (group G: 39% vs. group U: 10%; odds ratio, 5.6; P = 0.01), and the lateral projection of the dome (group G: 52% vs. group U: 13%; odds ratio, 3.2; P = 0.023) were significantly different between the 2 groups. The sensitivity and specificity of a cutoff Pcom diameter of 0.73 mm for predicting enlargement were 96% and 53%, respectively. CONCLUSIONS Pcom diameter, bleb formation, and lateral dome projection were associated with growth of Pcom aneurysms. Aneurysms with these risk factors require careful follow-up imaging, which may facilitate early detection of aneurysm growth and prevention of rupture through therapeutic interventions.
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Affiliation(s)
- Takeyoshi Tsutsui
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Taichi Ikedo
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Osaka, Japan.
| | - Yoshiaki Kitazawa
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Ryotaro Otsuka
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Takayuki Nishiwaki
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yuji Kushi
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Akihiro Niwa
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Saya Ozaki
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | | | - Koji Shimonaga
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Eika Hamano
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Kiyofumi Yamada
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Hirotoshi Imamura
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Hisae Mori
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Koji Iihara
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Hiroharu Kataoka
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Osaka, Japan
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