Postoperative LINAC-Based Stereotactic Radiotherapy for Grade I Intracranial Meningioma in Subtype Classification.

Objective: To evaluate outcomes of postoperative radiotherapy (RT) for residual WHO grade I meningioma based on subtype classification and relevant factors that may influence the outcomes. Material and Method: Medical records from 252 patients, with known histology of intracranial meningioma, who underwent stereotactic RT in Ramathibodi Hospital between 1998 and 2008, were reviewed. One hundred and two out of 252 patients were included. The data were categorized into 2 groups: common subtype (meningothelial and transitional subtypes) and uncommon subtype (fibroblastic, psammomatous, angiomatous, microcystic, secretory, lymphoplasmacyte-rich and metaplastic subtypes). Analysis of tumor control rate, tumor shrinkage rate and risk factors of treatment failure were conducted. Results: The median of follow-up period was 46 months (interquartile range (IQR): 53). The five-year tumor-control rates of overall, common and uncommon subtypes were 89.9%, 92.9% and 81.5%, respectively, which showed no significant difference between the two groups, p = 0.108. The five years tumor shrinkage rates of overall, common, and uncommon subtypes were 42.5%, 42.3% and 42.7%, respectively, there was no significant difference, p = 0.934. In univariate analysis, gender (male), total minimal dose and fraction demonstrated statistically significant impact on treatment failure. However, only a total minimal dose had any significant effect in multivariate analysis. Conclusion: Radiotherapy is highly effective in controlling postoperative residual meningioma. This study may be useful to evaluate patients' prognosis and possibility of recurrence based on histology subtypes. In addition, total minimal dosage was the sole risk factor of treatment failure found in the present study.

Intracranial Aneurysm Model for Detachable Coil Testing.

Intracranial aneurysm is major vascular disease which is life-threatening and challenging treatment. Detachable coil is one of the standard treatments. Because of little knowledge about it, the detachable coils were evaluated by various methods. Animal aneurysm models were also used to test this equipment. In the present study, sidewall aneurysms were created on common carotid arteries of Landrace-Yorkshire-Durocswine. External jugular vein grafts were used as aneurysm sac. End-to-side anastomosis was done. Ten aneurysms were created successfully in 5 swine. There is no perioperative death. This animal aneurysm model is appropriated for coil testing especially in the histopathology aspect.

Spinal Extramedullary Arteriovenous Fistulas: A 15-Year Endovascular Treatment Experience in a Tertiary Care Hospital in Thailand.

BACKGROUND: Spinal arteriovenous shunts are rare diseases. Different classifications have been proposed, but the most widely used are those classified by locations. Different locations (i.e., intramedullary and extramedullary) have different treatment outcomes and different posttreatment angiographical results. Our study presents the 15-year endovascular treatment outcomes of patients who had spinal extramedullary arteriovenous fistulas (AVFs) at Ramathibodi Hospital, which is a tertiary care hospital in Thailand. METHODS: A retrospective medical record and imaging review of all patients with spinal extramedullary AVFs, which were confirmed by a diagnostic spinal angiogram in our institute from January 2006 to December 2020, were performed. The angiographic complete obliteration rate in the first session of endovascular treatment, clinical outcomes of the patients, and complications of the procedures for all eligible patients were analyzed. RESULTS: Sixty-eight eligible patients were included in the study. The most common diagnosis was spinal dural AVF (45.6%). The most common presenting symptoms were weakness, numbness, and bowel-bladder involvement (70.6%, 67.6%, and 57.4%, respectively). Ninety-four percent had spinal cord edema in preoperative magnetic resonance imaging. All patients had pial venous reflux. Sixty-four patients (94.1%) received endovascular treatment as the first option. The complete obliteration rate in the first session of endovascular treatment was 75% and was high in all subgroups except for the perimedullary AVF group. The overall intraoperative complication of endovascular treatment was 9.4%. Follow-up imaging showed no residual AVF in 50 patients (87.7%). Most of the patients (57.4%) had improvement of neurological functions at 3- to 6-month follow-up. CONCLUSION: Treatment results of spinal extramedullary AVFs were good in terms of angiographic aspects and clinical outcomes. This may have resulted from the locations of the AVFs, which mostly did not involve the spinal cord arterial supply, with the exception of perimedullary AVFs. Although perimedullary AVF is difficult to treat, it can be cured by careful catherization and embolization.

VIsion Salvage Using Intra-Ophthalmic Arterial Alteplase Combine with Nimodipine in Central Retinal Artery Occlusion (VISION).

Purpose: To investigate the efficacy and safety of selective intra-ophthalmic arterial combined nimodipine and alteplase infusion in patients with central retinal artery occlusion (CRAO). Design: Non-randomized, prospective interventional study. Methods: All patients with CRAO who presented at our institute within 24 hours from CRAO onset from August 2020 to July 2022 were included. Intra-arterial nimodipine and alteplase were given selectively into the ophthalmic artery. Visual acuity was recorded during and after the procedure. Change in best corrected visual acuity (BCVA) 1 month post-treatment, relative to baseline, was set as the primary outcome measure. Significant improvement in vision and adverse events are reported as secondary outcomes. Patients: Nine patients with non-arteritic CRAO were enrolled. Results: A total of nine patients with CRAO underwent selective intra-ophthalmic arterial nimodipine and alteplase injection. Overall, BCVA had statistically significantly improved by 0.78 logarithm of the minimum angle of resolution (logMAR) at 1 month compared with baseline (95% confidence interval: (-1.24, -0.31), p-value = 0.001). Seven (77.8%) patients had significant visual improvement (≥0.3 logMAR) at 1-month post-treatment. There were minor adverse events during administration of the nimodipine, including chemosis and headache, which resolved after the discontinuation of nimodipine. There were also asymptomatic thromboembolic events in 2 patients (22.2%) after the intervention procedure, without any morbidity or mortality. Conclusion: The use of selective intra-ophthalmic arterial combined nimodipine and alteplase was efficacious in improving BCVA at 1 month for patients with non-arteritic CRAO presenting between 24 hours from onset, with minor adverse events but no serious adverse events.

Dolichoectasia of the internal carotid artery terminus, posterior communicating artery, and posterior cerebral artery: The embryonic caudal ramus internal carotid segmental vulnerability legacy.

Dolichoectasia of the distal internal carotid artery, posterior communication artery (PCoA) and posterior cerebral artery is an extremely rare abnormality. Dolichoectasia of the internal carotid artery, PCoA and the P1 segment of posterior cerebral artery can be postulated its pathogenesis by the embryological perspective basis from caudal ramus of the internal carotid artery terminus. The pathogenesis and treatment strategy are not well established. We reviewed and proposed embryological perspective, pathogenesis, clinical setting, radiological findings and management of this rare malformation.