scholarly journals Risk of Dependency Following Microsurgical Clipping in Good Grade Patients With Ruptured Anterior Circulation Aneurysms

2021 ◽  
Vol 7 (1) ◽  
pp. 49-56
Author(s):  
Sundus Ali ◽  
◽  
Fauzia Sajjad ◽  
Asif Shabbir ◽  
Akmal Azeemi ◽  
...  
Keyword(s):  
Surgical Techniques ◽  
Neurological Deficits ◽  
Anterior Circulation ◽  
Microsurgical Clipping ◽  
Operative Complications ◽  
Good Grade ◽  
Intraoperative Rupture ◽  
The Impact ◽  
Anterior Circulation Aneurysms

Background and Aim: Most good grade (WFNS I and II) patients who undergo microsurgical clipping achieve a favorable outcome. However, some independent patients before surgery face unfavorable outcomes after the operation, signifying the impact of microsurgical clipping. This study aimed to identify the risk of developing dependency in patients without previous neurological deficits. Methods and Materials/Patients: We reviewed 50 consecutive good grade patients with ruptured anterior circulation aneurysms who underwent microsurgical clipping between May 2017 and May 2020 in the Department of Neurosurgery, Punjab Institute of Neurosciences, Lahore, Pakistan. The clinical outcome at discharge and three months follow-up was assessed using the Glasgow Outcome Scale (GOS). Results: In this study, seven patients (14%) became dependent (GOS II and III) following clipping. Of whom, five patients (10%) suffered surgical insult in the form of intraoperative rupture (4%), post-op infarct (4%), and direct brain damage (2%). Conclusion: Patients without neurologic deficit pre-operatively still suffer unfavorable outcomes mainly due to operative complications. Vascular injuries remain the main cause of morbidity-producing dependency. Therefore, all surgical techniques must minimize the risk to vessels, both during dissection and at clip placement.

scholarly journals Microsurgical clipping of the anterior circulation aneurysms

2018 ◽  
Vol 20 (4) ◽  
pp. 409-414
Author(s):  
Carlos Eduardo Da Silva ◽  
Paulo Eduardo Peixoto De Freitas ◽  
Alicia Del Carmen Becerra Romero ◽  
Fáberson João Mocelin Oliveira ◽  
Márcio Aloisio Bezerra Cavalcanti Rockenbach ◽  
...  
Keyword(s):  
Relevant Literature ◽  
Cerebral Aneurysms ◽  
Series Data ◽  
Anterior Communicating Artery ◽  
Anterior Circulation ◽  
Ruptured Aneurysms ◽  
Microsurgical Clipping ◽  
The Mean ◽  
Anterior Circulation Aneurysms

Introduction: The authors present the analysis of the microsurgical clipping of 100 cerebral aneurysms of the anterior circulation and compare the series data with the literature. Methods: Eighty-eight patients presenting with 100 anterior circulation aneurysms operated on microsurgical techniques between 2002 and 2008 by the first author (CES) were retrospectively reviewed. Results: A total of 88 patients with 100 aneurysms of the anterior circulation were treated in a six years period. Fifty eight female (66%) and thirty male (34%) with nine patients (10.2%) presenting with multiple aneurysms. The mean age was 52 years (range from 26 to 76 years). Eighty five percent of the cases were ruptured aneurysms. The mean follow-up was 52.4 months (range from 5 to 76 months). The topography of the aneurysms was distributed as it follows: Anterior communicating artery (ACoA) 25%; posterior communicating artery (p-comm) 29%; middle cerebral artery (MCA) 27%; paraclinoidal aneurysms 8%; pericallosal artery 6% and internal carotid artery (ICA) tip 5%. The mortality was 7.9%, and such cases presenting with Hunt Hess graduation 3 and 4. The permanent morbidity was 4.5%, cases with Hunt Hess graduation 3 and 4. Perioperative rupture occurred in 17% of the cases, only in previous ruptured aneurysms. There was no clinical evidence of rebleeding during the follow-up period of the series. Conclusions: The microsurgical clipping of cerebral aneurysms of the anterior circulation is a safe and curative treatment for most of such lesions. At present, studies suggest evidences of superior results of surgery compared to the endovascular techniques in the rates of total occlusion of the aneurysms, lesser rates of rebleeding of the treated cases. The results of the present series are similar to the rates of the most relevant literature.

Abstract P568: Incidence and Progression of Posterior Circulation Involvement in Moyamoya Disease

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Yiping Li ◽  
Allan R Wang ◽  
Gary K STEINBERG
Keyword(s):  
Moyamoya Disease ◽  
Functional Outcomes ◽  
Posterior Circulation ◽  
External Carotid ◽  
Collateral Flow ◽  
Anterior Circulation ◽  
Bilateral Disease ◽  
Operative Complications ◽  
The Impact

Introduction: The incidence and natural history of posterior circulation moyamoya disease (PCMMD) is not well-characterized. Methods: Consecutive patients with moyamoya disease prospectively treated at our institution from 2015-2018 were reviewed. Results: 262 consecutive patients with moyamoya disease undergoing 370 revascularization procedures were enrolled. Concurrent PCMMD was identified in 68 (26%) patients – all of which were confined to the anterior circulation. There were no differences in age, sex, race, or rates of diabetes, hypertension, smoking, or symptoms upon presentation between patients with or without PCMMD. Patients with PCMMD were more likely to present with bilateral disease (p<0.001), higher Suzuki grade (p=0.001), more extensive collateral angiopathy (p<0.001), and pial-pial collaterals from the PCA territory (p=0.03). Patients with PCMMD were more likely to suffer from ischemic peri-operative complications in both the anterior (p=0.03) and posterior (p<0.001) circulation territories after anterior circulation revascularization. No differences were observed for hemorrhagic complications (p=1.0). Over a mean follow-up of 1.91±1.5 years, 19 (7.3%) developed new or progressive PCMMD. Patients with PCMMD progression had an Asian predilection and were less likely to present with sentinel symptoms such as headaches (p=0.05 and 0.01 respectively). Patients with bilateral disease (p=0.02), higher Suzuki (p<0.001) and collateral angiopathy grades (p=0.002), and more extensive external carotid artery supply (p=0.03) were also more likely to experience PCMMD progression. There was no association between PCMMD progression and delayed neurological events or functional outcomes, but patients with concurrent PCMMD upon presentation were associated with poor functional outcome (mRS >2) at last follow-up (p=0.02). Conclusions: Posterior circulation disease involvement often presents in the later stages of moyamoya and is associated with higher rates of ischemic peri-operative complications and poor functional outcomes likely due to reduced collateral flow. Progression of PCMMD is not uncommon. Future studies are needed to assess the impact of PCMMD progression on long-term outcomes.

scholarly journals Outcome of Microsurgical Clipping of Ruptured Anterior Circulation Aneurysms

2019 ◽  
Vol 23 (4) ◽  
Author(s):  
MUHAMMAD JAHANGIR KHAN ◽  
MUHAMMAD HAMMAD NASIR ◽  
SIKANDAR ALI ◽  
SARFRAZ KHAN ◽  
MUHAMMAD WAQAS ◽  
...  
Keyword(s):  
Anterior Communicating Artery ◽  
Sex Distribution ◽  
Surgical Clipping ◽  
Anterior Circulation ◽  
Efficient Treatment ◽  
Microsurgical Clipping ◽  
The Mean ◽  
Anterior Circulation Aneurysms ◽  
Grading Scales

Objective: The objective of the study was to analyze the operative outcome of microsurgical clipping in Ruptured Anterior Circulation Aneurysms.Materials and Methods: Twenty patients with Ruptured Anterior Circulation aneurysms were treated with surgical clipping. All the patients were evaluated pre-operatively according to Hunt & Hess and WFNS grading scales. Patients with grade I, II, and III were operated. All the aneurysms were clipped through Pterional approach under General anesthesia and Yasargil Aneurysm clips of appropriate sizes were used in each patient. Outcome was analyzed according to Glasgow Outcome Scale at the end of six months of follow up in each patient.Results: In this series of twenty cases, the mean patient age was 49 years. Lesion location included, the ACA/A. Com 55% (n = 11), the Middle Cerebral artery 25% (n = 5), P. Com 15% (n = 3), Ophthalmic artery 5% (n = 1). Sex distribution, female 55% (n = 11) and male 45% (n = 9). Per-operative complications, rupture of aneurysm 20% (n = 4), and damage to perforating branches of MCA 5% (n = 1). Conclusions: Surgical clipping still is the most efficient treatment of Ruptured Anterior Circulation aneurysm at the beginning of the new millennium. Anterior Communicating Artery is the commonest location of aneurysms. Major determinants of outcome are Hunt & Hess, WFNS grades on admission and the age of the patient.

Does the impact of elective temporary clipping on intraoperative rupture really influence neurological outcome after surgery for ruptured anterior circulation aneurysms?—A prospective multivariate study

2012 ◽  
Vol 155 (2) ◽  
pp. 237-246 ◽  
Author(s):  
Sivashanmugam Dhandapani ◽  
Sudhir S. Pal ◽  
Sunil K. Gupta ◽  
Sandeep Mohindra ◽  
Rajesh Chhabra ◽  
...  
Keyword(s):  
Neurological Outcome ◽  
Anterior Circulation ◽  
Multivariate Study ◽  
Intraoperative Rupture ◽  
The Impact ◽  
Temporary Clipping ◽  
Anterior Circulation Aneurysms

scholarly journals Intraaneurysmal Embolization for Wide-Necked Aneurysms Remodeling Technique, Combined Neck-Clipping and Coiling Therapy, Scaffolding Technique

2000 ◽  
Vol 6 (1_suppl) ◽  
pp. 95-101 ◽  
Author(s):  
T. Nakahara ◽  
T. Hidaka ◽  
M. Kutsuna ◽  
M. Yamanaka ◽  
K. Sakoda
Keyword(s):  
Endovascular Treatment ◽  
Neurological Deficits ◽  
Circulation System ◽  
Parent Artery ◽  
Anterior Circulation ◽  
Detachable Coil ◽  
Obliteration Rate ◽  
Guglielmi Detachable Coil ◽  
Scaffolding Technique

We reported the results of the endovascular treatment using Guglielmi detachable coil (GDC) for wide-necked aneurysms. Fourteen aneurysms were treated with remodeling technique. One aneurysm was performed endovascular treatment followed by partial neck clipping. The other was treated with scaffolding technique. All aneurysms could not be performed by conventional GDC treatment initially because of coil protrusion into the parent artery due to wide neck of these aneurysms. These aneurysms sited at anterior circulation system in 10 cases, and at posterior circulation system in 6 cases. Immediately after the procedure, the obliteration rate could be obtained complete occlusion in 3 cases, > 95% occlusion in 7 cases, > 90% occlusion in 3 cases and < 90% occlusion in 3 cases. In 14 patients follow-up angiography or magnetic resonance image (MRI) was carried out. The angiographic follow-up period is range from 2 to 19 months (mean: 10 months). The results of angiographical follow-up indicated increasing obliteration rate with all aneurysms except for 2 cases. In these 2 cases, the reembolization was needed for recanalization of the aneurysm. The clinical follow-up period is range form one to 26 months (mean: 15 months). There is no evidence of aneurysmal rupture and all cases have been survival without any permanent neurological deficits. The GDC treatment with additional technique (remodeling technique, combined neck-clipping and coiling therapy, scaffolding technique) provides safety and effectiveness, even if there are wide-necked aneurysms.

Transpalpebral Approach “Eyelid Incision” for Surgical Treatment of Intracerebral Aneurysms: Lessons Learned During a 10-Year Experience

2019 ◽  
Author(s):  
Gordon Mao ◽  
Michael Gigliotti ◽  
Khaled Aziz ◽  
Khaled Aziz
Keyword(s):  
Wound Healing ◽  
Artery Aneurysm ◽  
Postoperative Hemorrhage ◽  
Lessons Learned ◽  
Anterior Circulation ◽  
Upper Eyelid ◽  
Complete Obliteration ◽  
Cosmetic Outcomes ◽  
Anterior Circulation Aneurysms

Abstract BACKGROUND The classic pterional, pretemporal, and orbitozygomatic approaches achieve large areas of exposure with easy maneuverability. In select cases (eg, some anterior circulation aneurysms), the minimally invasive fronto-orbital craniotomy can yield adequate exposure that must be balanced with its risk of frontalis injury. OBJECTIVE To detail a 10-yr experience using the transpalpebral approach, characterized by an incision whose camouflage is the natural eyelid crease, notably the effectiveness and outcomes of this exposure for anterior circulation aneurysms. METHODS In this retrospective review, 82 patients with 88 aneurysms underwent a supraorbital frontal minicraniotomy via the eyelid incision performed by a single neurosurgeon and closure by an oculoplastic surgeon (2007-2016). Incision of the orbiculi oculi developed a plane between the muscle and orbital septum superiorly. Outcomes recorded included aneurysm occlusion or residual, treatment modality (clipping/wrapping), postoperative hemorrhage or stroke, postoperative wound healing, and overall cosmesis. RESULTS Of 85 (97%) aneurysms treated by clipping, postoperative and follow-up imaging showed complete obliteration in 81 (95%) aneurysms and residuals in 4 (5%). Cosmetic outcomes for the eyelid incision were excellent: 81 (99%) patients noted excellent wound healing at follow-up and no scarring; 1 patient developed significant temporalis wasting and upper eyelid scarring after posterior communicating artery aneurysm clipping. Overall, 13 minor and 8 major complications affected 19 patients. CONCLUSION Our findings confirm the versatility of the eyelid supraorbital frontal minicraniotomy for common anterior circulation aneurysms. This large series found that postoperative complication risks were similar to traditional techniques and cosmetic results were excellent.

Clinical Efficacy Between Microsurgical Clipping and Endovascular Coiling in the Treatment of Ruptured Poor-Grade Anterior Circulation Aneurysms

2019 ◽  
Vol 127 ◽  
pp. e321-e329
Author(s):  
Jie Shen ◽  
Kaiyuan Huang ◽  
Jian Shen ◽  
Yu Zhu ◽  
Hao Jiang ◽  
...  
Keyword(s):  
Clinical Efficacy ◽  
Endovascular Coiling ◽  
Anterior Circulation ◽  
Poor Grade ◽  
Microsurgical Clipping ◽  
Anterior Circulation Aneurysms

The Functional Endoscopic Approach to Inflammatory Sinus Disease: Current Perspectives and Technique Modifications

1988 ◽  
Vol 2 (3) ◽  
pp. 89-96 ◽  
Author(s):  
David W. Kennedy ◽  
S. James Zinreich
Keyword(s):  
Computed Tomography ◽  
Surgical Techniques ◽  
The United States ◽  
Endoscopic Examination ◽  
Lessons Learned ◽  
Current Status ◽  
Sinus Disease ◽  
Technical Modifications ◽  
The Impact

Endoscopic examination and pleuridirectional polytomography provided some important insights into the pathogenesis of inflammatory sinus disease. These insights have been further refined by the increasing utilization of endoscopy in medical therapy and surgical follow-up, and by the use of computed tomography for diagnosis. The aim of this paper is to review the current status of the diagnosis of chronic inflammatory sinus disease and of functional endoscopic surgical techniques. The impact of this approach on previously held theoretical and diagnostic concepts is evaluated. Technical modifications made since the surgery was first introduced in the United States and the lessons learned from close postsurgical endoscopic examination are presented.

CyberKnife frameless single-fraction stereotactic radiosurgery for benign tumors of the spine

2003 ◽  
Vol 14 (5) ◽  
pp. 1-5 ◽  
Author(s):  
Peter C. Gerszten ◽  
Cihat Ozhasoglu ◽  
Steven A. Burton ◽  
William J. Vogel ◽  
Barbara A. Atkins ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Tumor Volume ◽  
Surgical Techniques ◽  
Outpatient Setting ◽  
Neurological Deficits ◽  
Benign Tumors ◽  
Minimal Risk ◽  
Single Fraction ◽  
Spinal Lesions

Object The role of stereotactic radiosurgery in the treatment of benign intracranial lesions is well established. Its role in the treatment of benign spinal lesions is more limited. Benign spinal lesions should be amenable to radiosurgical treatment similar to their intracranial counterparts. In this study the authors evaluated the effectiveness of the CyberKnife for benign spinal lesions involving a single-fraction radiosurgical technique. Methods The CyberKnife is a frameless radiosurgery system in which an orthogonal pair of x-ray cameras is coupled to a dynamically manipulated robot-mounted linear accelerator possessing six degrees of freedom, whereby the therapy beam is guided to the intended target without the use of frame-based fixation. Cervical spine lesions were located and tracked relative to skull osseous landmarks; lower spinal lesions were tracked relative to percutaneously placed fiducial bone markers. Fifteen patients underwent single-fraction radiosurgery (12 cervical, one thoracic, and two lumbar). Histological types included neurofibroma (five cases), paraganglioma (three cases), schwannoma (two cases), meningioma (two cases), spinal chordoma (two cases), and hemangioma (one case). Radiation dose plans were calculated based on computerized tomography scans acquired using 1.25-mm slices. Planning treatment volume was defined as the radiographic tumor volume with no margin. The tumor dose was maintained at 12 to 20 Gy to the 80% isodose line (mean 16 Gy). Tumor volume ranged from 0.3 to 29.3 ml (mean 6.4 ml). Spinal canal volume receiving more than 8 Gy ranged from 0.0 to 0.9 ml (mean 0.2 ml). All patients tolerated the procedure in an outpatient setting. No acute radiation-induced toxicity or new neurological deficits occurred during the follow-up period. Pain improved in all patients who were symptomatic prior to treatment. No tumor progression has been documented on follow-up imaging (mean 12 months). Conclusions Spinal stereotactic radiosurgery was found to be feasible, safe, and effective for the treatment of benign spinal lesions. Its major potential benefits are the relatively short treatment time in an outpatient setting and the minimal risk of side effects. This new technique offers an alternative therapeutic modality for the treatment of a variety of benign spinal neoplasms in cases in which surgery cannot be performed, in cases with previously irradiated sites, and in cases involving lesions not amenable to open surgical techniques or as an adjunct to surgery.

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