Cotinine Levels Influence the Risk of Rupture of Brain Aneurysms

The relationship between nicotine levels in smokers and brain aneurysm has never been determined. To assess the levels of cotinine in smoker patients with ruptured and unruptured brain aneurysm and the risk of aneurysm rupture we quantified cotinine levels in smoker patients with ruptured or unruptured brain aneurysms. We identified a control group of smokers and nonsmokers without brain aneurysm. Out of 182 participants cerebral aneurysms were statistically significantly associated with smoking (P<0.001) and female sex (P=0.006). Cotinine levels were significantly correlated with both the presence (P=0.009) and the rupture (P=0.002) of brain aneurysms. Compared with nonsmokers, smokers had a 5-fold higher risk of having a brain aneurysm (OR, 5.72; 95% CI, 2.96–11.07; P<0.001). The risk of rupture of brain aneurysms increased by 50% with each cotinine unit and was 4-fold higher with cotinine levels between 4 and 6 (OR, 3.75; 95% CI, 1.48–9.53; P=0.005). With increasing age, the cotinine level decreased (P <0.001, rho= –0.28), declining by 2% with each year of age. In the whole population, the probability of a ruptured aneurysm in patients with cotinine levels between 4 and 6 was higher than in those with levels between 0 and 3 (OR, 5.55; 95% CI, 1.08–28.5; P=0.040). Our results suggest that high cotinine levels in smokers with brain aneurysm, rather than size, are significantly associated with high rupture risk. Cotinine levels decrease with age, possibly reducing the risk of formation and rupture of a brain aneurysm.

Abstract 1122‐000017: Giant Brain Aneurysm: A Case Report in a Pediatric Patient

Introduction : The incidence of intracranial aneurysms in the pediatric population ranges from 1 to 3 per million inhabitants. Within this population, aneurysms are even rarer in lactating patients. Unlike the adult population, the male gender is predominant, and the incidence is more significant in the posterior circulation, with a higher percentage in the middle cerebral artery. Microsurgical and endovascular treatment has been described as feasible treatment in these cases. Methods : Methodology: Description of a case report of a patient admitted to the Pediatric Intensive Care service of the Hospital Materno Infantil in Tegucigalpa, Honduras. We took informed consent from parents for the patient’s treatment and subsequent academic dissemination of the clinical and neuroimaging data. Results : Case report: A two‐year‐old male patient presented to the pediatric emergency department with a 24‐hour evolution of sudden headache of severe intensity, accompanied by nausea and multiple episodes of vomiting. At hospital arrival, the patient presented an episode of generalized epileptic seizures. At the initial clinical neurological evaluation with altered consciousness somnolent. Motor examination revealed a right facial and body hemiparesis and Hunt and Hess of 1. Noncontrast cerebral tomography (NCCT) showed Fisher IV subarachnoid haemorrhage, left frontal lobar intraparenchymal hematoma and acute hydrocephalus (Fig 1A). Consequently, we placed an external ventricular shunt, for which the patient was admitted to the pediatric intensive care unit. The computed tomography angiography (CTA) showed a giant aneurysm in the anterior communicating artery (Fig. 1B). The patient underwent an endovascular procedure with the placement of coils with a successful result (Fig. 1C and Fig. 1D). Conclusions : Giant aneurysms are sporadic in children. They are commonly associated with the posterior circulation and, to a lesser extent, the middle cerebral artery is more commonly affected with the anterior circulation. Aneurysms in children tend to be more extensive compared to their adult counterparts. Clinically, they present with subarachnoid haemorrhage and seizures, as in our case. This case is a pediatric patient with a giant brain aneurysm at a less common age and rare localization. Endovascular management was successful, adding information to the therapeutic spectrum in these cases. It is essential to perform a detailed angiographic investigation. Surgery is the treatment of choice; however, clinical trials are needed to clarify endovascular versus microsurgical management.

Development of a Clamping Device for Tensile Testing of Intracranial Flow Diverter Stents

The main danger of a brain aneurysm (a sack-like bulge on the vessel wall) is that in the event of a rupture a severe hemorrhage can occur which may cause death. However, if doctors have tools at their disposal, such as numerical models and simulations for analyzing patient-specific blood vessels, they could use them to decide if a particular treatment is necessary and if so, when. For such models, the different mechanical characteristics of the flow control devices are the input data. Several of these mechanical properties of the devices, such as modulus of elasticity and tensile strength, are determined by tensile testing. In the course of our research, we have developed a clamping device suitable for uniaxial tensile testing of flow diverter stents.

Three-Dimensional Virtual Reality Simulation to Safe Planning Neurosurgical Procedure in Brain Aneurysms, Latin American Single-Center Experience: Advantages and Limitations

Background The neurosurgical approach to clipping cerebral aneurysms has been a complex challenge for all neurosurgeon experts in cerebrovascular surgery. The three-dimensional computed tomography angiography (3D-CTA) allows identifying bone and vascular structures close to an aneurysm to simulate in virtual 3D images, the appropriate and safest approach to cerebral aneurysm clipping. Objectives This study aims to share our experience using 3D simulation as a support to the safe planning for cerebrovascular disease surgery. Materials and Methods We reviewed the surgical outcomes from a cerebrovascular neurosurgeon using the 3D-CTA images in 360-degree reconstruction in the planning of the preoperative surgical procedure for the treatment of brain aneurysm. In all patients, the virtual surgical approach was replicated in real-time surgery. Results We analyzed 34 patients around 51 ± 8 years of age. Of these, 76.5% (n = 26) and 23.5% (n = 8) were males and females, respectively. Saccular aneurysms were the most frequent (85%), the Arteries affected by aneurysms were middle cerebral artery (n = 6), basilar tip (n = 6), vertebral artery in V3 and V4 (n = 6), and posterior cerebral artery (n = 5). The virtual surgical pterional approach was the most frequently used (50%), followed by fronto-orbito-zigomático (29%) and far lateral (15%) approaches. There were no intraoperative complications in any patient. Conclusion Preoperative 3D virtual reality simulation is a great support tool to perform a safe surgical procedure in real-time for the treatment of simple and complex brain aneurysms.