Outcomes after carotid revascularization for symptomatic carotid artery web: A multi-institutional cohort study.

ObjectiveCarotid web can serve as a nidus for clot formation and subsequent thromboembolic stroke. Although treatment historically involved antiplatelet therapy, recent evidence demonstrates notably elevated recurrent stroke rates despite best medical therapy. We examined the safety and efficacy of carotid artery stenting (CAS), which involves placing a coil in the artery, and carotid endarterectomy (CEA), a surgery to remove the clot, for treatment of symptomatic carotid web.

Endovascular treatment of cerebral venous sinus thrombosis: A systematic review and meta-analysis of efficacy based on technique.

BackgroundCerebral venous sinus thrombosis (CVST) is rare but potentially life-threatening. Although systemic anticoagulation is the primary treatment, endovascular thrombectomy (EVT) or thrombolysis may be considered for refractory cases. Considering advanced techniques and device technology, we undertook an updated systematic review and meta-analysis to evaluate clinical and radiographic outcomes for treating CVST.

Technical Considerations for Optimizing Flow in Superficial Temporal Artery to Middle Cerebral Artery Bypass: Case Series.

Background And Objectives: Cerebral bypass can provide flow augmentation for select patients with moyamoya disease (MMD) and steno-occlusive cerebrovascular disease (SOCD). Earlier work has suggested that sacrificing the nondonor branch of the superficial temporal artery (STA) can optimize direct flow, which we assessed in real time.

Methods: This was a single-institution observational study of consecutive patients undergoing direct STA-middle cerebral artery (MCA) bypass with indirect encephalo-duro-myo-synangiosis for MMD and SOCD over 1 year.

Intraprocedural Thromboembolism From Infective Endocarditis With Immediate Endovascular Mechanical Thrombectomy: A Case of Remarkable Timing.

Infectious intracranial aneurysms and embolic strokes are common neurological complications in patients with infective endocarditis. Diagnostic cerebral angiograms are often performed prior to cardiac valve repair if an infectious intracranial aneurysm or intracranial hemorrhage is suspected. We report a unique case of a patient with endocarditis who experienced an embolic stroke that resulted in large-vessel occlusion (LVO) of the middle cerebral artery during a diagnostic cerebral angiogram.

Inappropriate antithrombotic use in geriatric patients with complicated traumatic brain injury.

Background: Preinjury antithrombotic (AT) use is associated with worse outcomes for geriatric (65 years or older) patients with traumatic brain injury (TBI). Previous studies have found that use of AT outside established guidelines is widespread in TBI patients.

Methods: In this single-center retrospective cross-sectional study, we examined inappropriate AT use among geriatric patients presenting with traumatic intracranial hemorrhage.

The clinical potential of radiomics to predict hematoma expansion in spontaneous intracerebral hemorrhage: a narrative review.

Spontaneous intracerebral hemorrhage (sICH) is associated with significant morbidity and mortality, with subsequent hematoma expansion (HE) linked to worse neurologic outcomes. Accurate, real-time predictions of the risk of HE could enable tailoring management-including blood pressure control or surgery-based on individual patient risk. Although multiple radiographic markers of HE have been proposed based on standard imaging, their clinical utility remains limited by a reliance on subjective interpretation of often ambiguous findings and a poor overall predictive power.

The Treatment of Symptomatic Diffuse Proliferative Cerebral Angiopathy With Cilostazol: A Case Report.

Diffuse proliferative cerebral angiopathy (DPCA) is a rare form of cerebral vascular malformation responsible for 3.4% of all cerebral arteriovenous malformations (AVMs). The relative risk of rupture for DPCA is lower than for classic AVMs, so they are often managed medically.

Subtemporal Approach for the Treatment of Ruptured and Unruptured Distal Basilar Artery Aneurysms: Is There a Contemporary Use?

Background And Objectives: Distal basilar artery aneurysms (DBAs) are high-risk lesions for which endovascular treatment is preferred because of their deep location, yet indications for open clipping nonetheless remain. The subtemporal approach allows for early proximal control and direct visualization of critical posterior perforating arteries, especially for posterior-projecting aneurysms. Our objective was to describe our clinical experience with the subtemporal approach for clipping DBAs in the evolving endovascular era.

Preservation of cranial nerve function in large and giant trigeminal schwannoma resection: a case series.

Background: Trigeminal schwannomas (TSs) are intracranial tumors that can cause significant brainstem compression. TS resection can be challenging because of the risk of new neurologic and cranial nerve deficits, especially with large (≥ 3 cm) or giant (≥ 4 cm) TSs. As prior surgical series include TSs of all sizes, we herein present our clinical experience treating large and giant TSs via microsurgical resection.

Dural arteriovenous fistula in the setting of cerebral venous sinus thrombosis and COVID-19 infection.

Objective: The aim of this study was to examine the presence of concurrent venous thrombosis and COVID-19 infections in patients with dural arteriovenous fistulas (dAVFs).

Methods: An analysis of all patients diagnosed with dAVF via cerebral angiography by the senior author was conducted, with special attention given to the presence of cerebral venous sinus thrombosis (CVST) and COVID-19 infection. General demographics, clinical presentation, presence of CVST, and COVID-19 infection status were reported.

Safety and efficacy of the Pipeline Flex embolization device with Shield Technology for the acute treatment of ruptured internal carotid artery pseudoaneurysms: a multi-institution case series.

Objective: Ruptured blister, dissecting, and iatrogenic pseudoaneurysms are rare pathologies that pose significant challenges from a treatment standpoint. Endovascular treatment via flow diversion represents an increasingly popular option; however, drawbacks include the requirement for dual antiplatelet therapy and the potential for thromboembolic complications, particularly acute complications in the ruptured setting. The Pipeline Flex embolization device with Shield Technology (PED-Shield) offers reduced material thrombogenicity, which may aid in the treatment of ruptured internal carotid artery pseudoaneurysms.

Improved Accuracy and Lowered Learning Curve of Ventricular Targeting Using Augmented Reality-Phantom and Cadaveric Model Testing.

Background: Augmented reality (AR) has demonstrated significant potential in neurosurgical cranial, spine, and teaching applications. External ventricular drain (EVD) placement remains a common procedure, but with error rates in targeting between 10% and 40%.

Objective: To evaluate Novarad VisAR guidance system for the placement of EVDs in phantom and cadaveric models.

Investigation of Neutrophil Extracellular Traps as Potential Mediators in the Pathogenesis of Non-Acute Subdural Hematomas: A Pilot Study.

Non-acute subdural hematomas (NASHs) are a cause of significant morbidity and mortality, particularly with recurrences. Although recurrence is believed to involve a disordered neuroinflammatory cascade involving vascular endothelial growth factor (VEGF), this pathway has yet to be completely elucidated. Neutrophil extracellular traps (NETs) are key factors that promote inflammation/apoptosis and can be induced by VEGF.

Modified lateral orbitotomy approach for resection of anterior temporal cavernous malformation.

Background: The lateral orbitotomy approach (LOA) provides a direct and minimally invasive corridor to orbital apex, cavernous sinus, and middle cranial fossa (MCF) lesions. Removal of the lateral orbital wall and retraction of the orbital contents, as performed with a traditional LOA, can cause diplopia and enophthalmos and affect visual acuity. The modified LOA (mLOA) preserves the lateral orbital wall to limit this morbidity.

Radiographic and clinical outcomes with particle or liquid embolic agents for middle meningeal artery embolization of nonacute subdural hematomas.

Background: Middle meningeal artery (MMA) embolization is an apparently efficacious minimally invasive treatment for nonacute subdural hematomas (NASHs), but how different embolisates affect outcomes remains unclear. Our objective was to compare radiographic and clinical outcomes after particle or liquid MMA embolization.

Methods: Patients who had MMA embolization for NASH were retrospectively identified from a multi-institution database.

Factors Associated With Morbidity and Retreatment After Surgical Management of Nonacute Subdural Hematomas in Elderly Patients.

Background Preoperative identification of clinical, radiographic, and surgery-specific factors associated with nonacute subdural hematomas (SDHs) may enable clinicians to optimize the efficacy of the initial surgical intervention, improve outcomes, and decrease rates of surgical recurrence. Methods The authors identified patients aged ≥65 years who underwent surgical treatment of chronic, subacute, or mixed-density SDH at a level-1 trauma hospital over a ten-year period (2010-2019). Pre-and postoperative clinical, radiographic, and surgery-specific data were collected.

Ketamine Boluses Are Associated with a Reduction in Intracranial Pressure and an Increase in Cerebral Perfusion Pressure: A Retrospective Observational Study of Patients with Severe Traumatic Brain Injury.

Background: Increased intracranial pressure (ICP) and hypotension have long been shown to lead to worse outcomes in the severe traumatic brain injury (TBI) population. Adequate sedation is a fundamental principle in TBI care, and ketamine is an attractive option for sedation since it does not commonly cause systemic hypotension, whereas most other sedative medications do. We evaluated the effects of ketamine boluses on both ICP and cerebral perfusion pressure (CPP) in patients with severe TBI and refractory ICP.

Frontotemporal Approach for Infectious Aneurysm Trapping and Superficial Temporal Artery-Middle Cerebral Artery Bypass.

Although neurotropic, the varicella-zoster virus (VZV) is a rare cause of mycotic cerebral aneurysms. As with other mycotic aneurysms, medical management can provide complete resolution. Surgery for refractory aneurysms can be complicated by vessel friability and complex morphologies requiring excision and revascularization.

Paradigms in chronic subdural hematoma pathophysiology: Current treatments and new directions.

Chronic subdural hematomas (CSDHs) are an increasingly common pathology encountered in a neurosurgical trauma practice. Although the operative and nonoperative management of CSDH has been studied extensively, the recurrence rate of CSDH remains high, with no significant decrease in recent years. We undertook a detailed assessment of the known pathophysiological mechanisms by which CSDHs recur to improve our ability to treat patients with this disease successfully.

Middle meningeal artery embolization treatment of nonacute subdural hematomas in the elderly: a multiinstitutional experience of 151 cases.

Objective: The incidence of already common chronic subdural hematomas (CSDHs) and other nonacute subdural hematomas (NASHs) in the elderly is expected to rise as the population ages over the coming decades. Surgical management is associated with recurrence and exposes elderly patients to perioperative and operative risks. Middle meningeal artery (MMA) embolization offers the potential for a minimally invasive, less morbid treatment in this age group.