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Avascular necrosis, or Kummel disease, is a potential complication of vertebral compression fractures. It is believed to arise as a result of a failed fracture healing process,1 2 leading to the formation of an air or fluid filled cavity within the vertebral body.3 Percutaneous vertebroplasty seems to provide both pain relief and increased spinal stability in avascular necrosis.4 In this technical video, we present the case of an osteoporotic patient with a complicated vertebroplasty, caused by trapping of the bone needle inside the intravertebral cement cast. Two methods were used sequentially, leading to retrieval of the bone needle. We identified several technical aspects, such as injection speed, quasi-filling of the vertebral cavity, and frequent rotation of the bone needle as essential for the success of the procedural. We suggest that improving these parameters may prevent intravertebral bone needle trapping in patients with avascular necrosis.Video 1

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Introduction. Non-saccular aneurysms are independent vascular entities, characterized by particular pathogenesis, localization, natural history and treatment. The fusiform subtype comprises an estimated tenth of all intracranial aneurysm, while the dolichoectatic subtype has different reported prevalence values, owing to several proposed diagnostic criteria (Smoker et al. criteria1 being the most widely used). The most frequent initial clinical presentations are ischemic stroke and transient ischemic attack, due to different hemodynamics and mechanism of formation. Prognosis is usually poor and progression can be demonstrated in almost half of ectatic vessels. Treatment can be either conservative in asymptomatic or ischemic presentations or by endovascular or microsurgical conduit in other cases. case presentation. We report the case of a hypertensive 63-year old male patient with multiple intracranial vascular anomalies; he was initially admitted for ischemic stroke, with right hemiplegia and mixt aphasia. Non-contrast CT demonstrated a thrombosed left posterior cerebral artery aneurysm and contrast enhanced CT revealed a middle cerebral artery saccular aneurysm, two saccular and fusiform right PCA aneurysms and vertebrobasilar dolichoectasia. Cerebral angiography confirmed the previous findings and revealed lack of contrast at the level of the left PCA in the P2 segment. The patient was treated conservatively with aspirin and high-dose statins and had a favorable outcome, regaining part of his right-side function, object-naming and simple sentence construction capabilities. conclusions. Upon ischemic presentation in the case of non-saccular aneurysms, a conservative attitude is recommended. These aneurysms commonly have an unfavorable prognosis, demanding periodic follow-up for detecting recurrent ischemic events, possible hemorrhage and progression.