Introduction: Rupture of intracranial aneurisms leads to severe morbidity and mortality. There are two modalities of treatment surgery and endovascular treatment. The diagnosis is made by angiography (DSA, CTA, RMA). ...Introduction: Rupture of intracranial aneurisms leads to severe morbidity and mortality. There are two modalities of treatment surgery and endovascular treatment. The diagnosis is made by angiography (DSA, CTA, RMA). The angiographic features used to assess the risk of the complications and choose the treatment modality are size, location and aneurism morphology. Materials and Methods: We reviewed and analyzed the computed tomographic angiography and magnetic resonance angiography of all patients admitted to the hospital of Mali with IAs from 2015 to 2021 either 7 years. Patients who were less than 18 years old, those with non-aneurysmal SAH, patients who request a discharge and those with an incomplete angiographic description of the IAs were excluded from the analysis. Results: We have collected 105 patients with 109 aneurysms. The sex ratio was 2/1 in favor of females. The mean age was 44.51 years with the range from 18 to 70 years. The presentation mode was subarachnoid hemorrhage (SAH) in 97% of cases. 76.19% had confirmed high blood pressure before the bleeding. 19.04% were diabetics. 98% of our patients have made a CT angiography and 2% have made MR angiography for the aneurysm diagnosis. 97.24% of aneurisms were located in the anterior part of the Willis circle. 39.44% of these aneurisms were the anterior communicating complex aneurysm. 27.52% of aneurysm had a small size, 42.20% had a medium size, 20.18% large size against 5.50% of the giant (Figure 3) and the middle cerebral artery was the most involved in the least. 95.41% of cases were saccular aneurysms against 4.59% fusiform. Conclusion: The angiographic feature of an intracranial aneurism in the Malian population may differ from other populations of the sub-region. The anterior communicating complex aneurysm is more common and the aneurism of the posterior part of the Willis circle is less common. We found the aneurism size ≥ 6 mm, ACA, MCA and Pcom more frequent.展开更多
In recent years, the increasing number of cardiologists and cardiac surgeons tend to think that surgical treatment of patients with atherosclerotic aneurisms does not fully comply with contemporary ideas of what the d...In recent years, the increasing number of cardiologists and cardiac surgeons tend to think that surgical treatment of patients with atherosclerotic aneurisms does not fully comply with contemporary ideas of what the disease is. Some data show that early operations in the presence of this pathology are associated with an unreasonably high mortality. Additionally, the use of intra-aortic stents and grafts cannot principally affect the therapeutic efficacy. Therefore, more attention is paid to the development of conservative therapeutic approaches leaving surgery defeated without surgical treatment. Two groups of patients with similar descending thoracic aortic atherosclerotic aneurisms (DTAAA) and abdominal aortic aneurisms (AAA) were retro- and prospectively studied over a 2-year period. Control group (Comparison group), (63 patients) received common surgical treatment from 2009 to 2010 whereas Main group (121 subjects) received multifaceted medical treatment to remove inflammatory reactions, strengthen aortic wall and control its dilation from 2011 to 2012. Operative treatment was used only in case of potential aneurism rupture. The comparison of the two groups of subjects showed that 2-year all-cause mortality in control group was 20.6% while in the main group it amounted to 9.1% due to the similar incidence of aneurism ruptures and deaths associated with concomitant diseases. It suggests that the odds ratio (OR) of survival when using attenuated therapeutic approach to treating atherosclerotic aneurisms is 2.6-fold higher compared to conventional surgical approach. One of the principal factors contributing to a higher mortality when using traditional surgical approach was the presence of polyorgan pathology that required constant medical correction irrespective of therapeutic option (surgical or medical) used. Another important factor is aortic aneurism wall frailty. The development of mechanisms that would allow its strengthening is considered a principal challenge of cutting-edge medicine that should be based on studies of triggers, molecular genetic bases of aortic wall immune-depending inflammatory formation, the production of pro-inflammatory cytokines, metalloproteinase activity that damages elastin and collagen fibers.展开更多
BACKGROUND The vein of Galen aneurismal malformations(VGAM) are rare arteriovenous malformations of the embryonic choroid plexus. They represent about 30% of paediatric neurovascular disorders and show diverse charact...BACKGROUND The vein of Galen aneurismal malformations(VGAM) are rare arteriovenous malformations of the embryonic choroid plexus. They represent about 30% of paediatric neurovascular disorders and show diverse characteristics. The VGAM is constituted by a midline dilated venous structure that receives blood from abnormal macroscopic or microscopic arteriovenous shunting vessels. Two types of VGAM exist, the choroidal and the mural. The treatment represents a challenge with the therapeutic objective to preserve the normal brain development without creating new neurological deficits.CASE SUMMARY We present three cases of VGAM in the early postnatal period and their treatment. All patents were treated with the endovascular technique, which was successful. According to our experience, the endovascular technique is a safe and efficient mode of VGAM treatment.CONCLUSION The objective of treatment aims to child's normal neurological development. A proper selection of patients and a thorough diagnostic workup is of vital importance. When the endovascular treatment is performed, the primary aim is not a complete VGAM exclusion at one time, which could produce a sudden reversal of blood flow with consequent venous infarction and ischemia. The aim is therefore to occlude as much of the VGAM as needed to relieve the congestive cardiac failure, to gain time and to create the conditions for a normal maturation of the neurovascular system. With the use of endovascular techniques, which represent not only the first choice of treatment but also the only safe therapeutic modality, the natural history of VGAM and their risks may be avoided safely.展开更多
Aim: The interest of inflammatory marker increased in the last years, even in preventing clinical outcome after subarachnoid hemorrhage (SAH). Our objective was to study the relationships between C-reactive protein le...Aim: The interest of inflammatory marker increased in the last years, even in preventing clinical outcome after subarachnoid hemorrhage (SAH). Our objective was to study the relationships between C-reactive protein levels and clinical outcome and the development of cerebral vasospasm after aneurismal SAH. Methods: One hundred adult patients with aneurismal SAH were prospectively evaluated. Glasgow Coma Scale (GCS) score, Hunt and Hess grade, Fisher grade, CT scans, digital subtraction angiography studies, transcranial doppler (TCD) and daily neurological examinations were recorded. Serial serum CRP measurements were obtained on daily between admission and 10th days. Glasgow Outcome Scale (GOS) and the modified Rankin Scale (mRS) were used to predict outcome. Results: A progressive increase in the CRP levels from the admission to the 3rd postictal day was observed, followed by a slow decrease until the 9th day. Hemodynamic changes in TCD were associated with higher serum CRP levels. Patients with lower GCS scores presented with increased CRP levels. Patients with higher Hunt and Hess grades on admission developed significantly higher CRP serum levels. Patients with higher admission Fisher grades showed increased levels of CRP. A statistically significant inverse correlation was established in our series between CRP serum levels and GOS and mRS scores on discharge and CRP levels. Conclusion: Increased CRP levels were strongly associated with poor clinical outcome. CRP levels can predict cerebral vasospasm and delayed ischemic deficits with higher statistic significance. There are relationships between hemodynamic chances in TCD and higher CRP levels.展开更多
目的:探讨CT平扫图像纹理分析鉴别骨巨细胞瘤(Giant cell tumor of bone,GCT)与动脉瘤样骨囊肿(Aneurismal bone cyst,ABC)的价值。方法:回顾性分析经手术病理证实的14例骨巨细胞瘤和15例动脉瘤样骨囊肿的影像学资料。在CT图像上手动勾...目的:探讨CT平扫图像纹理分析鉴别骨巨细胞瘤(Giant cell tumor of bone,GCT)与动脉瘤样骨囊肿(Aneurismal bone cyst,ABC)的价值。方法:回顾性分析经手术病理证实的14例骨巨细胞瘤和15例动脉瘤样骨囊肿的影像学资料。在CT图像上手动勾画ROI测量CT值及提取纹理特征参数。采用两独立样本t检验或MannWhitney U检验比较两组间CT值及纹理参数的差异,对得到的CT值及纹理参数进行单因素和多因素Logistic回归分析,绘制ROC评价CT值、纹理参数和纹理参数模型的诊断效能。结果:两组间CT值差异有统计学意义,鉴别GCT和ABC的AUC为0.162。CT平扫图像共提取1044个纹理参数,经筛选获得8个有统计学意义的参数(orrelation_angle45_offset4、GLCMEntropy_AllDirection_offset1、sumVariance、sumEntropy、histogramEntropy、GLCMEntropy_angle45_offset1、Inertia_angle0_offset2、ShortRunEmphasis_angle135_offset6),其鉴别GCT和ABC的AUC分别为0.343、0.843、0.776、0.800、0.800、0.848、0.795、0.771;多因素Logistic回归分析获得的纹理参数模型预测GCT和ABC的AUC为0.900,CT值结合纹理参数获得的模型鉴别GCT和ABC的AUC为0.948。结论:CT值结合纹理参数模型对于鉴别GCT和ABC具有较高价值。展开更多
Modern medicine has achieved much progress in the field of medical and surgical repair of a variety of disorders. It is especially true for the early stages of treatments. In long-term period, however, instead of reco...Modern medicine has achieved much progress in the field of medical and surgical repair of a variety of disorders. It is especially true for the early stages of treatments. In long-term period, however, instead of recovery, we frequently observe progressive regression, which completely annuls all our efforts. Moreover, the algorithm used to correct acute process may sometimes be detrimental to organs and tissues. Such situation is also frequent in the treatment of atherosclerotic descending aortic aneurysms (DAA). This is because the successful medical and even surgical repair to prevent aneurysm rupture in long-term period may trigger some detrimental processes in other regions thus producing negative results of the treatment. The present article doesn’t aim to prove some provisions in DAA clinical picture, atherosclerosis and inflammatory states. But we have faced some systematicity at these clinical implications which are absolutely not specified in literature. We have managed to find an explanation for this thing making a scrupulous analysis of nonsurgical sources. Comparing them with our observations, we have found out that aseptic and septic inflammation of connective tissue, probably, is a key component in the formation of DAA disregarding of which correction of dyslipidemia may lead to negative results. We are looking for in-depth research and discussion.展开更多
文摘Introduction: Rupture of intracranial aneurisms leads to severe morbidity and mortality. There are two modalities of treatment surgery and endovascular treatment. The diagnosis is made by angiography (DSA, CTA, RMA). The angiographic features used to assess the risk of the complications and choose the treatment modality are size, location and aneurism morphology. Materials and Methods: We reviewed and analyzed the computed tomographic angiography and magnetic resonance angiography of all patients admitted to the hospital of Mali with IAs from 2015 to 2021 either 7 years. Patients who were less than 18 years old, those with non-aneurysmal SAH, patients who request a discharge and those with an incomplete angiographic description of the IAs were excluded from the analysis. Results: We have collected 105 patients with 109 aneurysms. The sex ratio was 2/1 in favor of females. The mean age was 44.51 years with the range from 18 to 70 years. The presentation mode was subarachnoid hemorrhage (SAH) in 97% of cases. 76.19% had confirmed high blood pressure before the bleeding. 19.04% were diabetics. 98% of our patients have made a CT angiography and 2% have made MR angiography for the aneurysm diagnosis. 97.24% of aneurisms were located in the anterior part of the Willis circle. 39.44% of these aneurisms were the anterior communicating complex aneurysm. 27.52% of aneurysm had a small size, 42.20% had a medium size, 20.18% large size against 5.50% of the giant (Figure 3) and the middle cerebral artery was the most involved in the least. 95.41% of cases were saccular aneurysms against 4.59% fusiform. Conclusion: The angiographic feature of an intracranial aneurism in the Malian population may differ from other populations of the sub-region. The anterior communicating complex aneurysm is more common and the aneurism of the posterior part of the Willis circle is less common. We found the aneurism size ≥ 6 mm, ACA, MCA and Pcom more frequent.
文摘In recent years, the increasing number of cardiologists and cardiac surgeons tend to think that surgical treatment of patients with atherosclerotic aneurisms does not fully comply with contemporary ideas of what the disease is. Some data show that early operations in the presence of this pathology are associated with an unreasonably high mortality. Additionally, the use of intra-aortic stents and grafts cannot principally affect the therapeutic efficacy. Therefore, more attention is paid to the development of conservative therapeutic approaches leaving surgery defeated without surgical treatment. Two groups of patients with similar descending thoracic aortic atherosclerotic aneurisms (DTAAA) and abdominal aortic aneurisms (AAA) were retro- and prospectively studied over a 2-year period. Control group (Comparison group), (63 patients) received common surgical treatment from 2009 to 2010 whereas Main group (121 subjects) received multifaceted medical treatment to remove inflammatory reactions, strengthen aortic wall and control its dilation from 2011 to 2012. Operative treatment was used only in case of potential aneurism rupture. The comparison of the two groups of subjects showed that 2-year all-cause mortality in control group was 20.6% while in the main group it amounted to 9.1% due to the similar incidence of aneurism ruptures and deaths associated with concomitant diseases. It suggests that the odds ratio (OR) of survival when using attenuated therapeutic approach to treating atherosclerotic aneurisms is 2.6-fold higher compared to conventional surgical approach. One of the principal factors contributing to a higher mortality when using traditional surgical approach was the presence of polyorgan pathology that required constant medical correction irrespective of therapeutic option (surgical or medical) used. Another important factor is aortic aneurism wall frailty. The development of mechanisms that would allow its strengthening is considered a principal challenge of cutting-edge medicine that should be based on studies of triggers, molecular genetic bases of aortic wall immune-depending inflammatory formation, the production of pro-inflammatory cytokines, metalloproteinase activity that damages elastin and collagen fibers.
文摘BACKGROUND The vein of Galen aneurismal malformations(VGAM) are rare arteriovenous malformations of the embryonic choroid plexus. They represent about 30% of paediatric neurovascular disorders and show diverse characteristics. The VGAM is constituted by a midline dilated venous structure that receives blood from abnormal macroscopic or microscopic arteriovenous shunting vessels. Two types of VGAM exist, the choroidal and the mural. The treatment represents a challenge with the therapeutic objective to preserve the normal brain development without creating new neurological deficits.CASE SUMMARY We present three cases of VGAM in the early postnatal period and their treatment. All patents were treated with the endovascular technique, which was successful. According to our experience, the endovascular technique is a safe and efficient mode of VGAM treatment.CONCLUSION The objective of treatment aims to child's normal neurological development. A proper selection of patients and a thorough diagnostic workup is of vital importance. When the endovascular treatment is performed, the primary aim is not a complete VGAM exclusion at one time, which could produce a sudden reversal of blood flow with consequent venous infarction and ischemia. The aim is therefore to occlude as much of the VGAM as needed to relieve the congestive cardiac failure, to gain time and to create the conditions for a normal maturation of the neurovascular system. With the use of endovascular techniques, which represent not only the first choice of treatment but also the only safe therapeutic modality, the natural history of VGAM and their risks may be avoided safely.
文摘Aim: The interest of inflammatory marker increased in the last years, even in preventing clinical outcome after subarachnoid hemorrhage (SAH). Our objective was to study the relationships between C-reactive protein levels and clinical outcome and the development of cerebral vasospasm after aneurismal SAH. Methods: One hundred adult patients with aneurismal SAH were prospectively evaluated. Glasgow Coma Scale (GCS) score, Hunt and Hess grade, Fisher grade, CT scans, digital subtraction angiography studies, transcranial doppler (TCD) and daily neurological examinations were recorded. Serial serum CRP measurements were obtained on daily between admission and 10th days. Glasgow Outcome Scale (GOS) and the modified Rankin Scale (mRS) were used to predict outcome. Results: A progressive increase in the CRP levels from the admission to the 3rd postictal day was observed, followed by a slow decrease until the 9th day. Hemodynamic changes in TCD were associated with higher serum CRP levels. Patients with lower GCS scores presented with increased CRP levels. Patients with higher Hunt and Hess grades on admission developed significantly higher CRP serum levels. Patients with higher admission Fisher grades showed increased levels of CRP. A statistically significant inverse correlation was established in our series between CRP serum levels and GOS and mRS scores on discharge and CRP levels. Conclusion: Increased CRP levels were strongly associated with poor clinical outcome. CRP levels can predict cerebral vasospasm and delayed ischemic deficits with higher statistic significance. There are relationships between hemodynamic chances in TCD and higher CRP levels.
文摘目的:探讨CT平扫图像纹理分析鉴别骨巨细胞瘤(Giant cell tumor of bone,GCT)与动脉瘤样骨囊肿(Aneurismal bone cyst,ABC)的价值。方法:回顾性分析经手术病理证实的14例骨巨细胞瘤和15例动脉瘤样骨囊肿的影像学资料。在CT图像上手动勾画ROI测量CT值及提取纹理特征参数。采用两独立样本t检验或MannWhitney U检验比较两组间CT值及纹理参数的差异,对得到的CT值及纹理参数进行单因素和多因素Logistic回归分析,绘制ROC评价CT值、纹理参数和纹理参数模型的诊断效能。结果:两组间CT值差异有统计学意义,鉴别GCT和ABC的AUC为0.162。CT平扫图像共提取1044个纹理参数,经筛选获得8个有统计学意义的参数(orrelation_angle45_offset4、GLCMEntropy_AllDirection_offset1、sumVariance、sumEntropy、histogramEntropy、GLCMEntropy_angle45_offset1、Inertia_angle0_offset2、ShortRunEmphasis_angle135_offset6),其鉴别GCT和ABC的AUC分别为0.343、0.843、0.776、0.800、0.800、0.848、0.795、0.771;多因素Logistic回归分析获得的纹理参数模型预测GCT和ABC的AUC为0.900,CT值结合纹理参数获得的模型鉴别GCT和ABC的AUC为0.948。结论:CT值结合纹理参数模型对于鉴别GCT和ABC具有较高价值。
文摘Modern medicine has achieved much progress in the field of medical and surgical repair of a variety of disorders. It is especially true for the early stages of treatments. In long-term period, however, instead of recovery, we frequently observe progressive regression, which completely annuls all our efforts. Moreover, the algorithm used to correct acute process may sometimes be detrimental to organs and tissues. Such situation is also frequent in the treatment of atherosclerotic descending aortic aneurysms (DAA). This is because the successful medical and even surgical repair to prevent aneurysm rupture in long-term period may trigger some detrimental processes in other regions thus producing negative results of the treatment. The present article doesn’t aim to prove some provisions in DAA clinical picture, atherosclerosis and inflammatory states. But we have faced some systematicity at these clinical implications which are absolutely not specified in literature. We have managed to find an explanation for this thing making a scrupulous analysis of nonsurgical sources. Comparing them with our observations, we have found out that aseptic and septic inflammation of connective tissue, probably, is a key component in the formation of DAA disregarding of which correction of dyslipidemia may lead to negative results. We are looking for in-depth research and discussion.
