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Cerebral aneurysm randomized

Fang Zhu, Jason Chui, Ian Herrick, Janet Martin
OBJECTIVES: We aim to evaluate the diagnostic test accuracy (DTA) of intraoperative evoked potential (EP) monitoring to detect cerebral injury during clipping of cerebral aneurysms. DESIGN: Systematic review. DATA SOURCES: Major electronic databases including MEDLINE, EMBASE, LILACS. ELIGIBILITY CRITERIA: We included studies that reported the DTA of intraoperative EP monitoring during intracranial aneurysm clipping procedures in adult patients...
February 12, 2019: BMJ Open
Adnan I Qureshi, Ammad Ishfaq, Muhammad F Ishfaq, Abhi Pandhi, Sundas I Ahmed, Savdeep Singh, Ali Kerro, Rashi Krishnan, Aman Deep, Alexandros L Georgiadis
Objective: To assess the effectiveness of cilostazol, a selective inhibitor of phosphodiesterase type III, in preventing cerebral ischemia related to cerebral vasospasm after aneurysmal subarachnoid hemorrhage (SAH). Methods: A total of six clinical studies met the inclusion criteria and were included in the meta-analysis. We calculated pooled risk ratios (RR) and 95% confidence intervals (CI) using random-effects models. The primary endpoint was cerebral ischemia related to vasospasm...
November 2018: Journal of Vascular and Interventional Neurology
Huijie Wei, Mengchen Yang, Kai Yu, Wang Dong, Wang Liang, Zengguang Wang, Rongcai Jiang, Jianning Zhang
BACKGROUND Endothelial injury is the early pathological change of cerebral aneurysm (CA) formation. In addition to its lipid-lowering activity, atorvastatin (ATR) also reportedly promotes vascular repair via mobilizing endothelial progenitor cells (EPC). Here, we investigated the influence of ATR on vascular worsening after CA induction in rats. MATERIAL AND METHODS Adult male Sprague-Dawley rats were randomly assigned to 3 groups: a control (CTR) group, a CA group, and a CA+ATR treatment group. Circulating EPC level and hematological and lipid profiles were measured 3 months after CA induction...
February 2, 2019: Medical Science Monitor: International Medical Journal of Experimental and Clinical Research
Hiroyuki Nagata, Kazuhiro Murayama, Shigetaka Suzuki, Ayumi Watanabe, Motoharu Hayakawa, Yasuo Saito, Kazuhiro Katada, Hiroshi Toyama
PURPOSE: Diagnostic and neurosurgical procedures require the precise localization of small intracranial arteries, but this may be difficult using conventional computed tomography angiography (CTA). This study was conducted to evaluate the quality of CTA images acquired using a prototype ultra-high-resolution computed tomography (U-HRCT) system compared with those acquired using a conventional computed tomography (C-CT) system. MATERIALS AND METHODS: From July through September 2015, 10 adult patients (6 women and 4 men) previously scanned by C-CT were examined using U-HRCT to locate and assess cerebral aneurysms...
January 31, 2019: Japanese Journal of Radiology
Xiaoxi Zhang, Yu Zhou, Guoli Duan, Haishuang Tang, Qiao Zuo, Pengfei Yang, Yi Xu, Bo Hong, Qinghai Huang, Jianmin Liu
OBJECTIVE: Endovascular treatment for ruptured middle cerebral artery (MCA) aneurysms, which were more likely to be recommended for neurosurgical clipping because of complex anatomic configuration, still remain controversial. In this study, angiographic and clinical outcomes ofendovacularly treated ruptured MCA aneurysms were systematically reviewed. MATERIALS AND METHODS: Online database including Cochrane, Medline, web of science and Embase were retrospectively and systematically searched...
January 24, 2019: World Neurosurgery
T Gaberel, C Gakuba, F Fournel, E Le Blanc, C Gaillard, L P Saint Paul, F Chaillot, P Tanguy, J-J Parienti, E Emery
INTRODUCTION: Aneurysmal subarachnoid hemorrhage (SAH) is a devastating form of stroke, which often causes acute hydrocephalus requiring the insertion of an external ventricular drain (EVD). A major complication of aneurysmal SAH is delayed cerebral ischemia (DCI). As DCI is linked to the presence of blood within the subarachnoid space, it has been hypothesized that removing this blood may decrease the risk of DCI. This could be achieved by injecting a fibrinolytic agent through the EVD, a strategy called intraventricular fibrinolysis (IVF)...
January 9, 2019: Neuro-Chirurgie
Thomas J Sorenson, Vitor M Pereira, Leonardo Rangel Castilla, Chris A Hilditch, Patrick J Nicholson, Waleed Brinjikji
INTRODUCTION: To assess the early safety and efficacy of anterior cerebral artery (ACA) and anterior communicating artery (ACoA) aneurysm treatment with flow-diversion devices (FDDs), we performed a systematic review and meta-analysis for these aneurysms. EVIDENCE ACQUISITION: A literature search was performed by a reference librarian, and, after screening, eight case series were included for meta-analysis. We estimated from each study the cumulative incidence (event rate) and 95% confidence interval (CI) for each outcome...
January 4, 2019: Journal of Neurosurgical Sciences
Han-Gil Jeong, Bong Geun Cha, Dong-Wan Kang, Do Yeon Kim, Seul Ki Ki, Song I Kim, Ju Hee Han, Wookjin Yang, Chi Kyung Kim, Jaeyun Kim, Seung-Hoon Lee
Background and Purpose- Despite early aneurysm repair and aggressive management for complications, subarachnoid hemorrhage (SAH) results in at least 25% mortality rate and 50% persistent neurological deficit. We investigated whether ceria nanoparticles which have potent antioxidative activities can protect against subarachnoid hemorrhage via attenuating fatal brain injuries. Methods- Uniform, 3 nm, water-dispersed ceria nanoparticles were prepared from short sol-gel reaction of cerium (III) ions with aminocaproic acid in aqueous phase...
December 2018: Stroke; a Journal of Cerebral Circulation
Song Jiang, Xiufen Xie
Objective: To analyze the clinical effectiveness and safety of early interventional embolization in the treatment of ruptured cerebral aneurysm. Methods: Eighty-eight patients with cerebral aneurysm rupture who were admitted to the hospital between February 2015 and October 2016 were selected as the research subjects and were randomly divided into a control group (N=44) and an observation group (N=44) using random number table. Patients in the control group were given interventional embolization three days after admission, while patients in the observation group were given interventional embolization within three days after admission...
November 2018: Pakistan Journal of Medical Sciences Quarterly
E D Zvereva, B B Komakha, D A Zverev, M A Chernyavsky, M L Gordeev
OBJECTIVE: The purpose of the study was to assess surgical outcomes in patients suffering from an infrarenal abdominal aortic aneurysm and treated at the Department of Cardiovascular Surgery #2 of the National Medical Research Centre named after V.A. Almazov. PATIENTS AND METHODS: We carried out a non-randomized retrospective study including a total of 209 patients presenting with an infrarenal abdominal aortic aneurysm. Of these, 160 (76%) patients were subjected to open surgical interventions (Group One) and 49 (24%) patients underwent endovascular isolation of the abdominal aortic aneurysm (Group Two)...
2018: Angiologii︠a︡ i Sosudistai︠a︡ Khirurgii︠a︡, Angiology and Vascular Surgery
Marielle Ernst, Levente Kriston, Uta Hanning, Andreas M Frölich, Jens Fiehler, Jan Hendrik Buhk
BACKGROUND AND PURPOSE: To evaluate factors influencing the confidence of management recommendation for unruptured intracranial aneurysms (UIAs) and to assess the ability of neurointerventionalists to predict procedure-related neurological complications compared with a 3-point risk score. MATERIALS AND METHODS: Twenty-eight neurointerventionalists were asked to evaluate digital subtraction angiographies examinations of patients with UIAs by determining the best management approach, their level of confidence in their management recommendation, and estimating the risk of procedure-related neurological complications...
December 4, 2018: Journal of Neurointerventional Surgery
Jie Song, Yue-Qin Xue, Yan-Ju Wang, Peng Xu, De-Ke Sun, Wei Chen
AIMS: The present meta-analysis was conducted to provide an update on the efficacy and safety profile of clazosentan with different doses in aSAH. METHODS: We performed a comprehensive and electronic search of the following databases updated to September, 2018: the Cochrane library, Embase and PubMed, to identify relevant clinical trials. Trials of the effectiveness of clazosentan in treating cerebral vasospasm after aSAH were studied, of which the main outcomes included new cerebral infarction (NCI), delayed ischemic neurological deficit (DIND), vasospasm associated with morbidity/mortality (M/M), angiographic vasospasm, rescue therapy and adverse events...
November 26, 2018: World Neurosurgery
Ofer Sadan, Owen Samuels, William H Asbury, John J Hanfelt, Kai Singbartl
BACKGROUND: Aneurysmal subarachnoid hemorrhage (aSAH) is a life-threatening condition that results from a ruptured cerebral vessel. Cerebral edema and vasospasm are common complications and frequently require treatment with hypertonic solutions, in particular hypertonic sodium chloride (NaCl). We have previously shown that hyperchloremia in patients with aSAH given hypertonic NaCl is associated with the development of acute kidney injury (AKI), which leads to higher morbidity and mortality...
November 14, 2018: Trials
Rabie Soliman, Gomaa Zohry
BACKGROUND: Aneurysmal subarachnoid hemorrhage is an important cause of premature death and disability worldwide. Magnesium sulphate is shown to have a neuroprotective effect and it reverses cerebral vasospasm. Milrinone is also used in the treatment of cerebral vasospasm. The aim of the present study was to compare the effect of prophylactic magnesium sulphate and milrinone on the incidence of cerebral vasospasm after subarachnoid hemorrhage. METHODS: The study included 90 patients with aneurysmal subarachnoid hemorrhage classified randomly (by simple randomization) into two groups: magnesium sulphate was given as an infusion of 500mg...
November 5, 2018: Revista Brasileira de Anestesiologia
Jie Sun, Yuchun Liu, Junjun Zhang, Xiaosheng Chen, Zhiqing Lin, Sheng Nie, Manhua Shi, Xiang Gao, Yi Huang
Cerebral vasospasm is the major cause of a poor outcome after aneurysmal subarachnoid hemorrhage (aSAH), and effective treatments for vasospasm are limited. The purpose of this study was to research the impact of electroacupuncture (EA) on cerebral vasospasm and the outcomes of patients with aSAH. A total of 60 age- and sex-matched aSAH patients were collected from Ningbo First Hospital between December 2015 and June 2017. All patients were given a basic treatment of nimodipine and randomized into two groups...
2018: Frontiers in Neuroscience
Kazutaka Sugimoto, Sadahiro Nomura, Satoshi Shirao, Takao Inoue, Hideyuki Ishihara, Reo Kawano, Akiko Kawano, Fumiaki Oka, Eiichi Suehiro, Hirokazu Sadahiro, Mizuya Shinoyama, Takayuki Oku, Yuichi Maruta, Yuya Hirayama, Koichiro Hiyoshi, Miwa Kiyohira, Hiroshi Yoneda, Koki Okazaki, Jens P Dreier, Michiyasu Suzuki
OBJECTIVE: Traditionally, angiographic vasospasm (aVS) has been thought to cause delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (aSAH). However, successful treatment of aVS alone does not result in improved neurological outcome. Therefore, there may be other potential causes of poor neurological outcome, including spreading depolarization (SD). A recent study showed beneficial effects of cilostazol on DCI and neurological outcome. The present prospective clinical trial and experimental study focused on effects of cilostazol on SDs...
December 2018: Annals of Neurology
Jonathan Rychen, Davide Croci, Michel Roethlisberger, Erez Nossek, Matthew B Potts, Ivan Radovanovic, Howard A Riina, Luigi Mariani, Raphael Guzman, Daniel W Zumofen
OBJECTIVE: To clarify the reported experience with keyhole approaches for the treatment of intracranial aneurysms. METHODS: The PubMed and Embase databases were searched up to December 2017 for full-text publications that report the treatment of aneurysms with the eyebrow variant of the supraorbital craniotomy (SOC), the minipterional craniotomy, or the eyelid variant of the SOC. The anatomical distribution of aneurysms, the postoperative aneurysm occlusion rate, and the type and rate of complications were examined using univariate analysis...
October 12, 2018: Neurological Research
Giuseppe Esposito, Martina Sebök, Sepideh Amin-Hanjani, Luca Regli
BACKGROUND AND AIMS: Cerebral bypasses are categorized according to function (flow augmentation or flow preservation) and to characteristics: direct, indirect or combined bypass, extra-to-intracranial or intra-to-intracranial bypass, and high-, moderate- or low-capacity bypass. We critically summarize the current state of evidence and grades of recommendation for cerebral bypass surgery. METHODS: The current indications for cerebral bypass are discussed depending on the function of the bypass (flow preservation or augmentation) and analyzed according to level of evidence criteria...
2018: Acta Neurochirurgica. Supplement
Hamidreza Saber, Aaron Desai, Mohan Palla, Wazim Mohamed, Navid Seraji-Bozorgzad, Muhammed Ibrahim
OBJECTIVES: Cilostazol, a selective inhibitor of phosphodiesterase 3, may reduce symptomatic vasospasm and improve outcome in patients with aneurysmal subarachnoid hemorrhage considering its anti-platelet and vasodilatory effects. We aimed to analyze the effects of cilostazol on symptomatic vasospasm and clinical outcome among patients with aneurysmal subarachnoid hemorrhage (aSAH). PATIENTS AND METHODS: We searched PubMed and Embase databases to identify 1) prospective randomized trials, and 2) retrospective trials, between May 2009 and May 2017, that investigated the effect of cilostazol in patients with aneurysmal aSAH...
November 2018: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Jean-Mathieu Mastantuono, Christophe Combescure, Nadia Elia, Martin R Tramèr, Christopher Lysakowski
OBJECTIVES: To evaluate the performance of transcranial Doppler and transcranial color-coded duplex Doppler in patients with cerebral vasospasm due to aneurysm rupture. Angiography was considered as the gold standard comparator. DATA SOURCES: Search in MEDLINE, Embase, and Central from January 2001 to October 2017, without language restriction. Bibliographies of retrieved articles were screened for additional studies. STUDY SELECTION: Randomized studies comparing transcranial Doppler or transcranial color-coded duplex Doppler with angiography in adults...
October 2018: Critical Care Medicine
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