Initial Experience with Left Transradial Neurointerventions for Cerebral Aneurysms Using the 6-French Simmons Guiding Sheath

ObjectiveThe use of a transradial approach utilizing a Simmons-shaped catheter for neurointervention has been steadily increasing. Although the right radial artery is commonly used, in interventional cardiology, the left transradial approach offers clear clinical benefits for right-handed patients. To the best of our knowledge, no previous studies have examined intracranial aneurysm embolization with the routine use of the left transradial approach. The aim of this study was to evaluate the technical feasibility of left transradial intracranial aneurysm embolization.MethodsWe conducted a retrospective review of a prospective database of consecutive patients who had undergone left transradial intracranial aneurysm coiling using a 6-French Simmons guiding sheath between January and August 2021. The following outcome variables were then analyzed: whether the catheterization was successful, the angiographical results, and the presence of any procedure-related complications.ResultsIn total, 25 patients underwent left transradial coiling for 15 anterior and 10 posterior circulation aneurysms. The Simmons guiding sheath could be successfully shaped and cannulated into the targeted vessel in all patients. All aneurysms were completely embolized without any complications. Immediate postoperative angiograms showed Raymond 1 in 10 aneurysms (40.0%), Raymond 2 in 12 (48.0%), and Raymond 3a in 3 (12.0%). None of the patients required crossover to the right radial or femoral arteries, and no radial artery spasms or occlusions were observed.ConclusionThe results of this study suggest that the left transradial approach for intracranial aneurysm coiling is not only safe, effective, and technically feasible, but also provides improved comfort to right-handed patients.     

翼点微骨孔入路治疗颅内前循环动脉瘤

目的探讨应用微骨孔入路治疗颅内前循环动脉瘤的临床效果。方法2000年11月～2001年12月采用翼点微骨孔入路治疗前循环动脉瘤病人83例,共86个动脉瘤。其中颈内动脉眼段动脉瘤3例,颈内动脉C2段动脉瘤40例,颈内动脉分叉部动脉瘤4例,前交通动脉瘤19例,前动脉水平段动脉瘤2例,中动脉水平段5例,中动脉分叉部动脉瘤13例。结果成功治疗前循环动脉瘤病人83例,共夹闭86个动脉瘤。术后出现肢体活动障碍4例,占4.8%;无手术死亡。术后80例复查脑血管造影,显示动脉瘤消失。无与开颅入路相关的并发症。本组均未输异体血液,术中采用自体血回收后输血26例。结论翼点微骨孔入路夹闭颅内前循环动脉瘤,可以降低手术中的医源性损伤并获得满意的手术效果。     

EEG features associated with the occurrence of epilepsy after surgery for intracranial aneurysm and acoustic neuroma.

An investigation was carried out on 199 postoperative EEGs from 83 patients who underwent surgery for ruptured intracranial aneurysm or acoustic neuroma removal. The tracings were quantified without knowlege of the diagnostic group and whether or not epilepsy had supervened. The number of spikes and sharp components and slow waves at the site of the operative brain lesion were substantially and often significantly greater in the tracings from patients who developed epilepsy than from those who did not.     

Congenital anomalies of cerebral artery and intracranial aneurysm]

It is well known that congenital anomalies such as polycystic kidney, aortic coarctation, Marfan syndrome, Ehler-Danlos syndrome are apt to be complicated by intracranial aneurysms. In this report we attempt to reveal the relation and incidence between cerebrovascular anomalies and intracranial aneurysms. The etiology of aneurysms has been discussed, too. 12 cases of persistent trigeminl artery, 2 cases of persistent hypoglossal artery and 11 cases of fenestration were obtained from 3841 patients who were angiographically examined in our clinic for 5 years. The incidence is 0.31%, 0.05% and 0.29%, respectively. Persistent trigeminal arteries were complicated by 2 cases of intracranial aneurysms and one case of arterivenous malformations (AVM), persistent hypoglossal arteries were complicated by one case of aneurysm, and fenestrations were complicated by 2 cases of aneurysms and one case of AVM. One case of congenital agenesis of right internal carotid artery was obtained which was complicated by aneurysm of anterior communicating artery. Totally, 8 cases of aneurysms and AVM were obtained from 26 cases of cerebrovascular anomalies (incidence 30.8%). On the other hand, thalamic or caudate hemorrhage revealed the highest incidence of complication of intracranial aneurysms among intracerebral hematomas (10.7%). Compared with the incidence of aneurysms between cerebro vascular anomalies (30.8%) and thalamic or caudate hemorrhage (10.7%), the difference is statistically signigicant (P less than 0.05). The cause of intracranial aneurysm has not yet been clarified. But it is well accepted that the defect of tunica media vasorum is most responsible factor as to the occurrence of intracranial aneurysms. We concluded that the genetic error of cerebral vessels including defect of media caused intracranial aneurysms, and this result was supported from the evidence that cerebrovascular anomalies showed statistically high incidence of complication of intracranial aneurysms.     

前交通动脉破裂动脉瘤术后认知功能障碍的影响因素

目的 探讨前交通动脉破裂动脉瘤术后发生认知功能障碍的影响因素。方法 回顾性分析2017年1月至2020年2月手术治疗的204例前交通动脉破裂动脉瘤的临床资料。术后随访20～57个月,平均（36.7±9.4）个月;末次随访时,应用修订版认知功能电话问卷（TICS-m）评分评估认知功能,其中TICS-m评分≤27分认为存在认知功能障碍。结果 57例术后存在认知功能障碍,发生率为27.9%。多因素logistic回归分析显示,高血压病、开颅夹闭术、小学及以下教育程度是术后发生认知功能障碍的独立影响因素（P<0.05）。结论 前交通动脉破裂动脉瘤术后认知功能障碍发生率较高;治疗方法上,优先选择介入治疗,术后认知功能障碍风险低于夹闭术。另外,高血压病及病人受教育水平也与术后认知功能障碍密切相关。     

颅内破裂动脉瘤栓塞术后并发脑疝的危险因素分析

目的 探讨颅内破裂动脉瘤血管内栓塞术后发生脑疝的危险因素及预后。方法 回顾性分析2017年5月至2019年5月行血管内治疗的303例颅内破裂动脉瘤的临床资料。结果 26例术后发生脑疝,脑疝发生率为8.58%。多因素logistic回归分析显示入院WFNS分级Ⅳ～Ⅴ级、动脉瘤再次破裂、脑水肿是术后发生脑疝的独立危险因素（P<0.05）。ROC曲线分析显示,对于预测术后发生脑疝的效能：入院WFNS分级Ⅳ～Ⅴ级的曲线下面积（AUC）为0.734(95%CI 0.639～0.829;P<0.001),动脉瘤再破裂的AUC为0.632(95%CI 0.504～0.760;P=0.026),脑水肿的AUC为0.826(95%CI 0.723～0.928;P<0.001);入院WFNS分级Ⅳ～Ⅴ级+动脉瘤再次破裂+脑水肿的AUC为0.897(95%CI 0.819～0.974;P<0.001)。26例脑疝中,8例去骨瓣减压术治疗（4例出院时死亡;4例存活,随访1年,预后良好2例,预后不良2例）,18例未行去骨瓣减压术均死亡。26例脑疝病死率为84.62%。结论 颅内破裂动脉瘤...     

Incidence of postoperative epilepsy after a transtentorial approach to acoustic nerve tumours.

Sixty-nine patients who had neurosurgical treatment for acoustic neuroma by one of two different techniques were studied with a view to determining the incidence of postoperative epilepsy. Fourty-five patients who had larger tumours underwent a combined translabyrinthine and transtentorial neurosurgical approach. For the others with smaller neuromas a translabyrinthine method was used. Only the combined approach was associated with postoperative epilepsy, and it occurred in 22% of the patients. Epilepsy was associated with temporal love trauma during surgery.     

颅内动脉瘤术中微血管多普勒的应用研究

目的 探讨微血管多普勒超声(MDS)在颅内动脉瘤央闭术中的应用价值.方法 采用频率20MHZ、探头直径1mm的MDS对133例患者共141个脑动脉瘤术中监测,记录夹闭动脉瘤前后的瘤体内血流信号、载瘤动脉及其主要邻近血管的声频信号和血流速度.术后全部病例行DSA检查,与术中MDS监测结果对照分析.结果 手术夹闭全部动脉瘤.42例(31.6%)患者术中应用MDS定位动脉瘤或判断载瘤动脉走向.初次夹闭瘤颈后MDS显示,11个动脉瘤夹闭不全,16例发生载瘤动脉或邻近血管狭窄,调整瘤夹至瘤体内无血流信号、载瘤动脉及邻近血管恢复正常血流动力学特征.瘤夹调整率:大脑中动脉40.9%,颈内一后交通动脉段14%,颈内动脉其他段15.2%,前交通动脉段14.3%.术后复查DSA未见瘤体残留及瘤周血管狭窄.结论 MDS是一种无创、快捷、可信赖的术中监测技术,对动脉瘤定位有重要指导意义.     

Neuroform支架在颅内宽颈动脉瘤栓塞治疗中的应用

目的评估Neuroform支架对颅内宽颈动脉瘤的栓塞治疗效果。方法11例颅内宽颈动脉瘤使用Neuroform自膨式颅内支架结合电解可脱弹簧圈进行栓塞治疗。将预装好的Neuroform支架系统引入载瘤动脉处,通过同轴导管释放支架覆盖动脉瘤颈;支架释放后,行可脱弹簧圈栓塞术;术后维持全身肝素化48h。结果动脉瘤100%栓塞8例,95%栓塞2例,1例后交通动脉瘤,在支架释放后,颈内动脉痉挛,放弃栓塞,改为二期栓塞治疗。4例术后6个月复查脑血管造影,动脉瘤消失,载瘤动脉通畅。结论Neuroform支架结合电解可脱弹簧圈栓塞颅内宽颈动脉瘤可克服目前血管内治疗的技术障碍,既可保护载瘤动脉通畅,又可改善宽颈动脉瘤栓塞效果。     

Unruptured intracranial aneurysm as a cause of focal epilepsy: an excellent postoperative outcome after intra-arterial treatment.

This report involves a patient suffering from focal epilepsy caused by an unruptured, intracranial aneurysm (UIA), and her treatment using intravascular embolisation, with an excellent postoperative outcome in terms of the epilepsy. A 52 year-old, right-handed woman had been suffering for three years from focal seizures, characterized by loss of consciousness, and oroalimentary and hand automatisms. The epilepsy was not controlled by carbamazepine monotherapy. Magnetic resonance imaging and digital subtraction angiography revealed a saccular aneurysm at the bifurcation of the middle cerebral artery, in contact with the cortex of the temporal opercular region. An intra-arterial embolisation, using a detachable, mechanical spiral (MDS, Bold Platinum), was performed, with no complications. The purpose of embolisation was the treatment of the aneurysm. The patient had two more, complex partial seizures (CPS) in the early postoperative period, but was seizure-free between September 1998 and September 2002. This is the first case report that presents the successful treatment of UIA-related epilepsy by means of intravascular embolisation.     

大脑前动脉A1优势征与前交通动脉瘤关系的临床研究

目的探讨大脑前动脉（ACA）A1优势征与前交通动脉瘤的发生及生长方向之间的关系。方法回顾性分析500例数字减影脑血管造影的影像学资料,其中前交通动脉瘤128例,其他部位的动脉瘤244例,其余非动脉瘤患者128例。比较各组间A1优势征发生率的差别;同时比较A1优势征与A1对称患者动脉瘤生长方向的区别。结果全脑血管造影显示A1优势征的发生率在前交通动脉瘤患者为63.3%;其它部位动脉瘤患者为17.6%,非动脉瘤患者为20.3%。前交通动脉瘤中A1优势征的出现率明显高于其他两组（P〈0.05）。A1优势征的前交通动脉瘤向前上生长者明显高于A1对称者,分别为53.1%和31.9%（P〈0.05）;向后下、后上方的生长者总计少于A1对称者,分别为22.2%和42.6%（P〈0.05）。结论A1优势征与前交通动脉瘤的发生及生长方向密切相关。     

微血管多普勒超声在颈内动脉瘤手术中的应用

目的 探讨微血管多普勒超声(MVD)在颈内动脉瘤手术中的应用.方法 采用探头频率20MHz、直径1.5 mm,对32例颈内动脉瘤患者(共计36个动脉瘤)进行动脉瘤夹闭前后血流动力学监测.术后血管造影进行评估.结果 所有患者均能在动脉瘤顶或瘤体部监测到涡流样或毛刺样血流信号、闻及杂音.动脉瘤夹闭术后即刻监测,发现载瘤动脉狭窄8例,闭塞1例;动脉瘤夹闭不全2例,均经调整瘤夹位置,显示载瘤动脉远段的血流频谱形态和音频信号正常,术后经DSA/CTA证实.以上情况的发生与动脉瘤大小及载瘤动脉有粥样硬化斑块有关.结论 MVD可作为颅内动脉瘤手术的常规检测方法,尤其对瘤颈粗、甚至无明显瘤颈的巨大型动脉瘤手术具有指导意义.     

颅内动脉瘤术中临时阻断载瘤动脉的临床研究

目的探讨颅内动脉瘤手术中载瘤动脉临时阻断后继发脑缺血性脑功能损伤的相关因素。方法128例患者的130个动脉瘤临时阻断载瘤动脉，术后根据相应部位有无脑功能障碍，CT检查阻断血管供应区有无新鲜梗塞灶为标准判断是否造成缺血性脑损伤，并将性别、年龄、有无蛛网膜下腔出血、Hunt-Hess分级、动脉瘤的大小、部位、手术时机、阻断部位、时间、次数、方式、术中破裂、有无高血压、高血糖、载瘤动脉硬化斑块等14种因素进行单因素分析、探讨动脉阻断后可能导致缺血性损伤的原因。结果在130个动脉瘤中，共临时阻断166次，平均每个动脉瘤阻断1.28次，阻断时间为3～45min，平均每个动脉瘤阻断时间约为（9.8±7.8）min，有18例术后出现与载瘤动脉阻断有关新的脑缺血灶（14.06%），单因素分析显示年龄≥60岁、蛛网膜下腔出血、阻断时间≥20min和动脉硬化斑块对术后发生脑缺血具有较高危险性（均P〈0.05）。结论载瘤动脉临时阻断继发缺血性脑损伤与阻断部位、阻断时间、阻断方式、侧支循环的个体差异、病人术前状况等因素有关。阻断时间〈20min，临时载瘤动脉阻断是安全的。     

颅内蛇形动脉瘤的外科治疗（附21例报告）

目的 探讨蛇形动脉瘤的手术治疗方法。方法 21例蛇形动脉瘤中,14例未破裂动脉瘤,主要症状为头痛4例、可逆性脑缺血发作3例、颈项强直和后组脑神经压迫5例、视野缺损1例、癫痫发作1例;有动脉瘤破裂的7例中,Hunt - Hess Ⅰ级和Ⅱ级6例、Ⅲ级1例。病程从20d至3.5年,平均7.3个月。动脉瘤位于大脑中动脉M1段6例,M2段近端4例;大脑前动脉A1段1例,A.2段近端1例;大脑后动脉P1段2例;基底动脉主干2例,椎动脉5例。动脉瘤直径0.3 ～2.5 em,平均1.2 cm。13例动脉瘤长3.0 cm以上,8例动脉瘤长5.O cm以上。桡动脉移植搭桥7例,颞浅动脉搭桥6例,枕动脉搭桥6例,大隐静脉移植搭桥2例。12例为颅内外动脉搭桥,供血动脉为颈外动脉5例,枕动脉4例,颌内动脉3例。接受动脉为大脑中动脉5例,小脑后下动脉3例,大脑后动脉P2段3例,小脑前下动脉1例。9例为动脉瘤近端与远端间的血管间插入移植搭桥,包括大脑中动脉M1与M2段间的插入移植搭桥3例,M1段间的搭桥2例,大脑前动脉A1远端与A2近端插入搭桥2例,椎动脉颅内与颅外端间搭桥2例。在搭桥外血管完毕后,11例行动脉瘤孤立术;7例行动脉瘤切除;3例仅将动脉瘤近心端阻断,保护穿通动脉开通,避免缺血发生。结果 20例术后恢复良好,包括头痛缓解,癫痫局部发作或大发作消失,肢体活动障碍的改善和视力的恢复。1例出院时需要照顾。术后脑血管造影检查,19例移植搭桥血管畅通,动脉瘤消失;1例吻合血管未通,但无神经功能缺失表现;1例颅内外搭桥后,术后第2天手术部位出现血肿,手术清除血肿,术后肢体肌力Ⅳ级。结论 对于单纯手术无法夹闭的蛇形动脉瘤,通过适当血管搭桥或插入性移植的方法可得到满意的效果。     

Long-term aneurysm recurrence and de novo aneurysm formation after surgical treatment of unruptured intracranial aneurysms: a cohort study and systematic review

ABSTRACT

Objective: There is a relative lack of literature on long-term aneurysm recurrence and de novo aneurysm formation following surgical treatment of unruptured intracranial aneurysms. This retrospective single-center cohort study, therefore, analyzes the incidence of aneurysm recurrence, and the incidence of de novo aneurysms formation in patients with at least 10yrs of radiological follow-up. The data are put into the context of a systematic review of the literature.

Methods: Patients that underwent surgical treatment of an unruptured intracranial aneurysm at the Basel University Hospital were retrospectively identified. The rate of recurrent or de novo aneurysm formation was assessed for all patients with imaging follow-up ≥10yrs. A systematic review including studies with a mean follow-up period of ≥10yrs was then performed.

Results: A total of 95 patients had undergone surgical treatment of an unruptured intracranial aneurysm between 1994 and 2008. Twenty-one patients (22.1%) had available imaging follow-up ≥10yrs (mean: 13.1yrs). In these patients, aneurysm recurrence and de novo aneurysm formation were equally found in 23.8% (n = 5; 1.8%/yr). There was no case of aneurysm rupture from a recurrent or a de novo aneurysm. The systematic literature review covered a combined cohort of 1778 patients over a mean follow-up period of 14.0yrs. In this cohort, the aneurysm recurrence rate was 16.4% (0.7%/yr), and the rate of de novo aneurysm formation was 6.2% (0.4%/yr).

Discussion: Despite some discrepancy regarding the incidence, both cohorts show a non-negligible long-term risk of aneurysm recurrence and de novo aneurysm formation, which warrants life-long imaging follow-up.

Abbreviations: SD: standard deviation; DSA: digital subtraction angiography; CTA: computed tomography angiography; MRA: magnetic resonance angiography; MCA: middle cerebral artery; ACA: anterior cerebral artery; ACommA: anterior communicating artery; ICA: internal carotid artery; ADPKD: autosomal dominant polycystic kidney disease; MeSH: Medical Subject Headings     

Intracranial Aneurysm with Concomitant Rupture of an Undiagnosed Visceral Artery Aneurysm

Background  

Concomitant intracranial and visceral artery aneurysms are a rare occurrence. We report the case of a patient who underwent surgical repair of a ruptured intracranial aneurysm but subsequently experienced a ruptured hepatic artery aneurysm in the immediate postoperative period.     

MRA Fly-around重建在近颅底颅内动脉瘤诊治中的初步应用

目的初步评估MRA Fly-around重建在近颅底颅内动脉瘤诊治中的临床应用价值.方法 14例经手术确诊为颅内动脉瘤的病例术前应用东芝1.5 T MRVISART磁共振行3D TOF MRA检查,其后进行常规最大密度投影(MIP)和FLy-around重建.所有病例均接受了MSCTA检查.并在术后对2例病例进行了MRA复查.结果 MRA Fly-around重建发现动脉瘤14个,与手术和MSCTA相比动脉瘤的检出率为93.3%.MRA Fly-around重建能够清楚显示动脉瘤,而且可以去除骨影,消除骨质对动脉瘤观察的影响.术后MRA Fly-around重建动脉瘤夹局部可见伪影,影响对载瘤动脉局部的观察.结论 MRA Fly-around重建与常规MIP重建相比可以更好地描述动脉瘤及其与载瘤动脉之间的关系,在近颅底颅内动脉瘤诊断和治疗中可对DSA及CTA起到补充作用,但在使用钛制动脉瘤夹的颅内动脉瘤夹闭术后复查中效果欠佳.     

颅内肿瘤术后早期癫痫风险预测模型的构建和评价

目的 构建颅内肿瘤术后早期癫痫（EPS）风险预测模型并评价其预测效率、区分度、校准度及临床适用性。方法 回顾性分析2019年9月至2021年4月手术治疗的402例颅内肿瘤的临床资料。术后1周根据临床表现和脑电图诊断EPS。采用多因素logistic回归模型分析EPS的独立预测因素,采用R软件构建列线图预测模型并进行内部验证及评价。结果 402例中,42例术后1周发生EPS,发生率为10.45%。多因素logistic回归分析显示,术前癫痫病史、肿瘤未全切除、肿瘤位于额叶、术区水肿、术区出血是颅内肿瘤术后发生EPS的独立危险因素（P<0.05）,构建的列线图预测模型Harrell’s C-index为0.821(95%CI 0.754～0.888),预测灵敏度为0.857、特异度为0.625,内部验证后列线图的ROC曲线下面积为0.831(95%CI 0.765～0.886)。结论 颅内肿瘤发生EPS的影响因素很多,根据术前癫痫病史、肿瘤切除程度和肿瘤位置、术区水肿、术区出血构建的列线图预测模型具有良好的校准度和区分度,具有一定的临床适用性,能为临床提供参考依据。     

高级别动脉瘤性蛛网膜下腔出血再破裂的危险因素分析

目的 探讨高Fisher分级动脉瘤性蛛网膜下腔出血(aSAH)患者再破裂出血的相关危险因素,为早期预防再出血提供指导.方法 对327例高Fisher分级aSAH患者的临床资料进行回顾性分析,依据入院3日内是否发生再出血分为再出血组(n=37)和未出血组(n =290),利用单因素和多因素的方法来筛选影响再出血的相关危险...     

Intracranial meningiomas and epilepsy: incidence, prognosis and influencing factors

In a retrospective study of a consecutive series of 222 surgically treated meningiomas, it was found that 26.6% of the patients presented epilepsy as their initial symptom. In this group, surgical excision of the intracranial meningiomas stopped the epilepsy in about 62.7% of the patients. But approximately one-fifth of the patients with intracranial meningiomas and no history of preoperative epilepsy developed new onset postoperative seizures. Of the patients with early onset of postoperative epilepsy, epilepsy appeared in 66.7% within first 48 h after surgery. Of the patients with postoperative epilepsy, 71.2% were seizure-free following 1 year of anticonvulsant therapy. Regarding preoperative existing factors, intracranial meningiomas located at supratentorium, convexity, and with evidence of or severe peritumoral edema significantly contributed to preoperative epilepsy. And in patients with preoperative epilepsy, those tumors with evidence of or severe perifocal edema and cerebral edema at the operative site were significantly more likely to suffer from postoperative epilepsy.