Surgical outcomes of patients after treatment of ruptured anterior communicating artery aneurysms: “real-world” evidence from southern Thailand

Abstract Background Anterior communicating artery (AComA) aneurysm rupture is the most common cause of subarachnoid hemorrhage worldwide. In this study, we aimed to determine the factors associated with a poor clinical outcome in patients with ruptured AComA aneurysms undergoing microsurgical clipping. Methods We retrospectively reviewed the clinical and radiologic features as well as clinical outcomes of 150 consecutive patients with ruptured AComA aneurysm who underwent surgical clipping during the 11-year study period. Logistic regression analysis was performed to identify independent factors associated with unfavorable clinical outcomes (defined as a modified Rankin scale score of 3–6). Results The study included 83 male and 67 female patients, with a mean age of 51.3 ± 11.5 years. At admission, most of the patients had good neurological status, including 97 (64.7%) patients with a Hunt and Hess grade of 1 or 2 and 109 (72.6%) patients with a World Federation of Neurosurgical Societies grade of 1 or 2. Unfavorable outcomes at 6 months were observed in 23 (22.0%) patients, and the 6-month mortality rate was 8.0%. Multivariate analysis showed that preoperative intraventricular hemorrhage (odds ratio [OR], 19.66; 95% confidence interval [CI], 5.10–75.80; P < 0.001), A1 hypoplasia (OR, 8.90; 95% CI, 2.82–28.04; P < 0.001), and postoperative cerebral infarction (OR, 3.21; 95% CI, 1.16–8.88; P = 0.025) were strong independent risk factors for unfavorable outcomes. Conclusions Proper management of preoperative intraventricular hemorrhage, A1 hypoplasia, and intensive care for postoperative brain infarction are warranted for improved surgical outcomes in patients with ruptured AComA aneurysm undergoing surgical clipping.

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Surgical Outcomes of Patients After Treatment of Ruptured Anterior Communicating Artery Aneurysms: “Real-World” Evidence From Southern Thailand

10.21203/rs.3.rs-513032/v1 ◽

2021 ◽

Author(s):

Kanisorn Sungkaro ◽

Thara Tunthanathip ◽

Chin Taweesomboonyat ◽

Anukoon Kaewborisutsakul

Keyword(s):

Clinical Outcomes ◽

Brain Infarction ◽

Neurological Status ◽

Aneurysm Rupture ◽

Anterior Communicating Artery ◽

Surgical Clipping ◽

Microsurgical Clipping ◽

Real World Evidence ◽

Southern Thailand ◽

Poor Outcomes

Abstract Background Anterior communicating artery (AComA) aneurysm rupture are the most common cause of subarachnoid hemorrhage worldwide. We aim to evaluate the clinical outcomes of patients with ruptured AComA aneurysms who underwent microsurgical clipping and factors related to poor outcomes at our institute. Methods We retrospectively review 150 consecutive patients with ruptured AComA aneurysm who underwent surgical clipping in eleven-year period. Their clinical and radiologic features, as well as, clinical outcomes, were reviewed. In addition, logistic regression analysis was performed to identify independent factor for unfavorable clinical outcomes (modified Rankin scale 3–6). Results Enrolled patients included 83 male 67 females with mean age of 51.3 ± 11.5 years. Admission neurological status with a Hunt and Hess grade of 1 or 2 (97 patients; 64.7%) and a WFNS grade of 1 or 2 (109 patients; 72.6%). Unfavorable outcomes at 6 months was observed in 23 (22.0%) patients and mortality rate was 8.0%. The multivariate analysis showed that preoperative intraventricular hemorrhage (IVH) (P < 0.001; OR, 19.66; 95% CI, 5.10–75.80), A1 hypoplasia (P < 0.001; OR, 8.90; 95% CI, 2.82–28.04), and postoperative cerebral infarction (P = 0.025; OR, 3.21; 95% CI, 1.16–8.88) were strongly independent risk factor for unfavorable outcomes in this group. Conclusions Among the ruptured AComA aneurysm patients who underwent surgical clipping; proper management of preoperative IVH, A1 hypoplasia and intensive care for postoperative brain infarction are warrant for improved the surgical outcome.

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Intracranial hematoma following ruptured anterior communicating artery aneurysms: risk factors, outcome, and prognostic factors after management of coiling first

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2021-017506 ◽

2021 ◽

pp. neurintsurg-2021-017506

Author(s):

Heng Ni ◽

Lin-Bo Zhao ◽

Sheng Liu ◽

Zhen-Yu Jia ◽

Yue-Zhou Cao ◽

...

Keyword(s):

Risk Factors ◽

Prognostic Factors ◽

Neurological Status ◽

External Ventricular Drainage ◽

Anterior Communicating Artery ◽

Intracranial Hematoma ◽

Factors Associated ◽

Independent Variable ◽

Logistic Regressions ◽

Significant Factors

BackgroundTo determine the risk factors for intracranial hematoma (ICH) development following ruptured anterior communicating artery (AcomA) aneurysms and to determine prognostic factors associated with unfavorable outcomes after coiling first.MethodsFrom March 2014 to February 2020, 235 patients with ruptured AcomA aneurysms underwent endovascular treatment in our department. The clinical and radiographic conditions were collected retrospectively. Modified Rankin Scale (mRS) scores of ≤ 2 were accepted as favorable outcomes. Univariate and multivariate logistic regressions were performed to identify significant factors contributing to the incidence of ICHs and to unfavorable outcomes.ResultsOf these 235 patients, 68 had additional ICHs. A posterior orientation of ruptured AcomA aneurysms was the independent variable associated with the incidence of ICHs (OR 3.675; p<0.001). Furthermore, having preoperative Hunt–Hess grades Ⅳ–Ⅴ was an independent variable associated with unfavorable outcomes for ICH patients (OR 80.000; p<0.001). Among the 68 patients with ICHs, 40% (27/68) had Hunt–Hess grades IV–V. Four percent of patients (3/68) underwent surgical hematoma evacuation after the coiling procedure and 15% of the patients (10/68) underwent external ventricular drainage. A favorable outcome was achieved in 72% (49/68) of patients with ruptured AcomA aneurysms. The mortality rate was 21% (14/68) at 6 months.ConclusionA posterior orientation of ruptured AcomA aneurysms was associated with the incidence of ICHs. Coiling first with surgical management if necessary seems to be an acceptable treatment for ruptured AcomA aneurysms with ICHs. The clinical outcome was associated with the clinical neurological status on admission.

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Delayed aneurysm rupture following treatment with the WEB embolization device

BMJ Case Reports ◽

10.1136/bcr-2021-017439 ◽

2021 ◽

Vol 14 (4) ◽

pp. 1-2

Author(s):

Bradley A Gross ◽

Michael J Lang

Keyword(s):

Intracranial Pressure ◽

Ct Scan ◽

Intraventricular Hemorrhage ◽

Artery Aneurysm ◽

Aneurysm Rupture ◽

Post Treatment ◽

Anterior Communicating Artery ◽

Anterior Communicating Artery Aneurysm ◽

Microsurgical Clipping ◽

The Web

Delayed rupture of an aneurysm following WEB embolization has not yet been reported. We present a case of a multiply ruptured anterior communicating artery aneurysm treated via WEB embolization. A post-treatment CT scan confirmed no evidence of rebleeding during treatment. Four hours after treatment, the patient developed an acute, significant increase in intracranial pressure with bloody ventriculostomy output, with CT scan demonstrating new parenchymal and intraventricular hemorrhage. The aneurysm was subsequently treated via microsurgical clipping that did not identify an “uncovered” bleb or rupture source.

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Rupture of anterior communicating artery aneurysms during computed tomography angiography: description of the pathway for intraseptal and intraventricular hemorrhage

Journal of Neurosurgery ◽

10.3171/2011.4.jns101629 ◽

2011 ◽

Vol 115 (3) ◽

pp. 617-620 ◽

Cited By ~ 6

Author(s):

Felix Scholtes ◽

Francesco Signorelli ◽

Michel W. Bojanowski

Keyword(s):

Computed Tomography ◽

Contrast Medium ◽

Computed Tomography Angiography ◽

Intraventricular Hemorrhage ◽

Aneurysm Rupture ◽

Septum Pellucidum ◽

Ventricular System ◽

Anterior Communicating Artery ◽

Lamina Terminalis ◽

Interhemispheric Fissure

Intraventricular hemorrhage is common after the rupture of anterior communicating artery (ACoA) aneurysms, although the anatomical pathway has not been described. Knowledge of the mechanism of hemorrhage may enhance understanding of its prognosis. Using CT angiography, the authors analyzed this pathway in 2 cases of ACoA aneurysm rupture associated with intraventricular hemorrhage. The initial hemorrhages created a hyperdense ventriculographic image on which the subsequent contrast medium ejection could be followed. The contrast medium entered the subarachnoid space of the anterior interhemispheric fissure and broke through the lamina rostralis into the septum pellucidum and into the frontal horns of the lateral ventricles. Thus, the authors provide an explanation for bleeding from ACoA aneurysms into the ventricular system in the presence of an intact lamina terminalis. The septum pellucidum may act as a buffer before extension of the bleeding into the ventricular system.

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Factors Associated with Clinical Outcomes in Patients with Primary Intraventricular Hemorrhage

Medical Science Monitor ◽

10.12659/msm.899309 ◽

2017 ◽

Vol 23 ◽

pp. 1401-1412 ◽

Cited By ~ 9

Author(s):

Sang-Hoon Lee ◽

Kyung-Jae Park ◽

Dong-Hyuk Park ◽

Shin-Hyuk Kang ◽

Jung-Yul Park ◽

...

Keyword(s):

Clinical Outcomes ◽

Intraventricular Hemorrhage ◽

Factors Associated

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Rescue Treatment with Pipeline Embolization for Postsurgical Clipping Recurrences of Anterior Communicating Artery Region Aneurysms

Interventional Neurology ◽

10.1159/000460264 ◽

2017 ◽

Vol 6 (3-4) ◽

pp. 135-146 ◽

Cited By ~ 11

Author(s):

Li-Mei Lin ◽

Rajiv R. Iyer ◽

Matthew T. Bender ◽

Thomas Monarch ◽

Geoffrey P. Colby ◽

...

Keyword(s):

Aneurysm Rupture ◽

Flow Diversion ◽

Anterior Communicating Artery ◽

Parent Vessel ◽

Surgical Clipping ◽

Microsurgical Clipping ◽

Rescue Treatment ◽

Efficacious Treatment ◽

Aneurysm Occlusion ◽

Vessel Reconstruction

Background: Postsurgical clipping aneurysm recurrences or residuals can be difficult to manage with either traditional open microsurgical approaches or endosaccular coiling. Endoluminal parent vessel reconstruction with flow diversion may be an ideal method for treating these recurrences by avoiding reoperative surgery or intraprocedural aneurysm rupture with aneurysm access. Method: We retrospectively reviewed a single-center aneurysm database identifying all anterior communicating artery (ACom) region aneurysms with recurrences after microsurgical clipping. Cases subsequently treated with Pipeline embolization device (PED) were identified for analysis. Results: Nine PED neurointerventions were performed for the treatment of 6 ACom region recurrent aneurysms after surgical clipping (ACom, n = 4 and A1-A2 junction, n = 2). Of the 6 aneurysms treated, 4 were previously ruptured. Mean patient age was 59.5 ± 6.9 years (range 50-67 years). Mean aneurysm size was 5.1 ± 2.2 mm (range 3-9 mm). Mean fluoroscopy time was 44.1 ± 12.4 min. A single PED, deployed from ipsilateral A2 to ipsilateral A1, was used in 6 cases. No instances of periprocedural complications were encountered. Angiographic follow-up was available in all aneurysms; 5 of these 6 (83%) demonstrated complete aneurysm occlusion. Conclusion: Flow diversion with PED can be a safe and efficacious treatment approach for recurrent ACom region aneurysms after surgical clipping.

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Surgery-related predictable risk factors influencing postoperative clinical outcomes for thoracic myelopathy caused by ossification of the posterior longitudinal ligament: a multicenter retrospective study

Journal of Neurosurgery Spine ◽

10.3171/2019.10.spine19831 ◽

2020 ◽

Vol 32 (5) ◽

pp. 703-709

Author(s):

Hirokazu Saiwai ◽

Seiji Okada ◽

Mitsumasa Hayashida ◽

Katsumi Harimaya ◽

Yoshihiro Matsumoto ◽

...

Keyword(s):

Risk Factors ◽

Clinical Outcomes ◽

Surgical Outcomes ◽

Japanese Orthopaedic Association ◽

Posterior Longitudinal Ligament ◽

Neurological Status ◽

Thoracic Myelopathy ◽

Number Of Patients ◽

Surgical Methods ◽

Csf Leakage

OBJECTIVECompression of the spinal cord by thoracic ossification of the posterior longitudinal ligament (T-OPLL) often causes severe thoracic myelopathy. Although surgery is the most effective treatment for T-OPLL, problems associated with surgical intervention require resolution because surgical outcomes are not always favorable, and a small number of patients experience deterioration of their neurological status after surgery. The aim of the present study was to examine the surgery-related risk factors contributing to poor clinical outcomes for myelopathy caused by T-OPLL.METHODSData were extracted from the records of 55 patients with thoracic myelopathy due to T-OPLL at institutions in the Fukuoka Spine Group. The mean follow-up period was 5.3 years. Surgical outcomes were assessed using the Japanese Orthopaedic Association (JOA) scale. To investigate the definitive factors associated with surgical outcomes, univariate and multivariate regression analyses were performed with several patient-related and surgery-related factors, including preoperative comorbidities, radiological findings, JOA score, surgical methods, surgical outcomes, and complications.RESULTSNeurological status improved in 33 patients (60.0%) and deteriorated in 10 patients (18.2%) after surgery. The use of instrumentation was significantly associated with an improved outcome. In the comparison of surgical approaches, posterior decompression and fusion resulted in a significantly higher neurological recovery rate than did anterior decompression via a posterior approach and fusion or decompression alone. It was also found that postoperative neurological status was significantly poorer when there were fewer instrumented spinal levels than decompression levels. CSF leakage was a predictable risk factor for deterioration following surgery.CONCLUSIONSIt is important to identify preventable risk factors for poor surgical outcomes for T-OPLL. The findings of the present study suggest that intraoperative CSF leakage and a lower number of instrumented spinal fusion levels than decompression levels were exacerbating factors for the neurological improvement in T-OPLL surgery.

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Anterior Communicating Artery Aneurysm Uncommon Hemorrhagic Presentation: Case Report

Arquivos Brasileiros de Neurocirurgia Brazilian Neurosurgery ◽

10.1055/s-0039-3402488 ◽

2020 ◽

Vol 39 (01) ◽

pp. 054-057

Author(s):

Dan Zimelewicz Oberman ◽

Nicollas Nunes Rabelo ◽

Rafael Rego Barros ◽

Othavio Lopes ◽

Jorge Amorim

Keyword(s):

Computed Tomography ◽

Subarachnoid Hemorrhage ◽

Intracerebral Hemorrhage ◽

Intraventricular Hemorrhage ◽

Unusual Case ◽

Artery Aneurysm ◽

Aneurysm Rupture ◽

Anterior Communicating Artery ◽

Anterior Communicating Aneurysm ◽

Head Computed Tomography

AbstractIntracranial aneurysm rupture causes subarachnoid hemorrhage in 80% of the cases, and it may be associated with intracerebral hemorrhage and/or intraventricular hemorrhage (IVH) in 34% and 17% of the patients, respectively. However, on rare occasions, aneurysm rupture may be present causing isolate intracerebral hemorrhage or IVH without subarachnoid hemorrhage.We describe an unusual case of an anterior communicating aneurysm rupture presented with IVH, without subarachnoid hemorrhage.Although isolated IVH is rare, aneurysm rupture is a possible condition. Patients presenting with head computed tomography revealing IVH without subarachnoid hemorrhage should be promptly investigated with contrasted image exam to identify and treat possible causes, even in the absence of subarachnoid hemorrhage.

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Subarachnoid Hemorrhage

10.2310/em.4707 ◽

2016 ◽

Author(s):

Imoigele P Aisiku

Keyword(s):

Blood Pressure ◽

Subarachnoid Hemorrhage ◽

Delayed Cerebral Ischemia ◽

Aneurysm Rupture ◽

World Federation ◽

Neurogenic Pulmonary Edema ◽

Surgical Clipping ◽

Systemic Complications ◽

Risk Of Rupture ◽

Anterior Communicating Aneurysm

Subarachnoid hemorrhage (SAH) represents a small portion of cerebrovascular disease but a disproportionally large percentage of the morbidity and mortality. The overall prognosis depends on the volume of the initial bleeding, rebleeding, and the degree of delayed cerebral ischemia. The presence of cardiac manifestations and neurogenic pulmonary edema at the initial presentation indicates a higher degree of severity and systemic complications. This review covers the pathophysiology, stabilization and assessment, diagnosis and treatment, and disposition and outcomes of SAH. Figures show common saccular aneurysm locations, a noncontrast head computed tomographic scan of an SAH, an angiogram and surgical clipping of a broad-based anterior communicating aneurysm, and a three-dimensional reconstruction angiogram of a complex anterior communicating aneurysm with additional imaging of endoscopic stent-assisted coiling of the same aneurysm. Tables list the natural history of unruptured aneurysms and the annual risk of rupture, common clinical features and syndromes related to aneurysm location, the World Federation of Neurologic Surgeons grading system, the Hunt and Hess grading systems, and the Fisher scale. This review contains 4 highly rendered figures, 5 tables, and 144 references. Key words: aneurysm rupture, cerebral aneurysm, cerebral vasospasm, Fisher scale, Glasgow Coma Scale assessment, Hunt and Hess grading criteria, subarachnoid hemorrhage, World Federation of Neurologic Surgeons grading scale Key Advances CT angiography is an emerging technology that has the diagnostic advantage of being non-invasive. The diagnostic accuracy of CTA varies widely and when compared to the standard digital subtraction angiography (DSA) the sensitivity and specificity range from 77% to 100% and 87%-100% respectively. The 2012 AHA guidelines and the 2011 Neurocritical care society (NCS) consensus guidelines recommend that from the time of symptom onset to securing of the aneurysm, the blood pressure be controlled with a titratable agent with a goal systolic blood pressure of less than 160mmHg or a MAP of less than 110mmHg. Cardiac abnormalities are common following acute SAH. Subendocardial ischemia may result from autonomic stimulation from the brain and circulating catecholamine surge, resulting in an abnormal ECG in 50% to 100% of patients with SAH in the acute phase depending on severity. The International Subarachnoid Aneurysm Trial ISAT was a landmark study that looked at aSAH repair comparing surgical clipping with endoscopic coiling and demonstrated a mortality benefit with coiling in the right patient population.

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