What Percentage of Surgically Clipped Intracranial Aneurysms Have Residual Necks?

Thornton, John; Bashir, Qasim; Aletich, Victor; Debrun, Gérard; Ausman, James I.; Charbel, Fady T.

doi:10.1097/00006123-200006000-00003

Cited by 155 publications

(71 citation statements)

References 12 publications

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“…Except for the results of postoperative cerebral angiography, these were relatively high rates compared with previous incidences, 5,8,18,24) and may be attributed to various factors. First, in the present study, a small residual neck that may have been previously ignored was included as an aneurysm remnant.…”

Section: Discussionmentioning

confidence: 57%

“…24) Postoperative angiography after clipping of cerebral aneurysms showed that the incidence of residual aneurysms was 2.3% to 14%. 24) Aneurysm remnants after clipping may regrow and lead to recurrent symptoms of hemorrhage or mass effect.…”

Section: Introductionmentioning

confidence: 99%

“…24) Aneurysm remnants after clipping may regrow and lead to recurrent symptoms of hemorrhage or mass effect. 4,5,[7][8][9]11,14,[16][17][18][19][20][21]24) Therefore, aneurysm surgery should aim at complete circulatory exclusion of aneurysms, but this cannot be achieved in several circumstances including large necks, insufficient exposure, and mal-positioning of clips. 4,7,9,20) Aneurysm remnants can be classified into two groups, dog-ear and broad-based remnant.…”

Section: Introductionmentioning

confidence: 99%

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Simulation of Clipping Position for Cerebral Aneurysms Using Three-dimensional Computed Tomography Angiography

Futami

Nakada

Iwato

et al. 2004

Neurol. Med. Chir.(Tokyo)

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A novel method for the simulation of the clipping position for cerebral aneurysms based on threedimensional computed tomography (3D CT) angiography was evaluated. Rotating the regional 3D CT angiography images including the aneurysm provided the virtual intraoperative views of 36 cerebral aneurysms that were eligible for clipping through a pterional approach with a perpendicularly applied straight clip. The cut-along-trace function of the 3D CT workstation was used to simulate the clipping position. The presence or absence of aneurysm remnants was preoperatively evaluated by observing the clipping simulation image. Intraoperative endoscopy and postoperative cerebral angiography were routinely performed to confirm the completeness of obliterations. Nineteen of 21 aneurysms for which complete obliteration was preoperatively expected were confirmed to have no aneurysm remnant. Nine of 15 aneurysms which were expected to have aneurysm remnant were confirmed to persist. The clipping simulation images could correctly predict aneurysm remnant after the initial clipping with a sensitivity of 90.5% and specificity of 60%. The present simulation method can predict aneurysm remnants and improve the likelihood of complete obliteration by clipping.

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Section: Discussionmentioning

confidence: 57%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Simulation of Clipping Position for Cerebral Aneurysms Using Three-dimensional Computed Tomography Angiography

Futami

Nakada

Iwato

et al. 2004

Neurol. Med. Chir.(Tokyo)

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“…10,11 Long-term follow-up has also revealed new aneurysms in 8% of patients after subarachnoid hemorrhage, 12,13 indicating the importance of postoperative follow-up. To date, postoperative status has usually been evaluated by using DSA.…”

Section: Discussionmentioning

confidence: 99%

Subtraction 3D CT Angiography with the Orbital Synchronized Helical Scan Technique for the Evaluation of Postoperative Cerebral Aneurysms Treated with Cobalt-Alloy Clips

Watanabe¹,

Kashiwagi²,

Yamada³

et al. 2008

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE:CT angiography (CTA) has been used for the evaluation of intracranial aneurysms and recently has been applied to assess postoperative aneurysms treated with titanium-alloy clips. We investigated the clinical usefulness of subtraction CTA by using the orbital synchronized helical scan technique (OSHST) for evaluating intracranial aneurysms surgically treated with cobalt-alloy clips.

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“…Na série de 169 casos publicada por Cognard et al 15 , em 44% deles foi verificada oclusão sub-total ou incompleta, 18 deles necessitando de tratamento endovascular complementar. A análise destas séries é de grande importância na comparação dos resultados obtidos após clipagem cirúrgica 16,17 .…”

Section: Discussionunclassified

Estudo comparativo entre aneurismas rotos tratados por cirurgia e por via endovascular

Conrad

Pélissou-Guyotat

Morel

et al. 2002

Arq. Neuro-Psiquiatr.

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RESUMO -Realizamos análise comparativa dos resultados clínicos e radiológicos após o tratamento de aneurisma roto, localizado no setor anterior, por cirurgia ou por via endovascular. Entre 1995 e 1999, 78 pacientes foram tratados em nosso serviço por apresentarem ruptura de aneurisma intracraniano com grau clínico (Hunt & Hess) variando entre I e III. Dentre estes pacientes, 52 foram operados, 21 embolizados e 5 fizeram tratamento combinado. Dos casos cirúrgicos, o resultado clínico foi considerado ótimo em 80,8% com mortalidade de 5% e oclusão completa do aneurisma em 96,2%. Dos pacientes embolizados, 95% dos casos o resultado foi considerado ótimo com oclusão completa do aneurisma em 42,8%. O tratamento endovascular de aneurismas intracranianos apresenta uma vantagem no resultado clínico em relação aos aneurismas operados. Porém, apresentam taxa de exclusão completa baixa e podem necessitar de tratamento complementar. PALAVRAS-CHAVES: aneurismas intracranianos, repermeabilização, cirurgia após embolização.Comparative study for ruptured aneurysms treated by surgery and endovascular method Comparative study for ruptured aneurysms treated by surgery and endovascular method Comparative study for ruptured aneurysms treated by surgery and endovascular method Comparative study for ruptured aneurysms treated by surgery and endovascular method Comparative study for ruptured aneurysms treated by surgery and endovascular method ABSTRACT -The management of intracranial aneurysms has truly evolved after the introduction of the endovascular treatment. In this paper we compare patients that were operated or embolized for intracranial aneurysms. Between 1995 and 1999, 78 grade I to III ruptured aneurysms were treated in our service: 52 patients were operated, 21 were embolized and 5 were submitted to combinated endovascular and surgical treatment. In the surgical group, clinical outcome was very good in 80.8% of cases with 5% of mortality with 96.2% of total exclusion of the aneurysm. In the endovascular group, 95% of cases the clinical outcome was very good with only 42.8% of total exclusion of the aneurysm. By the endovascular method for treatment of aneurysms, we can obtain a good clinical outcome but a poor radiological outcome and sometimes need a complementary surgical procedure to treat residual aneurysm. O manejo dos aneurismas intracranianos e suas complicações tem evoluido após a introdução do tratamento endovascular por Guglielmi Detachable Coils (GDC) na década de 90. Este método é uma opção alternativa para os casos de difícil acesso cirúr-gico. Os resultados do tratamento cirúrgico dos aneurismas tem melhorado após a aplicação de técnicas microscópicas e do tratamento clínico e cirúrgico precoces após a sua ruptura 1,2 . As técnicas do tratamento endovascular têm evoluido muito nestes úl-timos anos, após os primeiros relatos de Serbinenko em 19743 . Isto conduziu a ampla utilização da téc-nica no tratamento dos aneurismas intracranianos, até mesmo em casos em que uma clipagem cirúrgi-ca seria possível, devido ao...

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What Percentage of Surgically Clipped Intracranial Aneurysms Have Residual Necks?

Cited by 155 publications

References 12 publications

Simulation of Clipping Position for Cerebral Aneurysms Using Three-dimensional Computed Tomography Angiography

Simulation of Clipping Position for Cerebral Aneurysms Using Three-dimensional Computed Tomography Angiography

Subtraction 3D CT Angiography with the Orbital Synchronized Helical Scan Technique for the Evaluation of Postoperative Cerebral Aneurysms Treated with Cobalt-Alloy Clips

Estudo comparativo entre aneurismas rotos tratados por cirurgia e por via endovascular

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