scholarly journals Clinical outcomes of surgical clipping for intracranial aneurysms in patients with a Hunt and Hess grade 4 or 5

2016 ◽  
Vol 74 (6) ◽  
pp. 478-481 ◽  
Author(s):  
Yang Zhang ◽  
Xiaobo Zhu ◽  
Kun Hou ◽  
Jinchuan Zhao ◽  
Xianfeng Gao ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Clinical Condition ◽  
Intracranial Aneurysms ◽  
Pulmonary Infection ◽  
Mortality Rates ◽  
Surgical Clipping ◽  
Postoperative Hematoma ◽  
Grade 5 ◽  
High Incidence ◽  
Ventriculo Peritoneal Shunt

ABSTRACT We retrospectively evaluated the records of 49 grade 4 and 5 patients with 42 intracranial aneurysms treated within 72 h of subarachnoid hemorrhage (SAH). In total, 35 patients (71%) were grade 4, and 14 (29%) were grade 5. A total of 42 (85%) patients had one aneurysm, 6 (12%) had two aneurysms, and 1 (3%) had three aneurysms. Out of 49 patients, one technical (2%) and one clinical (2%) complication occurred at surgery. Twenty-one (43%) patients recovered well, including 7 with postoperative hematoma requiring an immediate evacuation of a clot. Fourteen (29%) patients had hydrocephalus and required a ventriculo-peritoneal shunt; 12 patients underwent tracheotomy postoperatively due to coma and pulmonary infection. We found that patients with Hunt and Hess grade 4 and 5 aneurysms can undergo successful neurosurgical clipping of the aneurysms after SAH. However, the morbidity and mortality rates remain high because of their poor clinical condition and a high incidence of vasospasm during treatment.

Aneurysmal Subarachnoid Hemorrhage: Neurosurgical Frontiers and Nursing Challenges

1991 ◽  
Vol 2 (4) ◽  
pp. 665-674
Author(s):  
Helen A. Cook
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Intracranial Aneurysms ◽  
Seizure Activity ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Delayed Cerebral Ischemia ◽  
Treatment Strategies ◽  
Mortality Rates ◽  
Aneurysmal Rupture ◽  
Management Of Complications ◽  
Ruptured Intracranial Aneurysms

Despite increases in survival beyond the initial hemorrhage, the devastating consequences of subarachnoid hemorrhage persist. Ruptured intracranial aneurysms are the most likely cause of subarachnoid hemorrhage, with morbidity and mortality rates approaching 75%. Complications arising from aneurysmal subarachnoid hemorrhage include rebleeding, delayed cerebral ischemia, hydrocephalus, hypothalamic dysfunction, and seizure activity. In order to positively influence outcome after subarachnoid hemorrhage, preservation of an adequate cerebral blood flow and prevention of secondary aneurysmal rupture is essential. This article reviews aneurysmal subarachnoid hemorrhage, relating the management of complications to currently accepted treatment strategies

An Immersed Porous Boundary Method for Computational Fluid Dynamics of Blood Flow in Aneurysms With Flow Diverters

2012 ◽  
Author(s):  
Viorel Mihalef ◽  
Puneet Sharma ◽  
Ali Kamen ◽  
Thomas Redel
Keyword(s):  
Fluid Dynamics ◽  
Computational Fluid Dynamics ◽  
Blood Flow ◽  
Subarachnoid Hemorrhage ◽  
Cerebral Artery ◽  
Intracranial Aneurysms ◽  
Mortality Rates ◽  
Morbidity And Mortality ◽  
High Morbidity ◽  
Flow Diverters

Intracranial aneurysms are pathological dilatations of a cerebral artery that may suffer rupture and lead to subarachnoid hemorrhage. Such a condition presents high morbidity and mortality rates for the patients concerned.

scholarly journals Multiple Intracranial Aneurysms: Endovascular Treatment and Complications

2014 ◽  
Vol 20 (4) ◽  
pp. 442-447 ◽  
Author(s):  
Xun Shen ◽  
Tao Xu ◽  
Xuan Ding ◽  
Wenlei Wang ◽  
Zhi Liu ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Clinical Outcome ◽  
Brain Ischemia ◽  
Intracranial Aneurysms ◽  
Mass Effect ◽  
Endovascular Embolization ◽  
Endovascular Techniques ◽  
Surgical Clipping ◽  
Multiple Intracranial Aneurysms

This study evaluated the results of endovascular embolization of multiple intracranial aneurysms. A retrospective hospital chart and radiograph review were made of all patients with multiple intracranial aneurysms seen between March 2010 and January 2011. Ten patients presented with subarachnoid hemorrhage, four with mass effect, two with brain ischemia and twenty were incidental. These 36 patients harbored 84 aneurysms, 63 of which were treated with endovascular techniques, two by surgical clipping, and 19 were left untreated. Of the coil-treated lesions, a complete endovascular occlusion was achieved in 54 aneurysms (85.7%), and eight (12.7%) presented neck remnants with one (1.6%) stented only. Twenty-six patients (72.2%) underwent coil embolization of more than one aneurysm in the first session. Follow-up angiographic studies in 31 patients demonstrated an unchanged or improved result in 93.0% of the aneurysms (53 lesions) and coil compaction in 7.0% (four lesions). The overall clinical outcome was excellent in 33 patients (91.7%), good in one (2.8%) and fair in two (5.5%). Endovascular techniques may be a particularly suitable method for treating multiple intracranial aneurysms.

Surgical treatment of asymptomatic and incidental intracranial aneurysms

1980 ◽  
Vol 53 (1) ◽  
pp. 20-21 ◽  
Author(s):  
Jose Luis Salazar
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Surgical Treatment ◽  
Clinical Condition ◽  
Intracranial Aneurysms ◽  
Consecutive Series ◽  
Content Type ◽  
Incidental Aneurysms ◽  
Fine Print

✓ A consecutive series of 78 patients underwent surgery for 106 aneurysms between 1972 and 1978; this group included 14 patients with subarachnoid hemorrhage who had multiple, unruptured, incidental aneurysms (20 additional aneurysms). These aneurysms were operated on with no mortality. In 15 other patients, who underwent angiography for various nonhemorrhagic disorders, a total of 18 asymptomatic aneurysms were found. These were also operated on with no mortality. Three of the 29 patients had postoperative hemiplegia, which persists in only one. The author recommends that all aneurysms should be considered for operation when diagnosed, if the patient's clinical condition is stable.

scholarly journals Ultra-Early Versus Early Aneurysm Surgery After Subarachnoid Hemorrhage: A Retrospective Outcome Analysis

2020 ◽  
Vol 39 (02) ◽  
pp. 095-100
Author(s):  
Miguel Trigo Carvalho ◽  
António Canotilho Lage ◽  
Ricardo Pereira ◽  
Jorge Gonçalves ◽  
Ana Matos ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Intracranial Aneurysms ◽  
Early Surgery ◽  
Outcome Analysis ◽  
World Federation ◽  
Fisher Exact Test ◽  
Surgical Clipping ◽  
Poor Grade ◽  
Good Grade ◽  
The Impact

Abstract Object The timing of definitive management of ruptured intracranial aneurysms has been the subject of considerable debate, although the benefits of early surgery (until 72 hours postictus) are widely accepted. The aim of the present study is to evaluate the potential benefit of ultra-early surgery (until 24 hours) when compared with early surgery, in those patients who were treated by surgical clipping at the Neurosurgery Department of the Coimbra Hospital and University Centre. Methods A 17-year database of consecutive ruptured and surgically treated intracranial aneurysms was analyzed. Outcome was measured by the Glasgow Outcome Scale (GOS). Baseline characteristics were analyzed by the Fisher exact test, the chi-squared and Mann-Whitney tests. Logistic regression was used to assess the impact of good grade according to the World Federation of Neurological Surgeons (WFNS) scale and ultra-early surgery in a good GOS outcome. Results 343 patients who were submitted to surgical clipping in the first 72 hours post-ictus were included, 165 of whom have undergone ultra-early surgery. Demographics and preoperative characteristics of ultra-early and early surgery patients were similar. Good-grade patients according to the WFNS scale submitted to ultra-early surgery demonstrated an improved GOS at discharge and at 6 months. Poor-grade patients according to the WFNS scale submitted to ultra-early surgery demonstrated an improved GOS at discharge. Conclusions Ultra-early surgery for aneurysmal subarachnoid hemorrhage patients improves outcome mainly on good-grade patients. Efforts should be made on the logistics of emergency departments to consider achieving treatment on this timeframe as a standard of care.

Hydrocephalus and Vasospasm after Subarachnoid Hemorrhage from Ruptured Intracranial Aneurysms

Neurosurgery ◽  
1986 ◽  
Vol 18 (1) ◽  
pp. 12-16 ◽  
Author(s):  
Peter McL. Black
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Intracranial Aneurysms ◽  
Ventricular Enlargement ◽  
Cerebrospinal Fluid Flow ◽  
Computed Tomographic ◽  
High Incidence ◽  
Computed Tomographic Scan ◽  
Delayed Neurological Deterioration ◽  
The Relationship ◽  
Ruptured Intracranial Aneurysms

Abstract The incidence of hydrocephalus and vasospasm and the relationship between them were analyzed retrospectively in 87 patients with subarachnoid hemorrhage from ruptured intracranial aneurysms. Sixty-seven per cent of the patients showed ventricular enlargement on a computed tomographic scan done within 30 days of the hemorrhage; in patients whose first scan was done within 3 days of the hemorrhage, 63% seemed to have ventricular enlargement by a neuroradiologist's interpretation. Shunts were required in 14% of the patients because of delayed neurological deterioration or enlarging ventricles; 3% required ventriculostomy shortly after admission. Seventy-four per cent of the patients had angiographic spasm on an angiogram done within the first 30 days after hemorrhage. Sixty-two per cent of the patients had both hydrocephalus and vasospasm: 22% had neither. Five per cent had hydrocephalus, but no spasm; 11% had spasm. but no hydrocephalus. Hydrocephalus and vasospasm were significantly associated (P < 0.01, x2). These data document a high incidence of mild ventricular enlargement and angiographic vasospasm after subarachnoid hemorrhage. They also emphasize that these two sequelae of subarachnoid hemorrhage are closely linked, probably by the presence of blood in the basal cisterns obstructing cerebrospinal fluid flow and surrounding arteries there.

One-Year Morbidity and Mortality Rates Associated with Clipping Unruptured Intracranial Aneurysms

2019 ◽  
Author(s):  
Khodayar Goshtasbi ◽  
Ronald Sahyouni ◽  
Alice Wang ◽  
Edward Choi ◽  
Gilbert Cadena ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Mortality Rates ◽  
Morbidity And Mortality ◽  
Unruptured Intracranial Aneurysms ◽  
One Year

Murphey’s teat: history and insight into an enigmatic cerebrovascular eponym

2020 ◽  
Vol 133 (2) ◽  
pp. 369-373
Author(s):  
Daniel M. Heiferman ◽  
Daphne Li ◽  
Joseph C. Serrone ◽  
Matthew R. Reynolds ◽  
Anand V. Germanwala ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Intracranial Aneurysms ◽  
Important Work ◽  
Multiple Intracranial Aneurysms ◽  
Angiographic Evidence ◽  
Insight Into

Dr. Francis Murphey of the Semmes-Murphey Clinic in Memphis recognized that a focal sacculation on the dome of an aneurysm may be angiographic evidence of a culpable aneurysm in the setting of subarachnoid hemorrhage with multiple intracranial aneurysms present. This has been referred to as a Murphey’s “teat,” “tit,” or “excrescence.” With variability in terminology, misspellings in the literature, and the fact that Dr. Murphey did not formally publish this important work, the authors sought to clarify the meaning and investigate the origins of this enigmatic cerebrovascular eponym.

scholarly journals Evaluation of the Accero Stent for Stent-Assisted Coiling of Unruptured Wide-Necked Intracranial Aneurysm Treatment with Short-Term Follow-Up

2020 ◽  
Vol 9 (9) ◽  
pp. 2808
Author(s):  
Wojciech Poncyljusz ◽  
Kinga Kubiak ◽  
Leszek Sagan ◽  
Bartosz Limanówka ◽  
Katarzyna Kołaczyk
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Intracranial Aneurysms ◽  
Clinical Results ◽  
Class I ◽  
Unruptured Aneurysms ◽  
Patient Demographics ◽  
Stent Deformation ◽  
Unruptured Intracranial Aneurysms ◽  
Occlusion Rate

Background: Stent-assisted coiling is an effective method of treating intracranial aneurysms. The aim of the study was to assess the safety and efficacy of the new Accero stent for the treatment of intracranial aneurysms. Materials and Methods: It was a retrospective, single-center study. Eighteen unruptured intracranial aneurysms were treated using the stent-assisted coiling method with the Accero stent. Patient demographics, aneurysm characteristics, procedural parameters, grade of occlusion, complications, and clinical results were analyzed. Follow-up magnetic resonance (MR) was performed 6 months after intervention. Results: Seventeen patients with 18 incidental unruptured aneurysms were electively treated with coiling and the Accero stent. The aneurysms were located on internal carotid artery (ICA), middle cerebral artery (MCA) and basilar artery (BA). All stents were deployed successfully. Immediate complete occlusion rate Raymond-Roy occlusion classification (RROC) class I was achieved in 13 cases and class II in 4 cases. Complications occurred in 2/17 treatments and included guidewire stent perforation with subarachnoid hemorrhage (SAH) and stent deformation. Vascular spasm in the subarachnoid hemorrhage (SAH) patient subsided before discharge. Ninety days after intervention, the modified Rankin Scale (mRS) value was 0. RROC class I was observed in 88.23% of cases in follow-up. Conclusion: The Accero stent provides excellent support for coil mass. It constitutes an efficacious device with good initial occlusion rate for treating wide-necked unruptured intracranial aneurysms.

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