1,720,964 research outputs found
A systematic review and meta-analysis of treatment and outcome of blister-like aneurysms
Full text linkBACKGROUND AND PURPOSE: Blister-like aneurysms are uncommon but challenging lesions. Their small size and atypical location often make the diagnosis difficult. Microsurgery and endovascular procedures have been used for their treatment, but there is no consensus on the best treatment technique. We conducted a systematic review and meta-analysis of treatments and outcomes of these vascular lesions. MATERIALS AND METHODS: We reviewed English-language articles on "blood blister-like aneurysms" published between January 1997 and November 2014. All studies reporting patients with these aneurysms treated with surgery, endovascular procedures, or combined therapy with data on treatment modalities and clinical and/or angiographic outcomes were selected, including case reports and series. We performed a meta-analysis on the 2 largest treatment groups (surgery and endovascular management). RESULTS: Sixty studies with 334 patients met our inclusion criteria. Surgery was performed in 114 patients (34.2%), and endovascular treatment, in 199 patients (59.5%). A combined treatment was used in 19 patients (5.7%). A favorable outcome (mRS 0-2) was reported in 67.4% and 78.9% of patients treated with surgery and with endovascular therapy, respectively (P = .034). CONCLUSIONS: Blister-like aneurysms are challenging vascular lesions. The choice of treatment method must be based on the initial clinical presentation and an analysis of the radiologic features of the lesion to select the best technique. Endovascular treatment seems to have lower morbidity and mortality and provides a better outcome compared with surgical approaches. Further prospective studies must be performed to confirm such interesting result
Historical Landmarks in the Management of Aneurysms and Arteriovenous Malformations of the Central Nervous System
No full textBlister-like aneurysms in atypical locations: a single-center experience and comprehensive literature review
No full textOBJECTIVE: Blister-like aneurysms (BLAs) were originally described to arise typically along the nonbranching segment of the dorsal wall of the internal carotid artery (ICA); however, BLAs located in areas other than the dorsal ICA have been described more recently. We present a case series of "atypical" BLAs and a systematic review of the literature on this subject.
METHODS: We conducted a literature search using the key word "blister-like aneurysm." Studies reporting BLAs in locations other than the dorsal ICA wall were selected. Clinical presentation, treatment modality, complications, and outcomes (modified Rankin Scale for neurologic outcomes and Roy scale for radiologic outcomes) were extracted from each study. We also reviewed our single-institution experience with atypical BLAs and analyzed the topography and outcomes of all the atypical BLAs according to each specific treatment modality.
RESULTS: Atypical BLAs were observed in the anterior communicating, middle cerebral, basilar, posterior cerebral, anterior cerebral, and posterior inferior cerebellar arteries. Surgery was the treatment in 65% of patients, an endovascular approach was used in 30%, and a combined approach was used in 5%. A good outcome (modified Rankin Scale 0-1-2) was experienced by 88% and 55% of the patients in the endovascular and surgical groups, respectively. There were 4 deaths, 2 in the endovascular group and 2 in the surgical group.
CONCLUSIONS: Endovascular treatment of BLAs seems to be associated with reduced morbidity and mortality and to provide a better outcome compared with surgical approaches. Further prospective studies are needed to confirm these results. It is important for clinicians to remember that BLAs may also occur in sites other than the typical ICA location
Delayed intraparenchymal hematoma following diagnostic lumbar puncture
No full textLumbar puncture is a safe and commonly performed procedure, with an overall complication rate of 0.1% to 0.5%. Well-known contraindications to lumbar puncture are an intracranial tumor, noncommunicating hydrocephalus, coagulopathy, and ruptured aneurysm with subarachnoid hemorrhage. We report a case of a young man with epilepsy who, after a lumbar puncture performed for research purposes, presented with an intracerebral hematoma and neurological deficits. To the best of our knowledge, post-tap intraparenchymal hematoma is extremely rare and only 1 case has been reported previously. In consideration, all patients undergoing a lumbar puncture should be informed about this possible rare complication, even in the absence of documented hemorrhagic risk factors
Posterior Cervical Transfacet Fusion with Facetal Spacer for the Treatment of Single-Level Cervical Radiculopathy: A Randomized, Controlled Prospective Study
No full textFlow diverter stent treatment for ruptured basilar trunk perforator aneurysms
No full textBasilar trunk perforator (BTP) aneurysms are rare. Treatment options traditionally considered for these uncommon lesions have included direct surgery, endovascular therapy, or conservative management. Flow diverters represent a newer therapeutic option for BTP aneurysms but pitfalls and complications are unknown. We describe three patients with BTP aneurysms treated with flow diverter stents
Treatment timing and multidisciplinary approach in Apert syndrome
Full text linkApert syndrome is a rare congenital disorder characterized by craniosynostosis, midface hypoplasia and symmetric syndactyly of hands and feet. Abnormalities associated with Apert syndrome include premature fusion of coronal sutures system (coronal sutures and less frequently lambdoid suture) resulting in brachiturricephalic dismorphism and impaired skull base growth.
After this brief explanation it is clear that these anatomical abnormalities may have a negative impact on the ability to perform essential functions.
Due to the complexity of the syndrome a multidisciplinary (respiratory, cerebral, maxillo-mandibular, dental, ophthalmic and orthopaedic) approach is necessary in treating the psychological, aesthetic and functional issues. The aim of this paper is to analyse the different functional issues and surgical methods trying to enhance results through a treatment plan which includes different specialities involved in Apert syndrome treatment. Reduced intellectual capacity is associated to the high number of general anaesthesia the small patients are subject to. Therefore the diagnostic and therapeutic treatment plan in these patients has established integrated and tailored surgical procedures based on the patients’ age in order to reduce the number of general anaesthesia, thus simplifying therapy for both Apert patients and their family members
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Full text linkWe performed a comprehensive literature search in the PubMed and Scopus data bases on blister-like aneurysms
Intrathecal Versus Intravenous Morphine in Minimally Invasive Posterior Lumbar Fusion: A Blinded Randomized Comparative Prospective Study
No full textSTUDY DESIGN: A blinded, randomized, comparative prospective study.
OBJECTIVE: The aim of this study was to compare the use of intrathecal morphine
to endovenous morphine on postoperative pain after posterior lumbar surgery.
SUMMARY OF BACKGROUND DATA: Intrathecal morphine can provide significant safe
analgesia for at least 12 hours and up to 24 hours in patients undergoing major
surgery. Its dosages have been decreasing in the last 30 years, but currently,
the optimal dose remains unknown. As of today, there are no studies comparing the
efficacy and the side effects of this technique with intravenous morphine
administration after minimally invasive lumbar fusion surgery.
METHODS: We randomized and compared two groups of 25 patients, who were given
either 100 μg intrathecal (ITM group) or 5 ± 2 mg intravenous morphine delivered
intravenously for 24 hours at 2 mL/h (IVM group) after minimally invasive
posterior lumbar fusion. VAS score at 0, 6, 12, 24 hours, mobilization out of bed
at 6 hours, hospitalization duration and complications as lower limbs
paresthesia, urinary retention at 6 and 12 hours, nausea, vomit, itch, and
constipation were evaluated.
RESULTS: Data showed a lower VAS score, a reduction of constipation, lower limbs
paresthesia, or urinary retention at 12 hours in ITM rather than in the IVM
group. None suffered of vomit, itch, or nausea in both groups. Urinary retention
was observed more frequently in ITM group at 6 hours. Patients of ITM group were
mobilized out bed earlier than those from IVM group.
CONCLUSION: A low dosage of intrathecal morphine is safe and effective after
minimally invasive lumbar fusion surgery. The reduction of pain in the study
group permitted a shorter hospitalization and earlier mobilization out of bed,
augmenting patients' comfort.
LEVEL OF EVIDENCE: 2
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