scholarly journals Two-stage surgical treatment of subarachnoid and paryhymatous blood effects with the use of endovascular embolization of damaged aneurysm

2019 ◽  
Keyword(s):  
Surgical Treatment ◽  
Subarachnoid Haemorrhage ◽  
Cerebral Aneurysm ◽  
Endovascular Embolization ◽  
Neurological Deficits ◽  
Ruptured Aneurysm ◽  
Motor Deficit ◽  
Intracerebral Hematoma ◽  
Subsequent Removal ◽  
Two Stage

Introduction. Aneurysmal subarachnoid hemorrhage (SAH) is complicated by concomitant intracerebral hemorrhage (IUD) with a frequency of 4% to 42.5%. More than 80% of patients die in conservative therapy, and when removing only hematomas without occlusion of an aneurysm, the mortality rate reaches 75%. Objectives. The aim of the study was the optimization of treatment of aneurysmatic subarachnoid haemorrhage complicated by the formation of intracerebral hematoma. Materials and methods. The analysis of the results of surgical treatment of 101 patients in the acute period of cerebral aneurysm rupture was performed. The first group of observations in which the surgical treatment was limited to endovascular occlusion of cerebral aneurysms. In the second group of observations, multi-stage surgical treatment was performed - endovascular embolization of cerebral aneurysm with subsequent removal of parenchymal hematoma for 24–48 hours. Results. In most cases, surgical treatment was limited to endovascular embolization of the ruptured aneurysm. In 3 observations, multistage surgical treatment was performed - endovascular embolization of cerebral aneurysm with subsequent removal of intracerebral hematoma. In two cases, positive dynamics with a regression of neurological deficits in the postoperative period was noted. In one observation, partial regression of motor deficit. Conclusions. Two - stage surgical treatment of subarachnoid haemorrhage with intracerebral hematoma the use of endovascular embolization of the ruptured aneurysm and subsequent evacuation of hematoma is effective and can be used in cases where there is a technical possibility of occlusion of the aneurysm s and the compensated state of the patient.

Six Cases of Ruptured Aneurysm, Treated with Cellulose Acetate Polymer

1998 ◽  
Vol 4 (1_suppl) ◽  
pp. 97-100
Author(s):  
M. Matsunaga ◽  
K. Kinugasa ◽  
S. Mandai ◽  
T. Ohmoto
Keyword(s):  
Cellulose Acetate ◽  
Neurological Deficits ◽  
Ruptured Aneurysm ◽  
Intracerebral Hematoma ◽  
Anterior Choroidal Artery ◽  
Complete Obstruction ◽  
Poor Grade ◽  
Anterior Choroidal ◽  
Mca Aneurysm ◽  
Choroidal Artery

We review 6 cases of ruptured aneurysm which were elderly, poor-grade SAH or requiring high-risk surgery treated with Cellulose Acetate Polymer (CAP). A 76-year-old female with A-com aneurysm was comatose. Heart failure was her complication (case 1). An 81-year-old female with A-com aneurysm was semicomatose (case 2). An 89-year-old female with MCA aneurysm was semicomatose and had right hemiplegia (case 3), An 88-year-old female with MCA aneurysm was comatose (case 4). A 55-year-old male with IC-PC aneurysm had a small intracerebral hematoma and was semicomatose (case 5). A 52-year-old female with IC-Ach aneurysm was somnolent (case 6). All cases had no rebleeding after embolization. CAP embolization was complete in all cases but case 1. Case 4 died from primary brain damage on the day 7. Three cases stayed in a severely disabled state and died after 3 months (case 1), 2 months (case 2) and 4 months (case 3) from onset respectively. Case 5 remains in a moderately disabled state after 2 years, Case 6 had a anterior choroidal artery which was hard to spare on aneurysmal clipping. She is free from neurological deficits after CAP embolization. Angiography after 2 years demonstrated complete obstruction of the aneurysm. CAP is good for cases which are elderly, poor-grade SAH or difficult to treat with surgery. CAP embolization has some advantages over GDC coil obstruction for aneurysm treatment.

scholarly journals Embolization of a peripheral cerebral aneurysm associated with intracranial major artery occlusion through a transdural anastomotic artery: Case report

2018 ◽  
Vol 25 (2) ◽  
pp. 172-176 ◽  
Author(s):  
Norito Fukuda ◽  
Kazuya Kanemaru ◽  
Koji Hashimoto ◽  
Hideyuki Yoshioka ◽  
Nobuo Senbokuya ◽  
...  
Keyword(s):  
Cerebral Aneurysm ◽  
Artery Occlusion ◽  
Endovascular Embolization ◽  
Acute Onset ◽  
Ruptured Aneurysm ◽  
Occipital Artery ◽  
Collateral Vessel ◽  
Pericallosal Artery ◽  
Collateral Vessels ◽  
The Right

A peripheral cerebral aneurysm is known to develop at collateral vessels as a result of hemodynamic stress by the occlusion of the intracranial major arteries. We report a case of successful embolization of a ruptured aneurysm through a transdural anastomotic artery. The aneurysm formed at the developed collateral vessel from the meningeal branch of the occipital artery (OA) to the posterior pericallosal artery. A 59-year-old man presented with acute-onset headache, and computed tomography revealed subarachnoid hemorrhage and intracerebral hemorrhage at the splenium of the corpus callosum with intraventricular hemorrhage. Digital subtraction angiography demonstrated a ruptured aneurysm located at a transdural anastomotic artery from the right OA to the posterior pericallosal artery. The patient underwent endovascular treatment for the aneurysm through the transdural anastomotic artery with a coil and n-butyl-2-cyanoacrylate. Because it was impossible to navigate a microcatheter to the aneurysm through the right anterior cerebral artery because of the occlusion of its proximal portion, it was advanced through the transdural anastomosis from the right OA. The aneurysm was completely occluded without complications. Endovascular embolization is a useful treatment option for a peripheral cerebral aneurysm developed at a collateral vessel with intracranial major artery occlusion.

TYPE 2 DIABETES MELLITUS REMISSION AND ITS PREDICTION AFTER TWO-STAGE SURGICAL TREATMENT OF PATIENTS WITH MORBID OBESITY

2019 ◽  
Vol 72 (5) ◽  
pp. 739-743
Author(s):  
Oleksandr Yu. Ioffe ◽  
Mykola S. Kryvopustov ◽  
Yuri A. Dibrova ◽  
Yuri P. Tsiura
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Morbid Obesity ◽  
Weight Loss ◽  
Type 2 Diabetes Mellitus ◽  
Surgical Treatment ◽  
Two Stage ◽  
C Peptide ◽  
Peptide Level

Introduction: Morbid obesity (MO) has a significant impact on mortality, health and quality of life of patients. Type 2 diabetes mellitus (T2DM) is a common comorbidity in patients with MO. The aim is to study T2DM remission and to develop a prediction model for T2DM remission after two-stage surgical treatment of patients with MO. Materials and methods: The study included 97 patients with MO. The mean BMI was 68.08 (95% CI: 66.45 - 69.71) kg/m2. 70 (72,2%) patients with MO were diagnosed with T2DM. The first stage of treatment for the main group (n=60) included the IGB placement, for the control group (n=37) - conservative therapy. In the second stage of treatment the patients underwent bariatric surgery. The study addresses such indicators as BMI, percentage of weight loss, percentage of excess weight loss, ASA physical status class, fasting glucose level, HbA1c, C-peptide. Results: Two-stage treatment of morbidly obese patients with T2DM promotes complete T2DM remission in 68.1% of patients. The risk prediction model for failure to achieve complete T2DM remission 12 months after LRYGB based on a baseline C-peptide level has a high predictive value, AUC = 0.84 (95% CI: 0.69-0.93), OR = 0.23 ( 95% CI: 0.08-0.67). Conclusions: Two-stage treatment of patients with MO promotes improvement of carbohydrate metabolism indicators. With a C-peptide level > 3.7 ng/ml, prediction of complete T2DM remission 12 months after Laparoscopic Roux-en-Y Gastric Bypass is favorable.

scholarly journals Adenosine-induced Asystole during AVM Embolization

2021 ◽  
Author(s):  
V. Hellstern ◽  
P. Bhogal ◽  
M. Aguilar Pérez ◽  
M. Alfter ◽  
A. Kemmling ◽  
...  
Keyword(s):  
Demographic Data ◽  
Clinical Results ◽  
Endovascular Embolization ◽  
Neurological Deficits ◽  
Residual Shunt ◽  
Grade 5 ◽  
Martin Grade ◽  
Grade 3 ◽  
Brain Avms

Abstract Background Adenosine induced cardiac standstill has been used intraoperatively for both aneurysm and arteriovenous malformation (AVM) surgery and embolization. We sought to report the results of adenosine induced cardiac standstill as an adjunct to endovascular embolization of brain AVMs. Material and Methods We retrospectively identified patients in our prospectively maintained database to identify all patients since January 2007 in whom adenosine was used to induce cardiac standstill during the embolization of a brain AVM. We recorded demographic data, clinical presentation, Spetzler Martin grade, rupture status, therapeutic intervention and number of embolization sessions, angiographic and clinical results, clinical and radiological outcomes and follow-up information. Results We identified 47 patients (22 female, 47%) with average age 42 ± 17 years (range 6–77 years) who had undergone AVM embolization procedures using adjunctive circulatory standstill with adenosine. In total there were 4 Spetzler Martin grade 1 (9%), 9 grade 2 (18%), 15 grade 3 (32%), 8 grade 4 (18%), and 11 grade 5 (23%) lesions. Of the AVMs six were ruptured or had previously ruptured. The average number of embolization procedures per patient was 5.7 ± 7.6 (range 1–37) with an average of 2.6 ± 2.2 (range 1–14) embolization procedures using adenosine. Overall morbidity was 17% (n = 8/47) and mortality 2.1% (n = 1/47), with permanent morbidity seen in 10.6% (n = 5/47) postembolization. Angiographic follow-up was available for 32 patients with no residual shunt seen in 26 (81%) and residual shunts seen in 6 patients (19%). The angiographic follow-up is still pending in 14 patients. At last follow-up 93.5% of patients were mRS ≤2 (n = 43/46). Conclusion Adenosine induced cardiac standstill represents a viable treatment strategy in high flow AVMs or AV shunts that carries a low risk of mortality and permanent neurological deficits.

Two Stage Surgical Treatment of Cuboid Osteomyelitis. A Case Report and Review of the Literature

The Foot ◽  
2021 ◽  
pp. 101796
Author(s):  
Elias S. Vasiliadis ◽  
Christos Vlachos ◽  
Angelos Antoniades ◽  
Eftychios Papagrigorakis ◽  
Matthaios Bakalakos ◽  
...  
Keyword(s):  
Case Report ◽  
Surgical Treatment ◽  
Review Of The Literature ◽  
Two Stage

Saccular aneurysms in the post–Barrow Ruptured Aneurysm Trial era

2021 ◽  
pp. 1-8
Author(s):  
Joshua S. Catapano ◽  
Mohamed A. Labib ◽  
Visish M. Srinivasan ◽  
Candice L. Nguyen ◽  
Kavelin Rumalla ◽  
...  
Keyword(s):  
Aneurysmal Subarachnoid Hemorrhage ◽  
Endovascular Embolization ◽  
Endovascular Intervention ◽  
Ruptured Aneurysm ◽  
Endovascular Coiling ◽  
Neurological Outcomes ◽  
Microsurgical Clipping ◽  
Poor Neurological Outcome ◽  
Technical Advances ◽  
Saccular Aneurysms

OBJECTIVE The Barrow Ruptured Aneurysm Trial (BRAT) was a single-center trial that compared endovascular coiling to microsurgical clipping in patients treated for aneurysmal subarachnoid hemorrhage (aSAH). However, because patients in the BRAT were treated more than 15 years ago, and because there have been advances since then—particularly in endovascular techniques—the relevance of the BRAT today remains controversial. Some hypothesize that these technical advances may reduce retreatment rates for endovascular intervention. In this study, the authors analyzed data for the post-BRAT (PBRAT) era to compare microsurgical clipping with endovascular embolization (coiling and flow diverters) in the two time periods and to examine how the results of the original BRAT have influenced the practice of neurosurgeons at the study institution. METHODS In this retrospective cohort study, the authors evaluated patients with saccular aSAHs who were treated at a single quaternary center from August 1, 2007, to July 31, 2019. The saccular aSAH diagnoses were confirmed by cerebrovascular experts. Patients were separated into two cohorts for comparison on the basis of having undergone microsurgery or endovascular intervention. The primary outcome analyzed for comparison was poor neurological outcome, defined as a modified Rankin Scale (mRS) score > 2. The secondary outcomes that were compared included retreatment rates for both therapies. RESULTS Of the 1014 patients with aSAH during the study period, 798 (79%) were confirmed to have saccular aneurysms. Neurological outcomes at ≥ 1-year follow-up did not differ between patients treated with microsurgery (n = 451) and those who received endovascular (n = 347) treatment (p = 0.51). The number of retreatments was significantly higher among patients treated endovascularly (32/347, 9%) than among patients treated microsurgically (6/451, 1%) (p < 0.001). The retreatment rate after endovascular treatment was lower in the PBRAT era (9%) than in the BRAT (18%). CONCLUSIONS Similar to results from the BRAT, results from the PBRAT era showed equivalent neurological outcomes and increased rates of retreatment among patients undergoing endovascular embolization compared with those undergoing microsurgery. However, the rate of retreatment after endovascular intervention was much lower in the PBRAT era than in the BRAT.

scholarly journals Cerebral Proliferative Angiopathy: Case Report

2018 ◽  
Vol 37 (02) ◽  
pp. 131-133 ◽  
Author(s):  
Luana Gatto ◽  
Rodrigo Brisson ◽  
Zeferino Demartini ◽  
Gelson Koppe ◽  
Carlos Rocha
Keyword(s):  
Case Report ◽  
Endovascular Procedures ◽  
Brain Parenchyma ◽  
Neurological Deficits ◽  
Motor Deficit ◽  
Brain Arteriovenous Malformation ◽  
Cerebral Vascular Disease ◽  
Functional Brain ◽  
History Of ◽  
Over Time

AbstractProliferative angiopathy (PA) is a rare cerebral vascular disease in which anomalous vessels continually recruit additional feeder arteries, amid a functional brain parenchyma. We report the case of a young woman with progressive history of headache, motor deficit, seizures and drowsiness. She received a misdiagnosis of brain arteriovenous malformation (AVM) and evolved with dysarthria and cognitive decline after an unsuccessful embolization performed at another institution. We opted for conservative treatment with periodic control by imaging tests. Proliferative angiopathy differs in natural history, prognosis, histopathology and treatment of the usual AVMs. Endovascular procedures aggravate the neurological deficits, which are usually progressive and tend to worsen over time.

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