Safety Study of Minimally Invasive Approaches to Unruptured Anterior Circulation Aneurysms

NCT ID: NCT02345395

Last Updated: 2015-01-26

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

NA

Total Enrollment

120 participants

Study Classification

INTERVENTIONAL

Study Start Date

2013-09-30

Study Completion Date

2015-12-31

Brief Summary

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The study is designed to evaluate the efficacy and safety of minimally invasive neurosurgical techniques for patients with incidental cerebral aneurysms of the anterior circulation in the Hospital das Clínicas of the University of São Paulo Medical School.

Detailed Description

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Minimally Invasive Neurosurgery is a inexorable tendency and it is already a reality in many centers of the world. It is a broad and relative concept and there is few consistent medical data to validate its benefits. In this manner, this is the first clinical trial in Brazil questioning the safety of the of minimally invasive surgery to treat incidental cerebral aneurysms of the anterior circulation. For countries like Brazil, the indirect demonstration of reduction in hospital costs through lower hospital stays is a breakthrough to provide better health for the entire population.

Patients with the diagnosis of incidental brain aneurysms of the anterior circulation will be recruited from the spontaneous demand of the Hospital das Clínicas of University of São Paulo Medical School. The investigators expect to recruit 60 patients for the experimental group and 60 for the control group.

In the study group patients will be submitted to a minimally invasive approach (transpalpebral mini fronto-orbital craniotomy or modified minipterional craniotomy). All patients in this group will be submitted to surgery starting at 8 o'clock in the morning. After 6 hours of the end of surgery, all patients will have a control CT scan and if the result is adequate, they are going to be discharged from the ICU with no IV drugs. The hospital discharge will be in the next day. The control group are patients that will be submitted to a classical pterional craniotomy with hospital discharge occurring in 4-5 days.

All patients will be submitted to the standard care offered by the Hospital das Clinicas. All surgical and ambulatory data will be collected by the main investigators (Dr. Mauricio Mandel and Dr. Eberval Figueiredo). The adverse events will be promptly reported to the chair of the department and to the CAPPESQ (the ethics committee of the hospital).

Ambulatory data will be collected during the regular post operative medical appointments and a web based questionnaire. The post operative follow-up is unified in only one ambulatory center and day (thursdays mornings).

Statistical analysis will compare primary and secondary objectives of the two groups, as specified in the study protocol.

Conditions

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Cerebral Aneurysm Aneurysm, Middle Cerebral Artery Aneurysm, Anterior Communicating Artery Aneurysm, Posterior Communicating Artery Aneurysm, Carotid Artery Brain Aneurysm

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Transpalpebral Approach

Aneurysm Clipping - Patients will be submitted to a Transpalpebral Approach to Unruptured Anterior Circulation Aneurysm and they will be discharged from the hospital on the next day.

Group Type EXPERIMENTAL

Aneurysm Clipping

Intervention Type PROCEDURE

All Patients will be submitted to a surgical intervention in order to clip their unruptured brain aneurysm

NanoPterional Approach

Aneurysm Clipping - Patients will be submitted to a Modified MiniPterional Approach (Nanopterional) to Unruptured Anterior Circulation Aneurysm and they will be discharged from the hospital on the next day.

Group Type EXPERIMENTAL

Aneurysm Clipping

Intervention Type PROCEDURE

All Patients will be submitted to a surgical intervention in order to clip their unruptured brain aneurysm

Classical Pterional Craniotomy

Aneurysm Clipping - Patients will be submitted to a Classical Pterional Approach to Unruptured Anterior Circulation Aneurysm and they will be discharged from the hospital 4-5 days after the procedure.

Group Type SHAM_COMPARATOR

Aneurysm Clipping

Intervention Type PROCEDURE

All Patients will be submitted to a surgical intervention in order to clip their unruptured brain aneurysm

Interventions

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Aneurysm Clipping

All Patients will be submitted to a surgical intervention in order to clip their unruptured brain aneurysm

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Patients with the diagnosis of incidental unruptured cerebral aneurysms (4mm to 2cm)

Exclusion Criteria

* Patients who do not have adequate family care during the immediate post-operative period (the patient's family must commit to stay with the patient in the first five days after hospital discharge)
* Patients who are unable to communicate by telephone
* People with cardiovascular disease, liver or kidney failure.
* Pregnant women or breastfeeding
* Patients with coagulation abnormalities
* Patients with High Surgical Risk evaluated by different risk scores (ASA, AHA, Goldman, Detsky)
Minimum Eligible Age

18 Years

Maximum Eligible Age

80 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Fundação de Amparo à Pesquisa do Estado de São Paulo

OTHER_GOV

Sponsor Role collaborator

University of Sao Paulo General Hospital

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Eberval G Figueiredo, MD, PhD

Role: STUDY_DIRECTOR

University of Sao Paulo

Locations

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Hospital das Clínicas of University of São Paulo Medical School

São Paulo, São Paulo, Brazil

Site Status RECRUITING

Countries

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Brazil

Central Contacts

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Mauricio Mandel, MD

Role: CONTACT

55 11 996299224

Ester M Tomazini

Role: CONTACT

55 11 2661-7152/8014

Facility Contacts

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Mauricio Mandel, MD

Role: primary

55 11 996299224

Ester M Tomazini

Role: backup

2661-7152/8014

References

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Ohjimi H, Taniguchi Y, Tanahashi S, Era K, Fukushima T. Accessing the Orbital Roof via an Eyelid Incision: The Transpalpebral Approach. Skull Base Surg. 2000;10(4):211-6. doi: 10.1055/s-2000-9337.

Reference Type BACKGROUND
PMID: 17171150 (View on PubMed)

Andaluz N, Romano A, Reddy LV, Zuccarello M. Eyelid approach to the anterior cranial base. J Neurosurg. 2008 Aug;109(2):341-6. doi: 10.3171/JNS/2008/109/8/0341.

Reference Type BACKGROUND
PMID: 18671651 (View on PubMed)

Abdel Aziz KM, Bhatia S, Tantawy MH, Sekula R, Keller JT, Froelich S, Happ E. Minimally invasive transpalpebral "eyelid" approach to the anterior cranial base. Neurosurgery. 2011 Dec;69(2 Suppl Operative):ons195-206; discussion 206-7. doi: 10.1227/NEU.0b013e31821c3ea3.

Reference Type BACKGROUND
PMID: 21499147 (View on PubMed)

Figueiredo EG, Deshmukh V, Nakaji P, Deshmukh P, Crusius MU, Crawford N, Spetzler RF, Preul MC. An anatomical evaluation of the mini-supraorbital approach and comparison with standard craniotomies. Neurosurgery. 2006 Oct;59(4 Suppl 2):ONS212-20; discussion ONS220. doi: 10.1227/01.NEU.0000223365.55701.F2.

Reference Type BACKGROUND
PMID: 17041490 (View on PubMed)

Figueiredo EG, Deshmukh P, Nakaji P, Crusius MU, Crawford N, Spetzler RF, Preul MC. The minipterional craniotomy: technical description and anatomic assessment. Neurosurgery. 2007 Nov;61(5 Suppl 2):256-64; discussion 264-5. doi: 10.1227/01.neu.0000303978.11752.45.

Reference Type BACKGROUND
PMID: 18091240 (View on PubMed)

Other Identifiers

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TRANSPALPEBRAL USP

Identifier Type: -

Identifier Source: org_study_id

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