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cerebral dissecting aneurysm

Jagdish C Mohan, Madhu Shukla, Vishwas Mohan, Arvind Sethi
Left atrial dissection is a very uncommon complication of cardiac surgery and usually causes significant hemodynamic compromise. Little is known about spontaneous dissection of the left atrium. Two patients, one middle-aged man and another elderly woman were evaluated following stroke. Routine trans-thoracic echocardiogram showed vertical division of the left atrium with both chambers communicating with each other through an orifice. Detailed trans-oesophageal echocardiographic study revealed dissection of the left atrium producing an additional false chamber (pseudo-aneurysm) placed posterior to the left atrial appendage and above the postero-lateral aspect of mitral annulus...
September 2016: Indian Heart Journal
Sung-Pil Joo, Seung-Hoon Jung, Sung-Hyun Kim, Tae-Sun Kim
BACKGROUND: Preservation of the superficial Sylvian veins (SSV) is essential to prevent neurological deficits during Sylvian dissection. We describe an appropriate surgical approach for unruptured middle cerebral artery (MCA) aneurysms to preserve these veins by using indocyanine green videoangiography (ICG-VA). METHODS: Between August 2014 and August 2015, we performed microsurgical clipping for 37 unruptured MCA aneurysms in 36 patients. We classified all the cases into 3 types according to the location between the Sylvian fissure and the SSV...
October 11, 2016: World Neurosurgery
Sven Maier, Fabian Kari, Bartosz Rylski, Matthias Siepe, Christoph Benk, Friedhelm Beyersdorf
Open aortic arch replacement is a complex and challenging procedure, especially in post dissection aneurysms and in redo procedures after previous surgery of the ascending aorta or aortic root. We report our experience with the simultaneous selective perfusion of heart, brain, and remaining body to ensure optimal perfusion and to minimize perfusion-related risks during these procedures. We used a specially configured heart-lung machine with a centrifugal pump as arterial pump and an additional roller pump for the selective cerebral perfusion...
September 2016: Journal of Extra-corporeal Technology
Soumya Mukherjee, Arun Chandran, Anil Gopinathan, Mani Putharan, Tony Goddard, Paul R Eldridge, Tufail Patankar, Hans-Christean Nahser
OBJECTIVE The goal of this study was to assess the safety and feasibility of PulseRider, a novel endovascular stent, in the treatment of intracranial bifurcation aneurysms with wide necks. The authors present the initial results of the first 10 cases in which the PulseRider device was used. METHODS Patients whose aneurysms were intended to be treated with the PulseRider device at 2 institutions in the United Kingdom were identified prospectively. Patient demographics, procedural details, immediate neurological and clinical status, and immediate angiographic outcomes and 6-month clinical and imaging follow-up were recorded prospectively...
September 30, 2016: Journal of Neurosurgery
Seung Chai Jung, Ho Sung Kim, Choong-Gon Choi, Sang Joon Kim, Sun U Kwon, Dong-Wha Kang, Jong S Kim
PURPOSE: The aim of this article is to present high-resolution magnetic resonance imaging (HR-MRI) findings of chronic stage spontaneous and unruptured intracranial artery dissection (ICAD). MATERIAL AND METHODS: From March 2012 to April 2016 a total of 29 patients (15 male and14 female, age range 37-68 years) with chronic stage spontaneous and unruptured ICAD (vertebral artery 27, posterior inferior cerebellar artery 1 and middle cerebral artery 1) were retrospectively enrolled...
September 27, 2016: Clinical Neuroradiology
Jung Soo Park, Hyo Sung Kwak, Jong Myong Lee
Use of the Pipeline embolization device (PED) has increased based on studies about its safety and effectiveness, and new reports that describe peri- or postprocedural complications are now emerging. We report a rare periprocedural device-related complication that occurred during endovascular treatment with the pipeline embolization device for a dissecting aneurysm on the vertebral artery. A 55-year old woman was admitted due to left medullary infarction, and angiography showed a fusiform dilatation in the left vertebral artery that was suspicious for dissecting aneurysm...
September 2016: Journal of Korean Neurosurgical Society
Nakao Ota, Felix Goehre, Takanori Miyazaki, Yu Kinoshita, Hidetoshi Matsukawa, Takeshi Yanagisawa, Humihiro Sakakibara, Norihiro Saito, Shiro Miyata, Kosumo Noda, Toshiyuki Tsuboi, Hiroyasu Kamiyama, Sadahisa Tokuda, Kyousuke Kamada, Rokuya Tanikawa
BACKGROUND: The application of bypass procedures to the posterior cerebral artery (PCA) in combination with proximal clipping or trapping is a useful option for the treatment of complex posterior circulation aneurysms, especially those of the PCA. Due to its course around the midbrain through various cisterns, different approaches are required to access the PCA. OBJECTIVE: The presented study analyzes a retrospective case series of bypass procedures to the PCA to investigate the relevant treatment strategies and their outcomes...
September 16, 2016: World Neurosurgery
Malik Zaben, Hassan Othman, Paul Leach, Muhammad Imran Bhatti
Ruptured intracranial aneurysms in infants are very rare but if missed can lead to poor outcomes. Spontaneously dissecting false aneurysms have been described only in a handful of cases. We report a case of a three-month old girl with deteriorating neurological function due to a ruptured distal middle cerebral artery pseudoaneurysm.
September 19, 2016: British Journal of Neurosurgery
Yasuhiko Kaku, Hiroaki Takei, Masafumi Miyai, Kentarou Yamashita, Jouji Kokuzawa
BACKGROUND AND AIMS: Cerebral revascularization strategies may become necessary in select patients who present with challenging cerebral aneurysms. In this study, we present the techniques of a moderate-flow extra-intracranial bypass using a short interposition vein graft and concurrent aneurysm management. METHODS: The short interposition vein graft was used for the reconstruction of complex cerebral aneurysms in nine patients. In eight of them, the superficial temporal artery (STA) main trunk was used as a donor site for the anastomosis of a short interposition vein graft, and an extracranial vertebral artery (VA) was used in one case...
2016: Acta Neurochirurgica. Supplement
Eduard Quintana, Pietro Bajona, Hartzell V Schaff, Joseph A Dearani, Richard Daly, Kevin Greason, Alberto Pochettino
Open aortic arch surgery after coronary artery bypass grafting (CABG) is considered a high-risk operation. We reviewed our surgical approach and outcomes to establish the risk profile for this patient population. In methods, from 2000-2014, 650 patients underwent aortic arch surgery with circulatory arrest. Of these, 45 (7%) had previous CABG. Complete medical record was available for review including all preoperative coronary angiograms and detailed management of myocardial protection. In results, the mean interval from previous CABG to aortic arch surgery was 6...
2016: Seminars in Thoracic and Cardiovascular Surgery
Hideaki Matsumura, Noriyuki Kato, Yusuke Fujiwara, Hisayuki Hosoo, Tomosato Yamazaki, Susumu Yasuda, Akira Matsumura
We present a retrospective analysis of endovascular treatments for posterior cerebral artery (PCA) aneurysms and discuss the susceptibility of a fetal-type PCA to vascular insufficiency after parent artery occlusion. Among 1207 aneurysms treated with endovascular therapy between March 1997 and March 2013 in our institution, 10 patients (0.8%) presented PCA aneurysms. The principal strategy was to employ selective coil embolization for the aneurysm. However, in certain cases of fusiform or dissecting aneurysms, we performed parent artery occlusion with coils...
October 2016: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
H Y Li, H Chen, Y M Li, Y Li, X W Shi
OBJECTIVE: To investigate the causes and strategies for intraoperative rupture during clipping the anterior circulation aneurysms. METHODS: Nineteen patients with anterior circulation aneurysms ruptured during clipping, who admitted to the Department of Neurosurgery, Henan Provincial People's Hospital from November 2012 to February 2014, were enrolled. Their clinical data were analyzed retrospectively to summarize the causes and strategies for intraoperative rupture...
July 5, 2016: Zhonghua Yi Xue za Zhi [Chinese medical journal]
Hilary P Grocott, Emma Ambrose, Mike Moon
PURPOSE: Selective antegrade cerebral perfusion (SACP) involving cannulation of either the axillary or innominate artery is a commonly used technique for maintaining cerebral blood flow (CBF) during the use of hypothermic cardiac arrest (HCA) for operations on the aortic arch. Nevertheless, asymmetrical CBF with hypoperfusion of the left cerebral hemisphere is a common occurrence during SACP. The purpose of this report is to describe an adjunctive maneuver to improve left hemispheric CBF during SACP by applying extrinsic compression to the left carotid artery...
October 2016: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
Orlando Diaz, Leonardo Rangel-Castilla
Intracranial aneurysms are abnormal dilations of the intracranial vessels, in which all the layers of the vascular wall are affected by degenerative changes that lead to distension of the vessel. Intracranial aneurysms can be classified based on their anatomic location, size, and morphology. Subarachnoid hemorrhage is the most devastating clinical presentation. The goal of preventing hemorrhage or rehemorrhage can only be achieved by excluding the aneurysm from the cerebral circulation. Endovascular or surgical clipping can achieve this goal...
2016: Handbook of Clinical Neurology
Thomas P Madaelil, Adam N Wallace, Arindam N Chatterjee, Gregory J Zipfel, Ralph G Dacey, DeWitte T Cross, Christopher J Moran, Colin P Derdeyn
BACKGROUND: Ruptured intracranial dissecting aneurysms must be secured quickly to prevent re-hemorrhage. Endovascular sacrifice of the diseased segment is a well-established treatment method, however postoperative outcomes of symptomatic stroke and re-hemorrhage rates are not well reported, particularly for the perforator-rich distal vertebral artery or proximal posterior inferior cerebellar artery (PICA). METHODS: We retrospectively reviewed cases of ruptured distal vertebral artery or PICA dissecting aneurysms that underwent endovascular treatment...
August 2016: Journal of Neurointerventional Surgery
Amin B Kassam, Srikant S Chakravarthi, Juanita Celix, Melanie Fukui, Jonathan Jennings, Sarika Walia, Richard A Rovin
INTRODUCTION: The conventional stereoscopic microscope (CS-m) made safe surgery for intracranial vascular pathology. Recently, an integrated image-guided robotic optical positioning system (ROVOT-m) has been released for clinical use. We undertook a benchside, cadaveric and clinical study to determine its applicability to aneurysm surgery. METHODS: Benchside measurements of field of view (FOV) and depth of field (DOF) were obtained for CS-m and ROVOT-m. Two cadavers were operated on to simulate aneurysm surgery using both CS-m and ROVOT-m...
August 2016: Neurosurgery
Dong Seong Shin, Ali Yilmaz, Ayca Ozkul, Dong Kyu Yeo, Sun-Chul Hwang, Bum-Tae Kim
Objective The transfemoral approach is a common route for catheterization of the supra-aortic vessels in neuroendovascular therapy. However, in some cases, the patient's anatomy prevents transfemoral catheterization or distal access to the carotid s. In such cases, direct carotid exposure (DCE) for neuroendovascular approaches may be used to treat cerebrovascular diseases. Methods We present 11 cases in which we were unable to perform the distal approach and DCE was the preferred neuroendovascular treatment procedure...
July 1, 2016: Journal of Neurological Surgery. Part A, Central European Neurosurgery
Keisuke Kadooka, Michihiro Tanaka, Kenji Shimada, Hiromu Hadeishi
A 36-year-old woman on chronic hemodialysis presented with sudden onset of headache and deterioration of consciousness. She was sent to our hospital on day 1, with subarachnoid hemorrhage. Cerebral angiography showed pearl and string sign on the left posterior communicating artery, which was consistent with a diagnosis of hemorrhage from a dissecting aneurysm of the left posterior communicating artery. She underwent parent artery occlusion via endovascular treatment on day 2. Although cone beam computed tomography before embolization showed a perforator from the lesion, there were no ischemic lesions on diffusion-weighted imaging after the procedure...
October 2016: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Kai-Xiong Qing, Bin Yang, Hong-Bo Cai, Hui Jin
Spontaneous isolated subclavian artery dissecting aneurysm is rare. This is to our knowledge the first case in the world's literature to report a patient with subclavian artery dissecting aneurysm. Although the endovascular approach of treating subclavian artery pathologies is not challenging, the choice of using a covered stent for this patient was a new attempt in treating subclavian artery dissections. This case report highlights the possibility and safety of using covered stent in treating patients with subclavian artery dissecting aneurysms after reassuring the patency of the cerebral circulation system...
August 2016: Annals of Vascular Surgery
Andreas Martens, Erik Beckmann, Tim Kaufeld, Julia Umminger, Felix Fleissner, Nurbol Koigeldiyev, Heike Krueger, Jakob Puntigam, Axel Haverich, Malakh Shrestha
OBJECTIVES: Aortic arch surgery is associated with substantial perioperative risks. New prostheses as well as novel perfusion techniques have been developed to reduce the risks of these procedures. The routine application of these new techniques warrants reassessment of risk factors of aortic arch repair. METHODS: Between April 2010 and December 2015, 199 patients [61% male, median age 63 years (interquartile range 52-70 years)] underwent total aortic arch repair in our institution...
May 26, 2016: European Journal of Cardio-thoracic Surgery
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