scholarly journals A Location-Based Outcome Analysis of the Most Common Microsurgically Clipped Cerebral Aneurysms: A Single-Center Experience

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
Peyton L Nisson ◽  
Ali Tayebi Meybodi ◽  
Garrett K Berger ◽  
Austen Thompson ◽  
Ramin A Morshed ◽  
...  
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Cerebral Aneurysms ◽  
Neurological Status ◽  
Senior Author ◽  
Ruptured Aneurysm ◽  
Outcome Analysis ◽  
Anterior Communicating Artery ◽  
Single Center Experience ◽  
Microsurgical Clipping

ABSTRACT BACKGROUND Intracranial aneurysms of the anterior communicating artery (AComA), posterior communicating artery (PComA), and the middle cerebral artery (MCA) comprise the majority of all aneurysms encountered and treated by vascular neurosurgeons. OBJECTIVE To analyze and compare outcomes between these locations using multivariable logistic regression and to assess what clinical features may differ between them. METHODS Solitary aneurysms microsurgically clipped by the senior author were included from a prospective database of patients treated between January 2010 and April 2013 at a tertiary academic medical center. Neurological status was assessed using the modified Rankin Scale (mRS). Neurological outcomes were dichotomized, with mRS scores 0-2 considered “good” and 3-6 considered “poor.” RESULTS A total of 196 patients were treated; 69 aneurysms were located at the MCA, 77 at the AComA, and 50 at the PComA. A total of 48% (97/196) of patients presented with a ruptured aneurysm and 14% (25/180) were considered large. PComA was more commonly presented as a ruptured aneurysm (64%) compared to AComA (56%) and MCA (28%) (P ≤ .001), and when ruptured, PComA aneurysms were 1.6 times more likely to experience a favorable outcome compared to MCA aneurysms (P = .01). Regression analysis revealed PComA was associated with a lower risk for poor outcomes (odds ratio [OR] 0.19, P = .01) controlling for age, presentation type, and vasospasm. CONCLUSION Patients who underwent microsurgical clipping of ruptured PComA aneurysms experienced significantly better outcomes, while those with MCA aneurysms suffered the worst. Further investigation on this topic and the potential reasons that may account for these differences is warranted.

scholarly journals MICROSURGICAL CLIPPING IN THE RUPTURED AN ANEURYSM OF ANTERIOR COMMUNICATING ARTERY: A CASE REPORT

2017 ◽  
Vol 10 (10) ◽  
pp. 7
Author(s):  
Wayan Niryana ◽  
Aslesa Wangpathi Pagehgiri ◽  
Putu Eka Widyadharma
Keyword(s):  
Case Report ◽  
Intraoperative Monitoring ◽  
Cerebral Aneurysms ◽  
Medical Problem ◽  
Definitive Treatment ◽  
Anterior Communicating Artery ◽  
Microsurgical Technique ◽  
The Third ◽  
Microsurgical Clipping ◽  
Saccular Aneurysms

Objective: Ruptured saccular aneurysms are a common and serious medical problem. The prevalence of aneurysms is low during the first two decades of life and increases steadily after the third decade. Anterior communicating artery (AComA) aneurysms are regarded as the most complex of all intracranial aneurysms.Methods: Here, we report a case of an aneurysm of AComA patient with the development of microsurgical technique and intraoperative monitoring technique.Results: Permanent clipping was successfully performed in the neck of an aneurysm of AComA.Conclusion: Microsurgical clipping still remains a definitive treatment of ruptured cerebral aneurysms.

scholarly journals Microsurgical clipping of the anterior circulation aneurysms

2018 ◽  
Vol 20 (4) ◽  
pp. 409-414
Author(s):  
Carlos Eduardo Da Silva ◽  
Paulo Eduardo Peixoto De Freitas ◽  
Alicia Del Carmen Becerra Romero ◽  
Fáberson João Mocelin Oliveira ◽  
Márcio Aloisio Bezerra Cavalcanti Rockenbach ◽  
...  
Keyword(s):  
Relevant Literature ◽  
Cerebral Aneurysms ◽  
Series Data ◽  
Anterior Communicating Artery ◽  
Anterior Circulation ◽  
Ruptured Aneurysms ◽  
Microsurgical Clipping ◽  
The Mean ◽  
Anterior Circulation Aneurysms

Introduction: The authors present the analysis of the microsurgical clipping of 100 cerebral aneurysms of the anterior circulation and compare the series data with the literature. Methods: Eighty-eight patients presenting with 100 anterior circulation aneurysms operated on microsurgical techniques between 2002 and 2008 by the first author (CES) were retrospectively reviewed. Results: A total of 88 patients with 100 aneurysms of the anterior circulation were treated in a six years period. Fifty eight female (66%) and thirty male (34%) with nine patients (10.2%) presenting with multiple aneurysms. The mean age was 52 years (range from 26 to 76 years). Eighty five percent of the cases were ruptured aneurysms. The mean follow-up was 52.4 months (range from 5 to 76 months). The topography of the aneurysms was distributed as it follows: Anterior communicating artery (ACoA) 25%; posterior communicating artery (p-comm) 29%; middle cerebral artery (MCA) 27%; paraclinoidal aneurysms 8%; pericallosal artery 6% and internal carotid artery (ICA) tip 5%. The mortality was 7.9%, and such cases presenting with Hunt Hess graduation 3 and 4. The permanent morbidity was 4.5%, cases with Hunt Hess graduation 3 and 4. Perioperative rupture occurred in 17% of the cases, only in previous ruptured aneurysms. There was no clinical evidence of rebleeding during the follow-up period of the series. Conclusions: The microsurgical clipping of cerebral aneurysms of the anterior circulation is a safe and curative treatment for most of such lesions. At present, studies suggest evidences of superior results of surgery compared to the endovascular techniques in the rates of total occlusion of the aneurysms, lesser rates of rebleeding of the treated cases. The results of the present series are similar to the rates of the most relevant literature.

A3-A3 Bypass Surgery for Aneurysm: Technical Nuances

2018 ◽  
Vol 17 (3) ◽  
pp. 277-285 ◽  
Author(s):  
Florina-Nicoleta Grigore ◽  
Sepideh Amin-Hanjani
Keyword(s):  
Bypass Surgery ◽  
Relevant Literature ◽  
Cerebral Aneurysms ◽  
Patient Positioning ◽  
Technical Difficulty ◽  
Senior Author ◽  
Anterior Communicating Artery ◽  
Relative Depth ◽  
Bypass Procedure

Abstract BACKGROUND Cerebral bypass remains important for the treatment of complex cerebral aneurysms including dissecting, giant, and fusiform aneurysms not amenable to endovascular treatment or simple clip ligation. For such aneurysms involving the anterior communicating artery complex or its branches, distal anterior cerebral artery (ACA) A3-A3 side-to-side bypass represents a valuable treatment option. Distal ACA in situ anastomosis is recognized to be technically demanding mainly due to the relative depth and narrowness of the interhemispheric surgical corridor and type of anastomosis. OBJECTIVE To demonstrate technical nuances of A3-A3 side-to-side in situ bypass surgery through case illustrations and operative videos. METHODS Elements of the procedure relating to positioning, approach, and anastomosis which have evolved in the operative technique of the senior author were collated based on review of clinical case material, imaging and video recordings of ACA aneurysms treated with side-to-side in situ A3-A3 bypass procedure. Technical elements were contrasted with relevant literature. RESULTS Nuances relative to patient positioning, selection of craniotomy variants, adjunctive intraoperative tools and microsurgical nuances of the side-to-side bypass procedure are reviewed. Three illustrative operative video cases, along with illustrations, are provided to complement the description of the nuances. CONCLUSION In the light of the inherent technical difficulty, as well as the rather limited case volumes, the technical tips provided may contribute to bringing additional refinement and simplicity to the A3-A3 bypass procedure.

scholarly journals Experiences in Electronic Consultation (eConsult) Service in Gynecology from a Quaternary Academic Medical Center

2021 ◽  
Vol 45 (5) ◽  
Author(s):  
Chiara M. Corbetta-Rastelli ◽  
Tamandra K. Morgan ◽  
Nazaneen Homaifar ◽  
Lisa Deangelis ◽  
Amy M. Autry
Keyword(s):  
Pap Smear ◽  
Medical Center ◽  
Academic Medical Center ◽  
Abnormal Uterine Bleeding ◽  
Turnaround Time ◽  
Senior Author ◽  
Fiscal Year ◽  
Program Manager ◽  
Electronic Consultation ◽  
Improve Access

AbstractTo evaluate an academic institution’s implementation of a gynecologic electronic consultation (eConsult) service, including the most common queries, turnaround time, need for conversion to in-person visits, and to demonstrate how eConsults can improve access and convenience for patients and providers. This is a descriptive and retrospective electronic chart review. We obtained data from the UCSF eConsult and Smart Referral program manager. The medical system provided institution-wide statistics. Three authors reviewed and categorized gynecologic eConsults for the last fiscal year. The senior author resolved conflicts in coding. The eConsult program manager provided billing information and provider reimbursement. A total of 548 eConsults were submitted to the gynecology service between July 2017 and June 2020 (4.5% of institutional eConsult volume). Ninety-five percent of the eConsults were completed by a senior specialist within our department. Abnormal pap smear management, abnormal uterine bleeding, and contraception questions were the most common queries. Over half (59.3%) of all inquiries were answered on the same day as they were received, with an average of 9% declined. Gynecology was the 10th largest eConsult provider at our institution in 2020. The present investigation describes one large university-based experience with eConsults in gynecology. Results demonstrate that eConsults permit appropriate, efficient triaging of time-sensitive conditions affecting patients especially in the time of the COVID-19 pandemic. eConsult services provide the potential to improve access, interdisciplinary communication, and patient and provider satisfaction.

scholarly journals Aneurysms of the pericallosal artery (literature review)

2019 ◽  
Vol 20 (4) ◽  
pp. 95-103
Author(s):  
I. V. Grigoryev ◽  
I. V. Sen’ko
Keyword(s):  
Risk Factors ◽  
Surgical Treatment ◽  
Cerebral Aneurysms ◽  
Ruptured Aneurysm ◽  
Mortality Data ◽  
Study Objective ◽  
Unruptured Aneurysms ◽  
Pericallosal Artery ◽  
Microsurgical Clipping ◽  
Optimal Approach

The study objective is to analyze scientific sources describing features of surgical treatment of aneurysms of the pericallosal artery (APcA) and unfavorable outcome risk factors.Materials and methods. The analysis included 4 russian and 57 foreign sources.Results and conclusion. Conservative treatment of patients with ruptured APcAs yields unsatisfactory results due to high mortality. Data on surgical outcomes of ruptured APcAs are contradictory: per some sources, they do not differ from results of treatment of cerebral aneurysms of other locations; another sources state that they are worse. The main risk factors are severity per the Hunt–Hess scale ≥IV, large size of intracranial hematoma. Outcomes of surgical treatment of unruptured aneurysms are mostly favorable. Microsurgical clipping allows to achieve favorable results both for ruptured and unruptured APcAs. Due to deep APcA localization, the majority of revascularization surgeries can be performed only using intracranial-to-intracranial bypass. Extracranial-intracranial bypass in the anterior cerebral artery system is rarely performed. For surgical treatment, choice of its timeframe in critically ill patients (grade IV–V by the Hunt–Hess scale) causes difficulties: early surgery prevents repeated hemorrhages, while postponed surgeries eliminate the possibility of affecting this and other factors. There are arguments for preventive exclusion of APcA from blood flow even if its size is <5 mm because of high frequency of APcA ruptures and more severe consequences. For combination of an unruptured APcA with a ruptured aneurysm in another location, either simultaneous exclusion of all aneurysms is performed or two-stage surgery with primary exclusion of the ruptured aneurysm, but the first approach is not always possible. Selection of optimal approach depends on the location of the aneurysm: pterional approach is used for clipping infracallosal aneurysms, variations of interhemispheric accesses – for exclusion of supracallosal aneurysms and aneurysms located at the genu of corpus collosum. Temporary pharmacological cardioplegia is considered a promising method which potentially can replace temporary APcA clipping.

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.

Accuracy in Identifying the Source of Subarachnoid Hemorrhage in the Setting of Multiple Intracranial Aneurysms

Neurosurgery ◽  
2017 ◽  
Vol 83 (1) ◽  
pp. 62-68 ◽  
Author(s):  
Jennifer L Orning ◽  
Sophia F Shakur ◽  
Ali Alaraj ◽  
Mandana Behbahani ◽  
Fady T Charbel ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Subarachnoid Hemorrhage ◽  
Cerebral Aneurysms ◽  
Endovascular Embolization ◽  
Ruptured Aneurysm ◽  
Multiple Aneurysms ◽  
Microsurgical Clipping ◽  
Computed Tomography Scans ◽  
Rupture Site

Abstract BACKGROUND Subarachnoid hemorrhage cases with multiple cerebral aneurysms frequently demonstrate a hemorrhage pattern that does not definitively delineate the source aneurysm. In these cases, rupture site is ascertained from angiographic features of the aneurysm such as size, morphology, and location. OBJECTIVE To examine the frequency with which such features lead to misidentification of the ruptured aneurysm. METHODS : Records of patients who underwent surgical clipping of a ruptured aneurysm at our institution between 2004 and 2014 and had multiple aneurysms were retrospectively reviewed. A blinded neuroendovascular surgeon provided the rupture source based on the initial head computed tomography scans and digital subtraction angiography images. Operative reports were then assessed to confirm or refute the imaging-based determination of the rupture source. RESULTS One hundred fifty-one patients had multiple aneurysms. Seventy-one patients had definitive hemorrhage patterns on initial computed tomography scans and 80 patients had nondefinitive hemorrhage patterns. Thirteen (16.2%) of the cases with nondefinitive hemorrhage patterns had discordance between the imaging-based determination of the rupture source and intraoperative findings of the true ruptured aneurysm, yielding an imperfect positive predictive value of 83.8%. Of all multiple aneurysm cases with subarachnoid hemorrhage treated by surgical or endovascular means at our institution, 4.3% (13 of 303) were misidentified. CONCLUSION Morphological features cannot reliably be used to determine rupture site in cases with nondefinitive subarachnoid hemorrhage patterns. Microsurgical clipping, confirming obliteration of the ruptured lesion, may be preferentially indicated in these patients unless, alternatively, all lesions can be contemporaneously and safely treated with endovascular embolization.

scholarly journals Automatic ID Consultation for Inpatients With COVID-19: Point, Counterpoint, and a Single-Center Experience

2020 ◽  
Vol 7 (10) ◽  
Author(s):  
Cynthia T Nguyen ◽  
Gregory Olson ◽  
Mai T Pho ◽  
Alison K Lew ◽  
David Pitrak ◽  
...  
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Single Center Experience ◽  
Academic Medical ◽  
Clinician Satisfaction ◽  
Potential Benefits ◽  
Infectious Diseases Consultation ◽  
The Impact

Abstract There are many unknowns with regard to COVID-19 clinical management, including the role of Infectious Diseases Consultation (IDC). As hospitalizations for COVID-19 continue, hospitals are assessing how to optimally and efficiently manage COVID-19 inpatients. Typically, primary teams must determine when IDC is appropriate, and ID clinicians provide consultation upon request of the primary team. IDC has been shown to be beneficial for many conditions; however, the impact of IDC for COVID-19 is unknown. Herein, we discuss the potential benefits and pitfalls of automatic IDC for COVID-19 inpatients. Important considerations include the quality of care provided, allocation and optimization of resources, and clinician satisfaction. Finally, we describe how automatic IDC changed throughout the COVID-19 pandemic at a single academic medical center.

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