Diagnostic limitations in the treatment of cerebral aneurysms.

Background: Endovascular coiling has become a standard technique in the treatment of cerebral aneurysms. The mechanisms of recurrence are incompletely understood.

Methods: In our clinical investigations we present three uncommon cases where the pathology at the base might has been underestimated in digital subtraction or magnetic resonance angiography.

Surgical management of an ACM aneurysm eight years after coiling.

The authors present a case report on rebleeding of a medial cerebral aneurysm (MCA) eight years after complete endovascular coiling. The primarily successfully coiled MCA aneurysm showed a local regrowth which, however, was not the source of the rebleeding. The angiogram demonstrated no evidence of contrast filling of the coiled segment, but according to intraoperative findings (haematoma location, displacement of coils, evident place of rupture) there is no doubt that the coiled segment of the aneurysm was responsible for the haemorrhage.

Microneurosurgical water probe.

When constructing the micro-neurosurgical water ball probe, the authors have simply combined the properties of a ball probe with an irrigational function and the supportive role of water current to form a new irrigating ball dissector. The micro-instrument has an outlet mechanism with which the surgeon can regulate the flow of physiological solution into the operational field. Its point has the properties of a ball probe, and the overall bayonet shape facilitates surgical interventions in deep tissues under microscopic control.

Cerebrovascular stereolithographic biomodeling for aneurysm surgery. Technical note.

Stereolithographic (SL) biomodeling is a new technology that allows three-dimensional (3D) imaging data to be used in the manufacture of accurate solid plastic replicas of anatomical structures. The authors describe their experience with a patient series in which this relatively new visualization method was used in surgery for cerebral aneurysms. Using the rapid prototyping technology of stereolithography, 13 solid anatomical biomodels of cerebral aneurysms with parent and surrounding vessels were manufactured based on 3D computerized tomography scans (three cases) or 3D rotational angiography (10 cases).

Surgical or endovascular treatment of carotid stenosis.

Carotid endarterectomy (CEA) is a proved standard treatment in stenosis of high-grade carotid artery stenosis. On the basis of new experience, percutaneous transluminal angioplasty with stent (PTAS) has gradually been established as an alternative method to carotid endarterectomy. The aim of the three-month investigation was to evaluate PTAS, CEA and conservative medicamentous therapy.