scholarly journals Clinicoradiological profile and outcome of microsurgical clipping of ruptured anterior circulation aneurysms: A single-institute experience

2021 ◽  
Vol 16 (2) ◽  
pp. 316
Author(s):  
Jagminder Singh ◽  
Shivender Sobti ◽  
Saurabh Sharma ◽  
Hanish Bansal ◽  
AshwaniKumar Chaudhary
Keyword(s):  
Anterior Circulation ◽  
Microsurgical Clipping ◽  
Anterior Circulation Aneurysms

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

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.

Woven Endobridge Embolization Versus Microsurgical Clipping for Unruptured Anterior Circulation Aneurysms: A Propensity Score Analysis

Neurosurgery ◽  
2020 ◽  
Author(s):  
Lukas Goertz ◽  
Thomas Liebig ◽  
Eberhard Siebert ◽  
Lenhard Pennig ◽  
Kai Roman Laukamp ◽  
...  
Keyword(s):  
Propensity Score ◽  
Functional Outcomes ◽  
Technical Success ◽  
Anterior Circulation ◽  
Microsurgical Clipping ◽  
Aneurysm Occlusion ◽  
Woven Endobridge ◽  
Major Adverse Events ◽  
Anterior Circulation Aneurysms ◽  
The Web

Abstract BACKGROUND Intrasaccular flow-disruption represents a new paradigm in endovascular treatment of wide-necked bifurcation aneurysms. OBJECTIVE To retrospectively compare Woven Endobridge (WEB) embolization with microsurgical clipping for unruptured anterior circulation aneurysms using propensity score adjustment. METHODS A total of 63 patients treated with WEB and 103 patients treated with clipping were compared based on the intention-to-treat principle. The primary outcome measures were immediate technical treatment success, major adverse events, and 6-mo complete aneurysm occlusion. RESULTS The technical success rates were 83% for WEB and 100% for clipping. Procedure-related complications occurred more often in the clipping group (13%) than the WEB group (6%, adjusted P < .01). However, the rates of major adverse events were comparable in both groups (WEB: 3%, clip: 4%, adjusted P = .53). At the 6-mo follow-up, favorable functional outcomes were achieved in 98% of the WEB embolization group and 99% of the clipping group (adjusted P = .19). Six-month complete aneurysm occlusion was obtained in 75% of the WEB group and 94% of the clipping group (adjusted P < .01). CONCLUSION Microsurgical clipping was associated with higher technical success and complete occlusion rates, whereas WEB had a lower complication rate. Favorable functional outcomes were achieved in ≥98% of both groups. The decision to use a specific treatment modality should be made on an individual basis and in accordance with the patient's preferences.

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.

Woven Endobridge Embolization Versus Microsurgical Clipping for Unruptured Anterior Circulation Aneurysms: A Propensity Score Analysis

Neurosurgery ◽  
2021 ◽  
Vol 89 (Supplement_2) ◽  
pp. S113-S113
Author(s):  
Lukas Goertz ◽  
Thomas Liebig ◽  
Eberhard Siebert ◽  
Lenhard Pennig ◽  
Kai Roman Laukamp ◽  
...  
Keyword(s):  
Propensity Score ◽  
Propensity Score Analysis ◽  
Anterior Circulation ◽  
Microsurgical Clipping ◽  
Score Analysis ◽  
Woven Endobridge ◽  
Anterior Circulation Aneurysms

scholarly journals Contralateral approach for clipping of bilateral anterior circulation aneurysms

2015 ◽  
Vol 39 (videosuppl1) ◽  
pp. V9 ◽  
Author(s):  
Justin M. Caplan ◽  
Eric Sankey ◽  
David Gullotti ◽  
Joanna Wang ◽  
Erick Westbroek ◽  
...  
Keyword(s):  
Left Middle Cerebral Artery ◽  
Anterior Circulation ◽  
Intraoperative Angiography ◽  
Pterional Craniotomy ◽  
Microsurgical Clipping ◽  
Contralateral Approach ◽  
Anterior Choroidal ◽  
Management Challenge ◽  
Choroidal Artery ◽  
Anterior Circulation Aneurysms

Patients with bilateral anterior circulation aneurysms present a management challenge. These lesions may be treated in a staged manner or alternatively, for select patients, a contralateral approach may be utilized to treat bilateral aneurysms with a single surgery. In this narrated video illustration, we present the case of a 57-year-old woman with incidentally discovered bilateral aneurysms (left middle cerebral artery [MCA], left anterior choroidal artery and right MCA). A contralateral approach through a left pterional craniotomy was performed formicrosurgical clipping of all three aneurysms. The techniques of pterional craniotomy, contralateral approach, microsurgical clipping and intraoperative angiography are reviewed.The authors are grateful to Wuyang Yang, M.D. for his assistance.The video can be found here: http://youtu.be/MlPIu3hQZkg.

scholarly journals A randomized controlled study comparing microsurgical clipping via the keyhole approach, conventional craniotomy, and endovascular coiling for ruptured anterior circulation aneurysms

2021 ◽  
Author(s):  
Qing Zhu ◽  
Qing Lan ◽  
Ailin Chen
Keyword(s):  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Controlled Study ◽  
Endovascular Coiling ◽  
Anterior Circulation ◽  
Complete Occlusion ◽  
Randomized Controlled ◽  
Microsurgical Clipping ◽  
Keyhole Approach ◽  
Anterior Circulation Aneurysms

Abstract Objective: Few prospective randomized controlled studies have investigated the efficacy of endovascular treatment and microsurgical clipping of intracranial aneurysms, especially via microsurgical keyhole approach. We compared the efficacy of three techniques in treating patients with ruptured anterior circulation aneurysms to provide surgeons with a more objective basis for treatment selection. Methods: 150 patients with ruptured anterior circulation aneurysms were randomly assigned to endovascular treatment, conventional craniotomy, and keyhole approach groups. Aneurysm occlusion, surgical time, hospitalization time, hospitalization expenses, and surgical complications were compared between groups. Results: The complete occlusion rates of aneurysms at discharge were 90% in the endovascular group, 94% in the conventional group, and 96% in the keyhole group. No significant differences in complete occlusion rates or Glasgow Outcome Scale scores were found between groups. In the keyhole approach, conventional craniotomy, and endovascular groups, the overall surgical times were 161.78±34.51 min, 201.55±38.79 min, and 85.86±58.57 min, respectively; the hospitalization times were 11.42±6.64 d, 18.03±7.14 d, and 10.57±8.67 d; hospitalization expenses were 10574.25±4154.25 USD, 13214.54±5487.65 USD, and 20134.58±6587.61 USD; and the incidence rates of postoperative complications such as intracranial infection, cerebral vasospasm, hydrocephalus, intracranial hematoma, and epilepsy were 8%, 28%, and 20%. Conclusions: Endovascular coiling and the microsurgical keyhole approach have the advantages of simple execution, time savings, and short hospitalization. Microsurgical clipping of intracranial aneurysms needs to be updated to a minimally invasive procedure to maintain its complementary value with endovascular treatment.Clinical trial registration: The study has been retrospectively registered in clinicaltrial.org (NCT05049564) in Sep. 8th, 2021.

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 Use of our protocol of multimodality tools to aid in the safe microsurgical clipping of unruptured anterior circulation aneurysms

2019 ◽  
Vol 14 (3) ◽  
pp. 773
Author(s):  
Satish Kannan ◽  
Yasuhiro Yamada ◽  
Kyosuke Miyatani ◽  
Takao Teranishi ◽  
ArunReddy Marathi ◽  
...  
Keyword(s):  
Anterior Circulation ◽  
Microsurgical Clipping ◽  
Anterior Circulation Aneurysms
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