Gamma Knife radiosurgery of saccular aneurysms in a rabbit model (original) (raw)
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American Journal of Neuroradiology, 2019
BACKGROUND AND PURPOSE: The natural history of flow-related aneurysms after obliteration of brain arteriovenous malformations is poorly understood. The purpose of this study was to evaluate the angioarchitecture and morphologic change in flow-related aneurysms after gamma knife surgery of brain arteriovenous malformations. MATERIALS AND METHODS: During a 12-year period, 823 patients with brain arteriovenous malformations underwent gamma knife surgery at our institution with complete peritherapeutic angiographic evaluation. From this population, a series of 72 patients (8.8%) with 111 flow-related aneurysms were enrolled (1.5 aneurysms per patient). There were 43 men and 29 women; ages ranged from 18 to 72 years (mean, 43 years). The morphologic change of flow-related aneurysms was longitudinally evaluated before and after obliteration of brain arteriovenous malformations. After gamma knife surgery, angiographic follow-up varied from 26 to 130 months (mean, 58 months). RESULTS: All flow-related aneurysms were small (mean, 4.1 mm; range, 2-9 mm). There were 72 proximal flow-related aneurysms (mean size, 4.3 mm) and 39 distal flow-related aneurysms (mean size, 3.7 mm). Spontaneous thrombosis occurred more frequently in distal flow-related aneurysms than in proximal flow-related aneurysms (P Ͻ .001). Smaller flow-related aneurysms (Ͻ5 mm) tended to spontaneously occlude after obliteration of brain arteriovenous malformations (P ϭ .036). Two patients had ruptures of proximal flow-related aneurysms at 27-and 54-month follow-ups, respectively. CONCLUSIONS: Spontaneous thrombosis occurred more frequently in distal flow-related aneurysms due to occlusion or normalization of distal feeders. Smaller flow-related aneurysms also tended to spontaneously thrombose after obliteration of brain arteriovenous malformations. The rate of flow-related aneurysm rupture in our series was similar to that of natural intradural aneurysms. ABBREVIATIONS: ACA ϭ anterior cerebral artery; BAVM ϭ brain arteriovenous malformation; FA ϭ flow-related aneurysm; GKS ϭ gamma knife surgery
In Vivo Experimental Intracranial Aneurysm Models: A Systematic Review
American Journal of Neuroradiology, 2009
Animal models are necessary to develop and test innovations in aneurysm therapy before clinical introduction. This review aims at identifying the most likely candidates for standardizing preclinical testing of aneurysm devices. We systematically searched electronic databases for publications on animal aneurysm models from 1961-2008 to assess the methodologic quality of the studies and collect data on the patency and angiographic and pathologic outcomes of treatments. There has been a steady increase in the annual number of publications with time. Species that were most frequently used were dogs, rabbits, and rodents, followed by swine. Most publications are single-laboratory studies with variables and poorly validated outcome measures, a small number of subjects, and limited standardization of techniques. The most appropriate models to test for recurrences after endovascular occlusion were the surgical bifurcation model in dogs, and the elastase-induced aneurysm model in rabbits. A standardized multicenter study is needed to improve the preclinical evaluation of endovascular devices in aneurysm therapy. ABBREVIATIONS: Angio ϭ angiography; ICA ϭ intracranial aneurysms; IHC ϭ immunohistochemistry; SEM ϭ scanning electron microscope; w ϭ width
Histologic and morphologic comparison of experimental aneurysms with human intracranial aneurysms
AJNR. American journal of neuroradiology, 1998
Vein pouch aneurysms are the most commonly created experimental lesions in neuroendovascular research. We sought to determine whether an experimental aneurysm that is derived from a pancreatic elastase-digested arterial sac (EDASA) models the histology and morphology of human cerebral aneurysms more accurately than the vein pouch aneurysm does. EDASAs were created in the common carotid arteries of four rabbits, and vein pouch aneurysms were created in the common carotid arteries of four pigs. Five recently ruptured human cerebral aneurysms were obtained at autopsy. Identical histologic preparations were made for all specimens, and a vascular pathologist performed blinded histologic analyses. Morphologic dimensions were measured with a micrometer at 40-fold magnification. In each human cerebral aneurysm, there was complete absence of internal elastic lamina and tunica media, and none showed evidence of mural inflammation or neointimal proliferation. Average wall thickness was 51 micr...
Case-series analysis of intracranial saccular aneurysms treatment
Acta medica Lituanica, 2015
Nowadays, selection of the best treatment method for intracranial aneurysms is one of the most discussed topics. We report our operative and coiling experience of 128 cases – series with 106 ruptured and 22 unruptured aneurysms. The aim of the research was to identify the factors influencing the optimal radical method for treatment of intracranial aneurysms and to compare the neurosurgical and neuroradiological activity of our hospital with that of other regions of the world. Of 128 aneurysms the clipped group was 94 patients (mean age ± SD: 52.21 ± 13.34 years, 73.4%) while 34 patients underwent aneurysm embolization (mean age ± SD: 61.59 ± 13.34 years, 36.6%). Most of the aneurysms were located at the anterior communicating artery (n = 36, 28.13%), the middle cerebral artery (n = 34, 26.56%) and the internal carotid artery (n = 20, 15.63%). Comorbidity, neurology status at admission, clinical outcomes, operative complications, aneurysm localization, size and condition were ana...
Open Access Macedonian Journal of Medical Sciences
AIM: To evaluate the short-term effectiveness of Gamma knife radiosurgery as a modality of treatment of brain arteriovenous malformation. METHODS: Sixty-three patients with arteriovenous brain malformations underwent Gamma knife radiosurgery included in this prospective study between April 2017 and September 2018 with clinical and radiological with MRI follow up was done at three months and six months post-Gamma knife radiosurgery. By the end of the 12th-month post-Gamma knife radiosurgery, the patients were re-evaluated using digital subtraction angiography co-registered with M.R.I. During the 12 months follow up, CT scan or MRI was done at any time if any one of the patients᾽ condition deteriorated or developed signs and symptoms of complications. The mean volume of the arteriovenous malformations treated was 26.0 ± 5 cm3 (range 12.5–39.5 cm3) in The Neurosciences Hospital, Baghdad/Iraq. RESULTS: By the end of the 12th month of follow up, the overall obliteration of the arterioven...
Tratamiento de aneurismas de arteria cerebral media: estudio comparativo y algoritmo de tratamiento
Cirugía y Cirujanos
Objectives: We aimed to compare outcomes of patients with middle cerebral artery (MCA) aneurysms treated by either microsurgical clipping or endovascular therapy and provide a treatment algorithm based on available evidence. Materials and methods: We performed a retrospective analysis of 77 patients with 95 MCA aneurysms. Demographic, clinical, and aneurysm morphological variables were collected. Patients were divided into two groups depending on the received treatment. Clinical and radiological outcomes were collected at the end of a 1-year follow-up period and compared between both treatment groups. Results: Mean age was 51.4 years. Fifty patients (65%) underwent microsurgical clipping and 27 (35%) were treated by endovascular therapy. Fifty-four patients (70%) presented with subarachnoid hemorrhage, while 23 (30%) were treated for unruptured aneurysms. Patients with subarachnoid hemorrhage were more frequently treated by microsurgical clipping than patients with unruptured aneurysms. Clinical outcomes, including functional status, were similar between treatment groups after 1-year follow-up even when adjusting for clinical presentation. Residual aneurysms were found less frequently in the microsurgical group (OR = 0.09; p < 0.001). Conclusions: In patients with MCA aneurysms, clinical outcomes at 1 year are similar between microsurgical clipping and endovascular therapy. However, microsurgery is associated with a lower risk of residual aneurysms.