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Cerebral Aneurysm

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81. Vessel Wall Imaging of Evolving Unruptured Intracranial Aneurysms. (Abstract)

Vessel Wall Imaging of Evolving Unruptured Intracranial Aneurysms. Background and Purpose- Unruptured intracranial aneurysms (UIAs) have various scenarios of growth and rupture. Magnetic resonance vessel wall imaging can detect aneurysmal wall thickening with inflammation and neovascularization. This study was performed to explore the vessel wall imaging findings of UIAs with consecutive follow-up. Methods- A total of 60 aneurysms with serial angiography over 2 years (mean period, 49 months (...) , range, 24-192 months) were evaluated by vessel wall imaging. UIAs were morphologically categorized into 3 patterns: stable, whole sac expansion, or daughter sac formation. Aneurysm wall enhancement (AWE) was evaluated after administration of gadolinium. Results- Thirty-three of the 60 UIAs (55%) demonstrated no morphological changes, whereas 16 UIAS (27%) showed whole sac expansion and 11 UIAs (18%) demonstrated daughter sac formation. AWE was significantly less frequent in stable UIAs compared

2019 Stroke

82. FRED Italian Registry: a multicenter experience with the flow re-direction endoluminal device for intracranial aneurysms. (Abstract)

FRED Italian Registry: a multicenter experience with the flow re-direction endoluminal device for intracranial aneurysms. OBJECTIVEThe introduction of flow-diverter devices (FDDs) has revolutionized the endovascular treatment of intracranial aneurysms. Here the authors present their Italian multicenter experience using the flow re-direction endoluminal device (FRED) in the treatment of cerebral aneurysms, evaluating both short- and long-term safety and efficacy of this device.METHODSBetween (...) February 2013 and December 2014, 169 consecutive aneurysms treated using FRED in 166 patients were entered into this study across 30 Italian centers. Data collected included patient demographics, aneurysm location and characteristics, baseline angiography, adverse event and serious adverse event information, morbidity and mortality rates, and pre- and posttreatment modified Rankin Scale scores, as well as angiographic and cross-sectional CT/MRI follow-up at 3-6 months and/or 12-24 months per

2019 Journal of Neurosurgery

83. Characteristics of Intracranial Aneurysms According to Levels of Coronary Artery Calcium. Full Text available with Trip Pro

Characteristics of Intracranial Aneurysms According to Levels of Coronary Artery Calcium. Background and Purpose- Several vascular risk factors are known to be associated with the occurrence of intracranial aneurysms (IAs). Coronary artery calcium (CAC), which reflects the atherosclerotic burden of the coronary arteries, is a known predictor of cardiovascular events and stroke. We investigated the relationship between IA and CAC. Methods- We retrospectively enrolled Korean subjects at a single (...) university hospital who had both brain magnetic resonance angiography and cardiac computed tomography as part of health examinations from January 2010 to July 2017. Subjects were categorized into 4 groups according to CAC score as assessed by cardiac computed tomography: zero (0), low (1-99), intermediate (100-399), or high (≥400). Then, the prevalence of IA in each CAC score group was assessed. We also performed subgroup analysis by age, sex, and location of IA. Results- A total of 4934 subjects (mean

2019 Stroke

84. 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. Full Text available with Trip Pro

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

2019 BMC Anesthesiology Controlled trial quality: uncertain

85. Intracranial aneurysms formation after radiotherapy for head and neck cancer: a 10-year nationwide follow-up study. Full Text available with Trip Pro

the following ICD9 codes: nonruptured cerebral aneurysm (ICD9:4373), aneurysm clipping (ICD9:3951). Patients who did not receive curative treatment and those with intracranial aneurysms before the diagnosis of head and neck cancer were excluded.In total, 70,691 patients were included in the final analysis; they were categorized into the following three groups: nasopharyngeal carcinoma (NPC) with RT, non-NPC with RT, and non-NPC without RT. Patients in the NPC with RT group had the highest risk of developing (...) Intracranial aneurysms formation after radiotherapy for head and neck cancer: a 10-year nationwide follow-up study. Intracranial aneurysms after radiotherapy (RT) have previously been reported. However, the majority of studies were case reports. Therefore, we performed a nationwide study to explore the risk of radiation-induced intracranial aneurysms.This study included patients diagnosed with head and neck cancer (ICD9: 140-149, 161). Intracranial aneurysms formation was identified using

2019 BMC Cancer

86. How definitive treatment affects the rupture rate of unruptured cerebral aneurysms: a competing risk survival analysis. (Abstract)

How definitive treatment affects the rupture rate of unruptured cerebral aneurysms: a competing risk survival analysis. OBJECTIVETo investigate the risk of bleeding from unruptured cerebral aneurysms (UCAs), previous studies have used Kaplan-Meier analyses without treating the definitive treatment as a competing risk event, which may underestimate the rupture rate. The authors analyzed the survival of patients with UCAs alongside the occurrence of aneurysm bleeding and its competing risk (...) events.METHODSA retrospective analysis was conducted on 722 patients diagnosed with UCAs in the period from 2000 to 2009 using an institution's electronic medical records and telephone interviews. The cumulative incidence of aneurysm rupture was examined, and factors contributing to rupture were assessed using regression analyses.RESULTSBy 2014, 19 patients had experienced aneurysm rupture, with an overall rupture rate of 0.57% per year over 3320.8 person-years. However, cumulative incidence analysis

2019 Journal of Neurosurgery

87. Perioperative rupture risk of unruptured intracranial aneurysms in cardiovascular surgery. (Abstract)

the optimal management of unruptured intracranial aneurysms before cardiovascular surgery.© The Author(s) (2019). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved. For Permissions, please email: journals.permissions@oup.com. (...) Perioperative rupture risk of unruptured intracranial aneurysms in cardiovascular surgery. Although unruptured intracranial aneurysms are increasingly being diagnosed incidentally, perioperative rupture risk of unruptured intracranial aneurysm in patients undergoing cardiovascular surgery remains unclear. Therefore, we conducted an observational study to assess the prevalence and perioperative rupture risk of unruptured intracranial aneurysm in patients undergoing cardiovascular surgery. Adult

2019 Brain

88. Decreased wall shear stress at high-pressure areas predicts the rupture point in ruptured intracranial aneurysms. (Abstract)

Decreased wall shear stress at high-pressure areas predicts the rupture point in ruptured intracranial aneurysms. OBJECTIVEDegenerative cerebral aneurysm walls are associated with aneurysm rupture and subarachnoid hemorrhage. Thin-walled regions (TWRs) represent fragile areas that may eventually lead to aneurysm rupture. Previous computational fluid dynamics (CFD) studies reported the correlation of maximum pressure (Pmax) areas and TWRs; however, the correlation with aneurysm rupture has (...) not been established. This study aims to investigate this hemodynamic correlation.METHODSThe aneurysmal wall surface at the Pmax areas was intraoperatively evaluated using a fluid flow formula under pulsatile blood flow conditions in 23 patients with 23 saccular middle cerebral artery (MCA) bifurcation aneurysms (16 unruptured and 7 ruptured). The pressure difference (Pd) at the Pmax areas was calculated by subtracting the average pressure (Pave) from the Pmax and normalized by dividing

2019 Journal of Neurosurgery

89. Fibrin-associated large B-cell lymphoma: first case report within a cerebral artery aneurysm and literature review. Full Text available with Trip Pro

Fibrin-associated large B-cell lymphoma: first case report within a cerebral artery aneurysm and literature review. Fibrin-associated diffuse large B-cell lymphoma (FA-DLBCL) is a rare Epstein-Barr virus (EBV) positive lymphoproliferative disorder included in the current World Health Organization (WHO) classification. It arises within fibrinous material in the context of hematomas, pseudocysts, cardiac myxoma or in relation with prosthetic devices. In these clinical settings the diagnosis (...) requires an high index of suspicion, because it does not form a mass itself, being composed of small foci of neoplastic cells. Despite overlapping features with diffuse large B-cell lymphoma associated with chronic inflammation, it deserves a separate classification, being not mass-forming and often following an indolent course.A 64-year-old immunocompetent woman required medical care for cerebral hemorrhage. Computed Tomography (CT) angiography identified an aneurysm in the left middle cerebral artery

2019 BMC Cancer

90. The risk factors of shunt-dependent hydrocephalus after subarachnoid space hemorrhage of intracranial aneurysms. Full Text available with Trip Pro

The risk factors of shunt-dependent hydrocephalus after subarachnoid space hemorrhage of intracranial aneurysms. Shunt-dependent hydrocephalus is a common complication of aneurysmal subarachnoid hemorrhage (aSAH) which indicated intensive care unit stay and unfavorable outcome. Our aim is to study the risk factors of shunt-dependent hydrocephalus after aneurysmal subarachnoid space hemorrhage. Patients with intracranial aneurysms treated in our department from January 2014 to October 2018 were (...) included in the study. Patients' age, gender, history of hypertension and diabetes, location of aneurysms, Glasgow coma scale (GCS) score, Hunt-Hess grading, intraventricular hemorrhage, therapeutic option, shunt placement, clinical outcome, length of stay were analyzed. The follow-up period was 1 to 5 years. Statistics included Chi-squared, Student t test, 1-way analysis of variance, Pearson correlation coefficient, and multivariate logistic regression. About 845 cases with intracranial aneurysms

2019 Medicine

91. Feasibility and efficacy of enhanced recovery after surgery protocol in Chinese elderly patients with intracranial aneurysm. Full Text available with Trip Pro

Feasibility and efficacy of enhanced recovery after surgery protocol in Chinese elderly patients with intracranial aneurysm. Intracranial aneurysm is a kind of severe intracranial disease mainly responsible for subarachnoid hemorrhage, and the rupture of intracranial aneurysm results in a mortality rate of 30%-40%. For the first time in the world, this study aimed to assess the feasibility and efficacy of enhanced recovery after surgery (ERAS) protocol in Chinese elderly patients (...) with intracranial aneurysm.In this study, 300 elderly patients with intracranial aneurysm were recruited and divided into two groups as follows: ERAS group (n=150, ERAS protocol) and control group (n=150, conventional management).Age of whole cohort was 65 (64-67) years with 140 males (46.7). There was no difference between two groups in baseline features of patients, such as age, sex, medical histories, percentages of aneurysmal location, aneurysmal number >1 per patient, aneurysmal diameter >5 mm, or lobular

2019 Clinical interventions in aging Controlled trial quality: uncertain

92. Presymptomatic Screening for Intracranial Aneurysms in Patients with Autosomal Dominant Polycystic Kidney Disease. Full Text available with Trip Pro

Presymptomatic Screening for Intracranial Aneurysms in Patients with Autosomal Dominant Polycystic Kidney Disease. Intracranial aneurysm rupture is the most devastating complication of autosomal dominant polycystic kidney disease. Whether selective or widespread intracranial aneurysm screening is indicated remains controversial.Records of 3010 patients with autosomal dominant polycystic kidney disease evaluated at the Mayo Clinic between 1989 and 2017 were reviewed. Those who had presymptomatic (...) magnetic resonance angiography screening were included.Ninety-four intracranial aneurysms were diagnosed in 75 of 812 (9%) patients who underwent magnetic resonance angiography screening. Sex, age, race, and genotype were similar in the groups with and without aneurysms; hypertension and history of smoking were more frequent in the aneurysm group. Twenty-nine percent of patients with aneurysms compared with 11% of those without aneurysms had a family history of subarachnoid hemorrhage (P<0.001). Most

2019 Clinical Journal of the American Society of Nephrology

93. A step-by-step problem-solving strategy in a patient with heart failure and cerebral aneurysm. (Abstract)

A step-by-step problem-solving strategy in a patient with heart failure and cerebral aneurysm. Left ventricular assist devices (LVAD) implantation is an established treatment for patients with end-stage heart failure. HeartMate 3 (HM3) is a continuous-flow centrifugal pump, recently introduced in the clinic, which has shown greater hemocompatibility compared to similar devices of previous generations. Nevertheless, anticoagulation is still required after HM3 implant to avoid pump dysfunction (...) . Hereafter, we describe the case of a patient candidate to LVAD implantation for end-stage heart failure presenting a concomitant cerebrovascular lesion, accidentally found during pre-operative assessment, which would have contraindicated the procedure (for the prohibitive risk of cerebral hemorrhage), unless a step by step problem-solving approach was adopted.Copyright © 2019. Published by Elsevier Inc.

2019 Annals of Thoracic Surgery

94. Technical note: the use of frameless stereotactic guidance in the treatment of peripheral intracranial aneurysms. (Abstract)

Technical note: the use of frameless stereotactic guidance in the treatment of peripheral intracranial aneurysms. Frameless stereotactic guidance (FSG) has previously been reported to have advantages over intraoperative computed tomography (CT) and frame-based imaging guidance methods in the targeting of intracranial lesions. We report our experience using FSG to minimize brain dissection during microsurgical repair of peripheral aneurysms. We used FSG as a surgical adjunct in the management (...) of 91 peripheral aneurysms. It was used to localise and avoid larger bridging veins, enabling us to minimise unnecessary brain dissection by coming directly down on the aneurysm dome in unruptured lesions or targeting the parent artery just proximal to the aneurysm in ruptured cases. We treated 72 aneurysms located on the distal ACA (79%), 7 on the PCA (7.7%), 6 on the MCA distal to the MCA bifurcation (6.6%), and 6 on the SCA (6.6%). There were no complications related to FSG use. However, we noted

2019 British Journal of Neurosurgery

95. Rebleeding drives poor outcome in aneurysmal subarachnoid hemorrhage independent of delayed cerebral ischemia: a propensity-score matched cohort study. (Abstract)

Rebleeding drives poor outcome in aneurysmal subarachnoid hemorrhage independent of delayed cerebral ischemia: a propensity-score matched cohort study. Delayed cerebral ischemia (DCI) and aneurysm rebleeding contribute to morbidity and mortality in aneurysmal subarachnoid hemorrhage (aSAH); however, the relationship between their impacts on overall functional outcome is incompletely understood.The authors conducted a cohort study of all aSAH during the study period from 2001 to 2016. Primary (...) end points were overall functional outcome and ischemic aSAH sequelae, defined as delayed cerebral ischemia (DCI), DCI with infarction, symptomatic vasospasm (SV), and global cerebral edema (GCE). Outcomes were compared between the rebleed and nonrebleed cohorts overall and after propensity-score matching (PSM) for risk factors and treatment modality. Univariate and multivariate ordered logistic regression analyses for functional outcomes were performed in the PSM cohort to identify predictors

2019 Journal of Neurosurgery

96. Cerebrospinal fluid macrophage migration inhibitory factor: a potential predictor of cerebral vasospasm and clinical outcome after aneurysmal subarachnoid hemorrhage. (Abstract)

Cerebrospinal fluid macrophage migration inhibitory factor: a potential predictor of cerebral vasospasm and clinical outcome after aneurysmal subarachnoid hemorrhage. In patients with aneurysmal subarachnoid hemorrhage (aSAH), poor outcomes have been shown to be correlated with subsequent cerebral vasospasm (CV) and delayed cerebral ischemia (DCI). The identification of novel biomarkers may aid in the prediction of which patients are vulnerable to developing vasospasm, cerebral ischemia

2019 Journal of Neurosurgery

97. Clip-first policy versus coil-first policy for the exclusion of middle cerebral artery aneurysms. (Abstract)

Clip-first policy versus coil-first policy for the exclusion of middle cerebral artery aneurysms. Middle cerebral artery (MCA) aneurysms are a particular subset of intracranial aneurysms that can be excluded by clipping or coiling. A comparison of the results between these two methods is often limited by a selection bias in which wide-neck and large aneurysms are frequently treated with surgery. Here, the authors report the results of two centers using opposing policies in the management of MCA (...) aneurysms: one center used a clip-first policy while the other used a coil-first policy, which limited the selection bias and ensured a good comparison of these two treatment modalities.All patients treated for either ruptured or unruptured MCA aneurysms at one of two institutions between January 2012 and December 2015 were eligible for inclusion in this study. At one center a clip-first policy was applied, whereas the other applied a coil-first policy. The authors retrospectively reviewed the medical

2019 Journal of Neurosurgery

98. Decrease of blood flow velocity in the middle cerebral artery after stellate ganglion block following aneurysmal subarachnoid hemorrhage: a potential vasospasm treatment? (Abstract)

Decrease of blood flow velocity in the middle cerebral artery after stellate ganglion block following aneurysmal subarachnoid hemorrhage: a potential vasospasm treatment? Cerebral vasospasm (CV) is a delayed, sustained contraction of the cerebral arteries that tends to occur 3-14 days after aneurysmal subarachnoid hemorrhage (aSAH) from a ruptured aneurysm. Vasospasm potentially leads to delayed cerebral ischemia, and despite medical treatment, 1 of 3 patients suffer a persistent neurological (...) deficit. Bedside transcranial Doppler (TCD) ultrasonography is used to indirectly detect CV through recognition of an increase in cerebral blood flow velocity (CBFV). The present study aimed to use TCD ultrasonography to monitor how CBFV changes on both the ipsi- and contralateral sides of the brain in the first 24 hours after patients have received a stellate ganglion block (SGB) to treat CV that persists despite maximum standard therapy.The data were culled from records of patients treated between

2019 Journal of Neurosurgery

99. Vasa vasorum formation is associated with rupture of intracranial aneurysms. (Abstract)

Vasa vasorum formation is associated with rupture of intracranial aneurysms. Subarachnoid hemorrhage (SAH) has a poor outcome despite modern advancements in medical care. The development of a novel therapeutic strategy to prevent rupture of intracranial aneurysms (IAs) or a novel diagnostic marker to predict rupture-prone lesions is thus mandatory. Therefore, in the present study, the authors established a rat model in which IAs spontaneously rupture and examined this model to clarify (...) examination using ruptured IAs, rupture-prone IAs induced at a PCoA or ACoA, and IAs induced at an anterior cerebral artery-olfactory artery bifurcation that never ruptured revealed the formation of vasa vasorum as an event associated with rupture of IAs.The authors propose the contribution of a structural change in an adventitia, i.e., vasa vasorum formation, to the rupture of IAs. Findings from this study provide important insights about the pathogenesis of IAs.

2019 Journal of Neurosurgery

100. Comparison of stent-assisted and no-stent coil embolization for safety and effectiveness in the treatment of ruptured intracranial aneurysms. (Abstract)

Comparison of stent-assisted and no-stent coil embolization for safety and effectiveness in the treatment of ruptured intracranial aneurysms. The safety of the stent-assisted coil embolization (SAC) technique for acutely ruptured aneurysms has not been established yet. SAC is believed to be associated with a high risk of thromboembolic and hemorrhagic complications in acute subarachnoid hemorrhage (SAH). The aim of this study was to evaluate the safety and efficacy of the SAC technique (...) in clinical or angiographic outcomes between the SAC and NSC techniques in patients with acute SAH. The rate of ventriculostomy-related hemorrhagic complications was higher in the SAC group than that in the NSC group (63.6% vs 12.5%; OR 12.25, 95% CI 1.78-83.94, p = 0.01). However, all these complications were asymptomatic and so small that they were only able to be diagnosed with imaging.Ruptured wide-necked aneurysms could be effectively and safely treated with the SAC technique, which showed clinical

2019 Journal of Neurosurgery

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