The safety and efficacy of double microcatheter technique in small and tiny ruptured aneurysms: A single center study

Objective@#Double microcatheter technique (dMC) can be the alternative to Single microcatheter technique (sMC) for challenging cases, but there is lack of studies comparing dMC to sMC especifically for small ruptured aneurysms. Our objective was to compare the safety and efficacy of dMC to sMC in treating small (≤5 mm) and tiny (≤3 mm) ruptured aneurysms. @*Methods@#This study focused on 91 out of 280 patients who had ruptured aneurysms and underwent either single or double microcatheter coil embolization. These patients were treated with either single or double microcatheter coil embolization. We divided the patients into two groups based on the procedural method and evaluated clinical features and outcomes. Subgroup analyses were conducted specifically for tiny aneurysms, comparing the two methods, and within the dMC group, we also examined whether the aneurysm was tiny or not. In addition, univariate logistic regression analysis was performed to assess the impact of coil packing density. @*Results@#The mean values for most outcome measures in the dMC group were higher than those in the sMC group, but these differences did not reach statistical significance (coil packing density, 45.739% vs. 39.943%; procedural complication, 4.17% vs. 11.94%; recanalization, 8.3% vs. 10.45%; discharge discharge modified Rankin Scale (mRS), 1.83 vs. 1.97). The comparison between tiny aneurysms and other sizes within the dMC group did not reveal any significant differences in terms of worse outcomes or increased risk. The only factor that significantly influenced coil packing density in the univariate logistic regression analysis was the size of the aneurysm (OR 0.309, 95% CI 0.169–0.566, p=0.000). @*Conclusions@#The dMC proved to be a safe and viable alternative to the sMC for treating small ruptured aneurysms in challenging cases.

Epithelioid Hemangioendothelioma

Epithelioid hemangioendothelioma is a rare vascular neoplasm characterized by epithelioid tumor cells and borderline biologic behavior. We present a case of grade III malignant epithelioid hemangioendothelioma of the skull and brain parenchyme in a 58-year-old female. The tumor consisted of loose aggregates of epithelioid cells with a focal small nest pattern and tumor cells displayed frequent intracytoplasmic vacuoles and contained areas with significant atypia and mitotic activity(more than 2/10 HPF). Immunohistochemically, the tumor cells showed positive staining for facor VIII-RGA and vimentin. Radiological and histopathologic characteristics of this tumor with a review of pertinent literature is presented.