scholarly journals When Is Diagnostic Subtraction Angiography Indicated Before Clipping of Unruptured and Ruptured Intracranial Aneurysms? An International Survey of Current Practice

2021 ◽  
pp. 9-17
Author(s):  
Martina Sebök ◽  
Jean-Philippe Dufour ◽  
Marco Cenzato ◽  
Yasuhiko Kaku ◽  
Michihiro Tanaka ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Previous Treatment ◽  
Digital Subtraction ◽  
Multiple Choice Questions ◽  
Complex Aneurysm ◽  
International Panel ◽  
Paraclinoid Aneurysm ◽  
Unruptured Intracranial Aneurysms ◽  
Life Threatening ◽  
Ruptured Intracranial Aneurysms

AbstractIntroduction: The goal of this survey is to investigate the indications for preoperative digital subtraction angiography (DSA) before clipping of ruptured and unruptured intracranial aneurysms in an international panel of neurovascular specialists.Methods: An anonymous survey of 23 multiple-choice questions relating to indications for DSA before clipping of an intracranial aneurysm was distributed to the international panel of attendees of the European-Japanese Cerebrovascular Congress (EJCVC), which took place in Milan, Italy on 7–9 June 2018. The survey was collected during the same conference. Descriptive statistics were used to analyze the data.Results: A total of 93 surveys were distributed, and 67 (72%) completed surveys were returned by responders from 13 different countries. Eighty-five percent of all responders were neurosurgeons. For unruptured and ruptured middle cerebral artery (MCA) aneurysms without life-threatening hematoma, approximately 60% of responders perform surgery without preoperative DSA. For aneurysms in other locations than MCA, microsurgery is done without preoperative DSA in 68% of unruptured and in 73% of ruptured cases. In cases of ruptured MCA or ruptured non-MCA aneurysms with life-threatening hematoma, surgery is performed without DSA in 97% and 96% of patients, respectively. Factors which lead to preoperative DSA being performed were: aneurysmal shape (fusiform, dissecting), etiology (infectious), size (>25 mm), possible presence of perforators or efferent vessels arising from the aneurysm, intra-aneurysmal thrombus, previous treatment, location (posterior circulation and paraclinoid aneurysm) and flow-replacement bypass contemplated for final aneurysm treatment. These are all factors that qualify an aneurysm as a complex aneurysm.Conclusion: There is still a high variability in the surgeons’ preoperative workup regarding the indication for DSA before clipping of ruptured and unruptured intracranial aneurysms, except for ruptured aneurysms with life-threatening hematoma. There is a general consensus among cerebrovascular specialists that any angioanatomical feature indicating a complex aneurysm should lead to a more detailed workup including preoperative DSA.

Preoperative Digital Subtraction Angiography in Incidental Unruptured Intracranial Aneurysms

2018 ◽  
Vol 28 (3) ◽  
pp. 429-435 ◽  
Author(s):  
Moriz Herzberg ◽  
Robert Forbrig ◽  
Christian Schichor ◽  
Hartmut Brückmann ◽  
Franziska Dorn
Keyword(s):  
Digital Subtraction Angiography ◽  
Intracranial Aneurysms ◽  
Digital Subtraction ◽  
Unruptured Intracranial Aneurysms

scholarly journals Treatment of ruptured intracranial aneurysms in children associated with arteriovenous malformation

2013 ◽  
Vol 60 (4) ◽  
pp. 65-69
Author(s):  
Milan Mrdak ◽  
Nikola Repac ◽  
Igor Nikolic ◽  
Igor Djoric ◽  
Aleksandar Janicijevic ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Intraventricular Hemorrhage ◽  
Intracranial Aneurysms ◽  
Endovascular Procedures ◽  
Pediatric Population ◽  
Digital Subtraction ◽  
Ruptured Aneurysms ◽  
Recovery Potential ◽  
Side Body ◽  
Ruptured Intracranial Aneurysms

Introduction. Intracranial aneurysms are very rare in the pediatric population . Very rarely they are accompanied by subarachnoid hemorrhage (SAH). As in the adults they are most often discovered after their rupture. Case report. We report the case of a child 14 months old at the time of rupture of the aneurysm , which led to intraventricular hemorrhage and accompanied by left side body weakness. After diagnosis - digital subtraction angiography (DSA) aneurysm on the posterior chorioid artery was verified. Consultatory there was no decision for surgical treatment. The child is now 6 years old, there is a discrete left side pyramidal deficit , control DSA - finding stationary. Conclusion: Despite the development of modern diagnosis of intracranial aneurysms their treatment is still a big challenge. Child?s brain has great recovery potential, which encourages aggressive therapy for these disorders and provide good results. In younger patients with ruptured aneurysms and vascular anomalies associated with neurological deficit, where surgical treatment or endovascular procedures associated with the high risk of complications, conservative treatment is indicated.

scholarly journals The relationship between the level of vitamin D and ruptured intracranial aneurysms

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Sen Wei ◽  
Xin Yuan ◽  
Feng Fan ◽  
Xin‑bin Guo ◽  
Sheng Guan
Keyword(s):  
Vitamin D ◽  
Intracranial Aneurysms ◽  
Univariate Analysis ◽  
Clinical Information ◽  
Binary Logistic Regression ◽  
Binary Logistic Regression Analysis ◽  
Unruptured Intracranial Aneurysms ◽  
Vitamin D Levels ◽  
The Relationship ◽  
Ruptured Intracranial Aneurysms

AbstractThe purpose of our research is to explore whether vitamin D levels were associated with the rupture of intracranial aneurysms. In this retrospective study, 105 patients diagnosed with ruptured intracranial aneurysms (RIAs) and 185 patients diagnosed with unruptured intracranial aneurysms (UIAs) at The First Affiliated Hospital of Zhengzhou University were recruited from September 2019 to September 2020. Patients’ demographic and clinical information, including vitamin D levels, were recorded and compared. Univariate analysis showed that patients with UIAs had higher vitamin D levels than RIAs (p = 0.019). In addition, there were significant differences in aneurysm location (p < 0.001), aspirin use (p = 0.001), and comorbid diabetes mellitus (p = 0.037) between patients with UIAs and RIAs. Binary logistic regression analysis showed that the level of vitamin D was independently associated with RIAs [odds ratio (OR) 0.960; 95% confidence intervals (CI), 0.926–0.996, p = 0.028].

Comparison Between CTA and Digital Subtraction Angiography in the Diagnosis of Ruptured Aneurysms

Neurosurgery ◽  
2017 ◽  
Vol 80 (5) ◽  
pp. 769-777 ◽  
Author(s):  
Lucas R. Philipp ◽  
D. Jay McCracken ◽  
Courtney E. McCracken ◽  
Sameer H. Halani ◽  
Brendan P. Lovasik ◽  
...  
Keyword(s):  
Digital Subtraction Angiography ◽  
Intracranial Aneurysms ◽  
Internal Carotid ◽  
Cerebral Aneurysms ◽  
Small Sample ◽  
Digital Subtraction ◽  
Ruptured Intracranial Aneurysm ◽  
Small Sample Sizes ◽  
Low Sensitivity ◽  
Ruptured Intracranial Aneurysms

Abstract BACKGROUND: Computerized tomography angiography (CTA) is commonly used to diagnose ruptured cerebral aneurysms with sensitivities reported as high as 97% to 100%. Studies validating CTA accuracy in the setting of subarachnoid hemorrhage (SAH) are scarce and limited by small sample sizes. OBJECTIVE: To evaluate the diagnostic accuracy of CTA in detecting intracranial aneurysms in the setting of SAH. METHODS: A single-center, retrospective cohort of 643 patients was reviewed. A total of 401 patients were identified whose diagnostic workup included both CTA and confirmatory digital subtraction angiography (DSA). Aneurysms missed by CTA but diagnosed by DSA were further stratified by size and location. RESULTS: Three hundred and thirty aneurysms were detected by CTA while DSA detected a total of 431 aneurysms. False positive CTA results were seen for 24 aneurysms. DSA identified 125 aneurysms that were missed by CTA and 83.2% of those were &lt;5 mm in diameter. The sensitivity of CTA was 57.6% for aneurysms smaller than 5 mm in size, and 45% for aneurysms originating from the internal carotid artery. The overall sensitivity of CTA in the setting of SAH was 70.7%. CONCLUSION: The accuracy of CTA in the diagnosis of ruptured intracranial aneurysm may be lower than previously reported. CTA has a low sensitivity for aneurysms less than 5 mm in size, in locations adjacent to bony structures, and for those arising from small caliber parent vessels. It is our recommendation that CTA should be used with caution when used alone in the diagnosis of ruptured intracranial aneurysms.

Neurosurgical Issues in Pregnancy

2017 ◽  
Vol 37 (06) ◽  
pp. 689-693 ◽  
Author(s):  
Anil Can ◽  
Rose Du
Keyword(s):  
Arteriovenous Malformations ◽  
Intracranial Aneurysms ◽  
Vascular Malformations ◽  
Significant Risk ◽  
Unborn Child ◽  
Cavernous Malformations ◽  
Life Threatening ◽  
Ruptured Intracranial Aneurysms ◽  
Cerebral Vascular Malformations ◽  
Cerebral Vascular

AbstractAlthough rare, intracranial hemorrhage due to rupture of cerebral vascular malformations or intracranial aneurysms during pregnancy is a potentially devastating and life-threatening disorder, posing a diagnostic and therapeutic challenge to a multidisciplinary team of neurosurgeons, neurologists, obstetricians, and anesthesiologists. Despite the significant risk of morbidity and mortality affecting both the mother and the unborn child, knowledge of the natural history, epidemiology, and appropriate management of cerebral vascular malformations and intracranial aneurysms in pregnant women is limited. Although emergent neurosurgical concerns usually outweigh obstetric considerations, and treatment of these disorders is generally similar in pregnant and nonpregnant women, any necessary and feasible modifications to protect the unborn child should be made. This article reviews the management of ruptured intracranial aneurysms and cerebral vascular malformations, including arteriovenous malformations, cavernous malformations, and moyamoya disease, in women during pregnancy, partus, and puerperium.

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