Changes in Modified Raymond-Roy Classification Occlusion Classes and Predictors of Recurrence-Free Survival in Patients with Intracranial Aneurysms after Endovascular Coil Embolization.

PURPOSE: To assess changes in modified Raymond-Roy classification (MRRC) occlusion classes and recurrence rates over time and evaluate recurrence-free survival after coil embolization and its predictors. MATERIALS AND METHODS: During 2007-2016, 201 patients (mean age, 57.1 ± 13.4 years; 75.5% women) with 240 aneurysms treated with coil embolization were enrolled. MRRC Class I (n = 210), Class II (n = 14), Class IIIa (n = 10), and Class IIIb (n =6) closures were assessed. Recurrence was defined as recanalization in MRRC Class I closures or an increase of at least 20% in any of the dimensions of the remnants of the other classes. Recurrence-free survival and its predictors were analyzed using survival analysis. RESULTS: Most changes in MRRC class occurred in the first year after treatment. MRRC Class I closures had a slightly lower probability of change than that associated with other classes within 1-5 years, whereas Class IIIb closures remained unchanged. Rates of recurrence or regression for all classes were highest within the first year. The median recurrence-free survival times among patients with Class IIIa and Class IIIb closures were 11.56 and 5.55 months, respectively. Significant predictors of recurrence included aneurysm size of 13-24 mm, ruptured or wide-necked aneurysms, and MRRC Class IIIa or IIIb closures. CONCLUSIONS: Class changes and recurrence rates for all MRRC classes were highest in the first year. MRRC Class IIIb closures had the highest recurrence rate and the shortest recurrence-free survival. Recurrence risk increased in Classes IIIa and IIIb and with large, ruptured or wide-necked aneurysms.

Predictors of seizure control in patients with cerebral arteriovenous malformation.

PURPOSE: We aimed to define the predictors of a 2-year seizure-free outcome among patients with cerebral arteriovenous malformation (AVM). METHODS: A retrospective cohort study recruited patients diagnosed with AVM admitted in the hospital between 2002 and 2020. The demographic data, clinical presentations, seizure semiology, neuro-imaging findings, modality of treatment, and clinical outcomes were compared between the 2-year seizure-free and non-2-year seizure-free groups. A logistic regression model was applied to determine the significant predictors of a 2-year seizure-free outcome. RESULTS: Of 372 radiologically confirmed patients with cerebral AVM, 105 (28.23%) experienced seizure and a 2-year seizure-free outcome was achieved in 76.19%. Most seizures presented as the initial symptom. Generalized onset seizure was the most common seizure semiology. A nidus diameter < 3 cm (adjusted odds ratio [aOR] 3.102; 95% CI 1.129-9.683; p = 0.046) was the independent predictor of a 2-year seizure-free period, whereas underlying epilepsy (aOR 0.141; 95% CI 0.010-0.688; p = 0.015) was an independent predictor against a 2-year seizure-free outcome. CONCLUSION: A nidus diameter < 3 cm was the independent predictor of a 2-year seizure-free outcome, whereas underlying epilepsy was the factor against a 2-year seizure-free outcome.

Cerebral venous sinus thrombosis in early pregnancy: an unusual presentation of primary antiphospholipid syndrome.

Cerebral venous sinus thrombosis, an unusual presentation of antiphospholipid syndrome, is a rare condition in pregnancy, particularly in the first trimester. The authors of this case report present the case of a 20-year-old woman with sudden onset of headaches and hemiparesis in the first trimester of pregnancy. She underwent a computed tomography scan and magnetic resonance imaging. The image findings and the autoimmune serum test were consistent with a cerebral venous sinus thrombosis complicated by primary antiphospholipid syndrome. The patient's hemiparesis improved with subcutaneous low molecular weight heparin and oral aspirin. In the third trimester of pregnancy, she developed seizures that were controlled by antiepileptic drugs. She delivered a healthy baby at 37 weeks' gestation without immediate or late postpartum complications.

Outcome of Ruptured Posterior Communicating Artery Aneurysm Treatment Comparing Between Clipping and Coiling Techniques.

BACKGROUND: Very few data stratify the functional outcome of ruptured posterior communicating artery (PCoA) aneurysm treatment based on each treatment strategy. Therefore, the authors aimed to evaluate the outcome of PCoA aneurysm treatment to compare the clipping and coiling techniques and find the factors that determined the treatment outcomes. METHODS: Patients with ruptured PCoA aneurysm at Songklanagarind Hospital between November 2002 and March 2018 were retrospectively reviewed and classified into the clipping group or the coiling group. The primary outcome was the modified Rankin Scale (mRS) at 6 months after treatment, and the patients were stratified into "good outcome" (mRS 0-2) and "poor outcome" (mRS 3-6). Using logistic regression analysis, various factors were analyzed for association with the treatment outcome. RESULTS: This study included 189 patients: 104 and 85 patients in the clipping and coiling groups, respectively. Patients in the coiling group were significantly older, with more underlying diseases. However, the treatment outcomes at 6 months were not significantly different between the 2 groups. The percentages of poor outcomes in the clipping and coiling groups were 28% and 31%, respectively (P = 0.734). Older age, seizure, higher Hunt and Hess grade, deterioration before aneurysm obliteration, an aneurysm on the left side, and a medially projected PCoA aneurysm were statistically significantly correlated with poor outcomes. CONCLUSIONS: Neurosurgical clipping and endovascular coiling are effective treatments for aneurysm obliteration in ruptured PCoA aneurysm. An aneurysm on the left side and a medially projected PCoA aneurysm were the factors correlated with poor outcome.

Patient Radiation Dose in Neurointerventional Radiologic Procedure: A Tertiary Care Experience.

PURPOSE: Neurointerventional radiology procedures often require a long time to perform. Patient radiation dose is an important issue due to the hazards of ionizing radiation. The objective of this study was to measure the peak skin dose (PSD) and effective dose to estimate the deterministic and stochastic effects of a therapeutic interventional neuroradiologic procedure. MATERIALS AND METHODS: The cumulative dose (CD) and dose area product (DAP) were automatically recorded by a fluoroscopic machine and collected prospectively between April and November 2015. The study included 54 patients who underwent therapeutic neurointerventional radiology procedures. The CD of each patient was used to estimate the peak skin dose and the DAP was also calculated to estimate the effective dose. RESULTS: The average estimated peak skin dose was 1,009.68 mGy. Two patients received radiation doses of more than 2 Gy, which is the threshold that may cause skin complications and radiation-induced cataract. The average effective dose was 35.32 mSv. The majority of patients in this study (85.2%) who underwent therapeutic neurointerventional radiologic procedures received effective doses greater than 20 mSv. CONCLUSION: Not all therapeutic neurointerventional radiology procedures are safe from deterministic complications. A small number of patients received doses above the threshold for skin complications and radiation induced cataract. In terms of stochastic complications, most neurointerventional radiology procedures in this study were quite safe in terms of radiation-induced cancer.