Endovascular Treatment of Cerebral Aneurysms: Coiling Techniques / 신경중재치료의학

For an effective and durable occlusion of cerebral aneurysm, the aneurysmal sac should be packed by detachable coils as densely as technically possible. Navigating microcatheters, coil framing, and packing of the sac are the major technical steps of aneurismal embolization. There are several additional techniques and devices for dealing with wide-necked aneurysms. This paper reviews and describes various techniques for safe navigation of microcatheters including tip shaping, selection of the shapes for initial coil framing, selection of coil sizes techniques for packing, and techniques of balloon- or stent-assisted coiling for embolization of wide-necked lesions.

Simple Decompression of the Ulnar Nerve for Cubital Tunnel Syndrome

OBJECTIVE: Cubital tunnel syndrome is the second most common entrapment neuropathy of the upper extremity. Although many different operative techniques have been introduced, none of them have been proven superior to others. Simple cubital tunnel decompression has numerous advantages, including simplicity and safety. We present our experience of treating cubital tunnel syndrome with simple decompression in 15 patients. METHODS: According to Dellon's criteria, one patient was classified as grade 1, eight as grade 2, and six as grade 3. Preoperative electrodiagnostic studies were performed in all patients and 7 of them were rechecked postoperatively. Five patients of 15 underwent simple decompression using a small skin incision (2 cm or less). RESULTS: Preoperative mean value of motor conduction velocity (MCV) within the segment (above the elbowbelow the elbow) was 41.8+/-15.2 m/s and this result showed a decrease compared to the result of MCV in the below the elbow-wrist segment (57.8+/-6.9 m/s) with statistical significance (p<0.05). Postoperative mean values of MCV were improved in 6 of 7 patients from 39.8+/-12.1 m/s to 47.8+/-12.1 m/s (p<0.05). After an average follow-up of 4.8+/-5.3 months, 14 patients of 15 (93%) reported good or excellent clinical outcomes according to a modified Bishop scoring system. Five patients who had been treated using a small skin incision achieved good or excellent outcomes. There were no complications, recurrences, or subluxation of the ulnar nerve. CONCLUSION: Simple decompression of the ulnar nerve is an effective and successful minimally invasive technique for patients with cubital tunnel syndrome.