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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. (Abstract)

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. 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. Full Text available with Trip Pro

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

2019 Brain Circulation Controlled trial quality: predicted high

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

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

5. Relationship between middle cerebral parent artery asymmetry and middle cerebral artery aneurysm rupture risk factors. (Abstract)

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

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

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

2018 Stroke and vascular neurology

7. Long-term results of middle cerebral artery aneurysm clipping in the Barrow Ruptured Aneurysm Trial. Full Text available with Trip Pro

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.

2018 Journal of Neurosurgery Controlled trial quality: uncertain

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

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

9. 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

10. 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. Full Text available with Trip Pro

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

2017 Journal of Neurosurgery

11. Adenosine to facilitate the clipping of cerebral aneurysms: literature review Full Text available with Trip Pro

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

2017 Stroke and vascular neurology

12. 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

13. 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

14. Hemodynamic characteristics of hyperplastic remodeling lesions in cerebral aneurysms. Full Text available with Trip Pro

Hemodynamic characteristics of hyperplastic remodeling lesions in cerebral aneurysms. Hyperplastic remodeling (HR) lesions are sometimes found on cerebral aneurysm walls. Atherosclerosis is the results of HR, which may cause an adverse effect on surgical treatment for cerebral aneurysms. Previous studies have demonstrated that atherosclerotic changes had a correlation with certain hemodynamic characteristics. Therefore, we investigated local hemodynamic characteristics of HR lesions of cerebral (...) aneurysms using computational fluid dynamics (CFD).Twenty-four cerebral aneurysms were investigated using CFD and intraoperative video recordings. HR lesions and red walls were confirmed on the intraoperative images, and the qualification points were determined on the center of the HR lesions and the red walls. The qualification points were set on the virtual operative images for evaluation of wall shear stress (WSS), normalized WSS (NWSS), oscillatory shear index (OSI), relative residence time (RRT

2018 PLoS ONE

15. Phase-contrast MRI versus numerical simulation to quantify hemodynamical changes in cerebral aneurysms after flow diverter treatment. Full Text available with Trip Pro

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

2018 PLoS ONE

16. Impact of the serum albumin level on acute kidney injury after cerebral artery aneurysm clipping. Full Text available with Trip Pro

Impact of the serum albumin level on acute kidney injury after cerebral artery aneurysm clipping. Although hypoalbuminemia is a known risk factor for acute kidney injury (AKI) following surgery, little is known about its effects following aneurysm clipping surgery. We aimed to investigate the predictors of AKI and overall mortality and assessed the relationship between preoperative albumin and postoperative outcomes after aneurysm clipping surgery.This study included 2,339 patients who (...) underwent aneurysm clipping surgery. According to the criteria updated by the Kidney Disease: Improving Global Outcomes (KDIGO), patients were classified into AKI and no AKI group. Independent AKI predictors were analyzed by multivariate methods, and the influence of AKI on the outcome variables was assessed with by propensity score matching analysis. Survival in relation to AKI was analyzed using the Kaplan-Meier method.The total proportion of patients who developed AKI was 1.9%. The cutoff value

2018 PLoS ONE

17. 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

18. Assessment of lipoprotein-associated phospholipase A2 level and its changes in the early stages as predictors of delayed cerebral ischemia in patients with aneurysmal subarachnoid hemorrhage. (Abstract)

Assessment of lipoprotein-associated phospholipase A2 level and its changes in the early stages as predictors of delayed cerebral ischemia in patients with aneurysmal subarachnoid hemorrhage. OBJECTIVEThe relationship between lipoprotein-associated phospholipase A2 (Lp-PLA2) and various cardiovascular and cerebrovascular diseases is inconsistent. However, the connection between Lp-PLA2 level and delayed cerebral ischemia (DCI) following aneurysmal subarachnoid hemorrhage (aSAH) remains unclear

2019 Journal of Neurosurgery

19. Rupture risk of small unruptured cerebral aneurysms. (Abstract)

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

20. Intraoperative evoked potential monitoring for detecting cerebral injury during adult aneurysm clipping surgery: a systematic review and meta-analysis of diagnostic test accuracy. Full Text available with Trip Pro

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

2019 BMJ open

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