Objective To evaluate the clinical and angiographic outcomes of intracranial aneurysm treatment using a single Pipeline Embolization Device (PED), and to evaluate the factors affecting aneurysm obliteration rate. Methods The demographic characteristics and anatomical features of 58 aneurysms in 47 patients treated with a single Pipeline embolization device were reviewed retrospectively. All aneurysms treated with one PED at a single center, and with follow-up angiograms of at least six months were included in this study. Results The overall rate of complete and near-complete occlusion was 84% (49/58) after a mean follow-up period of 18.3 months. The complete aneurysm obliteration rate was reduced when an arterial branch arose from the aneurysm neck; 13% (1/8) compared with 68% (34/50) for aneurysms without an arterial branch (P value: 0.0075). The overall complete and near-complete aneurysm occlusion rate was 90% (45/50) in aneurysms without an arterial branch arising from its neck. There was no statistically significant association between neck-width, aneurysm size, type, or history of prior coil embolization on obliteration rate. Conclusions Our data suggests that a single PED is sufficient to induce complete or near-complete obliteration of most aneurysms. The presence of a branching artery arising from the aneurysm neck is highly predictive of incomplete occlusion after treatment with a single PED.

SummaryA simple technique for blood collection in pigs of body weight 15-40 kg is described. The subcutaneous abdominal vein was used for rapid collection of 5-20 ml of blood samples. The animals were premedicated with 10 mg/kg of ketamine and 600 ",g of atropine given intramuscularly prior to blood collection.

Decompressive hemicraniectomy (DCHC) may be indicated in the setting of subarachnoid hemorrhage (SAH) complicated by persistent elevated intracranial pressure (ICP) that is refractory to medical interventions. Outcomes can be variable as indications for surgery can include focal hematomas, infarctions, and regional or diffuse edema. Bilateral DCHC for medically refractory elevated ICP in the setting of SAH is not well described in the literature, and the viability of this option in terms of patient outcomes is unclear. We describe the cases of four patients with medically refractory ICP secondary to diffuse cerebral edema who underwent bilateral DCHC in the setting of SAH. This is a retrospective case review of four patients with aneurysmal SAH who underwent bilateral DCHC for management of diffuse global edema resulting in medically refractory ICP. We describe two patients who made impressive recoveries after bilateral DCHC and two patients who required significant continued care needs despite ICP control in all patients. Bilateral DCHC is a viable option for control of refractory elevated ICP in SAH patients who develop diffuse cerebral edema. Bilateral DCHC in this setting can be considered after exhaustion of other therapeutic options.

No abstract

Prior work has shown that the human placenta is an available and realistic model for microdissection simulation. We sought to find a measurable improvement in the technical skills of neurosurgical residents with deliberate practice of microdissection tasks using a placental model. Postgraduate year (PGY) 1 to 3 neurosurgery residents were consented. A 1-min video of each participant's baseline skills skeletonizing placental vessels was recorded. Participants underwent 10 practice sessions with intermittent informal feedback for 30-60 min over 18 mo. Another 1-min video was recorded following the 10th dissection. The videos were blinded and assessed by 3 board eligible or certified microsurgical neurosurgeons using a modified Objective Structured Assessment of Aneurysm Clipping Skills. Performance was compared via t-testing among four domains: instrument handling, time flow and forward planning, quality of dissection, and respect for tissue. Microdissection,  instrument handling, and quality of dissection were significantly improved after deliberate practice with the placental simulator (P < .05). Improvement was seen in time flow and forward planning and respect for tissue; however, this failed to be significant. Subjectively, residents expressed enjoyment performing the exercise. They also expressed a desire for demonstrations or videos to watch before practice sessions. The placental simulation model provides microsurgical skill development with minimal deliberate practice sessions. Practice exercises are favorably regarded and interest in continuing them is strong by residents. Residents expressed a desire to make the dissection more deliberate with demonstration, breakdown of steps, and mimicry, which could improve the effectiveness and enjoyment of the skills session.