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Aim: To compare the risk of postoperative haemorrhage with different sizes of brain biopsy needles. Patients and Method: A cohort of patients using a 2.5-mm outer diameter side-cutting biopsy needle was compared to a subsequent cohort using a 1.8-mm needle of the same type. All data were collected prospectively. A CT scan was done within 12 h after surgery. Any visible haemorrhage at the operated site was documented. Results: From 2007 to 2013, 54 stereotactic brain biopsies (all frameless except for one frame-based) were performed. The 2.5-mm group comprised 29 procedures from 2007 to 2009. The 1.8-mm group comprised the subsequent 25 procedures. The diagnostic yields were 90 and 96% in the 2.5- and the 1.8-mm group, respectively (p = 0.615). Comparing the 2.5- and the 1.8-mm group, haemorrhage was significantly reduced: incidence (72 vs. 40%, p = 0.016); size of haemorrhage (mean 7.2 vs. 2.6 mm, p = 0.002); proportion of haemorrhage size >10 mm (34.5 vs. 4%, p = 0.006). Symptomatic haemorrhage rates were 3.4 and 0.0% in the 2.5- and the 1.8-mm group, respectively (p = 1.00). Conclusion: The 1.8-mm outer diameter needle carried a lower risk of postoperative haemorrhage than the 2.5-mm one, without compromising the diagnostic yield.

Spontaneous subarachnoid haemorrhage accounts for only 3-4% of all stroke but the consequences can be devastating. In the present review article, we review the epidemiology, clinical features, investigations and management philosophy in patients with aneurysmal subarachnoid haemorrhage. Oral nimodipine, aneurysmal occlusion and advances in neurointensive care are the keys to improve neurological outcome in patients after aneurysmal subarachnoid haemorrhage. These patients should be managed by a combined team with expertise in microsurgery, endovascular surgery and neurointensive care for optimal management outcome. Early diagnosis and treatment is the key to improve outcome and reduce disability and mortality.

Single burr hole rigid ETV/ETB is likely to be safe within maximum FM displacements of 4.8 mm anterior for ETV and 5.5 mm posterior for ETB. Preoperative trajectory planning using neuronavigation software is recommended.

Background: Intracranial aneurysm rupture has the highest levels of mortality and morbidity among all stroke types. To answer the question of how and why different well-established and novel treatment techniques were developed, it is crucial to understand the historic hurdles and breakthroughs in intracranial aneurysm treatment over the years. Methods: Literature review was carried out using PubMed and the electronic database of Surgical Practice. Relevant articles were retrieved for further appraisal. Results: The neuro-endovascular treatment field has evolved from the use of detachable balloons or coils to the use of bioactive coils, balloon test occlusion, the balloon-and stent-assisted techniques, and the flowdiverting stent. The application of intraoperative indocyanine green angiography has also improved microsurgical treatment in recent years. Conclusions: Advances in endovascular technology have made coiling the cornerstone of intracranial aneurysm treatment. However, the roles played by different endovascular tools need to be better understood.

Aim:  Previously‐published meta‐analyses have concluded that coil embolization of very small (≤ 3 mm) intracranial aneurysms carry a high risk of procedural rupture, leading to morbidity and mortality. Several case series subsequently questioned the real procedural rupture risk. We therefore carried out an updated meta‐analysis. Patients and Methods:  Computerized EMBASE, MEDLINE and PubMed searches of the literature for reports on the safety and efficacy of treatment of intracranial aneurysms with a maximum dimension of ≤ 3 mm were carried out from January 1990 to January 2011. Statistical analyses were generated using SPSS for Windows Version 15.0 and Comprehensive MetaAnalysis 2.0 for Windows. Results of the meta‐analyses are presented with 95 per cent confidence intervals (CI). Results:  Twelve eligible studies with 637 patients (660 aneurysms) were analysed. Procedural aneurysm rupture occurred in 39 (5.9 per cent) of 660 aneurysm treatments (random‐effect‐weighted average: 7.2 per cent; 95 per cent CI: 5.3–9.6 per cent; Q‐value: 11; I2 = 4 per cent). Immediate satisfactory occlusion was achieved in 508 (88 per cent) of 579 aneurysm treatments (random‐effect‐weighted average: 84 per cent; 95 per cent CI: 81–87 per cent; Q‐value: 48; I2 = 81 per cent). Delayed satisfactory occlusion was achieved in 379 (88 per cent) of 433 aneurysm treatments (random‐effect‐weighted average: 82 per cent; 95 per cent CI: 77–86 per cent; Q‐value: 48; I2 = 83 per cent). Conclusions:  The present findings suggest that coiling of very small intracranial aneurysms is associated with 7.2 per cent procedural aneurysm rupture risk. Further prospective multicenter studies should be carried out in Hong Kong to review the procedural morbidity and mortality.

Precipitating hydrophobic injectable liquid (PHIL; MicroVention, Aliso Viejo, CA, USA) and Squid (Balt, Irvine, CA, USA) are 2 newer liquid embolic agents used in endovascular embolization of cerebral arteriovenous malformation (AVM). This study aims to investigate and compare the effectiveness and safety profile of the 2 newer liquid embolic agents in the embolization of cerebral AVM. This is a retrospective study on all patients diagnosed with cerebral AVM undergoing endovascular embolization with liquid embolic agents PHIL and Squid admitted to the Division of Neurosurgery, Department of Surgery in Prince of Wales Hospital from January 2014 to June 2021. Twenty-three patients with cerebral AVM were treated with 34 sessions of endovascular embolization with either PHIL or Squid (17 sessions each) liquid embolic agents with a male to female ratio of 2.3:1 (male 16; female 7) and mean age of 44.6 (range, 12 to 67). The mean total nidus obliteration rate per session was 57% (range, 5% to 100%). Twenty-one patients (91.3%) received further embolization, stereotactic radiosurgery, or surgical excision after initial endovascular embolization. There were 2 morbidities (1 neurological and 1 non-neurological, 6%) and no mortalities (0%). All patients had static or improvement in modified Rankin Scale at 3 to 6 months at discharge. PHIL and Squid are effective and safe liquid embolic agents for endovascular embolization of cerebral AVM, achieving satisfactory nidal obliteration rates and patient functional outcomes.