Yiping Li

Indiana University-Purdue University Indianapolis, Indianapolis, IN, United States

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Publications (3)5.48 Total impact

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    ABSTRACT: The anterior choroidal artery (AChA) supplies important areas of the nervous system, particularly the posterior limb of the internal capsule and optic radiation. Treatment of AChA aneurysms poses particular challenges due to the complex anatomy of the aneurysm associated with the relatively small diameter of AChAs, making preservation of the parent vessel during clip ligation or endosaccular coiling challenging. To investigate the incidence and features of ischemia in treatment of AChA aneurysms. A prospectively maintained database of patients who underwent treatment of aneurysms from 1985 to 2011 was queried to find patients with AChA aneurysms. Age, gender, Hunt Hess grade, treatment modality, and complications were analyzed using unpaired Student t test and Fisher's exact test. 122 patients harbored 127 AChA aneurysms, and 67% (82 of 122) had multiple aneurysms. Treatment included 112 microsurgical clip ligations, 8 endosaccular coil embolizations, 5 aneurysmal wrappings, and 2 surgical explorations. Complications developed in 53% (67 of 127) of AChA aneurysms. Postoperative ischemia occurred in 12% (15 of 127) of treated aneurysms. The number of temporary clip applications was most closely associated with postoperative ischemia. Glasgow outcome scores of 4 or 5 were obtained by 78% at discharge, 89% at 6 months, and 85% at 1 year. The ischemic complication rate from surgical treatment of AChA aneurysms is most closely associated with higher frequency of temporary clip applications for proximal control and may be lower than previously reported. Supplementary intraoperative tools and limitation of vessel manipulation should be employed to improve outcomes.
    Neurosurgery 08/2013; · 2.53 Impact Factor
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    ABSTRACT: Fluorescence-guidance has demonstrated potential in maximizing extent of high-grade glioma resection. Different fluorophores (fluorescent biomarkers), including 5-aminolevulinic acid (5-ALA) and fluorescein have been examined using several imaging techniques. The authors' goal is to review the state of this technology and discuss strategies for more widespread adoption. A Medline search was performed using the key words "fluorescence," "intraoperative fluorescence-guided resection," "intraoperative image-guided resection," and "brain glioma" for articles from 1960 until the present. This initial search revealed 267 articles. Each abstract and article was reviewed and the reference lists from select articles were further evaluated for relevance. A total of 64 articles included information about the role of fluorescence in resection of high-grade gliomas and therefore were selectively included for our analysis. 5-ALA and fluorescein sodium have shown promise as fluorescent markers in detecting residual tumor intra-operatively. These techniques have demonstrated significant increase in the extent of tumor resection. Regulatory barriers have limited the use of 5-ALA and technological challenges have restricted the use of fluorescein and its derivatives in the United States. There are currently limitations to this technology, such as the fact that fluorescence at tumor margins is not always reliable for identification of tumor-brain interface. These techniques are safe and effective for increasing gross total resection. Development of more tumor-specific fluorophores is needed to resolve problems with subjective interpretation of fluorescent signal at tumor margins. Techniques such as Quantum Dots and polymer or iron oxide-based nanoparticles have shown promise as potential future tools.
    World Neurosurgery 07/2013; · 1.77 Impact Factor
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    ABSTRACT: Recent studies have hypothesized that hemodynamic changes in parent vessels are responsible for the formation and regression of cerebral aneurysms. One author has described regression of a "flow-related" 4-mm posterior communicating artery (PCoA) aneurysm following ipsilateral carotid endarterectomy (CEA), resulting in reversal of blood flow in the PCoA. We report a 68-year-old woman with a coincidental intracranial aneurysm (ICA) and contralateral internal carotid artery stenosis. The aneurysm spontaneously regressed subsequent to contralateral ICA endarterectomy as documented by repeat computed tomographic angiography. This report also demonstrates the first known case of an ICA in the anterior cerebral artery territory to undergo spontaneous regression. We conclude that the regression and potentially the formation of this aneurysm correlated with hemodynamic factors associated with stenosis of the contralateral ICA.
    Surgical Neurology International 01/2012; 3:66. · 1.18 Impact Factor

Publication Stats

2 Citations
5.48 Total Impact Points

Institutions

  • 2013
    • Indiana University-Purdue University Indianapolis
      • Department of Neurological Surgery
      Indianapolis, IN, United States
    • Indiana University-Purdue University School of Medicine
      • Department of Neurological Surgery
      Indianapolis, Indiana, United States