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ObjectiveSuperior hypophyseal artery (SHA) aneurysms are intradural, and their rupture can result in subarachnoid hemorrhage. Considering the related surgical difficulty and anatomical restrictions, endovascular treatment (EVT) is considered the most favorable modality for SHA aneurysms; however, the long-term outcomes of EVT have rarely been reported. The study assessed the incidence of and risk factors for recurrence of SHA aneurysms after EVT as well as the correlation factors for SHA aneurysm rupture.MethodsWe included 112 patients with SHA aneurysms treated with EVT at our facility between 2009 and 2020. Here, EVT included non–stent-assisted (simple or balloon-assisted) or stent-assisted coiling. Flow diverter was not included because it was barely used due to its high cost under our national insurance’s limitation, and a high proportion of ruptured aneurysms in our series. Univariate and multivariate logistic regression was performed to evaluate the correlation factors for SHA aneurysm rupture, along with the incidence of and risk factors for post-EVT SHA aneurysm recurrence and re-treatment.ResultsIn our patients, the mean angiographic follow-up period was 3.12 years. The presence of type IA or IB cavernous internal carotid artery (cICA) was strongly correlated with SHA aneurysm rupture. Recurrence occurred in 17 (13.4%) patients, of which only 1 (1.4%) patient had received stent-assisted coiling. All cases of recurrence were observed within 2 years after EVT. The multivariate logistic regression results showed that ruptured aneurysm and non–stent-assisted coiling were independent risk factors for aneurysm recurrence. Of the 17 cases of aneurysm recurrence, 9 (52.9%) received re-treatment. Moreover, aneurysm rupture was the only factor significantly correlated with re-treatment in multivariate logistic regression. No re-recurrence was observed when a recurrent aneurysm was treated with stent-assisted coiling.ConclusionType I cICA was common factor for aneurysm rupture. Although flow-diverter treatment serves as another suitable technique that was not compared with, coils embolization was effective treatment modality for SHA aneurysms, leading to low recurrence and complication rates, especially with stent use. All cases of recurrence occurred within 2 years after EVT; they were strongly associated with prior aneurysm rupture. Further stent-assisted coiling was noticed to prevent re-recurrence.

Abstract Background Cerebral vasospasm still results in high morbidity and mortality rates in patients after aneurysmal subarachnoid hemorrhage (SAH). The aim of this study was to establish a protocol for the management of vasospasm and demonstrate our experience of angioplasty using the Scepter XC balloon catheter. Methods In this retrospective study, a computed tomography angiography and perfusion image was arranged if early symptoms occurred or on the 7th day following aneurysmal SAH. In patients with clear consciousness, balloon angioplasties were performed for symptomatic vasospasms, which were not improved within 6–12 h after maximal medical treatments. In unconscious patients, balloon angioplasties were performed for all patients with angiographic vasospasms. Results Fifty patients underwent Scepter XC balloon angioplasty among 396 consecutive patients who accepted endovascular or surgical treatments for ruptured aneurysms. All angioplasty procedures were successful without complications. 100% angiographic improvement and 94% clinical improvement were reached immediately after the angioplasties. A favorable functional outcome (modified Rankin Score of ≤2) could be achieved in 82% of patients. Even in patients with poor clinical grading (Hunt–Hess grade 4–5), a clinical improvement rate of 87.5% and favorable outcome rate was 70.8% could be achieved. Conclusion Balloon angioplasty with Scepter XC balloon catheter is safe and effective for post-SAH vasospasm. This device’s extra-compliant characteristics could considerably improve the quality of angioplasty procedures. For all patients, even those with poor neurological status, early treatment with combined protocol of nimodipine and angioplasty can have good clinical outcomes.

ObjectiveDelayed progressive mass effect (DPME) after securing an aneurysm is uncommon following microsurgical or endovascular repair and leads to a poor clinical outcome. Patients with ruptured middle cerebral artery (MCA) aneurysms have a high risk of postoperative oedema and mass effect, which may require decompressive treatment. Because few studies have discussed the risk and predictive factors, we focused on ruptured MCA aneurysms and evaluated the outcomes of these patients and the necessity of salvage surgery when DPME presented.MethodsData on 891 patients with aneurysmal subarachnoid haemorrhage (aSAH) treated between January 2011 and February 2020 were extracted from the medical database of a tertiary referral centre. A total of 113 patients with aSAH resulting from at least one MCA aneurysm were identified. After excluding patients with several clinical confounders, we enrolled 80 patients with surgically treated aSAH. We examined the characteristics of aneurysms and hematomas, perioperative contrast pooling patterns, presence of distal hematomas, perisylvian low density, occlusive treatment modality, management strategies, the need for salvage surgical decompression, and postoperative 90-day outcomes to identify possible risk factors.ResultsDPME was observed in 27 of the 80 patients (33.7%). The DPME and non-DPME group differed significantly in some respects. The DPME group had a higher risk of salvage surgery (p

ObjectivesFor the endovascular intervention of acute ischemic stroke, a transcervical route is an alternative approach in patients with challenging anatomical variations. Percutaneous puncture is a common way, but it can cause many fatal complications. Direct carotid artery exposure is an alternative for reducing complications. We demonstrate a technique of direct carotid exposure in patients for whom transfemoral or transbrachial approaches were impossible. We present patient outcomes and discuss the indications and limitations of this procedure.MethodsWe retrospectively reviewed the cases of patients undergoing direct carotid exposure for acute ischemic stroke in a hybrid angiography suite and presented the details of the technique.ResultsAmong 548 consecutive patients with acute large vessel strokes who were treated by emergency endovascular thrombectomy or stenting between January 2015 and September 2020 in our center, only 8 (1.46%) required a transcervical approach. Of them, 7 underwent direct carotid exposure with successful recanalization and good clinical outcomes.ConclusionsDirect carotid exposure for endovascular stroke treatment is effective and advantageous in patients with challenging anatomical variations. Performing this procedure in carefully selected patients in the hybrid angiography suite can be beneficial in terms of open surgeries, saving time, and decreasing the risk of postoperative complications.

Because of its large area and complicated space utilization, in the event of a disaster, rescue efforts in specific areas of Taipei Main Station would be difficult. In addition, rescue efforts are also difficult to implement, because each area is managed by different units. In order to ensure emergency and safe evacuation of passengers and reduce the loss of related property during a disaster, a suitable disaster prevention system is required. This study conducted risk assessment based on the triggering factors of disaster types over the years. After synthesizing the results of the disaster risk assessment, a disaster preparedness contingency plan was designed. According to the Incident Command System (ICS), this study formulated the usual management measures and emergency response procedures for various levels of disasters. When an accident occurs, the system can automatically initiate various emergency disaster relief measures, monitor the development of the incident, transmit disaster information, and coordinate disaster emergency response procedures. This study established a building information modeling (BIM)-based cyber-physical system (CPS) and intelligent disaster prevention system integrated under the overall management of the Intelligent Joint Emergency Operation Center. The “Taipei Main Station Intelligent Disaster Prevention System” can manage the disaster prevention and relief information of various business entities in a unified way, and provide an intelligent disaster prevention function integrating BIM and virtual reality (VR). This system is functionally verified through exercises such as short-circuiting of wires in advertising boxes, firefighter disaster relief drills, indiscriminate violent attacks, and demolition of explosives. In this study, ICS was established through expert interviews, disaster-causing factors over the years, and a cloud-based electronic management system was established in combination with the BIM platform. The system provides emergency and safe evacuation of passengers in the event of a disaster, and reduces the loss of related properties.

Neurocutaneous melanosis (NCM) is characterized by diffuse or focal proliferation of melanin-producing cells over the skin or leptomeninges. Even without malignant transformation, the prognosis is poor after symptomatic progression of NCM, resulting from either mass effect in central nervous system or hydrocephalus. We reported a 26-year-old female patient with rapid deterioration after the onset of NCM. Despite no solid tumor formation, elevated cerebrospinal fluid protein content, which complicated shunting procedure, associated with hydrocephalus played the key role in clinical deterioration. Adult onset of NCM with Dandy–Walker malformation was never reported in our literature review. Diagnosis and treatment for such disease entity are discussed.

Globally, 50.44% of buildings are over 30 years old. Old buildings have problems such as obsolete safety monitoring systems and poor management efficiency caused by the use of old equipment. For the better management of buildings and their facilities, we developed an efficient management system based on digitized data from sensors in each device that is connected to the system. The system monitored the operation of each device in real time and sent messages to maintenance personnel in case of any abnormality in each device. This system ensured the normal operation of the building and saved costs and energy via efficient functions. The system was developed and implemented for one year. The operation outcome showed the completeness, relevance, standardization, and visualization of collected data and information. It also enabled the effective scheduling of operation and maintenance by querying the data from each device for intelligent building management. [ABSTRACT FROM AUTHOR]

Objective: Degenerative spondylolisthesis of the spine is less common in the lower thoracic region than in the lumbar and cervical regions. However, lower thoracic degenerative spondylolisthesis may develop secondary to intervertebral disc degeneration. Most of our patients are found to have concomitant lumbar spondylosis. By retrospective review of our cases, current diagnosis and treatments for this rare disease were discussed. Materials and methods: We present a series of 5 patients who experienced low back pain, progressive numbness, weakness and even paraparesis. Initially, all of them were diagnosed with lumbar spondylosis at other clinics, and 1 patient had even received prior decompressive lumbar surgery. However, their symptoms continued to progress, even after conservative treatments or lumbar surgeries. These patients also showed wide-based gait, increased deep tendon reflex (DTR), and urinary difficulty. All these clinical presentations could not be explained solely by lumbar spondylosis. Thoracolumbar spinal magnetic resonance imaging (MRI), neurophysiologic studies such as motor evoked potential (MEP) or somatosensory evoked potential (SSEP), and dynamic thoracolumbar lateral radiography were performed, and a final diagnosis of lower thoracic degenerative spondylolisthesis was made. Results: Bilateral facet effusions, shown by hyperintense signals in T2 MRI sequence, were observed in all patients. Neurophysiologic studies revealed conduction defect of either MEP or SSEP. One patient refused surgical management because of personal reasons. However, with the use of thoracolumbar orthosis, his symptoms/signs stabilized, although partial lower leg myelopathy was present. The other patients received surgical decompression in association with fixation/fusion procedures performed for managing the thoracolumbar lesions. Three patients became symptom-free, whereas in 1 patient, paralysis set in before the operation; this patient was able to walk with assistance 6 months after surgical decompression. The average Nurick scale score improved from 3.75 before the operation to 2 after the operation. Conclusion: Lower thoracic degenerative spondylolisthesis is a rare disease, which may occur concomitantly with lumbar spondylosis and confuse clinicians. Diagnosis should be made properly, especially because symptoms/signs cannot be explained purely on the basis of the available images. Micromotion due to facet joint laxity and disc degeneration was believed as the cause of progressive myelopathy. Posterior decompression with fixation/fusion procedure was appropriate for the treatment of thoracic spondylolisthesis secondary to thoracic disc degeneration. [ABSTRACT FROM AUTHOR]

Among patients with medulloblastoma, an unrare aggressive central nervous system (CNS) tumor found mostly in the posterior fossa, drop metastasis from primary location to anatomically lower sites including whole spinal cord is known as a potential way for tumor to spread. There were already lots of extensive discussions regarding diagnosis and treatment for such common neurologic complication in systemic cancer; however, fewer were found about medulloblastoma. This study aimed to reexamine the possible known prognostic factors, especially drop metastasis, and defined the influence of them. We retrospectively review a series of 36 patients who suffered from posterior fossa medulloblastoma and found leptomeningeal metastasis in 12 of them. Incidence, diagnosis, prognostic factors, and treatments for this common complication are discussed. The magnetic resonance images (MRI) of these patients were reviewed. The time sequence between primary surgical procedure and development of MRI evidences of drop metastasis was used for subgrouping. Log-rank test was used for survival analysis. By survival analysis, patients with late drop metastasis, defined as new radiologic evidence of leptomeningeal involvement after primary CNS procedures, were found to have significant survival difference to those with early metastasis defined as drop metastasis found at the time of diagnosis (log-rank test, p = 0.0047). Further stratification of patients within this group may help in evaluation of prognosis and development of different treatment strategies. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "The clinical experience of medulloblastoma treatment and the significance of time sequence for development of leptomeningeal metastasis" in the December 24, 2010 issue.