Abstract:
BACKGROUND:Unfavorable anatomy can preclude traditional anterograde endovascular interventions. Transcirculation approaches, which consist of primary catheterization of a target artery from the contralateral side or opposite cerebral circulation, can provide alternative pathways for successful treatment of these patients. We aimed to assess the safety, efficacy, and outcomes of endovascular embolization through transcirculation approaches. METHODS:Nine centers provided retrospective data on patients who underwent transcirculation procedures for embolization of intracranial aneurysms (IAs), dural arteriovenous fistulas (dAVFs), and arteriovenous malformations (AVMs). Raymond-Roy Occlusion Classification (RROC) grades and degree of obliteration were used to evaluate treatment success. Minor/major complications and clinical/angiographic outcomes were also assessed. A review of the literature reporting patients who underwent transcirculation embolizations was also performed. RESULTS:Forty patients were included in the study (34 IAs, 3 AVMs, and 3 dAVFs). Most IAs (22/34, 64.7%) were treated electively. Three AVMs and 2 dAVFs presented ruptured. RROC grade I-II was achieved in 97% of IAs. All AVMs and dAVFs were completely obliterated. One patient developed a transient arterial thrombus that was successfully treated with intravenous tirofiban. The most common indications for a transcirculation approach were difficult access angle of the target lesion (42.5%) and occlusion of the parent artery (27.5%). The review of the literature pooled 152 IAs treated via transcirculation approaches. Most common locations were the basilar tip (27%), posterior inferior cerebellar artery (25%), and internal carotid artery (15.1%). The posterior communicating artery was crossed in 60 (39.5%), anterior communicating artery in 48 (31.6%), and vertebral artery in 37 (24.3%) patients. Primary coiling alone was performed in 22 (14.5%), stent-assisted coiling in 67 (44.1%), balloon-assisted coiling in 36 (23.7%), stent-assisted coiling + balloon-assisted coiling in 20 (13.2%) and flow diversion in 7 (4.6%) patients. After intervention, 142 (93.4%) IAs achieved successful RROC grades I-II. Two major complications (1.3%) leading to death were reported, both of which were intraprocedural aneurysmal ruptures with massive subarachnoid hemorrhage and herniation. After a mean angiographic follow-up of 11.3 months, only 6/108 (5.6%) IAs showed intrasaccular filling/recurrence. CONCLUSIONS:Transcirculation approaches seem to be safe and effective in the treatment of IAs, dAVFs, and AVMs. The most common indication for a transcirculation approach is the presence of a difficult angle to access the target lesion and occlusion of the parent artery.
journal_name
World Neurosurgjournal_title
World neurosurgeryauthors
Roa JA,Ortega-Gutierrez S,Martinez-Galdamez M,Maud A,Dabus G,Pazour A,Dandapat S,Arteaga MS,Fernandez JG,Paez-Granda D,Kalousek V,Pons RB,Mowla A,Duckwiler G,Szeder V,Jabbour P,Hasan DM,Samaniego EAdoi
10.1016/j.wneu.2019.11.078subject
Has Abstractpub_date
2020-02-01 00:00:00pages
e1015-e1027eissn
1878-8750issn
1878-8769pii
S1878-8750(19)32916-Xjournal_volume
134pub_type
杂志文章,多中心研究abstract:BACKGROUND:Approximately 60 cases of schwannoma unrelated to the cranial nerve have been reported, and only 12 arose from the tentorium. We present a case of tentorial schwannoma extending into the pons and midbrain without cranial nerve involvement, which was almost totally resected with an occipital transtentorial ap...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2016.11.049
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abstract:BACKGROUND:The use of a 3-throw knot for anastomosis by microvascular neurosurgeons is the usual standard. There is an inherent belief that the third throw adds extra security to the knot; however, the third throw can make the knot heavy and unbalanced and can exert undue extra pressure on the opposing walls of the sma...
journal_title:World neurosurgery
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doi:10.1016/j.wneu.2020.12.078
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abstract:BACKGROUND:Local hemostatic agents have been used in the neurosurgical field for many years; it is safe and efficient with no fatal complication reported in the literature. We routinely used a gelatin-thrombin hemostatic agent (FloSeal Hemostatic Matrix) for hemostasis in minimally invasive endoscopic-assisted surgery ...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2019.03.030
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abstract:BACKGROUND:Microsurgical clipping is regarded as the most durable treatment for cerebral aneurysms. Aneurysm recurrence after clipping is uncommon and is associated with an increased risk of rupture. Reoperation for recurrent cerebral aneurysms is particularly challenging because of adhesions and scaring, and it carrie...
journal_title:World neurosurgery
pub_type: 杂志文章,多中心研究
doi:10.1016/j.wneu.2016.06.065
更新日期:2016-09-01 00:00:00
abstract:OBJECTIVE:We sought to assess the validity of a virtual surgical training system on lumbar pedicle screw placement for residents. METHODS:Ten inexperienced residents were randomly assigned to the simulation training (ST) group (n = 5) and control group (n = 5). The ST group performed the lumbar pedicle screw placement...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2017.12.015
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pub_type: 杂志文章
doi:10.1016/j.wneu.2018.12.090
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abstract:BACKGROUND:Awake craniotomy is a technique used to maximize resection of lesions in eloquent areas of the brain and preserve function. Although its use in high-income centers is well documented for tumors and vascular lesions, reports of its use in low-middle-income countries are limited. There are no published series ...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2020.10.070
更新日期:2021-01-01 00:00:00
abstract:BACKGROUND:Traumatic posterior fossa subdural hemorrhage (SDH) is a rare subtype of subdural hemorrhage in head injuries. Existing data on its pathophysiology and outcome are currently limited; therefore, the condition is not yet fully understood. The present study aimed to determine the incidence, outcome, and prognos...
journal_title:World neurosurgery
pub_type: 杂志文章,多中心研究
doi:10.1016/j.wneu.2018.07.191
更新日期:2018-11-01 00:00:00
abstract:BACKGROUND:Spinal tuberculosis is the most common form of tuberculosis affecting bone and often needs surgical treatment. Single anterior, single posterior, and combined anterior and posterior approaches are the 3 most commonly used approaches in surgical treatment. Clinically, the choice of optimal surgical approach r...
journal_title:World neurosurgery
pub_type: 杂志文章,评审
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journal_title:World neurosurgery
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doi:10.1016/j.wneu.2020.03.064
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abstract:BACKGROUND:Affective symptoms are frequent in patients with brain tumors. The origin of such symptoms is unknown; either focal brain injury or reactive emotional distress may be responsible. This cross-sectional pilot study linked depressive symptoms and anxiety to white matter integrity. The objective was to test the ...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2015.05.031
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abstract:BACKGROUND:Nonlethal neural tube defects are developmental malformations with complex pathogenesis usually manifested at birth or in childhood. CASE DESCRIPTION:We report the case of a 61-year-old woman without significant previous clinical history presenting for neck pain and stiffness. An extensive workup detected m...
journal_title:World neurosurgery
pub_type:
doi:10.1016/j.wneu.2020.02.164
更新日期:2020-06-01 00:00:00
abstract:BACKGROUND:Cerebrospinal fluid (CSF)-containing cysts at the level of the choroidal fissure are rare embryological entities infrequently described in the literature because of their benign nature. On the occasion of a case series, we present an overview of the literature and discuss anatomical and embryological locatio...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2010.12.056
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journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2018.01.121
更新日期:2018-05-01 00:00:00
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journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2019.06.021
更新日期:2019-10-01 00:00:00
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journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2019.04.253
更新日期:2019-08-01 00:00:00
abstract:BACKGROUND:The semi-sitting position is preferred in some surgeries of the posterior fossa and the cervical spine. At the same time, it is associated with a risk of air embolism. In the presence of a patent foramen ovale (PFO) with an intracardial right-to-left shunt, an air embolism can result in a paradoxical embolis...
journal_title:World neurosurgery
pub_type: 杂志文章,评审
doi:10.1016/j.wneu.2018.04.114
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journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2018.07.124
更新日期:2018-10-01 00:00:00
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journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2018.12.039
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journal_title:World neurosurgery
pub_type:
doi:10.1016/j.wneu.2020.07.042
更新日期:2020-11-01 00:00:00
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journal_title:World neurosurgery
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pub_type: 杂志文章,评审
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更新日期:2016-05-01 00:00:00
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pub_type: 杂志文章
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journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2020.03.104
更新日期:2020-08-01 00:00:00
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journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2020.08.038
更新日期:2020-11-01 00:00:00
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journal_title:World neurosurgery
pub_type: 杂志文章,评审
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更新日期:2019-12-01 00:00:00
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journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2011.02.010
更新日期:2011-07-01 00:00:00
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pub_type: 杂志文章
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journal_title:World neurosurgery
pub_type: 杂志文章
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更新日期:2020-10-28 00:00:00
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pub_type: 杂志文章,meta分析,评审
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更新日期:2018-04-01 00:00:00