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Unruptured cerebral aneurysm

Saleem I Abdulrauf, Peter Vuong, Ritesh Patel, Raghu Sampath, Ahmed M Ashour, Lauren M Germany, Jonathon Lebovitz, Colt Brunson, Yuvraj Nijjar, J Kyle Dryden, Maheen Q Khan, Mihaela G Stefan, Evan Wiley, Ryan T Cleary, Connor Reis, Jodi Walsh, Paula Buchanan
OBJECTIVE Risk of ischemia during aneurysm surgery is significantly related to temporary clipping time and final clipping that might incorporate a perforator. In this study, the authors attempted to assess the potential added benefit to patient outcomes of "awake" neurological testing when compared with standard neurophysiological testing performed under general anesthesia. The procedure is performed after the induction of conscious sedation, and for the neurological testing, the patient is fully awake. METHODS The authors conducted an institutional review board-approved prospective study of clipping unruptured intracranial aneurysms (UIAs) in 30 consecutive adult patients who underwent awake clipping...
October 21, 2016: Journal of Neurosurgery
Jacques Sedat, Yves Chau, Jean Gaudart, Marina Sachet, Stephanie Beuil, Michel Lonjon
BACKGROUND: Thromboembolic complications are the main problem in stent-assisted coil embolization of unruptured intracranial aneurysms. The combination of aspirin and clopidogrel is generally used to decrease these complications, but some patients do not respond to clopidogrel and have a higher risk of stent thrombosis. In cardiology, clinical trials have shown that prasugrel reduced the incidence of ischaemic events in patients with acute coronary syndrome compared with clopidogrel but, according to several authors, prasugrel would produce an increased risk of cerebral haemorrhagic complications...
October 19, 2016: Interventional Neuroradiology
Ady Thien, Angela An Qi See, Samantha Ya Lyn Ang, Nishal Kishinchand Primalani, Mervyn Jun Rui Lim, Yew Poh Ng, Nicolas Kon Kam King
BACKGROUND: The prevalence of asymptomatic unruptured intracranial aneurysms (AUIA) in a Southeast Asian population has not been previously studied. Knowing the disease burden and population at risk can assist us in making informed decisions when managing AUIAs. We aimed to determine if the local prevalence of AUIAs differed from other populations in the published literature. METHODS: Magnetic resonance angiography radiology reports and images for 4572 patients between January 2013 and January 2014 were reviewed for AUIAs...
October 12, 2016: World Neurosurgery
Wonhyoung Park, Jae Sung Ahn, Jung Cheol Park, Byung Duk Kwun, Deok Hee Lee
OBJECTIVE: Intracranial infectious aneurysms (IIAs) are a very rare but unique subtype of potentially life-threatening vascular lesion. However, there is no widely accepted standard protocol for their management. We reviewed our treatment experiences of IIAs from 2001 to 2015 and proposed a treatment strategy for future use. METHODS: We retrospectively reviewed 25 patients with 33 IIAs. All patients had predisposing infectious disease for which the causative organism had been identified...
October 11, 2016: World Neurosurgery
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
Sandeep Talari, Yoko Kato, Hanbing Shang, Yasuhiro Yamada, Kei Yamashiro, Daisuke Suyama, Tsukasa Kawase, Vladimir Balik, Wu Rile
CONTEXT: The increase in the detection of unruptured cerebral aneurysms has led to management dilemma. Prediction of risk based on the size of the aneurysm is not always accurate. There is no objective way of predicting rupture of aneurysm so far. Computational fluid dynamics (CFDs) was proposed as a tool to identify the rupture risk. AIMS: To know the correlation of CFD findings with intraoperative microscopic findings and to know the relevance of CFD in the prediction of rupture risk and in the management of unruptured intracranial aneurysms...
October 2016: Asian Journal of Neurosurgery
S F Chen, Y Kato, A Kumar, G W Tan, D Oguri, J Oda, T Watabe, S Imizu, H Sano, Z X Wang
Intraoperative rerupture (IOR) during clipping of cerebral aneurysms is a difficult complication of microneurosurgery. The aim of this study was to evaluate the incidence of IOR and analyze the strategies for controlling profound hemorrhage. A total of 165 patients with unruptured intracranial aneurysms and 46 patients with subarachnoid hemorrhage (SAH) treated surgically between April 2010 and March 2011, were reviewed. The data were collected with regard to age, sex, presence of symptoms, confounding factors and strategy for controlling intraoperative hemorrhage was analyzed in terms of location of aneurysms, timing of rupture and severity of IOR...
September 27, 2016: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Lorenzo Rinaldo, Brandon A McCutcheon, Meghan E Murphy, Mohamad Bydon, Alejandro A Rabinstein, Giuseppe Lanzino
OBJECTIVE Hypoplasia of the A1 segment of the anterior cerebral artery is frequently observed in patients with anterior communicating artery (ACoA) aneurysms. The effect of this anatomical variant on ACoA aneurysm morphology is not well understood. METHODS Digital subtraction angiography images were reviewed for 204 patients presenting to the authors' institution with either a ruptured or an unruptured ACoA aneurysm. The ratio of the width of the larger A1 segment to the smaller A1 segment was calculated. Patients with an A1 ratio greater than 2 were categorized as having A1 segment hypoplasia...
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
Alejandro M Spiotta, Kyle M Fargen, Jonathan Lena, Imran Chaudry, Raymond D Turner, Aquilla S Turk, Daniel Huddle, David Loy, Richard Bellon, Donald Frei
INTRODUCTION: Traditional platinum coils used for cerebral aneurysm embolization have a uniform degree of softness throughout an individual coil's length. Recently, SMART Coils (Penumbra Inc., Alameda, CA) have been developed, which transition in softness along the length of their coils. We report the initial clinical results with this technology. METHODS: A retrospective study of all patients undergoing aneurysm coiling with SMART Coils at two centers was performed to evaluate the safety and efficacy of this new technology...
September 15, 2016: World Neurosurgery
Tadayoshi Nakagomi, Kazuhide Furuya, Junichi Tanaka, Shigehiko Takanashi, Takehiro Watanabe, Takayuki Shinohara, Akiko Ogawa, Norio Fujii
Clipping surgeries for 139 consecutive unruptured middle cerebral aneurysms were performed between April 1991 and March 2014. Left hemiparesis occurred in one case (0.7 %). Transient symptoms arose in six patients due to perforator injury, arterial branch occlusion, damage to the venous system, or chronic subdural hematoma. Neither mortality nor decline in cognitive function was noted in this study. Clipping surgery for unruptured middle cerebral artery aneurysms can be done with minimal morbidity. However, meticulous management during the perioperative period as well as the use of modern technologies during the surgery, such as MEP monitoring and ICG videoangiography, are needed for safe and secure clipping surgery...
2016: Acta Neurochirurgica. Supplement
Ying-Ying Zhang, Yi-Bin Fang, Yi-Na Wu, Qi Zhang, Qiang Li, Yi Xu, Qing-Hai Huang, Jian-Min Liu
OBJECTIVE: This report aimed to review the angiographic characteristics and to evaluate the safety and feasibility of endovascular treatment of A1 aneurysms. METHODS: Nineteen ruptured and thirteen unruptured A1 aneurysms treated endovascularly were evaluated in this study. The angiographic and clinical records were retrospectively reviewed. RESULTS: Endovascular treatments were successfully applied in all 32 aneurysms. Conventional coiling was performed in 24 aneurysms, stent-assisted coiling in 7, and solo stenting in 1...
September 5, 2016: World Neurosurgery
Christina A Hamisch, Anastasios Mpotsaris, Marco Timmer, Michael Reiner, Pantelis Stavrinou, Gerrit Brinker, Roland Goldbrunner, Boris Krischek
OBJECTIVE: Intracranial infectious aneurysms (IIAs) are a rare clinical entity without a definitive treatment guideline. In this study, we evaluate the treatment options of these lesions based on our own clinical experience and review the current knowledge of therapy as portrayed in the literature. METHODS: We conducted a single-center retrospective analysis of all patients with an IIA and performed a systematic review of the literature using the MEDLINE database...
September 7, 2016: Cerebrovascular Diseases
Anastasia Tsyben, Iddo Paldor, John Laidlaw
Although common after subarachnoid haemorrhage, cerebral vasospasm (CVS) and delayed ischaemic neurological deficit (DIND) rarely occur following elective clipping of unruptured aneurysms. The onset of this complication is variable and its pathophysiology is poorly understood. We report two patients with CVS associated with DIND following unruptured aneurysmal clipping. The literature is reviewed and the potential mechanisms in the context of patient presentations are discussed. A woman aged 53 and a man aged 70 were treated with elective clipping of unruptured middle cerebral artery aneurysms, the older patient also having an anterior communicating artery aneurysm clipped...
September 2, 2016: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Enes Duman, İlker Çöven, Erkan Yildirim, Cem Yilmaz, Ulaş Pinar
AIM: Flow diverter (FD) stents have been used in the treatment of unruptured intracranial aneurysms. There are a few studies that report the use of these devices in ruptured blister-like aneurysms. We present 5 consecutive patients, who have ruptured intracranial wide necked or side branch close to the neck of saccular aneurysms, have no other treatment options, treated with FD stents and coil embolization. MATERIAL AND METHODS: Between September 2012 and April 2015, 139 ruptured aneurysms of 133 consequent patients were treated...
December 28, 2015: Turkish Neurosurgery
Adomas Bunevicius, Paulius Cikotas, Vesta Steibliene, Vytenis P Deltuva, Arimantas Tamsauskas
BACKGROUND: Intracranial aneurysms most commonly present following rupture causing subarachnoid hemorrhage. Mental disorders are common among patients with unruptured intracranial aneurysms and in aneurysmal subarachnoid hemorrhage survivors. However, to the best of our knowledge, there is no published report of unruptured intracranial aneurysm presenting as a mental disorder. CASE DESCRIPTION: A 69-year-old male without a past history of mental disorders and neurological symptoms presented with a 2-month history of anxiety, sadness, lack of pleasure in usual activities, fatigue, difficulties falling asleep and waking up early in the morning, reduced appetite, and weight loss...
2016: Surgical Neurology International
K Ravishankar
The term "thunderclap headache" (TCH) was first coined in 1986 by Day and Raskin to describe headache that was the presenting feature of an underlying unruptured cerebral aneurysm. The term is now well established to describe the abrupt onset headache seen with many other conditions and is also now included in The International Classification of Headache Disorders 3(rd) edition beta version rubric 4.4. An essential to label an acute headache as "TCH" and differentiate it from other "sudden onset, severe headaches" is the arbitrary time frame of 1 min from onset to peak intensity for "TCH...
July 2016: Annals of Indian Academy of Neurology
Damian Kocur, Miłosz Zbroszczyk, Nikodem Przybyłko, Mariusz Hofman, Tomasz Jamróz, Jan Baron, Piotr Bażowski, Stanisław Kwiek
OBJECTIVE: We report our experience with stent-assisted coiling of anterior communicating artery aneurysms with special consideration of angiographic and clinical outcomes, retreatment rate and periprocedural complications. MATERIALS AND METHODS: The analysis included 34 consecutive ruptured and unruptured wide-neck aneurysms. The aneurysm size ranged from 2 to 18mm (mean 5.47). Clinical examinations with the use of modified Rankin Score and angiographic outcomes were evaluated initially post-embolization and at a minimum follow-up of 6 months...
July 26, 2016: Neurologia i Neurochirurgia Polska
Kimon Bekelis, Dan Gottlieb, Yin Su, Nicos Labropoulos, Stavropoula Tjoumakaris, Pascal Jabbour, Todd A MacKenzie
BACKGROUND: The impact of early physician follow-up on out-of-hospital outcomes after cerebral aneurysm treatment has not been studied before. We investigated the association of early physician follow-up (within 30 days of discharge) with mortality and readmissions for elderly patients undergoing treatment for cerebral aneurysms. METHODS: We performed a cohort study of 100% of Medicare fee-for-service claims data for elderly patients who underwent treatment for cerebral aneurysms from 2007 to 2012...
August 18, 2016: World Neurosurgery
Jimmy Ghostine, Naim Khoury, Francis Cloutier, Marc Kotowski, Jean-Christophe Gentric, André L Batista, Alain Weill, Daniel Roy, Tim E Darsaut, Jean Raymond
BACKGROUND: Endovascular coil embolization of cerebral aneurysms is an effective treatment for the prevention of aneurysm rebleeding after subarachnoid hemorrhage. It is also often used in unruptured aneurysms, but it is associated with aneurysm remnants and recurrences in up to 20%-33% of patients. We hypothesized that better aneurysm occlusion rates can be achieved with coils of larger caliber. METHODS: The Does Embolization with Larger coils lead to better Treatment of Aneurysms (DELTA) trial is an investigator-initiated, multicenter, prospective, randomized, controlled clinical trial...
August 16, 2016: Interventional Neuroradiology
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