Isolated Cerebral Cyst Hydatid Removal with Dowling's Technique in a 6-Year-Old Pediatric Patient: Case Report.

Hydatid disease, caused by the Echinococcus parasite, is a worldwide zoonosis produced by the larval stage of the tapeworm. In urban living patients with cerebral abscesses, hydatid cysts should not be excluded from the differential diagnosis. We report an exceptional primary cerebral hydatid cyst in which imaging showed a large, round, contrast-enhancing lesion with a mass effect. The patient presented with a dull headache for over a year and progressively worsened left hemiparesis. The magnetic resonance imaging showed a huge intracranial mass, and the pathology was corrected with cyst hydatid. Surgery was performed via Dowling's technique, and the patient recovered without neurologic deficits. Echinococcosis should be considered a differential diagnosis for single or multiple cerebral abscesses, even in the absence of liver infections. The history of living in rural areas does not exclude cerebral hydatid cysts and Echinococcus .

Management and Outcome of Intracranial Dural Arteriovenous Fistulas That Have Caused a Hemorrhage in the Posterior Fossa : A Clinical Study.

OBJECTIVE: We evaluated the diagnosis, treatment, and long-term results of patients with dural arteriovenous fistula (dAVF), which is a very rare cause of posterior fossa hemorrhage. METHODS: This study included 15 patients who underwent endovascular, surgical, combined, or Gamma Knife treatments between 2012 and 2020. Demographics and clinical features, angiographic features, treatment modalities, and outcomes were analyzed. RESULTS: The mean age of the patients was 40±17 years (range, 17-68), and 68% were men (11/15). Seven of the patients (46.6%) were in the age group of 50 years and older. While the mean Glasgow coma scale was 11.5±3.9 (range, 4-15), 46.3% presented with headache and 53.7% had stupor/coma. Four patients (26.6%) had only cerebellar hematoma and headache. All dAVFs had cortical venous drainage. In 11 patients (73.3%), the fistula was located in the tentorium and was the most common localization. Three patients (20%) had transverse and sigmoid sinus localizations, while one patient (6.7%) had dAVF located in the foramen magnum. Eighteen sessions were performed on the patients during endovascular treatment. Sixteen sessions (88.8%) were performed with the transarterial (TA) route, one session (5.5%) with the transvenous (TV) route, and one session (5.5%) with the TA+TV route. Surgery was performed in two patients (14.2%). One patient (7.1%) passed away. While there were nine patients (64.2%) with a Rankin score between 0 and 2, the total closure rate was 69.2% in the first year of control angiograms. CONCLUSION: In the differential diagnosis of posterior fossa hemorrhages, the differential diagnosis of dAVFs, which is a very rare entity, should be considered, even in the middle and elderly age groups, in patients presenting with good clinical status and pure hematoma. The treatment of such patients can be done safely and effectively in a multidisciplinary manner with a good understanding of pathological vascular anatomy and appropriate endovascular treatment approaches.

Treatment of Ruptured Anterior Choroidal Artery Aneurysms by Acute Coiling Followed by Flow Diversion.

BACKGROUND: Flow-diverter treatments are successful endovascular treatments in protecting important perforating branches during aneurysm treatments. Because these treatments are performed under antiplatelet therapy, acute flow-diverter treatments in ruptured aneurysms are still controversial. Acute coiling followed by flow diversion has emerged as an intriguing and feasible treatment option for ruptured anterior choroidal artery aneurysm treatment. As a single-center retrospective case series study, this study reported the clinical and angiographic results of staged endovascular treatment in patients with a ruptured anterior choroidal aneurysm. METHODS: This is a single-center retrospective case series study between March 2011 and May 2021. Patients with ruptured anterior choroidal aneurysm received flow-diverter therapy in a different session after acute coiling. Patients treated with primary coiling or only flow diversion were excluded. Preoperative demographic and presenting symptoms, aneurysm morphology, perioperative and postoperative complications, and long-term clinical and angiographic outcome as measured using the modified Rankin Scale and O'Kelly Morata Grading scale and also Raymond-Roy occlusion classification respectively. RESULTS: Sixteen patients underwent coiling in the acute phase to undergo flow diversion later. The mean maximum aneurysm diameter is 5.44 ± 3.39 mm. All patients had a subarachnoid hemorrhage and were treated acutely between days 0 and 3 of acute bleeding. The mean age at the presentation was 54.12 ± 12 years (32-73 years). Two patients (12.5%) had minor ischemic complications, which are seen on magnetic resonance angiography as clinically silent infarcts, after the procedure. One patient (6.2%) had a technical complication with the flow-diverter shortening and deployed a second flow diverter telescopically. No mortality or permanent morbidity was reported. The mean interval time between the 2 treatments was 24.06 ± 11.83 days. All patients were followed up with digital subtraction angiography; 14/16 patients (87.5%) had aneurysms that were completely occluded and 2/16 (12.5%) showed near-complete occlusion. Mean follow-up was 16.62 ± 3.22 months; all patients had modified Rankin Scale scores ≤2; 14/16 (87.5%) had a total occlusion 14/16 (87.5%) had near-complete occlusion. None of the patients had retreatment or rebleeding. CONCLUSIONS: Staged treatment of ruptured anterior choroidal artery aneurysms with acute coiling and flow-diverter treatment after recovery from subarachnoid hemorrhage is safe and effective. In this series, no cases of rebleeding occurred during the interval between coiling and flow diversion. Staged treatment should be considered a valid option in patients with challenging ruptured anterior choroidal aneurysms.

The Evaluation of Low-Profile Surpass EvolveTM Flow Diverter for Endovascular Treatment of Distal Cerebral Artery Aneurysms: A Single-Center Experience.

AIM: To report our experience with the 2.5-mm Surpass EvolveTM flow diverter (FD) in the treatment of distal small cerebral artery aneurysms. MATERIAL AND METHODS: This study included 41 patients with 52 aneurysms. Clinical and radiological records and procedural and follow-up outcomes were reviewed retrospectively. RESULTS: The aneurysm morphology was saccular in 45 patients, dissecting in five patients, and fusiform in two patients. Fifty-two aneurysms were treated with 41 Surpass Evolve FDs. The mean diameters of the proximal and distal parent arteries were 2.56 and 2.17 mm, respectively. The mean duration of follow-up was 16.2 ± 6.6 (6-28) months. Four (10%) patients had acute subarachnoid hemorrhage. In the same session, two patients with two tandem aneurysms and one patient with four tandem aneurysms were treated using a single FD. Intraprocedural hemorrhage and femoral artery pseudoaneurysm occurred in two patients during the procedure. Digital subtraction angiography was performed on 38/41 (92%) patients with 47/52 (88%) having aneurysms. Complete occlusion (OKM D) was observed in 39/47 (82%) aneurysms, and near complete-complete occlusion (OKM C-D) was observed in 46/47 (98%) aneurysms. CONCLUSION: Endovascular treatment of distal cerebral artery aneurysms with the 2.5-mm Surpass Evolve < sup > TM < /sup > FD provides a high rate of aneurysm occlusion with low periprocedural complications, even in ruptured and tandem aneurysms.

An Illustrative Case of Bilateral Internal Carotid Artery Occlusion Concomitant with Aneurysm of the Obstructed ICA Reconstituted via Collaterals: Emphasizing the Role of Rescue Collaterals in Decision-Making.

In patients with bilateral internal carotid artery (ICA) obstruction, the basilar and ophthalmic arteries become the most critical arteries for brain perfusion, and the location of aneurysm formation may be associated with increased wall shear stress induced by compromised carotid circulation. Consideration of collateral routes may have an impact on therapeutic decisions for patients undergoing extracranial to intracranial (EC-IC) bypass and aneurysm surgery. We report a rare case of a young woman with bilateral ICA occlusion simultaneous with dissecting aneurysm of the obstructed ICA reconstituted via collaterals, emphasizing the functional value of collaterals and therapeutic strategy. We present a young woman with angiographic evidence of cerebrovascular early atherosclerotic disease. A young patient was found to have bilateral ICA occlusion and dissecting aneurysm of the obstructed ICA. A large fusiform aneurysm was clipped. Then, an anastomosis was performed from the left superficial temporal to the M3 segment of the middle cerebral artery. The patient's postoperative course was uneventful, and she was discharged to rehabilitation with no residual sequelae. This case illustrates a rare case of bilateral ICA occlusions, presented with robust collaterals, and dissecting aneurysm of the obstructed ICA reconstituted via collaterals. We also demonstrate excellent surgical clipping of a challenging ICA aneurysm and cerebral bypass surgery.

An Illustrative Case of Vein of Labbe Thrombosis Presented as a Glioma.

Cerebral vein thrombosis is a unique and rare type of cerebrovascular disease. The main challenge in identifying cerebral vein thrombosis is the presence of vague signs and symptoms that can resemble a variety of other intracranial pathologies. Our goal is to present the unique case of a young patient whose MRI scan revealed an abnormally enhancing tumor-like brain lesion that was heterogeneous in intensity and whose intraoperative view and histopathological findings were consistent with the vein of Labbe thrombosis, with ipsilateral transverse and sigmoid sinus involvement.

Craniovertebral junction aneurysms.

OBJECTIVE: The course of the vertebral artery and its relationship to the C0-1-2 structures render it particularly vulnerable to mechanical trauma. In the present study, we investigated the course of vertebral arteries along the craniovertebral junction (CJ) to cast light on the biomechanical aspects of aneurysm formation, focusing mainly on the relation of the vertebral artery injuries to the CJ bony landmarks. Herein, we report our experience with fourteen cases of craniovertebral junction vertebral artery (CJVA) aneurysms and their presentations, management, and outcomes. MATERIALS AND METHODS: We extracted from 83 vertebral artery aneurysms only those 14 cases whose aneurysms were located at the C0-1-2. We reviewed all medical records, including operative reports and radiologic images. We divided the CJVA into 5 segments and then carefully reviewed the cases, largely focusing on the CJVA segments involved in the aneurysm. Angiographic outcomes were determined by angiography, which was scheduled at 3-6 months, 1, 2.5, and 5 years postoperatively. RESULTS: A total of 14 patients with CJVA aneurysms were included in the present study. 35.7 % had cerebrovascular risk factors, while 23.5 % had other predisposing factors such as an AVM, an AVF, or a foramen magnum tumor. Predisposing factors in the form of neck trauma, both direct and indirect, were identified in 50 % of cases. The segmental distribution of aneurysms was as follows: three (21.4 %) at CJV 1, one (7.1 %) at CJV 2, four (28.6 %) at CJV 3, two (14.3 %) at CJV 4, and four (28.6 %) isolated to the CJV 5 segment. Of the 6 indirect traumatic aneurysms, 1 (16.7 %) was located at CJV 1, 4 (66.7 %) were located at CJV 3 and 1 (16.7 %) was located at CJV 5. The 1/1 direct traumatic aneurysm (100 %) from the penetrating injury was located at CJV 1. 100 % of cases with cerebrovascular risk factors, the affected vessels were on the dominant side. 42.9 % of cases presented symptoms of a vertebrobasilar stroke. All 14 aneurysms were managed only endovascularly. 85.8 % of patients we implemented flow diverters only. 57.1 % of follow-up cases were completely occluded angiographically, and 42.9 % of cases were near-completely or incompletely occluded at 1, 2.5, and 5-year follow-ups. CONCLUSIONS: The current article is the first report of a series of vertebral artery aneurysms located in CJ. Herein, the association of vertebral artery aneurysm, hemodynamics, and trauma is well established. We clarified all segments of the CJVA and showed that the segmental distribution of CJVA aneurysms significantly differs between traumatic and spontaneous cases. We showed that treatment with flow diverters should be the mainstay of CJVA aneurysm treatment.

Utility of flow diverters in treatment of acutely ruptured uncoilable aneurysms of the posterior circulation of the brain.

PURPOSE: Aim of this study is to evaluate safety and efficacy of flow diverters (FDs) in treatment of acutely ruptured posterior circulation aneurysms MATERIALS AND METHODS: Databases of three participating institutions were retrospectively scanned for patients in whom FD placement was attempted for treatment of acutely ruptured vertebrobasilar aneurysms. An interval of 14 days or fewer between the latest ictus and treatment was used as inclusion criterion. Patients with dolichoectasia of vertebrobasilar arteries were excluded. If necessary, adjunctive techniques including coiling or stenting were utilized. Clinical outcomes were graded using mWFNS (modified World Federation of Neurosurgical Societies Scale) and mRS (modified Rankin Scale). Aneurysmal occlusion was defined as Raymond-Roy Class 1. Spearman's (ρ) test was used to assess the correlation between variables. Univariate and multivariate logistic regression were used to assess outcomes. RESULTS: 31 patients (25 women, mean age: 52.7 ± 15.2) harboring 32 aneurysms (16 non-saccular, mean size: 11.4 ± 7 mm) were included. Mean number of FDs used was 1.22 ± 0.42. In six cases, adjunctive coiling and in five cases, apposing stent placement were used. Overall mortality rate and procedure-related mortality rates were 22.5% (7/31) and 9.6% (3/31), respectively. At a mean imaging follow-up of 17.2 ± 12.6 months, total occlusion was achieved in 22 aneurysms (91.6%). Univariate analysis showed that mortality was positively correlated with vasospasm (ρ = 0.600, p < 0.05), higher mWFNS Scale (ρ = 0.685, p < 0.05), higher modified Fischer Score (ρ = 0.609, p < 0.05), higher mRS (ρ = 0.594, p < 0.05) on admission and negatively correlated with saccular morphology (ρ = -0.529, p < 0.05). Multivariate logistic regression identified mWFNS on admission as a significant predictor. (OR: 7.148, 95% CI 1.777-28.758, p: 0.01). Adjunctive coiling positively correlated with aneurysm occlusion. (ρ = 0.522, p < 0.05). CONCLUSION: The procedure-related morbidity and mortality is not negligible. However, the risks and efficacy associated with FDs are acceptable, especially when adjunctive coiling is possible, given the lack of treatment alternatives.

Endovascular treatment of challenging aneurysms with FRED Jr flow diverter stents: a single-center experience.

PURPOSE: To analyze clinical safety and efficacy of flow re-direction endoluminal device (FRED) Jr flow diverter for treatment of unruptured, ruptured, or recanalyzed aneurysms. MATERIALS AND METHODS: Between October 2019 and February 2022, 25 patients with 31 aneurysms treated with FRED Jr were included in the study. Clinical and radiological records, procedural details, and follow-up outcomes were retrospectively evaluated. Eighteen (72%) patients were female. Median age was 48.8 (age range 9-85). Mean follow-up was 21 months (6-28 months). Location of the aneurysms were as follows; 13 in middle cerebral artery (MCA), 7 in anterior cerebral artery (ACA), 4 in posterior cerebral artery (PCA), 3 in true posterior communicating artery (PCom), 2 in anterior communicating artery (ACom), 1 in superior cerebellar artery (SCA), 1 in true ophthalmic artery. Five patients (20%) presented with acute subarachnoid hemorrhage (aSAH). RESULTS: In all procedures, FRED Jr was successfully deployed. Three true Pcom aneurysms and a true ophthalmic aneurysm were treated with FRED Jr. Three patients with two adjacent aneurysms were treated with a single FRED Jr. In two (8%) patients in-stent thrombosis occurred intraoperatively, they were treated with iv tirofiban and thrombectomy without any sequelae. Post-discharge 2 weeks later, intraparenchymal hemorrhage occurred in a patient. He was treated with surgical drainage, the clinical course was modified Rankin score (mRS) 2. Digital subtraction angiography (DSA) was performed on 16 (64%) patients with 21 (67%) aneurysms. Near complete-complete occlusion (O'Kelly-Morata grading scale (OKM C-D) was documented in 15/16 (93.7%) patients, 20/21 (95.2%) aneurysms. In nine (36%) patients, no residual filling was observed in the magnetic resonance angiography (MRA). Good clinical outcome (mRS 0-1) was achieved in 24/25 (96%) of patients. CONCLUSION: Endovascular treatment of small cerebral aneurysms with FRED Jr is safe and effective even in complex and challenging morphologies allowing high rates of aneurysm occlusion with low periprocedural complications. Our cohort, consisting of a rate 20% acute ruptured aneurysms, is the major additive data to the published literature.

Vertebral arteriovenous fistula due to blunt neck trauma: A case report.

The arteriovenous fistulas (AVFs) of the vertebral artery are usually caused by iatrogenic and penetrating traumas. Vertebral AVF is rarely seen after blunt cervical trauma. A 65-year-old male patient applied to the emergency clinic due to falling from a height of about 3 m. In his neurological examination, he had weakness in the left upper limb and tinnitus in the left ear. The cervical computed tomog-raphy examination showed a Hangman's fracture, a C3 vertebra corpus compression fracture, and a C1 anterior arch fracture. There was a separation on the C1-2 transverse foramen due to the fracture, and there was a fracture in the left C3-4 transverse foramen. In cervical magnetic resonance imaging (MRI), the presence of a contusion in the spinal cord at the C2 corpus level was observed. Through an MRI angiography examination of the vertebral artery, it was determined that the left vertebral artery had developed an AVF at the V2-3 segment level. Stabilization surgery was performed with a posterior approach for unstable vertebrae. Then, vertebral AVF was then closed endovascularly using a stent coil. Improvement in neurological deficit was seen after surgery and endovascular treatment. There were no complications related to the procedure. Transverse foramen should be carefully evaluated, especially in the upper cervical trauma. Vertebral artery imaging should be performed before instability surgery in the presence of a separation in the fracture line to determine whether the damage to the vertebral artery is iatrogenic.

Influence of galantamine on peripheral nerve degeneration after experimental compression injury of the rat sciatic nerve.

BACKGROUND: Galantamine is well-known for its neuroprotective effects and is currently used in the treatment of individuals with Alzheimer's disease. In this study, we induced experimental sciatic nerve injury (SCI) in rats to test the beneficial effects of galantamine. METHODS: Thirty male Wistar albino rats were divided into three groups, as follows: sham, SCI + saline, and SCI + galantamine. After the administration of an intraperitoneal ketamine and xylazine mixture, which was used for anesthesia, SCI was induced by sur-gical clip compression at the midthigh region of the rats. After surgery, a single daily intraperitoneal dose of galantamine was adminis-tered for 7 days, and nerve tissue sections were obtained 1 week after injury. Histopathology studies were performed to assess neural thickness and apoptotic cell counts, and light microscopic morphological examination was used to determine a potential beneficial effect of galantamine on peripheral nerve degeneration. RESULTS: We observed a markedly increased microvasculature, increased nerve fiber thickness, and a statistically significant increase in apoptotic cell counts distal to the level of injury in the saline group compared with the sham group. However, the increases in nerve fiber thickness and apoptotic cell counts were less in the galantamine group compared with the saline group. CONCLUSION: In our experimental model, pharmacological intervention with galantamine demonstrated a protective effect on degeneration after peripheral nerve injury.

A pediatric case of completely thrombosed giant cavernous carotid aneurysm with ipsilateral ICA occlusion mimicking an intra-axial cystic lesion: a case report and review of the literature.

INTRODUCTION: There have been a few cases where completely thrombosed cavernous carotid artery (CCA) aneurysms have resembled neoplasms based on neuroimaging data, but no reports have been documented in children. CASE REPORT: We describe an unusual pediatric case of a huge cavernous sinus mass mimicking a cystic neoplasm with peripheral rim enhancement on magnetic resonance imaging (MRI), where the surgery and subsequent histopathological investigation revealed that this mass was a completely thrombosed giant aneurysm of the CCA. The patient showed postoperatively no new neurological deficits and discharged a week later after surgery. CONCLUSIONS: In this case report, we describe a pediatric case of a completely thrombosed giant CCA aneurysm with ipsilateral internal carotid artery (ICA) occlusion, which imitates an intra-axial cystic lesion on MRI.

Endovascular Stroke Therapy Focused on Direct Clot Aspiration Using the SOFIATM Catheter for Acute Ischemic Stroke.

AIM: To report our experience of mechanical thrombectomy using the SOFIA < sup > TM < /sup > catheter, in terms of its effectivenessicacy and safety. MATERIAL AND METHODS: Acute ischemic stroke patients with large vessel occlusions who underwent mechanical thrombectomy, with the SOFIA < sup > TM < /sup > aspiration catheter as the first-line approach, were retrospectively identified. For all patients, the data, including reperfusion success (modified Thrombolysis in Cerebral Infarction [mTICI]), procedural details, clinical status at the baseline and post-discharge at 90 days, and complications, were analysed. RESULTS: During the study period (January 2017-July 2020), 73 patients underwent endovascular thrombectomy. The mean age and the baseline National Institutes of Health Stroke scores were 72 (41-83) and 16 (12-25), respectively. Successful reperfusion (mTICI≥2b-3) was obtained in 80.8 % (n=59) of the patients. Using ADAPT, a first-pass effect was achieved in 63.01% (n=46) of the patients. Rescue stent retriever (SRV) had to be utilized in 36.98% (n=27) of the patients; all presented with a favourable clinical outcome (modified Rankin score ≤0-2) at 90 days. The complication rate in the study was 13.7% (n=10). CONCLUSION: The contact aspiration approach with SOFIA < sup > TM < /sup > catheters as a first-line device appears to be fast, safe, and effective. Our results were comparable to the findings of other series. In the case of insufficient response on contact aspiration, we could easily modify the SOFIA < sup > TM < /sup > catheter approach for an additional stent retriever rescue treatment.

Dual Stenting with New-Generation Stents for Aneurysm Embolization in Acute Subarachnoid Hemorrhage.

OBJECTIVE: Endosaccular treatment is the backbone of endovascular treatment for acutely ruptured aneurysms. Stent-assisted coiling is a niche technique in this context. Data on X-stenting or Y-stenting (dual crossing stenting, DCS) in the acute phase after subarachnoid hemorrhage (aSAH) are scarce, and the impact of stent properties on the outcome is unknown. We retrospectively evaluated the clinical and imaging results of DCS in patients treated for aSAH. METHODS: Patients with aSAH treated with DCS were evaluated retrospectively. Patient and procedural characteristics were evaluated to determine clinical outcomes, associated complications, and follow-up imaging findings. RESULTS: Sixteen procedures (16 patients; 10 women, mean age 55.8) were performed within 3.2 ± 2.6 days (range 1-10 days) of aSAH. Only the latest generation of intracranial stents (dual Neuroform Atlas-12 cases, dual Leo Baby-2 cases, Neuroform Atlas with Acclino Flex, or Leo Baby-2 cases) were used. Technical success rate was 100%; however, 25% of the procedures were complicated, leading to adverse events in 3 procedures (18.8%; 2 stent thrombosis, 1aneurysm rupture). Procedure-related morbidity and mortality and overall permanent morbidity and mortality were 6.3%, none, 6.3%, and 12.5%, respectively. No additional neurologic events were noted on a mean clinical follow-up of 160 ± 156 (range: 1-540) days. CONCLUSIONS: Our findings and the patient-by-patient data we extracted from the literature suggest that DCS can be performed with new-generation, low-profile stents in aSAH if a definite procedural risk is acceptable for a specific patient. New-generation open-cell stent combinations appear as a viable choice for DCS in aSAH.

Comparison of Histological and Angiographic Measurements of the Basilar Artery in an Experimental Rabbit Subarachnoid Hemorrhage Model.

AIM: To compare the histological and angiographic measurements of the basilar artery in an experimental rabbit subarachnoid hemorrhage model. MATERIAL AND METHODS: The basilar artery was measured using both histological and angiographic methods in experimental subarachnoid hemorrhage (SAH) and vasospasm rabbit models. New Zealand white rabbits were randomly categorized into two groups: control and SAH groups. The SAH group rabbits were operated on to create an experimental SAH. Both groups were examined angiographic and histological methods. RESULTS: On comparing the two methods, angiographic and histopathological measurements of the basilar artery were similar in the control group. However, in the SAH group, the difference between the angiographic and histopathological measurement methods was significant. Histopathological measurements of the basilar artery were lower than angiographic measurements, and the difference was statistically significant. In the angiographic method, although there was a marked decrease in basilar artery measurements in the SAH group, the differences between the groups was not statistically significant. However, in the histopathological method, measurement differences between the control and SAH groups were statistically significant. CONCLUSION: Histopathological measurements were shown to be more sensitive than angiographic methods in demonstrating cerebral vasopasm in experimental SAH rabbit models.

The Experience of the Derivo® Embolisation Device in Intracranial Aneurysms.

AIM: To investigate the safety and efficacy of Derivo® embolisation device (DED), a new-generation flow diverter designed to treat cerebrovascular aneurysms, and its long-term clinical outcomes. MATERIAL AND METHODS: In total, 146 patients with 182 aneurysms were treated with DED. The mean age of the participants was 51.5 years; among them, 46 (31.5%) presented with acute subarachnoid haemorrhage. The mean aneurysm size was 8.3 mm, and 12 aneurysms were involved the vertebrobasilar system. Ophthalmic aneurysms account for most internal carotid artery (ICA) aneurysms. RESULTS: The Glasgow Coma Scale (GCS) score of 12 patients was < 15. DED was associated with a mortality rate of 2.7% and permanent morbidity rate of 3.4%, and a complete aneurysm occlusion rate was achieved in 78.7% of cases after 7.02 months. CONCLUSION: The DED device is a new-generation flow diverter with excellent opening behaviour and navigational benefits. Our results indicated a safe aneurysm occlusion with optimum morbidity and mortality values despite the fact that almost one-third of the patients presented with subarachnoid haemorrhage.

Urgent operation improves weakness in cauda equina syndrome due to lumbar disc herniation.

OBJECTIVES: This study aims to examine the effect of surgical timing on the sphincter function and improvement of motor function in patients with cauda equine syndrome (CES) due to lumbar disc herniation (LDH). PATIENTS AND METHODS: Between January 2005 and December 2013, a total of 33 patients (18 males, 15 females; mean age 48.6±2.2 years, range, 24 to 73 years) who underwent lumbar spinal surgery and were diagnosed with CES due to LDH were retrospectively analyzed. Data including demographics, muscle weakness, sensory deficit, sphincter control, LDH level, time from the initiation of symptoms to admission, and time to surgery were documented. The latest muscle weakness, sensory deficits, and sphincter control were also recorded. The patients were divided into two groups according to the rate of muscle strength improvement and data including age, sex, and operation time were compared. RESULTS: The weakness remained unchanged in 11 (33.3%), improved in 13 (39.4%), and returned to normal in nine (27.3%) patients. Sphincter control resolved in five patients. Sensory loss resolved in two patients. While admission duration was shorter in the group with improved muscle strength (p=0.02), there was no significant difference in the time to surgery (p=0.63). Logistic regression analyses revealed that only the admission within 0 to 24 hours was significant for the muscle strength improvement (regression coeeficient [B]=2.83, standard error [SE]=0.86, p=0.006). CONCLUSION: A significant improvement in the motor strength can be achieved in patients with CES who are operated within 24 hours. On the other hand, patients with CES should be received surgery immediately when first seen, regardless of the time, since the muscle strength is slightly improved.

WITHDRAWN: Retrospective Analysis of the Endovascular and Surgical Treatment Outcomes in Patients with Cerebral Arteriovenous Malformations.

This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause.

Endovascular Treatment of Superior Cerebellar Artery Aneurysms.

AIM: To present our experience on superior cerebellar artery (SCA) aneurysms treated with embolization by using current endovascular techniques. MATERIAL AND METHODS: All SCA aneurysms treated by our endovascular team since 2013 were retrospectively evaluated. Clinical information and angiographic findings on presentation, during treatment and on follow-up were noted. RESULTS: Endovascular treatment was the primary treatment method for SCA aneurysms during the study period. Twenty three patients (15 female, 8 male) with a mean age of 50.6 years, 12 of whom with subarachnoid hemorrhage were treated. Treatments included coiling (56%), stent assisted coiling, stentriever assisted coiling, Y stent assisted coiling and flow diversion with either flow diverter placement or telescopic stenting. Two patients died secondary to consequences of subarachnoid hemorrhage. The outcome of 1 patient was Modified Rankin Scale (mRS) 3 and the outcome of remaining 20 patients was mRS 0. The rates of aneurysm occlusion according to Raymond-Roy classification were: class 1 in 11 patients, class 2 in 6 patients and class 3 in 2 patients on a mean follow-up of 15.3 months. Only one patient required retreatment. CONCLUSION: Current endovascular techniques are able to address the high rate of recanalization and retreatment of SCA aneurysms which are currently the major drawbacks associated with primary coiling when compared with surgical treatment. It remains to be shown if use of these latest techniques are associated with increased risk of thromboembolic events.

Endovascular Therapy in Posterior Fossa Brain Arteriovenous Malformations: A Clinical Study.

AIM: To assess posterior fossa brain arteriovenous malformation (PFbAVM) patients who received initial endovascular intervention to reduce the lesion size, as well as embolization for the obliteration of the lesions. MATERIAL AND METHODS: This retrospective analysis included 16 patients (7 males and 9 females) with PFbAVMs who were treated between 2010 and 2017 via surgery, endovascular techniques, or combinations of modalities. Patient demographic and clinical features, angiographic characteristics, treatment modalities, complications, and outcomes were analyzed. RESULTS: Six patients with cerebellar AVMs, 2 with brainstem AVMs, and 8 with cerebellarâ€"brainstem AVMs were included in this study. All patients were treated by endovascular embolization as initial or final treatment. Patient characteristics were assessed for all 16 patients; 7 (43.75%) presented with hemorrhage, and they were further treated by microsurgery because of residual niduses. Complete obliteration was obtained in all patients. Two patients had persistent neurological deficits. The outcome was measured with the modified Rankin scale (mRS). Serviceable outcome (mRS ≤ 2) was attained in 14 patients. CONCLUSION: Successful treatment of PFbAVMs depends on an integrated team of neurosurgeons, radiosurgeons, and endovascular neurosurgeons. In PFbAVMs, endovascular embolization as adjuvant or final treatment is useful and safe.