Visualization and Maneuverability Features of a Robotic Arm Three-Dimensional Exoscope and Operating Microscope for Clipping an Unruptured Intracranial Aneurysm: Video Comparison and Technical Evaluation

Abstract BACKGROUND The current gold standard for evaluation of the surgical result after intracranial aneurysm (IA) clipping is two-dimensional (2D) digital subtraction angiography (DSA). While there is growing evidence that postoperative 3D-DSA is superior to 2D-DSA, there is a lack of data on intraoperative comparison. OBJECTIVE To compare the diagnostic yield of detection of IA remnants in intra- and postoperative 3D-DSA, categorize the remnants based on 3D-DSA findings, and examine associations between missed 2D-DSA remnants and IA characteristics. METHODS We evaluated 232 clipped IAs that were examined with intraoperative or postoperative 3D-DSA. Variables analyzed included patient demographics, IA and remnant distinguishing characteristics, and 2D- and 3D-DSA findings. Maximal IA remnant size detected by 3D-DSA was measured using a 3-point scale of 2-mm increments. RESULTS Although 3D-DSA detected all clipped IA remnants, 2D-DSA missed 30.4% (7 of 23) and 38.9% (14 of 36) clipped IA remnants in intraoperative and postoperative imaging, respectively (95% CI: 30 [ 12, 49] %; P-value .023 and 39 [23, 55] %; P-value = <.001), and more often missed grade 1 (< 2 mm) clipped remnants (odds ratio [95% CI]: 4.3 [1.6, 12.7], P-value .005). CONCLUSION Compared with 2D-DSA, 3D-DSA achieves a better diagnostic yield in the evaluation of clipped IA. Our proposed method to grade 3D-DSA remnants proved to be simple and practical. Especially small IA remnants have a high risk to be missed in 2D-DSA. We advocate routine use of either intraoperative or postoperative 3D-DSA as a baseline for lifelong follow-up of clipped IA.

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Abstract TP295: Stroke Prevention Surgery > Quality of Life and Cognitive Ability to Drive Are Maintained After Surgical Repair of Unruptured Intracranial Aneurysm

Stroke ◽

10.1161/str.51.suppl_1.tp295 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Joan M ODonnell ◽

Maurizio Manuguerra ◽

Jemma L Hodge ◽

Greg Savage ◽

Michael K Morgan

Keyword(s):

Quality Of Life ◽

Intracranial Aneurysm ◽

Surgical Management ◽

Cognitive Abilities ◽

Short Form ◽

Unruptured Intracranial Aneurysm ◽

Significant Difference ◽

Ability To Drive

Background: Studies have questioned the effectiveness of surgery for the management of unruptured intracranial aneurysm (uIA). Few studies have examined the ability to drive and quality of life (QOL) after surgery for uIA. Objective: This study examined the effectiveness of surgical management of uIA by measuring patients’ perceived quality of life and their cognitive abilities related to driving. Methods: Between January 2011 and January 2016 patients with a uIA were assessed using the Quality Metric Short Form 36 (SF36) and the off-road driver screening instrument DriveSafeDriveAware. Reassessments were conducted at the 6-week post-operative follow-up for surgical patients and at 12-month follow-up for surgical and conservatively managed patients. Results: 175 patients enrolled in the study, of which 112(66%) had surgical management of their aneurysm. For the surgical cases who completed all assessments (N=74), there was a trend for the DriveSafe pre-operative mean score of 108 (SD 10.7) to be lower than the 6-week and 12-month post-operative mean scores (111 SD 9.7 and 112 SD 10.2 respectively)(p=0.05). There were no significant changes in DriveAware scores at any epoch or between patient groups nor in the MCS in the surgical group.. There was a significant decline in PCS scores at 6 weeks post-operatively which recovered at 12 months (52 SD 8.1, 46 SD 6.8 and 52 SD 7.1 respectively)( p <0.01). There was no significant difference in 12-month mRS scores between the surgical cases who completed with cases who did not complete all assessments. Conclusion: Surgery for uIA did not affect cognitive abilities for driving at 6 weeks or 12 months after surgery. There was a decline in the QOL in the first months after surgery, however QOL returned to pre-surgical status 12 months after surgery. If the risk of seizures is low and there are no post-operative complications, returning to driving can be recommended.

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Unruptured Intracranial Aneurysm Involving the Distal Anterior Cerebral Artery: A Cadaveric Study

Journal of Case Reports ◽

10.17659/01.2013.0002 ◽

2013 ◽

Vol 3 (1) ◽

pp. 5-9

Author(s):

S. Allwyn Joshua ◽

Sheela G Nayak ◽

V S Pare ◽

Ashok ◽

Roopa Sebastian

Keyword(s):

Intracranial Aneurysm ◽

Cerebral Artery ◽

Anterior Cerebral Artery ◽

Cadaveric Study ◽

Unruptured Intracranial Aneurysm ◽

Distal Anterior Cerebral Artery

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Low-Dose 3D Rotational Angiography in Measuring the Size of Intracranial Aneurysm: In Vitro Feasibility Study Using Aneurysm Phantom

Neurointervention ◽

10.5469/neuroint.2020.00437 ◽

2021 ◽

Vol 16 (1) ◽

pp. 59-63

Author(s):

Hee Jong Ki ◽

Bum-soo Kim ◽

Jun-Ki Kim ◽

Jai Ho Choi ◽

Yong Sam Shin ◽

...

Keyword(s):

Intracranial Aneurysm ◽

Endovascular Treatment ◽

Low Dose ◽

Three Dimensional ◽

3D Measurement ◽

Rotational Angiography ◽

3D Rotational Angiography ◽

Conventional Dose ◽

Noninferiority Margin

Purpose: Three-dimensional (3D) measurement of intracranial aneurysms is important in planning endovascular treatment, and 3D rotational angiography (RA) is effective in accurate measurement. The purpose of this study was to evaluate the feasibility of low dose 3D RA (5 seconds 0.10 μGy/frame) in measuring an intracranial aneurysm using an in vitro phantom.Materials and Methods: We investigated an <I>in vitro</i> 3D phantom of an intracranial aneurysm with 10 acquisitions of 3D RA with a conventional dose (5 seconds 0.36 μGy/frame) and 10 acquisitions with a low-dose (5 seconds 0.10 μGy/frame). 3D size and neck diameters of the aneurysm were measured and compared between the 2 groups (conventional and low-dose) using noninferiority statistics.Results: The aneurysm measurements were well-correlated between the 2 readers, and noninferiority in the measurement of aneurysmal size of low-dose 3D RA was demonstrated, as the upper margin of the 1-sided 97.5% confidence interval did not cross the pre-defined noninferiority margin of 0.2 mm by the 2 readers.Conclusion: Low-dose (5 seconds 0.10 μGy/frame) cerebral 3D RA is technically feasible and not inferior in in vitro 3D measurement of an intracranial aneurysm. Thus, low-dose 3D RA is promising and needs further evaluation for its clinical utility in the planning of endovascular treatment of an intracranial aneurysm.

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Initial Treatment for Unruptured Intracranial Aneurysm and Its Follow-up: A Cost Analysis of Pipeline Flow Diverters versus Coiling

Cureus ◽

10.7759/cureus.5692 ◽

2019 ◽

Author(s):

Spencer Twitchell ◽

Herschel W Wilde ◽

Philipp Taussky ◽

Michael Karsy ◽

Ramesh Grandhi

Keyword(s):

Intracranial Aneurysm ◽

Cost Analysis ◽

Initial Treatment ◽

Unruptured Intracranial Aneurysm ◽

Pipeline Flow ◽

Flow Diverters

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颅内未破裂动脉瘤的诊断治疗现状及研究进展

亚洲临床医学杂志 ◽

10.26549/yzlcyxzz.v2i2.1768 ◽

2019 ◽

Vol 2 (2) ◽

pp. 36

Author(s):

国栋张 ◽

长武窦

Keyword(s):

Intracranial Aneurysm ◽

Unruptured Intracranial Aneurysm

颅内未破裂动脉瘤(unruptured intracranial aneurysm, UIA)多指未发生破裂出血的颅内动脉瘤，多因其它疾病（如头痛头晕）或颅神经症状（视力下降、动眼神经麻痹）而行CTA或MRA检查时发现。对于颅内未破裂动脉瘤的治疗意见尚无统一标准。本文对颅内未破裂动脉瘤的诊断方法、治疗方法及患者的临床表现进行综述，以期为临床医生诊断、治疗颅内未破裂动脉瘤提供参考。

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