Endovascular treatment of complex intracranial aneurysms

Abstract

PurposeComplex intracranial aneurysms (CIA) are heterogenous group of intracranial vascular malformations. Due to its giant size, difficult location, broad neck, branches arising from the aneurysm, wall structure, calcification, presence of intraluminal thrombus or previous treatments it requires more careful approach. The aim of this study was to evaluate endovascular treatment results of CIA in our Department.Material and methodsIn order to differentiate CIA from all the aneurysms, treated endovascularly in years 2008-2014, authors proposed their own qualification criteria. Additionally, subgroup of patients with CIA with simultaneous subarachnoid haemorrhage (SAH) was divided. Clinical outcomes of patients were assessed with Glasgow Outcome Scale (GOS), while radiological outcomes were assessed with Montreal Scale. Aneurysm localization, incidence of aborted procedures, intraoperative complications were also evaluated.ResultsInternal carotid artery was the most common localization in both CIA and non-complex (nCIA) groups. Incidence of aborted procedures was significantly higher in CIA group than in nCIA (25% vs. 7%; p < 0.01). CIA group had worse Montreal scores then nCIA group (1.90 vs. 1.49; p < 0.01). Clinical outcome in GOS scale in patients with SAH and CIA was significantly worse than in SAH and nCIA (2.86 vs. 4.06; p = 0.04).ConclusionsTo conclude, proposed criteria of CIA should be taken into consideration during diagnosis and qualification to invasive treatment. Classifying aneurysm as CIA is related to greater possibility of aborting endovascular procedure due to technical difficulties.

A Computational Model of Blood D-Dimer, Cystatin C, and CRP Levels Predicts the Risk of Intracranial Aneurysms and their Rupture

“…Intracranial aneurysms are the main cause of subarachnoid hemorrhage, which can cause 30% to 50% of patients to die within the first 14 days after subarachnoid hemorrhage, and surviving patients will also have varying degrees of disability [4,23,24]. Studies have found that intracranial aneurysms can occur in people at any age and are more common in people aged 40 to 60, which has a serious impact on the lives of patients [25].…”

Outcome measures in neurosurgery: Is a unified approach better? A literature review

“…[ 27 ] However, the generality of the scale and the broad involvement of TBIs has allowed for applying GOS in several other areas, such as intracranial aneurysms, tumors, strokes, and cranioplasties. [ 12 , 14 , 16 , 40 ]…”

“…[27] However, the generality of the scale and the broad involvement of TBIs has allowed for applying GOS in several other areas, such as intracranial aneurysms, tumors, strokes, and cranioplasties. [12,14,16,40] Oncologic neurosurgery -The KPS Oncologic neurosurgery is mainly concerned with the management of all intracranial neoplastic tumors. Outcome measures of this subspecialty are crucial to assess the patient's response to different treatments.…”

“…Assess the functional recovery of patients after severe brain damage [13] Severe brain damage after traumatic brain injury [13] 1=Dead 2=Persistent neurovegetative state (patient unresponsiveness and speechless for weeks or months) 3=Severe disability (conscious but dependent for daily support) 4=Moderate disability (disabled but independent in daily life) 5=Good recovery [33] Intracranial aneurysms, tumors, strokes, and cranioplasties [12,27,46,48] mRS Classify functional recovery of patients with cerebrovascular accident at the time of discharge [42] Assess patients with cerebrovascular disease in adults (>60-years-old) at discharge or referral [42] 0=No symptom at all 1=No significant disability, able to carry out all usual duties and activities. 2=Slight disability, unable to carry out all previous activities but able to look after own affairs without assistance [10] 3=Moderate disability, requires some help but able to walk without assistance 4=Moderately severe disability, unable to walk without assistance and unable to attend to own bodily needs without assistance 5=Severe disability, bedridden, incontinent, and requiring constant nursing care and attention 6=Dead [42] e mRS has been used in aneurysmal pathologies, general brain injury, trials for targeted hypothermia, sarcopenia, spinal meningiomas, and in children with transverse myelitis [5,10,17,20,21,24,35] KPS Assess the functional status of tumours.…”