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Cerebral Aneurysm

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5381. Retreatment of ruptured cerebral aneurysms in patients randomized by coiling or clipping in the International Subarachnoid Aneurysm Trial (ISAT). (PubMed)

Retreatment of ruptured cerebral aneurysms in patients randomized by coiling or clipping in the International Subarachnoid Aneurysm Trial (ISAT). Because the long-term security of endovascular treatments remains uncertain, a follow-up study of the patients treated in the International Subarachnoid Aneurysm Trial was performed to compare the frequency, timing, and consequences of aneurysm recurrence.Patient data were reclassified by actual treatment performed. Aneurysm and patient

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2007 Stroke Controlled trial quality: uncertain

5382. Cerebral hemorrhage produced by ruptured dissecting aneurysm in miliary aneurysm. (PubMed)

Cerebral hemorrhage produced by ruptured dissecting aneurysm in miliary aneurysm. This report describes, for what may be only the second time, a ruptured miliary aneurysm within a cerebral hemorrhage. The report is unique in that the aneurysm has arisen at the site of a dissection within the wall of an arteriole at a site of fibrinoid necrosis. The case not only is a unique illustration of this pathogenetic pathway to miliary aneurysm formation, but also reemphasizes the relationship between (...) fibrinoid and miliary aneurysm formation.

2003 Annals of Neurology

5383. Relation between aneurysm volume, packing, and compaction in 145 cerebral aneurysms treated with coils. (PubMed)

Relation between aneurysm volume, packing, and compaction in 145 cerebral aneurysms treated with coils. To assess the relation between aneurysm volume, packing, and compaction in cerebral aneurysms treated with coils.The volumes of 145 aneurysms that were treated with coils were calculated with biplanar angiographic images and a custom-designed method. Partially thrombosed aneurysms were excluded. Packing was defined as the ratio between the volume of the inserted coils and the volume (...) with volumes of less than 200 mm(3), compaction did not occur when packing was above 20%.The common practice of inserting as many coils as possible in cerebral aneurysms is sensible in trying to avoid compaction. In aneurysms with packing of 24% or more, no compaction occurred at 6-month angiographic follow-up. In aneurysms with a volume of more than 600 mm(3), high packing could not be achieved, which resulted in compaction in the majority of aneurysms.Copyright RSNA, 2004

2004 Radiology

5384. Simulation of the natural history of cerebral aneurysms based on data from the International Study of Unruptured Intracranial Aneurysms. (PubMed)

Simulation of the natural history of cerebral aneurysms based on data from the International Study of Unruptured Intracranial Aneurysms. Despite recent publications of large-scale study data, controversy over the management of unruptured cerebral aneurysms continues. The low rupture rates in the International Study of Unruptured Intracranial Aneurysms (ISUIA) apparently contradicted surgeons' experiences with ruptured aneurysms. In the present study, based on data from the ISUIA, a mathematical (...) model describing the natural history of cerebral aneurysms was developed. With this model, the author aimed to examine the validity of data from the ISUIA and to provide a better treatment guideline for unruptured aneurysms.The author made a computer simulation of the natural history of cerebral aneurysms that was used to calculate such figures as the prevalence of unruptured aneurysms, incidence of subarachnoid hemorrhage (SAH), and age and size distribution of both unruptured and ruptured

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2006 Journal of Neurosurgery

5385. Microsurgical removal of previously placed aneurysm clips and application of new clips for recurrent cerebral aneurysms. Technical note. (PubMed)

Microsurgical removal of previously placed aneurysm clips and application of new clips for recurrent cerebral aneurysms. Technical note. A technique is described for removing previously placed aneurysm clips and applying new aneurysm clips for the treatment of regrown or reruptured cerebral aneurysms in patients more than 10 years after the original clipping of the aneurysm neck. The adherent tissue covering previously placed clips is cut just on and alongside the clips themselves using a small (...) procedure for treatment of regrown or reruptured cerebral aneurysms occurring a significantly long time after initial clipping of an aneurysm neck.

2007 Journal of Neurosurgery

5386. Reliability of cobalt-chromium alloy aneurysm clips after long-term implantations in patients with cerebral aneurysms. (PubMed)

Reliability of cobalt-chromium alloy aneurysm clips after long-term implantations in patients with cerebral aneurysms. Aneurysm clip reliability after long-term implantation in vivo has not been examined. In this study the authors evaluated the mechanical properties and surface elemental composition of Co-Cr alloy aneurysm clips implanted for more than 10 years in patients with cerebral aneurysms.Five aneurysm clips implanted for ruptured or unruptured intracranial aneurysms were retrieved (...) and examined. New aneurysm clips were applied to the regrown aneurysms. The implantation period ranged from 11 to 20 years. Four new and unused aneurysm clips were also examined as controls. The mechanical properties of the clips were tested by measuring their closing force and bending strength. The surface elemental composition of the aneurysm clips was evaluated using x-ray photoelectron spectroscopy. The closing force of the retrieved clips exceeded the minimum force requirement at the time

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2006 Journal of Neurosurgery

5387. Bilobed Wide Neck Posterior Cerebral Artery Aneurysm Associated with Fusiform Basilar Aneurysm, Subarachnoid Hemorrhage and Chronic Renal Failure: A Case Report* (PubMed)

Bilobed Wide Neck Posterior Cerebral Artery Aneurysm Associated with Fusiform Basilar Aneurysm, Subarachnoid Hemorrhage and Chronic Renal Failure: A Case Report* A 56 year-old woman presented with a ruptured bilobed wide neck aneurysm of the P2 segment of the PCA, atherosclerotic fusiform basilar artery aneurysm, subarachnoid bleeding with negative CT scan and chronic renal failure. She was managed by a cooperative approach involving neurosurgeons, neuroradiologist, neurointensivist, emergency (...) room physicians, nurses and technicians. She underwent operation by proximal clipping for the aneurysm of the PCA. Postoperative neurological deficits include homonymous hemianopsia and ipsilateral third nerve palsy. The operation was performed through asubtemporal approach. At surgery, the aneurysm was located in the distal of the P2 segment of PCA, bilobed up and down, no definitive neck with small distal branches, and was treated by proximal clipping of the PCA aneurysm. The fusiform basilar

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2004 Interventional Neuroradiology

5388. Experimental cerebral aneurysms in the female heterozygous Blotchy mouse (PubMed)

Experimental cerebral aneurysms in the female heterozygous Blotchy mouse The Blotchy mouse is characterized by an X-linked inherited disorder of connective tissue synthesis. The susceptibility to aneurysm formation in the cerebral arteries of the circle of Willis was compared in female heterozygous 'Blotchy' and control mice subjected to unilateral carotid artery ligation either alone or associated with hypertension. Cerebral aneurysms developed only in hypertensive Blotchy mice (6/31 vs. 0/30 (...) in parallel to the occurrence of aneurysms in all the different arterial sites. Thus, in an apparently normally viable animal, the presence of a mutated gene which indirectly leads to defective elastin and collagen fibre synthesis, favours the formation of both peripheral and cerebral aneurysms. However, the development of cerebral aneurysms requires the addition of an increase in haemodynamic stress.

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1999 International journal of experimental pathology

5389. Transcranial Doppler versus angiography in patients with vasospasm due to a ruptured cerebral aneurysm: A systematic review. (PubMed)

Transcranial Doppler versus angiography in patients with vasospasm due to a ruptured cerebral aneurysm: A systematic review. Transcranial Doppler (TCD) is used for diagnosis of vasospasm in patients with subarachnoid hemorrhage due to a ruptured aneurysm. Our aim was to evaluate both the accuracy of TCD compared with angiography and its usefulness as a screening method in this setting.A search (MEDLINE, EMBASE, Cochrane Library, bibliographies, hand searching, any language, through January 31 (...) , 2001) was performed for studies comparing TCD with angiography. Data were critically appraised using a modified published 10-point score and were combined using a random-effects model.Twenty-six reports compared TCD with angiography. Median validity score was 4.5 (range 1 to 8). Meta-analyses could be performed with data from 7 trials. For the middle cerebral artery (5 trials, 317 tests), sensitivity was 67% (95% CI 48% to 87%), specificity was 99% (98% to 100%), positive predictive value (PPV

2001 Stroke

5390. Linear and whorled nevoid hypermelanosis with bilateral giant cerebral aneurysms. (PubMed)

Linear and whorled nevoid hypermelanosis with bilateral giant cerebral aneurysms. A 24-year-old woman presented with bilateral giant intracavernous carotid artery aneurysms manifesting as a cavernous sinus syndrome on the left side, and anisocoria, ophthalmic pain, and oculomotor paresis on the left side. Physical examination showed mild hyperextensibility of the metacarpophalangeal joints, amelogenesis imperfecta, and hyperpigmentation following Blaschko lines. Analysis of the NEMO gene (...) for incontinentia pigmenti syndrome and of collagen III for Ehlers-Danlos type IV was normal. Skewed X-inactivation patterns in blood lymphocytes were detected. To the best of our knowledge, this association of linear hyperpigmentation and cerebral aneurysms has never been previously reported.Copyright 2002 Wiley-Liss, Inc.

2002 American Journal of Medical Genetics

5391. Prevalence of cerebral aneurysms in patients with fibromuscular dysplasia: a reassessment. (PubMed)

Prevalence of cerebral aneurysms in patients with fibromuscular dysplasia: a reassessment. The aim of this study was to determine the prevalence of cerebral saccular aneurysms in patients with carotid artery and/or vertebral artery (VA) fibromuscular dysplasia (FMD).A metaanalysis was performed using data from 17 previously reported series of patients with internal carotid artery (ICA) and/or VA FMD that included information on the prevalence of cerebral aneurysms. In addition, the authors (...) retrospectively evaluated their own series of 117 patients with ICA and/or VA FMD to determine the prevalence of cerebral aneurysms. The metaanalysis of the 17 earlier series, which included 498 patients, showed a 7.6 +/- 2.5% prevalence of incidental, asymptomatic aneurysms in patients with ICA and/or VA FMD. In the authors' series of patients with FMD, 6.3 +/- 4.9% of patients harbored an incidental, asymptomatic aneurysm. When the authors' series was combined with those included in the metaanalysis

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1998 Journal of neurosurgery

5392. Cerebral aneurysm perforations complicating therapy with Guglielmi detachable coils: a meta-analysis. (PubMed)

Cerebral aneurysm perforations complicating therapy with Guglielmi detachable coils: a meta-analysis. The risk of intraprocedural aneurysm perforation in patients with previously ruptured aneurysms tends to be higher than that of patients with previously unruptured aneurysms, but a statistically significant difference has not been shown. Our purpose was to define the rates of occurrence and of morbidity and mortality associated with aneurysmal perforation associated with coil embolization.A (...) meta-analysis of the results from 17 published retrospective reports of aneurysm perforations complicating therapy with Guglielmi detachable coils (GDCs) was performed. Rates of perforation and associated morbidity and mortality in previously ruptured and unruptured aneurysms were calculated. The mechanism of perforation was noted.The risk of intraprocedural perforation was significantly higher in patients with ruptured aneurysms compared with patients with unruptured aneurysms (4.1% vs 0.5%; P

2002 AJNR. American journal of neuroradiology

5393. Obtunding the sympathetic response to intubation. Experience at 2 minutes after administration of the test agent in patients with cerebral aneurysms. (PubMed)

Obtunding the sympathetic response to intubation. Experience at 2 minutes after administration of the test agent in patients with cerebral aneurysms. The sympathetic response to laryngoscopy and intubation was studied in 39 patients who were to undergo surgical clipping of a cerebral aneurysm. Intravascular radial artery pressure and ECG monitoring for ST-segment changes or dysrhythmias were used. Ward blood pressures were controlled on bed rest and labetalol. Induction of anaesthesia

1988 South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde Controlled trial quality: uncertain

5394. Therapeutic trial of intravenous nimodipine in patients with established cerebral vasospasm after rupture of intracranial aneurysms. (PubMed)

Therapeutic trial of intravenous nimodipine in patients with established cerebral vasospasm after rupture of intracranial aneurysms. The therapeutic efficacy of intravenous nimodipine to treat the syndrome of delayed ischemic deterioration or vasospasm after subarachnoid hemorrhage caused by a ruptured aneurysm was investigated in a randomized, double-blind, placebo-controlled multicenter study. A total of 188 patients (nimodipine (N) = 102, placebo (P) = 86) were enrolled in the study, both

1988 Neurosurgery Controlled trial quality: predicted high

5395. [Intravenous nimodipine in the treatment of cerebral vasospasm following subarachnoid hemorrhage caused by aneurysm rupture: a comparative multicenter study]. (PubMed)

[Intravenous nimodipine in the treatment of cerebral vasospasm following subarachnoid hemorrhage caused by aneurysm rupture: a comparative multicenter study]. The efficacy of intravenous Nimodipine (used at the rate of 2 mg.h-1) was investigated in the treatment of delayed ischemic deterioration or angiographic vasospasm after subarachnoid haemorrhage caused by a ruptured aneurysm in a randomized, double-blind, placebo-controlled multicenter study. A total of 127 case reports was validated: 73 (...) in group Nimodipine. The results of this study demonstrate the efficacy of intravenous Nimodipine in the treatment of consequences of cerebral vasospasm after a subarachnoid haemorrhage caused by a ruptured aneurysm.

1989 Agressologie: revue internationale de physio-biologie et de pharmacologie appliquées aux effets de l'agression Controlled trial quality: uncertain

5396. Long-term effects of nimodipine on cerebral infarcts and outcome after aneurysmal subarachnoid hemorrhage and surgery. (PubMed)

Long-term effects of nimodipine on cerebral infarcts and outcome after aneurysmal subarachnoid hemorrhage and surgery. A total of 213 patients with verified aneurysmal subarachnoid hemorrhage (SAH) of Grades I to III (Hunt and Hess classification) were enrolled in a double-blind placebo-controlled trial to determine the effect of intravenous nimodipine on delayed ischemic deterioration and computerized tomography (CT)-visualized infarcts after SAH and surgery. The administration of the drug (...) or matching placebo was started immediately after the radiological diagnosis of a ruptured aneurysm had been made. Of the 213 patients enrolled in the study, 58 were operated on early (within 72 hours after the bleed: Days 0 to 3), 69 were operated on subacutely (between Days 4 and 7), and 74 had late surgery (on Day 8 or later). Eleven patients died before surgery was undertaken and one was not operated on. A follow-up examination with CT scanning, performed 1 to 3 years after the SAH (mean 1.4 years

1991 Journal of neurosurgery Controlled trial quality: predicted high

5397. Effect of AT877 on cerebral vasospasm after aneurysmal subarachnoid hemorrhage. Results of a prospective placebo-controlled double-blind trial. (PubMed)

Effect of AT877 on cerebral vasospasm after aneurysmal subarachnoid hemorrhage. Results of a prospective placebo-controlled double-blind trial. With the cooperation of 60 neurosurgical centers in Japan, a prospective randomized placebo-controlled double-blind trial of a new calcium antagonist AT877 (hexahydro-1-(5-isoquinolinesulfonyl)-1H-1,4-diazepine hydrochloride, or fasudil hydrochloride) was undertaken to determine the drug's effect on delayed cerebral vasospasm in patients with a ruptured (...) cerebral aneurysm. A total of 276 patients, who underwent surgery within 3 days after subarachnoid hemorrhage (SAH) of Hunt and Hess Grades I to IV, were entered into the study. Nine patients were excluded because of protocol violation. The remaining 267 patients received either 30 mg AT877 or a placebo (saline) by intravenous injection over 30 minutes, three times a day for 14 days following surgery. Demographic and clinical data were well matched between the two groups. It was found that AT877

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1992 Journal of neurosurgery Controlled trial quality: predicted high

5398. A phase II clinical trial of recombinant human tissue-type plasminogen activator against cerebral vasospasm after aneurysmal subarachnoid hemorrhage. (PubMed)

A phase II clinical trial of recombinant human tissue-type plasminogen activator against cerebral vasospasm after aneurysmal subarachnoid hemorrhage. The results of a Phase II clinical trial of intrathecal recombinant tissue-type plasminogen activator for the prevention of vasospasm were reported. The subjects were 53 patients with aneurysmal subarachnoid hemorrhage (SAH), Groups 2 to 4 in Fisher's preoperative computed tomography classification and Grades II to IV in the Hunt-Kosnik

1994 Neurosurgery Controlled trial quality: uncertain

5399. Angles between A1 and A2 segments of the anterior cerebral artery visualized by three-dimensional computed tomographic angiography and association of anterior communicating artery aneurysms. (PubMed)

Angles between A1 and A2 segments of the anterior cerebral artery visualized by three-dimensional computed tomographic angiography and association of anterior communicating artery aneurysms. The angle of arteries at bifurcations, as well as the blood flow, are factors of hemodynamic stress on the apical region, where aneurysms often develop. Using images obtained with three-dimensional computed tomographic angiography, we sought to determine the angles between the A1 and A2 segments (...) of the anterior cerebral artery of the anterior communicating artery (ACoA) complex associated with aneurysms. These angles cannot be detected by conventional cerebral angiography.The course of the anterior cerebral artery was studied using three-dimensional computed tomographic angiography in 42 consecutive patients with ACoA aneurysms. Twenty-one other subjects, randomly chosen from patients without aneurysms, served as controls. Bilateral A1-A2 angles of the contrast-opacified anterior cerebral artery were

1999 Neurosurgery Controlled trial quality: uncertain

5400. Efficacy of transluminal angioplasty for the management of symptomatic cerebral vasospasm following aneurysmal subarachnoid hemorrhage. (PubMed)

Efficacy of transluminal angioplasty for the management of symptomatic cerebral vasospasm following aneurysmal subarachnoid hemorrhage. Transluminal angioplasty has become a widely used adjunct therapy to medical management of symptomatic cerebral vasospasm following subarachnoid hemorrhage (SAH). Despite anecdotal reports of universal, angiographically confirmed reversal of vasospasm and high rates of clinical improvement, no rigorous examination of the efficacy of this procedure has been (...) conducted. In this study the authors assess the efficacy of the aforementioned procedure.Thirty-eight patients enrolled as part of the North American trial of tirilazad in aneurysmal SAH underwent transluminal angioplasty for symptomatic cerebral vasospasm. Fifty-three percent of these patients showed good recovery or moderate disability based on their 3-month Glasgow Outcome Scale score. Among the 38 patients who underwent angioplasty, the severity and type of vasospasm, use of papaverine in addition

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2000 Journal of neurosurgery Controlled trial quality: uncertain

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