Cerebral Artery
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2021 ◽  
Vol 11 ◽  
Yang Li ◽  
XingShu Zhang ◽  
Jun Su ◽  
Chaoying Qin ◽  
Xiangyu Wang ◽  

ObjectiveParasellar meningiomas (PMs) represent a cohort of skull base tumors that are localized in the parasellar region. PMs tend to compress, encase, or even invade the cerebral arteries and their perforating branches. The surgical resection of PMs without damaging neurovascular structures is challenging. This study aimed to analyze functional outcomes in a series of patients who underwent surgery with individualized cerebral artery protection strategies based on preoperative imaging.MethodsA retrospective review was performed on a single surgeon’s experience of the microsurgical removal of PMs in 163 patients between January 2012 and March 2020. Individualized approaches with a bidirectional dissection strategy were used. Cerebral artery invasion classification, neurological outcomes, MRC Scale for muscle strength, and Karnofsky performance scale were used to assess tumor vascular invasion, functional outcome, and patient quality-of-life outcomes, respectively.ResultsTotal resection (Simpson grade I or II) was achieved in 114 patients (69.9%) in our study. A total of 44.7% of patients had improved vision at consecutive follow-ups, 51.1% were stable, and 3.8% deteriorated. Improvements in cranial nerves III, IV, and VI were observed in 41.1%, 36.2%, and 44.8% of patients, respectively. The mean follow-up time was (38.8 ± 27.9) months, and the KPS at the last follow-up was 89.6 ± 8.5. Recurrence was observed in eight patients (13.8%) with cavernous sinus meningiomas, and the recurrence rates in anterior clinoid meningiomas and medial sphenoid wing meningiomas were 3.8% and 2.8%, respectively.ConclusionsPreoperative imaging is important in the selection of surgical approaches. Maximum tumor resection and cerebral artery protection can be achieved concurrently by utilizing the bidirectional dissection technique. Individualized cerebral artery protection strategies provide great utility in improving a patient’s quality of life.

2021 ◽  
Vol Publish Ahead of Print ◽  
Humdoon Choudhry ◽  
Jessica Klingensmith ◽  
Lloyd Border Dalton ◽  
My Myers ◽  
Edgar Mercado

Thalia Mok ◽  
Jose Paulo Pereira ◽  
Nasim C. Sobhani ◽  
Renan Fonseca Cardozo ◽  
Helena Abreu Valle ◽  

Objective The aim of this study was to investigate the role of middle cerebral artery (MCA) Doppler measurements for the prediction of abnormal neonatal outcomes in pregnancies affected by Zika virus (ZIKV). Methods Secondary analysis of a prospective cohort of pregnant women diagnosed with ZIKV infection from September 2015 to December 2016 at a single regional referral center. Ultrasonography with measurements of MCA peak systolic velocity (PSV), PSV multiples of the median (MoM) for gestational age, and pulsatility index (PI) were collected. The primary outcome was a composite abnormal neonatal outcome. MCA Doppler values of normal and abnormal neonatal outcomes were compared with Wilcoxon rank sum test. The predictive value of MCA Dopplers for development of abnormal neonatal outcome was calculated by logistic regression. Results One-hundred twenty-seven ZIKV-positive pregnancies with MCA Doppler measurements and known neonatal outcomes were included. Of the 132 neonates, 66 (50%) had an abnormal neonatal outcome. Lower MCA PSV (p = 0.027) and PSV MoM (p = 0.008) were associated with abnormal neonatal outcomes. There was no significant difference in MCA PI. Abnormal neonatal outcomes had lower MCA PSV by 5.36 cm/s (95% confidence interval [CI]: 0.95–9.77, p = 0.018) and lower MCA PSV MoM by 0.13 (95% CI: 0.05–0.22, p = 0.002). MCA PSV of 30 cm/s had a 65% predicted probability of an abnormal neonatal outcome (95% CI: 51–79%). Conclusion In ZIKV-infected pregnancies, lower MCA PSV and PSV MoM measurements were seen with abnormal neonatal outcomes. This may represent a physiologic response to fetal ZIKV infection. Evaluation of MCA Dopplers may be of clinical utility in the surveillance of ZIKV-affected pregnancies. Key Points

2021 ◽  
pp. neurintsurg-2021-018120
Alexander von Hessling ◽  
Tomás Reyes del Castillo ◽  
Lutz Lehmann ◽  
Justus Erasmus Roos ◽  
Grzegorz Karwacki

The Columbus steerable guidewire (Rapid Medical, Israel) is a 0.014 inch guidewire with a remotely controlled deflectable tip intended for neuronavigational purposes. 1 The tip can be shaped by pulling or pushing the handle. Pulling the handle decreases the radius (from 4 mm to 2 mm) and curves the tip, while pushing the handle increases the curvature radius and straightens the tip until it bends in the opposite direction. The amount of deflection is at the discretion of the operator. Video 1 The response of the Columbus guidewire to rotational movements is inferior to that of standard wires, and the tip is very soft and malleable but brings great support when bent. We present two cases where the Columbus guidewire was used. In the first case, the Columbus enabled us to probe a posterior cerebral artery arising from a giant basilar tip aneurysm without wall contact. In the second case, the Columbus was used as a secondary wire to help cannulate the pericallosal artery in a patient with a recurrent anterior complex aneurysm; this subsequently permitted successful stent-assisted coiling of the aneurysm.Video 1

2021 ◽  
Vol 12 ◽  
pp. 571
Kazuaki Okamura ◽  
Yoichi Morofuji ◽  
Nobutaka Horie ◽  
Tsuyoshi Izumo ◽  
Kei Sato ◽  

Background: Whether hematoma expansion after aneurysmal rupture is always a sign of rerupture remains unclear. Hence, the present study aimed to assess the incidence and risk factors of hematoma expansion unrelated to aneurysmal rerupture after endovascular embolization for ruptured cerebral aneurysms. Methods: We included patients who underwent endovascular embolization for ruptured cerebral aneurysms within 48 h after onset at our institution between January 2009 and February 2014. The medical records of 70 consecutive patients were reviewed and analyzed retrospectively. Results: Hematoma expansion unrelated to aneurysmal rerupture occurred in 7 (10%) of 70 patients. Interestingly, four of seven patients had distal anterior cerebral artery (ACA) aneurysms. The interval from onset to aneurysm coiling was shorter in patients with hematoma expansion than in those without (P = 0.040). Conclusion: Early embolization of ruptured ACA aneurysms might increase the risk of hematoma expansion unrelated to aneurysmal rerupture because the procedures were conducted under systemic anticoagulation. It would be better to refer the patient for direct clipping if the patient has a distal ACA aneurysm with parenchymal hematoma at interhemispheric fissure. Delayed coil embolization, which means around 12–18 h delayed, might be another option for ruptured distal ACA aneurysms to prevent hematoma expansion.

Stroke ◽  
2021 ◽  
Theodore E. Liston ◽  
Aldric Hama ◽  
Johannes Boltze ◽  
Russell B. Poe ◽  
Takahiro Natsume ◽  

Background and Purpose: Treatment with A1R/A3R (adenosine A1 and A3 receptor) agonists in rodent models of acute ischemic stroke results in significantly reduced lesion volume, indicating activation of adenosine A1R or A3R is cerebroprotective. However, dosing and timing required for cerebroprotection has yet to be established, and whether adenosine A1R/A3R activation will lead to cerebroprotection in a gyrencephalic species has yet to be determined. Methods: The current study used clinical study intervention timelines in a nonhuman primate model of transient, 4-hour middle cerebral artery occlusion to investigate a potential cerebroprotective effect of the dual adenosine A1R/A3R agonist AST-004. Bolus and then 22 hours intravenous infusion of AST-004 was initiated 2 hours after transient middle cerebral artery occlusion. Primary outcome measures included lesion volume, lesion growth kinetics, penumbra volume as well as initial pharmacokinetic-pharmacodynamic relationships measured up to 5 days after transient middle cerebral artery occlusion. Secondary outcome measures included physiological parameters and neurological function. Results: Administration of AST-004 resulted in rapid and statistically significant decreases in lesion growth rate and total lesion volume. In addition, penumbra volume decline over time was significantly less under AST-004 treatment compared with vehicle treatment. These changes correlated with unbound AST-004 concentrations in the plasma and cerebrospinal fluid as well as estimated brain A1R and A3R occupancy. No relevant changes in physiological parameters were observed during AST-004 treatment. Conclusions: These findings suggest that administration of AST-004 and combined A1R/A3R agonism in the brain are efficacious pharmacological interventions in acute ischemic stroke and warrant further clinical evaluation.

Petrea Frid ◽  
Johan Wasselius ◽  
Mattias Drake ◽  
Ona Wu ◽  
Jesper Petersson ◽  

D.V. Shcheglov ◽  
V.N. Zahorodnii ◽  
S.V. Konotopchik ◽  
A.A. Pastushin

The observation of endovascular treatment of acute tandem occlusion of internal carotid artery (ICA), anterior cerebral artery (ACA) and middle cerebral artery (MCA) in combination with the thrombosis of the right ICA and the critical stenosis of the left vertebral artery is presented.Man, 61 years old. He was delivered to the Center of endovascular neuroradiology, NAMS of Ukraine on January 15, 2021 with an ischemic stroke clinic in the left internal carotid artery basin. He fell ill acutely ‒ against the background of complete well-being, sensorimotor aphasia and right-sided hemiplegia appeared. Upon admission on the NIHSS (National Institutes of Health Stroke Scale) ‒ 18 points. On the performed initial multispiral computed tomography of the brain according to ASPECTS (Alberta Stroke Program Early CT score) ‒ 8 points. In the endovascular operating room, cerebral angiography was performed, followed by surgery aimed at restoring cerebral blood flow. The time from the onset of the disease to the puncture was 330 minutes, the duration of the operation was 135 minutes, thus the time from the onset of the disease to reperfusion was 465 minutes. Angiography revealed acute thrombosis of the left ICA starting from the orifice, M1-segment of the left MCA and A2-segment of the left ACA. Partial compensation of the basin through the supra-block anastomosis (external carotid artery ‒ ICA), as well as from the vertebro-basilar system through the network of leptomeningeal arteries. Collaterals ‒ ACG 3. Thrombosis of the right ICA and critical stenosis (95 %) of the V1-segment of the left vertebral artery were also revealed. The operation was performed ‒ recanalization of thrombosis of the left ICA orifice followed by balloon angioplasty, thrombectomy from the MCA and ACA pools. The end result is eTICI 2c reperfusion. There were no complications during this operation. The patient was discharged the next day (transferred to the neurological department at the place of residence). Control multispiral computed tomography of the brain showed positive dynamics (ASPECTS ‒ 1 point).

2022 ◽  
Vol 17 (1) ◽  
pp. 254-258
Duy Ton Mai ◽  
Trung Kien Tran ◽  
Tien Dung Nguyen ◽  
Quoc Viet Bui ◽  
Trung Hieu Dinh ◽  

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