Advancements have been made in the understanding of intracranial aneurysms and their management. Surgical strategies have evolved, with many principles revisited, many approaches reconsidered, and many frontiers successfully conquered. The global expansion of endovascular services has challenged the existence of aneurysm surgery, changing the complexity of aneurysm case mix and volume that are presently referred for surgical repair. As in the evolution of any type of procedures, innovations arise from the criticisms of currently available techniques. The development and technological maturation of endoscopic surgery in recent years have emboldened neurosurgeons, who are already familiar with the transsphenoidal techniques, to consider expanded endonasal approaches for the treatment of more complex cranial base pathologies. The surgical relevance of an endoscopic transnasal access for the clip reconstruction of intracranial aneurysms is a natural extension of the philosophy underlying this evolution. This thesis presents a compilation of scientific investigations (through literature reviews, clinical studies and preclinical experiments) that examined the history, evolution and contemporary innovations in the surgical management of intracranial aneurysms. The results of this study have the potential to expand the therapeutic options for intracranial aneuryms.
Table of ContentsChapter 1. The history and evolution of intracranial aneurysm surgery -- Chapter 2. The impact of changing intracranial aneurysm practice on the education of the cerebrovascular neurosurgeon -- Chapter 3. Incidence of subarachnoid hemorrhage : an Australian national hospital morbidity database analysis -- Chapter 4. Predictors of in-hospital shunt-dependent hydrocephalus following rupture of cerebral aneurysms : a nationwide analysis of 10,807 aneurysmal subarachnoid hemorrhage patients -- Chapter 5. The risk of seizures during in-hospital admission for surgical or endovascular treatment of unruptured intracranial aneurysms -- Chapter 6. Outcomes for a case series of unruptured ophthalmic segment artery aneurysm surgery -- Chapter 7. Outcomes for a case series of unruptured anterior communicating artery aneurysm surgery -- Chapter 8. The importance of anterior choroidal artery preservation during the surgical clip reconstruction of unruptured posterior communicating artery aneurysms -- Chapter 9. Smoking increases the risk of de novo intracranial aneurysm -- Chapter 10. The use of indocyanine green videoangiography during intracranial aneurysm surgery reduces the incidence of postoperative ischemic complications : a retrospective matched-pair comparison with historic control -- Chapter 11. A cadaveric study of the endoscopic endonasal transclival approach to the basilar artery. -- Chapter 12. A cadaveric study of the endoscopic endonasal transplanum approach to the paraclinoid internal carotid artery -- Chapter 13. A cadaveric study of the endoscopic endonasal transtubercular approach to the anterior communicating artery complex -- Chapter 14. Expanded endoscopic endonasal skull base surgery and the risk of postoperative seizure : a systematic review of published evidence -- Chapter 15. The risk of meningitis following expanded endoscopic endonasal skull base surgery : a systematic review -- Chapter 16. Thesis summary, discussion and conclusion.
NotesBibliography: pages 263-324
Awarding InstitutionMacquarie University
Degree TypeThesis PhD
DegreePhD, Macquarie University, Faculty of Human Sciences, Australian School of Advanced Medicine
Department, Centre or SchoolAustralian School of Advanced Medicine
Year of Award2014
Principal SupervisorMichael Kerin Morgan
Additional Supervisor 1Richard J. Harvey
RightsCopyright Leon Tat Lai 2014.
Copyright disclaimer: http://www.copyright.mq.edu.au
Extent1 online resource (331 pages) colour illustrations