Clinical Practice Guideline for the Management of Intracranial Aneurysms

Jeong, Hae Woong; Seo, Jung Hwa; Jung, Cheolkyu; Suh, Sangil

doi:10.5469/neuroint.2014.9.2.63

Cited by 47 publications

(33 citation statements)

References 63 publications

(91 reference statements)

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“…6 However, most respondents in this study considered size, location, and shape of aneurysms as main factors for treatment strategy and reported using none of the data of ISUIA study, 6 UCAS Japan, 7 or PHASES score 8 to make decisions to treat unruptured aneurysms (63%). Even though the authorized guidelines in Korea 11,12 recommend treatment of unruptured IAs over 5 mm or under 5 mm with risk factors for rupture, considerable cases of unruptured IAs that are 3 to 5 mm were treated in the real world. In Korea, the majority of respondents treated unruptured IAs that are 3 to 5 mm and located on ACOM, PCOM, and vertebrobasilar artery.…”

Section: Discussionmentioning

confidence: 99%

Endovascular Treatment for Intracranial Aneurysms: A Nationwide Survey in Korea

et al. 2020

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Purpose: In Korea, endovascular treatment (EVT) for intracranial aneurysms (IAs) has increased steadily. We conducted a nationwide survey to evaluate the current status of EVT for IAs and to identify treatment preference in the real world.Materials and Methods: A Google online survey was distributed to representative clinicians at hospitals treating IAs, where members of Korean Society of Interventional Neuroradiology (KSIN). The data was collected from October 2017 to December 2017. The responding hospitals were divided into 2 groups (tertiary and non-tertiary hospitals). And variable factors involved in decision making for treatment were evaluated.Results: In total, 73 hospitals (tertiary: 37, non-tertiary: 36) responded to the survey. Most hospitals that responded had over 100 cases of diagnostic angiography (93%) and over 50 cases of EVT for IAs (74%) performed in 2016. The proportion of EVT for ruptured aneurysms in non-tertiary hospitals was significantly higher than tertiary hospitals (49% vs. 9%). The proportion of EVT for unruptured aneurysms at non-tertiary hospitals was significantly higher than tertiary hospitals (66% vs. 44%). Most physicians tended to make decision for treatment on location, shape, and size of unruptured IAs and patients’ age, more than the results from previous clinical trials for unruptured IAs. Although EVT was preferred for older patients (age >70) with unruptured IAs (99%), surgical clipping was still considered as the first treatment of choice for younger patients (age 30 to 50 years) at considerable rates (56%). Over two-thirds of respondents preferred surgical clipping for middle cerebral artery aneurysms, while EVT was preferred initially at other locations.Conclusion: This nationwide survey showed that EVT is considered as the first treatment modality for IAs and there is a discrepancy between current guidelines and real-world practice for decision making of treatment options.

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Section: Discussionmentioning

confidence: 99%

Endovascular Treatment for Intracranial Aneurysms: A Nationwide Survey in Korea

et al. 2020

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“…After the International Subarachnoid Aneurysm Trial, endovascular treatment became the main surgical method to treat cerebral aneurysms8,11,16). However, depending on the anatomic configuration of the aneurysm, it can be difficult to treat with this approach.…”

Section: Discussionmentioning

confidence: 99%

Superficial Temporal Artery-Sparing Mini-Pterional Approach for Cerebral Aneurysm Surgery

Ahn

Kim

et al. 2017

J Korean Neurosurg Soc

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ObjectiveThe purposes of this study were to introduce a superficial temporal artery (STA)-sparing mini-pterional approach for the treatment of cerebral aneurysms and review the surgical results of this approach.MethodsBetween June 2010 and December 2015, we performed the STA-sparing mini-pterional approach for 117 patients with 141 unruptured intracranial aneurysms. We analyzed demographic, radiologic, and clinical variables including age, sex, craniotomy size, aneurysm location, height of STA bifurcation, and postoperative complications.ResultsThe mean age of patients was 58.4 years. The height of STA bifurcation from the superior border of the zygomatic arch was 20.5 mm±10.0 (standard deviation [SD]). The craniotomy size was 1051.6 mm2±206.5 (SD). Aneurysm neck clipping was possible in all cases. Intradural anterior clinoidectomy was performed in four cases. Contralateral approaches to aneurysms were adopted for four cases. Surgery-related complications occurred in two cases. Permanent morbidity occurred in one case.ConclusionOur STA-sparing mini-pterional approach for surgical treatment of cerebral aneurysms is easy to learn and has the advantages of small incision, STA sparing, and a relatively wide surgical field. It may be a good alternative to the conventional pterional approach for treating cerebral aneurysms.

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“…We used DSA for follow-up of treated UIAs. DSA is the gold standard for follow-up of UIAs after endovascular treatment (20). CT angiography and MR angiography can be utilized, however both are inferior to DSA for detection of residue or recurrence of the aneurysm (21).…”

Section: Discussionmentioning

confidence: 99%

Mid-Term Outcome Following Pipeline Embolization of Unruptured Intracranial Aneurysms

et al. 2017

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Background: As an advanced generation of flow diverters (FD), pipeline embolization device (PED) is introduced for endovascular aneurysm occlusion. In the present study, we aimed to present the mid-term results after endovascular treatment of unruptured intracranial aneurysms using PED. Methods: A total of 20 patients with 20 intracranial wide neck aneurysms were treated with PED between July and October 2010. Patients were followed up 4 to 8 months after the procedure. Digital subtraction angiography (DSA) was carried out to assess stent integrity, displacement, and the presence of residual aneurysm. Results: Out of 20 participants, PED deployment was successful in 19; whereas, intervention failed in one patient due to technical factors in device deployment. No severe acute complications were observed. One patient died after three months as a result of subarachnoid hemorrhage (SAH). Out of the remaining patients, DSA showed complete occlusion of aneurysms in 14 individuals (77.8%), while in four patients (22.2%), residual aneurysm was noted. Stent migration was not observed in any patients. Intra-stent stenosis (25% -50%) was visualized in only one patient (5.5%). Conclusions: This study showed promising mid-term results for the pipeline embolization device in the treatment of unruptured intracranial aneurysms. Larger studies with longer follow-up duration are warranted.

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Clinical Practice Guideline for the Management of Intracranial Aneurysms

Cited by 47 publications

References 63 publications

Endovascular Treatment for Intracranial Aneurysms: A Nationwide Survey in Korea

Endovascular Treatment for Intracranial Aneurysms: A Nationwide Survey in Korea

Superficial Temporal Artery-Sparing Mini-Pterional Approach for Cerebral Aneurysm Surgery

Mid-Term Outcome Following Pipeline Embolization of Unruptured Intracranial Aneurysms

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