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We investigated the safety and efficacy of the Numen coil compared with the Axium coil in the treatment of intracranial aneurysms. Because CATCH (Coil Application Trial in China) is a prospective randomized controlled open-label noninferiority trial conducted in 10 centers across China, patients who fulfilled the inclusion and exclusion criteria were randomized 1:1 to either a test group (Numen) or a control group (Axium). The primary outcome was based on successful aneurysm occlusion at 6 months follow-up, whereas secondary outcomes included technical success, the recanalization and retreatment rates, and the rate of serious adverse events (SAEs) at 6 months and 12 months follow-up. Between August 2017 and December 2019, 350 patients presenting with 350 aneurysms were enrolled and randomized. Per-protocol analysis showed that the successful aneurysm occlusion rate at 6 months was 91.18% for the test group compared with 91.85% in the control group, with a difference of –0.68% (P = 0.8419), and the overall mortality during the 30-day follow-up period was 1.19% and 1.81% in the test and control group, respectively, showing no significant difference between the 2 groups (P = 0.6837), whereas the SAE incidence during the 12-month follow-up period was 12.50% and 17.47% in the test and control groups, respectively, which was not statistically significant (P = 0.2222). This trial showed that the Numen coil was noninferior to the Axium coil in terms of intracranial aneurysm embolization and can be considered as a safe and effective coil for treating patients with intracranial aneurysm in clinical practice. [ABSTRACT FROM AUTHOR]

To introduce the application of robot-assisted frameless stereoelectroencephalography (SEEG) based on multimodal image fusion technology in pediatric refractory epilepsy in a pediatric center from a developing country. We retrospectively evaluated pediatric patients with drug-resistant epilepsy who underwent SEEG monitoring at the Children's Hospital of Fudan University from July 2014 to August 2017. Application of multimodal image fusion technology in SEEG was described in detail. Seizure outcomes were assessed according to the International League Against Epilepsy classification. A total of 208 patients were initially eligible and underwent a rigorous phase I evaluation. SEEG explorations were performed in 20 patients who entered phase II assessment (11 male and 9 female patients) with a median age of 7.99 ± 4.07 years. In total, 181 electrodes were implanted (9 per implantation), among which 16 implantations were unilateral (6 left and 10 right) and 4 were bilateral. The mean operating time was 3 hours and no obvious hemorrhage occurred. Electrode displacement and pneumocephalus were observed in 1 and 2 patients, respectively. Thirteen and 7 patients underwent tailored resection and radiofrequency thermocoagulation, respectively. Among resection cases, focal cortical dysplasia was the predominant pathologic type. The overall seizure outcome after a mean follow-up of 2.65 years was International League Against Epilepsy class 1 in 13, class 2 in 2, class 3 in 3, class 4 in 1, and class 5 in 1 patient, respectively. The combination of multimodal image fusion and frameless robot-assisted SEEG is demonstrated to be safe and effective on children with refractory epilepsy in developing countries. [ABSTRACT FROM AUTHOR]

Objective We sought to inspect the role of AMD3100, which acts as an antagonist of stromal cell–derived factor-1/CXC chemokine receptor 4 on the formation of neointima in rabbit saccular aneurysm after flow diverter (FD) treatment. Methods Twenty saccular aneurysm models were established by using porcine pancreatic elastase. Three weeks later, a Tubridge FD was implanted into the saccular aneurysm. All treated models were immediately divided into 2 groups: the AMD3100 group was subcutaneously injected with AMD3100 (5 mg/kg per day), while the control group received saline. Morphology and thickness of the neointima were investigated 2 and 4 weeks after FD treatment, using hard tissue section and masson trichrome staining. Scanning electron microscope was used to observe endothelial-like cells, and fluorescence quantitative polymerase chain reaction was used to determine mRNA expression of neointima biomarkers, such as kinase insert domain receptor, VE-cadherin, CD34, and Tie2. Results Two and 4 weeks after FD treatment, the AMD3100 group had more endothelial-like cells than the control group in the neointima. Masson trichrome staining showed that the neointima in the AMD3100 group was more intact and thicker than that in the control group. Furthermore, increased mRNA levels of kinase insert domain receptor, VE-cadherin, and Tie2 in the neointima were found in the AMD3100 group compared with the control group. Conclusions Interval use of AMD3100 promotes the formation of neointima in rabbit saccular aneurysm and facilitates the endothelialization of the neointima after FD treatment. [ABSTRACT FROM AUTHOR]

Objective Endoscopic third ventriculostomy (ETV) is a valuable option in the treatment of shunt failure, but no clinical data exist for young children. The aim of this study was to elucidate the role of ETV in patients younger than 3 years of age with shunt malfunction. Methods A cohort of 37 patients younger than 3 years of age with shunt malfunction underwent ETV instead of shunt revision. Patients' preoperative condition and medical history were studied to determine the impact of a number of variables on outcome. The Fisher exact test was used to assess differences among groups. Results Median age at ETV was 21.6 months (8–36 months). Diagnosis was obstructive hydrocephalus in 24 patients and communicating hydrocephalus in 13. Median age at initial shunt placement was 3.2 months (10 days to 30 months). The etiology of shunt malfunction was obstruction ( n = 27) or infection ( n = 10). Overall ETV failure rate was 40.5% (15/37). Patients whose age at initial shunt placement was <6 months and/or who had a preterm birth history had higher relative rates of ETV failure. Other variables, including type of hydrocephalus, interval between initial shunt placement and ETV, history of intraventricular bleeding and/or infection, and etiology of shunt malfunction, did not significantly affect the final outcome. Conclusions Patients younger than 3 years with obstructive or communicating hydrocephalus may benefit from ETV in the event of shunt malfunction and have about a 60% probability of becoming shunt free. [ABSTRACT FROM AUTHOR]

Background Hematoma evacuation is regular treatment for acute traumatic epidural hematoma (ATEDH) patients meeting with surgery indications. However, it is an invasive approach performed under general anesthesia. Here, a novel minimally invasive method of endovascular embolization with subsequent drainage surgery and use of urokinase was established to treat ATEDH under local anesthesia. Methods A novel minimally invasive method of endovascular embolization with subsequent drainage surgery and use of urokinase was established to treat ATEDH under local anesthesia. Firstly, 23 ATEDH patients with hematomas in the temporal area underwent digital subtraction angiography detecting the bleeding point. Next, embolization was performed. After embolization, drainage surgery was taken and urokinase was injected into the hematoma cyst by drainage tube to lyse hematoma twice per day. Results The results showed that the middle meningeal artery was the bleeding source. Embolization immediately ceased bleeding. Most clots were resolved and drained after treatment. No recurrence of hematoma or infection was observed. Conclusion The findings suggest that the combined treatments can be an alternative minimally invasive option for ATEDHs, especially for elderly patients or those contraindicated for general anesthesia. [ABSTRACT FROM AUTHOR]

Endovascular embolization with transvenous sinus preservation using balloon is at present the preferred modality for dural arteriovenous fistulas involving venous sinuses (sagittal, transverse, and sigmoid) with potential drainage function. The aim of the study was to evaluate the necessity and medium-term efficacy of this technique. Patients with dural arteriovenous fistulas involving large sinuses who underwent vascular embolization with transvenous balloon protection technique at our center from December 2012 to July 2017 were retrospectively reviewed. The clinical symptoms, postoperative and mid-term follow-up imaging results, perioperative complications, and follow-up clinical outcomes were analyzed. Eighteen patients (8 women and 10 men) with mean age 49 years were included in this study. Complete (16 of 18) or near-complete (1 of 18) occlusion of original fistula was achieved in 17 patients (94.4%). Recurrence of original fistula (1 of 18) or de novo fistula (3 of 18) occurred in 4 patients (22.2%). The patency rate of balloon-protected sinus was 72.2% (13 of 18) during the follow-up, and the involved sinuses were eventually occluded in 5 patients (27.8%). The frequency of de novo fistulas was higher in patients with sinus occlusion (P < 0.05). Stenosis of the involved sinus was more likely related to balloon-protected sinus occlusion (P < 0.05). After a mean follow-up of 17.6 months, 17 patients (94.4%) achieved remission of the original symptoms. Transvenous balloon protection technique maintains sinus patency in most cases, and preoperative stenosis increases the probability of sinus occlusion. De novo fistula is related to sinus occlusion during the follow-up. [ABSTRACT FROM AUTHOR]

To investigate outcomes and prognostic factors of ruptured middle cerebral artery (MCA) aneurysms, treated via endovascular approach, with improving treatment materials and techniques. A total of 185 consecutive patients, admitted with acutely ruptured MCA aneurysms and treated by endovascular methods between 2006 and 2016, were retrospectively reviewed. Their baseline characteristics, procedure-related complications, and angiographic and clinical outcomes were collected. Univariate analysis and logistic regression analysis were completed to identify any association between procedure-related complications or clinical outcomes and potential risk factors. Procedure-related complications occurred in 28 patients (15.1%), including aneurysm rebleeding in 7 (3.8%), hematoma expansion in 10 (5.4%), and ischemia in 13 (7.0%) (concurrent hemorrhage and ischemia in 2 patients), which resulted in morbidity/mortality of 7% and 1.4%. Final evaluations indicated that 153 patients (82.7%, 153/185) had a good outcome (modified Rankin Scale score 0–2). Among 120 (69.4%) who underwent angiographic follow-up, 89 (74.2%) were completely occluded and 20/120 (16.7%) were recanalized. Multivariate analysis of clinical outcome indicated that a high preoperative Hunt and Hess grade (IV–V), intrasylvian/intracerebral hematoma, and early period treatment (2006–2013) were associated with unfavorable outcomes. Endovascular treatment for patients with ruptured middle cerebral artery aneurysms may offer favorable clinical and angiographic outcomes. With the evolution of treatment materials and updated techniques, treatment complications have become less common than previously reported in literature, and clinical outcomes have been improved in recent years. [ABSTRACT FROM AUTHOR]

To evaluate the safety and efficacy of dual stent-assisted coiling in treatment of intracranial complex and wide-necked bifurcation aneurysms, we have reported our own center experience and performed a systematic review and meta-analysis of the reported data. The experience in our center was reviewed and a comprehensive search of the reported data on dual stent-assisted treatment of intracranial complex and wide-necked bifurcation aneurysms was performed using the databases PubMed, Ovid EMBASE, and Ovid MEDLINE before October 1, 2018. Information was extracted regarding patient demographic data, clinical characteristics, radiographic data, treatment outcomes, complications, and clinical and angiographic follow-up data. The data were analyzed using random effects and fixed effects meta-analyses. Including our series of 26 patients, the data from 21 studies with 721 patients were analyzed. The procedure was technically successful in 97.6% (95% confidence interval [CI], 96.5%–98.7%). The complete occlusion rate was 61.6% (95% CI, 47.3%–75.8%) immediately after the procedure compared with 88.4% (95% CI, 84.6%–92.2%) at the last follow-up examination. The rate of periprocedural complications, total complications, procedure-related mortality was 8.8% (95% CI, 5.8%–11.9%), 9.5% (95% CI, 6.2%–12.9%), and 1.1% (95% CI, 0.3%–1.8%), respectively. The recurrence rate, retreatment rate, and good neurologic outcome rate was 3.3% (95% CI, 2.0%–4.7%), 2.7% (95% CI, 1.5%–4.0%), and 96.6% (95% CI, 95.0%–98.1%), respectively. The dual stent-assisted coiling technique is a feasible and effective option for the treatment of intracranial complex and wide-necked bifurcation aneurysms. It results in a relatively low rate of procedure-related complications and mortality and recurrence and a high rate of mid-term complete occlusion and good neurologic outcomes. [ABSTRACT FROM AUTHOR]

Background Intraprocedural rupture (IPR) is a rare complication that can occur during endovascular treatment (EVT) of unruptured intracranial aneurysms (UIAs). However, it universally leads to poor outcomes if not properly managed. In the present study, we sought to illuminate the risk factors for IPR during EVT of UIAs. Methods The data from patients with UIAs who had undergone EVT in our center from January 2010 to March 2017 were retrospectively collected and reviewed. Univariate analysis and multivariate logistic analysis were performed to analyze the risk factors for IPR. Results A total of 1232 patients with 1312 unruptured aneurysms were included in the present study. IPR occurred in 11 patients (0.9%). Univariate analysis showed that cardiac comorbidities, irregular morphology, and location at the anterior communicating artery (AcomA) were significantly associated with the development of IPR (P < 0.05). In addition, stent placement was related to a lower risk of IPR compared with no stent placement (P = 0.024). The multivariate analysis showed that cardiac comorbidities (odds ratio [OR], 6.320; P = 0.016), irregular morphology (OR, 9.562; P = 0.001), and location on the AcomA (OR, 6.971; P = 0.006) were independent risk factors for IPR. Conclusions The occurrence rate of IPR was relatively low. Cardiac comorbidities, irregular morphology, and location on the AcomA are independent risk factors for IPR. Stents and flow diverters are safe and feasible in treating UIA, with a significantly low risk of IPR. Highlights • The incidence of IPR in managing UIAs was extremely low. • Cardiac comorbidities, irregular morphology, and AcomA location were independent risk factors for IPR. • Stent and flow diverter deployment was related to a decreased incidence of IPR. [ABSTRACT FROM AUTHOR]

Objective To clarify the safety and efficacy of flow diverter (FD) treatment for blood blister–like aneurysm (BBA) through a systematic review and literature analyzing perioperative and long-term clinical and angiographic outcomes. Methods We performed a comprehensive review of the current literature for studies with >2 patients related to FD treatment of BBAs published. A random-effects meta-analysis was used to pool the following outcomes: complete occlusion, technical success, aneurysm recurrence, rebleeding, perioperative mortality, perioperative stroke, procedure-related morbidity and mortality, long-term neurological morbidity and mortality, and overall good neurologic outcome. Results We included 15 noncomparative studies with a total of 165 target BBAs. Complete occlusion rates were 72% (95% confidence interval [CI], 0.59–0.85). Recurrence occurred in 13% (95% CI, 0.04–0.29) and rebleeding in 3% (95% CI, -0.02 to 0.07) of patients. Procedure-related morbidity and mortality were 26% (95% CI, 0.19–0.33) and 3% (95% CI, -0.01 to 0.07), respectively. The rate of long-term good outcomes was 83% (95% CI, 0.77–0.89). Subgroup analysis indicated that a single FD strategy for BBA seemed to have a higher rate of good outcomes compared with an overlapped FD strategy (89.9% vs. 61.9%; odds ratio, 1.42; 95% CI, 1.25–14.98, P = 0.02). Complete occlusion rate and procedure-related morbidity rate did not see any significant difference between these 2 strategies. Conclusions Our meta-analysis suggests that in selected cases, FD can be safe and effective. A single FD strategy may result in a higher rate of good outcomes compared with an overlapped FD strategy. Ultimately, treatment of BBA should be considered on a case-by-case basis to maximize patient benefits and limit the risk of perioperative complications. Highlights • Flow diverters (FDs) can be safe and effective in treating blood blister–like aneurysms. • A single FD strategy may result in a higher rate of good outcomes compared with an overlapped FD strategy. • Treatment of blood blister–like aneurysm (BBA) should be considered on a case-by-case basis. [ABSTRACT FROM AUTHOR]

Background Stent-assisted coiling technique has been more and more adopted in the treatment of intracranial aneurysms and has been shown to improve long-term angiographic results; however, the treatment is relatively contraindicated in acutely ruptured aneurysms for its ischemic and hemorrhagic complications. Staged stenting after conventional coiling has emerged as a potential treatment strategy for ruptured wide-neck aneurysms. This study assessed the safety and efficacy of coiling in the acute phase followed by delayed stenting for ruptured wide-neck intracranial aneurysms. Methods Patients with ruptured wide-neck intracranial saccular aneurysms treated with endovascular coiling in acute phase followed by stent placement at a later date (4 weeks) in our center between November 2006 and September 2016 were reviewed. The primary outcomes were procedural safety, target aneurysm rebleeding, and long-term follow-up of clinical and angiographic outcomes. Results A total of 47 patients were enrolled in this study, all patients received staged therapy of stent placement at the required time. The median interval time to retreatment was 4.2 weeks. No cases of rebleeding occurred during the intervals between coiling and stent implantation. No permanent morbidity or mortality resulting from stenting or coiling was observed. All 47 patients underwent angiographic follow-up at a mean of 16.1 months, and complete occlusion was achieved in 38 (80.85%) patients. A total of 44 patients had modified Rankin Scale scores ≤2 during a mean of 21 months. Conclusions Staged treatment of ruptured wide-neck aneurysms with coiling in the acute phase followed by delayed stenting is safe and effective. [ABSTRACT FROM AUTHOR]

Objective To retrospectively evaluate the midterm therapeutic effect of enlarged encephalo-duro-myo-synangiosis (EDMS) for moyamoya disease (MMD) in young children. Methods Seventy-seven children diagnosed with MMD by digital subtraction angiography (DSA) or magnetic resonance angiography (MRA) were treated between January 2011 and December 2014 in our center. Their clinical features, imaging, and operative reports were analyzed. Results Four patients presented with intracerebral hemorrhage, whereas 73 presented with ischemic symptoms. Revascularization procedures were performed unilaterally on 11 left hemispheres and 9 right hemispheres, and 57 had bilateral surgeries. The average length of surgery was 143 ± 24 minutes, with 28 ± 9 mL of blood loss. The mean period of follow-up was 28.43 ± 15.31 months. Cerebral blood flow increased 3 months after the operations in the previously affected regions. Collateralization from the deep temporal artery, superficial temporal artery, and the middle meningeal artery was found by DSA or MRA. In cases where single-photon emission computed tomography was obtained, it demonstrated better perfusion postoperatively. The ischemic symptoms were relieved in 118 (88.06%) hemispheres, and remained stable in 5 (3.73%) hemispheres. There were 12 radiographic cerebral infarctions (8.96%) within 1 month postoperatively. Conclusions Enlarged EDMS is safe and effective for MMD in young children. Extensive and multilayered revascularization could significantly preserve neurologic function. The long-term effect on posterior circulation disease development needs further investigation. [ABSTRACT FROM AUTHOR]