scholarly journals Microsurgery for Multiple Intracranial Aneurysms

2021 ◽  
Vol 32 (1) ◽  
pp. 81-88
Author(s):  
Laís Miotta Simoncello ◽  
Hsuan Hua Chen ◽  
Lucas do Amaral Genta Mansano ◽  
Manauela Iglesias Borges ◽  
Sophia Fuentes Rosa ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Cerebral Aneurysms ◽  
Single Stage ◽  
Anterior Communicating Artery ◽  
Multiple Intracranial Aneurysms ◽  
Complex Aneurysms ◽  
Microsurgical Clipping ◽  
Microsurgical Approach ◽  
The Right ◽  
Age Range

Background: A total of 23 patients with 52 aneurysms were surgically treated in single surgery at a Neurosurgical Service of the Health Service of the State of São Paulo from 2009 to 2011. Method: Retrospective analysis of patients undergoing clipping of two or more cerebral aneurysms in a single stage, from January 2007 to July 2012. Results: Twenty-nine patients underwent two or more clipping cerebral aneurysms in a single surgery – 28 with a single craniotomy and one through two craniotomies. Of these, 20, 7, 1 and 1 were submitted to the clipping of 2, 3, 4 and 5 cerebral aneurysms, respectively. Five were male and 24 were female, and the age range was 40 to 66-years-old. Eight left craniotomies were performed to approach 17 lateralized brain aneurysms to the left and five to the right, as well as three anterior communicating complex aneurysms. Twelve craniotomies were performed on the right to approach 23 intracranial aneurysms lateralized to the right and six on the left, as well as 15 anterior communicating artery complex aneurysms and 1 on the basilar artery. Of the 29 patients, 28 evolved with 1-3 pts and only one with 4-5 pts on the Rankin scale, six months after surgery. Conclusion: We advocate microsurgical approach for most of the cases of multiple intracranial aneurysms aiming the microsurgical clipping of all intracranial aneurysms if feasible through a single stage and a single craniotomy.

scholarly journals MICROSURGICAL CLIPPING IN THE RUPTURED AN ANEURYSM OF ANTERIOR COMMUNICATING ARTERY: A CASE REPORT

2017 ◽  
Vol 10 (10) ◽  
pp. 7
Author(s):  
Wayan Niryana ◽  
Aslesa Wangpathi Pagehgiri ◽  
Putu Eka Widyadharma
Keyword(s):  
Case Report ◽  
Intraoperative Monitoring ◽  
Cerebral Aneurysms ◽  
Medical Problem ◽  
Definitive Treatment ◽  
Anterior Communicating Artery ◽  
Microsurgical Technique ◽  
The Third ◽  
Microsurgical Clipping ◽  
Saccular Aneurysms

Objective: Ruptured saccular aneurysms are a common and serious medical problem. The prevalence of aneurysms is low during the first two decades of life and increases steadily after the third decade. Anterior communicating artery (AComA) aneurysms are regarded as the most complex of all intracranial aneurysms.Methods: Here, we report a case of an aneurysm of AComA patient with the development of microsurgical technique and intraoperative monitoring technique.Results: Permanent clipping was successfully performed in the neck of an aneurysm of AComA.Conclusion: Microsurgical clipping still remains a definitive treatment of ruptured cerebral aneurysms.

scholarly journals Vasa Vasorum Formation is Associated With Rupture of Intracranial Aneurysms

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Haruka Miyata ◽  
Hirokazu Koseki ◽  
Kampei Shimizu ◽  
Yu Abekura ◽  
Mieko Oka ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Intracranial Aneurysms ◽  
Histopathological Examination ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Vasa Vasorum ◽  
Systemic Hypertension ◽  
External Carotid ◽  
Anterior Communicating Artery ◽  
Sprague Dawley ◽  
The Right

Abstract INTRODUCTION Subarachnoid hemorrhage has a poor outcome despite a modern advancement in medical care. The development of a novel therapeutic strategy to prevent rupture of intracranial aneurysms (IAs) or a novel diagnostic marker to predict rupture-prone lesions is thus mandatory. Therefore, in the present study, we established a rat model in which IAs spontaneously rupture and examined this model to clarify histopathological features associated with rupture of lesions. METHODS In detail, female Sprague-Dawley rats were subjected to the bilateral ovariectomy, the ligation of the left common carotid, the right external carotid, and the right pterygopalatine arteries, the induced systemic hypertension, and the administration of a lysyl oxidase inhibitor. RESULTS Aneurysmal subarachnoid hemorrhage occurred one-thirds of manipulated animals and locations of ruptured IAs were exclusively at a posterior or an anterior communicating artery. Histopathological examination using ruptured IAs, rupture-prone ones induced at a posterior or an anterior communicating artery, ones induced at an anterior cerebral artery-olfactory artery bifurcation that never rupture revealed the formation of vasa vasorum as an event associated with rupture of IAs. CONCLUSION We thus proposed the contribution of a structural change in an adventitia, vasa vasorum formation, to rupture of IAs. Findings from this study provide important insights about the pathogenesis of IAs.

STENT REMODELING TECHNIQUE FOR COILING OF RUPTURED WIDE-NECK CEREBRAL ANEURYSMS: CASE REPORT

Neurosurgery ◽  
2009 ◽  
Vol 65 (5) ◽  
pp. E1007-E1008 ◽  
Author(s):  
Demetrius K. Lopes ◽  
Kalani Wells
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cerebral Aneurysms ◽  
Artery Aneurysm ◽  
Anterior Communicating Artery ◽  
Parent Vessel ◽  
Aneurysm Neck ◽  
Acute Subarachnoid Hemorrhage ◽  
The Right ◽  
Wide Neck ◽  
Cordis Corporation

Abstract OBJECTIVE To describe a novel stent remodeling technique for the coiling of ruptured wide-neck cerebral aneurysms. CLINICAL PRESENTATION A 46-year-old man presented with acute subarachnoid hemorrhage (Hunt and Hess grade IV), intracerebral hemorrhage, and hydrocephalus. Cerebral angiography revealed a wide-neck small anterior communicating artery aneurysm. Conventional coiling was not successful because of coil instability and compromise of the dominant anterior cerebral artery. TECHNIQUE A 6-French shuttle sheath (Cook Medical, Indianapolis, IN) was advanced from a right femoral approach into the right common carotid artery. To protect the parent vessel during coiling without compromising blood flow, a Prowler Select Plus catheter (Cordis Corporation, Bridgewater, NJ) was navigated across the aneurysm neck. Subsequently, an Enterprise stent (22-mm length; Cordis Corporation) was partially deployed across the aneurysm's wide neck. It was very important to watch the distal markers of the stent and lock the stent delivery wire to the Prowler Select Plus with a hemostatic valve once the stent was halfway deployed. This maneuver was essential to prevent further deployment of the stent. The SL-10 microcatheter and Synchro 14 wire (Boston Scientific, Natick, MA) were carefully navigated to the aneurysm passing through the partially deployed stent. Coils were then delivered to the aneurysm using the stent as a scaffold. After coiling, the SL-10 microcatheter was removed and the stent was recaptured into the Prowler Select Plus catheter. During the recapture, there was initial resistance. This was easily overcome after deploying the stent a little more before resheathing. During the procedure, the patient received 2000 U of heparin after the first coil was detached in the aneurysm. CONCLUSION The stent remodeling technique is a novel endovascular technique that can be used to treat ruptured wide-neck aneurysms and maintain patency of parent vessels, avoiding the use of antiplatelet therapy in acute subarachnoid hemorrhage.

scholarly journals Y-Stent-Assisted Coil Embolization of Anterior Circulation Aneurysms Using Two Solitaire AB Devices: A Single Center Experience

2012 ◽  
Vol 18 (2) ◽  
pp. 158-163 ◽  
Author(s):  
M. Martínez-Galdámez ◽  
P. Saura ◽  
J. Saura ◽  
A. Martinez ◽  
J.M. De Campos ◽  
...  
Keyword(s):  
Coil Embolization ◽  
Intracranial Aneurysms ◽  
Treatment Method ◽  
Anterior Communicating Artery ◽  
Branch Points ◽  
Anterior Circulation ◽  
Single Center Experience ◽  
Complex Aneurysms ◽  
Previously Treated ◽  
Wide Neck

Wide-neck intracranial aneurysms remain a challenge to endovascular treatment. We describe our experience in repairing wide-neck aneurysms of the anterior circulation located at arterial branch points using coil embolization assisted by Y-stenting using two Solitaire® stents. Six wide-neck intracranial aneurysms located on the middle cerebral artery bifurcation 3, pericallosal artery 1, and anterior communicating artery 2 were repaired by Y-stent-assisted coil embolization using two Solitaire® stents. Four cases were incidental findings of aneurysm and two cases were previously treated ruptured aneurysms that had undergone recanalization. All the cases were successfully treated without complications. Follow-up by digital subtraction angiography and magnetic resonance angiography at six months showed the stents to be patent with no recanalization of the aneurysm sacs. Repairing wide-neck aneurysms of the anterior circulation by Y-stent-assisted coil embolization using two Solitaire® stents is a simple and safe method of treating complex aneurysms. While the results are promising, larger series with longer term follow-ups are needed to corroborate that this treatment method is superior to other techniques.

Deep Hypothermic Circulatory Arrest for Complex Cerebral Aneurysms: Lessons Learned

Neurosurgery ◽  
2007 ◽  
Vol 60 (5) ◽  
pp. 815-827 ◽  
Author(s):  
William J. Mack ◽  
Andrew F. Ducruet ◽  
Peter D. Angevine ◽  
Ricardo J. Komotar ◽  
Debra B. Shrebnick ◽  
...  
Keyword(s):  
Cerebral Metabolism ◽  
Circulatory Arrest ◽  
Posterior Inferior Cerebellar Artery ◽  
Cerebral Aneurysms ◽  
Deep Hypothermic Circulatory Arrest ◽  
Hypothermic Circulatory Arrest ◽  
Lessons Learned ◽  
Anterior Communicating Artery ◽  
Computed Tomographic ◽  
Complex Aneurysms

AbstractOBJECTIVEDeep hypothermic circulatory arrest is a useful adjunct for treating complex aneurysms. Decreased cerebral metabolism and resultant ischemic tolerance create an environment suitable for devascularizing high-risk lesions. However, the advent of modern imaging modalities, innovative cerebral revascularization strategies, and the emergence of endovascular stenting and coiling limit the number of aneurysms requiring this surgical intervention. We present 66 patients with intracranial aneurysms who underwent surgical clipping under deep hypothermic arrest and attempt to identify patients well-suited for this procedure.METHODSThis study was conducted during a 15-year period and examined patients with aneurysms of the anterior and posterior cerebral circulation. Demographics, aneurysm characteristics, and surgical factors were evaluated as predictors of functional outcome.RESULTSPatient age and the duration of cardiac arrest were independent predictors of early clinical outcome (P < 0.05). Our experience suggests that the ideal patient is younger than 60 years old and harbors few medical comorbidities. Individuals with large aneurysms of the anterior communicating artery, internal carotid artery bifurcation, posterior inferior cerebellar artery, midbasilar, or vertebral arteries and with an absence of thrombosis and calcium may be most likely to experience favorable outcomes. Circulatory arrest should not exceed 30 minutes. Postoperative computed tomographic scanning and timely anesthetic emergence allow for early detection of hemorrhage. Complete dissection of the aneurysm before bypass and avoiding extreme hypothermia yield a low incidence of life-threatening postoperative hematomas.CONCLUSIONHypothermic circulatory arrest is a useful technique for neuroprotection during the clipping of complex cerebral aneurysms. This procedure, however, has several associated risks. Patient factors, pathoanatomic characteristics, and surgical parameters may be used to guide patient selection.

scholarly journals Surgical outcome of multiple intracranial aneurysms

2016 ◽  
Vol 11 (4) ◽  
Author(s):  
Mubashir Ahmed ◽  
Anjum Habib Vohra
Keyword(s):  
Surgical Outcome ◽  
Glasgow Outcome Scale ◽  
Intracranial Aneurysms ◽  
Clinical Presentation ◽  
Metabolic Disturbance ◽  
Ruptured Aneurysm ◽  
Multiple Intracranial Aneurysms ◽  
Good Outcome ◽  
Ct Brain ◽  
Age Range

Multiple intracranial aneurysms are relatively uncommon among patients of intracranial aneurysms. The aim of management has traditionally been the same i.e. clipping of all the aneurysms to eliminate the risk of rebleed. This study was conducted to determine the outcome of patients of multiple intracranial aneurysms at Mayo Hospital Lahore, Pakistan. The study period was from September 1999 to January 2002. Four patients were diagnosed having multiple intracranial aneurysms. Age range was 40 to 65 years and 2 (50%) patients were female. Patients were assessed according to Hunt & Hess grade. Clinical presentation was favoring the site of ruptured aneurysm in one patient and CT brain was suggestive of site in two patients. All patients had 2 aneurysms. In three (75%) cases, aneurysm were unilateral and in one (25%) case, bilateral. Half (50%) patients had clipping of aneurysms through single craniotomy and half (50%) had bilateral craniotomies. Outcome was graded according to Glasgow Outcome Scale. Three (7 5%) patients had good outcome and one (25%) patient died after clipping of aneurysms due to vasospasm, infarction and metabolic disturbance.

scholarly journals Single-stage clipping with bifrontal and bilateral frontotemporal craniotomies for subarachnoid hemorrhage with multiple cerebral aneurysms using Sugita head holding system: A case report

2020 ◽  
Vol 11 ◽  
pp. 76
Author(s):  
Masahito Katsuki ◽  
Naomichi Wada ◽  
Yasunaga Yamamoto
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cerebral Artery ◽  
Treatment Strategies ◽  
Cerebral Aneurysms ◽  
Single Stage ◽  
Ruptured Aneurysm ◽  
Left Middle Cerebral Artery ◽  
Multiple Aneurysms ◽  
Single Fixation ◽  
The Right

Background: Subarachnoid hemorrhage with multiple aneurysms is very challenging because it is difficult to identify the ruptured aneurysm. We could not identify the ruptured aneurysm preoperatively, so we decided to treat all of the aneurysms as a single-stage surgery. Case Description: A 79-year-old woman was diagnosed with subarachnoid hemorrhage with multiple cerebral aneurysms at the right distal anterior cerebral artery, left middle cerebral artery, and right internal carotid artery- posterior communicating artery bifurcation. We could not identify the ruptured aneurysm preoperatively. We fixed her head using the Sugita head holding system (Mizuho Co., Ltd., Tokyo) and performed clipping for each aneurysm with bifrontal craniotomy and bilateral frontotemporal craniotomy as a single-stage operation. The last aneurysm seemed ruptured, and clipping for all the aneurysms was successful. She was discharged with a good postoperative course. The Sugita head holding system allowed turning the head of the patient toward the right and left with single fixation, leading to this single-stage operation. Conclusion: Several methods for identifying a ruptured aneurysm from multiple aneurysms have been reported, but under limited medical resources, this procedure would be one of the treatment strategies.

scholarly journals Microsurgical clipping of the anterior circulation aneurysms

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.

Definitive Treatment With Microsurgical Clipping After Recurrence and Rerupture of Coiled Anterior Cerebral Artery Aneurysms

2020 ◽  
Vol 19 (4) ◽  
pp. 393-402
Author(s):  
Daniel M S Raper ◽  
Caleb Rutledge ◽  
Ethan A Winkler ◽  
Adib A Abla
Keyword(s):  
Cerebral Artery ◽  
Intracranial Aneurysms ◽  
Anterior Cerebral Artery ◽  
Significant Risk ◽  
Subsequent Treatment ◽  
Definitive Treatment ◽  
Endovascular Coiling ◽  
Anterior Communicating Artery ◽  
Recent Experience ◽  
Microsurgical Clipping

Abstract BACKGROUND The extent of obliteration of ruptured intracranial aneurysms treated with coil embolization has been correlated with the risk of rerupture. However, many practitioners consider that a small neck remnant is unlikely to result in significant risk after coiling. OBJECTIVE To report our recent experience with ruptured anterior cerebral artery aneurysms treated with endovascular coiling, which recurred or reruptured, requiring microsurgical clipping for subsequent treatment. METHODS Retrospective review of patients with intracranial aneurysms treated at our institution since August 2018. Patient and aneurysm characteristics, initial and subsequent treatment approaches, and outcomes were reviewed. RESULTS Six patients were included. Out of those 6 patients, 5 patients had anterior communicating artery aneurysms, and 1 patient had a pericallosal aneurysm. All initially presented with subarachnoid hemorrhage (SAH) and were treated with coiling. Recurrence occurred at a median of 7.5 mo. In 2 cases, retreatment was initially performed with repeat endovascular coiling, but further recurrence was observed. Rerupture from the residual or recurrent aneurysm occurred in 3 cases. In 2 cases, the aneurysm dome recurred; in 1 case, rerupture occurred from the neck. All 6 patients underwent treatment with microsurgical clipping. Follow-up catheter angiography demonstrated a complete occlusion of the aneurysm in all cases with the preservation of the parent vessel. CONCLUSION Anterior cerebral artery aneurysms may recur after endovascular treatment, and even small neck remnants present a risk of rerupture after an initial SAH. Complete treatment requires a complete exclusion of the aneurysm from the circulation. Even in cases that have been previously coiled, microsurgical clipping can represent a safe and effective treatment option.

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