The significance of stent sizing for parent vessel stenosis after flow diversion of MCA bifurcation aneurysms.

Background: Wide-necked bifurcation aneurysms (WNBA) of the middle cerebral artery (MCA) present significant therapeutic challenges. Flow-diverter stents have been increasingly adopted for their management, though they may give rise to adverse outcomes such as in-stent stenosis (ISS). This study explores the association between stent oversizing and the incidence of ISS following flow-diverter stent placement in MCA bifurcation aneurysms.

Flow diversion with hydrophilic polymer coating with prasugrel as single antiplatelet therapy in the treatment of acutely ruptured intracranial aneurysms: a multicenter case series, complication and occlusion rates.

Background: This study reports a multicenter experience of using hydrophilic polymer-coated (HPC) flow diverters with prasugrel single antiplatelet therapy to treat ruptured aneurysms with subarachnoid hemorrhage (SAH).

Methods: Patients treated for intracranial aneurysms within 30 days after SAH with a p64/p48 MW HPC flow diverter were prospectively identified. Clinical presentation and outcomes, periprocedural and postprocedural complications, and degree of occlusion at follow-up were evaluated.

Mapping of Capsular Side Effects by using Intraoperative Motor-Evoked Potentials during Asleep Deep Brain Stimulation Surgery of the Subthalamic Nucleus for Parkinson's Disease.

Introduction: The aim of this study was to present a novel technique for subthalamic nucleus (STN) deep brain stimulation (DBS) implantation under general anesthesia by using intraoperative motor-evoked potentials (MEPs) through direct lead stimulation and determining their correlation to the thresholds of postoperative stimulation-induced side effects.

Methods: This study included 22 consecutive patients with advanced Parkinson's disease who underwent surgery in our institution between January 2021 and September 2023. All patients underwent bilateral implantation in the STN (44 leads) under general anesthesia without microelectrode recordings (MERs) by using MEPs with electrostimulation directly through the DBS lead.

Monopolar stereoelectroencephalography-guided radiofrequency thermocoagulation.

Objective: Stereoelectroencephalography (SEEG)-guided radiofrequency thermocoagulation (RFTC) has the advantage of producing a lesion in the epileptogenic zone (EZ) at the end of SEEG. The majority of published SEEG-guided RFTCs have been bipolar and usually performed between contiguous contacts of the same electrode. In the present study, the authors evaluate the safety, efficacy, and benefits of monopolar RFTC at the end of SEEG.

Comaneci stent-angioplasty for the optimization of inadequately deployed flow diverter stents.

Background And Purpose: In endovascular procedures, inadequate deployment of a flow diverter stent is a highly concerning technical complication that can lead to acute parent vessel occlusion and ischaemic events. This study aimed to assess the off-label use of the Comaneci device in managing technical difficulties associated with flow diversion.

Materials And Methods: We conducted an analysis of all flow diverter procedures documented in our prospectively collected database.

Management of Mirror Middle Cerebral Artery Aneurysms: Surgical Results and Morphological Parameters.

Aim: To investigate the safety and applicability of two main methods for treating mirror intracranial aneurysms, based on correlations in their geometric characteristics.

Material And Methods: We conducted a retrospective analysis on 125 patients who underwent 138 surgical interventions for MCA aneurysms and were treated with microsurgical clipping and endovascular embolization at the Department of Neurosurgery in the University Hospital "St. Iv.

Developmental venous anomaly causing obstructive hydrocephalus due to aqueductal stenosis: а case report.

Cerebral developmental venous anomalies are asymptomatic benign cerebrovascular malformations that are commonly found accidentally on brain magnetic resonance imaging. It is not uncommon for cerebrospinal fluid flow to be obstructed at the level of the aqueduct of Sylvius, causing an obstructive non-communicating hydrocephalus. Most notable reasons for such an obstruction at that level are tumors, congenital etiology, or post-inflammatory gliotic atresia.

Endovascular treatment of wide-necked intracranial aneurysms using the Nautilus Intrasaccular System: initial case series of 41 patients at a single center.

Background: Endovascular treatment of intracranial wide-necked and bifurcation aneurysms (WNBA) is technically challenging. The Nautilus Intrasaccular System is designed to provide a mechanical barrier at the aneurysm neck to support coil embolization. We report the results of a single-center series of patients treated for intracranial aneurysms with the Nautilus.

Progressive volume reduction and long-term aneurysmal collapse following flow diversion treatment of giant and symptomatic cerebral aneurysms.

Background: The primary goal of conventional endovascular and microvascular approaches is the clinical and radiological resolution of the symptomatic aneurysm-induced mass effect. This study assessed the volume changes and mass effect reduction due to sac shrinkage after treatment with flow diverter stents (FD) for unruptured cerebral aneurysms.

Methods: We analyzed retrospectively 36 symptomatic aneurysms that were larger or equal to 25 mm in diameter in patients treated at our center from January 2016 to April 2022.

Flow Diversion for the Management of Ruptured Intracranial Arterial Infudibular Dilatation: Proof of Principle and Therapeutic Protocol.

Thought to be benign anatomical variants, cerebral infundibular dilatations (ID) are most commonly encountered at the junction of the internal carotid artery (ICA) and the posterior communicating artery (PcomA). The true nature of this entity remains controversial, as some literature reports suggest they should be considered preaneurysmal lesions and a potential source of devastating subarachnoid hemorrhage. This report describes cases of presumably ruptured IDs and their therapeutic endovascular management.

Critical Angiographic and Sonographic Analysis of Intra Aneurysmal and Downstream Hemodynamic Changes After Flow Diversion.

Introduction: Successful treatment of intracranial aneurysms after flow diversion (FD) is dependent on the flow modulating effect of the device. We aimed to investigate the intra-aneurysmal and parent vessel hemodynamic changes, as well as the incidence of silent emboli following treatment with various FD devices.

Methods: We evaluated the appearance of the eclipse sign in nine distinct phases of cerebral angiography before and immediately after FD placement in correlation with aneurysm occlusion.

And don't forget your anti in-stent stenosis pill! Commentary on 'Factors associated with in-stent stenosis after cerebral aneurysm embolization using a Pipeline embolization device' by Flores-Milan et al.

In their INR study, Flores-Milan et al. present a retrospective single-centre study that aimed to investigate and determine some of the factors associated with in-stent stenosis (ISS) after intracranial aneurysm (IA) embolization using a commercially available flow diverter stent (FD). The retrospective analyses included ruptured and unruptured intracranial aneurysms treated with standalone flow diverter stent implantation or initial coil obliteration with the FD device placed subsequently two weeks after initial treatment.

Theoretical stereoelectroencephalography density on the brain convexity.

Introduction: Invasive electroencephalography (EEG) remains the "gold standard" for diagnosing the epileptogenic zone in patients with drug-resistant epilepsy and discrepancies between seizure semiology, video-EEG and magnetic resonance imaging (MRI) findings. However, the possibilities of stereoelectroencephalography (SEEG) to explore the brain surface remain a matter of debate and subdural EEG (SDEEG) is still preferred in some centers for cases when the supposed epileptogenic zone is on the brain convexity. The aim of our study was to evaluate the theoretical safe SEEG coverage on the brain convexity and to compare the theoretical SEEG cortical density with the usual SDEEG density.

Diversion-p64: results from an international, prospective, multicenter, single-arm post-market study to assess the safety and effectiveness of the p64 flow modulation device.

Background: The use of flow diversion to treat intracranial aneurysms has increased in recent years.

Objective: To assess the safety and angiographic efficacy of the p64 flow modulation device.

Methods: Diversion-p64 is an international, prospective, multicenter, single-arm, study conducted at 26 centers.

Nautilus-assisted coil embolization for a complex AcomA wide-necked aneurysm in the setting of acute subarachnoid hemorrhage.

Numerous devices and sophisticated strategies have been developed to further increase the number of aneurysms amenable to endovascular treatment.1-4 Despite the superfluity of available neurovascular armamentarium, wide-necked bifurcation aneurysms can still pose a significant technical challenge to the treating clinician.5-7 Neck bridging is a conceptually new approach, which provides increased occlusion rates with lower recurrence and complications rates.

Nautilus-Assisted Coiling of an Unruptured Wide-Necked Aneurysm of the Posterior Communicating Artery.

A variety of recently introduced devices have allowed more complex aneurysms to be rendered for endovascular embolization. Tiny and sophisticated implants are nowadays designed to provide further either temporary or permanent remodeling of the wide-necked aneurysms and improve coil occlusion rates. Such improvements in the technical armamentarium include the Woven EndoBridge (Sequent Medical, California, USA), the Medina Embolic Device (Medtronic, Irvine, California, USA), The Contour Neurovascular System (Cerus Endovascular, Fremont, California, USA), and pCONUS 2 HPC (Phenox, GmbH, Bohum, Germany).

Awake Epilepsy Surgery in Patients with Focal Cortical Dysplasia.

Background: Awake craniotomy (AC) and direct electric stimulation emerged together with epilepsy surgery >80 years ago. The goal of our study was to evaluate the benefits of awake surgery in patients with drug-resistant epilepsy caused by focal cortical dysplasia (FCD) affecting eloquent areas.

Methods: Our material included 95 patients with drug-resistant epilepsy and FCD, who were operated on between January 2009 and December 2018.

Acutely ruptured basilar artery bifurcation aneurysm, treated with simultaneous Cascade and Comaneci temporary-assisted coiling.

Temporary stent-assisted coiling is an eligible approach for the treatment of acutely ruptured complex cerebral aneurysms. Improved material properties and industrial advances in braiding technology have led to the introduction of new stent-like devices to augment endovascular coil embolization. Such technology includes the Cascade and Comaneci neck-bridging devices.

Endovascular treatment of patients with intracranial aneurysms: feasibility and successful employment of a new low profile visible intraluminal support (LVIS) EVO stent.

Background And Purpose: Low-profile self-expandable stents have increased the number of intracranial aneurysms treated by endovascular means. The new low-profile visible intraluminal support device LVIS EVO (Microvention), the successor of LVIS Jr, is a self-expandable and retrievable microstent system, designed for implantation into intracranial arteries with a diameter up to 2.0 mm.

Transvenous Embolization of a Ruptured Arteriovenous Malformation.

Transvenous embolization is a not so widely used technique for treatment of arteriovenous malformations. However, in the reported cases and series in the literature, it is proven to be a safe and efficient method that can lead to total occlusion of the formation in 1 procedure. The transvenous approach is reserved for small, deeply localized formations with a single draining vein.