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Griessenauer CJ, Dodier P, Stroh NH, Mercea PA, Bavinzski G, Dorfer C, Rössler K, Gruber A, Gmeiner M, Thomé C, Leber KA, Wolfsberger S, Baghban M, Al-Schameri R, Kral M, Thakur S, Lunzer M, Popadic B, Sherif C, Juráň V, Smrčka M, Netuka D, Štekláčová A, Lipina R, Hrbáč T, Večeřa Z, Fiedler J, Grubhoffer M, Hrabálek L, Krahulík D, Koller L, Kretschmer T, Přibáň V, Mraček J, Sameš M, Hejčl A, Klener J, Šroubek J, Petr O. Open Microsurgical Cerebral Aneurysm Treatment After Failed Endovascular Therapy: An Evaluation of Aneurysm Treatment Frequencies in All Neurovascular Centers Across Austria and the Czech Republic Over 20 Years. Neurosurgery 2024:00006123-990000000-01212. [PMID: 38864626 DOI: 10.1227/neu.0000000000003040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 04/02/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Endovascular treatment of cerebral aneurysms has tremendously advanced over the past decades. Nevertheless, aneurysm residual and recurrence remain challenges after embolization. The objective of this study was to elucidate the portion of embolized aneurysms requiring open surgery and evaluate whether newer endovascular treatments have changed the need for open surgery after failed embolization. METHODS All 15 cerebrovascular centers in Austria and the Czech Republic provided overall aneurysm treatment frequency data and retrospectively reviewed consecutive cerebral aneurysms treated with open surgical treatment after failure of embolization from 2000 to 2022. All endovascular modalities were included. RESULTS On average, 1362 aneurysms were treated annually in the 2 countries. The incidence increased from 0.006% in 2005 to 0.008% in 2020 in the overall population. Open surgery after failed endovascular intervention was necessary in 128 aneurysms (0.8%), a proportion that remained constant over time. Subarachnoid hemorrhage was the initial presentation in 70.3% of aneurysms. The most common location was the anterior communicating artery region (40.6%), followed by the middle cerebral artery (25.0%). The median diameter was 6 mm (2-32). Initial endovascular treatment included coiling (107 aneurysms), balloon-assist (10), stent-assist (4), intrasaccular device (3), flow diversion (2), and others (2). Complete occlusion after initial embolization was recorded in 40.6%. Seventy-one percent of aneurysms were operated within 3 years after embolization. In 7%, the indication for surgery was (re-)rupture and, in 88.3%, reperfusion. Device removal was performed in 16.4%. Symptomatic intraoperative and postoperative complications occurred in 10.2%. Complete aneurysm occlusion after open surgery was achieved in 94%. CONCLUSION Open surgery remains a rare indication for cerebral aneurysms after failed endovascular embolization even in the age of novel endovascular technology, such as flow diverters and intrasaccular devices. Regardless, it is mostly performed for ruptured aneurysms initially treated with primary coiling that are in the anterior circulation.
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Affiliation(s)
- Christoph J Griessenauer
- Department of Neurosurgery, Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria
| | - Philippe Dodier
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Nico H Stroh
- Department of Neurosurgery, Kepler University Hospital Linz, Johannes Kepler University, Linz, Austria
| | - Petra A Mercea
- Department of Neurosurgery, Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria
| | - Gerhard Bavinzski
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Christian Dorfer
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Karl Rössler
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Andreas Gruber
- Department of Neurosurgery, Kepler University Hospital Linz, Johannes Kepler University, Linz, Austria
| | - Matthias Gmeiner
- Department of Neurosurgery, Kepler University Hospital Linz, Johannes Kepler University, Linz, Austria
| | - Claudius Thomé
- Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria
| | - Klaus A Leber
- Department of Neurosurgery, Medical University of Graz, Graz, Austria
| | | | - Mustafa Baghban
- Department of Neurosurgery, Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria
| | - Rahman Al-Schameri
- Department of Neurosurgery, Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria
| | - Michael Kral
- Department of Neurosurgery, Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria
| | - Som Thakur
- Department of Neurosurgery, Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria
| | - Manuel Lunzer
- Department of Neurosurgery, Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria
| | - Branko Popadic
- Department of Neurosurgery, University Hospital St. Pölten, St. Pölten, Austria
| | - Camillo Sherif
- Department of Neurosurgery, University Hospital St. Pölten, St. Pölten, Austria
| | - Vilém Juráň
- Department of Neurosurgery, University Hospital Brno and Masaryk University, Brno, Czech Republic
| | - Martin Smrčka
- Department of Neurosurgery, University Hospital Brno and Masaryk University, Brno, Czech Republic
| | - David Netuka
- Department of Neurosurgery and Neuro-Oncology, 1st Medical Faculty, Charles University, Central Military Hospital, Prague, Czech Republic
| | - Anna Štekláčová
- Department of Neurosurgery and Neuro-Oncology, 1st Medical Faculty, Charles University, Central Military Hospital, Prague, Czech Republic
| | - Radim Lipina
- Department of Neurosurgery, University Hospital Ostrava, Ostrava, Czech Republic
| | - Tomáš Hrbáč
- Department of Neurosurgery, University Hospital Ostrava, Ostrava, Czech Republic
| | - Zdeněk Večeřa
- Department of Neurosurgery, University Hospital Ostrava, Ostrava, Czech Republic
| | - Jiří Fiedler
- Department of Neurosurgery, Ceske Budejovice Hospital, České Budějovice, Czech Republic
| | - Marek Grubhoffer
- Department of Neurosurgery, Ceske Budejovice Hospital, České Budějovice, Czech Republic
- Department of Neurosurgery, Pilsen University Hospital, Pilsen, Czech Republic
| | - Lumír Hrabálek
- Department of Neurosurgery, University Hospital Olomouc, Olomouc, Czech Republic
| | - David Krahulík
- Department of Neurosurgery, University Hospital Olomouc, Olomouc, Czech Republic
| | - Lukas Koller
- Department of Neurosurgery and Neurorestoration, Klinikum Klagenfurt, Klagenfurt, Austria
| | - Thomas Kretschmer
- Department of Neurosurgery and Neurorestoration, Klinikum Klagenfurt, Klagenfurt, Austria
| | - Vladimír Přibáň
- Department of Neurosurgery, Pilsen University Hospital, Pilsen, Czech Republic
| | - Jan Mraček
- Department of Neurosurgery, Pilsen University Hospital, Pilsen, Czech Republic
| | - Martin Sameš
- Department of Neurosurgery, Usti nad Labem Hospital, Ústí nad Labem, Czech Republic
| | - Aleš Hejčl
- Department of Neurosurgery, Usti nad Labem Hospital, Ústí nad Labem, Czech Republic
| | - Jan Klener
- Unit of Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Jan Šroubek
- Unit of Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
- Department of Neurosurgery, Charles University Hospital, Hradec Kralove, Czech Republic
| | - Ondra Petr
- Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria
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Marsool Marsool MD, Bharadwaj HR, Ali SH, Aderinto N, Shah MH, Shing N, Dalal P, Huang H, Wellington J, Chaudri T, Awuah WA, Pacheco-Barrios N, Macha-Quillama L, Fernandez-Guzman D, Hussien Mohamed Ahmed KA. Exploring the Landscape of Intracranial Aneurysms in South America: A Comprehensive Narrative Review Intracranial Aneurysms in South America. World Neurosurg 2024; 185:3-25. [PMID: 38286319 DOI: 10.1016/j.wneu.2024.01.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 01/19/2024] [Indexed: 01/31/2024]
Abstract
Exploring the landscape of intracranial aneurysms in South America unravels a complex interplay of epidemiological factors, clinical manifestations, and therapeutic challenges. The study methodically conducts a comprehensive literature review spanning the years 2003 to 2023, focusing on English-language articles obtained from diverse databases to elucidate the multifaceted nature of intracranial aneurysms in the region. Results and discussions categorize outcomes into positive domains, emphasizing successful treatments, favorable recoveries, and high survival rates, while also shedding light on negative aspects such as residual aneurysms and complications. The research illuminates significant gaps in pathological typing of intracranial aneurysms and exposes challenges in healthcare accessibility, notably the disparities in neurosurgical resources. Management challenges, including constrained infrastructure access, a neurosurgeon shortage, and gender disparities, are underscored. Transitioning to future prospects, the study advocates for strategic interventions, proposing expanded neurosurgical training, multidisciplinary approaches, improved funding, enhanced access to care, and fostering international collaborations. The study concludes by emphasizing the pivotal role of collaborative efforts, intensified training programs, and global partnerships in propelling intracranial aneurysm management forward in South America, ultimately contributing to enhanced patient outcomes across the region.
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Affiliation(s)
| | | | - Syed Hasham Ali
- Faculty of Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Nicholas Aderinto
- Internal Medicine Department, LAUTECH Teaching Hospital, Oyo, Nigeria
| | | | - Nathanael Shing
- School of Medicine, University of Central Lancashire, Preston, United Kingdom
| | - Priyal Dalal
- School of Medicine, University of Central Lancashire, Preston, United Kingdom
| | - Helen Huang
- University of Medicine and Health Science, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Jack Wellington
- Department of Neurosurgery, Bradford Teaching Hospital NHS Foundation Trust, Bradford, United Kingdom
| | | | | | | | - Luis Macha-Quillama
- Alberto Hurtado Medical School, Cayetano Heredia Peruvian University, Lima, Peru
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Habibi MA, Rashidi F, Fallahi MS, Arshadi MR, Mehrtabar S, Ahmadi MR, Shafizadeh M, Majidi S. Woven endo bridge device for recurrent intracranial aneurysms: A systematic review and meta-analysis. Neuroradiol J 2024:19714009241247457. [PMID: 38613671 DOI: 10.1177/19714009241247457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2024] Open
Abstract
BACKGROUND Recurrent intracranial aneurysms present a significant clinical challenge, demanding innovative and effective treatment approaches. The Woven EndoBridge (WEB) device has emerged as a promising endovascular solution for managing these intricate cases. This study aims to assess the safety and efficacy of the WEB device in treating recurrent intracranial aneurysms. METHODS We conducted a comprehensive search across multiple databases, including PubMed, Scopus, Embase, and Web of Science, from inception to June 5, 2023. Eligible studies focused on evaluating WEB device performance and included a minimum of five patients with recurrent intracranial aneurysms. The complete and adequate occlusion rates, neck remnant rates, and periprocedural complication rates were pooled using SATA V.17. RESULTS Our analysis included five studies collectively enrolling 73 participants. Participant ages ranged from 52.9 to 65 years, with 64.4% being female. Aneurysms were wide-necked and predominantly located in the middle cerebral artery, basilar artery, and anterior cerebral artery. Previous treatments encompassed coiling, clipping, and the use of WEB devices. Our study found an overall adequate occlusion rate of 0.80 (95% CI 0.71-0.89), a complete occlusion rate of 0.39 (95% CI 0.28-0.50), and a neck remnant rate of 0.38 (95% CI 0.27-0.48). Periprocedural complications were reported at a rate of 0%, although heterogeneity was observed in this data. Notably, evidence of publication bias was identified in the reporting of periprocedural complication rates. CONCLUSION Our findings suggest that the WEB device is associated with favorable outcomes for treating recurrent wide-neck intracranial aneurysms.
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Affiliation(s)
- Mohammad Amin Habibi
- Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Iran
| | - Farhang Rashidi
- School of Medicine, Tehran University of Medical Sciences, Iran
| | | | - Mohammad Reza Arshadi
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Iran
| | - Saba Mehrtabar
- Immunology Research Center, Tabriz University of Medical Sciences, Iran
| | | | - Milad Shafizadeh
- Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Iran
| | - Shahram Majidi
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Shao Y, Yang Y, Huang H, Wang T, Li J, Jiang Y, Yuan Z, Tang J, Wang D, Xiang Z, Zeng X, Yu Z, He Z, Yuan Z. Thrombectomy for delayed thromboembolism in a recurrent cerebral aneurysm previously treated with coiling: A case report. Medicine (Baltimore) 2024; 103:e37403. [PMID: 38518052 PMCID: PMC10957009 DOI: 10.1097/md.0000000000037403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 02/07/2024] [Indexed: 03/24/2024] Open
Abstract
RATIONALE Giant intracranial aneurysms pose a significant threat due to high mortality rates upon rupture, prompting interventions such as neurosurgical clipping or endovascular coiling. PATIENT CONCERNS We present a rare case involving a 47-year-old female with a history of successfully treated ruptured giant intracranial aneurysms. Six months post-surgical clipping, she developed symptoms of acute ischemic stroke, prompting the decision for neurosurgical coiling and stent-assisted aneurysm coil embolization due to recurrent intracranial aneurysms. DIAGNOSES Subsequently, occlusion occurred at the previously implanted stent site during embolization, necessitating exploration of alternative therapeutic options. Digital subtraction angiography confirmed stent occlusion in the right middle cerebral artery. INTERVENTIONS Despite an initial unsuccessful attempt using a direct aspiration first-pass technique, the patient underwent successful mechanical thrombectomy with a retrievable stent, leading to successful reperfusion. This study aims to highlight the challenges and therapeutic strategies in managing delayed cerebral vascular occlusion following stent-assisted coil embolization, emphasizing the significance of exploring alternative interventions to enhance patient outcomes. OUTCOMES The patient achieved successful reperfusion, and the study underscores the importance of recognizing and addressing delayed cerebral vascular occlusion after stent-assisted coil embolization for recurrent cerebral aneurysms. LESSONS Our findings suggest that retrievable stent mechanical thrombectomy may serve as a viable therapeutic option in challenging scenarios, emphasizing the need for further exploration of alternative interventions to enhance patient care.
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Affiliation(s)
- Ya Shao
- Department of Neurology, Gansu Provincial Hospital of Traditional Chinese Medicine, Lanzhou, China
| | - Yuan Yang
- Department of Neurology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Haidong Huang
- Department of Neurosurgery, The General Hospital of Western Theater Command, Chengdu, China
| | - Ting Wang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jinglun Li
- Department of Neurology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Yushan Jiang
- School of Clinical Medicine, Southwest Medical University, Luzhou, China
| | - Ziwei Yuan
- School of Clinical Medicine, Southwest Medical University, Luzhou, China
| | - Jiayi Tang
- School of Clinical Medicine, Southwest Medical University, Luzhou, China
| | - Dihu Wang
- School of Clinical Medicine, Southwest Medical University, Luzhou, China
| | - Zerui Xiang
- School of Clinical Medicine, Southwest Medical University, Luzhou, China
| | - Xue Zeng
- School of Clinical Medicine, Southwest Medical University, Luzhou, China
| | - Zhou Yu
- Department of Neurology, The First People's Hospital of Liangshan Yi Autonomous Prefecture, Liangshan, China
| | - Zhongchun He
- Department of Neurology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
| | - Zhengzhou Yuan
- Department of Neurology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
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