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Unruptured cerebral aneurysm

Junhui Chen, Chunlei Zhang, Peipei Li, Lei Chen, Yuhai Wang
Giant intracranial aneurysms have always been remain the most difficult cerebrovascular lesions to treat, especially for giant cavernous carotid aneurysm (CCA). The treatment of giant CCA is a greatest challenge for neurosurgeons. Surgical clipping morbidity and mortality rates are relatively high, and endovascular embolization also have a high complication. The authors reported a special 74-year-old female patient who presented with blurred vision and double vision for 3 years, a giant CCA was found by digital subtraction angiography and computed tomography angiography...
March 16, 2018: Journal of Craniofacial Surgery
Yung Ki Park, Hyeong-Joong Yi, Kyu-Sun Choi, Young-Jun Lee, Hyoung-Joon Chun
OBJECTIVE: Intraprocedural rupture (IPR) during endovascular treatment of cerebral aneurysm is the most feared complication with high morbidity and mortality. The aim of this study was to estimate the incidence and risk factors of IPR during endovascular treatment of ruptured and unruptured cerebral aneurysms. METHODS: A total of 235 intracranial aneurysms (80 ruptured and 155 unruptured) in 219 patients who received endovascular treatment in our institution between Jan 2010 and Dec 2016 were enrolled in our study...
March 13, 2018: World Neurosurgery
Stephan A Munich, Marshall C Cress, Leonardo Rangel-Castilla, Ashish Sonig, Christopher S Ogilvy, Giuseppe Lanzino, Ondra Petr, J Mocco, Peter J Morone, Kenneth V Snyder, L Nelson Hopkins, Adnan H Siddiqui, Elad I Levy
BACKGROUND: Neck remnants are not uncommon after endovascular treatment of cerebral aneurysms. Critics of endovascular treatments for cerebral aneurysms cite neck remnants as evidence in favor of microsurgical clipping. However, studies have failed to evaluate the true clinical significance of aneurysm neck remnants following endovascular therapies. OBJECTIVE: To assess the clinical significance of residual aneurysm necks and to determine the rate of subsequent rupture following coiling or stent-assisted coiling of cerebral aneurysms...
March 8, 2018: Neurosurgery
Tackeun Kim, O-Ki Kwon, Heeyoung Lee, Min Jai Cho, Hyun Jean Jeong, Seung Pil Ban
OBJECTIVE: To investigate nationwide statistics on flow-diverting stent usage for cerebral aneurysm treatment and related mortality data. METHODS: We requested data extraction from the National Health Insurance Service claims database using electronic data interchange codes (J3207064, J3207073). Patient and hospital information as well as death statistics were collected from the database. RESULTS: A total of 169 procedures were performed using flow-diverting stents for cerebral aneurysm treatment from November 2014 to December 2016 in Korea...
March 2018: Journal of Korean Neurosurgical Society
Pius Kim, Suk Jung Jang
OBJECTIVE: Surgical clipping of the cerebral aenurysm is considered as a standard therapy with endovascular coil embolization. The surgical clipping is known to be superior to the endovascular coil embolization in terms of recurrent rate. However, a recurrent aneurysm which is initially treated by surgical clipping is difficult to handle. The purpose of this study was to research the management of the recurrent cerebral aneurysm after a surgical clipping and how to overcome them. METHODS: From January 1996 to December 2015, medical records and radiologic findings of 14 patients with recurrent aneurysm after surgical clipping were reviewed retrospectively...
March 2018: Journal of Korean Neurosurgical Society
Jong Young Lee, Jong-Hwa Park, Hong Jun Jeon, Dae Young Yoon, Seoung Woo Park, Byung Moon Cho
PURPOSE: A complicated course of the femoral route for neurointervention can prevent approaching the target. Thus, we determined whether transcervical access in the hybrid angiosuite is applicable and beneficial in real practice. METHODS: From January 2014 to March 2017, this approach was used in 17 of 453 (3.75%) cases: 11 cerebral aneurysms (4 ruptured, 7 unruptured), 4 acute occlusions of the large cerebral artery, 1 proximal internal carotid artery (ICA) stenosis, and 1 direct carotid cavernous fistula (CCF)...
March 1, 2018: Neuroradiology
Syuhei Domoto, Manzo Suzuki, Shinpei Suzuki, Hiroyasu Bito
Background: Subdural hematoma (SDH) after accidental dural puncture (ADP) is rare but may be lethal. We experienced a patient who developed SDH after combined spinal and epidural anesthesia without a headache. Case presentation: A 41-year-old parturient female with an unruptured cerebral aneurysm, was scheduled to undergo elective cesarean delivery. Cerebrospinal fluid leakage was identified during puncture of the epidural space, and a catheter was placed after re-puncture...
2018: JA Clin Rep
Alejandro Santillan, Srikanth Boddu, Justin Schwarz, Ning Lin, Y Pierre Gobin, Jared Knopman, Athos Patsalides
Background and purpose This retrospective study evaluates the safety, effectiveness, and long-term clinical and angiographic follow-up of intracranial aneurysms treated with the Low-Profile Visualized Intraluminal Support Junior (LVIS Jr.) stent and parent vessels of diameter equal to or less than 2.5 mm. Materials and methods We included all patients treated with the LVIS Jr. stent in aneurysms with small parent vessel diameter between March 2015 and July 2017. Periprocedural adverse events, immediate aneurysm occlusion rates, and clinical and angiographic follow-up are reported...
January 1, 2018: Interventional Neuroradiology
Gang-Qin Xu, Bu-Lang Gao, Zi-Liang Wang, Wei-Xing Bai, Jiang-Yu Xue, Liang-Fu Zhu, Tian-Xiao Li
PURPOSE: To investigate characteristics of the posterior cerebral artery anterior temporal branch (ATB) aneurysm and the safety and efficacy of endovascular management. MATERIALS AND METHODS: A total of six patients with ATB aneurysms were enrolled. All six patients had concurrent occlusion of the ipsilateral anterior circulating arteries. The aneurysms ranged 2.5-5.0 mm. All patients were treated and followed up. RESULTS: Four unruptured aneurysms were treated with coil embolization of the aneurysm sac only, with the parent artery maintained in two patients, slow flow in the parent artery in one and thrombosis at the aneurysm neck leading to parent artery occlusion in the last one...
February 17, 2018: World Neurosurgery
Meshal Alreshidi, David J Cote, Hormuzdiyar H Dasenbrock, Michael Acosta, Anil Can, Joanne Doucette, Thomas Simjian, M Maher Hulou, Lee A Wheeler, Kevin Huang, Hasan A Zaidi, Rose Du, M Ali Aziz-Sultan, Rania A Mekary, Timothy R Smith
BACKGROUND: Open microsurgical clipping of unruptured intracranial aneurysms has long been the gold standard, yet advancements in endovascular coiling techniques have begun to challenge the status quo. OBJECTIVE: To compare endovascular coiling with microsurgical clipping among adults with unruptured middle cerebral artery aneurysms (MCAA) by conducting a meta-analysis. METHODS: A systematic search was conducted from January 2011 to October 2015 to update a previous meta-analysis...
February 9, 2018: Neurosurgery
Kenji Yoshiki, Kouichi Misaki, Iku Nambu, Issei Fukui, Masanao Mohri, Naoyuki Uchiyama, Mitsutoshi Nakada
An unruptured aneurysm was incidentally found in the right middle cerebral artery in a 67-year-old woman. During an attempt to turn the temporalis muscle for surgical clipping, systolic blood pressure suddenly increased. After opening the dura mater, we found a subarachnoid hemorrhage and severe brain swelling. We promptly expanded the craniotomy area to reach the aneurysm while pulling part of the frontal lobe to apply a clip. We retrospectively analyzed the aneurysm using computational fluid dynamics. Our analysis suggests that the rupture of the aneurysm occurred at a location with very low wall shear stress...
September 2017: Case Reports in Neurology
Dong Hyun Yoo, Young Dae Cho, Jusun Moon, Jeongjun Lee, Hyun-Seung Kang, Won-Sang Cho, Jeong Eun Kim, Gyojun Hwang, O-Ki Kwon, Moon Hee Han
Stent-assisted coil embolization technique have broadened indications for endovascular therapy of aneurysms. The Low-profile Visualized Intraluminal Support device (LVIS) is a self-expanding, nitinol single-braid and closed-cell device introduced fairly recently. We aim to evaluate long-term outcome of LVIS device in stent-assisted coiling of intracranial aneurysms. Between October 2012 and February 2013, a total of 55 patients with unruptured wide-necked intracranial aneurysms underwent coil embolization procedures involving LVIS devices...
February 5, 2018: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Nefize Turan, Robert A Heider, Anil K Roy, Brandon A Miller, Mark E Mullins, Daniel L Barrow, Jonathan Grossberg, Gustavo Pradilla
BACKGROUND: Intracranial aneurysms (IA) are pathological dilatations of cerebral arteries. This systematic review summarizes and compares imaging techniques for assessing unruptured intracranial aneurysms (UIAs). This review also addresses their uses in different scopes of practice. Pathophysiologic mechanisms are reviewed to better understand the clinical utility of each imaging modality. METHODS: A literature review was performed using PubMed with these search terms: "intracranial aneurysm," "cerebral aneurysm," "magnetic resonance angiography (MRA)," computed tomography angiography (CTA)," "catheter angiography," "digital subtraction angiography," "molecular imaging" "ferumoxytol" and "myeloperoxidase"...
January 19, 2018: World Neurosurgery
Katsuhiro Mizutani, Tomoru Miwa, Takenori Akiyama, Yoshiaki Sakamoto, Hirokazu Fujiwara, Kazunari Yoshida
PURPOSE: The primitive tentorial, occipital, and falcine sinuses are thought to attain the adult pattern or regress between the fetal stage and adulthood. The anatomy of these three primitive dural sinuses has seldom been studied in the infant population, and it remains unclear when these dural sinuses reach the adult condition. Using computed tomography digital subtraction venography (CT-DSV), we analyzed the anatomy of these embryonic dural sinuses in infants. METHODS: We included 13 infants who underwent CT-DSV prior to neurosurgery and 35 cases with unruptured cerebral aneurysms as normal adult controls...
January 22, 2018: Neuroradiology
Puyuan Zhao, Deyuan Zhu, Wanling Wen, Yu Zhou, Yibin Fang, Qiang Li, Rui Zhao, Bo Hong, Yi Xu, Jianmin Liu, Qinghai Huang
OBJECTIVES: This study sought to evaluate the safety and efficacy of endovascular treatment of middle cerebral artery dissecting aneurysms(MCADAs). METHOD: Fourteen patients with MCADAs received endovascular treatment between July 2009 and April 2016. MCADAs were identified by virtue of their unique radiographic features on cerebral angiography. Baseline characteristics, angiographic features, angiographic and clinical outcomes were analyzed retrospectively. RESULTS: All fourteen MCADAs (including 6 ruptured and 8 unruptured) were successfully treated with the endovascular approach...
January 16, 2018: World Neurosurgery
Laurent Pierot, Laurent Spelle, Jérôme Berge, Anne-Christine Januel, Denis Herbreteau, Mohamed Aggour, Michel Piotin, Alessandra Biondi, Xavier Barreau, Charbel Mounayer, Chrisanthi Papagiannaki, Jean-Paul Lejeune, Jean-Yves Gauvrit, Vincent Costalat
BACKGROUND AND PURPOSE: Flow diverters are increasingly used for the treatment of intracranial aneurysms. Evaluation of the first devices available for clinical use showed high efficacy of this treatment although safety results were worse compared with coiling or balloon-assisted coiling. The Safety and Efficacy Analysis of FRED Embolic Device in Aneurysm Treatment (SAFE) trial is a single-arm, multicenter, prospective study conducted to precisely analyze the safety and efficacy of the FRED and FRED Jr devices...
January 19, 2018: Journal of Neurointerventional Surgery
Chandramohan Sharma, Banshi Lal Kumawat, Deepika Sagar, Maulik Panchal
Unruptured aneurysm usually presents with headache and neuro-ophthalmic features; when it ruptures, it presents with subarachnoid haemorrhage. Basilar artery aneurysm represents only 3-5% of cerebral aneurysms. Non-haemorrhagic symptoms and the signs of unruptured aneurysms are manifested as mass effect, thromboembolic phenomenon or epileptical attacks. Clinical presentation of unruptured aneurysm depends on structures which are involved. In our case, the patient had insidious onset headache and spastic quadriparesis with sixth cranial nerve palsy, which implicate involvement of corticospinal pathways at the level of pons...
January 17, 2018: BMJ Case Reports
Robert M Starke, John W Thompson, Muhammad S Ali, Crissey L Pascale, Alejandra Martinez Lege, Dale Ding, Nohra Chalouhi, David M Hasan, Pascal Jabbour, Gary K Owens, Michal Toborek, Joshua M Hare, Aaron S Dumont
OBJECTIVE: Cigarette smoke exposure (CSE) is a risk factor for cerebral aneurysm (CA) formation, but the molecular mechanisms are unclear. Although CSE is known to contribute to excess reactive oxygen species generation, the role of oxidative stress on vascular smooth muscle cell (VSMC) phenotypic modulation and pathogenesis of CAs is unknown. The goal of this study was to investigate whether CSE activates a NOX (NAPDH oxidase)-dependent pathway leading to VSMC phenotypic modulation and CA formation and rupture...
January 18, 2018: Arteriosclerosis, Thrombosis, and Vascular Biology
Vincent M Tutino, Kerry E Poppenberg, Kaiyu Jiang, James N Jarvis, Yijun Sun, Ashish Sonig, Adnan H Siddiqui, Kenneth V Snyder, Elad I Levy, John Kolega, Hui Meng
BACKGROUND: Unruptured intracranial aneurysms (IAs) are typically asymptomatic and undetected except for incidental discovery on imaging. Blood-based diagnostic biomarkers could lead to improvements in IA management. This exploratory study examined circulating neutrophils to determine whether they carry RNA expression signatures of IAs. METHODS: Blood samples were collected from patients receiving cerebral angiography. Eleven samples were collected from patients with IAs and 11 from patients without IAs as controls...
2018: PloS One
Víctor Hugo Escobar-de la Garma, Marco Zenteno, Felipe Padilla-Vázquez, Daniel San-Juan, Aurelio Cerón-Morales
Endovascular treatment and prognosis of intracranial aneurysms are based on size and volume, which demand more accurate neuroimaging techniques. Aneurysm volume calculation is important to choose endovascular treatment modalities and packing density calculation. Of all these methods, it remains unknown which one is the most accurate to calculate aneurysm volume. The objective of this study is to compare the accuracy of three angiography-based versus three tomographic-based methods which calculate aneurysm volume...
January 16, 2018: Neurosurgical Review
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