endovascular embolization

血管内栓塞
  • 文章类型: Case Reports
    经鼻内窥镜视神经管减压术广泛用于治疗头和颅面部外伤后的外伤性视神经病变(TON)。术中出血是视神经管减压期间的灾难性手术并发症。
    我们介绍了两例TON患者,他们在内窥镜经鼻视神经管减压术中意外出现术中大出血。术中止血后,急诊脑血管造影显示颈内动脉假性动脉瘤的形成,立即用带有或不带有Onyx的线圈在球囊辅助下栓塞。其中一例还因术后脑脊液漏而复杂化,腰椎引流治疗失败,但经鼻内镜手术成功修复。
    术中破裂的ICA假性动脉瘤在TON患者中是一种罕见但灾难性的并发症。术中大量出血提示ICA假性动脉瘤破裂。术后应安排急诊血管造影和血管内治疗,以评估和修复脑血管损伤。在假性动脉瘤栓塞后,内镜经鼻手术修复抗腰椎引流的CSF渗漏可能是有效且安全的。
    UNASSIGNED: Endoscopic transnasal optic canal decompression is widely used in the treatment of traumatic optic neuropathy (TON) following head and craniofacial trauma. Intraoperative hemorrhage is a catastrophic surgical complication during optic canal decompression.
    UNASSIGNED: We present two cases of patients with TON who suffered unexpected intra-operative massive bleeding during endoscopic transnasal optic canal decompression. After intraoperative hemostasis was achieved, emergent cerebral angiograms demonstrated the formation of internal carotid pseudoaneurysms, which were immediately embolized with coils combined with or without Onyx with balloon assistance. One of these cases was also complicated by a postoperative cerebrospinal fluid leak, which failed to be treated with lumbar drainage but was successfully repaired with endoscopic transnasal surgery.
    UNASSIGNED: The intra-operative rupture of ICA pseudoaneurysm is a rare but catastrophic complication in TON patients. Intraoperative massive bleeding indicates rupture of ICA pseudoaneurysm. Postoperative emergency angiography and endovascular therapy should be arranged to evaluate and repair the cerebral vascular injury. Endoscopic trans-nasal surgery repairing CSF leaks resistant to lumbar drainage could be efficient and safe following pseudoaneurysm embolization.
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  • 文章类型: Case Reports
    脑动静脉畸形(cAVM)是脑血管的发育性病理损害,其中多个动脉将血液直接分流到静脉引流网络中。它们是病因不清楚的病变,如果不及时治疗,可能承受偏头痛等并发症的重大风险,癫痫发作,神经功能缺损,颅内出血.诊断基于几种成像方法,血管造影是主要方法。治疗方式包括显微外科手术,放射外科,意图闭塞的栓塞,和各种多学科方法。我们旨在介绍一名有症状的cAVM成年女性患者的病例,该患者接受了病变的部分血管内栓塞治疗,并评估其恢复情况和治疗方式的总体可靠性。一名22岁的女性患者出现在神经外科诊所,临床表现为光敏性癫痫发作,偏头痛,和持续一年的睡眠障碍史。指定的MRI和血管造影显示,位于左脑半球顶内沟内的大脑中动脉前顶支的肾小球cAVM(Spetzler-Martin2级)。畸形的静脉引流导致周围脑实质中的营养损失(偷窃现象),导致癫痫发作。患者成功接受了Onyx经动脉血管内栓塞,在术后血管造影中被证明是局部的,并拒绝进一步的栓塞手术。术后无并发症。患者在12个月的随访中没有报告癫痫发作或睡眠障碍。伴随着零星的微弱头痛。cAVM在未诊断时仍然是具有显著发病率和死亡率的病理学。当畸形具有适当的血管结构时,仅通过血管内栓塞就可以可靠地管理导致盗血现象和癫痫发作的症状性cAVM。location,尺寸,和低Spetzler-Martin得分.然而,在进一步的多阶段栓塞手术被拒绝和/或病变完全闭塞不可行的情况下,需要进一步调查部分栓塞的使用情况.该病例报告强调,部分血管内栓塞可以成功地用作由cAVM静脉引流的盗血现象引起的症状的治疗方式,如癫痫和偏头痛,在极少数情况下,当患者拒绝多阶段栓塞并且病变的闭塞仍然是次要的。
    Cerebral arteriovenous malformations (cAVMs) are developmental pathologic lesions of the blood vessels of the brain in which multiple arteries shunt blood directly into the venous drainage network. They are lesions with an unclear etiology and, if left untreated, can bear significant risks of complications such as migraines, seizures, neurological deficits, and intracranial hemorrhages. The diagnosis is based on several imaging methods, with angiography being the primary method. Treatment modalities include microsurgery, radiosurgery, embolization with the intent of obliteration, and various multidisciplinary approaches. We aim to introduce the case of an adult female patient with symptomatic cAVM who underwent partial endovascular embolization of the lesion and evaluate her recovery and the overall reliability of her treatment modality. A 22-year-old female patient has presented to the Neurosurgery Clinic with clinical manifestations with photosensitive seizures, migraines, and a history of sleep disturbances persisting for a period of one year. An appointed MRI and angiography revealed the presence of a glomerular cAVM of the anterior parietal branch of the middle cerebral artery located within the intraparietal sulcus of the left cerebral hemisphere (Spetzler-Martin grade 2). The venous drainage of the malformation led to a loss of nutrients in the surrounding brain parenchyma (a steal phenomenon), causing the seizures. The patient successfully underwent transarterial endovascular embolization with Onyx, which proved to be partial on a postoperative angiography, and refused further embolization procedures. There were no postoperative complications to be mentioned. The patient reported no seizures or sleep disturbances at the 12-month follow-up, with sporadic weak headaches remaining. cAVMs remain a pathology with significant morbidity and mortality when undiagnosed. Symptomatic cAVMs leading to a steal phenomenon and seizures can be reliably managed via endovascular embolization alone when the malformation has an appropriate angioarchitecture, location, size, and a low Spetzler-Martin score. However, further inquiry is required into the use of partial embolization in cases where further multiple-stage embolization procedures are declined and/or complete occlusion of the lesion is unfeasible. This case report emphasizes that partial endovascular embolization can be successfully utilized as a treatment modality for the symptoms caused by a steal phenomenon of the venous drainage of a cAVM, such as seizure disorders and migraines, in the rare instance when multiple-stage embolization is declined by the patient and occlusion of the lesion remains subtotal.
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  • 文章类型: Case Reports
    支气管肺隔离症在成人中很少出现,并且在动脉瘤异常供血动脉中的频率较低。支气管肺隔离症的治疗通常包括血管结扎的肺切除术;然而,动脉瘤性疾病增加了术中和术后出血的风险,通常需要更广泛的手术来控制血管.一名39岁的女性患者,有腹部手术史,突然出现上腹部和背部疼痛。计算机断层扫描显示动脉瘤异常肺动脉起源于腹主动脉,邻近腹腔动脉,在右下肺叶提供叶内肺隔离症。她也有胆石症的证据,混淆症状相关性。她接受了微创混合方法的治疗,其中涉及延迟胸腔镜肺切除术前的血管内动脉栓塞。这是一种安全有效的方法,可降低术中出血的风险,同时安全地实现动脉瘤疾病附近的血管控制。
    Bronchopulmonary sequestration presents rarely in adults and less frequently with an aneurysmal aberrant feeding artery. Treatment of bronchopulmonary sequestration generally involves lung resection with vascular ligation; however, aneurysmal disease increases the risk of intra- and postoperative hemorrhage and often necessitates more extensive surgery for vascular control. A 39-year-old female patient with a history of prior abdominal surgery presented with sudden onset epigastric and back pain. Computed tomography demonstrated an aneurysmal aberrant pulmonary artery originating from the abdominal aorta, adjacent to the celiac artery, supplying an intralobar pulmonary sequestration in the inferior right lower lung lobe. She also had evidence of cholelithiasis, with confusing symptom correlation. She was treated with a minimally invasive hybrid approach, which involved endovascular arterial embolization prior to delayed thoracoscopic lung resection. This is a safe and effective approach that reduces the risk of intraoperative bleeding while safely achieving vascular control proximal to the aneurysmal disease.
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  • 文章类型: Case Reports
    支气管动脉-肺动脉瘘是最常见的由感染引起的罕见血管畸形。我们的病例是一名57岁的男性,他因空洞性肺结核(TB)而出现有症状的支气管动脉-肺动脉瘘。诊断是通过胸部的多相CT血管造影(包括肺动脉和全身动脉期)进行的。患者被带到介入放射科进行进一步的调查和管理。成功发现左上叶支气管动脉-肺动脉瘘,并进行血管内栓塞治疗。支气管动脉-肺动脉瘘可能构成诊断和治疗挑战。我们的病例证明血管内栓塞是治疗有症状的支气管动脉-肺动脉瘘的有效方法。
    Bronchial artery-pulmonary artery fistulae are rare vascular malformations most commonly caused by infection. Our case presents a 57-year-old male who presented to the Emergency Department with a symptomatic bronchial artery-pulmonary artery fistula due to cavitating pulmonary tuberculosis (TB). The diagnosis was made with multiphase CT angiography of the thorax (including pulmonary and systemic arterial phases). The patient was brought to interventional radiology for further investigation and management. The left upper lobe bronchial artery-pulmonary artery fistula was successfully identified and treated with endovascular embolization. Bronchial artery-pulmonary artery fistulae can pose a diagnostic and therapeutic challenge. Our case demonstrates endovascular embolization as an effective method of treating symptomatic bronchial artery-pulmonary artery fistulae.
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  • 文章类型: Case Reports
    Galen动脉瘤畸形(VGAM)静脉是Markowski胚胎前脑正中静脉的罕见先天性动静脉瘘,导致其病理性扩张。如果不及时治疗,在新生儿期会导致多种严重的并发症,其中包括梗阻性脑积水。我们提供了一例6岁男性患者的病例报告,该患者患有严重的癫痫持续状态,并有VGAM和阻塞性脑积水的临床病史。通过MRI和MR血管造影诊断。脑积水在六个月大时通过脑室造口术治疗,而VGAM在患者4岁时接受了部分经动脉血管内栓塞。程序成功了,并且没有观察到明显的术后并发症。癫痫发作在稍后的时间点开始,并成功地用丙戊酸盐治疗。然而,由于患者父母降低了药物剂量,他们恢复了。患者给予适当剂量的新丙戊酸方案,他的父母报告没有进一步的癫痫发作。该病例报告强调对VGAM使用适当的产前和新生儿诊断方法,并探讨了与可能的特发性共病相关的病理及其并发症的多程序治疗方法的性质。即癫痫。
    The vein of Galen aneurysmal malformation (VGAM) is a rare congenital arteriovenous fistula of the embryonic median prosencephalic vein of Markowski, resulting in its pathological dilation. If left untreated, it can lead to multiple severe complications in the neonatal period, among which obstructive hydrocephalus. We present a case report of a six-year-old male patient with severe status epilepticus and a clinical history of VGAM and obstructive hydrocephalus, diagnosed via an MRI and an MR-angiography. The hydrocephalus was treated via a ventriculostomy at the age of six months, while the VGAM underwent a partial transarterial endovascular embolization when the patient was four years old. The procedures were successful, and there were no significant post-operative complications observed. The epileptic seizures began at a later point and were successfully medicated with valproate. However, they resumed due to a lowering of the medication dosage by the patient\'s parents. The patient was given a new valproic acid regimen with an appropriate dosage, and his parents reported no further seizures. This case report emphasizes the use of appropriate prenatal and neonatal diagnostic methods for VGAM and explores the nature of the multi-procedural therapy approach towards the pathology and its complications in relation to a possibly idiopathic co-pathology, namely epilepsy.
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  • 文章类型: Case Reports
    血管畸形,其中包括淋巴或血管系统疾病,可以以各种方式出现在射线照片上,在放射科,和组织学。具有直接动静脉连接的高流量病变被称为动静脉畸形(AVM)。这些病变会导致软组织丢失和畸形,因为它们很难早期诊断。该病例报告描述了一名75岁的女性,她的上唇出现严重的蓝紫色肿胀。在进行了彻底的调查之后,患者的病情很快被确定为AVM。经USG多普勒和组织学检查确认后,该患者接受了成功的手术切除,发现了提示AVM的狭窄血管病变。讨论探讨了导致AVM形成的血液动力学和胚胎学因素,指出血流动力学特性和临床症状的差异。治疗选择受根据临床标准和血管造影血流特征对外周AVM进行分类的影响。
    Vascular malformations, which include disorders of the lymphatic or vascular systems, can appear in a variety of ways on radiographs, in the radiological department, and histologically. High-flow lesions with direct arteriovenous connections are known as arteriovenous malformations (AVMs). These lesions can cause soft tissue loss and deformity since they are difficult to diagnose early. This case report describes a 75-year-old female who presented with a severe bluish-purple swelling on her top lip. After conducting a thorough investigation, the patient\'s condition was quickly identified as AVM. After confirmation by USG Doppler and histological examination, the patient underwent a successful surgical resection that revealed a confined vascular lesion suggestive of AVM. The discussion explores the hemodynamic and embryologic factors that contribute to the formation of AVM, pointing out differences in hemodynamic properties and clinical symptoms. Treatment choices are influenced by the categorization of peripheral AVMs according to clinical standards and angiographic flow characteristics.
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  • 文章类型: Case Reports
    颈静脉血管球瘤(GJT)是罕见的颅内肿瘤。通常,这些病变伴有颅神经麻痹,头痛,和脑积水.很少,GJT表现为自发性蛛网膜下腔出血。然而,在一般脑肿瘤或特别是颈静脉血管球瘤继发脑积水的患者中,从未有关于脑室-腹腔分流术后弥漫性蛛网膜下腔出血的报道。
    作者介绍了在一名61岁女性患者中插入脑室-腹膜分流术(VPS)后,弥漫性蛛网膜下腔出血的一种极为罕见的并发症,该患者被诊断具有临床和放射学特征继发于高血管巨大颈静脉球瘤的急性梗阻性脑积水。
    脑室-腹腔分流术后蛛网膜下腔出血是一种极其罕见的并发症。应强烈考虑术前CT血管造影,以寻找极度血管化的肿块性病变中相关的血管畸形。鉴于GJT的所有治疗选择并不普遍,特别是在低收入和中等收入环境中,GJT的不良结果是重要的,它促进了全球神经外科议程。
    UNASSIGNED: Glomus jugulare tumors (GJTs) are rare intra-cranial tumors. Commonly, these lesions present with cranial nerve palsies, headaches, and hydrocephalus. Rarely, GJTs present with spontaneous subarachnoid hemorrhage. However, there has never been a report of diffuse subarachnoid hemorrhage following ventriculoperitoneal shunt insertion in a patient who developed hydrocephalus secondary to any brain tumor in general or glomus jugulare tumors in particular.
    UNASSIGNED: The authors presented an extremely rare complication of diffuse subarachnoid hemorrhage following the insertion of a ventriculoperitoneal shunt (VPS) in a 61-year-old female patient who was diagnosed to have both clinical and radiologic features of acute obstructive hydrocephalus secondary to a highly vascular huge glomus jugulare tumor.
    UNASSIGNED: Subarachnoid hemorrhage following ventriculoperitoneal shunt insertion for hydrocephalus caused by a mass lesion is an extremely rare complication. Preoperative CT angiography should be strongly considered to look for the associated vascular malformations in extremely vascularized mass lesions. Given the not ubiquitous availability of all therapeutic options for GJTs, especially in low and middle income settings contributes for the poor outcome of GJTs and it fosters a global neurosurgery agenda.
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  • 文章类型: Journal Article
    背景:胰十二指肠动脉瘤(PDAA)是一种罕见的,而是致命的疾病.然而,动脉瘤大小与破裂风险之间的关联尚不清楚.有许多治疗策略的选择应该很好地讨论,因为治疗选择通常是复杂且高侵入性的。然而,目前尚不清楚是否所有接受搭桥手术的患者都需要额外的血管内治疗.这里,我们介绍了一例上PDAA(SPDAA)动脉瘤切除术和主动脉脾旁路后,三联PDAA伴有腹腔轴闭塞和下PDAA(IPDAA)自发完全消退的病例。
    方法:一名68岁女性因腹腔轴闭塞而出现1例SPDAA和2例IPDAA。IPDAA的动脉瘤切除术由于其解剖位置和形状而很困难。因此,我们计划了两阶段混合疗法.患者接受了主动脉脾旁路术和SPDAA切除术。在计划的血管内栓塞之前,进行随访CT以评估IPDAA。IPDAA的自发消退和标准化的PDA拱廊降低了PDA拱廊中的血流量。病人在没有移植物阻塞的情况下做得很好,IPDAA在手术后7年完全消退。
    结论:PDA拱廊的高流入标准化可导致PDAA的消退。有可能,当PDA的扩张改善时,可能并非在所有病例中都需要额外的血管内治疗.然而,必须积累更多病例,以建立预测短期和长期PDAA破裂风险的标准.
    BACKGROUND: Pancreaticoduodenal artery aneurysm (PDAA) is a rare, but fatal disease. However, the association between aneurysm size and the risk of rupture remains unclear. There are many options for therapeutic strategies that should be discussed well because the treatment options are often complicated and highly invasive. However, it remains unclear whether additional endovascular therapy is essential for all patients undergoing bypass surgery. Here, we present a case of triple PDAAs with celiac axis occlusion and spontaneous complete regression of inferior PDAAs (IPDAA) after aneurysmectomy of superior PDAA (SPDAA) and aorto-splenic bypass.
    METHODS: A 68-year-old woman presented with one SPDAA and two IPDAAs caused by celiac axis occlusion. Aneurysmectomy for IPDAAs was difficult because of their anatomical location and shape. Therefore, we planned a two-stage hybrid therapy. The patient underwent aorto-splenic bypass and resection of the SPDAA. Follow-up CT was performed to evaluate the IPDAAs before planned endovascular embolization. Spontaneous regression of the IPDAAs and normalized PDA arcade decreased the blood flow in the PDA arcade. The patient is doing well without graft occlusion, and the IPDAAs have completely regressed 7 years after surgery.
    CONCLUSIONS: Normalization of hyperinflow to the PDA arcade can lead to the regression of PDAA. Potentially, additional endovascular therapy may not be required in all cases when dilation of the PDA improves. However, more cases must be accumulated to establish criteria for predicting the risks of short- and long-term PDAA ruptures.
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  • 文章类型: Case Reports
    本手稿强调了在创伤后胃十二指肠动脉假性动脉瘤病例中及时诊断和干预的重要意义。这样的事件,特别是在儿科人群中,是腹部创伤后罕见但可能危及生命的并发症,需要提高临床意识。尽管它们很少,延迟识别和管理的破坏性后果强调了先进的成像模式和个性化治疗策略的必要性.
    一名17岁男性足球摔倒后出现严重的上腹痛。尽管最初的稳定性,持续的症状促使进一步调查.传统的筛选方法没有定论,导致对比增强计算机断层扫描(CT)扫描显示肠系膜上动脉(SMA)假性动脉瘤的空肠分支。随后的透视引导的血管造影和使用胶水的成功栓塞说明了在这种情况下及时干预的重要性。
    该病例强调了早期识别和适当干预SMA假性动脉瘤创伤后空肠分支的重要性。通过血管内栓塞取得的成功结果强调了在类似临床情况下警惕监测和定制管理策略的必要性。
    UNASSIGNED: This manuscript underscores the critical significance of prompt diagnosis and intervention in cases of post-traumatic gastroduodenal artery pseudoaneurysms. Such occurrences, particularly in the paediatric population, are rare but potentially life-threatening complications following abdominal trauma, necessitating heightened clinical awareness. Despite their rarity, the devastating consequences of delayed recognition and management emphasize the necessity for advanced imaging modalities and individualized treatment strategies.
    UNASSIGNED: A 17-year-old male presented with severe epigastric pain following a football fall. Despite initial stability, persistent symptoms prompted further investigation. Conventional screening methods proved inconclusive, leading to a contrast-enhanced computed tomography (CT) scan that revealed a jejunal branch of superior mesenteric artery (SMA) pseudoaneurysm. The subsequent fluoroscopy-guided angiography and successful embolization using glue exemplify the importance of timely intervention in such cases.
    UNASSIGNED: This case highlights the importance of early recognition and appropriate intervention in post-traumatic jejunal branch of SMA pseudoaneurysms. The successful outcome achieved through endovascular embolization underscores the necessity for vigilant monitoring and tailored management strategies in similar clinical scenarios.
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  • 文章类型: Journal Article
    探讨Tubridge引流器展开治疗颅内动脉瘤的安全性和效果。回顾性研究了85例接受Tubridge分流术治疗的颅内动脉瘤患者。包括基线数据在内的临床数据,治疗前后的动脉瘤参数,并评估随访结果.在85名患者中,男性35例(41.2%),女性50例(58.8%),年龄在17-77岁(平均56.7±11.1)岁,动脉瘤110例。五名(5.9%)患者最初因动脉瘤破裂而出现蛛网膜下腔出血。动脉瘤大小为2-30(平均8.6)mm,动脉瘤颈部为2-10.6(平均5.7±2.3)mm。部署了93个Tubridge支架。25例(29.4%)患者经历了辅助松动。支架展开后,进入动脉瘤的血流量明显减少。3例(3.5%)患者发生围手术期并发症,包括一名患者在栓塞期间的支架内血栓形成(1.2%),1例患者右侧结膜水肿(1.2%),1例急性多发性脑梗死(1.2%)。在3-36(平均15.3±5.6)个月后对67例(78.8%)患者进行了血管造影随访。在11名(16.4%或11/67)患者中,2例(3.0%)患者的O\'Kelly-Marotta(OKM)B级和9例(13.4%)C级患者的血流仍然进入动脉瘤,而在其他56个(83.6%或56/67)动脉瘤中实现了完全闭塞(OKMD级)。5例(7.5%)患者存在支架内狭窄,其中3例(4.5%)患者约为25%,2例(3.0%)患者约为50%。总之,Tubridge分流器可以安全有效地应用于颅内小动脉瘤和大动脉瘤的治疗,围手术期并发症发生率低,高度遮挡,尽管大型动脉瘤可能需要更长的手术时间和辅助卷绕,但随访时支架内狭窄率低。
    To investigate the safety and effect of Tubridge flow diverter deployment for the treatment of intracranial aneurysms, 85 patients with intracranial aneurysms treated with the Tubridge flow diverter were retrospectively enrolled. The clinical data including the baseline data, aneurysm parameters before and after treatment, and follow-up outcomes were assessed. Among 85 patients, there were 35 (41.2%) males and 50 females (58.8%) aged 17-77 (mean 56.7 ± 11.1) years with 110 aneurysms. Five (5.9%) patients initially presented with subarachnoid hemorrhage from aneurysm rupture. The aneurysm size was 2-30 (mean 8.6) mm, and the aneurysm neck was 2-10.6 (mean 5.7 ± 2.3) mm. Ninety-three Tubridge stents were deployed. Twenty-five (29.4%) patients experienced adjunctive loose coiling. Blood flow was significantly reduced from entering the aneurysm after stent deployment. Periprocedural complications occurred in three (3.5%) patients, including in-stent thrombosis during embolization in one patient (1.2%), conjunctiva edema on the right in one patient (1.2%), and acute multiple cerebral infarctions in one patient (1.2%). Angiographic follow-up was conducted in 67 (78.8%) patients 3-36 (mean 15.3 ± 5.6) months later. In 11 (16.4% or 11/67) patients, blood flow still entered the aneurysm with the O\'Kelly-Marotta (OKM) grade B in two (3.0%) patients and grade C in nine (13.4%), whereas complete occlusion (OKM grade D) was achieved in the other 56 (83.6% or 56/67) aneurysms. In-stent stenosis was present in five (7.5%) patients with approximately 25% stenosis in three (4.5%) patients and 50% in two (3.0%). In conclusion, the Tubridge flow diverter can be safely and efficiently applied in the treatment of small and large intracranial aneurysms, with a low periprocedural complication rate, a high occlusion degree, and a low in-stent stenosis rate at follow-up even though large aneurysms may necessitate a longer surgical time and adjunctive coiling.
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