Coil embolization of very small (2 mm or smaller) berry aneurysms: feasibility and technical issues.

BACKGROUND AND PURPOSE: The very small size of cerebral aneurysms is considered to be one of the limitations for endovascular treatment, with a high risk for intraoperative rupture. We report on treatment of very small saccular ruptured cerebral aneurysms by coil embolization. All the cases were of 2-mm aneurysms with at least 1 of the dimensions being less than 2 mm. MATERIALS AND METHODS: We performed retrospective analysis of 7 consecutive cases of very small aneurysms treated by coil embolization in our institution between July 2006 and April 2008. RESULTS: 3D rotational angiography (3DRA) was found to be most accurate in the detection of these aneurysms; in 2 cases, 3DRA revealed the aneurysms after results on digital subtraction angiography (DSA) were considered to be negative. Coil embolization was successfully performed in 6 cases, whereas in 1 case, spontaneous thrombosis occurred after microcatheter placement. Complete (n = 5) or near complete (n = 2) immediate occlusion was seen. A single soft coil was used in all cases with the shortest available length. Balloon assistance was used in 3 cases. Although minimal coil projection in the parent vessel was seen in 3 cases, no untoward clinical complication was seen. Follow-up DSA and MR angiography in 4 patients demonstrated persistent occlusion (n = 3) or progressive thrombosis (n = 1) of the aneurysms. All of the patients with available follow-up are independent in day-to-day activities with a modified Rankin Score (mRS) of 0 or 1. CONCLUSIONS: Coil embolization of very small ruptured cerebral aneurysms is feasible. Careful consideration of the technical issues in treatment of these cases is essential to achieve technical success while avoiding complications.

Use of CT angiography for anatomic localization of arteriovenous malformation Nidal components.

We report a case of diffuse arteriovenous malformation (AVM) in basal ganglia and an internal capsule associated with venous aneurysms. The patient was treated by embolization guided by CT angiography to target the basal ganglionic portion of the AVM while sparing the internal capsule. Our case demonstrates that it is possible to obtain good quality intranidal angiograms by using CT angiography, which can be useful for exact localization of the catheterized part of the nidus.

Cytidine-5-diphosphocholine supplement in early life induces stable increase in dendritic complexity of neurons in the somatosensory cortex of adult rats.

Cytidine-5-diphosphocholine (CDP-choline or citicholine) is an essential molecule that is required for biosynthesis of cell membranes. In adult humans it is used as a memory-enhancing drug for treatment of age-related dementia and cerebrovascular conditions. However the effect of CDP-choline on perinatal brain is not known. We administered CDP-choline to Long Evans rats each day from conception (maternal ingestion) to postnatal day 60 (P60). Pyramidal neurons from supragranular layers 2/3, granular layer 4 and infragranular layer 5 of somatosensory cortex were examined with Golgi-Cox staining at P240. CDP-choline treatment significantly increased length and branch points of apical and basal dendrites. Sholl analysis shows that the complexity of apical and basal dendrites of neurons is maximal in layers 2/3 and layer 5. In layer 4 significant increases were seen in basilar dendritic arborization. CDP-choline did not increase the number of primary basal dendrites on neurons in the somatosensory cortex. Primary cultures from somatosensory cortex were treated with CDP-choline to test its effect on neuronal survival. CDP-choline treatment neither enhanced the survival of neurons in culture nor increased the number of neurites. However significant increases in neurite length, branch points and total area occupied by the neurons were observed. We conclude that exogenous supplementation of CDP-choline during development causes stable changes in neuronal morphology. Significant increase in dendritic growth and branching of pyramidal neurons from the somatosensory cortex resulted in enlarging the surface area occupied by the neurons which we speculate will augment processing of sensory information.

Acute pancreatitis: a lesser-known complication of aluminum phosphide poisoning.

There have been no case reports on aluminum phosphide-induced pancreatitis in the literature available. In this report, we present the case of a young man who developed acute pancreatitis and probably acute myocarditis following ingestion of aluminum phosphide pellets in the absence of the usual risk factors and after exclusion of other possible causes of pancreatitis. In the absence of re-challenge, we put forth the probable causative association of pancreatitis with aluminum phosphide or phosphine gas, its active pesticidal component.

Scalp malignant peripheral nerve sheath tumor (MPNST) with bony involvement and new bone formation: case report.

Malignant peripheral nerve sheath tumors (MPNSTs) are rare neoplasms, usually arising from somatic soft tissues or peripheral nerves. Primary MPNST of the scalp is extremely rare, with only a single case reported so far. Here, we describe an unusual case of scalp MPNST in a 50-year-old male. The tumor was associated with bony projection, intracranial extension and underlying bone destruction. The tumor was treated with complete surgical excision followed by adjuvant radiotherapy. Histologically, the tumor showed malignant spindle cells with focal S-100 positivity on immunohistochemistry and a diagnosis of MPNST was made. This case is being reported for its rarity and presence of associated bony projection, which to the best of our knowledge, has not been described before in soft tissue sarcomas.