Effect of early versus delayed middle meningeal artery embolization on clinical outcomes in chronic subdural hematoma: A propensity score-matched cohort study.

Background: Chronic subdural hematoma (cSDH) is a common neurosurgical condition with a high recurrence rate following surgical evacuation. Middle meningeal artery embolization (MMAE) has emerged as an adjunctive or standalone treatment, but the optimal timing of embolization remains unclear. We evaluated whether early MMAE (≤2 days) versus delayed MMAE (3-7 days) is associated with improved clinical outcomes.

Composite arterial and venous collateral score on single-phase CTA predicts 90-day outcomes in anterior circulation large-vessel occlusion stroke.

Background: Collateral circulation influences clinical outcomes in patients with acute ischemic stroke due to anterior circulation large-vessel occlusion (LVO). While both arterial and venous collateral assessments on single-phase computed tomography angiography (CTA) have prognostic value, they have traditionally been evaluated independently.

Purpose: We developed the CTA Collateral Impairment Score (CCIS), a composite measure incorporating arterial (Tan) and venous (Cortical Venous Opacification Score (COVES)) scores, and investigated its association with 90-day functional outcomes.

Preoperative middle meningeal artery embolization is associated with reduced reoperation rates in chronic subdural hematoma.

BackgroundMiddle meningeal artery embolization (MMAE) has recently emerged as a promising adjunctive therapy to surgical evacuation for patients with chronic subdural hematoma (cSDH). However, the optimal timing of MMAE relative to surgery remains poorly defined. Therefore, this large retrospective cohort study aimed to assess the impact of MMAE timing (preoperative vs.

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.

Interobserver and Intraobserver Variability in the Assessment of Prolonged Venous Transit in Anterior Circulation Large-Vessel Occlusion Ischemic Stroke.

Background And Purpose: Prolonged venous transit (PVT) on time-to-maximum (Tmax) perfusion maps has been associated with worse outcomes in patients with acute ischemic stroke due to anterior circulation large-vessel occlusion (AIS-LVO). The qualitative nature of PVT assessment introduces potential variability, and its reproducibility has not been systematically evaluated.

Materials And Methods: In a retrospective study of patients with confirmed AIS-LVO, 2 board-certified neuroradiologists independently reviewed pretreatment Tmax maps to assess PVT in the posterior superior sagittal sinus and torcula.

Hypoperfusion intensity ratio is associated with follow-up infarct volume in medium vessel occlusions: A multicenter multinational study.

Medium vessel occlusion (MeVO) contributes significantly to acute ischemic stroke (AIS). The hypoperfusion intensity ratio (HIR), reflecting collateral circulation via the ratio of Tmax >10s to Tmax >6s volumes, predicts infarct progression in large-vessel occlusions but is unstudied in MeVOs. In this multicenter, multinational retrospective study, we evaluated consecutive patients with MeVO who underwent mechanical thrombectomy with or without intravenous thrombolysis.

Utilization of CTA in Strangulation Evaluation.

Background And Purpose: Computed tomographic angiography (CTA) is a commonly utilized study in the setting of strangulation-related injuries due to the concern for blunt cerebrovascular injuries (BCVIs). However, patients can present with a variety of histories and symptoms, which can make screening for at-risk populations in this group difficult. Therefore, this study aimed to identify risk factors and rates of BCVIs in the setting of strangulation-related injuries to guide imaging strategies.

Tranexamic acid with surgery vs. surgery alone for chronic subdural hematoma: Propensity score-matched analysis.

Background: Chronic subdural hematoma (CSDH) is frequently managed with surgical evacuation, but recurrence often necessitates repeat surgery. Tranexamic acid (TXA), an antifibrinolytic agent, has been proposed as an adjunct to reduce rebleeding and recurrence. Data on its benefits and risks remain limited.

Dose-response and infusion duration of intra-arterial nimodipine in cerebral vasospasm after aneurysmal subarachnoid hemorrhage: a single-center case series.

Background: This single-center case series evaluates the effects on arterial diameter, perfusion imaging, and safety of intra-arterial (IA) nimodipine administration for CV following aSAH.

Methods: In this prospective single-center observational study (SAVEBRAIN PWI; NCT05276934), 14 patients with CV refractory to medical treatment were treated with IA nimodipine. We assessed changes in vessel diameter and perfusion parameters pre- and post-treatment.

Outcomes of external ventricular drainage and lumbar drainage in aneurysmal subarachnoid hemorrhage: A systematic review and meta-analysis.

Background: Lumbar drainage (LD) and external ventricular drainage (EVD) are used in patients with aneurysmal subarachnoid hemorrhage (aSAH) for cerebrospinal fluid diversion and blood clearance. While both have potential benefits, the relative efficacy and safety of LD versus EVD remain unclear, particularly given their use in differing clinical contexts. This study aims to provide a crude comparison of LD and EVD in the context of aSAH using the most updated and comprehensive meta-analysis.

Integrating perfusion imaging derived venous outflow and tissue-level collateral parameters in a comprehensive clinical model enhances prognostication in large vessel occlusion stroke.

Arterial inflow restoration and collateral status have been significantly correlated with functional outcomes in AIS-LVO patients undergoing mechanical thrombectomy (MT). CT perfusion imaging biomarkers, including prolonged venous transit (PVT), cerebral blood volume (CBV) index, and hypoperfusion intensity ratio (HIR), have emerged as reliable pretreatment adjunct parameters of comprehensive flow assessment. However, their absolute and comparative effectiveness in improving prognostic prediction remains unclear when used in conjunction with clinical and arterial inflow parameters.

Petechial hemorrhage in mechanical thrombectomy for distal and medium-vessel occlusions: technical considerations and outcomes.

Objective: Mechanical thrombectomy (MT) is well established for large-vessel occlusion (LVO) strokes, but its safety in distal and medium-vessel occlusions (DMVOs) requires further investigation. This study analyzed the relationship between procedural approaches, petechial hemorrhage (PetH), and clinical outcomes in DMVO thrombectomy, with particular attention to technical considerations and the complex interplay between tissue injury and hemorrhagic complications.

Methods: A retrospective cohort study was conducted on DMVO stroke patients treated with MT at 37 stroke centers worldwide from 2016 to 2024.

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.

Perfusion imaging parameters predict long-term clinical outcome in isolated posterior cerebral artery occlusion stroke patients.

BackgroundIsolated posterior cerebral artery (PCA) occlusions, which account for 5% of ischemic strokes, significantly impact patient quality of life due to effects on the thalamus and visual cortex. Current guidelines for acute treatment and the prognostic utility of perfusion imaging in PCA strokes remain limited and underexplored.MethodsWe conducted a retrospective analysis of 21 patients with isolated PCA occlusions from January 2017 to March 2023 at two comprehensive medical institutions.

A multicenter, propensity score-matched analysis of functional outcomes and recanalization success with or without Trevo for Medium and distal vessel occlusion.

BackgroundEndovascular therapy (EVT) for stroke due to distal or medium vessel occlusion (DMVO) is safe. Due to the distinct anatomical characteristics of DMVOs, further evaluation of EVT is crucial to determine which devices may yield better outcomes.MethodsA retrospective analysis of adults with DMVO treated in 37 centers (11 countries) was queried.

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.

Outcomes of arteriovenous malformations with single versus multiple draining veins: A multicenter study.

Background: Cerebral arteriovenous malformations (AVMs) are complex vascular lesions that pose a risk for hemorrhagic stroke. The number of draining veins has recently emerged as a significant predictor of rupture risk. This multicenter study aimed to evaluate the outcomes in adult AVM patients with single versus multiple draining veins.

Comparative diagnostic performance of [68 Ga]Ga-FAPI PET/CT and [18 F]FDGPET/CT in biliary tract cancers: a systematic review and meta-analysis.

Background: Biliary tract cancers (BTCs) are aggressive malignancies with poor prognosis due to late-stage diagnosis. While [18 F]-FDG PET/CT is widely used for detection and staging, its sensitivity for certain BTC subtypes is limited, prompting the evaluation of 68 Ga-FAPI PET/CT as a promising alternative.

Objective: To compare the diagnostic performance of [68 Ga]Ga-FAPI PET/CT and [18 F]FDG PET/CT in detecting BTCs, including primary tumors, lymph node involvement, and distant metastases.

Prolonged Venous Transit as a Superior Predictor of Functional Outcomes in Successfully Reperfused Large Vessel Occlusions: Comparative Analysis With Cerebral Blood Volume Index and Hypoperfusion Intensity Ratio.

Background: Collateral status plays a crucial role in outcomes after acute ischemic stroke due to large vessel occlusion. Tissue-level collaterals and venous outflow are key components following mechanical thrombectomy. This study evaluates the predictive performance of prolonged venous transit (PVT), cerebral blood volume index, and hypoperfusion intensity ratio in determining 90-day functional outcomes.

Spetzler-martin grade IV cerebral arteriovenous malformations in adult patients: a propensity-score matched analysis of resection and stereotactic radiosurgery.

Spetzler-Martin Grade IV arteriovenous malformations (AVMs) are challenging due to high risks associated with both treatment and natural progression. This study compares the outcomes of microsurgical resection and stereotactic radiosurgery (SRS) in high-grade AVMs, analyzing obliteration rates, complications, and functional outcomes. A retrospective cohort of 96 patients treated with either microsurgical resection (33 patients) or SRS (63 patients) was analyzed.

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.

Minimal clinical impact of embolization to new territory on outcomes in medium vessel occlusion strokes treated with mechanical thrombectomy: a retrospective multicenter study.

Background: Mechanical thrombectomy (MT) is established as an effective treatment for large vessel occlusion strokes, but its efficacy and safety for medium vessel occlusions (MeVOs) remain less clear. This study examines the impact of periprocedural embolization to a new vascular territory (ENT) on clinical outcomes in patients with MeVO stroke treated with MT.

Methods: A multicenter, retrospective analysis was conducted using the MAD-MT (Multicenter Analysis of primary Distal medium vessel occlusions: effect of Mechanical Thrombectomy) registry, including 2122 patients with MeVO stroke w-ho underwent MT between September 2017 and July 2023.

Spetzler-Martin grade I and II cerebral arteriovenous malformations: a propensity-score matched analysis of resection and stereotactic radiosurgery in adult patients.

Cerebral arteriovenous malformations (AVMs) are congenital vascular anomalies that can lead to severe complications, including hemorrhage and neurological deficits. This study compares the outcomes of microsurgical resection and stereotactic radiosurgery (SRS) for SM grade I and II AVMs. Out of a large multicenter registry, we identified 180 matched patients with SM grade I and II AVMs treated with either microsurgical resection or SRS between 2010 and 2023.

Epilepsy as primary tumor manifestation correlates with patient status, age, and tumor volume but not with survival in elderly glioblastoma patients: a retrospective bicentric analysis.

Assessment of the potential impact of epilepsy as primary tumor manifestation on survival in elderly glioblastoma multiforme (GBM) patients. Two academic neurosurgical centers retrospectively analyzed all GBM patients aged 65 years and older with de-novo tumors, who underwent surgery between 2006 and 2021. Epidemiological, histopathological, imaging and survival data were obtained from patients' electronic charts, and screened for the presence of epilepsy preoperatively and during follow-up.

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.