Ebook Decision making in neurovascular disease: Part 2
➤ Gửi thông báo lỗi ⚠️ Báo cáo tài liệu vi phạmNội dung chi tiết: Ebook Decision making in neurovascular disease: Part 2
Ebook Decision making in neurovascular disease: Part 2
32 Fusiform Aneurysms of the Anterior CirculationLeonardo B.C. Btasltiense. Pedro Agullai-Satinas. Douglas Gonsales. Andrey Lima. Eric Sau^ageau. and Ebook Decision making in neurovascular disease: Part 2 Ricardo A. HanelAbstract The estimated prevalence of intracranial aneurysms (1A) in the general population ranees between 2 and 4% Although fusiform aneurysms are more commonly found in the vertebrobasilar circulation, these challenging lesions can occur in the anterior circulation with a prevalenc Ebook Decision making in neurovascular disease: Part 2e ranging from 0.1 to 0.3%. Fusiform aneurysms are complex lesions that involve more than 50% of the arterial circumference and are typically characteEbook Decision making in neurovascular disease: Part 2
rized by a lack of discernible neck. In general, this subset of lesions is associated with worse outcomes, higher rates of complications. and death. I32 Fusiform Aneurysms of the Anterior CirculationLeonardo B.C. Btasltiense. Pedro Agullai-Satinas. Douglas Gonsales. Andrey Lima. Eric Sau^ageau. and Ebook Decision making in neurovascular disease: Part 2r options. Microsurgery remains an adequate treatment option and some of the vascular reconstructions include trapping, wrapping, bypass, and excision and induction of aneurysm thrombosis by proximal dipping. Endovascular options for fusiform aneurysms are typically associated with the use of stents Ebook Decision making in neurovascular disease: Part 2 or flow1 diverters with or without the use of adjuvant coiling. Overall, these procedures have demonstrated a safe and effective profile favoring thiEbook Decision making in neurovascular disease: Part 2
s option over microsurgery However, in some instances, a combined approach can be done. Although there is no consensus for the optimal management of f32 Fusiform Aneurysms of the Anterior CirculationLeonardo B.C. Btasltiense. Pedro Agullai-Satinas. Douglas Gonsales. Andrey Lima. Eric Sau^ageau. and Ebook Decision making in neurovascular disease: Part 2life span in contrast to neurosurgeon's perceptions of potential complications, particularly major neurological morbidity and loss of functional independence.Keywords: intracranial aneurysm, fusiform aneurysm, surgery, endovascularIntroductionIntracranial aneurysms are estimated to occur in approxim Ebook Decision making in neurovascular disease: Part 2ately 23% of the general population and giant aneurysms (i25 mm in largest diameter) represent an infrequent subset of lesions representing only 3 toEbook Decision making in neurovascular disease: Part 2
5% of inưacranial aneurysms These lesions are often also categorized into saccular and fusiform based on their morphology and appearance on imaging st32 Fusiform Aneurysms of the Anterior CirculationLeonardo B.C. Btasltiense. Pedro Agullai-Satinas. Douglas Gonsales. Andrey Lima. Eric Sau^ageau. and Ebook Decision making in neurovascular disease: Part 2st, fusiform aneurysms are complex lesions involving more than 50% of the arterial circumference and typically characterized by no discernible neck, which has important treatment implications. Although fusiform aneurysms are more commonly found in the vertebrobasilar circulation, these challenging l Ebook Decision making in neurovascular disease: Part 2esions also occur in the anterior Circulation with an estimated prevalence ranging from 0.1 to 03%. Within the anterior circulation, the majority of fEbook Decision making in neurovascular disease: Part 2
usiform aneurysms occur in the internal carotid artery (1CA). Fusiform aneurysms involving the anterior cerebral arteries (ACAs) and middle cerebral a32 Fusiform Aneurysms of the Anterior CirculationLeonardo B.C. Btasltiense. Pedro Agullai-Satinas. Douglas Gonsales. Andrey Lima. Eric Sau^ageau. and Ebook Decision making in neurovascular disease: Part 2 to aneurysms located in the cavernous segment (10% over the same period) The former lesions are also associated with worse outcomes, higher rates of complications, recanalizatfon. and deathIn the past, some authors have suggested that fusiform aneurysms may have an atherosclerotic component in thei Ebook Decision making in neurovascular disease: Part 2r etiology However, other pathogenic factors unrelated to atherosclerosis have been previously demonstrated to increase the risk of aneurysm enlargemeEbook Decision making in neurovascular disease: Part 2
nt over time and bleeding. Age of the patient IS a very good indicator of lesion pathogenesis. Young patients often develop these aneurysms in the con32 Fusiform Aneurysms of the Anterior CirculationLeonardo B.C. Btasltiense. Pedro Agullai-Satinas. Douglas Gonsales. Andrey Lima. Eric Sau^ageau. and Ebook Decision making in neurovascular disease: Part 2on With vessel atherosclerosis.Major controversies in decision making addressed in this chapter include:1Imaging surveillance versus treatment.2Microsurgical treatment versus endovascular techniques.3Long-term durability of current treatment strategies.4State-of-the-art endovascular devices.Whether Ebook Decision making in neurovascular disease: Part 2to TreatCompared to saccular aneurysms, live natural history and risk of rupture for fusiform aneurysms in the anterior circulation remains a topic onEbook Decision making in neurovascular disease: Part 2
ly marginally understood and an area that would benefit greatly from further studies. As with other intracranial aneurysms, factors to aid in the trea32 Fusiform Aneurysms of the Anterior CirculationLeonardo B.C. Btasltiense. Pedro Agullai-Satinas. Douglas Gonsales. Andrey Lima. Eric Sau^ageau. and Ebook Decision making in neurovascular disease: Part 2e. Smaller asymptomatic lesions can be safely monitored with serial imaging and rarely demonstrate further growth (1 in algorithm The decision to treat should always take in consideration the estimated risks associated with treatment weighted against the natural history.Anatomical ConsiderationsIntr Ebook Decision making in neurovascular disease: Part 2acranial aneurysms are more likely to occur in certain segments of the artery, which has generally been based on regional differences in blood flow. SEbook Decision making in neurovascular disease: Part 2
imilarly, fusiform aneurysms tend to occur between areas of vessel bifurcation in both proximal and distal segments of major intracranial arteries. Th32 Fusiform Aneurysms of the Anterior CirculationLeonardo B.C. Btasltiense. Pedro Agullai-Satinas. Douglas Gonsales. Andrey Lima. Eric Sau^ageau. and Ebook Decision making in neurovascular disease: Part 2%).MCA bifurcation (32-41%). and rarely ACA (02-1.0%). Fusiform aneurysms involving the ACA are usually restricted to the Al segment and similarly, these lesions are more likely to occur at the Ml segment when the MCA is involved.PathophysiologyThe events leading to the development of fusiform aneur Ebook Decision making in neurovascular disease: Part 2ysms are often unknown; atherosclerosis has been postulated as a potential mechanism due to disruption of the internal elastic lamina (IEL). It has alEbook Decision making in neurovascular disease: Part 2
so been hypothesized that these lesions may arise from arterial microdissections with intramural hemorrhage between the intima and the media leading t32 Fusiform Aneurysms of the Anterior CirculationLeonardo B.C. Btasltiense. Pedro Agullai-Satinas. Douglas Gonsales. Andrey Lima. Eric Sau^ageau. and Ebook Decision making in neurovascular disease: Part 2ients, and atherosclerosis occurs more often tn older patients. In addition, turbulent flow within the aneurysm lumen has been shown to create nonphysiological transmural pressures and shear stress on the vessel wall, which may induce changes in smooth muscle cell homeostasis and loss of endothelial Ebook Decision making in neurovascular disease: Part 2 integrity. Fusiform aneurysms often have unique underlying pathological features on autopsy including calcified walls, onion skin pattern in the vessEbook Decision making in neurovascular disease: Part 2
el wall, partial aneurysm thrombosis, and absence of aneurysm neck. Although uncommon, infection involving the vessel has been found to predispose the32 Fusiform Aneurysms of the Anterior CirculationLeonardo B.C. Btasltiense. Pedro Agullai-Satinas. Douglas Gonsales. Andrey Lima. Eric Sau^ageau. and Ebook Decision making in neurovascular disease: Part 2hyperplasia. Tumor cell infiltration of intracranial vessels Via the vasa vasorum has also been associated With pseudoaneurysm formation and fusiform dilatations with partial destruction of the vessel wall, microvascular occlusion by the tumor, and direct invasion of the artenal wall Rare cases of f Ebook Decision making in neurovascular disease: Part 2usiform aneurysm formation have been reported in patients with X-lmlxd lymphoproliferative IXÍP) syndrome in which the immune system is unable to mounEbook Decision making in neurovascular disease: Part 2
t an adequate response to viral infections.212Rangel-Castilla et al. Decision Making In Neurovascular Disease (ISBN 978-1-68420-057-3),copyright & 20132 Fusiform Aneurysms of the Anterior CirculationLeonardo B.C. Btasltiense. Pedro Agullai-Satinas. Douglas Gonsales. Andrey Lima. Eric Sau^ageau. and Ebook Decision making in neurovascular disease: Part 2diversion•Stcntassnted coiliny•Parent vessel iXckiMỚns«9«y•Clip ligation w/woJoeuiysriv>rrjpl>y •6yp»;Algorithm 32.1 Docisbo-makâig accr'rthm fc* fusiform anoaryan: h tbi anwrtcr ckoJation. SAH. Suborachncid hcmorrhaga: T14. osrcion: ischomic smack.213Rangel-Castilla et al. Decision Making in Neurov Ebook Decision making in neurovascular disease: Part 2ascular Disease (ISBN 978-1 -68420-057-3),copyright © 2018 Thieme Medical Publishers. All rights reserved. Usage subject to terms and conditions of liEbook Decision making in neurovascular disease: Part 2
cense.Aneurysms Anterior Circulationparticularly by the Epstein-Barr virus, which may result in diffuse necrotizing vasculitis affecting liia-or intra32 Fusiform Aneurysms of the Anterior CirculationLeonardo B.C. Btasltiense. Pedro Agullai-Satinas. Douglas Gonsales. Andrey Lima. Eric Sau^ageau. and Ebook Decision making in neurovascular disease: Part 2 disorganization of the medial layer, which can result in dilatation of the artery.Gọi ngay
Chat zalo
Facebook