OLFACTORY DYSFUNCTION AFTER IPSILATERAL AND CONTRALATERAL PTERIONAL APPROACHES FOR CEREBRAL ANEURYSMS

Abstract OBJECTIVE This study investigated olfactory dysfunction after using a contralateral or ipsilateral pterional approach for anterior circulation aneurysms and related risk factors. METHODS This study included 189 patients who experienced an aneurysmal subarachnoid hemorrhage and in whom a pterional approach was used, including a contralateral pterional approach (12 patients), a pterional approach for an anterior communicating artery (AComA) aneurysm (70 patients), and an ipsilateral pterional approach for aneurysms of the anterior circulation, excluding the AComA (107 patients). In addition to questionnaires on olfactory function, Sniffin' Sticks tests were performed 12 to 38 months after the operation. RESULTS The incidence of olfactory dysfunction was high: 58% (7 of 12) with a contralateral pterional approach, 14% (10 of 70) with a pterional approach for an AComA aneurysm, and 4% (4 of 107) with an ipsilateral pterional approach for aneurysms of the anterior circulation, except for the AComA. In addition, patients 55 years and older had a higher incidence of olfactory dysfunction. Among the 12 patients in whom the contralateral pterional approach was used, 5 (42%) were anosmic and 2 (17%) were hyposmic. The incidence of olfactory dysfunction was also significantly higher at ages 55 years and older. The size and location of the contralateral aneurysm, if small (<1 cm) and located within a 3-cm lateral distance from the midline, were not found to influence the incidence. CONCLUSION A higher incidence of olfactory dysfunction was found in those patients in whom a contralateral pterional approach and a pterional approach for an AComA aneurysm were used. Another major risk factor was an age of 55 years and older.

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Microsurgical clipping of the anterior circulation aneurysms

JBNC - JORNAL BRASILEIRO DE NEUROCIRURGIA ◽

10.22290/jbnc.v20i4.1001 ◽

2018 ◽

Vol 20 (4) ◽

pp. 409-414

Author(s):

Carlos Eduardo Da Silva ◽

Paulo Eduardo Peixoto De Freitas ◽

Alicia Del Carmen Becerra Romero ◽

Fáberson João Mocelin Oliveira ◽

Márcio Aloisio Bezerra Cavalcanti Rockenbach ◽

...

Keyword(s):

Relevant Literature ◽

Cerebral Aneurysms ◽

Series Data ◽

Anterior Communicating Artery ◽

Anterior Circulation ◽

Ruptured Aneurysms ◽

Microsurgical Clipping ◽

The Mean ◽

Anterior Circulation Aneurysms

Introduction: The authors present the analysis of the microsurgical clipping of 100 cerebral aneurysms of the anterior circulation and compare the series data with the literature. Methods: Eighty-eight patients presenting with 100 anterior circulation aneurysms operated on microsurgical techniques between 2002 and 2008 by the first author (CES) were retrospectively reviewed. Results: A total of 88 patients with 100 aneurysms of the anterior circulation were treated in a six years period. Fifty eight female (66%) and thirty male (34%) with nine patients (10.2%) presenting with multiple aneurysms. The mean age was 52 years (range from 26 to 76 years). Eighty five percent of the cases were ruptured aneurysms. The mean follow-up was 52.4 months (range from 5 to 76 months). The topography of the aneurysms was distributed as it follows: Anterior communicating artery (ACoA) 25%; posterior communicating artery (p-comm) 29%; middle cerebral artery (MCA) 27%; paraclinoidal aneurysms 8%; pericallosal artery 6% and internal carotid artery (ICA) tip 5%. The mortality was 7.9%, and such cases presenting with Hunt Hess graduation 3 and 4. The permanent morbidity was 4.5%, cases with Hunt Hess graduation 3 and 4. Perioperative rupture occurred in 17% of the cases, only in previous ruptured aneurysms. There was no clinical evidence of rebleeding during the follow-up period of the series. Conclusions: The microsurgical clipping of cerebral aneurysms of the anterior circulation is a safe and curative treatment for most of such lesions. At present, studies suggest evidences of superior results of surgery compared to the endovascular techniques in the rates of total occlusion of the aneurysms, lesser rates of rebleeding of the treated cases. The results of the present series are similar to the rates of the most relevant literature.

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Surgical treatment of intracranial aneurysms: six-year experience in Belo Horizonte, MG, Brazil

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2004000200010 ◽

2004 ◽

Vol 62 (2a) ◽

pp. 245-249 ◽

Cited By ~ 2

Author(s):

Leodante Batista da Costa Jr ◽

Josaphat Vilela de Morais ◽

Agustinho de Andrade ◽

Marcelo Duarte Vilela ◽

Renato P. Campolina Pontes ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Surgical Treatment ◽

Intracranial Aneurysms ◽

Aneurysmal Subarachnoid Hemorrhage ◽

The United States ◽

Anterior Circulation ◽

Common Location ◽

Belo Horizonte ◽

Spontaneous Subarachnoid Hemorrhage ◽

Anterior Circulation Aneurysms

Spontaneous subarachnoid hemorrhage accounts for 5 to 10 % of all strokes, with a worldwide incidence of 10.5 / 100000 person/year, varying in individual reports from 1.1 to 96 /100000 person/year. Angiographic and autopsy studies suggest that between 0.5% and 5% of the population have intracranial aneurysms. Approximately 30000 people suffer aneurysmal subarachnoid hemorrhage in the United States each year, and 60% die or are left permanently disabled. We report our experience in the surgical treatment of intracranial aneurysms in a six year period, in Belo Horizonte, Minas Gerais, Brazil. We reviewed the hospital files, surgical and out-patient notes of all patients operated on for the treatment of intracranial aneurysms from January 1997 to January 2003. Four hundred and seventy-seven patients were submitted to 525 craniotomies for treatment of 630 intracranial aneurysms. The majority of patients were female (72.1%) in the fourth or fifth decade of life. Anterior circulation aneurysms were more common (94.4%). The most common location for the aneurysm was the middle cerebral artery bifurcation. The patients were followed by a period from 1 month to 5 years. The outcome was measured by the Glasgow Outcome Scale (GOS). At discharge, 62.1% of the patients were classified as GOS 5, 13.9% as GOS 4, 8.7% as GOS 3, 1.7% as GOS 2 and 14.8% as GOS 1.

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Transient Adenosine-Induced Asystole During the Surgical Treatment of Anterior Circulation Cerebral Aneurysms: Technical Note

Operative Neurosurgery ◽

10.1227/neu.0b013e3181f7ef46 ◽

2010 ◽

Vol 67 (suppl_2) ◽

pp. ons461-ons470 ◽

Cited By ~ 13

Author(s):

Ciaran J. Powers ◽

David R. Wright ◽

David L. McDonagh ◽

Cecil O. Borel ◽

Ali R. Zomorodi ◽

...

Keyword(s):

Cardiac Arrest ◽

Cerebral Aneurysms ◽

Technical Note ◽

Aortic Aneurysms ◽

Anterior Circulation ◽

Aneurysm Neck ◽

Short Period ◽

Delayed Complication ◽

Patient Responses ◽

Anterior Circulation Aneurysms

Abstract BACKGROUND: Transient adenosine-induced asystole is a reliable method for producing a short period of relative hypotension during surgical and endovascular procedures. Although the technique has been described in the endovascular treatment of brain arteriovenous malformations, aortic aneurysms, and posterior circulation cerebral aneurysms, little description of its use in anterior circulation aneurysms is available. OBJECTIVE: To assess the benefits of adenosine-induced transient asystole in complex anterior circulation aneurysms, to describe our experience in selected cases, and to provide the first experience of the use of adenosine in anterior circulation aneurysms. METHODS: The adenosine-induced cardiac arrest protocol allows us to titrate the duration of cardiac arrest on the basis of individual patient responses. The operative setup is the same as with all aneurysm clippings, with the addition of the placement of transcutaneous pacemakers as a precaution for prolonged bradycardia or asystole. Escalating doses of adenosine are given to determine the approximate dose that results in 30 seconds of asystole. When requested by the surgeon, the dose of adenosine is administered for definitive dissection and clipping. We present 6 cases in which this technique was used. RESULTS: The use of transient adenosine-induced asystole provided excellent circumferential visualization of the aneurysm neck and safe clip application. All patients did well neurologically and suffered no evidence of perioperative cerebral ischemia or delayed complication from the use of adenosine itself. CONCLUSION: Transient adenosine-induced asystole is a safe and effective technique in select circumstances that may aid in safe and effective aneurysm clipping. Along with the traditional techniques of brain relaxation, skull base approaches, and temporary clipping, adenosine-induced asystole facilitates circumferential visualization of the aneurysm neck and is another technique available to cerebrovascular surgeons.

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ENDOVASCULAR AND SURGICAL TREATMENT OF RUPTURED CEREBRAL ANEURYSMS IN PEDIATRIC PATIENTS

Neurosurgery ◽

10.1227/01.neu.0000327573.42267.cc ◽

2008 ◽

Vol 63 (5) ◽

pp. 859-866 ◽

Cited By ~ 40

Author(s):

Michael F. Stiefel ◽

Gregory G. Heuer ◽

Anuj K. Basil ◽

John B. Weigele ◽

Leslie N. Sutton ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Clinical Condition ◽

Pediatric Patients ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Multidisciplinary Treatment ◽

Cerebral Aneurysms ◽

Posterior Circulation ◽

Anterior Circulation ◽

Fisher Grade ◽

Good Clinical Condition

Abstract OBJECTIVE Pediatric cerebral aneurysms are rare. There are very few recent studies that focus on the multidisciplinary treatment of ruptured aneurysms. We reviewed our pediatric endovascular and surgical experience with ruptured cerebral aneurysms. METHODS Pediatric patients aged 16 years and younger who were admitted with a diagnosis of aneurysmal subarachnoid hemorrhage and treated at the Children's Hospital of Philadelphia were included in this analysis. RESULTS Twelve patients with 13 aneurysms (4 male patients and 8 female patients; age range, 4 months–16 years; mean age, 5.1 years), were admitted with subarachnoid hemorrhage during the past 12 years. The majority of patients were admitted in good clinical condition; 31% were in Hunt and Hess Grade II, and 31% were in Hunt and Hess Grade III. The remaining patients were in poor clinical condition and were in Hunt and Hess Grade IV (23%) or Grade V (15%). Computed tomography revealed that 15% of the patients were in Fisher Grade 2, 23% were in Fisher Grade 3, and 62% were in Fisher Grade 4. Endovascular techniques were used in the treatment of 5 aneurysms, and microsurgery was used in the treatment of 8 aneurysms. In the endovascular group, aneurysm sizes ranged from 2 to 35 mm (mean, 12.6 mm); 3 aneurysms were in the anterior circulation, and 2 were in the posterior circulation. In the microsurgery group, 6 aneurysms were in the anterior circulation, and 2 were in the posterior circulation; sizes ranged from 3 to 15 mm (mean, 6.8 mm). Sixty-nine percent of the patients were independent at follow-up. CONCLUSION Contemporary endovascular and microsurgical techniques can be used effectively to treat ruptured cerebral aneurysms in pediatric patients. In the time period studied, the techniques were equally effective when used in the appropriate patients.

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Efficacy and safety of flow diverters in posterior circulation aneurysms and comparison with their efficacy in anterior circulation aneurysms: A systematic review and meta-analysis

Interventional Neuroradiology ◽

10.1177/15910199211003017 ◽

2021 ◽

pp. 159101992110030

Author(s):

Mohamed Abdel-Tawab ◽

Ahmed K Abdeltawab ◽

Mohamed Abdelmonem ◽

Mahmoud A Moubark ◽

Mohamed AH Taha ◽

...

Keyword(s):

Meta Analysis ◽

Cerebral Aneurysms ◽

Flow Diverter ◽

Posterior Circulation ◽

Efficacy And Safety ◽

Analysis Model ◽

Anterior Circulation ◽

Mortality And Morbidity ◽

Posterior Circulation Aneurysms ◽

Anterior Circulation Aneurysms

Purpose We aimed to assess the efficacy and safety of flow-diverter stents (FDs) in the management of posterior circulation cerebral aneurysms and compare FD efficacy between anterior and posterior circulation aneurysms. Methods We searched the PubMed, Scopus, Cochrane, and Web of Science databases for relevant studies through March 2020. Studies assessing FDs for posterior circulation aneurysms that included ≥20 treated aneurysms were included. Moreover, the studies compared FD efficacy between anterior and posterior circulation aneurysms were included. Data regarding angiographic aneurysmal occlusion, procedural complications, mortality, and morbidity were extracted and pooled in a random-effects meta-analysis model. Results Fourteen studies with a total of 659 patients and 676 posterior circulation aneurysms were included. The pooled rate of aneurysmal occlusion at long-term angiographic follow-up was 78% [95% confidence interval (CI), 71–85]. The pooled rates of intraparenchymal hemorrhage, ischemia, and procedure-related mortality and neurological morbidity were 2%, 8%, 7%, and 6%, respectively. Complete occlusion occurred in 82.4% of the posterior circulation aneurysm subgroup and 77.5% of the anterior circulation aneurysm subgroup. The difference was not significant (relative risk 1.01; 95% CI, 0.86–1.19; p = 0.91). Regression analysis showed that elderly patients and females had higher morbidity. Conclusion Posterior circulation aneurysms can be effectively treated with FDs with comparable occlusion rates to those in anterior circulation aneurysms. However, periprocedural complications are not negligible.

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How Safe and Effective Is Shifting from Pterional to Supraorbital Keyhole Approach for Clipping Ruptured Anterior Circulation Aneurysms? A Surgeon’s Transition Phase Comparative Study

Journal of Neurosciences in Rural Practice ◽

10.1055/s-0041-1727301 ◽

2021 ◽

Author(s):

Sivashanmugam Dhandapani ◽

Rajasekhar Narayanan ◽

Manju Dhandapani ◽

Hemant Bhagat

Keyword(s):

Surgical Outcome ◽

Delayed Cerebral Ischemia ◽

Anterior Communicating Artery ◽

Parent Vessel ◽

Anterior Circulation ◽

Lumbar Drain ◽

Significant Difference ◽

Keyhole Approach ◽

Intraoperative Rupture ◽

Anterior Circulation Aneurysms

Abstract Background Comparative studies between standard pterional and supraorbital keyhole approaches for aneurysms had potential biases with the heterogeneity of patient selection, differences among surgeons, or varying expertise across the surgeon’s learning curve. This is a study of a surgeon’s transition from pterional to keyhole approach for early clipping of selected consecutive ruptured anterior circulation aneurysms. Methods Patients more than 18 years, presenting within 72 hours of ictus, in good clinical grades 1 to 3, no midline shift, with saccular aneurysms less than 25 mm at either communicating segment of internal carotid artery, anterior communicating artery, or middle cerebral artery segment till bifurcation were studied between the last 25 cases of pterional and first 25 cases of the keyhole, for the intraoperative and postoperative surgical outcome parameters. Results There was no significant difference among baseline parameters, including the location of aneurysms across both groups. While only four cases of pterional had an intraoperative ventricular puncture, the lumbar drain was electively inserted in all keyhole patients. The intraoperative parameters, such as a dural tear, adequate parent vessel exposure, temporary clipping, and intraoperative rupture, did not show any significant difference. None had immediate postoperative deficits. While delayed cerebral ischemia and wound complaints were similar in both groups, temporal hollowing and chewing difficulty were significantly more in pterional patients(p = 0.01). Conclusion A surgeon experienced in pterional approach can comfortably and safely shift to the keyhole for early clipping of selected ruptured aneurysms less than 25 mm, with a comparable surgical outcome but better cosmesis and mastication.

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Application of the Endoscopic Micro-Inspection Tool QEVO® in the Surgical Treatment of Anterior Circulation Aneurysms—A Technical Note and Case Series

Frontiers in Surgery ◽

10.3389/fsurg.2020.602080 ◽

2020 ◽

Vol 7 ◽

Author(s):

Karl-Michael Schebesch ◽

Christian Doenitz ◽

Amer Haj ◽

Julius Höhne ◽

Nils Ole Schmidt

Keyword(s):

Case Series ◽

Cerebral Aneurysms ◽

Technical Note ◽

The Novel ◽

Digital Subtraction ◽

Aneurysm Surgery ◽

Anterior Circulation ◽

Unruptured Cerebral Aneurysms ◽

Cerebral Ischemic ◽

Anterior Circulation Aneurysms

Introduction: The application of neuro-endoscopes in cerebral aneurysm surgery may help to avoid unintended aneurysm remnants and the accidental clipping of perforating arteries and aid the detection of blood collecting in the subdural spaces. Here, we present our experience with the novel endoscopic micro-inspection tool QEVO® (Carl Zeiss Meditec, Germany) in aneurysm surgery.Materials and Equipment: In all patients the surgical microscope KINEVO® (Carl Zeiss Meditec, Germany) and the Microinspection tool QEVO® were applied.Methods: The case series comprises 22 unruptured cerebral aneurysms of the anterior circulation. All aneurysms were treated surgically. All patients routinely underwent computed tomography and digital subtraction angiography within 10 days after surgery.Results: No aneurysm remnants, cerebral ischemic deficits, or subdural hematomas were detected.Discussion: In this technical note, we discuss the benefits and limitations of the QEVO® tool and illustrate the major paradigms by means of intraoperative photographs.

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Outcome of Microsurgical Clipping of Ruptured Anterior Circulation Aneurysms

Pakistan Journal Of Neurological Surgery ◽

10.36552/pjns.v23i4.383 ◽

2019 ◽

Vol 23 (4) ◽

Author(s):

MUHAMMAD JAHANGIR KHAN ◽

MUHAMMAD HAMMAD NASIR ◽

SIKANDAR ALI ◽

SARFRAZ KHAN ◽

MUHAMMAD WAQAS ◽

...

Keyword(s):

Anterior Communicating Artery ◽

Sex Distribution ◽

Surgical Clipping ◽

Anterior Circulation ◽

Efficient Treatment ◽

Microsurgical Clipping ◽

The Mean ◽

Anterior Circulation Aneurysms ◽

Grading Scales

Objective: The objective of the study was to analyze the operative outcome of microsurgical clipping in Ruptured Anterior Circulation Aneurysms.Materials and Methods: Twenty patients with Ruptured Anterior Circulation aneurysms were treated with surgical clipping. All the patients were evaluated pre-operatively according to Hunt & Hess and WFNS grading scales. Patients with grade I, II, and III were operated. All the aneurysms were clipped through Pterional approach under General anesthesia and Yasargil Aneurysm clips of appropriate sizes were used in each patient. Outcome was analyzed according to Glasgow Outcome Scale at the end of six months of follow up in each patient.Results: In this series of twenty cases, the mean patient age was 49 years. Lesion location included, the ACA/A. Com 55% (n = 11), the Middle Cerebral artery 25% (n = 5), P. Com 15% (n = 3), Ophthalmic artery 5% (n = 1). Sex distribution, female 55% (n = 11) and male 45% (n = 9). Per-operative complications, rupture of aneurysm 20% (n = 4), and damage to perforating branches of MCA 5% (n = 1). Conclusions: Surgical clipping still is the most efficient treatment of Ruptured Anterior Circulation aneurysm at the beginning of the new millennium. Anterior Communicating Artery is the commonest location of aneurysms. Major determinants of outcome are Hunt & Hess, WFNS grades on admission and the age of the patient.

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Combined interhemispheric and pterional approach for ACOM and left MCA aneurysms

Neurosurgical FOCUS ◽

10.3171/2015.v1.focus14559 ◽

2015 ◽

Vol 38 (videosuppl1) ◽

pp. Video15 ◽

Cited By ~ 1

Author(s):

Satoshi Kiyofuji ◽

Tomohiro Inoue ◽

Akira Tamura ◽

Isamu Saito

Keyword(s):

Cerebral Aneurysms ◽

Anterior Communicating Artery ◽

Left Middle Cerebral Artery ◽

Pterional Approach ◽

High Position ◽

Complex Figure ◽

Unruptured Cerebral Aneurysms ◽

Mca Aneurysm ◽

Brain Retraction ◽

Left Middle

This video demonstrates combined two separate craniotomies for two difficult unruptured cerebral aneurysms. The anterior communicating artery (ACOM) aneurysm existed at a high position, projected posteriorly, and thus necessitated an interhemispheric approach. Left middle cerebral artery (MCA) aneurysm with complex figure was treated through a separate pterional approach. Meticulous micro-cisternal opening under high magnification enabled safe and effective exposure of both aneurysms with minimal brain retraction, which alleviated brain damage as shown in postoperative images.The video can be found here: http://youtu.be/mBYsaAVekCA.

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Comparison of Efficacy of Intraoperative Indocyanine Green Videoangiography in Clipping of Anterior Circulation Aneurysms with Postoperative Digital Subtraction Angiography

Journal of Neurosciences in Rural Practice ◽

10.4103/jnrp.jnrp_1_17 ◽

2017 ◽

Vol 08 (03) ◽

pp. 342-345 ◽

Cited By ~ 2

Author(s):

Vikas Kumar ◽

Anita Jagetia ◽

Daljit Singh ◽

Arvind Kumar Srivastava ◽

Monica Sehgal Tandon

Keyword(s):

Indocyanine Green ◽

Digital Subtraction Angiography ◽

Cerebral Aneurysms ◽

Postoperative Outcome ◽

Cost Effective ◽

Digital Subtraction ◽

Anterior Circulation ◽

Indocyanine Green Videoangiography ◽

Aneurysm Neck ◽

Anterior Circulation Aneurysms

ABSTRACT Introduction: The aim of this study is to assess the efficacy of intraoperative indocyanine green videoangiography (ICG-VA) using postoperative digital subtraction angiography (DSA) in clipped anterior circulation aneurysms. Materials and Methods: A prospective study was conducted for 1 year which included thirty patients of anterior circulation aneurysm treated by clipping of aneurysm. Intraoperative ICG-VA was performed on all the patients. Postoperative DSA was performed to assess the efficacy of ICG-VA. Results: Intraoperative ICG-VA revealed the occlusion of aneurysm in all the thirty patients. Postoperative DSA revealed aneurysm neck remnant in two patients and demonstrated no branch occlusion. Conclusions: Intraoperative ICG-VA is useful in assessing the completeness of clipping of cerebral aneurysms and ensures patency of branch vessels, thus providing a better postoperative outcome. It replaces the need for invasive postoperative angiographic imaging in a selected group of patients and is also cost effective.

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