Treatment of large intracranial aneurysms using the Woven EndoBridge (WEB): a propensity score-matched analysis.

The Woven EndoBridge (WEB) device is primarily used for treating wide-neck intracranial bifurcation aneurysms under 10 mm. Limited data exists on its efficacy for large aneurysms. We aim to assess angiographic and clinical outcomes of the WEB device in treating large versus small aneurysms. We conducted a retrospective review of the WorldWide WEB Consortium database, from 2011 to 2022, across 30 academic institutions globally. Propensity score matching (PSM) was employed to compare small and large aneurysms on baseline characteristics. A total of 898 patients were included. There was no significant difference observed in clinical presentations, smoking status, pretreatment mRS, presence of multiple aneurysms, bifurcation location, or prior treatment between the two groups. After PSM, 302 matched pairs showed significantly lower last follow-up adequate occlusion rates (81% vs 90%, p = 0.006) and higher retreatment rates (12% vs 3.6%, p < 0.001) in the large aneurysm group. These findings may inform treatment decisions and patient counseling. Future studies are needed to further explore this area.

Levetiracetam treatment in an experimental model of sciatic nerve injury: A randomized controlled trial.

AIM: This study examined whether levetiracetam contributes to improvements in the axon-nerve damage in an experimental rat model. MATERIALS AND METHODS: Forty-eight Wistar albino adult male rats weighing 250-300 gr were randomized into six groups having or not having sciatic nerve damages and receiving different (none, 300 and 600 mg/kg) levetiracetam doses, and control (non-levetiracetam). Functional gait analysis and tissue sample analysis with the aid of light microscopy and hematoxylin-eosin dye were evaluated between the groups. Additionally, scanning electron microscopy (SEM) was used for the detailed examination of sciatic nerves. S-100 (Schwann cell marker) immunoreactivities in sciatic nerve was detected by immunohistochemistry. RESULTS: Sciatic functional index of the injured rats receiving 300 mg/kg levetiracetam was -65.59 ± 29.48 and -47.13 ± 21.36 in the 2nd and 6th weeks, respectively (p < 0.001). Also, IMA and TOS levels were significantly higher in the control group compared to those receiving levetiracetam (p = 0.001 and p < 0.001, respectively).      The most significant nerve regeneration was in the group injured and treated with LEV 600 mg/kg (p < 0.05). CONCLUSION: There was a significant improvement in the sciatic functional index, histopathological findings, and parameters showing tissue oxidant status in rats with sciatic nerve injury receiving levetiracetam treatment. Further investigations should be performed to evaluate the contribution of levetiracetam as a treatment modality in sciatic nerve injuries.

Feasibility of freehand CT and 3-T MR guided brain aspiration biopsies with 18/20-gauge coaxial needles.

BACKGROUND AND PURPOSE: An accurate histopathological examination with minimal neuronal damage is essential for optimizing treatment strategies of central nervous system lesions. We investigated the feasibility and safety of CT and 3-tesla (3 T) MR-guided freehand brain aspiration biopsies with 18/20-gauge coaxial needles in performing a single imaging unit. MATERIALS AND METHODS: We reviewed CT and 3 T-MR guided freehand aspiration biopsies with 18/20-gauge coaxial needles of 33 patients (11-female and 22-male, mean and median ages: 53 years, min-max 21-79 years) in our tertiary hospital within an 8-year-period were included in this retrospective study. Lesion sizes, diagnostic yield, morbidity, and mortality rates of these biopsies without a scalp incision, surgical burr-hole, or stereotactic-instrumentation/neuro-navigation guidance were assessed. All biopsies were performed with local anesthesia and sedation within a single imaging unit of our radiology department. All free-hand biopsies were done as in-patient procedures and the patients were closely observed after the biopsies. RESULTS: The mean diameter of the lesions was 27 mm (median 25; range 15-46 mm). The diagnostic yield of all free-hand brain biopsies was 88% [one inconclusive result (90%) for 3 T-MR; three inconclusive results (87%) for CT]. There was no major hemorrhage or hematoma, no clinical deterioration, or no infection in our patients on early- and late-phase examinations. Postprocedural minor hemorrhage with a ≤ 2 cm diameter was observed in two patients. The morbidity rate of the study population is 6%. There was no procedure-related infection or mortality in the post-procedural 3 weeks. CONCLUSIONS: Freehand CT or 3 T-MR guided aspiration biopsy was a safe and feasible method for pathological diagnosis of intracranial lesions. Biopsy workflow was simplified with this technique. It could be considered a valuable alternative for stereotaxic biopsies, especially for centers that do not have stereotaxic equipment or experience.

Long-term efficacy and safety of WovenEndoBridge (WEB)-assisted cerebral aneurysm embolization.

PURPOSE: Long-term compaction, compression, migration, and recurrence rates of the WovenEndoBridge devices remain unknown. The purpose of this study was to detect these rates and safety profiles of the WovenEndoBridge within 7 years period. MATERIALS AND METHODS: Eighty-three aneurysms of 79 patients treated with the WovenEndoBridge device were retrospectively evaluated using an occlusion scale (e.g. complete occlusion, neck remnant, and aneurysm remnant) on angiography images. RESULTS: The residual aneurysm was observed in 11 (13%) aneurysms. The mean and median diameters of the recurrent aneurysms were 6 and 7 mm. Most of the recurrent aneurysms were complex type and/or ruptured. Mean diameters and the neck-to-body ratios of all residual aneurysms in the preoperative imaging exams were above 4 mm and 0.6, respectively. The median values of preoperative height and neck measurements were higher in the recurrent aneurysms than in the adequate occlusion group (p = 0.006, p = 0.019, respectively). There was a statistically significant positive relationship between preoperative height/neck measurements and the mean diameters of residual aneurysms (rs = 0.32 and p = 0.003; rs = 0.28 and p = 0.011, respectively). The WovenEndoBridge compaction/compression and migration were observed in 5 (45%) and 2 (18%) of the recurrent aneurysms. In 7 (64%) of the residual aneurysms, thrombosed areas were found within the aneurysm. In the follow-up period, four aneurysms (4.8%) were retreated due to widened residual aneurysm. Other aneurysms were improved or stable within 7 years. DISCUSSION: Our adequate occlusion rate was 87%. Occlusion rates are less favorable than aneurysms with a long height, wide neck, or high neck-to-body ratio. Our study confirms the high safety and efficiency of the WovenEndoBridge. Compaction, compression, and/or migration of the WovenEndoBridge and the presence of intra-aneurysmal thrombosis are the main reasons for the recurrences.

Feasibility of 3D T1W sequences in contrast-material enhanced MR cisternography at 3T.

BACKGROUND: We investigated the diagnostic values and artifact severities of 3D-T1W sequences in the diagnosis of cerebrospinal fluid (CSF) leakage. METHODS: We retrospectively reviewed 3-tesla contrast-material enhanced MR cisternography exams of 22 patients with suspected CSF leakage in 4 years. The presence of the artifacts on 3D-T1W data was evaluated using a 4-point scale (0: none; 1: minimal; 2: moderate; 3: prominent). Agreements between CSF leakage results of the 3D-T1W sequences and consensus decisions were evaluated via kappa values. Artifact scores were analyzed by Fisher's exact test. RESULTS: The most compatible techniques with the consensus diagnoses were fat-saturated 3D-T1W-SPACE and 3D-T1W-VIBE sequences. The most artifact containing the 3D-T1W sequence was 3D-MPRAGE. DISCUSSION: 3D-SPACE and 3D-VIBE are more successful in evaluating CSF leakages compared to 3D-MPRAGE. 3D-SPACE has lower artifact scores compared to 3D-VIBE and 3D-MPRAGE sequences.

A comparison between the CS-TOF and the CTA/DSA for WEB device management.

PURPOSE: There is no study on the role of three-dimensional compressed sensing time of flight MR angiography (3D-CS-TOF) in the management of the WEB device. We evaluated the efficacy of 3-tesla 3D-CS-TOF for the management and follow-up of the WEB device implantations. MATERIALS AND METHODS: Seventy-three aneurysms of 69 patients treated with the WEB device were retrospectively examined. Morphological parameters and embolization results of the aneurysms were assessed and compared on 3D-CS-TOF, CTA, and DSA images. RESULTS: Occluded, neck remnant, and recurrent aneurysms were observed in 61 (83.6%), 7 (9.6%), and 5 (6.8%) aneurysms, respectively. Inter- and intra-reader agreement values related to aneurysm size measurements were perfect. Aneurysms size, age, and proximal vessel tortuosity were negatively correlated with the visibility of the aneurysms and parent vessels on 3D-CS-TOF images (p = 0.043; p = 0.032; p < 0.001, respectively). Subarachnoid hemorrhage and age are associated with 3D-CS-TOF artifacts (p = 0.031; p = 0.005, respectively). 3D-CS-TOF findings are in perfect agreement with DSA or CT angiography (CTA) results (p < 0.001). CONCLUSION: According to our results, 3D-CS-TOF can be an easy, fast, and reliable alternative for the management or follow-up of WEB assisted embolization.

Effect of clival bone growth on the localization of the abducens nerve at the petroclival region: a postmortem anatomical study.

PURPOSE: To investigate the effect of the clival bone pattern on the abducens nerve (AN) localization in the petroclival region between the Pediatric and Adult Groups. METHODS: This study used 12 pediatric and 17 adult heads obtained from the autopsy. The length and width of the clivus and the length of the petrosphenoidal ligaments (PSLs) were measured. The ratio of the length and width of the clivus was accepted as the clival index (CI). The localization of the AN at the petroclival region below the PSL, classified as lateral and medial, were recorded. RESULTS: The average length of the clivus was 26.92 ± 2.88 mm in the Pediatric Group, and 40.66 ± 4.17 mm in the Adult Group (p < 0.001). The average width of the clivus was 22.35 ± 2.88 mm in the Pediatric Group, and 29.96 ± 3.86 mm in the Adult Group (p < 0.001). The average value of the CI was 1.20 in the Pediatric Group and 1.36 in the Adult Group (p = 0.003). The length of the PSL was 7.0 ± 1.47 mm in the Pediatric Group and 11.05 ± 2.95 mm in the Adult Group (p < 0.001). The nerve was located below the medial side of the PSL in the Pediatric Group and below the lateral side in the Adult Group (p = 0.002). CONCLUSIONS: The petrous apex localization of the AN in adults compared with pediatric subjects could be related to the increased growth in the length of the clivus than its width.

The Coexistence of Olfactory Groove with Optic Nerve Sheath Meningioma Presenting with Anosmia: A Case Report.

INTRODUCTION: Meningiomas are the third most common intracranial tumors in adults after glial tumors and metastases. Olfactory groove meningiomas often grow without symptoms due to their slow growth rates and location in the frontal lobe. Optic nerve sheath meningiomas are benign neoplasms of the meninges surrounding the optic nerve. The coexistence of olfactory groove and optic nerve sheath meningiomas without any history of neurofibromatosis or radiotherapy has never been reported in the literature. CASE REPORT: A 36-year-old female patient was reported with anosmia, headache, memory disturbance, and visual impairment and with the diagnosis of olfactory groove meningioma. In the postoperative period, optic nerve sheath meningioma was detected in the imaging performed due to persistence of visual impairment. CONCLUSION: Olfactory groove and optic nerve sheath meningiomas are rare tumors and can be diagnosed late because they progress slowly. Early diagnosis and treatment may affect the prognosis and morbidity of these patients favorably.

Spinal gas accumulation causing lumbar discogenic disease: a case report.

Vacuum disc phenomenon is seen frequently with degenerative disc disease and is characterized by the collection of gas in the disc space. Although the accumulation of gas within the disc space does not have clinical significance, symptoms may develop when occurring within the spinal canal. We present a 60-year-old female patient with low back and left leg pain occurring for 3 months before admission to our clinic. Straight leg raise test was 50 degrees in the left leg. Magnetic resonance imaging showed a narrowing of the L5-S1 disc space with vacuum disc phenomenon and hypointense cystic mass in T1 and T2-weighted images. The decision for surgery was made and left L5-S1 hemilaminectomy and foraminotomy was performed. The cyst wall was adherent to the root and dura mater and was partially excised. The patient was pain-free on the first postoperative day. In cases of gas accumulation in the spinal canal, discogenic pain may occur. Surgical therapy is still an acceptable method for the treatment of vacuum disc phenomenon and accumulation of gas within the spinal canal.

Anatomic relationship between the anterior sylvian point and the pars triangularis.

The aim of this study was to show morphological sulcal variations of the pars triangularis of the inferior frontal gyrus and to provide a clearer description of the anterior sylvian point. Thirty-six hemispheres of 18 adult cadavers were studied. The hemispheres were harvested by the classical autopsy method and fixed in 10% formalin solution for three weeks. In six hemispheres, the arteries and veins were filled with colored silicone. The proximal and distal segments of the sylvian fissure, the perpendicular distance of both the anterior sylvian point and inferior rolandic point to the insular cortex and the distances between the anterior ascending ramus and the precentral, central, and postcentral sulcus were measured. The anterior horizontal and ascending rami were exposed. The sulcus located on the pars triangularis was appraised. The relationship between the anterior sylvian point and the vascular structure around the sylvian fissure was examined. The rising of the anterior horizontal and ascending ramus from the sylvian fissure defines the shape of the pars triangularis. The pars triangularis has three shapes: V, U, and Y. In V- and Y-shaped pars triangularis both rami merge but in U-shaped pars triangularis the rami do not merge. The pars triangularis was Y-shaped in 30.76% (4/13) of the right hemispheres and in 50% (7/14) of the left hemispheres; U-shaped in 20.3% (3/13) of the right hemispheres and in 35.71% (5/14) of the left hemispheres; V-shaped in 40.61% (6/13) of the right hemispheres and in 14.29% (2/14) of the left hemispheres. Minimally invasive procedures use basic anatomic landmarks intracranially to reach the targeted area; therefore, exact and detailed knowledge of the anatomy of the sylvian fissure and pars triangularis is of great importance.

Pituitary adenoma apoplexy presenting with bilateral third nerve palsy and bilateral proptosis: a case report.

OBJECTIVE: To report a case of pituitary adenoma apoplexy presenting with bilateral proptosis and bilateral third nerve palsy that developed after cardiovascular surgery. CLINICAL PRESENTATION AND INTERVENTION: A 45-year-old man developed bilateral proptosis and bilateral third nerve palsy after a coronary artery bypass grafting operation. A pituitary macroadenoma with extension into the sphenoid sinus and cavernous sinus with bilateral involvement was resected on computed tomography scan by microscopic transsphenoidal procedure. Third nerve palsy improved partially on the first postoperative day and completely improved in the fourth month after the operation. CONCLUSION: This is a rare case of pituitary adenoma apoplexy that presented with bilateral third cranial nerve palsy.

Subarachnoid, subdural and interdural spaces at the clival region: an anatomical study.

AIM: We aimed to show the significance of the anterior pontine membrane as a determining structure between the subdural and subarachnoid space in the clival region. MATERIAL AND METHODS: Five adult cadaver heads and five cerebral hemispheres were used. The skull vault and hemipheres were removed by sectioning through the pontomesencephalic junction. Five other heads hemispheres were removed but the arachnoid membrane was protected and the cerebral side of the clival dura mater was dissected. In another specimen, the dural porus of the abducens nerve was sectioned for histological evaluation. Three cases of hematoma at the clivus were presented to support our findings. RESULTS: The anterior pontine membrane is the arachnoid membrane forming the anterior wall of the prepontine cistern with its lateral extension at the skull base. This membrane forms the subdural and subarachnoid spaces by forming a barrier between the clival dura mater and neurovascular structures of the brainstem. There were rigid fibrous trabeculations between both cerebral and periosteal dural layers forming the basilar plexus as the interdural space in the clivus. CONCLUSION: The anterior pontine membrane separates the subdural and subarachnoid spaces at the clival region. The hematomas of the clival region require to be evaluated with consideration given to the existance of the subdural space.

Symptomatic spontaneous pneumocephalus after spinal fusion for spondylolisthesis.

Symptomatic spontaneous pneumocephalus after a spinal fusion for spondylolisthesis without injury to the dura mater is rare. There are only a few reports of tension pneumocephalus after spinal operations published in English. We present a patient who developed tension pneumocephalus without recognised dural injury during surgery. CT cisternography and MRI showed no anatomical defects that could have caused the pneumocephalus. We suggest that spontaneous pneumocephalus without dural injury may occur after a spondylolisthesis operation because of increased intra-abdominal pressure, and thus may be avoided by the careful management of abdominal pressure.

Review of a series with abducens nerve palsy.

OBJECTIVE: In this report, we aimed to investigate the patients that presented at our clinic complaint with diplopia due to the abducens nerve palsy and neurosurgical disease. METHODS: The study design was a retrospective review of ten cases with the abducens nerve palsy. The causes of the abducens nerve paralysis of our patients were as follows: two cases with head trauma, three cases with pituitary tumors, one case with sphenoid sinus mucocele, one case with greater superficial petrosal nerve cellular schwannoma at the petrous apex, one case with hypertensive intraventricular hemmorhage, one case with hydrocephalus, and one case with parotid tumor and skull base/brain stem invasion. RESULTS: Depending on the location of the lesion, the symptoms due to nuclear damage showed no improvement as in our case with adenocarcinoma of the parotid gland. The lesions sited at the subarachnoid portion of the abducens nerve or in the cavernous sinus, the abducens nerve palsy improved or botilinum injection was performed during recovery period. CONCLUSION: We presented abducens nerve palsy cases due to neruosurgical disorders. A botilinum injection was performed in three patients with the abducens palsy. Botilinum injection can help patients with sixth nerve palsy during the recovery period.