Career Outcomes Among Neurosurgery Resident Graduates in Canada: An Update.

Background: Many Royal College of Physicians and Surgeons of Canada (RCPSC) graduates in neurosurgery face significant challenges in finding full-time employment. The current study describes the career outcomes of neurosurgery residents from Canadian programs.

Methods: All RCPSC neurosurgery graduates ( = 106) who completed their residency between 2015 and 2020 were included in this study.

National multicentered retrospective review of clinical and intraoperative factors associated with the development of cerebellar mutism after pediatric posterior fossa tumor resection.

Background: Cerebellar mutism (CM) is characterized by a significant loss of speech in children following posterior fossa (PF) surgery. The biological origin of CM remains unclear and is the subject of ongoing debate. Significant recovery from CM is less likely than previously described despite rigorous multidisciplinary neuro-rehabilitational efforts.

Optimal Glucose Target After Aneurysmal Subarachnoid Hemorrhage: A Matched Cohort Study.

Background: Hyperglycemia has been associated with poor outcomes in patients with aneurysmal subarachnoid hemorrhage (aSAH). However, there remains debate as to what optimal glucose targets should be in this patient population.

Objective: To assess whether we could identify an optimal glucose target for patients with aSAH.

A nationwide prospective multicenter study of external ventricular drainage: accuracy, safety, and related complications.

Objective: External ventricular drainage (EVD) catheters are associated with complications such as EVD catheter infection (ECI), intracranial hemorrhage (ICH), and suboptimal placement. The aim of this study was to investigate the rates of EVD catheter complications and their associated risk factor profiles in order to optimize the safety and accuracy of catheter insertion.

Methods: A total of 348 patients with urgently placed EVD catheters were included as a part of a prospective multicenter observational cohort.

Preoperative Embolization of Fisch Grades II-IVa Juvenile Nasopharyngeal Angiofibromas: Transarterial Embolization in the Age of Onyx.

Objective The current mainstay treatment for juvenile nasopharyngeal angiofibromas (JNAs) is surgical resection, but embolization of primary feeding arteries through endovascular transarterial and direct tumoral puncture embolizations with various agents has been described. We describe a single institutional experience with JNA embolization utilizing Onyx (Medtronic, Dublin, Ireland). Methods A retrospective records review was performed to identify patients who underwent embolization for devascularization of Fisch grades II-IVa JNA (tumor extension beyond the sphenopalatine region) before surgical resection between 2010 and 2019.

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.

Gene expression profiling of brain endothelial cells after experimental subarachnoid haemorrhage.

Subarachnoid haemorrhage (SAH) is a type of hemorrhagic stroke that is associated with high morbidity and mortality. New effective treatments are needed to improve outcomes. The pathophysiology of SAH is complex and includes early brain injury and delayed cerebral ischemia, both of which are characterized by blood-brain barrier (BBB) impairment.

Complete flow control using transient concurrent rapid ventricular pacing or intravenous adenosine and afferent arterial balloon occlusion during transvenous embolization of cerebral arteriovenous malformations: case series.

Background: There are no reports that describe complete flow control using concurrent transient rapid ventricular pacing or intravenous (IV) adenosine and afferent arterial balloon flow arrest to aid transvenous embolization of cerebral arteriovenous malformations (AVM). We describe our experience with the use of this technique in patients undergoing transvenous AVM embolization.

Methods: Consecutive patients in whom transvenous embolization was attempted at our institute between January 2017 and July 2019 were included.

Use of expandable stent retriever for mechanical thrombectomy of the right internal carotid artery terminus occlusion.

Background: Tigertriever (Rapid Medical, Sunrise, FL) is an adjustable-diameter stent retriever that is being tested in an investigational device exemption clinical trial, Treatment with Intent to Generate Reperfusion (TIGER). The retriever is available in three lengths with corresponding adjustable diameters; however, a single device cannot be used for multiple thrombectomy attempts. A clicker-based expansion mechanism allows incremental expansion of the retriever and step-wise increase in radial force to the parent vessel diameter.

Endovascular management of radial artery loop for neuroangiography: Case series.

Background: Radial loops are rare congenital radial artery anomalies that may pose a significant challenge to successful transradial neuroangiography. In this case series, we describe the anatomy and frequency of radial artery loops and provide a technique for successful navigation of this anatomic anomaly.

Methods: We reviewed our database of radial diagnostic or interventional neuroangiographic procedures to identify cases in which a radial loop was encountered during the procedure.

Coil Occlusion of Right M2 Fusiform Aneurysm After Balloon-Test Occlusion: 2-Dimensional Video.

We present a 73-year-old man with an incidental right M2 fusiform aneurysm demonstrating growth on serial noninvasive imaging over 5 years (Video 1). After multidisciplinary conference review, the decision was to proceed with intracranial balloon-test occlusion (BTO) followed by coil occlusion if the patient passed this test or by trap and bypass if the patient failed this test. With the patient under moderate conscious sedation, a transfemoral 8F approach was used with positioning of a TracStar 95-cm 088 guide catheter (Imperative Care, Campbell, California, USA) into the distal right cervical ICA.

Unfavorable Outcome After Good Grade Aneurysmal Subarachnoid Hemorrhage: Exploratory Analysis.

Objective: Patients with good-grade aneurysmal subarachnoid hemorrhage (aSAH) are thought to recover well, yet some do not. This work sought to identify predictors of unfavorable functional outcome after good-grade aSAH.

Methods: We performed a post-hoc analysis of the CONSCIOUS-1 trial.

A data-driven model to identify high-risk aneurysms and guide management decisions: the Rupture Resemblance Score.

Objective: Previous studies have found that ruptured intracranial aneurysms (RIAs) have distinct morphological and hemodynamic characteristics, including higher size ratio and oscillatory shear index and lower wall shear stress. Unruptured intracranial aneurysms (UIAs) that possess similar characteristics to RIAs may be at a higher risk of rupture than those UIAs that do not. The authors previously developed the Rupture Resemblance Score (RRS), a data-driven computer model that can objectively gauge the similarity of UIAs to RIAs in terms of morphology and hemodynamics.

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.

Measurement of instant flow reserve to quantify functional flow limitation across stenosis in intracranial atherosclerotic disease.

Angiographic stenosis may not be an accurate reflection of physiological flow limitation. Measurement of instant flow reserve (IFR) to quantify functional flow limitation across stenosis may be valuable in identifying lesions causing significant flow limitation. A case of left middle cerebral artery atherosclerotic disease is presented.

Safety and feasibility of ulnar artery access for neuroangiography and neurointervention: a case series.

Background: Radial access has become popular among neurointerventionalists because it has favorable risk profiles compared with femoral access. Difficulties in accessing or navigating the radial artery have been viewed as a reason to convert to femoral access, but ulnar artery access may prevent complications associated with transfemoral procedures.

Objective: To evaluate the safety and feasibility of ulnar access for neurointerventions and diagnostic neuroangiographic procedures.

Transradial access for flow diversion of intracranial aneurysms: Case series.

Background: Transradial access for neurointerventions offers advantages of fewer access-site complications, reduced procedure time, and greater patient comfort over transfemoral access. Data about transradial access for flow diversion are limited. We share our early experience with transradial access for flow diversion in a relatively large case series.

Transradial middle meningeal artery embolization for chronic subdural hematoma using Onyx: case series.

Background: Middle meningeal artery (MMA) embolization is an emerging therapy for the resolution of subacute or chronic subdural hematoma (CSDH). CSDH patients are often elderly and have several comorbidities. We evaluated our experience with transradial access (TRA) for MMA embolization using predominantly Onyx under conscious sedation.

Mechanical thrombectomy of right internal carotid artery terminus occlusion using the ADAPT technique: impact of aspiration on parent vessel.

The impact of ADAPT-"a direct aspiration first pass technique"-on intracranial vasculature is not well understood, since the change of arterial diameter is often not visible during aspiration. We present a unique case in which the impact of aspiration on the parent vessel was visualized due to a previously deployed Neuroform Atlas stent and a Pipeline embolization device. The patient presented with right internal carotid artery occlusion.

Treatment of Carotid Ophthalmic Aneurysm With Woven EndoBridge (WEB SL): 2-Dimensional Operative Video.

Wide-necked cerebral aneurysms often require complex treatment strategies for optimal treatment. As the surgeon's arsenal continues to expand, consideration of all potential applications of available devices is important. The Woven EndoBridge (WEB) device (MicroVention-Terumo, Aliso Viejo, California) capitalizes on flow disruption to promote thrombosis and is Food and Drug Administration (FDA) approved for saccular wide-necked bifurcation aneurysms located at the middle cerebral artery bifurcation, internal carotid artery (ICA) terminus, anterior communicating artery complex, and basilar apex.

Navigating a proximal loop in the radial artery and avoiding the recurrent radial artery.

Several anatomical variations of the radial artery have been described in the literature. Common variations include radial artery loop, recurrent branch, and anastomotic channels connecting the radial and brachial arteries. These variations can pose significant technical challenges to safe radial artery catheterization.

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.

Use of a neck-bridging device for endovascular coiling of a wide-necked middle cerebral artery aneurysm.

Endovascular treatment of wide-necked bifurcation intracranial aneurysms is technically challenging, often requiring adjunctive devices such as stents or balloons to maintain coil mass within the aneurysm sac. Comaneci is a radiopaque embolization-assist device that can be temporarily deployed in the parent artery across the aneurysm neck without arresting blood flow for remodeling of coil mass. It is removed once coiling without luminal coil protrusion is achieved.