Natural history of dolichoectatic vertebrobasilar aneurysms: a multinational study.

Objective: Dolichoectatic vertebrobasilar aneurysms (DVBAs) are expansions of arterial tissue leading to aneurysmal formations without an obvious neck. Their natural history is poorly understood; usually patients are admitted with thromboembolic complications and/or neurological symptoms from the mass effect. There have not been international collective data, and correct timing for highly risky treatments has been under discussion.

Single-View Fluoroscopic X-Ray Pose Estimation: A Comparison of Alternative Loss Functions and Volumetric Scene Representations.

Many tasks performed in image-guided procedures can be cast as pose estimation problems, where specific projections are chosen to reach a target in 3D space. In this study, we construct a framework for fluoroscopic pose estimation and compare alternative loss functions and volumetric scene representations. We first develop a differentiable projection (DiffProj) algorithm for the efficient computation of Digitally Reconstructed Radiographs (DRRs) from either Cone-Beam Computerized Tomography (CBCT) or neural scene representations.

Middle Meningeal Artery Embolization for Chronic Subdural Hematoma: A Bibliometric Analysis.

Background: Middle meningeal artery embolization (MMAE) is an endovascular technique that has been rapidly adopted in the management of chronic subdural hematoma (cSDH), with numerous positive results across the literature. This study aimed to summarize the body of original research published on MMAE for the treatment of cSDH through bibliometric methods.

Methods: The Web of Science, Science Citation Index Expanded database was queried on October 1, 2024 for articles related to MMAE for cSDH.

Volume-staged versus dose-staged stereotactic radiosurgery, with or without embolization, in the treatment of large brain arteriovenous malformations: A systematic review and meta-analysis.

Background And Objective: While safe and effective modalities exist to treat small arteriovenous malformations (AVMs), large (>10 cm) AVMs remain difficult to cure via surgical or endovascular means. Staged stereotactic radiosurgery (SRS), either volume-staged (VS) or dose-staged (DS), has been proposed for large AVMs. The relative efficacy of these two strategies, with or without endovascular embolization, is unclear.

An International, Multicenter Feasibility Study on Active and Continuous Irrigation With Cerebrospinal Fluid Exchange for Improving Outcomes in Cerebral Ventriculitis.

Background And Objectives: Cerebral ventriculitis remains a challenging neurosurgical condition because of poor outcomes including mortality rates of nearly 80% and a prolonged course of treatment in survivors. Despite current conventional management, outcomes in some cases remain unsatisfactory, with no definitive therapeutic guidelines. This feasibility study aims to explore the use of a novel active, continuous irrigation and drainage system (IRRAflow [IRRAS AB]) combined with intraventricular drug delivery for patients with cerebral ventriculitis.

P2Y12 inhibitor use predicts hematoma expansion in patients with intracerebral hemorrhage.

Objective: Hematoma expansion (HE) predicts disability and death after acute intracerebral hemorrhage (ICH). Aspirin and anticoagulants have been associated with HE. We tested the hypothesis that P2Y12 inhibitors predict subsequent HE in patients.

Bivalirudin as a substitute for heparin in neurointervention for patients with heparin-induced thrombocytopenia.

Objectives: Heparin-induced thrombocytopenia is a known complication of heparin exposure with potentially life-threatening sequelae. Direct thrombin inhibitors can be substituted for heparin in patients with heparin-induced thrombocytopenia that require anticoagulation. However, the use of direct thrombin inhibitors as a substitute for heparin has not been widely reported in the neuroendovascular literature.

Fixed- Versus Variable-Dose Prothrombin Complex Concentrate for the Emergent Reversal of Vitamin K Antagonists: A Systematic Review and Meta-Analysis.

Objectives: Four-factor prothrombin complex concentrate (4-PCC) is recommended for rapid reversal of vitamin K antagonists (VKAs) such as warfarin, yet optimal dosing remains uncertain.

Data Sources: A systematic review was conducted of PubMed, Embase, and Ovid MEDLINE (Wolters Kluwer) databases from January 2000 to August 2023 for clinical studies comparing fixed- vs. variable-dose 4-PCC for emergent VKA reversal with at least one reported clinical outcome.

Background Subtraction Angiography with Deep Learning Using Multi-frame Spatiotemporal Angiographic Input.

Catheter Digital Subtraction Angiography (DSA) is markedly degraded by all voluntary, respiratory, or cardiac motion artifact that occurs during the exam acquisition. Prior efforts directed toward improving DSA images with machine learning have focused on extracting vessels from individual, isolated 2D angiographic frames. In this work, we introduce improved 2D + t deep learning models that leverage the rich temporal information in angiographic timeseries.

Charlson Comorbidity Index and Frailty as Predictors of Resolution Following Middle Meningeal Artery Embolization for Chronic Subdural Hematoma.

Background: Research on variables associated with chronic subdural hematoma (cSDH) resolution following middle meningeal artery embolization (MMAE) is limited. This study investigated the clinical utility of age-adjusted Charlson Comorbidity Index (ACCI) and modified 5-item Frailty Index (mFI - 5) for predicting cSDH resolution following MMAE.

Methods: We identified patients who underwent MMAE at our institution between January 2018 and December 2022, with at least 20 days of follow-up and one radiographic follow-up study.

Clot composition and recanalization outcomes in mechanical thrombectomy.

Background: Mechanical thrombectomy (MT) has become standard for large vessel occlusions, but rates of complete recanalization are suboptimal. Previous reports correlated radiographic signs with clot composition and a better response to specific techniques. Therefore, understanding clot composition may allow improved outcomes.

Outpatient telemedicine in neurosurgery: 15,677 consecutive encounters in a comparative analysis of its effectiveness and impact on the surgical conversion rate.

Objective: The coronavirus disease 2019 (COVID-19) pandemic has necessitated the use of telehealth visits (THVs). The effects on neurosurgical practice have not been well characterized, especially concerning new-patient THVs. Therefore, the authors of this study reviewed their institution's experience with outpatient clinic visits and THVs from before the COVID-19 pandemic to the present to focus on clinical metrics, rates of surgery, and the effects of implementing THVs in order to better understand their implications for clinical practice as more data emerge over time.

Concomitant cervical spine fractures are the primary driver of disability after traumatic vertebral artery dissection: A Case series of 123 patients.

Background: Traumatic vertebral artery dissections (tVADs) occur in up to 20% of patients with head trauma, yet data on their presentation and associated sequelae are limited.

Aims And Objectives: To characterize the tVAD population and identify factors associated with clinical outcomes.

Materials And Methods: We retrospectively analyzed all cases of tVAD at our institution from January 2004 to December 2018 with respect to mechanism of injury, clinical presentation, anatomic factors, associated pathologies, and relevant outcomes.

Low-molecular-weight Heparin (enoxaparin) versus unfractionated heparin for venous thromboembolism prophylaxis in patients undergoing craniotomy.

Objective: To explore the difference in post-operative DVT, PE, and ICH complications following administration of prophylactic UFH or enoxaparin in patients undergoing craniotomy.

Methods: A retrospective chart review was conducted for 542 patients at our institution receiving either 5000units/0.5 mL UFH (BID or TID; 180 patients) or single daily 40 mg/0.

Ethical Considerations in Surgical Decompression for Stroke.

Stroke is a major cause of morbidity and mortality. Neurosurgical decompression is often considered for the treatment of malignant infarcts and intraparenchymal hemorrhages, but this treatment can be frought with ethical dilemmas. In this article, the authors outline the primary principles of bioethics and their application to stroke care, provide an overview of key ethical issues and special situations in the neurosurgical management of stroke, and highlight methods to improve ethical decision-making for patients with stroke.

Beyond the Scholl reaction - one-step planarization and edge chlorination of nanographenes by mechanochemistry.

The edge chlorination of the benchmark nanographenes triphenylene and hexa--hexabenzocoronene is conducted mechanochemically. This approach overcomes solubility limitations and eliminates the need for elaborate chlorination conditions. Additionally, the planarization of oligophenylenes and their edge-chlorination can be combined in a one-pot approach requiring as little as 60 minutes.

Continued Dominance of Carotid Endarterectomy over Stenting in the United States: Volumes, Outcomes, and Complications from the National Inpatient Sample (1997-2015).

Background: The introduction of carotid stenting (CAS) has led to numerous comparative trials with carotid endarterectomy (CEA).

Objective: The objective of the study was to review real-world volumes, outcomes, and complications following CEA versus CAS over an extended period to identify durable changes in practice.

Methods: Data were extracted from the National Inpatient Sample.

Holohemispheric Prostate Carcinoma Dural Metastasis Mimicking Subdural Hematoma: Case Report and Review of the Literature.

Prostate carcinomas are the most common malignancy to metastasize to the dura. These metastases can commonly mimic subdural hematomas and may similarly present with brain compression. The optimal management and outcomes after surgical management are not well characterized.

Histological composition of retrieved emboli in acute ischemic stroke is independent of pre-thrombectomy alteplase use.

Background And Purpose: Given recent evidence suggesting the clot composition may be associated with revascularization outcomes and stroke etiology, clot composition research has been a topic of growing interest. It is currently unclear what effect, if any, pre-thrombectomy thrombolysis has on clot composition. Understanding this association is important as it is a potential confounding variable in clot composition research.

Unplanned readmission after carotid stenting versus endarterectomy: analysis of the United States Nationwide Readmissions Database.

Background: Hospital readmissions are costly and reflect negatively on care delivered.

Objective: To have a better understanding of unplanned readmissions after carotid revascularization, which might help to prevent them.

Methods: The Nationwide Readmissions Database was used to determine rates and reasons for unplanned readmission following carotid endarterectomy (CEA) and carotid artery stenting (CAS).

Mass Deployment of Deep Neural Network: Real-Time Proof of Concept With Screening of Intracranial Hemorrhage Using an Open Data Set.

Background: Intracranial hemorrhage (ICH) is considered an emergency that requires rapid medical or surgical management. Previous studies have used artificial intelligence to attempt to expedite the diagnosis of this pathology on neuroimaging. However, these studies have used local, institution-specific data for training of networks that limit deployment of across broader hospital networks or regions because of data biases.

Quantification of clot spatial heterogeneity and its impact on thrombectomy.

Background: Compositional and structural features of retrieved clots by thrombectomy can provide insight into improving the endovascular treatment of ischemic stroke. Currently, histological analysis is limited to quantification of compositions and qualitative description of the clot structure. We hypothesized that heterogeneous clots would be prone to poorer recanalization rates and performed a quantitative analysis to test this hypothesis.