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Veken JVD, Keukeleire KD. Clipping of a persistent middle cerebral artery aneurysm after previous flow diverter placement: An illustrative case and review of the literature. J Cerebrovasc Endovasc Neurosurg 2024; 26:338-343. [PMID: 38291255 PMCID: PMC11449532 DOI: 10.7461/jcen.2024.e2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 11/29/2023] [Accepted: 01/04/2024] [Indexed: 02/01/2024] Open
Abstract
Flow diverter (FD) is increasingly used in the management of wide necked cerebral aneurysms. Despite a reported lower efficacy in middle cerebral artery (MCA) aneurysms, they are still being utilised. Microsurgery is best considered as an index treatment, but can also be a safe and effective treatment when encountering a persistent MCA aneurysm after prior FD. As there is a paucity in literature and more cases of failed FD are expected to appear, we want to add our experience to the existing literature. The microsurgical management of a persistent MCA bifurcation aneurysm, 3 years after a p48 MW HPC Flow Diverter (phenox GmbH, Bochum Germany) insertion is reported and the relevant literature discussed.
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Affiliation(s)
- Jorn Van Der Veken
- Neurosurgery Department, Aalsters Stedelijk Ziekenhuis, Aalst, Belgium
- Neurosurgery Department, AZ Sint Blasius, Dendermonde, Belgium
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Wang T, Ugurlu H, Yan Y, Li M, Li M, Wild AM, Yildiz E, Schneider M, Sheehan D, Hu W, Sitti M. Adaptive wireless millirobotic locomotion into distal vasculature. Nat Commun 2022; 13:4465. [PMID: 35915075 PMCID: PMC9343456 DOI: 10.1038/s41467-022-32059-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 07/14/2022] [Indexed: 11/23/2022] Open
Abstract
Microcatheters have enabled diverse minimally invasive endovascular operations and notable health benefits compared with open surgeries. However, with tortuous routes far from the arterial puncture site, the distal vascular regions remain challenging for safe catheter access. Therefore, we propose a wireless stent-shaped magnetic soft robot to be deployed, actively navigated, used for medical functions, and retrieved in the example M4 segment of the middle cerebral artery. We investigate shape-adaptively controlled locomotion in phantoms emulating the physiological conditions here, where the lumen diameter shrinks from 1.5 mm to 1 mm, the radius of curvature of the tortuous lumen gets as small as 3 mm, the lumen bifurcation angle goes up to 120°, and the pulsatile flow speed reaches up to 26 cm/s. The robot can also withstand the flow when the magnetic actuation is turned off. These locomotion capabilities are confirmed in porcine arteries ex vivo. Furthermore, variants of the robot could release the tissue plasminogen activator on-demand locally for thrombolysis and function as flow diverters, initiating promising therapies towards acute ischemic stroke, aneurysm, arteriovenous malformation, dural arteriovenous fistulas, and brain tumors. These functions should facilitate the robot's usage in new distal endovascular operations.
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Affiliation(s)
- Tianlu Wang
- Physical Intelligence Department, Max Planck Institute for Intelligent Systems, 70569, Stuttgart, Germany
- Department of Information Technology and Electrical Engineering, ETH Zurich, 8092, Zurich, Switzerland
| | - Halim Ugurlu
- Physical Intelligence Department, Max Planck Institute for Intelligent Systems, 70569, Stuttgart, Germany
- Clinic for Neuroradiology, Klinikum Stuttgart, 70174, Stuttgart, Germany
- Department of Biophysics, Aydın Adnan Menderes University, Graduate School of Health Sciences, 09010, Aydın, Turkey
| | - Yingbo Yan
- Physical Intelligence Department, Max Planck Institute for Intelligent Systems, 70569, Stuttgart, Germany
| | - Mingtong Li
- Physical Intelligence Department, Max Planck Institute for Intelligent Systems, 70569, Stuttgart, Germany
| | - Meng Li
- Physical Intelligence Department, Max Planck Institute for Intelligent Systems, 70569, Stuttgart, Germany
| | - Anna-Maria Wild
- Physical Intelligence Department, Max Planck Institute for Intelligent Systems, 70569, Stuttgart, Germany
| | - Erdost Yildiz
- Physical Intelligence Department, Max Planck Institute for Intelligent Systems, 70569, Stuttgart, Germany
| | - Martina Schneider
- Physical Intelligence Department, Max Planck Institute for Intelligent Systems, 70569, Stuttgart, Germany
| | - Devin Sheehan
- Physical Intelligence Department, Max Planck Institute for Intelligent Systems, 70569, Stuttgart, Germany
| | - Wenqi Hu
- Physical Intelligence Department, Max Planck Institute for Intelligent Systems, 70569, Stuttgart, Germany.
| | - Metin Sitti
- Physical Intelligence Department, Max Planck Institute for Intelligent Systems, 70569, Stuttgart, Germany.
- Department of Information Technology and Electrical Engineering, ETH Zurich, 8092, Zurich, Switzerland.
- School of Medicine and College of Engineering, Koç University, 34450, Istanbul, Turkey.
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Karadag A, Bozkurt B, Yagmurlu K, Ozcan AI, Moen S, Grande AW. Microsurgical Management of the Middle Cerebral Artery Bifurcation Aneurysms: An Anatomic Feasibility Study. ORL J Otorhinolaryngol Relat Spec 2021; 83:187-195. [PMID: 33721866 DOI: 10.1159/000514177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 12/28/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND The proper head positioning decreases the surgical complications by enabling a better surgical maneuverability. Middle cerebral artery (MCA) bifurcation aneurysms have been classified by Dashti et al. [Surg Neurol. 2007 May;67(5):441-56] as the intertruncal, inferior, lateral, insular, and complex types based on dome projection. Our aim was to identify the optimum head positions and to explain the anatomic variables, which may affect the surgical strategy of MCA bifurcation aneurysms. METHODS The lateral supraorbital approach bilaterally was performed in the 4 cadaveric heads. All steps of the dissection were recorded using digital camera. RESULTS The distal Sylvian fissure (SF) dissection may be preferred for insular type and the proximal SF dissection may be preferred for all other types. Fifteen degrees head rotation was found as the most suitable position for the intertruncal, lateral type and subtype of complex aneurysms related with superior trunk. Thirty degrees head rotation was found the most suitable position for the inferior type, insular type, and subtype of complex aneurysms related with inferior trunk. CONCLUSIONS The head positioning in middle cerebral bifurcation aneurysms surgery is a critical step. It should be tailored according to the projection and its relationship with the parent vessels of the middle cerebral bifurcation.
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Affiliation(s)
- Ali Karadag
- Department of Neurosurgery, Health Science University, Tepecik Research and Training Hospital, Izmir, Turkey,
| | - Baran Bozkurt
- Department of Neurosurgery, Acibadem University, Istanbul, Turkey
| | - Kaan Yagmurlu
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | | | - Sean Moen
- Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Andrew W Grande
- Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA
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Roy AK, Philipp LR, Howard BM, Cawley CM, Grossberg JA, Barrow DL. Microsurgical Treatment of Cerebral Aneurysms After Previous Endovascular Therapy: Single-Center Series and Systematic Review. World Neurosurg 2019; 123:e103-e115. [DOI: 10.1016/j.wneu.2018.11.065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 11/07/2018] [Accepted: 11/08/2018] [Indexed: 01/01/2023]
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