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Highlights • Embolization prior to GKS significantly may decrease the AVM obliteration rate. • Embolization prior to GKS didn't reduce the risk of hemorrhage compared to CKS alone in treating AVM. • Embolization prior to GKS didn't reduce the risk of permanent neurological deficits compared to CKS alone in treating AVM. Abstract The benefit and risk of gamma knife surgery (GKS) in the treatment of residual cerebral arteriovenous malformations (AVMs) after endovascular embolization remain controversial. The aim of this meta-analysis was to assess current evidence regarding the efficiency and safety of GKS for AVMs with and without prior embolization. To compare GKS in patients with and without embolization, the authors conducted a meta-analysis of studies by searching the literature via PubMed and EMBASE databases for the period between January 2006 and December 2017. Six retrospective studies were finally identified. Outcomes were the rate of AVM obliteration on a 3-year follow-up angiogram, hemorrhage at 3 years after GKS and permanent neurological deficits. Six studies eligible for analysis included 2069 patients: 637 had undergone embolization followed by GKS, and 1432 had undergone GKS alone. The obliteration rate was significantly lower in patients who had undergone embolization followed by GKS than in those who had undergone GKS alone (49.5% vs 70.4%, OR 2.29, 95% CI 1.55–3.38, p < 0.00001). Subgroup analysis also indicated high obliteration rates in 'similar mean nidus volume', 'high quality' and 'sample size over 100 patients' subgroups. However, the rates of rehemorrhage (8.9% vs 4.2%, OR 0.59, 95% CI 0.23–1.57, p = 0.29) and permanent neurological deficits rate (3.6% vs 4.6%, OR 0.51, 95% CI 0.57–3.12, p = 0.51) were not significantly different between the two groups and subgroups. Embolization prior to GKS significantly decreases the AVM obliteration rate and didn't reduce the risk of hemorrhage and permanent neurological deficits. Further evaluation by well-designed prospective or randomized cohort studies is highly needed. [ABSTRACT FROM AUTHOR]

• In selected cases, "X" stent-assisted coiling is safe and effective for intracranial bifurcation aneurysms. To clarify the safety and efficacy of "X" stent-assisted coiling (X-stenting) for the treatment of intracranial bifurcation aneurysms and to review the literature. We retrospectively reported five consecutive patients with six intracranial bifurcation aneurysms who underwent X-stenting between June 2014 and June 2020. The clinical and angiographic results were analyzed. We also performed an extensive PubMed review of medical literature up to June 2021. Endovascular procedures were successfully applied to all six aneurysms. No procedure-related complications were noted. Follow-up angiograms were available for all patients and revealed occlusion in five aneurysms and improvement in one aneurysm. Clinical follow-up was performed for all patients, and the mRS score at follow-up was 0 in all patients. Thus, good outcomes were achieved in all patients, and no ischemic or hemorrhagic events were observed. X-stenting appears to be safe for treating intracranial bifurcation aneurysms and effective in immediate and short-term outcome. Further research is required with well-designed, prospective studies with large sample sizes. [ABSTRACT FROM AUTHOR]

Abstract: On April 1st 2013, HUANG Yang, a medical master student in Fudan University, was poisoned by his roommate, LIN Senhao. Unfortunately, HUANG died 15 days later. It's quite a shock to the whole society. We have to reconsider our education, and our expectancy to doctors. We have to ask ourselves “How to become a qualified doctor?” Learn to release the pressure from studies and lives; learn to defend ourselves from danger. Is it enough? No! Whatever happened, never do harm to others. Medical humanity is the most important thing we should always remember. [Copyright &y& Elsevier]