scholarly journals Usage of perioperative anxiety neuromarker for improving the quality of life of a patient operated on for critical stenosis of the internal carotid artery

2016 ◽  
Vol 23 (4) ◽  
pp. 612-617 ◽  
Author(s):  
Mariusz Trystuła ◽  
Paweł Półrola ◽  
Juri Kropotov
Keyword(s):  
Quality Of Life ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Critical Stenosis

scholarly journals Clival chordomas: considerations after 16 years of endoscopic endonasal surgery

2018 ◽  
Vol 128 (2) ◽  
pp. 329-338 ◽  
Author(s):  
Matteo Zoli ◽  
Laura Milanese ◽  
Rocco Bonfatti ◽  
Marco Faustini-Fustini ◽  
Gianluca Marucci ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Survival Rate ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Skull Base ◽  
Internal Carotid ◽  
Neurological Deficits ◽  
Tumor Removal ◽  
Endoscopic Endonasal

OBJECTIVEIn the past decade, the role of the endoscopic endonasal approach (EEA) has relevantly evolved for skull base tumors. In this study, the authors review their surgical experience with using an EEA in the treatment of clival chordomas, which are deep and infiltrative skull base lesions, and they highlight the advantages and limitations of this ventral approach.METHODSAll consecutive cases of chordoma treated with an EEA between 1998 and 2015 at a single institution are included in this study. Preoperative assessment consisted of neuroimaging (MRI and CT with angiography sequences) and endocrinological, neurological, and ophthalmological evaluations, which were repeated 3 months after surgery and annually thereafter. Postoperative adjuvant therapies were considered.RESULTSSixty-five patients (male/female ratio 1:0.9) were included in this study. The median age was 48 years (range 9–80 years). Gross-total resection (GTR) was achieved in 47 cases (58.7%). On univariate analysis, primary procedures (p = 0.001), location in the superior or middle third of the clivus (p = 0.043), extradural location (p = 0.035), and histology of conventional chordomas (p = 0.013) were associated with a higher rate of GTR. The complication rate was 15.1%, and there were no perioperative deaths. Most complications did not result in permanent sequelae and included 2 CSF leaks (2.5%), 5 transient cranial nerve VI palsies (6.2%), and 2 internal carotid artery injuries (2.5%), which were treated with coil occlusion of the internal carotid artery without neurological deficits. Three patients (3.8%) presented with complications resulting in permanent neurological deficits due to a postoperative hematoma (1.2%) causing a hemiparesis, and 2 permanent ophthalmoplegias (2.5%). Seventeen patients (26.2%) have died of tumor progression over the course of follow-up (median 52 months, range 7–159 months). Based on Kaplan-Meier analysis, the survival rate was 77% at 5 years and 57% at 10 years. On multivariate analysis, the extent of tumor removal (p = 0.001) and the absence of previous treatments (p = 0.001) proved to be correlated with a longer survival rate.CONCLUSIONSThe EEA was associated with a high rate of tumor removal and symptom control, with low morbidity and preservation of a good quality of life. These results allow for a satisfactory overall survival rate, particularly after GTR and for primary surgery. Considering these results, the authors believe that an EEA can be a helpful tool in chordoma surgery, achieving a good balance between as much tumor removal as possible and the preservation of an acceptable patient quality of life.

Comprehensive Treatment Strategy for Internal Carotid Artery Blowout Syndrome Caused by Nasopharyngeal Carcinoma

2020 ◽  
pp. 019459982096312
Author(s):  
Zhouyang Zhao ◽  
Lijin Huang ◽  
Jinhua Chen ◽  
Weijia Huang ◽  
Xiaobin Zhang ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Nasopharyngeal Carcinoma ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Retrospective Analysis ◽  
Treatment Strategy ◽  
Internal Carotid ◽  
Comprehensive Treatment ◽  
Stent Group

Objective To evaluate a treatment strategy for internal carotid artery blowout syndrome caused by nasopharyngeal carcinoma. Study Design A retrospective analysis of a case series was performed. Setting Carotid blowout syndrome is a catastrophic complication caused by malignant tumor of the skull base. Methods A retrospective analysis based on 69 patients with internal carotid artery blowout syndrome admitted to our center between April 2018 and January 2020 was performed. The patients were divided into 2 groups: an EBBA (internal carotid artery embolization + bypass based on American Society of Intervention and Therapeutic Neuroradiology/Society of Interventional Radiology [ASITN/SIR]) group and an embolization/stent group. The follow-up time was 6 to 9 months. Results In the EBBA group, 41 patients (41/49, 83.7%) survived. Forty patients had a satisfactory quality of life after 3 months. No death occurred within 3 months. Nonoperative death occurred in 8 cases (8/49, 16.3%). The rate of mortality and disability was 18.4% (9/49). In the embolization/stent group, 16 patients (16/20, 80%) survived. Nonoperative death occurred in 4 cases (4/20, 20%), 3 of which occurred within 1 to 3 months. Four cases reported Modified Rankin Scale ≥2 after 3 months. The rate of mortality and disability was 40% (8/20). Conclusion A comprehensive revascularization strategy for internal carotid artery (ICA) embolization and intracranial and extracranial bypass grafting based on ASITN/SIR score for ICA blowout syndrome patients not only can prolong the patient survival but also greatly improve the survival probability and quality of life as well as reduce their rate of mortality or disability.

Surgical Indications to Maintain Quality of Life in Elderly Patients with Ruptured Intracranial Aneurysms

Neurosurgery ◽  
2003 ◽  
Vol 52 (5) ◽  
pp. 1010-1016
Author(s):  
Shigetoshi Yano ◽  
Jun-ichiro Hamada ◽  
Yutaka Kai ◽  
Tatemi Todaka ◽  
Tsuyoshi Hara ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Barthel Index ◽  
Intracranial Aneurysms ◽  
Internal Carotid ◽  
Posterior Communicating Artery ◽  
Old Patients ◽  
Ruptured Intracranial Aneurysms

Abstract OBJECTIVE We performed a retrospective study to assess long-term outcomes in very old patients with ruptured intracranial aneurysms. The aim of the study was to develop guidelines for choosing surgical or conservative treatment with the goal of maintaining patients' quality of life. METHODS Between 1996 and 1999, 76 consecutive patients, aged 80 to 89 years, with ruptured intracranial aneurysms were treated at 18 participating centers. They were divided retrospectively into operated and nonoperated groups, and their preoperative characteristics and treatment outcomes were analyzed. Their Glasgow Outcome Scale and Barthel Index scores at least 2 years after the insult were recorded and analyzed from the perspective of their admission Hunt and Hess grade. RESULTS Our retrospective review encompassed 5.9 years. Of the original 76 patients, 54 (71.1%) died, 13 (17.1%) had a good outcome (Barthel Index ≥60), and 9 (11.8%) had a poor outcome (Barthel Index <60). All patients with Hunt and Hess grades of III or higher at admission had poor outcomes irrespective of treatment. Of 32 patients with an initial Hunt and Hess grade of I or II, 19 (59.4%) underwent surgery; 9 of these patients (47.4%) had good outcomes. Conversely, of 13 nonoperated patients (40.6%), only 2 (15.4%) experienced good outcomes. In seven of the nine operated patients with good outcomes, the aneurysm was small (<12 mm) and located at the internal carotid artery-posterior communicating artery junction. CONCLUSION Our results suggest that patients in the 9th decade of life with ruptured intracranial aneurysms can be considered for surgical treatment if they have a Hunt and Hess grade of I or II. The highest rate of favorable results was achieved in patients with small internal carotid artery-posterior communicating artery aneurysms.

NEUROMARKERS OF ANXIETY IN A PATIENT WHO HAD EXPERIENCED A TRANSIENT ISCHEMIC ATTACK (TIA) OF THE LEFT BRAIN HEMISPHERE AS A RESULT OF A CRITICAL STENOSIS OF THE INTERNAL CAROTID ARTERY (ICA) OPERATED ON BY ENDARTERECTOMY (CEA)

2021 ◽  
Vol 19 (1) ◽  
pp. 1-9
Author(s):  
Ewa Wilczek-Rużyczka ◽  
Andrzej Mirski ◽  
Maciej Korab ◽  
Mariusz Trystuła
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Human Brain ◽  
Transient Ischemic Attack ◽  
Internal Carotid ◽  
Event Related Potentials ◽  
Critical Stenosis ◽  
Left Brain ◽  
Related Potentials ◽  
Ischemic Attack

The search for neuromarkers is a very promising way to improve psychiatric and psychological care. They are now considered to be an innovative diagnostic tool in psychiatry and neuropsychology, but more broadly in all human health sciences. The aim of our study was to find the neuromarker of anxiety in a patient who had experienced a Transient IschemicAttack (TIA) of the left brain hemisphere as a result of a critical stenosis of the Internal Carotid Artery (ICA) operated on byendarterectomy (CEA). We will present the case of a 54-year-old man,an architect, who experienced a Transient Ischemic Attack (TIA) of the left brain hemispherecaused by a critical stenosis of theInternal Carotid Artery (ICA) and was treated successfully with surgical endarterectomy (CEA). One year after the surgery itself, the patient developed severe postoperative anxiety, headaches, difficulty in sleepingas well as the inability to continue working in his profession. Strong anxiety was notedon the adapted 100-millimeter Visual Analogue Anxiety Scale (VAAS). The patient was assessed using the Human Brain Index (HBI) methodology (Kropotov 2009; 2016; 2017; Pąchalska, Kaczmarek&Kropotov 2014) which consisted of recording 19-channel EEG in resting state conditions, during the cued GO/NOGO task and comparing the parameters of EEG spectra and Event-Related Potentials (ERPs) with the normative and patient databases of the Human Brain Index(HBI). No signs of cognitive dysfunction was found, however an excessive Rolandic beta was observed. In line with the working hypothesis as to the presence of an anxiety neuromarker, the patient’s studies confirmed an increased P1 time wave in the left hemisphere of the brain in ERP in response to visual stimuli, i.e. an anxiety neuromarker. Following the detection of this neuromarkera specific anodic Transcranial Direct Current Stimulations (tDCS) protocol was proposed (see: Kropotov 2016; Pąchalska, Kaczmarek & Kropotov 2020). Ten tDCS sessions were performed and the postoperativeanxiety was found to be resolved. The patient returned to work. The use of Human Brain Index (HBI) methodologyenabling the isolation of the Event Related Potentials (ERPs) patterns revealed the presence of a distinct anxietyneuromarker. Neurotherapy with the use of tDCS allowed the reduction of anxiety symptoms and the patient’s return to work. The above case study indicates the necessity to use new neurotechnologies in the diagnosis of mental diseases, with particular emphasis on postoperative anxiety.

Critical Stenosis of the Internal Carotid Artery

2019 ◽  
Vol 30 (5) ◽  
pp. e388-e392 ◽  
Author(s):  
Mehmet Hamdi Şahan ◽  
Neşe Asal ◽  
Nuray Bayar Muluk ◽  
Mikail Inal ◽  
Adil Doğan
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Critical Stenosis

scholarly journals Extracranial internal carotid artery aneurysm: case illustration

2017 ◽  
Vol 31 (4) ◽  
pp. 517-521
Author(s):  
Marco Zenteno ◽  
Liliana Escobar ◽  
Angel Lee ◽  
Hernando Raphael Alvis-Miranda ◽  
Willem Guillermo Calderon-Miranda ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Treatment Guideline ◽  
Artery Aneurysm ◽  
Extracranial Internal Carotid Artery ◽  
Carotid Artery Aneurysm ◽  
Internal Carotid Artery Aneurysm ◽  
Ischemic Attack

Abstract Extracranial internal carotid artery aneurysms (EICAA) are uncommon lesion. These aneurysms can be classified as true or false aneurysms, atherosclerotic, dysplastic, infectious, posttraumatic and iatrogenic aneurysms. The most common presentation is central neurologic dysfunction, either a stroke or a transient ischemic attack. The rupture of these aneurysms can lead to severely impairment and can affect the quality of life of the patients or even may lead to death. Management of these lesions is required in most cases to prevent complications, however there is no treatment guideline or expert consensus for the management. We present a case of an unusual EICAA, associated with kinking of the affected vessel and review the literature.

scholarly journals Free-floating thrombus and a fragment of atherosclerotic plaque in the lumen of the internal carotid artery – review of 2 cases

2021 ◽  
Vol 35 (1) ◽  
pp. 56-65
Author(s):  
S.V. Konotopchyk ◽  
F.H. Rzayeva ◽  
O.A. Pastushyn ◽  
N.M. Nosenko ◽  
O.Ye. Svyrydiuk ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Atherosclerotic Plaque ◽  
Cerebral Angiography ◽  
Internal Carotid ◽  
Floating Thrombus ◽  
Critical Stenosis ◽  
The Right

Free-floating thrombus or a fragment of atherosclerotic plaque (mobile plaque) in the lumen of the carotid artery is extremely rare. Atherosclerosis is the most common cause underlying their occurrence. The optimal treatment strategy has not been developed, at least in part due to the rarity of observations, as well as the lack of comparative studies between conservative and surgical treatment (carotid artery stenting, endovascular thrombectomy, endarterectomy). We present two cases that demonstrate the treatment tactics of these rather rare pathologies. Patient Yu., 62 years old, was hospitalized with focal neurological symptoms, National Institutes of Health Stroke Scale of 12. According to the CT of the brain, signs of an ischemic stroke in the right middle cerebral artery circulation were detected. Selective cerebral angiography diagnosed thrombosis of the arteries of the precentral and central sulcus of the right middle cerebral artery, critical stenosis of the mouth of the right internal carotid artery, and a free-floating thrombus in its lumen with a fixation point at the level of atherosclerotic plaque, which blocked the lumen of the artery by more than 60 %. Endovascular aspiration of a free-floating thrombus was performed, followed by angioplasty and stenting of critical stenosis with a favorable clinical outcome. Patient L., 73 years old, applied for carotid ultrasonography, during which a mobile atherosclerotic plaque was diagnosed at the level of the bifurcation of the right common carotid artery. Digital selective cerebral angiography confirmed a plaque fragment floating in the lumen of the artery. After applying a loading dose of ticagrelor without complications, an emergency implantation of a carotid stent was performed at the level of the bifurcation of the right common carotid artery.Taking into account the modern possibilities of interventional radiology and a wide range of tools, the endovascular approach to the treatment of complicated atherosclerotic plaque with a floating component or a formed blood clot is the best treatment option with a good safety profile.

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