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David A. Steinman and Vitor M. Pereira

Computational modeling of cerebral aneurysms, derived from clinical 3D angiography, has become widespread over the past 15 years. While such “image-based” or “patient-specific” models have shown promise for the assessment of rupture risk, much debate remains about their reliability in light of necessary modeling assumptions and incomplete or uncertain model input parameters derived from the clinic. The aims of this review were to walk through the various steps of this so-called patient-specific modeling pipeline and to highlight evidence supporting those steps that we can or cannot rely on. The relative importance of the different sources of error and variability on hemodynamic predictions is summarized, with recommendations to standardize for those that can be avoided and to pay closer attention those to that cannot.

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Stephen P. Lownie, Alan H. Menkis, Rosemary A. Craen, Bernard Mezon, James MacDonald and David A. Steinman

✓ Giant partially thrombosed intracranial aneurysms are a challenge to treat surgically, and they are also unsuitable for coil embolization. The current options for treatment include extracranial—intracranial bypass followed by parent artery occlusion or direct surgical occlusion in which deep hypothermic circulatory arrest is used.

The authors report the use of another approach in the treatment of a giant anterior circulation aneurysm: selective brain cooling accomplished by extracorporeal perfusion. This facilitated direct surgery on a 4.2-cm, partially thrombosed aneurysm of the middle cerebral artery (MCA). A brain temperature of 22°C was achieved after 20 minutes of perfusion with blood cooled using an extracorporeal technique of femoral—common carotid artery perfusion. This was followed by a 20-minute period of surgical trapping of the MCA, then evacuation and clip occlusion of the aneurysm. During the period of selective brain cooling the patient's core body temperature was maintained above 35°C.

This technique of selective brain cooling may be a useful alternative to currently available surgical and endovascular methods of treatment for giant aneurysms.