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10 pages, 3793 KiB

Open AccessCommunication

Morphological and Hemodynamic Changes during Cerebral Aneurysm Growth

by Emily R. Nordahl, Susheil Uthamaraj, Kendall D. Dennis, Alena Sejkorová, Aleš Hejčl, Jaroslav Hron, Helena Švihlová, Kent D. Carlson, Yildirim Bora Suzen and Dan Dragomir-Daescu

Brain Sci. 2021, 11(4), 520; https://doi.org/10.3390/brainsci11040520 - 19 Apr 2021

Cited by 13 | Viewed by 3162

Abstract

Computational fluid dynamics (CFD) has grown as a tool to help understand the hemodynamic properties related to the rupture of cerebral aneurysms. Few of these studies deal specifically with aneurysm growth and most only use a single time instance within the aneurysm growth [...] Read more.

Computational fluid dynamics (CFD) has grown as a tool to help understand the hemodynamic properties related to the rupture of cerebral aneurysms. Few of these studies deal specifically with aneurysm growth and most only use a single time instance within the aneurysm growth history. The present retrospective study investigated four patient-specific aneurysms, once at initial diagnosis and then at follow-up, to analyze hemodynamic and morphological changes. Aneurysm geometries were segmented via the medical image processing software Mimics. The geometries were meshed and a computational fluid dynamics (CFD) analysis was performed using ANSYS. Results showed that major geometry bulk growth occurred in areas of low wall shear stress (WSS). Wall shape remodeling near neck impingement regions occurred in areas with large gradients of WSS and oscillatory shear index. This study found that growth occurred in areas where low WSS was accompanied by high velocity gradients between the aneurysm wall and large swirling flow structures. A new finding was that all cases showed an increase in kinetic energy from the first time point to the second, and this change in kinetic energy seems correlated to the change in aneurysm volume. Full article

(This article belongs to the Special Issue Neurosurgery for Cerebral Aneurysms)

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7 pages, 505 KiB

Open AccessArticle

Can Aspartate Aminotransferase in the Cerebrospinal Fluid Be a Reliable Predictive Parameter?

by Petr Kelbich, Tomáš Radovnický, Iva Selke-Krulichová, Jan Lodin, Inka Matuchová, Martin Sameš, Jan Procházka, Jan Krejsek, Eva Hanuljaková and Aleš Hejčl

Brain Sci. 2020, 10(10), 698; https://doi.org/10.3390/brainsci10100698 - 1 Oct 2020

Cited by 4 | Viewed by 2127

Abstract

Brain ischemia after central nervous system (CNS) bleeding significantly influences the final outcome of patients. Catalytic activities of aspartate aminotransferase (AST) in the cerebrospinal fluid (CSF) to detect brain ischemia were determined in this study. The principal aim of our study was to [...] Read more.

Brain ischemia after central nervous system (CNS) bleeding significantly influences the final outcome of patients. Catalytic activities of aspartate aminotransferase (AST) in the cerebrospinal fluid (CSF) to detect brain ischemia were determined in this study. The principal aim of our study was to compare the dynamics of AST in 1956 CSF samples collected from 215 patients within a 3-week period after CNS hemorrhage. We compared concentrations of the AST catalytic activities in the CSF of two patient groups: survivors (Glasgow Outcome Score (GOS) 5–3) and patients in a vegetative state or dead (GOS 2–1). All statistical evaluations were performed using mixed models and the F-test adjusted by Kenward and Roger and the Bonferroni adjustment for multiple tests. The significantly higher catalytic activities of AST in the CSF from patients with the GOS of 2–1 when compared to those who survived (GOS 5–3, p = 0.001) were found immediately after CNS haemorrhage. In the further course of time, the difference even increased (p < 0.001). This study confirmed the key association between early signs of brain damage evidenced as an elevated AST activity and the prediction of the final patient’s clinical outcome. The study showed that the level of AST in the CSF could be the relevant diagnostic biomarker of the presence and intensity of brain tissue damage. Full article

(This article belongs to the Special Issue Neurosurgery for Cerebral Aneurysms)

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12 pages, 4464 KiB

Open AccessCommunication

Distal Aneurysms of Cerebellar Arteries—Case Series

by David Krahulik, Miroslav Vaverka, Lumir Hrabálek, Štefan Trnka, Martin Kocher and Marie Cerna

Brain Sci. 2020, 10(8), 538; https://doi.org/10.3390/brainsci10080538 - 10 Aug 2020

Cited by 1 | Viewed by 3155

Abstract

(1) Background: Distal aneurysms of cerebellar arteries are very rare. The authors report their case series of distal aneurysms of the cerebellar arteries solved successfully by microsurgery or by endovascular treatment (Table 1) (2) Materials and Methods: Between January 2010 and March 2020, [...] Read more.

(1) Background: Distal aneurysms of cerebellar arteries are very rare. The authors report their case series of distal aneurysms of the cerebellar arteries solved successfully by microsurgery or by endovascular treatment (Table 1) (2) Materials and Methods: Between January 2010 and March 2020, 346 aneurysms were treated in our institution. Eleven aneurysms in seven patients were located on distal cerebellar arteries and, in three patients, the aneurysms were combined with arteriovenous malformations. There were four women and three men, ranging from 50 to 72 years of age. Five patients presented with different grades of subarachnoid hemorrhage or intraventricular bleeding, and two patients were diagnosed because of headache. Aneurysm location was the posterior inferior cerebellar artery in six cases, the superior cerebellar artery in three cases, and the anterior inferior cerebellar artery in 2 cases. One patient had three aneurysms, and two patients had two aneurysms. (3) Results: Nine aneurysms were treated by microsurgery trapping or clipping and, in two patients, the associated arteriovenous malformation (AVM) was resected. Two aneurysms were treated by endovascular coiling, and one associated AVM was successfully embolized. Clinical follow-up was a mean of 11.5 months (range, 3–45 months). (4) Conclusion: The authors present their experience with the treatment of 11 peripheral aneurysms on distal branches of the cerebellar circulation in seven patients which were excluded from circulation by microsurgery or endovascular treatment. In three patients, the associated AVM was treated (two with microsurgery, one with embolization). Full article

(This article belongs to the Special Issue Neurosurgery for Cerebral Aneurysms)

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11 pages, 939 KiB

Open AccessCommunication

Current Treatment of Anterior Communicating Artery Aneurysms: Single Center Study

by Ondřej Navrátil, Kamil Ďuriš, Vilém Juráň, Karel Svoboda, Jakub Hustý, Evžen Hovorka, Eduard Neuman, Andrej Mrlian and Martin Smrčka

Brain Sci. 2020, 10(8), 501; https://doi.org/10.3390/brainsci10080501 - 31 Jul 2020

Cited by 3 | Viewed by 3618

Abstract

Introduction: Anterior communicating artery aneurysms (ACoAAs) are the most frequent intracranial aneurysms treated at neurosurgical departments with a vascular program. Material and methods: We reviewed patients with ACoAAs in a single institution over ten years (2008–2017). The focus was on the final outcome; [...] Read more.

Introduction: Anterior communicating artery aneurysms (ACoAAs) are the most frequent intracranial aneurysms treated at neurosurgical departments with a vascular program. Material and methods: We reviewed patients with ACoAAs in a single institution over ten years (2008–2017). The focus was on the final outcome; complications, age, and clinical condition with respect to modalities were analyzed. Results: A total of 198 patients treated during this period was included in the study: 176 patients had a ruptured ACoAA and 22 had an unruptured ACoAA. Then, 127 (71%) were treated surgically and 51 (29%) by endovascular means. Out of the whole series, a good recovery occurred in 123 patients (62%), moderate disability in 11 (5.5%), severe disability in 19 (10%), vegetative state in 11 (5.5%), and death in 34 (17%). In the 157 patients (72.5%) with a subarachnoid hemorrhage (SAH), both modalities had a favorable outcome: 27.5% had an unfavorable outcome, 12% had complications in surgery versus 17.6% during endovascular treatment. No statistical difference in outcome, complications, and age was noted between modalities. Surgical treatment was more frequently adopted for patients in a better clinical condition (p ≤ 0.05). Conclusion: More than two thirds of the patients (72.5%) reached a favorable outcome. There was no difference in age between the treatment modalities. Risks of complications are present and specific for both modalities. Full article

(This article belongs to the Special Issue Neurosurgery for Cerebral Aneurysms)

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7 pages, 5042 KiB

Open AccessCase Report

Bypass Procedure Performed in the Field of a Decompressive Craniectomy in the Case of an MCA Dissecting Aneurysm: Case Report and Review of the Literature

by Robert Bartoš, Jan Lodin, Aleš Hejčl, Ivan Humhej, Ingrid Concepción, Filip Cihlář and Martin Sameš

Brain Sci. 2021, 11(1), 29; https://doi.org/10.3390/brainsci11010029 - 29 Dec 2020

Cited by 2 | Viewed by 2810

Abstract

Treatment of complex aneurysms often requires additional surgical tools including the use of the extra-intracranial (EC-IC) bypass. The following report depicts the utilization of the EC-IC bypass in treating a dissecting aneurysm several hours after a salvage emergent evacuation of an acute subdural [...] Read more.

Treatment of complex aneurysms often requires additional surgical tools including the use of the extra-intracranial (EC-IC) bypass. The following report depicts the utilization of the EC-IC bypass in treating a dissecting aneurysm several hours after a salvage emergent evacuation of an acute subdural hematoma via decompressive craniectomy (DC). Preserving the superficial temporal artery during the DC provided a donor artery for the bypass surgery. Full article

(This article belongs to the Special Issue Neurosurgery for Cerebral Aneurysms)

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7 pages, 2092 KiB

Open AccessCase Report

Ruptured Thoracolumbar Perimedullary Arteriovenous Fistula during Pregnancy Complicated by Cerebral Subarachnoid Hemorrhage and Brainstem Hematoma: A Case Report

by Jan Sroubek, Ladislava Janouskova and Jan Klener

Brain Sci. 2020, 10(8), 561; https://doi.org/10.3390/brainsci10080561 - 15 Aug 2020

Cited by 1 | Viewed by 2984

Abstract

Intradural spinal arteriovenous fistulas (sAVF) are spinal vascular lesions that usually manifest due to myelopathy or local symptoms caused by venous congestion and ischemia. In addition, perimedullary arteriovenous fistulas (PMAVF) in particular may rupture and cause subarachnoid or intramedullary hemorrhage along with relevant [...] Read more.

Intradural spinal arteriovenous fistulas (sAVF) are spinal vascular lesions that usually manifest due to myelopathy or local symptoms caused by venous congestion and ischemia. In addition, perimedullary arteriovenous fistulas (PMAVF) in particular may rupture and cause subarachnoid or intramedullary hemorrhage along with relevant symptoms. Subarachnoid hemorrhage (SAH) can propagate into cranial space with clinically dominant symptoms and signs of typical aneurysmal intracranial SAH. The standard workup for cerebral SAH, after excluding an intracranial source of hemorrhage, is usually limited to a cervical spine MRI; therefore, thoracolumbar sources of hemorrhage can be missed, or their diagnosis may be delayed. Here we present a case of a pregnant patient who presented with cerebral SAH. The source of hemorrhage was not initially identified, leading to a presumptive diagnosis of benign pretruncal non-aneurysmal SAH. The correct diagnosis of spinal thoracolumbar PMAVF was revealed 2.5 months later due to the progression of local symptoms. While the diagnosis was being refined and endovascular treatment was being planned (but delayed due to pregnancy), there was a recurrence of intraconal hemorrhage followed by brainstem hemorrhage. This led to significant clinical deterioration. The PMAVF was then treated microsurgically and the patient experienced partial recovery. Full article

(This article belongs to the Special Issue Neurosurgery for Cerebral Aneurysms)

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13 pages, 3826 KiB

Open AccessCase Report

Delayed Ischemic Neurological Deficit after Uneventful Elective Clipping of Unruptured Intracranial Aneurysms

by Petr Vachata, Jan Lodin, Aleš Hejčl, Filip Cihlář and Martin Sameš

Brain Sci. 2020, 10(8), 495; https://doi.org/10.3390/brainsci10080495 - 29 Jul 2020

Cited by 2 | Viewed by 2944

Abstract

Cerebral vasospasm and subsequent delayed ischemic neurological deficit is a typical sequela of acute subarachnoid hemorrhage after aneurysm rupture. The occurrence of vasospasms after uncomplicated surgery of an unruptured aneurysm without history of suspected rupture is extremely rare. The pathogenesis and severity of [...] Read more.

Cerebral vasospasm and subsequent delayed ischemic neurological deficit is a typical sequela of acute subarachnoid hemorrhage after aneurysm rupture. The occurrence of vasospasms after uncomplicated surgery of an unruptured aneurysm without history of suspected rupture is extremely rare. The pathogenesis and severity of cerebral vasospasms is typically correlated with the amount of blood breakdown products extravasated during subarachnoid hemorrhage. In rare cases, where vasospasms occur after unruptured aneurysm surgery, the pathogenesis is most likely multifactorial and unclear. We present two cases of vasospasms following uncomplicated clipping of middle cerebral artery (MCA) aneurysms and a review of literature. Early diagnosis and therapy of this rare complication are necessary to achieve optimal clinical outcomes. Full article

(This article belongs to the Special Issue Neurosurgery for Cerebral Aneurysms)

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6 pages, 1229 KiB

Open AccessCase Report

The Iatrogenic Development of an Anterior Cerebral Artery Pseudoaneurysm during Lamina Terminalis Fenestration–Genesis, Diagnosis and Therapy: Lessons Learned

by Robert Bartoš, Jan Lodin, Aleš Hejčl, Martin Sameš and Filip Cihlář

Brain Sci. 2020, 10(6), 357; https://doi.org/10.3390/brainsci10060357 - 9 Jun 2020

Cited by 1 | Viewed by 3367

Abstract

Intracranial pseudoaneurysms (PSA) are scarcely presented in the literature. We describe the case of an intracranial PSA on the right anterior cerebral artery, which developed during the complicated surgical treatment of a ruptured right middle cerebral aneurysm. The pseudoaneurysm grew over time and [...] Read more.

Intracranial pseudoaneurysms (PSA) are scarcely presented in the literature. We describe the case of an intracranial PSA on the right anterior cerebral artery, which developed during the complicated surgical treatment of a ruptured right middle cerebral aneurysm. The pseudoaneurysm grew over time and was co-incidentally diagnosed 3 months after the original surgery. The PSA was successfully treated by coiling. In cases of vascular injuries during complicated brain surgery, the timely and careful radiological diagnosis of such a lesion is necessary to allow its fast and proper treatment and thus prevent the patient from potential risks. Full article

(This article belongs to the Special Issue Neurosurgery for Cerebral Aneurysms)

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8 pages, 824 KiB

Open AccessCase Report

Spontaneous Subarachnoid Hemorrhage in a Patient with a Co-Existent Posterior Communicating Artery Aneurysm and Cervical Spine Aneurysm Associated with Ventral Arterio-Venous Fistula

by Aleš Hejčl, Jan Lodin, Filip Cihlář and Martin Sameš

Brain Sci. 2020, 10(2), 70; https://doi.org/10.3390/brainsci10020070 - 28 Jan 2020

Cited by 1 | Viewed by 3484

Abstract

Severe spontaneous subarachnoid hemorrhage (SAH) is predominantly caused by aneurysm rupture, with non-aneurysmal vascular lesions representing only a minority of possible causes. We present the case of a 58-year old lady with a coincidental posterior communicating artery (PCom) aneurysm and a high cervical [...] Read more.

Severe spontaneous subarachnoid hemorrhage (SAH) is predominantly caused by aneurysm rupture, with non-aneurysmal vascular lesions representing only a minority of possible causes. We present the case of a 58-year old lady with a coincidental posterior communicating artery (PCom) aneurysm and a high cervical spine arterio-venous fistula associated with a small ruptured aneurysm. After the emergency clipping of the PCom aneurysm, additional diagnostic procedures—repeated digital subtraction angiography and spinal magnetic resonance imaging, revealed the actual cause of the SAH, a type-A ventral intradural fistula at cervical level C2/3. The fistula was treated micro surgically via a ventral approach using C3 somatectomy and C2-4 stabilization after the initial failure of endovascular therapy. Furthermore, the patient was treated for complications associated with severe SAH, including acute hydrocephalus and meningitis. In cases where the SAH pattern and perioperative findings do not suggest an intracranial aneurysm as the source of SAH, further diagnostic investigation is warranted to discover the real cause. Patients with severe non-aneurysmal SAH require a similar algorithm in diagnosing the cause of the hemorrhage as well as complex conditions such as ruptured aneurysms. Full article

(This article belongs to the Special Issue Neurosurgery for Cerebral Aneurysms)

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