ABSTRACT
Objective The treatment methods for blood blister-like aneurysm remain controversial due to its special patholog-ical structure,the risk of post-operative rebleeding and the high rate of recurrence. The arm of this paper is to access the feasibility and effectiveness of overlapping stent-assisted coiling in the treatment of blood blister-like aneurysms of the internal carotid artery. Methods Form January 2014 to December 2016,we treated 15 patients with blood blister-like aneurysm of the internal carotid artery by stent-assisted coiling in the Department of Neurosurgery,5 with two Enterprise tents,3 with three Enterprise tents,4 with Enter-prise+LVIS tents,and 3 with two LVIS tents. We determined the rate of immediate embolization of aneurysms by Raymond-Roy Occlu-sion Classification(RROC)and analyzed the clinical characteristics,postoperative complications,and follow-up data. Results All the coils and stents were successfully implanted. RROC showed 9 cases of gradeⅠ(60%),4 cases of gradeⅡ(27%),and 2 cases of gradeⅢimmediate occlusion(13%),with the parent arteries unobstructed in all the cases. Thrombosis in the stent was found in 2 cases intraoperatively,slight stent migration in 1 case,and internal carotid artery dissection in the petrous segment in another,but no cer-ebral vasospasm or aneurysm rupture in any case.Delayed cerebral in-farct was observed in 2 cases postoperatively. The patients were fol-lowed up for 2 weeks to 28 months,which showed that 11 of them were cured,2 remained stable and 2 developed further thrombosis,with an MRS score of 0-2 in 12 cases,4 in 1 case,5 in 1 case, and 6 in 1case. Conclusion Overlapping stent-assisted coiling is effective for the treatment of blood blister-like aneurysm by reduc-ing the risks of rebleeding and recurrence.
ABSTRACT
Objective: To investigate whether endothelial progenitor cells (EPCs) involved in the early healing process of aneurysms with flow diverting stents and the mechanisms. Methods: Five clean rabbits were chosen to prepare the animal model of aneurysm on the right carotid artery. After EPCs were cultured autologously, they were double labeled by Hoechst 33342 and carboxyfluorescein diacetate succinimidylester (CFSE). The aneurysms of rabbits were treated using flow diverting stents. The labeled EPCs were retransfused autologously via veins. EPCs involving in the intimai repair of aneurysms were observed with Cell tracking technology after 2 weeks. In combination of scanning electron microscopy, pathology and immunohistochemistry, EPCs involving in the process of intimal repair were analyzed. Results: Circled digit oneTwo weeks after simple flow diverting stents treatment, the rabbits were reexamined. Their aneurysms did not visualized completely (5/5). The aneurysms were obliferated completely, and the aneurysm necks were covered with neointima. Circled digit twoHoechst33342 and CFSE double-labeled positive cells were found in aneurysm sections. In the aneurysm sections of 2 experimental animals (2/5) , the positive cells were in the neointima. Circled digit threeScanning electron microscopy and immunohistochemistry results suggested that only a few amount of endothelial cells repaired the intimai surface. Conclusion: EPCs involved in the process of early intimal healing of aneurysms.
ABSTRACT
Objective To explore and compare the relevant regional anatomies as they relate the fron- tolateral keyhole approach under microscopy and neuroendoscopy for operations in anterior cranial base and sellar region.Methods Fifteen silieone-injected cadaveric heads were dissected to reveal and compare the extent of expesure through the transfrontolateral keyhole approach under neuroendoscopy and microscopy. Results Portions in the areas of olfactory groove,sellar region and sylvian tissure were blind under micro- scope.Endoscope could allow observation of areas considered blind under the microscope.It could increase light intensity during the approach to objects,extend viewing angles,clear depiction of details in close-up po- sitions and inspect hidden structures.But images of endoscope were two dimensional,lack of view depth.Mi- croscopy and neuroendoscopy could help each other to recuperate deficiency.Conclusion Endoscope-assis- ted neuromicrosurgery is helpful,safe and minimally invasive to treat deepseated lesions in anterior cranial base,sellar region by transfrontolateral keyhole approach.