Surgical clipping, aneurysm

For subarachnoid hemorrhage surgical clipping of the causative aneurysm or resection of the arteriovenous malformation is the mainstay of treatment. Endovascular coiling of the aneurysm can also be performed. Post-operative infection (either brain or respiratory) is an uncommon complication and not believed to be any more common than after other invasive surgical procedures. Hypervolemic-hemodilution and hypertensive (HHH) therapy is used to prevent spasm. There may be a role for anti-inflammatory measures for the prevention of vasospasm and delayed cerebral ischemia, as shown in a recent pilot study of patients treated with statins (Lynch et al., 2005). 

Sensory systems Eyes A 55-year-old woman developed choroidal infarction with permanent visual loss after intracranial irrigation with papaverine 3 ml (30 mg/ml), used to prevent postoperative vasospasm after surgical clipping of a left middle cerebral artery aneurysm [161 ]. 

The primary treatment goal of cerebral aneurysms is prevention of rupture. Surgical clipping has been the treatment modality of choice for both ruptured and unruptured cerebral aneurysms for decades. Just over 20 years ago endovascular treatment was mainly restricted to those patients with aneurysms unsuitable for clipping due to the size or location, or in whom surgical clipping was contraindicated... 

ISAT was a randomised, prospective, international, controlled trial of endovascular coiling vs surgical clipping for a selected group of patients with ruptured intracranial aneurysms deemed suitable for both types of therapy. Most patients were treated at high-volume centres in the United Kingdom, with the remainders from other European countries, Australia, Canada, and the United States. The primary endpoint was patient outcome, defined as a modified Rankin scale of 3-6 (dependent or deceased) at 1 year. The primary hypothesis was that endovascular treatment would reduce the proportion of patients dependent or deceased by 25% at 1 year. A total of 9559 patients with SAH were screened... 

Regli L, Uske A, de Tribolet N (1999) Endovascular coil placement compared with surgical clipping for the treatment of unruptured middle cerebral artery aneurysms a consecutive series. J Neurosurg 90 1025-1030... 

Endovascular coiling is preferred to surgical clipping for the treatment of intracranial aneurysms, which affect between 2% and 6% of the world population (Ahuja et al., 1993 Horowitz, Samson, Purdy, 1997). Hampikian et al. (2006) evaluated the feasibility of using a novel block copolymer polyurethane, CalomerT, to replace platinum in aneurysm coils. The thermomechanical and radiographic properties were tested for both SMP polyurethane and a composite made of SMP with 3% metal filler. The intracranial aneurysm helical coils made from the SMP composite were successfully deployed inside an aneurysm model with simulated fluid forces. The scientists at Lawrence Livermore National Laboratory also developed a laser-activated SMP foam device for aneurysm occlusion (Maitland et al., 2007). Their SMP was synthesized from HDI, HPED, and TEA, similar to that used in the clot removal device (Wilson et al., 2005). In their preliminary in vitro basilar aneurysm model study, the... 

In subarachnoid hemorrhage due to a ruptured intracranial aneurysm or arteriovenous malformation, surgical intervention to clip or ablate the vascular abnormality substantially reduces mortality from rebleeding. The benefits of surgery are less well documented in cases of primary intracerebral hemorrhage. In patients with intracerebral hematomas, insertion of an intraventricular drain with monitoring of intracranial pressure is... 

Cardiovascular In a 50-year-old man with a subarachnoid hemorrhage papaverine administered at the surgical area during aneurysm clipping resulted in bradycardia, hypotension, and sinus arrest within the first minute after administration [160 ]. 

Aneurysms of the basilar tip remain an extreme surgical challenge,both in terms of technical difficulties associated with the access and the significant postoperative morbidity and mortality rates reported by experienced centres following direct clipping. Clear results about morbidity and mortality rates... 

---