Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 13.693
Filter
1.
Acta Neurochir (Wien) ; 166(1): 253, 2024 Jun 07.
Article in English | MEDLINE | ID: mdl-38847921

ABSTRACT

BACKGROUND/PURPOSE: Several periprocedural adjuncts for elective surgical aneurysm treatment have been introduced over the last 20 years to increase safety and efficacy. Besides the introduction of IONM in the late-1990s, ICG-videoangiography (ICG-VAG) since the mid-2000s and intraoperative CT-angiography/-perfusion (iCT-A/-P) since the mid-2010s are available. We aimed to clarify whether the introduction of ICG-VAG and iCT-A/-P resulted in our department in a stepwise improvement in the rate of radiologically detected postoperative ischemia, complete aneurysm occlusion and postoperative new deficits. METHODS: Patients undergoing microsurgical clip occlusion for unruptured anterior circulation aneurysms between 2000 and 2019 were included, with ICG-VAG since 2009 and iCT-A/-P (for selected cases) since 2016. Baseline characteristics and treatment-related morbidity/outcome focusing on differences between the three distinct cohorts (cohort-I: pre-ICG-VAG-era, cohort-II: ICG-VAG-era, cohort-III: ICG-VAG&iCT-A/-P-era) were analyzed. RESULTS: 1391 patients were enrolled (n = 74 were excluded), 779 patients were interventionally treated, 538 patients were surgically clipped by a specialized vascular team (cohort-I n = 167, cohort-II n = 284, cohort-III n = 87). Aneurysm size was larger in cohort-I (8.9 vs. 7.5/6.8 mm; p < 0.01) without differences concerning age (mean:55years), gender distribution (m: f = 1:2.6) and aneurysm location (MCA:61%, ICA:18%, ACA/AcomA:21%). There was a stepwise improvement in the rate of radiologically detected postoperative ischemia (16.2vs.12.0vs.8.0%; p = 0.161), complete aneurysm occlusion (68.3vs.83.6vs.91.0%; p < 0.01) and postoperative new deficits (10.8vs.7.7vs.5.7%; p = 0.335) from cohort-I to -III. After a mean follow-up of 12months, a median modified Rankin scale of 0 was achieved in all cohorts. DISCUSSION: Associated with periprocedural technical achievements, surgical outcome in elective anterior circulation aneurysm surgery has improved in our service during the past 20 years.


Subject(s)
Brain Ischemia , Intracranial Aneurysm , Postoperative Complications , Humans , Intracranial Aneurysm/surgery , Intracranial Aneurysm/diagnostic imaging , Male , Female , Middle Aged , Postoperative Complications/etiology , Aged , Brain Ischemia/prevention & control , Brain Ischemia/etiology , Brain Ischemia/diagnostic imaging , Elective Surgical Procedures/methods , Neurosurgical Procedures/methods , Surgical Instruments , Adult , Treatment Outcome , Cerebral Angiography/methods , Retrospective Studies , Microsurgery/methods , Computed Tomography Angiography/methods
2.
Ideggyogy Sz ; 77(5-6): 177-185, 2024 May 30.
Article in English | MEDLINE | ID: mdl-38829250

ABSTRACT

Background and purpose:

Human brain aneurysms may often prove fatal if not re­cognized in time and treated accordingly. The understanding of development and rupture of aneurysms can significantly be improved by the application of numerical modelling, which in turn, requires the knowledge of mechanical properties of vessel wall. This study aims to identify assumed differences with respect to age, sex, spatial orientation, and rupture by utilizing detailed statistical analysis of uniaxial tensile measurements of human brain aneurysm samples, performed by the authors in a previous project.

. Methods:

At surgery of 42 patients, aneu­rysm fundi were cut distally to the clip. In each case, depending on size, varying number of stripes (altogether 88) were prepared and uniaxial stress-strain measurements were performed. Quantities related to the capacity, energy absorption or stiffness were determined and statistically analysed.

. Results:

The number of specimens in the aneurysm sample was sufficient to establish statistical differences with respect to sex and rupture (p<0.05). No significant differences were detected in orientation, though higher values of stresses and deformations were ob­tained in the circumferential direction com­pared to the meridional direction. 

. Conclusion:

Significant differences bet­ween sexes with respect to ultimate deformations were demonstrated according to expectation, and the hypothesis on equality of energy capacity could be supported. Similarity of curves with respect to specimen orientation was also observed and ruptured aneurysm sacs tended to be smaller in size. It seems that differences and trends described in this paper are realistic and need to be applied in numerical modelling.

.


Subject(s)
Aneurysm, Ruptured , Intracranial Aneurysm , Humans , Intracranial Aneurysm/physiopathology , Intracranial Aneurysm/surgery , Male , Female , Biomechanical Phenomena , Aneurysm, Ruptured/physiopathology , Stress, Mechanical , Middle Aged , Tensile Strength , Adult , Sex Factors
3.
BMC Neurol ; 24(1): 195, 2024 Jun 10.
Article in English | MEDLINE | ID: mdl-38858627

ABSTRACT

BACKGROUND: The newest generation of Neuroform Atlas stent™ (Stryker, Fremont, California) represents a recent advance of cerebral laser-cut microstents for the treatment of intracranial wide-necked aneurysms, and postoperative complications have been observed among Western patients. We assessed predictors of complications, morbidity, and unfavourable outcomes in a large cohort of patients with aneurysms that were treated with Neuroform Atlas stents in China. METHODS: This retrospective study included subjects who were treated with Atlas stents in China from November 2020 to January 2022. RESULTS: A total of 522 consecutive patients (mean age, 58.9 ± 9.9 years; female, 65.3% [341/522]) with 533 aneurysms were included in the study. In the early postoperative period, the neurological morbidity rate was 7.3% (38/522), the ischaemic stroke rate was 5.0% (26/522), the aneurysm rupture subarachnoid haemorrhage rate was 2.3% (12/522), and the mRS score deterioration rate was 5.4% (28/522). The mortality rate was 0.8% (4/522) in the postoperative period. The rate of neurological morbidity during the follow-up period was 1.2% (6/486). In the multifactor prediction analysis, cerebral infarction, Hunt-Hess grade (3-5), procedure duration, stent length and coil protrusion into the parent artery were found to be independent predictors of neurologic morbidity. The procedure duration, stent length and coil protrusion into the parent artery were found to be independent predictors of mRS score deterioration. CONCLUSIONS: The incidence of SCA (stent-assisted coiling)-related complications with the Atlas stent in this study population was comparable to that in Western populations. We identified the procedure duration and stent length as novel independent predictors of SCA-related ischaemic stroke, neurological morbidity, and mRS score deterioration among the Chinese population.


Subject(s)
Intracranial Aneurysm , Postoperative Complications , Stents , Humans , Intracranial Aneurysm/surgery , Intracranial Aneurysm/epidemiology , Female , Male , Middle Aged , Aged , Stents/adverse effects , China/epidemiology , Retrospective Studies , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Risk Factors , Cohort Studies , Endovascular Procedures/methods , Endovascular Procedures/adverse effects , Endovascular Procedures/instrumentation , Adult , Treatment Outcome , East Asian People
4.
Acta Neurochir (Wien) ; 166(1): 257, 2024 Jun 08.
Article in English | MEDLINE | ID: mdl-38850347

ABSTRACT

BACKGROUND: At times, a regulation internal carotid artery-posterior communicating artery junction (ICA-P-Comm) aneurysm becomes a surgical hurdle owing to its close proximity to the anterior clinoid process, an immovable ICA and a concealed dominant P-Comm artery arising from the aneurysm neck. METHOD: A 70 year old patient with a low lying ICA-P-Comm aneurysm underwent a "tailored" intradural clinoidectomy for aneurysm clipping. CONCLUSION: A tailored anterior clinoidectomy to expose "just enough" allows a proximal ICA control in a suitable area, mobility of an atherosclerotic ICA and exposes the P-Comm artery origin which are essential in safe clipping of these aneurysms.


Subject(s)
Carotid Artery, Internal , Intracranial Aneurysm , Aged , Humans , Carotid Artery Diseases/surgery , Carotid Artery, Internal/surgery , Carotid Artery, Internal/diagnostic imaging , Intracranial Aneurysm/surgery , Intracranial Aneurysm/diagnostic imaging , Neurosurgical Procedures/methods , Sphenoid Bone/surgery , Sphenoid Bone/diagnostic imaging , Treatment Outcome
6.
Article in Russian | MEDLINE | ID: mdl-38881011

ABSTRACT

Microsurgeries are common for complex aneurysms of the middle cerebral artery (MCA). OBJECTIVE: To evaluate the incidence and types of venous cerebral disorders after microsurgeries for complex MCA aneurysms. MATERIAL AND METHODS: A retrospective study included 285 patients with complex MCA aneurysms between 2009 and 2020. Pterional craniotomy and transsylvian approach were used in all cases. Aneurysm clipping was performed in 230 cases, revascularization - 27, trapping without bypass - 17, reinforcement - in 11 cases. Computed tomography within 1-3 days after surgery recognized venous cerebral disorders as heterogeneous foci of abnormal brain density with unclear boundaries. These foci were crescent-shaped as a rule and located in deep and basal parts of the frontal lobes. RESULTS: Venous abnormalities occurred in 76 (26.7%) patients. Thirty-five (12.3%) patients had mild venous edema of the frontal lobe alone. In 35 (12.3%) patients, we found moderate disorders with focus in the frontal lobe and compression of anterior horn of the left lateral ventricle with or without hemorrhagic imbibition. Severe disorders occurred in 6 (2.1%) patients with lesion extending to the frontal, insular and temporal lobes. These lesions were accompanied by hemorrhagic imbibition, and lateral dislocation exceeded 5 mm. CONCLUSION: Careful dissection of veins in Sylvian fissure with preservation of bridging veins is likely to reduce the risk of this complication. Cauterization of a large vein in Sylvian fissure should be followed by careful hemostasis within frontal or temporal cortex. Bleeding and cortical tension can indicate intracerebral hematoma whose likelihood is higher in patients with venous cerebral disorders.


Subject(s)
Intracranial Aneurysm , Microsurgery , Postoperative Complications , Humans , Intracranial Aneurysm/surgery , Intracranial Aneurysm/diagnostic imaging , Male , Female , Middle Aged , Microsurgery/methods , Microsurgery/adverse effects , Adult , Retrospective Studies , Postoperative Complications/etiology , Postoperative Complications/epidemiology , Postoperative Complications/diagnostic imaging , Aged , Middle Cerebral Artery/surgery , Middle Cerebral Artery/diagnostic imaging
7.
Article in Russian | MEDLINE | ID: mdl-38881016

ABSTRACT

BACKGROUND: Contrast enhancement of intracranial aneurysm wall during MRI with targeted visualization of vascular wall correlates with previous aneurysm rupture and, according to some data, may be a predictor of further rupture of unruptured aneurysms. OBJECTIVE: To analyze possible causes of aneurysm contrast enhancement considering morphological data of aneurysm walls. MATERIAL AND METHODS: The study included 44 patients with intracranial aneurysms who underwent preoperative MRI between November 2020 and September 2022. Each aneurysm was assessed regarding contrast enhancement pattern. Microsurgical treatment of aneurysm was accompanied by resection of its wall for subsequent histological and immunohistochemical analysis regarding thrombosis, inflammation and neovascularization. Specimens were subjected to histological and immunochemical analysis. Immunohistochemical analysis was valuable to estimate inflammatory markers CD68 and CD3, as well as neurovascularization marker SD31. RESULTS: Aneurysms with contrast-enhanced walls were characterized by higher number of CD3+, CD68+, CD31+ cells and parietal clots. Intensity of contrast enhancement correlated with aneurysm wall abnormalities. CONCLUSION: Contrast enhancement of aneurysm wall can characterize various morphological abnormalities.


Subject(s)
Intracranial Aneurysm , Magnetic Resonance Imaging , Humans , Intracranial Aneurysm/diagnostic imaging , Intracranial Aneurysm/surgery , Intracranial Aneurysm/pathology , Male , Female , Middle Aged , Magnetic Resonance Imaging/methods , Neuroimaging/methods , Antigens, Differentiation, Myelomonocytic/analysis , Antigens, Differentiation, Myelomonocytic/metabolism , Adult , Contrast Media , Antigens, CD/analysis , Antigens, CD/metabolism , Aged , Aneurysm, Ruptured/diagnostic imaging , Aneurysm, Ruptured/surgery , Aneurysm, Ruptured/pathology , Platelet Endothelial Cell Adhesion Molecule-1/analysis , Platelet Endothelial Cell Adhesion Molecule-1/metabolism , CD3 Complex/analysis , CD3 Complex/metabolism , CD68 Molecule
8.
Medicine (Baltimore) ; 103(24): e38337, 2024 Jun 14.
Article in English | MEDLINE | ID: mdl-38875397

ABSTRACT

To explore the influence of comfort nursing theory on the postoperative rehabilitation quality of patients with intracranial aneurysms. From October 2017 to December 2022, 315 patients with intracranial aneurysms underwent interventional surgery in our hospital were included in this retrospective study and divided into the routine group (n = 105) and comfort nursing group (n = 210) based on different nursing methods. The Glasgow Outcome Scale (GOS) was used to assess patient rehabilitation outcomes. Patients' anxiety, pain, quality of life, and their satisfaction with treatment were compared. Compared with the patients receiving routine nursing, the time for comfortable nursing patients to resume normal diet, get out of bed and exercise, and the total hospital stay were significantly shortened. And the GOS score of patients receiving comfort nursing was significantly higher than that of patients receiving routine nursing. After nursing, self-rating anxiety scale and visual analog scale scores of comfortable nursing patients were significantly lower than those of routine nursing, and Karnofsky performance status scores were significantly higher than those of routine nursing. This showed that receiving comfortable nursing was beneficial to improve perioperative anxiety and depression in patients with intracranial aneurysm, and significantly improve the quality of life of patients. The total satisfaction of comfortable nursing patients was 95.24%, while that of routine nursing patients was 76.19%. Complications occurred in 30 patients receiving routine nursing, while only 15 patients received comfort nursing. The immune indexes such as CD3+, CD4+, and CD23+ of comfortable nursing patients were significantly higher than the routine nursing patients within 1 and 5 days after operation, while the immune indexes of CD8+ were lower than the routine nursing patients 5 days after operation. Comfortable nursing from the perspective of quality nursing can significantly improve the physiological indicators of patients with intracranial aneurysms, accelerate the progress of postoperative rehabilitation, improve the anxiety, pain and quality of life of patients, and improve the satisfaction of patients with nursing. Comfort nursing from the perspective of quality nursing can reduce the occurrence of postoperative complications, which may be achieved by improving the patient's immune function.


Subject(s)
Intracranial Aneurysm , Patient Satisfaction , Quality of Life , Humans , Intracranial Aneurysm/surgery , Intracranial Aneurysm/nursing , Female , Male , Middle Aged , Retrospective Studies , Adult , Anxiety/etiology , Aged , Glasgow Outcome Scale , Postoperative Complications/psychology
9.
Neurol India ; 72(2): 242-247, 2024 Mar 01.
Article in English | MEDLINE | ID: mdl-38817167

ABSTRACT

BACKGROUND: Proximal anterior cerebral artery (PACA) aneurysms account for less than 1% of all intracranial aneurysms. These aneurysms possess a challenge to surgeons due to their small size, wide base, fragile wall, and accompanying vascular anomalies. Surgery and endovascular treatment are both effective treatment options for PACA aneurysms but there is currently no consensus on which is the method of choice. OBJECTIVE: A systematic review and meta-analysis was conducted to investigate treatment strategies for aneurysms at proximal anterior cerebral artery. MATERIAL AND METHODS: The Cochrane Library, EMBASE, PubMed, and Web of Science databases were systematically searched for studies published between January 01, 2000 and December 01, 2020 that investigated surgery and/or endovascular treatment for patients with PACA. RESULTS AND CONCLUSIONS: Nineteen retrospective studies involving 358 patients met the inclusion criteria. Among these patients, 150 were treated surgically and 208 were treated using an endovascular technique. Preoperative morbidity was significantly greater in the surgical patients compared with the endovascular treated patients but there was no difference between groups in procedural related morbidity. The rates of favorable clinical outcome at time of discharge and at follow-up were statistically significantly greater in the endovascular group compared with the surgical group. Procedural related mortality was 8.7% for the surgical group and 1% in the endovascular group. In summary, our meta-analysis emphasized the safety and efficiency of endovascular treatment, and concluded that it was superior to surgery in acquiring favorable clinical outcome and reducing the perioperative complications. However, surgery was still the preferred treatment strategy for ruptured PACA aneurysms. Preoperative evaluation seems to be of great vital.


Subject(s)
Endovascular Procedures , Intracranial Aneurysm , Humans , Intracranial Aneurysm/surgery , Endovascular Procedures/methods , Treatment Outcome , Anterior Cerebral Artery/surgery , Neurosurgical Procedures/methods
10.
J Craniofac Surg ; 35(4): 1152-1156, 2024 Jun 01.
Article in English | MEDLINE | ID: mdl-38743286

ABSTRACT

OBJECTIVE: To explore how to effectively manage the residual or recurrent intracranial aneurysms after embolization. METHODS: The authors retrospectively reviewed our experience of endovascular interventional therapy, surgical clipping, and cerebrovascular bypass surgery in the treatment of residual or recurrent aneurysms after embolization at the authors' institution from 2018 to 2022. RESULTS: The Glasgow Outcome Scale of 28 patients after the procedure and at discharge showed that 24 recovered well, 3 had severe disability, and 1 died. During the 24-month follow-up, 26 had a good recovery, 1 suffered from disability, and 1 died. Two cases of aneurysm recurrence were detected, and both were treated through endovascular therapy. Among them, 1 case underwent a repeat endovascular embolization, and 1 case was switched to surgical clipping. No residual aneurysms were observed in the remaining patients who underwent bypass surgery, and their bypass grafts were all patent. CONCLUSION: Based on the clinical status of patients, aneurysmal characteristics, surgical risk, and possibility of rerupture of aneurysms, an individualized strategy was proposed for residual or recurrent aneurysms after embolization. The use of endovascular interventional therapy or surgical clipping can be safely and effectively managed, and cerebrovascular bypass surgery can effectively manage complex aneurysms.


Subject(s)
Embolization, Therapeutic , Endovascular Procedures , Intracranial Aneurysm , Recurrence , Humans , Intracranial Aneurysm/surgery , Embolization, Therapeutic/methods , Male , Female , Middle Aged , Retrospective Studies , Adult , Endovascular Procedures/methods , Aged , Treatment Outcome , Glasgow Outcome Scale
12.
Phys Med ; 122: 103383, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38810393

ABSTRACT

PURPOSE: Radiation doses to adult patients submitted to cerebral angiography and intracranial aneurysms treatments were assessed by using DICOM Radiation Dose Structured Reports (RDSR) and Monte Carlo simulations. Conversion factors to estimate effective and organ doses from Kerma-Area Product (PKA) values were determined. METHODS: 77 cerebral procedures performed with five angiographic equipment installed in three Italian centres were analyzed. Local settings and acquisition protocols were considered. The geometrical, technical and dosimetric data of 16,244 irradiation events (13305 fluoroscopy, 2811 digital subtraction angiography, 128 cone-beam CT) were extracted from RDSRs by local dose monitoring systems and were input in MonteCarlo PCXMC software to calculate effective and organ doses. Finally, conversion factors to determine effective and organ doses from PKA were determined. Differences between centres were assessed through statistical analysis and accuracy of dose calculation method based on conversion factors was assessed through Bland-Altman analysis. RESULTS: Large variations in PKA (14-561 Gycm2) and effective dose (1.2-73.5 mSv) were observed due to different degrees of complexity in the procedures and angiographic system technology. The most exposed organs were brain, salivary glands, oral mucosa, thyroid and skeleton. The study highlights the importance of recent technology in reducing patient exposure (about fourfold, even more in DSA). No statistically significant difference was observed in conversion factors between centres, except for some organs. A conversion factor of 0.09 ± 0.02 mSv/Gycm2 was obtained for effective dose. CONCLUSIONS: Organ and effective doses were assessed for neuro-interventional procedures. Conversion factors for calculating effective and organ doses from PKA were provided.


Subject(s)
Radiation Dosage , Humans , Monte Carlo Method , Cerebral Angiography , Intracranial Aneurysm/diagnostic imaging , Intracranial Aneurysm/surgery , Intracranial Aneurysm/radiotherapy , Adult , Male , Female , Middle Aged , Radiometry , Angiography, Digital Subtraction
13.
Sci Rep ; 14(1): 10653, 2024 05 09.
Article in English | MEDLINE | ID: mdl-38724557

ABSTRACT

The efficacy of flow diverters is influenced by the strut configuration changes resulting from size discrepancies between the stent and the parent artery. This study aimed to quantitatively analyze the impact of size discrepancies between flow diverters and parent arteries on the flow diversion effects, using computational fluid dynamics. Four silicone models with varying parent artery sizes were developed. Real flow diverters were deployed in these models to assess stent configurations at the aneurysm neck. Virtual stents were generated based on these configurations for computational fluid dynamics analysis. The changes in the reduction rate of the hemodynamic parameters were quantified to evaluate the flow diversion effect. Implanting 4.0 mm flow diverters in aneurysm models with parent artery diameters of 3.0-4.5 mm, in 0.5 mm increments, revealed that a shift from oversized to undersized flow diverters led to an increase in the reduction rates of hemodynamic parameter, accompanied by enhanced metal coverage rate and pore density. However, the flow diversion effect observed transitioning from oversizing to matching was less pronounced when moving from matching to undersizing. This emphasizes the importance of proper sizing of flow diverters, considering the benefits of undersizing and not to exceed the threshold of advantages.


Subject(s)
Hemodynamics , Stents , Humans , Models, Cardiovascular , Intracranial Aneurysm/physiopathology , Intracranial Aneurysm/surgery , Computer Simulation , Arteries/physiology , Hydrodynamics
14.
Clin Ter ; 175(3): 146-153, 2024.
Article in English | MEDLINE | ID: mdl-38767071

ABSTRACT

Background: AneurysmFlow (Phillips Healthcare) is the flow measurement tool, utilizing an optical flow-based algorithm from DSA, lacks sufficient published studies. This study aimed to assess the significance of flow velocity changes and the Mean Aneurysm Flow Amplitude (MAFA) ratio in evaluating outcomes following flow-diverting treatments. Methods: Between June 2021 and October 2022, 41 patients with 42 aneurysms underwent FDS treatment with AneurysmFlow measu-rement at the Bach Mai Radiology Center. Results: The tool achieved a 90.5% success rate in 38 out of 42 patients. Most aneurysms (89.5%) were small to medium-sized (<10 mm), and a decrease in flow velocity post-stent deployment was ob-served in 78.9% of cases. Conversely, 21.1% showed increased flow, mainly in aneurysms smaller than 5 mm. No significant association was found between flow changes or MAFA ratio and aneurysm size characteristics. Twenty-two patients (59.5%) underwent re-examination at 6 months, revealing no correlation in MAFA ratio between completely and incompletely occluded aneurysms. Conclusions: Our current investigation, primarily centered on small and medium-sized aneurysms, did not uncover any link between quantitative flow changes assessed using the AneurysmFlow software and the occlusion status of aneurysms at the 6-month follow-up post-flow diverter treatment. Larger case series with extended follow-up imaging are necessary to further explore these findings.


Subject(s)
Hemodynamics , Stents , Humans , Female , Male , Middle Aged , Aged , Endovascular Procedures/methods , Intracranial Aneurysm/surgery , Intracranial Aneurysm/physiopathology , Blood Flow Velocity , Angiography, Digital Subtraction , Algorithms , Retrospective Studies , Adult , Treatment Outcome , Aged, 80 and over
15.
Acta Neurochir (Wien) ; 166(1): 234, 2024 May 28.
Article in English | MEDLINE | ID: mdl-38805034

ABSTRACT

PURPOSE: Progressive cerebral edema with refractory intracranial hypertension (ICP) requiring decompressive hemicraniectomy (DHC) is a severe manifestation of early brain injury (EBI) after aneurysmal subarachnoid hemorrhage (aSAH). The purpose of the study was to investigate whether a more pronounced cerebrospinal fluid (CSF) drainage has an influence on cerebral perfusion pressure (CPP) and the extent of EBI after aSAH. METHODS: Patients with aSAH and indication for ICP-monitoring admitted to our center between 2012 and 2020 were retrospectively included. EBI was categorized based on intracranial blood burden, persistent loss of consciousness, and SEBES (Subarachnoid Hemorrhage Early Brain Edema Score) score on the third day after ictus. The draining CSF and vital signs such as ICP and CPP were documented daily. RESULTS: 90 out of 324 eligible aSAH patients (28%) were included. The mean age was 54.2 ± 11.9 years. DHC was performed in 24% (22/90) of patients. Mean CSF drainage within 72 h after ictus was 168.5 ± 78.5 ml. A higher CSF drainage within 72 h after ictus correlated with a less severe EBI and a less frequent need for DHC (r=-0.33, p = 0.001) and with a higher mean CPP on day 3 after ictus (r = 0.2351, p = 0.02). CONCLUSION: A more pronounced CSF drainage in the first 3 days of aSAH was associated with higher CPP and a less severe course of EBI and required less frequently a DHC. These results support the hypothesis that an early and pronounced CSF drainage may facilitate blood clearance and positively influence the course of EBI.


Subject(s)
Aneurysm, Ruptured , Drainage , Subarachnoid Hemorrhage , Humans , Middle Aged , Male , Subarachnoid Hemorrhage/surgery , Subarachnoid Hemorrhage/complications , Female , Drainage/methods , Retrospective Studies , Adult , Aneurysm, Ruptured/surgery , Aneurysm, Ruptured/complications , Aged , Decompressive Craniectomy/methods , Brain Injuries , Brain Edema/etiology , Brain Edema/cerebrospinal fluid , Brain Edema/surgery , Cerebrospinal Fluid , Intracranial Hypertension/etiology , Intracranial Hypertension/surgery , Intracranial Hypertension/cerebrospinal fluid , Intracranial Aneurysm/surgery , Intracranial Aneurysm/complications
16.
Acta Neurochir (Wien) ; 166(1): 206, 2024 May 09.
Article in English | MEDLINE | ID: mdl-38719974

ABSTRACT

A 40-year-old female with a history of ischemic moyamoya disease treated with indirect revascularization at ages 12 and 25 years presented with a sudden severe headache. Imaging studies revealed focal parenchymal hemorrhage and acute subdural hematoma, confirming a microaneurysm formed on the postoperative transosseous vascular network as the source of bleeding. Conservative management was performed, and no hemorrhage recurred during the 6-month follow-up period. Interestingly, follow-up imaging revealed spontaneous occlusion of the microaneurysm. However, due to the rarity of this presentation, the efficacy of conservative treatment remains unclear. Further research on similar cases is warranted.


Subject(s)
Aneurysm, Ruptured , Cerebral Revascularization , Moyamoya Disease , Humans , Moyamoya Disease/surgery , Moyamoya Disease/diagnostic imaging , Moyamoya Disease/complications , Female , Adult , Cerebral Revascularization/methods , Aneurysm, Ruptured/surgery , Aneurysm, Ruptured/diagnostic imaging , Postoperative Complications/surgery , Postoperative Complications/etiology , Intracranial Aneurysm/surgery , Intracranial Aneurysm/diagnostic imaging , Anastomosis, Surgical/methods , Anastomosis, Surgical/adverse effects
17.
BMC Neurol ; 24(1): 170, 2024 May 23.
Article in English | MEDLINE | ID: mdl-38783204

ABSTRACT

PURPOSE: QT interval prolongation is one of the most common electrocardiographic (ECG) abnormalities in patients with aneurysmal subarachnoid hemorrhage (aSAH). Whether corrected QT interval (QTc) prolongation is associated with perioperative cardiac events and dismal neurological outcome in mid to long-term follow-up in patients after aSAH is insufficiently studied and remains controversial. METHODS: We retrospectively studied the adult (≥ 18 years) patients admitted to our institution between Jan 2018 and Dec 2020 for aSAH who underwent intracranial aneurysm clipping or embolization. The patients were divided into 2 groups (normal and QTc prolongation groups) according to their QTc. To minimize the confounding bias, a propensity score matching (PSM) analysis was performed to compare the neurologic outcomes between patients with normal QTc and QTc prolongation. RESULTS: After screening, 908 patients were finally included. The patients were divided into 2 groups: normal QTc groups (n = 714) and long QTc group (n = 194). Female sex, hypokalemia, posterior circulation aneurysm, and higher Hunt-Hess grade were associated with QTc prolongation. In multiple regression analysis, older age, higher hemoglobin level, posterior circulation aneurysm, and higher Hunt-Hess grade were identified to be associated with worse outcome during 1-year follow-up. Before PSM, patients with QTc prolongation had higher rate of perioperative cardiac arrest or ventricular arrhythmias. After PSM, there was no statistical difference between normal and QTc prolongation groups in perioperative cardiac events. However, patients in the QTc prolongation group still had worse neurologic outcome during 1-year follow-up. CONCLUSIONS: QTc prolongation is associated with worse outcome in patients following SAH, which is independent of perioperative cardiac events.


Subject(s)
Embolization, Therapeutic , Intracranial Aneurysm , Long QT Syndrome , Subarachnoid Hemorrhage , Humans , Male , Female , Retrospective Studies , Subarachnoid Hemorrhage/complications , Subarachnoid Hemorrhage/surgery , Middle Aged , Intracranial Aneurysm/surgery , Intracranial Aneurysm/complications , Long QT Syndrome/etiology , Embolization, Therapeutic/methods , Embolization, Therapeutic/adverse effects , Adult , Aged , Microsurgery/methods , Microsurgery/adverse effects , Treatment Outcome , Electrocardiography/methods
18.
Neurosciences (Riyadh) ; 29(2): 90-95, 2024 May.
Article in English | MEDLINE | ID: mdl-38740406

ABSTRACT

OBJECTIVES: To investigate the factors that contribute to the development of cerebral edema after aneurysm clipping in individuals with aneurysmal subarachnoid hemorrhage (aSAH). METHODS: A total of 232 patients with aSAH caused by rupture and treated with aneurysm clipping were included in the retrospective analysis of clinical data. Postoperatively, the participants were categorized into two groups based on the presence or absence of cerebral edema: a complication group (n=33) and a non-complication group (n=199).A comparison was made between the overall data of the 2 groups. RESULTS: In the complication group, there were higher proportions of patients experiencing recurrent bleeding, aneurysm in the posterior circulation, Fisher grade III-IV, World Federation of Neurosurgical Societies (WFNS) grade II, Hunt-Hess grade III-IV, concomitant hypertension, duration from onset to operation ≥12 h, and concomitant hematoma compared to the non-complication group (p<0.05). Cerebral edema after aneurysm clipping was associated with several risk factors including repeated bleeding, aneurysm in the back of the brain, Fisher grade III-IV, WFNS grade II, Hunt-Hess grade III-IV, simultaneous high blood pressure and hematoma, and a duration of at least 12 hours from the start of symptoms to the surgical procedure (p<0.05). CONCLUSION: In patients with aSAH, the risk of cerebral edema after aneurysm clipping is increased by recurrent bleeding, aneurysm in the posterior circulation, Fisher grade III-IV, WFNS grade II, Hunt-Hess grade III-IV, concomitant hypertension and hematoma, and duration of ≥12 h from onset to operation.


Subject(s)
Brain Edema , Subarachnoid Hemorrhage , Humans , Subarachnoid Hemorrhage/surgery , Subarachnoid Hemorrhage/complications , Male , Female , Middle Aged , Brain Edema/etiology , Risk Factors , Retrospective Studies , Adult , Aged , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Intracranial Aneurysm/surgery , Intracranial Aneurysm/complications , Neurosurgical Procedures/adverse effects , Surgical Instruments/adverse effects , Aneurysm, Ruptured/surgery , Aneurysm, Ruptured/complications
SELECTION OF CITATIONS
SEARCH DETAIL
...