Endovascular Retreatment of Previously Clipped Intracranial Aneurysms: An Individual Patient Data Meta-analysis.

Background And Objectives: To evaluate the effectiveness and safety of endovascular retreatment of previously clipped intracranial aneurysms (IAs).

Methods: Systematic searches of Medline, Embase and Cochrane Central were performed. The primary outcome was good functional outcome (modified Rankin Scale 0-2) at the last follow-up.

Awake Craniotomy for the Excision of a Pediatric Cerebral Arteriovenous Malformation for Language Preservation: A Case Description.

Awake craniotomy (AC) surgeries are less common in the pediatric population in comparison to their adult counterparts. Nonetheless, they can be considered for selected cases whereby speech preservation is paramount during maximal safe resection of intracranial lesions. We describe a case of AC for the excision of a brain arteriovenous malformation (bAVM) with language mapping in a pediatric patient.

Microsurgical management of 883 previously coiled intracranial aneurysms: a systematic review, meta-analysis, and meta-regression of its effectiveness and safety.

Objective: With the increasing number of intracranial aneurysms (IAs) treated by endovascular coiling, more residual and recurrent IAs are being encountered. This study aimed to evaluate the effectiveness and safety of the microsurgical management of these previously coiled IAs.

Methods: Systematic searches of the Medline, Embase, and Cochrane Central databases were performed.

Hyperostosis in meningioma: a retrospective exploration of histological correlates.

Purpose: Meningiomas are the most common type of primary brain tumour. Hyperostosis is commonly associated but remains incompletely understood. This study aimed to evaluate the relationship between meningioma-associated hyperostosis and other tumour variables.

Immersive virtual reality as a surgical training tool: A cohort study.

Background: Few studies have studied the efficacy of using immersive virtual reality (iVR) to teach surgical skills, especially by using real-world iVR recordings rather than simulations. This study aimed to investigate whether viewing 360° iVR instructional recordings produces greater improvements in basic suturing skills of students without prior medical training, beyond traditional methods like reading written manuals or watching 2D instructional videos.

Materials And Methods: This was a partially blinded randomized cohort study.

Intra-operative extracorporeal irradiation of tumour-invaded craniotomy bone flap in meningioma: a case series.

Background: Extracorporeal irradiation of tumorous calvaria (EITC) can be performed to restore function and form of the skull after resection of bone-invasive meningioma. We sought to examine the rate of tumour recurrence and other selected outcomes in patients undergoing meningioma resection and EITC.

Methods: Retrospective single-centre study of adult patients undergoing meningioma resection and EITC between January 2015 and November 2022 at a tertiary neurosurgical centre.

Results of Surgical Treatment of Aneurysmal Subarachnoid Hemorrhage in a Single Institution Over 12 Years.

Objective: For patients with aneurysmal subarachnoid hemorrhage (aSAH) in whom endovascular treatment is not the optimal treatment strategy, microsurgical clipping remains a viable option. We examined changes in morbidity and outcome over time in patients treated surgically and in relation to surgeon volume and experience.

Methods: All patients who underwent microsurgery for aSAH from 2007 to 2019 at our institution were included.

Technical considerations and long-term results of endovascular venous stenting to control venous hypertension from meningiomas invading intracranial venous sinuses.

Objective: Meningiomas invading the intracranial venous sinuses may cause intracranial venous hypertension, papilledema, and visual compromise. Sinus resection and graft reconstructions, however, add significant complexity to tumor surgery, with the potential for increased morbidity. In this study, the authors explored whether venous sinus stenting might provide an alternative means of controlling venous hypertension that would be sustainable over the long term.

Antiplatelet therapy in aneurysmal subarachnoid hemorrhage: an updated meta-analysis.

Antiplatelet therapy (AT) may serve to reduce the effects of aneurysmal subarachnoid hemorrhage (aSAH)-induced pro-coagulant state in the cerebral circulation. Several studies, however, have delivered conflicting conclusions on the efficacy of AT post aSAH. Systematic searches of Medline, Embase, and Cochrane Central were undertaken on 27th March 2023.

Use of Mixed Reality in Neurosurgery Training: A Single Centre Experience.

Background: Mixed reality (MR) technology has opened new avenues for planning, visualization, and education in surgery. Neurosurgical pathologies require a very clear understanding of the relationships between pathology and critical neurovascular structures. The decline in cadaveric dissections and resource constraints has pushed the educators to find newer ways of rendering the same knowledge.

Comparison of health-related quality of life in patients with traumatic brain injury, subarachnoid haemorrhage and cervical spine disease.

Purpose: The degree of disability that is acceptable to patients following traumatic brain injury (TBI) continues to be debated. While the dichotomization of outcome on the Glasgow Outcome Score (GOSE) into 'favourable' and 'unfavourable' continues to guide clinical decisions, this may not reflect an individual's subjective experience. The aim of this study is to assess how patients' self-reported quality of life (QoL) relates to objective outcome assessments and how it compares to other debilitating neurosurgical pathologies, including subarachnoid haemorrhage (SAH) and cervical myelopathy.

Impact of Intraoperative Magnetic Resonance Imaging on Short-Term and Long-Term Outcomes After Transsphenoidal Resection of Pituitary Adenoma: A Systematic Review and Meta-Analysis.

Background: Intraoperative magnetic resonance imaging (iMRI) allows for greater tumor visualization and extent of resection. It is increasingly used in transsphenoidal surgeries but its role is not yet established.

Objective: We aimed to clarify the usefulness of iMRI in transsphenoidal surgery using direct statistical comparisons, with additional subgroup and regression analyses to investigate which patients benefit the most from iMRI use.

Stereotactic Neurosurgical Robotics With Real-Time Patient Tracking: A Cadaveric Study.

Background: Robotic neurosurgery may improve the accuracy, speed, and availability of stereotactic procedures. We recently developed a computer vision and artificial intelligence-driven frameless stereotaxy for nonimmobilized patients, creating an opportunity to develop accurate and rapidly deployable robots for bedside cranial intervention.

Objective: To validate a portable stereotactic surgical robot capable of frameless registration, real-time tracking, and accurate bedside catheter placement.

Relevance of presenting risks of frailty, sarcopaenia and osteopaenia to outcomes from aneurysmal subarachnoid haemorrhage.

Introduction: Aneurysmal subarachnoid haemorrhage (aSAH) is a condition with significant morbidity and mortality. Traditional markers of aSAH have established their utility in the prediction of aSAH outcomes while frailty markers have been validated in other surgical specialties. We aimed to compare the predictive value of frailty indices and markers of sarcopaenia and osteopaenia, against the traditional markers for aSAH outcomes.

Gods and monsters: Greek mythology and Christian references in the neurosurgical lexicon.

Background: Myths and religion are belief systems centered around supernatural entities that attempt to explain the observed world and are of high importance to certain communities. The former is a collection of stories that belong to a cultural tradition and the latter are organized faiths that determine codes of ethics, rituals and philosophy. Deities or monstrous creatures in particular act as archetypes instructing an individual's conduct.

A systematic review and meta-analysis of the association between cyproterone acetate and intracranial meningiomas.

The influence of exposure to hormonal treatments, particularly cyproterone acetate (CPA), has been posited to contribute to the growth of meningiomas. Given the widespread use of CPA, this systematic review and meta-analysis attempted to assess real-world evidence of the association between CPA and the occurrence of intracranial meningiomas. Systematic searches of Ovid MEDLINE, Embase and Cochrane Controlled Register of Controlled Trials, were performed from database inception to 18th December 2021.

Long-term oncological outcomes after haemorrhagic apoplexy in pituitary adenoma managed operatively and non-operatively.

Introduction: Depending on severity of presentation, pituitary apoplexy can be managed with acute surgery or non-operatively. We aim to assess long-term tumour control, visual and endocrinological outcomes following pituitary apoplexy with special emphasis on patients treated non-operatively.

Methods: Multicentre retrospective cohort study.

Endoscopic excision of an aqueduct of Sylvius cavernoma causing obstructive hydrocephalus: technical note.

Background And Importance: Acquired lesions within the aqueduct of Sylvius are rare and their surgical management is challenging. Open transcranial approaches require dissection and manipulation of surrounding eloquent structures. Use of an endoscope can avoid potential morbidity from traversing and handling eloquent structures during open approaches whilst providing better visualisation of an intraventricular lesion.

Paediatric Cerebral Arteriovenous Malformation: Outcomes from a Singapore Children's Hospital.

Objectives: Paediatric brain arteriovenous malformation (bAVM) is a rare and distinct clinical entity. There is a growing body of literature that support the success of multimodality approaches for this difficult condition. The authors aim to firstly, describe our institutional experience with a consecutive series of patients and next, corroborate our results with current literature.

Far Lateral Approaches: Dural Arteriovenous Fistulae at the Hypoglossal Canal: 3-Dimensional Operative Video.

Cognard type V dural arteriovenous fistulae (dAVF) are typically located at the foramen magnum. Their presentation often mimics that of cervical myelopathy, and they can be easily misdiagnosed even if spinal vascular imaging is undertaken. Treatment typically involves endovascular embolization or surgery when embolization is not possible.

Far Lateral Approaches: Far Lateral Approach With Minimal Condylectomy for C2 Schwannoma: 3-Dimensional Operative Video.

Upper cervical schwannomas are rare lesions and together with meningiomas constitute around 5% of spinal tumors. The approach to these lesions is difficult because of the close proximity of the medulla and cervical spinal cord, lower cranial nerves, and the vertebral artery. Schwannomas in the upper cervical area typically arise from the dorsal roots and are located posterior to the dentate ligament.

Far Lateral Approaches: C1 Meningioma With Vertebral Artery Involvement: 3-Dimensional Operative Video.

Tumors around the cervicomedullary junction are rare and constitute 5% of spinal tumors and 1% of cranial tumors. The approach to these lesions is difficult because of the close proximity of the medulla and cervical spinal cord, lower cranial nerves, and vertebral artery (VA) as well as the complex articulation between occipital condyle, C1 and C2. Cervicomedullary junction meningiomas are commonly classified based on their origin in relation to the dentate ligament, but the relationship to the VA typically plays an important role in deciding the surgical approach.

Surgical Resection of an Arteriovenous Malformation of the Orbital Surface of the Frontal Lobe with Olfactory Tract Preservation: 2-Dimensional Operative Video.

Medial orbitofrontal area arteriovenous malformations (AVMs) are located in the noneloquent cortex and typically drain superficially into Sylvian veins or the superior sagittal sinus, making them favorable for surgical treatment. However, while typically supplied by pial/cortical branches of the anterior cerebral artery (ACA), they can incorporate the recurrent artery of Heubner and other ACA perforators on their way to the anterior perforated substance located just posterior. We present a case of a 30-year-old female admitted with sudden collapse and intraventricular hemorrhage from a ruptured medial orbitofrontal area AVM.