Smaller diameter sheaths are required to safely perform transradial neurointerventions.

We read with great interest the paper titled "Transradial access with Simmons guiding catheter for carotid artery stenting: Feasibility and procedural complications in a single-center experience" by Muszynski et al. The authors concluded that a transradial carotid artery stenting (CAS) using a Glidesheath Slender 7F Introducer/7F Envoy Simmons 2 catheter system was feasible with a high procedural success rate and low access site complication rate. We completely agree with their conclusions. In this study, large-diameter sheaths were used. Large sheaths increase the risk of developing radial artery spasms. Interventionalists must be aware that radial artery spasm can not only require an access crossover, but can also cause severe access site complications, such as eversion or avulsion of the radial artery, catheter/sheath entrapment, and compartment syndrome. A 6F Simmons guiding sheath has a smaller outer diameter than the Glidesheath Slender 7F Introducer does, and it offers a large-bore working channel compatible with a 10-mm diameter Wallstent and Acculink. Transradial CAS with a 6F Simmons guiding sheath has previously yielded a high procedural success rate without serious access site complications. Nevertheless, we believe that a further decrease in the sheath diameter is required to safely perform transradial neurointerventions in more patients.

Left Transradial Access Using a Radial-Specific Neurointerventional Guiding Sheath for Coil Embolization of Anterior Circulation Aneurysm Associated With the Aberrant Right Subclavian Artery: Technical Note and Literature Review.

BACKGROUND: Aberrant right subclavian artery (ARSA) is a rare condition, but the most common anomaly of the aortic arch. Although neurointerventions via transradial access (TRA) are becoming increasingly popular worldwide, transradial carotid cannulation has been extremely challenging in patients with an ARSA. Herein, we present a case of ARSA-associated anterior communicating artery (ACoA) aneurysm that was successfully treated with a radial-specific 6F Simmons guiding sheath via left TRA. We also review the relevant literature. METHODS: A 68-year-old-woman who was diagnosed as having an ARSA-associated ACoA aneurysm underwent simple coiling via left TRA. After the 6F Simmons guiding sheath was engaged into the right common carotid artery using the pull-back-technique, transradial quadraxial system (6F Simmons guiding sheath/6F intermediate catheter/3.2F intermediate catheter/coil-delivery microcatheter) was implemented. RESULTS: Simple coiling of the aneurysm was successfully achieved without catheter kinking or system instability. The postprocedural course was uneventful. A follow-up magnetic resonance angiography showed no evidence of recanalization 1 years 9 months after the procedure. CONCLUSIONS: Transradial anterior circulation intervention has been rarely used for patients with an ARSA due to unfavorable catheter trajectory. Left TRA using the 6F Simmons guiding sheath is a useful treatment option to address anterior circulation interventions for patients with an ARSA. Preoperative diagnosis of ARSA is necessary for the application of our method.

A rare pure intraventricular hemorrhage caused by ruptured internal carotid artery-anterior choroidal artery aneurysm: a case report and literature review.

Although intraventricular hemorrhage (IVH) frequently develops secondary to intraparenchymal or subarachnoid hemorrhage, pure IVH-non-traumatic spontaneous intracranial hemorrhage confined to the cerebral ventricular system-is rare. Moreover, pure IVH caused by ruptured proximal aneurysm is an extremely rare but life-threatening condition. Herein, we present a case of pure IVH due to a ruptured internal carotid artery -anterior choroidal artery (ICA-AChA) aneurysm and review related literature. A 77-year-old man presenting with altered mental status was hospitalized due to a massive pure IVH with ventriculomegaly. The patient was conservatively managed because his consciousness level improved. On the following day, computed tomography angiography revealed a right ICA-AChA aneurysm embedded in the temporal lobe adjacent to the anterior part of the inferior horn of the lateral ventricle, which was consistent with the hemorrhagic origin. Coil embolization of the aneurysm was successfully performed, and the postprocedural course was uneventful. To date, only a few cases have described pure IVH caused by a ruptured proximal aneurysm. If the ruptured proximal aneurysm remains unnoticed, catastrophic rehemorrhage may occur. Aneurysm obliteration should precede the treatment of acute hydrocephalus. Neurosurgeons/neurointerventionalists must be aware about pure IVH caused by a ruptured proximal aneurysm even if it rarely occurs.

Sequential Development of Putaminal Hemorrhage and Corona Radiata Infarction in the Same Lenticulostriate Arterial Territory.

Putaminal hemorrhage is a common type of spontaneous cerebral hemorrhage. However, to our knowledge, there have been no reports of sequential cerebral hemorrhage and infarction in the same perforating arterial territory. Herein, we present the first reported case of the sequential development of putaminal hemorrhage and corona radiata infarction in the same lenticulostriate arterial (LSA) territory. Early intensive blood pressure lowering treatment may have aggravated ischemic damage. If a patient presents with motor weakness that cannot be explained by putaminal hemorrhage, the sequential development of corona radiata infarction in the same LSA territory should be ruled out.

Intraoperative Image-Guided Surgery for Gliomas in the Smart Cyber Operating Theater (SCOT): A Preliminary Clinical Application.

BACKGROUND: Various devices exist for glioma image-guided surgery to improve tumor resection. These devices work as stand-alone units, making the flow of operative information complicated and disjointed. A novel networked operating room, the Smart Cyber Operating Theater (SCOT), has been developed, integrating stand-alone medical devices using the OPeLiNK communication interface. We report and evaluate the impact of SCOT for glioma surgery and our initial experiences. METHODS: Patients with gliomas who underwent tumor resection in SCOT between July 2018 and June 2021 were retrospectively reviewed. Various types of intraoperative information were integrated, managed, and shared with the surgical strategy desk using OPeLiNK. Patients' demographics, tumor characteristics, treatment details, and outcomes were obtained. The impact of the SCOT system was evaluated. RESULTS: Twenty-seven patients, with a mean age of 48.6 years (range, 13-88 years), met the inclusion criteria. We successfully completed all the surgical procedures using SCOT. The mean operation time was 420.6 minutes (range, 225-667 minutes).Gross total resection was accomplished in 13 patients (48.1%), subtotal resection in 4 (14.8%), and partial resection in 10 (37.0%). The main surgeon in the operating room and other neurosurgeons at the strategy desk shared and discussed the information in real time during the procedures. CONCLUSIONS: The use of SCOT was shown to be safe and feasible in glioma surgery. This study suggests that SCOT may improve surgical outcomes and educational impact by sharing information in real time with the strategy desk.

Rare sphenoid ridge intracranial mature teratoma in an adult female.

Intracranially located teratomas usually involve midline brain structures. However, they rarely occur in adults. A 26-year-old woman presented with a growing intracranial mass lesion in the left sphenoid ridge without neurological deficits. Magnetic resonance imaging revealed homogenous hyperintensities without contrast enhancement. The patient underwent gross total excision of the soft, yellowish sphenoid ridge tumor with no cystic component. The surgery was uneventful, with no intraoperative complications. Histological analysis revealed a mature teratoma. She attended regular outpatient neuroradiology follow-up appointments. The present case is an unusual example of a mature teratoma with regard to location, neuroimaging appearance, macroscopic intraoperative findings, histological tumor subtype, and patient age and sex.

Repair of wounded monolayers of cultured bovine aortic endothelial cells is inhibited by calcium spirulan, a novel sulfated polysaccharide isolated from Spirulina platensis.

Calcium spirulan (Ca-SP) is a novel sulfated polysaccharide isolated from a blue-green alga Spirulina platensis. Ca-SP inhibits thrombin by activation of heparin cofactor II. Therefore, it could serve as an origin of anti-atherogenic medicines. Since maintenance of vascular endothelial cell monolayers is important for prevention of vascular lesions such as atherosclerosis, the effect of Ca-SP at 20 microg/ml or less on the repair of wounded bovine aortic endothelial cell monolayers in culture was investigated in the present study. When the monolayers were wounded and cultured in the presence of Ca-SP, the polysaccharide inhibited the appearance of the cells in the wounded area. The inhibition was also observed even when the repair was promoted by excess basic fibroblast growth factor, which is one of the autocrine growth factors that are involved in the endothelial cell monolayer maintenance. On the other hand, Ca-SP inhibited the cell growth and the incorporation of [3H]thymidine into the acid-insoluble fraction of proliferating endothelial cells, suggesting that Ca-SP inhibits endothelial cell proliferation. From these results, it is concluded that Ca-SP may retard the repair process of damaged vascular endothelium through inhibition of vascular endothelial cell proliferation by induction of a lower ability to respond to stimulation by endogenous basic fibroblast growth factor.