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Raviol J, Plet G, Hasegawa R, Yu K, Kosukegawa H, Ohta M, Magoariec H, Pailler-Mattei C. Towards the mechanical characterisation of unruptured intracranial aneurysms: Numerical modelling of interactions between a deformation device and the aneurysm wall. J Mech Behav Biomed Mater 2024; 153:106469. [PMID: 38402693 DOI: 10.1016/j.jmbbm.2024.106469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 02/13/2024] [Accepted: 02/15/2024] [Indexed: 02/27/2024]
Abstract
Intracranial aneurysm is a critical pathology related to the arterial wall deterioration. This work is an essential aspect of a large scale project aimed at providing clinicians with a non-invasive patient-specific decision support tool regarding the rupture risk assessment. A machine learning algorithm links the aneurysm shape observed and a database of UIA clinical images associated with in vivo wall mechanical properties and rupture characterisation. The database constitution is derived from a device prototype coupled with medical imaging. It provides the mechanical characterisation of the aneurysm from the wall deformation obtained by inverse analysis based on the variation of luminal volume. Before performing in vivo tests of the device on small animals, a numerical model was built to quantify the device's impact on the aneurysm wall under natural blood flow conditions. As the clinician will never be able to precisely situate the device, several locations were considered. In preparation for the inverse analysis procedure, artery material laws of increasing complexity were studied (linear elastic, hyper elastic Fung-like). Considering all the device locations and material laws, the device induced relative displacements to the Systole peak (worst case scenario with the highest mechanical stimulus linked to the blood flow) ranging from 375 μm to 1.28 mm. The variation of luminal volume associated with the displacements was between 0.95 % and 4.3 % compared to the initial Systole volume of the aneurysm. Significant increase of the relative displacements and volume variations were found with the study of different cardiac cycle moments between the blood flow alone and the device application. For forthcoming animal model studies, Spectral Photon CT Counting, with a minimum spatial resolution of 250 μm, was selected as the clinical imaging technique. Based on this preliminary study, the displacements and associated volume variations (baseline for inverse analyse), should be observable and exploitable.
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Affiliation(s)
- J Raviol
- Laboratoire de Tribologie et Dynamique des Systèmes, CNRS UMR 5513, Université de Lyon, École Centrale de Lyon, France
| | - G Plet
- Laboratoire de Tribologie et Dynamique des Systèmes, CNRS UMR 5513, Université de Lyon, École Centrale de Lyon, France
| | - R Hasegawa
- Graduate School of Engineering, Tohuku University, 980-8579, Sendai Miyagi, Japan; Institute of Fluid Science, Tohuku University, 980-8577, Sendai Miyagi, Japan
| | - K Yu
- Institute of Fluid Science, Tohuku University, 980-8577, Sendai Miyagi, Japan
| | - H Kosukegawa
- Institute of Fluid Science, Tohuku University, 980-8577, Sendai Miyagi, Japan
| | - M Ohta
- Institute of Fluid Science, Tohuku University, 980-8577, Sendai Miyagi, Japan; ElyT MaX, CNRS UMI 3537, Université de Lyon, Tohoku University, France, Japan
| | - H Magoariec
- Laboratoire de Tribologie et Dynamique des Systèmes, CNRS UMR 5513, Université de Lyon, École Centrale de Lyon, France
| | - C Pailler-Mattei
- Laboratoire de Tribologie et Dynamique des Systèmes, CNRS UMR 5513, Université de Lyon, École Centrale de Lyon, France; ISPB-Faculté de Pharmacie, Université Claude Bernard Lyon 1, Université de Lyon, France.
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Radojewski P, Dobrocky T, Branca M, Almiri W, Correia M, Raabe A, Bervini D, Gralla J, Wiest R, Mordasini P. Diagnosis of Small Unruptured Intracranial Aneurysms : Comparison of 7 T versus 3 T MRI. Clin Neuroradiol 2024; 34:45-49. [PMID: 37000197 PMCID: PMC10881608 DOI: 10.1007/s00062-023-01282-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 02/13/2023] [Indexed: 04/01/2023]
Abstract
PURPOSE Differentiating normal anatomical variants such as an infundibulum or a vascular loop from true intracranial aneurysms is crucial for patient management. We hypothesize that high-resolution 7 T magnetic resonance imaging (MRI) improves the detection and characterization of normal anatomical variants that may otherwise be misdiagnosed as small unruptured aneurysms. METHODS This is a retrospective, single-center study. All patients were scanned on a clinically approved 7 T MRI scanner and on a 3 T scanner. Image analysis was performed independently by three neuroradiologists blinded to clinical information. The presence of an unruptured intracranial aneurysm (UIA) and level of diagnostic certainty were assessed and the interrater agreement was calculated. If an aneurysm was present, the anatomic location and shape were recorded and compared. RESULTS In total, 53 patients with equivocal cerebrovascular findings on 1.5 T or 3 T MRI referred for a 7T MRI examination were included. Aneurysms were suspected in 42 patients examined at 3 T and in 23 patients at 7 T (rate difference 36%, 95% confidence interval, CI, 19-53%, p-value < 0.001). Major disagreement between the field strengths was observed in the A1 segment of anterior cerebral artery/anterior communicating artery (A1/ACOM) complex. The interrater agreement among the readers on the presence of an aneurysm on 7 T MRI was higher than that for 3 T MRI (0.925, 95% CI 0.866-0.983 vs. 0.786, 95% CI 0.700-0.873). CONCLUSION Our analysis demonstrates a significantly higher interrater agreement and improved diagnostic certainty when small intracranial aneurysms are visualized on 7 T MRI compared to 3 T. In a selected patient cohort, clinical implementation of 7 T MRI may help to establish the definitive diagnosis and thus have a beneficial impact on patient management.
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Affiliation(s)
- Piotr Radojewski
- Institute of Diagnostic and Interventional Neuroradiology, Bern University Hospital, Inselspital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland.
- Translational Imaging Center, sitem-insel, Bern, Switzerland.
| | - Tomas Dobrocky
- Institute of Diagnostic and Interventional Neuroradiology, Bern University Hospital, Inselspital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | | | - William Almiri
- Institute of Diagnostic and Interventional Neuroradiology, Bern University Hospital, Inselspital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Manuel Correia
- Institute of Diagnostic and Interventional Neuroradiology, Bern University Hospital, Inselspital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
- Hospital de Santa Maria-Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - Andreas Raabe
- Department of Neurosurgery, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - David Bervini
- Department of Neurosurgery, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Jan Gralla
- Institute of Diagnostic and Interventional Neuroradiology, Bern University Hospital, Inselspital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Roland Wiest
- Institute of Diagnostic and Interventional Neuroradiology, Bern University Hospital, Inselspital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
- Translational Imaging Center, sitem-insel, Bern, Switzerland
| | - Pasquale Mordasini
- Institute of Diagnostic and Interventional Neuroradiology, Bern University Hospital, Inselspital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
- Netzwerk Radiologie, Kantonsspital St. Gallen, St. Gallen, Switzerland
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Sakurada K, Ikedo T, Hosokawa Y, Sugasawa S, Shimonaga K, Kushi Y, Niwa A, Ozaki S, Hattori EY, Hamano E, Yamada K, Imamura H, Mori H, Iihara K, Kataoka H. Irreversible postoperative cognitive impairment after unruptured intracranial aneurysm treatment in the elderly. Acta Neurochir (Wien) 2024; 166:30. [PMID: 38265605 DOI: 10.1007/s00701-024-05933-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 11/29/2023] [Indexed: 01/25/2024]
Abstract
PURPOSE Postoperative cognitive dysfunction and recovery remain unclear in older patients undergoing interventional therapies for unruptured intracranial aneurysms (UIAs). This study aimed to compare changes in postoperative cognitive function between younger and older patients and to detect factors associated with non-recovery from postoperative cognitive dysfunction. METHODS This study reviewed 59 consecutive patients with UIAs who underwent interventional therapies, including microsurgical clipping or endovascular treatment, from 2021 to 2022. All patients were divided into the older (aged ≥ 70 years) and younger (aged < 70 years) groups. Mini-Mental State Examination (MMSE) and Frontal Assessment Battery (FAB) were performed within 2 months before interventions, at 1 week postoperatively (POW1), and 3-6 months postoperatively (POM3-6). RESULTS MMSE and FAB scores decreased more frequently in the older group than in the younger group at POW1 (older vs. younger: MMSE: 48% vs. 21%, p < 0.05; FAB: 56% vs. 18%, p < 0.01). In the older group, the FAB Z-score decreased in POW1 and recovered by POM3-6 (p < 0.01), while the MMSE Z-score continued to decrease (p = 0.04). Age and the preoperative MSME Z-score were significantly associated with non-recovery from decreased MMSE score at POM3-6 (recovery vs. non-recovery, age: 62 years old vs. 72 years old, p = 0.03, preoperative MMSE Z-score: 0.16 vs. - 0.90, p < 0.01). CONCLUSIONS This retrospective study found that older patients were more likely to have a postoperative cognitive decline after UIA treatment and implicated that global cognitive function tended to decline more than executive function in the long term. In addition, this study demonstrated that lower preoperative cognitive function was associated with inadequate postoperative cognitive recovery. The findings potentially contribute to the establishment of indications for treating UIAs in older patients.
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Affiliation(s)
- Kokyo Sakurada
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Taichi Ikedo
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan.
| | - Yuma Hosokawa
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Shin Sugasawa
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Koji Shimonaga
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Yuji Kushi
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Akihiro Niwa
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Saya Ozaki
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Etsuko Yamamoto Hattori
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Eika Hamano
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Kiyofumi Yamada
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Hirotoshi Imamura
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Hisae Mori
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Koji Iihara
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Hiroharu Kataoka
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
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Zheng DX, Lv YY, Zhang XJ, Ye JS, Zhang JX, Chen C, Luo B, Yan D. Neutrophil-to-lymphocyte ratio associated with symptomatic saccular unruptured intracranial aneurysm. Eur J Med Res 2024; 29:40. [PMID: 38212838 PMCID: PMC10782625 DOI: 10.1186/s40001-023-01608-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 12/21/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND AND PURPOSE Whether symptomatic unruptured intracranial aneurysms (UIAs) lead to change in circulating inflammation remains unclear. This study aims to evaluate the role of hematological inflammatory indicators in predicting symptomatic UIA. METHODS Adult patients diagnosed with saccular intracranial aneurysm from March 2019 to September 2023 were recruited retrospectively. Clinical and laboratory data, including the white blood cells (WBC), neutral counts (NEUT), lymphocyte counts (LYM), and monocyte counts (MONO) of each patient, were collected. The neutrophil-to-lymphocyte ratio (NLR) and lymphocyte-to-monocyte ratio (LMR) were calculated as NLR = NEUT/LYM, LMR = LYM/MONO, SII = PLT*NEUT/LYM. The hematological inflammatory indicators were compared in symptomatic saccular and asymptomatic UIA patients. Multivariable logistic regression analyses were performed to explore the factors predicting symptomatic UIA. RESULTS One hundred and fifty UIA patients with a mean age of 58.5 ± 12.4 were included, of which 68% were females. The NLR and LMR were significantly associated with symptomatic UIA, and the association remained in small UIAs (< 7 mm). The multiple logistic regression analysis showed that NLR was independently associated with symptomatic UIA. On ROC curve analysis, the optimal cutoff value of NLR to differentiate symptomatic from asymptomatic was 2.38. In addition, LMR was significantly associated with symptomatic UIA smaller than 7 mm. CONCLUSION There was a significant correlation between NLR and symptomatic UIA. The NLR was independently associated with symptomatic UIA.
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Affiliation(s)
- De-Xiang Zheng
- Department of Clinical Laboratory, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yi-Yang Lv
- Department of Blood Transfusion, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xiao-Jing Zhang
- Department of Epilepsy Center, The Second Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jie-Shun Ye
- School of Civil Engineering and Transportation, South China University of Technology, Guangzhou, 510640, China
| | - Jian-Xing Zhang
- Department of Neurosurgery, The Eighth Affiliated Hospital, Sun Yat-Sen University, Shenzhen, 518033, China
| | - Cha Chen
- Department of Clinical Laboratory, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China.
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China.
| | - Bin Luo
- Department of Neurosurgery, The Eighth Affiliated Hospital, Sun Yat-Sen University, Shenzhen, 518033, China.
| | - Dan Yan
- Department of Ultrasound, The Second Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China.
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Lee CH, Kwak HS, Kang HS, Jung KH, Jeong SK. Geometric versus Hemodynamic Indexes for Rupture-Destined Aneurysms: A Retrospective Cohort and a Repeated-Measures Study. Cerebrovasc Dis 2023:1-8. [PMID: 37696264 DOI: 10.1159/000533167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 07/13/2023] [Indexed: 09/13/2023] Open
Abstract
INTRODUCTION A proper stratification of intracranial aneurysms is critical in identifying rupture-destined aneurysms and unruptured intracranial aneurysms. We aimed to determine the utility of geometric and hemodynamic indexes in differentiating two types of aneurysms and to examine the characteristics of natural evolutionary changes of unruptured aneurysms. METHODS Rupture-destined aneurysm refers to an aneurysm that undergoes subsequent aneurysmal subarachnoid hemorrhage (SAH). On the other hand, an unruptured intracranial aneurysm is characterized by an aneurysm that does not experience rupture during serial time-of-flight magnetic resonance angiography (TOF-MRA). In addition to geometric indexes, signal intensity gradient (SIG), an in vivo approximated wall shear stress from TOF-MRA, was measured in aneurysms. The difference between the maximum and minimum values of SIG in an aneurysm compared to parent arterial values was designated as the delta-SIG ratio. RESULTS This study analyzed 20 rupture-destined aneurysms in 20 patients and 45 unruptured intracranial aneurysms in 41 patients with follow-up TOF-MRA. While geometric indexes did not show differences between the two groups, the delta-SIG ratio was higher in the rupture-destined aneurysms (1.5 ± 0.6 vs. 1.1 ± 0.3, p = 0.032). The delta-SIG ratio showed a higher area under the receiver operating characteristic curve for SAH than the size ratio (0.72 [95% CI, 0.58-0.87] vs. 0.56 [95% CI, 0.41-0.72], p = 0.033). The longitudinal re-examination of TOF-MRA in the unruptured intracranial aneurysms revealed evidence of aneurysmal growth, while concurrently exhibiting hemodynamic stability. CONCLUSION The delta-SIG ratio showed higher discriminatory results between the two groups compared to geometric indexes. Aneurysmal rupture risk should be assessed by considering both geometric and hemodynamic information. This study was registered on ClinicalTrials.gov (NCT05450939).
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Affiliation(s)
- Chan-Hyuk Lee
- Department of Neurology, Asan Medical Center, Seoul, Republic of Korea
- Department of Neurology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Hyo Sung Kwak
- Department of Radiology and Research Institute of Clinical Medicine of Jeonbuk National University, Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Hyun-Seung Kang
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Keun-Hwa Jung
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seul-Ki Jeong
- Seul-Ki Jeong Neurology Clinic, Seoul, Republic of Korea
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Siller S, Kunz M, Lauseker M, Dimitriadis K, Dorn F, Tonn JC, Schichor C. The impact of initial counselling for patients' decision-making and the accuracy of interdisciplinary neurovascular board evaluation in elective treatment of unruptured intracranial aneurysms - a German single-centre retrospective study. Clin Neurol Neurosurg 2023; 232:107896. [PMID: 37454599 DOI: 10.1016/j.clineuro.2023.107896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/10/2023] [Accepted: 07/11/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE Interdisciplinary-neurovascular-boards (INVB) are deemed to find the patient's optimum treatment-modality in elective unruptured intracranial aneurysm-repair (EUIAR). If INVB judges risk/success estimation similar for microsurgical/endovascular EUIAR, the choice for either modality is up to the informed patient. However, it is unknown if the patients' decision-making might be biased by the discipline of initial counselling prior to INVB and if INVB's equal risk/success estimation is finally accurate. METHODS We analysed all our patients with EUIAR after INVB-discussion between 2007 and 2017 and identified those patients where INVB-recommendation estimated similar risk/success rates for both treatment-modalities. We investigated the procedural/outcome parameters and determined if the mode of initial counselling prior to INVB influenced the patients' choice of EUIAR and if INVB's equal risk/success estimation was accurate. RESULTS Within altogether 572 patients with EUIAR during our study period, we identified 99 patients (agemean:58 yrs; m:f=1:2) in whom pre-treatment INVB-discussion estimated risk/success rates for both modalities of EUIAR to be similar. Prior to INVB-discussion, 80 of the 99 patients had been initially counselled in the neurosurgical discipline and 19 patients in the endovascular discipline. The final patients' decision rates for surgical vs. endovascular EUIAR (after secondary consultation of each patient in both disciplines after INVB-discussion) were 67% vs. 33% in the first and 58% vs. 42% in the latter group (no significant difference: p = 0.345). Uni- and multivariate analysis did not show any hints for a bias in patients' decision-making caused by the discipline of initial counselling prior to INVB/secondary bilateral consultations. Clinical and procedural outcome at last follow-up (median:18mos) did not differ between those 66 patients that eventually decided for microsurgical and those 33 patients that eventually decided for endovascular EUIAR, underlining the high accuracy of INVB's pre-treatment risk/success estimations. CONCLUSION Only in a small number of patients, INVB estimates both disciplines to be of equal value for EUIAR which proves to be highly accurate at long-term outcome measures. Initial contact to one or the other neurovascular discipline does not appear to play a significant role in the final patient's decision-making process.
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Affiliation(s)
- Sebastian Siller
- Neurosurgical Clinic, Clinic of the University of Munich (LMU), Campus Grosshadern, Marchioninistrasse 15, 81377 Munich, Germany; Department of Neuroradiology, Clinic of the University of Munich (LMU), Campus Grosshadern, Marchioninistrasse 15, 81377 Munich, Germany.
| | - Mathias Kunz
- Neurosurgical Clinic, Clinic of the University of Munich (LMU), Campus Grosshadern, Marchioninistrasse 15, 81377 Munich, Germany; Department of Neuroradiology, Clinic of the University of Munich (LMU), Campus Grosshadern, Marchioninistrasse 15, 81377 Munich, Germany
| | - Michael Lauseker
- Institute for Medical Information Processing, Biometry and Epidemiology, Clinic of the University of Munich (LMU), Campus Grosshadern, Marchioninistrasse 15, 81377 Munich, Germany; Department of Neuroradiology, Clinic of the University of Munich (LMU), Campus Grosshadern, Marchioninistrasse 15, 81377 Munich, Germany
| | - Konstantinos Dimitriadis
- Neurological Clinic, Clinic of the University of Munich (LMU), Campus Grosshadern, Marchioninistrasse 15, 81377 Munich, Germany; Department of Neuroradiology, Clinic of the University of Munich (LMU), Campus Grosshadern, Marchioninistrasse 15, 81377 Munich, Germany
| | - Franziska Dorn
- Institute for Medical Information Processing, Biometry and Epidemiology, Clinic of the University of Munich (LMU), Campus Grosshadern, Marchioninistrasse 15, 81377 Munich, Germany; Department of Neuroradiology, Clinic of the University of Munich (LMU), Campus Grosshadern, Marchioninistrasse 15, 81377 Munich, Germany; Department of Neuroradiology, University Hospital of Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - Joerg-Christian Tonn
- Neurosurgical Clinic, Clinic of the University of Munich (LMU), Campus Grosshadern, Marchioninistrasse 15, 81377 Munich, Germany; Department of Neuroradiology, Clinic of the University of Munich (LMU), Campus Grosshadern, Marchioninistrasse 15, 81377 Munich, Germany
| | - Christian Schichor
- Neurosurgical Clinic, Clinic of the University of Munich (LMU), Campus Grosshadern, Marchioninistrasse 15, 81377 Munich, Germany; Department of Neuroradiology, Clinic of the University of Munich (LMU), Campus Grosshadern, Marchioninistrasse 15, 81377 Munich, Germany
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Hwang J, Cho WH, Cha SH, Ko JK. Posterior reversible encephalopathy syndrome following uneventful clipping of an unruptured intracranial aneurysm: A case report. World J Clin Cases 2023; 11:4723-4728. [PMID: 37469736 PMCID: PMC10353519 DOI: 10.12998/wjcc.v11.i19.4723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 05/10/2023] [Accepted: 06/06/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND Posterior reversible encephalopathy syndrome (PRES) is characterized mainly by occipital and parietal lobe involvement, which can be reversible within a few days. Herein, we report a rare case of PRES that developed after craniotomy for an unruptured intracranial aneurysm (UIA).
CASE SUMMARY A 59-year-old man underwent clipping surgery for the treatment of UIA arising from the left middle cerebral artery. Clipping surgery was performed uneventfully, and he regained consciousness quickly immediately after the surgery. At the 4th hour after surgery, he developed a disorder of consciousness and aphasia. Magnetic resonance imaging revealed cortical and subcortical T2/FLAIR hyperintensities in the parietal, occipital, and frontal lobes ipsilaterally, without restricted diffusion, consistent with unilateral PRES. With conservative treatment, his symptoms and radiological findings almost completely disappeared within weeks. In our case, the important causative factor of PRES was suspected to be a sudden increase in cerebral perfusion pressure associated with temporary M1 occlusion.
CONCLUSION Our unique case highlights that, to our knowledge, this is the second report of PRES developing after craniotomy for the treatment of UIA. Surgeons must keep PRES in mind as one of the causes of perioperative neurological abnormality following clipping of an UIA.
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Affiliation(s)
- Joseph Hwang
- Department of Neurosurgery, Biomedical Research Institute, Pusan National University Hospital, School of Medicine, Pusan National University, Busan 49241, South Korea
| | - Won-Ho Cho
- Department of Neurosurgery, Biomedical Research Institute, Pusan National University Hospital, School of Medicine, Pusan National University, Busan 49241, South Korea
| | - Seung-Heon Cha
- Department of Neurosurgery, Biomedical Research Institute, Pusan National University Hospital, School of Medicine, Pusan National University, Busan 49241, South Korea
| | - Jun-Kyueng Ko
- Department of Neurosurgery, Biomedical Research Institute, Pusan National University Hospital, School of Medicine, Pusan National University, Busan 49241, South Korea
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Ortiz AFH, Suriano ES, Eltawil Y, Sekhon M, Gebran A, Garland M, Cuenca NTR, Cadavid T, Almarie B. Prevalence and risk factors of unruptured intracranial aneurysms in ischemic stroke patients - A global meta-analysis. Surg Neurol Int 2023; 14:222. [PMID: 37404522 PMCID: PMC10316137 DOI: 10.25259/sni_190_2023] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 05/31/2023] [Indexed: 07/06/2023] Open
Abstract
Background Unruptured intracranial aneurysms (UIAs) have an estimated global prevalence of 2.8% in the adult population; however, UIA was identified among more than 10% of ischemic stroke patients. Many epidemiological studies and reviews have pointed to the presence of UIA among patients with ischemic stroke; yet, the extent of this association is not fully known. We performed a systematic review and meta-analysis to determine the prevalence of UIA in patients admitted to hospitals with ischemic stroke and transient ischemic attack (TIA) at both global and continental levels and evaluate factors associated with UIA in this population. Methods We identified, in five databases, all studies describing UIA in ischemic stroke and TIA patients between January 1, 2000, and December 20, 2021. Included studies were of observational and experimental design. Results Our search yielded 3581 articles of which 23 were included, with a total of 25,420 patients. The pooled prevalence of UIA was 5% (95% confidence interval [CI] = 4-6%) with stratified results showing 6% (95% CI = 4-9%), 6% (95% CI = 5-7%), and 4% (95% CI = 2-5%) in North America, Asia, and Europe, respectively. Significant risk factors were large vessel occlusion (odds ratios [OR] = 1.22, 95% CI = 1.01-1.47) and hypertension (OR = 1.45, 95% CI = 1.24-1.69), while protective factors were male sex (OR = 0.60, 95% CI = 0.53-0.68) and diabetes (OR = 0.82, 95% CI = 0.72-0.95). Conclusion The prevalence of UIA is notably higher in ischemic stroke patients than the general population. Physicians should be aware of common risk factors in stroke and aneurysm formation for appropriate prevention.
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Affiliation(s)
| | | | - Yasmin Eltawil
- Department of Medicine, San Francisco School of Medicine, San Francisco, California, United States
| | - Manraj Sekhon
- Department of Medicine, University of California, Riverside School of Medicine, Riverside, California, United States
| | - Anthony Gebran
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Mateo Garland
- Department of Internal Medicine, Rutgers New Jersey Medical School, Newark, United States
| | | | - Tatiana Cadavid
- Department of Nuclear Medicine, Fundación Universitaria Sanitas, Bogotá, Colombia
| | - Bassel Almarie
- Department of Surgery, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland
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9
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Hall S, Abouharb A, Anderson I, Bacon A, Bahl A, Brydon H, Dow G, Fouyas I, Galea J, Ghosh A, Gurusinghe N, Kamel M, Minhas P, Mitchell P, Mowle D, Mukerji N, Nair R, Norris J, Patel H, Patel J, Patel K, St George J, Teo M, Toma A, Trivedi R, Uff C, Visca A, Walsh DC, White E, Whitfield P, Bulters D. A survey of the radiological follow-up of unruptured intracranial aneurysms in the United Kingdom. Br J Neurosurg 2023; 37:163-169. [PMID: 34738491 DOI: 10.1080/02688697.2021.1995587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Unruptured intracranial aneurysms (UIA) are common. For many the treatment risks outweigh their risk of subarachnoid haemorrhage and patients undergo surveillance imaging. There is little data to inform if and how to monitor UIAs resulting in widely varying practices. This study aimed to determine the current practice of unruptured UIA surveillance in the United Kingdom. METHODS A questionnaire was designed to address the themes of surveillance protocols for UIA including when surveillance is initiated, how frequently it is performed, and when it is terminated. Additionally, how aneurysm growth is managed and how clinically meaningful growth is defined were explored. The questionnaire was distributed to members of the British Neurovascular Group using probability-based cluster and non-probability purposive sampling methods. RESULTS Responses were received from 30 of the 30 (100.0%) adult neurosurgical units in the United Kingdom of which 27 (90.0%) routinely perform surveillance for aneurysm growth. Only four units had a unit policy. The mean patient age up to which a unit would initiate follow-up of a low-risk UIA was 65.4 ± 9.0 years. The time points at which imaging is performed varied widely. There was an even split between whether units use a fixed duration of follow-up or an age threshold for terminating surveillance. Forty percent of units will follow-up patients more than 5 years from diagnosis. The magnitude in the change in size that was felt to constitute growth ranged from 1 to 3mm. No units routinely used vessel wall imaging although 27 had access to 3T MRI capable of performing it. CONCLUSIONS There is marked heterogeneity in surveillance practices between units in the United Kingdom. This study will help units better understand their practice relative to their peers and provide a framework forplanning further research on aneurysm growth.
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Affiliation(s)
- Samuel Hall
- Wessex Neurological Centre, University Hospitals Southampton NHS Foundation Trust, Southampton, UK
| | - Ashraf Abouharb
- Department of Neurosurgery, Belfast Health and Social Care Trust, Belfast, UK
| | - Ian Anderson
- Department of Neurosurgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Andrew Bacon
- Sheffield Centre for Neurosurgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Anuj Bahl
- Department of Neurosurgery, Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
| | - Howard Brydon
- Department of Neurosurgery, University Hospital of North Midlands NHS Trust, Stoke on Trent, UK
| | - Graham Dow
- Department of Neurosurgery, Queens Medical Centre, Nottingham, UK
| | - Ioannis Fouyas
- Department of Clinical Neurosciences, University of Edinburgh, Edinburgh, UK
| | - James Galea
- Department of Neurosurgery, Cardiff and Vale University Health Board, Cardiff, UK
| | - Anthony Ghosh
- Department of Neurosurgery, Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, UK
| | - Nihal Gurusinghe
- Department of Neurourgery, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | | | - Pawan Minhas
- Department of Neurosurgery, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Patrick Mitchell
- Department of Neurosurgery, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - David Mowle
- Department of Neurosurgery, Ninewells Hospital and Medical School, Dundee, UK
| | - Nitin Mukerji
- Department of Neurosurgery, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - Ramesh Nair
- Department of Neurosurgery, Imperial College Healthcare NHS Trust, London, UK
| | - John Norris
- Hurstwood Park Neurosciences Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Hiren Patel
- Department of Neurosurgery, Salford Royal NHS Foundation Trust, Salford, UK
| | - Jash Patel
- Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Krunal Patel
- Department of Neurosurgery, University Hospitals Coventry and Warwickshire, Coventry, UK
| | | | - Mario Teo
- Department of Neurosurgery, North Bristol NHS Trust, Bristol, UK
| | - Ahmed Toma
- National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Rikin Trivedi
- Department of Neurosurgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Chris Uff
- Department of Neurosurgery, Barts Health NHS Trust, London, UK
| | - Anna Visca
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Daniel C Walsh
- Department of Neurosurgery, King's College Hospital NHS Trust, London, UK
| | - Edward White
- Department of Neurosurgery, Queen Elizabeth Hospital, Birmingham, UK
| | - Peter Whitfield
- Department of Neurosurgery, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Diederik Bulters
- Wessex Neurological Centre, University Hospitals Southampton NHS Foundation Trust, Southampton, UK
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10
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Essiet E, Shapey J, Kailaya-Vasan A. The incidence and prevalence of unruptured intracranial aneurysms in sickle cell disease patients: a systematic review. Br J Neurosurg 2022; 36:669-677. [PMID: 35938739 DOI: 10.1080/02688697.2022.2104217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Unruptured Intracranial Aneurysms (UIAs) pose a significant risk of morbidity in the general population and much more so among sickle cell disease (SCD) patients. Meanwhile, the proportion of these patients with UIAs is not established just as the course and characteristics of the aneurysms are not well known. AIM To estimate the prevalence, incidence and characteristics of UIAs in SCD patients and compare same with the metrics and features in the general population. METHODS The Data repositories, Medline (PubMed), Embase and Web of science were systematically searched from January 1st, 1990, to July 31st, 2021. Publications that passed an inclusion test were reviewed for data on the incidence and prevalence of UIAs, aneurysm characteristics and outcomes in SCD patients extracted. Findings from the included studies were appraised, using the Methodological Index for Non-randomized studies score (MINORS). The results were descriptively analysed. Given the marked heterogeneity of retrieved data, results were reported as standardized values, including the mean weighted annual incidence rate. RESULTS 105 SCD patients with 186 UIAs were identified in 10 retrospective studies. Mean age ranged from 10.5 to 40.18 across studies with adult (>18 years) predominance. The prevalence of UIAs in SCD was 4.1% (95%CI 3.6 and 4.6) incidence rate was 1290.3/100,000 patient-years (95% CI 1018.0-1562.6). Aneurysms tended to be small (60%), anterior (76.1%), multiple (45.7%), and managed conservatively (62%) with mostly good outcomes (95%). The average MINORS score was 9.4 ± 3.1 for non-comparative studies (n = 8) and 19.5 ± 0.7 for comparative studies (n = 2). CONCLUSION UIAs have a definite relationship with SCD, with higher incidence figures relative to the general population. Aneurysmal characteristics although largely similar, tend to be smaller in SCD patients. The low methodological quality of reviewed studies informs the need for well-designed prospective randomized controlled studies to better understand the mechanics of this relationship.
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Affiliation(s)
- Edidiong Essiet
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College Denmark Hill Campus, London, UK
| | - Jonathan Shapey
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK.,School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Ahilan Kailaya-Vasan
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK
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11
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Tanaka T, Goto H, Momozaki N, Honda E. Rapid Change in Shape of Unruptured Intracranial Aneurysm with Acute Perforating Infarction. Case Rep Neurol 2022; 14:400-403. [PMID: 36636275 PMCID: PMC9830295 DOI: 10.1159/000527451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 09/16/2022] [Indexed: 12/31/2022] Open
Abstract
Acute ischemic stroke is a rare complication resulting from an unruptured intracranial aneurysm (UIA). Ischemic stroke adjacent to the aneurysms is considered the risk of rupture of aneurysms. However, there is presently no consensus on the optimal strategy for the management of UIAs with ischemic stroke. A 27-year-old woman presented with sudden onset left hemiparesis. Acute infarction of the right basal ganglia and an aneurysm of the right middle cerebral artery were discovered on brain imaging. Antiplatelet therapy was used to treat her. The diagnosis revealed ischemic stroke caused by a thrombosed aneurysm due to the change in the shape of the aneurysm on day 4. The UIA clipping procedure was performed on day 21 due to the risk of subarachnoid hemorrhage (SAH). The findings of the surgery and indocyanine green imaging revealed a partially thrombosed aneurysm and occlusion of a perforating artery. As is well known, enlargement of aneurysm size indicates increasing rupture risk. In the present case, after ischemic events developed, magnetic resonance angiography revealed enlargement of the aneurysm. The findings of the surgery revealed possible pathogenic mechanisms were perforating artery occlusion due to local extension of the luminal thrombus. Clinicians should be aware of the risk of ischemic stroke due to luminal thrombosis of the UIA and SAH and should consider urgent treatment of the UIA even immediately after ischemic stroke.
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Affiliation(s)
- Tatsuya Tanaka
- Department of Neurosurgery, School of Medicine, International University of Health and Welfare, Narita, Japan,*Tatsuya Tanaka,
| | - Hirofumi Goto
- Department of Neurology, Imari Arita Kyoritsu Hospital, Arita, Japan
| | - Nobuaki Momozaki
- Department of Neurosurgery, Imari Arita Kyoritsu Hospital, Arita, Japan
| | - Eiichiro Honda
- Department of Neurosurgery, Shiroishi Kyoritsu Hospital, Shiroishi, Japan
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12
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Iancu D, Collins J, Farzin B, Darsaut TE, Eneling J, Boisseau W, Olijnyk L, Boulouis G, Chaalala C, Bojanowski MW, Weill A, Roy D, Raymond J. Recruitment in a pragmatic randomized trial on the management of unruptured intracranial aneurysms. World Neurosurg 2022; 163:e413-e419. [PMID: 35395427 DOI: 10.1016/j.wneu.2022.03.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 03/30/2022] [Accepted: 03/31/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The Comprehensive Aneurysm Management (CAM) study is a pragmatic trial designed to manage UIA patients within a care research framework. METHOD CAM is an all-inclusive study. Management options are allocated according to an algorithm combining pre-randomization and clinical judgment. Eligible patients are offered 1:1 randomized allocation of intervention versus conservative management and 1:1 randomization allocation of surgical versus endovascular treatment. Ineligible patients are registered. The primary outcome is survival without dependency (mRS<3) at 10 years. All UIA patients at one center are reported. RESULTS Between February 2020 and July 2021, 403 UIA patients were recruited: 179 (44%) in one of the RCTs and 224 (56%) in one of the registries. Conservative management was recommended for 205/403 patients (51%); of 198 (49%) patients considered for curative treatment, 159 (80%) were randomly allocated conservative (n=81) or curative treatment (n=78). These patients were younger and had larger aneurysms than those in the observation registry (P = .004). In 39/198 patients (20%), conservative management was not considered reasonable (17 patients were recommended endovascular, 2 surgery, and 20 the RCT comparing endovascular with surgical treatment). In total, 70 patients were recruited in the RCT comparing surgery and endovascular treatment. After informed discussion at time of consent, 141/159 patients (89%) agreed with the randomly allocated management plan, while 11% crossed-over to the alternative management option. CONCLUSION CAM was successfully integrated into routine practice. Meaningful conclusions can be obtained if multiple centers actively participate in the trial.
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Affiliation(s)
- Daniela Iancu
- Department of Radiology, Service of Interventional Neuroradiology, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada and CHUM Research Center (CRCHUM), Montreal, Quebec, Canada
| | - Jennifer Collins
- Department of Radiology, Service of Interventional Neuroradiology, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada and CHUM Research Center (CRCHUM), Montreal, Quebec, Canada
| | - Behzad Farzin
- Department of Radiology, Service of Interventional Neuroradiology, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada and CHUM Research Center (CRCHUM), Montreal, Quebec, Canada
| | - Tim E Darsaut
- University of Alberta Hospital, Mackenzie Health Sciences Centre, Department of Surgery, Division of Neurosurgery, Edmonton, Alberta, Canada
| | - Johanna Eneling
- Department of Radiology, Service of Interventional Neuroradiology, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada and CHUM Research Center (CRCHUM), Montreal, Quebec, Canada
| | - William Boisseau
- Department of Radiology, Service of Interventional Neuroradiology, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada and CHUM Research Center (CRCHUM), Montreal, Quebec, Canada
| | - Leonardo Olijnyk
- Department of Radiology, Service of Interventional Neuroradiology, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada and CHUM Research Center (CRCHUM), Montreal, Quebec, Canada
| | - Grégoire Boulouis
- Neuroradiology Department, Université Paris Descartes, INSERM S894, Centre Hospitalier Sainte-Anne, France
| | - Chiraz Chaalala
- Department of Surgery, Service of Neurosurgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada
| | - Michel W Bojanowski
- Department of Surgery, Service of Neurosurgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada
| | - Alain Weill
- Department of Radiology, Service of Interventional Neuroradiology, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada and CHUM Research Center (CRCHUM), Montreal, Quebec, Canada
| | - Daniel Roy
- Department of Radiology, Service of Interventional Neuroradiology, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada and CHUM Research Center (CRCHUM), Montreal, Quebec, Canada
| | - Jean Raymond
- Department of Radiology, Service of Interventional Neuroradiology, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada and CHUM Research Center (CRCHUM), Montreal, Quebec, Canada.
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13
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Galassi W, Yuyangkate W, Paholthep P, Tangsriwong T, Jaikon P, Leiwan T, Jiranukool J, Thiarawat P. Prevalence of unruptured intracranial aneurysms among first-degree relatives of Thai patients who had aneurysmal subarachnoid hemorrhage. Surg Neurol Int 2021; 12:566. [PMID: 34877052 PMCID: PMC8645480 DOI: 10.25259/sni_741_2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 11/09/2021] [Indexed: 12/16/2022] Open
Abstract
Background: The prevalence of familial unruptured intracranial aneurysm (UIA) in Thai population was unknown. Methods: Our study population comprised first-degree relatives of patients who were diagnosed with aneurysmal subarachnoid hemorrhage (aSAH) in two cerebrovascular neurosurgical centers from January 2018 to December 2018. The volunteers underwent three-dimensional time-of-flight magnetic resonance angiography for screening intracranial aneurysms (IA). Those who were reported positive or suspected of IA then underwent computed tomography angiography for confirmation. Results: We identified 12 patients who had 12 unruptured IAs (UIAs) from among 93 first-degree relatives. The prevalence of UIA among our study population was 12.9%. An estimated prevalence of UIA among Thai population was 9.05% (95% confidence interval [CI] 7.32–10.78). Of the 93 relatives, 84 had only one first-degree relative who suffered aSAH. Siblings posed a higher risk for UIA than offspring (16% vs. 9.5%), but the difference was not statistically significant (odds ratio 1.810, 95% CI 0.50–6.50, P = 0.274). The most common aneurysm location was the anterior cerebral artery territory (50%). Conclusion: The prevalence of familial UIA in a Thai population was relatively high. There was no significant between-group difference in the occurrence of UIA between the siblings and offspring of the aSAH patients.
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Affiliation(s)
| | - Warin Yuyangkate
- Department of Surgery Buddhashinnaraj Hospital, Mueang, Phitsanulok, Thailand
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14
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Wójtowicz K, Kunert P, Przepiórka Ł, Marchel A. Warning Signs in the Era of Unruptured Intracranial Aneurysms: Report on 2 Cases of Fatal Aneurysmal Hemorrhage. Cerebrovasc Dis Extra 2021; 11:77-80. [PMID: 34350866 PMCID: PMC8647099 DOI: 10.1159/000517421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 05/20/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction The timing of treatment remains unresolved for patients with unruptured intracranial aneurysms (UIAs) and headaches, particularly when the pain is short term, localized, and related to the aneurysm site. We lack evidence to support the notion that when a headache accompanies an aneurysm, it elevates the risk of rupture. Results We describe 2 cases of fatal subarachnoid hemorrhage in patients with a history of headache and known aneurysms. Both of these patients had good indications for treatment: a young age and an aneurysm >7 mm, and both were qualified for elective surgery. However, both patients died of fatal aneurysm ruptures before the planned surgery. Conclusion These cases suggested that treatment should be started as soon as possible, when a UIA is diagnosed based on a short-term period of severe headaches or when a UIA is observed and then severe headaches appear. There is no straightforward guideline for treatment timing in these patients. However, in this era of UIAs, the significance of sentinel headaches should be reevaluated. Given the incidence of headaches in the general population and the very low risk of aneurysm rupture, there may be a tendency to neglect the role of headache as a possible warning sign.
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Affiliation(s)
| | - Przemysław Kunert
- Department of Neurosurgery, Medical University of Warsaw, Warsaw, Poland
| | - Łukasz Przepiórka
- Department of Neurosurgery, Medical University of Warsaw, Warsaw, Poland
| | - Andrzej Marchel
- Department of Neurosurgery, Medical University of Warsaw, Warsaw, Poland
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15
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Mallereau CH, Todeschi J, Lefevre E, Chibbaro S, Proust F, Cebula H. Is physical activity a trigger factor for subarachnoid hemorrhage? Neurochirurgie 2021; 68:315-319. [PMID: 34214496 DOI: 10.1016/j.neuchi.2021.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 05/14/2021] [Accepted: 06/20/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Subarachnoid hemorrhage (SAH) is a serious pathology, associated with 43% mortality and significant disability. In the absence of relevant guidelines, some teams advocate that patients harboring an unruptured intracranial aneurysm (ICA) abstain from all sports activity, as a prophylactic precaution. The aim of the present study was to evaluate the impact of physical activity as a risk factor for SAH, through a review of the literature. METHOD A systematic literature review was performed for the period 2000 to 2020 in accordance with the PRISMA guidelines. Prospective and retrospective articles reporting more than 50 patients whose physical activity was associated with onset of SAH were included. The main end-point was prevalence of SAH occurring after physical activity. For comparison purposes, the prevalences of other circumstances were calculated to establish a range of frequency. RESULTS Physical activity appeared to be quite rarely associated with onset of SAH, with a prevalence of 3%, compared to 30% at rest, 7.3% in association with defecation and 4.5% in association with sexual activity. Age under 60 years, male gender (M/F ratio 1.38) and smoking (67.1%) were associated with onset of SAH during physical activity. CONCLUSION Physical activity appears to be a rare trigger factor for SAH. These results are in contrast to the idea that physical activity should, as a precaution, be avoided in patients with unruptured ICA. There is at present no scientific evidence of an association with aneurysmal SAH.
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Affiliation(s)
- C-H Mallereau
- Neurosurgery Department, Strasbourg University Hospital, Strasbourg, France.
| | - J Todeschi
- Neurosurgery Department, Strasbourg University Hospital, Strasbourg, France
| | - E Lefevre
- Neurosurgery Department, Hôpital de La Pitié-Salpêtrière, AP-HP, Paris, France
| | - S Chibbaro
- Neurosurgery Department, Strasbourg University Hospital, Strasbourg, France
| | - F Proust
- Neurosurgery Department, Strasbourg University Hospital, Strasbourg, France
| | - H Cebula
- Neurosurgery Department, Strasbourg University Hospital, Strasbourg, France
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16
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Mandel M, Tutihashi R, Li Y, Rosi J, Ping Jeng BC, Teixeira MJ, Figueiredo EG. MISIAN (Minimally Invasive Surgery for Treatment of Unruptured Intracranial Aneurysms): A Prospective Randomized Single-Center Clinical Trial With Long-Term Follow-Up Comparing Different Minimally Invasive Surgery Techniques with Standard Open Surgery. World Neurosurg 2021; 151:e533-e544. [PMID: 33905907 DOI: 10.1016/j.wneu.2021.04.079] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 04/16/2021] [Accepted: 04/17/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Unruptured intracranial aneurysms (UIAs) are increasingly diagnosed but treatment is still controversial. Although the descriptions and use of minimally invasive surgery (MIS) have increased, comparative studies with standard approaches are rare. OBJECTIVE MISIAN (Minimally Invasive Surgery for Treatment of Unruptured Intracranial Aneurysms) is a prospective randomized single-center clinical trial with long-term follow-up comparing different MIS techniques with standard open surgery for treatment of UIAs. METHODS We randomly allocated a standard pterional approach (PtA) or MIS (1:2) to 111 patients with UIAs of the anterior circulation (mean dome diameter, 6.4 mm; range, 3-20 mm). Patients selected for MIS underwent a second randomization between a transeyelid approach (TelA) or nanopterional approach (NPtA) (1:1). RESULTS Forty-one patients were randomized to and treated with the PtA, 36 with the TelA, and 34 with the NPtA. Only patients treated with PtA had permanent facial nerve palsy (n = 4 [10%]; P = 0.032). MIS cosmetic results were considered better than those of PtA by independent observers (P < 0.001), and less temporal atrophy in the MIS group was also observed (P = 0.0034). The proportion of excellent results was higher in the TelA group than in the NPtA group (86% vs. 67.6%; P = 0.039). Patients undergoing MIS also reported consistently higher satisfaction and quality-of-life scores (P < 0.001). CONCLUSIONS MIS is superior to standard PtA for microsurgical clipping of small UIAs of the anterior circulation in terms of cosmetic, satisfaction, and quality-of-life outcomes. The TelA or NPtA for UIAs did not show significant outcome differences at 12-18 months.
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Affiliation(s)
- Mauricio Mandel
- Hospital das Clínicas of University of São Paulo Medical School, São Paulo, Brazil; Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA.
| | - Rafael Tutihashi
- Hospital das Clínicas of University of São Paulo Medical School, São Paulo, Brazil
| | - Yiping Li
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
| | - Jefferson Rosi
- Hospital das Clínicas of University of São Paulo Medical School, São Paulo, Brazil
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17
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Uchikawa H, Kin T, Takeda Y, Koike T, Kiyofuji S, Koizumi S, Shiode T, Suzuki Y, Miyawaki S, Nakatomi H, Mukasa A, Saito N. Correlation of Inflow Velocity Ratio Detected by Phase Contrast Magnetic Resonance Angiography with the Bleb Color of Unruptured Intracranial Aneurysms. World Neurosurg X 2021; 10:100098. [PMID: 33733086 PMCID: PMC7941010 DOI: 10.1016/j.wnsx.2021.100098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 01/05/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Intraoperative rupture is the most fatal and catastrophic complication of surgery for unruptured intracranial aneurysms (UIAs); thus, it is extremely useful to predict reddish and thin-walled regions of the UIA before surgery. Although several studies have reported a relationship between the hemodynamic characteristics and intracranial aneurysm wall thickness, a consistent opinion is lacking. We aimed to investigate the relationship between objectively and quantitatively evaluated bleb wall color and hemodynamic characteristics using phase-contrast magnetic resonance angiography (PC-MRA). METHODS Ten patients diagnosed with UIA who underwent surgical clipping and preoperative magnetic resonance imaging along with PC-MRA were included in this study. Bleb wall color was evaluated from an intraoperative video. Based on the Red (R), Green, and Blue values, bleb wall redness (modified R value; mR) was calculated and compared with the hemodynamic characteristics obtained from PC-MRA. RESULTS The wall redness distribution of 18 blebs in 11 UIAs in 10 patients was analyzed. Bleb/neck inflow velocity ratio (Vb/Va: r = 0.66, P = 0.003) strongly correlated with mR, whereas bleb/neck inflow rate ratio (r = 0.58, P = 0.012) correlated moderately. Multivariate regression analysis revealed that only Vb/Va (P = 0.017) significantly correlated with mR. There was no correlation between wall shear stress and mR. CONCLUSIONS The bleb redness of UIAs and Vb/Va, calculated using PC-MRA, showed a significantly greater correlation. Thus, it is possible to predict bleb thickness noninvasively before surgery. This will facilitate more detailed pre- and intraoperative strategies for clipping and coiling for safe surgery.
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Key Words
- 3D, 3-dimensional
- Bleb
- CFD, Computational fluid dynamics
- Inflow velocity ratio
- MRI, Magnetic resonance imaging
- PC-MRA, Phase-contrast magnetic resonance angiography
- Phase contrast magnetic resonance angiography
- Qa, Inflow rate of the aneurysm
- Qb, Inflow rate of the bleb
- Qb/Qa, Bleb/neck inflow rate ratio
- RGB, Baseline red, green, and blue
- RRT, Relative residence time
- TIWRs, Thin-walled regions
- TOF, Time-of-flight
- UIAs, Unruptured intracranial aneurysms
- Unruptured intracranial aneurysm
- Va, Inflow velocity of the aneurysm
- Vb, Inflow velocity of the bled
- Vb/Va, Bleb/neck inflow velocity ratio
- WSS, Wall shear stress
- Wall thickness
- mR, Modified R value
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Affiliation(s)
- Hiroki Uchikawa
- Department of Neurosurgery, University of Tokyo, Tokyo, Japan
- Department of Neurosurgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Taichi Kin
- Department of Neurosurgery, University of Tokyo, Tokyo, Japan
| | - Yasuhiro Takeda
- Department of Neurosurgery, University of Tokyo, Tokyo, Japan
| | - Tsukasa Koike
- Department of Neurosurgery, University of Tokyo, Tokyo, Japan
| | | | - Satoshi Koizumi
- Department of Neurosurgery, University of Tokyo, Tokyo, Japan
| | - Taketo Shiode
- Department of Neurosurgery, University of Tokyo, Tokyo, Japan
| | - Yuichi Suzuki
- Department of Radiology, University of Tokyo, Tokyo, Japan
| | - Satoru Miyawaki
- Department of Neurosurgery, University of Tokyo, Tokyo, Japan
| | | | - Akitake Mukasa
- Department of Neurosurgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Nobuhito Saito
- Department of Neurosurgery, University of Tokyo, Tokyo, Japan
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18
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Kincaid KJ, Yu J, Echevarria FD, Simpkins AN. Giant Vertebrobasilar Fusiform Aneurysm Mass Effect Heralds Rapid in Situ Thrombosis and Ischemic Stroke in the Setting of Ulcerative Colitis. J Stroke Cerebrovasc Dis 2021; 30:105621. [PMID: 33581546 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 01/15/2021] [Indexed: 11/24/2022] Open
Abstract
Here we describe a case of brainstem infarction secondary to rapid thrombus formation in a giant vertebrobasilar fusiform aneurysm (GVBFA) that was preceded clinically by several months of headaches and dizziness initially attributable to mass effect. Less than a month after initial identification of the aneurysm, a large partially-occluding thrombus formed leading to infarction of the brainstem. Interestingly, this patient also had ulcerative colitis, which has been associated with acquired hypercoagulability. Balancing risk versus benefit in the management of GVBFA to prevent morbidity and mortality is very challenging; thus more information is needed to better stratify treatment options for patients, particularly those that may have an accelerating clinical course or co-morbidities that increase clotting risk.
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徐 旭, 张 金, 彭 婉, 刘 科, 胡 斯, 曾 令, 夏 春, 李 真. [Application of 3.0T Time-of-flight Magnetic Resonance Angiography with Sparse Undersampling and Iterative Reconstruction in the Diagnosis of Unruptured Intracranial Aneurysms]. Sichuan Da Xue Xue Bao Yi Xue Ban 2021; 52:92-97. [PMID: 33474896 PMCID: PMC10408958 DOI: 10.12182/20210160602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To evaluate the diagnostic value of 3.0T time-of-flight MR angiography with sparse undersampling and iterative reconstruction (TOFu-MRA) for unruptured intracranial aneurysms (UIAs) on the basis of using digital subtraction angiography (DSA) as the reference standard. METHODS A total of 65 patients with suspected UIAs were prospectively enrolled and all patients underwent TOFu-MRA and DSA. Relying on DSA as the reference standard, the sensitivity (SEN), specificity (SPE), positive predictive value (PPV) and negative predictive value (NPV) of using TOFu-MRA in UIA diagnosis were calculated, and the inter-observer agreement between two doctors was determined. Comparison of maximum intensity projection (MIP) and volume rendering (VR) image datasets was made to evaluate the agreement between DSA results and TOFu-MRA in the measurement of UIA morphological parameters, including the neck width (D neck), height (H) , and width (D width) of UIAs. RESULTS The study covered 55 UIAs from 46 patients. The SEN, SPE, PPV and NPV of the two doctors using TOFu-MRA in UIA diagnosis were as follows: (95.7%, 95.7%), (94.7%, 94.7%), (97.8%, 97.8%) and (90.0%, 90.0%), respectively for patient-based assessment; (96.4%, 94.5%), (94.7%, 94.7%), (98.1%, 98.1%) and (90.0%, 85.7%), respectively, for aneurysm-based assessment. There is a strong inter-observer agreement (Kappa=0.93 for patient-based assessment and 0.96 for aneurysm-based assessment) between the two doctors. Moreover, Bland-Altman analysis showed that more than 95% points fell within the limits of agreement (LoA), suggesting strong agreement between the two examination methods for the measurement of UIAs morphological parameters. CONCLUSION TOFu-MRA showed good diagnostic efficacy for UIAs and the results were in good agreement with those of DSA, the reference standard, for assessing UIA morphological parameter. TOFu-MRA can be used as a first choice for noninvasive diagnostic evaluation of UIAs.
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Affiliation(s)
- 旭 徐
- 四川大学华西医院 放射科 ( 成都 610041)Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 金戈 张
- 四川大学华西医院 放射科 ( 成都 610041)Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 婉琳 彭
- 四川大学华西医院 放射科 ( 成都 610041)Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 科伶 刘
- 四川大学华西医院 放射科 ( 成都 610041)Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 斯娴 胡
- 四川大学华西医院 放射科 ( 成都 610041)Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 令明 曾
- 四川大学华西医院 放射科 ( 成都 610041)Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 春潮 夏
- 四川大学华西医院 放射科 ( 成都 610041)Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 真林 李
- 四川大学华西医院 放射科 ( 成都 610041)Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China
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20
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Majewska P, Gulati S, Øie L, Salvesen Ø, Müller TB, Solheim O. Smoking habits and detection rate of unruptured intracranial aneurysms and incidence rate of subarachnoid haemorrhage in Norway between 2008 and 2015. Acta Neurochir (Wien) 2020; 162:3161-3165. [PMID: 32856106 PMCID: PMC7593283 DOI: 10.1007/s00701-020-04541-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 08/16/2020] [Indexed: 11/25/2022]
Abstract
Objective The aim of this study was to investigate the detection rate of unruptured intracranial aneurysms (UIAs) and incidence of aneurysmal subarachnoid haemorrhage (SAH) in relation to the rapidly changing smoking rates in Norway between 2008 and 2015. Methods The registry-based study included all patients (≥ 16 years old) admitted to a hospital in Norway between 2008 and 2015 with a primary diagnosis of aneurysmal SAH or an outpatient diagnosis of UIAs. Age group–specific and total detection rate of UIAs and incidence rate of SAH over the years were calculated. Age group–specific data on smoking habits was retrieved from a national annual survey representative of the whole Norwegian population. Results The rate of daily smokers decreased by 48% between 2008 and 2015. The detection rate of UIAs decreased by 47% from 17.3 in 2008 to 9.3 per 100,000 persons in 2015, and the incidence of SAH decreased by 30% from 11.3 in 2008 to 7.9 per 100,000 persons in 2015. The average annual decline in prevalence of daily smoking, UIA detection rate, and SAH incidence was 6.9%, 6.7%, and 4.3% per year, respectively. Multinomial logistic regression analyses revealed that the correlation between the decline in estimated daily smoking rates and decline in detection rate of UIAs (hazard ratio 52.5 CI = (14.9,∞), p < 0.00001) and incidence of SAH (hazard ratio 11.8 CI=(5.6,32.5), p < 0.00001) are statistically significant. The association is particularly strong in young and middle-aged cohorts (< 66 years old). Conclusion It is likely that reducing cigarette smoking on a population-based level strongly reduces the rates of UIAs and SAH.
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Affiliation(s)
- Paulina Majewska
- Department of Neurosurgery, St. Olav's University Hospital, Trondheim, Norway.
| | - Sasha Gulati
- Department of Neurosurgery, St. Olav's University Hospital, Trondheim, Norway
- Department of Neuromedicine and Movement Science, NTNU, Trondheim, Norway
| | - Lise Øie
- Department of Neuromedicine and Movement Science, NTNU, Trondheim, Norway
- Department of Neurology, St. Olav's University Hospital, Trondheim, Norway
| | - Øyvind Salvesen
- Unit for Applied Clinical Research, Faculty of Medicine, NTNU, Trondheim, Norway
| | - Tomm B Müller
- Department of Neurosurgery, St. Olav's University Hospital, Trondheim, Norway
- Department of Neuromedicine and Movement Science, NTNU, Trondheim, Norway
| | - Ole Solheim
- Department of Neurosurgery, St. Olav's University Hospital, Trondheim, Norway
- Department of Neuromedicine and Movement Science, NTNU, Trondheim, Norway
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21
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Patel PD, Chotai S, Liles C, Chen H, Shannon CN, Froehler MT, Fusco MR, Chitale RV. Impact of Neurovascular Comorbidities and Complications on Outcomes After Procedural Management of Intracranial Aneurysm: Part 1, Unruptured Intracranial Aneurysm. World Neurosurg 2020; 146:e233-e269. [PMID: 33122142 DOI: 10.1016/j.wneu.2020.10.092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 10/14/2020] [Accepted: 10/15/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVE This study investigates the relationship between neurovascular comorbidities and in-hospital complications in determining functional outcome, mortality, length of stay (LOS), and cost of stay. METHODS Patients were identified from the 2012-2015 National Inpatient Sample (NIS) using International Classification of Diseases, Ninth Revision codes for unruptured intracranial aneurysm (UIA) treatment in patients without subarachnoid hemorrhage. In-hospital complications were divided into medical complications, surgical complications, and seizures. Primary outcomes were functional outcome measured by modified Rankin Scale (mRS)-equivalent measure, in-hospital mortality, LOS, and cost. Multivariable logistic regression models were built for mRS-equivalent and in-hospital mortality. Multivariable linear regression models in log scale were built for LOS and cost. RESULTS A total of 7398 procedurally managed patients with UIA were included (median age, 58 years; 75% female; 66% white; 43% private insurance). Higher Neurovascular Comorbidities Index (NCI) was associated with seizure (odds ratio [OR], 1.11 if NCI = 1; OR, 2.49 if NCI = 7; P < 0.001), medical complication (OR, 1.21, NCI = 1; OR, 3.46, NCI = 7; P < 0.001), and surgical complication (OR, 1.25, NCI = 1; OR, 3.47, NCI = 7; P < 0.001). NCI remained significantly predictive of poor mRS-equivalent outcome (OR, 1.20, NCI = 1; OR, 5.79, NCI = 7; P < 0.001), in-hospital mortality (OR, 1.98, NCI = 1; OR, 10.9, NCI = 7; P < 0.001), LOS (coefficient dependent on multiple variables, P < 0.001), and cost (coefficient dependent on multiple variables, P < 0.001) after adjustment. CONCLUSIONS Neurovascular comorbidities are the primary driver of poor mRS-equivalent outcome, in-hospital mortality, higher LOS, and higher cost after procedural treatment of UIA. The conditional event of complication influences patients with fewer comorbidities more so than those with no comorbidities or high comorbidities. It is imperative to precisely account for these factors to optimize targeted resource allocation and increase the value of care for patients with UIA.
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Affiliation(s)
- Pious D Patel
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA; Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, USA.
| | - Silky Chotai
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, USA
| | - Campbell Liles
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, USA
| | - Heidi Chen
- Center for Quantitative Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, USA
| | - Chevis N Shannon
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, USA
| | - Michael T Froehler
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, USA
| | - Matthew R Fusco
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, USA
| | - Rohan V Chitale
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, USA
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22
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Yoon BH, Byun J, Park YS, Kim M, Lee JS, Park W, Park JC, Ahn JS. Clinical Interrogation of Mandatory Insertion of Central Venous Catheter for Clipping Surgery of Unruptured Intracranial Aneurysm: A Propensity Score Matched Study. World Neurosurg 2020; 146:e405-e412. [PMID: 33250188 DOI: 10.1016/j.wneu.2020.10.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/20/2020] [Accepted: 10/20/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND OBJECTIVE Microsurgical clipping, along with endovascular treatment, has evolved in the treatment of unruptured intracranial aneurysms (UIA), and these developments have resulted in a reduction of the complication rate. We discuss the need for a central venous catheter (CVC) insertion as an anesthetic preparation for microsurgical clipping. METHODS Between January 2019 and September 2019, 722 patients with UIA were treated at our institution. We excluded patients with a history of endovascular treatment or bypass surgery, recurrent aneurysms after coil embolization, brain tumors, or subarachnoid hemorrhages. A total of 272 patients were enrolled. Eighty-four patients underwent CVC insertion, and 188 patients underwent clipping surgery without CVC insertion. Outcome-related factors were compared between the 2 groups. We performed propensity score matching of the 2 groups to increase comparability. RESULTS There were no significant differences in outcome, sex, aneurysm location, aneurysm multiplicity, aneurysm size, or comorbid disease between the 2 groups. The mean age at the time of surgery was higher in the non-CVC insertion group than in the CVC insertion group. There were no meaningful differences in primary outcomes, including premature rupture and intraoperative motor evoked potential/somatosensory evoked potential change, and secondary outcomes, including estimated blood loss, duration of intensive care unit stay, duration of hospitalization, and Glasgow Outcome Scale score at discharge. CONCLUSIONS CVC insertion for clipping surgery for UIA is not mandatory. Considering the possible complications associated with CVCs, we cautiously suggest aneurysm surgery with CVC insertion in patients with serious medical comorbidities, aneurysm sizes >10 mm, and difficult proximal parent artery control.
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Affiliation(s)
- Byul Hee Yoon
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Joonho Byun
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Yong Seok Park
- Department of Anesthesiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Moinay Kim
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji Sung Lee
- Department of Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Wonhyoung Park
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jung Cheol Park
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Sung Ahn
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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23
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Lee IH, Choi JΙ. Remote cerebellar hemorrhage following surgical clipping of an unruptured cerebral aneurysm of the middle cerebral artery. J Cerebrovasc Endovasc Neurosurg 2020; 23:49-53. [PMID: 33050685 PMCID: PMC8041513 DOI: 10.7461/jcen.2020.e2020.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 09/15/2020] [Indexed: 11/23/2022] Open
Abstract
An infrequent complication, remote cerebellar hemorrhage (RCH) may occur after supratentorial craniotomy at a reported incidence of 0.08-0.6%. Although RCH is mostly self limiting, early diagnosis and treatment are necessary as the condition may result in severe neurologic deficits or mortality. Because RCH is often asymptomatic, occurrence of it was occasionally recognized with brain computed tomography (CT) scans only. We experienced two contrasting cases of RCH in patients with unruptured cerebral aneurysms of the middle cerebral artery. These cases indicate that it should be mandatory to perform a brain CT scans immediately after surgery and on appropriate time to detect RCH. Awareness of this complication and close monitoring are essential for avoiding fatal neurological deficits or mortality.
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Affiliation(s)
- In-Hyoung Lee
- Department of Neurosurgery, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Jong-Ιl Choi
- Department of Neurosurgery, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
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24
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Oishi H, Fujii T, Yatomi K, Teranishi K, Suzuki K, Mishima Y, Nakajima S. Stent-assisted coil embolization of unruptured middle cerebral artery aneurysms using LVIS Jr. stents. J Clin Neurosci 2020; 80:87-91. [PMID: 33099374 DOI: 10.1016/j.jocn.2020.07.070] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 07/24/2020] [Accepted: 07/30/2020] [Indexed: 01/28/2023]
Abstract
Authors reported the anatomical and clinical results of the stent assisted coiling (SAC) of unruptured middle cerebral artery (MCA) aneurysms using Low-profile Visualized Intraluminal Support Junior (LVIS Jr.). Forty-seven MCA aneurysms in 46 patients were the subjects of this study. The mean aneurysm size, neck width were 4.5 ± 1.8 mm, 3.0 ± 1.0 mm, respectively. Immediate anatomical outcomes were class Ⅰ in 31 (65.0%), class Ⅱ in 5 (10.6%) and class III in 11 (23.4%) patients according to Raymond-Roy classification. The latest anatomical outcomes were class Ⅰ in 33 (86.8%), class Ⅱ in 2 (5.3%) and class III in 3 (7.9%) patients. The change of aneurysm obliteration status were unchanged in 27 (71.0%), improved in 9 (23.7%) and worsen in 2 (5.3%). There were no recurrence necessitating additional treatment. Two patients suffered from angiographically evident in-stent thrombosis, but their clinical outcomes remain good. The modified Rankin scale at discharge were 0 in 45 patients, 1 in 1 patient. No patient showed clinical worsening during the clinical follow-up period at outpatient clinic (mean, 27.4 months). SAC of unruptured MCA aneurysms using LVIS Jr. provide safe and durable effect with high complete obliteration rate recurrence rate.
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Affiliation(s)
- Hidenori Oishi
- Department of Neurosurgery, Juntendo University, Faculty of Medicine, Japan.
| | - Takashi Fujii
- Department of Neurosurgery, Juntendo University, Faculty of Medicine, Japan
| | - Kenji Yatomi
- Department of Neurosurgery, Juntendo University, Faculty of Medicine, Japan
| | - Kohsuke Teranishi
- Department of Neurosurgery, Juntendo University, Faculty of Medicine, Japan
| | - Kazumoto Suzuki
- Department of Neurosurgery, Juntendo University, Faculty of Medicine, Japan
| | - Yumiko Mishima
- Department of Neurosurgery, Juntendo University, Faculty of Medicine, Japan
| | - Shintaro Nakajima
- Department of Neurosurgery, Juntendo University, Faculty of Medicine, Japan
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25
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Ospel J, Kashani N, Mayank A, Kaesmacher J, Hanning U, Brinjikji W, Cloft H, Almekhlafi M, Mitha AP, Wong JH, Costalat V, van Zwam W, Goyal M. Physician factors influencing endovascular treatment decisions in the management of unruptured intracranial aneurysms. Neuroradiology 2020; 63:117-123. [PMID: 32740709 DOI: 10.1007/s00234-020-02509-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 07/28/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE Deciding about whether an unruptured intracranial aneurysm (UIA) should be treated or not is challenging because robust data on rupture risks, endovascular treatment complication rates, and treatment success rates are limited. We aimed to investigate how neurointerventionalists conceptually approach endovascular treatment decision-making in UIAs. METHODS In a web-based international multidisciplinary case-based survey among neurointerventionalists, participants provided their demographics and UIA treatment-volumes, estimated 5-year rupture rates, endovascular treatment complication and success rates and gave their endovascular treatment decision for 15 pre-specified UIA case-scenarios. Differences in estimated 5-year rupture rates, endovascular treatment complication and success rates based on physician and hospital characteristics were evaluated with the Kruskal-Wallis test. Multivariable logistic regression analysis was used to derive adjusted effect size estimates for predictors of endovascular treatment decision. RESULTS Two hundred-thirty-three neurointerventionalists from 38 countries participated in the survey (median age 47 years [IQR: 41-55], 25/233 [10.7%] females). The ranges of estimates for 5-year rupture risks, endovascular treatment complication rates, and particularly endovascular treatment success rates were wide, especially for UIAs in the posterior circulation. Estimated 5-year rupture risks, endovascular treatment complication and success rates differed significantly based on personal and institutional endovascular UIA treatment volume, and all three estimates were significantly associated with physicians' endovascular treatment decision. CONCLUSION Although several predictors of endovascular treatment decision were identified, there seems to be a high degree of uncertainty when estimating rupture risks, treatment complications, and treatment success for endovascular UIA treatment. More data on the clinical course of UIAs with and without endovascular treatment is needed.
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Affiliation(s)
- Johanna Ospel
- Department of Radiology and Clinical Neurosciences, Foothills Medical Centre, University of Calgary, 1403 29th St. NW, Calgary, AB, T2N2T9, Canada.,Division of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Nima Kashani
- Department of Radiology and Clinical Neurosciences, Foothills Medical Centre, University of Calgary, 1403 29th St. NW, Calgary, AB, T2N2T9, Canada.,Department of Radiology, University of Calgary, Calgary, Canada
| | - Arnuv Mayank
- Department of Radiology and Clinical Neurosciences, Foothills Medical Centre, University of Calgary, 1403 29th St. NW, Calgary, AB, T2N2T9, Canada
| | - Johannes Kaesmacher
- University Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Uta Hanning
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Harry Cloft
- Department of Radiology, Mayo Clinic, Rochester, NY, USA
| | - Mohammed Almekhlafi
- Department of Radiology and Clinical Neurosciences, Foothills Medical Centre, University of Calgary, 1403 29th St. NW, Calgary, AB, T2N2T9, Canada.,Department of Radiology, University of Calgary, Calgary, Canada
| | - Alim P Mitha
- Department of Radiology and Clinical Neurosciences, Foothills Medical Centre, University of Calgary, 1403 29th St. NW, Calgary, AB, T2N2T9, Canada.,Department of Radiology, University of Calgary, Calgary, Canada.,Division of Neurosurgery, University of Calgary, Calgary, Canada
| | - John H Wong
- Department of Radiology and Clinical Neurosciences, Foothills Medical Centre, University of Calgary, 1403 29th St. NW, Calgary, AB, T2N2T9, Canada.,Department of Radiology, University of Calgary, Calgary, Canada.,Division of Neurosurgery, University of Calgary, Calgary, Canada
| | - Vincent Costalat
- Department of Neuroradiology, CHU Montpellier, Montpellier, France
| | - Wim van Zwam
- Department of Radiology and Nuclear Medicine, Cardiovascular Research Institute Maastricht, School for Mental Health and Sciences, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Mayank Goyal
- Department of Radiology and Clinical Neurosciences, Foothills Medical Centre, University of Calgary, 1403 29th St. NW, Calgary, AB, T2N2T9, Canada. .,Department of Radiology, University of Calgary, Calgary, Canada.
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Darsaut TE, Desal H, Cognard C, Januel AC, Bourcier R, Boulouis G, Shiva Shankar JJ, Findlay JM, Rempel JL, Fahed R, Boccardi E, Valvassori L, Magro E, Gentric JC, Bojanowski MW, Chaalala C, Iancu D, Roy D, Weill A, Diouf A, Gevry G, Chagnon M, Raymond J. Comprehensive Aneurysm Management (CAM): An All-Inclusive Care Trial for Unruptured Intracranial Aneurysms. World Neurosurg 2020; 141:e770-e777. [PMID: 32526362 DOI: 10.1016/j.wneu.2020.06.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 06/01/2020] [Accepted: 06/02/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND In the absence of randomized evidence, the optimal management of patients with unruptured intracranial aneurysms (UIA) remains uncertain. METHODS Comprehensive Aneurysm Management (CAM) is an all-inclusive care trial combined with a registry. Any patient with a UIA (no history of intracranial hemorrhage within the previous 30 days) can be recruited, and treatment allocation will follow an algorithm combining clinical judgment and randomization. Patients eligible for at least 2 management options will be randomly allocated 1:1 to conservative or curative treatment. Minimization will be used to balance risk factors, using aneurysm size (≥7 mm), location (anterior or posterior circulation), and age <60 years. RESULTS The CAM primary outcome is survival without neurologic dependency (modified Rankin Scale [mRS] score <3) at 10 years. Secondary outcome measures include the incidence of subarachnoid hemorrhage during follow-up and related morbidity and mortality; morbidity and mortality related to endovascular treatment or surgical treatment of the UIA at 1 year; overall morbidity and mortality at 1, 5, and 10 years; when relevant, duration of hospitalization; and, when relevant, discharge to a location other than home. The primary hypothesis for patients randomly allocated to at least 2 options, 1 of which is conservative management, is that active UIA treatment will reduce the 10-year combined neurologic morbidity and mortality (mRS score >2) from 24% to 16%. At least 961 patients recruited from at least 20 centers over 4 years will be needed for the randomized portion of the study. CONCLUSIONS Patients with unruptured intracranial aneurysms can be comprehensively managed within the context of an all-inclusive care trial.
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Affiliation(s)
- Tim E Darsaut
- University of Alberta Hospital, Mackenzie Health Sciences Centre, Department of Surgery, Division Crosurgery, Edmonton, Alberta, Canada
| | - Hubert Desal
- Service de Neuroradiologie Diagnostique et Interventionnelle du CHU de Nantes, Nantes, France
| | - Christophe Cognard
- Service de Neuroradiologie Diagnostique et Thérapeutique du CHU de Toulouse, Toulouse, France
| | - Anne-Christine Januel
- Service de Neuroradiologie Diagnostique et Thérapeutique du CHU de Toulouse, Toulouse, France
| | - Romain Bourcier
- Service de Neuroradiologie Diagnostique et Interventionnelle du CHU de Nantes, Nantes, France
| | - Grégoire Boulouis
- Service Imagerie Morphologique et Fonctionnelle, Hôpital Sainte-Anne, Paris, France
| | | | - J Max Findlay
- University of Alberta Hospital, Mackenzie Health Sciences Centre, Department of Surgery, Division Crosurgery, Edmonton, Alberta, Canada
| | - Jeremy L Rempel
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Robert Fahed
- Department of Radiology, Service of Interventional Neuroradiology, University of Ottawa Hospitals, Civic Campus, Ottawa, Ontario, Canada
| | - Edoardo Boccardi
- Department of Neuroradiology, Metropolitan Hospital Niguarda, Milan, Italy
| | - Luca Valvassori
- Department of Neuroradiology, Metropolitan Hospital Niguarda, Milan, Italy
| | - Elsa Magro
- Service de Neurochirurgie, CHU Cavale Blanche, INSERM UMR 1101 LaTIM, Brest, France
| | | | - Michel W Bojanowski
- Department of Surgery, Service of Neurosurgery, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Chiraz Chaalala
- Department of Surgery, Service of Neurosurgery, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Daniela Iancu
- Department of Radiology, Service of Interventional Neuroradiology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada; CHUM Research Center, Montreal, Quebec, Canada
| | - Daniel Roy
- Department of Radiology, Service of Interventional Neuroradiology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada; CHUM Research Center, Montreal, Quebec, Canada
| | - Alain Weill
- Department of Radiology, Service of Interventional Neuroradiology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada; CHUM Research Center, Montreal, Quebec, Canada
| | - Ange Diouf
- Department of Radiology, Service of Interventional Neuroradiology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Guylaine Gevry
- Department of Radiology, Service of Interventional Neuroradiology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada; CHUM Research Center, Montreal, Quebec, Canada
| | - Miguel Chagnon
- Department of Mathematics and Statistics, Université de Montréal, Montreal, Quebec, Canada
| | - Jean Raymond
- Department of Radiology, Service of Interventional Neuroradiology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada; CHUM Research Center, Montreal, Quebec, Canada.
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Zhong W, Du Y, Guo Q, Tan X, Li T, Chen C, Liu M, Shen J, Su W, Wang D, Wang Y. The Clinical and Morphologic Features Related to Aneurysm Wall Enhancement and Enhancement Pattern in Patients with Anterior Circulation Aneurysms. World Neurosurg 2019; 134:e649-e656. [PMID: 31689567 DOI: 10.1016/j.wneu.2019.10.156] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 10/24/2019] [Accepted: 10/25/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND Aneurysm wall enhancement (AWE) may predict rupture-prone intracranial aneurysms (IAs). However, the clinical and morphologic risk factors related to AWE have not been well described. Furthermore, the risk factors related to enhancement patterns have never been studied, especially in patients with anterior circulation aneurysms. Therefore, we aimed to investigate the risk factors related to wall enhancement and the enhancement patterns in anterior circulation unruptured aneurysms. METHODS One hundred patients (median age, 59 years; 68% female) with 113 anterior circulation unruptured aneurysms were included in this prospective study. Clinical and morphologic risk factors related to wall enhancement and circumferential enhancement were analyzed using univariate and multivariate analyses. RESULTS There were 33 symptomatic unruptured IAs (29.2%) and 50 IAs with AWE (44.2%) (partial [n = 16] and circumferential [n = 34]). Univariate analysis showed that symptomatic IAs and morphologic factors (irregular shape, size, width, dome depth, size ratio, aspect ratio, and bottleneck) correlated with wall enhancement. Furthermore, female sex, blood parameters (cholesterol and low-density lipoprotein), and morphologic factors (size and dome depth) correlated with wall enhancement patterns (P <0.05). Multivariate analysis showed that size was the most important factor in wall enhancement (P = 0.06; odds ratio, 3.758) and a trend for symptomatic IAs (P = 0.033; odds ratio, 2.426). Female sex was the most important factor in circumferential enhancement (P = 0.017; odds ratio, 7.276). CONCLUSIONS AWE was strongly associated with aneurysm size and was observed more frequently in symptomatic unruptured IAs. Sex hormones and atherosclerotic factors may be involved in circumferential enhancement. However, further studies should be performed to investigate the pathologic mechanisms for pattern of enhancement.
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Affiliation(s)
- Weiying Zhong
- Department of Neurosurgery, Qilu Hospital of Shandong University and Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, China; Shandong Key Laboratory of Brain Function Remodeling, Jinan, China
| | - Yiming Du
- Department of Pharmacy, Yinan County People's Hospital, Linyi, China
| | - Qinglong Guo
- Department of Neurosurgery, Caoxian Panshi Hospital, Heze, China
| | - Xianjun Tan
- Department of Neurosurgery, Qilu Hospital of Shandong University and Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, China
| | - Tao Li
- Department of Neurosurgery, Qilu Hospital of Shandong University and Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, China
| | - Chao Chen
- Department of Neurosurgery, Qilu Hospital of Shandong University and Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, China; Shandong Key Laboratory of Brain Function Remodeling, Jinan, China
| | - Ming Liu
- Department of Neurosurgery, Qilu Hospital of Shandong University and Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, China; Shandong Key Laboratory of Brain Function Remodeling, Jinan, China
| | - Jie Shen
- Department of Neurosurgery, Qilu Hospital of Shandong University and Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, China; Shandong Key Laboratory of Brain Function Remodeling, Jinan, China
| | - Wandong Su
- Department of Neurosurgery, Qilu Hospital of Shandong University and Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, China; Shandong Key Laboratory of Brain Function Remodeling, Jinan, China
| | - Donghai Wang
- Department of Neurosurgery, Qilu Hospital of Shandong University and Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, China; Shandong Key Laboratory of Brain Function Remodeling, Jinan, China
| | - Yunyan Wang
- Department of Neurosurgery, Qilu Hospital of Shandong University and Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, China; Shandong Key Laboratory of Brain Function Remodeling, Jinan, China.
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Yamagami K, Hatano T, Nakahara I, Ishii A, Ando M, Chihara H, Ogura T, Suzuki K, Kondo D, Kamata T, Higashi E, Sakai S, Sakamoto H, Iihara K, Nagata I. Long-term Outcomes After Intraprocedural Aneurysm Rupture During Coil Embolization of Unruptured Intracranial Aneurysms. World Neurosurg 2019; 134:e289-e297. [PMID: 31629140 DOI: 10.1016/j.wneu.2019.10.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 10/07/2019] [Accepted: 10/08/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND The long-term outcomes of patients with intraprocedural aneurysm rupture (IPR) during endovascular coiling of unruptured intracranial aneurysms (UIAs) remain unclear. We investigated the long-term outcomes and predictors of neurological outcomes in patients who sustained IPR during coil embolization of UIAs. METHODS We retrospectively analyzed the medical record of 312 untreated UIAs in 284 patients who underwent endovascular coiling between April 2013 and July 2018. RESULTS The mean follow-up period for the entire cohort was 25.6 months. Twelve patients (3.8%) experienced IPR. The mean aneurysm size in the IPR cohort was significantly smaller than that in the no-IPR cohort (P = 0.045). The IPR cohort had a higher percentage of earlier subarachnoid hemorrhage from another aneurysm (P = 0.019), anterior communicating artery (AComA) aneurysm (P < 0.001), and basilar artery (BA) aneurysm (P = 0.022) than the no-IPR cohort. Neurologic deterioration was observed in 3 patients. The morbidity and mortality rates of the IPR cohort were 25% and 8.3%, respectively. Patients with IPR during coil embolization for AComA aneurysm did not develop neurological deterioration. Two of the 3 patients (66.7%) with a BA aneurysm had neurological deterioration. The proportion of patients with an mRS score of 0-2 at the last follow-up did not differ between the 2 cohorts (P = 0.608). CONCLUSIONS The proportion of functionally independent patients did not differ between patients with and without IPR. Patients with BA aneurysms who developed an IPR tended to exhibit more unfavorable clinical courses than patients with AcomA aneurysms.
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Affiliation(s)
- Keitaro Yamagami
- Stroke Center, Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu, Fukuoka, Japan; Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | - Taketo Hatano
- Stroke Center, Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu, Fukuoka, Japan
| | - Ichiro Nakahara
- Department of Comprehensive Strokology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Akira Ishii
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Mitsushige Ando
- Stroke Center, Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu, Fukuoka, Japan
| | - Hideo Chihara
- Stroke Center, Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu, Fukuoka, Japan
| | - Takenori Ogura
- Stroke Center, Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu, Fukuoka, Japan
| | - Keita Suzuki
- Stroke Center, Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu, Fukuoka, Japan
| | - Daisuke Kondo
- Stroke Center, Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu, Fukuoka, Japan
| | - Takahiko Kamata
- Stroke Center, Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu, Fukuoka, Japan
| | - Eiji Higashi
- Stroke Center, Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu, Fukuoka, Japan
| | - Shota Sakai
- Stroke Center, Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu, Fukuoka, Japan
| | - Hiroki Sakamoto
- Stroke Center, Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu, Fukuoka, Japan
| | - Koji Iihara
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Izumi Nagata
- Stroke Center, Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu, Fukuoka, Japan
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Sánchez van Kammen M, Greving JP, Kuroda S, Kashiwazaki D, Morita A, Shiokawa Y, Kimura T, Cognard C, Januel AC, Lindgren A, Koivisto T, Jääskeläinen JE, Ronkainen A, Pyysalo L, Öhman J, Rahi M, Kuhmonen J, Rinne J, Leemans EL, Majoie CB, Vandertop WP, Verbaan D, Roos YBWEM, Berg RVD, Boogaarts HD, Moudrous W, Wijngaard IRVD, Hove LT, Teo M, George EJS, Hackenberg KAM, Abdulazim A, Etminan N, Rinkel GJE, Vergouwen MDI. External Validation of the ELAPSS Score for Prediction of Unruptured Intracranial Aneurysm Growth Risk. J Stroke 2019; 21:340-346. [PMID: 31590478 PMCID: PMC6780020 DOI: 10.5853/jos.2019.01277] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 08/19/2019] [Indexed: 11/16/2022] Open
Abstract
Background and Purpose Prediction of intracranial aneurysm growth risk can assist physicians in planning of follow-up imaging of conservatively managed unruptured intracranial aneurysms. We therefore aimed to externally validate the ELAPSS (Earlier subarachnoid hemorrhage, aneurysm Location, Age, Population, aneurysm Size and Shape) score for prediction of the risk of unruptured intracranial aneurysm growth.
Methods From 11 international cohorts of patients ≥18 years with ≥1 unruptured intracranial aneurysm and ≥6 months of radiological follow-up, we collected data on the predictors of the ELAPSS score, and calculated 3- and 5-year absolute growth risks according to the score. Model performance was assessed in terms of calibration (predicted versus observed risk) and discrimination (c-statistic).
Results We included 1,072 patients with a total of 1,452 aneurysms. During 4,268 aneurysm-years of follow-up, 199 (14%) aneurysms enlarged. Calibration was comparable to that of the development cohort with the overall observed risks within the range of the expected risks. The c-statistic was 0.69 (95% confidence interval [CI], 0.64 to 0.73) at 3 years, compared to 0.72 (95% CI, 0.68 to 0.76) in the development cohort. At 5 years, the c-statistic was 0.68 (95% CI, 0.64 to 0.72), compared to 0.72 (95% CI, 0.68 to 0.75) in the development cohort.
Conclusions The ELAPSS score showed accurate calibration for 3- and 5-year risks of aneurysm growth and modest discrimination in our external validation cohort. This indicates that the score is externally valid and could assist patients and physicians in predicting growth of unruptured intracranial aneurysms and plan follow-up imaging accordingly.
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Affiliation(s)
- Mayte Sánchez van Kammen
- Department of Neurology and Neurosurgery, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Jacoba P Greving
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Satoshi Kuroda
- Department of Neurosurgery, University of Toyama, Toyama, Japan
| | | | - Akio Morita
- Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan
| | | | - Toshikazu Kimura
- Department of Neurosurgery, NTT Medical Center Tokyo, Tokyo, Japan
| | - Christophe Cognard
- Department of Neuroradiology, Toulouse University Hospital, Toulouse, France
| | - Anne C Januel
- Department of Neuroradiology, Toulouse University Hospital, Toulouse, France
| | - Antti Lindgren
- Department of Neurosurgery, Kuopio University Hospital, Kuopio, Finland
| | - Timo Koivisto
- Department of Neurosurgery, Kuopio University Hospital, Kuopio, Finland
| | - Juha E Jääskeläinen
- Department of Neurosurgery, Kuopio University Hospital, Kuopio, Finland.,Institute of Clinical Medicine-Neurosurgery, University of Eastern Finland, Kuopio, Finland
| | - Antti Ronkainen
- Department of Neurosurgery, University of Tampere, Tampere, Finland
| | - Liisa Pyysalo
- Department of Neurosurgery, University of Tampere, Tampere, Finland
| | - Juha Öhman
- Department of Neurosurgery, University of Tampere, Tampere, Finland
| | - Melissa Rahi
- Department of Neurosurgery, University of Turku, Turku, Finland
| | | | - Jaakko Rinne
- Department of Neurosurgery, University of Turku, Turku, Finland
| | - Eva L Leemans
- Department of Neuroradiology, Academic Medical Center, Amsterdam, the Netherlands.,Department of Biomedical Engineering and Physics,Academic Medical Center, Amsterdam, the Netherlands
| | - Charles B Majoie
- Department of Neuroradiology, Academic Medical Center, Amsterdam, the Netherlands
| | - W Peter Vandertop
- Department of Neurosurgery, Academic Medical Center, Amsterdam, the Netherlands
| | - Dagmar Verbaan
- Department of Neurosurgery, Academic Medical Center, Amsterdam, the Netherlands
| | - Yvo B W E M Roos
- Department of Neurology, Academic Medical Center, Amsterdam, the Netherlands
| | - René van den Berg
- Department of Neuroradiology, Academic Medical Center, Amsterdam, the Netherlands
| | - Hieronymus D Boogaarts
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Walid Moudrous
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Ido R van den Wijngaard
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands.,Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Laura Ten Hove
- Department of Radiology, Haaglanden Medical Center, Den Haag, the Netherlands
| | - Mario Teo
- Department of Neurosurgery, Institute of Neurological Science, Glasgow, UK
| | - Edward J St George
- Department of Neurosurgery, Institute of Neurological Science, Glasgow, UK
| | | | - Amr Abdulazim
- Department of Neurosurgery, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Nima Etminan
- Department of Neurosurgery, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Gabriël J E Rinkel
- Department of Neurology and Neurosurgery, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Mervyn D I Vergouwen
- Department of Neurology and Neurosurgery, University Medical Centre Utrecht, Utrecht, the Netherlands
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Yanagawa T, Harada Y, Hatayama T, Kono T. Rupture immediately after growth of unruptured intracranial aneurysms during follow-up. Surg Neurol Int 2019; 10:164. [PMID: 31583161 PMCID: PMC6763665 DOI: 10.25259/sni_262_2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 06/19/2019] [Indexed: 11/20/2022] Open
Abstract
Background: The annual rupture rate of small unruptured intracranial aneurysms (UIAs) <5 mm is generally low; further, small UIAs are often treated conservatively. While the growth of aneurysms during follow-up is associated with a high risk of rupture, the urgency for surgical treatment of asymptomatic enlarged UIAs remains controversial. We experienced two patients in whom UIAs ruptured shortly after asymptomatic growth during follow-up. Case Description: A 1-mm right middle cerebral artery aneurysm was incidentally found in a 63-year-old woman. Preventive surgery was planned because the aneurysm grew rapidly; however, the aneurysm ruptured preoperatively. A 68-year-old woman had a small (4 mm) aneurysm at the left internal carotid-posterior communicating artery. The aneurysm grew rapidly after many years. Several hours after magnetic resonance imaging was performed, she presented to the hospital with loss of consciousness, and a diagnosis of subarachnoid hemorrhage due to the ruptured aneurysm was made. Conclusion: UIAs that rapidly increase during follow-up may be regarded as impending ruptured aneurysms.
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Affiliation(s)
- Taro Yanagawa
- Department of Neurosurgery, Mito Brain Heart Center, Mito, Ibaraki, Japan
| | - Yoichi Harada
- Department of Neurosurgery, Mito Brain Heart Center, Mito, Ibaraki, Japan
| | - Toru Hatayama
- Department of Neurosurgery, Mito Brain Heart Center, Mito, Ibaraki, Japan
| | - Takuji Kono
- Department of Neurosurgery, Mito Brain Heart Center, Mito, Ibaraki, Japan
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31
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Campe C, Neumann J, Sandalcioglu IE, Rashidi A, Luchtmann M. Vasospasm and delayed cerebral ischemia after uneventful clipping of an unruptured intracranial aneurysm - a case report. BMC Neurol 2019; 19:226. [PMID: 31526396 PMCID: PMC6745799 DOI: 10.1186/s12883-019-1458-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 09/10/2019] [Indexed: 01/14/2023] Open
Abstract
Background Due to improvements in both the quality and availability of intracranial imaging as well as the evolution of surgical and endovascular techniques during the last decade, the number of treatments of unruptured intracranial aneurysms (UIA) has increased steadily. However, it is not generally known that vasospasm can arise after an uneventful clipping. Case presentation We present a case of a 69-year-old woman who suffered from vasospasm and delayed cerebral ischemia that occurred after an uneventful clipping of a UIA. The aneurysm of the right middle cerebral artery was found incidentally via magnetic resonance imaging ordered after the patient complained of a short period of slight gait disturbances. To avoid a subarachnoid hemorrhage and consecutive complications like vasospasms, the patient elected microsurgical treatment. Clipping was managed by keyhole approach. Temporal clipping of the M1 was not necessary. After clip placement, appropriate flow in all distal segments was confirmed by indocyanine green video-angiography and micro-Doppler. The patient was discharged seven days after surgery without neurological deficits. After 12 days, the patient developed at home a sudden drooping on the left side of the face. Upon admission to the emergency room, the patient was alert but slightly confused. Neurological examination revealed a left-sided hemiparesis and motor speech disorder. In contrast to the preoperative transfemoral catheter angiography, the subsequent right internal carotid angiogram showed clear signs of vasospasm along the M1 and M2 segments of the right middle cerebral artery. Antithrombotic treatment with acetylsalicylic acid was begun. In accordance with guidelines for the treatment of subarachnoid hemorrhage and vasospasm, nimodipine was added. After 11 days the patient was discharged with no symptoms. Conclusion Cerebral vasospasm as a cause of ischemic stroke after uneventful surgery for a UIA seems to be a rare but possibly underestimated etiology that demands particular attention with respect to providing appropriate treatment. In future, it may be prudent to perform follow-up transcranial ultrasonography testing after the clipping of a UIA, especially considering the availability of potentially neuroprotective medications like nimodipine.
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Affiliation(s)
- Christin Campe
- Department of Neurology, Medical Faculty, Otto von Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Jens Neumann
- Department of Neurology, Medical Faculty, Otto von Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - I Erol Sandalcioglu
- Department of Neurosurgery, Medical Faculty, Otto von Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Ali Rashidi
- Department of Neurosurgery, Medical Faculty, Otto von Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Michael Luchtmann
- Department of Neurosurgery, Medical Faculty, Otto von Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.
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Hashimoto Y, Matsushige T, Shimonaga K, Hosogai M, Kaneko M, Ono C, Mizoue T. Vessel Wall Imaging Predicts the Presence of Atherosclerotic Lesions in Unruptured Intracranial Aneurysms. World Neurosurg 2019; 132:e775-e782. [PMID: 31415889 DOI: 10.1016/j.wneu.2019.08.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 08/02/2019] [Accepted: 08/03/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Recent studies have suggested that magnetic resonance vessel wall imaging (VWI) can visualize thickened intracranial aneurysm wall. We aimed to investigate correlations between VWI findings and intraoperative aneurysm wall features based on the hypothesis that VWI can visualize atherosclerotic changes in unruptured intracranial aneurysm (UIA) walls. METHODS A total of 36 microsurgically treated UIAs were retrospectively reviewed. All aneurysms underwent VWI before microsurgical clipping, and fusion images with time-of-flight magnetic resonance angiography were created to localize aneurysm wall enhancement (AWE) lesions. Intraoperatively, 2 neurosurgeons who were blinded to the VWI findings evaluated the aneurysm wall features, giving each aneurysm an atherosclerosis score on a 5-point scale (5: yellowish, 4: whitish, 3: normal, 2: slightly reddish, 1: reddish). We defined atherosclerotic lesions as those having average scores ≥4. We evaluated the rate of correspondence between AWE lesions and atherosclerotic lesions, and the factors associated with AWE. RESULTS Sixteen of the 36 UIAs (44%) were identified as AWE. The sensitivity, specificity, positive predictive value, and negative predictive value of correspondence between AWE lesions and atherosclerotic lesions were 79%, 94%, 94%, and 80%, respectively. The average atherosclerosis scores (4.2 ± 0.5 vs. 2.7 ± 0.9; P < 0.001) were significantly higher in aneurysms with AWE. Twelve of 16 UIAs with wall enhancement had wall thinning adjacent to the part with AWE. CONCLUSIONS AWE lesions corresponded with intraoperatively confirmed atherosclerotic lesions of UIAs. Detecting these lesions would be valuable in exploring UIAs with wall degeneration.
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Affiliation(s)
- Yukishige Hashimoto
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | - Toshinori Matsushige
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan.
| | - Koji Shimonaga
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | - Masahiro Hosogai
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | - Mayumi Kaneko
- Department of Pathology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | - Chiaki Ono
- Department of Radiology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | - Tatsuya Mizoue
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
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33
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Jung YJ, Chang CH, Kim JH. Advantages of Coil Embolization Performed Immediately After Diagnostic Cerebral Digital Subtraction Angiography in Unruptured Intracranial Aneurysms: Patients' Perspective. World Neurosurg 2019; 130:e573-e576. [PMID: 31254708 DOI: 10.1016/j.wneu.2019.06.154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 06/17/2019] [Accepted: 06/19/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND We are inevitably faced with the need to perform coil embolization immediately after diagnostic cerebral digital subtraction angiography (DSA) for economic reasons, patient convenience, fear of rupture, and other reasons. Here we report the advantages of coil embolization performed immediately after diagnostic cerebral DSA for unruptured intracranial aneurysms (UIAs) from the patients' perspective. METHODS Between January 2017 and October 2018, 145 patients were treated for UIAs with endovascular coil embolization at the Yeungnam University Medical Center. There were 87 patients in the group in which coil embolization was to be performed at least 1 week after diagnostic cerebral DSA (regular [R] group) and 58 patients in the group in which coil embolization was to be performed immediately after diagnostic cerebral DSA (immediate [I] group). RESULTS There were no statistically significant between group differences in any factor analyzed expect for medical expenses (out-of-pocket costs), 2,218,416 KRW (1963 USD) for the R group and 1,128,906 KRW (999 USD) for the I group (P < 0.001). There were no statistically significant differences in the rate of complications between the 2 groups, with 4 minor complications and 1 death in the R group and 3 minor complications and 1 death in the I group. CONCLUSIONS Our findings indicate that coil embolization performed immediately after diagnostic cerebral DSA can be a relatively safe alternative approach to treating patients with UIAs.
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Affiliation(s)
- Young-Jin Jung
- Department of Neurosurgery, College of Medicine, Yeungnam University, Namgu, Daegu, Korea
| | - Chul-Hoon Chang
- Department of Neurosurgery, College of Medicine, Yeungnam University, Namgu, Daegu, Korea
| | - Jong-Hoon Kim
- Department of Neurosurgery, College of Medicine, Yeungnam University, Namgu, Daegu, Korea.
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O'Neill AH, Chandra RV, Slater LA, Chong W, Xenos C, Danks AR, Lai LT. Influence of comorbidities on treatment of unruptured intracranial aneurysms in the elderly. J Clin Neurosci 2019; 62:38-45. [PMID: 30655235 DOI: 10.1016/j.jocn.2019.01.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 12/15/2018] [Accepted: 01/03/2019] [Indexed: 11/30/2022]
Abstract
Current evidence does not conclusively justify conservative management of unruptured intracranial aneurysms (UIA) in the elderly (age ≥ 65 years). To rationalise intervention, the authors investigated the role of age and comorbidity burden on treatment outcomes. A retrospective chart review for consecutive cases of UIAs treated in the elderly between 2007 and 2018 was performed. Preoperative Charlson Comorbidity Index (CCI) and Neurovascular Comorbidities Index (NCI) were calculated. Standard statistical methods with univariate and multiple logistic regression were used. A total of 123 patients (46 surgery, 77 endovascular) with 131 UIAs were treated. The mean age was 70.6 ± 4.1 years, and 90 patients were female (73.1%). The mean aneurysm size was 8.6 ± 5.0 mm, and the mean follow up period was 22.9 ± 21.3 months. The rates of poor outcome (mRS > 1) at discharge, 6 weeks and 6 months were 9.8%, 5.8% and 3.6%, respectively. There was no difference in outcomes between surgical and endovascular treatment. Correlation and regression analyses revealed that aneurysm size, higher preoperative comorbidity index (CCI > 4), and endovascular treatment with a stent or flow diverter (p = 0.009, 0.02, and 0.005, respectively) were associated with a poor outcome. When adjusted in a multivariate analysis, only high comorbidity burden (CCI > 4) predicted unfavourable outcome (p = 0.01). Elderly patients who undergo treatment for UIAs are at high risk of postoperative deterioration. Careful preoperative case selection based on comorbidity burden, rather than chronological age, would be useful for improved risk stratification.
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Affiliation(s)
| | - Ronil V Chandra
- Department of Surgery, Monash University, Melbourne, Australia; Neuro-Interventional Radiology Unit, Department of Imaging, Monash Health, Melbourne, Australia
| | - Lee-Anne Slater
- Neuro-Interventional Radiology Unit, Department of Imaging, Monash Health, Melbourne, Australia
| | - Winston Chong
- Neuro-Interventional Radiology Unit, Department of Imaging, Monash Health, Melbourne, Australia
| | | | - Andrew Robert Danks
- Department of Neurosurgery, Monash Health, Melbourne, Australia; Department of Surgery, Monash University, Melbourne, Australia
| | - Leon T Lai
- Department of Neurosurgery, Monash Health, Melbourne, Australia; Department of Surgery, Monash University, Melbourne, Australia.
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Hoffman H, Toshkezi G, Swarnkar A, Gould G, Chin LS, Krishnamurthy S. A retrospective comparison of sac and lobe morphology between ruptured and unruptured intracranial aneurysms. J Clin Neurosci 2018; 60:88-92. [PMID: 30309802 DOI: 10.1016/j.jocn.2018.09.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 09/26/2018] [Indexed: 11/25/2022]
Abstract
There are few reliable morphologic indices to aid in the determination of an intracranial aneurysm's rupture risk. We sought to characterize morphological characteristics of aneurysm sacs and their lobes that are associated with ruptured status at time of initial evaluation with diagnostic angiography. These factors could be associated with an aneurysm's risk of rupturing. We retrospectively reviewed all aneurysms imaged with digital subtraction angiography (DSA) at a single institution over five years. Patients presenting with aneurysmal subarachnoid hemorrhage (aSAH) were assigned to the ruptured group, and those presenting without aSAH were assigned to the unruptured group. Angiograms were evaluated for the presence of various morphological parameters. Binary logistic regression was used to assess their associations between groups. A total of 331 aneurysms among 241 patients were included in the analysis. Posterior circulation, larger size ratio, and the presence of two or more lobes were associated with aneurysm rupture (p < 0.001 for each). Aneurysms containing a lobe with a greater height than width were observed more frequently in the ruptured group (OR 5.26, 95% CI 2.66-10.41). In the receiver operating characteristic (ROC) curves, mean diameter had an AUC of 0.72 and an optimum threshold of 2.85 mm. For size ratio, the AUC was 0.70 and the optimum threshold was 2.02. A larger SR was observed in ruptured aneurysms. The presence of multiple lobes and greater lobe height than width were associated with rupture status as well. These factors merit investigation in a prospective study.
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Affiliation(s)
- Haydn Hoffman
- Department of Neurosurgery, State University of New York Upstate Medical University, Syracuse, NY, USA.
| | - Gentian Toshkezi
- Department of Neurosurgery, State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Amar Swarnkar
- Department of Radiology, State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Grahame Gould
- Department of Neurosurgery, State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Lawrence S Chin
- Department of Neurosurgery, State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Satish Krishnamurthy
- Department of Neurosurgery, State University of New York Upstate Medical University, Syracuse, NY, USA
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Matsukawa H, Kamiyama H, Miyazaki T, Kinoshita Y, Ota N, Noda K, Saito N, Shonai T, Takahashi O, Tokuda S, Tanikawa R. Analysis for risk factors of 12-month neurological worsening in patients with surgically treated small-to-moderate size unruptured intracranial aneurysms. J Clin Neurosci 2018; 58:160-4. [PMID: 30279118 DOI: 10.1016/j.jocn.2018.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 05/05/2018] [Accepted: 08/08/2018] [Indexed: 11/24/2022]
Abstract
The risk associated with surgical treatment for small-to-moderate size unruptured intracranial aneurysms (SMUIAs, defined as <15 mm) has not been well characterized. Authors aimed to investigate risk factors for poor outcome in surgical treatment of SMUIAs. The data of prospectively collected 801 consecutive patients harboring 971 surgically treated SMUIAs was evaluated. Neurological worsening (NW) was defined as an increase in 1 or more modified Rankin Scale at 12-month. Clinical and radiological characteristics were compared. Neurological worsening was observed in 45 (4.6%). In multivariate analysis, only perforator territory infarction (PTI) on postoperative diffusion-weighted imaging (odds ratio (OR), 13; 95% confidence interval (CI), 4.9-32, p < 0.0001), and aneurysm locations (paraclinoid (OR, 6.9; 95% CI, 3.1-15, p < 0.0001), basilar artery (OR, 4.5; 95% CI, 1.5-14, p = 0.008), vertebral artery (OR, 11; 95% CI, 3.3-34, p < 0.0001)) were related to neurological worsening. Multivariate analysis showed that statin use (OR, 12; 95% CI, 3.8-39, p < 0.0001) and aneurysm locations (internal carotid artery-posterior communicating artery (OR, 3.9; 95% CI, 1.8-8.2, p < 0.0001) and basilar artery (OR, 6.3; 95% CI, 2.3-17, p = 0.008)), and aneurysm size >10 mm (OR, 5.3; 95% CI, 1.8-15, p = 0.003) were related to PTI. Although all SMUIAs should be carefully considered whether to be treated, those with statins, specific locations, and larger sizes should perhaps be more meticulously contemplated, and neurosurgeons should continue to avoid PTI.
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Jang CK, Park KY, Lee JW, Huh SK, Kim JH, Kim S, Chung J. Microsurgical Treatment of Unruptured Anterior Choroidal Artery Aneurysms: Incidence of and Risk Factors for Procedure-Related Complications. World Neurosurg 2018; 119:e679-e685. [PMID: 30092482 DOI: 10.1016/j.wneu.2018.07.241] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 07/25/2018] [Accepted: 07/26/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To describe our experiences with microsurgical treatment of unruptured anterior choroidal artery (AchA) aneurysms, and to evaluate the incidence of and risk factors for procedure-related complications. METHODS The study included 110 patients treated between January 2012 and December 2016. All patients met the following criteria: 1) microsurgical treatment of an unruptured AchA aneurysm was performed; and 2) clinical and radiographic follow-up data were available, including findings from preoperative digital subtraction angiography. The incidence of and risk factors for procedure-related complications were retrospectively evaluated. The χ2 test and Mann-Whitney U test were used in statistical analysis, and univariate analysis and multivariate logistic regression analysis were conducted. RESULTS Procedure-related complications occurred in 5 patients (4.5%), including symptomatic complications in 4 patients (3.6%) and asymptomatic complications in 1 patient (0.9%). Multivariate logistic regression analysis indicated that the angle between the vertical line to the cranial base and the axis of the communicating segment of the internal carotid artery (MiC angle) (odds ratio [OR], 1.66; 95% confidence interval [CI], 1.13-5.26; P = 0.038) and the angle between the projection line of the aneurysmal dome and the axis of the communicating segment of the internal carotid artery (DC angle) (OR, 3.82; 95% CI, 1.49-11.7; P = 0.014) were independent risk factors for procedure-related complications. CONCLUSIONS When microsurgical treatment of unruptured AchA aneurysms was performed, the procedure-related complication rate was 4.5%. Patients with AchA aneurysms with a smaller MiC angle and smaller DC angle may be at a higher risk of procedure-related complications when undergoing microsurgical treatment.
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Affiliation(s)
- Chang Ki Jang
- Department of Neurosurgery, Severance Hospital, Stroke Center, Yonsei University College of Medicine, Seoul, Korea
| | - Keun Young Park
- Department of Neurosurgery, Severance Hospital, Stroke Center, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Whan Lee
- Department of Neurosurgery, Severance Hospital, Stroke Center, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Kon Huh
- Department of Neurosurgery, Severance Hospital, Stroke Center, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Hoon Kim
- Department of Radiology, Busan Paik Hospital, Inje University, Busan, Korea
| | - Sunghan Kim
- Department of Neurosurgery, Seoul Medical Center, Seoul, Korea
| | - Joonho Chung
- Department of Neurosurgery, Severance Hospital, Stroke Center, Yonsei University College of Medicine, Seoul, Korea; Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, Korea.
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Suzuki M, Satow T, Komuro T, Kobayashi A, Miyamoto S. A local excitation magnetic resonance imaging method for intracranial unruptured aneurysm at the distal internal carotid artery. J Clin Neurosci 2018; 54:152-155. [PMID: 29907386 DOI: 10.1016/j.jocn.2018.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Accepted: 06/04/2018] [Indexed: 10/14/2022]
Abstract
It is often difficult to diagnose an intracranial aneurysm at the distal internal carotid artery by conventional magnetic resonance imaging. PURPOSE We assessed the effectiveness of the local excitation technique, a new application for magnetic resonance imaging, to clarify the geometric structure of aneurysm and adjacent branches at the distal internal carotid artery. STUDY DESIGN Two independent evaluators diagnosed 10 cases of suspected aneurysms at the distal internal carotid artery by T2-weighted magnetic resonance imaging with application of local excitation, adding it to conventional time-of-flight-magnetic resonance angiography. FINDINGS We successfully distinguished the aneurysm from infundibular dilatation in five of 10 cases. CONCLUSION Our results suggested that addition of local excitation to conventional magnetic resonance angiography was effective to diagnose unruptured aneurysm at the distal internal carotid artery, to clarify the configuration of the prominent lesion or whether the location of the adjacent branch orifice on the parent vessel was symmetric or asymmetric.
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Affiliation(s)
- Megumu Suzuki
- Department of Neurosurgery, Nagahama City Hospital, 313 Oinui-cho, Nagahama City, Shiga 526-0043, Japan; Department of Neurosurgery, Kyoto University Graduate School of Medicine, 54 Kawahara-cho Shogoin Sakyo-ku, Kyoto 606-8507, Japan.
| | - Takeshi Satow
- Department of Neurosurgery, Nagahama City Hospital, 313 Oinui-cho, Nagahama City, Shiga 526-0043, Japan
| | - Taro Komuro
- Department of Neurosurgery, Nagahama City Hospital, 313 Oinui-cho, Nagahama City, Shiga 526-0043, Japan
| | - Akira Kobayashi
- Department of Neurosurgery, Nagahama City Hospital, 313 Oinui-cho, Nagahama City, Shiga 526-0043, Japan
| | - Susumu Miyamoto
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, 54 Kawahara-cho Shogoin Sakyo-ku, Kyoto 606-8507, Japan
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Kang JH, Huh SK, Kim J, Park KY, Chung J. Subdural Fluid Collection After the Clipping of Unruptured Intracranial Aneurysms: Its Clinical Course and Significance. World Neurosurg 2018; 116:e266-e272. [PMID: 29730098 DOI: 10.1016/j.wneu.2018.04.185] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 04/23/2018] [Accepted: 04/24/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE We evaluated the clinical course and significance of postoperative subdural fluid collection (SFC) and identified the patients who were at risk of developing postoperative chronic subdural hematoma (CSDH) after the clipping of unruptured intracranial aneurysms (UIAs). METHODS Between January 2012 and June 2014, we retrospectively reviewed 298 patients with UIAs treated by microsurgical clipping. Among them, 257 patients were enrolled in the present study. Subdural lesions (SDLs) were defined as SFC at 1-month follow-up computed tomography (CT) and a CSDH at any time within 1 month after the clipping of UIAs. We examined the volume changes, Hounsfield unit (HU) values, and the end results of SFC in serial CT scans. RESULTS The incidence of postoperative CSDH that needed burr hole surgery was 2.5%. Changes in SFC volume that occurred within 1 week of surgery were a risk factor for the occurrence of SDL at the 1-month follow-up CT (odds ratio 34.039; P < 0.001). The corrected average HU value of SCF (cut-off value: 11.9, with a sensitivity of 83.3% and specificity of 73.7%) on postoperative day 7 was an independent risk factor for development of a CSDH at the 1-month follow-up CT (odds ratio 19.261; P = 0.003). CONCLUSIONS SDLs seen during 1-month follow-up may be associated with the occurrence of increased SFC volume within a week after the clipping of UIAs. The corrected average HU value of the SFC on postoperative day 7 was the only risk factor for the development of CSDHs at 1-month follow-up CT.
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Affiliation(s)
- Jeong-Han Kang
- Department of Neurosurgery, Gumdan Top Hospital, Incheon, Republic of Korea; Department of Neurosurgery, Kangwon National University School of Medicine, Chuncheon, Republic of Korea
| | - Seung Kon Huh
- Department of Neurosurgery, Severance Hospital, Stroke Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jinna Kim
- Division of Head & Neck Neuroradiology, Department of Radiology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Keun Young Park
- Department of Neurosurgery, Severance Hospital, Stroke Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Joonho Chung
- Department of Neurosurgery, Severance Hospital, Stroke Center, Yonsei University College of Medicine, Seoul, Republic of Korea; Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Park JH, Kim H, Kim SR, Park IS, Byeon MS, Kim YW. Headache Outcomes After Coil Embolization in Patients with Unruptured Intracranial Aneurysms: Do They Get Better or Worse? A Prospective Analysis. World Neurosurg 2018; 114:e191-8. [PMID: 29510275 DOI: 10.1016/j.wneu.2018.02.138] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 02/21/2018] [Accepted: 02/23/2018] [Indexed: 01/03/2023]
Abstract
BACKGROUND To investigate the association between headache outcomes and coil embolization and to identify potential factors associated with different headache outcomes in patients with unruptured intracranial aneurysms (UIAs) after treatment with coil embolization. METHODS A prospective study of patients with planned coil embolization for UIAs was conducted. The changes in headache patterns, headache-related disability, and depression were assessed before coil embolization and at 3 days and 2 and 6 weeks after coil embolization. All variables were analyzed to identify factors associated with different headache outcomes. RESULTS Fifty-nine (72%) of 82 patients reported headaches before coil embolization. Of these, improvements in the severity of headaches were reported by 42 patients (71%). In addition to a significant reduction in headache severity, significant reductions in headache-related disability and depression scores also were observed. Demographic factors, aneurysmal characteristics, or procedural factors were not found to be significantly associated with improvement in the severity of headaches after coil embolization. In addition, the number of microemboli on diffusion-weighted imaging was not significantly associated with improvement of headaches after coil embolization. Twenty-three patients reported no headaches before coil embolization, and 3 (13%) patients reported new-onset headaches after coil embolization. All new-onset headaches were mild and dull in nature without combined symptoms in the temporal area. CONCLUSIONS Our study suggested that regardless of headache characteristics, the aneurysm size (even those <5 mm in diameter), technique used (stent-assisted or not stent-assisted), and coil embolization of UIAs resulted in headache improvement in most patients with pretreatment headaches.
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Li M, Wu J, Chen X, Jiang P, Yang F, Ma Y, Li Z, Cao Y, Wang S. Symptomatic and silent cerebral infarction following surgical clipping of unruptured intracranial aneurysms: incidence, risk factors, and clinical outcome. Neurosurg Rev 2018; 41:675-82. [PMID: 28983720 DOI: 10.1007/s10143-017-0913-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 09/21/2017] [Accepted: 09/25/2017] [Indexed: 11/27/2022]
Abstract
Cerebral infarction (CI) associated with clipping of unruptured intracranial aneurysms (UIAs) has not been completely studied. The role of individual and operative characteristics is not known, and the risk of silent CI has not been well described. To determine the incidence, risk factors, and clinical outcome of postoperative CI, we retrospectively analyzed 388 consecutive patients undergoing clipping of UIAs between January 2012 and December 2015. We reviewed the pre- and postoperative computed tomography (CT) images of each patient. Postoperative CI was defined as a new parenchymal hypodensity in the vascular territory of treated artery. Patient-specific, aneurysm-specific, and operative variables were analyzed as potential risk factors. Functional outcome at discharge was assessed with the modified Rankin Scale (mRS). Postoperative CI was found in 49 (12.6%) patients, 29 of whom manifested neurological deficits. The incidences of symptomatic stroke and silent CI were 7.5 and 5.2%, respectively. Multivariate analysis showed that larger aneurysm size and history of hypertension were significantly associated with CI. Disability (mRS > 2) rate was 42.9% among patients with CI, which was substantially higher than that among patients without (0.9%). In conclusion, the incidence of CI following clipping of UIAs was not low. Larger aneurysm size and history of hypertension were independent risk factors. Postoperative symptomatic stroke correlated with an extremely high risk of disability. Silent CI was seemingly nondisabling, but the possible cognitive consequence is pending.
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Zheng YR, Wu C, Zhang H, Xue Z, Wang HW, Sun ZH. [Concomitant unruptured intracranial aneurysms and ischemic cerebrovascular diseases: a surgical experience of 31 cases]. Zhonghua Yi Xue Za Zhi 2017; 97:2779-82. [PMID: 28954339 DOI: 10.3760/cma.j.issn.0376-2491.2017.35.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To summarize the clinic experience of preventing cerebral ischemic events during perioperative period in patients which concomitant unruptured intracranial aneurysms and ischemic cerebrovascular diseases. Methods: The clinical materials of 31 consecutive patients with concomitant unruptured intracranial aneurysms and ischemic cerebrovascular diseases from April 2010 to April 2014 were retrospectively reviewed.A total of 35 aneurysms were detected, and all of them were unruptured aneurysms.Among them, 17 cases were located on the ipsilateral side of artery stenosis or occlusion, and 18 cases were detected in the contralateral side. Minimal invasive surgical approaches such as small pterional approach and lateral sub-frontal approach were adopted.The better management of perioperative blood pressure was performed. Intraoperative electroencephalogram and somatosensory evoked potential monitoring, indocyanine green video angiography and/or microvascular Doppler ultrasonography were regularly used to guarantee the safety of the surgery. The follow-up by digital subtraction angiography or computed tomography angiography were made. Results: All of 35 aneurysms were clipped. Major infarction occurred in one patient with posterior communicating artery aneurysm concomitant with common cervical carotid artery stenosis.Large bone flap was resected and dural-matter were got enlarged to tolerate the edema period.Paralysis and aphasia accompanied at discharge.Minor infarction in posterior limb of internal capsule occurred in one patient.Twenty-nine patients were favorable with Glasgow Outcome Scale (GOS) score 5 at discharge, one patient with minor neurological defect (GOS 4), and one patient with severe neurological defect (GOS 3). The follow-up period was 6 to 40 months.Four patients were lost.The modified Rankin scale (MRS) of last follow-up were 0-1 in 25 patients, 2 in one patient and 3 in one patient.Third months after operation, 3 cases were performed carotid artery stenosis, 1 patients were performed carotid endarterectomy. Conclusion: Reinforcing the management of perioperative blood pressure, adjusting the perioperative blood coagulation function, and combine application of intraoperative monitoring technology can effectively prevent the occurrence of cerebral ischemia.
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Ji W, Xu L, Wang P, Sun L, Feng X, Lv X, Liu A, Wu Z. Risk Factors to Predict Neurologic Complications After Endovascular Treatment of Unruptured Paraclinoid Aneurysms. World Neurosurg 2017; 104:89-94. [PMID: 28366751 DOI: 10.1016/j.wneu.2017.03.098] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 03/20/2017] [Accepted: 03/21/2017] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Unruptured paraclinoid aneurysms are often asymptomatic, and endovascular coiling is the main treatment. However, endovascular treatment of these lesions still leads to neurologic complications. We aimed to identify predictors of neurologic complications in these lesions. METHODS We retrospectively analyzed patients with unruptured paraclinoid aneurysms who were treated with endovascular coiling between January 2014 and December 2015. A neurologic complication was defined as any transient or permanent increase in the modified Rankin Scale score after aneurysm embolization. Univariate and mulitivariate logistic regression analyses were performed to assess the risk factors of neurologic complications. RESULTS Of the 443 unruptured paraclinoid aneurysms that were included in this study, the incidence of neurologic complications was 5.2%. Neurologic complications were highly correlated with hypertension (odds ratio [OR], 3.147; 95% confidence interval [CI], 1.217-8.138; P = 0.018), cerebral ischemic comorbidities (OR, 3.396; 95% CI, 1.378-8.374; P = 0.008), and aneurysm size (OR, 7.714; 95% CI, 1.784-31.635; P < 0.001), and irregular shape (OR, 3.157; 95% CI, 1.239-8.043; P = 0.016) in the univariate analysis. Cerebral ischemic comorbidities (OR, 2.837, 95% CI, 1.070-7.523; P = 0.036) and aneurysm size as dichotomous variables (OR, 7.557; 95% CI, 2.975-19.198; P < 0.001) were strongly correlated with neurologic complications in the final adjusted multivariate logistic analysis. CONCLUSIONS Unruptured paraclinoid aneurysms after endovascular treatments had 5.2% of neurologic complications. Cerebral ischemic comorbidities and aneurysm size were predictors of neurologic complications.
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Affiliation(s)
- Wenjun Ji
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Lianfang Xu
- Department of Nursing, The Second Hospital of Yulin, Shaanxi Province, China
| | - Pengfei Wang
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Liqian Sun
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xin Feng
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xianli Lv
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Aihua Liu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
| | - Zhongxue Wu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
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Song J, Yang NR, Lee CY. Local Anesthesia for Endovascular Treatment of Unruptured Intracranial Aneurysms: Feasibility, Safety, and Periprocedural Complications. World Neurosurg 2017; 104:694-701. [PMID: 28546120 DOI: 10.1016/j.wneu.2017.05.077] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 05/11/2017] [Accepted: 05/12/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The aim of the study is to report the feasibility, safety, and outcomes associated with endovascular treatment (EVT) of unruptured intracranial aneurysms (UIAs) under local anesthesia. METHODS Between March 2011 and December 2016, 184 consecutive patients with 198 UIAs were treated with coil embolization under local anesthesia at the author's center. The data about medical comorbidities according to American Society of Anesthesiologists grade, procedural details, and clinical and radiographic outcomes were reviewed. RESULTS A total of 388 procedures were performed under local anesthesia, and 198 procedures with UIA were included. The mean age was 63.8 ± 12.5 years, and 118 (59.6%) cases had a risk status of American Society of Anesthesiologists class III or IV. Of those 198 procedures, 196 procedures (99.0%) were completed successfully. The overall procedure-related event rate was 5% (10/198). The rates of morbidity and mortality were 0.5% (1 of 198) and 0% at 1 month, respectively. Among the 3 recurred cases (1.5%), two (1%) underwent EVT again. The mean intensive care unit stay was 0.99 ± 0.1 days, and the mean postoperative hospital stay was 3.6 ± 7.2 days. CONCLUSIONS Local anesthesia in the EVT of UIA is feasible and safe. It could be considered as an alternative for the patients with high risk of general anesthesia.
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Affiliation(s)
- Jihye Song
- Department of Neurosurgery, College of Medicine, Konyang University Hospital, Konyang University Myunggok Medical Research Institute, Daejeon, Republic of Korea
| | - Na Rae Yang
- Department of Neurosurgery, Ewha Womans University School of Medicine, Mokdong Hospital, Seoul, Republic of Korea.
| | - Cheol-Young Lee
- Department of Neurosurgery, College of Medicine, Konyang University Hospital, Konyang University Myunggok Medical Research Institute, Daejeon, Republic of Korea
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Song J, Shin YS. Antiplatelet drug resistance did not increase the thromboembolic events after stent-assisted coiling of unruptured intracranial aneurysm: a single center experience of 99 cases. Neurol Sci 2017; 38:879-85. [PMID: 28233076 DOI: 10.1007/s10072-017-2859-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 02/17/2017] [Indexed: 10/20/2022]
Abstract
We aimed to evaluate the correlation between aspirin or clopidogrel resistance and the risk of thromboembolic events (TEs). Between June 2011 and April 2015, we reviewed clinical and angiographic characteristics, and TEs in the patients undergoing stent-assisted coil embolization (SAC) of unruptured intracranial aneurysms (UIA) at our institution. We did not modify antiplatelet medication in patients with resistance. The relationships between antiplatelet resistance and the occurrence of acute symptomatic TEs, any diffusion-positive lesions, multiple diffusion-positive lesions, or delayed TEs were investigated. Ninety-nine endovascular treatments with stent-assisted technique were performed on 99 patients. The prevalence of aspirin resistance was 12% and clopidogrel resistance was 62.6%. Acute symptomatic TEs were demonstrated in 4 patients (4%). Diffusion-positive lesions were found in 82 patients [82.1%; 36 patients were group I (≤5) and 46 patients were group II (>5)]. Delayed TEs were demonstrated in 10 patients (10.1%). Neither aspirin resistance nor clopidogrel resistance was relevant to the development of acute symptomatic TEs, any diffusion-positive lesions, multiple diffusion-positive lesions, and delayed TEs (P logistic = not available, 0.448, 0.362, and 0.829 for aspirin resistance and P logistic = 0.607, 0.367, 0.278, and 0.245 for clopidogrel resistance). Without modification of antiplatelet medication, we demonstrated 4% of acute symptomatic TEs and 10% of delayed TEs. Aspirin or clopidogrel resistance did not show significant relationships with acute and delayed TEs in the SAC of UIA.
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Lin F, Wan H, Kang D, Lin Y. Small Unruptured Intracranial Aneurysm (≤5 mm) Associated with Epilepsy: Report of 2 Cases and Literature Review. World Neurosurg 2016; 98:878.e1-878.e6. [PMID: 27890748 DOI: 10.1016/j.wneu.2016.11.070] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 11/13/2016] [Accepted: 11/15/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Owing to the continuing improvements in imaging technology, an increasing number of epileptogenic small (≤5 mm) unruptured intracranial aneurysms (sUIAs) are being diagnosed. However, these sUIAs have not been systematically described and reviewed until now. CASE DESCRIPTION AND LITERATURE REVIEW We report 2 patients with sUIAs who initially presented with complex partial seizures. Scalp electroencephalography identified the seizure activity as arising from the mesial temporal/frontal areas, but conventional magnetic resonance imaging (MRI) was normal in both patients. The diagnosis of sUIA was achieved by cerebral angiography. One of the patients had idiopathic seizures and sustained a subarachnoid hemorrhage before the final diagnosis of sUIA. Both of the patients were treated by surgical clipping without resection of the adjacent discolored brain tissue, and the seizures were controlled after surgery. Furthermore, we thoroughly reviewed the relevant literature. We analyzed a total of 5 documented cases, including out 2 cases, and described the clinical characteristics, diagnosis, underlying mechanism, treatment, and prognosis of epileptogenic sUIA. CONCLUSIONS The seizures caused by sUIAs are most likely related to subclinical hemorrhages. Angiography may be helpful in identifying seizures associated with sUIA in patients with normal conventional MRI findings. For epileptogenic sUIA with normal preoperative MRI, clipping without damaging the surrounding brain tissue may be sufficient to resolve this complex issue.
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Affiliation(s)
- Fuxin Lin
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fujian Medical University, Fuzhou, Fujian, China
| | - Hui Wan
- Department of Neurosurgery, The Fourth Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Dezhi Kang
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fujian Medical University, Fuzhou, Fujian, China
| | - Yuanxiang Lin
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fujian Medical University, Fuzhou, Fujian, China.
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Liu P, Qi H, Liu A, Lv X, Jiang Y, Zhao X, Li R, Lu B, Lv M, Chen H, Li Y. Relationship between aneurysm wall enhancement and conventional risk factors in patients with unruptured intracranial aneurysms: A black-blood MRI study. Interv Neuroradiol 2016; 22:501-5. [PMID: 27341856 PMCID: PMC5072207 DOI: 10.1177/1591019916653252] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 05/06/2016] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND AND PURPOSE Aneurysmal wall enhancement (AWE) has emerged as a new possible biomarker for depicting inflammation of the intracranial aneurysm (IA). However, the relationships of AWE with other risk factors are still unclear for unruptured IA. The purpose of this study was to investigate the association between AWE and other risk metrics. METHODS Forty-eight patients with unruptured saccular IAs diagnosed by digital subtraction angiography were recruited to undergo magnetic resonance (MR) black-blood imaging. AWE was evaluated using the pre- and post-contrast black-blood MR images. Univariate and multivariate logistic regression analysis was performed to investigate the association of AWE with other risk factors, including size, maximal neck width, parent vessel diameter, location, multiplicity, daughter sacs and other clinical factors. The prevalence of AWE in each ISUIA grade was reported and compared by Wilcoxon rank sum test. RESULTS In total, 61 aneurysms were detected in 48 patients. Aneurysm size was found to be an independent risk factor associated with AWE (OR 2.46 per mm increase, 95% CI 1.34-4.51; p = 0.004). Patient age was independently and inversely associated with AWE (OR 0.898 per year increase, 95% CI 0.812-0.994; p = 0.037). Higher prevalence of AWE was observed in larger aneurysms (12%, 71.4%, 100%, and 100% of ISUIA grade 1-4 IAs have AWE, respectively). Notably, 12% of small IAs (size <7 mm) exhibited AWE. The IAs with AWE had significant higher ISUIA grade than the IAs without (p < 0.001, Wilcoxon rank sum test). CONCLUSIONS The wall enhancement in contrast-enhanced black-blood MR images was independently associated with aneurysm size in unruptured IAs. However, some small unruptured aneurysms did exhibit wall enhancement, suggesting that AWE may provide additional aneurysm instability information to improve current size-based rupture risk evaluation metrics.
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Affiliation(s)
- Peng Liu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Haikun Qi
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, China
| | - Aihua Liu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xianli Lv
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yuhua Jiang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xihai Zhao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, China
| | - Rui Li
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, China
| | - Bing Lu
- Department of Internal Medicine, Nanyang City Center Hospital, China
| | - Ming Lv
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Huijun Chen
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, China
| | - Youxiang Li
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Hosainey SA, Meling TR. A 54-year-old man with 12 intracranial aneurysms and familial subarachnoid hemorrhage: case report. Neurosurg Rev 2016; 39:711-6. [PMID: 27452953 DOI: 10.1007/s10143-016-0769-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 07/01/2016] [Accepted: 07/13/2016] [Indexed: 10/21/2022]
Abstract
Unruptured intracranial aneurysms occur in 1-3 % of the general population, and the risk of rupture is generally considered to be low. However, patients with multiple aneurysms and familial predisposition carry a particular risk of subarachnoid hemorrhage (SAH). A 54-year-old hypertensive man underwent screening with a head CT angiography (CTA) because of his comorbidities. CTA revealed multiple bilateral aneurysms around the circle of Willis. At first surgery, seven aneurysms were clipped (BA, ACOM, ICA ×2, and MCA ×3), two of which were detected intraoperatively only. During the second surgery, another three aneurysms were surgically clipped (PCOM and MCA ×2), one of which was detected intraoperatively. Follow-up angiography revealed another two aneurysms. A PCOM aneurysm was treated by coil embolization and a VA aneurysm clipped surgically during a third admission. The patient made an uneventful recovery. However, 4 months after his second surgery, his daughter underwent surgical clipping of a right-sided ICA aneurysm. This case report highlights both the importance of screening of high risk patients with family history of SAH, as well as its limitations, as our patient developed two de novo aneurysms during 6-month follow-up and CTA preoperatively missed three small aneurysms.
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McCutcheon BA, Kerezoudis P, Porter AL, Rinaldo L, Murphy M, Maloney P, Shepherd D, Hirshman BR, Carter BS, Lanzino G, Bydon M, Meyer F. Coma and Stroke Following Surgical Treatment of Unruptured Intracranial Aneurysm: An American College of Surgeons National Surgical Quality Improvement Program Study. World Neurosurg 2016; 91:272-8. [PMID: 27108027 DOI: 10.1016/j.wneu.2016.04.039] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 04/12/2016] [Accepted: 04/12/2016] [Indexed: 01/08/2023]
Abstract
OBJECTIVE A large national surgical registry was used to establish national benchmarks and associated predictors of major neurologic complications (i.e., coma and stroke) after surgical clipping of unruptured intracranial aneurysms. METHODS The American College of Surgeons National Surgical Quality Improvement Program data set between 2007 and 2013 was used for this retrospective cohort analysis. Demographic, comorbidity, and operative characteristics associated with the development of a major neurologic complication (i.e., coma or stroke) were elucidated using a backward selection stepwise logistic regression analysis. This model was subsequently used to fit a predictive score for major neurologic complications. RESULTS Inclusion criteria were met by 662 patients. Of these patients, 57 (8.61%) developed a major neurologic complication (i.e., coma or stroke) within the 30-day postoperative period. On multivariable analysis, operative time (log odds 0.004 per minute; 95% confidence interval [CI], 0.002-0.007), age (log odds 0.05 per year; 95% CI, 0.02-0.08), history of chronic obstructive pulmonary disease (log odds 1.26; 95% CI, 0.43-2.08), and diabetes (log odds 1.15; 95% CI, 0.38-1.91) were associated with an increased odds of major neurologic complications. When patients were categorized according to quartile of a predictive score generated from the multivariable analysis, rates of major neurologic complications were 1.8%, 4.3%, 6.7%, and 21.2%. CONCLUSIONS Using a large, national multi-institutional cohort, this study established representative national benchmarks and a predictive scoring system for major neurologic complications following operative management of unruptured intracranial aneurysms. The model may assist with risk stratification and tailoring of decision making in surgical candidates.
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Affiliation(s)
- Brandon A McCutcheon
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA; Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - Panagiotis Kerezoudis
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA; Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - Amanda L Porter
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA; Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - Lorenzo Rinaldo
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA; Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - Meghan Murphy
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA; Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - Patrick Maloney
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA; Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel Shepherd
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA; Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - Brian R Hirshman
- Department of Neurosurgery, University of California, San Diego, La Jolla, California, USA
| | - Bob S Carter
- Department of Neurosurgery, University of California, San Diego, La Jolla, California, USA
| | - Giuseppe Lanzino
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Mohamad Bydon
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA; Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA.
| | - Fredric Meyer
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
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Son YJ, Kwon OK, Hwang G, Park NM, Oh CW, Bang JS. Major recanalization occurs more often in young patients after unruptured aneurysm coil embolization. Acta Neurochir (Wien) 2016; 158:551-6. [PMID: 26743913 DOI: 10.1007/s00701-015-2668-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 12/14/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND The recanalization rate after coil embolization of unruptured aneurysms was compared between young and old age groups. METHODS From May 2003 to December 2010, 636 patients with 715 saccular unruptured intracranial aneurysms (UIA) underwent endovascular coiling and were followed for at least 6 months. For comparative analysis, patients were categorized into two groups according to age 40: 42 patients with 46 aneurysms who were 40 years or younger (young age group) and 594 patients with 669 aneurysms who were older than 40 years (old age group). Angiographic and clinical outcomes including recanalization rates were compared. RESULTS Angiographically, class 1 or 2 occlusion according to the Raymond-Roy Occlusion Classification system was achieved in 89.2 % of the patients (91.3 % in the young age group and 89.1 % in the old age group, p = 0.74). Procedure-related complication rate was 2.2 % and 3.4 % in the young and the old age group (p = 0.16), respectively. The mean follow-up duration was 30.51 ± 18.59 months. Major recanalization occurred in seven aneurysms (15.2 %) in the young age group and in 44 aneurysms (6.6 %) in the old age group (p = 0.03). Retreatment was performed in seven patients (15.2 %) in the young age group and in 35 patients (5.2 %) in the old age group (p = 0.01). CONCLUSIONS The present study showed that the technical feasibility and safety of endovascular coiling for UIA did not differ between the two age groups. However, the major recanalization rate was higher in the young age group.
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Affiliation(s)
- Young-Je Son
- Department of Neurosurgery, Seoul National University Boramae Medical Center, Seoul, South Korea
| | - O-Ki Kwon
- Department of Neurosurgery, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, 463-707, Seongnam, Gyeonggido, South Korea.
| | - Gyojun Hwang
- Department of Neurosurgery, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, 463-707, Seongnam, Gyeonggido, South Korea
| | - Nam Mi Park
- Department of Neurosurgery, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, 463-707, Seongnam, Gyeonggido, South Korea
| | - Chang Wan Oh
- Department of Neurosurgery, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, 463-707, Seongnam, Gyeonggido, South Korea
| | - Jae Seung Bang
- Department of Neurosurgery, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, 463-707, Seongnam, Gyeonggido, South Korea
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