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Neurosurgery 2021 May 14. Epub 2021 May 14.

Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA.

Background: The Woven EndoBridge (WEB) device was granted premarket approval in the United States following results of the Woven EndoBridge Intrasaccular Therapy (WEB-IT) study. WEB-IT reported excellent adequate angiographic occlusion of treated aneurysms with a high safety profile. These results were achieved, however, in the context of a prospective study with strict inclusion criteria and rigorous training support. Read More

J Neurointerv Surg 2021 May 13. Epub 2021 May 13.

Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China

Background: Although coiling with a flow diverter may provide immediate dome protection, no studies have evaluated the effect on complications of postoperative occlusion degree immediately postoperatively. The purpose of this study was to determine whether postoperative occlusion degree immediately after flow-diverter placement with adjunctive coiling was associated with complications.

Methods: All patients' data were collected from the post-market multi-center cohort study of embolization of intracranial aneurysms with a pipeline embolization device (PED) in China (PLUS) registry. Read More

Eur Heart J Case Rep 2021 May 5;5(5):ytab168. Epub 2021 May 5.

Department of Cardiology, Kettering General Hospital, NHS, Rothwell Road, Kettering, NN16 8UZ, UK.

Background: Myocardial infarction (MI) with non-obstructive coronary arteries presenting with ST-segment elevation can be challenging. Understanding the cardiac and non-cardiac causes aid in identifying the underlying diagnosis and deciding on the management. Neurological insult resulting in a mismatch of oxygen supply or demand to cardiomyocytes can lead to type 2 MI. Read More

Front Neurol 2021 26;12:613027. Epub 2021 Apr 26.

Department of Neurology, Affiliated Hospital of Yangzhou University, Yangzhou, China.

This study was to examine the patients with acute cerebral infarction (ACI) treated at a single center over 9 years and who underwent Unruptured intracranial aneurysm (UIA) screening by three-dimensional time-of-flight magnetic resonance angiography (3D-TOF-MRA), and to explore the factors associated with outcomes. The outcome was the modified Rankin scale (mRS) score at 90 days after stroke onset. The outcome was classified into a good outcome (mRS score of 0-2 points) and poor outcome (mRS score of 3-6 points). Read More

Turk Neurosurg 2021 Feb 5. Epub 2021 Feb 5.

University of Medicine and Pharmacy Carol Davila, Department of Neurosurgery, Bucharest, Romania.

Aim: Pediatric aneurysms are rare, occurring in under 5% of cases, and their clinical presentation, rupture probability, location, and outcome differ from those in adults. The present study aimed to analyze the demographic characteristics and surgical outcomes of the largest series of patients with pediatric aneurysms reported in Romania, in consideration of the primary factors that lead to good long-term outcomes. Given that all cases involved ruptured aneurysms, we also investigated the ability of microsurgical clipping to prevent massive hemorrhage and aggravation of neurological deficits. Read More

Gan To Kagaku Ryoho 2021 Apr;48(4):596-598

Dept. of Gastroenterological Surgery, Toho University Omori Medical Center.

The case is a 59‒year‒old woman. A detailed examination of fecal occult blood revealed a diagnosis of cStage Ⅳ sigmoid colon cancer cT3N1M1b(liver H2, hilar liver and celiac artery lymph nodes). After excision of the primary lesion, decided to give chemotherapy. Read More

WMJ 2021 Apr;120(1):82-84

SSM Health Saint Mary's Hospital, Madison, Wisconsin.

Introduction: species are ubiquitous fungi that may cause invasive infection, particularly in immunocompromised patients. Invasive aspergillosis most commonly affects the lungs but can also disseminate to the central nervous system (CNS). Manifestations of CNS aspergillosis include abscesses and, rarely, mycotic aneurysm leading to subarachnoid hemorrhage (SAH). Read More

Clin Neuroradiol 2021 May 11. Epub 2021 May 11.

Siemens Healthineers Ltd., Seoul, Korea (Republic of).

Purpose: In 15-20% of patients with nontraumatic diffuse subarachnoid hemorrhage (SAH), the initial conventional angiography does not reveal a causative vascular abnormality, such as intracranial aneurysm. In this study, we evaluated clinical utility of 3D high-resolution vessel wall magnetic resonance imaging (HR-VWI) in patients with diffuse nonaneurysmal SAH.

Methods: A total of 17 patients with diffuse nonaneurysmal SAH were included in this retrospective study. Read More

Cardiovasc Res 2021 May 11. Epub 2021 May 11.

Department of Pathology and Immunology.

Aims: Wall shear stress (WSS) determines intracranial aneurysm (IA) development. Polycystic kidney disease (PKD) patients have a high IA incidence and risk of rupture. Dysfunction/absence of primary cilia in PKD endothelial cells (ECs) may impair mechano-transduction of WSS and favour vascular disorders. Read More

Acta Neurochir Suppl 2021 ;132:145-149

Department of Neurosurgery, Asahi University Hospital, Gifu, Japan.

Objective: In Japan, hybrid neurosurgeons who perform both open surgical clipping as well as endovascular embolization for the treatment of intracranial aneurysms are common. Although many Japanese neurosurgeons can perform surgical clipping of middle cerebral artery aneurysms or internal carotid artery-posterior communicating artery aneurysms and coil embolization of cerebral aneurysms using simple techniques-only a limited number of neurosurgeons are able to perform surgical clipping and endovascular procedures for anterior communicating artery aneurysms, paraclinoid, or posterior circulation aneurysms using both treatment modalities equally and safely.

Materials And Methods: The senior author's personal experience of more than 500 cases each of surgical clipping and endovascular embolization over the past 25 years included 110 cases of basilar tip aneurysms and 104 cases of paraclinoid internal carotid artery (ICA) aneurysms. Read More

Acta Neurochir Suppl 2021 ;132:27-32

Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan.

Hemodynamics is thought to play an important role in the pathogenesis of cerebral aneurysms and recent development of computer technology makes it possible to simulate blood flow using high-resolution 3D images within several hours. A lot of studies of computational fluid dynamics (CFD) for cerebral aneurysms were reported; therefore, application of CFD for cerebral aneurysms in clinical settings is reviewed in this article.CFD for cerebral aneurysms using a patient-specific geometry model was first reported in 2003 and it has been revealing that hemodynamics brings a certain contribution to understanding aneurysm pathology, including initiation, growth and rupture. Read More

Acta Neurochir Suppl 2021 ;132:19-26

Department of Neurosurgery, Kepler University Hospital, Linz, Austria.

Introduction: Very large and giant aneurysms are among the most challenging cerebrovascular pathologies in neurosurgery.

Methods: The aim of this paper is to review the current literature on the management of very large and giant aneurysms and to describe representative cases illustrating possible treatment strategies.

Results: In view of the poor natural history, active management using multiprofessional individualized approaches is required to achieve aneurysm occlusion, relief of mass effect, and obliteration of the embolic source. Read More

Acta Neurochir Suppl 2021 ;132:9-17

Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.

Introduction: The goal of this survey is to investigate the indications for preoperative digital subtraction angiography (DSA) before clipping of ruptured and unruptured intracranial aneurysms in an international panel of neurovascular specialists.

Methods: An anonymous survey of 23 multiple-choice questions relating to indications for DSA before clipping of an intracranial aneurysm was distributed to the international panel of attendees of the European-Japanese Cerebrovascular Congress (EJCVC), which took place in Milan, Italy on 7-9 June 2018. The survey was collected during the same conference. Read More

Cerebrovasc Dis 2021 May 10:1-8. Epub 2021 May 10.

Department of Neurosurgery, NYU Langone Health, New York, New York, USA.

Background: Comaneci (Rapid Medical) is a compliant, adjustable mesh that provides temporary scaffolding during coiling of wide-necked intracranial aneurysms (WNAs) that preserves antegrade flow. We report our early multi-institutional experience with the Comaneci device in the USA.

Method: We reviewed all patients with WNAs that were treated using the Comaneci device for coil remodeling of ruptured and unruptured aneurysms at 4 institutions between July 2019 and May 2020. Read More

Aging (Albany NY) 2021 May 10;13. Epub 2021 May 10.

Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Graduate School of Peking Union Medical College, Beijing, China.

We aimed to develop and validate a morphology-based radiomics signature nomogram for assessing the risk of intracranial aneurysm (IA) rupture. A total of 254 aneurysms in 105 patients with subarachnoid hemorrhage and multiple intracranial aneurysms from three centers were retrospectively reviewed and randomly divided into the derivation and validation cohorts. Radiomics morphological features were automatically extracted from digital subtraction angiography and selected by the least absolute shrinkage and selection operator algorithm to develop a radiomics signature. Read More

Cochrane Database Syst Rev 2021 May 10;5:CD013312. Epub 2021 May 10.

Department of Surgery, Division of Vascular and Endovascular Surgery, Universidade Federal de São Paulo, São Paulo, Brazil.

Background: Unruptured intracranial aneurysms are relatively common lesions in the general population, with a prevalence of 3.2%, and are being diagnosed with greater frequency as non-invasive techniques for imaging of intracranial vessels have become increasingly available and used. If not treated, an intracranial aneurysm can be catastrophic. Read More

J Am Acad Orthop Surg Glob Res Rev 2020 May;4(5):e1900156

From the National Guard Health Affairs, King Abdulaziz Medical City, Riyadh, Saudi Arabia.

Aim: This study presents a rare case of pseudoaneurysm mimicking a tumor on the back, with no history of fever, trauma, or surgical intervention. In which no identifiable symptoms or warning signs were present. This pseudoaneurysm arises from intercostal arteries and segmental arteries. Read More

J Thorac Cardiovasc Surg 2021 Apr 1. Epub 2021 Apr 1.

Center for Cerebral and Cardiovascular Disease Information, National Cerebral and Cardiovascular Center, Osaka, Japan.

Objective: We performed a multicenter prospective comparative study to determine the impact of a Japanese frozen elephant trunk device on total arch replacement compared with conventional repair without it.

Methods: Between 2016 and 2019, a total of 684 patients (frozen elephant trunk procedure; n = 369; conventional repair, n = 315) from 41 institutions were enrolled. The 2 procedures were selected according to each center's strategy. Read More

BMJ Case Rep 2021 May 7;14(5). Epub 2021 May 7.

Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK.

Both acute and chronic subdural haematomas typically occur following trauma. Non-traumatic causes are less common, but aetiologies include arteriovenous malformation, intracranial aneurysm rupture, tumour-associated haemorrhage and coagulopathies. May-Hegglin anomaly is an example of a coagulopathy, which is caused by a mutation in the gene encoding non-muscle myosin heavy chain 9 (MYH9) and therefore falls into a group of diseases referred to as MYH9-related diseases (MYH9-RD). Read More

J Neurosurg 2021 May 7:1-9. Epub 2021 May 7.

Faculty of Medicine, Divisions of1Neurosurgery and.

Objective: The main goal of preventive treatment of unruptured intracranial aneurysms (UIAs) is to avoid the morbidity and mortality associated with aneurysmal subarachnoid hemorrhage. A comparison between the conservative approach and the surgical approach combining endovascular treatment and microsurgical clipping is currently lacking. This study aimed to conduct an updated evaluation of cost-effectiveness comparing the two approaches in patients with UIA. Read More

Front Neurol 2021 20;12:590383. Epub 2021 Apr 20.

Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France.

The aim of this study was to characterize neurological complications after flow diverter (FD) treatment on a long follow-up cohort and identify predictive factors associated with these complications. This study was conducted on a monocentric cohort of patients treated for intracranial aneurysms by FD. Between September 2008 and July 2018, 413 patients were treated for 514 aneurysms: 18% of the patients presented with at least one neurological complication during a median follow-up of 446 days (IQR 186-1,210). Read More

Interv Neuroradiol 2021 May 6:15910199211014708. Epub 2021 May 6.

Department of Neurosurgery, Yildirim Beyazit University, Ankara, Turkey.

Purpose: There is no study on the role of three-dimensional compressed sensing time of flight MR angiography (3D-CS-TOF) in the management of the WEB device. We evaluated the efficacy of 3-tesla 3D-CS-TOF for the management and follow-up of the WEB device implantations.

Materials And Methods: Seventy-three aneurysms of 69 patients treated with the WEB device were retrospectively examined. Read More

Stroke 2021 May 7:STROKEAHA121033293. Epub 2021 May 7.

Mayo Clinic, Rochester, MN (G.L.).

Neurosurg Rev 2021 May 6. Epub 2021 May 6.

Department of Neurosurgery, The University of Tokyo Hospital, Bunkyo-ku, HongoTokyo, Japan.

This study aimed to compare the muscle-preserving pterional approach (modified classic pterional approach, mCP) and the mini-pterional approach (mPA) with respect to postoperative temporalis muscle atrophy.From November 2013 to April 2020, 78 patients with unruptured intracranial aneurysm of the anterior circulation underwent surgery using mCP or mPA in our institution. Patients' background characteristics, postoperative complications, and temporalis muscle volume (MV) rates (operative side/healthy side) were retrospectively investigated. Read More

Acta Neurochir (Wien) 2021 May 6. Epub 2021 May 6.

Department of Neurosurgery, King's College Hospital, Denmark Hill, Brixton, London, SE5 9RS, UK.

Background: There is limited evidence to direct the management of unruptured intracranial aneurysms. Models extrapolated from existing data have been proposed to guide treatment recommendations. The aim of this study is to assess whether a consensus-based treatment score (UIATS) or rupture rate estimation model (PHASES) can be used to benchmark UK multi-disciplinary team (MDT) practice. Read More

Ther Adv Neurol Disord 2021 9;14:1756286420987939. Epub 2021 Apr 9.

Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.

Background And Aims: The role of statins in unruptured intracranial aneurysm (UIA) growth and rupture remains ambiguous. This study sought to determine whether atorvastatin is associated with aneurysm growth and rupture in patients harboring UIA <7 mm.

Methods: This prospective, multicenter cohort study consecutively enrolled patients with concurrent UIA <7 mm and ischemic cerebrovascular disease from four hospitals between 2016 and 2019. Read More

Interv Neuroradiol 2021 May 5:15910199211015578. Epub 2021 May 5.

Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA.

Background And Purpose: Flow diversion of aneurysms located in the M1 segment and middle cerebral artery bifurcation with Pipeline embolization device is sometimes performed, but further study is needed to support its regular use in aneurysm treatment. Here, we report measures of safety and efficacy for Pipeline embolization in the proximal middle cerebral artery in a multi-center cohort.

Materials And Methods: Clinical and angiographic data of eligible patients were retrospectively obtained from participating centers and assessed for key clinical and angiographic outcomes. Read More

Stroke 2021 May 6:STROKEAHA120032500. Epub 2021 May 6.

Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China (X.F., P.Q., J.L., D.W.).

Background And Purpose: It remains unclear whether the additive effect of coexisting intracranial aneurysms increases the risk of subarachnoid hemorrhage (SAH) in patients with multiple intracranial aneurysms. We have performed a tentative analysis for the additive effect of coexisting aneurysms.

Methods: This multi-institutional cross-sectional study included 1781 aneurysms from 746 patients with multiple intracranial aneurysms. Read More

Surg Neurol Int 2021 8;12:147. Epub 2021 Apr 8.

Department of Neurosurgery, Yamagata University, Yamagata, Japan.

Background: Persistent primitive olfactory artery (PPOA) is a rare anomaly of the anterior cerebral artery. We experienced a rare case of subarachnoid hemorrhage caused by a ruptured saccular aneurysm of PPOA.

Case Description: A 72-year-old man was transported to our hospital with sudden headache. Read More

Surg Neurol Int 2021 8;12:143. Epub 2021 Apr 8.

Department of Neurosurgery, Ascension St Mary's Hospital, Saginaw, Michigan, United States.

Background: Neoplastic cerebral aneurysms related to metastatic processes are exceptionally rare and carry a dismal prognosis. Only four previous reports exist of neoplastic aneurysms secondary to metastatic adenocarcinoma, all of which were found to be lung cancer in origin. We present the fifth reported metastatic adenocarcinomatous cerebral aneurysm, and the first case is secondary to a non-lung cancer primary. Read More