Contralateral approach to anterior circulation aneurysms

Research output: ThesisDoctoral ThesisCollection of Articles

Abstract

Objective Multiple intracranial aneurysms are frequent, with an incidence of 15-40% among intracranial aneurysms carriers. Of these carriers, 20-40% have bilateral intracranial aneurysms. The rupture risk is higher for patients with multiple intracranial aneurysms. For those patients, several treatment options are available (microsurgery comprising a unilateral-contralateral approach, bilateral craniotomies in one-stage or two stages surgery, and endovascular methods) varying from institution s resources and surgeon s experience. The present study focuses and analyses the angiographic characteristics, specific parameters, and surgical results of the unilateral-contralateral approach for ICA-opht segment and MCA aneurysms. In addition, it describes and analyses the proximal vascular control by transient cardiac arrest induced by adenosine during the contralateral clipping of ICA-opht segment aneurysms. Patients and Methods We retrospectively reviewed 68 patients with ICA-opht segment and bMCA aneurysms treated through a contralateral approach at the department of neurosurgery of the University of Helsinki, between January 1998 and December 2013. A detailed analyses of the aneurysms characteristics and constrains of the contralateral surgical corridor was performed. A further subgroup analysis of 8 patients harboring ICA-opht segment aneurysms approached through a contralateral craniotomy and requiring intravenous adenosine administration to induce transient cardiac arrest during microsurgical clipping was performed as well. Results ICA-opht segment aneurysms: All the 30 ICA-opth aneurysms were small (less than 7 mm), unruptured, saccular, and had no wall irregularities, calcifications or secondary pouches. Microsurgical clipping of these aneurysms was possible when the prechiasmatic distance had a median of 5.7 mm (range 3.4-8.7 mm) and the interoptic distance a median of 10.5 mm (range, 7.6-15.9). The most frequent aneurysm dome projection was superomedial (77%). Of the patients with ICA-opht segment aneurysms approached through a contralateral craniotomy, 93% had good postoperative outcome at 3-month follow-up. bMCA aneurysms: The contralateral approach for bMCA aneurysms was possible in 38 patients. All the 38 contralaterally approached MCA aneurysms were unruptured and had saccular shape (expect one with bilobular shape). The majority (97%) of contralateral aneurysms were small to medium in size. The median length of the contralateral A1 was 13.2 mm (range: 6-19.8 mm), and the median length of the contralateral M1 was 14.2 mm (range: 4.6-21 mm). Of the patients with unruptured bMCA aneurysms treated through a contralateral approach, 24 (86%) patients had good outcome and 4 (14%) had poor outcome at 3-month follow-up, 1 patient was lost to follow-up. There were 9 patients harboring bMCA aneurysm presented with SAH due to a ruptured ipsilateral aneurysm. Of these patients, 7 (78%) had good outcomes, and 2 (22%) had poor outcomes at 3 months. Olfactory disturbances were present in 21% of cases treated through a contralateral approach. Transient cardiac arrest induced by adenosine during contralateral clipping of ICA-opht aneurysms: 8 patients received intravenous bolus of adenosine to induce transient cardiac arrest during clipping. Of the total patients, 5 received single bolus of adenosine, and 3 patients received multiple doses. The median single dose of adenosine was 22.5 mg (range, 5-50 mg). The asystole time range between 20-40 seconds after adenosine administration. All the 8 patients showed good surgical outcomes at 3-month and 1-year follow-up, and showed no procedure-related complications. Conclusion: The contralateral approach remains as a feasible option for microsurgical treatment of ICA-opht segment aneurysms, and bMCA aneurysms. Its feasibility depends on general parameters related to the aneurysm itself (shape, morphology, size, status and projection), and specific parameters that varies according to the vascular segment to be treated (prechiasmatic and interoptic distances, length of A1 and M1). Transient cardiac arrest induced adenosine represents a useful tool to obtain proximal vascular control while performing a contralateral approach for ICA-opth segment aneurysms in selected patients.
Original languageEnglish
Place of PublicationHelsinki
Publisher
Print ISBNs978-951-51-2199-8
Electronic ISBNs978-951-51-2200-1
Publication statusPublished - 2016
MoE publication typeG5 Doctoral dissertation (article)

Fields of Science

  • 3112 Neurosciences
  • 3126 Surgery, anesthesiology, intensive care, radiology

Cite this

@phdthesis{ad6242bee08e48f7882e4e112952d986,
title = "Contralateral approach to anterior circulation aneurysms",
abstract = "Objective Multiple intracranial aneurysms are frequent, with an incidence of 15-40{\%} among intracranial aneurysms carriers. Of these carriers, 20-40{\%} have bilateral intracranial aneurysms. The rupture risk is higher for patients with multiple intracranial aneurysms. For those patients, several treatment options are available (microsurgery comprising a unilateral-contralateral approach, bilateral craniotomies in one-stage or two stages surgery, and endovascular methods) varying from institution s resources and surgeon s experience. The present study focuses and analyses the angiographic characteristics, specific parameters, and surgical results of the unilateral-contralateral approach for ICA-opht segment and MCA aneurysms. In addition, it describes and analyses the proximal vascular control by transient cardiac arrest induced by adenosine during the contralateral clipping of ICA-opht segment aneurysms. Patients and Methods We retrospectively reviewed 68 patients with ICA-opht segment and bMCA aneurysms treated through a contralateral approach at the department of neurosurgery of the University of Helsinki, between January 1998 and December 2013. A detailed analyses of the aneurysms characteristics and constrains of the contralateral surgical corridor was performed. A further subgroup analysis of 8 patients harboring ICA-opht segment aneurysms approached through a contralateral craniotomy and requiring intravenous adenosine administration to induce transient cardiac arrest during microsurgical clipping was performed as well. Results ICA-opht segment aneurysms: All the 30 ICA-opth aneurysms were small (less than 7 mm), unruptured, saccular, and had no wall irregularities, calcifications or secondary pouches. Microsurgical clipping of these aneurysms was possible when the prechiasmatic distance had a median of 5.7 mm (range 3.4-8.7 mm) and the interoptic distance a median of 10.5 mm (range, 7.6-15.9). The most frequent aneurysm dome projection was superomedial (77{\%}). Of the patients with ICA-opht segment aneurysms approached through a contralateral craniotomy, 93{\%} had good postoperative outcome at 3-month follow-up. bMCA aneurysms: The contralateral approach for bMCA aneurysms was possible in 38 patients. All the 38 contralaterally approached MCA aneurysms were unruptured and had saccular shape (expect one with bilobular shape). The majority (97{\%}) of contralateral aneurysms were small to medium in size. The median length of the contralateral A1 was 13.2 mm (range: 6-19.8 mm), and the median length of the contralateral M1 was 14.2 mm (range: 4.6-21 mm). Of the patients with unruptured bMCA aneurysms treated through a contralateral approach, 24 (86{\%}) patients had good outcome and 4 (14{\%}) had poor outcome at 3-month follow-up, 1 patient was lost to follow-up. There were 9 patients harboring bMCA aneurysm presented with SAH due to a ruptured ipsilateral aneurysm. Of these patients, 7 (78{\%}) had good outcomes, and 2 (22{\%}) had poor outcomes at 3 months. Olfactory disturbances were present in 21{\%} of cases treated through a contralateral approach. Transient cardiac arrest induced by adenosine during contralateral clipping of ICA-opht aneurysms: 8 patients received intravenous bolus of adenosine to induce transient cardiac arrest during clipping. Of the total patients, 5 received single bolus of adenosine, and 3 patients received multiple doses. The median single dose of adenosine was 22.5 mg (range, 5-50 mg). The asystole time range between 20-40 seconds after adenosine administration. All the 8 patients showed good surgical outcomes at 3-month and 1-year follow-up, and showed no procedure-related complications. Conclusion: The contralateral approach remains as a feasible option for microsurgical treatment of ICA-opht segment aneurysms, and bMCA aneurysms. Its feasibility depends on general parameters related to the aneurysm itself (shape, morphology, size, status and projection), and specific parameters that varies according to the vascular segment to be treated (prechiasmatic and interoptic distances, length of A1 and M1). Transient cardiac arrest induced adenosine represents a useful tool to obtain proximal vascular control while performing a contralateral approach for ICA-opth segment aneurysms in selected patients.",
keywords = "Adenosine, Carotid Artery Diseases, +surgery, Cerebral Angiography, Carotid Artery, Internal, Craniotomy, Heart Arrest, +chemically induced, Intracranial Aneurysm, +pathology, +radiography, Microsurgery, +methods, Middle Cerebral Artery, Neurosurgical Procedures, Operative Time, Ophthalmic Artery, Retrospective Studies, Treatment Outcome, Vascular Surgical Procedures, 3112 Neurosciences, 3126 Surgery, anesthesiology, intensive care, radiology",
author = "{Andrade Barazarte}, Hugo",
note = "M1 - 101 s. Helsingin yliopisto Volume: Proceeding volume:",
year = "2016",
language = "English",
isbn = "978-951-51-2199-8",
publisher = "[H. Andrade Barazarte]",
address = "Finland",

}

Contralateral approach to anterior circulation aneurysms. / Andrade Barazarte, Hugo .

Helsinki : [H. Andrade Barazarte], 2016. 72 p.

Research output: ThesisDoctoral ThesisCollection of Articles

TY - THES

T1 - Contralateral approach to anterior circulation aneurysms

AU - Andrade Barazarte, Hugo

N1 - M1 - 101 s. Helsingin yliopisto Volume: Proceeding volume:

PY - 2016

Y1 - 2016

N2 - Objective Multiple intracranial aneurysms are frequent, with an incidence of 15-40% among intracranial aneurysms carriers. Of these carriers, 20-40% have bilateral intracranial aneurysms. The rupture risk is higher for patients with multiple intracranial aneurysms. For those patients, several treatment options are available (microsurgery comprising a unilateral-contralateral approach, bilateral craniotomies in one-stage or two stages surgery, and endovascular methods) varying from institution s resources and surgeon s experience. The present study focuses and analyses the angiographic characteristics, specific parameters, and surgical results of the unilateral-contralateral approach for ICA-opht segment and MCA aneurysms. In addition, it describes and analyses the proximal vascular control by transient cardiac arrest induced by adenosine during the contralateral clipping of ICA-opht segment aneurysms. Patients and Methods We retrospectively reviewed 68 patients with ICA-opht segment and bMCA aneurysms treated through a contralateral approach at the department of neurosurgery of the University of Helsinki, between January 1998 and December 2013. A detailed analyses of the aneurysms characteristics and constrains of the contralateral surgical corridor was performed. A further subgroup analysis of 8 patients harboring ICA-opht segment aneurysms approached through a contralateral craniotomy and requiring intravenous adenosine administration to induce transient cardiac arrest during microsurgical clipping was performed as well. Results ICA-opht segment aneurysms: All the 30 ICA-opth aneurysms were small (less than 7 mm), unruptured, saccular, and had no wall irregularities, calcifications or secondary pouches. Microsurgical clipping of these aneurysms was possible when the prechiasmatic distance had a median of 5.7 mm (range 3.4-8.7 mm) and the interoptic distance a median of 10.5 mm (range, 7.6-15.9). The most frequent aneurysm dome projection was superomedial (77%). Of the patients with ICA-opht segment aneurysms approached through a contralateral craniotomy, 93% had good postoperative outcome at 3-month follow-up. bMCA aneurysms: The contralateral approach for bMCA aneurysms was possible in 38 patients. All the 38 contralaterally approached MCA aneurysms were unruptured and had saccular shape (expect one with bilobular shape). The majority (97%) of contralateral aneurysms were small to medium in size. The median length of the contralateral A1 was 13.2 mm (range: 6-19.8 mm), and the median length of the contralateral M1 was 14.2 mm (range: 4.6-21 mm). Of the patients with unruptured bMCA aneurysms treated through a contralateral approach, 24 (86%) patients had good outcome and 4 (14%) had poor outcome at 3-month follow-up, 1 patient was lost to follow-up. There were 9 patients harboring bMCA aneurysm presented with SAH due to a ruptured ipsilateral aneurysm. Of these patients, 7 (78%) had good outcomes, and 2 (22%) had poor outcomes at 3 months. Olfactory disturbances were present in 21% of cases treated through a contralateral approach. Transient cardiac arrest induced by adenosine during contralateral clipping of ICA-opht aneurysms: 8 patients received intravenous bolus of adenosine to induce transient cardiac arrest during clipping. Of the total patients, 5 received single bolus of adenosine, and 3 patients received multiple doses. The median single dose of adenosine was 22.5 mg (range, 5-50 mg). The asystole time range between 20-40 seconds after adenosine administration. All the 8 patients showed good surgical outcomes at 3-month and 1-year follow-up, and showed no procedure-related complications. Conclusion: The contralateral approach remains as a feasible option for microsurgical treatment of ICA-opht segment aneurysms, and bMCA aneurysms. Its feasibility depends on general parameters related to the aneurysm itself (shape, morphology, size, status and projection), and specific parameters that varies according to the vascular segment to be treated (prechiasmatic and interoptic distances, length of A1 and M1). Transient cardiac arrest induced adenosine represents a useful tool to obtain proximal vascular control while performing a contralateral approach for ICA-opth segment aneurysms in selected patients.

AB - Objective Multiple intracranial aneurysms are frequent, with an incidence of 15-40% among intracranial aneurysms carriers. Of these carriers, 20-40% have bilateral intracranial aneurysms. The rupture risk is higher for patients with multiple intracranial aneurysms. For those patients, several treatment options are available (microsurgery comprising a unilateral-contralateral approach, bilateral craniotomies in one-stage or two stages surgery, and endovascular methods) varying from institution s resources and surgeon s experience. The present study focuses and analyses the angiographic characteristics, specific parameters, and surgical results of the unilateral-contralateral approach for ICA-opht segment and MCA aneurysms. In addition, it describes and analyses the proximal vascular control by transient cardiac arrest induced by adenosine during the contralateral clipping of ICA-opht segment aneurysms. Patients and Methods We retrospectively reviewed 68 patients with ICA-opht segment and bMCA aneurysms treated through a contralateral approach at the department of neurosurgery of the University of Helsinki, between January 1998 and December 2013. A detailed analyses of the aneurysms characteristics and constrains of the contralateral surgical corridor was performed. A further subgroup analysis of 8 patients harboring ICA-opht segment aneurysms approached through a contralateral craniotomy and requiring intravenous adenosine administration to induce transient cardiac arrest during microsurgical clipping was performed as well. Results ICA-opht segment aneurysms: All the 30 ICA-opth aneurysms were small (less than 7 mm), unruptured, saccular, and had no wall irregularities, calcifications or secondary pouches. Microsurgical clipping of these aneurysms was possible when the prechiasmatic distance had a median of 5.7 mm (range 3.4-8.7 mm) and the interoptic distance a median of 10.5 mm (range, 7.6-15.9). The most frequent aneurysm dome projection was superomedial (77%). Of the patients with ICA-opht segment aneurysms approached through a contralateral craniotomy, 93% had good postoperative outcome at 3-month follow-up. bMCA aneurysms: The contralateral approach for bMCA aneurysms was possible in 38 patients. All the 38 contralaterally approached MCA aneurysms were unruptured and had saccular shape (expect one with bilobular shape). The majority (97%) of contralateral aneurysms were small to medium in size. The median length of the contralateral A1 was 13.2 mm (range: 6-19.8 mm), and the median length of the contralateral M1 was 14.2 mm (range: 4.6-21 mm). Of the patients with unruptured bMCA aneurysms treated through a contralateral approach, 24 (86%) patients had good outcome and 4 (14%) had poor outcome at 3-month follow-up, 1 patient was lost to follow-up. There were 9 patients harboring bMCA aneurysm presented with SAH due to a ruptured ipsilateral aneurysm. Of these patients, 7 (78%) had good outcomes, and 2 (22%) had poor outcomes at 3 months. Olfactory disturbances were present in 21% of cases treated through a contralateral approach. Transient cardiac arrest induced by adenosine during contralateral clipping of ICA-opht aneurysms: 8 patients received intravenous bolus of adenosine to induce transient cardiac arrest during clipping. Of the total patients, 5 received single bolus of adenosine, and 3 patients received multiple doses. The median single dose of adenosine was 22.5 mg (range, 5-50 mg). The asystole time range between 20-40 seconds after adenosine administration. All the 8 patients showed good surgical outcomes at 3-month and 1-year follow-up, and showed no procedure-related complications. Conclusion: The contralateral approach remains as a feasible option for microsurgical treatment of ICA-opht segment aneurysms, and bMCA aneurysms. Its feasibility depends on general parameters related to the aneurysm itself (shape, morphology, size, status and projection), and specific parameters that varies according to the vascular segment to be treated (prechiasmatic and interoptic distances, length of A1 and M1). Transient cardiac arrest induced adenosine represents a useful tool to obtain proximal vascular control while performing a contralateral approach for ICA-opth segment aneurysms in selected patients.

KW - Adenosine

KW - Carotid Artery Diseases

KW - +surgery

KW - Cerebral Angiography

KW - Carotid Artery, Internal

KW - Craniotomy

KW - Heart Arrest

KW - +chemically induced

KW - Intracranial Aneurysm

KW - +pathology

KW - +radiography

KW - Microsurgery

KW - +methods

KW - Middle Cerebral Artery

KW - Neurosurgical Procedures

KW - Operative Time

KW - Ophthalmic Artery

KW - Retrospective Studies

KW - Treatment Outcome

KW - Vascular Surgical Procedures

KW - 3112 Neurosciences

KW - 3126 Surgery, anesthesiology, intensive care, radiology

M3 - Doctoral Thesis

SN - 978-951-51-2199-8

PB - [H. Andrade Barazarte]

CY - Helsinki

ER -