Bacterial intracranial aneurysms

1980 ◽  
Vol 53 (5) ◽  
pp. 633-641 ◽  
Author(s):  
John G. Frazee ◽  
Leslie D. Cahan ◽  
James Winter
Keyword(s):  
Cerebral Angiography ◽  
Intracranial Aneurysms ◽  
Elective Surgery ◽  
Bacterial Endocarditis ◽  
Severe Headache ◽  
High Dose ◽  
Review Of The Literature ◽  
Content Type ◽  
Neurological Signs ◽  
Fine Print

✓ The treatment of 13 patients with bacterial intracranial aneurysms is reported. The incidence of bacterial intracranial aneurysms was 4% of all patients admitted with intracranial aneurysms and 3% of all patients admitted with bacterial endocarditis. Each patient had neurological signs or symptoms suggestive of intracranial disease prior to the diagnosis of an aneurysm. Alpha Streptococcus was the most common infecting organism. All patients were treated with specific, high-dose antibiotics, and five patients underwent surgery as well. There were no surgical deaths. Six of eight nonsurgically treated patients died. A review of the literature confirms a high mortality for patients treated with only antibiotics, and a low mortality for elective surgery. The authors conclude that 1) patients with bacterial endocarditis, who develop sudden severe headache, focal neurological signs or symptoms, or seizures, should undergo serial cerebral angiography every 7 to 10 days throughout their hospitalization; 2) if an aneurysm is identified it should be excised whenever possible; and 3) patients with proximal or multiple aneurysms should be considered for surgery.

Cerebral angiography during operation for intracranial aneurysms and arteriovenous malformations

1971 ◽  
Vol 34 (5) ◽  
pp. 706-708 ◽  
Author(s):  
Martin L. Lazar ◽  
Clark C. Watts ◽  
Bassett Kilgore ◽  
Kemp Clark
Keyword(s):  
Cerebral Angiography ◽  
Arteriovenous Malformations ◽  
Intracranial Aneurysms ◽  
Operative Procedure ◽  
Superficial Temporal Artery ◽  
Technical Problem ◽  
Temporal Artery ◽  
Content Type ◽  
Actual Operation ◽  
Fine Print

✓ Angiography during the operative procedure is desirable, but is often difficult because of the problem of maintaining a needle or cannula in an artery for long periods of time. Cannulation of the superficial temporal artery avoids this technical problem. The artery is easily found, cannulation is simple, and obliteration of the artery is of no consequence. Cerebral angiography then provides a means for prompt evaluation of the surgical procedure at any time during the actual operation.

Multiple intracranial aneurysms in sickle cell anemia

1985 ◽  
Vol 62 (3) ◽  
pp. 430-434 ◽  
Author(s):  
M. Chris Overby ◽  
Allen S. Rothman
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Sickle Cell ◽  
Sickle Cell Anemia ◽  
Intracranial Aneurysms ◽  
Neurological Complications ◽  
Review Of The Literature ◽  
Hemoglobin S ◽  
Content Type ◽  
Multiple Intracranial Aneurysms ◽  
Fine Print

✓ Neurological complications of sickle cell anemia occur in 18% to 29% of patients with homozygous hemoglobin S disease. A review of the literature yielded reports of two cases, both treated conservatively, of multiple intracranial aneurysms occurring in patients with sickle cell anemia. The authors report two cases of subarachnoid hemorrhage secondary to multiple intracranial aneurysms in patients with sickle cell anemia. One of the two patients underwent three craniotomies for ablation of six intracranial aneurysms. The techniques used in the treatment of these patients are presented.

Super giant globoid intracranial aneurysm in an infant

1980 ◽  
Vol 53 (3) ◽  
pp. 411-416 ◽  
Author(s):  
Enrique C. G. Ventureyra ◽  
Sin H. Choo ◽  
Brien G. Benoit
Keyword(s):  
Intracranial Aneurysm ◽  
Cerebral Angiography ◽  
Intracranial Aneurysms ◽  
Posterior Cerebral Artery ◽  
Uneventful Recovery ◽  
Baby Girl ◽  
Content Type ◽  
Two Stages ◽  
Arterial Aneurysms ◽  
Fine Print

✓ The incidence of intracranial aneurysms in infancy is less than 1%. Intracranial arterial aneurysms are very rare in patients under 1 year of age. This 6-month-old baby girl presented with progressive macrocephaly and anemia. Computerized tomography and cerebral angiography demonstrated a giant globoid aneurysm, 8 × 9 cm in size, arising from an anomalous posterior cerebral artery. The aneurysm was successfully clipped and excised in two stages. The child made an uneventful recovery. The congenital nature of the aneurysm is discussed, and the literature concerning intracranial aneurysms in patients under 1 year of age is reviewed.

Familial intracranial aneurysms

1980 ◽  
Vol 52 (4) ◽  
pp. 501-503 ◽  
Author(s):  
John L. Fox ◽  
Jehoon P. Ko
Keyword(s):  
Cerebral Angiography ◽  
Intracranial Aneurysms ◽  
Mendelian Inheritance ◽  
Content Type ◽  
Subarachnoid Hemorrhages ◽  
Fine Print

✓ The authors present a family of 13 siblings: six are proven to have had intracranial aneurysms, five have had elective cerebral angiography with normal findings, and two have refused angiography. Of the six aneurysm cases, two had disabling and one had fatal subarachnoid hemorrhages; three underwent successful clipping of their aneurysms which were discovered by elective angiography. It is concluded that the two remaining patients who have refused angiography have a 50% statistical chance of harboring a potentially lethal aneurysm, for in this family the occurrences of six proven cases among 11 siblings studied is consistent with a dominant Mendelian inheritance.

Elective surgery for asymptomatic, unruptured, intracranial aneurysms: a cost-effectiveness analysis

1995 ◽  
Vol 83 (3) ◽  
pp. 403-412 ◽  
Author(s):  
Joseph T. King ◽  
Henry A. Glick ◽  
Thomas J. Mason ◽  
Eugene S. Flamm
Keyword(s):  
Cost Effectiveness ◽  
Intracranial Aneurysms ◽  
Elective Surgery ◽  
Cost Effective ◽  
Cost Effectiveness Analysis ◽  
Aneurysm Surgery ◽  
Content Type ◽  
Effectiveness Analysis ◽  
Unruptured Intracranial Aneurysms ◽  
Fine Print

✓ Cost-effectiveness analysis uses both economic and clinical outcomes data to evaluate treatment options. In this era of economic constraints on health care, treatments that are not cost-effective will increasingly be denied public and private insurance reimbursement. The authors used mathematical modeling techniques to assess the cost-effectiveness of elective surgery for the treatment of asymptomatic, unruptured, intracranial aneurysms. Input values for the Markov model used in this study were determined from both the literature and clinical judgment. Direct medical costs for hospitalization and physician fees were derived from Medicare cost reports and resource-based relative-value units, expressed in 1992 U.S. dollars. Costs and benefits were discounted at an annual rate of 5%. Using baseline model assumptions for a 50-year-old patient, elective aneurysm surgery provides an average of 0.88 additional quality-adjusted life years (QALYs) compared with nonsurgical treatment. However, prompt elective surgery ($23,300) costs more than expectant management ($2100), in which only patients whose aneurysms rupture incur treatment costs. Combining the outcomes and cost data, the incremental cost-effectiveness of elective aneurysm surgery is $24,200 per QALY, which is comparable to other accepted medical or surgical interventions, such as total knee arthroplasty ($15,200/QALY) or antihypertensive therapy in a 50-year-old patient ($29,800/QALY). Prompt elective surgery for asymptomatic, unruptured, intracranial aneurysms is recommended as a cost-effective use of medical resources provided: 1) surgical morbidity and mortality remain at reported levels; 2) the patient has a life expectancy of at least 13 additional years; and 3) the patient experiences a decrease in quality of life from knowingly living with an unruptured aneurysm.

Optochiasmal arachnoiditis following muslin wrapping of ruptured anterior communicating artery aneurysms

1991 ◽  
Vol 75 (3) ◽  
pp. 393-396 ◽  
Author(s):  
Robert M. McFadzean ◽  
Donald M. Hadley ◽  
Gawn G. McIlwaine
Keyword(s):  
Inflammatory Response ◽  
Steroid Therapy ◽  
Optic Neuropathy ◽  
Intracranial Aneurysms ◽  
Anterior Communicating Artery ◽  
Review Of The Literature ◽  
Optic Nerves ◽  
Content Type ◽  
Ruptured Intracranial Aneurysms ◽  
Fine Print

✓ Optochiasmal arachnoiditis has been reported following treatment of ruptured intracranial aneurysms, particularly arising from the anterior communicating artery. It has been suggested that the accompanying loss of vision is due to a muslin-induced optic neuropathy. This paper considers five cases of this condition; the response to steroid therapy was beneficial in three cases. A review of the literature is included. The arachnoiditis is considered to be due to an inflammatory response to muslin gauze placed close to the optic nerves and chiasm.

Morbidity and mortality from elective surgery for asymptomatic, unruptured, intracranial aneurysms: a meta-analysis

1994 ◽  
Vol 81 (6) ◽  
pp. 837-842 ◽  
Author(s):  
Joseph T. King ◽  
Jesse A. Berlin ◽  
Eugene S. Flamm
Keyword(s):  
Confidence Interval ◽  
Intracranial Aneurysms ◽  
Elective Surgery ◽  
Meta Analysis ◽  
Morbidity And Mortality ◽  
Morbidity Rate ◽  
Content Type ◽  
Unruptured Intracranial Aneurysms ◽  
The Impact ◽  
Fine Print

✓ A meta-analysis of the literature on morbidity and mortality from elective surgery for asymptomatic unruptured intracranial aneurysms was performed to obtain a more precise, accurate, and generalizable estimate of operative risk than is currently available. The authors used a MEDLINE search from 1966 to 1992, supplemented with manual searches, to locate studies containing four or more patients who had undergone elective surgery for these aneurysms. Only patients with asymptomatic, unruptured aneurysms were eligible for inclusion. Demographic and clinical data were collected from each series; aneurysms were categorized as incidental, multiple, or unclassifiable. Data were analyzed using Fisher's exact test and logistical regression. There were twenty-eight articles containing data on 733 patients who met eligibility criteria. The mean patient age was 48.6 ± 5.5 years, and 55% ± 17% of the patients were women. There was a total of 30 deficits for a morbidity rate of 4.1% (95% confidence interval 2.8, 5.8%) and a total of seven deaths for a mortality rate of 1.0% (95% confidence interval 0.4, 2.0%). There was insufficient statistical power to detect a difference in morbidity or mortality rates related to study size, year of publication, or potential risk factors such as patient sex or age, or aneurysm size, location, or category (incidental, multiple, or unclassifiable) (for all analyses, p ≥ 0.16). Elective surgery for asymptomatic unruptured intracranial aneurysms, as reported in the literature, has low rates of morbidity (4.1%) and mortality (1.0%). At present there is insufficient detail in the literature to understand the impact of patient and aneurysm characteristics on elective surgical outcomes.

Arteriovenous malformation and glioma: coexistent or sequential?

1990 ◽  
Vol 72 (5) ◽  
pp. 798-805 ◽  
Author(s):  
Robert Goodkin ◽  
Barbara Zaias ◽  
W. Jost Michelsen
Keyword(s):  
Arteriovenous Malformation ◽  
Vascular Malformation ◽  
Cerebral Angiography ◽  
Behavioral Changes ◽  
Mass Lesion ◽  
Review Of The Literature ◽  
Content Type ◽  
Embolization Procedure ◽  
Fine Print

✓ A 9-year-old girl was evaluated for behavioral changes and seizures. Initial computerized tomography and cerebral angiography revealed a left cerebral vascular mass, diagnosed as an arteriovenous malformation. An embolization procedure was attempted but was terminated before completion because the patient developed a right hemiparesis. Her right-sided neurological deficit subsequently increased with enlargement of the mass lesion. On follow-up cerebral angiography approximately 2 years later the vascular malformation was no longer demonstrated. Biopsy of the mass lesion revealed it to be an anaplastic astrocytoma. This case is reported with a review of the literature on the coexistence of a brain tumor and a vascular malformation, the difficulties in diagnosis, and possible etiologies.

Dual-isotope single-photon emission computerized tomography scanning in patients with glioblastoma multiforme: association with patient survival and histopathological characteristics of tumor after high-dose radiotherapy

1998 ◽  
Vol 89 (1) ◽  
pp. 60-68 ◽  
Author(s):  
Richard B. Schwartz ◽  
B. Leonard Holman ◽  
Joseph F. Polak ◽  
Basem M. Garada ◽  
Marc S. Schwartz ◽  
...  
Keyword(s):  
Survival Rate ◽  
Glioblastoma Multiforme ◽  
Single Photon ◽  
Photon Emission ◽  
High Dose ◽  
Term Survival ◽  
Content Type ◽  
Dual Isotope ◽  
Fine Print

Object. The study was conducted to determine the association between dual-isotope single-photon emission computerized tomography (SPECT) scanning and histopathological findings of tumor recurrence and survival in patients treated with high-dose radiotherapy for glioblastoma multiforme. Methods. Studies in which SPECT with 201Tl and 99mTc-hexamethypropyleneamine oxime (HMPAO) were used were performed 1 day before reoperation in 47 patients with glioblastoma multiforme who had previously been treated by surgery and high-dose radiotherapy. Maximum uptake of 201Tl in the lesion was expressed as a ratio to that in the contralateral scalp, and uptake of 99mTc-HMPAO was expressed as a ratio to that in the cerebellar cortex. Patients were stratified into groups based on the maximum radioisotope uptake values in their tumor beds. The significance of differences in patient gender, histological characteristics of tissue at reoperation, and SPECT uptake group with respect to 1-year survival was elucidated by using the chi-square statistic. Comparisons of patient ages and time to tumor recurrence as functions of 1-year survival were made using the t-test. Survival data at 1 year were presented according to the Kaplan—Meier method, and the significance of potential differences was evaluated using the log-rank method. The effects of different variables (tumor type, time to recurrence, and SPECT grouping) on long-term survival were evaluated using Cox proportional models that controlled for age and gender. All patients in Group I (201Tl ratio < 2 and 99mTc-HMPAO ratio < 0.5) showed radiation changes in their biopsy specimens: they had an 83.3% 1-year survival rate. Group II patients (201T1 ratio < 2 and 99mTc-HMPAO ratio of ≥ 0.5 or 201Tl ratio between 2 and 3.5 regardless of 99mTc-HMPAO ratio) had predominantly infiltrating tumor (66.6%); they had a 29.2% 1-year survival rate. Almost all of the patients in Group III (201Tl ratio > 3.5 and 99mTc-HMPAO ratio ≥ 0.5) had solid tumor (88.2%) and they had a 6.7% 1-year survival rate. Histological data were associated with 1-year survival (p < 0.01); however, SPECT grouping was more closely associated with 1-year survival (p < 0.001) and was the only variable significantly associated with long-term survival (p < 0.005). Conclusions. Dual-isotope SPECT data correlate with histopathological findings made at reoperation and with survival in patients with malignant gliomas after surgical and high-dose radiation therapy.

Gamma knife radiosurgery in patients with advanced breast cancer undergoing bone marrow transplant

2002 ◽  
Vol 97 ◽  
pp. 663-665 ◽  
Author(s):  
Kenneth J. Levin ◽  
Emad F. Youssef ◽  
Andrew E. Sloan ◽  
Rajiv Patel ◽  
Rana K. Zabad ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Advanced Breast Cancer ◽  
Gamma Knife ◽  
Gamma Knife Radiosurgery ◽  
High Dose Chemotherapy ◽  
Advanced Breast ◽  
High Dose ◽  
Initial Management ◽  
Content Type ◽  
Fine Print

Object. Recent studies have suggested a high incidence of cognitive deficits in patients undergoing high-dose chemotherapy, which appears to be dose related. Whole-brain radiotherapy (WBRT) has previously been associated with cognitive impairment. The authors attempted to use gamma knife radiosurgery (GKS) to delay or avoid WBRT in patients with advanced breast cancer treated with high-dose chemotherapy and autologous bone marrow transplantation (HDC/ABMT) in whom brain metastases were diagnosed. Methods. A retrospective review of our experience from 1996 to 2001 was performed to identify patients who underwent HDC/ABMT for advanced breast cancer and brain metastasis. They were able to conduct GKS as initial management to avoid or delay WBRT in 12 patients following HDC/ABMT. All patients were women. The median age was 48 years (range 30–58 years). The Karnofsky Performance Scale score was 70 (range 60–90). All lesions were treated with a median prescription dose of 17 Gy (range 15–18 Gy) prescribed to the 50% isodose. Median survival was 11.5 months. Five patients (42%) had no evidence of central nervous system disease progression and no further treatment was given. Four patients were retreated with GKS and three of them eventually received WBRT as well. Two patients were treated with WBRT as the primary salvage therapy. The median time to retreatment with WBRT was 8 months after the initial GKS. Conclusions. Gamma knife radiosurgery can be effectively used for the initial management of brain metastases to avoid or delay WBRT in patients treated previously with HDC, with acceptable survival and preserved cognitive function.

Sign in / Sign up

Export Citation Format

Share Document