Stentplasty for treating symptomatic intracranial atherosclerotic disease following failure of medical therapy.

Purpose: Endovascular treatment of intracranial atherosclerotic disease (ICAD) remains challenging due to procedural risks and stroke recurrence. Previous trials have favored aggressive medical therapy. In patients refractory to medical therapy, 'stentplasty' using expandable and retrievable devices may provide a safer alternative to balloon angioplasty by allowing controlled submaximal vessel dilation without flow arrest.

Volume of Aneurysmal Subarachnoid Hemorrhage and Cognitive Outcomes.

Background: The modified Fisher score is commonly used after aneurysmal subarachnoid hemorrhage (aSAH) to estimate hemorrhage burden and support early prognostication, although its accuracy in predicting cognitive outcomes remains limited. This study compares the predictive value of the subjective asessment of aSAH volume through the modified Fisher score with an objetive volumetric quantification in prognosticating cognitive outcomes.

Methods: This retrospective observational study included patients with aSAH between 2009 and 2024 and good functional recovery (modified Rankin score ≤ 2) at least 6 months after aSAH.

TBI Biomarker Improvements Following Rodent Decompressive Craniectomy and Motor Outcome Validation of Early Cranioplasty.

BackgroundDecompressive craniectomy (DC) is a venerable clinical tool to manage moderate-to-severe traumatic brain injury (TBI). The utility of recently approved neuroinflammatory biomarkers glial fibrillary acidic protein () and ubiquitin C-terminal hydrolase-L1 () is unclear in DC patients as does the timing of cranioplasty to repair/restore the missing cranial bone. We hypothesize that DC diminishes acute neuroinflammatory biomarkers and and that early cranioplasty improves motor recovery following DC in moderate-to-severe TBI.

Impact of Clinical Variables and Aneurysm Morphology on Hemorrhage Volume and Clinical Outcomes.

Background And Objectives: It is unknown what determines the volume of aneurysmal subarachnoid hemorrhage (aSAH). We aimed to investigate the features associated to the burden of subarachnoid hemorrhage after aneurysm rupture and its impact on clinical outcomes.

Methods: Patients admitted with aSAH between 2009 and 2022 were included.

Predictive models for assessing the risk of brain aneurysm rupture.

Objective: Increased contrast enhancement of the aneurysm wall may indicate aneurysm instability. The authors tested different predictive models of aneurysm instability on a cohort of patients imaged with high-resolution magnetic resonance imaging (HR-MRI).

Methods: Patients with intracranial aneurysms were prospectively scanned with HR-MRI.

Exploratory randomised trial of tranexamic acid to decrease postoperative delirium in adults undergoing lumbar fusion-a trial stopped early.

Background: Postoperative delirium may be mediated by systemic inflammation and neuroinflammation. By inhibiting the proinflammatory actions of plasmin, tranexamic acid (TXA) may decrease postoperative delirium. To explore this hypothesis, we modified an ongoing randomised trial of TXA on blood loss, adding measures of delirium, cognition, systemic inflammation, and astrocyte activation.

Flow diversion for posterior circulation intracranial aneurysms: a systematic review and meta-analysis.

Background: Posterior circulation (PC) aneurysms are associated with a higher risk of rupture. Flow diverters (FDs) are widely used for carotid intracranial aneurysms, but their role in PC aneurysms is less established. This meta-analysis examines the available literature on the safety and effectiveness of FDs for PC aneurysms.

Predictors of angiographic occlusion after embolization of intracranial arteriovenous malformations with curative intent.

BackgroundEndovascular embolization is a potential alternative to open surgery for treating intracranial arteriovenous malformations (AVMs). To our knowledge, predictors of occlusion after curative embolization of AVMs remain limited in literature. Our study aims to identify predictors of radiographic occlusion after embolization of AVMs with curative intent.

Blood pressure in human large cerebral arteries: a feasibility study.

The lack of direct measures of brain blood pressure (BBP) has severely restricted understanding of cerebral pressure-flow relationships and their control. We sought to evaluate the feasibility of directly measuring BBP and its pulsatility between the aorta and middle cerebral artery (MCA) during elective endovascular surgical procedures. We report five case studies (four female, 61 ± 13 yr; means ± SD) of patients undergoing cerebrovascular interventional procedures for aneurysm and stenoses, using direct BBP measures with the COMET 2 pressure guidewire system (Boston Scientific).

Clinical Advances in the Diagnosis and Treatment of Cerebrovascular Diseases.

The management of cerebrovascular diseases has significantly evolved over the last decade or so [...

Expanded Endoscopic Endonasal Clipping of a Giant Cavernous Carotid Aneurysm.

Cavernous carotid aneurysms are typically small, asymptomatic, and often do not require treatment. We present the case of a 59-year-old woman, a 3-pack-a-day smoker, who presented with the primary complaint of left retro-orbital pain, left complete ophthalmoplegia, left-sided blindness, and right abducens palsy. Imaging revealed a giant right cavernous carotid aneurysm, which had expanded to the contralateral cavernous sinus wall and superiorly through the diaphragm sellae.

Exploratory Randomised Trial of Tranexamic Acid to Decrease Postoperative Delirium in Adults Undergoing Lumbar Fusion: A trial stopped early.

Background: Postoperative delirium may be mediated by perioperative systemic- and neuro-inflammation. By inhibiting the pro-inflammatory actions of plasmin, tranexamic acid (TXA) may decrease postoperative delirium. To explore this hypothesis, we modified an ongoing randomised trial of TXA, adding measures of postoperative delirium, cognitive function, systemic cytokines, and astrocyte activation.

Neuromodulation with Ultrasound: Hypotheses on the Directionality of Effects and Community Resource.

Low-intensity Transcranial Ultrasound Stimulation is a promising non-invasive technique for brain stimulation and focal neuromodulation. Research with humans and animal models has raised the possibility that TUS can be biased towards enhancing or suppressing neural function. Here, we first collate a set of hypotheses on the directionality of TUS effects and conduct an initial meta-analysis on the available TUS studies reporting stimulation parameters and outcomes ( = 47 studies, 52 experiments).

Primary Embolization of Cerebral Arteriovenous Malformations With Intention to Cure: A Systematic Review of Literature and Meta-Analysis.

Background And Objectives: The treatment of brain arteriovenous malformations (AVMs) involves multiple approaches, including embolization, microsurgical resection, and radiosurgery. With the advent of new embolisates, dual-lumen balloon catheters, detachable tip microcatheters, and transvenous embolization, endovascular AVM obliteration has become more effective. Although adjuvant embolization and embolization are commonly used, the safety and effectiveness of curative embolization remain unclear.

Contemporary Methods for Detection and Intervention of Distal Medium and Small Vessel Occlusions.

The efficacy of using mechanical thrombectomy for proximal large vessel occlusions has been demonstrated in multiple large-scale trials and has further raised the question of its potential utility for distal medium and small vessel occlusions (DMSVOs). Their longer, more tortuous course and smaller corresponding vascular territories render a significant challenge for detection and intervention. The aim of this study is to provide a comprehensive overview of the current imaging and endovascular intervention options for DMSVOs and review the current works in the literature.

Deep brain stimulation for substance use disorder: a systematic review and meta-analysis.

Objective: Substance use disorder (SUD) is a significant public health issue with a high mortality rate. Deep brain stimulation (DBS) has shown promising results in treating SUD in certain cases. In this study, we conducted a meta-analysis to evaluate the efficacy of DBS in the treatment of SUD and reduction of relapse rates.

Novel Use of Robotically Harvested Internal Thoracic Artery in High-Flow Cerebral Bypass.

Mesenchymal tumors of the head and neck can lead to tumor-induced osteopeni, necessitating a biochemical cure to alleviate associated symptoms. We present a case of a 40-year-old man who presented with diffuse pain and wheelchair dependency secondary to a skull base mesenchymal tumor producing tumor-induced osteopeni. The tumor involved the cavernous sinus, infratemporal fossa, and middle cranial fossa.

Microsurgical Resection of Spinal Arteriovenous Malformation with Clipping of Anterior Spinal Artery Aneurysm.

Spinal cord arteriovenous malformations (AVMs) are rare and usually present in younger patients. We present the case of a 76-year-old woman with a 2-year history of unsteady gait. She presented to us with sudden-onset thoracic pain, numbness, and weakness in both legs.

Long-Term Follow-Up of Cerebral Aneurysms Completely Occluded at 6 Months After Intervention with the Woven EndoBridge (WEB) Device: a Retrospective Multicenter Observational Study.

The Woven EndoBridge (WEB) device has been widely used to treat intracranial wide neck bifurcation aneurysms. Initial studies have demonstrated that approximately 90% of patients have same or improved long-term aneurysm occlusion after the initial 6-month follow up. The aim of this study is to assess the long-term follow-up in aneurysms that have achieved complete occlusion at 6 months.

The Adjustable Cranial Plate: A Novel Implant Designed to Eliminate the Need for Cranioplasty Surgery Following a Hemicraniectomy Operation.

Background: Decompressive hemicraniectomy (DHC) is performed to relieve life-threatening intracranial pressure elevations. After swelling abates, a cranioplasty is performed for mechanical integrity and cosmesis. Cranioplasty is costly with high complication rates.

Microsurgery of Meningiomas Involving the Superior Sagittal Sinus.

Meningiomas involving major dural sinuses can be difficult to resect without proper handling of the sinus. In young patients, a gross total resection should be attempted when feasible. A 24-year-old man presented with headaches, progressive left-sided weakness, and partial motor seizures.