Endovascular Treatment of Cavernous Sinus Dural Arteriovenous Fistulas via Direct Transorbital Puncture Using Cone-Beam Computed Tomography Image Guidance: Report of 3 Cases.

BACKGROUND: Certain cavernous sinus (CS) dural arteriovenous fistulas (DAVFs) are difficult to access through transarterial or transvenous routes and may necessitate access through direct transorbital puncture of the superior ophthalmic vein (SOV) or the CS. However, to be successful, the accurate design of the puncture route and guidance are crucial. This study aimed to report our preliminary clinical experience using cone-beam computed tomography (CT) with real-time fluoroscopic overlays for image guidance during transorbital needle puncture. METHODS: Between December 2017 and July 2018, 3 patients with CS DAVFs were treated via a transorbital puncture to establish access to the CS under the guidance of XperGuide planning software either via direct CS puncture or through the SOV. The guidance trajectory was superimposed onto the real-time fluoroscopic image during needle puncture. Once access was established, the CS DAVFs were treated with a combination of liquid embolic materials and coils. RESULTS: Image guidance aided to avoid at-risk structures and treatment resulted in all cases in complete obliteration of the CS DAVFs as verified by control angiography without peri- or postprocedural complications. CONCLUSIONS: Endovascular embolization of CS DAVFs via direct transorbital puncture aided by image guidance provided an alternative option when more conventional approaches are deemed not possible.

Giant Serpentine Aneurysm of the Middle Cerebral Artery.

BACKGROUND: Giant serpentine aneurysms (GSAs) are a subgroup of giant intracranial aneurysms, distinct from saccular and fusiform varieties, that are defined as partially thrombosed giant aneurysms with tortuous internal vascular channel. Clinicopathologic characteristics of middle cerebral artery GSAs have been rarely reported in the literature, with discussion of radiologic characteristics only. We clarify patient clinical and neuroradiologic features and discuss the mechanism of formation and progression. CASE DESCRIPTION: A 43-year-old woman presented with a GSA arising from the middle cerebral artery. There was a separate inflow and outflow channel of the aneurysm, with the outflow channel feeding the distal branches of the parent artery and supplying normal brain parenchyma. The GSA was treated successfully by aneurysmectomy and superficial temporal artery-middle cerebral artery bypass followed by proximal occlusion and vascular reconstruction. An aneurysm specimen was examined to correlate pathologic findings and morphologic characteristics. RESULT: Pathologic results showed that thickness of the aneurysmal wall was typically increased and varied, and no internal elastic lamina or endothelial lining could be identified. The sac contained thrombi of various ages with recanalizing vessel formation and chronic inflammation infiltration. Intimal hyperplasia and neoangiogenesis in the wall and hyaline degeneration of the media were observed. Vessels coursing in their adventitia showed mucoid changes, which are responsible for the contrast enhancement of the aneurysmal rim on computed tomography scan. CONCLUSIONS: GSAs are a specific pathologic entity with unique morphologic and pathologic characteristics that can affect intracranial blood vessels. The pathogenic mechanisms are unclear; this report suggests that GSAs may be associated with degeneration of the vascular wall.

SBA-15 mesoporous silica coated with macrocyclic calix[4]arene derivatives: solid extraction phases for heavy transition metal ions.

A layer of macrocyclic calix[4]arene derivatives has been grafted on the internal surface of the mesochannels of the ordered mesoporous SBA-15 to develop highly efficient trap for heavy transition metal (HTM) ions. To ensure the successful anchoring of calix[4]arene derivatives on the surface of SBA-15, two different types of calix[4]arene derivatives, one with one trimethoxysilane functional group and another with two trimethoxysilane functional groups have been explored. XRD, N(2) adsorption and TEM results provide strong evidence that the mesoporous structure of the supporting materials retain their long range ordering throughout the grafting process. Solid-state NMR, TG and FT-IR spectroscopy indicate that both types of calix[4]arene derivatives can be well-anchored on the surface of the wall of SBA-15. Calix[4]arene derivative with only one trimethoxysilane functional group showed high grafting efficiency compared to that with two trimethoxysilane functional groups due to the intramolecular and intermolecular polycondensation between two trimethoxysilane functional groups. The HTM ions extraction capacity in aqueous solution of macrocycle functionalized SBA-15 nanohybrides for a series of HTM ions has been studied. The obtained materials demonstrated very high HTM ions extraction capacity up to 96% for Pb(2+) in aqueous solution.

Fl-DFO molecules@mesoporous silica materials: highly sensitive and selective nanosensor for dosing with iron ions.

Highly sensitive and selective nanosensor for labile iron pool (LIP) determination, has been designed and prepared by immobilization of Fluoresceine-Desferrioxamine (Fl-DFO), a bifunctional fluoro-siderophore probe molecule with great affinity for iron ions (pKf=30.7), into highly ordered mesoporous silica structure. Different immobilization methods of Fl-DFO molecules, such as their encapsulation in surfactant micelles used as templating agents for the synthesis of mesoporous silica, direct impregnation into the mesochannels of as-synthesized mesoporous silica and their surface anchoring by covalent binding with propylamine groups implanted by post-synthesis on the internal surface of mesochannels, have been explored. Each nanohybrid has been fully characterized by small angle XRD, TEM, SEM, solid state (29)Si and (13)C MAS NMR and N(2) adsorption-desorption. The fluorescence properties of nanohybrids obtained have been correlated with the immobilization methods, generating interesting information concerning the localization of Fl-DFO molecules in the channels of mesoporous silica. The leaching of Fl-DFO molecules from mesoporous materials has been investigated. The nanosensor prepared by surface anchoring of Fl-DFO at the internal surface of mesochannels showed high performances with no leaching effect and high sensitivity in regards to its responses to ferric ions. Its fluorescence intensity decreased as soon as first Fe(III) ions are in contact with this nanosensor. A linear relationship between the fluorescence intensity and the ferric ions concentration was observed in low micromolar range. The selectivity of this nanosensor towards other metal ions has also been tested and shown its high affinity to ferric ions. This study can allow the design of a stable, portable, simple, regenerable and cost-effective nanosensor highly sensitive and selective for iron ions with detection limits in the range of cellular LIP in cells, e.g. lower micromolar range.