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Background: The comparative efficacy and safety of first-generation flow diverters (FDs), Pipeline Embolization Device (PED) (Medtronic, Irvine, California), Silk (Balt Extrusion, Montmorency, France), Flow Re-direction Endoluminal Device (FRED) (Microvention, Tustin, California), and Surpass Streamline (Stryker Neurovascular, Fremont, California), is not directly established and largely inferred. Purpose: This study aimed to compare the efficacy of different FDs in treating sidewall ICA intracranial aneurysms. Methods: We conducted a retrospective review of prospectively maintained databases from eighteen academic institutions from 2009–2016, comprising 444 patients treated with one of four devices for sidewall ICA aneurysms. Data on demographics, aneurysm characteristics, treatment outcomes, and complications were analyzed. Angiographic and clinical outcomes were assessed using various imaging modalities and modified Rankin Scale (mRS). Propensity score weighting was employed to balance confounding variables. The data analysis used Kaplan-Meier curves, logistic regression, and Cox proportional-hazards regression. Results: While there were no significant differences in retreatment rates, functional outcomes (mRS 0–1), and thromboembolic complications between the four devices, the probability of achieving adequate occlusion at the last follow-up was highest in Surpass device (HR: 4.59; CI: 2.75–7.66, p < 0.001), followed by FRED (HR: 2.23; CI: 1.44–3.46, p < 0.001), PED (HR: 1.72; CI: 1.10–2.70, p = 0.018), and Silk (HR: 1.0 ref. standard). The only hemorrhagic complications were with Surpass (1%). Conclusion: All the first-generation devices achieved good clinical outcomes and retreatment rates in treating ICA sidewall aneurysms. Prospective studies are needed to explore the nuanced differences between these devices in the long term. [ABSTRACT FROM AUTHOR]

Loss of consciousness (LOC) at presentation with aneurysmal subarachnoid hemorrhage (aSAH) has been associated with early brain injury and poor functional outcome. The impact of LOC on the clinical course after aSAH deserves further exploration. A retrospective analysis of 149 aSAH patients who were prospectively enrolled in the Cerebral Aneurysm Renin Angiotensin Study (CARAS) between 2012 and 2015 was performed. The impact of LOC was analyzed with emphasis on patients presenting in excellent or good neurological condition (Hunt and Hess 1 and 2). A total of 50/149 aSAH patients (33.6%) experienced LOC at presentation. Loss of consciousness was associated with severity of neurological condition upon admission (Hunt and Hess, World Federation of Neurosurgical Societies (WFNS), Glasgow Coma Scale (GCS) grade), hemorrhage burden on initial head CT (Fisher CT grade), acute hydrocephalus, cardiac instability, and nosocomial infection. Of Hunt and Hess grade 1 and 2 patients, 21/84 (25.0%) suffered LOC at presentation. Cardiac instability and nosocomial infection were significantly more frequent in these patients. In multivariable analysis, LOC was the predominant predictor of cardiac instability and nosocomial infection. Loss of consciousness at presentation with aSAH is associated with an increased rate of complications, even in good-grade patients. The presence of LOC may identify good-grade patients at risk for complications such as cardiac instability and nosocomial infection. [ABSTRACT FROM AUTHOR]

Ventriculoperitoneal shunt (VPS) is the mainstay of therapy for hydrocephalus. The aim of this study is to compare outcomes of laparoscopic (LVPS) versus open (OVPS) techniques for placement of distal VPS catheters. All patients undergoing new VPS placement at a tertiary care center between January 2004 and August 2007 were included. Univariate analysis was performed. Wilcoxon rank-sum, chi-square, and Fisher’s exact tests were used to make comparisons between LVPS and OVPS groups. Stepwise backward logistic regression was performed to predict complications requiring operative intervention. A Kaplan–Meier estimate of the survival function was calculated for shunt survival. All data is presented as median and range unless otherwise specified. Five hundred thirty-five consecutive patients underwent 579 VPS (258 LVPS, 321 OVPS). Median age (52.0 years) and American Society of Anesthesiologists (ASA) score (3) were similar in LVPS and OVPS groups. Body mass index (BMI) [27.8 (17.0–64.9) kg/m2 versus 25.9 (12.3–44.4) kg/m2, p = 0.007], previous operations [0.8 ± 0.9 versus 0.6 ± 0.7, p = 0.004 (mean ± standard deviation)], estimated blood loss (EBL) [20 (0–175) ml versus 25 (0–500) ml, p < 0.001], operating room (OR) time [37.5 (17.0–152.0) min versus 52.0 (20.0–197.0) min, p < 0.001], and length of stay (LOS) [11 (1–77) days versus 14 (1–225) days, p = 0.016] were statistically different between the LVPS and OVPS groups, respectively. LVPS abdominal complication rate of 5.8% and OVPS rate of 6.9% were similar ( p = 0.611). Previous abdominal operation [odds ratio (OR) 1.673, 95% confidence interval (CI) 1.100–2.543, p = 0.016] and previous VPS (OR 1.929, 95% CI 1.147–3.243, p = 0.016) were significant predictors of complications requiring operative intervention. Kaplan–Meier analysis demonstrated no difference in survival between LVPS and OVPS groups ( p = 0.538), with overall shunt survival of 86.4% at 6 months and 83.0% at 1 year. LVPS is associated with decreased OR time, less blood loss, and shorter LOS with no difference in complication rate when compared OVPS. The laparoscopic approach for VPS is a safe, effective, and readily reproducible alternative to the traditional open approach. [ABSTRACT FROM AUTHOR]

Computed tomography (CT) perfusion imaging is a technique for the measurement of cerebral blood flow, cerebral blood volume, and time-to-peak or mean transit time. The technique involves the administration of a single-bolus dose of iodinated contrast material, followed by spiral CT imaging during the passage of the contrast bolus through the cerebral vasculature. CT perfusion is a fast and inexpensive brain imaging modality for use in the management of patients with various neurological disorders, ranging from acute stroke to subarachnoid hemorrhage. This article reviews the technique of CT perfusion and presents several illustrative cases in which this imaging modality was used effectively in the critical care of patients with neurological disorders. [ABSTRACT FROM AUTHOR]