Results and Current Trends of Multimodality Treatment for Infectious Intracranial Aneurysms

Matsubara, Noriaki; Miyachi, Shigeru; Izumi, Tohru; Yamanouchi, Takashi; Asai, Takumi; Ota, Kohei; Wakabayashi, Toshihiko

doi:10.2176/nmc.oa.2014-0197

Cited by 29 publications

(38 citation statements)

References 24 publications

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“…However, infectious complications were not observed in our patients. According to our review, there were no reports concerning infectious complications after endovascular treatment for IIAs, 3,9,10) and, in this respect, endovascular treatment is also considered to be a relatively safe approach.…”

Section: Discussionmentioning

confidence: 85%

“…However, flow-directed catheters such as Marathon selected because the parent artery itself is made vulnerable due to infection. 3,8,9) Direct surgery is recommended for aneurysms arising in the eloquent area probably to add bypass surgery. 3) However, IIAs often affect peripheral blood vessels, and the peripheral blood flow is likely to be maintained by leptomeningeal collaterals.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, embolization using liquid embolic agents such as N-butyl-2-cyanoacrylate (NBCA) and Onyx are also reported. 8,9,12,13) Using these materials, a sufficient hemostatic effect can be obtained even if the aneurysm is inaccessible. However, we have to keep in mind that excessive injection and unintended entry of a liquid embolic agent may induce enlargement of the ischemic focus.…”

Section: Discussionmentioning

confidence: 99%

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Treatment Strategy for Infectious Intracranial Aneurysms in the Era of Interventional Neuroradiology

Nakamura

Fujinaka

Nishida

et al. 2017

JNET

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Objective: Aggressive therapeutic intervention is recommended for infectious intracranial aneurysms (IIAs) because they have a higher hemorrhage risk than non-IIAs. In this study, we retrospectively reviewed patients with IIAs treated at our institution and evaluated the contents of treatment and the complications. Results: Endovascular treatment, direct surgery, and conservative management were performed in five, five, and three patients, respectively. In endovascular treatment patients, none developed any hemorrhagic or infectious complications.In the five direct surgery patients, we selected direct surgery because three patients needed hematoma evacuation, and the catheter navigation was not achievable in the remaining two patients. Conclusion:Since IIAs often occur in peripheral arteries and are accompanied by local infection, aneurysmectomy by direct surgery used to be preferred. However, as embolization of cortical branches using a flexible catheter and small coils has become technically possible by the improvements of endovascular devices, endovascular parent artery occlusion might be a reasonable alternative for IIAs.

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Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Treatment Strategy for Infectious Intracranial Aneurysms in the Era of Interventional Neuroradiology

Nakamura

Fujinaka

Nishida

et al. 2017

JNET

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“…After screening of the titles and abstracts, 63 studies were selected for full review [1,3,4,7,10,11,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71]. Thirty studies with 2 or more patients and 33 case reports with a total number of 814 patients were identified.…”

Section: Resultsmentioning

confidence: 99%

“…Some authors described that the patients' condition was very poor and surgery or interventional treatment was not possible [4,16,26]. Another mentioned therapy concept was to treat initially conservatively and to occlude the aneurysm only in cases of a size enlargement in the control angiography [23,32]. …”

Section: Resultsmentioning

confidence: 99%

Interdisciplinary Treatment of Intracranial Infectious Aneurysms

Hamisch¹,

Mpotsaris

Timmer³

et al. 2016

Cerebrovasc Dis

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Objective: Intracranial infectious aneurysms (IIAs) are a rare clinical entity without a definitive treatment guideline. In this study, we evaluate the treatment options of these lesions based on our own clinical experience and review the current knowledge of therapy as portrayed in the literature. Methods: We conducted a single-center retrospective analysis of all patients with an IIA and performed a systematic review of the literature using the MEDLINE database. We undertook a comprehensive literature search using the OVID gateway of the MEDLINE database (1950-October 2015) using the following keywords (in combination): ‘infectious', ‘mycotic', ‘cerebral aneurysm', ‘intracranial aneurysm'. 1,721 potentially relevant abstracts were identified and 63 studies were selected for full review. The studies were analysed regarding ruptured versus unruptured aneurysms, aneurysm localization and treatment, as well as clinical and radiological outcome. Results: Our institutional series consisted of 6 patients (median age 57 [32-76]) treated between 2011 and 2015. All patients presented with ruptured IIAs located on the middle cerebral artery (MCA, 5 patients) and anterior cerebral artery (ACA, 1 patient). Five patients were treated by clipping and resecting the aneurysm, 1 patient underwent coiling. All patients received antibiotic therapy and 1 patient died. We further identified 814 patients (median age 35.5 [0-81]) in 63 studies. Locations of the aneurysms were mentioned in 55 studies. The most frequent locations of the aneurysms were: MCA (63.5%), posterior cerebral artery (14%), ACA (9.0%) and others (13.5%). Treatment for IIAs was described in 62 studies: antibiotic treatment (56.1%), a combination of antibiotics and surgery (20.9%) or antibiotics and endovascular treatment (23.0%). Outcome was mentioned in 82.4% of the patients with a mortality rate of 16.8%. An evaluation of treatment outcome was limited due to the heterogeneity of patients in the published case series. Conclusion: Antibiotic therapy of patients with IIA is mandatory. However, due to the complexity of the disease and its accompanying comorbidities, a general treatment algorithm could not be defined. Analogous to non-mycotic aneurysms, further treatment decisions require an interdisciplinary approach involving neurosurgeons, interventionists and infectious disease specialists.

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Infectious Aneurysms (Mycotic Aneurysms)

Ren

2022

Eight Aneurysms

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Results and Current Trends of Multimodality Treatment for Infectious Intracranial Aneurysms

Cited by 29 publications

References 24 publications

Treatment Strategy for Infectious Intracranial Aneurysms in the Era of Interventional Neuroradiology

Treatment Strategy for Infectious Intracranial Aneurysms in the Era of Interventional Neuroradiology

Interdisciplinary Treatment of Intracranial Infectious Aneurysms

Infectious Aneurysms (Mycotic Aneurysms)

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