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Radiology 2019 Feb 19:181399. Epub 2019 Feb 19.

From the Departments of Radiology and Biomedical Imaging (A.M., X.W., C.C.M., H.P.F.), Neurosurgery (C.C.M.), Economics (H.P.F.), Management (H.P.F.), and Public Health (H.P.F.), Yale School of Medicine, 333 Cedar St, Box 208042, Tompkins East 2, New Haven, CT 06520-8042; Department of Radiology, University of Maryland School of Medicine, Baltimore, Md (D.G.); and Department of Radiology, Northwell Health, Manhasset, NY (P.S.).

Background Autosomal dominant polycystic kidney disease (ADPKD) affects one in 400 to one in 1000 individuals; 10%-11% of these individuals have intracranial aneurysms. The frequency and patterns of screening for intracranial aneurysms have not been defined. Purpose To evaluate different MR angiography screening and surveillance strategies for unruptured intracranial aneurysms in patients with ADPKD. Read More

Eur J Radiol 2019 Mar 15;112:88-92. Epub 2019 Jan 15.

Department of Radiology, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China. Electronic address:

Purpose: To study the association of the enhancement ratio (ER) of aneurysmal wall enhancement (AWE) with symptomatic intracranial aneurysms (IAs), we hypothesized that the ER of AWE would be stronger in symptomatic IAs than in asymptomatic IAs, as assessed by high-resolution magnetic resonance imaging (HRMRI).

Materials And Methods: Between February 2016 and February 2018, 80 consecutive patients with 89 unruptured IAs were reviewed. Patients and IAs were divided into symptomatic and asymptomatic groups. Read More

Stroke 2019 Feb 19:STROKEAHA118023771. Epub 2019 Feb 19.

From the Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas. (V.S.B., T.Y.E.A., S.G.A., A.R.P., K.A.L., C.E., J.B., C.M.M., B.G.W., D.S., H.H.B., J.W.).

Background and Purpose- Predicting long-term functional outcomes after intracranial aneurysmal rupture can be challenging. We developed and validated a scoring system-the Southwestern Aneurysm Severity Index-that would predict functional outcomes at 1 year after clipping of ruptured aneurysms. Methods- Ruptured aneurysms treated microsurgically between 2000 and 2014 were included. Read More

Clin Neurol Neurosurg 2019 Feb 5;179:4-8. Epub 2019 Feb 5.

Department of Neurosurgery, The Second Hospital of Shandong University, Jinan 250033, Shandong, China. Electronic address:

Objective: This study aimed to investigate the efficacy of early management for poor-grade aneurysmal subarachnoid hemorrhage (aSAH; WFNS grade IV and V), and analyze the prognostic factors.

Patients And Methods: A total of 104 consecutive patients with poor-grade aSAH from the Department of Neurosurgery, the Second Hospital of Shandong University were enrolled between January 2010 and December 2017. All these patients underwent early microsurgical clipping or endovascular coiling within three days after onset. Read More

World Neurosurg 2019 Feb 15. Epub 2019 Feb 15.

Department of Neurology, University of Missouri Hospital and Clinics, Columbia, Missouri, USA.

Background: Dantrolene has a safe side-effect profile and a mechanism of action that makes it attractive as an option for treatment of cerebral vasospasm. The authors report two cases of refractory cerebral vasospasm secondary to aneurysmal subarachnoid hemorrhage that were successfully treated with intra-arterial dantrolene.

Case Descriptions: Two patients, a 63-year-old woman and 36-year-old woman, developed severe vasospasm refractory to intra-arterial vasodilators after rupture of anterior communicating artery aneurysms. Read More

World Neurosurg 2019 Feb 15. Epub 2019 Feb 15.

Oncological Neurosurgery Unit, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy.

Background: Distal outflow occlusion and extracranial-intracranial bypass represent a possible option for the surgical management of complex middle cerebral artery (MCA) aneurysm. A limitation of distal clipping strategy combined to bypass relies on the difficulties in predicting intraoperatively the good blood flow supply to the brain territory distal to the aneurysm and the extent and speed of aneurysmal thrombosis.

Methods: The authors presented an innovative approach in which Contrast-enhanced US (CEUS) and indocyanine green video-angiography (ICG-VA) have been synergistically used to study the effect of distal clipping on the aneurysm flow and the parenchymal blood flow after the bypass. Read More

Expert Rev Med Devices 2019 Feb 18. Epub 2019 Feb 18.

a Service de neuroradiologie , Hôpital Maison Blanche, Centre Hospitalier Universitaire de Reims , 45 rue Cognacq-Jay, 51092 Reims , France.

Introduction: Intrasaccular flow disruption is an innovative technique for the endovascular treatment of intracranial aneurysms. Among flow disrupting devices, the Woven EndoBridge (WEB) is currently the only flow disrupter on the market and has seen an extensive scientific evaluation. It was shown that the device provides a safe and effective treatment particularly for wide-neck aneurysms of proximal bifurcations. Read More

Clin Interv Aging 2019 23;14:203-207. Epub 2019 Jan 23.

Department of Neurosurgery, Inner Mongolia Xing'an Meng People's Hospital, Ulanhot 137400, China,

Objective: Intracranial aneurysm is a kind of severe intracranial disease mainly responsible for subarachnoid hemorrhage, and the rupture of intracranial aneurysm results in a mortality rate of 30%-40%. For the first time in the world, this study aimed to assess the feasibility and efficacy of enhanced recovery after surgery (ERAS) protocol in Chinese elderly patients with intracranial aneurysm.

Methods: In this study, 300 elderly patients with intracranial aneurysm were recruited and divided into two groups as follows: ERAS group (n=150, ERAS protocol) and control group (n=150, conventional management). Read More

J Stroke Cerebrovasc Dis 2019 Feb 13. Epub 2019 Feb 13.

Department of Neurosurgery, Tohoku University, Sendai, Japan.

Moyamoya syndrome (MMS) is an uncommon late complication after cranial irradiation. Its hemorrhagic presentation from the associated pseudo-aneurysm is extremely rare, and the optimal management strategy is undetermined. We herein report a 36-year-old man who developed intraventricular hemorrhage from a pseudo-aneurysm at the extended left anterior choroidal artery as an abnormal collateral of MMS 30 years after surgical removal and cranial irradiation for childhood craniopharyngioma. Read More

J Neurosurg Pediatr 2019 Feb 15:1-4. Epub 2019 Feb 15.

1Department of Neurosurgery, Division of Clinical Neurosciences.

OBJECTIVEKawasaki disease (KD) is a vasculitis that can cause aneurysm formation in coronary arteries and, more rarely, in peripheral arteries. A possible connection between KD and intracranial aneurysms is unclear. The purpose of this study was to determine if KD is associated with intracranial aneurysms. Read More

Clin Neurol Neurosurg 2019 Mar 8;178:93-96. Epub 2019 Feb 8.

Department of Cerebrovascular Surgery, International Medical Center, Saitama Medical University, Hidaka, Japan. Electronic address:

Objective: The aim of the study was to better define the incidence of and risk factors for early seizures after repair of unruptured intracranial aneurysms in modern microsurgical techniques.

Patients And Methods: The medical records of 414 consecutive patients who underwent neck clipping of unruptured intracranial aneurysms in our institution over a 5-year period were retrospectively reviewed. Clinical and neuroimaging variables were analyzed to investigate putative predictors of perioperative seizures using multivariate logistic regression analysis. Read More

World Neurosurg 2019 Feb 13. Epub 2019 Feb 13.

Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA; Department of Neurosurgery, The National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia. Electronic address:

Background And Purpose: Posterior communicating artery segment aneurysms are one of the most frequent intracranial aneurysms. Currently, there is limited literature describing the use of the pipeline embolization device in these aneurysms.

Material And Methods: We conducted a multicenter retrospective review of 3 prospectively-collected databases of patients treated with pipeline between January 2013 and December 2017. Read More

J Neurosci Rural Pract 2019 Jan-Mar;10(1):142-144

Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA.

Despite the widespread use of the pipeline embolization device (PED), no complete aneurysm regrowth after its placement has been reported in the literature. We report the first case of aneurysm regrowth after the initial follow-up angiography demonstrating near-complete occlusion of the aneurysm and remodeling of the vessel with on-label PED use for a large 20 mm × 24 mm × 22 mm (width × depth × height) cavernous segment internal carotid artery (ICA) aneurysm. The patient was treated with two overlapping PED (4. Read More

AJNR Am J Neuroradiol 2019 Feb 14. Epub 2019 Feb 14.

From the Department of Diagnostic and Interventional Neuroradiology, Klinikum Augsburg, Augsburg, Germany.

Background And Purpose: The optimal treatment of unruptured middle cerebral aneurysms is still under debate. Although today almost any aneurysm can be treated endovascularly, there is a lack of data comparing endovascular and microsurgical repair of MCA aneurysms. The aim of our analysis is to provide data on the efficacy, clinical outcome, complications and re-treatment rates of endovascular treatment of this subtype of aneurysms. Read More

BMJ Open 2019 Feb 12;9(2):e022810. Epub 2019 Feb 12.

Department of Anesthesia and Perioperative Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.

Objectives: We aim to evaluate the diagnostic test accuracy (DTA) of intraoperative evoked potential (EP) monitoring to detect cerebral injury during clipping of cerebral aneurysms.

Design: Systematic review.

Data Sources: Major electronic databases including MEDLINE, EMBASE, LILACS. Read More

J Clin Med 2019 Feb 12;8(2). Epub 2019 Feb 12.

TENSOR-Team of NeuroSurgery-Oriented Reaserch, Jagiellonian University Medical College, 31-008 Kraków, Poland.

Tortuosity of blood vessels is a common angiographic finding that may indicate systemic disease and can be correlated with vascular pathologies. In this work, we determined whether patients with and without internal carotid artery (ICA) aneurysm presented with differences in its tortuosity descriptors. We retrospectively analysed data of 298 patients hospitalized between January 2014 and June 2018. Read More

Arq Neuropsiquiatr 2019 Jan;77(1):63

China-Japan Union Hospital of Jilin University, Department of Neurosurgery, Changchun, China.

J Emerg Med 2019 Feb 8. Epub 2019 Feb 8.

Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland.

Background: Spontaneous spinal and intracranial subdural hematomas are rarely reported, especially occurring simultaneously. Anticoagulation use has been associated with spontaneous hemorrhages. Prompt diagnosis is required to prevent permanent neurological sequelae. Read More

World Neurosurg 2019 Feb 8. Epub 2019 Feb 8.

University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany, Department of Health Economics and Health Services Research.

Objective: Rupture of unruptured intracranial aneurysms (UIA) is the main cause for subarachnoid hemorrhage (SAH). UIA are widespread among the population. Advanced technology enables us to diagnose UIAs with increasing reliability and subsequently treat them. Read More

World Neurosurg 2019 Feb 8. Epub 2019 Feb 8.

Department of Cerebrovascular Surgery, International Medical Center, Saitama Medical University, Hidaka, Japan.

Background: The treatment of complex unruptured middle cerebral artery (MCA) aneurysms which are untreatable with conventional surgical techniques are rare, and direct aneurysmal clipping usually remains the first-line treatment for large and giant saccular MCA aneurysms. Tandem clipping and multiple clipping techniques represent neck reconstruction in direct clipping surgeries that address for these aneurysms.

Case Description: The authors describe a simple variation of neck reconstructive clipping techniques for the large MCA unruptured aneurysm in a patient with an unruptured 20mm MCA bifurcation aneurysm. Read More

World Neurosurg 2019 Feb 8. Epub 2019 Feb 8.

Neurosurgery, Xuanwu Hospital, Capital Medical University. 45 # Changchun Street, Xicheng District, Beijing, 100054, China.

Background: The STA connected to proximal MCA has been reported before. However, the flow supply capacity of the double-barrel STA to proximal MCA bypass in treating complex intracranial aneurysms has not been well documented.

Methods: Consecutive cases using this technique to treat complex intracranial aneurysms during the past five years have been collected. Read More

Med Sci Monit 2019 Feb 11;25:1133-1139. Epub 2019 Feb 11.

Department of Gastroenterology, Centre Hospital of Weihai, Weihai, Shandong, China (mainland).

BACKGROUND Preliminary microarray data in our laboratory indicated that the novel long noncoding RNA (lncRNA), GASL1, was downregulated in patients with intracranial aneurysms. This study aimed to investigate the expression of lncRNA GASL1 in patients with intracranial aneurysms and its role in the regulation of vascular smooth muscle cell (VSMC) proliferation by transforming growth factor-β1 (TGF-β1). MATERIAL AND METHODS The study included 68 patients with unruptured intracranial aneurysms and 56 healthy volunteers. Read More

J Surg Case Rep 2019 Jan 31;2019(1):rjz013. Epub 2019 Jan 31.

Department of Radiology, Section of Neuroradiology Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC.

Intracranial solitary fibrous tumors are rare mesenchymal neoplasms originating in the meninges and constitute a heterogeneous group of rare spindle cell tumors that include benign and malignant neoplasms of which hemangiopericytoma is nowadays considered a cellular phenotypic variant. From literatures, the incidence of coexistence of brain tumors and intracranial aneurysms is ~0.7-5. Read More

World Neurosurg 2019 Feb 7. Epub 2019 Feb 7.

Department of Neurosurgery, Stanford University, 300 Pasteur Drive, Stanford, California, 94305, U.S.A.

Magnetic particle imaging (MPI) is a novel radiation-free tomographic imaging method that provides a background-free, signal attenuation-free, direct quantification of the spatial distribution of superparamagnetic iron-oxide nanoparticles (SPIONs) with high temporal resolution (milliseconds), high spatial resolution (< 1 mm), and extreme sensitivity (μmol). The technique is based on non-linear magnetization of the SPIONs when exposed to an oscillating magnetic field. MPI was first described in 2001. Read More

World Neurosurg 2019 Feb 7. Epub 2019 Feb 7.

Department of Neurosurgery, the First Affiliated Hospital of Chongqing Medical University, NO.1 of Youyi Rd, Yuzhong District, Chongqing, China. Electronic address:

Objective: The purpose of this study was to investigate the imaging characteristics of fenestrated AcomA aneurysm and clinical outcome of patients with fenestrated AcomA aneurysm.

Methods: We performed a retrospective study of consecutive patients with AcomA aneurysms between January 2013 and December 2017. According to the vascular variations of the AcomA, the patients were divided into two groups: fenestrated AcomA aneurysms and non-fenestrated AcomA aneurysms. Read More

Transl Stroke Res 2019 Feb 8. Epub 2019 Feb 8.

Department of Molecular Pharmacology, Research Institute, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan.

Intracranial aneurysm (IA) usually induced at a bifurcation site of intracranial arteries causes a lethal subarachnoid hemorrhage. Currently, IA is considered as a macrophage-mediated inflammatory disease triggered by a high wall shear stress (WSS) on endothelial cells. However, considered the fact that a high WSS can be observed at every bifurcation site, some other factors are required to develop IAs. Read More

World Neurosurg 2019 Feb 5. Epub 2019 Feb 5.

Department of Neurological Surgery, University of California San Francisco, San Francisco, CA; Department of Neurological Surgery, Barrow Neurological Institute, Phoenix, AZ. Electronic address:

Introduction: The aim of this study was to analyze practice trends in specific intracranial bypass types in a large, consecutuve bypass experience.

Methods: This retrospective review of a prospectively maintained database included all intracranial bypasses performed by a single surgeon over 21 years. Bypass types were grouped into 7 categories and analyzed in seven 3-year time intervals: type 1 = extracranial-to-intracranial (EC-IC) bypass with scalp arteries as donors; type 2 = EC-IC bypass with interposition graft to cervical carotid arteries; type 3 = arterial reimplantation; type 4 = in situ bypass; type 5 = reanastomosis; type 6 = intracranial-to-intracranial (IC-IC) bypass with interposition graft; and type 7= combination bypass. Read More

Stroke 2018 Dec;49(12):3081-3084

From the Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Switzerland (M.N.S., E.K., O.B., L.R.)

Background and Purpose—Commonly used tools to determine functional outcome after aneurysmal subarachnoid hemorrhage (aSAH) have limitations. Time spent at the patient’s home has previously been proposed as a robust outcome measure after ischemic stroke. Here, we set out to validate home-time as an outcome measure after aSAH. Read More

Clin Neuroradiol 2019 Feb 7. Epub 2019 Feb 7.

Department of Neuroradiology, University Hospital of Cologne, Kerpener Straße 67, 50937, Cologne, Germany.

Purpose: The Woven EndoBridge (WEB) device has been proven to be a safe and efficient endovascular treatment option for wide-necked bifurcation aneurysms. The study aimed to evaluate the incidence and risk factors of procedural complications related to WEB embolization of ruptured and unruptured intracranial aneurysms.

Methods: This was a multicenter, observational study of consecutive patients with ruptured and unruptured aneurysms who were treated with the WEB at three German tertiary care centers between May 2011 and February 2018. Read More

AJNR Am J Neuroradiol 2019 Feb 7. Epub 2019 Feb 7.

Hemorrhagic Brain Pathology Research Group (J.F.), Neurocenter, Kuopio University Hospital, Kuopio, Finland.

Background And Purpose: Aneurysm hemodynamics has been associated with wall histology and inflammation. We investigated associations between local hemodynamics and focal wall changes visible intraoperatively.

Materials And Methods: Computational fluid dynamics models were constructed from 3D images of 65 aneurysms treated surgically. Read More

J Cereb Blood Flow Metab 2019 Feb 7:271678X19827446. Epub 2019 Feb 7.

5 Department of Translational Medicine and Cell Technology, Fraunhofer Research Institution for Marine Biotechnology and Cell Technology and Institute for Medical and Marine Biotechnology, University of Lübeck, Lübeck, Germany.

Neuroendovascular procedures have led to breakthroughs in the treatment of ischemic stroke, intracranial aneurysms, and intracranial arteriovenous malformations. Due to these substantial successes, there is continuous development of novel and refined therapeutic approaches. Large animal models feature various conceptual advantages in translational research, which makes them appealing for the development of novel endovascular treatments. Read More

J Neuroradiol 2019 Feb 4. Epub 2019 Feb 4.

Department of Neuroradiology, CHU Reims, Hôpital Maison Blanche, Université Reims-Champagne Ardenne, Reims, France. Electronic address:

Purpose-Standard dual antiplatelet therapy (DAPT) for complex aneurysms treated with flow diversion and flow disruption is acetylsalicylic acid (ASA) plus clopidogrel. However, clopidogrel resistance frequently occurs and can lead to thromboembolic events. Ticagrelor is an alternative not requiring platelet inhibition testing. Read More

Curr Opin Obstet Gynecol 2019 Feb 5. Epub 2019 Feb 5.

Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, New York, USA.

Purpose Of Review: To summarize recent research findings and current concepts related to care of neurologic diseases in pregnancy and the risks of pregnancy to the mother-infant dyad. Recent publications related to best practices for neurologic care, risks of pregnancy, rate of relapse during and after pregnancy, as well as medication safety in pregnancy and lactation for more commonly used neurologic medications are reviewed.

Recent Findings: Data continues to grow that women with neurologic conditions can experience pregnancy with minimal risks. Read More

Korean J Fam Med 2019 Feb 7. Epub 2019 Feb 7.

Department of Family Medicine, Hongik Hospital, Seoul, Korea.

Background: Cadmium is a toxic element in cigarette smoke associated with ischemic vascular disease. Its association with cerebral aneurysm is unknown.

Methods: We retrospectively analyzed the medical records of patients with headache who underwent imaging studies between March 2014 and August 2016. Read More

Pharmacotherapy 2019 Feb 5. Epub 2019 Feb 5.

Virginia Commonwealth University, Richmond, VA, USA.

Patients undergoing neuroendovascular procedures such as cerebral aneurysm coiling and intracranial stent deployment are frequently treated with antiplatelet agents to prevent thrombotic complications. The combination of aspirin and a P2Y12 inhibitor such as clopidogrel is often initiated days prior to elective procedures or as loading doses for emergent procedures; however, some patients may still experience thrombotic complications. Patients identified as clopidogrel hyporesponders are more likely to experience poor outcomes and may require changes to their regimens. Read More

eNeurologicalSci 2019 Mar 8;14:77-84. Epub 2019 Jan 8.

Medtronic Core Technologies, Minneapolis, MN, United States.

Flow diversion is a disruptive technology for the treatment of intracranial aneurysms. However, these intraluminal devices pose a risk for thromboembolic complications despite dual antiplatelet therapy. We report the thrombogenic potential of the following flow diversion devices measured experimentally in a novel human blood in-vitro pulsatile flow loop model: Pipeline™ Flex Embolization Device (Pipeline), Pipeline™ Flex Embolization Device with Shield Technology™ (Pipeline Shield), Derivo Embolization Device (Derivo), and P64 Flow Modulation Device (P64). Read More

Cureus 2018 Nov 27;10(11):e3643. Epub 2018 Nov 27.

Neurosurgery, Advocate Christ Medical Center, Oak Lawn, USA.

Traumatic intracranial aneurysms are rare lesions that occur after blunt or primarily penetrating mechanisms. These are extremely fragile vessel injuries associated with significant morbidity and mortality, especially after rupture. Disease natural history, surveillance strategies, and management are based on small case series. Read More

Neuroophthalmology 2019 Feb 25;43(1):53-55. Epub 2018 Apr 25.

Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt.

A 61-year-old male presents with diplopia of acute onset and progressive course. He has a history of previous intracranial haemorrhage that was surgically evacuated 7 years ago and was also associated with diplopia. Examination revealed left complete oculomotor nerve paralysis with a fixed and dilated left pupil. Read More

Zh Vopr Neirokhir Im N N Burdenko 2018 ;82(6):5-14

Semashko Republican Clinical Hospital, Simferopol', Russia.

Objective: The objective of this study was to evaluate the results of surgical treatment of cerebral aneurysms in the Russian Federation.

Material And Methods: We analyzed performance indicators in neurosurgical departments of regional and federal health institutions of the Russian Federation for 2017. The results of surgical treatment of cerebral aneurysms (CAs) were analyzed in 19 regional vascular centers (RVCs) in several federal districts and in 3 federal centers (FCs) with the most dynamically developing vascular neurosurgery and smoothly running system of statistical data processing. Read More

J ECT 2019 Feb 1. Epub 2019 Feb 1.

Department of Surgery (Neurosurgery) Dalhousie University Halifax, Nova Scotia, Canada Department of Psychiatry Dalhousie University Halifax, Nova Scotia, Canada.

J ECT 2019 Feb 1. Epub 2019 Feb 1.

From the Department of Neurology, Johns Hopkins Hospital, Baltimore, MD.

Objectives: The aim of the study was to report a case of a patient who experienced a fatal aneurysmal subarachnoid hemorrhage during the course of electroconvulsive therapy (ECT).

Methods: This is a case report and review of the literature.

Results: Electroconvulsive therapy is widely viewed as a safe and effective treatment for major depressive disorder; however, there remains some uncertainty regarding the safety of ECT in patients with cerebral aneurysms. Read More

J Neurointerv Surg 2019 Feb 4. Epub 2019 Feb 4.

Department of Radiology, Huashan Hospital Affiliated to Fudan University, Shanghai, China.

Objective: This study aimed to compare the hemodynamic differences among no sac (NOS), porous media (POM) and finite element analysis (FEA) models to investigate the recurrence-related risks for coiled intracranial aneurysms (IAs).

Methods: The study enrolled 10 patients with 11 IAs who received simple coiling treatment and hemodynamic simulations were performed for all IAs using the above three models. Velocity, wall shear stress (WSS) and residual flow volume (RFV) were calculated and compared in order to assess the model differences for both aneurysm sac and parent vessel regions. Read More

Neurosurg Focus 2019 Feb;46(2):E10

1Department of Neurosurgery, SanBo Brain Hospital, Capital Medical University, Beijing, China.

OBJECTIVEThe rapid innovation of the endovascular armamentarium results in a decreased number of indications for a classic surgical approach. However, a middle cerebral artery (MCA) aneurysm remains the best example of one for which results have favored microsurgery over endovascular intervention. In this study, the authors aimed to evaluate the experience and efficacy regarding surgical outcomes after applying internal maxillary artery (IMA) bypass for complex MCA aneurysms (CMCAAs). Read More

Neurosurg Focus 2019 Feb;46(2):E4

1Department of Neurological Surgery, University of California, San Francisco, California; and.

OBJECTIVECerebral bypass procedures are microsurgical techniques to augment or restore cerebral blood flow when treating a number of brain vascular diseases including moyamoya disease, occlusive vascular disease, and cerebral aneurysms. With advances in endovascular therapy and evolving evidence-based guidelines, it has been suggested that cerebral bypass procedures are in a state of decline. Here, the authors characterize the national trends in cerebral bypass surgery in the United States from 2002 to 2014. Read More

Neurosurg Focus 2019 Feb;46(2):E15

OBJECTIVEThe development and recent widespread dissemination of flow diverters may have reduced the utilization of surgical bypass procedures to treat complex or giant unruptured intracranial aneurysms (UIAs). The aim of this retrospective cohort study was to observe trends in cerebral revascularization procedures for UIAs in the United States before and after the introduction of flow diverters by using the National (Nationwide) Inpatient Sample (NIS).METHODSThe authors extracted data from the NIS database for the years 1998-2015 using the ICD-9/10 diagnostic and procedure codes. Read More

World Neurosurg 2019 Feb 1. Epub 2019 Feb 1.

Lyerly Neurosurgery, Baptist Medical Center, Jacksonville, Florida, USAs.

Background: Massive epistaxis from rupture of an intracavernous internal carotid artery (ICA) aneurysm is a potentially fatal event. Although rare, this presentation is seen most often in patients after trauma or iatrogenic injury secondary to transsphenoidal surgery or radiation therapy.

Case Description: We present our unusual case of a patient with no significant risk factors who had recurrent epistaxis due to a ruptured true cavernous ICA aneurysm. Read More

Oper Neurosurg (Hagerstown) 2019 Jan 30. Epub 2019 Jan 30.

Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona.

A dolichoectatic intracranial vessel with multiple fusiform aneurysms on the same vessel segment is rare, and usually managed with a bypass with aneurysm trapping. This video demonstrates trapping and a double-barrel superficial temporal artery-to-middle cerebral artery (STA-MCA) bypass to treat two fusiform aneurysms in a left dolichoectatic superior MCA trunk. A 46-year-old man with AIDS presented with aphasia and hemiparesis. Read More

J Vasc Surg 2018 Oct 24. Epub 2018 Oct 24.

Department of Epidemiology and Biostatistics, Mayo Clinic, Rochester, Minn.

Objective: Upper extremity (UE) access is frequently used during fenestrated-branched endovascular aortic repair (F-BEVAR) to facilitate catheterization of downgoing vessels. Limitations include risk of cerebral embolization and of UE arterial or peripheral nerve injury. The aim of this study was to assess outcomes of F-BEVAR using UE access. Read More

J Stroke Cerebrovasc Dis 2019 Jan 31. Epub 2019 Jan 31.

Division of Cerebrovascular diseases, Department of Neurology, Carver College of Medicine, University of Iowa, Iowa city, Iowa, USA; Department of Epidemiology, College of Public Health, University of Iowa, Iowa city, Iowa, USA; Department of Neurosurgery, Carver College of Medicine, University of Iowa, Iowa city, Iowa, USA.

Importance: Understanding of the epidemiology, outcomes, and management of spontaneous subarachnoid hemorrhage (sSAH) during pregnancy is limited. Small, single center series suggest a slight increase in morbidity and mortality.

Objective: To determine if incidence of sSAH in pregnancy is increasing nationally and also to study the outcomes for this patient population. Read More