scholarly journals Prevention of complication in cerebral aneurysm microsurgery, associated with their non-radical clipping

2020 ◽  
Vol 33 (3) ◽  
pp. 66-77
Author(s):  
A.V. Byndiu ◽  
M.Yu. Orlov ◽  
M.V. Yelieinyk ◽  
S.O. Lytvak
Keyword(s):  
Cerebral Aneurysm ◽  
Glasgow Outcome Scale ◽  
Cerebral Arteries ◽  
Cerebral Aneurysms ◽  
Saccular Aneurysm ◽  
Results Of Treatment ◽  
Intraoperative Rupture ◽  
Temporary Clipping ◽  
The Brain

Objective ‒ to analyze the effectiveness of intraoperative contact Doppler, repositioning the clip on the aneurysm and pilot clipping of the cervical aneurysm as the main methods of prevention of inadequate clipping of the cervical aneurysm in patients with intraoperative rupture of aneurysms. Materials and methods. Due to the use of intraoperative contact ultrasound Doppler control it was possible to avoid inadequate clipping of cerebral aneurysms in 16 cases, of which in 12 (75.00 %) cases ‒ incomplete clipping of cerebral aneurysms, in 3 (18.75 %) cases ‒ compression of the aneurysm’s artery-carrier, in 1 (6.25 %) case ‒ slipping of the clip with cerebral aneurysm. Perioperative examination of patients, in addition to intraoperative contact ultrasound Doppler control of radical clipping cerebral aneurysms, included clinical and neurological examination, computed tomography of the brain, cerebral angiography, ultrasound duplex scanning of the main vessels of the head and neck. In the analysis of observations of inadequate clipping of cerebral aneurysms (according to contact intraoperative Doppler), the following parameters were considered: size, location of cerebral aneurysm, timing of surgery after subarachnoid hemorrhage, anatomical forms of intracranial hemorrhage. Results. The purpose of the operations was to devascularize saccular aneurysm to prevent its re-rupture, to reduce the mass effect caused by intracerebral hematoma; reduction of intracranial pressure, rehabilitation of basal cisterns of the brain., But in the postoperative period there was a tendency to worsen the results of treatment, the appearance of focal neurological symptoms on the background of cerebral vasospasm with subsequent development of ischemic complications in patients with III‒V degree according to the Hunt‒Hess Scale on admission, in patients with prolonged temporary clipping of the cerebral aneurysm-artery and prolonged mechanical manipulation of the cerebral arteries and cerebral aneurysm. It should be noted that all patients in our sample, with complicated clipping of cerebral saccular aneurysms, had an intraoperative rupture of the MA, which complicated the process of clipping the saccular aneurysm and prolonged the time of surgery and was one of the inducers of postoperative aggravating consequences. There was a tendency to worsen the results of treatment in patients with III–IV degree according to the Hunt‒Hess Scale. Thus, patients with 1 point according to the Glasgow Outcome Scale, there were 2 patients who had II and III degrees according to Hunt–Hess Scale at hospitalization; among discharged patients with 3 point according to Glasgow Outcome Scale was dominated by patients from the second century according to Hunt‒Hess Scale at hospitalization, among patients with 5 point according to Glasgow Outcome Scale dominated patients who had I degree according to the Hunt‒Hess Scale at hospitalization. Conclusions. Inadequate clipping of the cervix cerebral aneurysm is the main type of non-hemorrhagic complications in the surgery of cerebral aneurysms. The Inadequate clipping of the cervix of the cerebral aneurysm includes the presence of residual blood flow in the cerebral aneurysm after its clipping, stenosis/compression of the main and perforating cerebral arteries with a clip, slipping of the clip from the aneurysm. Among the factors influencing the radical and adequate clipping of the cervix cerebral aneurysm are the size, location of the aneurysm, atherosclerotic lesions of the walls of the arteries and neck of the aneurysm and transferred subarachnoid hemorrhage. Reliable methods of prevention of inadequate clipping of saccular aneurysm are the use of intraoperative Doppler blood flow control, pilot clipping of complex aneurysms, optimization and individualization of surgical access. Aggravating factors that lead to unsatisfactory results of treatment of patients and negative clinical dynamics after the operation of clipping cerebral saccular aneurysm are: severe condition of the patient before surgery (III‒V gr. according to the Hunt‒Hess Scale), severe cerebral edema, intraoperative rupture of saccular aneurysm, long-term mechanical manipulations on cerebral arteries (long-term temporary clipping of saccular aneurysm, isolation of saccular aneurysm and «neighboring» cerebral arteries from arachnoid adhesions, frequent repositioning of the clip).

Cerebral aneurysms following radiotherapy for medulloblastoma

1989 ◽  
Vol 70 (4) ◽  
pp. 545-550 ◽  
Author(s):  
Peter J. Benson ◽  
Joo Ho Sung
Keyword(s):  
Cerebral Arteries ◽  
Cerebral Aneurysms ◽  
Content Type ◽  
Histological Features ◽  
Autopsy Examination ◽  
Cerebellar Medulloblastoma ◽  
Radiation Induced ◽  
The Brain ◽  
Fine Print ◽  
Saccular Aneurysms

✓ Three patients, two males and one female aged 21, 14, and 31 years, respectively, developed cerebral saccular aneurysms several years after undergoing radiotherapy for cerebellar medulloblastoma at 2, 5, and 14 years of age, respectively. Following surgery, all three received combined cobalt-60 irradiation and intrathecal colloidal radioactive gold (198Au) therapy, and died from rupture of the aneurysm 19, 9, and 17 years after the radiotherapy, respectively. Autopsy examination revealed no recurrence of the medulloblastoma, but widespread radiation-induced vasculopathy was found at the base of the brain and in the spinal cord, and saccular aneurysms arose from the posterior cerebral arteries at the basal cistern or choroidal fissure. The aneurysms differed from the ordinary saccular aneurysms of congenital type in their location and histological features. Their locations corresponded to the areas where intrathecally administered colloidal 198Au is likely to pool, and they originated directly from a segment of the artery rather than from a branching site as in congenital saccular aneurysms. It is, therefore, concluded that the aneurysms in these three patients were most likely radiation-induced.

scholarly journals LONG-TERM RESULTS OF THE MICROSURGICAL TREATMENT OF THE CEREBRAL ANEURYSM RUPTURES IN PATIENTS AT A COMPENSATED STATE

2018 ◽  
Vol 25 (3) ◽  
pp. 129-132
Author(s):  
L. V. SHAGAL ◽  
V. V. TKACHEV ◽  
V. V. SHAGAL ◽  
I. S. BLUMENAU ◽  
N. V. ZABOLOTSKIKH ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Cerebral Aneurysms ◽  
Severe Headache ◽  
Severe Disability ◽  
Long Term Results ◽  
Anxiety And Depression ◽  
Results Of Treatment

Aim. To study the severity of cognitive and psychoemotional disorders in the outcome of treatment of the patients with cerebral aneurysms ruptures, who were admitted in a compensated condition.Materials and methods. 57 cases are analyzed in the article. These are the cases of patients who were operated on in an acute state of aneurysmal subarachnoid hemorrhage. The severity of their state when they were admitted was 1-3 according to the Hunt-Hess scale. Depending on the results of treatment, the patients were divided into 2 groups: the first included 37 patients with excellent immediate results of treatment on the inverted Glasgow outcome scale (GOS 1), the second included 20 patients with moderate and severe disability (GOS 2-3).Results. The patients with moderate and severe disability as immediate results of treatment have a lower quality of life than patients with excellent results, due to the presence of severe headache, anxiety and depression disorders.Conclusion. The decline in the quality of life of patients with moderate and severe disability as immediate results of treatment of the cerebral aneurysms ruptures requires a rehabilitation therapy.

Relationship Between Cerebral Aneurysm Development and Cerebral Artery Shape

2018 ◽  
Vol 22 (2) ◽  
pp. 249-255 ◽  
Author(s):  
Marin Yasugi ◽  
◽  
Belayat Hossain ◽  
Manabu Nii ◽  
Syoji Kobashi
Keyword(s):  
Cerebral Aneurysm ◽  
Cerebral Artery ◽  
Cerebral Arteries ◽  
Cerebral Aneurysms ◽  
Support Vector ◽  
Shape Feature ◽  
Branch Points ◽  
Bifurcation Angle ◽  
The One ◽  
Major Factors

Lifestyle and genetics are known to be the major factors causing cerebral aneurysms, but some studies suggest that the shape of cerebral arteries might be correlated with the risk of aneurysm occurrence. This study focuses on the shape of cerebral arteries where cerebral aneurysms tend to occur. First, it extracts the shape feature of the cerebral artery ring, which is a predilection site of cerebral aneurysm, from 3-D magnetic resonance angiography images, and calculates four types of shape feature vectors – 3-D shape, bifurcation angle, degree of meandering, and direction of the branch points. Then, it estimates the risk of cerebral aneurysms occurring, based on the extracted features using support vector machine. To validate the proposed method, we conducted a leave-one-out cross validation test using 80 subjects (40 subjects with and 40 subjects without cerebral aneurysms). The method using a 3-D artery shape achieved 75% sensitivity and 75% specificity; the one using the bifurcation angle showed 47% sensitivity and 41% specificity. The method using the degree of meandering showed 55% sensitivity and 53% specificity, and the one that used the direction of the six branch points showed 30% sensitivity and 27% specificity. These results show that the 3-D artery shape could be a possible indicator for predicting the risk of developing cerebral aneurysms.

Norepinephrine in cerebrospinal fluid of patients with cerebral vasospasm

1982 ◽  
Vol 56 (3) ◽  
pp. 344-349 ◽  
Author(s):  
Taku Shigeno
Keyword(s):  
Cerebrospinal Fluid ◽  
Cerebral Arteries ◽  
Cerebral Aneurysms ◽  
Fluorometric Method ◽  
Content Type ◽  
Highly Sensitive ◽  
Secondary Phenomenon ◽  
Lumbar Cerebrospinal Fluid ◽  
The Brain ◽  
Fine Print

✓ The content of norepinephrine (NE) in the ventricular, basal cisternal, and lumbar cerebrospinal fluid (CSF) was determined in 19 patients with ruptured cerebral aneurysms at different intervals according to the presence or absence of vasospasm. Twelve were operated on within 3 days after subarachnoid hemorrhage (SAH), prior to the occurrence of vasospasm. Postoperatively, CSF was continuously drained from a basal cistern or lateral ventricle. Norepinephrine was assayed by the highly sensitive automated fluorometric method. The concentration of NE increased in all sites of CSF sampling along with the appearance of vasospasm. Above all, the cisternal CSF of patients with vasospasm contained significantly higher NE (0.246 ± 0.049 ng/ml, mean ± SEM) compared to those without vasospasm (0.075 ± 0.001 ng/ml) (p < 0.001). However, since this increase cannot be considered to be high enough locally to constrict cerebral arteries, this might be only a secondary phenomenon due to release of NE into CSF from various sources in the brain.

Long-Term Results of Ruptured Cerebral Aneurysms Embolized in Acute Stage with Interlocking Detachable Coils

1997 ◽  
Vol 3 (2_suppl) ◽  
pp. 118-120
Author(s):  
H. Manabe ◽  
S. Fujita ◽  
K. Akasaka ◽  
S. Suzuki
Keyword(s):  
Cerebral Aneurysms ◽  
Critical Factor ◽  
Dissecting Aneurysm ◽  
Acute Stage ◽  
Saccular Aneurysm ◽  
Long Term Results ◽  
Complete Occlusion ◽  
Detachable Coils

We report on a series of eight patients presenting with SAH secondary to ruptured saccular (n=7) or dissecting (n=1) aneurysm, treated in the acute stage (within 14 days) by embolization with interlocking detachable coils (IDCs) who survived at least 3 months following initial hemorrhage. Embolization resulted in complete occlusion in 2 of 7 cases of saccular aneurysm, 90–95% occlusion was obtained in the remaining 5 cases of saccular aneurysm. Proximal occlusion with intra-aneurysmal coil packing was achieved in 1 case of dissecting aneurysm. In all 5 cases with partial occlusion, follow-up angiograms taken 2–4 months after the embolization showed partial recanalization due to coil compaction, while no recanalization was recognized in cases with complete occlusion in follow-up angiograms at 5 and 9 months respectively. Clinical disability, at 9 months after the embolization was rated as none in 4 cases, moderate in 1, and severe in 1. Two patients died of re-rupture at 4 and 8 months respectively after the embolization. Of the other 3 cases with partial recanalization, 2 were retreated by re-embolization or surgical clipping, one has been followed clinically and angiographically. Histological findings of the re-ruptured aneurysm showed neither endothelialization of the aneurysmal orifice nor organization of the clot around the coils. Aneurysmal re-rupture secondary to coil compaction related recanalization remains a critical factor in long-term clinical outcome and prognosis.

scholarly journals Silent Cerebral Infarcts and Cerebral Aneurysms Are Prevalent in Adults with Sickle Cell Disease

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 2712-2712
Author(s):  
Adetola A. Kassim ◽  
Sumit Pruthi ◽  
Matthew Day ◽  
Michael R. DeBaun ◽  
Lori C. Jordan
Keyword(s):  
Sickle Cell Disease ◽  
Cerebral Aneurysm ◽  
Sickle Cell ◽  
Cerebral Aneurysms ◽  
Cell Disease ◽  
Cerebral Infarcts ◽  
Transfusion Therapy ◽  
History Of ◽  
The Brain ◽  
Saccular Aneurysms

Abstract Introduction: Neurologic complications are a major cause of morbidity in sickle cell disease (SCD). The cumulative cerebral risk for neurological complications in sickle cell anemia has been estimated around 50% by age 14 (Bernaudin et. al, 2011;Blood 4:1130-40). Silent cerebral infarcts (SCI), is the most commonly recognized cause of neurological injury, associated with cognitive difficulties (King et al, Am J Hematol 2014;89:162-7) found in 20-40% of children with SCD, more common in genotype SS or Sβ0 thalassemia. The prevalence of SCI has not been well studied in adults. The prevalence of intracranial saccular aneurysms by radiographic and autopsy series is estimated to be 3.2% in a population without comorbidity, a mean age of 50 years, and a 1:1 gender ratio. (Valk et al, Lancet Neurol 2011; 10: 626–36) while other investigators found a 1.8% prevalence and no increased incidence with age (Vernooij et al NEJM 2007;357:1821-8). The goal of this study was to assess the prevalence of neurologic morbidity, including SCI, overt stroke, and cerebral aneurysm, in a large cohort of adults with SCD. We hypothesized the SCI would be more prevalent in adults compared to children with SCD. Methods: Due to the high prevalence of cerebral infarcts in children with SCD, we elected to obtain as part of routine clinical practice, a MRI and magnetic resonance angiography (MRA) of the brain in adults with SCD in our Hematology clinic. As standard care if SCIs are seen, neurocognitive testing is recommended, and based on this testing and MRI results, appropriate patients are referred for vocational rehabilitation service. All MRIs and MRAs were reviewed by 2 board certified neuroradiologists and consensus findings were recorded including presence of cerebral infarcts, intracerebral hemorrhage, aneurysms and cerebralvasculopathy. All adults with SCD were followed by a single hematologist and were asked about neurological symptoms. Medical records were reviewed to see if stroke like symptoms had been reported. If no symptoms were reported and no abnormalities were documented on neurological examination, then infarcts were judged to be silent. Results: The study population included 94 adults with SCD (80% HbSS or Hb Sβ0 thalassemia; 11% HbSC, and 9% other), 51% males, median age 26 years, interquartile range (22-36 years) who had MRI of the brain and 88 had MRA of the brain. Of these, 91 MRIs were of sufficient quality to assess for the presence or absence of infarcts. Infarcts were present in 58% (53 individuals) with multiple infarcts in 40% (37 patients); infarcts were overt/symptomatic in 13% (12) and silent in 45% (41). Hemorrhages were present in 8 patients (9%) and of these, 7 of 8 also had infarcts present on MRI. MRI and MRA of the brain were felt of adequate quality to assess for vascular disease or aneurysm in 79 patients. Of these 7.5% (6 of 79 patients) had moyamoya vasculopathy and 7.5% (6 of 79 patients) had saccular aneurysms with no overlap between groups. All of the adults with moyamoya vasculopathy had overt strokes. The aneurysms were incidental findings and all were <5mm in size. Patients were referred to Neurosurgery for evaluation of aneurysmal lesions. Amongst the 12 adults with a history of overt stroke, 67% were on therapy (50% on hydroxyurea therapy; 17% on chronic blood transfusion therapy), 42% (5 of 12) received aspirin for stroke and 1 patient was already on warfarin for history of systemic thrombosis at the time of stroke. Conclusions: Silent cerebral infarctions are common in adults with SCD. Silent cerebral infarcts were present in 45% and over strokes had occurred in 13% of adults with SCD. Our aneurysm prevalence of 7.5% in a younger cohort (median age 26 years) suggests that adults with SCD may have a higher prevalence of cerebral aneurysms than the general population. Further study is warranted to assess whether SCD should be considered a comorbidity that confers a higher risk of cerebral aneurysm in adults. The optimal strategies for primary and secondary stroke prevention and to mitigate against the progressive cerebral vasculopathy in adults with SCD are still being debated. Disclosures No relevant conflicts of interest to declare.

Risk Assessment of Cerebral Aneurysm Rupture and Regrowth

2008 ◽  
Author(s):  
Emily M. Childress ◽  
Christina Yarborough ◽  
Sinjae Hyun ◽  
Arthur J. Ulm ◽  
Joe Sam Robinson
Keyword(s):  
Risk Assessment ◽  
Blood Vessels ◽  
Cerebral Aneurysm ◽  
Cerebral Aneurysms ◽  
Aneurysm Rupture ◽  
Ruptured Aneurysms ◽  
Central Nerve System ◽  
Nerve System ◽  
The Brain

Cerebral aneurysms are dilatations in blood vessels of the brain. It is estimated that approximately 10 in every 100,000 persons per year has cerebral aneurysms and it occurs most often in people between ages 30 and 60 years [1]. Of these, roughly 27,000 patients per year are reported to have ruptured aneurysms. Since ruptures can lead to such conditions as central nerve system (CNS) hemorrhages in subarachnoid and intraparenchymal spaces, the chance of survival, once this occurs, is 50%.

A Novel Flow Diverter for Direct Treatment of Cerebral Aneurysms

2013 ◽  
Author(s):  
Jiayao Ma ◽  
Zhong You ◽  
James Byrne
Keyword(s):  
Cerebral Aneurysm ◽  
Adult Population ◽  
Cerebral Aneurysms ◽  
Flow Diverter ◽  
Severe Disability ◽  
Direct Treatment ◽  
Brain Vasculature ◽  
The Brain

Cerebral aneurysm (CA) is a localised dilatation in the wall of the brain vasculature which can cause it to swell out like a balloon. If not treated, it will continue to grow and eventually tear or rupture, resulting in severe disability from stroke and, in around 25% of cases, death [1]. CAs affect up to 5% of the adult population with 1% of detected aneurysms rupture every year [2].

The Acute Effect of Alcohol on Various Memory Processes

2010 ◽  
Vol 24 (4) ◽  
pp. 249-252 ◽  
Author(s):  
Márk Molnár ◽  
Roland Boha ◽  
Balázs Czigler ◽  
Zsófia Anna Gaál
Keyword(s):  
Low Dose ◽  
Short Term Memory ◽  
Acute Effect ◽  
Long Term Memory ◽  
Term Memory ◽  
Memory Processes ◽  
Different Types ◽  
The Brain ◽  
Legal Consequences

This review surveys relevant and recent data of the pertinent literature regarding the acute effect of alcohol on various kinds of memory processes with special emphasis on working memory. The characteristics of different types of long-term memory (LTM) and short-term memory (STM) processes are summarized with an attempt to relate these to various structures in the brain. LTM is typically impaired by chronic alcohol intake but according to some data a single dose of ethanol may have long lasting effects if administered at a critically important age. The most commonly seen deleterious acute effect of alcohol to STM appears following large doses of ethanol in conditions of “binge drinking” causing the “blackout” phenomenon. However, with the application of various techniques and well-structured behavioral paradigms it is possible to detect, albeit occasionally, subtle changes of cognitive processes even as a result of a low dose of alcohol. These data may be important for the consideration of legal consequences of low-dose ethanol intake in conditions such as driving, etc.

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