Medical Aspects of Vasospasm

Macdonald, R. Loch; Weir, Bryce

doi:10.1016/b978-012464161-7/50010-x

Cited by 10 publications

(16 citation statements)

References 297 publications

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“…The rate of ischemic stroke, however, or occurrence of DCI did not seem to correlate with the SF variants, rendering other factors responsible for DCI like vasospasms, injury of veins during surgery, or injury of perforating arteries. [10] DCI has a huge number of factors that can be responsible for its occurrence, but the SF anatomy seems to be excluded of list of triggers. [1819] Additionally, the outcome of patients based on the GOS does not seem to correlate with the SF anatomy.…”

Section: Discussionmentioning

confidence: 99%

Anatomical configuration of the Sylvian fissure and its influence on outcome after pterional approach for microsurgical aneurysm clipping

Ngando

Maslehaty²,

Schreiber³

et al. 2013

Surg Neurol Int

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Background:The sylvian fissure (SF) is the anatomical pathway used in a pterional approach, which leads to most aneurysms. There are four different anatomical variants of the SF described. In the present retrospective study the four different categories of the SF were studied in order to evaluate any correlation of these variants to surgical outcome.Methods:Patients treated for intracranial aneurysms by a pterional transsylvian approach during 2003-2012 (N = 237) were included in the study. The SF category was determined by analysis of preoperative computed tomography (CT) scanning. Patients were grouped into unruptured intracranial aneurysms (UIA) and ruptured intracranial aneurysms with subarachnoid hemorrhage (SAH) according to the Hunt and Hess grades. Brain edema, vasospasms, ischemic lesion rate, and outcome were evaluated for possible correlation with SF anatomical variants.Results:Postsurgically brain edema formation correlated significantly with more complex anatomical variants of the SF in patients with UIAs and in patients with Hunt and Hess 1 and 2. Ischemia rate, vasospasms, or clinical outcome was not negatively affected though.Conclusion:The classification of the SF as proposed by Yasargil is more than a pure anatomical observation. In this retrospective study, we show that the anatomical variants of the SF can be associated to postoperative complications like formation of brain edema or ischemic lesions Preoperative knowledge of the SF anatomy and possibly consecutive adapted extend of the surgical approach can decrease procedure-related morbidity.

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Section: Discussionmentioning

confidence: 99%

Anatomical configuration of the Sylvian fissure and its influence on outcome after pterional approach for microsurgical aneurysm clipping

Ngando

Maslehaty²,

Schreiber³

et al. 2013

Surg Neurol Int

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“…The half-life of the isotope is 122.1 seconds, and the acquisition time for an 15 O PET image is less than 3 minutes [1, 16, 52]. The rapidity of the test minimizes the radiation dose to the patient.…”

Section: Positron Emission Tomography (Pet)mentioning

confidence: 99%

Advanced Imaging Modalities in the Detection of Cerebral Vasospasm

Mills

Mehta²,

Russin³

et al. 2013

Neurology Research International

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The pathophysiology of cerebral vasospasm following aneurysmal subarachnoid hemorrhage (SAH) is complex and is not entirely understood. Mechanistic insights have been gained through advances in the capabilities of diagnostic imaging. Core techniques have focused on the assessment of vessel caliber, tissue metabolism, and/or regional perfusion parameters. Advances in imaging have provided clinicians with a multifaceted approach to assist in the detection of cerebral vasospasm and the diagnosis of delayed ischemic neurologic deficits (DIND). However, a single test or algorithm with broad efficacy remains elusive. This paper examines both anatomical and physiological imaging modalities applicable to post-SAH vasospasm and offers a historical background. We consider cerebral blood flow velocities measured by Transcranial Doppler Ultrasonography (TCD). Structural imaging techniques, including catheter-based Digital Subtraction Angiography (DSA), CT Angiography (CTA), and MR Angiography (MRA), are reviewed. We examine physiologic assessment by PET, HMPAO SPECT, 133Xe Clearance, Xenon-Enhanced CT (Xe/CT), Perfusion CT (PCT), and Diffusion-Weighted/MR Perfusion Imaging. Comparative advantages and limitations are discussed.

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“…It potentially results in reduced cerebral perfusion, cerebral ischemia, potential infarction, and further deterioration of neurological function. The average mortality rate from vasospasm is approximately 33% [14]. Given the high mortality rate and the need to intervene quickly in situations when vasospasm occurs, our goal is to develop a model that predicts whether a patient with a ruptured aneurysm will develop vasospasms.…”

Section: Case Study: Cerebral Vasospasmsmentioning

confidence: 99%

An Approach for Incorporating Context in Building Probabilistic Predictive Models

Hsu

Bui

2012

2012 IEEE Second International Conference on Healthcare Informatics, Imaging and Systems Biology

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With the increasing amount of information collected through clinical practice and scientific experimentation, a growing challenge is how to utilize available resources to construct predictive models to facilitate clinical decision making. Clinicians often have questions related to the treatment and outcome of a medical problem for individual patients; however, few tools exist that leverage the large collection of patient data and scientific knowledge to answer these questions. Without appropriate context, existing data that have been collected for a specific task may not be suitable for creating new models that answer different questions. This paper presents an approach that leverages available structured or unstructured data to build a probabilistic predictive model that assists physicians with answering clinical questions on individual patients. Various challenges related to transforming available data to an end-user application are addressed: problem decomposition, variable selection, context representation, automated extraction of information from unstructured data sources, model generation, and development of an intuitive application to query the model and present the results. We describe our efforts towards building a model that predicts the risk of vasospasm in aneurysm patients.

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Medical Aspects of Vasospasm

Cited by 10 publications

References 297 publications

Anatomical configuration of the Sylvian fissure and its influence on outcome after pterional approach for microsurgical aneurysm clipping

Anatomical configuration of the Sylvian fissure and its influence on outcome after pterional approach for microsurgical aneurysm clipping

Advanced Imaging Modalities in the Detection of Cerebral Vasospasm

An Approach for Incorporating Context in Building Probabilistic Predictive Models

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