OBJECTIVE: Frameless stereotactic aspiration of a hematoma can be the one of the treatment options for spontaneous intracerebral hemorrhage in the basal ganglia. Postoperative hematoma enlargement, however, can be a serious complication of intracranial surgery that frequently results in severe neurological deficit and even death. Therefore, it is important to identify the risk factors of postoperative hematoma growth. METHODS: During a 13-year period, 101 patients underwent minimally invasive frameless stereotactic aspiration for basal ganglia hematoma. Patients were classified into two groups according to whether or not they had postoperative hematoma enlargement in a computed tomography scan. Baseline demographic data and several risk factors, such as hypertension, preoperative hematoma growth, antiplatelet medication, presence of concomitant intraventricular hemorrhage (IVH), were analysed via a univariate statistical study. RESULTS: Nine of 101 patients (8.9%) showed hematoma enlargement after frameless stereotactic aspiration. Among the various risk factors, concomitant IVH and antiplatelet medication were found to be significantly associated with postoperative enlargement of hematomas. CONCLUSION: In conclusion, our study revealed that aspirin use and concomitant IVH are factors associated with hematoma enlargement subsequent to frameless stereotactic aspiration for basal ganglia hematoma.
Aspirin ; Basal Ganglia Hemorrhage ; Basal Ganglia* ; Cerebral Hemorrhage ; Hematoma* ; Hemorrhage ; Humans ; Hypertension ; Risk Factors* ; Statistics as Topic ; Stereotaxic Techniques ; Suction

Symptomatic cerebral vasospasm (CVS) and delayed ischemic neurologic deficit (DIND) after unruptured aneurysm surgery are extremely rare. Its onset timing is variable, and its mechanisms are unclear. We report two cases of CVS with DIND after unruptured aneurysm surgery and review the literature regarding potential mechanisms. The first case is a 51-year-old woman with non-hemorrhagic vasospasm after unruptured left anterior communicating artery aneurysm surgery. She presented with delayed vasospasm on postoperative day 14. The second case is a 45-year-old woman who suffered from oculomotor nerve palsy caused by an unruptured posterior communicatig artery (PCoA) aneurysm. DIND with non-hemorrhagic vasospasm developed on postoperative day 12. To our knowledge, this is the first report of symptomatic CVS with oculomotor nerve palsy following unruptured PCoA aneurysm surgery. CVS with DIND after unruptured aneurysm surgery is very rare and can be triggered by multiple mechanisms, such as hemorrhage, mechanical stress to the arterial wall, or the trigemino-cerebrovascular system. For unruptured aneurysm surgery, although it is rare, careful observation and treatments can be needed for postoperative CVS with DIND.

Objective: : When treating high-positioned anterior communicating artery (ACoA) aneurysms, pterional-transsylvian and interhemispheric approaches are both viable options, yet comparative studies of these two surgical approaches are rare. Accordingly, this retrospective study investigated the surgical results of both approaches. Methods: : Twenty-four patients underwent a pterional approach (n=11) or interhemispheric approach (n=13), including a unilateral low anterior interhemispheric approach or bifrontal interhemispheric approach, for high-positioned ACoA aneurysms with an aneurysm dome height >15 mm and aneurysm neck height >10 mm both measured from the level of the anterior clinoid process. The clinical and radiological data were reviewed to investigate the surgical results and risk factors of incomplete clipping. Results: : The pterional patient group showed a significantly higher incidence of incomplete clipping than the interhemispheric patient group (p=0.031). Four patients (36.4%) who underwent a pterional approach showed a postclipping aneurysm remnant, whereas all the patients who experienced an interhemispheric approach showed complete clipping. In one case, the aneurysm remnant was obliterated by coiling, while follow-up of the other three cases showed the remnants remained limited to the aneurysm base. A multivariate analysis revealed that a pterional approach for a large aneurysm with a diameter >8 mm presented a statistically significant risk factor for incomplete clipping. Conclusion : For high-positioned ACoA aneurysms with a dome height >15 mm and neck height >10 mm above the level of the anterior clinoid process, a large aneurysm with a diameter >8 mm can be clipped more completely via an interhemispheric approach than via a pterional approach.

Symptomatic cerebral vasospasm (CVS) and delayed ischemic neurologic deficit (DIND) after unruptured aneurysm surgery are extremely rare. Its onset timing is variable, and its mechanisms are unclear. We report two cases of CVS with DIND after unruptured aneurysm surgery and review the literature regarding potential mechanisms. The first case is a 51-year-old woman with non-hemorrhagic vasospasm after unruptured left anterior communicating artery aneurysm surgery. She presented with delayed vasospasm on postoperative day 14. The second case is a 45-year-old woman who suffered from oculomotor nerve palsy caused by an unruptured posterior communicatig artery (PCoA) aneurysm. DIND with non-hemorrhagic vasospasm developed on postoperative day 12. To our knowledge, this is the first report of symptomatic CVS with oculomotor nerve palsy following unruptured PCoA aneurysm surgery. CVS with DIND after unruptured aneurysm surgery is very rare and can be triggered by multiple mechanisms, such as hemorrhage, mechanical stress to the arterial wall, or the trigemino-cerebrovascular system. For unruptured aneurysm surgery, although it is rare, careful observation and treatments can be needed for postoperative CVS with DIND.

Objective: : When treating high-positioned anterior communicating artery (ACoA) aneurysms, pterional-transsylvian and interhemispheric approaches are both viable options, yet comparative studies of these two surgical approaches are rare. Accordingly, this retrospective study investigated the surgical results of both approaches. Methods: : Twenty-four patients underwent a pterional approach (n=11) or interhemispheric approach (n=13), including a unilateral low anterior interhemispheric approach or bifrontal interhemispheric approach, for high-positioned ACoA aneurysms with an aneurysm dome height >15 mm and aneurysm neck height >10 mm both measured from the level of the anterior clinoid process. The clinical and radiological data were reviewed to investigate the surgical results and risk factors of incomplete clipping. Results: : The pterional patient group showed a significantly higher incidence of incomplete clipping than the interhemispheric patient group (p=0.031). Four patients (36.4%) who underwent a pterional approach showed a postclipping aneurysm remnant, whereas all the patients who experienced an interhemispheric approach showed complete clipping. In one case, the aneurysm remnant was obliterated by coiling, while follow-up of the other three cases showed the remnants remained limited to the aneurysm base. A multivariate analysis revealed that a pterional approach for a large aneurysm with a diameter >8 mm presented a statistically significant risk factor for incomplete clipping. Conclusion : For high-positioned ACoA aneurysms with a dome height >15 mm and neck height >10 mm above the level of the anterior clinoid process, a large aneurysm with a diameter >8 mm can be clipped more completely via an interhemispheric approach than via a pterional approach.

Methods: In total, 176 stent-assisted coil embolization procedures were investigated. Among them, 77 ruptured and 99 unruptured aneurysms were grouped and compared respectively. In the ruptured group, only SAPT (aspirin) was administered after the procedure. Meanwhile, in the unruptured group, dual antiplatelet therapy (DAPT) (aspirin and clopidogrel) was administered before and after the procedure following standard guidelines. We compared both groups in regards to thromboembolic complications by analyzing post procedural diffusion-weighted images (DWI), hyperacute thrombosis during the procedure, and post-procedural symptoms. Results: The single antiplatelet therapy ruptured intracranial aneurysm (SAPT-RIA) group had 77 saccular aneurysms (62 ICA, 3 MCA, 4 ACA, 8 posterior circulation) with a mean diameter of 8.07 mm. The dual antiplatelet therapy unruptured intracranial aneurysm (DAPT-UIA) group had 99 aneurysms (81 ICA, 5 MCA, 3 ACA, 10 posterior circulation) with a mean diameter of 6.32 mm. DWI positivity rates were similar between groups, but hyperacute thrombosis was higher in the SAPT-RIA group (10.4%) compared to none in the DAPT-UIA group. Each group had one symptomatic complication. Conclusions SAPT could be a viable option for the peri-procedural management of SAC in acutely ruptured cases.

Methods: In total, 176 stent-assisted coil embolization procedures were investigated. Among them, 77 ruptured and 99 unruptured aneurysms were grouped and compared respectively. In the ruptured group, only SAPT (aspirin) was administered after the procedure. Meanwhile, in the unruptured group, dual antiplatelet therapy (DAPT) (aspirin and clopidogrel) was administered before and after the procedure following standard guidelines. We compared both groups in regards to thromboembolic complications by analyzing post procedural diffusion-weighted images (DWI), hyperacute thrombosis during the procedure, and post-procedural symptoms. Results: The single antiplatelet therapy ruptured intracranial aneurysm (SAPT-RIA) group had 77 saccular aneurysms (62 ICA, 3 MCA, 4 ACA, 8 posterior circulation) with a mean diameter of 8.07 mm. The dual antiplatelet therapy unruptured intracranial aneurysm (DAPT-UIA) group had 99 aneurysms (81 ICA, 5 MCA, 3 ACA, 10 posterior circulation) with a mean diameter of 6.32 mm. DWI positivity rates were similar between groups, but hyperacute thrombosis was higher in the SAPT-RIA group (10.4%) compared to none in the DAPT-UIA group. Each group had one symptomatic complication. Conclusions SAPT could be a viable option for the peri-procedural management of SAC in acutely ruptured cases.

Methods: In total, 176 stent-assisted coil embolization procedures were investigated. Among them, 77 ruptured and 99 unruptured aneurysms were grouped and compared respectively. In the ruptured group, only SAPT (aspirin) was administered after the procedure. Meanwhile, in the unruptured group, dual antiplatelet therapy (DAPT) (aspirin and clopidogrel) was administered before and after the procedure following standard guidelines. We compared both groups in regards to thromboembolic complications by analyzing post procedural diffusion-weighted images (DWI), hyperacute thrombosis during the procedure, and post-procedural symptoms. Results: The single antiplatelet therapy ruptured intracranial aneurysm (SAPT-RIA) group had 77 saccular aneurysms (62 ICA, 3 MCA, 4 ACA, 8 posterior circulation) with a mean diameter of 8.07 mm. The dual antiplatelet therapy unruptured intracranial aneurysm (DAPT-UIA) group had 99 aneurysms (81 ICA, 5 MCA, 3 ACA, 10 posterior circulation) with a mean diameter of 6.32 mm. DWI positivity rates were similar between groups, but hyperacute thrombosis was higher in the SAPT-RIA group (10.4%) compared to none in the DAPT-UIA group. Each group had one symptomatic complication. Conclusions SAPT could be a viable option for the peri-procedural management of SAC in acutely ruptured cases.

OBJECTIVE: This study used the intradural procedural time to assess the overall technical difficulty involved in surgically clipping an unruptured middle cerebral artery (MCA) aneurysm via a pterional or superciliary approach. The clinical and radiological variables affecting the intradural procedural time were investigated, and the intradural procedural time compared between a superciliary keyhole approach and a pterional approach. METHODS: During a 5.5-year period, patients with a single MCA aneurysm were enrolled in this retrospective study. The selection criteria for a superciliary keyhole approach included : 1) maximum diameter of the unruptured MCA aneurysm <15 mm, 2) neck diameter of the MCA aneurysm <10 mm, and 3) aneurysm location involving the sphenoidal or horizontal segment of MCA (M1) segment and MCA bifurcation, excluding aneurysms distal to the MCA genu. Meanwhile, the control comparison group included patients with the same selection criteria as for a superciliary approach, yet who preferred a pterional approach to avoid a postoperative facial wound or due to preoperative skin trouble in the supraorbital area. To determine the variables affecting the intradural procedural time, a multiple regression analysis was performed using such data as the patient age and gender, maximum aneurysm diameter, aneurysm neck diameter, and length of the pre-aneurysm M1 segment. In addition, the intradural procedural times were compared between the superciliary and pterional patient groups, along with the other variables. RESULTS: A total of 160 patients underwent a superciliary (n=124) or pterional (n=36) approach for an unruptured MCA aneurysm. In the multiple regression analysis, an increase in the diameter of the aneurysm neck (p<0.001) was identified as a statistically significant factor increasing the intradural procedural time. A Pearson correlation analysis also showed a positive correlation (r=0.340) between the neck diameter and the intradural procedural time. When comparing the superciliary and pterional groups, no statistically significant between-group difference was found in terms of the intradural procedural time reflecting the technical difficulty (mean±standard deviation : 29.8±13.0 min versus 27.7±9.6 min). CONCLUSION: A superciliary keyhole approach can be a useful alternative to a pterional approach for an unruptured MCA aneurysm with a maximum diameter <15 mm and neck diameter <10 mm, representing no more of a technical challenge. For both surgical approaches, the technical difficulty increases along with the neck diameter of the MCA aneurysm.
Aneurysm ; Humans ; Intracranial Aneurysm* ; Middle Cerebral Artery* ; Neck ; Patient Selection ; Retrospective Studies ; Skin ; Wounds and Injuries

OBJECTIVE: While the risk of aneurysmal rebleeding induced by catheter cerebral angiography is a serious concern and can delay angiography for a few hours after a subarachnoid hemorrhage (SAH), current angiographic technology and techniques have been much improved. Therefore, this study investigated the risk of aneurysmal rebleeding when using a recent angiographic technique immediately after SAH.METHODS: Patients with acute SAH underwent immediate catheter angiography on admission. A four-vessel examination was conducted using a biplane digital subtraction angiography (DSA) system that applied a low injection rate and small volume of a diluted contrast, along with appropriate control of hypertension. Intra-angiographic aneurysmal rebleeding was diagnosed in cases of extravasation of the contrast medium during angiography or increased intracranial bleeding evident in flat-panel detector computed tomography scans.RESULTS: In-hospital recurrent hemorrhages before definitive treatment to obliterate the ruptured aneurysm occurred in 11 of 266 patients (4.1%). Following a univariate analysis, a multivariate analysis using a logistic regression analysis revealed that modified Fisher grade 4 was a statistically significant risk factor for an in-hospital recurrent hemorrhage (p =0.032). Cerebral angiography after SAH was performed on 88 patients ≤3 hours, 74 patients between 3–6 hours, and 104 patients >6 hours. None of the time intervals showed any cases of intra-angiographic rebleeding. Moreover, even though the DSA ≤3 hours group included more patients with a poor clinical grade and modified Fisher grade 4, no case of aneurysmal rebleeding occurred during erebral angiography.CONCLUSION: Despite the high risk of aneurysmal rebleeding within a few hours after SAH, emergency cerebral angiography after SAH can be acceptable without increasing the risk of intra-angiographic rebleeding when using current angiographic techniques and equipment.
Aneurysm ; Aneurysm, Ruptured ; Angiography ; Angiography, Digital Subtraction ; Catheters ; Cerebral Angiography ; Emergencies ; Hemorrhage ; Humans ; Hypertension ; Intracranial Aneurysm ; Logistic Models ; Multivariate Analysis ; Risk Factors ; Subarachnoid Hemorrhage