Aneurysm, Infected/surgery* ; Endocarditis/surgery* ; Endocarditis, Bacterial/surgery* ; Humans ; Intracranial Aneurysm/surgery*

OBJECTIVETo evaluate the effect of aneurysm clipping and partial blood clot removal in the subarachnoid space on hemorrhage volume in the subarachnoid space and cerebral vasospasm in patients with different Fisher grades.

METHODSPatients with subarachnoid space hemorrhage (SAH) of Fisher Grades I, II, and III were subdivided into control and treatment groups for comparative studies. The patients with unruptured intracranial aneurysms (UIAs) undergoing aneurysm clipping were also compared with Fisher grade I control subgroup. OxyHb levels in the cerebrospinal fluid and cerebral blood flow volume (CBFV) of the middle cerebral artery (MCA) were measured on days 3, 7, and 13 day after SAH.

RESULTSThe patients with UIAs and Fisher Grade I control subgroup showed significant differences in OxyHb levels on day 3 in CBFV of the MCA on days 3 and 7 (P<0.05). In the SAH groups, OxyHb levels increased significantly on day 3 day in the treatment subgroups of Fisher Grades I and II, but declined significantly on days 7 and 13 in Fisher Grade III treatment subgroup as compared with the corresponding control subgroups (P<0.05); in Fisher Grade I group on days 3 and 7 and in Fisher Grade II group on day 7, CBFV of the MCA increased significantly in the treatment subgroups, but in Fisher Grade III group, CBFV decreased significantly on days 7 and 13 compared with the control subgroup (P<0.05). A positive correlation was found between OxyHb levels in the cerebrospinal fluid and CBFV of the MCA (P<0.05).

CONCLUSIONFor patients with Fisher Grades I and II aneurysms, craniotomy may increase hemorrhage volume in the subarachnoid space and exacerbate cerebral vasospasm, but for Grade III patients, aneurysm clipping and blood clot removal shows beneficial effects in terms of reducing hemorrhage volume and relieving cerebral vasospasm.

Aged ; Aneurysm, Ruptured ; surgery ; Female ; Humans ; Intracranial Aneurysm ; surgery ; Male ; Middle Aged ; Subarachnoid Hemorrhage ; cerebrospinal fluid ; surgery ; Vasospasm, Intracranial ; surgery

OBJECTIVETo investigate the feasibility,safety and follow-up results of multiple stents parallel placement and reconstruction technique for treating giant vertebrobasilar dissecting aneurysms.

METHODSFive consecutive patients with giant fusiform vertebrobasilar dissecting aneurysms in Department of Neurology,Chinese People's Liberation Army General Hospital were retrospectively reviewed from April 2011 to October 2013. All patients were diagnosed vertebrobasilar dissecting aneurysms by MRI and digital subtraction angiography (DSA), the aneurysm size ranged 8.2-15.0 mm. All patients were treated by multiple stents parallel placement and reconstruction technique under general anesthesia. In the endovascular treatment process, 2-3 Solitaire or Neuroform self-expandable stents were parallel implanted in the maximum extension segment of the aneurysms to reconstruct the cavity of the aneurysm and solved the problem that the diameter of the intracranial stent is less than the diameter of the aneurysms. Multiple stents parallel placement can keep the stents stable in the cavity. The parallel stent can close the dissection as well as strengthen the aneurysm walls to alleviate the vessel pulsative compression of the brain stem. Furthermore, one of the parallel stents was selected for the main blood flow channel. Based on the main channel, telescope technique was used to completely covering the dissection. It can not only prevent the progress of dissection to normal regions, but also be helpful for blood flow channel reconstruction to reduce the hemodynamic disorders. All Patients received routine antiplatelet therapy before and after endovascular treatment.

RESULTSThe operative procedures were succeeded in all patients. Five patients were implanted 18 stents (3 stents in 3 patients; 4 stents in 1 patient; 5 stents in 1 patient; parallel 3 stents in 2 patients; parallel 2 stents in 3 patients). The signs and symptoms of brain stem and posterior group of cranial nerves improved significantly. All patients lived and worked normally and had no recurrent symptoms on follow-up of 6-24 months. All patients performed DSA reexamination at 6-12 months postoperation. The aneurysm size lessened in 2 patients and had no change in 3 patients.

CONCLUSIONSMultiple stents parallel placement and reconstruction technique for treating giant fusiform vertebrobasilar dissecting aneurysms is feasible and have good operation safety. It may control the dilatation of the aneurysm and reduce the probability of thrombosis or hemorrhage. It can improve the patients' clinical symptoms and quality of life in short term follow-up. The long term result need for further follow-up.

Aneurysm, Dissecting ; surgery ; Humans ; Intracranial Aneurysm ; surgery ; Quality of Life ; Retrospective Studies ; Stents ; Treatment Outcome

OBJECTIVETo evaluate the efficacy of the surgery with lateral supraorbital approach for clipping anterior circulation aneurysms.

METHODSThe clinical data of 99 patients with anterior circulation aneurysms who underwent a clipping via lateral supraorbital approach from October 2012 to September 2014 and 75 patients, who underwent a clipping via pterional approach from January 2010 to December 2011 in the second Affiliated Hospital, Zhejiang University School of Medicine were reviewed. The operative duration, prognosis, residual rate and rupture rate during surgery were compared between two groups.

RESULTSThe patients by lateral supraorbital approach had a shorter operative duration, namely 37~61 min less than that in the patients by pterional approach. No difference were found in residual rate and rupture rate between two groups. The Glasgow Outcome Scale (GOS) at 3 months after surgery showed no significant difference between two groups.

CONCLUSIONThe lateral supraorbital approach can be used safely and effectively with shorter operative duration and less tissue damage for treatment of patients with anterior circulation aneurysms.

Aneurysm, Ruptured ; surgery ; Glasgow Outcome Scale ; Humans ; Intracranial Aneurysm ; surgery ; Neurosurgical Procedures ; methods

OBJECTIVETo review the surgical modality with pterional keyhole approach in treatment of anterior circulation aneurysm.

METHODSThree hundred and thirteen patients with ruptured anterior circulation intracranial aneurysm treated surgically with pterional keyhole approach between January 2009 and June 2014 in Department of Neurosurgery, the Second Affiliated Hospital of Zhejiang University School of Medicine, were included in the analysis. Complete occlusion rate of aneurysms and incidence of major complications including delayed cerebral ischemia and chronic hydrocephalus were documented. Surgical outcomes at 6-month follow up were assessed by modified Rankin Scale.

RESULTSTotally 348 aneurysms were treated with pterional keyhole approach, 326 aneurysms were completely clipped, 16 aneurysms were partly clipped, and 6 aneurysms were wrapped with gauze material. Among 313 patients, 15 patients (4.79%) suffered from delayed cerebral ischemia, and 10 patients (3.19%) suffered from hydrocephalus. At the 6-month follow up, the rate of good outcome was 66.77% (209/313).

CONCLUSIONSThe pterional keyhole approach can be used to clip most of anterior circulation aneurysms, and it seems to have advantages over the traditional approaches with lower incidence of complications and similar outcomes.

Aneurysm, Ruptured ; surgery ; Humans ; Intracranial Aneurysm ; surgery ; Neurosurgical Procedures ; methods ; Retrospective Studies ; Treatment Outcome

In recent years, in the absence of venous component, dilated, overlapping, and tortuous arteries forming a mass of arterial loops with a coil-like appearance have been defined as pure arterial malformation (PAM). It is extremely rare, and its etiology and treatment have not yet been fully elucidated. Here, we reported 2 cases of PAM with associated aneurysmal subarachnoid hemorrhage in this paper. Both patients had severe headache as the first symptom. Subarachnoid hemorrhage was found by CT and computed tomography angiography (CTA) and PAM with associated aneurysm was found by digital subtraction angiography (DSA). In view of the distribution of blood and the location of aneurysms, the aneurysm rupture was the most likely to be considered. Based on the involvement of the lesion in the distal blood supply, only the aneurysm was clamped during the operation. It used to be consider that PAM is safety, because of the presentation and natural history of previously reported cases. Through the cases we reported, we have doubted about "the benign natural history" and discussed its treatment. PAM can promote the formation of aneurysms and should be reviewed regularly. The surgical indications for PAM patients with aneurysm formation need to be further clarified. Management of PAM patients with ruptured aneurysm is the same as that of ruptured aneurysm. Whether there are indications needed to treat simple arterial malformations remains to be further elucidated with the multicenter, randomized controlled studies on this disease.
Aneurysm, Ruptured/surgery* ; Angiography, Digital Subtraction ; Cerebral Angiography ; Humans ; Intracranial Aneurysm/surgery* ; Subarachnoid Hemorrhage/etiology*

Giant and complex aneurysm of the posterior circulation can pose several technical challenges with high operative morbidity. Recent advances in cardiac surgery have raised interest in the technique of deep hypothermic circulatory arrest for the management of giant and complex intracranial aneurysms of posterior circulation. The criteria for selecting patients for this procedure can be based on a preoperative analysis of available studies that suggests high risk with standard intervention. Using the technique of deep hypothermic circulatory arrest, we have successfully operated on a case of complex basilar tip aneurysm with MoyaMoya disease resulting in no significant neurological complications. We therefore suggest that patients with giant and complex intracranial aneurysms of posterior circulation might benefit from the use of deep hypothermic circulatory arrest technique.
Aneurysm* ; Cardiopulmonary Bypass ; Circulatory Arrest, Deep Hypothermia Induced* ; Humans ; Intracranial Aneurysm ; Moyamoya Disease* ; Thoracic Surgery

The management of infectious intracranial aneurysm, either by antibiotics alone or by surgery plus antibiotic therapy, remains controversal. Some authors have recommended initial treatment with antibiotics, plus serial angiography, and consider surgery only in cases where aneurysm enlargement during antibiotic treatment or persistence after treatment is documented. Due to the unpredictable rebleeding rate and high morbidity and mortality rate associated with rebleeding, others have argued for prompt surgical intervention. We report a case of surgically treated infectious intracranial aneurysm located distal to the trifurcation of the right middle cerebral artery. During the course of high-dose antibiotic therapy, rupture and rapid enlargement occurred ; after the operation, the patient underwent cardiac surgery and is at present in good health.
Aneurysm ; Angiography ; Anti-Bacterial Agents ; Humans ; Intracranial Aneurysm* ; Middle Cerebral Artery ; Mortality ; Rupture ; Thoracic Surgery

Adult ; Female ; Humans ; Intracranial Aneurysm ; surgery ; Middle Aged ; Subarachnoid Hemorrhage ; surgery ; Takayasu Arteritis ; surgery

This paper analysed the rhinoscope's clinical value in microsurgical treatment of intracranial aneurysms. Application of the rhinoscope in 87 patients, only 2 patients had ruptured during operation. However, 11 cases had ruptured in 94 cases without using rhinoscope, P < 0.05, they had a significant difference. By DSA follow-up review, 82 cases of used rhinoscope only 2 cases had remained the aneurysm neck, but 9 cases had the aneurysm neck in 77 cases which had not used the rhinoscope in the microsurgical treatment, P < 0.05, they also had significant difference. The application of rhinoscope in microsurgical treatment of intracranial aneurysms intraoperative, can reduce the risk of the intraoperative aneurysm rupture. It can achieve better clinical effect.
Adult ; Aged ; Endoscopy ; Female ; Humans ; Intracranial Aneurysm ; surgery ; Male ; Microsurgery ; Middle Aged ; Nose ; surgery ; Treatment Outcome