Role of Intravenous Tissue Plasminogen Activator in Acute Ischemic Stroke with Large Vessel Occlusion.

Objective: The goal of the present study was to determine the safety and efficacy of intravenous tissue plasminogen activator (IVT) in patients with acute ischemic stroke (AIS) with large vessel occlusion (LVO) undergoing mechanical thrombectomy (MT).

Methods: We performed a retrospective analysis of prospectively collected data gathered during a 3-year period for all our patients with AIS and LVO. We analyzed the stroke outcomes and complications between patients who had received a combination of IVT and MT and those who had undergone MT only.

Presigmoid Transpetrosal Approach for Superficial Temporal Artery to Distal Posterior Cerebral Artery Bypass and Trapping of Aneurysm.

Background And Importance: Aneurysms of the posterior cerebral artery (PCA) are uncommon, estimated at less than 1% of all cerebral aneurysms, and less than half occur distal to the P1/2 junction. Unfortunately, the conventional bypass approach for PCA aneurysms-primarily occipital artery to distal PCA cortical branches-has a history of unsatisfying results.

Clinical Presentation: A 42-yr-old female presented with Fisher 3 Hunt-Hess 2 subarachnoid hemorrhage secondary to ruptured distal PCA aneurysm.

In Vitro Modeling of Human Brain Arteriovenous Malformation for Endovascular Simulation and Flow Analysis.

Background: Current in vitro models for human brain arteriovenous malformation (AVM) analyzing the efficacy of embolic materials or flow conditions are limited by a lack of realistic anatomic features of complex AVM nidus. The purpose of this study was to evaluate a newly developed in vitro AVM model for embolic material testing, preclinical training, and flow analysis.

Methods: Three-dimensional (3D) images of the AVM nidus were extracted from 3D rotational angiography from a patient.

Updates in the management of cranial dural arteriovenous fistula.

Dural arteriovenous fistula (dAVF) accounts for approximately 10% of all intracranial vascular malformations. While they can be benign lesions, the presence of retrograde venous drainage and cortical venous reflux makes the natural course of these lesions aggressive high risk of haemorrhage, neurological injury and mortality. Endovascular treatment is often the first line of treatment for dAVF.

Increased Rate of Successful First Passage Recanalization During Mechanical Thrombectomy for M2 Occlusion.

Background: Mechanical thrombectomy (MT) is the standard of care for the treatment of acute ischemic stroke (AIS) caused by anterior circulation large-vessel occlusion. However, the true safety and efficacy of MT in medium-size vessel occlusions such as the M2 segment of the middle cerebral artery have yet to be completely defined. In this study, we analyze the safety and efficacy of MT in M2 occlusions compared with M1 occlusions.

A systematic review of shunt-related extraneural metastases of primary central nervous system tumors.

Extraneural metastasis (ENM) of primary central nervous system (CNS) tumors is an uncommon occurrence. Case reports and case series describe ENM after shunting, but this phenomenon has not been well characterized. In this review we aim to better understand the risk factors and clinical implications of ENM associated with shunting.

Pineal germ cell tumors: Two cases with review of histopathologies and biomarkers.

Pineal germ cell tumors (GCTs) are primarily seen in pediatric and Asian populations. These tumors are divided into germinomatous and non-germinomatous GCTs (NGGCTs). GCTs are thought to arise by misplacement of totipotent stem cells en route to gonads during embryogenesis.

Rigorous anaesthesia management protocol for patients with intracranial arterial stenosis: a prospective controlled-cohort study.

Objectives: Reducing variability is integral in quality management. As part of the ongoing Encephaloduroarteriosynangiosis Revascularisation for Symptomatic Intracranial Arterial Stenosis (ERSIAS) trial, we developed a strict anaesthesia protocol to minimise fluctuations in patient parameters affecting cerebral perfusion. We hypothesise that this protocol reduces the intraoperative variability of targeted monitored parameters compared to standard management.

Matched Cohort Analysis of the Effects of Limb Remote Ischemic Conditioning in Patients with Aneurysmal Subarachnoid Hemorrhage.

Remote ischemic conditioning (RIC) is a powerful innate response to transient subcritical ischemia that protects against severe ischemic insults at distant sites. We have previously shown the safety and feasibility of limb RIC in aneurysmal subarachnoid hemorrhage (aSAH) patients, along with changes in neurovascular and cerebral metabolism. In this study, we aim to detect the potential effect of an established lower-limb conditioning protocol on clinical outcomes of aSAH patients.

Remote Ischemic Conditioning Alters Methylation and Expression of Cell Cycle Genes in Aneurysmal Subarachnoid Hemorrhage.

Background And Purpose: Remote ischemic conditioning (RIC) is a phenomenon in which short periods of nonfatal ischemia in 1 tissue confers protection to distant tissues. Here we performed a longitudinal human pilot study in patients with aneurysmal subarachnoid hemorrhage undergoing RIC by limb ischemia to compare changes in DNA methylation and transcriptome profiles before and after RIC.

Methods: Thirteen patients underwent 4 RIC sessions over 2 to 12 days after rupture of an intracranial aneurysm.

Long-Term Evaluation of Changes in Operative Technique and Hardware-Related Complications With Deep Brain Stimulation.

Background: Deep brain stimulation is the most frequent neurosurgical procedure for movement disorders.

Objective: While this elective procedure carries a low-risk profile, it is not free of complications. As a new procedure, the pattern of complications changed with experience and modification of surgical technique and equipment.

Management of extracranial carotid artery disease.

Stroke is the third leading cause of death in developed nations. Up to 88% of strokes are ischemic in nature. Extracranial carotid artery atherosclerotic disease is the third leading cause of ischemic stroke in the general population and the second most common nontraumatic cause among adults younger than 45 years.

The role of regulatory T-cells in glioma immunology.

Despite recent advances in treatment, the prognosis for glioblastoma multiforme (GBM) remains poor. The lack of response to treatment in GBM patients may be attributed to the immunosuppressed microenvironment that is characteristic of invasive glioma. Regulatory T-cells (Tregs) are immunosuppressive T-cells that normally prevent autoimmunity when the human immune response is evoked; however, there have been strong correlations between glioma-induced immunosuppression and Tregs.

Tight glycemic control reduces infection and improves neurological outcome in critically ill neurosurgical and neurological patients.

Background: Tight glycemic control (TGC) may improve outcomes in hyperglycemic neurosurgical patients. The adoption of TGC has been limited by a lack of adequate data on optimal insulin delivery protocols and serum glucose concentration and by concerns about the risks of hypoglycemia.

Objective: This study was designed as a meta-analysis of outcomes to compare intensive insulin therapy and TGC with conventional insulin therapy and conventional glucose control.

An evaluation of hardware and surgical complications with deep brain stimulation based on diagnosis and lead location.

Introduction: Deep brain stimulation is the most frequently performed neurosurgical procedure for movement disorders. This procedure is well tolerated, but not free of complications. Analysis of hardware complications based on patient diagnosis and lead location could prove valuable in recognizing potential pitfalls and patients at higher risk.

Contributing factors to surgical site infections.

Surgical site infections (SSIs) are the most common nosocomial infections. These complications lead to revision surgery, delayed wound healing, increased use of antibiotics, and increased length of hospital stay, all of which have a significant impact on patients and the cost of health care. Such intraoperative factors as proper skin preparation, adherence to sterile technique, surgical duration, and traffic in the operating room contribute more to SSIs than do patient-related risk factors such as diabetes mellitus, obesity, and preexisting colonization with methicillin-resistant Staphylococcus aureus.

Spinal cord injury induced by a cervical spinal cord stimulator.

Objective: The use of cervical spinal cord stimulators for the treatment of refractory neck and upper extremity pain is widely accepted and growing in use as a treatment modality. This case highlights a previously unreported potential complication of spinal cord stimulators.

Methods: Analysis of a patient with a cervical spinal cord stimulator presenting with a spinal cord injury.

Simultaneous use of neurostimulators in patients with a preexisting cardiovascular implantable electronic device.

Object: Neurostimulation is widely accepted for the treatment of refractory Parkinson's disease, essential tremor, and chronic pain. The presence of a cardiovascular implantable electronic device (CIED) might be considered a contraindication for neurostimulators due to the possible interaction between the two devices. The purpose of this study is to report the feasibility and safety of concomitant use of neurostimulators and CIED, and to review surgical and clinical precautions needed to avoid possible interference between the two systems.

Thalamic stimulation for epilepsy.

With the growing applications for deep brain stimulators (DBS) in recent years, interest in using DBS as an option for patients with epilepsy has increased. Thalamic DBS appears to be a viable minimally invasive treatment for patients experiencing medically intractable seizures. Thalamic DBS has been associated with significant reduction in seizure frequency and an improvement in overall quality of life, especially in patients who have failed maximal antiepileptic drugs or other surgical alternatives.

Intracarotid amobarbital procedure for epilepsy surgery.

The intracarotid amobarbital procedure (IAP) has been used for more than half a century to determine language dominance and to assess risk for amnesia after anterior temporal lobectomy. However, because of the risk associated with angiography and the development of noninvasive techniques, the need for the IAP when evaluating patients for epilepsy surgery can now be questioned. The purpose of this review is to examine the clinical indications and efficacy of the Wada test in the preoperative evaluation of epilepsy surgery candidates.