Single-Session Middle Meningeal Artery Embolization With Concomitant Evacuation Surgery for Chronic Subdural Hematoma: Impact of Surgical Approach.

Background And Objectives: Single-session middle meningeal artery embolization (MMAE) combined with surgical evacuation is a rapidly emerging strategy in the treatment of chronic subdural hematoma (cSDH). However, the effect of different evacuation techniques within this approach remains unclear.

Methods: We conducted a retrospective multicenter cohort study across 8 US institutions of patients with cSDH who underwent single-session MMAE with concomitant surgical evacuation between 2018 and 2024.

The Effect of A1 Segment Dominance on Angular Morphology of the Anterior Communicating Artery Bifurcation in Healthy and Aneurysmal Patients.

Background: The anterior communicating artery (ACOM) bifurcation, a common site for aneurysm formation, carries high risk of aneurysm rupture. Due to its anastomotic nature, it exhibits complex hemodynamic and morphological profiles. Previously, ACOM angles were evaluated without accounting for unique characteristics.

Single-Session Middle Meningeal Artery Embolization With Concomitant Evacuation Surgery for Chronic Subdural Hematomas: A Multicenter Assessment of Feasibility, Safety, and Efficacy.

Background And Objectives: Middle meningeal artery embolization (MMAE) is a safe and efficacious adjunct to surgical evacuation for symptomatic chronic subdural hematoma (cSDH). We evaluated the concomitant performance of MMAE with surgical evacuation in a single anesthetic session rather than a staged approach.

Methods: In this retrospective, multicenter cohort study, patients with cSDH who underwent MMAE and surgical evacuation during 1 anesthetic session from January 2020 through August 2024 were included.

Comparative Study on Clinical Outcomes of Posterior Endoscopic Cervical Foraminotomy under Local Anesthesia with Conscious Sedation and General Anesthesia.

Objective: Posterior endoscopic cervical foraminotomy (PECF) is a minimally invasive surgical technique for treating cervical radiculopathy. Traditionally, PECF is performed under general anesthesia in the prone position, but concerns over anesthesia-related complications have led to the exploration of local anesthesia in the lateral decubitus position as an alternative. This study aims to compare the clinical outcomes, safety, and efficacy of PECF performed under local anesthesia in the lateral decubitus position versus general anesthesia in the prone position.

Trends and disparities in ischemic stroke mortality and location of death in the United States: A comprehensive analysis from 1999-2020.

Background: Stroke remains the fifth leading cause of mortality in the United States, with significant geographical and racial disparities in outcomes. Understanding trends in location of death for ischemic stroke patients is crucial for improving end-of-life care and addressing healthcare inequities.

Methods & Findings: This retrospective study used Centers for Disease Control and Prevention's Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) data to examine ischemic stroke mortality, stratified by urbanization level and race.

Considerations for delayed-onset spinal arachnoid web after intracranial subarachnoid hemorrhage.

Spinal arachnoid web (AW) is a rare condition causing spinal cord-related issues. Its cause is often idiopathic but can be linked to past trauma or spine surgery. We describe two cases of AWs that developed after subarachnoid hemorrhage (SAH).

Reducing implicit bias in the neurosurgery application and interview process: a single-institution experience.

Objective: The neurosurgical match is a challenging process for applicants and programs alike. Programs must narrow a wide field of applicants to interview and then determine how to rank them after limited interaction. To streamline this, programs commonly screen applicants using United States Medical Licensing Examination (USMLE) Step scores.

Multiple craniotomies for the resection of symptomatic multifocal intracranial metastatic cardiac myxoma: A case report.

Background: Myxomas, rare benign mesenchymal lesions, are the most common cardiac tumors. Patients may rarely develop hematogenous metastasis to the brain, which can present as new-onset neurological deficits that correlate with multifocal hemorrhagic lesions on imaging. Limited guidelines presently exist for the treatment of such lesions.

Clinical and histopathological principles for the diagnosis of a recurrent paraganglioma of the jugular foramen initially diagnosed as a middle ear adenoma: illustrative case.

Background: Paragangliomas (PGLs) are rare neoplasms that may be associated with hereditary PGL syndromes and variable risk of metastasis. Middle ear adenomas are extremely rare tumors with no known hereditary predisposition and extremely low risk of metastasis. Although often easily differentiated, they may share clinical and pathological features that misdirect and confuse the diagnosis.

Spinal anesthesia in contemporary and complex lumbar spine surgery: experience with 343 cases.

Objective: Spinal anesthesia (SA) is an alternative to general anesthesia (GA) for lumbar spine surgery, including complex instrumented fusion, although there are relatively few outcome data available. The authors discuss their experience using SA in a modern complex lumbar spine surgery practice to describe its utility and implementation.

Methods: Data from patients receiving SA for lumbar spine surgery by one surgeon from March 2017 to December 2020 were collected via a retrospective chart review.

Aneurysm presence at the anterior communicating artery bifurcation is associated with caliber tapering of the A1 segment.

Objective: Vessel tapering results in blood flow acceleration at downstream bifurcations (firehose nozzle effect), induces hemodynamics predisposing to aneurysm initiation, and has been associated with middle cerebral artery (MCA) aneurysm presence and rupture status. The authors sought to determine if vessel caliber tapering is a generalizable predisposing factor by evaluating upstream A1 segment profiles in association with aneurysm presence in the anterior communicating artery (ACoA) complex, the most prevalent cerebral aneurysm location associated with a high rupture risk.

Methods: Three-dimensional rotational angiographic studies were analyzed for 68 patients with ACoA aneurysms, 37 nonaneurysmal contralaterals, and 53 healthy bilateral controls (211 samples total).

Diagnosis of a chronic spinal cord injury via televisit in a patient from an underserved community.

A 42-year-old woman from a medically underserved community in rural New England was referred by her primary care provider (PCP) for televisit during the coronavirus disease 2019 (COVID-19) pandemic following 2 years of chronic neck pain and numbness in her left hand that was initially concerning for demyelinating disease. Upon further evaluation, it was revealed that she had experienced a traumatic fall with a concussion and symptoms consistent with central cord syndrome but had refused magnetic resonance imaging (MRI) at her initial medical evaluation. On MRI conducted 1 month prior to neurosurgical evaluation she was found to have a disc bulge and 4-mm T2-hyperintense lesion at the C4-C5 level that was consistent with a chronic spinal cord injury secondary to spinal trauma with associated vertebrogenic injury.

Increased focal internal carotid artery angulation in patients with posterior communicating artery aneurysms.

Background: Aneurysms at the posterior communicating artery (PCOM) origin represent the most common location on the internal carotid artery (ICA), and are associated with greater recurrence following endovascular treatment. We evaluate the association between ICA angulation in three-dimensional (3D) space and PCOM aneurysmal development, using high-resolution 3D rotational angiography (3DRA) studies.

Methods: 3DRA datasets were evaluated in 70 patients with PCOM aneurysms, 31 non-aneurysmal contralateral, and 86 healthy controls (187 total).

The use of decompressive segmental sublaminoplasty to treat myelopathy caused by lumbar stenosis in tethered cord syndrome.

A 79-year-old woman presented with acute-onset right leg pain in the setting of 3 months of progressive gait deterioration and bilateral leg weakness. On exam she had right lower extremity hyperreflexia and weakness. Lumbar spine magnetic resonance imaging demonstrated L3-L5 central canal stenosis with L4-L5 spondylolisthesis and a previously undiagnosed tethered cord.