1/129. Profound hypothermia and circulatory arrest with skull base approaches for treatment of complex posterior circulation aneurysms.OBJECTIVE: cardiopulmonary bypass with profound hypothermia and circulatory arrest has seen a resurgence as an adjunct technique in neurological surgery. We report our experience with this technique in treating seven complex vertebro-basilar aneurysms. methods: skull base approaches were used in all cases, providing excellent exposure and minimizing brain retraction. There were six basilar artery aneurysms and one giant fusiform vertebro-basilar artery aneurysm. All aneurysms but one had an apparent neck, which could be clipped. The fusiform vertebro-basilar artery aneurysm was trapped, partially resected, and the circulation was reestablished with a saphenous vein graft from the cervical internal carotid artery to the mid-basilar artery. RESULTS: Five patients had an excellent outcome and two had a good outcome at one year or at latest follow up. Two of the patients showed improvement of neurological deficits which were present before the surgical intervention. CONCLUSION: Applying very strict selection criteria in this small series of patients with posterior circulation aneurysms, excellent or good results were achieved using the profound hypothermic circulatory arrest technique.- - - - - - - - - - ranking = 1keywords = aneurysm (Clic here for more details about this article) |
2/129. Traumatic aneurysm of the inferior lateral geniculate artery after total knee replacement.A 55-year old man incurred a false aneurysm of the inferior lateral geniculate artery after total knee replacement. The false aneurysm appeared as a pulsatile mass with compressive neuropathy of the posterior tibial nerve. The development of this complication and treatment are discussed.- - - - - - - - - - ranking = 0.6keywords = aneurysm (Clic here for more details about this article) |
3/129. Surgical management of arteriosclerotic coronary artery aneurysm.A 60-year-old man suffered antero-septal myocardial infarction at the age of 56. coronary angiography demonstrated total occlusion of the left anterior descending artery and a large saccular aneurysm of the right coronary artery. Diffuse coronary ectasia was also shown in the right coronary artery adjacent to the aneurysm. Despite anticoagulant therapy, the aneurysm formed a thrombus and developed coronary artery stenosis distal to the aneurysm. ligation of the aneurysm and in situ gastroepiploic artery grafting were performed. Sudden heart failure was developed during skin closure. As this condition was considered to be graft hypoperfusion, supplemental saphenous vein grafting was placed. ligation is a simple, reliable technique to prevent future complications for a large saccular right coronary artery aneurysm, however, gastroepiploic artery might be an inappropriate bypass conduit for the ligated coronary artery with diffuse ectasia.- - - - - - - - - - ranking = 1keywords = aneurysm (Clic here for more details about this article) |
4/129. Successful completion of endoluminal repair of an abdominal aortic aneurysm after intraoperative iatrogenic rupture of the aneurysm.PURPOSE: A method of achieving successful completion of endoluminal repair of an abdominal aortic aneurysm (AAA) in the presence of intraoperative iatrogenic rupture of the aneurysm is reported. methods: An 83-year-old woman with an AAA that was 7 cm in diameter was treated electively by means of endoluminal repair with a Vanguard bifurcated prosthesis (boston Scientific, Natick, Mass). No difficulty was experienced with the introduction of the delivery catheter, despite extreme angulation in the aneurysm. An acute episode of hypotension prompted an aortogram to be performed. Extravasation of contrast outside the aneurysm sac was demonstrated. The balloon on the delivery catheter was immediately advanced to the suprarenal aorta and inflated. hypotension was reversed, and hemodynamic stability was restored, thus enabling deployment of the prosthesis to proceed and the repair to be completed by means of the endoluminal method. RESULTS: The patient's blood pressure remained stable after deflation of the balloon, allowing a postprocedure aortogram to be performed. Exclusion of the aneurysm sac was demonstrated. Exclusion of the aneurysm sac from the circulation and a large retroperitoneal hematoma were confirmed by means of a postoperative contrast computed tomography scan. convalescence was complicated by acute renal failure, pneumonia, and prolonged ileus. The patient remained well and active at the follow-up examination 6 months after operation. CONCLUSION: Iatrogenic perforation of an AAA during endoluminal repair may be treated by endovascular means and does not necessarily require conversion to open repair, although this may be the safest option.- - - - - - - - - - ranking = 1.4keywords = aneurysm (Clic here for more details about this article) |
5/129. Quantitative assessment of vessel flow integrity for aneurysm surgery. Technical note.Quantitative measurement of blood flow in cerebral vessels during aneurysm surgery can help prevent ischemic injury and improve patient outcome. The authors report a case of a superior cerebellar artery (SCA) aneurysm in which perivascular microflow probes were used to measure blood flow quantitatively in both the SCA and the posterior cerebral artery before and after aneurysm clipping. Following aneurysm clipping, blood flow in the SCA was reduced to less than 25% of its initial baseline value. Prompt detection of compromised blood flow gave the surgeon the opportunity to adjust the clip and restore SCA flow to its preclipping value within 5 minutes of initial clip placement. Quantitative vessel-flow measurements were integral to the safe progression of the operation and may have prevented an adverse neurological outcome in this patient. The recommended surgical technique and the principle of operation are described.- - - - - - - - - - ranking = 0.8keywords = aneurysm (Clic here for more details about this article) |
6/129. Biochemical changes related to hypoxia during cerebral aneurysm surgery: combined microdialysis and tissue oxygen monitoring: case report.OBJECTIVE AND IMPORTANCE: The objective of this study was to monitor brain metabolism on-line during aneurysm surgery, by combining the use of a multiparameter (brain tissue oxygen, brain carbon dioxide, pH, and temperature) sensor with microdialysis (extracellular glucose, lactate, pyruvate, and glutamate). The case illustrates the potential value of these techniques by demonstrating the effects of adverse physiological events on brain metabolism and the ability to assist in both intraoperative and postoperative decision-making. CLINICAL PRESENTATION: A 41-year-old woman presented with a World Federation of Neurological Surgeons Grade I subarachnoid hemorrhage. Angiography revealed a basilar artery aneurysm that was not amenable to coiling, so the aneurysm was clipped. Before the craniotomy was performed, a multiparameter sensor and a microdialysis catheter were inserted to monitor brain metabolism. INTERVENTION: During the operation, the brain oxygen level decreased, in relation to biochemical changes, including the reduction of extracellular glucose and pyruvate and the elevation of lactate and glutamate. These changes were reversible. However, when the craniotomy was closed, a second decrease in brain oxygen occurred in association with brain swelling, which immediately prompted a postoperative computed tomographic scan. The scan demonstrated acute hydrocephalus, requiring external ventricular drainage. The patient made a full recovery. CONCLUSION: The monitoring techniques influenced clinical decision-making in the treatment of this patient. On-line measurement of brain tissue gases and extracellular chemistry has the potential to assist in the perioperative and postoperative management of patients undergoing complex cerebrovascular surgery and to establish the effects of intervention on brain homeostasis.- - - - - - - - - - ranking = 0.7keywords = aneurysm (Clic here for more details about this article) |
7/129. Delayed onset of ascending paralysis after thoracic aortic stent graft deployment.Delayed spinal cord ischemia after thoracic aortic aneurysm repair is an infrequent but devastating complication. The use of stent grafts to exclude aortic aneurysms is thought to decrease the incidence of the neurologic deficit because there is no period of significant aortic occlusion. We report a case of paraplegia that progressed to quadriplegia occurring 48 hours after the apparently successful deployment of a thoracic aortic stent graft.- - - - - - - - - - ranking = 0.2keywords = aneurysm (Clic here for more details about this article) |
8/129. Intraoperative acute occlusion of aortic bifurcation during extracorporeal circulation.A 36-year-old male patient showed a significant decrease of arterial pressure in the lower extremities during coronary artery bypass grafting (CABG) with extracorporeal circulation (ECC). arterial pressure measured in the femoral artery fell to 10-20 mmHg at the end of ECC, whereas in the upper extremities arterial pressure levels were normal. At the end of the surgery a complete ischemia of both lower extremities was observed. We suspected Leriche's syndrome and performed a successful aortic embolectomy through bilateral femoral arteriotomies immediately. An insufficient anticoagulation could be excluded by prolonged "activated clotting time" (ACT), therefore we presumed that the source of embolus was a small aneurysm of the left ventricle. The shape and superficial structure of the extracted embolus, which was partly covered with endocardium, confirmed our suspicion. No complications occurred throughout the postoperative period. On the 10th postoperative day, the patient left our department for postoperative rehabilitation with a normal perfusion of the lower extremities.- - - - - - - - - - ranking = 0.1keywords = aneurysm (Clic here for more details about this article) |
9/129. Pseudoaneurysm of a lateral internal carotid artery in the middle ear.We report a case where a 7-year-old girl suffered significant aural bleeding following myringotomy of the tympanic membrane. Investigations by computed tomography scan, carotid angiography, and magnetic resonance angiography showed a lateral aberrant internal carotid artery (LACI) with a little pseudoaneurysm in the middle ear. The anomaly of the internal carotid artery was supposed to be congenital, and the pseudoaneurysm was supposed to be traumatic, formed after incision into the wall of the artery. Considerations about diagnosis, symptoms, and treatment are discussed. The patient was treated by balloon embolization in the internal carotid artery without sequelae.- - - - - - - - - - ranking = 0.65752129001958keywords = aneurysm, pseudoaneurysm (Clic here for more details about this article) |
10/129. Pseudoaneurysm of a septal perforator in beating heart coronary bypass grafting.A 46-year-old man with unstable angina underwent beating heart coronary bypass grafting for a left anterior descending coronary artery. Postoperative angiography showed intramuscular extravasation (6 x 8 mm) distal to the anastomosis, which was most likely the result of a needle injury caused by a snare during the operation. Follow-up angiography 2 weeks later revealed no extravasation.- - - - - - - - - - ranking = 0.4keywords = aneurysm (Clic here for more details about this article) |
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