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Delayed cerebral vasospasms after subarachnoid hemorrhage (SAH) are a risk factor for poor prognosis after successful treatment of ruptured intracranial aneurysms. Different strategies to remove clots from the subarachnoid space and prevent vasospasms have different outcomes. Intrathecal urokinase infusion therapy combined with endovascular treatment (EVT) can reduce the incidence of symptomatic vasospasms. To analyze the relationship between symptomatic vasospasms and residual SAHs after urokinase infusion therapy, we retrospectively reviewed the records of 348 consecutive patients managed with EVT and intrathecal urokinase infusion therapy for aneurysmal SAH at our institution between 2010 and 2021. Among them, 163 patients met the study criteria and were classified into two groups according to the presence of residual SAH in the cisterns, Sylvian fissures, and frontal interhemispheric fissure. The incidence of symptomatic vasospasms and the clinical outcomes were assessed. In total, eight (5.0%) patients developed symptomatic vasospasms. Patients with symptomatic vasospasms had a significantly higher incidence of residual SAH in the Sylvian or frontal interhemispheric fissures than those without (P.0001). No patient with SAHs resolved by urokinase infusion therapy developed symptomatic vasospasms. However, the two groups did not differ significantly in terms of modified Rankin scale scores at discharge. Treatment with intrathecal urokinase infusion after EVT for aneurysmal SAH can substantially reduce the risk of clinically evident vasospasms.

Background and Study Aims Various minimally invasive approaches are used in neurosurgery. Surgeons must perform nondynamic fine movements in a narrow corridor, so specially designed surgical devices are essential. Unsophisticated instruments may pose potential hazards. The purpose of this study was to assess the factors associated with muscle fatigue during minimally invasive neurosurgery and to investigate whether physical stress can be reduced by refining the devices used. Material and Methods Four physical aspects of a handpiece were investigated: torque of conduits (0.20, 0.28, and 0.37 kgf*cm), shape of hand grip (five types), angle of the nozzle (0, 20, and 40 degrees), and weight balance (neutral, proximal, and distal). To evaluate muscle fatigue, surface electromyography was recorded from the extensor carpi radialis muscle and flexor carpi radialis muscle during a geometric tracing task. The maximum voluntary contraction (MVC) of each muscle and %MVC (muscle contraction during a task/MVC × 100) were used as the indexes of muscle fatigue. Results The shape of the hand grip significantly reduced %MVC, which is associated with muscle fatigue. The torque of conduits and angle of the nozzle tended to reduce muscle fatigue but not significantly. Weight balance did not affect muscle fatigue. Based on these results, we made two refined models: model α (torque of conduits 0.2 kgf*cm, angle of nozzle 20 degrees, neutral balance, hand grip with a 2.9 × 2.0-cm oval section with angled finger rest), and model β (torque of conduits 0.2 kgf*cm, angle of nozzle 20 degrees, neutral balance, hand grip with a 2.9-cm round section with a curved finger rest). The %MVC was significantly decreased with both types (p Conclusions The geometrically refined surgical device can improve muscle load during surgery and reduce the surgeon's physical stress, thus minimizing the risk of complications.

A 9-year-old male mixed breed cat showed chronic progressive neurological symptoms, which are represented by ataxia and seizures. At necropsy, spinal roots and spinal ganglions at the level of sixth cervical nerve to second thoracic nerve were bilaterally swollen and replaced by white mass lesions. Right brachial plexus and cranial nerves (III, V and VII) were also swollen. A mass lesion was found in the right frontal lobe of the cerebrum. Histologically, neoplastic lymphocytes extensively involved the peripheral nerves, and they infiltrated into the cerebral and spinal parenchyma according to the peripheral nerve tract. Immunohistochemically, most neoplastic lymphocytes were positive for CD20. The clinical and histological features in this case resemble those of neurolymphomatosis in humans.