Lim S, et al. Korean J Neurotrauma. 2022 May;18:e27. https://doi.org/10.13004/kjnt.2022.18.e27

We report our experience in treating a ruptured dissecting posterior inferior cerebellar artery (PICA) aneurysm. To our knowledge, this is the first reported case of overlapping stenting without coils for a ruptured dissecting aneurysm of the proximal PICA. A 66-year-old male patient presented with sudden altered mental state and a subarachnoid hemorrhage (SAH). The cerebral angiography revealed a long segmental dissecting aneurysm on proximal PICA. Overlapping stents were deployed to the dissecting site, and angiogram showed intact distal PICA flow and decreased contrast staining in the dissecting site. Successful flow diversion was achieved with stents. Procedure-associated complications did not occur. The patient’s postoperative course was uneventful. In follow-up cerebral angiography, dissecting aneurysm achieved complete remodeling. The decision that led to the choice of treatment is discussed.

Background and Objectives: The usefulness of extracorporeal membrane oxygenation (ECMO) therapy for acute respiratory distress syndrome (ARDS) in patients with traumatic brain injury (TBI), spontaneous intracerebral hemorrhage (ICH), or subarachnoid hemorrhage (SAH) is limited. This study aimed to investigate the survival benefit of ECMO in ARDS that developed during hospitalization in high-risk neurological patients. Materials and Methods: This retrospective study evaluated patients with TBI or spontaneous ICH and SAH admitted to our hospital’s neurosurgery intensive care unit and who received ECMO therapy for ARDS between March 2017 and March 2024. Clinicodemographic characteristics, indications for and methods of ECMO application, occurrence of comorbidities, hospital survival rates, and ECMO weaning success rates were compared between survivors and non-survivors. Results: Among the 16 patients evaluated, seven (43.8%) were successfully discharged. The mean ages of the survivor and non-survivor groups were 52.1 and 58.6 years, respectively. The PaO₂/FiO₂ ratio pre-ECMO was similar in both groups (66.6 vs. 69.2); however, it improved significantly post-ECMO in the survivor group (264.1 vs. 209.4). The ECMO success rate was 100% in the survivor group and only 33.3% in the non-survivor group. The intensive care unit and hospital lengths of stay were longer in the survivor group. Most patients received veno-venous ECMO, and hemorrhagic complications were rare. Conclusions: ECMO for ARDS in patients with severe TBI or spontaneous ICH and SAH positively impacts survival and functional recovery and may be a beneficial treatment modality.