Small Ruptured Anterior Communicating Artery Aneurysms in the Endovascular Right-of-First-Refusal Era: Intraprocedural Rupture Risk and Retreatment at Follow-up.

Background: Ruptured small anterior communicating artery (ACoA) aneurysms can pose a technical challenge for endovascular therapy. We sought to explore treatment and follow-up results in the modern endovascular right of first refusal era.

Methods: Smaller (≤ 7mm) ruptured aneurysms of the ACoA undergoing treatment were compared with non-ACoA counterparts, and further dichotomized by size (≤3mm and 3-7mm).

Delayed Cerebral Ischemia and Vasospasm After Aneurysmal Subarachnoid Hemorrhage: Impact of Stents and Dual Antiplatelet Therapy.

Background And Objectives: As stent-assisted coiling and flow diversion permeate the treatment armamentarium for appropriately selected ruptured aneurysms, the effect of dual antiplatelet therapy (DAPT) on hemorrhagic complications is primarily scrutinized. However, the effect of DAPT and the presence of a stent on vasospasm and delayed cerebral ischemia (DCI) is less well studied.

Methods: Our prospectively maintained institutional database of intracranial aneurysms was queried for DCI and postaneurysmal subarachnoid hemorrhage (aSAH) vasospasm among patients undergoing stent coiling/flow diversion with subsequent usage of DAPT (S-DAPT).

Clinical comparison of flow diversion and microsurgery for retreatment of intracranial aneurysms.

Background: The goal of aneurysm retreatment is effective, durable obliteration. Flow diversion (FD) and microsurgical clipping generally represent two aneurysm treatment options with high obliteration rates. However, their relative efficacy in aneurysm retreatment has been infrequently evaluated.

Pharmaceutical Modulation of Intracranial Aneurysm Development and Rupture.

Management of intracranial aneurysms (IAs) is determined by patient age, risk of rupture, and comorbid conditions. While endovascular and microsurgical interventions offer solutions to mitigate the risk of rupture, pharmacological management strategies may complement these approaches or serve as alternatives in appropriate cases. The pathophysiology of IAs allows for the targeting of inflammation to prevent the development and rupture of IAs.

Long-term outcomes of deep pediatric arteriovenous malformations.

Objective: Multimodality treatment has been shown to be the optimal management strategy for pediatric arteriovenous malformations (AVMs). Deep AVMs represent a subset of AVMs for which optimal management may be achieved with a combination of radiosurgery and highly selective embolization, in the absence of compelling features requiring operative intervention. The objective of this study was to identify predictors of good functional outcomes in pediatric patients with deep AVMs.

Dural Sealants Do Not Reduce Postoperative Cerebrospinal Fluid Leak after Endoscopic Endonasal Skull Base Surgery.

 The application of cranial tissue sealants to assist with postoperative closure is widespread, but data are lacking regarding its utility in endoscopic endonasal surgery (EEA). A prospective study was conducted to assess the effect of sealant usage on postoperative cerebrospinal fluid (CSF) leak rate following standard reconstruction.  A prospective trial of sealant usage after endoscopic endonasal skull base surgery was performed from May 2016 to June 2019 at a tertiary referral cranial base center.

Adverse radiation effects in volume-staged radiosurgery for large arteriovenous malformations: a multiinstitutional study.

Objective: The optimal treatment paradigm for large arteriovenous malformations (AVMs) is controversial. One approach is volume-staged stereotactic radiosurgery (VS-SRS). The authors previously reported efficacy of VS-SRS for large AVMs in a multiinstitutional cohort; here they focus on risk of symptomatic adverse radiation effects (AREs).

Impact of a Hands-on Pre-Clinical Neurosurgery Elective Course on Second-Year Medical Student Interest and Attitudes.

Introduction: Medical student involvement opportunities and educational experiences with surgical residents during medical school have been shown to increase the chance of students deciding to specialize in surgical specialties. This study aims to determine the effect of a neurosurgery elective during the second preclinical year on student interest and opinion of neurosurgery.

Methods: Thirty-nine students completed opinion-based surveys and factual knowledge quizzes during a neurosurgical elective course over 3 iterations, which included lecture and skills lab instruction.

Dose response and architecture in volume staged radiosurgery for large arteriovenous malformations: A multi-institutional study.

Background: Optimal treatment paradigm for large arteriovenous malformations (AVMs) is controversial. Volume-staged stereotactic radiosurgery (VS-SRS) provides an effective option for these high-risk lesions, but optimizing treatment for these recalcitrant and rare lesions has proven difficult.

Methods: This is a multi-centered retrospective review of patients treated with a planned prospective volume staging approach to stereotactically treat the entire nidus of an AVM with volume stages separated by intervals of 3-6 months.

Repeat Stereotactic Radiosurgery for Progressive or Recurrent Vestibular Schwannomas.

Background: Stereotactic radiosurgery (SRS) is a highly effective management approach for patients with vestibular schwannomas (VS), with 10-yr control rates up 98%. When it fails, however, few data are available to guide management.

Objective: To perform a retrospective analysis of patients who underwent 2 SRS procedures on the same VS to assess the safety and efficacy of this practice.

How to improve obliteration rates during volume-staged stereotactic radiosurgery for large arteriovenous malformations.

Objective: The management of large-volume arteriovenous malformations (AVMs) with stereotactic radiosurgery (SRS) remains challenging. The authors retrospectively tested the hypothesis that AVM obliteration rates can be improved by increasing the percentage volume of an AVM that receives a minimal threshold dose of radiation.

Methods: In 1992, the authors prospectively began to stage anatomical components in order to deliver higher single doses to AVMs > 15 cm3 in volume.

Stereotactic Radiosurgery for Intracranial Ependymomas: An International Multicenter Study.

Background: Stereotactic radiosurgery (SRS) is a potentially important option for intracranial ependymoma patients.

Objective: To analyze the outcomes of intracranial ependymoma patients who underwent SRS as a part of multimodality management.

Methods: Seven centers participating in the International Gamma Knife Research Foundation identified 89 intracranial ependymoma patients who underwent SRS (113 tumors).