Massive Hyperostotic Meningioma En Plaque Mimicking Fibrous Dysplasia.

The authors report an extremely rare case of a massive hyperostotic meningioma en plaque, which had characteristics of unique bony growth. A 34-year-old man presented with a palpable solid mass in the left cranial region that had gradually grown in size with a broad base on the calvarium for 8 years. Radiologically, the area involved by the mass ranged from the sphenoid bone to the frontal, parietal, temporal, and occipital bones.

Morphologic differences between ruptured and unruptured choroidal anastomosis in adult moyamoya disease: a high-resolution vessel wall imaging study.

Objective: Choroidal anastomosis (ChA) has been implicated as the main indicator of an increased hemorrhagic risk in adult moyamoya disease. In this retrospective study, the authors aimed to identify the potential risk factors that can influence the rupture of ChA.

Methods: The authors evaluated the clinical and radiological data on brain hemispheres positive for ChA from September 2019 to March 2023.

High resolution vessel-wall imaging for peripheral aneurysms in adult moyamoya disease: a report of three cases.

Peripheral aneurysms in patients with moyamoya disease have been reported to be hazardous owing to their rupture-prone nature. High-resolution vessel wall imaging has recently emerged as a useful modality for evaluating intracranial aneurysmal status. We present the vessel-wall imaging of peripheral aneurysms in three patients with moyamoya disease.

Surgical Thrombectomy for Extensive Cerebral Venous Sinus Thrombosis after COVID-19 Vaccination : A Novel Surgical Technique and Literature Review.

Surgical treatment of refractory and extensive cerebral venous sinus thrombosis (CVST) has limited applications. Here, we describe an open, direct sinus thrombectomy in the early phase of extensive CVST. A 49-year-old man with extensive CVST that occurred after the coronavirus disease 2019 (COVID-19) vaccination and affected the drainage of the Labbé vein presented with clinical deterioration and left temporal hemorrhagic infarction.

Clinical significance of "periventricular collateral enhancement sign" in symptomatic moyamoya disease: A vessel wall imaging study.

Background: Periventricular collaterals are associated with high risk of hemorrhagic stroke in adult moyamoya disease (MMD). However, the clinical significance of the periventricular collateral enhancement sign (PCES), which indicates wall enhancement of periventricular collaterals on contrast-enhanced vessel wall imaging (VWI), has yet to be determined.

Methods: Thirty-seven patients with MMD with acute neurological symptoms were consecutively recruited.

Diagnostic Performance of High-Resolution Vessel Wall Magnetic Resonance Imaging and Digital Subtraction Angiography in Intracranial Vertebral Artery Dissection.

Purpose: Intracranial vertebral artery dissection (VAD) is being increasingly recognized as a leading cause of Wallenberg syndrome and subarachnoid hemorrhage. Conventional angiography is considered the standard diagnostic modality, but the diagnosis of VAD remains challenging. This study aimed to compare the diagnostic performance of high-resolution vessel wall imaging (HR-VWI) with digital subtraction angiography (DSA) for intracranial VAD.

Geometric Classification of Paraclinoid Aneurysms for Microcatheter Superselection in Coil Embolization.

Aim: To suggest a geometric classification of paraclinoid aneurysms for microcatheter superselection.

Material And Methods: Clinical data from 76 patients (80 paraclinoid aneurysms) who underwent endovascular treatments were retrospectively reviewed. Paraclinoid aneurysms were classified according to the six directions where the aneurysm neck lies and simplified into three groups as follows: superior, medial, and lateral groups.

Incidental Microaneurysms During Microvascular Surgery: Incidence, Treatment, and Significance.

Background: Although new imaging tools have been developed for the detection of smaller aneurysms, angiographically negative microaneurysms are still encountered during cerebral microsurgery. Currently, only limited information regarding incidence and efficacy of treatment of these microaneurysms is available.

Methods: We investigated the incidence and treatment of incidental microaneurysms (IMAs) in the last 5 years.

Life-Threatening Hemothorax Caused by Spontaneous Extracranial Vertebral Aneurysm Rupture in Neurofibromatosis Type 1.

Background: Although vascular abnormality is an uncommon comorbidity of neurofibromatosis type 1 (NF1), it is potentially fatal. We present spontaneous hemothorax caused by rupture of a vertebral artery (VA) aneurysm in a patient with NF1.

Case Description: A 36-year-old man with a history of NF1 was transferred to the emergency department with dyspnea.

Intracranial Arterial Tortuosity According to the Characteristics of Intracranial Aneurysms.

Objective: Intracranial aneurysm (IA) is the leading cause of subarachnoid hemorrhage. The pathomechanisms of IA are poorly understood but can be related to arterial tortuosity resulting from underlying systemic factors leading to arterial wall weakening. We aimed to analyze the tortuosity of the intracranial artery in a cohort with IA, hypothesizing that the tortuosity of intracranial arteries differs depending on the characteristics of the IA.

Gamma knife radiosurgery for trigeminal schwannoma: a 20-year experience with long-term treatment outcome.

Purpose: This study evaluated the long-term tumor control rate (TCR) and symptomatic outcomes of patients treated with gamma knife radiosurgery (GKRS) for trigeminal schwannomas (TSs).

Methods: Thirty-two patients with TS who underwent GKRS between January 1994 and January 2013 with at least 2 years of follow-up were enrolled in the study. Clinical charts and surgical records were retrospectively reviewed to evaluate factors affecting TCR and symptomatic outcomes.

A label-free cellulose SERS biosensor chip with improvement of nanoparticle-enhanced LSPR effects for early diagnosis of subarachnoid hemorrhage-induced complications.

It is very difficult to predict some complications after subarachnoid hemorrhage (SAH), despite rapid advances in medical science. Herein, we introduce a label-free cellulose surface-enhanced Raman spectroscopy (SERS) biosensor chip with pH-functionalized, gold nanoparticle (AuNP)-enhanced localized surface plasmon resonance (LSPR) effects for identification of SAH-induced cerebral vasospasm and hydrocephalus caused by cerebrospinal fluid (CSF). The SERS biosensor chip was implemented by the synthesis reaction of the AuNPs, which were charged positively through pH level adjustment, onto a negatively-charged cellulose substrate with ξ = -30.

Surgical Revascularization for the Treatment of Complex Anterior Cerebral Artery Aneurysms: Experience and Illustrative Review.

Background: Many methods for treating complex anterior cerebral artery (ACA) aneurysms are available; however, there is substantial variation among methods because of various aneurysm locations, the relationship of the aneurysm to arterial branches, aneurysm size and other morphologic characteristics, and the diameters of the parent or branching arteries.

Methods: We reviewed complex ACA aneurysms based on both our own experience and the available literature. Each unique case is analyzed in terms of the characteristics of the aneurysm, along with analysis and classification of the revascularization method used.

In Situ Side-to-Side Anastomosis: Surgical Technique and Complication Avoidance.

In situ side-to-side (STS) anastomosis is a unique technique used for intracranial artery-intracranial artery revascularization. Over a 7-year period, 7 STS anastomoses were performed for anterior cerebral artery aneurysms in 6 patients and a posteroinferior cerebellar artery aneurysm in 1 patient. We provide a step-by-step guide for suturing techniques from arteriotomy to vessel wall sutures based on clinical experiences, with detailed illustrations.

Affordable self-regulating irrigation device for microsurgery using readily available malleable wire and a Silastic tube: a technical note.

Background: A relevant irrigating and flushing maneuver during cerebral microsurgical procedures allows for a neat and optimal operative field. However, when operating on the deep region of the brain, a delicately created slim surgical corridor could unintentionally hinder the assisting surgeon from properly performing this routine maneuver.

Method: To address this problem, the authors devised a useful and convenient irrigation system that can be used during cerebral microsurgery.

Clinical outcomes and radiosurgical considerations for pediatric arteriovenous malformation: influence of clinical features on obliteration rate.

Purpose: Gamma knife radiosurgery (GKRS) is an established treatment modality for brain arteriovenous malformation (AVM), but there have been few published studies examining the relationship between clinical features of AVM and successful obliteration with GKRS in pediatric patients. In the current study, we investigate the outcomes of GKRS for pediatric patients with brain AVM and analyze the variables that influence obliteration.

Methods: We analyzed 68 pediatric patients (≤ 18 years) with a mean follow-up period of 61.

A Portable Training Model for Deep Bypass Surgery.

Introduction: Deep bypass surgery remains a challenging operative procedure. For novice trainees, there is a high barrier to improving the microsurgical skills needed for this procedure because of the relatively low number of cases and the high cost of microsurgical instruments. Here, the authors introduce a training model that includes highly accessible devices and does not require a microscope.

Rescue bypass for the treatment of pseudoaneurysm on the distal anterior cerebral artery: a case report of vertical side-to-side anastomosis of the distal callosomarginal artery-pericallosal artery.

Pseudoaneurysm on the distal anterior cerebral artery (ACA) is rare but potentially fatal. It usually cannot be treated with typical treatment modalities. A 47-year-old female patient was diagnosed with a ruptured aneurysm on the pericallosal artery (PerA).

Puncture of Cerebellar Horizontal Fissure for Retrosigmoid Approach: A Prospective and Quantitative Analysis.

Background: Cerebrospinal fluid (CSF) drainage is important in retrosigmoid approached surgery; however, in some cases, it is not feasible due to cerebellar swelling.

Objective: To introduce a method, puncture of the horizontal fissure of the cerebellum, which can reduce the cerebellum to easily obtain a good operative corridor and slowly drain CSF.

Methods: Between January and December 2014, we estimated the precise location of the horizontal fissure in 56 patients who underwent surgery via a retrosigmoid approach.

An Affordable Microsurgical Training System for a Beginning Neurosurgeon: How to Realize the Self-Training Laboratory.

Objective: To provide detailed information about how to realize a self-training laboratory with cost-effective microsurgical instruments, especially pertinent for the novice trainee.

Methods: Our training model is designed to allow the practice of the microsurgery skills in an efficient and cost-effective manner. A used stereoscopic microscope is prepared for microsurgical training.

Tailored Double-Barrel Bypass Surgery Using an Occipital Artery Graft for Unstable Intracranial Vascular Occlusive Disease.

Purpose: This report describes the need for a tailored approach for intracranial vascular occlusive disease and introduces the usefulness of the OA as a donor artery for interposition graft.

Materials And Methods: A 65-year-old male patient suffered from repeated transient ischemic attack (TIA). Imaging studies revealed complete occlusion of the proximal left side of the internal carotid artery (ICA) and multiple infarction in the watershed zone.

Spontaneous Aggressive Conversion of Venous Drainage Pattern in Dural Arteriovenous Fistula Treated with Onyx Embolization.

We report a case of dural arteriovenous fistula (DAVF) that showed spontaneous conversion of venous drainage pattern from Borden type II to type III within a four month period of follow-up. Upon admission, the patient presented with aggravated neurologic status and newly developed seizure. After admission, endovascular embolization was performed through the middle meningeal artery with Onyx®.

A Technically Simple and Safe Method for Preparing an Anterior Pericranial Flap Using Saline Injection into the Subgaleal Space: A Technical Note.

Background: Cranial defects following anterior cranial base surgery have been frequently reconstructed using the pericranial flap.

Methods: We present a simple technique for preparing the flap using injection of saline into the subgaleal space.

Results: We inserted a 20-gauge needle perpendicular to 8-10 spots in the frontal area and injected 5-7 mL of saline at each spot 10 minutes before skin incision.

Triple Stent Therapy for the Treatment of Vertebral Dissecting Aneurysms: Efficacy and Safety.

Background: There are several treatment modalities for vertebral dissecting aneurysms. The purpose of this study was to evaluate the efficacy and safety of triple stent therapy for intracranial vertebral dissecting aneurysm (VDA).

Methods: Eight patients with 9 VDAs underwent multiple stent insertion therapy.

Treatment Strategy for Isolated Posterior Inferior Cerebellar Artery Dissection.

Objective: Isolated dissections that develop on the posterior inferior cerebellar artery (PICA) require intensive treatment because of their potential fatality. However, because of the rarity of these dissections, the optimal treatment has not yet been established.

Methods: We retrospectively reviewed the clinical records of all patients who underwent any PICA dissection treatment in our institute over the last 4 years.