Differences in Size Between Unruptured and Ruptured Saccular Intracranial Aneurysms by Location.

Objective: It is generally accepted that larger saccular intracranial aneurysms are at greater risk to rupture. We investigated whether aneurysm location influences the effect of aneurysm size on the propensity of rupture.

Methods: We reviewed patient and aneurysm characteristics in a consecutive series of patients with unruptured and ruptured aneurysms presenting to our institution between 2006 and 2018.

Predictors of Initial Presentation with Hemorrhage in Patients with Cavernous Malformations.

Background: Cavernous malformations (CMs) are low-flow vascular malformations of the central nervous system which are incidental or present with hemorrhage, seizures, or focal neurologic deficit (FND). Little is known about the time course of symptoms and the predictors of initial hemorrhagic presentation.

Methods: Beginning in 2015, consecutive patients with radiologically confirmed CMs were recruited and completed a structured interview and written survey at baseline.

A Multicenter Pilot Study on the Clinical Utility of Computational Modeling for Flow-Diverter Treatment Planning.

Background And Purpose: Selection of the correct flow-diverter size is critical for cerebral aneurysm treatment success, but it remains challenging due to the interplay of device size, anatomy, and deployment. Current convention does not address these challenges well. The goals of this pilot study were to determine whether computational modeling improves flow-diverter sizing over current convention and to validate simulated deployments.

Carotid Intraplaque-Hemorrhage Volume and Its Association with Cerebrovascular Events.

Background And Purpose: Our aim was to assess the relationship between volume and percentage of intraplaque hemorrhage measured using CT and the occurrence of cerebrovascular events at the time of CT.

Materials And Methods: One-hundred-twenty-three consecutive subjects (246 carotid arteries) with a mean age of 69 years who underwent CTA were included in this retrospective study. Plaque volume of components and subcomponents (including intraplaque hemorrhage volume) was quantified with dedicated software.

Multimodal Approach for Treatment of Hemorrhaged Mesencephalic Arteriovenous Malformation.

Brainstem arteriovenous malformations (AVMs) are complex and life-threatening lesions. In our video (Video 1), we illustrate resection of a posterior midbrain hemorrhaged AVM (Spetzler-Martin grade III, Lawton-Young grade III, Supplementary Spetzler-Martin grade 6) in a 55-year-old woman presenting with ventricular hemorrhage and coma. Multimodal therapy with endovascular embolization of an associated prenidal aneurysm of the right posteromedial choroidal artery, followed by microsurgical resection via supracerebellar-infratentorial approach, is demonstrated.

Population-Based Evaluation of Lumbar Puncture Opening Pressures.

Prior studies evaluating opening pressure (OP) have mostly involved lumbar puncture (LP) for diagnosis of neurologic disease or small cohorts of healthy volunteers and therefore the normal OP is not well-defined. The goal of this study was to establish the normal range of OP in a community-based population using the Mayo Clinic Study of Aging (MCSA) and to evaluate factors that contribute to OP variability. LP OP were obtained from participants aged 32-95 years between 11/1/07 and 10/1/17, as part of routine data collection for the MCSA, a longitudinal, population-based study of residents of Olmsted County, Minnesota.

Long-term antithrombotic therapy and risk of intracranial haemorrhage from cerebral cavernous malformations: a population-based cohort study, systematic review, and meta-analysis.

Background: Antithrombotic (anticoagulant or antiplatelet) therapy is withheld from some patients with cerebral cavernous malformations, because of uncertainty around the safety of these drugs in such patients. We aimed to establish whether antithrombotic therapy is associated with an increased risk of intracranial haemorrhage in adults with cerebral cavernous malformations.

Methods: In this population-based, cohort study, we used data from the Scottish Audit of Intracranial Vascular Malformations, which prospectively identified individuals aged 16 years and older living in Scotland who were first diagnosed with a cerebral cavernous malformation during 1999-2003 or 2006-10.

Carotid Plaque CTA Analysis in Symptomatic Subjects with Bilateral Intraparenchymal Hemorrhage: A Preliminary Analysis.

Background And Purpose: The presence of IPH is considered the most dangerous feature because it is significantly associated with clinical ipsilateral cerebrovascular events. Our aim was to explore the characterization of plaque with CT in symptomatic subjects with bilateral intraplaque hemorrhage.

Materials And Methods: Three-hundred-forty-three consecutive patients with recent anterior circulation ischemic events (<2 weeks) and CT of the carotid arteries (performed within 14 days of the cerebrovascular event) evaluated between June 2012 and September 2017 were analyzed for plaque volume composition to identify all subjects with bilateral intraplaque hemorrhage.

Flow Diversion of an Incompletely-Treated Fusiform Middle Cerebral Artery Aneurysm: 2-Dimensional Operative Video.

Fusiform aneurysms involving the M2 branches of the middle cerebral artery are often dissecting, identified by a characteristic diseased adjacent segment, and location not at a branch point. Herein, we present the case of a 38-yr-old man with a symptomatic, dissecting M2 aneurysm that was previously incompletely treated with stent-assisted coiling. In our experience, symptomatic fusiform aneurysms in this location tend to recur unless the involved segment is completely trapped or reconstructed with flow diversion.

Aneurysm morphology in patients with autosomal dominant polycystic kidney disease: A case-control study.

Purpose: Approximately 8% of patients with autosomal dominant polycystic kidney disease (ADPKD) develop intracranial aneurysms. The reason for development of intracranial aneurysms in ADPKD patients might be related to interactions between the presence of hypertension and the basic mechanism underlying the disease, which leads to weakness of the connective tissue. In this study, we aimed to identify differences in aneurysm morphology between ADPKD patients and a location-matched set of controls.

Rebleeding drives poor outcome in aneurysmal subarachnoid hemorrhage independent of delayed cerebral ischemia: a propensity-score matched cohort study.

Objective: Delayed cerebral ischemia (DCI) and aneurysm rebleeding contribute to morbidity and mortality in aneurysmal subarachnoid hemorrhage (aSAH); however, the relationship between their impacts on overall functional outcome is incompletely understood.

Methods: The authors conducted a cohort study of all aSAH during the study period from 2001 to 2016. Primary end points were overall functional outcome and ischemic aSAH sequelae, defined as delayed cerebral ischemia (DCI), DCI with infarction, symptomatic vasospasm (SV), and global cerebral edema (GCE).

MR characteristics of unruptured intracranial arteriovenous malformations associated with seizure as initial clinical presentation.

Background: Patients with intracranial arteriovenous malformations (AVMs) are at increased risk of seizures.

Objective: To identify MRI characteristics of unruptured intracranial AVMs associated with seizures at presentation.

Materials And Methods: A retrospective review was completed of patients diagnosed with unruptured intracranial AVMs on MRI between January 1, 2000 and December 31, 2016.

Progressive Pure Arterial Malformations of the Anterior Cerebral Artery.

Background: Pure arterial malformations (PAMs) are rare intracranial vascular anomalies. As recently reported, PAMs have a benign natural history and can be treated conservatively. However, their etiology, natural history, and treatment have not yet been fully elucidated.

Microsurgical resection of an enlarging lateral pontomedullary cavernous malformation.

The extended retrosigmoid approach provides an excellent corridor to the lateral aspect of the pontomedullary junction (PMJ). This video demonstrates a microsurgical resection of a progressive enlarging cavernous malformation (CM) of the PMJ. The patient is a 33-year-old woman with progressive symptoms, including right facial droop, left hemianesthesia, diplopia, and nystagmus.

The Flower Petal Training System in Microsurgery: Validation of a Training Model Using a Randomized Controlled Trial.

Introduction: Despite hundreds of training models for microsurgery being available in the literature, very few of them are scientifically validated. We chose to validate our low-fidelity training model on flower petals by comparing it head-to-head with a moderate fidelity training model, the anastomosis on chicken leg femoral artery.

Materials And Methods: A total of 16 participants of different levels of expertise were randomized into 2 groups, 1 training on flower petals and 1 on chicken leg femoral arteries.

Development and validation of the Skills Assessment in Microsurgery for Brain Aneurysms (SAMBA) instrument for predicting proficiency in aneurysm surgery.

Objective: Surgical performance evaluation was first described with the OSATS (Objective Structured Assessment of Technical Skills) and modified for aneurysm microsurgery simulation with the OSAACS (Objective Structured Assessment of Aneurysm Clipping Skills). These methods rely on the subjective opinions of evaluators, however, and there is a lack of objective evaluation for proficiency in the microsurgical treatment of brain aneurysms. The authors present a new instrument, the Skill Assessment in Microsurgery for Brain Aneurysms (SAMBA) scale, which can be used similarly in a simulation model and in the treatment of unruptured middle cerebral artery (MCA) aneurysms to predict surgical performance; the authors also report on its validation.

Effect of fixed-setting versus programmable valve on incidence of shunt revision after ventricular shunting for idiopathic normal pressure hydrocephalus.

Objective: Although ventricular shunting is an effective therapy for idiopathic normal pressure hydrocephalus (iNPH), the effect of shunt valve type on the incidence of revision surgery is not well defined. To address this issue, shunt revision rates between patients with iNPH receiving a fixed-setting valve (FSV) versus a programmable valve (PV) were compared.

Methods: Patients with iNPH treated with ventricular shunting between 2001 and 2017 were included for analysis.

Carotid Cavernous Fistula Mimicking Hemicrania Continua: A Case Report.

Background: Hemicrania continua is a primary headache disorder characterized by a continuous, unilateral headache associated with ipsilateral cranial autonomic features that responds to indomethacin. By definition, the symptoms are not referable to an underlying structural pathology. However, several cases of secondary hemicrania continua related to underlying structural lesions have been reported.

Transitional venous anomalies and DVAs draining brain AVMs: A single-institution case series and review of the literature.

Objective: Developmental venous anomalies (DVAs) are typically benign lesions purely venous in nature. However, a subset of DVAs are either 1) associated with brain arteriovenous malformations (AVMs) or 2) demonstrate shunting themselves. The goal of this case series and literature review is to present clinical characteristics, management strategies and outcomes of this patient population.

Outcomes following surgical versus endovascular treatment of spinal dural arteriovenous fistula: a systematic review and meta-analysis.

Although surgical resection is associated with a complete cure in most cases of spinal dural arteriovenous fistulas (SDAVF), there has been an increasing trend towards embolisation. We performed a systematic review and meta-analysis comparing surgical resection with endovascular treatment in terms of success of treatment, rate of recurrence and complications. A literature search was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Comparison of non-contrast vessel wall imaging and 3-D time-of-flight MRA for atherosclerotic stenosis and plaque characterization within intracranial arteries.

Purpose: We compared the ability of intracranial high-resolution vessel wall imaging (VWI) without gadolinium and 3-D time-of-flight (3D-TOF) MRA techniques to characterize intracranial arterial stenosis and arterial wall plaque consistent with atherosclerotic plaque.

Methods: Consecutive intracranial VWI examinations performed within 2 months of a 3D-TOF exam with at least 1 noted plaque was included. Examinations assessed 17 vessel segments for plaque and diameters of stenotic and normal segments using double oblique reformatted images.

Symptomatic Cavernous Malformation Presenting with Seizure without Hemorrhage: Analysis of Factors Influencing Clinical Presentation.

Background: Supratentorial cavernous malformations (CMs) can be epileptogenic lesions. However, little is known about clinical comorbidities, medication use, and radiologic features that predict a first seizure presentation without associated CM hemorrhage.

Methods: We queried a prospective registry of consecutive patients with CM established in January 2015.