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Related Concept Videos

Aneurysm III: Interprofessional Care01:26

Aneurysm III: Interprofessional Care

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Aneurysm management involves either conservative medical therapy or surgical intervention, depending on the size and symptoms of the aneurysm. Conservative management is generally reserved for smaller, asymptomatic aneurysms, while larger or symptomatic aneurysms often necessitate surgical repair.Conservative Medical TherapyFor small, asymptomatic aneurysms, particularly abdominal aortic aneurysms (AAA) less than 5.5 centimeters in diameter, conservative medical therapy is recommended. This...
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Aneurysm IV: Nursing Management01:22

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Vigilant monitoring for aneurysm rupture is essential for patients undergoing aortic surgery.Preoperative Nursing ManagementContinuously monitor the patient for manifestations of aneurysm rupture, such as pallor, weakness, tachycardia, hypotension, abdominal, back, groin, or periumbilical pain, changes in consciousness, and a pulsating abdominal mass. Regularly assess the patient's peripheral pulses.Instruct the patient to consume a clear liquid diet the day before surgery and administer...
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Aneurysm II: Clinical Manifestations and Diagnostic Studies01:21

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Thoracic, aortic arch and abdominal aneurysms are significant vascular conditions that can present with various clinical manifestations and lead to serious complications. Understanding these manifestations and the appropriate diagnostic studies is essential for effective management and treatment.Thoracic Aortic AneurysmsThoracic aortic aneurysms often remain asymptomatic until they reach a size that impinges on adjacent structures. They typically cause deep, diffuse chest pain that radiates to...
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The human body's intricate network of arteries ensures that every organ system receives the necessary oxygen and nutrients for optimal function. The arterial network in the head and neck region is particularly complex, providing vital blood flow to the brain, eyes, and other critical structures. Prominent arteries in this region include the internal carotid arteries and the vertebral arteries.
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An aortic aneurysm is a localized outpouching or dilation at a weak point in the artery wall. It may involve different parts of the aorta, such as the abdominal aorta, aortic arch, or thoracic aorta.Etiological factorsSeveral disorders are associated with aortic aneurysms.Congenital causes, such as primary connective tissue disorders like Marfan syndrome, impact the integrity and strength of connective tissues, notably affecting the aorta. Marfan syndrome is a genetic disorder that specifically...
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The coronary arteries, originating from the ascending aorta, bifurcate from two sinuses located within the ascending aorta. Positioned just above the aortic semilunar valve, these sinuses house essential aortic baroreceptors and chemoreceptors, crucial for maintaining cardiac function. The left coronary artery and the right coronary artery branch off from the left posterior and anterior aortic sinuses, respectively.
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Management of Complex Cerebral Aneurysms.

Lorenzo Pescatori1, Giovanni Grasso2, Maria Pia Tropeano3

  • 1Department of Human Neurosciences, Neurosurgery, University "Sapienza" of Rome, Rome, Italy.

World Neurosurgery
|March 8, 2022
PubMed
Summary

Endovascular treatment is the preferred approach for complex intracranial aneurysms (CIAs). Surgical clipping and revascularization are viable alternatives, with proper treatment selection ensuring favorable patient outcomes.

Keywords:
Cerebral aneurysmClippingEndovascularRupture

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Area of Science:

  • Neurosurgery
  • Interventional Radiology
  • Vascular Neurology

Background:

  • Complex intracranial aneurysms (CIAs) present significant treatment challenges due to factors like size, prior treatments, location, poor collateral circulation, thrombosis, and calcification.
  • The primary goal in treating CIAs is to occlude the malformation from cerebral circulation, with both endovascular and surgical methods being effective options.

Purpose of the Study:

  • To evaluate the efficacy and outcomes of different treatment modalities for complex intracranial aneurysms (CIAs).
  • To determine the optimal treatment strategy for CIAs based on patient presentation and aneurysm characteristics.

Main Methods:

  • A retrospective analysis of 170 complex intracranial aneurysms (CIAs) treated between 1990 and 2020.
  • Aneurysms were located in various intracranial segments, including the internal carotid artery (ICA), cavernous sinus, paraclinoid region, and posterior circulation.
  • Treatment decisions were made by a multidisciplinary team, prioritizing endovascular methods, followed by surgical clipping, and revascularization when necessary.

Main Results:

  • Out of 170 patients, 45 received endovascular treatment, 77 underwent surgical clipping, and 55 required revascularization procedures.
  • In the unruptured group, outcomes included 12 deaths, 22 major complications, 3 minor complications, and 101 uneventful courses.
  • In the ruptured group, outcomes included 9 deaths, 10 major complications, 1 minor complication, and 13 complete recoveries.

Conclusions:

  • Endovascular treatment is recommended as the primary therapeutic option for complex intracranial aneurysms (CIAs).
  • Direct surgical clipping and revascularization serve as important alternative treatments.
  • Accurate selection of the therapeutic approach is crucial for achieving positive clinical outcomes in CIA management.