Endovascular treatment of intracranial aneurysms and vasospasm after aneurysmal subarachnoid hemorrhage

Introduction: To report clinical outcome of aneurysmal subarachnoid hemorrhage (aSAH) patients exposed to cerebral vasospasm (CVS) targeted treatments in a systematic review and meta-analysis and compare the efficacy of endovascular and non-endovascular treatments in severe / refractory vasospasm patients. Methods: The literature was searched using PubMed, EMBASE, and The Cochrane Library database. Eligibility criteria were (1) Rated clinical outcome; (2) at least 10 patients; (3) aSAH; (4) study published in English or French (January 2006 - October 2014); and (5) methodological quality score > 10, according to STROBE criteria. Endpoint included unfavorable outcome rate, defined as mRS 3-6, GOS 1-3 or GOSE 1-4 at latest follow-up. Analyses included stratification per route of administration (oral, i.v., intra-arterial or cisternoventricular) and per study inclusion criteria (severe, CVS, refractory CVS or high risk for CVS). Univariate and multivariate subgroup analyses were performed to identify interventions associated with a better outcome. Results: Sixty-two studies, including 26 randomized controlled trials, were included (8976 patients). Overall 2490 patients had unfavorable outcome including death (random-effect weighted average: 33.7%, 99%CI, 28.1-39.7%; Q-value: 806.0, I 2 =92.7%). Clinical outcome was significantly better in severe or refractory patients for whom, on top of best medical treatment, endovascular intervention was performed (RR=0.76, IC95% [0.66-0.89], p <0.00001) whereas other route of administration didn’t show significant differences. RR of unfavorable outcome was significantly lower, vs control groups, in patients treated with Cilostazol (RR=0.46 (IC99% [0.25-0.85], P = 0.001, Q value 1.5, I 2 = 0). Conclusion: In case of CVS following aSAH, endovascular treatment in severe / refractory vasospasm patients. including intra-arterial injection of pharmacological agents or balloon angioplasty, improves outcome as compared to other route of administration.

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Surgical treatment of intracranial aneurysms: six-year experience in Belo Horizonte, MG, Brazil

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2004000200010 ◽

2004 ◽

Vol 62 (2a) ◽

pp. 245-249 ◽

Cited By ~ 2

Author(s):

Leodante Batista da Costa Jr ◽

Josaphat Vilela de Morais ◽

Agustinho de Andrade ◽

Marcelo Duarte Vilela ◽

Renato P. Campolina Pontes ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Surgical Treatment ◽

Intracranial Aneurysms ◽

Aneurysmal Subarachnoid Hemorrhage ◽

The United States ◽

Anterior Circulation ◽

Common Location ◽

Belo Horizonte ◽

Spontaneous Subarachnoid Hemorrhage ◽

Anterior Circulation Aneurysms

Spontaneous subarachnoid hemorrhage accounts for 5 to 10 % of all strokes, with a worldwide incidence of 10.5 / 100000 person/year, varying in individual reports from 1.1 to 96 /100000 person/year. Angiographic and autopsy studies suggest that between 0.5% and 5% of the population have intracranial aneurysms. Approximately 30000 people suffer aneurysmal subarachnoid hemorrhage in the United States each year, and 60% die or are left permanently disabled. We report our experience in the surgical treatment of intracranial aneurysms in a six year period, in Belo Horizonte, Minas Gerais, Brazil. We reviewed the hospital files, surgical and out-patient notes of all patients operated on for the treatment of intracranial aneurysms from January 1997 to January 2003. Four hundred and seventy-seven patients were submitted to 525 craniotomies for treatment of 630 intracranial aneurysms. The majority of patients were female (72.1%) in the fourth or fifth decade of life. Anterior circulation aneurysms were more common (94.4%). The most common location for the aneurysm was the middle cerebral artery bifurcation. The patients were followed by a period from 1 month to 5 years. The outcome was measured by the Glasgow Outcome Scale (GOS). At discharge, 62.1% of the patients were classified as GOS 5, 13.9% as GOS 4, 8.7% as GOS 3, 1.7% as GOS 2 and 14.8% as GOS 1.

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Neonatal intracranial aneurysms: case report and review of the literature

Journal of Neurosurgery Pediatrics ◽

10.3171/2017.10.peds17226 ◽

2018 ◽

Vol 21 (5) ◽

pp. 471-477 ◽

Cited By ~ 3

Author(s):

Jeewaka E. Mohotti ◽

Nicole S. Carter ◽

Victor Jia Wei Zhang ◽

Leon T. Lai ◽

Christopher Xenos ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Endovascular Treatment ◽

Intracranial Aneurysms ◽

Time Of Flight ◽

Review Of The Literature ◽

Microsurgical Treatment ◽

Enhanced Mri ◽

Contrast Enhanced ◽

Mca Aneurysm ◽

Contrast Enhanced Mri

Intracranial aneurysms in the neonate, presenting in the first 4 weeks of life, are exceedingly rare. They appear to have characteristics, including presentation and location, that vary from those found in adults. The authors present a case of a 28-day-old neonate with a ruptured distal middle cerebral artery (MCA) aneurysm. Initial noninvasive imaging with transfontanelle ultrasound and CT confirmed intraparenchymal and subarachnoid hemorrhage. Contrast-enhanced MRI revealed a 14-mm ruptured fusiform MCA aneurysm that was not identified on time-of-flight magnetic resonance angiography (MRA). Microsurgical treatment was performed with partial neurological recovery. A comprehensive review of the literature from 1949 to 2017 revealed a total of 40 aneurysms in 37 neonates, including the present case. The most common presenting symptom was seizure. Although subarachnoid hemorrhage was the most common form of hemorrhage, 40% had intraparenchymal hemorrhage. The median aneurysm size was 10 mm (range 2–30 mm) and the most common location was the MCA, with two-thirds of cases involving the distal intracranial vasculature. Over the last 10 years, there has been a trend of increasing noninvasive diagnosis of ruptured cerebral aneurysms in neonates, with CT angiography and contrast-enhanced MRI being the most useful diagnostic modalities. The use of contrast-enhanced MRI may improve sensitivity over time-of-flight MRA. Microsurgical treatment was the most common treatment modality overall, with increased use of endovascular treatment in the last decade. Most patients underwent microsurgical vessel ligation or endovascular parent vessel occlusion. There were high rates of neurological recovery after microsurgical or endovascular treatment, particularly for patients with distal aneurysms.

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Surgical and endovascular treatment of poor-grade aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis

Journal of Neurosurgical Sciences ◽

10.23736/s0390-5616.16.03457-3 ◽

2017 ◽

Vol 61 (4) ◽

Author(s):

Bing Zhao ◽

Alejandro Rabinstein ◽

Mohammad H. Murad ◽

Giuseppe Lanzino ◽

Pietro Panni ◽

...

Keyword(s):

Systematic Review ◽

Subarachnoid Hemorrhage ◽

Endovascular Treatment ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Meta Analysis ◽

Poor Grade

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Vasa Vasorum Formation is Associated With Rupture of Intracranial Aneurysms

Neurosurgery ◽

10.1093/neuros/nyz310_676 ◽

2019 ◽

Vol 66 (Supplement_1) ◽

Author(s):

Haruka Miyata ◽

Hirokazu Koseki ◽

Kampei Shimizu ◽

Yu Abekura ◽

Mieko Oka ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Intracranial Aneurysms ◽

Histopathological Examination ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Vasa Vasorum ◽

Systemic Hypertension ◽

External Carotid ◽

Anterior Communicating Artery ◽

Sprague Dawley ◽

The Right

Abstract INTRODUCTION Subarachnoid hemorrhage has a poor outcome despite a modern advancement in medical care. The development of a novel therapeutic strategy to prevent rupture of intracranial aneurysms (IAs) or a novel diagnostic marker to predict rupture-prone lesions is thus mandatory. Therefore, in the present study, we established a rat model in which IAs spontaneously rupture and examined this model to clarify histopathological features associated with rupture of lesions. METHODS In detail, female Sprague-Dawley rats were subjected to the bilateral ovariectomy, the ligation of the left common carotid, the right external carotid, and the right pterygopalatine arteries, the induced systemic hypertension, and the administration of a lysyl oxidase inhibitor. RESULTS Aneurysmal subarachnoid hemorrhage occurred one-thirds of manipulated animals and locations of ruptured IAs were exclusively at a posterior or an anterior communicating artery. Histopathological examination using ruptured IAs, rupture-prone ones induced at a posterior or an anterior communicating artery, ones induced at an anterior cerebral artery-olfactory artery bifurcation that never rupture revealed the formation of vasa vasorum as an event associated with rupture of IAs. CONCLUSION We thus proposed the contribution of a structural change in an adventitia, vasa vasorum formation, to rupture of IAs. Findings from this study provide important insights about the pathogenesis of IAs.

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