Objective: To clarify the usefulness and safety of neuroendovascular treatment with a 6 Fr guiding sheath via the right radial artery for anterior circulation lesions.Methods: A total of 20 patients (carotid artery stenting: 11 patients, coil embolization of cerebral aneurysms: nine patients) who underwent neuroendovascular treatment via the right radial artery under general anesthesia, between September 2016 and June 2017, were included in this study. We retrospectively analyzed 1) the pertinent anatomy of the target-side common carotid artery and the aortic arch, 2) devices, 3) method to advance the guiding sheath into the common carotid artery, 4) hemostasis at the puncture site, and 5) outcome (success rate, perioperative complications, and complications at the site of puncture). Results:In all patients, a 6 Fr guiding sheath could be guided into the common carotid artery, and treatment was accomplished. Furthermore, there was no perioperative or puncture-site complication. Conclusion:Transradial neuroendovascular treatment is considered as a safe and successful choice for anterior circulation lesions.

OBJECTIVE:The authors have developed a novel sterile draped touch display solution for convenient intraoperative access to imaging data. This study describes the technology and clinical experience with the system. METHODS: We developed a flexible-mounted touch display tablet PC (Apple iPad) that allows fixation of the display on the operation microscope and fine adjustments during the surgery when the microscope is moved. We compared this setup with a conventional wall-mounted flat-panel and a mobile display stand in illustrative cases of vestibular schwannoma. RESULTS:The surgeon was able to employ the system without the need to leave the operation field or need for external assistance while referring to imaging data.Commanding through imaging data with sterile gloves on the touch display was more convenient, precise and faster than with other modalities.CONCLUSION: The operation-microscope-mounted touch display provides useful assistance for intraoperative imaging visualization in neurosurgical procedures.

Microvascular decompression (MVD) via lateral suboccipital craniotomy is the standard surgical intervention for trigeminal neuralgia (TN). For recurrent TN, difficulties are sometimes encountered when performing reoperation via the same approach because of adhesions and prosthetic materials used in the previous surgery. In the present case report the authors describe the efficacy of the subtemporal transtentorial approach for use in recurrent TN after MVD via the lateral suboccipital approach. An 86-year-old woman, in whom an MVD via a lateral suboccipital craniotomy had previously been performed for TN, underwent surgery for recurrent TN via the subtemporal transtentorial approach, which provided excellent visualization of the neurovascular relationships and the trigeminal nerve without adhesions due to the previous surgery. Her TN disappeared after the MVD. The present approach is ideal for visualizing the trigeminal root entry zone, and the neurovascular complex can be easily dissected using a new surgical trajectory. This approach could be another surgical option for reoperation when the previous MVD had been performed via the suboccipital approach.

We report two patients for whom the proximal balloon protection (PBP) method was used during transradial carotid artery stenting (TR-CAS). Case Presentations: Case 1 was a 79-year-old male. TR-CAS for acute occlusion of the internal carotid artery was performed. A 6 Fr balloon guiding catheter was introduced into a 6 Fr guiding sheath, and CAS was conducted by passing through the lesion under PBP. Case 2 was an 83-year-old male. TR-CAS was performed to treat marked stenosis of the internal carotid artery. It was difficult to pass the catheter through the lesion, but PBP with a balloon guiding catheter enhanced the supporting power, facilitating lesion passage, and CAS was successful. Conclusion: No study has reported PBP during TR-CAS, but we were able to perform PBP during TR-CAS by adopting this method, and the support for lesion passage may be enhanced. This method may be useful for patients at risk of distal embolism or for those in whom lesion passage is difficult. Keywords▶ carotid artery stenting, transradial approach, lesion cross, proximal balloon protection, flow reversal method

Objective: We formulated a simulator system for catheter intervention training by developing a sliding table and an electrically controlled camera-holding C-arm and combining them with the silicone vessel model EndoVascular Evaluator (EVE). We performed simulation of mechanical thrombectomy using this system and evaluated its usability for simulation training.Methods: After three experts in neuroendovascular treatment were given instructions for the use of this system, they performed mechanical thrombectomy by a procedure as close as possible to that in clinical situations using an artificial thrombus model simulating left middle cerebral artery occlusion, and the procedural times and maneuvers were studied.The time required for guiding catheter placement in the cervical internal carotid artery (guiding time), time required for stent placement (stent placement time), and time required for retrieval of thrombus together with the stent (stent retrieval time) were measured, and the number of movements of the sliding table and C-arm during the procedure were counted. Results:The intended procedure could be executed faithfully by all physicians. The mean guiding, stent placement, and stent retrieval times were 185 ± 18, 387 ± 33, and 616 ± 27 seconds, respectively. The mean numbers of table and C-arm movements during the procedure were 14 ± 1.7 and 8.3 ± 0.5, respectively. Conclusion:This system allows operators to faithfully reproduce the mechanical thrombectomy procedure and is considered to have functions necessary for simulation training of catheter intervention and performance assessment.