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Introduction: Brain arteriovenous malformations (BAVMs) are high-flow intracranial vascular malformations characterized by the direct connection of arteries to veins without an intervening capillary bed. They are one of the main causes of intracranial hemorrhage and epilepsy, although morbidity is low. Angiogenesis, heredity, inflammation, and arteriovenous malformation syndromes play important roles in BAVM formation. Animal experiments and previous studies have confirmed that NOTCH4 may be associated with BAVM development. Our study identifies a connection between NOTCH4 gene polymorphisms and BAVM in a Chinese Han population. Methods: We enrolled 150 patients with BAVMs confirmed by digital subtraction angiography (DSA) in the Department of Neurosurgery, Zhujiang Hospital, Southern Medical University from June 2017 to July 2019. Simultaneously, 150 patients without cerebrovascular disease were confirmed by computed tomography angiography/magnetic resonance angiography/DSA. DNA was extracted from peripheral blood and NOTCH4 genotypes were identified by PCR-ligase detection reaction. The χ2 test or Fisher’s exact test was used to evaluate the differences in allele and genotype frequencies between the BAVM group, control group, bleeding group, and other complications. Results: Two single-nucleotide polymorphisms (SNPs), rs443198 and rs438475, were significantly associated with BAVM. No SNP genotypes were significantly associated with hemorrhage or epilepsy. SNPs rs443198_AA-SNP and rs438475_AA-SNP may be associated with a lower risk of BAVM (p = 0.011, odds ratio (OR) = 0.459, 95% confidence interval (CI): 0.250–0.845; p = 0.033, OR = 0.759, 95% CI: 0.479–1.204). Conclusion: NOTCH4 gene polymorphisms were associated with BAVM and may be a risk factor in a Chinese Han population.

Intracranial aneurysms (IAs) are a life-threatening disease. Their rupture can lead to hemorrhagic stroke. Most studies applying deep learning for the detection of aneurysms are based on angiographic images. However, critical diagnostic information such as morphology and aneurysm location are not captured by deep learning algorithms and still require manual assessments.Digital subtraction angiography (DSA) is the gold standard for aneurysm diagnosis. To facilitate the fully automatic diagnosis of aneurysms, we proposed a comprehensive system for the detection, morphology measurement, and location classification of aneurysms on three-dimensional DSA images, allowing automatic diagnosis without further human input.The system comprised three neural networks: a network for aneurysm detection, a network for morphology measurement, and a network for aneurysm location identification. A cross-scale dual-path transformer module was proposed to effectively fuse local and global information to capture aneurysms of varying sizes. A multitask learning approach was also proposed to allow an accurate localization of aneurysm neck for morphology measurement.The cross-scale dual-path transformer module was shown to outperform other state-of-the-art network architectures, improving segmentation, and classification accuracy. The detection network in our system achieved an F2 score of 0.946 (recall 93%, precision 100%), better than the winning team in the Cerebral Aneurysm Detection and Analysis challenge. The measurement network achieved a relative error of less than 10% for morphology measurement, at the same level as human operators. Perfect accuracy (100%) was achieved on aneurysm location classification.We have demonstrated that a comprehensive system can automatically detect, measure morphology and report the aneurysm location of aneurysms without human intervention. This can be a potential tool for the diagnosis of IAs, improving radiologists' performance and reducing their workload.

Background: Traditional Chinese medicine (TCM) has been widely used in the treatment of human diseases. However, the synergistic effects of multiple TCM prescriptions in the treatment of stroke have not been thoroughly studied.Objective of the study: This study aimed to reveal the mechanisms underlying the synergistic effects of these TCM prescriptions in stroke treatment and identify the active compounds.Methods: Herbs and compounds in the Di-Tan Decoction (DTD), Xue-Fu Zhu-Yu Decoction (XFZYD), and Xiao-Xu-Ming Decoction (XXMD) were acquired from the TCMSP database. SEA, HitPick, and TargetNet web servers were used for target prediction. The compound-target (C-T) networks of three prescriptions were constructed and then filtered using the collaborative filtering algorithm. We combined KEGG enrichment analysis, molecular docking, and network analysis approaches to identify active compounds, followed by verification of these compounds with an oxygen-glucose deprivation and reoxygenation (OGD/R) model.Results: The filtered DTD network contained 39 compounds and 534 targets, the filtered XFZYD network contained 40 compounds and 508 targets, and the filtered XXMD network contained 55 compounds and 599 targets. The filtered C-T networks retained approximately 80% of the biological functions of the original networks. Based on the enriched pathways, molecular docking, and network analysis results, we constructed a complex network containing 3 prescriptions, 14 botanical drugs, 26 compounds, 13 targets, and 5 pathways. By calculating the synergy score, we identified the top 5 candidate compounds. The experimental results showed that quercetin, baicalin, and ginsenoside Rg1 independently and synergistically increased cell viability.Conclusion: By integrating pharmacological and chemoinformatic approaches, our study provides a new method for identifying the effective synergistic compounds of TCM prescriptions. The filtered compounds and their synergistic effects on stroke require further research.

We proposed a new approach to train deep learning model for aneurysm rupture prediction which only uses a limited amount of labeled data.Using segmented aneurysm mask as input, a backbone model was pretrained using a self-supervised method to learn deep embeddings of aneurysm morphology from 947 unlabeled cases of angiographic images. Subsequently, the backbone model was finetuned using 120 labeled cases with known rupture status. Clinical information was integrated with deep embeddings to further improve prediction performance. The proposed model was compared with radiomics and conventional morphology models in prediction performance. An assistive diagnosis system was also developed based on the model and was tested with five neurosurgeons.Our method achieved an area under the receiver operating characteristic curve (AUC) of 0.823, outperforming deep learning model trained from scratch (0.787). By integrating with clinical information, the proposed model's performance was further improved to AUC = 0.853, making the results significantly better than model based on radiomics (AUC = 0.805, p = 0.007) or model based on conventional morphology parameters (AUC = 0.766, p = 0.001). Our model also achieved the highest sensitivity, PPV, NPV, and accuracy among the others. Neurosurgeons' prediction performance was improved from AUC=0.877 to 0.945 (p = 0.037) with the assistive diagnosis system.Our proposed method could develop competitive deep learning model for rupture prediction using only a limited amount of data. The assistive diagnosis system could be useful for neurosurgeons to predict rupture.• A self-supervised learning method was proposed to mitigate the data-hungry issue of deep learning, enabling training deep neural network with a limited amount of data. • Using the proposed method, deep embeddings were extracted to represent intracranial aneurysm morphology. Prediction model based on deep embeddings was significantly better than conventional morphology model and radiomics model. • An assistive diagnosis system was developed using deep embeddings for case-based reasoning, which was shown to significantly improve neurosurgeons' performance to predict rupture.

BackgroundSpecifying generic flow boundary conditions in aneurysm hemodynamic simulations yields a great degree of uncertainty for the evaluation of aneurysm rupture risk. Herein, we proposed the use of flowrate-independent parameters in discriminating unstable aneurysms and compared their prognostic performance against that of conventional absolute parameters.MethodsThis retrospective study included 186 aneurysms collected from three international centers, with the stable aneurysms having a minimum follow-up period of 24 months. The flowrate-independent aneurysmal wall shear stress (WSS) and energy loss (EL) were defined as the coefficients of the second-order polynomials characterizing the relationships between the respective parameters and the parent-artery flows. Performance of the flowrate-independent parameters in discriminating unstable aneurysms with the logistic regression, Adaboost, and support-vector machine (SVM) methods was quantified and compared against that of the conventional parameters, in terms of sensitivity, specificity, and area under the curve (AUC).ResultsIn discriminating unstable aneurysms, the proposed flowrate-independent EL achieved the highest sensitivity (0.833, 95% CI 0.586 to 0.964) and specificity (0.833, 95% CI 0.672 to 0.936) on the SVM, with the AUC outperforming the conventional EL by 0.133 (95% CI 0.039 to 0.226, p=0.006). Likewise, the flowrate-independent WSS outperformed the conventional WSS in terms of the AUC (difference: 0.137, 95% CI 0.033 to 0.241, p=0.010).ConclusionThe flowrate-independent hemodynamic parameters surpassed their conventional counterparts in predicting the stability of aneurysms, which may serve as a promising set of hemodynamic metrics to be used for the prediction of aneurysm rupture risk when physiologically real vascular boundary conditions are unavailable.

Background: Intracranial aneurysm wall degradation can be associated with lipid infiltration. However, the relationship between lipid infiltration and aneurysm rupture has not been explored quantitatively. To investigate the correlation between lipid infiltration and aneurysm rupture, we utilized patient-specific simulation of low-density lipoprotein (LDL) transport to analyze lipid infiltration in the cerebral aneurysm wall.Methods: Sixty-two aneurysms were analyzed. Patient blood pressure, plasma LDL concentration, and three-dimensional angiographic images were obtained to simulate LDL transport in aneurysms. Morphological, hemodynamic, and lipid accumulation parameters were compared between ruptures and unruptured groups. Multivariate logistic regression was also performed to determine parameters that are independently associated with rupture.Results: Size ratio, wall shear stress, low shear area, relative residence time, area-averaged LDL infiltration rate, and maximum LDL infiltration rate were significant parameters in univariate analysis (P < 0.05). Multivariate analysis revealed that only average LDL infiltration remained as a significant variable (P < 0.05). The prediction model derived showed good performance for rupture prediction (AUC, 0.885; 95% CI, 0.794–0.976).Conclusions: Ruptured aneurysms showed significantly higher LDL infiltration compared to unruptured ones. Our results suggested that lipid infiltration may promote aneurysm rupture. Lipid infiltration characteristics should be considered when assessing aneurysm rupture risk.

Intracranial 'kissing' aneurysms are rare types of multiple aneurysms referring to two adjacent aneurysms arising from identical or different arteries with separate origins and partially adherent walls. The present study reported a 54-year-old female patient, who was identified with a 'kissing' aneurysm in the A3 segment of the bilateral anterior cerebral arteries, as demonstrated by head computed tomography and emergency cerebral digital subtraction angiography analysis. In total, 12 days following the clipping of the aneurysms, the patient was discharged with a Modified Rankin Scale=0 and recovered well with no neurological deficits. Based on previous literature, it was indicated that the majority of patients with 'kissing' aneurysm have a good prognosis and the cure rate is as high as 96.8%. However, the recovery rate may not be that high as the sample size is not large enough to thoroughly demonstrate the complete prognosis of 'kissing' aneurysms.

Symptomatic headaches attributed to unruptured brain arteriovenous malformations (ubAVMs) are very common and affect patients' quality life, but multidisciplinary care of ubAVMs to improve symptomatic headache remains unclear.The objective is to identify the features of symptomatic headaches, and to obtain headache outcomes following multidisciplinary care of ubAVMs, as well as provide background on the natural history of ubAVMs.The features of symptomatic headaches and headache outcomes were analyzed in a large cohort of cases after multidisciplinary care of ubAVMs. We have also provided information on the natural history of ubAVMs.This study was conducted at the Department of Neurosurgery of Zhujiang Hospital where 336 patients from 1998 to 2014 were reviewed by a multidiscipline team. Only 124 patients were eligible.The demographics, clinical features, imaging features, and headache details of eligible patients were reviewed. An 11-point pain scale score was used to assess symptomatic headaches before, during, and after treatment. The headache outcomes, death or stroke, and adverse functional outcomes (modified Rankin Scale score = 2, mRS = 2) were assessed following multidisciplinary care of ubAVMs.Twenty-three (56.1%) of 41 patients had migraine-like headaches located in occipital lobe (P0.001), while forty (63.5%) of 63 patients had tension-type-like headaches located in frontotemporal lobe (P0.001). For patients with tension-type-like or all types of headache, headache improvement differed between the multidisciplinary group and medical group (87.8% vs. 31.8%, P0.001; 85.7% vs. 40.7%, P0.001). The risk of death or stroke did not differ between multidisciplinary group and medical group (P = 0.393), whereas the risk of adverse functional outcome (mRS = 2) differed significantly by long-time follow-up (23.0% vs.10.0%, P = 0.022).This study provides the initial experience to support multidisciplinary care for ubAVMs to improve symptomatic headaches and patients' quality life, but based on the retrospective study with inherent limitations, larger samples and multi-center trials are needed on this interesting issue.Occipital ubAVM is more likely to present with migraine-like headache, while frontotemporal ubAVM tends to present with tension-type-like headache. The effectiveness of multidisciplinary care for ubAVM to improve headache has been shown, but the natural history of ubAVM patients with headache remains unclear.Key Words: Unruptured brain arteriovenous malformations, headache, headache improvement, natural history.

BACKGROUND AND PURPOSE: The incidence of unruptured intracranial aneurysms is increasing in the elderly population as life expectancy increases, and patients often present with headache. The goal of this study was to determine the effect of endovascular treatment on headache and identify factors associated with headache outcome in elderly patients with unruptured intracranial aneurysms. MATERIALS AND METHODS: A retrospective study was conducted for elderly patients (≥ 65 years old) being treated for unruptured intracranial aneurysms. Headache assessment was performed by a quantitative 11-point headache scale in all patients before and after endovascular treatment. Factors associated with headache outcome were investigated by univariate analyses. RESULTS: A total of 72 patients (mean age, 70.0 years; age range, 65–80 years; 41 women) fulfilled the inclusion criteria. There were 52 patients (72.2%) who presented with preoperative headache (headache score ≥ 1). Among them, 40 (76.9%) reported that headache score had an improvement according to their self-reported quantitative headache score after endovascular treatment. The average headache score was 5.63 preoperatively vs 2.50 postoperatively ( P = .000). Twenty patients (27.8%) had no headache before treatment (headache score = 0), of whom 2 (10.0%) reported new onset of headache postoperatively. Only a preoperative headache score was associated with treatment outcome of headache, and a higher headache score predicted a lack of headache relief after endovascular treatment ( P = .003). CONCLUSIONS: Endovascular coiling of unruptured intracranial aneurysms resulted in relief of headache in most of the elderly patients. Preoperative headache score was the only statistically significant predictor of headache outcome.

Objective Recovery of aneurysm-induced oculomotor nerve paresis (ONP) after endosaccular coiling has not yet been adequately assessed. The aim of this study was to investigate the factors that affect the outcome of ONP after endovascular treatment of posterior communicating artery (PcomA) aneurysms. Materials and methods We retrospectively evaluated the clinical characteristics and the outcome of oculomotor nerve function in a series of 36 patients with ONP due to PcomA aneurysms treated by endovascular coiling. Univariate analysis was applied to test the association between ONP recovery and clinical variables. Results Thirty-six consecutive patients (20 women, 16 men; mean age, 54.3±9 years) presenting with ONP underwent endosaccular coiling were enrolled in this study. Subarachnoid hemorrhage was present in 21 patients. The mean size of the aneurysms was 9.3±3.9mm. ONP was complete in 14 patients (38.9%) and partial in 22 patients (61.1%) at admission. Seventeen patients (47.2%) had complete recovery of oculomotor nerve function, 15 had incomplete recovery (41.7%), and 4 (11.1%) remained unchanged after treatment. Factors showing significant association with recovery of oculomotor nerve function were the length and degree of ONP before treatment ( P =0.035 and P =0.019, respectively). Conclusions Endosaccular coiling of PcomA aneurysms in patients with ONP resulted in cure or improvement of oculomotor nerve dysfunction in the majority of patients. The length and degree of preoperative ONP were the statistically significant predictors of complete ONP recovery.

We applied the "interlacing ball" technique to 18 ruptured sausage-shaped intracranial aneurysms (SSIA) with Hunt and Hess Grades I to III in 18 patients. Coils were joined to form the first three-dimensional ball-like structure at the dome of the aneurysm. A segment of the last coil was purposely left out of the first ball so that it could be joined with the next coil used to form a second "ball". This second ball was woven into the neck portion in a net-like fashion to prevent coil protrusion into the parent artery. An immediate post-procedural angiogram showed complete occlusion in 16 aneurysms (88.9%) and near-complete occlusion in two aneurysms with no complications. Sixteen patients were discharged with a Glasgow Outcome Scale (GOS) score of 5, and two with a GOS score of 4. One patient developed an enlarging aneurysm neck as visualized on an angiogram, while 17 aneurysms (94.4%) demonstrated no recurrence, within 3 months to 37 months of follow-up. We report that this technique is useful for the successful embolization of SSIA.

Objective: Cerebral venous sinus thrombosis (CVST) is a rare but life-threatening disease and an animal model for in-depth study of CVST is needed. This study aimed to develop a rat model suitable for studying clinically relevant aspects of CVST and investigating its dynamic pathophysiological changes during a 7-day period. Method: A photothrombosis method was used to create a rat sinus-vein thrombosis model. A spot size-adjustable Diode Pumped Solid State laser (DPSS) combined with thrombin injection occluded the rostral and caudal superior sagittal sinus (SSS). The model was used to evaluate pathophysiological changes at different time points over 7 days. Evans Blue dye injection was used to detect alterations in blood–brain barrier (BBB) permeability. Brain water content was also measured. Moreover, we examined changes in brain infarct volume, neurological function, as well as histology after induction of CVST. Result: CVST in rats significantly altered BBB permeability, consistent with the development of brain edema. It was accompanied by an increase in brain infarct volume and deficits in neurological function that began on day 1, peaked on day 2, and typically improved by day 7 due to the neuroprotective effects of angiogenesis and gliocyte proliferation. Conclusion: In this study, we describe a rat model that produces clinically relevant pathophysiology and pathology that will facilitate evaluation of therapeutic regimens for CVST. Furthermore, our results indicate a period of optimal clinical intervention for patients with CVST, which may reduce the probability of dependency and death.

The aim of the present study was to analyze the feasibility, rate of procedure-related complications and midterm angiographic follow-up outcomes using the Enterprise (EP) and Solitaire™ AB (ST) stents in the stent-assisted coiling of intracranial aneurysms. In total, 81 patients with 90 aneurysms were included in the study, with the aim to treat 43 aneurysms with the EP stent (47.8%) and 47 aneurysms with the ST stent (52.2%). The 90 aneurysms were successfully stented and subsequently coiled; however, in four patients undergoing treatment with the EP stent, the stent was not navigable; thus, treatment with the ST stent was employed (EP, n=39, 43.3%; ST, n=51, 56.7%). Of the 90 aneurysms, 44 cases were ruptured aneurysms, with 74 located in the anterior circulation and 16 located in the posterior circulation. The stenting success rate of the ST stent was significantly higher compared with the EP stent. However, no statistically significant differences were observed with regard to the packing density, complete occlusion, progressive occlusion, recurrence rate, procedure-related complications, in-stent stenosis and stent migration rates between the two groups. In conclusion, the two common medical devices used for intracranial aneurysms are relatively safe and effective for the treatment of intracranial aneurysms. However, due to the higher stenting success rate of the ST stent, this medical devise was demonstrated to be more flexible and feasible compared with the EP stent.

To study the surgical approach and curative effect of the "interlocking basket" technique in interventional therapy for longitudinal intracranial aneurysm.Thirty-eight Hunt and Hess Grade I-III patients with longitudinal intracranial aneurysm underwent interventional therapy using the "interlocking basket" technique. During the operation, the aneurysm was divided into two segments based on its length and occluded with two coils. The first coil with a transverse diameter matching that of the aneurysm was deployed to form a "basket", which was densely occluded, and a portion of this coil out of the "basket" was interlocked with the second coil to form another "basket" crossing the aneurysmal neck to prevent the coils from escaping till the neck of the aneurysm was densely occluded.Thirty-five aneurysms (92.1%) were completely embolized, and 3 (7.9%) were 95% embolized. No coil escaping from the aneurysm neck or other complications occurred. Twenty-five patients were discharged with a GOS score of 5 (65.8%), 7 (18.4%) with a score of 4, and 6 (15.8%) had a score of 3. In the follow-up for 3-25 months after the embolization, angiography was performed in 28 cases, and recurrence was found in 2 cases (7.14%).The "interlocking basket" technique can increase the coil stability in longitudinal intracranial aneurysm and allows reliable block of the aneurysm neck and dense embolization of the aneurysm to improve the clinical outcomes of the patients.

Purpose The paper mainly involved the retrospective approach to risk factors of intraprocedual rerupture (IPR) and illustration of our empirical prevention and management on this event as well as its postembolization outcomes evaluation. Materials and methods Endovascular treatment was performed in 1308 patients with 1308 ruptured intracranial aneurysms, and IPR occurred in 18 cases. We retrospectively reviewed their clinical records and images, and analysis risk factors of IPR by using multivariate logistic regression. Results The morbidity of IPR was 1.38% and mortality was 33.33%. Nine patients survived from rapid completion of coiling with immediate reversal of heparin anticoagulation with protamine sulfate, and 3 from emergent external ventricular drainage (EVD). However, 9 of them presented with different degrees of disability and 3 were fully recovered. Small aneurysms (diameter ≤ 3.0 mm) (OR 284.212, 95% C.I. 17.368–4650.780, P = 0.000), atherosclerosis (OR 7.866, 95% C.I. 1.113–55.570, P = 0.039), Fisher Grade III (OR 82.099, 95% C.I. 1.563–431.696, P = 0.029), vasospasm (grade I) (OR 32.269, 95% C.I. 2.393–435.132, P = 0.009) and vasospasm (grade II) (OR 30.238, 95% C.I. 1.770–516.552, P = 0.019) are risk factors of IPR. Aneurysms at proximal part of internal carotid artery (ICA), bifurcation and basilar artery (BA) stem (OR 0.003, 95% C.I. 0.000–0.101, P = 0.001) and Hunt and Hess Grade II (OR 0.010, 95% C.I. 0.000–0.346, P = 0.011) are identified as protective factors. Conclusions Small aneurysms, atherosclerosis, Fisher Grade of SAH and cerebral vasospasm are the predictors of IPR. Aneurysms at proximal part of ICA bifurcation and BA stem and Hunt and Hess Grade II are less associated with IPR. Rapid completion of coiling combined with immediate reversal of heparin anticoagulation is confirmed to be the best strategy in our series.

This study aimed to observe nine factors expressed in rat ischemic brain after transplantation of bone marrow stromal cells (BMSC) and/or endothelial progenitor cells (EPC). These factors were vascular endothelial growth factor (VEGF), stromal cell-derived factor-1 (SDF-1), basic fibroblast growth factor (bFGF), insulin-like growth factor (IGF-l), transforming growth factor-β (TGF-β), platelet-derived growth factor-BB (PDGF-BB), brain-derived neurotrophic factor (BDNF), glial cell line-derived neurotrophic factor (GDNF) and nerve growth factor (NGF).Adult Wistar rats were divided randomly into four groups: a vehicle group, BMSC group, EPC group and BMSC combined with EPC group. The rats were subjected to middle cerebral artery occlusion (MCAO) then implanted intravenously with 3 × 10(6) BMSC, EPC, BMSC/EPC or phosphate-buffered saline (PBS) 24 h after MCAO. Neurologic functional deficits were measured on days 1, 7, 14, 28 after transplantation. On day 7 after transplantation, quantitative reverse transcription (qRT)-polymerase chain reaction (PCR) and Western blot were employed to detect the expression of VEGF, SDF-1, bFGF, IGF-l, TGF-β, PDGF-BB, BDNF, GDNF and NGF.The neurologic evaluation found that the neurologic severity scores were no different between the four groups on day 1, and the scores of rats in the BMSC/EPC group were significantly lower than those of rats in the other groups on days 7, 14 and 28 after transplantation. The expressions of bFGF, VEGF and BNDF were significantly higher in the BMSC/EPC group compared with the other groups.The intravenous transplantation of BMSC combined with EPC could promote the functional rehabilitation of rats with focal cerebral ischemia, and the mechanism may be related to the enhanced expression of factors.

Background The diagnostic value of virtual imaging combined with three-dimensional computed tomographic angiography (3D-CTA) for intracranial aneurysms has not been fully elucidated yet. This study aimed to evaluate the value of combined application of virtual imaging techniques and 3D-CTA in diagnosing patients with aneurismal subarachnoid hemorrhage (SAH) at the acute stage. Methods Eighty patients with non-traumatic SAH received 3D-CTA examinations. The raw CT data of these patients were reconstructed and transferred into the 3D mode through the surgical plan system based on virtual reality (VR) image, and the 3D virtual images of skulls and brain blood vessels were acquired. The location, size and shape of aneurysms and their anatomic relationship with adjacent tissues were measured from many points of view. Results Seventy-three aneurysms were detected in 68 of the 80 patients, but 2 aneurysms were detected in 2 of the 5 patients who had been found free of aneurysms previously and had received 3D-CTA examinations for a second time one month later. The 3D virtual images produced by the virtual imaging system were clear and vivid, and they could reveal the location and size of the aneurysm and its relations to the parent artery and skull directly. Conclusions The imaging of 3D-CTA is convenient, reliable and fast in diagnosing intracranial aneurysms and can be regarded as the first choice for the diagnosis and treatment of ruptured intracranial aneurysms. Combined with the surgical plan system based on the VR image, 3D-CTA may obtain more imaging information about aneurysms.

To investigate the value of virtual imaging technique in diagnosis of intracranial aneurysms.Fifty-four cases of 54 intracranial aneurysm diagnosed by three-dimensional CT angiography (3D-CTA) examinations were enrolled in this study. Three-dimensional virtual images of the skull and cerebral vessels were acquired by three-dimensional reconstruction of the original CT images using the surgical planning system, and the location, size and shape of the aneurysms and their anatomical relationship with the adjacent tissues were observed and measured from several angles. All the patients underwent surgical planning and simulated surgical operations using the virtual surgical instruments available in the system.All the 54 cases had successful three-dimensional virtual image reconstruction and the surgical planning operations. The virtual imaging system generated clear and vivid three-dimensional virtual images which clearly visualized the location and size of the aneurysms and their precise anatomical relations to the parent arteries and skull. This virtual reality imaging system also allowed simulation of simple surgical procedures.The surgical planning system based on the virtual reality imaging can serve as a useful means to assist the diagnosis and provide precise imaging details of intracranial aneurysms.

To explore the expression of transforming growth factor beta1 (TGFbeta1) and its type I receptors activin-like kinase 1 (ALK1) and ALK5 mRNA in the development of brain arteriovenous malformation (BAVM).The mRNA expressions of TGFbeta1, ALK1and ALK5 were detected with semiquantitative RT-PCR in patients with BAVM.The expressions of TGFbeta1 and ALK5 mRNA increased significantly in BAVM, and their relative expression quantity were 0.777-/+0.047 and 0.585-/+0.074, respectively. However, ALK1 mRNA expression declined significantlies with a relative expression of 0.173-/+0.044 in comparison with the control group (0.720-/+0.098, P0.01).The balance of TGFbeta1 and its type I receptors ALK1 and ALK5 mRNA expressions may play important role in the development of BAVM.

To investigate the diagnostic value of digital subtraction angiography (DSA) and the clinical efficacy of preoperative embolization for miningiomas.Fifty-eight patients with meningioma were examined by DSA, and preoperative embolization was performed in patients whose miningiomas were supplied predominantly by the external carotid artery (ECA).In 43 patients, the meningiomas was exclusively or predominantly supplied by ECA, and the feeding arteries were embolized with particles of 250-350 microm through catherization of ECA. The blood supply of the tumor in 31 patients was completely blocked, and partial occlusion through embolization was performed in 12 patients. No complications in relation to the embolization occurred. Fifty-three patients underwent total removal of the meningiomas and the others had partial removal 1-7 days following DSA and embolization, with tumor-associated intraoperative hemorrhage of 600 ml on average.DSA has important diagnostic value for meningiomas, and preoperative embolization can be safe and effective to reduce bleeding, shorten the operation time and prevent postoperative complications.

To evaluate the effect of endovascular embolization of internal carotid-posterior communicating artery (IC-PC) aneurysm.145 patients with IC-PC aneurysms underwent endovascular embolization through the microcatheter under digital subtraction angiography (DSA). Of the 145 cases, 55 patients with 62 aneurysms were embolized by mechanical detachable spiral (MDS) and 90 patients with 106 aneurysms were embolized by Guglielmi detachable coil (GDC) or electrical detachable coil (EDC).168 aneurysms in 145 patients, 96 of which with 100% embolization, 45 with 95% embolization, 15 with 90% embolization, and 12 with less than 90% embolization, were embolized successfully. During the surgery, aneurysm rupture occurred in 3 cases, cerebral vasospasm in 5, and cerebral infarction in 1 case. 118 cases were cured, 23 improved, and 3 died. 17 patients were followed-up by DSA, 3 aneurysms recurred and 2 were totally embolized with EDC for the second time.Endovascular embolization is a safe and effective therapeutic method for IC-PC aneurysm.

To evaluate the choice of approaches, surgical techniques and clinical outcome of endovascular embolization for treating traumatic carotid cavernous fistula (TCCF).A retrospective analysis of 119 patients with TCCF was conducted, in whom totally 128 embolizations were performed. In these procedures, the femoral artery approach was adopted in 112 cases, femoral vein approach in 5 cases, and superior ophthalmic vein approach in 2 cases. For the embolization materials, balloons were used in 101 cases, microcoils in 13 cases, both materials in 2 cases, and lyophilized dura mater in 3 cases. After the embolization procedures, 110 patients were followed-up for 3 months to 10 years, and 29 patients reexamined with angiography.Successful embolization for TCCF in a single procedure was achieved in 111 cases, and failure occurred due to balloon leakage in 8 cases, all embolized successfully in a second attempt. The total success rate was 100% in these cases, with a rate of internal carotid artery patency of 90.8% (108/119). No perioperative mortality or complication occurred, nor was TCCF recurrence seen during the follow-up.In general, TCCF can be successfully treated by balloon embolization via the femoral artery, while microcoil embolization has better performance for small fistula. Embolization can be done through venous approach when the internal carotid artery is ligated or occluded, and no procedure should be performed at the convenient expense of the internal carotid artery. Right choices of the approaches and embolization materials are key to the success of the procedure.

A 19-years-old boy was admitted after brain trauma with subarachnoid hemorrhage, left oculomotor nerve palsy, elevated pressure in the cavernous sinus and intracranial noise. The diagnosis of traumatic basilar-cavernous fistula complicated with basilar artery aneurysm was established by digital subtraction angiography. After endovascular occlusion of the vessels twice using detachable coils, the patient was cured without relapse during the 2-year follow-up. It is at the time being second report globally and the first one in China.

A patient with cerebral aneurysm received embolism therapy using mechanical detachable spiral, but the aneurysm recurred because of absorption of the coil. Secondary embolism therapy was successfully implemented using Guglielmi detachable coil.