Olfactory dysfunction after subarachnoid hemorrhage caused by ruptured aneurysms of the anterior communicating artery

2009 ◽  
Vol 111 (5) ◽  
pp. 958-962 ◽  
Author(s):  
Gemma Escartin Martin ◽  
Carme Junqué ◽  
Montserrat Juncadella ◽  
Andreu Gabarrós ◽  
Maria Angels de Miquel ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Coil Embolization ◽  
Olfactory Dysfunction ◽  
Control Group ◽  
Anterior Communicating Artery ◽  
Treatment Groups ◽  
Olfactory Test ◽  
Endovascular Coil Embolization ◽  
Olfactory Impairment ◽  
Smell Identification

Object Olfactory dysfunction has an important impact on quality of life. In patients with subarachnoid hemorrhage (SAH), anosmia has mainly been reported after surgery for aneurysms of the anterior communicating artery (ACoA). The authors studied whether and how frequently patients with ACoA aneurysms present with smell identification deficits in 2 treatment groups (endovascular and surgical treatment). Methods A prospective study was conducted of patients with SAH caused by ruptured ACoAs and who had a Glasgow Outcome Scale score of 1 or 2, in comparison with a control group matched by age and sex. Olfactory function was assessed using the University of Pennsylvania Smell Identification Test (UPSIT). Results A total of 39 patients were enrolled. A marked olfactory impairment was observed in patients with ruptured ACoAs compared with the control group (p < 0.001). Seventeen patients with ruptured ACoAs (44%) compared with 1 patient in the control group (3%) showed a smell identification deficit according to performance on the UPSIT (p < 0.001). Both groups that underwent treatment presented with olfactory impairment. Ten (59%) of 17 patients who underwent aneurysmal clip placement versus 6 (28.5%) of 21 patients who underwent coil embolization scored below the 25th percentile on the UPSIT, and surgical patients also performed worse than endovascular patients (p = 0.048). The authors observed a worse performance on the olfactory test in patients subjected to endovascular coil embolization when cerebral vasospasm (p = 0.037) or frontal cerebral lesions (p = 0.009) were present. This difference was not observed in patients who underwent surgery. Conclusions Olfactory disorders after SAH caused by rupture of the ACoA are very frequent and were present in both treatment groups. Cerebral vasospasm and frontal lobe lesions are related to worse performance on an olfactory test in patients undergoing endovascular coil embolization.

Feasibility and Limitations of Endovascular Coil Embolization of Anterior Communicating Artery Aneurysms: Morphological Considerations

Neurosurgery ◽  
2006 ◽  
Vol 59 (1) ◽  
pp. 43-52 ◽  
Author(s):  
John K. Birknes ◽  
Sung-Kyun Hwang ◽  
Aditya S. Pandey ◽  
Kevin Cockroft ◽  
Anne-Marie Dyer ◽  
...  
Keyword(s):  
Coil Embolization ◽  
Anterior Communicating Artery ◽  
Anterior Communicating Artery Aneurysms ◽  
Endovascular Coil Embolization

Quality of life and brain damage after microsurgical clip occlusion or endovascular coil embolization for ruptured anterior communicating artery aneurysms: neuropsychological assessment

2009 ◽  
Vol 110 (1) ◽  
pp. 19-29 ◽  
Author(s):  
François Proust ◽  
Olivier Martinaud ◽  
Emmanuel Gérardin ◽  
Stéphane Derrey ◽  
Sophie Levèque ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Executive Functions ◽  
Verbal Memory ◽  
Coil Embolization ◽  
Endovascular Coiling ◽  
Anterior Communicating Artery ◽  
Microsurgical Clipping ◽  
Endovascular Coil Embolization ◽  
Clip Occlusion

Object For anterior communicating artery (ACoA) aneurysms, endovascular coil embolization constitutes a safe alternative therapeutic procedure to microsurgical clip occlusion. The authors' aim in this study was to evaluate the quality of life (QOL), cognitive function, and brain structure damage after the treatment of ruptured ACoA aneurysms in a group of patients who underwent microsurgical clipping (36 patients) compared with a reference group who underwent endovascular coiling (14 patients). Methods At 14 months posttreatment all patients underwent evaluations by independent observers. These observers evaluated global efficacy, executive functions using a frontal assessment battery of tests (Trail making test, Stroop tasks, dual task of Baddeley, verbal fluency, and Wisconsin Card Sorting test), behavior dysexecutive syndrome (the Inventaire du Syndrome Dysexécutif Comportemental questionnaire [ISDC]), and QOL by using the Reintegration To Normal Living Index. Brain damage was analyzed using MR imaging. Results In the microsurgical clipping and endovascular coiling groups, the distribution on the modified Rankin Scale (p = 0.19) and mean QOL score (85.4 vs 83.4, respectively) were similar. Moreover, the proportion of executive dysfunctions (19.4 vs 28.6%, respectively) and the mean score on the ISDC questionnaire (8.9 vs 8.5, respectively) were not significant, but verbal memory was more altered in the microsurgical clipping group (p = 0.055). Magnetic resonance imaging revealed that the incidence of local encephalomalacia and the median number of lesions per patient increased significantly in the microsurgical clipping group (p = 0.003). Conclusions In the 2 groups, no significant difference was observed regarding QOL, executive functions, and behavior. Despite the significant decrease in verbal memory after microsurgical clipping, the interdisciplinary approach remains a safe and useful strategy.

scholarly journals Endovascular Surgery for Ruptured Aneurysms with Vasospasm

2007 ◽  
Vol 13 (1_suppl) ◽  
pp. 48-52 ◽  
Author(s):  
A. Kurata ◽  
S. Suzuki ◽  
J. Niki ◽  
H. Ozawa ◽  
M. Yamada ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Coil Embolization ◽  
Preliminary Report ◽  
Endovascular Procedures ◽  
Neurological Deficits ◽  
Parent Artery ◽  
Ruptured Aneurysms ◽  
Number Of Patients ◽  
Endovascular Coil Embolization ◽  
The One

With the existence of vasospasm, it is recommended that direct clipping surgery for a ruptured aneurysm be delayed until its disappearance, but this may be associated with aneurysmal re-rupture resulting in a poor outcome for the patients. Indications for endovascular coil embolization in such cases are discussed. Since November in 2003, we have applied endovascular coil embolization in 11 consecutive patients with ruptured aneurysms and apparent vasospasm of the parent artery from two to 17 days (average: eight days) after initial subarachnoid hemorrhage. Three patients had aneurysmal re-rupture before treatment, but the other eight had only experienced the one episode of subarachnoid hemorrhage. With one exception, all endovascular procedures could be successfully performed, resulting in complete occlusion of aneurysms and remarkable dilatation of inserted spastic vessels without technical complications or aneurysmal re-rupture. For the one case of failure because of a tortuous artery, direct clipping surgery was performed after disappearance of vasospasm. Cerebral infarction occurred in four, but only one correlated with the distribution of catheterization, and neurological deficits had completely disappeared three months after the onset. This preliminary report concerning a small number of patients suggests that endovascular coil embolization is not contra-indicated for aneurysms with vasospasm requiring catheterization. A large study for confirmation is now warranted.

scholarly journals Clinical Results of Endovascular Coil Embolization on Acute Stage for Elderly Patients with Subarachnoid Hemorrhage in Poor Neurological Grades

2006 ◽  
Vol 34 (2) ◽  
pp. 86-90 ◽  
Author(s):  
Shinichi YOSHIMURA ◽  
Jun YAMADA ◽  
Jouji KOKUZAWA ◽  
Motoshi SAWADA ◽  
Yasuhiko KAKU ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Elderly Patients ◽  
Coil Embolization ◽  
Clinical Results ◽  
Acute Stage ◽  
Endovascular Coil Embolization

scholarly journals Nautilus-assisted coil embolization for a complex AcomA wide-necked aneurysm in the setting of acute subarachnoid hemorrhage

2021 ◽  
pp. neurintsurg-2021-017670
Author(s):  
Alexander Sirakov ◽  
Svetozar Matanov ◽  
Pervinder Bhogal ◽  
Stanimir Sirakov
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Coil Embolization ◽  
Cerebral Aneurysms ◽  
Anterior Communicating Artery ◽  
New Approach ◽  
Content Type ◽  
Acute Subarachnoid Hemorrhage ◽  
Inner Diameter ◽  
Aneurysmal Neck ◽  
Video Player

Numerous devices and sophisticated strategies have been developed to further increase the number of aneurysms amenable to endovascular treatment.1–4 Despite the superfluity of available neurovascular armamentarium, wide-necked bifurcation aneurysms can still pose a significant technical challenge to the treating clinician.5–7 Neck bridging is a conceptually new approach, which provides increased occlusion rates with lower recurrence and complications rates.8–10 The Nautilus (EndoStream Medical) is an intrasaccular bridging device intended to assist in coil embolization of wide-necked cerebral aneurysms. This CE-marked device, available in various sizes, consists of flexible-layers, and is a nitinol-based, detachable implant. The device is delivered through a standard microcatheter with a minimal 0.0165" inner diameter and is fully radiopaque and completely resheathable.Owing to its unique ‘tornado’ like shape the device entirely reconstructs the aneurysmal neck, which facilitates the following coil embolization. In this video 1, we demonstrate the use of Nautilus - assisted coil embolization for a complex anterior communicating artery (AcomA) wide-necked aneurysm in the setting of acute subarachnoid hemorrhage.Video 1

scholarly journals Improved screening of COVID-19 cases through a Bayesian network symptoms model and psychophysical olfactory test

2021 ◽  
Author(s):  
Susana Eyheramendy ◽  
Pedro A. Saa ◽  
Eduardo A. Undurraga ◽  
Carlos Valencia ◽  
Carolina López ◽  
...  
Keyword(s):  
Bayesian Network ◽  
Low Cost ◽  
Olfactory Dysfunction ◽  
Effective Vaccine ◽  
Test Results ◽  
Routine Testing ◽  
Viral Spread ◽  
Olfactory Test ◽  
Two Samples ◽  
Olfactory Impairment

AbstractThe infectiousness and presymptomatic transmission of COVID-19 hinder pandemic control efforts worldwide. Therefore, the frequency of testing, accessibility, and immediate results are critical for reopening societies until an effective vaccine becomes available for a substantial proportion of the population. The loss of sense of smell is among the earliest, most discriminant, and prevalent symptoms of COVID-19, with 75-98% prevalence when clinical olfactory tests are used. Frequent screening for olfactory dysfunction could substantially reduce viral spread. However, olfactory dysfunction is generally self-reported and not measured, which is specially problematic as partial olfactory impairment is broadly unrecognized. To address this limitation, we developed a rapid psychophysical olfactory test (KOR) deployed on a web platform for automated reporting and traceability based on a low-cost, six-odor olfactory identification kit. Based on test results, we defined an anosmia score –a classifier for olfactory impairment–, and a Bayesian Network (BN) model that incorporates other symptoms for detecting COVID-19 cases. We trained and validated the BN model on two samples: suspected COVID-19 cases in five healthcare centers (n = 926; 32% COVID-19 prevalence) and healthy (asymptomatic) mining workers (n = 1, 365; 1.1% COVID-19 prevalence). All participants had COVID-19 assessment by RT-PCR assay. Using the BN model, we predicted COVID-19 status with 76% accuracy (AUC=0.79 [0.75 − 0.82]) in the healthcare sample and 84% accuracy (AUC=0.71 [0.63 − 0.79]) among miners. The KOR test and BN model enabled the detection of COVID-19 cases that otherwise appeared asymptomatic. Our results confirmed that olfactory dysfunction is the most discriminant symptom to predict COVID-19 status when based on olfactory function measurements. Overall, this work highlights the potential for low-cost, frequent, accessible, routine testing for COVID-19 surveillance to aid society’s reopening.

ENDOVASCULAR COIL EMBOLIZATION OF RUPTURED AND UNRUPTURED POSTERIOR CIRCULATION ANEURYSMS

Neurosurgery ◽  
2007 ◽  
Vol 60 (4) ◽  
pp. 626-637 ◽  
Author(s):  
Aditya S. Pandey ◽  
Christopher Koebbe ◽  
Robert H. Rosenwasser ◽  
Erol Veznedaroglu
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Clinical Outcome ◽  
Coil Embolization ◽  
Glasgow Outcome Scale ◽  
Posterior Circulation ◽  
Biologically Active ◽  
Cerebellar Artery ◽  
Posterior Circulation Aneurysms ◽  
Endovascular Coil Embolization

Abstract OBJECTIVE Treatment of posterior circulation aneurysms poses a great technical challenge for the practicing neurosurgeon. The advent of endovascular techniques has made such treatment more feasible. We report our experience with the endovascular management of ruptured and unruptured posterior circulation aneurysms during the past 10 years. METHODS A retrospective analysis was performed on all patients with posterior circulation aneurysms undergoing endovascular treatment at Jefferson Hospital for Neuroscience between July 1995 and December 2005. This yielded 275 patients (67 men and 208 women). The degree of aneurysm occlusion was determined by the operating endovascular neurosurgeon at the time of the procedure. Successful embolization was defined as greater than 95% occlusion of the dome without any coil prolapsing into the parent vessel. Clinical outcome was evaluated using the modified Glasgow Outcome Scale. Clinical follow-up data was obtained for 262 patients (95.3%); the follow-up period ranged from 1 to 94 months (mean, 31.8 mo for procedures performed before 2004 and 13.3 mo for procedures performed during 2004 and 2005). Angiographic follow-up data was obtained for 224 patients (84.8%) for periods ranging from 6 to 94 months (mean, 31.3 mo for procedures performed before 2004 and 13.7 mo for procedures performed during 2004 and 2005). RESULTS Based on the Hunt and Hess grading scale, the patient population included 106 patients (38.5%) with unruptured aneurysms, 43 patients (15.6%) with Grade I aneurysms, 16 patients (5.8%) with Grade II aneurysms, 56 patients (20.5%) with Grade III aneurysms, and 54 patients (19.6%) with Grade IV aneurysms. The locations of the posterior circulation aneurysms included 189 (68.7%) in the basilar apex or posterior cerebral artery, 23 (8.4%) in the basilar trunk/anterior inferior cerebellar artery, 22 (8%) in the superior cerebellar artery, and 41 (14.9%) in the vertebral artery or posterior inferior cerebellar artery. Of the 275 patients, 208 (76%) were women and 67 (24%) were men. The mean age at the time of treatment was 53.9 years (range, 7–90 yr). Of all patients treated, 237 patients (87.8%) had successful embolization (&gt;95% occlusion of the dome). On angiographic follow-up, 55 patients (24.5%) developed recanalization of at least 5%. Retreatment was required in 11 patients (4.9%; 0.01%/patient yr) and rehemorrhage occurred in three patients (1.1%; 0.003%/patient yr). Clinical follow-up was graded using the modified Glasgow Outcome Scale (mGOS) and revealed 229 patients (87.4%) in the mGOS I category, 12 patients (4.6%) in the mGOS II category, eight patients (3%) in the mGOS III category, two patients (0.8%) in the mGOS IV category, and 11 patients (4.2%) were deceased (mGOS V). Clinically significant vasospasm requiring angioplasty occurred in 11 patients (6.5%) with subarachnoid hemorrhage, and 120 patients (71%) with subarachnoid hemorrhage required ventricular shunts. Complications causing clinical morbidity occurred in 14 patients (5.1%) and ranged from postoperative ischemia to recurrent subarachnoid hemorrhage. Of all clinical factors evaluated, Hunt and Hess grade was the strongest predictor of good clinical outcome (P &lt; 0.0001). CONCLUSION Endovascular coil embolization of posterior circulation aneurysms is an effective treatment in the short term but is associated with recurrence, which requires close surveillance, possible retreatment, and can, albeit very rarely, lead to rehemorrhage. Future technological advancements such as the development of biologically active coils will be essential in the permanent obliteration of aneurysms.

Safety and efficacy of anterior communicating artery compromise during endovascular coil embolization of adjoining aneurysms

2020 ◽  
Vol 132 (4) ◽  
pp. 1068-1076
Author(s):  
Hyun Ho Choi ◽  
Young Dae Cho ◽  
Dong Hyun Yoo ◽  
Su Hwan Lee ◽  
Eung Koo Yeon ◽  
...  
Keyword(s):  
Coil Embolization ◽  
Independent Risk Factor ◽  
Binary Logistic Regression ◽  
Outcome Data ◽  
Anterior Communicating Artery ◽  
Binary Logistic Regression Analysis ◽  
Safety And Efficacy ◽  
Endovascular Coil Embolization

OBJECTIVEIn the presence of symmetric A1 flow, the safety and efficacy of compromising the anterior communicating artery (ACoA) during coil embolization of ACoA aneurysms has yet to be evaluated. Herein, the authors describe their experience, focusing on procedural safety.METHODSBetween October 2012 and July 2017, 285 ACoA aneurysms with symmetric A1 flows were treated at the authors’ institution by endovascular coil embolization. Clinical and angiographic outcome data were subjected to binary logistic regression analysis.RESULTSACoA compromise was chosen in the treatment of 71 aneurysms (24.9%), which were completely (n = 15) or incompletely (n = 56) compromised. In the remaining 214 lesions, the ACoA was preserved. Although 9 patients (3.2%) experienced procedure-related thromboembolisms (compromised, 4; preserved, 5), all but 1 patient (with ACoA compromise) were asymptomatic. In multivariate analysis, subarachnoid hemorrhage at presentation was the sole independent risk factor for thromboembolism (OR 15.98, p < 0.01), with ACoA compromise being statistically unrelated. In 276 aneurysms (96.8%) with follow-up of > 6 months (mean 20.9 ± 13.1 months, range 6–54 months), recanalization was confirmed in 21 (minor, 15; major, 6). A narrow (≤ 4 mm) saccular neck (p < 0.01) and ACoA compromise (p = 0.04) were independently linked to prevention of recanalization.CONCLUSIONSDuring coil embolization of ACoA aneurysms, the ACoA may be compromised without serious complications if A1 flows are symmetric. This approach may also confer some long-term protection from recanalization, serving as a valid treatment option for such lesions.

Stent Reconstruction of Wide-Necked Aneurysms Across the Circle of Willis

2007 ◽  
Vol 61 (suppl_5) ◽  
pp. ONS249-ONS255 ◽  
Author(s):  
Michael E. Kelly ◽  
Raymond Turner ◽  
Vivek Gonugunta ◽  
Henry H. Woo ◽  
Peter A. Rasmussen ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Coil Embolization ◽  
Intracranial Aneurysms ◽  
Neurological Complications ◽  
Circle Of Willis ◽  
Anterior Communicating Artery ◽  
Boston Scientific ◽  
Short Term ◽  
Novel Technique ◽  
Neuroform Stent

Abstract Objective: To describe a novel technique for single stent reconstruction of wide-necked aneurysms arising from the circle of Willis. Methods: Neuroform stents (Boston Scientific/Target, Fremont, CA) were placed across the basilar apex (right P1 to left P1) via the posterior communicating artery in two patients, across the left carotid terminus (left A1 to left M1) via the anterior communicating artery in two patients, and across the anterior communicating artery (left A1 to right A1) in one patient for stent-supported coil embolization. Results: Five women underwent successful deployment of the Neuroform stent across the circle of Willis to support subsequent coil embolization of a wide-necked cerebral aneurysm. In two patients with subarachnoid hemorrhage, initial dome coiling was performed for short-term protection, and stents were applied across the circle of Willis to support completion of coil embolization during a second session. None of the patients experienced any periprocedural or delayed neurological complications. Conclusion: Stenting across the circle of Willis represents a novel adjuvant technique to support the coiling of selected wide-necked intracranial aneurysms. This technique is particularly useful for wide-necked terminal aneurysms that incorporate both branches of a bifurcation in a configuration unfavorable for Y-stent reconstruction.

Effects of Timing of Coil Embolization after Aneurysmal Subarachnoid Hemorrhage on Procedural Morbidity and Outcomes

Neurosurgery ◽  
2000 ◽  
Vol 47 (6) ◽  
pp. 1320-1331 ◽  
Author(s):  
Gerasimos S. Baltsavias ◽  
James V. Byrne ◽  
Jim Halsey ◽  
Stuart C. Coley ◽  
Min-Joo Sohn ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Coil Embolization ◽  
Glasgow Outcome Scale ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
World Federation ◽  
Treatment Groups ◽  
Scale Scores ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

ABSTRACT OBJECTIVE To elucidate the effect of treatment timing on procedural clinical outcomes after aneurysmal subarachnoid hemorrhage (SAH) for patients treated by endosaccular coil embolization. METHODS A group of 327 patients who were consecutively treated, during a 46-month period, for ruptured intracranial aneurysms by coil embolization within 30 days after SAH were evaluated. Outcomes were assessed by comparing immediate pretreatment World Federation of Neurological Surgeons (WFNS) grades, 72-hour posttreatment WFNS grades, and modified Glasgow Outcome Scale scores at 6 months for patients treated within 48 hours (Group 1), 3 to 10 days (Group 2), or 11 to 30 days (Group 3) after SAH. RESULTS The three interval-to-treatment groups included 33, 38, and 29% of the patients, respectively. Before treatment, 70% of the patients in Group 1, 78% of those in Group 2, and 83% of those in Group 3 were in good clinical grades (i.e., WFNS Grade 1 or 2). After coil embolization, the WFNS grades were either unchanged or improved for 93.5% of the patients in Group 1, 89.5% of those in Group 2, and 91.5% of those in Group 3. After 6 months, 81.3% of the patients in Group 1 experienced good outcomes (modified Glasgow Outcome Scale scores of 1 or 2), as did 84% of those in Group 2 and 80% of those in Group 3. No statistical difference was demonstrated between the three groups when they were compared for these two variables. CONCLUSION The interval between endovascular treatment and SAH did not affect periprocedural morbidity rates or 6-month outcomes. Coil embolization should therefore be performed as early as possible after aneurysmal SAH, to prevent aneurysmal rerupture.

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