Diss. (sammanfattning) Linköping : Linköpings universitet, 2005. / Härtill 4 uppsatser.

Submitted by Irene Nascimento (irene.kessia@ufpe.br) on 2016-09-15T18:22:21Z No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) DISSERTAÇÃO.pdf: 6914963 bytes, checksum: b59dc4afc22cc256f6af81abdcd285cc (MD5) / Made available in DSpace on 2016-09-15T18:22:21Z (GMT). No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) DISSERTAÇÃO.pdf: 6914963 bytes, checksum: b59dc4afc22cc256f6af81abdcd285cc (MD5) Previous issue date: 2016-02-24 / Introdução: Os aneurismas intracranianos trazem consequências importantes para o paciente acometido. A hemorragia subaracnóidea (HSA) possui uma forte correlação com aneurismas saculares e devido a sua gravidade e alta ocorrência de sequelas, o seu estudo merece importância. Uma alteração sensorial que pode esta relacionada à HSA é o déficit olfatório. Dentre os métodos de avaliação do olfato descritos, os quantitativos são ferramentas que podem ser utilizados a fim de garantir resultados mais fidedignos considerando o quadro clínico desses pacientes. Objetivos: Caracterizar o olfato de pacientes pré e pós tratamento cirúrgico para hemorragia subaracnóidea aneurismática. Método: Esta dissertação está composta por dois artigos. O primeiro constou de um artigo de revisão com título Métodos de avaliação do olfato em pacientes vítimas de hemorragia subaracnóidea: revisão sistemática. O segundo é um artigo original intitulado Avaliação do olfato na hemorragia subaracnóidea aneurismática antes e após o tratamento cirúrgico, neste foram estudados 15 adultos com hemorragia subaracnóidea aneurismática, atendidos no Hospital da restauração de Pernambuco, avaliados em três momentos distintos: Após a hemorragia, com uma semana de pós-operatório e com três meses de pós-operatório. A pesquisa foi iniciada após aprovação pelo Comitê de Ética em Pesquisa do hospital. Após a aplicação do Termo de Consentimento Livre e Esclarecido foi realizada a revisão do prontuário, entrevista com o participante e avaliação do olfato por meio de um teste de soluções aquosas, adaptado de outros estudos, construído pela farmácia escola da UFPE. Resultados: O primeiro artigo mostrou heterogeneidade nos métodos utilizados para avaliação do olfato na hemorragia subaracnóidea, como também no momento selecionado para aplicação das avaliações, com evidencias de déficit olfatório nesta população. Nos resultados provenientes do estudo original desta dissertação foi observado maior número de classificações olfatórias normais, além disso, não foi encontrada correlação significativa entre a pontuação olfatória com as seguintes variáveis (Idade, Intervalo em dias entre a hemorragia subaracnóidea e a avaliação olfatória, escolaridade e topografia do aneurisma). Não houve mudança significativa na pontuação olfatória após a cirurgia. Houve diferença estatística significativa na comparação entre a pontuação olfatória com uma semana de pós-operatório e com três meses de pós-operatório. Considerações finais: Os resultados deste estudo mostram a ocorrência de alteração olfatória após a hemorragia subaracnóidea aneurismática, assim como piora na classificação do olfato após a cirurgia. Foi observada melhora no olfato após três meses de pós-operatório, com significância estatística. Sugere-se a continuação de estudos com o tema, como também que façam investigação da percepção subjetiva do olfato visando o esclarecimento dos prejuízos que a alteração olfatória causa na vida dessa população. / Introduction: Intracranial aneurysms bring important consequences for the affected patient. The subarachnoid hemorrhage (HSA) has a strong correlation with saccular aneurysms and due to its gravity and high occurrence of sequels, its study deserves importance. A sensory change can this ASH-related is the olfactory deficit. Among the methods of valuation of smell described, are quantitative tools that can be used to ensure more reliable results considering the clinical picture of these patients.Objectives: Characterize the smell of patients before and after surgical treatment for aneurysmal subarachnoid hemorrhage. Method: This dissertation is composed of two articles. The first consisted of a review article with title Methods of evaluation of smell in victims of subarachnoid hemorrhage patients: a systematic review. The second is an original article entitled Olfactory evaluation in aneurysmal subarachnoid hemorrhage before and after surgery, this 15 were studied adults with aneurysmal subarachnoid hemorrhage, met at the Hospital da Restauração de Pernambuco, evaluated in three different moments: After the bleeding, a week after surgery and three months postoperatively. The search was started after approval by the Research Ethics Committee of the Hospital. After the application of informed consent was held to review the medical records, interview with the participant and evaluation of smell through a test of aqueous solutions, adapted from other studies, built by the Pharmacy School, Federal University of Pernambuco. Results: The first article showed heterogeneity of the methods used to evaluate the smell in aneurysmal subarachnoid hemorrhage and in the methods selected for application of evaluations, with evidence of olfactory deficits in this population. The results from the original study of this dissertation it was observed as many olfactory normal ratings, moreover, was not found significant correlation between olfactory score with the following variables (age, interval in days between the subarachnoid hemorrhage and the olfactory evaluation, education and topography of the aneurysm). There was no significant change in scoring olfactory after surgery. There was a statistically significant difference in the comparison between the olfactory score with a week after surgery and three months postoperatively. Final considerations: The results of this study show the occurrence of olfactory disfunction after aneurysmal subarachnoid hemorrhage, as well as worsens the classification of smell after surgery. Improvement was observed in the nose after three months postoperatively, with statistical significance. It is suggested a continuation of studies with the theme, but also to make the subjective perception of smell to identify the problems that the disfunction olfactory cause in this population´s life.

Orientador: Donizeti Cesar Honorato / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-21T22:21:39Z (GMT). No. of bitstreams: 1 Kaleff_PauloRoland_D.pdf: 1126011 bytes, checksum: 23cb0c05a54790e4896ebd16d8754941 (MD5) Previous issue date: 2012 / Resumo: A angiotomografia cerebral 3D (ATC) passou a ser uma alternativa à angiografia por subtração digital (ASD) para a detecção dos aneurismas intracranianos. As recomendações atuais para a hemorragia subaracnóidea aguda (HSA) secundária à ruptura de aneurismas intracranianos incluem o tratamento definitivo precoce. O objetivo primário deste estudo foi o de avaliar a contribuição da ATC para a diminuição do tempo entre o diagnóstico da HSA e o diagnóstico do aneurisma, bem como para a diminuição do tempo entre a admissão do paciente e a exclusão do aneurisma, quando comparada com a ASD. Como objetivo secundário buscou-se comparar a sensibilidade de ambos os métodos diagnósticos, comparar os resultados clínicos de dois grupos de pacientes diagnosticados pala ATC e/ou pela ASD e avaliar a contribuição da ATC na abordagem cirúrgica aos hematomas secundários à ruptura de aneurismas intracranianos. Uma análise retrospectiva foi conduzida cobrindo 100 pacientes admitidos com HSA e diagnosticados para aneurisma via ATC (n=60) ou via ASD (n=40). Os dados coletados foram divididos de acordo com o método diagnóstico utilizado inicialmente para a detecção do aneurisma. Os tempos transcorridos entre o diagnostico da HSA e o diagnóstico do aneurisma foi consistentemente inferior para os pacientes submetidos à ATC (p<0.000005). Em relação ao tempo transcorrido entre a admissão e o tratamento definitivo, 70% das ocorrências para pacientes submetidos à ATC ficaram abaixo de 72 horas enquanto 60% das ocorrências para pacientes submetidos à ASD excederam 72 horas (p<0.003). A sensibilidade da ATC para aneurismas rotos foi de 0, 967 e para todos os aneurismas de 0, 931. A maioria dos casos submetidos à ATC antes da drenagem do hematoma teve o aneurisma tratado no mesmo procedimento cirúrgico. A ATC contribuiu para a redução do tempo entre o diagnóstico da HSA e o diagnóstico do aneurisma, bem como para a redução do tempo entre a admissão e o tratamento definitivo do aneurisma. A sensibilidade dos métodos foi equivalente, especialmente para os aneurismas rotos, em exames tecnicamente satisfatórios. Nos casos de hematomas secundários à ruptura de aneurismas intracranianos, a realização da ATC previamente à abordagem cirúrgica contribuiu para o tratamento definitivo do aneurisma no mesmo procedimento cirúrgico da drenagem do hematoma / Abstract: Due to its technical advancements, 3D cerebral computed tomography angiography (CTA) is increasingly being considered as an alternative to digital subtraction angiography (DSA) in the detection of intracranial aneurysms. Actual guidelines for acute subarachnoid hemorrhage (aSAH) recommend early definitive treatment. The primary goal of this study was to evaluate the contribution of CTA in shortening of time span between the diagnosis of the aSAH and the diagnosis of the aneurysm, as well as the shortening of time span between admission and definitive aneurysm treatment, when compared to DSA. As secondary goals we aimed at comparing the sensitivity of both methods, at comparing the clinical results between two studied patient groups diagnosed by CTA and/or by DSA and at evaluating the contribution of CTA to the surgical approach to intracranial hematomas secondary to aneurysm rupture. A retrospective analysis was performed covering 100 patients admitted with aSAH and diagnosed with intracranial aneurysms either by CTA (n=60) or by DSA (n=40). The data collected for both groups were separated according to the method used for the initial diagnosis of the aneurysm. The time spans between the diagnosis of the aSAH and the diagnosis of the aneurism were consistently smaller for CTA patients than for DSA patients (p<0.000005). Regarding the time spans between the admission and the final treatment, 70% of the outcomes for CTA patients remained below 72 hours and 60% of the outcomes for the DSA group exceeded 72 hours (p<0.003). The sensitivity for ruptured aneurysms was 0,967 and for all aneurysms 0,931. In the majority of cases where a CTA was performed previously to the hematoma evacuation the aneurysm could be treated in the same surgical procedure. CTA contributed to the shortening of the time elapsed between the diagnosis of the aSAH and the diagnosis of the aneurysm, as well as to the shortening of the time elapsed between admission and definitive treatment. The sensitivity of the methods was equivalent, especially for ruptured aneurysms, in technically satisfactory CTA. The use of CTA did not have a negative impact in the clinical outcome or the treatment. CTA performed previously to hematoma evacuation contributed to the definitive treatment of the aneurism in the same surgical approach / Doutorado / Neurologia / Doutor em Ciências Médicas

Objective: This study aims to derive a clinically-applicable decision rule to predict the risk of symptomatic vasospasm, a neurological deficit primarily due to abnormal narrowing of cerebral arteries supplying an attributable territory, in aneurysmal subarachnoid hemorrhage (SAH). Methods: SAH patients presenting from 2002 to 2011 were analyzed using logistic regression and recursive partitioning to identify clinical, radiological, and laboratory features that predict the occurrence of symptomatic vasospasm. Results: The incidence of symptomatic vasospasm was 21.0%. On multivariate logistic regression analysis, significant predictors of symptomatic vasospasm included age 40-59 years, high Modified Fisher Grade (Grades 3 and 4), and anterior circulation aneurysms. Conclusion: Development of symptomatic vasospasm can be reliably predicted using a clinical decision rule created by logistic regression. It exhibits increased accuracy over the Modified Fisher Grade alone and may serve as a useful clinical tool to individualize vasospasm risk once prospectively validated in other neurosurgical centres.

京都大学 / 新制・課程博士 / 博士(医学) / 甲第23380号 / 医博第4749号 / 京都大学大学院医学研究科医学専攻 / (主査)教授 山下 潤, 教授 木村 剛, 教授 YOUSSEFIAN Shohab / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

京都大学 / 0048 / 新制・論文博士 / 博士(医学) / 乙第13167号 / 論医博第2154号 / 新制||医||1029(附属図書館) / (主査)教授 宮本 享, 教授 小泉 昭夫, 教授 柳田 素子 / 学位規則第4条第2項該当 / Doctor of Medical Science / Kyoto University / DFAM

Intracranial aneurysms represent a potentially life-threatening condition and occur in 3–5% of the population. They are increasingly diagnosed due to the broad application of cranial magnetic resonance imaging and computed tomography in the context of headaches, vertigo, and other unspecific symptoms. For each affected individual, it is utterly important to estimate the rupture risk of the respective aneurysm. However, clinically applied decision tools, such as the PHASES score, remain insufficient. Therefore, a machine learning approach assessing the rupture risk of intracranial aneurysms is proposed in our study. For training and evaluation of the algorithm, data from a single neurovascular center was used, comprising 446 aneurysms (221 ruptured, 225 unruptured). The machine learning model was then compared with the PHASES score and proved superior in accuracy (0.7825), F1-score (0.7975), sensitivity (0.8643), specificity (0.7022), positive predictive value (0.7403), negative predictive value (0.8404), and area under the curve (0.8639). The frequency distributions of the predicted rupture probabilities and the PHASES score were analyzed. A symmetry can be observed between the rupture probabilities, with a symmetry axis at 0.5. A feature importance analysis reveals that the body mass index, consumption of anticoagulants, and harboring vessel are regarded as the most important features when assessing the rupture risk. On the other hand, the size of the aneurysm, which is weighted most in the PHASES score, is regarded as less important. Based on our findings we discuss the potential role of the model for clinical practice in geographically confined aneurysm patients.

An intracranial aneurysm (IA) is a balloon-like focal lesion on the cerebral arterial wall. IAs are poorly understood, but are commonly considered to be a disease caused by multiple factors. Current interventional treatments are accompanied with risks. Given the low incidence of rupture, it would be ideal to only treat aneurysms identified with rupture risk. Numerical models of aneurysm development may provide insight into the disease mechanisms, and contribute to the prediction of disease progression. Better understanding of the disease aetiology will also guide clinical decision making. Different hypotheses have been proposed on the influence of haemodynamic stimuli on IA inception. We investigate this influence by examining the haemodynamic stimuli of the 'pre-aneurysmal' vasculature in the locations of IA formation in 22 clinical cases. The 'pre aneurysmal' geometries are obtained by applying a novel numerical vessel reconstruction method on the aneurysmal geometries. This automated reconstruction method propagates a closed curve along the vessel skeleton using the local Frenet frames to smoothly morph the upstream boundary into the downstream boundary. We observe that locally elevated wall shear stress (WSS) and gradient oscillatory number (GON) are highly correlated with regions susceptible to sidewall IA formation, whilst haemodynamic indices associated with the oscillation of the WSS vectors have much lower correlations. A common assumption made in the literature on arterial growth and remodelling (G&R) is that the 'state of stretch' (denoted as the attachment stretch) at which collagen fibres are configured in the extracellular matrix (ECM) is assumed to be constant. This will lead to an unrealistically thickened arterial wall in modelling aneurysm evolution. We propose a novel 1D mathematical model of collagen microstructural adaption during IA evolution. We assume new collagen fibres are configured into the ECM in a state of attachment stretch distribution which can be temporally adaptive. We explicitly define the functional form of this distribution and model its temporal adaption during IA evolution. This model is then implemented into two 3D models of IA evolution: a solid structural model and Fluid-Solid-Growth (FSG) model. In the solid structural model, the artery is modelled as a two-layer, nonlinear elastic cylindrical membrane using a physiologically realistic constitutive model. The development of the aneurysm is considered as a consequence of the growth and remodelling of its material constituents: elastinous constituents are prescribed to degrade in a localised circular patch; collagen concentration and recruitment variables enable the growth and remodelling of collagen fabric to be simulated; adaption of the attachment stretch distribution is confined locally within the region of aneurysm evolution. The sophisticated solid model predicts stabilised saccular IAs with realistic sizes and wall thicknesses. The FSG model simulates the IA development on patient-specific vasculature: the updated 3D solid structural model is integrated into a patient-specific geometry of the vasculature and the growth and remodelling of the constituents is now linked to the local haemodynamic stimuli obtained from a rigid-wall computational fluid dynamics analysis. Adaption of the attachment stretch distribution is also confined locally in the region where the constituents degrade. An illustrative case of IA development on patient specific geometry is provided. Based on our study, we conclude that incorporating the adaption of attachment stretch distribution is necessary to simulate IA evolution with physiological evolving wall thicknesses. However, how vascular cells confine this adaption heterogeneously needs further investigation. Improved understanding and modelling of the biology of the arterial wall is needed for more sophisticated models of aneurysm evolution. It will in turn assist in understanding the aetiology of IA formation. Ultimately we hope to have a patient-specific growth model that could have the potential be used to assist diagnostic decisions.

Introdução. As artérias perfurantes comumente são evidenciadas durante a dissecção microcirúrgica para clipagem de aneurismas intracranianos. A oclusão de artérias perfurantes pode ser responsável por infarto encefálico isquêmico e resultados clínicos indesejáveis. O presente estudo objetiva descrever a utilidade da vídeo-angiografia intra-operatória com indocianina verde (VAIICG) na avaliação do fluxo sanguíneo em artérias perfurantes visibilizadas no campo microcirúrgico, durante a clipagem de aneurismas intracranianos. Secundariamente, foi analisada a incidência de artérias perfurantes envolvidas durante a cirurgia de aneurismas intracranianos, e a ocorrência de infarto encefálico isquêmico causado pelo comprometimento das artérias perfurantes. Método. Sessenta pacientes, com 64 aneurismas intracranianos foram tratados cirurgicamente, e prospectivamente incluídos neste estudo. A VAIICG intra-operatória foi realizada com o uso de microscópio neurocirúrgico (Carl Zeiss Co. Oberkochen, Germany) com a tecnologia VAIICG integrada. A presença e o envolvimento de artérias perfurantes foram analisados no campo microcirúrgico durante a dissecção cirúrgica, e durante a clipagem do aneurisma. A patência vascular após a clipagem também foi investigada. Apenas artérias pequenas que não foram visibilizadas nas imagens pré-operatórias de angiografia digital com subtração (ADS) foram consideradas para análise. Resultados. A VAIICG permitiu a visibilização do fluxo sanguíneo em todos os casos que apresentaram artérias perfurantes no campo microcirúrgico. Dentre 36 casos cujas artérias perfurantes estavam visíveis à VAIICG, 11 casos (30,5%) apresentaram relação próxima entre o aneurisma e artérias perfurantes. Em um paciente (9,0%), dentre os 11 casos com relação próxima, a VAIICG evidenciou oclusão de uma artéria perfurante de P1 após a aplicação do clipe, cujo reposicionamento correto restabeleceu imediatamente o fluxo sanguíneo, o qual foi visibilizado com a VAIICG, sem conseqüências clínicas. Quatro pacientes (6,7%) apresentaram infarto pós-operatório em território de artérias perfurantes, sendo que em três deles, as artérias perfurantes estavam ausentes ou distantes do aneurisma clipado. Conclusão. O envolvimento de artérias perfurantes durante a clipagem microcirúrgica de aneurismas intracranianos é comum. A VAIICG intra-operatória fornece informação visual do fluxo sanguíneo em artérias de calibre milimétrico, e seu uso possibilita evitar a oclusão de artérias perfurantes e subseqüente infarto encefálico. / Background. Perforating arteries are commonly involved during the surgical dissection and clipping of intracranial aneurysms. Occlusion of perforating arteries may be responsible for ischemic infarction and poor outcome. The goal of this study was to describe the usefulness of near-infrared indocyanine green videoangiography (ICGA) for the intraoperative assessment of blood flow in perforating arteries that are visible in the surgical field during clipping of intracranial aneurysms. In addition we analyzed the incidence of perforating vessels involved during the aneurysms surgery and the incidence of ischemic infarct caused by compromising of these small arteries. Method. Sixty patients harboring 64 aneurysms were surgically treated and prospectively included in this study. Intraoperative ICGA was performed using a surgical microscope (Carl Zeiss Co. Oberkochen, Germany) with integrated ICGA technology. The presence and involvement of perforating arteries was analyzed in the microsurgical field, during surgical dissection, and during the clip application. Assessment of vascular patency after clipping was also investigated. Only those small arteries that were not visible on preoperative digital subtraction angiography (DSA) were considered for analysis. Results. In all cases in which perforating vessels were found in the microscope field, the ICGA was able to visualize flow. Among 36 cases whose perforating vessels were visible on ICGA, 11 cases (30,5%) presented a close relation between the aneurysm and perforating arteries. In one patient (9,0%), among these 11 cases with close relation, ICGA showed occlusion of a P1 perforating artery after clip application, which led to immediate correction of the clip confirmed by immediate re-establishment of flow visible with ICGA without clinical consequences. Four patients (6,7%) presented with postoperative perforating artery infarct of whom in 3 patients the perforating arteries were either not visible or distant from the aneurysm. Conclusion. The involvement of perforating arteries during clip application for aneurysm occlusion is a usual finding. Intraoperative ICGA provide visual information with regard to patency of these milimetric vessels, which may avoid their occlusion and further ischemic infarction.

Introdução: A alta incidência de oclusão incompleta e recanalização dos aneurismas intracranianos de colo largo tratados por via endovascular levaram ao desenvolvimento de novas técnicas, entre elas o uso do Onyx ®. Objetivos: avaliar a eficiência do agente embólico líquido Onyx® em produzir oclusão completa dos aneurismas intracranianos de colo largo e avaliar a estabilidade do tratamento aos 6 meses e aos 18 meses, por meio de controles angiográficos. Casuística e métodos: Esta tese foi realizada na Seção de Neuroradiologia Intervencionista da Med Imagem, do Hospital São Joaquim da Real e Benemérita Associação Portuguesa de Beneficência de São Paulo, através da revisão de dados clínicos e radiológicos de 69 pacientes tratados pelo autor, com 84 aneurismas intracranianos de colo largo no período de julho de 2002 a fevereiro de 2006. Dez pacientes eram do sexo masculino e 59 do sexo feminino, com idade variando de 24 anos a 86 anos (mediana de 52 anos). Todos os aneurismas tinham origem lateral à artéria e apresentavam pelo menos um dos critérios usados para definir colo largo - colo maior que 4 mm de diâmetro e relação saco/colo menor que 1,5. Cinqüenta aneurismas eram pequenos, 30 grandes e quatro gigantes (diâmetro máximo menor que 12mm, de 12mm a 25mm e maiores que 25mm, respectivamente). As apresentações clínicas mais comuns foram: achado incidental em 34 pacientes, pós-hemorragia sub aracnóide e recanalização após tratamento com espirais destacáveis em 10. A maioria dos aneurismas era da artéria carótida interna (76 aneurismas). Controles angiográficos foram feitos ao final, aos seis meses e aos 18 meses do tratamento (controles I, II e III respectivamente), sendo analisados principalmente o grau de oclusão (completa ou incompleta), incidência de recanalização e complicações clínicas. Avaliação estatística foi feita pelo método de Kaplan-Meier para o percentual cumulativo de oclusão completa e percentual de recanalização e análise univariada e multivariada dos fatores preditivos de oclusão total imediata e tardia através de regressão logística. Resultados: O índice de oclusão completa foi de 65,5%, 84,6% e de 90,3% para todos os aneurismas, nos controles I, II e III respectivamente. Estes índices foram de 74%, 95,1% e de 95,2% para os aneurismas pequenos e de 53,3%, 70% e de 80% para os aneurismas grandes nos controles I, II e III respectivamente. Oclusão completa ocorreu em 50% dos aneurismas gigantes nos controles I e II, sem haver controle III neste grupo. Recanalização ocorreu em 3 aneurismas (4,6%). O porcentual cumulativo de oclusão completa foi de 97,63% (IC de 95% variando de 95,27 a 100) para os aneurismas pequenos aos 9 meses e de 83,86% (IC de 95% variando de 67,73 a 100) para os aneurismas grandes aos 21 meses. Três pacientes faleceram (4,3%), havendo relação com o procedimento em dois (2,9%). Morbidade permanente ocorreu em cinco pacientes (7,2%), sendo incapacitante em um (1,4%). Conclusões: 1. O uso do Onyx® foi eficiente na oclusão completa dos aneurismas intracranianos de colo largo. 2. O tratamento foi estável nos controles angiográficos aos 6 meses e aos 18 meses. / Introduction: The high rate of incomplete occlusion and intracranial large neck aneurysms recanalization lead to the development of new techniques, including the use of Onyx®. Purpose: to evaluate the efficacy of the liquid embolic system Onyx ® to produce completes occlusion of the intracranial large neck aneurysms and evaluates the stability of the treatment at 6 month and 18 month angiographic control. Materials and Methods: this thesis has been performed at Section of Interventional Neuroradiology of Med Imagem, at the Hospital São Joaquim da Real e Benemérita Associação Portuguesa de Beneficência de São Paulo, based on a review of clinical and radiological records of 69 patients treated by the author, harboring 84 large neck intracranial aneurysms between July 2002 and February 2006. Ten patients were male and 59 female, with age ranging from 24 to 86 years old. All aneurysms were lateral to the parent vessel and were wide neck (neck > 4 mm and/or domus to neck ratio < 1.5). Fifty aneurysms were small (<12 mm), 30 were large (12 to 25 mm) and 4 were giant (> 25 mm). Thirty four aneurysms were incidental, 10 were ruptured and 10 were recanalized after coil treatment and the majority was located in the internal carotid artery (76). Angiographic follow-up was done at the end of the procedure, at six month and at 18 month (controls I, II and III respectively), analyzing the rate of complete occlusion, recanalization and clinical complication. Statically analysis were done by Kaplan-Meier method for cumulative percentage of complete aneurysm occlusion and for recanalization, and univariate and multivariate analysis of predictive factors of immediate and late complete occlusion through logistic regression. Results: Complete aneurysm occlusion was achieved in 65.5% on immediate control, in 84.6% at 6 month, and in 90.3% at 18 month follow-up periods for all aneurysms. This rate was 74%, 95.1% and 95.2% for small and 53.3%, 70% and 80% for large aneurysms at the same follow-up periods. In the giant aneurysm group, two had complete and stable occlusion at six month follow-up angiography. Recanalization was seen in three aneurysms (4,6%). Kaplan Meyer\'s cumulative percentage of complete aneurysm occlusion was 97.63% (CI 95% ranging from 95,27 to 100) for small aneurysms at 9 months and 83.86% (CI 95% ranging from 67,73 to 100) for large aneurysms at 21 months. There were three deaths (4,3%), two procedure-related (2.9%). Overall morbidity was 7.2%, being disabling in one (1,4%). Conclusions: 1. The use of Onyx was efficient in the complete occlusion of wide neck intracranial aneurysms. 2. The treatment was stable at 6 month and 18 month angiographic controls.