Our retrospective study confirms that morbidity and mortality rates in treatment with FDD of unruptured wide-neck or untreatable cerebral aneurysms do not differ from those reported in the largest series.

BackgroundExperience with the endovascular treatment of cerebral aneurysms using the p64 Flow Modulation Device is still limited. This study discusses the results and complications of this new flow diverter device.Methods40 patients (30 women, 10 men) with 50 cerebral aneurysms treated in six Italian neurointerventional centers with the p64 Flow Modulation Device between April 2013 and September 2015 were retrospectively reviewed.ResultsComplete occlusion was obtained in 44/50 aneurysms (88%) and partial occlusion in 3 (6%). In the other three aneurysms (6%), two cases of asymptomatic in-stent thrombosis and one intraprocedural occlusion of the parent vessel occurred. Technical complications were observed in eight procedures (16%). Permanent morbidity due to acute in-stent thrombosis and consequent ischemic stroke occurred in one patient (2.5%). No delayed aneurysm rupture, subarachnoid or intraparenchymal hemorrhage, or ischemic complications occurred and there were no deaths.ConclusionsEndovascular treatment with the p64 Flow Modulation Device is a safe treatment for unruptured cerebral aneurysms, resulting in a high rate of occlusion. As with other flow diverter devices, we recommend this treatment mainly for large-necked aneurysms of the internal carotid artery siphon. However, endovascular treatment with the p64 device should also be encouraged in difficult cases such as aneurysms of the posterior circulation and beyond the circle of Willis.

Aortocaval fistula (ACF) is a rare complication of abdominal aortic aneurysm (AAA). We report the endovascular repair of an AAA rupture into the inferior vena cava. A 78-year-old woman was admitted to our hospital for acute hypotension. She presented with a pulsatile abdominal mass and became rapidly anuric. Abdominal computed tomography (CT) showed an AAA rupture into the inferior vena cava. The features of the AAA made it suitable for endovascular repair. To prevent pulmonary embolism caused by the presence of sac thrombosis near the vena cava lumen, a temporary vena cava filter was deployed before the procedure. A bifurcated stent-graft was placed with the patient under local anaesthesia, and the AAA was successfully treated. A transient type II endoleak was detected on CT 3 days after endograft placement. At routine follow-up 6 and 12 months after the procedure, the patient was in good clinical condition, and the type II endoleak had sealed completely. Endovascular treatment offers an attractive therapeutic alternative to open repair in case of ACF; however, only small numbers of patients have been treated, and long-term follow-up interval is lacking.

BACKGROUND intraoperative computer tomography (iCT) and advanced image fusion algorithms could improve the management of brainshift and the navigation accuracy. OBJECTIVE To evaluate the performance of an iCT-based fusion algorithm using clinical data. METHODS Ten patients with brain tumors were enrolled; preoperative MRI was acquired. The iCT was applied at the end of microsurgical resection. Elastic image fusion of the preoperative MRI to iCT data was performed by deformable fusion employing a biomechanical simulation based on a finite element model. Fusion accuracy was evaluated: the target registration error (TRE, mm) was measured for rigid and elastic fusion (Rf and Ef) and anatomical landmark pairs were divided into test and control structures according to distinct involvement by the brainshift. Intraoperative points describing the stereotactic position of the brain were also acquired and a qualitative evaluation of the adaptive morphing of the preoperative MRI was performed by 5 observers. RESULTS The mean TRE for control and test structures with Rf was 1.81 ± 1.52 and 5.53 ± 2.46 mm, respectively. No significant change was observed applying Ef to control structures; the test structures showed reduced TRE values of 3.34 ± 2.10 mm after Ef (P < .001). A 32% average gain (range 9%-54%) in accuracy of image registration was recorded. The morphed MRI showed robust matching with iCT scans and intraoperative stereotactic points. CONCLUSIONS The evaluated method increased the registration accuracy of preoperative MRI and iCT data. The iCT-based non-linear morphing of the preoperative MRI can potentially enhance the consistency of neuronavigation intraoperatively.