Predictors of recurrence after surgical resection of parafalcine and parasagittal meningiomas.

Purpose: Owing to their vicinity near the superior sagittal sinus, parasagittal and parafalcine meningiomas are challenging tumors to surgically resect. In this study, we investigate key factors that portend increased risk of recurrence after surgery.

Methods: This is a retrospective study of patients who underwent resection of parasagittal and parafalcine meningiomas at our institution between 2012 and 2018.

Radiomic signatures of meningiomas using the Ki-67 proliferation index as a prognostic marker of clinical outcomes.

Objective: The clinical behavior of meningiomas is not entirely captured by its designated WHO grade, therefore other factors must be elucidated that portend increased tumor aggressiveness and associated risk of recurrence. In this study, the authors identify multiparametric MRI radiomic signatures of meningiomas using Ki-67 as a prognostic marker of clinical outcomes independent of WHO grade.

Methods: A retrospective analysis was conducted of all resected meningiomas between 2012 and 2018.

Coil Embolization with Subsequent Subacute Flow Diversion Before Hospital Discharge as a Treatment Paradigm for Ruptured Aneurysms.

Background: Subtotal coil embolization followed by subsequent flow diversion is often pursued for treatment of acutely ruptured aneurysms. Owing to the need for anti-platelet therapy, the optimal time of safely pursuing flow diversion treatment has not been fully elucidated. In this study, we aim to demonstrate the safety and feasibility of staged treatment of acutely ruptured aneurysms with early coil embolization followed by flow diversion prior to discharge.

Improved Functional Outcomes of Stroke Patients Undergoing Mechanical Thrombectomy After Arriving via a Mobile Stroke Unit.

Background: Mobile stroke units (MSUs) have been implemented worldwide for stroke care, but outcome data are lacking to show their efficacy specifically in patients undergoing mechanical thrombectomy (MT). Here, we include patients from our stroke network MSU and compare them to patients who arrived conventionally.

Methods: A retrospective review of a stroke database was performed to identify patients who underwent MT after arrival via an MSU from August 2019 to December 2020.

Frameless Angiography-Based Gamma Knife Stereotactic Radiosurgery for Cerebral Arteriovenous Malformations: A Proof-of-Concept Study.

Background: Traditional Gamma Knife radiosurgery (GKRS) of brain arteriovenous malformations (AVMs) using digital subtraction angiography (DSA) requires head immobilization using a stereotactic frame.

Objective: We describe our protocol of frameless GKRS using DSA while maintaining high spatial resolution for precision.

Methods: This study is a retrospective review of patients with unruptured AVMs who underwent frameless GKRS.

Chronic relapsing neutrophilic meningitis as the sole manifestation of nocardiosis in a patient with mixed connective tissue disease.

We describe a rare case of a patient with mixed connective tissue disease maintained on chronic oral corticosteroids, who was hospitalized on five occasions over five consecutive months due to persistent relapsing neutrophilic meningitis caused by . Immunosuppression due to the chronic use of corticosteroids was identified as the underlying mechanism of susceptibility. Our report highlights the challenges associated with systemic Nocardiosis, particularly in the immunocompromised host.

Comparison of Anesthetic Agents Dexmedetomidine and Midazolam During Mechanical Thrombectomy.

Objectives: The ideal anesthetic for mechanical thrombectomy (MT) is a subject of debate. Recent studies have supported the use of monitored anesthesia care (MAC), but few have attempted to compare MAC neuroanesthetics. Our study directly compares midazolam and dexmedetomidine (DEX) on blood pressure control during thrombectomy and functional outcomes at discharge.

Glioblastoma with deep supratentorial extension is associated with a worse overall survival.

Glioblastoma (GBM) with deep-supratentorial extension (DSE) involving the thalamus, basal ganglia and corpus collosum, poses significant challenges for clinical management. In this study, we present our outcomes in patients who underwent resection of supratentorial GBM with associated involvement of deep brain structures. We conducted a retrospective review of patients who underwent resection of GBM at our institution between 2012 and 2018.

Decompressive Hemicraniectomy in the Modern Era of Mechanical Thrombectomy.

Objectives: We aim to determine the incidence of decompressive hemicraniectomy (DHC) in the modern era of mechanical thrombectomy techniques and improved revascularization outcomes.

Methods: We performed a retrospective analysis of 512 patients admitted with acute ischemic strokes with anterior circulation large-vessel occlusion that were treated by mechanical thrombectomy from 2010-2019. The primary endpoint was the need for surgical decompression.

Predictors of aneurysm occlusion following treatment with the WEB device: systematic review and case series.

The Woven EndoBridge (WEB) device is becoming increasingly popular for treatment of wide-neck aneurysms. As experience with this device grows, it is important to identify factors associated with occlusion following WEB treatment to guide decision making and screen patients at high risk for recurrence. The aim of this study was to identify factors associated with adequate aneurysm occlusion following WEB device treatment in the neurosurgical literature and in our case series.

Machine Learning Using Multiparametric Magnetic Resonance Imaging Radiomic Feature Analysis to Predict Ki-67 in World Health Organization Grade I Meningiomas.

Background: Although World Health Organization (WHO) grade I meningiomas are considered "benign" tumors, an elevated Ki-67 is one crucial factor that has been shown to influence tumor behavior and clinical outcomes. The ability to preoperatively discern Ki-67 would confer the ability to guide surgical strategy.

Objective: In this study, we develop a machine learning (ML) algorithm using radiomic feature analysis to predict Ki-67 in WHO grade I meningiomas.

Discrepancies in Stroke Distribution and Dataset Origin in Machine Learning for Stroke.

Background: Machine learning algorithms depend on accurate and representative datasets for training in order to become valuable clinical tools that are widely generalizable to a varied population. We aim to conduct a review of machine learning uses in stroke literature to assess the geographic distribution of datasets and patient cohorts used to train these models and compare them to stroke distribution to evaluate for disparities.

Aims: 582 studies were identified on initial searching of the PubMed database.

Capturing Initial Understanding and Impressions of Surgical Therapy for Parkinson's Disease.

Deep Brain Stimulation (DBS) is an underutilized surgical therapy for Parkinson's Disease (PD). Both physician and patient hesitancies have been described as potential barriers to DBS, but the specifics of patient perceptions of DBS have not been well-characterized in the general PD population. To characterize the understanding and impressions of surgical therapy in PD patients prior to formal surgical evaluation.

A comparison of dual-lumen balloon and simple microcatheters in the embolization of DAVFs and AVMs using onyx.

Endovascular embolization of arteriovenous malformations (AVMs) and dural arteriovenous fistulas (DAVFs) has become the mainstay in treatment for these pathologies. Traditional techniques required the formation of a proximal plug of Onyx around the microcatheter prior to embolization to avoid reflux. Recently, dual-lumen balloon catheters have been introduced as a potential solution to this issue.

Ultrasound-Guided Ventricular Puncture During Cranioplasty.

Background: In patients with brain parenchyma extending beyond the craniectomy defect, cerebrospinal fluid diversion may be necessary to facilitate proper bone flap replacement during cranioplasty. In this study, we present our case series of patients who underwent ultrasound-guided ventricular puncture during cranioplasty and report periprocedural metrics and clinical outcomes.

Methods: A retrospective study of patients who presented for cranioplasty that required ultrasound-guided ventricular puncture was performed.

Onyx Embolization of Carotid-Cavernous Fistulas and Its Impact on Intraocular Pressure and Recurrence: A Case Series.

Background: Carotid-cavernous fistulas (CCFs) are acquired pathological shunting lesions between the carotid artery and the cavernous sinus leading to elevated intraocular pressure (IOP). CCFs are commonly treated via endovascular embolization, which theoretically restores physiological pressure differentials.

Objective: To present our institutional data with CCF treated with embolization and discuss endovascular routes, recurrence rates, and dynamic IOP changes.

Developing standardized titles to classify the adverse events in 7,418 cranial and spinal neurosurgical procedures.

Background: Neurosurgical procedures are life- and function-saving but carry a risk of adverse events (AE) which can cause permanent neurologic deficits. Unfortunately, there is lack of clearly defined AEs associated with given procedures, and their reporting is non-uniform and often arbitrary. However, with an increasing number of neurosurgical procedures performed, there is a need for standardization of AEs for systematic tracking.

Ophthalmic artery catheterization for retinoblastoma treatment: does reflux affect tumor response?

Background: Intra-arterial chemotherapy (IAC) for retinoblastoma (Rb) has been established as a primary treatment for the disease. To determine whether the presence of reflux into the ICA is associated with tumor response or with any other adverse events in pediatric retinoblastoma patients.

Methods: A retrospective chart review was performed for patients diagnosed with Rb and managed with ophthalmic artery catheterization (OAC).

Predictors of Complications, Functional Outcome, and Morbidity in a Large Cohort Treated With Flow Diversion.

Background: A dramatic improvement in obliteration rates of large, wide-necked aneurysms has been observed after the FDA approved the Pipeline Embolization Device (PED) in 2011.

Objective: To assess the predictors of complications, morbidity, and unfavorable outcomes in a large cohort of patients with aneurysms treated with PED.

Methods: A retrospective chart review of a prospectively maintained database for subjects treated with flow diversion from 2010 to 2019.

Safety and Efficacy of Bilateral Flow Diversion for Treatment of Anterior Circulation Cerebral Aneurysms.

Background: Nearly 20% of individuals with an aneurysm will have multiple aneurysms-these individuals are at increased risk of subarachnoid hemorrhage. Treatment of bilateral aneurysms with flow diverters (FDs), or Pipeline embolization device, has not yet been established as an effective therapy. We evaluated the safety and efficacy of a 2-stage treatment of bilateral aneurysms with Pipeline embolization devices placed 6 months apart.

Analysis of the utility of early MRI/MRA in 400 patients with spontaneous intracerebral hemorrhage.

Objective: MRI and MRA studies are routinely obtained to identify the etiology of intracerebral hemorrhage (ICH). The diagnostic yield of MRI/MRA in the setting of an acute ICH, however, remains unclear. The authors' goal was to determine the utility of early MRI/MRA in detecting underlying structural lesions in ICH and to identify patients in whom additional imaging during hospitalization could safely be foregone.

Flow diversion for small caliber vessel aneurysms: efficacy, safety, and functional outcome.

Background: Flow-diverting stents had gained prominence among neurointerventionalists. Aneurysms originating from distal vessels, particularly dissecting or fusiform, pose more technical challenges. The aim of the following single center large series was to report the safety, efficacy, and functional outcome of flow diversion for aneurysms originating from small caliber vessel and compare to proximal vessels group.