Background/objective The concomitant origin of the anterior spinal artery (ASA) or the posterior spinal artery (PSA) from the feeder of a spinal dural arteriovenous fistula (SDAVF) is rare and the exact incidence is not known. We present our experience with the management of SDAVFs in such cases. Methods In 63 patients with SDAVF between 1993 and 2015, the feeder origin of the SDAVF was evaluated to determine whether it was concomitant with the origin of the ASA or PSA. Embolization was attempted when the patient did not want open surgery and an endovascular approach was regarded as safe and possible. The outcome of the procedure was evaluated as complete, partial, or no obliteration. The clinical outcome was evaluated by Aminoff–Logue (ALS) gait and micturition scale scores. Results Nine patients (14%) had a concomitant origin of the ASA or PSA with the feeder. There were two cervical, five thoracic, and two lumbar level SDAVFs. A concomitant origin of the feeder was identified with the ASA (n=7) and PSA (n=2). Embolization was performed in four patients and open surgery was performed in five. Embolization resulted in complete obliteration in three patients and partial obliteration in one. Using the ALS gait and micturition scale, the final outcome improved in six while three cases remained in an unchanged condition over 2–148 months. Conclusions The concomitant origin of the ASA or PSA with the feeder occurs occasionally. Complete obliteration of the fistula can be achieved either by embolization or open surgery. Embolization can be carefully performed in selected patients who are in a poor condition and do not want to undergo open surgery.

A medical linear accelerator (LINAC) delivers high-energy X-rays or electrons to the patient’s tumor. In this study, we categorized failures and predicted downtime leading to discontinuous radiation treatment using a descriptive time series analysis of a 20-year maintenance dataset of a medical LINAC. A LINAC dataset of failure records for 359 instances was collected from 2001 to 2021. Next, we performed institution-specific seasonal autoregressive integrated moving average (ARIMA) modeling to analyze the causes of the failure categories and predict the downtime. Furthermore, we evaluated the performance of the predictive model using standard error metrics and statistical methods. Our results show that the downtime will increase by 95 h/year after 2022 and 100 h/year after 2023. The accumulated downtime in 2029 is predicted to be a maximum of 2820 h. The modeled seasonal ARIMA showed statistical significance (p < 0.001) with a residual error of ${\sigma }^2$ (328.33 ± 9.4). In addition, the forecasting performance of the model was assessed using the mean absolute percentage error (MAPE). The failure parts where the major downtime occurred were the multileaf collimator (25.2%), gantry and couch motion part (15.4%), dosimetric part (11.7%), and computer console (10.0%). Using the development of the ARIMA model specific to our institution, the downtime is predicted to reach up to 2820 h.

Background: The objective of this investigation was to formulate a model for predicting intracranial pressure (ICP) by utilizing optic nerve sheath diameter (ONSD) during endovascular treatment for an aneurysmal subarachnoid hemorrhage (aSAH), incorporating explainable predictive modeling. Methods: ONSD measurements were conducted using a handheld ultrasonography device during the course of endovascular treatment (n = 126, mean age 58.82 ± 14.86 years, and female ratio 67.46%). The optimal ONSD threshold associated with an increased ICP was determined. Additionally, the association between ONSD and ICP was validated through the application of a linear regression machine learning model. The correlation between ICP and various factors was explored through the modeling. Results: With an ICP threshold set at 20 cmH₂O, 82 patients manifested an increased ICP, with a corresponding ONSD of 0.545 ± 0.08 cm. Similarly, with an ICP threshold set at 25 cmH₂O, 44 patients demonstrated an increased ICP, with a cutoff ONSD of 0.553 cm. Conclusions: We revealed a robust correlation between ICP and ONSD. ONSD exhibited a significant association and demonstrated potential as a predictor of ICP in patients with an ICP ≥ 25 cmH₂O. The findings suggest its potential as a valuable index in clinical practice, proposing a reference value of ONSD for increased ICP in the institution.

Lee BJ, et al. Korean J Neurotrauma. 2023 Dec;19(4):446-453. https://doi.org/10.13004/kjnt.2023.19.e62