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PURPOSE: Although meningiomas are the most common primary intracranial tumors, their genetic etiologies have not been fully elucidated. To date, only two genome-wide association studies (GWASs) have focused on European ancestries, despite ethnic differences in the incidence of meningiomas. The aim of this study was to conduct the first GWAS of Japanese patients with meningiomas to identify the SNPs associated with meningioma susceptibility. METHODS: In this multicenter prospective case-control study, we studied 401 Japanese patients with meningioma admitted in five institutions in Japan, and 50,876 control participants of Japanese ancestry enrolled in Biobank Japan. RESULTS: The quality control process yielded 536,319 variants and imputation resulted in 8,224,735 variants on the autosomes and 224,820 variants on the X chromosomes. This GWAS eventually revealed no genetic variants with genome-wide significance (P < 5 × 10 - 8) and observed no significant association in the previously reported risk variants rs11012732 and rs2686876 due to low minor allele frequency in the Japanese population. CONCLUSION: This is the first GWAS of meningiomas in East Asian populations and is expected to contribute to the development of GWAS research for meningiomas.
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Predisposição Genética para Doença , Estudo de Associação Genômica Ampla , Neoplasias Meníngeas , Meningioma , Polimorfismo de Nucleotídeo Único , Humanos , Meningioma/genética , Meningioma/epidemiologia , Estudos Prospectivos , Neoplasias Meníngeas/genética , Neoplasias Meníngeas/epidemiologia , Masculino , Feminino , Japão/epidemiologia , Estudos de Casos e Controles , Pessoa de Meia-Idade , Idoso , AdultoRESUMO
BACKGROUND AND PURPOSE: Environmental factors are important with respect to the rupture of cerebral aneurysms. However, the relationship between the gut microbiome, an environmental factor, and aneurysm rupture is unclear. Therefore, we compared the gut microbiome in patients with unruptured intracranial aneurysms (UIAs) and ruptured aneurysms (RAs) to identify the specific bacteria causing the rupture of cerebral aneurysms. METHODS: A multicenter, prospective case-control study was conducted over one year from 2019 to 2020. The fecal samples of patients with stable UIAs and RAs immediately after onset were collected. Their gut microbiomes were analyzed using 16S rRNA sequencing. Subsequently, a phylogenetic tree was constructed, and polymerase chain reaction was performed to identify the specific species. RESULTS: A total of 28 RAs and 33 UIAs were included in this study. There was no difference in patient characteristics between RAs and UIAs: age, sex, hypertension, dyslipidemia, diabetes status, body mass index, and smoking. No difference was observed in alpha diversity; however, beta diversity was significantly different in the unweighted UniFrac distances. At the phylum level, the relative abundance of Campylobacter in the RA group was larger than that in the UIA group. Furthermore, the gut microbiome in the RA and UIA groups exhibited significantly different taxonomies. However, Campylobacter was focused on because it is widely known as pathogenic among these bacteria. Then, a phylogenetic tree of operational taxonomic units related to Campylobacter was constructed and 4 species were identified. Polymerase chain reaction for these species identified that the abundance of the genus Campylobacter and Campylobacter ureolyticus was significantly higher in the RA group. CONCLUSIONS: The gut microbiome profile of patients with stable UIAs and RAs were significantly different. The genus Campylobacter and Campylobacter ureolyticus may be associated with the rupture of cerebral aneurysms.
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Aneurisma Roto/microbiologia , Campylobacter , Disbiose/microbiologia , Microbioma Gastrointestinal , Aneurisma Intracraniano/microbiologia , Idoso , Campylobacter/classificação , Campylobacter/crescimento & desenvolvimento , Campylobacter/isolamento & purificação , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Two cases of ruptured blood blister-like internal carotid artery aneurysms for which low flow bypass was sufficient to attain successful treatment of trapping are reported. In the acute stage of rupture, it is troublesome to perform accurate examinations of tolerance to ischemia like balloon occlusion test(BOT)for estimating the required amount of bypass flow. In our cases, X-ray angiography perfusion(XAP)analysis was introduced, which could be performed in a couple dozen seconds without room-to-room transfer of patients, following the ordinary examination of diagnostic digital subtraction angiography. The perfusion index(PI)ratio measured in this analysis is equivalent to the laterality of cerebral blood flow between the right and left hemispheres. The PI ratio of 0.85 approximately corresponds to the mean stump pressure(MSTP)of 40mmHg, on the basis of the correlation diagram between the PI ratio and MSTP(approximate straight line:PI ratio%=0.6×MSTP+60). Even though the PI ratio of the cases was superior to this threshold of tolerance for parent artery occlusion, complementary low flow bypass was added in the acute case for the overwhelming succeeding vasospasm and for securing the flow to peripheral perforators, which resulted in a successful treatment without any ischemic events.
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Aneurisma Roto/diagnóstico por imagem , Aneurisma Intracraniano/diagnóstico por imagem , Adulto , Aneurisma Roto/cirurgia , Angiografia Digital , Angiografia Cerebral , Humanos , Aneurisma Intracraniano/cirurgia , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: Compression of the carotid artery (CA) by hyoid bony structures, such as the hyoid bone and thyroid cartilage, during swallowing or neck rotation can induce stroke. However, no reports have described ischemic stroke caused by mechanical compression of the CA by the pharynx during swallowing. OBSERVATIONS: A man with left CA stenosis developed recurrent ischemic stroke in his left hemisphere. Computed tomography angiography of the neck showed that the left common carotid artery was trapped by the hyoid bone and thyroid cartilage and that the internal carotid artery (ICA) ran in the retropharyngeal space. Angiography during swallowing of a contrast agent showed dynamic compression of the left CA posterolaterally by the pharynx during swallowing, despite the fact that the CA on the healthy right side moved anteromedially. The retropharyngeal ICA was then transposed to its normal location and endarterectomy was performed. No ischemic events occurred postoperatively, and angiography showed that the left CA now moved anteromedially during swallowing. LESSONS: Movement of the pharynx during swallowing can be a risk factor for CA stenosis. It is important to evaluate the anatomical interaction between the CA and surrounding structures, as well as their dynamics, to ensure appropriate diagnosis and treatment. https://thejns.org/doi/10.3171/CASE2483.
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Cerebral organoids (COs) are derived from human-induced pluripotent stem cells in vitro and mimic the features of the human fetal brain. The development of COs is largely dependent on "self-organization" mechanisms, in which differentiating cells committed to cortical cells autonomously organize into the cerebral cortex-like tissue. However, extrinsic manipulation of their morphology, including size and thickness, remains challenging. In this study, we discovered that silicate microfiber scaffolds could support the formation of cortical neuronal layers and successfully generated cortical neuronal layers, which are 9 times thicker than conventional COs, in 70 days. These cortical neurons in the silicate microfiber layer were differentiated in a fetal brain-like lamination pattern. While these cellular characteristics such as cortical neurons and neural stem/progenitor cells were like those of conventional COs, the cortical neuronal layers were greatly thickened in sheet-like configuration. Moreover, the cortical neurons in the scaffolds showed spontaneous electrical activity. We concluded that silicate microfiber scaffolds support the formation of the cortical neuronal layers of COs without disturbing self-organization-driven corticogenesis. The extrinsic manipulation of the formation of the cortical neuronal layers of COs may be useful for the research of developmental mechanisms or pathogenesis of the human cerebral cortex, particularly for the development of regenerative therapy and bioengineering.
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Células-Tronco Pluripotentes Induzidas , Células-Tronco Neurais , Humanos , Neurônios , Córtex Cerebral/fisiologia , Organoides , Diferenciação CelularRESUMO
Interaction between the gut microbiome and host plays a key role in human health. Here, we perform a metagenome shotgun-sequencing-based analysis of Japanese participants to reveal associations between the gut microbiome, host genetics, and plasma metabolome. A genome-wide association study (GWAS) for microbial species (n = 524) identifies associations between the PDE1C gene locus and Bacteroides intestinalis and between TGIF2 and TGIF2-RAB5IF gene loci and Bacteroides acidifiaciens. In a microbial gene ortholog GWAS, agaE and agaS, which are related to the metabolism of carbohydrates forming the blood group A antigen, are associated with blood group A in a manner depending on the secretor status determined by the East Asian-specific FUT2 variant. A microbiome-metabolome association analysis (n = 261) identifies associations between bile acids and microbial features such as bile acid metabolism gene orthologs including bai and 7ß-hydroxysteroid dehydrogenase. Our publicly available data will be a useful resource for understanding gut microbiome-host interactions in an underrepresented population.
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Antígenos de Grupos Sanguíneos , Microbioma Gastrointestinal , Humanos , Microbioma Gastrointestinal/genética , Estudo de Associação Genômica Ampla , População do Leste Asiático , Metaboloma , Proteínas Repressoras/genética , Proteínas de Homeodomínio/genéticaRESUMO
Human DNA present in faecal samples can result in a small number of human reads in gut shotgun metagenomic sequencing data. However, it is presently unclear how much personal information can be reconstructed from such reads, and this has not been quantitatively evaluated. Such a quantitative evaluation is necessary to clarify the ethical concerns related to data sharing and to enable efficient use of human genetic information in stool samples, such as for research and forensics. Here we used genomic approaches to reconstruct personal information from the faecal metagenomes of 343 Japanese individuals with associated human genotype data. Genetic sex could be accurately predicted based on the sequencing depth of sex chromosomes for 97.3% of the samples. Individuals could be re-identified from the matched genotype data based on human reads recovered from the faecal metagenomic data with 93.3% sensitivity using a likelihood score-based method. This method also enabled us to predict the ancestries of 98.3% of the samples. Finally, we performed ultra-deep shotgun metagenomic sequencing of five faecal samples as well as whole-genome sequencing of blood samples. Using genotype-calling approaches, we demonstrated that the genotypes of both common and rare variants could be reconstructed from faecal samples. This included clinically relevant variants. Our approach can be used to quantify personal information contained within gut metagenome data.
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Genoma Humano , Metagenoma , Humanos , Fezes , Sequenciamento Completo do Genoma , GenótipoRESUMO
The occurrence of early brain injury (EBI) following subarachnoid hemorrhage (SAH) is crucial in the prognosis of SAH; however, no effective treatment for EBI has been developed. Gut microbiome (GM) composition influences the outcome of various diseases, including ischemic stroke. Here, we evaluated whether prior GM alteration could prevent EBI following SAH. We altered the GM of 7-week-old male rats by administering antibiotic-containing water for 2 weeks and performing fecal microbiome transplantation after antibiotic induction. Composition of the GM was profiled using 16S rRNA. We induced SAH by injecting blood in the subarachnoid space of control rats and rats with altered GM. We evaluated EBI indicators such as neurological score, brain water content, Evans blue extravasation, and neuronal injury. Additionally, we studied inflammatory cells using immunohistochemistry, immunocytochemistry, quantitative PCR, and flow cytometry. EBI was significantly averted by alterations in GM using antibiotics. The altered GM significantly prevented neutrophil infiltration into the brain among inflammatory cells, and this anti-inflammatory effect was observed immediately following SAH onset. The altered GM also prevented neutrophil extracellular trap formation in the brain and blood, indicating the systemic protective effect. The cause of the protective effect was attributed to a significant decrease in aged neutrophils (CXCR4high CD62Llow) by the altered GM. These protective effects against EBI disappeared when the altered GM was recolonized with normal flora. Our findings demonstrated that EBI following SAH is associated with GM, which regulated neutrophil infiltration.
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We reconstructed 19,084 prokaryotic and 31,395 viral genomes from 787 Japanese gut metagenomes as Japanese metagenome-assembled genomes (JMAG) and Japanese Virus Database (JVD), which are large microbial genome datasets for a single population. Population-specific enrichment of the Bacillus subtilis and ß-porphyranase among the JMAG could derive from the Japanese traditional food natto (fermented soybeans) and nori (laver), respectively. Dairy-related Enterococcus_B lactis and Streptococcus thermophilus were nominally associated with the East Asian-specific missense variant rs671:G>A in ALDH2, which was associated with dairy consumption. Of the species-level viral genome clusters in the JVD, 62.9% were novel. The ß crAss-like phage composition was low among the Japanese but relatively high among African and Oceanian peoples. Evaluations of the association between crAss-like phages and diseases showed significant disease-specific associations. Our large catalog of virus-host pairs identified the positive correlation between the abundance of the viruses and their hosts.
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Very few studies have described the blood flow pattern in the ipsilateral ophthalmic artery (OphA) during internal carotid artery (ICA) balloon test occlusion performed to estimate the risk of cerebral ischemia associated with therapeutic ICA sacrifice. This study aimed to investigate the relationship between ipsilateral OphA flow patterns just after ICA temporary occlusion and balloon test occlusion findings. We retrospectively reviewed 32 balloon test occlusion procedures performed at our institution between 2010 and 2019, and analyzed the OphA flow patterns and the conventional balloon test occlusion assessment items: neurological symptoms, stump pressure, stump-pressure ratio, collateral circulations, and venous phase delay. The flow patterns were categorized as type I (retrograde flow reaching the middle cerebral artery [MCA]), type II (retrograde flow to the ICA not reaching the MCA), or type III (no retrograde flow). Tolerance to balloon test occlusion was observed in 4/21 patients (19.0%), 4/6 patients (66.7%), and all five patients with types I, II, and III flows, respectively. The mean pressure ratios during balloon test occlusion in flow types I, II, and III were 35.6% ± 3.5%, 56.4% ± 6.5%, and 69.4% ± 7.1%, respectively (P <0.001). The mean stump pressures in flow types I, II, and III were 36.2 ± 3.6 mmHg, 46.6 ± 6.7 mmHg, and 66.6 ± 7.3 mmHg, respectively (P = 0.003). The mean venous phase delay in flow types I, II, and III were 0.99 ± 0.14 s, 0.25 ± 0.25 s, and 0.0 ± 0.28 s, respectively (P = 0.004). All the above variables showed significant flow-related differences. These results suggest that the OphA flow patterns may provide an additional diagnostic criterion for balloon test occlusion.
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Oclusão com Balão , Doenças das Artérias Carótidas , Artéria Carótida Interna/diagnóstico por imagem , Circulação Cerebrovascular , Circulação Colateral , Humanos , Artéria Oftálmica , Estudos RetrospectivosRESUMO
The number of heart transplantations performed in Japan has been continuously increasing. Here, we report the case of a patient with an unruptured cerebral artery aneurysm after undergoing heart transplantation and was treated using coil embolization. The patient was a 50-year-old woman who was positive for heparin-induced thrombocytopenia (HIT) antibodies and underwent heart transplantation for dilated cardiomyopathy. An unruptured middle cerebral artery aneurysm was treated with coil embolization using argatroban as a heparin substitute. The patient was discharged without any complications. Despite these patients with heart transplantation are characterized by high HIT antibodies rate and the need for immunosuppressive agents, they currently have an excellent prognosis, especially in Japan. Therefore, the knowledge of patient characteristics after heart transplantation is essential for ensuring that these patients receive the most appropriate treatment.
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Transarterial embolization (TAE) is a useful option for anterior cranial fossa-dural arteriovenous fistula (ACF-dAVF) as endovascular devices have progressed. Liquid agents are usually injected via a microcatheter positioned just proximal to the shunt pouch beyond the ophthalmic artery; however, high blood flow from the internal maxillary artery (IMA) often impedes penetration of embolic materials into the shunt pouch. Therefore, reducing blood flow from the IMA before embolization can increase the success rate. In the present case, to reduce blood flow from branches of the IMA, we inserted surgical gauze infiltrated with xylocaine and epinephrine into bilateral nasal cavities. Using this method, we achieved curative TAE with minimal damage to the nasal mucosa. Transnasal flow reduction is an easy, effective and minimally invasive method. This method should be considered in the endovascular treatment of ACF-dAVF, especially in patients with high blood flow from theIMA.
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OBJECTIVE: The greatest advantage of local anesthesia (LA) in endovascular treatment (EVT) of unruptured intracranial aneurysms (UIAs) is that direct neurologic evaluation can be performed during the procedure, unlike with general anesthesia. However, the usefulness of such direct evaluation has not been established. In this study, we attempted to assess the effects of direct neurologic evaluation by identifying the causes, management, and outcomes of clinical symptoms during the procedure and procedure-related events during EVT under LA. METHODS: We retrospectively evaluated the medical and radiologic data of 1000 patients (1015 UIAs) who had undergone coil embolization under LA from 2008 to 2016. RESULTS: Clinical symptoms were identified in 62 patients (6.2%) during the procedure. The symptoms improved during the procedure in 27 of these patients (44%) and after the procedure in another 28 (45%). One month after the procedure, 55 patients (89%) had good outcomes and 7 (11%) had poor outcomes. Procedure-related events occurred in 67 patients (6.7%); of these 67 events, 39 were symptomatic and 28 were asymptomatic. Thirty-five of the 39 symptomatic events (90%) [13 of 13 (100%) ruptures, 6 of 10 (60%) thrombus formations, and 16 of 16 (100%) thromboembolisms] were detected on the basis of clinical symptoms before angiographic changes were identified, and they were managed promptly. All 28 patients with asymptomatic events were managed safely without further complications before symptoms developed. CONCLUSIONS: We demonstrated that appropriate management of clinical symptoms and procedure-related events under LA led to favorable outcomes of EVT of UIAs.
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Anestesia Local , Embolização Terapêutica/métodos , Procedimentos Endovasculares/métodos , Aneurisma Intracraniano/terapia , Exame Neurológico/métodos , Idoso , Feminino , Humanos , Cuidados Intraoperatórios , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
BACKGROUND: Although endovascular coiling of unruptured aneurysms is widely accepted, the endovascular treatment of wide-neck bifurcation aneurysms remains one of the most challenging morphologies. Our purpose was to describe our experience with 24-month follow-up for the treatment of unruptured intracranial bifurcation aneurysms using the PulseRider (Cerenovus, New Brunswick, NJ). METHODS: This study is a single-center, single-arm registry performed under institutional review board control to evaluate efficacy and safety of the PulseRider. Patients with bifurcation aneurysms were identified and enrolled prospectively. Angiography immediately after treatment and at 6 months, and magnetic resonance imaging and magnetic resonance angiography at 12- and 24-month follow-up were retrospectively analyzed. A modified Rankin score was obtained prior to procedure, at discharge, and at 6-, 12- and 24-month follow-up visits. RESULTS: Eight patients with a mean age of 66 years were treated with the PulseRider. All patients had bifurcation aneurysms (2 anterior communicating, 2 carotid terminus, and 4 basilar apex). The aneurysm diameters ranged from 4.6 to 13.6 mm (mean 7.4 mm) with dome/neck ratio ranging from 1.4 to 2.2 (mean 1.6). In all cases, the PulseRider was successfully deployed. Complete occlusion was demonstrated at 6-month follow-up on 6 of 8 (75%), near complete occlusion in 1 of 8 (12.5%), and residual aneurysm in 1 of 8 (12.5%) patients. There was no change or recurrence on magnetic resonance angiography, nor clinical complication after the procedure through 24-month follow-up. CONCLUSIONS: Our experience with 24-month follow-up demonstrated favorable efficacy in the treatment of intracranial wide-neck bifurcation aneurysms using the PulseRider.
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Embolização Terapêutica/instrumentação , Aneurisma Intracraniano/terapia , Adulto , Idoso , Embolização Terapêutica/métodos , Procedimentos Endovasculares , Feminino , Seguimentos , Humanos , Angiografia por Ressonância Magnética , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-IdadeRESUMO
OBJECTIVE: To describe our initial experience with the Versi Retriever for mechanical thrombectomy in patients with acute ischemic stroke. METHODS: This study is a single-center, single-arm, first-in-man registry under institutional review board control to evaluate the efficacy and safety of the new stent retriever, the Versi Retriever. Patients with acute ischemic stroke were consecutively enrolled between September and November 2017. The clinical and procedural data were retrospectively analyzed. The angiographic result after the procedure was self-graded based on the Thrombolysis in Cerebral Infarction (TICI) scale by each operator. RESULTS: Eleven patients with a mean age of 69.4 years were treated with the Versi Retriever. Median National Institutes of Health Stroke Scale score on admission was 16 (IQR 10-34). The occluded vessel was located in the anterior circulation in 81.8%. Revascularization rates of TICI 2b-3 and TICI 3 at final angiogram were achieved in 100% and 63.6%, respectively. A favorable functional outcome (modified Rankin Scale 0-2) at 90 days was obtained in 72.7%. No symptomatic intracranial hemorrhage occurred and no procedure-related complication was observed. CONCLUSIONS: Our initial experience suggests that the Versi Retriever is a safe and effective stent retriever for mechanical thrombectomy in patients with acute ischemic stroke. CLINICAL TRIAL REGISTRATION: NCT03366818.
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Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/cirurgia , Stents Farmacológicos , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/cirurgia , Trombectomia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Ligas/administração & dosagem , Angiografia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Estudos Retrospectivos , Trombectomia/instrumentação , Resultado do Tratamento , Adulto JovemRESUMO
A middle-aged patient with an internal carotid-posterior communicating artery aneurysm and basilar artery tip aneurysm was treated by stent-assisted coiling. One ischemic infarction and two transient ischemic attacks occurred with the same symptoms (inability to walk unassisted and tendency to fall to the left) during the first 2 years post-treatment. The ischemic infarction was found in the right side of the pons, consistent with the vascular territory of the stent-containing vessel. The cause of the delayed ischemic stroke was investigated on DSA and cone beam CT, which revealed that the proximal end of the stent, one marker band, was just covering a small perforating artery of the basilar artery trunk. The present case suggests that marker band occlusion can induce delayed ischemic stroke. To prevent this complication, it is important to evaluate the perforating vessels preoperatively and carefully deploy a stent for the marker band to avoid occlusion of large perforating vessels. Post-treatment evaluation is also important because dual antiplatelet therapy will be required for a longer period if an artery is occluded by a marker band.
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Artéria Basilar/diagnóstico por imagem , Isquemia Encefálica/diagnóstico por imagem , Aneurisma Intracraniano/diagnóstico por imagem , Stents/efeitos adversos , Acidente Vascular Cerebral/diagnóstico por imagem , Isquemia Encefálica/etiologia , Seguimentos , Humanos , Aneurisma Intracraniano/terapia , Pessoa de Meia-Idade , Acidente Vascular Cerebral/etiologia , Terapia Trombolítica/efeitos adversos , Terapia Trombolítica/métodosRESUMO
The precise mechanism of the development of chronic subdural hematoma (CSDH) as a postoperative complication after aneurysmal clipping remains unclear. The purpose of this study was to identify the independent risk factors for CSDH after craniotomy for aneurysmal clipping and to elucidate the relationship between CSDH and subdural air (SDA) collection immediately after surgery. The medical records and radiologic data of 344 patients who underwent surgical clipping of unruptured aneurysms from July 2010 to July 2016 were retrospectively evaluated. Patient characteristics, aneurysm characteristics, and operation data were statistically analyzed to reveal their relationships with CSDH development. Among the 344 patients, 46 (13.4%) developed CSDH and 13 (3.8%) required subsequent burr-hole surgery for evacuation and irrigation. Multivariate analyses showed that advanced age (P < 0.0001), male sex (P = 0.035), and surgical clipping of multiple aneurysms (P = 0.037) were independent preoperative predictors of CSDH development. Advanced age (P = 0.0005) and postoperative SDA after clipping surgery (P < 0.0001) were independent postoperative predictors of CSDH development. Postoperative SDA and CSDH were not associated with the individual surgeon or operation time. Postoperative severe SDA was significantly associated with the ipsilateral development of CSDH, irrespective of the side of craniotomy. Postoperative SDA is an independent risk factor for CSDH after surgical clipping of unruptured aneurysms and is as important as advanced age, male sex, and surgical clipping of multiple aneurysms in predicting CSDH.
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Craniotomia/efeitos adversos , Hematoma Subdural Crônico/etiologia , Aneurisma Intracraniano/cirurgia , Complicações Pós-Operatórias/etiologia , Espaço Subdural , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de RiscoRESUMO
BACKGROUND AND PURPOSE: The risk factors for intraprocedural rupture (IPR) of unruptured intracranial aneurysms (UIAs) and the outcomes of IPR itself are unclear. This study was performed to identify the independent risk factors for and outcomes of IPR. MATERIALS AND METHODS: We retrospectively evaluated the medical records and radiologic data of 1375 patients (1406 UIAs) who underwent coil embolization from January 2001 to October 2016. RESULTS: IPR occurred in 20 aneurysms of 20 patients (1.4%). Univariate analyses showed that the rate of IPR was significantly higher in the treatment of aneurysms with a small dome size, aneurysms in the anterior communicating artery (AcomA) (6.6%), and patients with a medical history of dyslipidemia. Multivariate analyses showed that a small dome size and aneurysms in the AcomA were independently associated with IPR (p=0.0096 and p=0.0001, respectively). IPR induced by a microcatheter was associated with a higher risk of severe subarachnoid hemorrhage than other causes of IPR (57% vs 0%, respectively). Thromboembolic complications occurred in seven (35%) patients with IPR. Six (30%) patients required external ventricular drainage placement after developing symptoms of acute hydrocephalus. The overall morbidity and mortality rates from IPR were 0.22% and 0.15%, respectively. CONCLUSIONS: Aneurysms in the AcomA and with a small dome size are likely to be risk factors for IPR. IPR induced by microcatheters can result in poor outcomes. The rate of IPR-associated thromboembolic complications is high, and IPR itself is associated with acute hydrocephalus. If managed appropriately, however, most patients with IPR can survive without neurological deterioration.
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Aneurisma Roto/diagnóstico por imagem , Procedimentos Endovasculares/efeitos adversos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/cirurgia , Complicações Intraoperatórias/diagnóstico por imagem , Adulto , Idoso , Aneurisma Roto/etiologia , Aneurisma Roto/prevenção & controle , Prótese Vascular/efeitos adversos , Embolização Terapêutica/efeitos adversos , Procedimentos Endovasculares/tendências , Feminino , Humanos , Aneurisma Intracraniano/terapia , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/prevenção & controle , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Resultado do TratamentoRESUMO
OBJECTIVE: The authors sought to compare methods of measurement for venous phase delay (VPD) or mean stump pressure (MSTP) to rank their potential to predict ischemic tolerance during balloon test occlusion in the internal carotid artery, exploring a more correlative and convenient way to measure cerebral blood flow (CBF) that could be utilized even in the acute phase or in institutions not adequately equipped to measure CBF during the test. METHODS: X-ray angiography perfusion analysis using diagnostic digital subtraction angiography (DSA) equipment enables 1-step examination (without any room-to-room transfer of patients) to measure CBF, VPD, and MSTP completely simultaneously, which has not been accomplished by any previous perfusion studies. RESULTS: This analysis was applied to 17 patients and resulted in successful estimation of all 3 parameters in each case. The average VPD of several cortical veins had a strong correlation with relative CBF (rCBF) between bilateral hemispheres with a correlation coefficient of 0.89443, a correlation as strong as that (0.90357) of the "approximate VPD," which is interpreted based on the trend line of the scatterplot of the time to peak contrast opacification in cortical veins and their spatial positioning from the median sagittal plane. MSTP and classic visual determination of VPD have weaker correlation coefficients with rCBF (0.56119 and 0.70048, respectively). Overall, subjective visual determination in combination with the calculation of the trend line to estimate VPD provided a considerably strong correlation with rCBF (R = 0.86660) without any dedicated software or hardware. CONCLUSIONS: VPD has a stronger correlation with rCBF than MSTP. rCBF could be successfully predicted on common DSA equipment, even by visual determination without expensive software, if the trend line is adopted for processing to estimate VPD.
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A middle-aged patient with an internal carotid-posterior communicating artery aneurysm and basilar artery tip aneurysm was treated by stent-assisted coiling. One ischemic infarction and two transient ischemic attacks occurred with the same symptoms (inability to walk unassisted and tendency to fall to the left) during the first 2 years post-treatment. The ischemic infarction was found in the right side of the pons, consistent with the vascular territory of the stent-containing vessel. The cause of the delayed ischemic stroke was investigated on DSA and cone beam CT, which revealed that the proximal end of the stent, one marker band, was just covering a small perforating artery of the basilar artery trunk. The present case suggests that marker band occlusion can induce delayed ischemic stroke. To prevent this complication, it is important to evaluate the perforating vessels preoperatively and carefully deploy a stent for the marker band to avoid occlusion of large perforating vessels. Post-treatment evaluation is also important because dual antiplatelet therapy will be required for a longer period if an artery is occluded by a marker band.