A case of recurrent subdural hematoma after unilateral MMA embolization that resolved after contralateral MMA embolization.

Middle meningeal artery embolization (MMAe) is rapidly emerging as a valuable intervention to decrease the risk of recurrent subdural hematoma (SDH) after surgical evacuation. The role of upfront bilateral MMAe for unilateral SDH and the value of contralateral MMAe after SDH recurrence post evacuation and ipsilateral MMAe are still unknown. Here, we report the case of an elderly patient that presented with a large acute on chronic SDH and underwent surgical drainage and ipsilateral MMAe (with Contour PVA particles, 150-250 µm).

Interhemispheric Contralateral Transcallosal Approach to a Giant Thalamic Cavernous Malformation: 2-Dimensional Operative Video.

Thalamic cavernous malformations are challenging lesions to approach given their deep location and proximity to eloquent neurovascular structures. Several approaches to this region exist, and small nuances in the location of the lesion dictate different surgical trajectories. For cavernous malformations presenting to the superomedial surface of the thalamus, the interhemispheric transcallosal approach affords an excellent trajectory as the anterior two-thirds of the superomedial thalamus constitutes the lateral aspect of the floor of the body of the lateral ventricle.

Arteriovenous shunts of the cervical spine: patient demographics, presentation, patterns of high-risk venous drainage, and updated classification.

Background: Intracranial dural arteriovenous (AV) fistula classifications focus on presence/absence of retrograde flow in the cortical veins of the brain as this angiographic finding portends a worse prognosis. However, prior categorization systems of AV shunts in the spine do not incorporate these features. We propose an updated classification for spinal shunting lesions that terms any shunting lesion with retrograde flow in any cortical vein of the brain or spinal cord medullary vein as "high risk".

Strategies to Improve Drug Delivery Across the Blood-Brain Barrier for Glioblastoma.

Purpose Of Review: Glioblastoma remains resistant to most conventional treatments. Despite scientific advances in the past three decades, there has been a dearth of effective new treatments. New approaches to drug delivery and clinical trial design are needed.

Middle meningeal artery embolization for chronic subdural hematoma: A single-center experience and predictive modeling of outcomes.

Background: Remarkable interest is rising around middle meningeal artery embolization (MMAE) as an emerging alternative therapy for chronic subdural hematoma (cSDH). The study aims to highlight a large center experience and the variables associated with treatment failure and build experimental machine learning (ML) models for outcome prediction.

Material And Methods: A 2-year experience in MMAE for managing patients with chronic subdural hematoma was analyzed.

Middle meningeal artery embolization with polyvinyl alcohol particles in a patient with ophthalmic artery origin from middle meningeal artery: Case report and technical note.

This is a case report of an adult with chronic subdural hematoma (cSDH) who underwent endovascular treatment for middle meningeal artery (MMA) embolization. There was a prominent meningo-ophthalmic branch with an absence of an ophthalmic artery from the internal carotid artery. MMA embolization was performed utilizing particles with no complications and the resolution of the cSDH was within 4 months.

Endovascular revascularization of chronically occluded common carotid artery for symptomatic cerebral hypoperfusion.

Endovascular recanalization is increasingly being utilized in symptomatic patients with chronically occluded carotid arteries. In carefully selected patients, endovascular recanalization has shown to lower the risk of ischemic events when compared to medical management alone.1 However, successful endovascular revascularization is technically challenging and not without risk.

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.

Carotid Artery Tortuosity and Internal Carotid Artery Plaque Composition.

Background: Little is known about the association between carotid artery tortuosity and internal carotid artery atherosclerosis. This study sought to evaluate the associations between various types of arterial tortuosity and vulnerable plaque components on magnetic resonance angiography (MRA).

Material And Methods: A retrospective review was completed of 102 patients who had undergone MRA neck imaging, with intraplaque hemorrhage (IPH) present in one or both cervical internal carotid arteries (ICA).

Vagus nerve stimulation using an endovascular electrode array.

. Vagus nerve stimulation (VNS), which involves a surgical procedure to place electrodes directly on the vagus nerve (VN), is approved clinically for the treatment of epilepsy, depression, and to facilitate rehabilitation in stroke. VNS at surgically implanted electrodes is often limited by activation of motor nerve fibers near and within the VN that cause neck muscle contraction.

Intraplaque hemorrhage on magnetic resonance angiography: How often do signal abnormalities persist on follow-up imaging?

Background And Purpose: Intraplaque hemorrhage (IPH) in carotid atherosclerosis demonstrates increased signal on magnetic resonance angiography images. Little remains known about how this signal changes on subsequent examinations.

Materials And Methods: A retrospective observational study was completed of patients that had IPH on a neck MRA between 1/1/2016 and 3/25/2021, defined as ≥ 200 % signal intensity of the sternocleidomastoid muscle on MPRAGE images.

Revascularization of a Complex Case of Vertebrobasilar Insufficiency with Occipital Artery-Anterior Inferior Cerebellar Artery Bypass.

Atherosclerotic disease is the most common etiology in causing posterior circulation strokes and can be found within the intracranial vertebrobasilar system. Endovascular and surgical approaches to treat this disease have been defined with both advantages and disadvantages. We present a case of surgical revascularization of a complex case of vertebrobasilar insufficiency with occipital artery (OA)-anterior inferior cerebellar artery (AICA) bypass (Video 1).

Pituitary adenomas and cerebrovascular disease: A review on pathophysiology, prevalence, and treatment.

Pituitary adenomas (PAs) have been shown to cause excess cardiovascular disease comorbidity and mortality. Cerebrovascular disease (CeVD) is a small subset of cardiovascular disease with high morbidity, and its risk in patients with pituitary adenomas has been sparingly explored. In this review, we examine what is known about the prevalence of cerebrovascular disease in patients with PAs, from its initial discovery in 1970 to present.

Construction and Validation of a Benchtop Model for Testing of Mechanical Thrombectomy Devices for Pulmonary Embolism.

Purpose: This study aims to define the process of designing and manufacturing 3D printed and glass models of the pulmonary artery (PA) and utilizing them in a test bed for evaluation of devices for mechanical thrombectomy of pulmonary embolism (PE).

Materials And Methods: Patient derived computed tomography angiography (CTA) images of the PA were digitally converted into a hollowed-out structure and translated into clear 3D printed and glass models. A test bed was created using a peristaltic pump and silicone tubing connected to the models.

Vessel wall imaging features of Moyamoya disease in a North American population: patterns of negative remodelling, contrast enhancement, wall thickening, and stenosis.

Background: This study characterized vessel wall imaging (VWI) features of Moyamoya disease (MMD) in a predominantly adult population at a North American center.

Methods: Consecutive patients with VWI were included. Twelve arterial segments were analyzed for wall thickening, degree and pattern of contrast enhancement, and remodeling.

Surgical Techniques and Nuances for Superior Cervical Ganglionectomy and Decentralization in Rats.

The sympathetic nervous system has been implicated in various physiological and pathological processes, including regulation of homeostatic functions, maintenance of the circadian rhythms, and neuronal disruption and recovery after injury. Of special interest is focus on the role of the superior cervical ganglion (SCG) in regulating the daily changes in pineal function. Removal of the superior cervical ganglion (SCGx) and decentralization have served as valuable microsurgical models to investigate the effects of surgical denervation on this gland or organ.

Electroencephalogram and heart rate variability features as predictors of responsiveness to vagus nerve stimulation in patients with epilepsy: a systematic review.

Introduction: Vagus nerve stimulation (VNS) is a mainstay treatment in people with medically refractive epilepsy with a growing interest to identify biomarkers that are predictive of VNS efficacy. In this review, we looked at electroencephalography (EEG) and heart rate variability (HRV) parameters as potential biomarkers.

Methodology: A comprehensive search of several databases limited to the English language and excluding animal studies was conducted.

Evaluation of an in vivo preclinical model for human middle meningeal artery embolization using the posterior intercostal artery of the swine.

Background: Embolization of the middle meningeal artery (MMA) is a promising minimally invasive technique that is gaining traction in the treatment of chronic subdural hematoma. Unfortunately, the human meninges and associated arteries are significantly larger than those of conventional laboratory animals, making the development of a clinically relevant animal model for testing of embolization agents elusive.

Objective: To introduce the posterior intercostal artery (PIA) model in swine and provide anatomical, angiographic, histological, and procedural data to validate its relevance in modeling the human MMA.

The "Michelangelo Code": The Quest for Universal Truth.

Michelangelo's unparalleled frescoes in the Sistine Chapel have been traditionally construed to represent the traditional, Roman Catholic interpretation of the Seven Days of Creation in the Book of Genesis and the Last Judgement. Indeed, in September 2018, Pope Francis I offered a benediction for the Vatican's art treasures and for "those who contributed to the Church's history through art." A number of studies have suggested that Michelangelo concealed anatomic information about the human brain in his renderings of God and biblical prophets and saints.