Microsurgical clipping versus newer endovascular techniques in treatment of unruptured anterior communicating artery-complex aneurysms: a meta-analysis and systematic review

2021 ◽  
Author(s):  
F. Diana ◽  
A. Pesce ◽  
G. Toccaceli ◽  
V. Muralidharan ◽  
E. Raz ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Anterior Communicating Artery ◽  
Endovascular Techniques ◽  
Complex Aneurysms ◽  
Microsurgical Clipping

scholarly journals Endovascular Treatment of Anterior Communicating Artery Aneurysms: A Systematic Review and Meta-Analysis

2013 ◽  
Vol 35 (5) ◽  
pp. 943-947 ◽  
Author(s):  
S. Fang ◽  
W. Brinjikji ◽  
M. H. Murad ◽  
D. F. Kallmes ◽  
H. J. Cloft ◽  
...  
Keyword(s):  
Systematic Review ◽  
Endovascular Treatment ◽  
Meta Analysis ◽  
Anterior Communicating Artery ◽  
Anterior Communicating Artery Aneurysms

The New Aneurysm Clip System for Particularly Complex Aneurysm Surgery

2010 ◽  
Vol 66 (suppl_2) ◽  
pp. onsE336-onsE338 ◽  
Author(s):  
Matthias J. Krammer ◽  
Christianto B. Lumenta
Keyword(s):  
Anterior Communicating Artery ◽  
Aneurysm Surgery ◽  
Ongoing Debate ◽  
Complex Aneurysm ◽  
Complex Aneurysms ◽  
Microsurgical Clipping ◽  
International Subarachnoid Aneurysm Trial ◽  
Clip Application ◽  
Potential Benefits ◽  
Technical Complication

Abstract BACKGROUND Currently, there is an ongoing debate regarding the best treatment option for ruptured aneurysms. The International Subarachnoid Aneurysm Trial study suggests that an endovascular procedure is the best treatment. In some complex cases, or in patients with an additional large intracerebral hemorrhage, aneurysms require further microsurgical clipping. OBJECTIVE We introduce a new clip system to improve clipping procedures in especially complex aneurysms. METHODS The inverted opening mechanism of the clip in combination with the special clip applier provides the surgeon with a good overview in the operating field. The new design also enables a wider opening of the clip jaws in contrast to all other well-known titanium aneurysm clips. This should provide a better and safer application and decrease the danger of premature rupture. RESULTS From January 2006 to July 2008, 55 aneurysms were clipped in 45 patients. The most common aneurysm location was the anterior communicating artery (20 patients) followed by the M1 segment of the middle cerebral artery (16 patients). Four patients had 2, one had 3, and one had 5 aneurysms. Two clipping procedures were performed for an ateriovenous malformation-associated aneurysm. All aneurysms were clipped without any technical complication. CONCLUSION The use of the new clip system, especially in complex aneurysm surgery, has potential benefits because of the better surgical vision during clip application and the wider opening of the clip jaws. It is easy to handle and compatible with magnetic resonance imaging.

scholarly journals Microsurgery for Multiple Intracranial Aneurysms

2021 ◽  
Vol 32 (1) ◽  
pp. 81-88
Author(s):  
Laís Miotta Simoncello ◽  
Hsuan Hua Chen ◽  
Lucas do Amaral Genta Mansano ◽  
Manauela Iglesias Borges ◽  
Sophia Fuentes Rosa ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Cerebral Aneurysms ◽  
Single Stage ◽  
Anterior Communicating Artery ◽  
Multiple Intracranial Aneurysms ◽  
Complex Aneurysms ◽  
Microsurgical Clipping ◽  
Microsurgical Approach ◽  
The Right ◽  
Age Range

Background: A total of 23 patients with 52 aneurysms were surgically treated in single surgery at a Neurosurgical Service of the Health Service of the State of São Paulo from 2009 to 2011. Method: Retrospective analysis of patients undergoing clipping of two or more cerebral aneurysms in a single stage, from January 2007 to July 2012. Results: Twenty-nine patients underwent two or more clipping cerebral aneurysms in a single surgery – 28 with a single craniotomy and one through two craniotomies. Of these, 20, 7, 1 and 1 were submitted to the clipping of 2, 3, 4 and 5 cerebral aneurysms, respectively. Five were male and 24 were female, and the age range was 40 to 66-years-old. Eight left craniotomies were performed to approach 17 lateralized brain aneurysms to the left and five to the right, as well as three anterior communicating complex aneurysms. Twelve craniotomies were performed on the right to approach 23 intracranial aneurysms lateralized to the right and six on the left, as well as 15 anterior communicating artery complex aneurysms and 1 on the basilar artery. Of the 29 patients, 28 evolved with 1-3 pts and only one with 4-5 pts on the Rankin scale, six months after surgery. Conclusion: We advocate microsurgical approach for most of the cases of multiple intracranial aneurysms aiming the microsurgical clipping of all intracranial aneurysms if feasible through a single stage and a single craniotomy.

scholarly journals Silk® Flow Diverter Device for Intracranial Aneurysm Treatment: A Systematic Review and Meta-analysis

2021 ◽  
Author(s):  
William A Florez ◽  
Ezequiel Garcia-Ballestas ◽  
Gabriel Alexander Quiñones-Ossa ◽  
Tariq Janjua ◽  
Subhas Konar ◽  
...  
Keyword(s):  
Systematic Review ◽  
Complication Rate ◽  
Intracranial Aneurysms ◽  
Meta Analysis ◽  
Flow Diverter ◽  
Thromboembolic Complication ◽  
Hemorrhagic Complication ◽  
Complete Occlusion ◽  
Complex Aneurysms ◽  
Observational Cohort

Flow diverters have become a critical instrument for complex aneurysms treatment. However, limited data are currently available regarding short and long-term outcomes for the Silk flow diverter. The objective of the study is to determine neurological prognosis and mortality rates for the Silk flow diversion device used in intracranial aneurysms. A systematic review with meta-analysis was performed using databases. The following descriptors were used for the search: “SILK”, “Flow Diverter”, “Mortality”, and “Prognosis”. The following data were extracted: mortality, good functional outcome, Glasgow outcome scale, complete or near-complete occlusion rates, rate of retreatment, and complications (thromboembolic and hemorrhagic complications). A total of 14 studies were selected. Among the 14 studies, 13 were retrospective observational cohort studies and 1 was a prospective observational cohort study. The mortality rate was 2.84%. The clinical good outcomes rate was 93.3%. The poor outcome rate was 6.6%. The overall thromboembolic complication rate was 6.06% (95% confidence interval [CI] 0.00–6.37, P=0.12, I<sup>2</sup>=3.13%). The total hemorrhagic complication rate was 1.62% (95% CI 0.00–5.34, P=0.28, I<sup>2</sup>=1.56%). The complete aneurysm occlusion rate was 80.4% (95% CI 8.65–9.38, P<0.0001, I<sup>2</sup>=9.09%). The Silk diverter device has a good safety and efficacy profile for treating intracranial aneurysms with high complete occlusion rates.

scholarly journals Combined treatment for complex intracranial aneurysm

2015 ◽  
Vol 29 (2) ◽  
pp. 189-193
Author(s):  
A. Chiriac ◽  
Georgiana Ion ◽  
N. Dobrin ◽  
St.M. Iencean ◽  
I. Poeata
Keyword(s):  
Combined Treatment ◽  
Endovascular Coiling ◽  
Endovascular Techniques ◽  
Close Collaboration ◽  
Aneurysm Neck ◽  
Complex Aneurysm ◽  
Neck Reconstruction ◽  
Complex Aneurysms ◽  
Microsurgical Clipping ◽  
Aneurysm Occlusion

Abstract Complex aneurysms often cannot be completely excluded by a single approaches. Today successful treatment of these lesions requires a combination between microsurgical and endovascular techniques. Planning of combined treatment require a very good understanding of aneurysm anatomy and a close collaboration between neurosurgeon and neuroendovascular interventionist. Endovascular coiling can usually be used as early treatment for a partially aneurysm occlusion including the ruptured area and followed by definitive clipping. On the other hand microsurgical clipping also can be used as first treatment for complex aneurysm neck reconstruction, allowing successful secondary placement of coils inside the remnant aneurysm sac

The effects of low-ratio n-6/n-3 PUFA on biomarkers of inflammation: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Yali Wei ◽  
Yan Meng ◽  
Na Li ◽  
Qian Wang ◽  
Liyong Chen
Keyword(s):  
Systematic Review ◽  
Fatty Acid ◽  
Polyunsaturated Fatty Acid ◽  
Meta Analysis ◽  
Chain Polyunsaturated Fatty Acid ◽  
Inflammation Markers ◽  
Pufa Supplementation ◽  
Long Chain

The purpose of the systematic review and meta-analysis was to determine if low-ratio n-6/n-3 long-chain polyunsaturated fatty acid (PUFA) supplementation affects serum inflammation markers based on current studies.

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