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ABSTRACT: BACKGROUND:: Classification of MCA aneurysms is sometimes difficult, as the identification of the main MCA bifurcation, the key for accurate classification of MCA aneurysms, is inconsistent and somewhat subjective. OBJECTIVE:: We aimed to use the meeting point of M1 and M2 trunks as an objective, generally accepted and angiographically evident hallmark for identification of MCA bifurcation and more accurate classification of MCA aneurysms. METHODS:: We reviewed the CT angiography (CTA) data of 1009 consecutive patients with 1309 MCA aneurysms. The M2 trunks were followed proximally until their meeting with the M1 trunk at the main MCA bifurcation (Mbif). The aneurysms were classified according to their relative location: proximal, at, or distal to the Mbif. The M1 aneurysms (M1As) were further subgrouped into M1-ECBAs--M1 early cortical branch aneurysms, and M1-LSAAs--M1 lenticulostriate artery aneurysms, extending the classic three-group classification of MCA aneurysms into a four-group classification. RESULTS:: The main MCA bifurcation was the most common location for MCA aneurysms, harboring 829 (63%) aneurysms. The 406 M1 aneurysms comprised 242 (60%) M1-ECBAs and 164 (40%) M1-LSAAs. We found 106 (8%) MCA aneurysms at the origin of large early frontal branches simulating M2 trunks liable to be misclassified as MCA bifurcation aneurysms. Even though 51% of the 407 ruptured MCA aneurysms were associated with an intracerebral hematoma, it did not affect the classification. CONCLUSION:: Studying MCA angioarchitecture and applying the four-group classification of MCA aneurysms is practical and facilitates the accurate classification of MCA aneurysms, helping to improve the surgical outcome.
Neurosurgery 04/2013; · 2.79 Impact Factor
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ABSTRACT: BACKGROUND AND PURPOSE: Long-term angiographic follow-up studies on pediatric aneurysm patients are scarce. METHODS: We gathered long-term clinical and angiographic follow-up data on all pediatric aneurysm patients (≤18 years at diagnosis) treated at the Department of Neurosurgery, Helsinki University Central Hospital, between 1937 and 2009. RESULTS: Fifty-nine patients with cerebral aneurysms in childhood had long-term clinical and radiological follow-up (median, 34 years; range, 4-56 years). Twenty-four patients (41%) were diagnosed with altogether 25 de novo and 11 recurrent aneurysms, with 9 (25%) of the aneurysms being symptomatic. New subarachnoid hemorrhage occurred in 7 patients; 4 of these patients died. Eight patients (33%) had multiple new aneurysms. The annual rate of hemorrhage was 0.4%, and the annual rate for the development of de novo or recurrent aneurysm was 1.9%. There were no de novo aneurysms in 7 patients with previously unruptured aneurysms. However, 1 recurrent aneurysm was diagnosed. Current and previous smoking (risk ratio, 2.44; 95% confidence interval, 1.07-5.55) was the only statistically significant risk factor for de novo and recurrent aneurysm formation in patients with previous subarachnoid hemorrhage, whereas hypertension, sex, or age at onset had no statistically significant effect. Smoking was also a statistically significant risk factor for new subarachnoid hemorrhage. CONCLUSIONS: Patients with ruptured intracranial aneurysms in childhood have a high risk for new aneurysms and new subarachnoid hemorrhage, especially if they start to smoke as adults. Life-long angiographic follow-up is mandatory.
Stroke 03/2013; · 5.73 Impact Factor
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ABSTRACT: OBJECTIVE: To review the management of aneurysms arising at the origin of a duplicated middle cerebral artery (DMCA) which is an extremely rare entity. METHODOLOGY: We present our 4 cases with ICA-DMCA aneurysms and review 24 previously published cases. RESULTS: Out of the 28 aneurysms 17 were ruptured and 11 unruptured. The aneurysms were equally distributed on the right and left sides and were small in size≤6mm except for two which were of medium size. All were treated surgically except for two very small ones which have been followed-up conservatively for 9 years. CONCLUSION: Although all previously published clinical cases of ICA-DMCA aneurysms were treated surgically, in very small unruptured ones conservative follow-up is a viable option.
World Neurosurgery 10/2012; · 0.68 Impact Factor
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ABSTRACT: Knowledge of the long-term excess mortality in pediatric aneurysm patients is lacking. The aim of this study was to assess the long-term excess mortality of 102 pediatric patients with cerebral aneurysm treated at the department of neurosurgery at Helsinki University Central Hospital between 1937 and 2009.
Patients were followed from diagnosis until death or the end of the year 2010. Relative survival ratio provided the measure of excess mortality in these patients compared with mortality of the general Finnish population matched by age, sex, and calendar time.
A majority of the patients (n=89) presented with subarachnoid hemorrhage. Aneurysms (n=118) were treated operatively (n=79), endovascularly (n=1), or conservatively (n=36). The mean follow-up time was 26.8 years (range, 0-55.6 years). By the end of follow-up, 34 of the 102 patients had died; 26 of these deaths (76%) were aneurysm-related. There was overall excess mortality of 10% (cumulative relative survival ratio, 0.90; 95% CI, 0.80-0.96) and 19% (cumulative relative survival ratio, 0.81; 95% CI, 0.66-0.91) at 20 and 40 years after the diagnosis among the 1-year subarachnoid hemorrhage survivors, respectively. The excess mortality was particularly high in boys. There was no long-term excess mortality among patients with unruptured aneurysms. Aneurysm-related deaths included rebleedings from open or partially occluded aneurysms, epileptic seizures, de novo and recurrent aneurysms, or sequelae of subarachnoid hemorrhage.
There is long-term excess mortality in pediatric patients with aneurysm even decades after successful treatment of a ruptured aneurysm, especially among boys. The excess mortality is mainly aneurysm-related.
Stroke 06/2012; 43(8):2091-6. · 5.73 Impact Factor
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ABSTRACT: Population-based data on pediatric patients with aneurysms are limited. The aim of this study is to clarify the characteristics and long-term outcomes of pediatric patients with aneurysms.
All pediatric patients (≤ 18 years old) with aneurysms among the 8996 aneurysm patients treated at the Department of Neurosurgery in Helsinki from 1937 to 2009 were followed from admission to the end of 2010.
There were 114 pediatric patients with 130 total aneurysms during the study period. The mean patient age was 14.5 years (range 3 months to 18 years). The male:female ratio was 3:2. Eighty-nine patients (78%) presented with subarachnoid hemorrhage. The majority of the aneurysms (116 [89%]) were in the anterior circulation, and the most common location was the internal carotid artery bifurcation (36 [28%]). The average aneurysm diameter was 11 mm (range 2-55 mm) with 16 giant aneurysms (12%). Eighty aneurysms (62%) were treated microsurgically, and 37 (28%) were treated conservatively due to poor medical and neurological status of the patient or due to technical reasons during the early years of the patient series. No connective tissue disorders common to pediatric aneurysm patients were diagnosed in this series, with the exception of 1 patient with tuberous sclerosis complex. The mean follow-up duration was 24.8 years (range 0-55.8 years). At the end of follow-up, 71 patients (62%) had a good outcome, 3 (3%) were dependent, and 40 (35%) had died. Twenty-seven deaths (68%) were assessed to be aneurysm-related. Factors correlating with a favorable long-term outcome were good neurological condition of the patient on admission, aneurysm location in the anterior circulation, complete aneurysm closure, and absence of vasospasm. Six patients developed symptomatic de novo aneurysms after a median of 25 years (range 11-37 years). Fourteen patients (12%) had a family history of aneurysms. There was no increased incidence for cardiovascular diseases in long-term follow-up.
Most aneurysms were ruptured and of medium size. Internal carotid artery bifurcation was the most frequent location of the aneurysms. There was a male predominance of pediatric patients with aneurysms. Most patients experienced good recovery, with 91% of the long-term survivors living at home independently without assistance and meaningfully employed. Altogether, almost a third of these patients finished high school and one-fifth had a college or university degree. Pediatric patients had a tendency to develop de novo aneurysms.
Journal of Neurosurgery Pediatrics 06/2012; 9(6):636-45. · 1.53 Impact Factor
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ABSTRACT: Residual and recurrent intracranial aneurysms after endovascular treatment with Guglielmi detachable coils may necessitate a microsurgical occlusion.
To analyze the microsurgical technique and describe how the location, morphology, and appearance of the coiled aneurysm affect the technique.
We retrospectively analyzed 81 patients with 82 previously coiled aneurysms treated microsurgically at 2 Finnish neurosurgical university hospitals in Helsinki and Kuopio between July 1995 and August 2009. Seven videos were selected to demonstrate the microsurgical strategy in various locations.
Fifty-eight aneurysms (71%) were located at anterior circulation and 24 (29%) at posterior circulation. Fifteen patients were operated on within the first month (early surgery) after coiling, whereas 66 were treated later (late surgery). Complete or partial removal of coils during surgery may facilitate clipping, but is significantly (P < .001) more difficult to accomplish in late surgery. Removal of coils may also increase the chance of poor outcome. Chance of poor outcome also increased with intraoperative aneurysm rupture, size of the aneurysm, and posterior circulation location. Good clinical outcome (same or better clinical condition 3 months after surgery) was achieved in 71 patients (88%). After microsurgery, 4 patients were severely disabled and 6 patients died, 3 of them because of poor clinical condition.
Complete microsurgical occlusion of the residual aneurysm is possible. However, in large or giant aneurysms direct microsurgery is a challenging high-risk procedure, and we recommend that these patients be referred to a dedicated neurovascular center to minimize surgical complications. Even in experienced hands, use of different bypass procedures may be the best option for demanding growing lesions, especially those in the posterior circulation.
Neurosurgery 01/2011; 68(1):140-53; discussion 153-4. · 2.79 Impact Factor
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Martin Lehecka,
Reza Dashti,
Aki Laakso,
Jouke S van Popta,
Rossana Romani,
Ondrej Navratil,
Leena Kivipelto,
Riku Kivisaari,
Mansoor Foroughi,
Jouji Kokuzawa, Hanna Lehto,
Mika Niemelä,
Jaakko Rinne,
Antti Ronkainen,
Timo Koivisto,
Juha E Jääskelainen,
Juha Hernesniemi
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ABSTRACT: Anterior choroid artery aneurysms (AChAAs) constitute 2%-5% of all intracranial aneurysms. They are usually small, thin walled with one or several arteries originating at their base, and often associated with multiple aneurysms. In this article, we review the practical microsurgical anatomy, the preoperative imaging, surgical planning, and the microneurosurgical steps in the dissection and the clipping of AChAAs.
This review, and the whole series on intracranial aneurysms (IAs), are mainly based on the personal microneurosurgical experience of the senior author (J.H.) in two Finnish centers (Helsinki and Kuopio) that serve, without patient selection, the catchment area in Southern and Eastern Finland.
These two centers have treated more than 10,000 patients with IAs since 1951. In the Kuopio Cerebral Aneurysm Database of 3005 patients with 4253 IAs, 831 patients (28%) had altogether 980 internal carotid artery (ICA) aneurysms, of whom 95 patients had 99 (2%) AChAAs. Ruptured AChAAs, found in 39 patients (41%), with median size of 6 mm (range = 2-19 mm), were associated with intracerebral hematoma (ICH) in only 1 (3%) patient. Multiple aneurysms were seen in 58 (61%) patients.
The main difficulty in microneurosurgical management of AChAAs is to preserve flow in the anterior choroid artery originating at the base and often attached to the aneurysm dome. This necessitates perfect surgical strategy based on preoperative knowledge of 3 dimensional angioarchitecture and proper orientation during the microsurgical dissection.
World Neurosurgery 05/2010; 73(5):486-99. · 0.68 Impact Factor
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Rossana Romani,
Aki Laakso,
Mika Niemelä,
Martin Lehecka,
Reza Dashti,
Puchong Isarakul,
Ozgür Celik,
Ondrej Navratil, Hanna Lehto,
Riku Kivisaari,
Juha Hernesniemi
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ABSTRACT: Microneurosurgical techniques introduced by Prof. Yaşargil have been modified by the senior author (JH) when treating more than 4,000 patients with aneurysms at two of the Departments of Neurosurgery in Finland, Kuopio and Helsinki, with a total catchment area of close to three million people. This experience is reviewed, and the treatment of anterior circulation aneurysms by simple, fast, normal anatomy preserving strategy is presented.Most of the aneurysms of the anterior circulation are treated by using the lateral supraorbital approach, a less invasive, more frontally located modification of the pterional approach. To avoid extensive skull base surgery, a slack brain is needed and achieved by experienced neuroanesthesia and by surgical tricks for removal of CSF.Diagnosis of cerebral aneurysm before rupture improves treatment results more than any technical advances. Until this is realized, we continue to treat cerebral aneurysms by simple, fast, preserving normal anatomy-strategy, which has served our patients well.Patients with cerebral aneurysms should be treated at specialized neurovascular centers.
Acta neurochirurgica. Supplement 01/2010; 107:3-7.
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ABSTRACT: Distal anterior cerebral artery (DACA) aneurysms, also known as pericallosal artery aneurysms, represent about 6% of all intracranial aneurysms. They are located on the A2-A5 segments of the anterior cerebral artery and on its distal branches.
This paper summarizes present knowledge on radiological features, treatment options, treatment results, and long-term follow-up of DACA aneurysms.
Typical features of DACA aneurysms are small size, broad base, and branches originating from the base. When ruptured, they cause intracerebral hematoma in nearly half of the cases. DACA aneurysms are nowadays more often treated with microsurgical clipping than endovascular coiling due to their distal location and morphologic features. With clipping the results are same or slightly better than for aneurysms at other locations, coiling is often associated with more complications than in other aneurysms.
Clipping is a long-lasting treatment with very small recurrence rate, there is no long-term data available on efficacy of coiling yet. For ruptured DACA aneurysms the most important factors affecting outcome is the severity of initial bleeding and patient's age.
Acta neurochirurgica. Supplement 01/2010; 107:15-26.
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Rossana Romani,
Aki Laakso,
Mika Niemelä,
Martin Lehecka,
Reza Dashti,
Puchong Isarakul,
Özgür Celik,
Ondrej Navratil, Hanna Lehto,
Riku Kivisaari,
Juha Hernesniemi
[show abstract]
[hide abstract]
ABSTRACT: Microneurosurgical techniques introduced by Prof. Yaşargil have been modified by the senior author (JH) when treating more
than 4,000 patients with aneurysms at two of the Departments of Neurosurgery in Finland, Kuopio and Helsinki, with a total
catchment area of close to three million people. This experience is reviewed, and the treatment of anterior circulation aneurysms
by simple, fast, normal anatomy preserving strategy is presented.
Most of the aneurysms of the anterior circulation are treated by using the lateral supraorbital approach, a less invasive,
more frontally located modification of the pterional approach. To avoid extensive skull base surgery, a slack brain is needed
and achieved by experienced neuroanesthesia and by surgical tricks for removal of CSF.
Diagnosis of cerebral aneurysm before rupture improves treatment results more than any technical advances. Until this is realized,
we continue to treat cerebral aneurysms by simple, fast, preserving normal anatomy-strategy, which has served our patients
well.
Patients with cerebral aneurysms should be treated at specialized neurovascular centers.
KeywordsLateral supraorbital approach–Microsurgical technique–Cerebral aneurysm–Anterior circulation–Skull base surgery
12/2009: pages 3-7;
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Surgical Neurology 08/2009; · 1.67 Impact Factor
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Martin Lehecka,
Reza Dashti,
Rossana Romani,
Ozgür Celik,
Ondrej Navratil,
Leena Kivipelto,
Riku Kivisaari,
Hu Shen,
Keisuke Ishii,
Ayse Karatas, Hanna Lehto,
Jouji Kokuzawa,
Mika Niemelä,
Jaakko Rinne,
Antti Ronkainen,
Timo Koivisto,
Juha E Jääskelainen,
Juha Hernesniemi
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ABSTRACT: Internal carotid artery bifurcation aneurysms form 2% to 9% of all IAs. They are more frequent in younger patients than other IAs. In this article, we review the practical microsurgical anatomy, the preoperative imaging, surgical planning, and the microneurosurgical steps in the dissection and the clipping of ICAbifAs.
This review and the whole series on IAs are mainly based on the personal microneurosurgical experience of the senior author (JH) in 2 Finnish centers (Helsinki and Kuopio), which serve, without patient selection, the catchment area in Southern and Eastern Finland.
These 2 centers have treated more than 11 000 patients with IAs since 1951. In the Kuopio Cerebral Aneurysm Database of 3005 patients with 4253 IAs, 831 (28%) patients had altogether 980 ICA aneurysms, of whom 137 patients had 149 (4%) ICAbifAs. Ruptured ICAbifAs, found in 78 (52%) patients, with median size of 8 mm (range, 2-60 mm), were associated with ICH in 15 (19%) patients. Ten (7%) ICAbifAs were giant (> or = 25 mm). Multiple aneurysms were seen in 59 (43%) patients. The ICAbifAs represented 18% of all IAs ruptured before the age of 30 years.
The main difficulty in microneurosurgical management of ICAbifAs is to preserve flow in all the perforators surrounding or adherent to the aneurysm dome. This necessitates perfect surgical strategy based on preoperative knowledge of 3D angioarchitecture and proper orientation during the microsurgical dissection.
Surgical Neurology 04/2009; 71(6):649-67. · 1.67 Impact Factor
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ABSTRACT: Fenestration of the lamina terminalis (LT) is an alternative means of cerebrospinal fluid (CSF) drainage during acute or emergency surgery of ruptured intracranial aneurysms in patients with high-grade subarachnoid hemorrhage. External ventricular drainage allows drainage of CSF and also measurement of intracranial pressure after the surgery. Catheterization of the third ventricle via the fenestrated LT after clipping the aneurysm is an alternative to conventional ventriculostomies. This method has been used by the senior author (JAH) since 2001. The authors describe their experience with this technique, which can be used safely in selected cases of high-grade subarachnoid hemorrhage.
Seventy-eight patients with aneurysmal subarachnoid hemorrhage underwent third ventriculostomy via the LT between March 2001 and December 2005. Clinical and radiological data of these consecutive patients were retrospectively reviewed.
There were no procedure-related complications. Eight patients (10%) later required a conventional ventriculostomy, 7 because of catheter occlusion and 1 because of catheter displacement. In 7 patients (9%), a positive CSF culture was found.
Ventriculostomy via the fenestrated LT performed during aneurysm surgery is a practical way for later CSF removal and intracranial pressure monitoring. The catheter can be applied via the same craniotomy without the need for an additional intervention. No procedure-related complications were observed in the present series. This technique can be suggested as a safe alternative to a classical ventriculostomy.
Neurosurgery 04/2009; 64(3):430-4; discussion 434-5. · 2.79 Impact Factor
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ABSTRACT: The prognosis of giant aneurysms remains poor despite recent advances in microneurosurgery. Thick-walled and partially calcified giant aneurysms with an atheromatic base are difficult to clip safely. Special techniques allowing reshaping of the base and ensuring the stability of clips are often needed. We present our experience with direct clipping of thick-walled giant aneurysms with the aid of the DeBakey cardiovascular clamp (Aesculap, Tuttlingen, Germany).
Eighty-two patients with a giant aneurysm (>/=25 mm) were treated actively at the Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland, between 1997 and 2007. The vascular clamp technique was used in 8 of 50 patients in whom direct clipping was performed. The remaining patients were treated with bypass and trapping, trapping only, proximal occlusion, coiling, or explorative surgery.
The vascular clamp (DeBakey in 5 cases, Crile forceps [Medicon Medizin-Technik, Tuttlingen, Germany] in 2 cases, and Halsted-Mosquito forceps [Medicon Medizin-Technik, Tuttlingen, Germany] in 1 case) was used in 7 saccular middle cerebral artery aneurysms and 1 fusiform basilar bifurcation aneurysm. Two patients had postoperative infarctions, 1 attributable to occlusion of perforators by a clip and the other caused by clips sliding down the calcified base, occluding a major branch. Six patients had no neurological sequelae, 1 patient had transient upper limb paresis, and the patient with the occluded major branch died.
The DeBakey vascular clamp is helpful in assisting direct clipping of thick-walled giant aneurysms with a partially calcified atheromatic base. Some practical features of this instrument require further refinement.
Neurosurgery 03/2009; 64(3 Suppl):ons113-20; discussion ons120-1. · 2.79 Impact Factor
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Juha Hernesniemi,
Rossana Romani,
Baki S Albayrak, Hanna Lehto,
Reza Dashti,
Christian Ramsey,
Ayse Karatas,
Andrea Cardia,
Ondrej Navratil,
Anna Piippo,
Minoru Fujiki,
Stefano Toninelli,
Mika Niemelä
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ABSTRACT: Lesions of the pineal region are histopathologically heterogeneous but often accompanied with severe progression of clinical signs. Surgical treatment remains challenging because of the close vicinity of the deep venous system and the mesencephalo-diencephalic structures in this region. We present the surgical approaches and techniques in a consecutive series of 119 patients treated by the senior author (J.H.) between 1980 and 2007 at 2 different neurosurgical university centers in Kuopio and Helsinki, Finland.
Of the included patients, 107 (90%) presented with pineal region tumors and 12 (10%) with vascular malformations. The ITSC route was used for removal of the lesion in 111 (93%) patients and the OIH approach in 8 (7%) patients. All except one patient were operated on in a sitting position.
We reviewed all clinical data and radiographic images and analyzed all surgical videos. The pineal lesions were removed completely in most cases (88%). There was no surgical mortality. Twenty-two (18%) of the patients had complications in the postoperative period; these included 1 epidural hematoma, 9 transient Parinaud syndrome, 2 meningitis, 3 wound infections, 2 transient memory disturbances, 2 mild hemiparesis, 1 CSF fistula, and 2 cranial nerves palsies (IV and VI). During a 3.5-year follow-up, 12 patients with malignant lesions died; all patients with benign tumors survived.
The ITSC route is a safe and effective surgical approach, associated with low morbidity, complete lesion removal, and definitive histopathologic diagnosis. Considering risk vs benefit, we therefore believe that the surgical treatment can be offered in most cases as the first treatment option for pineal tumors.
Surgical Neurology 01/2009; 70(6):576-83. · 1.67 Impact Factor
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ABSTRACT: Anterior communicating artery complex is the most frequent site of intracranial aneurysms in most reported series. Anterior communicating artery aneurysms are the most complex aneurysms of the anterior circulation due to the angioarchitecture and flow dynamics of the ACoA region, frequent anatomical variations, deep interhemispheric location, and danger of severing the perforators with ensuing neurologic deficits. The authors review the practical microsurgical anatomy, importance of preoperative imaging in surgical planning, and microneurosurgical steps in dissection and clipping of ACoAAs.
This review, and the whole series on intracranial aneurysms, are mainly based on the personal microneurosurgical experience of the senior author (JH) in 2 Finnish centers (Helsinki and Kuopio), which serve, without patient selection, the catchment area in Southern and Eastern Finland.
These 2 centers have treated more than 10000 patients with aneurysm since 1951. In the Kuopio Cerebral Aneurysm Database of 3005 patients with 4253 aneurysms, 1145 patients (38%) had altogether 1179 ACA aneurysms; of them, 898 patients harbored 921 (78%) ACoAAs. In this series, 715 patients (80%) presented with ruptured ACoAAs with the median diameter of 7 mm. Giant ACoAAs were present in 15 (2%), whereas only 3 (0.3%) were classified as fusiform.
Anterior communicating artery aneurysms present frequently with SAH at small size. Furthermore, unruptured ACoAAs may have increased risk of rupture regardless of size, also as an associated aneurysm, and require treatment. The aim in microneurosurgical management of an ACoAA is total occlusion of the aneurysm sac with preservation of flow in all branching and perforating arteries. This demanding task necessitates perfect surgical strategy based on review of the 3D angioarchitecture and abnormalities of the patient's ACoA complex with its ACoAA and to orientate accordingly during the microsurgical dissection. The surgical trajectory should provide optimal visualization of the ACoA complex without massive brain retraction. Precise dissection in the 3D anatomy of the ACoA complex and perforators requires not only experience and skill but patience to work the dome and base under repeated protection of temporary clips and pilot clips. This is particularly important with the complex, large, and giant aneurysms.
Surgical Neurology 08/2008; 70(1):8-28; discussion 29. · 1.67 Impact Factor
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ABSTRACT: Colloid cysts are rare tumors (incidence 3.2/1000000 pear year) located in the anterosuperior part of the third ventricle. In this article, we present our microneurosurgical experience on 134 patients focusing on the nuances of ITA with demonstrative videoclips.
This surgical series is based on the microsurgical experience of the senior author (JH) at 2 Finnish neurosurgical centers (Helsinki and Kuopio, 1980-2007). Surgical anatomy is demonstrated, and the pitfalls of the different surgical steps are analyzed to avoid complications. The series reflects the whole patient profile of Southern and Eastern Finland, without any selection bias.
There was no surgical mortality, and morbidity remained mainly transitory among 134 patients treated by ITA.
Favorable overall outcome of this series demonstrates that removal of third ventricular colloid cyst via transcallosal approach is a direct and safe way to treat these lesions.
Surgical Neurology 06/2008; 69(5):447-53; discussion 453-6. · 1.67 Impact Factor
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ABSTRACT: This study presents the combined experience of two Finnish neurosurgical centers in the treatment of 501 consecutive patients with distal anterior cerebral artery (DACA) aneurysms. Our aim was to compare treatment outcomes of these lesions with intracranial aneurysms in general and to identify factors predicting the outcome.
We analyzed the clinical and radiological data of all 501 patients and focused on the 427 patients treated between 1980 and 2005, the era of microsurgery and computed tomographic imaging. No patients were lost to follow-up. We compared treatment and outcome of ruptured DACA aneurysms (n = 277) with all consecutive ruptured aneurysms from the Kuopio Cerebral Aneurysm Database (n = 2243) and used multivariate analysis to identify factors predicting 1-year outcome.
DACA aneurysms accounted for 6% of all intracranial aneurysms. They were smaller (median, 6 versus 8 mm), more frequently associated with multiple aneurysms (35 versus 18%), and presented more often with intracerebral hematomas (53 versus 26%) than ruptured aneurysms in general. Their microsurgical treatment showed the same complication rates (treatment morbidity, 15%; treatment mortality, 0.4%) as for other ruptured aneurysms. At 1 year after subarachnoid hemorrhage, they had similar favorable outcome (Glasgow Coma Scale score >or=4) as other ruptured aneurysms (74 versus 69%), but their mortality rate was lower (13 versus 24%). Factors predicting unfavorable outcome for ruptured DACA aneurysms were advanced age, Hunt and Hess grade greater than or equal to III, rebleeding before treatment, intracerebral hematoma, intraventricular hemorrhage, and severe preoperative hydrocephalus.
Despite their specific features, with modern treatment methods, ruptured DACA aneurysms have the same favorable outcome and lower mortality at 1 year as ruptured aneurysms in general.
Neurosurgery 03/2008; 62(3):590-601; discussion 590-601. · 2.79 Impact Factor
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Reza Dashti,
Juha Hernesniemi, Hanna Lehto,
Mika Niemelä,
Martin Lehecka,
Jaakko Rinne,
Matti Porras,
Antti Ronkainen,
Surachest Phornsuwannapha,
Timo Koivisto,
Juha E Jääskeläinen
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ABSTRACT: Aneurysms originating from the proximal segment of anterior cerebral artery (A1As) are rare, forming less than 1% of all IAs. There are only few reports on microneurosurgical management of A1As. In this article, the authors review the practical anatomy, preoperative planning, and avoidance of complications in the microsurgical dissection and clipping of A1As.
This review, and the whole series on IAs, is mainly based on the personal microneurosurgical experience of the senior author (JH) in 2 Finnish centers (Helsinki and Kuopio), which serve without patient selection the catchment area in Southern and Eastern Finland.
These 2 centers have treated more than 10,000 patients with aneurysm since 1951. In the Kuopio Cerebral Aneurysm Database of 3005 patients with 4253 aneurysms, there were 23 patients carrying 23 A1As, forming 0.8% of all patients with aneurysm, 0.5% of all aneurysms, and 2% of all ACA aneurysms. Twelve (52%) patients presented with ruptured A1As with ICH in 3 (25%) and IVH in 2 (17%). Seventy percent of patients had at least 1 associated aneurysm.
Aneurysms arising from A1 are usually small, with a fragile wall. Our data suggest that A1As rupture at smaller size than IAs in general. Because of their small size and involvement of perforating arteries at their base, microneurosurgical clipping is the method of choice in treatment of ruptured A1As. Unruptured A1As also need microneurosurgical clipping even when they are small.
Surgical Neurology 11/2007; 68(4):366-77. · 1.67 Impact Factor
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Reza Dashti,
Juha Hernesniemi,
Mika Niemelä,
Jaakko Rinne,
Martin Lehecka,
Hu Shen, Hanna Lehto,
Baki S Albayrak,
Antti Ronkainen,
Timo Koivisto,
Juha E Jääskeläinen
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ABSTRACT: Distal middle cerebral artery aneurysms originate from branches of MCA distal to its main bifurcation or the peripheral branches. Distal middle cerebral artery aneurysms are the least frequently seen among the middle cerebral artery aneurysms. The purpose of this article is to review the practical anatomy, preoperative planning, and avoidance of complications in the microsurgical dissection and clipping of MdistAs.
This review, and the whole series on intracranial aneurysms, are mainly based on the personal microneurosurgical experience of the senior author (JH) in 2 Finnish centers (Helsinki and Kuopio), which serve without patient selection the catchment area in Southern and Eastern Finland.
These 2 centers have treated more than 10000 aneurysm patients since 1951. In the Kuopio Cerebral Aneurysm Database of 3005 patients with 4253 aneurysms, 69 patients carrying altogether 78 MdistAs formed 5% of all MCA aneurysms. Among the 18 patients with ruptured MdistAs (23%), an ICH occurred in 9 (50%).
Distal middle cerebral artery aneurysms are rare. The microneurosurgical treatment of MdistAs is challenging. They are often difficult to localize during the operation, and lack of collateral circulation makes their occlusion more demanding. High rate of ICH and high tendency of rebleeding urge acute or emergency surgery in most of ruptured cases. Microneurosurgical clipping is the most effective treatment of MdistAs.
Surgical Neurology 07/2007; 67(6):553-63. · 1.67 Impact Factor
