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© 2014 Selenica et al.; licensee BioMed Central Ltd.Background: Abnormal tau hyperphosphorylation and its accumulation into intra-neuronal neurofibrillary tangles are linked to neurodegeneration in Alzheimer's disease and similar tauopathies. One strategy

A man in his early 70s presented to the emergency department about 3.5 hours after acute onset right sided hemiplegia and aphasia. CT angiography confirmed an acute occlusion of the M1 segment of the left middle cerebral artery and severe, but stable, dissection of the aortic arch and a large dissecting aortic aneurysm extending into the innominate artery and beyond into the descending aorta. The risk of aggravating existing aortic pathology while trying to navigate from a transfemoral or transradial approach was considered to be very high; therefore, the decision was made to proceed with direct carotid puncture for mechanical thrombectomy. The procedure was successfully completed, and the carotid puncture site was closed without issue using the Celt ACD vascular closure device (Vasorum, Dublin, Ireland). The patient recovered and was discharged home at his prestroke neurologic baseline 9 days later. Here we discuss the safe and effective use of this novel closure device in the setting of direct carotid puncture for neurointerventional procedures., Competing Interests: Competing interests: AHS: financial Interest/investor/stock options/ownership: Adona Medical, Bend IT Technologies, BlinkTBI, Borvo Medical, Cerebrotech Medical Systems, Code Zero Medical, Cognition Medical, Collavidence, CVAID, E8, Endostream Medical, Galaxy Therapeutics, Hyperion Surgical, Imperative Care, InspireMD, Instylla, Launch NY, Neurolutions, NeuroRadial Technologies (sold to Medtronic in 2021), Neurovascular Diagnostics, Peijia Medical, PerFlow Medical, Piraeus Medical, Q’Apel Medical, QAS.ai, Radical Catheter Technologies, Rebound Therapeutics (purchased 2019 by Integra Lifesciences), Rist Neurovascular (purchased 2020 by Medtronic), Sense Diagnostics, Serenity Medical, Silk Road Medical, Sim & Cure, Spinnaker Medical, StimMed, Synchron, Tulavi Therapeutics, Vastrax, Viseon, Whisper Medical, and Willow Medtech; consultant/advisory board: Amnis Therapeutics, Apellis Pharmaceuticals, Boston Scientific, Canon Medical Systems USA, Cardinal Health 200, Cerebrotech Medical Systems, Cerenovus, Cordis, Corindus, Endostream Medical, Hyperfine Operations, Imperative Care, InspireMD, Integra, IRRAS AB, Medtronic, MicroVention, Minnetronix Neuro, Peijia Medical, Penumbra, Piraeus Medical, Q’Apel Medical, Rapid Medical, Serenity Medical, Silk Road Medical, StimMed, Stryker Neurovascular, VasSol, and Viz.ai; national PI/steering committees: Cerenovus EXCELLENT and ARISE II trial; Medtronic SWIFT PRIME, VANTAGE, EMBOLISE, and SWIFT DIRECT trials; MicroVention FRED trial and CONFIDENCE study; MUSC POSITIVE trial; Penumbra 3D Separator trial, COMPASS trial, INVEST trial, MIVI neuroscience EVAQ trial; Rapid Medical SUCCESS trial; and InspireMD C-GUARDIANS IDE pivotal trial; patent: patent No US 11,464,528 B2, October 11, 2022, Clot retrieval system for removing occlusive clot from a blood vessel, applicant and assignee, Neuravi Limited (Galway), role, co-inventor., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Background and Objective: Ambulatory surgery centers (ASCs) are increasingly common venues for same-day neurosurgical procedures, allowing for cost-effective, high-quality patient care. We present the first and largest series of patients undergoing diagnostic cerebral angiography at an ASC to demonstrate the effectiveness, safety, and efficiency of outpatient endovascular care., Methods: We retrospectively reviewed data for consecutive patients who underwent diagnostic cerebral angiography at our ASC between January 1, 2024, and May 29, 2024. Data collected included vascular access approach, procedural duration, turnover time, and periprocedural complications. Using a standardized 2-week postprocedural survey, patients were asked to provide comments and rate their subjective satisfaction from a 1 to 5 scale, with "5" being completely satisfied. All cases were performed with a physician team comprising 1 attending neuroendovascular neurosurgery and 1 neuroendovascular fellow present. Fentanyl and midazolam were administered for conscious sedation in all cases., Results: Among the 67 patients included in this series, the mean procedural duration was 29.4 ± 8.6 minutes. The mean turnover time was 13.7 ± 3.6 minutes. Between transradial (46 of 67 [68.7%]) and transfemoral (21 of 67 [31.3%]) access site approaches, there were no statistically significant differences in mean procedural duration (29.4 ± 8.0 vs 29.2 ± 9.9 minutes, respectively; P = .72) or turnover time (14.0 ± 3.9 vs 12.9 ± 2.8 minutes, respectively; P = .4). No complications occurred periprocedurally or within the 2-week follow-up period. A total of 48 (71.6%) of 67 patients responded to the postprocedural survey, all of whom unanimously reported a score of "5.", Conclusion: We found that diagnostic cerebral angiography performed at our ASC was safe and effective for patient care. In addition, all survey respondents (71.6% of those provided the survey) reported highest levels of satisfaction. The integration of neuroendovascular procedures into ASCs potentially offers a cost-effective and highly efficient option in an evolving economic landscape., (Copyright © Congress of Neurological Surgeons 2024. All rights reserved.)

Cavernous sinus thrombosis is a potentially lethal subset of cerebral venous sinus thrombosis that may occur as a result of septic and aseptic etiologies. The overall incidence is estimated to be between 0.2 and 1.6 per 100,000 persons; and treatments include antibiotics, anticoagulation, corticosteroids, and surgery. Recent morbidity and mortality estimates are approximately 15% and 11%, respectively. Rapid identification and treatment are essential and may reduce the risk of poor outcome or death., Competing Interests: Disclosure Dr J.M. Davies reports consulting fees, payment, or honoraria for lectures, presentations, speakers’ bureaus, article writing, or educational events from Medtronic and Rapid Medical; support for attending meetings and/or travel from Medtronic and Rapid Medical; patents planned, issued, or pending from QAS.ai; participation on a data safety monitoring board or advisory board for the National Institutes of Health National Institute of Neurological Disorders and Stroke Strokenet; and stock or stock options from Synchron, Cerebrotech, and QAS.ai. No disclosures were reported by the other authors., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Cerebral pial arteriovenous fistulas (pAVFs) are rare and complex high-flow vascular malformations found in pediatric and adolescent populations. 1 They are often divided into two groups based on the pattern of venous drainage, galenic or nongalenic. Nongalenic pAVFs are typically supratentorial and carry a high risk of rupture. Their angioarchitecture is very complex with various patterns of feeding arteries and draining veins not originating from dural vessels or the vein of Galen. 2 The natural history has not been well established; however, mortality estimates range as high 63%. 1 Presentations include hemorrhage, seizure, congestive heart failure, and elevated intracranial pressure. 3 We describe the case of an adolescent girl with acute onset of headaches that led to the discovery of an occipital, nongalenic pAVF. Transarterial and transvenous embolizations performed during a single procedure resulted in complete obliteration of the fistula. No complications arose, and the patient remained at her neurological baseline., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Surface modification of flow diverters (FDs) has been explored as a solution for reducing thrombotic risk of these devices, without necessarily using dual antiplatelet therapy (DAPT). If effective, this could pose a promising alternative for treatment of ruptured aneurysms not amenable to other modalities., Methods: We performed a comprehensive search of PubMed, MEDLINE, and Embase databases following Preferred Reporting Items for Systematic reviews and Meta-analyzes guidelines. We included articles reporting use of surface-modified FDs for treatment of ruptured aneurysms. Demographics, subarachnoid hemorrhage (SAH) severity, aneurysm characteristics, devices used, periprocedural complications, angiographic outcomes, and mortality were extracted for sample size-based weighted analysis., Results: Six studies comprising 59 patients with 64 aneurysms were included. Mean patient age was 56.6 ± 6.3 years and 60.6% (95% confidence interval [CI], 46.7-72.9%) were women. The anterior circulation was the location in 60.4% (95%CI, 45.5-73.5%) of aneurysms; 41.8% of the aneurysms were saccular (95%CI, 29.3-55.4%), 16.7% were fusiform (95%CI, 8.3-30.8%), 29.9% were dissecting (95%CI, 12.8-55.4%), 24.4% were blood-blister (95%CI, 15.2-36.7%), and 5.7% were mycotic (95%CI, 2-15.1%). Poor SAH grade was reported in 46.9% (95%CI, 33.3-60.9%). Adjunctive coiling was used in 33.2% (95%CI, 12.4-63.6%). Periprocedural thromboembolic and hemorrhagic complications occurred in 20% (95%CI, 7.1-45.1%) and 8.8% (95%CI, 3.7-19.5%), respectively. Complete occlusion was achieved in 76.4% (95%CI, 58.1-88.3%); no retreatments during follow-up were reported. Overall mortality was 15.1% (95%CI, 7.7-27.6%). There were no differences between single antiplatelet therapy (SAPT) and DAPT regimens with respect to periprocedural thromboembolic complications ( P  = 0.09), hemorrhagic ( P  = 0.834) complications, and mortality ( P  = 0.312)., Conclusion: Surface-modified FD treatment of ruptured aneurysms resulted in high rates of thromboembolic complications and acceptable rates of hemorrhagic complications. A considerable proportion of aneurysms were nonsaccular. Rates of complete occlusion were high and retreatment were low. Importantly, no statistically significant difference was found between SAPT and DAPT with respect to complications and mortality., Competing Interests: Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: AM, AK, BD, CCK, SMB, MW, SBH—None. JMC—Consulting Fees: Cerenovus, J&J Medical Device Companies; Integra Lifesciences, Corp.; MIVI Neuroscience, Inc.; Penumbra, Inc.; Stryker, Corp. Support for attending meetings and/or travel: Stryker, Corp.; Penumbra, Inc. JMD—Consulting fees; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events; support for attending meetings and/or travel: Medtronic. Patents planned, issued, or pending: QAS.ai. Participation on a Data Safety Monitoring Board or Advisory Board: NIH NIHDS Strokenet. Stock or stock options: Synchron, Cerebrotech, QAS.ai. KVS—Consulting Fees: Boston Scientific, Canon Medical Systems USA, Inc., MicroVention, Medtronic, Stryker Neurovascular. Payment or honoraria for lectures, presentations, speakers’ bureaus, manuscript writing, or educational event: Canon Medical Systems USA Inc. Stock or stock options: Boston Scientific, Access Closure Inc, Niagara Gorge Medical. EIL—Shareholder/Ownership Interest: NeXtGen Biologics, RAPID Medical, Claret Medical, Cognition Medical, Imperative Care, Rebound Therapeutics, StimMed, Three Rivers Medical; Patent: Bone Scalpel; Honorarium for Training & Lectures: Medtronic, Penumbra, Microvention, Integra, Consultant: Clarion, GLG Consulting, Guidepoint Global, Imperative Care, Medtronic, StimMed, Misionix, Mosiac; Chief Medical Officer: Haniva Technology; National PI: Medtronic- Steering Committees for SWIFT Prime and SWIFT Direct Trials; Site PI Study: Microvention (CONFIDENCE Study) Medtronic (STRATIS Study-Sub 1); Advisory Board: Stryker (AIS Clinical Advisory Board), NeXtGen Biologics, MEDX, Cognition Medical; Endostream Medical, IRRAS AB (Consultant/Advisory Board, Medical Legal Review: Dr Levy renders medical/legal opinions as an expert witness;); Leadership or fiduciary roles in other board society, committee, or advocacy group, paid and unpaid: CNS, ABNS, UBNS. AHS—Consulting fees: Amnis Therapeutics, Apellis Pharmaceuticals, Inc., Boston Scientific, Canon Medical Systems USA, Inc., Cardinal Health 200, LLC, Cerebrotech Medical Systems, Inc., Cerenovus, Cerevatech Medical, Inc., Cordis, Corindus, Inc., Endostream Medical, Ltd, Imperative Care, InspireMD, Ltd, Integra, IRRAS AB, Medtronic, MicroVention, Minnetronix Neuro, Inc., Peijia Medical, Penumbra, Q’Apel Medical, Inc., Rapid Medical, Serenity Medical, Inc., Silk Road Medical, StimMed, LLC, Stryker Neurovascular, Three Rivers Medical, Inc., VasSol, Viz.ai, Inc. Leadership or fiduciary role in other board, society, committee or advocacy group: Secretary—Board of the Society of NeuroInterventional Surgery 2020–2021, Chair—Cerebrovascular Section of the AANS/CNS 2020–2021. Stock or stock options: Adona Medical, Inc., Amnis Therapeutics, Bend, IT Technologies, Ltd, BlinkTBI, Inc, Cerebrotech Medical Systems, Inc., Cerevatech Medical, Inc., Cognition Medical, CVAID Ltd, E8, Inc., Endostream Medical, Ltd, Galaxy Therapeutics, Inc., Imperative; Care, Inc., InspireMD, Ltd, Instylla, Inc., International Medical Distribution Partners, Launch NY, Inc.; Neurolutions, Inc., NeuroRadial Technologies, Inc., NeuroTechnology Investors, Neurovascular Diagnostics, Inc., Peijia; Medical, PerFlow Medical, Ltd, Q’Apel Medical, Inc., QAS.ai, Inc., Radical Catheter Technologies, Inc., Rebound Therapeutics Corp. (Purchased 2019 by Integra Lifesciences, Corp), Rist Neurovascular, Inc. (Purchased 2020 by Medtronic), Sense Diagnostics, Inc., Serenity Medical, Inc., Silk Road Medical, Sim & Cure, SongBird Therapy, Spinnaker Medical, Inc., StimMed, LLC, Synchron, Inc., Three Rivers Medical, Inc., Truvic Medical, Inc., Tulavi Therapeutics, Inc., Vastrax, LLC, VICIS, Inc., Viseon, Inc. Other financial or non-financial interests: National PI/Steering Committees: Cerenovus EXCELLENT and ARISE II Trial; Medtronic SWIFT PRIME, VANTAGE, EMBOLISE and SWIFT DIRECT Trials; MicroVention FRED Trial & CONFIDENCE Study; MUSC POSITIVE Trial; Penumbra 3D Separator Trial, COMPASS Trial, INVEST Trial, MIVI neuroscience EVAQ Trial; Rapid Medical SUCCESS Trial; InspireMD C-GUARDIANS IDE Pivotal Trial.

Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Advanced salvage techniques are an essential tool in the armamentarium of any experienced endovascular surgeon. In this video, we show a patient presenting with rerupture of an anterior communicating artery (ACoA) aneurysm that had been treated with balloon-assisted coiling several months earlier in a ruptured setting. Premature coil detachment occurred during an attempt to coil a new bleb that the aneurysm had developed, and a sequence of salvage maneuvers was performed. An initial attempt to implant that coil failed, and retrieval with a snare unfortunately caused coil fragmentation and occlusion of the anterior cerebral artery (ACA). Further salvage maneuvers required inducing flow-arrest with a balloon-guide catheter, use of a stent-retriever to recanalize the ACA A2 segment, and aspiration to capture a small fragment of coil that was seen at the tip of the balloon guide catheter., Competing Interests: Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: MW, SBH, AM—nothing to disclose. JMC-Consulting Fees: Cerenovus, J&J Medical Device Companies; Integra Lifesciences, Corp.; MIVI Neuroscience, Inc.; Penumbra, Inc.; Stryker, Corp.; AHS—Consulting fees: Amnis Therapeutics, Apellis Pharmaceuticals, Inc., Boston Scientific, Canon Medical Systems USA, Inc., Cardinal Health 200, LLC, Cerebrotech Medical Systems, Inc., Cerenovus, Cerevatech Medical, Inc., Cordis, Corindus, Inc., Endostream Medical, Ltd, Imperative Care, Integra, IRRAS AB, Medtronic, MicroVention, Minnetronix Neuro, Inc., Penumbra, Q’Apel Medical, Inc., Rapid Medical, Serenity Medical, Inc., Silk Road Medical, StimMed, LLC, Stryker Neurovascular, Three Rivers Medical, Inc., VasSol, Viz.ai, Inc., W.L. Gore & Associates. Leadership or fiduciary role in other board, society, committee or advocacy group: Secretary of the Board of the Society of NeuroInterventional Surgery, Chair of the Cerebrovascular Section of the AANS/CNS. Stock or stock options: Adona Medical, Inc., Amnis Therapeutics, Bend IT Technologies, Ltd, BlinkTBI, Inc, Buffalo Technology Partners, Inc., Cardinal Consultants, LLC, Cerebrotech Medical Systems, Inc, Cerevatech Medical, Inc., Cognition Medical, CVAID Ltd, E8, Inc., Endostream Medical, Ltd, Imperative Care, Inc., Instylla, Inc., International Medical Distribution Partners, Launch NY, Inc., NeuroRadial Technologies, Inc., Neurotechnology Investors, Neurovascular Diagnostics, Inc., PerFlow Medical, Ltd, Q’Apel Medical, Inc., QAS.ai, Inc., Radical Catheter Technologies, Inc., Rebound Therapeutics Corp. (Purchased 2019 by Integra Lifesciences, Corp), Rist Neurovascular, Inc. (Purchased 2020 by Medtronic), Sense Diagnostics, Inc., Serenity Medical, Inc., Silk Road Medical, Adona Medical, Inc., Amnis Therapeutics, Bend IT Technologies, Ltd, BlinkTBI, Inc, Buffalo Technology Partners, Inc., Cardinal Consultants, LLC, Cerebrotech Medical Systems, Inc, Cerevatech Medical, Inc., Cognition Medical, CVAID Ltd, E8, Inc., Endostream Medical, Ltd, Imperative Care, Inc., Instylla, Inc., International Medical Distribution Partners, Launch NY, Inc., NeuroRadial Technologies, Inc., Neurotechnology Investors, Neurovascular Diagnostics, Inc., PerFlow Medical, Ltd, Q’Apel Medical, Inc., QAS.ai, Inc., Radical Catheter Technologies, Inc., Rebound Therapeutics Corp. (Purchased 2019 by Integra Lifesciences, Corp), Rist Neurovascular, Inc. (Purchased 2020 by Medtronic), Sense Diagnostics, Inc., Serenity Medical, Inc., Silk Road Medical, SongBird Therapy, Spinnaker Medical, Inc., StimMed, LLC, Synchron, Inc., Three Rivers Medical, Inc., Truvic Medical, Inc., Tulavi Therapeutics, Inc., Vastrax, LLC, VICIS, Inc., Viseon, Inc. Other financial or non-financial interests: National PI/Steering Committees: Cerenovus EXCELLENT and ARISE II Trial; Medtronic SWIFT PRIME, VANTAGE, EMBOLISE and SWIFT DIRECT Trials; MicroVention FRED Trial & CONFIDENCE Study; MUSC POSITIVE Trial; Penumbra 3D Separator Trial, COMPASS Trial, INVEST Trial, MIVI neuroscience EVAQ Trial; Rapid Medical SUCCESS Trial; InspireMD C-GUARDIANS IDE Pivotal Trial.EIL--Shareholder/Ownership Interest: NeXtGen Biologics, RAPID Medical, Claret Medical, Cognition Medical, Imperative Care, Rebound Therapeutics, StimMed, Three Rivers Medical; Patent: Bone Scalpel; Honorarium for Training & Lectures: Medtronic, Penumbra, MicroVention, Integra, Consultant: Clarion, GLG Consulting, Guidepoint Global, Imperative Care, Medtronic, StimMed, Misionix, Mosiac; Chief Medical Officer: Haniva Technology; National PI: Medtronic- Steering Committees for SWIFT Prime and SWIFT Direct Trials; Site PI Study: MicroVention (CONFIDENCE Study) Medtronic (STRATIS Study-Sub 1); Advisory Board: Stryker (AIS Clinical Advisory Board), NeXtGen Biologics, MEDX, Cognition Medical; Endostream Medical, IRRAS AB (Consultant/Advisory Board, Medical Legal Review: render medical/legal opinions as an expert witness; leadership or fiduciary roles in other board society, committee or advocacy group, paid and unpaid: CNS, ABNS, UBNS; Support for attending meetings and/or travel: Stryker, Corp.; Penumbra, Inc.Video ©University at Buffalo Neurosurgery, Inc. April 2022. With permission.

Background: The transradial approach (TRA) for mechanical thrombectomy (MT) for acute ischemic stroke has been limited by the size of catheters usable in the radial artery, with the smaller access site precluding balloon-guide catheter (BGC) use. However, promising results have been reported for a TRA with a sheathless BGC (sTRA). We sought to perform a comparative study of MT with a BGC via the sTRA versus the transfemoral approach (TFA)., Methods: A retrospective review of our MT database was conducted. Baseline, procedure-related, and outcome data were compared for patients aged ≥18 years with anterior circulation large vessel occlusion, Alberta Stroke Program Early CT Score ≥6, and prestroke modified Rankin Scale score ≤2 treated with either approach., Results: Ninety-three consecutive patients (34 sTRA and 59 TFA) were included. Both groups had similar demographics, comorbidities, stroke severity, intravenous alteplase use, and occlusion location. Mean time from puncture to final recanalization was faster in the sTRA group (29 vs 36 min, p=0.059) despite a higher access site crossover rate in the sTRA group (11.8% vs 0%, p=0.016). There were no differences between groups regarding last modified Thombolysis in Cerebral Infarction score; first-pass or modified first-pass effect; time from last known well to puncture; use of stent-retriever, aspiration, or combination first approach; number of passes; symptomatic intracranial hemorrhage; hospital stay; 90-day functional independence; and mortality. National Institutes of Health Scale score and modified first-pass effect were the only independent predictors of poor outcomes., Conclusions: Comparable patients treated with MT via the sTRA or TFA had similar angiographic and clinical outcomes., Competing Interests: Competing interests: MW, AM, MDK, FA, SBH, JL, and RHD: None. JMC: Consulting Fees: Cerenovus, J&J Medical Device Companies; Integra Lifesciences; MIVI Neuroscience; Penumbra; Stryker. Support for attending meetings and/or travel: Stryker; Penumbra. KVS: Consulting Fees: Boston Scientific, Canon Medical Systems USA, MicroVention, Medtronic, Stryker Neurovascular. Payment or honoraria for lectures, presentations, speakers’ bureaus, manuscript writing, or educational event: Canon Medical Systems USA. Stock or stock options: Boston Scientific, Access Closure, Niagara Gorge Medical. JMD: Consulting fees; payment or honoraria for lectures, presentations, speakers’ bureaus, manuscript writing, or educational events: Medtronic, Rapid Medical. Support for attending meetings and/or travel: Medtronic, Rapid Medical. Patents planned, issued, or pending: QAS.ai; Participation on a Data Safety Monitoring Board or Advisory Board: NIH NIHDS Strokenet. Stock or stock options: Synchron, Cerebrotech, QAS.ai. AHS: Consulting fees: Amnis Therapeutics, Apellis Pharmaceuticals, Boston Scientific, Canon Medical Systems USA, Cardinal Health 200, Cerebrotech Medical Systems, Cerenovus, Cerevatech Medical, Cordis, Corindus., Endostream Medical, Imperative Care, Integra, IRRAS AB, Medtronic, MicroVention, Minnetronix Neuro, Penumbra, Q’Apel Medical, Rapid Medical, Serenity Medical, Silk Road Medical, StimMed, Stryker Neurovascular, Three Rivers Medical, VasSol, Viz.ai, W.L. Gore & Associates. Leadership or fiduciary role in other board, society, committee or advocacy group: Secretary of the Board of the Society of NeuroInterventional Surgery, Chair of the Cerebrovascular Section of the AANS/CNS. Stock or stock options: Adona Medical, Amnis Therapeutics, Bend IT Technologies, BlinkTBI, Buffalo Technology Partners, Cardinal Consultants, Cerebrotech Medical Systems, Cerevatech Medical, Cognition Medical, CVAID, E8, Endostream Medical, Imperative Care, Instylla, International Medical Distribution Partners, Launch NY, NeuroRadial Technologies, Neurotechnology Investors, Neurovascular Diagnostics, PerFlow Medical, Q’Apel Medical, QAS.ai, Radical Catheter Technologies, Rebound Therapeutics (purchased 2019 by Integra Lifesciences), Rist Neurovascular, (purchased 2020 by Medtronic), Sense Diagnostics, Serenity Medical, Silk Road Medical, Adona Medical, Amnis Therapeutics, Bend IT Technologies, BlinkTBI, Buffalo Technology Partners, Cardinal Consultants, Cerebrotech Medical Systems, Cerevatech Medical, Cognition Medical, CVAID, E8, Endostream Medical, Imperative Care, Instylla, International Medical Distribution Partners, Launch NY, NeuroRadial Technologies, Neurotechnology Investors, Neurovascular Diagnostics, PerFlow Medical, Q’Apel Medical, QAS.ai, Radical Catheter Technologies, Rebound Therapeutics (purchased 2019 by Integra Lifesciencesp), Rist Neurovascular (purchased 2020 by Medtronic), Sense Diagnostics, Serenity Medical, Silk Road Medical, SongBird Therapy, Spinnaker Medical, StimMed, Synchron, Three Rivers Medical, Truvic Medical, Tulavi Therapeutics, Vastrax, VICIS, Viseon. Other financial or non-financial interests: National PI/Steering Committees: Cerenovus EXCELLENT and ARISE II Trial; Medtronic SWIFT PRIME, VANTAGE, EMBOLISE and SWIFT DIRECT Trials; MicroVention FRED Trial and CONFIDENCE Study; MUSC POSITIVE Trial; Penumbra 3D Separator Trial, COMPASS Trial, INVEST Trial, MIVI neuroscience EVAQ Trial; Rapid Medical SUCCESS Trial; InspireMD C-GUARDIANS IDE Pivotal Trial. EIL: Shareholder/Ownership Interest: NeXtGen Biologics, RAPID Medical, Claret Medical, Cognition Medical, Imperative Care, Rebound Therapeutics, StimMed, Three Rivers Medical; Patent: Bone Scalpel; Honorarium for Training & Lectures: Medtronic, Penumbra, MicroVention, Integra. Consultant: Clarion, GLG Consulting, Guidepoint Global, Imperative Care, Medtronic, StimMed, Misionix, Mosiac; Chief Medical Officer: Haniva Technology; National PI: Medtronic; Steering Committees for SWIFT Prime and SWIFT Direct Trials; Site PI Study: MicroVention (CONFIDENCE Study) Medtronic (STRATIS Study-Sub 1); Advisory Board: Stryker (AIS Clinical Advisory Board), NeXtGen Biologics, MEDX, Cognition Medical; Endostream Medical, IRRAS AB (Consultant/Advisory Board, Medical Legal Review: render medical/legal opinions as an expert witness; leadership or fiduciary roles in other board society, committee or advocacy group, paid and unpaid: CNS, ABNS, UBNS., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Background and Objectives: Social determinants of health (SDOH) are nonmedical factors that affect health outcomes. Limited investigation has been completed on the potential association of these factors to adverse outcomes in pediatric populations. In this study, the authors aimed to analyze the effects of SDOH disparities and their relationship with outcomes after brain tumor resection or biopsy in children., Methods: The authors retrospectively reviewed the records of their center's pediatric patients with brain tumor. Black race, public insurance, median household income, and distance to hospital were the investigated SDOH factors. Univariate analysis was completed between number of SDOH factors and patient demographics. Multivariate linear regression models were created to identify coassociated determinants and outcomes., Results: A total of 272 patients were identified and included in the final analysis. Among these patients, 81 (29.8%) had no SDOH disparities, 103 (37.9%) had 1, 71 (26.1%) had 2, and 17 (6.2%) had 3. An increased number of SDOH disparities was associated with increased percentage of missed appointments ( P = .002) and emergency room visits ( P = .004). Univariate analysis demonstrated increased missed appointments ( P = .01), number of postoperative imaging ( P = .005), and number of emergency room visits ( P = .003). In multivariate analysis, decreased median household income was independently associated with increased length of hospital stay ( P = .02)., Conclusion: The SDOH disparities are prevalent and impactful in this vulnerable population. This study demonstrates the need for a shift in research focus toward identifying the full extent of the impact of these factors on postoperative outcomes in pediatric patients with brain tumor., (Copyright © Congress of Neurological Surgeons 2023. All rights reserved.)

Background: Literature on volumetric resolution and recurrence over time between surgical evacuation alone (SEA) and standalone middle meningeal artery embolization (MMAE) in comparable chronic subdural hematoma (cSDH) patients is limited., Methods: A retrospective database analysis of cSDH patients managed with either SEA or MMAE was conducted. Propensity-score matching was performed for axial and coronal lengths, maximum diameter, and midline shift. Volumetric measurements at multiple time intervals and recurrence were compared between the groups., Results: 48 matched hematoma pairs in patients with similar demographics, comorbidities, medications, and symptoms were obtained. Median volume was significantly lower at 24 hours in the SEA group (12.6 mL vs 52.7 mL, p<0.001) but not at remaining intervals. Median volume reduction was significantly greater in the SEA group at 24 hours (39.1 mL vs 8.8 mL in the MMAE group, p<0.001) and at 3-12 weeks (50.8 mL vs 23.7 mL, p<0.001), but not at remaining intervals. The SEA group had a significantly greater median hematoma resolution rate at 24 hours (39.1 mL/day vs 8.8 mL/day, p<0.001) and 3-12 weeks (1 mL/day vs 0.4 mL/day, p<0.001), but not at remaining intervals. Near-complete resolution at 3-12 weeks and 12-60 weeks was not significantly different between groups. Overall, the recurrence rate was significantly higher in the SEA group (22.9% vs 4.2%, p=0.01)., Conclusions: In comparable cSDH patients, SEA resulted in better volumetric outcomes in immediate postoperative and early follow-up periods, as expected. However, this difference was not significant at more distant follow-up intervals. Furthermore, surgical patients experienced a significantly higher rate of recurrence., Competing Interests: Competing interests: JMC - Consulting fees: Cerenovus, J&J Medical Device Companies; Integra Lifesciences, Corp; MIVI Neuroscience, Inc; Penumbra, Inc; Stryker, Corp. Support for attending meetings and/or travel: Stryker, Corp; Penumbra, Inc. KVS - Consulting fees: Boston Scientific, Canon Medical Systems USA, Inc, MicroVention, Medtronic, Stryker Neurovascular. Payment or honoraria for lectures, presentations, speakers’ bureaus, manuscript writing, or educational event: Canon Medical Systems USA Inc. Stock or stock options: Boston Scientific, Access Closure Inc, Niagara Gorge Medical. AHS - Consulting fees: Amnis Therapeutics, Apellis Pharmaceuticals, Inc, Boston Scientific, Canon Medical Systems USA, Inc, Cardinal Health 200, LLC, Cerebrotech Medical Systems, Inc, Cerenovus, Cerevatech Medical, Inc, Cordis, Corindus, Inc, Endostream Medical, Ltd, Imperative Care, Integra, IRRAS AB, Medtronic, MicroVention, Minnetronix Neuro, Inc, Penumbra, Q’Apel Medical, Inc, Rapid Medical, Serenity Medical, Inc, Silk Road Medical, StimMed, LLC, Stryker Neurovascular, Three Rivers Medical, Inc, VasSol, Viz.ai, Inc, W.L. Gore & Associates. Leadership or fiduciary role in other board, society, committee or advocacy group: Secretary of the Board of the Society of NeuroInterventional Surgery, Chair of the Cerebrovascular Section of the AANS/CNS. Stock or stock options: Adona Medical, Inc, Amnis Therapeutics, Bend IT Technologies, Ltd, BlinkTBI, Inc, Buffalo Technology Partners, Inc, Cardinal Consultants, LLC, Cerebrotech Medical Systems, Inc, Cerevatech Medical, Inc, Cognition Medical, CVAID Ltd, E8, Inc, Endostream Medical, Ltd, Imperative Care, Inc, Instylla, Inc, International Medical Distribution Partners, Launch NY, Inc, NeuroRadial Technologies, Inc, Neurotechnology Investors, Neurovascular Diagnostics, Inc, PerFlow Medical, Ltd, Q’Apel Medical, Inc, QAS.ai, Inc, Radical Catheter Technologies, Inc, Rebound Therapeutics Corp (purchased 2019 by Integra Lifesciences, Corp), Rist Neurovascular, Inc (purchased 2020 by Medtronic), Sense Diagnostics, Inc, Serenity Medical, Inc, Silk Road Medical, Adona Medical, Inc, Amnis Therapeutics, Bend IT Technologies, Ltd, BlinkTBI, Inc, Buffalo Technology Partners, Inc, Cardinal Consultants, LLC, Cerebrotech Medical Systems, Inc, Cerevatech Medical, Inc, Cognition Medical, CVAID Ltd, E8, Inc, Endostream Medical, Ltd, Imperative Care, Inc, Instylla, Inc, International Medical Distribution Partners, Launch NY, Inc, NeuroRadial Technologies, Inc, Neurotechnology Investors, Neurovascular Diagnostics, Inc, PerFlow Medical, Ltd, Q’Apel Medical, Inc, QAS.ai, Inc, Radical Catheter Technologies, Inc, Rebound Therapeutics Corp (purchased 2019 by Integra Lifesciences, Corp), Rist Neurovascular, Inc (purchased 2020 by Medtronic), Sense Diagnostics, Inc, Serenity Medical, Inc, Silk Road Medical, SongBird Therapy, Spinnaker Medical, Inc, StimMed, LLC, Synchron, Inc, Three Rivers Medical, Inc, Truvic Medical, Inc, Tulavi Therapeutics, Inc, Vastrax, LLC, VICIS, Inc, Viseon, Inc. Other financial or non-financial interests: National PI/Steering Committees: Cerenovus EXCELLENT and ARISE II Trial; Medtronic SWIFT PRIME, VANTAGE, EMBOLISE and SWIFT DIRECT Trials; MicroVention FRED Trial & CONFIDENCE Study; MUSC POSITIVE Trial; Penumbra 3D Separator Trial, COMPASS Trial, INVEST Trial, MIVI neuroscience EVAQ Trial; Rapid Medical SUCCESS Trial; InspireMD C-GUARDIANS IDE Pivotal Trial. EIL - Consulting fees: Claret Medical, GLG Consulting, Guidepoint Global, Imperial Care, Medtronic, Rebound, StimMed, Misionix, Mosiac, Clarion, IRRAS. Payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events: Medtronic; payment for expert testimony: for rendering medical/legal opinions as an expert. Support for attending meetings and/or travel: reimbursement for travel and food for some meetings with the CNS and ABNS. Stock or stock options: NeXtGen Biologics, RAPID Medical, Claret Medical, Cognition Medical, Imperative Care, Rebound Therapeutics, StimMed, Three Rivers Medical. JMD - Consulting fees; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events; support for attending meetings and/or travel: Medtronic. Patents planned, issued, or pending: QAS.ai. Participation on a Data Safety Monitoring Board or Advisory Board: NIH NIHDS Strokenet. Stock or stock options: Synchron, Cerebrotech, QAS.ai., (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

Background and Importance: Extracranial carotid artery pseudoaneurysm is a rare entity with potential etiologies including infection, blunt trauma, postsurgical atherosclerotic disease, and invasive neoplasia. Although the natural history of carotid pseudoaneurysm is difficult to determine because of its rarity, complications such as stroke, rupture, and local mass effect may occur at staggering rates., Clinical Presentation: In this case, a middle-aged man presented with a tandem carotid, middle cerebral artery occlusion that was treated with a carotid stent and mechanical thrombectomy. He returned 3 weeks later with a ruptured carotid pseudoaneurysm that was then treated with a covered stent. He made a full recovery and was neurologically intact on follow-up., Conclusion: This case illustrates a rare potential complication of carotid occlusion and stenting with possible catastrophic consequences. The goal of this report was to educate other clinicians in remaining vigilant in awareness of this complication and provide a framework for potential treatment if and when it occurs., (Copyright © Congress of Neurological Surgeons 2023. All rights reserved.)

Necrobiotic xanthogranuloma is a condition that was first identified in 1980 based on its characteristic histological identity, and it has been known since then as a dermatologic manifestation of an underlying systemic dysproteinemia. Intracranial manifestation is a rare presentation of this condition and has been reported only once in its more than 40 years of existence. Herein and to our knowledge, we report the second observation of an intracranial manifestation and, surprisingly, the first case without the expected dermatologic and systemic dysproteinemia associations. This case identifies an existing knowledge gap in our understanding of necrobiotic xanthogranuloma and emphasises the need for further research into understanding the presentation, comorbidities and management of this condition., Competing Interests: Competing interests: Cappuzzo—Consulting Fees: Cerenovus, J Integra Lifesciences, Corp.; MIVI Neuroscience, Inc.; Penumbra, Inc.; Stryker, Corp. Support for attending meetings and/or travel: Stryker, Corp.; Penumbra, Inc. EIL— Shareholder/Ownership Interest: NeXtGen Biologics, RAPID Medical, Claret Medical, Cognition Medical, Imperative Care, Rebound Therapeutics, StimMed, Three Rivers Medical; Patent: Bone Scalpel; Honorarium for Training Chief Medical Officer: Haniva Technology; National PI: Medtronic—Steering Committees for SWIFT Prime and SWIFT Direct Trials; Site PI Study: MicroVention (CONFIDENCE Study) Medtronic (STRATIS Study-Sub 1); Advisory Board: Stryker (AIS Clinical Advisory Board), NeXtGen Biologics, MEDX, Cognition Medical; Endostream Medical, IRRAS AB (Consultant/Advisory Board, Medical Legal Review: EIL renders medical/legal opinions as an expert witness); Leadership or fiduciary roles in other board society, committee, or advocacy group, paid and unpaid: CNS, ABNS, UBNS., (© BMJ Publishing Group Limited 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: Flow diverter devices have revolutionized the treatment of intracranial aneurysms (IAs) since their approval in 2011 and have continued to evolve. The devices have been widely adopted across institutions and centers over the past decade; however, long-term follow-up after treatment with the Pipeline embolization device (PED) is not well described in the literature. The authors' institution was among the first to begin using PEDs, allowing them to report their series of patients treated with flow diverters ≥ 10 years ago. In this study, the authors aimed to evaluate the long-term angiographic and clinical outcomes of these patients and review lessons learned along the way., Methods: The authors performed a retrospective review of their institution's IA database from January 2007 to July 2012. All patients with IAs treated with a PED prior to July 2012 were included. Clinical and angiographic characteristics were extracted. Available angiographic follow-up at 1, 3, 5, and 10 years was reported., Results: A total of 83 patients with 92 aneurysms treated with a PED ≥ 10 years ago were identified and included in the study. The mean aneurysm dome diameter was 9.2 (SD 5.7) mm, the mean aneurysm height was 10.4 (SD 6.8) mm, and the mean neck width was 4.1 (SD 2.4) mm. Only 1 (1.1%) aneurysm was ruptured at presentation. Eight (8.7%) aneurysms were recurrences of previous treatment modalities. The morphology was saccular in 77 (83.7%) aneurysms, fusiform in 14 (15.2%), and blister-like in 1 (1.1%). Among saccular aneurysms, 60 (77.9%) were wide-necked. Seventy-five (81.5%) aneurysms were in the internal carotid artery, 12 (13.0%) were vertebrobasilar, 3 (3.3%) were in the middle cerebral artery, and 2 (2.2%) were in the posterior cerebral artery. Angiographic follow-up at 1, 3, 5, and 10 years was available for 75, 59, 50, and 15 patients, respectively. The complete occlusion rates at 1, 3, 5, and 10 years were 94.7%, 96.6%, 96.0%, and 100%, respectively. The retreatment rates at 1, 3, 5, and 10 years were 8.0%, 6.8%, 8.0%, and 6.7%, respectively., Conclusions: The authors provide their single-institution series of IA patients treated with a PED ≥ 10 years ago, with the first report of 10-year follow-up for the available patients.

Background: Intraoperative aneurysm rupture during microsurgical clipping can be managed with different salvage techniques. In an aneurysm with a very wide neck that is located at a bifurcation, repairing an iatrogenic tear can be challenging and carry the risk of branch occlusion and infarction., Objective: To describe a variation of the cotton-clipping technique modified to better fit the bifurcation anatomy, which we call "felt-fenestrated clipping.", Methods: An illustrative case of intraoperative rupture of a wide-necked middle cerebral artery bifurcation aneurysm is presented. Radiological imaging, operative video, and technique illustration were obtained and prepared for this report., Results: A middle-aged woman underwent microsurgical clipping of a wide-necked middle cerebral artery bifurcation aneurysm. A right-angle clip became dislodged from the clip applier and snapped across the aneurysm causing a small rupture at the base. This was later determined to be the result of improper placement of a standard clip onto a mini-clip applier. After a few salvage attempts, a small piece of Teflon felt was placed over the rupture site and held in place using a straight, fenestrated clip. Then, the right-angle clip was applied over the true neck of the aneurysm and the edge of the rupture site, covering the Teflon felt to obtain true hemostasis., Conclusion: We demonstrate a technically successful felt-fenestrated clipping technique for treatment of an intraoperative rupture not amenable to other salvage options. This technique is useful to achieve hemostasis while preserving branches in wide-necked bifurcation aneurysms., (Copyright © Congress of Neurological Surgeons 2022. All rights reserved.)

Middle meningeal artery embolization is increasingly becoming popular in the treatment of chronic subdural hematomas. The safety and efficacy of the procedure has previously been demonstrated in the literature; however, complications do arise from time to time. Here we present the case of an elderly gentleman who experienced inadvertent embolization of the superior sagittal sinus through an occult arteriovenous fistula between the middle meningeal artery and the superior sagittal sinus. Multiple rescue techniques including aspiration and stent retriever thrombectomy were performed with restoration of venous flow and an overall optimal result.

Background: Pilocytic astrocytomas account for approximately 5%-6% of all gliomas and are most commonly diagnosed between the ages of 8 and 13 years. Although they may occur throughout the neuraxis, approximately two thirds arise from the cerebellum and optic pathway. Other locations of origin include midline structures such as thalamus, hypothalamus, and periventricular regions. Surgical approaches to lateral or third ventricular tumors include anterior transcallosal, subfrontal translamina terminalis, and anterior transcortical approaches. The Aurora Surgiscope is a single-use, disposable minimally invasive neurological endoscope designed for intraparenchymal hemorrhage evacuation. We present the successful use of this system to aid resection of a large intraventricular pilocytic astrocytoma., Methods: A 29-year-old man presented with signs of developing hydrocephalus and was found to have a large intraventricular tumor, which was later identified to be a rare intraventricular pilocytic astrocytoma. A ventriculostomy was performed as a temporizing measure, and he was transferred to our tertiary care facility for surgical management. Sulcal dissection was performed, and the endoscope was inserted to create a minimally invasive corridor to the lateral ventricle. Using the endoscope, bimanual surgery using multiple instruments simultaneously was possible and enabled gross total resection of the tumor., Results: The patient tolerated the procedure well and was discharged at his neurological baseline level., Conclusions: Extensive sulcal dissection preceding placement of the endoscope allowed access to the intraventricular space with minimal passage of parenchymal tissue. High-definition visualization was provided and allowed the operating surgeon to freely use both hands during surgery., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: Statins have been reported to reduce the rates of recurrence and improve the resolution of chronic subdural hematomas (cSDHs) treated surgically or conservatively. No studies have investigated the effect of statins in patients treated with middle meningeal artery embolization., Methods: We performed a retrospective search of our cSDH database to identify patients treated with middle meningeal artery embolization alone. Only patients with at least 1 noncontrast computed tomography scan obtained 3-12 weeks after embolization were included. Hematoma volumes were measured at baseline and last noncontrast computed tomography available. The volumes, volume reduction, speed of resolution, and recurrence were compared between patients already receiving statin therapy when admitted and those who were not., Results: Forty-six patients with 50 cSDHs were included (statins, 17 patients with 18 cSDHs vs. nonstatins, 29 patients with 32 cSDHs). The statin group had a significantly higher rate of hyperlipidemia (statin, 64.7% vs. nonstatin, 31%, P = 0.03) but similar demographics, remaining comorbidities, medications, and hematoma thickness, axial and coronal lengths, and baseline volumes. The time between procedure and last noncontrast computed tomography scan was similar between groups. There were no differences between the groups regarding volume reduction, final volume, speed of resolution, complete resolution, and recurrence., Conclusions: Patients treated with middle meningeal artery embolization alone who were on statin therapy had no differences in cSDH resolution or recurrence compared to those who were not on statin therapy. It is possible that the anti-inflammatory effects of statins may not be relevant when supply to the dura is interrupted by treatment with embolization., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Treatment of wide-necked posterior communicating artery (PCoA) aneurysms is extremely challenging, especially in fetal posterior cerebral artery (PCA) configurations. This technical video demonstrates the nuances of an innovative use of flow diversion to treat a recurrent wide-necked PCoA aneurysm. This middle-aged patient presented with recurrence of a previously ruptured, coil-embolized PCoA aneurysm. Initial attempts at Comaneci-assisted coiling were unsuccessful because the coil herniated into the middle cerebral artery (MCA). Therefore, a low-profile visualized intraluminal support (LVIS) was placed in the fetal PCA across the aneurysm ostium and a flow diverter was placed in the internal carotid artery and MCA to constitute a Y-construct. The video can be found here: https://stream.cadmore.media/r10.3171/2022.7.FOCVID2262., Competing Interests: Disclosures Dr. Cappuzzo: consulting fees from Cerenovus, J&J Medical Device Companies, Integra Lifesciences Corp., MIVI Neuroscience Inc., Penumbra Inc., and Stryker Corp.; and support for attending meetings and/or travel from Stryker Corp. and Penumbra Inc. Dr. Levy: shareholder/ownership interest in NeXtGen Biologics, RAPID Medical, Claret Medical, Cognition Medical, Imperative Care, Rebound Therapeutics, StimMed, and Three Rivers Medical; patent with Bone Scalpel; honorarium for training and lectures from Medtronic, Penumbra, MicroVention, and Integra; consultant for Clarion, GLG Consulting, Guidepoint Global, Imperative Care, Medtronic, StimMed, Misionix, and Mosiac; chief medical officer for Haniva Technology; national PI for Medtronic—Steering Committees for SWIFT PRIME and SWIFT DIRECT Trials; site PI for MicroVention (CONFIDENCE Study) and Medtronic (STRATIS Study-Sub 1); advisory board for Stryker (AIS Clinical Advisory Board), NeXtGen Biologics, MEDX, Cognition Medical, Endostream Medical, and IRRAS AB (Consultant/Advisory Board); personal fees for rendering medical/legal opinions as an expert witness; and leadership or fiduciary roles in CNS, ABNS, and UBNS. Dr. Siddiqui: consulting fees from Amnis Therapeutics, Apellis Pharmaceuticals Inc., Boston Scientific, Canon Medical Systems USA Inc., Cardinal Health 200, LLC, Cerebrotech Medical Systems Inc., Cerenovus, Cerevatech Medical Inc., Cordis, Corindus Inc., Endostream Medical Ltd., Imperative Care, InspireMD Ltd., Integra, IRRAS AB, Medtronic, MicroVention, Minnetronix Neuro Inc., Peijia Medical, Penumbra, Q’Apel Medical Inc., Rapid Medical, Serenity Medical Inc., Silk Road Medical, StimMed, LLC, Stryker Neurovascular, Three Rivers Medical Inc., VasSol, and Viz.ai Inc.; secretary of Board of the Society of NeuroInterventional Surgery (2020-2021); chair of Cerebrovascular Section of the AANS/CNS (2020-2021); stock or stock options in Adona Medical Inc., Amnis Therapeutics, Bend IT Technologies Ltd., BlinkTBI Inc., Cerebrotech Medical Systems Inc., Cerevatech Medical Inc., Cognition Medical, CVAID Ltd., E8 Inc., Endostream Medical Ltd., Galaxy Therapeutics Inc., Imperative Care Inc., InspireMD Ltd., Instylla Inc., International Medical Distribution Partners, Launch NY Inc., Neurolutions Inc., NeuroRadial Technologies Inc., NeuroTechnology Investors, Neurovascular Diagnostics Inc., Peijia Medical, PerFlow Medical Ltd., Q’Apel Medical Inc., QAS.ai Inc., Radical Catheter Technologies Inc., Rebound Therapeutics Corp. (purchased in 2019 by Integra Lifesciences Corp.), Rist Neurovascular Inc. (purchased in 2020 by Medtronic), Sense Diagnostics Inc., Serenity Medical Inc., Silk Road Medical, Sim & Cure, SongBird Therapy, Spinnaker Medical Inc., StimMed, LLC, Synchron Inc., Three Rivers Medical Inc., Truvic Medical Inc., Tulavi Therapeutics Inc., Vastrax, LLC, VICIS Inc., and Viseon Inc.: and national PI/steering committees for Cerenovus EXCELLENT and ARISE II Trial; Medtronic SWIFT PRIME, VANTAGE, EMBOLISE, and SWIFT DIRECT Trials; MicroVention FRED Trial and CONFIDENCE Study; MUSC POSITIVE Trial; Penumbra 3D Separator Trial, COMPASS Trial, and INVEST Trial; MIVI Neuroscience EVAQ Trial; Rapid Medical SUCCESS Trial; and InspireMD C-GUARDIANS IDE Pivotal Trial. Devices included in this video and their manufacturers: Armadillo guide catheter, Q’Apel Medical; Comaneci device, Rapid Medical; FRED, MicroVention; LVIS Jr., MicroVention; and SynchroSelect microwire, Stryker Neurovascular.Dr. Cappuzzo: consulting fees from Cerenovus, J&J Medical Device Companies, Integra Lifesciences Corp., MIVI Neuroscience Inc., Penumbra Inc., and Stryker Corp.; and support for attending meetings and/or travel from Stryker Corp. and Penumbra Inc. Dr. Levy: shareholder/ownership interest in NeXtGen Biologics, RAPID Medical, Claret Medical, Cognition Medical, Imperative Care, Rebound Therapeutics, StimMed, and Three Rivers Medical; patent with Bone Scalpel; honorarium for training and lectures from Medtronic, Penumbra, MicroVention, and Integra; consultant for Clarion, GLG Consulting, Guidepoint Global, Imperative Care, Medtronic, StimMed, Misionix, and Mosiac; chief medical officer for Haniva Technology; national PI for Medtronic—Steering Committees for SWIFT PRIME and SWIFT DIRECT Trials; site PI for MicroVention (CONFIDENCE Study) and Medtronic (STRATIS Study-Sub 1); advisory board for Stryker (AIS Clinical Advisory Board), NeXtGen Biologics, MEDX, Cognition Medical, Endostream Medical, and IRRAS AB (Consultant/Advisory Board); personal fees for rendering medical/legal opinions as an expert witness; and leadership or fiduciary roles in CNS, ABNS, and UBNS. Dr. Siddiqui: consulting fees from Amnis Therapeutics, Apellis Pharmaceuticals Inc., Boston Scientific, Canon Medical Systems USA Inc., Cardinal Health 200, LLC, Cerebrotech Medical Systems Inc., Cerenovus, Cerevatech Medical Inc., Cordis, Corindus Inc., Endostream Medical Ltd., Imperative Care, InspireMD Ltd., Integra, IRRAS AB, Medtronic, MicroVention, Minnetronix Neuro Inc., Peijia Medical, Penumbra, Q’Apel Medical Inc., Rapid Medical, Serenity Medical Inc., Silk Road Medical, StimMed, LLC, Stryker Neurovascular, Three Rivers Medical Inc., VasSol, and Viz.ai Inc.; secretary of Board of the Society of NeuroInterventional Surgery (2020-2021); chair of Cerebrovascular Section of the AANS/CNS (2020-2021); stock or stock options in Adona Medical Inc., Amnis Therapeutics, Bend IT Technologies Ltd., BlinkTBI Inc., Cerebrotech Medical Systems Inc., Cerevatech Medical Inc., Cognition Medical, CVAID Ltd., E8 Inc., Endostream Medical Ltd., Galaxy Therapeutics Inc., Imperative Care Inc., InspireMD Ltd., Instylla Inc., International Medical Distribution Partners, Launch NY Inc., Neurolutions Inc., NeuroRadial Technologies Inc., NeuroTechnology Investors, Neurovascular Diagnostics Inc., Peijia Medical, PerFlow Medical Ltd., Q’Apel Medical Inc., QAS.ai Inc., Radical Catheter Technologies Inc., Rebound Therapeutics Corp. (purchased in 2019 by Integra Lifesciences Corp.), Rist Neurovascular Inc. (purchased in 2020 by Medtronic), Sense Diagnostics Inc., Serenity Medical Inc., Silk Road Medical, Sim & Cure, SongBird Therapy, Spinnaker Medical Inc., StimMed, LLC, Synchron Inc., Three Rivers Medical Inc., Truvic Medical Inc., Tulavi Therapeutics Inc., Vastrax, LLC, VICIS Inc., and Viseon Inc.: and national PI/steering committees for Cerenovus EXCELLENT and ARISE II Trial; Medtronic SWIFT PRIME, VANTAGE, EMBOLISE, and SWIFT DIRECT Trials; MicroVention FRED Trial and CONFIDENCE Study; MUSC POSITIVE Trial; Penumbra 3D Separator Trial, COMPASS Trial, and INVEST Trial; MIVI Neuroscience EVAQ Trial; Rapid Medical SUCCESS Trial; and InspireMD C-GUARDIANS IDE Pivotal Trial. Devices included in this video and their manufacturers: Armadillo guide catheter, Q’Apel Medical; Comaneci device, Rapid Medical; FRED, MicroVention; LVIS Jr., MicroVention; and SynchroSelect microwire, Stryker Neurovascular., (© 2022, The Authors.)

Background: Statins have been proposed to improve the resolution of chronic subdural hematoma (cSDH), with conflicting results likely due to underpowered analysis or confounding factors, such as the use of antithrombotic medication. We performed a systematic literature review and meta-analysis to better elucidate the effect of statin therapy on cSDH recurrence., Methods: We performed a comprehensive search of PubMed, MEDLINE, and Embase databases following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Articles were included if the number of recurrences requiring surgical evacuation or leading to neurological deterioration was reported and could be extracted separately for patients who did or did not receive statin therapy., Results: Seven studies were included, comprising 1359 cSDH patients (statin therapy, 449 vs. non-statin therapy, 910). Age was not different between groups (P = 0.548). The proportion of men was significantly different (statin, 80.1% vs. non-statin, 74.7%; P = 0.02). Use of antithrombotic medication was significantly higher (P = 0.005) in the statin group (11.7%) than in the non-statin group (7.3%). The statin group had a non-significant lower odds of recurrence (odds ratio 0.80, 95% confidence interval 0.35-1.81). In an exploratory data analysis of 4 studies without a difference between groups in antithrombotic medication use, the statin group had significantly lower odds of recurrence (odds ratio 0.29, 95% confidence interval 0.17-0.50)., Conclusions: Overall, we found that statin use did not result in lower odds of cSDH recurrence, likely due to a dilution caused by the higher rate of patients on antithrombotic medications in the statin group., (Copyright © 2022. Published by Elsevier Inc.)

Background and Importance: Spinal epidural lipomatosis is a rare condition commonly associated with chronic corticosteroid use and obesity that involves deposition of adipose tissue in the epidural space of the spinal canal. This accumulation of adipose tissue may cause compression of the spinal cord and/or nerve roots and result in compressive symptoms such as myelopathy or radiculopathy. Spinal involvement is usually confined to either the thoracic or lumbar spine but can infrequently affect both regions. Depending on pre-existing conditions, treatment options include weight loss and discontinuation of exogenous steroid use, both of which have been shown to be effective therapeutic methods. Surgical decompression may be useful for appropriately selected patients in whom conservative therapy has failed or who experience acute neurological deterioration, although this is rarely indicated., Clinical Presentation: In this study, we describe a patient receiving long-term corticosteroid therapy who presented with symptomatic epidural lipomatosis that involved the thoracic and lumbar spine. She was treated with decompression by continuous T3-L5 hemilaminectomies performed through 5 small incisions of alternating laterality. After surgery, the patient experienced clinical improvement and was able to return to her baseline., Conclusion: We illustrate a successful spinal decompression of extensive epidural lipomatosis through a less-invasive surgical approach using several small incisions to accomplish uninterrupted hemilaminectomies. This alternative approach to a standard continuous incision can be considered in cases of extensive spinal epidural lipomatosis in patients with multiple medical comorbidities in whom wound healing is believed to be an issue and for whom minimizing blood loss is crucial., (Copyright © Congress of Neurological Surgeons 2022. All rights reserved.)

Background: Extracranial-to-intracranial (EC-IC) bypass was first described by Yasargil in the 1960s for treatment of symptomatic distal internal carotid artery (ICA) and/or proximal middle cerebral artery (MCA) steno-occlusive disease through direct anastomosis. Subsequent bypass trials failed to demonstrate benefit for overall outcomes and stroke rates compared with best medical therapy. However, the procedure remained in the neurosurgeon's armament, with studies showing benefits in select patient populations. With advancements in technology, patient selection has become more comprehensive., Objective: To provide a contemporary evaluation of EC-IC bypass from our high-volume cerebrovascular center, focusing on associated clinical outcomes., Methods: Consecutive patients who underwent direct EC-IC bypass surgeries for symptomatic distal ICA and/or proximal MCA steno-occlusive disease between April 2015 and September 2019 were identified retrospectively. Medical records were reviewed to collect demographics, clinical presentation, computed tomography perfusion imaging findings, transcranial Doppler results, procedure indication, donor vessel types, anastomosis site, bypass patency, periprocedural complications, postprocedural complications, symptom recrudescence, repeat or new interventions, subjective improvements, and modified Rankin Scale scores., Results: We identified 27 patients who underwent 32 EC-IC bypass procedures. The rate of ipsilateral stroke was 9.4%, with a median follow-up of 8 months (IQR, 4-13 months). Patients experienced a 22.3% improvement in modified Rankin Scale scores, and 70.3% of patients reported subjective improvement and satisfaction at follow-up., Conclusion: Direct EC-IC bypass remains a viable option for revascularization in symptomatic patients with distal ICA and/or proximal MCA steno-occlusive disease., (Copyright © Congress of Neurological Surgeons 2022. All rights reserved.)

Background: Intrameningeal cysts are rare lesions without definitive etiologies that can involve the dura or arachnoid mater. Spinal arachnoid cysts have been described, and several different etiologies have been hypothesized. This includes one-way valve mechanisms, traumatic herniation of arachnoid through the dura, and abnormal arachnoid membrane proliferation. To the authors' knowledge, no such descriptions exist regarding purely dural-based cystic lesions; however, the authors hypothesize similar mechanisms may be involved. Most notably, a traumatic injury to the dura leading to a one-way valve mechanism may allow for egress of cerebrospinal fluid between the dural layers, splitting them open. This progressive enlargement can lead to displacement of neural elements and subsequent neurological compromise., Methods: We describe a 17-year-old girl who presented with progressive neck and back pain, left upper-extremity numbness, bilateral lower-extremity weakness, paresthesias, and numbness without obvious etiology despite an extensive neurologic investigation. She had undergone conservative management options including multiple medications, physical and chiropractic therapy, and epidural steroid injections. Computed tomography myelography revealed a cerebrospinal fluid leak into the lumbar epidural space for which surgical exploration was performed. Despite utilizing fluoroscopy and intrathecal fluorescein, no leak source was identified. Fluid collection was found contained within the dural layers rather than the epidural space., Results: An intracystic blood patch was performed with near-complete resolution of the lesion by 6-week follow-up and near-complete return of neurologic function., Conclusions: Ventral panspinal cysts are an exceedingly rare cause of radiculopathy and myelopathy that can be resolved by an intracystic blood patch., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: Arteriovenous malformations (AVMs) are congenital errors of vascular morphogenesis that occur during development of the cardiovascular system. Multiple treatment options exist, including coil embolization, Onyx embolization, n-butyl-2 cyanoacrylate, alcohol embolization or sclerotherapy, and open surgical treatments. When the AVM involves superficial regions of the face, head, and neck, it is important to consider cosmetic side effects, such as surgical scarring and skin discoloration., Methods: A 23-year-old woman presented with a large, anterior mandibulofacial AVM first identified on computed tomography angiography and confirmed with digital subtraction angiography. The lesion was subsequently embolized using n-butyl-2 cyanoacrylate and contrast stasis for visualization during the procedure, instead of traditional tantalum powder., Results: Flow arrest accompanied by contrast stasis allowed changes in density observed using digital subtraction software, thus avoiding the use of material that might be cosmetically disfiguring., Conclusions: This technique for treatment of superficial AVMs avoids the use of materials that may be seen through or discolor the skin and other soft tissue., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background and Importance: Penetrating missile injury to the carotid arteries may lead to catastrophic hemorrhagic and/or ischemic complications. The incidence of carotid injury in patients with penetrating cervical trauma (PCT) is 11% to 13%, with most cases involving the common carotid artery (73%), followed by the internal carotid artery (ICA) (22%) and external carotid artery (5%). Approximately 50% of PCT cases result in mortality, with specific injury to the carotid arteries carrying nearly a 100% mortality rate. Although historically limited because most patients do not survive these serious injuries, treatment has become more feasible with advancements in endovascular techniques and technologies., Clinical Presentation: A young man presented to our trauma center after sustaining a gunshot wound to the right neck, leading to significant hemorrhage and ultimately a Biffl grade IV ICA injury. He was taken emergently to the operating room for cervical exploration and hemostasis. A computed tomography stroke study performed after initial stabilization revealed complete right ICA occlusion with increased time-to-peak in the right hemisphere. The patient was resuscitated to maintain sufficient cerebral perfusion pressure. Later, once hemodynamic stability was achieved, the patient underwent confirmatory angiography, followed by complete ICA revascularization using a balloon guide catheter to achieve flow arrest and placement of multiple carotid stents. He made a good neurological recovery., Conclusion: Endovascular carotid artery revascularization may be performed successfully in the subacute phase after PCT. The use of flow arrest obtained with a balloon guide catheter assists in preventing catastrophic hemorrhage in the event of rupture., (Copyright © Congress of Neurological Surgeons 2022. All rights reserved.)

Background: Social media have revolutionized access to educational content. Given the extensive presence of social media, these platforms have the potential to influence neurosurgical training and education of residents and fellows. We explored the attitudes of neurosurgical trainees (postgraduate years 1-9) toward social media and their perceived influence on training and education., Methods: This study was a survey of trainees at North American neurosurgery residency programs. A 22-item survey, including 2 free-text questions, was distributed through the Congress of Neurological Surgeons listserv. The survey consisted of questions regarding demographics, social media platform use, and trainee views on social media; their perceived impact on education and job performance was gauged using a 5-point Likert scale. Descriptive analysis was performed., Results: The survey was disseminated to 1160 neurosurgery trainees, with a response rate of 15.3%. Of 178 respondents, 132 (74.2%) were men; 142 (79.8%) were 25-34 years old. All respondents used social media. The most commonly used platforms were Facebook (87.1%), followed by YouTube (84.3%), Instagram (81.5%), and Twitter (74.7%). The most common reasons for social media use were personal social (89.8%), networking (65.5%), and academic resources (65.0%); 113 respondents (63.5%) reported spending <25% of their time on social media for academics. The Neurosurgical Atlas (63.3%), Congress of Neurological Surgeons (11.2%), and American Association of Neurological Surgeons (10.1%) social media accounts were the most commonly used academic platforms., Conclusions: Social media use was ubiquitous among trainees. Although most used social media for personal social communication, most also used it for academic purposes., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Medial sphenoid wing meningiomas constitute up to 10% of all intracranial meningiomas.1 These meningiomas have a tendency to engulf the internal carotid artery (ICA), its termination, and the middle cerebral artery. These arteries and the optic apparatus are at a particularly high risk of injury during the microsurgical resection of these tumors. ICA injuries are potentially devastating and challenging to manage. In this technical video, we demonstrate the management of inadvertent ICA terminus injury during the microsurgical resection of the medial sphenoid. Rapid vascular control was obtained with temporary clips on the ICA and anterior cerebral artery (ACA). Tamponade with a felt and primary repair of the arterial tear were attempted without success. We then created a tamponade around the tear with the help of a Hemashield strip (Meadox Medicals, Oakland, New Jersey), which was secured with a 90-degree-angled clip. Temporary clips were removed, and microsurgical dissection was completed. The Hemashield strip was removed at the end of the procedure. This maneuver resulted in complete hemostasis. Vascular patency was confirmed using Doppler imaging and intraoperative indocyanine green angiography. Postoperatively, the patient had transient right-sided weakness, which resolved 2 d later. The patient was discharged without any neurological deficit. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Video ©University at Buffalo, April 2020. Published with permission., (Copyright © 2020 by the Congress of Neurological Surgeons.)

Background: Middle meningeal artery (MMA) embolization is an emerging therapy for the resolution of subacute or chronic subdural hematoma (CSDH). CSDH patients are often elderly and have several comorbidities. We evaluated our experience with transradial access (TRA) for MMA embolization using predominantly Onyx under conscious sedation., Methods: Data for consecutive patients who underwent transradial MMA embolization for CSDH during a 2-year period (2018-2019) were analyzed from a single-center, prospectively-maintained database. Patient demographics, comorbidities, ambulatory times, subdural hematoma resorption status, and guide catheter type were recorded. Conversion to femoral access and complication rates were also recorded. Univariate and multivariate analyses were performed., Results: Forty-six patients (mean age, 71.7±14.4 years) were included in this study. Mean CSDH size was 14±5.5 mm. Most (91.3%) TRA embolizations were performed with 6-French 0.071-inch Benchmark guide catheters (Penumbra). MMA embolization was successful in 44 patients (95.7%) (including two cases of TRA conversion). Twenty-one (48%) patients had a severe Charlson Comorbidity Index ( > 5). Symptomatic improvement was noted in 39 of 44 patients (88.6%). Mean length of stay was 4±3 days. Patients were ambulated immediately postprocedure. At mean follow-up (8±4 weeks), 86.4% of patients had complete or partial CSDH resolution. Persistent use of antiplatelet agents after the procedure was associated with failed or minimal CSDH resorption (5 of 6, 83.3% vs 9 of 38 23.7% with complete or near-complete resolution; P=0.009)., Conclusion: Transradial Onyx MMA embolization under conscious sedation is safe and effective for CSDH treatment. TRA may be especially useful in elderly patients with numerous comorbidities., Competing Interests: Competing interests: GBR, MW, RHD, KV, AG, KR, SBH, HHR, FC, MKT: NoneEIL: shareholder/ownership interests: NeXtGen Biologics, RAPID Medical, Claret Medical, Cognition Medical, Imperative Care (formerly the Stroke Project), Rebound Therapeutics, StimMed, Three Rivers Medical; National Principal Investigator/Steering Committees: Medtronic (merged with Covidien Neurovascular) SWIFT Prime and SWIFT Direct Trials; Honoraria: Medtronic (training and lectures); Consultant: Claret Medical, GLG Consulting, Guidepoint Global, Imperative Care, Medtronic, Rebound, StimMed; Advisory Board: Stryker (AIS Clinical Advisory Board), NeXtGen Biologics, MEDX, Cognition Medical, Endostream Medical; Site Principal Investigator: CONFIDENCE study (MicroVention), STRATIS Study—Sub I (Medtronic).AHS: financial interest/investor/stock options/ownership: Adona Medical, Inc, Amnis Therapeutics, (purchased by Boston Scientific October 2017), Blink TBI Inc., Buffalo Technology Partners Inc., Cerebrotech Medical Systems, Inc., Cognition Medical, Endostream Medical Ltd., Imperative Care, International Medical Distribution Partners, Neurovascular Diagnostics Inc., Q’Apel Medical Inc, Rebound Therapeutics Corp. (purchased 2019 by Integra Lifesciences, Corp), Rist Neurovascular Inc., Sense Diagnostics, Inc., Serenity Medical Inc., Silk Road Medical, Spinnaker Medical, Inc., StimMed, Synchron, Three Rivers Medical Inc., Vastrax, LLC, VICIS, Inc., Viseon Inc; consultant/advisory board: Amnis Therapeutics, Boston Scientific, Canon Medical Systems USA Inc., Cerebrotech Medical Systems Inc., Cerenovus, Corindus Inc., Endostream Medical Ltd., Imperative Care, Inc. Integra LifeSciences Corp., Medtronic, MicroVention, Minnetronix Neuro, Inc., Northwest University–DSMB Chair for HEAT Trial, Penumbra, Q’Apel Medical Inc., Rapid Medical, Rebound Therapeutics Corp.(purchased by Integra LifeSciences Corp.), Serenity Medical Inc., Silk Road Medical, StimMed, Stryker, Three Rivers Medical, Inc., VasSol, W.L. Gore & Associates; principal investigator/steering committee for the following trials: Cerenovus NAPA and ARISE II; Medtronic SWIFT PRIME and SWIFT DIRECT; MicroVention FRED & CONFIDENCE; MUSC POSITIVE; and Penumbra 3D Separator, COMPASS, INVEST, TIGER.KVS: consulting and teaching for Canon Medical Systems Corporation, Penumbra Inc., Medtronic, and Jacobs Institute. Co-founder: Neurovascular Diagnostics, Inc.JMD: Research grant: National Center for Advancing Translational Sciences of the National Institutes of Health under award number KL2TR001413 to the University at Buffalo. Consulting: Medtronic; Honoraria: Neurotrauma Science, LLC; shareholder/ownership interests: Cerebrotech, RIST Neurovascular. University at Buffalo Neurosurgery received an educational grant from Penumbra, Inc. However, the company had no editorial control., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

Aims: The current study utilizes the adeno-associated viral gene transfer system in the CAMKIIα-tTA mouse model to overexpress human wild type TDP-43 (wtTDP-43) and α-synuclein (α-Syn) proteins. The co-existence of these proteins is evident in the pathology of neurodegenerative disorders such as frontotemporal lobar degeneration (FTLD), Parkinson disease (PD), and dementia with Lewy bodies (DLB)., Methods: The novel bicistronic recombinant adeno-associated virus (rAAV) serotype 9 drives wtTDP-43 and α-Syn expression in the hippocampus via "TetO" CMV promoter. Behavior, electrophysiology, and biochemical and histological assays were used to validate neuropathology., Results: We report that overexpression of wtTDP-43 but not α-Syn contributes to hippocampal CA2-specific pyramidal neuronal loss and overall hippocampal atrophy. Further, we report a reduction of hippocampal long-term potentiation and decline in learning and memory performance of wtTDP-43 expressing mice. Elevated wtTDP-43 levels induced selective degeneration of Purkinje cell protein 4 (PCP-4) positive neurons while both wtTDP-43 and α-Syn expression reduced subsets of the glutamate receptor expression in the hippocampus., Conclusions: Overall, our findings suggest the significant vulnerability of hippocampal neurons toward elevated wtTDP-43 levels possibly via PCP-4 and GluR-dependent calcium signaling pathways. Further, we report that wtTDP-43 expression induced selective CA2 subfield degeneration, contributing to the deterioration of the hippocampal-dependent cognitive phenotype., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: Abnormal tau hyperphosphorylation and its accumulation into intra-neuronal neurofibrillary tangles are linked to neurodegeneration in Alzheimer's disease and similar tauopathies. One strategy to reduce accumulation is through immunization, but the most immunogenic tau epitopes have so far remained unknown. To fill this gap, we immunized mice with recombinant tau to build a map of the most immunogenic tau epitopes., Methods: Non-transgenic and rTg4510 tau transgenic mice aged 5 months were immunized with either human wild-type tau (Wt, 4R0N) or P301L tau (4R0N). Each protein was formulated in Quil A adjuvant. Sera and splenocytes of vaccinated mice were collected to assess the humoral and cellular immune responses to tau. We employed a peptide array assay to identify the most effective epitopes. Brain histology was utilized to measure the effects of vaccination on tau pathology and inflammation., Results: Humoral immune responses following immunization demonstrated robust antibody titers (up to 1:80,000 endpoint titers) to each tau species in both mice models. The number of IFN-γ producing T cells and their proliferation were also increased in splenocytes from immunized mice, indicating an increased cellular immune response, and tau levels and neuroinflammation were both reduced. We identified five immunogenic motifs within either the N-terminal (9-15 and 21-27 amino acids), proline rich (168-174 and 220-228 amino acids), or the C-terminal regions (427-438 amino acids) of the wild-type and P301L tau protein sequence., Conclusions: Our study identifies five previously unknown immunogenic motifs of wild-type and mutated (P301L) tau protein. Immunization with both proteins resulted in reduced tau pathology and neuroinflammation in a tau transgenic model, supporting the efficacy of tau immunotherapy in tauopathy.

Introduction: Tau pathology is associated with a number of age-related neurodegenerative disorders. Few treatments have been demonstrated to diminish the impact of tau pathology in mouse models and none are yet effective in humans. Histone deacetylase 6 (HDAC6) is an enzyme that removes acetyl groups from cytoplasmic proteins, rather than nuclear histones. Its substrates include tubulin, heat shock protein 90 and cortactin. Tubastatin A is a selective inhibitor of HDAC6. Modification of tau pathology by specific inhibition of HDAC6 presents a potential therapeutic approach in tauopathy., Methods: We treated rTg4510 mouse models of tau deposition and non-transgenic mice with tubastatin (25 mg/kg) or saline (0.9%) from 5 to 7 months of age. Cognitive behavior analysis, histology and biochemical analysis were applied to access the effect of tubastatin on memory, tau pathology and neurodegeneration (hippocampal volume)., Results: We present data showing that tubastatin restored memory function in rTg4510 mice and reversed a hyperactivity phenotype. We further found that tubastatin reduced the levels of total tau, both histologically and by western analysis. Reduction in total tau levels was positively correlated with memory improvement in these mice. However, there was no impact on phosphorylated forms of tau, either by histology or western analysis, nor was there an impact on silver positive inclusions histologically., Conclusion: Potential mechanisms by which HDAC6 inhibitors might benefit the rTg4510 mouse include stabilization of microtubules secondary to increased tubulin acetylation, increased degradation of tau secondary to increased acetylation of HSP90 or both. These data support the use of HDAC6 inhibitors as potential therapeutic agents against tau pathology.