BACKGROUND: The use of a Pipeline Embolization Device (PED) in combination with coils (PEDC) to treat intracranial aneurysms remains unclear as to whether it offers significant benefits for the patients since the results have varied. PURPOSE: This study aimed to investigate the clinical outcome of PEDC compared to PED in treating intracranial aneurysms. DATA SOURCES: We systematically searched the articles from PubMed, Web of Science, and the Cochrane Library databases published before January 25, 2024. STUDY SELECTION: We selected studies comparing PEDC vs. PED to treat intracranial aneurysms. Patients treated with PEDC but using dense coiling were excluded from the study. DATA ANALYSIS: The clinical outcomes observed in this meta-analysis were intraprocedural complications, postoperative complications (stenosis, stroke, hemorrhage, mortality), favorable outcome (mRS ≤ 2), complete occlusion rate, and retreatment rate. Forest plot was used to analyze pooled Odds Ratio (OR) of clinical outcomes. DATA SYNTHESIS: A total of 3001 subjects from nine observational studies were included. PEDC was mainly used to treat larger aneurysms. PEDC has a significantly higher complete occlusion rate at 6 months [OR= 2.66, 95% CI(1.26, 5.59), p= 0.01], a lower retreatment rate [OR= 0.18, 95% CI(0.05, 0.07), p= 0.010], higher stroke-related complications [OR= 1.66, 95% CI(1.16, 2.37), p= 0.005], and higher hemorrhage-related complications [OR= 1.98, 95% CI(1.22, 3.21), p = 0.005]. There was no significant difference in intraprocedural complications, stenosis-related complications, mortality, favorable outcomes, and complete occlusion at the end of the study. LIMITATIONS: No randomized controlled trials have been performed comparing PEDC and PED. Considering that all the included studies were observational, the patients9 baseline characteristics were not completely balanced. CONCLUSIONS: This meta-analysis study showed that PEDC in large intracranial aneurysms induces a faster complete occlusion rate at 6 months and a lower retreatment rate. However, it increases the risk of stroke-related postoperative complications, and the faster complete aneurysm occlusion rate found in this study did not correlate with a reduction in long-term aneurysm or distal artery ruptures. Thus, this study suggests the need to find a better strategy to improve long-term hemorrhage-related complications in large intracranial aneurysms. ABBREVIATIONS: F = female; FDDs = flow-diverter devices; M = male; NOS = Newcastle-Ottawa Scale; PED = pipeline embolization device; PEDC = pipeline embolization device in combination with coils.

We report a rare case of a high-grade glioma masquerading as a small subcortical hemorrhage. A 71-year-old woman came to a local hospital with sudden right upper extremity numbness. Computed tomography revealed a small subcortical hemorrhage with faint perifocal edema in the left postcentral gyrus. Conservative treatment was initiated, and she was discharged from the hospital with no neurological deficits. Six months later after discharge, she suffered an acute partial seizure of the right upper extremity. Magnetic resonance imaging with gadolinium demonstrated a ring-enhancing mass surrounded by severe perifocal edema in the hemorrhagic scar. We performed complete resection of the tumor, and the histological diagnosis was anaplastic oligodendroglioma. The diagnosis of a high-grade glioma was delayed due to intratumoral hemorrhages mimicking a small subcortical hemorrhage; consequently, we suspected the hemorrhage was induced by cerebral amyloid angiopathy. It may be important to repeat radiological follow up, if necessary, and to maintain clinical observance of possible intracranial neoplasm, even when the hemorrhage is small, particularly when the cause of bleeding is unknown.

Background: This study aimed to investigate what treatment are selected for malignant brain tumors, particularly glioblastoma (GBM) and primary central nervous system lymphoma (PCNSL), in real-world Japan and the costs involved. Methods: We conducted a questionnaire survey regarding treatment selections for newly diagnosed GBM and PCNSL treated between July 2021 and June 2022 among 47 institutions in the Japan Clinical Oncology Group-Brain Tumor Study Group. We calculated the total cost and cost per month of the initial therapy for newly diagnosed GBM or PCNSL. Results: The most used regimen (46.8%) for GBM in patients aged ≤74 years was ‘Surgery + radiotherapy concomitant with temozolomide’. This regimen’s total cost was 7.50 million JPY (Japanese yen). Adding carmustine wafer implantation (used in 15.0%), TTFields (used in 14.1%), and bevacizumab (BEV) (used in 14.5%) to the standard treatment of GBM increased the cost by 1.24 million JPY for initial treatment, and 1.44 and 0.22 million JPY per month, respectively. Regarding PCNSL, ‘Surgery (biopsy) + rituximab, methotrexate, procarbazine, and vincristine (R-MPV) therapy’ was the most used regimen (42.5%) for patients of all ages. This regimen incurred 1.07 million JPY per month. The three PCNSL regimens based on R-MPV therapy were in ultra-high-cost medical care (exceeding 1 million JPY per month). Conclusions: Treatment of malignant brain tumors is generally expensive, and cost-ineffective treatments such as BEV are frequently used. We believe that the results of this study can be used to design future economic health studies examining the cost-effectiveness of malignant brain tumors.