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Cerebral Aneurysms

Vaner Koksal, Selim Kayaci
INTRODUCTION: The treatment of giant intracranial aneurysms is one of the most challenging cerebrovascular problems of neurosurgery. We report the rupture of a giant, lobulated, and almost completely thrombosed middle cerebral artery (MCA) aneurysm that is the ninth such report in the literature. We also investigated additional solutions used in the treatment of this patient. CASE PRESENTATION: A 58-year-old man had been admitted with headache 8 years previously (in 2005), and a giant MCA aneurysm was detected...
August 2016: Iranian Red Crescent Medical Journal
Navneet Singla, Ashish Aggarwal, Sameer Vyas, Ankur Sanghvi, Pravin Salunke, Ravi Garg
BACKGROUND: A sudden onset of neurological symptoms in patients is conventionally thought to be due to vascular phenomenon, with one common differential diagnosis being subarachnoid hemorrhage. Another important differential diagnosis is ischemic stroke. An uncommon cause of such acute symptoms can be hemorrhage in a pre-existing tumor, that is, intratumoral hemorrhage (ITH). PURPOSE: ITH is an important, though uncommon differential diagnosis in cases of sudden onset of neurological deterioration...
October 2016: Annals of Neurosciences
Thomas Peach, Katerina Spranger, Yiannis Ventikos
Bifurcation aneurysms account for a large fraction of cerebral aneurysms and often present morphologies that render traditional endovascular treatments, such as coiling, challenging and problematic. Flow-diverter stents offer a potentially elegant treatment option for such aneurysms, but clinical use of these devices remains controversial. Specifically, the deployment of a flow-diverter device in a bifurcation entails jailing one or more potentially vital vessels with a low-porosity mesh designed to restrict the flow...
October 25, 2016: Proceedings of the Institution of Mechanical Engineers. Part H, Journal of Engineering in Medicine
Thiago Giansante Abud, Andrew D Nguyen, Lucas Giansante Abud, Emmanuel Houdart
No abstract text is available yet for this article.
July 2016: Radiologia Brasileira
Joham Choque-Velasquez, Roberto Colasanti, George Fotakopoulos, Humberto Elera-Florez, Juha Hernesniemi
BACKGROUND: Multiple intracranial aneurysms treatment is particularly demanding, even more in a developing country where the access to specialized centers may be prevented by different factors. CASE DESCRIPTION: Herein, we report a challenging case regarding the single-stage surgical treatment of seven cerebral aneurysms in a 58-year-old woman from the northern Peruvian Andes. All the aneurysm were successfully and safely clipped through two lateral supraorbital craniotomies...
October 21, 2016: World Neurosurgery
Apar S Patel, Christoph J Griessenauer, Raghav Gupta, Nimer Adeeb, Paul M Foreman, Hussain Shallwani, Justin M Moore, Mark R Harrigan, Adnan H Siddiqui, Christopher S Ogilvy, Ajith J Thomas
INTRODUCTION: Cerebral vasospasm following subarachnoid hemorrhage (SAH) is the single most important cause of neurological decline following successful treatment of the ruptured aneurysm. Here, we report safety and efficacy of non-compliant balloon angioplasty for the treatment of cerebral vasospasm. METHODS: Three major academic institutions in the United States provided data on cerebral vasospasm treated with non-compliant balloon angioplasty between October 2004 and February 2016...
October 21, 2016: World Neurosurgery
Daniel Dubinski, Sae-Yeon Won, Jürgen Konczalla, Jan Mersmann, Christof Geisen, Eva Herrmann, Volker Seifert, Christian Senft
OBJECTIVE: Rupture of an intracranial aneurysm usually presents with an acute onset, requires multidisciplinary intensive care treatment, and the overall death and disability rates are high. The ABO blood type is known to play an important role in hemostasis, thrombosis and vascular NO response. The aspect of ABO blood type in onset, clinical progress and outcome after SAH are to date largely unexplored. We conducted this study to elucidate the association of ABO blood type on the occurrence and outcome of aneurysmal SAH...
October 21, 2016: World Neurosurgery
Yuxia Duan, Haoli Xu, Rui Li, Kuikui Zheng, Zilong Hu, Nan Wu, Yunjun Yang, Qichuan Zhuge, Weijian Chen
BACKGROUND AND PURPOSE: Delayed cerebral ischemia (DCI) is a frequent and fearful complication following aneurysmal subarachnoid hemorrhage (aSAH). The aim of this study is to assess the diagnostic accuracy of computed tomography perfusion (CTP) during an admission baseline period for the prediction of DCI. METHODS: Fifty-four aSAH cases were screened by baseline CTP within 3 days after aSAH and were reexamined with CTP 7-17 days after aSAH. Relative cerebral blood volume, relative cerebral blood flow (CBF), and relative mean transit time were measured...
October 21, 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Mitsumasa Hata, Yukihiko Orime, Shinji Wakui, Tetsuya Nakamura, Rei Hinoura, Atsushi Harada, Kenji Akiyama
OBJECTIVE: We assessed the efficacy of distal limited open stenting procedure in octogenarians with distal aortic arch aneurysm. METHODS: During the last 5 years, 24 patients underwent distal limited open stenting. Mean patient age was 81.6 ± 2.5 years, ranging from 80 to 90 years. The hemicircumference of the anterior surface of the arch around the left common carotid artery was obliquely incised, and a J-Graft Open Stent (Japan Lifeline Co, Ltd, Tokyo, Japan) was inserted into the descending aorta...
September 24, 2016: Journal of Thoracic and Cardiovascular Surgery
Akil Patel, Timothy R Miller, Ravi Shivashankar, Gaurav Jindal, Dheeraj Gandhi
BACKGROUND AND OBJECTIVE: Acute thrombus formation following aneurysm treatment with the Pipeline embolization device (PED) is a potentially devastating complication that may result in significant thromboembolic sequelae if not promptly treated. We therefore evaluated PED cases complicated by acute thrombus formation at our institution, with an emphasis on identifying early angiographic signs that may portend this event. MATERIALS AND METHODS: We retrospectively identified cases of acute thrombosis following PED placement in 100 consecutive procedures performed at our institution from a prospectively maintained clinical database...
October 21, 2016: Journal of Neurointerventional Surgery
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
Ryan C Shelstad, Justin G Reeves, Katsuhiro Yamanaka, T Brett Reece
We review the operative techniques of aortic arch replacement. Aortic arch replacement presents several formidable challenges, as it requires arresting the circulation to the body and replacement of the brachiocephalic vessels with special consideration for protecting the central nervous system. Perfusion strategies, selective antegrade cerebral perfusion, and operative graft selection are key elements in aortic arch replacement surgery. Standard approaches include the island technique, the branched graft technique, and the "Spielvogel" trifurcated graft technique-each having its own advantages...
October 7, 2016: Seminars in Cardiothoracic and Vascular Anesthesia
Ivan R Da Silva, Joao A Gomes, Ari Wachsman, Gabriel Rodriguez de Freitas, Jose Javier Provencio
BACKGROUND: It is not well understood whether age impacts transcranial Doppler (TCD) mean flow velocities (MFVs) in patients with aneurysmal subarachnoid hemorrhage (SAH) with or without delayed cerebral ischemia (DCI). The aim of our study was to analyze the behavior of TCD MFV during the first 7 days after SAH in patients of different ages and correlate them with the occurrence of DCI. METHODS: This study is a databank analysis of patients with SAH admitted between 2010 and 2012 in a single center...
October 21, 2016: European Neurology
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
Francis Cloutier, Naim Khoury, Jimmy Ghostine, Behzad Farzin, Marc Kotowski, Alain Weill, Daniel Roy, Jean Raymond
BACKGROUND AND PURPOSE: Endovascular coil embolization of cerebral aneurysms is associated with suboptimal angiographic results in up to 20-30% of patients. Coil packing density has been used as an index of the success of the initial procedure. The trial sought to study the effects of using 15-caliber coils, as compared with 10-caliber coils, on packing density. METHODS: Does Embolization with Larger coils lead to better Treatment of Aneurysms (DELTA) is an investigator-initiated multicenter prospective, randomized, controlled clinical trial...
October 19, 2016: Interventional Neuroradiology
Min S Park, Marcus D Mazur, Karam Moon, Michael J Nanaszko, John R W Kestle, Lubdha M Shah, Blair Winegar, Felipe C Albuquerque, Philipp Taussky, Cameron G McDougall
OBJECT: Despite the popularity of flow-diverting stents for the treatment of cerebral aneurysms, there is no widely accepted scale for the characterization of results. We present an outcomes-based grading scale that considers factors related to failure of flow diversion. METHODS: The grading scale was developed using the results from consecutive patients at two institutions who were treated with flow diversion for a cerebral aneurysm. The initial treatment results were graded on patient, aneurysm, and treatment characteristics...
October 19, 2016: Journal of Neurointerventional Surgery
Riikka S K Takala, Riku Kiviranta, Klaus T Olkkola, Tero Vahlberg, Dan Laukka, Anna Kotkansalo, Melissa Rahi, Matti Sankinen, Jussi Posti, Ari Katila, Jaakko Rinne
PURPOSE: The aim was to assess anterior pituitary hormone levels during the acute phase of aneurysmal subarachnoid hemorrhage (aSAH) and analyze the possible association with the clinical condition and outcome. MATERIAL AND METHODS: Forty patients with aSAH whose aneurysm was secured by endovascular coiling were enrolled. Basal secretions of cortisol, testosterone, luteinizing hormone (LH), prolactin (PRL), and sex hormone binding globulin (SHBG) levels were measured up to 14 days after the incident...
October 18, 2016: Endocrine Research
Taerim Kim, Shin Ahn, Chang Hwan Sohn, Dong Woo Seo, Won Young Kim
OBJECTIVE: Reversible cerebral vasoconstriction syndrome (RCVS) is an underestimated cause of thunderclap headache that shares many characteristics with subarachnoid hemorrhage (SAH). This fact makes the two easily confused by emergency physicians. This study evaluated the clinical manifestations, radiological features, and outcomes of patients with RCVS. METHODS: The electronic medical records of 18 patients meeting the diagnostic criteria of RCVS at our emergency department between January 2013 and December 2014 were retrospectively reviewed...
December 2015: Clin Exp Emerg Med
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
Dominic Girardi, Josef Küng, Raimund Kleiser, Michael Sonnberger, Doris Csillag, Johannes Trenkler, Andreas Holzinger
Established process models for knowledge discovery find the domain-expert in a customer-like and supervising role. In the field of biomedical research, it is necessary to move the domain-experts into the center of this process with far-reaching consequences for both their research output and the process itself. In this paper, we revise the established process models for knowledge discovery and propose a new process model for domain-expert-driven interactive knowledge discovery. Furthermore, we present a research infrastructure which is adapted to this new process model and demonstrate how the domain-expert can be deeply integrated even into the highly complex data-mining process and data-exploration tasks...
September 2016: Brain Informatics
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