Isoflurane Conditioning Provides Protection against Subarachnoid Hemorrhage Induced Delayed Cerebral Ischemia through NF-kB Inhibition.

Delayed cerebral ischemia (DCI) is the largest treatable cause of poor outcome after aneurysmal subarachnoid hemorrhage (SAH). Nuclear Factor Kappa-light-chain-enhancer of Activated B cells (NF-kB), a transcription factor known to function as a pivotal mediator of inflammation, is upregulated in SAH and is pathologically associated with vasospasm. We previously showed that a brief exposure to isoflurane, an inhalational anesthetic, provided multifaceted protection against DCI after SAH.

Complex Morphologic Analysis of Cerebral Aneurysms Through the Novel Use of Fractal Dimension as a Predictor of Rupture Status: A Proof of Concept Study.

Background: Aneurysm morphology has been correlated with rupture. Previous reports identified several morphologic indices that predict rupture status, but they measure only specific qualities of the morphology of an aneurysm in a semiquantitative fashion. Fractal analysis is a geometric technique whereby the overall complexity of a shape is quantified through the calculation of a fractal dimension (FD).

Anterior occipital condyle screw placement through the endonasal corridor: proof of concept study with cadaveric analysis.

Purpose: Odontoidectomy for ventral compressive pathology may result in O-C1 and/or C1-2 instability. Same-stage endonasal C1-2 spinal fusion has been advocated to eliminate risks associated with separate-stage posterior approaches. While endonasal methods for C1 instrumentation and C1-2 trans-articular stabilization exist, no hypothetical construct for endonasal occipital instrumentation has been validated.

Brain Vasculature Color-Labeling Using the Triple-Injection Method in Cadaveric Heads: A Technical Note for Improved Teaching and Research in Neurovascular Anatomy.

Background: Color-labeling injections of cadaveric heads have revolutionized education and teaching of neurovascular anatomy. Silicone-based and latex-based coloring techniques are currently used, but limitations exist because of the viscosity of solutions used.

Objective: To describe a novel "triple-injection method" for cadaveric cranial vasculature and perform qualitative and semiquantitative evaluations of colored solution penetration into the vasculature.

C1 Lateral Mass Screw Placement Through Endonasal Corridor for Purpose of O-C1 Fusion: Morphometric Analysis in Cadaveric Specimens.

Background: Odontoidectomy may pose some risks for O-C1 and/or C1-C2 instability, with previous authors reporting techniques for endonasal C1-C2 fusion. However, no technique for endonasal O-C1 fusion currently exists. We sought to describe the feasibility of endonasal anterior C1 (AC1) screw placement for endonasal O-C1 fusion.

Primary Dural Repair via an Endoscopic Endonasal Corridor: Preliminary Development of a 3D-Printed Model for Training.

 Endonasal suturing is an investigational method for dural repair that has been reported to decrease the incidence of cerebrospinal fluid fistula. This method requires handling of single-shaft instrumentation in the narrow endonasal corridor. In this study, we designed a low-cost, surgical model using three-dimensional (3D) printing technology to simulate dural repair through the endonasal corridor and subsequently assess the utility of the model for surgical training.

Development and validation of Egyptian developmental screening chart for children from birth up to 30 months.

Background: Detecting developmental delay in children is an ongoing world commitment, especially for those below three years. To accurately assess the development of children; a culturally appropriate screening tool must be used. Egypt lacks such tool and multiple studies have shown that western tools are not suitable in other cultures.

Case Report of Transgender Patient with Gonadotropic Dysfunction Secondary to Craniopharyngioma: Toward Improving Understanding of Biopsychosocial Dynamics of Gender Identity in Neurosurgical Care.

Background: There is a paucity of information in the literature linking possible neuroendocrinologic repercussions of anterior pituitary insufficiency from tumor-associated mass effect with gender identity in transindividuals. The authors present the case of a 26-year-old transgender woman who was found to have a sellar/suprasellar neoplasm after reporting loss of vision in a bitemporal distribution.

Case Description: Magnetic resonance imaging demonstrated a 2.

Comparative efficacy of autologous versus cadaveric saphenous vein grafts in cerebral revascularization surgery.

Objective: Cerebral bypasses are performed for the purpose of either flow augmentation for ischemic cerebrovascular disease or flow replacement for vessel sacrifice during complex aneurysm or tumor surgery. Saphenous vein grafts (SVGs) are commonly used interposition grafts. The authors of this study sought to compare the efficacy of autologous versus cadaveric SVGs in a large series of cerebral bypasses using interposition vein grafts with long-term angiographic follow-up.

2D parametric contrast time-density analysis for the prediction of complete aneurysm occlusion at six months' post-flow diversion stent.

Objective: Indications for the treatment of cerebral aneurysms with flow diversion stents are expanding. The current aneurysm occlusion rate at six months ranges between 60 and 80%. Predictability of complete vs.

The cut flow index revisited: utility of intraoperative blood flow measurements in extracranial-intracranial bypass surgery for ischemic cerebrovascular disease.

Objective: In extracranial-intracranial (EC-IC) bypass surgery, the cut flow index (CFI) is the ratio of bypass flow (ml/min) to donor vessel cut flow (ml/min), and a CFI ≥ 0.5 has been shown to correlate with bypass patency. The authors sought to validate this observation in a large cohort of EC-IC bypasses for ischemic cerebrovascular disease with long-term angiographic follow-up.

Role of Resistivity Index Analysis in the Prediction of Hemodynamically Significant Venous Sinus Stenosis in Patient With Idiopathic Intracranial Hypertension.

Background: The resistivity index (RI) in cerebral venous sinus stenosis (VSS) has not been studied in patients with idiopathic intracranial hypertension (IIH).

Objective: To evaluate the role of RI measured by quantitative magnetic resonance venogram (QMRV) as a noninvasive tool in the diagnosis of venous hypertension associated with VSS in IIH.

Methods: Retrospective evaluation of 13 consecutive IIH patients who underwent venous sinus stenting at our institution between 2013 and 2018.

Motor Cortex Stimulation for Deafferentation Pain.

Purpose Of Review: Since the early 1990s, motor cortex stimulation (MCS) has been a unique treatment modality for patients with drug-resistant deafferentation pain. While underpowered studies and case reports have limited definitive, data-driven analysis of MCS in the past, recent research has brought new clarity to the MCS literature and has helped identify appropriate indications for MCS and its long-term efficacy.

Recent Findings: In this review, new research in MCS, repetitive transcranial magnetic stimulation (rTMS), and transcranial direct current stimulation (tDCS) are analyzed and compared with historical landmark papers.

Contrast Time-Density Time on Digital Subtraction Angiography Correlates With Cerebral Arteriovenous Malformation Flow Measured by Quantitative Magnetic Resonance Angiography, Angioarchitecture, and Hemorrhage.

Background: Digital subtraction angiography (DSA) currently provides angioarchitectural features of cerebral arteriovenous malformations (AVMs) but its role in the hemodynamic evaluation of AVMs is poorly understood.

Objective: To assess contrast time-density time (TT) on DSA relative to AVM flow measured using quantitative magnetic resonance angiography (QMRA).

Methods: Patients seen at our institution between 2007 and 2014 with a supratentorial AVM and DSA and QMRA obtained prior to any treatment were retrospectively reviewed.

Cerebral Aneurysm Size and Distal Intracranial Hemodynamics: An Assessment of Flow and Pulsatility Index Using Quantitative Magnetic Resonance Angiography.

Background: The relationship between cerebral aneurysm size and risk of rupture is well documented, but the impact of aneurysms on distal intracranial hemodynamics is unknown.

Objective: To examine the relationship between aneurysm size and distal intracranial hemodynamics prior to treatment.

Methods: Patients seen at our institution between 2006 and 2015 with cerebral aneurysms within the internal carotid artery (ICA) segments (proximal to ICA terminus) were retrospectively reviewed.

Thresholds for Volume and Expansion in Intraparenchymal Hemorrhage: Predictors of Neurologic Deterioration and Mortality.

Objective: Spontaneous intraparenchymal hemorrhage (IPH) is a common neurosurgical emergency, with hemorrhage size and expansion associated with poor clinical outcomes. In this study, radiologic risk factors and specific IPH volume thresholds were calculated to identify heightened risk of neurologic deterioration and mortality.

Methods: A consecutive review of all patients with nontraumatic IPH transferred to a tertiary academic neurosurgery service was performed over 2 years.

Transorbital Glue Embolization of a Recurrent Venous Varix Using Real-Time Image Guidance in the Neuroangiography Suite.

Orbital lesions are challenging to access due to their location amid critical anatomic structures. Here, we demonstrate direct transorbital cannulation of an orbital venous varix using image guidance. A 36-year-old male was diagnosed with a left orbital venous varix approximately 5 years ago at an outside institution.

Middle cerebral artery flow velocity increases more in patients with delayed intraparenchymal hemorrhage after Pipeline.

Objective: Pipeline Embolization Devices (PED) are commonly used for endovascular treatment of cerebral aneurysms but can be associated with delayed ipsilateral intraparenchymal hemorrhage (DIPH). The role that altered intracranial hemodynamics may play in the pathophysiology of DIPH is poorly understood. We assess middle cerebral artery (MCA) flow velocity changes after PED deployment.

Aneurysm size and the Windkessel effect: An analysis of contrast intensity in digital subtraction angiography.

Large cerebral aneurysms are considered more dangerous than their smaller counterparts, with higher risk of subarachnoid hemorrhage. Understanding the hemodynamics of large aneurysms has potential to predict their response to treatment. Digital subtraction angiography images for patients with intracranial aneurysms over a seven-year period were reviewed.

Reducing length of stay in aneurysmal subarachnoid hemorrhage: A three year institutional experience.

Hospital length of stay is a common metric of excellence in health care. With limited data evaluating hospital length of stay (LOS) and cost in subarachnoid hemorrhage (SAH), in this study we explore multiple prognostic factors and present our institutional experience in shortening LOS. 345 SAH patients were reviewed over a three year period.

Neurosurgical Emergency Transfers: An Analysis of Deterioration and Mortality.

Background: Neurological deterioration and mortality are frequent in neurosurgical patients transferred to tertiary centers, but the precise predictors leading to them are unclear.

Objective: To analyze and quantify risk factors predicting deterioration and death in neurosurgery transfers.

Methods: A consecutive review of all transfers with cranial pathology to a tertiary academic neurosurgery service was performed over a 2-year period.

Changes in contrast transit times on digital subtraction angiography post-Pipeline Embolization Device deployment.

It is postulated that hemodynamic changes occur in the distal vascular bed post-deployment of Pipeline Embolization Devices (PEDs). In this paper, we evaluate changes in the contrast transit times (TTs) on digital subtraction angiography (DSA) post-PED interventions. DSA films were analyzed using custom-made software for the time-density relationship at baseline and compared to post-PED deployment.

Cerebral Arteriovenous Malformation Flow Is Associated With Venous Intimal Hyperplasia.

Background And Purpose: The pathogenesis of venous intimal hyperplasia and venous outflow stenosis associated with cerebral arteriovenous malformation (AVM) draining veins is poorly understood. We sought to determine the relationship between maximum vein wall thickness and AVM flow.

Methods: Patients who underwent AVM surgical resection and had flow measured before treatment using quantitative magnetic resonance angiography were retrospectively reviewed.

Validation of cerebral arteriovenous malformation hemodynamics assessed by DSA using quantitative magnetic resonance angiography: preliminary study.

Background: The hemodynamic evaluation of cerebral arteriovenous malformations (AVMs) using DSA has not been validated against true flow measurements.

Objective: To validate AVM hemodynamics assessed by DSA using quantitative magnetic resonance angiography (QMRA).

Materials And Methods: Patients seen at our institution between 2007 and 2016 with a supratentorial AVM and DSA and QMRA obtained before any treatment were retrospectively reviewed.

Quantitative assessment of parent vessel and distal intracranial hemodynamics following pipeline flow diversion.

Background Pipeline embolization devices (PEDs) are commonly used for endovascular treatment of cerebral aneurysms but can be associated with delayed ipsilateral intraparenchymal hemorrhage. Although intra-aneurysmal hemodynamic changes have been studied, parent vessel and intracranial hemodynamics after PED use are unknown. We examine the impact of flow diversion on parent artery and distal intracranial hemodynamics.