Postcoiling syndrome including headache and fever after endovascular cerebral aneurysmal coil embolization: A narrative review.

Endovascular cerebral aneurysmal coil embolization is becoming more popular than direct aneurysmal neck clipping due to its noninferiority in long-term outcomes and being less invasive. Neuroradiologists often find postoperative symptoms such as headache and fever after unruptured aneurysmal coil embolization, however, they have not paid much attention because symptoms almost always resolve spontaneously within a few days. Since the concept of this syndrome has not been standardized, we named it postcoiling syndrome (PCS). In this short review, we reviewed the criteria, risk factors, mechanisms, significance, and treatment of PCS based on a few pieces of literature. Almost all literature has regarded that some kind of bioactive reaction might be involved in PCS. Preliminary data showed the possibility of inhibition of PCS by histamine-2 receptor antagonists. PCS also might have the potential of more predictive maker than previously reported risk factors for recurrence after aneurysm coil embolization. Further investigation is needed in the future, including the accumulation of cases, unification of concepts, and mid-to-long-term follow-up.

[A Case of Traumatic Carotid Artery Dissection Treated with Mechanical Thrombectomy Followed by Carotid Artery Stenting].

Traumatic carotid artery dissection(TCAD)is often associated with severe traumatic brain injuries and has high rates of morbidity and mortality. Here, we report a case of TCAD that was treated with mechanical thrombectomy followed by carotid artery stenting(CAS). A 50-year-old man suffered from minor facial trauma due to a motorcycle accident and had disturbance of consciousness with left hemiplegia 2 hours after sustaining the injury. Magnetic resonance imaging scans revealed cerebral infarction in a part of the middle cerebral artery territory, and magnetic resonance angiography showed cervical internal carotid artery occlusion. The patient was diagnosed with TCAD and underwent acute revascularization. Complete recanalization was with a combined technique using a stent-retriever and an aspiration catheter. Carotid angiography revealed a dissection of the internal carotid artery on the right side, and CAS was performed on the right side. Postoperatively, the patient recovered from disturbance of consciousness and left hemiplegia and was discharged once he was ambulatory. In cases of worsening symptomatology or worsening imaging findings, an endovascular approach should be considered for the treatment of TCAD.

Endovascular Treatment of Patients with Oculomotor Nerve Palsy Induced by Posterior Communicating Artery Aneurysms.

Objective: Whether coiling is the best treatment option for oculomotor nerve palsy (ONP) induced by posterior communicating artery (PComA) aneurysms remains controversial. In this study, we retrospectively analyzed the recovery of ONP caused by PComA aneurysms. Methods: Between 2007 and 2019, 8 patients with PComA aneurysms and ONP underwent coiling at our institution. We retrospectively reviewed ONP recovery, duration from onset of ONP to treatment, and complications of procedures. Results: At the last available clinical follow-up, ONP recovery was complete in 4 patients (50%) and partial in 4 patients (50%). Patients with partial recovery of ONP had sequelae of eye movement impairment that did not affect daily life. In 1 patient, hemiplegia developed due to cerebral infarction of the corona radiata the day after coiling, but it fully recovered 1 year after operation. The delay from the onset of ONP to coiling was significantly related to partial ONP recovery (r = -0.83, p = 0.01). Conclusion: Endovascular treatment is a relatively safe and satisfactory treatment for PComA aneurysms with ONP.

[A Case of Brainstem Hemorrhage Following Embolization of a Large Basilar Aneurysm with Hydrogel-Coated Coils].

OBJECTIVE: Endovascular coil embolization of intracranial aneurysms is associated with better outcomes and a lower mortality rate compared with surgical clip occlusion. However, a principal disadvantage of endovascular therapy is the higher rate of retreatment compared with neurosurgical clipping. Self-expandable hydrogel-coated coils were developed to reduce recanalization rates of cerebral aneurysms by promoting complete volumetric aneurysm occlusion. Herein, we report a case of brainstem hemorrhage following coil embolization of a large basilar aneurysm with hydrogel-coated coils. CASE PRESENTATION: A 65-year-old female with a history of hypertension, who presented with worsening headaches, right hemiplegia, and left oculomotor palsy, underwent endovascular treatment for a large basilar aneurysm. The aneurysm was treated with both hydrogel-coated coils and bare platinum coils. Hydrogel-coated coils represented 46% of the coil length in the aneurysm. The patient was discharged from the hospital with improvement of neurological deficits 6 days after the procedure. However, the patient was readmitted with perianeurysmal edema in the midbrain 23 days after coil embolization. Follow-up angiography 26 days after the procedure showed complete obliteration of the aneurysm. Two weeks later, the patient presented with a large brainstem hemorrhage and died. Pathological findings revealed intraparenchymal hemorrhage in the pons without rupture of the aneurysm. CONCLUSION: Hydrogel-coated coils may cause a marked inflammatory response that may result in intracerebral hemorrhage.

Outcome and surgical management for geriatric traumatic brain injury: analysis of 888 cases registered in the Japan Neurotrauma Data Bank.

OBJECTIVE: As the aged population is rapidly growing globally, geriatric traumatic brain injury (TBI) becomes an increasing problem. There are higher mortality and poorer functional outcome in the geriatric TBI population (≥65 years) compared with younger groups despite neurosurgical interventions. Therefore, current treatment priorities and cost-effectiveness should be critically examined. We evaluated the benefit of surgical management in the elderly (≥65 years) after TBI. METHODS: A total of 3194 patients with confirmed TBI were enrolled from 1998 to 2011, in the Japan Neurotrauma Data Bank. Retrospective analysis was conducted from the Japan Neurotrauma Data Bank on 888 (28%) patients (≥65 years) who did and did not undergo surgery. In particular, the effect of low Glasgow coma scale (GCS) (3-5) was compared with outcome with and without surgery. RESULTS: Of all the patients 65 years of age and over, 478 (54%) were given surgical management (craniectomy, craniotomy, or burr-hole evacuation). This group of patients had significantly more favorable outcome at 6 months (18% vs. 7%) and less mortality (62% vs. 81%). However, within this surgical group, patients with initial GCS scores of 3-5 had significantly more unfavorable outcome (96% vs. 79%) and more mortality (87% vs. 57%) compared with those with GCS scores of 6-15. CONCLUSIONS: We confirmed that age is a major determinant of outcome after TBI. In addition, we found that neurosurgical management is associated with the improvement of the prognosis and a decrease in the rate of mortality in geriatric TBI. However, surgical management was not shown to be an effective treatment in elderly patients with GCS scores of 3-5.

Simulation to locate burr hole sites in a patient for deep brain stimulation surgery and clipping of intracranial aneurysm.

BACKGROUND AND OBJECTIVE: Deep brain stimulation (DBS) candidates with neurologic diseases such as unruptured aneurysm present additional challenges to neurosurgeons when craniotomy must precede DBS surgery. Such craniotomy may potentially overlap with intended burr hole sites for the later insertion of DBS electrodes, and the skin incision for craniotomy may lie very close to or intersect with that for the burr holes. We report here a case of forehead craniotomy prior to DBS surgery in which we employed a neuronavigation system to simulate locations for the craniotomy and burr holes. METHOD: A 62-year-old male patient with Parkinson's disease was a candidate for DBS. He also had an aneurysm and was planned first to undergo frontal craniotomy for clipping before the DBS surgery. The locations of the craniotomy, burr holes, and skin incisions were therefore simulated using a neuronavigation system during craniotomy. RESULTS: Two weeks after the craniotomy, the patient underwent DBS surgery. Planning software confirmed the absence of cortical veins beneath the entry points of tentative burr holes and aided trajectory planning. The DBS surgery was performed without the interference of the burr holes and head pins and the craniotomy. CONCLUSION: Simulation of the locations of craniotomy and burr holes using a neuronavigation system proved valuable in the present case of frontal craniotomy before DBS surgery.

Fatal hemorrhage from AVM after DBS surgery: case report.

OBJECTIVES: Intracranial hemorrhage is a crucial complication of deep brain stimulation (DBS) surgery. The bleeding caused by mechanical tissue injury due to microelectrode and/or DBS electrode lead insertion has been well studied. However, hemorrhage caused by a congenital underlying disease such as vascular malformation has not been examined carefully. MATERIALS AND METHODS: We encountered a case of intracerebral hemorrhage from arteriovenous malformation (AVM) after DBS surgery. Preoperative magnetic resonance (MR) imaging did not show any abnormality in the patient. Computed tomography (CT) images taken immediately after the surgery did not show any intracranial hematoma and other abnormal findings. However, the patient did not recover from the general anesthesia, and hemorrhage in the left occipital lobe was detected by CT performed a day after the surgery. The location of the hematoma was markedly distant from the trajectory of DBS leads. Evacuation of the hematoma under general anesthesia was immediately performed. RESULTS: As an intraoperative finding, we noted the presence of abnormal vessels inside the hematoma in the occipital lobe. Tissue specimens including the abnormal vessels were obtained for histopathological analysis, results of which led to the diagnosis was AVM. CONCLUSION: Despite its low incidence, we would like to advise that such a type of hemorrhage could occur and measures should be taken to prevent its occurrence as much as possible. Preoperative detection of abnormal vessels by MR angiography and/or CT angiography might be helpful. Moreover, paying close attention to the possible leakage of cerebrospinal fluid during surgery might be important.

Decoding continuous three-dimensional hand trajectories from epidural electrocorticographic signals in Japanese macaques.

Brain­machine interface (BMI) technology captures brain signals to enable control of prosthetic or communication devices with the goal of assisting patients who have limited or no ability to perform voluntary movements. Decoding of inherent information in brain signals to interpret the user's intention is one of main approaches for developing BMI technology. Subdural electrocorticography (sECoG)-based decoding provides good accuracy, but surgical complications are one of the major concerns for this approach to be applied in BMIs. In contrast, epidural electrocorticography (eECoG) is less invasive, thus it is theoretically more suitable for long-term implementation, although it is unclear whether eECoG signals carry sufficient information for decoding natural movements. We successfully decoded continuous three-dimensional hand trajectories from eECoG signals in Japanese macaques. A steady quantity of information of continuous hand movements could be acquired from the decoding system for at least several months, and a decoding model could be used for ∼10 days without significant degradation in accuracy or recalibration. The correlation coefficients between observed and predicted trajectories were lower than those for sECoG-based decoding experiments we previously reported, owing to a greater degree of chewing artifacts in eECoG-based decoding than is found in sECoG-based decoding. As one of the safest invasive recording methods available, eECoG provides an acceptable level of performance. With the ease of replacement and upgrades, eECoG systems could become the first-choice interface for real-life BMI applications.

Multidimensional recording (MDR) and data sharing: an ecological open research and educational platform for neuroscience.

Primate neurophysiology has revealed various neural mechanisms at the single-cell level and population level. However, because recording techniques have not been updated for several decades, the types of experimental design that can be applied in the emerging field of social neuroscience are limited, in particular those involving interactions within a realistic social environment. To address these limitations and allow more freedom in experimental design to understand dynamic adaptive neural functions, multidimensional recording (MDR) was developed. MDR obtains behavioral, neural, eye position, and other biological data simultaneously by using integrated multiple recording systems. MDR gives a wide degree of freedom in experimental design because the level of behavioral restraint is adjustable depending on the experimental requirements while still maintaining the signal quality. The biggest advantage of MDR is that it can provide a stable neural signal at higher temporal resolution at the network level from multiple subjects for months, which no other method can provide. Conventional event-related analysis of MDR data shows results consistent with previous findings, whereas new methods of analysis can reveal network mechanisms that could not have been investigated previously. MDR data are now shared in the public server Neurotycho.org. These recording and sharing methods support an ecological system that is open to everyone and will be a valuable and powerful research/educational platform for understanding the dynamic mechanisms of neural networks.