Expanded Endoscopic Endonasal Clipping of a Giant Cavernous Carotid Aneurysm.

Cavernous carotid aneurysms are typically small, asymptomatic, and often do not require treatment. We present the case of a 59-year-old woman, a 3-pack-a-day smoker, who presented with the primary complaint of left retro-orbital pain, left complete ophthalmoplegia, left-sided blindness, and right abducens palsy. Imaging revealed a giant right cavernous carotid aneurysm, which had expanded to the contralateral cavernous sinus wall and superiorly through the diaphragm sellae.

Exploratory Randomised Trial of Tranexamic Acid to Decrease Postoperative Delirium in Adults Undergoing Lumbar Fusion: A trial stopped early.

Background: Postoperative delirium may be mediated by perioperative systemic- and neuro-inflammation. By inhibiting the pro-inflammatory actions of plasmin, tranexamic acid (TXA) may decrease postoperative delirium. To explore this hypothesis, we modified an ongoing randomised trial of TXA, adding measures of postoperative delirium, cognitive function, systemic cytokines, and astrocyte activation.

Predictors of Aneurysm Obliteration in Patients Treated with the WEB Device: Results of a Multicenter Retrospective Study.

Background And Purpose: Despite the numerous studies evaluating the occlusion rates of aneurysms following WEB embolization, there are limited studies identifying predictors of occlusion. Our purpose was to identify predictors of aneurysm occlusion and the need for retreatment.

Materials And Methods: This is a review of a prospectively maintained database across 30 academic institutions.

Neuromodulation with Ultrasound: Hypotheses on the Directionality of Effects and a Community Resource.

Low-intensity Transcranial Ultrasound Stimulation (TUS) is a promising non-invasive technique for deep-brain stimulation and focal neuromodulation. Research with animal models and computational modelling has raised the possibility that TUS can be biased towards enhancing or suppressing neural function. Here, we first conduct a systematic review of human TUS studies for perturbing neural function and alleviating brain disorders.

Primary Embolization of Cerebral Arteriovenous Malformations With Intention to Cure: A Systematic Review of Literature and Meta-Analysis.

Background And Objectives: The treatment of brain arteriovenous malformations (AVMs) involves multiple approaches, including embolization, microsurgical resection, and radiosurgery. With the advent of new embolisates, dual-lumen balloon catheters, detachable tip microcatheters, and transvenous embolization, endovascular AVM obliteration has become more effective. Although adjuvant embolization and embolization are commonly used, the safety and effectiveness of curative embolization remain unclear.

Contemporary Methods for Detection and Intervention of Distal Medium and Small Vessel Occlusions.

The efficacy of using mechanical thrombectomy for proximal large vessel occlusions has been demonstrated in multiple large-scale trials and has further raised the question of its potential utility for distal medium and small vessel occlusions (DMSVOs). Their longer, more tortuous course and smaller corresponding vascular territories render a significant challenge for detection and intervention. The aim of this study is to provide a comprehensive overview of the current imaging and endovascular intervention options for DMSVOs and review the current works in the literature.

Deep brain stimulation for substance use disorder: a systematic review and meta-analysis.

Objective: Substance use disorder (SUD) is a significant public health issue with a high mortality rate. Deep brain stimulation (DBS) has shown promising results in treating SUD in certain cases. In this study, we conducted a meta-analysis to evaluate the efficacy of DBS in the treatment of SUD and reduction of relapse rates.

Novel Use of Robotically Harvested Internal Thoracic Artery in High-Flow Cerebral Bypass.

Mesenchymal tumors of the head and neck can lead to tumor-induced osteopeni, necessitating a biochemical cure to alleviate associated symptoms. We present a case of a 40-year-old man who presented with diffuse pain and wheelchair dependency secondary to a skull base mesenchymal tumor producing tumor-induced osteopeni. The tumor involved the cavernous sinus, infratemporal fossa, and middle cranial fossa.

Microsurgical Resection of Spinal Arteriovenous Malformation with Clipping of Anterior Spinal Artery Aneurysm.

Spinal cord arteriovenous malformations (AVMs) are rare and usually present in younger patients. We present the case of a 76-year-old woman with a 2-year history of unsteady gait. She presented to us with sudden-onset thoracic pain, numbness, and weakness in both legs.

Long-Term Follow-Up of Cerebral Aneurysms Completely Occluded at 6 Months After Intervention with the Woven EndoBridge (WEB) Device: a Retrospective Multicenter Observational Study.

The Woven EndoBridge (WEB) device has been widely used to treat intracranial wide neck bifurcation aneurysms. Initial studies have demonstrated that approximately 90% of patients have same or improved long-term aneurysm occlusion after the initial 6-month follow up. The aim of this study is to assess the long-term follow-up in aneurysms that have achieved complete occlusion at 6 months.

The Adjustable Cranial Plate: A Novel Implant Designed to Eliminate the Need for Cranioplasty Surgery Following a Hemicraniectomy Operation.

Background: Decompressive hemicraniectomy (DHC) is performed to relieve life-threatening intracranial pressure elevations. After swelling abates, a cranioplasty is performed for mechanical integrity and cosmesis. Cranioplasty is costly with high complication rates.

Microsurgery of Meningiomas Involving the Superior Sagittal Sinus.

Meningiomas involving major dural sinuses can be difficult to resect without proper handling of the sinus. In young patients, a gross total resection should be attempted when feasible. A 24-year-old man presented with headaches, progressive left-sided weakness, and partial motor seizures.

Minimally Invasive Double-Barrel Superficial Temporal Artery-Middle Cerebral Artery Bypass.

Superficial temporal artery (STA)-middle cerebral artery (MCA) bypass is used to augment flow in various cases. We present a patient with a refractory right MCA transient ischemic attack and a minor stroke. He was perfusion dependent.

Increased Concentrations of Atherogenic Proteins in Aneurysm Sac Are Associated with Wall Enhancement of Unruptured Intracranial Aneurysm.

Current MR-vessel wall imaging (VWI) of unruptured intracranial aneurysms (UIAs) permits the visualization of wall structures. Aneurysm wall enhancement (AWE) was associated with atherosclerotic remodeling of the aneurysm wall accompanied by infiltration of inflammatory cells, potentially contributing to rupture. This study sought to investigate whether the luminal concentrations of atherosclerotic proteins in the aneurysm sac were associated with increased wall enhancement of UIAs in VWI.

Melatonin and risk of mortality in subjects with aneurysmal subarachnoid hemorrhage.

Background: Delayed cerebral ischemia (DCI) is a cause of morbidity associated with aneurysmal subarachnoid hemorrhage (aSAH). Neuroinflammation contributes to the development of DCI. Melatonin is a sleep-promoting hormone known to have cerebral anti-inflammatory properties.

The Woven EndoBridge (WEB) device: feasibility, techniques, and outcomes after FDA approval.

Objective: Wide-neck bifurcation cerebral aneurysms have historically required either clip ligation or stent- or balloon-assisted coil embolization. This predicament led to the development of the Woven EndoBridge (WEB) aneurysm embolization system, a self-expanding mesh device that achieves intrasaccular flow disruption and does not require antithrombotic medications. The authors report their operative experience and 6-month follow-up occlusion outcomes with the first 115 aneurysms they treated via WEB embolization.

Postoperative cognitive dysfunction after endovascular treatments for unruptured intracranial aneurysms: A pilot study.

Objective: Post operative cognitive dysfunction (POCD) has been widely observed after major surgery, particularly in elderly patients with general anesthesia (GA). However, a specific unanswered question is whether different approaches to anesthetic managements are associated with different cognitive outcomes after endovascular treatments for unruptured intracranial aneurysms (UIAs). The purpose of this study is to assess the correlation of POCD with GA versus monitored anesthesia care (MAC).

Phase 1/2a Trial of ISPASM.

Background And Purpose: Microthrombosis could play a role in delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage. Tirofiban has shown promising results in reducing delayed cerebral ischemia in retrospective studies. However, the safety of using tirofiban in aneurysmal subarachnoid hemorrhage is not rigorously established.

Aneurysm Wall Enhancement Is Associated With Decreased Intrasaccular IL-10 and Morphological Features of Instability.

Background: High-resolution vessel wall imaging plays an increasingly important role in assessing the risk of aneurysm rupture.

Objective: To introduce an approach toward the validation of the wall enhancement as a direct surrogate parameter for aneurysm stability.

Methods: A total of 19 patients harboring 22 incidental intracranial aneurysms were enrolled in this study.

Case series of sphenoid wing meningioma - What is a maximal safe resection?

Background: Sphenoid wing meningiomas are a challenging surgical disease with relatively high perioperative morbidity. Most studies to date have focused on resection strategies as it relates to disease recurrence. Few have examined the optimal strategy as it relates to overall patient survival.

Melanoma Brain Metastases in the Era of Targeted Therapy and Checkpoint Inhibitor Therapy.

Brain metastases commonly develop in melanoma and are associated with poor overall survival of about five to nine months. Fortunately, new therapies, including immune checkpoint inhibitors and BRAF/MEK inhibitors, have been developed. The aim of this study was to identify outcomes of different treatment strategies in patients with melanoma brain metastases in the era of checkpoint inhibitors.

Atypical presentation of rotational vertebral artery insufficiency: illustrative case.

Background: Rotational vertebral artery insufficiency (RVAI), also known as bow hunter's syndrome, is an uncommon cause of vertebrobasilar insufficiency that leads to signs of posterior circulation ischemia during head rotation. RVAI can be subdivided on the basis of the anatomical location of vertebral artery compression into atlantoaxial RVAI (pathology at C1-C2) or subaxial RVAI (pathology below C2). Typically, RVAI is only seen with contralateral vertebral artery pathologies, such as atherosclerosis, hypoplasia, or morphological atypia.

Concentration of Lp(a) (Lipoprotein[a]) in Aneurysm Sac Is Associated With Wall Enhancement of Unruptured Intracranial Aneurysm.

Background And Purpose: Atherosclerotic remodeling of the aneurysm wall, which could be detected as aneurysm wall enhancement (AWE) by magnetic resonance-vessel wall imaging, is a part of degenerative change of unruptured intracranial aneurysms (UIAs). The purpose of this study was to determine whether the luminal concentrations of atherosclerotic proteins in the aneurysm sac were associated with increased wall enhancement of UIAs in vessel wall imaging.

Methods: We performed a prospective study of subjects undergoing endovascular treatments for UIAs.