Hybrid Operating Room for Combined Neuroendovascular and Endoscopic Treatment of Ruptured Cerebral Aneurysms with Intraventricular Hemorrhage.

BACKGROUND: Intraventricular hemorrhages (IVHs) caused by ruptured cerebral aneurysms often have poor outcomes. Treatment challenges include comorbidities, increased intracranial pressure caused by IVH, and risk of rebleeding. CASE DESCRIPTION: Two cases of severe IVH accompanied by acute hydrocephalus caused by ruptured aneurysm were treated with coil embolization followed by endoscopic hematoma evacuation as a single treatment session in a hybrid operating room (OR) equipped with a multipurpose angio biplane system. The first case was an 84-year-old woman with a ruptured basilar top aneurysm, who presented with Hunt and Hess (H&H) grade 5 subarachnoid hemorrhage (SAH) with packed IVH. The second case was a 43-year-old man with a ruptured anterior communicating artery aneurysm who presented with H&H grade 5 SAH with packed IVH. In both cases, endovascular coil embolization was performed first to prevent intraoperative bleeding. The coiled aneurysms suddenly appeared on the screen of the endoscope during the hematoma removal, which could have led to massive rebleeding if not treated previously. Neither patient needed a reinsertion of the ventricular drainage or developed chronic hydrocephalus during hospitalization. The hybrid OR enabled the 2 treatment approaches to be performed without the need to transfer the patient, thereby minimizing the transition time between the modalities. Intraoperative cone-beam computed tomography contributed to the evaluation of residual clots. CONCLUSIONS: A hybrid OR may contribute to a combined neuroendoscopic and endovascular treatment for ruptured cerebral aneurysms with severe intraventricular hemorrhage.

Fluid structure interaction analysis reveals facial nerve palsy caused by vertebral-posterior inferior cerebellar artery aneurysm.

Cranial nerve palsy caused by aneurysmal compression has not been fully evaluated. The main causes of symptoms are considered to be direct mechanical compression and aneurysm pulsations. Recent studies indicate that nerve dysfunction is mainly induced by pulsation rather than by direct compression, and successful cases of endovascular surgery have been reported. We describe a patient with an unruptured vertebral artery-posterior inferior cerebellar artery (VA-PICA) aneurysm compressing the facial nerve at the root exit zone (REZ). The patient presented with peripheral facial nerve palsy but not hemifacial spasm and was successfully treated by coil embolization. To investigate the mechanisms underlying peripheral facial nerve palsy, fluid structure interaction (FSI) analysis can approximate displacement and the magnitude of aneurysmal wall motion due to hemodynamic forces. In our case, maximum mesh displacement was observed at the aneurysmal wall attached to the facial nerve inside the pons rather than the REZ, which explains the clinical manifestation of facial nerve palsy in the absence of hemifacial spasm. This preliminary report demonstrates the utility of FSI analysis for investigating cranial nerve neuropathy.

Influence of extremely low frequency, low energy electromagnetic fields and combined mechanical stimulation on chondrocytes in 3-D constructs for cartilage tissue engineering.

Articular cartilage, once damaged, has very low regenerative potential. Various experimental approaches have been conducted to enhance chondrogenesis and cartilage maturation. Among those, non-invasive electromagnetic fields have shown their beneficial influence for cartilage regeneration and are widely used for the treatment of non-unions, fractures, avascular necrosis and osteoarthritis. One very well accepted way to promote cartilage maturation is physical stimulation through bioreactors. The aim of this study was the investigation of combined mechanical and electromagnetic stress affecting cartilage cells in vitro. Primary articular chondrocytes from bovine fetlock joints were seeded into three-dimensional (3-D) polyurethane scaffolds and distributed into seven stimulated experimental groups. They either underwent mechanical or electromagnetic stimulation (sinusoidal electromagnetic field of 1 mT, 2 mT, or 3 mT; 60 Hz) or both within a joint-specific bioreactor and a coil system. The scaffold-cell constructs were analyzed for glycosaminoglycan (GAG) and DNA content, histology, and gene expression of collagen-1, collagen-2, aggrecan, cartilage oligomeric matrix protein (COMP), Sox9, proteoglycan-4 (PRG-4), and matrix metalloproteinases (MMP-3 and -13). There were statistically significant differences in GAG/DNA content between the stimulated versus the control group with highest levels in the combined stimulation group. Gene expression was significantly higher for combined stimulation groups versus static control for collagen 2/collagen 1 ratio and lower for MMP-13. Amongst other genes, a more chondrogenic phenotype was noticed in expression patterns for the stimulated groups. To conclude, there is an effect of electromagnetic and mechanical stimulation on chondrocytes seeded in a 3-D scaffold, resulting in improved extracellular matrix production.

Site directed vascular gene delivery in vivo by ultrasonic destruction of magnetic nanoparticle coated microbubbles.

Site specific vascular gene delivery for therapeutic implications is favorable because of reduction of possible side effects. Yet this technology faces numerous hurdles that result in low transfection rates because of suboptimal delivery. Combining ultrasonic microbubble technology with magnetic nanoparticle enhanced gene transfer could make it possible to use the systemic vasculature as the route of application and to magnetically trap these compounds at the target of interest. In this study we show that magnetic nanoparticle-coated microbubbles bind plasmid DNA and successfully deliver it to endothelial cells in vitro and more importantly transport their cargo through the vascular system and specifically deliver it to the vascular wall in vivo at sites where microbubbles are retained by magnetic force and burst by local ultrasound application. This resulted in a significant enhancement in site specific gene delivery compared with the conventional microbubble technique. Thus, this technology may have promising therapeutic potential. FROM THE CLINICAL EDITOR: This work focuses on combining ultrasonic microbubble technology with magnetic nanoparticle enhanced gene transfer to enable targeted gene delivery via the systemic vasculature and magnetic trapping of these compounds at the target of interest.

First theoretic analysis of magnetic drug targeting in the lung.

Magnetic drug targeting in the bloodstream has been intensively studied recently, but also other interesting access and transport pathways fulfill the basic conditions for this method. More recently, magnetic drug targeting has even been accomplished for aerosol application in mouse models and indicated unmistakable advantages over all currently available therapies for lung tumors and any other very localized lung disease. In this paper, the application of magnetically labeled aerosols to the lung via the airways is theoretically highlighted for the first time in the literature. The fundamental difference compared to targeting via the bloodstream lies in the medium and the presence of the bronchial surface: When touching the epithelium of the lung outside the target region, a particle will deposit on the surface and not enter the air stream again. We are the first to compose a comprehensive physical description and provide a fundamental understanding of this potential expedient for treating cancer and other localized diseases. With our approach, we found optimal conditions for this sort of therapy. As a main parameter for optimization, the droplet size could be identified by minimizing unwanted deposition outside the target due to secondary effects, which compete with the magnetic forces. This may improve therapeutic efficiency and reduce side effects of otherwise not well-tolerated compounds, such as chemotherapeutics at the same time.