scholarly journals Kinematic measures provide useful information after intracranial aneurysm treatment

2017 ◽  
Vol 4 ◽  
pp. 205566831774499
Author(s):  
Rachael K Raw ◽  
Richard M Wilkie ◽  
Mark Mon-Williams ◽  
Stuart A Ross ◽  
Kenan Deniz ◽  
...  
Keyword(s):  
Intracranial Aneurysm ◽  
Subarachnoid Haemorrhage ◽  
Memory Function ◽  
Pilot Trial ◽  
Aneurysmal Subarachnoid Haemorrhage ◽  
Operative Outcomes ◽  
Aneurysm Treatment ◽  
Operative Care ◽  
Kinematic Measures

Introduction Current methods of assessing the outcomes of intracranial aneurysm treatment for aneurysmal subarachnoid haemorrhage are relatively insensitive, and thus unlikely to detect subtle deficits. Failures to identify cognitive and motor outcomes of intracranial aneurysm treatment might prevent delivery of optimal post-operative care. There are also concerns over risks associated with using intracranial aneurysm treatment as a preventative measure. Methods We explored whether our kinematic tool would yield useful information regarding motor/cognitive function in patients who underwent intracranial aneurysm treatment for aneurysmal subarachnoid haemorrhage or unruptured aneurysm. Computerised kinematic motor and learning tasks were administered alongside standardised clinical outcome measures of cognition and functional ability, in 10 patients, as a pilot trial. Tests at post-intracranial aneurysm treatment discharge and six-week follow-up were compared to see which measures detected changes. Results Kinematic tests captured significant improvements from discharge to six-week follow-up, indexed by reduced motor errors and improved learning. Increased Addenbrooke’s Cognitive Examination-Revised scores reflected some recovery of memory function for most individuals, but other standardised cognitive measures, functional outcome scores and a psychological questionnaire showed no changes. Conclusions Kinematic measures can identify variation in performance in individuals with only slightly improved abilities post-intracranial aneurysm treatment. These measures may provide a sensitive way to explore post-operative outcomes following intracranial aneurysm treatment, or other similar surgical procedures.

scholarly journals Aneurysm characteristics and risk of rebleeding after subarachnoid haemorrhage

2018 ◽  
Vol 4 (2) ◽  
pp. 153-159
Author(s):  
Inez Koopman ◽  
Jacoba P Greving ◽  
Irene C van der Schaaf ◽  
Albert van der Zwan ◽  
Gabriel JE Rinkel ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Aspect Ratio ◽  
Subarachnoid Haemorrhage ◽  
Independent Risk Factor ◽  
Irregular Shape ◽  
Aneurysmal Subarachnoid Haemorrhage ◽  
Aneurysm Size ◽  
Aneurysm Treatment ◽  
Independent Risk Factors

Introduction Knowledge of risk factors for rebleeding after aneurysmal subarachnoid haemorrhage can help tailoring ultra-early aneurysm treatment. Previous studies have identified aneurysm size and various patient-related risk factors for early (≤24 h) rebleeding, but it remains unknown if aneurysm configuration is also a risk factor. We investigated whether irregular shape, aspect- and bottleneck ratio of the aneurysm are independent risk factors for early rebleeding after aneurysmal subarachnoid haemorrhage. Patients and methods From a prospectively collected institutional database, we investigated data from consecutive aneurysmal subarachnoid haemorrhage patients who were admitted ≤24 h after onset between December 2009 and January 2015. The admission computed tomographic angiogram was used to assess aneurysm size and configuration. With Cox regression, we calculated stepwise-adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) for irregular shape, aspect ratio ≥1.6 mm and bottleneck ratio ≥1.6 mm. Results Of 409 included patients, 34 (8%) patients had in-hospital rebleeding ≤24 h after ictus. Irregular shape was an independent risk factor for rebleeding (HR: 3.9, 95% CI: 1.3–11.3) after adjustment for age, sex, PAASH score, aneurysm location, aneurysm size and aspect- and bottleneck ratio. Aspect ratio ≥1.6 mm (HR: 2.3, 95% CI: 0.8–6.5) and bottleneck ratio ≥1.6 mm (HR: 1.7, 95% CI: 0.8–3.6) were associated with an increased risk of rebleeding, but were not independent risk factors after multivariable adjustment. Conclusions Irregular shape is an independent risk factor for early rebleeding. However, since the majority of subarachnoid haemorrhage patients have an irregular aneurysm, additional risk factors have to be found for aneurysm treatment prioritisation.

scholarly journals Intravenous Nimodipine in Initial Intensive Care Management of Vasospasm in Aneurysmal Subarachnoid Haemorrhage – A Review

2021 ◽  
Author(s):  
Sreehari N R ◽  
Aadharsa Sugunan ◽  
Sheen Reynold ◽  
Athulya Subhash ◽  
Athul Gopan ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Intensive Care ◽  
Subarachnoid Haemorrhage ◽  
Care Management ◽  
T Test ◽  
Post Treatment ◽  
Aneurysmal Subarachnoid Haemorrhage ◽  
Intensive Care Management ◽  
The Difference

Abstract Background: As known to every Neuroscientist the spontaneous subarachnoid haemorrhage is a medical condition in which bleeding occurs in subarachnoid space due to cerebrovascular disease most commonly due ruptured aneurysms. Nimodipine is a calcium channel antagonist used to treat vasospasm. When compared to oral, intravenous nimodipine shows better neurological outcome with low dose, less frequency of administration and less fluctuations of blood pressure in between doses ( as in oral ) due to availability of continuous infusion . Titrated dose Intra venous nimodipine is useful in the initial Intensive Care management of Subarachnoid haemorrhage for Vasospasm with close monitoring of blood pressure.Objective: To evaluate the clinical outcomes of intravenous Nimodipine in the management of acute ischemic vasospasm in subarachnoid hemorrhagic patients. Material and methods: The study was a prospective and observational study conducted in all inpatients with SAH having acute ischemic vasospasm in the intensive care unit using IV Nimodipine admitted the department of Neurosurgery in AIMS during a period of 1yr.Results: Evaluation of SAH occurrence in study patients (n=38) showed predominance of females (68.4%) and majority with hypertension (57.9%) as the common comorbid condition. The chance of developing SAH was high in patients who did not practice any form of exercise (60.5%). None of the patients had occurrence of adverse drug reactions while administering IV nimodipine other than hypotension which was corrected with inotropic support with close blood pressure monitoring. Out of the subjects enrolled, 37 patients showed improvement clinically and resolution of ischemic changes in CT scan . Majority of patients experienced cerebral edema. Using pair t test, it was found that the difference between the Glasgow Coma Score pre and follow up post treatment score were mild. Using pair t test, it was found that the difference between the mRS pre and follow up post treatment score were significant.Conclusion: Introduction of IV Nimodipine to the treatment strategy of SAH showed significant improvement in the clinical and radiological outcome.IV Nimodipine showed benefit in treating the condition without any life-threatening adverse events other than correctable hypotension. A significant decrease in the mRS score in majority of patients after treatment indicates the improvement in the quality of life of SAH patients. Pre and Post neurological status strengthens the evidence of improvement in our study subjects.

Clipping versus Coiling: Neuropsychological Follow up After Aneurysmal Subarachnoid Haemorrhage (SAH)

2004 ◽  
Vol 26 (8) ◽  
pp. 1081-1092 ◽  
Author(s):  
Christian Bellebaum ◽  
Lasse Schäfers ◽  
Beate Schoch ◽  
Isabel Wanke ◽  
Dietmar Stolke ◽  
...  
Keyword(s):  
Subarachnoid Haemorrhage ◽  
Aneurysmal Subarachnoid Haemorrhage

scholarly journals Comparative results of operative and endovascular treatment of intracranial aneurysms

2011 ◽  
Vol 58 (3) ◽  
pp. 49-57
Author(s):  
Igor Nikolic ◽  
Branislav Nestorovic ◽  
Goran Tasic ◽  
Miodrag Rakic ◽  
Vaso Antunovic ◽  
...  
Keyword(s):  
Intracranial Aneurysm ◽  
Subarachnoid Haemorrhage ◽  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
International Experience ◽  
Aneurysm Treatment ◽  
Patient Status ◽  
Treatment Analysis ◽  
Comparative Results

Terapeutic protoclol for intracranial aneurysm treatment is very complex. In depand of patient status and anviografic founding we determinate modality and time of treatment. Analysis included 137 patients who were treated in Neurosurgical clinic CCS because sponatenus subarachnoid haemorrhage rigine from aneurysm belading. We performed direct surgery (microsurgery) in 109 patients. In early termine we operated 28 patients (25.69%), in first 24 hours 5 of them. In interemdiare period we performed surgery in 9, and other 72 patient we operated in postpone period. Embolisation was performed in 22 patinet. GOS form embolised patient was 4.636+0.581 and in operated 4.113+1.106 (p<0.05). Cumulative experient of Neurisurgical Clinic CCS and sumation of international experience impose as the best treatment is the treatment which is best known for the physitan.

scholarly journals One and done? The effect of number of Pipeline embolization devices on aneurysm treatment outcomes

2019 ◽  
Vol 26 (2) ◽  
pp. 147-155
Author(s):  
Muhammad Waqas ◽  
Kunal Vakharia ◽  
Andrew D Gong ◽  
Hamid H Rai ◽  
Audrey Wack ◽  
...  
Keyword(s):  
Intracranial Aneurysm ◽  
Thromboembolic Complication ◽  
Optimum Number ◽  
Complication Rates ◽  
Computed Tomographic ◽  
Aneurysm Treatment ◽  
Significant Difference ◽  
Angiographic Data ◽  
Aneurysm Occlusion

Background Controversy exists regarding the optimum number of flow diverters for the treatment of intracranial aneurysms. We explored the effect of the number of Pipeline embolization devices (PEDs; Medtronic, Dublin, Ireland) deployed on rates of aneurysm occlusion and complications. Methods Consecutive patients who underwent saccular intracranial aneurysm treatment solely with the PED were included in this retrospective study. Computed tomographic, magnetic resonance, or digital subtraction angiographic images at 6 and 12 months and last follow-up (>12 months) were reviewed for aneurysm occlusion. Complication and retreatment rates were recorded and analyzed statistically. Results The study included 141 aneurysm treatments in 119 patients. A single PED was deployed in 105 cases, two PEDs in 31 cases, and three PEDs in 5 cases (total = 182 devices). Six-month angiographic data were available for 103 patients. Occlusion rates were 67.1% for single-PED cases and 90.0% for cases with > 1 PED (p = 0.028). The 12-month occlusion rate (follow-up available for 132) for single-PED cases was 74.7% compared to 91.7% for multiple-PED cases (p = 0.04). On multivariate analysis, number of PEDs was an independent predictor of aneurysm occlusion at 12 months (odds ratio 6.3, 95% confidence interval 1.8–22.8, p = 0.005). Thromboembolic complication rates were the same in the single- and multiple-PED treatment groups (2.8%). The retreatment rate was higher in patients treated with a single PED (16.2% vs. 0%, p = 0.01). Conclusions Deployment of > 1 Pipeline embolization device was associated with higher intracranial aneurysm occlusion and lower retreatment rates. No significant difference was found in complication rates.

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