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Intracranial Aneurysms: Multidisciplinary and Multidimensional Approaches

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Clinical Neurology".

Deadline for manuscript submissions: closed (25 November 2023) | Viewed by 4229

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Dr. Behnam Rezai Jahromi

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Guest Editor

Department of Neurosurgery and Interventional Neuroradiology, University of Helsinki and Helsinki University Hospital, 266, FI-00029 Helsinki, Finland
Interests: intracranial aneurysms; AVM; CCM; ICH; IVH

Special Issue Information

Dear Colleagues,

The progress in the treatment of intracranial aneurysms has been enormous in the last two decades. Cutting-edge endovascular methods and state-of-the-art revascularizations have brought to us more reliable ways to treat previously inoperable aneurysms. The neurosurgical and neuroendovascular community has reached a point in which aneurysms are rarely untreatable. The main remaining questions for unruptured intracranial aneurysms are:

Which patient needs prophylactic treatment? When is the best treatment timing? What is the best and personalized approach to treat these potentially fatal lesions?

Moreover, the new advances in imaging technology provide to us more reliable views to see intracranial arteries and aneurysms with new computer fluid dynamics and artificial intelligence. Robotics in the endovascular field has showed promise. However, our practice is often based on outdated data and not on personalized approaches for each patient. To define more reliable ways to approach intracranial aneurysm patients, we need new personalized approaches to each patient and lesion.

In this Special Issue, we welcome authors to submit papers on the clinical and translational advances of intracranial aneurysms in terms of both diagnosis and treatment.

Dr. Behnam Rezai Jahromi
Guest Editor

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Keywords

aneurysm
SAH
computer flow dynamics
personalized medicine
complication
endovascular
microneurosurgery

Published Papers (4 papers)

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Research

14 pages, 36958 KiB

Open AccessArticle

Fusiform versus Saccular Intracranial Aneurysms—Hemodynamic Evaluation of the Pre-Aneurysmal, Pathological, and Post-Interventional State

by Jana Korte, Laurel M. M. Marsh, Sylvia Saalfeld, Daniel Behme, Alberto Aliseda and Philipp Berg

J. Clin. Med. 2024, 13(2), 551; https://doi.org/10.3390/jcm13020551 - 18 Jan 2024

Viewed by 612

Abstract

Minimally-invasive therapies are well-established treatment methods for saccular intracranial aneurysms (SIAs). Knowledge concerning fusiform IAs (FIAs) is low, due to their wide and alternating lumen and their infrequent occurrence. However, FIAs carry risks like ischemia and thus require further in-depth investigation. Six patient-specific IAs, comprising three position-identical FIAs and SIAs, with the FIAs showing a non-typical FIA shape, were compared, respectively. For each model, a healthy counterpart and a treated version with a flow diverting stent were created. Eighteen time-dependent simulations were performed to analyze morphological and hemodynamic parameters focusing on the treatment effect (TE). The stent expansion is higher for FIAs than SIAs. For FIAs, the reduction in vorticity is higher (

Δ

35–75% case 2/3) and the reduction in the oscillatory velocity index is lower (

Δ

15–68% case 2/3). Velocity is reduced equally for FIAs and SIAs with a TE of 37–60% in FIAs and of 41–72% in SIAs. Time-averaged wall shear stress (TAWSS) is less reduced within FIAs than SIAs (

Δ

30–105%). Within this study, the positive TE of FDS deployed in FIAs is shown and a similarity in parameters found due to the non-typical FIA shape. Despite the higher stent expansion, velocity and vorticity are equally reduced compared to identically located SIAs. Full article

(This article belongs to the Special Issue Intracranial Aneurysms: Multidisciplinary and Multidimensional Approaches)

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18 pages, 2607 KiB

Open AccessArticle

The Role of Early Serum Biomarkers and Clinical Rating Scales in the Prediction of Delayed Cerebral Ischaemia and Short-Term Outcome after Aneurysmal Subarachnoid Haemorrhage: Single Centre Experience

by Małgorzata Burzyńska, Agnieszka Uryga, Jowita Woźniak, Rafał Załuski, Chiara Robba and Waldemar Goździk

J. Clin. Med. 2023, 12(17), 5614; https://doi.org/10.3390/jcm12175614 - 28 Aug 2023

Viewed by 809

Abstract

Considering the variety of complications that arise after aneurysmal subarachnoid haemorrhage (aSAH) and the complex pathomechanism of delayed cerebral ischaemia (DCI), the task of predicting the outcome assumes a profound complexity. Therefore, there is a need to develop early predictive and decision-making models. This study explores the effect of serum biomarkers and clinical scales on patients’ outcomes and their interrelationship with DCI and systemic complications in aSAH. This was a retrospective analysis including aSAH patients admitted to the Wroclaw University Hospital (Wrocław, Poland) from 2011 to 2020. A good outcome was defined as a modified Rankin Scale (mRS) score of 0–2. The prediction of the development of DCI and poor outcome was conducted using logistic regression as a standard model (SM) and random forest as a machine learning method (ML). A cohort of 174 aSAH patients were included in the analysis. DCI was diagnosed in 79 (45%) patients. Significant differences between patients with poor vs. good outcome were determined from their levels of albumin (31 ± 7 vs. 35 ± 5 (g/L); p < 0.001), D-dimer (3.0 ± 4.5 vs. 1.5 ± 2.8 (ng/mL); p < 0.001), procalcitonin (0.2 ± 0.4 vs. 0.1 ± 0.1 (ng/mL); p < 0.001), and glucose (169 ± 69 vs. 137 ± 48 (nmol/L); p < 0.001). SM for DCI prediction included the Apache II scale (odds ratio [OD] 1.05; 95% confidence interval [CI] 1.00–1.09) and albumin level (OD 0.88; CI 0.82–0.95). ML demonstrated that low albumin level, high Apache II scale, increased D-dimer and procalcitonin levels had the highest predictive values for DCI. The integration of clinical parameters and scales with a panel of biomarkers may effectively facilitate the stratification of aSAH patients, identifying those at high risk of secondary complications and poor outcome. Full article

(This article belongs to the Special Issue Intracranial Aneurysms: Multidisciplinary and Multidimensional Approaches)

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14 pages, 3139 KiB

Open AccessArticle

DSA-Based 2D Perfusion Measurements in Delayed Cerebral Ischemia to Estimate the Clinical Outcome in Patients with Aneurysmal Subarachnoid Hemorrhage: A Technical Feasibility Study

by Sebastian R. Reder, Steffen Lückerath, Axel Neulen, Katja U. Beiser, Nils F. Grauhan, Ahmed E. Othman, Marc A. Brockmann, Carolin Brockmann and Andrea Kronfeld

J. Clin. Med. 2023, 12(12), 4135; https://doi.org/10.3390/jcm12124135 - 19 Jun 2023

Viewed by 1122

Abstract

(1) Background: To predict clinical outcomes in patients with aneurysmal subarachnoid hemorrhage (aSAH) and delayed cerebral ischemia (DCI) by assessment of the cerebral perfusion using a 2D perfusion angiography (2DPA) time–contrast agent (CA) concentration model. (2) Methods: Digital subtraction angiography (DSA) data sets of n = 26 subjects were acquired and post-processed focusing on changes in contrast density using a time–concentration model at three time points: (i) initial presentation with SAH (T0); (ii) vasospasm-associated acute clinical impairment (T1); and (iii) directly after endovascular treatment (T2) of SAH-associated large vessel vasospasm (LVV), which resulted in n = 78 data sets. Maximum slope (MS in SI/ms), time-to-peak (TTP in ms), and maximum amplitude of a CA bolus (dSI) were measured in brain parenchyma using regions of interest (ROIs). First, acquired parameters were standardized to the arterial input function (AIF) and then statistically analyzed as mean values. Additionally, data were clustered into two subsets consisting of patients with regredient or with stable/progredient symptoms (or Doppler signals) after endovascular treatment (n = 10 vs. n = 16). (3) Results: Perfusion parameters (MS, TTP, and dSI) differed significantly between T0 and T1 (p = 0.003 each). Significant changes between T1 and T2 were only detectable for MS (0.041 ± 0.016 vs. 0.059 ± 0.026; p = 0.011) in patients with regredient symptoms at T2 (0.04 ± 0.012 vs. 0.066 ± 0.031; p = 0.004). For dSI, there were significant differences between T0 and T2 (5095.8 ± 2541.9 vs. 3012.3 ± 968.3; p = 0.001), especially for those with stable symptoms at T2 (5685.4 ± 2967.2 vs. 3102.8 ± 1033.2; p = 0.02). Multiple linear regression analysis revealed that a) the difference in MS between T1 and T2 and b) patient’s age (R = 0.6; R² = 0.34; p = 0.009) strongly predict the modified Rankin Scale (mRS) at discharge. (4) Conclusions: 2DPA allows the direct measurement of treatment effects in SAH associated DCI and may be used to predict outcomes in these critically ill patients. Full article

(This article belongs to the Special Issue Intracranial Aneurysms: Multidisciplinary and Multidimensional Approaches)

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8 pages, 411 KiB

Open AccessArticle

Relevance of Routine Postoperative CT Scans Following Aneurysm Clipping—A Retrospective Multicenter Analysis of 423 Cases

by Michał Krakowiak, Justyna Małgorzata Fercho, Tomasz Szmuda, Kaja Piwowska, Aleksander Och, Karol Sawicki, Kamil Krystkiewicz, Dorota Modliborska, Sara Kierońska, Waldemar Och, Zenon Dionizy Mariak, Jacek Furtak, Stanisław Gałązka, Paweł Sokal and Paweł Słoniewski

J. Clin. Med. 2022, 11(23), 7082; https://doi.org/10.3390/jcm11237082 - 29 Nov 2022

Viewed by 1011

Abstract

Aim: Postoperative head computed tomography (POCT) is routinely performed in numerous medical institutions, mainly to identify possible postsurgical complications. This study sought to assess the clinical appropriateness of POCT in asymptomatic and symptomatic patients after ruptured or unruptured aneurysm clipping. Methods: This is a retrospective multicenter study involving microsurgical procedures of ruptured (RA) and unruptured intracranial aneurysm (UA) surgeries performed in the Centers associated with the Pomeranian Department of the Polish Society of Neurosurgeons. A database of surgical procedures of intracranial aneurysms from 2017 to 2020 was created. Only patients after a CT scan within 24 h were included. Results: A total of 423 cases met the inclusion criteria for the analysis. Age was the only significant factor associated with postoperative blood occurrence on POCT. A total of 37 (8.75%) cases of deterioration within 24 h with urgent POCT were noted, 3 (8.1%) required recraniotomy. The highest number necessary to predict (NNP) one recraniotomy based on patient deterioration was 50 in the RA group. Conclusion: We do not recommend POCTs in asymptomatic patients after planned clipping. New symptom onset requires radiological evaluation. Simultaneous practice of POCT after ruptured aneurysm treatment within 24 h is recommended. Full article

(This article belongs to the Special Issue Intracranial Aneurysms: Multidisciplinary and Multidimensional Approaches)

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