Overlapping Stent-assisted Coil Embolization for Ruptured Blood Blister-like Aneurysms of Basilar Trunk: Two Case Reports
Yusuke MorinagaKouhei NiiAyumu EtoHayatsura HanadaTakafumi MitsutakeFumihiro HiraokaRitsurou InoueKimiya SakamotoMasanori Tsutsumi
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Objective: In this report, we discuss the cases of two patients with a ruptured blood blister-like aneurysm (BBA) of the basilar trunk, who we treated with overlapping stent-assisted coil embolization (SACE).Case Presentations: Case 1: The first patient was a 52-year-old male with a World Federation of Neurosurgical Societies (WFNS) Grade IV subarachnoid hemorrhage (SAH).A 2 mm anterior wall BBA of the basilar artery (BA) was detected on cerebral angiography on day 10 and treated with overlapping SACE.No recanalization was observed at 12 months after surgery.Case 2: The second patient was a 62-year-old female with WFNS Grade I SAH.A 1.7 mm posterior wall BBA of the BA was detected on cerebral angiography on day 5, which was treated with overlapping stents alone, but a residual aneurysm was noted on day 14, and SACE was additionally performed.Infarction of the perforating branch was noted after surgery, but the aneurysm was completely occluded on follow-up after 1 week.No recanalization was observed at 10 months after surgery. Conclusion:Although overlapping SACE may be effective for ruptured BBAs of the basilar trunk, attention should be paid to the damage of the perforating branch after surgery in cases of aneurysm of the posterior wall of the BA.For appropriate multiple overlapping stents, accumulation of cases and further investigations are necessary.Keywords▶ basilar trunk, ruptured blood blister-like aneurysms, overlapping stent-assisted coil embolization, low-profile visualized intraluminal support, barrel technique Case PresentationsCase 1: The first patient was a 52-year-old male.Off-time response is usually measured by transient electromagnetic (TEM) system to detect subsurface targets. Compared with off-time response, on-time response of TEM system is more sensitive to high-conductivity targets, such as UXOs. However, it is difficult to obtain on-time response directly due to the strong primary field response. The key problem for on-time measurement is to eliminate the primary field response. Bucking coil is adopted here to compensation the primary field of transmitter coil at receiving coil for on-time response measuring. Firstly, the structure of the sensor with transmitting coil, bucking coil, and receiving coil is presented. Then, the primary field of transmitting coil and bucking coil at the position of receiving coil is calculated theoretically. With the side length of transmitting coil, bucking coil and the receiving coil fixed, the number of turns for transmitting coil and bucking coil are optimized for the best compensation. Calculated results show that the best compensation effect can reach 0.53%. Finally, the sensor with a transmitting coil (constructed with a side length and number of turns of 96 cm and 30, respectively), a bucking coil (constructed with a side length and number of turns of 26 cm and 8, respectively), and a receiving coil (constructed with a side length of 6 cm) was built. Measured results show that the primary field response after compensation is no more than 1% of the original response, and the maximum amplitude is only 0.4V. The on-time response of targets can be accurately recorded.
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The trunk is the part of the human body that provides basic mechanical stabilization. It provides strength transmission between the upper and lower body regions. Body control is the ability of the body muscles to maintain the upright posture, to adapt to weight transfers, and to maintain selective trunk and limb movements by maintaining the support surface in static and dynamic postural adjustments. Good proximal trunk control provides better distal limb movements, balance, and functional motion. There are many evaluation methods, devices, and scales for trunk function and performance. 3D kinematic, electromyography, hand-held dynamometer, isokinetic dynamometer, trunk accelerometer are some devices that measure trunk function. The motor assessment scale-trunk subscale, the stroke impairment assessment set- trunk control subscale, trunk control test, trunk impairment scale are the most used scales. This chapter explores the effect of strokes on the trunk.
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A RLC model of magnetic stimulator with arbitrary coil shape and computations of the model parameters is presented. To optimize coil, the characteristics specifying a coil are classified into peak magnetic energy and coil geometry, respectively characterizing the coil output and coil structure. With the activating function at stimulating threshold, an optimal coil is searched by adjusting the coil structure parameters and computing the corresponding coil output. It is demonstrated from the optimization that maximum outer radius of coil is a key structure factor in determining the coil output, and with optimally selected maximum outer radius of coil and given the stimulating threshold, the peak magnetic energy can be greatly reduced. It is also shown that current circular coil isn′t optimal and the D shape coil is superior to the circular coil.
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[Purpose] To explore the differences in bilateral trunk muscle activation between chronic stroke patients and healthy controls, this study investigated the symmetry index and cross-correlation of trunk muscles during trunk flexion and extension movements. This study also assessed the differences in trunk reposition error between groups and the association between trunk reposition error and bilateral trunk muscle activation. [Subjects and Methods] Fifteen stroke patients and 15 age- and gender-matched healthy subjects participated. Bilateral trunk muscle activations were collected by electromyography during trunk flexion and extension. Trunk reposition errors in trunk flexion and extension directions were recorded by a Qualisys motion capture system. [Results] Compared with the healthy controls, the stroke patients presented lower symmetrical muscle activation of the bilateral internal oblique and lower cross-correlation of abdominal muscles during trunk flexion, and lower symmetry index and cross-correlation of erector spinae in trunk extension. They also showed a larger trunk extension reposition error. A smaller trunk reposition error was associated with higher cross-correlation of bilateral trunk muscles during trunk movements in all subjects. [Conclusion] Trunk muscle function during symmetrical trunk movements and trunk reposition sense were impaired in the chronic stroke patients, and trunk position sense was associated with trunk muscle functions. Future studies should pay attention to symmetrical trunk movements as well as trunk extension position sense for patients with chronic stroke.
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[Purpose] The purposes of this study were to investigate differences between patients with chronic stroke and age matched healthy controls in trunk stability, by assessing the kinematics of the center of mass and moving body segments during voluntary limb and trunk movement, and the relationship between trunk stability and clinical measurements. [Subjects and Methods] Fifteen stroke patients and 15 age- and gender-matched healthy subjects participated. Each subject performed flexion of the hip and shoulder of the non-paretic or matched side as fast as possible, as well as trunk flexion and extension at a self-selected speed. A Qualisys motion system was employed to track the kinematics of the trunk and limbs. [Results] Patients presented larger mediolateral displacement of the center of mass during all limb and trunk movements, and larger velocity of center of mass during hip flexion movement. Healthy subjects showed greater movement velocity during shoulder flexion, trunk flexion and extension. Patients' clinical measurements only correlated with movement characteristics during voluntary trunk motions. [Conclusion] Trunk stability in patients with chronic stroke was compromised during voluntary trunk as well as non-paretic limb movements, and the voluntary trunk movements reflected the trunk deficits measured using clinical measurements. Rehabilitation of patients with chronic stroke should include programs to improve trunk stability.
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This study examined the effects of various seated trunk postures on upper extremity function. 59 adults were tested using the Jebsen Taylor Hand Function Test while in three different trunk postures. Significant mean differences between the neutral versus the flexed and laterally flexed trunk postures were noted during selected tasks. Specifically, dominant hand performance during the tasks of feeding and lifting heavy cans was significantly slower while the trunk was flexed and laterally flexed than when performed in the neutral trunk position. Performance of the nondomi nant hand during the tasks of picking up small objects, page turning, as well as the total score was slower while the trunk was flexed compared to performance in the neutral trunk position. These findings support the assumption that neutral trunk posture improves upper extremity performance during daily activities although the effect is not consistent across tasks. Findings are discussed along with limitations and recommendations for research.
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Transcranial magnetic stimulation (TMS) has recently been used as a method for the treatment of neurological and psychiatric diseases. Daily TMS sessions can provide continuous therapeutic effectiveness, and the installation of TMS systems at patients' homes has been proposed. A figure-eight coil, which is normally used for TMS therapy, induces a highly localized electric field; however, it is challenging to achieve accurate coil positioning above the targeted brain area using this coil. In this paper, a bowl-shaped coil for stimulating a localized but wider area of the brain is proposed. The coil's electromagnetic characteristics were analyzed using finite element methods, and the analysis showed that the bowl-shaped coil induced electric fields in a wider area of the brain model than a figure-eight coil. The expanded distribution of the electric field led to greater robustness of the coil to the coil-positioning error. To improve the efficiency of the coil, the relationship between individual coil design parameters and the resulting coil characteristics was numerically analyzed. It was concluded that lengthening the outer spherical radius and narrowing the width of the coil were effective methods for obtaining a more effective and more uniform distribution of the electric field.
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Female participants present a unique challenge as the design of the bra used to support the breasts occludes the correct positioning of many recommended trunk marker sets. This study aimed to compare the effect of two existing and one new trunk marker set on the calculation of trunk and breast kinematics. Twelve females had markers placed on their trunk and right nipple; these markers were tracked using infrared cameras during five running gait cycles and used to define three trunk calculation methods: Trunk 1: suprasternal notch, right and left ribs; Trunk 2: supersternal notch, processus xiphoideus, 7th cervical and 8th thoracic spinous process; Trunk 3: Trunk 2 plus a marker 33% from the suprasternal notch to the processus xiphoideus, and another 50% between the 7th cervical and 8th thoracic spinous process. Trunk segment capture success, segment origin instability, segmental residual, trunk kinematics, and breast range of motion (relative to the trunk segment), were calculated for each trunk segment. Segment capture success varied from 88% (Trunk 1) to 100% (Trunk 2 and 3). Segment origin instability ranged from 0.2 cm (Trunk 2 and 3) to 1.5 cm (Trunk 1). Maximum trunk extension differed by 7° and breast range of motion varied by 41% (anterioposterior), 54% (mediolateral), and 21% (superioinferior) between trunk calculation methods. The selection of marker set used to construct the trunk segment is critical before recommending improvements to bra design to improve breast support. The Trunk 3 marker set is recommended for subsequent breast research.
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