The risk of rupture of unruptured cerebral aneurysms in the Japanese population: a systematic review of the literature from Japan by Morita, et al.

2005 ◽  
Vol 102 (4) ◽  
pp. 597-598 ◽  
Author(s):  
David O. Wiebers
Keyword(s):  
Systematic Review ◽  
Japanese Population ◽  
Cerebral Aneurysms ◽  
Review Of The Literature ◽  
Risk Of Rupture ◽  
Unruptured Cerebral Aneurysms

scholarly journals Prediction of Thin-Walled Areas of Unruptured Cerebral Aneurysms through Comparison of Normalized Hemodynamic Parameters and Intraoperative Images

2018 ◽  
Vol 2018 ◽  
pp. 1-9
Author(s):  
Kwang-Chun Cho ◽  
Ji Hun Choi ◽  
Je Hoon Oh ◽  
Yong Bae Kim
Keyword(s):  
Interaction Analysis ◽  
Cerebral Aneurysms ◽  
Weighted Average ◽  
Weighting Factor ◽  
Hemodynamic Parameters ◽  
Color Analysis ◽  
Risk Of Rupture ◽  
Thin Walled ◽  
Unruptured Cerebral Aneurysms ◽  
Normalization Scheme

Object. Rupture of a cerebral aneurysm occurs mainly in a thin-walled area (TWA). Prediction of TWAs would help to assess the risk of rupture and select appropriate treatment strategy. There are several limitations of current prediction techniques for TWAs. To predict TWAs more accurately, HP should be normalized to minimize the influence of analysis conditions, and the effectiveness of normalized, combined hemodynamic parameters (CHPs) should be investigated with help of the quantitative color analysis of intraoperative images. Methods. A total of 21 unruptured cerebral aneurysms in 19 patients were analyzed. A normalized CHP was newly suggested as a weighted average of normalized wall shear stress (WSS) and normalized oscillatory shear index (OSI). Delta E from International Commission on Illumination was used to more objectively quantify color differences in intraoperative images. Results. CFD analysis results indicated that WSS and OSI were more predictive of TWAs than pressure (P<.001, P=.187, P=.970, respectively); these two parameters were selected to define the normalized CHP. The normalized CHP became more statistically significant (P<.001) as the weighting factor of normalized WSS increased and that of normalized OSI decreased. Locations with high CHP values corresponded well to those with high Delta E values (P<.001). Predicted TWAs based on the normalized CHP showed a relatively good agreement with intraoperative images (17 in 21 cases, 81.0%). Conclusion. 100% weighting on the normalized WSS produced the most statistically significant result. The normalization scheme for WSS and OSI suggested in this work was validated using quantitative color analyses, rather than subjective judgments, of intraoperative images, and it might be clinically useful for predicting TWAs of unruptured cerebral aneurysms. The normalization scheme would also be integrated into further fluid-structure interaction analysis for more reliable estimation of the risk of aneurysm rupture.

Natural history and general management of unruptured intracranial aneurysms

2004 ◽  
Vol 17 (5) ◽  
pp. 1-6 ◽  
Author(s):  
Peng Roc Chen ◽  
Kai Frerichs ◽  
Robert Spetzler
Keyword(s):  
Natural History ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Cerebral Aneurysms ◽  
Population Based ◽  
Unruptured Aneurysms ◽  
Unruptured Intracranial Aneurysms ◽  
Risk Of Rupture ◽  
History Of ◽  
Unruptured Cerebral Aneurysms ◽  
Noninvasive Neuroimaging

After an aneurysmal subarachnoid hemorrhage, nearly half of the patients die and the half who survive suffer from irreversible cerebral damage. With increasing use of noninvasive neuroimaging techniques (for example, magnetic resonance and computerized tomography angiography), more unruptured cerebral aneurysms are found. To understand the prevalence of unruptured aneurysms in the general population, along with the risks of aneurysm formation, data on growth and rupture rates are crucial. The risk of rupture in aneurysms smaller than 10 mm is still not quite clear without a population-based prospective study. Nevertheless, a 0.5 to 2% annual risk may be a reasonable estimate. Growing aneurysms and those larger than 10 mm carry a higher rate of rupture. The management of an unruptured intracranial aneurysm should be based on a thorough understanding of the natural history of these lesions and careful evaluation of the morbidity and mortality levels associated with each treatment option.

Residual Cerebral Aneurysms After Microsurgical Clipping: A New Scale, an Agreement Study, and a Systematic Review of the Literature

2019 ◽  
Vol 121 ◽  
pp. e302-e321 ◽  
Author(s):  
Marc Kotowski ◽  
Behzad Farzin ◽  
Robert Fahed ◽  
François Guilbert ◽  
Miguel Chagnon ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cerebral Aneurysms ◽  
Review Of The Literature ◽  
Microsurgical Clipping ◽  
Agreement Study

Geometry Anticipates Hemodynamic Phenotype of Basilar Tip Aneurysms

2007 ◽  
Author(s):  
Matthew D. Ford ◽  
Sang-Wook Lee ◽  
Stephen P. Lownie ◽  
David W. Holdsworth ◽  
David A. Steinman
Keyword(s):  
Endovascular Therapy ◽  
Cerebral Aneurysms ◽  
Patient Specific ◽  
Clinical Use ◽  
Hemodynamic Forces ◽  
Risk Of Rupture ◽  
Specific Manner ◽  
Computational Fluid Dynamics Cfd ◽  
Unruptured Cerebral Aneurysms ◽  
Hemodynamic Information

The prevalence of unruptured cerebral aneurysms is estimated to be as high as 5% [1]. Basilar tip aneurysms account for 4–5% of these, but have a higher risk of rupture [2]. They are also difficult to treat surgically, and so endovascular therapy is often the only option. Hemodynamic forces have been implicated in the risk of rupture [3] and complications of endovascular therapy [4]; however, hemodynamic information is difficult to acquire clinically. Computational fluid dynamics (CFD), in combination with clinical imaging, can be used to accurately capture the intra-aneurysmal hemodynamics in a patient-specific manner [5]. Still, these techniques have not translated to routine clinical use, largely due to the time and effort required to construct, simulate, and interpret these models.

Risk of rupture associated with intact cerebral aneurysms in the Japanese population: a systematic review of the literature from Japan

2005 ◽  
Vol 102 (4) ◽  
pp. 601-606 ◽  
Author(s):  
Akio Morita ◽  
Satoru Fujiwara ◽  
Kazuo Hashi ◽  
Hiroshi Ohtsu ◽  
Takaaki Kirino
Keyword(s):  
Cohort Studies ◽  
Japanese Population ◽  
Large Scale ◽  
Cerebral Aneurysms ◽  
Natural Course ◽  
High Rate ◽  
Rupture Risk ◽  
Content Type ◽  
Risk Of Rupture ◽  
Fine Print

Object. Knowing the rate of rupture associated with unruptured cerebral aneurysms (UCAs) can help surgeons determine a case management strategy in patients harboring these lesions. According to large-scale cohort studies involving populations in North America and Europe, small unruptured aneurysms carry a very low risk of rupture. In Japan, however, there have been sporadic reports of higher rates of rupture. To identify the rupture risk associated with UCAs in the Japanese population, the authors systematically reviewed retrospective studies of the natural course of these lesions. Methods. The authors searched Medline and the Japan Medical Abstract Society Index for reports of UCAs in Japan. Two of the authors verified the eligibility of the reports and extracted data independently. Additional information was directly obtained from the authors of the original reports. Thirteen reports covering a total of 3801 patient-years fulfilled the criteria for our study. Subsequent rupture was documented in 104 patients and the annual rupture rate was 2.7% (95% confidence interval 2.2–3.3%). Large, posterior-circulation, and symptomatic aneurysms were associated with significantly higher rates of rupture (relative risks 6.4, 2.3, and 2.1, respectively). The risk of rupture determined by the authors' review was significantly higher than that reported by investigators from international cohort studies. Conclusions. Although a selection bias of patients may be the cause of the higher rupture risk, untreated UCAs that have been followed in Japanese institutions have a considerably high rate of rupture. The natural course of UCAs should be carefully estimated in countries not included in the international studies.

Determining the Presence of Thin-Walled Regions at High-Pressure Areas in Unruptured Cerebral Aneurysms by Using Computational Fluid Dynamics

Neurosurgery ◽  
2016 ◽  
Vol 79 (4) ◽  
pp. 589-595 ◽  
Author(s):  
Tomoaki Suzuki ◽  
Hiroyuki Takao ◽  
Takashi Suzuki ◽  
Yukinao Kambayashi ◽  
Mitsuyoshi Watanabe ◽  
...  
Keyword(s):  
Fluid Dynamics ◽  
Computational Fluid Dynamics ◽  
High Pressure ◽  
Dynamic Pressure ◽  
Cerebral Aneurysms ◽  
Maximum Pressure ◽  
Pressure Elevation ◽  
Risk Of Rupture ◽  
Thin Walled ◽  
Unruptured Cerebral Aneurysms

Abstract BACKGROUND Thin-walled regions (TWRs) of cerebral aneurysms are at high risk of rupture, and careful attention should be paid during surgical procedures. Despite this, an optimal imaging technique to estimate TWRs has not been established. Previously, pressure elevation at TWRs was reported with computational fluid dynamics (CFD) but not fully evaluated. OBJECTIVE To investigate the possibility of predicting aneurysmal TWRs at high-pressure areas with CFD. METHODS Fifty unruptured middle cerebral artery aneurysms were analyzed. Spatial and temporal maximum pressure (Pmax) areas were determined with a fluid-flow formula under pulsatile blood flow conditions. Intraoperatively, TWRs of aneurysm domes were identified as reddish areas relative to the healthy normal middle cerebral arteries; 5 neurosurgeons evaluated and divided these regions according to Pmax area and TWR correspondence. Pressure difference (PD) was defined as the degree of pressure elevation on the aneurysmal wall at Pmax and was calculated by subtracting the average pressure from the Pmax and dividing by the dynamic pressure at the aneurysm inlet side for normalization. RESULTS In 41 of the 50 cases (82.0%), the Pmax areas and TWRs corresponded. PD values were significantly higher in the correspondence group than in the noncorrespondence group (P = .008). A receiver-operating characteristic curve demonstrated that PD accurately predicted TWRs at Pmax areas (area under the curve, 0.764; 95% confidence interval, 0.574-0.955; cutoff value, 0.607; sensitivity, 66.7%; specificity, 82.9%). CONCLUSION A high PD may be a key parameter for predicting TWRs in unruptured cerebral aneurysms.

scholarly journals Risk of rupture of unruptured cerebral aneurysms in elderly patients

Neurology ◽  
2015 ◽  
Vol 85 (21) ◽  
pp. 1879-1885 ◽  
Author(s):  
Tomohito Hishikawa ◽  
Isao Date ◽  
Koji Tokunaga ◽  
Shinjiro Tominari ◽  
Kazuhiko Nozaki ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Cerebral Aneurysms ◽  
Risk Of Rupture ◽  
Unruptured Cerebral Aneurysms

Risk of rupture of unruptured cerebral aneurysms in elderly patientsAuthor Response

Neurology ◽  
2016 ◽  
Vol 86 (17) ◽  
pp. 1650-1650 ◽  
Author(s):  
Tomoyuki Kawada ◽  
Tomohito Hishikawa ◽  
Isao Date ◽  
Shinjiro Tominari ◽  
Akio Morita
Keyword(s):  
Cerebral Aneurysms ◽  
Risk Of Rupture ◽  
Unruptured Cerebral Aneurysms

Telepractice for Adult Speech-Language Pathology Services: A Systematic Review

2020 ◽  
Vol 5 (1) ◽  
pp. 326-338 ◽  
Author(s):  
Kristen Weidner ◽  
Joneen Lowman
Keyword(s):  
Systematic Review ◽  
Primary Progressive Aphasia ◽  
Future Research ◽  
Service Delivery Model ◽  
Speech Language Pathology ◽  
Review Of The Literature ◽  
Research Designs ◽  
Assessment And Treatment ◽  
Language Pathology ◽  
Screening Assessment

Purpose We conducted a systematic review of the literature regarding adult telepractice services (screening, assessment, and treatment) from approximately 2014 to 2019. Method Thirty-one relevant studies were identified from a literature search, assessed for quality, and reported. Results Included studies illustrated feasibility, efficacy, diagnostic accuracy, and noninferiority of various speech-language pathology services across adult populations, including chronic aphasia, Parkinson's disease, dysphagia, and primary progressive aphasia. Technical aspects of the equipment and software used to deliver services were discussed. Some general themes were noted as areas for future research. Conclusion Overall, results of the review continue to support the use of telepractice as an appropriate service delivery model in speech-language pathology for adults. Strong research designs, including experimental control, across multiple well-described settings are still needed to definitively determine effectiveness of telepractice services.

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