Long-term Stability and Reliability of Baseline Cognitive Assessments in High School Athletes Using ImPACT at 1-, 2-, and 3-year Test-Retest Intervals.

Objective: The ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing) neurocognitive testing battery is a widely used tool used for the assessment and management of sports-related concussion. Research on the stability of ImPACT in high school athletes at a 1- and 2-year intervals have been inconsistent, requiring further investigation. We documented 1-, 2-, and 3-year test-retest reliability of repeated ImPACT baseline assessments in a sample of high school athletes, using multiple statistical methods for examining stability.

An Intraoperative Look at Failure of Flow Diversion: When Additional or Alternative Treatments Should Be Considered.

Background: The pipeline embolization device (PED) is a flow-diverting stent that provides an additional treatment modality in the management of intracranial aneurysms. An aneurysm treated with a flow diverter is expected to involute over time, contrary to the immediate obliteration expected by surgical clipping or coiling. Yet, which aneurysms will respond to PED therapy and the time frame to expect full obliteration remain unclear.

Imaging characteristic analysis of metastatic spine lesions from breast, prostate, lung, and renal cell carcinomas for surgical planning: Osteolytic versus osteoblastic.

Background: Surgeons treating metastatic spine disease can use computed tomography (CT) imaging to determine whether lesions are osteolytic, osteoblastic, or mixed. This enables treatment that considers the structural integrity of the vertebral body (VB), which is impaired with lytic lesions but not blastic lesions. The authors analyzed CT imaging characteristics of spine metastasis from breast, lung, prostate, and renal cell carcinomas (RCCs) to determine the metastasis patterns of each of these common tumors.

Quantitative imaging analysis of posterior fossa ependymoma location in children.

Purpose: Imaging descriptions of posterior fossa ependymoma in children have focused on magnetic resonance imaging (MRI) signal and local anatomic relationships with imaging location only recently used to classify these neoplasms. We developed a quantitative method for analyzing the location of ependymoma in the posterior fossa, tested its effectiveness in distinguishing groups of tumors, and examined potential associations of distinct tumor groups with treatment and prognostic factors.

Methods: Pre-operative MRI examinations of the brain for 38 children with histopathologically proven posterior fossa ependymoma were analyzed.

Mechanical thrombectomy for emergent large vessel occlusion: a critical appraisal of recent randomized controlled clinical trials.

Background And Purpose: After numerous attempts to prove efficacy for endovascular treatment of ischemic stroke, a series of recent randomized controlled clinical trials (RCTs) established fast mechanical thrombectomy (MT) as a safe and effective novel treatment for emergent large vessel occlusion (ELVO) in the anterior cerebral circulation.

Methods: We reviewed five recent RCTs that evaluated the safety and efficacy of MT in ELVO patients and captured available information on recanalization/reperfusion, symptomatic intracranial hemorrhage (sICH), clinical outcome, and mortality. MT was performed with stent retrievers, aspiration techniques, or a combination of these endovascular approaches.

Mechanical Thrombectomy Improves Functional Outcomes Independent of Pretreatment With Intravenous Thrombolysis.

Background And Purpose: Endovascular intervention for emergent large-vessel occlusion (ELVO) has evolved rapidly during the past decade. The question of whether pretreatment with intravenous thrombolysis (IVT) has a significant impact on the functional outcome of patients with ELVO still remains unanswered.

Methods: We conducted a systematic review and meta-analysis of all available randomized controlled trials evaluating the efficacy of endovascular therapy (ET) for acute ischemic stroke.

Endovascular reperfusion therapies for acute ischemic stroke: dissecting the evidence.

Background: Ischemic stroke is a major cause of death and disability and intravenous thrombolysis has been the only approved acute reperfusion therapy (RT) for many years.

Methods: Seven randomized-controlled clinical trials (RCTs) evaluating the safety and efficacy of endovascular therapy in patients with acute ischemic stroke (AIS) due to emergent large vessel occlusion (ELVO) have been recently published.

Results: These studies have changed the treatment paradigm by establishing mechanical thrombectomy (MT) as the most effective acute stroke therapy for improving functional outcome in anterior circulation ELVO with a NNT of 6.

Clinical and Procedural Predictors of Outcomes From the Endovascular Treatment of Posterior Circulation Strokes.

Background And Purpose: Patients with posterior circulation strokes have been excluded from recent randomized endovascular stroke trials. We reviewed the recent multicenter experience with endovascular treatment of posterior circulation strokes to identify the clinical, radiographic, and procedural predictors of successful recanalization and good neurological outcomes.

Methods: We performed a multicenter retrospective analysis of consecutive patients with posterior circulation strokes, who underwent thrombectomy with stent retrievers or primary aspiration thrombectomy (including A Direct Aspiration First Pass Technique [ADAPT] approach).

Critical Care of Brain Reperfusion.

Over the last few decades, the management of acute ischemic stroke has undergone significant advancements with the introduction of intravenous thrombolysis and more recently punctuated by the success of endovascular mechanical thrombectomy trials for large vessel occlusion. These advancements have transformed the practice of neurocritical care. In this review, we present a case-based discussion of common brain reperfusion techniques with an emphasis on complication recognition and management.

Pediatric intracranial gunshot wounds: the Memphis experience.

OBJECTIVE Penetrating brain injury in civilians is much less common than blunt brain injury but is more severe overall. Gunshot wounds (GSWs) cause high morbidity and mortality related to penetrating brain injury; however, there are few reports on the management and outcome of intracranial GSWs in children. The goals of this study were to identify clinical and radiological factors predictive for death in children and to externally validate a recently proposed pediatric prognostic scale.

3-Factor Versus 4-Factor Prothrombin Complex Concentrate for Warfarin Reversal in Severe Bleeding: A Multicenter, Retrospective, Propensity-Matched Pilot Study.

Current guidelines recommend 4-factor prothrombin complex concentrate (4PCC) for emergent reversal of bleeding secondary to warfarin. While current research has demonstrated superiority of 4PCC over plasma, direct comparisons with 3-factor PCC (3PCC) are lacking. The purpose of this study is to compare the efficacy and safety of 3PCC and 4PCC.

Separating the wheat from the chaff: region of interest combined with metal artifact reduction for completion angiography following cerebral aneurysm treatment.

Introduction: Following complicated endovascular or microsurgical treatments, assessment of radiographic outcome can be challenging due to device resolution and metallic artifact. Two-dimensional and three-dimensional angiography can reveal information about flow and aneurysm obliteration, but may be limited by beam hardening, overlapping vessels, and image degradation in the region of metallic implants. In this study, we investigated the combination of a collimated volumetric imaging (volume of interest, VOI) protocol followed by metal artifact reduction (MAR) post-processing to evaluate the correct positioning of stents, flow diverters, coils, and clips while limiting the radiation dose to the patient.

Benefit of Transforaminal Lumbar Interbody Fusion vs Posterolateral Spinal Fusion in Lumbar Spine Disorders: A Propensity-Matched Analysis From the National Neurosurgical Quality and Outcomes Database Registry.

Background: Despite increasing use and potential benefits of transforaminal lumbar interbody fusion (TLIF) compared with posterolateral spinal fusion (PSF), previous studies have not documented improved clinical outcomes with TLIF vs PSF.

Objective: To compare the outcomes of TLIF with PSF in patients with spondylolisthesis, spinal stenosis, and adjacent level disease.

Methods: The National Neurosurgical Quality and Outcomes Database was queried for patients who had a lumbar fusion.

Treatment of Distal Anterior Circulation Aneurysms With the Pipeline Embolization Device: A US Multicenter Experience.

Background: Utilization of the Pipeline embolization device (PED) to treat distal carotid circulation aneurysms has not been well studied.

Objective: To report the collective experience of using PED to treat distal anterior circulation aneurysms.

Methods: We retrospectively reviewed clinical and radiographic records of all patients who underwent Pipeline embolization of distal anterior circulation aneurysms at 10 US neurosurgical centers between 2011 and 2013.

Two-color 3D-3D fusion of selective rotational cerebral angiograms: a novel approach to imaging in cerebrovascular neurosurgery.

Background: Since its introduction, digital subtraction angiography has been considered the gold standard in diagnostic imaging for neurovascular disease. Modern post-processing techniques have made angiography even more informative to the cerebrovascular neurosurgeon or neurointerventionalist. Open neurosurgical procedures such as aneurysm clipping, extirpation of arteriovenous malformations, and extracranial-intracranial bypass remain important techniques in the armamentarium of a comprehensive cerebrovascular neurosurgeon.

The fate of cranial neuropathy after flow diversion for carotid aneurysms.

Objective: The authors sought to determine whether flow diversion with the Pipeline Embolization Device (PED) can approximate microsurgical decompression in restoring function after cranial neuropathy following carotid artery aneurysms.

Methods: This multiinstitutional retrospective study involved 45 patients treated with PED across the United States. All patients included presented between November 2009 and October 2013 with cranial neuropathy (cranial nerves [CNs] II, III, IV, and VI) due to intracranial aneurysm.

Postoperative cerebral glucose metabolism in pediatric patients receiving proton therapy for craniopharyngioma.

OBJECT The aim of the study was to document postoperative cerebral glucose distribution before proton therapy using F-18 fluorodeoxyglucose positron emission tomography (FDG PET) in children with craniopharyngioma. METHODS Between August 2011 and April 2014, 50 patients (20 males, 30 females) enrolled in a prospective trial for craniopharyngioma underwent FDG PET imaging before proton therapy. Proton therapy was delivered using doublescattered beams with a total prescribed dose of 54 cobalt gray equivalent.

Posterior circulation CT angiography collaterals predict outcome of endovascular acute ischemic stroke therapy for basilar artery occlusion.

Introduction: The natural history of acute ischemic stroke (AIS) due to basilar artery occlusion (BAO) is poor. Endovascular reperfusion therapy (EVT) improves recanalization rates in patients with emergent large vessel intracranial occlusion.

Objective: To examine the hypothesis that good collateral patterns identified by pretreatment CT angiography (CTA) might be associated with favorable outcomes after EVT.

Comparison of Intraoperative Indocyanine Green Angiography and Digital Subtraction Angiography for Clipping of Intracranial Aneurysms.

Background: Residual aneurysm after microsurgical clipping carries a risk of aneurysm growth and rupture. Digital subtraction angiography (DSA) remains the standard to determine the adequacy of clipping. Intraoperative indocyanine green (ICG) angiography is increasingly utilized to confirm optimal clip positioning across the neck and to evaluate the adjacent vasculature.

Spontaneous Thrombosis of a Ruptured Brain Arteriovenous Malformation: The Argument for Early Conservative Management.

Generally, definitive treatment of brain arteriovenous malformations (BAVM) presenting with hemorrhage is recommended to prevent recurrent hemorrhage. The risk of craniotomy and resection of BAVM has been well described using the Spetzler-Martin grading scale; however, the optimal timing for the definitive treatment of ruptured BAVM remains unclear. We report an interesting case of spontaneous BAVM thrombosis in which the patient presented with right occipital intracerebral hemorrhage caused by ruptured right occipital micro-BAVM.

Effects of Surgery and Proton Therapy on Cerebral White Matter of Craniopharyngioma Patients.

Purpose: The purpose of this study was to determine radiation dose effect on the structural integrity of cerebral white matter in craniopharyngioma patients receiving surgery and proton therapy.

Methods And Materials: Fifty-one patients (2.1-19.

Diffuse Large B-Cell Lymphoma of the Frontal Sinus Presenting as a Pott Puffy Tumor: Case Report.

Objective Sinonasal non-Hodgkin lymphoma (NHL) is a very rare condition. NHL located specifically in the frontal sinus is even rarer with only 14 cases in the literature reported to date. A unique case of diffuse large B-cell lymphoma of the frontal sinus that presented first and was treated as suspected Pott puffy tumor is presented along with a review of the literature.