scholarly journals Intraaneurysmal GDC Embolization for Ruptured Aneurysm in the Acute Stage

2000 ◽  
Vol 6 (1_suppl) ◽  
pp. 75-78
Author(s):  
M. Ezura ◽  
A. Takahashi ◽  
T. Yoshimoto
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Clinical Outcome ◽  
Systemic Disease ◽  
Cerebral Aneurysms ◽  
Acute Stage ◽  
Ruptured Aneurysm ◽  
Poor Grade ◽  
Symptomatic Vasospasm ◽  
Tissue Plasminogen ◽  
High Age

This report focused on our treatment protcol and results on the intraaneurysmal GDC embolization for ruptured aneurysm in the acute stage. Clinical materials of this study consist of 39 patients who were treated with intraaneurysmal GDC embolization within 72 hours after the onset of subarachnoid hemorrhage from March 1997 to May 1999. Patients with cerebral aneurysms are always examined as a possible candidate for neurosurgical clipping. If the patient had any difficulties and/or problems on neurosurgical clipping (high age 24, poor grade 12, surgically difficult location 11, systemic disease 2), the patient was treated by intraaneurysmal GDC embolization. GDCs were inserted as tight as possible. Then, spinal drainage was set in patients with thick subarachnoid hemorrhage. Tissue plasminogen activator was administered via the drainage in patients with thicker subarachnoid hemorrhage. Two patients experienced rerupture during peritherapeutic period. Symptomatic vasospasm was observed in 2 patients (5.1%). Good outcome was obtained in 31 out of 34 surviving patients. Symptomatic complication caused by distal embolism occurred in 1 patient, parent artey occlusion in 3 patients. In conclusion, intraaneurysmal GDC embolization is thought to be sufficient regarding prevention of rerup tu re, incidence of vasospasm, and clinical outcome.

Intra-aneurysmal GDC Embolization for Ruptured Aneurysm in the Acute Stage

1999 ◽  
Vol 5 (1_suppl) ◽  
pp. 183-186
Author(s):  
M. Ezura ◽  
A. Takahashi ◽  
T. Yoshimoto
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Clinical Outcome ◽  
Systemic Disease ◽  
Cerebral Aneurysms ◽  
Acute Stage ◽  
Ruptured Aneurysm ◽  
Poor Grade ◽  
Symptomatic Vasospasm ◽  
Tissue Plasminogen ◽  
High Age

This study focused on our experiences in intra-aneurysmal embolization for ruptured aneurysm in the acute stage. Clinical materials of this study consist of 37 patients who were treated with intra-aneurysmal GDC embolization within 72 hours after the onset of subarachnoid hemorrhage from December 1995 to July 1998. Patients with cerebral aneurysms are always examined as possible candidates for neurosurgical clipping. If the patient had any difficulties and/or problems on neurosurgical clipping (high age 22, poor grade 15, surgically difficult location 9, systemic disease 3), the patient was treated by intra-aneurysmal GDC embolization. GDCs were inserted as tight as possible. Then, spinal drainage was set in patients with thick subarachnoid hemorrhage. Tissue plasminogen activator was administered via the drainage in patients with thicker subarachnoid hemorrhage. One patient experienced rerupture during peritherapeutic period. Symptomatic vasospasm was observed in three patients (8.1%). Good outcome was obtained in 26 out of 30 surviving patients. Symptomatic complication caused by distal embolism occurred in two patients. In conclusion, intra-aneurysmal GDC embolization is thought to be sufficient regarding prevention of rerupture, incidence of vasospasm, and clinical outcome.

Comparison of Clinical Results between GDC Treatment and Direct Surgery for Ruptured Cerebral Aneurysms

1999 ◽  
Vol 5 (1_suppl) ◽  
pp. 207-210
Author(s):  
K. Fukui ◽  
M. Miyazaki ◽  
K. Hattori ◽  
H. Osawa ◽  
S. Miyachi ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Glasgow Outcome Scale ◽  
Death Rate ◽  
Cerebral Aneurysms ◽  
Clinical Results ◽  
Acute Stage ◽  
Clinical Grade ◽  
Systemic Complication ◽  
High Death Rate ◽  
High Death

We present a comparison of clinical results between GDC treatment and direct surgery for ruptured cerebral aneurysms. From May 97 to April 98, 32 aneurysms were treated by direct surgery (DS) or GDC treatment. Treatments were selected depending on the clinical grade, degree of hematoma and anatomical aspect of the aneurysms. There were 13 GDC treated cases and 19 direct surgery cases. In GDC cases, there were acute stage embolization for ruptured basilar aneurysm, recurrence of case after clipping for BA-SCA aneurysm, advanced age cases, and systemic complication cases. Glasgow outcome scale (GOS) in GDC cases were 8 GR, 2 MD and 3 SD. GOS in direct surgery cases were 7 GR, 4 MD, 4 SD and 4 deaths. Cases of severe subarachnoid hemorrhage with hematoma influenced the high death rate in direct surgery group. There were three complications associated with the procedure in the GDC group, however, the rate improved after advancement of the procedure. In conclusion, GDC treatment for ruptured cerebral aneurysm was satisfactorily acceptable compared to the results of direct surgery, however, more cases will be needed for precise comparison.

Intraoperative rerupture during surgical treatment of aneurysmal subarachnoid hemorrhage is not associated with an increased risk of vasospasm

2014 ◽  
Vol 120 (2) ◽  
pp. 409-414 ◽  
Author(s):  
Sunil A. Sheth ◽  
Daniel Hausrath ◽  
Adam L. Numis ◽  
Michael T. Lawton ◽  
S. Andrew Josephson
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cerebral Aneurysms ◽  
Surgical Clipping ◽  
Acute Hemorrhage ◽  
Exact Test ◽  
Symptomatic Vasospasm ◽  
Angiographic Vasospasm ◽  
Fisher Grade ◽  
Increased Risk ◽  
Male Sex

Object Intraoperative rerupture during open surgical clipping of cerebral aneurysms in subarachnoid hemorrhage (SAH) is a relatively frequent and potentially catastrophic occurrence. Patients who suffer rerupture have been shown to have worse outcomes at discharge compared with those who do not have rerupture. Perioperative injury likely plays a large part in the clinical worsening of these patients. However, due to the increased vessel manipulation and repeat exposure to acute hemorrhage, it is possible that secondary injury from increased incidence of vasospasm also contributes. Identifying an increased rate of vasospasm in these patients would justify early aggressive treatment with measures to prevent delayed cerebral ischemia. The authors investigated whether patients who suffer intraoperative rerupture during surgical treatment of ruptured cerebral aneurysms are at increased risk of developing vasospasm. Methods Five hundred consecutive patients treated with open surgical clipping for SAH were reviewed, and clinical and imaging data were collected. Angiographic vasospasm was defined as vessel narrowing believed to be consistent with vasospasm on angiography. Symptomatic vasospasm was defined as angiographic vasospasm in the setting of a clinical change attributable to vasospasm. Rates of angiographic and symptomatic vasospasm among patients with and without intraoperative rerupture were compared. Results There were no significant differences between the groups with and without rupture with respect to age, sex, modified Fisher grade, history of hypertension, or smoking. The group with intraoperative rupture had more patients with Hunt and Hess Grade I. Angiographic vasospasm was noted in 279 (66%) of the 425 patients without rerupture compared with 49 (65%) of the 75 patients with rerupture (p = 1.0, Fisher's exact test). Symptomatic vasospasm was noted in 154 (36%) of the 425 patients without rerupture, compared with 31 (41%) of the 75 patients with rerupture (p = 0.44, Fisher's exact test). In multivariate analysis, higher modified Fisher grade was significantly predictive of vasospasm, whereas older age and male sex were protective. Conclusions This study found no significant influence of intraoperative rerupture during open surgical clipping on the rate of angiographic or symptomatic vasospasm. Brief exposure to acute hemorrhage and vessel manipulation associated with rerupture events did not affect the rate of vasospasm. Risk of vasospasm was related to increased modified Fisher grade, and inversely related to age and male sex. These results do not justify early, targeted vasospasm therapy in patients with intraoperative rerupture.

scholarly journals Intra-Arterial Nimodipine Infusion for Cerebral Vasospasm in Patients with Aneurysmal Subarachnoid Hemorrhage

2011 ◽  
Vol 17 (2) ◽  
pp. 169-178 ◽  
Author(s):  
W-S. Cho ◽  
H-S. Kang ◽  
J.E. Kim ◽  
O-K. Kwon ◽  
C.W. Oh ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Clinical Outcome ◽  
Clinical Response ◽  
Clinical Improvement ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Related Complication ◽  
Improvement Rate ◽  
Deterioration Rate ◽  
Symptomatic Vasospasm ◽  
Favorable Clinical Outcome

This study evaluated the efficacy of intra-arterial nimodipine infusion for symptomatic vasospasm in patients with aneurysmal subarachnoid hemorrhage (aSAH). Clinical data collected from 42 consecutive patients with symptomatic vasospasm after aSAH were retrospectively reviewed. Forty-two patients underwent 101 sessions of intra-arterial nimodipine infusion. Angiographic response, immediate clinical response, and clinical outcome were evaluated at discharge and six months later. Angiographic improvement was achieved in 82.2% of patients. The immediate clinical improvement rate was 68.3%, while the deterioration rate was 5.0%. A favorable clinical outcome was achieved in 76.2% at discharge and 84.6% six months. Vasospasm-related infarction occurred in 21.4%. There was no drug-related complication. The nimodipine group showed satisfactory outcomes. Nimodipine can be recommended as an effective and safe intra-arterial agent for the treatment of symptomatic vasospasm after aSAH.

scholarly journals Single-stage clipping with bifrontal and bilateral frontotemporal craniotomies for subarachnoid hemorrhage with multiple cerebral aneurysms using Sugita head holding system: A case report

2020 ◽  
Vol 11 ◽  
pp. 76
Author(s):  
Masahito Katsuki ◽  
Naomichi Wada ◽  
Yasunaga Yamamoto
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cerebral Artery ◽  
Treatment Strategies ◽  
Cerebral Aneurysms ◽  
Single Stage ◽  
Ruptured Aneurysm ◽  
Left Middle Cerebral Artery ◽  
Multiple Aneurysms ◽  
Single Fixation ◽  
The Right

Background: Subarachnoid hemorrhage with multiple aneurysms is very challenging because it is difficult to identify the ruptured aneurysm. We could not identify the ruptured aneurysm preoperatively, so we decided to treat all of the aneurysms as a single-stage surgery. Case Description: A 79-year-old woman was diagnosed with subarachnoid hemorrhage with multiple cerebral aneurysms at the right distal anterior cerebral artery, left middle cerebral artery, and right internal carotid artery- posterior communicating artery bifurcation. We could not identify the ruptured aneurysm preoperatively. We fixed her head using the Sugita head holding system (Mizuho Co., Ltd., Tokyo) and performed clipping for each aneurysm with bifrontal craniotomy and bilateral frontotemporal craniotomy as a single-stage operation. The last aneurysm seemed ruptured, and clipping for all the aneurysms was successful. She was discharged with a good postoperative course. The Sugita head holding system allowed turning the head of the patient toward the right and left with single fixation, leading to this single-stage operation. Conclusion: Several methods for identifying a ruptured aneurysm from multiple aneurysms have been reported, but under limited medical resources, this procedure would be one of the treatment strategies.

scholarly journals The Endovascular Management of Superior Cerebellar Artery Aneurysms

2004 ◽  
Vol 31 (1) ◽  
pp. 53-57 ◽  
Author(s):  
Charles Haw ◽  
Robert Willinsky ◽  
Ronit Agid ◽  
Karel TerBrugge
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cerebral Aneurysms ◽  
The Other ◽  
Superior Cerebellar Artery ◽  
Poor Grade ◽  
Cerebellar Artery ◽  
Clinical Series ◽  
Recovery Management ◽  
Endovascular Coils

Background:Superior cerebellar artery aneurysms are rare. We present a clinical series of twelve of these aneurysms that were treated exclusively with endovascular coils.Method:A retrospective analysis of a prospectively collected database of cerebral aneurysms treated with coil embolization was performed. Clinical notes and radiological images were reviewed.Results:Twelve superior cerebellar artery aneurysms were treated in eleven patients between 1992 and 2001. Seven patients presented with subarachnoid hemorrhage, two with neurologic deficit, and two had asymptomatic aneurysms. Coiling resulted in complete aneurysm obliteration in six patients and incomplete obliteration in the other six. No subsequent hemorrhage occurred with follow-up between 6 and 119 months (mean follow-up 50 months). Procedural morbidity was one superior cerebellar artery infarct with good recovery. Management morbidity was one middle cerebral artery embolus during a follow-up angiogram that required thrombolysis with a good clinical result. Nine out of 11 patients on follow-up were performing at Glasgow Outcome Scale (GOS) 5. One patient with GOS 3 presented with a poor grade subarachnoid hemorrhage and the other patient with GOS 4 presented with a parenchymal hemorrhage due to an arteriovenous malformation.Conclusion:Endovascular treatment of superior cerebellar artery aneurysms is an effective treatment strategy with low morbidity.

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