Aneurysm growth appears to be associated with an increased risk of rupture. Therefore, it may be of interest to identify mechanisms contributing to aneurysm growth. Angiogenic factors, particularly vascular endothelial growth factor (VEGF), appear to play an important role in the pathogenesis and growth of cerebrovascular malformations. We aimed to study systemic VEGF levels as a potential systemic marker in patients with non-ruptured intracranial aneurysms compared with healthy controls. Mean VEGF plasma concentrations were found to be increased in patients with non-ruptured intracranial aneurysms compared with healthy controls (85.2 pg/ml versus 44.1 pg/ml). This difference did not reach significance in the analyzed study cohort (p=0.05) but only when the analysis was restricted to male patients (p=0.04). Female patients and controls demonstrated significantly increased VEGF plasma levels only on correlation with age but not with the presence of aneurysms. Neither the presence of multiple aneurysms nor aneurysm location were correlated with VEGF levels. Although overall VEGF plasma difference was not statistically significant, we found significantly increased levels in male patients. Furthermore, we identified a distinct group of female patients with intracranial aneurysms who presented excessively increased VEGF plasma levels to an amount that was not observed in the controls. Further studies may clarify the relationship of aneurysm growth and VEGF.

The authors describe a patient who had Kirschner (K-) wire osteosynthesis of a right lateral clavicular fracture and developed a tetraparesis after 3 months. Plain X-ray and CT scan showed an intraspinal migration of one K-wire through the intervertebral foramen of C5/6. The K-wire was pulled out through an opening of the wound over the right clavicle. No CSF fistula was seen. The patient recovered without any postoperative neurological deficit. Patients with K-wire osteosynthesis should be informed about the risk of dislocation and wandering and should regularly be seen in the outpatient clinic. Regular X-rays should be performed. The K-wires must be sufficiently bent at the distal end to prevent wandering into the proximal direction. The K-wires should be removed soon after 6 weeks and, in cases of dislocation and migration, as early as possible.