Bilateral aberrant C1/2 intradural vertebral arteries: a rare cause of cervical myelopathy

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The Hong Kong Neurosurgical Society prospective observational study on outcome of cerebrospinal fluid diversion procedures: an interim report

Conference Theme: Brain Attack: A New EraPosters: no. P-05OBJECTIVE: Cerebrospinal fluid diversion in the form of ventricular drains and permanent internal shunts are the most common neurosurgical procedures. Both are known to be associated with complications which could result in significant morbidities and mortalities. The Hong Kong Neurosurgical Society supported the present study to investigate the local rates of infection and other early procedure-related complications in CSF diversion procedures; and to identify risk ...postprin

Primary endovascular treatment of post-irradiated carotid pseudoaneurysm at the skull base with the Pipeline embolization device

Background A post-irradiated carotid pseudoaneurysm at the skull base can cause life-threatening blowout syndrome. Conventional treatments include parent vessel occlusion, endovascular coiling or covered stenting. Use of the Pipeline embolization device (PED) for pseudoaneurysm exclusion at the skull base is not well described. Objective To report the clinical and angiographic outcome after using multiple PEDs to treat recently ruptured radiation-induced carotid pseudoaneurysms at the skull base. Methods Retrospective review of the clinical and angiographic records of patients who received PEDs as primary treatment for skull base carotid pseudoaneurysm between April 1, 2011 to March 31, 2013. Results Seven patients (five men, two women) with a mean age of 58 years (range 47–65) were treated in the study period. Primary treatment with the PED alone, with adjunct coil embolization in two patients, achieved immediate hemostasis in all patients, with no pseudoaneurysm rebleeding after a mean follow-up of 15.3 months (range 4–24 months). One patient had periprocedural cerebral infarction. Delayed internal carotid artery occlusion secondary to in-stent thrombosis occurred in three patients, one of whom had lacunar infarct and two remained asymptomatic. Conclusions Endovascular treatment with the PED was effective in excluding skull base post-irradiated carotid pseudoaneurysms and preventing recurrent blowout. However, the risk of ischemic complications in this group of patients was high and our experience did not support the use of flow diverters as a first-line treatment for this condition.postprin

Intraoperative direct embolization with N-butyl cyanoacrylate (NBCA) for vascular tumours of the spinal cord: a technical report

Oral-Poster Presentation 1Meeting Theme: Degenerative Lumbar SpineINTRODUCTION: Intramedullary vascular tumors such as hemangioma or hemangioblastoma in the cervical cord are challenging lesions to remove surgically. The vascularity of the lesion can cause significant bleeding and difficulties during tumor debulking and dissection, and increase the risk of spinal cord damage. Pre-operative endovascular embolization is well described for intra-cranial lesions, but seldom used in intraspinal intramedullary tumors due to the technical difficulties and risk of spinal cord ischemia. We describe our experience of intra-operative direct embolization of difficult cervical cord vascular tumors with N-butyl cyanoacrylate (NBCA) glue in achieving prompt hemostasis and facilitating tumor removal …published_or_final_versio

Long-term results of endoscopic-assisted cranionasal resection for olfactory neuroblastoma - single centre experience of fourteen patients

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Minimal access microsurgical ligation of spinal dural arteriovenous fistula with tubular retractor

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Moyamoya disease in Hong Kong: natural history and surgical revascularization outcome

Free Paper 3Theme: Brain Attack: A New EraOBJECTIVE: Moya-moya disease (MMD) is an occlusive cerebral vasculopathy associated with high risk of recurrent ischemic and hemorrhagic events. Surgical revascularization had proven benefits in ischemic MMD but the role in hemorrhagic presentations is less clear. We studied the natural history of symptomatic MMD patients in Hong Kong and compared the long term ...postprin

Carotid blowout syndrome: EC-IC bypass and endovascular management of ruptured radiation-related pseudoaneurym in nasopharyngeal cancer patients

Parallel Session: Free Paper Session VB - Oral Presentation (Epilepsy & General)PURPOSE: With prolonged survival in nasopharyngeal cancer patients treated with radiation therapy, delayed vascular complication such as carotid blowout due to ruptured pseudoaneurysm has emerged as an not infrequent and often fatal clinical emergency. Management of carotid blowout syndrome in these patients is challenging and controversial, including endovascular flow-diverting stents, coiling, balloon occlusion, and EC-IC bypass; alone or in combination. We review our experience of treating carotid blowout syndrome and discuss on different management strateg...postprin

Computational fluid dynamics study of bifurcation aneurysms treated with pipeline embolization device: side branch diameter study

An intracranial aneurysm, abnormal swelling of the cerebral artery, may lead to undesirable rates of mortality and morbidity upon rupture. Endovascular treatment involves the deployment of a flow-diverting stent that covers the aneurysm orifice, thereby reducing the blood flow into the aneurysm and mitigating the risk of rupture. In this study, computational fluid dynamics analysis is performed on a bifurcation model to investigate the change in hemodynamics with various side branch diameters. The condition after the deployment of a pipeline embolization device is also simulated. Hemodynamic factors such as flow velocity, pressure, and wall shear stress are studied. Aneurysms with a larger side branch vessel might have greater risk after treatment in terms of hemodynamics. Although a stent could lead to flow reduction entering the aneurysm, it would drastically alter the flow rate inside the side branch vessel. This may result in side-branch hypoperfusion subsequent to stenting. In addition, two patient-specific bifurcation aneurysms are tested, and the results show good agreement with the idealized models. Furthermore, the peripheral resistance of downstream vessels is investigated by varying the outlet pressure conditions. This quantitative analysis can assist in treatment planning and therapeutic decision-making.published_or_final_versio

Shunt outcome of idiopathic normal pressure hydrocephalus: a Hong Kong-wide review of 15 years

Free Paper 4Conference Theme: Degenerative Lumbar SpineBACKGROUND: Idiopathic normal pressure hydrocephalus (iNPH) is a potentially treatable cause of dementia and impaired mobility in the geriatric population. There are no standard diagnostic criteria and reliable predictors of treatment response is lacking. Ventriculo-peritoneal shunt (VPS) is the standard treatment with variable success rate. OBJECTIVE: To assess the functional outcome, complications and predictors of treatment response of iNPH patients treated with VPS in Hong Kong over the last 15 years …published_or_final_versio