Neuroradiologic and neuropathologic findings with growing giant intracranial aneurysm. Review of the literature

Artmann, H; Vonofakos, D.; Müller, Hans Robert; Grau, H.

doi:10.1016/0090-3019(84)90120-4

Cited by 64 publications

(20 citation statements)

References 45 publications

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“…14,15,35 Fusiform, dysplastic, and otherwise complex aneurysms may not be amenable to direct clipping and may require alternative management strategies. 1,3,11,[15][16][17]26,33,34,65 We have previously reported our experience with wrapping and clip-wrapping these types of aneurysms with cotton. 15,35 However, our wrapping strategies have evolved over the past decade, and we now most frequently use Gore-Tex membrane (W. L. Gore & Associates, Inc.) when circumferentially wrapping unclippable aneurysms.…”

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confidence: 99%

Techniques and long-term outcomes of cotton-clipping and cotton-augmentation strategies for management of cerebral aneurysms

Safavi–Abbasi

Moron²,

Sun

et al. 2016

JNS

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obJective To address the challenges of microsurgically treating broad-based, frail, and otherwise complex aneurysms that are not amenable to direct clipping, alternative techniques have been developed. One such technique is to use cotton to augment clipping ("cotton-clipping" technique), which is also used to manage intraoperative aneurysm neck rupture, and another is to reinforce unclippable segments or remnants of aneurysm necks with cotton ("cottonaugmentation" technique). This study reviews the natural history of patients with aneurysms treated with cotton-clipping and cotton-augmentation techniques. methods The authors queried a database consisting of all patients with aneurysms treated at Barrow Neurological Institute in Phoenix, Arizona, between January 1, 2004, and December 31, 2014, to identify cases in which cotton-clipping or cotton-augmentation strategies had been used. Management was categorized as the cotton-clipping technique if cotton was used within the blades of the aneurysm clip and as the cotton-clipping technique if cotton was used to reinforce aneurysms or portions of the aneurysm that were unclippable due to the presence of perforators, atherosclerosis, or residual aneurysms. Data were reviewed to assess patient outcomes and annual rates of aneurysm recurrence or hemorrhage after the initial procedures were performed. results The authors identified 60 aneurysms treated with these techniques in 57 patients (18 patients with ruptured aneurysms and 39 patients with unruptured aneurysms) whose mean age was 53.1 years (median 55 years; range 24-72 years). Twenty-three aneurysms (11 cases of subarachnoid hemorrhage) were treated using cotton-clipping and 37 with cotton-augmentation techniques (7 cases of subarachnoid hemorrhage). In total, 18 patients presented with subarachnoid hemorrhage. The mean Glasgow Outcome Scale (GOS) score at the time of discharge was 4.4. At a mean follow-up of 60.9 ± 35.6 months (median 70 months; range 10-126 months), the mean GOS score at last follow-up was 4.8. The total number of patient follow-up years was 289.4. During the follow-up period, none of the cotton-clipped aneurysms increased in size, changed in configuration, or rebled. None of the patients experienced early rebleeding. The annual hemorrhage rate for aneurysms treated with cotton-augmentation was 0.52% and the recurrence rate was 1.03% per year. For all patients in the study, the overall risk of hemorrhage was 0.35% per year and the annual recurrence rate was 0.69%. coNclusioNs Cotton-clipping is an effective and durable treatment strategy for intraoperative aneurysm rupture and for management of broad-based aneurysms. Cotton-augmentation can be safely used to manage unclippable or partially clipped intracranial aneurysms and affords protection from early aneurysm re-rupture and a relatively low rate of late rehemorrhage.

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confidence: 99%

Techniques and long-term outcomes of cotton-clipping and cotton-augmentation strategies for management of cerebral aneurysms

Safavi–Abbasi

Moron²,

Sun

et al. 2016

JNS

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“…Review of 23 cases of growing giant aneurysms found that the interval between the first diagnosis and the detection of growth ranged from 5 to 216 months. 1) Clinically silent growth must have occurred in most cases of giant aneurysm, and the course is unpredictable even after a long period of clinical silence unless the aneurysm is totally calcified. Therefore, once growth of the lesion has been observed, frequent neuroradiological examination (once every 3-6 months) is necessary, even if the patient remains without symptoms.…”

Section: Discussionmentioning

confidence: 99%

Serial Neuroimaging of a Growing Thrombosed Giant Aneurysm of the Distal Anterior Cerebral Artery. Case Report.

Kaneko

Nomura

Yamashima

et al. 2001

Neurol. Med. Chir.(Tokyo)

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An 81-year-old female presented with a giant aneurysm of the distal anterior cerebral artery (A 3 ) which grew from a small saccular aneurysm to a huge aneurysm within 36 months before manifesting as a mass lesion. The thrombosed portion of the aneurysm showed growth, whereas the aneurysmal cavity did not change in size. Computed tomography and magnetic resonance imaging showed new bleeding in the thrombosed portion. Hemorrhage into the thrombus and/or aneurysmal wall might have caused the aneurysmal growth. She refused surgery and was discharged with no deficits. Distal anterior cerebral artery aneurysm which shows neuroimaging signs of growth requires regular follow up as such lesions may become giant before manifesting clinical symptoms.

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“…In some cases, the site of the IVA can be estimated on the basis either as the IVH defect or as the prolonged presence of a hyperdense area on the ventricle wall (Hamada et al, 1994). In the course of a giant aneurysm, the appearance on CT is characteristic, consisting of a well-circumscribed round an oval mass (Artmann et al, 1984). The presence of thrombus determines the central attenuation characteristics, which may range from iso-to hyperdense.…”

Section: Ct Scanmentioning

confidence: 99%

“…A peripheral zone of increased attenuation is frequently seen due to mural thrombus (Schubiger et al, 1987). After administration of the contrast media, CT scans show intense enhancement of the residual aneurysm lumen, and this rapidly declines after cessation of contrast media injection (Artmann et al, 1984).…”

Section: Ct Scanmentioning

confidence: 99%

Intraventricular Cerebrovascular Pathologies of Hydrocephalus and Managements

Şanlı¹,

Kertmen²,

Gürer³

2012

Hydrocephalus

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Neuroradiologic and neuropathologic findings with growing giant intracranial aneurysm. Review of the literature

Cited by 64 publications

References 45 publications

Techniques and long-term outcomes of cotton-clipping and cotton-augmentation strategies for management of cerebral aneurysms

Techniques and long-term outcomes of cotton-clipping and cotton-augmentation strategies for management of cerebral aneurysms

Serial Neuroimaging of a Growing Thrombosed Giant Aneurysm of the Distal Anterior Cerebral Artery. Case Report.

Intraventricular Cerebrovascular Pathologies of Hydrocephalus and Managements

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