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Cerebral Aneurysm surgery

Eric S Nussbaum, Michael T Madison, James K Goddard, Jeffrey P Lassig, Kevin M Kallmes, Leslie A Nussbaum
OBJECTIVE Advances in endovascular therapy for the treatment of middle cerebral artery (MCA) aneurysms have led to scrutiny of its benefits compared with microsurgical repair. To provide information regarding complication rates and outcomes, the authors reviewed the results of a large series of unruptured MCA aneurysms treated with open microsurgery. METHODS The authors included all patients who underwent surgical repair of an unruptured MCA aneurysm between 1997 and 2015. All surgical procedures, including clipping, wrapping, bypass, and parent artery occlusion, were performed by a single neurosurgeon...
June 22, 2018: Journal of Neurosurgery
Robert C Rennert, Ben A Strickland, Kristine Ravina, Joshua Bakhsheshian, Vance Fredrickson, Joseph Carey, Jonathan J Russin
BACKGROUND: Revascularization strategies for complex cerebral aneurysms are largely based on subjective interpretation of flow demands, or indirect measures of perfusion in at-risk territories. Indocyanine Green -based flow analyses ((ICG-BFA); Flow 800, Carl Zeiss, Oberkochen, Germany) provide a real-time, semiquantitative measure of intraoperative cortical perfusion during cerebral bypass surgery for complex aneurysms. OBJECTIVE: To determine the utility of intraoperative ICG-BFA for assessing cortical perfusion in at-risk territories during cerebral bypass for complex aneurysms requiring vessel sacrifice...
June 12, 2018: Operative Neurosurgery (Hagerstown, Md.)
Christina Petridou, Lenka Strakova, Ruan Simpson
Introduction: Campylobacter is a common pathogen of the gastrointestinal tract, but invasive disease is rare. Campylobacter fetus can play a role in osteomyelitis, meningitis and joint infection and has a prediliction for the vascular endothelium, causing mycotic aneurysms, thrombophlebitis and endocarditis. Here we present a case of prosthetic valve endocarditis caused by C. fetus and a review of the literature. Case presentation: An 85-year-old woman with a tissue aortic valve replacement and atrial fibrillation was admitted to hospital with tonic-clonic seizures, right-sided hemiparesis, facial droop and hemianopia...
May 2018: JMM Case Reports
Erwan Salaun, Anissa Touil, Sandrine Hubert, Jean-Paul Casalta, Frédérique Gouriet, Emmanuelle Robinet-Borgomano, Emilie Doche, Nadia Laksiri, Caroline Rey, Cécile Lavoute, Sébastien Renard, Hervé Brunel, Anne-Claire Casalta, Julie Pradier, Jean-François Avierinos, Hubert Lepidi, Laurence Camoin-Jau, Alberto Riberi, Didier Raoult, Gilbert Habib
BACKGROUND: Although intracranial cerebral haemorrhage (ICH) complicating infective endocarditis (IE) is a critical clinical issue, its characteristics, impact, and prognosis remain poorly known. AIMS: To assess the incidence, mechanisms, risk factors and prognosis of ICH complicating left-sided IE. METHODS: In this single-centre study, 963 patients with possible or definite left-sided IE were included from January 2000 to December 2015. RESULTS: Sixty-eight (7%) patients had an ICH (mean age 57±13 years; 75% male)...
June 5, 2018: Archives of Cardiovascular Diseases
Di Guo, Yanli Li, Haiyun Wang, Xinyue Wang, Wei Hua, Qingkai Tang, Lumin Miao, Guolin Wang
Animal studies have demonstrated that propofol post-conditioning produces long-term neuroprotection in focal cerebral ischemia-reperfusion injury. However, whether propofol post-conditioning provides neuroprotection in human beings has never been explored. The aim of this study was to evaluate the role of propofol post-conditioning on oxidative stress and post-operative cognitive function following aneurysm clipping. Sixty patients undergoing intracranial aneurysm clipping were randomized into a propofol post-conditioning group or a sevoflurane group...
June 8, 2018: International Journal of Neuroscience
Hao Zhang, Yan Zhao, Gargi Naha, Changkai Hou, Zhe Wang, Xinyu Yang
BACKGROUND: Unruptured extracranial vertebral artery (VA) aneurysms are uncommon and have rarely been described with treatment options. CASE DESCRIPTION: Here we report the successful reconstruction of an asymptomatic extracranial left VA aneurysm highlighting the treatment for extracranial VA aneurysm and the superiority of hybrid operating room in cerebral vascular diseases. The case reported a 57-year-old female who suffered an extracranial left VA aneurysm. MRA showed bilateral vertebral arteries as co-dominant in the vertebrobasilar system...
June 1, 2018: World Neurosurgery
Yuhua Jiang, Keyun Liu, Youxiang Li
To evaluate the feasibility and safety of the robot of endovascular treatment (RobEnt) in clinical practice, we carried out a cerebral angiography using this robot system. We evaluated the performance of application of the robot system to clinical practice through using this robotic system to perform the digital subtraction angiography for a patient who was suspected of suffering intracranial aneurysm. At the same time, through comparing the postoperative head nuclear magnetic and blood routine with the preoperative examination, we evaluated the safety of application of the robot system to clinical practice...
2018: Applied Bionics and Biomechanics
Prity Gupta, Amer Harky, Saleem Jahangeer, Benjamin Adams, Mohamad Bashir
Cardiovascular surgeons have long debated the safe duration of deep hypothermic circulatory arrest during thoracic aortic aneurysm surgery. The rationale for using adjunctive cerebral perfusion (or not) is to achieve the best technical aortic repair with the lowest risk of morbidity and death. In this literature review, we highlight the debates surrounding these issues, evaluate the disparate findings on deep hypothermic circulatory arrest durations and temperatures, and consider the usefulness of adjunctive perfusion...
April 2018: Texas Heart Institute Journal
Ryota Sugisawa, Masaki Sano, Naoto Yamamoto, Kazunori Inuzuka, Hiroki Tanaka, Takaaki Saito, Kazuto Katahashi, Tatsuro Yata, Takafumi Kayama, Yuta Yamanaka, Hiroya Takeuchi, Naoki Unno
BACKGROUND: Innominate artery aneurysm (IAA) is a rare cervical artery aneurysm. Although atherosclerosis is its most common cause, IAAs due to cervical injury are often reported. Operative indications for IAAs include rupture or symptomatic aneurysm, saccular aneurysm, aneurysm with a diameter of 3 cm or greater, and aneurysmal change of the origin of the innominate artery. Although the ligature of the innominate artery or open surgical repair is well described, the usefulness of endovascular repair has also recently been reported...
January 1, 2018: Vascular and Endovascular Surgery
Konstantinos Tsagakis, Daniel Wendt, Alexandros M Dimitriou, Matthias Thielmann, Shehada Sharaf-Eldin, Mohamed El Gabry, Heinz G Jakob
BACKGROUND: Frozen elephant trunk (FET) is considered to be the treatment of choice in complex multi-segmental thoracic aortic disease involving the distal arch. Institutional results of FET technique are presented. METHODS: From 01.2005 to 10,2017 2018 286 patients underwent FET surgery in our department. Patients (age mean±SD 59±11 years) were operated for acute type I (55%) aortic dissection (AD), chronic AD (23%) and aneurysm (22%). Arch repair was performed with the E- vita open prosthesis under with selective cerebral perfusion and hypothermic circulatory arrest...
May 25, 2018: Journal of Cardiovascular Surgery
Shivani D Rangwala, Ben A Strickland, Robert C Rennert, Kristine Ravina, Joshua Bakhsheshian, Kyle Hurth, Steven L Giannotta, Jonathan J Russin
BACKGROUND AND IMPORTANCE: Infectious intracranial aneurysms are a rare subset of intracranial aneurysms caused by bacterial, fungal, or viral sources. Intracranial aneurysms of fungal etiology carry a high mortality risk and typically occur in immunocompromised patients via direct extension of skull base infections, or more rarely, after intracranial surgery. CLINICAL PRESENTATION: We present the case of a 27-yr-old female with systemic lupus erythematous and primary pulmonary mucormycosis, who suffered a subarachnoid hemorrhage from a ruptured fusiform distal middle cerebral artery aneurysm...
May 24, 2018: Operative Neurosurgery (Hagerstown, Md.)
Vadim A Byvaltsev, Serik K Akshulakov, Roman A Polkin, Sergey V Ochkal, Ivan A Stepanov, Yerbol T Makhambetov, Talgat T Kerimbayev, Michael Staren, Evgenii Belykh, Mark C Preul
Cerebrovascular diseases are among the most widespread diseases in the world, which largely determine the structure of morbidity and mortality rates. Microvascular anastomosis techniques are important for revascularization surgeries on brachiocephalic and carotid arteries and complex cerebral aneurysms and even during resection of brain tumors that obstruct major cerebral arteries. Training in microvascular surgery became even more difficult with less case exposure and growth of the use of endovascular techniques...
2018: Minimally Invasive Surgery
Mitsuya Watanabe, Eiji Abe, Reo Ishimoto, Naohide Fujita, Hiroshi Hasegawa, Hideaki Ueno, Yasuaki Nakao, Takuji Yamamoto, Ryo Wada
A 40-year-old man with a rare case of dissecting aneurysm of the distal middle cerebral artery(MCA, M2 segment)presented with ischemic stroke, manifesting as headache, nausea, and visual disorder. Computed tomography(CT)scan revealed cerebral infarction, and three-dimensional CT angiogram revealed stenotic change at the M2 segment. The patient was conservatively treated and remained neurologically stable. Ten months later, CT scan and magnetic resonance imaging(MRI)revealed outpouching of the M2 segment at the location of the initial stenosis...
May 2018: No Shinkei Geka. Neurological Surgery
Alba Scerrati, Giovanni Sabatino, Giuseppe Maria Della Pepa, Alessio Albanese, Enrico Marchese, Alfredo Puca, Alessandro Olivi, Carmelo Lucio Sturiale
Thrombosed aneurysms of the middle cerebral artery (MCA) usually show large dimension and complex morphology with neck sclerosis and perforating vessels originating from the sac. Only limited experiences from case reports or small mixed series including thrombosed aneurysms in different locations are available in literature. To systematically review all the pertinent literature, a comprehensive literature review with the search terms "MCA, aneurysm, and thrombosis" and a pooled analysis including our institutional series were performed...
May 22, 2018: Neurosurgical Review
David H Tian, Justin Weller, Shaheen Hasmat, Aung Oo, Paul Forrest, Hosen Kiat, Tristan D Yan
OBJECTIVE: Retrograde cerebral perfusion is becoming less frequently used as a method of neuroprotection during aortic surgery. The present meta-analysis aims to compare outcomes after arch surgery with hypothermic circulatory arrest versus hypothermic circulatory arrest + retrograde cerebral perfusion. METHODS: Electronic searches were performed using 7 databases from their inception to September 2016. Relevant comparative studies that included patient groups who underwent aortic arch surgery using hypothermic circulatory arrest with continuous retrograde cerebral perfusion or hypothermic circulatory arrest alone were identified, and data were extracted by 2 independent researchers...
April 21, 2018: Journal of Thoracic and Cardiovascular Surgery
Chun-Yu Cheng, Rakshith Shetty, Laligam N Sekhar
A 59-yr-old man presented with intraventricular hemorrhage and was found to have a large temporo-occipital arteriovenous malformation (AVM), Spetzler-Martin grade 4. The preoperative intra-arterial digital subtraction angiography (IADSA) showed the AVM was 4 × 4 cm2, had superficial and deep venous drainage, and was fed by multiple branches of the posterior cerebral artery and middle cerebral artery. Preoperative embolization was done in 4 stages. He underwent a left temporo-occipital craniotomy, mastoidectomy, and retrosigmoid craniotomy with a posterior temporal approach...
May 18, 2018: Operative Neurosurgery (Hagerstown, Md.)
Vijay Agarwal, Daniel L Barrow
Selecting appropriate patient position for surgery must take into consideration a variety of factors. For an interhemispheric approach to distal anterior cerebral artery (DACA) aneurysms, the patient may be positioned with the head either horizontal or vertical with respect to the floor. We preferentially place the patient in the supine position with the shoulder elevated and the head turned parallel to the floor with the side of the approach down and the vertex tilted 45° up. In this way, gravity is utilized to allow the right frontal lobe to fall away from the falx, eliminating the need for retraction...
May 18, 2018: Operative Neurosurgery (Hagerstown, Md.)
Chao-Hung Kuo, Lynn B McGrath, Joseph A Carnevale, Neena I Marupudi, Jeffery G Ojemann, Richard G Ellenbogen, Anthony C Wang
BACKGROUND: Duane syndrome is a congenital eye movement disorder characterized by congenital malformation of the abducens nucleus. Thrombogenic conditions during development may lead to vascular anomalies in Duane syndrome, however, the presence of a giant aneurysm in this patient population is a rarely documented phenomenon. CASE DESCRIPTION: We reported a case of a large cerebral aneurysm in a pediatric patient with Duane syndrome, and performed a review of the literatures to identify other potential cases and associations...
May 16, 2018: World Neurosurgery
Xianli Lv, Wei Li, Huijian Ge, Hengwei Jin, Hongwei He, Chuhan Jiang, Youxiang Li
Background: Experience with respect to parent vessel sacrifice (PVS) for unclippable/uncoilable ruptured aneurysms is limited. Objective: The aim of the present systematic review was to evaluate the risk of PVS for unclippable/uncoilable ruptured aneurysms. Materials and Methods: The PUBMED and SCIENCEDIRECT databases were searched using "parent vessel occlusion OR parent artery occlusion" AND "acute subarachnoid hemorrhage" till December 27, 2015, and 1 journal was searched from November 1995 to April 2016 for relevant results...
May 2018: Neurology India
Laligam N Sekhar, Chun-Yu Cheng, Harley Brito Da Silva, Zeeshan Qazi
No abstract text is available yet for this article.
May 2018: Neurology India
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