Venous infarction following the interhemispheric approach in patients with acute subarachnoid hemorrhage

1991 ◽  
Vol 74 (5) ◽  
pp. 715-729 ◽  
Author(s):  
Kazuo Tsutsumi ◽  
Yoshiaki Shiokawa ◽  
Tatsuo Sakai ◽  
Nobuhiko Aoki ◽  
Masaru Kubota ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Venous Drainage ◽  
Acute Stage ◽  
Anterior Communicating Artery ◽  
Aneurysm Surgery ◽  
Venous Infarction ◽  
Content Type ◽  
Interhemispheric Approach ◽  
Acute Subarachnoid Hemorrhage ◽  
Bridging Veins

✓ Postoperative venous infarction following aneurysm surgery was studied in 48 patients with anterior communicating artery aneurysms operated on through the interhemispheric approach at the acute stage of subarachnoid hemorrhage (SAH). Of 23 patients whose bridging veins were sacrificed during surgery, 11 (47.8%) showed venous infarction in the frontal lobes. In contrast, only one (5.9%) of 17 patients whose bridging veins were preserved developed cerebral edema. None of eight patients who were operated on after Day 11 (the day of SAH was defined as Day 0) showed this complication, although bridging veins were sacrificed in six of them. Venous infarction following acute aneurysm surgery tended to occur more frequently in patients of higher SAH grade and/or more advanced age, but these correlations were not significant. However, the correlation between the sacrifice of veins and venous infarction was significant (p < 0.025). Because this potential complication may compromise the benefit of acute aneurysm surgery and cause damage, it is important to preserve the venous system and in some instances to select another surgical approach based on the pattern of venous drainage in the frontal lobe.

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

Vascular anomalies associated with aneurysms of the anterior communicating artery: microsurgical observations

1990 ◽  
Vol 72 (5) ◽  
pp. 706-709 ◽  
Author(s):  
Akira Ogawa ◽  
Michiyasu Suzuki ◽  
Yoshiharu Sakurai ◽  
Takashi Yoshimoto
Keyword(s):  
Anterior Cerebral Artery ◽  
Vascular Anomaly ◽  
Vascular Anomalies ◽  
Anterior Communicating Artery ◽  
Aneurysm Surgery ◽  
Operative Field ◽  
Content Type ◽  
Interhemispheric Approach ◽  
Median Artery ◽  
Vascular Structures

✓ Direct operations were performed on 206 patients with aneurysms of the anterior communicating artery (ACoA) using a bifrontal craniotomy and an interhemispheric approach. A total of 44 (21.4%) of these patients had vascular anomalies in the vicinity of the ACoA; these included a median artery of the corpus callosum (MACC) in 27 cases (13.1%), duplication of the ACoA in 20 (9.7%), and duplication of the A1 segment of the anterior cerebral artery in one (0.5%). A retrospective study of the angiograms indicated that diagnosis of the A1 or ACoA duplication was not possible; only 11 (41%) of the 27 MACC's were easily identified, while eight (30%) could not be diagnosed. The majority of the cases of ACoA aneurysms with MACC (81.5%) showed trifurcation of the ACoA, A2, and MACC. The operative results in the patients with MACC did not differ significantly from the results of the entire ACoA aneurysm series. From the above study it is concluded that, regardless of whether a vascular anomaly has been identified preoperatively, ACoA aneurysm surgery should be undertaken with that possibility in mind. A bifrontal craniotomy and an interhemispheric approach has the advantage of allowing for a wide operative field and the attainment of a good understanding of the vascular structures near the ACoA. It is particularly useful in cases of vascular anomaly in this region.

Bifrontal basal interhemispheric approach to craniopharyngioma resection with or without division of the anterior communicating artery

1996 ◽  
Vol 84 (6) ◽  
pp. 951-956 ◽  
Author(s):  
Masato Shibuya ◽  
Masakazu Takayasu ◽  
Yoshio Suzuki ◽  
Kiyoshi Saito ◽  
Kenichiro Sugita
Keyword(s):  
Late Complications ◽  
Pituitary Stalk ◽  
Anterior Communicating Artery ◽  
Operative Field ◽  
Content Type ◽  
Visual Improvement ◽  
Interhemispheric Approach ◽  
Anterior Interhemispheric Approach ◽  
Bridging Veins ◽  
Perforating Arteries

✓ The authors describe the use of a bifrontal basal interhemispheric approach with or without division of the anterior communicating artery (ACoA) for removal of large craniopharyngiomas. This approach is a more basal modification of the anterior interhemispheric approach, allowing preservation of most bridging veins. Since 1988, 22 patients underwent operations using this approach to achieve total or near-total excision of large craniopharyngiomas. Division of the ACoA was performed in 11 of 17 patients with retrochiasmatic tumors with no early or late complications related to division of the artery. There were no operative mortalities. Visual improvement (59%) and preservation of the pituitary stalk (64%) were achieved in a high percentage of patients. Preservation of the pituitary stalk correlated well with postoperative pituitary function. The bifrontal basal interhemispheric approach allowed a bilateral, wider operative field with better orientation and views of important neural structures and perforating arteries without requiring combination with other approaches. When the ACoA limited operative exposure, the artery could be divided safely. The authors discuss indications for, and advantages of, the bifrontal basal interhemispheric approach with or without division of the ACoA in the removal of large craniopharyngiomas.

An experimental study of the acute stage of subarachnoid hemorrhage

1983 ◽  
Vol 59 (6) ◽  
pp. 917-924 ◽  
Author(s):  
Ken Kamiya ◽  
Hideyuki Kuyama ◽  
Lindsay Symon
Keyword(s):  
Blood Flow ◽  
Subarachnoid Hemorrhage ◽  
Acute Stage ◽  
Flow Measurements ◽  
Content Type ◽  
Baboon Model ◽  
Differential Increase ◽  
Blood Flow Measurements ◽  
Fine Print ◽  
Made In

✓ A baboon model of subarachnoid hemorrhage (SAH) has been developed to study the changes in cerebral blood flow (CBF), intracranial pressure (ICP), and cerebral edema associated with the acute stage of SAH. In this model, hemorrhage was caused by avulsion of the posterior communicating artery via a periorbital approach, with the orbit sealed and ICP restored to normal before SAH was produced. Local CBF was measured in six sites in the two hemispheres, and ICP monitored by an implanted extradural transducer. Following sacrifice of the animal, the effect of the induced SAH on ICP, CBF, autoregulation, and CO2 reactivity in the two hemispheres was assessed. Brain water measurements were also made in areas of gray and white matter corresponding to areas of blood flow measurements, and also in the deep nuclei. Two principal patterns of ICP change were found following SAH; one group of animals showed a return to baseline ICP quite quickly and the other maintained high ICP for over an hour. The CBF was reduced after SAH to nearly 20% of control values in all areas, and all areas showed impaired autoregulation. Variable changes in CO2 reactivity were evident, but on the side of the hemorrhage CO2 reactivity was predominantly reduced. Differential increase in pressure lasting for over 7 minutes was evident soon after SAH on the side of the ruptured vessel. There was a significant increase of water in all areas, and in cortex and deep nuclei as compared to control animals.

STENT REMODELING TECHNIQUE FOR COILING OF RUPTURED WIDE-NECK CEREBRAL ANEURYSMS: CASE REPORT

Neurosurgery ◽  
2009 ◽  
Vol 65 (5) ◽  
pp. E1007-E1008 ◽  
Author(s):  
Demetrius K. Lopes ◽  
Kalani Wells
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cerebral Aneurysms ◽  
Artery Aneurysm ◽  
Anterior Communicating Artery ◽  
Parent Vessel ◽  
Aneurysm Neck ◽  
Acute Subarachnoid Hemorrhage ◽  
The Right ◽  
Wide Neck ◽  
Cordis Corporation

Abstract OBJECTIVE To describe a novel stent remodeling technique for the coiling of ruptured wide-neck cerebral aneurysms. CLINICAL PRESENTATION A 46-year-old man presented with acute subarachnoid hemorrhage (Hunt and Hess grade IV), intracerebral hemorrhage, and hydrocephalus. Cerebral angiography revealed a wide-neck small anterior communicating artery aneurysm. Conventional coiling was not successful because of coil instability and compromise of the dominant anterior cerebral artery. TECHNIQUE A 6-French shuttle sheath (Cook Medical, Indianapolis, IN) was advanced from a right femoral approach into the right common carotid artery. To protect the parent vessel during coiling without compromising blood flow, a Prowler Select Plus catheter (Cordis Corporation, Bridgewater, NJ) was navigated across the aneurysm neck. Subsequently, an Enterprise stent (22-mm length; Cordis Corporation) was partially deployed across the aneurysm's wide neck. It was very important to watch the distal markers of the stent and lock the stent delivery wire to the Prowler Select Plus with a hemostatic valve once the stent was halfway deployed. This maneuver was essential to prevent further deployment of the stent. The SL-10 microcatheter and Synchro 14 wire (Boston Scientific, Natick, MA) were carefully navigated to the aneurysm passing through the partially deployed stent. Coils were then delivered to the aneurysm using the stent as a scaffold. After coiling, the SL-10 microcatheter was removed and the stent was recaptured into the Prowler Select Plus catheter. During the recapture, there was initial resistance. This was easily overcome after deploying the stent a little more before resheathing. During the procedure, the patient received 2000 U of heparin after the first coil was detached in the aneurysm. CONCLUSION The stent remodeling technique is a novel endovascular technique that can be used to treat ruptured wide-neck aneurysms and maintain patency of parent vessels, avoiding the use of antiplatelet therapy in acute subarachnoid hemorrhage.

Cerebral circulation and metabolism in the acute stage of subarachnoid hemorrhage

2000 ◽  
Vol 93 (6) ◽  
pp. 1014-1018 ◽  
Author(s):  
Toshiaki Hayashi ◽  
Akifumi Suzuki ◽  
Jun Hatazawa ◽  
Iwao Kanno ◽  
Reizo Shirane ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cerebral Circulation ◽  
Cerebral Blood Volume ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Cerebral Metabolism ◽  
Aneurysm Rupture ◽  
Acute Stage ◽  
Content Type ◽  
Positron Emission ◽  
Fine Print

Object. The mechanism of reduction of cerebral circulation and metabolism in patients in the acute stage of aneurysmal subarachnoid hemorrhage (SAH) has not yet been fully clarified. The goal of this study was to elucidate this mechanism further.Methods. The authors estimated cerebral blood flow (CBF), cerebral metabolic rate of oxygen (CMRO2), O2 extraction fraction (OEF), and cerebral blood volume (CBV) preoperatively in eight patients with aneurysmal SAH (one man and seven women, mean age 63.5 years) within 40 hours of onset by using positron emission tomography (PET). The patients' CBF, CMRO2, and CBF/CBV were significantly lower than those in normal control volunteers. However, OEF and CBV did not differ significantly from those in control volunteers. The significant decrease in CBF/CBV, which indicates reduced cerebral perfusion pressure, was believed to be caused by impaired cerebral circulation due to elevated intracranial pressure (ICP) after rupture of the aneurysm. In two of the eight patients, uncoupling between CBF and CMRO2 was shown, strongly suggesting the presence of cerebral ischemia.Conclusions. The initial reduction in CBF due to elevated ICP, followed by reduction in CMRO2 at the time of aneurysm rupture may play a role in the disturbance of CBF and cerebral metabolism in the acute stage of aneurysmal SAH.

Chronic subdural hematoma presenting as spontaneous subarachnoid hemorrhage

1985 ◽  
Vol 63 (5) ◽  
pp. 691-692 ◽  
Author(s):  
Zbigniew Kotwica ◽  
Jerzy Brzeziński
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Clinical Findings ◽  
Content Type ◽  
Acute Subarachnoid Hemorrhage ◽  
Spontaneous Subarachnoid Hemorrhage ◽  
Fine Print

✓ Six cases of chronic subdural hematoma presenting with the clinical findings of acute subarachnoid hemorrhage are reported. No systemic or focal cause for the bleeding was found, and possible mechanisms are discussed.

Bifrontal interhemispheric approach to aneurysms of the anterior communicating artery

1986 ◽  
Vol 64 (2) ◽  
pp. 183-190 ◽  
Author(s):  
Jiro Suzuki ◽  
Kazuo Mizoi ◽  
Takashi Yoshimoto
Keyword(s):  
Cerebral Arteries ◽  
Distal Portion ◽  
Anterior Communicating Artery ◽  
Content Type ◽  
Interhemispheric Approach ◽  
Interhemispheric Fissure ◽  
Early Operations ◽  
Temporary Clip ◽  
Fine Print

✓ The authors review their experience with the bifrontal interhemispheric approach in 603 cases of single anterior communicating artery (ACoA) aneurysms and describe the operative technique. With this approach, the olfactory tracts are dissected, and both A1 segments of the anterior cerebral arteries are identified subfrontally. The interhemispheric fissure is then dissected and A2segments are followed from the distal portion toward the ACoA complex. Following the administration of a combination of mannitol, vitamin E, and dexamethasone, a temporary clip is placed on at least the dominant A1 segment prior to dissection of the aneurysm itself. Once the aneurysm has been completely freed from the surrounding structures, the neck is ligated and clipped. If the aneurysm ruptures during surgery, temporary clips are placed on both A1 and A2 segments bilaterally and the operation proceeds in a completely dry field. With this method, it is possible to occlude any of the intracranial vessels for up to 40 minutes within 100 minutes of drug administration. To prevent the possibility of rerupture and the development of vasospasm in the period before aneurysm surgery, the authors have adopted a policy of performing ultra-early operations within 48 hours of the onset of symptoms. Among the 257 cases operated on during the 9 years since 1975, one-fifth have been operated on within 48 hours of rupture, and the in-hospital mortality rate has been only 4.3% (11 cases). Follow-up studies have shown that 87% of the 246 surviving patients have returned to useful lives.

Use of spiral computerized tomography angiography in patients with subarachnoid hemorrhage in whom subtraction angiography did not reveal cerebral aneurysms

2000 ◽  
Vol 92 (2) ◽  
pp. 278-283 ◽  
Author(s):  
Hiroyuki Hashimoto ◽  
Jun-Ichi Iida ◽  
Yasuo Hironaka ◽  
Masato Okada ◽  
Toshisuke Sakaki
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Ct Angiography ◽  
Cerebral Aneurysms ◽  
Spiral Ct ◽  
The Other ◽  
Anterior Communicating Artery ◽  
Content Type ◽  
Spiral Ct Angiography ◽  
Spiral Computerized Tomography ◽  
Fine Print

Object. Patients with subarachnoid hemorrhage (SAH) in whom angiography does not demonstrate diagnostic findings sometimes suffer recurrent disease and actually harbor undetected cerebral aneurysms. The management strategy for such cases remains controversial, but technological advances in spiral computerized tomography (CT) angiography are changing the picture. The purpose of this prospective study was to examine how spiral CT angiography can contribute to the detection of cerebral aneurysms that cannot be visualized on angiography.Methods. In 134 consecutive patients with SAH, a prospective search for the source of bleeding was performed using digital subtraction (DS) and spiral CT angiography. In 21 patients in whom initial DS angiography yielded no diagnostic findings, spiral CT angiography was performed within 3 days. Patients in whom CT angiography provided no diagnostic results underwent second and third DS angiography sessions after approximately 2 weeks and 6 months, respectively.Six patients with perimesencephalic SAH were included in the 21 cases. Six of the other 15 patients had small cerebral aneurysms detectable by spiral CT angiography, five involving the anterior communicating artery and one the middle cerebral artery. Two patients in whom initial angiograms did not demonstrate diagnostic findings proved to have a ruptured dissecting aneurysm of the vertebral artery; in one case this was revealed at autopsy and in the other during the second DS angiography session. A third DS angiography session revealed no diagnostic results in 13 patients.Conclusions. Spiral CT angiography was useful in the detection of cerebral aneurysms in patients with SAH in whom angiography revealed no diagnostic findings. Anterior communicating artery aneurysms are generally well hidden in these types of SAH cases. A repeated angiography session was warranted in patients with nonperimesencephalic SAH and in whom initial angiography revealed no diagnostic findings, although a third session was thought to be superfluous.

The role of calcium and cellular membrane dysfunction in experimental trauma and subarachnoid hemorrhage

1985 ◽  
Vol 62 (5) ◽  
pp. 698-703 ◽  
Author(s):  
Otakar R. Hubschmann ◽  
Douglas C. Nathanson
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cellular Membrane ◽  
Membrane Injury ◽  
Content Type ◽  
Experimental Trauma ◽  
Acute Subarachnoid Hemorrhage ◽  
A Chain ◽  
The Moment ◽  
Large Vessels

✓ Acute subarachnoid hemorrhage (SAH) and intraparenchymal hematoma (IPH) in cats are accompanied by massive cellular depolarization. This depolarization, characterized by potassium (K+) efflux and calcium (Ca++) influx, results in membrane destabilization, osmotic imbalance, and a decrease in electrical conduction. The Ca++ influx appears to initiate a chain reaction that, in some instances, may result in delayed cell destruction. The ionic dysequilibrium probably contributes to both brain engorgement and spasm in large vessels. The cellular depolarization and calcium-induced cell membrane injury at the moment of impact may play a greater role in the pathophysiology of head trauma than previously thought.

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