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1.
No Shinkei Geka ; 48(1): 47-54, 2020 Jan.
Artigo em Japonês | MEDLINE | ID: mdl-31983688

RESUMO

We report a rare case of perianeurysmal edema(PAE)around the dome of a usual intracranial aneurysm. A 79-year-old woman who presented with a dull headache that had become stronger from a month before was referred to our hospital for further examination of an aneurysm. MR angiogram had detected the aneurysm, having a dumbbell shape and arising from the M2 bifurcation of the right middle cerebral artery. Initial fluid attenuated inversion recovery and T2 weighed images revealed a slightly high intensity area in the brain around the dome of the aneurysm buried in the right temporal lobe, suggesting the presence of PAE possibly due to a preceding minor leak or partial thrombosis or impending rupture of the aneurysm. A CT angiogram revealed bleb formation of the aneurysm(size:10×6 to 4mm)without definite intraluminal thrombosis. The patient and her family consented to emergency craniotomy. During the microsurgical approach, thickening of the arachnoid membrane on the right sylvian fissure was observed. The subarachnoid space between the right frontal and temporal lobes was turbid/adhesive, and deposition of hemosiderin was observed around the aneurysm, indicating a preceding minor bleeding. The aneurysm was successfully clipped, and the postoperative course was uneventful. The present case showed that PAE could be observed even in a usual aneurysm. This finding might be an indirect sign of a preceding minor leak from the aneurysm, particularly when the dome is buried in brain parenchyma or is in close contact with the surrounding brain surface.


Assuntos
Edema , Aneurisma Intracraniano , Idoso , Craniotomia , Edema/diagnóstico por imagem , Edema/etiologia , Feminino , Humanos , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/cirurgia , Imagem por Ressonância Magnética , Artéria Cerebral Média
2.
World Neurosurg ; 133: 173-177, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31605854

RESUMO

BACKGROUND: Despite a variety of technologies that are available for treatment of complex intracranial aneurysms, certain anatomic configurations remain challenging to address endovascularly. CASE DESCRIPTION: A patient was found to have an incidental 12 mm × 11 mm × 10 mm, wide-necked right posterior communicating artery aneurysm with a fetal origin of the posterior cerebral artery arising directly from the aneurysm dome. After multidisciplinary discussion, a staged endovascular treatment approach was undertaken in 2 stages. First, a Y-stent construct using 2 overlapping Neuroform Atlas stents was placed into the M1 and fetal posterior cerebral artery segments. Two months later, after endothelialization of the stent construct, coil embolization of the aneurysm was performed. The patient tolerated both stages of the procedure well and was discharged the following day in each case. She remained neurologically intact, and at follow-up 5 months later had no evidence of residual or recurrent aneurysm. CONCLUSIONS: This case illustrates a number of important considerations in the management approach for wide-necked intracranial aneurysms.


Assuntos
Embolização Terapêutica/métodos , Aneurisma Intracraniano/cirurgia , Artéria Cerebral Posterior/cirurgia , Stents , Idoso , Feminino , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Imagem por Ressonância Magnética , Artéria Cerebral Posterior/diagnóstico por imagem , Resultado do Tratamento
3.
World Neurosurg ; 133: e739-e744, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31606499

RESUMO

OBJECTIVE: To carry out surgery safely in vessels with stents, it is essential to have knowledge of what would happen if the stents were clamped or cut. Using all stents that are permitted in Japan, we recorded with a surgical microscope the behavior of stents when they were clamped or cut and discussed the morphologic changes along with image findings. METHODS: We classified carotid artery and intracranial stents as group 1A and 1B or group 2A and 2B according to the structure of stent eye: laser cut or blade. Each stent was clamped using a Yasargil aneurysm clip, bulldog forceps, and vascular forceps. Degree of closure and presence or absence of stent deformation after declamping were recorded using a surgical microscope. Furthermore, we performed morphologic evaluations using high-resolution cone-beam computed tomography. Lastly, each stent was cut; the behavior of the cut stent was recorded, and differences between stents were examined. RESULTS: Complete clamping was confirmed both visually and based on image evaluations with bulldog forceps and vascular forceps in the groups of carotid artery stents, with the Yasargil aneurysm clip in the intracranial stents. In the blade-type stents, we found that the stents elongated during clamping, and the component wire scattered at the time of stent cutting. Furthermore, the stents could be easily separated by holding with forceps. CONCLUSIONS: Knowing the properties of each stent is essential to conduct safe surgery in response to complications. Special care must be taken when clamping and cutting blade-type stents.


Assuntos
Procedimentos Endovasculares/instrumentação , Teste de Materiais , Stents , Artérias Carótidas/cirurgia , Humanos , Técnicas In Vitro , Aneurisma Intracraniano/cirurgia
4.
World Neurosurg ; 133: 159-162, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31606505

RESUMO

BACKGROUND: The persistent trigeminal artery is the most common type of persistent fetal carotid-basilar anastomosis. Patients who are found to have a persistent trigeminal artery are more likely to harbor intracranial aneurysms, both along the persistent trigeminal artery and elsewhere in the cerebral vasculature. CASE DESCRIPTION: We report the case of a 48-year-old male who presented with a ruptured persistent trigeminal artery aneurysm arising at the trigeminal artery-basilar junction. In this patient, the trigeminal artery was the primary blood supply to the internal carotid artery due to an absent common carotid artery. He was treated successfully with balloon-assisted coil embolization and occlusion of the persistent trigeminal artery. CONCLUSIONS: Although several variations of the persistent trigeminal artery describe blood flow from the internal carotid to the posterior circulation, this is the first case to describe a persistent trigeminal artery that is the primary supply of the internal carotid artery due to an absent common carotid artery. Successful treatment of aneurysms of the persistent trigeminal artery may require occlusion of the artery.


Assuntos
Aneurisma Roto/cirurgia , Oclusão com Balão , Artéria Basilar/cirurgia , Aneurisma Intracraniano/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
5.
World Neurosurg ; 133: e666-e682, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31568908

RESUMO

BACKGROUND: Giant aneurysms at carotid arteries are typically treated with flow diverter (FD) stents in the clinic. Although the goal of an FD stent is to direct most of the blood flow into the main artery, not much is known regarding the effects of wire number an FD possesses on the hemodynamics inside the aneurysm. METHODS: In this study, 48-, 72-, and 96-wire FD stents were separately implanted into the site of aneurysm of a 45-year-old woman to evaluate the effects of the FD's number of wires on fluid flow behavior in the aneurysm sac. Time evolution of both finite-time Lyapunov exponent (FTLE) and hyperbolic time fields in the aneurysm sac were calculated by using computational fluid dynamics along with Lagrangian coherent structure (LCS) methods. RESULTS: The computations reveal that a 48-wire FD stent allows a large amount of blood to enter inside the aneurysm sac revealing scattered nonstagnant flow zones formation. Besides, time-dependent results of LCS analysis show that most of the blood flow is diverted into the main artery when 72- and 96-wire number Surpass brand FD stents are separately implanted into the site of the aneurysm, yielding a small amount of blood flow to penetrate into the aneurysm sac. CONCLUSIONS: Furthermore, FTLE and hyperbolic time field plots are in good agreement with the patient's digital subtraction angiography image captured 3.5 minutes after 72-wire Surpass brand FD stent implantation.


Assuntos
Procedimentos Endovasculares/instrumentação , Hemodinâmica/fisiologia , Aneurisma Intracraniano/cirurgia , Modelos Biológicos , Stents , Angiografia Digital , Simulação por Computador , Feminino , Humanos , Hidrodinâmica , Pessoa de Meia-Idade
6.
World Neurosurg ; 133: 172, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31542443

RESUMO

A 5-year-old girl was brought to the clinic because of chronic intermittent left-sided headaches. The patient underwent computed tomographic angiography, which demonstrated a giant aneurysm that involved the P2 segment of the left posterior cerebral artery. Before treatment proceeded, consent was obtained from the patient's legal guardian. A trapping-evacuation technique was used for proximal control and decompression so that a clip could be placed on the proximal inflow artery of the aneurysm. First, embolization was performed for aneurysm trapping and for sacrifice of the parent vessel. Two days later, the patient was taken to the operating room for open surgical decompression, clipping, and reconstruction. Heparin was administered during the embolization stage of the operation. The patient did well postoperatively and was discharged home. The 3-month follow-up evaluation demonstrated a right superior homonymous quadrantanopia and no other neurologic deficits. The patient's clinical course is summarized in Video 1.


Assuntos
Descompressão Cirúrgica/métodos , Aneurisma Intracraniano/cirurgia , Artéria Cerebral Posterior/cirurgia , Angiografia Cerebral , Criança , Pré-Escolar , Angiografia por Tomografia Computadorizada , Embolização Terapêutica , Feminino , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Artéria Cerebral Posterior/diagnóstico por imagem
7.
World Neurosurg ; 133: 21-24, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31526883

RESUMO

BACKGROUND: Giant serpentine aneurysms that occur in the distal anterior cerebral artery are extremely rare and challenging to manage because of their complex structure. In this case, we show an aneurysm resection performed after in situ side-to-side A3-A3 bypass to treat a giant serpentine distal anterior cerebral artery aneurysm. CASE DESCRIPTION: Here, we present the case of a 55-year-old man with a giant distal anterior cerebral artery serpentine aneurysm who presented with severe headache and progressive unconsciousness. Computed tomography and cerebral angiography revealed a giant serpentine aneurysm in the right A2 segment. Both the right pericallosal and callosal marginal arteries branched from the outflow tract. To relieve the mass effect and preserve distal blood flow, an in situ side-to-side A3-A3 anastomosis and a partial aneurysm resection were performed sequentially. Postoperative cerebral angiography revealed no aneurysm blood filling and good perfusion in both anterior cerebral artery territories. CONCLUSIONS: Anterior cerebral artery giant serpentine aneurysms are rare and usually present with headache and mass effect. Aneurysm resection and distal flow protection are issues that we must consider. The sequential procedure of anastomosis and aneurysm resection is a feasible and safe option.


Assuntos
Anastomose Cirúrgica/métodos , Artéria Cerebral Anterior/cirurgia , Revascularização Cerebral/métodos , Aneurisma Intracraniano/cirurgia , Artéria Cerebral Anterior/diagnóstico por imagem , Angiografia Cerebral , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Resultado do Tratamento
8.
World Neurosurg ; 133: 74-79, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31574334

RESUMO

BACKGROUND: Indocyanine green (ICG) video angiography has been widely used in cerebrovascular surgery. ICG injection is generally safe, with a low incidence of complications. ICG-related anaphylactic reactions during neurosurgery have been rarely reported. We report the cases of 2 patients who had experienced anaphylactic shock in response to intravenous ICG injection (DID Indocyanine Green [Dongindang, Inc., Gyeonggi-do, Republic of Korea]) during intracranial aneurysm (IA) surgery. CASE DESCRIPTION: The first patient, a 69-year-old woman with an unruptured IA, had been undergoing clipping surgery under general anesthesia. Immediately after ICG injection, her blood pressure suddenly decreased from 140/80 mm Hg to 50/30 mm Hg and she developed a skin rash on her abdomen and all extremities. Chest compression was initiated, and her vital signs gradually recovered to their pre-ICG levels within 10 minutes. The second patient was a 58-year-old woman with an unruptured IA who had been undergoing clipping surgery. After ICG injection, her blood pressure had decreased from 130/80 mm Hg to 60/40 mm Hg, and a rash-like skin lesion was observed on her abdomen. After intravenous injection of norepinephrine and dexamethasone, her blood pressure recovered to its pre-ICG level within 30 minutes and remained stable thereafter. The postoperative ICG skin provocation test findings were positive for both patients; however, only 1 patient showed markedly increased serum tryptase levels. CONCLUSION: Despite the rarity of ICG-related anaphylaxis, clinicians should be aware of this unexpected, but potentially life-threatening, drug reaction in patients undergoing cerebrovascular surgery.


Assuntos
Anafilaxia/etiologia , Angiografia Digital/efeitos adversos , Angiografia Cerebral/efeitos adversos , Verde de Indocianina/efeitos adversos , Aneurisma Intracraniano/cirurgia , Procedimentos Neurocirúrgicos/efeitos adversos , Idoso , Feminino , Humanos , Pessoa de Meia-Idade
9.
World Neurosurg ; 133: e89-e96, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31479795

RESUMO

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.


Assuntos
Oclusão com Balão , Artéria Carótida Interna/cirurgia , Revascularização Cerebral/métodos , Aneurisma Intracraniano/cirurgia , Artéria Cerebral Média/cirurgia , Artéria Radial/transplante , Artérias Temporais/cirurgia , Adulto , Idoso , Aneurisma Roto/etiologia , Aneurisma Roto/cirurgia , Circulação Cerebrovascular , Transtornos Cognitivos/etiologia , Estudos de Viabilidade , Feminino , Hemiplegia/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos Retrospectivos , Hemorragia Subaracnóidea/etiologia , Adulto Jovem
10.
World Neurosurg ; 133: e149-e155, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31476473

RESUMO

BACKGROUND: Although new imaging tools have been developed for the detection of smaller aneurysms, angiographically negative microaneurysms are still encountered during cerebral microsurgery. Currently, only limited information regarding incidence and efficacy of treatment of these microaneurysms is available. METHODS: We investigated the incidence and treatment of incidental microaneurysms (IMAs) in the last 5 years. IMAs are unidentifiable and invisible on preoperative angiography, but are detected during microvascular surgery. The inclusion criteria were aneurysm cases treated with microsurgery via transsylvian approaches, and those undergoing preoperative digital subtraction angiography. RESULTS: This study enrolled 484 surgical cases (248 cases of subarachnoid hemorrhage and 236 cases of unruptured aneurysms) in 460 patients, and 33 tiny aneurysms were found in 31 operative cases (6.4% incidence per operation). The most typical type was located on another branching site of the middle cerebral artery found during neck clipping of the middle cerebral artery bifurcation aneurysm. A patient with multiple aneurysms presented a statistically significant risk (375/78 vs. 15/16; P < 0.001) of IMA identification. IMAs were treated by clipping and wrapping in 18 and 15 cases, respectively, without complications. CONCLUSIONS: This study revealed a 6.4% incidence of IMAs; however, this could be underestimated because of the limited range of inspection. Early detection of an IMA through careful inspection during microvascular surgery could be beneficial, especially in patients with multiple aneurysms.


Assuntos
Aneurisma Intracraniano/epidemiologia , Microaneurisma/epidemiologia , Microcirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Aneurisma Roto/cirurgia , Bandagens , Angiografia Cerebral , Comorbidade , Constrição , Craniotomia , Feminino , Humanos , Incidência , Achados Incidentais , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/cirurgia , Aneurisma Intracraniano/terapia , Masculino , Microaneurisma/diagnóstico por imagem , Microaneurisma/cirurgia , Microaneurisma/terapia , Pessoa de Meia-Idade
11.
World Neurosurg ; 133: 392-397, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31476475

RESUMO

BACKGROUND: Up to 3.2% of the adult population has an unruptured intracranial aneurysm (IA). Flow diversion is a relatively new treatment technique that is especially useful for large and morphologically unfavorable IAs. METHODS: A previously healthy woman aged 32 years presented with a 6-month history of ptosis and ophthalmoplegia of the left eye. A magnetic resonance imaging scan revealed a giant left internal carotid artery aneurysm. She was admitted for treatment using flow diversion. After delivery of the flow diverter (FD), prolapse of the proximal end of the stent into the aneurysmal sac was observed. FD stabilization was achieved by deploying multiple coils through a previously placed microcatheter to push the prolapsed end away from the aneurysmal lumen. RESULTS: The patient had a favorable outcome, with reduction of preoperative mass effect symptoms and complete obliteration of the aneurysm persisting at the 3-month follow-up. CONCLUSIONS: Giant IAs remain one of the most daunting clinical problems to treat. FD displacement is a rare (0.5%-0.75%) and possibly fatal complication. Currently, no clinical guidelines exist for its management. Adjunctive coiling is a possible rescue strategy for stabilizing an FD that foreshortened and prolapsed into the aneurysmal sac. Further studies are needed to identify the best approach to this complication.


Assuntos
Embolização Terapêutica/métodos , Procedimentos Endovasculares/métodos , Aneurisma Intracraniano/cirurgia , Stents , Adulto , Feminino , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Imagem por Ressonância Magnética , Resultado do Tratamento
13.
Angiol Sosud Khir ; 25(4): 131-138, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31855210

RESUMO

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.


Assuntos
Artéria Carótida Externa/cirurgia , Artéria Carótida Interna/cirurgia , Aneurisma Intracraniano/cirurgia , Artéria Cerebral Média/cirurgia , Anastomose Cirúrgica , Isquemia Encefálica/etiologia , Isquemia Encefálica/prevenção & controle , Humanos , Aneurisma Intracraniano/complicações , Ligadura , Artéria Radial/transplante , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/prevenção & controle , Procedimentos Cirúrgicos Vasculares/métodos
14.
No Shinkei Geka ; 47(12): 1261-1267, 2019 Dec.
Artigo em Japonês | MEDLINE | ID: mdl-31874947

RESUMO

A 3-year-old girl was admitted to our hospital with symptoms including headache, nausea, and vomiting. Head CT scan showed subarachnoid hemorrhage in the right carotid cistern. Digital subtraction angiography revealed right internal caortid artery(ICA)malformation at the C1 segment with collateral plexiform arterial network. The right ICA branched into posterior communicating artery and anterior choroidal artery(AChoA)and the ICA was decreased in caliber. The distal portion of the C1 segment of the ICA continued to the collateral plexiform arterial network, forming a saccular aneurysm. The plexiform arterial network connected to the right AChoA and the anterior communicating artery and continued to the distal portion of the right M1 segment. Right cervical carotid artery was normal. There was no transdural collateral flow from the right external carotid artery. Genetic analysis of a variant of RING finger protein 213 was negative. We diagnosed this patient with C1 dysplasia. We performed coil embolization for the aneurysm. The patient was discharged without any neurological deficit. Four months after the surgery, recurrence of the aneurysm was observed. We suspected that the aneurysm was formed due to hemodynamic mechanism and vulnerability of the collateral plexiform arterial network.


Assuntos
Aneurisma Roto , Aneurisma Intracraniano , Hemorragia Subaracnóidea , Aneurisma Roto/complicações , Aneurisma Roto/cirurgia , Angiografia Digital , Artéria Carótida Interna , Pré-Escolar , Feminino , Humanos , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/cirurgia , Hemorragia Subaracnóidea/etiologia , Hemorragia Subaracnóidea/cirurgia
15.
No Shinkei Geka ; 47(10): 1089-1092, 2019 Oct.
Artigo em Japonês | MEDLINE | ID: mdl-31666426

RESUMO

We report a unique case of middle cerebral artery fenestration with M2 fusion detected during an aneurysm clipping. A 72-year-old woman was diagnosed with an unruptured aneurysm of the right middle cerebral artery, and middle cerebral artery fenestration with M2 fusion was detected during the aneurysm clipping surgery. It was difficult to identify this unusual vascular anomaly before the surgery. Therefore, neurosurgeons should be cautious of such hidden vascular anomalies and be prepared for the possible complications during surgery.


Assuntos
Aneurisma Intracraniano , Artéria Cerebral Média , Idoso , Feminino , Humanos , Aneurisma Intracraniano/cirurgia
16.
J Comput Assist Tomogr ; 43(6): 948-952, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31688249

RESUMO

PURPOSE: This study aimed to evaluate the image quality and degree of metal artifact reduction using the new-generation gemstone spectral imaging (GSI) and metal artifact reduction software (MARs) and to demonstrate the optimal monochromatic energy level for dual-energy cerebral computed tomography angiography (CTA) in patients with intracranial aneurysm after endovascular treatment. MATERIAL AND METHODS: A total of 20 patients with cerebral aneurysms treated with coils or clips underwent CTA using gemstone spectral computed tomography. Artifact index was calculated at each energy level with and without MARs. Signal-to-noise (SNR) and contrast-to-noise (CNR) ratios were calculated on all axial images with MARs; subjective evaluation was done by using a 4-point scale and a 3-point scale for assessing noise and vessel contrast, respectively, and compared between the monochromatic energy levels. RESULTS: The artifact index value of group GSI-MARs was significantly lower than that of group GSI at each monochromatic energy level (all, P < 0.01). Contrast-to-noise ratio and SNR of the parent arteries decreased as the energy increased from 40 to 140 keV in group GSI-MARs (all, P < 0.01). Signal-to-noise ratio and CNR between each 2 adjacent monochromatic energy level showed significant difference (all, P < 0.01). Subjective evaluation showed that a monochromatic energy level between 40 and 70 keV provided the optimal image quality. CONCLUSION: Gemstone spectral imaging with MARs could reduce metal artifacts and improve the image quality of cerebral CTA after coil or clip treatment. The new generation of GSI could provide better CNR and SNR at lower energy level, and the best image quality was obtained at energy level 40 to 70 keV for GSI-MARs.


Assuntos
Procedimentos Endovasculares/métodos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/cirurgia , Intensificação de Imagem Radiográfica/métodos , Adulto , Idoso , Artefatos , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Estudos Retrospectivos , Razão Sinal-Ruído , Software
17.
Neurosurg Rev ; 42(4): 843-852, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31617125

RESUMO

To perform a systematic review of the techniques for transient circulatory arrest during intracerebral aneurysm surgery according to the PRISMA guidelines. Search of PubMed and Google Scholar using the following: ("heart arrest" OR "cardiac standstill"[All Fields]) AND ("intracranial aneurysm" OR "intracranial"[All Fields] AND "aneurysm"[All Fields]). A total of 41 original articles were retrieved, of which 17 were excluded (review articles, editorials and single-case reports). A total of 24 separate articles published between 1984 and 2018 were included in the final analysis, where the majority of patients harbored anterior circulation giant or large aneurysms. Adenosine-induced cardiac arrest gave a short, temporary asystole. The method had benefits in aneurysm with a broad neck, a thin wall, in specific localizations with narrow surgical corridors or in case of intraoperative rupture. Rapid ventricular pacing (RVP) allows a longer and more easily controlled hypotension. Its use is largely limited to elective cases. Deep hypothermic circulatory arrest required a complex infrastructure, and fatal procedure complications lead to a 11.5-30% 30-day mortality rate, limiting its application to giant or complex aneurysm of the basilar artery or to residual posterior circulation aneurysm after endovascular treatment. Adenosine and RVP are both effective options to facilitate clipping of complex aneurysms. However, their use in patient with ischemic heart disease and cardiac arrhythmias should be avoided, and their safety in the context of subarachnoid hemorrhage is yet to be determined. Today, deep hypothermic circulatory arrest is almost obsolete due to endovascular alternatives.


Assuntos
Parada Cardíaca Induzida/métodos , Aneurisma Intracraniano/cirurgia , Procedimentos Neurocirúrgicos/métodos , Adenosina/administração & dosagem , Estimulação Cardíaca Artificial/métodos , Fármacos Cardiovasculares/administração & dosagem , Parada Circulatória Induzida por Hipotermia Profunda , Humanos , Hipotensão/induzido quimicamente , Hipotensão/etiologia
18.
BMC Neurol ; 19(1): 245, 2019 Oct 22.
Artigo em Inglês | MEDLINE | ID: mdl-31640586

RESUMO

BACKGROUND: The purpose of this study was to report our preliminary experience of stent-assisted coiling (SAC) of wide-necked intracranial aneurysms with a single microcatheter in patients with parent arteries that were small-caliber, with stenosis, or a very tortuous course. METHODS: Between March 2018 and December 2018, we treated 394 aneurysms in 359 patients with endovascular treatment. Among 197 aneurysms treated by SAC, there were 16 cases (all wide-necked unruptured aneurysms) treated by SAC with a single microcatheter and a Neuroform Atlas stent. Follow-up angiography was performed at 6 to 12 months after SAC, and clinical follow-up was performed from 6 to 12 months in all patients. RESULTS: The reasons for SAC with a single 0.0165-in. microcatheter were small-caliber (n = 4), stenosis (n = 2), and very tortuous course (n = 10) of the parent arteries. There was no complication related to delivering or deploying the Neuroform Atlas stent as well as no failure of selecting aneurysm by cell-through technique. All patients had a modified Rankin score of 0 at discharge and at follow-up. Initial angiographic results showed six cases (37.5%) of complete occlusion. In follow-up angiographies, 12 cases (75.0%) achieved compete occlusion. CONCLUSION: When performing SAC of wide-necked intracranial aneurysms in parent arteries with small-caliber, stenosis, or a very tortuous course, cell-through SAC using a single microcatheter and a Neuroform Atlas stent within a 5 Fr- (or smaller) guiding or intermediate catheter might be a useful option.


Assuntos
Procedimentos Endovasculares/instrumentação , Aneurisma Intracraniano/cirurgia , Idoso , Procedimentos Endovasculares/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Stents , Resultado do Tratamento
20.
Medicine (Baltimore) ; 98(39): e17151, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574820

RESUMO

RATIONALE: Persistent primitive hypoglossal artery (PPHA) is often associated with intracranial anomalies such as aneurysms. Surgical treatment of aneurysms on the PPHA is challenging due to that the posterior circulation depends solely on PPHA. PATIENT CONCERNS: A case of an 83-year-old woman with a large aneurysm on PPHA presented with vertigo was reported. DIAGNOSIS: Three-dimensional angiogram revealed a wide-neck aneurysm on the PPHA. INTERVENTIONS: The aneurysm was successfully treated using a novel low-profile visualized intraluminal support stent-assisted coiling technique. OUTCOMES: No complications occurred during the procedure. The final angiogram confirmed the patency of the posterior inferior cerebellar artery and the parent artery and its distal branches. LESSONS: Our case suggests that stent-assisted coil embolization is safe and effective for the treatment of aneurysms on the PPHA.


Assuntos
Embolização Terapêutica/métodos , Aneurisma Intracraniano/cirurgia , Artéria Cerebral Posterior/cirurgia , Stents , Idoso de 80 Anos ou mais , Embolização Terapêutica/instrumentação , Feminino , Humanos , Resultado do Tratamento
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