Safety and efficacy of very short flow diverters for the treatment of intracranial internal carotid artery aneurysms.

Deploying flow diverters (FDs) around the carotid siphon typically favors longer FDs for easier manipulation and safety, leaving shorter FDs less explored. We reviewed 263 patients with unruptured intracranial saccular ICA aneurysms treated with FDs from 2013 to 2023. Fifty-five were treated with very short flow diverters (VSFD; 10-12 mm).

Feasibility of middle meningeal artery embolization following large craniotomy: A case series.

IntroductionWhile middle meningeal artery embolization (MMAE) has been shown to be feasible for recurrent subdural hematoma (SDH) after craniotomy, large traumatic craniotomies exceeding 8000 mm have typically been excluded. In this novel case series, we assess the feasibility and efficacy of MMAE in treating recurrent SDH following large open neurosurgical intervention (non-burr hole or bedside procedures). In all cases, a portion of the middle meningeal artery (MMA) territory remained patent and was successfully embolized.

A novel classification for posterior communicating artery aneurysms in the presence of fetal posterior cerebral artery: A registry-based study.

Background and objectivesFetal posterior cerebral artery (fPCA) is a common anatomical variant where the P1 segment is hypoplastic or absent, and the posterior communicating artery supplies the posterior cerebral artery (PCA) territory. Aneurysms in this setting often form at the internal carotid artery (ICA)-posterior communicating artery junction and are poorly defined. This study introduces a novel classification to address the fPCA variant, treatment challenges, and outcomes.

Can antithrombotic therapy be safely resumed after middle meningeal artery embolization with or without surgery for chronic subdural hematoma? a systematic review and meta-analysis.

Background: Middle meningeal artery embolization (MMAE), whether alone or with surgery, reduces chronic subdural hematoma (cSDH) recurrence. However, the impact of resuming antithrombotic (AT) therapy after MMAE and optimal resumption time remains unclear.

Methods: A systematic review and meta-analysis were conducted following PRISMA guidelines.

Illustrated step-by-step guide to stent-assisted coiling of wide-neck posterior inferior cerebellar aneurysm via a contralateral vertebral artery approach.

Background and ObjectivesPosterior inferior cerebellar artery (PICA) aneurysms are uncommon, occurring in 0.5% to 3% of all intracranial aneurysms. Due to the distinct anatomy and varying geometrical configuration at the PICA origin, endovascular treatment can be challenging.

Assessing Occlusion and Recovery in Large and Giant Intracranial Aneurysms: A Comparative Retrospective Study of Flow Diversion Alone Versus Combined With Coiling and the Role of Packing Density.

Background And Objectives: Flow diversion (FD) is a conventional treatment of large and giant intracranial aneurysms. The aim of this study was to explore the impact of combining FD with coiling and analyze the required packing density (PD) for optimal aneurysm occlusion.

Methods: This retrospective study compared large (10-15 mm), very large (15-25 mm), and giant (≥25 mm) intracranial aneurysm treatment with FDs alone vs FD + coiling at 2 large institutions from 2015 to 2023.

Initial experience of utilizing a lower-profile transradial approach for mechanical thrombectomy: Comparable efficacy to larger-bore transfemoral approaches.

BackgroundWhile transfemoral access is commonly used for mechanical thrombectomy (MT) due to large-bore catheters providing greater aspiration forces, some centers employ transradial access (TRA) in select cases with favorable anatomy. We report our institutional experience to evaluate the efficacy of using TRA as the default approach for large-vessel occlusion (LVO) with a streamlined, lower-profile system.MethodsA retrospective review was conducted on 23 consecutive thrombectomies performed via TRA, regardless of patient anatomy or LVO location.

Decreased Incidence of Radial Artery Vasospasm Using a Distal Transradial Approach in Diagnostic Cerebral Angiography: A Comparison of 200 Consecutive Cases.

Background And Objectives: Radial artery vasospasm is a common complication of radial artery catheterization. During the implementation of distal transradial approach (dTRA), we observed a decreased incidence of radial artery vasospasm on radial artery angiography following access that was not well detailed in the literature. The purpose of this study was to characterize the phenomenon of radial artery vasospasm in the context of different radial artery access points for diagnostic cerebral angiography.

Absence of Foramen Spinosum on Computed Tomography Scan Determines Feasibility of Middle Meningeal Artery Embolization.

Background And Objectives: Middle meningeal artery embolization (MMAE) has emerged as a novel treatment of chronic subdural hematoma. In 0.5% of patients, however, there exists an ophthalmic origin of the middle meningeal artery (MMA) known as the recurrent meningeal artery.

Transradial Angiography Skill Acquisition Using an Endovascular Simulation Program.

Background: Given the benefits of neuroendovascular simulation to resident education, this study aimed to assess the efficacy of simulation-based training for neuroendovascular intervention with primary and secondary catheters using a transradial approach (TRA).

Methods: Five neurosurgical residents (PGY 1-3) from our institution enrolled in a standardized pilot training protocol. Trainees used the Mentice (Gothenburg, Vastra Gotaland, Sweden) Visit G5 simulator with a type II arch using a right TRA.

An early case of successful peripheral nerve repair in 1880: Francis L. Parker, MD.

The modern technique of epineural suture repair, along with a detailed reporting of functional restoration, came from Carl Hueter in 1873. While there is extensive information on peripheral nerve surgery throughout recorded history leading up to the 1800s, little early American scientific literature is available. While Schwann, Nissl, and Waller were publishing their work on nerve anatomy and physiology, Francis LeJau Parker was born.

Infantile traumatic pericallosal aneurysm: illustrative case.

Background: Traumatic aneurysms are a rare sequela of nonaccidental head trauma in infants. The rate of nonaccidental trauma (NAT) in the pediatric population is increasing; therefore, traumatic aneurysms are an important consideration in the evaluation of pediatric patients with abusive head trauma.

Observations: A 24-day-old infant with no significant past medical or birth history presented with twitching and poor oral intake for 1 day.

A Case of Extremely Rapid Progression in Foix-Alajouanine Syndrome.

Foix-Alajouanine syndrome is a rare cause of spinal dural arteriovenous fistula that can cause irreversible myelopathy and paraplegia if not treated promptly. The complex nature of this pathology often leads to missed or delayed diagnosis regardless of broad workups executed. We present a symptomatically classic Foix-Alajouanine 68-year-old patient with an accelerated progression reaching stages of severe myelopathy in less than a year.

Exoscope Efficacy and Feasibility in Pediatric Spinal Neurosurgery: A Single-Institution Cohort Case Series.

Background: The exoscope has emerged as an efficacious microscope in adult spinal neurosurgery providing improved operative field visibility and surgeon ergonomics. However, outcome data and feasibility are underrepresented in the pediatric literature. We present the largest case series aimed at assessing operative and clinical outcomes in pediatric patients undergoing various exoscope-assisted spinal surgeries.

Chronic subdural hematoma recurrence due to contralateral neovascularization following middle meningeal artery embolization.

Introduction: Chronic subdural hematoma (CSDH) is one of the most commonly encountered neurosurgical diseases. Middle meningeal artery embolization (MMAE) is a technique for the management of CSDH that has elicited promising results. Despite the encouraging results of MMAE, recurrence does occur.

Endoscopic decompression of epidural spinal metastasis causing lumbar radiculopathy through a transforaminal approach: report of two cases.

Radiculopathy in patients with metastatic spine disease (MSD) may be palliated with open or microsurgical techniques. However, delay of chemoradiation, infection risk, extended hospitalization periods, and surgical site pain may complicate surgical efforts to improve these patients' lives. Endoscopic approaches, heretofore used almost exclusively in degenerative spine disease, may also palliate debilitating pain while mitigating the drawbacks of surgical intervention in providing focal tumor debulking.

A case of primary central nervous system lymphoma presenting as a shunt complication.

The authors describe an 82-year-old female with a right frontal ventriculoperitoneal (VP) shunt for long-standing normal pressure hydrocephalus (NPH) who presented with worsening incontinence and gait instability. She was found to have right lateral ventricle collapse around the shunt catheter and subsequently underwent shunt revision, which failed to improve her symptoms. Magnetic resonance imaging (MRI) was obtained on postoperative day two, which demonstrated a ventricular lesion.

Economic benefit of neurosurgical intervention for infant hydrocephalus in Haiti.

Objective: Previous models have been utilized in other low- and middle-income countries (LMICs) to explore and assess the cost, sustainability, and effectiveness of infant hydrocephalus treatment. However, similar models have not been implemented in Haiti due to a paucity of data, epidemiology, and outcomes for hydrocephalus. Therefore, the authors utilized previously described economic modeling to estimate the annual cost and benefit of treating hydrocephalus in infants at a neurosurgery referral center, Hospital Bernard Mevs (HBM), in Port-au-Prince, Haiti.

The shipboard Beirut terrorist bombing experience: a historical account and recommendations for preparedness in events of mass neurological injuries.

On a Sunday morning at 06:22 on October 23, 1983, in Beirut, Lebanon, a semitrailer filled with TNT sped through the guarded barrier into the ground floor of the Civilian Aviation Authority and exploded, killing and wounding US Marines from the 1st Battalion 8th Regiment (2nd Division), as well as the battalion surgeon and deployed corpsmen. The truck bomb explosion, estimated to be the equivalent of 21,000 lbs of TNT, and regarded as the largest nonnuclear explosion since World War II, caused what was then the most lethal single-day death toll for the US Marine Corps since the Battle of Iwo Jima in World War II. Considerable neurological injury resulted from the bombing.

Preoperative Hypoglycemia and Hyperglycemia Are Related to Postoperative Infection Rates in Implant-Based Breast Reconstruction.

Objectives: Diabetic patients undergoing surgery are known to have a higher risk for infection. However, current literature does not adequately investigate the effects of preoperative hypoglycemia or hyperglycemia on postoperative infection risk.

Methods: A retrospective review of a national private payer database within the PearlDiver Supercomputer application (Warsaw, IN) for patients undergoing breast reconstruction with implant/expander (BR) was conducted.

Economic benefit of carpal tunnel release in the Medicare patient population.

OBJECTIVE The epidemiology of carpal tunnel syndrome (CTS) has been extensively researched. However, data describing the economic burden of CTS is limited. The purpose of this study was to quantify the disease burden of CTS and determine the economic benefit of its surgical management.

Endoscopic versus Open In Situ Cubital Tunnel Release: A Systematic Review of the Literature and Meta-Analysis of 655 Patients.

Background: Cubital tunnel syndrome is the second most common peripheral entrapment syndrome. To date, there is no true consensus on the ideal surgical management. A minimally invasive, endoscopic approach has gained popularity but has not been adequately compared to the more traditional, open approach.

Trends in Open and Endoscopic Cubital Tunnel Release in the Medicare Patient Population.

Background: Cubital tunnel syndrome (CUT) is the second most common peripheral neuropathy with an annual incidence of 24.7 per 100 000, affecting nearly twice as many men as women. With increasing focus on cost-effectiveness and cost-containment in medicine, a critical understanding of utilization of health care resources for open and endoscopic approaches for cubital tunnel release is of value.

Trends in open and endoscopic carpal tunnel release utilization in the Medicare patient population.

Background: Surgical management of carpal tunnel syndrome (CTS) is performed with an open or endoscopic approach. Current literature suggests that the endoscopic approach is associated with higher costs and a steeper learning curve. This study evaluated the billing and utilization trends of both approaches.