The retrolabyrinthine presigmoid transpetrosal approach is a modification of the subtemporal approach which is suitable for complete amygdalectomy.

RS-5186, which inhibits thromboxane A2 (TXA2) synthetase activity, ameliorated delayed cerebral vasospasm in a canine two-hemorrhage model. Subarachnoid hemorrhage was induced in 15 dogs, which were divided into two groups. In the RS-5186-treated group (9 dogs), 50 mg kg-1 of RS-5186 was administered twice a day for seven days. The remaining six dogs without administration of RS-5186 were used as a control group. In the RS-5186-treated group, the angiographic diameter of the basilar artery on Day 7 after subarachnoid hemorrhage was constricted to 60.9% +/- 11.6% (n = 9, mean +/- SD) of that on Day 0, before subarachnoid hemorrhage. The corresponding value was 42.8% +/- 6.1% (n = 6) in the control group. There was a statistically significant difference between these percentages. In the RS-5186-treated group, plasma thromboxane B2 level on Day 7 was 144.3 +/- 28.1 pg ml-1 (n = 4), which was lower than the 815.5 +/- 162.0 pg ml-1 (n = 4) in the control group (p < 0.0005). The plasma 6-keto-prostaglandin F1 alpha level on Day 7 was 180.5 +/- 66.5 pg ml-1 (n = 4) in the RS-5186-treated group, and higher than 107.3 +/- 12.4 pg ml-1 (n = 4) in the control group (p = 0.0734). Thus, administration of RS-5186 reduced TXA2 plasma level and had a beneficial effect on angiographically-detected delayed vasospasm.

The operative indication for pseudo-occlusion of the internal carotid artery is controversial. In this study, we report the technical aspects of and periprocedural care in carotid artery stenting (CAS) for the treatment of this condition. Nineteen cases of pseudo-occlusion of the internal carotid artery (17 symptomatic, 2 asymptomatic) were treated with stenting. Acetazolamide-enhanced singlephoton emission computed tomography revealed hemodynamic compromise in 14 of the 19 cases. To prevent postoperative hyperperfusion syndrome, staged angioplasty and stenting were performed in seven cases. All cases were treated with a flow reversal embolic protection technique during the initial treatment. We observed postoperative intracerebral hemorrhage in one patient due to postoperative hyperperfusion syndrome. Thereafter, we used dexmedetomidine (DEX), a selective α-adrenergic agent, as an intra-and postoperative sedative and analgesic agent, in nine cases to stabilize intraoperative hemodynamics. After staged percutaneous transluminal angioplasty and periprocedural use of DEX, we did not observe hyperperfusion syndrome after CAS. In five cases with extremely tight lesions, we experienced difficulties in crossing the guidewire. In such cases, we applied a 0.014-in coronary chronic total occlusion guidewire to cross the lesions. In this study, we demonstrated fairly positive outcomes of CAS in patients with pseudo-occlusion of the internal carotid artery. This was achieved by focusing on the prevention of hyperperfusion syndrome and proper management of perioperative procedures, especially with respect to blood pressure control.

Objective: Transarterial embolization (TAE) using liquid embolic material is adopted in the treatment of dural arteriovenous fi stulas (DAVFs) with direct cortical venous drainage or in patients in whom transvenous access is limited. Arresting fl ow by wedging a microcatheter tip into a main feeding vessel is important to achieve complete obliteration of DAVF with TAE. The Masamune catheter is a double lumen microcatheter with a silicone balloon at its distal end, characterized by the shortness of its catheter tip to the distal balloon end. Two cases of DAVF treated by TAE with the balloon fl ow arrest technique using a Masamune balloon microcatheter are reported. Case Report: Case 1, a 50-year-old man, was incidentally diagnosed with a tentorial DAVF with direct cortical venous drainage. An infl ated Masamune balloon catheter was wedged in the occipital artery, and trans-arterial embolization was performed under a fl ow-arrested condition. As preparative embolization of the other minor feeding arteries had not been performed, complete obliteration of DAVF was not achieved by competing fl ow. Case 2, a 64-year-old man, was diagnosed with a left transverse-sigmoid DAVF on angiogram. The DAVF was completely obliterated with the balloon fl ow arrest technique using liquid embolic material. Conclusion: The Masamune catheter can easily achieve an artificial flow-arrest condition by inflation of its distal balloon to prevent fragmentation of liquid embolic material. In conjunction with preparative embolization of minor feeding vessels, curative embolization may be achieved from a main feeder using this catheter.