Hemodynamics in Ruptured Intracranial Aneurysms

Incidental detection of unruptured intracranial aneurysms (UIA) has increased in the recent years. There is a need in the clinical community to identify those that are prone to rupture and would require preventive treatment. Hemodynamics in cerebral blood vessels plays a key role in the lifetime cycle of intracranial aneurysms (IA). Understanding their initiation, growth, and rupture or stabilization may identify those hemodynamic features that lead to aneurysm instability and rupture. Modeling hemodynamics using computational fluid dynamics (CFD) could aid in understanding the processes in the development of IA. The neurosurgical approach during operation of IA allows direct visualization of the aneurysm sac and its sampling in many cases. Detailed analysis of the quality of the aneurysm wall under the microscope, together with histological assessment of the aneurysm wall and CFD modeling, can help in building complex knowledge on the relationship between the biology of the wall and hemodynamics. Detailed CFD analysis of the rupture point can further strengthen the association between hemodynamics and rupture. In this chapter we summarize current knowledge on CFD and intracranial aneurysms

Experimental bridging of spinal cord injury with hydrogels

Hydrogels are biomaterials used in the treatment of experimental spinal cord injury (SCI). In a model of acute SCI, we implanted hydrogels based on 2-hydroxyethylmethacrylate (HEMA) and hydroxypropylmethacryla-mide (HPMA). One month after implantation the hydrogels bridged the cavity, adhered well to the spinal cord and created permissive environment, infiltrated with blood vessels, axons and Schwann cells. Physical modifications (e.g. surface charge) of hydrogels may improve bridging of acute SCI. We implanted hydrogels based on HEMA with a surface charge in spinal cord hemisection and compared with a hydrogel without charge. Hydrogels with surface charge improved connective tissue adhesion and growth of axons compared to a hydrogel without charge. Biodegradable hydrogels may bridge a lesion followed by complete re-sorption. In a model of acute SCI we implanted hydrogels based on the copolymer of HPMA and etoxyethylmethacrylate (EOMA) degraded from the periphery, which was substituted with new tissue after 1 month, to the center, comprising amorphous residuals of the hydrogel. Delayed hydrogel implantation may improve bridging of spinal cord le-sion. We implanted hydrogels based on HEMA acutely or in a delayed fashion (after 7 days) in spinal cord transection. Delayed implantation re-duced the volume of..

Experimental bridging of spinal cord injury with hydrogels

Hydrogels are biomaterials used in the treatment of experimental spinal cord injury (SCI). In a model of acute SCI, we implanted hydrogels based on 2-hydroxyethylmethacrylate (HEMA) and hydroxypropylmethacryla-mide (HPMA). One month after implantation the hydrogels bridged the cavity, adhered well to the spinal cord and created permissive environment, infiltrated with blood vessels, axons and Schwann cells. Physical modifications (e.g. surface charge) of hydrogels may improve bridging of acute SCI. We implanted hydrogels based on HEMA with a surface charge in spinal cord hemisection and compared with a hydrogel without charge. Hydrogels with surface charge improved connective tissue adhesion and growth of axons compared to a hydrogel without charge. Biodegradable hydrogels may bridge a lesion followed by complete re-sorption. In a model of acute SCI we implanted hydrogels based on the copolymer of HPMA and etoxyethylmethacrylate (EOMA) degraded from the periphery, which was substituted with new tissue after 1 month, to the center, comprising amorphous residuals of the hydrogel. Delayed hydrogel implantation may improve bridging of spinal cord le-sion. We implanted hydrogels based on HEMA acutely or in a delayed fashion (after 7 days) in spinal cord transection. Delayed implantation re-duced the volume of..

Spontaneous Subarachnoid Hemorrhage in a Patient with a Co-Existent Posterior Communicating Artery Aneurysm and Cervical Spine Aneurysm Associated with Ventral Arterio-Venous Fistula

Severe spontaneous subarachnoid hemorrhage (SAH) is predominantly caused by aneurysm rupture, with non-aneurysmal vascular lesions representing only a minority of possible causes. We present the case of a 58-year old lady with a coincidental posterior communicating artery (PCom) aneurysm and a high cervical spine arterio-venous fistula associated with a small ruptured aneurysm. After the emergency clipping of the PCom aneurysm, additional diagnostic procedures—repeated digital subtraction angiography and spinal magnetic resonance imaging, revealed the actual cause of the SAH, a type-A ventral intradural fistula at cervical level C2/3. The fistula was treated micro surgically via a ventral approach using C3 somatectomy and C2-4 stabilization after the initial failure of endovascular therapy. Furthermore, the patient was treated for complications associated with severe SAH, including acute hydrocephalus and meningitis. In cases where the SAH pattern and perioperative findings do not suggest an intracranial aneurysm as the source of SAH, further diagnostic investigation is warranted to discover the real cause. Patients with severe non-aneurysmal SAH require a similar algorithm in diagnosing the cause of the hemorrhage as well as complex conditions such as ruptured aneurysms

The Iatrogenic Development of an Anterior Cerebral Artery Pseudoaneurysm during Lamina Terminalis Fenestration–Genesis, Diagnosis and Therapy: Lessons Learned

Intracranial pseudoaneurysms (PSA) are scarcely presented in the literature. We describe the case of an intracranial PSA on the right anterior cerebral artery, which developed during the complicated surgical treatment of a ruptured right middle cerebral aneurysm. The pseudoaneurysm grew over time and was co-incidentally diagnosed 3 months after the original surgery. The PSA was successfully treated by coiling. In cases of vascular injuries during complicated brain surgery, the timely and careful radiological diagnosis of such a lesion is necessary to allow its fast and proper treatment and thus prevent the patient from potential risks

Bypass Procedure Performed in the Field of a Decompressive Craniectomy in the Case of an MCA Dissecting Aneurysm: Case Report and Review of the Literature

Treatment of complex aneurysms often requires additional surgical tools including the use of the extra-intracranial (EC-IC) bypass. The following report depicts the utilization of the EC-IC bypass in treating a dissecting aneurysm several hours after a salvage emergent evacuation of an acute subdural hematoma via decompressive craniectomy (DC). Preserving the superficial temporal artery during the DC provided a donor artery for the bypass surgery

Can Aspartate Aminotransferase in the Cerebrospinal Fluid Be a Reliable Predictive Parameter?

Brain ischemia after central nervous system (CNS) bleeding significantly influences the final outcome of patients. Catalytic activities of aspartate aminotransferase (AST) in the cerebrospinal fluid (CSF) to detect brain ischemia were determined in this study. The principal aim of our study was to compare the dynamics of AST in 1956 CSF samples collected from 215 patients within a 3-week period after CNS hemorrhage. We compared concentrations of the AST catalytic activities in the CSF of two patient groups: survivors (Glasgow Outcome Score (GOS) 5–3) and patients in a vegetative state or dead (GOS 2–1). All statistical evaluations were performed using mixed models and the F-test adjusted by Kenward and Roger and the Bonferroni adjustment for multiple tests. The significantly higher catalytic activities of AST in the CSF from patients with the GOS of 2–1 when compared to those who survived (GOS 5–3, p = 0.001) were found immediately after CNS haemorrhage. In the further course of time, the difference even increased (p < 0.001). This study confirmed the key association between early signs of brain damage evidenced as an elevated AST activity and the prediction of the final patient’s clinical outcome. The study showed that the level of AST in the CSF could be the relevant diagnostic biomarker of the presence and intensity of brain tissue damage