Risk factors and outcome analysis of patients with intraoperative rupture (IOR) of ruptured cerebral aneurysm during microsurgical clipping

A case of an intracranial arterial aneurysm at internal carotid bifurcation in a 10-year-old girl is described with the special features of cerebral aneurysm which occur in children, comparing with the adults. We alert for the necessity of carefully operative technique in order to avoid damage and intraoperative rupture of the aneurysm due to the very thin vessel wall that this population can develop. Our recommendation is early surgery in these patients.

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Risk Factors for Cerebral Aneurysm Rupture in Mongolia

Clinical Neuroradiology ◽

10.1007/s00062-021-01051-z ◽

2021 ◽

Author(s):

Matthias Bechstein ◽

Amarjargal Gansukh ◽

Boldbat Regzengombo ◽

Oyun Byambajav ◽

Lukas Meyer ◽

...

Keyword(s):

Risk Factors ◽

Medical History ◽

Cerebral Aneurysm ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Imaging Modality ◽

Treatment Options ◽

Time Estimation ◽

Developed Countries ◽

Aneurysm Rupture ◽

Risk Of Rupture

Abstract Purpose Identification of country-specific demographic, medical, lifestyle, and geoenvironmental risk factors for cerebral aneurysm rupture in the developing Asian country of Mongolia. First-time estimation of the crude national incidence of aneurysmal subarachnoid hemorrhage (aSAH). Methods A retrospective analysis of all intracranial digital subtraction angiographies (DSA) acquired in Mongolia during the 2‑year period 2016–2017 (1714 examinations) was performed. During this period, DSA was used as primary diagnostic imaging modality for acute severe neurological symptoms in the sole hospital nationwide dedicated to neurological patients. The catchment area of the hospital included the whole country. Patients with incidental and ruptured aneurysms were reviewed with respect to their medical history and living conditions. The data was used to install a Mongolian aneurysm registry. Results The estimated annual crude incidence of cerebral aneurysm rupture was 6.71 for the country of Mongolia and 14.53 per 100,000 persons for the capital region of Ulaanbaatar. Risk factors common in developed countries also applied for the Mongolian population: A medical history of hypertension, smoking or the presence of multiple aneurysms led to a higher relative risk of rupture. In contrast, female gender was not associated with a higher risk in this national cohort. Males pursuing a traditional nomadic living may exhibit a specifically high risk of rupture. Conclusion Disease management of over 200 individuals/year with aSAH constitutes a socioeconomic burden in Mongolia. Efforts to raise awareness of the risk factors hypertension and smoking among the Mongolian population are desirable. Measures to improve the nationwide availability of modern neurovascular treatment options are currently under consideration.

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Risk factors for the development of brain metastases in patients with HER2-positive breast cancer

ESMO Open ◽

10.1136/esmoopen-2018-000440 ◽

2018 ◽

Vol 3 (6) ◽

pp. e000440 ◽

Cited By ~ 11

Author(s):

Christian Maurer ◽

Lorraine Tulpin ◽

Michel Moreau ◽

Cristina Dumitrescu ◽

Evandro de Azambuja ◽

...

Keyword(s):

Breast Cancer ◽

Risk Factors ◽

Brain Metastases ◽

Cox Regression ◽

Lung Metastases ◽

Screening Method ◽

Outcome Analysis ◽

Asymptomatic Patients ◽

Number Of Patients ◽

Positive Breast Cancer

BackgroundPatients with metastatic human epidermal growth factor receptor 2-positive breast cancer (HER2+ BC) frequently experience brain metastases (BM). We aimed to define risk factors for the development of BM in patients with HER2+ BC and to report on their outcome.MethodsThis is a retrospective analysis of patients diagnosed with HER2+ BC between January 2000 and December 2014 at Institut Jules Bordet, Belgium. Statistical analyses were conducted with SAS V.9.4 using Kaplan-Meier method and Cox regression analyses.ResultsA total of 483 patients were included of whom 108 (22.4%) developed metastases and 52 (10.8%) BM. Among 96 metastatic patients without BM at diagnosis, 40 (41.7%) developed BM in the course of their disease. In multivariate analysis, risk factors for the development of BM were age ≤40 years (HR 2.10, 95 % CI 1.02 to 4.36), tumour size >2 cm (HR 4.94, 95% CI 1.69 to 14.47), nodal involvement (HR 3.48, 95% CI 1.47 to 8.25), absence or late start (≥6 months after initial diagnosis) of adjuvant anti-HER2 treatment (HR 3.79, 95% CI 1.52 to 9.43 or HR 2.65, 95% CI 1.03 to 6.82) and the development of lung metastases as first site of relapse (HR 6.97, 95% CI 3.41 to 14.24). Twenty-two patients with HER2+ BC and BM sent to our institute for further treatment were included in the outcome analysis. Asymptomatic patients at the time of BM diagnosis showed a better overall survival than symptomatic patients (HR 0.49, 95% CI 0.25 to 0.94).ConclusionA considerable number of patients with metastatic HER2+ BC will develop BM. Screening of patients with risk factors for BM might lead to early detection and better outcome. However, randomised controlled trials examining the use of MRI as a screening method for BM in patients with metastatic BC are warranted before such an approach can be recommended.

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Intraoperative rupture of cerebral aneurysm and the use of temporary arterial occlusion

Vojnosanitetski pregled ◽

10.2298/vsp0202125r ◽

2002 ◽

Vol 59 (2) ◽

pp. 125-130 ◽

Cited By ~ 3

Author(s):

Zoran Roganovic ◽

Goran Pavlicevic

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Cerebral Aneurysm ◽

Cerebral Artery ◽

Internal Carotid ◽

Arterial Occlusion ◽

Favorable Outcome ◽

Clinical State ◽

Aneurysm Size ◽

Intraoperative Rupture

Objectives: The aim was to analyze the risk factors for intraoperative rupture (IR) of cerebral aneurysm and for temporary clips (TC) use, as well as their influence on the final postoperative outcome. Methods: Retrospective study was done 72 IR patients, and on 75 TC patients. For patients with or without IR, as well as for the patients with or without TK, outcome of the treatment aneurysm size and localization, preoperative clinical state and operative timing was analyzed, and statistical significance of obtained differences was tested. Results: IR occurred in 40% of anterior cerebral artery aneurysms and in 16.7% of internal carotid artery aneurysms (p>0.05), while TCs were used in 52% of middle cerebral artery aneurysms and 34.8% of internal carotid artery aneurysms (p>0.05). Average size was 17.3 mm for aneurysms with IR and 11.7 mm for those without IR (p>0.05). Aneurysms were significantly larger in patients with TCs, than in patients without TCs (16.7 mm and 9.4 mm respectively, p<0.05). Preoperative period was 10.2 days for patients with IR, and 16.8 days for patients without IR (p<0.05). Favorable outcome was observed in 71.4% of patients with IR and in 70.6% of those without IR, as well as in 76.4% of patients who required TC and in 75.6% of cases without TC (p>0.05). Average duration of temporary occlusion was 5.8 min for patients with favorable outcome and 15 min for patients with poor outcome (p<0.05). Conclusions: Incidence of IR mostly depended on the duration of preoperative interval, while the frequency of TC use depended mostly on aneurysm size. IR did not influence the surgical outcome, as well as TC use, if the occlusion was shorter than 8-10 min.

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Association of ABO blood groups with risk factors of intracranial cerebral aneurysm formation

International Journal of Students� Research ◽

10.4103/2230-7095.149764 ◽

2014 ◽

Vol 4 (2) ◽

pp. 36

Author(s):

Anil Nanda ◽

ShyamalC Bir ◽

Piyush Kalakoti ◽

Sudheer Ambekar ◽

Papireddy Bollam

Keyword(s):

Risk Factors ◽

Cerebral Aneurysm ◽

Blood Groups ◽

Abo Blood Groups ◽

Aneurysm Formation

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Potential risk factors for maxillary sinus membrane perforation and treatment outcome analysis

Clinical Implant Dentistry and Related Research ◽

10.1111/cid.12699 ◽

2018 ◽

Vol 21 (1) ◽

pp. 66-72 ◽

Cited By ~ 3

Author(s):

Saša Marin ◽

Barbara Kirnbauer ◽

Petra Rugani ◽

Michael Payer ◽

Norbert Jakse

Keyword(s):

Risk Factors ◽

Treatment Outcome ◽

Maxillary Sinus ◽

Potential Risk ◽

Outcome Analysis ◽

Membrane Perforation ◽

Potential Risk Factors ◽

Sinus Membrane

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Microsurgical Clipping of Anterior Choroidal Artery Aneurysms: A Systematic Approach to Reducing Ischemic Complications in an Experience with 146 Patients

Operative Neurosurgery ◽

10.1093/ons/opz007 ◽

2019 ◽

Vol 17 (4) ◽

pp. 413-423 ◽

Cited By ~ 2

Author(s):

Ethan A Winkler ◽

Alex Lu ◽

Jan-Karl Burkhardt ◽

W Caleb Rutledge ◽

John K Yue ◽

...

Keyword(s):

Indocyanine Green ◽

Systematic Approach ◽

Anterior Choroidal Artery ◽

Indocyanine Green Videoangiography ◽

Microsurgical Clipping ◽

Ischemic Complications ◽

Anterior Choroidal ◽

Intraoperative Rupture ◽

Temporary Clipping ◽

Choroidal Artery

Abstract BACKGROUND Aneurysms of the anterior choroidal artery (AChA) have been associated with high treatment-associated morbidity due to ischemic complications. OBJECTIVE To report a large clinical experience of microsurgically treated AChA aneurysms and describe a systematic approach to reduce ischemic complications. METHODS One hundred forty-six patients with AChA aneurysms were retrospectively reviewed from a prospectively maintained database. Clinical characteristics, surgical techniques, clinical outcomes, arterial infarction, and use of intraoperative adjuncts (ie, ultrasonography, indocyanine green videoangiography, and neuromonitoring) were analyzed. RESULTS In total, one hundred forty-three aneurysms (97.9%) were clipped. Temporary clipping was utilized in 47 cases (32.2%) with mean occlusion time of 5.6 min. Arterial infarction occurred in 12 patients (8.2%). In clipped aneurysms, 90.5% were completely obliterated, 8.8% had minimal residual (<5% of original), and 0.7% were incompletely occluded (>5% of original). Mortality (2.7%) was limited to patients with high-grade subarachnoid hemorrhage. Indocyanine green videoangiography and neuromonitoring altered operative technique in ∼20% of cases. Multivariate logistic regression identified intraoperative rupture as the sole predictor for arterial infarction. CONCLUSION Open microsurgical clipping remains a safe, effective treatment for AChA aneurysms. Microsurgical technique is paramount in preserving AChA patency and reducing ischemic complications. Despite increasing reliance on qualitative measures of AChA blood flow (videoangiography and ultrasonography) and neurophysiological monitoring, these technologies aid us infrequently. However, these adjuncts provide important safety checks for AChA patency. Temporary clipping must be used judiciously to lower the risk of intraoperative rupture while limiting possible ischemia in the AChA territory.

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Surgical treatment of postinfarction ventricular septal defect: risk factors and outcome analysis

Interactive Cardiovascular and Thoracic Surgery ◽

10.1093/icvts/ivx230 ◽

2017 ◽

Vol 26 (1) ◽

pp. 41-46 ◽

Cited By ~ 1

Author(s):

Marek Pojar ◽

Jan Harrer ◽

Nedal Omran ◽

Zdenek Turek ◽

Jana Striteska ◽

...

Keyword(s):

Risk Factors ◽

Surgical Treatment ◽

Ventricular Septal Defect ◽

Septal Defect ◽

Outcome Analysis ◽

Postinfarction Ventricular Septal Defect

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Vitreous Hemorrhage after Aneurismal Rupture: Terson Syndrome

Arquivos Brasileiros de Neurocirurgia Brazilian Neurosurgery ◽

10.1055/s-0036-1581085 ◽

2016 ◽

Vol 37 (03) ◽

pp. 163-166

Author(s):

Rodrigo Souza ◽

Guilherme Aguiar ◽

Sarah Weber ◽

Juan Flores ◽

Mario Conti ◽

...

Keyword(s):

Visual Acuity ◽

Cerebral Aneurysm ◽

Ultrasound Examination ◽

Vitreous Hemorrhage ◽

Terson Syndrome ◽

Microsurgical Clipping ◽

Intraocular Hemorrhage ◽

Neurosurgical Treatment ◽

One Year ◽

Spontaneous Subarachnoid Hemorrhage

Introduction Terson syndrome is described as an intraocular hemorrhage consequent to a spontaneous subarachnoid hemorrhage (SSAH). In the present article, we describe cases of patients who underwent neurosurgical treatment of ruptured cerebral aneurysm at our institution over a period of one year, and who were diagnosed with Terson syndrome. Methods The present study included patients with a diagnosis of SSAH by rupture of a cerebral aneurysm who underwent treatment in our neurosurgical service from December 2009 to December 2010. The patients were followed-up for a minimum of 20 months. We have also performed a literature review and compared the data with those available in the current literature. Results The present study included 34 patients, 18 (53%) of which underwent endovascular treatment, and 16 (47%) who underwent microsurgical clipping. In the sample, the mortality was 14.7% (5 patients), the same percentage of patients who were diagnosed with Terson Syndrome, which is an incidence of 14.7%. Regarding the ophthalmologic evaluation, all patients had vitreous hemorrhage detected by an ultrasound examination, which was unilateral in only two patients. Visual acuity improved in all patients, being incomplete in only one of them. Conclusion Terson syndrome is relatively common and is associated with higher mortality. With the existence of an effective treatment, it should be investigated in all patients with SSAH.

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