[Malignant transformation of Ollier disease-related multiple glioma with IDH1 p.R132C mutation].

A 21-year-old man who was diagnosed with Ollier disease at the age of 1 year developed incidental multiple gliomas at the age of 15 years. Subsequently, the multiple gliomas enlarged and the patient underwent three surgical removals. Genetic analysis revealed the IDH1 p.R132C mutation in the gliomas, and histopathology showed malignant transformation. Despite multimodality treatment, the gliomas could not be controlled, and the patient died at the age of 23 years. Ollier disease is a rare disease with IDH1/2 mutations and is often associated with gliomas. However, there are very few reports on genetic analysis of IDH1/2 mutations and long-term follow-up in Ollier disease-related gliomas. Genetic analysis of IDH mutations may contribute to the elucidation of its pathogenesis. The cross-departmental collaboration is required for long-term follow-up of Ollier disease-related gliomas.

Endoscopic Evacuation of Putaminal Hemorrhage Using the Trans-Middle Temporal Gyrus Approach: Technical Notes and Case Presentations.

BACKGROUND: The development of minimally invasive endoscopic neurosurgery has enabled widespread application of endoscopic surgery via the ipsilateral transfrontal approach for putaminal hematoma evacuation. However, this approach is unsuitable for putaminal hematomas that extend into the temporal lobe. We adopted the endoscopic trans-middle temporal gyrus approach, instead of the conventional surgical approach, for the management of these complicated cases and determined its safety and feasibility. METHODS: Twenty patients with putaminal hemorrhage underwent surgical treatment at the Shinshu University Hospital between January 2016 and May 2021. Of these, two patients with left putaminal hemorrhage that extended into the temporal lobe underwent surgical treatment using the endoscopic trans-middle temporal gyrus approach. The procedure entailed the use of a thinner transparent sheath to reduce the technique's invasiveness, a navigation system to determine the location of the middle temporal gyrus and the sheath's trajectory, and an endoscope with a 4K camera for higher image quality and utility. The sylvian fissure was compressed superiorly using our novel "port retraction technique" (i.e., by tilting the transparent sheath superiorly) to avoid damage to the middle cerebral artery and Wernicke's area. RESULTS: The endoscopic trans-middle temporal gyrus approach allowed sufficient hematoma evacuation and hemostasis under endoscopic observation without any surgical complexities or complications. The postoperative course was uneventful in both patients. CONCLUSION: The endoscopic trans-middle temporal gyrus approach for putaminal hematoma evacuation helps avoid damage to normal brain tissue, which could result from the wide range of motion of the conventional technique, particularly when the hemorrhage extends to the temporal lobe.

Postoperative Intratumoral or Peritumoral Hematomas After Vestibular Schwannoma Resection.

BACKGROUND: Surgical removal of a vestibular schwannoma is a complex and challenging procedure, which may be complicated by development of postoperative hematomas, particularly after incomplete resection of the tumor. OBJECTIVE: To investigate the occurrence of postoperative intra- or peritumoral hematomas after surgery for a vestibular schwannoma. METHODS: This retrospective study evaluated 49 patients (age range 17-78 years) with a vestibular schwannoma, who were treated surgically via the lateral suboccipital approach between 2011 and 2016. The tumors ranged in size from 0 mm (in a case of an intracanalicular lesion) to 56 mm. In 30 cases (61%), total or near-total resection was accomplished, and in 19 cases (39%), subtotal or partial resection was done. On the basis of their bleeding tendency during tumor removal, the patients were divided into a "less-bleeding" (38 cases; 78%) and a "more-bleeding" (11 cases; 22%) subgroups. RESULTS: A maximal vestibular schwannoma diameter >30 mm, patient age >60 years, and more bleeding during tumor removal were significantly associated with incomplete (subtotal or partial) resection. In six cases (12%), serial computed tomography after surgery demonstrated a postoperative hematoma, which was caused by insufficient irrigation of the surgical field (in two cases) or resulted from peritumoral hemorrhage (in two cases), intratumoral hemorrhage (in one case), or both intra- and peritumoral hemorrhage (in one case). The latter patient required urgent reoperation. In all cases, postoperative hematomas occurred after incomplete (subtotal or partial) resection of a vestibular schwannoma, and their development was significantly associated with more bleeding during tumor removal. CONCLUSION: For avoidance of postoperative hematomas, careful hemostasis is required after completion of vestibular schwannoma removal, especially in cases with incomplete resection and an excessive bleeding tendency of the tumor tissue.

The efficacy of a visiting surgical service versus that of a hospital-based surgical service in providing endoscopic endonasal surgery to remove nonfunctioning pituitary adenomas in rural communities.

PURPOSE: To satisfy the increasing demand for endoscopic endonasal approach (EEA) to treat pituitary tumors, especially in rural areas, the "mobile EEA" system, a visiting surgical service, has been established We report this unique system for maintaining community healthcare and evaluate the surgical results of mobile EEA. METHODS: A retrospectively acquired database of 225 consecutive cases of EEA at Shinshu University Hospital (i.e., "home EEA") and its affiliated hospitals (i.e., "away EEA") between May 2018 and May 2022 was reviewed. A total of 105 consecutive patients who fulfilled the criterion of a diagnosis of new-onset nonfunctioning pituitary adenoma (PA) were included. Clinical characteristics and postoperative clinical outcomes were statistically compared between the home EEA and away EEA groups to assess the presence of a home advantage and/or an away disadvantage. RESULTS: Patients were stratified into two cohorts: patients treated at our hospital (home EEA: n = 41 [39.0%]) and those treated in the visiting surgical service at an affiliated hospital (away EEA: n = 64 [61.0%]). Postoperative clinical outcomes, such as the extent of tumor resection (p = 0.39), operation time (p = 0.80), visual function (p = 0.54), and occurrence of surgical complications (p = 0.53), were comparable between the groups. There were no visiting surgical service-related adverse events or accidents caused by physicians' driving to away hospitals. CONCLUSION: Pituitary surgeries performed via the mobile EEA system for nonfunctioning PAs may help maintain local community healthcare. Furthermore, this system can also contribute to the efficient training of surgeons by the same experienced pituitary surgeon using the same protocol.

A rare pure intraventricular hemorrhage caused by ruptured internal carotid artery-anterior choroidal artery aneurysm: a case report and literature review.

Although intraventricular hemorrhage (IVH) frequently develops secondary to intraparenchymal or subarachnoid hemorrhage, pure IVH-non-traumatic spontaneous intracranial hemorrhage confined to the cerebral ventricular system-is rare. Moreover, pure IVH caused by ruptured proximal aneurysm is an extremely rare but life-threatening condition. Herein, we present a case of pure IVH due to a ruptured internal carotid artery -anterior choroidal artery (ICA-AChA) aneurysm and review related literature. A 77-year-old man presenting with altered mental status was hospitalized due to a massive pure IVH with ventriculomegaly. The patient was conservatively managed because his consciousness level improved. On the following day, computed tomography angiography revealed a right ICA-AChA aneurysm embedded in the temporal lobe adjacent to the anterior part of the inferior horn of the lateral ventricle, which was consistent with the hemorrhagic origin. Coil embolization of the aneurysm was successfully performed, and the postprocedural course was uneventful. To date, only a few cases have described pure IVH caused by a ruptured proximal aneurysm. If the ruptured proximal aneurysm remains unnoticed, catastrophic rehemorrhage may occur. Aneurysm obliteration should precede the treatment of acute hydrocephalus. Neurosurgeons/neurointerventionalists must be aware about pure IVH caused by a ruptured proximal aneurysm even if it rarely occurs.

Surgical revascularization for quasi-moyamoya disease associated with polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes (POEMS) syndrome: a case report and literature review.

POEMS (polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes) syndrome is a rare multisystem disease characterized by plasma cell dyscrasia and overproduction of vascular endothelial growth factor, which is related to disease activity. Recent treatment strategies have improved survival of patients suffering from this disorder; however, ischemic stroke remains a poor prognostic factor. POEMS patients with ischemic stroke frequently develop cerebral large artery stenosis/occlusion, followed by progressive stroke. Post literature review, we present an ischemic stroke case of quasi-moyamoya disease linked with this syndrome that was successfully treated with surgical revascularization. A 41-year-old woman diagnosed with POEMS syndrome developed progressive ischemic stroke due to quasi-moyamoya disease, despite decreased vascular endothelial growth factor level with lenalidomide and dexamethasone treatment. She underwent superficial temporal artery to middle cerebral artery bypass with encephalo-duro-myo-synangiosis bilaterally. The postoperative course was uneventful. Two years and five months after the stroke, neuroimaging demonstrated bypass patency, neovascularization after encephalo-duro-myo-synangiosis, and no recurrence of stroke. Our case is the first to report successful surgical revascularization for a POEMS patient. Surgical revascularization may be a useful treatment option for patients with quasi-moyamoya disease associated with POEMS syndrome, especially for those who develop refractory ischemic stroke despite reduced vascular endothelial growth factor level.

Transorbital penetrating head injury by a wooden chopstick in the cavernous sinus: a case report and literature review.

Penetrating head injury is a relatively rare condition associated with high morbidity and mortality. Although the immediate treatment of penetrating head injury is needed, surgical strategies are varied based on the trajectory of the penetrating objects in the cranium. We present a case of 24-year-old man who sustained a transorbital penetrating injury caused by a wooden chopstick. Neuroimages revealed a linear lesion extending from the left intraorbital segment to the cavernous sinus passing through the superior orbital fissure. The foreign body was successfully removed via the transcranial approach without complications. A careful management based on the perioperative images and correct diagnosis is necessary to avoid unfavorable complications. Four cases of transorbital penetrating injuries have been previously reported, in which the foreign body penetrated through the superior orbital fissure and lodged in the cavernous sinus. The frontotemporal craniotomy with extradural approach can be a useful option to remove foreign bodies around the cavernous sinus regions.

Single-lane clipping technique for a ruptured aneurysm of A1 fenestration of the anterior cerebral artery: a case report and literature review.

Fenestration of the A1 segment of the anterior cerebral artery is a rare vascular anomaly with a high risk of saccular aneurysm at the proximal end of the A1 fenestration. These aneurysms have a high risk of rupture. However, conventional surgical clipping can be technically challenging due to the anatomical characteristics. We report a case of A1 fenestration with a ruptured aneurysm wherein we successfully achieved complete obliteration of the aneurysm with a new "single-lane" clipping technique. A 64-year-old woman presented with a ruptured saccular A1 aneurysm at the proximal end of an A1 fenestration, resulting in subarachnoid hemorrhage. Microsurgical clipping was attempted; however, adequate exposure of the aneurysm could not be achieved. The recurrent artery of Heubner originated near the distal end of the lateral limb of the A1 fenestration. The lateral limb of the A1 fenestration had no perforating arteries, according to surgical examination. Thus, the aneurysm neck and lateral limb were concurrently obliterated using a nonfenestrated clip, preserving the medial limb of the A1 fenestration. The antegrade flow of the recurrent artery of Heubner was detected using the retrograde flow of the distal part of the lateral limb of the A1 fenestration during intraoperative indocyanine green video angiography. The postoperative course was uneventful without any evidence of ischemic stroke. For A1 aneurysms arising from the proximal end of the A1 fenestration, this technique may be a useful treatment option. Before using this technique, careful surgical exploration should be performed to assess the A1 perforating arteries.

Conversion surgery after lenvatinib treatment for anaplastic thyroid carcinoma: a case report.

BACKGROUND: Anaplastic thyroid carcinoma (ATC) is the most aggressive form of thyroid carcinoma. Lenvatinib, a multikinase inhibitor, is rarely used in preoperative settings due to adverse effects including delayed wound healing and fistula formation. Herein, we report the use of lenvatinib treatment prior to conversion surgery for the treatment of ATC. CASE PRESENTATION: A 71-year-old woman was referred to our hospital with suspected thyroid cancer with recurrent laryngeal nerve invasion and cervical lymph node metastasis based on the results of ultrasonography. Computed tomography demonstrated the presence of a thyroid tumor invading the trachea and esophagus with no evidence of distant metastasis. Fine needle aspiration of the left cervical lymph node indicated the lymph node metastasis of ATC. As the tumor had widely invaded the trachea and esophagus, unresectable ATC was diagnosed and treatment with lenvatinib was initiated at a dose of 24 mg/day. On day 13 of lenvatinib treatment, the primary tumor and lymph node metastases demonstrated a partial response to therapy. As the tumor was now considered resectable, the decision was made to perform conversion surgery. Total thyroidectomy and left lateral neck node dissection were performed 7 days after the withdrawal of lenvatinib. The patient was discharged on postoperative day 5 with no complications. Histopathological examination demonstrated that the tumor contained the component of papillary thyroid carcinoma, squamoid ATC cells, and granulation tissue. In areas of granulation tissue, atypical cells with spindle-shaped or polygonal morphology, pyknotic nuclei, and scant cytoplasm were observed. Immunohistochemically, these cells were positive for cytokeratin AE1/AE3, TTF-1, and p53 and negative for thyroglobulin and PAX8. Therefore, the areas of granulation tissue observed within tumor samples were also considered ATC that were affected by lenvatinib treatment. In total, approximately 50% of resected tumor comprised ATC, and 70% of them had been changed to granulation tissue. CONCLUSIONS: The findings in the present case indicate that lenvatinib may have significant antitumor effects in preoperative settings. Lenvatinib may represent a promising candidate therapy for unresectable ATC by increasing tumor resectability.

Intraspinal canal platform system for coil embolization of anterior spinal artery aneurysm associated with spinal cord arteriovenous malformation: a case report and literature review.

BACKGROUND: The prognosis for spinal artery aneurysms associated with spinal cord arteriovenous malformations (AVMs) is poor because of the high rupture rate of aneurysms. However, endovascular treatment remains technically difficult because the catheter system must be constructed via the small-caliber anterior spinal artery (ASA) or posterior spinal artery (PSA), which feeds functionally eloquent spinal cord. A 2.6F Carnelian HF-S microcatheter (Tokai Medical Products, Aichi, Japan) has been specifically designed to assist a 1.6F Carnelian MARVEL S microcatheter (Tokai Medical Products) as a small-profile 'platform catheter' close to the target lesion. Here we present a prenidal ASA aneurysm treated using a 2.6F Carnelian HF-S microcatheter as an intraspinal canal platform catheter and review related literature. CASE PRESENTATION: A 50-year-old man presented with a subarachnoid haemorrhage due to cervical spinal cord AVM. Diagnostic vertebral angiography revealed the AVM supplied by the PSA originated from the right C2 segmental artery and ASA arising from the right V4 segment. Superselective angiography for each feeder was achieved through a 2.6F Carnelian HF-S microcatheter, and a prenidal ASA aneurysm was diagnosed, which was clinically consistent with haemorrhagic origin. A 1.6F Carnelian MARVEL S microcatheter was cannulated into the aneurysm through the 2.6F Carnelian HF-S microcatheter positioned at the ASA. The aneurysm coiling was successfully performed without system instability or periprocedural complications. CONCLUSIONS: Only a few cases have described endovascular treatment for spinal artery aneurysms. To date, no reports have been published regarding the use of an intraspinal canal platform catheter to treat spinal artery aneurysms. A 2.6F Carnelian HF-S microcatheter served as a useful intraspinal canal platform catheter for coil embolization of the ASA aneurysm. This system can provide excellent accessibility and controllability for endovascular treatment of spinal artery lesions.

Transradial Mechanical Thrombectomy Using a Radial-specific Neurointerventional Guiding Sheath for Anterior Circulation Large-Vessel Occlusions: Preliminary Experience and Literature Review.

BACKGROUND: Transradial mechanical thrombectomy (MT) is increasingly used because it is associated with a low incidence of vascular access site complications. However, transradial carotid cannulation can be technically challenging to perform in patients with an unfavorable supra-aortic takeoff. In this study, the feasibility and safety of a new transradial MT system with a radial-specific neurointerventional guiding sheath-6F Simmons guiding sheath was evaluated-in patients with anterior circulation large-vessel occlusions. Additionally, a literature review was performed. METHODS: We retrospectively analyzed data from our institutional database about consecutive patients who underwent transradial MT for anterior circulation large-vessel occlusion. After the 6F Simmons guiding sheath was engaged into the target common carotid artery, a triaxial system (Simmons guiding sheath/aspiration catheter/microcatheter), was established. MT using the continuous aspiration prior to intracranial vascular embolectomy technique was performed. Then, procedural success rate, successful revascularization, and procedure-related complications were assessed. RESULTS: A total of 13 patients who had transradial MT were included in the analysis. All 13 patients underwent successful thrombectomy without catheter kinking or system instability, and 12 of them achieved successful revascularization (modified Thrombolysis in Cerebral Infarction score of ≥2b). No complications occurred. CONCLUSIONS: To the best of our knowledge, this is the first case series on transradial MT using a radial-specific neurointerventional system for anterior circulation large-vessel occlusions. This method may increase the success rate of transradial MT. Based on our initial experience, transradial MT, using this system, was feasible and safe for anterior circulation large-vessel occlusions.

Transradial Stent-Assisted Coiling Using "Dual-Jailing" Technique for Kissing Aneurysms of the Internal Carotid Artery: Technical Note and Literature Review.

BACKGROUND: Kissing aneurysms are an unusual type of multiple intracranial aneurysms having different origins with partially adherent walls. Although endovascular treatment is a useful alternative to surgical clipping, endovascular management for small wide-necked kissing aneurysms has not been adequately investigated to date. Herein, we present a case of small wide-necked kissing aneurysms successfully treated with transradial stent-assisted coiling (SAC) using the "dual-jailing" technique. We also performed a review of the relevant literature. CASE PRESENTATION: A 64-year-old woman who was diagnosed with small wide-necked kissing aneurysms relating to the ophthalmic artery underwent SAC using the dual-jailing technique. After a 6F Simmons guiding sheath was delivered into the target common carotid artery via transradial access, a 6F intermediate catheter was navigated into the petrous internal carotid artery to achieve both triple microcatheter manipulation and contrast injection. Two coil-delivery microcatheters were cannulated into each aneurysm, followed by a Neuroform Atlas stent deployment over the aneurysm necks via a third stent-delivery microcatheter. By using the jailed microcatheters, SAC of the kissing aneurysms was successfully achieved, preserving the ophthalmic artery. The postprocedural course was uneventful. A follow-up magnetic resonance angiography showed no evidence of recanalization 2 years 3 months post procedure. CONCLUSIONS: The dual-jailing technique may provide simple and time-saving SAC compared with previous reported method. This technique can be a useful treatment option for small wide-necked kissing aneurysms.

[A Case of T-Cell Lymphoma Treated by Emergency Surgery Due to Bleeding of Jejunal Lesion].

A 78-year-old man was aware of lightheadedness and darkness at a routine outpatient visit, and his blood pressure was declined at 87/51 mmHg. Contrast-enhanced CT scan showed an extravascular leakage image at jejunum. We diagnosed as small intestinal hemorrhage. Because he was in hemorrhagic shock, emergency surgery was performed. A tumor was found coincident with the bleeding site, and partial resection of the small intestine including enlarged lymph nodes was performed. Based on the pathological findings of T-cell origin and positive for serum anti-HTLV-1 antibody, he was suspected as adult T-cell leukemia/lymphoma(ATLL). Endoscopic examination of the upper and lower gastrointestinal tracts, bone marrow examination, and PET-CT scan were performed, but no other lesions were found. We report a case of the T-cell lymphoma with suspected solitary ATLL of the jejunum.

The Current Status in Intraoperative Image-Guided Neurosurgery Associated with Progressive Operating Rooms: A Retrospective Analysis.

OBJECTIVE: Shinshu University Hospital has advanced operating rooms including a mobile computed tomography (mCT) room, Smart Cyber Operating Theater (SCOT) with intraoperative magnetic resonance imaging, hybrid operating room (hOR) with intraoperative image-guided surgery, and conventional operating rooms. We investigated the characteristics of cases assigned to each operating room. METHODS: Five hundred forty neurosurgery cases from January 2018 to April 2021 were analyzed. We analyzed the selection of operating room according to pathology, surgical device requirement, and urgency, and we examined associations between operating room characteristics and these factors. RESULTS: Neurological surgeries were performed in an mCT room, an hOR, a SCOT, and a conventional operating room in 333 (61.7%), 64 (11.9%), 49 (9.1%), and 94 (17.4%) cases, respectively. mCT rooms were more frequently selected than other rooms for vascular/extra-axial tumors, which have a lower need for intraoperative image guidance. Spinal surgeries with segment diagnosis or intraoperative bone removal tended to be performed in the hOR. The rate of SCOT use tended to be higher for intra-axial tumors with poorly circumscribed borders than for vascular/extra-axial tumors. Endoscopic procedures were more frequently performed in the SCOT and mCT rooms than in hORs and conventional operating rooms. Emergency surgeries were often performed in the conventional operating rooms, even in cases where SCOT and hOR seemed suitable. CONCLUSIONS: Intraoperative image-guided surgeries were performed according to the characteristics of each operating room best suited for various diseases and operative methods. Further research is needed to prove whether operating room selection improves neurosurgical outcomes.

Sequential Development of Putaminal Hemorrhage and Corona Radiata Infarction in the Same Lenticulostriate Arterial Territory.

Putaminal hemorrhage is a common type of spontaneous cerebral hemorrhage. However, to our knowledge, there have been no reports of sequential cerebral hemorrhage and infarction in the same perforating arterial territory. Herein, we present the first reported case of the sequential development of putaminal hemorrhage and corona radiata infarction in the same lenticulostriate arterial (LSA) territory. Early intensive blood pressure lowering treatment may have aggravated ischemic damage. If a patient presents with motor weakness that cannot be explained by putaminal hemorrhage, the sequential development of corona radiata infarction in the same LSA territory should be ruled out.

Successful management of testicular primitive neuroectodermal tumor with multiple bone metastases.

Introduction: Germ cell tumor with malignant transformation is extremely rare. We present a case of testicular primitive neuroectodermal tumor with multiple metastases that was effectively managed by surgery, irradiation, and second-line chemotherapy. Case presentation: A 22-year-old man was diagnosed as having teratoma including primitive neuroectodermal tumor with lymph node and multiple bone metastases. Five months afterwards the first-line therapy, his skull metastasis recurred. Vincristine, doxorubicin, and cyclophosphamide therapy followed by vincristine, actinomycin D, and cyclophosphamide therapy was given as second-line chemotherapy. Computed tomography revealed no disease progression 3 months after the treatments. Conclusion: Metastatic primitive neuroectodermal tumor may be successfully managed by multidisciplinary cancer treatment.

Cerebral Edema Due to Chemotherapeutic Wafer Implantation for Malignant Glioma: Registry Study of Correlation with Perioperative Epileptic Seizures.

Factors predicting adverse events following implantation with wafers containing 1,3-bis(2-chloroethyl)-1-nitrosourea (carmustine, BCNU), which is used in local chemotherapy for malignant gliomas (MGs), are unknown. The association between cerebral edema (CE), which often occurs after implantation, and perioperative seizures, which are often observed in MG cases, is under debate. This study investigated risk factors for CE associated with BCNU wafer implantation and their relationship with perioperative seizures. A total of 31 surgical cases involving 28 adult patients who underwent BCNU wafer implantation for MGs were investigated and classified into those with and without postoperative transient CE. We assessed the correlations between CE caused by BCNU implantation and various factors, including postoperative epileptic seizures. World Health Organization (WHO) grade III MGs significantly affected postoperative CE (p = 0.003) and the occurrence of seizures (p = 0.0004). Factors predictive of postoperative seizures were WHO grade III MGs (p = 0.0026), increased postoperative CE (p = 0.0272), and history of preoperative seizures (p = 0.0316). Postoperative CE, WHO grade III MGs, and a history of preoperative seizures might predict the postoperative occurrence of seizures, necessitating stringent management of seizures and CE in the affected patients.

A preliminary study of the diagnostic efficacy and safety of the novel boring biopsy for brain lesions.

Existing methods for biopsy of intraparenchymal brain lesions, including stereotactic biopsy and open block biopsy, have advantages and disadvantages. We propose a novel biopsy method, called "boring biopsy," which aims to overcome the drawbacks of each conventional method. This method is less invasive and allows obtaining continuous specimens of sufficient volume. We aimed to assess the feasibility and efficacy of using boring biopsy for intraparenchymal brain lesions. We included 26 consecutive patients who underwent boring biopsy for intraparenchymal lesions. Columnar continuous specimens from the surface of the normal brain tissue to the tumor margin and the center of the lesion were obtained using the boring biopsy method. We used a catheter introducer with original modifications to create a cylindrical biopsy tool for surgery. Columnar continuous specimens were successfully obtained. Histopathological diagnosis was based on cellular changes and differentiation from normal tissues to the core of the lesion and established in all cases. No permanent deficits, major adverse outcomes, or deaths were observed. This novel technique may improve diagnostic accuracy and reduce invasiveness associated with brain biopsy. This method may become the next standard procedure, particularly in some cases where histological evaluation is paramount, and conventional biopsy methods are not suitable.

Contralateral Transradial Access for Coil Embolization of Distal Anterior Cerebral Artery Aneurysm Associated With a Steep Ipsilateral A1-A2 Angle.

OBJECTIVE: Endovascular treatment of distal anterior cerebral artery aneurysms is commonly addressed via the ipsilateral A1 segment of the anterior cerebral artery. However, when the parent pericallosal artery has a sharp ipsilateral A1-A2 angle, catheterization through the ipsilateral A1 segment can potentially result in vessel injury, catheter kinking, and/or compromised/stagnant anterior cerebral artery flow. Here, we present a case of a distal anterior cerebral artery aneurysm associated with a steep ipsilateral A1-A2 angle treated with contralateral transradial coil embolization. CASE PRESENTATION: A 91-year-old woman presented with a ruptured left distal anterior cerebral artery aneurysm at the A3 segment. The parent pericallosal artery had a steep ipsilateral A1-A2 angle. To safely achieve coil embolization of the aneurysm, a contralateral transradial system via the right A1 segment was employed. Although a secondary ipsilateral transradial system was required for contrast injection, aneurysm obliteration was successfully achieved without vessel injury or system instability. CONCLUSION: The A1-A2 angle can be a key anatomical factor in the endovascular treatment of distal anterior cerebral artery aneurysms. The contralateral transradial system is a useful treatment option for distal anterior cerebral artery aneurysms associated with sharp ipsilateral A1-A2 angles. However, if the distal anterior cerebral artery aneurysm cannot be clearly visualized through the contralateral system, an ipsilateral system will be required for contrast injection.

Intraoperative Image-Guided Surgery for Gliomas in the Smart Cyber Operating Theater (SCOT): A Preliminary Clinical Application.

BACKGROUND: Various devices exist for glioma image-guided surgery to improve tumor resection. These devices work as stand-alone units, making the flow of operative information complicated and disjointed. A novel networked operating room, the Smart Cyber Operating Theater (SCOT), has been developed, integrating stand-alone medical devices using the OPeLiNK communication interface. We report and evaluate the impact of SCOT for glioma surgery and our initial experiences. METHODS: Patients with gliomas who underwent tumor resection in SCOT between July 2018 and June 2021 were retrospectively reviewed. Various types of intraoperative information were integrated, managed, and shared with the surgical strategy desk using OPeLiNK. Patients' demographics, tumor characteristics, treatment details, and outcomes were obtained. The impact of the SCOT system was evaluated. RESULTS: Twenty-seven patients, with a mean age of 48.6 years (range, 13-88 years), met the inclusion criteria. We successfully completed all the surgical procedures using SCOT. The mean operation time was 420.6 minutes (range, 225-667 minutes).Gross total resection was accomplished in 13 patients (48.1%), subtotal resection in 4 (14.8%), and partial resection in 10 (37.0%). The main surgeon in the operating room and other neurosurgeons at the strategy desk shared and discussed the information in real time during the procedures. CONCLUSIONS: The use of SCOT was shown to be safe and feasible in glioma surgery. This study suggests that SCOT may improve surgical outcomes and educational impact by sharing information in real time with the strategy desk.