Percutaneous femoral access: Stuck guide wire, decannulation difficulty due to unravelling and knotting.

Percutaneous techniques for femoral arterial access are increasingly being performed due to advances in endovascular cerebral procedures, as they provide a less morbid and minimally invasive approach than open procedures. Common complications associated with this peripheral puncture include hematoma, bleeding, pseudoaneurysm, arteriovenous fistula, retroperitoneal bleeding, inadvertent venous puncture, dissection, etc. The retrograde femoral access is currently the most frequently used arterial access as it is technically straightforward, allows for the use of larger size sheaths and catheters, allows repeated attempts, etc. Although being technically less challenging, grave complications can occur due to hardware failure. Here, we present a case of unruptured posterior inferior cerebellar artery (PICA) aneurysm, who underwent uneventful diagnostic cerebral digital substraction angiography (DSA) via right femoral artery route on first attempt, but on second attempt for therapeutic intervention, landed up with stuck guide wire and faced decannulation difficulty due to unravelling of guide wire and multiple knot formation, which was finally removed after multiple attempts at pulling and improvised manoeuvres. Such cannulation and decannulation difficulties have been reported multiple times for central venous access, but extremely rarely for femoral routes, making this case a rarity and worth reporting.

Sellar colloid cyst: Peculiar radiological characteristics of a common lesion at an uncommon location.

Background: Colloid cysts, common benign lesions of the third ventricle, have rarely been reported in uncommon extraventricular locations such as the pituitary fossa. Even in the sellar region, it is usually seen between the anterior and posterior pituitary lobes (pars intermedia). Case Description: Here, we report a case of a female patient, who was incidentally diagnosed with a sellar colloid cyst, while being evaluated for nonspecific holocranial headache. On imaging, there was a lesion located in the anterior sellar region, compressing the whole pituitary gland posteriorly (first reported case to the best of our knowledge), that was found to be a colloid cyst intraoperatively during microsurgical excision through transnasal transsphenoidal route. Conclusion: This rare entity should be kept in mind while considering lesions of the pituitary region, as evident by typical radiological features, in spite of being located in a less likely site.

Internal carotid artery agenesis presenting with ruptured Acom aneurysm: Rare case report.

Developmental anomalies of internal carotid artery (ICA), being rare entities, are mostly asymptomatic by themselves because of good collateral supply. However, when present with other associated intracranial anomalies requiring treatment, there can be catastrophic consequences, if special attention is not paid to this condition. We present a case of 36 years old male, who reported to our emergency department with complaints of headache and loss of consciousness. He was diagnosed as a case of ruptured anterior communicating aneurysm with subarachnoid hemorrhage and agenesis of left ICA with trans-cavernous anastomosis. He underwent clipping of aneurysm and was discharged uneventfully. This report highlights the importance of skillful microsurgical clipping in extremely high-risk conditions, in contemporary era of hybrid neurosurgeons.

Adult transsphenoidal meningoencephalocele: Clinical image.

Background: Encephalocele is herniation of cranial contents through a skull defect, classified according to their contents and location, and is usually seen in pediatric age group. The transsphenoidal type represents <5% of all basal meningoencephaloceles. Of them, the presentation in adulthood is even rarer. Case Description: A 19-year-old female complaining of breathing difficulties during sleep and exertional dyspnea was diagnosed with a transsphenoidal meningoencephalocele, likely representing patent craniopharyngeal canal. On exploration through bifrontal craniotomy, the defect was identified in the sellar floor after completely reducing the contents into the cranial cavity and was repaired. She had immediate symptomatic relief and an uneventful postoperative course. Conclusion: There can be significant symptomatic relief with minimal postoperative morbidity after transcranial repair of such large transsphenoidal meningoencephaloceles, through traditional skull base approaches.