Early surgical removal of migrated coil/stent after failed embolization of intracranial aneurysm.

OBJECT: Distal coil or stent migration is a rare, but potentially morbid complication of intracranial aneurysm embolization. At present, there is no established standard of surgical evacuation of displaced material-in particular, there is no consensus on the optimum time for such intervention. The authors report their positive experiences with an ultra-early surgical evacuation of 2 migrated coils and a flow-diverter stent. METHODS: Uncontrolled coil or stent migration occurred in 3 (0.75%) of approximately 400 patients treated between 1999 and 2012 in the authors' institution. In all 3 cases, the materials moved from their intended position to the middle cerebral artery (MCA). Surgical evacuation was started immediately (within half an hour) after a futile attempt of removing them via intraarterial route, under the same anesthesia and with no active reversal of heparinization. RESULTS: No excessive bleeding was observed. Displaced coils were extracted through an incision of a branch of MCA-the anterior temporal artery, the stent was removed through a direct incision of MCA. Recombinant tissue plasminogen activator (rtPA) was injected to the stem of the internal carotid artery toward the end of the procedure, with no discernible adverse effects. Two patients were discharged with no deficit (Glasgow Outcome Scale [GOS] Score 5); the other patient was conscious with mild hemiparesis (GOS Score 4) at discharge. CONCLUSIONS: The experiences of these 3 cases suggest that immediate removal of a migrated stent/coil is feasible and may be effective. Indirect access to the MCA through its branch helps to shorten the time of temporary clipping of the artery to a minimum. Maintaining active heparinization and direct intraarterial injection of rtPA are helpful in promoting blood flow in the MCA.

Rehabilitation of patients with obstructive sleep apnea syndrome.

The current treatment of obstructive sleep apnea syndrome (OSAS) focuses on alleviation of symptoms by increasing airway patency during sleep through positive airway pressure, oral appliances, changes in sleep position, weight loss, or surgical treatment. Continuous positive airway pressure (CPAP) is currently the treatment of choice and prevents upper airway obstruction, resulting in improved sleep architecture and daytime symptoms. Despite proven efficacy, adherence to CPAP treatment is still not efficient. The new methods of rehabilitation (exercise training programs, hypoglossal nerve stimulation) for patients with OSAS are currently modified. The aim of the present study was to present recent developments in the field of selected aspects of rehabilitation in patients with OSAS. Database search was focused on exercise training programs and electrostimulation of genioglossus muscle. The search for articles on the rehabilitation interventions for OSAS was performed using the PubMed database from 1966 to 2013. Most of the findings have shown beneficial effects of rehabilitation. In detail, we describe the recent developments and potential adverse effects of electrostimulation and physical exercises. According to the results of studies presented, the above therapy might support conventional treatment or may be an alternative for patients with poor compliance to CPAP therapy, mandibular advancement devices, or ineffective results of surgical procedures as well.