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Cerebral Aneurysm

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101. Risk of Radiation-Induced Cancer From Computed Tomography Angiography Use in Imaging Surveillance for Unruptured Cerebral Aneurysms. (PubMed)

Risk of Radiation-Induced Cancer From Computed Tomography Angiography Use in Imaging Surveillance for Unruptured Cerebral Aneurysms. Background and Purpose- Although computed tomography angiography (CTA) is an excellent, noninvasive imaging modality for surveillance of intracranial aneurysms, radiation concerns have been cited to restrict its use in surveillance imaging. The goal of this study was to estimate distributions of radiation-induced central nervous system cancer incidence from CTA (...) surveillance for intracranial aneurysms, and the impact of frequency and duration of surveillance imaging using follow-up CTAs. Methods- Simulation-modeling approach was performed using data on CTA associated radiation risk. We used the Radiation Risk Assessment Tool, based on the data using the BEIR VII report (BEIR VII). Each CTA was assigned as a separate exposure event. Men and women, respectively, starting surveillance imaging at 30, 40, and 50 years and receiving annual CTAs were considered

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2018 Stroke

102. Reduced Intravoxel Incoherent Motion Microvascular Perfusion Predicts Delayed Cerebral Ischemia and Vasospasm After Aneurysm Rupture. (PubMed)

Reduced Intravoxel Incoherent Motion Microvascular Perfusion Predicts Delayed Cerebral Ischemia and Vasospasm After Aneurysm Rupture. Proximal artery vasospasm and delayed cerebral ischemia (DCI) after cerebral aneurysm rupture result in reduced cerebral perfusion and microperfusion and significant morbidity and mortality. Intravoxel incoherent motion (IVIM) magnetic resonance imaging extracts microvascular perfusion information from a multi-b value diffusion-weighted sequence. We determined (...) whether decreased IVIM perfusion may identify patients with proximal artery vasospasm and DCI.We performed a pilot retrospective cohort study of patients with ruptured cerebral aneurysms. Consecutive patients who underwent a brain magnetic resonance imaging with IVIM after ruptured aneurysm treatment were included. Patient demographic, treatment, imaging, and outcome data were determined by electronic medical record review. Primary outcome was DCI development with proximal artery vasospasm

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2018 Stroke

103. Impact of isolated cerebral perfusion technique for aortic arch aneurysm repair in elderly patients. (PubMed)

Impact of isolated cerebral perfusion technique for aortic arch aneurysm repair in elderly patients. In aortic surgery, a severely atherosclerotic aorta is a known risk factor for perioperative stroke. The authors adopted a novel procedure of selective cerebral perfusion, named isolated cerebral perfusion (ICP), for the prevention of stroke during aortic arch operations.Between January 2010 and June 2016, 48 patients (mean age, 80 ± 3 years) at Yokohama City University Medical Center, Yokohama (...) into the LCCA were performed. Extracorporeal circulation through the bilateral axillary arteries and selective cerebral perfusion to the LCCA were simultaneously started. Finally, at a bladder temperature of 25°C, clamping of the brachiocephalic and left subclavian arteries was performed.Preoperative evaluation by enhanced computed tomography confirmed that 62.2% of patients had severely atherosclerotic aortas and 37.8% had shaggy aortas. The overall 30-day mortality rate was 2.1%, whereas that for elective

2018 Annals of Thoracic Surgery

104. Systemic High-Mobility Group Box-1: A Novel Predictive Biomarker for Cerebral Vasospasm in Aneurysmal Subarachnoid Hemorrhage. (PubMed)

Systemic High-Mobility Group Box-1: A Novel Predictive Biomarker for Cerebral Vasospasm in Aneurysmal Subarachnoid Hemorrhage. To investigate the release of proinflammatory damage-associated molecular pattern molecule "high-mobility group box-1" in the serum of patients after aneurysmal subarachnoid hemorrhage and its association with cerebral vasospasm.Retrospective observational study.University hospital.Aneurysmal subarachnoid hemorrhage patients admitted within 24 hours of ictus.Standard (...) subarachnoid hemorrhage treatment after clipping or coiling of aneurysm.We enrolled 53 aneurysmal subarachnoid hemorrhage patients from which peripheral venous blood was withdrawn on days 1, 3, 5, 7, 9, 11, and 13 and once from the controls to obtain the serum. Serum high-mobility group box-1 concentration was quantified by enzyme-linked immunosorbent assay. Serum interleukin-6 and peripheral blood leukocytes were also determined over the first 2 weeks after subarachnoid hemorrhage. Patients' data were

2018 Critical Care Medicine

105. Association between vasoactive peptide urotensin II in plasma and cerebral vasospasm after aneurysmal subarachnoid hemorrhage: a potential therapeutic target. (PubMed)

Association between vasoactive peptide urotensin II in plasma and cerebral vasospasm after aneurysmal subarachnoid hemorrhage: a potential therapeutic target. OBJECTIVECerebral vasospasm (VS) is a severe complication of aneurysmal subarachnoid hemorrhage (SAH). Urotensin II (UII) is a potent vasoactive peptide activating the urotensin (UT) receptor, potentially involved in brain vascular pathologies. The authors hypothesized that UII/UT system antagonism with the UT receptor antagonist/biased (...) patients with VS (median 66 pg/ml [IQR 30-110 pg/ml]) and SAH patients without VS (27 pg/ml [IQR 15-46 pg/ml], p < 0.001) but no significant difference between VS patients and healthy volunteers (44 pg/ml [IQR 27-51 pg/ml]) or between non-VS patients and healthy volunteers.CONCLUSIONSThe results of this study suggest that UT receptor antagonism with urantide prevents VS and improves neurological outcome after SAH in mice and that an increase in plasma UII is associated with cerebral VS subsequent

2018 Journal of Neurosurgery

106. Cerebral revascularization for the management of complex intracranial aneurysms: a single-center experience. (PubMed)

Cerebral revascularization for the management of complex intracranial aneurysms: a single-center experience. OBJECTIVEBecause simple intracranial aneurysms (IAs) are increasingly treated endovascularly, neurovascular surgery has become focused on complex IAs that may require deconstructive aneurysm therapy with concomitant surgical bypass. The authors describe the decision-making process concerning cerebral revascularization and present outcomes that were achieved in a large case series (...) of complex IAs managed with cerebral revascularization and parent artery occlusion.METHODSThe authors retrospectively reviewed the medical records, including neuroimaging studies, operative reports, and follow-up clinic notes, of all patients who were treated at the National Brain Aneurysm Center between July 1997 and June 2015 using cerebral revascularization as part of the management of an IA. They recorded the location, rupture status, and size of each IA, as well as neurological outcome using

2018 Journal of Neurosurgery

107. A case report on middle cerebral artery aneurysm treated by rapid ventricular pacing: A CARE compliant case report. (PubMed)

A case report on middle cerebral artery aneurysm treated by rapid ventricular pacing: A CARE compliant case report. Cerebral aneurysm is a common cause of intracranial hemorrhage, stroke, and death. It is treated with vascular surgeries, such as coil embolism and artery clipping. However, surgery itself is a risk factor that may cause rupture of aneurysm, and leads to irreversible brain damage, and even death. Rapid ventricular pacing (RVP) is a procedure that temporarily lowers blood pressure (...) by increasing heart rate and reducing ventricular filling time. RVP has been widely used to reduce blood vessel tension in many cardiovascular surgeries.A 46-year-old man came to our hospital with intermittent right-side headache for 5 years, and left lower limb numbness for 3 months.Magnetic resonance imaging (MRI) of the head and digital subtraction angiography confirmed the diagnosis of right middle cerebral artery (MCA) aneurysm.Considering the large size of this MCA aneurysm, RVP was used to reduce

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2018 Medicine

108. Deep Learning for MR Angiography: Automated Detection of Cerebral Aneurysms. (PubMed)

Deep Learning for MR Angiography: Automated Detection of Cerebral Aneurysms. Purpose To develop and evaluate a supportive algorithm using deep learning for detecting cerebral aneurysms at time-of-flight MR angiography to provide a second assessment of images already interpreted by radiologists. Materials and Methods MR images reported by radiologists to contain aneurysms were extracted from four institutions for the period from November 2006 through October 2017. The images were divided (...) % (31 of 649) and 13% (10 of 80), respectively, compared with the initial reports. Conclusion A deep learning algorithm detected cerebral aneurysms in radiologic reports with high sensitivity and improved aneurysm detection compared with the initial reports. © RSNA, 2018 See also the editorial by Flanders in this issue.

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2018 Radiology

109. Recurrent delayed-onset cerebral vasospasm following ruptured ICA aneurysm: case report. (PubMed)

Recurrent delayed-onset cerebral vasospasm following ruptured ICA aneurysm: case report. We report a unique case of late-onsetcerebral vasospasm at 21 and again at 30 days following aneurismal subarachnoid hemorrhage.

2018 British Journal of Neurosurgery

110. Clinical prediction of delayed cerebral ischemia in aneurysmal subarachnoid hemorrhage. (PubMed)

Clinical prediction of delayed cerebral ischemia in aneurysmal subarachnoid hemorrhage. OBJECTIVEThe aim of this study was to derive a clinically applicable decision rule using clinical, radiological, and laboratory data to predict the development of delayed cerebral ischemia (DCI) in aneurysmal subarachnoid hemorrhage (aSAH) patients.METHODSPatients presenting over a consecutive 9-year period with subarachnoid hemorrhage (SAH) and at least 1 angiographically evident aneurysm were included (...) angiographic vasospasm with an overall DCI incidence of 21%. Age, modified Fisher grade, and ruptured aneurysm location were significantly associated with DCI. This combination of predictors had a greater area under the receiver operating characteristic curve than the modified Fisher grade alone (0.73 [95% CI 0.67-0.78] vs 0.66 [95% CI 0.60-0.71]). Patients 70 years or older with modified Fisher grade 0 or 1 SAH and a posterior circulation aneurysm had the lowest risk of DCI at 1.2% (0 points). The highest

2018 Journal of Neurosurgery

111. Basal ganglion hematoma evacuation and clipping of middle cerebral artery aneurysm by neuroendoscopy: A case report. (PubMed)

Basal ganglion hematoma evacuation and clipping of middle cerebral artery aneurysm by neuroendoscopy: A case report. Basal ganglia hematomas resulting from the rupture of aneurysms of the distal middle cerebral artery (MCA) are extremely rare and are usually treated by craniotomy. To date, only 5 cases of MCA aneurysm have been treated using neuroendoscopy, and none of these cases involved hematomas. For the first time, we report a special case in which neuroendoscopy was used to evacuate (...) a hematoma and clip an aneurysm at the same time.A massive basal ganglia hematoma in a 60-year-old man was evacuated using neuroendoscopy, and a distal MCA aneurysm was discovered and clipped successfully under the neuroendoscopy during the operation.Basal ganglia hematoma, Distal MCA aneurysm.The patient's left pupil shrunk, and his state of consciousness gradually improved after the operation.Our experience with this patient demonstrates that an aneurysm originating in the distal MCA and accompanied

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2018 Medicine

112. Keyhole strategy aiming at minimizing hospital stay for surgical clipping of unruptured middle cerebral artery aneurysms. (PubMed)

Keyhole strategy aiming at minimizing hospital stay for surgical clipping of unruptured middle cerebral artery aneurysms. OBJECTIVEAneurysms of the middle cerebral artery (MCA) are still most often treated by clipping through standard craniotomy, but a longer hospital stay is one of the main drawbacks of this treatment. The authors developed a pterional keyhole clipping strategy for unruptured MCA aneurysms with the intention of minimizing hospital stay. In this paper, they report (...) on their experience with this approach and analyze the long-term neurological and radiological outcomes.METHODSA total of 160 relatively small unruptured MCA aneurysms (mean 6.4 mm) were clipped through the pterional keyhole approach (19-30 mm, mean 24.6 mm) in 149 patients (aged 34-79 years, mean 62 years). Neurological and cognitive function were examined by several scales, including the modified Rankin Scale (mRS) and Mini-Mental State Examination (MMSE). Patients' level of depression was assessed using

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2018 Journal of Neurosurgery

113. Cerebral embolization during endovascular infrarenal, juxtarenal, and suprarenal aortic aneurysm repair, high-risk maneuvers, and associated neurologic outcomes. (PubMed)

Cerebral embolization during endovascular infrarenal, juxtarenal, and suprarenal aortic aneurysm repair, high-risk maneuvers, and associated neurologic outcomes. Risk factors for postoperative cognitive decline after noncardiac surgery are multifactorial and poorly understood. Evidence suggests that perioperative microembolic damage to the brain on movement of wires and catheters during endovascular aortic procedures may play an important role. Endovascular aortic aneurysm repair requires (...) invasive manipulation of wires and cannulas within the aorta, but research into cerebral emboli during aortic aneurysm repair and cognitive or neurologic injury is scarce and limited to thoracic aneurysms. This study prospectively studied embolic phenomena detected in the middle cerebral artery during infrarenal, juxtarenal, and thoracic endovascular aortic repair (TEVAR) and investigated links to delirium, stroke, and postoperative cognitive decline.There were 60 patients who received continuous left

2018 Journal of Vascular Surgery

114. Predictors of cerebral aneurysm persistence and occlusion after flow diversion: a single-institution series of 445 cases with angiographic follow-up. (PubMed)

Predictors of cerebral aneurysm persistence and occlusion after flow diversion: a single-institution series of 445 cases with angiographic follow-up. OBJECTIVEFlow diversion requires neointimal stent overgrowth to deliver aneurysm occlusion. The existing literature on aneurysm occlusion is limited by heterogeneous follow-up, variable antiplatelet regimens, noninvasive imaging modalities, and nonstandard occlusion assessment. Using a large, single-center cohort with low attrition (...) and standardized antiplatelet tapering, the authors evaluated outcomes after flow diversion of anterior circulation aneurysms to identify predictors of occlusion and aneurysm persistence.METHODSData from a prospective, IRB-approved database was analyzed for all patients with anterior circulation aneurysms treated by flow diversion with the Pipeline embolization device (PED) at the authors' institution. Follow-up consisted of catheter cerebral angiography at 6 and 12 months postembolization. Clopidogrel

2018 Journal of Neurosurgery

115. Permeability imaging as a predictor of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage. (PubMed)

Permeability imaging as a predictor of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage. Blood-brain barrier (BBB) dysfunction has been implicated in ischemic risk following aneurysmal subarachnoid hemorrhage (aSAH), but never directly imaged. We prospectively examined whether post-bleed day 4 dynamic contrast-enhanced magnetic resonance (DCE-MR) BBB permeability imaging could predict development of delayed cerebral ischemia (DCI). Global MR-derived BBB permeability ( Ktrans

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2018 Journal of Cerebral Blood Flow and Metabolism

116. Clipping as re-treatment strategy after treatment of a cerebral aneurysm with the Woven EndoBridge embolization device: case report. (PubMed)

Clipping as re-treatment strategy after treatment of a cerebral aneurysm with the Woven EndoBridge embolization device: case report. Recently, treatment of cerebral aneurysms with the Woven EndoBridge (WEB) device has become an established endovascular strategy. However, over time, neurosurgeons and neuroradiologists will be confronted with the challenge of how to treat aneurysm recanalization. The authors report the case of a 49-year-old woman who underwent re-treatment with clipping after (...) the recanalization of a 4 × 3-mm anterior communicating artery aneurysm that had previously been treated using a 4 × 3 WEB device. In contrast to the authors' prior experiences with clipping of previously coiled aneurysms, the WEB device was found to have a responsive softness during clip placement, and the aneurysm was more maneuverable. Moreover, evaluation with indocyanine green angiography was easy to perform because of the transparent mesh of the WEB device. No profound scarring or WEB protrusion was noted

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2018 Journal of Neurosurgery

117. Association of plasma D-dimer level with thromboembolic events after endovascular coil treatment of ruptured cerebral aneurysms. (PubMed)

Association of plasma D-dimer level with thromboembolic events after endovascular coil treatment of ruptured cerebral aneurysms. OBJECTIVEAlthough endovascular therapy is favored for acutely ruptured intracranial aneurysms, hematological factors associated with acute subarachnoid hemorrhage (SAH) may predispose to procedure-related ischemic complications. The aim of this study was to evaluate whether an elevated level of plasma D-dimer, a parameter of hypercoagulation in patients with acute SAH (...) , is correlated with increased incidence of thromboembolic events during endovascular coiling of ruptured aneurysms.METHODSThe authors analyzed data from 103 cases of acutely ruptured aneurysms (in 103 patients) treated with endovascular coil embolization at a single institution. Factors associated with elevated D-dimer level on admission were identified. The authors also evaluated whether D-dimer elevation was independently correlated with increased incidence of perioperative thromboembolic events.RESULTSAn

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2018 Journal of Neurosurgery

118. Computer-aided analysis of middle cerebral artery tortuosity: association with aneurysm development. (PubMed)

Computer-aided analysis of middle cerebral artery tortuosity: association with aneurysm development. OBJECTIVEBlood vessel tortuosity may play an important role in the development of vessel abnormalities such as aneurysms. Currently, however, there are no studies analyzing the impact of brain blood vessel tortuosity on the risk of aneurysm formation. Therefore, the authors performed a computer-aided analysis of middle cerebral artery (MCA) tortuosity, especially among patients diagnosed (...) cerebral artery aneurysm formation is strongly associated with blood vessel tortuosity parameters, which can potentially be used to screen for patients at risk for MCA aneurysm formation.

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2018 Journal of Neurosurgery

119. Hemodynamic characteristics associated with cerebral aneurysm formation in patients with carotid occlusion. (PubMed)

Hemodynamic characteristics associated with cerebral aneurysm formation in patients with carotid occlusion. OBJECTIVEThe pathogenesis of cerebral aneurysms in patients with internal carotid artery (ICA) occlusion is hypothesized to be hemodynamic. For the first time, the authors quantify the hemodynamic characteristics associated with aneurysm formation in patients with ICA occlusion.METHODSRecords of patients with unilateral ICA stenosis or occlusion ≥ 90% who underwent hemodynamic assessment (...) aneurysms are often located on collateral vessels. Thus, robust primary collaterals after ICA occlusion may be a contributing factor in cerebral aneurysm formation.

2018 Journal of Neurosurgery

120. Association of copeptin, a surrogate marker of arginine vasopressin, with cerebral vasospasm and delayed ischemic neurologic deficit after aneurysmal subarachnoid hemorrhage. (PubMed)

Association of copeptin, a surrogate marker of arginine vasopressin, with cerebral vasospasm and delayed ischemic neurologic deficit after aneurysmal subarachnoid hemorrhage. OBJECTIVEDelayed ischemic neurological deficit (DIND) is a leading cause of mortality and morbidity after aneurysmal subarachnoid hemorrhage (aSAH). Arginine vasopressin (AVP) is a hormone released by the posterior pituitary. It is known to cause cerebral vasoconstriction and has been implicated in hyponatremia secondary

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2018 Journal of Neurosurgery

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