scholarly journals The Role of Neurophysiological Monitoring during Complex Aneurysm Surgery: Report of Two Cases and Review of the Literature

2019 ◽  
Vol 38 (04) ◽  
pp. 348-353
Author(s):  
Roger Schmidt Brock ◽  
Marcos Queiroz Teles Gomes ◽  
Félix Hendrik Pahl ◽  
José Erasmo Dal Col Lúcio ◽  
José Francisco Pereira Júnior ◽  
...  
Keyword(s):  
Intraoperative Monitoring ◽  
Intracranial Aneurysms ◽  
Neurophysiological Monitoring ◽  
Aneurysm Surgery ◽  
Surgical Team ◽  
Review Of The Literature ◽  
Giant Aneurysms ◽  
Complex Aneurysm ◽  
Complex Aneurysms

AbstractThe surgical treatment of intracranial aneurysms is a routine operation in the neurosurgeon practice. Complex aneurysms are those with morphological irregularities, usually large or giant; thrombosed, partially thrombosed or calcified; with aberrant fundus/neck ratio and near eloquent neurological structures. These cases demand special skills by the surgical team. The present article is a report of two cases of complex aneurysms successfully treated, with a discussion on the role of neurophysiological monitoring. In these two cases of supra- and infratentorial complex giant aneurysms, intraoperative monitoring was extremely relevant. Thus, we believe that treating complex and giant aneurysms carries several pitfalls, and the use of multimodal intraoperative monitoring is mandatory to mitigate risks and deliver the best result to the patient.

Abstract 1122‐000071: Large and Giant Intracranial Aneurysms, Clinico‐Radiological Outcome and Predictors with Flow Diverter Stent

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Islam El Malky ◽  
Ayman Zakaria ◽  
Essam Abdelhameed ◽  
Hazem Abdelkhalek
Keyword(s):  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Flow Diverter ◽  
Artery Occlusion ◽  
Parent Artery ◽  
Giant Aneurysms ◽  
Complex Aneurysms ◽  
Parent Artery Occlusion ◽  
Large And Giant Aneurysms ◽  
Flow Diverters

Introduction : Endovascular treatment for large and giant aneurysms has included either a reconstructive approach or a deconstructive approach by parent artery occlusion. 1,2 Stent‐assisted coiling and balloon‐assisted coiling were alternative techniques developed to deal with such complex aneurysms, but studies have shown less expected efficacy. This study aims to assess the safety and efficacy of the flow diverter stents for treating large and giant intracranial aneurysms and to examine possible predictors for radiological and clinical outcomes such as location and presence of branching artery, bifurcation, and adjuvant coiling. Methods : This study had been conducted on 65 consecutive patients with 65 large and giant aneurysms (size ≥ 10 mm) treated with flow diverters; Periprocedural complications were reported in all patients and clinical outcomes. Follow‐up angiography was done for 60 patients (92.3%) at 12 months. Results : The study included 65 patients who harbored 65 aneurysms. The median age was 55.5 years (IQR: 44.25 ‐ 62.75 years), the female represented 70.8 % of all patients. The clinical presentation had been reported (Headache, cranial nerve palsy, motor deficit, seizures, and visual field defect in 40 patients (61.5%), nine patients (13.8%), seven patients (10.8%), five patients (7.7%), and four patients (6.2%) respectively. The vascular risk factors had been reviewed (HTN, DM, smoking, and Hyperlipidemia in 25 patients (9.2%), Six patients (9.2%), sixteen (24.6%), and 10 patients (15.4%) respectively). The median size of aneurysms was 16.4 mm (IQR: 12.50 ‐ 23.85 mm) and the median neck width was 7.15 mm (IQR: 5.85‐10.24 mm). Fourteen aneurysms (21.4 %) had previous treatment, eleven aneurysms (16.9%) were treated by coils only, one case (1.5%) by assisted procedure, one case (1.5%) by previous FDS, and parent artery occlusion in one case (1.5%). Complete occlusion in 50 from 60 aneurysms (83.4%), neck remnant in 8 aneurysms (13.3%), and sac remnant in two aneurysms (3.3%). Periprocedural problems were encountered in 14 patients (21.5%) with morbidity in six patients (9.2%) and mortality in one patient (1.5%). Univariate and multivariate logistic regression analysis was used to discover possible predictors of combined mortality and morbidity and occlusion in Table (1). Conclusions : From this study, it could be concluded that Endovascular treatment of the large and giant aneurysms with flow diverters represents a safe method for treating this kind of complex intracranial aneurysms. Complex aneurysms with branching artery and bifurcation were associated with aneurysm persistence and complications respectively while the location of the aneurysm was the only predictor for clinical outcome.

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.

Social Representations and Commitment

2018 ◽  
Vol 23 (3) ◽  
pp. 233-249 ◽  
Author(s):  
Eric Bonetto ◽  
Fabien Girandola ◽  
Grégory Lo Monaco
Keyword(s):  
Social Representations ◽  
Social Representation ◽  
Second Line ◽  
Review Of The Literature ◽  
First Line ◽  
Research Perspectives ◽  
The Social ◽  
Bibliographic Search ◽  
English Articles

Abstract. This contribution consists of a critical review of the literature about the articulation of two traditionally separated theoretical fields: social representations and commitment. Besides consulting various works and communications, a bibliographic search was carried out (between February and December, 2016) on various databases using the keywords “commitment” and “social representation,” in the singular and in the plural, in French and in English. Articles published in English or in French, that explicitly made reference to both terms, were included. The relations between commitment and social representations are approached according to two approaches or complementary lines. The first line follows the role of commitment in the representational dynamics: how can commitment transform the representations? This articulation gathers most of the work on the topic. The second line envisages the social representations as determinants of commitment procedures: how can these representations influence the effects of commitment procedures? This literature review will identify unexploited tracks, as well as research perspectives for both areas of research.

Stages of the formation of temporary and permanent occlusion and the impact of early tooth extraction on the dentition state. Literature review

2019 ◽  
pp. 22-24
Author(s):  
G.A. Murachueva ◽  
I.M. Rasulov ◽  
S.G. Gusenov
Keyword(s):  
Literature Review ◽  
Temporomandibular Joint ◽  
Tooth Extraction ◽  
Physiological State ◽  
Review Of The Literature ◽  
Full Development ◽  
Permanent Occlusion ◽  
The Impact

A review of the literature on the stages of the formation of temporary and permanent occlusion has been performed. This stages play an important role not only for the full development of the maxillofacial apparatus, temporomandibular joint, but also the whole organism. The role of early tooth extraction in the formation of the physiological state of the dentoalveolar system is considered. The conclusion is drawn about the need for a deeper study of this problem in the structure of general dental morbidity.

Virome and Inflammasomes, a Finely Tuned Balance with Important Consequences for the Host Health

2019 ◽  
Vol 26 (6) ◽  
pp. 1027-1044 ◽  
Author(s):  
Giulia Freer ◽  
Fabrizio Maggi ◽  
Mauro Pistello
Keyword(s):  
Immune System ◽  
Human Beings ◽  
Review Of The Literature ◽  
Adaptive Immune ◽  
Downstream Effects ◽  
Host Health ◽  
Inflammatory Processes ◽  
Human Immune ◽  
Immune Defences

Background:The virome is a network of viruses normally inhabiting humans. It forms a conspicuous portion of the so-called microbiome, once generically referred to as resident flora. Indeed, viruses infecting humans without leading to clinical disease are increasingly recognized as part of the microbiome and have an impact on the development of our immune system. In addition, they activate inflammasomes, multiprotein complexes that assemble in cells and that are responsible for the downstream effects of sensing pathogens.Objective:This review aims at summarizing the evidence on the role of the virome in modulating inflammation and emphasizes evidence for Anelloviruses as useful molecular markers to monitor inflammatory processes and immune system competence.Method:We carried out a review of the literature published in the last 5 years and summarized older literature to take into account ground-breaking discoveries concerning inflammasome assembly and virome.Results:A massive amount of data recently emerging demonstrate that the microbiome closely reflects what we eat, and many other unexpected variables. Composition, location, and amount of the microbiome have an impact on innate and adaptive immune defences. Viruses making up the virome contribute to shaping the immune system. Anelloviruses, the best known of such viruses, are present in most human beings, persistently without causing apparent disease. Depending on their interplay with such viruses, inflammasomes instruct host defences to tolerate or forfeit a specific microorganism.Conclusion:The virome plays an important role in shaping human immune defences and contributes to inflammatory processes by quenching or increasing them.

Jurisprudence Study of the Importance of the Role of a Woman’s Right to Have a Child: A Review

2020 ◽  
Vol 16 (3) ◽  
pp. 188-193
Author(s):  
Fatemeh Ghodrati
Keyword(s):  
Pregnant Women ◽  
Civil Law ◽  
Google Scholar ◽  
Review Of The Literature ◽  
Maternal Role ◽  
The Right ◽  
Time Limitations ◽  
Natural Barrier ◽  
Taking Care

Background: Every woman has the right to have children. Objective: This study aimed to investigate the Jurisprudence study of the importance of the role of a woman right to have a child. Methods: A review of the literature with keywords of motherhood. The viewpoints of the jurists, jurisprudent law, right contraception and breastfeeding, spiritual rewards, pregnant women, instinct of having a child and the Quran. The Information Centers such as Scopus and Iranmedex, Magi ran SID, Google Scholar, Science Direct, Pub med, and in the returns without any time limitations up to 2018. Therefore, Qur'anic verses based on the topic and authentic Hadith texts as well as authoritative, authentic scientific articles. Results: Narrations and Quran verses on greatness and respect of a mother show the importance of the maternal role. The maternal role is a fabulous facet of perfection of a woman and Islam has considered spiritual rewards for it. In the Quran, many biological changes such as pregnancy, childbirth, breastfeeding and taking care of a child and spiritual characteristics of mothers as the instinct seeking a child or generosity towards child have been mentioned. Islamic rules have a duty to extend this culture and aid mothers to achieve this right. Nobody can deprive a woman of it. Conclusion: In view of jurisprudent rules in Islam, if there is no limitation or natural barrier for a woman to have a child but her husband’s illogical unwillingness for having a child; this is, according to article 1130 of civil law, a kind of distress and embarrassment and the woman has the right to divorce.

Safety and efficacy of ticagrelor as single antiplatelet therapy in prevention of thromboembolic complications associated with the Pipeline Embolization Device (PED): multicenter experience

2020 ◽  
Vol 12 (11) ◽  
pp. 1113-1116 ◽  
Author(s):  
Mahmoud H Mohammaden ◽  
Stephen W English ◽  
Christopher J Stapleton ◽  
Eman Khedr ◽  
Ahmed Shoyb ◽  
...  
Keyword(s):  
Antiplatelet Therapy ◽  
Intracranial Aneurysms ◽  
Posterior Circulation ◽  
Thromboembolic Complications ◽  
Anterior Circulation ◽  
Safety And Efficacy ◽  
Complex Aneurysm ◽  
Post Procedure ◽  
Systemic Side Effects ◽  
Ischemic Events

BackgroundFlow diversion (FD) is a common treatment modality for complex intracranial aneurysms. A major concern regarding the use of FD is thromboembolic events (TEE). There is debate surrounding the optimal antiplatelet regimen to prevent TEE. We aim to evaluate the safety and efficacy of ticagrelor as a single antiplatelet therapy (SAPT) for the prevention of TEE following FD for complex aneurysm treatment.MethodsA retrospective review of a prospectively maintained neuroendovascular database at three endovascular centers was performed. Patients were included if they had an intracranial aneurysm that was treated with FD between January 2018 and September 2019 and were treated with ticagrelor as SAPT. Primary outcomes included early (within 72 hours post-procedure) and late (within 6 months) ischemic events.ResultsA total of 24 patients (mean age 47.7 years) with 36 aneurysms were eligible for analysis, including 15 (62.5%) females. 14 (58.3%) patients presented with subarachnoid hemorrhage. 35 aneurysms arose from the anterior circulation and 1 from the posterior circulation. 23 aneurysms had a saccular morphology, whereas 7 were fusiform and 6 were blister. For the treatment of all 36 aneurysms, 30 procedures were performed with 32 FD devices. Procedural in-stent thrombosis occurred in 2 cases and was treated with intra-arterial tirofiban without complications. Aneurysm re-bleeding was reported in 1 (4.2%) patient. There were no reported early or late TEE. Three patients discontinued ticagrelor due to systemic side effects.ConclusionTicagrelor is a safe and effective SAPT for the prevention of TEE after FD. Large multicenter prospective studies are warranted to validate our findings.

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