PURPOSE: Dual velocity encoding PC-MRI can produce spurious artifacts when using high ratios of velocity encoding values (VENCs), limiting its ability to generate high-quality images across a wide range of encoding velocities. This study aims to propose and compare dual-VENC correction methods for such artifacts. THEORY AND METHODS: Two denoising approaches based on spatiotemporal regularization are proposed and compared with a state-of-the-art method based on sign correction. Accuracy is assessed using simulated data from an aorta and brain aneurysm, as well as 8 two-dimensional (2D) PC-MRI ascending aorta datasets. Two temporal resolutions (30,60) ms and noise levels (9,12) dB are considered, with noise added to the complex magnetization. The error is evaluated with respect to the noise-free measurement in the synthetic case and to the unwrapped image without additional noise in the volunteer datasets. RESULTS: In all studied cases, the proposed methods are more accurate than the Sign Correction technique. Using simulated 2D+T data from the aorta (60 ms, 9 dB), the Dual-VENC (DV) error 0.82±0.07$$ 0.82\pm 0.07 $$ is reduced to: 0.66±0.04$$ 0.66\pm 0.04 $$ (Sign Correction); 0.34±0.04$$ 0.34\pm 0.04 $$ and 0.32±0.04$$ 0.32\pm 0.04 $$ (proposed techniques). The methods are found to be significantly different (p-value <0.05$$ <0.05 $$ ). Importantly, brain aneurysm data revealed that the Sign Correction method is not suitable, as it increases error when the flow is not unidirectional. All three methods improve the accuracy of in vivo data. CONCLUSION: The newly proposed methods outperform the Sign Correction method in improving dual-VENC PC-MRI images. Among them, the approach based on temporal differences has shown the highest accuracy.
- MeSH
- algoritmy * MeSH
- aorta * diagnostické zobrazování MeSH
- artefakty * MeSH
- fantomy radiodiagnostické MeSH
- interpretace obrazu počítačem metody MeSH
- intrakraniální aneurysma diagnostické zobrazování MeSH
- lidé MeSH
- magnetická rezonanční tomografie * metody MeSH
- mozek diagnostické zobrazování MeSH
- počítačová simulace MeSH
- počítačové zpracování obrazu * metody MeSH
- poměr signál - šum * MeSH
- reprodukovatelnost výsledků MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
Background: Using two case reports of adult women with moyamoya disease presenting with intracranial hemorrhage from ruptured aneurysms on moyamoya collateral vessels, we aim to demonstrate the potential for effective endovascular treatment navigated by CT angiography, digital subtraction angiography, and flat panel CT. Case 1 Presentation: A 45-year-old female patient with sudden onset of headache, followed by somnolency. CT scan showed a four-ventricle hematocephalus caused by a 27 × 31 × 17 mm hematoma located in the left basal ganglia. Angiography revealed a 3 mm aneurysm on hypertrophic lenticulostriate artery bridging the M1 occlusion. Selective catheterization and distal embolisation with acrylic glue was done. Case 2 Presentation: A 47-year-old woman was admitted for a sudden onset of severe headache, CT scan showed four-ventricle hematocephalus. A 4 mm aneurysm on the collateral vessel-anterior chorioidal artery bridging the closure of the terminal segment of the internal carotid artery was diagnosed as the source of bleeding. Selective catheterization and distal embolisation with acrylic glue was done. Conclusions: Selective embolisation of ruptured aneurysms on moya moya collaterals is a simple, effective, and safe procedure when relevant microcatheters are used with imaging software navigation such as 3D DSA, 3D road map and flat-panel CT.
- MeSH
- digitální subtrakční angiografie metody MeSH
- endovaskulární výkony * metody MeSH
- intrakraniální aneurysma terapie komplikace diagnostické zobrazování MeSH
- lidé středního věku MeSH
- lidé MeSH
- moyamoya nemoc * komplikace terapie MeSH
- počítačová rentgenová tomografie MeSH
- prasklé aneurysma * terapie komplikace MeSH
- terapeutická embolizace metody MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
BACKGROUND: Brain strokes comprise the third leading cause of death worldwide. Microsurgical clipping is recognized as being one of the most effective approaches to the treatment of brain aneurysms. The incomplete closure of the distal-side aneurysm neck is the most common cause of the persistent filling of the dome. Since the diameter of the neck increases when the neck of the aneurysm is squeezed closed by the blades of the clip, the blades should be correspondingly longer. This study provided an assessment of whether the presurgical selection of clips using a 3D planning system is feasible in terms of selecting the most suitable clip for aneurysm occlusion. METHODS: The computational model was created based on computer tomography data obtained from nine brain aneurysms. The closing of the aneurysm was provided in two steps. The first the length of the blades used for closing corresponded to the length of the aneurysm neck as confirmed by the radiological measurements. The second the length of the blades was adjusted according to stage one, so as to determine the minimum required for the closure of all the gaps in the interior space of the aneurysm neck. RESULTS: No differences were detected between the radiological measurement of the aneurysm neck size and the measurements obtained from the reconstructed stereolithographic 3D models. It was observed that the size of the aneurysm neck increased following clipping by 40% to 60% of its original size. The larger the aneurysm neck, the greater the deformation of the aneurysm. CONCLUSION: Firstly, the 3D reconstruction of CT/MRI data did not result in any loss of accuracy and the measurement of the neck of the aneurysm was the same for both of the methods employed. The second, and more important, outcome was that the deformation of the neck of the cerebral aneurysm is at least 1.4x greater than its original size. This information is essential in terms of the pre-selection of the size of the clip.
Cieľ: Prítomnosť intrakraniálnych aneuryziem a ich hemoragických a tromboembolických komplikácií predstavuje závažnú nozologickú jednotku, ktorá významne ohrozuje svojich nositeľov. Sú väčšinou asymptomatické až do vzniku ruptúry. V dvoch kazuistikách predstavujeme mladých pacientov so zhoršeným videním a bolesťami hlavy, u ktorých sme zistili prítomnosť intrakraniálnych aneuryziem. Materiál a metódy: Prezentácia dvoch kazuistík pacientov, ktorí prišli na naše pracovisko so zhoršením videnia a bolesťami hlavy. Na našom pracovisku pacienti podstúpili kompletné očné vyšetrenie, vrátane vyšetrenia zorného poľa. Na základe výsledkov vyšetrenia boli indikovaní na zobrazovacie vyšetrenie mozgu, ktoré odhalilo prítomnosť intrakraniálnych aneuryziem. Pacienti boli následne odoslaní do centra intervenčnej neurorádiológie, kde podstúpili neinvazívny endovaskulárny neuroembolizačný výkon s implantáciou flow divertera. Pacientov sme ďalej po výkone sledovali a výsledky vyšetrení dokumentujeme do obdobia 1 roku po výkone. Výsledky a záver: Vďaka rýchlemu záchytu, diagnostike a manažmentu oboch pacientov sme predišli vzniku ruptúry aneuryzmy a život ohrozujúceho stavu. Po endovaskulárnych výkonoch s implantáciou flow diverterta došlo k výraznému zlepšeniu zrakovej ostrosti ako aj perimetrického nálezu u oboch pacientov. Pri záchyte intakraniálnych aneuryziem do týždňa od vzniku očných príznakov a ich ošetrení do troch mesiacov, došlo v priebehu 6–12 mesiacov u našich dvoch pacientov k zlepšeniu defektov v zornom poli, u jedného z týchto pacientov až k takmer ich kompletnému vymiznutiu.
Purpose: Intracranial aneurysms and their hemorrhagic and thromboembolic complications represent a serious nosological unit that significantly endangers those afflicted. They are mostly asymptomatic until rupture occurs. In two case reports, we present our observations of young patients with impaired vision and headaches, in whom we found the presence of intracranial aneurysms. Observations: Presentation of two case reports of patients who came to our department with impaired vision and headaches. The patients underwent a complete eye examination at our center, including a visual field examination. Based on the results of the examination, they were referred for an imaging examination of the brain, which revealed the presence of intracranial aneurysms. The patients were subsequently sent to the interventional neuroradiology center, where they underwent a noninvasive endovascular neuroembolization procedure with flow diverter implantation. We continued to monitor the patients after the procedure and document the examination results up to 1 year after the procedure. Conclusions and significance: Thanks to the fast detection, diagnosis, and management of both patients, we prevented the occurrence of aneurysm rupture, thus a life-threatening complication. After endovascular procedures with flow diverter implantation, we observed a significant improvement in visual acuity as well as perimetric findings in both patients. When intracranial aneurysms are found within a week of the onset of eye symptoms and treated within three months, defects in the visual fields improved in our two patients within 6–12 months, and in one of the two patients the defects almost completely disappeared.
- Klíčová slova
- neuroembolizace,
- MeSH
- bolesti hlavy etiologie MeSH
- diagnostické techniky oftalmologické MeSH
- dospělí MeSH
- endovaskulární výkony metody MeSH
- intrakraniální aneurysma * chirurgie diagnostické zobrazování klasifikace patologie MeSH
- lidé MeSH
- magnetická rezonanční tomografie MeSH
- mozková angiografie MeSH
- poruchy zraku chirurgie diagnostické zobrazování etiologie terapie MeSH
- terapeutická embolizace * metody MeSH
- zraková pole MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- Publikační typ
- kazuistiky MeSH
Cíl: Cílem této práce bylo zhodnocení našich zkušeností s metodou 3D tisku v neurochirurgii. Vedle známé tvorby kraniálních implantátů je možné mnohem širší využití této moderní, rychle se rozvíjející technologie. Metodika: Představujeme a hodnotíme soubor našich deseti pacientů, kteří byli operováni s využitím metody 3D tisku. V oblasti cévní neurochirurgie se jednalo ve čtyřech případech o model mozkového aneuryzmatu a o jeden model arteriovenózních malformací. U dvou pacientů metoda přispěla k uzavření defektu lební baze „na míru“ tvarovanou mřížkou a v neuroonkologii u dvou pacientů zlepšila naši představu o pozici nádorů lební baze. U jednoho pacienta 3D model obratle C2 umožnil volbu optimální trajektorie fixačního materiálu. Výsledky: Ve zmíněných případech bylo dosaženo požadovaného výsledku a u všech pacientů metoda 3D tisku přispěla ke správnému ošetření. Závěr: Na základě našich zkušeností si dovolujeme konstatovat, že kromě již běžně využívané 3D implantologie metoda 3D tisku představuje zajímavou a inovativní modalitu v oblastech neurochirurgického plánování, simulace a tréninku. Předpokládáme, že se bude stále více uplatňovat v mnoha oblastech neurochirurgie.
Aim: The aim of this work was to evaluate our experience with the 3D printing method in neurosurgery. In addition to the well-known utilization of cranial implants, a significant use of this modern, rapidly developing technology is possible. Methods: We present and evaluate the series of our ten patients, which we operated on using 3D printing methods. In the field of vascular neurosurgery, four cases involved a brain aneurysm model and one arteriovenous malformation model. In two patients, this method contributed to the closure of the skull base defect with a custom-shaped cranial grid and in neuro-oncology, it improved the visualization of skull base tumors in two patients. In one patient, the 3D model of the C2 vertebra allowed the choice of the optimal trajectory of the fixation material. Results: In the mentioned cases, the desired result was achieved and the 3D printing method was adapted to the correct treatment in all patients. Conclusion: Based on our experiences, we can claim that the 3D printing method, in addition to the already commonly used 3D implantology, also presents a new and interesting modality in the field of neurosurgical planning, simulation and training. We assume that it will be increasingly used in many areas of neurosurgery.
- MeSH
- 3D tisk * přístrojové vybavení MeSH
- dospělí MeSH
- intrakraniální aneurysma chirurgie diagnostické zobrazování MeSH
- lidé středního věku MeSH
- lidé MeSH
- nemoci centrálního nervového systému chirurgie diagnostické zobrazování MeSH
- neurochirurgie * metody trendy MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- klinická studie MeSH
- práce podpořená grantem MeSH
OBJECTIVES: To investigate the impact of intracerebral haematoma (ICH) on the outcomes and the factors related to an ICH in patients with aneurysmal subarachnoid haemorrhage (aSAH) in a low- and middle-income country. DESIGN: A multicentre prospective cohort study. SETTING: Three central hospitals in Hanoi, Vietnam. PARTICIPANTS: This study included all patients (≥18 years) presenting with aSAH to the three central hospitals within 4 days of ictus, from August 2019 to June 2021, and excluded patients for whom the admission Glasgow Coma Scale was unable to be scored or patients who became lost at 90 days of follow-up during the study. OUTCOME MEASURES: The primary outcome was ICH after aneurysm rupture, defined as ICH detected on an admission head CT scan. The secondary outcomes were 90-day poor outcomes and 90-day death. RESULTS: Of 415 patients, 217 (52.3%) were females, and the median age was 57.0 years (IQR: 48.0-67.0). ICH was present in 20.5% (85/415) of patients with aSAH. There was a significant difference in the 90-day poor outcomes (43.5% (37/85) and 29.1% (96/330); p=0.011) and 90-day mortality (36.5% (31/85) and 20.0% (66/330); p=0.001) between patients who had ICH and patients who did not have ICH. The multivariable regression analysis showed that systolic blood pressure (SBP) ≥140 mm Hg (adjusted odds ratio (AOR): 2.674; 95% CI: 1.372 to 5.214; p=0.004), World Federation of Neurosurgical Societies (WFNS) grades II (AOR: 3.683; 95% CI: 1.250 to 10.858; p=0.018) to V (AOR: 6.912; 95% CI: 2.553 to 18.709; p<0.001) and a ruptured middle cerebral artery (MCA) aneurysm (AOR: 3.717; 95% CI: 1.848 to 7.477; p<0.001) were independently associated with ICH on admission. CONCLUSIONS: In this study, ICH was present in a substantial proportion of patients with aSAH and contributed significantly to a high rate of poor outcomes and death. Higher SBP, worse WFNS grades and ruptured MCA aneurysms were independently associated with ICH on admission.
- MeSH
- cerebrální krvácení komplikace MeSH
- cévní mozková příhoda * komplikace MeSH
- hematom diagnostické zobrazování epidemiologie etiologie MeSH
- intrakraniální aneurysma * komplikace diagnostické zobrazování chirurgie MeSH
- lidé středního věku MeSH
- lidé MeSH
- prospektivní studie MeSH
- subarachnoidální krvácení * komplikace diagnostické zobrazování MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- Geografické názvy
- Vietnam MeSH
Recidiva intrakraniálního aneuryzmatu (IA) po chirurgickém ošetření (klip aneuryzmatu) je v klinické praxi relativně raritní. Pro řešení takové recidivy je nutné individuální rozhodnutí na základě precizní radiodiagnostiky a zkušeností daného týmu. Chirurgická léčba recidiv aneuryzmat je technicky náročnější v porovnání s primární operací vzhledem k postoperačním změnám. Cílem naší práce je shrnout současné znalosti o problematice a managementu recidiv IA po klipu a prezentovat naše zkušenosti s jejich chirurgickou léčbou.
Recurrence of intracranial aneurysms (IA) after surgical treatment (aneurysm clipping) is relatively rare in clinical practice. The treatment of such an aneurysm requires an individualized approach based on precise medical imaging and experience of the team. Surgical treatment of recurrent aneurysms is technically more demanding compared to primary surgery especially due to postoperative changes. The goal of this study is to review current knowledge and management of recurrent IA after clipping and present our experience with such cases.
- Klíčová slova
- klip,
- MeSH
- intrakraniální aneurysma * chirurgie dějiny diagnostické zobrazování klasifikace MeSH
- lidé MeSH
- počítačová rentgenová tomografie MeSH
- recidiva MeSH
- sekundární prevence MeSH
- terciární prevence MeSH
- zobrazování trojrozměrné MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
- přehledy MeSH
BACKGROUND: Clipping of ophthalmic artery (OA) aneurysms present one of the treatment strategies for long-term disease management. Existing surgical techniques primarily require extra/intradural removal of the anterior clinoid process, carrying a higher risk of infection, damage to surrounding structures or technical complications. METHODS: We present the technique of minimally invasive partial medial clinoidectomy with the unroofing of the optic canal for surgical clipping of OA aneurysms, and besides its pros and cons, we also discuss proper technical indications. CONCLUSION: The partial medial clinoidectomy improves manoeuvrability around the paraclinoid region, provides better protection for adjacent structures and renders excellent treatment outcome.
- MeSH
- arteria carotis interna chirurgie MeSH
- arteria ophthalmica * diagnostické zobrazování chirurgie MeSH
- intrakraniální aneurysma * diagnostické zobrazování chirurgie MeSH
- klínová kost chirurgie MeSH
- lidé MeSH
- neurochirurgické výkony metody MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
Over the past 25 years the endovascular treatment of cerebral aneurysms has gained preference in some countries over the traditional surgical procedures. The review part of the article clearly demonstrates that the clinical results of both modalities are similar and the difference is seen only in technical effectivity. Surgical techniques fail far less frequently than the endovascular ones. Incompletely occluded or growing aneurysms after the endovascular approach expose the patient to the risk of rebleeding with all possible consequences. Markedly repeated procedures are much more common for endovascularly treated aneurysms, again with all the risks.In the authors institution over the past 20 years, a total of 2032 aneurysms were treated. In 1263 endovascularly managed aneurysms the regrowth or inclomplete initial occlusion necessitated 159 repeated propcedures (12.6%). In surgical group the total of 27 aneurysms needed retreatment (3.5%). The difference is statistically significant. In nine patients in endovascular group the rebleeding was the reason for repeated procedures. No rebleeding was seen in the surgical group.This fact, also shown in the review part of the article, is important in patients counseling. Given the similar clinical results of both modalities the patient should be advised on the necessity of repeated follow-ups and of possible technical failure and eventual repeated procedure which is more likely if endovascular procedure is chosen.
- MeSH
- intrakraniální aneurysma diagnostické zobrazování patofyziologie patologie MeSH
- intrakraniální hypertenze diagnostické zobrazování patofyziologie patologie MeSH
- lidé MeSH
- nádory centrálního nervového systému * diagnostické zobrazování patofyziologie patologie MeSH
- oční symptomy * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
