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Korte J, Marsh LMM, Saalfeld S, Behme D, Aliseda A, Berg P. Fusiform versus Saccular Intracranial Aneurysms-Hemodynamic Evaluation of the Pre-Aneurysmal, Pathological, and Post-Interventional State. J Clin Med 2024; 13:551. [PMID: 38256685 PMCID: PMC11154261 DOI: 10.3390/jcm13020551] [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: 11/25/2023] [Revised: 01/08/2024] [Accepted: 01/11/2024] [Indexed: 01/24/2024] Open
Abstract
Minimally-invasive therapies are well-established treatment methods for saccular intracranial aneurysms (SIAs). Knowledge concerning fusiform IAs (FIAs) is low, due to their wide and alternating lumen and their infrequent occurrence. However, FIAs carry risks like ischemia and thus require further in-depth investigation. Six patient-specific IAs, comprising three position-identical FIAs and SIAs, with the FIAs showing a non-typical FIA shape, were compared, respectively. For each model, a healthy counterpart and a treated version with a flow diverting stent were created. Eighteen time-dependent simulations were performed to analyze morphological and hemodynamic parameters focusing on the treatment effect (TE). The stent expansion is higher for FIAs than SIAs. For FIAs, the reduction in vorticity is higher (Δ35-75% case 2/3) and the reduction in the oscillatory velocity index is lower (Δ15-68% case 2/3). Velocity is reduced equally for FIAs and SIAs with a TE of 37-60% in FIAs and of 41-72% in SIAs. Time-averaged wall shear stress (TAWSS) is less reduced within FIAs than SIAs (Δ30-105%). Within this study, the positive TE of FDS deployed in FIAs is shown and a similarity in parameters found due to the non-typical FIA shape. Despite the higher stent expansion, velocity and vorticity are equally reduced compared to identically located SIAs.
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Affiliation(s)
- Jana Korte
- Department of Fluid Dynamics and Technical Flows, University of Magdeburg, 39106 Magdeburg, Germany
- Research Campus STIMULATE, University of Magdeburg, 39106 Magdeburg, Germany; (L.M.M.M.); (S.S.); (D.B.); (P.B.)
| | - Laurel M. M. Marsh
- Research Campus STIMULATE, University of Magdeburg, 39106 Magdeburg, Germany; (L.M.M.M.); (S.S.); (D.B.); (P.B.)
- Department of Mechanical Engineering, George Mason University, Fairfax, VA 22030, USA
| | - Sylvia Saalfeld
- Research Campus STIMULATE, University of Magdeburg, 39106 Magdeburg, Germany; (L.M.M.M.); (S.S.); (D.B.); (P.B.)
- Department of Computer Science and Automation, Ilmenau University of Technology, 98693 Ilmenau, Germany
| | - Daniel Behme
- Research Campus STIMULATE, University of Magdeburg, 39106 Magdeburg, Germany; (L.M.M.M.); (S.S.); (D.B.); (P.B.)
- University Hospital Magdeburg, University of Magdeburg, 39106 Magdeburg, Germany
| | - Alberto Aliseda
- Department of Mechanical Engineering, University of Washington, Seattle, WA 98195, USA;
| | - Philipp Berg
- Research Campus STIMULATE, University of Magdeburg, 39106 Magdeburg, Germany; (L.M.M.M.); (S.S.); (D.B.); (P.B.)
- Department of Medical Engineering, University of Magdeburg, 39106 Magdeburg, Germany
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Caffes N, Kim KT, Nagm A, Wang TI, Cherian J, Gandhi D, Labib M. Complex M1 Middle Cerebral Artery Aneurysm Treated With High-Flow Bypass and Trapping: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2023:01787389-990000000-00982. [PMID: 38047659 DOI: 10.1227/ons.0000000000001028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 10/22/2023] [Indexed: 12/05/2023] Open
Affiliation(s)
- Nicholas Caffes
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Kevin T Kim
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Alhusain Nagm
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Neurosurgery, Al-Azhar University School of Medicine, Cairo, Egypt
| | - Tina I Wang
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Jacob Cherian
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Radiology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Dheeraj Gandhi
- Department of Radiology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Mohamed Labib
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
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Romano A, Moltoni G, Piazza A, Trasimeni G, Miscusi M, Palizzi S, Romano A, Raco A, Bozzao A. Giant serpentine aneurysm: Neuroradiological and neurosurgical management in a left-handed patient. Radiol Case Rep 2023; 18:4384-4388. [PMID: 37840892 PMCID: PMC10569986 DOI: 10.1016/j.radcr.2023.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/04/2023] [Accepted: 09/05/2023] [Indexed: 10/17/2023] Open
Abstract
Giant serpentine aneurysms are rare huge and partially thrombosed aneurysms, with an eccentric tortuous intra-aneurysmal vascular channel. Surgical treatment is often necessary due to the great mass effect. We describe a case of a left-handed woman with a giant serpentine aneurysm of the left middle cerebral artery whose management was complex. The challenge was to exclude the aneurysm from circulation, reduce the mass effect, and, mostly, preserve the language function. Since the patient was left-handed the language dominance needed to be assessed; functional MRI (fMRI) and Wada test (WT) showed a right dominance. Surgical treatment was performed, as a complication, the patient developed left fronto-basal ischemia with a slight paresis of the right hand but without any language deficit. Our case shows the importance of a multidisciplinary team in patient management, with a pivotal role of neuroradiological functional tests in presurgical planning.
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Affiliation(s)
- Andrea Romano
- NESMOS, Department of Neuroradiology, S.Andrea Hospital, University Sapienza, Rome, Italy
| | - Giulia Moltoni
- NESMOS, Department of Neuroradiology, S.Andrea Hospital, University Sapienza, Rome, Italy
| | - Amedeo Piazza
- NESMOS, Department of Neuroradiology, S.Andrea Hospital, University Sapienza, Rome, Italy
| | - Guido Trasimeni
- NESMOS, Department of Neuroradiology, S.Andrea Hospital, University Sapienza, Rome, Italy
| | - Massimo Miscusi
- NESMOS, Department of Neuroradiology, S.Andrea Hospital, University Sapienza, Rome, Italy
| | - Serena Palizzi
- NESMOS, Department of Neuroradiology, S.Andrea Hospital, University Sapienza, Rome, Italy
| | - Allegra Romano
- NESMOS, Department of Neuroradiology, S.Andrea Hospital, University Sapienza, Rome, Italy
| | - Antonino Raco
- NESMOS, Department of Neuroradiology, S.Andrea Hospital, University Sapienza, Rome, Italy
| | - Alessandro Bozzao
- NESMOS, Department of Neuroradiology, S.Andrea Hospital, University Sapienza, Rome, Italy
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Shin DS, Yeo DK, Choi EJ. Successive development of ischemic malignant strokes in a patient with multiple fusiform aneurysms: A case report. World J Clin Cases 2023; 11:7712-7717. [DOI: 10.12998/wjcc.v11.i31.7712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 09/21/2023] [Accepted: 10/26/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Intracranial fusiform aneurysms are rare, spindle-shaped, and nonsaccular arterial dilatations that may be caused by dissection.
CASE SUMMARY A 48-year-old man complained of wake-up onset of dysarthria and left-sided weakness. Diffusion-weighted magnetic resonance imaging of the brain revealed an infarction in the territories of the right middle and posterior cerebral arteries. Computed tomography angiography showed fusiform aneurysms in the right vertebral artery and bilateral petrous segments of the internal carotid arteries (ICAs). Despite conservative management, malignant ischemic stroke recurred in the contralateral ICA territory within a day of the onset of the index stroke.
CONCLUSION We report a rare case of successive malignant strokes in a patient with multiple fusiform aneurysms. Herein, we emphasize that clinicians should consider aggressive treatment for patients with ischemic stroke and multiple fusiform aneurysms.
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Affiliation(s)
- Dae-Seop Shin
- Department of Neurology, Soonchunhyang University Gumi Hospital, Gumi 39371, South Korea
| | - Dong Kyu Yeo
- Department of Neurosurgery, Soonchunhyang University Gumi Hospital, Gumi 39371, South Korea
| | - Eu Jene Choi
- Department of Neurology, Soonchunhyang University Gumi Hospital, Gumi 39371, South Korea
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Shibano A, Sakata J, Fujita A, Harada T, Okino R, Yamamoto D, Miyake S. Stent assisted coil embolization for a dissecting cerebral aneurysm of middle cerebral artery: A case report and the literature review. Surg Neurol Int 2023; 14:375. [PMID: 37941638 PMCID: PMC10629289 DOI: 10.25259/sni_619_2023] [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: 07/24/2023] [Accepted: 09/22/2023] [Indexed: 11/10/2023] Open
Abstract
Background Dissecting aneurysms of the middle cerebral artery (MCA) are very rare. We herein report a case of an unruptured dissecting aneurysm of the MCA treated by stent-assisted coil embolization. Case Description A 65-year-old man with no history of trauma presented with a headache. Time-of-flight imaging revealed a dissecting cerebral aneurysm in the right M1 segment of the MCA, and the aneurysm had increased in size within a short time. We treated the aneurysm by endovascular stenting with coils, and the patient developed no neurological deficits. Conclusion Because of the potential involvement of the lenticulostriate artery (LSA) in the area of dissection, choosing the best treatment (such as direct surgery or endovascular treatment) may be challenging. Treatment efficacy depends on whether the LSA is affected and on the length of the dissection. In our case, the dissection did not involve the LSA and could therefore be treated by stent-assisted coil embolization.
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Affiliation(s)
- Ayaka Shibano
- Department of Neurosurgery, Kita-Harima Medical Center, Ono, Japan
| | - Junichi Sakata
- Department of Neurosurgery, Kita-Harima Medical Center, Ono, Japan
| | - Atsushi Fujita
- Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tomoaki Harada
- Department of Neurosurgery, Kita-Harima Medical Center, Ono, Japan
| | - Reiichi Okino
- Department of Neurosurgery, Kita-Harima Medical Center, Ono, Japan
| | - Daisuke Yamamoto
- Department of Neurosurgery, Kita-Harima Medical Center, Ono, Japan
| | - Shigeru Miyake
- Department of Neurosurgery, Kita-Harima Medical Center, Ono, Japan
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Xia J, Peng F, Chen X, Yang F, Feng X, Niu H, Xu B, Liu X, Guo J, Zhong Y, Sui B, Ju Y, Kang S, Zhao X, Liu A, Zhao J. Statins may Decrease Aneurysm wall Enhancement of Unruptured Fusiform Intracranial Aneurysms: A high-resolution 3T MRI Study. Transl Stroke Res 2023:10.1007/s12975-023-01190-0. [PMID: 37673834 DOI: 10.1007/s12975-023-01190-0] [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: 08/10/2023] [Revised: 08/18/2023] [Accepted: 08/31/2023] [Indexed: 09/08/2023]
Abstract
Inflammation plays an integral role in the formation, growth, and progression to rupture of unruptured intracranial aneurysms. Aneurysm wall enhancement (AWE) in high-resolution magnetic resonance imaging (HR-MRI) has emerged as a surrogate biomarker of vessel wall inflammation and unruptured intracranial aneurysm instability. We investigated the correlation between anti-inflammatory drug use and three-dimensional AWE of fusiform intracranial aneurysms (FIAs). We retrospectively analyzed consecutive patients with FIAs in our database who underwent 3T HR-MRI at three Chinese centers. FIAs were classified as fusiform-type, dolichoectatic-type, or transitional-type. AWE was objectively defined using the aneurysm-to-pituitary stalk contrast ratio in three-dimensional space by determining the contrast ratio of the average signal intensity in the aneurysmal wall and pituitary stalk on post-contrast T1-weighted images. Data on aneurysm size, morphology, and location, as well as patient demographics and comorbidities, were collected. Univariate and multivariate logistic regression analyses were performed to determine factors independently associated with AWE of FIAs on HR-MRI. In total, 127 FIAs were included. In multivariate analysis, statin use (β = -0.236, P = 0.007) was the only independent factor significantly associated with decreased AWE. In the analysis of three FIA subtypes, the fusiform and transitional types were significantly associated with statin use (rs = -0.230, P = 0.035; and rs = -0.551, P = 0.010; respectively). It establishes an incidental correlation between the use of statins daily for ≥ 6 months and decreased AWE of FIAs. The findings also indicate that the pathophysiology may differ among the three FIA subtypes.
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Affiliation(s)
- Jiaxiang Xia
- Department of Neurosurgery, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Fei Peng
- Department of Neurosurgery, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xuge Chen
- Department of Neurosurgery, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Fan Yang
- Department of Neurosurgery, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xin Feng
- Neurosurgery Center, Department of Cerebrovascular Surgery, Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Hao Niu
- Department of Neurosurgery, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Boya Xu
- Department of Neurosurgery, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xinmin Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jiahuan Guo
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yao Zhong
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Binbin Sui
- Tiantan Neuroimaging Center of Excellence, National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yi Ju
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shuai Kang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
| | - Aihua Liu
- Department of Neurosurgery, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
| | - Jizong Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
- Center for Neurological Diseases, China National Clinical Research, Beijing, China.
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China.
- Beijing Translational Engineering Center for 3D Printer in Clinical Neuroscience, Beijing, China.
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Mizowaki T, Fujita A, Tanaka H, Takaishi Y, Kondoh T. Ruptured giant serpentine aneurysm of anterior cerebral artery long after Gamma Knife radiosurgery for cerebral arteriovenous malformation. Neurochirurgie 2023; 69:101447. [PMID: 37146509 DOI: 10.1016/j.neuchi.2023.101447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 04/18/2023] [Indexed: 05/07/2023]
Affiliation(s)
- Takashi Mizowaki
- Department of Neurosurgery, Shinsuma General Hospital, 3-1-14 Kinugake-cho, Suma-ku, 654-0048 Hyogo, Kobe, Japan.
| | - Atsushi Fujita
- Department of Neurosurgery, Kobe University Graduate School of Medicine, 7-5-2 Chuo-ku, Kusunoki-cho, 650-0017 Hyogo, Kobe, Japan
| | - Hirotomo Tanaka
- Department of Neurosurgery, Shinsuma General Hospital, 3-1-14 Kinugake-cho, Suma-ku, 654-0048 Hyogo, Kobe, Japan
| | - Yoshiyuki Takaishi
- Department of Neurosurgery, Shinsuma General Hospital, 3-1-14 Kinugake-cho, Suma-ku, 654-0048 Hyogo, Kobe, Japan
| | - Takeshi Kondoh
- Department of Neurosurgery, Shinsuma General Hospital, 3-1-14 Kinugake-cho, Suma-ku, 654-0048 Hyogo, Kobe, Japan
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Le K, Heskett C, De Stefano FA, Fry L, Lei C, Dharia A, Brake A, Chatley K, Peterson J, Ebersole K. An Analysis of Landmark Articles Regarding Aneurysms of the Middle Cerebral Artery. World Neurosurg 2023; 171:72-83. [PMID: 36473598 DOI: 10.1016/j.wneu.2022.11.135] [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: 10/18/2022] [Revised: 11/28/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Aneurysms located on the middle cerebral artery (MCA) range from 22% to 31.5% in prevalence of all aneurysms in the anterior cerebral circulation. This bibliometric analysis summarizes the most cited articles on MCA aneurysms and highlights the landmark publications that contributed to evidence-based practice. METHODS In the execution of this bibliometric-based review article, the Scopus database was used to perform a title-specific, keyword-based search for all publications until August 2022. The keyword "(middle cerebral artery OR MCA) AND aneurysm" was used. Our results were arranged in descending order based on the citation count of the article. The 100 most cited articles were selected for analysis. Parameters included the following: title, citation count, citations per year, authors, specialty of first author, institution, country of origin, publishing journal, Source Normalized Impact per Paper, and Hirsch index. RESULTS The keyword-based search showed that 1206 articles on MCA aneurysms were published up to August 2022. The top 100 articles were published between 1940 and 2019. The top 100 most cited articles collected a total of 6232 citations with an average of 62.3 citations per article. The rate of self-citations accounted for an average of 5.75% of the total number of citations. CONCLUSIONS The bibliometric analysis provides a quantitative overview of how medical literature and interventions are analyzed in academic medicine. In the present study, we evaluated the global trends in research regarding MCA aneurysms by finding the top 100 most cited articles.
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Affiliation(s)
- Kevin Le
- University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Cody Heskett
- University of Kansas School of Medicine, Kansas City, Kansas, USA.
| | - Frank A De Stefano
- Department of Neurological Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Lane Fry
- University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Catherine Lei
- University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Anand Dharia
- Department of Neurological Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Aaron Brake
- University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Kevin Chatley
- Department of Neurological Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Jeremy Peterson
- Department of Neurological Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Koji Ebersole
- Department of Neurological Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
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Peng F, Liu L, Niu H, Feng X, Zhang H, He X, Xia J, Xu B, Bai X, Li Z, Sui B, Liu A. Comparisons between cross-section and long-axis-section in the quantification of aneurysmal wall enhancement of fusiform intracranial aneurysms in identifying aneurysmal symptoms. Front Neurol 2022; 13:945526. [PMID: 35959406 PMCID: PMC9361002 DOI: 10.3389/fneur.2022.945526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 06/27/2022] [Indexed: 11/21/2022] Open
Abstract
Background To investigate the quantification of aneurysmal wall enhancement (AWE) in fusiform intracranial aneurysms (FIAs) and to compare AWE parameters based on different sections of FIAs in identifying aneurysm symptoms. Methods Consecutive patients were prospectively recruited from February 2017 to November 2019. Aneurysm-related symptoms were defined as sentinel headache and oculomotor nerve palsy. All patients underwent high resolution magnetic resonance imaging (HR-MRI) protocol, including both pre and post-contrast imaging. CRstalk (signal intensity of FIAs' wall divided by pituitary infundibulum) was evaluated both in the cross-section (CRstalk−cross) and the long-axis section (CRstalk−long) of FIAs. Aneurysm characteristics include the maximal diameter of the cross-section (Dmax), the maximal length of the long-axis section (Lmax), location, type, and mural thrombus. The performance of parameters for differentiating symptomatic and asymptomatic FIAs was obtained and compared by a receiver operating characteristic (ROC) curve. Results Forty-three FIAs were found in 43 patients. Eighteen (41.9%) patients who presented with aneurysmal symptoms were classified in the symptomatic group. In univariate analysis, male sex (P = 0.133), age (P = 0.013), FIAs type (P = 0.167), mural thrombus (P = 0.130), Lmax (P = 0.066), CRstalk−cross (P = 0.027), and CRstalk−long (P = 0.055) tended to be associated with aneurysmal symptoms. In the cross-section model of multivariate analysis, male (P = 0.038), age (P = 0.018), and CRstalk−cross (P = 0.048) were independently associated with aneurysmal symptoms. In the long-axis section model of multivariate analysis, male (P = 0.040), age (P = 0.010), CRstalk−long (P = 0.046), and Lmax (P = 0.019) were independently associated with aneurysmal symptoms. In the combination model of multivariate analysis, male (P = 0.027), age (P = 0.011), CRstalk−cross (P = 0.030), and Lmax (P = 0.020) were independently associated with aneurysmal symptoms. CRstalk−cross has the highest accuracy in predicting aneurysmal symptoms (AUC = 0.701). The combination of CRstalk−cross and Lmax exhibited the highest performance in discriminating symptomatic from asymptomatic FIAs (AUC = 0.780). Conclusion Aneurysmal wall enhancement is associated with symptomatic FIAs. CRstalk−cross and Lmax were independent risk factors for aneurysmal symptoms. The combination of these two factors may improve the predictive performance of aneurysmal symptoms and may also help to stratify the instability of FIAs in future studies.
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Affiliation(s)
- Fei Peng
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Lang Liu
- Department of Neurosurgery, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Hao Niu
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xin Feng
- Neurosurgery Center, Department of Cerebrovascular Surgery, Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Hong Zhang
- Operating Room, Heze Municipal Hospital, Heze, China
| | - Xiaoxin He
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jiaxiang Xia
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Boya Xu
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiaoyan Bai
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhiye Li
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Binbin Sui
- Tiantan Neuroimaging Center of Excellence, China National Clinical Research Center for Neurological Diseases, Beijing, China
- *Correspondence: Binbin Sui
| | - Aihua Liu
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Neurosurgery, The Third Xiangya Hospital, Central South University, Changsha, China
- Aihua Liu
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Peng F, Fu M, Xia J, Niu H, Liu L, Feng X, Xu P, Bai X, Li Z, Chen J, Tong X, He X, Xu B, Chen X, Liu H, Sui B, Duan Y, Li R, Liu A. Quantification of aneurysm wall enhancement in intracranial fusiform aneurysms and related predictors based on high-resolution magnetic resonance imaging: a validation study. Ther Adv Neurol Disord 2022; 15:17562864221105342. [PMID: 35847373 PMCID: PMC9280813 DOI: 10.1177/17562864221105342] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 05/18/2022] [Indexed: 11/18/2022] Open
Abstract
Background: Aneurysm wall enhancement (AWE) in high-resolution magnetic resonance imaging (HR-MRI) has emerged as a new imaging biomarker of intracranial aneurysm instability. Objective: To determine a standard method of AWE quantification for predicting fusiform intracranial aneurysms (FIAs) stability by comparing the sensitivity of each parameter in identifying symptomatic FIAs. The predictors of AWE and FIA types were also identified. Methods: We retrospectively analyzed consecutive fusiform aneurysm patients who underwent HR-MRI from two centers. The aneurysm-to-pituitary stalk contrast ratio (CRstalk), aneurysm enhancement ratio, and aneurysm enhancement index were extracted, and their sensitivities in discriminating aneurysm symptoms were compared using the receiver-operating characteristic curve. Morphological parameters of fusiform aneurysm were extracted based on 3D vessel model. Uni- and multivariate analyses of related predictors for AWE, CRstalk, and FIA types were performed, respectively. Results: Overall, 117 patients (mean age, 53.3 ± 11.7 years; male, 75.2%) with 117 FIAs underwent HR-MRI were included. CRstalk with the maximum signal intensity (CRstalk-max) had the highest sensitivity in identifying symptomatic FIAs with an area under the curve value (0.697) and a cut-off value of 0.90. The independent predictors of AWE were aneurysm symptoms [(odds ratio) OR = 3.754, p = 0.003], aspirin use (OR = 0.248, p = 0.037), and the maximum diameter of the cross-section (OR = 1.171, p = 0.043). The independent predictors of CRstalk-max were aneurysm symptoms (OR = 1.289, p = 0.003) and posterior circulation aneurysm (OR = 1.314, p = 0.001). Transitional-type showed higher rates of hypertension and mural thrombus over both dolichoectatic- and fusiform-type FIAs. Conclusion: CRstalk-max may be the most reliable parameter to quantify AWE to distinguish symptomatic FIAs. It also has the potential to identify unstable FIAs. Several factors contribute to the complex pathophysiology of FIAs and need further validation in a larger cohort.
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Affiliation(s)
- Fei Peng
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Mingzhu Fu
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University, Beijing, China
| | - Jiaxiang Xia
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Hao Niu
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Lang Liu
- Department of Neurosurgery, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Xin Feng
- Neurosurgery Center, Department of Cerebrovascular Surgery, Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Peng Xu
- Department of Neurosurgery, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
| | - Xiaoyan Bai
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhiye Li
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jigang Chen
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Xin Tong
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Xiaoxin He
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Boya Xu
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Xuge Chen
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Hongyi Liu
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Binbin Sui
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yonghong Duan
- Department of Neurosurgery, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
| | - Rui Li
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University, Beijing, China
| | - Aihua Liu
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, No. 119, South 4th Ring West Road, Fengtai District, Beijing 100070, China
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11
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Saalfeld S, Stahl J, Korte J, Miller Marsh LM, Preim B, Beuing O, Cherednychenko Y, Behme D, Berg P. Can Endovascular Treatment of Fusiform Intracranial Aneurysms Restore the Healthy Hemodynamic Environment?–A Virtual Pilot Study. Front Neurol 2022; 12:771694. [PMID: 35140672 PMCID: PMC8818669 DOI: 10.3389/fneur.2021.771694] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 12/08/2021] [Indexed: 11/13/2022] Open
Abstract
Numerous studies assess intracranial aneurysm rupture risk based on morphological and hemodynamic parameter analysis in addition to clinical information such as aneurysm localization, age, and sex. However, intracranial aneurysms mostly occur with a saccular shape located either lateral to the parent artery or at a bifurcation. In contrast, fusiform intracranial aneurysms (FIAs), i.e., aneurysms with a non-saccular, dilated form, occur in approximately 3–13% of all cases and therefore have not yet been as thoroughly studied. To improve the understanding of FIA hemodynamics, this pilot study contains morphological analyses and image-based blood flow simulations in three patient-specific cases. For a precise and realistic comparison to the pre-pathological state, each dilation was manually removed and the time-dependent blood flow simulations were repeated. Additionally, a validated fast virtual stenting approach was applied to evaluate the effect of virtual endovascular flow-diverter deployment focusing on relevant hemodynamic quantities. For two of the three patients, post-interventional information was available and included in the analysis. The results of this numerical pilot study indicate that complex flow structures, i.e., helical flow phenomena and the presence of high oscillating flow features, predominantly occur in FIAs with morphologically differing appearances. Due to the investigation of the individual healthy states, the original flow environment could be restored which serves as a reference for the virtual treatment target. It was shown that the realistic deployment led to a considerable stabilization of the individual hemodynamics in all cases. Furthermore, a quantification of the stent-induced therapy effect became feasible for the treating physician. The results of the morphological and hemodynamic analyses in this pilot study show that virtual stenting can be used in FIAs to quantify the effect of the planned endovascular treatment.
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Affiliation(s)
- Sylvia Saalfeld
- Research Campus STIMULATE, University of Magdeburg, Magdeburg, Germany
- Department of Simulation and Graphics, University of Magdeburg, Magdeburg, Germany
- *Correspondence: Sylvia Saalfeld
| | - Janneck Stahl
- Research Campus STIMULATE, University of Magdeburg, Magdeburg, Germany
- Department of Fluid Dynamics and Technical Flows, University of Magdeburg, Magdeburg, Germany
| | - Jana Korte
- Research Campus STIMULATE, University of Magdeburg, Magdeburg, Germany
- Department of Simulation and Graphics, University of Magdeburg, Magdeburg, Germany
| | - Laurel Morgan Miller Marsh
- Research Campus STIMULATE, University of Magdeburg, Magdeburg, Germany
- Department of Fluid Dynamics and Technical Flows, University of Magdeburg, Magdeburg, Germany
- Department of Mechanical Engineering, University of Washington, Seattle, WA, United States
| | - Bernhard Preim
- Department of Simulation and Graphics, University of Magdeburg, Magdeburg, Germany
| | - Oliver Beuing
- Department of Radiology, AMEOS Hospital Bernburg, Bernburg, Germany
| | - Yurii Cherednychenko
- Endovascular Centre, Dnipropetrovsk Regional Clinical Hospital named after I.I. Mechnikov, Dnipro, Ukraine
| | - Daniel Behme
- Research Campus STIMULATE, University of Magdeburg, Magdeburg, Germany
- Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany
| | - Philipp Berg
- Research Campus STIMULATE, University of Magdeburg, Magdeburg, Germany
- Department of Fluid Dynamics and Technical Flows, University of Magdeburg, Magdeburg, Germany
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12
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Tsunoda S, Inoue T. Microsurgical Treatment Strategy of Vertebral Artery Fusiform Aneurysm-From the Standpoint of Hemodynamic Integrity and Perforator Preservation. Front Neurol 2021; 12:728176. [PMID: 34616354 PMCID: PMC8488355 DOI: 10.3389/fneur.2021.728176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 08/10/2021] [Indexed: 11/13/2022] Open
Abstract
During treatment of vertebral artery (VA) fusiform aneurysms, it is critical to preserve peripheral perforators and anterograde blood flow of the VA and to reduce hemodynamic load to the contralateral VA. Even in the era of endovascular treatment, there are still many benefits to using microsurgical treatments with appropriate clip application and preservation of the perforators around the aneurysm, in conjunction with various bypass techniques. The ideal microsurgical technique involves reconstructive clipping that obliterates the aneurysm but preserves anterograde blood flow of the VA, followed by isolation of the aneurysm and VA reconstruction. If these two methods are unavailable, proximal clipping of the aneurysm combined with flow-augmentation bypass to the distal branch can be considered as an alternative surgical management. We discuss the microsurgical treatment of unruptured VA fusiform aneurysms in our surgical cases on the basis of a review of the current literature.
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Affiliation(s)
- Sho Tsunoda
- Department of Neurosurgery, NTT Medical Center Tokyo, Tokyo, Japan
| | - Tomohiro Inoue
- Department of Neurosurgery, NTT Medical Center Tokyo, Tokyo, Japan
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13
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Khan NR, Chen SH, Morcos JJ. Microsurgical Clipping and Bypass for Fusiform Middle Cerebral Artery Aneurysm: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2021; 21:E445-E446. [PMID: 34382091 DOI: 10.1093/ons/opab281] [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: 12/04/2020] [Accepted: 06/16/2021] [Indexed: 11/13/2022] Open
Abstract
Fusiform middle cerebral artery (MCA) aneurysms that require treatment can often necessitate complex endovascular or microsurgical treatment. We present a case of a 25-yr-old female with an incidentally discovered left 14-mm fusiform MCA aneurysm incorporating the frontal MCA trunk origin in its dome. The location and anatomy were not favorable for endovascular treatment with flow diversion. The patient was offered continued observation or microsurgical treatment. Direct clipping of this aneurysm was not possible. After a thorough discussion of the risks, benefits, indications, and natural history of the lesion, the patient desired to have the aneurysm treated given her young age, location, size of the aneurysm, and the significant clinical experience of the treating team in bypass surgery. The patient underwent superficial temporal artery to frontal M2 (STA-FM2) direct bypass for flow replacement followed by microsurgical trapping and clip ligation. The patient was maintained on antiplatelet therapy preoperatively and postoperatively. The patient had a transient aphasia and mild right upper extremity weakness (4/5) in the immediate postoperative period, which fully recovered by the time of patient discharge. The case presentation, surgical anatomy, technique, and postoperative course and outcome are reviewed. The different strategies for bypass and clip ligation are reviewed with particular focus on the anatomic constraints for each bypass configuration. The outcomes of bypass surgery for MCA aneurysms are reviewed.1-7 The patient gave verbal consent for participating in the procedure, surgical video, and publication of their image.
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Affiliation(s)
- Nickalus R Khan
- Department of Neurosurgery, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Stephanie H Chen
- Department of Neurosurgery, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Jacques J Morcos
- Department of Neurosurgery, Miller School of Medicine, University of Miami, Miami, Florida, USA
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14
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Guo Y, Song Y, Hou K, Yu J. Intracranial Fusiform and Circumferential Aneurysms of the Main Trunk: Therapeutic Dilemmas and Prospects. Front Neurol 2021; 12:679134. [PMID: 34305790 PMCID: PMC8299836 DOI: 10.3389/fneur.2021.679134] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 06/08/2021] [Indexed: 11/16/2022] Open
Abstract
Intracranial fusiform and circumferential aneurysms (IFCAs), especially those located on the main trunk, are uncommon and difficult to manage. Currently, literature focused on IFCAs on the main trunk of cerebral arteries is lacking. The treatment of IFCAs is still under debate. Therefore, in this review, we further explore the treatment of this complicated entity. In addition, we also present some interesting cases. Based on the literature review and our experience, we found that IFCAs are often located in the vertebrobasilar system and that ruptured or large symptomatic IFCAs are associated with increased mortality and higher rebleeding rates. The treatment strategies for IFCAs can be classified as deconstructive and reconstructive methods via open surgery and/or endovascular treatment (EVT). Currently, EVT is a popular method and the main therapeutic choice. In particular, flow diversion has revolutionized the treatment of IFCAs. Parent artery occlusion (PAO) with or without revascularization may still be considered a suitable choice. Complex IFCAs that cannot be resolved by EVT can also be treated via open surgery with or without extracranial–intracranial bypass. Targeted embolization for the weak points of IFCAs is a temporary or palliative choice that is rarely used. In summary, despite complications, both surgical treatment and EVT are effective options for appropriately selected cases. Due to the development of endovascular implants, EVT will have better prospects in the future.
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Affiliation(s)
- Yunbao Guo
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
| | - Ying Song
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
| | - Kun Hou
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
| | - Jinlu Yu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
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15
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Anagnostakou V, Ughi GJ, Puri AS, Gounis MJ. Optical Coherence Tomography for Neurovascular Disorders. Neuroscience 2021; 474:134-144. [PMID: 34126186 DOI: 10.1016/j.neuroscience.2021.06.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 06/03/2021] [Accepted: 06/06/2021] [Indexed: 11/26/2022]
Abstract
Diagnosis of cerebrovascular disease includes vascular neuroimaging techniques such as computed tomography (CT) angiography, magnetic resonance (MR) angiography (with or without use of contrast agents) and catheter digital subtraction angiography (DSA). These techniques provide mostly information about the vessel lumen. Vessel wall imaging with MR seeks to characterize cerebrovascular pathology, but with resolution that is often insufficient for small lesions. Intravascular imaging techniques such as ultrasound and optical coherence tomography (OCT), used for over a decade in the peripheral circulation, is not amendable to routine deployment in the intracranial circulation due to vessel caliber and tortuosity. However, advances in OCT technology including the probe profile, stiffness and unique distal rotation solution, holds the promise for eventual translation of OCT into the clinical arena. As such, it is apropos to review this technology and present the rationale for utilization of OCT in the cerebrovasculature.
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Affiliation(s)
- Vania Anagnostakou
- University of Massachusetts Medical School, Radiology, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, United States
| | - Giovanni J Ughi
- University of Massachusetts Medical School, Radiology, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, United States
| | - Ajit S Puri
- University of Massachusetts Medical School, Radiology, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, United States
| | - Matthew J Gounis
- University of Massachusetts Medical School, Radiology, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, United States.
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16
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A case report on dissecting giant middle cerebral artery aneurysm in a six years old patient: Combined approach. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2020.101027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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17
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Jung HN, Suh SI, Ryoo I, Kim I. Usefulness of 3D High-resolution Vessel Wall MRI in Diffuse Nonaneurysmal SAH Patients. Clin Neuroradiol 2021; 31:1071-1081. [PMID: 33974086 DOI: 10.1007/s00062-021-01018-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 04/11/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE In 15-20% of patients with nontraumatic diffuse subarachnoid hemorrhage (SAH), the initial conventional angiography does not reveal a causative vascular abnormality, such as intracranial aneurysm. In this study, we evaluated clinical utility of 3D high-resolution vessel wall magnetic resonance imaging (HR-VWI) in patients with diffuse nonaneurysmal SAH. METHODS A total of 17 patients with diffuse nonaneurysmal SAH were included in this retrospective study. We characterized demographics and HR-VWI findings and reviewed the clinical management and outcomes. RESULTS Of the patients 14 (14/17; 82.4%,) showed abnormal findings on HR-VWI, including 5 with intracranial dissections (29.4%), 3 with blood blister-like aneurysm (17.6%), 1 with ruptured fusiform aneurysm (5.9%), and 5 with focal nodular wall enhancement without unclassified pathology (29.4%). Of these patients were treated with endovascular management. Most patients (16/17) had a favorable modified Rankin scale scores of 0-2 on discharge. CONCLUSION The 3D HR-VWI revealed various hidden pathologies, such as intracranial arterial dissection, blood blister-like aneurysm, and fusiform aneurysm in patients with diffuse nonaneurysmal SAH. In addition, 3D HR-VWI had an impact on the management of SAH. The 3D HR-VWI can be a complementary diagnostic method for patients with diffuse nonaneurysmal SAH in a research or clinical setting.
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Affiliation(s)
- Hye Na Jung
- Department of Radiology, Guro Hospital, Korea University College of Medicine, 148 Guro-dong, 08308, Guro-gu, Seoul, Korea (Republic of)
| | - Sang-Il Suh
- Department of Radiology, Guro Hospital, Korea University College of Medicine, 148 Guro-dong, 08308, Guro-gu, Seoul, Korea (Republic of).
| | - Inseon Ryoo
- Department of Radiology, Guro Hospital, Korea University College of Medicine, 148 Guro-dong, 08308, Guro-gu, Seoul, Korea (Republic of)
| | - InSeong Kim
- Siemens Healthineers Ltd., Seoul, Korea (Republic of)
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18
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Ko HC, Lee SH, Shin HS, Koh JS. Treatment for Hemifacial Spasm Associated with a Dissecting Vertebral Artery Aneurysm Requiring Microvascular Decompression in Addition to Endovascular Trapping: A Case Report with Literature Review. J Neurol Surg A Cent Eur Neurosurg 2021; 83:377-382. [PMID: 33690877 DOI: 10.1055/s-0040-1721681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND The treatment protocol for hemifacial spasm (HFS) associated with dissecting vertebral artery aneurysm (DVAA) has not been established. CASE DESCRIPTION A-42-year-old man with left HFS underwent endovascular trapping for a DVAA that was identified on brain imaging. Although the dissecting segment was treated successfully, the HFS persisted for 3 months, and subsequently microvascular decompression (MVD) was needed. The posteroinferior cerebellar artery (PICA) was found to be interposed between the root exit zone of the facial nerve and DVAA during surgery. After pulling out the PICA, the HFS ceased immediately. CONCLUSION HFS associated with DVAA should be considered carefully before formulating a treatment strategy. Moreover, the cause of pulsatile compression may not be visible on brain imaging, and MVD surgery may be indicated in such cases.
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Affiliation(s)
- Hak-Cheol Ko
- Department of Neurosurgery, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Seung Hwan Lee
- Department of Neurosurgery, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Hee Sup Shin
- Department of Neurosurgery, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Jun Seok Koh
- Department of Neurosurgery, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
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19
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Borota L, Nyberg C, Lenell S, Semnic R, Mahmoud E. Endovascular treatment of type 1 and type 4 non-saccular aneurysms of cerebral arteries - a single-Centre experience. Interv Neuroradiol 2021; 27:372-387. [PMID: 33467952 DOI: 10.1177/1591019920988204] [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: 11/16/2022] Open
Abstract
AIM OF THE STUDY The aim of this study was to evaluate our results regarding treatment options, complications, and outcomes in patients with non-saccular aneurysms of cerebral arteries belonging to type 1 and type 4 according to Mizutani's classification. METHODS A total of 26 aneurysms in 26 patients were treated between 2014 and 2019. There were 13 males (mean age 42.77 ± 11.73 years) and 13 females (mean age 50.84 ± 9.37 years). In 23 cases the onset was haemorrhagic and in three cases non-haemorrhagic. A combination of conventional stents and coils was used in 10 cases, conventional stents and flow diverters in three cases, flow diverters and coils in five cases, and flow diverters only were used in eight cases. Radiological results of treatment were assessed after eight months and clinical after one year. RESULTS In 24 patients, aneurysms were occluded at the end of the follow-up period. An iatrogenic dissection and two haemorrhagic complications were registered. In three cases, parent arteries were occluded due to re-growth of the aneurysm, which caused middle cerebral artery infarction in one case. A favourable clinical outcome was registered in 19, patients, and non-favourable in five. Two patients died in the early postoperative period due to extensive damage to the brain parenchyma caused by initial bleeding. CONCLUSION Our results indicate that treatment of type 1 and type 4 non-saccular aneurysms with various combination of stents and flow diverters, with or without coils, is promising, although very challenging and technically demanding.
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Affiliation(s)
- Ljubisa Borota
- Department of Surgical Sciences, University Hospital, Uppsala, Sweden
| | | | - Samuel Lenell
- Department of Surgical Sciences, University Hospital, Uppsala, Sweden
| | - Robert Semnic
- Department of Surgical Sciences, University Hospital, Uppsala, Sweden
| | - Ehab Mahmoud
- Department of Surgical Sciences, University Hospital, Uppsala, Sweden
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20
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Distal middle cerebral artery dissection with concurrent completely thrombosed aneurysm manifesting as cerebral ischemia. A case report and review of the literature. Radiol Case Rep 2020; 15:2582-2588. [PMID: 33082902 PMCID: PMC7552809 DOI: 10.1016/j.radcr.2020.09.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/21/2020] [Accepted: 09/25/2020] [Indexed: 11/22/2022] Open
Abstract
We report the case of a 70-year-old woman who presented with an acute ischemic stroke involving the left frontal operculum secondary to an M2 dissection and a concomitant completely thrombosed aneurysm of the left distal middle cerebral artery. Initial imaging work-up was inconclusive due to the lack of typical radiographic features and only repeated imaging studies pointed towards the presence of an arterial dissection combined with a completely thrombosed aneurysm. The aneurysm was partially clipped and wrapped with excellent clinical result at 1-year follow-up. The clinical, imaging and therapeutic challenges of this rare entity are discussed.
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21
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Telles JPM, Solla DJF, Yamaki VN, Rabelo NN, da Silva SA, Caldas JGP, Teixeira MJ, Junior JR, Figueiredo EG. Comparison of surgical and endovascular treatments for fusiform intracranial aneurysms: systematic review and individual patient data meta-analysis. Neurosurg Rev 2020; 44:2405-2414. [PMID: 33205313 DOI: 10.1007/s10143-020-01440-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 10/14/2020] [Accepted: 11/12/2020] [Indexed: 12/29/2022]
Abstract
Fusiform intracranial aneurysms (FIA) are associated with significant morbidity and mortality. We carried out a systematic review and meta-analysis of individual participant data with propensity score adjustment to compare the functional and angiographic outcomes between surgical and endovascular approaches to FIA. We conducted a systematic review for articles on the treatment of FIA with individual patient-level detailing. Data from patients treated for FIA in our institution from 2010 to 2018 were also collected. The primary studied outcome was morbidity, and secondary outcomes were angiographic results and retreatment. Propensity score-adjusted mixed-effects logistic regression models evaluated treatment options, stratified by anatomical location. Compiling original and published data, there were 312 cases, of which 79 (25.3%) had open surgery, and 233 (74.5%) were treated with endovascular procedures. There were no differences between treatment groups, for neither cavernous ICA (OR 1.04, 95% CI 0.05-23.6) nor supraclinoid aneurysms (OR 7.82, 95% CI 0.65-94.4). Both size (OR 1.11, 95% CI 1.03-1.19) and initial mRS (OR 2.0, 95% CI 1.2-3.3) were risk factors for morbidity, independent of location. Neither age nor rupture status influenced the odds of posterior morbidity. Unfavorable angiographic outcomes were more common in the endovascular group for supraclinoid and vertebrobasilar aneurysms (χ2, P < 0.01). There were no differences between morbidity of surgical and endovascular treatments for FIA, regardless of aneurysm location. Size and initial mRS were correlated with functional outcomes, whereas age and rupture status were not. Microsurgery seems to yield better long-term angiographic results compared to endovascular procedures.
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Affiliation(s)
- João Paulo Mota Telles
- Department of Neurology, Division of Neurosurgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
| | - Davi Jorge Fontoura Solla
- Department of Neurology, Division of Neurosurgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Department of Interventional Neuroradiology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Vitor Nagai Yamaki
- Department of Neurology, Division of Neurosurgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Nicollas Nunes Rabelo
- Department of Neurology, Division of Neurosurgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Saul Almeida da Silva
- Department of Neurology, Division of Neurosurgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Department of Interventional Neuroradiology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - José Guilherme Pereira Caldas
- Department of Interventional Neuroradiology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Manoel Jacobsen Teixeira
- Department of Neurology, Division of Neurosurgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Jefferson Rosi Junior
- Department of Neurology, Division of Neurosurgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Eberval Gadelha Figueiredo
- Department of Neurology, Division of Neurosurgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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22
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Seo D, Lee SU, Oh CW, Kwon OK, Ban SP, Kim T, Byoun HS, Kim YD, Lee Y, Won YD, Bang JS. Characteristics and Clinical Course of Fusiform Middle Cerebral Artery Aneurysms According to Location, Size, and Configuration. J Korean Neurosurg Soc 2019; 62:649-660. [PMID: 31591999 PMCID: PMC6835147 DOI: 10.3340/jkns.2019.0132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 07/26/2019] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To analyze the angiographic features and clinical course, including treatment outcomes and the natural course, of fusiform middle cerebral artery aneurysms (FMCAAs) according to their location, size, and configuration. METHODS We reviewed the literature on adult cases of FMCAAs published from 1980 to 2018; from 25 papers, 112 FMCAA cases, for which the location, size, and configuration could be identified, were included in this study. Additionally, 33 FMCAA cases in our hospital were included, from which 16 were assigned to the observation group. Thus, a total of 145 adult FMCAA cases were included. We classified the FMCAAs according to their location (l-type 1, beginning from prebifurcation; l-type 2, beginning from bifurcation; l-type 3, beginning from postbifurcation), size (small, <10 mm; large, ≥10 mm; giant, ≥25 mm), and configuration (c-type 1, classic dissecting aneurysm; c-type 2, segmental ectasia; c-type 3, dolichoectatic dissecting aneurysm). RESULTS The c-type 3 was more commonly diagnosed with ischemic symptoms (31.8%) than hemorrhage (13.6%), while 40.9% were found accidentally. In contrast, c-type 2 was more commonly diagnosed with hemorrhagic symptoms (14.9%) than ischemic symptoms (10.6%), and 72.3% were accidentally discovered. According to location, ischemic symptoms and hemorrhage were the most frequent symptoms in l-type 1 (28.6%) and l-type 3 (34.6%), respectively. Most of l-type 2 FMCAAs were found incidentally (68.4%). Based on the size of FMCAAs, only 11.1% of small aneurysms were found to be hemorrhagic, while 18.9% and 26.0% of large and giant aneurysms were hemorrhagic, respectively. Although four aneurysms of the 16 FMCAAs in the observation group increased in size and one aneurysm decreased in size during the observation period, no rupture was seen in any case and there were no significant predictors of aneurysm enlargement. Of 104 FMCAAs treated, 14 cases (13.5%) were aggravated than before surgery and all the aggravated cases were l-type 1. CONCLUSION While ischemic symptoms occurred more frequently in l-type 1 and c-type 3, hemorrhagic rather than ischemic symptoms occurred more frequently in l-type 3 and c-type 2. In case of l-type 1 FMCAAs, more caution is required in determining the treatment due to the relatively high complication rate.
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Affiliation(s)
- Dongwook Seo
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Si Un Lee
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Chang Wan Oh
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - O-Ki Kwon
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Seung Pil Ban
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Tackeun Kim
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Hyoung Soo Byoun
- Department of Neurosurgery, Chungnam National University Hospital, Daejeon, Korea
| | - Young Deok Kim
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Yongjae Lee
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Yu Deok Won
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jae Seung Bang
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Barletta EA, Gaspar RHML, Araújo JFM, Neves MWF, de Aquino JLB, Belsuzarri TAB. Nonsaccular aneurysms: A wide comparison between the four main types. Surg Neurol Int 2019; 10:30. [PMID: 31528368 PMCID: PMC6499464 DOI: 10.4103/sni.sni_138_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 08/20/2018] [Indexed: 11/24/2022] Open
Abstract
Background: The present study aims to present the most important considerations when it comes to patients features, clinical presentation, localization, morphology, pathogenesis, and the best treatment for each type of the nonsaccular aneurysms. Methods: We performed a literature review using PubMed. The search was limited to the studies published in English, from 2010 to 2017. Results: Data about the clinical presentation; the aneurysm pathogenesis, morphology, and localization; the patient features; and about the surgical or endovascular approach were analyzed for the four types of nonsaccular aneurysms presented. Conclusion: All types of nonsaccular aneurysms have a higher prevalence in young adults. Men are more affected by fusiform and mycotic aneurysms while women suffer more with blister-like aneurysms (BLAs). The mycotic and the BLAs affect more the anterior circulation while the fusiform affects more the posterior circulation. Mycotic and blister-like has as its major complication and clinical presentation the hemorrhage; however, the fusiform aneurysms usually present ischemia and/or mass effect. The reconstructive endovascular techniques for all types of nonsaccular aneurysms presented as the treatment with the best outcomes. Among this technique, the flow diversion presented good results in all types of aneurysms and it seems to promote the best outcomes.
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Affiliation(s)
| | | | | | | | | | - Telmo Augusto Barba Belsuzarri
- Medicine Student from Pontifical Catholic University of Campinas, Campinas, SP, Brazil.,Neurosurgery Department from Pontifical Catholic University of Campinas, Campinas, SP, Brazil.,Post-Graduation Department at Pontifical Catholic University of Campinas, Campinas, SP, Brazil
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24
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Barletta EA, Ricci RL, Silva RDG, Gaspar RHML, Araújo JFM, Neves MWF, de Aquino JLB, Barba Belsuzarri TA. Fusiform aneurysms: A review from its pathogenesis to treatment options. Surg Neurol Int 2018; 9:189. [PMID: 30294493 PMCID: PMC6169346 DOI: 10.4103/sni.sni_133_18] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 08/09/2018] [Indexed: 12/23/2022] Open
Abstract
Background This study aims to present the most important considerations when it comes to patients features, clinical presentation, localization, and morphology of the aneurysm and the treatments outcomes of the fusiform aneurysms. Methods We performed a literature review using PubMed. The search was limited to the studies published in English, from 2003 to 2017. Results The studies analyzed that showed data about the patient features, clinical presentation, the aneurysm localization, morphology, and pathogenesis didn't present much divergence. The surgical and the endovascular approach showed similar treatments outcomes. The reconstructive techniques seem to be safer than the deconstructive. The flow diversion is a technique that showed great results. Conclusion Most of the patients are men, younger than 50 years old, pediatric patients are the most affected. Surgical procedures still have an important place in this field. Reconstructive and deconstructive techniques are both effective; the reconstructive techniques are possibly safer than deconstructive techniques. The most important feature of an aneurysm to predict a bad prognose is to determine if the aneurysm is ruptured. The reconstructive EVT accompanied by dual antiplatelet after and before the procedure showed the best results to treat the basilar fusiform aneurysms. Deconstructive treatment including posterior inferior cerebellar artery occlusion should be considered.
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Affiliation(s)
| | | | | | | | | | | | | | - Telmo Augusto Barba Belsuzarri
- Department of Neurosurgery from Pontifical Catholic University of Campinas, Brazil.,Post Graduation at the State Server Hospital (IAMSPE), Brazil.,Post Graduation Program, Masters in Health Sciences, Pontifical Catholic University of Campinas, Brazil
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25
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Shekhtman OD, Gorozhanin VA, Kulikov AS, Okisheva EA. [Proximal clipping of a large fusiform aneurysm of the A2 segment of the left anterior cerebral artery with awakening of the patient (a case report and literature review)]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2018; 82:97-102. [PMID: 30137043 DOI: 10.17116/neiro201882497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Arterial aneurysms of the A2 segment are very rare (<1%) peripheral aneurysms of the anterior cerebral artery (ACA) territory. Usually, these are saccular aneurysms; there are single reports of fusiform aneurysms of this location. Surgical treatment of these aneurysms involves both microsurgical and endovascular interventions. In the presented case, we used deconstructive surgery (proximal clipping of the aneurysm) with intraoperative awakening of the patient, which verified sufficient collateral blood flow. In the case of focal deficit development, we planned to simultaneously perform an interarterial anastomosis between the A3 segments of the right and left ACAs.
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Affiliation(s)
| | | | - A S Kulikov
- Burdenko Neurosurgical Institute, Moscow, Russia
| | - E A Okisheva
- Sechenov First Moscow State Medical University, Moscow, Russia
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26
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Growth of Asymptomatic Intracranial Fusiform Aneurysms. Clin Neuroradiol 2018; 29:717-723. [DOI: 10.1007/s00062-018-0695-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Accepted: 04/26/2018] [Indexed: 10/16/2022]
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27
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Xu F, Xu B, Huang L, Xiong J, Gu Y, Lawton MT. Surgical Treatment of Large or Giant Fusiform Middle Cerebral Artery Aneurysms: A Case Series. World Neurosurg 2018; 115:e252-e262. [PMID: 29660547 DOI: 10.1016/j.wneu.2018.04.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 04/04/2018] [Accepted: 04/05/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Management of large or giant fusiform middle cerebral artery (MCA) aneurysms represents a significant challenge. OBJECTIVE To describe the authors' experience in the treatment of large or giant fusiform MCA aneurysm by using various surgical techniques. METHODS We retrospectively reviewed a database of aneurysms treated at our division between 2015 and 2017. RESULTS Overall, 20 patients (11 males, 9 females) were identified, with a mean age of 40.7 years (range, 13-65 years; median, 43 years). Six patients (30%) had ruptured aneurysms and 14 (70%) had unruptured aneurysms. The mean aneurysm size was 19 mm (range, 10-35 mm). The aneurysms involved the prebifurcation in 5 cases, bifurcation in 4 cases, and postbifurcation in 11 cases. The aneurysms were treated by clip reconstruction (n = 5), clip wrapping (n = 1), proximal occlusion or trapping (n = 4), and bypass revascularization (n = 10). Bypasses included 7 low-flow superficial temporal artery-MCA bypasses, 2 high-flow extracranial-intracranial bypasses, and 1 intracranial-intracranial bypass (reanastomosis). Bypass patency was 90%. Nineteen aneurysms (95%) were completely obliterated, and no rehemorrhage occurred during follow-up. There was no procedural-related mortality. Clinical outcomes were good (modified Rankin Scale score ≤2) in 18 of 20 patients (90%) at the last follow-up. CONCLUSIONS Surgical treatment strategy for large or giant fusiform MCA aneurysms should be determined on an individual basis, based on aneurysm morphology, location, size, and clinical status. Favorable outcomes can be achieved by various surgical techniques, including clip reconstruction, wrap clipping, aneurysm trapping, aneurysm excision followed by reanastomosis, and partial trapping with bypass revascularization.
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Affiliation(s)
- Feng Xu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.
| | - Bin Xu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Lei Huang
- Department of Radiology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Ji Xiong
- Department of Pathology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yuxiang Gu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Michael T Lawton
- Department of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital & Medical Center, Phoenix, Arizona, USA
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28
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Jiang G, Li Z, Jiang X, Li Z, Xu S, Fang X. Development of fusiform aneurysms induced by topical application of elastase in a rabbit model. Chin Neurosurg J 2017. [DOI: 10.1186/s41016-017-0093-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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29
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Takagaki M, Togami Y, Murasawa A, Nakao K. Multiple fusiform aneurysms of the distal middle cerebral artery showing different radiological courses: A case report. INTERDISCIPLINARY NEUROSURGERY 2017. [DOI: 10.1016/j.inat.2017.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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30
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Mortazavi MM, Hassanzadeh T, Khalili K, Suriya SS, Taqi MA, Fard SA, Tubbs RS. Falxuplication, a Novel Method for Wrap-Clipping a Fusiform Aneurysm: Technical Note. World Neurosurg 2017; 109:40-46. [PMID: 28939539 DOI: 10.1016/j.wneu.2017.09.059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 09/07/2017] [Accepted: 09/09/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Various techniques have been used for wrap-clipping a ruptured, fusiform intracranial aneurysm; however, there is no available literature on use of the falx cerebri for wrap-clipping. We present a review of the literature, with an illustrative case, of a ruptured fusiform pericallosal artery aneurysm firmly attached to the lower edge of the falx cerebri and not amenable to endovascular intervention. METHODS Although the firm attachment between the inferior falx and the fusiform aneurysm was maintained, a section of the lower thinner part of the falx cerebri firmly attached to the aneurysm was dissected and wrapped around the fusiform aneurysm, and then stabilized with a fenestrated clip. We chose a segment slightly longer than the length of the fusiform aneurysm to avoid pre- and post-wrap-clipping stenosis. RESULTS Postprocedure, except for a small area of numbness on the left distal anterolateral left leg, the patient was neurologically intact and remained neurologically intact at a 12-month follow-up. CONCLUSIONS An inferior thin segment of the falx cerebri can be used for wrap-clipping of ruptured fusiform anterior cerebral artery aneurysms. Furthermore, the inferior falx can be wrapped around the attached fusiform anterior cerebral artery aneurysm without compromising flow, offering a safe solution in these unusually complex cases.
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Affiliation(s)
| | | | | | - Sajid S Suriya
- National Skull Base Center, Thousand Oaks, California, USA
| | - M Asif Taqi
- National Skull Base Center, Thousand Oaks, California, USA
| | - Salman A Fard
- National Skull Base Center, Thousand Oaks, California, USA
| | - R Shane Tubbs
- Seattle Science Foundation, Seattle, Washington, USA
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31
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Wang K, Sui Q. Surgical treatment of posterior inferior cerebellar artery aneurysms. Acta Neurochir (Wien) 2017; 159:1653-1654. [PMID: 28741182 DOI: 10.1007/s00701-017-3272-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 07/10/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Kai Wang
- Department of Neurosurgery, Weihai Central Hospital, The Affiliated Hospital of Weifang Medical College, No. 3 MiShan Dong Road, Wendeng District, Weihai, 264400, China
| | - Qiangbo Sui
- Department of Neurosurgery, Weihai Central Hospital, The Affiliated Hospital of Weifang Medical College, No. 3 MiShan Dong Road, Wendeng District, Weihai, 264400, China.
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32
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Awad AJ, Mascitelli JR, Haroun RR, De Leacy RA, Fifi JT, Mocco J. Endovascular management of fusiform aneurysms in the posterior circulation: the era of flow diversion. Neurosurg Focus 2017; 42:E14. [DOI: 10.3171/2017.3.focus1748] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Fusiform aneurysms are uncommon compared with their saccular counterparts, yet they remain very challenging to treat and are associated with high rates of rebleeding and morbidity. Lack of a true aneurysm neck renders simple clip reconstruction or coil embolization usually impossible, and more advanced techniques are required, including bypass, stent-assisted coiling, and, more recently, flow diversion. In this article, the authors review posterior circulation fusiform aneurysms, including pathogenesis, natural history, and endovascular treatment, including the role of flow diversion. In addition, the authors propose an algorithm for treatment based on their practice.
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Affiliation(s)
- Ahmed J. Awad
- 1Department of Neurological Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York; and
- 2Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Justin R. Mascitelli
- 1Department of Neurological Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York; and
| | - Reham R. Haroun
- 1Department of Neurological Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York; and
| | - Reade A. De Leacy
- 1Department of Neurological Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York; and
| | - Johanna T. Fifi
- 1Department of Neurological Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York; and
| | - J Mocco
- 1Department of Neurological Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York; and
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33
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Safavi-Abbasi S, Kalani MYS, Frock B, Sun H, Yagmurlu K, Moron F, Snyder LA, Hlubek RJ, Zabramski JM, Nakaji P, Spetzler RF. Techniques and outcomes of microsurgical management of ruptured and unruptured fusiform cerebral aneurysms. J Neurosurg 2017; 127:1353-1360. [PMID: 28186451 DOI: 10.3171/2016.9.jns161165] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Fusiform cerebral aneurysms represent a small portion of intracranial aneurysms; differ in natural history, anatomy, and pathology; and can be difficult to treat compared with saccular aneurysms. The purpose of this study was to examine the techniques of treatment of ruptured and unruptured fusiform intracranial aneurysms and patient outcomes. METHODS In 45 patients with fusiform aneurysms, the authors retrospectively reviewed the presentation, location, and shape of the aneurysm; the microsurgical technique; the outcome at discharge and last follow-up; and the change in the aneurysm at last angiographic follow-up. RESULTS Overall, 48 fusiform aneurysms were treated in 45 patients (18 male, 27 female) with a mean age of 49 years (median 51 years; range 6 months-76 years). Twelve patients (27%) had ruptured aneurysms and 33 (73%) had unruptured aneurysms. The mean aneurysm size was 8.9 mm (range 6-28 mm). The aneurysms were treated by clip reconstruction (n = 22 [46%]), clip-wrapping (n = 18 [38%]), and vascular bypass (n = 8 [17%]). The mean (SD) hospital stay was 19.0 ± 7.4 days for the 12 patients with subarachnoid hemorrhage and 7.0 ± 5.6 days for the 33 patients with unruptured aneurysms. The mean follow-up was 38.7 ± 29.5 months (median 36 months; range 6-96 months). The mean Glasgow Outcome Scale score for the 12 patients with subarachnoid hemorrhage was 3.9; for the 33 patients with unruptured aneurysms, it was 4.8. No rehemorrhages occurred during follow-up. The overall annual risk of recurrence was 2% and that of rehemorrhage was 0%. CONCLUSIONS Fusiform and dolichoectatic aneurysms involving the entire vessel wall must be investigated individually. Although some of these aneurysms may be amenable to primary clipping and clip reconstruction, these complex lesions often require alternative microsurgical and endovascular treatment. These techniques can be performed with acceptable morbidity and mortality rates and with low rates of early rebleeding and recurrence.
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Affiliation(s)
- Sam Safavi-Abbasi
- 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - M Yashar S Kalani
- 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - Ben Frock
- 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - Hai Sun
- 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - Kaan Yagmurlu
- 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - Felix Moron
- 2Department of Neurological Surgery, HIGA Vicente Lopez y Planes, Gral Rodriguez, Buenos Aires, Argentina
| | - Laura A Snyder
- 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - Randy J Hlubek
- 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - Joseph M Zabramski
- 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - Peter Nakaji
- 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
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Fernandes ST, Alves RV, Dória-Netto HL, Puglia Júnior P, Rivau FR, Jory M. Treatment of complex intracranial aneurysm: Case report of the simultaneous use of endovascular and microsurgical techniques. Surg Neurol Int 2017; 7:S1060-S1064. [PMID: 28144484 PMCID: PMC5234295 DOI: 10.4103/2152-7806.196375] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Accepted: 10/21/2016] [Indexed: 11/24/2022] Open
Abstract
Background: The surgical treatment of complex intracranial aneurysms (CIAs) represents a significant challenge to the skill and expertise of the neurosurgeon. The natural history of complex cerebrovascular lesions is especially unfavorable because of the pressure effect on adjacent areas, the risk of embolism in the presence of intraluminal thrombi, and the possibility of hemorrhage through leakage or rupture of the aneurysm. The surgical strategy must be customized for each case in order to maximize the treatment effectiveness and the safety of the patient. Case Description: A 68-year-old woman presented with a 10-month history of atypical headaches but no other neurological symptoms. Computed tomography scan and digital subtraction angiography revealed an unruptured saccular aneurysm on the M1 segment of the right middle cerebral artery. The lesion was 21 mm in length in its largest diameter and with an undefined neck (extensive involvement of the walls of the afferent vessel). Craniotomy was performed in order to expose the lesion and allow microsurgical dissection of the neck of the aneurysm and its adjacent structures. A balloon catheter was navigated via the internal carotid artery to a position alongside the aneurysm neck. With the balloon fully inflated, the aneurysm was punctured and drained, and a guide clip was located at the neck of the aneurysm. Additional clips were applied using a similar procedure to ensure the exclusion of the aneurysm. Conclusion: The patient recovered without complications and complete occlusion of the CIA was confirmed on follow-up angiography. A modified Rankin score of 0 was attributed to the patient 6 months after treatment. A multidisciplinary perspective is important in planning and executing the treatment of CIAs.
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Affiliation(s)
- Sérgio T Fernandes
- Department of Neurosurgery, Vascular Neurosurgery Unit, Hospital de Transplantes do Estado de São Paulo, São Paulo, Brazil
| | - Raphael V Alves
- Department of Neurosurgery, Vascular Neurosurgery Unit, Hospital de Transplantes do Estado de São Paulo, São Paulo, Brazil
| | - Hugo L Dória-Netto
- Department of Neurosurgery, Vascular Neurosurgery Unit, Hospital de Transplantes do Estado de São Paulo, São Paulo, Brazil
| | - Paulo Puglia Júnior
- Interventional Neuroradiology Unit, Hospital de Transplantes do Estado de São Paulo, São Paulo, SP, Brazil
| | - Fabiano R Rivau
- Interventional Neuroradiology Unit, Hospital de Transplantes do Estado de São Paulo, São Paulo, SP, Brazil
| | - Maurício Jory
- Interventional Neuroradiology Unit, Hospital de Transplantes do Estado de São Paulo, São Paulo, SP, Brazil
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Ito H, Miyano R, Sase T, Wakui D, Matsumori T, Takasuna H, Oshio K, Tanaka Y. Outflow occlusion with A3-A3 anastomosis for a doughnut-shaped partially thrombosed giant A2 aneurysm. Surg Neurol Int 2016; 7:S1069-S1071. [PMID: 28144486 PMCID: PMC5234299 DOI: 10.4103/2152-7806.196379] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 10/11/2016] [Indexed: 11/22/2022] Open
Abstract
Background: A doughnut-shaped aneurysm, which is defined as a round-shaped aneurysm composed of an intraluminar thrombus and marginal parent artery, is an extremely uncommon subtype of partially thrombosed giant aneurysms. Surgical treatment of this characteristic aneurysm is technically challenging. Case Description: We report a rare case of a 79-year-old man with a symptomatic doughnut-shaped giant aneurysm at the A2 portion, which was successfully treated by outflow occlusion with an A3–A3 side-to-side anastomosis. Postoperative angiograms demonstrated no filling of the doughnut-shaped aneurysm and perfusion in the distal right anterior cerebral artery territory via the anastomosis. Follow-up magnetic resonance imaging 1 year after the surgery demonstrated significant diminution of the aneurysm. Conclusions: Outflow occlusion with distal revascularization could be an effective surgical option for such a unique aneurysm. To the best of our knowledge, this is the first report of outflow occlusion as a therapy for doughnut-shaped aneurysms.
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Affiliation(s)
- Hidemichi Ito
- Department of Neurosurgery, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Ryotaro Miyano
- Department of Neurosurgery, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Taigen Sase
- Department of Neurosurgery, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Daisuke Wakui
- Department of Neurosurgery, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Takashi Matsumori
- Department of Neurosurgery, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Hiroshi Takasuna
- Department of Neurosurgery, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Kotaro Oshio
- Department of Neurosurgery, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Yuichiro Tanaka
- Department of Neurosurgery, St. Marianna University School of Medicine, Kanagawa, Japan
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36
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Santiago-Sim T, Fang X, Hennessy ML, Nalbach SV, DePalma SR, Lee MS, Greenway SC, McDonough B, Hergenroeder GW, Patek KJ, Colosimo SM, Qualmann KJ, Hagan JP, Milewicz DM, MacRae CA, Dymecki SM, Seidman CE, Seidman JG, Kim DH. THSD1 (Thrombospondin Type 1 Domain Containing Protein 1) Mutation in the Pathogenesis of Intracranial Aneurysm and Subarachnoid Hemorrhage. Stroke 2016; 47:3005-3013. [PMID: 27895300 PMCID: PMC5134902 DOI: 10.1161/strokeaha.116.014161] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 08/24/2016] [Accepted: 09/14/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE A ruptured intracranial aneurysm (IA) is the leading cause of a subarachnoid hemorrhage. This study seeks to define a specific gene whose mutation leads to disease. METHODS More than 500 IA probands and 100 affected families were enrolled and clinically characterized. Whole exome sequencing was performed on a large family, revealing a segregating THSD1 (thrombospondin type 1 domain containing protein 1) mutation. THSD1 was sequenced in other probands and controls. Thsd1 loss-of-function studies in zebrafish and mice were used for in vivo analyses and functional studies performed using an in vitro endothelial cell model. RESULTS A nonsense mutation in THSD1 was identified that segregated with the 9 affected (3 suffered subarachnoid hemorrhage and 6 had unruptured IA) and was absent in 13 unaffected family members (LOD score 4.69). Targeted THSD1 sequencing identified mutations in 8 of 507 unrelated IA probands, including 3 who had suffered subarachnoid hemorrhage (1.6% [95% confidence interval, 0.8%-3.1%]). These THSD1 mutations/rare variants were highly enriched in our IA patient cohort relative to 89 040 chromosomes in Exome Aggregation Consortium (ExAC) database (P<0.0001). In zebrafish and mice, Thsd1 loss-of-function caused cerebral bleeding (which localized to the subarachnoid space in mice) and increased mortality. Mechanistically, THSD1 loss impaired endothelial cell focal adhesion to the basement membrane. These adhesion defects could be rescued by expression of wild-type THSD1 but not THSD1 mutants identified in IA patients. CONCLUSIONS This report identifies THSD1 mutations in familial and sporadic IA patients and shows that THSD1 loss results in cerebral bleeding in 2 animal models. This finding provides new insight into IA and subarachnoid hemorrhage pathogenesis and provides new understanding of THSD1 function, which includes endothelial cell to extracellular matrix adhesion.
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Affiliation(s)
- Teresa Santiago-Sim
- From the Department of Neurosurgery (T.S.-S., X.F., G.W.H., K.J.P., S.M.C., K.J.Q., J.P.H., D.H.K.) and Division of Medical Genetics, Department of Internal Medicine (D.M.M.), The University of Texas Medical School at Houston; Department of Genetics, Harvard Medical School, Boston, MA (M.L.H., S.V.N., S.R.D., S.C.G., B.M., S.M.D., C.E.S., J.G.S.); Department of Neurosurgery (S.V.N.), Department of Medicine (M.S.L., C.A.M.), and Cardiovascular Division (C.E.S.), Brigham and Women's Hospital, Boston, MA; and Howard Hughes Medical Institute, Chevy Chase, MD (C.E.S.)
| | - Xiaoqian Fang
- From the Department of Neurosurgery (T.S.-S., X.F., G.W.H., K.J.P., S.M.C., K.J.Q., J.P.H., D.H.K.) and Division of Medical Genetics, Department of Internal Medicine (D.M.M.), The University of Texas Medical School at Houston; Department of Genetics, Harvard Medical School, Boston, MA (M.L.H., S.V.N., S.R.D., S.C.G., B.M., S.M.D., C.E.S., J.G.S.); Department of Neurosurgery (S.V.N.), Department of Medicine (M.S.L., C.A.M.), and Cardiovascular Division (C.E.S.), Brigham and Women's Hospital, Boston, MA; and Howard Hughes Medical Institute, Chevy Chase, MD (C.E.S.)
| | - Morgan L Hennessy
- From the Department of Neurosurgery (T.S.-S., X.F., G.W.H., K.J.P., S.M.C., K.J.Q., J.P.H., D.H.K.) and Division of Medical Genetics, Department of Internal Medicine (D.M.M.), The University of Texas Medical School at Houston; Department of Genetics, Harvard Medical School, Boston, MA (M.L.H., S.V.N., S.R.D., S.C.G., B.M., S.M.D., C.E.S., J.G.S.); Department of Neurosurgery (S.V.N.), Department of Medicine (M.S.L., C.A.M.), and Cardiovascular Division (C.E.S.), Brigham and Women's Hospital, Boston, MA; and Howard Hughes Medical Institute, Chevy Chase, MD (C.E.S.)
| | - Stephen V Nalbach
- From the Department of Neurosurgery (T.S.-S., X.F., G.W.H., K.J.P., S.M.C., K.J.Q., J.P.H., D.H.K.) and Division of Medical Genetics, Department of Internal Medicine (D.M.M.), The University of Texas Medical School at Houston; Department of Genetics, Harvard Medical School, Boston, MA (M.L.H., S.V.N., S.R.D., S.C.G., B.M., S.M.D., C.E.S., J.G.S.); Department of Neurosurgery (S.V.N.), Department of Medicine (M.S.L., C.A.M.), and Cardiovascular Division (C.E.S.), Brigham and Women's Hospital, Boston, MA; and Howard Hughes Medical Institute, Chevy Chase, MD (C.E.S.)
| | - Steven R DePalma
- From the Department of Neurosurgery (T.S.-S., X.F., G.W.H., K.J.P., S.M.C., K.J.Q., J.P.H., D.H.K.) and Division of Medical Genetics, Department of Internal Medicine (D.M.M.), The University of Texas Medical School at Houston; Department of Genetics, Harvard Medical School, Boston, MA (M.L.H., S.V.N., S.R.D., S.C.G., B.M., S.M.D., C.E.S., J.G.S.); Department of Neurosurgery (S.V.N.), Department of Medicine (M.S.L., C.A.M.), and Cardiovascular Division (C.E.S.), Brigham and Women's Hospital, Boston, MA; and Howard Hughes Medical Institute, Chevy Chase, MD (C.E.S.)
| | - Ming Sum Lee
- From the Department of Neurosurgery (T.S.-S., X.F., G.W.H., K.J.P., S.M.C., K.J.Q., J.P.H., D.H.K.) and Division of Medical Genetics, Department of Internal Medicine (D.M.M.), The University of Texas Medical School at Houston; Department of Genetics, Harvard Medical School, Boston, MA (M.L.H., S.V.N., S.R.D., S.C.G., B.M., S.M.D., C.E.S., J.G.S.); Department of Neurosurgery (S.V.N.), Department of Medicine (M.S.L., C.A.M.), and Cardiovascular Division (C.E.S.), Brigham and Women's Hospital, Boston, MA; and Howard Hughes Medical Institute, Chevy Chase, MD (C.E.S.)
| | - Steven C Greenway
- From the Department of Neurosurgery (T.S.-S., X.F., G.W.H., K.J.P., S.M.C., K.J.Q., J.P.H., D.H.K.) and Division of Medical Genetics, Department of Internal Medicine (D.M.M.), The University of Texas Medical School at Houston; Department of Genetics, Harvard Medical School, Boston, MA (M.L.H., S.V.N., S.R.D., S.C.G., B.M., S.M.D., C.E.S., J.G.S.); Department of Neurosurgery (S.V.N.), Department of Medicine (M.S.L., C.A.M.), and Cardiovascular Division (C.E.S.), Brigham and Women's Hospital, Boston, MA; and Howard Hughes Medical Institute, Chevy Chase, MD (C.E.S.)
| | - Barbara McDonough
- From the Department of Neurosurgery (T.S.-S., X.F., G.W.H., K.J.P., S.M.C., K.J.Q., J.P.H., D.H.K.) and Division of Medical Genetics, Department of Internal Medicine (D.M.M.), The University of Texas Medical School at Houston; Department of Genetics, Harvard Medical School, Boston, MA (M.L.H., S.V.N., S.R.D., S.C.G., B.M., S.M.D., C.E.S., J.G.S.); Department of Neurosurgery (S.V.N.), Department of Medicine (M.S.L., C.A.M.), and Cardiovascular Division (C.E.S.), Brigham and Women's Hospital, Boston, MA; and Howard Hughes Medical Institute, Chevy Chase, MD (C.E.S.)
| | - Georgene W Hergenroeder
- From the Department of Neurosurgery (T.S.-S., X.F., G.W.H., K.J.P., S.M.C., K.J.Q., J.P.H., D.H.K.) and Division of Medical Genetics, Department of Internal Medicine (D.M.M.), The University of Texas Medical School at Houston; Department of Genetics, Harvard Medical School, Boston, MA (M.L.H., S.V.N., S.R.D., S.C.G., B.M., S.M.D., C.E.S., J.G.S.); Department of Neurosurgery (S.V.N.), Department of Medicine (M.S.L., C.A.M.), and Cardiovascular Division (C.E.S.), Brigham and Women's Hospital, Boston, MA; and Howard Hughes Medical Institute, Chevy Chase, MD (C.E.S.)
| | - Kyla J Patek
- From the Department of Neurosurgery (T.S.-S., X.F., G.W.H., K.J.P., S.M.C., K.J.Q., J.P.H., D.H.K.) and Division of Medical Genetics, Department of Internal Medicine (D.M.M.), The University of Texas Medical School at Houston; Department of Genetics, Harvard Medical School, Boston, MA (M.L.H., S.V.N., S.R.D., S.C.G., B.M., S.M.D., C.E.S., J.G.S.); Department of Neurosurgery (S.V.N.), Department of Medicine (M.S.L., C.A.M.), and Cardiovascular Division (C.E.S.), Brigham and Women's Hospital, Boston, MA; and Howard Hughes Medical Institute, Chevy Chase, MD (C.E.S.)
| | - Sarah M Colosimo
- From the Department of Neurosurgery (T.S.-S., X.F., G.W.H., K.J.P., S.M.C., K.J.Q., J.P.H., D.H.K.) and Division of Medical Genetics, Department of Internal Medicine (D.M.M.), The University of Texas Medical School at Houston; Department of Genetics, Harvard Medical School, Boston, MA (M.L.H., S.V.N., S.R.D., S.C.G., B.M., S.M.D., C.E.S., J.G.S.); Department of Neurosurgery (S.V.N.), Department of Medicine (M.S.L., C.A.M.), and Cardiovascular Division (C.E.S.), Brigham and Women's Hospital, Boston, MA; and Howard Hughes Medical Institute, Chevy Chase, MD (C.E.S.)
| | - Krista J Qualmann
- From the Department of Neurosurgery (T.S.-S., X.F., G.W.H., K.J.P., S.M.C., K.J.Q., J.P.H., D.H.K.) and Division of Medical Genetics, Department of Internal Medicine (D.M.M.), The University of Texas Medical School at Houston; Department of Genetics, Harvard Medical School, Boston, MA (M.L.H., S.V.N., S.R.D., S.C.G., B.M., S.M.D., C.E.S., J.G.S.); Department of Neurosurgery (S.V.N.), Department of Medicine (M.S.L., C.A.M.), and Cardiovascular Division (C.E.S.), Brigham and Women's Hospital, Boston, MA; and Howard Hughes Medical Institute, Chevy Chase, MD (C.E.S.)
| | - John P Hagan
- From the Department of Neurosurgery (T.S.-S., X.F., G.W.H., K.J.P., S.M.C., K.J.Q., J.P.H., D.H.K.) and Division of Medical Genetics, Department of Internal Medicine (D.M.M.), The University of Texas Medical School at Houston; Department of Genetics, Harvard Medical School, Boston, MA (M.L.H., S.V.N., S.R.D., S.C.G., B.M., S.M.D., C.E.S., J.G.S.); Department of Neurosurgery (S.V.N.), Department of Medicine (M.S.L., C.A.M.), and Cardiovascular Division (C.E.S.), Brigham and Women's Hospital, Boston, MA; and Howard Hughes Medical Institute, Chevy Chase, MD (C.E.S.)
| | - Dianna M Milewicz
- From the Department of Neurosurgery (T.S.-S., X.F., G.W.H., K.J.P., S.M.C., K.J.Q., J.P.H., D.H.K.) and Division of Medical Genetics, Department of Internal Medicine (D.M.M.), The University of Texas Medical School at Houston; Department of Genetics, Harvard Medical School, Boston, MA (M.L.H., S.V.N., S.R.D., S.C.G., B.M., S.M.D., C.E.S., J.G.S.); Department of Neurosurgery (S.V.N.), Department of Medicine (M.S.L., C.A.M.), and Cardiovascular Division (C.E.S.), Brigham and Women's Hospital, Boston, MA; and Howard Hughes Medical Institute, Chevy Chase, MD (C.E.S.)
| | - Calum A MacRae
- From the Department of Neurosurgery (T.S.-S., X.F., G.W.H., K.J.P., S.M.C., K.J.Q., J.P.H., D.H.K.) and Division of Medical Genetics, Department of Internal Medicine (D.M.M.), The University of Texas Medical School at Houston; Department of Genetics, Harvard Medical School, Boston, MA (M.L.H., S.V.N., S.R.D., S.C.G., B.M., S.M.D., C.E.S., J.G.S.); Department of Neurosurgery (S.V.N.), Department of Medicine (M.S.L., C.A.M.), and Cardiovascular Division (C.E.S.), Brigham and Women's Hospital, Boston, MA; and Howard Hughes Medical Institute, Chevy Chase, MD (C.E.S.)
| | - Susan M Dymecki
- From the Department of Neurosurgery (T.S.-S., X.F., G.W.H., K.J.P., S.M.C., K.J.Q., J.P.H., D.H.K.) and Division of Medical Genetics, Department of Internal Medicine (D.M.M.), The University of Texas Medical School at Houston; Department of Genetics, Harvard Medical School, Boston, MA (M.L.H., S.V.N., S.R.D., S.C.G., B.M., S.M.D., C.E.S., J.G.S.); Department of Neurosurgery (S.V.N.), Department of Medicine (M.S.L., C.A.M.), and Cardiovascular Division (C.E.S.), Brigham and Women's Hospital, Boston, MA; and Howard Hughes Medical Institute, Chevy Chase, MD (C.E.S.)
| | - Christine E Seidman
- From the Department of Neurosurgery (T.S.-S., X.F., G.W.H., K.J.P., S.M.C., K.J.Q., J.P.H., D.H.K.) and Division of Medical Genetics, Department of Internal Medicine (D.M.M.), The University of Texas Medical School at Houston; Department of Genetics, Harvard Medical School, Boston, MA (M.L.H., S.V.N., S.R.D., S.C.G., B.M., S.M.D., C.E.S., J.G.S.); Department of Neurosurgery (S.V.N.), Department of Medicine (M.S.L., C.A.M.), and Cardiovascular Division (C.E.S.), Brigham and Women's Hospital, Boston, MA; and Howard Hughes Medical Institute, Chevy Chase, MD (C.E.S.)
| | - J G Seidman
- From the Department of Neurosurgery (T.S.-S., X.F., G.W.H., K.J.P., S.M.C., K.J.Q., J.P.H., D.H.K.) and Division of Medical Genetics, Department of Internal Medicine (D.M.M.), The University of Texas Medical School at Houston; Department of Genetics, Harvard Medical School, Boston, MA (M.L.H., S.V.N., S.R.D., S.C.G., B.M., S.M.D., C.E.S., J.G.S.); Department of Neurosurgery (S.V.N.), Department of Medicine (M.S.L., C.A.M.), and Cardiovascular Division (C.E.S.), Brigham and Women's Hospital, Boston, MA; and Howard Hughes Medical Institute, Chevy Chase, MD (C.E.S.)
| | - Dong H Kim
- From the Department of Neurosurgery (T.S.-S., X.F., G.W.H., K.J.P., S.M.C., K.J.Q., J.P.H., D.H.K.) and Division of Medical Genetics, Department of Internal Medicine (D.M.M.), The University of Texas Medical School at Houston; Department of Genetics, Harvard Medical School, Boston, MA (M.L.H., S.V.N., S.R.D., S.C.G., B.M., S.M.D., C.E.S., J.G.S.); Department of Neurosurgery (S.V.N.), Department of Medicine (M.S.L., C.A.M.), and Cardiovascular Division (C.E.S.), Brigham and Women's Hospital, Boston, MA; and Howard Hughes Medical Institute, Chevy Chase, MD (C.E.S.).
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Tanaka Y, Motoyama Y, Nishimura F, Park YS, Nakase H. Evolution of a Stump Aneurysm That Transformed From a Fusiform Aneurysm in the Middle Cerebral Artery. World Neurosurg 2016; 97:759.e9-759.e12. [PMID: 27742503 DOI: 10.1016/j.wneu.2016.09.124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Revised: 09/27/2016] [Accepted: 09/29/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND A spontaneous fusiform aneurysm in the middle cerebral artery (MCA) can present with both ischemic and hemorrhagic symptoms, but this aneurysm's clinical course and prognosis are unclear because of its rarity. CASE DESCRIPTION An asymptomatic fusiform-shaped aneurysm was found in a branch of the right middle cerebral artery (MCA) incidentally during a medical check-up in a 51-year-old woman with no medical history. This aneurysm was followed by annual magnetic resonance imaging with no medical treatment. A distal side of the branch of the MCA harboring the fusiform aneurysm gradually narrowed, and finally occluded 6 years after initial detection. The stump of the branch transformed into an aneurysmal dilatation, which grew for 2 years. To prevent future subarachnoid hemorrhage, surgical intervention was performed. An aneurysmal dilation with a thin wall was found to originate between an intact branch and a funicular occluded branch, which was obliterated with clip application. At 3-year follow-up, no regrowth or de novo aneurysm could be seen. CONCLUSION This is the first case report in which serial images demonstrate the stepwise occlusion of an artery with fusiform change and the evolution of a stump aneurysm in the MCA over an extended period.
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Affiliation(s)
- Yoshitaka Tanaka
- Department of Neurosurgery, Nara Medical University, Kashihara, Nara, Japan
| | - Yasushi Motoyama
- Department of Neurosurgery, Nara Medical University, Kashihara, Nara, Japan.
| | - Fumihiko Nishimura
- Department of Neurosurgery, Nara Medical University, Kashihara, Nara, Japan
| | - Young-Su Park
- Department of Neurosurgery, Nara Medical University, Kashihara, Nara, Japan
| | - Hiroyuki Nakase
- Department of Neurosurgery, Nara Medical University, Kashihara, Nara, Japan
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Jung SC, Kim HS, Choi CG, Kim SJ, Kwon SU, Kang DW, Kim JS. Spontaneous and Unruptured Chronic Intracranial Artery Dissection : High-resolution Magnetic Resonance Imaging Findings. Clin Neuroradiol 2016; 28:171-181. [PMID: 27677627 DOI: 10.1007/s00062-016-0544-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 08/31/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE The aim of this article is to present high-resolution magnetic resonance imaging (HR-MRI) findings of chronic stage spontaneous and unruptured intracranial artery dissection (ICAD). MATERIAL AND METHODS From March 2012 to April 2016 a total of 29 patients (15 male and14 female, age range 37-68 years) with chronic stage spontaneous and unruptured ICAD (vertebral artery 27, posterior inferior cerebellar artery 1 and middle cerebral artery 1) were retrospectively enrolled. Patients underwent HR-MRI more than 2 months (median interval 564 days, range 69-391 days) after symptom onset and were diagnosed at symptom onset or at the first imaging acquisition, which included luminal angiography and/or HR-MRI with clinical information. The HR-MRI findings were evaluated against those of luminal angiography on the basis of the lumen wall morphology, including thickening, contrast enhancement and residual dissection. RESULTS The HR-MRI findings were classified into complete normalization (normal lumen and wall with or without mild enhancement, n = 6), complete normalization with minimal wall changes (focal wall thickening with enhancement but normal luminal angiography, n = 8), incomplete normalization (focal wall thickening with enhancement with dilatation and stenosis on luminal angiography, n = 4), dissecting aneurysm (fusiform aneurysm with residual dissection findings, n = 8) and occlusion (small outer arterial diameter with diffuse contrast enhancement, n = 3). CONCLUSION The use of HR-MRI can demonstrate the distinguishing morphological features of chronic stage of spontaneous and unruptured ICAD as complete normalization, complete normalization with minimal wall changes, incomplete normalization, dissecting aneurysm and occlusion.
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Affiliation(s)
- Seung Chai Jung
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, 138-736, Seoul, Songpa-Gu, Republic of Korea.
| | - Ho Sung Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, 138-736, Seoul, Songpa-Gu, Republic of Korea
| | - Choong-Gon Choi
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, 138-736, Seoul, Songpa-Gu, Republic of Korea
| | - Sang Joon Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, 138-736, Seoul, Songpa-Gu, Republic of Korea
| | - Sun U Kwon
- Department of Neurology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Dong-Wha Kang
- Department of Neurology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Jong S Kim
- Department of Neurology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
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Morishita H, Nakamura S, Toma N, Nakatsuka Y, Takeuchi K. A case of vertebral artery aneurysm presenting with dysphagia. Auris Nasus Larynx 2016; 44:479-483. [PMID: 27496007 DOI: 10.1016/j.anl.2016.07.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 07/15/2016] [Accepted: 07/20/2016] [Indexed: 11/26/2022]
Abstract
Here, we report a case of vertebral artery aneurysm causing dysphagia in a 56-year-old man who had no remarkable past history. Two months before the first visit, he developed posterior neck pain followed by difficulty swallowing 1 month later. He was referred to our clinic because of gradually worsening dysphagia. Physical examination showed paralysis of cranial nerves IX, X, and XII; therefore, he was hospitalized. Because enhanced CT and MRI showed a partially thrombosed right vertebral artery aneurysm, he was transferred to the care of the Department of Neurosurgery. Parent artery occlusion of the right vertebral artery aneurysm was performed and it improved his symptoms. After regaining his ability to take in liquid food, he was transferred to another hospital for further rehabilitation. In this case, we attributed the dysphagia to aneurysmal compression of the roots of cranial nerves IX, X, and XII. A partially thrombosed cerebral artery aneurysm may often rupture and cause worsening of neurologic symptoms. The prognosis is generally poor because the rupture rate is extremely high especially with large or giant aneurysms. However, this case had a good clinical course owing to treatment by parent artery occlusion.
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Affiliation(s)
- Hiroyuki Morishita
- Department of Otorhinolaryngology, Head & Neck Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Satoshi Nakamura
- Department of Otorhinolaryngology, Head & Neck Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Naoki Toma
- Department of Neurosurgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Yoshinari Nakatsuka
- Department of Neurosurgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Kazuhiko Takeuchi
- Department of Otorhinolaryngology, Head & Neck Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan.
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Safavi-Abbasi S, Moron F, Sun H, Wilson C, Frock B, Oppenlander ME, Xu DS, Ghafil C, Zabramski JM, Spetzler RF, Nakaji P. Techniques and Outcomes of Gore-Tex Clip-Wrapping of Ruptured and Unruptured Cerebral Aneurysms. World Neurosurg 2016; 90:281-290. [PMID: 26960285 DOI: 10.1016/j.wneu.2016.02.109] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 02/23/2016] [Accepted: 02/25/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Some aneurysms without a definable neck and associated parent vessel pathology are particularly difficult to treat and may require clipping with circumferential wrapping. We report the largest available contemporary series examining the techniques of Gore-Tex clip-wrapping of ruptured and unruptured intracranial aneurysms and patient outcomes. METHODS The presentation, location, and shape of the aneurysm; wrapping technique; outcome at discharge and last follow-up; and any change in the aneurysm at last angiographic follow-up were reviewed retrospectively in 30 patients with Gore-Tex clip-wrapped aneurysms. RESULTS Gore-Tex clip-wrapping was used in 8 patients with ruptured aneurysms and 22 patients with unruptured aneurysms. Aneurysms included 23 fusiform, 3 blister, and 4 otherwise complex, multilobed, or giant aneurysms. Of the 30 aneurysms, 63% were in the anterior circulation. The overall mean patient age was 52.5 years (range, 17-80 years). Postoperatively, there were no deaths or worsening of neurologic status and no parent vessel stenoses or strokes. The mean Glasgow Outcome Scale score at last follow-up was 4.7. The mean follow-up time was 42.3 months (median, 37.0 months; range, 3-96 months). There were 105.8 patient follow-up years. Aneurysms recurred in 2 patients with Gore-Tex clip-wrapping. No patients developed rehemorrhage. Overall risk of recurrence was 1.9% annually. CONCLUSIONS Gore-Tex has excellent material properties for circumferential wrapping of aneurysms and parent arteries. It is inert and does not cause a tissue reaction or granuloma formation. Gore-Tex clip-wrapping can be used safely for microsurgical management of ruptured and unruptured cerebral aneurysms with acceptable recurrence and rehemorrhage rates.
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Affiliation(s)
- Sam Safavi-Abbasi
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Felix Moron
- Department of Neurological Surgery, HIGA Vicente Lopez y Planes Gral Rodriguez, Buenos Aires, Argentina
| | - Hai Sun
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Christopher Wilson
- Department of Neurological Surgery, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma, USA
| | - Ben Frock
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Mark E Oppenlander
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - David S Xu
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Cameron Ghafil
- Department of Neurological Surgery, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma, USA
| | - Joseph M Zabramski
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Robert F Spetzler
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Peter Nakaji
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
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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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Can A, Xu J, Volovici V, Dammers R, Dirven CM, MacRae CA, Du R. Fusiform Aneurysms Are Associated with Aortic Root Dilatation in Patients with Subarachnoid Hemorrhage. World Neurosurg 2015; 84:1681-5. [DOI: 10.1016/j.wneu.2015.07.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Revised: 07/01/2015] [Accepted: 07/02/2015] [Indexed: 10/23/2022]
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Durst CR, Hixson HR, Schmitt P, Gingras JM, Crowley RW. Endovascular Treatment of a Fusiform Aneurysm at the M3-M4 Junction of the Middle Cerebral Artery Using the Pipeline Embolization Device. World Neurosurg 2015; 86:511.e1-4. [PMID: 26485414 DOI: 10.1016/j.wneu.2015.10.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 10/06/2015] [Accepted: 10/07/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Peripheral fusiform cerebral aneurysms remain difficult to treat. Current surgical approaches to the treatment of fusiform aneurysms include wrapping, clip occlusion or vessel reconstruction without parent vessel sacrifice, and aneurysm trapping with or without bypass, although these may carry high morbidity (36%). Classic endovascular approaches to the treatment of peripheral aneurysms include selective or parent artery occlusion, which imparts the risk of distal infarction. It may be possible to use a flow diversion device off label to treat the aneurysm and preserve flow to the distal territory. CASE DESCRIPTION After a presyncopal event, a patient was found to have an unruptured fusiform aneurysm at the junction of the M3 and M4 segments of the right middle cerebral artery. After initiating dual antiplatelet therapy, the aneurysm was successfully treated with a Pipeline embolization device. Three months after treatment, the aneurysm has completely thrombosed, the parent artery remains widely patent, and the patient remains at her neurologic baseline. CONCLUSIONS Flow diversion devices may provide the neurointerventional surgeon with an opportunity to treat fusiform peripheral aneurysms and preserve flow to the distal territory.
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Affiliation(s)
- Christopher R Durst
- Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia, USA
| | - H Robert Hixson
- Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Paul Schmitt
- Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Jean M Gingras
- Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia, USA
| | - R Webster Crowley
- Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia, USA.
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44
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Pabaney AH, Mazaris PA, Kole MK, Reinard KA. Endovascular management of fusiform aneurysm of anterior temporal artery: Technical report. Surg Neurol Int 2015; 6:119. [PMID: 26290771 PMCID: PMC4521225 DOI: 10.4103/2152-7806.161239] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Accepted: 05/27/2015] [Indexed: 11/09/2022] Open
Abstract
Background: The treatment of a rare, nontraumatic, fusiform aneurysm of the anterior temporal artery (ATA) via endovascular techniques is presented, and procedural nuances are highlighted. Methods: We performed a retrospective chart review and collected demographic and clinical data on the patient presented here; procedural details were extracted from operative notes. Results: Following successful balloon test occlusion (BTO) of the ATA, complete coil embolization of the ATA, and its associated fusiform aneurysm was performed. Postprocedurally, the patient did not suffer any adverse neurological sequelae. Conclusion: Selective BTO of intracranial branch vessels is safe, technically feasible, and could serve as a useful technical tool in the treatment of complex, fusiform intracranial aneurysms.
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Affiliation(s)
| | - Paul A Mazaris
- Department of Neurosurgery, Hartford Hospital, Hartford, CT, USA
| | - Max K Kole
- Department of Neurosurgery, Henry Ford Hospital, Detroit, MI, USA
| | - Kevin A Reinard
- Department of Neurosurgery, Henry Ford Hospital, Detroit, MI, USA
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45
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Abstract
Aneurysmal subarachnoid hemorrhage (SAH) is a worldwide health burden with high fatality and permanent disability rates. The overall prognosis depends on the volume of the initial bleed, rebleeding, and degree of delayed cerebral ischemia (DCI). Cardiac manifestations and neurogenic pulmonary edema indicate the severity of SAH. The International Subarachnoid Aneurysm Trial (ISAT) reported a favorable neurological outcome with the endovascular coiling procedure compared with surgical clipping at the end of 1 year. The ISAT trial recruits were primarily neurologically good grade patients with smaller anterior circulation aneurysms, and therefore the results cannot be reliably extrapolated to larger aneurysms, posterior circulation aneurysms, patients presenting with complex aneurysm morphology, and poor neurological grades. The role of hypothermia is not proven to be neuroprotective according to a large randomized controlled trial, Intraoperative Hypothermia for Aneurysms Surgery Trial (IHAST II), which recruited patients with good neurological grades. Patients in this trial were subjected to slow cooling and inadequate cooling time and were rewarmed rapidly. This methodology would have reduced the beneficial effects of hypothermia. Adenosine is found to be beneficial for transient induced hypotension in 2 retrospective analyses, without increasing the risk for cardiac and neurological morbidity. The neurological benefit of pharmacological neuroprotection and neuromonitoring is not proven in patients undergoing clipping of aneurysms. DCI is an important cause of morbidity and mortality following SAH, and the pathophysiology is likely multifactorial and not yet understood. At present, oral nimodipine has an established role in the management of DCI, along with maintenance of euvolemia and induced hypertension. Following SAH, hypernatremia, although less common than hyponatremia, is a predictor of poor neurological outcome.
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Affiliation(s)
- Stanlies D'Souza
- Department of Neuroanesthesiology, Baystate Medical Center, Tufts University School of Medicine, Springfield, MA
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46
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The imaging features of neurologic complications of left atrial myxomas. Eur J Radiol 2015; 84:933-9. [PMID: 25737060 DOI: 10.1016/j.ejrad.2015.02.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Revised: 12/27/2014] [Accepted: 02/02/2015] [Indexed: 11/22/2022]
Abstract
BACKGROUND Neurologic complications may be the first symptoms of atrial myxomas. Understanding the imaging features of neurologic complications of atrial myxomas can be helpful for the prompt diagnosis. OBJECTIVE To identify neuroimaging features for patients with neurologic complications attributed to atrial myxoma. METHODS We retrospectively reviewed the medical records of 103 patients with pathologically confirmed atrial myxoma at Xiangya Hospital from January 2009 to January 2014. The neuroimaging data for patients with neurologic complications were analyzed. RESULTS Eight patients with atrial myxomas (7.77%) presented with neurologic manifestations, which constituted the initial symptoms for seven patients (87.5%). Neuroimaging showed five cases of cerebral infarctions and three cases of aneurysms. The main patterns of the infarctions were multiplicity (100.0%) and involvement of the middle cerebral artery territory (80.0%). The aneurysms were fusiform in shape, multiple in number (100.0%) and located in the distal middle cerebral artery (100.0%). More specifically, high-density in the vicinity of the aneurysms was observed on CT for two patients (66.7%), and homogenous enhancement surrounding the aneurysms was detected in the enhanced imaging for two patients (66.7%). CONCLUSION Neurologic complications secondary to atrial myxoma consist of cerebral infarctions and aneurysms, which show certain characteristic features in neuroimaging. Echocardiography should be performed in patients with multiple cerebral infarctions, and multiple aneurysms, especially when aneurysms are distal in location. More importantly, greater attention should be paid to the imaging changes surrounding the aneurysms when myxomatous aneurysms are suspected and these are going to be the relevant features in our article.
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47
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Sim SY, Chung J, Shin YS. Are blood blister-like aneurysms a specific type of dissection? A comparative study of blood blister-like aneurysms and ruptured mizutani type 4 vertebral artery dissections. J Korean Neurosurg Soc 2014; 56:395-9. [PMID: 25535516 PMCID: PMC4272997 DOI: 10.3340/jkns.2014.56.5.395] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Revised: 06/30/2013] [Accepted: 07/04/2014] [Indexed: 12/19/2022] Open
Abstract
Objective Blood blister-like aneurysms (BBAs) resemble arterial dissections. The purpose of this study was to investigate the relationship between these two disease entities and highlight commonalities and distinct features. Methods Among 871 consecutive patients with aneurysmal subarachnoid hemorrhage, 11 BBAs of internal carotid artery and seven vertebral artery dissections (VADs) with a short segmental eccentric dilatation (Mizutani type 4), which is morphologically similar to a BBA, were selected. The following clinical factors were studied in each group : age, gender, risk factors, Hunt and Hess grade (HHG), Fisher grade (FG), vasospasms, hydrocephalus, perioperative rebleeding rate, and treatment outcome. Results The mean age was 47.9 years in the BBAs group and 46.4 years in the type 4 VADs group. All the BBA patients were female, whereas there was a slight male predominance in the type 4 VAD group (male : female ratio of 4 : 3). In the BBA and type 4 VAD groups that underwent less aggressive treatment to save the parent artery, 29% (n=2/7) and 66.6% (n=2/3), respectively, eventually required retreatment. Perioperative rebleeding occurred in 72.7% (n=8) and 28.6% (n=2) of patients in the BBA and type 4 VAD groups, respectively. There was no statistical difference in the other clinical factors in both groups, except for the male dominancy in the type 4 VAD group (p=0.011). Conclusion BBAs and ruptured type 4 VADs have a similar morphological appearance but there is a distinct clinical feature in gender and perioperative rebleeding rates. Complete isolation of an aneurysm from the parent artery might be the most important discipline for the treatment of these diseases.
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Affiliation(s)
- Sook Young Sim
- Department of Neurosurgery, Inje University Seoul Paik Hospital, Seoul, Korea
| | - Joonho Chung
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Sam Shin
- Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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48
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Kinoshita M, Kida S, Hasegawa M, Yamashita J, Nomura M. Pathological examination of a ruptured fusiform aneurysm of the middle cerebral artery. Surg Neurol Int 2014; 5:S465-8. [PMID: 25422790 PMCID: PMC4235114 DOI: 10.4103/2152-7806.143722] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 08/26/2014] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Little is known about the pathogenesis and clinical course of fusiform compared with saccular aneurysms. The case of a ruptured fusiform aneurysm accompanied by dissection at the M2 portion of the middle cerebral artery (MCA) is reported, along with pathological findings. CASE DESCRIPTION A 41-year-old female presenting with subarachnoid hemorrhage was revealed to have a ruptured fusiform aneurysm at the M2 portion of the right MCA on angiography. She was treated with superficial temporal artery-MCA anastomosis and trapping of the aneurysm. The aneurysm consisted of a whitish fusiform dilatation with a thickened wall of the MCA and two red protrusions on it. Pathological examinations revealed disruption and fragmentation of the internal elastic lamina and intimal thickening in the fusiform lesion. There were two aneurysmal protrusions on the main fusiform dilatation. In one protruded lesion, a dissection of the intima was observed. CONCLUSION We propose that a dissection and saccular aneurysm additionally developed on the wall of a preexisting segmental ectasia of the MCA in our case. In this report, we discuss the etiology of fusiform aneurysms of the MCA.
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Affiliation(s)
- Masashi Kinoshita
- Department of Neurosurgery, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Shinya Kida
- Department of Neurosurgery, Fukui Prefectural Hospital, Fukui, Japan
| | - Mitsuhiro Hasegawa
- Department of Neurosurgery, Fujita Health University School of Medicine, Nagoya, Japan
| | - Junkoh Yamashita
- Department of Neurosurgery, Asanogawa General Hospital, Kanazawa, Japan
| | - Motohiro Nomura
- Department of Neurosurgery, Yokohama Sakae Kyosai Hospital, Yokohama, Japan
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49
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Sacho RH, Saliou G, Kostynskyy A, Menezes R, Tymianski M, Krings T, Radovanovic I, Terbrugge K, Rinkel GJE, Willinsky R. Natural history and outcome after treatment of unruptured intradural fusiform aneurysms. Stroke 2014; 45:3251-6. [PMID: 25205312 DOI: 10.1161/strokeaha.114.006292] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Management of unruptured fusiform intracranial aneurysms is controversial because of the paucity of natural history data. We studied their natural history and outcome after treatment. METHODS We reviewed our neurovascular database from January 2000 to October 2013. Inclusion criteria were unruptured, intradural fusiform aneurysms with a diameter of <2.5 cm. Criteria were developed to define atherosclerotic aneurysms. For outcome assessment, we used the modified Ranking Scale and aneurysm measurements on serial imaging. Mann-Whittney (continuous) and Fisher exact (categorical) tests were used for risk factor analysis. RESULTS For nonatherosclerotic aneurysms (96 patients; 193 person-years follow-up), 1 patient died (rupture) during follow-up (mortality, 0.51% per year) and 8 patients (10%) showed aneurysm progression (risk, 1.6% per year). Risk factors for progression were maximum diameter (>7 mm; odds ratio, 12; 95% confidence interval, 1.4-104) and symptomatic clinical presentation (odds ratio, 16; 95% confidence interval, 3.1-81.4). Of the 23 treated patients, 3 had died (mortality, 12.5%) and 3 had serious disability (modified Ranking Scale, ≥3; 12.5%). For the atherosclerotic aneurysms (25 patients; 97 person-years follow-up), 5 had died (mortality, 5.2% per year) and 13 of 20 (65%) had aneurysm progression (risk, 12% per year). When compared with patients with nonatherosclerotic aneurysms, case fatality (odds ratio, 19.2; 95% confidence interval, 2.1-172) and aneurysm progression (odds ratio, 17.8; 95% confidence interval, 5.3-56) were higher. CONCLUSIONS Nonatherosclerotic fusiform intradural aneurysms have a low risk of adverse outcome within the first few years after diagnosis and remain stable unless symptomatic on presentation or >7 mm in maximum diameter. High risks of treatment should be balanced against this benign natural history. Atherosclerotic aneurysms have a worse natural history and may represent a different disease entity.
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Affiliation(s)
- Raphael H Sacho
- From the Departments of Interventional Neuroradiology (R.H.S., G.S., A.K., R.M., T.K., K.T., R.W.) and Neurosurgery (R.H.S., M.T., I.R.), University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada; and Department of Neurology and Neurosurgery, University Medical Centre Utrecht, Utrecht, The Netherlands (G.J.E.R.).
| | - Guillaume Saliou
- From the Departments of Interventional Neuroradiology (R.H.S., G.S., A.K., R.M., T.K., K.T., R.W.) and Neurosurgery (R.H.S., M.T., I.R.), University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada; and Department of Neurology and Neurosurgery, University Medical Centre Utrecht, Utrecht, The Netherlands (G.J.E.R.)
| | - Alex Kostynskyy
- From the Departments of Interventional Neuroradiology (R.H.S., G.S., A.K., R.M., T.K., K.T., R.W.) and Neurosurgery (R.H.S., M.T., I.R.), University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada; and Department of Neurology and Neurosurgery, University Medical Centre Utrecht, Utrecht, The Netherlands (G.J.E.R.)
| | - Ravi Menezes
- From the Departments of Interventional Neuroradiology (R.H.S., G.S., A.K., R.M., T.K., K.T., R.W.) and Neurosurgery (R.H.S., M.T., I.R.), University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada; and Department of Neurology and Neurosurgery, University Medical Centre Utrecht, Utrecht, The Netherlands (G.J.E.R.)
| | - Michael Tymianski
- From the Departments of Interventional Neuroradiology (R.H.S., G.S., A.K., R.M., T.K., K.T., R.W.) and Neurosurgery (R.H.S., M.T., I.R.), University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada; and Department of Neurology and Neurosurgery, University Medical Centre Utrecht, Utrecht, The Netherlands (G.J.E.R.)
| | - Timo Krings
- From the Departments of Interventional Neuroradiology (R.H.S., G.S., A.K., R.M., T.K., K.T., R.W.) and Neurosurgery (R.H.S., M.T., I.R.), University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada; and Department of Neurology and Neurosurgery, University Medical Centre Utrecht, Utrecht, The Netherlands (G.J.E.R.)
| | - Ivan Radovanovic
- From the Departments of Interventional Neuroradiology (R.H.S., G.S., A.K., R.M., T.K., K.T., R.W.) and Neurosurgery (R.H.S., M.T., I.R.), University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada; and Department of Neurology and Neurosurgery, University Medical Centre Utrecht, Utrecht, The Netherlands (G.J.E.R.)
| | - Karel Terbrugge
- From the Departments of Interventional Neuroradiology (R.H.S., G.S., A.K., R.M., T.K., K.T., R.W.) and Neurosurgery (R.H.S., M.T., I.R.), University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada; and Department of Neurology and Neurosurgery, University Medical Centre Utrecht, Utrecht, The Netherlands (G.J.E.R.)
| | - Gabriel J E Rinkel
- From the Departments of Interventional Neuroradiology (R.H.S., G.S., A.K., R.M., T.K., K.T., R.W.) and Neurosurgery (R.H.S., M.T., I.R.), University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada; and Department of Neurology and Neurosurgery, University Medical Centre Utrecht, Utrecht, The Netherlands (G.J.E.R.)
| | - Robert Willinsky
- From the Departments of Interventional Neuroradiology (R.H.S., G.S., A.K., R.M., T.K., K.T., R.W.) and Neurosurgery (R.H.S., M.T., I.R.), University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada; and Department of Neurology and Neurosurgery, University Medical Centre Utrecht, Utrecht, The Netherlands (G.J.E.R.)
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50
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Lamis FC, De Paiva Neto MA, Cavalheiro S. Fusiform superior cerebellar artery aneurysm treated with STA-SCA bypass and trapping. Surg Neurol Int 2014; 5:S139-42. [PMID: 25071936 PMCID: PMC4109170 DOI: 10.4103/2152-7806.134806] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Accepted: 04/30/2014] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Fusiform aneurysms of cerebellar arteries are rare. Different surgical techniques to address these challenging lesions have been described, and their application depends on whether the goal is to maintain the flow in the parent vessel or to occlude it. CASE DESCRIPTION The authors reported a case of a fusiform aneurysm located in the lateral pontomesencephalic segment of the superior cerebellar artery (SCA) in a 32-year-old man who presented with subarachnoid hemorrhage. The patient was subjected to aneurysm trapping followed by a bypass between the superficial temporal artery (STA) and SCA and had an uneventful recovery. CONCLUSIONS Although only a few cases of fusiform aneurysms in the supracerebellar artery have been reported in the literature, the treatment strategies adopted were diverse. In selected cases of patients in good neurological condition with ruptured fusiform aneurysms at the proximal segments of SCA and who have poor evidence of collateral supply, the possibility of a STA-SCA bypass with aneurysm trapping must be considered. A review of the current treatment modalities of this pathology is also presented.
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Affiliation(s)
- Fabricio C Lamis
- Department of Neurosurgery, Federal University of São Paulo, São Paulo, Brazil
| | | | - Sergio Cavalheiro
- Department of Neurosurgery, Federal University of São Paulo, São Paulo, Brazil
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