Results of Endovascular Coil Embolization Treatment for Small (≤ 5 mm) Unruptured Intracranial Aneurysms

OBJECTIVE: Researchers and clinicians have been unable to fully elucidate the natural course of and proper treatment for unruptured intracranial aneurysms (UIAs) smaller than or equal to 5 mm, particularly with regard to whether close observation or surgery is more appropriate. In this retrospective study, we evaluated the safety and efficacy of endovascular coil embolization of small (≤ 5 mm) asymptomatic UIAs by analyzing outcomes and complications associated with the procedure. MATERIALS AND METHODS: We analyzed data from 150 patients with small asymptomatic UIAs (≤ 5 mm) treated with coil embolization between January 2011 and December 2015. Three-dimensional angiography was used to measure aneurysm size. We evaluated procedure-related morbidity and mortality, immediate post-operative angiographic results, brain computed thomography follow-up results on post-operative day one, and clinical progress. RESULTS: UIAs occurred primarily in the anterior circulation area (142 cases, 94.67%), though eight patients exhibited UIAs of the posterior circulation. Following coil embolization, aneurysms with complete occlusion were observed in 137 cases (91.3%). Partial occlusion occurred in five cases (3.33%), while the procedure had failed in eight cases (5.33%). Procedure-related morbidity and mortality were five cases (3.33%) and zero cases, respectively. CONCLUSION: The endovascular treatment of small asymptomatic UIAs is associated with good short-term outcomes without permanent neurologic complications as well as low overall complication and morbidity rates. Thus, the procedure should be considered for patients with smaller asymptomatic UIAs.

The Benefits of Navien™ Intracranial Support Catheter for Endovascular Treatment

OBJECTIVE: Endovascular treatment is one of the most important treatments along with open craniotomy for cerebrovascular surgery. The successful treatment of endovascular disease relies on appropriate instruments and the surgeon's skill. Endovascular treatment needs to provide safe and stable access to the catheter cavity. Additionally, it is important to maintain a round shape without changing to an oval shape. The catheter for endovascular treatment has to be flexible and accommodate at least 0.027 inches of inner diameter. The 6-Fr Navien™ Intracranial Support Catheter (formerly the ReFlex Intracranial Catheter; Covidien Vascular Therapies, Mansfield, MA, USA) provides 0.072 inches of inner diameter. MATERIALS AND METHODS: We reviewed 61 cases for 56 cases of endovascular treatment with a Navien catheter. A triaxial system was used for all procedures with femoral arterial access. The Navien catheter was placed in the petrous segment of the internal carotid artery or third segment of the vertebral artery. The patients had various shapes of intracranial arteries, including tortuous vessels. RESULTS: The Navien catheter was used for 61 cases of endovascular treatment. We had 59 cases of coil embolization at unruptured and ruptured aneurysms and two cases of stent insertion into the middle cerebral artery. All the cases were successful without any catheter-related complications. CONCLUSION: The Navien catheter is a recently developed catheter that has several strengths compared with previously developed catheters. It provides a more stable environment for endovascular treatment. It provides a cavity sufficient for endovascular treatment devices. Additionally, it is sufficiently flexible to approach tortuous vessels.

PTEN Expression in Human Brain Glial Tumors

OBJECTIVE: PTEN is a novel tumor-suppressor gene located on chromosomal band 10q23. Loss of PTEN function has been implicated in the progression of several types of cancer, including glial tumors. This study is performed to evaluate the difference of PTEN expression between the low grade glial tumors and the high grade one. METHODS: Formalin fixed and paraffin embedded tissues from 15 patients with low grade astrocytoma and oligodendroglioma, and 26 patients with glioblastoma, anaplastic astrocytoma, anaplastic oligodendroglioma and malignant mixed glial tumor were evaluated for PTEN expression by immunohistochemical method. RESULTS: Eleven(73%) of 15 cases of low grade glial tumors revealed PTEN expression and eight(31%) of 26 cases of high grade glial tumors, including glioblastoma, revealed PTEN expression. CONCLUSION: The present study suggests that loss of PTEN expression is related with tumor progression from the low grade glial tumor to glioblastoma.

Pilocytic Astrocytoma Occuring in a Patient Treated with Gamma Knife Surgery: Case Report

We report a case of pilocytic astrocytoma and atypical meningioma occurred within the field of gamma knife surgery for the management of preexisting meningioma. A 76-year old woman received gamma knife surgery for the management of meningioma in the right parietal convexity 9 years ago. Three weeks before admission, left hemiparesis and speech disturbance were developed and magnetic resonance image showed cystic mass with nodular enhancement in the right parietal area. Craniotomy and total removal of mass was performed and the histological diagnosis of atypical meningioma and pilocytic asrtocytoma were done.