How Do Patient Outcomes in Mechanical Thrombectomy for Large-Core Stroke Vary Based on Neuroimaging Modalities Used for Patient Selection? A Multicenter Multinational Study.

The role of different imaging modalities-non-contrast CT (NCCT), CT perfusion (CTP), and diffusion-weighted imaging (DWI)-in selecting patients with large-core stroke for endovascular thrombectomy (EVT) is a subject of ongoing debate. This study aims to determine whether patients with large-core acute ischemic stroke (AIS) undergoing EVT triaged with CTP or DWI in addition to NCCT had different clinical outcomes compared to those only triaged with NCCT. We queried the Stroke Thrombectomy and Aneurysm Registry (STAR) for patients enrolled between 2014 and 2023 who presented with anterior-circulation AIS and large ischemic core (ASPECTS < 6) who underwent EVT in 41 stroke centers in the USA, Europe, Asia, and South America.

Reversible edema after radiosurgery for arteriovenous malformations (AVMs): Inflow and outflow imbalance.

We examine the remodeling of arterial feeders and draining veins following Stereotactic Radiosurgery (SRS) and explore their relationship with radiation-induced edema using retrospective data from 50 patients with cerebral AVMs treated with CyberKnife between 2010 and 2023 at a single center. Univariate analyses were performed. 46% of patients developed post-SRS edema.

Comparison of the Diagnostic Utility of Computed Tomography Angiography Head With and Without 3-Dimensional Volume-Rendered Images for Aneurysm Detection in Subarachnoid Hemorrhage Patients Versus Digital Subtraction Angiography.

Background And Objectives: Generating computed tomography (CT) angiography (CTA) 3-dimensional (3D) volume-rendered (3DVR) images can be time consuming without specialized technical staff or artificial intelligence solutions. However, their role in aneurysm detection in patients with subarachnoid hemorrhage is not known. Our aim was to assess the diagnostic utility of 64-detector row CTA with 3DVR (CTA+3DVR) vs without 3DVR (CTA-3DVR) in intracranial aneurysm detection.

Middle meningeal artery embolization for chronic subdural hematoma in octogenarians and nonagenarians: an individual patient pooled meta-analysis.

Chronic subdural hematoma (cSDH) is a highly common neurosurgical condition with significant burden in the elderly, and patients aged ≥ 80 represent nearly one-third of cases. Middle meningeal artery embolization (MMAE) has emerged as a promising treatment method to reduce hematoma growth and recurrence; however, octogenarians and nonagenarians remain underrepresented in clinical trials. We conducted a systematic review and meta-analysis of individual patient data to evaluate outcomes of MMAE in this high-risk group.

Optimal imaging follow-up strategies for conservatively managed cerebral cavernous malformations: a cost-effectiveness analysis.

Objective: Cavernous malformations are low-flow vascular anomalies within the central nervous system, notable for their potential to cause seizures or intraparenchymal hemorrhage. Currently, no consensus exists to recommend a specific interval for following radiographic imaging of cerebral cavernous malformations (CCMs) that are not treated with either resection or radiation. Herein, the authors aimed to determine the most cost-effective strategy for MRI follow-up of CCM in both brainstem and nonbrainstem locations in order to enable earlier diagnosis and potentially circumvent fatal events due to CCM-related hemorrhages.

Impact of smoking on occlusion rates following stereotactic radiosurgery for Spetzler Martin grade I-III brain arteriovenous malformations - A propensity score matched analysis of the MISTA consortium.

Backgroundand Objective: The authors compareocclusion rates in grade I-III AVMs in smokers and non-smokers, using propensity score matching (PSM).

Methods: The authors performed a subgroup analysis of the MISTA consortium, a multicenter registry that includes patients aged 1 to 89 years with AVMs treated between January 2010 and December 2023. Only grade I-III AVMs were included.

The Orbital Grading system yields higher precision than the Matsushima grading system in assessing angiographic outcomes after EDAS for Moyamoya disease: an interrater reliability analysis.

Matsushima Grading System has been widely used to evaluate vessel ingrowth after bypass procedures for patients with Moyamoya disease (MMD). However, Matsushima is notably subjective and prone to measurement variability among clinicians. To address these limitations, the Orbital Grading System was developed as an objective approach to assess collateralization after EDAS, utilizing orbital craniometric landmarks to segment the ipsilateral skull into three distinct regions.

Pump Versus Syringe: Aspiration Thrombectomy Direct Pressure Comparisons in a Comprehensive Benchtop 3-Dimensional-Printed Circle of Willis Model.

Background And Objectives: Experiments have shown that 60-cc syringes generate stronger vacuum forces than mechanical pumps. However, few studies have measured catheter tip suction pressure during thrombus engagement. Therefore, this study aimed to compare aspiration forces and pressure drops, generated by mechanical pumps and 60-cc syringes connected to various catheters when aspirating synthetic clots in a 3-dimensional-printed model.

Addressing Limited Generalizability in Artificial Intelligence-Based Brain Aneurysm Detection for Computed Tomography Angiography: Development of an Externally Validated Artificial Intelligence Screening Platform.

Background And Objectives: Brain aneurysm detection models, both in the literature and in industry, continue to lack generalizability during external validation, limiting clinical adoption. This challenge is largely due to extensive exclusion criteria during training data selection. The authors developed the first model to achieve generalizability using novel methodological approaches.

Advancements in flow measurement techniques within cerebrovascular neurosurgery.

Purpose: The cerebral vasculature operates as a highly dynamic system that actively regulates blood flow to maintain the brain's physiological equilibrium while providing essential support for its functions. Therefore, enhancing our understanding of how cerebral blood flow is controlled, modified, or adapts in the presence of specific pathologies-such as stroke, Moyamoya disease, arteriovenous malformations (AVMs), or aneurysms-is critical for accurately evaluating the effects of these conditions and for developing effective therapeutic strategies for patients.

Materials And Methods: A comprehensive literature review was performed with the aim of exploring recent advances in neuroimaging techniques used to assess hemodynamic alterations in the cerebral vasculature.

Comparative Effectiveness of Conservative Management Versus Surgical Fixation in Acute Type II Odontoid Fractures.

Background And Objectives: Managing acute type II odontoid fractures in the elderly is challenging because of comorbidities and frailty. This study evaluates radiological and functional outcomes of conservative vs surgical treatment.

Methods: A retrospective analysis at a single US institution on elderly patients with acute type II odontoid fractures (January 2015-December 2023) was performed.

Risk factors of postprocedure seizures following standalone middle meningeal artery embolization of chronic subdural hematomas: a bi-institutional retrospective analysis.

Background: Seizures have been reported to arise after middle meningeal artery embolization (MMAE) for the treatment of chronic subdural hematomas (cSDH). However, the rates and factors influencing their development have been poorly established in the literature. Herein, we assess for risk factors for seizures post-MMAE.

Management of cervical carotid pseudoaneurysms: Integrating clinical practice with computational fluid dynamics insights.

Background: Cervical carotid dissections are a significant cause of thromboembolic events in young adults. While endovascular treatment is often used for large or enlarging lesions, smaller lesions are frequently managed conservatively. However, there is limited research on the hemodynamic differences between conservatively managed and endovascularly treated cervical carotid pseudoaneurysms.

Moyamoya disease manifesting with bilateral involvement of the proximal vertebral arteries: A case report.

Moyamoya disease (MMD) is a cerebrovascular disorder characterized by progressive occlusion of intracranial arteries, often leading to stroke and intracerebral hemorrhage. While MMD classically affects the intracranial vasculature, we present an unusual case of bilateral vertebral steno-occlusion, resulting in vertebrobasilar insufficiency in a 37-year-old man with MMD and treated with angioplasty and stenting of the dominant vertebral artery. Review of the literature demonstrates proximal vertebral artery involvement to be a rare manifestation of moyamoya disease.

Seizure presentation and incidence-associated factors in treated cerebral arteriovenous malformations: a secondary analysis of the MISTA consortium.

Seizures occur in 20-45% of patients with cerebral arteriovenous malformations (AVMs) and can potentially influence their quality of life. Some studies have suggested risk factors influencing their development, but the evidence is limited to small cohorts. To analyze seizure presentation and factors influencing seizure development in patients with cerebral AVMs using a multi-institutional consortium.

Understanding Risk Factors for Postoperative Seizure Following Surgical Treatment and Middle Meningeal Artery Embolization of Chronic Subdural Hematomas.

Objective: Chronic subdural hematoma (cSDH) is often associated with clinical seizures, with incidence rates ranging from 2.6% to 23%. While risk factors like hematoma size and craniotomy with membranectomy are well established, the impact of middle meningeal artery embolization (MMAe) remains underexplored.

Bridging the Global Technology Gap in Neurosurgery: Disparities in Access to Advanced Tools for Brain Tumor Resection.

Background And Objectives: The advent of advanced technologies has brought unprecedented precision and efficacy to neurosurgical procedures for brain tumor resection. Despite the remarkable progress, disparities in technology access across different nations persist, creating significant challenges in providing equitable neurosurgical care. The purpose of the following work was to comprehensively analyze the existing disparities in access to innovative neurosurgical technologies and the impact of such disparities on patient outcomes and research.

Postoperative Hemorrhage in Patients with Aneurysms Associated with Arteriovenous Malformations. A Systematic Review and Meta-Analysis.

Objective: To compare the rates of postoperative hemorrhages (PHs) for aneurysms associated with brain arteriovenous malformation (AVM) evaluating the lesion that was initially treated.

Methods: A systematic review of the literature was carried out following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The search was performed in PubMed, Embase, and Scopus.

Aneurysm dome and vessel pressure measurements with coiling, stent assisted coiling and flow diversion.

Background: Variability in long-term endovascular treatment outcomes for intracranial aneurysms has prompted questions regarding the effects of these treatments on aneurysm hemodynamics. Endovascular techniques disrupt aneurysmal blood flow and shear, but their influence on intra-aneurysmal pressure remains unclear. A better understanding of aneurysm pressure effects may aid in predicting outcomes and guiding treatment decisions.

Intracranial hemorrhagic events associated with flow diversion treatment: a retrospective analysis from a single academic institution.

Intracranial hemorrhages are highly concerning but underreported complications related to flow diversion (FD) treatment of intracranial aneurysms. Herein, we aimed to characterize these complications and the factors influencing their occurrence. We retrospectively reviewed patients treated with FD from 2013 to 2023 at a single U.

Anterior choroidal artery aneurysm case series: a clinical decision algorithm for endovascular and surgical treatment using a novel classification system.

Anterior choroidal artery (AChA) aneurysms represent 2-5% of intracranial aneurysms. The proximity of the origin of the AChA to the aneurysm neck poses a risk of thromboembolic complications following treatment. AChA occlusion can result in significant neurological deficits.

Socioeconomic Disparities in the Clinical Outcomes of Pediatric Traumatic Brain Injury: A Nationwide Analysis of the Past Decade.

Background: Socioeconomic status has historically influenced traumatic brain injury (TBI) outcomes, yet pediatric TBI disparities remain understudied. We aimed to analyze the National Inpatient Sample database for socioeconomic disparities in the outcomes of pediatric TBI patients.

Methods: The National Inpatient Sample from 2011 to 2020 was retrospectively analyzed for pediatric TBI patients.

Sequential Hemodynamic Analysis of Ruptured Posterior Communicating Artery Aneurysms Treated With Coil Embolization and Delayed Flow Diversion.

Background And Objectives: Computational fluid dynamics has advanced our knowledge of the pathogenesis of intracranial aneurysms and the dynamic changes observed after treatment. Herein, we analyze hemodynamic changes throughout the intervention stages for ruptured posterior communicating artery (PComA) aneurysms, treated with acute coiling and delayed flow diversion (FD).

Methods: We performed a retrospective analysis of ruptured PComA aneurysms treated with the acute coiling and delayed FD strategy between June 2013 to November 2022, using 3-dimensional reconstructions of digital subtraction angiographies.