Lack of functional patency of the lamina terminalis after fenestration following clipping of anterior circulation aneurysms

2013 ◽  
Vol 119 (3) ◽  
pp. 629-633 ◽  
Author(s):  
Muhammad Omar Chohan ◽  
Andrew P. Carlson ◽  
Blaine L. Hart ◽  
Howard Yonas
Keyword(s):  
Contrast Agent ◽  
Positive Control ◽  
Negative Control ◽  
Lamina Terminalis ◽  
Surgical Clipping ◽  
Anterior Circulation ◽  
Ruptured Aneurysms ◽  
Aneurysm Clipping ◽  
Anterior Circulation Aneurysms ◽  
Basal Cisterns

Object Fenestration of the lamina terminalis (FLT) during aneurysm surgery for subarachnoid hemorrhage can, in theory, improve CSF circulation from the lateral and third ventricles to the cortical subarachnoid space, which may, in turn, decrease the incidence of hydrocephalus and vasospasm. However, the actual effects of FLT on CSF circulation have been difficult to determine, due to confounding factors. In addition, it is unclear whether the lamina terminalis remains functionally patent when the brain resumes its normal position. The goal of this study was to assess the functional patency of the fenestrated lamina terminalis in patients who underwent surgery for ruptured aneurysms. Methods This prospective study included 15 patients who underwent surgical clipping of ruptured anterior circulation aneurysms, with FLT performed during surgery. On postoperative Day 1, the external ventricular drain of each patient was closed, and 1 ml of Omnipaque 300, an iodine based contrast agent, was injected intraventricularly, accompanied by cranial maneuvering designed to position the contrast agent adjacent to the lamina terminalis. Three to 5 minutes after cranial maneuvering, the flow of contrast agent into the basal cisterns was assessed with CT imaging. Flow was verified by an increase in Hounsfield units in a prespecified “region of interest” within the basal cisterns on the CT scan. This procedure was performed using a standardized protocol designed in consultation with the Department of Radiology and approved by the institutional review board. One patient who underwent endoscopic third ventriculostomy was recruited as a positive control to validate the technique, and 1 patient who underwent aneurysm clipping but not FLT was recruited as a negative control. Results Seventeen patients consented to study participation. In the 15 patients who underwent aneurysm clipping and FLT, and the negative control patient who underwent aneurysm clipping but not FLT, the contrast agent followed the normal ventricular pathway from the lateral ventricles into the fourth ventricle, and did not appear in the basal cisterns. In the positive control patient, the contrast agent robustly and immediately filled the basal cisterns. Conclusions Fenestration of the lamina terminalis did not result in functional patency of the lamina terminalis when performed as part of surgical clipping for ruptured aneurysms.

scholarly journals Level of headaches after surgical aneurysm clipping decreases significantly faster compared to endovascular coiled patients

2017 ◽  
Vol 7 (2) ◽  
Author(s):  
Athanasios K. Petridis ◽  
Jan F. Cornelius ◽  
Marcel A. Kamp ◽  
Sina Falahati ◽  
Igor Fischer ◽  
...  
Keyword(s):  
Aneurysm Rupture ◽  
Endovascular Coiling ◽  
Analog Scale ◽  
Surgical Clipping ◽  
Time Points ◽  
Ruptured Aneurysms ◽  
Aneurysm Clipping ◽  
Incidental Aneurysms ◽  
The Difference ◽  
Late Recovery

In incidental aneurysms, endovascular treatment can lead to post-procedural headaches. We studied the difference of surgical <em>clipping</em> <em>vs</em>. endovascular <em>coiling</em> in concern to post-procedural headaches in patients with ruptured aneurysms. Sixtyseven patients with aneurysmal subarachnoidal haemorrhage were treated in our department from September 1<sup>st</sup> 2015 - September 1<sup>st</sup> 2016. 43 Patients were included in the study and the rest was excluded because of late recovery or highgrade subarachnoid bleedings. Twenty-two were surgical treated and twenty-one were interventionally treated. We compared the post-procedural headaches at the time points of 24 h, 21 days, and 3 months after treatment using the visual analog scale (VAS) for pain. After surgical clipping the headache score decreased for 8.8 points in the VAS, whereas the endovascular treated population showed a decrease of headaches of 3.3 points. This difference was highly statistical significant and remained significant even after 3 weeks where the pain score for the surgically treated patients was 0.68 and for the endovascular treated 1.8. After 3 months the pain was less than 1 for both groups with surgically treated patients scoring 0.1 and endovascular treated patients 0.9 (not significant). Clipping is relieving the headaches of patients with aneurysm rupture faster and more effective than endovascular coiling. This effect stays significant for at least 3 weeks and plays a crucial role in stress relieve during the acute and subacute ICU care of such patients.

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.

ANEURYSMS OF THE DISTAL ANTERIORCEREBRAL ARTERY

Neurosurgery ◽  
2007 ◽  
Vol 60 (2) ◽  
pp. 227-234 ◽  
Author(s):  
David A. Steven ◽  
Stephen P. Lownie ◽  
Gary G. Ferguson
Keyword(s):  
Cerebral Artery ◽  
Endovascular Coiling ◽  
Anterior Circulation ◽  
Operative Morbidity ◽  
Unruptured Aneurysms ◽  
Ruptured Aneurysms ◽  
Grade Ii ◽  
The Mean ◽  
Distal Anterior Cerebral Artery ◽  
Anterior Circulation Aneurysms

Abstract OBJECTIVE The aim of this study was to present the clinical and radiological characteristics, surgical management, and outcome in a large series of patients with aneurysms of the distal anterior cerebral artery (DACA) managed in the microsurgical era. METHODS The records of 1109 patients with anterior circulation aneurysms managed at the authors' institution between 1970 and 1998 were reviewed. RESULTS Fifty-nine patients (5.3%) were identified with 67 DACA aneurysms. Seventy-three percent of the patients were women. The mean age of all patients was 47 years. Multiple aneurysms were identified in 51% of all patients, most commonly on the middle cerebral artery. Thirty-six patients had ruptured DACA aneurysms and 23 had unruptured aneurysms. In those with ruptured aneurysms, the admission grade was Grade I in 10 patients (27.8%), Grade II in three patients (8.3%), Grade III in 10 patients (27.8%), Grade IV in seven patients (19.4%), and Grade V in six patients (16.7%). Frontal lobe hematomas occurred in 28% of the patients with ruptured aneurysms and carried a poor prognosis. In those with unruptured aneurysms, 11 were incidental and 12 were identified after a subarachnoid hemorrhage from another aneurysm. The mean diameter was 10 mm in ruptured aneurysms and 5.8 mm in unruptured aneurysms. Fifty-eight patients underwent surgery and one patient was treated with endovascular coiling. Six patients, all with ruptured aneurysms, died. Seventy percent of survivors with ruptured aneurysms had a favorable outcome. CONCLUSION DACA aneurysms possess a number of characteristics that distinguish them from the more common intracranial aneurysms. With modern neurosurgical and endovascular techniques, an acceptable operative morbidity and mortality can be achieved.

scholarly journals Outcome of Microsurgical Clipping of Ruptured Anterior Circulation Aneurysms

2019 ◽  
Vol 23 (4) ◽  
Author(s):  
MUHAMMAD JAHANGIR KHAN ◽  
MUHAMMAD HAMMAD NASIR ◽  
SIKANDAR ALI ◽  
SARFRAZ KHAN ◽  
MUHAMMAD WAQAS ◽  
...  
Keyword(s):  
Anterior Communicating Artery ◽  
Sex Distribution ◽  
Surgical Clipping ◽  
Anterior Circulation ◽  
Efficient Treatment ◽  
Microsurgical Clipping ◽  
The Mean ◽  
Anterior Circulation Aneurysms ◽  
Grading Scales

Objective: The objective of the study was to analyze the operative outcome of microsurgical clipping in Ruptured Anterior Circulation Aneurysms.Materials and Methods: Twenty patients with Ruptured Anterior Circulation aneurysms were treated with surgical clipping. All the patients were evaluated pre-operatively according to Hunt & Hess and WFNS grading scales. Patients with grade I, II, and III were operated. All the aneurysms were clipped through Pterional approach under General anesthesia and Yasargil Aneurysm clips of appropriate sizes were used in each patient. Outcome was analyzed according to Glasgow Outcome Scale at the end of six months of follow up in each patient.Results: In this series of twenty cases, the mean patient age was 49 years. Lesion location included, the ACA/A. Com 55% (n = 11), the Middle Cerebral artery 25% (n = 5), P. Com 15% (n = 3), Ophthalmic artery 5% (n = 1). Sex distribution, female 55% (n = 11) and male 45% (n = 9). Per-operative complications, rupture of aneurysm 20% (n = 4), and damage to perforating branches of MCA 5% (n = 1). Conclusions: Surgical clipping still is the most efficient treatment of Ruptured Anterior Circulation aneurysm at the beginning of the new millennium. Anterior Communicating Artery is the commonest location of aneurysms. Major determinants of outcome are Hunt & Hess, WFNS grades on admission and the age of the patient.

scholarly journals A technical note

2020 ◽  
pp. 321-325
Author(s):  
Samer S. Hoz ◽  
Zaid Aljuboori ◽  
Zahraa F. Al-Sharshahi
Keyword(s):  
Technical Note ◽  
Lamina Terminalis ◽  
Anterior Circulation ◽  
Critical Part ◽  
Aneurysm Clipping ◽  
Lumbar Drain ◽  
Specific Setting ◽  
Brain Relaxation ◽  
The Brain

The Liliequist membrane is a critical membrane located at the base of the brain separating the supratentorial from the infratentorial cisterns. The advantages of Liliequist membrane fenestration as a critical part of the pterional trans-Sylvian approach for ruptured anterior circulation aneurysm clipping is not well established. We demonstrated that the fundamental role of Liliequist membrane fenestration is brain relaxation through the egress of CSF that is not usually gained from other modalities (e.g., placement of a lumbar drain, fenestration of lamina terminalis) in this specific setting.

scholarly journals Endovascular Selective Intra-Arterial Infusion of Mesenchymal Stem Cells Loaded With Delta-24 in a Canine Model

Neurosurgery ◽  
2020 ◽  
Vol 88 (1) ◽  
pp. E102-E113
Author(s):  
Visish M Srinivasan ◽  
Joy Gumin ◽  
Kevin M Camstra ◽  
Dalis E Collins ◽  
Melissa M Chen ◽  
...  
Keyword(s):  
Stem Cells ◽  
Mesenchymal Stem Cells ◽  
Canine Model ◽  
Positive Control ◽  
Negative Control ◽  
Anterior Circulation ◽  
Transfemoral Approach ◽  
Survival Experiment ◽  
Large Animals ◽  
Virus Delivery

Abstract BACKGROUND Delta-24-RGD, an oncolytic adenovirus, shows promise against glioblastoma. To enhance virus delivery, we recently demonstrated that human bone marrow-derived mesenchymal stem cells loaded with Delta-24-RGD (hMSC-D24) can eradicate glioblastomas in mouse models. There are no studies examining the safety of endovascular selective intra-arterial (ESIA) infusions of MSC-D24 in large animals simulating human clinical situations. OBJECTIVE To perform canine preclinical studies testing the feasibility and safety of delivering increasing doses of hMSCs-D24 via ESIA infusions. METHODS ESIA infusions of hMSC-D24 were performed in the cerebral circulation of 10 normal canines in the target vessels (internal carotid artery [ICA]/P1) via transfemoral approach using commercially available microcatheters. Increasing concentrations of hMSC-D24 or particles (as a positive control) were injected into 1 hemisphere; saline (negative control) was infused contralaterally. Toxicity (particularly embolic stroke) was assessed on postinfusion angiography, diffusion-weighted magnetic resonance imaging, clinical exam, and necropsy. RESULTS ESIA injections were performed in the ICA (n = 7) or P1 (n = 3). In 2 animals injected with particles (positive control), strokes were detected by all assays. Of 6 canines injected with hMSC-D24 through the anterior circulation, escalating dose from 2 × 106 cells/20 mL to 1 × 108 cells/10 mL resulted in no strokes. Two animals had ischemic and hemorrhagic strokes after posterior cerebral artery catheterization. A survival experiment of 2 subjects resulted in no complications detected for 24-h before euthanization. CONCLUSION This novel study simulating ESIA infusion demonstrates that MSCs-D24 can be infused safely at least up to doses of 1 × 108 cells/10 mL (107 cells/ml) in the canine anterior circulation using commercially available microcatheters. These findings support a clinical trial of ESIA infusion of hMSCs-D24.

Clinical Study of Correlation Between Osteoporosis and Osteoarthritis of Knee Joint Using Gold Nanomaterial Contrast Agent

2020 ◽  
Vol 20 (12) ◽  
pp. 7761-7768
Author(s):  
Dan Li ◽  
Yunpeng Wan ◽  
Yongjin Sun ◽  
Xing Wu
Keyword(s):  
Medical Imaging ◽  
Knee Joint ◽  
Contrast Agent ◽  
Positive Control ◽  
Negative Control ◽  
Magnetic Resonance Imaging Examination ◽  
Mineral Density ◽  
Clinical Value ◽  
Traditional Chinese Medicine Syndrome ◽  
Gold Nanomaterial

The relationship between osteoporosis (OP) and knee osteoarthritis (OA) was studied using gold nanomaterial (GNP) contrast agent from the imaging and clinical perspectives. Patients were divided into the OA and OP comorbidity group (experimental), OA group (positive control), and OP group (negative control) and evaluated using the Lysholm knee joint score and traditional Chinese medicine syndrome score. Bone density was measured by parallel X-ray examination, magnetic resonance imaging examination, Recht classification, and arthroscopic Outerbridge classification. GNP contrast agents were used in the medical imaging tests. There were significant differences between the various factors compared between the experimental and positive control groups (P < 0.05). The correlation analysis of the variables and bone mineral density in all patients showed a positive linear relationship (P < 0.05). There was a positive correlation between OP and knee OA. GNP has good clinical value in medical imaging.

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