Surgical Management of Cerebral Aneurysms in Comparison with Endovascular Treatment

We report our surgical results of 92 intrabasal (below the ophthalmic segment) carotid aneurysms and 16 basilar aneurysms after the era of skull base surgery. These lesions were the most difficult location for neck clipping of aneurysms. Mortality, surgery associated mortality and morbidity of intrabasal carotid aneurysm surgery were 2.2%, 0% and 9.7% respectively. Mortality and morbidity of basilar ameurysm surgery were 0% and 6.2% respectively. Although endovascular treatment of cerebral aneurysms with detachable coils is premising treatment due to its convenience and less invasiveness, results of this treatment must be superior to the results of microsurgery for it to become a widely accepted therapy.

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Three-Dimensional Model for Virtual Surgical Simulation, during Complex Skull Base Surgery and Aneurysm Surgery

Skull Base ◽

10.1055/s-2008-1093271 ◽

2008 ◽

Vol 18 (S 01) ◽

Author(s):

Akio Morita ◽

Toshikazu Kimura ◽

Shigeo Sora ◽

Kengo Nishimura ◽

Hisayuki Sugiyama ◽

...

Keyword(s):

Skull Base ◽

Surgical Simulation ◽

Skull Base Surgery ◽

Three Dimensional ◽

Aneurysm Surgery ◽

Dimensional Model ◽

Three Dimensional Model

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MTI (Dendron) Variable Detachable Coils

Interventional Neuroradiology ◽

10.1177/159101990300900106 ◽

2003 ◽

Vol 9 (1) ◽

pp. 47-52

Author(s):

J. Thammaroj ◽

V. Jayakrishnan ◽

S. Lamin ◽

S. Jenkins ◽

E. Teasdale ◽

...

Keyword(s):

Endovascular Treatment ◽

Feasibility Study ◽

Clinical Experience ◽

Cerebral Aneurysms ◽

Detachable Coils ◽

Formed Part ◽

Small Aneurysms ◽

Initial Clinical Experience

We present our initial clinical experience of Dendron Variable Detachable System (VDS) coils, now Sapphire VDS from MTI, in the endovascular treatment of cerebral aneurysms. VDS coils, uniquely, can be detached at variable points along their length, allowing placement of as much or as little as desired of the coil within the aneurysm. Our ten patients formed part of a multicentre feasibility study. VDS coils were successfully deployed in all but one aneurysm. The electrolytic detachment mechanism with practice is both simple to use and reliable. The coils are however slightly stiffer than standard coils limiting their use in small aneurysms. This remains a technology in evolution.

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Surgical results of skull base surgery for the treatment of head and neck malignancies involving skull base: multi-institutional studies on 143 cases in Japan

Auris Nasus Larynx ◽

10.1016/s0385-8146(01)00083-9 ◽

2001 ◽

Vol 28 ◽

pp. S71-S75 ◽

Cited By ~ 11

Author(s):

Satoshi Fukuda ◽

Noboru Sakai ◽

Shin-Etsu Kamata ◽

Hideo Nameki ◽

Seiji Kishimoto ◽

...

Keyword(s):

Head And Neck ◽

Skull Base ◽

Skull Base Surgery ◽

Surgical Results ◽

Head And Neck Malignancies

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Surgical management of rhinosinusitis in endoscopic-endonasal skull-base surgery

International Forum of Allergy & Rhinology ◽

10.1002/alr.21476 ◽

2015 ◽

Vol 5 (4) ◽

pp. 339-343 ◽

Cited By ~ 11

Author(s):

Gurston G. Nyquist ◽

Mark E. Friedel ◽

Saurabh Singhal ◽

D. David Beahm ◽

Christopher J. Farrell ◽

...

Keyword(s):

Skull Base ◽

Surgical Management ◽

Skull Base Surgery ◽

Endoscopic Endonasal

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Endovascular Treatment of Skull Base Dural Fistulae by Venous Retrograde Approach Using Mechanical Detachable Coils

Rivista di Neuroradiologia ◽

10.1177/197140090301600672 ◽

2003 ◽

Vol 16 (6) ◽

pp. 1296-1297

Author(s):

M. Musacchio ◽

F. Mont'alverne ◽

F. Belzile ◽

V. Lenz ◽

C. Riquelme ◽

...

Keyword(s):

Endovascular Treatment ◽

Skull Base ◽

Retrograde Approach ◽

Detachable Coils

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FRED Italian Registry: a multicenter experience with the flow re-direction endoluminal device for intracranial aneurysms

Journal of Neurosurgery ◽

10.3171/2019.1.jns183005 ◽

2020 ◽

Vol 133 (1) ◽

pp. 174-181 ◽

Cited By ~ 5

Author(s):

Mariangela Piano ◽

Luca Valvassori ◽

Emilio Lozupone ◽

Guglielmo Pero ◽

Luca Quilici ◽

...

Keyword(s):

Adverse Event ◽

Endovascular Treatment ◽

Intracranial Aneurysms ◽

Cerebral Aneurysms ◽

Flow Diverter ◽

Anterior Circulation ◽

Cross Sectional ◽

Safety And Efficacy ◽

Mortality And Morbidity

OBJECTIVEThe introduction of flow-diverter devices (FDDs) has revolutionized the endovascular treatment of intracranial aneurysms. Here the authors present their Italian multicenter experience using the flow re-direction endoluminal device (FRED) in the treatment of cerebral aneurysms, evaluating both short- and long-term safety and efficacy of this device.METHODSBetween February 2013 and December 2014, 169 consecutive aneurysms treated using FRED in 166 patients were entered into this study across 30 Italian centers. Data collected included patient demographics, aneurysm location and characteristics, baseline angiography, adverse event and serious adverse event information, morbidity and mortality rates, and pre- and posttreatment modified Rankin Scale scores, as well as angiographic and cross-sectional CT/MRI follow-up at 3–6 months and/or 12–24 months per institutional standard of care. All images were reviewed and adjudicated by an independent core lab.RESULTSOf the 169 lesions initially entered into the study, 4 were later determined to be extracranial or nonaneurysmal by the core lab and were excluded, leaving 165 aneurysms in 162 patients treated in 163 procedures. Ninety-one (56.2%) patients were asymptomatic with aneurysms found incidentally. Of the 165 aneurysms, 150 (90.9%) were unruptured. One hundred thirty-four (81.2%) were saccular, 27 (16.4%) were fusiform/dissecting, and the remaining 4 (2.4%) were blister-like. One hundred thirty-seven (83.0%) arose from the anterior circulation.FRED deployment was impossible in 2/163 (1.2%) cases, and in an additional 4 cases (2.5%) the device was misdeployed. Overall mortality and morbidity rates were 4.3% and 7.3%, respectively, with rates of mortality and morbidity potentially related to FRED of up to 2.4% and 6.2%, respectively. Neuroimaging follow-up at 3–6 months showed complete or nearly complete occlusion of the aneurysm in 94% of cases, increasing to 96% at 12–24 months’ follow-up. Aneurysmal sac shrinkage was observed in 78% of assessable aneurysms.CONCLUSIONSThis preliminary experience using FRED for endovascular treatment of complex unruptured and ruptured aneurysms showed a high safety and efficacy profile that is comparable to those of other FDDs currently in use.

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Magnetic Resonance Angiography for Evaluation of Intracranial Aneurysms Treated with Guglielmi Detachable Coils

Rivista di Neuroradiologia ◽

10.1177/197140099801100102 ◽

1998 ◽

Vol 11 (1) ◽

pp. 19-25 ◽

Cited By ~ 6

Author(s):

E. Cotroneo ◽

M. Dazzi ◽

R. Gigli ◽

G. Guidetti ◽

G.P. Cantore ◽

...

Keyword(s):

Endovascular Treatment ◽

Mr Angiography ◽

Cerebral Aneurysms ◽

Digital Subtraction ◽

Contrast Injection ◽

Guglielmi Detachable Coils ◽

Non Invasive ◽

Mri Angiography ◽

Detachable Coils

Thirteen cases of cerebral aneurysms submitted to endovascular treatment using Guglielmi detachable coils (GDC) are described. Control MRI-angiography 3D TOF was performed three and six months later. In order to spare patients the discomfort and risks related to repeated trauma and iodate contrast injection, we examined the possibility of an alternative non-invasive diagnostic method. For this purpose, the digital subtraction angiograms performed three and six months after embolisation were compared with the MR-angiograms obtained in the same period, all using the same tomograph at middle field intensity (0.5T). We discuss the outcome of this comparison and the limits of the MR-angiography method in the follow-up of aneurysms submitted to endovascular treatment.

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Surgical management of unruptured asymptomatic aneurysms

Journal of Neurosurgery ◽

10.3171/jns.1977.46.6.0731 ◽

1977 ◽

Vol 46 (6) ◽

pp. 731-734 ◽

Cited By ~ 97

Author(s):

Duke S. Samson ◽

Richard M. Hodosh ◽

W. Kemp Clark

Keyword(s):

Surgical Technique ◽

Natural History ◽

Surgical Management ◽

Population Characteristics ◽

Aneurysm Surgery ◽

Content Type ◽

Mortality And Morbidity ◽

History Of ◽

Fine Print ◽

Significant Mortality

✓ The natural history of unruptured asymptomatic aneurysms is unclear. Because of this uncertainty regarding risk of ultimate enlargement and/or hemorrhage, and in view of the significant mortality and morbidity traditionally involved in aneurysm surgery, clinicians have varied in their advocacy of surgical management of such lesions. Forty-nine consecutive patients harboring 52 such aneurysms were treated surgically over a 57-month period. There were no surgical deaths and morbidity was within acceptable limits. Patient population characteristics and surgical technique are discussed.

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Endovascular treatment of cerebral aneurysms following incomplete clipping

Journal of Neurosurgery ◽

10.3171/jns.1997.87.2.0184 ◽

1997 ◽

Vol 87 (2) ◽

pp. 184-189 ◽

Cited By ~ 41

Author(s):

Kent R. Thielen ◽

Douglas A. Nichols ◽

Jimmy R. Fulgham ◽

David G. Piepgras

Keyword(s):

Endovascular Treatment ◽

Cerebral Aneurysms ◽

Surgical Clipping ◽

Content Type ◽

Coil Occlusion ◽

Neurological Morbidity ◽

Posterior Circulation Aneurysm ◽

Detachable Coils ◽

Fine Print

✓ The authors report their experience using electrolytically detachable coils for the treatment of residual cerebral aneurysms following incomplete surgical clipping. Eight patients were treated for six anterior and two posterior circulation aneurysm remnants. All patients were referred for endovascular treatment by experienced cerebrovascular neurosurgeons at the authors' institution. Patients underwent follow-up angiography immediately after endovascular treatment. In seven of the eight patients, additional follow-up angiographic studies were obtained at periods ranging from 7 weeks to 2 years posttreatment. The latest follow-up angiograms demonstrated that six of the eight aneurysm remnants were 100% occluded, with near-complete occlusion of the other two aneurysm remnants. There was no permanent neurological or non-neurological morbidity or mortality associated with the treatment. There was no incidence of aneurysm hemorrhage during or after treatment. Endovascular treatment of cerebral aneurysm remnants following prior surgical clipping can be accomplished with acceptable morbidity and mortality rates. Endovascular coil occlusion can play an important adjunctive role in the treatment of those aneurysms that have been incompletely obliterated by surgical clipping.

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