A challenging entity of unruptured giant saccular aneurysms of vertebrobasilar artery

Purpose Giant intracranial aneurysms commonly cause poor clinical outcome and few studies focus on them. This study is to retrospectively report the angiographic and clinical presentations in unruptured giant saccular vertebrobasilar aneurysms with and without endovascular treatment. Methods Out of 400 patients who had unruptured posterior circulation aneurysms in a single center, we found 10 unruptured giant (>25mm) saccular vertebrobasilar aneurysms. Clinical and angiographic presentations as well as their clinical outcomes were assessed. Results Of the 10 giant aneurysms in 10 patients, three were left untreated. During 6 months follow-up, all 3 of these patients died from aneurysm rupture. The remaining 7 patients were treated by endovascular procedure, 5 received stent-assisted coiling, 1 was treated by parent artery occlusion (PAO), and 1 was treated by conventional coiling. Of these treated patients, only one survived during a 22 month period of follow-up. Conclusions Patients with giant saccular aneurysms of vertebrobasilar artery presenting mass effect may have extremely poor clinical outcomes and may not benefit from endovascular treatment

The History and Development of Endovascular Neurosurgery

Endovasuclar neurosurgery, neuroendovascular surgery and neurointervention are all defined as endovascular diagnosis and treatment of vascular lesions involving the brain and spinal cord using catheters in the DSA (digital subtraction angiography) unite. Based on literature evidences, the field of endovascular neurosurgery has evolved rapidly and successfully over the past half century and has resulted in effective endovascular therapies for carotid-cavernous fistulas (CCFs), intracranial aneurysms, arteriovenous malformations (AVMs), dural arteriovenous fistulas, atherosclerosis of cerebral arteries, acute stroke, carotid artery disease, and vascular tumors of the head, neck, and spinal vascular malformations and tumors. The scope of practice of neurovascular endovascular surgery has become complex, requiring training in specific skill sets and techniques. The evolution of the neuroendovascular field has resulted in the development of program requirements for residency or fellowship education in endovascular neurosurgery

Numerical Method for a Cauchy Problem for Multi-Dimensional Laplace Equation with Bilateral Exponential Kernel

This study examined a Cauchy problem for a multi-dimensional Laplace equation with mixed boundary. This problem is severely ill-posed in the sense of Hadamard. To solve this problem, a mollification approach is suggested based on a bilateral exponential kernel and this is a new approach. The stable error estimates are obtained under the priori and posteriori rule, in which the numerical findings are much influenced by the unknown a priori information. An error estimate between the exact and regular solution is given. A numerical experiment of interest reveals that our procedure is efficient and stable for perturbation noise in the data

Transarterial AVM embolization using Tsinghua grading system: Patient selection and complete obliteration

Objective: Endovascular embolization has an important role in the management of brain arteriovenous malformations (AVMs). A Tsinghua AVM grading system has been proposed for patient selection and complete obliteration. The authors sought to validate this system in an independent patient cohort and compare it to the Buffalo grading system. Methods: Consecutive 52 patients underwent endovascular AVM embolization between January 2019 and December 2021 according to Tsinghua AVM grading system. Each AVM was also graded using Buffalo grading system. Baseline clinical characteristics, complications, and AVM obliteration were compared between Tsinghua and Buffalo scales. Results: Complete obliteration of AVM was obtained in 29 patients (55.8%). Three complications were encountered, one bleeding (1.9%) and 2 ischemic (3.8%), in 3(5.7%) patients who recovered completely at follow-up. The Tsinghua scale (p=0.017) was predictor of complete obliteration as well as Buffalo scale (p=0.002) on ROC curve analysis and their AUCs were not significantly different (p=0.672). The Tsinghua scale was also associated with the initial patient status (p=0.003) and injected Onyx volume (p=0.003) on linear regression test. Because of the low complication rate, neither the Tsinghua scale nor the Buffalo scale predicted complication risk related to AVM embolization. Conclusions: The bleeding complication rate of 1.9% is within the range of rupture risk reported in the natural history of AVMs. In addition to predicting complete AVM obliteration as well as Buffalo scale, the Tsinghua scale can also predict the patients' status and the volume of Onyx avoid over injection. Key messages: The Tsinghua grading system for endovascular AVM embolization will guide patient selection of AVM embolization

Traumatic Injury of the Carotid and Vertebral Arteries and their Neurointerventional Treatment

Traumatic injuries of the carotid and vertebral arteries include direct carotid-cavernous fistula, intracranial pseudoaneurysm and arterial dissection, which cause a series of symptoms and may be life threatening. Computed tomographic angiography is the most common modality for initial screening and diagnosis. The subsequent management of any identified vessel injury, however, is not clearly defined. With the development of neurointerventional materials and technology, endovascular therapy is playing an important role in treatment of these neurovascular injuries. Balloon, coil, liquid embolic materials, covered stent and flow diversion have been effectively used in clinical practice. This chapter reviews the epidemiology, injury mechanism, clinical manifestations, classification system, diagnostic imaging and endovascular treatment of traumatic neurovascular injuries