Surgical Clipping vs Endovascular Coiling for Newly Diagnosed and Recurrent Cerebral Aneurysms: an Update on the Current Literature. Single-Center Case Series

2018 ◽  
Vol 2 (1) ◽  
pp. 16-21
Author(s):  
F. Salle ◽  
A. Jaume ◽  
G. Castelluccio ◽  
E. Spagnuolo
Keyword(s):  
Intracranial Aneurysms ◽  
Young Patients ◽  
Case Series ◽  
Cerebral Aneurysms ◽  
Endovascular Coiling ◽  
Newly Diagnosed ◽  
Review Of The Literature ◽  
Surgical Experience ◽  
Surgical Clipping ◽  
The Ideal

Abstract The ideal treatment for intracranial aneurysms has been highly controversial in the last few decades. It is particularly difficult to decide between clipping vs. coiling when it comes to an aneurysm that has already been treated. The authors performed a review of the literature published in the last ten years amongst the main neurosurgical publications and make recommendations based on this evidence and the surgical experience of the eldest author of this paper (ES). A series of cases of recurrent, incompletely coiled aneurysms treated with surgery is presented. Conclusions: aneurysms with a convenient configuration and location for either clipping or coiling might be better managed by surgical clipping in young patients considering that this treatment achieves higher rates of occlusion with a lower incidence of rebleeding. In elderly patients, each case must be discussed.

Cerebral Aneurysm Clipping

2018 ◽  
Author(s):  
Irene P. Osborn ◽  
Jocelin Jones Molina
Keyword(s):  
Intracranial Aneurysms ◽  
Perioperative Management ◽  
Cerebral Aneurysms ◽  
Endovascular Coiling ◽  
Endovascular Techniques ◽  
Surgical Clipping ◽  
Traditional Treatment ◽  
Aneurysm Clipping ◽  
Skilled Personnel ◽  
Development And Evolution

Subarachnoid hemorrhage (SAH) is usually caused by the rupture of an intracranial aneurysm. Craniotomy and surgical management has been the traditional treatment for decades until the development and evolution of endovascular techniques. Operative clipping of cerebral aneurysms is performed less frequently, but the procedure is still required for aneurysms that are not amenable to endovascular coiling. Some centers do not have the skilled personnel to perform endovascular techniques, and craniotomy is therefore necessary to treat the aneurysm and prevent the problem of rebleeding and avoid vasospasm. This discussion will address specifically the perioperative management of surgical clipping for intracranial aneurysms.

scholarly journals Acute Pancreatitis as a Complication of Antiepileptic Treatment: Case Series and Review of the Literature

2021 ◽  
Vol 13 (1) ◽  
pp. 98-103
Author(s):  
Agnieszka Pawłowska-Kamieniak ◽  
Paulina Krawiec ◽  
Elżbieta Pac-Kożuchowska
Keyword(s):  
Valproic Acid ◽  
Acute Pancreatitis ◽  
Metabolic Disorders ◽  
Genetic Factors ◽  
Clinical Symptoms ◽  
Gallstone Disease ◽  
Young Patients ◽  
Case Series ◽  
Review Of The Literature ◽  
Acid Therapy

Acute pancreatitis (AP) appears to be rare disease in childhood. In children, it has a different aetiology and course, and requires different management than in adult patients. The diagnosis of AP is based on at least two of the three criteria, which include typical clinical symptoms, abnormalities in laboratory tests and/or imaging studies of the pancreas. There are many known causes leading to AP in children including infections, blunt abdominal trauma, genetic factors, gallstone disease, metabolic disorders, anatomical defects of the pancreas, systemic diseases, as well as drugs, including antiepileptic drugs, and especially preparations of valproic acid. In our study, we present four cases of young patients diagnosed with acute pancreatitis as a complication of valproic acid therapy and we present a review of the literature. We believe that the activity of pancreatic enzymes should be monitored in children treated with valproate preparations in the case of clinical symptoms suggesting AP.

scholarly journals Endovascular management of intracranial aneurysms during pregnancy in three cases and review of the literature

2015 ◽  
Vol 21 (6) ◽  
pp. 654-658 ◽  
Author(s):  
Peng Liu ◽  
Xianli Lv ◽  
Youxiang Li ◽  
Ming Lv
Keyword(s):  
Cesarean Section ◽  
Cerebral Aneurysms ◽  
Endovascular Coiling ◽  
Review Of The Literature ◽  
Endovascular Techniques ◽  
Healthy Baby ◽  
Unruptured Aneurysms ◽  
Gestational Week ◽  
Basilar Tip Aneurysm ◽  
Case Basis

We present three cases of cerebral aneurysms (1 unruptured; 2 ruptured) treated with endovascular techniques in pregnancies. The first ruptured case is a 28-year-old female on 20th gestational week. After the endovascular coiling, the patient suffered persistent hemiparesis and delivered a healthy baby by cesarean section. The second ruptured case is a 25-year-old female on 36th week of pregnancy. She died of aneurysm re-rupture after delivery of a healthy baby by cesarean section. The third unruptured case is a 31-year-old woman on the 26th gestational week of pregnancy who died of a giant basilar tip aneurysm after stent-assisted coiling. Ruptured aneurysm obliteration should be prioritized followed by vaginal delivery or cesarean section. The decision regarding the treatment of unruptured aneurysms should be carefully considered on a case-by-case basis. Stent-assisted coiling may be applicable to aneurysm during pregnancy.

scholarly journals Endovascular Coiling of Aneurysm Remnants after Clipping in Patients with Follow-up

2005 ◽  
Vol 11 (1) ◽  
pp. 41-48 ◽  
Author(s):  
S. Mangiafico ◽  
M. Cellerini ◽  
G. Villa ◽  
F. Ammannati ◽  
L. Paoli ◽  
...  
Keyword(s):  
Treatment Strategy ◽  
Intracranial Aneurysms ◽  
Endovascular Embolization ◽  
Endovascular Coiling ◽  
Surgical Clipping ◽  
Anterior Circulation ◽  
Therapeutic Alternative ◽  
Relative Safety

The vast majority of intracranial aneurysms can be obliterated completely with surgical clipping. However, postoperative remnants occur in about 4 to 8% of patients who undergo postoperative angiography. Endovascular embolization has been successfully performed in patients with postoperative aneurysm remnant and it may represent a therapeutic alternative to surgical reintervention. Twelve aneurysm remnants after surgical clipping were treated with endovascular embolization using GDC. All aneurysms were located in the anterior circulation. Our experience confirms the feasibility and relative safety of this treatment strategy that may be considered a valid alternative to reintervention.

Treatment of cerebral aneurysms in children: analysis of the Kids' Inpatient Database

2014 ◽  
Vol 14 (1) ◽  
pp. 23-30 ◽  
Author(s):  
Aws Alawi ◽  
Randall C. Edgell ◽  
Samer K. Elbabaa ◽  
R. Charles Callison ◽  
Yasir Al Khalili ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Coil Embolization ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Cerebral Aneurysms ◽  
Endovascular Coiling ◽  
Complication Rates ◽  
Surgical Clipping ◽  
Treatment Groups ◽  
Risk Of Death ◽  
Inpatient Database

Object Endovascular coiling and surgical clipping are viable treatment options of cerebral aneurysms. Outcome data of these treatments in children are limited. The objective of this study was to determine hospital mortality and complication rates associated with surgical clipping and coil embolization of cerebral aneurysms in children, and to evaluate the trend of hospitals' use of these treatments. Methods The authors identified a cohort of children admitted with the diagnoses of cerebral aneurysms and aneurysmal subarachnoid hemorrhage from the Kids' Inpatient Database for the years 1998 through 2009. Hospital-associated complications and in-hospital mortality were compared between the treatment groups and stratified by aneurysmal rupture status. A multivariate regression analysis was used to identify independent variables associated with in-hospital mortality. The Cochrane-Armitage test was used to assess the trend of hospital use of these operations. Results A total of 1120 children were included in this analysis; 200 (18%) underwent aneurysmal clipping and 920 (82%) underwent endovascular coiling. Overall in-hospital mortality was higher in the surgical clipping group compared with the coil embolization group (6.09% vs 1.65%, respectively; adjusted odds ratio [OR] 2.52, 95% CI 0.97–6.53, p = 0.05). The risk of postoperative stroke or hemorrhage was similar between the two treatment groups (p = 0.86). Pulmonary complications and systemic infection were higher in the surgical clipping population (p < 0.05). The rate of US hospitals' use of endovascular coiling has significantly increased over the years included in this study (p < 0.0001). Teaching hospitals were associated with a lower risk of death (OR 0.13, 95% CI 0.03–0.46; p = 0.001). Conclusions Although both treatments are valid, endovascular coiling was associated with fewer deaths and shorter hospital stays than clip placement. The trend of hospitals' use of coiling operations has increased in recent years.

scholarly journals Balloon-Assisted Cannulation for Difficult Anterior Cerebral Artery Access

2017 ◽  
Vol 7 (1-2) ◽  
pp. 48-52
Author(s):  
Varun Naragum ◽  
Mohamad AbdalKader ◽  
Thanh N. Nguyen ◽  
Alexander Norbash
Keyword(s):  
Cerebral Artery ◽  
Paradigm Shift ◽  
Intracranial Aneurysms ◽  
Anterior Cerebral Artery ◽  
Endovascular Coiling ◽  
Anterior Communicating Artery ◽  
Surgical Clipping ◽  
Ruptured Aneurysms ◽  
Common Location ◽  
Proximal Middle Cerebral Artery

The anterior communicating artery is a common location for intracranial aneurysms. Compared to surgical clipping, endovascular coiling has been shown to improve outcomes for patients with ruptured aneurysms and we have seen a paradigm shift favoring this technique for treating aneurysms. Access to the anterior cerebral artery can be challenging, especially in patients with tortuous anatomy or subarachnoid hemorrhage or in patients presenting with vasospasm. We present a technique for cannulating the anterior cerebral artery using a balloon inflated in the proximal middle cerebral artery as a rebound surface.

Influence of Stent Configuration on Cerebral Aneurysm Fluid Dynamics

2010 ◽  
Author(s):  
Haithem Babiker ◽  
L. Fernando Gonzalez ◽  
Felipe Albuquerque ◽  
Daniel Collins ◽  
Arius Elvikis ◽  
...  
Keyword(s):  
Fluid Dynamics ◽  
Treatment Option ◽  
Treatment Options ◽  
Cerebral Aneurysms ◽  
Endovascular Coiling ◽  
Invasive Technique ◽  
Surgical Clipping ◽  
The Past ◽  
Alternative Treatment Option ◽  
Wide Neck

Treatment options for cerebral aneurysms have drastically evolved in the last decade. In the past, surgical clipping through craniotomy was the predominant treatment option for cerebral aneurysms. Presently, endovascular coiling, a minimally invasive technique, has superseded clipping in many centers [1]. However, the coiling of wide-neck aneurysms is still a challenge [2]. Complete aneurysmal occlusion is often impossible [3]. Recently, stand-alone stents have been explored as an alternative treatment option for wide-neck aneurysms [4].

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