Emerging role for radiomics in the management of intracranial arteriovenous and cavernous malformations.

Introduction: Intracranial arteriovenous malformations (AVMs) and cavernous malformations (CMs) pose substantial diagnostic, prognostic, and therapeutic challenges. Traditional imaging techniques used for AVM/CM diagnostic and treatment decision-making are limited by subjectivity and reliance on human interpretation. Radiomics, an artificial intelligence-driven technique that extracts quantitative imaging biomarkers, is a promising tool for improving detection, risk assessment, and treatment planning.

Simultaneous Microsurgical Clipping of Bilateral Intracranial Aneurysms.

Intracranial aneurysms (IAs) affect approximately 3%-6% of adults, and up to one third of these patients have multiple IAs, which are associated with an increased risk of rupture. Treatment of multiple IAs is dictated by patient and aneurysm characteristics as well as surgical efficiency, when feasible. In this video, we demonstrate the technical nuances of a case involving simultaneous clipping of bilateral IAs.

Vestibular dysfunction after mild traumatic brain injury: A systematic review.

Vestibular system dysfunction (VD), a condition characterized by impairments in balance, spatial orientation, and eye movement control, is frequently encountered after mild traumatic brain injury (mTBI). We reviewed the existing literature on the various forms of post-traumatic VD and discuss the epidemiology and natural history, diagnostic methods, assessment tools, and therapeutic interventions crucial to identifying and managing these impairments. We examined diagnostic techniques, therapeutic strategies, and outcomes reported in the literature on patients with mTBI with VD.

Progression of intracranial hemorrhages in neurotrauma patients: A clinical and radiological comparison of isolated versus multiple areas of hemorrhage and associated transfusion treatment strategies.

Purpose: The similar presentation of patients with multiple simultaneous (mICHs) or isolated (iICH) intracranial hemorrhages prompted investigation of clinical and radiological ICH progression during hospitalization in these cohorts. We also examined the role of aggressive transfusion and acute interventions on patient morbidity and mortality.

Methods: Adult (>18 years) neurotrauma patients treated at our Level 1 trauma center between January 1, 2002, and December 31, 2022, with an iICH or mICH were included based on meeting 5 criteria: isolated neurotrauma; ICH injury beyond subarachnoid hemorrhage; repeat head CT available; no anticoagulant usage; and survivable injuries.

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.

Systematic Review of Radiomics and Artificial Intelligence in Intracranial Aneurysm Management.

Intracranial aneurysms, with an annual incidence of 2%-3%, reflect a rare disease associated with significant mortality and morbidity risks when ruptured. Early detection, risk stratification of high-risk subgroups, and prediction of patient outcomes are important to treatment. Radiomics is an emerging field using the quantification of medical imaging to identify parameters beyond traditional radiology interpretation that may offer diagnostic or prognostic significance.

Applying an updated brain injury guideline classification to interhospital transfer of patients with traumatic brain injury: Who benefits most?

Objective: The Brain Injury Guidelines (BIG) categorize patients with mild, moderate, and severe traumatic brain injuries (TBIs). We examined whether TBI transfer guidelines should be modified to incorporate BIG alongside polytrauma and patient frailty assessments to identify which patients are most likely to benefit from transfer.

Methods: Patients ≥ 18 years old transferred to our Level 1 trauma center in 2019-2023 with nonpenetrating blunt cranial trauma were identified retrospectively.

Expanded applications of knotless tissue control devices in neurosurgical cranial and spinal applications.

Objectives: Effective wound closure is essential to neurosurgical procedures. Historical rates of neurosurgical wound complications range from 7 to 14 %. Knotless suturing with barbed sutures may offer effective closure rates but has had limited evaluation of safety in neurosurgical applications.

Barriers to Care: Examining the Unique Obstacles of Indigenous American Patients With Acute Neurosurgical Injuries.

Background And Objectives: Historically, Indigenous American (IA) populations have faced barriers to adequate health care. Although IA people experience higher rates of traumatic brain injury-related mortality than other racial groups in the United States, attributes of their neurosurgical care have not been evaluated. We demonstrate and compare care patterns and outcomes in IA and non-IA adults with acute neurosurgical injuries and identify disparities limiting access to medical care.

Management of External Ventricular Drains for Neuromonitoring and Traumatic Brain Injury Treatment in Pediatric Patients Outside of Intensive Care Units: A Single-Institution Retrospective Study.

Background: Most pediatric hospitals manage patients who require external ventricular drains (EVDs) exclusively within pediatric intensive care units (PICUs) because of institutional protocols. Our institution commonly manages patients with EVDs on the neurotrauma floor (NTF). We evaluated whether this practice results in more EVD-associated complications.

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.

Radiographic abnormalities and their clinical significance in patients with Parkinson disease who receive deep brain stimulation implants.

Objective: Preoperative MR images obtained in patients with Parkinson disease (PD) undergoing deep brain stimulation (DBS) often reveal incidental radiographic abnormalities (RAs). These findings range from small changes to gross pathologies. The effect of these findings on patients' clinical outcomes is unknown.

Assessing survival in non-small cell lung cancer brain metastases after stereotactic radiosurgery: before and after the start of the targetable mutation era.

Purpose: Targeted treatment options for non-small cell lung cancer (NSCLC) brain metastases (BMs) may be combined with stereotactic radiosurgery (SRS) to optimize survival. We assessed patient outcomes after SRS for NSCLC BMs, identifying survival trajectories associated with targetable mutations.

Methods: In this retrospective time-dependent analysis, we analyzed median overall survival of patients who received ≥ 1 SRS courses for BM from NSCLC from 2001 to 2021.

Disparities in Indications and Outcomes Reporting for Spinal Column Shortening for Tethered Cord Syndrome: The Need for a Standardized Approach.

Study Design: Systematic review.

Objective: To identify commonly reported indications and outcomes in spinal column shortening (SCS) procedures.

Background: SCS is a surgical procedure used in patients with tethered cord syndrome-characterized by abnormal attachment of neural components to surrounding tissues-to shorten the vertebral column, release tension on the spinal cord/neural elements, and alleviate associated symptoms.

Lumbar Epidural Hematoma as a Rare Complication From Minimally Invasive Lumbar Decompression.

Lumbar spinal stenosis (LSS) is a common and debilitating pathology globally. Conservative and surgical treatment options exist for patients. Recently, minimally invasive lumbar decompression (MILD) has been described as a less invasive technique for the treatment of early spinal stenosis ≥2.