Flow-diverter stents combined with flow-T stenting-assisted coiling for the treatment of a large basilar apex aneurysm: a case report with a 9-month follow-up.

Background: Endovascular or surgical treatment of wide-neck, large basilar apex aneurysms is challenging. We present a novel concept for the treatment of complex basilar apex aneurysms using flow-diverter devices combined with the flow-T stenting-assisted coiling technique. Assess the efficacy and safety profile of the technique in this complex aneurysm. Case description: A patient with multiple unruptured intracranial aneurysms underwent staged treatment. A large basilar apex aneurysm was treated with a flow-diverter stent combined with a flow-T stenting-assisted coiling technique in the first stage, and a giant supraclinoid aneurysm was treated with a flow-diverter stent applied in the second stage. Clinical presentations, technical details, intra- and perioperative complications, and clinical and angiographic outcomes were recorded, with a 9-month follow-up. Results: The patient achieved full neurologic recovery postoperatively. Cerebral angiography performed postoperatively showed revascularization, good laminar flow, and no in-stent or adjacent stenosis. Conclusion: Flow-diverter stents combined with flow-T stenting-assisted coiling for the treatment of giant basilar apex aneurysms is a feasible technique with efficacy demonstrated at a 9-month follow-up. Staged endovascular treatment of multiple intracranial aneurysms may be a safe and viable option.

LEF1-AS1 is implicated in the malignant development of glioblastoma via sponging miR-543 to upregulate EN2.

Glioblastoma (GBM) has been regarded as the most aggressive disease in the nervous system. Accumulating literatures have illustrated the crucial role of competing endogenous RNAs (ceRNAs) network in the pathogenesis and progression of various tumors. The promoting effect of LEF1-AS1 on GBM development has been previously identified. This study attempted to explore the underlying mechanism of LEF1-AS1 in GBM. Data of clinical GBM patients was downloaded from TCGA and GEO databases. The proliferative ability, clonogenic vitality, invasive, and migratory capabilities of GBM cells were measured using Cell counting kit-8 (CCK-8), colony formation and transwell assays. Luciferase reporter gene analysis was performed to verify the correlations between LEF1-AS1/EN2 and miR-543. qRT-PCR and western blotting were implemented to evaluate the mRNA and protein levels, respectively. Our results consolidated that LEF1-AS1 was highly expressed in GBM tissue specimens and its up-regulation induced unfavorable prognosis. The loss/gain-of-function analyses verified that LEF1-AS1 promoted the GBM cell malignant behaviors. Mechanically, LEF1-AS1 acted as a ceRNA for miR-543 and positively regulated engrailed homeobox 2 (EN2) expression. Down-regulation of miR-543 elevated GBM cell malignant behaviors, which was reversed by LEF1-AS1 knockdown. Meanwhile, the LEF1-AS1 inhibition could arrest the promoting effect of high-regulated EN2 on GBM cell aggressiveness and vice versa. In conclusion, our findings identified LEF1-AS1 as a ceRNA for miR-543 and showed that EN2 was positively regulated by LEF1-AS1. The LEF1-AS1/miR-543/EN2, as a novel ceRNA network, was implicated in the progression of GBM, which provided a novel insight for GBM treatment.

A persistent primitive hypoglossal artery-posterior inferior cerebellar artery convergence aneurysm treated by stent-assisted coil embolization: A case report.

RATIONALE: Persistent primitive hypoglossal artery (PPHA) is often associated with intracranial anomalies such as aneurysms. Surgical treatment of aneurysms on the PPHA is challenging due to that the posterior circulation depends solely on PPHA. PATIENT CONCERNS: A case of an 83-year-old woman with a large aneurysm on PPHA presented with vertigo was reported. DIAGNOSIS: Three-dimensional angiogram revealed a wide-neck aneurysm on the PPHA. INTERVENTIONS: The aneurysm was successfully treated using a novel low-profile visualized intraluminal support stent-assisted coiling technique. OUTCOMES: No complications occurred during the procedure. The final angiogram confirmed the patency of the posterior inferior cerebellar artery and the parent artery and its distal branches. LESSONS: Our case suggests that stent-assisted coil embolization is safe and effective for the treatment of aneurysms on the PPHA.

Case Report of Late Type IIIb Endoleak with Willis Covered Stent (WCS) and Literature Review.

OBJECTIVE: We report a case of late type IIIb endoleak with Willis covered stent (WCS) developed 14 months after endovascular paraclinoid aneurysm repair. METHODS: A 52-year-old woman presented with episodic headache, caused by a giant paraclinoid aneurysm. She underwent a successful 3.5 x 16mm WCS positioning to treat the aneurysm. Fourteen months later, the patient was admitted with the same symptoms. Digital subtraction angiography examination showed recurrence of the aneurysm, which was similar to the preoperative one. DynaCT (Siemens, Erlangen, Germany) indicated the intact of the metal structure of the stent without migration. Type IIIb endoleak (defect in the graft fabric) was confirmed with a whole aneurysm neck located in the middle part of the stent. The type IIIb endoleak was treated with another WCS (4.0 x 16mm). The immediate digital subtraction angiography imaging indicated that the endoleak disappeared and the aneurysm was completely occluded. Re-examination done 1 year after the second treatment showed a complete exclusion of the aneurysm sac. CONCLUSIONS: Type IIIb endoleaks can be safely treated by the endovascular positioning of another WCS. Continuous surveillance after endovascular paraclinoid aneurysm repair for intracranial aneurysms is warranted to make ensure the safety of WCS.

Large bone-flap decompressive craniotomy for treatment of serious craniocerebral injury associated with cerebral infarction.

OBJECTIVE: To elucidate the therapeutic effect of subtemporal decompressive craniotomy with large flap resection on serious craniocerebral injury associated with cerebral infarction. METHODS: Forty-eight cases of serious head injury accompanied by cerebral infarction were classified into two groups with each having 24 cases: treatment group, in which large bone-flap decompressive craniotomy was performed; control group, in which routine craniotomy and hematoma evacuation were adopted. The status of cerebral infarction pre- and post-operation, as well as the curative effect 3 months after operation were comparatively analysed between the two groups. RESULTS: There was no significant difference regarding the status of cerebral infarction on the first day after operation; while one week after operation, the size of cerebral infarction was significantly smaller in treatment group than control one (P less than 0.05). Postoperative 3 months, the mortality rate was 20.8% in treatment group, being evidently superior to that of control group (33.3%, P less than 0.05). The mo- derate disability (good and fair) rate was 41.7% in treatment group, significantly higher than that in control group (25.0%, P less than 0.05). CONCLUSION: Large bone-flap decompressive craniotomy is confirmed effective and hence it offers us a preferable alternative of treatment by which to reduce disability and fatality rates for patients with serious head injury accompanied by cerebral infarction.