Ceramic Aneurysm Clip with Titanium Spring.

OBJECTIVE: To design and evaluate ceramic aneurysm clips with integrated titanium springs, focusing on ergonomic application and precision in neurosurgical procedures. METHODS: The clip design was executed with precision using Creo Parametric 3D CAD software. It comprises a zirconia body and a titanium spring for durability and consistent tension and features a four-coil hairpin titanium spring for enhanced closing force and a ball-type head for versatile maneuverability during surgery. To assess durability, closing forces were rigorously measured using a force gauge system, comparing the ceramic clip with the standard Mizuho permanent clip over 30 open-close cycles. For MR artifact assessment, both ceramic and Yasargil clips were evaluated using a 3 Tesla magnetic resonance imaging (MRI) scanner with specific imaging sequences. RESULTS: The straight type ceramic clip's initial closing force was 1.70 N, dropping to 1.22 N after 30 cycles, indicating a retention of 72% of its initial force. In MRI, the ceramic clip displayed significantly lower measurement discrepancies compared to the titanium alloy Yasargil clip, particularly in high resolution T1 weighted images. The lowest variance was at measurement point L2, where the ceramic clip showed 3% discrepancy. Further, the ceramic clip yielded clearer images than the titanium alloy clip, particularly at the clip's end. CONCLUSIONS: Ceramic clips with titanium springs demonstrated satisfactory closing force and superior MRI compatibility, promising enhancements in surgical application and postoperative assessment.

Multiple telescopic stenting versus single flow diverter for the treatment of vertebral artery dissecting aneurysm.

Objective: Reconstruction methods, including stent-assisted coiling, multiple telescopic stents, and flow diverters, are preferred modalities for the treatment of unruptured vertebral artery dissecting aneurysms (VADAs). We aimed to compare the clinical outcomes between two reconstructive flow diversion techniques: single flow diverter (FD) device and multiple telescopic stenting (TS). Methods: We retrospectively reviewed the clinical data of 39 patients with unruptured VADAs. Of these, 17 patients were treated with multiple TS and 22 with a single FD device. Aneurysm characteristics and clinical outcomes were compared between the two groups. Results: All aneurysms included in this study successfully achieved flow diversion, regardless of the treatment modality and duration. However, the mean procedure duration to complete the diversion was shorter in the FD group. Subgroup analysis in TS group showed that there were no significant clinical differences between the low-profile visualized intraluminal support and Enterprise stents, except for the mean procedure duration. Conclusions: Both the single FD and multiple TS methods showed excellent angiographic and clinical outcomes in the treatment of unruptured VADAs. However, single FD required a shorter procedure duration and was associated with faster achievement of complete flow diversion.

Anterior Choroidal Artery Aneurysm Clipping: Angiographic Diagnostics and Surgical Tactics Focused on Visualizing the Anterior Choroidal Artery Behind the Aneurysm.

OBJECTIVE: This study describes our experiences with anterior choroidal artery (AChA) aneurysm clipping with a focus on visualizing the AChA just behind the aneurysm to identify the risk factors for adhesion of the AChA or its branches to the posterior wall of the AChA aneurysm. METHODS: The initial segment of the AChA just behind the aneurysm was evaluated preoperatively using three-dimensional (3D) rotational angiography, and its course was designated as posteromedial, posterior, or posterolateral. The posterior aspect of the AChA aneurysm was inspected intraoperatively using an endoscope or micromirror. RESULTS: Based on 3D rotational angiography, the main trunk of the AChA showed a posteromedial (n = 47, 57.3%), posterior (n = 18, 22.0%), or posterolateral (n = 17, 20.7%) course just behind the aneurysm. Intraoperatively, 14.6% (12 of 82) of the clipped AChA aneurysms revealed an AChA branch adhered to the posterior wall of the aneurysm. A multivariate analysis revealed that the posterior or posterolateral course of the initial segment of the AChA was a statistically significant risk factor for adhesion of an AChA branch to the posterior wall of the aneurysm (odds ratio [OR] 21.083, 95% confidence interval [CI] 2.567-173.166, P = 0.005). CONCLUSIONS: The initial course of the AChA just behind an AChA aneurysm can be evaluated using 3D rotational angiography. In contrast to a posteromedial course, a posterior or posterolateral course of the AChA just behind an AChA aneurysm can be a significant risk factor for adhesion of an AChA branch to the posterior wall of an AChA aneurysm.

Successive Development and Rupture of Blister-Like Anterior Communicating Artery Aneurysms at Mirror Locations.

This is the first report of the successive development and rupture of blister-like anterior communicating artery (ACoA) aneurysms at mirror locations with a short interval. A 49-year-old man presented with an angiogram-negative subarachnoid hemorrhage with significant basal frontal interhemispheric blood. Surgical exploration revealed a blister-like aneurysm on the left side of the superior wall of the ACoA, which was treated using a microsuturing technique. On the 18th day after the initial subarachnoid hemorrhage, the second operation due to another angiogram-negative hemorrhage revealed a de novo blister-like aneurysm with a small blood clot on the posterosuperior wall of the ACoA close to the right A1/A2 junction. The rupture point and ACoA on the right side were occluded using an aneurysm clip. Follow-up digital subtraction angiogram (DSA) at 4 years and computed tomography angiogram (CTA) at 14 years after the surgery showed no recurrence or associated abnormality.

Characteristics of Hirayama Disease in Young South Korean Soldiers.

BACKGROUND AND PURPOSE: The purpose of this study was to describe the clinical presentation and features in electrodiagnostic and imaging investigations of young South Korean males diagnosed with Hirayama disease (HD). METHODS: We reviewed the electronic medical records of South Korean enlisted soldiers who were diagnosed with HD and discharged from military service during 2011-2021. We investigated the clinical characteristics and results of electrodiagnostic and magnetic resonance imaging (MRI) investigations. We analyzed laterality and identified the involved muscles using needle electromyography (EMG). Loss of lordosis, localized cervical cord atrophy, loss of attachment between the posterior dura and subjacent lamina, asymmetric flattening of the cord, crescent-shaped mass in the posterior epidural space, and noncompressive intramedullary T2-weighted high signal intensity were investigated using neutral- or flexion-position MRI. RESULTS: Forty-two male patients aged 20.2±0.8 years (mean±standard deviation) were identified. All patients complained of hand weakness, and 10 complained of hand tremor (23.8%). Four patients (9.5%) had symptoms in both upper limbs, and five (11.9%) had sensory disturbances. Needle EMG revealed that muscles in the C7-T1 myotome were commonly involved, and C5-C6 involvement of the deltoid (10.5%) and biceps brachii (12.5%) was also observed. In cervical MRI, localized cord atrophy (90.0%) was the most characteristic finding, and cord atrophy was most severe at the C5-C6 level (58.3%). CONCLUSIONS: This is the first description of a large number of patients with HD in South Korea. The clinical presentation and features found in electrodiagnostic and imaging investigations will improve the understanding of HD in the young South Korean male population.

Prevalence of Neuromuscular Diseases in Young South Korean Males; A Korean Military Manpower Administration and Medical Command Data-Based Study.

BACKGROUND AND PURPOSE: All young males in South Korea must undergo a physical examination for their participation in military service. We aimed to determine the prevalence rate (PR) of various neuromuscular diseases in young South Korean males using the data of exempted patients and soldiers. METHODS: The number of males exempted based on specific items of physical examination corresponding to neuromuscular disease during 2011-2020 were obtained from the records of the Military Manpower Administration. The list of enlisted soldier patients who were discharged from military service due to neuromuscular diseases during 2011-2020 was obtained from the Armed Forces Medical Command, and their medical records were reviewed. RESULTS: The PR of neuromuscular diseases was calculated among 948 identified males: 713 exempted males and 235 soldiers. The PRs of overall hereditary neuropathies, Hirayama disease (HD), myasthenia gravis (MG), and inherited muscle diseases in South Korean males in their early 20s were 8.34 (95% confidence interval [CI], 7.39-9.30), 5.54 (95% CI, 4.76-6.32), 2.97 (95% CI, 2.40-3.55), and 10.38 (95% CI, 9.31-11.46) per 100,000 persons, respectively. Among the enlisted soldiers, hereditary neuropathy with liability to pressure palsy was the most common neuromuscular disease, with a prevalence among the enlisted soldiers of 3.11 (95% CI, 2.42-3.80) per 100,000 persons. Myotonic dystrophy was the most prevalent myopathy, followed by facioscapulohumeral muscular dystrophy. CONCLUSIONS: The 10-year PRs of hereditary polyneuropathies, HD, MG, and inherited muscle diseases in young South Korean males have been reported. These data could be valuable to understanding each neuromuscular disease in the young male population of South Korea.

Acceptable durability of split inner table graft for the reconstruction of a bone defect in pterional craniotomies: a case series.

Objective: During a pterional craniotomy, the bone defect was reconstructed by a surgical technique using an autogenous bone graft instead of commercially available alloplastic materials. The technical feasibility, durability of the grafted bone, and cosmetic outcome were all evaluated. Methods: After a pterional craniotomy was performed, the bone defect at the frontobasal burr hole and drilled sphenoid wing was reconstructed using an autogenous split inner table graft (1 cm × 2 cm) harvested from the craniotomy bone flap. Results: The bone reconstruction technique was successfully performed on nine patients with intracranial aneurysms. After 12-19 months from the surgery, a volumetry study using three-dimensional skull images reconstructed from computed tomography angiography showed a minimal decrease in the area of the split inner table graft due to bone resorption in six patients, which ranged from 5.7% to 14.8%. In the other three patients, the bone resorption was more substantial, ranging from 21.2% to 27.5%. However, in the three latter cases, the resorption was mainly limited to the posterior part of the split inner table graft covered by the temporalis muscle and did not affect the cosmetic outcomes. The resultant cosmetic outcomes for the nine patients were all favorable, with only a slight or no anterior temporal hollow. Conclusion: The proposed surgical technique using a split inner table graft harvested from the craniotomy bone flap seems viable for reconstructing the bone defect at the frontobasal burr hole and drilled sphenoid wing after a pterional craniotomy.

Infundibular Widening of Angiographically Invisible Duplicate Anterior Choroidal Artery Mimicking Typical Anterior Choroidal Artery Aneurysm.

A diagnosis of an intracranial aneurysm depends on the angiographic configuration and should be cautiously differentiated from aneurysm mimics. In cases of duplicate anterior choroidal arteries (AChAs), infundibular widening of the distal minor AChA can be an aneurysm mimic. If the minor AChA with a smaller diameter is obscured angiographically due to poor contrast filling, an associated infundibular widening beside the proximal large AChA can misinterpreted as a typical AChA aneurysm in angiograms. The authors report on two such cases of duplicate AChAs with infundibular widening presenting like a typical AChA aneurysm in angiograms. Surgical exploration revealed a perforating artery emitting from the dome of the saccular lesion, confirming infundibular widening of a duplicate AChA. No reparative procedure was applied to the infundibular widening in a 48-year-old man, while two vascular outpouchings from the infundibular widening were clipped preserving the duplicate AChA in a 55-year-old woman.

Frictional force analysis of stent retriever devices using a realistic vascular model: Pilot study.

Objective: To date, no vascular model to analyze frictional forces between stent retriever devices and vessel walls has been designed to be similar to the real human vasculature. We developed a novel in vitro intracranial cerebrovascular model and analyzed frictional forces of three stent retriever devices. Methods: A vascular mold was created based on digital subtraction angiography of a patient's cerebral vessels. The vascular model was constructed using polydimethylsiloxane (PDMS, Dow Corning, Inc.) as a silicone elastomer. The vascular model was coated on its inner surface with a lubricating layer to create a low coefficient of friction (~0.037) to closely approximate the intima. A pulsatile blood pump was used to produce blood flow inside the model to approximate real vascular conditions. The frictional forces of Trevo XP, Solitaire 2, and Eric 4 were analyzed for initial and maximal friction retrieval forces using this vascular model. The total pulling energy generated during the 3 cm movement was also obtained. Results: Results for initial retrieval force were as follows: Trevo, 0.09 ± 0.04 N; Solitaire, 0.25 ± 0.07 N; and Eric, 0.33 ± 0.21 N. Results for maximal retrieval force were as follows: Trevo, 0.36 ± 0.07 N; Solitaire, 0.54 ± 0.06 N; and Eric, 0.80 ± 0.13 N. Total pulling energy (N·cm) was 0.40 ± 0.10 in Trevo, 0.65 ± 0.10 in Solitaire, and 0.87 ± 0.14 in Eric, respectively. Conclusions: Using a realistic vascular model, different stent retriever devices were shown to have statistically different frictional forces. Future studies using a realistic vascular model are warranted to assess SRT devices.

True Posterior Communicating Artery Aneurysms with High Risk of Rupture despite Very Small Diameter.

OBJECTIVE: This retrospective study investigated the clinical and angiographic characteristics of ruptured true posterior communicating artery (PCoA) aneurysms in comparison with junctional PCoA aneurysms presenting with a subarachnoid hemorrhage. METHODS: The medical records and radiological data of 93 consecutive patients who underwent three-dimensional rotational angiography and surgical or endovascular treatment for a ruptured junctional or true PCoA aneurysm over an 8-year period were examined. RESULTS: The maximum diameter of the ruptured true PCoA aneurysm (n=13, 14.0%) was significantly smaller than that of the ruptured junctional PCoA aneurysms (n=80, 4.45±1.44 vs. 7.68±3.36 mm, p=0.001). In particular, the incidence of very small aneurysms <4 mm was 46.2% (six of 13 patients) in the ruptured true PCoA aneurysm group, yet only 2.5% (two of 80 patients) in the ruptured junctional PCoA aneurysm group. Meanwhile, the diameter of the PCoA was significantly larger in the true PCoA aneurysm group than that in the junctional PCoA aneurysm group (1.90±0.57 vs. 1.15±0.49 mm, p<0.001). In addition, the ipsilateral PCoA/P1 ratio was significantly larger in the true PCoA aneurysm group than that in the group of a junctional PCoA aneurysm (mean PCoA/P1 ratio±standard deviation, 2.67±1.22 vs. 1.14±0.88; p<0.001). No between-group difference was identified for the modified Fisher grade, clinical grade at admission, and 3-month modified Rankin Scale score. CONCLUSION: A true PCoA aneurysm was found to be associated with a larger PCoA and ruptured at a smaller diameter than a junctional PCoA aneurysm. In particular, the incidence of a ruptured aneurysm with a very small diameter <4 mm was significantly higher among the patients with a true PCoA aneurysm.

Hydroprinting Technology to Transfer Ultrathin, Transparent, and Double-Sided Conductive Nanomembranes for Multiscale 3D Conformal Electronics.

Transparent multiscale 3D conformal electronics using hydroprinting with polyvinyl alcohol (PVA) as a sacrificial layer to transfer networks of silver nanowires (AgNWs) without a carrier layer is developed. However, AgNWs are known to disperse on water surfaces during the transfer process. Therefore, a functional film is developed by simultaneously welding and embedding AgNWs in the PVA through a simple one-step thermal pressing, demonstrating that ultrathin, transparent, and double-sided conductive/patterned nanomembranes with welded AgNWs can float on water without dispersion. The nanomembrane with an excellent figure of merit of 1200, a low sheet resistance of 16.2 Ω sq-1 , and a high transmittance of 98.17% achieves conformal contact with excellent step surface coverage of complex macro- and microstructures because of its nanoscale thickness (54.39 nm) and numerous deformable micro- and nanopores. Furthermore, the double-sided conductive nanomembranes facilitate wiring and layer-by-layer assembly, regardless of the transfer direction of the surface. As a proof-of-concept demonstration, a nanomembrane-based aneurysm sensor is developed. Its high transparency enables coil embolization, and the sensor can measure the pushing force of the coil within an aneurysm in an endovascular simulator. Moreover, this newly developed hydroprinting technology provides a new method for the fabrication of transparent multiscale 3D conformal electronics.

Retrospective 6 month-outcomes and prognostic factors following spontaneous angiogram-negative non-perimesencephalic subarachnoid hemorrhage.

Our objective was to analyze functional outcomes and prognostic factors in patients suffering from angiogram-negative non-perimesencephalic subarachnoid hemorrhage (non-PMH). In total, 1601 patients presenting with spontaneous SAH between January 2009 to December 2019 admitted to our institution were reviewed. Among them, 51 patients with angiogram negative non-perimesencephalic subarachnoid hemorrhage were analyzed. We divided patients into groups according to hemorrhage pattern and duration. Prognostic factors were assessed according to initial neurologic grade, early hydrocephalus, fisher grade, and duration of hemorrhage. Outcomes were assessed according to the modified Rankin Scale after 6 months. Overall, 41 patients (80.3%) with angiogram-negative non-PMH achieved a favorable outcome. In univariate analysis, good initial neurologic grade, absence of early hydrocephalus, non-Fisher-type 3 bleeding pattern, and short term hemorrhage (blood wash out <7 days after onset) duration were significantly associated with a favorable outcome. In multivariate analysis, a non-Fisher-type 3 hemorrhagic pattern (p < 0.05) and good initial neurologic state (p < 0.01) were independent predictors of favorable outcomes in angiogram-negative non-PMH patients. Patients with angiogram-negative non-PMH generally had favorable outcomes. A non-Fisher-type 3 hemorrhagic pattern and good initial neurologic state were prognostic factors of a favorable outcome in non-PMH. Furthermore, patients with long-term SAH were more likely to develop hydrocephalus. Evaluating the pattern and duration of subarachnoid hemorrhage may allow better prediction of outcomes in patients with angiogram negative and non-PMH.

Cerebral Vasospasm with Delayed Ischemic Neurologic Deficit after Unruptured Aneurysm Surgery : Report of Two Cases and Review of the Literature.

Symptomatic cerebral vasospasm (CVS) and delayed ischemic neurologic deficit (DIND) after unruptured aneurysm surgery are extremely rare. Its onset timing is variable, and its mechanisms are unclear. We report two cases of CVS with DIND after unruptured aneurysm surgery and review the literature regarding potential mechanisms. The first case is a 51-year-old woman with non-hemorrhagic vasospasm after unruptured left anterior communicating artery aneurysm surgery. She presented with delayed vasospasm on postoperative day 14. The second case is a 45-year-old woman who suffered from oculomotor nerve palsy caused by an unruptured posterior communicatig artery (PCoA) aneurysm. DIND with non-hemorrhagic vasospasm developed on postoperative day 12. To our knowledge, this is the first report of symptomatic CVS with oculomotor nerve palsy following unruptured PCoA aneurysm surgery. CVS with DIND after unruptured aneurysm surgery is very rare and can be triggered by multiple mechanisms, such as hemorrhage, mechanical stress to the arterial wall, or the trigemino-cerebrovascular system. For unruptured aneurysm surgery, although it is rare, careful observation and treatments can be needed for postoperative CVS with DIND.

Quantitative gait analysis of idiopathic normal pressure hydrocephalus using deep learning algorithms on monocular videos.

A vision-based gait analysis method using monocular videos was proposed to estimate temporo-spatial gait parameters by leveraging deep learning algorithms. This study aimed to validate vision-based gait analysis using GAITRite as the reference system and analyze relationships between Frontal Assessment Battery (FAB) scores and gait variability measured by vision-based gait analysis in idiopathic normal pressure hydrocephalus (INPH) patients. Gait data from 46 patients were simultaneously collected from the vision-based system utilizing deep learning algorithms and the GAITRite system. There was a strong correlation in 11 gait parameters between our vision-based gait analysis method and the GAITRite gait analysis system. Our results also demonstrated excellent agreement between the two measurement systems for all parameters except stride time variability after the cerebrospinal fluid tap test. Our data showed that stride time and stride length variability measured by the vision-based gait analysis system were correlated with FAB scores. Vision-based gait analysis utilizing deep learning algorithms can provide comparable data to GAITRite when assessing gait dysfunction in INPH. Frontal lobe functions may be associated with gait variability measurements using vision-based gait analysis for INPH patients.

Postoperative Clipping Status after a Pterional versus Interhemispheric Approach for High-Positioned Anterior Communicating Artery Aneurysms.

OBJECTIVE: When treating high-positioned anterior communicating artery (ACoA) aneurysms, pterional-transsylvian and interhemispheric approaches are both viable options, yet comparative studies of these two surgical approaches are rare. Accordingly, this retrospective study investigated the surgical results of both approaches. METHODS: Twenty-four patients underwent a pterional approach (n=11) or interhemispheric approach (n=13), including a unilateral low anterior interhemispheric approach or bifrontal interhemispheric approach, for high-positioned ACoA aneurysms with an aneurysm dome height >15 mm and aneurysm neck height >10 mm both measured from the level of the anterior clinoid process. The clinical and radiological data were reviewed to investigate the surgical results and risk factors of incomplete clipping. RESULTS: The pterional patient group showed a significantly higher incidence of incomplete clipping than the interhemispheric patient group (p=0.031). Four patients (36.4%) who underwent a pterional approach showed a postclipping aneurysm remnant, whereas all the patients who experienced an interhemispheric approach showed complete clipping. In one case, the aneurysm remnant was obliterated by coiling, while follow-up of the other three cases showed the remnants remained limited to the aneurysm base. A multivariate analysis revealed that a pterional approach for a large aneurysm with a diameter >8 mm presented a statistically significant risk factor for incomplete clipping. CONCLUSION: For high-positioned ACoA aneurysms with a dome height >15 mm and neck height >10 mm above the level of the anterior clinoid process, a large aneurysm with a diameter >8 mm can be clipped more completely via an interhemispheric approach than via a pterional approach.

Advantage of Balloon Guide Catheter During Endovascular Treatment of Direct Carotid-Cavernous Sinus Fistula: Technical Note and Report of 2 Cases.

BACKGROUND: As previous studies reported, the balloon guide catheter is useful for identifying the fistula point during diagnosis of direct carotid-cavernous sinus fistula (d-CCF). We demonstrate an additional advantage of the balloon guide catheter during intraarterial endovascular treatment of d-CCF. METHODS: Two cases of d-CCF are presented in this report. A balloon guide catheter is used to help achieve successful coil embolization of the fistula in both cases. RESULTS: Microcatheter positioning into the fistulous point can be easier after balloon inflation. Balloon inflation can help with coil deployment. CONCLUSIONS: Using a balloon guiding catheter can reduce internal carotid artery flow near the fistula point at the cavernous segment of the internal carotid artery. As a result, better identification of the fistula point can be made, which allows easier placement of the microcatheter into the fistula point and more stable coil deployment.

Discrepancy between MRA and DSA in identifying the shape of small intracranial aneurysms.

OBJECTIVE: The authors evaluated the sensitivity and accuracy of MRA in identifying the shape of small-sized unruptured intracranial aneurysms. METHODS: Small (< 7 mm) unruptured intracranial aneurysms initially detected by MRA and confirmed by DSA between January 2017 and December 2018 were morphologically reviewed by neuroradiologists. Regularity or irregularity of aneurysm shape was analyzed by two independent reviewers using MRA without DSA results. DSA findings served as the reference standard for aneurysm shape. Irregular shape, which in small aneurysms is associated with a higher likelihood of rupture, was defined as positive, and MRA sensitivity, specificity, and accuracy were determined by using evaluations based on location, size, and MRA magnetic strength (1.5T vs 3T MRA). Multivariate analysis was performed to determine risk factors for false-negative MRA results for irregularly shaped aneurysms. RESULTS: In total, 652 unruptured intracranial aneurysms in 530 patients were reviewed for this study. For detecting aneurysm shape irregularity, the overall MRA sensitivity was 60.4% for reviewer 1 and 60.9% for reviewer 2. Anterior cerebral artery aneurysms had the lowest sensitivity for location (36.7% for reviewer 1, 46.9% for reviewer 2); aneurysms sized < 3 mm had the lowest sensitivity for size (26.7% for both reviewers); and 1.5T MRA had lower sensitivity and accuracy than 3T MRA. In multivariate analysis, location, size, and magnetic strength of MRA were independent risk factors for false-negative MRA results for irregularly shaped aneurysms. CONCLUSIONS: MRA had a low sensitivity for detecting the irregular shape of small intracranial aneurysms. In particular, anterior cerebral artery location, aneurysm size < 3 mm, and detection with 1.5T MRA were associated with a higher risk of irregularly shaped aneurysms being misjudged as regular.

Prediction of Motor Recovery in Patients with Basal Ganglia Hemorrhage Using Diffusion Tensor Imaging.

Predicting prognosis in patients with basal ganglia hemorrhage is difficult. This study aimed to investigate the usefulness of diffusion tensor imaging in predicting motor outcome after basal ganglia hemorrhage. A total of 12 patients with putaminal hemorrhage were included in the study (aged 50 ± 12 years), 8 patients were male (aged 46 ± 11 years) and 4 were female (aged 59 ± 9 years). We performed diffusion tensor imaging and measured clinical outcome at baseline (pre) and 3 weeks (post1), 3 months (post2), and 6 months (post3) after the initial treatment. In the affected side of the brain, the mean fractional anisotropy (FA) value on pons was significantly higher in the good outcome group than that in the poor outcome group at pre (p = 0.004) and post3 (p = 0.025). Pearson correlation analysis showed that mean FA value at pre significantly correlated with the sum of the Brunnstrom motor recovery stage scores at post3 (R = 0.8, p = 0.002). Change in the FA ratio on diffusion tractography can predict motor recovery after hemorrhagic stroke.

Supraorbital Keyhole Approach for Intracranial Aneurysms : Transitioning from Concerns to Confidence.

For surgical minimalism to reduce iatrogenic traumatization, a supraorbital keyhole approach has already been successfully applied to treat many unruptured anterior circulation aneurysms. However, using this minimal approach also raises several technical concerns due to the small cranial opening and cosmetic impact of a facial incision. Yet, such technical limitations can be overcome by using favorable surgical indications, slender surgical instruments, and optimized surgical techniques, while excellent cosmetic outcomes can be achieved using a short skin incision located <1 cm from the supraorbital margin, reconstruction of any bone defects around the bone flap, and meticulous wound closure. Thus, given such reassuring surgical results, in terms of the clipping status, neurological effects, and cosmetic outcomes, any concerns can be transitioned into confidence.