Reoperative management of intracranial aneurysms

1995 ◽  
Vol 83 (3) ◽  
pp. 387-393 ◽  
Author(s):  
Steven L. Giannotta ◽  
N. Scott Litofsky
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Operative Procedure ◽  
Technical Difficulty ◽  
Mass Effect ◽  
Time Interval ◽  
Anterior Circulation ◽  
Content Type ◽  
Coating Agents ◽  
Intraoperative Rupture ◽  
Fine Print

✓ Nineteen patients underwent 20 operative procedures for the treatment of recurrent or residual aneurysms. There were 13 small, three large, and four giant lesions; with one exception, all were in the anterior circulation. Five individuals presented with recurrent subarachnoid hemorrhage, six were referred for symptoms of mass effect, and nine were known to have had inadequate treatment at the time of the initial operative procedure. The average time interval from initial treatment to either recurrent subarachnoid hemorrhage or compressive effects was 10.5 and 9.75 years, respectively. No deaths resulted from the reoperative procedures. Two patients suffered moderate disability and one had severe disability. Malpositioned or slipped clips, intraoperative rupture, and inadequate exposure were responsible for 75% of the initial operative failures. The technical difficulty of the reoperative procedure correlated with the length of time between initial and reoperative treatment, the presence of clips and coating agents, and the complexity of the lesion. A classification scheme for preoperative planning and case selection is proposed based on the technical adjuncts required for reoperative aneurysm procedures.

Ultra-early rebleeding in spontaneous subarachnoid hemorrhage

1996 ◽  
Vol 84 (1) ◽  
pp. 35-42 ◽  
Author(s):  
Yukihiko Fujii ◽  
Shigekazu Takeuchi ◽  
Osamu Sasaki ◽  
Takashi Minakawa ◽  
Tetsuo Koike ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Multivariate Analysis ◽  
Subarachnoid Hemorrhage ◽  
Early Operation ◽  
Time Interval ◽  
High Systolic Blood Pressure ◽  
Content Type ◽  
Spontaneous Subarachnoid Hemorrhage ◽  
Fine Print

✓ To determine the incidence of, and risk factors for, the occurrence of rebleeding between admission and early operation (ultra-early rebleeding) in patients with spontaneous subarachnoid hemorrhage (SAH), the authors reviewed the cases of 179 patients admitted within 24 hours after their last attack of SAH. Thirty-one (17.3%) of these patients had ultra-early rebleeding despite scheduling of early operation (within 24 hours after admission). The incidence of rebleeding significantly decreased as the time interval between the last attack and admission increased. Patients with rebleeding before admission, high systolic blood pressure, intracerebral or intraventricular hematoma, those in poor neurological condition on admission, and those who underwent angiography within 6 hours of the last SAH were significantly more likely to have ultra-early rebleeding than those without these factors. The incidence of rebleeding also significantly increased as levels of enhancement of platelet sensitivity and thrombin—antithrombin complex increased. Multivariate analysis revealed that the following three factors were independently associated with ultra-early rebleeding: the level of enhancement of platelet sensitivity; the time interval between the last attack and admission; and the level of thrombin—antithrombin complex. On the basis of these findings, the authors suggest that many of the risk factors for ultra-early rebleeding are interrelated. A particularly high risk of ultra-early rebleeding was observed in those patients 1) who had platelet hypoaggregability; 2) who were admitted shortly after their last SAH; and 3) whose thrombin—antithrombin complex levels were extremely high and were thus in severe clinical condition.

The poor prognosis of ruptured intracranial aneurysms of the posterior circulation

1995 ◽  
Vol 82 (5) ◽  
pp. 791-795 ◽  
Author(s):  
Wouter I. Schievink ◽  
Eelco F. M. Wijdicks ◽  
David G. Piepgras ◽  
Chu-Pin Chu ◽  
W. Michael O'Fallon ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Initial Period ◽  
Posterior Circulation ◽  
Medical Record Linkage ◽  
Anterior Circulation ◽  
Content Type ◽  
Clinical Series ◽  
Posterior Circulation Aneurysms ◽  
Fine Print

✓ The first 48 hours after aneurysmal subarachnoid hemorrhage are critical in determining final outcome. However, most patients who die during this initial period are not included in hospital-based studies. We investigated the occurrence of subarachnoid hemorrhage in a population-based study to evaluate possible predictors of poor outcome. All patients diagnosed with aneurysmal subarachnoid hemorrhage between 1955 and 1984 were selected for analysis of mortality in the first 30 days using the medical record—linkage system employed for epidemiological studies in Rochester, Minnesota. One hundred and thirty-six patients were identified. The mean age of these 99 women and 37 men was 55 years. Rates for survival to 48 hours were 32% for the 19 patients with posterior circulation aneurysms, 77% for the 87 patients with anterior circulation aneurysms, and 70% for the 30 patients with a presumed aneurysm (p < 0.0001). Rates for survival to 30 days were 11%, 57%, and 53%, respectively, in these three patient groups (p < 0.0001). Clinical grade on admission to the hospital, the main variable predictive of death within 48 hours, was significantly worse in patients with posterior circulation aneurysms than in others (p < 0.0001). The prognosis of ruptured posterior circulation aneurysms is poor. The high early mortality explains why posterior circulation aneurysms are uncommon in most clinical series of patients with subarachnoid hemorrhage. The management of incidentally discovered intact posterior circulation aneurysms may be influenced by these findings.

Endovascular occlusion of vertebral arteries in the treatment of unclippable vertebrobasilar aneurysms

1991 ◽  
Vol 74 (3) ◽  
pp. 393-398 ◽  
Author(s):  
Armand Aymard ◽  
Y. Pierre Gobin ◽  
Jonathan E. Hodes ◽  
Siegfried Bien ◽  
Daniel Rüfenacht ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Vertebral Artery ◽  
Mass Effect ◽  
Content Type ◽  
Vertebral Arteries ◽  
Endovascular Occlusion ◽  
Vertebrobasilar Circulation ◽  
Partial Thrombosis ◽  
Vertebrobasilar Aneurysms ◽  
Fine Print

✓ Twenty-one patients with aneurysms of the vertebrobasilar circulation underwent unilateral or bilateral endovascular occlusion of the vertebral artery. Six patients presented with subarachnoid hemorrhage (SAH), 10 with mass effect, four with mass effect and SAH, and one with ischemic symptoms. Thirteen patients had good outcomes with complete clinical and angiographic cure. Six patients had partial thrombosis of their aneurysms. There was one death and one treatment failure. One patient suffered transient stroke. It is concluded that endovascular occlusion of the vertebral artery following test occlusion is a safe and effective treatment for proximal aneurysms of the vertebrobasilar circulation.

Comparison of balloon angioplasty and papaverine infusion for the treatment of vasospasm following aneurysmal subarachnoid hemorrhage

1998 ◽  
Vol 88 (2) ◽  
pp. 277-284 ◽  
Author(s):  
J. Paul Elliott ◽  
David W. Newell ◽  
Derek J. Lam ◽  
Joseph M. Eskridge ◽  
Colleen M. Douville ◽  
...  
Keyword(s):  
Blood Flow ◽  
Subarachnoid Hemorrhage ◽  
Balloon Angioplasty ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Repeated Treatment ◽  
Anterior Circulation ◽  
Content Type ◽  
Paired Samples ◽  
Distal Internal Carotid Artery ◽  
Fine Print

Object. The purpose of this study was to test the hypothesis that balloon angioplasty is superior to papaverine infusion for the treatment of proximal anterior circulation arterial vasospasm following subarachnoid hemorrhage (SAH). Between 1989 and 1995, 125 vasospastic distal internal carotid artery or proximal middle cerebral artery vessel segments were treated in 52 patients. Methods. Blood flow velocities of the involved vessels were assessed by using transcranial Doppler (TCD) monitoring in relation to the day of treatment with balloon angioplasty or papaverine infusion. Balloon angioplasty and papaverine infusion cohorts were compared based on mean pre- and posttreatment velocity at 24 and 48 hours using the one-tailed, paired-samples t-test. Balloon angioplasty alone was performed in 101 vessel segments (81%) in 39 patients (75%), whereas papaverine infusion alone was used in 24 vessel segments (19%) in 13 patients (25%). Although repeated treatment after balloon angioplasty was needed in only one vessel segment, repeated treatment following papaverine infusion was required in 10 vessel segments (42%) in six patients because of recurrent vasospasm (p < 0.001). Seven vessel segments (29%) with recurrent spasm following papaverine infusion were treated with balloon angioplasty. Although vessel segments treated with papaverine demonstrated a 20% mean decrease in blood flow velocity (p < 0.009) on posttreatment Day 1, velocities were not significantly lower than pretreatment levels by posttreatment Day 2 (p = 0.133). Balloon angioplasty resulted in a 45% mean decrease in velocity to a normal level following treatment (p < 0.001), a decrease that was sustained. Conclusions. Balloon angioplasty is superior to papaverine infusion for the permanent treatment of proximal anterior circulation vasospasm following aneurysmal SAH.

Preoperative ventriculostomy and rebleeding after aneurysmal subarachnoid hemorrhage

2002 ◽  
Vol 97 (5) ◽  
pp. 1042-1044 ◽  
Author(s):  
Jon I. McIver ◽  
Jonathan A. Friedman ◽  
Eelco F. M. Wijdicks ◽  
David G. Piepgras ◽  
Mark A. Pichelmann ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Time Interval ◽  
Content Type ◽  
Acute Hydrocephalus ◽  
Increased Risk ◽  
The Mean ◽  
Aneurysm Repair ◽  
Mean Time ◽  
Fine Print

Object. Despite the widespread use of ventriculostomy in the treatment of acute hydrocephalus after aneurysmal subarachnoid hemorrhage (SAH), there is no consensus regarding the risk of rebleeding associated with ventriculostomy before aneurysm repair. This present study was conducted to assess the risk of rebleeding after preoperative ventriculostomy in patients with aneurysmal SAH. Methods. The authors reviewed the records of all patients with acute SAH who were treated at a single institution between 1990 and 1997. Thus, the records of 304 consecutive patients in whom an aneurysmal SAH source was documented on angiographic studies and who had presented to the authors' institution within 7 days of ictus were analyzed. Rebleeding was confirmed by evidence of recurrent hemorrhage on computerized tomography scans in all cases. Forty-five patients underwent ventriculostomy for acute hydrocephalus after aneurysmal SAH at least 24 hours before aneurysm repair. Ventriculostomy was performed within 24 hours of SAH in 38 patients, within 24 to 48 hours in three patients, and more than 48 hours after SAH in four patients. The mean time interval between SAH and surgery in patients who did not undergo ventriculostomy was no different from the mean interval between ventriculostomy and surgery in patients who underwent preoperative ventriculostomy (3.6 compared with 3.8 days, p = 0.81). Fourteen (5.4%) of the 259 patients who did not undergo ventriculostomy suffered preoperative aneurysm rebleeding, whereas two (4.4%) of the 45 patients who underwent preoperative ventriculostomy had aneurysm rebleeding. Conclusions. No evidence was found that preoperative ventriculostomy performed after aneurysmal SAH is associated with an increased risk of aneurysm rebleeding when early aneurysm surgery is performed.

Cerebral aneurysms in childhood and adolescence

1989 ◽  
Vol 70 (3) ◽  
pp. 420-425 ◽  
Author(s):  
Fredric B. Meyer ◽  
Thoralf M. Sundt ◽  
Nicolee C. Fode ◽  
Michael K. Morgan ◽  
Glen S. Forbes ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Vascular Malformations ◽  
Cerebral Aneurysms ◽  
Mass Effect ◽  
Posterior Circulation ◽  
Childhood And Adolescence ◽  
Postoperative Results ◽  
Content Type ◽  
Presenting Symptoms ◽  
Fine Print

✓ In this study, 24 aneurysms occurring in 23 patients under the age of 18 years (mean 12 years) are analyzed. The male:female ratio was 2.8:1, and the youngest patient was 3 months old. Mycotic lesions and those associated with other vascular malformations were excluded. Forty-two percent of the aneurysms were located in the posterior circulation, and 54% were giant aneurysms. Presenting symptoms included subarachnoid hemorrhage in 13 and mass effect in 11. Several of these aneurysms were documented to rapidly increase in size over a 3-month to 2-year period of observation. All aneurysms were surgically treated: direct clipping was performed in 14; trapping with bypass in four; trapping alone in four; and direct excision with end-to-end anastomosis in two. The postoperative results were excellent in 21 aneurysms (87%), good in two (8%), and poor in one. The pathogenesis of cerebral aneurysms is reviewed.

Changes in functional outcome and quality of life in patients and caregivers after aneurysmal subarachnoid hemorrhage

2001 ◽  
Vol 95 (6) ◽  
pp. 957-963 ◽  
Author(s):  
Jeannette W. Hop ◽  
Gabriel J. E. Rinkel ◽  
Ale Algra ◽  
Jan van Gijn
Keyword(s):  
Quality Of Life ◽  
Subarachnoid Hemorrhage ◽  
Functional Outcome ◽  
Case Fatality ◽  
Time Interval ◽  
Consecutive Series ◽  
Content Type ◽  
Sf 36 ◽  
Fine Print

Object. Although the case-fatality rate after subarachnoid hemorrhage (SAH) does not change considerably after the first 4 weeks, functional outcome and the quality of life (QOL) may. To assess the extent of changes in functional outcome and QOL after SAH, the authors conducted a follow-up study at 18 months in patients and caregivers who had participated in a previous study of QOL 4 months after SAH. Methods. In a consecutive series of 98 patients admitted with SAH, 68 had survived until 4 months postbleed, at which time an initial outcome assessment had been performed in 64 of them. This series of 64 patients was contacted again at a median of 18 months after SAH. In all patients, functional outcome was assessed by means of the modified Rankin Scale (mRS). In 48 patients and 35 caregivers QOL was assessed using the SF-36, the Sickness Impact Profile (SIP), and a visual analog scale. The results were compared with the scores that had been obtained at 4 months after SAH. Thirty-two patients (50%) had improved at least one point on the mRS, in 23 patients functional outcome had remained unchanged, six patients had deteriorated one point on the mRS, and three had died. No major changes in the QOL of patients and caregivers could be found on the SIP, but on the SF-36 an improved QOL was detected in patients with better Rankin grades. On both instruments, the QOL at 18 months was still reduced compared with the reference population in all patients. Conclusions. Functional outcome improves significantly between 4 months and 18 months post-SAH; studies on functional outcome after SAH can be compared only if outcome is assessed at the same time interval. The improved functional outcome seems to be accompanied by an improved QOL.

Aneurysm-induced third nerve palsy

1972 ◽  
Vol 36 (5) ◽  
pp. 548-551 ◽  
Author(s):  
Iftikhar A. Raja
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Functional Recovery ◽  
Poor Prognosis ◽  
Nerve Palsy ◽  
Nerve Function ◽  
Content Type ◽  
Third Nerve Palsy ◽  
Carotid Ligation ◽  
Third Nerve ◽  
Fine Print

✓ Forty-two patients with aneurysm-induced third nerve palsy are described. After carotid ligation, 58% showed satisfactory and 42% unsatisfactory functional recovery. In some patients the deficit continued to increase even after carotid ligation. Early ligation provided a better chance of recovery of third nerve function. Patients in whom third nerve palsy began after subarachnoid hemorrhage had a poor prognosis. No relationship was noted between the size of the aneurysm and the recovery of third nerve function.

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.

Arteriovenous malformation of choroid plexus

1975 ◽  
Vol 42 (4) ◽  
pp. 457-461 ◽  
Author(s):  
Charles J. Hodge ◽  
Robert B. King
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Arteriovenous Malformation ◽  
Choroid Plexus ◽  
Content Type ◽  
Fine Print

✓ The authors describe a patient with subarachnoid hemorrhage from an arteriovenous malformation of the choroid plexus and present a brief review of related reports.

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