Surgical neurology international最新文献

{"title":"Dermatologic manifestations of complex regional pain syndrome improved after dorsal root ganglion stimulation.","authors":"Stephen Jaffee, Trent Shane Kite, Samuel Valletta, Feno Monaco, Nestor Tomycz","doi":"10.25259/SNI_1000_2024","DOIUrl":"https://doi.org/10.25259/SNI_1000_2024","url":null,"abstract":"<p><strong>Background: </strong>Complex regional pain syndrome is a condition that causes autonomic dysfunction, including severe pain, swelling, temperature fluctuations, and cutaneous flushing.</p><p><strong>Case description: </strong>The patient was a 38-year-old woman with complex regional pain syndrome type I of the right foot that developed after a work-related accident. At the time of presentation, she complained of a stabbing and burning pain, which subjectively felt like extreme warmth for 6 weeks. On physical examination, she presented with diffuse cutaneous flushing, erythema, nonpitting edema, skin mottling of the medial aspect of the right foot and ankle, a purple macule on the right inferomedial aspect of the great toe, and a purple patch on the inferomedial aspect of the heel. The patient underwent right-sided L5/S1 open dorsal root ganglion (DRG) stimulation under the care of neurological surgery. Postprocedurally, the cutaneous flushing, erythema, edema, mottling, purple macule, and patch had completely resolved. At the 1-year postoperative appointment, the patient continued to have a significant improvement in her preoperative pain and notably improved allodynia, flushing, mottling, and temperature sensitivity.</p><p><strong>Conclusion: </strong>We have described the successful resolution of complex regional pain syndrome associated dermatologic manifestations in the setting of DRG stimulation. To our knowledge, a case of this nature has yet to be described in the literature.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"139"},"PeriodicalIF":0.0,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12065513/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144015420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mechanical thrombectomy for cerebral embolism due to cardiac papillary fibroelastoma: A case report.","authors":"Kentaro Izumi, Youhei Takeuchi, Naoya Iwabuchi, Masahiro Yoshida, Kuniyasu Niizuma, Hidenori Endo","doi":"10.25259/SNI_68_2025","DOIUrl":"https://doi.org/10.25259/SNI_68_2025","url":null,"abstract":"<p><strong>Background: </strong>Papillary fibroelastoma (PFE) and myxoma are relatively common types of benign cardiac tumors. PFE and myxoma can be associated with fatal embolic events. However, PFE is not widely recognized within the field of cerebrovascular diseases.</p><p><strong>Case description: </strong>A 54-year-old male presented with a sudden onset of left hemiparesis. Three-dimensional computed tomography (CT) angiography revealed incomplete occlusion of the right middle cerebral artery. Thrombolytic therapy with recombinant tissue-type plasminogen activator was performed, followed by mechanical thrombectomy. Reperfusion was achieved within 199 minutes, resulting in thrombolysis in cerebral infarction grade 2b. The retrieved emboli appeared as a white gelatinous substance, which was diagnosed as PFE by histopathological examination. Transesophageal echocardiography and cardiac CT identified a 6-mm mobile mass in the left atrium. PFE in the left atrium was considered to be the source of the embolism and tumor resection was performed on day 18. Histopathological findings of the resected tumor were identical to those of the emboli. The patient was transferred to a rehabilitation facility on day 36, with a modified Rankin Scale score of 2.</p><p><strong>Conclusion: </strong>PFE and myxoma share many clinical features, but PFE tends to be smaller, so detection is more challenging and has likely resulted in under-recognition. PFE and myxoma can be associated with fatal embolic events. Resection is recommended for left-sided, mobile, symptomatic tumors larger than 10 mm. The differential diagnosis of embolus retrieved through mechanical thrombectomy should consider both myxoma and PFE and persistent efforts should be made to detect the embolic origin.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"141"},"PeriodicalIF":0.0,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12065518/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143995814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic endonasal transcavernous approach for removal of pituitary macroadenoma with apoplexy: Technical nuances.","authors":"Adnan Hussain Shahid, Mehdi Khaleghi, Sudhir Suggala, Garrett Dyess, Danner Warren Butler, Ursula Hummel, Mark Richard Gacek, Jai Deep Thakur","doi":"10.25259/SNI_941_2024","DOIUrl":"https://doi.org/10.25259/SNI_941_2024","url":null,"abstract":"<p><strong>Background: </strong>The endoscopic endonasal transcavernous approach is an extended approach for sellar masses with cavernous invasion with negligible complications regarding permanent cranial nerve (CN) palsy or internal carotid artery (ICA) injury. With a proper understanding of surgical anatomy regarding the ICA and its relation to the cavernous sinus, an endoscopic trans-cavernous approach through the anterior wall of the cavernous sinus with lateral and superior extension can allow for safe and efficient tumor visualization and removal in the inferior and superior CS compartment. The aim is to describe the technical nuances involved during the transvenous approach.</p><p><strong>Case description: </strong>A 67-year-old male with acute onset of left vision loss, headache, and left side complete CN III and VI palsy with large sellar mass measuring 3.1 × 2.0 × 5.6 cm extending to the left cavernous sinus encasing the ICAs with evidence of apoplexy. An endonasal transcavernous approach was done involving tumor removal from the superior and inferior compartment, resulting in gross total resection. Histological examination revealed a nonfunctioning apoplectic pituitary adenoma. The patient was discharged on Post-operative day (POD) 2 with partial palsy in CN III and CN VI and was noted to have a progressive improvement in CN palsy with complete resolution of ptosis and partial palsy of CN VI at the 3-month follow-up visit.</p><p><strong>Conclusion: </strong>Pseudocapsular apoplectic plane identification, extracapsular dissection, identification of parasellar ligaments, and understanding of adenoma-cavernous sinus ICA relationship are key surgical highlights that we discuss in our case. The combination of these techniques, along with the use of intraoperative Doppler, helped us to maximize pituitary gland preservation, CN improvement, and gross total resection of a large pituitary adenoma with cavernous sinus invasion presenting as apoplexy. Future studies with endoscopic endonasal transvenous approaches with cavernous sinus extension for large pituitary adenoma with apoplexy are warranted to study long-term CN outcomes.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"133"},"PeriodicalIF":0.0,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12065514/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144056418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utility of ultrasound in the diagnosis and management of a radial nerve perineurioma in a pediatric patient.","authors":"Jared M Pisapia, Ian J Mason, Sabrina L Zeller, Eric Feldstein, Apurva S Shah, Gregory G Heuer","doi":"10.25259/SNI_925_2024","DOIUrl":"https://doi.org/10.25259/SNI_925_2024","url":null,"abstract":"<p><strong>Background: </strong>Intraneural perineuriomas are tumors originating from the perineurial cells surrounding nerve sheath fascicles. Intraneural perineuriomas represent about 1% of peripheral nerve tumors and are often misdiagnosed due to their rarity. In this case, we report a pediatric patient with a radial nerve perineurioma, in which ultrasound played a key role in diagnosis.</p><p><strong>Case description: </strong>We present the case of a 4-year-old male with over 6 months of progressive left upper extremity weakness found to have chronic left radial neuropathy distal to the triceps branch of the radial nerve on electromyography/nerve conduction study. Ultrasound showed a well-defined fusiform hypoechoic mass of approximately 1.5 × 0.5 × 0.8 cm, with the radial nerve noted to enter and exit the mass. Magnetic resonance imaging (MRI) did not encompass the pathology. The mass was excised with small margins, and pathology was consistent with perineurioma. The resultant 3 cm gap was repaired through nerve grafting. Surveillance MRI showed no recurrence of the perineurioma over time.</p><p><strong>Conclusion: </strong>Ultrasound served as a necessary adjunct in the workup of upper extremity weakness despite negative MRI findings. This imaging modality should be considered if there is high clinical suspicion of a peripheral nerve lesion.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"129"},"PeriodicalIF":0.0,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12065482/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144063789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Presentation of extranodal NK/T-cell lymphoma as a pituitary mass: A case report and review of the literature.","authors":"Molly Butler, Christopher Carr, Mehul Mehra, Anne Marie Barnett, Jacey Salley, Ayushi Chauhan, Sami Belakhlef, Gerald C Wallace Iv, Martin Rutkowski, John Vender, Fernando L Vale","doi":"10.25259/SNI_956_2024","DOIUrl":"https://doi.org/10.25259/SNI_956_2024","url":null,"abstract":"<p><strong>Background: </strong>Primary pituitary lymphomas are uncommon neoplasms that are typically derived from a B-cell lineage. Extranodal natural killer (NK)/T-cell lymphoma is distinct from B- and T-cell lymphomas and is associated with Epstein-Barr virus infection. Primary central nervous system (CNS) presentations of this neoplasm are exceptionally rare. Here, we report the case of extranodal NK/T-cell lymphoma presenting as a pituitary mass and review the literature related to this rare clinical entity.</p><p><strong>Case description: </strong>A 31-year-old previously healthy male presented with 2 weeks of progressive headaches and ophthalmoplegia. Imaging revealed a large intrasellar mass with retroclival extension and involvement of the sphenoid and cavernous sinuses. An endoscopic biopsy of the sphenoidal mucosa was performed, and pathological examination was consistent with extranodal NK/T-cell lymphoma. Despite treatment with chemo- and radiotherapy, the patient died approximately 8 months after initial presentation due to systemic disease progression with multiorgan failure.</p><p><strong>Conclusion: </strong>The presentation of extranodal NK/T-cell lymphoma as a pituitary lesion is very rare, having been reported only twice in the previous literature. Patients with primary CNS extranodal NK/T-cell lymphoma typically experience an aggressive clinical course with a poor prognosis, as in our case.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"136"},"PeriodicalIF":0.0,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12065498/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144059720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hybrid therapy and use of carbon-fiber-reinforced polyetheretherketone instrumentation for management of mobile spine chordomas: A case series and review of the literature.","authors":"Chi Shing Adrian Lam, Vicente de Paulo Martins Coelho, Seth Wilson, Joshua Palmer, Anas Bardeesi, Vikram Chakravarthy","doi":"10.25259/SNI_53_2025","DOIUrl":"https://doi.org/10.25259/SNI_53_2025","url":null,"abstract":"<p><strong>Background: </strong>Mobile spine chordomas demonstrate varied surgical risk profiles compared to their sacral analogs. Often, the limitation to performing an <i>en bloc</i> resection of a mobile spine chordoma is tumor violation of the epidural space. Given these limitations, we propose the utilization of carbon fiber-reinforced polyetheretherketone (CFR-PEEK) instrumentation in separation surgery to enhance visualization for stereotactic body radiation therapy (SBRT) planning, allowing an ablative radiosurgical dose to be delivered.</p><p><strong>Methods: </strong>We present two illustrative cases highlighting the advantages of hybrid therapy (separation surgery and adjuvant SBRT) with CFR-PEEK instrumentation in the management of mobile spine chordoma.</p><p><strong>Results: </strong>Case 1 is a 62-year-old female with an L4 chordoma who underwent separation surgery and L3-5 posterior instrumented fusion using CFR-PEEK instrumentation. Case 2 is a 68-year-old female with a L3 chordoma who underwent revision separation surgery encompassing completion of L3 partial corpectomy and CFR-PEEK screw exchange of prior L2-4 titanium instrumentation. Both patients received postoperative ablative SBRT. At 18-month postoperative time points, both patients were clinically stable, with no signs of tumor recurrence or progression.</p><p><strong>Conclusion: </strong>Mobile spine chordomas present a unique challenge in obtaining a margin negative <i>en bloc</i> resection. Separation surgery allows the ability to decrease surgical morbidity and deliver an ablative radiosurgical dose. Furthermore, the incorporation of CFR-PEEK instrumentation allows the utilization of multiparametric magnetic resonance imaging for long-term disease monitoring. Hybrid therapy, a less morbid alternative to standard <i>en bloc</i> spondylectomy, offers a better surgical morbidity profile by combining effectively with SBRT for optimal tumor control.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"130"},"PeriodicalIF":0.0,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12065495/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144059799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Successful total <i>en bloc</i> resection of a lumbar vertebra for a giant cell tumor: A case report.","authors":"Oualid Mohammed Hmamouche, Faycal Lakhdar, Marouane Hammoud, Mohammed Benzagmout, Khalid Chakour, Mohammed El Faiz Chaoui","doi":"10.25259/SNI_322_2023","DOIUrl":"https://doi.org/10.25259/SNI_322_2023","url":null,"abstract":"<p><strong>Background: </strong>Giant cell tumor (GCT) is a benign neoplasm that most commonly arises in the long bones; when these tumors rarely present as primary spinal bone tumors, they may exhibit local aggressive behavior, warranting extensive surgical resection.</p><p><strong>Case description: </strong>An 11-year-old female presented with lower back, radicular pain, and paraparesis. The magnetic resonance imaging showed an L5 tumor with an extension into the spinal canal. Total <i>en bloc</i> spondylectomy of the L5, vertebra revealed a GCT. Postoperatively, the patient did well for 3 months.</p><p><strong>Conclusion: </strong>GCTs of bone are aggressive benign bone tumors that rarely involve the spine. Gross total surgical excision is the treatment of choice for these lesions that exhibit high local recurrence rates.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"134"},"PeriodicalIF":0.0,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12065483/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144050881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chiari 1 malformation in patient with Noonan syndrome: A case report and review of literature.","authors":"Leonie Witters, Salah-Eddine Achahbar, Samuel Klein, Sacha Meeuws, Mark Plazier, Eric Put, Gert Roosen, Steven Vanvolsem, Maarten Wissels, Sven Bamps","doi":"10.25259/SNI_1132_2024","DOIUrl":"https://doi.org/10.25259/SNI_1132_2024","url":null,"abstract":"<p><strong>Background: </strong>Different theories exist about the pathogenesis of Chiari 1 malformations (CM-I), but none of them is thought to be exhaustive. Likewise, the role of genetic factors contributing to these conditions has not yet been elucidated, but there is a co-occurrence of CM-I with genetic syndromes such as Noonan syndrome (NS) and other RASopathies.</p><p><strong>Case description: </strong>We describe the case of a 16-year-old female known with NS, currently presenting with Valsalva-induced headaches. Imaging of the brain and spine showed a CM-I with extensive syringohydromyelia. The patient was treated with a foramen magnum decompression and C1 laminectomy with duraplasty. The postoperative course was uneventful and the symptoms improved postoperatively.</p><p><strong>Conclusion: </strong>In the literature, sixteen cases of CM-I in patients with NS are reported. Our reported case illustrates the co-occurrence between CM-I and RASopathies. We review current literature about the understanding of the possible association or pathogenetic link between the two conditions. This case report highlights the clinical importance of recognizing the co-occurrence of CM-I and NS, potentially guiding early diagnosis and management strategies.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"132"},"PeriodicalIF":0.0,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12065493/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144013813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Brain abscess mimicking a brain tumor only realized during surgery: A case report in a resource strained environment.","authors":"Daouda Wagué, Ebrima Kalilu Manneh, Fatou Sène, Richard Salif Djigo, Maguette Mbaye, Mbaye Thioub","doi":"10.25259/SNI_67_2025","DOIUrl":"https://doi.org/10.25259/SNI_67_2025","url":null,"abstract":"<p><strong>Background: </strong>Diagnosis of brain tumors increased in sub-Saharan Africa since the advent of computed tomography (CT)-scans and magnetic resonance imaging (MRI) in these regions, enabling easy diagnosis. However, some histological types of brain tumors can be confusing, especially on CT-scan, simulating other pathologies such as inflammatory granulomas or pyogenic abscesses. MRI, in this instance, with its diffusion-weighted imaging, susceptibility weighted imaging, or perfusion imaging, is important to help with accurate diagnosis. The down side of these imaging facilities, however, is that less and less importance is accorded to proper and detailed history taking. Such a care-free attitude to history taking can be costly, especially in resource strained environments.</p><p><strong>Case description: </strong>We report the case of a 06-year-old child who presented with seizures associated with headaches and vomiting. In this case, proper history taking following the surgical intervention revealed a history of head trauma after a fall with a scalp wound, which was suppurated but later progressed well. The CT scan showed a solid cystic lesion. The first component is a ring enhanced portion (hyperdense ring with the hypodense center, surrounded by edema) with central calcification located in the frontal region, and the second component is a cystic portion located in the temporal region. This lesion with dual component was more suggestive of a tumoral lesion on imaging than an abscess. The child did not benefit from further imaging due to unavailability in the region as well as the socioeconomic status of the family making them incapable of going elsewhere to do it. A decision to surgically excise the lesion was made, and during surgery, we found a well-circumscribed yellowish lesion associated with an arachnoid cyst. The capsule of the lesion was very thick, and after opening it, the content was pus combined with debris. The child did well on antibiotic therapy post-surgery. The follow-up was unremarkable.</p><p><strong>Conclusion: </strong>Brain MRI is essential to differentiate some pyogenic brain abscesses from tumors. However, meticulous history taking is important to gather as much information as possible about any medical pathology, which would then be corroborated with the physical examination findings and imaging to increase diagnostic accuracy and minimize misdiagnosis.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"131"},"PeriodicalIF":0.0,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12065485/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144056372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Triple Woven EndoBridge device strategy for recurrent basilar tip aneurysm: A case report.","authors":"James Russell Withers, Adam A Dmytriw, Omer Doron, Christopher J Stapleton, Aman B Patel, Robert W Regenhardt","doi":"10.25259/SNI_445_2024","DOIUrl":"https://doi.org/10.25259/SNI_445_2024","url":null,"abstract":"<p><strong>Background: </strong>Coil embolization and surgical clipping are among the treatment options for acutely ruptured cerebral aneurysms. However, wide-neck aneurysms may necessitate stent placement, introducing dual antiplatelet therapy risks during subarachnoid hemorrhage (SAH). The Woven EndoBridge (WEB) intrasaccular device provides a unique solution for wide-neck aneurysms that does not require dual antiplatelet therapy.</p><p><strong>Case description: </strong>This case report details a 56-year-old male with a recurrent basilar tip aneurysm, treated with three WEB devices. He presented with Hunt Hess grade 4 SAH and underwent initial embolization with a WEB 9 × 7.6 mm. He made a significant recovery, but recurrence of the aneurysm base was observed after 6 months. He underwent embolization with a second WEB 7 × 5.6 mm. A year later, follow-up angiography revealed a recurrence of the aneurysm base yet again, and he underwent embolization with a third WEB 5 × 3 mm.</p><p><strong>Conclusion: </strong>This case demonstrates the application of the WEB for a ruptured aneurysm, obviating the need for dual antiplatelet therapy and minimizing the risks of re-rupture and extraventricular drain complications. It also demonstrates the technical feasibility of deploying three WEB devices in the same aneurysm, providing a strategy for challenging aneurysm recurrence. The WEB offers a safe approach for intrasaccular flow disruption with satisfactory occlusion rates for recurrent aneurysms.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"128"},"PeriodicalIF":0.0,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12065516/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144055300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}