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https://www.readbyqxmd.com/read/28223258/the-neurologic-protection-of-unilateral-versus-bilateral-antegrade-cerebral-perfusion-in-aortic-arch-surgery-with-deep-hypothermic-circulatory-arrest-a-study-of-77-cases
#1
Bowen Li, Xiaoping Hu, Zhiwei Wang
BACKGROUD: Unilateral and bilateral antegrade cerebral perfusions (ACP) are recognized methods of cerebral protection in aortic arch surgery. However, the adequacy of cerebral protection in aortic arch surgery with deep hypothermic circulatory arrest is controversial. In this study, we compared unilateral and bilateral ACP of cerebral protection in aortic arch surgery by assessing the patient's intraoperative and postoperative brain function. METHODS: A total of 77 patients undergoing aortic arch surgery were included in this study...
February 18, 2017: International Journal of Surgery
https://www.readbyqxmd.com/read/28223049/outcomes-of-coronary-artery-bypass-and-stents-for-unprotected-left-main-coronary-stenosis
#2
Yin-Shu Chang, Jia-Xiang Wang, Da-Wei Chang
BACKGROUND: This study assessed the short-, medium-, and long-term outcomes of coronary artery bypass grafting vs stenting for patients with unprotected left main coronary artery disease through a meta-analysis of randomized controlled trials. METHODS: PubMed, Embase, Scopus, Web of Science, Cochrane Library, and major conference proceedings databases were systematically searched for randomized controlled trials of coronary artery bypass grafting compared with stents in unprotected left main coronary artery disease...
February 18, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28215461/the-use-of-ultrasound-for-postoperative-monitoring-of-cerebral-bypass-grafts-a-technical-report
#3
Ryan P Morton, Isaac Joshua Abecassis, Anne E Moore, Cory M Kelly, Michael R Levitt, Louis J Kim, Laligam N Sekhar
Duplex ultrasound and transcranial Doppler are valuable tools for post-operative monitoring of extracranial-intracranial cerebral bypass grafts. Here we describe our technique for the evaluation of both high-flow and low-flow cerebral bypass grafts over a nine year period. 186 bypass grafts were studied daily during the inpatient period between Jan 2005 and Dec 2014 after surgery for various cerebrovascular pathologies. There was a technical success rate of 97%. Duplex ultrasonographic flow measurements had excellent interobserver reliability with an intraclass correlation coefficient (ICC) of 0...
February 16, 2017: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
https://www.readbyqxmd.com/read/28209313/the-arborization-bypass-sequential-intracranial-intracranial-bypasses-for-an-unruptured-fusiform-mca-aneurysm
#4
Jonathan J Russin
Revascularization techniques are being featured more prominently as endovascular treatments continue to select out complex cerebrovascular pathologies for open surgical management. The current healthcare environment requires decreased hospital stays and improved clinical outcomes despite the growing complexity of open surgical cases. Recent efforts to reduce operative room time and decrease risk for bypass surgery have focused on avoiding graft harvest and maintaining the entire bypass intracranial. The presented technique features an arborization bypass to serially anastomose the middle cerebral artery vessels allowing for proximal trapping of a complex aneurysm without graft harvest...
February 10, 2017: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
https://www.readbyqxmd.com/read/28193536/blood-brain-barrier-disruption-after-cardiopulmonary-bypass-diagnosis-and-correlation-to-cognition
#5
Dan Abrahamov, Oren Levran, Sharon Naparstek, Yael Refaeli, Shani Kaptson, Mahmud Abu Salah, Yaron Ishai, Gideon Sahar
BACKGROUND: Cardiopulmonary bypass (CPB) elicits a systemic inflammatory response that may impair blood-brain barrier (BBB) integrity. BBB disruption can currently be detected by dynamic contrast enhancement magnetic resonance imaging (MRI), reflected by an increase in the permeability constant (K(trans)). We aimed to determine (1) whether CPB induces BBB disruption, (2) duration until BBB disruption resolution, and (3) the obtainable correlation between BBB injury (location and intensity) and neurocognitive dysfunction...
February 10, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28191623/the-ivy-sign-on-fluid-attenuated-inversion-recovery-images-related-to-single-photon-emission-computed-tomography-cerebral-blood-flow-in-moyamoya-disease-a-case-report
#6
Fumihiro Matano, Yasuo Murai, Asami Kubota, Takayuki Mizunari, Shiro Kobayashi, Akio Morita
BACKGROUND: Moyamoya disease is an idiopathic progressive cerebrovascular steno-occlusive disorder characterized by the formation of numerous collaterals called moyamoya vessels. Accurate evaluation of vascular status and CBF is needed for prompt treatment to prevent ischemic and/or hemorrhagic events. The pathogenesis of the ivy sign on fluid attenuated inversion recovery (FLAIR) images of moyamoya disease patients is unclear. We report a moyamoya disease case wherein the ivy sign changed in relation to SPECT-measured CBF during progression and following treatment...
January 17, 2017: Turkish Neurosurgery
https://www.readbyqxmd.com/read/28191601/the-maxillary-artery-and-its-variants-an-anatomical-study-with-neurosurgical-applications
#7
Jorge E Alvernia, Joaquin Hidalgo, Marc P Sindou, Chad Washington, Gustavo Luzardo, Eddie Perkins, Remi Nader, Patrick Mertens
BACKGROUND: The maxillary artery (MA) has gained attention in neurosurgery particularly in cerebral revascularization techniques, intracranial endonasal approaches and endovascular procedures. OBJECTIVES: To describe and illustrate the anatomy of the MA and its neurosurgical importance in a detailed manner. METHODS: Six cadaveric heads (12 MAs) were injected with latex. The arteries and surrounding structures were dissected and studied using microsurgical techniques...
February 13, 2017: Acta Neurochirurgica
https://www.readbyqxmd.com/read/28190436/neurologic-complications-of-cardiac-and-vascular-surgery
#8
K N Sheth, E Nourollahzadeh
This chapter will provide an overview of the major neurologic complications of common cardiac and vascular surgeries, such as coronary artery bypass grafting and carotid endarterectomy. Neurologic complications after cardiac and vascular surgeries can cause significant morbidity and mortality, which can negate the beneficial effects of the intervention. Some of the complications to be discussed include ischemic and hemorrhagic stroke, seizures, delirium, cognitive dysfunction, cerebral hyperperfusion syndrome, cranial nerve injuries, and peripheral neuropathies...
2017: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/28186451/techniques-and-outcomes-of-microsurgical-management-of-ruptured-and-unruptured-fusiform-cerebral-aneurysms
#9
Sam Safavi-Abbasi, M Yashar S Kalani, Ben Frock, Hai Sun, Kaan Yagmurlu, Felix Moron, Laura A Snyder, Randy J Hlubek, Joseph M Zabramski, Peter Nakaji, Robert F Spetzler
OBJECTIVE Fusiform cerebral aneurysms represent a small portion of intracranial aneurysms; differ in natural history, anatomy, and pathology; and can be difficult to treat compared with saccular aneurysms. The purpose of this study was to examine the techniques of treatment of ruptured and unruptured fusiform intracranial aneurysms and patient outcomes. METHODS In 45 patients with fusiform aneurysms, the authors retrospectively reviewed the presentation, location, and shape of the aneurysm; the microsurgical technique; the outcome at discharge and last follow-up; and the change in the aneurysm at last angiographic follow-up...
February 10, 2017: Journal of Neurosurgery
https://www.readbyqxmd.com/read/28181086/bilateral-cavernous-carotid-aneurysms-treated-by-two-stage-extracranial-intracranial-bypass-followed-by-parent-artery-occlusion-case-report-and-literature-review
#10
Yaoling Liu, Xiang'en Shi, Fangjun Liu, Yuming Sun, Hai Qian, Ting Lei
Bilateral cavernous carotid aneurysms (CCAs) are often not amenable to neurosurgical clipping or endovascular coiling. Here, we report the case of a 50-year-old female who presented with a 1-year history of gradual severe headache. Preoperative angiograms revealed bilateral CCAs. Among these findings, the right giant CCA had been trapped after the external carotid artery-saphenous vein-middle cerebral artery (ECA-SV-MCA) bypass 8 years prior. Additionally, the left CCA was again trapped after the internal maxillary artery-radial artery-middle cerebral artery (IMA-RA-MCA) bypass, followed by parent artery occlusion (PAO), because of the enlargement of a 0...
February 8, 2017: Acta Neurochirurgica
https://www.readbyqxmd.com/read/28153625/ruptured-mycotic-aneurysm-and-cerebral-vasospasm-in-the-setting-of-endocarditis-and-heart-failure-requiring-cardiothoracic-surgery-case-report-and-review
#11
Chih-Ta Lin, Bruce Tranmer, Susan Durham, David Johnson, Mark Hamlin, R Morton Bolman
BACKGROUND: Ruptured mycotic aneurysm in the setting of cardiac failure and cerebral vasospasm presents unique management challenges. CASE DESCRIPTION: The authors describe a case of a ruptured mycotic aneurysm with subarachnoid hemorrhage (SAH), cerebral vasospasm, and endocarditis with heart failure who successfully underwent craniotomy, neuro-endovascular treatments, and cardiopulmonary bypass for mitral valve replacement while in cerebral vasospasm. This case highlights the clinical management strategies of a patient with a ruptured mycotic aneurysm, SAH, cerebral vasospasm, endocarditis, and heart failure...
January 30, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28137542/developing-the-first-highly-specialized-neurosurgical-center-of-excellence-in-trujillo-peru-work-in-progress-first-four-months-results
#12
Joham Choque-Velasquez, Roberto Colasanti, Virginia Baffigo-Torre, Luisa Estela Sacieta-Carbajo, Jacqueline Olivari-Heredia, Yolanda Falcon-Lizaraso, Juan Huber Mallma-Torres, Humberto Elera-Florez, Juha Hernesniemi
BACKGROUND: Economic, cultural, and geographical reasons usually limit the access to specialized health centers in developing countries, especially in rural areas. Peruvian health system indicators still highlight significant unmet clinical need for neurosurgical patients. Our project is to develop the first highly specialized neurosurgical center in the EsSalud hospital of Trujillo, with the goal to improve the treatment of neurosurgical diseases in that region, thus optimizing their outcomes while decreasing expensive and risky patients transfer to the neurosurgical departments in the capital district...
January 27, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28132587/aortic-arch-reconstruction-deep-and-moderate-hypothermic-circulatory-arrest-with-selective-antegrade-cerebral-perfusion
#13
YanWen Wu, LiQiong Xiao, Ting Yang, Lei Wang, Xin Chen
OBJECTIVE: To compare the effects of moderate and deep hypothermic circulatory arrest (DHCA) with selective antegrade cerebral perfusion (SACP) during aortic arch surgery in adult patients and to offer the evidence for the detection of the temperature which provides best brain protection in the subjects who accept aortic arch reconstruction surgery. METHODS: A total of 109 patients undergoing surgery of the aortic arch were divided into the moderate hypothermic circulatory arrest group (Group I) and the deep hypothermic circulatory arrest group (Group II)...
January 1, 2017: Perfusion
https://www.readbyqxmd.com/read/28131431/the-standardized-concept-of-moderate-to-mild-%C3%A2-28%C3%A2-c-systemic-hypothermia-during-selective-antegrade-cerebral-perfusion-for%C3%A2-all-comers-in-aortic-arch-surgery-single-center-experience-in-587-consecutive-patients-over-a-15-year-period
#14
Ali El-Sayed Ahmad, Nestoras Papadopoulos, Petar Risteski, Anton Moritz, Andreas Zierer
BACKGROUND: Whether selective antegrade cerebral perfusion (ACP) during moderate-to-mild systemic hypothermia (≥28°C) is applicable to aortic arch surgery without restrictions including the emergency setting of an acute type A aortic dissection or extensive total arch procedures such as elephant and frozen elephant trunk techniques is an ongoing subject of controversy. METHODS: Between January 2000 and January 2015, 587 consecutive all-comers underwent aortic arch surgery at our institution uniformly applying selective ACP (unilateral: n = 393 [67%]; bilateral: n = 194 [33%]) during moderate-to-mild systemic hypothermia (28...
January 25, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28126980/-a-case-of-cervical-internal-carotid-artery-occlusion-presenting-with-subarachnoid-hemorrhage-caused-by-rupture-of-leptomeningeal-anastomosis
#15
Tsuyoshi Tsukada, Toru Masuoka, Hideo Hamada, Shoutarou Itou, Takuya Akai, Hideaki Iizuka
A 71-year-old man was admitted to our hospital with a diagnosis of subarachnoid hemorrhage (SAH). Angiographies revealed neither aneurysms nor vascular anomalies. However, these images elucidated the occlusion of the left cervical internal carotid artery as well as developed leptomeningeal anastomoses through the ipsilateral posterior cerebral artery, which resulted in blood perfusing the ipsilateral middle and anterior cerebral artery territories. Because the localization of SAH coincided with the developed leptomeningeal anastomosis, we speculated that the rupture of the developed leptomeningeal anastomosis in the basal cistern was the cause of SAH...
January 2017: Brain and Nerve, Shinkei Kenkyū No Shinpo
https://www.readbyqxmd.com/read/28109863/disruption-of-cortical-arterial-network-is-associated-with-the-severity-of-transient-neurological-events-after-direct-bypass-surgery-in-adult-moyamoya-disease
#16
Yusuke Egashira, Keita Yamauchi, Yukiko Enomoto, Noriyuki Nakayama, Shinichi Yoshimura, Toru Iwama
OBJECTIVE: Transient neurological events (TNEs) frequently occur after revascularization in adult moyamoya disease (MMD). In the present study, we hypothesized that cortical arterial network disruption may be associated with TNE severity following bypass surgery. METHODS: This retrospective study included 76 hemispheres in 45 consecutive adult MMD patients who underwent direct revascularization surgery at our institution. We classified cortical arterial network disruption grade (NDG) into the following four categories based on angiography: NDG 0, > 90% of suprasylvian cortical branches of the middle cerebral artery demonstrated anterograde filling; NDG 1, 50% to 90%; NDG 2, < 50%; NDG 3, none...
January 18, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28109102/-long-term-outcomes-of-off-pump-coronary-artery-bypass-grafting-in-patients-aged-over-75-years
#17
Yi Guo, Chong-Lei Ren, Chang-Qing Gao, Cang-Song Xiao, Hua-Jun Zhang
OBJECTIVE: To investigate the long-term outcomes of off-pump coronary artery bypass grafting (OPCAB) in patients aged over 75 years and analyze the risk factors affecting the outcomes of the procedure. METHODS: Clinical data were reviewed for 97 consecutive patients aged 75 years or above receiving OPCAB at our center between November, 2000 and November, 2013. The perioperative data including length of ICU stay, duration of mechanical ventilation, incidence of postoperative complications and mortality rate of the patients were analyzed...
January 20, 2017: Nan Fang Yi Ke da Xue Xue Bao, Journal of Southern Medical University
https://www.readbyqxmd.com/read/28108563/patient-management-in-aortic-arch-surgery%C3%A2
#18
REVIEW
Sven Peterss, Maximilian Pichlmaier, Alexander Curtis, Maximilian Luehr, Frank Born, Christian Hagl
SummaryAortic arch surgery requires complex patient management beyond the manual replacement of the diseased vessel. These procedures include (i) a thorough and pathologically adjusted preoperative evaluation, (ii) initiation and control of cardiopulmonary bypass, (iii) cerebral protection strategies and (iv) techniques to protect the abdominal end organs during prolonged operations. Due to the complexity of aortic arch procedures, multimodal real-time surveillance is required during all stages of the operation...
January 2017: European Journal of Cardio-thoracic Surgery
https://www.readbyqxmd.com/read/28104728/early-and-long-term-cognitive-outcome-after-conventional-cardiac-valve-surgery
#19
Stephan C Knipp, Christian Weimar, Marc Schlamann, Sebastian Schweter, Daniel Wendt, Matthias Thielmann, Jaroslav Benedik, Heinz Jakob
OBJECTIVES: Adverse cognitive outcome is well recognized after coronary artery bypass grafting (CABG) while little is known about the extent and duration of decline after cardiac valve surgery. We investigated changes in cognitive function following conventional cardiac valve surgery over up to 4 years. METHODS: Among 36 patients (65.2 ± 9.2 years, 36% women) who received valve surgery, we assessed serial cognitive function with a battery of 11 standardized tests across 3-4 years...
January 18, 2017: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/28100120/hybrid-stage-i-procedure-as-initial-palliation-for-neonate-with-hypoplastic-left-heart-syndrome-and-right-congenital-diaphragmatic-hernia
#20
Draginja Cvetkovic, Joseph Giamelli, Michael Lyew, Markus Erb, Suvro Sett, Youmna DiStefano
During the past decade, a hybrid procedure has emerged and dramatically evolved as an alternative stage I palliation to the conventional Norwood procedure in neonates with hypoplastic left heart syndrome (HLHS). The hybrid approach avoids the need for cardiopulmonary bypass (CPB) utilizing stenting of the arterial duct and bilateral pulmonary artery banding. Cerebral and coronary perfusion pressure is maintained, and the pulmonary vasculature is protected from higher systemic pressure. Elimination of risks associated with CPB gains vital time to stabilize the patient and correct coexisting noncardiac anomalies and allows growth in preparation for the later stages of the Fontan pathway...
January 1, 2017: Seminars in Cardiothoracic and Vascular Anesthesia
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