pCONUS 2 and pCONUS 2-HPC in the treatment of wide-necked intracranial aneurysms: Multicentre UK experience.

BACKGROUND/PURPOSE: pCONUS 2 and pCONUS 2-HPC are neck-bridging devices that provide coiling support in the endovascular treatment of wide-necked intracranial aneurysms. To date, limited multicentre data has been published. This study provides the first pooled data from multiple UK centres regarding outcomes for these devices covering the periprocedural period to 6-month follow-up. MATERIALS/METHODS: This retrospective, single-arm study assessed 65 patients treated over 3 years from the time of procedure to 6 months post-procedure across four UK centres. Data collected included patient demographics, aneurysm characteristics and antiplatelet regimens. Outcome measures were angiographic results and procedure-related complications from the immediate periprocedural period to 6-month follow-up. RESULTS: Fifty-four unruptured (83.1%) and 11 ruptured (16.9%) aneurysms were treated. Fifty-five aneurysms were located in the anterior circulation (87.7%). There were four device-related intraprocedural complications: three cases of asymptomatic, temporary thrombus formation and one mortality associated with branch vessel occlusion and aneurysm re-bleeding in a ruptured case. There were no post-procedural device-related complications. Satisfactory occlusion was achieved in 58/65 procedures (89.2%) at time of treatment and in 44/60 (73.3%) at 6 months. Satisfactory occlusion correlated with aneurysm size and coiling packing density. Retreatment was required for five unruptured cases (7.7%) and was straightforward with the device in situ. CONCLUSION: pCONUS 2 and pCONUS 2-HPC have good short-term safety profiles. The use of pCONUS 2-HPC in the acute treatment of ruptured aneurysms with postprocedural SAPT is feasible. The devices have an intraprocedural complication rate of 4/65 (6.2%) across multiple UK centres, including a single death (1.5%).

Missed cervical spine injuries: aim for the top.

PURPOSE: To determine the incidence of missed cervical spine injuries by radiology registrars in a major trauma centre and to identify any common blind spots. MATERIALS AND METHODS: All patients with an acute traumatic injury who underwent a CT scan of the cervical spine in our unit, which serves a population of approximately 900,000, between September 2016 and December 2017 and whom had a separate radiology trainee report and final neuroradiology consultant report available were included in the study. We recorded the date and time of the scan, the registrar error and the registrar grade. An error was defined as follows: (1) a missed fracture; (2) a missed ligamentous injury; (3) overcall of a fracture (e.g. degenerative calcification or nutrient vessel). Groups were compared with the chi-square test. RESULTS: Five hundred seventy-three CT scans of the cervical spine fitted the inclusion criteria and were analysed. There were a total of 149 injuries over eight levels in 96 patients. There were 12 registrar errors (2.1% discrepancy rate), of which 11 were missed acute injuries (9 fractures and 2 disco-ligamentous injuries). The grade of the registrar was not significant (p = 0.603). Seventy-three percent (8/11) missed injuries were disproportionately at the cranio-cervical junction, where only 11.6% of traumatic cervical spine injuries occur p < 0.0001. Forty-five percent of the missed injuries included occipital condyle fractures, which occurred in only 12/149 injuries (8%). CONCLUSIONS: Radiology registrars safely report emergency CT scans of the cervical spine performed following trauma with a low discrepancy rate. Missed cervical spine injuries commonly occur at the cranio-cervical junction, which should become a standard review area.

Martius graft for TOT extrusion: a case series.

INTRODUCTION: The management of mid-urethral tape extrusion is inconsistent. We believe that we present here the first case series detailing the use of the Martius graft for trans-obturator tape (TOT) extrusion. METHODS: Five women had a Martius graft for TOT extrusion. Data were obtained retrospectively from case notes and a review postoperatively to investigate the results in the short and intermediate term. RESULTS: All extrusions were greater than 1 cm in diameter and situated between the midline and the lateral vaginal sulcus. In 3 women the tape extrusion was discovered at 6-12 weeks postoperatively and 2 presented with symptoms again after 12 months. Following the Martius graft, there was no ipsilateral recurrence of tape extrusion or exposure. Postoperatively, 2 women received oral antibiotics. Two women developed de novo sexual problems, which had resolved at follow-up. CONCLUSIONS: It is promising that all the tape extrusions were successfully treated with a Martius Graft, thus preserving tape function. There was a high incidence of minor complications initially, but there was minimal long-term morbidity and no cosmetic dissatisfaction. We believe that testing this proposition in a larger case series will provide better evidence.