World Neurosurg
-
A 30-year-old woman experienced nasal stuffiness followed by a progressive headache and reduced visual acuity for 3 weeks. She underwent an endoscopic endonasal transsphenoidal approach for pituitary spindle cell oncocytoma 13 months before the present admission. Magnetic resonance imaging revealed an intrasellar cystic lesion with a suprasellar extension. ⋯ Microscopy revealed mites and fungal hyphae. Cultures from the abscess showed Staphylococcus hyicus, Stenotrophomonas maltophilia, and Aspergillus sp. The patient received a 6-week antibiotic treatment, which completely resolved the clinical symptoms and cleared the magnetic resonance imaging findings.
-
A variety of recently introduced devices have allowed more complex aneurysms to be rendered for endovascular embolization. Tiny and sophisticated implants are nowadays designed to provide further either temporary or permanent remodeling of the wide-necked aneurysms and improve coil occlusion rates.1-4 Such improvements in the technical armamentarium include the Woven EndoBridge (Sequent Medical, California, USA), the Medina Embolic Device (Medtronic, Irvine, California, USA), The Contour Neurovascular System (Cerus Endovascular, Fremont, California, USA), and pCONUS 2 HPC (Phenox, GmbH, Bohum, Germany).5-7 Intrasaccular neck bridging is a conceptually new technique descending from the theoretical combination of intrasaccular flow diversion and temporary-stent assisted coiling.8 The Nautilus (EndoStream Medical, Tel Aviv, Israel) is an intrasaccular bridging device that offers complete neck reconstruction in coil embolization of wide-neck cerebral aneurysms. It has been granted a CE mark by the European Union. ⋯ This is what we consider a great advantage of the proposed technique over the alternative options of intrasaccular and intraluminal flow diversion. This technical video (Video 1) demonstrates the successful obliteration of a complex posterior communicating artery aneurysm with Nautilus-assisted endovascular coiling. To our knowledge, this is the first technical video demonstrating an in-vivo and step-by-step implementation of this novel device.