Neuroanatomy of the vertebrobasilar perforators: implications for aneurysm treatment.

The anatomy of vertebrobasilar perforators has been widely studied in human cadavers, with most reports found in the neurosurgical literature. These arterial perforators are extremely hard to visualize consistently with traditional two-dimensional digital subtraction angiography, but are reliably visible with cross sectional cone beam CT techniques. A clear understanding of this specific neurovascular anatomy and pathology is essential for informed treatment decisions.

Treatment of Acute Iatrogenic Cerebrovascular Injury Using Flow Diverter Stents.

Background And Objectives: Iatrogenic cerebrovascular injury can cause intracranial hemorrhage and pseudoaneurysm formation, putting patients at high risk for postoperative bleeding. No consensus for management exists. This study describes endovascular treatment of these acute injuries with flow diverter stents.

Pain Outcomes Following Endoscopic Microvascular Decompression for Trigeminal Neuralgia Based on Vascular Compression Type.

 Arterial compression of the trigeminal nerve at the root entry zone has been the long-attributed cause of compressive trigeminal neuralgia despite numerous studies reporting distal and/or venous compression. The impact of compression type on patient outcomes has not been fully elucidated.  We categorized vascular compression (VC) based on vessel and location of compression to correlate pain outcomes based on compression type.

Comprehensive Analysis of Post-Pipeline Endothelialization and Remodeling.

Background And Purpose: Successful post-flow-diverter endoluminal reconstruction is widely believed to require endothelial overgrowth of the aneurysmal inflow zone. However, endothelialization/neointimal overgrowth is a complex process, over which we currently have very limited influence. Less emphasized is vascular remodeling of the target arterial segment, the dynamic response of the vessel to flow-diverter implantation.

Superior hypophyseal arteries: angiographic re-discovery, comprehensive assessment, and embryologic implications.

Unlabelled: The superior hypophyseal arteries (SHAs) are well known in anatomical and surgical literature, with a well-established role in supply of the anterior hypophysis and superjacent optic apparatus. However, due to small size and overlap with other vessels, in vivo imaging by any modality has been essentially non-existent. Advances in high resolution cone beam CT angiography (CBCTA) now enables this deficiency to be addressed.

Multimodal Neuromonitoring and Neurocritical Care in Swine to Enhance Translational Relevance in Brain Trauma Research.

Neurocritical care significantly impacts outcomes after moderate-to-severe acquired brain injury, but it is rarely applied in preclinical studies. We created a comprehensive neurointensive care unit (neuroICU) for use in swine to account for the influence of neurocritical care, collect clinically relevant monitoring data, and create a paradigm that is capable of validating therapeutics/diagnostics in the unique neurocritical care space. Our multidisciplinary team of neuroscientists, neurointensivists, and veterinarians adapted/optimized the clinical neuroICU (e.

Postoperative Outcomes and Resource Utilization Following Open vs Endoscopic Far Lateral Lumbar Discectomy.

Background: Operative approaches for far lateral disc herniation (FLDH) repair may be classified as open or minimally invasive. The present study aims to compare postoperative outcomes and resource utilization between patients undergoing open and endoscopic (one such minimally invasive approach) FLDH surgeries.

Methods: A total of 144 consecutive adult patients undergoing FLDH repair at a single, university health system over an 8-year period (2013-2020) were retrospectively reviewed.

Gamma Knife radiosurgery for trigeminal neuralgia provides greater pain relief at higher dose rates.

In Gamma Knife (GK) radiosurgery, dose rate decreases during the life cycle of its radiation source, extending treatment times. Prolonged treatments influence the amount of sublethal radiation injury that is repaired during exposure, and is associated with decreased biologically-equivalent dose (BED). We assessed the impact of treatment times on clinical outcomes following GK of the trigeminal nerve - a rare clinical model to isolate the effects of treatment times.

Application of a TEG-Platelet Mapping Algorithm to Guide Reversal of Antiplatelet Agents in Adults with Mild-to-Moderate Traumatic Brain Injury: An Observational Pilot Study.

Background: Traumatic intracranial hemorrhages expand in one third of cases, and antiplatelet medications may exacerbate hematoma expansion. However, the reversal of an antiplatelet effect with platelet transfusion has been associated with harm. We sought to determine whether a thromboelastography platelet mapping (TEG-PM)-guided algorithm could limit platelet transfusion in patients with hemorrhagic traumatic brain injury (TBI) prescribed antiplatelet medications without a resultant clinically significant increase in hemorrhage volume, late hemostatic treatments, or delayed operative intervention.

Stereoelectroencephalography in the very young: Case report.

Stereoelectroencephalography (SEEG) is an increasingly popular invasive monitoring approach to epilepsy surgery in patients with drug-resistant epilepsies. The technique allows a three-dimensional definition of the epileptogenic zones (EZ) in the brain. It has been shown to be safe and effective in adults and older children but has been used sparingly in children less than two years old due to concerns about pin fixation in thin bone, registration accuracy, and bolt security.

The Pennsylvania Postmarket Multicenter Experience With Flow Redirection Endoluminal Device.

Background: The flow redirection endoluminal device (FRED) is a novel self-expanding double-layer nitinol braided flow diverter that recently received FDA approval. However, early postmarket studies from the United States are lacking.

Objective: To report our short-term multicenter experience.

Carotid artery revascularization using the Walrus balloon guide catheter: safety and feasibility from a US multicenter experience.

Introduction: The Walrus balloon guide catheter (BGC) is a new generation of BGC, designed to eliminate conventional limitations during mechanical thrombectomy.

Objective: To report a multi-institutional experience using this BGC for proximal flow control (PFC) in the setting of carotid artery angioplasty/stenting (CAS) in elective (eCAS) and tandem strokes (tCAS).

Methods: Prospectively maintained databases at 8 North American centers were queried to identify patients with cervical carotid disease undergoing eCAS/tCAS with a Walrus BGC.

Dose to neuroanatomical structures surrounding pituitary adenomas and the effect of stereotactic radiosurgery on neuroendocrine function: an international multicenter study.

Objective: Stereotactic radiosurgery (SRS) provides a safe and effective therapeutic modality for patients with pituitary adenomas. The mechanism of delayed endocrine deficits based on targeted radiation to the hypothalamic-pituitary axis remains unclear. Radiation to normal neuroendocrine structures likely plays a role in delayed hypopituitarism after SRS.

Endovascular Transcarotid Artery Revascularization Using the Walrus Balloon Guide Catheter: Preliminary Experience.

Background: The Walrus Balloon Guided System Catheter is a new generation of balloon guide catheter (BGC) designed to bypass some technical limitations of conventional BGC devices. Their utility in cervical carotid disease treatment has not been reported. We report our preliminary experience in cervical carotid treatment using the Walrus BGC to perform a modified endovascular transcarotid artery revascularization technique.

Endoscopic Microvascular Decompression for Hemifacial Spasm: A Technical Case Report Demonstrating the Benefits of the Angled Endoscope and Intraoperative Neuromonitoring.

A 57-year-old female with eight years of hemifacial spasm (HFS) underwent endoscopic microvascular decompression (MVD) of the facial nerve. Baseline stimulation of the zygomatic branch of the facial nerve activated at 1.2 mA.

Household income is associated with return to surgery following discectomy for far lateral disc herniation.

Background: Numerous studies have demonstrated that household income is independently predictive of postsurgical morbidity and mortality, but few studies have elucidated this relationship in a purely spine surgery population. This study aims to correlate household income with adverse events after discectomy for far lateral disc herniation (FLDH).

Methods: All adult patients (N.

Outcomes Following Discectomy for Far Lateral Disc Herniation Are Not Predicted by Obstructive Sleep Apnea.

Introduction Previous studies have demonstrated that obstructive sleep apnea (OSA) is associated with adverse postoperative outcomes, but few studies have examined OSA in a purely spine surgery population. This study investigates the association of the STOP-Bang questionnaire, a screening tool for undiagnosed OSA, with adverse events following discectomy for far lateral disc herniation (FLDH). Methods All adult patients (n = 144) who underwent FLDH surgery at a single, multihospital, academic medical center (2013-2020) were retrospectively enrolled.

Charlson Comorbidity Index score predicts adverse post-operative outcomes after far lateral lumbar discectomy.

Introduction: The Charlson Comorbidity Index (CCI) score has been shown to predict 10-year all-cause mortality and post-neurosurgical complications but has never been examined in a far lateral disc herniation (FLDH) population. This study aims to correlate CCI score with adverse outcomes following FLDH repair.

Patients And Methods: All patients (n = 144) undergoing discectomy for FLDH at a single, multihospital academic medical system (2013-2020) were retrospectively analyzed.

Cavernous Malformation Surgery in the United States: Validation of a Novel International Classification of Disease, 10th Edition, Clinical Modification Code Search Algorithm and Volume-Driven Surgical Outcomes.

Objective: The surgical decision-making process for cavernous malformation (CM) must weigh the risks of surgery against the burden of patient symptoms/hemorrhage and anticipated natural history. Here, we sought to internally validate an International Classification of Disease (ICD)-10 search algorithm for CM surgery to use to analyze a nationwide administrative database.

Methods: Institutional records were accessed to test the validity of a novel ICD-10 search algorithm for CM surgery.

Endoscopic Microvascular Decompression for Vagoglossopharyngeal Neuralgia.

Glossopharyngeal neuralgia (GN) is a nerve compression syndrome that presents with episodes of unilateral sharp, stabbing pain in the distribution of the ninth cranial nerve. This syndrome may present with cardiac and autonomic manifestations - a condition termed vagoglossopharyngeal neuralgia (VGPN). Most cases of VGPN arise from neurovascular insult at the cerebellopontine angle.

Thoracolumbar Transverse Process Fractures Are More Frequently Associated with Nonspinal Injury than Clinically Significant Spine Fracture.

Objective: We studied the risk of associated spinal and nonspinal injuries (NSIs) in the setting of observed thoracolumbar transverse process fracture (TPF) and examined the clinical management of TPF.

Methods: Patients treated at a Level I trauma center over a 5-year period were screened for thoracolumbar TPF. Prevalence of associated spinal fractures and NSIs as well as relationship to level of TPF was explored.

Surgical Management of Trauma-Related Intracranial Hemorrhage-a Review.

Purpose Of Review: The surgical management of trauma-related intracranial hemorrhage is characterized by marked heterogeneity. Large prospective randomized trials have generally been prohibited by the ubiquity of concordant pathology, diversity of trauma systems, and paucity of clinical equipoise among providers.

Recent Findings: To date, the results of retrospective studies and surgeon preference have driven the indications, modality, extent, and timing of surgical intervention in the global neurosurgical community.

Microsurgical Treatment of a Complex Cognard V Tentorial Dural Fistula with Superior Cerebellar Artery Supply.

This case video demonstrates a microsurgical technique for the clipping and obliteration of a Cognard V tentorial dural fistula (Video 1). The patient was a 49-year-old male who presented with progressive upper and lower extremity weakness over 12 months, with associated cervical spinal cord edema. The patient was initially misdiagnosed with transverse myelitis; however, abnormal flow voids on magnetic resonance imaging led to a cerebral angiogram being performed.