Genetic ancestry and radical prostatectomy findings in Hispanic/Latino patients.

Background: African ancestry is a known factor associated with the presentation and aggressiveness of prostate cancer (PC). Hispanic/Latino populations exhibit varying degrees of genetic admixture across Latin American countries, leading to diverse levels of African ancestry. However, it remains unclear whether genetic ancestry plays a role in the aggressiveness of PC in Hispanic/Latino patients. We explored the associations between genetic ancestry and the clinicopathological data in Hispanic/Latino PC patients from Colombia. Patients and methods: We estimated the European, Indigenous and African genetic ancestry, of 230 Colombian patients with localized/regionally advanced PC through a validated panel for genotypification of 106 Ancestry Informative Markers. We examined the associations of the genetic ancestry components with the Gleason Grade Groups (GG) and the clinicopathological characteristics. Results: No association was observed between the genetic ancestry with the biochemical recurrence or Gleason GG; however, in a two groups comparison, there were statistically significant differences between GG3 and GG4/GG5 for European ancestry, with a higher mean ancestry proportion in GG4/GG5. A lower risk of being diagnosed at an advanced age was observed for patients with high African ancestry than those with low African ancestry patients (OR: 0.96, CI: 0.92-0.99, p=0.03). Conclusion: Our findings revealed an increased risk of presentation of PC at an earlier age in patients with higher African ancestry compared to patients with lower African ancestry in our Hispanic/Latino patients.

Impact of presentation timing in metastatic hormone-sensitive prostate cancer: Characterization of patients and identification of prognostic factors.

BACKGROUND: The treatment and surveillance of metastatic hormone-sensitive prostate cancer (mHSPC) has evolved since the introduction of several treatment intensification options associated with hormonal blockade and classifications based on the timing of metastatic disease presentation and disease volume. Using a hospital-based registry, we aimed to assess whether these new classifications are applicable to our population, as few studies have demonstrated their prognostic value for overall survival (OS) and time to development of castration-resistant prostate cancer (CRPC), and to establish prognostic factors in our population. METHODS: A retrospective cohort of mHSPC patients who were attended at an oncology referral hospital in Bogota between 2017 and 2021 were included in this study. The primary and secondary endpoints were OS and time to CRPC. The distribution of outcome measures was estimated using the Kaplan-Meier method. Proportional hazard models were constructed using the Cox regression approach and stratified according to risk factors. RESULTS: The study cohort included 373 patients. The median castration resistance-free survival was 48 months (CI: 32-73 months), and OS was 43 months (CI: 37-48 months). In multivariate analysis, nodal staging, ECOG status, and surgical castration were independent prognostic factors. CONCLUSION: In our hospital-based registry, the independent impact of the time of presentation on castration-resistant-free survival or OS could not be demonstrated, nor could the grouping of prognostic categories based on metastatic presentation temporality and volume. Other independent prognostic factors have been proposed.

Three-Dimensional Morphometric Analysis of Anterior Cerebral Circulation Aneurysms.

This article assesses the association between anterior circulation morphometry and the presence of intracranial aneurysm using three-dimensional rotational angiography (3DRA). A retrospective analysis at a Peruvian academic medical center between December 2018 and February 2020 identified 206 patients with unruptured intracranial aneurysms and matched controls who underwent 3DRA. Angiographic images were obtained per standard of care, and measurements of the vasculature were performed using 3DRA vascular automated software. A total of 163 aneurysms and 43 control angiograms were evaluated. Women represented 82.5% of the cases and the mean age was 55.9 years (standard deviation ± 14.2). In multivariate analysis, five specific features were found to be statistically significant predictors for presence of an anterior circulation aneurysm: female sex (odds ratio [OR] = 2.71; p = 0.048), C-shape of the middle cerebral artery (MCA) (OR = 2.73; p = 0.018), distal internal carotid artery (ICA) diameter (OR = 3.42; p = 0.012), ICA bifurcation angle (OR = 1.02; p = 0.036), and length of the carotid siphon (OR = 1.08; p = 0.047). Features detected on 3DRA suggest morphological characteristics of the ICA and MCA may be predictive for intracranial aneurysm. Our findings build from prior reports by demonstrating five specific patient and imaging features associated with anterior circulation aneurysms. While 3DRA is the standard of care in many settings, medical centers with resource limitations may not have access to this technique. The demographic and morphological features identified in our study may have correlates that if detected on contrast computed tomography or magnetic resonance imaging studies, may be used to help screen for a higher level of care in select patients.

Endovascular trends in the treatment of intracranial aneurysms in a Peruvian reference center.

Objectives: Endovascular treatment of intracranial aneurysms (IAs) has evolved in recent years and is currently the preferred treatment worldwide. We analyzed the trends in the number of patients, number of aneurysms, aneurysm characteristics, and techniques used in a pure endovascular cohort of patients treated in a reference center. Materials and Methods: Between 2010 and 2020, a retrospective data collection of patients who underwent endovascular intervention of IAs was performed. We used the Mann-Kendal test to evaluate the trends. In addition, the moving-average technique was used to assess smoother curves. Results: Eight hundred and forty-five aneurysms were treated in 765 patients, the mean age was 53.9 ± 14.6 years and 81% were women. The number of patients (P = 0.016) and aneurysms (P = 0.003) increased significantly. Unruptured (P = 0.029) and posterior communicating artery aneurysms increased their frequency of treatment (P = 0.042). Balloon remodeling (P = 0.01) and the use of flow diverters showed a positive trend (P = 0.016). Conclusion: There have been an increased number of patients and aneurysms treated endovascularly at our institution, including unruptured and posterior communicating aneurysms. Advanced endovascular techniques also increased. Comparative studies including surgical cases must be done in our region to determine the best approach.

Safety and radiologic clearance of chronic subdural hematoma after endovascular embolization using SQUID 18 in patients older than 80 years.

The aim of the study was to evaluate radiographic clearance and clinical outcomes in patients over age 80 who undergo SQUID 18 embolization of the middle meningeal artery (MMA) for the management of chronic subdural hematoma (cSDH). From April 2020 to October 2021, data were obtained from patients with cSDH who underwent MMA embolization at our institution. Clinical and radiological data including pre-operative and last follow-up CT scans were analyzed. Six embolization procedures were performed in five patients using SQUID 18, a liquid embolic agent. The median age was 83 years, and three subjects were female. Two of the six cases were recurrent hematomas. MMA embolization was achieved in 100% of cases. The median diameter of the hematoma at admission was 20 mm and at last follow-up was 5.3 mm, demonstrating statistically significant radiographic clearance (P = 0.043). There were no intra or post-operative complications. Mortality was not noted during observation period. SQUID MMA embolization safely and significantly reduced the hematoma diameter and offers an alternative treatment in patients older than 80 years with cSDH.

Embolization as stand-alone strategy for pediatric low-grade brain arteriovenous malformations.

OBJECTIVES: We evaluated the safety and efficacy of endovascular embolization as first-line stand-alone strategy for the treatment of low-grade brain arteriovenous malformations (bAVMs) (Spetzler Martin [SM] grade I and II) in pediatric patients. In addition, we assessed the predictors of procedure-related complications and radiographic complete obliteration in a single session. MATERIAL AND METHODS: We conducted a single center retrospective cohort study of all pediatric (≤18 years) patients who underwent embolization as a stand-alone strategy for low-grade bAVMs between 2010 and 2022. Safety was measured by procedure-related complications and mortality. Efficacy was defined as complete angiographic obliteration after the last embolization session. RESULTS: Sixty-eight patients (41 females; median age 14 years) underwent a total of 102 embolization sessions. There were 24 (35%) SM grade I lesions and 44 (65%) grade II. Six procedure-related complications (5.8% of procedures) were observed and no deaths were reported. All the complications were intraoperative nidus ruptures. A single draining vein was the only significant predictor of procedure-related complications (OR=0.10; 95% CI 0.01 - 0.72; p=0.048). Complete angiographic obliteration was achieved in 44 patients (65%). In 35 patients (51%) the bAVM was completely occluded in one session. The bAVM nidal size was a predictor of complete obliteration in one session (OR=0.44; 95% CI, 0.21-0.80; p=0.017). CONCLUSION: Endovascular treatment as a stand-alone strategy for pediatric low-grade bAVMs is an adequate first-line approach in high volume centers with endovascular expertise. Nidal size evaluation is relevant in order to optimize patient selection for embolization as a stand-alone treatment modality.

Embolización de aneurismas intracraneales múltiples en sesión única

Objetivo: Determinar los resultados clínicos y angiográficos en pacientes con aneurismas intracraneales múltiples tratados endovascularmente en una única sesión. Materiales y Métodos: Se incluyó a todos los pacientes mayores de 18 años con aneurismas múltiples (≥2), rotos o no rotos, tratados con terapia endovascular en una única sesión entre 2019 y 2021. Se recolectaron los datos clínicos y angiográficos. Se determinó la tasa de oclusión inmediata y del seguimiento. La escala de Rankin modificado se usó para valorar el resultado clínico. Resultados: Se trataron 25 pacientes, de los cuales 14 se presentaron con hemorragia subaracnoidea. Se diagnosticaron un total de 78 aneurismas, de los cuales 59 aneurismas fueron tratados. La localización más frecuente fue el segmento oftálmico. La altura máxima promedio fue de 5.2mm, lo cual tuvo diferencia estadística significativa con el estado de ruptura (p ≤ 0.02). El principal tipo de tratamiento endovascular fue la técnica de remodeling en el 39 % de casos. El Raymond Roy inmediato fue I en el 60 % y IIIa en el 35 % de casos. La tasa de complicaciones fue del 24 % y de mortalidad fue del 8 %. Conclusiones: El tratamiento endovascular en una única sesión es una opción efectiva y segura en casos de aneurismas intracraneales múltiples en nuestra institución con tasa de oclusión y complicaciones aceptable.

Objective: To determine clinical and angiographical outcomes in patients with multiple intracranial aneurysms who underwent endovascular therapy in a single session. Materials and Methods: Patients older than 18 years with multiple (≥2) ruptured or non-ruptured aneurysms were included, and all of them underwent endovascular therapy in a single session between 2019 and 2021. Clinical and angiographic data was collected. Immediate occlusion and follow-up data were collected. Rankin modified scale was used for assessing clinical outcomes. Results: Twenty-five patients were treated, and fourteen had subarachnoid hemorrhage. Seventy-eight aneurysms were diagnosed, and 59 of them were treated. The most frequent location was at the ophthalmic segment. Maximum average height was 5.2- mm, which showed significant statistical difference with a ruptured condition (p≤0.02). The main modality for endovascular therapy was the remodeling technique, which was used in 39% of all cases. Immediate Raymond Roy staging was I in 60% of all cases, and IIIa in 35% of all cases. Complication rate was 24%, and mortality rate was 8%. Conclusions: Single session endovascular therapy is an effective and safe option for cases of multiple intracranial aneurysms in our institution. Occlusion and complication rates were acceptable.

Transvenous embolization of a ruptured thalamic arteriovenous malformation supplied by the tuberothalamic artery.

Background: Basal ganglia and thalamic arteriovenous malformations (AVM) represent 10% of all AVM. They are associated with a high rate of morbidity and mortality due to their high hemorrhagic presentation and eloquence. Radiosurgery has been the first line treatment, whereas surgical removal and endovascular therapy are possible in selected cases. Deep AVM with small niduses and a single draining vein can achieve cure with embolization. Case Description: A 10-year-old boy with sudden headache and vomiting underwent a brain computed tomography scan that showed a right thalamic hematoma. Cerebral angiography revealed a small ruptured right anteromedial thalamic AVM with a single feeder arising from the tuberothalamic artery and a single drainage to the superior thalamic vein. Transvenous approach using precipitating hydrophobic injectable liquid 25%® achieved a complete obliteration of the lesion in a single-session. He was discharged home without neurological sequelae and maintained clinically intact at follow-up. Conclusion: Transvenous embolization of deep-located AVM as a primary treatment is curative in selected cases, with complication rates comparable to other therapeutic strategies.

A Retrospective Study of Metastatic Renal Cell Carcinoma Patients With Brain Metastases.

Metastatic renal cell carcinoma (mRCC) involving the central nervous system is currently an excluded subgroup of patients in the systemic treatment; for this reason, there is no solid data to support the efficacy of therapies in this subgroup. That is why it is important to describe real-life experiences in order to know if there is a special change in clinical behavior or treatment response in these kinds of patients. Patients and methods A retrospective review was performed to characterize mRCC patients diagnosed with brain metastases (BrM) during treatment at the National Institute of Cancerology of Bogota, Colombia. Descriptive statistics and time-to-event methods are used to evaluate the cohort. For the descriptive measures of quantitative variables, the mean with standard deviation was taken, and the minimum and maximum values were reported. In the case of qualitative variables, absolute and relative frequencies were used. The software used was R - Project v4.1.2 (R Foundation for Statistical Computing, Vienna, Austria). Results A total of 16 patients were included with mRCC between January 2017 to August 2022 with a median 35.1-month follow-up, 4/16 (25%) were diagnosed with BrM at the time of screening and 12/16 (75%) during treatment. The International Metastatic RCC Database Consortium risk (IMDC) was favorable for 12.5%, intermediate for 43.7%, and poor for 25%, and not classified for 18.8%, BrM involvement was multifocal in 50% of the population and localized, brain-directed therapy was done in 43.7% of patients, predominantly palliative radiotherapy. Median overall survival (OS) for all the patients regardless of the time of metastatic presentation of the disease in the central nervous system was 53.5 months (0-70.3), and OS for cases with central nervous system involvement was 10.9 months. IMDC risk did not correlate with survival (log-rank, p=0.67). The OS for the subgroup of patients who debut with metastatic disease in the central nervous system is different from the group that developed metastasis in the progression of their disease (OS of 42 vs 3.6 months, respectively). Conclusions This is the largest descriptive study in Latin America and the second in the world from one institution that admits patients with metastasic renal cell carcinoma and central nervous system metastasis. In these kinds of patients with metastatic disease or progression to the central nervous system, there is a hypothesis that shows more aggressive clinical behavior. There is limited data on locoregional intervention to metastatic disease in the nervous system drastically, but trends show this could impact overall survival outcomes.

Combined Reporting of Surgical Quality and Cancer Control after Surgical Treatment for Penile Tumors with Inguinal Lymph Node Dissection: The Tetrafecta Achievement.

BACKGROUND: To optimize results reporting after penile cancer (PC) surgery, we proposed a Tetrafecta and assessed its ability to predict overall survival (OS) probabilities. METHODS: A purpose-built multicenter, multi-national database was queried for stage I-IIIB PC, requiring inguinal lymphadenectomy (ILND), from 2015 onwards. Kaplan-Meier (KM) method assessed differences in OS between patients achieving Tetrafecta or not. Univariable and multivariable regression analyses identified its predictors. RESULTS: A total of 154 patients were included in the analysis. The 45 patients (29%) that achieved the Tetrafecta were younger (59 vs. 62 years; p = 0.01) and presented with fewer comorbidities (ASA score ≥ 3: 0% vs. 24%; p < 0.001). Although indicated, ILND was omitted in 8 cases (5%), while in 16, a modified template was properly used. Although median LNs yield was 17 (IQR: 11-27), 35% of the patients had <7 nodes retrieved from the groin. At Kaplan-Maier analysis, the Tetrafecta cohort displayed significantly higher OS probabilities (Log Rank = 0.01). Uni- and multivariable logistic regression analyses identified age as the only independent predictor of Tetrafecta achievement (OR: 0.97; 95%CI: 0.94-0.99; p = 0.04). CONCLUSIONS: Our Tetrafecta is the first combined outcome to comprehensively report results after PC surgery. It is widely applicable, based on standardized and reproducible variables and it predicts all-cause mortality.

Metabolic pathways enriched according to ERG status are associated with biochemical recurrence in Hispanic/Latino patients with prostate cancer.

BACKGROUND: The role of ERG-status molecular subtyping in prognosis of prostate cancer (PCa) is still under debate. In this study, we identified differentially expressed genes (DEGs) according to ERG-status to explore their enriched pathways and implications in prognosis in Hispanic/Latino PCa patients. METHODS: RNA from 78 Hispanic PCa tissues from radical prostatectomies (RP) were used for RNA-sequencing. ERGhigh /ERGlow tumor groups were determined based on the 1.5-fold change median expression in non-tumor samples. DEGs with a False Discovery Rate (FDR) < 0.01 and a fold change >2 were identified between ERGhigh and ERGlow tumors and submitted to enrichment analysis in MetaCore. Survival and association analyses were performed to evaluate biochemical recurrence (BCR)-free survival. RESULTS: The identification of 150 DEGs between ERGhigh and ERGlow tumors revealed clustering of most of the non-BCR cases (60%) into de ERGhigh group and most of the BCR cases (60.8%) in ERGlow group. Kaplan-Meier survival curves showed a worst BCR-free survival for ERGlow patients, and a significant reduced risk of BCR was observed for ERGhigh cases (OR = 0.29 (95%CI, 0.10-0.8)). Enrichment pathway analysis identified metabolic-related pathways, such as the renin-angiotensin system and angiotensin maturation system, the linoleic acid metabolism, and polyamines metabolism in these ERG groups. CONCLUSIONS: ERGlow tumor cases were associated with poor BCR-free survival in our Hispanic/Latino patients, with metabolism-related pathways altered in the BCR progression. IMPACT: Our findings suggest the need to dissect the role of diet, metabolism, and lifestyle as risk factors for more aggressive PCa subtypes.

Primary seminoma of the seminal vesicle. A case report.

Testicular germ cell tumors, including seminomas, originate mainly from the testicles and rarely from extragonadal locations, often retroperitoneum and mediastinum. Moreover, primary seminal vesicle tumors are extremely rare, and the most described histology is adenocarcinoma. We report, as far as we know, the second case of primary seminoma of the seminal vesicle.

Aneurisma tipo blister roto con manejo satifactorio con la técnica de remodelado - Reporte de un caso

Introducción : Los aneurismas tipo blíster son aneurismas pequeños, complejos, menores de 3mm, con alta tasa de morbilidad y mortalidad, así como de resangrado y recurrencia. Son difíciles de tratar y se han propuesto técnicas microquirúrgicas y endovasculares, siendo estas últimas las de menor tasa de complicaciones. Caso Clínico : Mujer de 74 años, ingresa con 6 horas de evolución de trastorno de sensorio brusco. La tomografía muestra hemorragia subaracnoidea difusa a predominio izquierdo. Se le realiza una angiografía cerebral que evidencia un aneurisma blíster de la trifurcación de la arteria cerebral media izquierda. Se emboliza con técnica de remodeling y coils, logrando obliterar la totalidad del aneurisma. Conclusión : Los aneurismas tipo blíster son aneurismas complejos y raros, siendo la terapia endovascular una alternativa segura y eficaz con menor tasa de complicaciones.

Introduction : Blister-like aneurysms are small, complex, smaller than 3mm, with high rate of morbidity and mortality, as well as rebleeding and recurrence. They are difficult to treat and microsurgical and endovascular techniques are current treatment modalities. Endovascular technique has the lowest rate of complications. Clinical case : 74-year-old woman, admitted with 6 hours of sudden sensory disorder. The CT scan shows diffuse subarachnoid hemorrhage predominantly on the left side. A cerebral angiography showed a blister-like aneurysm of the left middle cerebral artery trifurcation. The patient was treated with coiling and remodeling technique, achieving a complete occlusion. Conclusion : Blister-like aneurysms are complex and rare, whereas endovascular therapy is a safe and effective alternative with low complication rate.

Utilidad de la angiografía intra-operatoria en el tratamiento quirúrgico de malformaciones arteriovenosas y aneurismas intracraneales

Objetivo: Determinar la utilidad de la angiografía intraoperatoria (AIO) para detectar lesiones residuales en casos de resección quirúrgica de malformaciones arteriovenosas (MAV) y aneurismas intracraneales. Material y métodos: Estudio observacional, descriptivo, tipo serie de casos. Entre noviembre de 1993 y abril de 2001, se diagnosticaron 778 pacientes con patología vascular cerebral, de los cuales 477 fueron sometidos a cirugía. Se empleó AIO en 119 casos y se analizaron las variables clínicas y radiológicas. Resultados: Se analizaron 119 casos, 105 (88,2%) con MAV y 14 (11,8%) con aneurisma. La edad promedio fue de 35 años (rango 6 - 69) y el sexo masculino representó el 52% de los casos. La asociación entre MAV y aneurisma se encontró en 17 casos (14,3%). El aneurisma más frecuente fue el paraclinoideo gigante (71,3%), mientras que las MAV supratentoriales y Spetzler-Martin grado 3 representaron el 83,8% y 73,3% de los casos, respectivamente. Se demostró lesión residual en 7 casos, de los cuales 5 fueron nido residual de MAV y 2 casos aneurisma remanente. Las complicaciones relacionadas a la AIO fueron del 3,4% y mortalidad del 2,5%. Conclusiones: La AIO es una técnica útil para detectar lesiones residuales en patología vascular cerebral sometidas a cirugía abierta.

SUMMARY Objective: To determine the utility of intraoperative angiography (IOA) to detect residual lesions after surgical repair of arteriovenous malformations (AVM) and intracranial aneurysms (ICA). Methods: This is a case series including 778 patients from November 1993 to April 2001; of which 477 underwent surgical intervention. IOA was used in 119 cases. Results: A total of 119 cases were analyzed, 105 patients with AVM (88.2%) and 14 with an aneurysm (11.8%). The mean age was 35 years (range 6 - 69) and males represented 52% of the cases. Both AVM and aneurysms occurred in 17 cases (14.3%). Giant paraclinoid aneurysm was the most common aneurysm (71.3%), whereas supratentorial and grade 3 Spetzler-Martin AVM represented 83.3% and 73.3% of the cases, respectively. A residual lesion was was detected in 7 cases, of which 5 were residual nidus of an AVM and 2 remnant aneurysms. IOA-related complications occurred in 3.4% and mortality was 2.5%. Conclusions: IOA is a useful technique to detect residual cerebro-vascular lesions after open surgeries

Inverted urethral flap reconstruction after partial penectomy: Long-term oncological and functional outcomes.

INTRODUCTION: Penile aesthetics after partial penectomy (PP) for penile cancer (PC), significantly affect a patient's health-related quality of life (HRQoL), self-esteem, and sexual function. Satisfactory reconstruction has become a major milestone in the treatment of these patients. METHODS: Clinical charts of all patients that underwent PP and reconstruction with an inverted urethral flap (IUF) were reviewed. The primary endpoints were recurrence-free survival (RFS), overall survival (OS), and progression-free survival (PFS) which were graphically represented by Kaplan-Meier estimates. The key secondary endpoints were Health-related quality of life (HRQoL), erectile function, and lower urinary tract symptoms. RESULTS: Between May 2007 and December 2019, 74 patients with PC underwent PP and IUF reconstruction. The median age was 62 years (IQR 52-76), median follow-up was 72 months (IQR 38-121). Twenty-nine patients (39.2%) underwent inguinal lymph node dissection, 62 (83.8%) underwent dynamic sentinel lymph node biopsy. Kaplan-Meier estimates of OS, RFS, and PFS showed a 6-year OS of 86.5%, 6-year RFS of 90.5%, and a 6-year PFS of 85.1%. Regarding functional outcomes, we found a mean global health score of 84.6% ± 10.4 at the EQ-5D-3L-VAS. The mean Voiding score of the ICIQ-MLUTS was 1.7 ± 3.2 and a mean IIEF-5 score of 17.3 ± 7. CONCLUSIONS: To the best of our knowledge, we report the largest cohort in the literature of PP with IUF reconstruction. These results are important since early-stage PC is the most common stage at diagnosis. In carefully selected patients' preservation of a longer urethral stump to allow for the inverted flap is safe and does not compromise oncological outcomes while preserving HRQoL.

Endovascular treatment of medium and large intracranial aneurysms with large volume coils: A single-center experience.

BACKGROUND: Large volume coils are an alternative to conventional coils for the treatment of intracranial aneurysms. However, there are no published reports documenting occlusion and complication rates in medium and large intracranial aneurysms. Therefore, we present our results in this subgroup of aneurysms. METHODS: A single-center, retrospective analysis of consecutive patients treated with Penumbra coils 400 in aneurysms ≥7 mm was performed. Demographics, aneurysm features, procedural details, intraoperative complications, clinical outcomes, and occlusion rates were analyzed. RESULTS: Thirty-three patients were included for analysis, and a total of 33 intracranial aneurysms were analyzed. Mean age was 57.6 years (SD ± 12.4) and 85% of the patients were women. Large aneurysms represented 46% of cases. Paraclinoid (55%) followed by posterior communicating (30.3%) aneurysms was the most frequently treated. Ruptured and saccular aneurysms were found in 49% and 63% of the cases, respectively. The mean aneurysmal dimensions were 14.2 mm width, 11.9 mm length, 5.4 mm neck, and 2.4 dome-to-neck ratio. A dome-neck ratio <2 was identified in 39% of cases. The mean number of coils per aneurysm was 4.8. Immediate modified Raymond-Roy Grades 1, 2, and 3A were achieved in 15%, 21%, and 64%, respectively. Twenty-six patients were evaluated at a mean follow-up period of 11 months, with an adequate occlusion of 92% and a good clinical outcome (modified Rankin score ≤2) in 96% of patients. CONCLUSION: Endovascular treatment with PC400 coils is an effective and safe option for medium and large intracranial aneurysms with high occlusion rates, few complications, and good clinical outcomes at follow-up.

Initial Experience Using the Transradial Approach for Endovascular Treatment of Vascular Pathologies: Safety and Feasibility.

Background Endovascular treatment of vascular pathologies through the transradial approach has been increasingly used and has demonstrated a low rate of complications. Objective To report our initial experience in the endovascular treatment of cerebrovascular diseases with the transradial approach and to determine its safety and feasibility. Methods Consecutive patients who underwent the transradial approach for endovascular treatment of aneurysms and vascular malformations were reviewed at a single institution. Technical success, fluoroscopy time, and access-related complications were analyzed. Results Eight patients underwent endovascular treatment with the transradial approach. One arteriovenous fistula, one superficial temporal artery aneurysm, three arteriovenous malformations, and four aneurysms were treated successfully. The radial artery was successfully approached and a 6-F sheath was used in all the cases. Navigation of guiding catheters (5 and 6 F) was done without complications. The most commonly approached artery was the right internal carotid artery, followed by the right vertebral artery. Postoperative vasospasm was identified in three patients. Mean fluoroscopy time was 34.7 minutes. Conversion to transfemoral approach was not required. No postoperative complications were reported. Conclusions In our initial experience, the transradial approach is a safe and feasible alternative for the endovascular treatment of cerebrovascular pathologies.

Curative Embolization for Pediatric Spetzler-Martin Grade III Cerebral Arteriovenous Malformations.

OBJECTIVE: Spetzler-Martin (SM) grade III arteriovenous malformations (AVMs) represent a gray zone due to their high variability in location, size, and angioarchitecture. In addition, there is a lack of information on curative embolization in the pediatric population, especially in this subgroup of lesions. Here we present our experience treating grade III AVMs by curative embolization in pediatric patients. METHODS: Clinical and angiographic data from pediatric patients with grade III SM AVMs were retrospectively collected between 2011 and 2020 in a referral institution. We grouped the AVMs into subtypes according to size (S), venous drainage (V), and eloquence (E) and obtained subtypes: IIIA (S1V1E1), IIIB (S2V1E0), IIIC (S2V0E1), and IIID (S3V0E0). RESULTS: A total of 61 embolization sessions were performed in 35 pediatric patients. There were 25 females (64%), and the mean age was 12.2 years (range 5-18). Complete angiographic occlusion was achieved in 16 patients (47%). In 13 patients (37%), the AVM was occluded with a single embolization session and most (12/13) had small lesions (IIIA subtype). Among the 19 patients with incomplete occlusion, most (58%) had large lesions (IIIB, IIIC, and IIID). Large AVMs (IIIB, IIIC, and IIID) underwent 36 sessions; however, only 3 patients (21%) achieved complete occlusion in 11 sessions. Eight intraoperative complications (13% procedures) occurred mainly in ruptured AVMs (7/8) and eloquent zones (7/8). CONCLUSIONS: Curative embolization for SM grade III AVMs in children carries a high complication rate, especially in small, ruptured, and eloquent lesions. In addition, acceptable immediate complete angiographic occlusion rates were achieved, especially in small AVMs.

Predictores de mortalidad intrahospitalaria y de mal pronóstico funcional en pacientes sometidos a evacuación quirúrgica de hemorragia intracerebral / Predictors of in-hospital mortality and poor functional outcomes in patients who underwent surgical evacuation of intracerebral hemorrhage

RESUMEN Objetivo : Determinar predictores de mortalidad intrahospitalaria y mal pronóstico funcional en pacientes sometidos a cirugía por hemorragia intracerebral. Materiales y métodos : Se analizaron las historias clínicas, reportes operatorios y tomografías cerebrales de pacientes con hemorragia intracerebral desde marzo 2018 hasta marzo de 2020. Se realizó un análisis de regresión logística univariado y multivariado para determinar predictores independientes de mortalidad intrahospitalaria y mal pronóstico funcional al alta. Resultados : La mortalidad intrahospitalaria fue de 33,7 % (n = 31 pacientes). Predictores independientes de mortalidad fueron el sexo femenino (OR = 3.01; p = 0.031) y un Glasgow < 8 puntos al ingreso (OR = 3.19; p = 0.031). Un mal pronóstico funcional luego de la intervención se encontró en 77 pacientes (83,7 %). Predictores independientes de mal pronóstico funcional fueron una Escala de Rankin modificada > 3 (OR = 15.5; p = 0.01) y déficit motor pre-operatorio (OR = 8.95; p = 0.042). Conclusiones : En pacientes con diagnóstico de hemorragia intracerebral tratados con cirugía se encontró una alta mortalidad y morbilidad. El sexo femenino y factores clínicos como el estado de conciencia y el estado funcional al ingreso fueron predictores independientes de mortalidad intrahospitalaria y mal pronóstico funcional.

ABSTRACT Objective : To determine predictors of in-hospital mortality and poor functional prognosis in patients undergoing surgery for intracerebral hemorrhage. Materials and Methods : Clinical records, operative reports, and cerebral CT scans of patients with intracerebral hemorrhage from March 2018 to March 2020 were analyzed. Univariate and multivariate logistic regression analyses were performed for determining independent predictors of in-hospital mortality and poor functional prognosis at discharge. Results : In-hospital mortality was 33.7% (n= 31 patients). Independent predictors for mortality were female sex (OR= 3.01, p= 0.031) and Glasgow score <8 on admission (OR= 3.19, p= 0.031). A poor functional prognosis after the intervention was found in 77 patients (83.7%). Independent risk factors for a poor functional prognosis were score >3 in the modified Rankin scale (OR= 15.5; p= 0.01), and preoperative motor deficit (OR= 8.95; p= 0.042). Conclusions : In patients with intracerebral hemorrhage who were surgically treated, high morbidity and mortality rates were found. Female sex and clinical factors, such as consciousness condition and functional status on admission were independent predictors for in-hospital mortality and poor functional prognosis.

Safety and Effectiveness of the Flexible Cervical Implant: Preliminary Short-Term Clinical Results.

OBJECTIVE: We sought to determine the safety and effectiveness of the Flexible Cervical Implant in 1- or 2-level cervical segments. METHODS: Retrospective data collection was carried out on consecutive patients who underwent the implantation of the Flexible Cervical Implant in a local private health institution. Demographics, clinical pictures, magnetic resonance images, x-ray images, technical considerations, and postoperative clinical results were reviewed. RESULTS: Twelve patients were treated with 15 implants. The mean age was 57.5 years (range 28-81), and 6 patients were males. The most common level was C5/C6 (7 cases). Radicular pain was the main symptom in all patients. Short-term postoperative clinical outcomes showed improvement in the visual analog scale (VAS) and the Neck Disability Index (NDI). The median VAS score for radicular pain improved from 6 to 2 (P < 0.001), whereas the median NDI showed a significant improvement from 25 to 5 (P < 0.001). No implant-related complications were reported. The mean follow-up was 7.3 months. CONCLUSIONS: The newly developed Flexible Cervical Implant was safe and effective in terms of morbidity and improvement in clinical outcomes. This new cervical artificial disk is promising, and further long-term clinical and radiologic follow-up is needed to determine its benefits.