“Subarachnoid Hemorrhage is non-traumatic nasty bleeding into the subarachnoid area, the territory between the arachnoid and the piamater of the central nervous system showing prompt developing signs of neurological ...“Subarachnoid Hemorrhage is non-traumatic nasty bleeding into the subarachnoid area, the territory between the arachnoid and the piamater of the central nervous system showing prompt developing signs of neurological sequelae”. It is one among the neurological emergencies which is a very distressing cerebrovascular disease with complicated mechanisms that risks brain perfusion and its function, having higher morbidity and mortality rates. Its mortality rate is still ranged between 8.3% and 66.7%, with noticeable regional variations, beside recent advances in treatment approaches. The incidence of SAH among the population of 2 - 22.5/100,000 was reported with a minimum of 60% of aneurysm ruptures occurring amid ages of 40 and 60 years with 3:2 male:female ratio. The rupture risks for unruptured aneurysms are increased by the issues like present smokers, larger size of aneurysm, and amid young population. The surgical treatment decision should be contemplated upon factors such as aneurysm’s size, aneurysm’s location, patient’s illness history, and surgeon’s operative experiences. Latest technical progresses in imaging techniques, increased consideration of illness history, more awareness of incidences of aneurysms and use of micro neurosurgery, have raised the chance for detection of subarachnoid hemorrhage (SAH) and possible better outcomes with surgical management. Factors that may affect outcome include age, size and site of aneurysm, interval between ictus and surgery, CT Fisher Grade & Hunt and Hess Grading earlier to surgery, & Glasgow Coma Scale at the while of discharge. The studies here support the wide spread concept that surgical clipping of SAH for Hunt and Hess Grade 4, 5 SAH, which is also considered as poor Grade SAH stipulates an effective treatment if done earlier provides better outcome.展开更多
Prompt diagnosis and therapy of aneurysms are critical for patients with nontraumatic subarachnoid hemorrhage （SAH）.The aim of our study was to assess the clinical usefulness of multislice computed tomography angiog...Prompt diagnosis and therapy of aneurysms are critical for patients with nontraumatic subarachnoid hemorrhage （SAH）.The aim of our study was to assess the clinical usefulness of multislice computed tomography angiography （CTA） in the surgical and endovascular treatment of intracranial aneurysms.A total of 195 cases with 206 intracranial aneurysms underwent CTA.Fifty （24%） aneurysms underwent surgical clipping while 156 （76%） aneurysms underwent endovascular coiling.In the five missed aneurysms at digital substraction angiography and the nine aneurysms with mass intracerebral hematomas,surgical treatment was successfully performed based on 16-slice CTA alone,and the other 36 aneurysms were clipped on the main basis of the CTA.The intraoperative findings correlated well with the CTA findings and all aneurysms were clipped successfully.Sixteen-slice CTA image information has been shown to determine the choice of aneurysm therapy and assist the surgical and endovascular treatment of intracranial aneurysms.展开更多
Basilar tip aneurysms account for 5% - 8% of all intracranial aneurysms. They are known to rupture more frequently than aneurysms in other locations. Surgical clipping of basilar apex aneurysms however challenging;rem...Basilar tip aneurysms account for 5% - 8% of all intracranial aneurysms. They are known to rupture more frequently than aneurysms in other locations. Surgical clipping of basilar apex aneurysms however challenging;remains the treatment of choice in Ivory Coast due in part, to multiple technical barriers. A 60-year-old right-handed patient presented to our Neurosurgical Unit in February 2nd 2013 after a sudden onset of altered consciousness. Neurological examination revealed both an upper motor neuron and meningeal syndromes with a Glasgow Coma Scale of 12. Brain NECT scan and a subsequent brain CT angiography showed a subarachnoid haemorrhage and a 3.8 mm (height) × 5.2 mm (width) basilar tip aneurysm respectively. Surgical clipping of the aneurysm was indicated but due to multiple technical barriers, surgery was delayed and the patient underwent surgery after the critical vasospasm period. The patient developed a hospital acquired pneumonia after surgery and was successfully treated with antibiotics. Since her discharge, she has been asymptomatic. We sought to report this case of a basilar apex aneurysm successfully occluded with non-ferromagnetic SUGITA clips and to share our experience of clipping these lesions through the frontotemporal approach. The patient was informed that non identifying information from the case would be submitted for publication, and she provided consent.展开更多
We modified a three-dimensional cerebral aneurysm model for surgical simulation and educational demonstration. Novel models are made showing perforating arteries arising around the aneurysm. Information about perforat...We modified a three-dimensional cerebral aneurysm model for surgical simulation and educational demonstration. Novel models are made showing perforating arteries arising around the aneurysm. Information about perforating arteries is difficult to obtain from individual radiological data sets. Perforators are therefore reproduced based on previous anatomical knowledge instead of personal data. Due to their fragility, perforating arteries are attached to the model using hard materials. At the same time, hollow models are useful for practicing clip application. We made a model for practicing the application of fenestrated clips for paraclinoid internal carotid aneurysms. Situating aneurysm models in the fissure of a brain model simulates the real surgical field and is helpful for educational demonstrations.展开更多
Background:Intracranial aneurysm is a common cerebrovascular disease, which cause wide concern by neurosurgeons. The 3D-DSA images simulated surgical path may improve the success rate of operation in bridging surgery ...Background:Intracranial aneurysm is a common cerebrovascular disease, which cause wide concern by neurosurgeons. The 3D-DSA images simulated surgical path may improve the success rate of operation in bridging surgery of emergency ruptured intracranial aneurysms.Methods: Eighteen patients with intracranial ruptured aneurysms that underwent craniotomy clipping surgery from January 2015 to January 2016 were included in this study. All patients were diagnosed with ruptured aneurysm and SAH, and 3 of them had concomitant hematoma. All patients were clipped in 3 days after diagnosis. Before clipping, the relevant information and data of the 3D-DSA images simulated surgical path were observed to guide intracranial aneurysm clipping surgery.Results: According to the information of the 3D-DSA images simulated surgical path, all aneurysms were clipped successfully. 1 patient died of vessel spasm, and the remaining patients recovered well.Conclusions: The 3D-DSA images simulated surgical path could provide surgeons with a lot of information in bridging surgery of emergency ruptured intracranial aneurysms,and is significant to improve the success rate of operation.展开更多
Background: Potentially lethal, aneurysmal subarachnoid hemorrhage has a bad prognosis for many individuals. Over the past few decades, endovascular and surgical interventions have been developed, including surgical c...Background: Potentially lethal, aneurysmal subarachnoid hemorrhage has a bad prognosis for many individuals. Over the past few decades, endovascular and surgical interventions have been developed, including surgical clipping, and endovascular coiling. Patients who have aSAH are also susceptible to delayed cerebral ischemia and cerebral vasospasm. The aim of this study is to compare the outcome of endovascular coiling with surgical clipping in patients with SAH, specifically in relation to prevalence of vasospasm, in the country of Georgia. Method: In this study, we present a retrospective review of the outcomes of 217 patients with acute subarachnoid hemorrhage who underwent endovascular coiling or surgical clipping. The data were gathered from patients who are admitted to New Vision University Hospital and Caucasus Medical Center in Tbilisi, Georgia, between 2017 and 2022. Results: Vasospasm was prevalent in 217 of the patients who had aneurysmal rupture when they first appeared. Endovascular coiling or surgical clipping was used to treat aneurysmal rupture. In our sample, 24.81 percent of patients who underwent coiling experienced vasospasm after 14 days, compared to 31.25 percent of patients who underwent clipping. After endovascular coiling and surgical clipping, the severity of vasospasm was only slightly different, according to Lindegaard ratios. Finally, 32 patients (23.35 percent) died after coiling whereas 55 patients (68.75 percent) died within three decades of clipping. Conclusion: After 5 years of data collection, this study has demonstrated the most favorable option for treatment is endovascular coiling. However, the treatment choice takes multiple factors into account, and clipping is not ideal for some ruptured aneurysms. Despite the fact that endovascular coiling is usually successful and minimally invasive, complications can occur and additional monitoring and potential surgical intervention are indicated.展开更多
Objective: To evaluate and compare the outcomes of microsurgical clipping and endovascular coiling of ruptured anterior cerebral circulation aneurysms. Methods: The current study retrospectively included 61 patients p...Objective: To evaluate and compare the outcomes of microsurgical clipping and endovascular coiling of ruptured anterior cerebral circulation aneurysms. Methods: The current study retrospectively included 61 patients presented with subarachnoid hemorrhage (SAH), treated by clipping or coiling for ruptured aneurysms located in anterior circulation. Anatomic outcome and post-operative ischemic events were evaluated. The primary clinical outcomes were evaluated as operative complications while the secondary clinical outcome was evaluated by modified Rankin scale (mRS) at discharge. Results: Of 61 ruptured aneurysms, 47 and 14 were treated by surgery and coiling, respectively. The average follow-up duration was 19.1 ± 18.6 months for clipping and 21.7 ± 14.8 months for coiling. Complete occlusion was greater in surgery group (80.8%) than endovascular group (21.4%). Re-growth occurred in 2 cases of the coiling group only. Ischemic events were encountered in both groups;silent ones were higher in coiling group (21.4%) than in clipping group (6.3%), while symptomatic ones were higher in the clipping group (49%). Good outcome (mRS 0 - 2) was 51% and 71.4% after clipping and coiling respectively. Postoperative hospital period was longer after clipping (P = 0.04). Conclusions: For anterior circulation ruptured aneurysms, both treatments are feasible, coiling showed lower rate of morbidity while clipping results were better regarding durability and recurrence. Coil embolization may be preferred, which is the current point proved by the RCT like ISAT, but if you choose the patients carefully and find out the optimal candidate for the clipping, the clipping is still enough feasible as a mainstream.展开更多
Background: Intraventricular cerebral aneurysms are uncommon brain vascular disease in general population. The previous reported cases point with more frequency to Moyamoya disease as the main factor to originate aneu...Background: Intraventricular cerebral aneurysms are uncommon brain vascular disease in general population. The previous reported cases point with more frequency to Moyamoya disease as the main factor to originate aneurysms in the choroidal arteries. Those related to an AVM are even rarer and only two cases have been previously reported. Aim: To discuss the unusual location of this aneurysm, its relationship to other conditions and the type of treatment. Case Presentation: We present the case of a patient with a non-ruptured intraventricular aneurysm of lateral posterior choroidal artery related to a ruptured right temporal arteriovenous malformation, who was successfully treated by clipping immediately, after resection of the malformation. Conclusion: Intraventricular choroidal artery aneurysm is a rare pathology. Its deep location makes the treatment challenging but mandatory due to the high probability of bleeding, especially those flow-related to an arteriovenous malformation.展开更多
目的探究颅内动脉瘤破裂伴血肿患者夹闭术后预后不良的影响因素并构建临床预测模型。方法选取2017年9月至2023年10月东阳市人民医院收治的151例动脉瘤性颅内血肿患者。术后3个月,采用改良Rankin量表(modified Rankin scale,mRS)进行评...目的探究颅内动脉瘤破裂伴血肿患者夹闭术后预后不良的影响因素并构建临床预测模型。方法选取2017年9月至2023年10月东阳市人民医院收治的151例动脉瘤性颅内血肿患者。术后3个月,采用改良Rankin量表(modified Rankin scale,mRS)进行评分分组,预后良好组93例,预后不良组58例。采用单因素分析和多因素Logistic回归分析探究影响患者术后预后不良的风险因素,构建颅内动脉瘤破裂伴血肿患者夹闭术后预后不良预测模型,采用受试者操作特征曲线下面积(area under the curve,AUC)反映模型的鉴别效度,采取Hosmer-Lemeshow检验建立模型的拟合度。结果Hunt-Hess分级Ⅳ~Ⅴ级(OR=5.339)、改良Fisher分级Ⅲ~Ⅳ级(OR=5.145)、血肿量≥50ml(OR=7.426)、血肿清除率≤50%(OR=8.381)、责任动脉瘤直径>5mm(OR=3.053)、手术时间窗>5h(OR=2.659)、术中血管区操作时间>3h(OR=2.305)为颅内破裂动脉瘤伴血肿患者夹闭术后预后不良的独立风险因素(P<0.05)。本研究构建的夹闭术后预后不良预测模型的AUC为0.863(95%CI:0.781~0.946,P<0.001),模型预测效能较好,特异性79.6%,敏感度86.2%,预测正确率为82.1%。Hosmer-Lemeshow检验χ^(2)=5.778,P=0.679,模型预测值与实际观测值无显著差异。结论Hunt-Hess分级Ⅳ~Ⅴ级、改良Fisher分级Ⅲ~Ⅳ级、血肿量≥50ml、血肿清除率≤50%、责任动脉瘤直径>5mm、手术时间窗>5h、术中血管区操作时间>3h为颅内动脉瘤破裂伴血肿患者夹闭术后预后不良的风险因素。本研究构建的模型预测效能较高,可为临床开颅夹闭术患者治疗及术后康复提供指导。展开更多
文摘“Subarachnoid Hemorrhage is non-traumatic nasty bleeding into the subarachnoid area, the territory between the arachnoid and the piamater of the central nervous system showing prompt developing signs of neurological sequelae”. It is one among the neurological emergencies which is a very distressing cerebrovascular disease with complicated mechanisms that risks brain perfusion and its function, having higher morbidity and mortality rates. Its mortality rate is still ranged between 8.3% and 66.7%, with noticeable regional variations, beside recent advances in treatment approaches. The incidence of SAH among the population of 2 - 22.5/100,000 was reported with a minimum of 60% of aneurysm ruptures occurring amid ages of 40 and 60 years with 3:2 male:female ratio. The rupture risks for unruptured aneurysms are increased by the issues like present smokers, larger size of aneurysm, and amid young population. The surgical treatment decision should be contemplated upon factors such as aneurysm’s size, aneurysm’s location, patient’s illness history, and surgeon’s operative experiences. Latest technical progresses in imaging techniques, increased consideration of illness history, more awareness of incidences of aneurysms and use of micro neurosurgery, have raised the chance for detection of subarachnoid hemorrhage (SAH) and possible better outcomes with surgical management. Factors that may affect outcome include age, size and site of aneurysm, interval between ictus and surgery, CT Fisher Grade & Hunt and Hess Grading earlier to surgery, & Glasgow Coma Scale at the while of discharge. The studies here support the wide spread concept that surgical clipping of SAH for Hunt and Hess Grade 4, 5 SAH, which is also considered as poor Grade SAH stipulates an effective treatment if done earlier provides better outcome.
基金supported by grant of Changzhou science and technology projects of social development (No. CS2007203)
文摘Prompt diagnosis and therapy of aneurysms are critical for patients with nontraumatic subarachnoid hemorrhage （SAH）.The aim of our study was to assess the clinical usefulness of multislice computed tomography angiography （CTA） in the surgical and endovascular treatment of intracranial aneurysms.A total of 195 cases with 206 intracranial aneurysms underwent CTA.Fifty （24%） aneurysms underwent surgical clipping while 156 （76%） aneurysms underwent endovascular coiling.In the five missed aneurysms at digital substraction angiography and the nine aneurysms with mass intracerebral hematomas,surgical treatment was successfully performed based on 16-slice CTA alone,and the other 36 aneurysms were clipped on the main basis of the CTA.The intraoperative findings correlated well with the CTA findings and all aneurysms were clipped successfully.Sixteen-slice CTA image information has been shown to determine the choice of aneurysm therapy and assist the surgical and endovascular treatment of intracranial aneurysms.
文摘Basilar tip aneurysms account for 5% - 8% of all intracranial aneurysms. They are known to rupture more frequently than aneurysms in other locations. Surgical clipping of basilar apex aneurysms however challenging;remains the treatment of choice in Ivory Coast due in part, to multiple technical barriers. A 60-year-old right-handed patient presented to our Neurosurgical Unit in February 2nd 2013 after a sudden onset of altered consciousness. Neurological examination revealed both an upper motor neuron and meningeal syndromes with a Glasgow Coma Scale of 12. Brain NECT scan and a subsequent brain CT angiography showed a subarachnoid haemorrhage and a 3.8 mm (height) × 5.2 mm (width) basilar tip aneurysm respectively. Surgical clipping of the aneurysm was indicated but due to multiple technical barriers, surgery was delayed and the patient underwent surgery after the critical vasospasm period. The patient developed a hospital acquired pneumonia after surgery and was successfully treated with antibiotics. Since her discharge, she has been asymptomatic. We sought to report this case of a basilar apex aneurysm successfully occluded with non-ferromagnetic SUGITA clips and to share our experience of clipping these lesions through the frontotemporal approach. The patient was informed that non identifying information from the case would be submitted for publication, and she provided consent.
文摘We modified a three-dimensional cerebral aneurysm model for surgical simulation and educational demonstration. Novel models are made showing perforating arteries arising around the aneurysm. Information about perforating arteries is difficult to obtain from individual radiological data sets. Perforators are therefore reproduced based on previous anatomical knowledge instead of personal data. Due to their fragility, perforating arteries are attached to the model using hard materials. At the same time, hollow models are useful for practicing clip application. We made a model for practicing the application of fenestrated clips for paraclinoid internal carotid aneurysms. Situating aneurysm models in the fissure of a brain model simulates the real surgical field and is helpful for educational demonstrations.
文摘Background:Intracranial aneurysm is a common cerebrovascular disease, which cause wide concern by neurosurgeons. The 3D-DSA images simulated surgical path may improve the success rate of operation in bridging surgery of emergency ruptured intracranial aneurysms.Methods: Eighteen patients with intracranial ruptured aneurysms that underwent craniotomy clipping surgery from January 2015 to January 2016 were included in this study. All patients were diagnosed with ruptured aneurysm and SAH, and 3 of them had concomitant hematoma. All patients were clipped in 3 days after diagnosis. Before clipping, the relevant information and data of the 3D-DSA images simulated surgical path were observed to guide intracranial aneurysm clipping surgery.Results: According to the information of the 3D-DSA images simulated surgical path, all aneurysms were clipped successfully. 1 patient died of vessel spasm, and the remaining patients recovered well.Conclusions: The 3D-DSA images simulated surgical path could provide surgeons with a lot of information in bridging surgery of emergency ruptured intracranial aneurysms,and is significant to improve the success rate of operation.
文摘Background: Potentially lethal, aneurysmal subarachnoid hemorrhage has a bad prognosis for many individuals. Over the past few decades, endovascular and surgical interventions have been developed, including surgical clipping, and endovascular coiling. Patients who have aSAH are also susceptible to delayed cerebral ischemia and cerebral vasospasm. The aim of this study is to compare the outcome of endovascular coiling with surgical clipping in patients with SAH, specifically in relation to prevalence of vasospasm, in the country of Georgia. Method: In this study, we present a retrospective review of the outcomes of 217 patients with acute subarachnoid hemorrhage who underwent endovascular coiling or surgical clipping. The data were gathered from patients who are admitted to New Vision University Hospital and Caucasus Medical Center in Tbilisi, Georgia, between 2017 and 2022. Results: Vasospasm was prevalent in 217 of the patients who had aneurysmal rupture when they first appeared. Endovascular coiling or surgical clipping was used to treat aneurysmal rupture. In our sample, 24.81 percent of patients who underwent coiling experienced vasospasm after 14 days, compared to 31.25 percent of patients who underwent clipping. After endovascular coiling and surgical clipping, the severity of vasospasm was only slightly different, according to Lindegaard ratios. Finally, 32 patients (23.35 percent) died after coiling whereas 55 patients (68.75 percent) died within three decades of clipping. Conclusion: After 5 years of data collection, this study has demonstrated the most favorable option for treatment is endovascular coiling. However, the treatment choice takes multiple factors into account, and clipping is not ideal for some ruptured aneurysms. Despite the fact that endovascular coiling is usually successful and minimally invasive, complications can occur and additional monitoring and potential surgical intervention are indicated.
文摘Objective: To evaluate and compare the outcomes of microsurgical clipping and endovascular coiling of ruptured anterior cerebral circulation aneurysms. Methods: The current study retrospectively included 61 patients presented with subarachnoid hemorrhage (SAH), treated by clipping or coiling for ruptured aneurysms located in anterior circulation. Anatomic outcome and post-operative ischemic events were evaluated. The primary clinical outcomes were evaluated as operative complications while the secondary clinical outcome was evaluated by modified Rankin scale (mRS) at discharge. Results: Of 61 ruptured aneurysms, 47 and 14 were treated by surgery and coiling, respectively. The average follow-up duration was 19.1 ± 18.6 months for clipping and 21.7 ± 14.8 months for coiling. Complete occlusion was greater in surgery group (80.8%) than endovascular group (21.4%). Re-growth occurred in 2 cases of the coiling group only. Ischemic events were encountered in both groups;silent ones were higher in coiling group (21.4%) than in clipping group (6.3%), while symptomatic ones were higher in the clipping group (49%). Good outcome (mRS 0 - 2) was 51% and 71.4% after clipping and coiling respectively. Postoperative hospital period was longer after clipping (P = 0.04). Conclusions: For anterior circulation ruptured aneurysms, both treatments are feasible, coiling showed lower rate of morbidity while clipping results were better regarding durability and recurrence. Coil embolization may be preferred, which is the current point proved by the RCT like ISAT, but if you choose the patients carefully and find out the optimal candidate for the clipping, the clipping is still enough feasible as a mainstream.
文摘Background: Intraventricular cerebral aneurysms are uncommon brain vascular disease in general population. The previous reported cases point with more frequency to Moyamoya disease as the main factor to originate aneurysms in the choroidal arteries. Those related to an AVM are even rarer and only two cases have been previously reported. Aim: To discuss the unusual location of this aneurysm, its relationship to other conditions and the type of treatment. Case Presentation: We present the case of a patient with a non-ruptured intraventricular aneurysm of lateral posterior choroidal artery related to a ruptured right temporal arteriovenous malformation, who was successfully treated by clipping immediately, after resection of the malformation. Conclusion: Intraventricular choroidal artery aneurysm is a rare pathology. Its deep location makes the treatment challenging but mandatory due to the high probability of bleeding, especially those flow-related to an arteriovenous malformation.
文摘目的探究颅内动脉瘤破裂伴血肿患者夹闭术后预后不良的影响因素并构建临床预测模型。方法选取2017年9月至2023年10月东阳市人民医院收治的151例动脉瘤性颅内血肿患者。术后3个月,采用改良Rankin量表(modified Rankin scale,mRS)进行评分分组,预后良好组93例,预后不良组58例。采用单因素分析和多因素Logistic回归分析探究影响患者术后预后不良的风险因素,构建颅内动脉瘤破裂伴血肿患者夹闭术后预后不良预测模型,采用受试者操作特征曲线下面积(area under the curve,AUC)反映模型的鉴别效度,采取Hosmer-Lemeshow检验建立模型的拟合度。结果Hunt-Hess分级Ⅳ~Ⅴ级(OR=5.339)、改良Fisher分级Ⅲ~Ⅳ级(OR=5.145)、血肿量≥50ml(OR=7.426)、血肿清除率≤50%(OR=8.381)、责任动脉瘤直径>5mm(OR=3.053)、手术时间窗>5h(OR=2.659)、术中血管区操作时间>3h(OR=2.305)为颅内破裂动脉瘤伴血肿患者夹闭术后预后不良的独立风险因素(P<0.05)。本研究构建的夹闭术后预后不良预测模型的AUC为0.863(95%CI:0.781~0.946,P<0.001),模型预测效能较好,特异性79.6%,敏感度86.2%,预测正确率为82.1%。Hosmer-Lemeshow检验χ^(2)=5.778,P=0.679,模型预测值与实际观测值无显著差异。结论Hunt-Hess分级Ⅳ~Ⅴ级、改良Fisher分级Ⅲ~Ⅳ级、血肿量≥50ml、血肿清除率≤50%、责任动脉瘤直径>5mm、手术时间窗>5h、术中血管区操作时间>3h为颅内动脉瘤破裂伴血肿患者夹闭术后预后不良的风险因素。本研究构建的模型预测效能较高,可为临床开颅夹闭术患者治疗及术后康复提供指导。
