scholarly journals Surgical Clipping of Previously Coiled Recurrent Intracranial Aneurysms: A Single-Center Experience

2021 ◽  
Vol 12 ◽  
Author(s):  
Yongtao Zheng ◽  
Lili Zheng ◽  
Yuhao Sun ◽  
Dong Lin ◽  
Baofeng Wang ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Surgical Techniques ◽  
Mass Effect ◽  
Aneurysm Rupture ◽  
Surgical Clipping ◽  
Single Center Experience ◽  
Neurological Morbidity ◽  
Different Types ◽  
Coil Migration

Objective: This study reviews our experiences in surgical clipping of previously coiled aneurysms, emphasizing on recurrence mechanism of intracranial aneurysms (IAs) and surgical techniques for different types of recurrent IAs.Method: We performed a retrospective study on 12 patients who underwent surgical clipping of aneurysms following endovascular treatment between January 2010 and October 2020. The indications for surgery, surgical techniques, and clinical outcomes were analyzed.Result: Twelve patients with previously coiled IAs were treated with clipping in this study, including nine females and three males. The reasons for the patients having clipping were as follows: early surgery (treatment failure in two patients, postoperative early rebleeding in one patient, and intraprocedural aneurysm rupture during embolization in one patient) and late surgery (aneurysm recurrence in five patients, SAH in one, mass effect in one, and aneurysm regrowth in one). All aneurysms were clipped directly, and coil removal was performed in four patients. One patient died (surgical mortality, 8.3%), 1 patient (8.3%) experienced permanent neurological morbidity, and the remaining 10 patients (83.4%) had good outcomes. Based on our clinical data and previous studies, we classified the recurrence mechanism of IAs into coil compaction, regrowth, coil migration, and coil loosening. Then, we elaborated the specific surgical planning and timing of surgery depending on the recurrence type of IAs.Conclusion: Surgical clipping can be a safe and effective treatment strategy for the management of recurrent coiled IAs, with acceptable morbidity and mortality in properly selected cases. Our classification of recurrent coiled aneurysms into four types helps to assess the optimal surgical approach and the associated risks in managing them.

Complications After Treatment With Pipeline Embolization for Giant Distal Intracranial Aneurysms With or Without Coil Embolization

Neurosurgery ◽  
2012 ◽  
Vol 71 (2) ◽  
pp. E509-E513 ◽  
Author(s):  
Adnan H. Siddiqui ◽  
Peter Kan ◽  
Adib A. Abla ◽  
L. Nelson Hopkins ◽  
Elad I. Levy
Keyword(s):  
Basilar Artery ◽  
Coil Embolization ◽  
Intracranial Aneurysms ◽  
Artery Aneurysm ◽  
Mass Effect ◽  
Flow Diverter ◽  
Aneurysm Rupture ◽  
Parent Vessel ◽  
Acute Thrombosis ◽  
Vessel Reconstruction

Abstract BACKGROUND AND IMPORTANCE: The Pipeline Embolization Device (PED) is a flow diverter designed to treat intracranial aneurysms through endoluminal parent vessel reconstruction. The role of adjunctive coil embolization is unknown. CLINICAL PRESENTATION: This report details the authors' experience with the PED in 2 patients with symptomatic, giant distal intracranial aneurysms (1 basilar artery and 1 M1 segment middle cerebral artery). Both patients had successful parent vessel reconstruction. In the first patient, the basilar artery aneurysm was treated with PEDs alone, and the patient experienced early fatal brainstem hemorrhage from aneurysm rupture. In the second patient, the M1 aneurysm was treated with 2 PEDs along with dense coil embolization, with a good initial angiographic result. This patient experienced acute thrombosis of the PED post-procedure, likely related to mass effect and thrombogenicity of the dense coil mass. CONCLUSION: Flow diversion is an evolutionary step in the treatment of giant intracranial aneurysms. However, complete aneurysm occlusion occurs over a delayed period. The authors recommend placement of coils in addition to PED in the treatment of large or giant distal intracranial aneurysms in an attempt to protect the dome. However, robust packing is to be avoided because it can lead to acute PED thrombotic or compressive occlusion.

Pitfalls of GDC Embolisation of Intracranial Aneurysms

1998 ◽  
Vol 4 (3) ◽  
pp. 231-240 ◽  
Author(s):  
F. Mena ◽  
F. Viñuela ◽  
G. Duckwiler ◽  
Y.P. Gobin ◽  
Y. Murayama ◽  
...  
Keyword(s):  
Critical Analysis ◽  
Intracranial Aneurysms ◽  
Vascular Anatomy ◽  
Interventional Neuroradiology ◽  
Artery Occlusion ◽  
Aneurysm Rupture ◽  
Parent Artery ◽  
Clinical Complications ◽  
Parent Artery Occlusion ◽  
Coil Migration

We present a critical analysis of the cerebral aneurysm GDC embolisation technique and its numerous possible pitfalls with the experience of 448 aneurysms in 401 patients performed during a seven year period at UCLA's Division of Interventional Neuroradiology. A “pitfall” is defined as any hidden or not easily recognized danger or difficulty. We review pitfalls related to micro-catheterization, GDC coil delivery, complex vascular anatomy, post-embolisation management, and pre-existing patient's clinical condition. The possible associated technical and clinical complications include aneurysm rupture, parent artery occlusion, thrombo-embolic stroke, coil stretching/rupture, coil migration, incomplete embolisation or embolisation failure. Lastly we present a discussion of our experience and suggestions of how to avoid some of these pitfalls.

scholarly journals Multiple Intracranial Aneurysms: Endovascular Treatment and Complications

2014 ◽  
Vol 20 (4) ◽  
pp. 442-447 ◽  
Author(s):  
Xun Shen ◽  
Tao Xu ◽  
Xuan Ding ◽  
Wenlei Wang ◽  
Zhi Liu ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Clinical Outcome ◽  
Brain Ischemia ◽  
Intracranial Aneurysms ◽  
Mass Effect ◽  
Endovascular Embolization ◽  
Endovascular Techniques ◽  
Surgical Clipping ◽  
Multiple Intracranial Aneurysms

This study evaluated the results of endovascular embolization of multiple intracranial aneurysms. A retrospective hospital chart and radiograph review were made of all patients with multiple intracranial aneurysms seen between March 2010 and January 2011. Ten patients presented with subarachnoid hemorrhage, four with mass effect, two with brain ischemia and twenty were incidental. These 36 patients harbored 84 aneurysms, 63 of which were treated with endovascular techniques, two by surgical clipping, and 19 were left untreated. Of the coil-treated lesions, a complete endovascular occlusion was achieved in 54 aneurysms (85.7%), and eight (12.7%) presented neck remnants with one (1.6%) stented only. Twenty-six patients (72.2%) underwent coil embolization of more than one aneurysm in the first session. Follow-up angiographic studies in 31 patients demonstrated an unchanged or improved result in 93.0% of the aneurysms (53 lesions) and coil compaction in 7.0% (four lesions). The overall clinical outcome was excellent in 33 patients (91.7%), good in one (2.8%) and fair in two (5.5%). Endovascular techniques may be a particularly suitable method for treating multiple intracranial aneurysms.

scholarly journals An overview of intracranial aneurysms

2020 ◽  
Vol 9 (2) ◽  
Author(s):  
Alexander Keedy
Keyword(s):  
Intracranial Aneurysms ◽  
Clinical Presentation ◽  
Treatment Options ◽  
Mass Effect ◽  
Endovascular Coiling ◽  
Digital Subtraction ◽  
Surgical Clipping ◽  
Unruptured Aneurysms ◽  
Risk Of Rupture ◽  
Small Aneurysms

Intracranial aneurysms are relatively common, with a prevalence of approximately 4%. Unruptured aneurysms may cause symptoms mainly due to a mass effect, but the real danger is when an aneurysm ruptures, leading to a subarachnoid hemorrhage. Most aneurysms are asymptomatic and will not rupture, but they grow unpredictably and even small aneurysms carry a risk of rupture. Intracranial aneurysms are diagnosed and monitored with imaging including intra-arterial digital subtraction angiography, computed tomography angiography, magnetic resonance angiography, and recently transcranial Doppler ultrasonograpy has been proposed as a potential modality. Treatment options include observation, endovascular coiling, and surgical clipping. This paper will review the epidemiology, pathogenesis, clinical presentation, diagnosis, natural history, and management of unruptured saccular intracranial aneurysms.

Aneurysmal Disease in Children

1997 ◽  
Vol 3 (3) ◽  
pp. 215-229 ◽  
Author(s):  
P.L. Lasjaunias ◽  
A. Campi ◽  
G. Rodesch ◽  
H. Alvarez ◽  
I. Kanaan ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Epileptic Seizures ◽  
Mass Effect ◽  
Aneurysm Rupture ◽  
Neurological Deficits ◽  
Shear Stresses ◽  
Before And After ◽  
History Of ◽  
Location Type ◽  
Arterial Aneurysms

Twenty children (13 males, 7 females), referred to our group with non traumatic intracranial aneurysms between 1978 and January 1997, were included in this study. Their angiograms were reviewed to assess number, location, type of aneurysms and evolution before and after treatment. Their ages ranged from 1 month to 15 years. Seven patients (35%) presented with subarachnoid haemorrhage (SAH). Eleven patients (55%) presented with focal neurological deficits or seizures: epileptic seizures occurred in five patients, neurologic deficits or focal symptoms due to mass effect occurred in six. Total number of diagnosed intracranial aneurysms was 24. The most common sites involved were internal carotid (37%) and vertebrobasilar (32%) systems. The aetiology of the aneurysms was infective in four patients and unknown in the remaining 16 patients (80%). Endovascular treatment was successful in seven patients (37%). Three patients (15%) were surgically treated. Seven patients (35%) were conservatively treated. Two patients (10%) had spontaneous thrombosis of the aneurysm. SAH was more frequent in males, and never occurred in children under five years old. Frequent presentations such as focal symptoms or mass effect and less prevalence of aneurysm rupture are probably due to the high prevalence of large or giant aneurysms (25%) in our series. In conclusion, radiological findings and the natural history of symptomatic arterial aneurysms in children are clearly different from those in adults. Probably pathogenetic factors and aetiology are also different. Shear stresses, haemodynamic and hormonal factors do not appear to be dominant to reveal such defects, though their correction favours repair. Since repair is frequent, conservative treatment has a major role in their aneurysm management.

Dual stain kit for the microscopic gram classification of ocular infection bacteria

1993 ◽  
Vol 51 ◽  
pp. 248-249
Author(s):  
Jacob S. Hanker ◽  
Dale N. Holdren ◽  
Kenneth L. Cohen ◽  
Beverly L. Giammara
Keyword(s):  
Contact Lenses ◽  
Ocular Infection ◽  
Gram Negative Bacteria ◽  
Gram Negative ◽  
Gram Staining ◽  
Ocular Infections ◽  
Different Types ◽  
Culture Positive ◽  
Increased Susceptibility

Keratitis and conjunctivitis (infections of the cornea or conjunctiva) are ocular infections caused by various bacteria, fungi, viruses or parasites; bacteria, however, are usually prominent. Systemic conditions such as alcoholism, diabetes, debilitating disease, AIDS and immunosuppressive therapy can lead to increased susceptibility but trauma and contact lens use are very important factors. Gram-negative bacteria are most frequently cultured in these situations and Pseudomonas aeruginosa is most usually isolated from culture-positive ulcers of patients using contact lenses. Smears for staining can be obtained with a special swab or spatula and Gram staining frequently guides choice of a therapeutic rinse prior to the report of the culture results upon which specific antibiotic therapy is based. In some cases staining of the direct smear may be diagnostic in situations where the culture will not grow. In these cases different types of stains occasionally assist in guiding therapy.

Explanatory Power for Medical Expert Systems: Studies in the Representation of Causal Relationships for Clinical Consultations

1982 ◽  
Vol 21 (03) ◽  
pp. 127-136 ◽  
Author(s):  
J. W. Wallis ◽  
E. H. Shortliffe
Keyword(s):  
Explanatory Power ◽  
Prototype System ◽  
Inference Rules ◽  
Medical Expert ◽  
Comprehensive Knowledge ◽  
Different Types ◽  
Medical Expert Systems ◽  
Explanation System ◽  
Systems Studies

This paper reports on experiments designed to identify and implement mechanisms for enhancing the explanation capabilities of reasoning programs for medical consultation. The goals of an explanation system are discussed, as is the additional knowledge needed to meet these goals in a medical domain. We have focussed on the generation of explanations that are appropriate for different types of system users. This task requires a knowledge of what is complex and what is important; it is further strengthened by a classification of the associations or causal mechanisms inherent in the inference rules. A causal representation can also be used to aid in refining a comprehensive knowledge base so that the reasoning and explanations are more adequate. We describe a prototype system which reasons from causal inference rules and generates explanations that are appropriate for the user.

scholarly journals High-Resolution Vessel Wall Magnetic Resonance Imaging of Small Unruptured Intracranial Aneurysms

2021 ◽  
Vol 10 (2) ◽  
pp. 225
Author(s):  
Łukasz Zwarzany ◽  
Ernest Tyburski ◽  
Wojciech Poncyljusz
Keyword(s):  
Magnetic Resonance Imaging ◽  
Risk Factors ◽  
Magnetic Resonance ◽  
High Resolution ◽  
Vessel Wall ◽  
Intracranial Aneurysms ◽  
Aneurysm Rupture ◽  
Resonance Imaging ◽  
Aneurysm Wall ◽  
Conventional Risk Factors

Background: We decided to investigate whether aneurysm wall enhancement (AWE) on high-resolution vessel wall magnetic resonance imaging (HR VW-MRI) coexists with the conventional risk factors for aneurysm rupture. Methods: We performed HR VW-MRI in 46 patients with 64 unruptured small intracranial aneurysms. Patient demographics and clinical characteristics were recorded. The PHASES score was calculated for each aneurysm. Results: Of the 64 aneurysms, 15 (23.4%) showed wall enhancement on post-contrast HR VW-MRI. Aneurysms with wall enhancement had significantly larger size (p = 0.001), higher dome-to-neck ratio (p = 0.024), and a more irregular shape (p = 0.003) than aneurysms without wall enhancement. The proportion of aneurysms with wall enhancement was significantly higher in older patients (p = 0.011), and those with a history of prior aneurysmal SAH. The mean PHASES score was significantly higher in aneurysms with wall enhancement (p < 0.000). The multivariate logistic regression analysis revealed that aneurysm irregularity and the PHASES score are independently associated with the presence of AWE. Conclusions: Aneurysm wall enhancement on HR VW-MRI coexists with the conventional risk factors for aneurysm rupture.

scholarly journals Fetus in fetu: two case reports from North African country

2021 ◽  
Vol 69 (1) ◽  
Author(s):  
Moutaz Ragab ◽  
Omar Nagy Abdelhakeem ◽  
Omar Mansour ◽  
Mai Gad ◽  
Hesham Anwar Hussein
Keyword(s):  
Histopathological Examination ◽  
Case Reports ◽  
Abdominal Mass ◽  
Mature Teratoma ◽  
Surgical Techniques ◽  
Rare Condition ◽  
Mass Effect ◽  
Fetus In Fetu ◽  
Vascular Connection ◽  
First Case

Abstract Background Fetus in fetu is a rare congenital anomaly. The exact etiology is unclear; one of the mostly accepted theories is the occurrence of an embryological insult occurring in a diamniotic monochorionic twin leading to asymmetrical division of the blastocyst mass. Commonly, they present in the infancy with clinical picture related to their mass effect. About 80% of cases are in the abdomen retroperitoneally. Case presentation We present two cases of this rare condition. The first case was for a 10-year-old girl that presented with anemia and abdominal mass, while the second case was for a 4-month-old boy that was diagnosed antenatally by ultrasound. Both cases had vertebrae, recognizable fetal organs, and skin coverage. Both had a distinct sac. The second case had a vascular connection with the host arising from the superior mesenteric artery. Both cases were intra-abdominal and showed normal levels of alpha-fetoprotein. Histopathological examination revealed elements from the three germ layers without any evidence of immature cells ruling out teratoma as a differential diagnosis. Conclusions Owing to its rarity, fetus in fetu requires a high degree of suspicion and meticulous surgical techniques to avoid either injury of the adjacent vital structures or bleeding from the main blood supply connection to the host. It should be differentiated from mature teratoma.

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