Cavernous sinus aneurysms: risk of growth over time and risk factors

2020 ◽  
Vol 132 (1) ◽  
pp. 22-26 ◽  
Author(s):  
Giovanni Vercelli ◽  
Thomas J. Sorenson ◽  
Ahmad Z. Aljobeh ◽  
Roanna Vine ◽  
Giuseppe Lanzino
Keyword(s):  
Risk Factors ◽  
Internal Carotid ◽  
Limited Information ◽  
Benign Lesions ◽  
Risk Of Rupture ◽  
History Of ◽  
Aneurysm Growth ◽  
Over Time ◽  
New Onset

OBJECTIVECavernous internal carotid artery (ICA) aneurysms are frequently diagnosed incidentally and the benign natural history of these lesions is well known, but there is limited information assessing the risk of growth in untreated patients. The authors sought to assess and analyze risk factors in patients with cavernous ICA aneurysms and compare them to those of patients with intracranial berry aneurysms in other locations.METHODSData from consecutive patients who were diagnosed with a cavernous ICA aneurysm were retrospectively reviewed. The authors evaluated patients for the incidence of cavernous ICA aneurysm growth and rupture. In addition, the authors analyzed risk factors for cavernous ICA aneurysm growth and compared them to risk factors in a population of patients diagnosed with intracranial berry aneurysms in locations other than the cavernous ICA during the same period.RESULTSIn 194 patients with 208 cavernous ICA aneurysms, the authors found a high risk of aneurysm growth (19.2% per patient-year) in patients with large/giant aneurysms. Size was significantly associated with higher risk of growth. Compared to patients with intracranial berry aneurysms in other locations, patients with cavernous ICA aneurysms were significantly more likely to be female and have a lower incidence of hypertension.CONCLUSIONSAneurysms of the cavernous ICA are benign lesions with a negligible risk of rupture but a definite risk of growth. Aneurysm size was found to be associated with aneurysm growth, which can be associated with new onset of symptoms. Serial follow-up imaging of a cavernous ICA aneurysm might be indicated to monitor for asymptomatic growth, especially in patients with larger lesions.

Adult Victimization over Time

2018 ◽  
pp. 171-174
Author(s):  
Mary C. Zanarini
Keyword(s):  
Risk Factors ◽  
Sexually Abused ◽  
Female Gender ◽  
Physical Assault ◽  
Clinical Implications ◽  
Axis Ii ◽  
Borderline Patients ◽  
History Of ◽  
Over Time

At baseline, borderline patients reported higher rates of adult rape and physical assault by a partner than Axis II comparison subjects. Four risk factors were found to significantly predict whether borderline patients had an adult history of being a victim of physical and/or sexual violence before their index admission: female gender, a substance use disorder that began before the age of 18, childhood sexual abuse, and emotional withdrawal by a caretaker (a form of neglect). At six-year and 10-year follow-up, borderline patients reported higher rates of being verbally, emotionally, physically, and sexually abused or assaulted than did Axis II comparison subjects. However, each of these forms of abuse declined significantly over time. The clinical implications of these prevalence and predictive findings are discussed.

Risk Factors for Growth of Unruptured Intracranial Aneurysms: Follow-up Study by Serial 0.5–T Magnetic Resonance Angiography

Neurosurgery ◽  
2006 ◽  
Vol 58 (6) ◽  
pp. 1047-1053 ◽  
Author(s):  
Nobuhiko Miyazawa ◽  
Iwao Akiyama ◽  
Zentaro Yamagata
Keyword(s):  
Risk Factors ◽  
Subarachnoid Hemorrhage ◽  
Family History ◽  
Unruptured Aneurysms ◽  
Logistic Analysis ◽  
Aneurysm Size ◽  
History Of ◽  
Aneurysm Growth ◽  
Independent Risk Factors

Abstract OBJECTIVE: The independent risk factors for aneurysm growth were retrospectively investigated in 130 patients with unruptured aneurysms who were followed up by 0.5–T serial magnetic resonance angiography with stereoscopic images. METHODS: Age, sex, site of aneurysm, size of aneurysm, multiplicity of aneurysms, type of circle of Willis, length of follow-up period, cerebrovascular event, hypertension, diabetes, hyperlipidemia, smoking habit, and family history of subarachnoid hemorrhage were investigated using multiple logistic analysis. RESULTS: Fourteen patients (16 aneurysms) among the 130 patients (159 aneurysms) showed aneurysm growth (10.8%) during follow-up of 10 to 69 months (mean 29.3 ± 10.5 mo). Multiple logistic analysis disclosed that location on the middle cerebral artery (odds ratio [OR] 0.08, P < 0.01), multiplicity of aneurysms (OR 68.5, P < 0.01), aneurysm size of 5 mm or larger (OR 1.17, P = 0.05), and family history of subarachnoid hemorrhage (OR 10.9, P < 0.01) were independent risk factors. CONCLUSION: Location on the middle cerebral artery, multiplicity, aneurysm size of 5 mm or larger, and family history of subarachnoid hemorrhage are independent risk factors for aneurysm growth. These results may help to determine the treatment choice for unruptured aneurysms.

Abstract TP75: Natural History of Incidental Small Paraclinoid Unruptured Aneurysm

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Jeong Eun Kim ◽  
Jin Sue Jeon ◽  
Jun Hyong Ahn ◽  
Young-Je Son ◽  
Jae Seung Bang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Natural History ◽  
Treatment Plan ◽  
Cumulative Survival ◽  
High Risk Factors ◽  
Significant Difference ◽  
History Of ◽  
Aneurysm Growth ◽  
Arterial Branch

Objective: The optimal consensus over treatment of incidental small paraclinoid unruptured intracranial aneurysm (UIA) remains controversial. The aim of this study was to reveal the natural history of small paraclinoid UIA with the goal of informing a treatment plan. Methods: A total of 344 patients harboring 364 paraclinoid UIA (≤5 mm) were retrospectively evaluated during the mean follow-up of 32±17.3 months from September 2001 to May 2011. Barami’s classification was used for categorizing aneurysm location. Univariate and multivariate analyses were used to determine the risk factors of aneurysm growth. The Kaplan-Meier product-limit estimator and generalized Wilcoxon tests were performed to assess the cumulative survival without aneurysm growth. Results: None of the aneurysm ruptures and 12 (3.3%) cases of aneurysm growth were observed during the follow up of 969.7 aneurysm-years. Aneurysm ≥ 4mm (hazard ratio [HR], 6.73; p=0.001) and hypertension (HR, 4.92; p=0.02) were associated with aneurysm growth. Other variables including female (p=0.18), age (p=0.24), arterial branch related location (p=0.47), multiplicity (p=0.11), and smoking (p=0.36) did not differ significantly. The multivariate analysis disclosed that aneurysm ≥4mm (HR, 4.78; p=0.01) and hypertension (HR, 4.20; p=0.03) were significant predictable factors for aneurysm growth. The cumulative survival without aneurysm growth reached a significant difference in aneurysms ≥4mm (p<0.001) and with hypertension (p=0.01). No statistical difference was observed between arterial branch related and unrelated groups (p=0.16). Conclusions: Incidental small paraclinoid UIA can be primarily treated conservatively. Patients with high risk factors including aneurysm ≥4 mm and hypertension must be monitored closely.

Unruptured intracranial aneurysm growth trajectory: occurrence and rate of enlargement in 520 longitudinally followed cases

2020 ◽  
Vol 132 (4) ◽  
pp. 1077-1087 ◽  
Author(s):  
Aichi Chien ◽  
Rashida A. Callender ◽  
Hajime Yokota ◽  
Noriko Salamon ◽  
Geoffrey P. Colby ◽  
...  
Keyword(s):  
Risk Factors ◽  
Growth Rate ◽  
Medical Center ◽  
Growth Trajectory ◽  
Patient Specific ◽  
Limited Information ◽  
Initial Size ◽  
Unruptured Intracranial Aneurysms ◽  
Aneurysm Growth

OBJECTIVEAs imaging technology has improved, more unruptured intracranial aneurysms (UIAs) are detected incidentally. However, there is limited information regarding how UIAs change over time to provide stratified, patient-specific UIA follow-up management. The authors sought to enrich understanding of the natural history of UIAs and identify basic UIA growth trajectories, that is, the speed at which various UIAs increase in size.METHODSFrom January 2005 to December 2015, 382 patients diagnosed with UIAs (n = 520) were followed up at UCLA Medical Center through serial imaging. UIA characteristics and patient-specific variables were studied to identify risk factors associated with aneurysm growth and create a predicted aneurysm trajectory (PAT) model to differentiate aneurysm growth behavior.RESULTSThe PAT model indicated that smoking and hypothyroidism had a large effect on the growth rate of large UIAs (≥ 7 mm), while UIAs < 7 mm were less influenced by smoking and hypothyroidism. Analysis of risk factors related to growth showed that initial size and multiplicity were significant factors related to aneurysm growth and were consistent across different definitions of growth. A 1.09-fold increase in risk of growth was found for every 1-mm increase in initial size (95% CI 1.04–1.15; p = 0.001). Aneurysms in patients with multiple aneurysms were 2.43-fold more likely to grow than those in patients with single aneurysms (95% CI 1.36–4.35; p = 0.003). The growth rate (speed) for large UIAs (≥ 7 mm; 0.085 mm/month) was significantly faster than that for UIAs < 3 mm (0.030 mm/month) and for males than for females (0.089 and 0.045 mm/month, respectively; p = 0.048).CONCLUSIONSAnalyzing longitudinal UIA data as continuous data points can be useful to study the risk of growth and predict the aneurysm growth trajectory. Individual patient characteristics (demographics, behavior, medical history) may have a significant effect on the speed of UIA growth, and predictive models such as PAT may help optimize follow-up frequency for UIA management.

Enlargement of small, asymptomatic, unruptured intracranial aneurysms in patients with no history of subarachnoid hemorrhage: the different factors related to the growth of single and multiple aneurysms

2013 ◽  
Vol 119 (1) ◽  
pp. 190-197 ◽  
Author(s):  
Aichi Chien ◽  
Feng Liang ◽  
James Sayre ◽  
Noriko Salamon ◽  
Pablo Villablanca ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intracranial Aneurysms ◽  
Posterior Circulation ◽  
Unruptured Aneurysms ◽  
Multiple Aneurysms ◽  
Unruptured Intracranial Aneurysms ◽  
History Of ◽  
Aneurysm Growth ◽  
Small Aneurysms

Object This study was performed to investigate the risk factors related to the growth of small, asymptomatic, unruptured aneurysms in patients with no history of subarachnoid hemorrhage (SAH). Methods Between January 2005 and December 2010, a total of 508 patients in whom unruptured intracranial aneurysms were diagnosed at the University of California, Los Angeles medical center did not receive treatment to prevent rupture. Of these, 235 patients with no history of SAH who had asymptomatic, small, unruptured aneurysms (< 7 mm) were monitored with 3D CT angiography images. Follow-up images of the lesions were used to measure aneurysm size changes. Patient medical history, family history of SAH, aneurysm size, and location were studied to find the risk factors associated with small aneurysm growth. Results A total of 319 small aneurysms were included, with follow-up durations of 29.2 ± 20.6 months. Forty-two aneurysms increased in size during the follow-up; 5 aneurysms grew to become ≥ 7 mm within 38.2 ± 18.3 months. A trend of higher growth rates was found in single aneurysms than in multiple aneurysms (p = 0.07). A history of stroke was the only factor associated with single aneurysm growth (p = 0.03). The number of aneurysms (p = 0.011), number of aneurysms located within the posterior circulation (p = 0.030), and patient history of transient ischemic attack (p = 0.044) were related to multiple aneurysm growth. Conclusions Multiple small aneurysms are more likely to grow, and multiple aneurysms located in the posterior circulation may require additional attention. Although single aneurysms have a lower risk of growth, a trend of higher growth rates in single aneurysms was found.

scholarly journals Aspirin associated with decreased rate of intracranial aneurysm growth

2020 ◽  
Vol 133 (5) ◽  
pp. 1478-1485 ◽  
Author(s):  
Mario Zanaty ◽  
Jorge A. Roa ◽  
Daichi Nakagawa ◽  
Nohra Chalouhi ◽  
Lauren Allan ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Odds Ratio ◽  
Intracranial Aneurysms ◽  
Treatment Modalities ◽  
Polycystic Kidney ◽  
Rate Of Growth ◽  
History Of ◽  
Aneurysm Growth ◽  
Over Time

OBJECTIVEAspirin has emerged as a potential agent in the prevention of rupture of intracranial aneurysms (IAs). In this study, the authors’ goal was to test if aspirin is protective against aneurysm growth in patients harboring multiple IAs ≤ 5 mm.METHODSThe authors performed a retrospective review of a prospectively maintained database covering the period July 2009 through January 2019. Patients’ data were included if the following criteria were met: 1) the patient harbored multiple IAs; 2) designated primary aneurysms were treated by surgical/endovascular means; 3) the remaining aneurysms were observed for growth; and 4) a follow-up period of at least 5 years after the initial treatment was available. Demographics, earlier medical history, the rupture status of designated primary aneurysms, aneurysms’ angiographic features, and treatment modalities were gathered.RESULTSThe authors identified 146 patients harboring a total of 375 IAs. At the initial encounter, 146 aneurysms were treated and the remaining 229 aneurysms (2–5 mm) were observed. During the follow-up period, 24 (10.48%) of 229 aneurysms grew. All aneurysms observed to grow later underwent treatment. None of the observed aneurysms ruptured. Multivariate analysis showed that aspirin was significantly associated with a decreased rate of growth (odds ratio [OR] 0.19, 95% confidence interval [CI] 0.05–0.63). Variables associated with an increased rate of growth included hypertension (OR 14.38, 95% CI 3.83–53.94), drug abuse (OR 11.26, 95% CI 1.21–104.65), history of polycystic kidney disease (OR 9.48, 95% CI 1.51–59.35), and subarachnoid hemorrhage at presentation (OR 5.91, 95% CI 1.83–19.09).CONCLUSIONSIn patients with multiple IAs, aspirin significantly decreased the rate of aneurysm growth over time. Additional prospective interventional studies are needed to validate these findings.

Retrospective review of 290 small carotid cave aneurysms over 17 years

2020 ◽  
Vol 133 (5) ◽  
pp. 1473-1477 ◽  
Author(s):  
Aravind G. Kalluri ◽  
Madhav Sukumaran ◽  
Pouya Nazari ◽  
Pedram Golnari ◽  
Sameer A. Ansari ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Internal Carotid ◽  
Case Series ◽  
Aneurysm Rupture ◽  
Medial Aspect ◽  
Retrospective Case ◽  
Risk Of Rupture ◽  
History Of ◽  
Benign Nature

OBJECTIVEThe carotid cave is a unique intradural region located along the medial aspect of the internal carotid artery. Small carotid cave aneurysms confined within this space are bound by the carotid sulcus of the sphenoid bone and are thought to have a low risk of rupture or growth. However, there is a lack of data on the natural history of this subset of aneurysms.METHODSThe authors present a retrospective case series of 290 small (≤ 4 mm) carotid cave aneurysms evaluated and managed at their institution between January 2000 and June 2017.RESULTSNo patient presented with a subarachnoid hemorrhage attributable to a carotid cave aneurysm, and there were no instances of aneurysm rupture or growth during 911.0 aneurysm-years of clinical follow-up or 726.3 aneurysm-years of imaging follow-up, respectively.CONCLUSIONSThis series demonstrates the benign nature of small carotid cave aneurysms.

scholarly journals The Role of 64/128-Slice Multidetector Computed Tomography to Assess the Progression of Coronary Atherosclerosis

2015 ◽  
Vol 9 ◽  
pp. CMC.S20606 ◽  
Author(s):  
Sherif W. Ayad ◽  
Eman M. Elsharkawy ◽  
Salah M. Eltahan ◽  
Mohamed A. Sobhy ◽  
Reem H. Laymouna
Keyword(s):  
Risk Factors ◽  
Computed Tomography ◽  
Chest Pain ◽  
Multidetector Computed Tomography ◽  
Coronary Atherosclerosis ◽  
Plaque Progression ◽  
Plaque Composition ◽  
History Of ◽  
Over Time

Objectives We studied the progression of coronary atherosclerosis over time as detected by multidetector computed tomography (MDCT) in relation to risk factors and plaque composition. Background Studies using MDCT are limited to the assessment of the degree of stenosis without taking into consideration the plaque composition that is seen by MDCT. Methods This study included 200 patients, complaining of chest pain and referred to do 64/128-contrast–enhanced MDCT for the second time, and both studies were retrieved and evaluated for the presence of plaque, plaque type, vessel wall remodeling, percent area, and diameter stenosis and compared in both studies. Plaque progression over time and its association with risk factors were determined. Results We included 200 patients, and 348 plaques were detected by 64/128 MDCT. The duration between follow-up and baseline studies was 25.9 ± 19.2 month. In all, 200 plaques showed progression (57.47%), 122 were stable (35.06%), and 26 regressed (7.47%). In longitudinal regression analysis, the presence of history of diabetes mellitus and dyslipidemia and the absence of intraplaque calcium deposits were independently associated with plaque progression over time ( P < 0.0001). Conclusion Coronary plaque burden of patients with chest pain and no history of acute coronary syndrome significantly increased over time. Progression is dependent on plaque composition and cardiovascular risk factors. Larger studies and longer follow-up period are needed to confirm the determinant factors for plaque progression.

Unruptured intracranial aneurysms in children: 18 years’ experience in a tertiary care pediatric institution

2019 ◽  
Vol 24 (2) ◽  
pp. 184-189 ◽  
Author(s):  
Daniel-Alexandre Bisson ◽  
Peter Dirks ◽  
Afsaneh Amirabadi ◽  
Manohar M. Shroff ◽  
Timo Krings ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Natural History ◽  
Internal Carotid Artery ◽  
Intracranial Aneurysms ◽  
Internal Carotid ◽  
Tertiary Care ◽  
Unruptured Intracranial Aneurysms ◽  
History Of ◽  
Mean Size

OBJECTIVEThere are little data in the literature on the characteristics and natural history of unruptured intracranial aneurysms in children. The authors analyzed their experience with unruptured intracranial aneurysms in the pediatric population at their tertiary care pediatric institution over the last 18 years. The first objective was to assess the imaging characteristics and natural history of these aneurysms in order to help guide management strategies in the future. A second objective was to evaluate the frequency of an underlying condition when an incidental intracranial aneurysm was detected in a child.METHODSThe authors conducted a Research Ethics Board–approved retrospective review of incidental intracranial aneurysms in patients younger than 18 years of age who had been treated at their institution in the period from 1998 to 2016. Clinical (age, sex, syndrome) and radiological (aneurysm location, type, size, thrombus, mass effect) data were recorded. Follow-up imaging was assessed for temporal changes.RESULTSSixty intracranial aneurysms occurred in 51 patients (36 males, 15 females) with a mean age of 10.5 ± 0.5 years (range 9 months–17 years). Forty-five patients (88.2%) had a single aneurysm, while 2 and 3 aneurysms were found in 3 patients each (5.8%). Syndromic association was found in 22 patients (43.1%), most frequently sickle cell disease (10/22 [45.5%]). Aneurysms were saccular in 43 cases (71.7%; mean size 5.0 ± 5.7 mm) and fusiform in the remaining 17 (28.3%; mean size 6.5 ± 2.7 mm). Thirty-one aneurysms (51.7%) arose from the internal carotid artery (right/left 1.4), most commonly in the cavernous segment (10/31 [32.3%]). Mean size change over the entire follow-up of 109 patient-years was a decrease of 0.6 ± 4.2 mm (range −30.0 to +4.0 mm, rate −0.12 ± 9.9 mm/yr). Interval growth (2.0 ± 1.0 mm) was seen in 8 aneurysms (13.3%; 4 saccular, 4 fusiform). An interval decrease in size (8.3 ± 10.7 mm) was seen in 6 aneurysms (10%). There was an inverse relationship between aneurysm size and growth rate (r = −0.82, p < 0.00001). One aneurysm was treated endovascularly with internal carotid artery sacrifice.CONCLUSIONSUnruptured pediatric intracranial aneurysms are most frequently single but can occur in multiples in a syndromic setting. None of the cases from the study period showed clinical or imaging signs of rupture. Growth over time, although unusual and slow, can occur in a proportion of these patients, who should be identified for short-term imaging surveillance.

Anterior approach levator plication for congenital ptosis, absorpable versus non absorpable sutures

2021 ◽  
pp. 112067212110053
Author(s):  
Moustafa Salamah ◽  
Ashraf Mahrous Eid ◽  
Hani Albialy ◽  
Sherif Sharaf EL Deen
Keyword(s):  
Randomized Study ◽  
Early Postoperative Period ◽  
Polyglactin 910 ◽  
Exclusion Criteria ◽  
Congenital Ptosis ◽  
History Of ◽  
Group A ◽  
Group B ◽  
Over Time

Purpose: To compare the efficacy of two different suture types in levator plication for correction of congenital ptosis. Subjects and methods: Prospective comparative interventional randomized study involving 42 eyes of 42 patients aged more than 6 years with congenital ptosis and good levator action. The exclusion criteria were as follows: bilateral ptosis, history of previous surgery, fair or poor levator action, and associated other ocular diseases. Patients were randomized into group A, in which double-armed 5/0 polyester Ethibond were used, and group B, in which double-armed 5/0 Coated Vicryl® (polyglactin 910) suture material we used. Outcomes including eyelid height and stability of eyelid height over time were compared with follow-up data. The MRD was 4.05 ± 0.36 mm and 3.95 ± 0.34 after 1 week for both groups A and B, respectively. At the end of study follow up period (24 weeks), the MRD was 3.60 ± 0.42 mm in group A, and 2.52 ± 0.85 mm in group B. Conclusion: No difference in eyelid height between two groups in early postoperative period, but the postoperative eyelid height was more stable over time in the 5/0 polyester Ethibond group (group A) than in the 5/0 Coated Vicryl® (polyglactin 910) group (group B).

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