The principles for choosing a surgical technique for patients with acute cerebral aneurysm rupture

Eliava, Sh Sh; Yakovlev, S B; Белоусова, О Б; Pilipenko, Yu V; Kheyreddin, A S; Shekhtman, O D; Okishev, D N; Konovalov, A N; Mikeladze, K G; Arustamyan, S R; Bocharov, Alexander V.; Bukharin, E Yu; Kurdyumova, N V; Tabasaranskiy, T F

doi:10.17116/neiro201680515-21

Cited by 7 publications

(3 citation statements)

References 14 publications

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“…Third, although excluding endovascularly treated patients with aSAH made the pooled cohort more uniform, future studies are needed to verify whether these findings also apply to endovascularly treated patients. Although the prevalence of endovascular aneurysm repair continues to increase, a large number or even majority of patients with aSAH are still treated surgically, particularly in many non-Western countries such as India, 35 Pakistan, 36 Russia, 37 Indonesia, 38 and Brazil. 39 Therefore, our findings may also have a wide impact on current practices, especially considering the global obesity epidemic.…”

Section: Discussionmentioning

confidence: 99%

Body Mass Index and the Risk of Poor Outcome in Surgically Treated Patients With Good-Grade Aneurysmal Subarachnoid Hemorrhage

Rautalin

Juvela

Macdonald³

et al. 2022

Neurosurgery

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BACKGROUND: Heterogeneity among study populations and treatment procedures has led to conflicting results on outcome predictors for patients with aneurysmal subarachnoid hemorrhage (aSAH). One such conflicting predictor is body mass index (BMI). OBJECTIVE: To clarify whether high BMI values protect patients from poor outcome after aSAH, as previously suggested. METHODS: We surveyed 6 prospective studies conducted in 14 different countries (93 healthcare units) between 1985 and 2016 and pooled the data on surgically treated patients with good-grade (Glasgow Coma Scale 13-15 on admission) aSAH. We calculated BMI for each patient and created 4 balanced categories based on the BMI quartiles of each cohort. We calculated adjusted odds ratios (ORs) with 95% CIs for the 3-month poor outcome (Glasgow Outcome Scale 1-3) by BMI. RESULTS: The pooled study cohort included 1692 patients with good-grade aSAH (mean age 51 years; 64% female). At 3 months, 288 (17%) had poor outcomes. The risk for poor outcomes increased with increasing BMI values (OR = 1.15 [1.02-1.31] per each standard deviation increase of BMI). The risk for poor outcome was over 1.6 times higher (OR = 1.66 [1.13-2.43]) in the highest BMI category (range 27.1-69.2) compared with the lowest BMI category (range 14.4-23.8). These associations were found in each of the 6 study cohorts in both men and women, regardless of age. CONCLUSION: Because higher BMI values seem to associate with poor outcomes in surgically treated patients with good-grade aSAH, it seems unlikely that obesity protects patients with aSAH from poor outcomes.

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Section: Discussionmentioning

confidence: 99%

Body Mass Index and the Risk of Poor Outcome in Surgically Treated Patients With Good-Grade Aneurysmal Subarachnoid Hemorrhage

Rautalin

Juvela

Macdonald³

et al. 2022

Neurosurgery

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“…The choice of the surgery type was based on the institutional algorithms for cerebral aneurysms,[9,10] including: Preference for endovascular surgery in patients with aneurysms of the intracranial VA segmentPreference for microsurgery for all PICA aneurysms and VA aneurysms with PICA originating from the aneurysm neck or sac.…”

Section: Methodsmentioning

confidence: 99%

Vertebral artery and posterior inferior cerebellar artery aneurysms: Results of microsurgical treatment of eighty patients

Pilipenko¹,

Eliava²,

Okishev³

et al. 2019

Surgical Neurology International

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Background: The choice of surgical approaches and options for the microsurgical vertebral artery (VA) and posterior inferior cerebellar artery (PICA) aneurysms repair remains controversial. Methods: A retrospective analysis of the clinical, surgical, and angiographic data of 80 patients with VA and PICA aneurysms treated from 2012 to 2018 was performed. Results: The aneurysms were saccular in 50 cases (62.5%) and fusiform in 30 cases (37.5%). The median suboccipital craniotomy was the most common approach (73.8%). Retrosigmoid craniotomy was performed in 25% of patients. There were the following types of microsurgical operations: neck clipping (61.25%), clipping with the artery lumen formation (13.75%), trapping (10%), proximal clipping (5%), and deconstruction with anastomosis (10%). Fifty-seven (71.3%) patients were discharged without worsening of the clinical signs after surgery. The most common postoperative neurological disorder was palsy of IX and X cranial nerve revealed in 14 (17.5%) patients. No fatal outcomes or patients in vegetative state were identified. The complete occlusion of PICA and VA aneurysms according angiography was in 77 (96.3%) cases. Conclusion: Microsurgical treatment is an effective method for VA and PICA aneurysms. The majority of VA and PICA aneurysms do not require complex basal approaches. A thorough preoperative planning, reconstructive clipping techniques, and anastomoses creation, as well as patient selection based on the established algorithms and consultations with endovascular surgeons, may reduce the number of complications and increase the rate of complete microsurgical occlusion in VA and PICA aneurysms.

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“…4) Focusing: in order to obtain a clear image, the operating microscope needs to focus on the surgical field repeatedly. At present, although electromagnetic technology has been used to simplify the relevant process of focusing, however, focusing is a time-consuming step [6].…”

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confidence: 99%

Microsurgical Repair of Dura Mater Rupture Caused by Movement

2020

IJHPM

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With the increasing of medical technology, the demand for the repair of the related tissue and organ injury is also growing. At the same time, microsurgery plays an increasingly important role in the successful completion of difficult operations. After the end of spinal surgery, dural rupture and cerebrospinal fluid leakage are relatively common complications. In order to study the micro repair technique of dural rupture caused by surgery, 30 patients with dural rupture were selected in this paper. After MRI showed that there was suspected vascular lesions in spinal canal, all cases were confirmed by digital subtraction angiography. This study showed that after microsurgery, there were 20 patients with excellent evaluation grade, and the average score of aminov score was 0.6, accounting for 80% of the total number of patients; 5 patients with good evaluation grade, with an average score of 4.5 points, accounting for 10% of the total number; 3 patients with medium evaluation grade, with an average score of 6.2 points, accounting for 7% of the total number; 2 patients with poor evaluation grade, with an average score of 8.9 points, accounting for 3% of the total number. In the related evaluation of comprehensive efficacy, 23 cases were cured, accounting for 73% of the number of researchers, 5 cases were improved, accounting for 17% of the number of researchers, 2 cases were unchanged, accounting for 10% of the number of researchers, and there was no worsening case. Therefore, for the dural rupture caused by exercise, the treatment of dural rupture during operation and the comprehensive treatment after operation are very important.

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The principles for choosing a surgical technique for patients with acute cerebral aneurysm rupture

Cited by 7 publications

References 14 publications

Body Mass Index and the Risk of Poor Outcome in Surgically Treated Patients With Good-Grade Aneurysmal Subarachnoid Hemorrhage

Body Mass Index and the Risk of Poor Outcome in Surgically Treated Patients With Good-Grade Aneurysmal Subarachnoid Hemorrhage

Vertebral artery and posterior inferior cerebellar artery aneurysms: Results of microsurgical treatment of eighty patients

Microsurgical Repair of Dura Mater Rupture Caused by Movement

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