Blood-Blister Aneurysms of the Internal Carotid Artery in Tibetan and Han Populations : A Retrospective Observational Study

Objective@#: Blood-blister aneurysms (BBAs) of the internal carotid artery (ICA) are challenging lesions with high morbidity and mortality rates. Although research on BBAs is well documented in different populations, the study of BBAs in the Tibetan population is extremely rare. This study aimed to evaluate the characteristics of BBAs and analyze the treatment modalities and long-term outcomes in the Tibetan population in comparison with the Han population. @*Methods@#: The characteristics of patients with BBAs of the ICA from January 2009 to January 2021 at our institution were reviewed. The features of aneurysms, treatment modalities, complications, and follow-up outcomes were retrospectively analyzed. @*Results@#: A total of 130 patients (41 Tibetan and 89 Han patients) with BBAs of the ICA who underwent treatment were enrolled. Compared with the Han group, the Tibetan group significantly demonstrated a high ratio of BBAs among ICAs (8.6%, 41/477 vs. 1.6%, 89/5563; p<0.05), a high ratio of vasospasm (34.1%, 14/41 vs. 6.7%, 6/89; p=0.001), a high risk of ischemic events (43.9%, 18/41 vs. 22.5%, 20/89; p<0.05), and a low ratio of good outcomes (modified Rankin scale, 0–2) at the 1-year follow-up (51.2%, 21/41 vs. 74.2%, 66/89; p<0.05). The multivariate regression model showed that ischemic events significantly contributed to the prediction of outcomes at 1 year. Further analysis revealed that microsurgery and vasospasm were associated with ischemic events. @*Conclusion@#: In comparison with Han patients, the Tibetan population had a high ratio of BBA occurrence, a high incidence of ischemic events, and a high ratio of poor outcomes. The endovascular approach showed more benefits in BBA patients.

Gonadotropin-releasing hormone agonists cotreatment during chemotherapy in borderline ovarian tumor and ovarian cancer patients / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Recently, conservative surgery is acceptable in young patients with borderline ovarian tumor and ovarian cancer. The preservation of these patients' future fertility has been the focus of recent interest. This study aimed to observe the effect of gonadotropin-releasing hormone agonists (GnRHa) cotreatment during chemotherapy in borderline ovarian tumor and ovarian cancer patients.</p><p><b>METHODS</b>Sixteen patients who were treated with fertility preservation surgery for borderline ovarian tumor and ovarian cancer and then administered GnRHa during chemotherapy in Peking University People's Hospital from January 2006 to July 2010 were retrospectively analyzed. This group was compared with a control group of 16 women who were treated concurrently with similar chemotherapy (n = 5) without GnRHa or were historical controls (n = 11). The disease recurrence, the menstruation status and reproductive outcome were followed up and compared between the two groups.</p><p><b>RESULTS</b>There were no significant differences between both groups regarding age, body weight, height, marriage status, classification of the tumors, stage of the disease, as were the cumulative doses of each chemotherapeutic agent. One (1/16) patient in the study group while 2 (2/16) patients in the control group relapsed 2 years after conclusion of the primary treatment (P > 0.05). All of the 16 women in the study group compared with 11 of the 16 patients in the control group resumed normal menses 6 months after the termination of the treatment (P < 0.05). There were 4 spontaneous pregnancies in the study group while 2 in the control group, all of the neonates were healthy.</p><p><b>CONCLUSIONS</b>GnRHa administration before and during chemotherapy in borderline ovarian tumor and ovarian cancer patients who had undergone fertility preservation operation may bring up higher rates of spontaneous resumption of menses and a better pregnancy rate. Long-term follow up and large scale clinical studies are required.</p>

Misdiagnosis and management of iatrogenic pseudoaneurysm of vertebral artery after Harms technique of C₁-C₂ fixation / 中华创伤杂志(英文版)

Harms technique of C₁-C₂ fixation for atlantoaxial complex becomes more popular due to good fusion rate and low vertebral artery injury (VAI) rate. But considering the unique and variable anatomy of atlantoaxial complex, iatrogenic VAI will result in catastrophic consequences and provides particular surgical challenges for surgeons. To our knowledge, comparing with iatrogenic VAI in the screw hole, iatrogenic VAI in the "open space" is much rarer during the Harms technique of C₁-C₂ fixation. In this article, we present a case of iatrogenic vertebral artery pseudoaneurysm after Harms technique of posterior C₁-C₂ fixation. This case of iatrogenic VAI effectively treated by endovascular coil occlusion and external local compression was initially misdiagnosed as VAI by pedicle screw perforation. It can be concluded that intraoperative or postoperative computed angiography is very helpful to diagnose the exact site of VAI and the combination of endovascular coil occlusion as well as external local compression can further prevent bleeding and abnormal vertebral artery flow in the pseudoaneurysm. However, patients treated require further follow-up to confirm that there is no recurrence of the pseudoaneurysm.

Transcatheter Embolization of a Ruptured Internal Pudendal Artery Pseudoaneurysm in a Patient with Neurofibromatosis Type 1

Neurofibromatosis type 1 (NF-1) is an autosomal dominant disorder. Pseudoaneurysms formation and rupture is an unusual complication of neurofibromatosis. To date, pseudoaneurysm of the internal pudendal artery associated with NF-1 has not been reported. In this article, we present a 62-yr-old man with NF-1 suffering from spontaneous hematoma of the perinea and scrotum. A digital substraction angiography disclosed a ruptured pseudoaneurysm of the right internal pudendal artery, which was successfully managed with transcatheter embolization.

Endovascular Treatment of Traumatic Pseudoaneurysm Presenting as Intractable Epistaxis

OBJECTIVE: To investigate the clinical efficacy of individual endovascular management for the treatment of different traumatic pseudoaneurysms presenting as intractable epistaxis. MATERIALS AND METHODS: For 14 consecutive patients with traumatic pseudoaneurysm presenting as refractory epistaxes, 15 endovascular procedures were performed. Digital subtraction angiography revealed that the pseudoaneurysms originated from the internal maxillary artery in eight patients; and all were treated with occlusion of the feeding artery. In six cases, they originated from the internal carotid artery (ICA); out of which, two were managed with detachable balloons, two with covered stents, one by means of cavity embolization, and the remaining one with parent artery occlusion. All of these cases were followed up clinically from six to 18 months, with a mean follow up time of ten months; moreover, three cases were also followed with angiography. RESULTS: Complete cessation of bleeding was achieved in all the 15 instances (100%) immediately after the endovascular therapies. Of the six patients who suffered from ICA pseudoaneurysms, one presented with a permanent stroke and one had an episode of rebleeding requiring intervention. CONCLUSION: In patients presenting with a history of craniocerebral trauma, traumatic pseudoaneurysm must be considered as a differential diagnosis. Individual endovascular treatment is a relatively safe, plausible, and reliable means of managing traumatic pseudoaneurysms.

Giant Cavernous Aneurysm Associated with a Persistent Trigeminal Artery and Persistent Otic Artery

Primitive trigeminal artery (PTA) and primitive otic artery (POA) is a very rare entity in adult life. We present a case of PTA and POA associated with a giant unruptured cavernous aneurysm in a 54-year-old woman. The PTA and the POA arose from the sac of the aneurysm directly, which greatly complicated endovascular therapy management.

Clinical value of virtual three-dimensional instrument and cerebral aneurysm models in the interventional preoperative simulation / 中华放射学杂志

Objective To establish virtual three-dimensional instrument and cerebral aneurysm models by using three-dimensional moulding software,and to explore the effect of the models in interventional preoperative simulation.Methods The virtual individual models including cerebral arteries and aneurysms were established by using the three-dimensional moulding software of 3D Studio MAX R3 based on standard virtual cerebral aneurysm models and individual DSA image.The virtual catheter,guide wire,stent and coil were also established.The study of interventional preoperative simulation was run in personal computer,and included 3 clinical cases.Results The simulation results of the working angle and the moulding angle of the head of catheter and guide wire in 3 cases were identical with that of operation results. The simulation results of the requirement of number and size of coil in 1 case of anterior communicating aneurysm and 1 case of posterior communicating aneurysm were identical with that of operation results.The simulation results of coil for aneurysmal shape in 1 case of giant internal carotid artery aneurysm were more than 2 three-dimensional coils with size of 3mm?3 cm from the operation results,and the position of the second coil in aneurysmal neck was adjusted according to the results of real-time simulation.The results of retrospective simulation of operation procedure indicated that the simulation methods for regular and small aneurysms could become a routine simulation means but more simulation experience was needed to build up for the giant aneurysms.Conclusions The virtual three-dimensional instrument and cerebral aneurysm models established by the general software provided a new study method for neuro-interventional preoperative simulation,and it played an important guidance role in developing neuro- interventional operation.