Hydrocephalus: comparison of clipping and embolization in aneuryson treatment

2000 ◽  
Vol 92 (6) ◽  
pp. 991-994 ◽  
Author(s):  
Huma Sethi ◽  
Anne Moore ◽  
James Dervin ◽  
Andrew Clifton ◽  
J. Emma MacSweeney
Keyword(s):  
Artery Aneurysm ◽  
Anterior Communicating Artery ◽  
Chronic Hydrocephalus ◽  
Content Type ◽  
Vp Shunt ◽  
Shunt Placement ◽  
Technical Procedure ◽  
Internal Carotid Artery Aneurysm ◽  
Fisher Grade ◽  
Fine Print

Object. In this retrospective study conducted at Atkinson Morley's Hospital and Middlesbrough General Hospital, the authors analyzed 100 matched patients who had suffered subarachnoid hemorrhage (SAH) to determine whether the technical procedure by which aneurysms are treated affects the development of chronic hydrocephalus.Methods. Four hundred seventy-five patients presented with SAH between 1995 and 1998. Exclusion criteria included posterior circulation aneurysms, multiple aneurysms, electively clipped or embolized aneurysms, angiographically undetected SAH, patients who died within 1 month of neurosurgical intervention, and patients with the same aneurysm location but a different Fisher grade.The authors matched 50 patients who underwent embolization of their aneurysms with another 50 who had similar Fisher grades and aneurysm types and underwent clipping of their aneurysms. The maximum incidence of ruptured aneurysms occurred in patients who were between 41 and 60 years of age, with women preponderant in both study groups. In each group, 27 patients had anterior communicating artery aneurysm, 13 had posterior communicating artery aneurysm, seven had middle cerebral artery aneurysm, and three had internal carotid artery aneurysm. The lesions in three patients in each group were Fisher Grade I, in 23 patients they were Fisher Grade II, in 14 they were Fisher Grade III, and 10 patients had Fisher Grade IV SAH. Nine patients among those with clipped aneurysms and eight of the patients who underwent embolization had hydrocephalus for which they needed intervention. These interventions included lumbar puncture, ventricular drainage, and ventriculoperitoneal (VP) shunt placement; three patients in each group needed VP shunt placement.Conclusions. The technical procedure used to treat aneurysms, whether clipping or embolization, does not significantly affect the development of chronic hydrocephalus. However, a larger sample of patients is needed for accurate comparisons and stronger conclusions.

A positron emission tomography study of cerebrovascular reserve before and after shunt surgery in patients with idiopathic chronic hydrocephalus

1999 ◽  
Vol 91 (4) ◽  
pp. 605-609 ◽  
Author(s):  
Petra M. Klinge ◽  
Georg Berding ◽  
Thomas Brinker ◽  
Wolfram H. Knapp ◽  
Madjid Samii
Keyword(s):  
Positron Emission Tomography ◽  
Emission Tomography ◽  
Chronic Hydrocephalus ◽  
Content Type ◽  
Cerebrovascular Reserve ◽  
Shunt Placement ◽  
Positron Emission ◽  
Group A ◽  
Group B ◽  
Fine Print

Object. In this study the authors use positron emission tomography (PET) to investigate cerebral blood flow (CBF) and cerebrovascular reserve (CVR) in chronic hydrocephalus.Methods. Ten patients whose mean age was 67 ± 10 years (mean ± standard deviation [SD]) were compared with 10 healthy volunteers who were 25 ± 3 years of age. Global CBF and CVR were determined using 15O—H2O and PET prior to shunt placement and 7 days and 7 months thereafter. The CVR was measured using 1 g acetazolamide. Neurological status was assessed based on a score assigned according to the methods of Stein and Langfitt.Seven months after shunt placement, five patients showed clinical improvement (Group A) and five did not (Group B). The average global CBF before shunt deployment was significantly reduced in comparison with the control group (40 ± 8 compared with 61 ± 7 ml/100 ml/minute; mean ± SD, p < 0.01). In Group A the CBF values were significantly lower than in Group B (36 ± 7 compared with 44 ± 8 ml/100 ml/minute; p < 0.05). The CVR before surgery, however, was not significantly different between groups (Group A = 43 ± 21%, Group B = 37 ± 29%). After shunt placement, there was an increase in the CVR in Group A to 52 ± 37% after 7 days and to 68 ± 47% after 7 months (p < 0.05), whereas in Group B the CVR decreased to 14 ± 18% (p < 0.05) after 7 days and returned to the preoperative level (39 ± 6%) 7 months after shunt placement.Conclusions. The preliminary results indicate that a reduced baseline CBF before surgery does not indicate a poor prognosis. Baseline CBF before shunt placement and preoperative CVR are not predictive of clinical outcome. A decrease in the CVR early after shunt placement, however, is related to poor late clinical outcome, whereas early improvement in the CVR after shunt placement indicates a good prognosis.

Paradoxical aggravation of vasospasm with papaverine infusion following aneurysmal subarachnoid hemorrhage

1996 ◽  
Vol 84 (4) ◽  
pp. 690-695 ◽  
Author(s):  
Brent L. Clyde ◽  
Andrew D. Firlik ◽  
Anthony M. Kaufmann ◽  
MichaelP. Spearman ◽  
Howard Yonas
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cerebral Artery ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Artery Aneurysm ◽  
Anterior Communicating Artery ◽  
Left Middle Cerebral Artery ◽  
Xenon Ct ◽  
Content Type ◽  
Symptomatic Vasospasm ◽  
Fine Print

✓ Reports of intraarterial papaverine infusion as treatment for cerebral vasospasm are few and documented complications are uncommon. The authors report the case of a patient with paradoxical aggravation of cerebral arterial narrowing during selective intraarterial papaverine infusion intended to treat vasospasm following aneurysmal subarachnoid hemorrhage (SAH). A 48-year-old man presented to the authors' service with symptomatic vasospasm 10 days after experiencing an SAH. The ruptured anterior communicating artery aneurysm was surgically obliterated the following day, and thereafter maximum hypervolemic and hypertensive therapies were used. However, the patient remained lethargic, and a stable xenon—computerized tomography (CT) cerebral blood flow (CBF) study revealed CBF to be 15 cc/100 g/minute in the left anterior cerebral artery (ACA) and 25 cc/100 g/minute in the right ACA territories. Cerebral arteriography demonstrated diffuse severe left ACA and mild left middle cerebral artery (MCA) vasospasm. In response intraarterial papaverine was infused into the internal carotid artery just proximal to the ophthalmic artery. During the infusion the patient became aphasic and exhibited right hemiplegia. Arteriography performed immediately after the intraarterial papaverine infusion revealed diffuse exacerbation of vasospasm in the distal ACA and MCA territories. A repeat xenon—CT CBF study showed that CBF in the left ACA and the MCA had drastically decreased (2 cc/100 g/minute and 10 cc/100 g/minute, respectively). Despite aggressive management, infarction ultimately developed. This is the first clinical case to illustrate a paradoxical effect of intraarterial papaverine treatment for vasospasm following aneurysmal SAH. The possible mechanisms of this paradoxical response and potential therapeutic reactions are reviewed.

Foreign-body granuloma as a complication of wrapping and coating an intracranial aneurysm

1990 ◽  
Vol 72 (2) ◽  
pp. 292-294 ◽  
Author(s):  
Toshihiko Haisa ◽  
Korehito Matsumiya ◽  
Norio Yoshimasu ◽  
Nobuo Kuribayashi
Keyword(s):  
Foreign Body ◽  
Rare Case ◽  
Internal Carotid ◽  
Artery Aneurysm ◽  
Foreign Body Granuloma ◽  
Content Type ◽  
Carotid Artery Aneurysm ◽  
Internal Carotid Artery Aneurysm ◽  
Aron Alpha ◽  
Fine Print

✓ A rare case is presented in which a foreign-body granuloma developed at the site of muslin wrapping and Aron Alpha A coating of an internal carotid artery aneurysm. The importance of avoiding the use of muslin, especially close to the optic nerve and chiasm, is emphasized.

Early aneurysm recurrence after technically satisfactory Guglielmi detachable coil therapy: is early surveillance needed?

2000 ◽  
Vol 92 (2) ◽  
pp. 355-358 ◽  
Author(s):  
A. Shahram Makoui ◽  
Donald A. Smith ◽  
Avery J. Evans ◽  
David W. Cahill
Keyword(s):  
High Risk ◽  
Artery Aneurysm ◽  
Primary Treatment ◽  
Anterior Communicating Artery ◽  
Detachable Coil ◽  
Content Type ◽  
Anterior Communicating Artery Aneurysm ◽  
Guglielmi Detachable Coil ◽  
Control Angiography ◽  
Fine Print

✓ Guglielmi detachable coil (GDC) therapy was initially intended as a treatment for select patients harboring aneurysms deemed to be at high risk for clip ligation. As experience with the technique has grown, many centers are now offering GDC therapy as a primary treatment to patients who are also good surgical candidates. The authors report a case in which a ruptured anterior communicating artery aneurysm recurred within 2 weeks of a technically satisfactory GDC procedure. The patient subsequently underwent successful surgery for clip ligation of the lesion. This is the earliest reported recurrence of an aneurysm after angiographically confirmed successful GDC therapy and underscores the need for performing early control angiography in patients undergoing this procedure.

Enlargement of an intracranial aneurysm in the eighth decade of life

1985 ◽  
Vol 62 (4) ◽  
pp. 600-602 ◽  
Author(s):  
Ralph G. Dacey ◽  
David Pitkethly ◽  
H. Richard Winn
Keyword(s):  
Elderly Patients ◽  
Intracranial Aneurysms ◽  
Internal Carotid ◽  
Artery Aneurysm ◽  
Content Type ◽  
Carotid Artery Aneurysm ◽  
Internal Carotid Artery Aneurysm ◽  
History Of ◽  
Fine Print ◽  
Eighth Decade

✓ The management of intracranial aneurysms in elderly patients remains controversial, since the natural history of these lesions is not well understood. The authors describe the case of a 76-year-old woman with documented enlargement of an internal carotid artery aneurysm over 3 years. The management of intracranial aneurysms in elderly patients is discussed.

Cognition following subarachnoid hemorrhage from anterior communicating artery aneurysm: relation to timing of surgery

1999 ◽  
Vol 91 (3) ◽  
pp. 402-407 ◽  
Author(s):  
Nahal Mavaddat ◽  
Barbara J. Sahakian ◽  
Peter J. A. Hutchinson ◽  
Peter J. Kirkpatrick
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Temporal Lobe ◽  
Neurological Outcome ◽  
Artery Aneurysm ◽  
Timing Of Surgery ◽  
Anterior Communicating Artery ◽  
Content Type ◽  
Significant Difference ◽  
Favorable Neurological Outcome ◽  
Fine Print

Object. This study was conducted to define neuropsychological changes following operation for subarachnoid hemorrhage (SAH) caused by rupture of an anterior communicating artery (ACoA) aneurysm and to assess the influence of the timing of surgery to clip the aneurysm.Methods. Cognitive outcome was evaluated using the Cambridge Neuropsychological Test Automated Battery in patients with an ACoA aneurysm that had caused an SAH. Adult patients younger than 70 years of age who had achieved a favorable neurological outcome (Glasgow Outcome Scale scores of 4 or 5) were studied 6 to 24 months postsurgery. Patients were divided into early (Days 0–3) and late surgery groups (after Day 3) according to the timing of surgery after the ictus. Neuropsychological analysis was performed by reviewers who were blinded to the timing of surgery.Forty-seven patients whose mean age was 51.5 years were tested. They were compared with age- and intelligence quotient (IQ)—matched controls by using premorbid IQ as estimated on the National Adult Reading Test. Patients showed deficiencies in several tasks of verbal fluency, pattern recognition, and spatial working memory; this profile of deficits was similar to that seen in patients who underwent temporal lobe excisions. However, there was no significant difference in cognitive performance between the early and late surgery groups.Conclusions. After open surgery for ruptured ACoA aneurysms, patients who have achieved a favorable neurological outcome still exhibit significant cognitive deficits, primarily in tests sensitive to temporal lobe dysfunction. However, early surgery does not carry a higher risk of neuropsychological disability.

Traumatic middle meningeal arteriovenous fistula caused by three-point skull fixation

1984 ◽  
Vol 60 (4) ◽  
pp. 853-855 ◽  
Author(s):  
Tetsuji Inagawa ◽  
Tetsuji Takeda ◽  
Haruyoshi Taguchi ◽  
Kazuko Kamiya ◽  
Tohru Yamada
Keyword(s):  
Head Injury ◽  
Arteriovenous Fistula ◽  
Unusual Case ◽  
Artery Aneurysm ◽  
Anterior Communicating Artery ◽  
Content Type ◽  
Av Fistula ◽  
Anterior Communicating Artery Aneurysm ◽  
Av Fistulas ◽  
Fine Print

✓ Traumatic middle meningeal arteriovenous (AV) fistulas usually occur as rare complications of head injury. An unusual case of a middle meningeal AV fistula is presented which resulted from three-point fixation with a skull clamp to stabilize the head during surgery for an anterior communicating artery aneurysm.

Traumatic intracranial aneurysm due to arterial injury at surgery

1983 ◽  
Vol 58 (2) ◽  
pp. 291-294 ◽  
Author(s):  
G. Rees Cosgrove ◽  
Jean-Guy Villemure ◽  
Denis Melançon
Keyword(s):  
Intracranial Aneurysm ◽  
Artery Aneurysm ◽  
Arterial Injury ◽  
Anterior Communicating Artery ◽  
Content Type ◽  
Anterior Communicating Artery Aneurysm ◽  
Traumatic Origin ◽  
Fine Print

✓ A case is presented of false intracranial aneurysm of traumatic origin which developed following direct surgical attack on a congenital anterior communicating artery aneurysm. The secondary aneurysm was discovered on the 25th postoperative day and was clipped at a subsequent procedure. The possible pathophysiology is discussed with respect to other direct vessel injuries.

Congenital anastomosis between the vertebral artery and internal carotid artery in the neck

1979 ◽  
Vol 51 (5) ◽  
pp. 697-699 ◽  
Author(s):  
Dwight Parkinson ◽  
Venkatesha Reddy ◽  
R. T. Ross
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Vertebral Artery ◽  
Rare Case ◽  
Internal Carotid ◽  
Artery Aneurysm ◽  
Anterior Communicating Artery ◽  
Content Type ◽  
Anterior Communicating Artery Aneurysm ◽  
Fine Print

✓ A rare case of anastomosis between the vertebral artery and the internal carotid artery in the neck of a patient with an anterior communicating artery aneurysm is reported.

Endoscopic third ventriculostomy in patients with cerebrospinal fluid infection and/or hemorrhage

2002 ◽  
Vol 97 (3) ◽  
pp. 519-524 ◽  
Author(s):  
Vitaly Siomin ◽  
Giuseppe Cinalli ◽  
Andre Grotenhuis ◽  
Aprajay Golash ◽  
Shizuo Oi ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Success Rate ◽  
Endoscopic Third Ventriculostomy ◽  
Aqueductal Stenosis ◽  
Third Ventriculostomy ◽  
Content Type ◽  
Vp Shunt ◽  
Shunt Placement ◽  
History Of ◽  
Fine Print

Object. In this study the authors evaluate the safety, efficacy, and indications for endoscopic third ventriculostomy (ETV) in patients with a history of subarachnoid hemorrhage or intraventricular hemorrhage (IVH) and/or cerebrospinal fluid (CSF) infection. Methods. The charts of 101 patients from seven international medical centers were retrospectively reviewed; 46 patients had a history of hemorrhage, 42 had a history of CSF infection, and 13 had a history of both disorders. All patients experienced third ventricular hydrocephalus before endoscopy. The success rate for treatment in these three groups was 60.9, 64.3, and 23.1%, respectively. The follow-up period in successfully treated patients ranged from 0.6 to 10 years. Relatively minor complications were observed in 15 patients (14.9%), and there were no deaths. A higher rate of treatment failure was associated with three factors: classification in the combined infection/hemorrhage group, premature birth in the posthemorrhage group, and younger age in the postinfection group. A higher success rate was associated with a history of ventriculoperitoneal (VP) shunt placement before ETV in the posthemorrhage group, even among those who had been born prematurely, who were otherwise more prone to treatment failure. The 13 premature infants who had suffered an IVH and who had undergone VP shunt placement before ETV had a 100% success rate. The procedure was also successful in nine of 10 patients with primary aqueductal stenosis. Conclusions. Patients with obstructive hydrocephalus and a history of either hemorrhage or infection may be good candidates for ETV, with safety and success rates comparable with those in more general series of patients. Patients who have sustained both hemorrhage and infection are poor candidates for ETV, except in selected cases and as a treatment of last resort. In patients who have previously undergone shunt placement posthemorrhage, ETV is highly successful. It is also highly successful in patients with primary aqueductal stenosis, even in those with a history of hemorrhage or CSF infection.

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