Search

Flow diverters (FD) have become the mainstay for the endovascular treatment of unruptured intracranial aneurysms (UIA). Most FD procedures are performed under general anesthesia, and the influence of local anesthesia (LA) on outcomes remains unknown. This study evaluated the results of FD placement under LA. Data of patients treated for FD under LA between August 2016 and January 2022 were analyzed retrospectively. A good outcome was defined as a modified Rankin scale score of 0–2. Major stroke, steno-occlusive events of FD, mortality, and satisfactory aneurysm occlusion were also evaluated. In total, 169 patients undertook 182 treatments (139 [82%) female, mean age 61 ± 11 years). The median maximum aneurysm size was 9.5 mm (interquartile range 6.1-14 mm). A flow re-directed endoluminal device and pipeline embolization device were used in 103 (57%) and 78 (43%) treatments. One patient (0.59%) experienced major stroke, and steno-occlusive events were observed in four patients (2.4%). A good outcome at 90 days was obtained in 164 patients (98%), and one patient died (0.59% mortality). During the median follow-up period of 345 days (interquartile range 176–366 days), satisfactory aneurysm occlusion was observed in 126 of 160 aneurysms (79%). Our results suggest that FD placement under LA is a safe and effective treatment for UIA. [ABSTRACT FROM AUTHOR]

Objective We aimed to evaluate the relationship between aneurysm morphology, thalamoperforators' ischemia, outcome, and oculomotor nerve palsy (ONP) that continued during the follow-up period in 23 patients with complex unruptured basilar apex aneurysms (BAAs) treated with clipping. Methods Aneurysm morphology included the size, distance of neck from the posterior clinoid process, dome projection, and localization in the interpeduncular cistern (LIC). BAAs with neck >4 mm, posterior projection, retro/subsellar, and dome-to-neck ratios <1.2 were considered as complex. The poor outcome was defined as modified Rankin Scale (mRS) 2–6 at the 12 months' follow-up examination. Results All patients were treated by anterior temporal approach. Size ( P < 0.0001) and LIC ( P < 0.0001) were related to thalamoperforators' ischemia ( n = 3, 13%). Size ( P = 0.0010), dividing-posterior communicating artery ( P = 0.0050), thalamoperforator's ischemia ( P = 0.034), and LIC ( P < 0.0001) were related to poor outcome (mRS 2: n = 3, 13%). The mean follow-up period was 368 ± 52 days. No patients developed a bleed and showed evidence of any residual or recurrent aneurysm during follow-up. Postoperative ONP occurred in 15 patients (65%) and all were partial. During follow-up, full recovery of the ONP was seen in 13 patients (57%), and it continued in 2 (8.7%). Size ( P = 0.010) and posterior projection ( P = 0.043) and LIC ( P = 0.0050) were related to continued ONP. Conclusions The present study suggested that unruptured BAA patients with LIC should be meticulously treated in case of performing clipping because it was related to thalamoperforators' ischemia, poor outcome, and continued ONP. [ABSTRACT FROM AUTHOR]

Objective: The influence of blood alcohol level (BAL) on outcome remains unclear. This study investigated the relationships between BAL, type and number of diffuse axonal injury (DAI), intraventricular bleeding (IVB) and 6-month outcome. Methods: This study reviewed 419 patients with isolated blunt traumatic brain injury. First, it compared clinical and radiological characteristics between patients with good recovery and disability. Second, it compared BAL among DAI lesions. Third, it evaluated the correlation between the BAL and severity of IVB, number of DAI and corpus callosum injury lesions. Results: Regardless of BAL, older age, male gender, severe Glasgow Coma Scale score (<9), abnormal pupil, IVB and lesion on genu of corpus callosum were significantly related to disability. There were no significant differences between the BAL and lesions of DAI. Simple regression analysis revealed that there were no significant correlation between BAL and severity of IVB, number of DAI and corpus callosum injury lesions. Conclusions: Acute alcohol intoxication was not associated with type and number of DAI lesion, IVB and disability. This study suggested that a specific type of traumatic lesion, specifically lesion on genu of corpus callosum and IVB, might be more vital for outcome. [ABSTRACT FROM AUTHOR]

Objective: Some studies have investigated the relationship between anatomic location and outcome in patients with cerebellar hemorrhage (CH), but not as yet the relationship between location of CH, as categorized according to vascular territory, and outcome. Furthermore, other studies have shown that taking antithrombotics was related to having CH; however, there have been no studies assessing the relationship between antithrombotics and the location of CH. The aim of this study was to determine whether the outcome of patients with CH at 1-year after onset differed depending on antithrombotic use and lesion location. Methods: A retrospective, single-institution study involving 53 patients with CH was conducted. Location of the CH, categorized by vascular territory, was classified as either superior cerebellar artery hemorrhage (SCAH), anterior inferior cerebellar artery hemorrhage, or posterior inferior cerebellar artery hemorrhage. Outcome was evaluated using the modified Rankin scale (mRS) and mRS was divided into good (mRS ≤2) or poor (mRS ≥3). Results: Thirty-four patients had SCAH, 5 had anterior inferior cerebellar artery hemorrhage, and 14 had posterior inferior cerebellar artery hemorrhage. Patients with poor outcome had higher proportions of Glasgow coma scale score ≤8, SCAH, intraventricular bleeding, hydrocephalus, and maximal transverse diameter ≥30 mm by univariate analysis. After multivariate analysis, Glasgow coma scale score ≤8 and SCAH showed a significant association with poor outcome. Conclusions: Outcome at 1-year after onset differed by location of the CH lesion as categorized according to vascular territory. SCAH was related to poor outcome by a larger maximal transverse diameter of hematoma and hydrocephalus. [ABSTRACT FROM AUTHOR]