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1.
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
2.
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
3.
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
4.
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
5.
Pan Afr Med J ; 34: 63, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31762927

RESUMO

Bleeding during pregnancy may not be due to obstetric causes. Pregnancy is a predisposing factor for some disorders due to physiological changes. These obstetric bleedings are rare but are responsible for high materno-fetal mortality. Prognosis depends on the speed of diagnosis as well as on multidisciplinary management. Splenic artery aneurysm (SAA) rupture during pregnancy is rare with a dreadful prognosis. Common clinical signs including abdominal pain associated with hypotension and anemia are very misleading for the obstetrician who usually suspects retroplacental hematoma or uterine rupture. We report the case of a pregnant patient requiring emergency laparotomy due to the detection of splenic artery aneurysm rupture on imaging test.


Assuntos
Aneurisma Roto/diagnóstico por imagem , Complicações Cardiovasculares na Gravidez/diagnóstico por imagem , Artéria Esplênica/diagnóstico por imagem , Dor Abdominal/etiologia , Adulto , Aneurisma Roto/cirurgia , Feminino , Humanos , Laparotomia/métodos , Gravidez , Complicações Cardiovasculares na Gravidez/cirurgia , Ruptura Espontânea/diagnóstico por imagem , Ruptura Espontânea/cirurgia
7.
Artigo em Russo | MEDLINE | ID: mdl-31577274

RESUMO

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.


Assuntos
Aneurisma Roto , Aneurisma Intracraniano , Aneurisma Roto/cirurgia , Humanos , Aneurisma Intracraniano/cirurgia , Artéria Cerebral Média/cirurgia , Tomografia Computadorizada por Raios X
8.
Neurocirugía (Soc. Luso-Esp. Neurocir.) ; 30(5): 207-214, sept.-oct. 2019. ilus, tab
Artigo em Inglês | IBECS | ID: ibc-183873

RESUMO

Introduction and objectives: The anterior communicating complex is one the most common locations for aneurysm development. It receives blood from both carotid circulations and the effect of synchrony on the arrival of blood flow has not been previously studied. The objective of this study was to compare the asynchrony conditions of the A1 pulse and its effects on the haemodynamic conditions of anterior communicating artery (ACoA) aneurysms. Materials and methods: From 2008 to 2017, 54 anterior communicating artery aneurysms treated at our centre were included in the study. Computational fluid dynamics (CFD) techniques were employed and simulations consisted of complete conditions of synchrony and introducing a delay of 0.2s in the non-dominant A1 artery. Time-averaged wall shear stress (TAWSS), low shear area (LSA), A1 diameter and ACoA angles were measured. Results: The difference in the LSA in conditions of synchrony and asynchrony resulted in a broad range of positive and negative values. The symmetry index (p=0.04) and A1/A2 angle on the dominant artery (p=0.04) were associated with changes in LSA. Conclusions: In asynchrony, LSA increased in the absence of A1 asymmetry and low A1/A2 angles, potentially increasing the risk of aneurysm rupture in this location


Introducción y objetivos: El complejo comunicante anterior es una de las localizaciones más frecuentes para el desarrollo de aneurismas; recibe sangre de ambas circulaciones carotídeas y el efecto de la sincronía en la llegada de sangre no ha sido estudiado previamente. El objetivo de este estudio es comparar las condiciones de asincronía del pulso de A1 y sus efectos en las condiciones hemodinámicas de los aneurismas de la arteria comunicante anterior (ACoA). Materiales y métodos: Desde 2008 hasta 2017, 54 aneurismas de la ACoA tratados en nuestro centro se incluyeron en el estudio. Se emplearon técnicas de dinámica de fluidos computacional y las simulaciones consistieron en condiciones de completa sincronía y en la introducción de un retraso de 0,2s en la arteria A1 no dominante. Se realizaron mediciones del TAWSS, área de bajo cizallamiento (LSA), diámetros de A1 y ángulos de la AcoA. Resultados: La diferencia producida en el LSA en condiciones de sincronía y asincronía resultó en un amplio rango de valores positivos y negativos. El índice de simetría (p=0,04) y el ángulo A1/A2 en la arteria dominante (p=0,04) se relacionan con los cambios en el LSA. Conclusiones: En asincronía, el LSA se incrementó en ausencia de asimetría A1 y ángulos A1/A2 menores, incrementando potencialmente el riesgo de rotura de aneurismas en esta localización


Assuntos
Humanos , Masculino , Feminino , Fatores de Risco , Aneurisma/diagnóstico , Aneurisma Roto/diagnóstico , Aneurisma Roto/cirurgia , Hemodinâmica , Análise de Classes Latentes , Procedimentos Endovasculares
9.
Intern Med ; 58(18): 2721-2726, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31527370

RESUMO

A middle-aged man presented with a fever, arthralgia, gastrointestinal symptoms, headache, and rash. After two weeks, the patient suddenly complained of severe abdominal pain, and computed tomography revealed aneurysms in the hepatic and splenic arteries, which increased in size progressively. Given the elevated levels of inflammatory markers and orchitis, polyarteritis nodosa (PN) was initially suspected. Catheter embolization for the ruptured hepatic aneurysm and splenectomy for the large splenic ones were performed, and the pathological finding was consistent with segmental arterial mediolysis (SAM). Changes in inflammatory marker levels and aneurysmal size are also informative to differentiate SAM from PN.


Assuntos
Aneurisma Roto/cirurgia , Embolização Terapêutica/métodos , Artéria Hepática/cirurgia , Poliarterite Nodosa/diagnóstico , Poliarterite Nodosa/cirurgia , Artéria Esplênica/cirurgia , Túnica Média/cirurgia , Aneurisma Roto/fisiopatologia , Artéria Hepática/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Poliarterite Nodosa/fisiopatologia , Artéria Esplênica/fisiopatologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Túnica Média/fisiopatologia
10.
World Neurosurg ; 132: 103-105, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31493595

RESUMO

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.


Assuntos
Aneurisma Roto/cirurgia , Hemorragia Cerebral/cirurgia , Procedimentos Endovasculares/métodos , Infarto da Artéria Cerebral Média/terapia , Aneurisma Intracraniano/cirurgia , Artéria Cerebral Média/cirurgia , Procedimentos Neurocirúrgicos/métodos , Hemorragia Subaracnóidea/cirurgia , Adulto , Aneurisma Roto/complicações , Hemorragia Cerebral/complicações , Hemorragia Cerebral/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Humanos , Infarto da Artéria Cerebral Média/diagnóstico por imagem , Infarto da Artéria Cerebral Média/etiologia , Aneurisma Intracraniano/complicações , Masculino , Artéria Cerebral Média/diagnóstico por imagem , Hemorragia Subaracnóidea/complicações , Hemorragia Subaracnóidea/diagnóstico por imagem , Tomografia Computadorizada por Raios X
11.
Medicine (Baltimore) ; 98(33): e16821, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31415399

RESUMO

Aneurysmal subarachnoid hemorrhage (SAH) is a complex neurovascular syndrome with high disability and mortality. SAH patients may be managed with surgical clipping or coil embolization. In this study, we provided a real-world analysis of the outcome and prognostic factors of aneurysmal SAH in patients treated with coil embolization or microsurgical clipping.We retrospectively analyzed the medical records of aneurysmal SAH patients (n = 583) who underwent treatment at the First Hospital and the Second Hospital of Hebei Medical University, and Tangshan Worker's Hospital in China. All patients were evaluated by a combined neurosurgery and interventional neuroradiology team. Microsurgical aneurysmal clipping was performed using the skull base approach, while coil embolization was performed with bare platinum coils (with or without balloon assistance). The primary outcome was the Glasgow Outcome Scale (GOS) score at discharge.A total of 583 patients were included in this study, of which 397 (68.1%) of them underwent clipping and 186 (31.9%) received coil embolization. The patient cohort consisted of both poor grade and good grade aneurysmal SAH: 441 (75.6%) patients had good-grade (Hunt and Hess grade II or III) and 142 (24.4%) had poor grade (Hunt and Hess grade IV or V). Overall, 123 (21%) patients had unfavorable neurologic outcome (GOS score 1-3) and 460 (78.9%) patients had favorable neurologic outcome (GOS score 4 or 5). The mean GOS score at discharge was comparable for patients who underwent clipping and those received coil embolization (P > .05). Multivariate analysis showed that clipping only [OR (95%CI): 0.03 (0.01, 0.36); P = .000] and clipping with CSF drainage [OR (95%CI): 0.41 (0.18, 0.89); P = .001] were independent factors of a favorable outcome in patients with aneurysmal SAH. Coil embolization with hematoma removal [OR (95%CI): 0.03 (0.01, 0.36); P = .000] was also an independent determinant of a favorable outcome. High baseline Fisher grades were associated with significantly increased risk of an unfavorable outcome [OR (95%CI): 2.08 (1.30, 3.33); P = .002].Our findings suggested that both coil embolization and microsurgical clipping are viable treatment options for aneurysmal SAH patients. Procedures, such as CSF drainage and hematoma removal, performed in parallel with coil embolization and chipping should be considered when treating individual patients.


Assuntos
Aneurisma Roto/cirurgia , Embolização Terapêutica/métodos , Microcirurgia/métodos , Hemorragia Subaracnóidea/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Prótese Vascular , China , Drenagem/métodos , Feminino , Escala de Resultado de Glasgow , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
12.
World Neurosurg ; 131: e530-e542, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31394359

RESUMO

BACKGROUND: Upper basilar artery (BA) aneurysms, which consist of basilar tip and BA-superior cerebellar artery aneurysms, are challenging to treat with microsurgical clipping. The anterior temporal approach is one surgical approach used to treat aneurysms in this region. Most previous reports on this approach have consisted of unruptured cases. Assessing mostly ruptured cases in this study, we describe the surgical technique, patient characteristics, and surgical outcomes. METHODS: Twenty-three patients with aneurysms arising from the upper BA who received aneurysm clipping via an anterior temporal approach between December 2015 and January 2019 were retrospectively evaluated. RESULTS: The location of the aneurysms was the basilar tip in 15 patients (65.2%) and the BA-superior cerebellar artery junction in 8 patients (34.8%). Twenty-one patients (91.3%) presented with subarachnoid hemorrhage. Good outcomes (modified Rankin Scale score 0-2) at 3 months were achieved in 55.6% of all patients and in 80% of good-grade patients (World Federation of Neurosurgical Societies grades I-III) and patients with unruptured aneurysms. For patients with subarachnoid hemorrhage, a good outcome was achieved in 75% of good-grade patients. Postoperative transient oculomotor nerve palsy and thalamic infarctions were detected in 7 patients (30.4%) and 2 patients (8.7%), respectively. CONCLUSIONS: With appropriate case selection, the anterior temporal approach was effective and safe for clipping of upper BA aneurysms, especially under subarachnoid hemorrhage conditions.


Assuntos
Aneurisma Roto/cirurgia , Artéria Basilar/cirurgia , Aneurisma Intracraniano/cirurgia , Procedimentos Neurocirúrgicos/métodos , Hemorragia Subaracnóidea/cirurgia , Idoso , Idoso de 80 Anos ou mais , Aneurisma Roto/complicações , Infarto Cerebral/epidemiologia , Feminino , Osso Frontal , Humanos , Aneurisma Intracraniano/complicações , Masculino , Pessoa de Meia-Idade , Doenças do Nervo Oculomotor/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Hemorragia Subaracnóidea/etiologia , Osso Temporal , Tálamo/irrigação sanguínea , Resultado do Tratamento , Zigoma
13.
World Neurosurg ; 132: e820-e833, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31419590

RESUMO

OBJECTIVE: The long-term durability of different modalities of intracranial aneurysm repair remains unclear. The aim of this study was to conduct a meta-analysis comparing long-term rates of intracranial aneurysm recurrence, retreatment, and rebleeding after surgical clipping or endovascular treatment (EVT). METHODS: A systematic review of PubMed and Embase was performed in accordance with the PRISMA guidelines and a meta-analysis was conducted. Cohort studies and randomized controlled trials (RCTs) with a surgical and an endovascular arm of ≥10 patients each and a median follow-up of ≥3 years were included. Pooled-effect estimates for reported outcomes were calculated using the random-effects model; sensitivity analysis was performed using the fixed-effects model. RESULTS: Of 4876 articles, 11 studies including 3 RCTs comprising 4517 patients were analyzed. Coiling was the modality of EVT in all included studies. In the random-effects model, coiling was associated with an increased relative risk of 8.1 for recurrence (95% confidence interval [CI], 3.8-17.2), 4.5 for retreatment (95% CI, 3.4-5.9), and 2.1 for rebleeding (95% CI, 1.3-3.5); the fixed-effects model yielded similar results. Meta-regression by study design, length of follow-up, age, aneurysm size, ruptured versus unruptured aneurysms, or posterior versus anterior location did not yield significant results (all P interactions >0.05). No significant publication bias was identified. CONCLUSIONS: These results indicate better long-term durability of clipping compared with coiling-based EVT. The relatively high incidence of recurrence and retreatment after coiling should be considered when determining treatment strategy.


Assuntos
Procedimentos Endovasculares/métodos , Aneurisma Intracraniano/cirurgia , Aneurisma Roto/cirurgia , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
14.
J Clin Neurosci ; 68: 329-332, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31327587

RESUMO

Intrathalamic aneurysms are a cause of patient morbidity and mortality. Aneurysms in this location can be accessed microsurgically when they cannot be accessed endovascularly. Care must be taken to avoid critical white matter tracts when approaching the thalamus microsurgically. Use of a tubular retractor can offer safe brain retraction during the approach. A 53-year-old female with a history of hypertension and cerebrovascular accidents presented with slurred speech, altered mental status, and right-sided weakness. CT demonstrated an acute parenchymal hemorrhage within the left thalamus and the internal capsule. CT angiography demonstrated a left dorsal thalamic aneurysm. Following angiography with consideration for embolization, the patient was taken to the operating room for microsurgical clip ligation with the use of minimally invasive techniques. The aneurysm was accessed using a contralateral transventricular approach with a tubular retractor for microsurgical clip ligation. Postoperative imaging demonstrated successful interval clipping of the aneurysm within the thalamus. This is the first report using our described surgical approach for treatment of a dorsal intrathalamic aneurysm. We combined the use of diffusion tensor imaging with a tubular retractor to clip a dorsal thalamic aneurysm.


Assuntos
Aneurisma Roto/cirurgia , Aneurisma Intracraniano/cirurgia , Microcirurgia/métodos , Procedimentos Neurocirúrgicos/métodos , Feminino , Humanos , Ligadura/métodos , Microcirurgia/instrumentação , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/instrumentação , Instrumentos Cirúrgicos
15.
World Neurosurg ; 130: 277-284, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31323409

RESUMO

Cerebral aneurysms (CAs) are characterized by a pathological wall structure with internal elastic lamina and media disruption, which leads to focal weakened pouches of the arterial wall. The prevalence of unruptured CAs has been estimated to be 2%-5% in the general population. During the past few decades, the pathophysiological mechanisms behind the formation, growth, and rupture of CAs have been the focus of numerous research studies. In the present review, we have summarized the inflammatory pathways, genetics, and risk factors for the formation, growth, and rupture of CAs. In addition, we have discussed the concepts of geometric indexes, flow patterns, and fluid dynamics that govern CA development.


Assuntos
Aneurisma Roto/patologia , Hemodinâmica/fisiologia , Inflamação/patologia , Aneurisma Intracraniano/patologia , Aneurisma Roto/diagnóstico , Aneurisma Roto/cirurgia , Angiografia Cerebral/métodos , Humanos , Imagem Tridimensional/métodos , Inflamação/complicações , Aneurisma Intracraniano/diagnóstico , Aneurisma Intracraniano/cirurgia
16.
World Neurosurg ; 130: 324-334, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31323413

RESUMO

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.


Assuntos
Aneurisma Roto/cirurgia , Artéria Cerebral Anterior/cirurgia , Aneurisma Intracraniano/cirurgia , Artéria Cerebral Média/cirurgia , Aneurisma Roto/diagnóstico por imagem , Angiografia Cerebral/métodos , Feminino , Hemodinâmica/fisiologia , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Pessoa de Meia-Idade , Estresse Mecânico
17.
World Neurosurg ; 131: e192-e200, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31330337

RESUMO

OBJECTIVE: Indocyanine green (ICG) videoangiography (VAG) is an established method for assessment of cerebral blood flow during microsurgical clipping of intracranial aneurysms. FLOW 800 is a surgical microscope-integrated software program that shows the cerebral blood flow in color-coded maps, thus providing semi-quantitative and real-time analysis of ICG data. We aimed to establish reference values for FLOW 800 parameters before and after microsurgical clipping of intracranial aneurysms and to evaluate the potential of FLOW 800 to guide intraoperative decisions. METHODS: We retrospectively reviewed 54 patients (mean age, 53.6 ± 11.6 years) who underwent microsurgical clipping for 60 aneurysms and intraoperative evaluation of ICG fluorescence dynamics using FLOW 800 color-coded maps. FLOW 800 data were correlated with patient characteristics, clinical outcomes, and intraoperative decision making. RESULTS: There were no significant differences in FLOW 800 data between ruptured and unruptured aneurysms (P > 0.05). Likewise, the hemodynamic parameters were not significantly different before and after definite clip placement (P > 0.05). However, in 2 cases, analysis of transit times by FLOW 800 analysis showed a hemodynamically significant clip stenosis that might have been missed by conventional ICG-VAG and resulted in adjustment of the clip position. Overall, there was 1 cerebral infarction, which was not related to clip placement. CONCLUSIONS: FLOW 800 is a useful adjunct to ICG-VAG for intraoperative assessment of cerebral perfusion and may help to identify hemodynamically relevant clip stenosis. The beneficial impact of FLOW 800 on clinical outcome after microsurgical clipping needs to be confirmed by comparative studies.


Assuntos
Aneurisma Roto/cirurgia , Angiografia Cerebral/métodos , Aneurisma Intracraniano/cirurgia , Microcirurgia/métodos , Procedimentos Neurocirúrgicos/métodos , Software , Hemorragia Subaracnóidea/cirurgia , Adulto , Idoso , Aneurisma Roto/diagnóstico por imagem , Corantes , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Verde de Indocianina , Aneurisma Intracraniano/diagnóstico por imagem , Cuidados Intraoperatórios , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Hemorragia Subaracnóidea/diagnóstico por imagem
18.
World Neurosurg ; 130: 444-449, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31349077

RESUMO

BACKGROUND: Recurrent artery of Heubner (RAH) aneurysms are rare, with only 7 reported cases in the literature to date. In evaluating cerebral aneurysms, cerebral digital subtraction angiogram (DSA) is considered the gold standard and demonstrated the RAH aneurysms in previous case reports. We present a case of spontaneous subarachnoid hemorrhage secondary to RAH aneurysmal rupture, with initial DSA misleading, suggesting minor aneurysmal filling of a presumed thrombosed A1 segment aneurysm instead. CASE DESCRIPTION: A 71-year-old female presented with sudden-onset severe headache, nausea, and vomiting. Computed tomography along with computed tomography angiogram revealed a left-sided subarachnoid hemorrhage and a 5-mm aneurysm arising from either the left A1 or distal internal carotid artery. In addition, complex anterior cerebral artery anatomy with trifurcation was noted. This along with partial aneurysmal thrombosis made identification of the anatomy difficult on subsequent DSA, though a residual neck was still suggested to be arising from A1. Intraoperatively, the aneurysm was found to be arising from the RAH instead and was successfully secured by clipping. CONCLUSIONS: This case highlights the risk of RAH aneurysms masquerading as emanating from the A1 segment on DSA. Case particularities of complex anatomy and aneurysmal thrombosis were contributory. Other factors such as severe vasospasm, microaneurysms, and aneurysmal compression by overlying hematoma or brain parenchymal swelling could also distort DSA interpretation. These are important considerations in treatment planning by neurovascular surgeons and endovascular neuroradiologists.


Assuntos
Aneurisma Roto/diagnóstico por imagem , Aneurisma Intracraniano/diagnóstico por imagem , Trombose Intracraniana/diagnóstico por imagem , Idoso , Aneurisma Roto/cirurgia , Angiografia Digital , Doenças das Artérias Carótidas/diagnóstico por imagem , Artéria Carótida Interna/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Diagnóstico Diferencial , Feminino , Humanos , Aneurisma Intracraniano/cirurgia , Trombose Intracraniana/cirurgia , Recidiva , Hemorragia Subaracnóidea/etiologia
19.
Medicine (Baltimore) ; 98(28): e16442, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31305471

RESUMO

RATIONALE: Visceral arterial pseudoaneurysms are rare but important vascular entities because of their inclination to cause life-threatening hemorrhage. They were commonly reported to be associated with trauma, infection, inflammatory disease, or occurred as postoperative complication. To date, there has been no published report of a superior mesenteric artery (SMA) branch pseudoaneurysm rupture mimicking acute pancreatitis in a patient with acute type B aortic dissection. PATIENT CONCERNS: The patient's medical history, clinical information, imaging findings including follow-up computed tomography angiography (CTA), and treatment are reported. A 51-year-old male presenting with epigastric pain and fever was found to have an enlarged pancreatic head and obscure fatty space around it on abdominal nonenhanced CT. He has medical history of anaphylactoid purpura and uncontrolled hypertension. His serum lipase and amylase were both within normal limits. Thoracoabdominal CTA following a sudden blood pressure drop attributed to the accurate diagnosis. DIAGNOSES: He was diagnosed with acute type B aortic dissection involving SMA and retroperitoneal hemorrhage secondary to SMA branch pseudoaneurysm rupture. INTERVENTIONS: The patient was successfully treated by thoracic endovascular aortic repair without additional branch intervention. OUTCOMES: Follow-up CTA at 3 months later demonstrated that the endoprothesis is well positioned with no endoleaks, and SMA branch pseudoaneurysm disappeared. LESSONS: We report a rare and complicated case presenting with SMA branch pseudoaneurysm rupture and acute type B aortic dissection. CTA is vital in the diagnosis of such vessel pathology. We must inspect carefully to ensure that no small lesions are missed.


Assuntos
Aneurisma Dissecante/diagnóstico , Falso Aneurisma/diagnóstico , Aneurisma Roto/diagnóstico , Aneurisma Aórtico/diagnóstico , Artéria Mesentérica Superior , Aneurisma Dissecante/complicações , Aneurisma Dissecante/cirurgia , Falso Aneurisma/complicações , Falso Aneurisma/cirurgia , Aneurisma Roto/complicações , Aneurisma Roto/cirurgia , Aneurisma Aórtico/complicações , Aneurisma Aórtico/cirurgia , Diagnóstico Diferencial , Humanos , Masculino , Artéria Mesentérica Superior/diagnóstico por imagem , Pessoa de Meia-Idade , Pancreatite/diagnóstico
20.
World Neurosurg ; 130: 157-159, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31295587

RESUMO

BACKGROUND: Although vascular abnormality is an uncommon comorbidity of neurofibromatosis type 1 (NF1), it is potentially fatal. We present spontaneous hemothorax caused by rupture of a vertebral artery (VA) aneurysm in a patient with NF1. CASE DESCRIPTION: A 36-year-old man with a history of NF1 was transferred to the emergency department with dyspnea. Chest computed tomography scan revealed hemothorax in the left lung field with mediastinal shifting and aneurysmal dilatation of the left VA at the C6 vertebra level. Immediate drainage of the hematoma by chest tube insertion was performed. Diagnostic angiogram showed a 3- to 4-cm fusiform aneurysm of the VA. After the angiogram, cardiopulmonary arrest occurred after a rebleed of the VA aneurysm. The aneurysmal segment of the VA was urgently occluded with detachable coils. Postoperatively, the patient was in intensive care for 1 month because of fulminant pneumonia. After the patient regained consciousness, he was found to have right hemiparesis from a small infarction at the pons. The patient's function improved to near normal after 1 year of recovery. CONCLUSIONS: Hemothorax caused by VA rupture in a patient with NF1 is an extremely rare condition that can be fatal. Careful examination with suspicion for early detection and treatment is required for this urgent condition. Endovascular coiling was safe even for an unstable patient with massive bleeding.


Assuntos
Aneurisma Roto/complicações , Hemotórax/etiologia , Hemotórax/cirurgia , Neurofibromatose 1/cirurgia , Adulto , Aneurisma Roto/diagnóstico , Aneurisma Roto/cirurgia , Embolização Terapêutica/métodos , Hemotórax/diagnóstico , Humanos , Masculino , Neurofibromatose 1/complicações , Neurofibromatose 1/diagnóstico , Ruptura Espontânea/complicações , Ruptura Espontânea/cirurgia , Artéria Vertebral/cirurgia
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