Journal of cerebrovascular and endovascular neurosurgery最新文献

Central nervous system (CNS) aspergillosis is a life-threatening infection primarily affecting immunocompromised patients and may lead to severe cerebral infarction through vascular invasion. However, there is limited data on the treatment options for aspergillosis-induced cerebral infarction especially surgical treatments such as superficial temporal artery (STA)-middle cerebral artery (MCA) bypass surgery. Herein, we present a case of cerebral infarction in a 59-year-old male with progressive right eye ptosis. Specifically, he had ipsilateral MCA stenosis originating from paranasal sinusitis due to invasive aspergillosis. After 3 months, the patient was readmitted due to worsening cerebral infarction and complete internal carotid artery (ICA) occlusion. Conservative treatment failed to improve cerebral perfusion, leading to gradual neurological decline. Consequently, STA-MCA bypass was performed to stabilise the patient. Postoperative imaging revealed a patent bypass graft and an enhanced cerebral perfusion. Although the patient experienced persistent left-sided hemiparesis, his overall neurological condition remained stable for 1 year, with a Glasgow Coma Scale score of 15. STA-MCA bypass should be considered a potential treatment option for patients with aspergillosis-induced vasculitis resulting in cerebral infarction secondary to total ICA occlusion.

Objective: This study aimed to evaluate the prognosis of patients with subarachnoid hemorrhage after anterior communicating artery (Acom) artery aneurysm rupture who underwent endovascular treatment according to inflammatory markers.

Methods: A retrospective assessment of medical data revealed 223 consecutive patients who received endovascular Acom artery aneurysmal subarachnoid hemorrhage (SAH) therapy. The study comprised 80 patients, excluding those who had microsurgery following endovascular treatment, those who had diagnostic angiography, patients with ruptured aneurysms at other locations, and those who needed extra surgery. The patients' preoperative electronic medical records were used to collect values of white blood cell (WBC), neutrophil, lymphocyte, C-reactive protein (CRP), neutrophil/lymphocyte ratio (NLR), and CRP/lymphocyte ratio (CLR).

Results: The study divided patients into two groups based on their modified Rankin Scale (mRS) scores: Group 1 (71.2%) had 57 patients on a scale of 0-2 and Group 2 (28.8%) had 23 patients on a scale of 3-6. Inflammatory markers such as WBC, neutrophils, lymphocytes, CRP, NLR, and CLR levels were higher in Group 2 than in Group 1.

Conclusions: Our study evaluated the impact of inflammatory markers (WBC, neutrophils, lymphocytes, CRP, NLR, and CLR) on the prognosis of patients with intracerebral aneurysmal hemorrhage treated endovascularly. Our results indicated that these parameters aligned in their ability to predict the severity of the neurological condition.

Objective: Tortuosity in blood vessels is a common angiographic feature that plays a crucial role in hemodynamics and is implicated in systemic diseases such as arterial hypertension and diabetes mellitus. Although studies exist on the relationship between vessel tortuosity and intracranial aneurysms, standard imaging modalities and parameters representing vessel tortuosity are controversial. This study compared vessel tortuosity based on angle measurements using magnetic resonance angiography (MRA) and digital subtraction angiography (DSA).

Methods: A retrospective analysis of 85 patients with 63 males (75.3%) with unruptured anterior circulation aneurysms between December 2021 and December 2022 was conducted using MRA and DSA. The vessel angles of several segments in the carotid siphon, internal carotid artery bifurcation, and the inflow angles to intracranial aneurysms were measured to evaluate the discrepancy between MRA and DSA.

Results: No significant difference was observed in vessel and inflow angles between MRA and DSA, except the internal carotid artery-middle cerebral artery (ICA-MCA) angle, which shows a significant difference (MRA; 50.26˚ (interquartile range (IQR), 33.49-70.57), DSA; 50.75˚ (IQR, 34.91-62.24), p-value=0.035).

Conclusions: We found a discrepancy between MRA and DSA in measuring the ICA-MCA angle. Further studies are required to address observed discrepancies between imaging modalities and improve the accuracy of hemodynamic analysis in clinical settings.

Objective: Acute vertebrobasilar occlusion can led to a fatal outcome, but lack of established procedures poses many difficulties in its management. Although mechanical thrombectomy (MT) has shown positive outcomes recently, high reocclusion rate remains a hurdle. This study is to share experience and to review technical challenges of rescue angioplasty and/or stenting (RAS) for refractory occlusions after MT in posterior circulation ischemic stroke (PCIS).

Methods: Out of 494 patients with acute ischemic stroke from January 2014 to December 2022 in a Hospital, PCIS was identified in 50 patients. 2 extracranial vertebral artery occlusion patients were excluded. For 48 patients, MT was applied as the primary treatment. RAS was done for reocclusion after MT in 15 patients. We evaluated patient characteristics and clinical course, emphasizing the technical aspects of treatment.

Results: Compared to those without rescue procedures, RAS group had a higher percentage of large artery atherosclerosis as an etiology (p<0.001), long segment occlusions (p=0.03), and was more likely to involve posterior inferior cerebellar artery (p=0.007). There was no difference in functional outcome at 6 months between these two groups. Reopening could not achieve (N=2, 13.3%) and procedural complication rate (iatrogenic rupture) is 6.7% in RAS group. Rescue procedures were complicated with dissection, plaque rupture and migration, device damage, and misplacement of the balloon/stent. Avoiding these traps, finding true lumen, and reconstructing the flow by connecting the proximal and distal normal were the keys to the successful RAS.

Conclusions: RAS could be inevitable during endovascular treatment for PCIS and being aware of possible events and technical strategies would navigate interventionists to successful recanalization and the better outcomes.

Vertebral artery dural arteriovenous fistulae (VADAVF) are a rare entity. We present a patient who experienced pre-syncopal symptoms and was found to have a VADAVF between the posterior meningeal artery and a cortical vein draining into the sigmoid sinus. The patient initially underwent surgical intervention, which failed to obliterate the shunt. Endovascular treatment with use of a flow diverter provided definitive disconnection of the shunt.

The carotid web (CW), an intimal variant of fibromuscular dysplasia (FMD), is recognized as a cause of stroke and with a high-risk of stroke recurrence. Other names are carotid-bulb atypical FMD, carotid (bulb) diaphragms and it is described like a shelf of tissue from the posterior wall of the carotid bulb. Here we present a case of a young patient with recurrent stroke, with no other risk factors that was diagnosed with a common CW.

Objective: This review aims to perform qualitative and quantitative analysis to determine which dural graft materials are preferable for neurosurgical patients.

Methods: A literature search using the PubMed database was conducted to collect relevant articles that compared complications associated with autologous and non-autologous dural grafts. The extracted data included graft type and related complications. Screening of all studies was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Statistical tests were conducted using Microsoft Excel to compare categorical variables, and data analysis was performed using Review Manager 5.4.1.

Results: A total of twelve studies were deemed eligible from 1,646 articles. These studies included 1,877 patients; 965 (51.4%) received autologous grafts and 912 (48.6%) received non-autologous grafts. Pooled data from autologous grafts showed significant reductions in meningitis (OR=0.31; 95% CI 0.17-0.54), pseudomeningocele (OR=0.50; 95% CI 0.32-0.79), and wound infection rates (OR=0.34; 95% CI 0.14-0.80) compared to the non-autologous group. There were no significant differences in cerebrospinal fluid (CSF) leakage, hydrocephalus, or revision surgery rates.

Conclusions: Autologous dural grafts are more effective compared to non-autologous grafts in reducing the incidence of meningitis, pseudomeningocele, and wound infections following duraplasty. However, the risks of CSF leakage, hydrocephalus, and revision surgery are similar for both graft types.

The irony of life is that in the complex world of neurosurgery, where the skilled mind of the neurosurgeon navigates the delicate terrain of cerebral aneurysm, the same mind can be affected by the very thing it treats. Sometimes the healer becomes the one in need of healing. This predicament highlights the reality of existence that vulnerability transcends professional boundaries, and any individual can become a target.

Vertebral-venous fistula (VVF) is a rare vascular disorder characterized by an atypical, direct, high-flow shunt between an extracranial vertebral artery and its adjoining vein. While it can originate spontaneously in association with conditions affecting the vascular wall, trauma is also a recognized etiological factor. We report a case of a 64-year-old gentleman with multiple neurofibromas who presented with a cervical VVF leading to cervical myelopathy, successfully managed with endovascular coiling. The condition's rarity and the complex vascular anatomy involved have hindered the development of standardized management guidelines. Our experience aligns with literature indicating that endovascular treatment can be a safe and effective approach for VVF.

Intro: There is a growing preference among neurointerventionalists for transradial access (TRA) over transfemoral access (TFA) due to improved patient satisfaction, recovery time and reduced access site complication, but using balloon guide catheters (BGCs) in the radial artery remains a challenge. We report our experience in successfully using the 0.087" inner diameter Walrus BGC without a sheath via the radial artery for non-emergent neurointerventions.

Objective: Describe the technique for safely accessing the radial artery using the sheathless Walrus balloon guide catheter.

Methods: A retrospective chart review of thirteen consecutive patients who underwent intervention with radial artery access with a sheathless Walrus BGC was performed.

Results: All twelve procedures were performed successfully with no instances of conversion from TRA to TFA. There were no significant procedural or access site complications. The mean radial diameter was 2.51 mm.

Conclusions: The Walrus 0.087" ID BGC is an effective tool that can safely be used via the radial artery using a sheathless approach, which helps to maximize the size of the catheter that can be used. This is the first instance of our knowledge of this technique being utilized for neurointerventions and therefore could be used to expand the indications for TRA for a wider range of procedures.