Cerebral Blood Flow After Surgery for Unruptured Cerebral Aneurysms: Effects of Surgical Manipulation and Irrigation Fluid

Abstract BACKGROUND: Cerebral blood flow (CBF) is important in the management of cerebrovascular diseases. Surgical manipulation may compromise the appropriate interpretation of postoperative CBF changes, but the effects are not well understood. Objective: To investigate the effect of surgical manipulation on postoperative CBF in a setting of prospective randomized comparison of 2 irrigation fluids during surgery. Methods: Twenty patients undergoing the clipping of unruptured cerebral aneurysms through the pterional approach were randomly assigned to use of Artcereb, an artificial cerebrospinal fluid, or physiological saline as irrigation fluid. Postoperative CBF and clinical conditions were evaluated 3 times in the first 7 to 10 postoperative days. Results: Postoperative CBF decreased by 10 to 15% on the first postoperative day in the ipsilateral inferior frontal gyrus, where surgical manipulation may be greatest. CBF reduction was less in regions remote from the surgical site and later in the follow-up periods. Selection of irrigation fluid did not influence postoperative CBF significantly, although postoperative clinical conditions may be better using Artcereb. Conclusion: Postoperative CBF changes due to surgical manipulation should be considered in patients whose hemodynamic conditions are important for appropriate management.

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Neuropsychological evaluation and cerebral blood flow study of 30 patients with unruptured cerebral aneurysms before and after surgery

Surgical Neurology ◽

10.1016/s0090-3019(98)00090-1 ◽

1999 ◽

Vol 51 (2) ◽

pp. 132-139 ◽

Cited By ~ 38

Author(s):

Atsushi Fukunaga ◽

Koichi Uchida ◽

Jun Hashimoto ◽

Takeshi Kawase

Keyword(s):

Blood Flow ◽

Cerebral Blood Flow ◽

Cerebral Aneurysms ◽

Neuropsychological Evaluation ◽

Before And After ◽

Unruptured Cerebral Aneurysms ◽

Flow Study

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Surgical Results in Elderly Patients with Unruptured Cerebral Aneurysms Regarding Intellectual Function and Cerebral Blood Flow Alterations, and Their Long-term Prognosis

Surgery for Cerebral Stroke ◽

10.2335/scs.40.303 ◽

2012 ◽

Vol 40 (5) ◽

pp. 303-309

Author(s):

Masafumi OHTAKI ◽

Yukinori AKIYAMA ◽

Sounen KIN ◽

Hiroshige TSUDA ◽

Yusuke KIMURA

Keyword(s):

Blood Flow ◽

Cerebral Blood Flow ◽

Elderly Patients ◽

Cerebral Aneurysms ◽

Surgical Results ◽

Intellectual Function ◽

Long Term Prognosis ◽

Unruptured Cerebral Aneurysms

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Computational Fluid Dynamics Simulation of the Blood Flow in the Circle of Willis

Advances in Bioengineering ◽

10.1115/imece2002-32516 ◽

2002 ◽

Cited By ~ 1

Author(s):

M. Harazawa ◽

T. Yamaguchi

Keyword(s):

Blood Flow ◽

Blood Supply ◽

Internal Carotid ◽

Complex Geometry ◽

Cerebral Aneurysms ◽

Cerebrovascular Diseases ◽

Circle Of Willis ◽

Dynamics Simulation ◽

The Brain ◽

Internal Carotid Arteries

The blood supply for the brain is born by four arteries, that is, two internal carotid arteries and two vertebral arteries. They are mutually connected at the cerebral base, and form a closed arterial circle, called the circle of Willis, so that the safety of the brain blood supply is increased. However their anastomoses show a very wide variety of atypism. If some of anastomses are very thin, or even do not exist, the safety of the blood supply is not secured. This is particularly important when some diseases such as cerebral thrombosis occurs and the blood flow supply stops unilaterally. Redistribution of the blood supply in such cases is thought to be strongly affected by geometrical configuration of the anastomoses. It is also known that cerebral aneurysms, which may induce serious cerebrovascular diseases, preferentially occur at the circle of Willis. Complex blood flow pattern has been suspected of having an influence on this preference. This is again dependent on complex geometry of the circle.

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Improved detection of cerebrovascular disease processes: Introduction to the Journal of Cerebral Blood Flow and Metabolism special issue on cerebrovascular disease

Journal of Cerebral Blood Flow & Metabolism ◽

10.1177/0271678x17739802 ◽

2018 ◽

Vol 38 (9) ◽

pp. 1387-1390 ◽

Cited By ~ 6

Author(s):

Manus J Donahue ◽

Jeroen Hendrikse

Keyword(s):

Blood Flow ◽

Cerebral Blood Flow ◽

Cerebrovascular Disease ◽

Developed Countries ◽

The United States ◽

Cerebrovascular Diseases ◽

Stroke Recovery ◽

Special Issue ◽

Permanent Disability ◽

Stroke Incidence

Approximately 15 million individuals suffer a stroke worldwide each year, and stroke results in death or permanent disability in two-thirds of these individuals. Due to increased knowledge and management of modifiable risk factors, stroke incidence in developed countries is declining, however remains high at just under 1 million patients per year in the United States alone. Further improving management of patients with cerebrovascular disease (CVD) ultimately will require development and clinical adoption of sensitive markers of hemodynamic and metabolic failure, as well as trials that evaluate how to interpret these markers to optimize therapies. Realizing this goal and reducing the complete burden of CVD is dependent on an improved understanding of the pathophysiological processes that underlie CVD in all stages, including sub-clinical disease processes, acute stroke, and post-stroke recovery mechanisms. This document serves as an introduction to the Journal of Cerebral Blood Flow and Metabolism special issue on cerebrovascular diseases, which is comprised of contributions from experts in each of the above stages of CVD, and outlines current standards for patient management and emerging directions that have potential for improving patient care over the next decade.

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Cardiorespiratory burden of brass neck coils placed on Kayan Karen long-neck women of Thailand

Applied Physiology Nutrition and Metabolism ◽

10.1139/apnm-2019-0083 ◽

2019 ◽

Vol 44 (8) ◽

pp. 894-901

Author(s):

Pattawan Lapo ◽

Nakarin Inmutto ◽

Hirofumi Tanaka ◽

Daroonwan Suksom

Keyword(s):

Blood Flow ◽

Cerebral Blood Flow ◽

Flow Velocity ◽

Blood Flow Velocity ◽

Cerebral Blood Flow Velocity ◽

Health Impact ◽

Cerebrovascular Diseases ◽

Forced Expiratory Volume ◽

Radiographic Examination ◽

Flow Mediated Dilation

There is only scarce information regarding the physiological and health impact of lifelong wearing of the neck brass coils in Karen Kayan women. The purpose of this study was to determine the influence of wearing brass neck coils on cardiorespiratory and cerebrovascular functions in long-neck Karen women. A total of 28 Karen women (aged 23–66 years) were studied. Fourteen Karen women who had been wearing neck brass coils were compared with 14 Karen women with no neck coils. We also studied 14 age-matched city-living controls. Radiographic examination of 2 older Karen women wearing neck coils showed low levels of the clavicles. There were no group differences in resting heart rate and brachial-ankle pulse wave velocity. Both systolic and diastolic blood pressure was greater and functional capacity was lower in both Karen women than city-living controls (all p < 0.05). Karen women wearing neck coils demonstrated lower flow-mediated dilation, lung functions, including forced vital capacity and forced expiratory volume during the first second, and cerebral blood flow velocity than Karen women without neck coils (all p < 0.05). Karen women wearing neck coils demonstrate reduced endothelial and pulmonary functions as well as cerebral perfusion compared with age-matched Karen women without neck coils living in the same villages. Brass neck coils worn by Karen women may elevate risks of developing cardiopulmonary and cerebrovascular diseases. Novelty Cerebral blood flow velocity and macrovascular and microvascular functions were lower in Karen wearing neck coils. There appears to be substantial burden of brass neck coils exerted on physiological systems in Karen women.

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The Renin-Angiotensin System and the Cerebrovascular Diseases: Experimental and Clinical Evidence

Protein and Peptide Letters ◽

10.2174/0929866527666191218091823 ◽

2020 ◽

Vol 27 (6) ◽

pp. 463-475 ◽

Cited By ~ 5

Author(s):

Lucas M. Kangussu ◽

Lucas Alexandre Santos Marzano ◽

Cássio Ferraz Souza ◽

Carolina Couy Dantas ◽

Aline Silva Miranda ◽

...

Keyword(s):

Oxidative Stress ◽

Blood Flow ◽

Cerebral Blood Flow ◽

Renin Angiotensin System ◽

Cerebrovascular Diseases ◽

Therapeutic Effects ◽

Angiotensin System ◽

Renin Angiotensin ◽

Mas Receptor

Cerebrovascular Diseases (CVD) comprise a wide spectrum of disorders, all sharing an acquired or inherited alteration of the cerebral vasculature. CVD have been associated with important changes in systemic and tissue Renin-Angiotensin System (RAS). The aim of this review was to summarize and to discuss recent findings related to the modulation of RAS components in CVD. The role of RAS axes is more extensively studied in experimentally induced stroke. By means of AT1 receptors in the brain, Ang II hampers cerebral blood flow and causes tissue ischemia, inflammation, oxidative stress, cell damage and apoptosis. On the other hand, Ang-(1-7) by stimulating Mas receptor promotes angiogenesis in brain tissue, decreases oxidative stress, neuroinflammation, and improves cognition, cerebral blood flow, neuronal survival, learning and memory. In regard to clinical studies, treatment with Angiotensin Converting Enzyme (ACE) inhibitors and AT1 receptor antagonists exerts preventive and therapeutic effects on stroke. Besides stroke, studies support a similar role of RAS molecules also in traumatic brain injury and cerebral aneurysm. The literature supports a beneficial role for the alternative RAS axis in CVD. Further studies are necessary to investigate the therapeutic potential of ACE2 activators and/or Mas receptor agonists in patients with CVD.

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Hemodynamic Consideration of Intracranial Aneurysm

Translational Neuroscience and Clinics ◽

10.18679/cn11-6030_r.2017.034 ◽

2017 ◽

Vol 3 (4) ◽

pp. 229-236

Author(s):

Hiroshi Ujiie ◽

Chie Shinohara ◽

Yoshinori Tamano ◽

Kouichi Katou ◽

Akira Teramoto

Keyword(s):

Fluid Dynamics ◽

Blood Flow ◽

Intracranial Aneurysm ◽

Middle Cerebral Artery ◽

Internal Carotid ◽

Cerebral Aneurysms ◽

Anterior Communicating Artery ◽

Great Care ◽

Wall Strength ◽

Surgical Manipulation

We reviewed basic considerations in fluid dynamics of cerebral aneurysms and applied these in surgery on the three most common types: internal carotid-posterior communicating artery, middle cerebral artery, and anterior communicating artery. It was found that aneurysmal initiation and growth do not occur at symmetric bifurcations. As blood flow always obeys the law of inertia, jet flow into the aneurysm will disperse along the wall; assuming the aneurysmal wall strength is even, the shape of the aneurysm becomes round or oval. When neurosurgeons encounter an aneurysm that is not round or oval, the wall may be fragile and requires great care during surgical manipulation.

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Incidence and Predictive Factors of Cerebral Hyperperfusion After Extracranial-Intracranial Bypass for Occlusive Cerebrovascular Diseases

Neurosurgery ◽

10.1227/neu.0b013e3181f8c554 ◽

2010 ◽

Vol 67 (6) ◽

pp. 1548-1554 ◽

Cited By ~ 27

Author(s):

Kohji Yamaguchi ◽

Takakazu Kawamata ◽

Akitsugu Kawashima ◽

Tomokatsu Hori ◽

Yoshikazu Okada

Keyword(s):

Blood Flow ◽

Logistic Regression ◽

Regression Analysis ◽

Cerebral Blood Flow ◽

Predictive Factors ◽

Regional Cerebral Blood Flow ◽

Cerebrovascular Diseases ◽

Regional Cerebral Blood ◽

Cerebral Hyperperfusion ◽

Cerebral Vasoreactivity

Abstract BACKGROUND: Although many studies of postoperative cerebral hyperperfusion syndrome (CHS) after carotid endarterectomy have been reported, there are few reports related to extracranial-intracranial (EC-IC) bypass for atherosclerotic occlusive cerebrovascular diseases. OBJECTIVE: To examine the incidence of cerebral hyperperfusion and CHS after EC-IC bypass and to investigate predictive factors. METHODS: Fifty consecutive patients undergoing EC-IC bypass for atherosclerotic occlusive cerebrovascular diseases were studied. Immediately after bypass surgery, resting regional cerebral blood flow was determined under continuous sedation, and postoperative hyperperfusion was evaluated according to the definitions as follows: > 50% increase in regional cerebral blood flow compared with the contralateral side (method 1) and > 100% increase in corrected regional cerebral blood flow compared with preoperative values (method 2). Logistic regression analysis was conducted to determine the effect of multiple variables on postoperative hyperperfusion. RESULTS: Transient symptoms of CHS were observed in 3 patients. Cerebral hyperperfusion was detected in 12 patients (24%) as defined by method 1 and in 9 patients (18%) by method 2. Postoperative hyperperfusion occurred significantly more frequently in patients with the steal phenomenon (regional cerebral vasoreactivity ≤ 0%; P = .001 by method 1 and P = .001 by method 2) and correlated with impaired preoperative regional cerebral vasoreactivity (P < .001). Logistic regression analysis revealed that the steal phenomenon was a significant risk factor for hyperperfusion as defined by both methods 1 (P = .009) and 2 (P = .03). CONCLUSION: The incidence of cerebral blood flow-assessed postoperative hyperperfusion after EC-IC bypass for atherosclerotic occlusive cerebrovascular diseases was not rare. Post EC-IC bypass CHS could be reduced by continuous, strict blood pressure control under sedation.

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