Endovascular embolization for medically refractory pediatric epilepsy: a case series.

Background: Endovascular embolization has been reported in limited case series and case reports as a minimally invasive option for managing refractory epilepsy, particularly in cases where traditional surgical interventions are high risk.

Objective: To explores the feasibility, safety, and outcomes of endovascular embolization in pediatric patients with intractable epilepsy due to varied etiologies.

Methods: This retrospective case series includes four pediatric patients with medically refractory epilepsy, who underwent staged endovascular embolization at a tertiary care center between 2022 and 2024.

Drivers of neurosurgeon selection among operative intracranial tumor patients.

Objective: Despite increased access to online information, little is known about what factors patients consider when selecting a neurosurgeon for intracranial tumor resection. This study aims to identify patient priorities in neurosurgeon selection.

Methods: Patients who underwent intracranial tumor resection between January 1, 2023, and January 31, 2024, at a single institution were surveyed.

Self-Supervised Feature Detection and 3D Reconstruction for Real-Time Neuroendoscopic Guidance.

Objective: Transventricular approach to deep-brain targets offers direct visualization but also imparts deformation that challenges accurate neuronavigation. 3D reconstruction and registration of the endoscopic view could provide up-to-date, real-time guidance. We develop and evaluate a self-supervised feature detection method for 3D reconstruction and navigation in neuroendoscopy.

Bone Regrowth After Frontal Burr Hole Craniostomy: Natural History of 14-mm and 20-mm Burr Holes and Implications for Postoperative Trans-Burr Hole Ultrasound.

Background And Objective: Burr hole craniostomy is performed for ventriculoperitoneal shunt insertion and endoscopic third ventriculostomy in patients with cerebrospinal fluid disorders. These burr holes are increasingly being used as windows for postoperative ultrasound, an investigational alternative to computed tomography or MRI for follow-up imaging of ventricular caliber. However, bone regrowth reduces ultrasound visibility, and little is known about burr hole regrowth rates in adults.

Onyx embolization for salvage hemostasis after intraoperative rupture.

Video 1 shows three cases of intraoperative rupture during aneurysm coiling. Management of intraoperative aneurysm rupture is reviewed in brief, including reversal of anticoagulation/antiplatelets, intracranial pressure control, and rapid balloon deployment for control across the aneurysm neck. However, in all three cases, contrast extravasation continues despite aneurysm coiling, reversal of anticoagulation, and maximizing medical management.

Evaluation of cervical spine clearance scores in children younger than 3 years with blunt trauma.

Objective: The PEDSPINE I and PEDSPINE II scores were developed to determine when patients require advanced imaging to rule out cervical spine injury (CSI) in children younger than 3 years of age with blunt trauma. This study aimed to evaluate these scores in an institutional cohort.

Methods: The authors identified patients younger than 3 years with blunt trauma who received cervical spine MRI from their institution's prospective database from 2012 to 2015.

The Shunt Valve Recession Technique as a Neuroplastic Surgery Adjunct in Complex and High-Risk Shunt Revisions: Technical Note and Case Series.

Background And Objectives: Ventricular shunting is one of the most common procedures in neurosurgery. However, complications and revisions are frequent. Patients requiring multiple revisions often suffer secondary issues with scalp healing over hardware.

Cost-Effectiveness of a Direct-Aspiration First-Pass Technique versus Stent Retriever in Mechanical Thrombectomy.

Objective: A direct-aspiration first-pass technique (ADAPT) in mechanical thrombectomy has been described in recent studies as an efficacious strategy compared with using a stent retriever (SR). We sought to evaluate for cost differences of ADAPT technique versus SR as an initial approach.

Methods: We conducted a retrospective analysis of consecutive patients with mechanical thrombectomy at our institution between 2022 and 2023.

Soluble PD-L1 reprograms blood monocytes to prevent cerebral edema and facilitate recovery after ischemic stroke.

Acute cerebral ischemia triggers a profound inflammatory response. While macrophages polarized to an M2-like phenotype clear debris and facilitate tissue repair, aberrant or prolonged macrophage activation is counterproductive to recovery. The inhibitory immune checkpoint Programmed Cell Death Protein 1 (PD-1) is upregulated on macrophage precursors (monocytes) in the blood after acute cerebrovascular injury.

No Delayed Ruptures on Long-Term Follow-Up of a Case Series of Persistently Filling Saccular Internal Carotid Artery Aneurysms After Flow Diversion With the Pipeline Embolization Device.

Background And Objectives: Flow diversion of intracranial aneurysms results in high occlusion rates. However, 10% to 20% remain persistently filling at 1 year. Often, these are retreated, but benefits of retreatment are not well established.

Endovascular Thrombectomy versus Endovascular Thrombectomy Preceded by Intravenous Thrombolysis: A Systematic Review and Meta-Analysis.

Background: Randomized controlled trials comparing endovascular thrombectomy (EVT) versus EVT preceded by intravenous thrombolysis (EVT + IVT) for acute ischemic stroke due to large artery occlusion remain controversial. This systematic review and meta-analysis seek to compare these 2 modalities.

Methods: Online Protocol is available at PROSPERO (york.

Establishing proof of concept for sonolucent cranioplasty and point of care ultrasound imaging after posterior fossa decompression for Chiari malformation.

Background: Evaluation after posterior fossa decompression for Chiari malformation can require repeated imaging, particularly with persistent symptoms. Typically, CT or MRI is used. However, CT carries radiation risk and MRI is costly.

Spinal dysraphism in exstrophy: a single-center study of a 39-year prospective database.

Objective: The two main objectives of this study were to explore the rate of spinal dysraphism within bladder and cloacal exstrophy and to analyze the relationship between spinal dysraphism surgery, including timing of spinal dysraphism surgery, with urological and neurological outcomes.

Methods: A prospectively maintained IRB-approved database of pediatric exstrophy patients treated from 1982 to 2021 was retrospectively reviewed for patients with spinal dysraphism. Spinal dysraphism was categorized into the following 7 subtypes: lipoma-based closed defect, myelomeningocele, meningocele, diastematomyelia, myelocystocele, low-lying conus with tethered cord/fatty filum, and sacral bony defect.

Surgery or Endovascular Treatment in Patients with Anterior Communicating Artery Aneurysm: A Systematic Review and Meta-Analysis.

Background And Objective: Although randomized controlled trials have compared surgery versus endovascular treatment for intracranial aneurysms, the literature is sparse in terms of subgroup analysis for anterior communicating artery (ACoA) aneurysm management. This systematic review and meta-analysis sought to compare surgical versus endovascular treatment for ACoA aneurysms.

Methods: Medline, PubMed, and Embase were searched from inception to December 12, 2022.

Microsurgery Versus Stereotactic Radiosurgery for Treatment of Patients With Brain Arteriovenous Malformation: A Systematic Review and Meta-Analysis.

Background: Treatment decision-making for brain arteriovenous malformations (bAVMs) with microsurgery or stereotactic radiosurgery (SRS) is controversial.

Objective: To conduct a systematic review and meta-analysis to compare microsurgery vs SRS for bAVMs.

Method: Medline and PubMed were searched from inception to June 21, 2022.

Middle Meningeal Artery Embolization Versus Conventional Management for Patients With Chronic Subdural Hematoma: A Systematic Review and Meta-Analysis.

Background: The results from studies that compare middle meningeal artery (MMA) embolization vs conventional management for patients with chronic subdural hematoma are varied.

Objective: To conduct a systematic review and meta-analysis on studies that compared MMA embolization vs conventional management.

Methods: Medline, PubMed, and Embase databases were searched.

First Experience With Postoperative Transcranial Ultrasound Through Sonolucent Burr Hole Covers in Adult Hydrocephalus Patients.

Background: Managing patients with hydrocephalus and cerebrospinal fluid (CSF) disorders requires repeated head imaging. In adults, it is typically computed tomography (CT) or less commonly magnetic resonance imaging (MRI). However, CT poses cumulative radiation risks and MRI is costly.

Resection of Condylar Skull Base Tumor via Combined Far Lateral and Infrajugular Approaches with Single-Stage Occipitocervical Fusion.

Epithelioid hemangioma is a rare vascular mesenchymal tumor with a paucity of reports of cranial involvement. In particular, guidance on treatment for lateral skull base lesions is lacking, despite this being a highly technically challenging location. Nuances in the management decisions for this tumor type are discussed.

Sacrifice or preserve the superior petrosal vein in microvascular decompression surgery: a systematic review and meta-analysis.

Objective: In microvascular decompression (MVD) surgery through the retrosigmoid approach, the surgeon may have to sacrifice the superior petrosal vein (SPV). However, this is a controversial maneuver. To date, high-level evidence comparing the operative outcomes of patients who underwent MVD with and without SPV sacrifice is lacking.

The Translational Potential of Microglia and Monocyte-Derived Macrophages in Ischemic Stroke.

The immune response to ischemic stroke is an area of study that is at the forefront of stroke research and presents promising new avenues for treatment development. Upon cerebral vessel occlusion, the innate immune system is activated by danger-associated molecular signals from stressed and dying neurons. Microglia, an immune cell population within the central nervous system which phagocytose cell debris and modulate the immune response cytokine signaling, are the first cell population to become activated.