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Samuelsson J, Rentzos A, Rawshani A, Karlsson A, Ståleby M, Nilsson D. Risk of de novo aneurysm formation in patients previously diagnosed with a ruptured or unruptured aneurysm: 18-year follow-up. Clin Neurol Neurosurg 2023; 233:107980. [PMID: 37717358 DOI: 10.1016/j.clineuro.2023.107980] [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: 05/25/2023] [Revised: 09/11/2023] [Accepted: 09/12/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND Data on de novo aneurysm formation after treatment for intracranial aneurysms remains scarce. We studied the incidence of de novo aneurysm formation in patients who had undergone aneurysm treatment more than 18 years prior to follow-up. As it is a disease affecting a younger patient population more specific guidelines are needed when planning a follow-up regime. METHODS The rate of de novo aneurysm formation was assessed with Magnetic Resonance Angiography (MRA) follow-up >18 years after endovascular or microsurgical treatment for an intracranial aneurysm. Variables associated with de novo aneurysm formation were studied using logistic regression. Missing data were imputed using chained random forests. A data-driven model for the prediction of de novo aneurysm was created to calculate the relative variable importance of ten clinical features. RESULTS De novo aneurysms were identified in 11/81 (13.6 %) patients, of whom 1 was male, over a median follow-up of 20 years. Sex was the most important variable associated with de novo aneurysm formation. Regarding the development of de novo aneurysm, men displayed an odds ratio (OR) of 0.16 (0.01-0.97), compared with women. OR for mRS score 2 or more was 0.20 (95 % CI 0.01-1.34), and OR for smokers was 3.70 (0.54-31.18). Six out of 11 patients (54.5 %) needed treatment; 1 underwent endovascular treatment (EVT) and 5 underwent microsurgical treatment (MST). The overall annual de novo aneurysm formation rate was 0.92 %. CONCLUSIONS This study highlights the need for a longer follow-up imaging monitoring of patients that have previously undergone treatment for an intracranial aneurysm. These data are useful to take into consideration when planning a follow-up strategy.
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Affiliation(s)
- Jennifer Samuelsson
- Department of Clinical Neuroscience, Institute of Neurosciences and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Alexandros Rentzos
- Department of Radiology, Section of diagnostic and interventional neuroradiology, Sahlgrenska University Hospital, Region Vastra Gotaland, Gothenburg, Sweden; Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Araz Rawshani
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Adrian Karlsson
- Department of Radiology, Section of diagnostic and interventional neuroradiology, Sahlgrenska University Hospital, Region Vastra Gotaland, Gothenburg, Sweden; Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Marcus Ståleby
- Department of Radiology, Section of diagnostic and interventional neuroradiology, Sahlgrenska University Hospital, Region Vastra Gotaland, Gothenburg, Sweden; Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Daniel Nilsson
- Department of Clinical Neuroscience, Institute of Neurosciences and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden
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Han HJ, Lee W, Kim J, Park KY, Park SK, Chung J, Kim YB. Incidence rate and predictors of recurrent aneurysms after clipping: long-term follow-up study of survivors of subarachnoid hemorrhage. Neurosurg Rev 2022; 45:3209-3217. [PMID: 35739336 DOI: 10.1007/s10143-022-01828-x] [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: 03/11/2022] [Revised: 06/08/2022] [Accepted: 06/16/2022] [Indexed: 10/17/2022]
Abstract
Recurrent aneurysms are a major cause of re-aneurysmal subarachnoid hemorrhage (aSAH), but information on long-term clip durability and predictors is insufficient. This study aimed to present the incidence rate of > 10 years and investigate predictors of a recurrent aneurysm in aSAH survivors. We included 1601 patients admitted with aSAH and treated by microsurgical clipping between January 1993 and May 2010. Of these patients, 435 aSAH survivors were included in this study (27.2%). The total follow-up time was 5680.9 patient-years, and the overall incidence rate was 0.77% per patient-year. The cumulative probability of recurrence without residua and regrowth of the neck remnant was 0.7% and 13.9% at 10 years, respectively. Neck remnant (hazard ratio [HR], 10.311; 95% confidence interval [CI], 5.233-20.313) and alcohol consumption over the moderate amount (HR, 3.166; 95% CI, 1.313-7.637) were independent risk factors of recurrent aneurysm. Current smoking and multiplicity at initial aSAH presentation were significant factors in a univariate analysis. Furthermore, de novo intracranial aneurysms (DNIAs) were more common in the recurrent group than in the non-recurrent group (40.9% vs. 11.5%, P < 0.001). In the present study, we noted the long-term clip durability and predictor of recurrence after microsurgical clipping. These findings can assist clinicians in identifying patients at a high risk of recurrent aneurysm and recommending selective long-term surveillance after microsurgical clipping.
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Affiliation(s)
- Hyun Jin Han
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Woosung Lee
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Junhyung Kim
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Keun Young Park
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Sang Kyu Park
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Joonho Chung
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yong Bae Kim
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
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Fujimura S, Tanaka K, Takao H, Okudaira T, Koseki H, Hasebe A, Suzuki T, Uchiyama Y, Ishibashi T, Otani K, Karagiozov K, Fukudome K, Hayakawa M, Yamamoto M, Murayama Y. Computational fluid dynamic analysis of the initiation of cerebral aneurysms. J Neurosurg 2022; 137:335-343. [PMID: 34933277 DOI: 10.3171/2021.8.jns211452] [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: 06/14/2021] [Accepted: 08/09/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Relationships between aneurysm initiation and hemodynamic factors remain unclear since de novo aneurysms are rarely observed. Most previous computational fluid dynamics (CFD) studies have used artificially reproduced vessel geometries before aneurysm initiation for analysis. In this study, the authors investigated the hemodynamic factors related to aneurysm initiation by using angiographic images in patients with cerebral aneurysms taken before and after an aneurysm formation. METHODS The authors identified 10 cases of de novo aneurysms in patients who underwent follow-up examinations for existing cerebral aneurysms located at a different vessel. The authors then reconstructed the vessel geometry from the images that were taken before aneurysm initiation. In addition, 34 arterial locations without aneurysms were selected as control cases. Hemodynamic parameters acting on the arterial walls were calculated by CFD analysis. RESULTS In all de novo cases, the aneurysmal initiation area corresponded to the highest wall shear stress divergence (WSSD point), which indicated that there was a strong tensile force on the arterial wall at the initiation area. The other previously reported parameters did not show such correlations. Additionally, the pressure loss coefficient (PLc) was statistically significantly higher in the de novo cases (p < 0.01). The blood flow impact on the bifurcation apex, or the secondary flow accompanied by vortices, resulted in high tensile forces and high total pressure loss acting on the vessel wall. CONCLUSIONS Aneurysm initiation may be more likely in an area where both tensile forces acting on the vessel wall and total pressure loss are large.
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Affiliation(s)
- Soichiro Fujimura
- 1Department of Mechanical Engineering, Tokyo University of Science
- Departments of2Innovation for Medical Information Technology and
| | - Kazutoshi Tanaka
- Departments of2Innovation for Medical Information Technology and
| | - Hiroyuki Takao
- Departments of2Innovation for Medical Information Technology and
- 3Neurosurgery, The Jikei University School of Medicine
- 4Graduate School of Mechanical Engineering, Tokyo University of Science
| | - Takuma Okudaira
- Departments of2Innovation for Medical Information Technology and
| | | | - Akiko Hasebe
- 6Department of Neurosurgery, Fujita Health University, Aichi, Japan
| | - Takashi Suzuki
- Departments of2Innovation for Medical Information Technology and
- 5Siemens Healthcare K. K., Tokyo; and
| | - Yuya Uchiyama
- Departments of2Innovation for Medical Information Technology and
- 4Graduate School of Mechanical Engineering, Tokyo University of Science
| | | | - Katharina Otani
- 3Neurosurgery, The Jikei University School of Medicine
- 5Siemens Healthcare K. K., Tokyo; and
| | | | - Koji Fukudome
- 1Department of Mechanical Engineering, Tokyo University of Science
| | | | - Makoto Yamamoto
- 1Department of Mechanical Engineering, Tokyo University of Science
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Han HJ, Lee W, Kim J, Park KY, Park SK, Chung J, Kim YB. Formation, Growth, or Rupture of De Novo Intracranial Aneurysms: Long-Term Follow-up Study of Subarachnoid Hemorrhage Survivors. Neurosurgery 2021; 89:1104-1111. [PMID: 34634821 DOI: 10.1093/neuros/nyab364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 08/06/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The survival rate of aneurysmal subarachnoid hemorrhage (aSAH) has gradually increased, leading to more clinical cases of de novo intracranial aneurysms (DNIAs). OBJECTIVE To identify the characteristics of patients with DNIA growth or rupture. METHODS We included 1601 patients with aSAH treated by clipping from January 1993 to May 2010. According to the inclusion and exclusion criteria, 233 patients had no DNIAs, and 63 patients had 77 DNIAs. We assessed the incidence rate of DNIAs and risk factors for DNIA formation. After dichotomizing the DNIA group into the heed (patients with DNIA rupture or growth) and stable groups (patients without DNIA growth), we assessed the risk factors for DNIA growth or rupture. RESULTS The total follow-up period was 4427.9 patient-years. The incidence rate per patient-year was 1.42%. Age ≤50 yr, family history of aneurysm, and multiplicity at initial aSAH were significant risk factors for DNIA formation. Multivariate regression analysis revealed that female sex (odds ratio [OR], 5.566; 95% confidence interval [CI], 1.241-24.952), duration from initial aSAH to DNIA detection <120 mo (OR, 5.043; 95% CI, 1.362-18.668), multiplicity at initial aSAH (OR, 4.859; 95% CI, 1.207-19.563), and maximum DNIA diameter ≥4 mm (OR, 11.104; 95% CI, 2.337-52.772) were significant risk factors for DNIA growth or rupture. CONCLUSION DNIAs had a higher incidence rate than expected. Taking into account the presented incidence rate and risk factors, long-term surveillance in aSAH survivors for more than a decade may be worth considering, at least on a case-by-case basis.
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Affiliation(s)
- Hyun Jin Han
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Woosung Lee
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Junhyung Kim
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Keun Young Park
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sang Kyu Park
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Joonho Chung
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yong Bae Kim
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Tawk RG, Hasan TF, D'Souza CE, Peel JB, Freeman WD. Diagnosis and Treatment of Unruptured Intracranial Aneurysms and Aneurysmal Subarachnoid Hemorrhage. Mayo Clin Proc 2021; 96:1970-2000. [PMID: 33992453 DOI: 10.1016/j.mayocp.2021.01.005] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 12/27/2020] [Accepted: 01/12/2021] [Indexed: 12/11/2022]
Abstract
Unruptured intracranial aneurysms (UIAs) are commonly acquired vascular lesions that form an outpouching of the arterial wall due to wall thinning. The prevalence of UIAs in the general population is 3.2%. In contrast, an intracranial aneurysm may be manifested after rupture with classic presentation of a thunderclap headache suggesting aneurysmal subarachnoid hemorrhage (SAH). Previous consensus suggests that although small intracranial aneurysms (<7 mm) are less susceptible to rupture, aneurysms larger than 7 mm should be treated on a case-by-case basis with consideration of additional risk factors of aneurysmal growth and rupture. However, this distinction is outdated. The PHASES score, which comprises data pooled from several prospective studies, provides precise estimates by considering not only the aneurysm size but also other variables, such as the aneurysm location. The International Study of Unruptured Intracranial Aneurysms is the largest observational study on the natural history of UIAs, providing the foundation to the current guidelines for the management of UIAs. Although SAH accounts for only 3% of all stroke subtypes, it is associated with considerable burden of morbidity and mortality. The initial management is focused on stabilizing the patient in the intensive care unit with close hemodynamic and serial neurologic monitoring with endovascular or open surgical aneurysm treatment to prevent rebleeding. Since the results of the International Subarachnoid Aneurysm Trial, treatment of aneurysmal SAH has shifted from surgical clipping to endovascular coiling, which demonstrated higher odds of survival free of disability at 1 year after SAH. Nonetheless, aneurysmal SAH remains a public health hazard and is associated with high rates of disability and death.
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Affiliation(s)
- Rabih G Tawk
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL.
| | - Tasneem F Hasan
- Department of Neurology, Ochsner Louisiana State University Health Sciences Center, Shreveport
| | | | | | - William D Freeman
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL; Department of Neurology, Mayo Clinic, Jacksonville, FL; Department of Critical Care, Mayo Clinic, Jacksonville, FL
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Gokbel A, Secer M, Polat O. Assessment of risk factors in de novo aneurysm development. Brain Circ 2020; 6:208-210. [PMID: 33210047 PMCID: PMC7646385 DOI: 10.4103/bc.bc_2_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 05/22/2020] [Accepted: 07/08/2020] [Indexed: 11/19/2022] Open
Abstract
Aneurysms that occur anywhere in intracranial except where primary aneurysms develop, are called “de novo aneurysms”. The risk factors and formation time of de novo aneurysms are not fully known. Congenital, environmental and hemodynamic factors can play a role in aneurysm development. The 43-year-old female patient was operated with the middle cerebral artery superior trunk aneurysm in our clinic. She came to us again after 17 months with a severe headache. In computed cranial tomography angiography, the middle cerebral artery superior trunk placement aneurysm was found to have a partial clip and “de novo aneurysm” was developed. She was re-operated for “de novo aneurysm”. In this study, the risk factors in development of “de novo aneurysms” were discussed in the light of literature through this patient.
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Affiliation(s)
- Aykut Gokbel
- Department of Neurosurgery, Kocaeli Provincial Health Directorate Health Sciences University Derince Training and Research Hospital, Kocaeli, Turkey
| | - Mehmet Secer
- Department of Neurosurgery, Kocaeli Provincial Health Directorate Health Sciences University Derince Training and Research Hospital, Kocaeli, Turkey
| | - Omer Polat
- Department of Neurosurgery, Duzce University Faculty of Medicine Hospital, Duzce, Turkey
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Rotim K, Raguž M, Rotim A, Splavski B, Kalousek V. LATE ANEURYSM RELAPSE AFTER MICROSURGICAL TREATMENT OF MIDDLE CEREBRAL ARTERY ANEURYSM: A CASE REPORT AND LITERATURE REVIEW OF TREATMENT OPTIONS. Acta Clin Croat 2020; 59:532-538. [PMID: 34177065 PMCID: PMC8212637 DOI: 10.20471/acc.2020.59.03.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Recurrence of intracranial aneurysm after initial microsurgical or endovascular treatment is uncommon. Although the exact etiology remains unknown, recurrent aneurysms may be observed in surgical patients with big and multiple aneurysms, arterial hypertension, non-atherosclerotic cerebrovascular arteriopathies, as well as in those with a familial history of the disease. Such recurrence can occur over a wide period ranging from several months to years after the initial aneurysm treatment. Still, the occurrence delayed by more than 20 years is rather unusual. Herein, we present a case of a 70-year-old female patient who developed late intracranial aneurysm relapse 30 years after successful microsurgical clipping of the middle cerebral artery aneurysm. We also provide a brief review of relevant literature, discussing the etiology and pathophysiology of aneurysm reappearance, as well as different treatment options available. In conclusion, one should always consider the possibility of intracranial aneurysm recurrence regardless of the mode and time of primary surgery. In such a case, a multidisciplinary management approach using flow diverting endovascular techniques is advised in selected patients.
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Affiliation(s)
| | - Marina Raguž
- 1Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 3University of Applied Health Sciences, Zagreb, Croatia; 4Department of Neurosurgery, Dubrava University Hospital, Zagreb, Croatia; 5Josip Juraj Strossmayer University of Osijek, School of Dental Medicine and Health, Osijek, Croatia; 6Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Ante Rotim
- 1Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 3University of Applied Health Sciences, Zagreb, Croatia; 4Department of Neurosurgery, Dubrava University Hospital, Zagreb, Croatia; 5Josip Juraj Strossmayer University of Osijek, School of Dental Medicine and Health, Osijek, Croatia; 6Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Bruno Splavski
- 1Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 3University of Applied Health Sciences, Zagreb, Croatia; 4Department of Neurosurgery, Dubrava University Hospital, Zagreb, Croatia; 5Josip Juraj Strossmayer University of Osijek, School of Dental Medicine and Health, Osijek, Croatia; 6Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Vladimir Kalousek
- 1Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 3University of Applied Health Sciences, Zagreb, Croatia; 4Department of Neurosurgery, Dubrava University Hospital, Zagreb, Croatia; 5Josip Juraj Strossmayer University of Osijek, School of Dental Medicine and Health, Osijek, Croatia; 6Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
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Yeon EK, Cho YD, Yoo DH, Lee SH, Kang HS, Cho WS, Kim JE, Han MH. De Novo Intracranial Aneurysms Detected on Imaging Follow-Up of Coiled Aneurysms in a Korean Population. Korean J Radiol 2020; 20:1390-1398. [PMID: 31464117 PMCID: PMC6715560 DOI: 10.3348/kjr.2018.0914] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 06/12/2019] [Indexed: 11/29/2022] Open
Abstract
Objective Coiled aneurysms are known to recanalize over time, making follow-up evaluations mandatory. Although de novo intracranial aneurysms (DNIAs) are occasionally detected during routine patient monitoring, such events have not been thoroughly investigated to date. Herein, we generated estimates of DNIA development during long-term observation of coiled cerebral aneurysms, focusing on incidence and the risk factors involved. Materials and Methods In total, 773 patients undergoing coil embolization of intracranial aneurysms between 2008 and 2010 were reviewed retrospectively. Their medical records and radiologic data accrued over the extended period (mean, 52.7 ± 29.7 months) were analyzed. For the detection of DNIA, follow-up magnetic resonance angiography and/or conventional angiography were used. The incidence of DNIAs and related risk factors were analyzed using Cox proportional hazards regression and Kaplan-Meier product-limit estimator. Results In 19 (2.5%) of the 773 patients with coiled aneurysms, DNIAs (0.56% per patient-year) developed during continued long-term monitoring (3395.3 patient-years). Of these, 9 DNIAs (47.4%) were detected within 60 months, with 10 (52.6%) emerging thereafter. The most common site involved was the posterior communicating artery (n = 6), followed by the middle cerebral artery (n = 5) and the basilar top (n = 4). Multivariate analysis indicated that younger age (< 50 years) (hazard ratio [HR] = 1.045; p = 0.010) and recanalization of coiled aneurysms (HR = 2.560; p = 0.047) were significant factors in DNIA formation, whereas female sex, smoking, and hypertension fell short of statistical significance. Cumulative survival rates without DNIA were significantly higher in older subjects (> 60 years; p < 0.001) and in the absence of post-coiling aneurysm recurrence (p = 0.006). Conclusion In most patients with coiled aneurysms, development of DNIAs during long-term monitoring is rare. However, younger patients (< 50 years) or patients with recurring aneurysms appear to be predisposed to DNIAs.
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Affiliation(s)
- Eung Koo Yeon
- Department of Radiology, KyungHee University Medical Center, KyungHee University College of Medicine, Seoul, Korea
| | - Young Dae Cho
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
| | - Dong Hyun Yoo
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Su Hwan Lee
- Department of Neurosurgery, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
| | - Hyun Seung Kang
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Won Sang Cho
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong Eun Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Moon Hee Han
- Department of Radiology, Veterans Health Service Medical Center, Seoul, Korea
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Giordan E, Lanzino G, Rangel-Castilla L, Murad MH, Brinjikji W. Risk of de novo aneurysm formation in patients with a prior diagnosis of ruptured or unruptured aneurysm: systematic review and meta-analysis. J Neurosurg 2019; 131:14-24. [PMID: 29979115 DOI: 10.3171/2018.1.jns172450] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 01/19/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE De novo aneurysms are rare entities periodically discovered during follow-up imaging. Little is known regarding the frequency with which these lesions form or the time course. This systematic review and meta-analysis was undertaken to estimate the incidence of de novo aneurysms and to determine risk factors for aneurysm formation. METHODS The authors searched multiple databases for studies of patients with unruptured and ruptured aneurysms describing the rate of de novo aneurysm formation. The primary outcome was incidence of de novo aneurysm formation. A meta-analysis was performed using a random-effects model. The authors examined the associations of multiple aneurysms, prior subarachnoid hemorrhage, smoking, sex, age at presentation, and hypertension with de novo aneurysm formation. RESULTS The meta-analysis included 14,968 aneurysm patients who received imaging follow-up from 35 studies. The overall incidence of de novo aneurysm formation was 2% (95% CI 2%-3%) over a mean follow-up time of 8.3 years. The estimated incidence density was 0.3%/patient-year. There was no statistically significant difference in rates of de novo aneurysm formation between patients who had ruptured aneurysms and those with unruptured aneurysms. In 8 studies, 11.2% of de novo aneurysms were found in patients with ≤ 5 years of follow-up and 88.8% were found at > 5 years. The mean time to rupture for de novo aneurysms was 10 years. CONCLUSIONS This systematic review demonstrates that formation of de novo aneurysms is rare. Overall, routine screening for de novo aneurysms is likely to be of low yield and could be performed at time intervals of at least 5 to 10 years.
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Kim M, Lee HS, Lee S, Park JC, Ahn JS, Kwon DH, Kwun BD, Park W. Pediatric Intracranial Aneurysms: Favorable Outcomes Despite Rareness and Complexity. World Neurosurg 2019; 125:e1203-e1216. [PMID: 30794975 DOI: 10.1016/j.wneu.2019.01.280] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 01/27/2019] [Accepted: 01/30/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Pediatric intracranial aneurysms (IAs) are rare and differ from their adult counterparts in terms of their aneurysmal characteristics, presentation, treatment, and outcomes. Their treatment is often more difficult and complex compared with that of adults. However, studies outlining the clinical effect of pediatric IAs remain sparse. METHODS We retrospectively reviewed the data from patients aged ≤18 years admitted to our hospital from 2000 to 2017 with a diagnosis of IAs. RESULTS From the sample of 8207 patients with an IA diagnosis, 26 patients with 33 IAs were involved. Our cohort included 17 males and 9 females, with a mean age of 12.5 years. The mean follow-up duration was 4 years and 3 months. Seven patients (26.92%) were assumed to have a traumatic origin for their IAs. Ruptured aneurysms were more common than unruptured ones (61.53% vs. 38.46%). Complex features were observed in 14 aneurysms (42.42%). Initially, microsurgical and endovascular treatment were both performed in 10 patients (38.46%). A good recovery was obtained in 16 patients (61.54%) as determined by the Glasgow outcome scale scores at the 6-month follow-up visits. The complete obliteration of aneurysms was observed in 17 patients (65.38%). Endovascular treatment was the initial treatment in 3 patients with incomplete obliteration. CONCLUSIONS The treatment of pediatric IAs is challenging and technically demanding owing to their discrete nature compared with adult IAs and the need for greater surgical skills. We found a male predominance, with internal carotid artery bifurcation as the most frequent location of the aneurysms. Despite the greater incidence of ruptured and complex aneurysm cases, many patients had experienced a good recovery at the 6-month follow-up examinations.
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Affiliation(s)
- Moinay Kim
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Heui Seung Lee
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seungjoo Lee
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jung Cheol Park
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae Sung Ahn
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Do Hoon Kwon
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Byung Duk Kwun
- Department of Neurosurgery, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Wonhyoung Park
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
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Risk of de novo aneurysm formation in patients with unruptured intracranial aneurysms. Acta Neurochir (Wien) 2018; 160:747-751. [PMID: 29417227 DOI: 10.1007/s00701-018-3472-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 01/16/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND PURPOSE The rate of de novo aneurysm formation in patients with unruptured aneurysm without history of subarachnoid hemorrhage is scarcely defined in literature. We report the incidence of de novo aneurysm formation in a large contemporary series of patients with unruptured intracranial aneurysm (UIA) undergoing serial neurovascular imaging. METHODS Neurovascular imaging studies of 321 consecutive UIA patients with no prior history of subarachnoid hemorrhage, with at least 3 years of follow-up imaging, were reviewed by a neuroradiologist and a neurosurgeon. Rate of de novo aneurysm formation was reported on a per-patient and per-patient-year basis. RESULTS Of the 321 included patients, three patients (0.9%) developed a de novo aneurysm over a mean follow-up period of 5.2 years, for an incidence rate of 0.18% per patient-year. No de novo aneurysms ruptured and all three were 2 mm in size. CONCLUSIONS The rate of de novo aneurysm formation in patients with unruptured aneurysms and no history of subarachnoid hemorrhage is very low. These data are useful to advice patients with unruptured aneurysms from another aneurysm and to plan imaging follow-ups in these patients.
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Ghali MG, Srinivasan VM, Cherian J, Wagner KM, Chen SR, Johnson J, Lam SK, Kan P. Multimodal Treatment of Intracranial Aneurysms in Children: Clinical Case Series and Review of the Literature. World Neurosurg 2018; 111:e294-e307. [DOI: 10.1016/j.wneu.2017.12.057] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 12/07/2017] [Accepted: 12/09/2017] [Indexed: 12/18/2022]
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Walter J, Unterberg AW, Zweckberger K. Lethal Ultra-Early Subarachnoid Hemorrhage Due to Rupture of De Novo Aneurysm 5 Months After Primary Aneurysmatic Subarachnoid Hemorrhage. World Neurosurg 2018; 113:316-319. [PMID: 29482004 DOI: 10.1016/j.wneu.2018.02.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 02/14/2018] [Accepted: 02/15/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Approximately 1% of all patients surviving rupture of a cerebral aneurysm suffer from a second aneurysmatic subarachnoid hemorrhage later in their lives, 61% of which are caused by rupture of a de novo aneurysm. Latency between bleedings is usually many years, and younger patients tend to achieve better outcomes from a second subarachnoid hemorrhage. CASE DESCRIPTION We report an unusual case of lethal ultra-early rupture of a de novo aneurysm of the anterior communicating artery only 5 months after the initial subarachnoid hemorrhage and complete coiling in a young, healthy male patient. CONCLUSION Despite complete aneurysm obliteration, young age, and good recovery, patients may be subjected to secondary subarachnoid hemorrhages from de novo aneurysms after only a few months of the initial bleeding. Early-control magnetic resonance angiography might hence be advisable.
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Affiliation(s)
- Johannes Walter
- Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Andreas W Unterberg
- Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Klaus Zweckberger
- Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany.
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Ghali MGZ, Srinivasan VM, Cherian J, Kim L, Siddiqui A, Aziz-Sultan MA, Froehler M, Wakhloo A, Sauvageau E, Rai A, Chen SR, Johnson J, Lam SK, Kan P. Pediatric Intracranial Aneurysms: Considerations and Recommendations for Follow-Up Imaging. World Neurosurg 2017; 109:418-431. [PMID: 28986225 DOI: 10.1016/j.wneu.2017.09.150] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 09/20/2017] [Accepted: 09/21/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Pediatric intracranial aneurysms (IAs) are rare. Compared with adult IAs, they are more commonly giant, fusiform, or dissecting. Treatment often proves more complex, and recurrence rate and de novo aneurysmogenesis incidence are higher. A consensus regarding the most appropriate algorithm for following pediatric IAs is lacking. METHODS We sought to generate recommendations based on the reported experience in the literature with pediatric IAs through a thorough review of the PubMed database, discussion with experienced neurointerventionalists, and our own experience. RESULTS Digital subtraction angiography (DSA) was utilized immediately post-operatively for microsurgically-clipped and endovascularly-treated IAs, at 6-12 months postoperatively for endovascularly-treated IAs, and in cases of aneurysmal recurrence or de novo aneurysmogenesis discovered by non-invasive imaging modalities. Computed tomographic angiography was the preferred imaging modality for long-term follow-up of microsurgically clipped IAs. Magnetic resonance angiography (MRA) was the preferred modality for following IAs that were untreated, endovascularly-treated, or microsurgically-treated in a manner other than clipping. CONCLUSIONS We propose incidental untreated IAs to be followed by magnetic resonance angiography without contrast enhancement. Follow-up modality and interval for treated pediatric IAs is determined by initial aneurysmal complexity, treatment modality, and degree of posttreatment obliteration. Recurrence or de novo aneurysmogenesis requiring treatment should be followed by digital subtraction angiography and appropriate retreatment. Computed tomography angiography is preferred for clipped IAs, whereas contrast-enhanced magnetic resonance angiography is preferred for lesions treated endovascularly with coil embolization and lesions treated microsurgically in a manner other than clipping.
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Affiliation(s)
- Michael George Zaki Ghali
- Department of Neurosurgery, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA; Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | | | - Jacob Cherian
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Louis Kim
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Adnan Siddiqui
- Department of Neurosurgery, University at Buffalo, Buffalo, New York, USA
| | - M Ali Aziz-Sultan
- Vascular and Endovascular Neurosurgery, Department of Neurosurgery, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Michael Froehler
- Department of Neurology, Vanderbilt School of Medicine, Nashville, Tennessee, USA
| | - Ajay Wakhloo
- Department of Radiology, University of Massachusetts, Worcester, Massachusetts, USA
| | - Eric Sauvageau
- Baptist Neurological Institute, Lyerly Neurosurgery, Jacksonville, Florida, USA
| | - Ansaar Rai
- Department of Interventional Neuroradiology, West Virginia University, Morgantown, West Virginia, USA
| | - Stephen R Chen
- Department of Radiology, Baylor College of Medicine, Houston, Texas, USA
| | - Jeremiah Johnson
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Sandi K Lam
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Peter Kan
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA.
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Watanabe Z, Tomura N, Akasu I, Munakata R, Horiuchi K, Watanabe K. Comparison of Rates of Growth between Unruptured and Ruptured Aneurysms Using Magnetic Resonance Angiography. J Stroke Cerebrovasc Dis 2017; 26:2849-2854. [PMID: 28826580 DOI: 10.1016/j.jstrokecerebrovasdis.2017.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 06/09/2017] [Accepted: 07/08/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND PURPOSE Growth is a key risk factor for rupture of unruptured cerebral aneurysms. There are few reports of investigations into the actual growth of ruptured intracranial aneurysms. The aim of the present study was to ascertain the risk of rupture of aneurysms based on the growth of unruptured and ruptured aneurysms. METHODS Changes in size on magnetic resonance angiography (MRA) were examined in 50 patients with ruptured cerebral aneurysms. Images obtained before and after subarachnoid hemorrhage were used. Moreover, changes in aneurysm size were retrospectively examined in 73 patients with 100 unruptured cerebral aneurysms that were followed serially with MRA that was performed using a 1.5-T or 3-T system. The size of the aneurysm was determined by measuring the maximum diameter on maximum intensity projection MRA images. Based on these data, the annual growth rates (mm growth/year) of unruptured and ruptured aneurysms were calculated and compared. RESULTS The median annual growth rate of ruptured aneurysms was significantly greater than that of unruptured aneurysms (.69 versus .077 mm/year, P < .01). The annual growth rates of ruptured aneurysms showed a negative correlation between the duration from initial MRA to the time of rupture. CONCLUSION A high annual growth rate is a key risk factor for aneurysm rupture. This finding provides strong evidence for the treatment of unruptured cerebral aneurysms.
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Affiliation(s)
- Zenichiro Watanabe
- Department of Neurosurgery, Southern TOHOKU Research Institute for Neuroscience, Southern TOHOKU General Hospital, Japan.
| | - Noriaki Tomura
- Department of Neuroradiology, Southern TOHOKU Research Institute for Neuroscience, Southern TOHOKU General Hospital, Japan
| | - Isao Akasu
- Department of Neurosurgery, Southern TOHOKU Research Institute for Neuroscience, Southern TOHOKU General Hospital, Japan
| | - Ryoji Munakata
- Department of Neurosurgery, Southern TOHOKU Research Institute for Neuroscience, Southern TOHOKU General Hospital, Japan
| | - Kazuomi Horiuchi
- Department of Neurosurgery, Southern TOHOKU Research Institute for Neuroscience, Southern TOHOKU General Hospital, Japan
| | - Kazuo Watanabe
- Department of Neurosurgery, Southern TOHOKU Research Institute for Neuroscience, Southern TOHOKU General Hospital, Japan
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Brinjikji W, Zhu YQ, Lanzino G, Cloft HJ, Murad MH, Wang Z, Kallmes DF. Risk Factors for Growth of Intracranial Aneurysms: A Systematic Review and Meta-Analysis. AJNR Am J Neuroradiol 2015; 37:615-20. [PMID: 26611992 DOI: 10.3174/ajnr.a4575] [Citation(s) in RCA: 139] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 07/21/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Understanding risk factors for intracranial aneurysm growth is important for patient management. We performed a meta-analysis examining risk factors for intracranial aneurysm growth in longitudinal studies and examined the association between aneurysm growth and rupture. MATERIALS AND METHODS We searched the literature for longitudinal studies of patients with unruptured aneurysms. We examined the associations of demographics, multiple aneurysms, prior subarachnoid hemorrhage, family history of aneurysm or subarachnoid hemorrhage, smoking, and hypertension; and aneurysm shape, size, and location with aneurysm growth. We studied the association between aneurysm growth and rupture. A meta-analysis was performed by using a random-effects model by using summary statistics from included studies. RESULTS Twenty-one studies including 3954 patients with 4990 aneurysms with 13,294 aneurysm-years of follow-up were included. The overall proportion of growing aneurysms was 3.0% per aneurysm-year (95% CI, 2.0%-4.0%). Patient risk factors for growth included age older than 50 years (3.8% per year versus 0.9% per year, P < .01), female sex (3.2% per year versus 1.3% per year, P < .01), and smoking history (5.5% per year versus 3.5% per year, P < .01). Characteristics associated with higher growth rates included cavernous carotid artery location (14.4% per year), nonsaccular shape (14.7% per year versus 5.2% per year for saccular, P < .01), and aneurysm size (P < .01). Aneurysm growth was associated with a rupture rate of 3.1% per year compared with 0.1% per year for stable aneurysms (P < .01). CONCLUSIONS Observational evidence provided multiple clinical and anatomic risk factors for aneurysm growth, including age older than 50 years, female sex, smoking history, and nonsaccular shape. These findings should be considered when counseling patients regarding the natural history of unruptured intracranial aneurysms.
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Affiliation(s)
- W Brinjikji
- From the Departments of Radiology (W.B., Y.-Q.Z., G.L., H.J.C., D.F.K.)
| | - Y-Q Zhu
- From the Departments of Radiology (W.B., Y.-Q.Z., G.L., H.J.C., D.F.K.)
| | - G Lanzino
- From the Departments of Radiology (W.B., Y.-Q.Z., G.L., H.J.C., D.F.K.) Neurosurgery (G.L., H.J.C., D.F.K.)
| | - H J Cloft
- From the Departments of Radiology (W.B., Y.-Q.Z., G.L., H.J.C., D.F.K.) Neurosurgery (G.L., H.J.C., D.F.K.)
| | - M H Murad
- Center for Science of Healthcare Delivery (M.H.M., Z.W.), Mayo Clinic, Rochester, Minnesota
| | - Z Wang
- Center for Science of Healthcare Delivery (M.H.M., Z.W.), Mayo Clinic, Rochester, Minnesota
| | - D F Kallmes
- From the Departments of Radiology (W.B., Y.-Q.Z., G.L., H.J.C., D.F.K.) Neurosurgery (G.L., H.J.C., D.F.K.)
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Wang JY, Smith R, Ye X, Yang W, Caplan JM, Radvany MG, Colby GP, Coon AL, Tamargo RJ, Huang J. Serial Imaging Surveillance for Patients With a History of Intracranial Aneurysm. Neurosurgery 2015; 77:32-42; discussion 42-3. [DOI: 10.1227/neu.0000000000000730] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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18
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Wenz H, Ehrlich G, Wenz R, al Mahdi MM, Scharf J, Groden C, Schmiedek P, Seiz-Rosenhagen M. MR angiography follow-up 10 years after cryptogenic nonperimesencephalic subarachnoid hemorrhage. PLoS One 2015; 10:e0117925. [PMID: 25688554 PMCID: PMC4331285 DOI: 10.1371/journal.pone.0117925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 01/05/2015] [Indexed: 11/23/2022] Open
Abstract
Objectives Long-term magnetic resonance angiography (MRA) follow-up studies regarding cryptogenic nonperimesencephalic subarachnoid hemorrhage (nSAH) are scarce. This single-centre study identified all patients with angiographically verified cryptogenic nSAH from 1998 to 2007: The two main objectives were to prospectively assess the incidence of de novo aneurysm with 3.0-MRI years after cryptogenic nSAH in patients without evidence for further hemorrhage, and retrospectively assess patient demographics and outcome. Methods From prospectively maintained report databases all patients with angiographically verified cryptogenic nSAH were identified. 21 of 29 patients received high-resolution 3T-MRI including time-of-flight and contrast-enhanced angiography, 10.2 ± 2.8 years after cryptogenic nSAH. MRA follow-up imaging was compared with initial digital subtraction angiography (DSA) and CT/MRA. Post-hemorrhage images were related to current MRI with reference to persistent lesions resulting from delayed cerebral ischemia (DCI) and post-hemorrhagic siderosis. Patient-based objectives were retrospectively abstracted from clinical databases. Results 29 patients were identified with cryptogenic nSAH, 17 (59%) were male. Mean age at time of hemorrhage was 52.9 ± 14.4 years (range 4 – 74 years). 21 persons were available for long-term follow-up. In these, there were 213.5 person years of MRI-follow-up. No de novo aneurysm was detected. Mean modified Rankin Scale (mRS) during discharge was 1.28. Post-hemorrhage radiographic vasospasm was found in three patients (10.3%); DCI-related lesions occurred in one patient (3.4%). Five patients (17.2%) needed temporary external ventricular drainage; long-term CSF shunt dependency was necessary only in one patient (3.4%). Initial DSA retrospectively showed a 2 x 2 mm aneurysm of the right distal ICA in one patient, which remained stable. Post-hemorrhage siderosis was detected 8.1 years after the initial bleeding in one patient (4.8%). Conclusion Patients with cryptogenic nSAH have favourable outcomes and do not exhibit higher risks for de novo aneurysms. Therefore the need for long-term follow up after cryptogenic nSAH is questionable.
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Affiliation(s)
- Holger Wenz
- University Medical Center Mannheim, University of Heidelberg, Department of Neuroradiology, Mannheim, Germany
- * E-mail:
| | - Gregory Ehrlich
- University Medical Center Mannheim, University of Heidelberg, Department of Neurosurgery, Mannheim, Germany
| | - Ralf Wenz
- University Medical Center Mannheim, University of Heidelberg, Department of Neuroradiology, Mannheim, Germany
| | - Mohamad-Motaz al Mahdi
- University Medical Center Mannheim, University of Heidelberg, Department of Neurosurgery, Mannheim, Germany
| | - Johann Scharf
- University Medical Center Mannheim, University of Heidelberg, Department of Neuroradiology, Mannheim, Germany
| | - Christoph Groden
- University Medical Center Mannheim, University of Heidelberg, Department of Neuroradiology, Mannheim, Germany
| | - Peter Schmiedek
- University Medical Center Mannheim, University of Heidelberg, Department of Neurosurgery, Mannheim, Germany
| | - Marcel Seiz-Rosenhagen
- University Medical Center Mannheim, University of Heidelberg, Department of Neurosurgery, Mannheim, Germany
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Kono K, Fujimoto T, Terada T. Proximal stenosis may induce initiation of cerebral aneurysms by increasing wall shear stress and wall shear stress gradient. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2014; 30:942-950. [PMID: 24706583 DOI: 10.1002/cnm.2637] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Revised: 02/02/2014] [Accepted: 03/10/2014] [Indexed: 06/03/2023]
Abstract
Hemodynamic parameters, such as wall shear stress (WSS), WSS gradient (WSSG), aneurysm formation indicator (AFI), or gradient oscillatory number (GON), have been proposed to be linked to initiation of cerebral aneurysms. However, how such conditions occur in humans is unclear. We encountered a rare and interesting case to address this issue. A patient had a newly formed aneurysm with proximal stenosis, which was confirmed by serial imagings. We made two pre-aneurysm models: one with stenosis and the other without stenosis. We performed computational fluid dynamics simulations for these models. Owing to jet flow caused by the stenosis, the maximum WSS and WSSG on the aneurysm initiation site were approximately doubled and tripled, respectively. However, the oscillatory shear index (OSI), AFI, and GON did not change substantially by the stenosis. Computer simulations using artificial vascular models with different degrees of proximal stenosis at different distances demonstrated that oscillatory shear index, AFI, and GON did not change substantially by the stenosis. These results showed that proximal stenosis caused high WSS and high WSSG at the aneurysm initiation site, possibly leading to aneurysm initiation. Proximal stenosis may be a potential factor to induce initiation of one class of cerebral aneurysms by increasing WSS and WSSG.
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Affiliation(s)
- Kenichi Kono
- Department of Neurosurgery, Wakayama Rosai Hospital, 93-1 Kinomoto, Wakayama 640-8505, Japan
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20
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Mortimer AM, Marsh H, Klimczak K, Joshi D, Barton H, Nelson RJ, Bradley MD, Renowden SA. Is long-term follow-up of adequately coil-occluded ruptured cerebral aneurysms always necessary? A single-center study of recurrences after endovascular treatment. J Neurointerv Surg 2014; 7:373-9. [PMID: 24721754 DOI: 10.1136/neurintsurg-2014-011152] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 03/24/2014] [Indexed: 11/04/2022]
Abstract
PURPOSE Aneurysm recurrence following coil occlusion is well recognized. However, there is controversy as to how long these patients should be followed up after coiling to detect reopening. We aimed to identify the rate of late reopening and the risk factors for reopening in a large single-center cohort of ruptured aneurysms that appeared adequately occluded at 6 months. We also aimed to assess whether rates of recurrence have altered over time with improving coil and angiographic technology. METHODS Patients treated between 1996 and 2010 were assessed and those with both 6-month initial and subsequent long-term follow-up with either digital subtraction angiography or magnetic resonance angiography were included. Aneurysms were stratified by features such as size, neck width, anatomical location and time of treatment: 1996-2005 (cohort 1) and 2006-2010 (cohort 2). ORs for risk of recurrence were calculated for aneurysm features and rates of recurrence in each cohort were compared using a χ(2) test. RESULTS 437 patients with 458 adequately occluded aneurysms at 6 months had mean long-term follow-up of 31 months; 57 (12.4%) were large (≥ 10 mm) and 104 (22.7%) were wide-necked (>4 mm). Nine aneurysms (2%) showed significant late anatomical deterioration whereby retreatment was considered or undertaken. The risk was greater for large aneurysms (≥ 10 mm) (OR 15.61, 95% CI 3.79 to 64.33, p=0.0001) or wide-necked aneurysms (>4 mm) (OR 12.70, 95% CI 2.60 to 62.13, p=0.0017). The frequency of significant late anatomical deterioration and retreatment was also less common in those treated in cohort 2 (p<0.05). No completely occluded aneurysm at 6 months demonstrated significant late recurrence. CONCLUSIONS Most aneurysms adequately occluded at 6 months did not show evidence of late recurrence. Large and wide-neck aneurysms are, however, at greater risk of later recurrence.
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Affiliation(s)
- Alex M Mortimer
- Department of Neuroradiology, Frenchay Hospital, Bristol, UK
| | - Hannah Marsh
- Department of Neuroradiology, Frenchay Hospital, Bristol, UK
| | | | - Dhiraj Joshi
- Department of Neuroradiology, Frenchay Hospital, Bristol, UK
| | - Helena Barton
- Department of Neuroradiology, Frenchay Hospital, Bristol, UK
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Neuroimaging follow-up of cerebral aneurysms treated with endovascular techniques. RADIOLOGIA 2014. [DOI: 10.1016/j.rxeng.2014.04.002] [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]
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Lai LT, Morgan MK, Patel NJ. Smoking increases the risk of de novo intracranial aneurysms. World Neurosurg 2014; 82:e195-201. [PMID: 24518886 DOI: 10.1016/j.wneu.2014.02.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Revised: 11/16/2013] [Accepted: 02/06/2014] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Case series have identified that de novo intracranial aneurysms occur. However, the risk for this occurrence has not been established. We examined the risk for the de novo intracranial aneurysm detection in a consecutive surgical case series. METHODS A prospectively collected surgical database of intracranial aneurysms was retrospectively examined. Patients were analyzed if they were followed for more than 6 months postoperatively with angiography. Kaplan-Meier curve analysis of de novo aneurysms detection included the comparison of smoking vs. never smoked; those with and without a family history; single vs. multiple aneurysms at initial presentation; and original presentation with rupture vs. nonrupture. RESULTS Of the 1366 surgically treated patients (1942 aneurysms), 472 patients (702 aneurysms) were followed with angiography for more than 6 months (average, 54 months). Thirty-three patients (6.99%) were detected to have de novo aneurysms. Multivariate analysis found a smoking history significantly increases the likelihood of de novo aneurysm detection. Kaplan-Meier analysis found the 5- and 10-year de novo aneurysm detection rate to be 4.21% (95% confidence interval [CI] 3.86-12.8) and 15% (95% CI 10-16), respectively. A smoking history increases the 5- and 10-year detection rate to 5.81% and 17% (hazard ratio 2.58; 95% CI 1.13-5.90) respectively. No increased risk was present for an initial presentation that included multiple aneurysms, a family history, or rupture. CONCLUSION There is a 10-year de novo aneurysm detection rate of between 10% and 16% after surgery. Smoking increases the risk of de novo aneurysm detection. Consideration needs to be given to surveillance angiography after aneurysm treatment.
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Affiliation(s)
- Leon Tat Lai
- Australian School of Advanced Medicine, Macquarie University, Sydney, New South Wales, Australia.
| | - Michael Kerin Morgan
- Australian School of Advanced Medicine, Macquarie University, Sydney, New South Wales, Australia
| | - Nirav J Patel
- Australian School of Advanced Medicine, Macquarie University, Sydney, New South Wales, Australia
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Wenz H, Al Mahdi MM, Ehrlich G, Scharf J, Schmiedek P, Seiz M. De novo aneurysm of the anterior communicating artery presenting with subarachnoid hemorrhage 7 years after initial cryptogenic subarachnoid hemorrhage: a case report and review of the literature. Clin Neuroradiol 2014; 25:93-7. [PMID: 24384679 DOI: 10.1007/s00062-013-0278-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 12/12/2013] [Indexed: 11/25/2022]
Abstract
Spontaneous subarachnoid hemorrhage (SAH) is usually caused by a ruptured cerebral aneurysm. Despite the use of initial four-vessel cerebral digital subtraction angiography (DSA), 15 % of all cases remain idiopathic. According to the initial computed tomographic scan, the spontaneous SAH can be divided into a perimesencephalic group associated with a benign nature and a nonperimesencephalic group with a similar clinical course as aneurysmal SAH. We present a case of a 49-year-old man with a de novo aneurysm formation of the anterior communicating artery with SAH 7 years after initial cryptogenic nonperimesencephalic SAH. This observation suggests that in some cases, long-term angiographic studies might be justified.
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Affiliation(s)
- H Wenz
- Department of Neuroradiology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany,
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Kono K, Masuo O, Nakao N, Meng H. De Novo Cerebral Aneurysm Formation Associated With Proximal Stenosis. Neurosurgery 2013; 73:E1080-90. [DOI: 10.1227/neu.0000000000000065] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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25
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Sorteberg A, Dahlberg D. Intracranial Non-traumatic Aneurysms in Children and Adolescents. Curr Pediatr Rev 2013; 9:343-352. [PMID: 24696670 PMCID: PMC3970571 DOI: 10.2174/221155281120100005] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 07/19/2013] [Accepted: 09/12/2013] [Indexed: 11/22/2022]
Abstract
An intracranial aneurysm in a child or adolescent is a rare, but potentially devastating condition. As little as approximately 1200 cases are reported between 1939 and 2011, with many of the reports presenting diverting results. There is consensus, though, in that pediatric aneurysms represent a pathophysiological entity different from their adult counterparts. In children, there is a male predominance. About two-thirds of pediatric intracranial aneurysms become symptomatic with hemorrhage and the rate of re-hemorrhage is higher than in adults. The rate of hemorrhage from an intracranial aneurysm peaks in girls around menarche. The most common aneurysm site in children is the internal carotid artery, in particular at its terminal ending. Aneurysms in the posterior circulation are more common in children than adults. Children more often develop giant aneurysms, and may become symptomatic from the mass effect of the aneurysm (tumorlike symptoms). The more complex nature of pediatric aneurysms poses a larger challenge to treatment alongside with higher demands to the durability of treatment. Outcome and mortality are similar in children and adults, but long-term outcome in the pediatric population is influenced by the high rate of aneurysm recurrences and de novo formation of intracranial aneurysms. This urges the need for life-long follow-up and screening protocols.
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Affiliation(s)
- Angelika Sorteberg
- Dept of Neurosurgery, Oslo University Hospital - Rikshsospitalet, The National Hospital, Oslo, Norway
| | - Daniel Dahlberg
- Dept of Neurosurgery, Oslo University Hospital - Rikshsospitalet, The National Hospital, Oslo, Norway
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Etminan N, Buchholz BA, Dreier R, Bruckner P, Torner JC, Steiger HJ, Hänggi D, Macdonald RL. Cerebral aneurysms: formation, progression, and developmental chronology. Transl Stroke Res 2013; 5:167-73. [PMID: 24323717 DOI: 10.1007/s12975-013-0294-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2013] [Revised: 10/06/2013] [Accepted: 10/08/2013] [Indexed: 02/08/2023]
Abstract
The prevalence of unruptured intracranial aneurysms (UIAs) in the general population is up to 3%. Existing epidemiological data suggests that only a small fraction of UIAs progress towards rupture over the lifetime of an individual, but the surrogates for subsequent rupture and the natural history of UIAs are discussed very controversially at present. In case of rupture of an UIA, the case fatality is up to 50%, which therefore continues to stimulate interest in the pathogenesis of cerebral aneurysm formation and progression. Actual data on the chronological development of cerebral aneurysm has been especially difficult to obtain and, until recently, the existing knowledge in this respect is mainly derived from animal or mathematical models or short-term observational studies. Here, we review the current data on cerebral aneurysm formation and progression as well as a novel approach to investigate the developmental chronology of cerebral aneurysms.
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Affiliation(s)
- Nima Etminan
- Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University, Moorenstrasse 5, 40225, Dusseldorf, Germany,
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Delgado F, Saiz A, Hilario A, Murias E, San Román Manzanera L, Lagares Gomez-Abascal A, Gabarrós A, González García A. [Neuroimaging follow-up of cerebral aneurysms treated with endovascular techniques]. RADIOLOGIA 2013; 56:118-28. [PMID: 24144295 DOI: 10.1016/j.rx.2013.06.003] [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: 03/12/2013] [Revised: 06/25/2013] [Accepted: 06/25/2013] [Indexed: 11/25/2022]
Abstract
There are no specific recommendations in clinical guidelines about the best time, imaging tests, or intervals for following up patients with intracranial aneurysms treated with endovascular techniques. We reviewed the literature, using the following keywords to search in the main medical databases: cerebral aneurysm, coils, endovascular procedure, and follow-up. Within the Cerebrovascular Disease Group of the Spanish Society of Neuroradiology, we aimed to propose recommendations and an orientative protocol based on the scientific evidence for using neuroimaging to monitor intracranial aneurysms that have been treated with endovascular techniques. We aimed to specify the most appropriate neuroimaging techniques, the interval, the time of follow-up, and the best approach to defining the imaging findings, with the ultimate goal of improving clinical outcomes while optimizing and rationalizing the use of available resources.
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Affiliation(s)
- F Delgado
- Sección de Neurorradiología, Servicio de Radiodiagnóstico, Hospital Reina Sofia, Córdoba, España
| | - A Saiz
- Sección de Neurorradiología, Servicio de Radiodiagnóstico, Hospital Universitario Central de Asturias, Oviedo, España
| | - A Hilario
- Sección de Neurorradiología, Servicio de Radiodiagnóstico, Hospital 12 de Octubre, Madrid, España
| | - E Murias
- Sección de Neurorradiología, Servicio de Radiodiagnóstico, Hospital Universitario Central de Asturias, Oviedo, España
| | - L San Román Manzanera
- Sección de Neurorradiología, Servicio de Radiodiagnóstico, Hospital Clinic, Barcelona, España
| | | | - A Gabarrós
- Servicio Neurocirugía, Hospital de Bellvitge, Barcelona, España
| | - A González García
- Sección de Neurorradiología, Servicio de Radiodiagnóstico, Hospital Universitario Virgen del Rocío, Sevilla, España.
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Zali A, Khoshnood RJ, Zarghi A. De novo aneurysms in long-term follow-up computed tomographic angiography of patients with clipped intracranial aneurysms. World Neurosurg 2013; 82:722-5. [PMID: 23827320 DOI: 10.1016/j.wneu.2013.06.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2012] [Revised: 01/20/2013] [Accepted: 06/25/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE This study was undertaken to evaluate de novo aneurysm formation in the long-term follow-up of patients with clipped aneurysms. METHODS Of 459 patients who underwent clipping of ruptured cerebral aneurysms at our institution between 1997 and 2008, 119 patients were available in good condition and agreed to undergo 64-detector row computed tomographic (CT) angiography. In addition, eight patients underwent CT angiography for new subarachnoid hemorrhage. RESULTS The mean ± standard deviation interval from surgery was 7.2 ± 2.3 years for CT angiography controlled patients. De novo aneurysms were detected in 5 of 119 (4.5%) patients and 4 of 8 patients with new subarachnoid hemorrhage. A history of multiple aneurysms was associated with de novo aneurysm formation (P < 0.001). CONCLUSION The risk of de novo aneurysm formation in patients with clipped aneurysms is significant in long-term follow-up. CT angiography can be used as a noninvasive method for detection of de novo aneurysms in these patients.
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Affiliation(s)
- Alireza Zali
- Department of Neurosurgery, Functional Neurosurgery Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Reza Jalili Khoshnood
- Department of Neurosurgery, Functional Neurosurgery Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Afsaneh Zarghi
- Department of Neuroscience, Functional Neurosurgery Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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29
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Etame AB, Bentley JN, Pandey AS. Acute expansion of an asymptomatic posterior communicating artery aneurysm resulting in oculomotor nerve palsy. BMJ Case Rep 2013; 2013:bcr-2013-010134. [PMID: 23761613 DOI: 10.1136/bcr-2013-010134] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Acute expansion of an intracranial aneurysm is an extremely rare event. In this report, we describe the unusual radiographic documentation of acute expansion of a posterior communicating artery (PCOM) aneurysm from 4 to 8 mm, resulting in complete oculomotor nerve palsy. A 40-year-old man was admitted to our institution with a 3-week history of persistent occipital headaches but was otherwise neurologically intact. CT angiography demonstrated a 4 mm left PCOM aneurysm. Digital subtraction angiography performed several hours following presentation demonstrated an expansion in aneurysm size to 8 mm with new-onset complete oculomotor nerve palsy. The aneurysm was successfully obliterated by clip ligation. Although growth in aneurysm size is often a progressive phenomenon, acute expansions of aneurysms can occur.
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Affiliation(s)
- Arnold B Etame
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
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30
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Lindvall P, Borota L, Birgander R, Jonasson P, Ridderheim PÅ. Long-Term Follow-Up of Intracranial Aneurysms Treated With Endovascular Coiling. Vasc Endovascular Surg 2012; 46:325-8. [DOI: 10.1177/1538574412445602] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Peter Lindvall
- Department of Neurosurgery, Umeå University Hospital, Umeå, Sweden
| | - Ljubisa Borota
- Department of Radiation Sciences, Diagnostic Radiology, Umeå University Hospital, Umeå, Sweden
| | - Richard Birgander
- Department of Radiation Sciences, Diagnostic Radiology, Umeå University Hospital, Umeå, Sweden
| | - Per Jonasson
- Department of Radiation Sciences, Diagnostic Radiology, Umeå University Hospital, Umeå, Sweden
| | - Per-Åke Ridderheim
- Department of Radiation Sciences, Diagnostic Radiology, Umeå University Hospital, Umeå, Sweden
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31
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Spilberg G, Carniato SL, King RM, van der Bom IMJ, Mehra M, Walvick RP, Wakhloo AK, Gounis MJ. Temporal evolution of susceptibility artifacts from coiled aneurysms on MR angiography: an in vivo canine study. AJNR Am J Neuroradiol 2012; 33:655-60. [PMID: 22194374 PMCID: PMC8050436 DOI: 10.3174/ajnr.a2831] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Accepted: 06/27/2011] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Intracranial aneurysms treated by coiling have a risk for recurrence, requiring surveillance imaging. MRA has emerged as an attractive technique for postcoiling aneurysm imaging. Previous research has evaluated MR imaging artifacts of the coil mass in vitro. Our aim in this study was to evaluate MR imaging artifacts of coiled aneurysms in vivo with time. MATERIALS AND METHODS Four sidewall aneurysms were created in each of 4 dogs. Aneurysms were embolized receiving only 1 type of coils. After embolization, the animals were transferred to MR imaging, which included axial 3D TOF MRA (TEs, 3.5, 5, and 6.9 ms), phase-contrast MRA, and coronal CE-MRA. MR imaging studies were repeated at 1, 4, 6, 8, 14, and 28 weeks. We calculated an OEF: OEF = V(A)/V(CM), where the numerator represents the volume of the MR imaging artifacts and the denominator is the true volume of the coil mass measured by 3D RA. RESULTS OEFs were largest immediately after embolization and showed a gradual decay until approximately 4 weeks, when there was stabilization of the size of the artifacts. By 4 weeks, there was mild coil compaction (average coil mass volume decrease of 7.8%); however, the OEFs decreased by 25% after 4 weeks (P < .001). CONCLUSIONS MR imaging susceptibility artifacts change with time, being maximal in the postembolization setting and decaying until 4 weeks. The clinical implications of this study are that baseline MRA for comparison with future imaging should be acquired at a minimum of 1 week after the procedure.
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Affiliation(s)
- G Spilberg
- Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts 01655, USA
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Hetts SW, English JD, Dowd CF, Higashida RT, Scanlon JT, Halbach VV. Pediatric intracranial aneurysms: new and enlarging aneurysms after index aneurysm treatment or observation. AJNR Am J Neuroradiol 2011; 32:2017-22. [PMID: 22081674 DOI: 10.3174/ajnr.a2680] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Children with brain aneurysms may be at higher risk than adults to develop new or enlarging aneurysms in a relatively short time. We sought to identify comorbidities and angiographic features in children that predict new aneurysm formation or enlargement of untreated aneurysms. MATERIALS AND METHODS Retrospective analysis of the University of California-San Francisco Pediatric Aneurysm Cohort data base including medical records and imaging studies was performed. RESULTS Of 83 patients harboring 114 intracranial aneurysms not associated with brain arteriovenous malformations or intracranial arteriovenous fistulas, 9 (8.4%) developed new or enlarging brain aneurysms an average of 4.2 years after initial presentation. Comorbidities that may be related to aneurysm formation were significantly higher in patients who developed new aneurysms (89%) as opposed to patients who did not develop new or enlarging aneurysms (41%; RR, 9.5; 95% CI, 1.9%-48%; P = .0099). Patients with multiple aneurysms at initial presentation were more likely than patients with a single aneurysm at presentation to develop a new or enlarging aneurysm (RR, 6.2; 95% CI, 2.1%-185; P = .0058). Patients who initially presented with at least 1 fusiform aneurysm were more likely to develop a new or enlarging aneurysm than patients who did not present with a fusiform aneurysm (RR, 22; 95% CI, 3.6%-68%; P = .00050). Index aneurysm treatment with parent artery occlusion also was associated with higher risk of new aneurysm formation (RR, 4.2; 95% CI, 1.3%-13%; P = .024). New aneurysms did not necessarily arise near index aneurysms. The only fatality in the series was due to subarachnoid hemorrhage from a new posterior circulation aneurysm arising 20 months after index anterior circulation aneurysm treatment in an immunosuppressed patient. CONCLUSIONS Patients who presented with a fusiform aneurysm had a significantly greater incidence of developing a new aneurysm or enlargement of an index aneurysm than did those who presented with a saccular aneurysm. In our patient cohort, 8 of the 9 children who eventually developed new or enlarging brain aneurysms initially presented with fusiform aneurysm morphology. Other comorbidities or multiple aneurysms were also common in these patients at initial presentation.
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Affiliation(s)
- S W Hetts
- Department of Radiology, University of California, San Francisco, CA, USA.
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Suzuki MTM, Aguiar GB, Jory M, Conti MLM, Veiga JCE. De novo basilar tip aneurysm. Case report and literature review. Neurocirugia (Astur) 2011; 22:251-4. [PMID: 21743946 DOI: 10.1016/s1130-1473(11)70020-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The de novo aneurysms are the formation of new aneurysms in a location previously observed to be normal by a cerebral angiography or direct microsurgical exploration. In this report, we present a review of the theme and describe a case of a ruptured de novo basilar tip aneurysm in a patient previously treated with carotid occlusion for a giant intracavernous aneurysm and microsurgical clipping of contralateral posterior communicating artery aneurysm.
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Affiliation(s)
- M T M Suzuki
- Santa Casa Medical School. Department of Surgery. Division of Neurosurgery. São Paulo. Brazil
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Lanzino G, Rabinstein AA. Endovascular neurosurgery in the United States: a survey of 59 vascular neurosurgeons with endovascular training. World Neurosurg 2011; 75:580-5. [PMID: 21704910 DOI: 10.1016/j.wneu.2011.02.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2010] [Revised: 11/19/2010] [Accepted: 02/05/2011] [Indexed: 11/30/2022]
Abstract
OBJECTIVE We sought to assess general aspects of endovascular neurosurgery training, practice, and management for the treatment of intracranial aneurysms, arteriovenous malformations, acute ischemic stroke, and extracranial or intracranial occlusive disease within neurosurgery training and practice in the United States. METHODS A questionnaire was sent electronically to 80 U.S. neurosurgeons with endovascular training. RESULTS Fifty-nine surveys (74%) were returned. Survey responses illustrated different practice patterns and varying management of cerebrovascular disorders by neurosurgeons with endovascular training. CONCLUSION Our findings provide a snapshot of current neurosurgical endovascular practices in the United States.
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Affiliation(s)
- Giuseppe Lanzino
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
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35
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Long-term follow-up survey reveals a high yield, up to 30% of patients presenting newly detected aneurysms more than 10 years after ruptured intracranial aneurysms clipping. Neurosurg Rev 2011; 34:485-96. [DOI: 10.1007/s10143-011-0332-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2010] [Revised: 04/04/2011] [Accepted: 04/23/2011] [Indexed: 10/18/2022]
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36
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Ferns SP, Sprengers ME, van Rooij WJ, van Zwam WH, de Kort GA, Velthuis BK, Schaafsma JD, van den Berg R, Sluzewski M, Brouwer PA, Rinkel GJ, Majoie CB. Late Reopening of Adequately Coiled Intracranial Aneurysms. Stroke 2011; 42:1331-7. [DOI: 10.1161/strokeaha.110.605790] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Sandra P. Ferns
- From the Department of Radiology (S.P.F., M.E.S.S., R.v.d.B., C.B.L.M.M.), Academic Medical Center, Amsterdam; Department of Radiology (W.J.v.R., M.S.), St Elisabeth Ziekenhuis, Tilburg; Department of Radiology (W.H.v.Z.), Maastricht University Medical Center; Department of Radiology (G.A.P.d.K., B.K.V.), University Medical Center, Utrecht; Department of Radiology (R.v.d.B.), VU Medical Center Amsterdam; Department of Radiology (P.A.B.), Leiden University Medical Center; Department of Neurology from
| | - Marieke E.S. Sprengers
- From the Department of Radiology (S.P.F., M.E.S.S., R.v.d.B., C.B.L.M.M.), Academic Medical Center, Amsterdam; Department of Radiology (W.J.v.R., M.S.), St Elisabeth Ziekenhuis, Tilburg; Department of Radiology (W.H.v.Z.), Maastricht University Medical Center; Department of Radiology (G.A.P.d.K., B.K.V.), University Medical Center, Utrecht; Department of Radiology (R.v.d.B.), VU Medical Center Amsterdam; Department of Radiology (P.A.B.), Leiden University Medical Center; Department of Neurology from
| | - Willem Jan van Rooij
- From the Department of Radiology (S.P.F., M.E.S.S., R.v.d.B., C.B.L.M.M.), Academic Medical Center, Amsterdam; Department of Radiology (W.J.v.R., M.S.), St Elisabeth Ziekenhuis, Tilburg; Department of Radiology (W.H.v.Z.), Maastricht University Medical Center; Department of Radiology (G.A.P.d.K., B.K.V.), University Medical Center, Utrecht; Department of Radiology (R.v.d.B.), VU Medical Center Amsterdam; Department of Radiology (P.A.B.), Leiden University Medical Center; Department of Neurology from
| | - Wim H. van Zwam
- From the Department of Radiology (S.P.F., M.E.S.S., R.v.d.B., C.B.L.M.M.), Academic Medical Center, Amsterdam; Department of Radiology (W.J.v.R., M.S.), St Elisabeth Ziekenhuis, Tilburg; Department of Radiology (W.H.v.Z.), Maastricht University Medical Center; Department of Radiology (G.A.P.d.K., B.K.V.), University Medical Center, Utrecht; Department of Radiology (R.v.d.B.), VU Medical Center Amsterdam; Department of Radiology (P.A.B.), Leiden University Medical Center; Department of Neurology from
| | - Gérard A.P. de Kort
- From the Department of Radiology (S.P.F., M.E.S.S., R.v.d.B., C.B.L.M.M.), Academic Medical Center, Amsterdam; Department of Radiology (W.J.v.R., M.S.), St Elisabeth Ziekenhuis, Tilburg; Department of Radiology (W.H.v.Z.), Maastricht University Medical Center; Department of Radiology (G.A.P.d.K., B.K.V.), University Medical Center, Utrecht; Department of Radiology (R.v.d.B.), VU Medical Center Amsterdam; Department of Radiology (P.A.B.), Leiden University Medical Center; Department of Neurology from
| | - Birgitta K. Velthuis
- From the Department of Radiology (S.P.F., M.E.S.S., R.v.d.B., C.B.L.M.M.), Academic Medical Center, Amsterdam; Department of Radiology (W.J.v.R., M.S.), St Elisabeth Ziekenhuis, Tilburg; Department of Radiology (W.H.v.Z.), Maastricht University Medical Center; Department of Radiology (G.A.P.d.K., B.K.V.), University Medical Center, Utrecht; Department of Radiology (R.v.d.B.), VU Medical Center Amsterdam; Department of Radiology (P.A.B.), Leiden University Medical Center; Department of Neurology from
| | - Joanna D. Schaafsma
- From the Department of Radiology (S.P.F., M.E.S.S., R.v.d.B., C.B.L.M.M.), Academic Medical Center, Amsterdam; Department of Radiology (W.J.v.R., M.S.), St Elisabeth Ziekenhuis, Tilburg; Department of Radiology (W.H.v.Z.), Maastricht University Medical Center; Department of Radiology (G.A.P.d.K., B.K.V.), University Medical Center, Utrecht; Department of Radiology (R.v.d.B.), VU Medical Center Amsterdam; Department of Radiology (P.A.B.), Leiden University Medical Center; Department of Neurology from
| | - René van den Berg
- From the Department of Radiology (S.P.F., M.E.S.S., R.v.d.B., C.B.L.M.M.), Academic Medical Center, Amsterdam; Department of Radiology (W.J.v.R., M.S.), St Elisabeth Ziekenhuis, Tilburg; Department of Radiology (W.H.v.Z.), Maastricht University Medical Center; Department of Radiology (G.A.P.d.K., B.K.V.), University Medical Center, Utrecht; Department of Radiology (R.v.d.B.), VU Medical Center Amsterdam; Department of Radiology (P.A.B.), Leiden University Medical Center; Department of Neurology from
| | - Menno Sluzewski
- From the Department of Radiology (S.P.F., M.E.S.S., R.v.d.B., C.B.L.M.M.), Academic Medical Center, Amsterdam; Department of Radiology (W.J.v.R., M.S.), St Elisabeth Ziekenhuis, Tilburg; Department of Radiology (W.H.v.Z.), Maastricht University Medical Center; Department of Radiology (G.A.P.d.K., B.K.V.), University Medical Center, Utrecht; Department of Radiology (R.v.d.B.), VU Medical Center Amsterdam; Department of Radiology (P.A.B.), Leiden University Medical Center; Department of Neurology from
| | - Patrick A. Brouwer
- From the Department of Radiology (S.P.F., M.E.S.S., R.v.d.B., C.B.L.M.M.), Academic Medical Center, Amsterdam; Department of Radiology (W.J.v.R., M.S.), St Elisabeth Ziekenhuis, Tilburg; Department of Radiology (W.H.v.Z.), Maastricht University Medical Center; Department of Radiology (G.A.P.d.K., B.K.V.), University Medical Center, Utrecht; Department of Radiology (R.v.d.B.), VU Medical Center Amsterdam; Department of Radiology (P.A.B.), Leiden University Medical Center; Department of Neurology from
| | - Gabriël J.E. Rinkel
- From the Department of Radiology (S.P.F., M.E.S.S., R.v.d.B., C.B.L.M.M.), Academic Medical Center, Amsterdam; Department of Radiology (W.J.v.R., M.S.), St Elisabeth Ziekenhuis, Tilburg; Department of Radiology (W.H.v.Z.), Maastricht University Medical Center; Department of Radiology (G.A.P.d.K., B.K.V.), University Medical Center, Utrecht; Department of Radiology (R.v.d.B.), VU Medical Center Amsterdam; Department of Radiology (P.A.B.), Leiden University Medical Center; Department of Neurology from
| | - Charles B.L.M. Majoie
- From the Department of Radiology (S.P.F., M.E.S.S., R.v.d.B., C.B.L.M.M.), Academic Medical Center, Amsterdam; Department of Radiology (W.J.v.R., M.S.), St Elisabeth Ziekenhuis, Tilburg; Department of Radiology (W.H.v.Z.), Maastricht University Medical Center; Department of Radiology (G.A.P.d.K., B.K.V.), University Medical Center, Utrecht; Department of Radiology (R.v.d.B.), VU Medical Center Amsterdam; Department of Radiology (P.A.B.), Leiden University Medical Center; Department of Neurology from
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Ferns SP, Sprengers ME, van Rooij WJJ, van den Berg R, Velthuis BK, de Kort GA, Sluzewski M, van Zwam WH, Rinkel GJ, Majoie CB. De Novo Aneurysm Formation and Growth of Untreated Aneurysms. Stroke 2011; 42:313-8. [DOI: 10.1161/strokeaha.110.591594] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Sandra P. Ferns
- From the Department of Radiology (S.P.F., M.E.S.S., R.B., C.B.L.M.M.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology (G.J.E.R.), Rudolf Magnus Institute of Neuroscience, University Medical Center, Utrecht, the Netherlands; Department of Radiology (W.H.Z.), Maastricht University Medical Center, Maastricht, the Netherlands; Department of Radiology (B.K.V., G.A.P.K.), University Medical Center, Utrecht, the Netherlands; Department of Radiology (W.J.J.v.R., M.S.), St
| | - Marieke E.S. Sprengers
- From the Department of Radiology (S.P.F., M.E.S.S., R.B., C.B.L.M.M.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology (G.J.E.R.), Rudolf Magnus Institute of Neuroscience, University Medical Center, Utrecht, the Netherlands; Department of Radiology (W.H.Z.), Maastricht University Medical Center, Maastricht, the Netherlands; Department of Radiology (B.K.V., G.A.P.K.), University Medical Center, Utrecht, the Netherlands; Department of Radiology (W.J.J.v.R., M.S.), St
| | - Willem Jan J. van Rooij
- From the Department of Radiology (S.P.F., M.E.S.S., R.B., C.B.L.M.M.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology (G.J.E.R.), Rudolf Magnus Institute of Neuroscience, University Medical Center, Utrecht, the Netherlands; Department of Radiology (W.H.Z.), Maastricht University Medical Center, Maastricht, the Netherlands; Department of Radiology (B.K.V., G.A.P.K.), University Medical Center, Utrecht, the Netherlands; Department of Radiology (W.J.J.v.R., M.S.), St
| | - René van den Berg
- From the Department of Radiology (S.P.F., M.E.S.S., R.B., C.B.L.M.M.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology (G.J.E.R.), Rudolf Magnus Institute of Neuroscience, University Medical Center, Utrecht, the Netherlands; Department of Radiology (W.H.Z.), Maastricht University Medical Center, Maastricht, the Netherlands; Department of Radiology (B.K.V., G.A.P.K.), University Medical Center, Utrecht, the Netherlands; Department of Radiology (W.J.J.v.R., M.S.), St
| | - Birgitta K. Velthuis
- From the Department of Radiology (S.P.F., M.E.S.S., R.B., C.B.L.M.M.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology (G.J.E.R.), Rudolf Magnus Institute of Neuroscience, University Medical Center, Utrecht, the Netherlands; Department of Radiology (W.H.Z.), Maastricht University Medical Center, Maastricht, the Netherlands; Department of Radiology (B.K.V., G.A.P.K.), University Medical Center, Utrecht, the Netherlands; Department of Radiology (W.J.J.v.R., M.S.), St
| | - Gérard A.P. de Kort
- From the Department of Radiology (S.P.F., M.E.S.S., R.B., C.B.L.M.M.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology (G.J.E.R.), Rudolf Magnus Institute of Neuroscience, University Medical Center, Utrecht, the Netherlands; Department of Radiology (W.H.Z.), Maastricht University Medical Center, Maastricht, the Netherlands; Department of Radiology (B.K.V., G.A.P.K.), University Medical Center, Utrecht, the Netherlands; Department of Radiology (W.J.J.v.R., M.S.), St
| | - Menno Sluzewski
- From the Department of Radiology (S.P.F., M.E.S.S., R.B., C.B.L.M.M.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology (G.J.E.R.), Rudolf Magnus Institute of Neuroscience, University Medical Center, Utrecht, the Netherlands; Department of Radiology (W.H.Z.), Maastricht University Medical Center, Maastricht, the Netherlands; Department of Radiology (B.K.V., G.A.P.K.), University Medical Center, Utrecht, the Netherlands; Department of Radiology (W.J.J.v.R., M.S.), St
| | - Wim H. van Zwam
- From the Department of Radiology (S.P.F., M.E.S.S., R.B., C.B.L.M.M.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology (G.J.E.R.), Rudolf Magnus Institute of Neuroscience, University Medical Center, Utrecht, the Netherlands; Department of Radiology (W.H.Z.), Maastricht University Medical Center, Maastricht, the Netherlands; Department of Radiology (B.K.V., G.A.P.K.), University Medical Center, Utrecht, the Netherlands; Department of Radiology (W.J.J.v.R., M.S.), St
| | - Gabriël J.E. Rinkel
- From the Department of Radiology (S.P.F., M.E.S.S., R.B., C.B.L.M.M.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology (G.J.E.R.), Rudolf Magnus Institute of Neuroscience, University Medical Center, Utrecht, the Netherlands; Department of Radiology (W.H.Z.), Maastricht University Medical Center, Maastricht, the Netherlands; Department of Radiology (B.K.V., G.A.P.K.), University Medical Center, Utrecht, the Netherlands; Department of Radiology (W.J.J.v.R., M.S.), St
| | - Charles B.L.M. Majoie
- From the Department of Radiology (S.P.F., M.E.S.S., R.B., C.B.L.M.M.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology (G.J.E.R.), Rudolf Magnus Institute of Neuroscience, University Medical Center, Utrecht, the Netherlands; Department of Radiology (W.H.Z.), Maastricht University Medical Center, Maastricht, the Netherlands; Department of Radiology (B.K.V., G.A.P.K.), University Medical Center, Utrecht, the Netherlands; Department of Radiology (W.J.J.v.R., M.S.), St
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Jiang L, He ZH, Zhang XD, Lin B, Yin XH, Sun XC. Value of noninvasive imaging in follow-up of intracranial aneurysm. ACTA NEUROCHIRURGICA. SUPPLEMENT 2011; 110:227-232. [PMID: 21125476 DOI: 10.1007/978-3-7091-0356-2_41] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Follow-up is necessary for treated and untreated aneurysms. The purpose of this study is to assess the results of treated aneurysms, the development of untreated aneurysms and the incidence of new aneurysms through short-term follow-up with noninvasive imaging, including CTA and MRA. More-than-once follow-up imaging with either CTA or MRA was performed in 73 patients, 65 of them suffering SAH. CTA was performed in 46 patients with clipped aneurysms, 9 patients with coiled aneurysms and 8 cases with untreated aneurysms. MRA was performed in ten patients with coiled aneurysms. CTA follow-up demonstrated that in 48 clipped aneurysms, 47 aneurysms completely disappeared; one aneurysm with neck remnant and one new aneurysm was found. No recurrence was found after microsurgical clipping. CTA follow-up provided limited information for ten coiled aneurysms because of poor quality images due to artifacts from coil. MRA follow-up of 12 coiled aneurysms showed there were no recanalization, recurrence or new aneurysm. In 20 untreated aneurysms, 19 stayed unchanged, and one aneurysm automatically disappeared. The newest generation of CTA and MRA can be used for following-up of intracranial aneurysms, and is more readily accepted by Chinese patients because of convenience, non-invasiveness and low price.
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Affiliation(s)
- Li Jiang
- Department of Neurosurgery, First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China
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Abstracts. Neuroradiol J 2010. [DOI: 10.1177/19714009100230s111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Thines L, Dehdashti AR, Howard P, Costa LD, Wallace MC, Willinsky RA, Tymianski M, Lejeune JP, Agid R. Postoperative Assessment of Clipped Aneurysms With 64-Slice Computerized Tomography Angiography. Neurosurgery 2010; 67:844-53; discussion 853-4. [DOI: 10.1227/01.neu.0000374684.10920.a2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND
Multidetector computerized tomography angiography (MDCTA) is now a widely accepted technique for the management of intracranial aneurysms.
OBJECTIVE
To evaluate its accuracy for the postoperative assessment of clipped intracranial aneurysms.
METHODS
We analyzed a consecutive series of 31 patients that underwent direct surgical clipping procedures of 38 aneurysms. A 64 slice MDCT scanner (Aquilion 64, Toshiba) was used and results were compared with digital subtraction angiographies (DSA). Two independent neuroradiologists analyzed the following data: examination quality, artifacts, aneurysm remnant, and patency of collateral branches. Interobserver agreement, sensitivity, and specificity were calculated.
RESULTS
Seventy-nine percent of the aneurysms were located in the anterior circulation. Significant artifacts were found with multiple and cobalt-alloy clips. According to DSA, remnants >2 mm were found in 21% of the cases, and 2 patients had one collateral branch occluded. Sensitivity and specificity of 64-MDCTA for the detection of aneurysm remnants were 50% and 100%, respectively. Sensitivity and specificity of 64-MDCTA for the detection of a significant remnant (>2 mm) and the detection of the occlusion of a collateral branch were, respectively, 67% and 100% and 50% and 100%. No relationship was found with the location, type, shape, size, or number of clips, but missed remnants tended to be larger with cobalt-alloy clips.
CONCLUSIONS
64-MDCTA is a valuable technique to assess the presence of a significant postoperative remnant in single titanium clip application cases and might be useful for long-term follow-up. DSA remains the most accurate postoperative radiological examination.
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Affiliation(s)
- Laurent Thines
- Department of Neurosurgery, Lille University Hospital, Lille, France
- Division of Neurosurgery, Department of Surgery, University of Toronto Brain Vascular Malformation Study Group, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Amir R. Dehdashti
- Division of Neurosurgery, Department of Surgery, University of Toronto Brain Vascular Malformation Study Group, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Peter Howard
- Division of Neuroradiology, Department of Medical Imaging, University of Toronto Brain Vascular Malformation Study Group, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Leodante Da Costa
- Division of Neuroradiology, Department of Medical Imaging, University of Toronto Brain Vascular Malformation Study Group, Toronto Western Hospital, Toronto, Ontario, Canada
| | - M. Christopher Wallace
- Division of Neurosurgery, Department of Surgery, University of Toronto Brain Vascular Malformation Study Group, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Robert A. Willinsky
- Division of Neuroradiology, Department of Medical Imaging, University of Toronto Brain Vascular Malformation Study Group, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Michael Tymianski
- Division of Neurosurgery, Department of Surgery, University of Toronto Brain Vascular Malformation Study Group, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Jean-Paul Lejeune
- Department of Neurosurgery, Lille University Hospital, Lille, France
| | - Ronit Agid
- Division of Neuroradiology, Department of Medical Imaging, University of Toronto Brain Vascular Malformation Study Group, Toronto Western Hospital, Toronto, Ontario, Canada
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Tailor J, Goetz P, Chandrashekar H, Stephen T, Schiariti M, Grieve J, Watkins L, Brew S, Robertson F, Kitchen N. Stability of ruptured intracranial aneurysms treated with detachable coils: is delayed follow-up angiography warranted? Br J Neurosurg 2010; 24:405-9. [DOI: 10.3109/02688697.2010.487130] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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MR imaging of hydrogel filament embolic devices loaded with superparamagnetic iron oxide or gadolinium. Neuroradiology 2010; 53:449-56. [DOI: 10.1007/s00234-010-0744-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2010] [Accepted: 06/28/2010] [Indexed: 10/19/2022]
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Ferns SP, Nieuwkerk PT, van Rooij WJJ, Rinkel GJE, Majoie CBLM. Long-term MRA follow-up after coiling of intracranial aneurysms: impact on mood and anxiety. Neuroradiology 2010; 53:343-8. [PMID: 20571788 PMCID: PMC3077752 DOI: 10.1007/s00234-010-0726-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Accepted: 05/26/2010] [Indexed: 11/25/2022]
Abstract
Introduction Magnetic resonance angiography (MRA) screening for recurrence of a coiled intracranial aneurysm and formation of new aneurysms long-term after coiling may induce anxiety and depression. In coiled patients, we evaluated effects on mood and level of anxiety from long-term follow-up MRA in comparison to general population norms. Methods Of 162 patients participating in a long-term (>4.5 years) MRA follow-up after coiling, 120 completed the EQ-5D questionnaire, a visual analog health scale and a self-developed screening related questionnaire at the time of MRA. Three months later, the same questionnaires were completed by 100 of these 120 patients. Results were compared to general population norms adjusted for gender and age. Results Any problem with anxiety or depression was reported in 56 of 120 patients (47%; 95%CI38↔56%) at baseline and 42 of 100 patients (42%; 95%CI32↔52%) at 3 months, equally for screen-positives and -negatives. Compared to the reference population, participants scored 38% (95%CI9↔67%) and 27% (95%CI4↔50%) more often any problem with anxiety or depression. Three months after screening, 21% (20 of 92) of screen-negatives and 13% (one of eight) of screen-positives reported to be less afraid of subarachnoid hemorrhage (SAH) compared to before screening. One of eight screen-positives reported increased fear of SAH. Conclusions Patients with coiled intracranial aneurysms participating in long-term MRA screening reported significantly more often to be anxious or depressed than a reference group. Screening did not significantly increase anxiety or depression temporarily. However, subjectively, patients did report an increase in anxiety caused by screening, which decreased after 3 months.
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Affiliation(s)
- Sandra P Ferns
- Department of Radiology, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
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A Stijntje E Bor, Marieke JH Wermer, Gabriel JE Rinkel. Unruptured intracranial aneurysms: initial and follow-up screening. FUTURE NEUROLOGY 2010. [DOI: 10.2217/fnl.10.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Subarachnoid hemorrhage (SAH) from a ruptured intracranial aneurysm is a devastating disease that causes death or severe disability in half of patients. Intracranial aneurysms are not present at birth but develop during life. Actively searching and treating intracranial aneurysms before rupture may prevent SAH as a result of these aneurysms. The prevalence of intracranial aneurysms is approximately 2% in the general population, but higher in subgroups such as patients who have survived an episode of SAH, persons with a family history of SAH and patients with polycystic kidney disease. Screening for intracranial aneurysms should be considered in these high-risk groups. Some of the intracranial aneurysms detected with screening will be too small to be treated, and may therefore be followed over time, which can cause anxiety in the patient. In this article, we discuss current knowledge, remaining questions and future perspectives in screening and follow-up imaging for unruptured intracranial aneurysms.
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van Rooij WJ, Sluzewski M. Opinion: imaging follow-up after coiling of intracranial aneurysms. AJNR Am J Neuroradiol 2009; 30:1646-8. [PMID: 19617448 DOI: 10.3174/ajnr.a1673] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Coiling is increasingly used as treatment for intracranial aneurysms with favorable short-term outcome. Concern exists about long-term reopening and the inherent risk of recurrent subarachnoid hemorrhage (SAH), and long-term imaging follow-up is advocated. It is unknown for how long and how often coiled aneurysms need to be followed and what subgroups carry a higher or lower risk for reopening. Recently, new data have become available that concern the designation of an optimal long-term follow-up protocol. Three studies focused on a special subgroup, the coiled aneurysms that are adequately occluded at 6 months. This subgroup comprises about 80% of all coiled aneurysms. In these aneurysms, the risk of reopening that needs retreatment during the next 5-10 years is very low. In addition, the risk of recurrent SAH is almost zero, even lower than that after clipping. Within the first 5 years after coiling, the incidence of the development of de novo aneurysms or enlargement of existing untreated aneurysms is low, with an extremely low risk of recurrent SAH from these aneurysms. These data suggest that aneurysms that are adequately occluded at 6 months after coiling, in general, do not need prolonged imaging follow-up in the next 5-10 years. More data are needed to identify possible subgroups with adequately occluded coiled aneurysms at 6 months that behave differently on longer follow-up, such as giant aneurysms, partially thrombosed aneurysms, or patients with a positive family history.
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Affiliation(s)
- W J van Rooij
- Department of Radiology, St. Elisabeth Ziekenhuis, Tilburg, the Netherlands.
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Gallas S, Januel AC, Pasco A, Drouineau J, Gabrillargues J, Gaston A, Cognard C, Herbreteau D. Long-term follow-up of 1036 cerebral aneurysms treated by bare coils: a multicentric cohort treated between 1998 and 2003. AJNR Am J Neuroradiol 2009; 30:1986-92. [PMID: 19679641 DOI: 10.3174/ajnr.a1744] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The endovascular treatment (EVT) of cerebral aneurysms has experienced a revolution since 1991 with the introduction of platinum coil technology. During the past 10 years, there has been significant study of the feasibility of this technique, and clinical results of EVT have been published. The long-term durability of Guglielmi detachable coil (GDC) embolization of cerebral aneurysms still remains unknown. The purpose of this study was to evaluate the stability of anatomic occlusion of aneurysms and to assess the rate of recanalization and retreatment of these aneurysms. MATERIALS AND METHODS Between January 1998 and December 2003, 1036 aneurysms (804 ruptured and 232 nonruptured) were treated consecutively with GDC coils in 5 neuroradiology centers. Procedural feasibility, acute angiographic occlusion results, morbidity, and mortality associated with this technique were assessed. All patients were regularly followed by digital subtraction angiography and MR imaging each year after treatment. RESULTS Initial acute angiographic results in 1036 aneurysms demonstrated total occlusion in 731 patients (70.5%), subtotal occlusion in 252 (24.3%), incomplete occlusion in 20 (1.9%), and failures in 33% (3.3%) aneurysms. A remodeling technique was used in 10%. A second procedure was performed for 72 aneurysms (7%). The total aneurysm follow-up time was 49,923 months (4160.25 aneurysm-years). The retreatment period was either in the months following initial treatment in aneurysms incompletely occluded or in years due to recanalization or de novo aneurysms. Fewer than 5 patients rebled during 10 years of follow-up. Long-term follow-up angiograms were obtained in 899 aneurysms, with 646 total, 230 subtotal, and 23 incomplete results. CONCLUSIONS Long-term follow-up of cerebral aneurysms is necessary to depict recanalization. Only 7% of the aneurysms were retreated. Use of bare coils gives a good long-term level of occlusion.
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Affiliation(s)
- S Gallas
- Department of Neuroradiology, University François Rabelais, Centre Hospitalier Universitaire Bretonneau, Tours, France.
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Hetts SW, Narvid J, Sanai N, Lawton MT, Gupta N, Fullerton HJ, Dowd CF, Higashida RT, Halbach VV. Intracranial aneurysms in childhood: 27-year single-institution experience. AJNR Am J Neuroradiol 2009; 30:1315-24. [PMID: 19357386 DOI: 10.3174/ajnr.a1587] [Citation(s) in RCA: 115] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Pediatric aneurysms are rare and, thus, relatively poorly understood as compared to those in adults. Our aim was to characterize the clinical, imaging, treatment, and outcome data of patients younger than 19 years diagnosed with intracranial aneurysms at a tertiary care institution. MATERIALS AND METHODS We performed a retrospective medical record review of pediatric patients examined at our university hospital between 1981 and 2008. RESULTS We evaluated 77 patients (mean age, 12 years; 40 female, 37 male) with 103 intracranial aneurysms. Patients presented with headache (45%), cranial neuropathies (16%), nausea/vomiting (15%), vision changes (13%), trauma (13%), seizure (4%), or sensory changes (3%). Subarachnoid hemorrhage occurred in 25 patients. Thirty-one fusiform aneurysms occurred in 25 patients. Forty-seven saccular aneurysms occurred in 35 patients. Twelve infectious aneurysms occurred in 6 patients. Fifteen traumatic aneurysms occurred in 12 patients. Fifty-nine patients underwent treatment of their aneurysms; 18 patients' conditions were managed conservatively. Nineteen patients underwent primary endovascular coiling, 1 patient had endovascular stent-assisted coiling, 11 patients underwent endovascular parent artery occlusion, 19 patients underwent surgical clipping, and 10 patients had aneurysms trapped and bypassed. Mortality was 1.3%. Morbidity included 8% infarction and 4% new-onset seizures. Six patients developed new aneurysms or had enlargement of untreated aneurysms. CONCLUSIONS In our experience, intracranial aneurysms of childhood show a female predilection and predominantly saccular morphology. In neurovascular centers where microneurosurgical and endovascular options are available, most children with intracranial aneurysms can be successfully treated with low morbidity and mortality. Fusiform aneurysms require a combined microneurosurgical and endovascular approach more often than saccular aneurysms. The development of new aneurysms in pediatric patients during limited follow-up warrants further investigation.
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Affiliation(s)
- S W Hetts
- Department of Radiology, University of California, San Francisco, Calif, USA.
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Affiliation(s)
- J Raymond
- Interventional Neuroradiology Research Unit, Department of Radiology, Centre hospitalier de l'Université de Montréal, Notre-Dame Hospital, Montreal, Canada
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