Remote cerebellar hemorrhage after unruptured cerebral aneurysm surgery: two cases report

Background. The use and effectiveness of intraoperative cell salvage has been analyzed in many surgical specialties. Until now, no data exist evaluating the efficacy of intraoperative cell salvage in cerebral aneurysm surgery. Aim. To evaluate the efficacy and cost effectiveness of intraoperative cell salvage in cerebral aneurysm surgery. Methods. Data were collected retrospectively for all the patients who underwent cerebral aneurysm surgery at our institution between 2013 and 2019. Routinely, we apply blood salvage through autotransfusion. The cases were divided into a ruptured cerebral aneurysm group and a unruptured cerebral aneurysm group. Results. A total of 241 patients underwent cerebral aneurysm clipping. Of all the cerebral aneurysms, 116 were ruptured and 125 were unruptured and clipped electively. Age, location of the aneurysm, postoperative red blood cell count, intraoperative blood loss, and number of allogenic blood cell transfusions were statistically significantly different between the groups. The autotransfusion of salvaged blood could only be facilitated in eight cases with ruptured cerebral aneurysms and in none with unruptured cerebral aneurysms clipped electively (p < 0.01). Additionally, 35 patients with ruptured cerebral aneurysms and one patient with unruptured cerebral aneurysm required allogenic red blood cell transfusion after surgery, and 71 vs. 2 units of blood were transfused (p < 0.0001). In terms of cost effectiveness, a total of EUR 45,189 in 241 patients was spent to run the autotransfusion system, while EUR 13,797 was spent for allogenic blood transfusion. Conclusions. The use of cell salvage in patients with unruptured cerebral aneurysm, undergoing elective surgery, is not effective.

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Remote cerebellar hemorrhage after supratentorial unruptured aneurysm surgery: report of three cases

Neurological Research ◽

10.1179/174313209x459156 ◽

2010 ◽

Vol 32 (6) ◽

pp. 670-672 ◽

Cited By ~ 1

Author(s):

Chih-Yuan Huang ◽

Yu-Chang Hung ◽

E-Jian Lee

Keyword(s):

Unruptured Aneurysm ◽

Aneurysm Surgery ◽

Cerebellar Hemorrhage ◽

Remote Cerebellar Hemorrhage

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Verbal Memory Functions in Patients after the Ruptured and Unruptured Cerebral Aneurysm Surgery

Archives of Psychiatry Research ◽

10.20471/may.2021.57.01.10 ◽

2020 ◽

Vol 57 (1) ◽

pp. 81-92

Author(s):

Ljiljana Pačić-Turk ◽

Valerija Hauptfeld ◽

Lana Maljković ◽

Ivo Somek ◽

Larissa Kalaus

Keyword(s):

Cerebral Aneurysm ◽

Verbal Memory ◽

Verbal Learning ◽

Cerebral Aneurysms ◽

Anterior Communicating Artery ◽

Aneurysm Surgery ◽

Brain Aneurysm ◽

Memory Functions ◽

Unruptured Cerebral Aneurysm ◽

Significant Difference

A cerebral aneurysm is a bulge in the wall of a brain blood vessel with a risk to rupture. It occurs in about 2% of the population, somewhat more often in women. Most aneurysms are located in the anterior circulation area. Aneurysm rupture is relatively rare and accounts for 5% of all cerebrovascular brain incidents. Ruptured and asymptomatic/unruptured aneurysms are often treated surgically at the Department of Neurosurgery, Medical School University of Zagreb. The study included 134 patients after cerebral aneurysm surgery during the last 10 years, and neuropsychological testing was performed on average 77 days after surgery. The average age was 52 years and they completed an average of 12 years of education. In the group of patients included in this study, 40.3% of them were operated after ruptured, and 59.7% for unruptured cerebral aneurysm. Most aneurysms were located in the middle cerebral and anterior communicating arteries. With regard to lateralization, there was an equal number of aneurysms located in the right and left hemisphere and bilaterally (on the anterior communicating artery). As part of regular neuropsychological assessment, tests of verbal learning and memory (numerical, logical and mechanical memory) were applied. The aims of the study were to find out whether patients operated for ruptured cerebral aneurysms show greater verbal memory impairments than patients operated for unruptured cerebral aneurysms and whether there was the significant effect of lateralization of aneurysm (to check the interaction effect of both rupture and lateralization on those functions). The results obtained show that, even though there are no statistically significant differences between groups of patients that underwent surgery for ruptured and unruptured brain aneurysm, patients show a trend of somewhat better results on most of the verbal memory functions after surgery for unruptured brain aneurysm. The results show statistically significant difference between groups of patients that underwent surgery for ACoA aneurysm and those with right lateralized cerebral aneurysms on most of the trails on AVLT test. Also, patients with operated ACoA aneurysm have significantly worse scores in learning process (AVLT 3 and AVLT 4) and especially on short-term and long-term verbal memory than the patients who were operated for left or right lateralized aneurysm.

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Blading Technique : A Safe and Reliable Clipping Strategy for Unruptured Cerebral Aneurysm Surgery

Japanese Journal of Neurosurgery ◽

10.7887/jcns.24.822 ◽

2015 ◽

Vol 24 (12) ◽

pp. 822-832

Author(s):

Tohru Mizutani ◽

Tatsuya Sugiyama

Keyword(s):

Cerebral Aneurysm ◽

Aneurysm Surgery ◽

Unruptured Cerebral Aneurysm

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Endoscope-integrated indocyanine green video-angiography for cerebral aneurysm surgery: a more effective technique

Innovative Neurosurgery ◽

10.1515/ins-2015-0004 ◽

2015 ◽

Vol 3 (3-4) ◽

Author(s):

Ittichai Sakarunchai ◽

Yoko Kato ◽

Yasuhiro Yamada ◽

Thomas Tommy

Keyword(s):

Indocyanine Green ◽

Cerebral Aneurysm ◽

Conventional Technique ◽

Parent Artery ◽

Aneurysm Surgery ◽

Small Vessels ◽

Aneurysm Clipping ◽

Unruptured Cerebral Aneurysm ◽

Deep Area ◽

Perforating Arteries

AbstractMicroscope-integrated indocyanine green video-angiography (mICG-VA) is used as an adjunct to aneurysm surgery in checking for small compromised perforating arteries and the remnant of an aneurysmal neck. A limitation of mICG-VA is the inability to access the deep area where small vessels are located behind the aneurysm sac or the parent artery. The endoscope-integrated ICG-VA (eICG-VA) is not only a tool in obtaining a wide angle of surgical view, but also is a technique to detect real-time blood flow during aneurysm clipping.Patients with an unruptured cerebral aneurysm who had conventional endoscope-assisted microsurgery and eICG-VA were enrolled. We compared the efficacy and additional details of imaging from both types of procedures.The data of seven patients were reviewed. In two cases of small perforating arteries that were hidden by the aneurysm sacs, more details were detected by eICG-VA. While the performance of the conventional technique was limited, the eICG-VA revealed a wide view in the deep area during aneurysm clipping.The eICG-VA provides more details of the aneurysm, especially in small perforating vessels that were hidden by the aneurysm. It can resolve the limitations of the conventional endoscope and mICG-VA.

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