Can Endovascular Repair of Unruptured Intracranial Aneurysms Be Safely Performed in an Outpatient Setting? Lessons Learned from Spine Outcome Control Groups.

Background And Objectives: The performance of select neurosurgical procedures is being transitioned to an outpatient setting rather than an inpatient setting to increase healthcare cost-effectiveness. Despite numerous technological advancements in the treatment of unruptured intracranial aneurysms (UIAs), the procedures are solely performed in an inpatient setting. We aimed to compare the rate of short-term outcomes associated with inpatient endovascular treatment of UIAs with those for established outpatient neurosurgical procedures, including anterior cervical discectomy and fusions (ACDFs) and lumbar discectomies.

First Reported Series of Cerebral Angiography Performed at an Outpatient Center: Safety and Satisfaction Results.

Background And Objective: Ambulatory surgery centers (ASCs) are increasingly common venues for same-day neurosurgical procedures, allowing for cost-effective, high-quality patient care. We present the first and largest series of patients undergoing diagnostic cerebral angiography at an ASC to demonstrate the effectiveness, safety, and efficiency of outpatient endovascular care.

Methods: We retrospectively reviewed data for consecutive patients who underwent diagnostic cerebral angiography at our ASC between January 1, 2024, and May 29, 2024.

Cavernous Sinus Thrombosis.

Cavernous sinus thrombosis is a potentially lethal subset of cerebral venous sinus thrombosis that may occur as a result of septic and aseptic etiologies. The overall incidence is estimated to be between 0.2 and 1.

Mechanical Thrombectomy Versus Best Medical Management for Acute Ischemic Stroke in Elderly Patients: A Cost-Effectiveness Analysis.

Objective: To determine the cost-effectiveness of mechanical thrombectomy (MT) versus best medical management (BMM) in patients aged ≥80 years.

Methods: We performed a systematic literature review to identify comparative studies of MT versus BMM with or without intravenous tissue-type plasminogen activator (IV tPA) in patients ≥80 years. Clinical data including outcomes and mortality categorized as modified Rankin scale scores 0-2, 3-5, and 6, were collected from identified studies, and effectiveness scores were assigned to each outcome.

Learning curves for transradial access versus transfemoral access in diagnostic cerebral angiography: a case series.

Background: The perception of a steep learning curve associated with transradial access has resulted in its limited adoption in neurointervention despite the demonstrated benefits, including decreased access-site complications.

Objective: To compare learning curves of transradial versus transfemoral diagnostic cerebral angiograms obtained by five neurovascular fellows as primary operator.

Methods: The first 100-150 consecutive transradial and transfemoral angiographic scans performed by each fellow between July 2017 and March 2020 were identified.

Transition to Transradial Access for Mechanical Thrombectomy-Lessons Learned and Comparison to Transfemoral Access in a Single-Center Case Series.

Background: Trends in mechanical thrombectomy have emphasized larger bore aspiration catheters that may be difficult to deploy from a radial access point due to size constraints or need to obtain sheathless access. As such, many neurointerventionists are reticent to attempt thrombectomy through transradial access (TRA) for fear of worse outcomes.

Objective: To explore whether mechanical thrombectomy could be achieved safely and effectively through the transradial route.

Make Clipping Great Again: Microsurgery for Cerebral Aneurysms by Dual-Trained Neurosurgeons.

Objective: Despite an increasing focus on endovascular treatment of cerebral aneurysms, microsurgical clipping remains an integral part of management. We evaluated the safety and effectiveness of microsurgical clipping performed by dual-trained neurosurgeons at our institute, which has adopted an endovascular first approach.

Methods: We retrospectively reviewed clinical and radiographic data of 412 aneurysms in 375 patients treated with microsurgical clipping.

"Strokenomics": bending the cost curve in stroke care.

Objective: The mortality rates for stroke are decreasing, yet it remains a leading cause of disability and the principal neurological diagnosis in patients discharged to nursing homes. The societal and economic burdens of stroke are substantial, with the total annual health care costs of stroke expected to reach $240.7 billion by 2030.

Dual Microwire Rail Technique to Advance a Microcatheter Past the Ostium of a Dissecting Carotid Artery Aneurysm for Flow Diverter Deployment: 2-Dimensional Operative Video.

Flow diversion using a Pipeline embolization device (PED; Medtronic, Dublin, Ireland) is an effective therapy for treating cavernous aneurysms. Currently, flow diverters require a 0.027-inch microcatheter for deployment.

Use of Intra-Arterial Tissue Plasminogen Activator in Acute Stroke: Video Case.

This video illustrates access to tortuous distal intracranial vasculature and the use of intra-arterial (IA) tissue plasminogen activator (tPA) for the revascularization of small vessel occlusion. IA tPA is a reasonable approach for distal arterial occlusion resistant to intravenous tPA or mechanical thrombectomy. In this video, the patient had a posterior circulation stroke with elevated time-to-peak in the cerebellar hemispheres.

Management of Iatrogenic Internal Carotid Artery Dissection and Middle Cerebral Artery Restenosis during Endovascular Treatment of Acute Stroke: Video Case.

Iatrogenic dissection of the internal carotid artery (ICA) during endovascular approaches is challenging. This video illustrates a case of iatrogenic ICA dissection at the skull base during mechanical thrombectomy for M1 occlusion. This case was further complicated by post-thrombectomy M1 restenosis that did not improve with submaximal angioplasty.

The Prevalence of Burnout Among US Neurosurgery Residents.

Background: Burnout is a syndrome of emotional exhaustion, depersonalization, and reduced personal accomplishment. Its prevalence among US physicians exceeds 50% and is higher among residents/fellows. This is important to the practice of neurosurgery, as burnout is associated with adverse physical health, increased risk of substance abuse, and increased medical errors.

Assessing the accuracy of neurological surgery resident case logs at a single institution.

Background: Despite the importance of case logs in evaluating residents, no studies assess their accuracy in neurological surgery. Studies from other specialties reveal variations in reporting. This study assesses the accuracy of neurological surgery resident case logs at a single institution.

Spontaneous frontal intradiploic meningoencephalocele.

Background: Since 1976, 10 cases of intradiploic encephaloceles have been reported in the literature. This case is the first report of a spontaneous intradiploic meningoencephalocele of the frontal bone hypothesized to be secondary to distant head trauma.

Case Description: A 60-year-old female with a history of multiple traumatic head injuries as a child presenting with new onset generalized tonic-clonic seizures.