Endovascular Thrombectomy for Radial Artery Occlusion in Neuro-Interventional Procedures: A Report of Two Cases.

Transradial access has garnered increasing popularity and acceptance among the neuro-interventional community. As this technique becomes commonplace for both diagnostic and interventional procedures, an understanding of potential complications and management is tantamount. Here, we describe two cases of thrombosed radial arteries successfully recanalized with traditional thrombectomy techniques.

Postoperative Cerebrospinal Fluid-Related Complications After Posterior Fossa and Posterolateral Skull Base Surgeries: Development of a Predictive Model and Clinical Risk Score.

Background: Postoperative pseudomeningocele (PMC) and cerebrospinal fluid (CSF) leak are common complications following posterior fossa and posterolateral skull base surgeries. We sought to 1) determine the rate of CSF-related complications and 2) develop a perioperative model and risk score to identify the highest risk patients for these events.

Methods: We performed a retrospective cohort of 450 patients undergoing posterior fossa and posterolateral skull base procedures from 2016 to 2020.

Incidence and management of postoperative pseudomeningocele and cerebrospinal fluid leak after Chiari malformation type I decompression.

Objective: The optimal surgical management of Chiari malformation type I (CM-I) remains controversial and heterogeneous. The authors sought to investigate patient-specific, technical, and perioperative features that may affect the incidence of CSF-related complications including pseudomeningocele and CSF leak at their institution.

Methods: The authors performed a single-center, retrospective review of all adult patients with CM-I who underwent posterior fossa decompression.

A Case Report on the Progressive Hunterian Ligation of an Intracranial Aneurysm by Flow Diversion: The Endovascular Selverstone Clamp.

Proximal Hunterian ligation remains a treatment option for select complex brain aneurysms. Progressive occlusion over time (as accomplished with Selverstone clamping) can enable collateral flow to develop while the aneurysm regresses or occludes. A 50-year-old woman presented with an unruptured 16-mm posterior inferior cerebellar artery (PICA) aneurysm.

Medical Management Versus Surgical Bypass for Symptomatic Intracranial Atherosclerotic Disease: A Systematic Review.

Introduction: Intracranial atherosclerotic disease (ICAD) is a major cause of stroke worldwide. The optimal management of patients with symptomatic ICAD is controversial. Therefore, the aim of this systematic review is to compare medical management versus surgical bypass for the treatment of symptomatic ICAD.

Whole blood aggregometry prior to Pipeline embolization device treatment of intracranial aneurysms: defining an optimal platelet inhibition cutoff value for clopidogrel.

Objective: Dual antiplatelet therapy is required for the treatment of intracranial aneurysms with the Pipeline embolization device (PED). Platelet function testing (PFT) is often used to assess the efficacy of the antiplatelet regimen prior to PED placement. The optimal impedance values for whole blood aggregometry in this setting have not been defined.

Koos Classification of Vestibular Schwannomas: A Reliability Study.

Background: The Koos classification of vestibular schwannomas is designed to stratify tumors based on extrameatal extension and compression of the brainstem. While this classification system is widely reported in the literature, to date no study has assessed its reliability.

Objective: To assess the intra- and inter-rater reliability of the Koos classification system.

Proposal of a follow-up imaging strategy following Pipeline flow diversion treatment of intracranial aneurysms.

Objective: There is currently no standardized follow-up imaging strategy for intracranial aneurysms treated with the Pipeline embolization device (PED). Here, the authors use follow-up imaging data for aneurysms treated with the PED to propose a standardizable follow-up imaging strategy.

Methods: A retrospective review of all patients who underwent treatment for ruptured or unruptured intracranial aneurysms with the PED between March 2013 and March 2017 at 2 major academic institutions in the US was performed.

Angiographic Findings in the Tolosa-Hunt Syndrome and Resolution after Corticosteroid Treatment.

The Tolosa-Hunt syndrome is a rare clinical condition characterized by painful opthalmoparesis associated with idiopathic granulomatous inflammation of the orbital apex and cavernous sinus. Historically, this condition was thought to result from arteritic changes in the internal carotid artery and cavernous sinus. Modern digital angiographic techniques were unavailable when THS was initially described, and few reports exist on its high-resolution angiographic findings.

Antiplatelet Medication Reversal Strategies in Operative Intracranial Hemorrhage: A Survey of Practicing Neurosurgeons.

Background: Antiplatelet therapy is common and complicates operative management of acute intracranial hemorrhage. Few data exist to guide antiplatelet reversal strategies.

Methods: An online survey detailing antiplatelet reversal strategies in patients presenting with acute operative intracranial hemorrhage (subdural hematoma, epidural hematoma, and intracerebral hemorrhage) was distributed to board-certified neurosurgeons in North America.

Combined Outcomes of Endovascular or Surgical Treatment of Unruptured Anterior Communicating Artery Aneurysms: Is a More Aggressive Management Strategy Warranted?

Background: Updated natural history studies that suggest anterior communicating artery aneurysms have a higher risk of rupture than formerly appreciated. As endovascular and open techniques advance, morbidity may fall to levels that suggest the feasibility of intervention even for small aneurysms. This study was conducted to assess the risk associated with treating smaller, unruptured anterior communicating artery aneurysms.

Use of an Absorbable Synthetic Polymer Dural Substitute for Repair of Dural Defects: A Technical Note.

Repair of the dura after cranial neurosurgery can present a technical challenge and, for certain neurosurgical procedures, is critical to prevent cerebrospinal fluid leak and associated wound complications. Multiple options exist for dural repair, including the patient's own tissues, bovine collagen-derived commercially available grafts, as well as newer, entirely synthetic graft materials. This is the first report of surgical experience with a new synthetic and absorbable dura substitute which has recently gained Food and Drug Administration (FDA) approval.

Relationship between external ventricular drain clamp trials and ventriculoperitoneal shunt insertion following nontraumatic subarachnoid hemorrhage: a single-center study.

Objective: Currently, there is no established standard regarding the ideal number of external ventricular drain (EVD) clamp trials performed before ventriculoperitoneal (VP) shunt insertion following nontraumatic subarachnoid hemorrhage (SAH). In this study, the authors aimed to evaluate this relationship.

Methods: A retrospective review of all patients presenting with SAH between July 2007 and December 2016 was performed.

Defining a Clopidogrel Response Cut-Off Value Using Light Transmission Aggregometry Before Pipeline Embolization of Unruptured Intracranial Aneurysms.

Background: The choice of appropriate antiplatelet therapy before the Pipeline Embolization Device (PED) placement is usually guided by platelet function testing such as light transmission aggregometry (LTA). In this study, we aimed to define the optimal threshold LTA value for clopidogrel responsiveness to predict the risk of postprocedural thromboembolic complications and to help guide appropriate antiplatelet regimen.

Methods: A prospectively maintained database at an academic neurosurgical center in the United States was retrospectively analyzed from 2014 to 2017 to identify patients with unruptured intracranial aneurysms treated with the PED.

Sequential Coiling-Assisted Deployment of Flow Diverter for Treatment of Fusiform Middle Cerebral Artery Aneurysms.

Background And Importance: Fusiform intracranial aneurysms remain challenging lesions to treat. These aneurysms have historically required bypass procedures or clip remodeling constructs for cure. Recently, endovascular specialists have reported experience with flow diversion for complex fusiform aneurysms of the vertebrobasilar system, with mixed results.

Transarterial Onyx Embolization of Bilateral Transverse-Sigmoid Dural Arteriovenous Malformation with Transvenous Balloon Assist-Initial U.S. Experience with Copernic RC Venous Remodeling Balloon.

Background: Currently, the mainstay treatment of dural arteriovenous fistula (DAVF) involves endovascular approaches, especially for high-grade lesions. Transarterial embolization with preservation of venous sinuses has become the preferred approach due to the development of newer liquid embolic agents. For further precision during embolization, the use of temporary balloon occlusion to protect the patency of dural sinuses from the embolic agent's migration has been described.

Ruptured Distal Anterior Choroidal Artery Aneurysm Treated with Superselective Provocative Testing and Coil Embolization.

Background And Importance: Aneurysms of the anterior choroidal artery are uncommon, and distal anterior choroidal artery aneurysms are even rarer, with only 34 cases reported in the medical literature. These lesions have been most commonly reported in association with moyamoya disease or arteriovenous malformations. Most published experience with these aneurysms involves open surgical approaches.

Recrudescence of Symptoms of Remote Ischemic Stroke After a Cerebral Angiogram.

Background: Ischemic stroke recrudescence, or reappearance of previously resolved symptoms of ischemic stroke, may occur after physiologic stress. Although generally thought to be uncommon, this syndrome may account for a significant proportion of stroke mimics.

Case Description: A 67-year-old man was admitted with a Hunt and Hess grade 2 spontaneous subarachnoid hemorrhage.

Reliability assessment of the Biffl Scale for blunt traumatic cerebrovascular injury as detected on computer tomography angiography.

OBJECTIVE Blunt traumatic cerebrovascular injury (TCVI) represents structural injury to a vessel due to high-energy trauma. The Biffl Scale is a widely accepted grading scheme for these injuries that was developed using digital subtraction angiography. In recent years, screening CT angiography (CTA) has been used to identify patients with TCVI.

External ventricular drain placement in the intensive care unit versus operating room: evaluation of complications and accuracy.

Objective: External ventricular drain (EVD) placement is a common neurosurgical procedure performed in both the intensive care unit (ICU) and operating room (OR). The optimal setting for EVD placement in regard to safety and accuracy of placement is poorly defined.

Methods: A retrospective chart review was performed on 150 consecutive patients who underwent EVD placement at a tertiary care center from January of 2013 to February of 2014.

Chemoprophylaxis for venous thromboembolism in traumatic brain injury: a review and evidence-based protocol.

Venous thromboembolism (VTE) is a recognized source of morbidity and mortality in patients suffering traumatic brain injury (TBI). While traumatic brain injury is a recognized risk factor for the development of VTE, its presence complicates the decision to begin anticoagulation due to fear of exacerbating the intracranial hemorrhagic injury. The role of chemoprophylaxis in this setting is poorly defined, leading to a wide variability in clinical practice.

Treatment resistance mechanisms of malignant glioma tumor stem cells.

Malignant gliomas are highly lethal because of their resistance to conventional treatments. Recent evidence suggests that a minor subpopulation of cells with stem cell properties reside within these tumors. These tumor stem cells are more resistant to radiation and chemotherapies than their counterpart differentiated tumor cells and may underlie the persistence and recurrence of tumors following treatment.

PACAP modulation of the colon-inferior mesenteric ganglion reflex in the guinea pig.

We investigated the effect of pituitary adenylate cyclase activating peptide (PACAP) on the colon-inferior mesenteric ganglion (IMG) reflex loop in vitro. PACAP27 and PACAP38 applied to the IMG caused a prolonged depolarization and intense generation of fast EPSPs and action potentials in IMG neurones. Activation of PACAP-preferring receptors (PAC1-Rs) with the selective agonist maxadilan or vasoactive intestinal peptide (VIP)/PACAP (VPAC) receptors with VIP produced similar effects whereas prior incubation of the IMG with selective PAC1-R antagonists PACAP6-38 and M65 inhibited the effects of PACAP.