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  1. Article ; Online: Association of blood lipid levels with the risk of intracranial aneurysm formation and rupture calls for further studies: A commentary on the article by Zhang et al.

    Frösen, Juhana

    European journal of neurology

    2022  Volume 29, Issue 10, Page(s) 2879–2880

    MeSH term(s) Aneurysm, Ruptured/complications ; Humans ; Intracranial Aneurysm/complications ; Lipids ; Risk Factors
    Chemical Substances Lipids
    Language English
    Publishing date 2022-08-01
    Publishing country England
    Document type Journal Article
    ZDB-ID 1280785-0
    ISSN 1468-1331 ; 1351-5101 ; 1471-0552
    ISSN (online) 1468-1331
    ISSN 1351-5101 ; 1471-0552
    DOI 10.1111/ene.15514
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  2. Article ; Online: Reply to the letter by Yin et al. 'Reevaluating the impact of antihypertensive medication on intracranial aneurysm formation: a call for clarification and further study'.

    Frösen, Juhana / Räisänen, Sari / Lindgren, Antti

    European journal of neurology

    2024  , Page(s) e16272

    Language English
    Publishing date 2024-03-06
    Publishing country England
    Document type Letter
    ZDB-ID 1280785-0
    ISSN 1468-1331 ; 1351-5101 ; 1471-0552
    ISSN (online) 1468-1331
    ISSN 1351-5101 ; 1471-0552
    DOI 10.1111/ene.16272
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  3. Article ; Online: Recurrence of arteriovenous malformations of the brain after complete surgical resection. Kuopio University Hospital experience and systematic review of the literature.

    Järvelin, Patrik / Pekonen, Henri / Koivisto, Timo / Frösen, Juhana

    Neurosurgical review

    2023  Volume 46, Issue 1, Page(s) 99

    Abstract: Treatment for arteriovenous malformations of the brain (bAVMs) aims to achieve complete removal or occlusion of the lesion in order to eradicate the risk of rupture and subsequent morbidity associated with these lesions. Despite initially successful ... ...

    Abstract Treatment for arteriovenous malformations of the brain (bAVMs) aims to achieve complete removal or occlusion of the lesion in order to eradicate the risk of rupture and subsequent morbidity associated with these lesions. Despite initially successful treatment, bAVMs may carry a risk of recurrence especially in younger patients. We studied the rate of recurrence of surgically treated bAVMs at Kuopio University Hospital (KUH) in 1981-2021. The study population was collected retrospectively from KUH databases and presented a cohort of 135 surgically treated bAVMs with complete occlusion of the lesion. We also performed a systematic literature review on this topic. In our series, 6 out of 135 (4.4%) patients with angiographically confirmed removal of the lesion later developed a recurrent bAVM with a median time to diagnosis of recurrence of 7.46 years. In pediatric patients, the rate was 5 out of 17 (29.4%). bAVM recurrence was associated with age (p = 0.001) and initial hemorrhagic presentation (p = 0.039). Median age of the study population was 37 years (min 0, max 70), and 51/135 (37.8%) of the patients were female. Seventeen (12.6%) of the 135 bAVM patients were considered pediatric (18 years old or younger) at the time of the operation. In the literature review, 79 of 1739 (4.5%) of surgically treated patients later developed a recurrence with a mean delay of 3.1 years until diagnosis of recurrence. Young surgically treated bAVM patients with a hemorrhagic presentation at initial diagnosis are at a relatively high risk of bAVM recurrence. Follow-up imaging should be arranged for these patients in order to prevent rupture from a recurrent bAVM and subsequent morbidity.
    MeSH term(s) Adolescent ; Adult ; Child ; Female ; Humans ; Male ; Brain ; Hospitals ; Intracranial Arteriovenous Malformations/complications ; Retrospective Studies ; Vascular Diseases/complications
    Language English
    Publishing date 2023-04-29
    Publishing country Germany
    Document type Systematic Review ; Journal Article
    ZDB-ID 6907-3
    ISSN 1437-2320 ; 0344-5607
    ISSN (online) 1437-2320
    ISSN 0344-5607
    DOI 10.1007/s10143-023-02001-8
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  4. Article: Flow Dynamics of Aneurysm Growth and Rupture: Challenges for the Development of Computational Flow Dynamics as a Diagnostic Tool to Detect Rupture-Prone Aneurysms.

    Frösen, Juhana

    Acta neurochirurgica. Supplement

    2016  Volume 123, Page(s) 89–95

    Abstract: Saccular intracranial aneurysm (sIA) is a relatively common disease that can potentially cause a devastating, life-threatening intracranial hemorrhage. Many sIAs never rupture and thus do not necessitate interventions, making the detection of rupture- ... ...

    Abstract Saccular intracranial aneurysm (sIA) is a relatively common disease that can potentially cause a devastating, life-threatening intracranial hemorrhage. Many sIAs never rupture and thus do not necessitate interventions, making the detection of rupture-prone sIAs a very relevant clinical problem. Moreover, because currently available methods to prevent sIA rupture have significant risks of morbidity and mortality, diagnostic tools that can predict imminent rupture and help plan proper timing of prophylactic interventions, can improve patient care. Hemorrhage from an sIA occurs when hemodynamic stress exceeds sIA wall strength. Computational fluid dynamics (CFD) is a tool with which the hemodynamic stress to which the sIA wall is exposed can be determined non-invasively. Studies using CFD in sIAs have demonstrated associations of wall shear stress (WSS) with aneurysm growth, fragile sIA wall, and sIA rupture; these studies show the potential of CFD as a diagnostic tool. This review discusses the limitations of CFD and of the studies performed, and what needs to be done in order to develop CFD into a useful diagnostic tool to determine aneurysm-specific rupture risk.
    MeSH term(s) Aneurysm, Ruptured/physiopathology ; Biomechanical Phenomena ; Disease Progression ; Hemodynamics ; Humans ; Hydrodynamics ; Intracranial Aneurysm/physiopathology ; Models, Biological ; Shear Strength ; Stress, Mechanical
    Language English
    Publishing date 2016
    Publishing country Austria
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ISSN 0065-1419
    ISSN 0065-1419
    DOI 10.1007/978-3-319-29887-0_13
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  5. Article ; Online: Stability of infundibular dilatations: a single center follow-up study and systematic review of the literature.

    Tarkiainen, Jeremias / Pyysalo, Liisa / Hinkka, Tero / Pienimäki, Juha-Pekka / Ronkainen, Antti / Frösen, Juhana

    Acta neurochirurgica

    2024  Volume 166, Issue 1, Page(s) 48

    Abstract: Purpose: Although infundibular dilatations (IDs) have been thought to be benign anatomical variants, case reports suggest that they can grow and rupture. The aim of this study was to determine whether IDs have a tendency to grow or rupture.: Methods: ...

    Abstract Purpose: Although infundibular dilatations (IDs) have been thought to be benign anatomical variants, case reports suggest that they can grow and rupture. The aim of this study was to determine whether IDs have a tendency to grow or rupture.
    Methods: The study population was collected from the Tampere University Hospital (TAUH) Aneurysm Database. The presence of IDs was screened from the medical records and imaging studies of 356 intracranial aneurysm patients left to follow-up from 2005 to 2020. The imaging studies were reviewed to confirm the IDs, and their clinical course. Finally, we performed a systematic review of published cases of ID leading to aneurysmatic rupture from PubMed.
    Results: We found 97 typical IDs in 83 patients and 9 preaneurysmal lesions resembling ID in 9 patients. Out of the typical cone-shaped IDs, none grew or ruptured in a total follow-up of 409 patient-years. One preaneurysmal lesion ruptured during a follow-up: this lesion had components of both infundibular dilatation and aneurysm at the beginning of follow-up. In the systematic literature search, we found 20 cases of aneurysmatic SAHs originating from an ID. Of those, only 7 had imaging available prerupture. All 7 IDs were typically cone-shaped, but a branching vessel originating from the apex of ID was only seen in 4/7.
    Conclusion: Typical infundibular dilatations seem to be benign anatomical variants that are stable and, thus, do not need prophylactic treatment or imaging follow-up. Likely, the SAHs reported from IDs were actually caused by misdiagnosed preaneurysmal lesions.
    MeSH term(s) Humans ; Aneurysm, Ruptured/complications ; Cerebral Angiography ; Dilatation/adverse effects ; Dilatation, Pathologic/diagnostic imaging ; Dilatation, Pathologic/complications ; Follow-Up Studies ; Intracranial Aneurysm/diagnosis ; Systematic Reviews as Topic
    Language English
    Publishing date 2024-01-30
    Publishing country Austria
    Document type Journal Article
    ZDB-ID 80010-7
    ISSN 0942-0940 ; 0001-6268
    ISSN (online) 0942-0940
    ISSN 0001-6268
    DOI 10.1007/s00701-024-05890-w
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  6. Article ; Online: The clinical course and outcomes of non-aneurysmal subarachnoid hemorrhages in a single-center retrospective study.

    Tarkiainen, Jeremias / Hovi, Valtteri / Pyysalo, Liisa / Ronkainen, Antti / Frösen, Juhana

    Acta neurochirurgica

    2023  Volume 165, Issue 10, Page(s) 2843–2853

    Abstract: Background: Non-aneurysmal subarachnoid hemorrhages (SAHs) are thought to have a benign clinical course compared to aneurysmal SAHs. The aim of this study is to report the clinical course and outcomes of non-aneurysmal SAHs in a large single-center ... ...

    Abstract Background: Non-aneurysmal subarachnoid hemorrhages (SAHs) are thought to have a benign clinical course compared to aneurysmal SAHs. The aim of this study is to report the clinical course and outcomes of non-aneurysmal SAHs in a large single-center study.
    Methods: The patients with non-aneurysmal SAHs were screened from Tampere University Hospital from 2005 to 2020. The clinical data were collected from the patient's medical records and from the imaging studies. The primary interest was the neurological outcome assessed by dichotomized GOS at 2 months. Multivariable logistic regression was used to study the factors associated with unfavorable outcome.
    Results: We found 216 non-aneurysmal SAHs in 214 patients (2 patients with > 1 bleed). Ninety-seven percent of patients with a typical perimesencephalic bleeding pattern SAH (PSAH) (75/77) had a favorable outcome, while 86% of patients with non-perimesencephalic SAH (NPSAH) had a favorable outcome (84/98). In a multivariable logistic regression analysis, loss of consciousness (LOC) (aOR 214.67, 95% CI 17.62-2615.89) and Fisher grade 4 bleeding pattern (aOR 23.32, 95% CI 1.40-387.98) were associated with increased risk for unfavorable outcome (GOS 1-3). Vasospasm was seen in 20% of non-aneurysmal SAH patients, hydrocephalus in 17%, and 13% needed ventriculostomy.
    Conclusions: Non-aneurysmal SAH seems to have a good prognosis for majority of patients, especially for patients with a PSAH. Non-aneurysmal SAH patients are however affected by vasospasm and hydrocephalus and have similar risk factors for poor outcome as patients with aneurysmal SAH. This suggests that it is the severity of the bleed rather than the etiology that associates with poor outcome.
    MeSH term(s) Humans ; Subarachnoid Hemorrhage/diagnostic imaging ; Subarachnoid Hemorrhage/surgery ; Subarachnoid Hemorrhage/complications ; Retrospective Studies ; Vasospasm, Intracranial/etiology ; Hydrocephalus/surgery ; Hydrocephalus/complications ; Disease Progression
    Language English
    Publishing date 2023-09-02
    Publishing country Austria
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 80010-7
    ISSN 0942-0940 ; 0001-6268
    ISSN (online) 0942-0940
    ISSN 0001-6268
    DOI 10.1007/s00701-023-05767-4
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  7. Article ; Online: Correction to: The clinical course and outcomes of non-aneurysmal subarachnoid hemorrhages in a single-center retrospective study.

    Tarkiainen, Jeremias / Hovi, Valtteri / Pyysalo, Liisa / Ronkainen, Antti / Frösen, Juhana

    Acta neurochirurgica

    2023  Volume 165, Issue 12, Page(s) 3707

    Language English
    Publishing date 2023-10-25
    Publishing country Austria
    Document type Published Erratum
    ZDB-ID 80010-7
    ISSN 0942-0940 ; 0001-6268
    ISSN (online) 0942-0940
    ISSN 0001-6268
    DOI 10.1007/s00701-023-05834-w
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  8. Article ; Online: Smooth muscle cells and the formation, degeneration, and rupture of saccular intracranial aneurysm wall--a review of current pathophysiological knowledge.

    Frösen, Juhana

    Translational stroke research

    2014  Volume 5, Issue 3, Page(s) 347–356

    Abstract: Subarachnoid hemorrhage or intracerebral hemorrhage caused by rupture of a saccular intracranial aneurysm (sIA) is often fatal and causes significant loss of productive live years in addition to significant mortality. Around 3.5 % of the middle aged ... ...

    Abstract Subarachnoid hemorrhage or intracerebral hemorrhage caused by rupture of a saccular intracranial aneurysm (sIA) is often fatal and causes significant loss of productive live years in addition to significant mortality. Around 3.5 % of the middle aged otherwise healthy population carries unruptured sIAs. Many sIAs never rupture, and since their prophylactic treatment is associated with risks of morbidity and even mortality, it is paramount to elucidate the biology that leads to sIA rupture in order be able to identify rupture-prone sIAs and to improve current therapies. Smooth muscle cells (SMCs) play a critical role both in the formation of sIAs, as well as in the repair and adaptation of the sIA wall to hemodynamic and proteolytic stress to which it is subjected. Loss of mural SMCs is characteristic to ruptured sIA walls, and experiments in animal models suggest that this loss of mural SMCs is causative to sIA growth and eventual rupture. Genetic factors that impair the function or survival of SMCs may predispose to sIA formation. Local or systemic therapy that increases the number of functioning SMCs in the sIA wall may have a potential to reduce the risk of sIA rupture. This review discusses the mechanisms and cellular interactions that SMCs have in the pathobiology of the sIA wall.
    MeSH term(s) Aneurysm, Ruptured/complications ; Aneurysm, Ruptured/pathology ; Animals ; Humans ; Intracranial Aneurysm/genetics ; Intracranial Aneurysm/pathology ; Intracranial Hemorrhages/etiology ; Myocytes, Smooth Muscle/metabolism ; Myocytes, Smooth Muscle/pathology
    Language English
    Publishing date 2014-04-01
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't ; Review
    ZDB-ID 2541897-X
    ISSN 1868-601X ; 1868-4483
    ISSN (online) 1868-601X
    ISSN 1868-4483
    DOI 10.1007/s12975-014-0340-3
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  9. Article ; Online: Reader Response: Substantial Within-Country Variation in the Incidence of Subarachnoid Hemorrhage: A Nationwide Finnish Study.

    Frösen, Juhana / Tarkiainen, Jeremias / Kelahaara, Milla / Pyysalo, Liisa / Ronkainen, Antti

    Neurology

    2022  Volume 98, Issue 17, Page(s) 733–734

    MeSH term(s) Age Factors ; Finland/epidemiology ; Humans ; Incidence ; Subarachnoid Hemorrhage/epidemiology
    Language English
    Publishing date 2022-04-25
    Publishing country United States
    Document type Journal Article ; Comment
    ZDB-ID 207147-2
    ISSN 1526-632X ; 0028-3878
    ISSN (online) 1526-632X
    ISSN 0028-3878
    DOI 10.1212/WNL.0000000000200509
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    Zs.MO 374: Show issues

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  10. Article ; Online: Letter by Frösén and Lindgren Regarding Article, "Treatment Scoring of Unruptured Intracranial Aneurysms".

    Frösén, Juhana / Lindgren, Antti

    Stroke

    2019  Volume 50, Issue 11, Page(s) e337

    MeSH term(s) Aneurysm, Ruptured ; Humans ; Intracranial Aneurysm ; Risk Factors
    Language English
    Publishing date 2019-10-07
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 80381-9
    ISSN 1524-4628 ; 0039-2499 ; 0749-7954
    ISSN (online) 1524-4628
    ISSN 0039-2499 ; 0749-7954
    DOI 10.1161/STROKEAHA.119.027410
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