Minimally invasive surgical evacuation confers a mortality benefit in patients with moderate-sized putaminal hemorrhages.

Objective: Minimally invasive surgical (MIS) evacuation of basal ganglia hemorrhages has not demonstrated efficacy compared with medical management. Prior study from this group has suggested that MIS evacuation of moderate-sized putaminal intracranial hemorrhages (pICHs) using tubular retractors is associated with favorable functional outcomes. The authors hypothesized that postoperative functional outcomes were improved in patients with moderate-sized pICH compared with those of a matched cohort of medically managed patients.

Automated Computer Vision Methods for Image Segmentation, Stereotactic Localization, and Functional Outcome Prediction of Basal Ganglia Hemorrhages.

Background And Objectives: Basal ganglia intracranial hemorrhage (bgICH) morphology is associated with postoperative functional outcomes. We hypothesized that bgICH spatial representation modeling could be automated for functional outcome prediction after minimally invasive surgical (MIS) evacuation.

Methods: A training set of 678 computed tomography head and computed tomography angiography images from 63 patients were used to train key-point detection and instance segmentation convolutional neural network-based models for anatomic landmark identification and bgICH segmentation.

Predictors of withdrawal of life-sustaining therapies in older adults with TBI and a modified frailty index score.

Background: Withdrawal-of-life-sustaining-therapies (WLST) in patients with traumatic brain injury (TBI) is a complex decision-making process. The clinical factors related to WLST in older adults with TBI are currently poorly understood. The present study aims to determine the clinical predictors of WLST in older patients with TBI.

Quantitative Volumetric Computed Tomography Density Predicts Basal Ganglia Hemorrhage Expansion and Enhances Spot Sign Diagnostic Accuracy.

Background And Objectives: Identifying patients with basal ganglia intracranial hemorrhage (ICH) at risk of hematoma expansion (HE) may better define selection criteria for early surgical evacuation. The aim of this study was to use automated radiographic feature extraction to improve risk stratification for basal ganglia ICH expansion.

Methods: A single-center retrospective review was performed to identify patients with basal ganglia ICH between 2013 and 2024.

Direct Superficial Temporal Artery-Proximal Middle Bypass in Moyamoya Disease: Predicting Postoperative Symptomatic Contralateral Stroke Using Clinical Characteristics and Angiographic Collateralization Patterns.

Background: Moyamoya disease (MMD) is a rare cerebrovascular disorder marked by internal carotid artery narrowing, collateral neovascularization, and symptomatic cerebral ischemia. Select patients can benefit from direct bypass (superficial temporal artery [STA]-proximal middle [MCA] bypass) by restoring blood flow to hypoperfused territories. Symptomatic contralateral stroke (CS) following STA-MCA bypass is a devastating, poorly understood complication.

Computational modeling of basal ganglia hemorrhage morphology improves functional outcome prognostication after minimally invasive surgical evacuation.

Introduction: Anatomic factors that predict outcomes following basal ganglia intracranial hemorrhage (bgICH) evacuation are poorly understood. Given the compact neuroanatomic organization of the basal ganglia, we hypothesized that bgICH spatial representation could predict postoperative functional outcomes.

Methods: Patients undergoing minimally invasive surgical bgICH evacuation between 2013 and 2024 at one center were retrospectively reviewed.

Neurological Outcomes Following Craniotomy for Extracorporeal Membrane Oxygenation-Associated Intracranial Hemorrhage: Case Series and Literature Review.

Background: Intracranial hemorrhage (ICH) is a potential complication associated with extracorporeal membrane oxygenation (ECMO), which has been increasingly utilized in recent years. A paucity of data exists describing patient outcomes following invasive neurosurgical interventions in patients receiving ECMO therapy. The purpose of this study was to assess the clinical and functional outcomes in patients who underwent cranial neurosurgery for the management of an ECMO-associated intracranial complication.

The incidence of infratentorial arteriovenous malformation-associated aneurysms: an institutional case series and systematic literature review.

Background: Arteriovenous malformation (AVM)-associated aneurysms represent a high-risk feature predisposing them to rupture. Infratentorial AVMs have been shown to have a greater incidence of associated aneurysms, however the existing data is outdated and biased. The aim of our research was to compare the incidence of supratentorial vs infratentorial AVM-associated aneurysms.

Risk assessment of early therapeutic anticoagulation following cranial surgery: an institutional case series.

Objective: Postoperative thrombotic complications represent a unique challenge in cranial neurosurgery as primary treatment involves therapeutic anticoagulation. The decision to initiate therapy and its timing is nuanced, as surgeons must balance the risk of catastrophic intracranial hemorrhage (ICH). With limited existing evidence to guide management, current practice patterns are subjective and inconsistent.

Clinical presentation and extent of resection impacts progression-free survival in spinal ependymomas.

Purpose: Primary treatment of spinal ependymomas involves surgical resection, however recurrence ranges between 50 and 70%. While the association of survival outcomes with lesion extent of resection (EOR) has been studied, existing analyses are limited by small samples and archaic data resulting in an inhomogeneous population. We investigated the relationship between EOR and survival outcomes, chiefly overall survival (OS) and progression-free survival (PFS), in a large contemporary cohort of spinal ependymoma patients.

Repeat Flow Diversion for Retreatment of Incompletely Occluded Large Complex Symptomatic Cerebral Aneurysms: A Retrospective Case Series.

Background And Objectives: Data regarding radiographic occlusion rates after repeat flow diversion after initial placement of a flow diverter (FD) in large intracranial aneurysms are limited. We report clinical and angiographic outcomes on 7 patients who required retreatment with overlapping FDs after initial flow diversion for large intracranial aneurysms.

Methods: We performed a retrospective review of a prospectively maintained database of cerebrovascular procedures performed at our institution from 2017 to 2021.

The obesity paradox and ventriculoperitoneal shunting in aneurysmal subarachnoid hemorrhage patients undergoing microsurgical clipping.

Background: Aneurysmal subarachnoid hemorrhage (aSAH) can be devastating. Identifying predisposing factors is paramount in reducing aSAH-related mortality. Obesity's negative impact on health is well-established.

Prognosticators of Functional Outcome After Supratentorial Minimally Invasive Intracranial Hemorrhage Evacuation With Tubular Retractor Systems.

Background And Objectives: Prognosticators of good functional outcome after minimally invasive surgical (MIS) intracranial hemorrhage (ICH) evacuation are poorly defined. This study aims to investigate clinical and radiographic prognosticators of poor functional outcome after MIS evacuation of ICH with tubular retractor systems.

Methods: Single-center retrospective review of adult (age ≥18 years) patients who underwent surgical evacuation of a spontaneous supratentorial ICH evacuation using tubular retractors from 2013 to 2022 was performed.

Flow diversion for the treatment of intracranial bifurcation aneurysms: a systematic review and meta-analysis.

Background: Flow diversion (FD: flow diversion, flow diverter) is an endovascular treatment for many intracranial aneurysm types; however, limited reports have explored the use of FDs in bifurcation aneurysm management. We analyzed the safety and efficacy of FD for the management of intracranial bifurcation aneurysms.

Methods: A systematic review identified original research articles that used FD for treating intracranial bifurcation aneurysms.

A novel endoleak classification for intracranial aneurysm flow diversion: A retrospective case series.

Background: Although flow diversion (FD) is safe and effective in the treatment of intracranial aneurysms, a subset tends to continue filling on serial angiography. Risk factors for failed flow diversion include old age, large aneurysm size, and overstenting an adjacent end-arterial vessel. The hemodynamic modes of persistent aneurysm filling, or 'endoleaks', after FD are poorly understood.

Diffuse Axonal Injury Pattern Predicts Timing of In-Hospital Neurologic Recovery: A Retrospective Case Series.

Background: Diffuse axonal injury (DAI) is a devastating traumatic neurologic injury with variable prognosis. Although outcomes such as mortality have been described, the time course of neurologic progression is poorly understood. We investigated the association between DAI neuroanatomic injury pattern and neurologic recovery timing.

Percutaneous vertebral augmentation for acute traumatic vertebral Fractures: A TQIP database study.

Patients with vertebral fractures may be treated with percutaneous vertebroplasty (VP) and kyphoplasty (KP) for pain relief. Few studies examine the use of VP and KP in the setting of an acute trauma. In this study, we describe the current use of VP/KP in patients with acute traumatic vertebral fractures.

Surgical Resection of Deep-Seated Arteriovenous Malformations Through Stereotactically Guided Tubular Retractor Systems: A Case Series.

Background: Arteriovenous malformations (AVMs) in the subcortical and/or periventricular regions can cause significant intraventricular and intracranial hemorrhage. These AVMs can pose a unique surgical challenge because traditional, open approaches to the periventricular region require significant cortical/white matter retraction to establish sufficient operative corridors, which may result in risk of neurological injury. Minimally invasive tubular retractor systems represent a novel, feasible surgical option for treating deep-seated AVMs.

Diagnostic yield of cerebral angiography for intracranial hemorrhage in young patients: A single-center retrospective analysis.

BackgroundIntracranial hemorrhage (ICH) secondary to hypertension (HTN) classically occurs in the basal ganglia, cerebellum, or pons. Vascular lesions such as aneurysms or arteriovenous malformations (AVMs) are more common in younger patients. We investigated the utility of diagnostic subtraction angiography (DSA) in young hypertensive patients with non-lobar ICH.