Satoru Takahashi

Background: Transvenous embolization is the standard treatment for cavernous sinus dural arteriovenous fistulas (CS DAVFs). In some patients with CS DAVFs, selective embolization is possible if the shunted pouches can be accurately identified, avoiding the risk of cranial nerve damage due to excess coil use. Purpose: To evaluate the utility of three-dimensional (3D)-printed models in enhancing the spatial understanding of shunted pouches and approach routes and facilitating selective embolization for CS DAVFs. Material and Methods: The 3D-printed models of the CS of five patients with CS DAVFs treated between 2022 and 2024 were printed with fused deposition modeling 3D printers using 3D data from 3D digital subtraction angiography (3D-DSA). Shunted pouches were identified using high-resolution cone-beam computed tomography and four-dimensional DSA. Embolization procedures were planned based on the tactile and spatial understanding provided by 3D-DSA and 3D-printed models. Five patients treated between 2018 and 2022 without 3D-printed models were used as controls. Results: Complete shunt obliteration was observed in all five patients whose CS was 3D-printed. Two patients were treated successfully with selective embolization of the shunted pouch alone and three patients required additional partial sinus packing. In the control group, selective embolization was possible in only one patient, and only two patients achieved complete obliteration, including one requiring retreatment due to early recanalization. Conclusion: The use of 3D-printed models for CS DAVFs treatment may improve shunt point recognition and facilitate effective selective embolization.

Purpose: Coil embolization is a standard treatment for intracranial aneurysms. However, ischemic complications remain a concern, despite advancements in technology and the use of antithrombotic agents. Microcatheter-related thrombogenesis has been identified as a contributing factor to these complications. Although previous studies have focused on external morphological changes, limited data are available on the impact of changes in the inner lining of microcatheters on ischemic events. In this study, we used scanning electron microscopy (SEM) to investigate changes in the inner lining of microcatheters after coil embolization. Methods: Five SL-10, two Phenom 17, and one Echelon 10 microcatheters used in coil embolization procedures were examined using SEM. An unused microcatheter served as a control. The microcatheters were sectioned at various locations and analyzed under high magnification. Results: SEM provided high-resolution visualization of the inner lining of the microcatheter, revealing morphological alterations that were undetectable by light microscopy. The control had an intact membrane, whereas the SL-10 microcatheters showed varying degrees of damage. Microcatheters used in multiple-coil deliveries exhibited extensive peeling and cracking of the inner lining. Additionally, clots composed of red blood cells were observed inside the microcatheters. The same morphological changes in the inner linings were observed in other types of microcatheters, such as Phenom 17 and Echelon 10. Conclusion: SEM showed that repeated microcatheter use in coil embolization damages the inner lining, potentially contributing to thrombus formation and ischemic complications. These findings highlight the need to investigate microcatheter durability and thromboresistance to mitigate embolization-related ischemic risks.

Introduction It is important to assess the effectiveness of an antiseizure medication in treating different epilepsy aetiologies to optimise individualised therapeutic approaches. Data from the PERaMpanel pooled analysIs of effecTiveness and tolerability (PERMIT) Extension study were used to assess the effectiveness and safety/tolerability of perampanel (PER) when used to treat individuals with a range of epilepsy aetiologies in clinical practice. Methods A post hoc analysis was conducted of PERMIT Extension data from individuals with a known aetiology. Retention was assessed after 3, 6 and 12 months. Effectiveness was assessed after 3, 6 and 12 months and at the last visit (last observation carried forward). Effectiveness assessments included responder rate (≥ 50% seizure frequency reduction) and seizure freedom rate (no seizures since at least the prior visit). Safety/tolerability was assessed by evaluating adverse events (AEs) and AEs leading to discontinuation. Results PERMIT Extension included 1945 individuals with structural aetiology, 1012 with genetic aetiology, 93 with an infectious aetiology, and 26 with an immune aetiology. Retention rates at 12 months were 61.1% (structural), 65.9% (genetic), 56.8% (infectious) and 56.5% (immune). At the last visit, responder rates (total seizures) were 43.3% (structural), 68.3% (genetic), 37.0% (infectious) and 20.0% (immune), and corresponding seizure freedom rates were 15.8%, 46.5%, 11.1% and 5.0%, respectively. AE incidence rates were 58.0% (structural), 46.5% (genetic), 51.1% (infectious) and 65.0% (immune), and corresponding rates of discontinuation due to AEs over 12 months were 18.9%, 16.4%, 18.5% and 21.7%, respectively. The types of AEs reported were generally consistent across aetiology subgroups, with no idiosyncratic AEs emerging. Conclusion Although PER was effective and generally well tolerated when used to treat individuals with a range of epilepsy aetiologies in clinical practice, variability in its effectiveness and tolerability across the subgroups indicates that PER may be particularly useful for individuals with specific epilepsy aetiologies.

The eye lens of vertebrates is composed of fibre cells in which all membrane-bound organelles undergo degradation during terminal differentiation to form an organelle-free zone¹. The mechanism that underlies this large-scale organelle degradation remains largely unknown, although it has previously been shown to be independent of macroautophagy^2,3. Here we report that phospholipases in the PLAAT (phospholipase A/acyltransferase, also known as HRASLS) family—Plaat1 (also known as Hrasls) in zebrafish and PLAAT3 (also known as HRASLS3, PLA2G16, H-rev107 or AdPLA) in mice^4,5,6—are essential for the degradation of lens organelles such as mitochondria, the endoplasmic reticulum and lysosomes. Plaat1 and PLAAT3 translocate from the cytosol to various organelles immediately before organelle degradation, in a process that requires their C-terminal transmembrane domain. The translocation of Plaat1 to organelles depends on the differentiation of fibre cells and damage to organelle membranes, both of which are mediated by Hsf4. After the translocation of Plaat1 or PLAAT3 to membranes, the phospholipase induces extensive organelle rupture that is followed by complete degradation. Organelle degradation by PLAAT-family phospholipases is essential for achieving an optimal transparency and refractive function of the lens. These findings expand our understanding of intracellular organelle degradation and provide insights into the mechanism by which vertebrates acquired transparent lenses.

Background: Chronic subdural hematoma (CSDH) is a disorder that is commonly seen in routine neurosurgery. Although risk factors for recurrence have been studied, the findings are inconsistent. Furthermore, bilateral CSDHs are operated unilaterally or bilaterally depending on symptoms or hematoma volume. Although there are cases in which hematomas on nonoperated side in unilaterally operated bilateral CSDHs requiring for additional operation, little have been studied on the effect of the surgical selection. The purpose of this study is to identify risk factors for recurrence in operated hematomas and additional operation in nonoperated hematomas and improve surgical strategy. Materials and Methods: We retrospectively reviewed patients who underwent surgery in our facility for bilateral CSDHs between January 2011 and December 2016. Univariate and multivariate analyses were performed to examine the relationship between recurrence or requirement for additional operation and clinical and radiological variables. Results: Recurrence was observed significantly more frequent for operated hematomas when hematoma type was separated type as reported previously. In unilaterally operated bilateral CSDHs, there were 22 hematomas on nonoperated side, and five hematomas required an additional operation after the first hospitalization. Increased volume of hematoma on the nonoperated side was the risk factors for additional operation (P = 0.022). Receiver operating characteristic (ROC) curve revealed that requirement for additional operation significantly increased when hematoma volume enlarged to approximately 44 cm³ or greater 1 day after operation. Conclusions: In unilaterally operated bilateral CSDHs, when hematoma volume on nonoperated side increased 1 day after the last operation, additional operation in the early stage is considerable to prevent re-hospitalization and deterioration of activities of daily living.