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Cerebral Aneurysm

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1. Cerebral aneurysm

Cerebral aneurysm Cerebral aneurysm - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Cerebral aneurysm Last reviewed: February 2019 Last updated: April 2018 Summary Typically asymptomatic until ruptured, resulting in a subarachnoid haemorrhage. Head CT usually confirms the diagnosis of subarachnoid haemorrhage, but lumbar puncture is indicated if the CT is negative and suspicion persists. Cerebral angiogram (...) is the definitive investigation. CT angiography or magnetic resonance angiography may also be used. Definitive treatment aims to obliterate the aneurysm from the cerebral circulation. Options include endovascular coiling or open surgical clipping. Screening with non-invasive neuroangiography is recommended for at-risk populations. Definition A cerebral aneurysm is a focal abnormal dilation of the wall of an artery in the brain. Intra-cranial aneurysms are most commonly located at branching points of the major

2018 BMJ Best Practice

2. Impact of aneurysm shape and neck configuration on cerebral infarction during microsurgical clipping of intracranial aneurysms. (PubMed)

Impact of aneurysm shape and neck configuration on cerebral infarction during microsurgical clipping of intracranial aneurysms. OBJECTIVECerebral infarction is a significant cause of morbidity and mortality related to microsurgical clipping of intracranial aneurysms. The objective of this study was to determine the impact of aneurysm shape and neck configuration on cerebral infarction after aneurysm surgery.METHODSThe authors retrospectively reviewed consecutive cases of ruptured and unruptured (...) aneurysms treated with microsurgical clipping at their institution between 2010 and 2018. Three-dimensional reconstructions from preoperative computed tomography and digital subtraction angiography were used to determine aneurysm shape (regular/complex) and neck configuration (regular/irregular). Morphological and procedure-related risk factors for cerebral infarction were identified using univariate and multivariate statistical analyses.RESULTSAmong 243 patients with 252 aneurysms (148 ruptured, 104

2019 Journal of Neurosurgery

3. Effects of propofol versus sevoflurane on cerebral circulation time in patients undergoing coiling for cerebral artery aneurysm: a prospective randomized crossover study. (PubMed)

Effects of propofol versus sevoflurane on cerebral circulation time in patients undergoing coiling for cerebral artery aneurysm: a prospective randomized crossover study. Many neuroendovascular treatments are supported by real-time anatomical and visual hemodynamic assessments through digital subtraction angiography (DSA). Here we used DSA in a single-center prospective randomized crossover study to assess the intracranial hemodynamics of patients undergoing coiling for cerebral aneurysm (n (...)  = 15) during sevoflurane- and propofol-based anesthesia. Color-coded DSA was used to define time to peak density of contrast medium (TTP) at several intravascular regions of interest (ROIs). Travel time at a particular ROI was defined as the TTP at the selected ROI minus TTP at baseline position on the internal carotid artery (ICA). Travel time at the jugular bulb on the anterior-posterior view was defined as the cerebral circulation time (CCT), which was divided into four segmental circulation

2019 Journal of clinical monitoring and computing Controlled trial quality: uncertain

4. Relationship between middle cerebral parent artery asymmetry and middle cerebral artery aneurysm rupture risk factors. (PubMed)

Relationship between middle cerebral parent artery asymmetry and middle cerebral artery aneurysm rupture risk factors. OBJECTIVE The exact pathophysiological mechanisms underlying cerebral aneurysm formation remain unclear. Asymmetrical local vascular geometry may play a role in aneurysm formation and progression. The object of this study was to investigate the association between the geometric asymmetry of the middle cerebral artery (MCA) and the presence of MCA aneurysms and associated high (...) -risk features. METHODS Using a retrospective case-control study design, the authors examined MCA anatomy in all patients who had been diagnosed with an MCA aneurysm in the period from 2008 to 2017 at the University Hospitals Cleveland Medical Center. Geometric features of the MCA ipsilateral to MCA aneurysms were compared with those of the unaffected contralateral side (secondary control group). Then, MCA geometry was compared between patients with MCA aneurysms and patients who had undergone CTA

2019 Journal of Neurosurgery

5. Effect of remote ischemic preconditioning on cerebral vasospasm and biomarkers of cerebral ischemia in aneurysmal subarachnoid hemorrhage (ERVAS): A protocol for a randomized, controlled pilot trial. (PubMed)

Effect of remote ischemic preconditioning on cerebral vasospasm and biomarkers of cerebral ischemia in aneurysmal subarachnoid hemorrhage (ERVAS): A protocol for a randomized, controlled pilot trial. Cerebral vasospasm is a dreaded complication of aneurysmal subarachnoid hemorrhage (aSAH) predisposing to delayed cerebral ischemia. We intend to study the cerebroprotective effects of remote ischemic preconditioning (RIPC) in patients with aSAH.This is a single-center, prospective, parallel group (...) primary outcome measure is vasospasm on cerebral angiography and transcranial Doppler study, and concentration of serum S100B and neuron-specific enolase at 24 h after RIPC and on day 7 of ictus. Our secondary outcomes are safety of RIPC, cerebral oxygen saturation, and Glasgow coma score, and extended Glasgow outcome scale scores at discharge and at 1, 3, and 6 months following discharge. Outcome measures will be assessed by an observer blinded to the study intervention.If our preliminary results

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2019 Brain Circulation Controlled trial quality: predicted high

6. Procedural complexity independent of P2Y12 reaction unit (PRU) values is associated with acute in situ thrombosis in Pipeline flow diversion of cerebral aneurysms (PubMed)

Procedural complexity independent of P2Y12 reaction unit (PRU) values is associated with acute in situ thrombosis in Pipeline flow diversion of cerebral aneurysms Acute in situ thrombosis is an ischaemic phenomenon during Pipeline embolisation device (PED) procedures with potentially high morbidity and mortality. There is controversy regarding the role of platelet function testing with P2Y12 assay as a predictor of intraprocedural thromboembolic events. There is limited knowledge on whether (...) procedural complexity influences these events.Data were collected retrospectively on 742 consecutive PED cases at a single institution. Patients with intraprocedural acute thrombosis were compared with patients without these events.A cohort of 37 PED cases with acute in situ thrombosis (mean age 53.8 years, mean aneurysm size 8.4 mm) was matched with a cohort of 705 PED cases without intraprocedural thromboembolic events (mean age 56.4 years, mean aneurysm size 6.9 mm). All patients with in situ

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2018 Stroke and vascular neurology

7. Long-term results of middle cerebral artery aneurysm clipping in the Barrow Ruptured Aneurysm Trial. (PubMed)

Long-term results of middle cerebral artery aneurysm clipping in the Barrow Ruptured Aneurysm Trial. In BriefMicrosurgical clipping has withstood the test of time as a safe, effective, and durable treatment for ruptured middle cerebral artery (MCA) aneurysms. With continued advances in endovascular techniques, reports of endovascular treatment of ruptured MCA aneurysms are increasing. The authors report detailed outcomes of microsurgical clipping of MCA aneurysms from the Barrow Ruptured (...) Aneurysm Trial. These results should serve as a benchmark for future studies examining endovascular management of these patients.

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2018 Journal of Neurosurgery Controlled trial quality: uncertain

8. Phase-contrast MRI versus numerical simulation to quantify hemodynamical changes in cerebral aneurysms after flow diverter treatment. (PubMed)

Phase-contrast MRI versus numerical simulation to quantify hemodynamical changes in cerebral aneurysms after flow diverter treatment. Cerebral aneurysms are a major risk factor for intracranial bleeding with devastating consequences for the patient. One recently established treatment is the implantation of flow-diverters (FD). Methods to predict their treatment success before or directly after implantation are not well investigated yet. The aim of this work was to quantitatively study (...) hemodynamic parameters in patient-specific models of treated cerebral aneurysms and its correlation with the clinical outcome. Hemodynamics were evaluated using both computational fluid dynamics (CFD) and phase contrast (PC) MRI. CFD simulations and in vitro MRI measurements were done under similar flow conditions and results of both methods were comparatively analyzed. For preoperative and postoperative distribution of hemodynamic parameters, CFD simulations and PC-MRI velocity measurements showed

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2018 PLoS ONE

9. Cerebral Autoregulation in the Prediction of Delayed Cerebral Ischemia and Clinical Outcome in Poor-Grade Aneurysmal Subarachnoid Hemorrhage Patients. (PubMed)

Cerebral Autoregulation in the Prediction of Delayed Cerebral Ischemia and Clinical Outcome in Poor-Grade Aneurysmal Subarachnoid Hemorrhage Patients. Pressure reactivity index and oxygen reactivity index are used to assess cerebral autoregulation after acute brain injury. The value of autoregulation indices in the prediction of delayed cerebral ischemia and outcome in patients with subarachnoid hemorrhage is still inconclusive. In this study, we aimed to focus on the predictive value (...) reactivity index and oxygen reactivity index were evaluated as moving correlation coefficient between mean arterial pressure/intracranial pressure and cerebral perfusion pressure/brain tissue oxygen tension, respectively.Median autoregulation monitoring time was 188 ± 91 hours per patient. Initial pressure reactivity index was 0.31 ± 0.02 and decreased significantly to 0.01 ± 0.01 (p < 0.001) 3 days after admission with a second peak 10 days after admission (0.18 ± 0.14; p = 0.001). Admission oxygen

2018 Critical Care Medicine

10. Complex endovascular aneurysm repair in patients with juxta-renal or thoraco-abdominal aortic aneurysm

. 10 The flow to the side branches is preserved through fenestrations in the stent-graft fabric. B-EVAR is a technique which uses branched stent grafts for aneurysms that involve vital aortic side branches such as supra-renal and Type 4 thoraco-abdominal aneurysms or even the pre-cerebral vessels (aortic arch aneurysm). 10 Unlike the fenestrated grafts, which have only pre-made windows for the visceral and renal artery origins, branched grafts have branches already attached to the body of the 78 7 (...) Complex endovascular aneurysm repair in patients with juxta-renal or thoraco-abdominal aortic aneurysm 78 1 Health technology description Key points ? A single prospective observational study compared 30-day outcomes of fenestrated/branched endovascular aneurysm repair (F/B-EVAR) with open surgery repair (OSR) for the treatment of complex aortic aneurysm anatomies: para/juxta-renal aortic aneurysm (PRAA/JRAA) and thoraco-abdominal aortic aneurysm (TAAA). There was no statistically significant

2018 Evidence Notes from Healthcare Improvement Scotland

11. De novo giant posterior cerebral artery aneurysm developing 25 years after basilar bifurcation aneurysm treatment using a Drake tourniquet: case report and implications for aneurysm follow-up. (PubMed)

De novo giant posterior cerebral artery aneurysm developing 25 years after basilar bifurcation aneurysm treatment using a Drake tourniquet: case report and implications for aneurysm follow-up. The objective of this paper was to report a rare complication of basilar artery (BA) tourniquet treatment of a giant basilar tip aneurysm, and to discuss possible causes for the formation of a de novo giant posterior cerebral artery (PCA) aneurysm. A 34-year-old woman underwent satisfactory treatment (...) of a ruptured giant basilar bifurcation aneurysm by BA ligation (Drake tourniquet) in 1985. She presented 25 years later with a new aneurysm in the left PCA, successfully treated by coil embolization. To the authors' knowledge, this is the first case of de novo aneurysm formation on a PCA, and the first de novo aneurysm reported as a complication of BA ligation therapy by Drake tourniquet. Long-term follow-up is necessary in patients with treated cerebral aneurysms, particularly those occurring in young

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2017 Journal of Neurosurgery

12. Computational fluid dynamics (CFD) using porous media modeling predicts recurrence after coiling of cerebral aneurysms. (PubMed)

Computational fluid dynamics (CFD) using porous media modeling predicts recurrence after coiling of cerebral aneurysms. This study aimed to predict recurrence after coil embolization of unruptured cerebral aneurysms with computational fluid dynamics (CFD) using porous media modeling (porous media CFD).A total of 37 unruptured cerebral aneurysms treated with coiling were analyzed using follow-up angiograms, simulated CFD prior to coiling (control CFD), and porous media CFD. Coiled aneurysms were (...) classified into stable or recurrence groups according to follow-up angiogram findings. Morphological parameters, coil packing density, and hemodynamic variables were evaluated for their correlations with aneurysmal recurrence. We also calculated residual flow volumes (RFVs), a novel hemodynamic parameter used to quantify the residual aneurysm volume after simulated coiling, which has a mean fluid domain > 1.0 cm/s.Follow-up angiograms showed 24 aneurysms in the stable group and 13 in the recurrence group

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2017 PLoS ONE

13. Does prior subarachnoid haemorrhage increase the risk of rupture of small unruptured cerebral aneurysms?

Does prior subarachnoid haemorrhage increase the risk of rupture of small unruptured cerebral aneurysms? Print | PDF PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. CRD bears no responsibility or liability for the content of this registration record, any associated files or external websites. Email salutation (e.g. "Dr Smith" or "Joanne") for correspondence: Organisation web

2019 PROSPERO

14. Comparative effectiveness of prophylactic therapies for cerebral vasospasm secondary to aneurysmal subarachnoid hemorrhage: a network meta-analysis of randomized trials

Comparative effectiveness of prophylactic therapies for cerebral vasospasm secondary to aneurysmal subarachnoid hemorrhage: a network meta-analysis of randomized trials Print | PDF PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. The registrant confirms that the information supplied for this submission is accurate and complete. CRD bears no responsibility or liability

2019 PROSPERO

15. Adenosine to facilitate the clipping of cerebral aneurysms: literature review (PubMed)

Adenosine to facilitate the clipping of cerebral aneurysms: literature review Cerebral aneurysms have a high mortality rate when ruptured. Endovascular techniques have improved substantially in treating this pathology. However, surgical clip ligation remains the preferred option for some aneurysms. Various techniques are used intraoperatively to assist the surgeon in dissecting the aneurysmal dome free of surrounding tissue and placing a clip around the neck safely and effectively so

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2017 Stroke and vascular neurology

16. A systematic review of intraoperative complications of cerebral aneurysm surgery

A systematic review of intraoperative complications of cerebral aneurysm surgery Print | PDF PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. The registrant confirms that the information supplied for this submission is accurate and complete. CRD bears no responsibility or liability for the content of this registration record, any associated files or external websites. Email

2019 PROSPERO

17. Intraoperative evoked potential monitoring for detecting cerebral injury during adult aneurysm clipping surgery: a systematic review and meta-analysis of diagnostic test accuracy. (PubMed)

Intraoperative evoked potential monitoring for detecting cerebral injury during adult aneurysm clipping surgery: a systematic review and meta-analysis of diagnostic test accuracy. We aim to evaluate the diagnostic test accuracy (DTA) of intraoperative evoked potential (EP) monitoring to detect cerebral injury during clipping of cerebral aneurysms.Systematic review.Major electronic databases including MEDLINE, EMBASE, LILACS.We included studies that reported the DTA of intraoperative EP (...) for sensitivity and specificity for SSEP was 50%-63% and 81%-100%, and for MEP was 59%-74% and 93%-100%, and for combined SSEP and MEP was 89%-94% and 83%-100%.Due to the modest quality and high heterogeneity of the existing primary studies, it is not possible to confidently support or refute the diagnostic value of EP monitoring in cerebral aneurysm clipping surgery. However, combined SSEP and MEP appears to provide the best DTA for predicting postoperative stroke. Contrary to popular assertion, the modest

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2019 BMJ open

18. Rupture risk of small unruptured cerebral aneurysms. (PubMed)

Rupture risk of small unruptured cerebral aneurysms. OBJECTIVEThe annual rupture rate of small (3-4 mm) unruptured cerebral aneurysms (UCAs) is 0.36% per year, however, the proportion of small ruptured aneurysms < 5 mm is 35%. This discrepancy is explained by the hypothesis that most acute subarachnoid hemorrhage (SAH) is from recently formed, unscreened aneurysms, but this hypothesis is without definitive proof. The authors aimed to clarify the actual number of screened, ruptured small (...) aneurysms and risk factors for rupture.METHODSThe Unruptured Cerebral Aneurysm Study Japan, a project of the Japan Neurosurgical Society, was designed to clarify the natural course of UCAs. From January 2001 through March 2004, 6697 UCAs among 5720 patients were prospectively registered. At registration, 2839 patients (49.6%) had 3132 (46.8%) small UCAs of 3-4 mm. The registered, treated, and rupture numbers of these small aneurysms and the annual rupture rate were investigated. The rate was assessed

2019 Journal of Neurosurgery

19. The impact of statin therapy after surgical or endovascular treatment of cerebral aneurysms. (PubMed)

The impact of statin therapy after surgical or endovascular treatment of cerebral aneurysms. OBJECTIVECerebral aneurysms represent the most common cause of spontaneous subarachnoid hemorrhage. Statins are lipid-lowering agents that may expert multiple pleiotropic vascular protective effects. The authors hypothesized that statin therapy after coil embolization or surgical clipping of cerebral aneurysms might improve clinical outcomes.METHODSThis was a retrospective cohort study using (...) the National Health Insurance Service-National Sample Cohort Database in Korea. Patients who underwent coil embolization or surgical clipping for cerebral aneurysm between 2002 and 2013 were included. Based on prescription claims, the authors calculated the proportion of days covered (PDC) by statins during follow-up as a marker of statin therapy. The primary outcome was a composite of the development of stroke, myocardial infarction, and all-cause death. Multivariate time-dependent Cox regression analyses

2019 Journal of Neurosurgery

20. A comparison of effects of scalp nerve block and local anesthetic infiltration on inflammatory response, hemodynamic response, and postoperative pain in patients undergoing craniotomy for cerebral aneurysms: a randomized controlled trial. (PubMed)

A comparison of effects of scalp nerve block and local anesthetic infiltration on inflammatory response, hemodynamic response, and postoperative pain in patients undergoing craniotomy for cerebral aneurysms: a randomized controlled trial. The purpose of this study was to compare the effects of scalp nerve block (SNB) and local anesthetic infiltration (LA) with 0.75% ropivacaine on postoperative inflammatory response, intraoperative hemodynamic response, and postoperative pain control (...) in patients undergoing craniotomy.Fifty-seven patients were admitted for elective craniotomy for surgical clipping of a cerebral aneurysm. They were randomly divided into three groups: Group S (SNB with 15 mL of 0.75% ropivacaine), group I (LA with 15 mL of 0.75% ropivacaine) and group C (that only received routine intravenous analgesia). Pro-inflammatory cytokine levels in plasma for 72 h postoperatively, hemodynamic response to skin incision, and postoperative pain intensity were measured.The SNB

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2019 BMC Anesthesiology Controlled trial quality: uncertain

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