Microsurgical clipping as a retreatment strategy for previously ruptured aneurysms treated with the Woven EndoBridge (WEB) device: a mono-institutional case series

BACKGROUND

Since its approval by the US Food and Drug Administration (FDA) in 2018, the flow disruptor Woven EndoBridge (WEB) device has become increasingly popular for the endovascular treatment of unruptured and ruptured cerebral aneurysms. However, the occlusion rates seem rather low and the retreatment rates rather high compared to other treatment methods. For initially ruptured aneurysms, a retreatment rate of 13 % has been reported. A variety of retreatment strategies has been proposed; however, there is a paucity of data concerning microsurgical clipping of WEB-pretreated aneurysms, especially previously ruptured ones. Thus, we present a single-center series of five ruptured aneurysms treated with the WEB device and retreated with microsurgical clipping.

METHODS

A retrospective study including all patients presenting with a ruptured aneurysm undergoing WEB treatment at our institution between 2019 and 2021 was performed. Subsequently, all patients with an aneurysm remnant or recurrence of the target aneurysm retreated with microsurgical clipping were identified.

RESULTS

Overall, five patients with a ruptured aneurysm treated with WEB and retreated with microsurgical clipping were included. Besides one basilar apex aneurysm, all aneurysms were located at the anterior communicating artery (AComA) complex. All aneurysms were wide-necked with a mean dome-to-neck ratio of 1.5. Clipping was feasible and safe in all aneurysms, and complete occlusion was achieved in 4 of 5 aneurysms.

CONCLUSIONS

Microsurgical clipping for initially ruptured WEB-treated aneurysms is a feasible, safe, and effective treatment method in well-selected patients.

Impact of Implementing an Elaborated CT Perfusion Protocol for Aneurysmal SAH on Functional Outcome: CTP Protocol for SAH

BACKGROUND AND PURPOSE

The acute phase of aneurysmal SAH is characterized by a plethora of impending complications with the potential to worsen patients' outcomes. The aim of this study was to evaluate whether an elaborated CTP-based imaging protocol during the acute aneurysmal SAH phase is able to prevent delayed infarctions and contribute to a better outcome.

MATERIALS AND METHODS

In 2012, an elaborated CTP-based protocol was implemented for the management of patients with aneurysmal SAH. Retrospective analysis of patients with aneurysmal SAH treated from 2010 to 2013 was performed, comparing the patients treated before (group one, 2010-2011) with those treated after the protocol implementation (group two, 2012-2013) with regard to delayed infarctions and outcome according to the mRS at 3-months' follow-up.

RESULTS

A total of 133 patients were enrolled, of whom 57 were included in group 1, and 76, in group 2. There were no significant differences between the groups concerning baseline characteristics. In the multivariate analysis, independent predictors of a good outcome (mRS ≤ 2) were younger age (P < .001), lower World Federation of Neurosurgical Societies grade (P < .001), absence of delayed infarction (P = .01), and management according to the CTP protocol (P = .01). Larger or multiple infarctions occurred significantly more often in group 1 compared with group 2 (88% versus 33% of all delayed infarctions, P = .03). The outcome in group 2 was significantly better compared with group 1 (P = .005).

CONCLUSIONS

The findings suggest that implementation of an elaborated CTP protocol is associated with a better outcome. An earlier initiation of further diagnostics and treatment with prevention of large territorial and/or multiple infarctions might have led to this finding.

Cranial nerve deficits in giant cavernous carotid aneurysms and their relation to aneurysm morphology and location

BACKGROUND

Giant cavernous carotid aneurysms (GCCAs) usually exert substantial mass effect on adjacent intracavernous cranial nerves. Since predictors of cranial nerve deficits (CNDs) in patients with GCCA are unknown, we designed a study to identify associations between CND and GCCA morphology and the location of mass effect.

METHODS

This study was based on data from the prospective clinical and imaging databases of the Giant Intracranial Aneurysm Registry. We used magnetic resonance imaging and digital subtraction angiography to examine GCCA volume, presence of partial thrombosis (PT), GCCA origins, and the location of mass effect. We also documented whether CND was present.

RESULTS

We included 36 GCCA in 34 patients, which had been entered into the registry by eight participating centers between January 2009 and March 2016. The prevalence of CND was 69.4%, with one CND in 41.7% and more than one in 27.5%. The prevalence of PT was 33.3%. The aneurysm origin was most frequently located at the anterior genu (52.8%). The prevalence of CND did not differ between aneurysm origins (p = 0.29). Intracavernous mass effect was lateral in 58.3%, mixed medial/lateral in 27.8%, and purely medial in 13.9%. CND occurred significantly more often in GCCA with lateral (81.0%) or mixed medial/lateral (70.0%) mass effect than in GCCA with medial mass effect (20.0%; p = 0.03). After adjusting our data for the effects of the location of mass effect, we found no association between the prevalence of CND and aneurysm volume (odds ratio (OR) 1.30 (0.98-1.71); p = 0.07), the occurrence of PT (OR 0.64 (0.07-5.73); p = 0.69), or patient age (OR 1.02 (95% CI 0.95-1.09); p = 0.59).

CONCLUSIONS

Distinguishing between medial versus lateral location of mass effect may be more helpful than measuring aneurysm volumes or examining aneurysm thrombosis in understanding why some patients with GCCA present with CND while others do not.

CLINICAL TRIAL REGISTRATION NO

NCT02066493 ( clinicaltrials.gov ).

[Laboratory investigation of the chemical disinfection against different developmental stages of the housefly (Musca domestica Linnaeus, 1758)]

Possibilities for disinfection of the developmental stages from the housefly (Musca domestica) were investigated under laboratory conditions. The developmental stages (eggs, larvae I, II, III, pupae and adults) were sprayed with solutions of disinfectants on the basis of p-chlorine-m-cresol and o-phenylphenol at different concentrations (0.025%-3%). The effectiveness of both disinfectants was established by determining the emergence rate of eggs and pupae and of the live evidence of larvae and adults. Transmission electron microscopic investigations of the cover of the eggs revealed the bactericidal effect of both disinfectants. These results show the necessity of extending its use also to noxious arthropods.

[The effectiveness of different disinfectants based on p-chloro-m-cresol against Ascaris suum eggs under laboratory conditions]

The devitalizing effectiveness of 5 patterns of the disinfectant Neopredisan (active principle: p-chlorine-m-cresol) was tested to eggs of Ascaris suum in coincidence with the "guidelines for the testing of chemical disinfectants" of the German Veterinary Society (GVS). In the suspension-test all examined patterns indicated a 100% inhibition of development Ascaris suum-eggs. In the germ carrier test all patterns were in conformity with the necessities of the GVS-guidelines. Also in the modified testing method with a temperature in the refrigerator of +10 degrees C Neopredisan showed a reliable (100%) efficacy. The inhibition of development was clearly delayed with an admixture of 20% faeces to the suspension of eggs. In a suspension-test with Neopredisan 140 in 3% solution after 15 minutes with embryonated eggs a nearly 100% ovicide and larvicide respectively efficacy was proved. The investigations show, Neopredisan is of value as a suitable disinfectant in the complex of the combat against ascariasis in the breeding of pigs.

[Morphological studies of Babesia divergens during continuous transfer in Meriones unguiculatus]

A strain of Babesia divergens was propagated by inoculation of 1.5 x 10(7) parasitized erythrocytes in 30 passages under same conditions on altogether 150 jirds. The developmental stages of Babesia divergens revealed pleomorphism in the erythrocytes of the jird. Single parasites were observed as being pyriform, globular, budding, ring-like or amoebid. The shape of dividing parasites varied between the spherical and the pyriform. The stages in the erythrocytes were localized predominantly intermedia. The reduction of the number of dividing forms and the increase of single forms occurred with increasing numbers of passages. Length and breadth of double pyriforms increased by approximately 20%.

[A new system for the quantitative evaluation of the effectiveness of an Eimeria tenella radiovaccine]

The quantitative valuation of efficiency of an Eimeria tenella radiovaccine was performed on the basis of 21 tests under floor-pen conditions and on 34 tests under the conditions of industrial broiler production using the vaccination index, the recycling index and coccidiosis protection index. The immunogenic quality of the vaccine was classified quantitatively by the indices 1 to 4, in which the classes 1 and 2 fulfilled the requirements. Under floor-pen conditions the valuation in the classes 1 and 2 was ascertained on the vaccination index with 76.2%, on the recycling index with 44.4% and on the coccidiosis protection index with 100%. Under the conditions of the industrial mast these values amounted 66.7%, 64.7% and 66.7%.

[Morphological and biological characterization of a pure strain of Eimeria mitis]

A pure strain of Eimeria mitis was obtained from a crude field isolate by single oocyst inoculation of chicken. The strain was identified as Eimeria mitis by the morphology of the oocysts. Sporulated oocysts measured 16.1 +/- 2.1 microns in length and 13.6 +/- 1.0 microns in width. The shape index was 1.18. The prepatent period was 4 days and patency lasted 12 to 13 days. The highest number of oocysts was shed at day 6 after infection of chicken with 1 x 10(4), 5 x 10(4), or 1 x 10(5) oocysts and at day 8 after infection with 5 x 10(5) oocysts. A single infection of chicken with 1 x 10(4), 5 x 10(4), 1 x 10(5), or 5 x 10(5) oocysts resulted in reproduction values of 1:118,662, 1:15,720, 1:9,977 and 1:731, respectively.

[Determination of the purity of Eimeria species of chickens]

The morphologic criteria length and breadth were used for the examination of the purity from 23 strains of different Eimeria species in the fowl (Eimeria tenella, E. acervulina, E. maxima, E. necatrix) by three methods: Tabulate graphic method, determination of the size of concentration, analysis with counter. The tabulate graphic method by use of peak value as only criterion of valuation has suitable proved for the screening test. A qualification of the degree of purity is reached in the form of classes of homogeneity with the criteria peak value, first and second classes of the neighbour by the determination of the size of concentration. The quantitative certainly of the assertion increases by the analysis with counter from six statistical parameters (frequency of peak value, frequency of the sum from peak value, first and second classes of the neighbour, number of taking classes in the specific range of species, coefficient of variation, coefficient of correlation, divergence of specific index of the form in the species).

[The sporogony of Eimeria tenella]

In the course of the sporogony of Eimeria tenella 7 stages were differentiated: stage of rounded sporont, stage of knob formation, first four-globe stage, pyramid-stage, second four-globe stage, stage of sporozoit differentiation, stage of complete sporulation.

[Immunoprophylactic possibilities for the control of fowl coccidiosis]

Coccidiosis is a poultry disease causing considerable economic damage in poultry farming. At present coccidiosis is controlled by chemoprophylaxes. The problem of drug resistance has led to a growing interest in the development of vaccines for the control of these parasites. A review of new methods and developments in the immunological control of coccidiosis in poultry is given and discussed.

Panic attacks and temporal lobe seizures associated with a right temporal lobe arteriovenous malformation: case report

A 33-year-old woman developed temporal lobe seizures and was found to have a right frontotemporal arteriovenous malformation. She subsequently developed panic attacks that could be induced by lactate infusion and were successfully treated with imipramine. The possibility that the panic attacks were caused by a structural lesion of the right temporal lobe is discussed.

Pipotiazine palmitate: an evaluation of a new long acting intramuscular antipsychotic agent in severely ill schizophrenic patients

Findings in this study support earlier investigations in attesting to the antipsychotic efficacy and relatively low toxicity of pipotiazine palmitate. Results with all efficacy measures utilized were consistent in indicating a high level of efficacy for this investigational compound. Pipotiazine palmitate apparently has an average duration of action that extends beyond 4 weeks in severely ill schizophrenic patients. This particular long acting IM antipsychotic preparation appears to have an even longer duration of activity than some of the other available standard long acting agents. The optimal dosage range for severely ill schizophrenic patients appears to be between 100 and 600 mg once monthly. While this type of drug (as is the case with many antipsychotic drugs) does reduce the psychotic symptomatology and improves the thought associations sufficient to enable the patient to leave the hospital, it should be re-emphasized that socioeconomic and guidance counseling services are necessary to maintain the patient in the community. The availability of this type of long acting preparation is not only economical in terms of nursing care and hospital cost but it should also increase the efficacy of psychopharmacologic treatment of schizophrenics by reducing both patient errors and staff errors in administration of medication. In addition, this IM preparation should prove to be of invaluable help in maintaining the schizophrenic patient in his community by reducing the relapse and the rehospitalization rates. It should be noted that there are schizophrenic patients who either absorb compounds from the gastrointestinal tract in a very poor manner or too rapidly metabolize the antipsychotic agents with resultant suboptimal blood levels and these subjects may be called "drug refractory." This type of long acting medication is an ideal preparation for the schizophrenic patient who has these types of absorption or metabolic problems since the "circulatory pass" through the liver is minimal after IM medication as compared to that encountered by an orally administered agent. The clinical disadvantage of pipotiazine palmitate is the delay in onset of therapeutic activity after injection. Significant improvement is first noted after 3 to 4 days after the highest IM dosage administration. Therefore, it may be necessary to use an oral or IM preparation of a neuroleptic with a more rapid onset of activity or utilize an oral dosage of the pipotiazine salt during the first week following IM administration of pipotiazine palmitate.