To clarify the safety and efficacy of flow diverter (FD) treatment for blood blister–like aneurysm (BBA) through a systematic review and literature analyzing perioperative and long-term clinical and ...angiographic outcomes.
We performed a comprehensive review of the current literature for studies with >2 patients related to FD treatment of BBAs published. A random-effects meta-analysis was used to pool the following outcomes: complete occlusion, technical success, aneurysm recurrence, rebleeding, perioperative mortality, perioperative stroke, procedure-related morbidity and mortality, long-term neurological morbidity and mortality, and overall good neurologic outcome.
We included 15 noncomparative studies with a total of 165 target BBAs. Complete occlusion rates were 72% (95% confidence interval CI, 0.59–0.85). Recurrence occurred in 13% (95% CI, 0.04–0.29) and rebleeding in 3% (95% CI, -0.02 to 0.07) of patients. Procedure-related morbidity and mortality were 26% (95% CI, 0.19–0.33) and 3% (95% CI, -0.01 to 0.07), respectively. The rate of long-term good outcomes was 83% (95% CI, 0.77–0.89). Subgroup analysis indicated that a single FD strategy for BBA seemed to have a higher rate of good outcomes compared with an overlapped FD strategy (89.9% vs. 61.9%; odds ratio, 1.42; 95% CI, 1.25–14.98, P = 0.02). Complete occlusion rate and procedure-related morbidity rate did not see any significant difference between these 2 strategies.
Our meta-analysis suggests that in selected cases, FD can be safe and effective. A single FD strategy may result in a higher rate of good outcomes compared with an overlapped FD strategy. Ultimately, treatment of BBA should be considered on a case-by-case basis to maximize patient benefits and limit the risk of perioperative complications.
•Flow diverters (FDs) can be safe and effective in treating blood blister–like aneurysms.•A single FD strategy may result in a higher rate of good outcomes compared with an overlapped FD strategy.•Treatment of blood blister–like aneurysm (BBA) should be considered on a case-by-case basis.
Intracranial aneurysms with poor topography are still difficult and dangerous to be catheterized during endovascular procedures. Here we report a novel coil guiding catheterization technique which ...could be safe and helpful. Seven aneurysms of 5 cases were embolized with the novel coil guiding catheterization technique in Zhongshan Hospital, Fudan University, from January 2017 to March 2019. All the aneurysms were with poor topography for endovascular embolization. One of the aneurysms was in the posterior communicating segment of internal carotid artery (ICA), three in the ophthalmic segment of ICA, and one in the posterior cerebral artery. Two of the cases had multiple aneurysms. All the aneurysms were catheterized by coil guiding technique and embolized. All the aneurysms were catheterized successfully and safely. The aneurysms embolization results were as follows: Raymond Class 1 occlusion was achieved in 4 aneurysms, Class 2 occlusion in 1, Class 3 occlusion in 2 immediately after the procedure. Follow-up imaging demonstrated all the aneurysms achieved total occlusion. There was no aneurysm re-rupture or patient death. The results indicated that the technique has good safety and effectiveness, with a high rate of technical success and a low rate of periprocedural complications in the reported cases. Thus, appling coil guiding aneurysm catheterization could be considered as a safe and effective method, especially for aneurysms with poor topography.
Whether rupture risk of cerebral arteriovenous malformation (AVM) is higher during pregnancy and puerperium remains controversial. This study aimed to compare risk of rupture in pregnant and ...nonpregnant female patients with AVM in a singer-center series and assess current evidence regarding rupture risk of AVM during pregnancy and puerperium by pooled data analysis.
We retrospectively reviewed female patients with AVM in our center from January 2006 to August 2017. Hemorrhage events and patient-years were calculated during exposure period and nonexposure period, which was defined as either the interval from birth until AVM obliteration or last follow-up after subtracting the exposure period. Poisson rate ratio analysis was used to compare hemorrhage rate between the 2 periods. Pooled data analysis was performed by up-to-date literature review via PubMed and EMBASE databases.
In 264 female patients with AVM, overall annual hemorrhage rate for 222 total hemorrhages during an average of 7484 patient-years was 2.97%. Eight hemorrhages occurred in exposure periods, 214 hemorrhages occurred in nonexposure periods, and 155 hemorrhages occurred in nonexposure periods of reproductive-age patients, translating to annual hemorrhage rates of 5.40% in exposure periods, 2.92% in nonexposure periods, and 3.82% in nonexposure periods of reproductive-age patients. Pooled data analysis showed a higher annual hemorrhage rate in exposure periods than in nonexposure periods (5.59% vs. 2.52%; 95% confidence interval 1.52–6.70, P = 0.002).
This study demonstrated an increase in annual rate of cerebral AVM hemorrhage during pregnancy and puerperium. Female reproductive-age patients with cerebral AVM may have higher risks of AVM rupture. Further evaluation by well-designed prospective or randomized cohort studies is needed.
Because femoral pseudoaneurysm (FPA) is a dangerous complication of interventional procedures with a risk of life-threatening bleeding, our aim was to develop a predictive nomogram for FPA after ...neurointervention, and to suggest the best method for early identification of FPA.
We searched the PubMed database for literature addressing FPA after interventional procedures to analyze the risk factors, and we also reviewed the clinical data of patients from the Department of Neurosurgery who underwent neurointerventional procedures. Selected parameters were analyzed by univariate and multivariate logistic regression analysis. A nomogram was constructed using the independent risk factors by a multivariate regression model, and was validated by bootstrap resampling method, as well as receiver operating characteristic (ROC) curve, decision curve analysis (DCA) and calibration curve. The influence on the detection rate of FPA with Doppler ultrasound was also analyzed with Fisher's exact test.
According to existing studies, female sex, diabetes and hypertension are major risk factors of FPA. Among 1,098 clinical patients, hypertension (P=0.044), higher body mass index (BMI) (P=0.020), larger sheath size (P=0.049), puncture site hematoma (P=0.011) and closure failure (P=0.003) were identified as independent risk factors. The nomogram including these factors showed robust discrimination C-index, 0.916; 95% confidence interval (CI): 0.810-1.022 with an area under the curve of 0.916. DCA indicated clinical utility, and the calibration curves showed an acceptable consistency. A significant improvement in the detection rate occurred when Doppler ultrasound was utilized (P=0.031).
The presented nomogram showed favorable predictive accuracy for FPA after neurointervention. We recommend ultrasound examination for patients at high risk of FPA evaluated by the nomogram.
Since the communication network of the cyber-physical power system is responsible for communicating information, which guarantees the operation of the cyber-physical power system, researchers focus ...on the stability of the communication system. This article analyzes the risk of the communication transmission link interruption based on the network structure and characteristics of service transmission and proposes a path optimization method. First, we analyze the impact of link disruption on network structure and service, respectively, and quantify the impact as link interruption risk. According to the risk analysis, we propose an optimization method utilizing the Dijkstra’s algorithm and the genetic algorithm to reconfigure service paths, which aims to minimize time delay and realize the equilibrium of service distribution. Through a particular situation, we calculate the link interruption risk and use the optimization method to configure service path for affected service. The results show that the time delays of the optimized service paths are in the acceptable level as well as the balance index of the service distribution is decreased obviously. The simulation experiment reveals the operability of the risk analysis method and the effectiveness of the path optimization method, which provides a technical reference for risk analysis and service path configuration.
Background
As one of the most fundamental elements in exposure and decompression, the dissection of arachnoid has been rarely correlated with the surgical results in studies on Microvascular ...decompression (MVD) procedures for Hemifacial spasm (HFS).
Materials and methods
Patients’ records of the HFS cases treated with MVD from January 2016 to December 2021 in our center was retrospectively reviewed. The video of the procedures was inspected thoroughly to evaluate the range of dissection of arachnoid. Four areas were defined in order to facilitate the evaluation of the dissection range. The correlation between the arachnoid dissection and the surgical outcomes were analyzed.
Results
The arachnoid structures between the nineth cranial nerve and the seventh, eighth cranial nerves were dissected in all cases, other areas were entered based on different consideration. The rate of neurological complications of the extended dissection pattern group was higher than that of the standard pattern group (
P
< 0.05). The procedures in which the arachnoid structure above the vestibulocochlear nerve was dissected, led to more neurological complications (
P
< 0.05).
Conclusion
Thorough dissection as an initial aim for all cases was not recommended in MVD for HFS, arachnoid dissection should be tailored to achieving safety and effectiveness during the procedure.
Evaluate the efficacy, safety, and patient satisfaction of transradial access (TRA) compared with conventional transfemoral access (TFA) for diagnostic cerebral angiography in elderly patients (≥65 ...years of age).
We performed a retrospective review of patients receiving cerebral angiography via TRA or TFA between October 2020 and December 2021 at 3 institutions. Basic patient characteristics, angiographic data, postoperative complications, and patient satisfaction were collected for analysis.
Of the 357 enrolled elderly patients, 175 were performed through TRA and 182 were performed through TFA. There was no significant difference in mean fluoroscopy time (8.6 ± 3.8 minutes vs. 9.1 ± 3.1 minutes; P = 0.103) and radiation exposure (47.7 ± 10.8 Gy-cm2 vs. 49.8 ± 11.3 Gy-cm2; P = 0.068) between the TRA and TFA groups. However, the TRA group had a shorter procedural time (54.7 ± 6.2 minutes vs. 61.1 ± 5.6 minutes; P < 0.001) and less contrast agent (83.2 ± 28.1 mL vs. 100.1 ± 26.2 mL; P < 0.001) than the TFA group. In terms of safety, the incidence of minor vascular access complications in the TRA group was lower than that in the TFA group (1.7% vs. 8.8%; P = 0.003). The incidence of serious complications and neurologic complications in the TRA group was also lower, although the difference was not statistically significant. Overall patient satisfaction was higher in the TRA group than that in the TFA group.
TRA was an efficient and safe alternative to conventional TFA in elderly patients who underwent diagnostic cerebral angiography and who underwent TRA were more satisfied. Findings supported the radial-first strategy for cerebral angiography in elderly populations.
•The intra-operative observation of AMR usually falls into a pattern of “all or nothing”, but AMR seems to contain more information that could improve surgical results.•The appearance and observation ...of pre-decompression instability of AMR monitoring made a positive impact on the surgical outcomes of MVD surgeries.•The timely notification of the PDI advent improved the surgical outcomes of MVD surgery by increasing the electrophysiological relief rate and reducing the incidence of neurological dysfunction.
In microvascular decompression (MVD) surgery, abnormal muscle response (AMR) monitoring was utilized to confirm sufficient decompression. However, the AMR seems to contain more information that could improve surgical results.
Patients’ records of HFS treated with MVD under AMR monitoring, from January 2018 to December 2019 in our centre, were retrospectively reviewed. MVD procedures were performed via a suboccipital retrosigmoid approach, and AMR monitoring was performed. Pre-Decompression Instability (PDI) of AMR before the final decompression, including amplitude inconsistency and waveform chaos, was inspected and notified to the surgeon.
165 cases were found with full follow-up data. In these cases, PDI was recognized in 144 cases. And in the remaining 21 cases, the AMR disappeared abruptly or continued to exist to the end of the MVD surgery. When PDI appeared, the rate of electrophysiological relief was significantly higher (91.7 % vs 66.7 %, P = 0.001). In cases with PDI appearance during MVD procedure, the rate of neurological dysfunction was lower (13.2 % vs 38.1 %, P = 0.004). The relief rate the PDI group tended to be higher without statistical significance.
The appearance and observation of pre-decompression instability of AMR monitoring made a positive impact on the surgical outcomes of MVD surgeries. The advent of PDI indicates that the key step of the procedure has arrived. The timely notification of the PDI advent improved the surgical outcomes of MVD surgery by increasing the electrophysiological relief rate, reducing the incidence of neurological dysfunction, and possible elevation of the relief rate. Therefore, continuous intra-operative communication between the surgeon and electrophysiological monitoring staff should be encouraged.
The deep location of the thalamus and the complex neural circuits in the surrounding area make surgery extremely challenging. Feasibility and advisability of using a supracerebellar infratentorial ...approach (SCITA) for endoscopic resection of thalamic lesions remains to be further evaluated. Fifteen patients who underwent endoscopic resection of thalamic via SCITA from 2014 to 2021 were retrospectively collected. We analyzed preoperative tumor-related variables and surgical procedures in detail, as well as postoperative outcomes. Lesions mainly located in the posterior and/or medial part of the thalamus, and some of them expanded downward, or backward. The mean size of them was 30 × 24 mm. Five of the nine patients with preoperative hydrocephalus underwent cerebrospinal fluid shunts to relieve increased intracranial pressure. Among the 15 patients, 4 were glioblastoma, 3 were pilocytic astrocytoma, and the rest included 1 case of anaplastic astrocytoma, melanoma, polymorphous low-grade neuroepithelial tumor of the young, rosette-forming glioneuronal tumor, inflammatory lesion, diffuse midline glioma, and cavernous hemangioma. The majority of patients (10/15) achieved gross total resection, which has become more pronounced since paramedian SCITA was used in place of the midline approach in 2020 (6/8). Three patients had unresolved or new onset of clinical symptoms after surgery, resulting in a decreased KPS score at discharge. Neuro-endoscopic techniques can ameliorate many of the shortcomings of the SCITA. With the accumulation of experience and technological progress, more deficiencies of this approach may be improved, enabling safe and effective resection of posterior and/or medial part thalamic lesions.
Dural arteriovenous fistulas (DAVFs) in the falx cerebri are rare. This study presents a case of DAVF in the frontal falx cerebri that was successfully resected using a purely endoscopic keyhole ...microsurgical technique.
A 69-year-old male patient presented to the emergency department with an acute onset seizure. His condition was diagnosed as a DAVF in the frontal falx cerebri with multiple fistula points. A purely endoscopic resection was performed under neuronavigation. Postoperative angiography and clinical follow-up were performed after 10 days and 3 months, respectively.
The DAVF was satisfactorily observed and resected using a purely endoscopic keyhole microsurgical technique, with no deterioration of neural functions or major vessel ruptures. Postoperative angiogram revealed complete obliteration of the DAVF and no recurrent epilepsy during the clinical follow-up.
Supported by sufficient preoperative evaluation and meticulous manipulation,a purely endoscopic minimally invasive resection is feasible and safe for DAVF, with the advantages of close observation and panoramic view.
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