A rescue treatment to release the twist of a flow re-direction endoluminal device.

Background: A flow redirection endoluminal device (FRED) is a widely used flow diverter stent. Although high technical success and good treatment results were reported in the SAFE study, cases of technical failure of deployment have also been reported. A case in which a FRED was deployed with the proximal part twisted, but successful deployment was achieved, is presented. Case Description: A woman in her 40s was diagnosed with a left internal carotid artery aneurysm during radiological investigations for headaches. Due to her family's strong history of cerebral aneurysms, she opted for preventive treatment. A 5.5-mm FRED was selected because the proximal vessel diameter was ≥5 mm. However, the stent was deployed with the proximal side twisted. Fortunately, using a Scepter C and a CHIKAI 315 cm, the true lumen could be secure, the wire was guided distally, and the FRED was successfully placed. Later, with the patient's consent, a 3D blood vessel model was created, and whether the stent was difficult to open or whether it was just a technical problem which was verified experimentally. Precisely, the same situation as during the surgery was recreated, and the stent was deployed in the same way. Conclusion: A FRED is an effective device, but there are cases of difficult deployment. The present method may be an option if a FRED is difficult to open.

Hypertension as an Underlying Cause of Headache or Dizziness and the Usefulness of Choto-San for Both Diagnostic and Therapeutic Purposes.

Background Though headache, head discomfort, and dizziness are major complaints in neurosurgical outpatient departments in Japan, these nonspecific complaints are sometimes troublesome to treat, and most symptomatic treatments are not always sufficient to resolve patients' complaints. Objective This retrospective study was conducted to identify potential hypertension underlying symptoms relating to the head by prescribing choto-san, because patients with such symptoms were found to have relatively high blood pressure, and we realized that Kampo medicine was potentially effective for resolving the patients' conditions. Methods A total of 171 patients making their first visit to the neurosurgical outpatient division of our institution from January 2020 to June 2022 were investigated retrospectively. Symptoms were classified into three categories: headache, head discomfort, and dizziness. The effectiveness of choto-san, the rate of potential hypertension, and whether improvement in symptoms had a strong relationship with the prescription of choto-san were investigated. Results Choto-san significantly improved outcomes, with an odds ratio of 3.13 (95% confidence interval 1.83-5.35, p<0.001) for choto-san and 5.50 (95% confidence interval 1.24-24.4, p=0.025) for antihypertensives. The rate of choto-san prescription was significantly higher in patients who were diagnosed with hypertension (test of independence p<0.001). Choto-san was thought to be the most effective for the aforesaid symptoms with accompanying potential hypertension. Conclusion Hypertension was shown to be one of the main causes of various nonspecific complaints. Choto-san was an effective medicine not only for improving patients' subjective symptoms but also for identifying potential hypertension, which may lead to the prevention of cerebrovascular diseases.

Familiarization with lumboperitoneal shunt using some technical resources.

BACKGROUND: Although lumboperitoneal (LP) shunts are thought to be less invasive, they are used less frequently compared with ventriculoperitoneal shunts in the treatment of communicating hydrocephalus. This may be due to limitations such as troublesome patient positioning, difficulty in valve pressure confirmation and adjustment, and concerns regarding overdrainage. The aim of this study was to increase operator familiarization with the technical aspects of LP shunt procedures. METHODS: To reduce the abovementioned shortcomings, we developed a new device called SiphonGuard. Our method has the following technical advantages: avoidance of a halfway incision, valve placement between the dermis and subcutaneous fat in the patient's lumbar region near the puncture point, and minimal space requirement for valve placement. RESULTS: Two reversible complications were experienced, and there were no infectious complications. A relatively low rate of complications was achieved. Valve pressure detection on an anteroposterior view of a plain abdominal X-ray was possible in all patients with our method. CONCLUSIONS: Our method provides solutions to certain troublesome issues concerning LP shunt procedures; in practical terms, resolution of these issues may contribute to more widespread usage of LP shunt procedures by neurosurgeons. In this study, we demonstrate our familiarization procedure for LP shunt procedures.

Age-related urinary excretion of BK polyomavirus by nonimmunocompromised individuals.

Two polyomaviruses, BK virus (BKV) and JC virus (JCV), are ubiquitous in the human population, generally infecting children asymptomatically and then persisting in renal tissue. It is generally thought that reactivation leads to productive infection for both viruses, with progeny shed in the urine. Several studies have shown that the rate of JC viruria increases with the age of the host, but a systematic approach to examine the shedding of BKV has not been developed. To elucidate the relationship between BK viruria and host age, we obtained urine from donors (healthy volunteers or nonimmunocompromised patients) who were divided into nine age groups, each containing 50 members. A high-sensitivity PCR was used to detect BKV and JCV DNA from urinary samples, and the specificity of amplification was confirmed by sequencing or restriction analysis of the amplified fragments. The rate of BK viruria was relatively low in subjects aged <30 years but gradually increased with age in subjects aged > or =30 years. However, BK viruria was less frequent than JC viruria in adults. The detected BKV isolates were classified into subtypes, and detection rates for individual subtypes were compared among age groups; this analysis showed that viruria of subtypes I (the most prevalent subtype) and IV (the second most prevalent subtype) occurred more frequently in older subjects. Therefore, our results reveal new aspects of BK viruria in nonimmunocompromised individuals.