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3.
World Neurosurg ; 133: e89-e96, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31479795

RESUMEN

OBJECTIVE: To evaluate the feasibility to treat complex internal carotid aneurysms by superficial temporal artery trunk-radial artery-middle cerebral artery (STAT-RA-MCA) bypass combined with balloon occlusion of internal carotid artery. METHODS: Postoperative clinical symptoms, the patency of bridge vessels (radial artery graft [RAG]), STAT and RAG diameters, RAG flow, cerebral blood flow (CBF), and mean transit time (MTT) were observed in 14 cases. Their correlations were analyzed. RESULTS: Except 1 case, RAG was patent in 13 cases. Glasgow Outcome Scale score was 4 in one case and 5 in 13 cases. In the 13 cases with postoperative RAG patency, the mean diameter of STAT increased from 2.1 mm before operation to 3.0 mm on the first day after operation; the mean diameter of RAG was 3.7 mm on the first day after operation. In 3 of the 13 cases, STAT and RAG diameters further increased to 4.0 mm and 4.7 mm, respectively, 3 months after operation. There was a positive correlation between STAT and RAG diameters (P = 0.0005). The STAT (P < 0.0001, P < 0.0001) and RAG (P < 0.0001, P = 0.0042) diameters were positively correlated with RAG flow and CBF, but the STAT (r2 = 0.762, P < 0.0001) and RAG (r2 = 0.54, P = 0.0042) diameters were negatively correlated with MTT. CONCLUSIONS: STAT-RA-MCA bypass combined with balloon occlusion of internal carotid artery is feasible for the treatment of complex internal carotid aneurysms.


Asunto(s)
Oclusión con Balón , Arteria Carótida Interna/cirugía , Revascularización Cerebral/métodos , Aneurisma Intracraneal/cirugía , Arteria Cerebral Media/cirugía , Arteria Radial/trasplante , Arterias Temporales/cirugía , Adulto , Anciano , Aneurisma Roto/etiología , Aneurisma Roto/cirugía , Circulación Cerebrovascular , Trastornos del Conocimiento/etiología , Estudios de Factibilidad , Femenino , Hemiplejía/etiología , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Estudios Retrospectivos , Hemorragia Subaracnoidea/etiología , Adulto Joven
4.
J Stroke Cerebrovasc Dis ; 29(2): 104550, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31822375

RESUMEN

We report a 77-year-old woman with marked enlargement of a middle cerebral artery (MCA) aneurysm 4 years after the successful intra-aneurysmal embolization of an ipsilateral large internal carotid artery (ICA) aneurysm. She intially presented with right third cranial nerve palsy due to a large ICA aneurysm, 20.8 mm in diameter. Initial magnetic resonance angiography (MRA) revealed a signal decrease in the right MCA, suggesting hemodynamic disturbance based on the contrast pooling in the right large ICA aneurysm exhibiting "Windkessel phenomenon". The large ICA aneurysm was successfully managed by intra-aneurysmal embolization with parent artery preservation, and immediate post-treatment MRA demonstrated significant signal recovery in the right MCA. Meticulous follow-up by MRA identified sudden growth in the aneurysmal height within 1 week after embolization, with further growth over the following 4 years, necessitating microsurgical clipping. Enlargement of the ipsilateral distal aneurysm following the treatment of proximal large aneurysm could be altered by marked distal hemodynamic change in view of the sudden amelioration of the "Windkessel phenomenon". Thus, we recommend meticulous follow-up of the associated distal aneurysm after the management of proximal large or giant aneurysms with parent artery preservation.


Asunto(s)
Enfermedades de las Arterias Carótidas/terapia , Arteria Carótida Interna , Embolización Terapéutica/efectos adversos , Aneurisma Intracraneal/terapia , Arteria Cerebral Media , Anciano , Enfermedades de las Arterias Carótidas/diagnóstico por imagen , Enfermedades de las Arterias Carótidas/fisiopatología , Arteria Carótida Interna/diagnóstico por imagen , Arteria Carótida Interna/fisiopatología , Circulación Cerebrovascular , Progresión de la Enfermedad , Femenino , Hemodinámica , Humanos , Aneurisma Intracraneal/diagnóstico por imagen , Aneurisma Intracraneal/fisiopatología , Arteria Cerebral Media/diagnóstico por imagen , Arteria Cerebral Media/fisiopatología , Arteria Cerebral Media/cirugía , Factores de Tiempo , Resultado del Tratamiento
5.
World Neurosurg ; 135: 183-187, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31863893

RESUMEN

BACKGROUND: Accuracy of intraoperative cerebrovascular neuronavigation is difficult to maintain because of the ongoing need for brain shift correction. By including 3-dimensional rotational intraoperative digital subtraction angiography (3D-iDSA), the intraoperative cerebrovascular neuronavigation can be updated and upgraded throughout the microneurosurgical procedure. The aim of this technical note is to demonstrate the feasibility and advantage of updating and upgrading the accuracy of targeted cerebrovascular neuronavigation with an intraoperative 3D-DSA dataset. METHODS: A preoperative diagnostic selective 3D-DSA was registered with the neuronavigation software, followed by the automated segmentation of the vascular object of interest (an aneurysm in this case). After acquiring additional 3D-iDSA volumes, these steps were repeated, thereby updating the cerebrovascular roadmap and neuronavigation accuracy (i.e., brain shift correction). RESULTS: This technique was applied successfully in a patient who underwent elective microneurosurgical clipping of a right-sided middle cerebral artery (MCA) bifurcation aneurysm in a hybrid neurosurgical operating setting. After clipping of the MCA aneurysm, a selective 3D iDSA was performed that was then used to update the projection and accuracy of the initial 3D neurovascular object of interest (i.e., the aneurysm). In this revised rotational view, the projection refined the target segments of the clipped MCA aneurysm, the accuracy of clipping, and brain shift correction. CONCLUSIONS: 3D-iDSA vascular segmentations can update und upgrade the intraoperative neurovascular roadmap by thereby enhancing accuracy of cerebrovascular neuronavigation, as well as correcting brain shift. This technique is feasible within the hybrid operation room. Evaluation in larger series is required to support these findings.


Asunto(s)
Aneurisma Intracraneal/cirugía , Arteria Cerebral Media/cirugía , Neuronavegación/métodos , Procedimientos Neuroquirúrgicos/métodos , Procedimientos Quirúrgicos Vasculares/métodos , Angiografía de Substracción Digital/métodos , Estudios de Factibilidad , Humanos , Imagen Tridimensional/métodos , Aneurisma Intracraneal/diagnóstico por imagen , Microcirugia/métodos , Arteria Cerebral Media/diagnóstico por imagen , Tomografía Computarizada por Rayos X
6.
Angiol Sosud Khir ; 25(4): 131-138, 2019.
Artículo en Ruso | MEDLINE | ID: mdl-31855210

RESUMEN

Presented in the article are the results of surgical management of a patient with an extremely rare pathology - a saccular arterial aneurysm of the cavernous-ophthalmic segment of the left internal carotid artery. We performed multistage open surgical intervention in the following scope: osteoplastic pterional craniotomy on the left, creation of a wide-lumen anastomosis between the left external carotid artery and M2 segment of the left middle cerebral artery with the use of the radial artery, ligation of the cervical portion of the left internal carotid artery and clipping of its supraclinoid portion. The chosen surgical policy made it possible to create sufficient volumetric blood flow through the shunt, comparable to the blood flow through the internal carotid artery, which helped avoid ischaemic stroke after exclusion of the aneurysm from circulation. A conclusion was drawn on efficacy of this method of treatment.


Asunto(s)
Arteria Carótida Externa/cirugía , Arteria Carótida Interna/cirugía , Aneurisma Intracraneal/cirugía , Arteria Cerebral Media/cirugía , Anastomosis Quirúrgica , Isquemia Encefálica/etiología , Isquemia Encefálica/prevención & control , Humanos , Aneurisma Intracraneal/complicaciones , Ligadura , Arteria Radial/trasplante , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/prevención & control , Procedimientos Quirúrgicos Vasculares/métodos
7.
Medicine (Baltimore) ; 98(46): e16525, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31725599

RESUMEN

To evaluate the clinical value of NeuroGam software in assessing the brain foci perfusion changes by TC-ECD single photon emission computed tomography/computed tomography (SPECT/CT) brain imaging in patients with Moyamoya Disease (MMD).Seventy-two patients with MMD who underwent superficial temporal artery-middle cerebral artery (STA-MCA) bypass combined with encephalo-duro-myo-synangiosis (EDMS) surgical revascularization were included. Baseline and follow-up TC-ECD SPECT/CT brain scans were performed on all patients at least twice before and after operation. Pre- and post-SPECT dicom images were reoriented into Talairach space using NeuroGam Software package. Additional visual analysis was performed. Differences mean pixel value between pre- and post- operation brain perfusion were assessed with paired t test and McNemar test.Significant differences in the number of hypoperfusion foci were found between visual assessment and NeuroGam aided assessment. More hypoperfusion foci were found by NeuroGam software aided assessment in the frontal, parietal, temporal, occipital lobe, thalamus, basal ganglia and cerebellum before and after surgery (P < .0001). According to NeuroGam software assessment, the perfusion of frontal, parietal, temporal lobe, anterior and middle cerebral regions on the operative side significantly improved before and after surgery (t = -3.734, t = -3.935, t = -5.099, t = -4.006, t = -5.170, all P < .001). However, no significant differences were found in the occipital lobe (t = -1.962, P = .054), thalamus (t = 1.362, P = .177), basal ganglia (t = -2.394, P = .019), and cerebellum (t = 1.383, P = .171) before and after surgery.The NeuroGam software provides a quantitative approach for monitoring surgical effect of MMD in a variable time (3-12 months after surgery). It could discover the perfusion changes that are neglected in conventional visual assessment.


Asunto(s)
Cisteína/análogos & derivados , Interpretación de Imagen Asistida por Computador/métodos , Enfermedad de Moyamoya/diagnóstico por imagen , Compuestos de Organotecnecio , Radiofármacos , Tomografía Computarizada por Tomografía Computarizada de Emisión de Fotón Único/estadística & datos numéricos , Adolescente , Adulto , Encéfalo/diagnóstico por imagen , Encéfalo/cirugía , Revascularización Cerebral/métodos , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Arteria Cerebral Media/cirugía , Enfermedad de Moyamoya/cirugía , Periodo Posoperatorio , Periodo Preoperatorio , Tomografía Computarizada por Tomografía Computarizada de Emisión de Fotón Único/métodos , Programas Informáticos , Arterias Temporales/cirugía , Resultado del Tratamiento , Adulto Joven
8.
No Shinkei Geka ; 47(11): 1165-1171, 2019 Nov.
Artículo en Japonés | MEDLINE | ID: mdl-31761778

RESUMEN

The accessory middle cerebral artery(AMCA)is an anatomical variant of the MCA. It originates from the anterior cerebral artery, reaches the sylvian fissure, and supplies the territory of the middle cerebral artery. We report a case of embolic infarction associated with the AMCA that was treated using mechanical thrombectomy. An 82-year-old man with chronic atrial fibrillation experienced a sudden onset of left hemiparesis and was brought to our hospital. Magnetic resonance imaging showed a right temporal lobe, parietal lobe, and basal ganglion infarction, and indicated right internal carotid artery(ICA)occlusion. Mechanical thrombectomy using a Penumbra system was performed with complete recanalization. Final angiography revealed the existence of the AMCA, and the thrombus was located at the right ICA C2 portion to the main MCA. There have been twelve reported cases of ischemic stroke associated with the AMCA, including the present case. We summarized the data from the reported cases of ischemic stroke with an AMCA and evaluated their clinical characteristics and the pitfalls of endovascular treatment. These cases suggest that the AMCA may play a role in collateral flow around the main MCA occlusion, but provides insufficient collateral blood supply. Owing to the anatomical characteristics of the AMCA, we should pay attention to possible complications of endovascular treatment.


Asunto(s)
Arteria Cerebral Media , Accidente Cerebrovascular , Anciano de 80 o más Años , Arteria Carótida Interna , Angiografía Cerebral , Humanos , Infarto de la Arteria Cerebral Media , Masculino , Arteria Cerebral Media/cirugía , Trombectomía , Resultado del Tratamiento
9.
Artículo en Ruso | MEDLINE | ID: mdl-31577274

RESUMEN

OBJECTIVE: The purpose of the study is to present the results of successful treatment of a patient with traumatic arterial aneurysm of the middle cerebral artery (MCA). MATERIAL AND METHODS: A clinical case of traumatic arterial aneurysm of the M4 segment of MCA was studied. A patient with a ruptured traumatic aneurysm was transferred to Krasnogorsk City Hospital #1 for further examination and emergency surgery. RESULTS: On the sixth day after surgery, the patient was discharged in a satisfactory condition with almost complete regression of neurological symptoms. CONCLUSION: Treatment of traumatic arterial aneurysms requires an individual approach taking into account the past medical history, the clinical presentation, aneurysm location and anatomy, as well as the mechanism of injury. It is extremely difficult to suspect an arterial aneurysm after a patient had a traumatic brain injury as the incidence of this condition is very low. An angiographic study of cerebral vessels is needed for reliable diagnosis, not just solely performing standard computed tomography of the brain. Patients with this pathology require surgical intervention.


Asunto(s)
Aneurisma Roto , Aneurisma Intracraneal , Aneurisma Roto/cirugía , Humanos , Aneurisma Intracraneal/cirugía , Arteria Cerebral Media/cirugía , Tomografía Computarizada por Rayos X
11.
World Neurosurg ; 132: 292-294, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31476459

RESUMEN

BACKGROUND: Endovascular embolization is an important tool in the management of multiple pathologies as a preoperative adjunct in the care of arteriovenous malformations or vascular tumors. CASE DESCRIPTION: We report a case of delayed distal Onyx migration after surgical resection of a glomus vagale tumor, which had been preoperatively embolized. In this report, the patient underwent successful embolectomy of the migrated Onyx fragment using manual aspiration. CONCLUSIONS: This case represents the first in the literature to describe this potential delayed complication, as well as its management strategy.


Asunto(s)
Embolectomía/métodos , Migración de Cuerpo Extraño/cirugía , Tumor Glómico/terapia , Neoplasias de Cabeza y Cuello/terapia , Arteria Cerebral Media/cirugía , Arteria Oftálmica/cirugía , Polivinilos , Tantalio , Adulto , Angiografía por Tomografía Computarizada , Combinación de Medicamentos , Embolización Terapéutica , Migración de Cuerpo Extraño/diagnóstico por imagen , Migración de Cuerpo Extraño/etiología , Humanos , Masculino , Arteria Cerebral Media/diagnóstico por imagen , Arteria Oftálmica/diagnóstico por imagen
12.
World Neurosurg ; 132: 245-250, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31476466

RESUMEN

BACKGROUND: Little literature is available on mechanical thrombus aspiration in acute ischemic stroke with coincident ipsilateral unruptured aneurysm, especially with aneurysm proximal to the occlusion site. In this report, we describe a case of ischemic stroke in a patient with acute occlusion of M1 segment of the middle cerebral artery with coincident ipsilateral internal carotid artery-posterior communicating artery aneurysm who was successfully treated by mechanical clot retrieval using the Sofia (6F) PLUS technique (MicroVention Terumo, Tustin, California, USA). CASE DESCRIPTION: A 52-year-old woman presented at our hospital 6 hours after sudden onset of dysarthria and right limb hemiplegia on waking up in the morning. She was managed using a direct aspiration first pass technique for distal middle cerebral artery mechanical aspiration using the Sofia (6F) PLUS catheter. The thrombus was manually aspirated in 2 minutes, and Thrombolysis in Cerebral Infarction scale 3 flow was restored. Next, LVIS (MicroVention Terumo, Tustin, California, USA) stent-assisted coiling of the aneurysm of the posterior communicating segment of the left internal carotid artery was immediately undertaken. The National Institutes of Health Stroke Scale score was 4 at day 1 and 0 at day 7 postoperatively. No device-related or catheter-related complications occurred. CONCLUSIONS: Ischemic stroke patients with coincident aneurysm are at increased risk of aneurysmal rupture and should be managed with tailored endovascular strategies. Our case shows that a direct aspiration first pass technique using the Sofia (6F) PLUS catheter provides a safe, effective approach for thrombus aspiration in stroke patients.


Asunto(s)
Hallazgos Incidentales , Aneurisma Intracraneal/cirugía , Arteria Cerebral Media/cirugía , Accidente Cerebrovascular/cirugía , Trombectomía/métodos , Angiografía Cerebral , Angiografía por Tomografía Computarizada , Procedimientos Endovasculares/métodos , Femenino , Humanos , Aneurisma Intracraneal/complicaciones , Aneurisma Intracraneal/diagnóstico por imagen , Persona de Mediana Edad , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/diagnóstico por imagen , Resultado del Tratamiento
13.
World Neurosurg ; 132: 103-105, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31493595

RESUMEN

BACKGROUND: We present a case of a concurrent rupture of a middle cerebral artery (MCA) aneurysm and thrombosis of the associated vessel. CASE DESCRIPTION: A male patient presented with acute onset of hemiparesis and nuchal pain. A computed tomography scan revealed a right sided frontotemporal intracerebral hemorrhage and a basal subarachnoid hemorrhage. Owing to obliteration of the M1 segment of the MCA, no aneurysm was visible on digital subtraction angiography. Because of otherwise typical imaging for a subarachnoid hemorrhage, surgical exploration of the MCA was performed. During surgery, a thrombosed MCA bifurcation aneurysm was identified, clipped, and subsequently, endovascular (partly) recanalization of the MCA was performed. CONCLUSIONS: In extremely rare cases of aneurysm rupture and subsequent thrombosis of the associated vessel, a 2-stage approach seems to be feasible. In the present case, initial surgical securing of the aneurysm followed by endovascular recanalization of the occluded vessel provided good results.


Asunto(s)
Aneurisma Roto/cirugía , Hemorragia Cerebral/cirugía , Procedimientos Endovasculares/métodos , Infarto de la Arteria Cerebral Media/terapia , Aneurisma Intracraneal/cirugía , Arteria Cerebral Media/cirugía , Procedimientos Neuroquirúrgicos/métodos , Hemorragia Subaracnoidea/cirugía , Adulto , Aneurisma Roto/complicaciones , Hemorragia Cerebral/complicaciones , Hemorragia Cerebral/diagnóstico por imagen , Angiografía por Tomografía Computarizada , Humanos , Infarto de la Arteria Cerebral Media/diagnóstico por imagen , Infarto de la Arteria Cerebral Media/etiología , Aneurisma Intracraneal/complicaciones , Masculino , Arteria Cerebral Media/diagnóstico por imagen , Hemorragia Subaracnoidea/complicaciones , Hemorragia Subaracnoidea/diagnóstico por imagen , Tomografía Computarizada por Rayos X
14.
BMJ Case Rep ; 12(8)2019 Aug 26.
Artículo en Inglés | MEDLINE | ID: mdl-31451455

RESUMEN

A 92-year-old woman developed sudden consciousness disturbance, global aphasia and right hemiparesis. She had atrial fibrillation and cardioembolic stroke was diagnosed. Tissue plasminogen activator was administered, and endovascular treatment was initiated. The left middle cerebral artery was occluded and complete recanalisation was achieved after direct aspiration first-pass technique. However, MRI immediately after treatment showed reocclusion. Endovascular treatment was repeated and complete recanalisation was achieved. There was no evidence of cerebral artery dissection, but angiography soon after the second procedure revealed early reocclusion. Ozagrel, an antiplatelet agent, was administered intravenously and prevented reocclusion. Endothelial injury was speculated to have occurred during the first mechanical thrombectomy, leading to recurrent occlusion. Though the patient continued to have right hemiparesis, she recovered from her consciousness disturbance and aphasia after re-treatment.


Asunto(s)
Infarto de la Arteria Cerebral Media , Metacrilatos/administración & dosificación , Arteria Cerebral Media , Trombectomía , Anciano de 80 o más Años , Fibrilación Atrial/complicaciones , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/etiología , Isquemia Encefálica/cirugía , Angiografía Cerebral/métodos , Procedimientos Endovasculares/efectos adversos , Procedimientos Endovasculares/métodos , Femenino , Fibrinolíticos/administración & dosificación , Humanos , Infarto de la Arteria Cerebral Media/diagnóstico , Infarto de la Arteria Cerebral Media/etiología , Infarto de la Arteria Cerebral Media/cirugía , Angiografía por Resonancia Magnética/métodos , Arteria Cerebral Media/diagnóstico por imagen , Arteria Cerebral Media/lesiones , Arteria Cerebral Media/cirugía , Recurrencia , Reoperación/métodos , Trombectomía/efectos adversos , Trombectomía/métodos , Resultado del Tratamiento
15.
J Neurol Surg A Cent Eur Neurosurg ; 80(6): 441-453, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31466106

RESUMEN

OBJECTIVE: To investigate the difference in treatment outcomes according to the method used to select the recipient artery in superficial temporal artery-middle cerebral artery (STA-MCA) anastomoses. METHODS: We retrospectively analyzed the cases of 35 patients who underwent an STA-MCA anastomosis for internal carotid artery/MCA occlusion or stenosis. Patients were divided into two groups based on whether the recipient artery was precisely targeted by single-photon emission computed tomography (SPECT group) or less precisely targeted by visual assessment (Visual group). Then the bypass results in both groups were evaluated postoperatively based on changes in the regional cerebral blood flow (rCBF) and clinical outcomes. RESULTS: The delineated recipient artery in magnetic resonance angiography (MRA) matched the intraoperatively selected artery in 87.6% of the SPECT group cases and 83.3% of the Visual group cases. The SPECT group's digital subtraction angiography (DSA) findings coincided with the intraoperative selection in 76.9% of cases, and the MRA findings corresponded with the DSA findings in 92.3%. The postoperative areas with increased rCBF matched the perfused areas of intraoperatively selected arteries in 80.0% of the SPECT group cases and 77.8% of the Visual group cases. Postoperatively increased rCBF areas matching totally or partially with preoperative low-perfusion areas were observed in all cases. CONCLUSIONS: The present results revealed no significant differences in the change in rCBF in the low-perfusion area between the patients whose recipient arteries were selected by SPECT or visual assessment.


Asunto(s)
Anastomosis Quirúrgica/métodos , Estenosis Carotídea/cirugía , Arteria Cerebral Media/cirugía , Arterias Temporales/cirugía , Anciano , Angiografía de Substracción Digital , Estenosis Carotídea/diagnóstico por imagen , Revascularización Cerebral/métodos , Circulación Cerebrovascular/fisiología , Femenino , Humanos , Angiografía por Resonancia Magnética/métodos , Masculino , Persona de Mediana Edad , Arteria Cerebral Media/diagnóstico por imagen , Estudios Retrospectivos , Arterias Temporales/diagnóstico por imagen , Tomografía Computarizada de Emisión de Fotón Único , Resultado del Tratamiento
16.
Stroke ; 50(2): 419-427, 2019 02.
Artículo en Inglés | MEDLINE | ID: mdl-31287757

RESUMEN

Background and Purpose- It is unclear whether endovascular treatment (EVT) is beneficial for patients with acute ischemic stroke with occlusion of the M2 segment of the middle cerebral artery. We aimed to compare functional outcomes, technical aspects, and complications of EVT between patients with acute ischemic stroke because of M2 and M1 occlusions in clinical practice. Furthermore, outcome and complications after EVT in dominant and nondominant caliber M2 division occlusions were studied. Methods- Data were obtained from the MR CLEAN Registry (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) which is an ongoing observational study in 16 Dutch centers performing EVT in the Netherlands. Functional outcome was measured with the modified Rankin Scale score at 90 days. Neurological recovery (delta National Institutes of Health Stroke Scale), successful reperfusion rates (extended Thrombolysis in Cerebral Infarction ≥2B), and safety outcomes were also investigated. Associations between occlusion location and outcome were analyzed with ordinal logistic regression models, with adjustment for other prognostic factors. Results- In total, 244 (24%) patients with an M2 and 759 (76%) patients with an M1 occlusion who underwent EVT were analyzed. Functional outcomes were not significantly different between patients with M2 versus M1 occlusions (adjusted common odds ratio, 1.24; 95% CI, 0.87-1.73). Occurrence of symptomatic intracerebral hemorrhage was also similar for M2 and M1 occlusions (6.6% versus 5.9%; P=0.84). Further analysis about dominance of an M2 branch was performed in 175 (72%) patients. Neurological recovery was comparable (mean delta National Institutes of Health Stroke Scale, -2±10 for dominant M2, -5±5 for nondominant M2, and -4±9 [ P=0.24] for M1 occlusions). Furthermore, the effect of reperfusion status on functional outcome was comparable between occlusion divisions (common odds ratio, 1.27; 95% CI, 1.06-1.53 for dominant M2; common odds ratio, 1.32; 95% CI, 0.93-1.87 for nondominant M2; and common odds ratio, 1.35; 95% CI, 1.24-1.46 for M1 occlusions). Conclusions- Outcomes and complication rates after EVT were similar in patients with M2 and M1 occlusions. Although based on observational data and a limited sample size, a similar association of reperfusion status with functional outcome for all subgroups provides no evidence that patients with either a dominant or a nondominant M2 occlusion should be routinely excluded from EVT.


Asunto(s)
Procedimientos Endovasculares , Infarto de la Arteria Cerebral Media , Arteria Cerebral Media/cirugía , Sistema de Registros , Accidente Cerebrovascular , Anciano , Supervivencia sin Enfermedad , Femenino , Humanos , Infarto de la Arteria Cerebral Media/mortalidad , Infarto de la Arteria Cerebral Media/cirugía , Masculino , Persona de Mediana Edad , Países Bajos/epidemiología , Accidente Cerebrovascular/mortalidad , Accidente Cerebrovascular/cirugía , Tasa de Supervivencia
17.
J Craniofac Surg ; 30(8): 2597-2598, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31261337

RESUMEN

Distal MCA aneurysms are rarely seen in daily neurosurgical practice and they are, more commonly associated with infectious processes. Here, the authors present a 65-year-old, patient who had an atherosclerotic M4 segment located aneurysm. It was confirmed, that the aneurysm was not related with any infectious process. The patient had, presented clinically by a parietal infarction and she had been successfully operated. The neuronavigation system for this particular case aided us for a precise localization of the aneurysm and gave a chance for a smaller craniotomy.


Asunto(s)
Infarto Encefálico/cirugía , Aneurisma Intracraneal/cirugía , Lóbulo Parietal/cirugía , Anciano , Infarto Encefálico/complicaciones , Angiografía Cerebral , Craneotomía , Femenino , Humanos , Aneurisma Intracraneal/complicaciones , Arteria Cerebral Media/cirugía , Neuronavegación
18.
World Neurosurg ; 130: 324-334, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31323413

RESUMEN

BACKGROUND: Mirror aneurysms represent 2 adjacent arterial protrusions. Although the size is considered a major risk factor in terms of rupture, sometimes it is the smaller aneurysm that ruptures. Here, we present the contemporary management of mirror distal anterior cerebral artery (DACA) aneurysms associated with multiple aneurysms. Computational fluid dynamic (CFD) analysis was performed when assessing multiple aneurysms using Hemoscope, version 2015. CASE DESCRIPTION: Among multiple aneurysms, a mirror A2/A3 DACA aneurysm was found in a single patient. Surgical treatment was provided for all aneurysms through a single-stage procedure. The left ruptured A2/A3 aneurysm was smaller compared with the right (7.5 × 3.5 mm/10.8 × 3.2 mm). CFD showed greater wall pressure (WP) in the left ruptured A2/A3 aneurysm (left A2/A3 WP 84,000-84,402 Inst. mm Hg/right A2/3 WP 84,224-84,315). WP in the left middle cerebral artery and anterior communicating artery aneurysms showed lesser values compared with the ruptured aneurysm (WP upper values 84,361 and 84,367, respectively). Wall shear stress showed low values for all aneurysms with the lowest flow rate values in the left A2/A3 aneurysm. CONCLUSIONS: In cases of ruptured mirror aneurysms followed by the presence of intracerebral hematoma, surgery is considered the primary option with the best results. A one-stage dual craniotomy procedure was found safe in the associated treatment of other multiple aneurysms. At present, the size of the aneurysm, the hemodynamic influence, and the local configuration are all considerations during the preoperative assessment of multiple aneurysm cases. According to our knowledge, this article presents the first CFD analysis of mirror DACA aneurysms associated with aneurysm multiplicity.


Asunto(s)
Aneurisma Roto/cirugía , Arteria Cerebral Anterior/cirugía , Aneurisma Intracraneal/cirugía , Arteria Cerebral Media/cirugía , Aneurisma Roto/diagnóstico por imagen , Angiografía Cerebral/métodos , Femenino , Hemodinámica/fisiología , Humanos , Aneurisma Intracraneal/diagnóstico por imagen , Persona de Mediana Edad , Estrés Mecánico
19.
Rozhl Chir ; 98(6): 252-255, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31331182

RESUMEN

INTRODUCTION: Cerebrovascular events are among the most common causes of invalidity or death. The aim of treatment in acute cerebral ischemia is to restore the blood flow before irreversible necrosis of brain tissue and persistent neurologic deficit occur. Pharmacological, endovascular and surgical methods are employed in the treatment of these patients. CASE REPORT: The authors present a case report of a 56-year-old woman with acute cerebral ischemia caused by tandem occlusion of the left common carotid artery and the M1 segment of middle cerebral artery. In the initial phase the patient was treated by intravenous thrombolysis with minimal success. Common carotid artery was occluded and mechanical extraction of embolus was successfully performed through direct carotid bifurcation puncture. Almost complete regression of neurologic deficit occurred after the endovascular recanalization. Occluded common carotid stump and bifurcation was considered as a source of embolization and therefore, to prevent further cerebrovascular event, a subclavian-carotid bypass was performed on the 15th day after the stroke. CONCLUSION: In the reported patient with symptomatic tandem occlusion of common carotid artery and the M1 part of middle cerebral artery, recanalization of cerebral artery was attained by the combination of pharmacological and endovascular method. Consequent subclavian-to-carotid bypass was performed in tertiary prevention of further cerebrovascular event.


Asunto(s)
Estenosis Carotídea , Procedimientos Endovasculares , Arteria Cerebral Media , Accidente Cerebrovascular , Arteria Carótida Interna , Estenosis Carotídea/cirugía , Femenino , Humanos , Persona de Mediana Edad , Arteria Cerebral Media/cirugía , Resultado del Tratamiento
20.
World Neurosurg ; 130: e971-e987, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31302280

RESUMEN

OBJECTIVE: Middle cerebral artery (MCA) aneurysms have continued to be primarily managed microsurgically. In cases of complex MCA aneurysms, revascularization could facilitate effective aneurysm treatment. The MCA candelabra provides excellent candidates for in situ side-to-side bypass. In the present case series, we have described applications of MCA in situ side-to-side bypass for the management of complex MCA aneurysms, along with a review of the pertinent data. METHODS: A retrospective review of a prospectively maintained neurosurgical patient database was performed to identify all patients treated with MCA side-to-side in situ bypass. Six consecutive patients were identified and included in the present series, representing a single-surgeon experience from February 2016 to November 2018. RESULTS: Of the 6 complex MCA aneurysms, all were unruptured, and one half had been treated via a minipterional approach that also allowed for simultaneous anterior communicating artery aneurysm clipping in 1 case. The median temporary occlusion time for anastomosis was 33 minutes (interquartile range [IQR], 30.3-35 minutes). Bypass patency was confirmed in all cases both intraoperatively and postoperatively. The median hospitalization time was 4.5 days (IQR, 2-8 days). The median follow-up period was 5.5 months (IQR, 2.8-22.3 months). All patients had achieved excellent or good (≤1) modified Rankin scale scores at discharge and during the follow-up period. No mortalities occurred, and no technical, bypass-related, or ischemic morbidities had developed. CONCLUSIONS: Our experience with MCA side-to-side in situ bypass has demonstrated its safety and utility in complex MCA aneurysm management. The favorable anatomy of the MCA branches allows for minimally invasive revascularization and clipping that can potentially reduce the hospitalization time and incidence of perioperative morbidity.


Asunto(s)
Revascularización Cerebral/métodos , Aneurisma Intracraneal/cirugía , Arteria Cerebral Media/cirugía , Procedimientos Neuroquirúrgicos/métodos , Anciano , Femenino , Humanos , Aneurisma Intracraneal/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Arteria Cerebral Media/diagnóstico por imagen , Estudios Prospectivos , Estudios Retrospectivos , Resultado del Tratamiento
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