0000000000461139
AUTHOR
H. Böcher-schwarz
Histological Findings in Coil-packed Experimental Aneurysms 3 Months after Embolization
ABSTRACT OBJECTIVE Knowledge regarding tissue reactions within coil-packed aneurysms is poor. The purpose of this study was to analyze histological changes in a chronic experimental bifurcation aneurysm model that might explain the protective effect of Guglielmi detachable coils. METHODS The aneurysms were produced by means of a venous graft pouch at a surgically created bifurcation of the carotid artery in the neck of rabbits. After 3 weeks, embolization with Guglielmi detachable coils was performed in the treatment group but not in the control group (seven rabbits each). At the time of embolization, six of seven treated aneurysms were completely occluded according to radiological criteria…
Effect of Intra-Arterial Infusion of Papaverine Hydrochloride on Brain Tissue Oxygen Pressure in the Management of Severe Vasospasm Following Aneurysmal Subarachnoid Hemorrhage
Despite considerable advances in diagnostic, surgical and interventional techniques, the overall outcome for patients with aneurysmal subarachnoid hemorrhage remains poor. Concerning perioperative course, cerebral ischaemia is one of the major factors causing secondary brain demage. The aim of all therapeutic interventions is the stabilization and maintance of cerebral blood flow and tissue oxygenation in order to prevent cerebral ischaemia and consecutively brain infarction [1].
The keyhole concept in aneurysm surgery: results of the past 20 years.
Item does not contain fulltext BACKGROUND: Improvements in preoperative imaging and intraoperative visualization have led to a refinement in surgical techniques. OBJECTIVE: Report of a 20-year experience with application of the keyhole technique as a contribution to the ongoing debate on the impact of limited craniotomies in aneurysm surgery. METHODS: Over a 20-year period, 1000 consecutive patients with 1297 aneurysms were surgically treated in 1062 operations: 651 in the acute stage after SAH and 411 with unruptured aneurysms. The outcome was assessed with the modified Rankin scale and approach-related complications. RESULTS: The majority of the cases were treated by 4 different keyhole a…
Aneurysm surgery of patients in poor grade condition. Indications and experience
Out of a total of 196 patients admitted with aneurysmal subarachnoid haemorrhage (SAH) to the neurological department in Mainz over a 42 month period, 48 patients (24.5%) were considered as grade IV or V on admission. Aneurysm surgery within 48 hours after SAH was performed in 56.3% of these patients, 2% were operated between day 3 and 7 and 16.6% were operated after day 7. 25% did not undergo operation because of severe neurological deficit and brain damage. The overall outcome according to the Glasgow outcome scale in the surgically treated group was full recovery in 11.1%, moderate disability in 16.7%, severe disability in 47.2%, vegetative state in 2.8% and death in 22.2%. All patients …
Evaluation of collateral flow capacity in patients with vascular or tumorous lesions of the skull base by Doppler sonography
In 12 patients with vascular or tumorous lesions of the skull base, the collateral flow capacity was examined by transcranial Doppler sonography and carotid compression studies. In four patients no cross flow mechanism was found, in two patients the test remained unclear, and in six patients the examination suggested a good collateral flow capacity. However, for this application of Doppler sonography no borderlines have yet been defined and thus interpretation is difficult. Intraoperative Doppler sonography was used in five patients and proved to be helpful for localisation of the internal carotid artery within skull base tumors.
The preoperative assessment of stroke risk in lesions involving the internal carotid artery.
Patients with vascular or tumourous lesions involving the internal carotid artery are at risk of damage or occlusion of this vessel during surgical or endovascular procedures. To assess the stroke risk transcranial Doppler aided carotid compression tests were performed in 82 patients. Based on changes of blood flow velocity (BFV), pulsatility index, systolic/diastolic ratio and length of transient hyperaemic response three groups could be differentiated. Patients in group A (31%) showed only a slight reaction of BFV and were at minimal risk in case of carotid occlusion. Patients in group B (52%) underwent a distinct decrease of Doppler readings with partial improvement and were considered t…