Early and midterm results of treatment of giant internal carotid artery paraclinoid aneurysms with trapping and flow diverters

Makhambetov, Yerbol; Kaliyev, Assylbek; Kikuta, Ken-ichiro; Смагулов, Ф.Х.; Medetov, Yerkin; Kulmirzayev, Marat; Kerimbayev, Talgat; Kissamedenov, Nurlan; Tursynkhan, Aigerim; Doskaliyev, Aidos; Akshulakov, Serik

doi:10.1007/s00701-019-04002-3

Cited by 4 publications

(4 citation statements)

References 23 publications

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“…Comparing first our clinical outcome data to those from monotherapeutic centers, we looked at King [17] who analyzed in a meta-analysis the outcome data from 38 studies after surgery for UIA's, disclosing a general mortality of 1% and general morbidity of 4.1%, or at Raaymakers [29] who analyzed 61 studies on surgery for UIAs disclosing a general mortality of 2.6% and a morbidity of 10.9% and saw our clinical results in good order. For endovascular UIA therapy, there is recent information given by Kallmes [16] who described in an international retrospective multicenter study mortality after stent embolizations as 3.8% and with giant aneurysms as 10.9%.and others [6,22]. Although the capacity of microsurgery to reconstruct vessel walls is known to be higher than from endovascular tools, publications indicate that there is a significant rate of incomplete aneurysm occlusions even after surgical treatment (Dellaretti as 10.2%, Nussbaum as 8%, and Nanda as 6% [11,23,24]).…”

Section: Resultsmentioning

confidence: 99%

Microsurgical and endovascular treatment of un-ruptured cerebral aneurysms by European hybrid neurosurgeons to balance surgical skills and medical staff management

et al. 2021

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Background In Europe, aneurysm treatment performed by dually trained neurosurgeons is extremely scarce. We provide outcome data for un-ruptured aneurysm patients treated at a European hybrid center to prove that hybrid neurosurgeons achieve clinical and angiographical results allowing to integrate hybrid neurosurgery into routine aneurysm treatment. This will not only help to maintain neurovascular microsurgical skills but will influence staff costs in related hospitals. Methods We retrospectively analyzed all consecutively treated un-ruptured aneurysm patients between 2000 and 2016. The decision-making took into account the pros and cons of both modalities and considered patient and aneurysm characteristics. Clinical outcome was assessed by the modified Rankin scale (mRS). Occlusion rates were stratified into grade I for 100%, grade II for 99–90%, and grade III for <90% occlusion. To account for the introduction of stents, two treatment periods (p1, 2000 to 2008; p2, 2009 to 2016) were defined. Results The study population consisted of 274 patients (median age 55 years) harboring 338 un-ruptured aneurysms. Microsurgery (MS) was performed in 51.8% and endovascular therapy (EVT) in 43.1%; 5.1% required combined treatment. Overall, 93% showed a favorable clinical outcome (mRS 0–2), 94.3% after MS and 91.5% after EVT. Grade I aneurysm occlusion was achieved in 82.6% patients, 91.9% after MS and 72.9% after EVT. Procedure-related complications occurred after MS in 5.6% and after EVT in 4.4% patients. Mortality was recorded for five (1.8%) patients, one patient after MS and four after EVT. For the EVT cohort, significant improvement from p1 to p2 was seen with clinical outcomes (P=0.030, RR = 0.905, CI: 0.8351–0.9802) and occlusion rates (P=0.039, RR = 0.6790, CI: 0.499–0.923). Conclusion Hybrid neurosurgeons achieve qualified clinical and angiographic results. Dual training will allow to maintain neurovascular caseloads and preserve future aneurysm treatment within neurosurgery. Furthermore economic benefits could be observed in hospital management.

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Section: Resultsmentioning

confidence: 99%

Microsurgical and endovascular treatment of un-ruptured cerebral aneurysms by European hybrid neurosurgeons to balance surgical skills and medical staff management

et al. 2021

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“…A number of important branches arise from the ophthalmic segment of the ICA, such as the OphA and superior hypophyseal artery (SHA). This segment also lies adjacent to the ON and ACP 4 ; therefore, the technique of anterior clinoidectomy, sufficient mobilization of the ON, and exposure of the distal dural ring are essential for exposure and safe clipping of OSAs. 5 Owing to the narrow operating space, the vessels, nerves, and other important structures can easily be injured during OSA surgery.…”

Section: Discussionmentioning

confidence: 99%

“…At the same time, large or giant aneurysms still have high recurrence and incomplete occlusion rates after interventional therapy because of their wide neck. 4,7,8 The technique of anterior clinoidectomy is a complex but essential skill for neurosurgical skull base surgeons, 9 and removal of the ACP can provide a better view and range of motion for the ON and ICA. The traditional subdural and epidural approaches require abrasion of the complete ACP, whose lateral edge of abrasion should reach the incisura supraorbitalis.…”

Section: Discussionmentioning

confidence: 99%

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Clipping Ophthalmic Segment Artery Aneurysms Using a Modified Subdural Dolenc Approach: Classification and Experience Sharing

Zhou

Wang²,

Zhan³

et al. 2022

Operative Neurosurgery

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BACKGROUND:Ophthalmic segment artery aneurysms (OSAs) are difficult to clip; therefore, improvement of the surgical method is of great significance to the prevention of complications, and the classification of the aneurysms is essential to formulate a reasonable surgical plan.OBJECTIVE:To explore the strategies and effects of surgery for OSAs using a modified subdural Dolenc approach.METHODS:The clinical data of 38 patients (12 men and 26 women, aged 48-73 years) with OSA were analyzed retrospectively. A total of 44 aneurysms were identified, 40 of which were OSAs. The 40 aneurysms were divided into types Ia1 (n = 2), Ia2 (n = 2), Ib (n = 6), IIa (n = 4), IIb (n = 4), IIIa (n = 0), IIIb (n = 4), IIIc (n = 16), and IV (n = 2) based on preoperative images. Thirty-nine OSAs were operated successfully through pterional craniotomy combined with the modified subdural Dolenc approach, and 1 aneurysm was clipped through the contralateral approach. Clinical outcomes were evaluated using the Glasgow Outcome Scale (GOS).RESULTS:Thirty-nine OSAs were clipped, and one was wrapped. Visual dysfunction, headache, and dizziness improved after the operation in 18 patients. One patient had new visual impairment, and there were no deaths. At discharge, the GOS score was 5 in 36 cases, 4 in 1 case, and 3 in 1 case. Thirty-seven patients had a GOS score of 5, and 1 patient had a score of 3 at 6 months after the operation.CONCLUSION:The modified subdural Dolenc approach (Zheng approach) for clipping OSAs may be associated with less trauma and good postoperative outcomes.

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2019

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Early and midterm results of treatment of giant internal carotid artery paraclinoid aneurysms with trapping and flow diverters

Cited by 4 publications

References 23 publications

Microsurgical and endovascular treatment of un-ruptured cerebral aneurysms by European hybrid neurosurgeons to balance surgical skills and medical staff management

Microsurgical and endovascular treatment of un-ruptured cerebral aneurysms by European hybrid neurosurgeons to balance surgical skills and medical staff management

Clipping Ophthalmic Segment Artery Aneurysms Using a Modified Subdural Dolenc Approach: Classification and Experience Sharing

Aspirin/clopidogrel

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