Intracranial aneurysm embolization using Penumbra fill and finish coils: 1-year results of a prospective, real-world, multicenter SURF study.

Background: SURF was a prospective, multicenter, single-arm, observational study with core lab adjudication of radiographic data, assessing embolization of intracranial aneurysms (IAs) using WAVE Extra Soft Coils as part of SMART Coil System.

Methods: Adults undergoing IA embolization with the SMART Coil System (Penumbra, Inc.) comprising 75% of implanted coils and WAVE as the final finishing coil were enrolled at 43 global centers.

Carotid Revascularization in the Modern Era: A Comparative Review of Carotid Endarterectomy, Carotid Angioplasty and Stenting, and Transcarotid Artery Revascularization.

Carotid artery stenosis is a major cause of acute ischemic stroke, accounting for approximately 15% of cases. Although optimal medical therapy remains the cornerstone of management, current guidelines recommend consideration of surgical intervention for symptomatic patients with ≥50% stenosis and asymptomatic patients with ≥70% stenosis. Extensive evidence supports carotid endarterectomy (CEA) as the gold standard procedure, whereas transfemoral carotid angioplasty and stenting (TF-CAS) and transcarotid artery revascularization (TCAR) offer safe alternatives for patients with high surgical risk.

Safety and efficacy of preoperative embolization in the treatment of brain arteriovenous malformations with perinidal aneurysms and single draining vein: a multicenter study with propensity score-weighting.

Background And Objectives: Arteriovenous malformations (AVMs) with perinidal aneurysms and single draining vein are associated with an elevated risk of rupture and increased procedural complexity. The role of preoperative embolization in this high-risk anatomical subset remains unclear. This study aimed to evaluate the safety and efficacy of microsurgery with preoperative embolization, compared with microsurgery alone in patients with such AVMs.

Safety and efficacy of the Celt arterial closure device in a femoral first neuroendovascular practice: prospective cohort study.

Objectives: To evaluate the safety and efficacy of the Celt arterial closure device (ACD), allowing immediate upright position and ambulation within 30 minutes, for femoral access closure in neuroendovascular procedures.

Methods: Single center prospective study of consecutive neuroendovascular procedures performed via transfemoral access over 6 months. The Celt ACD was preferentially used for arterial closure in eligible cases.

Angiographic perfusion outperforms large artery vasospasm for predicting the impact of rescue therapy in subarachnoid hemorrhage.

Aneurysmal subarachnoid hemorrhage (aSAH) contributes disproportionately to stroke-related disability due to its prevalence in younger patients. Large vessel vasospasm complicates aSAH and is often treated with endovascular rescue therapy (ERT). However, clinical trials have not demonstrated a clear link between vasospasm improvement and better outcomes.

Demonstration of physiologic, clinical and angiographic improvement of dural arteriovenous fistula via primary transverse sinus stenting.

A healthy, middle-aged man presented with acute on chronic progressive photophobia, headache and visual impairment. Clinical workup demonstrated advanced papilledema, tortuous optic nerves, flattened globes and intracranial pressure of >55 cm HO. Diagnostic cerebral angiogram demonstrated a Cognard IIA tentorial dural arteriovenous fistula (dAVF) associated with transverse sinus stenosis.

Neurosurgical Resident Skill Development Using a Novel Simulator-Based Anterior Cervical Discectomy and Fusion Curriculum.

Background: Simulation-based training is increasingly integrated into surgical education as a method to enhance technical skills in a safe and reproducible environment. This dual-institution pilot study - conducted within the neurosurgery residency programs at Massachusetts General Hospital and Stanford University - evaluates the feasibility and impact of integrating a three-dimensional printed anterior cervical discectomy and fusion (ACDF) simulator (UpSurgeon S.r.

Traumatic Vertebral Artery Injury: Diagnosis, Natural History, and Key Considerations for Management.

Vertebral artery injury (VAI) is a known complication of blunt cervical spine trauma with a potential risk of stroke. Factors including cervical bony injury, spinal cord injury, and overall trauma severity have been linked to an increased risk of VAI. Despite its prevalence, there is little consensus on various aspects of this pathology, including its initial screening, diagnostic approaches, and therapeutic strategies.

International multi-center study of middle meningeal artery embolization for chronic subdural hematoma in cancer patients: Efficacy, safety, and outcomes in a high-risk population.

BackgroundMiddle meningeal artery embolization (MMAE) is a promising treatment for chronic subdural hematoma (cSDH). Cancer patients are at risk for cSDH due to thrombocytopenia. The efficacy of MMAE in this population has not been studied.

Effect of race on procedural and clinical outcomes in middle meningeal artery embolization for primary and adjunctive treatment of chronic subdural hematoma.

BackgroundWe investigated racial disparities in radiologic and clinical outcomes of patients after middle meningeal artery embolization (MMAE) for chronic subdural hematoma (CSDH) with or without evacuation surgery.MethodsThis multicenter retrospective study includes consecutive patients who underwent MMAE across 11 institutions in North America (10 in the United States and 1 in Canada). Patients were stratified using self-reported racial data.

Triple Woven EndoBridge device strategy for recurrent basilar tip aneurysm: A case report.

Background: 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.

Higher risk of recurrence in partially thrombosed cerebral aneurysms post-WEB (Woven EndoBridge) device treatment: insights from the WorldWideWEB Consortium registry.

Background: The Woven EndoBridge (WEB) device is a prevalent treatment for intracranial aneurysms. While many studies have assessed the obliteration rate post-WEB embolization, few have focused on long-term outcomes in partially thrombosed aneurysms.

Objective: To assess whether partially thrombosed aneurysms are at higher risk of recurrence or retreatment following WEB embolization compared with non-thrombosed aneurysms.

Parenchymal Hematoma After Endovascular Thrombectomy Is Associated With Pretreatment Basal Ganglia Infarct Volume.

Background And Purpose: Parenchymal hematomas (PHs) represent an important complication in ischemic stroke after endovascular thrombectomy (EVT), but the risk factors are incompletely understood. Neuroimaging data preintervention, such as infarct topography, may help elucidate predisposing factors and inform more nuanced patient care intra- and postprocedurally.

Methods: Large vessel occlusion patients with pre-EVT MRI were included from a single quaternary center.

Prediction of persistent incomplete occlusion of intracranial aneurysms treated with woven EndoBridge device.

While the Woven EndoBridge (WEB) device has transformed the treatment of wide-neck intracranial aneurysms, incomplete occlusion remains a significant challenge requiring better understanding of contributing factors. A retrospective analysis was conducted on multicenter data from patients who underwent WEB device treatment for intracranial aneurysms between January 2011 and December 2022. Using machine learning models, Cox regression, and time-stratified analyses, we evaluated factors associated with persistent incomplete occlusion, defined as non-improving Raymond-Roy Occlusion Classification grade 2 or 3 at final follow-up.

Traumatic vertebral artery occlusion is associated with high rates of recanalization: insights from a systematic review and meta-analysis.

Background: Vertebral artery occlusion (VAO) is a known complication of blunt cervical injuries and can be associated with a risk of devastating strokes. VAO can spontaneously recanalize, particularly following cervical spine intervention. The aim of this study is to examine overall recanalization rates, recanalization in the context of cervical spine intervention, and the associations between VAO and stroke, spinal cord injury, and acute cervical deformity.

Incidence and predictors of Woven EndoBridge (WEB) shape modification following treatment of intracranial aneurysms in a large multicenter study.

The Woven EndoBridge (WEB) device is FDA-approved for the treatment of bifurcation aneurysms. Despite its wide popularity, it has been under scrutiny for its association with potential aneurysm recanalization and retreatment due to device shape modification. This study aims to analyze the shape modification rate of WEB devices and identify factors associated with this phenomenon, as well as its correlation with aneurysm retreatment.

Endovascular thrombectomy for large vessel occlusion stroke patients with baseline disability: Long-term outcomes and end-of-life care.

Background: One third of all patients with acute ischemic strokes have a pre-existing disability. Patients with pre-existing disabilities have historically been excluded from landmark clinical trials of acute stroke interventions, leading to ongoing controversy about the risks and benefits of acute stroke interventions such as endovascular thrombectomy (EVT). To address this controversy, we compared long-term outcomes and end-of-life care in large vessel occlusion (LVO) patients with moderate-to-severe baseline disability treated with EVT versus medical management alone.

Pre-operative internal maxillary artery embolization for temporomandibular joint replacement: safety and outcomes from a 10-year institutional experience.

Background: Temporomandibular joint replacement (TMJR) can result in large volume blood loss (BL) from the underlying internal maxillary artery (IMA). Pre-operative IMA embolization has been utilized to reduce intra-operative BL, but prior studies are limited to small case series.

Methods: Adult patients undergoing pre-operative IMA embolization for TMJR between June 2014 and September 2024 at a single institution were included.

Impact of smoking on recurrence rates among wide-neck intracranial aneurysms treated with Woven EndoBridge: a multicenter retrospective study.

Objective: Tobacco smoking is among the factors known to significantly augment the risk of untreated intracranial aneurysm (IA) growth and rupture. Smoking appears to have a variable effect on different endovascular treatment modalities. The impact of smoking on the safety, efficacy, and outcomes of Woven EndoBridge (WEB) device use for wide-neck IAs has not been evaluated.

Sub-Internship Academy: Implementation and Evaluation of Single-Day Resident-Driven Focused Sub-Internship Preparation Course.

Objective: Strong performance in neurosurgical sub-internships is a vital component of a successful residency application and requires adequate familiarity with clinical knowledge and technical skills that may not be covered in standard medical school curricula. Accordingly, a need exists for immersive and comprehensive sub-internship preparation programs that respect time and resource limitations, are optimized based on longitudinal student feedback, provide opportunities for mentorship, and foster enthusiasm for neurosurgery. Therefore, residents at a single institution designed and implemented a comprehensive curriculum for a 1-day sub-internship academy.