Search results for "intracranial aneurysm"
showing 10 items of 51 documents
Spontaneous confabulation, temporal context confusion and reality monitoring: a study of three patients with anterior communicating artery aneurysms.
2010
AbstractSpontaneous confabulation involves the production of false or distorted memories, and is commonly associated with ventromedial prefrontal damage. One influential theory proposes that the critical deficit is a failure to suppress currently irrelevant memory traces that intrude into ongoing thinking (Schnider & Ptak, 1999). In this study, we report experimental investigations with three spontaneously confabulating patients aimed at exploring this account. Using Schnider and Ptak’s (1999) continuous recognition paradigm, we replicated their experimental results with our patients. However, our data suggest that the critical impairment might be more generalized than a failure to supp…
Minimally invasive superficial temporal artery to middle cerebral artery bypass through a minicraniotomy: benefit of three-dimensional virtual realit…
2009
Object The aim of the authors in this study was to introduce a minimally invasive superficial temporal artery to middle cerebral artery (STA-MCA) bypass surgery by the preselection of appropriate donor and recipient branches in a 3D virtual reality setting based on 3-T MR angiography data. Methods An STA-MCA anastomosis was performed in each of 5 patients. Before surgery, 3-T MR imaging was performed with 3D magnetization-prepared rapid acquisition gradient echo sequences, and a high-resolution CT 3D dataset was obtained. Image fusion and the construction of a 3D virtual reality model of each patient were completed. Results In the 3D virtual reality setting, the skin surface, skull surface…
Ten-year Experience with the Supraorbital Subfrontal Approach through an Eyebrow Skin Incision
2005
Abstract OBJECTIVE: More than ever before, the priority in contemporary neurosurgery is to achieve the greatest therapeutic effect while causing the least iatrogenic injury. The evolution of microsurgical techniques with refined instrumentation and illumination and the enormous development of preoperative and intraoperative diagnostic tools enable neurosurgeons to treat different lesions through limited and specific keyhole approaches. METHODS: Based on our surgical experience, the technique of supraorbital subfrontal craniotomy is described in detail in this article. After an eyebrow skin incision is made, a limited supraorbital craniotomy is performed with a width of 15 to 25 mm and a hei…
The risk of intravenous thrombolysis-induced intracranial hemorrhage in Taiwanese patients with unruptured intracranial aneurysm.
2017
Background The presence of an intracranial aneurysm is contraindicated to recombinant tissue plasminogen activator (r-tPA) treatment for acute ischemic stroke. However, it is difficult to exclude asymptomatic intracranial aneurysms by using conventional, noncontrast head computed tomography (CT), which is the only neuroimaging suggested before r-tPA. Recent case reports and series have shown that administering r-tPA to patients with a pre-existing aneurysm does not increase the bleeding risk. However, Asians are known to have a relatively higher bleeding risk, and little evidence is available regarding the risk of using r-tPA on Asian patients with intracranial aneurysms. Methods Medical re…
Can biomechanical analysis shed some light on aneurysmal pathophysiology? Preliminary study on ex vivo cerebral arterial walls
2019
Abstract Background The pathophysiology of cerebral aneurysm is complex and poorly understood, and it can have the most catastrophic clinical presentation. Flow dynamics is a key player in the initiation and progression of aneurysm. Better understanding the interaction between hemodynamic loading and biomechanical wall responses can help to add the missing piece on aneurysmal pathophysiology. In this laboratory study we aimed to analyze the effect of the application of a mechanical force to cerebral arterial walls. Methods Displacement control tests were performed on five porcine cerebral arteries. The test machine was the T150 Nanotensile. The stiffness variation with the increment of the …
FLOW DIVERTER DEVICE IN THE ACUTE SETTING OF RUPTURED BLISTER LIKE ANEURYSM: A CASE REPORT
2021
Blister-like aneurysms (BLA) are a rare half-dome-shaped aneurysm, with a broad-based appearance, originating more often from a non-branching site of the supraclinoid internal carotid artery (ICA). They are sometimes difficult to recognize due to their morphological changes and high tendency to rupture. BLAs are often undiagnosed and may be detected only after repeated angiograms in the case of acute subarachnoid hemorrhage (SAH). BLA are life-threatening and no consensus has so far been reached on the best management strategy. We describe a patient with a BLA in the left ICA successfully treated by flow-diverting device using intraoperative abciximab bolus, with successful results. Recentl…
Microsurgical Management of Intracranial Aneurysms After Flow Diversion Failure
2019
Subarachnoid hemorrhage (SAH) occurring after an intracranial aneurysm rupture has an incidence of 10.5 per 100,000 person-years and accounts for about 5% of strokes. The resulting outcome depends on several factors including the severity of the initial hemorrhage, rebleeding, perioperative medical management, and the timing and technical success for aneurysm treatment. The overall mortality rates from 32%−67% with 10%–20% of patients with long-term dependence due to brain damage. It is well known that 12% of patients die before achieving medical treatment and 25% die within the first 24 hours. Again, 40%–60% mortality rate occurs within 30 days. Among the surviving patients, about one thir…
Comprehensive Anatomic Assessment of Ipsilateral Pterional Versus Contralateral Subfrontal Approaches to the Internal Carotid Ophthalmic Segment: A C…
2019
Objective Medially pointing aneurysms of the ophthalmic segment of the internal carotid artery (oICA) represent a neurosurgical challenge. Conventional ipsilateral approaches require internal carotid artery and optic nerve (ON) mobilization as well as anterior clinoidectomy (AC), all associated with increased surgical risk. Contralateral approaches could provide a better exposure of the superomedial aspect of the oICA, ophthalmic artery, and superior hypophyseal artery, sparing AC and internal carotid artery or ON mobilization. However, the microsurgical anatomy of this approach has not been systematically studied. In the present work, we exhaustibly analyzed the anatomic and morphometric c…
Management of Complex Cerebral Aneurysms
2022
BACKGROUND: Complex intracranial aneurysms (CIAs) are challenging pathologies to treat. Characteristics making an aneurysm complex include dimension, history of previous treatment, location, absence of collateral circulation, intraluminal thrombosis, and calcification of the wall. The goal of the therapeutic process is to exclude the malformation from the cerebral circulation and both endovascular and surgical treatments are valid procedures.METHODS: Between 1990 and 2020, 170 CIAs were treated at our institution (33 ruptured, 137 unruptured). They were 3 prepetrous segment of the internal carotid artery (ICA), 14 purely intracavernous sinus, 27 intracavernous with subarachnoid extension, 6…
FLOW DIVERTER DEVICE IN THE ACUTE SETTING OF RUPTURED BLISTER LIKE ANEURYSM: A CASE REPORT
2021
Blister-like aneurysms (BLA) are a rare half-dome-shaped aneurysm, with a broad-based appearance, originating more often from a non-branching site of the supraclinoid internal carotid artery (ICA). They are sometimes difficult to recognize due to their morphological changes and high tendency to rupture. BLAs are often undiagnosed and may be detected only after repeated angiograms in the case of acute subarachnoid hemorrhage (SAH). BLA are life-threatening and no consensus has so far been reached on the best management strategy. We describe a patient with a BLA in the left ICA successfully treated by flow-diverting device using intraoperative abciximab bolus, with successful results. Recentl…