Understanding and Managing Cerebral Aneurysms / edited by Xianli Lv.

Format:

Book

Contributor:

Lv, Xianli, editor.

Series:

Neurosurgical topics.

Neurosurgery Research Progress Series

Language:

English

Subjects (All):

Intracranial aneurysms--Treatment.

Intracranial aneurysms.

Physical Description:

1 online resource (430 pages)

Edition:

First edition.

Place of Publication:

New York, NY : Nova Science Publishers, Inc., [2024]

Summary:

"This book provides a detailed introduction to the characteristics of cerebral aneurysms and the current treatment methods. Cerebral aneurysms are not rare, and it is a common disease with a high disability and mortality rate. Most patients are unaware that they have a cerebral aneurysm, with the most common being cerebral hemorrhage. The diagnosis and treatment of cerebral aneurysms have been ongoing for over 100 years. Now, we can say that we have achieved very perfect results, but there are still many things that we do not know. An increasing number of unruptured cerebral aneurysms are accidentally discovered during neuroimaging examinations. The greatest risk of cerebral aneurysm is the risk of rupture and serious consequences. Due to the extremely high mortality rate, once these aneurysms are detected, systematic treatment is necessary. The earlier a patient is referred to a neurosurgeon or interventional neuroradiologist, the better the outcome will be compared to the patient experiencing rupture. The decision to treat is multifactorial"-- Provided by publisher.

Contents:

Intro

Contents

Preface

Chapter 1

Intracranial Aneurysms

Abstract

Introduction

Anatomy of Intracranial Aneurysm

Pathophysiology

Risk Factors for Aneurysm Rupture

Dissecting Aneurysm

Microneurosurgery for Aneurysms

Endovascular Surgery of Cerebral Aneurysms

Aneurysm Rupture and Management during Pregnancy

Conclusion

References

Chapter 2

Anatomy and Endovascular Approach for Anterior Communicating Artery Aneurysms

Background

Determination of Aneurysm Projection

Clinical Series

Techniques of Microcatheter and Coil Embolization

Techniques for Stents

Previous Classifications of Acom Aneurysms

Chapter 3

Posterior Communicating Artery Aneurysms

Key Points

1.1. Posterior Communicating Artery Anatomy

1.1.1. Course

1.1.2. Termination

1.1.3. Morphology

1.1.4. Perforating Branches

1.1.5. Surrounding Structures

1.2. Posterior Communicating Artery Aneurysm

1.3. Patho-Anatomy And Morphological Parameters of PcomA Aneurysm

1.3.1. Origin

1.3.2. Size

1.3.3. Neck

1.3.4. Dome Orientation

1.3.5. PcomA Aneurysmal wall

1.3.6. PcomA Fusiform Aneurysm

1.4. Clinical features of PcomA Aneurysm

1.4.1. Ruptured PcomA aneurysm

1.4.2. Subarachnoid Hemorrhage (SAH)

1.4.3. Intracerebral Hemorrhage (ICH)

1.4.4. Subdural Hematoma (SDH)

1.4.5. Rebleeding

1.4.6. Oculomotor Nerve Palsy (OMNP)

1.5. Investigation of PcomA Aneurysm and Diagnostic Modalities

1.5.1. CTA

1.5.2. MRA

1.5.3. DSA

1.5.4. Brain Endoscopy

1.6. Management of PcomA

1.6.1. Decision-Making

1.6.2. Surgical Management of PcomA Aneurysm

1.6.2.1. Preparation and Head Positioning

1.6.2.2. Craniotomy

1.6.2.2.1. Standard Pterional Craniotomy

1.6.2.3. Superciliary Keyhole Approach.

1.6.2.4. Subtemporal Approach

1.6.2.5. Anterior Subtemporal Approach

1.6.2.6. Anterior Temporal Approach

1.6.2.7. Brain Relaxation

1.6.2.7.1. Method

1.6.2.8. Dissection of the Sylvian Fissure

1.6.2.9. Anterior Clinoidectomy

1.6.2.10. Approach to the PcomA Aneurysm Neck

1.6.2.11. Approach to Junctional PcomA Aneurysm

1.6.2.12. Approach to true PcomA Aneurysm

1.6.2.13. Temporary Clipping

1.6.2.14. Permanent Clip Placement

1.6.2.15. Post-Clipping Evaluation

1.6.3. Endovascular Treatment Modalities of PcomA Aneurysm

1.6.3.1. Endovascular Coiling

1.6.3.1.1. Procedure of Aneurysm Coiling

1.6.3.1.2. Limitation of Endovascular Coiling

1.6.3.2. Stent-Assisted Coil Embolization

1.6.3.3. Flow Diversion

1.6.4. Surgery vs. Endovascular Management of PcomA Aneurysms

1.7. Short-Term and Long-Term Outcome and Recovery Predictors

1.8. Recurrency of PcomA Aneurysm

1.9. Follow-up Plan for PcomA Aneurysm Patients

1.10. Cases of PcomA Aneurysms

1.10.1. Case 1

1.10.1.1. Pure Posteriorly Directed PcomA Aneurysm [63]

1.10.2. Case 2

1.10.2.1. Bilateral PcomA Aneurysms

1.10.3. Case 3

1.10.3.1. Left Sided Posteriorly Directed PcomA Aneurysm

Chapter 4

Endovascular and Surgical Options for Ruptured Middle Cerebral Artery Aneurysms

Symptoms and Clinical Presentation

Diagnosis of MCA Aneurysm Rupture

Surgical Options for Ruptured MCA Aneurysms

Preparation

Approaches and Related Positioning

The Proximal Sylvian Fissure Approach

The Distal Sylvian Fissure Approach

The Superior Temporal Approach

Focused Opening of the Sylvian Fissure

Choosing the Right Approach

Dissection and Clipping

Complex Aneurysms

Endovascular Treatment

Clipping versus Coiling of Ruptured MCA Aneurysms

Conclusion.

Conflict of Interest

Funding

Chapter 5

Innovative Surgical Strategy for Giant Middle Cerebral Artery Aneurysms: Avoiding Parent Artery Occlusion and Optimizing Outcome

Case Report

Surgical Treatment

Technical Nuance of the Bypass Procedure

The Procedure with Advantages to Overcome Limitations and Complication

Advantages of this Approach

Chapter 6

The Characteristics, Embolization Techniques, and Treatment Results in Saccular Aneurysm with the Middle Cerebral Artery

Abbreviations

Materials and Methods

Patient Population

Complications and Outcomes

Follow-Up Outcomes

Procedure

Statistical Analysis

Results

Patient and Aneurysm Characteristics

Treatment and Outcomes

Hemorrhagic Complications

Thromboembolic Complications

Major Events (mRS&gt

2)

Initial and Follow-Up Angiographic Outcomes

Neurological Complications at Follow-Up

Discussion

Limitations

Chapter 7

Endovascular Treatment of Distal Aneurysms of the Intracranial Arteries: Sacrifice or Reconstruction

1. Introduction

2. Definition, Incidence, Pathogenesis, and Classification of DAIAs

2.1. Definition

2.2. Incidence

2.3. Pathogenesis

2.4. Classification

3. Therapeutic Options for DAIAs

3.1. General Overview

3.2. EVT Status

4. Reconstructive EVT for DAIAs

5. Risk of Endovascular PAO and the Balloon Occlusion Test

5.1. Risk of Endovascular PAO

5.2. Balloon Occlusion Test

6. Options for Embolic Materials for Endovascular PAO

7. PAO Characteristics of Each DAIA

7.1. Distal ACA

7.2. Distal MCA

7.3. Distal PCA

7.4. Distal SCA

7.5. Distal AICA

7.6. Distal PICA.

7.7. Flow-related aneurysms in BAVM, MMD and MCA occlusion

Chapter 8

Intracranial Dissecting Aneurysms

Part 1: Etiology and epidemiology

Part 2: Pathological Mechanisms

Part 3: Symptoms

Part 4: Imaging and Diagnosis

Part 5: Treatment

Flow Diversion Treatment for Dissecting Aneurysms

Vertebral Artery Dissecting Aneurysm

Vertebrobasilar Artery Dissecting Aneurysm

Basilar Artery Dissecting Aneurysm

Dissecting Aneurysms of the Main Branch of the Vertebrobasilar Artery

Dissecting Aneurysms of Carotid Circulation

Chapter 9

Intracranial Infectious Aneurysms: An Exceptional Contender

Epidemiology

Pathogenesis

Natural History and Prognosis

Diagnosis

Clinical Manifestations

Laboratory Features

Imaging Features

Management

Treatment Algorithm

Unruptured IIAs (Medical Therapy and Surveillance)

Ruptured IIAs

Surgical Management

Endovascular

Deconstructive Therapy

Reconstructive Therapy

De-Reconstructive Therapy

Disclaimer

Chapter 10

Endovascular Treatment of Cerebral Aneurysms

Endovascular Aneurysm Repair: History of Development

Indications for Endovascular Treatment

Aneurysm Embolization Technique

Performing Angiographic Imaging and Choosing an Approach

Balloon-Assistance

Stent-Assistance

Flow Diverters

Post-Embolization Complications

Post-Coiling Complications

Complications After FD Implantation

Balloon and Chemical Angioplasty

Chapter 11

Flow Diversion Treatment on Ruptured Proximal A1 Aneurysms: Three Case Reports and Review of the Literature

Case 1

Case 2

Case 3

Chapter 12.

Reconstructive Endovascular Treatment on Vertebrobasilar Junction Aneurysms: Case Series and Review of the Literature

Treatment with Primary Coiling Case 1

Treatment with Flow Diverter Case 2

Treatment with Stent-Assisted Coiling Case 3

Chapter 13

Atypical Manifestations of V4 Aneurysms: Persistent Cough May Be an Initial Symptom of an Aneurysm

Neck Pain with Vomiting is a Red Flag

Chronic Cough Could Be Only Symptom of a Vertebral Aneurysm

Chapter 14

Intracranial Stents for Cerebral Aneurysms

Generations of Neurostents

Stent-Assisted Coiling Technique

Mesh Piercing Technique

Jailing Technique

Stent Technique for Endovascular Treatment of Aneurysms at Bifurcation

Intrasaccular Flow Disruptor

Flow-Diversion Devices

Chapter 15

Stent-Assisted Coiling of Cerebral Aneurysms Using the Laser-Cut Closed-Cell Stents: Enterprise and Solitaire AB Stents

Patients and Aneurysm Treatment

Data Collection and Statistical Analysis

Clinical and Angiographic Outcome Measures

Characteristics of Treated Aneurysms

Success of Stents

Procedure Related Morbidity and Mortality

Initial Angiographic Results

Follow-Up Findings

Experience in Using Stents

Chapter 16

Intrasaccular Flow Diverter (WEB) Assisted Cerebral Aneurysm Embolization

Wide-Necked and/or Bifurcation Aneurysms (WNBAs)

The Woven Endo Bridge (WEB) Devices

The Advantages of the WEB Devices

Safety and Complication Issues

Occlusion and Recurrence Assessments.

Compaction or Compression of the WEB Devices.

Notes:

Description based on publisher supplied metadata and other sources.

Description based on print version record.

Includes bibliographical references.

ISBN:

9798891136830