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Current microsurgical and neurointerventional therapy of cerebral aneurysms


Authors: V. Přibáň 1,2;  M. Choc 1;  J. Mraček 1;  V. Runt 1;  J. Fiedler 2;  P. Duras 3
Authors‘ workplace: Neurochirurgické oddělení, Lékařská fakulta Univerzity Karlovy a Fakultní nemocnice v Plzni, primář: MUDr. V. Přibáň, Ph. D. 1;  Neurochirurgické oddělení, Nemocnice České Budějovice, a. s., primář: MUDr. V. Chlouba. 2;  Klinika zobrazovacích metod, Lékařská fakulta Univerzity Karlovy a Fakultní nemocnice v Plzni, přednosta: Doc. MUDr. B. Kreuzberg CSc. 3
Published in: Rozhl. Chir., 2012, roč. 91, č. 11, s. 588-596.
Category: Review

Overview

Cerebral aneurysms occur in 5% of the adult population. Their most severe clinical manifestation is subarachnoid haemorrhage occurring in half of the patients. Morbidity and mortality of subarachnoid hemorrhage is relatively high. Stopping blood flow into the aneurysmal sac is the treatment objective. The basic techniques to achieve this are closing the aneurysmal neck with a clip – clipping – and the induction of intraaneurysmal thrombosis using platinum coils – coiling. Fusiform and giant aneurysms represent a technical challenge. The solution for indicated cases is the occlusion of the magistral artery along with a high-flow bypass. A new option is the use of special stents – flow-diverters – in unruptured aneurysms.

The authors present the current view on the treatment of both ruptured and unruptured aneurysms. At the same time the authors focus on factors that influence the application of up-to-date knowledge on everyday activities in their departments.

Key words:
intracranial aneurysms – unruptured, subarachnoid haemorrhage – microsurgical therapy – endovascular treatment


Sources

1. Wiebers DO, Whisnant JP, Sunt TM et al. The significance of unruptured intracranial saccular aneurysms. J Neurosurg 1987; 66:23–29.

2. Šteňo J. Cievna neurochirurgia. In: Haruštiak S et al. Princípy chirurgie II. 1. vyd. Bratislava, Slovak Academic Press, s.r.o. 2010:165–203.

3. Fox JL. Intracranial aneurysms. New York, Springer-Verlag 1983.

4. Greenberg MS. Handbook of neurosurgery. 6th edition, New York, Thieme 2006.

5. Hop JW, Rinkel GJ, Algra A et al. Case-fatality rates and functional outcome after subarachnoid hemorrhage. A systemic review. Stroke 1997;28:660–664.

6. Kassel NF, Sasaki T, Colohan AR et al. Cerebral vasospasm following aneurysmal subarachnoid hemorrhage. Stroke 1985; 16:567–572.

7. Kassel NF, Drake, CG. Review of the management of saccular aneurysms. Neurol Clin 1983;1:73–86.

8. Raps EC, Galetta SL, Solomon RA et al. The clinical spectrum of unruptured intracranial aneurysms. Arch Neurol 1993;50:265 –268.

9. Yasargil MG. Microneurosurgery. Vol. II. Stuttgart. New York, Georg Thieme Verlag 1984.

10. Schramm J, Cedzich, Outcome and management of intraoperative aneurysm rupture. Surg Neurol 1993;40:26–30.

11. Lehecka M, Laako A, Hernesniemi J. Helsinki Microneurosurgery Basics and Tricks. Helsinki, Druckerei Hohl, 2011.

12. Dashti R, Laakso A, Niemelä M, Porras M, Hernesniemi J. Microscope-integrated near-infrared indocyanine green videoangiography during surgery of intracranial aneurysms: the Helsinki experience. Surg Neurol 2009;71:543–550.

13. Szelényi A, Langer D, Kothbauer K et al. Monitoring of muscle motor evoked potentials during cerebral aneurysm surgery: intraoperative changes and postoperative outcome. J Neurosurg 2006;105:675–681.

14. Amin-Hanjani S, Alaraj A, Charbel FT. Flow replacement bypass for aneurysms: decision-making using intraoperative blood flow measurement. Acta Neurochir 2010;152:1021–1032.

15. Geyik S, Ertugrul O, Yavuz K et al. Comparison of bioactive coils and bare platinum coils for treatment of intracranial aneurysms: a matched-pair analysis. J Neurosurg 2010;112:709–713.

16. White PM, Lewis SG, Gholkar A et al. Hydrogel-coated coils versus bare platinum coils for the endovascular treatment of intracranial aneurysms (HELPS): a randomized controlled trial. Lancet 2011;377:1655–1662.

17. Linfante I, DeLeo MJ, Gounis MJ et al. Cerecyte versus platinum coils in the treatment of intracranial aneurysms: packing attenuation and clinical and angiographical midterm results. Am J Neuroradiol 2009;30:1496–1501.

18. Lubicz B, Collington L, Raphaeli G et al. Flow-diverter stent for the endovascular treatment of intracranial aneurysms: A prospective study in 29 patients with 34 aneurysms. Stroke 2010; 41:2247–2253.

19. Fischer S, Vajda Z, Perez MA et al. Pipeline embolization device (PED) for neurovascular reconstruction: initial experience in the treatment of 101 intracranial aneurysms and dissections. Neuroradiology 2012;54:369–382.

20. Koebbe CJ, Veznedaroglu E, Jabbour P et al. Endovascular management of intracranial aneurysms: current experience and future advances. Neurosurgery 2006;59(5) suppl: 93–100.

21. Drake CG, Peerless SJ, Ferguson GG. Hunterian proximal arterial occlusion and giant aneurysms of the carotid circulation. J Neurosurg 1994;81:651–665.

22. Lawton MT, Hamilton MV, Morcos JJ et al. Revascularization and aneurysm surgery: current techniques, indications, and outcomes. Neurosurgery 1996;38:83–94.

23. Standard SC, Ahuja A, Guterman LR et al. Balloon test occlusion of the internal carotid artery with hypotensive challenge. Am J Neuroradiol 1995;16(7):1453–1458.

24. Kassel NF, Torner JC, Jane JA et al. The international cooperative study on the timing of aneurysm surgery. Part 2: Surgical results. J Neurosurg 1990;73:37–47.

25. Koivisto T, Vanninen R, Hurskainen H et al. Outcomes of early endovascular versus surgical treatment of ruptured cerebral aneurysms. A prospective randomized study. Stroke 2000;31: 2369–2377.

26. Molyneux A, Kerr R, Stratton I et al. International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomized trial. Lancet 2002;360:1267–1274.

27. Molyneux A, Kerr RSC, Birks J et al. Risk of subarachnoid haemorrhage, death, or dependence and standardised mortality ratios after clipping or coiling of an intracranial aneurysm in the international Subarachnoid Aneurysm Trial (ISAT): long-term follow-up. Lancet Neurol 2009;8:427–433.

28. McDougall CG, Spetzler RF, Zabramski JM et al. The Barrow Ruptured Aneurysm Trial. J Neurosurg 2012;116:135–144.

29. The International Study Group of Unruptured Intracranial Aneurysms Investigators (ISUIA): Unruptured aneurysms - risk of rupture and risk of surgical intervention. N Engl J Med 1998; 339:1725–1733.

30. Wiebers DO, Whisnant JP, Huston J et al. Unruptured intracranial aneurysms: natural history, clinical outcome, and risk of surgical and endovascular treatment. Lancet 2003;362:103–110.

31. Juvela S, Porras M, Poussa K. Natural history of unruptured intracranial aneurysms: probability of and risk factors for aneurysm rupture. J Neurosurg 2008;108:1052–1060.

32. Thornton J, Debrun GM, Aletich VA et al. Follow-up angiography of intracranial aneurysms treated with endovascular placement of Guglielmi detachable coils. Neurosurgery 2002;50:249–250.

33. Schaafsma JD, Sprengers ME, VanRooij WJ et al. Long-term recurrent subarachnoid hemorrhage after adequate coiling versus clipping of ruptured intracranial aneurysms. Stroke 2009; 40:1758–1763.

34. Johnston SC, Dowd CF, Higashida RT et al. Predictors of rehemorrhage after treatment of ruptured intracranial aneurysms: the Cerebral Aneurysm Rerupture After Treatment (CARAT) study. Stroke 2008;39:120–125.

35. Molyneux AJ, Clarke A, Sneade M et al. Cerecyte coil trial: Angiographic outcomes of a prospective randomized trial comparing endovascular coiling of cerebral aneurysms with either cerecyte or bare platinum coils. Stroke 2012. www.controled-trials.com. ISRCT TN 82461286.

36. Byrne JV, Beltechi R, Yarnold JA et al. Early experience in the treatment of intra-cranial aneurysms by endovascular flow diversion: A multicentre prospective study. Plos ONE 2010;5(9): e12492.

37. Briganti F, Napoli M, Tortora F et al. Italian multicenter experience with flow-diverter devices for intracranial unruptured aneurysms treatment with periprocedural complications -retrospective data analysis. Neuroradiology 2012; DOI: 10/s0234-012-1047–3.

38. Berge J, Biondi A, Machi P et al. Flow-diverter silk stent for the treatment of intracranial aneurysms: 1-year follow-up in a multicenter study. Am J Neuroradiol 2012;33:1150–1155.

39. Maimon S, Gonen L, Nossek E et al. Treatment of intra-cranial aneurysms with the SILK flow diverter: 2 years experience with 28 patients at single center. Acta Neurochir (Wien) 2012;154: 979–987.

40. Brinjikji W, Rabinstein AA, Lanzino G et al. Effect of age on outcome of treatment of unruptured cerebral aneurysms. A study of National Inpatient Sample 2001–2008. Stroke 2011;42: 1320–1324.

41. Kaku Y, Yamashita K, Kokuzawa J et al. Treatment of ruptured cerebral aneurysms-clip and coil, not clip versus coil. Acta Neurochir suppl. 2010;107:9–13.

42. Lanzino G, Fraser K, Kanaan Y, Wangenbach A. Treatment of ruptured intracranial aneurysms since the International Subarachnoid Aneurysm Trial: practice utilizing clip ligation and coil embolization as individual or complementary therapies J Neurosurg 2006;104:344–349.

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