Reinitiating anticoagulation in chronic subdural hematomas: does adding middle meningeal artery embolization add value? A multi-institutional, multinational database study.

Background: The safety of early anticoagulation in chronic subdural hematoma (cSDH) patients treated with surgery, with or without middle meningeal artery embolization (MMAE), remains unclear. This study evaluates 6-month outcomes among cSDH patients who received early anticoagulation following surgery with adjunct MMAE and compares outcomes between anticoagulated patients treated with surgery alone versus surgery plus MMAE.

Methods: Patients aged ≥18 years with cSDH who underwent surgery alone or surgery plus MMAE and received anticoagulation were identified using the 10th revision of the International Classification of Diseases (ICD-10) and RXNORM codes on the TriNetX platform.

SUMMIT MAX: A Randomized Trial of the Super Large Bore HiPoint Reperfusion System Versus Vecta System for Aspiration Thrombectomy.

Background: Rapid and complete recanalization is a primary goal in the endovascular treatment of large vessel occlusion stroke. The effectiveness and safety of super large bore aspiration catheters (0.088″ inner diameter) for the treatment of large vessel occlusion stroke have not been demonstrated in a randomized trial.

Super-large bore catheter in the treatment of large vessel occlusions: initial multicenter experience.

Purpose: Large bore catheters are increasingly used in mechanical thrombectomy (MT) for large vessel occlusions (LVOs).

Objective: To evaluate the efficacy and safety of the super-large bore Cereglide 0.092" (C-92) catheter, featuring the largest inner diameter available.

Middle meningeal artery embolization with surgical evacuation improves outcomes in chronic subdural hematoma: a multi-institutional and multinational database study.

Background: Middle meningeal artery embolization (MMAE) is emerging as a promising adjunctive treatment in patients with chronic subdural hematomas (cSDH). This study presents real world multicenter data comparing outcomes in cSDH patients undergoing surgical treatment alone or combined with MMAE.

Methods: This multi-institutional, multinational, retrospective, propensity-matched study utilized the TriNetX platform to compare outcomes in patients undergoing surgical evacuation and MMAE versus surgery alone for cSDH.

Embolization of the Middle Meningeal Artery for Chronic Subdural Hematoma.

Background: Patients receiving standard treatment for chronic subdural hematoma have a high risk of treatment failure. The effect of adjunctive middle meningeal artery embolization on the risk of treatment failure in this population remains unknown.

Methods: We randomly assigned patients with symptomatic chronic subdural hematoma to undergo middle meningeal artery embolization as an adjunct to standard treatment (embolization group) or to receive standard treatment alone (control group).

High variability in physician estimations of flow-diverting stent deployment versus PreSize Neurovascular software simulation: a comparison study.

Background: Physician variablity in preoperative planning of endovascular implant deployment and associated inaccuracies have not been documented. This study aimed to quantify the variability in accuracy of physician flow diverter (FD) planning and directly compares it with PreSize Neurovascular (Oxford Heartbeat Ltd) software simulations.

Methods: Eight experienced neurointerventionalists (NIs), blinded to procedural details, were provided with preoperative 3D rotational angiography (3D-RA) volumetric data along with images annotated with the distal landing location of a deployed Surpass Evolve (Stryker Neurovascular) FD from 51 patient cases.

Thyroid ima artery embolization for the treatment of Graves' disease and thyroid storm.

Graves' disease may be managed with thyroid embolization when other traditional strategies are less suitable. To date, no reports exist on the embolization of the thyroid ima artery for Graves' disease or the outcomes of this procedure. Here, we present a safe and successful report of thyroid ima artery embolization in a neutropenic patient with thyroid storm.

Online interactive medical neuroimaging exercise to identify human brain structures.

A persisting need remains for developing methods for inspiring and teaching undergraduate medical students to quickly learn to identify the hundreds of human brain structures, tracts and spaces that are clinically relevant (viewed as three-dimensional volumes or two-dimensional neuroimages), and to accomplish this with the option of virtual on-line methods. This notably includes teaching the essentials of recommended diagnostic radiology to allow students to be familiar with patient neuroimages routinely acquired using magnetic resonance imaging (MRI) and computed tomography (CT). The present article includes a brief example video plus details a clinically oriented interactive neuroimaging exercise for first year medical students (MS1s) in small groups, conducted with instructors either in-person or as an entirely online virtual event.

Endoscopic Endonasal Orbital Apex Decompression for Carotid Cavernous Fistula.

Significance Statement: This case report demonstrates a novel approach to treating a rare indirect carotid cavernous fistula (CCF) and associated abducens palsy. Although endovascular treatment is the standard of care in the management of CCFs, it was contraindicated in this patient. Instead, she underwent an endoscopic endonasal approach (EEA) with decompression of the medial orbital apex, including the cavernous sinus and optic nerve, with complete resolution of headache, lateral gaze palsy, and diplopia within 2 months.

Semi-automated cerebral aneurysm segmentation and geometric analysis for WEB sizing utilizing a cloud-based computational platform.

Background: Accurate aneurysm measurements are important for selecting the WEB device. The objective was to validate a cloud-based platform, SurgicalPreview (SP) against manual measurements for aneurysm analysis.

Methods: Two sets of measurements each for SP and manual methods were obtained for 40 aneurysms.

Woven EndoBridge device for ruptured aneurysms: perioperative results of a US multicenter experience.

Background: The Woven EndoBridge (WEB) device is approved in the USA for treatment of unruptured wide-neck bifurcation aneurysms. However, the safety and effectiveness of the WEB device in the treatment of ruptured intracranial aneurysms is not clear. We aim to evaluate the perioperative safety and effectiveness of the WEB device in patients with ruptured intracranial aneurysms.

Spinal dural fistula evaluation using 4-Dimensional intra-aortic spinal CTAngiography in a hybrid angiography suite.

Intra-aortic CT Angiography (IA-CTA) is a relatively new technique that shows promise in efficient diagnosis and evaluation of the angioarchitecture of spinal dural arteriovenous fistulae(sdAVF). The authors document the first reported use of a 4D-CT and C-arm fluoroscope in a hybrid interventional suite to evaluate a sdAVF. Time resolved IA-CTA is clinically feasible in the evaluation of sdAVF, has higher temporal resolution as compared to standard IA-CTA and reduced contrast load, radiation dose and potential for procedural complications as compared to standard spinal angiography.

Comparison of operating room variables, radiation exposure and implant costs for WEB versus stent assisted coiling for treatment of wide neck bifurcation aneurysms.

Background: The WEB device offers another option for treating wide neck bifurcation aneurysms (WNBA). The objective was to compare procedure variables, radiation and implant cost between WEB and stent assisted coiling (SAC) for WNBA.

Methods: A retrospective comparison of similarly sized WNBA treated with SAC or WEB over 5-years was performed.

Embolization of a Superior Thyroid Artery Hemorrhage after Fine-Needle Aspiration Biopsy of a Thyroid Nodule.

Fine-needle aspiration biopsy (FNAB) is a procedure completed thousands of times daily across the world as an efficacious and safe way to evaluate thyroid nodules. Complications of an FNAB typically range from patient intolerance to small intrathyroidal hematomas. In rare situations, an FNA may result in significant bleeding leading to airway compromise or significant blood loss.

Early postmarket results with PulseRider for treatment of wide-necked intracranial aneurysms: a multicenter experience.

Objective: Traditionally, stent-assisted coiling and balloon remodeling have been the primary endovascular treatments for wide-necked intracranial aneurysms with complex morphologies. PulseRider is an aneurysm neck reconstruction device that provides parent vessel protection for aneurysm coiling. The objective of this study was to report early postmarket results with the PulseRider device.

Therapeutic nihilism of neurological diseases: A comparative qualitative study.

Objective: The notion of therapeutic nihilism may lead to early removal of care based upon perceived poor prognosis. The goal of this study was to examine if differences for nihilism perspectives exist between professions and within professions at the different levels of experience and exposure to neurological conditions.

Method: Survey methods was used to assess perception of care futility and therapeutic nihilism using six case-based scenarios followed by five questions regarding practitioner care choices and perspective.

Acute Onset of Hypersomnolence and Aphasia Secondary to an Artery of Percheron Infarct and a Proposed Emergency Room Evaluation.

Artery of Percheron (AOP) is a rare anatomical variant, which supplies bilateral paramedian thalami and the rostral mesencephalon via a single dominant thalamic perforating artery arising from the P1 segment of a posterior cerebral artery. AOP infarcts can present with a plethora of neurological symptoms: altered mental status, memory impairment, hypersomnolence, coma, aphasia, and vertical gaze palsy. Given the lack of classic stroke signs, majority of AOP infarcts are not diagnosed in the emergency setting.

An autopsy report of basilar artery aneurysm flow diversion complicated by postoperative day 3 hemorrhage from vessel rupture.

A middle-aged patient presented with posterior circulation symptoms attributable to a large eccentric basilar trunk aneurysm. The planned treatment was flow diversion with loose coil packing which was successfully performed using a Pipeline Flex device deployed from the basilar to the left posterior cerebral artery. The complete procedure including live biplane fluoroscopy was digitally recorded.

Rare Phenomenon of Limb-shaking TIA, Resolved With Intracranial Wingspan Stenting.

Objective: Illustrates the importance of differentiating limb-shaking transient ischemic attack (LS-TIA) from focal seizures and carefully selecting patients for intracranial stenting.

Background: LS-TIA is associated with severe carotid stenosis or occlusion, often precipitated by cerebral hypoperfusion. A case study of 313 patients with symptomatic intracranial artery stenosis/occlusion reported 11% with LS-TIA.

An autopsy report of basilar artery aneurysm flow diversion complicated by postoperative day 3 hemorrhage from vessel rupture.

A middle-aged patient presented with posterior circulation symptoms attributable to a large eccentric basilar trunk aneurysm. The planned treatment was flow diversion with loose coil packing which was successfully performed using a Pipeline Flex device deployed from the basilar to the left posterior cerebral artery. The complete procedure including live biplane fluoroscopy was digitally recorded.

The potential dangers of neck manipulation & risk for dissection and devastating stroke: An illustrative case & review of the literature.

Chiropractic cervical manipulation is a common practice utilized around the world. Most patients are never cleared medically for manipulation, which can be devastating for those few who are at increased risk for dissections. The high velocity thrust used in cervical manipulation can produce significant strain on carotid and vertebral vessels.