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Barros G, Levitt MR. Intraoperative Neuromonitoring in Microsurgical and Endovascular Treatment of Intracranial Aneurysms: Always, Sometimes, or Never? World Neurosurg 2024:S1878-8750(24)00675-2. [PMID: 38744619 DOI: 10.1016/j.wneu.2024.04.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Affiliation(s)
- Guilherme Barros
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Michael R Levitt
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
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Auricchio AM, Di Bonaventura R, Marchese E, Della Pepa GM, Sturiale CL, Menna G, Skrap B, Olivi A, Albanese A. Navigating Complexity: A Comprehensive Approach to Middle Cerebral Artery Aneurysms. J Clin Med 2024; 13:1286. [PMID: 38592120 PMCID: PMC10931706 DOI: 10.3390/jcm13051286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 02/18/2024] [Accepted: 02/22/2024] [Indexed: 04/10/2024] Open
Abstract
Background: The concept of aneurysm "complexity" has undergone significant changes in recent years, with advancements in endovascular treatments. However, surgical clipping remains a relevant option for middle cerebral artery (MCA) aneurysms. Hence, the classical criteria used to define surgically complex MCA aneurysms require updating. Our objective is to review our institutional series, considering the impacts of various complexity features, and provide a treatment strategy algorithm. Methods: We conducted a retrospective review of our institutional experience with "complex MCA" aneurysms and analyzed single aneurysmal-related factors influencing treatment decisions. Results: We identified 14 complex cases, each exhibiting at least two complexity criteria, including fusiform shape (57%), large size (35%), giant size (21%), vessel branching from the sac (50%), intrasaccular thrombi (35%), and previous clipping/coiling (14%). In 92% of cases, the aneurysm had a wide neck, and 28% exhibited tortuosity or stenosis of proximal vessels. Conclusions: The optimal management of complex MCA aneurysms depends on a decision-making algorithm that considers various complexity criteria. In a modern medical setting, this process helps clarify the choice of treatment strategy, which should be tailored to factors such as aneurysm morphology and patient characteristics, including a combination of endovascular and surgical techniques.
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Affiliation(s)
- Anna Maria Auricchio
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.M.A.); (R.D.B.); (E.M.); (G.M.D.P.); (B.S.); (A.O.)
- Department of Neurosurgery, UMC Utrecht, 3584 CX Utrecht, The Netherlands
| | - Rina Di Bonaventura
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.M.A.); (R.D.B.); (E.M.); (G.M.D.P.); (B.S.); (A.O.)
| | - Enrico Marchese
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.M.A.); (R.D.B.); (E.M.); (G.M.D.P.); (B.S.); (A.O.)
| | - Giuseppe Maria Della Pepa
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.M.A.); (R.D.B.); (E.M.); (G.M.D.P.); (B.S.); (A.O.)
| | - Carmelo Lucio Sturiale
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.M.A.); (R.D.B.); (E.M.); (G.M.D.P.); (B.S.); (A.O.)
| | - Grazia Menna
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.M.A.); (R.D.B.); (E.M.); (G.M.D.P.); (B.S.); (A.O.)
| | - Benjamin Skrap
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.M.A.); (R.D.B.); (E.M.); (G.M.D.P.); (B.S.); (A.O.)
| | - Alessandro Olivi
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.M.A.); (R.D.B.); (E.M.); (G.M.D.P.); (B.S.); (A.O.)
| | - Alessio Albanese
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.M.A.); (R.D.B.); (E.M.); (G.M.D.P.); (B.S.); (A.O.)
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Gulino V, Brunasso L, Avallone C, Campisi BM, Bonosi L, Costanzo R, Cammarata E, Sturiale CL, Cordova A, Iacopino DG, Maugeri R. The Use of Intraoperative Microvascular Doppler in Vascular Neurosurgery: Rationale and Results-A Systematic Review. Brain Sci 2024; 14:56. [PMID: 38248271 PMCID: PMC10813139 DOI: 10.3390/brainsci14010056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 12/27/2023] [Accepted: 01/04/2024] [Indexed: 01/23/2024] Open
Abstract
Surgical treatment of neurovascular lesions like intracranial aneurysms, arteriovenous malformations and arteriovenous dural fistulas is still associated with high morbidity. Several recent studies are providing increasing insights into reliable tools to improve surgery and reduce complications. Inadvertent vessel compromise and incomplete occlusion of the lesion represent the most possible complications in neurovascular surgery. It is clear that direct visual examination alone does not allow to identify all instances of vessel compromise. Various modalities, including angiography, microvascular Doppler and neurophysiological studies, have been utilized for hemodynamics of flow vessels in proper clipping of the aneurysm or complete obliteration of the lesion. We intended to review the current knowledge about the intraoperative microvascular Doppler (iMDS) employment in the most updated literature, and explore the most recent implications not only in intracranial aneurysms but also in neurovascular lesions like arteriovenous malformations (AVMs) and arteriovenous dural fistulas (AVDFs). According to the PRISMA guidelines, systematic research in the most updated platform was performed in order to provide a complete overview about iMDS employment in neurovascular surgery. Twelve articles were included in the present paper and analyzed according to specific research areas. iMDS employment could represent a crucial tool to improve surgery in neurovascular lesions. The safety and effectiveness of the surgical treatment of neurovascular lesions like intracranial aneurysm and other neurovascular lesions like AVMs and AVDFs requires careful and accurate consideration regarding the assessment of anatomy and blood flow. Prognosis may depend on suboptimal or incomplete exclusion of the lesion.
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Affiliation(s)
- Vincenzo Gulino
- Neurosurgical Clinic AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, Via del Vespro 127, 90127 Palermo, Italy; (V.G.); (L.B.); (C.A.); (B.M.C.); (L.B.); (R.C.); (R.M.)
| | - Lara Brunasso
- Neurosurgical Clinic AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, Via del Vespro 127, 90127 Palermo, Italy; (V.G.); (L.B.); (C.A.); (B.M.C.); (L.B.); (R.C.); (R.M.)
| | - Chiara Avallone
- Neurosurgical Clinic AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, Via del Vespro 127, 90127 Palermo, Italy; (V.G.); (L.B.); (C.A.); (B.M.C.); (L.B.); (R.C.); (R.M.)
| | - Benedetta Maria Campisi
- Neurosurgical Clinic AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, Via del Vespro 127, 90127 Palermo, Italy; (V.G.); (L.B.); (C.A.); (B.M.C.); (L.B.); (R.C.); (R.M.)
| | - Lapo Bonosi
- Neurosurgical Clinic AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, Via del Vespro 127, 90127 Palermo, Italy; (V.G.); (L.B.); (C.A.); (B.M.C.); (L.B.); (R.C.); (R.M.)
| | - Roberta Costanzo
- Neurosurgical Clinic AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, Via del Vespro 127, 90127 Palermo, Italy; (V.G.); (L.B.); (C.A.); (B.M.C.); (L.B.); (R.C.); (R.M.)
| | - Emanuele Cammarata
- Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Via del Vespro 127, 90127 Palermo, Italy; (E.C.); (A.C.)
| | - Carmelo Lucio Sturiale
- Department of Neurosurgery, Fondazione Policlinico Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy;
| | - Adriana Cordova
- Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Via del Vespro 127, 90127 Palermo, Italy; (E.C.); (A.C.)
| | - Domenico Gerardo Iacopino
- Neurosurgical Clinic AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, Via del Vespro 127, 90127 Palermo, Italy; (V.G.); (L.B.); (C.A.); (B.M.C.); (L.B.); (R.C.); (R.M.)
| | - Rosario Maugeri
- Neurosurgical Clinic AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, Via del Vespro 127, 90127 Palermo, Italy; (V.G.); (L.B.); (C.A.); (B.M.C.); (L.B.); (R.C.); (R.M.)
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