Objective: The Basic Act for Gender Equality was enforced in June 1999, and efforts are now being made in various places in line with the Fifth Basic Plan for Gender Equality. In 2021, the Japanese Society of Neuroendovascular Therapy (JSNET) established a gender equality committee and started activities as the Diversity Promotion Committee. This time in order to investigate the working environment of academic members and their needs for a diverse society, we conducted a survey of all physician members regarding their work environment.

Methods: A questionnaire survey was conducted among 4,374 JSNET physician members. The survey period was from August 2, 2021, to September 12, 2021.

Results: We received responses from 848 physicians (19.4%). Ninety-five percent were male, 5% were female, 91% were neurosurgeons, 6% were neurologists, 1% were radiologists, and 77% were specialists. Although there were issues such as the burden on those around them due to life events such as childcare and the impact on their own career development, the majority of the respondents agreed that both sexes werre included in their departments.

Conclusion: For both males and females, career continuity contributes to the improvement of the working environment. It is important to set up a system that both genders can keep their career continuously with mutual understanding.

Objective: We report the case of bilateral vertebral artery dissection (VAD) with subarachnoid hemorrhage diagnosed by vessel wall imaging (VWI).

Case Presentation: A 56-year-old man had suffered from sudden onset of a mild headache 2 days before admission. He was diagnosed with subarachnoid hemorrhage. Conventional angiography showed irregular dilatation on V4 segment of bilateral vertebral artery, both of which were suspicious of arterial dissections. Identification of the ruptured side was difficult by the angiographic appearance as both dilatations were comparable, and MRA failed to detect either the intimal flap or double lumen sign. Fortunately, VWI by GdT1-SPACE demonstrated enhancement along the vessel wall in both lesions, and intimal flap was also observed in the right side, confirming the diagnosis of bilateral VAD. MRA on Day 1 showed the worsening of right VAD, while no morphological changes were observed in the contralateral side. Thus, the right VAD was considered the ruptured side, and we performed proximal occlusion of the right VA in endovascular, preserving the right posterior inferior cerebellar artery (PICA) by the retrograde flow via contralateral VA. MRA on Day 5 showed the stenosis of left VA; therefore, systemic administration of heparin was applied to prevent the thrombotic occlusion of left VA. Finally, the resolution of the stenosis was confirmed in Day 13, and he was discharged in Day 34 with modified Rankin Scale score of 1.

Conclusion: VWI appears useful for the diagnosis of VAD even in difficult cases such as bilateral lesions.

Objective: We report a rare case of a suspected dissecting aneurysm of the anterior communicating artery (ACoA) from intraoperative findings who underwent endovascular internal trapping using a parallel stent-assisted technique for bilateral anterior cerebral arteries.

Case Presentations: A 21 year-old male presented with a subarachnoid hemorrhage. Emergent neck clipping failed due to difficulty in hemostasis, indicating dissection of ACoA. Parallel stent-assisted internal trapping was performed on the following day. Even though he recovered well without re-rupture, additional embolization was required fourteen days later because of recanalization on the follow-up angiography.

Conclusion: This is the first report of parallel stenting for internal trapping of ACoA to the best of our knowledge; however, careful follow-up is necessary for a dissecting aneurysm is suspected.

Objective: This study is based on a patient with cavernous sinus dural arteriovenous fistula (CS-dAVF) presented with brainstem edema. A prompt transvenous embolization was successfully performed on the patient, yielding a good outcome.

Case Presentation: An 80-year-old female patient developed CS-dAVF, initially presenting with conjunctival hyperemia and diplopia. MRI and MRA showed inflow into the posterolateral part of the cavernous sinus (CS) with a dilated right superior ophthalmic vein. During follow-up, she presented with progressive conjunctival hyperemia, and MRI re-examination revealed edema in the right medulla oblongata, right pons, and right midbrain. Cerebral angiography showed venous drainage from the right CS to the brainstem via the right pontine bridging vein (PBV). We performed transvenous embolization via the left inferior petrosal sinus, including the origin of the PBV, resulting in complete occlusion. Immediately after the surgery, the patient showed improvement of conjunctival hyperemia, and the brainstem edema was reduced.

Conclusion: Immediate therapeutic intervention may help prevent neurological deterioration in patients with CS-dAVF presented with brainstem edema.

Objective: Aortic arch bifurcation affects catheterization techniques. Due to the coronavirus disease 2019 pandemic, non-contrast chest CT (computed tomography) for the purpose of lung field evaluation is increasing. By performing 3D construction of the aortic arch using chest CT images for lung field evaluation, we investigated whether the bifurcation morphology of the aortic arch can be intuitively evaluated.

Case Presentations: From March 2021 to December 2021, 25 patients were hospitalized at our hospital’s neurosurgery department and underwent angiography or endovascular treatment. Four neurosurgeons retrospectively examined the usefulness of 3D images created by non-contrast CT.

Conclusion: Nine patients (36%) had a type 3 aortic arch. One case had bovine arch. There were no cases in which visualization was poor, or it was difficult to grasp the morphology of the aortic arch, and it was possible to intuitively evaluate the morphology of the aortic bifurcation with 3D constructed images using non-contrast chest CT images.

Objective: We report a method for creating a cerebrovascular lumen model that avoids deformation of the original normal vascular structures by its own weight and allows vessel shift.

Method: A cerebrovascular model of a 61-year-old woman's anterior communicating artery aneurysm was created by using 3D editing software and an optical 3D printer, with the vessel wall changed in steps from 0.5 to 1.5 mm.

Result: Vessel shift was possible by catheter manipulation, overcoming fragility and deformation of the vascular structure due to its own weight.

Conclusion: By outputting appropriate 3D vessel data and editing with open software, it is possible to create a cerebrovascular lumen model that can shift vessels under its own weight, which may be useful for preoperative training of endovascular treatment.