Co-administration of dexmedetomidine with total intravenous anaesthesia in carotid endarterectomy reduces requirements for propofol and improves haemodynamic stability: A single-centre, prospective, randomised controlled trial.

Background: Total intravenous anaesthesia guided by electroencephalography and neurophysiological monitoring may be used for carotid endarterectomy. Reduction of brain metabolic demand during cross-clamping of the internal carotid artery with propofol titrated to burst suppression requires effect-site concentrations that may delay emergence and interfere with intraoperative neurophysiological monitoring.

Objective: To test the hypothesis that dexmedetomidine decreases the effect-site concentration of propofol required for burst-suppression in patients undergoing carotid endarterectomy.

Validation of a dynamic 4D microsurgical bypass simulator for training and teaching microvascular anastomosis techniques with blood flow and fluorescence imaging.

Objective: Microvascular anastomosis is challenging, and training surgeons to develop and maintain skills is imperative. Current training models either miss the simulation of the surgical workflow, lack 3D key-hole space, need ethical approval, require special preparation, or lack realism. To circumvent these issues, this study describes the use of a mixed reality 3D printed model with integrated blood flow for training cerebral anastomosis and assesses its validity.

Frailty indices predict mortality, complications and functional improvements in supratentorial meningioma patients over 80 years of age.

Purpose: To assess whether the Modified 5 (mFI-5) and 11 (mFI-11) Factor Frailty Indices associate with postoperative mortality, complications, and functional benefit in supratentorial meningioma patients aged over 80 years.

Methods: Baseline characteristics were collected from eight centers. Based on the patients' preoperative status and comorbidities, frailty was assessed by the mFI-5 and mFI-11.

European survey on follow-up strategies for unruptured intracranial aneurysms.

Introduction: The increasing detection rates of unruptured intracranial aneurysms (UIA) pose a challenge for both neurovascular centers, tasked with managing a growing pool of patients requiring regular monitoring with imaging, and the healthcare system that must bear the costs of such surveillance. While there is consensus on the need for follow-up of UIA, uncertainties persist regarding the optimal cessation of surveillance, especially when considering diverse patient risk factors and, notably, in cases of treated aneurysms with stable rest perfusion. Detailed guidelines on UIA follow-up are currently lacking, exacerbating these challenges.

Basilar Artery Perforator Aneurysms - The Phantom Menace of the Intracranial Universe.

Cerebral perforators are end-arteries that vascularize specific deep territories in the cerebral hemispheres and brainstem. Due to improved imaging quality, these aneurysms are increasingly diagnosed in clinical routine. High resolution 3D angiographic images are mandatory and in some occasions fusion images might be helpful to detect these aneurysms.

Laser speckle contrast imaging versus microvascular Doppler sonography in aneurysm surgery: A prospective study.

Objective: This study aimed to compare microvascular Doppler sonography (MDS) and laser speckle contrast imaging (LSCI) for assessing vessel patency and aneurysm occlusion during microsurgical clipping of intracranial aneurysms.

Methods: MDS and LSCI were used after clip placement during six neurovascular procedures including six patients, and agreement between the two techniques was assessed. LSCI was performed in parallel or right after MDS evaluation.

Quality of life in patients with unruptured intracranial aneurysms treated conservatively, before and after occlusion. A single center cohort study.

Introduction: Rupture of intracranial aneurysms is the most frequent cause of subarachnoid hemorrhage and is associated with high morbidity. Recommendations for preventive treatment of unruptured aneurysms (UIAs) remain controversial due to inconsistent data on their natural history and the risks associated with treatment. The awareness of being diagnosed with one or more UIAs can provoke feelings of anxiety and psychosocial distress.

Cortical perfusion measurements with laser speckle contrast imaging during adenosine induced cardiac arrest for aneurysm clipping: a case report.

Adenosine induced cardiac arrest (AiCA) is one of the methods used to facilitate microsurgical aneurysm clipping by providing more visibility and less pressure in the aneurysmal sac and neighboring vessels. We report the use of laser speckle contrast imaging (LSCI) during AiCA to monitor the changes in pulsation and perfusion on the cortical surface during adenosine induced cardiac arrest for aneurysm clipping surgery. Application of this technology for perfusion monitoring may improve workflow and surgical guidance and provide valuable feedback continuously throughout the procedure.

Training Performance Assessment for Intracranial Aneurysm Clipping Surgery Using a Patient-Specific Mixed-Reality Simulator: A Learning Curve Study.

Background And Objectives: The value of simulation-based training in medicine and surgery has been widely demonstrated. This study investigates the introduction and use of a new mixed-reality neurosurgical simulator in aneurysm clipping surgery, focusing on the learning curve and performance improvement.

Methods: Five true-scale craniotomy head models replicating patient-specific neuroanatomy, along with a mixed-reality simulator, a neurosurgical microscope, and a set of microsurgical instruments and clips, were used in the operation theater to simulate aneurysm microsurgery.

Time for "Code ICH"? Workflow Metrics of Hyperacute Treatments and Outcome in Patients with Intracerebral Haemorrhage.

Introduction: Knowledge about uptake and workflow metrics of hyperacute treatments in patients with non-traumatic intracerebral haemorrhage (ICH) in the emergency department is scarce.

Methods: Single-centre retrospective study of consecutive patients with ICH between 01/2018-08/2020. We assessed uptake and workflow metrics of acute therapies overall and according to referral mode (stroke code, transfer from other hospital, or other).

Continuous hemodynamics monitoring during arteriovenous malformation microsurgical resection with laser speckle contrast imaging: case report.

AVM surgery is challenging due to progressive and often unforeseeable flow changes during its resection which involve both the AVM and the surrounding brain tissue. Hence, accurate monitoring of blood flow is crucial to minimize complications and improve outcomes. The following case report illustrates the usefulness of complimentary non-invasive tools that can provide real time blood flow assessment.

Dynamic Mixed-Reality Patient-Specific Aneurysm Clipping Simulation for Two Cases-A Feasibility Study.

Background And Objective: Intracranial aneurysm (IA) clipping is a complex neurosurgical procedure which demands advanced technology to minimize risks and maximize patient outcomes. This study aims to evaluate the feasibility of training patient-specific microsurgical clipping procedures using a mixed-reality physical neurosurgical simulator for unruptured IA.

Methods: Two board-certified neurosurgeons were asked to simulate surgery in 2 patient-specific left-side unruptured middle cerebral artery-bifurcation IA models.

Intraoperative Laser Speckle Contrast Imaging to Assess Vessel Flow in Neurosurgery: A Pilot Study.

Background And Objectives: Laser speckle contrast imaging (LSCI) has emerged as a promising tool for assessment of vessel flow during neurosurgery. We aimed to investigate the feasibility of visualizing vessel flow in the macrocirculation with a new fully microscope-integrated LSCI system and assess the validity and objectivity of findings compared with fluorescence angiography (FA).

Methods: This is a single-center prospective observational study enrolling adult patients requiring microsurgical treatment for brain vascular pathologies or brain tumors.

Surgical Outcome of Patients With Supratentorial Meningiomas Aged 80 Years or Older-Retrospective International Multicenter Study.

Background And Objectives: Demographic changes will lead to an increase in old patients, a population with significant risk of postoperative morbidity and mortality, requiring neurosurgery for meningiomas. This multicenter study aims to report neurofunctional status after resection of patients with supratentorial meningioma aged 80 years or older, to identify factors associated with outcome, and to validate a previously proposed decision support tool.

Methods: Neurofunctional status was assessed by the Karnofsky Performance Scale (KPS).

Small vessel disease burden and risk of recurrent cerebrovascular events in patients with lacunar stroke and intracerebral haemorrhage attributable to deep perforator arteriolopathy.

Introduction: Deep perforator arteriolopathy (DPA) causes intracerebral haemorrhage (ICH) and lacunar strokes (LS). We compare patient characteristics, MRI findings and clinical outcomes among patients with deep ICH and LS.

Patients And Methods: We included patients with MRI-confirmed LS or ICH in the basal ganglia, thalamus, internal capsule or brainstem from the Bernese Stroke Registry.

Simulation training approaches in intracranial aneurysm surgery-a systematic review.

Background: With the increasing complexity and decreasing exposure to intracranial aneurysm surgery, training and maintenance of the surgical skills have become challenging. This review elaborated on simulation training for intracranial aneurysm clipping.

Methods: A systematic review was performed according to the PRISMA guidelines to identify studies on aneurysm clipping training using models and simulators.

3D-Printed Head Model in Patient's Education for Micro-Neurosurgical Aneurysm Clipping Procedures.

Background: Computed tomography (CT), Magnetic resonance imaging (MRI), and 3D reconstruction from Digital Subtraction Angiography (DSA) are currently used in clinical consultations for patients diagnosed with intracranial aneurysms; however, they have limitations in helping patients understand the disease and possible treatments. This study investigates the use of a 3D-printed model of the patients' neurosurgical anatomy and vascular pathology as an educational tool in outpatient clinics.

Methods: A 3D-printed model of a middle cerebral artery aneurysm was created for use during patient consultations to discuss microsurgical treatment of unruptured cerebral aneurysms.

Intracranial Aneurysm "Clip Anchoring": Technical Note.

Clip slippage and displacement during or after intracranial aneurysm surgery is associated with morbidity and can be detrimental. We report the usage of concomitant aneurysm clips and artery clips aiming to avoid this complication in a patient undergoing elective aneurysm surgical clipping.

Diagnosis of Small Unruptured Intracranial Aneurysms : Comparison of 7 T versus 3 T MRI.

Purpose: Differentiating normal anatomical variants such as an infundibulum or a vascular loop from true intracranial aneurysms is crucial for patient management. We hypothesize that high-resolution 7 T magnetic resonance imaging (MRI) improves the detection and characterization of normal anatomical variants that may otherwise be misdiagnosed as small unruptured aneurysms.

Methods: This is a retrospective, single-center study.