Publications by authors named "Visish Srinivasan"

Objective: Dolichoectatic vertebrobasilar aneurysms (DVBAs) are expansions of arterial tissue leading to aneurysmal formations without an obvious neck. Their natural history is poorly understood; usually patients are admitted with thromboembolic complications and/or neurological symptoms from the mass effect. There have not been international collective data, and correct timing for highly risky treatments has been under discussion.

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Background: Middle meningeal artery embolization (MMAE) is a safe and effective treatment for chronic subdural hematoma (cSDH); however, the appropriate level of postoperative care is unknown.

Objective: To evaluate whether elective MMAE for cSDH could be safely performed in an outpatient setting.

Methods: This was a multicenter, retrospective study of patients with cSDH who underwent elective MMAE.

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Brain arteriovenous malformations (AVMs) are vascular lesions characterized by abnormal connections between parenchymal arteries and veins, bypassing a capillary bed, and forming a nidus. Brain AVMs are consequential as they are prone to rupture and associated with significant morbidity. They can broadly be subdivided into hereditary vs.

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Background: Spetzler-Martin (SM) Grade III brain arteriovenous malformations (BAVMs) represent a transitional risk zone between low- and high-grade BAVMs, characterized by diverse angioarchitecture. The primary treatment options are endovascular embolization, microsurgical resection (MS), and stereotactic radiosurgery (SRS). This study compares the efficacy and outcomes of MS and SRS.

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Article Synopsis
  • * A study analyzed 101 patients across four US centers, finding low complication rates (5.9% thromboembolic events and 0% procedure-related mortality), and satisfactory aneurysm occlusion at follow-ups (58% at 6 months and 74.8% at 6-12 months).
  • * The results suggest that FRED X stenting is a safe and effective option for treating unruptured intracranial aneurysms, although more long-term data is needed for comprehensive evaluation.*
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Background: Arteriovenous malformations (AVMs) are uncommon cerebral lesions that can cause significant neurological complications. Surgical resection is the gold standard for treatment, but endovascular embolization and stereotactic radiosurgery (SRS) are viable alternatives.

Objective: To compare the outcomes of endovascular embolization versus SRS in the treatment of AVMs with Spetzler-Martin grades I-III.

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  • * A multicenter analysis involved 269 patients, reporting a high success rate (100% effective distal penetration), a low complication rate (2.2%), and significant improvements in cSDH diameter and neurological function at 60-day follow-up.
  • * The findings suggest that using MMA embolization with the n-BCA D5W push technique is a safe and viable option alongside or instead of traditional surgery, showing a reduction in recurrence
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  • - Extended reality (XR), which includes augmented reality (AR), virtual reality (VR), and mixed reality (MR), has significant potential in endovascular neurosurgery, particularly for improving training and understanding of complex cerebrovascular imaging.
  • - A systematic review identified 19 studies, revealing that VR was the most utilized modality for educational purposes, primarily for simulation and anatomical modeling, while AR was used for live guidance and MR for modeling and teaching during operations.
  • - The use of VR and MR in anatomical education provides detailed, patient-specific 3-D models, enhancing the learning experience; however, there are challenges like inaccurate tracking of surgical tools that need to be addressed for effective implementation in training.
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  • Social media helps patients with rare diseases, like arteriovenous malformations (AVM), connect and share experiences, as shown in an analysis of posts from platforms like Twitter, Instagram, and TikTok.
  • The study found that common themes in posts included raising awareness (87%), recounting symptoms (50.2%), and sharing positivity (17.5%), with most engagement coming from female users.
  • Social media serves as a crucial platform for AVM patients to connect with others and discuss their experiences, increasing public awareness about the condition.
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Background And Objectives: Flow diversion (FD) of intracranial aneurysms (IAs) is an increasingly used and efficacious treatment modality. Transcirculation approaches, or approaches that cross the contralateral or anteroposterior arterial supply before reaching a target vessel, have been used to treat cerebrovascular pathologies when traditional approaches are unsuitable or require intraoperative complication management. This study sought to review IAs treated with FD using a transcirculation approach to determine the technique's safety and efficacy.

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  • Robotic neurointervention, specifically using the CorPath GRX platform, improves precision, reduces radiation risk, and enhances access to care, particularly in spinal angiography where data is limited.
  • A study of 11 patients from February 2022 to March 2023 showed that although 36.36% of procedures required a switch to manual techniques, there were no robot-related complications and few procedure-related issues.
  • The findings suggest that the CorPath GRX system is a safe and reliable option for spinal angiographic procedures, contributing to better accuracy and lower radiation exposure for healthcare providers.
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Objective: The cerebral and spinal venous systems have similar functions but unique anatomical and physiological properties. CSF occupies space in the cranial and spinal vaults, is continuously produced, and has many roles, including maintaining a favorable environment for CNS structures. The influence of the cerebrospinal venous system on CSF dynamics has been theorized since the 1940s.

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Background: With transradial access (TRA) being more progressively used in neuroendovascular procedures, we compared TRA with transfemoral access (TFA) in middle meningeal artery embolization (MMAE) for chronic subdural hematoma (cSDH).

Methods: Consecutive patients undergoing MMAE for cSDH at 14 North American centers (2018-23) were included. TRA and TFA groups were compared using propensity score matching (PSM) controlling for: age, sex, concurrent surgery, previous surgery, hematoma thickness and side, midline shift, and pretreatment antithrombotics.

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  • * The WEB has significantly more citations (mean 35.6) compared to other intrasaccular flow disruptors (mean 4.24), with most studies being retrospective reviews and a noticeable lack of contributions from African authors.
  • * The analysis highlights that leading countries in WEB research (like France) differ from those contributing to other flow disruptors (like Germany), indicating a skew in global research collaboration and production, primarily concentrated in Europe and North America.
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  • The study investigates the outcomes of two different radial catheters (Armadillo and RIST) used in neurointervention procedures, focusing on their effectiveness and safety.
  • Conducted as a retrospective multicenter study involving 206 patients, the findings show no significant differences in successful catheterization rates, complications, or conversion to femoral access between the two catheters.
  • Ultimately, both catheters demonstrated similar performance, indicating that either option could be a viable choice for transradial neuroendovascular interventions.
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  • The study investigates the transition from alteplase (TPA) to tenecteplase (TNK) in four Pennsylvania stroke systems for patients with large vessel occlusion (LVO) strokes who received intravenous thrombolysis before endovascular treatment (EVT) from January 2020 to June 2023.
  • Among 635 patients, nearly half were treated with TNK and the other half with TPA, showing similar functional outcomes at 90 days (47.6% for TNK vs. 49.7% for TPA).
  • Results indicated comparable rates for early recanalization, successful reperfusion, risk of symptomatic intracranial hemorrhage, and 90-day mortality between the TNK
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  • The text discusses a case of urgent carotid endarterectomy (CEA) and distal thrombectomy in a patient with multiple strokes and significant carotid artery occlusion.
  • The patient presented with symptoms like facial droop and aphasia, leading to imaging studies that revealed severe blockages in the left carotid artery and middle cerebral artery (MCA).
  • Despite initial attempts at thrombectomy being unsuccessful, the surgeons converted to open CEA, successfully achieved blood flow restoration to the MCA, and delivered reperfusion to improve the patient's condition.
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Objective: Posterior fossa arteriovenous malformations (AVMs) represent 7% to 15% of all intracranial AVMs and are associated with an increased risk of hemorrhage, morbidity, and mortality compared with supratentorial AVMs, thus prompting urgent and definitive treatment. Cerebellopontine angle (CPA) AVMs are a unique group of posterior fossa AVMs incorporating characteristics of brainstem and cerebellar lesions, which are particularly amenable to microsurgical resection. This study reports the clinical, radiological, operative, and outcome features of patients with CPA AVMs in a large cohort.

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Transcirculation catheterization, also known as the retrograde approach, involves the navigation of a catheter or other endovascular device from one arterial circulation to the other (right to left, or anterior to posterior).1-4 We present a case of a complex vertebrobasilar junction aneurysm previously treated by bilateral vertebral artery deconstruction, precluding antegrade access (video 1). Following the creation of a protective occipital artery to posterior inferior cerebellar artery (PICA) bypass, the patient was treated with transcirculation placement of a Pipeline embolization device (PED).

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  • The study investigates neurosurgeons' awareness of intraoperative radiation exposure and its health impacts, noting that high radiation can increase cancer risk.* -
  • Out of 3344 surveyed neurosurgeons, only 6.8% responded, revealing that many do not use dosimeters, but most wear protective gear; however, knowledge of radiation safety limits was low.* -
  • Findings indicate heightened concern about radiation exposure among neurosurgeons and highlight a significant correlation between increased radiation exposure and the risk of developing leukemia and thyroid nodular diseases.*
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