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Objective To evaluate the monitoring effect of microvascular Doppler blood flow detector in intracranial aneurysm surgery. Methods One hundred and twenty patients with intracranial aneurysms from July 2015 to July 2017 who received craniotomy and used microvascular Doppler ultrasound 1 mm microprobe to detect the hemodynamics of the parent artery and related perforating artery change were retrospectively analyzed . According to the blood flow signal, aneurysm clip was not adjusted in 55 cases; when the tumor artery or perforator artery blood flow signal decreased or disappeared after treatment, aneurysm clip clamping position was changed in 65 cases, so that the blood flow of tumor artery or perforator artery returned to normal. The blood flow velocity and pulsation index (PI) of the artery was measured before and after adjustment of the aneurysm clip. The patients underwent CT angiography (CTA) or DSA examination 1 week after surgery. Angiography was performed to evaluate the postoperative results in one month, three months, and six months' follow-up. The data obtained were statistically analyzed. Results Vascular obstruction or neck residual rate of 120 cases was lower than 5％vascular obstruction or residual neck residual rate in large cases. Conclusions The microvascular Doppler blood flow detector is safe, reliable and easy to operate. This technique is useful for finding the clips in the craniotomy of the intracranial aneurysm or the incomplete clamping of the tumor-bearing artery, so as to adjust the position of the aneurysm clip in time and improve the curative effect.
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Objective To investigate the value of cerebrospinal fluid drainage after aneurysm clipping in patients with intracranial aneurysm complicated with subarachnoid hemorrhage .Methods 84 intracranial aneurysms patients with subarachnoid hemorrhage were selected ,and they were randomly divided into study group (n =42) and control group (n =42).The control group used simple suture after aneurysm clipping ,the study group was given lumbar cistern drainage by implementation of the dural suture tube after aneurysm clipping .Before and after hydro-cephalus and cerebral vasospasm ,treatment changes of serum insulin-like growth factor 1 (IGF-1) and soluble vascular cell adhesion molecule-1 (sVCAM-1) levels were compared between the two groups .Results The incidence rate of hydrocephalus of the study gruop was 4.8%,which was significantly lower than the 14.3% of the control group (χ2 =9.743,P <0.05).The incidence rate of cerebral vasospasm of the study group was 7.1%,which was significantly lower than 19.0% of the control group (χ2 =11.802,P <0.05).The incidence rates of intracranial infection,cerebrospinal fluid leakage and other complications between the two groups had no statistically significant differences (χ2 =2.074,2.125,all P >0.05).The serum levels of IGF-1 and sVCAM-1 between the two groups had no statistically significant differences before operation (t =0.417,0.603,all P >0.05).At the 8th day after oper-ation,the serum levels of sVCAM-1 and IGF-1 of the study group were significantly lower than those of the control group (t =7.335,6.856,all P <0.05).Conclusion After aneurysm clipping,the lumbar cistern drainage tube drainage is beneficial to reduce hydrocephalus and cerebral vasospasm incidence ,inhibit the expression of serum IGF-1,sVCAM-1,with less adverse reactions,it is worthy of application.
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Objective To investigate the application value of digital subtraction angiography ( DSA) combined with volume rendering technique ( VRT) in intracranial aneurysm clipping. Methods From January to July 2016,19 consecutive patients with intracranial aneurysm admitted to the Department of Neurosurgery,Northern Jiangsu People′s Hospital were enrolled retrospectively. All patients underwent craniotomy clipping immediately after clipping,DSA was performed and VRT was use to process the related images. For those with poor clipping effect, angiography was performed again after the adjustment of the aneurysm clips,until angiography confirmed that the clipping was satisfactory. Good treatment was defined as no recurrence of aneurysms and the Glasgow outcome scale of 4-5 . Results Nineteen patients had 26 aneurysms. They were all clipped completely observed under the microscope. Confirmed by angiography, 18 aneurysms were clipped completely for the first time,1 apical aneurysm of basilar artery and its contralateral posterior cerebral artery were clipped with a residual aneurysm neck,the contralateral A2 artery was clipped in 1 anterior communicating artery aneurysm, an anterior choroidal artery was clipped completetly in 1 posterior communicating aneurysm,3 aneurysms had residual necks, the upper stem artery was stenosis after 1 middle cerebral artery bifurcation aneurysm was clipped,the anterior communicating artery and the origin of contralateral A2 was stenotic after one anterior communicating artery aneurysm being clipped.Except for 2 aneurysms ruptured without adjustment during the operation,the clipping of other aneurysms was ideal after adjustment. In 2 patients with severe cerebral vasospasm,1 was relieved after a slow transcatheter injection of papaverine,1 was relieved after putting papaverine-wetted cotton piece on the site of vasospasm. The intraoperative DSA and VRT image processing time was 30-100 min. No complications associated with angiography occurred. The patients were followed up for 3-16 months,computed tomography angiography was showed no aneurysm recurrence and vascular stenosis,there were 1 case with hemiplegia and 18 cases with good recovery. Conclusions Intraoperative DSA combined with VRT can help to observe the clipping effect in real time and adjust the aneurysm clips. It can reduce the residual aneurysm neck,parent artery,and peritumoral vascular occlusion,thus improving the operation effect and reducing the disability and mortality.
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Objective To investigate the application value of digital subtraction angiography ( DSA) combined with volume rendering technique ( VRT) in intracranial aneurysm clipping. Methods From January to July 2016,19 consecutive patients with intracranial aneurysm admitted to the Department of Neurosurgery,Northern Jiangsu People′s Hospital were enrolled retrospectively. All patients underwent craniotomy clipping immediately after clipping,DSA was performed and VRT was use to process the related images. For those with poor clipping effect, angiography was performed again after the adjustment of the aneurysm clips,until angiography confirmed that the clipping was satisfactory. Good treatment was defined as no recurrence of aneurysms and the Glasgow outcome scale of 4-5 . Results Nineteen patients had 26 aneurysms. They were all clipped completely observed under the microscope. Confirmed by angiography, 18 aneurysms were clipped completely for the first time,1 apical aneurysm of basilar artery and its contralateral posterior cerebral artery were clipped with a residual aneurysm neck,the contralateral A2 artery was clipped in 1 anterior communicating artery aneurysm, an anterior choroidal artery was clipped completetly in 1 posterior communicating aneurysm,3 aneurysms had residual necks, the upper stem artery was stenosis after 1 middle cerebral artery bifurcation aneurysm was clipped,the anterior communicating artery and the origin of contralateral A2 was stenotic after one anterior communicating artery aneurysm being clipped.Except for 2 aneurysms ruptured without adjustment during the operation,the clipping of other aneurysms was ideal after adjustment. In 2 patients with severe cerebral vasospasm,1 was relieved after a slow transcatheter injection of papaverine,1 was relieved after putting papaverine-wetted cotton piece on the site of vasospasm. The intraoperative DSA and VRT image processing time was 30-100 min. No complications associated with angiography occurred. The patients were followed up for 3-16 months,computed tomography angiography was showed no aneurysm recurrence and vascular stenosis,there were 1 case with hemiplegia and 18 cases with good recovery. Conclusions Intraoperative DSA combined with VRT can help to observe the clipping effect in real time and adjust the aneurysm clips. It can reduce the residual aneurysm neck,parent artery,and peritumoral vascular occlusion,thus improving the operation effect and reducing the disability and mortality.
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Objective To investigate the CT signs of small intracranial aneurysm and the application value of multi-slice spiral CT angiography (MSCTA) before and after clipping surgery and in follow-up.Methods MSCTA imaging data of 81 patients with highly suspected small intracranial aneurysms from March 2013 to March 2015 were analyzed retrospectively.The confirmed patients underwent clipping surgery of small intracranial aneurysms.The imaging findings before and after clipping surgery were analyzed and compared with those by DSA and what observed during surgery.Results The relative accuracy,sensitivity and specificity of MSCTA over DSA and surgical diagnosis were 93.83％,93.75％ and 94.12％respectively,and MSCTA gained high relative consistency over DSA and surgical diagnosis (Kappa=0.825).The accuracy of MSCTA for diagnosing small intracranial aneurysm was not significantly different from those by DSA and surgical diagnosis.MSCT plain scan mainly showed subarachnoid or intracranial hemorrhage,and found 71 rhomboic or saccular aneurysms in 60 patients before operation.Totally 64 patients went through clipping surgery,60 ones had satisfactory results in the reexamination by MSCTA 2 weeks after surgery,and there were no abnormality found in 36 patients in 6 to 12-month follow-up.Conclusion MSCTA can provide abundant information for clipping surgery of small intracranial aneurysms,and can be used as the preferred imaging method for postoperative evaluation and follow-up.
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Objective To investigate closure of different Fisher grade patients with subarachnoid product volume and the degree of cerebral vasospasm aneurysm clipping.Methods Patients with subarachnoid hemorrhage (SAH) were selected from January 2014 to January 2015,including 20 patients with grade Ⅰ,25 patients with grade Ⅱ,and 15 patients with grade Ⅲ.They were divided into 20 patients with aneurysmal SAH(A group),18 patients without aneurysmal SAH (B group) and C group(22 cases).The operation effect was compared.Results C group as the standard,CT preoperative diagnosis had no statistically significant difference among A,B,C group (x2 =0.12,P ＞0.05).After treatment,the cerebral spasticity scores of A,B group were significantly decreased,and the level-Ⅰ and Ⅱ patients decreased more significantly compared with stage Ⅲ patients,the difference between the two groups was statistically significant(x2 =7.05,P ＜ 0.05).In group C,the blood flow velocity at the 7th and 13rd day significantly increased (x2 =7.05,P ＜ 0.05),and velocity of blood flow in group A and B Ⅰ and Ⅱ patients was significantly higher than that of grade Ⅲ patients (t =8.75,P ＜ 0.05).Conclusion For the patients with Fisher grade Ⅰ and Ⅱ,the increase in the volume of subarachnoid hemorrhage,cerebral vasospasm,and the effect of the patients with Ⅲ were more obvious.
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OBJECTIVE: Patients treated with surgical clipping for anterior communicating artery (A-com) aneurysm often complain of anosmia, which can markedly impede their quality of life. We introduce a simple and useful technique to reduce postoperative olfactory dysfunction in A-com aneurysm surgery. METHODS: We retrospectively reviewed the medical records of patients who underwent surgical clipping for unruptured aneurysm from 2011-2013 by the same senior attending physician. Since March 2012, olfactory protection using gelfoam and fibrin glue was applied in A-com aneurysm surgery. Therefore we categorized patients in two groups from this time-protected group and unprotected group. RESULTS: Of the 63 enrolled patients, 16 patients showed postoperative olfactory dysfunction-including 8 anosmia patients (protected group : unprotected group=1 : 7) and 8 hyposmia patients (protected group : unprotected group=2 : 6). Thirty five patients who received olfactory protection during surgery showed a lower rate of anosmia (p=0.037, OR 10.516, 95% CI 1.159-95.449) and olfactory dysfunction (p=0.003, OR 8.693, 95% CI 2.138-35.356). Superior direction of the aneurysm was also associated with a risk of olfactory dysfunction (p=0.015, OR 5.535, 95% CI 1.390-22.039). CONCLUSION: Superior direction of aneurysm appears associated with postoperative olfactory dysfunction. Olfactory protection using gelfoam and fibrin glue could be a simple, safe, and useful method to preserve olfactory function during A-com aneurysm surgery.
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Humans , Aneurysm , Arteries , Fibrin Tissue Adhesive , Fibrin , Gelatin Sponge, Absorbable , Intracranial Aneurysm , Medical Records , Olfaction Disorders , Quality of Life , Retrospective Studies , Surgical InstrumentsABSTRACT
Objective To explore the change of cerebral microcirculation before and after clipping of intracranial aneurysm using CT perfusion (CTP)imaging.Methods CTP images of 70 patients diagnosed intracranial aneurysm by CTA were retrospectively an-alysed.They were divided into four groups according to have or not intracranial arterial spasm:A group:Preoperative CVS,postop-erative CVS (4 cases),B group:Preoperative CVS,postoperative nCVS (13 cases),C group:Preoperative nCVS,postoperative CVS (20 cases),D group:Preoperative nCVS,postoperative nCVS (33 cases).CBV/CBF/MTT were measured in four groups be-fore and after surgery,and analyzed statistically.Results (1)The postoperative CBV/CBF/MTT was compared with the preopera-tive data.There were statistically significant in CBVA/B/C/D/CBFA/B/D/MTTA/B during the surgery (P 0.05).(2)There were statistically significant in the△CBVBC/BD/△CBFAB/BC/BD/△MTTAB/BD (P 0.05).Conclusion CTP can early and accurately predict the change of cerebral microcircu-lation after surgery.
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The authors present their series about middle cerebral artery (MCA) aneurysms. They discuss anatomical aspects as well as the results and complications of surgical treatment. Besides, they defend the idea that for having good results, it is necessary an extent Sylvian´s cistern dissection, permitting an adequate exposure of the aneurysms and their relationships not only with the MCA but with its branches, emphasizing too the not usefulness of temporary clipping in the approach of this pathology.
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Humans , Male , Female , Adult , Middle Aged , Anterior Cerebral Artery , Intracranial Aneurysm/surgery , Intracranial Aneurysm/complications , Middle Cerebral Artery/anatomy & histology , Middle Cerebral Artery/surgery , Cerebral Angiography , Middle Cerebral ArteryABSTRACT
Objective To discuss the selection of diagnosis for intracranial aneutysms,and to analyze thera-peutic efficacy of microsurgical treatment and endovascular embolizafion in the treatment of intracranial aneurysms.Methods 190 pailents suffeming from intracranial aneurysms experienced brain CT examination.37 cases detected by MRI.31 cases detected by MRA,134 were confirmed by computered tomographic angiography(CTA)or 3D-CTA,and 142 cases were confirmed by digital subtract angiography(DSA).96 patients underwent microsurgical treatment,4 of whom failed in endovascular embolization.92 cases underwent endovascufar therapy,2 of whom were embolized by ONYX,and the other were embolized by guglielmi detachable coil(GDC).Results 9 patients died,2 of whorn died of re-hemorrhage,3 died of severe vasospasm,4 died of pneumonia and other complications,and the others were cured.Conclusion CT is the first choice for the subarachniod hemorrhage;MBA could be a choice for the detection of intracranial aneurysm without hemorrhage,but is not suit for the aneurysm clipping.The size-form,relationship with patent arteries,and even the raptured point of aneurysms can be clearly demonstrated by CTA-and CTA can be used to the operation for intracranial aneurysms directly.DSA-especially 3D-DSA Call display the blood supply of the complicated aneurysms clearly,and can guide the treatment for intracnmial aneurysms directly.Endo-vascular therapy and aneurysm clipping seem like complimentary than competitive,patients with acute cerebral edema should try to undergo endovascular therapy,while the patients with severe vasespasm should be treated with microsur-gical operation immediately and resolutely.The ruptured aneurysms in multiple intracraniul aneurysm should be iden-tified correctly and treated in the early stage.
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OBJECTIVE: We evaluated the accuracy of multislice computerized tomographic angiography (MCTA) in the postoperative evaluation of clipped aneurysms by comparising it with three dimensional digital subtraction angiography (3D-DSA). METHODS: Between May 2004 and September 2006, we included patients with ruptured cerebral aneurysm of the anterior circulation that was surgically clipped and evaluated by both postoperative MCTA and postoperative 3D-DSA. We measured the diagnostic performance and calculated the sensitivity and specificity of postoperative MCTA compared to 3D-DSA in the detection of aneurysm remnants. RESULTS: A total of 11 neck remnants among the 92 clipped aneurysms (11.9%) were confirmed by 3D-DSA. According to Sindou's classification of aneurysm remnants, 8.7% of clipped aneurysms (8/92) had only neck remnant on 3D-DSA and 3.2% (3/92 aneurysms) had residuum of the neck and sac on 3D-DSA. There were 12 (13.04%) equivocal cases that were difficult to interpret based on the postoperative MCTA. The reasons for the equivocal cases included multiple clips (6 cases, 50.0%), beam-hardening effect (4 cases, 33.3%), motion artifact (1 case, 8.3%), fenestrated clip (1 case, 8.3%) and other combined causes. The sensitivity and specificity of the postoperative MCTA was 81.8% and 88.9%, respectively, by ROC curve (p=0.000). CONCLUSION: MCTA is an accurate noninvasive imaging method used for the assessment of clipped aneurysms in the anterior circulation. If the image quality of postoperative MCTA is good quality and the patient has been treated with a single titanium clip, except a fenestrated clip, the absence of an aneurysm remnant can be diagnosed by MCTA alone and the need for postoperative DSA can be reduced in a large percentage of cases.
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Humans , Aneurysm , Angiography , Angiography, Digital Subtraction , Artifacts , Classification , Intracranial Aneurysm , Neck , ROC Curve , Sensitivity and Specificity , TitaniumABSTRACT
OBJECT: Generally, it seems like that the incidence of vasospasm of vasospasm in endovascular coil embolization is higher than clipping in aneurysmal subarachnoid hemorrhage. But endovascular coil embolization in our study group was not associated with higher incidence of symptomatic vasospasm than direct clipping and we made an analysis of that cause. METHODS: The authors reviewed 220 patients with aneurysmal subarachnoid hemorrhage who had been treated with either neck clipping or coil embolization by a single surgeon between January 1997 and December 2002. Poor initial grade (Hunt & Hess grade IV & V) patients were excluded. Finally 171 patients were enrolled in this study. 126 patients(74%) underwent direct surgical clipping and 45 patients (26%) underwent endovascular treatments of their aneurysms. RESULTS: Overall symptomatic vasospasm occurred in 32 (19%) patients, 4 of 45 patients (9%) were coiling group and 28 of 126 (22%) were surgically treated group. There was no difference between two groups in age, initial Hunt & Hess grade, Glasgow coma scale, operation time, treatment initiation time, patient's medical status. CONCLUSIONS: Patients who underwent coil embolization were not more likely to suffer from symptomatic vasospasm than aneurysm neck clipping in better clinical grades (Hunt & Hess grade of I to III) patients in our institute.
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Humans , Aneurysm , Aneurysm, Ruptured , Embolization, Therapeutic , Glasgow Coma Scale , Incidence , Neck , Subarachnoid Hemorrhage , Surgical Instruments , Vasospasm, IntracranialABSTRACT
OBJECT: Generally, it seems like that the incidence of vasospasm of vasospasm in endovascular coil embolization is higher than clipping in aneurysmal subarachnoid hemorrhage. But endovascular coil embolization in our study group was not associated with higher incidence of symptomatic vasospasm than direct clipping and we made an analysis of that cause. METHODS: The authors reviewed 220 patients with aneurysmal subarachnoid hemorrhage who had been treated with either neck clipping or coil embolization by a single surgeon between January 1997 and December 2002. Poor initial grade (Hunt & Hess grade IV & V) patients were excluded. Finally 171 patients were enrolled in this study. 126 patients(74%) underwent direct surgical clipping and 45 patients (26%) underwent endovascular treatments of their aneurysms. RESULTS: Overall symptomatic vasospasm occurred in 32 (19%) patients, 4 of 45 patients (9%) were coiling group and 28 of 126 (22%) were surgically treated group. There was no difference between two groups in age, initial Hunt & Hess grade, Glasgow coma scale, operation time, treatment initiation time, patient's medical status. CONCLUSIONS: Patients who underwent coil embolization were not more likely to suffer from symptomatic vasospasm than aneurysm neck clipping in better clinical grades (Hunt & Hess grade of I to III) patients in our institute.