Endovascular treatment of wide-necked intracranial aneurysms using the novel Contour Neurovascular System: a single-center safety and feasibility study.

BACKGROUND AND PURPOSE: Wide-necked bifurcation aneurysms pose a significant challenge to the treating clinician. The Contour Neurovascular System embolization device is a novel tool for the treatment of such intracranial aneurysms. We report on our experience with this device. METHODS: Prospective clinical and radiological data were collected for all patients treated with the Contour device at our center. All our patients were treated on an elective basis. RESULTS: We have treated 11 patients successfully with the Contour device to date. All patients were women with a mean (SD) age of 65.0 (6.4) years. In total, four basilar tip, two internal carotid artery, three middle cerebral artery, one anterior communicating artery, and one superior cerebellar artery aneurysms were treated. At 1-year follow-up, complete occlusion (Raymond Class 1) was seen in 55.56% (5/9) of cases, with 44.44% (4/9) having small neck remnants (Raymond Class 2). One patient declined 1-year catheter angiography and another had no further follow-up due to an unrelated medical condition. For six patients, 2-year radiological follow-up is available and shows stability. At 6 weeks, nine of the 11 patients had a modifed Rankin Scale score of 0, with two patients scoring 1 for headaches. Two patients had thromboembolic events, but there were no complications leading to permanent neurological disability or death. We additionally had three patients where the Contour device was attempted but was unable to be successfully used. CONCLUSION: Initial results are promising although larger case numbers and longer follow-up are necessary to draw further conclusions on the utility and risk profile of this new device.

Interlaminar approach for excision of lateral lumbar disc herniation: technical note.

STUDY DESIGN: Technical note. OBJECTIVE: To show that approaching the lateral lumbar disc from the contralateral interlaminar space offers a wider exposure with reduced facet removal. SUMMARY OF BACKGROUND DATA: The interlaminar approach is a well-established approach for the removal of lateral lumbar disc herniation (LLDH). However, access to the lateral disc space via this approach may be difficult and requires generous facet joint removal. METHODS: A 41-year-old woman presented with a 2-year history of low back pain and severe left leg pain. Computerized tomography of the lumbar spine revealed a left-sided intraforaminal lateral disc protrusion at L4/5 level. RESULTS: The patient underwent a left L4/5 discectomy and removal of the lateral disc via the interlaminar approach from the contralateral (right) side with excellent postoperative result. CONCLUSIONS: The authors present a modification of the interlaminar microsurgical approach for excision of an intraforaminal lateral disc herniation in which the herniated disc is approached from the contralateral interlaminar space through a midline incision. The facet joint removal is less, and the exposure is superior to the traditional interlaminar approach.