The Experts below are selected from a list of 9570 Experts worldwide ranked by ideXlab platform
Eberhard Uhl - One of the best experts on this subject based on the ideXlab platform.
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Transorbital keyhole approach to Anterior Communicating Artery aneurysms.
Neurosurgery, 2001Co-Authors: Hans Jakob Steiger, Robert Schmid-elsaesser, W. Stummer, Eberhard UhlAbstract:OBJECTIVE: The transorbital keyhole approach to Anterior Communicating Artery aneurysms was developed as a minimally invasive method for safe control of the Anterior Communicating Artery complex. This approach does not necessitate resection of the gyrus rectus. METHODS: The technique is described in detail. The transorbital keyhole approach provides more ventral access than the supraorbital approaches, and the Anterior Communicating Artery complex can be controlled by splitting the basal aspect of the interhemispheric fissure. RESULTS: Since late 1998, the authors have used the transorbital keyhole approach routinely. During the initial experience with 33 patients, the only observed complication specific to this approach was transient diplopia in one patient. At follow-up examinations 2 to 15 months after surgery, the cosmetic results were favorable as compared with those of standard pterional craniotomy. CONCLUSION: We have designed a small, custom-tailored approach to the Anterior Communicating Artery complex for routine use. The small orbitocranial approach is a step toward the ideal of purely extra-axial safe control of Anterior Communicating Artery aneurysms. The orbitocranial keyhole approach seems to be substantially better than the craniotomy, although it requires additional effort and time.
Hans Jakob Steiger - One of the best experts on this subject based on the ideXlab platform.
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Transorbital keyhole approach to Anterior Communicating Artery aneurysms.
Neurosurgery, 2001Co-Authors: Hans Jakob Steiger, Robert Schmid-elsaesser, W. Stummer, Eberhard UhlAbstract:OBJECTIVE: The transorbital keyhole approach to Anterior Communicating Artery aneurysms was developed as a minimally invasive method for safe control of the Anterior Communicating Artery complex. This approach does not necessitate resection of the gyrus rectus. METHODS: The technique is described in detail. The transorbital keyhole approach provides more ventral access than the supraorbital approaches, and the Anterior Communicating Artery complex can be controlled by splitting the basal aspect of the interhemispheric fissure. RESULTS: Since late 1998, the authors have used the transorbital keyhole approach routinely. During the initial experience with 33 patients, the only observed complication specific to this approach was transient diplopia in one patient. At follow-up examinations 2 to 15 months after surgery, the cosmetic results were favorable as compared with those of standard pterional craniotomy. CONCLUSION: We have designed a small, custom-tailored approach to the Anterior Communicating Artery complex for routine use. The small orbitocranial approach is a step toward the ideal of purely extra-axial safe control of Anterior Communicating Artery aneurysms. The orbitocranial keyhole approach seems to be substantially better than the craniotomy, although it requires additional effort and time.
Kiyoshi Kazekawa - One of the best experts on this subject based on the ideXlab platform.
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Endovascular treatment of tiny ruptured Anterior Communicating Artery aneurysms
Neuroradiology, 2008Co-Authors: Masanori Tsutsumi, Hiroshi Aikawa, Masanari Onizuka, Tomonobu Kodama, Kouhei Nii, Shuko Matsubara, Minoru Iko, Housei Etou, Kimiya Sakamoto, Kiyoshi KazekawaAbstract:Introduction Because of its high complication rate, the endovascular treatment (EVT) of Anterior Communicating Artery (ACoA) aneurysms less than 3 mm in maximum diameter remains controversial. We evaluated EVT of tiny ruptured ACoA aneurysms with Guglielmi detachable coils (GDCs).
Michael P Marks - One of the best experts on this subject based on the ideXlab platform.
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patient outcomes and cerebral infarction after ruptured Anterior Communicating Artery aneurysm treatment
American Journal of Neuroradiology, 2017Co-Authors: Jeremy J Heit, Robyn L Ball, Nicholas A Telischak, Robert L Dodd, Gary K Steinberg, Steven D Chang, Max Wintermark, Michael P MarksAbstract:BACKGROUND AND PURPOSE: Anterior Communicating Artery aneurysm rupture and treatment is associated with high rates of dependency, which are more severe after clipping compared with coiling. To determine whether ischemic injury might account for these differences, we characterized cerebral infarction burden, infarction patterns, and patient outcomes after surgical or endovascular treatment of ruptured Anterior Communicating Artery aneurysms. MATERIALS AND METHODS: We performed a retrospective cohort study of consecutive patients with ruptured Anterior Communicating Artery aneurysms. Patient data and neuroimaging studies were reviewed. A propensity score for outcome measures was calculated to account for the nonrandom assignment to treatment. Primary outcome was the frequency of frontal lobe and striatum ischemic injury. Secondary outcomes were patient mortality and clinical outcome at discharge and at 3 months. RESULTS: Coiled patients were older (median, 55 versus 50 years; P = .03), presented with a worse clinical status (60% with Hunt and Hess Score >2 versus 34% in clipped patients; P = .02), had a higher modified Fisher grade ( P = .01), and were more likely to present with intraventricular hemorrhage (78% versus 56%; P = .03). Ischemic frontal lobe infarction (OR, 2.9; 95% CI, 1.1–8.4; P = .03) and recurrent Artery of Heubner infarction (OR, 20.9; 95% CI, 3.5–403.7; P P = .05) compared with coiled patients. Mortality and clinical outcome at 3 months were similar between coiled and clipped patients. CONCLUSIONS: Frontal lobe and recurrent Artery of Heubner infarctions are more common after surgical clipping of ruptured Anterior Communicating Artery aneurysms, and are associated with poorer clinical outcomes at discharge.
Yu-hai Wang - One of the best experts on this subject based on the ideXlab platform.
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Anterior Communicating Artery Aneurysms: Anatomical Considerations and Microsurgical Strategies.
Frontiers in neurology, 2020Co-Authors: Junhui Chen, Xun Zhu, Yan Chen, Chunlei Zhang, Wenwen Shi, Qianxue Chen, Yu-hai WangAbstract:Anterior Communicating Artery aneurysms account for 23-40% of ruptured intracranial aneurysms and 12-15% of unruptured aneurysms and are the most common intracranial ruptured or unruptured aneurysms. Because they have relatively complex anatomical structures and anatomical variations and are adjacent to important blood vessels and structures, in the process of microsurgical exposure of an Anterior Communicating Artery aneurysm, attention should be paid not only to the anatomical characteristics of the aneurysm itself but also to the adjacent important blood vessels and perforating arteries; therefore, both surgical clipping and endovascular embolization are serious challenges for neurosurgeons. No matter which treatment is chosen, it is necessary to determine the structure of the Anterior Communicating Artery and its perforating arteries as well as whether there is a fenestration deformity of the Anterior Communicating Artery and the relationship between bilateral A1-A2 before surgery. The shape and size of the aneurysm itself and its location relative to adjacent blood vessels also need to be considered to better complete the procedure, and this is especially true for microsurgical clipping. Clarifying the anatomy before surgery is helpful for better selecting the surgical approach and surgical side, which could affect the intraoperative exposure of the aneurysm and adjacent arteries, the surgical difficulty, the resection rate, and the postoperative complications. Therefore, starting with Anterior Communicating Artery aneurysms and their adjacent structures and variations, this paper reviews the latest progress in surgical treatment based on anatomic specificity as well as the most recent clinical studies.