Does the impact of elective temporary clipping on intraoperative rupture really influence neurological outcome after surgery for ruptured anterior circulation aneurysms?—A prospective multivariate study

2012 ◽  
Vol 155 (2) ◽  
pp. 237-246 ◽  
Author(s):  
Sivashanmugam Dhandapani ◽  
Sudhir S. Pal ◽  
Sunil K. Gupta ◽  
Sandeep Mohindra ◽  
Rajesh Chhabra ◽  
...  
Keyword(s):  
Neurological Outcome ◽  
Anterior Circulation ◽  
Multivariate Study ◽  
Intraoperative Rupture ◽  
The Impact ◽  
Temporary Clipping ◽  
Anterior Circulation Aneurysms

scholarly journals Risk of Dependency Following Microsurgical Clipping in Good Grade Patients With Ruptured Anterior Circulation Aneurysms

2021 ◽  
Vol 7 (1) ◽  
pp. 49-56
Author(s):  
Sundus Ali ◽  
◽  
Fauzia Sajjad ◽  
Asif Shabbir ◽  
Akmal Azeemi ◽  
...  
Keyword(s):  
Surgical Techniques ◽  
Neurological Deficits ◽  
Anterior Circulation ◽  
Microsurgical Clipping ◽  
Operative Complications ◽  
Good Grade ◽  
Intraoperative Rupture ◽  
The Impact ◽  
Anterior Circulation Aneurysms

Background and Aim: Most good grade (WFNS I and II) patients who undergo microsurgical clipping achieve a favorable outcome. However, some independent patients before surgery face unfavorable outcomes after the operation, signifying the impact of microsurgical clipping. This study aimed to identify the risk of developing dependency in patients without previous neurological deficits. Methods and Materials/Patients: We reviewed 50 consecutive good grade patients with ruptured anterior circulation aneurysms who underwent microsurgical clipping between May 2017 and May 2020 in the Department of Neurosurgery, Punjab Institute of Neurosciences, Lahore, Pakistan. The clinical outcome at discharge and three months follow-up was assessed using the Glasgow Outcome Scale (GOS). Results: In this study, seven patients (14%) became dependent (GOS II and III) following clipping. Of whom, five patients (10%) suffered surgical insult in the form of intraoperative rupture (4%), post-op infarct (4%), and direct brain damage (2%). Conclusion: Patients without neurologic deficit pre-operatively still suffer unfavorable outcomes mainly due to operative complications. Vascular injuries remain the main cause of morbidity-producing dependency. Therefore, all surgical techniques must minimize the risk to vessels, both during dissection and at clip placement.

scholarly journals How Safe and Effective Is Shifting from Pterional to Supraorbital Keyhole Approach for Clipping Ruptured Anterior Circulation Aneurysms? A Surgeon’s Transition Phase Comparative Study

2021 ◽  
Author(s):  
Sivashanmugam Dhandapani ◽  
Rajasekhar Narayanan ◽  
Manju Dhandapani ◽  
Hemant Bhagat
Keyword(s):  
Surgical Outcome ◽  
Delayed Cerebral Ischemia ◽  
Anterior Communicating Artery ◽  
Parent Vessel ◽  
Anterior Circulation ◽  
Lumbar Drain ◽  
Significant Difference ◽  
Keyhole Approach ◽  
Intraoperative Rupture ◽  
Anterior Circulation Aneurysms

Abstract Background Comparative studies between standard pterional and supraorbital keyhole approaches for aneurysms had potential biases with the heterogeneity of patient selection, differences among surgeons, or varying expertise across the surgeon’s learning curve. This is a study of a surgeon’s transition from pterional to keyhole approach for early clipping of selected consecutive ruptured anterior circulation aneurysms. Methods Patients more than 18 years, presenting within 72 hours of ictus, in good clinical grades 1 to 3, no midline shift, with saccular aneurysms less than 25 mm at either communicating segment of internal carotid artery, anterior communicating artery, or middle cerebral artery segment till bifurcation were studied between the last 25 cases of pterional and first 25 cases of the keyhole, for the intraoperative and postoperative surgical outcome parameters. Results There was no significant difference among baseline parameters, including the location of aneurysms across both groups. While only four cases of pterional had an intraoperative ventricular puncture, the lumbar drain was electively inserted in all keyhole patients. The intraoperative parameters, such as a dural tear, adequate parent vessel exposure, temporary clipping, and intraoperative rupture, did not show any significant difference. None had immediate postoperative deficits. While delayed cerebral ischemia and wound complaints were similar in both groups, temporal hollowing and chewing difficulty were significantly more in pterional patients(p = 0.01). Conclusion A surgeon experienced in pterional approach can comfortably and safely shift to the keyhole for early clipping of selected ruptured aneurysms less than 25 mm, with a comparable surgical outcome but better cosmesis and mastication.

Abstract WP88: Relationship Between Aneurysm Size and Distal Cerebral Hemodynamics

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Ahmed E Hussein ◽  
Denise Brunozzi ◽  
Sophia F Shakur ◽  
Fady T Charbel ◽  
Ali Alaraj
Keyword(s):  
Flow Velocity ◽  
Cerebral Hemodynamics ◽  
Flow Volume ◽  
Hemodynamic Parameters ◽  
Mean Flow ◽  
Anterior Circulation ◽  
Aneurysm Size ◽  
The Impact ◽  
The Relationship ◽  
Anterior Circulation Aneurysms

Introduction: The impact of aneurysms on distal cerebral hemodynamics is unknown. Here we examine the relationship between aneurysm size and distal hemodynamics prior to treatment. Methods: Patients seen at our institution between 2006-2015 with aneurysms within the cavernous or supraclinoid ICA segment (proximal to ICA terminus) were retrospectively reviewed. Only un-ruptured proximal anterior circulation aneurysms were included, patients with contralateral aneurysms were excluded. Patients were included if they had flow volume rate and flow velocities measured prior to any treatment using Quantitative MRA. Pulsatility index (PI) = [(systolic - diastolic flow velocity)/mean flow velocity] was calculated for ipsilateral and contralateral MCA and ICA. Hemodynamic parameters were analyzed with respect to aneurysm size. Results: 42 patients were included. Mean aneurysm size was 13.5 mm (range 2-40mm). There was significant correlation (Pearson’s) between aneurysm size and ipsilateral MCA PI ( P =0.006; r=0.441), MCA ipsilateral /ICA ipsilateral PI ratio ( P =0.003; r=0.57), and MCA ipsilateral /MCA contralateral PI ratio ( P =0.008; r=0.43). Conclusions: Larger aneurysm size is significantly associated with higher ipsilateral MCA PI, demonstrating that aneurysms change distal cerebral hemodynamics. Aneurysm treatment may thus acutely change those altered hemodynamics.

Comparative Anatomical Analysis between Minipterional and Supraorbital Approaches in the Treatment of Anterior Circulation Aneurysms

2020 ◽  
Author(s):  
Rafael Martinez-Perez ◽  
Thiago Albonette-Felicio ◽  
Giuliano Silveira-Bertazzo ◽  
Luis Requena ◽  
Ruichun Li ◽  
...  
Keyword(s):  
Anterior Circulation ◽  
Anatomical Analysis ◽  
Anterior Circulation Aneurysms

scholarly journals Acute Management Should Be Optimized in Patients with Less Specific Stroke Symptoms: Findings from a Retrospective Observational Study

2021 ◽  
Vol 10 (5) ◽  
pp. 1143
Author(s):  
Simona Halúsková ◽  
Roman Herzig ◽  
Dagmar Krajíčková ◽  
Abduljabar Hamza ◽  
Antonín Krajina ◽  
...  
Keyword(s):  
Wide Spectrum ◽  
Intravenous Thrombolysis ◽  
National Institutes Of Health ◽  
Vascular Territory ◽  
Anterior Circulation ◽  
Point Increase ◽  
Single Center Study ◽  
Mouth Corner ◽  
Specific Symptoms ◽  
The Impact

Anterior circulation stroke (ACS) is associated with typical symptoms, while posterior circulation stroke (PCS) may cause a wide spectrum of less specific symptoms. We aim to assess the correlation between the initial presentation of acute ischemic stroke (AIS) symptoms and the treatment timeline. Using a retrospective, observational, single-center study, the set consists of 809 AIS patients treated with intravenous thrombolysis (IVT) and/or endovascular treatment (EVT). We investigate the impact of baseline clinical AIS symptoms and the affected vascular territory on recanalization times in patients treated with IVT only and EVT (±IVT). Regarding the IVT-only group, increasing the National Institutes of Health Stroke Scale (NIHSS) score on admission and speech difficulties are associated with shorter (by 1.59 ± 0.76 min per every one-point increase; p = 0.036, and by 24.56 ± 8.42 min; p = 0.004, respectively) and nausea/vomiting with longer (by 43.72 ± 13.13 min; p = 0.001) onset-to-needle times, and vertigo with longer (by 8.58 ± 3.84 min; p = 0.026) door-to-needle times (DNT). Regarding the EVT (±IVT) group, coma is associated with longer (by 22.68 ± 6.05 min; p = 0.0002) DNT, anterior circulation stroke with shorter (by 47.32 ± 16.89 min; p = 0.005) onset-to-groin time, and drooping of the mouth corner with shorter (by 20.79 ± 6.02 min; p = 0.0006) door-to-groin time. Our results demonstrate that treatment is initiated later in strokes with less specific symptoms than in strokes with typical symptoms.

Results of Embolization Used as the First Treatment Choice in a Consecutive Nonselected Population of Ruptured Aneurysms: Clinical Results of the Clarity GDC Study

Neurosurgery ◽  
2011 ◽  
Vol 69 (4) ◽  
pp. 837-842 ◽  
Author(s):  
◽  
Christophe Cognard ◽  
Laurent Pierot ◽  
René Anxionnat ◽  
Frédéric Ricolfi
Keyword(s):  
Clinical Results ◽  
Morbidity And Mortality ◽  
World Federation ◽  
Consecutive Series ◽  
Ruptured Aneurysms ◽  
First Choice ◽  
International Subarachnoid Aneurysm Trial ◽  
Treatment Morbidity ◽  
Intraoperative Rupture ◽  
The Impact

Abstract BACKGROUND: The International Subarachnoid Aneurysm Trial (ISAT) showed that for ruptured aneurysms suitable for both techniques, coiling should be the first-choice treatment. Only a small proportion of patients (22%) with ruptured aneurysms were included in that trial. Operators were selected on their experience. One could then criticize the impact of the ISAT on clinical practice as a result of recruitment biases and operators' selection. OBJECTIVE: To evaluate the morbidity and mortality of coiling when used as first-choice treatment in a consecutive population of patients with ruptured aneurysms treated by nonselected operators. METHODS: Thirty-four operators from 19 French centers treated 405 patients with GDC coils from November 2006 to July 2007. The method of treatment was not prespecified. RESULTS: World Federation of Neurological Societies grade at admission was I/II in 65.7% and IV/V in 30.6% of patients. At the 3- to 6-month follow-up, 23.3% of patients were dependent or dead. Thromboembolic events and intraoperative rupture resulted in permanent deficit in 13 (3.2%) and 2 (0.5%), respectively, and death in 4 (1.0%) and 0. Early rebleeding occurred in 2 patients (0.5%) with 2 subsequent deaths. Permanent treatment morbidity and mortality were 3.7 % and 1.5 %, respectively. CONCLUSION: Clinical results of the multicenter prospective Clarity registry show that when coiling is performed as first-intention treatment in a consecutive series of nonselected ruptured aneurysms by nonselected operators, clinical results are similar to those of the ISAT.

Risk factors for meningitis after craniotomy in patients with subarachnoid hemorrhage due to anterior circulation aneurysms rupture

2015 ◽  
Vol 139 ◽  
pp. 302-306 ◽  
Author(s):  
Takashi Inoue ◽  
Hiroaki Shimizu ◽  
Miki Fujimura ◽  
Kenichi Sato ◽  
Hidenori Endo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Subarachnoid Hemorrhage ◽  
Anterior Circulation ◽  
Anterior Circulation Aneurysms

Surgical experience of minipterional craniotomy with 102 ruptured and unruptured anterior circulation aneurysms

2016 ◽  
Vol 27 ◽  
pp. 34-39 ◽  
Author(s):  
Eberval Gadelha Figueiredo ◽  
Leonardo C. Welling ◽  
Mark C. Preul ◽  
Gabriel Reis Sakaya ◽  
Iuri Neville ◽  
...  
Keyword(s):  
Surgical Experience ◽  
Anterior Circulation ◽  
Anterior Circulation Aneurysms

Efficacy of a direct puncture approach for anterior circulation aneurysms using a newly developed guiding catheter—especially for geriatric patients

2007 ◽  
Vol 67 (1) ◽  
pp. 30-34 ◽  
Author(s):  
Izumi Yuzawa ◽  
Akira Kurata ◽  
Sachio Suzuki ◽  
Hitoshi Ozawa ◽  
Hiroyuki Hagiwara ◽  
...  
Keyword(s):  
Geriatric Patients ◽  
Anterior Circulation ◽  
Direct Puncture ◽  
Anterior Circulation Aneurysms ◽  
Guiding Catheter

Transblepharo-Preseptal Modified Orbitozygomatic Approach for the Treatment of Ruptured Proximal Anterior Circulation Aneurysms

2018 ◽  
Vol 118 ◽  
pp. e335-e345 ◽  
Author(s):  
Robert C. Rennert ◽  
Ben A. Strickland ◽  
Kristine Ravina ◽  
Joshua Bakhsheshian ◽  
Joseph Carey ◽  
...  
Keyword(s):  
Anterior Circulation ◽  
Orbitozygomatic Approach ◽  
Anterior Circulation Aneurysms
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