Internal carotid artery (ICA) injury is a rare but potentially life-threatening complication of skull base and neck surgery. Although usually manifested by massive intraoperative haemorrhage, impairment of the ICA might go unnoticed and result in formation of a pseudoaneurysm, causing delayed bleeding. Often additional complications are observed such as thrombosis, spasm, embolism or carotico-cavernous fistula formation. The risk of carotid artery injury in aggressive endonasal skull base surgical interventions ranges from 1% to 9%. Digital subtracted angiography remains the gold standard for evaluation of patients with iatrogenic carotid artery injury as it allows for endovascular treatment at the time of the procedure. Endovascular embolization is currently the preferred method for treating ICA pseudoaneurysms and a successful alternative to the surgical approach. Even though endovascular approaches are considered the safer option, delayed complications have been registered, such as endovascular coil extrusion and migration, which increases the risk of further episodes of bleeding. We present our experience with late coil extrusion in a patient who was previously treated with flow diverter stent and coiling for iatrogenic ICA pseudoaneurysm.

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The Comaneci device offers a new promising and reliable technique that can safely support aneurysm coiling occlusion even in a rupture environment. However, long term monitoring of patients treated by this device is mandatory.

Summary The Eurasian Griffon Vulture Gyps fulvus is a large Palearctic, Indohimalayan and Afrotropical Old-World vulture. The species’ range is vast, encompassing territories from the Pyrenees to the Himalayas. We reviewed and analysed a long-term data set for Griffon Vulture in the Balkans to estimate the change in its population size and range between 1980 and 2019. After a large historical decline, the Griffon Vulture population slightly increased in the last 39 years (λ = 1.02) and reached 445–565 pairs in 2019. We recorded a gradual increase of Griffon Vulture subpopulations in Serbia (λ = 1.08 ± 0.003), Bulgaria (λ = 1.08 ± 0.003) and Croatia (λ = 1.05 ± 0.005) and steep to a moderate decline of the species subpopulations in Greece (λ = 0.88 ± 0.005) and North Macedonia (λ = 0.94 ± 0.01). However, species range contracted to half of its former range in the same period. It occurred in 42 UTM squares in the 1980–1990 period and only 20 UTM squares between 2011 and 2019 and concentrated into three source subpopulations in Bulgaria, Serbia, and Croatia. Following reintroductions of the Griffon Vulture in Bulgaria, new colonies were formed at three novel localities after 2010. Regular movements of individuals between the different subpopulations exist nowadays. Therefore, preservation of both current and former core areas used for breeding and roosting is essential for species conservation in the region. However, the Griffon Vulture still faces severe threats and risk of local extinction. Various hazards such as poisoning, collision with energy infrastructure, disturbance and habitat alteration are depleting the status of the Balkan population and its full recovery. Further studies should analyse age-specific survival and mortality, recruitment, genetic relatedness, spatial use to inform the viability of this population in the future.

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In this report, we present a novel technique of successful coil embolisation using temporary deployment of two Comaneci devices placed in Y configuration across a wide-neck ruptured basilar tip aneurysm. The placement of two devices across the wide aneurysm neck allowed optimal coverage for safe coil delivery, while maintaining parent vessel patency. This case highlights the unique and safe applicability of two crossed Comaneci devices in a ruptured aneurysm with unfavourable anatomy, ultimately resulting in complete aneurysm obliteration. To our knowledge, this is the first reported case of double Comaneci usage in a wide-neck ruptured aneurysm. This technique can be potentially applied in challenging wide-neck bifurcation aneurysms, particularly when double antiplatelet therapy is of concern.

Background Precipitating hydrophobic injectable liquid is a newly introduced liquid embolic agent for endovascular embolization with some technical advantages over other liquid embolic agents. We present our initial experience with precipitating hydrophobic injectable liquid in the endovascular treatment of cerebral arteriovenous malformations. Methods From October 2015 to January 2018, 27 patients harboring cerebral arteriovenous malformations underwent endovascular embolization with precipitating hydrophobic injectable liquid 25. Clinical features, angiographic results, procedural details, complications, and follow-up details were retrospectively analyzed. Results Twenty-seven patients with cerebral arteriovenous malformations were included. Total obliteration in one endovascular session was confirmed for 14/27 (52%) patients. Partial embolization was attained in 13 patients (48%) in whom staged treatment with following radiosurgery or surgery was planned. No mortality was recorded in this series. Complications during or after the embolization occurred in six of 27 (22.2%) patients. Conclusion In our initial experience, precipitating hydrophobic injectable liquid has acceptable clinical outcome comparable to other liquid embolic agents. Although this is the largest reported study in arteriovenous malformation treatment with precipitating hydrophobic injectable liquid, further studies are needed to validate its safety and efficacy.

Background and PurposeLiquid embolic agents (LEAs) are the determinant tool for successful embolization of cranial arteriovenous shunts. There are few currently available LEAs. The aim of the study was to summarize our initial experience with a recently introduced non-adhesive ethylene vinyl alcohol (EVOH) copolymer based LEA (Menox 18) in the endovascular treatment of cerebral arteriovenous malformations.MethodsFrom April 2018 to November 2018, 24 patients harboring cerebral arteriovenous malformations underwent endovascular embolization with Menox 18. Clinical features, angiographic results, procedural details, complications, and follow-up details were prospectively collected and retrospectively analyzed.ResultsCurative embolization in one endovascular session was achieved in 14/24 (58.3%) of the treated patients. Partial embolization was achieved in 10 patients (42.6%) in whom staged treatment with radiosurgery or microsurgical resection was planned. No mortality was recorded in our series. Clinical complications after embolization occurred in 1/24 (4.66%) patients. No technical complications were notedConclusionsOur pilot study suggests that the Menox embolization system offers similar technical and clinical results in comparison with the other currently available LEAs. Further studies with larger cohorts and long term follow-up data are needed to fully evaluate its efficacy