StrokeNet: An automated approach for segmentation and rupture risk prediction of intracranial aneurysm.

Intracranial Aneurysms (IA) present a complex challenge for neurosurgeons as the risks associated with surgical intervention, such as Subarachnoid Hemorrhage (SAH) mortality and morbidity, may outweigh the benefits of aneurysmal occlusion in some cases. Hence, there is a critical need for developing techniques that assist physicians in assessing the risk of aneurysm rupture to determine which aneurysms require treatment. However, a reliable IA rupture risk prediction technique is currently unavailable.

Toward Grading Subarachnoid Hemorrhage Risk Prediction: A Machine Learning-Based Aneurysm Rupture Score.

Objective: Existing approaches neither provide an accurate prediction of subarachnoid hemorrhage (SAH) nor offer a quantitative comparison among a group of its risk factors. To evaluate the population, hypertension, age, size, earlier subarachnoid hemorrhage, and location (PHASES) and unruptured intracranial aneurysm treatment score (UIATS) scores and develop an Artificial Intelligence-based 5-year and lifetime aneurysmal rupture criticality prediction (ARCP) score for a set of risk factors.

Methods: We design various location-specific and ensemble learning models to develop lifetime rupture risk, employ the longitudinal data to develop a linear regression-based model to predict an aneurysm's growth score, and use the Apriori algorithm to identify risk factors strongly associated with SAH.

Clinical Context-Aware Biomedical Text Summarization Using Deep Neural Network: Model Development and Validation.

Background: Automatic text summarization (ATS) enables users to retrieve meaningful evidence from big data of biomedical repositories to make complex clinical decisions. Deep neural and recurrent networks outperform traditional machine-learning techniques in areas of natural language processing and computer vision; however, they are yet to be explored in the ATS domain, particularly for medical text summarization.

Objective: Traditional approaches in ATS for biomedical text suffer from fundamental issues such as an inability to capture clinical context, quality of evidence, and purpose-driven selection of passages for the summary.

Introducing the Rupture Criticality Index to Compare Risk Factor Combinations Associated With Aneurysmal Rupture.

Background: Relative risk is insufficient to guide treatment decision-making for unruptured intracranial aneurysms. Our objective was to introduce a novel risk assessment methodology called the Rupture Criticality Index (RCI), which allows for concurrent evaluation of groups of risk factors (RFs).

Methods: From a retrospective database of saccular aneurysms, we identify 915 patients and delineate 50 potential RFs for aneurysms in 11 unique locations.

Arteriovenous malformations of the corpus callosum: Pooled analysis and systematic review of literature.

Background: Arteriovenous malformations (AVMs) of the corpus callosum (CC) are rare entities. We performed a systematic review of the available literature to better define the natural history, patient characteristics, and treatment options for these lesions.

Methods: A MEDLINE, Google Scholar, and The Cochrane Library search were performed for studies published through June 2015.

Racial disparities in the diagnosis and management of trigeminal neuralgia.

OBJECTIVE A number of studies have documented inequalities in care and outcomes for a variety of clinical conditions. The authors sought to identify racial and socioeconomic disparities in the diagnosis and treatment of trigeminal neuralgia (TN), as well as the potential underlying reasons for those disparities, which could serve as areas of focus for future quality improvement initiatives. METHODS The medical records of patients with an ICD-9 code of 350.

Surgical Management of Dural Arteriovenous Fistula After Craniotomy: Case Report and Review of Literature.

Background: Development of dural arteriovenous fistula (dAVF) with cortical venous drainage at the site of previous craniotomy is a rare manifestation of nontraumatic subarachnoid hemorrhage (SAH). The authors present a case of postcraniotomy dAVF formation and discuss plausible underlying mechanisms of fistula formation and treatment options as well as review the literature.

Case Description: A 62-year-old man, who had undergone craniotomy 2 decades previously, presented with SAH.

Management of arteriovenous malformations in the elderly: a single-center case series and analysis of outcomes.

OBJECT Treatment of brain arteriovenous malformations (bAVMs) in the elderly remains a challenge for cerebrovascular surgeons. In this study the authors reviewed the patient characteristics, treatments, angiographic results, and clinical outcomes in 28 patients over 65 years of age who were treated at Henry Ford Hospital between 1990 and 2014. METHODS The bAVM database at the authors' institution was queried for records of elderly patients with bAVMs, and data regarding patient demographics, presenting symptoms, bAVM angioarchitecture, treatment modalities, angiographic results, clinical outcomes, and treatment complications were tabulated and analyzed.

Surgical Management of Giant Intracranial Arteriovenous Malformations: A Single Center Experience over 32 years.

Objective: Treatment of giant intracranial arteriovenous malformations (gAVMs) is a formidable challenge for neurosurgeons and carries significant morbidity and mortality rates for patients compared with smaller AVMs. In this study, we reviewed the treatments, angiographic results, and clinical outcomes in 64 patients with gAVMs who were treated at Henry Ford Hospital between 1980 and 2012.

Methods: The arteriovenous malformation (AVM) database at our institution was queried for patients with gAVMs (≥ 6 cm) and data regarding patient demographics, presentation, AVM angioarchitecture, and treatments were collected.

Prenatal Diagnosis of Congenital Dermal Sinus.

Background Congenital dermal sinus (CDS) is an uncommon form of spinal dysraphism. Although postdelivery identification in the neonate is aided by several associated physical examination findings, establishing this diagnosis prenatally has proven to be elusive. Case Report We present a case of CDS where the prenatal findings at 20 weeks gestation led to the diagnosis, which was confirmed postnatally.

Left temporal craniotomy for clipping of fusiform aneurysm of posterior cerebral artery.

Aneurysms of the posterior cerebral artery (PCA) are a distinct pathological entity and are surgically challenging. Fusiform aneurysms involving the PCA are quite rare and scarcely reported in the literature. In this video, we demonstrate the utility of the subtemporal approach to surgically reconstruct an unruptured, fusiform aneurysm of the left PCA, located at the junction of P3 and P4 segments.

Novel technique for cranial reconstruction following retrosigmoid craniectomy using demineralized bone matrix.

Objective: A versatile neurosurgical approach, the retrosigmoid craniectomy (RS) has traditionally been associated with high rates of post-operative cerebrospinal fluid (CSF) leak, headaches, and aesthetic defects. We introduce a simple surgical strategy for bony cranial reconstruction designed to minimize peri-operative complications and improve cosmetic outcomes.

Methods: In accordance with the Institutional Review Board, the senior author's (G.

Spontaneous resolution of a flow-related ophthalmic-segment aneurysm after treatment of anterior cranial fossa dural arteriovenous fistula.

Background: The natural history of proximal, feeding-artery aneurysms after successful obliteration of high-grade, anterior cranial fossa dural arteriovenous fistulas (dAVFs) has not been well documented.

Case Description: A 52-year-old Caucasian male presented with an unruptured anterior cranial fossa (dAVF) and an associated aneurysm. Cerebral angiography revealed a large, contralateral, carotid-ophthalmic segment aneurysm, enlarged feeding ophthalmic arteries, as well as cortical venous drainage.

Management of perisylvian arteriovenous malformations: a retrospective institutional case series and review of the literature.

Object: Sylvian arteriovenous malformations (sAVMs) are challenging lesions of the central nervous system. The natural history of these unique lesions as well as clinical outcomes following treatment of sAVMs has been limited to case series owing to the rarity of these lesions. The authors present their experience with sAVMs and review the literature.

Creating accountable care for carotid angioplasty and stenting: A multidisciplinary carotid revascularization board.

Background: We tested the feasibility of a mandated multidisciplinary carotid revascularization board (MDCB) to review, approve and monitor all carotid artery and stenting (CAS) procedures and outcomes at our institution.

Methods: The board was composed of vascular surgeons, cardiologists, interventional neuroradiologists, neurosurgeons, and neurologists, who met weekly to facilitate an evidence-based, consensus recommendation to ensure appropriate CAS referral.

Results: The board successfully reviewed and continues to review and approve all CAS procedures at our center.

Statement of Ethics in Neurosurgery of the World Federation of Neurosurgical Societies.

This Statement of Ethics in Neurosurgery was developed by the Committee for Ethics and Medico-Legal Affairs of the World Federation of Neurosurgical Societies to help neurosurgeons resolve problems in the treatment of individual patients and meet obligations to the larger society. This document is intended as a framework rather than a set of rules. It cannot cover every situation and should be used with flexibility.

Erlotinib therapy for central nervous system hemangioblastomatosis associated with von Hippel-Lindau disease: a case report.

There is a need for effective systemic therapy for central nervous system (CNS) hemangioblastomas (HBs). We report a case of erlotinib therapy for CNS HBs in a patient with von Hippel-Lindau disease, in whom the HBs were associated with diffuse leptomeningeal seeding. We provide the first report of paired serum and cerebrospinal fluid (CSF) levels of erlotinib while on standard dosing.

Dural arteriovenous malformations of the skull base.

Dural arteriovenous malformations (AVMs) are interesting lesions, which can present as diagnostic and therapeutic challenges. Such AVMs were initially described as located solely in the dural venous sinuses, but during the last decade researchers have discovered them in other locations such as the tentorium and foramen magnum. It is understandable that they can develop in other locations because numerous arteriovenous shunts normally occur all over the dura.

Stent-within-a-stent technique for the treatment of dissecting vertebral artery aneurysms.

Subarachnoid hemorrhage from dissecting vertebral artery aneurysms is a well-known phenomenon. With the advent of navigable intracranial stents, these aneurysms are now amenable to endovascular stent placement. However, immediate aneurysm obliteration is often not accomplished, and current covered stents have poor short-term patency rates.

Carotid endarterectomy in patients with contralateral internal carotid artery occlusion without intraoperative shunting.

Background: Controversy about the optimal method of performing a carotid endarterectomy (CEA) exists despite its widespread application and support from various randomized clinical trials. Many surgeons selectively or routinely use electroencephalography (EEG) monitoring as well as shunting when performing this operation.

Methods: We conducted this retrospective study to assess the maximum carotid clamp time without shunting or EEG monitoring during a CEA without the development of neurological deficits in an already compromised cerebral circulation.