Background and Purpose— Flow diverter technology improvements are necessary to provide safe and good results and enable the treatment of a larger variety of aneurysms. We report a nationwide experience with the Derivo Embolization Device in the treatment of intracranial aneurysms. Methods— BRAIDED (Brazilian Registry of Aneurysms Assigned to Intervention With the Derivo Embolization Device) is a multicenter, prospective, interventional, single-arm trial of the Derivo Embolization Device for the treatment of intracranial aneurysms. The primary effectiveness end point was total aneurysm occlusion at 6- and 12-month angiographies. The secondary safety end point was the absence of serious adverse events during follow-up. Univariable and multivariable logistic regression was performed to identify predictors of aneurysm persistence, periprocedural complications, and adverse events during follow-up. Results— Between December 2016 and October 2018, 146 patients harboring 183 intracranial aneurysms were treated in 151 interventions at 7 centers. Derivo Embolization Device placement was technically successful in all patients. Most aneurysms (86.9%) were located at the internal carotid artery, and the mean diameter was 6.7 mm. At 6 months, 113 of 140 (80.7%) aneurysms met the study’s primary end point, and 74 of 83 (89.2%) met the study’s primary end point at 12 months. Saccular morphology of the aneurysm (odds ratio, 5.66; 95% CI, 1.01–31.77) and the presence of a branch arising from the sac (odds ratio, 6.36; 95% CI, 2.11–22.36) predicted persistence. A long duration of follow-up (odds ratio, 0.86; 95% CI, 0.78–0.95) predicted total occlusion. Of the 146 enrolled patients, 138 (94.5%) were treated without serious adverse events during follow-up. In the multivariable analysis, aneurysms located at a sidewall were less likely to experience these events than those located at bifurcations (odds ratio, 0.07; 95% CI, 0.01–0.51). Conclusions— The Derivo Embolization Device is a safe and effective treatment for intracranial aneurysms. Clinical Trial Registration— URL: http://plataformabrasil.saude.gov.br/login.jsf . Unique identifier: CAAE 77089717.7.1001.5125.

Objective Clarify the safety and efficacy of the endovascular treatment of distal anterior cerebral artery (DACA) aneurysms, reporting outcomes of the aneurysms coiled in our service were compared with series of microsurgical treatment. The impact of embolization on ruptured or unruptured aneurysms remains controversial according to the current data, considering aneurysm from this topography should be aggressively treated due to their high incidence of rupture, currently there is a tend to prefer endovascular treatment. Methods We conducted a retrospective cohort study with 1092 patients admitted with cerebral aneurysm from October 2005 to March 2015 in our service. There were 31 cases of DACA aneurysms treated with the endovascular technique. These were compared with same topography aneurysms underwent to clipping. Results A total of 21 (67%) of 31 cases presented with ruptured aneurysms, 13 (59%) suffered clinical or radiological vasospasms, with modified Rankin Scale (mRS) scores of 3-5 in 7 patients (31%), and 4 deaths (mRS 6), reaching 92% of occlusion at one year. Conclusion Endovascular approach is associated with high angiographic occlusion rates and security. ResumoObjetivo Para esclarecer a segurança e eficácia do tratamento endovascular dos aneurismas distais da artéria cerebral anterior distal (DACA), foram relatados os resultados de aneurismas embolizados em nosso serviço e comparados com séries de tratamento microcirúrgico. O impacto da embolização em aneurisma roto ou não roto permanece controverso com base nos dados atuais, considerando que o aneurisma dessa topografia deve ser tratado agressivamente devido à elevada incidência de ruptura, há uma tendência em preferir tratamento endovascular. Métodos Realizamos um estudo retrospectivo de 1092 pacientes admitidos com aneurisma cerebral entre Outubro de 2005 a Março de 2015 em nosso serviço. Haviam

Due to its dissecting nature, wall friability and lack of a substantial neck can make surgical clipping and selective coiling difficult and risky. Although endovascular parent artery occlusion is the best approach in the acute phase, in some situations it is not possible or very risky. In such scenario the use of flow diverter devices would be an alternative approach. Additionally, we discuss the potential advantages and risks of flow diverter deployment inside a developing vessel.

The TOBC was shown to be safe and effective for the treatment of intracranial aneurysms with BAC. In addition, it was successfully employed to perform angioplasty for vasospasm and BTO. Finally, it was used in the balloon anchor technique for the first time.

Objective Compare 30 days mortality of patients harboring acute subdural hematomas in two series, one treated only by wide aspiration of hematoma and other with aspiration followed by decompressive craniectomy. Methods Comparing retrospectively two series of ASD with and without DC. Involved 81 TBI patients with acute subdural hematoma and GCS 8 (Jan 2000 to Nov 2014) arranged into two groups. Group 1 -58 cases underwent to DC. Group 2 -23 patients underwent only hematoma aspiration. Results Group 1 showed 44.8% mortality directly due to brain lesion within 30 days. The most frequent associated lesion were contusion in 37.2%. Group 2 the mortality within 30 days was 47.8%. The majority of deaths (82%) resulted from uncontrollable brain swelling, midline shift was present in 94.7% of patients. Conclusion High admission GCS and age less than 50 remain better outcome predictor in 30 days survival for patients undergoing surgery of traumatic ASDH.

Objective This retrospective study aimed to analyze prognostic factors, effects of treatment, and survival outcome of patients with brain metastasis from melanoma at a single institution over the last 22 years. Methods Study transversal retrospective of 34 patients with brain metastases from melanoma, histologically proven, surgically treated by the Department of Neurosurgery at the Hospital Santa Isabel, Blumenau, over 22 years. Results The median patient age was 50 years and 67.6% of the patients were men. Most patients (70.6%) had a single cerebral metastasis and 29.4% had two three injuries. Twenty percent of the patients in this series had evidence of extracranial metastasis. The KPS at presentation was !70 in 12 patients (35.2%). Evidence of recurrent intracranial melanoma was found during follow-up review in 17.6% of patients. The overall median survival time from diagnosis of cerebral metastasis was 14.4 months. The absence of extracranial metastasis was associated with a significantly prolonged survival (p ¼ 0.052), as was adjuvant therapy (p ¼ 0.02). Conclusion The early diagnosis, with total resection of melanoma metastasis and association of adjuvant therapies showed a positive influence on survival. However, the number of lesions and extracranial disease decreased the survival rates.

A Trombose Venosa Cerebral (TVC) é uma afecção rara, que resulta em obstrução parcial ou total dos seios venosos cerebrais. Possui diversas causas desencadeantes como infecção, trauma e distúrbios de coagulação, assim como diversas apresentações clínicas. O trabalho relata o caso de TVC de um paciente jovem, do sexo masculino, que havia feito uso de Tamoxifeno, receitadona academia de musculação, para evitar crescimento das mamas pelo uso de suplementos de fórmula não conhecida. Foram discutidos também seu diagnóstico e abordagem escolhida.

RESUMOO acidente vascular encefálico é pouco frequente na população jovem. Entretanto, o impacto permanece devastador sobre a qualidade de vida, sendo uma importante causa de óbito e incapacitação. O objetivo do trabalho foi relatar um caso infrequente de AVE isquêmico em território da artéria basilar em uma paciente de 16 anos, que apresentava dois fatores de risco potenciais, o forame oval patente e o uso de anticoncepcional oral.