A randomized trial comparing endovascular and surgical management of ruptured intracranial aneurysms excluded from previous trials.

Objective: Many patients with ruptured intracranial aneurysms (RIAs) underrepresented or excluded from previous randomized controlled trials (RCTs) comparing surgery with endovascular treatment (EVT) are still considered for surgical clipping, but the best management of these patients remains unknown.

Methods: The International Subarachnoid Aneurysm Trial-2 was a randomized trial comparing surgical versus EVT of RIAs considered for surgical clipping, despite the results of previous RCTs, and also eligible for EVT. The primary endpoint was death or dependency according to the modified Rankin Scale score (mRS score > 2) at 1 year.

Computational hemodynamic pathophysiology of internal carotid artery blister aneurysms.

Objective: Blister aneurysms of the internal carotid artery (ICA) are rare and are primarily documented in the literature through small series and case reports. The intraoperative observation of a hemorrhage in the artery wall proximal to the aneurysmal bulge led to the hypothesis that some of these aneurysms might develop in a retrograde manner.

Methods: We developed software to reconstruct the ICA with and without Type I and II blister aneurysms using patients' imagery as input to simulate hemodynamic conditions before and after their formation.

Branching and nonbranching intracranial aneurysms in the presence of a persistent stapedial artery and an aberrant internal carotid artery assessed with computational hemodynamics: illustrative case.

Background: The mechanisms underlying the initiation and progression of bifurcation versus lateral wall aneurysms are not well understood. Computational fluid dynamics (CFD) can improve the understanding of these mechanisms and can consequently help identify patients at higher risk for developing aneurysms and monitor them more closely.

Observations: A 36-year-old man presented with a ruptured anterior communicating artery aneurysm, which was successfully treated with microsurgical clipping.

Craniovertebral and spinal adhesive arachnoiditis: a late complication of ruptured vertebral and posterior inferior cerebellar arteries aneurysms.

Background: Adhesive arachnoiditis is a rare yet serious complication that may occur following subarachnoid hemorrhage (SAH). In this circumstance, it is mainly due to ruptured vertebral artery (VA) or posterior inferior artery (PICA) aneurysms. It disrupts cerebrospinal fluid (CSF) flow leading to complications such as spinal arachnoiditis, syringomyelia, trapped 4th ventricle, or a combination of these conditions.

Hemodynamic factors of spontaneous vertebral artery dissecting aneurysms assessed with numerical and deep learning algorithms: Role of blood pressure and asymmetry.

Background And Objectives: The pathophysiology of spontaneous vertebral artery dissecting aneurysms (SVADA) is poorly understood. Our goal is to investigate the hemodynamic factors contributing to their formation using computational fluid dynamics (CFD) and deep learning algorithms.

Methods: We have developed software that can use patient imagery as input to recreate the vertebrobasilar arterial system, both with and without SVADA, which we used in a series of three patients.

Spontaneous intracranial vertebral artery dissections presenting with subarachnoid hemorrhage.

Background: Vertebral artery dissection (VAD) is an infrequent source of subarachnoid hemorrhage (SAH), with a high mortality rate, primarily due to the risk of rebleeding both before and after medical intervention. This paper provides a comprehensive analysis of the anatomy, pathophysiology, clinical presentation, treatment strategies, and outcomes of intracranial vertebral artery dissections that result in subarachnoid hemorrhage.

Methods: Comprehensive five-year literature review (2018-2022) and a retrospective analysis of patient records from our institution between 2016 and 2022.

A comprehensive review of the vertebral artery anatomy.

Background: The vertebral arteries (VA) play a critical role by supplying nearly one-third of the brain's blood flow, predominantly contributing to the posterior circulation. These arteries may need to be exposed in a various cranial and cervical procedures and offers access to investigate or treat vascular lesions by endovascular means related to the posterior circulation. Given its complex anatomy, which is subject to numerous variations, and its role in supplying vital brain regions, a thorough understanding of the VA's anatomy is paramount for any related procedure.

Using artificial intelligence to quantify dynamic retraction of brain tissue and the manipulation of instruments in neurosurgery.

Purpose: There is no objective way to measure the amount of manipulation and retraction of neural tissue by the surgeon. Our goal is to develop metrics quantifying dynamic retraction and manipulation by instruments during neurosurgery.

Methods: We trained a convolutional neural network (CNN) to analyze microscopic footage of neurosurgical procedures and thereby generate metrics evaluating the surgeon's dynamic retraction of brain tissue and, using an object tracking process, evaluate the surgeon's manipulation of the instruments themselves.

Palinacousis: an eloquent symptom of temporal lobe lesion.

A 24-year-old woman was referred to us for an intracranial haemorrhage in the left temporal lobe caused by a ruptured cavernous malformation; the bleeding extended over the left Heschl's gyrus and Wernicke area. On admission, the patient had global aphasia. A few days later, she spontaneously improved but remained with mild residual comprehensive dysphasia.

Persistent Trigeminal Artery as Collateral Circulation in Ischemic Stroke.

The persistent trigeminal artery is the most frequent of the persistent embryonic carotid-basilar artery anastomoses. In the literature, it has most often been described in relation to cerebrovascular pathologies such as aneurysms, vascular nerve compression, trigeminal cavernous fistulas, and thromboembolic ischemia. Its role as collateral circulation, thus supplying brain perfusion during main arterial trunk occlusion, has seldom been described.

How I do it: lateral supra-cerebellar infra-tentorial approach for P2-P3 junction cerebral aneurysms.

Background: P2-P3 junction aneurysms are challenging to treat surgically because of their frequent complex morphology and their location deep in close proximity to the midbrain. The sub-temporal route requires significant retraction of the temporal lobe in addition to potential injury to the vein of Labbe. We describe the technique for treating such aneurysms via a lateral supra-cerebellar infra-tentorial (LSCIT) approach, which eliminates manipulation of the temporal lobe.

Posterolateral route for a midbrain cavernous malformation reaching the anterior surface of the brainstem.

Cavernous malformations in the midbrain can be accessed via several safe entry zones. The accepted rule of thumb is to enter at the point where the lesion is visible at the surface of the brainstem to pass through as little normal brain tissue as possible. However, in some cases, in order to avoid critical neural structures, this rule may not apply.

Surgical treatment of ruptured anterior circulation aneurysms: comparison of pterional and supraorbital keyhole approaches.

Background: Recent advancements in microsurgical techniques and instrumentation have allowed the development of the keyhole approach in aneurysm surgery.

Objective: To compare the safety, efficacy, and 1-year clinical outcome of supraorbital keyhole and standard pterional approaches for ruptured anterior circulation aneurysms.

Methods: A total of 87 patients underwent surgical clipping, 40 through the pterional and 47 through the supraorbital keyhole approach.