World Neurosurg
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Wide-necked intracranial aneurysms present unique treatment challenges in the setting of subarachnoid hemorrhage. New generations of endoluminal devices (stents) have expanded our ability to treat complex aneurysms. The PulseRider Aneurysm Neck Reconstruction Device (PulseRider [Cerenovus, Irvine, California, USA]) is new to the U.S. market after receiving Food and Drug Administration approval in June 2017. Official recommendation for use of the PulseRider is with dual antiplatelet therapy (DAPT). Its design has been hypothesized to carry a lower risk of thromboembolic complications in the circumstance that DAPT needs to be discontinued. ⋯ The PulseRider device represents a novel design for stent-assisted coil embolization. We report a small but promising series of its successful use in the acute treatment of wide-necked, ruptured basilar artery aneurysms. Additional experience is needed to determine if this device has a place in our armamentarium for treatment of ruptured aneurysms.
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Until now, there were few studies on the safety analysis of oblique lumbar interbody fusion (OLIF) and extreme lateral interbody fusion (XLIF) in the initial stage of learning curve. The purpose of this study was to find out the safety differences between the 2 minimally invasive fusion methods in the initial stage of learning curve and to provide reference for beginners. ⋯ OLIF has a higher risk of neurovascular injury in the initial stage of learning. By contrast, the XLIF approach is simple and the incidence of complications is relatively low. Therefore, we believed that XLIF is more acceptable in the initial stage of anterolateral lumbar interbody fusion.
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The anterior temporal approach (ATA) has been reported as suitable for surgical clipping of posteriorly projecting internal carotid artery (ICA) aneurysms. As the ICA follows a variable course, tortuosity of the ICA may affect visualization of the aneurysm. The aim of this study was to investigate the impact of the intracranial course of the ICA and aneurysm projection on surgical approach. ⋯ A low-lying, laterally projecting intracranial ICA and posteriorly projecting aneurysm are predictors of the necessity for the ATA in the surgical clipping of posterior communicating artery aneurysms.
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Transvenous embolization (TVE) via occluded sinus is one option for the treatment of dural arteriovenous fistulas. Understanding of the anatomical characteristics of the occluded sinus is difficult. It is often hard to reach the shunt point because of some risk of vessel perforation. ⋯ Magnetic resonance imaging evaluation of the occluded sinus using both T1 VISTA BB and 3D FFE T1Gd gives us valuable information of the occluded sinus regarding the development and the course of the occluded sinus, the length of the thrombotic occlusion, and leads to safer catheter maneuvers in TVE.
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We investigated the use of high-flow superficial temporal artery trunk-to-radial artery-to-middle cerebral artery (STAt-RA-MCA) bypass to prevent ischemic stroke in patients with symptomatic internal carotid artery occlusion (SICAO). ⋯ Our results suggest that high-flow STAt-RA-MCA bypass can effectively reduce the risk of stroke in patients with SICAO. Moreover, the surgical procedure is a highly safe procedure. Further randomized controlled studies are required to draw more precise conclusions.