Simulation of the surgical manipulation involved in clipping a basilar artery aneurysm: concepts of virtual clipping

2000 ◽  
Vol 93 (2) ◽  
pp. 355-360 ◽  
Author(s):  
Toru Koyama ◽  
Kazuhiro Hongo ◽  
Yuichiro Tanaka ◽  
Shigeaki Kobayashi
Keyword(s):  
Cerebral Aneurysm ◽  
Basilar Artery ◽  
Morphological Changes ◽  
Three Dimensional ◽  
Artery Aneurysm ◽  
Content Type ◽  
Aneurysm Clip ◽  
Transsylvian Approach ◽  
Surgical Manipulation ◽  
Fine Print

✓ Despite recent advances in three-dimensional imaging based on a voxel-rendering method, these techniques do not simulate the morphological changes that occur during surgery. The authors' goal was to develop a computer-graphics model to simulate the manipulation that occurs during surgery when clipping a cerebral aneurysm.The authors developed an application program to interpolate the contours of models of an artery and an aneurysm clip. The center of displacement was determined inside the arterial model. The directions of displacement were changed to simulate saccular and broad-neck aneurysms, and the intensity of displacement was calculated by using a cosine-based formula. The morphological changes in a saccular aneurysm that may occur during clipping were calculated in x, y, and z coordinates by using sine- and cosine-based formulas. Clip movement was integrated with the aneurysm model, thus simulating the manipulation used during clipping of a cerebral aneurysm. Surgery performed to clip a basilar artery (BA) aneurysm via the transsylvian approach was simulated, in which displacement of the internal carotid artery and clipping of the BA aneurysm were necessary. The movements of an aneurysm clip and clip applicator were designed to represent those occurring when a surgeon actually manipulates a BA aneurysm.The authors have named this methodological tool “virtual clipping.” Use of this tool would assist the preoperative choice of clipping style and selection of the best clip.

Transoral transclival clipping of anterior inferior cerebellar artery aneurysm using new rotating applier

1991 ◽  
Vol 75 (3) ◽  
pp. 483-485 ◽  
Author(s):  
H. Alan Crockard ◽  
Turgut Koksel ◽  
Nigel Watkin
Keyword(s):  
Basilar Artery ◽  
Artery Aneurysm ◽  
Transoral Surgery ◽  
Anterior Inferior Cerebellar Artery ◽  
Content Type ◽  
Aneurysm Clip ◽  
Dural Closure ◽  
Cerebellar Artery ◽  
Fine Print

✓ A large, partly calcified aneurysm buried in the pons and arising from the junction of the basilar artery and the anterior inferior cerebellar artery was successfully occluded using a variangle aneurysm clip with a new rotating pistol-grip applier which allowed transoral access. The authors believe that the new applier, used in association with the current techniques for dural closure, allows for safe transoral surgery for basilar aneurysms.

Significance of a small bulge on the basilar artery in patients with perimesencephalic nonaneurysmal subarachnoid hemorrhage

2003 ◽  
Vol 98 (2) ◽  
pp. 426-429 ◽  
Author(s):  
Yuji Matsumaru ◽  
Kiyoyuki Yanaka ◽  
Ai Muroi ◽  
Hiroaki Sato ◽  
Takao Kamezaki ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Basilar Artery ◽  
Three Dimensional ◽  
Distinct Type ◽  
Rotational Angiography ◽  
Bleeding Pattern ◽  
Content Type ◽  
Nonaneurysmal Subarachnoid Hemorrhage ◽  
Excellent Clinical Outcome ◽  
Fine Print

✓ Perimesencephalic nonaneurysmal subarachnoid hemorrhage (SAH) is a distinct type of hemorrhage with a characteristic bleeding pattern and an excellent clinical outcome. The cause of this benign form of SAH remains unknown. The authors report on two cases of perimesencephalic nonaneurysmal SAH in which a small bulge on the basilar artery (BA) was demonstrated on three-dimensional rotational angiography studies. Based on data from these cases, one may infer that the lesion on the BA is responsible for the SAH. The possible pathogenesis is discussed.

Endovascular occlusion of intracranial vessels for curative treatment of unclippable aneurysms: report of 16 cases

1991 ◽  
Vol 75 (5) ◽  
pp. 694-701 ◽  
Author(s):  
Jonathan E. Hodes ◽  
Armand Aymard ◽  
Y. Pierre Gobin ◽  
Daniel Rüfenacht ◽  
Siegfried Bien ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Cerebral Artery ◽  
Basilar Artery ◽  
Posterior Inferior Cerebellar Artery ◽  
Artery Aneurysm ◽  
Neurological Deficits ◽  
Parent Vessel ◽  
Content Type ◽  
Fine Print

✓ Among 121 intracerebral aneurysms presenting at one institution between 1984 and 1989, 16 were treated by endovascular means. All 16 lesions were intradural and intracranial, and had failed either surgical or endovascular attempts at selective exclusion with parent vessel preservation. The lesions included four giant middle cerebral artery (MCA) aneurysms, one giant anterior communicating artery aneurysm, six giant posterior cerebral artery aneurysms, one posterior inferior cerebellar artery aneurysm, one giant mid-basilar artery aneurysm, two giant fusiform basilar artery aneurysms, and one dissecting vertebral artery aneurysm. One of the 16 patients failed an MCA test occlusion and was approached surgically after attempted endovascular selective occlusion. Treatment involved pretreatment evaluation of cerebral blood flow followed by a preliminary parent vessel test occlusion under neuroleptic analgesia with vigilant neurological monitoring. If the test occlusion was tolerated, it was immediately followed by permanent occlusion of the parent vessel with either detachable or nondetachable balloon or coils. The follow-up period ranged from 1 to 8 years. Excellent outcomes were obtained in 12 cases with complete angiographic obliteration of the aneurysm and no new neurological deficits and/or improvement of the pre-embolization symptoms. Four patients died: two related to the procedure, one secondary to rupture of another untreated aneurysm, and the fourth from a postoperative MCA thrombosis after having failed endovascular test occlusion. The angiographic, clinical, and cerebral blood flow criteria for occlusion tolerance are discussed.

Quantification of increased exposure resulting from orbital rim and orbitozygomatic osteotomy via the frontotemporal transsylvian approach

1999 ◽  
Vol 91 (6) ◽  
pp. 1020-1026 ◽  
Author(s):  
Marc S. Schwartz ◽  
Gregory J. Anderson ◽  
Michael A. Horgan ◽  
Jordi X. Kellogg ◽  
Sean O. McMenomey ◽  
...  
Keyword(s):  
Dimensional Space ◽  
Three Dimensional ◽  
Zygomatic Arch ◽  
Neurosurgical Procedures ◽  
Content Type ◽  
Transsylvian Approach ◽  
Surgical Access ◽  
Stereotactic Device ◽  
Orbital Rim ◽  
Fine Print

Object. Use of orbital rim and orbitozygomatic osteotomy has been extensively reported to increase exposure in neurosurgical procedures. However, there have been few attempts to quantify the extent of additional exposure gained by these maneuvers. Using a novel laboratory technique, the authors have attempted to measure the increase in the “area of exposure” that is gained by removal of the orbital rim and zygomatic arch via the frontotemporal transsylvian approach.Methods. The authors dissected five cadavers bilaterally. The area of exposure provided by the frontotemporal transsylvian approach was determined by using a frameless stereotactic device. With the tip of a microdissector placed on targets deep within the exposure, the position of the end of the microdissector handle was measured in three-dimensional space as the microdissector was rotated around the periphery of the operative field. This maneuver was performed via the frontotemporal approach alone as well as with orbital rim and orbitozygomatic osteotomy approaches. After data manipulation, the areas of exposure corresponding to the polygons used to define these handle positions were calculated and directly compared. On average, the area of exposure provided by the frontotemporal transsylvian approach was increased 26 to 39% (p < 0.05) by adding orbital rim osteotomy and an additional 13 to 22% (not significant) with removal of the zygomatic arch.Conclusions. Significant and consistent increases in surgical exposure were obtained by using orbital osteotomy, whereas zygomatic arch removal produced less consistent gains. Both maneuvers may be expected to improve surgical access. However, because larger and more consistent gains were afforded by orbital rim removal, the threshold for removal of this portion of the orbitozygomatic complex should be lower.

The effect of a lipid hydroperoxide of arachidonic acid on the canine basilar artery

1981 ◽  
Vol 54 (3) ◽  
pp. 357-365 ◽  
Author(s):  
Tomio Sasaki ◽  
Susumu Wakai ◽  
Takao Asano ◽  
Takashi Watanabe ◽  
Takaaki Kirino ◽  
...  
Keyword(s):  
Arachidonic Acid ◽  
Basilar Artery ◽  
Morphological Changes ◽  
Degenerative Change ◽  
Lipid Hydroperoxide ◽  
Second Phase ◽  
Electron Microscopic ◽  
Content Type ◽  
Fine Print

✓ The in vivo spasmogenic capacity of a lipid hydroperoxide (15-hydroperoxy arachidonic acid: 15-HPAA) was studied in a chronic experiment using the dog. The 15-HPAA was injected into the cisterna magna (0.2 or 2 mg emulsified in bovine serum albumin solution). The changes in diameter of the basilar artery were followed by angiography, and the morphological changes were studied by electron microscopy. The cisternal injection of 0.2 mg of 15-HPAA caused a mild constriction of the basilar artery which lasted about 7 hours. The cisternal injection of 2 mg of 15-HPAA caused a biphasic constriction, the initial phase of which was a moderate narrowing lasting about 10 hours. The second phase started on the 2nd or the 3rd day after injection. The intensity of the arterial narrowing was more pronounced in the second phase than in the first. The prolonged secondary constriction of the basilar artery continued until sacrifice on the 7th day after injection. Electron microscopic study revealed a marked degenerative change in the endothelium and myonecrotic changes in the tunica media. The prolonged arterial constriction in the second phase was invariably associated with remarkable degeneration of the endothelium. On the other hand, myonecrotic changes were limited to a small number of smooth-muscle cells. The results of the present study are consonant with the hypothesis that lipid peroxidation associated with lysis of the subarachnoid clot is involved in the genesis of chronic vasospasm in subarachnoid hemorrhage.

Cerebral aspergillosis

1973 ◽  
Vol 38 (4) ◽  
pp. 472-476 ◽  
Author(s):  
Pongsakdi Visudhiphan ◽  
Sira Bunyaratavej ◽  
Suwarindr Khantanaphar
Keyword(s):  
Brain Abscess ◽  
Intracranial Hemorrhage ◽  
Basilar Artery ◽  
Artery Aneurysm ◽  
Diagnosis And Treatment ◽  
Content Type ◽  
Basilar Artery Aneurysm ◽  
Fine Print

✓ Three patients with cerebral aspergillosis are reported. Each patient had a different lesion: a solitary brain abscess, a mycotic basilar artery aneurysm, and a massive infective intracranial hemorrhage. Aspergillosis is discussed, including its diagnosis and treatment.

A true mycotic (Aspergillus) aneurysm leading to fatal subarachnoid hemorrhage in a patient with hereditary hemorrhagic telangiectasia

1971 ◽  
Vol 35 (1) ◽  
pp. 71-76 ◽  
Author(s):  
Peter Davidson ◽  
David M. Robertson
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Basilar Artery ◽  
Hereditary Hemorrhagic Telangiectasia ◽  
Artery Aneurysm ◽  
Content Type ◽  
Intracranial Involvement ◽  
Basilar Artery Aneurysm ◽  
Fine Print

✓ A mycotic basilar artery aneurysm, in which Aspergillus was identified histologically, was found to be the cause of a massive subarachnoid hemorrhage in a 75-year-old man who suffered from hereditary hemorrhagic telangiectasia; there was no evidence of intracranial involvement by the latter disorder.

Three-dimensional blood flow analysis in a wide-necked internal carotid artery—ophthalmic artery aneurysm

2003 ◽  
Vol 99 (3) ◽  
pp. 526-533 ◽  
Author(s):  
Satoshi Tateshima ◽  
Fernando Viñuela ◽  
J. Pablo Villablanca ◽  
Yuichi Murayama ◽  
Taku Morino ◽  
...  
Keyword(s):  
Blood Flow ◽  
Secondary Flow ◽  
Flow Analysis ◽  
Three Dimensional ◽  
Artery Aneurysm ◽  
Content Type ◽  
Mean Size ◽  
Blood Flow Analysis ◽  
The Mean ◽  
Fine Print

Object. The aim of this study was to evaluate axial and secondary flow structures in a wide-necked internal carotid artery—ophthalmic artery aneurysm, one of the most common locations for endovascular coil placement. Methods. A clear acrylic aneurysm model was manufactured from a three-dimensional computerized tomography angiogram. Intraaneurysm blood flow analysis was conducted using an acrylic aneurysm model together with laser Doppler velocimetry and particle imaging velocimetry. The maximal axial blood flow velocities in the inflow and outflow zones at the aneurysm orifice were noted at the peak systolic phase, measuring 46.8 and 24.9% of that in the parent artery, respectively. The mean size of the inflow zone during one cardiac cycle was 44.3 ± 9.8% (range 35.6–58.7%) the size of the axial section at the aneurysm orifice. In the lower and upper planes of the aneurysm dome, the mean size of inward and outward flow areas were 43.3 ± 6.7% and 43.8 ± 6.8% the size of the axial cross-sectional plane, respectively. The axial flow velocity structures were dynamically altered throughout the cardiac cycle, particularly at the aneurysm orifice. The fastest secondary flow at the opening was also noted at the peak systolic and early diastolic phases. Axial blood flow velocity was slower in the upper axial plane of the aneurysm dome than in the lower one. Conversely, the secondary flow component was faster in the upper plane. Conclusions. The side-wall aneurysm in this study did not demonstrate a simple flow pattern as was previously seen in ideally shaped experimental aneurysms in vitro and in vivo. The flow patterns of inflow and outflow zones were very difficult to predict based on the limited flow information provided on standard digital subtraction angiography, even in an aneurysm with a relatively simple dome shape.

Three-dimensional computerized tomography angiography—guided surgery of acutely ruptured cerebral anuerysms

2001 ◽  
Vol 94 (5) ◽  
pp. 718-727 ◽  
Author(s):  
Masato Matsumoto ◽  
Masanori Sato ◽  
Masayuki Nakano ◽  
Yuji Endo ◽  
Youichi Watanabe ◽  
...  
Keyword(s):  
Ct Angiography ◽  
Computerized Tomography ◽  
Three Dimensional ◽  
Artery Aneurysm ◽  
3D Ct ◽  
Conventional Angiography ◽  
Content Type ◽  
Ruptured Aneurysms ◽  
3D Ct Angiography ◽  
Fine Print

Object. The aim of this study was to assess whether aneurysm surgery can be performed in patients with ruptured cerebral aneurysms by using three-dimensional computerized tomography (3D-CT) angiography alone, without conventional catheter angiography. Methods. In a previous study, 60 patients with subarachnoid hemorrhage (SAH) from ruptured aneurysms were prospectively evaluated using both 3D-CT and conventional angiography, which resulted in a 100% accuracy for 3D-CT angiography in the diagnosis of ruptured aneurysms, and a 96% accuracy in the identification of associated unruptured aneurysms. The results led the authors to consider replacing conventional angiography with 3D-CT angiography for use in diagnosing ruptured aneurysms, and to perform surgery aided by 3D-CT angiography alone without conventional angiography. Based on the results, 100 consecutive patients with SAH who had undergone surgery in the acute stage based on 3D-CT angiography findings have been studied since December 1996. One hundred ruptured aneurysms, including 41 associated unruptured lesions, were detected using 3D-CT angiography. In seven of 100 ruptured aneurysms, which included four dissecting vertebral artery aneurysms, two basilar artery (BA) tip aneurysms, and one BA—superior cerebellar artery aneurysm, 3D-CT angiography was followed by conventional angiography to acquire diagnostic confirmation or information about the vein of Labbé, which was needed to guide the surgical approach for BA tip aneurysms. All of the ruptured aneurysms were confirmed at surgery and treated successfully. Ninety-three patients who underwent operation with the aid of 3D-CT angiography only had no complications related to the lack of information gathered by conventional angiography. The 3D-CT angiography studies provided the authors with the aneurysm location as well as surgically important information on the configuration of its sac and neck, the presence of calcification in the aneurysm wall, and its relationship to the adjacent vessels and bone structures. Conclusions The authors believe that 3D-CT angiography can replace conventional angiography in the diagnosis of ruptured aneurysms and that surgery can be performed in almost all acutely ruptured aneurysms by using only 3D-CT angiography without conventional angiography.

Basilar-middle meningeal artery anastomoses associated with a cerebral aneurysm

1981 ◽  
Vol 54 (5) ◽  
pp. 677-680 ◽  
Author(s):  
Marcia Katz ◽  
Hugh S. Wisoff ◽  
Robert D. Zimmerman
Keyword(s):  
Cerebral Aneurysm ◽  
Basilar Artery ◽  
Middle Meningeal Artery ◽  
Ruptured Aneurysm ◽  
Anterior Communicating Artery ◽  
Content Type ◽  
Autopsy Findings ◽  
Meningeal Artery ◽  
Fine Print

✓ Unique radiographic and autopsy findings are described in a patient with bilateral basilar artery-middle meningeal artery (BA-MMA) anastomoses associated with a ruptured aneurysm of the anterior communicating artery. The literature, anatomy, and embryology of BA-MMA anastomosis is reviewed.

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