NEUROSURGICAL TREATMENT FOR ANEURYSM REMNANTS OR RECURRENCES AFTER COIL OCCLUSION

Neurosurgery ◽  
2008 ◽  
Vol 63 (4) ◽  
pp. 684-692 ◽  
Author(s):  
Jean-Paul Lejeune ◽  
Laurent Thines ◽  
Christian Taschner ◽  
Philippe Bourgeois ◽  
Hilde Henon ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Glasgow Outcome Scale ◽  
Postoperative Outcome ◽  
Consecutive Series ◽  
Anterior Circulation ◽  
Microsurgical Treatment ◽  
Coil Occlusion ◽  
Neurosurgical Treatment ◽  
Temporary Occlusion

ABSTRACT OBJECTIVE Neurosurgical management of residual aneurysms (RA) after coiling remains a challenging issue. We present a consecutive series of 21 patients who underwent microsurgical treatment of a previously coiled aneurysm. METHODS We retrospectively reviewed a consecutive series of 21 patients who underwent operations for an RA after coiling between 1997 and 2007. Postcoiling follow-up imaging included brain magnetic resonance angiography and digital subtraction angiography. The decision for surgical treatment was made when an RA was significant and unsuitable for re-embolization. Data related to the RA and to the surgical technique were analyzed. Postoperative outcome was evaluated with the Glasgow Outcome Scale. RESULTS Twenty aneurysms were initially ruptured. Twelve had undergone complete coil occlusion, whereas 6 had a residual neck, 2 had a residual lobule, and 1 had a residual sac. The aneurysms were in the anterior circulation in 18 cases and in the posterior circulation in 3 cases. Twenty RAs were excluded with the apposition of 1 clip beneath the coils, 2 required a temporary occlusion, 2 required extraction of the coils, and 1 presented with an operative rupture. All aneurysms, except 2 that had their residual neck wrapped, were completely occluded. The postoperative Glasgow Outcome Scale score was unchanged in 90% of patients, and 2 patients sustained a moderate disability. CONCLUSION Microsurgical treatment of RA after endovascular treatment is effective, provided that patients are selected appropriately. The surgical treatment of recanalized aneurysms after coiling is challenging but can result in a good outcome with low morbidity and no mortality.

Postoperative Outcome of Cerebral Amyloid Angiopathy-Related Lobar Intracerebral Hemorrhage

Neurosurgery ◽  
2011 ◽  
Vol 70 (1) ◽  
pp. 125-130 ◽  
Author(s):  
Yi Zhang ◽  
Xin Wang ◽  
Caleb Schultz ◽  
Giuseppe Lanzino ◽  
Alejandro A. Rabinstein
Keyword(s):  
Systematic Review ◽  
Length Of Stay ◽  
Intracerebral Hemorrhage ◽  
Glasgow Outcome Scale ◽  
Postoperative Outcome ◽  
Older Age ◽  
Amyloid Angiopathy ◽  
Cerebral Amyloid ◽  
Poor Postoperative Outcome

Abstract BACKGROUND Despite its accessible superficial location, the indication for surgical evacuation in cases of lobar intracerebral hemorrhage (LICH) suspected to be related to cerebral amyloid angiopathy (CAA) is controversial because of advanced patient age and concerns about postoperative hemostasis. OBJECTIVE To examine factors associated with postoperative outcome in CAA-related LICH. METHODS Review of consecutive patients with pathologically proven CAA who underwent LICH evacuation at Saint Marys Hospital, Rochester, Minnesota, between 1987 and 2006. End points were length of stay and postoperative outcome at discharge and last follow-up using the Glasgow Outcome Scale. We also performed a systematic review of all published studies evaluating the outcome of surgically treated CCA-related LICH published between 1984 and 2010. RESULTS We identified 23 patients with CAA-related LICH treated surgically. Favorable outcome (Glasgow Outcome Scale >3) at discharge was noted in 5 patients (22%), and at 6- to 12-month follow-up (n = 15) in 7 patients (47%). Three (13%) died in the hospital, including 1 of 4 patients with postoperative hemorrhage. Intraventricular hemorrhage (IVH) was associated with poor outcome at discharge. Older age (≥75 years), history of hypertension, and degree of preoperative midline shift were associated with more prolonged length of stay. In our systematic review, we identified 14 studies including 278 cases. Overall mortality rate was 25%, and poor postoperative outcome was associated with older age, IVH, and preoperative dementia. CONCLUSION Neurosurgical evacuation may be performed with acceptable safety in patients with CAA-related LICH. A systematic literature review indicates that older age, preexistent dementia, and presurgical IVH portend poor postoperative outcome.

Cervical Laminoplasty as a Management Option for Patients With Cervical Spondylotic Myelopathy

Neurosurgery ◽  
2010 ◽  
Vol 67 (2) ◽  
pp. 272-277 ◽  
Author(s):  
Anthony L. Petraglia ◽  
Vasisht Srinivasan ◽  
Michelle Coriddi ◽  
M. Gordon Whitbeck ◽  
James T. Maxwell ◽  
...  
Keyword(s):  
Cervical Spondylotic Myelopathy ◽  
Medical Center ◽  
Demographic Data ◽  
Adult Population ◽  
Postoperative Outcome ◽  
Outcome Data ◽  
Consecutive Series ◽  
Cervical Laminoplasty ◽  
Presenting Symptoms

Abstract BACKGROUND Cervical spondylotic myelopathy (CSM) is one of the leading causes of spinal cord dysfunction in the adult population. Laminoplasty is an effective decompressive procedure for the treatment of CSM. OBJECTIVE We present our experience with 40 patients who underwent cervical laminoplasty using titanium miniplates for CSM. METHODS We performed a retrospective review of the medical records of a consecutive series of patients with CSM treated with laminoplasty at the University of Rochester Medical Center or Rochester General Hospital. We documented patient demographic data, presenting symptoms, and postoperative outcome. Data are also presented regarding the general cost of constructs for a hypothetical 3-level fusion. RESULTS Forty patients underwent cervical laminoplasty; all were available for follow-up. The mean number of levels was 4. All patients were myelopathic, and 17 (42.5%) had signs of radiculopathy preoperatively. Preoperatively, 62.5% of patients had a Nurick grade of 2 or worse. The average follow-up was 31.3 months. The median length of stay was 48 hours. On clinical evaluation, 36 of 40 patients demonstrated an improvement in their myelopathic symptoms; 4 were unchanged. Postoperative kyphosis did not develop in any patients. CONCLUSION The management of CSM for each of its etiologies remains controversial. As demonstrated in our series, laminoplasty is a cost-effective, decompressive procedure for the treatment of CSM, providing a less destabilizing alternative to laminectomy while preserving mobility. Cervical laminoplasty should be considered in the management of multilevel spondylosis because of its ease of exposure, ability to decompress, effective preservation of motion, maintenance of spinal stability, and overall cost.

scholarly journals Microsurgical treatment of sacral perineural (Tarlov) cysts: case series and review of the literature

2016 ◽  
Vol 24 (5) ◽  
pp. 700-707 ◽  
Author(s):  
John F. Burke ◽  
Jayesh P. Thawani ◽  
Ian Berger ◽  
Nikhil R. Nayak ◽  
James H. Stephen ◽  
...  
Keyword(s):  
Case Series ◽  
Disease Process ◽  
Muscle Flap ◽  
Postoperative Outcome ◽  
Preoperative Imaging ◽  
Duration Of Symptoms ◽  
Microsurgical Treatment ◽  
Tarlov Cysts ◽  
Common Causes

OBJECTIVE Tarlov cysts (TCs) occur most commonly on extradural components of the sacral and coccygeal nerve roots. These lesions are often found incidentally, with an estimated prevalence of 4%–9%. Given the low estimated rates of symptomatic TC and the fact that symptoms can overlap with other common causes of low-back pain, optimal management of this entity is a matter of ongoing debate. Here, the authors investigate the effects of surgical intervention on symptomatic TCs and aim to solidify the surgical criteria for this disease process. METHODS The authors performed a retrospective review of data from consecutive patients who were surgically treated for symptomatic TCs from September 2011 to March 2013. Clinical evaluations and results from surveying pain and overall health were used. Univariate statistical analyses were performed. RESULTS Twenty-three adults (4 males, 19 females) who had been symptomatic for a mean of 47.4 months were treated with laminectomy, microsurgical exposure and/or imbrication, and paraspinous muscle flap closure. Eighteen patients (78.3%) had undergone prior interventions without sustained improvement. Thirteen patients (56.5%) underwent lumbar drainage for an average of 8.7 days following surgery. The mean follow-up was 14.4 months. Univariate analyses demonstrated that an advanced age (p = 0.045), the number of noted perineural cysts on preoperative imaging (p = 0.02), and the duration of preoperative symptoms (p = 0.03) were associated with a poor postoperative outcome. Although 47.8% of the patients were able to return to normal activities, 93.8% of those surveyed reported that they would undergo the operation again if given the choice. CONCLUSIONS This is one of the largest published studies on patients with TCs treated microsurgically. The data suggest that patients with symptomatic TCs may benefit from open microsurgical treatment. Although outcomes seem related to patient age, duration of symptoms, and extent of disease demonstrated on imaging, further study is warranted and underway.

scholarly journals Microsurgical treatment of basilar tip aneurysms: is it still acceptable?

2017 ◽  
Vol 75 (10) ◽  
pp. 697-702
Author(s):  
Felix Hendrik Pahl ◽  
Matheus Fernandes de Oliveira ◽  
José Marcus Rotta
Keyword(s):  
Surgical Treatment ◽  
Glasgow Outcome Scale ◽  
Surgical Results ◽  
Success Rates ◽  
Giant Aneurysms ◽  
Complex Anatomy ◽  
Scale Scores ◽  
Complete Exclusion ◽  
Small Aneurysms

ABSTRACT Basilar tip aneurysms (BTAs) have a complex anatomy, making them difficult to treat. We describe our surgical results for BTAs. Methods: From 2004 to 2015 (12 years), a total of 25 small BTAs and two giant BTAs were treated in the Hospital do Servidor Público Estadual de São Paulo. Results: In 23 patients harboring aneurysms positioned anteriorly or straight, all aneurysms were clipped (complete exclusion in all on follow-up angiography). In two patients with posteriorly positioned aneurysms, there was residual neck. All patients submitted to surgical treatment of small aneurysms presented with late Glasgow Outcome Scale scores of 4 or 5. Two patients with giant aneurysms died. Conclusion: Surgical treatment of these lesions may be accomplished with quite high success rates and low morbidity.

scholarly journals Surgery for Unruptured Intracranial Aneurysms in the ISAT and ISUIA Era

2012 ◽  
Vol 39 (2) ◽  
pp. 174-179 ◽  
Author(s):  
Laurent Thines ◽  
Philippe Bourgeois ◽  
Jean-Paul Lejeune
Keyword(s):  
Intracranial Aneurysms ◽  
Consecutive Series ◽  
Thin Wall ◽  
Anterior Circulation ◽  
Microsurgical Clipping ◽  
Unruptured Intracranial Aneurysms ◽  
Neurological Morbidity ◽  
Wide Neck ◽  
Temporary Clipping

Background:The ISAT and ISUIA studies, along with the improvement of endovascular treatment (EVT) have strongly influenced the management of intracranial aneurysms (IAs). We present our experience in the microsurgical treatment of unruptured IAs (UIAs) in this context.Methods:We retrospectively reviewed a consecutive series of non-giant UIAs selected for surgery during a five-year period. Patients and aneurysms characteristics, surgical results and outcome assessed by the Glascow Outcome Scale (GOS) at three month follow-up were studied.Results:Eighty-five patients underwent 93 surgical procedures to obliterate 113 UIAs. Those were incidental in 89% of the cases and mainly located on the middle cerebral artery (65%). Patients were assigned to surgery according to their medical history (young, previous subarachnoid haemorrhage), aneurysm characteristics (wide neck, branch at the neck, “small” size, associated “surgical” aneurysm) or failure of EVT (5%). Operatively, 48% of UIAs had thin wall or blebs and 71% were occluded with one titanium clip. Thrombectomy or temporary clipping were necessary in 4% and 11% of the cases, three aneurysms peroperatively ruptured, four were deemed unclippable, three paraclinoid UIAs had an intracavernous residue and 16% were wrapped because of a small neck remnant (class 2). The mortality rate was 0% and 4% of the patients experienced a definitive major neurological deterioration. Final GOS was unchanged in 96% of the patients.Conclusions:Despite reduction in operative cases and in appropriately selected patients ineligible to EVT, microsurgical clipping of non-giant anterior circulation UIAs can still achieve good outcome with very low mortality and neurological morbidity.

Chorea in the clinical presentation of moyamoya disease: results of surgical revascularization and a proposed clinicopathological correlation

2013 ◽  
Vol 11 (3) ◽  
pp. 313-319 ◽  
Author(s):  
Edward S. Ahn ◽  
R. Michael Scott ◽  
Richard L. Robertson ◽  
Edward R. Smith
Keyword(s):  
Surgical Treatment ◽  
Basal Ganglia ◽  
Moyamoya Disease ◽  
Clinical Presentation ◽  
Disease Stage ◽  
Consecutive Series ◽  
Unilateral Disease ◽  
Collateral Vessels ◽  
Revascularization Surgery

Object Chorea is a movement disorder characterized by brief, irregular, involuntary contractions that appear to flow from 1 muscle to another. There are a limited number of reports in the literature that have linked moyamoya disease and chorea. The authors describe their experience in treating moyamoya disease in patients in whom chorea developed as part of the clinical presentation. Methods The authors conducted a retrospective review of a consecutive series of 316 children who underwent pial synangiosis revascularization for moyamoya disease at the Boston Children's Hospital. Results Of 316 surgically treated patients with moyamoya disease, 10 (3.2%; 6 boys and 4 girls) had chorea as a part of their presentation. The average age at surgical treatment was 9.9 years (range 3.8–17.9 years). All patients had evidence of hypertrophied lenticulostriate collateral vessels through the basal ganglia on preoperative angiography and/or MRI on affected sides. Two patients had cystic lesions in the basal ganglia. Nine patients underwent bilateral craniotomies for pial synangiosis, and 1 patient underwent a single craniotomy for unilateral disease. Follow-up was available in 9 patients (average 50.1 months). The mean duration of chorea was 1.36 years (range 2 days to 4 years), with resolution of symptoms in all patients. One patient developed chorea 3 years after surgical treatment, 4 patients had transient chorea that resolved prior to surgery, and 5 patients experienced resolution of the chorea after surgery (average 13 months). Conclusions The authors describe children with moyamoya disease and chorea as part of their clinical presentation. The data suggest that involvement of the basal ganglia by the hypertrophied collateral vessels contributes to the development of chorea, which can wax or wane depending on disease stage or involution of the vessels after revascularization surgery. In most patients, however, the chorea improves or disappears about 1 year after presentation.

scholarly journals Intravesical and extravesical ureteral reimplantation in children with bilateral refluxing megaureter: comparison of results

2020 ◽  
Vol 8 (2) ◽  
pp. 21-28
Author(s):  
V. I. Dubrov ◽  
I. M. Kagantsov
Keyword(s):  
Surgical Treatment ◽  
Vesicoureteral Reflux ◽  
Postoperative Outcome ◽  
Ureteral Reimplantation ◽  
Patient Demographics ◽  
The Difference ◽  
Group 2 ◽  
Methods Of Treatment ◽  
Group 1

Introduction. Extravesical ureteral reimplantation is an accepted technique for the surgical treatment of high-grade vesicoureteral reflux. However, many surgeons continue to use an intravesical technique, including for the megaureter. We present our experience and outcomes with these techniques for primary bilateral refluxing megaureter.Purpose of the study. To improve the results of surgical treatment of refluxing megaureter in children.Materials and methods. A retrospective study was performed of 95 patients who underwent ureteral reimplantation between 2006 and 2019. The age of patients at the time of surgery was from 4 months to 13 years (median — 27.6 months), boys were 71 (74.7%), girls were 24 (25.3%). All patients are divided into 2 groups depending on the method of treatment. Group 1 consisted of 65 patients who underwent Cohen single-stage bilateral transvesical ureteral reimplantation. Group 2 included 30 children who underwent two-stage Barry extravesical ureteral reimplantation. The interval between operations was from 1 to 63 months (median — 5.2 months). Patient demographics, surgical technique and outcomes were recorded. A successful postoperative outcome was defined as improved hydronephrosis and no vesicoureteral reflux.Results. Median follow-up period was 3.2 years. The overall success rate was 80% for patients and 88% for ureters. Postoperative grade III – IV reflux had 15 patients (15,8%) and 16 ureters (8,4%). Persistent ureterohydronephrosis had 4 children (4,2%) and 6 ureters (3,2%). The effectiveness of treatment for patients in the Cohen group was 77%, in the Barry group — 87% (p = 0.408), for ureters — 86% and 93%, respectively (p = 0.223). The difference was not significant despite the higher effectiveness extravesical technique.Conclusion. Extravesical and transvesical ureteral reimplantation are effective methods of treatment for bilateral refluxing megaureter in children.

Endovascular coil occlusion of 152 middle cerebral artery aneurysms: initial and midterm angiographic and clinical results

2010 ◽  
Vol 112 (4) ◽  
pp. 703-708 ◽  
Author(s):  
Serge Bracard ◽  
Amr Abdel-Kerim ◽  
Lorrena Thuillier ◽  
Olivier Klein ◽  
René Anxionnat ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Vegetative State ◽  
Clinical Results ◽  
Endovascular Coiling ◽  
Consecutive Series ◽  
Unruptured Aneurysms ◽  
Coil Occlusion

Object The object of this study was to evaluate the initial and mid-term angiographic and clinical results after endovascular coil occlusion of middle cerebral artery (MCA) aneurysms at the authors' institution. Methods The authors conducted a retrospective analysis of a consecutive series of 152 MCA aneurysms (73 ruptured) treated by endovascular coiling in 140 patients. Angiographic and clinical data at initial and midterm follow-up as well as procedure-related complications were prospectively registered. Results At discharge, favorable clinical outcomes (Glasgow Outcome Scale score of 1 or 2) were obtained in 89.3% of patients (125/140). Seven patients (5%) were in a vegetative state or had died. Complications were encountered in association with 11.8% of the procedures (18/152), and most (13/18) involved thromboembolic events (which led to permanent ischemia in 4 cases and death in 1). The overall procedure-related mortality rate was 0.7%, and the rates of permanent and transient morbidity were 2.6 and 2%, respectively. At a mean follow-up duration of 4.3 years there had been 4 cases of rebleeding: early rebleeding occurred during the initial postoperative period in 3 cases and later in 1. Total or subtotal occlusion was obtained in 84.2% of aneurysms (128/152). At follow-up, this satisfactory occlusion persisted in 83.3% of aneurysms (110/132) at 1 year posttreatment, 79.5% (89/112) at 3 years, and 80.2% (73/91) at 5 years. Conclusions Risks and initial and midterm angiographic and clinical results after endovascular treatment of MCA aneurysms are nearly identical to other locations. Endovascular treatment may thus be proposed as an alternative to surgical clipping at this location. Nevertheless, a longer follow-up period is necessary to determine its efficacy, particularly in cases of unruptured aneurysms.

A Proposed Grading System of Brain and Spinal Cavernomas

Neurosurgery ◽  
2011 ◽  
Vol 69 (4) ◽  
pp. 807-814 ◽  
Author(s):  
Juri Kivelev ◽  
Aki Laakso ◽  
Mika Niemelä ◽  
Juha Hernesniemi
Keyword(s):  
Risk Factors ◽  
Glasgow Outcome Scale ◽  
Outcome Measure ◽  
Postoperative Outcome ◽  
Unfavorable Outcome ◽  
Surgical Removal ◽  
Grading System ◽  
Long Term Outcome

Abstract BACKGROUND: Most cavernomas in the central nervous system are characterized by a benign natural course. Progressive symptoms warrant surgical removal. In the literature, the factors affecting long-term postoperative outcome are not statistically well confirmed. OBJECTIVE: To perform a multifactorial analysis of risk factors on a large patient series and to use the results to propose a simple grading scale to predict outcome. METHODS: We studied 303 consecutive patients with cavernomas treated surgically at our department from 1980 to 2009. Follow-up assessment was performed on average 5.7 years postoperatively (range, 0.2-36 years). The main outcome measure was the patients' condition at the last follow-up on Glasgow Outcome Scale. For statistical analysis, the outcome measure was dichotomized to favorable (Glasgow Outcome Scale 5) and unfavorable (Glasgow Outcome Scale 1–4). Binary logistic regression analysis was used to estimate the effect of age, sex, seizures, preexisting neurological deficits, hemorrhage, and size and location of cavernoma on long-term outcome. RESULTS: Infratentorial, basal ganglia, or spinal location and preexisting neurological deficit were the only independent risk factors for unfavorable outcome, with relative risks of 2.7 (P = .008) and 3.2 (P = .002), respectively. We formulated a grading system based on a score of 1 to 3. When applied to our series, the proposed grading system strongly correlated with outcome (P < .001, Pearson χ2 test). The risk for long-term unfavorable outcome was 13%, 22%, and 55% for grades 1 through 3, respectively. CONCLUSION: The proposed grading system showed a convincing correlation with postoperative outcome in surgically treated cavernoma patients.

scholarly journals Surgical Treatment of Spinal Dural Arteriovenous Fistulae: A Consecutive Series of 154 Patients

Neurosurgery ◽  
2010 ◽  
Vol 67 (5) ◽  
pp. 1350-1358 ◽  
Author(s):  
Andrea Saladino ◽  
John L D Atkinson ◽  
Alejandro A Rabinstein ◽  
David G Piepgras ◽  
W Richard Marsh ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Motor Function ◽  
Neurological Complications ◽  
Motor Dysfunction ◽  
Sensory Loss ◽  
Consecutive Series ◽  
Arteriovenous Fistulae ◽  
Female Ratio ◽  
Presenting Symptoms

Abstract BACKGROUND: Embolization of spinal dural arteriovenous fistulae (SDVAFs) has emerged as an alternative to surgery. However, surgical disconnection is a simple and effective procedure. OBJECTIVE: To review results and complications of surgical treatment of 154 consecutive SDAVFs. METHODS: The records of 154 consecutive patients with SDAVFs were retrospectively reviewed. RESULTS: There were 120 males and 34 females (male/female ratio 3.5:1, mean age 63.6 years). The SDAVFs were located at the thoracic level in 92 patients and at the lumbar and sacral spine levels in 45 and 15 patients, respectively. The most common presenting symptoms were motor dysfunction (65 patients), sensory loss (31 patients), and paresthesias without sensory loss (13 patients). The mean interval from symptom onset to definitive diagnosis was 24.7 months (median 12 months). Surgery resulted in complete exclusion of the fistula at first attempt in 146 patients (95%). There were no deaths or major neurological complications related to the surgery. Six percent of patients experienced subjective or objective worsening of preoperative symptoms and signs by the time of discharge that persisted at follow-up. Other surgical complications consisted of wound infection in 2 patients and deep venous thrombosis in 3. Eight patients were lost to follow-up; 141 patients (96.6%) experienced improvement (120 patients, 82.2%) or stability (21 patients, 14.4%) of motor function at last follow-up compared with their preoperative status. Other symptoms such as numbness, sphincter dysfunction, and dysesthesias/neuropathic pain improved in 51.5%, 45%, and 32.6%, respectively. CONCLUSION: Surgical obliteration of SDAVFs is safe and very effective. Prognosis of motor function is favorable after surgical treatment.

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