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OBJECTIVES: We evaluated the safety and efficacy of endovascular embolization as first-line stand-alone strategy for the treatment of low-grade brain arteriovenous malformations (bAVMs) (Spetzler Martin [SM] grade I and II) in pediatric patients. In addition, we assessed the predictors of procedure-related complications and radiographic complete obliteration in a single session. MATERIAL AND METHODS: We conducted a single center retrospective cohort study of all pediatric (≤18 years) patients who underwent embolization as a stand-alone strategy for low-grade bAVMs between 2010 and 2022. Safety was measured by procedure-related complications and mortality. Efficacy was defined as complete angiographic obliteration after the last embolization session. RESULTS: Sixty-eight patients (41 females; median age 14 years) underwent a total of 102 embolization sessions. There were 24 (35%) SM grade I lesions and 44 (65%) grade II. Six procedure-related complications (5.8% of procedures) were observed and no deaths were reported. All the complications were intraoperative nidus ruptures. A single draining vein was the only significant predictor of procedure-related complications (OR=0.10; 95% CI 0.01 - 0.72; p=0.048). Complete angiographic obliteration was achieved in 44 patients (65%). In 35 patients (51%) the bAVM was completely occluded in one session. The bAVM nidal size was a predictor of complete obliteration in one session (OR=0.44; 95% CI, 0.21-0.80; p=0.017). CONCLUSION: Endovascular treatment as a stand-alone strategy for pediatric low-grade bAVMs is an adequate first-line approach in high volume centers with endovascular expertise. Nidal size evaluation is relevant in order to optimize patient selection for embolization as a stand-alone treatment modality.
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Embolización Terapéutica , Malformaciones Arteriovenosas Intracraneales , Radiocirugia , Femenino , Humanos , Niño , Adolescente , Estudios Retrospectivos , Resultado del Tratamiento , Malformaciones Arteriovenosas Intracraneales/terapia , Malformaciones Arteriovenosas Intracraneales/cirugía , Encéfalo , Angiografía , Embolización Terapéutica/efectos adversos , Embolización Terapéutica/métodosRESUMEN
PURPOSE: This study aimed to report the incidence of technical complications and immediate complete angiographic occlusion, identify associated factors with failure of complete occlusion and identify predictors of technical complications in a single-center experience of pediatric arteriovenous malformations (AVM) treated with endovascular treatment with intent to cure. METHODS: Patients between 1 and 18 years of age undergoing endovascular embolization between 2011 and 2020 were included. RESULTS: A total of 120 embolizations were performed in 69 patients. The most frequent clinical presentation was intracerebral hemorrhage (76.8%). Immediate obliteration of the malformations was achieved in 40 (58%) cases. The technical complication rate was 15%. AVM nidus size between 3 and 6 cm (OR: 3.91; 95% CI 1.1-13.85; p = 0.035) and the presence of multiple feeders (OR: 5.08; 95% CI 1.41-18.28; p = 0.074) were predictive of failure of immediate complete occlusion. The location of the temporal lobe (OR: 7.83; p = 0.048), deep venous drainage (OR: 4.67; p = 0.112), and the presence of an intranidal aneurysm (OR: 3.58; p = 0.134) were predictors of technical complications. CONCLUSIONS: Embolization of pediatric AVMs with intent to cure shows a high rate of technical complications and acceptable immediate occlusion rates. Nidus size and the presence of multiple feeders were predictive of failure of complete occlusion, while temporal lobe location, deep venous drainage, and the presence of an intranidal aneurysm were predictors of technical complications. Further studies are needed to determine the best therapeutic approach in the pediatric population.
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Embolización Terapéutica , Malformaciones Arteriovenosas Intracraneales , Niño , Humanos , Malformaciones Arteriovenosas Intracraneales/diagnóstico por imagen , Malformaciones Arteriovenosas Intracraneales/terapia , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
The intracerebral hemorrhage (ICH) score and the ICH-grading scale (ICH-GS) are mortality predictor tools developed predominantly in conservatively treated ICH cohorts. We aimed to compare and evaluate the external validity of both models in predicting mortality in patients with ICH undergoing surgical intervention. A retrospective review of all patients presenting with spontaneous ICH admitted to a Peruvian national hospital between January 2018 and March 2020 was conducted. We compared the area under the receiver operating characteristic curve (AUC) for the ICH score and ICH-GS for in-hospital, 30-day, and 6-month mortality prediction. The research protocol was approved by the Institutional Review Board. A total of 73 patients (median age 62 years, 56.2% males) were included in the study. The mean ICH and ICH-GS scores were 2.5 and 8.7, respectively. In-hospital, 30-day, and 6-month mortality were 37%, 27.4%, and 37%, respectively. The AUC for in-hospital, 30-day, and 6-month mortality was 0.69, 0.71, and 0.69, respectively, for the ICH score and 0.64, 0.65, and 0.68, respectively, for the ICH-GS score. In this study, the ICH score and ICH-GS had moderate discrimination capacities to predict in-hospital, 30-day, and 6-month mortality in surgically treated patients. Additional studies should assess whether surgical intervention affects the discrimination of these prognostic models in order to develop predictive scores based on specific populations.
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Hemorragia Cerebral , Femenino , Humanos , Masculino , Persona de Mediana Edad , Perú/epidemiología , Pronóstico , Curva ROC , Estudios RetrospectivosRESUMEN
INTRODUCTION: A double origin of the posterior inferior cerebellar artery (DOPICA) is a rare anatomical variant. Posterior fossa arteriovenous malformations (AVMs), especially cerebellar AVMs, are also not common. Consequently, the association of a DOPICA with a cerebellar AVM is even rare. CASE PRESENTATION: We present a rare case of a pediatric cerebellar AVM supplied by a branch of a DOPICA which was treated endovascularly with NBCA. Total obliteration was achieved in the immediate controls and at 1-year follow-up. CONCLUSION: Navigation through tortuous and long branches from a DOPICA is technically feasible. Although NBCA cure rates are relatively low, when the microcatheter can no longer navigate through the feeding artery, a correct dilution of NBCA with lipiodol can provide adequate penetration of this embolic agent, to obliterate the AVM nidus completely.
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Embolización Terapéutica , Malformaciones Arteriovenosas Intracraneales , Cerebelo/diagnóstico por imagen , Niño , Humanos , Malformaciones Arteriovenosas Intracraneales/diagnóstico por imagen , Malformaciones Arteriovenosas Intracraneales/cirugía , Resultado del Tratamiento , Arteria VertebralRESUMEN
INTRODUCTION: Arteriovenous malformations (AVMs) are the commonest cause of hemorrhagic stroke in children. Endovascular embolization is a feasible treatment modality, but cure rates are heterogenous from one series to another. We aimed to describe the immediate obliteration rates and periprocedural complications of embolization of pediatric AVMs. METHODS: Between 2011 and 2019, participants below 18 years of age with AVMs treated by the same neurosurgeon at a single center were included. The clinical features, immediate angiographic results, and periprocedural complications were retrospectively collected from the clinical records. RESULTS: Thirty-four embolization sessions were performed on 20 children (12 females with a mean age of 13). Intracranial hemorrhage was the most common presentation (75%), and the majority were frontal (30%) and basal ganglia (30%) lesions. An immediate complete angiographic obliteration was achieved in 9 patients (45%) with low-grade lesions (Spetzler-Martin grade I and II). NBCA was the most common embolic agent used (52.9%). Complications were reported in 3 (8.8%) out of 34 sessions. Two of them were intraoperative perforations with clinical consequences. A slight cortical hemorrhage during the procedure was observed in 1 patient without clinical repercussions. DISCUSSION: This single-surgeon single-center experience suggests that endovascular treatment is a safe and efficient treatment for pediatric AVMs. Pediatric prognostic scores for a suitable selection of candidates are needed. Further studies are required to validate these results.
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Embolización Terapéutica , Malformaciones Arteriovenosas Intracraneales , Niño , Embolización Terapéutica/efectos adversos , Femenino , Humanos , Malformaciones Arteriovenosas Intracraneales/diagnóstico por imagen , Malformaciones Arteriovenosas Intracraneales/cirugía , Microcirugia , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
This article assesses the association between anterior circulation morphometry and the presence of intracranial aneurysm using three-dimensional rotational angiography (3DRA). A retrospective analysis at a Peruvian academic medical center between December 2018 and February 2020 identified 206 patients with unruptured intracranial aneurysms and matched controls who underwent 3DRA. Angiographic images were obtained per standard of care, and measurements of the vasculature were performed using 3DRA vascular automated software. A total of 163 aneurysms and 43 control angiograms were evaluated. Women represented 82.5% of the cases and the mean age was 55.9 years (standard deviation ± 14.2). In multivariate analysis, five specific features were found to be statistically significant predictors for presence of an anterior circulation aneurysm: female sex (odds ratio [OR] = 2.71; p = 0.048), C-shape of the middle cerebral artery (MCA) (OR = 2.73; p = 0.018), distal internal carotid artery (ICA) diameter (OR = 3.42; p = 0.012), ICA bifurcation angle (OR = 1.02; p = 0.036), and length of the carotid siphon (OR = 1.08; p = 0.047). Features detected on 3DRA suggest morphological characteristics of the ICA and MCA may be predictive for intracranial aneurysm. Our findings build from prior reports by demonstrating five specific patient and imaging features associated with anterior circulation aneurysms. While 3DRA is the standard of care in many settings, medical centers with resource limitations may not have access to this technique. The demographic and morphological features identified in our study may have correlates that if detected on contrast computed tomography or magnetic resonance imaging studies, may be used to help screen for a higher level of care in select patients.
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INTRODUCTION: Multiple scales have been designed to stratify the severity and predict the prognosis in the initial evaluation of patients with aneurysmal subarachnoid hemorrhage (aSAH). Our study aimed to validate the most commonly used prognostic scales for aSAH in our population: Hunt-Hess, modified Hunt-Hess, World Federation of Neurosurgical Societies (WFNS), Prognosis on Admission of Aneurysmal Subarachnoid Hemorrhage (PAASH), and Barrow Aneurysm Institute (BAI) scales. METHODS: This study includes all aSAH cases treated at our institution between June 2019 and December 2020. We developed a retrospective cohort by reviewing medical records and radiologic images performed during hospitalization. The outcome was evaluated using the modified Rankin scale (mRS). It was defined as a poor outcome (mRS 4-5) and mortality (mRS 6). The ROC curves and the area under the curve (AUC) of each of the prognostic scales were calculated to evaluate their prognostic prediction capacity. RESULTS: A total of 142 patients were diagnosed with aSAH. A poor outcome occurred in 52.1% of the patients, whereas mortality was 27.5%. The AUC of the scales studied was similar and no significant difference was found between them for predicting a poor outcome (P = .709) or mortality (P = .715). CONCLUSION: We determined that the prognostic scales for aSAH had a similar predictive value for poor clinical outcomes and mortality in our institution, with no significant difference. Thus, we recommend the most simple and well-known scale used institutionally.
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Hemorragia Subaracnoidea , Humanos , Pronóstico , Hemorragia Subaracnoidea/diagnóstico por imagen , Resultado del Tratamiento , Estudios Retrospectivos , PerúRESUMEN
OBJECTIVE: This study aimed to determine the bibliometric characteristics of scientific articles on systematic reviews of neurosurgery worldwide. METHODS: Bibliographic searches were performed in journals indexed by the Web of Science database until 2022, with no language restrictions. A total of 771 articles were ultimately included on the basis of predefined inclusion criteria, which were manually reviewed. The bibliometric analysis involved the use of quantitative bibliometric indicators and network analysis, which were performed using the bibliometrix package in R and VOSviewer, respectively. RESULTS: The first publication was in 2002, and the number of publications increased over time, with the largest number of publications in 2021 (156 articles). The average number of citations per document was 17.36, and the annual growth rate was 6.82%. Nathan A. Shlobin was the author with the most published articles (19 articles). The most cited study was published by Jobst BC (2015). WORLD NEUROSURGERY was the journal with the most publications (51 articles). The country of corresponding authors with the most publications and the greatest number of total citations was the United States. The affiliations with the most articles were University of Toronto (67 articles) and Harvard Medical School (54 articles). CONCLUSIONS: The increasing trend during the past 20 years, and especially in the past 2 years, highlights the advancements in various subspecialities in the field. Our analysis revealed that North American and Western European countries are at the forefront of the field. There is a poor output of publications, authors, and affiliations in Latin-American and African countries.
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Neurocirugia , Humanos , Revisiones Sistemáticas como Asunto , Bibliometría , Lenguaje , Bases de Datos FactualesRESUMEN
BACKGROUND: Transvenous embolization (TVE) of brain arteriovenous malformations (bAVMs) is an emerging endovascular technique that has shown high cure rates in selected cases. The rationale of our study was to determine authorship and worldwide institutional trends and contributions to the knowledge in this topic. METHODS: Web of Science database was used. A total of 63 articles were included based on predefined inclusion criteria, which were manually reviewed. The bibliometric analysis involved the use of quantitative bibliometric indicators and network analysis with co-authorship and co-occurrence of terms, which were performed using the bibliometrix package in R and VOSviewer, respectively. RESULTS: The first article was published in 2010, with the largest number of articles published in 2022 (10 articles). The average number of citations per document was 11.38, and the annual growth rate was 14.35%. The top 10 authors with the most scientific production on TVE of bAVMs were from France, and the most cited study was published by Iosif C in 2015, followed by Consoli A in 2013, and Chen CJ in 2018. Journal of Neurointerventional Surgery was the journal with the most articles published. The most commonly used keywords were dural arteriovenous fistula, Onyx, vascular disorders, and neurological surgery around 2016, and intervention around 2021. CONCLUSIONS: TVE of bAVMs is an emerging technique. Our search identified some scientific articles, without randomized clinical trials, but many case series from single institutions. French and German institutions are the pioneers in the field, and further research is required in specialized endovascular centers.
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Background: Basal ganglia and thalamic arteriovenous malformations (AVM) represent 10% of all AVM. They are associated with a high rate of morbidity and mortality due to their high hemorrhagic presentation and eloquence. Radiosurgery has been the first line treatment, whereas surgical removal and endovascular therapy are possible in selected cases. Deep AVM with small niduses and a single draining vein can achieve cure with embolization. Case Description: A 10-year-old boy with sudden headache and vomiting underwent a brain computed tomography scan that showed a right thalamic hematoma. Cerebral angiography revealed a small ruptured right anteromedial thalamic AVM with a single feeder arising from the tuberothalamic artery and a single drainage to the superior thalamic vein. Transvenous approach using precipitating hydrophobic injectable liquid 25%® achieved a complete obliteration of the lesion in a single-session. He was discharged home without neurological sequelae and maintained clinically intact at follow-up. Conclusion: Transvenous embolization of deep-located AVM as a primary treatment is curative in selected cases, with complication rates comparable to other therapeutic strategies.
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The aim of the study was to evaluate radiographic clearance and clinical outcomes in patients over age 80 who undergo SQUID 18 embolization of the middle meningeal artery (MMA) for the management of chronic subdural hematoma (cSDH). From April 2020 to October 2021, data were obtained from patients with cSDH who underwent MMA embolization at our institution. Clinical and radiological data including pre-operative and last follow-up CT scans were analyzed. Six embolization procedures were performed in five patients using SQUID 18, a liquid embolic agent. The median age was 83 years, and three subjects were female. Two of the six cases were recurrent hematomas. MMA embolization was achieved in 100% of cases. The median diameter of the hematoma at admission was 20 mm and at last follow-up was 5.3 mm, demonstrating statistically significant radiographic clearance (P = 0.043). There were no intra or post-operative complications. Mortality was not noted during observation period. SQUID MMA embolization safely and significantly reduced the hematoma diameter and offers an alternative treatment in patients older than 80 years with cSDH.
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Objectives: Endovascular treatment of intracranial aneurysms (IAs) has evolved in recent years and is currently the preferred treatment worldwide. We analyzed the trends in the number of patients, number of aneurysms, aneurysm characteristics, and techniques used in a pure endovascular cohort of patients treated in a reference center. Materials and Methods: Between 2010 and 2020, a retrospective data collection of patients who underwent endovascular intervention of IAs was performed. We used the Mann-Kendal test to evaluate the trends. In addition, the moving-average technique was used to assess smoother curves. Results: Eight hundred and forty-five aneurysms were treated in 765 patients, the mean age was 53.9 ± 14.6 years and 81% were women. The number of patients (P = 0.016) and aneurysms (P = 0.003) increased significantly. Unruptured (P = 0.029) and posterior communicating artery aneurysms increased their frequency of treatment (P = 0.042). Balloon remodeling (P = 0.01) and the use of flow diverters showed a positive trend (P = 0.016). Conclusion: There have been an increased number of patients and aneurysms treated endovascularly at our institution, including unruptured and posterior communicating aneurysms. Advanced endovascular techniques also increased. Comparative studies including surgical cases must be done in our region to determine the best approach.
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INTRODUCTION: Posterior inferior cerebellar artery (PICA) aneurysms are uncommon vascular lesions of the posterior fossa. In addition to aneurysmal morphology, structural anatomic considerations may confer additional procedural risk, and as a result there is currently no consensus as to whether a surgical or endovascular approach offers greater safety and efficacy for patients. EVIDENCE ACQUISITION: We systematically examined peer-reviewed literature describing PICA aneurysm treatment planning from January 2000 to May 2021 using the PRISMA methodology. A meta-analysis of proportions was performed. Certainty of the evidence was assessed using the GRADE approach. EVIDENCE SYNTHESIS: Fifty-eight studies including 1673 PICA aneurysms were analyzed. Overall treatment occlusion rate was 97% (95% confidence interval [CI]: 93-100%) for surgery and 85% (95% CI: 78-92%) for endovascular therapy. The recurrence rate was 6% in the endovascular group and 1% for surgery. Overall morbidity and mortality were 16% and 7%, respectively. Intraoperative complications occurred in 9% of the surgical patients. CONCLUSIONS: Despite a large body of literature, analysis indicates that 62% of studies had moderate or serious risk of bias, suggesting very-low certainty results. Therefore, treatment via either approach should be determined on a case-by-case basis and according to institutional experience.
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Embolización Terapéutica , Procedimientos Endovasculares , Aneurisma Intracraneal , Humanos , Aneurisma Intracraneal/terapia , Resultado del Tratamiento , Embolización Terapéutica/métodos , Procedimientos Endovasculares/métodos , Arteria Vertebral/cirugíaRESUMEN
INTRODUCTION: Embolization with the intention to cure has not been well studied in ruptured arteriovenous malformations (AVMs). Furthermore, the role of primary curative embolization of pediatric AVMs is uncertain. Hence, we aimed to characterize the safety and efficacy of curative embolization of ruptured pediatric AVMs and assess predictors of obliteration and complications. METHODS: A retrospective analysis of all pediatric (≤18 years) patients who underwent curative embolization of ruptured AVMs was conducted in two institutions between 2010 and 2022. The efficacy (complete angiographic obliteration after the last embolization session), recurrence (radiological recurrence of the lesion after confirmed obliteration in follow-up imaging), and safety (procedure-related complications and mortality) of the procedure were evaluated. RESULTS: Sixty-eight patients (38 females; mean age 12.4 ± 3.4 years) underwent a total of 109 embolization sessions. Median follow-up time was 18 months after embolization (ranged from 2 to 47 months). Complete angiographic obliteration was achieved in 42 patients (62%). In 30 patients (44%) the AVM was occluded with a single embolization session. Recurrence of a totally embolized lesion occurred in 9 patients (13%). Thirteen complications (11.9% of procedures) were observed, and no deaths were reported. A nidus size > 2 cm was the only independent predictor of complete obliteration (OR = 0.16; 95% CI 0.03 - 0.77; p = 0.030). CONCLUSION: Embolization of pediatric ruptured AVMs with curative intent can achieve acceptable obliteration rates. However, recurrence after complete obliteration and procedure-related complications of curative embolization of these lesions cannot be ignored. Ruptured AVMs ≤ 2 cm are adequate to achieve complete obliteration with curative endovascular management.
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Embolización Terapéutica , Malformaciones Arteriovenosas Intracraneales , Radiocirugia , Femenino , Humanos , Niño , Adolescente , Resultado del Tratamiento , Estudios Retrospectivos , Malformaciones Arteriovenosas Intracraneales/diagnóstico por imagen , Malformaciones Arteriovenosas Intracraneales/terapia , Embolización Terapéutica/métodos , Angiografía , Radiocirugia/métodos , Estudios de SeguimientoRESUMEN
OBJECTIVE: We aimed to compare the efficacy and safety of microsurgical clipping versus endovascular treatment (EVT) for paraclinoid aneurysms. METHODS: A systematic search for studies including patients with paraclinoid aneurysms treated with a microsurgical or endovascular technique was conducted in 6 databases from inception to February 2022. Efficacy outcomes included complete angiographic occlusion at last follow-up, favorable functional outcome, and recurrence of the aneurysm. For safety, we assessed a composite of intraoperative and postoperative complications. Data were pooled using a random-effects model. RESULTS: A total of 95 studies including 6711 patients, 3029 in the surgical group and 3682 in the EVT group were found. Pooled rates of complete occlusion were 94% (95% CI 91%-96%; I2 = 0%) in the surgical group and 69% (95% CI 63%-74%; I2 = 79%) in the EVT group, respectively. The favorable functional outcome rate was 86% (95% CI 76%-92%; I2 = 72%) with surgical treatment and 95% (95% CI 92%-97%; I2 = 61%) with EVT. The rate of aneurysm recurrence with surgical treatment was 1% (95% CI 0%-4%; I2 = 0%) and 12% (95% CI 9%-16%; I2 = 57%) with EVT. The composite safety outcome rate in the surgical group was 24% (95% CI 18%-30%; I2 = 90%) and 10% (95% CI 8%-13%; I2 = 71%) in the EVT group. CONCLUSIONS: Our findings suggest that microsurgical clipping seems to have a higher efficacy than EVT in terms of angiographic occlusion and aneurysm recurrence; however, EVT seems to be safer in terms of intraoperative and postoperative complications. Considering the heterogeneity and low-level evidence of the data available, further prospective randomized studies are warranted to confirm our findings.
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Embolización Terapéutica , Procedimientos Endovasculares , Aneurisma Intracraneal , Humanos , Aneurisma Intracraneal/diagnóstico por imagen , Aneurisma Intracraneal/cirugía , Aneurisma Intracraneal/complicaciones , Resultado del Tratamiento , Procedimientos Endovasculares/métodos , Embolización Terapéutica/métodos , Complicaciones Posoperatorias/etiologíaRESUMEN
Background Endovascular treatment of vascular pathologies through the transradial approach has been increasingly used and has demonstrated a low rate of complications. Objective To report our initial experience in the endovascular treatment of cerebrovascular diseases with the transradial approach and to determine its safety and feasibility. Methods Consecutive patients who underwent the transradial approach for endovascular treatment of aneurysms and vascular malformations were reviewed at a single institution. Technical success, fluoroscopy time, and access-related complications were analyzed. Results Eight patients underwent endovascular treatment with the transradial approach. One arteriovenous fistula, one superficial temporal artery aneurysm, three arteriovenous malformations, and four aneurysms were treated successfully. The radial artery was successfully approached and a 6-F sheath was used in all the cases. Navigation of guiding catheters (5 and 6 F) was done without complications. The most commonly approached artery was the right internal carotid artery, followed by the right vertebral artery. Postoperative vasospasm was identified in three patients. Mean fluoroscopy time was 34.7 minutes. Conversion to transfemoral approach was not required. No postoperative complications were reported. Conclusions In our initial experience, the transradial approach is a safe and feasible alternative for the endovascular treatment of cerebrovascular pathologies.
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Agenesis of the internal carotid artery (ICA) is a rare condition, whereas the association of this condition and the presence of intracranial aneurysms is higher in comparison to patients with normal vasculature. Endovascular treatment of this particular subgroup of patients has been described, but complications associated during treatment have not. Herein, we describe the endovascular treatment of intracranial aneurysms in two cases complicated with coil protrusion and in-stent thrombosis in the setting of agenesis of the ICA which were treated successfully without clinical compromise. One-year follow-up digital subtraction angiography demonstrated the complete obliteration of both aneurysms. In most of the cases, coil protrusion does not require further intervention; nevertheless, in the setting of ICA agenesis, stent placement is a potential alternative. In-stent thrombosis should be treated promptly with the available tools, in our case intra-arterial Alteplase reperfused the parent vessel.
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Enfermedades de las Arterias Carótidas , Embolización Terapéutica , Procedimientos Endovasculares , Aneurisma Intracraneal , Humanos , Aneurisma Intracraneal/terapia , Aneurisma Intracraneal/cirugía , Arteria Carótida Interna/diagnóstico por imagen , Arteria Carótida Interna/cirugía , Stents , Enfermedades de las Arterias Carótidas/diagnóstico por imagen , Enfermedades de las Arterias Carótidas/cirugía , Complicaciones Intraoperatorias , Resultado del Tratamiento , Angiografía CerebralRESUMEN
Internal carotid dissection is the most common cause of stroke in the young population. Stroke, the presence of a pseudoaneurysm, and decreased artery lumen with cerebral flow impairment are indications for treatment. Medical therapy with antithrombotic drugs and endovascular therapy with stenting are the main available options. The C-Guard stent is an open cell mesh-covered dual layer stent that has been mainly used in cases of internal carotid artery stenosis with a post-operative reduction in stroke incidence. Thus, we present two cases of internal carotid artery dissections of the cervical segment treated with the open cell dual-layer C-Guard stent without complications.
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OBJECTIVE: We sought to determine the safety and effectiveness of the Flexible Cervical Implant in 1- or 2-level cervical segments. METHODS: Retrospective data collection was carried out on consecutive patients who underwent the implantation of the Flexible Cervical Implant in a local private health institution. Demographics, clinical pictures, magnetic resonance images, x-ray images, technical considerations, and postoperative clinical results were reviewed. RESULTS: Twelve patients were treated with 15 implants. The mean age was 57.5 years (range 28-81), and 6 patients were males. The most common level was C5/C6 (7 cases). Radicular pain was the main symptom in all patients. Short-term postoperative clinical outcomes showed improvement in the visual analog scale (VAS) and the Neck Disability Index (NDI). The median VAS score for radicular pain improved from 6 to 2 (P < 0.001), whereas the median NDI showed a significant improvement from 25 to 5 (P < 0.001). No implant-related complications were reported. The mean follow-up was 7.3 months. CONCLUSIONS: The newly developed Flexible Cervical Implant was safe and effective in terms of morbidity and improvement in clinical outcomes. This new cervical artificial disk is promising, and further long-term clinical and radiologic follow-up is needed to determine its benefits.
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Degeneración del Disco Intervertebral , Desplazamiento del Disco Intervertebral , Fusión Vertebral , Reeemplazo Total de Disco , Adulto , Anciano , Anciano de 80 o más Años , Vértebras Cervicales/diagnóstico por imagen , Vértebras Cervicales/cirugía , Discectomía/métodos , Femenino , Humanos , Degeneración del Disco Intervertebral/cirugía , Desplazamiento del Disco Intervertebral/cirugía , Masculino , Persona de Mediana Edad , Dolor/cirugía , Complicaciones Posoperatorias/cirugía , Estudios Retrospectivos , Fusión Vertebral/métodos , Reeemplazo Total de Disco/métodos , Resultado del TratamientoRESUMEN
BACKGROUND: Large volume coils are an alternative to conventional coils for the treatment of intracranial aneurysms. However, there are no published reports documenting occlusion and complication rates in medium and large intracranial aneurysms. Therefore, we present our results in this subgroup of aneurysms. METHODS: A single-center, retrospective analysis of consecutive patients treated with Penumbra coils 400 in aneurysms ≥7 mm was performed. Demographics, aneurysm features, procedural details, intraoperative complications, clinical outcomes, and occlusion rates were analyzed. RESULTS: Thirty-three patients were included for analysis, and a total of 33 intracranial aneurysms were analyzed. Mean age was 57.6 years (SD ± 12.4) and 85% of the patients were women. Large aneurysms represented 46% of cases. Paraclinoid (55%) followed by posterior communicating (30.3%) aneurysms was the most frequently treated. Ruptured and saccular aneurysms were found in 49% and 63% of the cases, respectively. The mean aneurysmal dimensions were 14.2 mm width, 11.9 mm length, 5.4 mm neck, and 2.4 dome-to-neck ratio. A dome-neck ratio <2 was identified in 39% of cases. The mean number of coils per aneurysm was 4.8. Immediate modified Raymond-Roy Grades 1, 2, and 3A were achieved in 15%, 21%, and 64%, respectively. Twenty-six patients were evaluated at a mean follow-up period of 11 months, with an adequate occlusion of 92% and a good clinical outcome (modified Rankin score ≤2) in 96% of patients. CONCLUSION: Endovascular treatment with PC400 coils is an effective and safe option for medium and large intracranial aneurysms with high occlusion rates, few complications, and good clinical outcomes at follow-up.