Aneurysm Surgery Research Articles

Aortic ischemia-reperfusion injury and potency of fluoxetine.

Due to cross-clamping of the aorta during aortic aneurysm surgeries, ischemia-reperfusion (IR) develops, and it may cause damage to the aorta itself or even to remote organs by oxidative stress or inflammation. Fluoxetine (FLX) which might be used in the preoperative period for its tranquilizing effect also has antioxidant effects in short-term use. The purpose of our study is to examine whether FLX protects aorta tissue, against the damage caused by IR. Three groups of Wistar rats were formed randomly. 1) Control group (sham-operated), 2) IR group (60 min ischemia+120 min perfusion), and 3) FLX+IR group (FLX dose was 20 mg/kg for 3 days IP before IR). At the end of each procedure, aorta samples were collected, and oxidant-antioxidant, anti-inflammatory, and anti-apoptotic status of the aorta were evaluated. Histological examinations of the samples were provided. Levels of LOOH, MDA, ROS, TOS, MPO, TNFα, IL-1β, IL-6, NF-kB, MMP-9, caspase-9, 8-OHdG, NO, and HA were found to be significantly increased in the IR group compared with control (P<0.05) and SOD, GSH, TAS, and IL-10 levels were significantly lower (P<0.05). FLX significantly decreased LOOH, MDA, ROS, TOS, MPO, TNFα, IL-1β, IL-6, NF-kB, MMP-9, caspase-9, 8-OHdG, NO, and HA levels in the FLX+IR group compared with IR group (P<0.05) and increased IL-10, SOD, GSH, and TAS (P<0.05). FLX administration prevented the deterioration of aortic tissue damage. Our study is the first study that demonstrates FLX-mediated suppression of IR injury in the infrarenal abdominal aorta by antioxidant, anti-inflammatory, and anti-apoptotic properties.

The epidemiology of pathologically confirmed clinically isolated aortitis: a North American population-based study.

Clinically isolated aortitis (CIA) refers to inflammation of the aorta without signs of systemic vasculitis or infection. Population-based data on the epidemiology of CIA in North America is lacking. We aimed to investigate the epidemiology of pathologically confirmed CIA. Residents of Olmsted County, Minnesota were screened for thoracic aortic aneurysm procedures with current procedural terminology codes between January 1, 2000, and December 31, 2021, using the resources of the Rochester Epidemiology Project. The medical records of all patients were manually reviewed. CIA was defined as histopathologically confirmed active aortitis diagnosed by evaluation of aortic tissue obtained during thoracic aortic aneurysm surgery in the absence of any infection, rheumatic disease, or systemic vasculitis. Incidence rates were age and sex adjusted to the 2020 United States total population. Eight incident cases of CIA were diagnosed during the study period; 6 (75%) of them were female. Median (IQR) age at diagnosis of CIA was 78.3 (70.2-78.9) years; all were diagnosed following ascending aortic aneurysm repair. The overall age and sex adjusted annual incidence rate of CIA was 8.9 (95% CI, 2.7-15.1) per 1,000,000 individuals over age 50 years. The median (IQR) duration of follow-up was 8.7 (1.2-12.0) years. The overall mortality compared to the age and sex matched general population did not differ (standardised mortality ratio: 1.58; 95% CI, 0.51-3.68). This is the first population-based epidemiologic study of pathologically confirmed CIA in North America. CIA predominantly affects women in their eighth decade and is quite rare.

Before emergency aneurysm surgery, CTA or DSA? A single center experience.

Subarachnoid hemorrhage (SAH) due to an intracranial aneurysm is a life-threatening surgical emergency. After the diagnosis of SAH, physicians should find the reason for the bleeding. CT- Angiography (CTA) and Digital Subtraction Angiography (DSA) are techniques used to visualize the aneurysm. However, which one will surgeons prefer? In this study, we have compared these two radiological examinations. This study includes 58 patients diagnosed with SAH and intracranial aneurysm diagnosis based on CTA (n=30) and DSA (n=28). We evaluated the patients according to demographic properties, CTA and DAS findings, aneurysm location, Fisher score, postoperative complications, and Glasgow outcome score. The most common location of aneurysms was the M1 level (48.3%). Patients in the DSA group had significantly more extended hospital stays (p= 0.021). There was no statistically significant difference between the two groups in complications. Enhanced CT Technologies provide higher fidelity images and shorten hospital stays. With CTA, surgeons may gain time for an emergency surgical procedure. Despite the fact that DSA remains a significant factor in aneurysm diagnosis, DSA is an invasive procedure and needs more time to diagnose.

Open Surgery for Abdominal Aortic Aneurysm: 980 Consecutive Patient Outcomes from a High-Volume Centre in the United Kingdom.

Controversy persists regarding the optimal treatment for large abdominal aortic aneurysm (AAA), highlighted by the publication of the National Institute for Health and Care Excellence (NICE) guideline (NG156) on March 2020. The pendulum of opinion swings once more from endovascular to open surgical treatment. We report our experience over the last 15years in treating consecutive AAA by open surgery. A retrospective review of a prospectively collected vascular database of all patients undergoing infra-renal open abdominal aortic aneurysm repair (OR) repair from 2004 to 2019 at the largest aneurysm centre in the United Kingdom. OR for elective and emergency (ruptured and symptomatic) outcomes included early morbidity and 30-day mortality, and long-term survival. 1017 patients underwent OR between 2004-2019, on application of our inclusion-criteria 994 patients formed our cohort for analysis (81.2% male) with a mean age 73.6 ± 7.8years treated by OR for AAA. In that group 672 were elective and 308 were emergency (for ruptured or symptomatic). Overall 30day mortality was 11.3%, elective 30day mortality was 2.5%, and emergency 30day mortality was 29.9%. 30day re-intervention rate was 9.5%, (elective 7.0%, emergency 15.9%). Survival at 1000days for elective repair was 72 v 46.7% for emergency and at 2000 days was 43.4% for elective v 25% for emergency. Our data confirm that open surgery for AAA can be performed in large volume centres quite safely. Elective and Emergency surgery does affect early 30day mortality but does not influence long-term outcome.

Modified extradural selective anterior clinoidectomy leaving the optic canal unopened for internal carotid aneurysms: A technical note

BackgroundAnterior clinoidectomy is an established procedure used to decompress the optic nerve, mobilize the internal carotid artery (ICA), or enlarge the retrocarotid space. However, its use carries the risk of optic nerve injury. In certain surgeries, such as those for internal carotid aneurysms, propose modification to the anterior clinoidectomy for enlarging the retrocarotid space, especially in operations for ICA aneurysms. MethodsAfter the anterior clinoid process (ACP) is sufficiently exposed, the internal cancellous bone or pneumatization can be removed through a small window created at its lateral edge to reveal the compact bone of the optic canal. Since the compact bone of the inferior surface facing the ICA is absent or very thin, the ACP can be removed by drilling through the anchoring compact bone with the optic canal in direct sight. ResultsIn 10 consecutive internal carotid aneurysm cases, the ACP was successfully removed without opening of the optic canal to enlarge the retrocarotid space. ConclusionsAnterior clinoidectomy can be performed to enlarge the retrocarotid space without opening the optic canal from outside the dura.

Hybrid surgery for thoracoabdominal aortic aneurysm at Dong Nai General Hospital: A case report

Introduction: Thoracic and abdominal aortic disease is a rare, serious disease and one of the major challenges for the surgeon with a high prognosis of complications and mortality. Surgery combined with endovascular intervention is a new, minimally invasive method with good early results and good mid-term results.&#x0D; Methods: We report a case diagnosed with thoracoabdominal aortic aneurysm underwent hybrid intervention at Dong Nai General Hospital&#x0D; Results: A 68-year-old female patient was diagnosed with Crawford Type V thoracoabdominal aortic aneurysm, underwent debranching surgery of the superior mesenteric artery and celiac trunk followed by stent graft deployment of the diseased aorta, the postoperative course was uneventful.&#x0D; Conclusions: Hybrid surgery to treat thoracoabdominal aortic aneurysms can initially be performed at Dong Nai General Hospital. The implementation of this technique at provincial hospitals helps to improve prognosis, reduce mortality and complications, and contribute to improving the professional quality of the hospital.

Successful combined treatment of a giant aneurysm of the posterior inferior cerebellar artery manifesting by brain stem compression

Giant aneurysms of the vertebrobasilar basin manifesting as brain stem compression are a rare pathology with an incidence ranging from 3 to 13,5 %. Surgery of such aneurysms is often associated with unsatisfactory treatment results due to the high traumatic nature of direct surgery on aneurysms of this region, as well as the close proximity of vital brain structures. Surgical intervention is also hampered by the large volume of the aneurysm, possible presence of thrombus in the sac, frequent absence of the neck, location in the anatomically difficult region, and small volume of the posterior cranial fossa (PCF). The above factors make it difficult to clip the aneurysm and increase the risk of perioperative complications. Endovascular intervention is a method of choice in most cases allowing to switch an aneurysm off the blood flow, however in the presence of mass effect aneurysm occlusion does not always achieve a clinical effect due to the preservation of brain stem compression. The aim of this publication was to demonstrate the possibility of successful combined surgical treatment of a giant aneurysm located in the PCF and accompanied by brain stem compression.

Is it time to rethink microsurgical training for the treatment of intracranial aneurysms in Australia?

BackgroundCase volume and complexity for microsurgical treatment of cerebral aneurysms have changed due to the growing use of endovascular therapy in clinical practice. The authors sought to quantify the clinical exposure of Australian neurosurgery trainees to cerebral aneurysm microsurgery. MethodsThis observational, retrospective cross-sectional study examined the Australian National Hospital Morbidity database for all admissions related to microsurgical and endovascular treatment of aneurysmal subarachnoid haemorrhage (aSAH) and unruptured intracranial aneurysms (UIAs) for the years 2008 to 2018. Procedural volumes were compared with neurosurgical trainee figures to investigate the rate of procedural exposure relative to the neurosurgical workforce. ResultsA total of 8,874 (41.6%) microsurgical procedures (3,662 for aSAH, 5,212 for UIAs), and 12,481 (58.4%) endovascular procedures (6,018 for aSAH, 6,463 for UIAs) were performed. Trainee exposure to microsurgery in aSAH declined from 9.1 to 7.3 cases per trainee per annum (mean 7.7), with case complexity confined mostly to simple anterior circulation aneurysms. There are significant state-by-state differences in the preferred treatment modality for aSAH. During the same study period, the number of microsurgical cases for UIAs increased (from 8.9 to 13.5 cases per trainee per annum, mean 11.0). Significantly more endovascular procedures are performed than microsurgery (10.7 to 17.0, mean 12.7 cases, for aSAH; 8.0 to 21.5, mean 13.7 cases, for UIAs). ConclusionsTrainee exposure to open aneurysm surgery for aSAH have significantly declined in both case volume and complexity. There is an overall increase in the number of surgeries for elective aneurysms, but this varies widely from state-to-state.

Enhance Safety in Aneurysm Surgery: Strategies for Prevention of Intraoperative Vascular Complications.

Complications during surgery for intracranial aneurysms can be devastating. Notorious pitfalls include premature rupture, parent vessel occlusion, local cerebral injury and brain contusion, and incomplete neck obliteration. These unfavorable intraoperative events can result in major neurological deficits with permanent morbidity and even mortality. Herein, the author highlights the relevant surgical strategies used in his daily practice of aneurysm surgery (e.g., aneurysm clipping with adenosine-induced temporary cardiac arrest), application of which may help prevent vascular complications and enhance surgical safety through reduction of the associated risks, thus allowing improvement of postoperative outcomes. Overall, all described methods and techniques should be considered as small pieces in the complex puzzle of prevention of vascular complications during aneurysm surgery.

Hemichorea after internal carotid artery bifurcation aneurysm clipping

Abstract Involuntary movements following aneurysm surgery are rare. Here, we report the case of a patient who developed left hemichorea following surgical clipping of a right internal carotid artery bifurcation aneurysm. The movement disorder resulted from an acute infarct involving the head of the caudate nucleus. The patient responded well to symptomatic treatment, with complete resolution of chorea. The occurrence of new-onset involuntary movements following aneurysm surgery should raise the suspicion of infarcts involving basal ganglia structures.

Impact of Reconstructing Intercostal Artery on Spinal Cord Circulation During Open Surgery for Thoracoabdominal Aortic Aneurysm.

We evaluated the outcomes of the selective intercostal artery reconstruction for preventing spinal cord injury during thoracoabdominal aortic aneurysm repair. We retrospectively assessed 84 consecutive patients who underwent thoracoabdominal aortic aneurysm repairs between 2004 and 2016. The mean age of the patients was 57.3 years. We performed preoperative multidetector computed tomography in 74 patients (88.0%) to identify the Adamkiewicz artery. Spinal cord injury preventive measures included motor evoked potential monitoring, hypothermia induction, Adamkiewicz artery or other intercostal artery reconstruction, and cerebrospinal fluid drainage. The hospital death rate was 5.9%, and paraplegia occurred in four patients (4.7%). The Adamkiewicz artery or other intercostal arteries were reconstructed selectively in 46 patients (54.7%). Of these patients, 41 underwent postoperative multidetector computed tomography, which revealed occlusion of the reconstructed grafts in 23 patients (56.0%). There was no paraplegia in the patients who underwent reconstruction of the Adamkiewicz artery, which was patent on postoperative multidetector computed tomography. Univariate analysis showed no significant effect of various risk factors on the development of spinal cord injury. Outcome of open surgery for thoracoabdominal aortic aneurysm in our institution regarding spinal cord injury was satisfactory. The benefits of Adamkiewicz artery reconstruction remain inconclusive, and further larger studies are required to identify its validation for spinal cord protection in thoracoabdominal aortic aneurysm repair.

Efficacy of superior cervical ganglion (SCG) block on the incidence and severity of vasospasm after middle cerebral artery (MCA) aneurysmal surgery using transcranial Doppler (TCD): A Randomized controlled trial

Efficacy of superior cervical ganglion (SCG) block on the incidence and severity of vasospasm after middle cerebral artery (MCA) aneurysmal surgery using transcranial Doppler (TCD): A Randomized controlled trial

Risk Factors for Intracranial Aneurysm Rupture: A Clinical Case Series and Systematic Review of the Literature.

To evaluate the patients who underwent surgery for an anterior communicating artery (AcomA) aneurysm at our institution. We analyzed our case series and systematically reviewed the literature to identify factors that could predict the rupture of an intracranial aneurysm in patients with AcomA aneurysms or any intracranial aneurysm. We conducted a cross-sectional analysis of prospectively collected data from patients who underwent surgery for AcomA aneurysms at a single institution between January 2014 and May 2023. Predictors for the rupture of intracranial aneurysm were systematically reviewed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the Pubmed and MEDLINE databases. Younger age (odds ratio (OR): 0.957, 95% confidence interval (CI): 0.920-0.995, p=0.028), presence of a daughter sac (OR: 3.209, 95% CI: 1.095-9.408, p=0.034), and ever-smoking (OR: 0.357, 95% CI: 0.137-0.930, p=0.035) were significant predictors of increased risk of rupture in patients with AcomA aneurysms. Several aneurysm- and patient-related risk factors for rupture of intracranial aneurysms were retrieved via the literature analysis. Younger age, ever-smoking, and presence of a daughter sac increased the risk of AcomA aneurysm rupture. A systematic literature review revealed several more aneurysm- and patient-related risk factors for rupture of the intracranial aneurysms. Our results could aid neurosurgeons during their decision-making process when treating patients with unruptured intracranial aneurysms.

Early Career Bypass surgery for intracranial aneurysms in the endovascular era: A case series

Early Career Bypass surgery for intracranial aneurysms in the endovascular era: A case series

Complicated visceral artery aneurysms in chronic pancreatitis

Visceral artery aneurysms are rare and occur only in 0.01-0.2% of people. According to various authors, incidence of aneurysm rupture is 10-20% with mortality rate of 20-70% depending on localization and dimensions. One of the causes of visceral artery aneurysms, in particular common hepatic artery aneurysm, is chronic pancreatitis. Incidence of this complication is 2-10%. The first clinical manifestation is often hemorrhagic shock following false aneurysm rupture and bleeding into abdominal cavity, gastrointestinal tract or retroperitoneal space. Common hepatic artery aneurysm is complicated by bleeding in 35% of cases, and mortality may be up to 75%. Treatment of visceral artery aneurysm following chronic pancreatitis and post-necrotic parapancreatic cyst includes several stages. Endovascular methods are the first stage of treatment. The second stage is elimination of the cause of visceral artery false aneurysm (surgery for chronic pancreatitis). We present 3 patients with visceral artery aneurysms and chronic pancreatitis.

Effect of early aneurysm surgery on prognosis: Calm down in a hurry!

Effect of early aneurysm surgery on prognosis: Calm down in a hurry!

Long-term results of surgical treatment of patients with cerebral arterial aneurysms

To study the long-term results of surgical treatment of patients operated on for cerebral aneurysms and their impact on functional recovery, independence and cognitive functions in the long-term period. A multivariate regression analysis of long-term results of surgical treatment of 324 patients for cerebral aneurysms was performed (on average after 3.5 years). Upon admission of the patient to the hospital for surgical intervention, a clinical diagnostic examination was performed to confirm the diagnosis and determine the volume, timing and type of intervention. In the late period, a clinical neurological study was performed, which included an assessment of the degree of disability with the Barthel index and a modified Rankin scale, cognitive functions with MMSE, and the mental sphere with HADS. The severity of the condition at admission, corresponding to grade III-IV according to the Hunt-Hess classification, was the risk factor for an unfavorable prognosis for the recovery of patients in the long-term period of cerebral aneurysm surgery. The severe condition of patients at the onset of the disease increases the risk of disability by 1.9 times (p<0.05) and the risk of dementia by 6 times (p<0.05). An independent risk factor for the development of cognitive impairment is the patient's age: with an increase in age by 1 year, the MMSE score decreases by 0.27 (p<0.05). The prevalence of hemorrhage according to the Fisher classification, corresponding to grade III, is a predictor of the development of angiospasm in 91% of cases. In patients with established angiospasm, the risk of developing dementia and pre-dementia cognitive impairment was 57.3% (p<0.05). The best predictions for recovery of cognitive functions in the long-term period were observed in patients who underwent simultaneous aneurysm clipping with extra-intracranial anastomosis (mean MMSE score 25) compared with patients who underwent only aneurysm clipping (mean score 20), endovascular intervention (average score 21) or microsurgical intervention followed by intrathecal fibrinolytic injection (mean MMSE score of 20) (p<0.05). The predictors of unfavorable recovery of cognitive functions and the development of disability in the long-term period of surgical treatment of cerebral aneurysms were the severity of the condition at admission, corresponding to III-IV st. according to the Hunt-Hess classification, the age of the patient at the time of the intervention, the prevalence of hemorrhage according to Fisher, and the choice of surgical technique.

Endoscopic-assisted aneurysm surgery via key-hole approach

Endoscopic-assisted aneurysm surgery via key-hole approach

Osteoplastic Pterional Craniotomy: Success Rate of Surgery in Patient Aspect.

To evaluate the effect of osteoplastic pterional craniotomy on temporal hollowing and its sequelae. A total of 97 patients who underwent pterional craniotomy for an aneurysm were analyzed retrospectively. Of these 97 patients, 63 underwent surgery via the conventional pterional approach and 34 underwent surgery via the osteoplastic pterional approach. The temporal muscle volume was calculated bilaterally on CT images obtained in the sixth postoperative month. The results obtained in the conventional and osteoplastic approaches were compared. Of the 97 included patients, 45 were female and 52 were male. The mean patient age was 50.37 years. In the conventional group, 31 were female and 32 were male. In the osteoplastic group, 14 were female and 20 were male. The temporal muscle volume difference between the operated and non-operated side was not statistically significant in the osteoplastic group. However, the volume was slightly lesser on the operated side than on the non-operated side in the conventional group. The osteoplastic pterional approach is superior to the conventional approach in preserving the muscle volume and function. Patients who underwent osteoplastic craniotomy demonstrated higher levels of satisfaction with their facial appearance compared to those who underwent craniotomy using the conventional pterional approach.

Retracted: Application of Virtual Reality Based on 3D-CTA in Intracranial Aneurysm Surgery.

[This retracts the article DOI: 10.1155/2021/9913949.].