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Background Blister aneurysms (BA) are high risk cerebrovascular lesions accounting for 1% of intracranial aneurysms. The defective vessel wall and broad-based neck make this clinical entity difficult to treat, with high rates of re-rupture and mortality in patients presenting with acute subarachnoid haemorrhage. Blister aneurysms pose substantial challenges for both endovascular and microsurgical management.Objective To evaluate endovascular and microsurgical outcomes in intracranial blister aneurysm management across two tertiary hospitals.Methods A review of two tertiary hospitals with a systematic imaging database search for term of “blister” in modalities from January 2010 to October 2022. Operation reports were screened for the 5-year period since cerebral angiogram reports transitioned to surgical database. Identified reports were screened and reviewed for confirmed diagnosis by consultant neuroradiologist.Results 21 cases of blister aneurysms managed at respective facilities were included. 16 cases (76%) were managed endovascularly – all with flow diversion stents. 4 cases (19%) were managed surgically – 2 with primary clipping, and 2 wrap and clipping. 1 case was managed conservatively (5%). Clinical outcomes were discharge disposition, aneurysm exclusion and post-operative complications.Conclusion BAs have challenging considerations with high mortality and morbidity. Endovascular treatment is less invasive option with lower rates of intraoperative rupture and mortality. Patients discharged home were comparable. Commencement of dual anti-platelet therapy was safe in patients with flow diversion stents despite sub-arachnoid blood volume. Management of blister aneurysms is complex. Endovascular treatment shows promise for acute treatment but careful consideration of antithrombotic regime and requirement for further surgery should be considered.

Objective Spinal Subdural Haematoma (SSH) is a rare and infrequently reported complication of hemilaminectomy, laminectomy and other spinal decompression surgeries. In this review, we aim to analyse the available literature for reported cases of SSH to better identify risk factors and presenting symptoms, as well as highlighting the importance in prompt investigation and management of SSH to prevent long-term morbidity and chronic neurological deficit. Method A review of the medical literature was undertaken using search terms hemilaminectomy OR laminectomy AND spinal subdural haematoma. All identified reports were screened for language, adult population and human studies. Report abstracts were screened for relevance to question, with SSH occurring postoperatively following hemilaminectomy or laminectomy included. Four reports were included in the review. Conclusion SSH is a rare, emergency condition with neurological deficit that can present as recurrent back pain and acute cauda equina post-operatively following hemilaminectomy and laminectomy procedures. Vigilance, early investigation and surgical evacuation is important in preventing short- and long-term morbidity. Further collation of data and analysis is required to better identify patients at high risk for developing SSH postoperatively.

Sosuga virus (SOSV) is a recently discovered paramyxovirus with a single known human case of disease. There has been little laboratory research on SOSV pathogenesis or immunity, and no approved therapeutics or vaccines are available. Here, we report the discovery of human monoclonal antibodies (mAbs) from the circulating memory B cells of the only known human case and survivor of SOSV infection. We isolated six mAbs recognizing the functional attachment protein (HN) and 18 mAbs against the fusion (F) protein. The anti-HN mAbs all target the globular head of the HN protein and can be organized into 4 competition-binding groups that exhibit epitope diversity. The anti-F mAbs can be divided into pre- or post-fusion conformation-specific categories and further into 8 competition-binding groups. Generally, pre-fusion conformation-specific anti-F mAbs showed higher potency in neutralization assays than did mAbs only recognizing the post-fusion conformation of F protein. Most of the anti-HN mAbs were more potently neutralizing than the anti-F mAbs, with mAbs in one of the HN competition-binding groups possessing ultra-potent (50) virus neutralization values. These findings provide insight into the molecular basis for human antibody recognition of paramyxovirus surface proteins and the mechanisms of SOSV neutralization.