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Several studies have shown promising outcomes of the Woven EndoBridge (WEB) device for the treatment of wide-necked intracranial bifurcation aneurysms. This is a multicenter study attempts to explore the changes in trends and treatment outcomes over time for WEB embolization of intracranial aneurysms. The WorldWideWEB consortium is a retrospective multicenter collaboration of data from international centers spanning from January 2011 and June 2021, with no limitations on aneurysm location or rupture status. Both bifurcation and sidewall aneurysms were included. These patients were stratified based on treatment year into five treatment intervals: 2011-2015 (N = 66), 2016-2017 (N = 77), 2018 (N = 66), 2019 (N = 300), and 2020-2021 (N = 173). Patient characteristics and angiographic and clinical outcomes were compared between these time intervals. This study comprised 671 patients (median age 61.4 years; 71.2% female) with 682 intracranial aneurysms. Over time, we observed an increasing tendency to treat patients presenting with ruptured aneurysms and aneurysms with smaller neck, diameter, and dome widths. Furthermore, we observed a trend towards more off-label use of the WEB for sidewall aneurysms and increased adoption of transradial access for WEB deployment. Moreover, the proportion of patients with adequate WEB occlusion immediately and at last follow-up was significantly higher in more recent year cohorts, as well as lower rates of compaction and retreatment. Mortality and complications did not differ over time. This learning curve study suggests improved experience using the WEB for the treatment of intracranial aneurysms and has yielded higher rates of adequate occlusion over time.

The objective of this study is to provide an update on endovascular treatments for iatrogenic internal carotid artery (ICA) injuries following endonasal surgery. A systematic review of the literature was performed by using Medline, Cochrane library, and Scopus from 1999 to 2019. We used a combination of the MeSH terms “internal carotid artery,” “iatrogenic disease,” and “endovascular procedure.” Twenty-six articles including 46 patients were identified for in this systematic review. The mean age of the patients was 49 years (CI: ± 4.2). The most common site of ICA injury was in cavernous segment (18 patients; 39%). The most common type of iatrogenic ICA injury was a traumatic pseudoaneurysm documented in 28 patients (60%). Endoluminal reconstruction was performed using covered stents in 28 patients, the Pipeline embolization device (PED) in 13 patients, the Surpass flow diverter device in three, the SILK flow diverter in one, and one case was treated using a combined approach of a covered stent and a PED. Flow diversion and covered stents resulted in a good clinical outcome in 94% and 89% of patients, respectively. This difference did not reach statistical significance (p = 1.0). Even though this systematic review was limited due to articles of small sample sizes and considerable heterogeneity, the results indicate that flow diverting devices and covered stents are good therapeutic options for endoluminal reconstruction of iatrogenic ICA injuries following endonasal surgery.

Variants of the posterior intracranial circulation are important for surgeon, interventionalists and radiologists. Herein, a unique configuration of the basilar artery is reported. A 54-year-old man with a history of COPD, hypothyroidism, smoking, and hyperlipidemia presented to an outside institution with nausea, confusion, altered mental status, and ataxia. The patient was evaluated for stroke. Imaging revealed rotation of the basilar apex of 180 degrees, fetal configuration of the posterior communicating artery, right posterior cerebral artery filling from the left vertebral artery, and duplication of the left and right superior cerebellar arteries. The patient continued to deteriorate neurologically and MRI revealed multifocal and symmetric signal abnormalities in the brain stem, thalami, basal ganglia, and hippocampi. The differential diagnosis included acute disseminated myeloencephalitis. Despite plasma exchange and steroid therapy, the patient died a few days later. This case report demonstrates a rare variation of the basilar apex.

Acute ischemic stroke affects men and women differently. In particular, women are often reported to experience higher acute stroke severity than men. We derived a low-dimensional representation of anatomical stroke lesions and designed a Bayesian hierarchical modeling framework tailored to estimate possible sex differences in lesion patterns linked to acute stroke severity (National Institute of Health Stroke Scale). This framework was developed in 555 patients (38% female). Findings were validated in an independent cohort (n = 503, 41% female). Here, we show brain lesions in regions subserving motor and language functions help explain stroke severity in both men and women, however more widespread lesion patterns are relevant in female patients. Higher stroke severity in women, but not men, is associated with left hemisphere lesions in the vicinity of the posterior circulation. Our results suggest there are sex-specific functional cerebral asymmetries that may be important for future investigations of sex-stratified approaches to management of acute ischemic stroke., Acute ischemic stroke impacts men and women differently. Here, the authors show how different lesion patterns in men and women are linked to the extent of stroke severity.

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.

The superior petrosal sinus is located between the middle and posterior cranial fossae and is important during many neurosurgical approaches to the skull base. Using standard search engines, the anatomical and clinical importance of the superior petrosal sinus was investigated. The superior petrosal sinus is important in many neurosurgical approaches and pathological entities. Therefore, it is important for those who operate at the skull base or interpret imaging here to have a good working knowledge of its anatomy, development, and pathological involvement.

Introduction Galen of Pergamum was the physician of Roman Emperors and contributed to our early understanding of medicine and anatomy. Herein, we present a short biography of Galen and review his multiple contributions to medicine and anatomy.

The inferior petrosal sinus is an important component of the cerebral venous system with implications in diagnosis and treatment of a variety of diseases such as Cushing’s disease, carotid cavernous, and dural arteriovenous fistulas. This manuscript will review the anatomy, embryology, and clinical implications of the inferior petrosal sinus. Knowledge of the inferior petrosal sinus is of great importance for open surgical approaches to the skull base and endovascular access to the cavernous sinus and sellar region.

Various case reports on nasal myiasis written during the 1990s and 2000s state that nasal myiasis, which is known as peenash among South Asian natives, is a form of divine punishment in Hindu mythology, but do not provide citations from Hindu scriptures that would suggest this interpretation. This paper aims to discuss the phenomenon of peenash in a historical context by examining medical literature written during the nineteenth and early twentieth centuries, to identify Hindu texts contributing to the belief of some Hindus that nasal myiasis is a form of divine punishment, and to provide an overview of contemporary treatment for and management of nasal myiasis.

The role of the choroid plexus in cerebrospinal fluid production has been identified for more than a century. Over the years, more intensive studies of this structure has lead to a better understanding of the functions, including brain immunity, protection, absorption, and many others. Here, we review the macro- and microanatomical structure of the choroid plexus in addition to its function and embryology. The literature was searched for articles and textbooks for data related to the history, anatomy, physiology, histology, embryology, potential functions, and surgical implications of the choroid plexus. All were gathered and summarized comprehensively. We summarize the literature regarding the choroid plexus and its surgical implications.

The cerebral ventricles have been recognized since ancient medical history. Their true function started to be realized more than a thousand years later. Their anatomy and function are extremely important in the neurosurgical panorama. The literature was searched for articles and textbooks of different topics related to the history, anatomy, physiology, histology, embryology and surgical considerations of the brain ventricles. Herein, we summarize the literature about the cerebral ventricular system.

Unilateral lambdoidal craniosynostosis is a rare disorder that occurs in approximately 3 % of all craniosynostosis phenotypes and only 0.03 % of one million live births. It is even more unusual for this type of synostosis to occur in siblings with only two other cases reported in the literature.We report a set of full-term dizygotic twins born with lambdoidal synostosis and a family history of connective tissue and cardiovascular anomalies. One of the twins also had concomitant bicoronal craniosynostosis.True familial lambdoidal synostosis is exceedingly rare. The present cases in dizygotic twins occurred in a family with a significant history of connective tissue disease suggesting a possible association.

William Watson Cheyne lived and trained during a period of great advances in medical knowledge and surgical techniques. Despite his various contributions to the fields of bacteriology and surgery, little is known about his career or his life apart from his affiliations with Joseph Lister. This article aims to identify Cheyne as a pioneer in the treatment of congenital hydrocephalus and sheds light on the man who existed in Lister's shadow for most of his life. Cheyne's technique for surgical intervention of hydrocephalus was a great turning point and contributes to the current treatment strategy utilized today for hydrocephalus.

Kleeblattschadel (cloverleaf) skull is a very uncommon form of pansynostosis. Some cases are associated with syndromes, but often, this skull deformity is seen in isolation. To date, a comprehensive review of this topic is not available in the medical literature. Herein, we review the history, associations, diagnosis, treatment, and complications of Kleeblattschadel skull.

Spondylolysis is most commonly observed in the lumbar spine, particularly L5, and is associated with spondylolisthesis, or anterior "slippage" of a vertebra in relation to an adjacent vertebra. Isthmic spondylolisthesis is the result of a pars interarticularis defect and will be the only type of spondylolisthesis addressed in this review.Spondylolysis and spondylolisthesis represent a relatively common cause of low back pain, especially in young athletes, and a less common cause of neurologic compromise. When discovered in a symptomatic patient with corroborating imaging findings, early intervention provides an excellent prognosis. Herein, we review the anatomy and pathology of spondylosis and spondylolisthesis of the L5 vertebra.

Gabriele Fallopio was one of the greatest anatomists of the sixteenth century. He discovered and named numerous parts of the human body. His name survives to this day as it is associated with several anatomical structures including the Fallopian canal, Fallopian hiatus, Fallopian valve, Fallopian muscle, and the Fallopian tube.Our current knowledge of human anatomy is based on giants such as Fallopio. His contributions to neuroanatomy laid the foundations for the development of this discipline.

The arachnoid mater is a delicate and avascular layer that lies in direct contact with the dura and is separated from the pia mater by the cerebrospinal fluid-filled subarachnoid space. The subarachnoid space is divided into cisterns named according to surrounding brain structures. The medical literature on this meningeal layer was reviewed in regard to historical aspects, etymology, embryology, histology, and anatomy with special emphasis on the arachnoid cisterns. Cerebrospinal fluid dynamics are discussed along with a section devoted to arachnoid cysts. Knowledge on the arachnoid mater and cerebrospinal fluid dynamics has evolved over time and is of great significance to the neurosurgeon in clinical practice.

There is scant and conflicting literature regarding bony canals of the clivus. To date, only osteological observations of dry skulls have been made of such structures and multiple hypotheses exist regarding the etiology of these entities and whether or not they represent normal variations or pathology. The present study was performed to elucidate, specifically, clival canals of the occipital portion of the clivus.One hundred dry skulls (80 adult and 20 children) and 47 adult cadavers were included, and the superior and inferior surfaces of their clivus were inspected for bony defects/canals. When identified, the canals were measured and their potential contents removed. The contents of the canals in these cadaveric specimens were submitted for histological analysis.A canal of the clivus was identified in 5% of dry specimens and in 6.4% of cadaveric specimens. One diagonal and five more or less vertical canals were found. One canal was observed to have a single opening and one canal was found to have three openings. For the cadaveric canals, histology of the contents revealed no pituitary or notochordal tissue with only vascular anatomy consistent with veins. These venous structures appeared to connect parts of the basilar venous plexus.Based on our study, which is the first of its kind, such canals of the occipital portion of the clivus should not be mistaken for pathology and represent simple vascular channels.

Conjoined twins fused at the head, or craniopagus twins,occur with an approximate incidence of one in every 2.5million live births, and such twins represent only 2 to 6 % ofconjoinedtwins[10].Incraniopagusparasiticus,whichisalsoknown as epicome [3]orepicomus [8], a parasitic twin headwith an undeveloped or underdeveloped body is conjoined tothe head of the developed twin [7, 8], as in the case of the“two-headedboyofBengal”(Fig.1andCoverFigure)bornin1783[3].TheauthorsbrieflydiscusstheapocryphaltaleofanEnglishman afflicted with this condition, Edward Mordake(Fig. 2), who has been the subject of various works of art,includingMordake,anoperabythecomposerErlingWold[5],and “Chained Together for Life,” asongbythesinger-songwriter Tom Waits, which is featured on his album Alice[6].Mordake’slegendmayfindagreateraudienceamongfansof the cinematic genre of horror through the fourth season ofthe American television series American Horror Story,subtitled Freak Show. This season of the series is set in 1952in Jupiter, FL, and revolves around a troupe of carnival per-formers with various congenitalanomalies [9].The actorWesBentleyplaysthetwo-facedcharacterof“EdwardMordrake,”whom one of the show’s creators, Ryan Murphy, describes asa subject of superstition among carnival performers [9].Mordake’s predicament is detailed in the following passagefrom Anomalies and Curiosities of Medicine by Gould andPyle, which was first published in 1896 [4]:“One of the weirdestas well as most melancholy stories ofhuman deformity is that of Edward Mordake, said to havebeenheir to one of the noblest peerages in England. He neverclaimed the title, however, and committed suicide in histwenty-third year. He lived in complete seclusion, refusingthe visits even of the members of his own family. He was ayoung man of fine attainments, a profound scholar, and amusician of rare ability. His figure was remarkable for itsgrace, and his face – that is to say, his natural face – was thatof Antinous. But upon the back of his head was another face,thatofa beautiful girl, ‘lovelyasa dream,hideousasa devil.’The female face was a mere mask, ‘occupying only a smallportion of the posterior part of the skull, yet exhibiting everysignofintelligence,ofamalignantsort,however.’ItwouldbeseentosmileandsneerwhileMordakewasweeping.Theeyeswould follow the movements of the spectator, and the lipswould ‘gibber without ceasing.’ No voice was audible, butMordake avers that he was kept from his rest at night by thehateful whispers of his ‘devil twin,’ as he called it, ‘whichnever sleeps, but talks to me forever of such things as theyonly speak of in hell. No imagination can conceivethe dread-ful temptations it sets before me. For some unforgiven wick-edness of my forefathers I am knitto this fiend – for a fiend itsurely is. I beg and beseech you to crush it out of humansemblance, even if I die for it.’ Such were the words of thehaplessMordaketoManversandTreadwell,hisphysicians.Inspite of careful watching he managed to procure poison,whereof he died, leaving a letter requesting that the ‘demonface’mightbedestroyedbeforehisburial,‘lestitcontinuesitsdreadfulwhisperingsinmygrave.’Athisownrequesthewasinterred in a waste place, without stone or legend to mark hisgrave.”Gould and Pyle note that Mordake’scasewas“taken fromlaysources”butwas“ofsufficientnotorietyandinterest”tobe

In this editorial, the issues of hypocapnia and its relation to symptomatic vasospasm, prognosis, and outcome among patients with aneurysmal subarachnoid hemorrhage is discussed. Potential directions for future studies are provided.