ObjectiveContrast-induced encephalopathy (CIE) is a rare neurological complication that can occur in the context of various endovascular procedures. Although many potential risk factors for CIE have been reported, it is still unclear whether anesthesia is a risk factor for the occurrence of CIE. The goal of this study was to investigate the incidence of CIE in patients who underwent endovascular treatment under different anesthesia methods and anesthetics administration and to explore whether general anesthesia was a potential risk factor for CIE.MethodsWe retrospectively reviewed available clinical data from 1,043 patients with neurovascular diseases undergoing endovascular treatment between June 2018 and June 2021 in our hospital. A propensity score-based matching strategy and logistic regression were used to analyze the association between anesthesia and the occurrence of CIE.ResultsIn this study, we implemented the embolization of intracranial aneurysm in 412 patients, stent implantation of extracranial artery stenosis in 346, stent implantation of intracranial artery stenosis in 187, embolization of cerebral arteriovenous malformation or dural arteriovenous fistula in 54, endovascular thrombectomy in 20, and other endovascular treatments in 24. A total of 370 patients (35.5%) received treatment under local anesthesia, while the remaining 673 (64.5%) underwent treatment under general anesthesia. In total, 14 patients were identified as CIE, resulting in a total incidence rate of 1.34%. After propensity score-based matching of anesthesia methods, the occurrence of CIE was significantly different between the general anesthesia and local anesthesia group (P = 0.007). After propensity score-based matching of CIE, the anesthesia methods were significantly different between the two groups. Pearson contingency coefficients and logistic regression showed a significant correlation between general anesthesia and the risk of CIE.ConclusionGeneral anesthesia might be a risk factor for CIE, and propofol might be associated with the increased occurrence of CIE.

ObjectiveThe coexistence of severe cranial artery stenosis and ipsilateral distal tandem intracranial aneurysm is an unusual phenomenon. Currently, there is no consensus to provide treatment guidelines for concomitant lesions. This study aims to evaluate the safety and effectiveness of single-stage endovascular treatment in patients under this special condition.MethodsWe illustrated a case series of 10 patients with the coexistence of severe cranial artery stenosis and ipsilateral distal tandem intracranial aneurysm in our hospital. And a systematic PubMed search of English-language literature published between 1990 and 2021 was carried out using the keywords: “(carotid OR vertebral OR subclavian artery stenosis) AND (aneurysm) AND (coincident OR coexist OR concomitant OR simultaneous OR ipsilateral).” Clinical information, including age, gender of the patients, as well as symptoms (artery stenosis or aneurysm), localization of artery stenosis and aneurysm, treatment, and outcome, were collected and analyzed.ResultsIn the majority of the patients, symptoms were attributed to severe artery stenosis, and the coexisted lesions were located in the anterior circulation system. Most patients achieved an excellent clinical outcome, and no death was observed. No differences were found in a prognosis between single-stage or multiple-stage endovascular treatment.ConclusionsA single-stage endovascular procedure is technically feasible and effective to treat the coexistence of severe cranial artery stenosis and ipsilateral distal tandem intracranial aneurysm in the anterior circulation as well as in the posterior circulation.

Purpose: Transsphenoidal surgery (TSS) is the first-line treatment for Cushing’s disease (CD), even with negative preoperative MRI results. It is not rare that patients experiencing hypercortisolism persistence or recurrence have negative MRI after the initial surgery. We aim to analyze the efficacy of repeat surgery in these two groups of patients and assess if there is association of the positive MRI finding with early remission.Patients and methods: Clinical, imaging and biochemical information from 42 patients who underwent repeat surgery by a single neurosurgeon between 2002 and 2021 were retrospectively analyzed. The endocrinological, histopathological and surgical outcomes before and after the repeat surgery of 14 CD patients with negative MRI findings were compared with 28 patients with positive findings.Results: Immediate remission was achieved in 29 patients (69.0%) underwent repeat surgery. Of all patients, 28 (66.7%) had MRI findings consistent with solid lesion. There was no difference of remission rate between the recurrence group and the persistence group (77.8% vs. 57.1%, Odds Ratio = 2.625, 95% Confidence Interval =0.651 to 10.586). In patients with remission after the repeat surgery was not associated with the positive MRI finding (Odds Ratio = 3.667, 95% Confidence Interval = 0.920 to 14.622).Conclusions: In terms of recurrence, the repeat surgery with either positive or negative MRI showed a reasonable remission rate. For persistent disease with positive MRI finding, repeat surgery is still an option, while more solid evidence is needed to define if the negative MRI is predictor for failure reoperation of persistent hypercortisolism.