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Sample records for cerebral aneurysm treatment

  1. Complications of endovascular treatment of cerebral aneurysms

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    Orrù, Emanuele, E-mail: surgeon.ema@gmail.com [Neuroradiology Department, Padua University Hospital, Via Giustiniani 2, Padua 35128 (Italy); Roccatagliata, Luca, E-mail: lroccatagliata@neurologia.unige.it [Neuroradiology Department, IRCCS San Martino University Hospital and IST, Largo Rosanna Benzi 10, Genoa 16132 (Italy); Department of Health Sciences (DISSAL), University of Genoa (Italy); Cester, Giacomo, E-mail: giacomo.cester@sanita.padova.it [Neuroradiology Department, Padua University Hospital, Via Giustiniani 2, Padua 35128 (Italy); Causin, Francesco, E-mail: francesco.causin@sanita.padova.it [Neuroradiology Department, Padua University Hospital, Via Giustiniani 2, Padua 35128 (Italy); Castellan, Lucio, E-mail: lucio.castellan@hsanmartino.it [Neuroradiology Department, IRCCS San Martino University Hospital and IST, Largo Rosanna Benzi 10, Genoa 16132 (Italy)

    2013-10-01

    The number of neuroendovascular treatments of both ruptured and unruptured aneurysms has increased substantially in the last two decades. Complications of endovascular treatments of cerebral aneurysms are rare but can potentially lead to acute worsening of the neurological status, to new neurological deficits or death. Some of the possible complications, such as vascular access site complications or systemic side effects associated with contrast medium (e.g. contrast medium allergy, contrast induced nephropathy) can also be encountered in diagnostic angiography. The most common complications of endovascular treatment of cerebral aneurysms are related to acute thromboembolic events and perforation of the aneurysm. Overall, the reported rate of thromboembolic complications ranges between 4.7% and 12.5% while the rate of intraprocedural rupture of cerebral aneurysms is about 0.7% in patients with unruptured aneurysms and about 4.1% in patients with previously ruptured aneurysms. Thromboembolic and hemorrhagic complications may occur during different phases of endovascular procedures and are related to different technical, clinical and anatomic reasons. A thorough knowledge of the different aspects of these complications can reduce the risk of their occurrence and minimize their clinical sequelae. A deep understanding of complications and of their management is thus part of the best standard of care.

  2. Endovascular treatment of posterior cerebral artery aneurysms using detachable coils

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    Roh, Hong Gee [Kangwon National University Hospital, Department of Radiology, Chuncheon, Kangwon-do (Korea); Konkuk University Hospital, Department of Radiology, Seoul (Korea); Kim, Sam Soo; Han, Heon [Kangwon National University Hospital, Department of Radiology, Chuncheon, Kangwon-do (Korea); Kang, Hyun-Seung [Konkuk University Hospital, Department of Neurosurgery, Seoul (Korea); Moon, Won-Jin [Konkuk University Hospital, Department of Radiology, Seoul (Korea); Byun, Hong Sik [Sungkyunkwan University School of Medicine, Department of Radiology and Center for Imaging Science, Samsung Medical Center, Seoul (Korea)

    2008-03-15

    Aneurysms of the posterior cerebral artery (PCA) are rare, and most of the studies reported in the literature in which the endovascular approach was applied were carried out on a limited number of patients with PCA aneurysms. We retrospectively reviewed our cases of PCA aneurysms - at various locations and of differing shapes - that received endovascular treatment and evaluated the treatment outcome. From January 1996 to December 2006, 13 patients (eight females and five males) with 17 PCA aneurysms (nine fusiform and eight saccular) were treated using the endovascular approach. The age of the patients ranged from 20 to 67 years, with a mean age of 44 years. Of the 13 patients, ten presented with intracranial hemorrhage, and one patient, with a large P2 aneurysm, presented with trigeminal neuralgia; the aneurysms were asymptomatic in the remaining two patients. All 13 patients were successfully treated, with only one procedure-related symptomatic complication. Seven patients were treated by occlusion of the aneurysm and parent artery together; five patients, by selective embolization of the aneurysm; one patient, by partial coiling. Although infarctions were found in two patients treated with selective embolization and in three patients treated with parent artery occlusion, only one patient with a ruptured P2 aneurysm treated with parent artery occlusion developed transient amnesia as an ischemic symptom. Posterior cerebral artery aneurysms can be treated safely with either occlusion of the aneurysm together with the PCA or with a selective coil embolization. Infarctions may occur after endovascular treatment, but they are rarely the cause of a disabling symptom. (orig.)

  3. Simultaneous Endovascular Treatment of Ruptured Cerebral Aneurysms and Vasospasm

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    Cho, Young Dae; Han, Moon Hee; Kang, Hyun Seung; Kim, Jeong Eun [Seoul National University Hospital, Seoul National University College of Medicine, Seoul (Korea, Republic of); Ahn, Jun Hyoung [Dept. of Neurosurgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang (Korea, Republic of); Jung, Seung Chai [Dept. of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of); Kim, Chang Hun [Dept. of Neurology, Stroke Center, Myongji Hospital, Goyang (Korea, Republic of); Lim, Jeong Wook [Dept. of Neurosurgery, Sun Hospital, Daejeon (Korea, Republic of)

    2015-02-15

    The management of patients with ruptured cerebral aneurysms and severe vasospasm is subject to considerable controversy. We intended to describe herein an endovascular technique for the simultaneous treatment of aneurysms and vasospasm. A series of 11 patients undergoing simultaneous endovascular treatment of ruptured aneurysms and vasospasm were reviewed. After placement of a guiding catheter within the proximal internal carotid artery for coil embolization, an infusion line of nimodipine was wired to one hub, and of a microcatheter was advanced through another hub (to select and deliver detachable coils). Nimodipine was then infused continuously during the coil embolization. This technique was applied to 11 ruptured aneurysms accompanied by vasospasm (anterior communicating artery, 6 patients; internal carotid artery, 2 patients; posterior communicating and middle cerebral arteries, 1 patient each). Aneurysmal occlusion by coils and nimodipine-induced angioplasty were simultaneously achieved, resulting in excellent outcomes for all patients, and there were no procedure-related complications. Eight patients required repeated nimodipine infusions. Our small series of patients suggests that the simultaneous endovascular management of ruptured cerebral aneurysms and vasospasm is a viable approach in patients presenting with subarachnoid hemorrhage and severe vasospasm.

  4. What You Should Know about Cerebral Aneurysms

    Science.gov (United States)

    ... T. Quiz 5 Things to Know About Stroke What You Should Know About Cerebral Aneurysms Updated:Jun ... Damage Treatments Click image to view an animation What is a cerebral aneurysm? An aneurysm is a ...

  5. Drug treatment of cerebral vasospasm after subarachnoid hemorrhage following aneurysms

    Institute of Scientific and Technical Information of China (English)

    Yongfei Liu; HanCheng Qiu; Juan Su; WeiJian Jiang

    2016-01-01

    Cerebral vasospasm (CVS) is a common and severe complication of aneurysmal subarachnoid hemorrhage (aSAH). Despite the improvement in treatment of aSAH, CVS complicating aSAH has remained the main cause of death. CVS begins most often on the third day after the ictal event and reaches the maximum on the 5th–7th postictal days. Several therapeutic modalities have been employed to prevent or reverse CVS. The aim of this review is to summate all the available drug treatment modalities for vasospasm.

  6. Surgical clipping as the preferred treatment for aneurysms of the middle cerebral artery

    NARCIS (Netherlands)

    van Dijk, J. Marc C.; Groen, Rob J. M.; Ter Laan, Mark; Jeltema, Johanna Rinck; Mooij, Jan Jacob A.; Metzemaekers, Jan D. M.

    2011-01-01

    In recent years the endovascular treatment of intracranial aneurysms (coiling) has progressively gained recognition, particularly after the publication of the International Subarachnoid Aneurysm Trial (ISAT) in 2002. Despite the fact that in ISAT middle cerebral artery (MCA) aneurysms were clearly u

  7. Treatment of a pediatric recurrent fusiform middle cerebral artery (MCA) aneurysm with a flow diverter.

    Science.gov (United States)

    Burrows, Anthony M; Zipfel, Gregory; Lanzino, Giuseppe

    2013-11-01

    Pediatric patients with aneurysm often have different localizations and morphologies from adults and recurrences are not uncommon after successful clip reconstruction/obliteration. Treatment of a recurrent pediatric aneurysm after clip ligation is a technical challenge. We present the case of an adolescent with a middle cerebral artery (MCA) fusiform aneurysm which recurred following clip reconstruction and bypass. The aneurysm was successfully treated with endovascular flow diversion.

  8. Treatment of a pediatric recurrent fusiform middle cerebral artery (MCA) aneurysm with a flow diverter

    OpenAIRE

    Burrows, Anthony M; Zipfel, Gregory; Lanzino, Giuseppe

    2012-01-01

    Pediatric patients with aneurysm often have different localizations and morphologies from adults and recurrences are not uncommon after successful clip reconstruction/obliteration. Treatment of a recurrent pediatric aneurysm after clip ligation is a technical challenge. We present the case of an adolescent with a middle cerebral artery (MCA) fusiform aneurysm which recurred following clip reconstruction and bypass. The aneurysm was successfully treated with endovascular flow diversion.

  9. Treatment of middle cerebral artery (MCA) aneurysms: a review of the literature

    Institute of Scientific and Technical Information of China (English)

    Wuyang Yang; Judy Huang

    2015-01-01

    Microsurgical treatment is well established as the preferred strategy for definitive obliteration of middle cerebral artery (MCA) aneurysms.However, increasing reports on the feasibility and efficacy of endovascular treatment of MCA aneurysms in large case series suggest coiling as a viable alternative to microsurgery.This review provides a critical overview of the current literature regarding MCA aneurysm treatment, with the objective to clarify the available evidence of efficacy with microsurgical compared to endovascular treatment.

  10. Aneurysmal wall enhancement and perianeurysmal edema after endovascular treatment of unruptured cerebral aneurysms

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    Su, I. Chang [Toronto Western Hospital, Division of Neuroradiology, Department of Medical Imaging, Toronto, ON (Canada); Taipei Cathay General Hospital, Division of Neurosurgery, Department of Surgery, Taipei (China); Willinsky, Robert A.; Agid, Ronit [Toronto Western Hospital, Division of Neuroradiology, Department of Medical Imaging, Toronto, ON (Canada); Fanning, Noel F. [Cork University Hospital, Department of Interventional Neuroradiology, Cork (Ireland)

    2014-06-15

    Perianeurysmal edema and aneurysm wall enhancement are previously described phenomenon after coil embolization attributed to inflammatory reaction. We aimed to demonstrate the prevalence and natural course of these phenomena in unruptured aneurysms after endovascular treatment and to identify factors that contributed to their development. We performed a retrospective analysis of consecutively treated unruptured aneurysms between January 2000 and December 2011. The presence and evolution of wall enhancement and perianeurysmal edema on MRI after endovascular treatment were analyzed. Variable factors were compared among aneurysms with and without edema. One hundred thirty-two unruptured aneurysms in 124 patients underwent endovascular treatment. Eighty-five (64.4 %) aneurysms had wall enhancement, and 9 (6.8 %) aneurysms had perianeurysmal brain edema. Wall enhancement tends to persist for years with two patterns identified. Larger aneurysms and brain-embedded aneurysms were significantly associated with wall enhancement. In all edema cases, the aneurysms were embedded within the brain and had wall enhancement. Progressive thickening of wall enhancement was significantly associated with edema. Edema can be symptomatic when in eloquent brain and stabilizes or resolves over the years. Our study demonstrates the prevalence and some appreciation of the natural history of aneurysmal wall enhancement and perianeurysmal brain edema following endovascular treatment of unruptured aneurysms. Aneurysmal wall enhancement is a common phenomenon while perianeurysmal edema is rare. These phenomena are likely related to the presence of inflammatory reaction near the aneurysmal wall. Both phenomena are usually asymptomatic and self-limited, and prophylactic treatment is not recommended. (orig.)

  11. Cerebral Aneurysms Fact Sheet

    Science.gov (United States)

    ... cerebral aneurysm from forming. People with a diagnosed brain aneurysm should carefully control high blood pressure, stop smoking, and avoid cocaine use or other stimulant drugs. They should also ...

  12. Aneurysmal wall enhancement and perianeurysmal edema after endovascular treatment of unruptured cerebral aneurysms.

    LENUS (Irish Health Repository)

    Su, I-Chang

    2014-06-01

    Perianeurysmal edema and aneurysm wall enhancement are previously described phenomenon after coil embolization attributed to inflammatory reaction. We aimed to demonstrate the prevalence and natural course of these phenomena in unruptured aneurysms after endovascular treatment and to identify factors that contributed to their development.

  13. ENDOVASCULAR TREATMENT OF SACCULAR CEREBRAL ANEURYSMS IN PATIENTS WITH PATHOLOGICAL KINKING AND LOOPING BRACHIOCEPHALIC ARTERIES IN ARTERIAL SPASM

    OpenAIRE

    Kuharuk, V.

    2013-01-01

    The objective — to analyses the results of endovascular treatment of cerebral aneurysm in patients with pathological kinking and looping in brachiocephalic arteries against the background of vasospasm. Materials and methods. The analysis of endovascular treatment of patients with saccular cerebral aneurysms was made in the neurosurgical department of Volyn Regional Hospital in 2008-2012. All patients that underwent various types of aneurysms and hemorrhage were operated by endovascular method...

  14. Distal posterior cerebral artery aneurysms: Retrospective review of characteristics and endovascular treatment

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    Baek, Jin Wook [Dept. of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Jeong, Bae Woong [Dept. of Diagnostic Radiology, Inje University College of Medicine, Busan Paik Hospital, Busan (Korea, Republic of); Seung, Won Bae [Dept. of Neurosurgery, Kosin University College of Medicine, Gospel Hospital, Busan (Korea, Republic of)

    2016-04-15

    The objective of this study was to review the clinical outcome after treatment of distal posterior cerebral artery (PCA) aneurysms via endovascular approach. Eleven patients with 11 distal PCA aneurysms who were treated via endovascular approach in Inje University Busan Paik Hospital and Kosin University Gospel Hospital from December 2002 to December 2013 were retrospectively reviewed. Among the 11 patients, there were 3 males (27.3%) and 8 females (72.7%). The mean age was 56.6 years (range 44 -72 years) and the mean aneurysm size was 8.45 mm (3 - 30 mm). Four (36.4%) aneurysms were located in the P2 segment, 6 (54.5%) in the P3 segment and 1 (9.1%) in the P1/2 junction. Seven (63.6%) aneurysms were treated with preservation of the parent artery; and the remaining 4 (36.4%) aneurysms were treated with parent artery occlusion. After treatment, the overall complication rate was 27% with the morbidity rate of 9.1% and the mortality rate of 18%. Endovascular treatment of distal PCA aneurysm might be used to minimize neurologic deficit, considering the diverse and rich collaterals of posterior cerebral artery.

  15. Pediatric cerebral aneurysms.

    Science.gov (United States)

    Gemmete, Joseph J; Toma, Ahmed K; Davagnanam, Indran; Robertson, Fergus; Brew, Stefan

    2013-11-01

    Childhood intracranial aneurysms differ from those in the adult population in incidence and gender prevalence, cause, location, and clinical presentation. Endovascular treatment of pediatric aneurysms is the suggested approach because it offers both reconstructive and deconstructive techniques and a better clinical outcome compared with surgery; however, the long-term durability of endovascular treatment is still questionable, therefore long-term clinical and imaging follow-up is necessary. The clinical presentation, diagnosis, and treatment of intracranial aneurysms in children are discussed, and data from endovascular treatments are presented.

  16. Clipping techniques in cerebral aneurysm surgery.

    Science.gov (United States)

    Acciarri, Nicola; Toniato, Giovanni; Raabe, Andreas; Lanzino, Giuseppe

    2016-03-01

    The history of cerebral aneurysm surgery owes a great tribute to the tenacity of pioneering neurosurgeons who designed and developed the clips used to close the aneurysms neck. However, until the beginning of the past century, surgery of complex and challenging aneurysms was impossible due to the lack of surgical microscope and commercially available sophisticated clips. The modern era of the spring clips began in the second half of last century. Until then, only malleable metal clips and other non-metallic materials were available for intracranial aneurysms. Indeed, the earliest clips were hazardous and difficult to handle. Several neurosurgeons put their effort in developing new clip models, based on their personal experience in the treatment of cerebral aneurysms. Finally, the introduction of the surgical microscope, together with the availability of more sophisticated clips, has allowed the treatment of complex and challenging aneurysms. However, today none of the new instruments or tools for surgical therapy of aneurysms could be used safely and effectively without keeping in mind the lessons on innovative surgical techniques provided by great neurovascular surgeons. Thanks to their legacy, we can now treat many types of aneurysms that had always been considered inoperable. In this article, we review the basic principles of surgical clipping and illustrate some more advanced techniques to be used for complex aneurysms. PMID:26657306

  17. CHARACTERIZATION OF PATIENTS WITH ENDOVASCULAR TREATMENT OF DISSECTING ANEURYSMS OF POSTERIOR CEREBRAL CIRCULATION IN CARTAGENA DE INDIAS

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    Rueda-Tamayo Leidy

    2015-12-01

    Full Text Available Introduction: the intracraneal aneurysms are local and permanent dilations in the artery. Objective: to describe the clinical, imagenologic and effectiveness of endovascular treatment in terms of its independence and mortality in patients with dissecting aneurysms of posterior cerebral circulation in Cartagena. Methods: a descriptive study was carried out with patients 18 years or older with a diagnosis of dissecting aneurysms of posterior cerebral circulation who received endovascular treatment in the period between January 2007 and December 2014 in the medical center Neurodinamia. The variables related to personal medical history, diagnosis and characteristics of the aneurysm, devices used for treatment, time clinical and imagenologic follow-up and complications were measured. Descriptive statistical analysis was performed according to the nature of the variables. Results: nineteen patients were analyzed to receive endovascular treatments. The average of age was 55 years. The subarachnoid hemorrhage was the most frequent clinical case; this was diagnosed with CT in 89.5%. The location in the PICA and vertebral artery were 36.8% and 31.6%, respectively. The devices used were coils in 36.8%, followed by coils and stent with 31.6%, and Onyx with 21.0%. At the end of VTE this was classified as favorable outcome in 18 patients (94.7%; however, there was one death during hospital care (5.3%. The Rankin scale showed improvement in 84.2% (16 patients. Conclusions: the endovascular treatment of dissecting aneurysms posterior cerebral circulation and the aneurysm occlusion showed high success rates 94.7%, patients (84.2% showed positive results after 30 days of treatment. Rev.cienc.biomed. 2015;6(2:298-308 KEY WORDS Aneurysm; Neurosurgery; Radiology interventional.

  18. Preemptive Medicine for Cerebral Aneurysms

    Science.gov (United States)

    AOKI, Tomohiro; NOZAKI, Kazuhiko

    2016-01-01

    Most of cerebral aneurysms (CAs) are incidentally discovered without any neurological symptoms and the risk of rupture of CAs is relatively higher in Japanese population. The goal of treatments for patients with CAs is complete exclusion of the aneurysmal rupture risk for their lives. Since two currently available major treatments, microsurgical clipping and endovascular coiling, have inherent incompleteness to achieve cure of CAs with some considerable treatment risks, and there is no effective surgical or medical intervention to inhibit the formation of CAs in patients with ruptured and unruptured CAs, new treatment strategies with lower risk and higher efficacy should be developed to prevent the formation, growth, and rupture of CAs. Preemptive medicine for CAs should be designed to prevent or delay the onset of symptoms from CAs found in an asymptomatic state or inhibit the de novo formation of CAs, but we have no definite methods to distinguish rupture-prone aneurysms from rupture-resistant ones. Recent advancements in the research of CAs have provided us with some clues, and one of the new treatment strategies for CAs will be developed based on the findings that several inflammatory pathways may be involved in the formation, growth, and rupture of CAs. Preemptive medicine for CAs will be established with specific biomarkers and imaging modalities which can sensor the development of CAs. PMID:27053328

  19. Effect of intra arterial nimodipine infusion for the treatment of symptomatic cerebral vasospasm following an aneurysmal subarachnoid hemorrhage

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    Lee, Jin Young; Shin, Hwa Seon; Choi, Hye Young; Chung, Sung Hoon; You, Jin Jong; Choi, Dae Seob; Son, Seung Nam [Gyeongsang National Univ. Hospital/Gyeongsang National Univ. School of Medicine, Jinju (Korea, Republic of); Ryu, Jae Wook [Samsung Seoul Hospital, Seoul (Korea, Republic of)

    2012-06-15

    Symptomatic cerebral vasospasm following an aneurysmal subarachnoid hemorrhage (SAH) is one of the major factors which cause morbidity and mortality of patients. The purpose of this study was to evaluate the effectiveness of intra-arterial nimodipine (IAN) infusion therapy in patients with symptomatic cerebral vasospasm. Between February 2005 and April 2011, fifty patients with symptomatic cerebral vasospasm following an aneurysmal SAH were treated with IAN infusion. After selective arterial catheterization, nimodipine was infused at a rate of 0.1 mg/min and a total of 2-3 mg per vessel was infused. We retrospectively reviewed the immediate angiographic results and clinical outcome at discharge. A grade of 5 and 4 in the Glasgow Outcome Scale (GOS) were considered favorable outcomes. In 50 patients, 117 procedures of IAN infusion (1-7; mean, 2.3)were done. After the treatment, immediate angiographic improvement was achieved in 113 (96.6%) of 117 procedures. No major complications occurred. At discharge, 38 (76%) patients showed a favorable clinical outcome in the GOS. IAN infusion therapy is safe and effective for the treatment of cerebral vasospasm following an aneurysmal SAH. However, the limitation is that repeated treatment is needed.

  20. Effect of intra arterial nimodipine infusion for the treatment of symptomatic cerebral vasospasm following an aneurysmal subarachnoid hemorrhage

    International Nuclear Information System (INIS)

    Symptomatic cerebral vasospasm following an aneurysmal subarachnoid hemorrhage (SAH) is one of the major factors which cause morbidity and mortality of patients. The purpose of this study was to evaluate the effectiveness of intra-arterial nimodipine (IAN) infusion therapy in patients with symptomatic cerebral vasospasm. Between February 2005 and April 2011, fifty patients with symptomatic cerebral vasospasm following an aneurysmal SAH were treated with IAN infusion. After selective arterial catheterization, nimodipine was infused at a rate of 0.1 mg/min and a total of 2-3 mg per vessel was infused. We retrospectively reviewed the immediate angiographic results and clinical outcome at discharge. A grade of 5 and 4 in the Glasgow Outcome Scale (GOS) were considered favorable outcomes. In 50 patients, 117 procedures of IAN infusion (1-7; mean, 2.3)were done. After the treatment, immediate angiographic improvement was achieved in 113 (96.6%) of 117 procedures. No major complications occurred. At discharge, 38 (76%) patients showed a favorable clinical outcome in the GOS. IAN infusion therapy is safe and effective for the treatment of cerebral vasospasm following an aneurysmal SAH. However, the limitation is that repeated treatment is needed

  1. Cerebral aneurysm treatment in India: Results of a national survey regarding practice patterns in India

    Directory of Open Access Journals (Sweden)

    Sudheer Ambekar

    2016-01-01

    Conclusion: Our study demonstrates the prevailing practice patterns in the management of IAs in India. Surgical clipping is the preferred treatment of choice for anterior circulation aneurysms and EVT for aneurysms along the posterior circulation. Corticosteroids and prophylactic "triple-H" therapy are still used by a large proportion of physicians.

  2. The Influence of Dome Size, Parent Vessel Angle, and Coil Packing Density on Coil Embolization Treatment in Cerebral Aneurysms

    Science.gov (United States)

    Frakes, David H.; Indahlastari, Aprinda; Ryan, Justin; Babiker, M. Haithem; Nair, Priya; Parthas, Varsha

    2013-11-01

    Intracranial aneurysms (ICAs) are dilated cerebral blood vessels. Treating ICAs effectively prior rupture is crucial since their association with 45% mortality rate. Embolic coiling is the most effective ICA treatment. Series of embolic coils are deployed into the aneurysm with the intent of reaching a sufficient packing density (PD) to help seal off the ICA from circulation. While coiling is effective, treatment failures have been associated with basilar tip aneurysms (BTAs), perhaps because of their geometry. The aim of this study was to examine the effect of dome size, parent vessel (PV) angle, and PD on intraaneurysmal (IA) velocity, crossneck (CN) flow and low wall shear stress (WSS) area using simulations and experiments in idealized BTA models. IA velocity and CN flow decreased after coiling, while low WSS area increased. With increasing PD, IA velocity and CN flow were further reduced, but low WSS area had a minimal change. Coil PD had the greatest impact on post-treatment flow while dome size had a greater impact than PV angle. Overall, the role of aneurysmal geometries may vary depending on treatment goal and timing e.g., high coil PD may reduce IA velocity more effectively during early aneurysmal growth when the dome size is small. Funded by the American Heart Association.

  3. Comprehensive Overview of Contemporary Management Strategies for Cerebral Aneurysms.

    Science.gov (United States)

    Manhas, Amitoz; Nimjee, Shahid M; Agrawal, Abhishek; Zhang, Jonathan; Diaz, Orlando; Zomorodi, Ali R; Smith, Tony; Powers, Ciarán J; Sauvageau, Eric; Klucznik, Richard P; Ferrell, Andrew; Golshani, Kiarash; Stieg, Philip E; Britz, Gavin W

    2015-10-01

    Aneurysmal subarachnoid hemorrhage (SAH) remains an important health issue in the United States. Despite recent improvements in the diagnosis and treatment of cerebral aneurysms, the mortality rate following aneurysm rupture. In those patients who survive, up to 50% are left severely disabled. The goal of preventing the hemorrhage or re-hemorrhage can only be achieved by successfully excluding the aneurysm from the circulation. This article is a comprehensive review by contemporary vascular neurosurgeons and interventional neuroradiolgists on the modern management of cerebral aneurysms. PMID:26072457

  4. Comprehensive Overview of Contemporary Management Strategies for Cerebral Aneurysms.

    Science.gov (United States)

    Manhas, Amitoz; Nimjee, Shahid M; Agrawal, Abhishek; Zhang, Jonathan; Diaz, Orlando; Zomorodi, Ali R; Smith, Tony; Powers, Ciarán J; Sauvageau, Eric; Klucznik, Richard P; Ferrell, Andrew; Golshani, Kiarash; Stieg, Philip E; Britz, Gavin W

    2015-10-01

    Aneurysmal subarachnoid hemorrhage (SAH) remains an important health issue in the United States. Despite recent improvements in the diagnosis and treatment of cerebral aneurysms, the mortality rate following aneurysm rupture. In those patients who survive, up to 50% are left severely disabled. The goal of preventing the hemorrhage or re-hemorrhage can only be achieved by successfully excluding the aneurysm from the circulation. This article is a comprehensive review by contemporary vascular neurosurgeons and interventional neuroradiolgists on the modern management of cerebral aneurysms.

  5. Pediatric cerebral artery aneurysms

    OpenAIRE

    Koroknay-Pál, PÀivi

    2012-01-01

    Objectives. Intracranial aneurysms in children are rare and population-based long-term follow-up studies are limited. In this study, a large clinical and angiographic long-term follow-up was carried out. The special characteristics of the patients and their aneurysms were assessed together with factors affecting early and long-term morbidity and mortality. Materials and Methods. All pediatric (≀18 years) aneurysm patients treated at the Department of Neurosurgery in Helsinki during 193...

  6. Endovascular management of giant middle cerebral artery aneurysms

    OpenAIRE

    Huang, Lei; Cao, Wenjie; Ge, Liang; Lu, Gang; Wan, Jun; Zhang, Lei; Gu, Weijin; Zhang, Xiaolong; Geng, Daoying

    2015-01-01

    Background: This article reported the experience of endovascular treatment in giant middle cerebral artery (MCA) aneurysms with parent artery occlusion or stent-assisted coiling. Material and methods: Eleven consecutive patients with giant MCA aneurysms were included. The aneurysms predominantly involved the M1 segment in two cases, bifurcation in four cases, and M2 in five cases. Four M2 fusiform aneurysms were treated with parent artery sacrifice after balloon occlusion test. The seven unru...

  7. Vortex Dynamics in Cerebral Aneurysms

    CERN Document Server

    Byrne, Greg

    2013-01-01

    We use an autonomous three-dimensional dynamical system to study embedded vortex structures that are observed to form in computational fluid dynamic simulations of patient-specific cerebral aneurysm geometries. These structures, described by a vortex which is enclosed within a larger vortex flowing in the opposite direction, are created and destroyed in phase space as fixed points undergo saddle-node bifurcations along vortex core lines. We illustrate how saddle-node bifurcations along vortex core lines also govern the formation and evolution of embedded vortices in cerebral aneurysms under variable inflow rates during the cardiac cycle.

  8. Brain atrophy and neuropsychological outcome after treatment of ruptured anterior cerebral artery aneurysms: a voxel-based morphometric study

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    Bendel, Paula; Koskenkorva, Paeivi; Vanninen, Ritva [Kuopio University Hospital and University of Kuopio, Department of Clinical Radiology, Kuopio (Finland); Koivisto, Timo; Aeikiae, Marja [Kuopio University Hospital and University of Kuopio, Department of Neurosurgery, Kuopio (Finland); Niskanen, Eini [Kuopio University Hospital and University of Kuopio, Department of Neurology, Kuopio (Finland); Kuopio University Hospital and University of Kuopio, Department of Physics, Kuopio (Finland); Koenoenen, Mervi [Kuopio University Hospital and University of Kuopio, Department of Clinical Radiology, Kuopio (Finland); Kuopio University Hospital and University of Kuopio, Department of Clinical Neurophysiology, Kuopio (Finland); Haenninen, Tuomo [Kuopio University Hospital and University of Kuopio, Department of Neurology, Kuopio (Finland)

    2009-11-15

    Cognitive impairment after aneurysmal subarachnoid hemorrhage (aSAH) is frequently detected. Here, we describe the pattern of cerebral (gray matter) atrophy and its clinical relevance after treatment of aSAH caused by a ruptured anterior cerebral artery (ACA) aneurysm. Thirty-seven aSAH patients with ACA aneurysm (17 surgical, 20 endovascular treatment) and a good or moderate clinical outcome (Glasgow Outcome Scale V or IV) and 30 controls underwent brain MRI. Voxel-based morphometric analysis was applied to compare the patients and controls. Patients also underwent a detailed neuropsychological assessment. The comparisons between controls and either all patients (n=37) or the subgroup of surgically treated patients (n=17) revealed bilateral cortical atrophy in the frontal lobes, mainly in the basal areas. The brainstem, bilateral thalamic and hypothalamic areas, and ipsilateral caudate nucleus were also involved. Small areas of atrophy were detected in temporal lobes. The hippocampus and parahippocampal gyrus showed atrophy ipsilateral to the surgical approach. In the subgroup of endovascularly treated patients (n = 15), small areas of atrophy were detected in the bilateral orbitofrontal cortex and in the thalamic region. Twenty patients (54%) showed cognitive deficits in neuropsychological assessment. Group analysis after aSAH and treatment of the ruptured ACA aneurysm revealed gray matter atrophy, principally involving the frontobasal cortical areas and hippocampus ipsilateral to the surgical approach. Areas of reduced gray matter were more pronounced after surgical than endovascular treatment. Together with possible focal cortical infarctions and brain retraction deficits in individual patients, this finding may explain the neuropsychological disturbances commonly detected after treatment of ruptured ACA aneurysms. (orig.)

  9. Brain atrophy and neuropsychological outcome after treatment of ruptured anterior cerebral artery aneurysms: a voxel-based morphometric study

    International Nuclear Information System (INIS)

    Cognitive impairment after aneurysmal subarachnoid hemorrhage (aSAH) is frequently detected. Here, we describe the pattern of cerebral (gray matter) atrophy and its clinical relevance after treatment of aSAH caused by a ruptured anterior cerebral artery (ACA) aneurysm. Thirty-seven aSAH patients with ACA aneurysm (17 surgical, 20 endovascular treatment) and a good or moderate clinical outcome (Glasgow Outcome Scale V or IV) and 30 controls underwent brain MRI. Voxel-based morphometric analysis was applied to compare the patients and controls. Patients also underwent a detailed neuropsychological assessment. The comparisons between controls and either all patients (n=37) or the subgroup of surgically treated patients (n=17) revealed bilateral cortical atrophy in the frontal lobes, mainly in the basal areas. The brainstem, bilateral thalamic and hypothalamic areas, and ipsilateral caudate nucleus were also involved. Small areas of atrophy were detected in temporal lobes. The hippocampus and parahippocampal gyrus showed atrophy ipsilateral to the surgical approach. In the subgroup of endovascularly treated patients (n = 15), small areas of atrophy were detected in the bilateral orbitofrontal cortex and in the thalamic region. Twenty patients (54%) showed cognitive deficits in neuropsychological assessment. Group analysis after aSAH and treatment of the ruptured ACA aneurysm revealed gray matter atrophy, principally involving the frontobasal cortical areas and hippocampus ipsilateral to the surgical approach. Areas of reduced gray matter were more pronounced after surgical than endovascular treatment. Together with possible focal cortical infarctions and brain retraction deficits in individual patients, this finding may explain the neuropsychological disturbances commonly detected after treatment of ruptured ACA aneurysms. (orig.)

  10. 3D Road-Mapping in the Endovascular Treatment of Cerebral Aneurysms and Arteriovenous Malformations

    OpenAIRE

    Rossitti, S.; Pfister, M

    2009-01-01

    3D road-mapping with syngo iPilot was used as an additional tool for assessing cerebral aneurysms and arteriovenous malformations (AVMs) for endovascular therapy. This method provides accurate superimposition of a live fluoroscopic image (native or vascular road-map) and its matching 2D projection of the 3D data set, delivering more anatomic information on one additional display. In the endovascular management of cases with complex anatomy, 3D road-mapping provides excellent image quality at ...

  11. Clinical presentation of cerebral aneurysms

    International Nuclear Information System (INIS)

    Presentation of a cerebral aneurysm can be incidental, discovered at imaging obtained for unrelated causes, can occur in the occasion of imaging obtained for symptoms possibly or likely related to the presence of an unruptured aneurysm, or can occur with signs and symptoms at the time of aneurismal rupture. Most unruptured intracranial aneurysms are thought to be asymptomatic, or present with vague or non-specific symptoms like headache or dizziness. Isolated oculomotor nerve palsies, however, may typically indicate the presence of a posterior circulation aneurysm. Ruptured intracranial aneurysms are by far the most common cause of non-traumatic subarachnoid hemorrhage and represent a neurological emergency with potentially devastating consequences. Subarachnoid hemorrhage may be easily suspected in the presence of sudden and severe headache, vomiting, meningism signs, and/or altered mental status. However, failure to recognize milder and more ambiguous clinical pictures may result in a delayed or missed diagnosis. In this paper we will describe the clinical spectrum of unruptured and ruptured intracranial aneurysms by discussing both typical and uncommon clinical features emerging from the literature review. We will additionally provide the reader with descriptions of the underlying pathophysiologic mechanisms, and main diagnostic pitfalls

  12. Clinical presentation of cerebral aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Cianfoni, Alessandro [Neurocentro della Svizzera Italiana, Ospedale Civico di Lugano, via Tesserete, 46, 6900 Lugano (Switzerland); Pravatà, Emanuele, E-mail: emanuele.pravata@gmail.com [Neurocentro della Svizzera Italiana, Ospedale Civico di Lugano, via Tesserete, 46, 6900 Lugano (Switzerland); De Blasi, Roberto [Neurocentro della Svizzera Italiana, Ospedale Civico di Lugano, via Tesserete, 46, 6900 Lugano (Switzerland); Tschuor, Costa Silvia [Dipartimento di Radiologia, Ospedale Civico di Lugano, via Tesserete, 46, 6900 Lugano (Switzerland); Bonaldi, Giuseppe [U.O. Neuroradiologia, Ospedali Riuniti di Bergamo, Largo Barozzi, 1, 24128 Bergamo (Italy)

    2013-10-01

    Presentation of a cerebral aneurysm can be incidental, discovered at imaging obtained for unrelated causes, can occur in the occasion of imaging obtained for symptoms possibly or likely related to the presence of an unruptured aneurysm, or can occur with signs and symptoms at the time of aneurismal rupture. Most unruptured intracranial aneurysms are thought to be asymptomatic, or present with vague or non-specific symptoms like headache or dizziness. Isolated oculomotor nerve palsies, however, may typically indicate the presence of a posterior circulation aneurysm. Ruptured intracranial aneurysms are by far the most common cause of non-traumatic subarachnoid hemorrhage and represent a neurological emergency with potentially devastating consequences. Subarachnoid hemorrhage may be easily suspected in the presence of sudden and severe headache, vomiting, meningism signs, and/or altered mental status. However, failure to recognize milder and more ambiguous clinical pictures may result in a delayed or missed diagnosis. In this paper we will describe the clinical spectrum of unruptured and ruptured intracranial aneurysms by discussing both typical and uncommon clinical features emerging from the literature review. We will additionally provide the reader with descriptions of the underlying pathophysiologic mechanisms, and main diagnostic pitfalls.

  13. Onyx in treatment of large and giant cerebral aneurysms and arteriovenous malformations

    Institute of Scientific and Technical Information of China (English)

    宋冬雷; 冷冰; 周良辅; 顾宇翔; 陈衔城

    2004-01-01

    @@ Onyx, a novel embolization material, is a mixture of ethylene-vinyl alcohol copolymer (EVOH), dimethyl sulfoxide (DMSO), and micronized tantalum. The polymer is dissolved in DMSO and is prepared in different concentration. Onyx HD-500 for aneurysm embolization contains 20% copolymer and 80% DMSO. Onyx-18 for arteriovenous malformations (AVMs) embolization contains 6.0% copolymer and 94.0% DMSO. When Onyx comes in contact with water or blood, the copolymer precipitates because of rapid diffusion of the DMSO solvent. It possesses stronger cohesiveness, but less likely to entrap the microcatheter. From September 2003, we have used Onyx to treat large and giant cerebral aneurysms and AVMs successfully in 10 patients. Here we report our preliminary experience with the Onyx technique.

  14. Re-treatment rates after treatment with the Pipeline Embolization Device alone versus Pipeline and coil embolization of cerebral aneurysms: a single-center experience.

    Science.gov (United States)

    Park, Min S; Nanaszko, Michael; Sanborn, Matthew R; Moon, Karam; Albuquerque, Felipe C; McDougall, Cameron G

    2016-07-01

    OBJECT The optimal strategy for use of the Pipeline Embolization Device (PED, ev3 Neurovascular) has not been clearly defined. The authors examined re-treatment rates after treatment with PED alone versus PED and adjunctive coil embolization (PED/coil). METHODS The authors retrospectively examined cerebral aneurysms treated with the PED from May 2011 to March 2014. Overall, 133 patients (25 men, 108 women; mean age 60.4 years, range 23-85 years) were treated for 140 aneurysms (mean size 11.8 ± 8.3 mm) requiring 224 PEDs (mean 1.7 PEDs per patient). Sixty-eight patients (13 men, 55 women) were treated with PED alone for 73 aneurysms (mean size 10.6 ± 9.2 mm) and 65 patients (12 men, 53 women) were treated with PED/coil for 67 aneurysms (mean size 12.8 ± 7.4 mm). RESULTS Eight aneurysms in 8 patients were re-treated in the PED-alone cohort versus only 1 aneurysm in 1 patient in the PED/coil cohort for re-treatment rates of 11.8% (8/68) and 1.5% (1/65), respectively (p = 0.03). Two patients in the PED-alone cohort were re-treated due to PED contraction, while the other 6 were re-treated for persistent filling of the aneurysms. The PED/coil patient experienced continued filling of a vertebrobasilar artery aneurysm. No aneurysms in either group ruptured after treatment. CONCLUSIONS Adjunctive coil embolization during flow diversion with the PED resulted in a significantly lower re-treatment rate compared with PED alone, suggesting an added benefit with adjunctive coil embolization. This result may provide the basis for future evaluation with randomized, controlled trials.

  15. Quantification of structural cerebral abnormalities on MRI 18 months after aneurysmal subarachnoid hemorrhage in patients who received endovascular treatment

    Energy Technology Data Exchange (ETDEWEB)

    Bresser, Jeroen de [University Medical Center Utrecht, Department of Radiology, P.O. Box 85500, Utrecht (Netherlands); Schaafsma, Joanna D.; Luitse, Merel J.A.; Rinkel, Gabriel J.E.; Biessels, Geert Jan [University Medical Center Utrecht, Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, Utrecht (Netherlands); Viergever, Max A. [University Medical Center Utrecht, Image Sciences Institute, Utrecht (Netherlands)

    2015-03-01

    Volume measurements performed on brain MRI after aneurysmal subarachnoid hemorrhage (aSAH) may provide insight into the structural abnormalities that underlie the commonly occurring and persistent long-term functional deficits after aSAH. We examined the pattern of long-term cerebral structural changes on MRI in relation to known risk factors for poor functional outcome. We studied MRI scans from 38 patients who received endovascular treatment and were not dependent for activities of daily life at 18 months after aSAH. Risk factors for poor functional outcome (clinical condition, Hijdra score, and bicaudate index on admission; occurrence of hydrocephalus or delayed cerebral infarction during hospitalization) were related to supratentorial cerebral parenchymal and lateral ventricular volumes on MRI with linear regression analyses adjusted for age, sex, and intracranial volume. Clinical condition, Hijdra score, and bicaudate index on admission were not related to cerebral parenchymal volume at 18 months. A higher bicaudate index on admission was related to lateral ventricular enlargement at 18 months after aSAH (Beta; 95%CI: 0.51; 0.14<->0.88). Delayed cerebral infarction was related to smaller cerebral parenchymal volumes (-0.14; -0.25<->-0.04) and to lateral ventricular enlargement (0.49; 0.16<->0.83) at 18 months. Volume measurements of the brain are able to quantify patterns of long-term cerebral damage in relation to different risk factors after aSAH. Application of volumetric techniques may provide more insight into the heterogeneous underlying pathophysiological processes. After confirmation of these results in larger studies, volumetric measures might even be used as outcome measures in future treatment studies. (orig.)

  16. Angiographic Findings In Patients With Cerebral Aneurysm

    Directory of Open Access Journals (Sweden)

    Miri S M

    2004-09-01

    Full Text Available Background: This investigation was conducted in order to study angiographic findings in patients with cerebral aneurysm. Materials and Methods: The study conducted on 136 cases of ruptured cerebral aneurysms between 1995-2000 confirmed by means of 4-vessel cerebral angiography to get an insight to racial, geographic and environmental factors predisposing to the occurrence of subarachnoid hemorrhage and aneurysm formation. Results: The data analysis revealed the following results: 58% of the population comprised of male and 42% female with a mean age of 46 years. 89% of the aneurysms were found in the anterior circulation and 11% occurred in the posterior cerebral circulation. The most common site in both the sexes was the anterior communicating artery. 9.6% of the patients displayed two separate aneurysms. 5.2% of the aneurysms were found to be giant aneurysms and 3% of the patients had fusiform aneurysms. Conclusion: The low average age, a predilection in male population and the prevalence of aneurysms at carotid and middle cerebral artery bifurcation and the distal branches of anterior cerebral artery and a higher incidence of anterior communicating artery in women were the findings observed in this study.

  17. Endovascular treatment of cerebral aneurysms: a retrospective study of 163 embolized aneurysms Tratamento endovascular de aneurismas cerebrais: estudo de 163 aneurismas embolizados

    Directory of Open Access Journals (Sweden)

    João Renato Figueiredo Souza

    2007-06-01

    Full Text Available OBJECTIVE: To present the results of cerebral aneurysms treated by endovascular technique. METHOD: Retrospective analysis of patient files of Hospital Geral de Fortaleza, Brazil. RESULTS: We report the results of 163 cerebral aneurysms treated by endovascular techniques from January 2002 to October 2005. Patients with ruptured aneurysms (87.2%, according to Hunt-Hess scale were: 33.7% HH I, 28.4% HH II, 24.1% HH III, 13.8% HH IV. The Fisher scale grade IV was the most common (39.7%. Remodeling, coil embolization, arterial occlusion and histoacryl embolization were the techniques employed. Effective occlusion was achieved in 87.7%, partial occlusion in 5.3% and non-effective occlusion in 7.0% of the patients. Glasgow outcome scale results were: 76.3% GOS 5, 5.0% GOS 4, 5.8% GOS 3, 1.4% GOS 2 and 11.5% GOS 1. CONCLUSION: Endovascular treatment seems to be feasible within Brazilian public health system, with results as good as those obtained in larger international centers.OBJETIVO: Apresentar os resultados de aneurismas tratados pela técnica endovascular. MÉTODO: Análise retrospectiva de prontuários do Hospital Geral de Fortaleza, Brasil. RESULTADOS: Apresentamos os resultados de 163 aneurismas cerebrais tratados por técnicas endovasculares de Janeiro de 2002 a Outubro de 2005. Os pacientes com aneurismas rotos (87,2% eram, segundo a escala de Hunt-Hess: 33,7% HH1; 28.4% HH II, 24.1% HH III, 13.8% HH IV. O Grau IV da escala de Fisher foi o mais comum (39,7%. Empregaram-se as técnicas de remodeling, espiras metálicas, oclusão arterial e embolização com histoacryl. Foi obtida oclusão efetiva em 87,7%, oclusão parcial em 5,3% e oclusão não-efetiva em 7,0% dos casos. De acordo com a Glasgow outcome scale, os resultados foram: 76,3% GOS 5, 5,0% GOS 4, 5,8% GOS 3, 1,4% GOS 2 e 11,5% GOS 1. CONCLUSÃO: A aplicação de técnica endovasculares mostra-se viável na rede pública brasileira, com resultados comparáveis aos de grandes centros

  18. Intra-arterial colforsin daropate for the treatment of cerebral vasospasm after aneurysmal subarachnoid hemorrhage

    International Nuclear Information System (INIS)

    Cerebral vasospasm (CV) remains a major cause of mortality and morbidity in patients with subarachnoid hemorrhage (SAH). Here, we examined the effectiveness and safety of intra-arterial injection of colforsin daropate hydrochloride (CDH). A consecutive series of 29 patients with angiographically confirmed CV received intra-arterial CDH (IAC) therapy. Angiographic changes in spastic vessels and the cerebral circulation time (CCT) were assessed before and after IAC treatment, together with the change in clinical status. IAC treatment was performed in 53 procedures in 29 patients. Angiographic improvement was observed following all procedures (100%), and clinical improvement was observed following 36 of 42 procedures (86%) in symptomatic cases. CCT improved significantly. At the 3-month follow-up, 19 patients (66%) showed good recovery or moderate disability on the Glasgow Outcome Scale. Major adverse effects were headache and increased heart rate. IAC treatment was effective and safe for the treatment of CV after SAH. (orig.)

  19. Combined Endovascular and Microsurgical Management of Complex Cerebral Aneurysms

    Directory of Open Access Journals (Sweden)

    Omar eChoudhri

    2013-08-01

    Full Text Available Cerebral aneurysms are associated with a 50% mortality rate after rupture and patients can suffer significant morbidity during subsequent treatment. Neurosurgical management of both ruptured and unruptured aneurysms has evolved over the years. The historical practice of using microsurgical clipping to treat aneurysms has benefitted in the last two decades from tremendous improvement in endovascular technology. Microsurgery and endovascular therapies are often viewed as competing treatments but it is important to recognize their individual limitations. Some aneurysms are considered complex, due to several factors such as aneurysm anatomy and a patient’s clinical condition. A complex aneurysm often cannot be completely excluded with a single approach and its successful treatment requires a combination of microsurgical and endovascular techniques. Planning such an approach relies on understanding aneurysm anatomy and thus should routinely include 3D angiographic imaging. In patients with ruptured aneurysms, endovascular coiling is a well-tolerated early treatment and residual aneurysms can be treated with intervals of definitive clipping. Microsurgical clipping also can be used to reconstruct the neck of a complex aneurysm, allowing successful placement of coils across a narrow neck. Endovascular techniques are assisted by balloons, which can be used in coiling and testing parent vessel occlusion before sacrifice. In some cases microsurgical bypasses can provide alternate flow for planned vessel sacrifice. We present current paradigms for combining endovascular and microsurgical approaches to treat complex aneurysms and share our experience in 67 such cases. A dual microsurgical–endovascular approach addresses the challenge of intracranial aneurysms. This combination can be performed safely and produces excellent rates of aneurysm obliteration. Hybrid angiographic operating-room suites can foster seamless and efficient complementary application

  20. [Elective cerebral arteriovenous malformation treatment with onyx after coil embolization of ruptured, flow-realeted aneurysm of the posterior circulation].

    Science.gov (United States)

    Poncyljusz, Wojciech; Falkowski, Aleksander; Rać, Monika; Sagan, Leszek; Kojder, Ireneusz

    2012-01-01

    Intracranial arteriovenous posterior circulation malformation was planned to embolize by onyx injection after acute coil embolization of ruptured flow-realeted aneurysm of posterior cerebral artery. Control angiography revealed completely embolized malformation with normal vessel patency at the end of procedure. There were no adverse events related to this procedure and no neurologic deficit at the discharge. PMID:23276020

  1. Anterior cerebral artery aneurysm associated with multiple intracranial aneurysms and abdominal aorta aneurysm

    OpenAIRE

    Lee, Yunghwan; Min, Hyung Ki; Yoon, Sang Pil

    2013-01-01

    We found multiple aneurysms in the intracranial arteries and abdominal aorta of an 87-year-old Korean female cadaver, whose cause of death was reported as "cholangiocarcinoma." An abdominal aortic aneurysm was observed in the infrarenal aorta, where the inferior mesenteric artery arose. The intracranial aneurysms were found in the A3 segment of the anterior cerebral artery and at the bifurcation of the middle cerebral artery. This case provides an example of the very rare association of perip...

  2. False-negative indocyanine green videoangiography among complex unruptured middle cerebral artery aneurysms: the importance of further aneurysm inspection.

    Science.gov (United States)

    Kulwin, Charles; Cohen-Gadol, Aaron A

    2014-10-01

    Successful surgical treatment of cerebral aneurysms requires complete occlusion of the aneurysm lumen while maintaining patency of the adjacent branching and perforating arteries. Intraoperative flow assessment allows aneurysm clip repositioning in the event these requirements are not met, avoiding the risk of postoperative rehemorrhage or infarction. A number of modalities have been proposed for primarily intraoperative qualitative blood flow assessment, including microdoppler ultrasonography, intraoperative digital subtraction angiography (DSA), and more recently noninvasive fluorescent angiography including indocyanine green (ICG) fluorescent imaging. Puncture of the aneurysm dome to exclude aneurysm sac filling may also assess the efficacy of clip placement. Although a high concordance between ICG and DSA has been reported, there remains an important subset of aneurysms for which negative ICG study may erroneously suggest aneurysm occlusion. A high-risk situation for such a false-negative study is an atherosclerotic middle cerebral artery (MCA) aneurysm in which vessel wall plaque interferes with the ICG signal. Furthermore, a decreased flow within the aneurysm may not allow enough emission light for detection under the current technology. In this report, we describe our experience with cases of MCA aneurysms with false-negative ICG-VA studies requiring clip adjustment for optimal surgical treatment and discuss two illustrative cases of MCA aneurysms with intraoperative fluorescence studies that were falsely negative, requiring puncture of the aneurysm to correctly identify incomplete aneurysm occlusion. PMID:24552255

  3. Effect of magnesium treatment and glucose levels on delayed cerebral ischemia in patients with subarachnoid hemorrhage : a substudy of the Magnesium in Aneurysmal Subarachnoid Haemorrhage trial (MASH-II)

    NARCIS (Netherlands)

    Leijenaar, Jolien F.; Mees, Sanne M. Dorhout; Algra, Ale; van den Bergh, Walter M.; Rinkel, Gabriel J. E.

    2015-01-01

    BackgroundMagnesium treatment did not improve outcome in patients with aneurysmal subarachnoid haemorrhage in the Magnesium in Aneurysmal Subarachnoid Haemorrhage II trial. We hypothesized that high glucose levels may have offset a potential beneficial effect to prevent delayed cerebral ischemia. We

  4. Endovascular treatment for pediatric intracranial aneurysms

    International Nuclear Information System (INIS)

    The purpose of this study is to report the characteristics and outcomes of pediatric patients with intracranial aneurysms. From 1998 to 2005, 25 pediatric patients (aged ≤17 years) with intracranial aneurysm were treated at our institute. Eleven of 25 patients had subarachnoid hemorrhage. In ten patients, the aneurysm was an incidental finding. One patient presented with cranial nerves dysfunction and three with neurological deficits. The locations of the aneurysms were as follows: vertebral artery (VA; n = 9), middle cerebral artery (MCA; n = 5), posterior cerebral artery (PCA; n = 4), basilar artery (BA; n = 2), anterior communicating artery (n = 2), anterior cerebral artery (n = 2), and internal carotid artery (n = 1). Five patients were treated with selective embolization with coils. Sixteen patients were treated with parent vessel occlusion (PVO). Eight PVOs were performed with balloons and eight were performed with coils. One patient with a VA aneurysm was spontaneously thrombosed 4 days after the initial diagnostic angiogram. In three patients treated with stent alone or stent-assisted coiling, one with BA trunk aneurysm died. One aneurismal recurrence occurred and was retreated. At a mean follow-up duration of 23.5 months, 96% of patients had a Glasgow Outcome Scale score of 4 or 5. Pediatric intracranial aneurysms occur more commonly in male patients and have a predilection for the VA, PCA, and MCA. PVO is an effective and safe treatment for fusiform aneurysms. Basilar trunk fusiform aneurysms were difficult to treat and were associated with a high mortality rate. (orig.)

  5. Time evolution and hemodynamics of cerebral aneurysms

    Science.gov (United States)

    Sforza, Daniel M.; Putman, Christopher; Tateshima, Satoshi; Viñuela, Fernando; Cebral, Juan

    2011-03-01

    Cerebral aneurysm rupture is a leading cause of hemorrhagic strokes. Because they are being more frequently diagnosed before rupture and the prognosis of subarachnoid hemorrhage is poor, clinicians are often required to judge which aneurysms are prone to progression and rupture. Unfortunately, the processes of aneurysm initiation, growth and rupture are not well understood. Multiple factors associated to these processes have been identified. Our goal is to investigate two of them, arterial hemodynamics (using computational fluid dynamics) and the peri-aneurysmal environment, by studying a group of growing cerebral aneurysms that are followed longitudinally in time. Six patients with unruptured untreated brain aneurysms which exhibited growth during the observation period were selected for the study. Vascular models of each aneurysm at each observation time were constructed from the corresponding computed tomography angiography (CTA) images. Subsequently, models were aligned, and geometrical differences quantified. Blood flow was modeled with the 3D unsteady incompressible Navier-Stokes equation for a Newtonian fluid, and wall shear stress distribution and flow patterns were calculated and visualized. Analysis of the simulations and changes in geometry revealed asymmetric growth patterns and suggests that areas subject to vigorous flows, i.e. relative high wall shear stress and concentrated streamlines patterns; correspond to regions of aneurysm growth. Furthermore, in some cases the geometrical evolution of aneurysms is clearly affected by contacts with bone structures and calcifications in the wall, and as a consequence the hemodynamics is greatly modified. Thus, in these cases the peri-aneurysmal environment must be considered when analyzing aneurysm evolution.

  6. Microsurgical Strategies Following Failed Endovascular Treatment with the Pipeline Embolization Device: Case of a Giant Posterior Cerebral Artery Aneurysm

    OpenAIRE

    Ding, Dale; Starke, Robert M.; Kenneth C. Liu

    2014-01-01

    Treatment of giant posterior circulation aneurysms, via endovascular or microsurgical approaches, carries a high risk of morbidity and mortality. While flow-diverting stents (FDSs) represent a potent therapy for endovascular reconstruction of complex aneurysms, they are also associated with novel complications for which effective salvage techniques are lacking. We present a unique complication from failed treatment with a FDS. A 51 year-old male presented with increasing headaches secondary t...

  7. Simultaneous presentation of two cerebral aneurysms.

    Science.gov (United States)

    Yoshida, Masahiro; Ezura, Masayuki; Sasaki, Kazuto; Chonan, Masashi; Mino, Masaki

    2012-01-01

    A 48-year-old woman experienced sudden onset of severe headache. Computed tomography showed subarachnoid hemorrhage (SAH) and intracerebral hematoma in the right frontal lobe. Digital subtraction angiography revealed three aneurysms in the anterior communicating artery (AcomA), the right posterior communicating artery (PcomA), and the right middle cerebral artery. The AcomA aneurysm was treated with endovascular coiling. However, her oculomotor nerve palsy was aggravated after the procedure. Embolization of the right PcomA aneurysm was conducted immediately and her oculomotor nerve palsy recovered completely 3 months later. Simultaneous presentation of multiple aneurysms with separate symptoms is rare. We speculate that the progressive oculomotor nerve palsy was caused by tiny enlargement or morphological change of the aneurysm caused by elevated blood pressure and pulsatile effect after SAH.

  8. Progressive Deconstruction of a Distal Posterior Cerebral Artery Aneurysm Using Competitive Flow Diversion.

    Science.gov (United States)

    Johnson, Andrew K; Tan, Lee A; Lopes, Demetrius K; Moftakhar, Roham

    2016-03-01

    Progressive deconstruction is an endovascular technique for aneurysm treatment that utilizes flow diverting stents to promote progressive thrombosis by diverting blood flow away from the aneurysm's parent vessel. While the aneurysm thromboses, collateral blood vessels develop over time to avoid infarction that can often accompany acute parent vessel occlusion. We report a 37-year-old woman with a left distal posterior cerebral artery aneurysm that was successfully treated with this strategy. The concept and rationale of progressive deconstruction are discussed in detail.

  9. Intrathecal treatment of cerebral vasospasm.

    Science.gov (United States)

    Zhang, Yi Ping; Shields, Lisa B E; Yao, Tom L; Dashti, Shervin R; Shields, Christopher B

    2013-11-01

    Treatment of cerebral vasospasm after aneurysmal subarachnoid hemorrhage (SAH) remains a major therapeutic challenge. Systemic drug administration is the current treatment of choice, but patients often do not respond beneficially to this approach. Intrathecal (IT) drug administration has several anatomic and pharmacodynamic advantages over conventional systemic treatment of cerebral vasospasm. We reviewed the most recent literature describing IT administration of several drugs to treat aneurysm-induced SAH and cerebral vasospasm, including 16 clinical trials using IT fibrinolytic agents and 10 trials using several IT vasodilators. We evaluated the safety and effectiveness of these trials but made no attempt to perform a meta-analysis using these data. IT drug administration of fibrinolytic agents and vasodilators caused lysis of the subarachnoid clot burden and diminished cerebral vasospasm, respectively. The studies reviewed reported a wide range of drug doses, intervals between aneurysm hemorrhage and initiation of treatment, success of clot dissolution, and degree of vasodilation of vessels in vasospasm. Treatment of vasospasm by IT drug administration is safe and largely effective after the aneurysm has been secured. Our findings indicate that IT treatment effectively delivers a higher drug concentration to vessels in vasospasm with minimal systemic effects. Drugs administered by this route are reported to lyse subarachnoid clots, attenuate cerebral vasospasm, improve clinical outcomes, and decrease the incidence of hydrocephalus. With greater understanding of drug pharmacodynamics, the IT route of drug administration may provide a rational, alternative approach to treating aneurysm-induced cerebral vasospasm. PMID:22651990

  10. Aneurysms of the posterior cerebral artery in children

    International Nuclear Information System (INIS)

    Two cases of aneurysms of the posterior cerebral artery, diagnosed by CT and confirmed angiographically, are reported. In the first case, the aneurysm was discovered fortuitously. The second began with intracerebral haemorrhage. A review of the literature is reported. (orig.)

  11. Endovascular treatment of an adolescent patient with ruptured intracranial aneurysm

    International Nuclear Information System (INIS)

    The occurrence of intracranial aneurysms in pediatric patients under 18 years of age is between 0,5-2% of all diagnosed aneurysms. We describe our experience with a patient of 10 years old with subarachnoid hemorrhage due to ruptured trilobular aneurysm on the top of the basilar artery, evidenced by CT angiography and DSA. Powered been consistently excluded from the bloodstream of two lobules of the aneurysm through coiling. Changed conditions of hemodynamics in aneurysmal sac fed to subsequent selftrombosing the third lobe of the aneurysm. Made control angiography after 10 months confirmed the good result of endovascular treatment and no neurological deficit. In conclusion it can be noted that in present conditions with a multidisciplinary approach endovascular treatment can be applied in this group of patients. (authors) Key words: SUBARACHNOID HEMORRHAGIA. CEREBRAL VESSEL ANEURYSM. BASILAR CEREBRAL ARTERY. COIL EMBOLIZATION

  12. A rare association of cerebral dural arteriovenous fistula with venous aneurysm and contralateral flow-related middle cerebral artery aneurysm.

    Science.gov (United States)

    Onu, David O; Hunn, Andrew W; Harle, Robin A

    2013-01-01

    The association of cerebral dural arteriovenous fistula (DAVF) and ipsilateral flow related aneurysm has infrequently been reported. We describe a male patient who presented with an acute haemorrhagic stroke and was found to have a large right fronto-parietal intra-parenchymal haemorrhage from the ruptured Borden type II DAVF in addition to a large venous aneurysm and a flow related intraosseous aneurysm of the contralateral middle meningeal artery (MMA) all clearly delineated by CT and DSA. He underwent emergency stereotactic evacuation of the intraparenchymal haemorrhage and successful surgical treatment of all the vascular lesions at the same time with residual neurological deficit. To our knowledge, this is the first such reported case. We discuss the challenging surgical treatment, emphasising the role of CT/DSA in management, and provide a literature review.

  13. Therapeutic approaches to cerebral vasospasm complicating ruptured aneurysm

    Directory of Open Access Journals (Sweden)

    Mohamed Barbarawi

    2009-10-01

    Full Text Available Cerebral vasospasm is a serious complication of ruptured aneurysm. In order to avoid short- and long-term effects of cerebral vasospasm, and as there is no single or optimal treatment modality employed, we have instituted a protocol for the prevention and treatment of vasospasm in patients suffering aneurysmal sub-arachnoid hemorrhage (SAH. We then reviewed the effectiveness of this protocol in reducing the mortality and morbidity rate in our institution. In this study we present a retrospective analysis of 52 cases. Between March 2004 and December 2008 52 patients were admitted to our service with aneurysmal SAH. All patients commenced nimodipine, magnesium sulphate (MgSO4 and triple H therapy. Patients with significant reduction in conscious level were intubated, ventilated and sedated. Intracranial pressure (ICP monitoring was used for intubated patients. Sodium thiopental coma was induced for patients with refractory high ICP; angiography was performed for diagnosis and treatment. Balloon angioplasty was performed if considered necessary. Using this protocol, only 13 patients (25% developed clinical vaso-spasm. Ten of them were given barbiturates to induce coma. Three patients underwent transluminal balloon angioplasty. Four out of 52 patients (7.7% died from severe vasospasm, 3 patients (5.8% became severely disabled, and 39 patients (75% were discharged in a condition considered as either normal or near to their pre-hemorrhage status. Our results confirm that the aforementioned protocol for treatment of cerebral vasospasm is effective and can be used safely.

  14. Neurosurgical versus endovascular treatment of subarachnoid haemorrhage caused by ruptured cerebral aneurysm: comparison of patient outcomes.

    Science.gov (United States)

    Kamensky, J

    2015-03-01

    The aim of this critical review is to determine whether endovascular treatment (EVT) of a subarachnoid haemorrhage (SAH) has better patient outcomes than neurosurgical treatment (NST). A review of six cohort studies (listed in Table 1) was carried out and the main findings were summarised in the conclusion. In addition the list of author's recommendations is included at the end of the paper. Theatre practitioners involved in neurosurgery might find this review useful in enhancing their understanding of how SAH is currently treated. It could also bring some insights about the reasons why a particular modality of the treatment was chosen for their patient. PMID:26016283

  15. Paediatric dissecting posterior cerebral aneurysms: report of two cases and review of the literature

    Energy Technology Data Exchange (ETDEWEB)

    Vilela, Pedro; Goulao, Augusto [Garcia de Orta Hospital, Neuroradiology Department, Almada (Portugal)

    2006-08-15

    Intracranial aneurysms in the paediatric population are uncommon, accounting for 2% to 6% of all aneurysms, and spontaneous arterial dissection is rarely reported as the cause of aneurysms in children, especially in the posterior cerebral artery. Two cases of paediatric spontaneous posterior cerebral artery dissecting aneurysms are reported, one in a 33-month-old male child presenting with aneurysmal rupture and subarachnoid haemorrhage and the other in a 9-year-old boy with an unruptured aneurysm. The first child was successfully treated by endovascular parent vessel occlusion without neurological deficit and in the second a spontaneous thrombosis of the aneurysm and its parent artery occurred associated with hydrocephalus and a favourable outcome. Dissecting aneurysms are dynamic lesions with variable and unpredictable evolution and close follow-up and/or early treatment is warranted. Spontaneous arterial dissection is a rare, probably still under-recognized, cause of intracranial aneurysms that may be responsible for a significant number of aneurysms and spontaneous aneurysmal thromboses in children. (orig.)

  16. Paediatric dissecting posterior cerebral aneurysms: report of two cases and review of the literature

    International Nuclear Information System (INIS)

    Intracranial aneurysms in the paediatric population are uncommon, accounting for 2% to 6% of all aneurysms, and spontaneous arterial dissection is rarely reported as the cause of aneurysms in children, especially in the posterior cerebral artery. Two cases of paediatric spontaneous posterior cerebral artery dissecting aneurysms are reported, one in a 33-month-old male child presenting with aneurysmal rupture and subarachnoid haemorrhage and the other in a 9-year-old boy with an unruptured aneurysm. The first child was successfully treated by endovascular parent vessel occlusion without neurological deficit and in the second a spontaneous thrombosis of the aneurysm and its parent artery occurred associated with hydrocephalus and a favourable outcome. Dissecting aneurysms are dynamic lesions with variable and unpredictable evolution and close follow-up and/or early treatment is warranted. Spontaneous arterial dissection is a rare, probably still under-recognized, cause of intracranial aneurysms that may be responsible for a significant number of aneurysms and spontaneous aneurysmal thromboses in children. (orig.)

  17. Abdominal Aortic Aneurysms: Treatments

    Science.gov (United States)

    ... access catheters Vertebroplasty Women and vascular disease Women's health Social Media Facebook Twitter ... Abdominal Aortic Aneurysms Interventional Radiologists Treat Abdominal Aneurysms Nonsurgically Interventional radiologists are vascular ...

  18. Posterior cerebral artery angle and the rupture of basilar tip aneurysms.

    Directory of Open Access Journals (Sweden)

    Allen L Ho

    Full Text Available Since the initial publication of the International Study of Unruptured Intracranial Aneurysms (ISUIA, management of unruptured intracranial aneurysms has been mainly based on the size of the aneurysm. The contribution of morphological characteristics to treatment decisions of unruptured aneurysms has not been well studied in a systematic and location specific manner. We present a large sample of basilar artery tip aneurysms (BTA that were assessed using a diverse array of morphological variables to determine the parameters associated with ruptured aneurysms. Demographic and clinical risk factors of aneurysm rupture were obtained from chart review. CT angiograms (CTA were evaluated with Slicer, an open source visualization and image analysis software, to generate 3-D models of the aneurysms and surrounding vascular architecture. Morphological parameters examined in each model included aneurysm volume, aspect ratio, size ratio, aneurysm angle, basilar vessel angle, basilar flow angle, and vessel to vessel angles. Univariate and multivariate analyses were performed to determine statistical significance. From 2008-2013, 54 patients with BTA aneurysms were evaluated in a single institution, and CTAs from 33 patients (15 ruptured, 18 unruptured were available and analyzed. Aneurysms that underwent reoperation, that were associated with arteriovenous malformations, or that lacked preoperative CTA were excluded. Multivariate logistic regression revealed that a larger angle between the posterior cerebral arteries (P1-P1 angle, p = 0.037 was most strongly associated with aneurysm rupture after adjusting for other morphological variables. In this location specific study of BTA aneurysms, the larger the angle formed between posterior cerebral arteries was found to be a new morphological parameter significantly associated with ruptured BTA aneurysms. This is a physically intuitive parameter that can be measured easily and readily applied in the clinical

  19. Stent-assisted coil embolization of a symptomatic middle cerebral artery aneurysm in an infant.

    Science.gov (United States)

    Savastano, Luis E; Chaudhary, Neeraj; Gemmete, Joseph J; Garton, Hugh J L; Maher, Cormac O; Pandey, Aditya S

    2014-11-01

    Pediatric intracranial aneurysms are rare and challenging to treat. Achieving efficacy and durability of aneurysmal occlusion while maintaining parent vessel patency requires innovative treatment strategies, especially in cases in which aneurysmal location or morphology pose substantial morbidity associated with microsurgical treatment. In the last 3 decades, endovascular treatments have had a remarkable evolution and are currently considered safe and effective therapeutic options for cerebral aneurysms. While endovascular techniques are well described in the English literature, the endovascular management of pediatric aneurysms continues to pose a challenge. In this report, the authors describe the case of a 9-month-old infant who presented with a 1-day history of acute-onset left-sided hemiparesis and left facial droop. Imaging revealed a large symptomatic saccular middle cerebral artery aneurysm. Treatment included successful stent-assisted aneurysm coiling. At follow-up, the patient continued to fare well and MR angiography confirmed complete occlusion of the aneurysm dome. This case features the youngest patient in the English literature to harbor an intracranial aneurysm successfully treated with stent-assisted coiling. Based on this experience, endovascular intervention with vascular reconstruction can be safe and effective for the treatment of infants and could further improve prognosis; however, further studies are necessary to confirm these findings.

  20. Prevalence of cerebral aneurysm in patients with acromegaly.

    Science.gov (United States)

    Oshino, Satoru; Nishino, Akio; Suzuki, Tsuyoshi; Arita, Hideyuki; Tateishi, Akihiro; Matsumoto, Katsumi; Shimokawa, Toshio; Kinoshita, Manabu; Yoshimine, Toshiki; Saitoh, Youichi

    2013-06-01

    The prevalence of cerebral aneurysm was retrospectively investigated in 208 patients with acromegaly relative to the rate of cerebral aneurysm in a group of control subjects. Neuroradiological examinations of the cerebral vascular system were conducted in 208 acromegaly patients (101 men; mean age, 48.8 years). The prevalence of cerebral aneurysm in the acromegaly patients was compared to that in a control group consisting of 7,390 subjects who underwent "brain checkup" between 2006 and 2008 (mean age, 51.6 years). In the acromegaly group, cerebral aneurysm was detected in 4.3 % of patients. By sex, the prevalence was 6.9 % in males, a significantly proportion than that in the control group with an odds ratio of 4.40. The prevalence in females did not differ between the two groups. In the acromegaly group, the rate of hypertension was significantly higher in the patients with aneurysm compared to those without aneurysm. Multiple logistic regression identified acromegaly as a significant factor related to the prevalence of cerebral aneurysm in all male subjects; other factors, such as age, hypertension and smoking, were not found to be significant. A significantly higher prevalence of cerebral aneurysm was detected in male patients with acromegaly. This finding indicates that excess growth hormone or insulin-like growth factor 1 affects the cerebral vascular wall, resulting in aneurysm formation. In addition to known systematic complications in the cardiovascular, respiratory, metabolic, and other systems, the risk of cerebral aneurysm should be considered in the management of acromegaly.

  1. Use of the pipeline embolization device to treat recently ruptured dissecting cerebral aneurysms.

    Science.gov (United States)

    Chan, Robert S K; Mak, Calvin H K; Wong, Alain K S; Chan, Kwong Yau; Leung, Kar Ming

    2014-01-01

    The Pipeline embolization device (PED) is one of the flow-diverting stents approved for the treatment of unruptured large or wide-necked cerebral aneurysms in 2011(1). Its use has now been extended to the treatment of recently ruptured dissecting cerebral aneurysm, carotid pseudoaneurysm from radiation injury, and blister aneurysms(2,3). We aimed to evaluate the effectiveness of utilizing the PED as a primary treatment for ruptured dissecting intracranial aneurysms. A single center retrospective review was conducted for all patients primarily treated with PED for acute subarachnoid hemorrhage (SAH) from ruptured dissecting cerebral aneurysms between December 2010 and February 2013. Patients were followed up with CT angiogram (CTA) or digital subtraction angiogram (DSA). Eight patients with a total of eight dissecting aneurysms were identified. The mean duration from SAH to treatment was 2.5 days. Six of the aneurysms arose from vertebral arteries and two from the basilar artery. Immediate check-DSA confirmed satisfactory contrast stasis in all eight cases, and complete aneurysmal obliteration was achieved at six months. There were two (25%) procedure-related complications, but no major procedure-related complications, such as thromboembolic events or rebleeding from aneurysm were encountered. The PED is a feasible treatment option for ruptured dissecting cerebral aneurysms in acute phase. According to our experience, using PED as flow-diverters in acute SAH does not significantly increase the complication risks or mortality rate if the antiplatelet regime is carefully monitored. Future studies shall evaluate the optimal antiplatelet regimen for using the PED in the acute phase. PMID:25207906

  2. Microsurgical subtemporal approach to aneurysms on the P 2 segment of the posterior cerebral artery

    Directory of Open Access Journals (Sweden)

    Zhitao Jing

    2010-01-01

    Full Text Available Background: Aneurysms arising from the P 2 segment of the posterior cerebral artery (PCA are rare, accounting for less than 1% of all intracranial aneurysms. To date, few studies concerning the management of P 2 segment aneurysms have been reported. Objective: To review the microsurgical techniques and clinical outcomes of microsurgical treatment by different approaches in patients with aneurysms on the P 2 segment of the PCA. Materials and Methods: Forty-two patients with P2 segment aneurysms had microsurgical treatment by subtemporal approach. All the patients had drainage of cerebrospinal fluid for decompression, and indocyanine green (ICG angiography was used in 20 patients to assess the effect of clipping. Results: Of the 42 patients, 16 were operated by combined pterional-subtemporal approach. In 40 patients aneurysms were successfully treated by clipping the P 2 aneurysmal neck while preserving the parent artery. Two patients with giant aneurysms were treated using surgical trapping. Postoperatively, 41 patients had a good recovery. One patient after aneurysm trapping had ischemic infarction in the PCA tertiary and presented with hemiparesis and homonymous hemianopia. However, this patient recovered after three weeks of treatment. Conclusion: Subtemporal approach is the most appropriate approach to clip the aneurysms of the P 2 segment. It allows the neurosurgeon to operate on the aneurysms while preserving the patency of the parent artery. Gaint P 2 segment aneurysms can safely be treated by rapping of the aneurysm by combined subtemporal or pterional-subtemporal approach in experienced hands.ICG angiography will be an important tool in monitoring for the presence of residual aneurysm or perforating artery occlusion during aneurysm clipping. Preoperative lumbar drainage of cerebrospinal fluid may help to avoid temporal lobe damage.

  3. Virtual reality system for diagnosis and therapeutic planning of cerebral aneurysms

    Institute of Scientific and Technical Information of China (English)

    MO Da-peng; BAO Sheng-de; LI Liang; YI Zhi-qiang; ZHANG Jia-yong; ZHANG Yang

    2010-01-01

    Background The virtual reality (VR) system can provide the neurosurgeon to intuitively interact with and manipulate the three dimensional (3-D) image similarly to manipulate a real object.it was seldom reported that the system was used in diagnosis and treatment of cerebral aneurysms.This study aimed to investigate the application of VR system in diagnosis and therapeutic planning of cerebral aneurysms.Methods A total of 24 cases of cerebral aneurysms were enrolled in this study from 2006 to 2008, which diagnosed by 3-D digital subtraction angiography (3D-DSA) or VR-based computed tomography angiographies (CTA).The VR system and 3D-DSA system were used to observe and measure aneurysms and the adjacent vessels.The data of observation and measurements were compared between VR image and 3D-DSA image.All the patients underwent surgical plan and simulated neurosurgical procedures in the VR system.Results There were 28 aneurysms detected in VR system and 3D-DSA system.The VR system generated clear and vivid 3-D virtual images which clearly displayed the location and size of the aneurysms and their precise anatomical spatial relations to the parent arteries and skull.The location, size and shape of the aneurysms and their anatomical relationship with the adjacent vessels were similar between 3-D virtual image and 3D-DSA, but the spatial relationship between aneurysms and skull only been displayed by VR system.This VR system also could simulate simple surgical procedures and surgical environments.Conclusions The VR system can provide a highly effective way to provide precise imaging details as same as 3D-DSA system and assist the diagnosis of cerebral aneurysms with virtual 3-D data based on CTA.It significantly enhances the chosen therapeutic strategy of cerebral aneurysms.

  4. Coil embolization in precommunicating (A1) segment aneurysms of anterior cerebral artery

    Energy Technology Data Exchange (ETDEWEB)

    Cho, Young Dae; Ahn, Jun Hyong; Jung, Seung Chai; Kim, Chang Hun [Seoul National University Hospital, Seoul National University College of Medicine, Department of Radiology, Seoul (Korea, Republic of); Kang, Hyun-Seung; Kim, Jeong Eun [Seoul National University Hospital, Seoul National University College of Medicine, Department of Neurosurgery, 28 Yongon-dong, Jongno-gu, Seoul (Korea, Republic of); Son, Young Je [Seoul National University Boramae Hospital, Seoul National University College of Medicine, Department of Neurosurgery, Seoul (Korea, Republic of); Han, Moon Hee [Seoul National University Hospital, Seoul National University College of Medicine, Department of Radiology, Seoul (Korea, Republic of); Seoul National University Hospital, Seoul National University College of Medicine, Department of Neurosurgery, 28 Yongon-dong, Jongno-gu, Seoul (Korea, Republic of)

    2014-03-15

    Precommunicating (A1) segment aneurysms of the anterior cerebral artery are rare and often pose technical challenges for coil embolization due to their distinctive configurations. Clinical and radiologic outcomes of treating such aneurysms through endovascular coil embolization are presented herein. Data accruing prospectively from May 2002 to August 2013 yielded 48 patients harboring 50 A1 segment aneurysms, each classified as proximal, middle, or distal by location. Clinical outcome of the patients and morphological outcome of the aneurysms were assessed, with emphasis on technical aspects of treatment. The aneurysms studied occupied either proximal (n = 39), middle (n = 6), or distal (n = 5). Proximal aneurysms were largely directed posteriorly (80 %), and most (97 %) were devoid of branches. Middle and distal aneurysms were associated with the medial lenticulostriate artery, cortical branches, or fenestrations. The preshaped ''S'' and steam-shaped ''S'' microcatheters facilitated aneurysm selection in 60 % of lesions. Single-microcatheter technique was most commonly applied for coil embolization (62 %), followed by balloon protection (16 %). Successful aneurysmal occlusion could be achieved in 76 % of the patients, with no procedure-related morbidity and mortality. At final follow-up (mean interval, 29.9 months), stable aneurysmal occlusion was sustained in 93 % of the patients (40/43). A1 segment aneurysms are amenable to safe and efficacious endovascular coil embolization by adjusting procedural strategy to accommodate distinctive anatomic configurations. (orig.)

  5. Endovascular strategy for unruptured cerebral aneurysms

    International Nuclear Information System (INIS)

    The treatment of unruptured intracranial aneurysms (UIAs) remains complex and not clearly defined. While for ruptured intracranial aneurysms the management and the treatment option (surgery or endovascular treatment) are well defined by several trials, for asymptomatic UIAs the best management is still currently uncertain. The rationale to treat an UIA is to prevent the rupture and its consequent SAH and all complications derived from hemorrhage or reduce/eliminate neurological palsy. Although this statement is correct, the indication to treat an UIA should be based on a correct balance between the natural history of UIA and treatment risk. Patient's clinical history, aneurysm characteristics, and strategy management influence the natural history of UIAs and treatment outcomes. In the last 10 years and more, two important large multicenter studies were performed in order to analysis of all these factors and to evaluate the best treatment option for UIAs. The aim of this paper is to try to synthesize the possible indications to the endovascular treatment (EVT), when and how to treat an UIA

  6. Endovascular strategy for unruptured cerebral aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Mangiafico, S., E-mail: mangiax@libero.it [Interventional Neuroradiology Unit, Careggi University Hospital, Florence (Italy); Guarnieri, G., E-mail: gianluigiguarnieri@hotmail.it [Neuroradiology Service, Cardarelli Hospital, Naples (Italy); Consoli, A., E-mail: onemed21@gmail.com [Interventional Neuroradiology Unit, Careggi University Hospital, Florence (Italy); Ambrosanio, G., E-mail: gambros@libero.it [Neuroradiology Service, Cardarelli Hospital, Naples (Italy); Muto, M., E-mail: mutomar@tiscali.it [Neuroradiology Service, Cardarelli Hospital, Naples (Italy)

    2013-10-01

    The treatment of unruptured intracranial aneurysms (UIAs) remains complex and not clearly defined. While for ruptured intracranial aneurysms the management and the treatment option (surgery or endovascular treatment) are well defined by several trials, for asymptomatic UIAs the best management is still currently uncertain. The rationale to treat an UIA is to prevent the rupture and its consequent SAH and all complications derived from hemorrhage or reduce/eliminate neurological palsy. Although this statement is correct, the indication to treat an UIA should be based on a correct balance between the natural history of UIA and treatment risk. Patient's clinical history, aneurysm characteristics, and strategy management influence the natural history of UIAs and treatment outcomes. In the last 10 years and more, two important large multicenter studies were performed in order to analysis of all these factors and to evaluate the best treatment option for UIAs. The aim of this paper is to try to synthesize the possible indications to the endovascular treatment (EVT), when and how to treat an UIA.

  7. Intravenous DSA as a screening method for cerebral aneurysms

    International Nuclear Information System (INIS)

    Intravenous DSA (IVDSA) was evaluated as a screening method for cerebral aneurysms. It was performed 390 times in 372 cases. Clinically useful images were obtained in 94.1% in all examinations. Nineteen aneurysms were visualized in cerebral angiography among 21 cases with SAH or 3rd nerve palsy, whereas in IVDSA 15 aneurysms were noted. Aneurysms not visualized in IVDSA were all 4 mm or less in size. Therefore, aneurysms, more than 4 mm in size, which have higher risks for rupture, were detectable in IVDSA. Based on these findings, IVDSA is considered to be clinically useful in screening for aneurysms. In all 372 cases, 33 aneurysms were suspected in IVDSA findings, whereas in cerebral angiography 21 of them turned to be aneurysms. Such 12 false positive cases were distributed mainly at anterior communicating and middle cerebral arteries. Improvement of image resolution, avoidance of vessel overlapping and proper selection of screened cases should be investigated for further development of this screening method. (author)

  8. Usefulness of CT angiography for demonstrating cerebral aneurysm

    International Nuclear Information System (INIS)

    We report the usefulness of computed cerebral angiotomography (CT angiography) for demonstrating cerebral aneurysm and the clinical significance of CT angiography for ruptured cerebral aneurysm. Our modified method of CT angiography was easy and less time-consuming. Fifteen seconds after starting a single bolus injection, 1 ml/kg/25 seconds via cubital vein, of contrast medium (60 % urograffin), 5 serial 5 mm thick-CT slices were scanned in every 6.5 seconds including 2 seconds of interval, beginning from an axial level 20 mm above the orbitomeatal line and ending at a level 40 mm. A total of 103 patients were examined in this report, consisting of 70 unruptured asymptomatic, 8 unruptured symptomatic (oculomotor nerve palsy) and 25 subarachnoid hemorrhage (SAH). Seven unruptured aneurysms in 4 asymptomatic cases, 2 unruptured aneurysms in 2 symptomatic cases 27 aneurysms in 24 SAH cases were suspected by CT angiography. Of these 36 aneurysms suspected by CT angiography 32 aneurysms were confirmed by cerebral angiography. The detection rate of CT angiography in this report was 89 %, higher than those of previous reports. Thirteen aneurysms were located at internal carotidposterior communicating artery (ICPC) junction. 11 at anterior communicating artery (Acom), 7 at middle cerebral artery (MCA). CT angiography showed a false positive findings in 4 cases, which were all located at Acom. Four aneurysms were not detected in CT angiography, which were all located at MCA and were very small (2 - 3 mm) in diameter. There were no deteriorated cases during and after CT angiography. We suggest that CT angiography is a useful and safe method for predicting the location of not only unruptured but ruptured aneurysms. (author)

  9. Outcomes of early physiotherapy in patients with cerebral aneurysms treated by surgical clipping or endovascular embolization☆

    OpenAIRE

    Guclu-Gunduz, Arzu; Bilgin, Sevil; KÖSE, Nezire; Oruckaptan, Hakan

    2012-01-01

    Early physiotherapy was given to 124 patients with ruptured or unruptured cerebral aneurysms who were treated by surgical clipping or endovascular embolization. Patients were divided into four groups according to their Hunt and Hess grade at admission and aneurysm treatment modality: Group 1, Hunt and Hess grade ≤ II and surgical clipping; Group 2, Hunt and Hess grade ≤ II and endovascular embolization; Group 3, Hunt and Hess grade ≥ III and surgical clipping; Group 4, Hunt and Hess grade ≥ I...

  10. Numerical predictions of hemodynamics following surgeries in cerebral aneurysms

    Science.gov (United States)

    Rayz, Vitaliy; Lawton, Michael; Boussel, Loic; Leach, Joseph; Acevedo, Gabriel; Halbach, Van; Saloner, David

    2014-11-01

    Large cerebral aneurysms present a danger of rupture or brain compression. In some cases, clinicians may attempt to change the pathological hemodynamics in order to inhibit disease progression. This can be achieved by changing the vascular geometry with an open surgery or by deploying a stent-like flow diverter device. Patient-specific CFD models can help evaluate treatment options by predicting flow regions that are likely to become occupied by thrombus (clot) following the procedure. In this study, alternative flow scenarios were modeled for several patients who underwent surgical treatment. Patient-specific geometries and flow boundary conditions were obtained from magnetic resonance angiography and velocimetry data. The Navier-Stokes equations were solved with a finite volume solver Fluent. A porous media approach was used to model flow-diverter devices. The advection-diffusion equation was solved in order to simulate contrast agent transport and the results were used to evaluate flow residence time changes. Thrombus layering was predicted in regions characterized by reduced velocities and shear stresses as well as increased flow residence time. The simulations indicated surgical options that could result in occlusion of vital arteries with thrombus. Numerical results were compared to experimental and clinical MRI data. The results demonstrate that image-based CFD models may help improve the outcome of surgeries in cerebral aneurysms. acknowledge R01HL115267.

  11. Endovascular Therapeutic Occlusion of the Posterior Cerebral Artery: An Option for Ruptured Giant Aneurysm in a Child.

    Science.gov (United States)

    Demartini, Zeferino; Matos, Luiz Afonso Dias; Dos Santos, Marcio Luis Tostes; Cardoso-Demartini, Adriane de Andre

    2016-01-01

    The incidence of intracranial aneurysms in the pediatric population is low, and surgical clipping remains a good long-term treatment option. However, posterior circulation aneurysms are even more complex to manage in children than in adults. We report a case of a giant aneurysm of the posterior cerebral artery in a 10-year-old boy presenting with subarachnoid hemorrhage. Endovascular treatment with platinum coils was performed with total occlusion of the aneurysm and the affected arterial segment without complications. The patient achieved good recovery, and a late control angiogram confirmed exclusion of the aneurysm. Occurrence of special features of cerebral aneurysm in children, in comparison to adults, is also described. Parent artery sacrifice is an effective therapeutic option, but long-term follow-up is necessary to avoid recurrence and rebleeding.

  12. Ruptured cerebral aneurysm associated with a persistent primitive trigeminal artery variant

    Science.gov (United States)

    Yamamoto, Takahiro; Hasegawa, Yu; Ohmori, Yuki; Kawano, Takayuki; Kai, Yutaka; Morioka, Motohiro; Kuratsu, Jun-ichi

    2011-01-01

    Background: Primitive trigeminal artery variants (PTAVs) are one of the rare persistent fetal anastomoses between the carotid and vertebrobasilar circulations. They originate from the internal carotid artery and join one of the cerebellar arteries instead of the basilar artery. Case Description: We present an 82-year-old woman with subarachnoid hemorrhage due to a ruptured aneurysm originating at a PTAV. Three-dimensional computed tomography angiogram and cerebral angiography revealed bilateral PTAV and two aneurysms originating at the left PTAV. The proximal and distal aneurysms were saccular and fusiform, respectively. She underwent surgical treatment and her postoperative course was uneventful. Conclusion: Our case demonstrates that extremely rare cerebral aneurysms associated with PTAV can be addressed successfully by surgical intervention. PMID:22059121

  13. Pericallosal lipoma and middle cerebral artery aneurysm: a coincidence?

    Energy Technology Data Exchange (ETDEWEB)

    Sommet, Julie; Schiff, Manuel; Evrard, Philippe [Hopital Robert Debre, APHP, Department of Paediatric Neurology and Metabolic Diseases, Paris Cedex 19 (France); Blanc, Raphael [Fondation Rothschild, Department of Interventional Radiology, Paris (France); Elmaleh-Berges, Monique [Hopital Robert Debre, Department of Paediatric Radiology, Paris (France)

    2010-08-15

    Intracranial lipomas are rare congenital malformations that can often be seen in association with other brain malformations; agenesis or dysgenesis of the corpus callosum is the most frequently associated brain anomaly. They are usually pericallosal asymptomatic midline lesions. Intracranial lipomas associated with a non-contiguous cerebral aneurysm are extremely rare. We report an infant with partial agenesis of the corpus callosum and pericallosal lipoma associated with cerebral haemorrhage due to a distal middle cerebral artery aneurysm. Such an association is probably not fortuitous and could suggest a pathogenic relationship. (orig.)

  14. Pericallosal lipoma and middle cerebral artery aneurysm: a coincidence?

    International Nuclear Information System (INIS)

    Intracranial lipomas are rare congenital malformations that can often be seen in association with other brain malformations; agenesis or dysgenesis of the corpus callosum is the most frequently associated brain anomaly. They are usually pericallosal asymptomatic midline lesions. Intracranial lipomas associated with a non-contiguous cerebral aneurysm are extremely rare. We report an infant with partial agenesis of the corpus callosum and pericallosal lipoma associated with cerebral haemorrhage due to a distal middle cerebral artery aneurysm. Such an association is probably not fortuitous and could suggest a pathogenic relationship. (orig.)

  15. Successful endovascular reconstruction of a recurrent giant middle cerebral artery aneurysm with multiple telescoping flow diverters in a pediatric patient.

    Science.gov (United States)

    Ikeda, Daniel S; Marlin, Evan S; Shaw, Andrew; Powers, Ciarán J

    2015-01-01

    Intracranial aneurysms of the pediatric population are rare, but giant fusiform aneurysms (GFAs) of the middle cerebral artery (MCA) are common within this cohort of patients. These aneurysms are difficult to treat and often require advanced microsurgical skills, as they are usually not amenable to direct clipping. Here, we report the successful treatment of a recurrent GFA of the MCA with three telescoping Pipeline Embolization Devices 6 months after attempted clip reconstruction in a pediatric patient.

  16. Endovascular treatment of scalp cirsoid aneurysms

    Directory of Open Access Journals (Sweden)

    Gupta A

    2008-01-01

    Full Text Available Background: Scalp is the most common site of soft tissue arteriovenous fistulae and surgical excision has been the primary mode of treatment. Endovascular treatment has evolved as an alternative to the surgery. Aims: To evaluate the effectiveness of percutaneous direct-puncture embolization of cirsoid aneurysms. Materials and Methods: From January 1995 to December 2004, 15 patients underwent percutaneous direct-puncture embolization of cirsoid aneurysms. Plain X-ray, computerized tomography scan and complete selective cerebral angiogram were done in all. Seven patients had forehead lesions, four had temporal and the remaining four patients had occipital region cirsoid aneurysms. Lesions were punctured with 21-gauge needle and embolized with 20-50% cyanoacrylate-lipiodol mixture. Circumferential compression was applied during injection. Results: Post-embolization angiogram showed complete obliteration in 11 patients. The remaining four patients required adjunctive transarterial embolization with polyvinyl alcohol particles for complete lesion devascularization. Two patients had post procedure surgery for removal of disfiguring and hard glue cast. There were no major procedure-related complications. No patients had any recurrence in the follow-up. Conclusion: Percutaneous direct puncture embolization of cirsoid aneurysms is a safe and effective procedure. It can be effectively used as an alternative to surgery. Sometimes adjunctive transarterial embolization is also required to deal with deeper feeders.

  17. Stroke associated with left atrial mass: Association of cerebral aneurysm with left atrial myxoma!

    Directory of Open Access Journals (Sweden)

    Shashi Srivastava

    2014-01-01

    Full Text Available Association of LA myxoma with cerebral aneurysm is rare. We describe a patient who had LA mass and cerebral aneurysm and developed stroke. The patient underwent clipping of the cerebral aneurysm. We discuss the pathology of the association and the anesthetic management.

  18. Microsurgical cerebral aneurysm training porcine model

    Directory of Open Access Journals (Sweden)

    Jon Olabe

    2011-01-01

    Full Text Available The authors developed a simple reproducible technique for aneurysm creation and adapted it to mimic intracranial dissection conditions using glue application as a pseudo-arachnoid type layer. Ten 1-2-month-old healthy domestic swine were employed under general anesthesia. A novel technique for bifurcation aneurysm creation was developed using two arteries and a vein. After aneurysm creation, diluted sulfuric acid was applied on the dome with a micropipette to increase aneurysm fragility in selected zones. The surgical field was then dried and contact glue was applied around the vascular complex in a circular manner so as to emulate arachnoidal connection fibers. Microsurgical dissection of the aneurysm and surrounding vessels was performed by delicately removing the adhesive substance. Diverse aneurysm clipping techniques, emergency rupture situations and vascular reconstruction procedures were trained. Twenty-two aneurysms were created at several vascular sites, one aneurysm dome ruptured during application of sulfuric acid, two aneurysm models were proved to be thrombosed, two aneurysms ruptured during the dissection and no intraoperative deaths occurred. All aneurysms were clipped in an acceptable manner. This bifurcation aneurysm model provides a novel training system to be used not only by neurosurgeons but also by neurovascular interventionists.

  19. Using COMSOL Multiphysics for Biomechanical Analysis of Stent Technology in Cerebral Aneurysms

    DEFF Research Database (Denmark)

    Rasmussen, Joachim; Thyregod, Jesper; Enevoldsen, Marie Sand;

    2009-01-01

    This work presents new fluid-structure interaction (FSI) models in both 2D and 3D of the effect of using vascular stents as treatment of cerebral berry aneurysms. The stent is positioned inside the cerebral artery covering the neck of the aneurysm. The stent is expected to alter the blood flow in...... and strut size, shape, and position are modeled in 2D and 3D FSI models. The models show that pore size and strut shape both have significant influence on stent efficiency....

  20. Spiral CT angiography for demonstrating cerebral aneurysms before and after treatment with titanium clips; Spiral-CT-Angiographie zur Darstellung von zerebralen Aneurysmen vor und nach Versorgung mit Titan-Clips

    Energy Technology Data Exchange (ETDEWEB)

    Becker, C.; Volkmar, C.; Weber, J.; Fink, U.; Holzknecht, N.; Reiser, M. [Institut fuer Radiologische Diagnostik, Klinikum Grosshadern, Universitaet Muenchen (Germany); Yousry, T. [Abteilung fuer Neuroradiologie, Institut fuer Radiologische Diagnostik, Klinikum Grosshadern, Universitaet Muenchen (Germany); Steiger, H.J. [Klinik fuer Neurochirurgie, Klinikum Grosshadern, Universitaet Muenchen (Germany)

    1997-11-01

    Purpose: To determine the suitability of spiral CT angiography (SCTA) in patients with intracerebral titanium aneurysm clips. Material and Method: The section parameters were optimised using a phantom. 16 patients were examined preoperatively and 18 following treatment of aneurysms with clips. Results: The resolution, sensitivity and specificity for demonstrating cerebral aneurysms measuring{>=}3 mm was 91.3% and 75% respectively. In 15 patients with intracerebral clips there were no or only minor artefacts; three examinations were of no value because of major metal artefacts. Amongst six aneurysms demonstrated angiographically, two, which measured more than 3 mm, could be shown by SCTA. Conclusion: SCTA was able to demonstrate intracerebral aneurysms measuring{>=}3 mm. Titanium clips did not usually affect image quality significantly. (orig.) [Deutsch] Ziel: Unsere Untersuchungen sollten die Eignung der Spiral-CT-Angiographie (SCTA) fuer Patienten mit intrazerebralen Titan-Aneurysma-Clips pruefen. Material und Methode: An einem Phantom wurden die Schichtparameter optimiert. 16 Patienten wurden praeopertiv und 18 nach operativer Clippung eines Aneurysmas untersucht. Ergebnisse: Die untere Nachweisgrenze, Sensitivitaet und Spezifitaet fuer den Nachweis von zerebralen Aneurysmen lag bei{>=}3 mm, 91,3% und 75%. Bei Patienten mit intrazerebralen Clips wiesen 15 Untersuchungen keine oder geringe Artefakte auf, drei Untersuchungen konnten wegen ausgepraegter Metallartefakte nicht ausgewertet werden. Von den 6 angiographisch nachweisbaren Restaneurysmen konnten zwei mittels SCTA dargestellt werden, deren Durchmesser ueber 3 mm lag. Schlussfolgerung: Mit der SCTA koennen intrazerebrale Aneurysmen und Restaneurysmen{>=}3 mm nachgewiesen werden. Titanclips beeintraechtigen dabei die Bildqualitaet meist nicht nachhaltig. (orig.)

  1. [The role of intraoperative flowmetry in surgery of cerebral aneurysms].

    Science.gov (United States)

    Shekhtman, O D; Éliava, Sh Sh; Shakhnovich, V A; Pilipenko, Iu V

    2011-01-01

    Aim of the study was to assess the capabilities of intraoperative ultrasonic flowmetry in cerebral aneurysm surgery for prevention and immediate correction of cerebral ischemia. Ultrasonic flowmeter (Model HT313/323, "ransonic Systems Inc.", USA) was used during surgery in patients with complicated, large and giant aneurysms for evaluation of cerebral blood flow in main arteries (internal carotid, anterior and middle cerebral) and their branches (branches of M2-M3 and A2 segments). The series included 20 adult patients (13 male and 7 female) operated in Burdenko Moscow Neurosurgery Institute during 2008-2011 years. Mean age was 47.4 +/- 8.6 years. Giant aneurysms (> 2.5 cm) were present in 12 (60%) patients, large (1.5-2.5 cm)--in 5 (25%). Aneurysms of internal carotid artery were found in 8 cases. 1 female patient was operated on giant aneurysm of anterior cerebral--anterior communicating artery. In 4 (20%) cases significant alterations of blood flow were registered after clipping (> 25% according to initial), the changes were not visible. This allowed to correct the position of clips. In 2 surgeries ('low' paraclinoid aneurysms) the collateral flow was sufficient during temporary clipping, this allowed trapping of aneurysms with good neurological outcome. In 3 cases flowmeter was used to evaluate blood flow after extracranial-intracranial bypass. Ultrasonic flowmetry is a simple, reproducible and safe technique for intraoperative assessment of blood flow. Despite visual sufficiency of arteries flowmetry allows detection of surgically significant alterations of blood flow after clipping. PMID:22066255

  2. Mycotic brain aneurysm and cerebral hemorrhagic stroke: a pediatric case report.

    Science.gov (United States)

    Flor-de-Lima, Filipa; Lisboa, Lurdes; Sarmento, António; Almeida, Jorge; Mota, Teresa

    2013-09-01

    Endocarditis due to Abiotrophia spp. is rare and often associated with negative blood cultures, infection relapse, and high rates of treatment failure and mortality (Lainscak et al., J Heart Valve Dis 14(1):33-36, 2005). The authors describe a case of an adolescent with cerebral hemorrhagic stroke due to mycotic brain aneurysm rupture.

  3. Value of three-dimensional computed tomography in screening cerebral aneurysms

    International Nuclear Information System (INIS)

    We performed three-dimensional computed tomography (3D-CT) in 6 patients of cerebral aneurysm. Prior cerebral angiography showed a total of 17 aneurysms. 3D-CT alone detected 10 cerebral aneurysm (59%). It was possible to identify aneurysms larger than 10 mm even when located near the circle of Willis. It was difficult to identify aneurysms when smaller than 7 mm regardless of their location. 3D-CT was of limited value in detecting cerebral aneurysms, particularly when located near the circle of Willis with complex vascular network. As cases of oculomotor palsy may be caused by lesions other than cerebral aneurysm, we advocate that 3D-CT be performed after magnetic resonance imaging (MRI) in screening cases of suspected cerebral aneurysm. (author)

  4. Value of three-dimensional computed tomography in screening cerebral aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Yamaguchi, Tamaki; Sugiura, Yusuke; Suzuki, Atsushi; Yamagata, Yoshitaka [Hyogo Medical Coll. (Japan)

    1997-10-01

    We performed three-dimensional computed tomography (3D-CT) in 6 patients of cerebral aneurysm. Prior cerebral angiography showed a total of 17 aneurysms. 3D-CT alone detected 10 cerebral aneurysm (59%). It was possible to identify aneurysms larger than 10 mm even when located near the circle of Willis. It was difficult to identify aneurysms when smaller than 7 mm regardless of their location. 3D-CT was of limited value in detecting cerebral aneurysms, particularly when located near the circle of Willis with complex vascular network. As cases of oculomotor palsy may be caused by lesions other than cerebral aneurysm, we advocate that 3D-CT be performed after magnetic resonance imaging (MRI) in screening cases of suspected cerebral aneurysm. (author)

  5. Gender differences in cerebral aneurysm location

    OpenAIRE

    Ali Jourabchi Ghods; Demetrius eLopes; Michael eChen

    2012-01-01

    Background and Purpose: A limited number of studies consisting predominantly of ruptured aneurysms have looked at differences in anatomical distribution of aneurysms between male and females. Unlike all other causes of stroke, subarachnoid-hemorrhages (SAH) occur more often in women and are thought to be a result of both hormonal influences and variation in wall shear stress (WSS). This paper retrospectively looks at a cohort of largely unruptured intracranial aneurysms to determine if there ...

  6. Clipping Surgery for Unruptured Middle Cerebral Artery Aneurysms.

    Science.gov (United States)

    Nakagomi, Tadayoshi; Furuya, Kazuhide; Tanaka, Junichi; Takanashi, Shigehiko; Watanabe, Takehiro; Shinohara, Takayuki; Ogawa, Akiko; Fujii, Norio

    2016-01-01

    Clipping surgeries for 139 consecutive unruptured middle cerebral aneurysms were performed between April 1991 and March 2014. Left hemiparesis occurred in one case (0.7 %). Transient symptoms arose in six patients due to perforator injury, arterial branch occlusion, damage to the venous system, or chronic subdural hematoma. Neither mortality nor decline in cognitive function was noted in this study. Clipping surgery for unruptured middle cerebral artery aneurysms can be done with minimal morbidity. However, meticulous management during the perioperative period as well as the use of modern technologies during the surgery, such as MEP monitoring and ICG videoangiography, are needed for safe and secure clipping surgery. PMID:27637633

  7. Endovascular repair of ruptured aneurysm arising from fenestration of the horizontal segment of the anterior cerebral artery: case report.

    Science.gov (United States)

    Yoshida, Masahiro; Ezura, Masayuki; Sasaki, Kazuto; Chonan, Masashi; Mino, Masaki

    2012-01-01

    A 50-year-old man presented with an aneurysm arising from a fenestration of horizontal portion (A(1)) of the anterior cerebral artery manifesting as subarachnoid hemorrhage. Coil embolization was conducted and the aneurysm was occluded easily. Most reported cases of these types of aneurysms underwent direct surgery. Aneurysm arising from the A(1) fenestration is rare, but the present case shows that coil embolization can be an effective treatment modality. Three-dimensional rotational angiography and aneurysmography were helpful to characterize this complicated vascular structure.

  8. Effect of coil embolization on blood flow through a saccular cerebral aneurysm

    Indian Academy of Sciences (India)

    Vishal Agrawal; Chandan Paul; M K Das; K Muralidhar

    2015-05-01

    Coil embolization is a mildly invasive endovascular method for treatment of a cerebral aneurysm. The presence of a coil reduces fluid loading of the blood vessel and delays further deformation of the walls. Its effectiveness depends on the coil porosity and permeability apart from the nature of flow pulsations and its geometry. In the present work, a three dimensional numerical study of pulsatile flow of blood through an artery with saccular cerebral aneurysm is reported. The flow is unsteady but is taken to be laminar and incompressible. The coil is treated as homogeneous and isotropic porous medium. A comparative study has been carried out on aneurysms with and without a coil insert considering blood as a non-Newtonian fluid. The simulation is carried out for Reynolds numbers $Re$ = 500 and 1500. Results show that the velocity magnitude within the coil embolized aneurysm becomes negligible after coil insertion. The wall shear stress within the aneurysm decreases to a great extent for both Reynolds numbers. Pressure levels remain relatively unchanged. Overall, reduced wall loading with a coil stabilizes the growth of the aneurysm and thus provides an advantage.

  9. Image based hemodynamic modeling of cerebral aneurysms and the determination of the risk of rupture

    Science.gov (United States)

    Kroon, D. J.; Slump, C. H.; Sluzewski, M.; van Rooij, W. J. J.

    2006-03-01

    This paper is about the quantitative prediction of the long term outcome of the endovascular coiling treatment of a patient's cerebral aneurysm. It is generally believed that the local hemodynamic properties of the patient's cerebral arteries are strongly influencing the origin and growth of aneurysms. We describe our approach: modelling the flow in a 3D Rotational Angiography (3DRA) reconstruction of the aneurysms including supplying and draining blood vessels, in combination with simulations and experiments of artificial blood vessel phantom constructs and measurements. The goal is to obtain insight in the observed phenomena to support the diagnostic decision process in order to predict the outcome of the intervention with possible simulation of the flow alternation due to the pertinent intervention.

  10. The Expanding Realm of Endovascular Neurosurgery: Flow Diversion for Cerebral Aneurysm Management

    Science.gov (United States)

    Krishna, Chandan; Sonig, Ashish; Natarajan, Sabareesh K.; Siddiqui, Adnan H.

    2014-01-01

    The worldwide prevalence of intracranial aneurysms is estimated to be between 5% and 10%, with some demographic variance. Subarachnoid hemorrhage secondary to ruptured intracranial aneurysm results in devastating neurological outcomes, leaving the majority of victims dead or disabled. Surgical clipping of intracranial aneurysms remained the definitive mode of treatment until Guglielmi detachable coils were introduced in the 1990s. This revolutionary innovation led to the recognition of neurointervention/neuroendovascular surgery as a bona fide option for intracranial aneurysms. Constant evolution of endovascular devices and techniques supported by several prospective randomized trials has catapulted the endovascular treatment of intracranial aneurysms to its current status as the preferred treatment modality for most ruptured and unruptured intracranial aneurysms. We are slowly transitioning from the era of coils to the era of flow diverters. Flow-diversion technology and techniques have revolutionized the treatment of wide-necked, giant, and fusiform aneurysms, where the results of microsurgery or conventional neuroendovascular strategies have traditionally been dismal. Although the Pipeline™ Embolization Device (ev3-Covidien, Irvine, CA) is the only flow-diversion device approved by the Food and Drug Administration for use in the United States, others are commercially available in Europe and South America, including the Silk (Balt Extrusion, Montmorency, France), Flow-Redirection Endoluminal Device (FRED; MicroVention, Tustin, CA), Surpass (Stryker, Kalamazoo, MI), and p64 (Phenox, Bochum, Germany). Improvements in technology and operator experience and the encouraging results of clinical trials have led to broader acceptance for the use of these devices in cerebral aneurysm management. Continued innovation and refinement of endovascular devices and techniques will inevitably improve technical success rates, reduce procedure-related complications, and broaden

  11. Combined treatment for complex intracranial aneurysm

    Directory of Open Access Journals (Sweden)

    Chiriac A.

    2015-06-01

    Full Text Available Complex aneurysms often cannot be completely excluded by a single approaches. Today successful treatment of these lesions requires a combination between microsurgical and endovascular techniques. Planning of combined treatment require a very good understanding of aneurysm anatomy and a close collaboration between neurosurgeon and neuroendovascular interventionist. Endovascular coiling can usually be used as early treatment for a partially aneurysm occlusion including the ruptured area and followed by definitive clipping. On the other hand microsurgical clipping also can be used as first treatment for complex aneurysm neck reconstruction, allowing successful secondary placement of coils inside the remnant aneurysm sac

  12. SOMATOSENSORY EVOKED-POTENTIALS IN CEREBRAL ANEURYSM SURGERY

    NARCIS (Netherlands)

    BUCHTHAL, A; BELOPAVLOVIC, M

    1992-01-01

    Monitoring of median nerve somatosensory evoked potentials (SSEP) during surgery for a basilar artery aneurysm under moderate hypothermia revealed an unexpected loss of the first cortical peak. This was due to compression of the middle cerebral artery under the retractor during the surgical approach

  13. Relationship between vasospasm, cerebral perfusion, and delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage

    NARCIS (Netherlands)

    Dankbaar, Jan W.; Rijsdijk, Mienke; van der Schaaf, Irene C.; Velthuis, Birgitta K.; Wermer, Marieke J. H.; Rinkel, Gabriel J. E.

    2009-01-01

    Vasospasm after aneurysmal subarachnoid hemorrhage (SAH) is thought to cause ischemia. To evaluate the contribution of vasospasm to delayed cerebral ischemia (DCI), we investigated the effect of vasospasm on cerebral perfusion and the relationship of vasospasm with DCI. We studied 37 consecutive SAH

  14. Matrix Metalloproteinases in Cerebral Vasospasm following Aneurysmal Subarachnoid Hemorrhage

    Directory of Open Access Journals (Sweden)

    Vivek Mehta

    2013-01-01

    Full Text Available Delayed cerebral vasospasm is a significant cause of morbidity and mortality following aneurysmal subarachnoid hemorrhage (SAH. While the cellular mechanisms underlying vasospasm remain unclear, it is believed that inflammation may play a critical role in vasospasm. Matrix metalloproteinasees (MMPs are a family of extracellular and membrane-bound proteases capable of degrading the blood-rain barrier (BBB. As such, MMP upregulation following SAH may result in a proinflammatory extravascular environment capable of inciting delayed cerebral vasospasm. This paper presents an overview of MMPs and describes existing data pertinent to delayed cerebral vasospasm.

  15. No advantage of time-of-flight magnetic resonance angiography at 3 Tesla compared to 1.5 Tesla in the follow-up after endovascular treatment of cerebral aneurysms

    International Nuclear Information System (INIS)

    Long-term follow-up after coil embolization of intracranial aneurysms is mandatory to monitor coil compacting and aneurysm recurrence. Most centers perform one digital subtraction angiography (DSA) on follow-up continuing with time-of-flight magnetic resonance angiography (TOF-MRA). This study explores the diagnostic value of TOF-MRA at 1.5 T versus 3 T compared to DSA. In 18 patients with 20 aneurysms treated with coil embolization, TOF-MRA at 1.5 and 3 T were performed the day before follow-up DSA, the latter serving as reference. Optimized diagnostic protocols were applied (1.5T:0.78 x 0.55 x 0.8 mm, voxel size; acquisition time (TA), 6.37 min; 3T:0.56 x 0.45 x 0.65 mm, voxel size; TA, 3.12 min). Three independent neuroradiologists experienced in neuroendovascular therapy rated the occlusion rate (''complete occlusion'' vs. ''residual neck'' vs. ''residual aneurysm'') and compared the two methods subjectively. Weighted κ statistics were calculated to assess the level of interobserver agreement. Compared to DSA, TOF-MRA was more sensitive in detecting neck remnants, with a slight advantage at 3 T. Regarding artifact load, there are advantages at 1.5 T. Ratings of the occlusion rate correlated highly between all observers (r>0.85, pw∼0.8, respectively). TOF-MRA is a reliable tool for follow-up imaging of cerebral aneurysms after endovascular treatment. Our study shows no advantage of TOF-MRA at 3 T over 1.5 T, when comparable measurement protocols are applied. TOF-MRA at 1.5 T therefore provides appropriate information regarding a therapeutic decision. (orig.)

  16. Parent artery occlusion for treatment of posterior cerebral artery dissecting aneurysms%载瘤动脉闭塞术治疗大脑后动脉夹层动脉瘤

    Institute of Scientific and Technical Information of China (English)

    刘恋; 潘显辉; 姜除寒; 贺红卫; 杨新建; 李佑祥; 吴中学

    2012-01-01

    Objective To study the safety and efficacy of parent artery occlusion for the treatment of posterior cerebral artery dissecting aneurysms.Methods 23 patients with posterior cerebral artery dissecting aneurysms were treated via endovascular parent artery occlusion in our institution.All of the aneurysms were at P2 or distal segment of PCA.Glasgow Outcome Scale (GOS) was used to evaluate the clinical outcome.Results The procedure was technically suocessful in all cases.Four procedure-related complications occurred:rebleeding ( n =1 ),hemiparesis ( n =1 ),and hemianopisia ( n =2).In the trapping group and the proximal occlusion group,all of the immediate angiography showed occlusion of the parent vessel and the aneurysm without retrograde filling from collateral vessels.And follow-up imaging showed no recurrence of the aneurysms.In the palliative embolization group,one of five patients was died of rebleeding after the procedure.The follow-up DSA showed that the other four aneurysms recurred.Conclusions Deliberate parent artery occlusion with detachable coils appears to be well tolerated for P2 or distal segment of PCA dissecting aneurysms.The technique may be the first choice of treatment for the treatment of dissecting aneurysms ofposterior cerebral artery.%目的 探索载瘤动脉闭塞术治疗大脑后动脉夹层动脉瘤的安全性和有效性.方法 回顾性分析应用载瘤动脉闭塞治疗的大脑后动脉夹层动脉瘤患者23例.动脉瘤均位于大脑后动脉P2段或以远部位.临床随访应用GOS评分.结果 23例患者手术均成功,无器械相关的并发症.其中4例术后出现并发症:再出血1例,轻偏瘫1例,偏盲2例.载瘤动脉完全闭塞的患者术后即刻造影显示动脉瘤和载瘤动脉完全闭塞.行姑息性闭塞治疗的5例中,1例死于术后再出血,其余4例随访DSA均显示动脉瘤有增大或复发.结论 载瘤动脉闭塞术对于大脑后动脉P2段及以远的夹层动脉瘤治疗是安全有效的.

  17. Sensitivity Analysis of Simulated Blood Flow in Cerebral Aneurysms

    OpenAIRE

    2011-01-01

    Bakgrunn: En cerebral aneurysme er en dilatasjon av en blodåre, som kan utvide seg og briste, og derved forårsake blødninger i og rundt hjernen. En slik tilstand er alvorlig og medfører ofte alvorlig hjerneskade eller død. For å bedre forstå hvorfor enkelte aneurysmer utvikler seg og brister, gjør man datasimuleringer av blodstrømningen i disse aneurysmene for å få en økt forståelse, og på sikt bidra til diagnoser og behandlingsmetoder. Slike simuleringer fører med seg mange usikkerhetsmoment...

  18. [Stent-Assisted Coil Embolization of a Dissecting Aneurysm of the Posterior Cerebral Artery: A Case Report].

    Science.gov (United States)

    Haruma, Jun; Sugiu, Kenji; Yukiue, Tadato; Sasaki, Tatsuya; Hattori, Yasuhiko; Kobayashi, Kazuki; Yoshida, Hideyuki; Muneda, Koji; Date, Isao

    2015-12-01

    Dissecting aneurysms of the posterior cerebral artery (PCA) are rare, especially those at the P1 segment. Here, we describe the case of a 57-year-old woman with a subarachnoid hemorrhage (SAH). Computed tomography angiography (CTA) and digital subtraction angiography (DSA) revealed a small (3 mm) dissecting aneurysm with the typical pearl-and-string sign at the right P1 segment. Fourteen days after onset, the patient developed aphasia. DSA revealed vasospasm of the right middle cerebral artery, and we performed endovascular treatment by the intra-arterial injection of 1-(5-isoquinolinesulfonyl) homopiperazine. After this treatment, the patient's symptoms recovered immediately. Vertebral angiography revealed enlargement of the dissecting aneurysm (up to 7 mm diameter). We started a loading dose of 300 mg aspirin and 400 mg clopidogrel after observing growth of the aneurysm. Fifteen days after onset, we performed a stent-assisted coil embolization, and obtained nearly complete obliteration of the aneurysm with preserved patency of the parent artery. Six-month follow-up DSA demonstrated complete occlusion of the aneurysm with good patency of the stented PCA; the patient was at modified Rankin Scale 1. In the treatment of ruptured dissecting aneurysms, parent vessel occlusion (PVO) with aneurysm is common. However, PVO may cause both cerebral infarction of the distal area and perforator occlusion of the occluded vessel. Stent-assisted coil embolization can preserve parent vessel flow and obliterate the aneurysm. Stents offer a therapeutic alternative for PCA dissecting aneurysms, especially when PVO cannot be tolerated. PMID:26646176

  19. Aneurysms of the P2P Segment of Posterior Cerebral Artery: Case Report and Surgical Steps

    Directory of Open Access Journals (Sweden)

    Paulo Aguiar

    2014-01-01

    Full Text Available The posterior cerebral artery (PCA is divided into 4 segments: precommunicating segment (P1, postcommunicating segment (P2, quadrigeminal segment (P3, and calcarine segment (P4. Small aneurysms are more prevalent than large aneurysms in patients with ruptured aneurysms. P2 and P3 aneurysms are usually managed by the subtemporal approach. This is a case report of rupture saccular aneurysm of posterior cerebral artery on P2P segment. The authors show the surgical steps of these rare aneurysms with an illustrative case.

  20. Efficacy and Safety of Endovascular Embolization Treatment of Middle Cerebral Artery Aneurysms%血管内栓塞治疗大脑中动脉动脉瘤的疗效及安全性研究

    Institute of Scientific and Technical Information of China (English)

    张峰; 李鹏; 高金玲; 刘建峰; 侯凯; 井山泉; 张超

    2014-01-01

    目的:探讨血管内栓塞治疗大脑中动脉动脉瘤的可行性、有效性和安全性。方法选取河北医科大学第一医院神经外科2005年6月-2013年10月采用血管内栓塞治疗的65例大脑中动脉动脉瘤患者,采用单纯弹簧圈栓塞术21例,球囊辅助弹簧圈栓塞术15例,支架辅助弹簧圈栓塞术12例,单纯支架置入术17例。回顾性分析65例患者的影像学资料,动脉瘤部位、治疗方法及结果,手术并发症,术后3个月进行随访。采用改良 Rankin 评分(mRS)衡量患者神经功能恢复状况。结果65例大脑中动脉动脉瘤患者中,大脑中动脉 M1段动脉瘤患者43例,大脑中动脉分叉部动脉瘤患者22例。12例为未破裂动脉瘤,颅脑 CT 显示为侧裂区类圆形高密度影;53例为破裂动脉瘤,颅脑CT 表现均为典型的蛛网膜下腔出血。采用血管内栓塞治疗均获成功。术后即刻造影,动脉瘤瘤颈显影5例,瘤体显影14例,致密栓塞46例。无围术期死亡病例。并发症4例,1例术中破裂,迅速完全栓塞动脉瘤后患者无相关症状;其中1例术后3 d 出现一过性肢体无力;1例术后1周动脉瘤再破裂出血,经手术清血肿治疗后好转;1例大脑中动脉分叉处动脉瘤球囊辅助栓塞后4 d 出现脑梗死。42例患者术后3个月行数字减影血管造影(DSA)检查,其中15例动脉瘤进展,再次栓塞治疗;27例无进展。3个月随防时 mRS 0分45例,1分14例,2分4例,4分2例。结论血管内栓塞治疗大脑中动脉动脉瘤是一种安全、有效的方法。%Objective To investigate the feasibility,effectiveness and safety of endovascular embolization treatment of middle cerebral artery aneurysms. Methods 65 patients with middle cerebral artery aneurysm treated by endovascular emboliza-tion in Department of Neurosurgery,the First Hospital of Hebei Medical University between June 2005 and October 2013 were en

  1. Accuracy of Computational Cerebral Aneurysm Hemodynamics Using Patient-Specific Endovascular Measurements

    Science.gov (United States)

    McGah, Patrick; Levitt, Michael; Barbour, Michael; Mourad, Pierre; Kim, Louis; Aliseda, Alberto

    2013-11-01

    We study the hemodynamic conditions in patients with cerebral aneurysms through endovascular measurements and computational fluid dynamics. Ten unruptured cerebral aneurysms were clinically assessed by three dimensional rotational angiography and an endovascular guidewire with dual Doppler ultrasound transducer and piezoresistive pressure sensor at multiple peri-aneurysmal locations. These measurements are used to define boundary conditions for flow simulations at and near the aneurysms. The additional in vivo measurements, which were not prescribed in the simulation, are used to assess the accuracy of the simulated flow velocity and pressure. We also performed simulations with stereotypical literature-derived boundary conditions. Simulated velocities using patient-specific boundary conditions showed good agreement with the guidewire measurements, with no systematic bias and a random scatter of about 25%. Simulated velocities using the literature-derived values showed a systematic over-prediction in velocity by 30% with a random scatter of about 40%. Computational hemodynamics using endovascularly-derived patient-specific boundary conditions have the potential to improve treatment predictions as they provide more accurate and precise results of the aneurysmal hemodynamics. Supported by an R03 grant from NIH/NINDS

  2. Retrospective analysis of the prevalence of asymptomatic cerebral aneurysm in 4518 patients undergoing magnetic resonance angiography. When does cerebral aneurysm develop?

    Energy Technology Data Exchange (ETDEWEB)

    Horikoshi, Toru; Yamagata, Zentaro; Nukui, Hideaki [Yamanashi Medical Univ., Tamaho (Japan); Akiyama, Iwao [Akiyama Neurosurgical Clinic, Nirasaki, Yamanashi (Japan)

    2002-03-01

    The natural history of cerebral aneurysms was investigated by measuring the prevalence of incidentally found unruptured aneurysms in the general population and evaluating the characteristics including risk factors. 'De novo' formation of aneurysm was also demographically estimated. The prevalence of incidental aneurysm was evaluated among 4518 patients who underwent magnetic resonance (MR) angiography for various reasons in a neurosurgical institute. Double the number of patients were randomly selected from the remaining patients without aneurysm as the Control group so that sex and age group were matched to the Aneurysm group. One hundred twenty seven patients (2.8%) had diagnoses of aneurysm. The prevalence of asymptomatic aneurysm among middle-aged and elderly patients were predominant in women and increased with age in both sexes. Patients with aneurysms had significantly more hypertension and family history of subarachnoid hemorrhage compared to the controls. The prevalence was markedly increased in the 8th decade in men and the 7th decade in women, and new aneurysms seemed to develop predominantly around these decades. Cerebral aneurysms become detectable on MR angiography in the middle or later decades, and women tend to develop aneurysm earlier than men. Hypertension and family history of subarachnoid hemorrhage are probably risk factors for the development of aneurysm. (author)

  3. Subtracted vortex centers path line method with cinematic angiography for measurement of flow speed in cerebral aneurysms

    OpenAIRE

    Ohta, M.; Fujimura, N; Augsburger, L.; Barath, K; Yilmaz, H; Abdo, G.; Lovblad, K.O.; Rüfenacht, D.A.

    2008-01-01

    BACKGROUND AND PURPOSE: The assessment of blood flow speed by imaging modalities is of increasing importance for endovascular treatment, such as stent implantation, of cerebral aneurysms. The subtracted vortex centers path line method (SVC method) utilizes image post-processing for determining flow quantitatively. In current practice, intra-aneurysmal flow in an in vitro model is visualized by laser sheet translumination and digitally recorded. In this study, we applied this method to cinemat...

  4. Pathomechanisms and treatment of pediatric aneurysms.

    Science.gov (United States)

    Krings, Timo; Geibprasert, Sasikhan; terBrugge, Karel G

    2010-10-01

    Pediatric aneurysms are rare diseases distinct from classical adult aneurysms and therefore require different treatment strategies. Apart from saccular aneurysms that are more commonly found in older children, three major pathomechanisms may be encountered: trauma, infection, and dissection. The posterior circulation and more distal locations are more commonly encountered in children compared to adults, and there is an overall male predominance. Clinical findings are not only confined to subarachnoid hemorrhage but may also comprise mass effects, headaches or neurological deficits. In traumatic aneurysms, the skull base and distal anterior communicating artery are commonly affected, and the hemorrhage occurs often delayed (2-4 weeks following the initial trauma). Infectious aneurysms are mostly bacterial in origin, and hemorrhage occurs early after a septic embolic shower. Dissecting aneurysms are the most often encountered aneurysm type in children and can lead to mass effect, hemorrhage, or ischemia depending on the fate of the intramural hematoma. Treatment strategies in pediatric aneurysms include endosaccular coil treatment only for the "classical berry-type" aneurysms; in the other instances, parent vessel occlusion, flow reversal, surgical options, or a combined treatment with bypass and parent vessel occlusion have to be contemplated.

  5. Embolization of ruptured intracranial aneurysms during the period of cerebral vasospasm

    International Nuclear Information System (INIS)

    Objective: To retrospectively analyze our experience of embolization of ruptured intracranial aneurysms during the period of cerebral vasospasm (CVS). Methods: Thirty-seven patients with ruptured intracranial aneurysms were embolized with electrolytic detachable coils during the period of CVS (days 4 to 14). Group A included the 14 patients with angiographic CVS and group B included 23 patients without angiographic CVS. All except 2 patients were transferred to our department during the CVS period. Glasgow outcome score (GOS) was evaluated 3 months after the treatment. Results: Twelve patients in group A successfully received the aneurysm embolization and treatment of the CVS with intraarterial papaverine injection and balloon angioplasty. GOS in 3 months was good recovery in 7 patients, moderate disability in 2, severe disability in 1, and dead in 2, respectively. Embolization failed in 2 patients because the micro catheters could't pass the spasmodic parent arteries. All the aneurysms in group B were successfully embolized. GOS were good recovery in 18 patients, moderate disability in 2, severe disability in 2, and dead in 1, respectively. There was no intraprocedural aneurysmal rupture but with 2 thromboembolic events. No rebleeding occurred during the mean 11 months follow-up. Conclusions: The so-called 'period of CVS' isn't always associated with CVS in angiograpy. Embolization of ruptured intracranial aneurysms during the period of pure CVS doesn't carry an increased risk. Both the aneurysms and CVS can be treated during the single procedure. It can reduce the rebleeding rate in hospital and improve the prognosis of the patients with CVS. (authors)

  6. 大脑前动脉远端破裂动脉瘤的显微外科治疗%Microsurgical treatment for ruptured distal anterior cerebral artery aneurysms

    Institute of Scientific and Technical Information of China (English)

    费小斌; 徐伟东; 那汉荣; 周新民; 潘鹤鸣; 高恒

    2013-01-01

    Objective To evaluate the clinical features and microsurgical strategies of ruptured distal anterior cerebral artery aneurysms ( DACAA). Methods 10 consecutive cases of ruptured DACAA operated from August 2006 to July 2011 were reviewed and followed up. According to Hunt-Hess classification, 2 belonged to grade Ⅰ, 2 gradeⅡ, 5 grade ⅢI and 1 grade Ⅳ. All patients were made definite diagnosis by 64 rows helical CT angiography ( CTA) or Digital Subtraction Angiography (DSA). The diameter of all DACAAs was between 3-16 mm. Pterional approach was selected for 3 cases with A2 aneurysm, 7 cases with A3 aneurysm underwent interhemispheric approach. Results 10 ruptured DACAAs were clipped through microsurgery in 10 cases. 2 cases carried multiple aneurysms. One middle cerebral artery bifurcation aneurysm was clipped through one-stage operation, the other fusiform basal artery aneurysm didn 't receive surgical treatment. According to Glasgow Outcome Scale, all cases were favorable except one death due to severe postoperative cerebral vasospasm. Conclusion Successful clinical management of DACAA depends on appropriate surgical approach and skilled microsurgery techniques.%目的 探讨破裂大脑前动脉远端动脉瘤的临床特征和显微外科治疗方法.方法 回顾性分析2006年8月~ 2011年7月经手术夹闭的10例患者的临床资料.术前Hunt-Hess分级Ⅰ级2例,Ⅱ级2例,Ⅲ级5例,Ⅳ级1例.64排CT血管造影(CTA)或脑血管造影(DSA)确诊.瘤体直径在3~16 mm之间,位于A2段3个,采用翼点入路;A3段7个,采用经大脑纵裂间入路.结果 10例患者的动脉瘤均经显微手术成功夹闭.2例为多发动脉瘤,其中1例大脑中动脉分叉处动脉瘤一期予以夹闭,另1例基底动脉梭形动脉瘤未予治疗.9例患者治疗效果满意,无明显神经功能缺损和其他并发症,1例术后并发严重脑血管痉挛死亡.按照GOS预后评分,9例恢复良好,1例死亡.结论 采用合适的手术入路和

  7. [Large distal anterior cerebral artery aneurysm associated with azygos anterior cerebral artery: case report].

    Science.gov (United States)

    Suzuki, Y; Kawamata, T; Matsumoto, H; Kunii, N; Matsumoto, K

    1998-10-01

    A 51-year-old woman presented with a distal anterior cerebral artery aneurysm (DACAA) manifesting as severe headache and monoparesis of the left lower limb. Computed tomography revealed subarachnoid hemorrhage in the interhemispheric fissure, bilateral sylvian fissures, and basal cistern, and a hematoma in the supracallosal region. Angiography showed a large aneurysm (23 x 18 mm) located on the distal end of the azygos anterior cerebral artery (azygos ACA) at the supracallosal portion. T2-weighted magnetic resonance imaging demonstrated the hematoma as a mixed intensity mass, compressing the corpus callosum downward, and the aneurysm as a flow void anterior to the hematoma. Unilateral frontoparietal parasagittal craniotomy was performed with a horse-shoe shaped incision. The aneurysm was clipped via the interhemispheric approach, and the hematoma was aspirated. Postoperative angiography showed disappearance of the aneurysm and intact azygos ACA. The patient was discharged with mild monoparesis, paresthesia of the left lower limb and diagnostic dyspraxia. DACAA almost always arises at or near the genu of the corpus callosum and is often associated with vascular anomaly. In the literature, 22 of 26 cases of large and giant DACAA were located at or near the genu, but only 3 cases, including ours, in the supracallosal area. 11 cases were associated with azygos ACA. Therefore, hemodynamic stress caused by vascular anomaly may be involved in the formation of large or giant DACAA in contrast with cases of normal DACAA. PMID:9789300

  8. Cerebral foreign body reaction after carotid aneurysm stenting

    DEFF Research Database (Denmark)

    Lorentzen, Anastasia Orlova; Nome, Terje; Bakke, Søren Jacob;

    2016-01-01

    Flow diverter stents are new important tools in the treatment of large, giant, or wide-necked aneurysms. Their delivery and positioning may be difficult due to vessel tortuosity. Common adverse events include intracranial hemorrhage and ischemic stroke, which usually occurs within the same day......, or the next few days after the procedure. We present a case where we encountered an unusual intracerebral complication several months after endovascular treatment of a large left internal carotid artery aneurysm, and where brain biopsy revealed foreign body reaction to hydrophilic polymer fragments distally...

  9. 手术治疗大脑前动脉远端动脉瘤(附九例报告)%Microsurgical treatment on distal anterior cerebral artery aneurysms (9 cases report)

    Institute of Scientific and Technical Information of China (English)

    朱巍巍; 张世明; 王中; 虞正权; 周幽心; 陆挺; 胡斌; 孙春明; 周岱

    2011-01-01

    Objective To report the clinical diagnosis and microsurgical treatment of ruptured distal anterior cerebral artery aneurysm(DACAA)patients treated over the last 3 years.Methods 9 consecutive cases of ruptured DACAA operated from October 2007 to March 2010 were reviewed and followed up.Methods 11 aneurysms were clipped through interhemispheric approach microsurgery in 9 cases with ruptured DACAA.The diameter of 11 aneurysms was between 3-30 mm.Of which 9 cases were saccular aneurysms,1 case was fusiform aneurysm and 1 case was giant aneurysm.There were 2 aneurysm located at A2 segment of the ACA,8 located at A3 and 1 located at distal pericallosal artery.So there were 2 cases with multiple aneurysms and 1 case combined with AVM.The clinical outcomes of these patients evaluated by Glasgow Outcome Scale were:Except 1 case of fusiform DACAA presented hemiplegic paralysis after the surgery,all 8 cases discharged without deficit and no mortality in the group.Conclusion Depending on precise understanding of angiography imaging and location of 3D- CTA and DSA,interhemispheric approach is a safe method to clip the DACAA.%目的 探讨大脑前动脉远端动脉瘤(DACAA)的诊断和显微外科手术治疗.方法 回顾分析2007年10月至2010年3月显微手术治疗DACAA 9例.术前Hunt-Hess分级0级1例,Ⅰ级2例,Ⅱ级4例,Ⅲ级1例,Ⅳ级1例.结果 9例DACAA经额纵裂入路成功夹闭动脉瘤11个,动脉瘤直径在3~30 mm之间,其中囊性动脉瘤9个,梭形动脉瘤1个,巨大动脉瘤1个;位于A2段2个,A3段8个,胼周动脉末梢段1个.2例为多发动脉瘤,1例合并动静脉畸形.1例梭形动脉瘤患者术后出现对侧肢体偏瘫,余治疗效果满意,无手术死亡,亦无其他并发症.按照GOS预后评分,8例恢复良好,1例重残.结论 通过术前3D-CTA和DSA等影像学诊断和准确手术定位,经额纵裂入路显微手术夹闭DACAA效果满意.

  10. Evaluation of contour of unruptured cerebral aneurysm using three-dimensional CT cisternogram.

    Directory of Open Access Journals (Sweden)

    Onoda K

    2004-06-01

    Full Text Available Angiography is gold standard technique as preoperative examination for unruptured aneurysmal surgery. Neurosurgeons have observed the unexpected irregular shape and size of the aneurysmal dome and neck in many cases of unruptured cerebral aneurysms during aneurysmal microsurgery, and known the discrepancy between the findings of angiography and operative view. We could not find out the report described the preoperative evaluation of outer-wall (contour of aneurysm. In the present study, we attempted to evaluate the outer-wall of an unruptured cerebral aneurysm using three-dimensional CT cisternogram (3D-CTC to provide useful preoperative information. The study was performed on three cases of unruptured cerebral aneurysm that were identified incidentally by MR angiography. We performed three-dimensional CT aniography (3D-CTA and 3D-CTC for each patient. In the present study, we visualized the contours of vessels and aneurysms using a 3D-CTC in three cases of unruptured cerebral aneurysm. We found the discrepancy between the 3D-CTC contour image and the intra-luminal image 3D-CTA image. This method may be useful for the decision of the surgical approach and have the potential to evaluate the anatomical structure of aneurysmal dome and neck preoperatively.

  11. Simulation of Cerebral Aneurysm Growth and Prediction of Evolving Rupture Risk

    Directory of Open Access Journals (Sweden)

    Martin Kroon

    2011-01-01

    Full Text Available Cerebral aneurysms are local expansions of blood vessel walls in the brain blood system. The rupture of an aneurysm is a very severe event associated with a high rate of mortality. When cerebral aneurysms are detected, clinicians need to decide if operation is required. The risk of aneurysm rupture is then compared to the risks associated with the medical intervention. In the present paper, a probabilistic framework for a mechanically based rupture risk assessment of cerebral aneurysms is proposed. The method is based on the assumption that the strength of aneurysmal tissues can be described by a statistical distribution. A structural analysis of the aneurysm in question is performed, and the maximum stress experienced by the aneurysm is compared to the strength distribution. The proposed model was compared with clinical results for ruptured aneurysms in terms of rupture density and accumulated rupture risk as a function of aneurysm size. The model was able to reproduce the clinical results well. The proposed framework may potentially be used under in vivo conditions to predict the risk of rupture for diagnosed aneurysms.

  12. Sexual Activity as a Risk Factor for the Spontaneous Rupture of Cerebral Aneurysms.

    Science.gov (United States)

    Blanke-Roeser, Constantin; Matschke, Jakob; Püschel, Klaus

    2016-06-01

    Subarachnoid hemorrhages from ruptured cerebral aneurysms have a high clinical relevance and often lead to death. Approximately 2% to 5% of the people worldwide, even of younger age, are said to have aneurysms at cerebral arteries. In many cases, they remain clinically unapparent for decades. However, there are numerous risk factors for the rupture of an aneurysm, including temporary raises of the blood pressure. Such changes of the blood pressure can be induced even by several everyday behaviors. For example, any sort of sexual activities may cause extensive raises of the blood pressure because of several physical and psychological factors. The term "sexual activity" covers sexual intercourse as well as masturbation. In this article, the remarkable case of a 24-year-old woman with a ruptured cerebral aneurysm in the context of masturbation is presented. It is discussed with respect to the possible pathophysiological effects of sexual activity on cerebral aneurysms. PMID:27043460

  13. Deviation from optimal vascular caliber control at middle cerebral artery bifurcations harboring aneurysms.

    Science.gov (United States)

    Baharoglu, Merih I; Lauric, Alexandra; Wu, Chengyuan; Hippelheuser, James; Malek, Adel M

    2014-10-17

    Cerebral aneurysms form preferentially at arterial bifurcations. The vascular optimality principle (VOP) decrees that minimal energy loss across bifurcations requires optimal caliber control between radii of parent (r₀) and daughter branches (r1 and r2): r₀(n)=r₁(n)+r₂(n), with n approximating three. VOP entails constant wall shear stress (WSS), an endothelial phenotype regulator. We sought to determine if caliber control is maintained in aneurysmal intracranial bifurcations. Three-dimensional rotational angiographic volumes of 159 middle cerebral artery (MCA) bifurcations (62 aneurysmal) were processed using 3D gradient edge-detection filtering, enabling threshold-insensitive radius measurement. Radius ratio (RR)=r₀(3)/(r₁(3)+r₂(3)) and estimated junction exponent (n) were compared between aneurysmal and non-aneurysmal bifurcations using Student t-test and Wilcoxon rank-sum analysis. The results show that non-aneurysmal bifurcations display optimal caliber control with mean RR of 1.05 and median n of 2.84. In contrast, aneurysmal bifurcations had significantly lower RR (0.76, pbifurcations revealed a daughter branch larger than its parent vessel, an absolute violation of optimality, not witnessed in non-aneurysmal bifurcations. The aneurysms originated more often off the smaller daughter (52%) vs. larger daughter branch (16%). Aneurysm size was not statistically correlated to RR or n. Aneurysmal males showed higher deviation from VOP. Non-aneurysmal MCA bifurcations contralateral to aneurysmal ones showed optimal caliber control. Aneurysmal bifurcations, in contrast to non-aneurysmal counterparts, disobey the VOP and may exhibit dysregulation in WSS-mediated caliber control. The mechanism of this focal divergence from optimality may underlie aneurysm pathogenesis and requires further study.

  14. Epidemiological study of 183 patients with spontaneous rupture of cerebral aneurysm

    International Nuclear Information System (INIS)

    Cerebral vessels aneurysms represent a significant part of the cerebral vessels pathology. There is no extensive study on that in Bulgaria. We present a study of 183 patients with spontaneous rupture of cerebral aneurysm, diagnosed and treated in UMHATEM ‘Pirogov’, Sofia. We used clinical methods - data from subject history, analysis of the accompanying documentation, subject medical chart; imaging-diagnostics methods - CT, DSA and MRI; and statistical methods. A total of 183 patients with ruptured intracranial aneurysms were studied. 65% were females and 35% were men.The ration female/male is 1.86, The mean age of all patients is 53.1 ±10.1 years. The highest incidence of ruptured aneurysms is seen in the age group 50 to 59 years. Aneurysms of a. cerebri media and a. communicants anterior are the most frequent (63.4% in total); while the lest are those of a basilaris (4.9%). 88.5% of the aneurysms in the studied group are small, 9.8% are large and 1.6% are giant. Intracranial hematomas are seen in 13.1% of the patients with ruptured aneurysms. Most frequently hematomas are connected with a. cerebri media and a.communicants anterior (87.5% in total). Patients with multiple aneurysms are 11.5% in total, 85.7% of them with an aneurysm of a.cerebri media. The incidence of ruptured cerebral aneurysms is higher amongst female. Frequency in the fifth decade of life is the highest. Most often seen are the aneurysms of a. cerebri media and a. communicants anterior, and the least - those of a. basilaris. Intracranial hematomas most frequently are associated with ruptures of a. cerebri media and a. communicants anterior, in patients with multiple aneurysms the highest is the frequency of aneurysms of a. cerebri media. (authors)

  15. Angiographic follow-up of cerebral aneurysms treated with Guglielmi detachable coils(GDCs): An analysis of 162 cases of 173 aneurysms

    Institute of Scientific and Technical Information of China (English)

    LI Ming-hua; GAO Bu-lang; FANG Chun; GU Bin-xian; CHENG Ying-sheng; WANG Wu; Giuseppe Scotti

    2005-01-01

    Objective To evaluate the mid- and long-term radiological outcomes of cerebral aneurysms with GDCs embolization.Methods One hundred and sixty-two patients with 173 aneurysms embolized with GDCs underwent angiographic follow-up from 1 to 54 months post-operatively and were retrospectively reviewed. Three neuro-radiologists reviewed each angiogram and made a comparison between initial and follow-up angiograms. Morphological outcomes were evaluated as follows: unchanged; progressive thrombosis; and re-opening or re-growth. Results Of 173 aneurysms with GDC embolization, 142 aneutysms had total or nearly total occlusion, 23 subtotal occlusion and 8 partial occlusion shown on initial angiograms. The incidence of re-opening was 17.1% (13/76) in less than 3 months, and 6.2% (6/97) between 3 and 6 months postoperatively. Four aneurysms showed recurrency(2.3%) on second follow-up angiography in one year after procedure and one-year cumulative recurrent rate was 13.3% of 56 aneurysms with the third follow-up angiography in the post-operation period of 12 to 54 months, four showed a little enlargement and the cmnulative recurrent rate so far was 20.2% (35/173). Conclusions The direct and main causes for aneurysmal recurrence are incomplete and loosening packing. The first angiographic follow-up is recommended to be performed at 3 months or earlier after the procedure, especially in aneurysms with initial incomplete occlusion. Re-treatment with balloon- or stent-assisted coil embolization is recommended in re-opening aneurysms. (J Intervent Radiol,2005,14:472-479)

  16. Hemodynamic alterations measured with phase-contrast MRI in a giant cerebral aneurysm treated with a flow-diverting stent

    Directory of Open Access Journals (Sweden)

    Matthew Ethan MacDonald, PhD

    2015-01-01

    Full Text Available Many risk factors have been proposed in the development of the cerebral aneurysms. Hemodynamics including blood velocity, volume flow rate (VFR, and intravascular pressure are thought to be prognostic indicators of aneurysm development. We hypothesize that treatment of cerebral aneurysm using a flow-diverting stent will bring these hemodynamic parameters closer to those observed on the contralateral side. In the current study, a patient with a giant cerebral aneurysm was studied pre- and postoperatively using phase contrast MRI (PC-MRI to measure the hemodynamic changes resulting from the deployment of a flow-diverting stent. PC-MRI was used to calculate intravascular pressure, which was compared to more invasive endovascular catheter-derived measurements. After stent placement, the measured VFRs in vessels of the treated hemisphere approached those measured on the contralateral side, and flow symmetry changed from a laterality index of -0.153 to 0.116 in the middle cerebral artery. Pressure estimates derived from the PC-MRI velocity data had an average difference of 6.1% as compared to invasive catheter transducer measurements. PC-MRI can measure the hemodynamic parameters with the same accuracy as invasive methods pre- and postoperatively.

  17. Comparison of two stents in modifying cerebral aneurysm hemodynamics.

    Science.gov (United States)

    Kim, Minsuok; Taulbee, Dale B; Tremmel, Markus; Meng, Hui

    2008-05-01

    There is a general lack of quantitative understanding about how specific design features of endovascular stents (struts and mesh design, porosity) affect the hemodynamics in intracranial aneurysms. To shed light on this issue, we studied two commercial high-porosity stents (Tristar stent and Wallstent) in aneurysm models of varying vessel curvature as well as in a patient-specific model using Computational Fluid Dynamics. We investigated how these stents modify hemodynamic parameters such as aneurysmal inflow rate, stasis, and wall shear stress, and how such changes are related to the specific designs. We found that the flow damping effect of stents and resulting aneurysmal stasis and wall shear stress are strongly influenced by stent porosity, strut design, and mesh hole shape. We also confirmed that the damping effect is significantly reduced at higher vessel curvatures, which indicates limited usefulness of high-porosity stents as a stand-alone treatment. Finally, we showed that the stasis-inducing performance of stents in 3D geometries can be predicted from the hydraulic resistance of their flat mesh screens. From this, we propose a methodology to cost-effectively compare different stent designs before running a full 3D simulation. PMID:18264766

  18. Adaptive grid generation in a patient-specific cerebral aneurysm

    Science.gov (United States)

    Hodis, Simona; Kallmes, David F.; Dragomir-Daescu, Dan

    2013-11-01

    Adapting grid density to flow behavior provides the advantage of increasing solution accuracy while decreasing the number of grid elements in the simulation domain, therefore reducing the computational time. One method for grid adaptation requires successive refinement of grid density based on observed solution behavior until the numerical errors between successive grids are negligible. However, such an approach is time consuming and it is often neglected by the researchers. We present a technique to calculate the grid size distribution of an adaptive grid for computational fluid dynamics (CFD) simulations in a complex cerebral aneurysm geometry based on the kinematic curvature and torsion calculated from the velocity field. The relationship between the kinematic characteristics of the flow and the element size of the adaptive grid leads to a mathematical equation to calculate the grid size in different regions of the flow. The adaptive grid density is obtained such that it captures the more complex details of the flow with locally smaller grid size, while less complex flow characteristics are calculated on locally larger grid size. The current study shows that kinematic curvature and torsion calculated from the velocity field in a cerebral aneurysm can be used to find the locations of complex flow where the computational grid needs to be refined in order to obtain an accurate solution. We found that the complexity of the flow can be adequately described by velocity and vorticity and the angle between the two vectors. For example, inside the aneurysm bleb, at the bifurcation, and at the major arterial turns the element size in the lumen needs to be less than 10% of the artery radius, while at the boundary layer, the element size should be smaller than 1% of the artery radius, for accurate results within a 0.5% relative approximation error. This technique of quantifying flow complexity and adaptive remeshing has the potential to improve results accuracy and reduce

  19. Subarachnoid Hemorrhage from Posterior Cerebral Artery Aneurysm during Puerperium – Case Report and Review of Literature

    OpenAIRE

    Schebesch, Karl-Michael; Schödel, Petra; Rennert, Janine; Mark, Karl-Heinz; Brawanski, Alexander

    2012-01-01

    Subarachnoid hemorrhages (SAH) due to true aneurysms of the Posterior Cerebral Artery (PCA) during puerperium in young and healthy females are extremely rare. We present the case of a 31-year old, healthy woman that experienced a spontaneous SAH due to a PCA aneurysm, arising from the P3 segment, 9 days post-delivery. The aneurysm was successfully treated via an endovascular approach and the patient recovered well. After 21 days she was discharged from hospital without neurological defici...

  20. Call-Fleming Syndrome (Reversible Cerebral Artery Vasoconstriction and Aneurysm Associated with Multiple Recreational Drug Use

    Directory of Open Access Journals (Sweden)

    Doniel Drazin

    2013-01-01

    Full Text Available Drug abuse represents a significant health issue. Evidence suggests that recreational drug use has a direct effect on the cerebral vasculature and is of greater concern in those with undiagnosed aneurysms or vascular malformations. The authors report a case of thunderclap headache with a negative head CT and equivocal lumbar puncture after a drug-fueled weekend. The patient underwent diagnostic cerebral angiogram which demonstrated multisegmental, distal areas of focal narrowing of the middle, anterior, posterior, and posterior inferior cerebral artery and an incidental aneurysm. It is often difficult to determine the exact origin of symptoms; thus we were left with a bit of a chicken or the egg debate, trying to decipher which part came first. Either the aneurysm ruptured with associated concomitant vasospasm or it is a case of Call-Fleming syndrome (reversible cerebral artery vasoconstriction with an incidental aneurysm. The authors proposed their management and rationale of this complex case.

  1. Call-fleming syndrome (reversible cerebral artery vasoconstriction) and aneurysm associated with multiple recreational drug use.

    Science.gov (United States)

    Drazin, Doniel; Alexander, Michael J

    2013-01-01

    Drug abuse represents a significant health issue. Evidence suggests that recreational drug use has a direct effect on the cerebral vasculature and is of greater concern in those with undiagnosed aneurysms or vascular malformations. The authors report a case of thunderclap headache with a negative head CT and equivocal lumbar puncture after a drug-fueled weekend. The patient underwent diagnostic cerebral angiogram which demonstrated multisegmental, distal areas of focal narrowing of the middle, anterior, posterior, and posterior inferior cerebral artery and an incidental aneurysm. It is often difficult to determine the exact origin of symptoms; thus we were left with a bit of a chicken or the egg debate, trying to decipher which part came first. Either the aneurysm ruptured with associated concomitant vasospasm or it is a case of Call-Fleming syndrome (reversible cerebral artery vasoconstriction) with an incidental aneurysm. The authors proposed their management and rationale of this complex case.

  2. Hemostasis and fibrinolysis in delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage : a systematic review

    NARCIS (Netherlands)

    Boluijt, Jacoline; Meijers, Joost C. M.; Rinkel, Gabriel J. E.; Vergouwen, Mervyn D. I.

    2015-01-01

    Delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (aSAH) has been associated with microthrombosis, which can result from activated hemostasis, inhibited fibrinolysis, or both. We systematically searched the PUBMED and EMBASE databases to identify hemostatic or fibrinolytic par

  3. Clinical value of three-dimensional digital subtraction angiography in the endovascular treatment of intracranial aneurysms

    Institute of Scientific and Technical Information of China (English)

    Tianxiao Li; Dengwei Zong

    2006-01-01

    BACKGROUND: The endovascular treatment of intracranial aneurysms requires clearly displayed anatomic structures of the aneurysm and the reference image of the aneurysm neck, the images of the form and struc ture of the aneurysm and the three-dimensional (3D) intracranial vascular structure are very important for the diagnosis and treatment of cerebral aneurysms. OBJECTIVE: To investigate the value of 3D digital subtraction angiography (3D DSA) in diagnosing intracra nial aneurysm, and compare the reliability with two-dimensional (2D) DSA in evaluating the intracranial aneurysm suitable for the endovascular occlusion: DESIGN: A double-blind case observation. SETTING: Department of Interventional Radiology, Henan People's Hospital. PARTICIPANTS: The patients, who were suspected to have intracranial aneurysms, were examined with 2D DSA and 3D DSA in Henan People's Hospital from October 2004 to October 2005. Fifty intracranial aneurysms were detected in 44 patients (19 males and 25 females) of 30-75 years, with an average of 51 years, including 5 cases were multiple aneurysms, including 2 aneurysms in 4 cases and 3 aneurysms in 1 case. The aneurysms located respectively at internal carotid artery (n =19), anterior cerebral artery (n =16), middle cerebral artery (n =8), basilar artery (n =6), and posterior inferior cerebellar artery (n =1 ). METHODS: The 50 ruptured intracranial aneurysms were examined with 2D DSA and 3D DSA. The method of volume reconstruction was applied to reconstruct the 3D DSA images, and the automatically generated images could be shifted, rotated and magnified, besides, the corresponding processing could also be performed, including resecting the unnecessary structure and sharpening margin of the images. Observations: ① Display of aneurysm neck: The site and range of the aneurysm neck, and the involvement of branches originated from the aneurysm arteries; ② Display of aneurysm form: The displays of aneurysm form and with or without arteries

  4. Experimental Induction of Cerebral Aneurysms by Developmental Low Copper Diet.

    Science.gov (United States)

    Jung, Keun-Hwa; Chu, Kon; Lee, Soon-Tae; Shin, Yong-Won; Lee, Keon-Joo; Park, Dong-Kyu; Yoo, Jung-Suk; Kim, Soyun; Kim, Manho; Lee, Sang Kun; Roh, Jae-Kyu

    2016-05-01

    Optimal models are needed to understand the pathophysiology of human cerebral aneurysms (CA). We investigated the development of experimental CA by decreasing the activity of lysyl oxidases by dietary copper deficiency from the time of gestation and then augmenting vascular stress by angiotensin II infusion in adulthood. Rats were fed copper-free, low-copper, or normal diets at different time periods from gestation to adulthood. The incidences of CAs were evaluated and autopsies performed to determine the coexistence of cardiovascular diseases. A copper-free diet from gestation was associated with high mortality rates (79.1%) resulting from rupture of ascending aorta aneurysms; a low-copper diet led to acceptable mortality rates (13.6%) and produced CAs and subarachnoid hemorrhage in 46.4% and 3.6% of animals, respectively. Higher proportions of CAs (up to 33.3%) in the rats primed for copper deficiency from gestation ruptured following angiotensin II infusion from adulthood. Gene expression array analyses of the CAs indicated that genes involving extracellular matrix and vascular remodeling were altered in this model. This model enables future research to understand the entire pathogenetic basis of CA development and rupture in association with systemic vasculopathies.

  5. Cerebral blood flow and metabolism during isoflurane-induced hypotension in patients subjected to surgery for cerebral aneurysms

    DEFF Research Database (Denmark)

    Madsen, J B; Cold, G E; Hansen, E S;

    1987-01-01

    Cerebral blood flow and cerebral metabolic rate for oxygen were measured during isoflurane-induced hypotension in 10 patients subjected to craniotomy for clipping of a cerebral aneurysm. Flow and metabolism were measured 5-13 days after the subarachnoid haemorrhage by a modification of the classi......Cerebral blood flow and cerebral metabolic rate for oxygen were measured during isoflurane-induced hypotension in 10 patients subjected to craniotomy for clipping of a cerebral aneurysm. Flow and metabolism were measured 5-13 days after the subarachnoid haemorrhage by a modification......). Controlled hypotension to an average MAP of 50-55 mm Hg was induced by increasing the dose of isoflurane, and maintained at an inspired concentration of 2.2 +/- 0.2%. This resulted in a significant decrease in CMRO2 (to 1.73 +/- 0.16 ml/100 g min-1), while CBF was unchanged. After the clipping...

  6. Advances in the understanding of delayed cerebral ischaemia after aneurysmal subarachnoid haemorrhage [version 1; referees: 4 approved

    Directory of Open Access Journals (Sweden)

    Liam Flynn

    2015-11-01

    Full Text Available Delayed cerebral ischaemia has been described as the single most important cause of morbidity and mortality in patients who survive the initial aneurysmal subarachnoid haemorrhage. Our understanding of the pathophysiology of delayed cerebral ischaemia is meagre at best and the calcium channel blocker nimodipine remains the only intervention to consistently improve functional outcome after aneurysmal subarachnoid haemorrhage. There is substantial evidence to support cerebral vessel narrowing as a causative factor in delayed cerebral ischaemia, but contemporary research demonstrating improvements in vessel narrowing has failed to show improved functional outcomes. This has encouraged researchers to investigate other potential causes of delayed cerebral ischaemia, such as early brain injury, microthrombosis, and cortical spreading depolarisation. Adherence to a common definition of delayed cerebral ischaemia is needed in order to allow easier assessment of studies using multiple different terms. Furthermore, improved recognition of delayed cerebral ischaemia would not only allow for faster treatment but also better assessment of interventions. Finally, understanding nimodipine’s mechanism of action may allow us to develop similar agents with improved efficacy.

  7. Analysis of slipstream flow in two ruptured intracranial cerebral aneurysms.

    Science.gov (United States)

    Imbesi, S G; Kerber, C W

    1999-10-01

    Replicas of ruptured posterior communicating and basilar artery aneurysms were created from cadaveric specimens and then were placed in a circuit of pulsating non-Newtonian fluid. Individual fluid slipstreams were opacified with isobaric dyes, and images were recorded on film. The slipstreams entered the distal aneurysm neck with impact against the distal lateral wall of the aneurysm. They then swirled slowly in a reverse vortical pattern within the aneurysm sac. Fluid exited the aneurysm at the proximal neck. The flow pattern clearly shows the impact zone of entering slipstreams (the point of aneurysm rupture) and provides information pertaining to aneurysm growth and formation. PMID:10543644

  8. Giant pediatric aneurysm treated with ligation of the middle cerebral artery with the Drake tourniquet and extracranial-intracranial bypass.

    Science.gov (United States)

    Lansen, T A; Kasoff, S S; Arguelles, J H

    1989-07-01

    Saccular intracranial aneurysms occur infrequently in children, and the incidence of pediatric giant aneurysms is statistically in the same proportion as in adults. The management of these giant aneurysms can be treacherous. This paper presents a case of a 9-year-old boy with a giant aneurysm of the right middle cerebral artery that was successfully managed by ligation of the middle cerebral artery using a Drake tourniquet with the patient awake and by augmentation of the middle cerebral artery circulation with superficial temporal artery-middle cerebral artery anastomosis without excision of the lesion.

  9. Unruptured Cerebral Aneurysm Detected after Intravenous Tissue Plasminogen Activator for Stroke

    Directory of Open Access Journals (Sweden)

    Yukihiro Yoneda

    2009-06-01

    Full Text Available Therapeutic guidelines of intravenous thrombolysis with tissue plasminogen activator (tPA for hyperacute ischemic stroke are very strict. Because of potential higher risk of bleeding complications, the presence of unruptured cerebral aneurysm is a contraindication for systemic thrombolysis with tPA. According to the standard CT criteria, a 66-year-old woman who suddenly developed aphasia and hemiparesis received intravenous tPA within 3 h after ischemic stroke. Magnetic resonance angiography during tPA infusion was performed and the presence of a small unruptured cerebral aneurysm was suspected at the anterior communicating artery. Delayed cerebral angiography confirmed an aneurysm with a size of 7 mm. The patient did not experience any adverse complications associated with the aneurysm. Clinical experiences of this kind of accidental off-label thrombolysis may contribute to modify the current rigid tPA guidelines for stroke.

  10. Chronic cerebral paragonimiasis combined with aneurysmal subarachnoid hemorrhage.

    Science.gov (United States)

    Choo, Juk-Dong; Suh, Bumn-Suk; Lee, Hyun-Sung; Lee, Jong-Soo; Song, Chang-June; Shin, Dae-Whan; Lee, Young-Ha

    2003-11-01

    A 67-year-old Korean woman attended our hospital complaining of a severe headache. A brain computed tomography scan showed conglomerated, high-density, calcified nodules in the left temporo-occipito-parietal area and high-density subarachnoid hemorrhage in the basal cisterns. Magnetic resonance imaging of the brain shows multiple conglomerated iso- or low-signal intensity round nodules with peripheral rim enhancement. She underwent craniotomies to clip the aneurysm and remove the calcified masses. Paragonimus westermani eggs were identified in the calcified necrotic lesions. Results of parasitic examinations on the sputum and an enzyme-linked immunosorbent assay for P. westermani were all negative. The patient presented with headache and dizziness that had occurred for more than 30 years. She had not eaten freshwater crayfish or crabs. However, she had sometimes prepared raw crabs for several decades. Overall, this case was diagnosed as chronic cerebral paragonimiasis, in which she may have been infected through the contamination of utensils during the preparation of the second intermediate hosts, combined with a cerebral hemorrhage.

  11. Balloon occlusion of the internal carotid artery in 40 cases of giant intracavernous aneurysm: Technical aspects, cerebral monitoring, and results

    International Nuclear Information System (INIS)

    We have studied the results of carotid occlusion in the treatment of giant intracavernous carotid artery (ICA) aneurysms in 40 patients. Clinical, angiographic, Doppler and cerebral blood flow (CBF) criteria for tolerance of occlusion are discussed. The patients had headaches (47.5%), cranial nerve compression (87.5%), decreased visual acuity (20%), ruptured aneurysm (15%) and 5% were asymptomatic. Balloon occlusion tests were performed under light sedation anaesthesia; a successful test required perfect clinical tolerance and adequate angiographic collateral circulation in arterial, parenchymatous, and venous phases. Additional criteria included xenon 133 CBF measurements, and transcranial Doppler sonography of the middle cerebral artery. According to these criteria, 5 patients did not tolerate test occlusion and required an extra-intracranial (EC-IC) bypass. Mean follow-up was 4.7 years. All patients were radiologically cured of their aneurysm, and in 35 the symptoms resolved, although 3 had persistent ocular motor nerve palsies, and in 4 visual defects were unchanged. Complications were 1 permament and 3 transient neurological deficits. Balloon occlusion of the ICA is an effective, reliable form of treatment for intracavernous giant aneurysm and should replace surgical ligation of the cervical carotid artery. With CBF or Doppler monitoring, the risk of neurological deficit is diminished. EC-IC bypass prior to ICA occlusion is indicated if test occlusion is not tolerated. (orig.)

  12. Computer-assisted spatial reconstruction of cerebral blood vessels and intracranial aneurysms

    Directory of Open Access Journals (Sweden)

    Nikolić Igor M.

    2006-01-01

    Full Text Available Introduction. Today, many medical procedures are based on image analysis with the aim of providing accurate diagnosis and optimal treatment. The goal of this report was to present clinical implications of computer-assisted geometric design of carotid aneurysms. Material and methods. In this study, the three-dimensional reconstruction was based on the approximation power of the parametric spline function, which achieves interpolation and surface fitting of the arterial information obtained by conventional angiography. Two views of conventional angiograms (anterioposterior and lateral views were used with a personal computer and commercial software. Results. This method of three-dimensional generated images was applied in 45 cases of cerebral aneurysms in carotid bifurcation. 3D reconstructions were made in approximately 20 minutes. They contributed to assessing vascular structures, and it was possible to rotate the three-dimensional image in different angles. Conclusion. Three-dimensional reconstruction of cerebral vessels is very useful for discussing surgical strategies preoperatively. Furthermore, it could also be used in endovascular procedures. .

  13. Endovascular Treatment of Unruptured Posterior Cerebral Artery Dissecting Aneurysms%未破裂大脑后动脉夹层动脉瘤的血管内治疗

    Institute of Scientific and Technical Information of China (English)

    纪文军; 康慧斌; 孙立倩; 刘爱华; 李佑祥; 杨新健; 姜除寒; 吴中学

    2015-01-01

    Objective To explore the clinical characteristics and clinical effect of endovascular treatment of unruptured posterior cerebral artery dissecting aneurysms. Methods We consecutively enrolled 20 cases with unruptured posterior cerebral artery dissecting aneurysm in department of interventional neuroradiology of Beijing Tiantan Hospital from January 2012 to December 2014. Clinical data were collected and we followed up the cases by imaging and telephone. Results For 20 cases of posterior cerebral artery dissecting aneurysms, male in 11 cases (55.0%), female in 9 cases (45.0%), age (46.2±15.5) years. 4 cases were in P1 segment (20.0%), 12 cases were in P2 segment (60.0%), 2 cases were in P1-2 segment (10.0%), 2 cases were in P3 segment (10.0%). Embolization only by coils was for 3 cases (15.0%), and parent artery occlusion was for 11 cases (55.0%), stent-asissted coiling was for 6 cases (30.0%). Instant imaging results by Raymond scale (class1 to class 3): class 1 in 15 cases (75%), class 2 in 5 cases (25.0%). Ischemic events occurred in 2 cases (10.0%) after procedures and recovered after 3 months of antisypotomatic treatment. Imaging was followed up in 16 cases for 10.5 (6.5) months. Imaging results of follow-up by Raymond scale: class 1 in 13 cases (81.3%) and class 2 in 2 cases (12.5%). 1 case (class 3, 6.2%) was recurrent and received the second endovascular treatment with stent-assisted coiling, the case was not recurrent in 6 months follow-up. Clincal follow-up was carried out in 20 cases for 12 (9.3)months, mRS 0 was in 9 cases (45.0%), mRS 1 was in 5 cases (25.0%), mRS 2 was in 5 cases (25.0%), mRS 3 was in 1 case (5.0%), rate of good prognosis was 95.0%. Conclusion Unruptured posterior cerebral artery dissecting aneurysms ware mainly located in P2 segment, embolization based on location, the clinical results were satisfactary.%目的探讨未破裂大脑后动脉夹层动脉瘤的临床特点及其血管内治疗效果。  方法回顾性分析2012年1

  14. 3D real-time visualization of blood flow in cerebral aneurysms by light field particle image velocimetry

    Science.gov (United States)

    Carlsohn, Matthias F.; Kemmling, André; Petersen, Arne; Wietzke, Lennart

    2016-04-01

    Cerebral aneurysms require endovascular treatment to eliminate potentially lethal hemorrhagic rupture by hemostasis of blood flow within the aneurysm. Devices (e.g. coils and flow diverters) promote homeostasis, however, measurement of blood flow within an aneurysm or cerebral vessel before and after device placement on a microscopic level has not been possible so far. This would allow better individualized treatment planning and improve manufacture design of devices. For experimental analysis, direct measurement of real-time microscopic cerebrovascular flow in micro-structures may be an alternative to computed flow simulations. An application of microscopic aneurysm flow measurement on a regular basis to empirically assess a high number of different anatomic shapes and the corresponding effect of different devices would require a fast and reliable method at low cost with high throughout assessment. Transparent three dimensional 3D models of brain vessels and aneurysms may be used for microscopic flow measurements by particle image velocimetry (PIV), however, up to now the size of structures has set the limits for conventional 3D-imaging camera set-ups. On line flow assessment requires additional computational power to cope with the processing large amounts of data generated by sequences of multi-view stereo images, e.g. generated by a light field camera capturing the 3D information by plenoptic imaging of complex flow processes. Recently, a fast and low cost workflow for producing patient specific three dimensional models of cerebral arteries has been established by stereo-lithographic (SLA) 3D printing. These 3D arterial models are transparent an exhibit a replication precision within a submillimeter range required for accurate flow measurements under physiological conditions. We therefore test the feasibility of microscopic flow measurements by PIV analysis using a plenoptic camera system capturing light field image sequences. Averaging across a sequence of

  15. Effects of segmentation on patient-specific numerical simulation of cerebral aneurysm hemodynamics

    Science.gov (United States)

    Venugopal, Prem; Schmitt, Holger; Duckwiler, Gary R.; Valentino, Daniel J.

    2006-03-01

    One of the factors affecting the accuracy of patient-specific, imaging-based computational hemodynamic studies is the accuracy of geometric models created from medical images. In the present study we have investigated as to how accurate the geometric models should be in the context of cerebral aneurysms in order to obtain an accurate reproduction of intra-aneurysmal hemodynamics in individual patients using numerical simulations. Computed tomography angiography (CTA) images obtained for a patient-specific anterior communicating artery (ACoA) aneurysm and a patient-specific middle cerebral artery (MCA) aneurysm were used to construct the geometric models. For each aneurysm, two models were created, one using a different threshold value for image segmentation than the other. The average distance between the models was about the size of one in-plane pixel. It was found that for the MCA aneurysm, the simulated pressure and shear stress distributions for the two models were entirely different while for the ACoA aneurysm the mean pressure distribution obtained for the two models were similar, but the shear stress distributions were completely different. These results indicate that accurate reproduction of intra-aneurysmal hemodynamics would require the geometric reconstruction from medical images to be highly accurate.

  16. A novel low profile wireless flow sensor to monitor hemodynamic changes in cerebral aneurysm

    Science.gov (United States)

    Chen, Yanfei; Jankowitz, Brian T.; Cho, Sung Kwon; Chun, Youngjae

    2015-03-01

    A proof of concept of low-profile flow sensor has been designed, fabricated, and subsequently tested to demonstrate its feasibility for monitoring hemodynamic changes in cerebral aneurysm. The prototype sensor contains three layers, i.e., a thin polyurethane layer was sandwiched between two sputter-deposited thin film nitinol layers (6μm thick). A novel superhydrophilic surface treatment was used to create hemocompatible surface of thin nitinol electrode layers. A finite element model was conducted using ANSYS Workbench 15.0 Static Structural to optimize the dimensions of flow sensor. A computational fluid dynamics calculations were performed using ANSYS Workbench Fluent to assess the flow velocity patterns within the aneurysm sac. We built a test platform with a z-axis translation stage and an S-beam load cell to compare the capacitance changes of the sensors with different parameters during deformation. Both LCR meter and oscilloscope were used to measure the capacitance and the resonant frequency shifts, respectively. The experimental compression tests demonstrated the linear relationship between the capacitance and applied compression force and decreasing the length, width and increasing the thickness improved the sensor sensitivity. The experimentally measured resonant frequency dropped from 12.7MHz to 12.48MHz, indicating a 0.22MHz shift with 200g ( 2N) compression force while the theoretical resonant frequency shifted 0.35MHz with 50g ( 0.5N). Our recent results demonstrated a feasibility of the low-profile flow sensor for monitoring haemodynamics in cerebral aneurysm region, as well as the efficacy of the use of the surface treated thin film nitinol for the low-profile sensor materials.

  17. Phantom-based experimental validation of computational fluid dynamics simulations on cerebral aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Sun Qi; Groth, Alexandra; Bertram, Matthias; Waechter, Irina; Bruijns, Tom; Hermans, Roel; Aach, Til [Philips Research Europe, Weisshausstrasse 2, 52066 Aachen (Germany) and Institute of Imaging and Computer Vision, RWTH Aachen University, Sommerfeldstrasse 24, 52074 Aachen (Germany); Philips Research Europe, Weisshausstrasse 2, 52066 Aachen (Germany); Philips Healthcare, X-Ray Pre-Development, Veenpluis 4-6, 5684PC Best (Netherlands); Institute of Imaging and Computer Vision, RWTH Aachen University, Sommerfeldstrasse 24, 52074 Aachen (Germany)

    2010-09-15

    Purpose: Recently, image-based computational fluid dynamics (CFD) simulation has been applied to investigate the hemodynamics inside human cerebral aneurysms. The knowledge of the computed three-dimensional flow fields is used for clinical risk assessment and treatment decision making. However, the reliability of the application specific CFD results has not been thoroughly validated yet. Methods: In this work, by exploiting a phantom aneurysm model, the authors therefore aim to prove the reliability of the CFD results obtained from simulations with sufficiently accurate input boundary conditions. To confirm the correlation between the CFD results and the reality, virtual angiograms are generated by the simulation pipeline and are quantitatively compared to the experimentally acquired angiograms. In addition, a parametric study has been carried out to systematically investigate the influence of the input parameters associated with the current measuring techniques on the flow patterns. Results: Qualitative and quantitative evaluations demonstrate good agreement between the simulated and the real flow dynamics. Discrepancies of less than 15% are found for the relative root mean square errors of time intensity curve comparisons from each selected characteristic position. The investigated input parameters show different influences on the simulation results, indicating the desired accuracy in the measurements. Conclusions: This study provides a comprehensive validation method of CFD simulation for reproducing the real flow field in the cerebral aneurysm phantom under well controlled conditions. The reliability of the CFD is well confirmed. Through the parametric study, it is possible to assess the degree of validity of the associated CFD model based on the parameter values and their estimated accuracy range.

  18. Validation of CFD Simulations of Cerebral Aneurysms With Implication of Geometric Variations

    OpenAIRE

    Hoi, Yiemeng; Woodward, Scott H.; Kim, Minsuok; Taulbee, Dale B.; Meng, Hui

    2006-01-01

    Computational fluid dynamics (CFD) simulations using medical-image-based anatomical vascular geometry are now gaining clinical relevance. This study aimed at validating the CFD methodology for studying cerebral aneurysms by using particle image velocimetry (PIV) measurements, with a focus on the effects of small geometric variations in aneurysm models on the flow dynamics obtained with CFD. Method of Approach. An experimental phantom was fabricated out of silicone elastomer to best mimic a sp...

  19. A compreensão do significado cultural do aneurisma cerebral e do tratamento atribuídos pelo paciente e familiares: um estudo etnográfico La comprensión del significado cultural del aneurisma cerebral y del tratamiento atribuídos por el paciente y los familiares: un estudio etnográfico The cultural meaning of cerebral aneurysm and its treatment for the patient and relatives: an ethnographic study

    Directory of Open Access Journals (Sweden)

    Maria Helena Pinto

    2000-01-01

    Full Text Available Este trabalho consiste de um estudo etnográfico descritivo, com 13 pacientes acometidos pelo aneurisma cerebral e seus familiares, com o objetivo de compreender o significado da doença e do tratamento. Os dados foram coletados por entrevistas e observações durante a hospitalização e depois da alta, no ambulatório e na residência. O tema central obtido do estudo foi "Tinha que ser para mim. Deus sabe o que faz". Este tema revela uma interpretação religiosa para a doença e uma fundamentação mágica para o tratamento. Assim, o aneurisma cerebral é interpretado como uma doença material (corpo e uma doença espiritual (alma.Esta investigación consiste en un estudio etnográfico de los pacientes afectados por aneurisma cerebral y sus familiares, con el objetivo de objetivo de comprender el significado de la enfermedad y el tratamiento. Los datos fueron recolectados por entrevistas y observaciones durante la hospitalización y después del alta en la consulta externa y en la residencia. El tema central obtenido del estudio fue: "Tenia que ser para mi. Dios sabe lo que hace". Este tema manifiesta una interpretación religiosa para la enfermedad y una fundamentación mágica para el tratamiento. Así, el aneurisma cerebral es comprendido como una enfermedad material (del cuerpo y una enfermedad espiritual (del alma.This is a descriptive ethnographic study with 13 patients with cerebral aneurysm and their relatives aiming at understanding the meaning of the illness and the treatment. The data were collected by interviews and observations during the hospitalization and, after the discharge, in the outpatient clinic and at home. The central theme obtained from the study was "It had to be for me! God knows what He does". This theme reveals a religious interpretation for the illness and a magic basis for its cure.Thus, cerebral aneurysm is interpreted as a material illness (body and a spiritual illness (soul.

  20. The Use of Solitaire AB Stents in Coil Embolization of Wide-Necked Cerebral Aneurysms.

    Directory of Open Access Journals (Sweden)

    Teng-Fei Li

    Full Text Available The Solitaire AB stent is one of many assistant stents used for treating wide-necked cerebral aneurysm, and has been used since 2003. However, large sample studies on its safety and effectiveness are lacking. The objective of this study was to evaluate the effectiveness and safety of the Solitaire AB stent in the coil embolization of wide-necked cerebral aneurysms.Retrospective review of the clinical and image data of 116 patients with wide-necked cerebral aneurysms who had been enrolled at six interventional neuroradiology centers from February 2010 to February 2014 and had been treated by coil embolization; in total, 120 Solitaire AB stents were used. The degree of aneurysm occlusion was examined using digital subtraction angiography (DSA immediately after the procedure and during follow-up, and was graded using the modified Raymond classification. We also observed complications to evaluate the safety and effectiveness of this therapy.The 120 Solitaire AB stents (4 mm × 15 mm, four stents; 4 mm × 20 mm, 16 stents; 6 mm × 20 mm, 36 stents; 6 mm × 30 mm, 64 stents were inserted to treat 120 wide-necked cerebral aneurysms. All stents were inserted successfully. DSA immediately post-surgery revealed 55 cases of complete occlusion, 59 cases of neck remnant, and six cases of aneurysm remnant. Perioperatively, there were four cases of hemorrhage and four cases of stent thrombosis. The follow-up spanned 3-37 months; of 92 patients examined by DSA at the 6-month follow up, 12 had disease recurrence.The Solitaire AB stent is effective with a good technical success rate and short-term effect for assisting coil embolization of wide-necked cerebral aneurysms.

  1. Numerical simulations of the discontinuous progression of cerebral aneurysms based on fluid-structure interactions study

    Institute of Scientific and Technical Information of China (English)

    2010-01-01

    Investigations into the characteristics of hemodynamics will provide a better understanding of the pathology of cerebral aneurysms for clinicians.In this work,a steady state discontinuous-growth model of the cerebral aneurysms was proposed.With the assumption of the fluid-structure interaction between the wall of blood vessel and blood,a fluid-structure coupling numerical simulation for this model was built using software ANSYS and CFX.The simulation results showed that as the aneurysm volume increased,a blood flow vortex came forth,the vortex region became asymptotically larger,and eddy density became gradually stronger in it.After the emergence of the vortex region,the blood flow in the vicinity of the downstream in the aneurysms volume turned into bifurcated flow,and the location of the flow bifurcated point was shifted with the aneurysm volume growing while directions of the shear stress applied to two sides of the bifurcated point were opposite.The Von Mises stress distribution along the wall of aneurysm volume decreased in the prior period and increased gradually in the later period.The maximum stress was in the neck of the volume and the minimum was on the distal end in the whole process of growth.It was shown that as the aneurysm increased the maximum deformation location of the aneurysm,vertical to the streamline,was transferred from the distal end of the aneurysm to its neck,then back to its distal end of the aneurysm again.

  2. Cigarette Smoke and Inflammation: Role in Cerebral Aneurysm Formation and Rupture

    Directory of Open Access Journals (Sweden)

    Nohra Chalouhi

    2012-01-01

    Full Text Available Smoking is an established risk factor for subarachnoid hemorrhage yet the underlying mechanisms are largely unknown. Recent data has implicated a role of inflammation in the development of cerebral aneurysms. Inflammation accompanying cigarette smoke exposure may thus be a critical pathway underlying the development, progression, and rupture of cerebral aneurysms. Various constituents of the inflammatory response appear to be involved including adhesion molecules, cytokines, reactive oxygen species, leukocytes, matrix metalloproteinases, and vascular smooth muscle cells. Characterization of the molecular basis of the inflammatory response accompanying cigarette smoke exposure will provide a rational approach for future targeted therapy. In this paper, we review the current body of knowledge implicating cigarette smoke-induced inflammation in cerebral aneurysm formation/rupture and attempt to highlight important avenues for future investigation.

  3. Endovascular treatment of coarctation and related aneurysms.

    Science.gov (United States)

    Galiñanes, E L; Krajcer, Z

    2014-06-11

    Today,surgical repair has almost doubled the 30year survival rate in patients with coarctation of the aorta (CoA), and 72% to 98% of patients now reach adulthood. Possible late complications include malignant hypertension, left ventricular dysfunction, aortic valve dysfunction, recurrent CoA, and aneurysm formation with risk of rupture. Treating postoperative CoA-related aneurysms with observation alone is associated with a mortality rate of 36%, compared with 9% for surgical repair. Even in the best surgeons' hands, aortic surgery has associated complications, and the complexity of reoperative surgery makes the risks substantially greater. For patients with CoA-related aneurysm, endovascular treatment constitutes a good alternative to reoperative surgery because it poses a lower risk of morbidity and mortality. Implanting an endograft has been shown to be successful in treating CoA and related aneurysms, producing excellent intermediate outcomes and minimal morbidity and mortality. Despite evidence that using covered stents improves outcomes, the superiority of any particular stent type has yet to be established. With a variety of endografts available, the decision of which stent to use depends on anatomy, availability, and operator preference.

  4. Safety and efficacy of aneurysm treatment with WEB

    DEFF Research Database (Denmark)

    Pierot, Laurent; Costalat, Vincent; Moret, Jacques;

    2016-01-01

    OBJECT WEB is an innovative intrasaccular treatment for intracranial aneurysms. Preliminary series have shown good safety and efficacy. The WEB Clinical Assessment of Intrasaccular Aneurysm Therapy (WEBCAST) trial is a prospective European trial evaluating the safety and efficacy of WEB in wide......-neck bifurcation aneurysms. METHODS Patients with wide-neck bifurcation aneurysms for which WEB treatment was indicated were included in this multicentergood clinical practices study. Clinical data including adverse events and clinical status at 1 and 6 months were collected and independently analyzed by a medical....... RESULTS Ten European neurointerventional centers enrolled 51 patients with 51 aneurysms. Treatment with WEB was achieved in 48 of 51 aneurysms (94.1%). Adjunctive implants (coils/stents) were used in 4 of 48 aneurysms (8.3%). Thromboembolic events were observed in 9 of 51 patients (17.6%), resulting...

  5. Microsurgical one-stage treatment of intracranial mirror aneurysms via bilateral frontolateral approaches

    Directory of Open Access Journals (Sweden)

    Hong-guang WANG

    2016-08-01

    Full Text Available Objective To investigate surgical strategies, clinical effects and complications of microsurgical one-stage treatment of intracranial mirror aneurysms via bilateral frontolateral approaches.  Methods Review clinical data of 18 cases with anterior circulation mirror aneurysms who underwent one-stage clipping via bilateral frontolateral approaches from July 2010 to July 2015 admitted to Department of Neurosurgery in Tianjin Huanhu Hospital. The operative efficacy was evaluated according to postoperative Glasgow Outcome Scale (GOS.  Results The 36 aneurysms in 18 patients were successfully clipped via bilateral frontolateral approaches at one-stage, including 18 posterior communicating artery (PCoA mirror aneurysms in 9 cases and 18 middle cerebral artery (MCA mirror aneurysms in 9 cases. GOS score of 5 was discovered in 16 cases, and 4 was discovered in 2 cases after operation. One case underwent ventriculoperitoneal shunting (VPS due to communicating hydrocephalus, one case got postoperative pulmonary infection and no death occurred. Intracranial CTA at 6 months postoperatively showed aneurysms of 18 patients were clipped completely, the parent artery blood flow was smooth, and no recurrence was found.  Conclusions Microsurgical one-stage clipping via bilateral frontolateral approaches for treating intracranial mirror aneurysms is a sugrical method with small incision, fitting surgical field, high safety, satisfactory effect and good prognosis, which is a new minimally invasive neurosurgical technique. DOI: 10.3969/j.issn.1672-6731.2016.08.012

  6. [Giant intracranial aneurysm in three years old boy: case report].

    Science.gov (United States)

    de Tella, Osvaldo Inácio; Crosera, João Francisco; Herculano, Marco Antonio; de Paiva Neto, Manoel Antonio

    2006-06-01

    Cerebral aneurysms are rare in the pediatric age group and differ from adults' aneurysms in size, localization and incidence. We report a 3-year-old boy with giant middle cerebral artery aneurysms who presented with subarachnoid hemorrhage. The patient was submitted to surgical treatment and the postoperative period was uneventful.

  7. ADAMTS genes and the risk of cerebral aneurysm.

    Science.gov (United States)

    Arning, Astrid; Jeibmann, Astrid; Köhnemann, Stephan; Brokinkel, Benjamin; Ewelt, Christian; Berger, Klaus; Wellmann, Jürgen; Nowak-Göttl, Ulrike; Stummer, Walter; Stoll, Monika; Holling, Markus

    2016-08-01

    OBJECTIVE Cerebral aneurysms (CAs) affect 2%-5% of the population, and familial predisposition plays a significant role in CA pathogenesis. Several lines of evidence suggest that genetic variations in matrix metalloproteinase genes (MMP) are involved in the etiopathology of CAs. The authors performed a case-control study to investigate the effect of 4 MMP variants from the ADAMTS family on the pathogenesis of CAs. METHODS To identify susceptible genetic variants, the authors investigated 8 single nucleotide polymorphisms (SNPs) in 4 genes from the ADAMTS family (ADAMTS2, -7, -12, and -13) known to be associated with vascular diseases. The study included 353 patients with CAs and 1055 healthy adults. RESULTS The authors found significant associations between CA susceptibility and genetic variations in 3 members of the ADAMTS family. The largest risk for CA (OR 1.32, p = 0.006) was observed in carriers of the ADAMTS2 variant rs11750568, which has been previously associated with pediatric stroke. Three SNPs under investigation are associated with a protective effect in CA pathogenesis (ADAMTS12 variant rs1364044: OR 0.65, p = 0.0001; and ADAMTS13 variants rs739469 and rs4962153: OR 0.77 and 0.63, p = 0.02 and 0.0006, respectively), while 2 other ADAMTS13 variants may confer a significant risk (rs2301612: OR 1.26, p = 0.011; rs2285489: OR 1.24, p = 0.02). CONCLUSIONS These results suggest that reduced integrity of the endothelial wall, as conferred by ADAMTS variants, together with inflammatory processes and defective vascular remodeling plays an important role in CA pathogenesis, although the mechanism of action remains unknown. The authors' findings may lead to specific screening of at-risk populations in the future. PMID:26745484

  8. ADAMTS genes and the risk of cerebral aneurysm.

    Science.gov (United States)

    Arning, Astrid; Jeibmann, Astrid; Köhnemann, Stephan; Brokinkel, Benjamin; Ewelt, Christian; Berger, Klaus; Wellmann, Jürgen; Nowak-Göttl, Ulrike; Stummer, Walter; Stoll, Monika; Holling, Markus

    2016-08-01

    OBJECTIVE Cerebral aneurysms (CAs) affect 2%-5% of the population, and familial predisposition plays a significant role in CA pathogenesis. Several lines of evidence suggest that genetic variations in matrix metalloproteinase genes (MMP) are involved in the etiopathology of CAs. The authors performed a case-control study to investigate the effect of 4 MMP variants from the ADAMTS family on the pathogenesis of CAs. METHODS To identify susceptible genetic variants, the authors investigated 8 single nucleotide polymorphisms (SNPs) in 4 genes from the ADAMTS family (ADAMTS2, -7, -12, and -13) known to be associated with vascular diseases. The study included 353 patients with CAs and 1055 healthy adults. RESULTS The authors found significant associations between CA susceptibility and genetic variations in 3 members of the ADAMTS family. The largest risk for CA (OR 1.32, p = 0.006) was observed in carriers of the ADAMTS2 variant rs11750568, which has been previously associated with pediatric stroke. Three SNPs under investigation are associated with a protective effect in CA pathogenesis (ADAMTS12 variant rs1364044: OR 0.65, p = 0.0001; and ADAMTS13 variants rs739469 and rs4962153: OR 0.77 and 0.63, p = 0.02 and 0.0006, respectively), while 2 other ADAMTS13 variants may confer a significant risk (rs2301612: OR 1.26, p = 0.011; rs2285489: OR 1.24, p = 0.02). CONCLUSIONS These results suggest that reduced integrity of the endothelial wall, as conferred by ADAMTS variants, together with inflammatory processes and defective vascular remodeling plays an important role in CA pathogenesis, although the mechanism of action remains unknown. The authors' findings may lead to specific screening of at-risk populations in the future.

  9. Evolution of Giant P2-Posterior Cerebral Artery Aneurysm over 16 Years: Saccular to Serpentine. A Case Report.

    Science.gov (United States)

    Sharma, S

    2009-12-14

    Giant intracranial aneurysms account for only about 5% of all intracranial aneurysms. Giant intradural aneurysms are associated with severe natural history, yet remain potentially curable. These aneurysms cause symptoms due to their mass effect, and only 14-35% of cases present with subarachnoid haemorrhage (SAH). The present case report is an imaging evolution of a giant posterior cerebral artery (PCA) aneurysm in a patient who was lost on follow-up from 1992 to 2008 giving insight into the natural history and morphologic evolution of giant serpentine aneurysms. Attempted surgery 16 years previously for a saccular PCA aneurysm produced encephalomalacia and created a more spacious perianeurysmal environment, preventing any mass effect on vital structures in its vicinity. This allowed the patient to have a long symptom-free period and also allowed the aneurysm to follow a morphologic evolution over a long period without causing symptoms which would have called for intervention. This unusual development gave a unique opportunity to study the evolution of a gaint serpentine aneurysm from a saccular aneurysm and also the clinical and morphologic changes in an aneurysm if it can be prevented from producing mass effect. The Coanda effect, or boundary wall effect, has been considered responsible for the development of the serpentine channel in the original globular aneurysm . However many Authors conclude that giant serpentine aneurysms are not derived from saccular aneurysms. PMID:24209407

  10. Endovascular treatment of renal aneurysms: A series of 18 cases

    International Nuclear Information System (INIS)

    Purpose: To retrospectively analyze the results and complications of the endovascular treatment of 18 renal aneurysms. Methods: From 2002 to 2011, 15 patients (aged 31–76), with 18 renal aneurysms, were admitted in our institution for treatment by embolization. Except one, all were wide-necked aneurysms. One aneurysm was treated by occluding the parent artery considering its distal location; a small-necked aneurysm was treated by simple coiling, and the remaining 16 were embolized utilizing adjunctive techniques to protect the parent artery. We analyzed the rates of technical success, complication and clinical consequence, post-operative occlusion and recurrence. Results: There was a 100% technical success rate. 15 aneurysms showed a total occlusion on the post-treatment angiogram. 2 aneurysms demonstrated neck remnants, and one had an intrasaccular residual in-flow. Two minor post-operative complications were encountered but resolved over time. No delayed clinical complications were observed and the long-term angiographic follow-up demonstrated stability of the occlusion of the target renal aneurysm with no major recurrence. Conclusion: Complications of the embolization of renal aneurysms are rare. Endovascular treatment should therefore be considered at first for the treatment of renal aneurysms.

  11. Aneurysms of the superficial venous system: classification and treatment

    Directory of Open Access Journals (Sweden)

    Ronald G. Bush

    2014-11-01

    Full Text Available Superficial venous aneurysms are rarely described and they may remain indolent or become the source for pulmonary emboli. A system of classification and treatment protocol according to size and location is proposed. Three hundred thirty patients were evaluated for symptomatic venous disease (C2-C6 over a 2-year period. A proposed designation for venous aneurysm is described. Patients fulfilling this criterion are described in reference to site of involvement, histologic findings, and method of treatment. Five percent of patients met the criteria for venous aneurysm. Nine aneurysms of the greater saphenous vein were identified. Three aneurysms were proximal to the subterminal valve and the rest were distal. Six aneurysms of the anterior accessory greater saphenous vein (AAGSV were identified. Three aneurysms of the AAGSV spontaneously thrombosed. Two patients presented with aneurysms of the small saphenous vein. Histology revealed thickened intima, smooth muscle and adventitia. Aneurysm designation relates to diameter of normal and contiguous vein. All superficial venous aneurysms in close proximity to the junction of the femoral or popliteal vein should be ligated. Classification of venous aneurysms should include the AAGSV, which may present with spontaneous thrombosis.

  12. Mesenteric ischaemia after endovascular coiling of ruptured cerebral aneurysms.

    LENUS (Irish Health Repository)

    Kamel, M H

    2012-02-03

    Three patients were referred to a national neurosurgical centre following CT evidence of subarachnoid haemorrhage. The three patients, who were referred from different institutions within a seven week period, were Fisher grade 3 and WFNS Grade I at all times. Angiography showed a PCOM aneurysm in one case, a ruptured Basilar tip aneurysm and an unruptured ACOM aneurysm in another case, and an ACOM aneurysm in the third case. It was decided that the aneurysms were suitable for endovascular coiling. These patients had unremarkable intraoperative catheterizations and coiling but subsequently deteriorated post-operatively due to mesenteric ischaemia. Two patients required colectomy for mesenteric ischaemia, and the third arrested secondary to sepsis from bowel perforation. We discuss the various causes that may explain this association, and we alert the neurosurgical community for this complication which has not been reported before.

  13. Unilateral supraorbital keyhole approach in patients with middle cerebral artery (M1-M2 segment) symmetrical aneurysms.

    Science.gov (United States)

    Martellotta, N; Gigante, N; Toscano, S; Maddalena, G F; Tripodi, M; Settembrini, G; Stroscio, C; Distefano, G; Citro, E

    2003-08-01

    A left middle cerebral artery aneurysm at the bifurcation (M1-M2 segment) and a right smaller aneurysm, symmetrical to the previous one were diagnosed in a 69-year-old female after angiographic examination for subarachnoid hemorrhage. The preoperative radiological study did not enable us to identify the bleeding aneurysm so a left supraorbital keyhole approach was performed to operate on the bigger aneurysm. In the same surgical session, using the same way of approach, we decided to attack also the right aneurysm which then revealed itself as being responsible for bleeding. The postoperative angiograms confirmed the complete exclusion of both aneurysms and the patient was discharged after good recovery. Although there are remarkable controversies about the surgical strategies for multiple aneurysms, our experience gives us the opportunity to emphasize the supraorbital keyhole approach and to reconsider the "timing" of multiple/bilateral aneurysms.

  14. [Stent-assisted mechanical removal of tromboembolism after embolization of middle cerebral artery aneurysm].

    Science.gov (United States)

    Poncyljusz, Wojciech; Falkowski, Aleksander; Rać, Monika; Sagan, Leszek; Kojder, Ireneusz

    2012-01-01

    Thrombotic occlusion of the middle cerebral artery's branch occurred just after embolization of a nonruptured cerebral aneurysm. Bail-out stent-assisted mechanical thrombectomy of the clot was performed. DSA revealed normal vessel patency at the end of the procedure. There were no adverse events related to this thrombectomy, and the patient recovered from the embolization with minor neurologic deficit. There was no neurologic deficit after 90 days follow-up. PMID:23276015

  15. Anterior communicating artery aneurysm associated with an infraoptic course of anterior cerebral artery and rare variant of the persistent trigeminal artery: a case report and literature review.

    Science.gov (United States)

    Turkoglu, Erhan; Arat, Anıl; Patel, Nirav; Kertmen, Hayri; Başkaya, Mustafa K

    2011-05-01

    Infraoptic course of the precommunicating segment of the anterior cerebral artery (A1) is a rare anomaly. Furthermore, the presence of this anomaly associated with persistent trigeminal artery variant has been reported in the literature only once. We present a patient who had infraoptic course of A1 associated with an ipsilateral persistent trigeminal artery variant arising from the right internal carotid artery with no apparent connection to the basilar artery. The persistent trigeminal artery variant supplied to the right posteroinferior cerebellar artery territory. The patient also had hypoplastic left vertebral artery, superior cerebellar arteries originating from posterior cerebellar arteries bilaterally, and a bilobed aneurysm of the anterior communicating artery. The aneurysm was clipped and the infraoptic course was verified during the surgery. The post-operative course was uneventful and a follow-up arteriogram on the 7th postoperative day revealed successful obliteration of the aneurysm. We reviewed the literature with respect to presentation, associated vascular anomalies, imaging, associated cerebral aneurysms and other cerebral abnormalities, and treatment of the associated aneurysms. A discussion of the embryogenesis of this rare anomaly is also provided. PMID:21269759

  16. [An infected partially thrombosed giant aneurysm of the azygos anterior cerebral artery].

    Science.gov (United States)

    Mishima, K; Watanabe, T; Sasaki, T; Saito, I; Takakura, K

    1990-05-01

    The authors report a case of partially thrombosed giant aneurysm which was secondarily infected with purulent meningitis. The relationship between the infection of the aneurysm, the rapid growth of the aneurysm and the development of severe cerebral edema was discussed. A 53 year-old man was admitted on September 1, 1986, with a diagnosis of bacterial meningitis. On his admission, his body temperature was 39 degrees C, and he showed mental confusion but no neurological deficits. Laboratory data revealed signs of infection in white blood cell count, CRP, and erythrocyte sedimentation rate. Computerized tomographic (CT) scan and magnetic resonance (MR) imaging showed a massive round mass with perifocal edema measuring 40mm in the maximum diameter in the left paramedian frontal region. T1 weighted MR image also showed the presence of pus accumulation in the left ventricle. Cerebral angiography demonstrated a giant aneurysm at the distal portion of the azygos anterior cerebral artery, and irregular narrowing of both the supraclinoid segment of the carotid artery and its main branches indicating arteritis due to purulent meningitis. The patient was treated with ventricular drainage and administration of antibiotics. Culture of the purulent CSF was negative. The patient's lab data, CSF finding and neurological status improved progressively. However, follow-up CT scan and angiogram a month later showed enlargement of the aneurysm, dilatation of the patent lumen and perifocal edema. On October 8, the patient suddenly became comatose with anisocoria. A CT scan showed massive edema with marked midline shift. Emergency bifrontal craniotomy was carried out, and clipping was completed after removal of the thrombosed portion of the aneurysm, and thromboendarterectomy of the aneurysmal neck.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2385324

  17. Delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage : the role of coagulation and fibrinolysis

    NARCIS (Netherlands)

    M.D.I. Vergouwen

    2009-01-01

    Patients with aneurysmal subarachnoid hemorrhage (SAH) are at risk to develop complications, especially within the first two weeks after the hemorrhage. Delayed cerebral ischemia (DCI) is a complication which occurs in about 30% of SAH patients, leading to symptoms such as aphasia, hemiparesis, or i

  18. FSI and CFD Modeling of Cerebral Aneurysm Model and Comparing to PIV Experiments

    Science.gov (United States)

    Wang, Zhaopeng; Hao, Qing

    2014-11-01

    Wall shear stress or strain is considered as an important factor for cerebral aneurysm growth and even rupture. The objective of present study is to evaluate wall shear stress in aneurysm sac and neck by Fluid Structure Interaction (FSI) and solid wall Computational Fluid Dynamics (CFD) approaches and compare the simulation results against Particle Image Velocimetry (PIV) experimental data from an elastic in vitro aneurysm model. The FSI and CFD simulation results showed that both approaches captured the flow patterns inside the aneurysm sac under pulsatile flow, that in diastole time period the flow inside the aneurysm sac was a stable circular clock-wise flow; when higher velocity entered into the aneurysm sac during systole and in a short diastole time period an anti-clock circular flow pattern emerged near the distal neck. Both approaches showed that the shear stress near the proximal neck experienced higher shear stress than the distal neck, while in the aneurysm dome the shear stress was always the lowest. In this study, we also showed that shear stress values at proximal neck and distal neck from FSI approach were lower than solid wall CFD approach.

  19. Safety and Feasibility of Simultaneous Ipsilateral Proximal Carotid Artery Stenting and Cerebral Aneurysm Coiling

    Directory of Open Access Journals (Sweden)

    Aamir Badruddin

    2010-10-01

    Full Text Available Background: Coexistence of cerebral aneurysm and carotid artery disease may be encountered in clinical practice. Theoretical increase in aneurysmal blood flow may increase risk of rupture if carotid artery disease is treated first. If aneurysm coiling is performed first, stroke risk may increase while repeatedly crossing the diseased artery. It is controversial which disease to treat first, and whether it is safe to treat both simultaneously via endovascular procedures. We document the safety and feasibility of such an approach. Methods: Review of collected neurointerventional database at our institution was performed for patients who underwent both Carotid artery stenting (CAS and aneurysm coil embolization (ACE simultaneously. All patients underwent carotid stenting followed by aneurysm coiling in the same setting. Demographic, clinical data and outcome measures including success rate and periprocedural complications were collected. Results: 590 aneurysms coiling were screened for patients who underwent combined CAS and ACE. Ten patients were identified. Mean age was 67.7 years (range 51 to 89. The success rate for stenting and coiling was 100% with no immediate complications. No stroke, TIAs, or aneurysmal rebleeding was found on their most recent follow up. Conclusions: Our case series demonstrates that it is safe and feasible to perform CAS and ACE simultaneously as one procedure which may avoid unwanted risk of treating either disease at two separate time sessions.

  20. Quantitative comparison of hemodynamics in simulated and 3D angiography models of cerebral aneurysms by use of computational fluid dynamics.

    Science.gov (United States)

    Saho, Tatsunori; Onishi, Hideo

    2015-07-01

    In this study, we evaluated hemodynamics using simulated models and determined how cerebral aneurysms develop in simulated and patient-specific models based on medical images. Computational fluid dynamics (CFD) was analyzed by use of OpenFOAM software. Flow velocity, stream line, and wall shear stress (WSS) were evaluated in a simulated model aneurysm with known geometry and in a three-dimensional angiographic model. The ratio of WSS at the aneurysm compared with that at the basilar artery was 1:10 in simulated model aneurysms with a diameter of 10 mm and 1:18 in the angiographic model, indicating similar tendencies. Vortex flow occurred in both model aneurysms, and the WSS decreased in larger model aneurysms. The angiographic model provided accurate CFD information, and the tendencies of simulated and angiographic models were similar. These findings indicate that hemodynamic effects are involved in the development of aneurysms. PMID:25911446

  1. HIMALAIA (Hypertension Induction in the Management of AneurysmaL subArachnoid haemorrhage with secondary IschaemiA) : a randomized single- blind controlled trial of induced hypertension vs. no induced hypertension in the treatment of delayed cerebral ischemia after subarachnoid hemorrhage

    NARCIS (Netherlands)

    Gathier, C. S.; van den Bergh, W. M.; Slooter, A. J. C.

    2014-01-01

    RationaleDelayed cerebral ischemia (DCI) is a major complication after aneurysmal subarachnoid hemorrhage (SAH). One option to treat delayed cerebral ischemia is to use induced hypertension, but its efficacy on the eventual outcome has not been proven in a randomized clinical trial. This article des

  2. Towards Predicting Patient-Specific Flow-Diverter Treatment Outcomes for Bifurcation Aneurysms: From Implantation Rehearsal to Virtual Angiograms.

    Science.gov (United States)

    Peach, T W; Spranger, K; Ventikos, Y

    2016-01-01

    Despite accounting for the majority of all cerebral aneurysm cases, bifurcation aneurysms present many challenges to standard endovascular treatment techniques. This study examines the treatment of bifurcation aneurysms endovascularly with flow-diverting stents and presents an integrative computational modeling suite allowing for rehearsing all aspects of the treatment. Six bifurcation aneurysms are virtually treated with 70% porosity flow-diverters. Substantial reduction (>50%) in aneurysm inflow due to device deployment is predicted in addition to reductions in peak and average aneurysm wall shear stress to values considered physiologically normal. The subsequent impact of flow-diverter deployment on daughter vessels that are jailed by the device is investigated further, with a number of simulations conducted with increased outlet pressure conditions at jailed vessels. Increased outlet pressures at jailed daughter vessels are found to have little effect on device-induced aneurysm inflow reduction, but large variation (13-86%) is seen in the resulting reduction in daughter vessel flow rate. Finally, we propose a potentially powerful approach for validation of such models, by introducing an angiographic contrast model, with contrast transport modeled both before and after virtual treatment. Virtual angiograms and contrast residence curves are created, which offer unique clinical relevance and the potential for future in vivo verification of simulated results.

  3. Endovascular coil embolization of aneurysm neck for the treatment of ruptured intracranial aneurysm with bleb formation

    OpenAIRE

    Wan, Jun; Gu, Weijin; Zhang, Xiaolong; Geng, Daoying; Lu, Gang; Huang, Lei; Zhang, Lei; Ge, Liang; Ji, Lihua

    2014-01-01

    Background Ruptured intracranial aneurysm (ICA) with bleb formation (RICABF) is a special type of ruptured ICA. However, the exact role and effectiveness of endovascular coil embolization (ECE) in RICABF is unknown. We aimed to investigate the effectiveness and safety of ECE of aneurysm neck for RICABF treatment. Material/Methods We retrospectively assessed consecutive patients who were hospitalized in our endovascular intervention center between October 2004 and May 2012. Overall, 86 patient...

  4. The Value of Cerebral CT Angiography with Low Tube Voltage in Detection of Intracranial Aneurysms

    Directory of Open Access Journals (Sweden)

    Kun Tang

    2015-01-01

    Full Text Available Objective. The aim of this study is to investigate the value of cerebral CT angiography (CTA with low tube voltage in detection of intracranial aneurysms. Materials and Methods. A total of 294 consecutive patients with spontaneous subarachnoid hemorrhage (SAH were enrolled in this study and randomly assigned into conventional voltage CTA (C-CTA group and low voltage CTA (L-CTA group. The objective and subjective image qualities were analyzed and compared between C-CTA and L-CTA groups. With the results of 3D-DSA as “gold standard,” the sensitivity, specificity, and accuracy of C-CTA and L-CTA in diagnosis of aneurysms were calculated and compared with each other. Results. Compared with group C-CTA, the CT dose index volume (CTDIvol of group L-CTA reduced by 35.65%. There were no significant differences between C-CTA and L-CTA groups regarding objective and subjective image qualities. The sensitivity, specificity, and accuracy of L-CTA in diagnosis of aneurysms were 95.16%, 99.72%, and 99.42%, respectively. There were no significant differences in sensitivity, specificity, and accuracy between the C-CTA and L-CTA groups. Conclusion. The value of cerebral CTA with 100 kV low tube voltage in detection of intracranial aneurysms is significant, and it should be recommended as a routine scan method.

  5. The Value of Cerebral CT Angiography with Low Tube Voltage in Detection of Intracranial Aneurysms

    OpenAIRE

    Kun Tang; Rui Li; Jie Lin; Xiangwu Zheng; Ling Wang; Weiwei Yin

    2015-01-01

    Objective. The aim of this study is to investigate the value of cerebral CT angiography (CTA) with low tube voltage in detection of intracranial aneurysms. Materials and Methods. A total of 294 consecutive patients with spontaneous subarachnoid hemorrhage (SAH) were enrolled in this study and randomly assigned into conventional voltage CTA (C-CTA) group and low voltage CTA (L-CTA) group. The objective and subjective image qualities were analyzed and compared between C-CTA and L-CTA groups. W...

  6. [Rapid 3-Dimensional Models of Cerebral Aneurysm for Emergency Surgical Clipping].

    Science.gov (United States)

    Konno, Takehiko; Mashiko, Toshihiro; Oguma, Hirofumi; Kaneko, Naoki; Otani, Keisuke; Watanabe, Eiju

    2016-08-01

    We developed a method for manufacturing solid models of cerebral aneurysms, with a shorter printing time than that involved in conventional methods, using a compact 3D printer with acrylonitrile-butadiene-styrene(ABS)resin. We further investigated the application and utility of this printing system in emergency clipping surgery. A total of 16 patients diagnosed with acute subarachnoid hemorrhage resulting from cerebral aneurysm rupture were enrolled in the present study. Emergency clipping was performed on the day of hospitalization. Digital Imaging and Communication in Medicine(DICOM)data obtained from computed tomography angiography(CTA)scans were edited and converted to stereolithography(STL)file formats, followed by the production of 3D models of the cerebral aneurysm by using the 3D printer. The mean time from hospitalization to the commencement of surgery was 242 min, whereas the mean time required for manufacturing the 3D model was 67 min. The average cost of each 3D model was 194 Japanese Yen. The time required for manufacturing the 3D models shortened to approximately 1 hour with increasing experience of producing 3D models. Favorable impressions for the use of the 3D models in clipping were reported by almost all neurosurgeons included in this study. Although 3D printing is often considered to involve huge costs and long manufacturing time, the method used in the present study requires shorter time and lower costs than conventional methods for manufacturing 3D cerebral aneurysm models, thus making it suitable for use in emergency clipping. PMID:27506842

  7. Differences between middle cerebral artery bifurcations with normal anatomy and those with aneurysms.

    Science.gov (United States)

    Sadatomo, Takashi; Yuki, Kiyoshi; Migita, Keisuke; Imada, Yasutaka; Kuwabara, Masashi; Kurisu, Kaoru

    2013-07-01

    The objectives of this study were to elucidate the normal anatomy of middle cerebral artery (MCA) bifurcations and to analyze the differences in patients with MCA aneurysms. In the present study, 62 patients underwent three-dimensional magnetic resonance angiography, and no intracranial lesions were noted. The widths of M1 and the superior and inferior M2 branches, as well as their respective lateral angles, were measured. These values were used to calculate the daughter artery ratio (DA ratio; width of larger M2/width of smaller M2) and the lateral angle ratio (LA ratio; lateral angle between M1 and larger M2/lateral angle between M1 and smaller M2). The DA and LA ratios of 54 MCA aneurysm patients (34 with ruptured aneurysms, 20 with unruptured aneurysms) were also calculated, using three-dimensional digital subtraction angiography, and compared with the normal values. In normal patients, the widths of M1 and the branches of M2, the lateral angles, and the LA and DA ratios were not significantly different between the right and left sides. The bilateral superior and inferior lateral angles of normal MCAs were significantly wider than those of MCAs with aneurysms. The DA ratio was 1.5 ± 0.4 in normal MCAs and 1.7 ± 0.7 in MCAs with aneurysms; this difference was significant (p bifurcations show close to symmetric structure in the M2 branches and the lateral angles, whereas aneurysmal MCAs do not show this symmetry.

  8. Medical Management of Cerebral Vasospasm following Aneurysmal Subarachnoid Hemorrhage: A Review of Current and Emerging Therapeutic Interventions.

    Science.gov (United States)

    Adamczyk, Peter; He, Shuhan; Amar, Arun Paul; Mack, William J

    2013-01-01

    Cerebral vasospasm is a major source of morbidity and mortality in patients with aneurysmal subarachnoid hemorrhage (aSAH). Evidence suggests a multifactorial etiology and this concept remains supported by the assortment of therapeutic modalities under investigation. The authors provide an updated review of the literature for previous and recent clinical trials evaluating medical treatments in patients with cerebral vasospasm secondary to aSAH. Currently, the strongest evidence supports use of prophylactic oral nimodipine and initiation of triple-H therapy for patients in cerebral vasospasm. Other agents presented in this report include magnesium, statins, endothelin receptor antagonists, nitric oxide promoters, free radical scavengers, thromboxane inhibitors, thrombolysis, anti-inflammatory agents and neuroprotectants. Although promising data is beginning to emerge for several treatments, few prospective randomized clinical trials are presently available. Additionally, future investigational efforts will need to resolve discrepant definitions and outcome measures for cerebral vasospasm in order to permit adequate study comparisons. Until then, definitive recommendations cannot be made regarding the safety and efficacy for each of these therapeutic strategies and medical management practices will continue to be implemented in a wide-ranging manner.

  9. Medical Management of Cerebral Vasospasm following Aneurysmal Subarachnoid Hemorrhage: A Review of Current and Emerging Therapeutic Interventions

    Directory of Open Access Journals (Sweden)

    Peter Adamczyk

    2013-01-01

    Full Text Available Cerebral vasospasm is a major source of morbidity and mortality in patients with aneurysmal subarachnoid hemorrhage (aSAH. Evidence suggests a multifactorial etiology and this concept remains supported by the assortment of therapeutic modalities under investigation. The authors provide an updated review of the literature for previous and recent clinical trials evaluating medical treatments in patients with cerebral vasospasm secondary to aSAH. Currently, the strongest evidence supports use of prophylactic oral nimodipine and initiation of triple-H therapy for patients in cerebral vasospasm. Other agents presented in this report include magnesium, statins, endothelin receptor antagonists, nitric oxide promoters, free radical scavengers, thromboxane inhibitors, thrombolysis, anti-inflammatory agents and neuroprotectants. Although promising data is beginning to emerge for several treatments, few prospective randomized clinical trials are presently available. Additionally, future investigational efforts will need to resolve discrepant definitions and outcome measures for cerebral vasospasm in order to permit adequate study comparisons. Until then, definitive recommendations cannot be made regarding the safety and efficacy for each of these therapeutic strategies and medical management practices will continue to be implemented in a wide-ranging manner.

  10. Normal anatomy and aneurysms of middle cerebral artery

    International Nuclear Information System (INIS)

    The aim of the present study is to clarify the existing anatomical knowledge and the nomenclature used in describing the normal anatomy of the MCA and its main and cortical branches. The different classifications now available have led to anatomical and terminological confusion and inaccuracy. In this study, it is proposed to make out a new classification and to correlate this with the radiological and operative findings in patients with MCA aneurysms. (orig.)

  11. Treatment of pediatric patient with ruptured intracranial aneurysm: Case report

    OpenAIRE

    Meljnikov Igor; Vuleković Petar; Cigić Tomislav; Borišev Vladimir; Milojević Aleksandar; Iđuški Stevan

    2012-01-01

    Introduction. Despite the contemporary diagnostics of intracranial aneurysms their treatment is still a great challenge. The decision when and if to apply a surgical or endovascular treatment of intracranial aneurysms should be made by a team of medical specialists which consists of a cerebrovascular neurosurgeon, neuro-radiologist and neuro-anesthesiologist. Case Report. We report a case of a patient aged 16 who was admitted because of a sudden intensive headache followed by sickness, ...

  12. Surgical treatment for ruptured anterior inferior cerebellar artery aneurysms

    Directory of Open Access Journals (Sweden)

    TONG Xiao-guang

    2013-03-01

    cases. All the patients recovered well. Conclusion AICA aneurysms are rare. The treatment includes microsurgery and endovascular therapy. For proximal, premeatal and meatal aneurysms, the retrosigmoidal approach is recommended; for the distal ones, the suboccipital approach with a center incision reverse to the ipsilateral (inverted 7 shaped would be better for its minimal disturbance to cranial nerves. The endovascular therapy is recommended for all. For premeatal aneurysms, coiling or stent-assisted coiling would be good, even the aneurysms with wide neck are treated well; for distal ones, PAO is effective but the decision should be made very carefully for its potential risk of neurological deficits.

  13. Transfundal stent placement for treatment of complex basilar tip aneurysm: technical note

    Science.gov (United States)

    Vasquez, Ciro; Hubbard, Molly; Jagadeesan, Bharathi Dasan; Tummala, Ramachandra Prasad

    2014-01-01

    We describe a case where a complex unruptured basilar tip aneurysm was treated with a unique method of stent-assisted coil embolization. The aneurysm was considered to have a complex anatomy since both the left posterior cerebral artery and left superior cerebellar artery originated from the dome of the aneurysm. Also, the right posterior cerebral artery was incorporated in the aneurysm neck and needed to be protected prior to coil embolization. This case describes placement of a stent across the span of the aneurysm fundus in order to preserve the two branches arising from it, and the aneurysm dome was coiled without any complication. Using modifications of existing strategies for stent-assisted coil embolization, the aneurysm was treated without any complications and all of the vessels at risk were preserved. PMID:25336546

  14. Play dough as an educational tool for visualization of complicated cerebral aneurysm anatomy

    Directory of Open Access Journals (Sweden)

    Eftekhar Behzad

    2005-05-01

    Full Text Available Abstract Background Imagination of the three-dimensional (3D structure of cerebral vascular lesions using two-dimensional (2D angiograms is one of the skills that neurosurgical residents should achieve during their training. Although ongoing progress in computer software and digital imaging systems has facilitated viewing and interpretation of cerebral angiograms enormously, these facilities are not always available. Methods We have presented the use of play dough as an adjunct to the teaching armamentarium for training in visualization of cerebral aneurysms in some cases. Results The advantages of play dough are low cost, availability and simplicity of use, being more efficient and realistic in training the less experienced resident in comparison with the simple drawings and even angiographic views from different angles without the need for computers and similar equipment. The disadvantages include the psychological resistance of residents to the use of something in surgical training that usually is considered to be a toy, and not being as clean as drawings or computerized images. Conclusion Although technology and computerized software using the patients' own imaging data seems likely to become more advanced in the future, use of play dough in some complicated cerebral aneurysm cases may be helpful in 3D reconstruction of the real situation.

  15. Influencing factors of immediate angiographic results in intracranial aneurysms patients after endovascular treatment.

    Science.gov (United States)

    Chen, Jia-Xiang; Lai, Ling-Feng; Zheng, Kuang; Li, Guo-Xiong; He, Xu-Ying; Li, Liang-Ping; Duan, Chuan-Zhi

    2015-09-01

    The purpose of this study was to analyze influencing factors associated with immediate angiographic results in intracranial aneurysms patients after endovascular treatment (EVT), providing theoretical evidence and guidance for clinical treatment of intracranial aneurysms. Totally 529 patients met the inclusive criteria, consisting of 338 males and 191 females. Gender; age; history of hypertension, diabetes, and smoking; intracranial atherosclerosis; rupture status, size and location, features of aneurysmal neck, shapes; vasospasm; treatment modality; and degree of aneurysm occlusion were all carefully and completely recorded. All data were investigated in univariate and multivariate logistic regression model to determine whether they were correlated with the degree of aneurysm occlusion. According to aneurysm size, aneurysms were classified as micro-miniature, miniature, and large aneurysms. There were 451 narrow-neck aneurysms and 78 wide-neck aneurysms. Totally 417 were regular and 112 were irregular. And 125 were un-ruptured aneurysms; 404 were ruptured aneurysms. The modalities of treatment were as follows: embolization with coil (n = 415), stent-assisted coil embolization (n = 89), and balloon-assisted coil embolization (n = 25). Univariate analysis showed that aneurysm size, feature of aneurysm neck, shape, and rupture status might affect the immediate occlusion after EVT. Multivariate logistic regression analysis indicated that ruptured aneurysm, tiny aneurysm, and wide-neck aneurysm were independent influencing factors of complete occlusion of intracranial aneurysm. Aneurysm rupture status, size, feature of aneurysmal neck, and shape might be the independent influencing factors of immediate angiographic results in intracranial aneurysm patients after EVT. Un-ruptured, micro-miniature, narrow-neck, and regular-shaped aneurysms were more probable to be occluded completely. PMID:26100332

  16. Assessment of long-term effects of aneurysms trapping and extracranial-intracranial bypass surgery in patients with complex cerebral aneurysms

    Directory of Open Access Journals (Sweden)

    MAO Zhi-qi

    2012-02-01

    Full Text Available Objective To study the long-term effects of extracranial-intracranial (EC-IC bypass and aneurysms trapping in patients with complex cerebral aneurysms. Methods Seventeen patients with complex aneurysms, who underwent EC-IC bypass and aneurysms trapping from 2008 to 2009, were followed up. Clinical records were reviewed, modified Rankin Scale (mRS was recorded at admission, discharging, and follow-up point, and activities of daily living (ADL scale (Barthel Index at admission and follow-up point. Results Seventeen patients (11 males and 6 females were followed up. At admission mRS scores were 1.06 ± 0.87, Barthel index 91.10 ± 10.30. Superficial temporal artery-middle cerebral artery (STA-MCA was performed in 8 cases, extracarotid artery-great saphenous vein-middle cerebral artery (ECA-GSV-MCA in 5 cases, extracarotid artery-radial artery-middle cerebral artery (ECA-RA-MCA in 3 cases, occipital artery-posterior inferior cerebellar artery (OA-PICA in 1 case. Patients were followed up for 19-39 months (mean 28.67 months. At follow-up point, 2 patients (11.76% died, operation-related mortality was 5.88% (1/17, operation-related morbidity 5.88% (1/17, mRS scores 1.07 ± 1.16, Barthel index 96.40 ± 10.30. Conclusion Patients with complex aneurysms who were impossible to be treated with surgical clipping or endovascular intervention could be cured with extracranial-intracranial bypass and aneurysms trapping, and good follow-up results were acquired.

  17. The early treatment strategy of ruptured intracranial aneurysms

    Directory of Open Access Journals (Sweden)

    LI Guang-you

    2013-03-01

    Full Text Available The clinical data and therapeutic results of 37 patients with ruptured intracranial aneurysms were retrospectively analyzed, among whom 22 patients underwent endovascular embolization or angioplasty and stenting, and 15 patients underwent clipping of the aneurysms. All of those patients were followed up for 6-12 months after operation. The recovery rate of the former was obviously higher than the latter, while the disability rate was lower. Compared with clipping, endovascular embolization therapy or stenting in the treatment for ruptured aneurysm has a lot of advantages, such as smaller trauma, faster recovery, shorter hospitalization time, high curative effect and safety, achieving satisfactory clinical effect.

  18. Use of triple microcatheters for endovascular treatment of wide-necked intracranial aneurysms: A single center experience

    Energy Technology Data Exchange (ETDEWEB)

    Cho, Young Dae; Rhim, Jong Kook; Kang, Hyun Seung; Kim, Jeong Eun; Cho, Won Sang; Han, Moon Hee [Seoul National University Hospital, Seoul National University College of Medicine, Seoul (Korea, Republic of); Park, Jeong Jin [Dept. of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Jeon, Jin Pyeong [Dept. of Neurosurgery, Kangwon National University Hospital, Kangwon National University College of Medicine, Chuncheon (Korea, Republic of)

    2015-10-15

    The dual microcatheter technique is common practice for coil embolization of a wide-necked aneurysm, due to safety and efficacy. However, technical limitations of some complex configurations may necessitate additional microcatheters to bolster coil stability, compact the coil, or for protection. Described herein is a triple microcatheter technique for endovascular management of wide-necked intracranial aneurysms. Data accruing prospectively between January 2006 and October 2014 on simultaneously executed triple microcatheter coil embolization procedures done in 38 saccular aneurysms were reviewed. Clinical and morphological outcomes were assessed, with emphasis on technical aspects of treatment. The triple microcatheter technique was successfully applied to all 38 saccular aneurysms, involving the posterior communicating artery (n = 13), the middle cerebral artery (n = 10), the basilar tip (n = 7), the anterior cerebral artery (n = 5), and the internal carotid artery (n = 3). Stent protection was added in four patients and balloon remodeling in one. Dual microcatheters (n = 24) were usually deployed to deliver the coil within sacs of aneurysms, with the additional microcatheter used for protection. Otherwise, triple microcatheters were deployed for coil delivery (n = 11) or coils were delivered via a single microcatheter, with dual microcatheters deployed for protection (n = 3). Successful occlusion of aneurysms was achieved in 89.5% of cases, with no procedure-related morbidity or mortality. Stable occlusion was maintained in 72.2% (26/36) of the aneurysms at the final follow-up (mean interval, 30.2 ± 22.7 months). The outcomes of this limited study suggest that the triple microcatheter technique may be an effective and safe therapeutic option for wide-necked aneurysms, using technical strategies tailored to complex angio-anatomic configurations.

  19. Surgical Treatment of Aortic Aneurysm and Aortic Dissection:A Retrospective Analysis of 122 Cases

    Institute of Scientific and Technical Information of China (English)

    Tucheng SUN; Xionggang JIANG; Kailun ZHANG; Jie CAI; Shu CHEN; NYANGASSA B J; Zongquan SUN

    2009-01-01

    The study summarizes the clinical experience of surgical treatments of various types of thoracic aneurysm and aortic dissection.Clinical data of 122 patients with thoracic aneurysm and aortic dissection during July 2005 to July 2008 were retrospectively analyzed.The elective operations were performed in 107 patients while emergency surgery was done in 15 cases.Different surgical strategies were employed on the basis of diseased region,including simple ascending aortic replacement (n=3),aortic root replacement (n=43),hemi-arch replacement/total arch replacement + elephant trunk technique (n=32),thoracic/thoracoabdominal aortic replacement (n=8) and endovascular repair (n=36).In this series,there is 4 cases of perioperative death due to massive cerebral hemorrhage (n=1),respiratory failure (n=1) and multiple organ dysfunction syndrome (MODS) (n=2).Three cases developed post-operative massive cerebral infarction and the relatives of the patients abandoned treatment.Instant success rate of endovascular repair was 100%.The intimal rupture was sealed.Blood flow was unobstructed in true lumen and no false lumen was visualized.It was concluded that aggressive surgery should be considered in the patients with thoracic aneurysm and aortic dissection.Surgical procedures should vary with the location and the nature of the lesions.

  20. Balloon-assisted coil embolization of a posterior cerebral artery aneurysm via a persistent primitive trigeminal artery: technical note

    Energy Technology Data Exchange (ETDEWEB)

    Schlamann, Marc; Doerfler, Arnd; Forsting, Michael; Wanke, Isabel [University of Essen Medical School, Department of Neuroradiology, Institute of Diagnostic and Interventional Radiology, Essen (Germany); Schoch, Beate [University of Essen Medical School, Department of Neurosurgery, Essen (Germany)

    2006-12-15

    We present a patient with an acutely ruptured, wide-necked aneurysm of the left posterior cerebral artery (PCA) treated with Guglielmi detachable coils using the remodeling technique. Since the left vertebral artery was compressed due to a tumor in the cerebellopontine angle and the right vertebral artery was hypoplastic, we used a carotid artery approach via a persistent primitive trigeminal artery (PPTA) to selectively catheterize the aneurysm. The aneurysm was occluded completely. To our knowledge this is the first case of a wide-necked PCA aneurysm treated via a PPTA and using the remodeling technique. In patients with hypoplastic vertebral arteries and a PPTA, this approach may represent an alternative for selective embolization of posterior circulation aneurysms not amenable to the conventional approach. (orig.)

  1. Giant serpentine aneurysm arising from the middle cerebral artery successfully treated with trapping and anastomosis: case report.

    Science.gov (United States)

    Abiko, Masaru; Ikawa, Fusao; Ohbayashi, Naohiko; Mitsuhara, Takafumi; Nosaka, Ryo; Inagawa, Tetsuji

    2009-02-01

    A 56-year-old man presented with a giant serpentine aneurysm arising from the middle cerebral artery (MCA) manifesting as right hemiparesis and motor aphasia. Magnetic resonance imaging and digital subtraction angiography identified the giant serpentine aneurysm arising from the MCA. The patient was treated surgically. Temporary clipping of the distal channel induced thrombosis in the vascular channel, and the thrombosis was aspirated with an ultrasonic suction device after superficial temporal artery-MCA anastomosis. This case shows that initial occlusion of the distal channel is effective to treat giant serpentine aneurysm. PMID:19246869

  2. Experimental study of physiological flow in a cerebral saccular basilar tip aneurysm

    Science.gov (United States)

    Tsai, William; Savas, Omer; Ortega, Jason; Maitland, Duncan; Saloner, David

    2008-11-01

    The subject matter of the research is the flow within cerebral saccular basilar tip aneurysms and exploring correlations with their growth and rupture. The flow phantom consists of an inlet pipe branching out 90^o into two outlets, simulating the basilar artery bifurcation and a nearly spherical dome at the flow divider simulating the aneurysm. Input flow is a physiological waveform for the basilar artery. Flow outlet branching ratios are controlled at will. Experiments are done at Reynolds numbers 221-376 and Sexl-Wormersley number 4.46. Flow visualization and particle image velocimetry are used to study velocity, vorticity, and wall shear stress. All flows can be characterized by an off-center inlet jet and a circulation region, whose transient strength and behavior depends on the outflow ratios.

  3. [Infective endocarditis due to Bartonella henselae following a rupture of a cerebral aneurysm].

    Science.gov (United States)

    de La Blanchardière, A; Fournier, P-E; Haustraete, E; du Cheyron, D; Lepage, O; Verdon, R

    2009-06-01

    We report a case of severe aortic bicuspid valve endocarditis, revealed by global cardiac failure without fever, in a 38-year-old man who had developed cerebral mycotic aneurysms nine months earlier. PCR analysis of the excised aortic valve and serological tests (even 9 months earlier) were positive for Bartonella henselae. A combination of intravenous then oral doxycyclin at 200mg/day and intravenous gentamycin at 90mg/day was given for 6 and 2 weeks respectively. The evolution was favorable on follow-up, 12 months after completion of the therapy. Only 49 cases of B. henselae endocarditis have been reported to date, none with associated mycotic aneurysm but most often located on the bicuspid aortic valve, and usually with severe valvular damage due to late diagnosis. PMID:19097835

  4. A Rare Case of Streptococcus alactolyticus Infective Endocarditis Complicated by Septic Emboli and Mycotic Left Middle Cerebral Artery Aneurysm.

    Science.gov (United States)

    Almeida, Patricia; Railsback, Jaclyn; Gleason, James Benjamin

    2016-01-01

    To date, S. alactolyticus endocarditis complicated by middle cerebral artery aneurysm has not been reported. We describe the case of a 65-year-old female with a history of hypertrophic cardiomyopathy with left ventricular outflow tract obstruction presenting with confusion and a apical holosystolic murmur. Angiography of the brain identified new bilobed left middle cerebral artery aneurysm. Serial blood cultures grew S. alactolyticus, and aortic and mitral valve vegetation were discovered on transesophageal echocardiography. The patient was treated with antimicrobial therapy, mitral and aortic valve replacements, and microsurgical clipping of cerebral aneurysm. This case serves to highlight the pathogenicity of a sparsely described bacterium belonging to the heterogenous S. bovis complex. PMID:27525136

  5. Endovascular Treatment of Intracerebral Mycotic Aneurysm before Surgical Treatment of Infective Endocarditis

    OpenAIRE

    Erdogan, Hasan Basri; Erentug, Vedat; Bozbuga, Nilgun; Goksedef, Deniz; AKINCI, Esat; Yakut, Cevat

    2004-01-01

    Mycotic aneurysms are rarely seen in patients who have infective endocarditis, and the management of these patients remains controversial. We present the case of a patient who had infective endocarditis complicated by a mycotic aneurysm of the left middle cerebral artery. There was substantial mitral regurgitation, and Streptococcus viridans was isolated from the blood samples. Dysarthria appeared during the 4th week of the antibiotic therapy, but resolved completely 8 hours after onset. The ...

  6. Surgical treatment of celiomesenteric trunk aneurysm-7 case report.

    Science.gov (United States)

    Wang, Chunxi; Cai, Xiangjun; Liang, Faqi; Chu, Futao; Chen, Gang; Duan, Zhiquan

    2014-01-01

    The celiomesenteric trunk is a rare anomaly characterized by a common origin of the celiac axis and superior mesenteric artery from the aorta, which accounts for less than 1% of all celiac artery anomalies, so the aneurysm occurred in such trunk is even rarer. There have been few reports on how to diagnose and deal with such malformed celiomesenteric trunk aneurysms till now. This paper tries to summarize the experience of how to expose and excise such kind of aneurysm according to the seven cases' data. The clinic data were collected retrospectively. There were seven cases with celiomesenteric trunk aneurysm from February 2000 to February 2013, including 5 males and 2 females aged 35~62. The operations were done including aneurysm resection and vascular reconstruction under general anesthesia. The operated patients were followed-up at the sixth month and each year post operation. The vascular stomas were detected or examined by Color Doppler Sonography, spiral Computed Tomography angiography (SCTA). The seven operated patients were cured and discharged from hospital, and they were followed up for 3~10 years (mean time 5 years), with four patients being followed up longer than 5 years. No sign of intestinal ischemia or hepatic ischemia or splenic ischemia was found, and no image of anastomosis stricture or stenosis was found during the follow-up. Five patients are alive now while two patients were dead, with one dying of large area myocardial infarction unexpectedly at 6 years post operation and the other dying of cerebral infarction abruptly at 4 years post operation. It is an effective and safe method to treat the celiomesenteric trunk aneurysm by using by-pass operation with artificial blood vessels, originating from inferior kidney aorta to visceral arteries including hepatic artery, splenic artery and superior mesenteric artery. Its short-term and middle-term effects are relatively better. PMID:25227061

  7. Clinical analysis of symptomatic cerebral vasospasm after endovascular treatment of ruptured cerebral aneurysms in patients of 70 and over 70 years%行血管内治疗的高龄颅内动脉瘤患者脑血管痉挛的临床分析

    Institute of Scientific and Technical Information of China (English)

    邹志鹏; 杨海; 夏军勇; 张化明; 张华; 魏恒; 马江红

    2015-01-01

    目的:评估70岁以上老年人动脉瘤性蛛网膜下腔出血(aSAH)患者行血管内治疗发生症状性脑血管痉挛(SCVS)的临床治疗效果。方法44例aSHA患者分为两组:低龄组(<70岁,32例)和高龄组(≥70岁,12例)。分析两组患者的临床特征、SCVS的发生率、改良Rankin量表(mRS)评分、以及mRS评分为3~6分患者的SCVS发生率。结果高龄组患者的SCVS发生率(58.3%)显著高于低龄组(12.5%;P<0.05)。对于mRS评分为3~6分患者,高龄组SCVS发生率(58.3%)显著高于低龄组(17.4%;P<0.05)。结论对于行血管内治疗的aSAH患者,≥70岁患者更易发生SCVS,从而导致更差的临床疗效和预后。%Objective To explore the curative effect on symptomatic cerebral vasospasm (SCVS) after aneurysmal subarachnoid hemorrhage (aSAH) in patients of 70 and over 70 years who underwent the endovascular therapy. Methods Forty-four patients with ruptured intracranial aneurysms were divided into two groups according to patient age, i.e. group A, in which there were 32 patients under 70 years of age, and group B, there were 12 patients of 70 and over 70 years. The clinical characteristics, incidence of SCVS and modified Rankin scale (mRS) scores were analyzed and compared between both the groups. Results The incidence of SVCS (58.3%, 7/12) was significantly higher in group B than that (12.5%, 4/32) in group A (P<0.01). The incidence of SCVS (58.3%, 7/12) was significantly higher in 12 patients with mRS 3~6 cores of group B than that (17.4%, 4/23) in 23 patients with mRS 3~6 scores of group A (P<0.05). Conclusion The prognosis is worse in aSAH patients of 70 and over 70 years than that in the aSAH patients under 70 years after the endovascular treatment because the former easilier suffered from SCVS than the latter after the endovascular treatment.

  8. Mitral valve replacement in a patient with infective endocarditis and aneurysm of the cerebral artery: A case report

    Directory of Open Access Journals (Sweden)

    Senka Mesihović-Dinarević

    2014-11-01

    Full Text Available Objective. Endocarditis can have profound and devastating neurological consequences, with the vast majority of these complications in patients with left-sided valvular disease. The approach to the acute management of stroke in children with infective endocarditis is limited by the inadequacy of published data on their clinical course and outcome. Case report. This case report presents a 12 year old girl with diagnosed endocarditis, complicated with intracranial hemorrhage, due to the rupture of an aneurysm of the peripheral branch medial cerebral artery and gradient therapeutic approach, with an excellent final result. Conclusion. Congestive heart failure resulting from valvular insufficiency required mitral valve replacement, after cerebral aneurysm clipping.

  9. Screening for aortic aneurysm after treatment of coarctation.

    Science.gov (United States)

    Hoffman, James L; Gray, Robert G; LuAnn Minich, L; Wilkinson, Stephen E; Heywood, Mason; Edwards, Reggie; Weng, Hsin Ti; Su, Jason T

    2014-01-01

    Isolated coarctation of the aorta (CoA) occurs in 6-8 % of patients with congenital heart disease. After successful relief of obstruction, patients remain at risk for aortic aneurysm formation at the site of the repair. We sought to determine the diagnostic utility of echocardiography compared with advanced arch imaging (AAI) in diagnosing aortic aneurysms in pediatric patients after CoA repair. The Congenital Heart Databases from 1996 and 2009 were reviewed. All patients treated for CoA who had AAI defined by cardiac magnetic resonance imaging (MRI), computed tomography (CT), or catheterization were identified. Data collected included the following: type, timing, and number of interventions, presence and time to aneurysm diagnosis, and mortality. Patients were subdivided into surgical and catheterization groups for analysis. Seven hundred and fifty-nine patients underwent treatment for CoA during the study period. Three hundred and ninety-nine patients had at least one AAI. Aneurysms were diagnosed by AAI in 28 of 399 patients at a mean of 10 ± 8.4 years after treatment. Echocardiography reports were available for 380 of 399 patients with AAI. The sensitivity of echocardiography for detecting aneurysms was 24 %. The prevalence of aneurysms was significantly greater in the catheterization group (p Aneurysm was also diagnosed earlier in the catheterization group compared with the surgery group (p = 0.02). Multivariate analysis showed a significantly increased risk of aneurysm diagnosis in patients in the catheterization subgroup and in patients requiring more than three procedures. Aortic aneurysms continue to be an important complication after CoA repair. Although serial echocardiograms are the test of choice for following-up most congenital cardiac lesions in pediatrics, our data show that echocardiography is inadequate for the detection of aneurysms after CoA repair. Because the time to aneurysm diagnosis was shorter and the risk greater in the

  10. Materials and techniques for coiling of cerebral aneurysms: how much scientific evidence do we have?

    Energy Technology Data Exchange (ETDEWEB)

    Kurre, W.; Berkefeld, J. [University of Frankfurt, Department of Neuroradiology, Frankfurt (Germany)

    2008-11-15

    Since coils were approved for aneurysm treatment, materials and techniques developed rapidly. It still remains an open question whether one material or method is superior. This article reviews the literature on various coil types and treatment approaches assessing the scientific evidence of its use. Studies on aneurysm treatment with Guglielmi detachable platinum coils, bioactive coils, hydrogel coated coils, and complex designs as well as balloon- and stent-assisted techniques were retrieved by a PubMed database search from 1990 until May 2008. Data were analyzed in terms of aneurysm occlusion, permanent morbidity and mortality, recanalization, and retreatment. We also assessed the level of evidence of the published studies. Only the International Subarachnoid Aneurysm Trial provides level I evidence proving the superiority of endovascular over surgical therapy in ruptured aneurysms. Randomized trials comparing bioactive or hydrogel coated devices with bare coils are ongoing. Other studies were based on registries or case series mainly conducted without control groups. Morbidity, mortality, and initial occlusion rates appear similar for all devices. No clear evidence exists for the superiority of bioactive- or hydrocoils regarding long-term stability. It remains ambiguous whether morbidity and mortality rises with the use of balloons and stents. There is no evidence that routine use of balloons improves treatment durability. Mid-term results of stent-assisted coiling of complex aneurysms appear favorable. There is a lack of studies with a high level of evidence comparing different coiling materials and techniques. Case series and registries were not able to prove the superiority of any device or method. (orig.)

  11. Flow Instability Detected by High-Resolution Computational Fluid Dynamics in Fifty-Six Middle Cerebral Artery Aneurysms.

    Science.gov (United States)

    Varble, Nicole; Xiang, Jianping; Lin, Ning; Levy, Elad; Meng, Hui

    2016-06-01

    Recent high-resolution computational fluid dynamics (CFD) studies have detected persistent flow instability in intracranial aneurysms (IAs) that was not observed in previous in silico studies. These flow fluctuations have shown incidental association with rupture in a small aneurysm dataset. The aims of this study are to explore the capabilities and limitations of a commercial cfd solver in capturing such velocity fluctuations, whether fluctuation kinetic energy (fKE) as a marker to quantify such instability could be a potential parameter to predict aneurysm rupture, and what geometric parameters might be associated with such fluctuations. First, we confirmed that the second-order discretization schemes and high spatial and temporal resolutions are required to capture these aneurysmal flow fluctuations. Next, we analyzed 56 patient-specific middle cerebral artery (MCA) aneurysms (12 ruptured) by transient, high-resolution CFD simulations with a cycle-averaged, constant inflow boundary condition. Finally, to explore the mechanism by which such flow instabilities might arise, we investigated correlations between fKE and several aneurysm geometrical parameters. Our results show that flow instabilities were present in 8 of 56 MCA aneurysms, all of which were unruptured bifurcation aneurysms. Statistical analysis revealed that fKE could not differentiate ruptured from unruptured aneurysms. Thus, our study does not lend support to these flow instabilities (based on a cycle-averaged constant inflow as opposed to peak velocity) being a marker for rupture. We found a positive correlation between fKE and aneurysm size as well as size ratio. This suggests that the intrinsic flow instability may be associated with the breakdown of an inflow jet penetrating the aneurysm space. PMID:27109451

  12. Treatment of abdominal aortic aneurysm in nine countries 2005-2009: a vascunet report

    DEFF Research Database (Denmark)

    Mani, K; Lees, T; Beiles, B;

    2011-01-01

    To study contemporary treatment and outcome of abdominal aortic aneurysm (AAA) repair in nine countries.......To study contemporary treatment and outcome of abdominal aortic aneurysm (AAA) repair in nine countries....

  13. Pituitary dysfunction in survivors of spontaneous subarachnoid hemorrhage of anterior communicating artery and middle cerebral artery aneurysms: A comparative study

    Directory of Open Access Journals (Sweden)

    Pinaki Dutta

    2012-01-01

    Full Text Available Background: The data on incidence of hypopituitarism after SAH are conflicting. Furthermore, it is still not known whether there is any difference in hormonal deficiencies between SAH due to anterior communicating artery (A-com and middle cerebral artery (MCA aneurysms. Materials and Methods: This study includes both retrospective and prospective arms. The data collected included baseline demographic profile, clinical severity on admission to the hospital by the Hunt and Hess grading system and World Federation of Neurological Surgeons (WFNS grading, radiological severity of bleed by the Fisher′s classification, and treatment details. All the patients underwent detailed hormonal evaluation at baseline and 6 months in prospective group while at the end of 1 year in the retrospective group. Hormonal deficiencies between patients with A-com and MCA aneurysmal SAH were compared using appropriate statistical tests. Results: Of 60 patients studied, 47 patients (A-com: 28 and MCA: 19 were in the retrospective group, while 13 patients (A-com-9, MCA-4 were in the prospective group. The baseline data were comparable between the two groups. At or after 6 months follow-up, 19 (31.6% patients, 10 patients with A-com and 9 patients with MCA aneurysmal SAH, had some form of hormone deficiency. Furthermore, there was no difference in endocrine dysfunctions between the two groups. There was no correlation between the severity of hormonal deficiency and the clinical severity of SAH grade by Hunt and Hess and radiological grade of SAH by Fisher′s grade. Conclusion: Hormonal deficiencies are not uncommon in patients with SAH. There is no difference in hormonal deficiencies and severity of hypopituitarism in patients with SAH due to A-com and MCA bleed.

  14. Detection of cerebral aneurysms in MRA, CTA and 3D-RA data sets

    Science.gov (United States)

    Hentschke, Clemens M.; Beuing, Oliver; Nickl, Rosa; Tönnies, Klaus D.

    2012-03-01

    We propose a system to automatically detect cerebral aneurysms in 3D X-ray rotational angiography images (3D-RA), magnetic resonance angiography images (MRA) and computed tomography angiography images (CTA). After image normalization, initial candidates are found by applying a blob-enhancing filter on the data sets. Clusters are computed by a modified k-means algorithm. A post-processing step reduces the false positive (FP) rate on the basis of computed features. This is implemented as a rule-based system that is adapted according to the modality. In MRA, clusters are excluded that are not neighbored to a vessel. As a final step, FP are further reduced by applying a threshold classification on a feature. Our method was tested on 93 angiographic data sets containing aneurysm and non-aneurysm cases. We achieved 95 % sensitivity with an average rate of 2.6 FP per data set (FP/DS) in case of 3D-RA, 89 % sensitivity at 6.6 FP/DS for MRA and 95 % sensitivity at 37.6 FP/DS with CTA, respectively. We showed that our post-processing approach eliminates FP in MRA with only a slight decrease of sensitivity. In contrast to other approaches, our algorithm does not require a vessel segmentation and does not require training of distributional properties.

  15. Akinetic Mutism Following Bilateral Anterior Cerebral Artery Territory Infarction Due to Aneurysm: A Case Report

    Directory of Open Access Journals (Sweden)

    Zeynep Özözen Ayas

    2014-04-01

    Full Text Available BACKGROUND AND PURPOSE: Bilateral anterior cerebral artery (ACA territory infarction is rare localization in stroke which should always prompt a search for an anterior communicating artery (ACoA aneurysm. The common neurological manifestations are contralateral weakness predominate in the lower extremite, behavior disturbance, motor inertia, muteness, incontinence, grasp reflex, diffuse rigidity, akinetic mutism. CASE DESCRIPTION: We describe a 38-year-old woman presented with a left sided hemiparesia and decrease of speech for last days. She was a smoker and morbide obese. She had no any diagnosed disease. Her neurological examination had weakness of left extremites affected leg more than the arm and akinetic mutism like as no spontaneously speech and move and grasp reflex. CT showed bilateral ACA infarction which included cingulate gyrus, the right side more than left and subarachnoid hemorrhage in the interhemispheric fissure. MRI angiography showed the appearance of AcoA aneurysm. CONCLUSION: We report a patient with bilateral infarction in the ACA which a rare localization and clinicians must be alert to exist AcoA aneurysm which may bleed, different symptoms and signs like as akinetic mutism, primitive reflexes.

  16. Relationship between brain interstitial fluid tumor necrosis factor-α and cerebral vasospasm after aneurysmal subarachnoid hemorrhage

    OpenAIRE

    Hanafy, Khalid A.; Stuart, R Morgan; Khandji, Alexander G.; Connolly, E. Sander; Badjatia, Neeraj; Mayer, Stephan A; Schindler, Christian

    2010-01-01

    Tumor necrosis factor-α (TNF-α) has a crucial role in the onset of hemolysis-induced vascular injury and cerebral vasoconstriction. We hypothesized that TNF-α measured from brain interstitial fluid would correlate with the severity of vasospasm following aneurysmal subarachnoid hemorrhage (aSAH). Methods and results: From a consecutive series of 10 aSAH patients who underwent cerebral microdialysis (MD) and evaluation of vasospasm by CT angiogram (CTA) or digital subtraction angiography (DSA)...

  17. No advantage of time-of-flight magnetic resonance angiography at 3 Tesla compared to 1.5 Tesla in the follow-up after endovascular treatment of cerebral aneurysms

    OpenAIRE

    Buhk, Jan-Hendrik; Kallenberg, Kai; Mohr, Alexander; Dechent, Peter; Knauth, Michael

    2008-01-01

    Introduction: Long-term follow-up after coil embolization of intracranial aneurysms is mandatory to monitor coil compacting and aneurysm recurrence. Most centers perform one digital subtraction angiography (DSA) on follow-up continuing with time-of-flight magnetic resonance angiography (TOFMRA). This study explores the diagnostic value of TOFMRA at 1.5 T versus 3 T compared to DSA. Materials and methods: In 18 patients with 20 aneurysms treated with coil embolization, TOFMRA at 1.5 and 3 T we...

  18. Surgical clipping is still a good choice for the treatment of paraclinoid aneurysms

    Directory of Open Access Journals (Sweden)

    Felix Hendrik Pahl

    2016-04-01

    Full Text Available ABSTRACT Paraclinoid aneurysms are lesions located adjacent to the clinoid and ophthalmic segments of the internal carotid artery. In recent years, flow diverter stents have been introduced as a better endovascular technique for treatment of these aneurysms. Method From 2009 to 2014, a total of 43 paraclinoid aneurysms in 43 patients were surgically clipped. We retrospectively reviewed the records of these patients to analyze clinical outcomes. Results Twenty-six aneurysms (60.5% were ophthalmic artery aneurysms, while 17 were superior hypophyseal artery aneurysms (39.5%. The extradural approach to the clinoid process was used to clip these aneurysms. One hundred percent of aneurysms were clipped (complete exclusion in 100% on follow-up angiography. The length of follow-up ranged from 1 to 60 months (mean, 29.82 months. Conclusion Surgical clipping continues to be a good option for the treatment of paraclinoid aneurysms.

  19. Aneurysm Formation After Endovascular Treatment of Acute Type A Dissection.

    Science.gov (United States)

    Yang, Lai; Wang, Jiaping

    2016-08-01

    Recently, reports have described successful endovascular stent graft (ESG) treatment of patients with acute type A aortic dissection. We report 1 ESG treatment for this condition and the complication of a new aneurysm formation during a 6-month follow-up. PMID:27630269

  20. Endovascular treatment of ruptured splenic artery aneurysm

    DEFF Research Database (Denmark)

    Bjerring, Ole Steen

    2008-01-01

    Splenic artery aneurysms (SAA) are traditionally treated surgically, but endovascular techniques are becoming increasingly popular. A 64 year-old male with chest pain and low blood pressure was admitted under suspicion of AMI. A CT scan showed a 56 mm SAA with signs of rupture. The patient...

  1. Endovascular treatment of large and giant ophthalmic aneurysms with preservation of parent artery

    International Nuclear Information System (INIS)

    Objective: To evaluate the endovascular embolization treatment of large and giant ophthalmic aneurysms. Methods: Three aneurysms were embolized with coils only and 5 aneurysms were treated with stent placement together with subsequent coiling. Results: In the 3 aneurysms treated only with GDC, total embolization was achieved in 1 and partial embolization in 2. In the stent placement and coiling case, 4 aneurysms were densely packed and another one was partially packed. Conclusions: Combined stenting and coiling is effective and safe for the treatment of large and giant ophthalmic artery aneurysm with the preservation of parent artery

  2. A Parallel Monolithic Approach for Fluid-Structure Interaction in a Cerebral Aneurysm

    Science.gov (United States)

    Sahin, Mehmet; Eken, Ali

    2014-11-01

    A parallel fully-coupled approach has been developed for the fluid-structure interaction problem in a cerebral artery with aneurysm. An Arbitrary Lagrangian-Eulerian formulation based on the side-centered unstructured finite volume method is employed for the governing incompressible Navier-Stokes equations and the classical Galerkin finite element formulation is used to discretize the constitutive law for the Saint Venant-Kirchhoff material in a Lagrangian frame for the solid domain. The time integration method for the structure domain is based on the energy conserving mid-point method while the second-order backward difference is used within the fluid domain. The resulting large-scale algebraic linear equations are solved using a one-level restricted additive Schwarz preconditioner with a block-incomplete factorization within each partitioned sub-domains. The parallel implementation of the present fully coupled unstructured fluid-structure solver is based on the PETSc library. The proposed numerical algorithm is initially validated for several classical benchmark problems and then applied to a more complicated problem involving unsteady pulsatile blood flow in a cerebral artery with aneurysm as a realistic fluid-structure interaction problem encountered in biomechanics. The authors acknowledge financial support from Turkish National Scientific and Technical Research Council through Project Number 112M107.

  3. [Medullary venous malformation with azygos anterior cerebral artery aneurysm: a case report].

    Science.gov (United States)

    Harada, K; Kobayashi, S; Sigemori, M; Watanabe, M; Kuramoto, S

    1987-03-01

    A case of medullary venous malformation with azygos anterior cerebral artery aneurysm is reported, which was associated with the leptomenigeal angiomatosis on the cortex of the right frontal lobe. A 62-year-old female was admitted to the Kurume University Hospital on June 21, 1985, because of a convulsive seizure. On admission, neurological and general examinations, except for slightly liver function disorder, was no abnormality. Plain CT scan showed the cortical atrophy and two small high-density areas in the right frontal lobe. Enhanced CT scan showed a high-density area in the genu of the corpus callosum. MRI (magnetic resonance imaging), on T2 weighted image, showed a high signal intensity area in the right paraventricular deep white matter and the right frontal region. A right internal carotid angiogram in the venous phase showed numerous enlarged medullary veins in the deep frontal region, converging into a single large draining vein that empties into the basal vein of Rosenthal. An azygos anterior cerebral artery was visualized on the right and left carotid angiograms. The aneurysm was situated at the distal end of the azygos artery. Twenty eight days after admission, a right frontal cranioplastic craniotomy was performed. During operation, the surface of the right frontal lobe was covered by fine, vascular networks, which was reddish brown. A right frontal lobectomy, including venous malformation and vascular networks, was performed. The aneurysm was clipped via an interhemispheric approach. Histologically, the malformation vessels had spread into the subarachnoid space.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3600991

  4. Reconfigurable Polymer Networks for Improved Treatment of Intracranial Aneurysms

    Science.gov (United States)

    Ninh, Chi Suze Q.

    Endovascular embolization of intracranial aneurysms is a minimally invasive treatment in which an implanted material forms a clot to isolate the weakened vessel. Current strategy suffers from long-term potential failure modes. These potential failure modes include (1) enzymatic degradation of the fibrin clot that leads to compaction of the embolic agent, (2) incomplete filling of the aneurysm sac by embolic agent, and (3) challenging geometry of wide neck aneurysms. In the case of wide neck aneurysms, usually an assisting metal stent is used to help open the artery. However, metal stents with much higher modulus in comparison to the soft blood vessel can cause biocompatibilities issues in the long term such as infection and scarring. Motivated to solve these challenges associated with endovascular embolization, strategies to synthesize and engineer reconfigurable and biodegradable polymers as alternative therapies are evaluated in this thesis. (1) Reconfiguration of fibrin gel's modulus was achieved through crosslinking with genipin released from a biodegradable polymer matrix. (2) Reconfigurability can also be achieved by transforming triblock co-polymer hydrogel into photoresponsive material through incorporation of melanin nanoparticles as efficient photosensitizers. (3) Finally, reconfigurability can be conferred on biodegradable polyester networks via Diels-Alder coupling of furan pendant groups and dimaleimide crosslinking agent. Taken all together, this thesis describes strategies to transform a broad class of polymer networks into reconfigurable materials for improved treatment of intracranial aneurysms as well as for other biomedical applications.

  5. Nursing experience in clinical endovascular treatment for renal artery aneurysms

    International Nuclear Information System (INIS)

    Objective: To discuss the standardized clinical nursing measures for patients receiving endovascular treatment of renal artery aneurysms. Methods: The clinical data of 9 patients with renal artery aneurysm, who were admitted to authors' hospital during the period from Jan. 2010 to Aug. 2011 and received endovascular treatment, were retrospectively analyzed. The related nursing points as well as the received endovascular. Results: A total of 9 cases with renal artery aneurysm were treated nursing measures were summarized. Results: A total of 9 cases with renal artery aneurysm were with interventional management, including embolization (n = 6), stent implantation (n = 2) and stent implantation together with coil embolization (n = 1). The mean hospitalization time was (10±2) days. Postoperative retention of urine was observed in one patient and postoperative retroperitoneal hemorrhage occurred in another patient. Neither nursing-related nor operation-related complications occurred. Conclusion: Standardized perioperative nursing care for patients with renal artery aneurysm can surely help enhance the patient's tolerance to the surgery, and effectively prevent the complications. (authors)

  6. Comprehensive validation of computational fluid dynamics simulationsof in-vivo blood flow in patient-specific cerebral aneurysms

    NARCIS (Netherlands)

    Sun, Q.; Groth, A.; Aach, T.

    2012-01-01

    Purpose: Recently, image-based computational fluid dynamic (CFD) simulations have been proposed to investigate the local hemodynamics inside human cerebral aneurysms. It is suggested that the knowledge ofthe computed three-dimensional flow fields can be used to assist clinical risk assessment and tr

  7. High mean fasting glucose levels independently predict poor outcome and delayed cerebral ischaemia after aneurysmal subarachnoid haemorrhage

    NARCIS (Netherlands)

    Kruyt, N. D.; Roos, Y. W. B. M.; Mees, S. M. Dorhout; van den Bergh, W. M.; Algra, A.; Rinkel, G. J. E.; Biessels, G. J.

    2008-01-01

    Background: Hyperglycaemia has been related to poor outcome and delayed cerebral ischaemia (DCI) after aneurysmal subarachnoid haemorrhage (aSAH). Objective: This study aimed to assess whether in patients with aSAH, levels of mean fasting glucose within the first week predict poor outcome and DCI be

  8. A case of cerebral aneurysm rupture and subarachnoid hemorrhage associated with air travel

    Directory of Open Access Journals (Sweden)

    Cui V

    2014-04-01

    Full Text Available Victoria Cui,1,2 Timur Kouliev,1 Jason Wood1 1Beijing United Family Hospital, Beijing, People's Republic of China; 2Department of Biological Sciences, Columbia University, New York, NY, USA Abstract: During air travel, passengers are exposed to unique conditions such as rapid ascent and descent that can trigger significant physiological changes. In addition, the cabins of commercial aircraft are only partially pressured to 552–632 mmHg or the equivalent terrestrial altitudes of 1,500–2,500 m (5,000–8,000 feet above sea level. While studies in high-altitude medicine have shown that all individuals experience some degree of hypoxia, cerebral edema, and increased cerebral blood flow, the neurological effects that accompany these changes are otherwise poorly understood. In this study, we report a case of acute subarachnoid hemorrhage from a ruptured cerebral aneurysm associated with travel on commercial aircraft. We then review relevant cases of neurological incidents with possible air travel-related etiology and discuss the physiological factors that may have contributed to the patient's acute subarachnoid hemorrhage. In the future, this report may serve as reference for more detailed and conservative medical guidelines and recommendations regarding air travel. Keywords: high-altitude, cabin pressure, emergency, cerebral edema, triage, neurological

  9. Post-Treatment Hemodynamics of a Basilar Aneurysm and Bifurcation

    Energy Technology Data Exchange (ETDEWEB)

    Ortega, J; Hartman, J; Rodriguez, J; Maitland, D

    2008-01-16

    Aneurysm re-growth and rupture can sometimes unexpectedly occur following treatment procedures that were initially considered to be successful at the time of treatment and post-operative angiography. In some cases, this can be attributed to surgical clip slippage or endovascular coil compaction. However, there are other cases in which the treatment devices function properly. In these instances, the subsequent complications are due to other factors, perhaps one of which is the post-treatment hemodynamic stress. To investigate whether or not a treatment procedure can subject the parent artery to harmful hemodynamic stresses, computational fluid dynamics simulations are performed on a patient-specific basilar aneurysm and bifurcation before and after a virtual endovascular treatment. The simulations demonstrate that the treatment procedure produces a substantial increase in the wall shear stress. Analysis of the post-treatment flow field indicates that the increase in wall shear stress is due to the impingement of the basilar artery flow upon the aneurysm filling material and to the close proximity of a vortex tube to the artery wall. Calculation of the time-averaged wall shear stress shows that there is a region of the artery exposed to a level of wall shear stress that can cause severe damage to endothelial cells. The results of this study demonstrate that it is possible for a treatment procedure, which successfully excludes the aneurysm from the vascular system and leaves no aneurysm neck remnant, to elevate the hemodynamic stresses to levels that are injurious to the immediately adjacent vessel wall.

  10. Operative treatment of aneurysms and Coanda effect: a working hypothesis.

    Science.gov (United States)

    Robinson, J L; Roberts, A

    1972-12-01

    The Coanda effect has been known to mechanical engineers for many decades. Consideration of this effect both by a neurosurgeon and a mechanical engineer revealed that it might be of importance during the operative treatment of intracranial aneurysms. If a jet effect were produced in the stream of blood after clipping an aneurysm, most of the flow of blood might be directed down only one limb of a bifurcation occurring in a vessel near to a clipped aneurysm. Blood might also be entrained from the other limb of the bifurcation. This boundary wall effect, which can occur without the rate of flow through the vessel being altered appreciably, could explain some of the unfortunate sequelae of aneurysm surgery which occur in the absence of any obvious cause such as postoperative thrombosis, etc. A possible mechanism for some of the complications after gradual occlusion of the common carotid artery in the neck is also proposed on this basis. Other details of how this data might be of clinical significance, together with suggestions for how to avoid fluidic effects during aneurysm surgery, are presented. PMID:4647852

  11. Abdominal aortic aneurysms: treatment with Zenith endoluminal stent-graft

    International Nuclear Information System (INIS)

    Objective: To evaluate the efficacy and safety of Zenith transrenal stent-graft in repairing the abdominal aortic aneurysms. Methods: Endoluminal stent-grafts repair was performed in 5 male patients with abdominal aortic aneurysms. Their age ranged from 52 years to 73 years with a mean of 65 years. Three-dimensional CT angiography demonstrated Blum type B in 4 cases and Blum type C in 1 case. The diameter of aneurysmal neck was between 21 mm and 25 mm (mean 22.8 mm), and the length of aneurysmal neck was between 16.5 mm and 32.8 mm (mean 25.6mm). Stent-grafts were inserted through surgically exposed femoral arteries in general anesthesia with the fluoroscopic guidance. The Zenith transrenal bifurcated stent-grafts were applied in all 5 patients. Results: The endoluminal stent-graft repair was successful in all 5 patients with operational duration of 1.8-3.0 hours. The hospitalization duration was 7-14 days following the procedure. No endoleaks occurred in the 5 cases following the contrast-enhanced CT scans seven days after the interventions. Still no endoleaks or stent-grafts migration recurred in 2 patients followed up at the 2nd and 11th month, respectively. During the follow-up from 6 months to 55 months (mean 26.6 months), five patients were still asymptomatic. Conclusion: Zenith aortic stent-graft repair of abdominal aortic aneurysms is an effective and safe treatment method

  12. The unruptured intracranial aneurysm treatment score : A multidis ciplinary consensus

    NARCIS (Netherlands)

    Etminan, Nima; Brown, Robert D.; Beseoglu, Kerim; Juvela, Seppo; Raymond, Jean; Morita, Akio; Torner, James C.; Derdeyn, Colin P.; Raabe, Andreas; Mocco, J.; Korja, Miikka; Abdulazim, Amr; Amin-Hanjani, Sepideh; Salman, Rustam Al Shahi; Barrow, Daniel L.; Bederson, Joshua; Bonafe, Alain; Dumont, Aaron S.; Fiorella, David J.; Gruber, Andreas; Hankey, Graeme J.; Hasan, David M.; Hoh, Brian L.; Jabbour, Pascal; Kasuya, Hidetoshi; Kelly, Michael E.; Kirkpatrick, Peter J.; Knuckey, Neville; Koivisto, Timo; Krings, Timo; Lawton, Michael T.; Marotta, Thomas R.; Mayer, Stephan A.; Mee, Edward; Pereira, Vitor Mendes; Molyneux, Andrew; Morgan, Michael K.; Mori, Kentaro; Murayama, Yuichi; Nagahiro, Shinji; Nakayama, Naoki; Niemelä, Mika; Ogilvy, Christopher S.; Pierot, Laurent; Rabinstein, Alejandro A.; Roos, Yvo B W E M; Rinne, Jaakko; Rosenwasser, Robert H.; Ronkainen, Antti; Schaller, Karl; Seifert, Volker; Solomon, Robert A.; Spears, Julian; Steiger, Hans Jakob; Vergouwen, Mervyn D I; Wanke, Isabel; Wermer, Marieke J H; Wong, George K C; Wong, John H.; Zipfel, Gregory J.; Sander Connolly, E.; Steinmetz, Helmuth; Lanzino, Giuseppe; Pasqualin, Alberto; Rüfenacht, Daniel; Vajkoczy, Peter; McDougall, Cameron; Hänggi, Daniel; Leroux, Peter; Rinkel, Gabriel J E; Loch Macdonald, R.

    2015-01-01

    Objective: We endeavored to develop an unruptured intracranial aneurysm (UIA) treatment score (UIATS) model that includes and quantifies key factors involved in clinical decision-making in the management of UIAs and to assess agreement for this model among specialists in UIA management and research.

  13. Antimicrobial Treatment to Impair Expansion of Abdominal Aortic Aneurysm (AAA)

    DEFF Research Database (Denmark)

    Bergqvist, David; Lindeman, Johannes H N; Lindholt, Jes Sanddal;

    2013-01-01

    Antimicrobial treatment to attenuate expansion of abdominal aortic aneurysm has been suggested, especially with the focus on Chlamydophila. In this systematic literature review only four randomized trials were identified. In two small studies there is an indication of an effect of roxithromycin...

  14. Surgical results in patients with unruptured asymptomatic cerebral aneurysms. Significance of evaluation of neuropsychological function, magnetic resonance images and cerebral blood flow

    International Nuclear Information System (INIS)

    We evaluated neuropsychological function, magnetic resonance (MR) images and cerebral blood flow (CBF) in patients with unruptured asymptomatic cerebral aneurysms. Among consecutive operations (n=73) on 70 patients since 2000, direct surgery was performed in 53 operations on 50 patients, and intravascular surgery was performed in 20 operations on 20 patients. Surgical results of direct surgery were studied. Direct surgery was selected mainly for patients with small and anterior circulation aneurysms. MR imaging was conducted 1 week after surgery, and Wechsler Adult Intelligence Scale-Revised (WAIS-R) examination and CBF measurement using 133Xe-SPECT were done before and 1 month after surgery. Abnormal neurological findings were recognized postoperatively in 26% of surgeries. Among them, visual disturbance was permanent in 4% of surgeries, all of which were surgeries for paraclinoid internal carotid artery aneurysms. WAIS-R results deteriorated in 26% of surgeries at 1 month and at least in 5% of surgeries at 1 year after surgery. MR images at 1 week after surgery revealed brain damage in 30% of surgeries and subdural fluid collection in 19% of surgeries. Patients with large brain damage or thick subdural fluid collection frequently showed neurological deficits and/or WAISR deterioration. These complications were recognized frequently in patients with ACoA aneurysms. Resting CBF decreased significantly in the area supplied by the anterior cerebral artery and anterior border zone on the operated side postoperatively. The brain damage and subdural fluid collection were observed frequently and caused neurological deficits and neuropsychological dysfunction, although these were usually transient. It may be necessary to evaluate neuropsychological function, MRI and CBF in patients with unruptured asymptomatic cerebral aneurysms to improve surgical results. (author)

  15. Development and application of a volume penalization immersed boundary method for the computation of blood flow and shear stresses in cerebral vessels and aneurysms

    NARCIS (Netherlands)

    Mikhal, Julia; Geurts, Bernard J.

    2013-01-01

    A volume-penalizing immersed boundary method is presented for the simulation of laminar incompressible flow inside geometrically complex blood vessels in the human brain. We concentrate on cerebral aneurysms and compute flow in curved brain vessels with and without spherical aneurysm cavities attach

  16. Combined Surgical and Endovascular Management of a Giant Fusiform PCA Aneurysm in a Pediatric Patient: A Case Report

    OpenAIRE

    Shin, S.H.; Choi, I.S.; Thomas, K.; David, C.A.

    2013-01-01

    Treatment of intracranial giant aneurysms presents is challenging. In the case of pediatric giant aneurysm, more challenges arise. We describe our experience with a 17-year-old pediatric patient who presented with severe headache. She was diagnosed as having a giant fusiform aneurysm at the right P1-P2-Pcom junction. The aneurysm was treated with superficial temporal artery-posterior cerebral artery bypass and subsequent coil embolization of the aneurysm with parent artery occlusion. The pati...

  17. The treatment of giant abdominal aorta aneurysm with endovascular stent-graf

    OpenAIRE

    Şeref Ulucan; Ahmet Keser; Ahmet Kuzgun; Fatih Aygün; Duran Efe

    2012-01-01

    The usage of endovascular stent-graft in the treatment of abdominal aorta aneurysm has been increasing in the abdominal surgery. This paper presents the case of a patient with right iliac artery aneurysm who was treated with the application of endovascular stent-graft. J Clin Exp Invest 2012; 3 (3): 423-425Key words: Abdominal Aorta Aneurysm, EVAR, Stentgraft

  18. Endovascular treatment of aneurysm of splenic artery arising from splenomesentric trunk using stent graft

    Energy Technology Data Exchange (ETDEWEB)

    Kulkami, Chinmay Bhimaji; Moorthy Srikanth; Pullara Sreekumar Karumathil; Kannan, Rajesh Ramaih [Department of Radiology, Amrita Institute of Medical Sciences, Amrita Lane (India)

    2013-12-15

    We report a rare case of aneurysm of splenic artery arising anomalously from the superior mesenteric artery (SMA). The aneurysm was treated successfully by coil embolization of the splenic artery distal to aneurysm and then deploying a stent graft in the SMA. A combination of stent graft and coil embolization for the treatment of aberrant splenic artery aneurysm has been reported only once. We describe the imaging findings and the endovascular procedure in this patient.

  19. Spontaneous thrombosis of a recurrent clipped intracranial aneurysm.

    Science.gov (United States)

    Hassan, F; Taschner, C-A; Thines, L; Lejeune, J-P; Pruvo, J-P; Leclerc, X

    2009-06-01

    Spontaneous thrombosis of an intracranial aneurysm is a rare event. It is predominantly observed with aneurysms that are large and have relatively narrow necks. We report here a case of a 48-year-old woman presenting with subarachnoid hemorrhage (SAH) due to rupture of a 2-mm aneurysm of the anterior cerebral artery treated by microsurgical clipping. Six months after treatment of the aneurysm, the patient presented with severe headache. SAH was excluded, but computed tomographic angiography (CTA) revealed the recurrence of a large aneurysm (7 mm) that was confirmed by cerebral angiography (DSA). Endovascular treatment was scheduled for several days later, but DSA also revealed spontaneous occlusion of the recurrent aneurysm. On the control CTA performed one week later, the recurrent aneurysm had again reappeared, again confirmed by DSA, and was subsequently treated by coil embolization. PMID:19144409

  20. Computer-assisted spatial reconstruction of cerebral blood vessels and intracranial aneurysms

    OpenAIRE

    Nikolić Igor M.

    2006-01-01

    Introduction. Today, many medical procedures are based on image analysis with the aim of providing accurate diagnosis and optimal treatment. The goal of this report was to present clinical implications of computer-assisted geometric design of carotid aneurysms. Material and methods. In this study, the three-dimensional reconstruction was based on the approximation power of the parametric spline function, which achieves interpolation and surface fitting of the arterial information obtained by ...

  1. Extended Endoscopic Endonasal Approaches for Cerebral Aneurysms: Anatomical, Virtual Reality and Morphometric Study

    Directory of Open Access Journals (Sweden)

    Alberto Di Somma

    2014-01-01

    Full Text Available Introduction. The purpose of the present contribution is to perform a detailed anatomic and virtual reality three-dimensional stereoscopic study in order to test the effectiveness of the extended endoscopic endonasal approaches for selected anterior and posterior circulation aneurysms. Methods. The study was divided in two main steps: (1 simulation step, using a dedicated Virtual Reality System (Dextroscope, Volume Interactions; (2 dissection step, in which the feasibility to reach specific vascular territory via the nose was verified in the anatomical laboratory. Results. Good visualization and proximal and distal vascular control of the main midline anterior and posterior circulation territory were achieved during the simulation step as well as in the dissection step (anterior communicating complex, internal carotid, ophthalmic, superior hypophyseal, posterior cerebral and posterior communicating, basilar, superior cerebellar, anterior inferior cerebellar, vertebral, and posterior inferior cerebellar arteries. Conclusion. The present contribution is intended as strictly anatomic study in which we highlighted some specific anterior and posterior circulation aneurysms that can be reached via the nose. For clinical applications of these approaches, some relevant complications, mainly related to the endonasal route, such as proximal and distal vascular control, major arterial bleeding, postoperative cerebrospinal fluid leak, and olfactory disturbances must be considered.

  2. A new self-expanding nitinol stent (Enterprise) for the treatment of wide-necked intracranial aneurysms: initial clinical and angiographic results in 31 aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Weber, Werner; Kuehne, Dietmar [Alfried Krupp Hospital, Department of Radiology and Neuroradiology, Essen (Germany); Bendszus, Martin; Solymosi, Laszlo [University of Wuerzburg, Department of Neuroradiology, Wuerzburg (Germany); Kis, Bernhard [University of Duisburg-Essen, Research Unit, Rheinische Kliniken Essen, Department of Psychiatry and Psychotherapy, Essen (Germany); Boulanger, Thierry [Centre Hospitalier of Luxembourg, Service of Neuroradiology, Luxembourg (Luxembourg)

    2007-07-15

    We report the results of a prospective clinical study using a new self-expanding nitinol stent (Enterprise) designed for the treatment of wide-necked intracranial aneurysms. We treated 31 saccular, wide-necked intracranial aneurysms in 30 patients. Ten aneurysms had recanalized after prior endovascular treatment without a stent, and 21 aneurysms had not been treated before. Stent deployment was successful in all procedures. Additional coil embolization was performed in all aneurysms. Initial complete angiographic occlusion was achieved in 6 aneurysms, a neck remnant was left in 18 aneurysms and there were 7 residual aneurysms. Angiographic follow-up examinations of 30 lesions after 6 months demonstrated 15 complete occlusions, 8 neck remnants and 7 residual aneurysms. One patient refused the 6-month angiographic follow-up. Spontaneous occlusion of the aneurysm had occurred in 14 patients, and 6 aneurysms showed recanalization. Four of these residual aneurysms were retreated. At the 6-month follow-up, 29 parent arteries were unaffected, whereas two parent vessels demonstrated minor asymptomatic narrowing at the stent site. Two patients experienced one or more possible or probable device-related serious adverse events during the 6-month follow-up period. There was no procedural morbidity or mortality at 6 months after the procedure. The reported results demonstrated the safety and feasibility of the Cordis Neurovascular Enterprise stent in the treatment of wide-necked intracranial aneurysms. Initial clinical and angiographic results are favorable. (orig.)

  3. A new self-expanding nitinol stent (Enterprise) for the treatment of wide-necked intracranial aneurysms: initial clinical and angiographic results in 31 aneurysms

    International Nuclear Information System (INIS)

    We report the results of a prospective clinical study using a new self-expanding nitinol stent (Enterprise) designed for the treatment of wide-necked intracranial aneurysms. We treated 31 saccular, wide-necked intracranial aneurysms in 30 patients. Ten aneurysms had recanalized after prior endovascular treatment without a stent, and 21 aneurysms had not been treated before. Stent deployment was successful in all procedures. Additional coil embolization was performed in all aneurysms. Initial complete angiographic occlusion was achieved in 6 aneurysms, a neck remnant was left in 18 aneurysms and there were 7 residual aneurysms. Angiographic follow-up examinations of 30 lesions after 6 months demonstrated 15 complete occlusions, 8 neck remnants and 7 residual aneurysms. One patient refused the 6-month angiographic follow-up. Spontaneous occlusion of the aneurysm had occurred in 14 patients, and 6 aneurysms showed recanalization. Four of these residual aneurysms were retreated. At the 6-month follow-up, 29 parent arteries were unaffected, whereas two parent vessels demonstrated minor asymptomatic narrowing at the stent site. Two patients experienced one or more possible or probable device-related serious adverse events during the 6-month follow-up period. There was no procedural morbidity or mortality at 6 months after the procedure. The reported results demonstrated the safety and feasibility of the Cordis Neurovascular Enterprise stent in the treatment of wide-necked intracranial aneurysms. Initial clinical and angiographic results are favorable. (orig.)

  4. [Ruptured distal anterior cerebral artery aneurysm and diagnostic dyspraxia: a case report].

    Science.gov (United States)

    Wada, M; Kajikawa, H; Fujii, S; Yamamura, K; Kajikawa, M

    1995-04-01

    A case of ruptured distal anterior cerebral artery aneurysm presenting with diagnostic dyspraxia is presented. A 54-year-old female was referred to our hospital with the complaint of sudden onset of headache followed by disturbance of consciousness. CT and MRI revealed subarachnoid hemorrhage with hematomas in the interhemispheric fissure and the supracallosal area, and CAG revealed a left-sided callosomarginal artery aneurysm. During and after hospitalization, she showed diagnostic dyspraxia characterized by behavior of both her hands opposite to what might be expected e.g. when she tried to pick up a bowl, both her hands moved forward and held it at once; she wiped her head and face with toilet paper after urination. At times her hands behaved in opposite ways. For example, while folding cloths, her right hand tended to fold them while the left hand tended to unfold them; when she put on a sweater, as the right hand put it on, the left hand took it off; when she put her shirt into her trousers, one hand pushed it in while the other hand pulled it out. This unusual behavior was considered to be caused by the impairment of the corpus callosum due to compression by the hematoma. It disappeared gradually over a period of one year. Involuntary motor behavior of the left hand while the right hand is in voluntary action is known as diagnostic dyspraxia. Although this symptom has rarely been reported so far in cases of ruptured distal anterior cerebral artery, it may become noticed more frequently through careful observation. PMID:7739777

  5. A completely thrombosed, nongiant middle cerebral artery aneurysm mimicking an intra-axial neoplasm

    Directory of Open Access Journals (Sweden)

    Ha Son Nguyen

    2015-01-01

    Conclusion: Completely thrombosed, nongiant aneurysms can mimic an intra-axial neoplasm. Typical imaging features for thrombosed aneurysms may be missed, especially if the aneurysms are small, where imaging characteristics of the intraluminal contents is more difficult to appreciate. Although imaging may be consistent with a neoplastic lesion, there should be suspicion for a potential underlying aneurysm.

  6. Atypical radiological and intraoperative findings of acute cerebral hemorrhage caused by ruptured cerebral aneurysm in a patient with severe chronic anemia.

    Science.gov (United States)

    Matano, Fumihiro; Murai, Yasuo; Nakagawa, Shunsuke; Kato, Taisei; Kitamura, Takayuki; Sekine, Tetsuro; Takagi, Ryo; Teramoto, Akira

    2014-01-01

    Acute intracerebral hemorrhage (ICH) associated with mild anemia is commonly observed on radiological examination, and there are several reports of ruptured aneurysms occurring with ICH but without accompanying subarachnoid hemorrhage. However, the relationship among computed tomography (CT), magnetic resonance imaging (MRI), and intraoperative findings of ICH caused by ruptured cerebral aneurysm in patients with severe chronic anemia has been rarely reported and is poorly understood. Here, we report atypical radiological and intraoperative findings of acute ICH caused by ruptured cerebral aneurysm in a patient with severe chronic anemia. A 64-year-old man with anemia was admitted to our hospital after he experienced left hemiparesis and a disturbance of consciousness. At a referring institution, he showed evidence of macrocytic anemia (white blood cell count, 9,000/μL; red blood cell count, 104×10(4)/μL; hemoglobin, 4.0 g/dL; hematocrit, 12.2%; and platelet count, 26.6×10(4)/μL). Both CT and MRI showed a right frontal ICH. The outer ring of the hematoma appeared as low-density area on CT, a low-intensity area on T1-weighted MRI, and a high-intensity area on T2-weighted MRI with a serous component. The patient received a blood transfusion and underwent surgical removal of the hematoma the following day. The white serous effusion visualized with CT and MRI was identified as a blood clot in the hematoma cavity. The blood that leaks from blood vessels appears as a high-intensity area on CT because it undergoes plasma absorption in a solidification shrinkage process, and is, therefore, concentrated. Although we did not examine the white effusion to determine if serous components were present, we speculated that the effusion may have contained serous components. Therefore, we removed the part of the effusion that appeared as a low-density area on CT. The presence of ICH without subarachnoid hemorrhage suggested the possible adhesion and rupture of a previous

  7. Spontaneous disappearance and reappearance of a ruptured cerebral aneurysm: one case found in a group of 33 consecutive patients with subarachnoid hemorrhage who underwent repeat angiography.

    Science.gov (United States)

    Nakajima, Y; Yoshimine, T; Mori, H; Nakamuta, K; Fujimura, I; Sakashita, K; Kohmura, E; Hayakawa, T; Yokota, J

    2000-09-01

    The spontaneous disappearance and reappearance of a ruptured cerebral aneurysm is generally assumed to be a rare phenomenon although the actual incidence is unknown. Among 39 consecutive cases of acute subarachnoid hemorrhage (SAH), 33 were studied by three-dimensional computed tomographic angiography (CTA) within 6 h after the onset of SAH, followed by digital subtraction angiography (DSA) within 24 h after the ictus. Of those patients, one, a 58-year-old woman, had a saccular aneurysm at the distal anterior cerebral artery; the aneurysm was clearly demonstrated by CTA 2.5 h after the SAH onset, but was not shown by a subsequent DSA performed 8.5 h after the ictus. A follow-up DSA detected the neck of aneurysm on day 11, and the whole aneurysm was visualized on day 19. The observations in this particular case suggest that the spontaneous disappearance of a ruptured cerebral aneurysm may occur during the ultra-early stage of SAH and that reappearance may follow during the next few weeks. The patient did not suffer complications such as vasospasm or systemic hypotension nor was she treated with antifibrinolytic agents. The aneurysmal shape and the surrounding clot are considered as putative factors possibly related to the intermittent appearance of the aneurysm. PMID:11045020

  8. Aneurysm flow characteristics in realistic carotid artery aneurysm models induced by proximal virtual stenotic plaques: a computational hemodynamics study

    Science.gov (United States)

    Castro, Marcelo A.; Peloc, Nora L.; Chien, Aichi; Goldberg, Ezequiel; Putman, Christopher M.; Cebral, Juan R.

    2015-03-01

    Cerebral aneurysms may rarely coexist with a proximal artery stenosis. In that small percent of patients, such coexistence poses a challenge for interventional neuroradiologists and neurosurgeons to make the best treatment decision. According to previous studies, the incidence of cerebral aneurysms in patients with internal carotid artery stenosis is no greater than five percent, where the aneurysm is usually incidentally detected, being about two percent for aneurysms and stenoses in the same cerebral circulation. Those cases pose a difficult management decision for the physician. Case reports showed patients who died due to aneurysm rupture months after endarterectomy but before aneurysm clipping, while others did not show any change in the aneurysm after plaque removal, having optimum outcome after aneurysm coiling. The aim of this study is to investigate the intra-aneurysmal hemodynamic changes before and after treatment of stenotic plaque. Virtually created moderate stenoses in vascular models of internal carotid artery aneurysm patients were considered in a number of cases reconstructed from three dimensional rotational angiography images. The strategy to create those plaques was based on parameters analyzed in a previous work where idealized models were considered, including relative distance and stenosis grade. Ipsilateral and contralateral plaques were modeled. Wall shear stress and velocity pattern were computed from finite element pulsatile blood flow simulations. The results may suggest that wall shear stress changes depend on relative angular position between the aneurysm and the plaque.

  9. Aneurisma gigante da artéria cerebral posterior: (segmento P3 Relato de caso Giant aneurysm of the posterior cerebral artery (P3 segment: case report

    Directory of Open Access Journals (Sweden)

    Ronaldo Pereira

    1995-09-01

    Full Text Available Apresentamos caso de aneurisma gigante do segmento distal (P3 da artéria cerebral posterior. O aneurisma foi tratado microcirurgicamente pela via combinada proposta por Sano com clipagem do ramo terminal da artéria cerebral posterior próximo ao aneurisma. A paciente teve evolução pós operatória favorável, com lesão parcial e transitória do III nervo craniano. Revisão da literatura e discussão a respeito da anatomia e da abordagem cirúrgica são feitas. A raridade desta patologia justifica o relato deste caso.A rare case of giant aneurysm of the P3 segment of the posterior cerebral artery is presented. The aneurysm was acessed through a combined approach proposed by Sano and the aneurysm was treated by proximal clipping. The patient had a good postoperative recovery without any neurological deficit. The anatomy and the operative approaches are discussed and the neurosurgical literature reviewed.

  10. 无蛛网膜下腔出血的破裂脑动脉瘤%Ruptured cerebral aneurysms without subarachnoid hemorrhage

    Institute of Scientific and Technical Information of China (English)

    梁玉敏; 江基尧; 潘耀华; 万杰清; 殷玉华; 包映晖; 高国一; 熊文浩; 徐纪文; 罗其中

    2009-01-01

    Objective To summarize the experiences of diagnosis and treatment of ruptured cerebral aneurysm without subarachnoid hemorrhage(SAH). Methods The clinical manifestations, neuroradiological results, methods of treatment and outcome of 15 cases of ruptured cerebral anenrysm which presented with intracerebral hemorrhage (ICH), and/or intraventricular hemorrhage (IVH), subdural hematoma (SDH) or intramural hemorrhage(IMH) without SAH on initial CT or MRI were reviewed retrospectively. Results The initial CT or MRI in 15 cases was obtained within 2 days after onset. Of these cases, three patients presented with ICH, six with ICH and IVH, one with IVH, one with SDH, three with IMH and 1 with mixed density. There are six middle cerebral artery, four anterior communicating artery, three posterior communicating artery, one anterior cerebral artery and one posterior inferior cerebellar artery aneurysms. Thirteen patients underwent a craniotomy for clipping and two patients endovascular coiling. According Glasgow Outcome Scale (GOS),8 patients recovered well, 3 became moderately disabled, 3 were severely disabled and 1 was in vegetative state on discharge. The incidence of aneurysm rupture with ICH and/or IVH, SDH, IMH without SAH is 3.8% in this report. Conclusions Initial CT or MRI of ruptured cerebral aneurysms may presented with ICH, and/or IVH, SDH and IMH without SAH, which may have a muhifactorial cause attributable to the timing of CT or MRI, location of the aneurysm and direction of its dome, and the amount of hemorrhage. The key points to improve the outcome of such cases are to control increased intracranial pressure earlier, diagnose and manage ruptured aneurysms promptly.%目的 总结无蛛网膜下腔出血(SAH)的破裂脑动脉瘤的诊治经验.方法 对15例在起病后2 d内首次CT或MRI上表现为脑内出血(ICH),和(或)脑室内出血(IVH)、硬脑膜下血肿(SDH)和壁间出血(IMH)而无SAH的破裂脑动脉瘤患者的临床

  11. Experimental insights into flow impingement in cerebral aneurysm by stereoscopic particle image velocimetry: transition from a laminar regime.

    Science.gov (United States)

    Yagi, Takanobu; Sato, Ayaka; Shinke, Manabu; Takahashi, Sara; Tobe, Yasutaka; Takao, Hiroyuki; Murayama, Yuichi; Umezu, Mitsuo

    2013-05-01

    This study experimentally investigated the instability of flow impingement in a cerebral aneurysm, which was speculated to promote the degradation of aneurysmal wall. A patient-specific, full-scale and elastic-wall replica of cerebral artery was fabricated from transparent silicone rubber. The geometry of the aneurysm corresponded to that found at 9 days before rupture. The flow in a replica was analysed by quantitative flow visualization (stereoscopic particle image velocimetry) in a three-dimensional, high-resolution and time-resolved manner. The mid-systolic and late-diastolic flows with a Reynolds number of 450 and 230 were compared. The temporal and spatial variations of near-wall velocity at flow impingement delineated its inherent instability at a low Reynolds number. Wall shear stress (WSS) at that site exhibited a combination of temporal fluctuation and spatial divergence. The frequency range of fluctuation was found to exceed significantly that of the heart rate. The high-frequency-fluctuating WSS appeared only during mid-systole and disappeared during late diastole. These results suggested that the flow impingement induced a transition from a laminar regime. This study demonstrated that the hydrodynamic instability of shear layer could not be neglected even at a low Reynolds number. No assumption was found to justify treating the aneurysmal haemodynamics as a fully viscous laminar flow.

  12. Impact of routine cerebral CT angiography on treatment decisions in infective endocarditis.

    Directory of Open Access Journals (Sweden)

    Marwa Sayed Meshaal

    Full Text Available Infective endocarditis (IE is commonly complicated by cerebral embolization and hemorrhage secondary to intracranial mycotic aneurysms (ICMAs. These complications are associated with poor outcome and may require diagnostic and therapeutic plans to be modified. However, routine screening by brain CT and CT angiography (CTA is not standard practice. We aimed to study the impact of routine cerebral CTA on treatment decisions for patients with IE.From July 2007 to December 2012, we prospectively recruited 81 consecutive patients with definite left-sided IE according to modified Duke's criteria. All patients had routine brain CTA conducted within one week of admission. All patients with ICMA underwent four-vessel conventional angiography. Invasive treatment was performed for ruptured aneurysms, aneurysms ≥ 5 mm, and persistent aneurysms despite appropriate therapy. Surgical clipping was performed for leaking aneurysms if not amenable to intervention.The mean age was 30.43 ± 8.8 years and 60.5% were males. Staph aureus was the most common organism (32.3%. Among the patients, 37% had underlying rheumatic heart disease, 26% had prosthetic valves, 23.5% developed IE on top of a structurally normal heart and 8.6% had underlying congenital heart disease. Brain CT/CTA revealed that 51 patients had evidence of cerebral embolization, of them 17 were clinically silent. Twenty-six patients (32% had ICMA, of whom 15 were clinically silent. Among the patients with ICMAs, 11 underwent endovascular treatment and 2 underwent neurovascular surgery. The brain CTA findings prompted different treatment choices in 21 patients (25.6%. The choices were aneurysm treatment before cardiac surgery rather than at follow-up, valve replacement by biological valve instead of mechanical valve, and withholding anticoagulation in patients with prosthetic valve endocarditis for fear of aneurysm rupture.Routine brain CT/CTA resulted in changes in the treatment plan in a significant

  13. Selective treatment of an anterior spinal artery aneurysm with endosaccular coil therapy. Case report.

    Science.gov (United States)

    Lavoie, Pascale; Raymond, Jean; Roy, Daniel; Guilbert, François; Weill, Alain

    2007-05-01

    The authors report the case of a 12-year-old boy with spinal cord arteriovenous malformation (AVM) and an associated anterior spinal artery (ASA) aneurysm treated with selective coil placement in the context of subarachnoid hemorrhage (SAH). The patient presented with headache. Head computed tomography scanning revealed no abnormal findings. The cerebrospinal fluid was sampled and analyzed and a diagnosis of SAH was established. Investigation, including magnetic resonance imaging of the cord as well as cerebral and spinal angiography, revealed a conus medullaris AVM and a saccular aneurysm located on the ASA at the T-11 level. The aneurysm was thought to be responsible for the bleeding. Superselective ASA angiography showed that the aneurysm was at the bifurcation between a large coronal artery supplying the AVM and the ASA. The relation of the aneurysm's neck to the main spinal axis and the aneurysm's morphological features indicated that the lesion was suited for endosaccular coil therapy. The aneurysm was selectively occluded, using electrodetachable bare platinum coils. Follow-up angiography immediately after surgery and at 6 months thereafter demonstrated complete occlusion of the aneurysm and a perfectly patent anterior spinal axis. On clinical follow-up examination, the patient remained neurologically intact. When the morphological features of a spinal aneurysm and its relation with the anterior spinal axis are favorable, selective endosaccular coil placement can successfully be achieved. PMID:17542515

  14. Patient-specific computational analysis of the influence of a stent on the unsteady flow in cerebral aneurysms

    Science.gov (United States)

    Takizawa, Kenji; Schjodt, Kathleen; Puntel, Anthony; Kostov, Nikolay; Tezduyar, Tayfun E.

    2013-06-01

    We present a patient-specific computational analysis of the influence of a stent on the unsteady flow in cerebral aneurysms. The analysis is based on four different arterial models extracted form medical images, and the stent is placed across the neck of the aneurysm to reduce the flow circulation in the aneurysm. The core computational technique used in the analysis is the space-time (ST) version of the variational multiscale (VMS) method and is called "DSD/SST-VMST". The special techniques developed for this class of cardiovascular fluid mechanics computations are used in conjunction with the DSD/SST-VMST technique. The special techniques include NURBS representation of the surface over which the stent model and mesh are built, mesh generation with a reasonable resolution across the width of the stent wire and with refined layers of mesh near the arterial and stent surfaces, modeling the double-stent case, and quantitative assessment of the flow circulation in the aneurysm. We provide a brief overview of the special techniques, compute the unsteady flow patterns in the aneurysm for the four arterial models, and investigate in each case how those patterns are influenced by the presence of single and double stents.

  15. Comparison of the association of sac growth and coil compaction with recurrence in coil embolized cerebral aneurysms.

    Directory of Open Access Journals (Sweden)

    Anna L Hoppe

    Full Text Available In recurrent cerebral aneurysms treated by coil embolization, coil compaction is regarded as the presumptive mechanism. We test the hypothesis that aneurysm growth is the primary recurrence mechanism. We also test the hypothesis that the coil mass will translate a measurable extent when recurrence occurs.An objective, quantitative image analysis protocol was developed to determine the volumes of aneurysms and coil masses during initial and follow-up visits from 3D rotational angiograms. The population consisted of 15 recurrence and 12 non-recurrence control aneurysms initially completely coiled at a single center. An investigator sensitivity study was performed to assess the objectivity of the methods. Paired Wilcoxon tests (p<0.05, one-tailed were performed to assess for aneurysm and coil growth. The translation of the coil mass center at follow-up was computed. A Mann Whitney U-Test (p<0.05, one-tailed was used to compare translation of coil mass centers between recurrence and control subjects.Image analysis protocol was found to be insensitive to the investigator. Aneurysm growth was evident in the recurrence cohort (p=0.003 but not the control (p=0.136. There was no evidence of coil compaction in either the recurrence or control cohorts (recurrence: p=0.339; control: p=0.429. The translation of the coil mass centers was found to be significantly larger in the recurrence cohort than the control cohort (p=0.047.Aneurysm sac growth, not coil compaction, was the primary mechanism of recurrence following successful coil embolization. The coil mass likely translates to a measurable extent when recurrence occurs and has the potential to serve as a non-angiographic recurrence marker.

  16. Endovascular Treatment of a Ruptured Posterior Inferior Cerebellar Artery Aneurysm during Pregnancy

    OpenAIRE

    Kim, Ki Dae; Chang, Chul Hoon; Choi, Byung Yon; Jung, Young Jin

    2014-01-01

    Aneurysmal subarachnoid hemorrhage (SAH) during pregnancy is quite rare, however it has a high maternal mortality rate. A pregnant woman in the 16th gestational week was admitted to our hospital with a drowsy level of consciousness. A brain magnetic resonance (MR) image showed hemorrhage on the prepontine cistern, and both sylvian fissures, and MR angiography and cerebral digital subtraction angiography demonstrated an aneurysm at the left posterior inferior cerebellar artery (PICA). We perfo...

  17. Inadvertent Complication of a Pipeline Embolization Device for Treatment with Vertebral Artery Dissecting Aneurysm : Distal Tip Fracture of Delivery Wire.

    Science.gov (United States)

    Park, Jung Soo; Kwak, Hyo Sung; Lee, Jong Myong

    2016-09-01

    Use of the Pipeline embolization device (PED) has increased based on studies about its safety and effectiveness, and new reports that describe peri- or postprocedural complications are now emerging. We report a rare periprocedural device-related complication that occurred during endovascular treatment with the pipeline embolization device for a dissecting aneurysm on the vertebral artery. A 55-year old woman was admitted due to left medullary infarction, and angiography showed a fusiform dilatation in the left vertebral artery that was suspicious for dissecting aneurysm. Endovascular treatment with PED was planned. Under general anesthesia, the procedure was performed without significant problems and a PED was deployed in an appropriate position. However, in the final step of the procedure, the distal tip of the PED delivery wire became engaged within a small branch of the posterior cerebral artery and fractured. Fortunately, imaging studies after the procedure revealed neither hemorrhagic nor ischemic stroke, and the patient recovered without neurological morbidities except initial symptoms. PMID:27651873

  18. Inadvertent Complication of a Pipeline Embolization Device for Treatment with Vertebral Artery Dissecting Aneurysm : Distal Tip Fracture of Delivery Wire.

    Science.gov (United States)

    Park, Jung Soo; Kwak, Hyo Sung; Lee, Jong Myong

    2016-09-01

    Use of the Pipeline embolization device (PED) has increased based on studies about its safety and effectiveness, and new reports that describe peri- or postprocedural complications are now emerging. We report a rare periprocedural device-related complication that occurred during endovascular treatment with the pipeline embolization device for a dissecting aneurysm on the vertebral artery. A 55-year old woman was admitted due to left medullary infarction, and angiography showed a fusiform dilatation in the left vertebral artery that was suspicious for dissecting aneurysm. Endovascular treatment with PED was planned. Under general anesthesia, the procedure was performed without significant problems and a PED was deployed in an appropriate position. However, in the final step of the procedure, the distal tip of the PED delivery wire became engaged within a small branch of the posterior cerebral artery and fractured. Fortunately, imaging studies after the procedure revealed neither hemorrhagic nor ischemic stroke, and the patient recovered without neurological morbidities except initial symptoms.

  19. Successful treatment of a giant pediatric fusiform basilar trunk aneurysm with surpass flow diverter.

    Science.gov (United States)

    Kan, Peter; Mokin, Maxim; Puri, Ajit S; Wakhloo, Ajay K

    2016-06-01

    Fusiform aneurysms present a unique challenge to traditional microsurgical and endovascular treatment because of the lack of a discernible neck and the involvement of parent vessel. Flow diversion has increasingly become the treatment of choice for fusiform aneurysms in the anterior circulation, but its results in the posterior circulation are variable. We report successful treatment of a giant fusiform upper basilar trunk aneurysm with the Surpass flow diverter in an adolescent, and discuss the potential advantages of this emerging technology in the treatment of fusiform posterior circulation aneurysms. PMID:26063795

  20. Successful treatment of a giant pediatric fusiform basilar trunk aneurysm with surpass flow diverter.

    Science.gov (United States)

    Kan, Peter; Mokin, Maxim; Puri, Ajit S; Wakhloo, Ajay K

    2015-06-03

    Fusiform aneurysms present a unique challenge to traditional microsurgical and endovascular treatment because of the lack of a discernible neck and the involvement of parent vessel. Flow diversion has increasingly become the treatment of choice for fusiform aneurysms in the anterior circulation, but its results in the posterior circulation are variable. We report successful treatment of a giant fusiform upper basilar trunk aneurysm with the Surpass flow diverter in an adolescent, and discuss the potential advantages of this emerging technology in the treatment of fusiform posterior circulation aneurysms.

  1. Mesenchymal stem cells for treatment of aortic aneurysms

    Institute of Scientific and Technical Information of China (English)

    Aika; Yamawaki-Ogata; Ryotaro; Hashizume; Xian-Ming; Fu; Akihiko; Usui; Yuji; Narita

    2014-01-01

    An aortic aneurysm(AA) is a silent but life-threatening disease that involves rupture. It occurs mainly in aging and severe atherosclerotic damage of the aortic wall. Even though surgical intervention is effective to prevent rupture, surgery for the thoracic and thoraco-abdom-inal aorta is an invasive procedure with high mortality and morbidity. Therefore, an alternative strategy for treatment of AA is required. Recently, the molecular pathology of AA has been clarified. AA is caused by an imbalance between the synthesis and degradation of extracellular matrices in the aortic wall. Chronic inflam-mation enhances the degradation of matrices directly and indirectly, making control of the chronic inflamma-tion crucial for aneurysmal development. Meanwhile, mesenchymal stem cells(MSCs) are known to be ob-tained from an adult population and to differentiate into various types of cells. In addition, MSCs have not only the potential anti-inflammatory and immunosuppres-sive properties but also can be recruited into damagedtissue. MSCs have been widely used as a source for celltherapy to treat various diseases involving graft-versus-host disease, stroke, myocardial infarction, and chronicinflammatory disease such as Crohn’s disease clinically.Therefore, administration of MSCs might be availableto treat AA using anti-inflammatory and immnosup-pressive properties. This review provides a summary ofseveral studies on "Cell Therapy for Aortic Aneurysm"including our recent data, and we also discuss the pos-sibility of this kind of treatment.

  2. 104例颅内动脉瘤和脑血管畸形患者氧治疗方案探讨%Observation on the therapeutic effects of different oxygen therapy protocols in the treatment of 104 patients with intracranial aneurysm and cerebral vascular malformations

    Institute of Scientific and Technical Information of China (English)

    卢晓欣; 彭慧平; 汤永建; 房卫红

    2012-01-01

    Objective To observe the therapeutic effects of different oxygen therapy protocols in the treatment of patients with intracranial aneurysm and cerebral vascular malformations. Methods Forty-one cases of intracranial aneurysm and 63 cases of various cerebral vascular malformations (with a total of 104 cases) were treated with different oxygen therapy protocols.High-flow normal pressure oxygen (NPO) therapy outside the chamber was given to 25 patients either with intracranial aneurysm or cerebral vascular malformation,who failed to receive surgical operation or endovascular treatment,or their family members refused to accept hyperbaric oxygen (HBO) therapy.Seventy-nine cases were treated with progressive HBO therapy protocol,i.e.treatment started with high-flow oxygen therapy outside the chamber,HBO therapy started from a lower pressure to a higher pressure,and a therapy protocol with relatively slower compression and decompression rates was adopted (with compression and decompression rates of 3- 4 kPa/min,the therapeutic pressure of 0.175 MPa and oxygen breathing for 60 min at stable pressure).At the same time,vital signs and ECG were analyzed,therapeutic effects and safety of the protocols were evaluated.Results Total effective rate for HBO therapy and high-flow NPO therapy outside the chamber was 97.5% and 40.0%.The therapeutic effectiveness of HBO therapy was superior to that of the high-flow NPO therapy outside the chamber,with statistical significance ( P < 0.05 ). Vital signs and ECG monitoring indicated that heart rate decreased [(83.63±15.80)/min]following HBO therapy,and statistical difference could be noted,when it was compared with those of the patients treated with high-flow NPO therapy outside the chamber.Arterial oxygen saturation all elevated for the two therapy protocols,but without statistical significance.As compared with those before compression,systolic and diastolic pressures all increased,when HBO therapy was implemented (P <0

  3. Fractional modeling of viscoelasticity in 3D cerebral arteries and aneurysms

    Science.gov (United States)

    Yu, Yue; Perdikaris, Paris; Karniadakis, George Em

    2016-10-01

    We develop efficient numerical methods for fractional order PDEs, and employ them to investigate viscoelastic constitutive laws for arterial wall mechanics. Recent simulations using one-dimensional models [1] have indicated that fractional order models may offer a more powerful alternative for modeling the arterial wall response, exhibiting reduced sensitivity to parametric uncertainties compared with the integer-calculus-based models. Here, we study three-dimensional (3D) fractional PDEs that naturally model the continuous relaxation properties of soft tissue, and for the first time employ them to simulate flow structure interactions for patient-specific brain aneurysms. To deal with the high memory requirements and in order to accelerate the numerical evaluation of hereditary integrals, we employ a fast convolution method [2] that reduces the memory cost to O (log ⁡ (N)) and the computational complexity to O (Nlog ⁡ (N)). Furthermore, we combine the fast convolution with high-order backward differentiation to achieve third-order time integration accuracy. We confirm that in 3D viscoelastic simulations, the integer order models strongly depends on the relaxation parameters, while the fractional order models are less sensitive. As an application to long-time simulations in complex geometries, we also apply the method to modeling fluid-structure interaction of a 3D patient-specific compliant cerebral artery with an aneurysm. Taken together, our findings demonstrate that fractional calculus can be employed effectively in modeling complex behavior of materials in realistic 3D time-dependent problems if properly designed efficient algorithms are employed to overcome the extra memory requirements and computational complexity associated with the non-local character of fractional derivatives.

  4. Update on diagnosis and treatment of cardiac pseudo aneurysm

    International Nuclear Information System (INIS)

    Echocardiography is an essential tool in the diagnosis of pseudo aneurysm. It has been the most studied in diagnosing this condition.The M, two-dimensional and Doppler apply to reach a correct diagnosis of ventricular pseudo aneurysm. The use of this imaging technique allows noninvasive detection of asymptomatic or postoperative pseudo aneurysms after M mode used to diagnose a pseudo aneurysm to recognize an echo-free space in the posterior wall of the left ventricle. In 1980, Catherwood et al used to compare the two-dimensional echo pseudo aneurysm and a true aneurysm cavity demonstrated pseudo aneurysm globular and discontinuity of the ventricular myocardium

  5. Endoleakage after endovascular treatment of abdominal aortic aneurysms: diagnosis, significance and treatment

    Energy Technology Data Exchange (ETDEWEB)

    Golzarian, Jafar [University of Iowa, University of Iowa Heath Care, IA (United States); Valenti, David [McGill University, Royal Victoria Hospital, McGill University Health Centre, Montreal (Canada)

    2006-12-15

    Endoleak, also called leakage, leak and Perigraft leak, is a major complication and its persistence represents a failure of endovascular aortic aneurysm repair. Its detection and treatment is therefore of primary importance, since endoleak can be associated with pressurization (increase in pressure) of the sac, resulting in expansion and rupture of the aneurysm. The aim of this paper is to discuss the definition, significance, diagnosis and different options to treat endoleak. (orig.)

  6. Clinical Practice Guidelines for Cerebral Abscess Treatment

    Directory of Open Access Journals (Sweden)

    Danny Barrueta Reyes

    2009-03-01

    Full Text Available Clinical Practice Guidelines for Cerebral Abscess Treatment. It has been defined as a festering process caused by any germ and placed inside the cerebral parenchyma; this is a diagnostic and therapeutic challenge for surgeons and general doctors since the clinical and radiological manifestations are often imprecise. This document describes its etiological agents, clinical presentation, diagnosis and treatment. It includes assessment guidelines focused on the most important aspects to be accomplished.

  7. Current Strategies for the Treatment of Aneurysmal Bone Cysts.

    Science.gov (United States)

    Tsagozis, Panagiotis; Brosjö, Otte

    2015-12-28

    Aneurysmal bone cysts are benign bone tumors that usually present in childhood and early adulthood. They usually manifest as expansile osteolytic lesions with a varying potential to be locally aggressive. Since their first description in 1942, a variety of treatment methods has been proposed. Traditionally, these tumors were treated with open surgery. Either intralesional surgical procedures or en bloc excisions have been described. Furthermore, a variety of chemical or physical adjuvants has been utilized in order to reduce the risk for local recurrence after excision. Currently, there is a shift to more minimally invasive procedures in order to avoid the complications of open surgical excision. Good results have been reported during percutaneous surgery, or the use of embolization. Recently, sclerotherapy has emerged as a promising treatment, showing effective consolidation of the lesions and functional results that appear to be superior to the ones of open surgery. Lastly, non-invasive treatment, such as pharmaceutical intervention with denosumab or bisphosphonates has been reported to be effective in the management of the disease. Radiotherapy has also been shown to confer good local control, either alone or in conjunction to other treatment modalities, but is associated with serious adverse effects. Here, we review the current literature on the methods of treatment of aneurysmal bone cysts. The indication for each type of treatment along reported outcome of the intervention, as well as potential complications are systematically presented. Our review aims to increase awareness of the different treatment modalities and facilitate decision-making regarding each individual patient. PMID:26793296

  8. Current strategies for the treatment of aneurysmal bone cysts

    Directory of Open Access Journals (Sweden)

    Panagiotis Tsagozis

    2015-12-01

    Full Text Available Aneurysmal bone cysts are benign bone tumors that usually present in childhood and early adulthood. They usually manifest as expansile osteolytic lesions with a varying potential to be locally aggressive. Since their first description in 1942, a variety of treatment methods has been proposed. Traditionally, these tumors were treated with open surgery. Either intralesional surgical procedures or en bloc excisions have been described. Furthermore, a variety of chemical or physical adjuvants has been utilized in order to reduce the risk for local recurrence after excision. Currently, there is a shift to more minimally invasive procedures in order to avoid the complications of open surgical excision. Good results have been reported during percutaneous surgery, or the use of embolization. Recently, sclerotherapy has emerged as a promising treatment, showing effective consolidation of the lesions and functional results that appear to be superior to the ones of open surgery. Lastly, non-invasive treatment, such as pharmaceutical intervention with denosumab or bisphosphonates has been reported to be effective in the management of the disease. Radiotherapy has also been shown to confer good local control, either alone or in conjunction to other treatment modalities, but is associated with serious adverse effects. Here, we review the current literature on the methods of treatment of aneurysmal bone cysts. The indication for each type of treatment along reported outcome of the intervention, as well as potential complications are systematically presented. Our review aims to increase awareness of the different treatment modalities and facilitate decision-making regarding each individual patient.

  9. Application of dual energy cerebral arteries computed tomographic angiography in diagnosis of cerebral aneurysm%双能量脑动脉CT血管造影在脑动脉瘤诊断中的应用

    Institute of Scientific and Technical Information of China (English)

    孙莉; 张岩睿; 刘艳; 李江红

    2014-01-01

    Objective To study the value of dual energy cerebral arteries computed tomographic angiography (CTA) in diagnosis of cerebral aneurysm.Methods As a gold standard of digital subtraction angiography (DSA) findings,the dual energy cerebral arteries CTA imaging features of 30 cases confirmed by DSA for cerebral aneurysm were retrospectively analyzed.The diagnosis accuracy of cerebral aneurysm between dual energy cerebral arteries and DSA was compared.Results Dual energy cerebral arteries CTA could display the direct signs of cerebral aneurysms,it played better in the signs of aneurysm of the siphon segment of internal carotid artery than that by conventional cerebral arteries CTA.The measurement of the size and neck by dual energy cerebral arteries CTA had good agreement to DSA,there was no statistical difference (P > 0.05).The radiation dose of dual energy cerebral arteries CTA was 19.1-25.4(21.7 ± 0.5)mSv.Conclusion The dual energy cerebral arteries CTA can show the size and neck of cerebral aneurysm clearly,has high value in clinical application of the diagnosis of cerebral aneurysm.%目的 探讨双能量脑动脉CT血管造影(CTA)在脑动脉瘤诊断中的价值.方法 以数字减影血管造影(DSA)结果为金标准,回顾性分析30例经DSA证实为脑动脉瘤患者的双能量脑动脉CTA影像学特点,比较双能量脑动脉CTA和DSA检查对脑动脉瘤诊断准确性.结果 双能量脑动脉CTA能较好地显示脑动脉瘤的直接征象,对颈内动脉虹吸段的动脉瘤征象显示优于常规脑动脉CTA扫描.对瘤体及瘤颈的测量与DSA有较高的一致性,两种方法比较差异无统计学意义(P>0.05).双能量脑动脉CTA辐射剂量为19.1~25.4(21.7±0.5) mSv.结论 双能量脑动脉CTA能够清晰显示脑动脉瘤的瘤体大小及瘤颈,对脑动脉瘤的诊断有较高的临床应用价值.

  10. Endovascular treatment of thoracic aorta aneurysm and dissection

    International Nuclear Information System (INIS)

    Full text: The aim is to give up to date information about modern endovascular treatment of aortic pathology Dissection and aneurysms of the aorta are life threatening condition requiring in most of the cases prompt surgical or endovascular treatment because of the poor natural evolution. Purpose: to assess the immediate and 1-year outcome of endovascular treatment in broad spectrum of acute and subacute aortic syndrome during the last 3 years (November 2012 - August 2015) in City Clinic (Sofia, Bulgaria). We performed endovascular treatment of 47 patients (43 men, 4 women) at average age 54 y. with dissection (24) and aneurysms (23) of the aortic arch and thoracic aorta (in 5 emergent treatment was performed for aortic rupture). All patients were treated with minimal surgical femoral approach. In 4 (9%) of them initial carotid to carotid bypass was performed in order to provide a sufficient landing zone for the endograft implantation.the last 9 patients (19%) were treated without general anesthesia with either deep sedation or epidural anesthesia. Results: In all patients successful endograft implantation was achieved. Additional stent-graft or open cell stent was implanted in 4 cases in order to centralize the flow in the compressed true lumen. In 5 cases additional vascular plug or large coil was delivered in the left subclavian arteryostium in order to interrupt retrograde aneurysm or false lumen filling. Complications: 30 days mortality-2.2%, neurologic disorders (4.4%). one year survival- 45 (90.5%). 3 and 6 mo control CT scan showed no migration of the graft in 100%, full false lumen isolation in 19 out of 24 dissections (80%) and aneurysm free of expansion in 20 out of 23 (86%), patent carotid bay-pass graft in 4 of 4 (100%). This one center study showed excellent immediate and 1 year clinical and device results from endovascular repair of potentially fatal disease. Endovascular treatment is a method of choice for broad spectrum of aortic pathology

  11. Sensitivity and specifity of different imaging methods for the detection of cerebral aneurysms; Sensitivitaet und Spezifitaet bildgebender Verfahren fuer den Nachweis intrakranieller Aneurysmen

    Energy Technology Data Exchange (ETDEWEB)

    Ringelstein, Adrian; Forsting, Michael [Universitaetsklinikum Essen (Germany). Inst. fuer Diagnostische und Interventionelle Radiologie und Neuroradiologie

    2015-09-15

    The prevalence or cerebral aneurysms is estimated at 2 %. Out of these aciniform aneurysm, 0,1 % rupture each year. The 30-day-mortality after a subarachnoid hemorrhage (SAH) is estimated at 45 %. Additionally, about 50 % of the patients suffer from severe persistent neurologic deficits. The most reliable way to prevent rupture is early detection and prophylactic therapy of an unruptured aneurysm. For this, knowledge of the different imaging methods currently available and their diagnostic potential is highly desirable. This review describes the potential of CT, MRI and catheter angiography in diagnosing cerebral aneurysms, as well as therapy planning and follow-up care of patients. Based on this, some recommendations are made for management of patients with SAH.

  12. WEB-DL endovascular treatment of wide-neck bifurcation aneurysms

    DEFF Research Database (Denmark)

    Lubicz, B; Klisch, J; Gauvrit, J-Y;

    2014-01-01

    BACKGROUND AND PURPOSE: Flow disruption with the WEB-DL device has been used safely for the treatment of wide-neck bifurcation aneurysms, but the stability of aneurysm occlusion after this treatment is unknown. This retrospective multicenter European study analyzed short- and midterm data...... was classified into 4 grades: complete occlusion, opacification of the proximal recess of the device, neck remnant, and aneurysm remnant. RESULTS: Forty-five patients (34 women and 11 men) 35-74 years of age (mean, 56.3 ± 9.6 years) with 45 aneurysms treated with the WEB device were included. Aneurysm locations...... at the last follow-up. Adequate occlusion (complete occlusion, opacification of the proximal recess, or neck remnant) was observed in 30/37 patients (81.1%) in short-term follow-up (median, 6 months) and in 26/29 patients (89.7%) in midterm follow-up (median, 13 months). Worsening of the aneurysm occlusion...

  13. Endovascular treatment of experimental aneurysms in rabbits using Guglielmi detachable coils - a feasibility study

    International Nuclear Information System (INIS)

    The Guglielmi detachable coil (GDC) has been generally accepted for treatment of intracranial aneurysms. Preclinical testing of new coil developments requires animal models of aneurysms which imitate human aneurysms in size, configuration and neck morphology. We assessed in detail the technical requirements and steps for transfemoral treatment of experimentally induced aneurysms at the top of the brachiocephalic trunk (TBC) in rabbits. We created aneurysms in five rabbits by distal ligation and intraluminal incubation of the right common carotid artery with elastase. All animals were treated successfully 2-3 weeks after induction of the aneurysm, with dense packing of the coils. No complications related to the procedures occurred. The study demonstrates that our animal model can be a suitable method for testing the biocompatibility and occlusion rate of new embolic materials. (orig.)

  14. Cerebral haemodynamics in patients with hydrocephalus after subarachnoid haemorrhage due to ruptured aneurysm

    Energy Technology Data Exchange (ETDEWEB)

    Chang, Chia-Cheng; Kuwana, Nobumasa; Ito, Susumu; Yokoyama, Takaakira [Department of Neurosurgery, Yokohama Minami Kyosai Hospital, 1-21-1 Mutsuurahigashi, Kanazawa-ku, Yokohama (Japan); Kanno, Hiroshi; Yamamoto, Isao [Department of Neurosurgery, Yokohama City University School of Medicine, Yokohama (Japan)

    2003-01-01

    Cerebral blood flow (CBF) and cerebrovascular reactivity (CVR) may be reduced in patients with normal pressure hydrocephalus (NPH) after subarachnoid haemorrhage (SAH). However, little is known about brain circulation in asymptomatic patients with ventriculomegaly after SAH. This study investigated CBF and CVR in symptomatic and asymptomatic patients with ventriculomegaly to clarify the mechanism of NPH. CBF and CVR were investigated in 48 patients with ventriculomegaly after SAH due to ruptured aneurysm. Mean CBF of the whole brain was measured by first-pass radionuclide angiography using technetium-99m hexamethylpropylene amine oxime. CVR was measured as the percentage change from the baseline mean CBF value after administration of 500 mg acetazolamide. Thirty patients with NPH who responded to shunting had significantly (P<0.01) reduced mean CBF and CVR compared with normal controls. Fourteen asymptomatic patients with ventriculomegaly showed significant (P<0.01) reduction in CVR but no difference in mean CBF. Four symptomatic patients who did not respond to shunting showed significantly (P<0.01) reduced mean CBF but had preserved CVR. Postoperative mean CBF and CVR increased significantly (P<0.01) in 21 patients who responded to shunting, but showed no significant change in four symptomatic patients who did not respond to shunting. Reduction of CBF superimposed on pre-existing impairment of CVR may be an essential step in the mechanism responsible for the manifestation of symptoms of NPH. (orig.)

  15. Giant and complex aneurysms treatment with preservation of flow via bypass technique.

    Science.gov (United States)

    Thines, L; Proust, F; Marinho, P; Durand, A; van der Zwan, A; Regli, L; Lejeune, J-P

    2016-02-01

    Due to their anatomical characteristics and the complexity of the procedures required to obtain their complete occlusion, the treatment of giant intracranial aneurysms is a real challenge. Direct reconstructive strategies, whether by interventional neuroradiology (coils, stents) or microsurgical (clipping) means, are not always applicable and, in patients that would not tolerate parent or collateral artery sacrifice, the adjunction of a revascularization procedure using a bypass technique might be necessary. Cerebral arterial bypasses can be classified according to their function (3 types: flow replacement, flow reversal or protective), the branching mode of the graft used (3 types: pedicled, interpositional or in situ), the sites of anastomosis (2 types: extracranial-intracranial or intracranial-intracranial) and the class of flow they are supposed to provide (3 types: low-, intermediate- or high-flow). In this article, the authors review the different aspects in the management of patients with a giant intracranial aneurysm using a bypass: preoperative work-up, types of bypass and indications, surgical techniques and results.

  16. The pretzel sign: angiographic pattern of tortuous intra-aneurysmal blood flow in a giant serpentine aneurysm.

    LENUS (Irish Health Repository)

    Fanning, N F

    2012-02-03

    Giant serpentine aneurysms (GSAs) form a specific subgroup of giant cerebral aneurysms that have pathognomonic angiographic features. We report the angiographic findings of a GSA demonstrating a striking convoluted dynamic flow pattern, which we have called the \\'pretzel sign\\'. The aneurysm was successfully treated by permanent occlusion of the parent vessel using a detachable balloon. GSAs should be identified prior to treatment in view of their particular management requirements.

  17. Intracranial aneurysms and subarachnoid hemorrhage: Clinical studies on diagnosis and treatment

    OpenAIRE

    van der Jagt, Mathieu

    2006-01-01

    textabstractComputerized tomography angiography (CTA) can be performed quicker, safer and cheaper than digital subtraction angiography (DSA) in patients after aneurysmal subarachnoid hemorrhage (SAH). However, DSA is still regarded as the gold standard in the diagnosis of intracranial ruptured aneurysms. No studies have specifically addressed the value of CTA in planning of endovascular treatment of ruptured aneurysms. Mathieu van der Jagt investigates the diagnostic value of CTA for endovasc...

  18. The treatment of giant abdominal aorta aneurysm with endovascular stent-graf

    Directory of Open Access Journals (Sweden)

    Şeref Ulucan

    2012-09-01

    Full Text Available The usage of endovascular stent-graft in the treatment of abdominal aorta aneurysm has been increasing in the abdominal surgery. This paper presents the case of a patient with right iliac artery aneurysm who was treated with the application of endovascular stent-graft. J Clin Exp Invest 2012; 3 (3: 423-425Key words: Abdominal Aorta Aneurysm, EVAR, Stentgraft

  19. Subarachnoid Hemorrhage from a Dissecting Aneurysm of the Posterior Cerebral Artery in a Child : Rebleeding after Stent-Assisted Coiling Followed by Stent-Within-Stent Technique

    OpenAIRE

    Lee, Ji Yeoun; Kwon, Bae Ju; Kang, Hyun-Seung; Wang, Kyu-Chang

    2011-01-01

    Pediatric patients with dissecting aneurysms usually present with ischemia rather than bleeding. We report a case of a 15-year-old boy with a dissecting aneurysm of the posterior cerebral artery (PCA) presenting with hemorrhage. He was first treated with stent-assisted coil embolization, in an attempt to avoid trapping of the PCA and preserve the perforators. After the procedure, he recovered well from general anesthesia, but rebleeding occurred from the same lesion 6 hours after the procedur...

  20. Successful treatment of a ruptured flow-related aneurysm in a patient with hemangioblastoma: Case report and review of literature

    Directory of Open Access Journals (Sweden)

    Masanori Suzuki

    2014-01-01

    Full Text Available Background:  No cerebral aneurysms on the feeder associated with hemangioblastomas that ruptured before resection have been reported. We report a patient with a ruptured flow-related aneurysm associated with cerebellar hemangioblastoma and a tumor feeder treated simultaneously by a single procedure of embolization using N-butyl cyanoacrylate before tumor removal. Case Description: A 36-year-old female with a cerebellar tumor was admitted to our institute. Four days later, she suffered a massive subarachnoid hemorrhage mainly in the posterior fossa. Left vertebral angiograms showed an aneurysm on the feeding artery, posterior inferior cerebellar artery. Both the aneurysm and its main feeder were simultaneously treated by a single procedure of embolization using N-butyl cyanoacrylate. Their complete obliteration was confirmed angiographically. Four days after the procedure, we removed the tumor and the embolized aneurysm. The pathological diagnosis was hemangioblastoma and flow-related ruptured aneurysm. Conclusion: Cerebral angiography should be performed to rule out vascular abnormalities such as cerebral aneurysms adjacent to the tumor in patients with hemangioblastoma who present with intracranial hemorrhage. We emphasize the usefulness of embolization with N-butyl cyanoacrylate for hemangioblastoma with ruptured feeder aneurysm, by which the aneurysm and the feeder could be simultaneously embolized.

  1. Spontaneous Anterior Cerebral Artery Dissection Presenting with Simultaneous Subarachnoid Hemorrhage and Cerebral Infarction in a Patient with Multiple Extracranial Arterial Dissections

    OpenAIRE

    Park, Yung Ki; Yi, Hyeong-Joong; Lee, Young Jun; Kim, Young-Seo

    2013-01-01

    Simultaneous subarachnoid hemorrhage and infarction is a quite rare presentation in a patient with a spontaneous dissecting aneurysm of the anterior cerebral artery. Identifying relevant radiographic features and serial angiographic surveillance as well as mode of clinical manifestation, either hemorrhage or infarction, could sufficiently determine appropriate treatment. Enlargement of ruptured aneurysm and progressing arterial stenosis around the aneurysm indicates impending risk of subseque...

  2. Volume changes of extremely large and giant intracranial aneurysms after treatment with flow diverter stents

    Energy Technology Data Exchange (ETDEWEB)

    Carneiro, Angelo; Byrne, James V. [ohn Radcliffe Hospital, Oxford Neurovascular and Neuroradiology Research Unit, Nuffield Department of Surgical Sciences, Oxford (United Kingdom); Rane, Neil; Kueker, Wilhelm; Cellerini, Martino; Corkill, Rufus [John Radcliffe Hospital, Department of Neuroradiology, Oxford (United Kingdom)

    2014-01-15

    This study assessed volume changes of unruptured large and giant aneurysms (greatest diameter >20 mm) after treatment with flow diverter (FD) stents. Clinical audit of the cases treated in a single institution, over a 5-year period. Demographic and clinical data were retrospectively collected from the hospital records. Aneurysm volumes were measured by manual outlining at sequential slices using computerised tomography (CT) or magnetic resonance (MR) angiography data. The audit included eight patients (seven females) with eight aneurysms. Four aneurysms involved the cavernous segment of the internal carotid artery (ICA), three the supraclinoid ICA and one the basilar artery. Seven patients presented with signs and symptoms of mass effect and one with seizures. All but one aneurysm was treated with a single FD stent; six aneurysms were also coiled (either before or simultaneously with FD placement). Minimum follow-up time was 6 months (mean 20 months). At follow-up, three aneurysms decreased in size, three were unchanged and two increased. Both aneurysms that increased in size showed persistent endosaccular flow at follow-up MR; in one case, failure was attributed to suboptimal position of the stent; in the other case, it was attributed to persistence of a side branch originating from the aneurysm (similar to the endoleak phenomenon of aortic aneurysms). At follow-up, five aneurysms were completely occluded; none of these increased in volume. Complete occlusion of the aneurysms leads, in most cases, to its shrinkage. In cases of late aneurysm growth or regrowth, consideration should be given to possible endoleak as the cause. (orig.)

  3. Enhancing brain lesions after endovascular treatment of aneurysms

    DEFF Research Database (Denmark)

    Cruz, J P; Marotta, T; O'Kelly, C;

    2014-01-01

    Complications of endovascular therapy of aneurysms mainly include aneurysm rupture and thromboembolic events. The widespread use of MR imaging for follow-up of these patients revealed various nonvascular complications such as aseptic meningitis, hydrocephalus, and perianeurysmal brain edema. We...

  4. Magnesium therapy after aneurysmal subarachnoid haemorrhage a dose-finding study for long term treatment

    NARCIS (Netherlands)

    van den Bergh, W M; Albrecht, K W; Berkelbach van der Sprenkel, J W; Rinkel, G J E

    2003-01-01

    BACKGROUND: Magnesium is a neuroprotective agent which might prevent or reverse delayed cerebral ischemia (DCI) after aneurysmal subarachnoid haemorrhage (SAH). Although the dosage for short-term magnesium therapy is well established, there is lack of knowledge on the dosage for extended use of magn

  5. Dose evaluation for long-term magnesium treatment in aneurysmal subarachnoid haemorrhage

    NARCIS (Netherlands)

    van Norden, A G W; van den Bergh, W M; Rinkel, G J E

    2005-01-01

    BACKGROUND: Magnesium is a neuroprotective agent that might prevent or reverse delayed cerebral ischaemia after aneurysmal subarachnoid haemorrhage (SAH). We are presently running a randomized, placebo-controlled, double blind trial with magnesium sulphate (64 mmol/day intravenously). We studied whe

  6. Endovascular aneurysm repair versus open aneurysm repair: comparison of treatment outcome and procedure-related reintervention rate.

    NARCIS (Netherlands)

    Aarts, F.; Sterkenburg, S. van; Blankensteijn, J.D.

    2005-01-01

    We conducted a retrospective study to compare treatment outcome and procedure-related reintervention rates of endovascular aneurysm repair (EVAR) with those of open repair. Clinical and radiological data of patients treated at the Rijnstate Hospital (Arnhem, The Netherlands) for nonsymptomatic aorti

  7. Validation of a Metal Artifact Reduction Algorithm Using 1D Linear Interpolation for Cone Beam CT after Endovascular Coiling Therapy for Cerebral Aneurysms.

    Science.gov (United States)

    Yasuda, Mitsuyoshi; Yoshikawa, Kohki; Kato, Kyoichi; Sai, Shogo; Sakiyama, Koshi; Kobayashi, Yoshifumi; Oosawa, Miwa; Sato, Hisaya; Matsumoto, Hiroaki; Nakazawa, Yasuo

    2014-12-01

    This study aimed to evaluate the effect of a metal artifact reduction (MAR) algorithm using 1D linear interpolation on cone-beam CT (CBCT). We performed phantom and clinical qualitative studies with and without MAR application using 1D linear interpolation. In the phantom study, the standard deviation (SD) was estimated from the images obtained from the water phantom in which a metal coil was placed at the center, and observed the changes in the SDs before and after MAR application. In the clinical qualitative study, the clinical images after endovascular treatment (EVT) for cerebral aneurysms were visually evaluated before and after MAR application. In the phantom study, the SDs after MAR application decreased by 56 to 35% compared with that before MAR application. In the clinical qualitative study, the artifacts from the metal coil decreased or increased depending on locations, and the contrasts of gray matter and white matter were attenuated when MAR was applied. In conclusion, the metal artifact decreases when MAR using 1D linear interpolation is applied to cerebral CBCT. However, another artifacts increase or soft tissue contrast is changed in some cases. MAR largely contributes to the reduction of streaking artifacts, whereas it may induce cerebral parenchyma at distant metal body or quality deterioration of the image not including the metal body. This should be taken into account in the diagnosis of secondary hemorrhage or infarction. PMID:25489899

  8. Endovascular treatment of popliteal artery aneurysm. Early and midterm results

    Directory of Open Access Journals (Sweden)

    Rodrigo Borges Domingues

    2015-02-01

    Full Text Available OBJECTIVE: to evaluate the efficacy of endovascular repair of popliteal artery aneurysms on maintaining patency of the stent in the short and medium term. METHODS: this was a retrospective, descriptive and analytical study, conducted at the Integrated Vascular Surgery Service at the Hospital da Beneficência Portuguesa de São Paulo. We followed-up 15 patients with popliteal aneurysm, totaling 18 limbs, treated with stent from May 2008 to December 2012. RESULTS: the mean follow-up was 14.8 months. During this period, 61.1% of the stents were patent. The average aneurysm diameter was 2.5cm, ranging from 1.1 to 4.5cm. The average length was 5cm, ranging from 1.5 to 10 cm. In eight cases (47.1%, the lesion crossed the joint line, and in four of these occlusion of the prosthesis occurred. In 66.7% of cases, treatment was elective and only 33.3% were symptomatic patients treated on an emergency basis. The stents used were Viabahn (Gore in 12 cases (66.7%, Fluency (Bard in three cases (16.7%, Multilayer (Cardiatis in two cases (11.1% and Hemobahn (Gore in one case (5.6%. In three cases, there was early occlusion (16.6%. During follow-up, 88.2% of patients maintained antiplatelet therapy. There was no leakage at ultrasound (endoleak. No fracture was observed in the stents. CONCLUSION: the results of this study are similar to other published series. Probably, with the development of new devices that support the mechanical characteristics found on the thighs, there will be improved performance and prognosis of endovascular restoration.

  9. Calcium homeostasis during magnesium treatment in aneurysmal subarachnoid hemorrhage

    NARCIS (Netherlands)

    van den Bergh, Walter M.; van de Water, Jolanda M. W.; Hoff, Reinier G.; Algra, Ale; Rinkel, Gabriel J. E.

    2008-01-01

    Objective Magnesium treatment in patients with subarachnoid hemorrhage (SAH) can result in hypocalcemia; this hypocalcemia increases the risk of delayed cerebral ischemia (DCI) and poor outcome. We assessed whether low serum levels of total calcium in patients with SAH treated with magnesium is medi

  10. Treatment of popliteal artery aneurysms with the Hemobahn stent-graft

    NARCIS (Netherlands)

    Tielliu, IFJ; Verhoeven, ELG; Prins, TR; Post, WJ; Hulsebos, RG; van den Dungen, JJAM

    2003-01-01

    Purpose: To report a prospective study to ascertain the results of popliteal aneurysm treatment with a self-expanding stent-graft. Methods: In a recent 3-year period, 21 patients (18 men; median age 67 years, range 5282) with 23 popliteal aneurysms were treated with Hemobahn stent-grafts. Follow-up

  11. Surgical Treatment of A Dissecting Aneurysm of the Superior Cerebellar Artery: Case Report

    Directory of Open Access Journals (Sweden)

    Stefanescu Florin

    2014-10-01

    Full Text Available Dissecting aneurysm located in the peripheral region of the superior cerebellar artery is very rare. There is little experience regarding their surgical or endovascular treatment. We present the case of a peripheral dissecting superior cerebellar artery aneurysm treated by surgical clipping.

  12. Collected World and Single Center Experience With Endovascular Treatment of Ruptured Abdominal Aortic Aneurysms

    NARCIS (Netherlands)

    Veith, Frank J.; Lachat, Mario; Mayer, Dieter; Malina, Martin; Holst, Jan; Mehta, Manish; Verhoeven, Eric L. G.; Larzon, Thomas; Gennai, Stefano; Coppi, Gioacchino; Lipsitz, Evan C.; Gargiulo, Nicholas J.; van der Vliet, J. Adam; Blankensteijn, Jan; Buth, Jacob; Lee, W. Anthony; Biasi, Giorgio; Deleo, Gaetano; Kasirajan, Karthikeshwar; Moore, Randy; Soong, Chee V.; Cayne, Neal S.; Farber, Mark A.; Raithel, Dieter; Greenberg, Roy K.; van Sambeek, Marc R. H. M.; Brunkwall, Jan S.; Rockman, Caron B.; Hinchliffe, Robert J.

    2009-01-01

    Background: Case and single center reports have documented the feasibility and suggested the effectiveness of endovascular aneurysm repair (EVAR) of ruptured abdominal aortic aneurysms (RAAAs), but the role and value of such treatment remain controversial. Objective: To clarify these we examined a c

  13. Collected world and single center experience with endovascular treatment of ruptured abdominal aortic aneurysms.

    NARCIS (Netherlands)

    Veith, F.J.; Lachat, M.; Mayer, D.; Malina, M.; Holst, J.; Mehta, M.; Verhoeven, E.L.; Larzon, T.; Gennai, S.; Coppi, G.; Lipsitz, E.C.; Gargiulo, N.J.; Vliet, J.A. van der; Blankensteijn, J.D.; Buth, J.; Lee, W.A.; Biasiol, G.; Deleo, G.; Kasirajan, K.; Moore, R.; Soong, C.V.; Cayne, N.S.; Farber, M.A.; Raithel, D.; Greenberg, R.K.; Sambeek, M.R. van; Brunkwall, J.S.; Rockman, C.B.; Hinchliffe, R.J.

    2009-01-01

    BACKGROUND: Case and single center reports have documented the feasibility and suggested the effectiveness of endovascular aneurysm repair (EVAR) of ruptured abdominal aortic aneurysms (RAAAs), but the role and value of such treatment remain controversial. OBJECTIVE: To clarify these we examined a c

  14. Rescue microsurgery with bypass and stent removal following Pipeline treatment of a giant internal carotid artery terminus aneurysm.

    Science.gov (United States)

    Bowers, Christian A; Taussky, Philip; Park, Min S; Neil, Jayson A; Couldwell, William T

    2015-12-01

    We report the microsurgical rescue and removal of a Pipeline stent embolization of a giant internal carotid artery terminus aneurysm. After the initial placement of a Pipeline Embolization Device (PED), it migrated proximally to the cavernous carotid with the distal end free in the middle of the aneurysm, resulting in only partial aneurysm neck coverage. The patient underwent microsurgical rescue with trapping, bypass, and opening of the aneurysm with PED removal. The vessel remained patent in the proximal segment previously covered by the Pipeline stent. Microsurgical rescue for definitive aneurysm treatment with PED removal can be safe and effective for aneurysms unsuccessfully treated with PED.

  15. Giant aneurysm in 6 years old child - case report

    International Nuclear Information System (INIS)

    Intracranial saccular aneurysms rare in childhood is. Even among the reported series of childhood aneurysms, it is unusual to find their occurrence in children less than 7 years old. The pathogenesis of these lesions is also a matter of debate and speculations. The peak age of incidence of juvenile cerebral aneurysms appear to be 12 years, occurrence below the age of 7 being rarity. We show a case of 6 years old boy with giant aneurysm. found because of episodes of headache and vomiting. Discussion of pathogenesis for the rare pathology. After discussion of multidisciplinary team, of neuroradiologist and neurosurgeons was decided to be perform endovascular embolization, because of the better outcome for the patient. We performed endovascular treatment of the aneurysm with achieving total embolization. The patient recovery completely, and after 4 days went home. (authors) Key words: GIANT ANEURYSM. SACCULAR ANEURYSM. EMBOLIZATION. STENT ASSISTED COILING

  16. Basilar Artery Aneurysm at a Persistent Trigeminal Artery Junction

    Science.gov (United States)

    Aguiar, G.B.; Conti, M.L.M.; Veiga, J.C.E.; Jory, M.; Souza, R.B.

    2011-01-01

    Summary The trigeminal artery is an anastomosis between the embryonic precursors of the vertebrobasilar and carotid systems, and may persist into adult life. The association of the persistent primitive trigeminal artery (PTA) with cerebral aneurysm is well documented in the literature and, in general, aneurysms are located in the anterior circulation. We describe a patient who presented with a panencephalic Fisher III subarachnoid hemorrhage due to rupture of an intracranial aneurysm. Digital arteriography showed a saccular aneurysm in the middle third of the basilar artery, adjacent to the junction with a persistent trigeminal artery. She was submitted to endovascular treatment with embolization of the basilar artery aneurysm with coils. Aneurysms at the PTA junction with the basilar artery are rare. This paper describes a case of PTA associated with an aneurysm in the basilar artery at PTA junction and briefly reviews the literature. PMID:22005697

  17. Different CT perfusion algorithms in the detection of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage

    International Nuclear Information System (INIS)

    Tracer delay-sensitive perfusion algorithms in CT perfusion (CTP) result in an overestimation of the extent of ischemia in thromboembolic stroke. In diagnosing delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (aSAH), delayed arrival of contrast due to vasospasm may also overestimate the extent of ischemia. We investigated the diagnostic accuracy of tracer delay-sensitive and tracer delay-insensitive algorithms for detecting DCI. From a prospectively collected series of aSAH patients admitted between 2007-2011, we included patients with any clinical deterioration other than rebleeding within 21 days after SAH who underwent NCCT/CTP/CTA imaging. Causes of clinical deterioration were categorized into DCI and no DCI. CTP maps were calculated with tracer delay-sensitive and tracer delay-insensitive algorithms and were visually assessed for the presence of perfusion deficits by two independent observers with different levels of experience. The diagnostic value of both algorithms was calculated for both observers. Seventy-one patients were included. For the experienced observer, the positive predictive values (PPVs) were 0.67 for the delay-sensitive and 0.66 for the delay-insensitive algorithm, and the negative predictive values (NPVs) were 0.73 and 0.74. For the less experienced observer, PPVs were 0.60 for both algorithms, and NPVs were 0.66 for the delay-sensitive and 0.63 for the delay-insensitive algorithm. Test characteristics are comparable for tracer delay-sensitive and tracer delay-insensitive algorithms for the visual assessment of CTP in diagnosing DCI. This indicates that both algorithms can be used for this purpose. (orig.)

  18. Different CT perfusion algorithms in the detection of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage

    Energy Technology Data Exchange (ETDEWEB)

    Cremers, Charlotte H.P. [University Medical Center Utrecht, Department of Neurology and Neurosurgery, Room G03.232, Brain Center Rudolf Magnus Department of Neurology and Neurosurgery, PO Box 85500, Utrecht (Netherlands); University Medical Center Utrecht, Department of Radiology, Utrecht (Netherlands); Dankbaar, Jan Willem; Bennink, Edwin; Velthuis, Birgitta K.; Schaaf, Irene C. van der [University Medical Center Utrecht, Department of Radiology, Utrecht (Netherlands); Vergouwen, Mervyn D.I.; Rinkel, Gabriel J.E. [University Medical Center Utrecht, Department of Neurology and Neurosurgery, Room G03.232, Brain Center Rudolf Magnus Department of Neurology and Neurosurgery, PO Box 85500, Utrecht (Netherlands); Vos, Pieter C. [University Medical Center Utrecht, Image Sciences Institute, Utrecht (Netherlands)

    2015-05-01

    Tracer delay-sensitive perfusion algorithms in CT perfusion (CTP) result in an overestimation of the extent of ischemia in thromboembolic stroke. In diagnosing delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (aSAH), delayed arrival of contrast due to vasospasm may also overestimate the extent of ischemia. We investigated the diagnostic accuracy of tracer delay-sensitive and tracer delay-insensitive algorithms for detecting DCI. From a prospectively collected series of aSAH patients admitted between 2007-2011, we included patients with any clinical deterioration other than rebleeding within 21 days after SAH who underwent NCCT/CTP/CTA imaging. Causes of clinical deterioration were categorized into DCI and no DCI. CTP maps were calculated with tracer delay-sensitive and tracer delay-insensitive algorithms and were visually assessed for the presence of perfusion deficits by two independent observers with different levels of experience. The diagnostic value of both algorithms was calculated for both observers. Seventy-one patients were included. For the experienced observer, the positive predictive values (PPVs) were 0.67 for the delay-sensitive and 0.66 for the delay-insensitive algorithm, and the negative predictive values (NPVs) were 0.73 and 0.74. For the less experienced observer, PPVs were 0.60 for both algorithms, and NPVs were 0.66 for the delay-sensitive and 0.63 for the delay-insensitive algorithm. Test characteristics are comparable for tracer delay-sensitive and tracer delay-insensitive algorithms for the visual assessment of CTP in diagnosing DCI. This indicates that both algorithms can be used for this purpose. (orig.)

  19. Nursing cooperation in endovascular aneurysm repair treatment for aortic dissection

    International Nuclear Information System (INIS)

    Objective: To summarize the main points of nursing cooperation in endovascular aneurysm repair treatment for aortic dissection. Methods: Preoperative psychological care and the other preparations were carefully conducted. During the operation, the patient's body was correctly placed. Active cooperation with the performance of angiography and close observation during heparinization were carried out. The proper delivery of catheter and stent to the operator was carefully done. Close observation for the patient's vital signs, the renal function and the changes of limb blood supply were made. Results: Under close cooperation of' the operators, nurses, anesthesiologists and technicians, the surgery was successfully accomplished in 35 patients. The monitoring of vital signs during the entire performance of operation was well executed. No surgical instruments delivery error's or surgery failure due to unsuitable cooperation occurred. Conclusion: Perfect preoperative preparation, strict nursing cooperation and team cooperation are the key points to ensure a successful endovascular aneurysm repair for aortic dissection. (authors)

  20. Hemichorea-hemiballismus caused by postoperative hyperperfusion after clipping of a giant unruptured middle cerebral artery aneurysm

    Directory of Open Access Journals (Sweden)

    Soichi Oya

    2015-01-01

    Conclusion: This case appears consistent with the theory that the connecting fibers responsible for the development of HC-HB are also located in the frontal lobe. The treatment of giant aneurysms involving the M1 portion can cause abrupt hemodynamic changes in both frontal cortex and the basal ganglia, which can potentially induce postoperative movement disorders.

  1. Accuracy of computed tomography perfusion in detecting delayed cerebral ischemia following aneurysmal subarachnoid hemorrhage: A meta-analysis

    Directory of Open Access Journals (Sweden)

    Haogeng Sun

    2013-01-01

    Full Text Available Background and Purpose: In recent years, significant literature shows that computed tomography perfusion (CTP can provide sufficient information on cerebral hemodynamics and effectively indicate delayed cerebral ischemia (DCI before the development of infarction. We aimed at performing a meta-analysis to provide a more full and accurate evaluation of CTP and CTP parameters in detecting DCI in patients with aneurysmal subarachnoid hemorrhage. Materials and Methods: We searched the PubMed, MedLine, Embase and Cochrane databases for analysis published from February 2005 to February 2013. We extracted CTP parameters, including cerebral blood volume (CBV, cerebral blood flow (CBF, mean transit time (MTT, time to peak (TTP, interhemispheric ratios for CBV and CBF and interhemispheric differences for MTT and TTP. Pooled estimates of sensitivity, specificity, positive likelihood ratio (PLR, negative likelihood ratio (NLR, diagnostic odds ratio (DOR and the summary receiver-operating characteristic curve were determined. Results: Four research studies are met the inclusion criteria for the analysis. The pooled sensitivity, specificity, PLR, NLR and DOR of CTP for detecting the DCI were 82%, 82%, 4.56, 0.22 and 20.96, respectively. Through the evaluation of absolute CTP parameters, CBF and MTT showed diagnostic value for DCI, but CBF and TTP did not. Moreover, CBF ratio, MTT difference and TTP difference showed more diagnostic value than CBV ratio in DCI detection by the assessment of relative CTP parameters. Conclusions: As a non-invasive and short time consuming screening method, CTP own a high diagnostic value for the detection of DCI after aneurysm rupture.

  2. The treatment of isolated iliac artery aneurysm in patients with non-aneurysmal aorta

    OpenAIRE

    Dorigo, W.; PULLI, R.; N. TROISI; A. Alessi Innocenti; G. Pratesi; L. AZAS; C. Pratesi

    2008-01-01

    OBJECTIVES: The aim of the study was to evaluate early and mid-term results of surgical repair of isolated iliac artery aneurysm (IAA) in patients with non aneurysmal abdominal aorta. METHODS: From January 1996 to December 2006, 34 patients with IAA had elective surgery. In 32 cases open repair was performed. Two patients had endovascular repair using a tube endoprosthesis and internal iliac artery coil embolization. The diameters of the abdominal aorta and iliac arteries were measur...

  3. Pharmacological treatment in Dyskinetic Cerebral Palsy

    OpenAIRE

    Allori P; Pasquinelli A; Varrella A

    2012-01-01

    Evaluation of the effect of Levo-Sulpiride, Trazodone and combined treatment in 46 subjects affected by pure and mixed forms of Dyskinetic Cerebral Palsy. The results were assessed according to "Neuromotor Disorders Assessment Scale" (Papini et al, 1995, 1998; Allori et al 2006).

  4. CEREBRAL ARTERIOVENOUS MALFORMATIONS IN CHILDREN. ENDOVASCULAR TREATMENT

    OpenAIRE

    Scheglov, D.; Zagorodniy, V.

    2013-01-01

    The objective — to learn the features of the cerebral arteriovenous malformations (АVМ) endovascular treatment in children. Materials and methods. Totally 39 children with cerebral AVMs were treated at the center from 2005 to 2012. The average age of the patients (12.6 ± 1.2) years. It was found that the most of AVMs were occurred in temporoparietal subcortical area — 46.2 % cases. Results. Small size of AVMs were detected in 15.4 % of patients, the middle — in 33.3 %, the large — in 38.5 %, ...

  5. 脑动脉瘤破裂手术前后的脑灌注成像探讨%The study of cerebral perfusion imaging for the ruptured cerebral aneurysms before and after the operation

    Institute of Scientific and Technical Information of China (English)

    林怡; 段玉霞; 李瑞; 陈伟建; 吴楠; 童秋云; 王殊

    2013-01-01

    目的:通过CT灌注成像观察颅内动脉瘤破裂出血手术前后的脑血流变化,为临床后续治疗提供相关信息.方法:回顾性分析颅内动脉瘤破裂手术前、后临床资料44例.所选患者术前行CT血管成像(CTA)和CT灌注成像(CTP)检查,并于术后1周行CTP复查.分别测量前后两次CTP的大脑前动脉区(ACA区)、大脑中动脉区(MCA区)、大脑后动脉区(PCA区)及基底节区灌注值.结果:44例入选患者中,34例伪彩图肉眼可见好转,患者的ACA区、MCA区、PCA区及基底节区脑血流量(CBF)与平均通过时间(MTT)变化差异有统计学意义(P< 0.05);8例肉眼可见局部灌注减低区的MTT值均延长、CBF值减低;2例灌注值未见明显异常.所有患者的脑血容量(CBV)值变化差异均无统计学意义.结论:颅内动脉瘤破裂手术前及手术后存在脑灌注调整,视个体和病情各异,脑灌注也将发生相应的变化.%Objective:To provide relevant information for clinical follow-up treatment through the observation on cerebral hemodynamic changes of ruptured intracranial aneurysm before and after operation in the CT perfusion imaging.Methods:The retrospective analysis of the pre-and post-operative clinical data in 44 patients with ruptured cerebral aneurysms was performed.These patients underwent CTA and CTP examination simultaneously before surgery,followed by CTP examination after operation.Then the perfusion values of anterior cerebral arterial territory (ACA area),middle cerebral arterial territory (MCA area),posterior cerebral arterial territory (PCA area) and basal ganglia area were respectively measured.Results:Among the 44 patients,the pseudo-color images of 34 patients showed visible improvement.In these patients,there was a significant change (P<0.05) between CBF and MTT in ACA,MCA,PCA and basal ganglia area.In the decreased perfusion area of 8 patients,which was visible to the naked eye,the MTT value was extended,and the CBF value was

  6. Automated segmentation of cerebral vasculature with aneurysms in 3DRA and TOF-MRA using geodesic active regions: An evaluation study

    NARCIS (Netherlands)

    H. Bogunović; J.M. Pozo; M.C. Villa-Uriol; C.B.L.M. Majoie; R. van den Berg; H.A.F.G. van Andel; J.M. Macho; J. Blasco; L.S. Román; A.F. Frangi

    2011-01-01

    Purpose: To evaluate the suitability of an improved version of an automatic segmentation method based on geodesic active regions (GAR) for segmenting cerebral vasculature with aneurysms from 3D x-ray reconstruction angiography (3DRA) and time of flight magnetic resonance angiography (TOF-MRA) images

  7. 儿童颅内动脉瘤血管内治疗%Endovascular treatment for pediatric intracranial aneurysms

    Institute of Scientific and Technical Information of China (English)

    李德洋; 石义亭; 吕宪利; 姜除寒

    2009-01-01

    目的 报道儿童颅内动脉瘤血管内治疗的特征和血管内治疗的结果.方法 2002-2006年收治29例儿童动脉瘤患者(年龄<19岁);其中14例蛛网膜下腔出血,10例意外发现,2例脑神经麻痹,3例神经功能障碍.动脉瘤的位置:10个椎动脉动脉瘤,5个大脑中动脉瘤,4个大脑后动脉瘤,3个基底动脉动脉瘤,3个前交通动脉瘤,1个小脑后下动脉瘤,2个大脑前动脉瘤,1个颈内动脉动脉瘤.结果 7例动脉瘤行动脉瘤囊内弹簧圈栓塞,17例载瘤动脉闭塞(9例使用球囊闭塞载瘤动脉,8例使用弹簧圈载瘤动脉闭塞).1例椎动脉瘤病人全脑血管造影后4 d动脉瘤白发血栓形成.4例行支架或者支架辅助弹簧圈栓塞动脉瘤(其中2例基底动脉瘤患者死亡,2例动脉瘤栓塞后复发并再次给予栓塞治疗).平均随访20.7个月,93.1%的病人GOS评分4分或5分.结论 儿童颅内动脉瘤在发病特点上,男性比女性多见,好发部位是椎动脉、大脑后动脉和人脑中动脉.对于梭形动脉瘤行载瘤动脉闭寒是一种安全有效的治疗方法.基底动脉主十的梭形动脉瘤治疗困难而且死亡率高.%Objective To study the characteristics and therapeutic outcomes of pediatric intracranial aneurysms. Method From 2002 to 2006, 29 pediatric patients (age < 19 years) with intraeranial aneurysm were treated in our institute. Fourteen of 29 patients had SAH. In 10 patients, the aneurysm was an incidental finding. Two patients presented with cranial nerves dysfunction and 3 with neurological deficits. The location of aneurysms were as follows: vertebral artery(n = 5), posterior cerebral artery(n =4), basilar artery(n =3), anterior communicating artery(n =3) ,posterior inferior cerebellar artery (n = 1), anterior cerebral artery (n = 2), internal carotid artery (n = 1). Results Seven patients were treated with selective embolization with coils. Seventeen patients were treated with parent vessel occlusion(POV). Nine POV

  8. Perioperative Management of Intravascular Embolization for Cerebral Aneurysm%颅内动脉瘤介入治疗围术期处理的研究

    Institute of Scientific and Technical Information of China (English)

    傅军; 庄金满; 马晓娟; 隋玉洁; 李选; 韩金涛; 王昌明; 栾景源; 吕献军; 李天润; 曲雯; 冯琦琛

    2015-01-01

    Objective To explore perioperative management of intravascular embolization therapy for cerebral aneurysm . Methods From December 2002 to May 2013, 210 cases of intracranial aneurysm underwent intravascular embolization therapy .The measures of comprehensive perioperative management included dehydration , antispasmodic , cerebral resuscitation , fluid resuscitation , antiplatelet, and so on. Results A total of 195 patients with subarachnoid or cerebral hemorrhage underwent cerebral angiography and intravascular embolization for cerebral aneurysm ( in 1 patient with negative findings of initial angiography , a re-examination was given 2 days later and aneurysm was confirmed and successfully embolized ) .Eight patients died after the operation , and 4 patients suffered from complications and were disabled .Three patients with coma when admitted were fully recovered after the therapy .Follow-up reviews for 6-116 months (mean, 43.5 months) were conducted in 190 cases, including >36 months in 130 cases and >60 months in 90 cases.Postoperative re-examinations found newly emerging or relapse of aneurysm in 12 cases at 6 -12 months after operation, which were given a second intravascular embolization , the recurrence rate being 6.3% (12/190).The GOS was 4-5 points (mean, 4.6 points), and the mean GCS was 13 points (5 -15 points) preoperatively and 15 points postoperatively. Conclusions Cerebral angiography should be actively undertaken for subarachnoid hemorrhage , which is essential for the diagnosis and embolization treatment of cerebral aneurysm .Perioperative management , such as dehydration , lumber puncture , anti-spasm, and anti-platelet, speeds the patients ’ recovery and reduces the complications .%目的:探讨颅内动脉瘤栓塞治疗的围手术期处理措施。方法2002年12月~2013年5月对210例颅内动脉瘤行弹簧圈栓塞,围手术期行脱水、解痉、脑复苏、控制输液、抗血小板等治疗。结果195例急性蛛网膜下腔

  9. Correlation between plasma total nitric oxide levels and cerebral vasospasm and clinical outcome in patients with aneurysmal subarachnoid hemorrhage in Indian population

    Directory of Open Access Journals (Sweden)

    Shruthi Shimoga Ramesh

    2014-01-01

    Full Text Available Context: Cerebral vasospasm remains a major cause of morbidity and mortality in patients with aneurysmal subarachnoid hemorrhage (aSAH. Reduced bioavailability of nitric oxide has been associated with the development of cerebral vasospasm after aSAH. Such data is not available in Indian population. Aims: The objective of the study was to measure the plasma total nitric oxide (nitrite and nitrate-NOx level in aSAH patients and healthy controls treated at a tertiary hospital in India and to investigate a possible association between plasma total nitric oxide level and cerebral vasospasm and clinical outcome following treatment in patients with aSAH. Settings and Design: A case-control study of aSAH patients was conducted. Plasma total NOx levels were estimated in aSAH patients with and without vasospasm and compared the results with NOx levels in healthy individuals. Materials and Methods: aSAH in patients was diagnosed on the basis of clinical and neuro-imaging findings. Plasma total NOx levels in different subject groups were determined by Griess assay. Results: Plasma total NOx level was found to be significantly decreased in patients with aSAH when compared to controls. Plasma total NOx level in the poor-grade SAH group was lower than that in the good-grade SAH group. Plasma total NOx level further reduced in patients with angiographic (P < 0.05 and clinical vasospasm. Conclusions: Reduced plasma NOx level is seen in aSAH patients as compared to normal individuals. In aSAH patients reduced levels are associated with increased incidence of cerebral vasospasm and poor outcome. Plasma total NOx level could be used as a candidate biomarker for predicting vasospasm and outcome for this pathology.

  10. Osteopontin and Osteoprotegerin as Potential Biomarkers in Abdominal Aortic Aneurysm before and after Treatment.

    Science.gov (United States)

    Filis, Konstantinos; Martinakis, Vasilios; Galyfos, George; Sigala, Fragiska; Theodorou, Dimitris; Andreadou, Ioanna; Zografos, Georgios

    2014-01-01

    Aim. Although osteopontin (OPN) and osteoprotegerin (OPG) have been associated with abdominal aortic aneurysms (AAAs), no association of these two biomarkers with AAA surgical or endovascular treatment has been reported. Material and Methods. Seventy-four AAA patients were prospectively selected for open or endovascular repair. All aneurysms were classified (Types A-E) according to aneurysmal extent in CT imaging (EUROSTAR criteria). All patients had preoperative serum OPN and OPG values measurements and 1 week after the procedure. Preoperative and postoperative values were compared with a control group of twenty patients (inguinal hernia repair). Results. Preoperative OPN values in patients with any type of aneurysm were higher than in the control group, while OPG values showed no difference. Postoperative OPN values in AAA patients were higher than in the control group. OPN values increased after open surgery and after EVAR. OPG values increased after open surgery but not after EVAR. There was no difference in OPN/OPG values between EVAR and open surgery postoperatively. Conclusions. OPN values are associated with aneurysm presence but not with aneurysm extent. OPG values are not associated either with aneurysm presence or with aneurysm extent. OPN values increase after AAA repair, independently of the type of repair.

  11. Gamma Knife treatment for cerebral arteriovenous malformations.

    Science.gov (United States)

    Kemeny, Andras A; Radatz, Matthias W R; Rowe, Jeremy G; Walton, Lee; Vaughan, Paul

    2007-01-01

    One of the earliest indications for Gamma Knife treatment, radiosurgery for cerebral arteriovenous malformations, has stood the test of time. While initially only the ideal cases (small, compact nidus in a non-eloquent site) were chosen, increasingly larger, more complex AVMs were treated. Combination treatment with embolisation and surgery enables most lesions to be treated with success and remarkably low complication rate. This paper is a brief overview of the experience gained in Sheffield.

  12. Surgical treatment of an aneurysm of a distal branch of the renal artery.

    Science.gov (United States)

    Abdalla, Solafah; Pierret, Charles; Ba, Bakar; Mlynski, Amélie; de Kerangal, Xavier; Houlgatte, Alain

    2014-01-01

    Aneurysms of the renal artery and its branches are rare, but are associated with significant morbimortality due to the absence of clinical symptoms and hemorrhagic risk in the event of rupture. We report the case of a patient with an aneurysm of a distal branch of the right renal artery that measured 25 mm in diameter. The diagnosis and localization were obtained using selective arteriography. Treatment consisted of resection of the aneurysmal sac associated with closure with a saphenous vein patch rather than an endovascular treatment in order to preserve the nephronic capital. Right renal parenchymatous vascularization was satisfactory on arterial echo-Doppler and angioscanner assessment at 1 year.

  13. Developing a new endograft for the treatment of juxtarenal aortic aneurysms: definition and experimentation

    Directory of Open Access Journals (Sweden)

    Sergio Q. Belczak

    2015-06-01

    Full Text Available OBJECTIVES: To analyze angiotomographic parameters of juxtarenal aneurysms to assess the applicability of an endograft model to patients and to create in vitro and in vivo models to assess the new endograft. METHODS: A total of 49 patients with juxtarenal aneurysms were submitted to angiotomographic evaluation, and parameters such as the aortic diameter, the length of the neck, and the angulations of the celiac trunk, superior mesenteric artery and renal arteries; the distances between them; and anatomic variations were analyzed. Based on these parameters, an endograft model was developed and tested in a newly created in vitro model of juxtarenal aneurysm. An experimental model of juxtarenal aneurysm was then established in six pigs weighing 50-60 kg to assess the new endograft model. RESULTS: The angiotomographic parameters of juxtarenal aneurysm measured in this study were similar to those reported in the literature and allowed the development of an endograft based on the hourglass concept, which was applicable to 85.8% of the patients. The in vitro model of juxtarenal aneurysm evidenced good radiopacity and functionality and permitted adjustments in the new device and technical improvements in the procedures for treating these aneurysms. In addition, the porcine model of juxtarenal aneurysm was successfully created in all six animals using a bovine pericardial patch, and use of the new endograft in three pilot procedures evidenced its feasibility. CONCLUSIONS: The Hourglass endograft was rendered applicable to treatment of the majority of patients with juxtarenal aneurysms simply by changing its diameter. Moreover, the new in vitro and in vivo models were shown to be effective for assessing both the presented endograft and experiments assessing the endovascular treatment of juxtarenal aneurysms.

  14. Endovascular repair:alternative treatment of ruptured abdominal aortic aneurysm

    Institute of Scientific and Technical Information of China (English)

    GUO Wei; ZHANG Hong-peng; LIU Xiao-ping; YIN Tai; JIA Xin; LIANG Fa-qi; ZHANG Guo-hua

    2009-01-01

    Background As an alternative to open aneurysm repair,endovascular aortic repair(EVAR)has been applied to ruptured abdominal aortic aneurysm(rAAA).The aim of this study was to evaluate the immediate and long-term outcomes of EVAR for rAAA.Methods From July 1997 to September 2007,20 men and six women with rAAA(median age,68 years)were treated with EVAR.Most patients with suspected rAAA underwent emergency computed tomographic angiography(CTA).The procedure was performed under general or local anesthesia.Endovascular clamping was attempted in hemodynamically unstable patients.Bifurcated endografts and aorto-uni-iliac(AUI)endografts with crossover bypass were used.Patients had CT scan prior to discharge,3,6,12 months after discharge,and annually thereafter.Results Time between diagnosis and EVAR ranged from 1 hour to 5 days.EVAR was performed under general anesthesia in 21 patients,and under local anesthesia in five patients.Endovascular aortic clamping was performed in four patients.There was no conversion to open surgery during EVAR.Stent-graft insertion was successful in all patients.One patient died during EVAR from acute myocardial infarction.Ten patients had systolic blood pressure<80 mm Hg.Eleven patients received a blood transfusion.Mean aneurysm size was(47c12)mm.Mean ICU stay was(8±3)days,mean hospital stay(18±6)days,and mean procedure time(120±32)minutes.The 30-day mortality was 23%(6/26patients),and major morbidity 35%(9/26 patients).Early endoleak occurred in 8/26 patients(31%).The mean follow-up was(18±7)months.No patient demonstrated migration of the stent-graft.Conclusions EVAR is a safe and effective option for treatment of acute rAAA,independent of the patient's general condition.Immediate and mid-term outcomes are favorable,but long-term outcome is unknown.Multi-center studies are necessary to establish the role of EVAR for rAAA.

  15. Endovascular treatment of experimentally induced aneurysms in rabbits using stents: a feasibility study

    International Nuclear Information System (INIS)

    Although Guglielmi detachable coil (GDC) systems have been generally accepted for treatment of intracranial aneurysms, primary stenting of aneurysms using porous stents or implantation of coils after stent placement remains experimental. Testing of these new methods requires an animal model which imitates human aneurysms in size, configuration and neck morphology. We assessed in detail the technical requirements of and steps for transfemoral stent treatment of experimentally induced aneurysms at the top of the brachiocephalic trunk in rabbits. We created aneurysms in ten rabbits by distal ligation and intraluminal digestion of the right common carotid artery with elastase. We treated five animals with porous stents alone, and five with stents plus coiling via the meshes of the stent, which permitted dense packing of coils. No complications related to the procedures occurred. In all animals, even in those treated solely with porous stents, total occlusion of the aneurysm was achieved. Our animal model can be suitable for testing the biocompatibility and occlusion rate of new methods and devices for the treatment of experimental aneurysms. (orig.)

  16. Correlation between Hemodynamics and Treatment Outcome of Intracranial Aneurysms after Intervention with Flow Diverters

    Science.gov (United States)

    Paliwal, Nikhil; Damiano, Robert; Davies, Jason; Siddiqui, Adnan; Meng, Hui

    2015-11-01

    Endovascular intervention by Flow Diverter (FD) - a densely woven stent - occludes an aneurysm by inducing thrombosis in the aneurysm sac and reconstructing the vessel. Hemodynamics plays a vital role in the thrombotic occlusion of aneurysms and eventual treatment outcome. CFD analysis of pre- and post-treatment aneurysms not only provides insight of flow modifications by FD, but also allows investigation of interventional strategies and prediction of their outcome. In this study 80 patient-specific aneurysms treated with FDs were retrospectively studied to evaluate the effect of intervention. Out of these cases, 16 required retreatment and thus are considered as having unfavorable outcome. Clinical FD deployment in these cases was simulated using an efficient virtual stenting workflow. CFD analysis was carried out on both pre- and post-treatment cases, and changes in hemodynamic parameters were calculated. Support vector machine algorithm was used to correlate the hemodynamic changes with outcome. Results show that cases having higher flow reduction into the aneurysmal sac have a better likelihood of occlusion. This suggests that changes in hemodynamics can be potentially used to predict the outcome of different clinical intervention strategies in aneurysms. This work was supported by the National Institutes of Health (R01 NS091075).

  17. Safety and efficacy of aneurysm treatment with WEB: results of the WEBCAST study.

    Science.gov (United States)

    Pierot, Laurent; Costalat, Vincent; Moret, Jacques; Szikora, Istvan; Klisch, Joachim; Herbreteau, Denis; Holtmannspötter, Markus; Weber, Werner; Januel, Anne-Christine; Liebig, Thomas; Sychra, Vojtech; Strasilla, Christoph; Cognard, Christophe; Bonafé, Alain; Molyneux, Andrew; Byrne, James V; Spelle, Laurent

    2016-05-01

    OBJECT WEB is an innovative intrasaccular treatment for intracranial aneurysms. Preliminary series have shown good safety and efficacy. The WEB Clinical Assessment of Intrasaccular Aneurysm Therapy (WEBCAST) trial is a prospective European trial evaluating the safety and efficacy of WEB in wide-neck bifurcation aneurysms. METHODS Patients with wide-neck bifurcation aneurysms for which WEB treatment was indicated were included in this multicentergood clinical practices study. Clinical data including adverse events and clinical status at 1 and 6 months were collected and independently analyzed by a medical monitor. Six-month follow-up digital subtraction angiography was also performed and independently analyzed by a core laboratory. Success was defined at 6 months as complete occlusion or stable neck remnant, no worsening in angiographic appearance from postprocedure, and no retreatment performed or planned. RESULTS Ten European neurointerventional centers enrolled 51 patients with 51 aneurysms. Treatment with WEB was achieved in 48 of 51 aneurysms (94.1%). Adjunctive implants (coils/stents) were used in 4 of 48 aneurysms (8.3%). Thromboembolic events were observed in 9 of 51 patients (17.6%), resulting in a permanent deficit (modified Rankin Scale [mRS] Score 1) in 1 patient (2.0%). Intraoperative rupture was not observed. Morbidity (mRS score > 2) and mortality were 2.0% (1 of 51 patients, related to rupture status on entry to study) and 0.0% at 1 month, respectively. Success was achieved at 6 months in 85.4% of patients treated with WEB: 23 of 41 patients (56.1%) had complete occlusion, 12 of 41 (29.3%) had a neck remnant, and 6 of 41 (14.6%) had an aneurysm remnant. CONCLUSIONS The WEBCAST study showed good procedural and short-term safety of aneurysm treatment with WEB and good 6-month anatomical results.

  18. Surgical treatment of complex aneurysms and thoracic aortic dissections with the Frozen Elephant Trunk technique

    Directory of Open Access Journals (Sweden)

    Ricardo Ribeiro Dias

    2015-04-01

    Full Text Available AbstractObjective:Report initial experience with the Frozen Elephant Trunk technique.Methods:From July 2009 to October 2013, Frozen Elephant Trunk technique was performed in 21 patients (66% male, mean age 56 ±11 years. They had type A aortic dissection (acute 9.6%, chronic 57.3%, type B (14.3%, all chronic and complex aneurysms (19%. It was 9.5% of reoperations and 38% of associated procedures (25.3% miocardial revascularization, 25.3% replacement of aortic valve and 49.4% aortic valved graft. Aortic remodeling was evaluated comparing preoperative and most recent computed tomography scans. One hundred per cent of complete follow-up, mean time of 28 months.Results:In-hospital mortality of 14.2%, being 50% in acute type A aortic dissection, 8.3% in chronic type A aortic dissection, 33.3% in chronic type B aortic dissection and 0% in complex aneurysms. Mean times of cardiopulmonary bypass (152±24min, myocardial ischemia (115±31min and selective cerebral perfusion (60±15min. Main complications were bleeding (14.2%, spinal cord injury (9.5%, stroke (4.7%, prolonged mechanical ventilation (4.7% and acute renal failure (4.7%. The need for second-stage operation was 19%. False-lumen thrombosis was obtained in 80%.Conclusion:Frozen Elephant Trunk is a feasible technique and should be considered. The severity of the underlying disease justifies high mortality rates. The learning curve is a reality. This approach allows treatment of more than two segments at once. Nonetheless, if a second stage is made necessary, it is facilitated.

  19. Quality Improvement Guidelines for Imaging Detection and Treatment of Endoleaks following Endovascular Aneurysm Repair (EVAR)

    Energy Technology Data Exchange (ETDEWEB)

    Rand, T., E-mail: Thomas.Rand@wienkav.at [General Hospital Hietzing, Department of Radiology (Austria); Uberoi, R. [John Radcliffe Hospital, Department of Radiology (United Kingdom); Cil, B. [Hacettepe University Hospitals, Department of Interventional Radiology (Turkey); Munneke, G. [St George' s Hospital, Department of Interventional Radiology (United Kingdom); Tsetis, D. [University Hospital of Heraklion, Medical School of Crete, Department of Radiology (Greece)

    2013-02-15

    Major concerns after aortic aneurysm repair are caused by the presence of endoleaks, which are defined as persistent perigraft flow within the aortic aneurysm sac. Diagnosis of endoleaks can be performed with various imaging modalities, and indications for treatment are based on further subclassifications. Early detection and correct classification of endoleaks are crucial for planning patient management. The vast majority of endoleaks can be treated successfully by interventional means. Guidelines for Imaging Detection and Treatment of endoleaks are described in this article.

  20. The role of extra- and intracranial bypass in the treatment of complex aneurysms.

    Science.gov (United States)

    Cenzato, Marco; Bortolotti, Carlo

    2016-03-01

    The availability of flow diverters and new endovascular techniques has greatly reduced the need and indications for bypass surgery. Nevertheless, there are situations where a bypass is the best option for a complex cerebrovascular problem. Generally, typical indications are giant aneurysms with a wide neck and/or partially calcified aneurysms with main branches or perforating arteries arising directly from the sac or from the neck itself, or fusiform aneurysms, partially calcified aneurysms. In this paper we discuss the following issues as they apply to the modern use of bypass techniques. In case of fusiform aneurysms involving the proximal bifurcations of the media or the internal carotid artery combined and coordinated evaluations and efforts by a team which includes neurosurgeons and endovascular specialists is essential. Treatment with bypass alone may not be sufficient and the combination of one or more bypasses with an endovascular treatment of occlusion, partial aneurysm embolization or flow diversion may be the best strategy. Addressing complex and fusiform aneurysm surgery requires a problem solving attitude and in this lies both the challenging and the fun side of this surgery. PMID:26947783

  1. Treatment of distal internal carotid artery aneurysm with the willis covered stent: a prospective pilot study

    International Nuclear Information System (INIS)

    Objective: To evaluate the flexibility and efficacy of the Willis covered stent in the treatment of distal internal carotid artery (DICA) aneurysms. Methods: The study was approved by the authors' institutional review board, and the research was conducted by the authors' institution and the MicroPort Medical Company (Shanghai, China). Thirty-one patients with 33 DICA aneurysms were considered for treatment with a Willis covered stent. The angiographic assessments were categorized as complete or incomplete occlusion. The data on technical success, initial and final angiographic results, mortality, morbidity, and final clinical outcome were collected, and follow-up was performed at 1, 3, 6, and 12 months and yearly after the procedures. Results: Navigation and deployment of the covered stents were successful in 97.6% (41 of 42; 95% confidence interval [CI]: 93%, 102%) of the attempted stent placement procedures. The initial angiographic results showed a complete occlusion in 23 patients with 25 aneurysms (of 32 aneurysms, 78.1% [95% CI: 63%, 93%]) and an incomplete occlusion in seven patients with seven aneurysms (21.9%). The angiographic follow-up (mean, 14 months [95% CI: 12, 15 months]) findings exhibited a complete occlusion in 27 patients with 29 aneurysms (of 31 aneurysms, 93.5% [95% CI: 84%, 103%]) and an incomplete occlusion in two aneurysms (6.5%), with a mild in-stent stenosis in two patients.The clinical follow-up (mean, 27 months [95% CI: 23, 30 months]) demonstrated that 15 patients experienced a full recovery and 14 patients improved. Conclusion: The preliminary results demonstrate good flexibility and efficacy of the Willis covered stent in the treatment of DICA aneurysms in selected patients; longer follow-up and expanded clinical trials are needed. (authors)

  2. Computational fluid dynamics study of bifurcation aneurysms treated with pipeline embolization device: side branch diameter study

    OpenAIRE

    Tang, Abraham Yik-Sau; Chung, Wai-Choi; Liu, Eric Tian-Yang; Qu, Jie-Qiong; Tsang, Anderson Chun-On; Leung, Gilberto Ka-Kit; Leung, Kar-Ming; Yu, Alfred Cheuk-Hang; Chow, Kwok-Wing

    2015-01-01

    An intracranial aneurysm, abnormal swelling of the cerebral artery, may lead to undesirable rates of mortality and morbidity upon rupture. Endovascular treatment involves the deployment of a flow-diverting stent that covers the aneurysm orifice, thereby reducing the blood flow into the aneurysm and mitigating the risk of rupture. In this study, computational fluid dynamics analysis is performed on a bifurcation model to investigate the change in hemodynamics with various side branch diameters...

  3. Successful treatment of a ruptured flow-related aneurysm in a patient with hemangioblastoma: Case report and review of literature

    OpenAIRE

    Masanori Suzuki; Katsuya Umeoka; Shushi Kominami; Akio Morita

    2014-01-01

    Background:  No cerebral aneurysms on the feeder associated with hemangioblastomas that ruptured before resection have been reported. We report a patient with a ruptured flow-related aneurysm associated with cerebellar hemangioblastoma and a tumor feeder treated simultaneously by a single procedure of embolization using N-butyl cyanoacrylate before tumor removal. Case Description: A 36-year-old female with a cerebellar tumor was admitted to our institute. Four days later, she suffered a m...

  4. Uso de dexmedetomidina em anestesia geral para tratamento cirúrgico de aneurisma cerebral, em paciente gestante, portadora de doença hipertensiva específica da gestação: relato de caso Uso de dexmedetomidina en anestesia general para tratamiento quirúrgico de aneurisma cerebral, en paciente embarazada, portadora de enfermedad hipertensiva específica del embarazo: relato de caso Dexmedetomidine in general anesthesia for surgical treatment of cerebral aneurysm in pregnant patient with specific hypertensive disease of pregnancy: case report

    Directory of Open Access Journals (Sweden)

    Kleber Machareth de Souza

    2005-04-01

    dexmedetomidina (0,7 µg.kg-1.min-1. La cirugía fue realizada sin cualquier acontecimiento, no habiendo secuela neurológica subyacente. CONCLUSIONES: El presente caso mostró que el uso de la dexmedetomidina posibilitó un adecuado manoseo hemodinámico, manteniendo optimizado el flujo sanguíneo útero-placentario y la vitalidad fetal. Se resaltan aún las condiciones adecuadas de manipulación quirúrgica del tejido cerebral, así como la ausencia de influencia en la morbidad después del procedimiento anestésico-quirúrgico.BACKGROUND AND OBJECTIVES: The incidence of non-obstetrical surgeries in pregnant patients is about 0.36% to 2%. However, surgeries aiming at surgical treatment of cerebral aneurysm in pregnant women are extremely rare. Specific hypertensive disease of pregnancy, shows clinical prevalence of 10%. It is a disease with high clinical complexity compromising multiple organs and systems. Dexmedetomidine, alpha2-adrenoceptor agonist drug, in therapeutic clinical doses has major selectivity for these receptors and promotes suitable hemodynamic stability if used in the preoperative period. The purpose of this report was to present an anesthetic technique able to provide adequate maintenance of maternal homeostasis, preserving to the highest level uterus-placental blood flow and fetal vitality, without neglecting fundamental aspects regarding the optimization of brain oxygen supply/demand ratio and favorable brain tissue conditions for surgical management. CASE REPORT: Pregnant patient, 19 years old, 27 weeks of gestation, was referred to the operating room for surgical treatment of cerebral aneurysm. In the preoperative period she was conscious, oriented, eupneic but with left side motor deficit and clinical signs compatible with toxemia of pregnancy. Dexmedetomidine (1 µg.kg-1.h-1 was administered in 20 minutes, followed by anesthetic induction with propofol (2.5 mg.kg-1, fentanyl (7.5 µg.kg-1, lidocaine (1 mg.kg-1 and rocuronium (1.2 mg.kg-1 in rapid

  5. A computerised relational database for auditing endovascular treatment of patients with intracranial aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Sohn, M.J.; Byrne, J.V. [Dept. of Neuroradiology, University of Oxford (United Kingdom)

    2000-10-01

    We describe the development and design of a database for auditing patients with intracranial aneurysms and their endovascular treatment. The database has been used since 1992. Our department's version now contains records of over 800 patients and well over 1000 aneurysms. The advantages of a relational database for this type of audit are discussed. Copies of the software can be obtained free of charge from the authors. (orig.)

  6. Non-enhanced MR imaging of cerebral aneurysms: 7 Tesla versus 1.5 Tesla.

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    Karsten H Wrede

    Full Text Available PURPOSE: To prospectively evaluate 7 Tesla time-of-flight (TOF magnetic resonance angiography (MRA in comparison to 1.5 Tesla TOF MRA and 7 Tesla non-contrast enhanced magnetization-prepared rapid acquisition gradient-echo (MPRAGE for delineation of unruptured intracranial aneurysms (UIA. MATERIAL AND METHODS: Sixteen neurosurgical patients (male n = 5, female n = 11 with single or multiple UIA were enrolled in this trial. All patients were accordingly examined at 7 Tesla and 1.5 Tesla MRI utilizing dedicated head coils. The following sequences were obtained: 7 Tesla TOF MRA, 1.5 Tesla TOF MRA and 7 Tesla non-contrast enhanced MPRAGE. Image analysis was performed by two radiologists with regard to delineation of aneurysm features (dome, neck, parent vessel, presence of artifacts, vessel-tissue-contrast and overall image quality. Interobserver accordance and intermethod comparisons were calculated by kappa coefficient and Lin's concordance correlation coefficient. RESULTS: A total of 20 intracranial aneurysms were detected in 16 patients, with two patients showing multiple aneurysms (n = 2, n = 4. Out of 20 intracranial aneurysms, 14 aneurysms were located in the anterior circulation and 6 aneurysms in the posterior circulation. 7 Tesla MPRAGE imaging was superior over 1.5 and 7 Tesla TOF MRA in the assessment of all considered aneurysm and image quality features (e.g. image quality: mean MPRAGE7T: 5.0; mean TOF7T: 4.3; mean TOF1.5T: 4.3. Ratings for 7 Tesla TOF MRA were equal or higher over 1.5 Tesla TOF MRA for all assessed features except for artifact delineation (mean TOF7T: 4.3; mean TOF1.5T 4.4. Interobserver accordance was good to excellent for most ratings. CONCLUSION: 7 Tesla MPRAGE imaging demonstrated its superiority in the detection and assessment of UIA as well as overall imaging features, offering excellent interobserver accordance and highest scores for all ratings. Hence, it may bear the potential to serve as a

  7. A primitive study of voxel feature generation by multiple stacked denoising autoencoders for detecting cerebral aneurysms on MRA

    Science.gov (United States)

    Nemoto, Mitsutaka; Hayashi, Naoto; Hanaoka, Shouhei; Nomura, Yukihiro; Miki, Soichiro; Yoshikawa, Takeharu; Ohtomo, Kuni

    2016-03-01

    The purpose of this study is to evaluate the feasibility of a novel feature generation, which is based on multiple deep neural networks (DNNs) with boosting, for computer-assisted detection (CADe). It is hard and time-consuming to optimize the hyperparameters for DNNs such as stacked denoising autoencoder (SdA). The proposed method allows using SdA based features without the burden of the hyperparameter setting. The proposed method was evaluated by an application for detecting cerebral aneurysms on magnetic resonance angiogram (MRA). A baseline CADe process included four components; scaling, candidate area limitation, candidate detection, and candidate classification. Proposed feature generation method was applied to extract the optimal features for candidate classification. Proposed method only required setting range of the hyperparameters for SdA. The optimal feature set was selected from a large quantity of SdA based features by multiple SdAs, each of which was trained using different hyperparameter set. The feature selection was operated through ada-boost ensemble learning method. Training of the baseline CADe process and proposed feature generation were operated with 200 MRA cases, and the evaluation was performed with 100 MRA cases. Proposed method successfully provided SdA based features just setting the range of some hyperparameters for SdA. The CADe process by using both previous voxel features and SdA based features had the best performance with 0.838 of an area under ROC curve and 0.312 of ANODE score. The results showed that proposed method was effective in the application for detecting cerebral aneurysms on MRA.

  8. Abdominal aortic aneurysm: Treatment options, image visualizations and follow-up procedures

    Institute of Scientific and Technical Information of China (English)

    Zhong-Hua Sun

    2012-01-01

    Abdominal aortic aneurysm is a common vascular disease that affects elderly population.Open surgical repair is regarded as the gold standard technique for treatment of abdominal aortic aneurysm,however,endovaseular aneurysm repair has rapidly expanded since its first introduction in 1990s.As a less invasive technique,endovascular aneurysm repair has been confirmed to be an effective alternative to open surgical repair,especially in patients with co-morbid conditions.Computed tomography (CT) angiography is currently the preferred imaging modality for both preoperative planning and post-operative follow-up.2D CT images are complemented by a number of 3D reconstructions which enhance the diagnostic applications of CT angiography in both planning and follow-up of endovascular repair.CT has the disadvantage of high cummulative radiation dose,of particular concern in younger patients,since patients require regular imaging follow-ups after endovascular repair,thus,exposing patients to repeated radiation exposure for life.There is a trend to change from CT to ultrasound surveillance of endovascular aneurysm repair.Medical image visualizations demonstrate excellent morphological assessment of aneurysm and stent-grafts,but fail to provide hemodynamic changes caused by the complex stent-graft device that is implanted into the aorta.This article reviews the treatment options of abdominal aortic aneurysm,various image visualization tools,and follow-up procedures with use of different modalities including both imaging and computational fluid dynamics methods.Future directions to improve treatment outcomes in the follow-up of endovascular aneurysm repair are outlined.

  9. Mitral endocarditis due to Rothia aeria with cerebral haemorrhage and femoral mycotic aneurysms, first French description.

    Science.gov (United States)

    Collarino, R; Vergeylen, U; Emeraud, C; Latournèrie, G; Grall, N; Mammeri, H; Messika-Zeitoun, D; Vallois, D; Yazdanpanah, Y; Lescure, F-X; Bleibtreu, A

    2016-09-01

    Rothia aeria is a Rothia species from the Micrococcaceae family. We report here the first French R. aeria endocarditis complicated by brain haemorrhage and femoral mycotic aneurysms. Altogether, severity and antimicrobial susceptibility should make us consider the management of R. aeria endocarditis as Staphylococcus aureus methicillin-susceptible endocarditis. PMID:27408740

  10. Mitral endocarditis due to Rothia aeria with cerebral haemorrhage and femoral mycotic aneurysms, first French description

    Directory of Open Access Journals (Sweden)

    R. Collarino

    2016-09-01

    Full Text Available Rothia aeria is a Rothia species from the Micrococcaceae family. We report here the first French R. aeria endocarditis complicated by brain haemorrhage and femoral mycotic aneurysms. Altogether, severity and antimicrobial susceptibility should make us consider the management of R. aeria endocarditis as Staphylococcus aureus methicillin-susceptible endocarditis.

  11. Stent implantation for the treatment of wide-necked aneurysms located at internal carotid artery bifurcation

    International Nuclear Information System (INIS)

    Objective: To preliminarily evaluate the feasibility, safety and efficacy of stent placement for the treatment of wide-necked aneurysms located at internal carotid artery bifurcation. Methods: Eleven patients with wide-necked aneurysms located at internal carotid artery bifurcation, who were encountered during the period from Jan. 2004 to Dec. 2010 in hospital, were collected. A total of 16 intracranial aneurysms were detected, of which 11 were wide-necked and were located at internal carotid artery bifurcation. The diameters of the aneurysms ranged from 2.5 mm to 18 mm. Individual stent type and stenting technique was employed for each patient. Follow-up at 1, 3, 6 and 12 months after the procedure was conducted. Results: A total of 11 different stents were successfully deployed in the eleven patients. The stents included balloon expandable stent (n=1) and self-expanding stent (n=10). According to Raymond grading for the immediate occlusion of the aneurysm, grade Ⅰ (complete obliteration) was obtained in 4, grade Ⅱ (residual neck) in 2 and grade Ⅲ (residual aneurysm) in 5 cases. No procedure-related complications occurred. At the time of discharge, the modified Rankin score was 0-1 in the eleven patients. During the follow-up period lasting for 1-108 months, all the patients were in stable condition and no newly-developed neurological dysfunction or bleeding observed. Follow-up examination with angiography (1-48 months) showed that the aneurysms were cured (no visualization) in 4 cases, improved in 2 cases and in stable condition in one case. Conclusion: For the treatment of wide-necked aneurysms located at internal carotid artery bifurcation, stent implantation is clinically feasible, safe and effective. Further studies are required to evaluate its long-term efficacy. (authors)

  12. Papaverine is a confounding factor in neurological assessment after cerebral aneurysm clipping: Report of three cases and review of the literature

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    Veena Sheshadri

    2016-01-01

    Full Text Available Intracisternal papaverine instillation is being used across many centers after cerebral aneurysm clipping to prevent and treat cerebral vasospasm. Pupillary dilatation secondary to papaverine can interfere with the neurological assessment postoperatively. This report describes pupillary changes in three patients following the papaverine application after craniotomy and aneurysm clipping, with one patient developing contralateral pupillary dilatation and the other two having bilateral pupillary dilatation. The pupillary changes resolved over 30 min to 4 h postoperatively. We conclude that pupillary changes following papaverine instillation could be a transient phenomenon and should not be considered ominous in absence of new onset neurological deficits. Intraoperative somatosensory evoked potential monitoring also helped in postoperative decision making in all our cases.

  13. [Increased urinary sodium excretion in the early phase of aneurysmal subarachnoid hemorrhage as a predictor of cerebral salt wasting syndrome].

    Science.gov (United States)

    Nakagawa, Ichiro; Kurokawa, Shinichiro; Takayama, Katsutoshi; Wada, Takeshi; Nakase, Hiroyuki

    2009-12-01

    Cerebral salt wasting syndrome (CSWS) in patients with aneurysmal subarachnoid hemorrhage (SAH) is considered to correlate with delayed ischemic neurological deficits (DIND) induced by cerebral vasospasm; however, its exact mechanism is still not well-known. The purpose of the present study is to evaluate the relationship between hyponatremia caused by CSWS and the increase of the urinary sodium excretion in early phase following SAH. Fifty-four patients with SAH were divided into 2 groups, normonatremia group and hyponatremia group which suffered hyponatremia after SAH. The hyponatremia group comprise 14 patients (26%) in whom the hyponatremia developed of the SAH. In this group, the serum level of sodium significantly decreased 7 days after SAH and then gradually normalised. Further, excretion of sodium in the urine tended to increase 3 days after SAH and significantly increased 7 days after SAH. In conclusion, the increased urinary sodium excretion in the early phase of SAH would serve as a predictive factor for CSWS after SAH. We consider that it is important to start sodium and fluid supplementation and inhibit natriuresis by fludrocortisone acetate administration before hyponatremia occurs in order to prevention delayed ischemic neurological deficits in SAH patients.

  14. Prediction of outcomes in young adults with aneurysmal subarachnoid hemorrhage.

    Science.gov (United States)

    Chotai, Silky; Ahn, Sung-Yong; Moon, Hong-Joo; Kim, Jong-Hyun; Chung, Heung-Seob; Chung, Yong-Gu; Kwon, Taek-Hyun

    2013-01-01

    Subarachnoid hemorrhage (SAH) is rare in young adults and little is known about aneurysms in this subgroup. The effect of clinical and prognostic factors on the outcome based on the Glasgow Outcome Scale (GOS) scores and the predictors of unfavorable outcomes were analyzed in young adults with aneurysmal SAH. A retrospective review of the clinical parameters, including age, sex, hypertension, smoking status, hyperlipidemia, location of the cerebral aneurysm, size of the aneurysm, multiplicity, perioperative complication such as hydrocephalus, vasospasm, and hematoma, and Hunt and Hess and Fisher grading on presentation, was conducted in 108 young adults (mean age 34.8 years) managed at our institute. The outcome was classified based on GOS grading into unfavorable (GOS scores 1-3) or favorable (GOS scores 4 or 5). The overall mortality rate was 3.7% (4/108 patients). Univariate regression analysis for the outcomes at discharge found that age at the time of presentation, male sex, size of aneurysm, multiple aneurysms, hyperlipidemia, and poor Hunt and Hess and Fischer grades were associated with unfavorable outcome. Multivariate regression analysis found independent effects of sex, multiple aneurysms, size of aneurysm, and Hunt and Hess grade on the outcome at discharge. Size of aneurysm, presence of multiple aneurysms, Hunt and Hess grade, and hypertension were the predictors of outcome at mean 2-year follow up based on multivariate exact regression analysis. The multimodal approach with aggressive medical management, early intervention, and surgical treatment might contribute to favorable long-term outcomes in patients with poor expected outcomes.

  15. ANEURYSMAL BONE CYST OF THE CLAVICLE IN CHILDREN (CLINICAL CASES AND TREATMENT

    Directory of Open Access Journals (Sweden)

    Тимур Фаизович Зубаиров

    2014-09-01

    Full Text Available The purpose. To examine the results of the treatment of children with aneurysmal cyst of the clavicle. Material and methods. The results of examination and treatment of patients aged 16 and 17 years with a diagnosis of aneurysmal cyst of the clavicle. All patients underwent surgical treatment with the ABC stage delimitation. We used a surgical technique, which consists in open removement of the abnormal tissue with replacement of the bone defect with bone-plastic material or autogenous bone from the iliac crest. Conclusions. The method of treatment of aneurysmal bone cyst of the clavicle must be individualized depending on the location, aggressiveness and extent of the lesion. The use bone-plastic material or autogenous bone from the iliac crest restore the structural integrity of a compromised clavicle gives good results in the observation period of up to 2 years.

  16. Postpartum cerebral angiopathy presenting with non-aneurysmal subarachnoid hemorrhage and interval development of neurological deficits: A case report and review of literature

    Directory of Open Access Journals (Sweden)

    Li Yang

    2013-01-01

    Full Text Available Postpartum cerebral angiopathy (PCA is a cerebrovascular disease that occurs during the postpartum period. It is characterized by reversible multifocal vasoconstriction of the cerebral arteries. We report a patient with PCA proven by cerebral angiography that revealed multifocal, segmental narrowing of the cerebral arteries and non-aneurysmal subarachnoid hemorrhage. The patient suddenly deteriorated with focal neurological deficits on the 5 th day of hospitalization. She was treated with calcium-channel blockers and monitored with daily transcranial Doppler ultrasound. Her symptoms gradually improved and she was discharged on the 11 th day of hospitalization. At 1-month follow-up, patient was completely symptom-free with no neurological deficits.

  17. Three-dimensional fusion angiography of a giant basilar aneurysm for coil embolization

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Joo Yeon; Suh, Dae Chul [Dept. of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul (Korea, Republic of)

    2015-05-15

    A giant aneurysm was unexpectedly found on computed tomography angiogram in a 54-year-old female. Cerebral angiogram showed a giant aneurysm at the ventral side of the lower basilar artery trunk. However, it was difficult to demonstrate the precise relationship between the aneurysmal sac and the parent artery because of the incomplete filling of the contrast medium secondary to the preferential flows from a well-balanced development of both vertebral arteries. Three-dimensional (3D) fusion angiography revealed complete filling of the aneurysm as well as the basilar trunk itself beyond the aneurysm, which was dysplastic. Coiling of the aneurysm was safely and completely accomplished based on the fusion images. In this report, we demonstrate a case of giant basilar aneurysm with 3D fusion angiography proving useful in assisting with treatment planning.

  18. Basilar artery aneurysm at a persistent trigeminal artery junction. A case report and literature review.

    Science.gov (United States)

    Aguiar, G B; Conti, M L M; Veiga, J C E; Jory, M; Souza, R B

    2011-09-01

    The trigeminal artery is an anastomosis between the embryonic precursors of the vertebrobasilar and carotid systems, and may persist into adult life. The association of the persistent primitive trigeminal artery (PTA) with cerebral aneurysm is well documented in the literature and, in general, aneurysms are located in the anterior circulation. We describe a patient who presented with a panencephalic Fisher III subarachnoid hemorrhage due to rupture of an intracranial aneurysm. Digital arteriography showed a saccular aneurysm in the middle third of the basilar artery, adjacent to the junction with a persistent trigeminal artery. She was submitted to endovascular treatment with embolization of the basilar artery aneurysm with coils. Aneurysms at the PTA junction with the basilar artery are rare. This paper describes a case of PTA associated with an aneurysm in the basilar artery at PTA junction and briefly reviews the literature. PMID:22005697

  19. Lumbar and iliac artery aneurysms in Menkes' disease: endovascular cover stent treatment of the lumbar artery aneurysm

    International Nuclear Information System (INIS)

    We report lumbar and iliac artery aneurysms in a 3-month-old boy with Menkes' disease. The iliac artery aneurysm thrombosed spontaneously, documented by follow-up colour Doppler sonography. The lumbar artery aneurysm was successfully treated using a cover stent. There was no filling of the lumbar artery aneurysm and no stenosis of the cover stent during the 9-month follow-up. (orig.)

  20. Multidetector-Row CT Angiography of Cerebral Vasospasm after Aneurysmal Subarachnoid Hemorrhage: Comparison of Bone Subtraction and Standard CT Angiography with Digital Subtraction Angiography

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Yong Hee; You, Jin Jong; Choi, Ho Cheol; Kim, Ji Eun [Dept. of Radiology, Gyeongsang National University Hospital, Jinju (Korea, Republic of); Choi, Dae Seob [Gyeongsang Institue of Health Science, Gyeongsang National University School of Medicine, Jinju (Korea, Republic of); Ryoo, Jae Wook [Dept. of Radiology, Samsung Seoul Hospital, Seoul (Korea, Republic of)

    2011-10-15

    To evaluate the usefulness of multidetector-row CT angiography (MDCTA) for the diagnosis of cerebral vasospasm after aneurysmal subarachnoid hemorrhage (SAH) by comparison of digital subtraction angiography (DSA) and to compare the bone subtraction CT angiography (BS-CTA) and standard CT angiography (S-CTA). Thirty-three patients who were treated with intraarterial nimodipine infusion for the cerebral vasospasm after aneurysmal SAH were evaluated with MDCTA and DSA. BS-CTA images were reconstructed from the S-CTA and unenhanced CT source images. A total of 207 vascular segments were evaluated. A four-step scale for the degree of stenosis was applied for each segment. With DSA as the standard images, BS-CTA and S-CTA images were comparied. On DSA, 56 segments (27%) presented vasospasm. Concordance between the DSA and S-CTA and between DSA and BS-CTA were 94.7% and 82.1%, respectively. Overestimation for the degree of stenosis was shown in 37 segments on BS-CTA and in 8 segments on S-CTA, but underestimated segments were only shown on S-CTA (n = 4). MDCTA with standard technique seems to be a useful imaging tool for the evaluation of the cerebral vasospasm after aneurysmal SAH. However, BS-CTA is not needed because of additional radiation and overestimation of the degree of stenosis.

  1. Three-dimensional hemodynamic design optimization of stents for cerebral aneurysms.

    Science.gov (United States)

    Lee, Chang-Joon; Srinivas, Karkenahalli; Qian, Yi

    2014-03-01

    Flow-diverting stents occlude aneurysms by diverting the blood flow from entering the aneurysm sac. Their effectiveness is determined by the thrombus formation rate, which depends greatly on stent design. The aim of this study was to provide a general framework for efficient stent design using design optimization methods, with a focus on stent hemodynamics as the starting point. Kriging method was used for completing design optimization. Three different cases of idealized stents were considered, and 40-60 samples from each case were evaluated using computational fluid dynamics. Using maximum velocity and vorticity reduction as objective functions, the optimized designs were identified from the samples. A number of optimized stent designs have been found from optimization, which revealed that a combination of high pore density and thin struts is desired. Additionally, distributing struts near the proximal end of aneurysm neck was found to be effective. The success of the methods and framework devised in this study offers a future possibility of incorporating other disciplines to carry out multidisciplinary design optimization.

  2. Early endovascular embolization for the treatment of Hunt-Hens V ruptured intracranial aneurysms

    International Nuclear Information System (INIS)

    Objective: To discuss the feasibility of early endovascular embolization for the treatment of Hunt-Hens V ruptured intracranial aneurysms. Methods: A total of 31 cases with Hunt-Hens V intracranial aneurysms encountered in the period from Sep. 2000 to Oct. 2010 were enrolled in this study. The clinical data and the therapeutic results were retrospectively analyzed. Thirty-one patients received interventional treatment within three days including 19 within 24 hours after admission. The diameter of the aneurysms was (2.7-12.7) mm. After endovascular embolization, external ventricular drainage (n=5), tracheotomy (n=23), lumbar puncture drainage (n=18) and/or evacuation of hematoma (n=7) was, when needed, further employed. All patients were followed up for 6 months. Results: A total of 32 intracranial aneurysms were detected in 31 patients. Interventional endovascular embolization was performed for 31 lesions. Compact embolization of intracranial aneurysm was used in 25 cases, and sub-compact embolization of intracranial aneurysm was adopted in 6 cases. Of the 31 patients, death occurred in 8 (25.8%) and severe disability was seen in 9 (29.0%), vegetable state in 4 (12.9%), good condition in 4 (12.9%), mild disability in 6 (19.4%). Hydrocephalus developed in 16 cases and establishment of ventricle-to-abdomen shunt was performed in 10 cases. Conclusion: For the treatment of Hunt-Hens V ruptured intracranial aneurysms, endovascular embolization should be carried out as early as possible in order to prevent the occurrence of severe complications. (authors)

  3. Endovascular Broad-Neck Aneurysm Creation in a Porcine Model Using a Vascular Plug

    International Nuclear Information System (INIS)

    Ruptured cerebral arterial aneurysms require prompt treatment by either surgical clipping or endovascular coiling. Training for these sophisticated endovascular procedures is essential and ideally performed in animals before their use in humans. Simulators and established animal models have shown drawbacks with respect to degree of reality, size of the animal model and aneurysm, or time and effort needed for aneurysm creation. We therefore aimed to establish a realistic and readily available aneurysm model. Five anticoagulated domestic pigs underwent endovascular intervention through right femoral access. A total of 12 broad-neck aneurysms were created in the carotid, subclavian, and renal arteries using the Amplatzer vascular plug. With dedicated vessel selection, cubic, tubular, and side-branch aneurysms could be created. Three of the 12 implanted occluders, two of them implanted over a side branch of the main vessel, did not induce complete vessel occlusion. However, all aneurysms remained free of intraluminal thrombus formation and were available for embolization training during a surveillance period of 6 h. Two aneurysms underwent successful exemplary treatment: one was stent-assisted, and one was performed with conventional endovascular coil embolization. The new porcine aneurysm model proved to be a straightforward approach that offers a wide range of training and scientific applications that might help further improve endovascular coil embolization therapy in patients with cerebral aneurysms.

  4. Treatment of an aneurysm of the celiac artery arising from a celiomesenteric trunk. Report of a case

    Directory of Open Access Journals (Sweden)

    G. Lipari

    2015-01-01

    Conclusion: Our finding of a very rare case of a celiomesenteric anomaly with a concurrent aneurysm is extremely rare (20 cases in word literature in the last 32 years. The feasibility of the endovascular approach for aneurysms originating from the common celiomesenteric trunk depends mainly on aneurysmal location, diameter and neck size. In case of specific unfit anatomy, a careful surgical treatment can ensure the best results.

  5. Endovascular treatment of a giant internal carotid artery bifurcation aneurysm with drainage into cavernous sinus

    Institute of Scientific and Technical Information of China (English)

    ZHANG Zhen-hai; YANG Xin-jian; WU Zhong-xue; LI You-xiang; JIANG Peng

    2012-01-01

    This report documents the treatment of a giant aneurysm of the internal carotid artery bifurcation with a fistula to the cavernous sinus,which appeared following closed head trauma.A 39-year-old man suffered from a blunt head trauma in an automobile accident.Two weeks after the trauma,progressive chemosis of left eye was presented.Four months after the trauma,digital subtraction angiography showed an internal carotid artery bifurcation aneurysm,with drainage into the cavernous sinus.The lesion was successfully obliterated with preservation of the parent artery by using coils in conjunction with Onyx.Follow-up angiography obtained 3 months postoperatively revealed persistent obliteration of the aneurysm and fistula as well as patency of the parent artery.Endovascular treatment involving the use of coils combined with Onyx appears to be a feasible and effective option for treatment of this hard-to-treat lesion.

  6. Percutaneous endovascular stent-graft treatment of aortic aneurysms and dissections: new techniques and initial experience

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Do Yun; Choi, Dong Hoon; Kang, Sung Gwon; Lee, Kwang Hoon; Won, Jong Yun [Yonsei University College of Medicine, Seoul (Korea, Republic of); Kang, Sung Gwon [Chosun University College of Medicine, Gwangju (Korea, Republic of); Won, Je Whan [Aju University College of Medicine, Suwon (Korea, Republic of); Song, Ho Young [Ulsan University College of Medicine, Seoul (Korea, Republic of)

    2003-01-01

    To evaluate the feasibility, safety and effectiveness of a newly designed percutaneously implanted separate stent-graft (SSG) for the treatment of aortic aneurysms and dissections. Using a percutaneous technique, SSG placement (in the descending thoracic aorta in 26 cases and infrarenal abdominal aorta in 24) was attempted in 50 patients with aortic aneurysms (n=27) or dissection (n=23). All SSGs were individually constructed using self-expandable nitinol stents and a Dacron graft, and were introduced through a 12 F sheath and expanded to a diameter of 20-34 mm. In all cases, vascular access was through the femoral artery. The clinical status of each patient was monitored, and postoperative CT was performed within one week of the procedure and at 3-6 month intervals afterwards. Endovascular stent-graft deployment was technically successful in 49 of 50 patients (98%). The one failure was due to torsion of the unsupported graft during deployment. Successful exclusion of aneurysms and the primary entry tears of dissections was achieved in all but three patients with aortic dissection. All patients in whom technical success was achieved showed complete thrombosis of the thoracic false lumen or aneurysmal sac, and the overall technique success rate was 92%. In addition, sixteen patients demonstrated complete resolution of the dissected thoracic false lumen (n=9) or aneurysmal sac (n=7). Immediate post-operative complications occurred at the femoral puncture site in one patient with an arteriovenous fistula, and in two, a new saccular aneurysm developed at the distal margin of the stent. No patients died, and there was no instance of paraplegia, stroke, side-branch occlusion or infection during the subsequent mean follow-up period of 9.4 (range, 2 to 26) months. In patients with aortic aneurysm and dissection, treatment with a separate percutaneously inserted stent-graft is technically feasible, safe, and effective.

  7. Endovascular Treatment of the Huge Dissecting Aneurysms Involving the Basilar Artery by the Internal Trapping Technique: Technical Note

    Directory of Open Access Journals (Sweden)

    Shi-Qing Mu

    2015-01-01

    Full Text Available Background: The endovascular strategy of the huge dissecting aneurysms involving the basilar artery (BA is controversial and challenging. This study was to investigate the clinical and angiographic outcomes of the treatment of the huge dissecting aneurysms involving the BA by the internal trapping (IT technique. Methods: We retrospectively studied 15 patients with the huge dissecting aneurysms involving the BA treated by the IT technique between September 2005 and September 2014 in Department of Interventional Neuroradiology of Beijing Tiantan Hospital. Clinical and angiographic data were reviewed and evaluated. Results: All patients were treated by the IT technique. That meant the dissecting artery and aneurysm segments were completed occlusion. After the procedure, the angiography demonstrated that all the dissecting artery and aneurysm segments were completed occlusion. Follow-up angiography was performed at 3-6 months or 12-18 months after the endovascular treatment (median 8 months, 14 patients had a good recovery. Re-canalization occurred in one patient whose aneurysm involved in bilateral vertebral arteries and the two third of the middle-lower BA. After the second treatment, the patient died by the ventricular tachycardia. Conclusions: The IT technique is a technically feasible and safe alternative for the treatment of BA dissecting aneurysms, but it is not necessarily the safest or most definitive treatment modality. The ideal treatment of the huge dissecting aneurysms involving the BA remains debatable and must be investigated on a case-by-case basis.

  8. Endovascular Treatment of the Huge Dissecting Aneurysms Involving the Basilar Artery by the Internal Trapping Technique: Technical Note

    Institute of Scientific and Technical Information of China (English)

    Shi-Qing Mu; Xin-Jian Yang; You-Xiang Li; Chu-Han Jiang; Zhong-Xue Wu

    2015-01-01

    Background:The endovascular strategy of the huge dissecting aneurysms involving the basilar artery (BA) is controversial and challenging.This study was to investigate the clinical and angiographic outcomes of the treatment of the huge dissecting aneurysms involving the BA by the internal trapping (IT) technique.Methods:We retrospectively studied 15 patients with the huge dissecting aneurysms involving the BA treated by the IT technique between September 2005 and September 2014 in Department of lnterventional Neuroradiology of Beijing Tiantan Hospital.Clinical and angiographic data were reviewed and evaluated.Results:All patients were treated by the IT technique.That meant the dissecting artery and aneurysm segments were completed occlusion.After the procedure,the angiography demonstrated that all the dissecting artery and aneurysm segments were completed occlusion.Follow-up angiography was performed at 3-6 months or 12-18 months after the endovascular treatment (median 8 months),14 patients had a good recovery.Re-canalization occurred in one patient whose aneurysm involved in bilateral vertebral arteries and the two third of the middle-lower BA.After the second treatment,the patient died by the ventricular tachycardia.Conclusions:The IT technique is a technically feasible and safe alternative for the treatment of BA dissecting aneurysms,but it is not necessarily the safest or most definitive treatment modality.The ideal treatment of the huge dissecting aneurysms involving the BA remains debatable and must be investigated on a case-by-case basis.

  9. Treatment of intracranial aneurysms by flow diverter devices: Long-term results from a single center

    Energy Technology Data Exchange (ETDEWEB)

    Briganti, Francesco, E-mail: frabriga@unina.it [Unit of Interventional Neuroradiology, Department of Advanced Biomedical Sciences, “Federico II” University, Via S.Pansini 5., 80131 Naples (Italy); Napoli, Manuela, E-mail: napoli.manuela@gmail.com [Department of Advanced Biomedical Sciences, “Federico II” University, Via S.Pansini 5., 80131 Naples (Italy); Leone, Giuseppe, E-mail: g.leonemd@gmail.com [Department of Advanced Biomedical Sciences, “Federico II” University, Via S.Pansini 5., 80131 Naples (Italy); Marseglia, Mariano, E-mail: mariano-marseglia@libero.it [Department of Advanced Biomedical Sciences, “Federico II” University, Via S.Pansini 5., 80131 Naples (Italy); Mariniello, Giuseppe, E-mail: giuseppe.mariniello@unina.it [Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, “Federico II” University, Via S.Pansini 5., 80131 Naples (Italy); Caranci, Ferdinando, E-mail: ferdinando.caranci@unina.it [Department of Advanced Biomedical Sciences, “Federico II” University, Via S.Pansini 5., 80131 Naples (Italy); Tortora, Fabio, E-mail: fabiotor@libero.it [Chair of Neuroradiology, “Magrassi Lanzara” Clinical-Surgical Department, Second University of Naples, Viale Colli Aminei 21, 80131 Naples (Italy); Maiuri, Francesco, E-mail: frmaiuri@unina.it [Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, “Federico II” University, Via S.Pansini 5., 80131 Naples (Italy)

    2014-09-15

    Highlights: • We report the long-term results (2–4 years) with Flow Diverter Devices (FDD) from a single-center. • We recommend the use of FDD for large-neck aneurysms of the ICA syphon. • We think that more sophisticate FDD will reduce the incidence of technical adverse events. - Abstract: Objectives: Flow-Diverter Devices (FDD) are a new generation stents designed for the treatment of the intracranial aneurysms. This article reports the long-term results (2–4 years) of this treatment from a single-center. Methods: From November 2008 to January 2012, 35 patients (29 females and 6 males; mean age 53.9 y) with 39 intracranial aneurysms were treated by FDD. Five patients (14.3%) had ruptured aneurysms and 30 (85.7%) had no previous hemorrhage. The procedures were performed in 5 patients (14.3%) with SILK and in 30 (85.7%) with PED. In 3 patients FDDs were used as a second treatment after failure of previous coiling (2 cases) or stenting (one case). The 39 aneurysms were in supraclinoid ICA in 26 (66.7%), cavernous ICA in 2 (5.1%), PCoA in 4 (10.2%), MCA in 5 (12.9%), SCA in 1 (2.6%) and PICA in 1 (2.6%). The aneurysms were small (<10 mm) in 32 cases (82%), large (11–25 mm) in 6 (15.3%) and giant in 1 (2.6%). The occlusion rate according to the aneurysm location, size and neck and the complications were evaluated. Results: Peri-procedural complications included transient dysarthria (2 patients), vasospasm with acute intra-stent aggregation (one), microwire rupture (one) and failure of the stent opening (one). The follow-up was made between 24 and 62 months (mean 41 months); clinical examination and CTA were performed at 1, 3, 6 and 12 months after the procedure. The complete occlusion was confirmed by CTA and DSA. MRI with angiographic-studies was taken every year. Complete occlusion was obtained in 35 aneurysms (92.1%) and subtotal in 3 (7.9%). Complete occlusion occurred at 3 months in 24 cases (68.6%), within 3 and 6 months in 9 (25.7%). The rate and

  10. Ten-Year Follow-Up of Endovascular Aneurysm Treatment with Talent Stent-Grafts

    International Nuclear Information System (INIS)

    The purpose of this study was to evaluate the clinical results, complications, and secondary interventions during long-term follow-up after endovascular aneurysm repair (EVAR) and to investigate the impact of endoleak sizes on aneurysm shrinkage. From 1997 to March 2007, 127 patients (12 female, 115 male; age, 73.0 ± 7.2 years) with abdominal aortic aneurysms were treated with Talent stent-grafts. Follow-up included clinical visits, contrast-enhanced MDCT, and radiographs at 3, 6, and 12 months and then annually. Results were analyzed with respect to clinical outcome, secondary interventions, endoleak rate and management, and change in aneurysm size. There was no need for primary conversion surgery. Thirty-day mortality was 1.6% (two myocardial infarctions). Procedure-related morbidity was 2.4% (paraplegia, partial infarction of one kidney, and inguinal bleeding requiring surgery). Mean follow-up was 47.7 ± 34.2 months (range, 0-123 months). Thirty-nine patients died during follow-up; three of the deaths were related to aneurysm (aneurysm rupture due to endoleak, n = 1; secondary surgical reintervention n = 2). During follow-up, a total of 29 secondary procedures were performed in 19 patients, including 14 percutaneous procedures (10 patients) and 15 surgical procedures (12 patients), including 4 cases with late conversion to open aortic repair (stent-graft infection, n = 1; migration, endoleak, or endotension, n = 3). Overall mean survival was 84.5 ± 4.7 months. Mean survival and freedom from any event was 66.7 ± 4.5 months. MRI depicted significantly more endoleaks compared to MDCT (23.5% vs. 14.3%; P 10% of the aneurysm area were associated with reduced aneurysm shrinkage compared to no endoleaks or <10% endoleaks (Δ at 3 years, -1.8% vs. -12.0%; P < 0.05). In conclusion, endovascular aneurysm treatment with Talent stent-grafts demonstrated encouraging long-term results with moderate secondary intervention rates. Primary occlusion of all aortic side

  11. Combined stent and coil in endovascular treatment of intracranial wide-necked and fusiform aneurysms

    Institute of Scientific and Technical Information of China (English)

    刘建民; 黄清海; 许奕; 洪波; 张珑; 张鑫

    2004-01-01

    Background Wide-necked and fusiform aneurysms are challenges for interventional neuroradiologists and neurosurgeons since they may involve entire vessels or be irregular in shape, making is possible for Guglielmi detachable coil to protrude into the parent arteries. This study was to evaluate the endovascular treatment of intracranial wide-necked and fusiform aneurysms by using a combination of stents and coils.Methods From October 2000 to July 2001, eighteen patients with intracranial wide-necked or fusiform aneurysms were treated with intraluminal stenting in combination with endosaccular coiling.Results Stent placement and coil packing were technically successful in all patients. There were no complications related to the procedure except for the migration of the stent in four cases. The aneurysms were embolized with the coils after precise stenting, and total occlusion was obtained in 13 cases, neck remnants in 3, and loose occlusion in 2. All the patients recovered well. Short-term follow-up angiograms suggested patency of the parent arteries without recanalization.Conclusions A combination of endovascular stenting and coil packing may be a favorable alternative for the treatment of intracranial aneurysms that are unsuitable for surgical clipping or coil embolization. Further study is necessary to assess the long-term outcome.

  12. Classical surgical approach and treatment with clips of extracranial internal carotid artery berry aneurysm

    Directory of Open Access Journals (Sweden)

    Haris Vukas

    2016-06-01

    Full Text Available Introduction: We can define extracranial carotid artery aneurysm (ECAA as bulb dilatation greater than 200% of the diameter of the internal carotid artery (ICA or in a case of common carotid artery (CCA greater than 150% of the diameter. Surgical intervention is required for the treatment of this disease.Case report: This study presents an open vascular surgical procedure to resolve ECAA. We report a case of 61 years old woman with an extracranial internal carotid artery berry aneurysm, presented with a headache and dizziness when turning the head aside. Classic open surgery was performed and the lumen of berry aneurysm was separated with three clips from the lumen of ICA.Conclusions: The open surgical approach is the method of choice for the treatment of extracranial internal carotid artery pathological conditions.

  13. Cervical mycotic aneurysm in an infant. MRI findings and endovascular treatment

    International Nuclear Information System (INIS)

    A case of cervical mycotic aneurysm in a 6-month-old infant is presented. Eight days after birth the preterm newborn had a perforated necrotizing enterocolitis. Treatment included abdominal percutaneous drainage and surgery. Hemo cultures grew staphylococcus aureus methicillin resistant. Antibiotic therapy was indicated with a favorable evolution. Five months later the infant showed a lateral cervical mass nad hemorrhagic fluid in her right external auditory canal. Ultrasound and MRI were performed. MRI demonstrated a heterogeneous fluid-containing neck mass, similar in appearance to a parapharyngeal hematoma, with flow void sign. Digital substraction angiography (DSA) was performed to highlight the vascular anatomy demonstrating a mycotic aneurysm adjacent to the ascendent pharyngeal artery. The endovascular treatment with Histoacryl-Lipiodol was successful without any technical or neurological complications. Mycotic aneurysm is a very rare, but potentially fatal complication in infants. In our case report, MRI and DSA provided an accurate diagnosis leading to a rapid endovascular therapy. (author)

  14. Non-Enhanced MR Imaging of Cerebral Aneurysms: 7 Tesla versus 1.5 Tesla

    OpenAIRE

    Wrede, Karsten H.; Philipp Dammann; Christoph Mönninghoff; Sören Johst; Stefan Maderwald; I Erol Sandalcioglu; Oliver Müller; Neriman Özkan; Ladd, Mark E.; Michael Forsting; Schlamann, Marc U.; Ulrich Sure; Lale Umutlu

    2014-01-01

    PURPOSE: To prospectively evaluate 7 Tesla time-of-flight (TOF) magnetic resonance angiography (MRA) in comparison to 1.5 Tesla TOF MRA and 7 Tesla non-contrast enhanced magnetization-prepared rapid acquisition gradient-echo (MPRAGE) for delineation of unruptured intracranial aneurysms (UIA). MATERIAL AND METHODS: Sixteen neurosurgical patients (male n = 5, female n = 11) with single or multiple UIA were enrolled in this trial. All patients were accordingly examined at 7 Tesla and 1.5 Tesla M...

  15. Intracranial Arterial Aneurysms

    OpenAIRE

    J Gordon Millichap

    1988-01-01

    Neurosurgeons from the Universita degli Studi di Roma “La Saspeinza,” Rome, Italy, report a 4-year-old girl with a cerebral saccular aneurysm and analyze 71 cases under 5 years of age in the literature.

  16. Operative treatment of aneurysms and Coanda effect: a working hypothesis 1

    Science.gov (United States)

    Robinson, J. L.; Roberts, A.

    1972-01-01

    The Coanda effect has been known to mechanical engineers for many decades. Consideration of this effect both by a neurosurgeon and a mechanical engineer revealed that it might be of importance during the operative treatment of intracranial aneurysms. If a jet effect were produced in the stream of blood after clipping an aneurysm, most of the flow of blood might be directed down only one limb of a bifurcation occurring in a vessel near to a clipped aneurysm. Blood might also be entrained from the other limb of the bifurcation. This boundary wall effect, which can occur without the rate of flow through the vessel being altered appreciably, could explain some of the unfortunate sequelae of aneurysm surgery which occur in the absence of any obvious cause such as postoperative thrombosis, etc. A possible mechanism for some of the complications after gradual occlusion of the common carotid artery in the neck is also proposed on this basis. Other details of how this data might be of clinical significance, together with suggestions for how to avoid fluidic effects during aneurysm surgery, are presented. PMID:4647852

  17. Surgical treatment of complicated traumatic aneurysm and arteriovenous fistula

    Institute of Scientific and Technical Information of China (English)

    乔正荣; 时德

    2003-01-01

    Objective: To evaluate the surgical methods and the outcome of management for traumatic arterial aneurysm (TAA) and traumatic arteriovenous fistula (TAVF). Methods: A total of 121 patients with TAA or TAVF were treated by surgery. Clinical, operative and postoperative data were collected and analyzed retrospectively. Results: The surgical techniques included aneurysmectomy and arterial end-to-end anastomosis or vascular grafting or artery ligation, aneurysm ligation and bypass, vascular repair, fistula excision and vascular ligation or vascular grafting or repair and so on. One patient died (0.83%). The follow-up rates of TAA and TAVF were 65.7% and 60% respectively. Conclusions: Complicated TAA and TAVF in different sites should be treated with different methods.

  18. Hybrid endografts combinations for the treatment 
of endoleak in endovascular abdominal aortic aneurysm repair.

    Science.gov (United States)

    Georgiadis, George S; Trellopoulos, George; Antoniou, George A; Georgakarakos, Efstratios I; Nikolopoulos, Evagelos S; Iatrou, Christos; Lazarides, Miltos K

    2013-01-01

    Hybrid endografting in endovascular abdominal aortic aneurysm repair (EVAR) is defined as the process of placing a series of two or more different types of covered stents, usually to treat a complex abdominal aortic aneurysm (AAA) or a primary or secondary endoleak. We describe the treatment of a type III, a type Ib, and a type Ia endoleak in three patients respectively, using hybrid solutions, assembling components from different manufacturers. An update of the current clinical and experimental evidence on the application of anatomically compatible, hybrid endograft systems in conventional EVAR is also provided. PMID:23280081

  19. Ultra Low Density Shape Memory Polymer Foams With Tunable Physicochemical Properties for Treatment of intracranial Aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Singhal, Pooja [Texas A & M Univ., College Station, TX (United States)

    2013-12-01

    Shape memory polymers (SMPs) are a rapidly emerging class of smart materials that can be stored in a deformed temporary shape, and can actively return to their original shape upon application of an external stimulus such as heat, pH or light. This behavior is particularly advantageous for minimally invasive biomedical applications comprising embolic/regenerative scaffolds, as it enables a transcatheter delivery of the device to the target site. The focus of this work was to exploit this shape memory behavior of polyurethanes, and develop an efficient embolic SMP foam device for the treatment of intracranial aneurysms.In summary, this work reports a novel family of ultra low density polymer foams which can be delivered via a minimally invasive surgery to the aneurysm site, actuated in a controlled manner to efficiently embolize the aneurysm while promoting physiological fluid/blood flow through the reticulated/open porous structure, and eventually biodegrade leading to complete healing of the vasculature.

  20. Angiographic analysis for phantom simulations of endovascular aneurysm treatments with a new fully retrievable asymmetric flow diverter

    Science.gov (United States)

    Yoganand, Aradhana; Wood, Rachel P.; Jimenez, Carlos; Siddiqui, Adnan; Snyder, Kenneth; Setlur Nagesh, S. V.; Bednarek, D. R.; Rudin, S.; Baier, Robert; Ionita, Ciprian N.

    2015-03-01

    Digital Subtraction Angiography (DSA) is the main diagnostic tool for intracranial aneurysms (IA) flow-diverter (FD) assisted treatment. Based on qualitative contrast flow evaluation, interventionists decide on subsequent steps. We developed a novel fully Retrievable Asymmetric Flow-Diverter (RAFD) which allows controlled deployment, repositioning and detachment achieve optimal flow diversion. The device has a small low porosity or solid region which is placed such that it would achieve maximum aneurysmal in-jet flow deflection with minimum impairment to adjacent vessels. We tested the new RAFD using a flow-loop with an idealized and a patient specific IA phantom in carotid-relevant physiological conditions. We positioned the deflection region at three locations: distally, center and proximally to the aneurysm orifice and analyzed aneurysm dome flow using DSA derived maps for mean transit time (MTT) and bolus arrival times (BAT). Comparison between treated and untreated (control) maps quantified the RAFD positioning effect. Average MTT, related to contrast presence in the aneurysm dome increased, indicating flow decoupling between the aneurysm and parent artery. Maximum effect was observed in the center and proximal position (~75%) of aneurysm models depending on their geometry. BAT maps, correlated well with inflow jet direction and magnitude. Reduction and jet dispersion as high as about 50% was observed for various treatments. We demonstrated the use of DSA data to guide the placement of the RAFD and showed that optimum flow diversion within the aneurysm dome is feasible. This could lead to more effective and a safer IA treatment using FDs.

  1. Comparative Study of Single- and Multi-Wall Carbon Nanotubes with Application in Cerebral Aneurysm

    Directory of Open Access Journals (Sweden)

    Rodica-Mariana Ion

    2011-01-01

    Full Text Available Helping improve humanity is one of the promises of nanotech-
    nology and nanomedicine. This paper will highlight some of the research findings in the nanomedicine area by testing some single- and multi-walls carbon nanotubues in rats cerebral aneurisms.

  2. Percutaneous Transabdominal Approach for the Treatment of Endoleaks after Endovascular Repair of Infrarenal Abdominal Aortic Aneurysm

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Sun Young; Lee, Do Yun; Lee, Kwang Hun [Severance Hospital, University of Yonsei, Seoul (Korea, Republic of); Won, Jong Yun [Gangnam Severance Hospital, University of Yonsei, Seoul (Korea, Republic of); Choi, Dong Hoon; Shim, Won Heum [Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2010-02-15

    The purpose of this study was to evaluate the technical feasibility and clinical efficacy of percutaneous transabdominal treatment of endoleaks after endovascular aneurysm repair. Between 2000 and 2007, six patients with type I (n = 4) or II (n = 2) endoleaks were treated by the percutaneous transabdominal approach using embolization with N-butyl cyanoacrylate with or without coils. Five patients underwent a single session and one patient had two sessions of embolization. The median time between aneurysm repair and endoleak treatment was 25.5 months (range: 0-84 months). Follow-up CT images were evaluated for changes in the size and shape of the aneurysm sac and presence or resolution of endoleaks. The median follow-up after endoleak treatment was 16.4 months (range: 0-37 months). Technical success was achieved in all six patients. Clinical success was achieved in four patients with complete resolution of the endoleak confirmed by follow-up CT. Clinical failure was observed in two patients. One eventually underwent surgical conversion, and the other was lost to follow-up. There were no procedure-related complications. The percutaneous transabdominal approach for the treatment of type I or II endoleaks, after endovascular aneurysm repair, is an alternative method when conventional endovascular methods have failed.

  3. Improvement after treatment of hydrocephalus in aneurysmal subarachnoid haemorrhage : implications for grading and prognosis

    NARCIS (Netherlands)

    ter Laan, M; Mooij, JJA

    2006-01-01

    Two patients with aneurysmal subarachnoid haemorrhage and hydrocephalus are presented. On admission they scored E1M4V1 and E1M3Vtube on the Glasgow Coma Scale. The first patient recovered to E3M5Vtube after treatment of hydrocpehalus by extraventricular drainage. The second recovered to E2M5Vtube an

  4. Risk of rebleeding after treatment of acute hydrocephalus in patients with aneurysmal subarachnoid hemorrhage

    NARCIS (Netherlands)

    Hellingman, Catharine A; van den Bergh, Walter M; Beijer, Inge S; van Dijk, Gert W; Algra, Ale; van Gijn, Jan; Rinkel, Gabriël J E

    2007-01-01

    BACKGROUND AND PURPOSE: Cerebrospinal fluid drainage is often indicated in patients with acute hydrocephalus after aneurysmal subarachnoid hemorrhage but is believed to increase the risk of rebleeding. We studied the risk of rebleeding in patients with subarachnoid hemorrhage during treatment for ac

  5. Intravascular treatment of a cavernous fistula by rupture of a traumatic carotid trigeminal aneurysm. Case reports

    Energy Technology Data Exchange (ETDEWEB)

    Flandroy, P.; Collignon, J.; Lacour, P.; Marsault, C.; Stevenaert, A.

    1987-05-01

    The authors report the particular treatment of a traumatic cavernous fistula caused by the rupture of an exceptional lesion: a false aneurysm of the C5 segment of the right carotid artery situated at the origin of a persistent trigeminal artery.

  6. Assessment of feasibility of endovascular treatment of ruptured intracranial aneurysms with 16-detector row CT angiography

    NARCIS (Netherlands)

    M. van der Jagt (Mathieu); H.Z. Flach (Zwenneke); H.L.J. Tanghe (Hervé); S.L.M. Bakker (Stef); M.G.M. Hunink (Myriam); P.J. Koudstaal (Peter Jan); A. van der Lugt (Aad)

    2008-01-01

    textabstractBackground: It is unclear whether 16-detector row CT angiography (CTA) can replace digital subtraction angiography (DSA) to assess the feasibility of endovascular treatment (EVT) in the acute phase after aneurysmal subarachnoid hemorrhage. Methods: We studied 80 consecutive patients with

  7. Hybrid procedure in the treatment of thoracoabdominal aortic aneurysms: Case report

    Directory of Open Access Journals (Sweden)

    Davidović Lazar B.

    2013-01-01

    Full Text Available Introduction. Treatment of thoracoabdominal aortic aneurysms is a major problem in vascular surgery. Conventional open repair is associated with significant rates of mortality and morbidity and therefore, there is a need for better solutions. One of them is a hybrid procedure that includes visceral debranching. This paper presents the first such case performed in Serbia, with a brief overview on all published procedures worldwide. Case Outline. A 57-year-old woman was admitted to the hospital because of thoracoabdominal aneurysms type V by Crawford-Safi classifications. Because of the significant comorbidities it was concluded that conventional treatment would bear unacceptably high perioperative risk, and that the possible alternative could be the hybrid procedure in two stages. In the first stage aortobiliacal reconstruction with bifurcated Dacron graft (16×8 mm and visceral debranching with hand made tailored branched graft was done. In the second act, the thoracoabdominal aneurysm was excluded with implantation of the endovascular Valiant stent graft, 34×150 mm (Medtronic, Santa Rosa, CA. Control MSCT angiography showed a proper visceral branch patency and positioning of the stent graft without endoleaks. Nine months after the procedure the patient was symptom-free, with no aneurysm, diameter change and no graft-related complication. All visceral branches were patent. Conclusion. So far about 500 cases of visceral debranching have been published with the aim of treating thoracoabdominal aneurysms, and still we have no valid guidelines concerning this method. However, in carefully selected high-risk patients this is an excellent alternative to open surgery of thoracoabdominal aneurysms.

  8. Intraorbital ophthalmic artery aneurysm associated with basilar tip saccular aneurysm

    Energy Technology Data Exchange (ETDEWEB)

    Dehdashti, A.R.; Tribolet, N. de [Department of Neurosurgery, HUG, Geneva (Switzerland); Safran, A.B. [Department of Ophthalmology, HUG, Geneva (Switzerland); Martin, J.B.; Ruefenacht, D.A. [Division of Neuroradiology, HUG, Geneva (Switzerland)

    2002-07-01

    We present a rare case of intraorbital ophthalmic artery aneurysm found incidentally, together with a ruptured aneurysm of the tip of the basilar artery. The intraorbital aneurysm was asymptomatic, and no treatment was offered. Angiographic control was recommended to detect any progression. Treatment may be indicated for documented enlargement or significant mass effect of the aneurysm. (orig.)

  9. Intraorbital ophthalmic artery aneurysm associated with basilar tip saccular aneurysm

    International Nuclear Information System (INIS)

    We present a rare case of intraorbital ophthalmic artery aneurysm found incidentally, together with a ruptured aneurysm of the tip of the basilar artery. The intraorbital aneurysm was asymptomatic, and no treatment was offered. Angiographic control was recommended to detect any progression. Treatment may be indicated for documented enlargement or significant mass effect of the aneurysm. (orig.)

  10. Intracranial aneurysm associated with relapsing polychondritis

    Energy Technology Data Exchange (ETDEWEB)

    Coumbaras, M.; Boulin, A.; Pierot, L. [Dept. of Neuroradiology, Hopital Foch, Suresnes (France); Piette, A.M.; Bletry, O. [Dept. of Medicine, Hopital Foch, Suresnes (France); Graveleau, P. [Dept. of Neurology, Hopital Foch, Suresnes (France)

    2001-07-01

    We describe a 50-year-old man with relapsing polychondritis (RP) involving auricular cartilage, uveitis and hearing loss, who had an aneurysm of the anterior cerebral artery. Intracranial aneurysm is a rare manifestation of RP. (orig.)

  11. A study of the treatment method of cerebral artery dissection

    International Nuclear Information System (INIS)

    Objective: To explore the best treatment method of cerebral artery dissection. Methods: This study included eight patients who were definitely diagnosed as cerebral artery dissection by the cerebral angiography in our department of neurology during Oct. 2009 and Nov. 2011. They were all treated by the anticoagulation or anti-platelet methods. Some patients received the stent therapy. All patients' were followed for at least three months. The treatment effect was assessed by NIHSS, mRS and by the cerebral angiography. Results: Six patients had carotid artery dissection, 2 had vertebral artery dissection. Four patients were given anticoagulant therapy and the other 4 were given anti-platelet therapy. The reexamination by angiography 10-14 days after admission showed that in 3 patients, the stenosis was aggravated or the infarction occurred. They were diagnosed as having repeated transient ischemic attack (TIA) during pharmacotherapy and received stents for treatment. There was no TIA and cerebral infarction in the follow-up period after individualized therapy. Mean NIHSS scores of 8 patients between pre and post treatment were 5.9, 1.6 respectively. Mean mRS scores pre and post treatment were 2.5, 0.9 respectively. Conclusion: The treatment for patients with cerebral artery dissection should be individuated. The patients in acute stage should get anticoagulation, anti-platelet therapy and angiography re-examination. According to the clinical manifestation and cerebral angiography, the next step for the treatment should be done. (authors)

  12. Endovascular therapeutic strategies in ruptured intracranial aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Machi, Paolo, E-mail: paolo.machi@gmail.com [CHRU Montpellier, Service de Neurorradiologie, Hopital Gui de Chauliac, 80 Avenue Augustin Fliche, 34295 Montpellier Cedex 5 (France); Lobotesis, Kyriakos, E-mail: kyriakos@lobotesis.co.uk [CHRU Montpellier, Service de Neurorradiologie, Hopital Gui de Chauliac, 80 Avenue Augustin Fliche, 34295 Montpellier Cedex 5 (France); Vendrell, Jean Francoise, E-mail: jfvendrell@yahoo.fr [CHRU Montpellier, Service de Neurorradiologie, Hopital Gui de Chauliac, 80 Avenue Augustin Fliche, 34295 Montpellier Cedex 5 (France); Riquelme, Carlos, E-mail: riquelme.carlos@neuf.fr [CHRU Montpellier, Service de Neurorradiologie, Hopital Gui de Chauliac, 80 Avenue Augustin Fliche, 34295 Montpellier Cedex 5 (France); Eker, Omer, E-mail: eker_omer@yahoo.fr [CHRU Montpellier, Service de Neurorradiologie, Hopital Gui de Chauliac, 80 Avenue Augustin Fliche, 34295 Montpellier Cedex 5 (France); Costalat, Vincent, E-mail: vincentcost@hotmail.com [CHRU Montpellier, Service de Neurorradiologie, Hopital Gui de Chauliac, 80 Avenue Augustin Fliche, 34295 Montpellier Cedex 5 (France); Bonafe, Alain, E-mail: bonafeh@aol.com [CHRU Montpellier, Service de Neurorradiologie, Hopital Gui de Chauliac, 80 Avenue Augustin Fliche, 34295 Montpellier Cedex 5 (France)

    2013-10-01

    The aim of the present study was to evaluate endovascular techniques used currently which were not available at the time of ISAT inclusion period, such as balloon remodelling and flow-divertion, in order to assess whether these new technologies have improved the endovascular approach outcomes. We present a review of articles, published in major journals, with the aim to evaluate the efficacy and the safety of coiling with balloon remodelling for the treatment of ruptured aneurysms in comparison to coiling performed without such coadjutant techniques. Furthermore, we reviewed publications reporting on the treatment of ruptured aneurysms in the acute phase with the one of the most recent technologies available nowadays: the flow diverting stent. Looking at the recent literature the results regarding ruptured aneurysms treated with balloon assisted coiling (BAC) have shown an improvement in terms of anatomical results and morbi-mortality rates. Case series of ruptured middle cerebral artery (MCA) aneurysms treated by EVT report results similar to those obtained by surgical clipping. Several articles recently report encouraging results in treating ruptured dissecting and blister aneurysms with flow diverters. Questions regarding the best treatment available for ruptured aneurysms are yet to be answered. Hence there is a need for a subsequent trial aiming to answer these unresolved issues.

  13. EXPERIENCE OF MINIMALLY INVASIVE TREATMENT IN 520 PATIENTS WITH INTRACRANIAL ANEURYSMS

    Institute of Scientific and Technical Information of China (English)

    丁育基; 李慎茂; 段安安; 于小千; 华杨; 柳江; 王建生; 曹家康; 赵瑞林; 徐庚; 谷春; 王仲朴

    2002-01-01

    Objective.To summarize the experience of minimally invasive treatment in 520 patients with intracranial aneurysms on a retrospective study.Methods.The measures used in the treatment of 520 patients were reviewed in terms of timing of surgery,induced hypotensive anesthesia,brain protection combined with temporal occlusion of the feeding artery,external drainage of CSF,dynamic monitoring of intracranial pressure,blood flow velocity,serum osmolality and CT scanning,anti vasospasm therapy as well as selected interventional endovascular embolization of aneurysms.Results.Of the 520 patients,485 were treated with either direct clipping or endovascular embolization and 35 patients were treated non surgically.In 449 patients undergoing direct clipping and 36 undergoing endovascular embolization,intraoperative rupture of aneurysm occurred in 27 (6.0%) and 0%,respectively.Death occurred in 13 (2.6%),hemiplegia in 8 (1.6%),and vegetative state in 2 (0.4%).The operative mortality of direct clipping was 3.8% in 210 patients before 1990 and 1.8% in 275 patients after 1990 (36 patients undergoing endovascular embolization,the operative mortality was 0%).Conclusion.The outcome of patients with intracranial aneurysms can be markedly improved and the operative mortality can be lowered by minimally invasive treatment.

  14. 颅内动脉瘤介入术前模拟的价值%Value and pitfall of interventional preoperative simulation in cerebral aneurysm

    Institute of Scientific and Technical Information of China (English)

    魏欣; 赵晓伟; 钟立明; 谢晓东; 王朝华; 游箭; 何家全; 胡鸿; 范润金; 胡孔琼

    2011-01-01

    Objective To explore the value and pitfall of virtual three - dimensional individual cerebral aneurysm and instrument models in interventional preoperative simulation.Methods The individual simulation results of 17 patients with interventional preoperative cerebral aneurysms were retrospectively analyzed and compared with the results of actual surgery.To evaluate the value and pitfall in the time - consuming of preoperative simulation and modeling, the simulation results of optimal showing angle of the aneurysm, the simulation pathway of inserting catheter, the simulation results of coil and stent placement accuracy and simulation results in teaching and training were evaluated.Results (1)The practical value of establishing individual cerebral aneurysm model was not ideal because of longer time -consuming.The practical value of preoperative simulation could be accepted because of shorter time -consuming.(2)The simulation results of optimal showing angle of the aneurysm had some practical value because the accuracy was high (14/17).The simulation results of intubation pathway had reference value to guide a reasonable micro - catheter and micro - wire tip moulding.The simulation results of packing coil and releasing stent compared with actual operation results were the same or similar (13/17).(3) Questionnaire survey results showed that the proportion in enhancing comprehension of the operative intent with a high value was 38/41, the proportion of software operation method with a high difficulty in establishing individual cerebral aneurysm model was 22/41.Conclusions In aspects of operational method of preoperative simulation, the accuracy of simulation results, the teaching and staff training have better practicability.In aspects of optimizing the individual modeling method of cerebral aneurysm is worth further study.%目的 探讨个体化颅内动脉瘤及介入器械的虚拟三维模型在神经介入术前模拟中的价值.方法 回顾性分析17例术前模

  15. Treatment of infrarenal abdominal aortic dissection concomitant with an aneurysm

    Institute of Scientific and Technical Information of China (English)

    WANG Li-xin; ZHU Ting; FU Wei-guo; WANG Yu-qi; XI Xun; GUO Da-qiao; CHEN Bin; JIANG Jun-hao; YANG Ju; SHI Zhen-yu

    2007-01-01

    @@ Aortic dissection occurs when layers of the aortic walls are separated by the blood flow through an intimal tear. Dissection of the aorta most frequently originates in the ascending aorta (70%), followed by the descending aorta (22%), the aortic arch (7%) and the abdominal aorta (1/%).1 The dissection limited to the abdominal aorta is rare.2 An isolated abdominal aortic dissection (IAAD) concomitant with an abdominal aortic aneurysm (AAA) is uncommon. We present here one patient with IAAD and AAA treated by endovascular therapy.

  16. Staged endovascular treatment with selective EC-IC bypass for symptomatic large-giant aneurysms in the cavernous portion of the internal carotid artery

    International Nuclear Information System (INIS)

    For the treatment of symptomatic large-giant aneurysm in the cavernous portion of the internal carotid artery (ICA), it is often necessary to occlude the ICA with or without extracranial-intracranial (EC-IC) bypass surgery. We report 11 patients with such symptomatic lesions treated between January 2004 and June 2008 by staged endovascular trapping of the aneurysm with detachable coils following selective EC-IC bypass placement. The necessity of the bypass was determined according to neurological conditions and radiological findings during the preoperative balloon test occlusion (BTO) of the ICA. When ischemic symptoms occurred during BTO, high-flow bypass was selected. Otherwise, findings on single-photon emission computed tomography were used for the bypass selection. Following completion of the bypass, dual antiplatelet therapy was induced. Then the confirmative BTO and endovascular ICA occlusion (ICA-O) under local anesthesia were planned several days after the bypass placement. A total of 4 high-flow bypasses with radial artery graft were placed before ICA-O, while 7 patients underwent endovascular ICA-O without bypass surgery. There were no perioperative complications related to the procedures in 10 cases, but 1 developed cerebral infarction 7 days after bypass placement possibly due to distal embolism from intraaneurysmal thrombus. No patients showed postoperative symptoms according to insufficient ipsilateral cerebral blood flow, and cranial nerve palsies improved in all patients. Favorable outcomes can be expected for patients with such aneurysms by staged endovascular ICA-O with selective EC-IC bypass. Although endovascular ICA-O can be safe and useful, understanding of adequate antithrombotic therapy and treatment timing are especially important in cases with bypass placement. (author)

  17. Endovascular treatment of ectopic bronchial artery aneurysm with brachiocephalic artery stent placement and coil embolization

    Science.gov (United States)

    Di, Xiao; Ji, Dong-Hua; Chen, Yu; Liu, Chang-Wei; Liu, Bao; Yang, Juan

    2016-01-01

    Abstract Background: Bronchial artery aneurysm (BAA) is an uncommon but potentially life-threatening disease, and multiple BAAs are even rarer. Clinically, the tortuous and short neck of a BAA may present significant challenges for invasive intervention. Methods: This report describes the detailed process of diagnosis and treatment and includes a literature review of the etiology, clinical presentation, and therapeutic management of BAA. Results: A rare case of multiple BAAs, with one having an inflow artery arising from the brachiocephalic trunk, was referred to our hospital. The patient was successfully treated with coil embolization and brachiocephalic artery stent placement. In addition, we conducted a literature review involving 63 cases of BAA. BAA was most commonly associated with bronchiectasis and was located predominantly in the mediastinum. There was no significant difference between the diameters of the ruptured aneurysms and those of the nonruptured aneurysms (P = 0.115). Transcatheter arterial embolization was the most commonly adopted technique to treat BAA, while thoracic aortic endovascular repair was selected if the neck between the aneurysm and the aorta was short. Subgroup analysis suggested that patients with > 1 BAA were significantly more likely to be female than male (χ2 test, P = 0.034). Conclusion: Transcatheter coil embolization combined with stent placement could be a reasonable treatment option for BAAs with a tortuous and short neck. According to our literature review, patients with multiple BAAs display distinctive clinical characteristics compared with patients with a single BAA. PMID:27583854

  18. Nursing assistance for spring coil occlusion for the treatment of intracranial giant internal carotid artery aneurysms

    International Nuclear Information System (INIS)

    Objective: To discuss the importance of balloon occlusion test before interventional treatment of the intracranial giant internal carotid artery aneurysms and to sum up the nursing experience in assisting the procedure. Methods: Proper perioperative nursing measures were carried out for 12 patients, who suffered from intracranial giant internal carotid artery aneurysm and underwent spring coil occlusion treatment. Nursing measures included mental care, observation of the vital signs, prevention of the complications, etc. Results: Neither death nor exacerbation of the condition occurred in all the 12 patients. The patients were discharged from the hospital with a mean hospitalization of nine days. During a follow-up period ranged from 4 months to one year, seven patients had no disagreeable feeling, one patient complained of discomfort but no abnormality was found on follow-up DSA, and disappearance of the aneurysm was observed in 4 patients. Conclusion: The monitoring of the vital signs, the prevention of the complications and the standard nursing care are the key points for ensuring a successful operation in treating intracranial giant internal carotid artery aneurysms with spring coil occlusion. (authors)

  19. [Stagewise treatment of a giant false paraanastomotic aneurysm of the abdominal aorta].

    Science.gov (United States)

    Ignatyev, I M; Volodyukhin, M Yu; Zanochkin, A V; Rafikov, A Yu; Khairullin, R N

    2016-01-01

    The article deals with a case report concerning successful stagewise treatment of a patient presenting with a giant false abdominal aortic paraanastomotic aneurysm having developed 2 months after an operation of linear prosthetic repair for a juxtarenal aneurysm with reimplantation of the left renal artery. The secondary operation was carried out 3 months after aortic reconstruction. The first stage consisted in performing endovascular prosthetic repair of the abdominal aortic paraanastomotic pseudoaneurysm by means of a bifurcated stent graft Endurant II (Medtronic), with the second stage being laparotomy with the removal of the retroperitoneal haematoma. The postoperative period turned out uneventful. The patient was discharged from hospital on the 8th day after the second operation. The patient was examined 2 months later, presenting no complaints and returning to his previous work. According to the findings of the check-up duplex scanning, the graft was patient, with no evidence of a paraanastomotic aneurysm. This is followed by discussion of the problems regarding the use of surgical and endovascular technologies in treatment of paraanastomotic aortic aneurysms. PMID:27336337

  20. [Coil embolization for incidental aneurysms in patients with chronic renal failure: midterm clinical results of two cases].

    Science.gov (United States)

    Nakashima, T; Katou, T; Murakawa, T; Yamakawa, H; Yoshimura, S; Kaku, Y; Sakai, N

    2000-06-01

    In spite of recent advances in perioperative management, the risk of neurosurgical intervention for patients with chronic renal failure is still considered too high. In this study, coil embolization for incidental aneurysms in such patients is demonstrated in reference to midterm results. A 42-year-old woman with a history of hemodialisis for 7 years presented with subcortical hemorrhage in her right frontal lobe. The magnetic resonance angiography (MRA) demonstrated a distal anterior cerebral artery aneurysm, but it was considered to be unrelated to the hemorrhage. Two and a half months after the hemorrhage the aneurysm was embolized with interlocking detachable coils. Thirty months after embolization, the angiogram revealed the coil compaction and the recanalization of the aneurysm neck. However, 54 months after embolization, the figure of the embolized aneurysm and neck remnant was the same as the previous findings. A 69-year-old woman with a history of hemodialisis for 5 years suddenly experienced left hemiparesis. Computed tomography revealed cerebral infarction in the right frontoparietal white matter. In addition, a left middle cerebral artery aneurysm was unexpectedly found on the MRA. Five months after the onset of the attack, the aneurysm was embolized with a Guglielmi detachable coli. An angiogram obtained 24 months after the embolization showed the aneurysm to be almost completely obliterated. In considering the therapeutic risks and benefits for incidental aneurysms of patients with chronic renal failure, intra-vascular surgery could be recommended as a less invasive treatment. PMID:10875114

  1. SEP监测在大脑前、中动脉动脉瘤栓塞术中的应用价值%Application of monitoring somatsensory evoked potential to endovascular embolization of anterior cerebral artery and middle cerebral artery aneurysms

    Institute of Scientific and Technical Information of China (English)

    陈岩; 肖玉强; 唐海涛; 李晶; 赵江

    2011-01-01

    embolization. Of 8 ACA aneurysms patients with abnormal SEP, 7 (28.0%) had abnormal SEP on the lower limbs and 1 (4.0%) on the upper and lower limbs. The abnormal rate of SEP on the upper limbs was significantly higher, and the abnormal rate of SEP on the lower limbs was significantly lower in the patients with MCA aneurysms than those in the patients with ACA aneurysms (P<0.01). The abnormal rate [37.5% (9/24)] of SEP was highest during the embolization of the first section aneurysms of the MCA. SEP returned to normal in 21 patients with abnormal SEP and SEP did not completely returned to normal in 3 patients with abnormal SEP after the intraoperative treatment. There were the different neurological function disturbance after the operation in 5 of 24 patients with abnormal SEP.Conclusions ① The abnormal SEP during the embolization may be related to the cerebral tissues ischemia. ② The monitoring SEP during the endovascular embolization is helpful to finding the cerebral ischemia in the patients with intraeranial aneurysms, whose prognoses can be improved by the timely treatment of the cerebral ischemia.

  2. Treatment of carotid artery aneurysms with covered stents; Aneurysmabehandlung der Arteria carotis interna mit gecoverten Stents

    Energy Technology Data Exchange (ETDEWEB)

    Rohr, A.; Alfke, K.; Doerner, L.; Jansen, O. [UKSH Kiel (Germany). Neurochirurgie Neuroradiologie; Bartsch, T.; Stingele, R. [UKSH Kiel (Germany). Neurologie

    2007-10-15

    Purpose: Evaluation of the use of covered stents in treating pseudoaneurysms of the cervical and intracranial/extradural carotid artery and determination of the periprocedural and short- to mid-term complication rate. Materials and Methods: 8 patients with 9 spontaneous dissecting aneurysms of the cervical carotid artery - 5 of which were symptomatic - plus one patient with ofthalmoplegia due to an aneurysm of the cavernous carotid artery were studied. While the latter was treated with a PTFE-covered balloon-mounted stainless steel stent (Jostent/Graftmaster), a self-expanding PTFE-covered Nitonol Stent (Symbiot) was used in all other cases. Intervention was performed with local anesthesia. Aspirin and Clopidogrel were both used as antiplatelet drugs. Clinical signs and symptoms and vascular imaging with DS, MR, CT angiography and ultrasound were recorded during patient follow-up, with a mean follow-up period of 14.6 months (4 - 30). Results: We were able to treat 8 out of 10 aneurysms (80 %) using covered stents. The aneurysms were immediately occluded and the associated stenoses of the parent vessel were eliminated. No clinically relevant complications occurred during the procedure or in the follow-up interval. In two cases, elongation of the carotid artery prevented the stent from being positioned over the aneurysm neck. These cases were shown to be stable with the use of antiplatelet drugs. Conclusion: Covered stents can be used in the treatment of pseudoaneurysms of the carotid artery as an alternative to long-term antithrombotic medication or surgery. In our study treatment was effective (80 %) and free of complications in the short- and mid-term follow-up. Possible indications, technique and the use of imaging modalities for patient follow-up are discussed. (orig.)

  3. Endovascular Treatment of an Aneurysmal Aberrant Systemic Artery Supplying a Pulmonary Sequestrum

    Energy Technology Data Exchange (ETDEWEB)

    Kristensen, Katrine Lawaetz, E-mail: klk@dadlnet.dk [Odense University Hospital, Department of Thoracic and Vascular Surgery (Denmark); Duus, Louise Aarup, E-mail: louise.brodersen@gmail.com [Sygehus Lillebaelt Vejle, Department of Radiology (Denmark); Elle, Bo, E-mail: Bo.Elle@rsyd.dk [Odense University Hospital, Department of Radiology (Denmark)

    2015-10-15

    An aberrant systemic artery originating from the abdominal aorta supplying a pulmonary sequestration is a rare congenital malformation. This causes a left-to-left shunt. Symptoms include recurrent pneumonias, hemoptysis, and, in the long term, heart failure. Aneurysm of the aberrant vessel is rarely seen. Traditionally, treatment of pulmonary sequestrations includes ligation of the feeding vessel and lobectomy. A new promising treatment is an endovascular approach. Only a few cases describe endovascular treatment of pulmonary sequestration. This is the first published case of a giant aneurysmal branch from the abdominal aorta to the normal basal segments of the lung, successfully occluded with an Amplatzer Vascular Plug II (AVP II, St.Jude Medical, MN, USA) alone.

  4. Endovascular Treatment of an Aneurysmal Aberrant Systemic Artery Supplying a Pulmonary Sequestrum

    International Nuclear Information System (INIS)

    An aberrant systemic artery originating from the abdominal aorta supplying a pulmonary sequestration is a rare congenital malformation. This causes a left-to-left shunt. Symptoms include recurrent pneumonias, hemoptysis, and, in the long term, heart failure. Aneurysm of the aberrant vessel is rarely seen. Traditionally, treatment of pulmonary sequestrations includes ligation of the feeding vessel and lobectomy. A new promising treatment is an endovascular approach. Only a few cases describe endovascular treatment of pulmonary sequestration. This is the first published case of a giant aneurysmal branch from the abdominal aorta to the normal basal segments of the lung, successfully occluded with an Amplatzer Vascular Plug II (AVP II, St.Jude Medical, MN, USA) alone

  5. Delayed treatment of basilar thrombosis in a patient with a basilar aneurysm: a case report

    Directory of Open Access Journals (Sweden)

    Fakhouri T

    2008-11-01

    Full Text Available Abstract Introduction Acute occlusion of the basilar artery is a neurological emergency that has a high risk of severe disability and mortality. Delayed thrombolysis or endovascular therapy has been performed with some success in patients who present after 3 hours of symptom onset. Here we present the first case of delayed intra-arterial thrombolysis of a basilar artery thrombosis associated with a large saccular aneurysm. Case presentation A 73-year-old Caucasian man with a history of smoking and alcohol abuse presented to the Emergency Department complaining of diplopia and mild slurred speech and who progressed over 12 hours to coma and quadriparesis. He was found to have a large basilar tip aneurysm putting him at high risk for hemorrhage with lytic treatment. Conclusion The treatment options for basilar thrombosis are discussed. Aggressive treatment options should be considered despite long durations of clinical symptoms in basilar thrombosis, even in extremely high risk patients.

  6. TPPS4 Nanotubes Architecture for Nanorobots with Application in Cerebral Aneurysm

    Science.gov (United States)

    Ion, Rodica-Mariana; Cocina, George-Costel

    2009-04-01

    The application of nanotechnology to the field of medicine is commonly called as nanomedicine. The paper describes the distinct properties of nanotubes generated by porphyrins, and their use for biomedical applications, are discussed. An innovative architecture for medical use of nanorobots are proposed as an advanced and precise tool for brain aneurysm instrumentation as nanorobots, due to its capacity of J-aggregates generation. Porphyrins can form a variety of structures from linear head-to-tail or J-aggregates to fractal aggregates with different and specific photophysical properties. In this paper, the controlled aggregation of meso-5, 10, 15, 20-sulfonato-phenyl porphyrin (TPPS4) was studied at room temperature. Structure of the aggregates was characterized by scanning electron microscopy (SEM), transmission electron microscopy (TEM) and UV-visible spectroscopy. TEM and SEM results indicated the formation of organized nanostructures from the porphyrin derivative. Spectroscopic data showed a J-aggregation among the monomer units. Such aggregates have the size of 5-6 nm in solution. The columnar structure formed by porphyrins has a length of 5 to 27 porphyrin unities. In this paper, the controlled aggregation of TPPS4 was studied at room temperature. The nanostructure formed by ionic self-assembly, is observed in the nanotubes of TPPS4 in solution. Neurons and glial cells incubated for several days with this porphyrin yielded to some connections between the islands are clearly apparent and interconnected networks are formed following the exact pattern of the NT (nanotube) templates. The bridging consists either of an axon or bundles of axons and dendrites. In PDT method with laser irradiation three days after incubation with TPPS4, show that cells first aggregate at the NT islands. As they complete this step axons and dendrites begin to form and to build connections.

  7. Development of a static bioactive stent prototype and dynamic aneurysm-on-a-chip(TM) model for the treatment of aneurysms

    Science.gov (United States)

    Reece, Lisa M.

    Aneurysms are pockets of blood that collect outside blood vessel walls forming dilatations and leaving arterial walls very prone to rupture. Current treatments include: (1) clipping, and (2) coil embolization, including stent-assisted coiling. While these procedures can be effective, it would be advantageous to design a biologically active stent, modified with magnetic stent coatings, allowing cells to be manipulated to heal the arterial lining. Further, velocity, pressure, and wall shear stresses aid in the disease development of aneurysmal growth, but the shear force mechanisms effecting wound closure is elusive. Due to these factors, there is a definite need to cultivate a new stent device that will aid in healing an aneurysm in situ. To this end, a static bioactive stent device was synthesized. Additionally, to study aneurysm pathogenesis, a lab-on-a-chip device (a dynamic stent device) is the key to discovering the underlying mechanisms of these lesions. A first step to the reality of a true bioactive stent involves the study of cells that can be tested against the biomaterials that constitute the stent itself. The second step is to test particles/cells in a microfluidic environment. Therefore, biocompatability data was collected against PDMS, bacterial nanocellulose (BNC), and magnetic bacterial nanocellulose (MBNC). Preliminary static bioactive stents were synthesized whereby BNC was grown to cover standard nitinol stents. In an offshoot of the original research, a two-dimensional microfluidic model, the Aneurysm-on-a-ChipTM (AOC), was the logical answer to study particle flow within an aneurysm "sac" - this was the dynamic bioactive stent device. The AOC apparatus can track particles/cells when it is coupled to a particle image velocimetry software (PIV) package. The AOC fluid flow was visualized using standard microscopy techniques with commercial microparticles/cells. Movies were taken during fluid flow experiments and PIV was utilized to monitor.

  8. Therapie rupturierter zerebraler Aneurysmen: Behandlungsoptionen und derzeitige Studienlage // Ruptured Intracranial Aneurysms: Treatment Options and Data from Recent Trials

    Directory of Open Access Journals (Sweden)

    Gruber A

    2016-01-01

    Full Text Available Several therapeutic options are available for the treatment of ruptured intracranial aneurysms. Generally speaking, these procedures can be reconstructive (ie, selective aneurysm occlusion or deconstructive (ie, parent artery occlusion in conjunction with aneurysm occlusion in nature. In view of the higher ischemic complication rate of deconstructive methods reconstructive procedures are the preferred techniques in the acute phase after aneurysmal subarachnoid haemorrhage. The role of the preferred reconstructive techniques for the management of ruptured intracranial aneurysms (ie, microsurgical clipping and endovascular coiling is in the process of being defined.br Recent publications of the International Subarachnoid Aneurysm Trial (ISAT and the Barrow Ruptured Aneurysm Trial (BRAT allow for a more precise discussion of the role of these treatment options. The ISAT long-term follow-up indicates a declining but still measurable advantage of endovascular over surgical treatment in a selected group of aneurysm patients. If preoperative fatal aneurysm re-ruptures in ISAT, however, were excluded from analysis, the difference between embolization and surgery with respect to management morbidity and mortality lost its statistical significance. The BRAT results demonstrate a 5-fold increase in treatment morbidity for surgical vs endovascular management of ruptured posterior circulation aneurysms, whereas no such differences were encountered in ruptured anterior circulation aneurysms. Although aneurysm re-ruptures were infrequent with both treatment forms, patients receiving endovascular therapy suffered re-ruptures more frequently. The morbidity of both surgical and endovascular treatment of aneurysms recurring after initial endovascular treatment is low.br In view of these findings, endovascular treatment is recommended for all ruptured posteriorcirculation aneurysms feasible for coil embolization, whereas management of ruptured anterior circulation

  9. Differential Gene Expression in Well-healed and Poorly Healed Experimental Aneurysms after Coil Treatment1

    OpenAIRE

    Kadirvel, Ramanathan; Ding, Yong-Hong; Dai, Daying; Lewis, Debra A.; Kallmes, David F

    2010-01-01

    Increased gene expression in densely packed aneurysms was associated with adhesion molecules, proteases, and cytokines in the rabbit aneurysm model; loosely packed aneurysms showed increased expression of multiple structural molecules, including collagens.

  10. Large and giant intracranial aneurysms: A radiologico-clinical study

    Energy Technology Data Exchange (ETDEWEB)

    Lovrencic, M.; Jelicic, I.; Jakovac, I.; Kalousek, M.; Besenski, N.; Surdonja, P.

    1983-12-01

    The brain scans and cerebral angiograms of 13 patients with intracranial aneurysms larger than 15 mm. in diameter are analysed. The radiological findings obtained are compared with clinical symptoms and signs. Twelve patients had genuine aneurysms and one patient a posttraumatic false aneurysm. Post-contrast CT in transversal and coronal plane revealed the real size of the aneurysm in 7 cases of intraluminal thrombosis. Cerebral angiography demonstrated the presence of aneurysms, their anatomic relations and haemodynamic changes.

  11. Hemodynamic effects of stenting on wide-necked intracranial aneurysms

    Institute of Scientific and Technical Information of China (English)

    ZHANG Yi-sen; LUO Bin; LI Chuan-hui; YANG Xin-jian; WANG Sheng-zhang; QIAO Ai-ke; CHEN Jia-liang; ZHANG Kun-ya; LIU Zhi-cheng; ZHAO Yu-jing; ZHANG Ying

    2010-01-01

    Background Stent placement has been widely used to assist coiling in cerebral aneurysm treatments. The present study aimed to investigate the hemodynamic effects of stenting on wide-necked intracranial aneurysms.Methods Three idealized plexiglass aneudsmal models with different geometries before and after stenting were created, and their three-dimensional computational models were constructed. Flow dynamics in stented and unstented aneurismal models were studied using in vitro flow visualization and computational fluid dynamics (CFD) simulations. In addition, effects of stenting on flow dynamics in a patient-specific aneurysm model were also analyzed by CFD.Results The results of flow visualization were consistent with those obtained with CFD simulations. Stent deployment reduced vortex inside the aneurysm and its impact on the aneurysm sac, and decreased wall shear stress on the sac.Different aneurysm geometries dictated fundamentally different hemodynamic patterns and outcomes of stenting.Conclusions Stenting across the neck of aneurysms improves local blood flow profiles. This may facilitate thrombus formation in aneurysms and decrease the chance of recanalization.

  12. Stent-graft and multilayer stent for treatment of type II thoracoabdominal aortic aneurysm in a high-risk patient.

    Science.gov (United States)

    Pane, B; Spinella, G; Salcuni, M; Palombo, D

    2013-08-01

    The aim of the present article was to present an alternative endovascular treatment for type II thoracoabdominal aortic aneurysm that would have the advantage of limiting the duration of the procedure and the use of contrast. A high-risk patient was admitted to our Vascular Unit for type II thoracoabdominal aneurysm according to Crawford's classification. Two thoracic stent-grafts (Valiant Captivia, Medtronic, Pewaukee, WI, USA), a bifurcated stent-graft (Endurant Medtronic) and two multilayer stents (Cardiatis SA, Isnes, Belgium) were deployed. No postoperative major complications were observed. Operative time and use of contrast material were 45 min and 80 mL, respectively. Computed angiography tomography at 1 and 6 months showed patency of visceral and renal arteries and progressive thrombosis of the aneurysmal sac. This stent-graft treatment in combination with multilayer stent could be an alternative treatment for thoracoabdominal aneurysm in high-risk patients. PMID:24013540

  13. Combined surgical and endovascular management of a giant fusiform PCA aneurysm in a pediatric patient. A case report.

    Science.gov (United States)

    Shin, S H; Choi, I S; Thomas, K; David, C A

    2013-06-01

    Treatment of intracranial giant aneurysms presents is challenging. In the case of pediatric giant aneurysm, more challenges arise. We describe our experience with a 17-year-old pediatric patient who presented with severe headache. She was diagnosed as having a giant fusiform aneurysm at the right P1-P2-Pcom junction. The aneurysm was treated with superficial temporal artery-posterior cerebral artery bypass and subsequent coil embolization of the aneurysm with parent artery occlusion. The patient had an excellent outcome at one-year follow-up. Our case suggests a combined approach of surgical and endovascular management may yield a better outcome than surgery or endovascular management alone in the treatment of pediatric giant aneurysm.

  14. Stent Graft-in-Stent Graft as a Rescue Technique for Endovascular Treatment of Giant Extracranial Internal Carotid Aneurysm

    Science.gov (United States)

    Jeha, Salim Abdon Haber

    2016-01-01

    Endovascular treatment of a giant extracranial internal carotid aneurysm by a stent graft implantation was unsuccessful due to a high flow leak directly through the stent graft's coating. The problem was solved deploying a second stent graft inside the previously implanted one resulting in complete exclusion of the aneurysmal sac and patent carotid lumen preservation. The review of the literature did not provide a case using this endovascular strategy. Follow-up for more than 12 months, using CT angiography, showed confirmed aneurysmal exclusion and carotid patency and no clinical complications have been detected. PMID:27752387

  15. CT Angiography May Be a More Useful Modality Than Digital Subtractional Angiography in the Diagnosis of Patients with Subarachnoid Hemorrhage Due to Cerebral Aneurysms

    Directory of Open Access Journals (Sweden)

    Masih Saboori

    2011-05-01

    Full Text Available Background/Objective: The preoperative diagnostic"nvalidity of two radiological modalities (computed"ntomographic angiography and digital subtractional"nangiography in the diagnosis of brain aneurysms were"ncompared."nPatients and Methods: During 2 years of study,"nreferred patients with signs of SAH to the emergency"nward underwent routine CT scan and after SAH was"nfirmly diagnosed, CTA and DSA methods were done"nand patients with correct indications were operated."nAfter surgery and detecting the existence of aneurysms"nand their location, the data were recorded in a"nchecklist. Sensitivity, specificity, positive and negative"npredictive values were calculated and compared in"nboth methods."nResults: The mean age of the 30 patients were"n49.5±9.13 years. 57.9 % of the subjects were female"nand the others were male. On CTA reports 100% true"npositive, 0% false positive, 85% true negative, and 15%"nfalse negative were calculated. DSA reports were true"npositive, false positive, true negative and false negative"nin 100%, 0%, 69% and 31%, respectively. CTA showed"n89% of sensitivity, and 100% of specificity in contrast"nto 74% sensitivity and 100% specificity of DSA."nPositive predictive values of both methods were 100%,"nbut negative predictive values of CTA and DSA were"n85% and 69%, respectively."nConclusion: Based on our data, CTA is more preferable"ndiagnostic modality for the brain aneurysm's site and"nanatomy in patients with subarachnoid hemorrhage"nthan DSA."nKeywords: CT Scan Angiography, Digital Subtraction"nAngiography, Cerebral Aneurysm, Subarachnoid"nHemorrhage

  16. Intracerebral malignant peripheral nerve sheath tumor in a child with neurofibromatosis Type 1 and middle cerebral artery aneurysm treated with endovascular coil embolization.

    Science.gov (United States)

    Ellis, Michael J; Cheshier, Samuel; Sharma, Sunjay; Armstrong, Derek; Hawkins, Cynthia; Bouffet, Eric; Rutka, James T; Taylor, Michael D

    2011-10-01

    Among the neoplastic conditions that affect patients with neurofibromatosis Type 1 (NF1) are malignant peripheral nerve sheath tumors (MPNSTs), which typically arise from peripheral nerves of the limbs, trunk, and lumbar and brachial plexuses. Ionizing radiation is an established risk factor for MPNST development, especially in susceptible patients such as those with NF1. Patients with NF1 are also at risk for intracranial aneurysms, which are increasingly being successfully managed with endovascular therapies. The authors describe the case of a 9-year-old, previously healthy girl who presented in extremis with a right frontal intracerebral hemorrhage resulting from a ruptured right middle cerebral artery (MCA) trifurcation aneurysm. Following urgent decompressive craniectomy, the patient underwent endovascular coil embolization of the MCA aneurysm without complication. Given her mother's history of NF1, the child underwent genetic testing, which disclosed signs positive for NF1. The patient recovered well, but follow-up MR imaging and MR angiography performed at 14 months demonstrated a large frontotemporal mass encasing the right MCA trifurcation. The patient underwent frontotemporal craniotomy and subtotal resection of the mass, which was histologically found to be an intracranial MPNST. The patient received chemotherapy and focal radiation therapy and remains alive at 6 months postresection. To the authors' knowledge, this represents the only known case of intracranial neoplasm arising in the region of an intracranial aneurysm repaired by endovascular coil embolization. While patients with NF1 represent a population with genetic susceptibility to radiation-induced tumors, the pathogenesis of intracerebral MPNSTs remains poorly understood. PMID:21961539

  17. La trapia endovascular: una nueva alternativa en el tratamiento del vasoespasmo cerebral asociado a la hemorragia subaracnoidea espontánea Endovascular therapy: new alternative for treatment of cerebral vasospasm associated with spontaneous subarachnoid hemorrhage

    Directory of Open Access Journals (Sweden)

    Sergio Vargas

    1998-04-01

    Full Text Available EI vaso espasmo cerebral es la principal causa tratable de muerte e incapacidad por hemorragia subaracnoidea espontánea secundaria a la ruptura de un aneurisma cerebral. Sin embargo, su tratamiento ha sido tradicionalmente frustrante, con resultados desalentadores. A pesar de que aún no se han aclarado del todo los mecanismos fisiopatológicos a través de los cuales ocurre este intrigante fenómeno, en los últimos 9 años, paralelamente al desarrollo de las técnicas endovasculares para el tratamiento de las enferm~dades cerebrovasculares, han surgido nuevas alternativas en el manejo del vasoespasmo cerebral. Entre ellas se destacan el uso intraarterial de papaverina y la angioplastia con balón de los vasos cerebrales. Se presenta una revisión del estado actual de estos novedosos instrumentos terapéuticos, así como el reporte de un caso en el cual usamos la papaverina intraarterial en el tratamiento del vasoespasmo quese presentó durante un procedimiento endovascular para excluir un aneurisma de la arteria cerebral media. Cerebral vasospasm is the first treatable cause of death and disability secondary to spontaneous subarachnoid hemorrhage due to ruptured cerebral aneurysms. However, its treatment has been disapointing with poor results. Despite the fact that the physiopathologic mechanisms governing this phenomenon are largely unknown, during the last nine years, simultaneously with the development of endovascular therapy techniques for treatment of cerebrovascular diseases, two new alternatives have emerged in order to alleviate cerebral vasospasm: intraarterial papaverine and cerebral balloon angioplasty. We report the use of intraarterial papaverine in one case to treat cerebral vasospasm presented during the endovascular therapy procedure; a review of literature is included.

  18. Aortic Endoprosthesis for the Treatment of Native Aortic Coarctation and Concomitant Aneurysm in an Octogenarian Patient.

    Science.gov (United States)

    Rabellino, Martín; Kotowicz, Vadim; Kenny, Alberto; Kohan, Andres Alejandro; García-Mónaco, Ricardo

    2015-11-01

    We report a case of an 82-year-old female patient with native coarctation of the aorta and poststenotic aneurysm of the descending thoracic aorta. On consultation, she was receiving 4 antihypertensive drugs, and physical examination revealed nonpalpable lower-limb pulses with intermittent claudication at 50 min. Because of her age, high surgical risk and combination of lesions, endovascular treatment was suggested. Placement of a Valiant thoracic aorta endoprosthesis followed by coarctation angioplasty was performed. At 48 hr, the patient was discharged on 1 antihypertensive drug, palpable pulses on both limbs and a normal ankle-brachial index. At 1 month follow-up, the patient remained as discharged and multislice computed tomography angiography depicted complete coarctation expansion without residual stenosis, exclusion of the aortic aneurysm, and no signs of endoleaks. PMID:26318556

  19. Aortic Endoprosthesis for the Treatment of Native Aortic Coarctation and Concomitant Aneurysm in an Octogenarian Patient.

    Science.gov (United States)

    Rabellino, Martín; Kotowicz, Vadim; Kenny, Alberto; Kohan, Andres Alejandro; García-Mónaco, Ricardo

    2015-11-01

    We report a case of an 82-year-old female patient with native coarctation of the aorta and poststenotic aneurysm of the descending thoracic aorta. On consultation, she was receiving 4 antihypertensive drugs, and physical examination revealed nonpalpable lower-limb pulses with intermittent claudication at 50 min. Because of her age, high surgical risk and combination of lesions, endovascular treatment was suggested. Placement of a Valiant thoracic aorta endoprosthesis followed by coarctation angioplasty was performed. At 48 hr, the patient was discharged on 1 antihypertensive drug, palpable pulses on both limbs and a normal ankle-brachial index. At 1 month follow-up, the patient remained as discharged and multislice computed tomography angiography depicted complete coarctation expansion without residual stenosis, exclusion of the aortic aneurysm, and no signs of endoleaks.

  20. Endovascular treatment of post-laparoscopic pancreatectomy splenic arteriovenous fistula with splenic vein aneurysm.

    Science.gov (United States)

    Ueda, Tatsuo; Murata, Satoru; Yamamoto, Akira; Tamai, Jin; Kobayashi, Yuko; Hiranuma, Chiaki; Yoshida, Hiroshi; Kumita, Shin-Ichiro

    2015-07-01

    Splenic arteriovenous fistulas (SAVFs) with splenic vein aneurysms are extremely rare entities. There have been no prior reports of SAVFs developing after laparoscopic pancreatectomy. Here, we report the first case. A 40-year-old man underwent a laparoscopic, spleen-preserving, distal pancreatectomy for an endocrine neoplasm of the pancreatic tail. Three months after surgery, a computed tomography (CT) scan demonstrated an SAVF with a dilated splenic vein. The SAVF, together with the splenic vein aneurysm, was successfully treated using percutaneous transarterial coil embolization of the splenic artery, including the SAVF and drainage vein. After the endovascular treatment, the patient's recovery was uneventful. He was discharged on postoperative day 6 and continues to be well 3 mo after discharge. An abdominal CT scan performed at his 3-mo follow-up demonstrated complete thrombosis of the splenic vein aneurysm, which had decreased to a 40 mm diameter. This is the first reported case of SAVF following a laparoscopic pancreatectomy and demonstrates the usefulness of endovascular treatment for this type of complication.

  1. Stem cell therapy: a novel treatment option for cerebral malaria?

    Science.gov (United States)

    Wang, Wei; Qian, Hui; Cao, Jun

    2015-01-01

    Cerebral malaria, a severe form of the disease, is one of the most severe complications of infection with Plasmodium parasites and a leading cause of malaria mortality. Currently available antimalarial therapy has proven insufficient to prevent neurological complications and death in all cases of cerebral malaria. Souza and colleagues observed that transplantation of bone marrow-derived mesenchymal stromal cells (BM-MSCs) increased survival, reduced parasitemia, decreased malaria pigment accumulation in the spleen, liver and kidney, elevated Kupffer cell count in liver, alleviated renal injury and lung inflammation, and improved lung mechanics in an experimental mouse model of cerebral malaria. Although plenty of challenges lie ahead, their findings show the promise of BM-MSC therapy for the treatment of cerebral malaria. PMID:26253514

  2. Ruptured, dissecting posterior inferior cerebellar artery aneurysms: endovascular treatment without parent vessel occlusion

    Energy Technology Data Exchange (ETDEWEB)

    Cellerini, Martino [Careggi Hospital, Interventional Neuroradiology, Florence (Italy); Centro Traumatologico-Ortopedico, Unita di Neuroradiologia, Florence (Italy); Mangiafico, Salvatore [Careggi Hospital, Interventional Neuroradiology, Florence (Italy); Ammannati, Franco; Mennonna, Pasquale [Careggi Hospital, Neurosurgery, Florence (Italy); Ambrosanio, Gennaro; Muto, Mario [Cardarelli Hospital, Neuroradiology, Naples (Italy); Galasso, Luigi [S. Luca Hospital, Neuroradiology, Salerno (Italy)

    2008-04-15

    Treatment of a dissecting aneurysm of the medullary segments of the posterior inferior cerebellar artery (PICA) usually entails trapping of the diseased arterial segment with possible sacrifice of brainstem perforators. The goal of the work was to review our experience with selective coiling of ruptured, dissecting aneurysms of the anterolateral segments of the PICA without parent vessel occlusion. Eleven consecutive patients (9 women, 2 men, mean age 47.2 years) were retrospectively reviewed from a prospectively acquired neuroradiological database. On admission three patients had Hunt and Hess (HH) grade I, three HH grade II, two HH grade III, and one HH grade IV. Outcome was evaluated according to the modified Rankin scale (mRS) score. Follow-up (mean:19.4 months) consisted of magnetic resonance angiography and/or digital subtraction angiography in ten patients. Ten patients had mRS score 0 and one mRS score 2. No treatment failure occurred. The aneurysm was completely occluded in seven patients, a neck residue was present in two, and a loose coil mesh was present in two. Recurrence occurred in three patients, and all were successfully retreated for a total of 13 procedures. Procedure-related complications were all without clinical consequences and included a coil perforation in one procedure and stagnant filling of the parent vessel in six procedures. PICA occlusion did not occur in any patient. Coiling of ruptured, isolated dissecting aneurysms of the PICA without parent vessel occlusion is feasible, relatively safe and effective in preventing early/medium-term rebleeding. A strict angiographic follow-up program is, however, necessary to detect recurrence. (orig.)

  3. Pathogenesis, diagnosis and treatment of cerebral fat embolism

    Institute of Scientific and Technical Information of China (English)

    Yihua Zhou; Ying Yuan; Chahua Huang; Lihua Hu; Xiaoshu Cheng

    2015-01-01

    In this study, we analyzed two cases of pure cerebral fat embolism and reviewed related literatures to explore the pathogenesis, clinical manifestations, diagnosis and treatment of cerebral fat embolism, improve the treatment efficiency and reduce the misdiagnosis rate.In our cases, patients fully returned to consciousness at the different times with good prognosis, normal vital signs and without obvious sequelae.For patients with the limb fractures, who developed coma without chest distress, dyspnea or other pulmonary symptoms 12 or 24 h post injury, cerebral fat embolism should be highly suspected, except for those with intracranial lesions, such as delayed traumatic intracerebral hemorrhage, etc.The early diagnosis and comprehensive treatment can improve prognosis.

  4. A novel arterial pouch model of saccular aneurysm by concomitant elastase and collagenase digestion

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Background: An ideal aneurysm model of cerebral aneurysm is of great importance for studying the pathogenesis of the lesion and testing new techniques for diagnosis and treatment. Several models have been created in rabbits and are now widely used in experimental studies; however, every model has certain intrinsic limitations. Here we report the development of a novel saccular aneurysm model in rabbits using an arterial pouch that is subject to in vitro pre-digestion with combined elastase and collagenase. Methods: A segment of right common carotid artery (CCA) was dissected out and treated with elastase (60 U/ml, 20 min) followed by type I collagenase (1 mg/ml, 15 min) in vitro. The graft was anastomosed to an arterial arch built with the left CCA and the remaining right CCA, while the other end of the graft was ligated. The dimension and tissue structure of the pouch were analysed immediately, 2 or 8 weeks after operation. Findings: Ten terminal aneurysms were produced. The gross morphology of the aneurysm resembles the human cerebral terminal aneurysms. We have observed the following pathological changes:(1) growth of the aneurysm (mean diameter increased from (2.0±0.1) to (3.2±0.3) mm at 2 weeks, P<0.001, n=7~10); (2) thinning of the aneurysmal wall (the mean wall thickness decreased to 44% at 2 weeks), which was accompanied by significant losses of elastic fibres, collagen and the cellular component; and (3) spontaneous rupture (3 out of 9, one aneurysm ruptured 24 h after operation with the other two at 2 and 4 weeks respectively). Conclusion: This rabbit arterial pouch model mimics human cerebral aneurysms in relation to morphology and histology. In particular, this model exhibited an increased tendency of spontaneous rupture.

  5. Risk factors and consequences of unexpected trapping for ruptured anterior communicating artery aneurysms

    Directory of Open Access Journals (Sweden)

    Hitoshi Fukuda

    2014-01-01

    Full Text Available Background: While clipping cerebral aneurysms at the neck is optimal, in some cases this is not possible and other strategies are necessary. The purpose of this study was to describe the incidence, risk factors, and outcomes for inability to clip reconstruct ruptured anterior communicating artery (ACoA aneurysms. Methods: Of the 70 cases of ruptured ACoA aneurysms between January 2006 and December 2013, our institutional experience revealed four cases of small ACoA aneurysms that had been considered clippable prior to operation but required trapping. When a unilateral A2 segment of anterior cerebral artery (ACA was compromised by trapping, revascularization was performed by bypass surgery. Clinical presentation, angiographic characteristics, operative approach, intraoperative findings, and treatment outcomes were assessed. Results: Very small aneurysm under 3 mm was a risk factor for unexpected trapping. The reason for unexpected trapping was laceration of the aneurysmal neck in two cases, and lack of clippaple component due to disintegration of entire aneurysmal wall at the time of rupture in the others. Aneurysms with bilateral A1 were treated with sole trapping through pterional approach in two cases. The other two cases had hypoplastic unilateral A1 segment of ACA and were treated with combination of aneurysm trapping and revascularization of A2 segment of ACA through interhemispheric approach. No patients had new cerebral infarctions of cortical ACA territory from surgery. Cognitive dysfunction was observed in three cases, but all patients became independent at 12-month follow up. Conclusions: Unexpected trapping was performed when ruptured ACoA aneurysms were unclippable. Trapping with or without bypass can result in reasonable outcomes, with acceptable risk of cognitive dysfunction.

  6. Minimally Invasive Treatment of Biventricular Hydrocephalus Caused by a Giant Basilar Apex Aneurysm via a Staged Combination of Endoscopy and Endovascular Embolization: A Case Report.

    Science.gov (United States)

    Setty, Pradeep; Volkov, Andrey; Richards, Boyd; Barrett, Ryan

    2015-01-01

    Biventricular hydrocephalus caused by a Giant Basilar Apex Aneurysm (GBAA) is a rare finding that presents unique and challenging treatment decisions. We report a case of GBAA causing a life-threatening biventricular hydrocephalus in which both the aneurysm and hydrocephalus were given definitive treatment through a staged, minimally invasive approach. An obtunded 82-year-old male was found to have biventricular hydrocephalus caused by an unruptured GBAA obstructing the foramina of Monro. The patient was treated via staged, minimally invasive technique that first involved endoscopic fenestration of the septum pellucidum to create communication between the lateral ventricles. A programmable ventriculo-peritoneal shunt was then placed with a high-pressure setting. The patient was then loaded with dual anti-platelet therapy prior to undergoing endovascular coiling of the GBAA with adjacent stenting of the Posterior Cerebral Artery. He remained on dual anti-platelet therapy and the shunt setting was lowered at the bedside to treat the hydrocephalus. At 6-month follow up, the patient had returned to his cognitive baseline, speaking fluently and appropriately. Biventricular hydrocephalus caused by a GBAA can successfully be treated in a minimally invasive fashion utilizing a combination of endoscopy and endovascular therapy, even when a stent-assisted coiling is needed.

  7. Multilayer stents, a new progress in the endovascular treatment of aneurysms

    Institute of Scientific and Technical Information of China (English)

    ZHANG Yong-xue; LU Qing-sheng; JING Zai-ping

    2013-01-01

    Objective To review the recent progress of multilayer stents in treating arterial aneurysms and to draw an initial conclusion about its paradigm.Data sources PubMed database and ELSEVIER database were searched with the keywords "cardiatis" or "multilayer stent" for relevant articles from January 2008 to September 2012.Relevant websites (provided by Cardiatis) were also involved in the review process.Study selection Well-controlled,relatively large-scale,retrospective studies as well as meaningful individual cases were all selected as materials.Results A total of 23 articles were involved in this review.The newly introduced Cardiatis multilayer stent aims at creating an active flow-modulating barrier between normal blood flow and aneurismal sac,which can induce thrombosis within aneurismal sac and preserve collateral circulation at the same time.Currently,it has been applied for complicated aneurysms located in different segments of the arterial system.Conclusion This new concept of multilayer uncovered stent offers a promising alterative in the treatment of arterial aneurysms.However,a further large-scale clinical and hemodynamic study is required to evaluate the long-term effects.

  8. Case report: ruptured aortic aneurysm into oesophagus - treatment by covered stent

    International Nuclear Information System (INIS)

    Full text: A case report of a 70 year old man acutely presenting with a large descending thoracic aortic aneurysm, ruptured into the adjacent oesophagus. He was treated with an Aneurex covered stent (Medtronics). This patient has a long history of ischaemic heart disease, hypertension and previously treated abdominal aortic aneurysm. After diagnosis by CT, the bleeding was emergency temponaded by insertion of a Sengstaken-Blackmore tube into the oesophagus and inflated to arterial pressure. After stabilisation in ICU, it was decided that open surgery would probably prove fatal, and insertion of a covered thoracic aortic stent was performed in theatre with a femoral artery cut-down. Post-operatively the bleeding from the aortic aneurysm ceased. However, the patient has ongoing problems with large, open oesophageal ulcer with chronic ooze requiring intermittent transfusions, chronic infection with MRSA, requiring long term antibiotics, feeding via feeding gastrostomy tubes. The patient is stable 12 months after presentation. Treatment of this otherwise fatal problem by covered stent has permitted survival benefit. However, there are significant, unresolved issues of oesophageal ulcer and ongoing MRSA infection. Copyright (2002) Blackwell Science Pty Ltd

  9. RECENT PROGRESSES OF ACUPUNCTURE TREATMENT OF CEREBRAL HEMORRHAGE

    Institute of Scientific and Technical Information of China (English)

    赵耀东; 郑俊江; 郑魁山

    2003-01-01

    In the present paper, the authors review recent progresses of acupuncture treatment of cerebral hem-orrhage and theoretical research. Regarding the clinical application of acupuncture therapy, in the acute stage of thedisease, many doctors adopt body acupuncture and scalp-acupuncture, fewer doctors applied eye acupuncture; whilein the chronic stage of the disease, many medical workers employ body acupuncture, sc alp-acupuncture, combinedtherapies of acupuncture, functional exercise, massage, acupoint injection, etc.. Concerning studies on the mecha-nisms of acupuncture in the treatment of cerebral hemorrhage, abundant experience evidence show that acupuncturecan raise the activity of the plasma fibrinolytic system to promote the absorption of blood clots of the foci; improve mi-crocirculation; reduce cerebral tissue edema; regulate some chemical substances' levels to lessen harmful effects ofoxygen free radicals; and enhance the patient' s immune function. However, some problems still exist in clinical re-searches at present and affect the reasonable evaluation on the clinical therapeutic effect of acupuncture.

  10. Treatment of a Common Iliac Aneurysm by Endovascular Exclusion Using the Amplatzer Vascular Plug and Femorofemoral Crossover Graft

    International Nuclear Information System (INIS)

    We report our initial experience using the Amplatzer Vascular Plug II (AVP2) in the treatment of a left common iliac aneurysm. Following investigation by computerized tomographic angiography and catheter angiography, a 79-year-old man was found to have a markedly tortuous iliac system, with a left common iliac artery aneurysm that measured 48 mm in maximal diameter. Due to the patient's age and comorbidities the surgical opinion was that conventional open repair was not suitable. However, due to the tortuous nature of the aneurysm and iliac vessels, standard endovascular repair, using either a bifurcated or an aorto-uni-iliac stent graft, was also not possible. A combined approach was used by embolizing the ipsilateral internal iliac artery using coils and excluding the aneurysm using two AVP2 occlusion devices, followed by femorofemoral crossover grafting. Total aneurysm occlusion was achieved using this method and this allowed the patient to have a much less invasive surgical procedure than with conventional open repair of common iliac aneurysms, thus avoiding potential comorbidity and mortality.

  11. Spontaneous healing and complete disappearance of a ruptured posterior inferior cerebellar artery dissecting aneurysm.

    Science.gov (United States)

    Su, Tsung-Ming; Cheng, Ching-Hsiao; Chen, Wu-Fu; Hsu, Shih-Wei

    2014-05-01

    A 7-month-old baby presented with a 4-day history of drowsiness and vomiting after a falling accident. Magnetic resonance imaging demonstrated diffuse subarachnoid hemorrhage, intraventricular hemorrhage, and variable stages of subdural hematoma in bilateral occipital and left temporal subdural spaces. A partially thrombosed aneurysm was noted in the right craniocervical junction. Ophthalmological examination revealed bilateral retinal petechial hemorrhages. Conventional cerebral angiography revealed a dissecting aneurysm in the right posterior inferior cerebellar artery (PICA). Endovascular embolization was suggested, but the family refused. After conservative treatment, follow-up MRI revealed that the PICA aneurysm had remodeled and ultimately disappeared completely at the 10th month. This case illustrates the relatively plastic nature of intracranial aneurysms in pediatric patients. More studies are necessary to clarify the natural history of spontaneously thrombosed aneurysms to assist in their overall management.

  12. Endovascular Treatment of Multiple HIV-related Aneurysms Using Multilayer Stents

    International Nuclear Information System (INIS)

    Complex peripheral aneurysm anatomy with major artery branches in the immediate vicinity and mycotic aneurysm often impede endovascular management using covered stent grafts. The Cardiatis Multilayer Stent (Cardiatis, Isnes, Belgium) is a recently approved innovative stent system for peripheral aneurysm management. Its multilayer design aims at decreasing mean velocity and vorticity within the aneurysm sac to cause thrombus formation while maintaining patency of branching vessels due to laminar flow. We present a case of bilateral subclavian artery aneurysms and perivisceral aortic aneurysms in an AIDS patient successfully treated with the Cardiatis Multilayer Stent at 18 months’ follow-up.

  13. Endovascular Treatment of Multiple HIV-related Aneurysms Using Multilayer Stents

    Energy Technology Data Exchange (ETDEWEB)

    Euringer, Wulf [University Hospital Freiburg, Department of Diagnostic Radiology (Germany); Suedkamp, Michael; Rylski, Bartosz [University Hospital Freiburg, Department of Cardiovascular Surgery (Germany); Blanke, Philipp, E-mail: philipp.blanke@uniklinik-freiburg.de [University Hospital Freiburg, Department of Diagnostic Radiology (Germany)

    2012-08-15

    Complex peripheral aneurysm anatomy with major artery branches in the immediate vicinity and mycotic aneurysm often impede endovascular management using covered stent grafts. The Cardiatis Multilayer Stent (Cardiatis, Isnes, Belgium) is a recently approved innovative stent system for peripheral aneurysm management. Its multilayer design aims at decreasing mean velocity and vorticity within the aneurysm sac to cause thrombus formation while maintaining patency of branching vessels due to laminar flow. We present a case of bilateral subclavian artery aneurysms and perivisceral aortic aneurysms in an AIDS patient successfully treated with the Cardiatis Multilayer Stent at 18 months' follow-up.

  14. Endovascular treatment of wide-necked intracranial aneurysms using of "remodeling technique" with the HyperForm balloon

    Institute of Scientific and Technical Information of China (English)

    MU Shi-qing; YANG Xin-jian; LI You-xiang; ZHANG You-ping; L(U) Ming; WU Zhong-xue

    2008-01-01

    Background Aneurysms with wide-necked or a large neck/fundus ratio, especially located on an arterial bifurcation or a small artery, are challenges for interventional neuroradiologist because of the risk of coil migration or coil protrusion into the parent vessels. Our study was designed to improve the efficacy and safety of the "remodeling technique" with the HyperForm balloon for these difficult aneurysms and was confirmed by a follow-up result. Methods From June 2004 to September 2006, forty-two patients(20 men, 22 women)with wide-necked or large neck/fundus ratio aneurysms were treated by using the"remodeling technique"with the HyperForm balloon. Results Forty wide-necked aneurysms were successfully treated with the HyperForm balloon remodeling technique with only two failed cases. Final results consisted of total occlusion in 34 cases(80.9%), subtotal in 4 (9.5%) and incomplete in 2(4.8%). One aneurysmal rupture occurred, but no clinical consequence was shown. No thromboembolic events were observed during treatment. Final angiographic follow-up time ranged from 3 to 18 months. Conclusions The "remodeling technique" with the HyperForm balloon is a very useful tool in the treatment of wide-necked or unfavorable neck/fundus ratio intracranial aneurysms-located on an arterial bifurcation or a small artery and, especially, located on the bifurcation of a large artery and a small one. In our experience, this technique provided a safe and efficient treatment for difficult aneurysms when the standard remodeling technique might have failed.

  15. Cerebral Aneurysms: A Rare Feature of Behçet's Disease—A Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Samia Younes

    2013-01-01

    Full Text Available Behçet's disease (BD is a multisystem vascular inflammatory disease with several clinical manifestations. Intracranial aneurysms are an extremely rare but nevertheless severe complication of BD. We report a case of a 44-year-old man. The diagnosis of BD was made based on the presence of recurrent oral aphthous ulcers and positive human leukocyte antigen (HLA- B51 in the absence of evidence of other diseases. MRI showed an ancient ischemic right capsulolenticular lesion, subacute white matter hypersignals of the left capsule lenticular region, and multiple arterial aneurysms. The patient underwent two-month systemic high-dose corticosteroids and immunosuppressive therapy associated with severe neurological deficiency upon admission and severe impairment upon discharge. A thorough review of the literature showed 20 case reports of intracranial aneurysms in BD.

  16. Haemodynamics of giant cerebral aneurysm: A comparison between the rigid-wall, one-way and two-way FSI models

    Science.gov (United States)

    Khe, A. K.; Cherevko, A. A.; Chupakhin, A. P.; Bobkova, M. S.; Krivoshapkin, A. L.; Orlov, K. Yu

    2016-06-01

    In this paper a computer simulation of a blood flow in cerebral vessels with a giant saccular aneurysm at the bifurcation of the basilar artery is performed. The modelling is based on patient-specific clinical data (both flow domain geometry and boundary conditions for the inlets and outlets). The hydrodynamic and mechanical parameters are calculated in the frameworks of three models: rigid-wall assumption, one-way FSI approach, and full (two-way) hydroelastic model. A comparison of the numerical solutions shows that mutual fluid- solid interaction can result in qualitative changes in the structure of the fluid flow. Other characteristics of the flow (pressure, stress, strain and displacement) qualitatively agree with each other in different approaches. However, the quantitative comparison shows that accounting for the flow-vessel interaction, in general, decreases the absolute values of these parameters. Solving of the hydroelasticity problem gives a more detailed solution at a cost of highly increased computational time.

  17. Endovascular treatment of abdominal aortic aneurysms--6 years of experience with Ella stent-graft system

    Energy Technology Data Exchange (ETDEWEB)

    Koecher, Martin E-mail: martin.kocher@seznam.cz; Utikal, Petr; Koutna, Jirina; Bachleda, Petr; Buriankova, Eva; Herman, Miroslav; Bucil, Jiri; Benysek, Vladimir; Cerna, Marie; Kojecky, Zdenek

    2004-08-01

    Purpose: Evaluation of 6-year results of abdominal aortic aneurysm (AAA) treatment by Ella stent-grafts with regard to safety and effectivity in relation to morphology of the aneurysm. Methods: From a group of 172 patients with AAA, in whom elective endovascular treatment was considered, 120 of them (69.8%) were found to be suitable for this type of therapy. The bifurcated type of stent-graft was implanted in 97 patients, uniiliacal type in 19 patients and only four patients were found to be suitable for tubular type of stent-graft. Additional necessary procedures (internal iliac artery occlusion or contralateral common iliac artery occlusion in a group of patients with uniiliacal type of stent-graft) were performed surgically during the stent-graft implantation. CT and US controls were performed at 3, 6 and 12 months after implantation, later every 12 months. Results: Primary technical success was achieved in 109 of the 120 patients (91%). Primary endoleak was recorded in 11 patients (primary endoleak type Ia in seven patients, type Ib in three patients and type IIIa in one patient). Assisted technical success after reintervention or spontaneous seal was 98.3%. Surgical conversion was indicated in two patients (1.7%). Perioperative mortality rate was 3.3%. Total average follow-up period was 20.7 months (range from 2 to 60 months). In nine patients (7.5%) secondary endoleak type II was found at control CT or US, in three patients partial thrombosis of the stent-graft was found. There was no aneurysm rupture during follow-up. Conclusion: Treatment of AAA with Ella stent-graft system is effective and safe. Bifurcated stent-graft is the most frequently used type. Uniiliacal type of stent-graft is used by us only in cases of complicated morphology.

  18. Vascular prosthesis implantation for treatment of isolated lilac artery aneurysm A 33-case report%人工血管移植治疗髂动脉瘤33例

    Institute of Scientific and Technical Information of China (English)

    王春喜; 胡海地; 宋清彬; 段志泉; 陈刚; 梁发启

    2009-01-01

    A total of 33 patients with isolated lilac artery aneurysms, 19 males and 14 females, who received treatment between January 1997 and June 2007, were retrospectively analyzed. Among these patients, 29 suffered from unilateral iliac artery aneurysm and 4 from bilateral iliac artery aneurysm. Under general anesthesia, all patients were subjected to aneurysmectomy, followed by vascular prosthesis implantation for vascular reconstruction. Results revealed that among 4 cases of bilateral iliac artery aneurysm, there was 1 case who was subjected to aorta-bilateral femoral artery vascular prosthesis implantation, and there were 3 cases who underwent aorta-bilateral lilac artery vascular prosthesis implantation; among 29 cases of unilateral lilac artery aneurysm, there was 1 case receiving aorta-common lilac artery vascular prosthesis implantation, 3 cases undergoing iliac-femoral artery vascular prosthesis implantation, 21 cases subjected to common-external iliac artery vascular prosthesis implantation, and 4 cases undertaking common -common lilac artery bypass. Color Doppler ultrasonic examination, spiral CT angiography, or digital subtraction arteriography was performed 3, 6 months, 1, 3, 5, 8, and 10 years after surgery. The mean follow-up time was 5 years. Three cases died of acute cerebral infarction, myocardial infarction, and traffic accident 3, 6, and 2 years after surgery, respectively. The remaining cases well survived as determined by no recurred Uiac artery aneurysm, anastomotic stoma stenosis or lower limb ischemia found. These results indicated that aneurysmectomy and subsequent vascular prosthesis implantation remained a good and primary means for treatment of isolated iliac artery aneurysm under the present medical condition.%回顾性分析1997-01/2007-06收治孤立性骼动脉瘤患者共33例,男19例,女14例,其中单侧髂动脉瘤29例,双侧4例.均在全身麻醉下行动脉瘤切除、人工血管移植血管重建.结果显示4

  19. Giant mycotic aneurysm of the internal carotid artery in a child: endovascular treatment

    International Nuclear Information System (INIS)

    We present a case of a giant mycotic aneurysm of the left internal carotid artery in a child, the result of direct extension of a deep neck space infection. This lesion is life threatening and may put the patient at risk of unwarranted biopsy or drainage if not recognized. Diagnosis and treatment planning rely heavily on cross-sectional imaging, and angiography is frequently necessary. This case is unique for two reasons: (1) we present for the first time the MRI findings and (2) we describe an alternative to surgical ligation -- neurointerventional embolotherapy. Minimally invasive transcatheter embolization was successfully performed on our patient to occlude the abnormal left internal carotid artery segment. (orig.)

  20. 颅内动脉瘤破裂诊疗的抉择%Decision making in diagnosis and treatment for ruptured intracranial aneurysm

    Institute of Scientific and Technical Information of China (English)

    汤恒心; 王守森; 张小军

    2015-01-01

    Objective To explore the selection of diagnosis and treatment for ruptured intracranial aneurysms .Methods 210 patients suffered from intracranial aneurysms between January 2008 to December 2011 were reviewed .All cases were confirmed by CTA/3D-CTA or DSA/3D-DSA. 92 patients were underwent microsurgical treatment , 4 of them were failure of endovascular embolization .113 patients were underwent endovascular therapy , all of them were embolized by guglielmi detachable coil ( GDC) or stent-assisted coiling .Results The anterior circulation aneurysms with Hunt-Hess gradesⅠ-Ⅲ,the prognoses were assessed by GOS in all pations .After the discharge , in the surgical group ,53 cases(73.2%) had good prognoses ,7(9.8%) were mild disabled,6(8.9%) were severely disabled ,2(2.8%) were vegetatively survived and 4(5.3%) died.In the endovascular treatment group,63 cases(75.3%) had good prognoses,13(15.1%) were mild disabled,4(5.4%) were severely disabled ,0 (0%) were vegetatively survived and 3 (4.2%) died.Conclusions The size,form,relationship with parent arteries , and even the ruptured point of aneurysms can be clearly demonstrated by CTA/3D-CTA or DSA/3D-DSA, which can be used to guide the treatment for intracranial aneurysms directly , both have advantages and disadvantages .Endovascular therapy and aneurysm clipping are the effective methods to treat intracranial aneurysms .The patients with intracranial aneurysm need individual treatment .The anterior circulation aneurysms or intracranial aneurysms with Hunt-Hess gradesⅠ-Ⅲmay be treated by both methods .The endovascular embolization should beselected first for the posterior circulation aneurysms .Patients of Ⅳ-Ⅴgrade intracranial ruptured ameurysm should be treated by endovascular intervention ;and also with external ventricular drainage ,lumbar puncture and drainage as well as hematoma removal as the subsequent treatment in an emergent state , The patients with severe cerebral vasosasm or intracranial

  1. Endovascular embolization treatment of ruptured intracranial aneurysms at the acute stage with micro - coils%微弹簧圈血管内栓塞治疗急性期破裂颅内动脉瘤

    Institute of Scientific and Technical Information of China (English)

    夏吉勇; 焦铁鹰; 李志强; 路长宇; 苗林; 郭吉卫

    2015-01-01

    Objective To investigate the efficacy and safety of the microcoil embolization treatment of ruptured intracranial aneurysms at the acute stage. Methods The clinical data of 30 cases(34 aneurysms)were retrospectively analyzed. All the patients were diagnosed as sub-arachnoid hemorrhage by CT. All cases were confirmed by DSA for intracranial aneurysms. And all of them underwent endovascular embolization within 72 hours after aneurysm rupture. Results Complete embolization was achieved in 24 of 34 aneurysms,95% embolization in 6 aneurysms, 90% embolization in 2 aneurysms,80% embolization in 2 aneurysms. The operation associated complications occurred in 6 patients. The last coil extruding into the patent artery was observed in 1 patient. Re - rupture of aneurysm during the operation in 1 patient,severe cerebral angiospasm in 2 patients and cerebral infarction in 2 patients. After operation,25 patients recovered well,4 patients with mild disability or paralysis,1 patient died of postoperative gastrointestinal bleeding. During the follow - up of 1 ~ 6 months,no rebleeding occurred. Conclusion Microcoil emboliza-tion is a safe and effective method to treat acutely ruptured intracranial aneurysms. Early intracranial surgery and timely treatment after operation is important to reduce fatality and disability.%目的:探讨微弹簧圈血管内栓塞治疗急性期破裂颅内动脉瘤的安全性及有效性。方法回顾性分析30例颅内动脉瘤在破裂出血后72小时内行微弹簧圈血管内栓塞治疗的临床资料。30例患者发病后均行 CT 检查,诊断为蛛网膜下腔出血,并经全脑血管造影证实为颅内动脉瘤,共检出34枚动脉瘤,其中单发26例,2枚4例。结果34枚动脉瘤中,100%栓塞24枚,95%栓塞6枚,90%栓塞2枚,80%栓塞2枚。术后发生手术相关并发症6例,包括微弹簧圈脱出至载瘤动脉1例,术中动脉瘤破裂1例,严重脑血管痉挛2例,术后脑梗死2

  2. Is the Gamma Knife Treatment of Cerebral Cavernous Angioma Effective?

    OpenAIRE

    Wenchuan, Zhang; Wenxiang, Zhong; Xuhui, Wang

    2013-01-01

    The treatment of cerebral cavernous angioma (CCA) has caused great controversy. In the case of recurrent haemorrhage, frequent epileptic attacks, clear dysneuria, etc., and by taking into consideration focal positions, number of foci, and conditions conducive to operations, it is our opinion that excision of CCA foci is the first choice to cure the disease. Controversy regarding the gamma knife treatment of CCA has existed for a long time. The main reason behind this i...

  3. Clinical characteristics and surgical treatment of patients with giant intracranial aneurysms

    Institute of Scientific and Technical Information of China (English)

    QI Wei; WANG Shuo; ZHAO Yuan-li; YANG Hai-bo; ZHAO Ji-zong

    2008-01-01

    Background Compared with smaller aneurysms,giant intracranial aneurysms (GICAs) have a poorer prognosis and require more meticulous surgical planning and techniques to exclude them from the circulation.GICAs continue to challenge the limits of neurosurgical techniques.A series of 170 patients with GICAs were reviewed for understanding the clinical characteristics.surgical treatment and outcomes of patients with GICAs.Methods Collected data of 170 consecutive patients with GICAs from January 1995 to July 2007 were analyzed.The clinicaI Characteristics in this study included age,sex,intracranial aneurysms size,the first presentations,locations and Hunt & Hess grade.Surgical methods included direct clipping of the aneurysm neck,parent artery reconstruction,proximal artery ligation,trapping and wrapping.Surgical results were evaluated postOperatively by the Glasgow Outcome Scale (GOS).Results GICAs were more commonly diagnosed at age 30 to 50 years with a mean age of 39.3 years and without obvious gender preponderance in our study (88 male and 82 female patients).The size of the GlCAs ranged from 2.5 cm to 8.0 cm(mean,2.9 cm).Hemorrhage (41%),mass effect (34%) and headache (12%) were the first 3 most common presentations.Regarding the Hunt & Hess classification,at admission there were 1 00 cases in grade 0,24 in grade 1,21 in grade 2,16 in grade 3,8 in grade 4 and 1 in grade 5.There were 84 cases of GICAs treated by direct neck-clipping,47 by parent artery reconstruction,19 by proximal artery occlusion(with 4 combined with reVascuIarization),18 by trapping and 2 by wrapping.The follow-up study (ranging from 6 to 115 months,mean 32 months)showed good results in 108 cases.moderate disability in 26 and severe disability in 15 according to GOS.Six cases died.Conclusions Surgical treatment is an effective treatment for GICAs.SurgicaI strategies should be made carefully and individually.Doppler ultrasonography,neuroendoscope and intraoperative angiography are useful to

  4. Percutaneous treatment of a ruptured superior mesenteric artery aneurysm in a child

    International Nuclear Information System (INIS)

    Splanchnic artery aneurysms are very rare in children. We report a 10-year-old girl with a large atraumatic ruptured superior mesenteric artery aneurysm that was considered inoperable. She was ultimately treated with two percutaneous US-guided thrombin injections, which led to complete occlusion of the aneurysm. The aetiology of the aneurysm remained unclear, but a family history was suggestive of a congenital connective tissue disease such as Ehlers-Danlos syndrome subtype IV. (orig.)

  5. Percutaneous treatment of a ruptured superior mesenteric artery aneurysm in a child

    Energy Technology Data Exchange (ETDEWEB)

    Oechsle, Susanne; Vollert, Kurt; Buecklein, Wolfgang; Michl, Wolfgang; Roemer, Frank W. [Klinikum Augsburg, Department of Radiology, Augsburg (Germany)

    2006-03-15

    Splanchnic artery aneurysms are very rare in children. We report a 10-year-old girl with a large atraumatic ruptured superior mesenteric artery aneurysm that was considered inoperable. She was ultimately treated with two percutaneous US-guided thrombin injections, which led to complete occlusion of the aneurysm. The aetiology of the aneurysm remained unclear, but a family history was suggestive of a congenital connective tissue disease such as Ehlers-Danlos syndrome subtype IV. (orig.)

  6. Automated segmentation of cerebral vasculature with aneurysms in 3DRA and TOF-MRA using geodesic active regions: An evaluation study

    Energy Technology Data Exchange (ETDEWEB)

    Bogunovic, Hrvoje; Pozo, Jose Maria; Villa-Uriol, Maria Cruz [Center for Computational Imaging and Simulation Technologies in Biomedicine (CISTIB), Universitat Pompeu Fabra (UPF) and Networking Biomedical Research Center on Bioengineering, Biomaterials and Nanomedicine - CIBER-BBN, Barcelona 08018 (Spain); and others

    2011-01-15

    Purpose: To evaluate the suitability of an improved version of an automatic segmentation method based on geodesic active regions (GAR) for segmenting cerebral vasculature with aneurysms from 3D x-ray reconstruction angiography (3DRA) and time of flight magnetic resonance angiography (TOF-MRA) images available in the clinical routine. Methods: Three aspects of the GAR method have been improved: execution time, robustness to variability in imaging protocols, and robustness to variability in image spatial resolutions. The improved GAR was retrospectively evaluated on images from patients containing intracranial aneurysms in the area of the Circle of Willis and imaged with two modalities: 3DRA and TOF-MRA. Images were obtained from two clinical centers, each using different imaging equipment. Evaluation included qualitative and quantitative analyses of the segmentation results on 20 images from 10 patients. The gold standard was built from 660 cross-sections (33 per image) of vessels and aneurysms, manually measured by interventional neuroradiologists. GAR has also been compared to an interactive segmentation method: isointensity surface extraction (ISE). In addition, since patients had been imaged with the two modalities, we performed an intermodality agreement analysis with respect to both the manual measurements and each of the two segmentation methods. Results: Both GAR and ISE differed from the gold standard within acceptable limits compared to the imaging resolution. GAR (ISE) had an average accuracy of 0.20 (0.24) mm for 3DRA and 0.27 (0.30) mm for TOF-MRA, and had a repeatability of 0.05 (0.20) mm. Compared to ISE, GAR had a lower qualitative error in the vessel region and a lower quantitative error in the aneurysm region. The repeatability of GAR was superior to manual measurements and ISE. The intermodality agreement was similar between GAR and the manual measurements. Conclusions: The improved GAR method outperformed ISE qualitatively as well as

  7. Alterations of blood flow pattern after triple stent endovascular treatment of saccular abdominal aortic aneurysm: a porcine model.

    Directory of Open Access Journals (Sweden)

    JAHIR RICHARD DE OLIVEIRA

    2016-06-01

    Full Text Available ABSTRACT Objective: to determine the blood flow pattern changes after endovascular treatment of saccular abdominal aortic aneurysm with triple stent. Methods: we conducted a hemodynamic study of seven Landrace and Large White pigs with saccular aneurysms of the infrarenal abdominal aorta artificially produced according to the technique described. The animals were subjected to triple stenting for endovascular aneurysm. We evaluated the pattern of blood flow by duplex scan before and after stent implantation. We used the non-paired Mann-Whitney test for statistical analysis. Results: there was a significant decrease in the average systolic velocity, from 127.4cm/s in the pre-stent period to 69.81cm/s in the post-stent phase. There was also change in the flow pattern from turbulent in the aneurysmal sac to laminate intra-stent. Conclusion: there were changes in the blood flow pattern of saccular abdominal aortic aneurysm after endovascular treatment with triple stent.

  8. [Surgical treatment of cerebral paragonimiasis miyazakii].

    Science.gov (United States)

    Soutsu, M; Nishida, S; Nakamura, N; Katakura, K; Kobayashi, A; Araki, K

    1984-06-01

    An operated case of cerebral paragonimiasis miyazakii was reported. A 25-year-old man was admitted to our hospital on Jan. 25, 1982, because of weakness, sensory disorder and focal convulsion of the right upper limb. He complained of slight headache but had no sign of meningeal irritation nor inflammation. CT scan revealed a left parietal low density mass with irregular ring-like contrast enhancement. Left carotid angiogram showed stretched arteries around the mass. Laboratory findings were normal except for eosinophilie (17%). Chest X-P was normal. Operation was performed under diagnosis of glioblastoma on Aug. 6, 1982. The tumor was well-circumscribed and had a firm capsule which containing necrotic substance. The tumor was removed totally and the bone flap was also removed since slight brain swelling was seen. Histologically it proved to be a granuloma and four eggs of helminth were found in the necrotic tissue. Post operative state of the patient was satisfactory and cranioplasty was performed 3 weeks later. On Aug. 31, he began to complain of chest pain, cough and hemosputum, and chest X-P disclosed a nodular shadow in the lower lobe of the right lung. Paragonimiasis was strongly suspected because he had a history of having three fresh-water crabs (Potamon dehaani) 18 months before. But not egg was found in either sputum nor stool. Skin test with paragonimus westermani antigen was highly positive.(ABSTRACT TRUNCATED AT 250 WORDS)

  9. Comparison Between Balloon-Assisted and Stent-Assisted Technique for Treatment of Unruptured Internal Carotid Artery Aneurysms

    Science.gov (United States)

    Park, Keun Young; Kim, Dong Joon

    2016-01-01

    Purpose To compare clinical and angiographic outcomes between balloon-assisted (BAC) and stent-assisted coiling for internal carotid artery unruptured aneurysms (ICA-UA). Materials and Methods A total of 227 ICA-UA in 190 patients were treated with BAC (120 patients, 141 ICA-UA) or SAC (70 patients, 86 ICA-UA. We compared characteristics of patients and ICA-UA, and clinical and angiographic outcomes between groups. Results Aneurysm size and neck diameter were greater for SAC than in BAC, but aneurysm volume and coil packing density were not different between groups. Immediate angiographic occlusion grade was better for BAC than for SAC. Periprocedural thromboembolic events were more frequent during SAC (11.6%) than BAC (2.4%) per aneurysm, but hemorrhagic events were the opposite (2.4% for BAC and none for SAC per aneurysm) (p resulting in a modified Rankin scale score of 4. Thus, overall treatment-related morbi-mortality rates were 1.7% in BAC and 2.9% in SAC. At imaging follow-up (BAC, 135 aneurysms [95.7%] for 28.3 months; SAC, 81 aneurysms [94.1%] for 23.9 months), BAC and SAC showed stable or improved occlusion in 94.1% and 95.0%, minor recurrence in 4.4% and 2.5%, and major recurrence in 1.5% and 2.5%, respectively. Conclusion Both BAC and SAC were safe and effective techniques for ICA-UA. There were no differences in morbi-mortality and recurrence rates between groups. PMID:27621946

  10. Cranio-orbital approach for complex aneurysmal surgery.

    LENUS (Irish Health Repository)

    Kelleher, M O

    2012-02-03

    Certain aneurysms of the anterior circulation continue to offer a technical challenge for safe exposure and clipping. The purpose of this paper was to describe the cranio-orbital approach for surgical clipping of complex aneurysms and to evaluate prospectively the associated complications of this approach. Prospective audit of all patients undergoing cranio-orbital approach for aneurysm surgery from 1997 to 2004 by the senior author. Twenty-five patients, eight male and 17 female, median age of 52 years, range 28-73. All patients had a standard pterional approach supplemented by an orbital osteotomy. In the 7-year period 367 patients underwent treatment for their aneurysms (169 clipped and 198 coiled). Of the 169 patients who were operated on, 29 had a skull base approach, of which 25 were cranio-orbital. The aneurysm location was as follows: 16 middle cerebral artery (MCA), three carotid bifurcation, four anterior communicating artery (ACOMM), one ophthalmic and one basilar. There were no approach-related complications. The cranio-orbital craniotomy can be a useful adjunct in the surgical treatment of giant or complex aneurysms. It offers the following advantages over a standard pterional approach: reduces operative distance; allows easy splitting of the sylvian fissure; and provides a wide arc of exposure with multiple working corridors.

  11. Surgical treatment of cerebral ischemia by means of diode laser: first experimental results and comparison with theoretical model

    Science.gov (United States)

    Signorelli, C. D.; Giaquinta, A.; Iofrida, G.; Donato, G.; Signorelli, Fr.; Bellecci, C.; Lo Feudo, T.; Gaudio, P.; Gelfusa, M.

    2007-07-01

    In the present paper feasibility and potential advantages of using diode laser for surgical treatment of cerebral ischemia and intracranial aneurysms will be evaluated. At this purpose non linear mathematical model was developed and experimentally validated to investigate the effects of the changes in tissue physical properties, in terms of operating time, tensile strength and tissue damage during medical laser application. The numerical simulations have been carried on by a finite-elements based software package (FEMLAB). In vitro results of human saphenous veins of inferior limbs (n=55) after 799 nm diode laser soldering, combined with an indocyanine green-enhanced, will be presented. The simulations results and their comparison with experimental measurements will be reported.

  12. Disappearing Saccular Intracranial Aneurysms: Do They Really Disappear?

    OpenAIRE

    Jayakumar, P. N.; Ravishankar, S.; Balasubramaya, K.S.; Chavan, R.; Goyal, G

    2007-01-01

    Evolution and natural history of cerebral aneurysms is a dynamic process. Spontaneous regression in size or complete disappearance of an aneurysm is a known phenomenon, more commonly noted in giant intracranial aneurysms. However, reappearance or regrowth of such aneurysms is rare with few anecdotal reports. We report a series of four cases including one giant aneurysm, which either disappeared or regressed on sequential angiograms. Regrowth or reappearance of two of these previously disappea...

  13. [Aneurysm of the anterior inferior cerebellar artery: case report].

    Science.gov (United States)

    Adorno, Juan Oscar Alarcón; de Andrade, Guilherme Cabral

    2002-12-01

    The intracranial aneurysms of the posterior circulation have been reported between 5 and 10% of all cerebral aneurysms and the aneurysms of the anterior inferior cerebellar artery (AICA) are considered rare, can cause cerebello pontine angle (CPA) syndrome with or without subarachnoid hemorrhage. Since 1948 few cases were described in the literature. We report on a 33 year-old female patient with subarachnoid hemorrhage due to sacular aneurysm of the left AICA. She was submitted to clipage of the aneurysm without complications.

  14. Endovascular Treatment of Visceral Aneurysms and Pseudoaneurysms: Long-term Outcomes from a Multicenter European Study

    Energy Technology Data Exchange (ETDEWEB)

    Spiliopoulos, Stavros, E-mail: stavspiliop@upatras.gr; Sabharwal, Tarun [Guy' s and St Thomas' Hospitals NHS Trust, Department of Interventional Radiology (United Kingdom); Karnabatidis, Dimitrios [Patras University Hospital, Department of Diagnostic and Interventional Radiology (Greece); Brountzos, Elias [Attikon University Hospital, 2nd Radiology Department (Greece); Katsanos, Konstantinos [Patras University Hospital, Department of Diagnostic and Interventional Radiology (Greece); Krokidis, Miltiadis; Gkoutzios, Panagiotis [Guy' s and St Thomas' Hospitals NHS Trust, Department of Interventional Radiology (United Kingdom); Siablis, Dimitrios [Patras University Hospital, Department of Diagnostic and Interventional Radiology (Greece); Adam, Andreas [Guy' s and St Thomas' Hospitals NHS Trust, Department of Interventional Radiology (United Kingdom)

    2012-12-15

    Purpose: To investigate the percutaneous endovascular management of visceral aneurysms (VA) and visceral pseudoaneurysms (VPA) treated in three European interventional radiology departments. Methods: Patient archives from the department's databases were examined and retrospectively analyzed. Patients diagnosed between 2000 and 2010 with VA and/or VPA, confirmed by computed tomography angiography, magnetic resonance angiography, or digital subtraction angiography and treated exclusively with percutaneous endovascular methods, were included in the study. The study's primary end points were procedural technical success, target lesion reintervention rate, and periprocedural mortality rate. Secondary end points included major and minor complications rates. Results: The medical records of 54 patients (41 male, mean age 55 {+-} 18.1 years) with 58 VAs or VPAs and treated with various percutaneous endovascular therapeutic modalities were analyzed. In total, 21 VAs (mean diameter 49.4 {+-} 21 mm, range 20-100 mm) and 37 VPAs (mean diameter 25.1 {+-} 14.6 mm, range 8-60 mm) were treated. Procedural technical success was achieved in 100% of the cases, while target lesion reintervention rate was 6.1% (2 of 33) and 14.2% (3 of 21) in the VPA and VA groups, respectively. Mean clinical follow-up period was 19.1 {+-} 21.4 months. Overall periprocedural mortality rate was 3% (1 of 33) in the VPA group and 0% (0 of 21) in the VA group. Conclusion: Percutaneous endovascular treatment of VAs and VPAs is safe and effective with low morbidity and mortality. There is a small but significant reintervention rate, particularly for true aneurysms; dedicated follow-up imaging is recommended. Successful aneurysm exclusion was achieved in all cases with a second procedure.

  15. Embolization by micro navigation for treatment of persistent type 2 Endoleaks after endovascular abdominal aortic aneurysm repair

    Directory of Open Access Journals (Sweden)

    Bruno Lorenção de Almeida

    2014-12-01

    Full Text Available Background:Endovascular repair has become established as a safe and effective method for treatment of abdominal aortic aneurysms. One major complication of this treatment is leakage, or endoleaks, of which type 2 leaks are the most common.Objective:To conduct a brief review of the literature and evaluate the safety and effectiveness of embolization by micronavigation for treatment of type 2 endoleaks.Method:A review of medical records from patients who underwent endovascular repair of abdominal aortic aneurysms identified 5 patients with persistent type 2 endoleaks. These patients were submitted to embolization by micronavigation.Results:In all cases, angiographic success was achieved and control CT scans showed absence of type 2 leaks and aneurysm sacs that had reduced in size after the procedure.Conclusion:Treatment of type 2 endoleaks using embolization by micronavigation is an effective and safe method and should be considered as a treatment option for this complication after endovascular repair of abdominal aortic aneurysms.

  16. Dissecting aneurysm of the middle cerebral artery treated with heparin infusion in a 6-year-old child; neurological recovery with delayed spontaneous thrombosis: case illustration and literature review.

    Science.gov (United States)

    Anichini, G; Passacantilli, E; Lenzi, J; Guidetti, G; Santoro, A

    2012-04-01

    Aneurysms in the pediatric population are a rare pathology with specific features which requires a deep knowledge of their pathogenesis for the best therapeutic choice; the authors report their experience with a patient presenting aneurysm of the middle cerebral artery (MCA) associated with proximal stenosis of the vessel. A six-year-old girl came to our observation after sudden onset of headache and left hemiparesis. Angio-MRI and angio-CT scan showed a right MCA dissecting aneurysms associated with proximal stenosis of the vessel. Patient started a therapy with low molecular weight heparin (LMWH), replaced, 15 days later, with acetyl-salicylic acid (ASA). Patient showed a rapid and almost complete neurological recovery, despite several radiological exams confirmed a complete occlusion of the right MCA. As many other authors noted, dissecting aneurysms in the pediatric population are probably due to a defect of the entire arterial wall. Combination of stenosis, turbulence and partial thrombosis of the aneurysm led to a complete occlusion of artery involved, leading to the formation of collateral circles. In our case, complete thrombosis was probably delayed with anticoagulant therapy and the progressive reinforcement of collateral circles lead to the patient's neurological recovery.

  17. The comparative study on diagnostic validity of cerebral aneurysm by computed tomography angiography versus digital subtraction angiography after subarachnoid hemorrhage

    Directory of Open Access Journals (Sweden)

    Masih Saboori

    2011-01-01

    Full Text Available Background: In order to declare the preoperative diagnostic value of brain aneurysms, two radiological modalities, computed tomographic angiography and digital subtraction angiography were compared. Methods: In this descriptive analytic study, diagnostic value of computed tomographic angiography (CTA was com-pared with digital subtraction angiography (DSA. Sensitivity, specificity, positive and negative predictive values were calculated and compared between the two modalities. All data were analyzed with SPSS software, version 16. Results: Mean age of patients was 49.5 ± 9.13 years. 57.9 % of subjects were female. CTA showed 89% sensitivity and 100% specificity whereas DSA demonstrated 74% sensitivity and 100% specificity. Positive predictive value of both methods was 100%, but negative predictive value of CTA and DSA was 85% and 69%, respectively. Conclusions: Based on our data, CTA is a valuable diagnostic modality for detection of brain aneurysm and su-barachnoid hemorrhage.

  18. “Real-world” comparison of non-invasive imaging to conventional catheter angiography in the diagnosis of cerebral aneurysms

    OpenAIRE

    Tomycz, Luke; Bansal, Neil K.; Hawley, Catherine R.; Goddard, Tracy L.; Ayad, Michael J; Mericle, Robert A.

    2011-01-01

    Background: Based on numerous reports citing high sensitivity and specificity of non-invasive imaging [e.g. computed tomography angiography (CTA) or magnetic resonance angiography (MRA)] in the detection of intracranial aneurysms, it has become increasingly difficult to justify the role of conventional angiography [digital subtraction angiography (DSA)] for diagnostic purposes. The current literature, however, largely fails to demonstrate the practical application of these technologies within...

  19. Aquatic exercise in the treatment of children with cerebral palsy

    OpenAIRE

    Dimitrijević Lidija; Bjelaković Bojko; Lazović Milica; Stanković Ivona; Čolović Hristina; Kocić Mirjana; Zlatanović Dragan

    2012-01-01

    Introduction. Aquatic exercise is one of the most popular supplementary treatments for children with neuro-motor impairment, especially for cerebral palsy (CP). As water reduces gravity force which increases postural stability, a child with CP exercises more easily in water than on land. Objective. The aim of the study was to examine aquatic exercise effects on gross motor functioning, muscle tone and cardiorespiratory endurance in children with spastic CP. Methods. The study included 1...

  20. Inferior Pancreaticoduodenal Artery Aneurysms Associated with Occlusive Lesions of the Celiac Axis: Diagnosis, Treatment Options, Outcomes, and Review of the Literature

    Energy Technology Data Exchange (ETDEWEB)

    Flood, Karen, E-mail: karenrogers@doctors.org.uk; Nicholson, Anthony A. [Leeds Teaching Hospitals, Department of Radiology (United Kingdom)

    2013-06-15

    Purpose. To describe the presentation, treatment, and outcomes for 14 patients with aneurysms of the inferior pancreaticoduodenal arteries associated with occlusive lesions of the celiac axis, and to review the literature for similar cases. Methods, Over a period of 12 years, 14 patients (10 women and 4 men) ranging in age from 26 to 50 (mean 46) years were demonstrated to have aneurysms of the inferior pancreaticoduodenal artery origin associated with stenosis or occlusion of the celiac axis. All patients were treated by a combination of surgery and interventional radiology. Results. Outcome data collected between 3 months and 4 years (mean 2 years) demonstrated that all aneurysms remained excluded, and all 14 patients were well. The 49 case reports in the literature confirm the findings of this cohort. Conclusion. In inferior pancreaticoduodenal artery aneurysm resulting from celiac occlusive disease, endovascular treatment is best achieved by stenting the celiac axis and/or embolizing the aneurysm when necessary.

  1. Hybrid treatment of recurring thoracoabdominal aortic aneurysm concomitant with retrograde type A aortic dissection

    Institute of Scientific and Technical Information of China (English)

    ZHANG Min-hong; GUO Wei; DU Xin; XIONG Jiang

    2010-01-01

    So far, standard therapy of complex thoracoabdominal aortic disease is open surgical repair requiring aortic clamping and replacement of the involved segment.Despite significant improvements, morbidity and mortality of open surgery remain high.I As a result, open surgery is often withheld owing to severe comorbidities of the patients. Endovascular technique has emerged as an alternative for treatment of these diseases in high risk patients,2 and has enlarged the options of treatment of complex aortic diseases. However, an endovascular approach alone is often deemed unsuitable for some complex aortic disorders because of the close proximity of the supraaortic or visceral branches. A hybrid open-endovascular approach has therefore been proposed as a viable alternative. We present here a unique patient with recurring thoracoabdominal aortic aneurysm (TAAA) concomitant with an aortic dissection (AD) treated by a hybrid open-endovascular approach.

  2. Tratamento endovascular de aneurismas cirsoideos do couro cabeludo Endovascular treatment of scalp cirsoid aneurysms

    Directory of Open Access Journals (Sweden)

    Eduardo Wajnberg

    2010-08-01

    Full Text Available OBJETIVO: Relatar os resultados da aplicação de técnicas endovasculares no tratamento de aneurismas cirsoideos do couro cabeludo. MATERIAIS E MÉTODOS: Quatro pacientes com diagnóstico de aneurismas cirsoideos foram submetidos ao tratamento por via endovascular. Todos os quatro pacientes incluídos nesta série tinham malformações arteriovenosas e foram tratados apenas com embolização. RESULTADOS: Três pacientes foram submetidos a tratamento endovascular mediante embolização transarterial e um foi tratado por punção direta da porção venosa. Os resultados clínicos e cosméticos foram satisfatórios em todos os pacientes. Não houve recidiva clínica durante o período de acompanhamento. CONCLUSÃO: A via endovascular é uma alternativa segura e eficaz no tratamento dos aneurismas cirsoideos. Embora possa ser efetivamente utilizado como uma alternativa adjuvante ou complementar à cirurgia, especialmente quando é necessário lidar com aferências profundas, a maioria dos casos pode ser totalmente curada apenas com a terapêutica endovascular. A escolha do método de tratamento deve ser baseada em uma variedade de características próprias da lesão, incluindo sua angioarquitetura, tamanho e apresentação clínica.OBJECTIVE: To report results of the application of endovascular techniques in the management of scalp cirsoid aneurysms. MATERIALS AND METHODS: Four patients diagnosed with cirsoid aneurysms were submitted to treatment by endovascular approach. All the four patients included in the present series had arteriovenous malformations and were treated solely by embolization. RESULTS: Three of the patients underwent endovascular treatment by transarterial embolization and one was treated by direct puncture of the venous segment. Both clinical and cosmetic outcomes were satisfactory in all of the patients. Clinical relapse was not observed along the follow-up period. CONCLUSION: The endovascular approach is safe and effective in

  3. Endovascular treatment for intracranial infectious aneurysms Tratamento endovascular de aneurismas infecciosos intracranianos

    Directory of Open Access Journals (Sweden)

    Eduardo Wajnberg

    2008-12-01

    Full Text Available OBJETIVE: To re-enforce an alternative, less aggressive treatment modality in the management of intracranial infectious aneurysms. METHOD: We present a series of five patients with infectious endocarditis and intracranial infectious aneurysms (mycotic aneurysms managed by means of endovascular treatment. RESULTS: Endovascular treatment was executed technically uneventfully in all patients. Three patients had favorable clinical outcome: two were classified as Glasgow Outcome Scale 4/5, and one had total neurological recovery (GOS 5/5. Two patients died (GOS 1/5, one in consequence of the initial intracranial bleeding and the other after cardiac complications from endocarditis and open-heart surgery. CONCLUSION: Endovascular techniques are an expanding option for the treatment of IIAs. It has been especially useful for infectious endocarditis patients with IIA, who will be submitted to cardiac surgery with cardiopulmonary bypass and anticoagulation, with the risk of intracranial bleeding.OBJETIVO: Enfatizar o método endovascular como uma opção de tratamento alternativa e menos agressiva no tratamento de aneurismas infecciosos intracranianos. MÉTODO: Apresentamos uma série de cinco pacientes com endocardite infecciosa e aneurismas infecciosos intra-cranianos (aneurismas micóticos tratados através da via endovascular. RESULTADOS: O tratamento endovascular teve sucesso técnico e sem intercorrências relacionadas ao cateterismo em todos os casos. Três pacientes tiveram desfecho clínico favorável: dois com escala de regeneração de Glasgow 4/5 e um com recuperação neurológica completa (GOS 5/5. Dois pacientes tiveram desfecho desfavorável (GOS 1/5, um devido às conseqüências do sangramento intracraniano inicial e outro devido a complicações cardíacas da endocardite e cirurgia de troca valvar. CONCLUSÃO: As técnicas endovasculares são uma nova opção de tratamento dos aneurismas infecciosos intracranianos. Ela é especialmente

  4. Endovascular Treatment of Infrarenal Abdominal Aortic Aneurysm with Short and Angulated Neck in High-Risk Patient

    Directory of Open Access Journals (Sweden)

    Stylianos Koutsias

    2013-01-01

    Full Text Available Endovascular treatment of abdominal aortic aneurysms (AAA is an established alternative to open repair. However lifelong surveillance is still required to monitor endograft function and signal the need for secondary interventions (Hobo and Buth 2006. Aortic morphology, especially related to the proximal neck, often complicates the procedure or increases the risk for late device-related complications (Hobo et al. 2007 and Chisci et al. 2009. The definition of a short and angulated neck is based on length (60° (Hobo et al. 2007 and Chisci et al. 2009. A challenging neck also offers difficulties during open repairs (OR, necessitating extensive dissection with juxta- or suprarenal aortic cross-clamping. Patients with extensive aneurysmal disease typically have more comorbidities and may not tolerate extensive surgical trauma (Sarac et al. 2002. It is, therefore, unclear whether aneurysms with a challenging proximal neck should be offered EVAR or OR (Cox et al. 2006, Choke et al. 2006, Robbins et al. 2005, Sternbergh III et al. 2002, Dillavou et al. 2003, and Greenberg et al. 2003. In our case the insertion of a thoracic endograft followed by the placement of a bifurcated aortic endograft for the treatment of a very short and severely angulated neck proved to be feasible offering acceptable duration of aneurysm exclusion. This adds up to our armamentarium in the treatment of high-risk patients, and it should be considered in emergency cases when the fenestrated and branched endografts are not available.

  5. Surgical management of large and giant intracavernous and paraclinoid aneurysms

    Institute of Scientific and Technical Information of China (English)

    Xu Bai-nan; SUN Zheng-hui; JIANG Jin-li; WU Chen; ZHOU Ding-biao; YU Xin-guang; LI Bao-min

    2008-01-01

    Background Due to their location,large and giant intracavernous and paraclinoid aneurysms remain a challenge for vascular neurosurgeons.We identified characteristics.surgical indications and treatment strategies of large and giant intracavernous and paraclinoid aneurysms in 36 patients.Methods The pterional approach was routinely used.The cervical internal carotid artery was exposed for proximal control of parent vessel and retrograde suction decompression.Paraclinoid aneurysms were directly clipped,intracavernous pseudoaneurysm was repaired and the intracavernous aneurysms were trapped with extracranial-intracranial bypass of saphenous vein graft.Intraoperative electroencephaIogram (EEG) and somatosensory evoked potential (SSEP) monitoring were used to detect cerebral ischemia during the temporary occlusion of parent arteries.Microvascular Doppler ultrasonography was used to assess blood flow of the parent and branch vessels.Endoscopy was helpful particularly in dealing with internal carotid artery posterior wall aneurysms.Postoperative digital subtraction angiography (DSA) was performed in 33 of the 36 patients.Results Thirty-two paraclinoid aneurysms were directly clipped,1 intracavernous pseudoaneurysm was repaired and the other 3 intracavernous aneurysms were trapped with revascula rization.Except for two patients who died in the early postoperative stage,34 patients' follow-up was 6-65 months (mean 10 months)and a Glasgow Outcome Scale score of 4 to 5 at discharge.At the 6-month follow-up examination,Rankin Outcome Scale scores were 0 to 2 in 32 patients.EEG and SSEP monitoring changed in six patients.Twelve clips were readjusted when insufficient blood flow in parent and branch vessels was detected.Three posterior wall aneurysms were clipped.Conclusions Intracavernous aneurysms not amenable to endovascular treatment should be treated surgically and surgical treatment is the first option for paraclinoid aneurysms.The temporary parent vessel occlusion

  6. Surgical treatment of intracranial aneurysms: six-year experience in Belo Horizonte, MG, Brazil Tratamento cirúrgico dos aneurismas intracranianos: experiência de seis anos em Belo Horizonte, MG, Brasil

    Directory of Open Access Journals (Sweden)

    Leodante Batista da Costa Jr

    2004-06-01

    Full Text Available Spontaneous subarachnoid hemorrhage accounts for 5 to 10 % of all strokes, with a worldwide incidence of 10.5 / 100000 person/year, varying in individual reports from 1.1 to 96 /100000 person/year. Angiographic and autopsy studies suggest that between 0.5% and 5% of the population have intracranial aneurysms. Approximately 30000 people suffer aneurysmal subarachnoid hemorrhage in the United States each year, and 60% die or are left permanently disabled. We report our experience in the surgical treatment of intracranial aneurysms in a six year period, in Belo Horizonte, Minas Gerais, Brazil. We reviewed the hospital files, surgical and out-patient notes of all patients operated on for the treatment of intracranial aneurysms from January 1997 to January 2003. Four hundred and seventy-seven patients were submitted to 525 craniotomies for treatment of 630 intracranial aneurysms. The majority of patients were female (72.1% in the fourth or fifth decade of life. Anterior circulation aneurysms were more common (94.4%. The most common location for the aneurysm was the middle cerebral artery bifurcation. The patients were followed by a period from 1 month to 5 years. The outcome was measured by the Glasgow Outcome Scale (GOS. At discharge, 62.1% of the patients were classified as GOS 5, 13.9% as GOS 4, 8.7% as GOS 3, 1.7% as GOS 2 and 14.8% as GOS 1.A hemorragia subaracnóidea espontânea é responsável por cerca de 5 a 10% de todos os acidentes vasculares cerebrais, com uma incidência mundial de 10,5 / 100000 pessoas/ano, variando em estudos individuais de 1,1 a 96 / 100000 pessoas / ano, de acordo com diferenças étnicas e geográficas. Estudos angiográficos e de necropsia sugerem que a presença de aneurismas intracranianos ocorre em 0,5-5% da população mundial. De acordo com estatísticas norte-americanas, ocorrem cerca de 30000 rupturas de aneurisma cerebral por ano naquele país, com conseqüências desastrosas para grande parte dos pacientes

  7. The diagnosis and treatment of severe cerebral fat embolism

    Institute of Scientific and Technical Information of China (English)

    周东生; 王甫; 王伯珉; 王鲁博; 李连欣; 许世宏; 穆卫东

    2003-01-01

    Objective: To improve the diagnosis and treatment of severe cerebral fat embolism (SCFE).Methods: The data of nine patients with SCFE were retrospectively analyzed. The manifestations of the central nerve system, respiratory system and hemorrhage were recorded, at the same time, accessory examination including arterial oxygen, fat macroglobules in venous blood and image examination was adapted. The patients were treated with exopexy, pharmocotherapy and oxygentherapy.Results: Two of the nine patients died of severe complications, the other seven recovered without severe sequela.Conclusions: Gurd standard should be improved for early diagnosis of SCFE. If svere complications can be prevented, patients who receive early treatment will have favourable prognosis.

  8. Aneurysm sac shrinkage after endovascular treatment of the aorta: beyond sac pressure and endoleaks.

    Science.gov (United States)

    Georgakarakos, Efstratios; Georgiadis, George S; Ioannou, Christos V; Kapoulas, Konstantinos C; Trellopoulos, George; Lazarides, Miltos

    2012-06-01

    The isolation of the aneurysm sac from systemic pressure and its consequent shrinkage are considered criteria of success after endovascular repair (EVAR). However, the process of shrinkage does not solely depend on the intrasac pressure, the predictive role of which remains ambiguous. This brief review summarizes the additional pathophysiological mechanisms that regulate the biomechanical properties of the aneurysm wall and may interfere with the process of aneurysm sac shrinkage. PMID:22402935

  9. COMPARISON OF CELLULOSE ACETATE POLYMER AND ELECTROLYTIC DETACHABLE COILS FOR TREATMENT OF CANINE ANEURYSMAL MODELS

    Institute of Scientific and Technical Information of China (English)

    杨新健; 吴中学; 李佑祥; 孙异临; 尹可

    2002-01-01

    Objective.Electrolytic detachable coils (EDC) have been the main embolic materials for intracranial aneurysms.Liquid aneurysmal embolic materials represented by cellulose acetate polymer (CAP) are still in controversy.In this research,the embolization results and pathological reactions after embolization of canine aneurysmal models with EDC or CAP were observed and compared. Methods.The canine aneurysmal models constructed by anastomosis of venous pouches were randomly grouped.The aneurysms were respectively occluded with CAP and electrolytic detachable coils that was named by Wu electrolytic detachable coil (WEDC) and made by us.Angiogram follow ups were performed at 24 hour,2 week,and 2 month after embolization.The occluded aneurysms were dissected in each stage for light microscopic,electron microscopic,and histochemical research. Results.The effect of embolization was significantly better with WEDC than that with CAP ( χ 2=5.56,P< 0.05) .Post embolized complications such as aneurysm rupture and stenosis of parent arteries could only be found in CAP group.Pathological research showed that CAP mass could packed the aneurysms more densely than coils.Acute chemical damage of aneurysmal wall and inflammatory cell infiltration was prominently found in early stage after CAP embolization.Organization of thrombus inside aneurysms and formation of endothelial tissue over the orifices of aneurysmal necks could be found in both groups 2 months after embolization.But parts of coils might be exposed outside endothelial layer. Conclusions.EDC are still the most safe,efficient,and reliable instruments to embolize aneurysm.CAP should be improved further to solve the problem of strong chemical corrosion and difficulty in control before it is widely used.

  10. Multiple antiplatelet therapy contributes to the reversible high signal spots on diffusion-weighted imaging in elective coiling of unruptured cerebral aneurysm

    Energy Technology Data Exchange (ETDEWEB)

    Matsushige, Toshinori; Okazaki, Takahito; Shinagawa, Katsuhiro; Ichinose, Nobuhiko; Kurisu, Kaoru [Hiroshima University, Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima (Japan); Kiura, Yoshihiro; Sakamoto, Shigeyuki [Hiroshima University Hospital, Department of Neurosurgery, Hiroshima (Japan); Takasu, Miyuki; Akiyama, Yuji [Hiroshima University Hospital, Department of Diagnostic Radiology, Hiroshima (Japan); Sugiyama, Kazuhiko [Hiroshima University Hospital, Department of Clinical Oncology and Neuro-oncology Program, Cancer Treatment Center, Hiroshima (Japan)

    2013-04-15

    Our aim was to systematically investigate radiographic characteristics and outcome of diffusion-weighted imaging (DWI) changes in the elective coiling of unruptured cerebral aneurysm with analyzing the correlation of antiplatelet therapy (APT). In a total of 34 consecutive patients with unruptured cerebral aneurysms initially treated by coiling without stent assist, 26 (76.5 %) had DWI changes with 91 high signal spots within 24-48 h after the procedure. We recorded DWI parameters (location, volume, mean, and minimum values of the apparent diffusion coefficient: expressed as ADC{sub AVE} and ADC{sub MIN}) for each lesion, and evaluated its radiographic outcome on conventional MRI at follow-up (interval, 58.4 {+-} 37.2 days) in the modes of APT. All patients with DWI high spots had no clinical symptoms. There was a strong correlation between ADC{sub AVE} and ADC{sub MIN} (r = 0.82, p < 0.0001). The mean ADC{sub AVE} and rADC{sub AVE} were 0.74 {+-} 0.14 x 10{sup -3} mm{sup 2}/s and 87 {+-} 10 %. DWI high spots were small with a mean volume of 0.13 {+-} 0.12 cm{sup 3}, ranging from 0.04 to 0.86 cm{sup 3}. A negative correlation was observed between the volume and values of ADC{sub AVE} (r = -0.48, p < 0.0001). The DWI volume was significantly larger in single APT than in multiple (0.15 {+-} 0.14 versus 0.10 {+-} 0.07 cm{sup 3}, p = 0.0091). The permanent signal change was more observed in single APT than in multiple (24.5 % versus 5.2 %, p = 0.02). DWI high spots after elective coiling were small without significant decrease of ADC, and do not correspond to brain infarction. Periprocedural use of multiple antiplatelet agents is expected to reduce the volume of thromboembolism and permanent tissue damages. (orig.)

  11. Surgical treatment of a giant left ventricular aneurysm- A case report

    Directory of Open Access Journals (Sweden)

    Gustavo Alves Schaitza

    2014-12-01

    Full Text Available An aneurysm of the left ventricle is a complication of acute myocardial infarction. We report a case of a giant aneurysm of the left ventricle after myocardial infarction in a 59 year-old male patient. The surgery to correct the aneurysm was performed with the use of cardiopulmonary bypass under normothermia. A bovine pericardial patch was used for the geometric reconstruction of the ventricular wall affected by the aneurysm. After the procedure, echocardiography and magnetic resonance imaging revealed improvement in left ventricular ejection fraction and volume reduction.

  12. Surgical treatment of a giant left ventricular aneurysm- a case report.

    Science.gov (United States)

    Schaitza, Gustavo Alves; Faria Neto, José Rocha; Francisco, Julio Cesar; Baena, Cristiana Pellegrino; Giffhorn, Helcio; Olandoski, Bruna; Meira, Leanderson Franco de; Guarita-Souza, Luiz César

    2014-01-01

    An aneurysm of the left ventricle is a complication of acute myocardial infarction. We report a case of a giant aneurysm of the left ventricle after myocardial infarction in a 59 year-old male patient. The surgery to correct the aneurysm was performed with the use of cardiopulmonary bypass under normothermia. A bovine pericardial patch was used for the geometric reconstruction of the ventricular wall affected by the aneurysm. After the procedure, echocardiography and magnetic resonance imaging revealed improvement in left ventricular ejection fraction and volume reduction.

  13. Doses to patients and staff from endovascular treatment of abdominal aortic aneurysms - Preliminary results

    International Nuclear Information System (INIS)

    Patient radiation doses received during endovascular treatment of abdominal aortic aneurysms (AAA) can be significant and give rise to both deterministic and stochastic effects. Recording of dose-area product (DAP), fluoroscopy time and number of exposures together with calculations of effective dose, were performed for 8 patients. In addition, the entrance surface dose was measured for 3 of the patients. Typically, DAPs of 340 Gycm2, fluoroscopy times of 30 minutes and 310 exposures were obtained together with maximum entrance surface doses of 1,8 Gy and effective doses of 50 mSv. Finger doses to the staff performing the procedure were in the order of a few hundred μSv. Conversion factors (effective dose/DAP) and (maximum entrance surface does/DAP) of 0,61·10-2 Gy/Gycm2 and 0,15 mSv/Gycm2 were obtained, respectively. (author)

  14. Aortic Aneurysm

    Science.gov (United States)

    ... Most aneurysms are in the aorta, the main artery that runs from the heart through the chest and abdomen. There are two types of aortic aneurysm: Thoracic aortic aneurysms (TAA) - these occur in the part of the aorta running through the chest Abdominal aortic aneurysms (AAA) - these occur in the part ...

  15. PATIENT-SPECIFIC BLOOD DYNAMIC SIMULATIONS IN ASSESSING ENDOVASCULAR OCCLUSION OF INTRACRANIAL ANEURYSMS

    Institute of Scientific and Technical Information of China (English)

    CHEN Jia-liang; WANG Sheng-zhang; DING Guang-hong; YANG Xin-jian; LI Hai-yun

    2009-01-01

    According to recent studies, there are various potential predictors for surgical outcome for cerebral aneurysms. An accurate surgical outcome assessment would help make better-informed decisions and avoid the risk of rebleeding. It is well known that hemodynamic factors play an important role in the pathogenesis and treatment of intracranial aneurysms. In this article, a computational fluid dynamic analysis is applied to one patient-specific model of the cerebral aneurysm located at the tip of basilar artery, by which the differences of hemodynamic parameters before and after endovascular treatment may be evaluated. Based on the model, we show that the flow behavior near the neck of the aneurysm sees great differences after endovascular treatment as compared with that before treatment, which also affects the wall shear stress and the displacement distribution. In addition, our whole simulation process is based on a series of CFD commercial software packages, which are easily available for doctors to implement such a method in their daily practice. These results would be used to assess the outcome of endovascular treatment for the aneurysm occlusion.

  16. Fenestrated stent grafts for the treatment of complex aortic aneurysm disease: A mature treatment paradigm.

    Science.gov (United States)

    Georgiadis, George S; van Herwaarden, Joost A; Antoniou, George A; Giannoukas, Athanasios D; Lazarides, Miltos K; Moll, Frans L

    2016-06-01

    The introduction of fenestrated stent grafts (SGs) to treat abdominal aortic aneurysms (AAAs) with short proximal necks began in 1999. Nowadays, the whole visceral aorta can be treated totally by endovascular means. The established use of fenestrated devices to treat complex AAAs as a first-line management option has been previously reported. An up-to-date evaluation of the literature was performed including all types of publications regarding the use of fenestrated technology to repair complex AAAs. Fenestrated repair is now an established alternative to hybrid/chimney/snorkel repairs. However, specific criteria and prerequisites are required for the use and improvement of this method. Multiple device morphologies have been used incorporating the visceral arteries in various combinations. This modular strategy connects different devices (bridging covered stents and bifurcated SGs) with the aortic main body, thus excluding the aneurysm from the circulation. Precise deployment of the fenestrated SG is mandatory for successful visceral vessel revascularization. Accurate SG sizing and customization, a high level of technical skill, and facilities with modern imaging techniques including 3D road mapping and dedicated hybrid rooms are required. Most experience has been with the custom-made Zenith Cook platform, although off-the-shelf devices have been recently implanted. More complex repairs have been performed over the last few years, but device complexity has also increased. Perioperative, mid-term, and a few recently reported long-term results are encouraging. Secondary interventions remain the main problem, similar to that observed after traditional endovascular abdominal aortic aneurysm repair (EVAR). PMID:27013644

  17. Cerebral vasospasm: Aetiopathogenesis and intensive care management

    Directory of Open Access Journals (Sweden)

    Murthy T

    2005-01-01

    Full Text Available Cerebral vasospasm is the prolonged, intense constriction of the larger conducting arteries in the subarachnoid space which are initially surrounded by subarachnoid clot. Significant narrowing develops gradually over the first few days after the aneurysmal rupture. The spasm usually is maximal in about a week′s time following haemorrhage. Vasospasm is the one of the leading causes of death after the aneurysmal rupture along with the effect of the initial haemorrhage and latter rebleeding. The purpose of this article is to outline the importance in early diagnosis and aggressive treatment of this otherwise challenging clinical entity.

  18. Treatment of the spasticity in children with cerebral palsy.

    Science.gov (United States)

    Meholjić-Fetahović, Ajsa

    2007-11-01

    Botulinum toxin is a natural purified protein and one of the strongest biological poisons--neurotoxin. It is produced by the bacterium Clostridium botulinum. Its medical usage started in USA in 1981 and in Europe in 1992. There are seven different immune types of the toxin: A, B, C1, D, E, F and G. Toxin types A and B are used to decrease muscular spasticity. Botulinum toxin prevents the formation of acetylcholine from cholinergic nerve tissues in muscles, which in the end irreversibly destroys neuromuscular synapses. It is called temporary local chemodenervation. It does not affect the synthesis of acetylcholine. As it affects neuromuscular bond it also affects one of the symptoms of cerebral palsy--spasticity. Decreasing the spasticity of children with cerebral palsy leads to the improvement of conscious movements, muscles are less toned, passive mobility is improved, orthosis tolerance is also improved, and the child is enabled to perform easier and better motor functions such as crawling, standing and walking. Since the action of Botulinum toxin is limited to 2-6 months, new neural collaterals are formed and neuromuscular conductivity is reestablished which in the end once again develops a muscular spasm. This leads to a conclusion that botulinum toxin should again be applied into spastic muscles. It is very important for good effect of Botulinum toxin to set the goals of the therapy in advance. The goals include improvement of a function, prevention of contractions and deformities, ease of care and decrease of pain for children with cerebral palsy. After application of botulinum toxin, it is necessary to perform adequate and intensive physical treatment with regular monitoring of effects. This work shows a case of a boy with spastic form of cerebral palsy. After being rehabilitated using Vojta therapy and Bobath concept and the conduct of certain physical procedures, botulinum toxin is administered into his lower limbs' muscles and kinesiotherapy is

  19. Prediction of shape diameter undergoing coil embolization of saccular intracranial aneurysm treatment using a hybrid decision support system

    International Nuclear Information System (INIS)

    The purpose of the study was to design a hybrid decision support system (HDSS) that could simulate the embolized coil selection pattern of the radiologists in aneurysms treatment. As the longest available length of the coils should be used in most cases, therefore only the shape diameter (SD) selection was modeled and varied. Ninety-eight aneurysms successfully treated by a radiologist with coil embolization were divided into two groups (86 for training and 12 randomly selected for validating). Eight aneurysms treated by another radiologist were also used to cross validate the proposed HDSS. The HDSS was developed using the classification and the linear regression methods (LRM). The dome and the width of an aneurysm were used as the system inputs. The system outputs were the SDs of the first three coils indexed according to the insertion order. The HDSS that consisted of Bagging classification and LRM achieved the highest accuracy for all cases. The errors were within 1 mm for the SD selection of the first two coils. For the third coil, the SD selection within 1 mm bound had 80 % accuracy. The experimental results indicated the feasibility of using the HDSS as the guidance for selecting the SDs of the first two coils. The selection of the third coil required more training data for the rarely used SD. Moreover, the cross validation with another radiologist showed the feasibility of using the proposed HDSS as the guidance, however further validation with more data is recommended.

  20. Endovascular Treatment of Isolated Bilateral Internal Ili- ac Artery Aneurysms with a Branched Endograft: A Case Report

    Directory of Open Access Journals (Sweden)

    SeyedEbrahim Kassaian

    2015-10-01

    Full Text Available Isolated bilateral internal iliac artery (IIA aneurysm is a rare and potentially lethal disease. Endovascular repair of this disorder is a matter of debate. A symptomatic 68-year-old male presented with severe pelvic pains. Computed tomography revealed a leaking 46-mm aneurysm in the right IIA, a 27-mm aneurysm in the left IIA, and ectatic changes at a diameter of 31 mm in the right common iliac artery (CIA. Due to lower rates of morbidity and mortality, an endovascular approach was chosen instead of open surgical repair. However, due to anatomical constraints, an endograft had to be implanted in a healthy aorta in order to support an iliac branch endograft in the left CIA. Subsequently, following coil embolization of the left IIA, an iliac stent graft was extended to the right external iliac artery (EIA. Two-year follow-up CT imaging showed complete exclusion of all the aneurysms and patency of the pelvic visceral arteries. The patient is currently asymptomatic.Endovascular repair of bilateral isolated IIAs can be a feasible treatment option. However, due to limited availability of sizes in iliac branch devices currently on the market, a main body device is sometimes required to be deployed in a healthy aorta for additional endograft support.

  1. Treatment for cerebral small vessel disease: effect of relaxin on the function and structure of cerebral parenchymal arterioles during hypertension

    OpenAIRE

    Chan, Siu-Lung; Sweet, Julie G.; Cipolla, Marilyn J.

    2013-01-01

    We investigated the effect of hypertension on the function and structure of cerebral parenchymal arterioles (PAs), a major target of cerebral small vessel disease (SVD), and determined whether relaxin is a treatment for SVD during hypertension. PAs were isolated from 18-wk-old female normotensive Wistar-Kyoto (WKY) rats, spontaneous hypertensive rats (SHRs), and SHRs treated with human relaxin 2 for 14 d (4 μg/h; n=8/group) and studied using a pressurized arteriograph system. Hypertension red...

  2. Long-term outcome of ruptured abdominal aortic aneurysm: Impact of treatment and age

    NARCIS (Netherlands)

    J.W. Raats (Jelle W.); H.C. Flu (Hans C.); G.H. Ho; E.J. Veen (Eelco J.); L.D. Vos (L.); E.W. Steyerberg (Ewout); L. van der Laan (Lyckle)

    2014-01-01

    textabstractBackground: Despite advances in operative repair, ruptured abdominal aortic aneurysm (rAAA) remains associated with high mortality and morbidity rates, especially in elderly patients. The purpose of this study was to evaluate the outcomes of emergency endovascular aneurysm repair (eEVAR)

  3. Multiple giant succular and fusiform right and left coronary artery aneurysms after early and adequate treatment of atypical kawasaki disease with unusual presentation.

    Directory of Open Access Journals (Sweden)

    Mostafa Behjati-Ardakani

    2014-06-01

    Full Text Available The major complication of Kawasaki disease is coronary artery dilatation and aneurysm. It occurs in approximately 15-25% of untreated children with Kawasaki Disease. Early diagnosis and treatment with Intravenous immune globulin (IVIG and aspirin (ASA can reduce the incidence of coronary artery abnormality to 2%-5%. We report one case of Atypical Kawasaki Disease with Multiple giant coronary artery aneurysms despite early adequate treatment with IVIG and ASA.

  4. Comparison of endovascular coiling and surgical clipping for the treatment of intracranial aneurysms: A prospective study.

    Directory of Open Access Journals (Sweden)

    Zeinab Taheri

    2015-03-01

    Full Text Available Management of intracranial aneurysms has made debates about the best treatment modality in recent years. The aim of this study was to compare the interventional outcomes between two groups of patients, one treated with endovascular coiling and the other treated with surgical clipping.This prospective study included 48 patients with intracranial aneurysms who underwent endovascular coiling (27 patients or surgical clipping (21 patients from July 2011 to August 2013. A neurologist examined patients in admission and followed them by phone call 1-year after intervention.Mean modified Rankin Scale (MRS score at the time of admission in endovascular group was 2.86 ± 0.974 whereas it was 3.81 ± 1.078 in surgical clipping group (P = 0.0040. Focal neurologic signs were higher in clipping during procedures (P = 0.0310. Of 37 patients who followed up for a year, 19 were in endovascular group and 18 in surgical clipping group. At 1 year follow-up, MRS improvement was statistically significant in coiling group (P = 0.0090, but not in clipping group (P = 0.8750. Mean difference of MRS score at the time of admission and at one year later, was 0.947 ± 1.224 in endovascular group and 0.111 ± 2.083 in surgical group (P = 0.3000.There was no statistically significant difference at 1 year outcome between two groups. We recommend further interventional studies with larger sample sizes for better evaluation of the modalities.

  5. Direct comparison of Neuroform and Enterprise stents in the treatment of wide-necked intracranial aneurysms

    International Nuclear Information System (INIS)

    Aim: To compare the complications and outcomes of Neuroform and Enterprise stents in the treatment of unruptured wide-necked aneurysms. Materials and methods: Under the auspices of the institutional review board, a review of a prospectively collected patient log identified 130 patients who underwent elective stent-assisted coil embolization of a wide-necked aneurysm, including 53 patients treated with an Enterprise stent and 77 patients treated with a Neuroform stent. Immediate and long-term clinical and radiographic outcomes were recorded for all patients. All patient data were handled in accordance with Health Insurance Portability and Accountability Act of 1996 (HIPAA) regulations. Results: The technical success rate was 94%. Overall morbidity was 15% with Enterprise stents and 3% with Neuroform stents (p = 0.020). However, the type of stent used was not predictive of clinical outcomes as measured by the modified Rankin scale. In a multivariate analysis, the use of a Neuroform stent was one of the predictors of retreatment (p = 0.034). Conclusion: Multivariate analyses identified the use of Neuroform stents as an independent predictor of the need for retreatment and the use of Enterprise stents as an independent predictor of morbidity. However, the type of stent was not predictive of clinical outcome as measured by the modified Rankin scale. - Highlights: • The use of Enterprise stents was an independent predictor of morbidity. • The use of Neuroform stents was an independent predictor for retreatment. • The type of stent was not predictive of clinical outcome as measured by the mRS

  6. Novel oral anticoagulants in the treatment of cerebral venous thrombosis.

    Science.gov (United States)

    Feher, Gergely; Illes, Zsolt; Komoly, Samuel; Hargroves, David

    2016-08-01

    Cerebral venous thrombosis (CVT) is an uncommon cause of stroke with extremely diverse clinical features, predisposing factors, brain imaging findings, and outcome. Anticoagulation is the cornerstone of CVT management, however, it is not supported by high-quality evicence. Novel oral anticoagulants (NOACs) have been extensively studied in patients with deep vein thrombosis, pulmonary embolism and non-valvular atrial fibrillation. The aim of our work was to review the available evidence for NOACs in the treatment of CVT. Based on our literature search there is insufficient evidence to support the use of NOACs in CVT, although case series with rivaroxaban and dabigatran have showed promising results. PMID:25994451

  7. Novel oral anticoagulants in the treatment of cerebral venous thrombosis

    DEFF Research Database (Denmark)

    Feher, G; Illes, Z; Komoly, S;

    2015-01-01

    Cerebral venous thrombosis (CVT) is an uncommon cause of stroke with extremely diverse clinical features, predisposing factors, brain imaging findings, and outcome. Anticoagulation is the cornerstone of CVT management, however, it is not supported by high-quality evicence. Novel oral anticoagulants...... (NOACs) have been extensively studied in patients with deep vein thrombosis (DVT), pulmonary embolism (PE) and non-valvular atrial fibrillation (NVAF). The aim of our work to review the available evidence for NOACs in the treatment of CVT. Based on our literature search there is insufficient evidence...

  8. OCULO-ACUPUNCTURE TREATMENT OF CEREBRAL INFARCTION INDUCED HEMIPLEGIA

    Institute of Scientific and Technical Information of China (English)

    FU Wenbin; FAN Li; MENG Changrong; LI Weixiong; MI Jianping

    2002-01-01

    Objective: To observe the therapeutic effect of oculo-acupuncture therapy in the treatment of cerebral infarction induced hemiplegia. Methods: 58 cases of stroke patients were randomly divided into treatment group (n =30) and control group (n = 28). In treatment group, on the basis of medication plus rehabilitation treatment, patients voluntarily accepted oculo-acupuncture therapy (acupuncture of Upper-Jiao Area and Lower-Jiao Area). In control group, patients only accepted medication and rehabilitation treatment. The therapeutic effect was evaluated with Brunstrom's 6-stages Assessing Method. Results: After 24 sessions of treatment, the ratios of the diseased limbs reaching stage Ⅵ and more in functional activity in the patients of treatment group increased from 16.7% (upper-limb) and 20.0% (lower-limb) before treatment to 70.0% and 90.0% respectively; while in control group, those ratios of the upper and lower limbs increased from 10.7% and 28.6% before treatment to 39.2% and 60.7% separately. There was a significant difference between two groups in the therapeutic effect (P < 0.05). Conclusion: Oculo-acupuncture plus medication is superior to simple medication treatment in improving functional activity of the hemiplegic limbs.

  9. The relationship between the morphological features of A1 segment of anterior cerebral artery and anterior communicating artery aneurysms

    Institute of Scientific and Technical Information of China (English)

    冯文峰

    2013-01-01

    Objective To improve the predictability of surgical clipping and guide the steam shaping of microcatheters in endovascular embolization by analyzing the association of morphological features of A1 segment of anterior cerebral artery(ACA) with formation and classification of anterior

  10. Microsurgical treatment of ruptured intracranial aneurysms in the early and intermediate stage%早、中期显微手术治疗破裂的颅内动脉瘤

    Institute of Scientific and Technical Information of China (English)

    李锦平; 赵奇煌; 孙永全; 李彤; 宋英伦; 杨新乾; 王宇; 谭可; 李涛

    2009-01-01

    Objective To explore the microsurgical method in treating ruptured aneurysms treatment and evaluating the treatment of the complication during or after the operation.Methods 36 cases of patients with intracranial aneurysm were analyzed retrospectively.All of the patients were subarachnoid hemorrhage (SAH) by CT scan on admission.The intracranial aneurysms were confirmed in 35 cases by DSA examination and A2 aneurysm was confirmed by explorative operation in 1 case.The microsurgical treatment was performed in 36 cases at the early or intermediate stage,22 cases were treated in the early stage,the other 14 cases were treated in the intermediate stage (early stage means within 3 days post SAH;intermediate stage means from 4 days to 10 days post SAH).Results After the operation,21 cases were GOS grade Ⅰ,4 cases were COS grade Ⅱ,4 cases were COS grade Ⅲ,4 cases were GOS grade Ⅳ.Of all the patients,CT scan was done after the operation,finding no intracranial bemorrhage,and cerebral infarction was disclosed in 5 cases.3 cases were dead,one suffered occipital lobe infaret after the PCoA aneurysm clipped,brain hernia occurred at last,one's Hunt Hess grade was Ⅴ,ACoA aneurysm was disclosed by DSA examination,severe brain edema occurred after the operation,the other suffered tonsillar hernia one week after the aneurysm clipping,which ruptured after endovascular treatment of ACoA aneurysm 2 years later.DSA examinations were done in 26 cases after operation,declaring 1 ACoA aneurysm was unclipped,1 PCoA aneurysm was incompletely clipped,and 1 PCoA was sacrificed.Conclusions It is a valuable method to clip the ruptured intracranial aneurysms in early and intermediate stage.The cerebral ischemia is the severe complication after clipping.Especially for the PCoA aneurysms,it is very important to protect the PCoA.Further research should be done for the treatment in the case with mother artery arteriosclerosis and thrombosis within the aneurysms.%目的 探讨早、中期

  11. Hygroma following endovascular femoral aneurysm exclusion

    DEFF Research Database (Denmark)

    Wad, Morten; Pedersen, Brian Lindegaard; Lönn, Lars;

    2013-01-01

    Endovascular treatment of aneurysms in the superficial femoral artery (SFA) and popliteal segments is a suggested alternative to open surgical repair. Careful selection of patients for endovascular treatment of SFA aneurysms is mandatory.......Endovascular treatment of aneurysms in the superficial femoral artery (SFA) and popliteal segments is a suggested alternative to open surgical repair. Careful selection of patients for endovascular treatment of SFA aneurysms is mandatory....

  12. Persistência da artéria trigeminal primitiva associada com aneurisma da artéria cerebral média: relato de caso e revisão da literatura Persistent trigeminal artery associated with aneurysm of the middle cerebral artery: case report and literature review

    Directory of Open Access Journals (Sweden)

    Mauro Augusto de Oliveira

    1997-01-01

    Full Text Available Os autores apresentam um caso, demonstrado angiograficamente, de achado incidental de artéria trigeminal primitiva persistente associada com aneurisma do polígono de Willis no território da artéria cerebral média. A propósito, a literatura é revisada e a embriologia envolvida relatada.The authors report a case of persistent primitive trigeminal artery angiographically demonstrated as an incidental finding. The persistent primitive trigeminal artery was associated with an aneurysm arising from the circle of Willis in the middle cerebral artery territory. The literature is reviewed and the embryology involved is related.

  13. Treatments for primary aneurysmal bone cysts of the cervical spine: experience of 14 cases

    Institute of Scientific and Technical Information of China (English)

    Wang Chao; Liu Xiaoguang; Jiang Liang; Yang Shaomin; Wei Feng; Wu Fengliang; Liu Zhongjun

    2014-01-01

    Background Aneurysmal bone cyst (ABC) is a benign lesion with the potential to be locally aggressive.The optimal treatment of cervical spine lesions remains controversial.This retrospective study was designed to evaluate the different treatments for primary ABCs of the cervical spine.Methods This series included eight men and six women diagnosed between 2002 and 2012.A retrospective review of the hospital charts,operating room reports,office charts,and radiographs was performed.The data collected included patient age,sex,radiological features,pathology,treatment method,outcomes,and complications from biopsies and treatments.The mean age at diagnosis was 17.5 years old with a range of 6-35 years.All patients had experienced local pain for a mean of 7.3 months (range,0.5-18.0 months),and three patients had neurological deficits (one with radiculopathy and two with myelopathy).The Frankel classification before treatment was E in 12 cases,D in one case,and C in one case.Results Four patients received radiotherapy alone.Ten patients underwent surgery,including five total spondyiectomies,two local resections,and three curettages.Three patients received preoperative selective arterial embolization,and four received adjuvant radiotherapy.The mean follow-up time was 44.5 months (range 12-96 months),and no recurrence was identified.Three patients with neurological deficits achieved complete recovery,as noted at the final follow-up examination.One patient received radiotherapy without appropriate immobilization as prescribed and developed C1-C2 subluxation with severe spinal cord compression but without myelopathy.He refused further treatment.Conclusions The results can be achieved by different treatments (surgical resection/curettage,selective arterial embolization,and radiotherapy) for ABC of the cervical spine.Reconstruction of stability is also important for the treatment of cervical ABC.

  14. Successful coil embolization of a ruptured basilar artery aneurysm in a child with leukemia: a case report.

    Science.gov (United States)

    Hayashi, Shihori; Maehara, Taketoshi; Mukawa, Maki; Aoyagi, Masaru; Yoshino, Yoshikazu; Nemoto, Shigeru; Ono, Toshiaki; Ohno, Kikuo

    2014-01-01

    Ruptured intracranial aneurysms are rare in the pediatric population compared to adults. This has incited considerable discussion on how to treat children with this condition. Here, we report a child with a ruptured saccular basilar artery aneurysm that was successfully treated with coil embolization. A 12-year-old boy with acute lymphoblastic leukemia and accompanying abdominal candidiasis after chemotherapy suddenly complained of a severe headache and suffered consciousness disturbance moments later. Computed tomography scans and cerebral angiography demonstrated acute hydrocephalus and subarachnoid hemorrhage caused by saccular basilar artery aneurysm rupture. External ventricular drainage was performed immediately. Because the patient was in severe condition and did not show remarkable signs of central nervous system infection in cerebrospinal fluid studies, we applied endovascular treatment for the ruptured saccular basilar artery aneurysm, which was successfully occluded with coils. The patient recovered without new neurological deficits after ventriculoperitoneal shunting. Recent reports indicate that both endovascular and microsurgical techniques can be used to effectively treat ruptured cerebral aneurysms in pediatric patients. A minimally invasive endovascular treatment was effective in the present case, but long-term follow-up will be necessary to confirm the efficiency of endovascular treatment for children with ruptured saccular basilar artery aneurysms.

  15. 大脑中动脉瘤影像学特点分析%IMAGING CHARACTERISTICS OF MIDDLE CEREBRAL ARTERY ANEURYSM

    Institute of Scientific and Technical Information of China (English)

    常青; 窦以河; 李照建; 刘霞; 吴泽玉; 孙鹏

    2013-01-01

    Objective To analyze the imaging characteristics of middie cerebral artery aneurysms (MCAA) on CT,CTA and DSA,and provide information for the diagnosis and therapy of the disease.Methods The imaging information of CT,CTA and DSA in 22 patients with clinically confirmed MCAA was analyzed retrospectively.The hemorrhage manifestation on CT and imaging features of MCAA were statistically analyzed,and the features of commonly seen summarized.Results Of the 22 patients with MCAA,all showed rupture and bleeding on plain CT scan,and were confirmed by CTA and/or DSA.Of whom,nine (40.9%) with subarachnoid space hemorrhage (SAH),three (13.6%) with temporal lobe hematoma (TLH),six (27.3%) with TLH complicating SAH,and three (13.6%) with TLH and broken into brain ventricle.One (4.6%) aneurysm arose from the M1 segment,18 (81.8%) from the bifurcation of M2,and three (13.6%) from the initial segment of M3.The diameter (range) of the neck of aneurysms was 2-4 mm (2.4 mm).The aneurysms directing to anterolateral site were noted in 14 (63.6%) cases,posterolateral in five (22.7%),posteromedial in three (13.7%).CTA or DSA showed vasospasm of the same-side middle cerebral artery in six cases.Conclusion MCAA is more commonly located at the M2 bifurcation with its anterolateral direction,when rupture,which always manifests as lateral-fissure SAH or temporal intraparenchymal hematoma,the bleeding part being closely related with the direction of aneurysm.%目的 探讨大脑中动脉瘤的CT、CTA及DSA影像学特点,为大脑中动脉瘤的临床诊断和治疗提供数据资料.方法 回顾性分析22例临床确诊大脑中动脉瘤病人的CT、CTA及DSA影像学资料,对其CT出血表现和动脉瘤瘤体成像特征等影像学参数进行统计分析,总结其常见影像学特点.结果 22例大脑中动脉瘤CT平扫均表现为破裂出血,均行CTA和(或)DSA检查确诊.单纯蛛网膜下隙出血9例(40.9%),单纯颞叶血肿3例(13.6%),颞叶

  16. Emergency Use of Stent and rtPA with Mechanical Cloth Defragmentation for a Thromboembolic Complication during GDC Coil Treatment of an Acutely Ruptured Basilar Tip Aneurysm.

    Science.gov (United States)

    Poncyljusz, W; Falkowski, A; Kojder, I; Sagan, L

    2006-11-30

    Thrombotic occlusion of both posterior cerebral arteries occurred during embolization of an acutely ruptured basilar tip aneurysm. Intracranial stenting and continuous superselective infusion of rtPA was administered combined with mechanical clot fragmentation to reestablish normal vessel flow. DSA disclosed that normal vessel patency was achieved within 30 min. There were no adverse events related to rtPA administration and the patient recovered from the embolization with minor neurologic deficit as present before the procedure. PMID:24351269

  17. Aneurysm of the vein of Galen

    International Nuclear Information System (INIS)

    We report a case of a vein of Galen aneurysm in a neonate in which MR imaging provided essentially all pertinent diagnostic information prior to surgery. MR findings correlated well with selective cerebral angiography. (orig./MG)

  18. Popliteal vein aneurysm.

    Science.gov (United States)

    Falkowski, A; Poncyljusz, W; Zawierucha, D; Kuczmik, W

    2006-06-01

    The incidence of a popliteal vein aneurysm is extremely low. Two cases of this rare venous anomaly are described. The epidemiology, morphology, and diagnostic methods are discussed and the potentially dangerous complications and treatment methods are presented. PMID:16796307

  19. The experimental study on aneurysm with PIV system

    Science.gov (United States)

    Yueshe, Wang; Xiaoqi, Ma; Di, Li

    2013-07-01

    Cerebral aneurysm, a local enlargement of an artery caused by weakness in the wall of a cerebral artery, has the high death rate and disability rate, and is a threat to public health. The forming mechanism of aneurysm is complex, which motivated many researchers to conduct studies in this field. The results indicated that increasing heart frequency can aggravate the oscillation of wall shear stress, and push The growth points of aneurysm along the aneurysm wall, thereby significantly affecting bthe growth and rupture mechanism of aneurysm. In addition, it is found that the curvature of the vessel is the key to induce the secondary vortex in the aneurysm; the secondary vortex increases the magnitude of WSS near the dome of aneurysm, which can cause the rupture of aneurysm dome. there is a linear relationship between the velocity of blood flow and the square root of hear frequency.

  20. Observation and nursing of symptomatic cerebral vasospasm of postoperative patients with intracranial aneurysm%颅内动脉瘤夹闭术后症状性脑血管痉挛的观察与护理

    Institute of Scientific and Technical Information of China (English)

    袁漪; 程平

    2011-01-01

    Objective To evaluate the effective nursing methods for preventing symptomatic cerebral vasospasm (CVS) after surgical clipping of intracranial aneurysms. Methods The key points of observation and nursing of CVS in 128 patients after surgical clipping of intracranial a-neurysms were summarized. Early observation was carried out in 128 patients after the craniotomy and clipping surgery of intracranial aneurysms, coupled with targeted psychological nursing intervention, cisternal catheter and medical care so as to prevent CVS. At the same time close observation was carried out on patient' s condition and complications. Results Symptomatic cerebral vasospasm occurred in 32 patients, among which 25 cases recovered well, 5 cases had moderate disability, and 2 cases were discharged from the hospital without cure of persistent coma. Conclusion Targeted psychological nursing could prevent and decrease the symptomatic CVS after surgical clipping of intracranial aneurysms effectively.%目的 探讨有效预防颅内动脉瘤夹闭术后症状性脑血管痉挛(CVS)发生的护理方法.方法 对128例急诊颅内动脉瘤夹闭术后发生症状性CVS的患者做好有针对性的心理护理、脑池内置管护理和用药护理,密切观察患者病情变化.结果本组有32例发生症状性CVS,经治疗后25例恢复良好,5例中度残疾,2例持续昏迷自动出院.结论 颅内动脉瘤夹闭术后针对性护理可以有效预防和减少症状性脑血管痉挛.

  1. Basic fibroblast growth factor gene transfection in repair of internal carotid artery aneurysm wall

    Institute of Scientific and Technical Information of China (English)

    Lei Jiao; Ming Jiang; Jinghai Fang; Yinsheng Deng; Zejun Chen; Min Wu

    2012-01-01

    Surgery or interventional therapy has some risks in the treatment of cerebral aneurysm. We established an internal carotid artery aneurysm model by dripping elastase in the crotch of the right internal and external carotid arteries of New Zealand rabbits. Following model induction, lentivirus carrying basic fibroblast growth factor was injected through the ear vein. We found that the longer the action time of the lentivirus, the smaller the aneurysm volume. Moreover, platelet-derived growth factor expression in the aneurysm increased, but smooth muscle 22 alpha and hypertension-related gene 1 mRNA expression decreased. At 1, 2, 3, and 4 weeks following model establishment, following 1 week of injection of lentivirus carrying basic fibroblast growth factor, the later the intervention time, the more severe the blood vessel damage, and the bigger the aneurysm volume, the lower the smooth muscle 22 alpha and hypertension-related gene 1 mRNA expression. Simultaneously, platelet-derived growth factor expression decreased. These data suggest that recombinant lentivirus carrying basic fibroblast growth factor can repair damaged cells in the aneurysmal wall and inhibit aneurysm dynamic growth, and that the effect is dependent on therapeutic duration.

  2. Combined surgical and catheter-based treatment of extensive thoracic aortic aneurysm and aortic valve stenosis

    DEFF Research Database (Denmark)

    De Backer, Ole; Lönn, Lars; Søndergaard, Lars

    2015-01-01

    endovascular aneurysm repair (TEVAR) has changed and extended management options in thoracic aorta disease, including in those patients deemed unfit or unsuitable for open surgery. Accordingly, transcatheter aortic valve replacement (TAVR) is increasingly used to treat patients with symptomatic severe aortic......An extensive thoracic aortic aneurysm (TAA) is a potentially life-threatening condition and remains a technical challenge to surgeons. Over the past decade, repair of aortic arch aneurysms has been accomplished using both hybrid (open and endovascular) and totally endovascular techniques. Thoracic...

  3. Management of Cerebral Cavernous Malformations: From Diagnosis to Treatment

    Directory of Open Access Journals (Sweden)

    Nikolaos Mouchtouris

    2015-01-01

    Full Text Available Cerebral cavernous malformations are the most common vascular malformations and can be found in many locations in the brain. If left untreated, cavernomas may lead to intracerebral hemorrhage, seizures, focal neurological deficits, or headaches. As they are angiographically occult, their diagnosis relies on various MR imaging techniques, which detect different characteristics of the lesions as well as aiding in planning the surgical treatment. The clinical presentation and the location of the lesion are the most important factors involved in determining the optimal course of treatment of cavernomas. We concisely review the literature and discuss the advantages and limitations of each of the three available methods of treatment—microsurgical resection, stereotactic radiosurgery, and conservative management—depending on the lesion characteristics.

  4. Botulinum Toxin Treatment for Limb Spasticity in Childhood Cerebral Palsy

    Science.gov (United States)

    Pavone, Vito; Testa, Gianluca; Restivo, Domenico A.; Cannavò, Luca; Condorelli, Giuseppe; Portinaro, Nicola M.; Sessa, Giuseppe

    2016-01-01

    CP is the most common cause of chronic disability in childhood occurring in 2–2.5/1000 births. It is a severe disorder and a significant number of patients present cognitive delay and difficulty in walking. The use of botulinum toxin (BTX) has become a popular treatment for CP especially for spastic and dystonic muscles while avoiding deformity and pain. Moreover, the combination of physiotherapy, casting, orthotics and injection of BTX may delay or decrease the need for surgical intervention while reserving single-event, multi-level surgery for fixed musculotendinous contractures and bony deformities in older children. This report highlights the utility of BTX in the treatment of cerebral palsy in children. We include techniques for administration, side effects, and possible resistance as well as specific use in the upper and lower limbs muscles. PMID:26924985

  5. Basilar artery aneurysm with autonomic features: an interesting pathophysiological problem

    OpenAIRE

    Giffin, N; Goadsby, P

    2001-01-01

    Unruptured cerebral aneurysms often present with neuro-ophthalmological symptoms but ocular autonomic involvement from an aneurysm of the posterior circulation has not previously been reported. A patient is described with a basilar artery aneurysm presenting with headache and unilateral autonomic symptoms. After angiographic coiling of the aneurysm there was a near complete resolution of these features. The relevant anatomy and proposed mechanism of autonomic involvement of what may be ...

  6. Aneurysmal subarachnoid haemorrhage: outcome of aneurysm clipping in elderly patients and predictors of unfavourable outcome

    International Nuclear Information System (INIS)

    To determine the outcome of treatment of microsurgical clipping in elderly (60 - 70 years) patients with aneurysmal subarachnoid hemorrhage and determine the predictors of poor outcome. Study Design: Longitudinal analytical study. Place and Duration of Study: Nishtar Hospital, Multan, Mayo Hospital, Lahore, Department of Neurosurgery, Lahore General Hospital, Lahore, from January 2000 to January 2010. Methodology: Elderly patients (60 - 70 years) with ruptured cerebral aneurysm were enrolled and graded on the basis of World Federation of Neurosurgeons Scale (WFNS). Aneurysm sac obliteration was done in all the patients with microsurgical clipping. Postoperatively, the patients were assessed upto 3 months for outcome parameters i.e., neurological deterioration (based on WFNS grade and modified Rankin scale as favourable (mRS score 2). The factors associated with unfavourable outcome were also noted which included age > 65 years, poor initial WFNS grade, and the occurrence of ischaemia. Results: The mean age of the 48 patients was 65 + 5.45 years. There were 31 (64.6%) male and 17 (35.4%) female patients. Postprocedural neurological deterioration occurred in 23 patients (47.9%) related to ischaemia in 14 (29.16%), rebleeding in 1 (2%), and hydrocephalus in 8 (16.66%). At 03 months, the outcome was favourable in 25 patients (52.08%) and unfavourable in 23 (47.91%). Conclusion: In old patients, careful pre-operative assessment, interdisciplinary approach and meticulous tissue handling during aneurysm clipping may decrease the unfavourable outcome. (author)

  7. Posterior reversible encephalopathy syndrome following hemodynamic treatment of aneurysmal subarachnoid hemorrhage-induced vasospasm.

    Science.gov (United States)

    Awori, Jonathan; Rajajee, Venkatakrishna; Gemmete, Joseph J; Chaudhary, Neeraj; Thompson, B Gregory; Pandey, Aditya S

    2016-04-01

    Posterior reversible encephalopathy syndrome (PRES) is an uncommon but significant complication of hemodynamic therapy after aneurysmal subarachnoid hemorrhage (aSAH)-induced vasospasm. We performed a PubMed literature search for the period January 1999 to January 2015 using the search terms "posterior reversible encephalopathy syndrome", "subarachnoid hemorrhage", "vasospasm", and "hypertensive encephalopathy", and identified nine cases of PRES after aSAH-induced vasospasm in the literature. We also present a 63-year-old man with aSAH complicated by vasospasm treated with hemodynamic augmentation who subsequently developed PRES. Imaging following development of PRES symptoms shows vasogenic edema in the white matter of the parietal and occipital lobes. Age, sex, history of hypertension, and baseline blood pressure were variable among patients in the literature review. In all cases, patients improved both from a radiological and clinical perspective following blood pressure reduction. To summarize, PRES is a rare complication of hemodynamic therapy for vasospasm following aSAH. The literature at the time of writing demonstrates no common pattern with regard to patient demographics, medical history, or mode of treatment for symptomatic vasospasm. Given its sporadic and unpredictable nature, considering PRES in the differential diagnosis is important when addressing neurological decline following hemodynamic treatment of vasospasm related to aSAH. PMID:26755456

  8. [Aortic aneurysm].

    Science.gov (United States)

    Villar, Fernando; Pedro-Botet, Juan; Vila, Ramón; Lahoz, Carlos

    2013-01-01

    Aortic aneurysm is one important cause of death in our country. The prevalence of abdominal aortic aneurism (AAA) is around 5% for men older than 50 years of age. Some factors are associated with increased risk for AAA: age, hypertension, hypercholesterolemia, cardiovascular disease and, in particular, smoking. The medical management of patients with an AAA includes cardiovascular risk treatment, particularly smoking cessation. Most of major societies guidelines recommend ultrasonography screening for AAA in men aged 65 to 75 years who have ever smoked because it leads to decreased AAA-specific mortality. PMID:24238836

  9. Novel Use of an Iliac Branch Device in the Treatment of an Abdominal Aortic Aneurysm.

    Science.gov (United States)

    Shiraev, Timothy P; Dubenec, Steven

    2016-07-01

    Iliac branch devices (IBDs) are commonly used to treat iliac artery aneurysms and maintain patency of the internal iliac artery or its branches. This case report illustrates another possible application for an IBD. We present the case of a 77-year-old male who underwent repair of his infrarenal aneurysm with an IBD as a bifurcated aortic stent-graft in a small diameter aorta to maintain bilateral common iliac artery patency. PMID:27174353

  10. Endovascular Treatment of an Aneurysmal Aberrant Systemic Artery Supplying a Pulmonary Sequestrum

    DEFF Research Database (Denmark)

    Kristensen, Katrine Lawaetz; Duus, Louise Aarup; Elle, Bo

    2015-01-01

    An aberrant systemic artery originating from the abdominal aorta supplying a pulmonary sequestration is a rare congenital malformation. This causes a left-to-left shunt. Symptoms include recurrent pneumonias, hemoptysis, and, in the long term, heart failure. Aneurysm of the aberrant vessel...... aneurysmal branch from the abdominal aorta to the normal basal segments of the lung, successfully occluded with an Amplatzer Vascular Plug II (AVP II, St.Jude Medical, MN, USA) alone....

  11. Complication of interventional treatment: noncoronary sinus of Valsalva aneurysm ruptured into the right atrium

    Institute of Scientific and Technical Information of China (English)

    DONG Hao-jian; ZHOU Ying-ling; HUANG Xin-sheng

    2007-01-01

    @@ Sinus of Valsalva aneurysm is a rare cardiac anomaly thought to be caused by a deficiency of fusion of the aorta's media with the aortic valve's annulus fibrosis, or by actual detachment. It is usually congenital but less commonly associated with endocarditis, atherosclerosis,trauma, syphilis, or aortic dissection.1 Since the first report in the mid-eighteenth century, sinus of Valsalva aneurysm has been described increasingly.

  12. Reassessment of Defibrase in the treatment of Acute Cerebral lnfarction

    Institute of Scientific and Technical Information of China (English)

    Liu XQ; Guo YP; Wang WZ; Zhang CX; Yang JH; Qin Z

    2000-01-01

    Objective: to assess the safety and efficacy of defibrase in the treatment of acute cerebral iinfarction by a large sample, multicerter, randomized, double-blind, and placebo-controlled clinical trial Methods: 2244 cases with acute infarction in 41centers were randomly allocated to receive either an imitial intrdvcnons infusion of defibrase 10Bu or placebo in 250ml of normal saline within 24 hours of stroke onset Subsequent in fusions of defibrase 5Bu or placebo on the third and fifth days respectively. This treatment protocol was determined on the bases of the pretrial of 114 patientsin 8 centers The end points fincluded Climcally Neurological De ficits Scale of Stroke, Barthel Index, Mortality, adverse reaction and the level of plasma fibrinogen (FIB)Results: (1) the level of plasma FIB in defibrase group was reurarkably declied after treatment whereas the bleeding evcnts and other adverse reaction was not incteased in comparison with control group There was difference in the imtcnsity of degrading plasna FIB between defibrase from Agkistrodon halys and that frorn Agkistrodon acutns. (2) Theare were no statistically significant differences at Clinically Neurological Deficits Scale of Stroke at 2 weeks, Barthel Index sc ore and mortality at 3 months between two groups. Conclutions: This study showed that defibrase atppears safe and effective in degading plastua FIB.The dose of defibrase should regnlate propcrly according to preparations from diffcrent snake venom .This study did not show that clinical efficacy of defibrase was supetior to those present used medicines for acute cerebral infarction It is necessary to further study about the relations between its clinical efficacy and the dose,protocol of drug administration and indication.

  13. Coil Knotting during Endovascular Coil Embolization for Ruptured MCA Aneurysm: A Case Report

    OpenAIRE

    Kwon, S.C.; Lyo, I.U.; Shin, S. H.; Park, J B; Kim, Y.

    2008-01-01

    Complications during coil embolization of cerebral aneurysms include thromboembolic events, hemorrhagic complications related to procedural aneurysmal rupture and parent vessel perforation, and coil-related complications. The present report describes a rare coil-related complication involving spontaneous coil knotting.

  14. Mechanism and treatment principle for cerebral vessel spasm caused by concussion

    Institute of Scientific and Technical Information of China (English)

    肖兴义; 郭新红; 王德文; 薛关生

    2002-01-01

    Objective: To discuss the mechanism of cerebral vessel spasm caused by concussion and the effect of Nimodipine on concussion. Methods: A total of 224 patients who were treated from March 1995 to October 1999 were divided into two groups randomly, ie, Nimodipine group (113 cases) and control group (111 cases). Middle cerebral artery (MCA), basilar artery (BA) and the average peak forward velocity of cerebral blood flow were observed by color three-dimensional transcranial Doppler (3D-TCD) within 24 hours after admission and at the end of 3-6 days of treatment. Cerebral blood flow changes, characteristics and treatment effect were analyzed and determined by clinical main symptom disappearance rate. Results: In concussion, cerebral blood flow was divided into 3 phases: cerebral blood flow low infusion dilation phase, cerebral blood vessel spasm phase and cerebral blood flow recovery phase. In the Nimodipine group, clinical main symptom disappearance rate was higher than that in the control group in the cerebral spasm and recovery phases with a significant difference (P<0.01).  Conclusions: Cerebral vessel spasm, hypoxia and ischemia lesion are the main pathological changes. Whether cerebral dysfunction is reversible or not is mainly determined by spasm time of cerebral blood vessel. Nimodipine has a good effect on releasing spasm and diminishing the cerebral blood flow velocity. It not only improves curative effect on concussion, but also reduces and prevents concussion sequelae. Hence, concussion patients who have cerebral spasm confirmed by 3D-TCD should be given Nimodipine routinely and early.

  15. Pituitary Insufficiency and Hyperprolactinemia Associated with Giant Intra- and Suprasellar Carotid Artery Aneurysm

    Directory of Open Access Journals (Sweden)

    A. Gungor

    2015-01-01

    Full Text Available Pituitary insufficiency secondary to internal carotid artery (ICA aneurysm is a very rare condition. Its prevalence is reported as 0.17% (Heshmati et al., 2001. We present a case of pituitary insufficiency and hyperprolactinemia secondary to suprasellar giant intracranial aneurysm. A 71-year-old man was admitted to our clinic with symptoms of hypopituitarism, hyperprolactinemia, and visual field defect. His pituitary MRI and cerebral angiography revealed a giant saccular aneurysm filling suprasellar cistern arising from the ophthalmic segment of the right ICA. Endovascular treatment was performed on the patient to decrease the mass effect of aneurysm and improve the hypophysis dysfunction. After treatment, his one-year follow-up showed the persistence of hypophysis insufficiency, decrease of prolactin (PRL level, and normal visual field. An intracranial aneurysm can mimic the appearance and behavior of a pituitary adenoma. Intracranial aneurysms should be taken into consideration in the situation of hypopituitarism and hyperprolactinemia. It is important to distinguish them because their treatment approach is different from the others.

  16. 容积CT 数字减影血管成像大脑中动脉动脉瘤特点研究%Study on characteristics of middle cerebral artery aneurysm in volume CT digital subtraction angiograhy

    Institute of Scientific and Technical Information of China (English)

    谢惠; 覃川; 吕发金; 张丽娟; 姚开情; 杨俊潇; 荣天; 张定均; 周帮建

    2014-01-01

    目的:探讨大脑中动脉动脉瘤(MCAA)的容积CT数字减影血管成像(VCTDSA)的部位特征。方法回顾性分析2009年5月至2011年1月69例72个MCAA VCTDSA影像特点,根据MCAA发生部位分为4类:M1段,M2分叉处,M2远段,M3~M5段,统计双侧动脉瘤数目,分析动脉瘤部位的影像学特征;两名神经放射学医生采用双盲法测量M2分叉处大脑中动脉瘤角度,并与正常大脑中动脉M2分叉处角度对照,统计分析二者的角度差异。结果(1)M1段动脉瘤共7个(9.70%),M2分叉处动脉瘤共58个(80.56%),M 2远段动脉瘤共5个(6.94%),M 3~M 5段动脉瘤共2个(2.78%)。(2)正常大脑中动脉M 2分叉处角度为(99.30±22.96)°,M 2分叉处动脉瘤角度为(139.26±27.61)°,两者比较差异有统计学意义( P<0.01)。(3)正常大脑中动脉M 2分叉处角度左右侧比较差异无统计学意义( P>0.05)。(4)破裂动脉瘤M 2分叉处角度为(133.98±30.24)°,未破裂动脉瘤M2分叉处角度为(144.53±21.81)°,两者比较差异无统计学意义(P>0.05)。结论 MCAA多发于M2分叉处;动脉瘤组与非动脉瘤组M2分叉处角度差异有统计学意义,M2分叉角度增大,动脉瘤的发生率增高。%Objective To study the occurrence site characteristics of middle cerebral artery aneurysm (MCAA ) in volume CT digital subtraction angiograhy(VCTDSA) .Methods The image characteristics in 72 cases of MCAA from May 2009 to January 2011 were retrospectively analyzed ,according to the running of middle cerebral artery ,the occurrence sites of aneurysm were divided into four categories :M1 segment ,M2 bifurcation ,M2 distal and M3-M5 segment ,the aneurysm number was conducted the statistics and the image characteristics were analyzed ;two neuroradiologists adopted the double-blind method to measure the MCAA angle in bifurcation of M2

  17. Mycotic aneurysms : radiological diagnosis and therapeutic alternatives; Aneurismas micoticos: diagnstico radiologico y alternativas terapeuticas

    Energy Technology Data Exchange (ETDEWEB)

    Urbano, J.; Arjonilla, M. A. [Universidad Autonoma de Madrid. Madrid (Spain)

    2002-07-01

    To review mycotic aneurysms, their radiological diagnosis and therapeutic alternatives. Five men and a woman between 69 and 84 years old were diagnosed during the last 4 years with mycotic aneurysms. Three were in the aorta, one in the thoracic and two in the abdominal region; one was affecting the left primitive iliac artery, another the left popliteal artery and, in the last case, the medial cerebral artery. Hemo cultures were done on all patients. The surgical specimen was cultivated in 4. CAT was done on 5 patients, angiography on another five and Doppler ultrasound scan on two. Five patients showed positive hemo cultures and in two the surgical specimen culture was positive. The findings of the CAT were decisive in being able to suspect that the lesions were mycotic in nature. Three patients had to undergo emergency, expiring either in surgery or in postoperative care. One case was treated by means of aortic endo prosthesis, and one year later the patient remains asymptomatic. The cerebral aneurysm was embolized with metal coils and the patient remains asymptomatic three years later. The popliteal aneurysm underwent surgical intervention using an established protocol with good results. CAT is decisive in the diagnosis of mycotic aneurysms. Once detected, they must be treated without delay as their natural evolution is one of rapid expansion and rupture. Angiographies help in planning the treatment. Radiological intervention plays an important role in the treatment. (Author) 13 refs.

  18. Brain Aneurysm

    Science.gov (United States)

    A brain aneurysm is an abnormal bulge or "ballooning" in the wall of an artery in the brain. They are sometimes called berry aneurysms because they ... often the size of a small berry. Most brain aneurysms produce no symptoms until they become large, ...

  19. Endovascular treatment of splenic artery aneurysms; Trattamento endovascolare degli aneurismi dell'arteria splenica

    Energy Technology Data Exchange (ETDEWEB)

    Lagana, Domenico; Carrafiello, Gianpaolo; Mangini, Monica; Fontana, Federico; Dizonno, Massimiliano; Fugazzola, Carlo [Insubria Univ., Varese (Italy). Cattedra di radiologia; Castelli, Patrizio [Insubria Univ., Varese (Italy). Chirurgia vascolare

    2005-07-15

    Purpose. To assess the feasibility and effectiveness of endovascular treatment of splenic artery aneurysm (SAAs). Materials and methods. Between May 2000 and June 2003 we treated 11 true SAAs in 9 patients (7 females and 2 males; mean age 58 years), 8 saccular and 3 fusiform, 4 located at the middle tract of the splenic artery, 5 at the distal tract and 2 intra-parenchymal. The diagnosis was performed with colour-Doppler ultrasound and/or CT-angiography; 7 patients were symptomless, 1 had left hypochondriac pain, and 1 had acute abdomen caused by a ruptured SAA. Four SAAs were treated by micro coil embolisation of the aneurysmal sac with preservation of splenic artery patency; in 2 cases this was associated with transcatheter injection of N-butyl-2-cyanoacrylate. Four cases were treated by endovascular ligature, with sectoral spleen ischaemia. One ruptured SAA received emergency treatment with splenic artery cyanoacrylate embolisation. Two intra-parenchymal SAAs were excluded, one by cyanoacrylate embolisation of the afferent artery and the other by transcatheter thrombin injection in the aneurysmal sac. Results. Technical success was observed in all cases (in 10/11 at the end of the procedure; in 1/11 at CT performed 3 days after the procedure). The follow-up (mean 18 months; range 6-36) was performed by colour-Doppler ultrasound and/or CT-angiography 3, 6 and 12 months after the procedure and subsequently once a year; the complete exclusion of the aneurysms was confirmed in 11/11 cases. The complications were: 4 cases of mild pleuritis; fever and left hypochondriac pain 1 day after the procedure (in the same 4 patients and in one other case); 5 cases of sectorial spleen ischaemia and 1 case of diffuse spleen infarction with partial revascularization by collateral vessels. No alteration of the levels of pancreatic enzymes was found; a transitory increase in platelet count occurred only in the patient with diffuse spleen infarction. Conclusions. Using different

  20. A new flow diverter stent for direct treatment of intracranial aneurysm.

    Science.gov (United States)

    Ma, Jiayao; You, Zhong; Peach, Thomas; Byrne, James; Rizkallah, Rafik R

    2015-12-16

    The use of a stand-alone flow diverter (FD) stent has demonstrated itself as an efficacious endovascular approach to intracranial aneurysm treatment. FD stents that are currently available adopt an interwoven braided design. The relatively low radial stiffness intrinsic to this design could cause difficulty in deployment and poor stent-wall apposition, leading to high complication rates. A new FD stent is proposed to overcome the problems of the interwoven FD stents. The new device is manufactured from a Nitinol tube through a laser-cutting technique, and its unique structure allows for both low porosity and high packaging efficiency. Computational simulation using Abaqus has been conducted to investigate the radial stiffness and longitudinal flexibility of the new device. The new device exhibits high radial stiffness when compared to interwoven FD stents and superior longitudinal flexibility. Results from on-going in-vivo experiments and CFD simulations have also demonstrated the efficacy of the new device as a FD stent. PMID:26592434

  1. Vortex dynamics in ruptured and unruptured intracranial aneurysms

    Science.gov (United States)

    Trylesinski, Gabriel

    Intracranial aneurysms (IAs) are a potentially devastating pathological dilation of brain arteries that affect 1.5-5 % of the population. Causing around 500 000 deaths per year worldwide, their detection and treatment to prevent rupture is critical. Multiple recent studies have tried to find a hemodynamics predictor of aneurysm rupture, but concluded with distinct opposite trends using Wall Shear Stress (WSS) based parameters in different clinical datasets. Nevertheless, several research groups tend to converge for now on the fact that the flow patterns and flow dynamics of the ruptured aneurysms are complex and unstable. Following this idea, we investigated the vortex properties of both unruptured and ruptured cerebral aneurysms. A brief comparison of two Eulerian vortex visualization methods (Q-criterion and lambda 2 method) showed that these approaches gave similar results in our complex aneurysm geometries. We were then able to apply either one of them to a large dataset of 74 patient specific cases of intracranial aneurysms. Those real cases were obtained by 3D angiography, numerical reconstruction of the geometry, and then pulsatile CFD simulation before post-processing with the mentioned vortex visualization tools. First we tested the two Eulerian methods on a few cases to verify their implementation we made as well as compare them with each other. After that, the Q-criterion was selected as method of choice for its more obvious physical meaning (it shows the balance between two characteristics of the flow, its swirling and deformation). Using iso-surfaces of Q, we started by categorizing the patient-specific aneurysms based on the gross topology of the aneurysmal vortices. This approach being unfruitful, we found a new vortex-based characteristic property of ruptured aneurysms to stratify the rupture risk of IAs that we called the Wall-Kissing Vortices, or WKV. We observed that most ruptured aneurysms had a large amount of WKV, which appears to agree with

  2. Nimodipine in aneurysmal subarachnoid hemorrhage: a randomized study of intravenous or peroral administration

    DEFF Research Database (Denmark)

    Kronvall, Erik; Undrén, Per; Rommer, Bertil Roland;

    2009-01-01

    treatment. The patients were monitored for at least 10 days after bleeding in terms of delayed ischemic neurological deficits (DINDs) and with daily measurements of blood flow velocities in the middle cerebral arteries by using transcranial Doppler ultrasonography. Three months after SAH, clinical outcome...... is an alternative and the preferred mode of treatment in many centers. It is unknown whether the route of administration is of any importance for the clinical efficacy of the drug. METHODS: One hundred six patients with acute aneurysmal SAH were randomized to receive either peroral or intravenous nimodipine...... and new cerebral infarctions according to MR imaging studies were recorded. RESULTS: Baseline characteristics (age, sex distribution, clinical status on admission, radiological findings, and aneurysm treatment) did not differ between the treatment groups. There was no significant difference...

  3. Efficacy of neurodevelopmental treatment combined with the Nintendo® Wii in patients with cerebral palsy

    OpenAIRE

    Acar, Gönül; Altun, Gamze Polen; Yurdalan, SaadetUfuk; Polat, Mine Gülden

    2016-01-01

    [Purpose] The aim of this study was to investigate the efficiency of Nintendo® Wii games in addition to neurodevelopmental treatment in patients with cerebral palsy. [Subjects and Methods] Thirty hemiparetic cerebral palsy patients (16 females, 14 males; mean age, 6–15 years) were included in the study and divided into two groups: a neurodevelopmental treatment+Nintendo Wii group (group 1, n=15) and a neurodevelopmental treatment group (group 2, n=15). Both groups received treatment in 45-min...

  4. Análisis de Sensibilidad en Simulaciones Fluido Dinámicas de Aneurismas Cerebrales Incluyendo Interacción Fluido Estructura Sensibility Analysis in Computational Fluid Dynamics of Cerebral Aneurysm including Fluid Structure Interaction

    Directory of Open Access Journals (Sweden)

    Alvaro Valencia

    2010-01-01

    Full Text Available Se presenta un estudio sobre sensibilidad de los resultados de simulación fluido dinámica (CFD en modelos de aneurismas cerebrales, incluyendo la interacción entre la pared arterial y el fluido (FSI. Con 83 modelos reconstruidos de aneurismas cerebrales se hizo un estudio geométrico y se seleccionó un caso para estudiar la fluido dinámica en detalle. Se varió el número de sifones carotideos usados para la simulación CFD. Se realizaron cinco simulaciones FSI variando el modulo de elasticidad arterial y el espesor arterial, y se reportó el efecto de la hipertensión arterial en los resultados. Las simulaciones FSI mostraron que el efecto más relevante en el incremento del estado de esfuerzos en la aneurisma es la hipertensión arterial, con esfuerzos máximos cercanos a 900 kPa. Se concluye que las simulaciones FSI se deben usar para determinar simultáneamente el estado de esfuerzos de la pared y la fluido dinámica dentro de aneurismas.A sensitivity study of the results provided by computational fluid dynamics (CFD in models of cerebral aneurysms including fluid structure interaction (FSI was performed. With 83 reconstructed models of cerebral aneurysms, a geometrical study was done and one case was selected for a detailed study of the computational fluid dynamics. In this model the number of carotid siphon used for the CFD simulations was varied. In the FSI study, five simulations were conducted varying the elastic modulus of the artery and the arterial wall thickness, and the effect of hypertension on the results was reported. The FSI simulations have shown that the most important parameter that affeets the aneurysm wall stress state is the arterial hypertension with máximum stress of around 900 kPa. It is concluded that FSI simulations must be used to simultaneously determine the wall stress and the fluid dynamics inside cerebral aneurysm.

  5. Comparison between 3D-CTA with volume reconstruction and 3D-DSA in diagnosis of acute rupture of minute cerebral aneurysms%容积重建成像3D-CTA与3D-DSA在诊断急性破裂性颅内微小动脉瘤的研究

    Institute of Scientific and Technical Information of China (English)

    曾少建; 舒航; 陈光忠; 李昭杰; 詹升全; 林晓风; 周东

    2010-01-01

    Objective To evaluate the diagnostic value of three dimensional computed tomographic angiog-raphy (3D-CTA) with volume reconstruction (VR) and 3D digital subtraction angiography (3D-DSA) in diagnosis of minimal cerebral aneurysms. Method A total of 174 patients in Guangdong General Hospital, May 2007 to November 2008, of subarachnoid hemorrhage were checked upon the original imaging obtained by GE' s Light Speed Plus 64 volume spiral CT scanner at first, and then by the means of using Volume rendering (VR) three dimen-sional reconstruction and assisting the use of multiple planar reconstruction (MPR) to complete the 3D-DSA imag-ing at last. The volume rendering (VR) was assessed. Results Eleven very small cerebral aneurysms in 174 pa-tients with subarachnoid hemorrhage were diagnosed by CTA and 10 of them by 3D-DSA. Finally, all of 11 patients were confirmed by intracranial operations. The 3D-CTA (VR) clearly showed the shape and size of the intracranial aneurysms and their relationship to adjacent structures as well. There was no significant difference in the diagnosis of very small cerebral aneurysms between 3D-DSA and 3D-CTA(VR). Conclusions The 3D-CTA (VR) is a re-liable and rapid non-invasive diagnostic device for very small intracranial aneurysms. For the emergency operation,3D-CTA (VR) can provide more detailed imaging information to help the development of treatment strategy.%目的 对比研究容积重建成像三维CT血管造影与三维DSA(3D-DSA)在颅内微小动脉瘤诊疗中的临床应用价值.方法 对广东省人民医院2007年5月至2008年11月收治的174例蛛网膜下腔出血患者首先采用采用GE公司的Light Speed Plus 64排容积螺旋CT机获得原始图像,采用容积重建成像技术(VR)进行三维重建.并辅助运用多轴面重建(MPR),然后再行全脑血管造影术,并行3D-DSA成像.结果 本组174例蛛网膜下腔出血患者诊断为颅内微小动脉瘤11例,均经开颅手术证实;其中CTA诊断11例,3D

  6. Different treatment modes for cerebral microlesions:a comparison of clinical efficacy

    Institute of Scientific and Technical Information of China (English)

    曲红

    2013-01-01

    Objective To tentatively establish a diagnosis and treatment mode for effectively controlling the progress of cerebral microlesions(CM) and preventing the incidence of cerebral infarction(CI) by comparing different intervention modes for treating CM.Methods Using a prospective

  7. What is cerebral palsy - new advances in treatment of cerebral palsy?

    OpenAIRE

    Perat, Milivoj Veličković

    2013-01-01

    Abstract. Cerebral palsy is the most frequent motorimpairment in childhood. In many countries, its prevalence is predicted toincrease. There are an estimated 15 million people with cerebral palsy aroundthe world and more than half of them are mentally retarded and one third haveepilepsy. It should be seen that it is more than merely a motor disorder. Therecan be problems of development, perceptual-cognitive impairment, social andfunctional problems of daily living, emotional and behavioural p...

  8. Surgical Treatment of a Voluminous Infrarenal Abdominal Aortic Aneurysm with Horseshoe Kidney: Tips and Tricks.

    Science.gov (United States)

    De Caridi, Giovanni; Massara, Mafalda; Greco, Michele; Mastrojeni, Claudio; Serra, Raffaele; Salomone, Ignazio; La Spada, Michele

    2015-01-01

    Horseshoe kidney is a common urology anomaly, while its association with infrarenal abdominal aortic aneurysm represents a very rare condition. Surgical approach remains controversial however, we believe that the left retroperitoneal approach should be preferred in order to avoid isthmus resection with any subsequent renal infarction, urinary tract damage and to facilitate renal arteries reimplantation, when required. We present a case of voluminous infrarenal abdominal aortic aneurysm associated with horseshoe kidney, successfully treated through a left retroperitoneal approach on the retro-renal space. PMID:26730260

  9. A Case of Endovascular Treatment of Severe Graft Limb Kinking after Endovascular Abdominal Aortic Aneurysm Repair

    Science.gov (United States)

    Shin, Jong-Beom; Park, Mi-Hwa; Jeong, Sang-Ho; Kwon, Sung Woo; Shin, Sung-Hee; Woo, Seong-Ill; Park, Sang-Don

    2016-01-01

    Endovascular aneurysm repair (EVAR) has been recommended as an alternative to open aneurysm repair. The risk of severe perioperative complications is lower than that in open surgical repair; however, late complications are more likely. After EVAR, regular yearly surveillance by duplex ultrasonography or computed tomography is recommended. We report the case of a 67-year-old man with a severely kinked left iliac branch of the stent graft 10 years after EVAR. He had not undergone regular follow-up during the last 4 years. We realigned the endograft kink by percutaneous transluminal angioplasty. PMID:27051658

  10. Meta-analysis of stent-assisted coiling versus coiling-only for the treatment of intracranial aneurysms.

    Science.gov (United States)

    Phan, Kevin; Huo, Ya R; Jia, Fangzhi; Phan, Steven; Rao, Prashanth J; Mobbs, Ralph J; Mortimer, Alex M

    2016-09-01

    Endovascular coil embolization is a widely accepted and useful treatment modality for intracranial aneurysms. However, the principal limitation of this technique is the high aneurysm recurrence. The adjunct use of stents for coil embolization procedures has revolutionized the field of endovascular aneurysm management, however its safety and efficacy remains unclear. Two independent reviewers searched six databases from inception to July 2015 for trials that reported outcomes according to those who received stent-assisted coiling versus coiling-only (no stent-assistance). There were 14 observational studies involving 2698 stent-assisted coiling and 29,388 coiling-only patients. The pooled immediate occlusion rate for stent-assisted coiling was 57.7% (range: 20.2%-89.2%) and 48.7% (range: 31.7%-89.2%) for coiling-only, with no significant difference between the two (odds ratio [OR}=1.01; 95% confidence intervals [CI}: 0.68-1.49). However, progressive thrombosis was significantly more likely in stent-assisted coiling (29.9%) compared to coiling-only (17.5%) (OR=2.71; 95% CI: 1.95-3.75). Aneurysm recurrence was significantly lower in stent-assisted coiling (12.7%) compared to coiling-only (27.9%) (OR=0.43; 95% CI: 0.28-0.66). In terms of complications, there was no significant difference between the two techniques for all-complications, permanent complications or thrombotic complications. Mortality was significantly higher in the stent-assisted group 1.4% (range: 0%-27.5%) compared to the coiling-only group 0.2% (range: 0%-19.7%) (OR=2.16; 95% CI: 1.33-3.52). Based on limited evidence, stent-assisted coiling shows similar immediate occlusion rates, improved progressive thrombosis and decreased aneurysm recurrence compared to coiling-only, but is associated with a higher mortality rate. Future randomized controlled trials are warranted to clarify the safety of stent-associated coiling. PMID:27344091

  11. Cerebral vasospasm following subarachnoid hemorrhage: time for a new world of thought

    DEFF Research Database (Denmark)

    Pluta, Ryszard M; Hansen-Schwartz, Jacob; Dreier, Jens;

    2009-01-01

    OBJECTIVE: Delayed cerebral vasospasm has long been recognized as an important cause of poor outcome after an otherwise successful treatment of a ruptured intracranial aneurysm, but it remains a pathophysiological enigma despite intensive research for more than half a century. METHOD: Summarized ...

  12. Aneurysmal subarachnoid hemorrhage in elderly patients: long-term outcome and prognostic factors in an interdisciplinary treatment approach.

    Science.gov (United States)

    Schöller, Karsten; Massmann, Maike; Markl, Gertraud; Kunz, Mathias; Fesl, Gunther; Brückmann, Hartmut; Pfefferkorn, Thomas; Tonn, Jörg-Christian; Schichor, Christian

    2013-04-01

    The number of elderly patients with aneurysmal subarachnoid hemorrhage (SAH) is increasing with the aging of the population. However, management recommendations based on long-term outcome data and analyses of prognostic factors are scarce. Our study focused exclusively on elderly patients aged ≥ 60 years at the onset of SAH. Patients were selected from an in-house database and compared in cohorts of age 60-69, 70-79, and ≥ 80, regarding pre-existing medical conditions, treatment, clinical course including complications, and outcome. A multivariate analysis was conducted to identify prognostic factors for death and disability. A total of 256 patients (138 aged 60-69, 93 aged 70-79, 25 aged ≥ 80) with putative aneurysmal SAH who had been admitted to our hospital between January 1, 1996 and June 30, 2007 were extracted. The median follow-up of our total cohort was 35.5 months (range <1-154 months). Endovascular or conservative aneurysm treatment was applied more often with increasing age (p < 0.006). The 1-year survival rate was 78, 65, and 38 % in the three age groups, respectively (p = 0.0002); most of the patients died from the initial hemorrhage or from medical complications. Patients aged <70 with an initial World Federation of Neurosurgical Societies (WFNS) score of I-III showed the best clinical recovery. WFNS score, age, and clipping/coiling were extracted as prognostic factors from the Cox model. Elderly patients who get admitted with a good WFNS score (I-III) seem to benefit from aggressive treatment whereas caution seems to be warranted particularly in patients ≥ 70 years of age who get admitted in a WFNS score of IV and V because of their limited short- and long-term prognosis.

  13. Microsurgical treatment for posterior communicating artery aneurysms%后交通动脉瘤的显微手术治疗

    Institute of Scientific and Technical Information of China (English)

    谢飞; 孙鸿; 毛伯镛; 游潮; 贺民; 刘翼; 毛庆

    2011-01-01

    Objective To review experience with microsurgical treatment for posterior communicating artery (PCoA) aneurysms. Methods Clinical data of 108 patients with PCoA aneurysms treated by microsurgery through the pterional approach were analyzed retrospectively, including clipping of aneurysmal neck in 107 cases and wrapping of aneurysm in 1. Aneurismal incision and the indocyanine green angiography were routinely performed after the clipping. Results Total clipping of aneurysmal neck in 107 cases and wrapping of aneurysm in 1. Intraoperatively intracranial aneurysm burst ruptured in 18 patients. Preoperative hydrocephalus occurred in 11 cases, and improved in 6 and no significantly improved in S postoperatively. The postoperative GOS scores were as follows: 4 to 5 scores in 93 patients, 2 to 3 in 11 and 1 (death) in 4. Eighty-four patients were followed up for 6 to 12 months, and there was no residual aneurysm or recurrence. Conclusions Microsurgery is an ideal method for treatment of PCoA aneurysms. Intraoperatively aneurysmal incision and the indocyanine green angiography are useful in judging the clipping effect.%目的 总结显微手术治疗后交通动脉瘤的经验.方法 回顾性分析108例后交通动脉瘤病人的临床资料,采用翼点入路显微手术治疗,行瘤颈夹闭术107例,动脉瘤包裹术1例.瘤颈夹闭后术中常规切开瘤体并行吲哚菁绿荧光血管造影.结果 动脉瘤颈完全夹闭107例,动脉瘤包裹1例.术中动脉瘤破裂18例.术前脑积水11例,术后改善6例,无明显改善5例.术后GOS评分:4~5分93例,2~3分11例,1分(死亡)4例.84例获随访6~12个月,无动脉瘤残留及复发.结论 显微手术是治疗后交通动脉瘤的理想方法,术中常规切开瘤体并行吲哚菁绿荧光血管造影可有效判断夹闭效果.

  14. Surgical treatment of multiple intracranial aneurysms%颅内多发动脉瘤的手术治疗

    Institute of Scientific and Technical Information of China (English)

    束旭俊; 孙正辉; 武琛; 王芙昱; 宋志军; 余新光

    2015-01-01

    Objective To discuss the surgical strategies and analyze the clinical outcomes of multiple intracranial aneurysms (MIA).Methods The clinical data of 49 MIA patients surgically treated between January 2009 and December 2013 was analyzed retrospectively.Among the 49 patients,12 patients were male and 37 were female,mean age(49 ± 11)years.Thirty-five patients had ruptured aneurysms,and 14 had unruptured aneurysms.Treatment strategies included one-stage operation (MIA were treated in one-stage with an unilateral approach),two-stage treatment (MIA were treated stage by stage) and partial treatment (only ruptured aneurysm was treated).Postoperative CT angiograms (CTA) or digital subtraction angiograms (DSA) were reviewed and the Glasgow Outcome Scale (GOS) scores were evaluated during follow-up period.Results Thirty-two patients (65.3%) underwent one-stage operation,9 patients (18.4%) underwent two-stage treatment,and 8 patients (16.3%) underwent partial treatment.Forty-seven patients were followed up 4-49 months,mean (22 ± 7) months.Postoperative CTA or DSA showed no aneurysm recurrence.According to the GOS scores,41 patients (83.7%) with good outcomes (GOS 4,5),6 patients (12.2%) were disabled (GOS 2,3) and 2 patients (4.1%) were dead (GOS 1).Conclusion Selecting the right patients for surgery and making personalized surgical strategies based on the characteristics of patients and aneurysms could improve the surgical outcomes of MIA.%目的 探讨颅内多发动脉瘤的手术策略并分析临床疗效.方法 回顾性分析2009年1月至2013年12月手术治疗49例颅内多发动脉瘤患者的临床资料.49例患者中,男性12例,女性37例;平均年龄(49±11)岁;35例动脉瘤破裂,14例未破裂;治疗策略有一期手术(一侧入路夹闭所有动脉瘤),二期治疗(分期处理所有动脉瘤)和部分治疗(只处理责任动脉瘤).随访中复查脑CT血管造影(CTA)或数字减影血管造影(DSA),用格拉斯哥预

  15. Treatment of chondroblastoma of the calcaneus with a secondary aneurysmal bone cyst using endoscopic curettage without bone grafting.

    Science.gov (United States)

    Otsuka, Takanobu; Kobayashi, Masaaki; Yonezawa, Masato; Kamiyama, Fumiaki; Matsushita, Yasusi; Matsui, Nobuo

    2002-04-01

    Chondroblastoma is a relatively rare benign bone tumor. Approximately 7% of chondroblastomas occur in the calcaneus, and 17% of chondroblastoma associated with cystic lesions. We report a case of a chondroblastoma in the calcaneus with a secondary aneurysmal bone cyst treated successfully by endoscopic curettage without bone grafting. New bone formation is facilitated by minimal damage to the bone and soft tissue. The cosmetic results of this procedure are good. Two years later, the patient is asymptomatic with no radiographic evidence of recurrence. Endoscopic curettage without bone grafting is a promising new treatment for chondroblastoma.

  16. Surgical Treatment of a Voluminous Infrarenal Abdominal Aortic Aneurysm with Horseshoe Kidney: Tips and Tricks

    OpenAIRE

    De Caridi, Giovanni; Massara, Mafalda; Greco, Michele; Mastrojeni, Claudio; Serra, Raffaele; Salomone, Ignazio; La Spada, Michele

    2015-01-01

    Horseshoe kidney is a common urology anomaly, while its association with infrarenal abdominal aortic aneurysm represents a very rare condition. Surgical approach remains controversial however, we believe that the left retroperitoneal approach should be preferred in order to avoid isthmus resection with any subsequent renal infarction, urinary tract damage and to facilitate renal arteries reimplantation, when required.

  17. Intracranial aneurysms and subarachnoid hemorrhage: Clinical studies on diagnosis and treatment

    NARCIS (Netherlands)

    M. van der Jagt (Mathieu)

    2006-01-01

    textabstractComputerized tomography angiography (CTA) can be performed quicker, safer and cheaper than digital subtraction angiography (DSA) in patients after aneurysmal subarachnoid hemorrhage (SAH). However, DSA is still regarded as the gold standard in the diagnosis of intracranial ruptured aneur

  18. Direct costs of modern treatment of aneurysmal subarachnoid hemorrhage in the first year after diagnosis

    NARCIS (Netherlands)

    Roos, Y B W E M; Dijkgraaf, M G W; Albrecht, K W; Beenen, L F M; Groen, R J M; de Haan, R J; Vermeulen, M

    2002-01-01

    BACKGROUND AND PURPOSE: The purpose of this study was to investigate the current direct costs of modern management of patients with aneurysmal subarachnoid hemorrhage in the first year after diagnosis. METHODS: During a 1-year period, we studied all admitted patients with subarachnoid hemorrhage fro

  19. Changing Profiles of Diagnostic and Treatment Options in Subclavian Artery Aneurysms

    NARCIS (Netherlands)

    Vierhout, B. P.; Zeebregts, C. J.; van den Dungen, J. J. A. M.; Reijnen, M. M. P. J.

    2010-01-01

    Background: Subclavian artery aneurysms (SAAs) are rare and may cause life- and limb-threatening complications. Therapeutic options greatly differ as do access alternatives. The aim of the study was to assess its clinical presentation, diagnostics and therapeutic options as reported in the literatur

  20. Aneurysmal bone cyst: the role of cryosurgery as local adjuvant treatment.

    NARCIS (Netherlands)

    Peeters, S.P.; Geest, I.C.M. van der; Rooy, J.W.J. de; Veth, R.P.H.; Schreuder, H.W.B.

    2009-01-01

    BACKGROUND: Aneurysmal bone cysts (ABCs) are most often treated with intralesional surgery (curettage) and additional bone grafting. There is debate on whether or not to use adjuvant therapy to decrease the local recurrence rate. This study is done to assess the outcome of curettage and cryosurgery