Suboptimal interventional conditions for the occlusion of ruptured intracranial aneurysms do not increase periprocedural complications and poor clinical outcomes.

BACKGROUND AND OBJECTIVE: Occluding a ruptured intracranial aneurysm as early as possible may entail certain periprocedural conditions that compromise the outcome. The aim of the present study was to evaluate the effectiveness, safety, and clinical outcome of endovascular coiling procedures performed on an emergency basis under potentially suboptimal conditions, and to compare results with those from scheduled procedures under potentially optimal conditions. METHODS: Interventions performed on 66 SAH patients were retrospectively analysed by classifying them into two groups: under emergency (within three hours from diagnosis or during non-standard working hours) or scheduled conditions. A binary logistic regression analysis was also performed to identify characteristics associated with poor outcomes. RESULTS: No differences in effectiveness, periprocedural complications, or clinical outcomes were found between the two groups. Rebleeding was detected in 4.8 % of the emergency interventions and 2.2 % of the scheduled interventions. Multivariate analysis identified age and Hunt and Hess grade, but no conditions of treatment, as the factors associated to poor outcome. CONCLUSION: Suboptimal interventional conditions for occluding ruptured intracranial aneurysms, such as performing procedures outside of standard working hours or within three hours of diagnosis, do not result in increased periprocedural complications and poor clinical outcomes compared with scheduled procedures under potentially optimal conditions. These results suggest the need for treatment to be provided as soon as possible.

Directional electrodes in deep brain stimulation: Results of a survey by the European Association of Neurosurgical Societies (EANS).

Introduction: Directional Leads (dLeads) represent a new technical tool in Deep Brain Stimulation (DBS), and a rapidly growing population of patients receive dLeads. Research question: The European Association of Neurosurgical Societies(EANS) functional neurosurgery Task Force on dLeads conducted a survey of DBS specialists in Europe to evaluate their use, applications, advantages, and disadvantages. Material and methods: EANS functional neurosurgery and European Society for Stereotactic and Functional Neurosurgery (ESSFN) members were asked to complete an online survey with 50 multiple-choice and open questions on their use of dLeads in clinical practice. Results: Forty-nine respondents from 16 countries participated in the survey (n = 38 neurosurgeons, n = 8 neurologists, n = 3 DBS nurses). Five had not used dLeads. All users reported that dLeads provided an advantage (n = 23 minor, n = 21 major). Most surgeons (n = 35) stated that trajectory planning does not differ when implanting dLeads or conventional leads. Most respondents selected dLeads for the ability to optimize stimulation parameters (n = 41). However, the majority (n = 24), regarded time-consuming programming as the main disadvantage of this technology. Innovations that were highly valued by most participants included full 3T MRI compatibility, remote programming, and closed loop technology. Discussion and conclusion: Directional leads are widely used by European DBS specialists. Despite challenges with programming time, users report that dLeads have had a positive impact and maintain an optimistic view of future technological advances.

Imaging and Surgical Findings in Patients with Hemi-Laryngopharyngeal Spasm and the Potential Role of MRI in the Diagnostic Work-Up.

BACKGROUND AND PURPOSE: Hemi-laryngopharyngeal spasm is a recently discovered condition characterized by episodic coughing and unilateral throat contractions that may lead to severe stridor. These symptoms are caused by a vascular compression of the ipsilateral vagus nerve, typically the PICA. Microvascular decompression of the vagus nerve has been demonstrated to be a potential cure for this neurovascular compression syndrome. The main aim of this study was to clarify the role of MR imaging in the diagnostic work-up of this rare condition. MATERIALS AND METHODS: We describe the imaging and surgical findings of 3 patients from our prospective case series of patients with hemi-laryngopharyngeal spasm from 2015 to 2017. Second, the imaging data of 100 patients (control cohort) with symptoms unrelated to hemi-laryngopharyngeal spasm were reviewed to investigate the rate and degree of neurovascular conflict of the vagus nerve. RESULTS: All patients with hemi-laryngopharyngeal spasm reported to date have had vascular compression of the vagus nerve due to the PICA. In the control cohort, there was a good interrater agreement in scoring the "contact" and "compression" of the vagus nerve (κ = 0.73. P = < .001). The frequency of contact or compression of the vagus nerve was approximately 50%. The PICA was the most frequent vessel involved in 74%. CONCLUSIONS: The presence of unilateral neurovascular contact or compression of the vagus nerve does not confirm the diagnosis of hemi-laryngopharyngeal spasm. The MR imaging finding of ipsilateral vascular compression of the vagus nerve is a necessary but not sufficient finding for the diagnosis of hemi-laryngopharyngeal spasm.

Encefalopatía posterior reversible: más allá de la descripción original / Posterior reversible encephalopathy: beyond the original description

Introducción. La encefalopatía posterior reversible (EPR) es una entidad clinicorradiológica caracterizada típicamente por cuadros de cefalea, alteraciones visuales y crisis epilépticas, asociada a edema vasógeno corticosubcortical reversible en la neuroimagen. Objetivo. Presentar una revisión de los aspectos fisiopatológicos de esta entidad y también de las asociaciones de la EPR descritas en la bibliografía. Desarrollo. Existe una serie de factores desencadenantes bien conocidos, como las crisis hipertensivas, la eclampsia o ciertos medicamentos. La descripción de cada vez más casos atípicos desde un punto de vista clínico y radiológico, así como de posibles nuevos factores desencadenantes, obliga a una redefinición de la entidad. Conclusiones. La EPR es un conjunto de manifestaciones clínicas y radiológicas que no se pueden enmarcar dentro la palabra ‘síndrome’. Aunque la EPR se ha comunicado como irreversible en ciertos casos, el concepto de reversibilidad debemantenerse en la definición de esta entidad, ya que, en la mayor parte de los casos, el rápido control de la condición desencadenante de la EPR permite la reversibilidad de las lesiones (AU)

Introduction. Posterior reversible encephalopathy (PRE) is a clinical and radiological entity that is typically characterized by headache, visual disturbances and seizures associated with cortical and subcortical reversible vasogenic edema in neuroimaging. Aim. To present a review of the pathophysiology of this entity, and also the associations of the PRE described in the literature. Development. Given its clinical presentation, often nonspecific and variable, magnetic resonance imaging is essential for diagnosis. There are a number of well-known triggers, such as hypertensive crisis, eclampsia or certain drugs. The description of increasingly atypical cases from clinical and radiological point of view, and possible new triggers, requires a redefinition of this entity. Conclusions. The PRE is a set of clinical and radiological manifestations that may not be framed within the word ‘syndrome’. lthough, the PRE has been reported in some cases irreversible, reversibility concept should be maintained in the definition of this entity, since in most cases the rapid control of the triggering condition allows reversibility of the lesions (AU)