Anesthetic Management of Intracranial Aneurysms

2018 ◽  
Author(s):  
Matthew J Hammer ◽  
Laura B Hemmer
Keyword(s):  
Intracranial Aneurysm ◽  
Intracranial Aneurysms ◽  
Motor Evoked Potentials ◽  
Anesthetic Management ◽  
Endovascular Coiling ◽  
Key Words Adenosine ◽  
The Past ◽  
Surgical Clip ◽  
Complex Patients ◽  
Grading Scales

Despite efforts in the past decades to improve outcomes, intracranial aneurysm surgery still carries a considerable mortality risk, and its complications can cause a marked disability. To optimize and safely anesthetize a patient for these high-risk surgeries, the anesthesiologist must have a detailed understanding of the natural history, systemic physiologic perturbations, and intraoperative and postoperative complications of intracranial aneurysms. Various grading scales are used to predict adverse events, such as vasospasm or mortality, and are outlined in this chapter. Endovascular coiling and open surgical clip ligation (clipping) are the two most commonly employed interventions for treatment of aneurysms. The anesthetic goals for these complex patients are summarized.   This review contains 2 tables and 59 references.  Key Words: adenosine, burst suppression, emergence hypertension, endovascular coiling, indocyanine green, intracranial aneurysm clipping, intraoperative hypothermia, motor evoked potentials

scholarly journals Evaluation of Safety and Successfulness of the Coil Embolization of Intracranial Aneurysms

2019 ◽  
Vol 20 (2) ◽  
pp. 17-22
Author(s):  
Snezana Lukic ◽  
Milan Mijailovic ◽  
Vojin Kovacevic ◽  
Valentina Opancina
Keyword(s):  
Intracranial Aneurysm ◽  
Intracranial Aneurysms ◽  
Interventional Procedure ◽  
Case Series ◽  
Interventional Neuroradiology ◽  
Endovascular Coiling ◽  
Minimal Invasiveness ◽  
Clinical Center ◽  
Ruptured Intracranial Aneurysm ◽  
Ruptured Intracranial Aneurysms

Abstract Intracranial aneurisms are ongoing problem for neurosurgeons and especially for interventional neuroradiologists due to its morbidity and mortality. The method of choice for treatment of the unruptured and ruptured intracranial aneurysms is endovascular coiling on account of its minimal invasiveness and high effectiveness. The aim of our study was to evaluate the safety and successfulness of endovascular coiling procedure in unruptured and ruptured intracranial aneurysms. Our study was designed as case series and consisted of patients older than 18 years, who underwent endovascular coiling of unruptured and ruptured intracranial aneurysms and follow-up examination 6 months after the interventional procedure. The procedures were performed from December 2010 to December 2016, by experienced interventional neuroradilogists (more than 400 performed embolizations each) at the Department for Interventional Neuroradiology, Clinical Center Kragujevac, Serbia. There were 681 patients (average age 47.5 ± 11.2 years) treated with endovascular coiling, out of them 324 (234 females, 90 males) had unruptured intracranial aneurysm and 357 (138 females, 219 males) had ruptured intracranial aneurysm. In our series, total complication rate was 11.71 %. Analysis of the results after first endovascular procedure has shown that complete aneurysm occlusion was accomplished in 546 patients (80.3%), near-complete in 81 patients (11.8%), and incomplete in 54 patients (7.9 %). Our results were satisfying regarding the procedure’s success, safety, outcomes and study material. However, further technical development of the materials and constant training of the interventional radiologists, are a necessity in order to improve treatment outcomes and patients’ benefit.

Uncertainty and agreement in the management of unruptured intracranial aneurysms

2014 ◽  
Vol 120 (3) ◽  
pp. 618-623 ◽  
Author(s):  
Tim E. Darsaut ◽  
Laurent Estrade ◽  
Sara Jamali ◽  
Michel W. Bojanowski ◽  
Miguel Chagnon ◽  
...  
Keyword(s):  
Decision Making ◽  
Coil Embolization ◽  
Intracranial Aneurysms ◽  
Treatment Options ◽  
Endovascular Coiling ◽  
Trial Participation ◽  
Years Of Experience ◽  
Surgical Clip ◽  
Unruptured Intracranial Aneurysms ◽  
Surgery Trial

Object The management of unruptured intracranial aneurysms remains controversial. The goal of this study was to evaluate the clinical community agreement in decision making regarding unruptured intracranial aneurysms. Methods A portfolio of 41 cases of unruptured intracranial aneurysms with angiographic images, along with a short description of the patient presentation, was sent to 28 clinicians (16 radiologists and 12 surgeons) with varying years of experience in the management of unruptured intracranial aneurysms. Five senior clinicians responded twice at least 3 months apart. Nineteen cases (46%) were selected from patients recruited in the Canadian UnRuptured Endovascular versus Surgery trial, an ongoing randomized comparison of coil embolization and clip placement. For each case, the responder was to first choose between 3 treatment options (observation, surgical clip placement, or endovascular coil embolization) and then indicate their level of certainty on a quantitative 0–10 scale. Agreement in decision making was studied using κ statistics. Results Decisions to coil were more frequent (n = 612, 53%) than decisions to clip (n = 289, 25%) or to observe (n = 259, 22%). Interjudge agreement was only fair (κ = 0.31 ± 0.02) for all cases and all judges, despite substantial intrajudge agreement (range 0.44–0.83 ± 0.10), with high mean individual certainty levels for each case (range 6.5–9.4 ± 2.0 on a scale of 0–10). Agreement was no better within specialties (surgeons or radiologists), within capability groups (those able to perform endovascular coiling alone, surgical clipping alone, or both), or with more experience. There was no correlation between certainty levels and years of experience. Agreement was lower when the cases were taken from the randomized trial (κ = 0.19 ± 0.2) compared with nontrial cases (κ = 0.35 ± 0.2). Conclusions Individuals do not agree regarding the management of unruptured intracranial aneurysms, even when they share a background in the same specialty, similar capabilities in aneurysm management, or years of practice. If community equipoise is a necessary precondition for trial participation, this study has found sufficient uncertainty and disagreement among clinicians to justify randomized trials.

scholarly journals The Changing Landscape of Treatment for Intracranial Aneurysm

2019 ◽  
Vol 46 (2) ◽  
pp. 159-165
Author(s):  
Christopher S. Lozano ◽  
Andres M. Lozano ◽  
Julian Spears
Keyword(s):  
Intracranial Aneurysm ◽  
Intracranial Aneurysms ◽  
Open Surgery ◽  
Flow Diversion ◽  
Surgical Approaches ◽  
Past Century ◽  
Crossover Point ◽  
The Past ◽  
Liquid Material ◽  
Over Time

ABSTRACT:There has been a significant transformation in the treatment of intracranial aneurysms (IAs) over the past century, with the most pivotal changes occurring in the past three decades. To characterize this evolution, we assessed the number of articles published on various procedures for the treatment of IA as a measure of their interest and usage over time. We separated our analysis into two main areas: surgical and endovascular approaches. We further subdivided these two main categories into clipping and bypass for surgery, and coiling, flow diversion, and liquid material embolization for endovascular approaches. We found 5956 publications on open surgical approaches in the 70-year period from 1947 to 2017, with papers on clipping (n = 4204), being the most common. We found 8602 endovascular publications beginning in 1964, with most of the activity taking place in the late 1990s and beyond. Coiling had the most publications of the endovascular approaches (n = 5436). In 1999, the number of annual publications on endovascular treatments surpassed those of open surgery, signaling a crossover point in the IA literature. The same trend continues to this date.

A New Stent for Direct Treatment of Intracranial Aneurysms

2009 ◽  
Author(s):  
Xiang Zhou ◽  
Zhong You
Keyword(s):  
Intracranial Aneurysms ◽  
Open Surgery ◽  
Layer Structure ◽  
Operation Time ◽  
Endovascular Coiling ◽  
Artery Wall ◽  
Surgical Clipping ◽  
Surgical Clip ◽  
Subarachnoid Hemorrhages ◽  
The Brain

The intracranial aneurysm is a weak region in the wall of an artery in the brain, where dilation of the artery wall may occur. Because the wall of the aneurysm is very thin, lacking the normal layer structure found in healthy arteries, it is easy to rupture and leads to subarachnoid hemorrhages [1, 2]. Current methods for treating the intracranial aneurysms are surgical clipping and endovascular coiling [3]. In the surgical clipping method, a surgical clip is placed across the neck of the aneurysm through open surgery. The risk of this method is high, especially for elderly or medically complicated patients. In endovascular coiling, one or more coils are delivered into the aneurysm from a remote incision on the artery to trigger a thrombus inside the aneurysm sac. This method is less invasive and therefore safer compared to surgical clipping. However, it is less suitable for treating wide-necked aneurysms because the coils can not stay permanently inside the aneurysm sac. To solve this problem, stents have been used in association with coils [4]. In this procedure, a stent is first placed across the neck of the aneurysm, serving as a scaffold inside the artery lumen. Then, the coils are delivered into the aneurysm through the interstices of the stent. Although stent-assisted coiling is superior to using coils alone for the treatment of the wide-necked aneurysms, it is more complicated and requires longer operation time. Besides, neither of the coiling embolization methods can be used for treating the aneurysms which lack a defined saccular component.

scholarly journals Secular pattern of aneurismal rupture with the lunar cycle and season

2016 ◽  
Vol 23 (1) ◽  
pp. 60-63 ◽  
Author(s):  
Jillian C Banfield ◽  
Mohamed Abdolell ◽  
Jai S Shankar
Keyword(s):  
Intracranial Aneurysm ◽  
Intracranial Aneurysms ◽  
Full Moon ◽  
Lunar Cycle ◽  
Aneurysm Rupture ◽  
Endovascular Coiling ◽  
The Moon ◽  
Moon Phases ◽  
Ruptured Intracranial Aneurysm ◽  
New Moon

Background The lunar cycle and seasons may be associated with rates of rupture of intracranial aneurysms, but the literature is mixed. Studies of the association between the lunar cycle and rates of aneurysm rupture used the eight qualitative moon phases. The purpose of this study was to assess any association of aneurysm rupture with the lunar cycle and with the season. Materials and methods We retrospectively reviewed all cases of subarachnoid haemorrhage secondary to ruptured intracranial aneurysm treated with endovascular coiling in our institution over a 10-year period. We included only cases with a known rupture date. We used the degree of illumination of the moon to quantitatively code the lunar cycle. Results A total of 212 cases were included in our analyses. The odds of aneurysm rupture were significantly greater ( p < 0.001) when the moon was least (new moon) and most (full moon) illuminated, as compared to the middle of the lunar cycle. The odds of rupture tended to be higher ( p = 0.059) in the summer, compared to autumn. Conclusions The odds of aneurysm rupture were greater when the moon was least illuminated (new moon) and most illuminated (full moon), compared to the middle of the lunar cycle.

Clinical Case: Complications after Endovascular Treatment of Intracranial Aneurysm in a Patient after Subarachnoid Hemorrhage

2020 ◽  
Vol 8 (1) ◽  
pp. 9-15
Author(s):  
Petrov Nikolay ◽  
◽  
Marinova R. ◽  
Odiseeva Ev.
Keyword(s):  
Intracranial Aneurysm ◽  
Endovascular Treatment ◽  
Clinical Case ◽  
Endovascular Coiling ◽  
Published Data ◽  
Military Medical Academy ◽  
Life Threatening ◽  
Arachnoid Hemorrhage ◽  
The Right ◽  
Brain Artery

Abstract: Intracranial aneurysm is one of the most common neurovascular complications. During the recent years the accepted treatment of enraptured cranial aneurysm is noninvasive endovascular coiling. This technique is modern but it is not without complications which can be serious and life-threatening. A clinical case of a patient admitted to the ICU of Military Medical Academy - Sofia with sub arachnoid hemorrhage is described. After a positive clinical course, the check-up magnetic resonance showed intracranial aneurism of the right carotid artery. The patient underwent angiographic endovascular treatment. Vasospasm of the middle and right brain artery and thrombosis were detected during the procedure. Attempt of thromboaspiration was made without success. This article reviews published data on broad-spectrum researches concerning complications of endovascular coiling of intracranial aneurysms and the ways to prevent and reduce them.

scholarly journals Endovascular embolization versus surgical clipping in a single surgeon series of basilar artery aneurysms: a complementary approach in the endovascular era

2021 ◽  
Vol 163 (5) ◽  
pp. 1527-1540
Author(s):  
Ethan A. Winkler ◽  
Anthony Lee ◽  
John K. Yue ◽  
Kunal P. Raygor ◽  
W. Caleb Rutledge ◽  
...  
Keyword(s):  
Basilar Artery ◽  
Open Surgery ◽  
Endovascular Embolization ◽  
Neurologic Outcome ◽  
Endovascular Coiling ◽  
Surgical Clip ◽  
Complementary Approach ◽  
Complete Obliteration ◽  
Good Neurologic Outcome ◽  
Appropriate Therapy

Abstract Background Currently, most basilar artery aneurysms (BAAs) are treated endovascularly. Surgery remains an appropriate therapy for a subset of all intracranial aneurysms. Whether open microsurgery would be required or utilized, and to what extent, for BAAs treated by a surgeon who performs both endovascular and open procedures has not been reported. Methods Retrospective analysis of prospectively maintained, single-surgeon series of BAAs treated with endovascular or open surgery from the first 5 years of practice. Results Forty-two procedures were performed in 34 patients to treat BAAs—including aneurysms arising from basilar artery apex, trunk, and perforators. Unruptured BAAs accounted for 35/42 cases (83.3%), and the mean aneurysm diameter was 8.4 ± 5.4 mm. Endovascular coiling—including stent-assisted coiling—accounted for 26/42 (61.9%) treatments and led to complete obliteration in 76.9% of cases. Four patients in the endovascular cohort required re-treatment. Surgical clip reconstruction accounted for 16/42 (38.1%) treatments and led to complete obliteration in 88.5% of cases. Good neurologic outcome (mRS ≤ 2) was achieved in 88.5% and 75.0% of patients in endovascular and open surgical cohorts, respectively (p = 0.40). Univariate logistic regression analysis demonstrated that advanced age (OR 1.11[95% CI 1.01–1.23]) or peri-procedural adverse event (OR 85.0 [95% CI 6.5–118.9]), but not treatment modality (OR 0.39[95% CI 0.08–2.04]), was the predictor of poor neurologic outcome. Conclusions Complementary implementation of both endovascular and open surgery facilitates individualized treatment planning of BAAs. By leveraging strengths of both techniques, equivalent clinical outcomes and technical proficiency may be achieved with both modalities.

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