Search

Objective: To evaluate clinical, angiographic features, and endovascular approach of ruptured and unruptured distal intracranial aneurysms (DIAs)., Methods: From January 2013 to February 2022, details of all consecutive intracranial aneurysms (IAs) treated endovascularly in our center were collected and retrospectively reviewed. IAs involving the anterior cerebral artery, middle cerebral artery, and posterior cerebral artery (distal to anterior communicating artery, limen insula, and P1 segment, respectively), and those distal to superior cerebellar artery, anterior-inferior cerebellar artery, and posterior inferior cerebellar artery's first segment were classified based on their etiology, location, size, and shape. Demographic, clinical, angiographic, and procedural variables, as well as follow-up outcomes were evaluated., Results: Of 2542 IAs, 151 (5.9%) DIAs were counted (average size 5.4±2.9 mm), including 61 (40.4%) unruptured and 90 (59.6%) ruptured. No difference in the aneurysmal size was observed, but aneurysms smaller than 4 mm were observed more frequently in the ruptured group (36.7% vs 18%; P=0.01). In addition, ruptured DIAs were more often non-saccular (40% vs 18%; P=0.004) and irregular (93.3% vs 59%; P<0.001), They were treated mostly by coiling, glue, and parent artery sacrifice (P=0.02, P=0.006, and P=0.001), whereas unruptured DIAs were treated by stent-assisted coiling and flow-diverter stents (P=0.001 and P<0.001, respectively), without any differences in occlusion (81.6% vs 82.5%) and recanalization (21.1% vs 17.5%) rates. Procedure-related complications occurred in 20/151 (13.2%) patients, without any differences between subgroups. Ruptured DIAs were more often re-treated (18.4% vs 5.3%, P=0.02). In multivariate analyses, irregular shape appeared as an independent predictor of ruptured presentation (OR=8.1, 95% CI 3.0 to 21.7; P<0.001)., Conclusions: Compared with unruptured DIAs, ruptured DIAs were more often non-saccular, irregular, and smaller than 4 mm. Despite different therapeutical approaches, ruptured and unruptured DIAs presented comparable occlusion and recanalization rates., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

We present a case of ultra-early symptomatic fish-mouth type stenosis (FMTS) of a Surpass Evolve flow diverter stent (SE-FDS) occurring within 24 h after deployment for the treatment of multiple unruptured right siphon aneurysms in a 44-year-old patient. The patient developed left hemiplegia and hemineglect, and was treated with mechanical thrombectomy (MT) and Tirofiban infusion. This is the first report of an ultra-early FMTS with a SE-FDS and its mechanism is discussed in the light of available data in the literature., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Although machine learning (ML) has shown promise across disciplines, out-of-sample generalizability is concerning. This is currently addressed by sharing multi-site data, but such centralization is challenging/infeasible to scale due to various limitations. Federated ML (FL) provides an alternative paradigm for accurate and generalizable ML, by only sharing numerical model updates. Here we present the largest FL study to-date, involving data from 71 sites across 6 continents, to generate an automatic tumor boundary detector for the rare disease of glioblastoma, reporting the largest such dataset in the literature (n = 6, 314). We demonstrate a 33% delineation improvement for the surgically targetable tumor, and 23% for the complete tumor extent, over a publicly trained model. We anticipate our study to: 1) enable more healthcare studies informed by large diverse data, ensuring meaningful results for rare diseases and underrepresented populations, 2) facilitate further analyses for glioblastoma by releasing our consensus model, and 3) demonstrate the FL effectiveness at such scale and task-complexity as a paradigm shift for multi-site collaborations, alleviating the need for data-sharing., (© 2022. The Author(s).)

Background: The standard of care is to utilize intraoperative neurophysiological monitoring (IOM) of triggered electromyography (tEMG) during posterior lumbosacral instrumented-fusion surgery. IOM should theoretically signal misplacement of S1 screws into the neural L5-S1 foramen or spinal canal, utilizing screw stimulation, and recording of the lower limb muscles and the anal sphincter. Here, we evaluated when and whether anterolateral S1 screw malposition could be detected by IOM/tEMG during open posterior lumbosacral instrumented fusion surgery., Methods: tEMG, somatosensory-evoked potential (SSEP), and transcranial electrical motor-evoked potential (TcMEP) data were retrospectively reviewed from 2015 to 2017 during open posterior lumbosacral instrumented fusions. We utilized screw stimulation alert thresholds of <14 mA (tEMG) and recorded from the lower extremity muscles and anal sphincter. Furthermore, all patients underwent routine postoperative computed tomography (CT) scans to confirm the screw location., Results: There were 106 S1 screws placed in 54 patients: 52 bilateral and 2 unilateral. In 6 patients (11.1%), 7 screws (6.6%) registered at low tEMG thresholds. In 1 patient, the postoperative CT scan documented external malposition of the screw despite no intraoperative IOM/tEMG alert. When S1 misplaced screws were stimulated, the most sensitive muscle was the tibialis anterior; the sensitivity of the IOM/tEMG was 87.5%, the specificity was 97.9%, the positive predictive value was 77.8%, and the negative predictive value was 98.9%. TcMEP and SSEP did not change during any of the operations. Notably, no patient developed a new neurological deficit., Conclusion: Anterolateral S1 screw malposition can be detected accurately utilizing IOM/tEMG stimulation of screws. When alerts occur, they can largely be corrected by partially backing out the screw (e.g., a few turns) and/ or changing the screw trajectory., Competing Interests: There are no conflicts of interest., (Copyright: © 2020 Surgical Neurology International.)

Objective To describe the use of the superior thyroid artery as a donor vessel in extracranial-intracranial (EC-IC) revascularization when a "low-flow" bypass is required and the superficial temporal artery is not available. Design Case report. Setting University hospital. Participants Four cases. Main Outcome Measures Postoperative course after EC-IC bypass surgery. Results In case 1, the parent vessel was occluded postoperatively. The radial bypass was sufficient to replace the internal carotid artery (ICA) flow, and a prophylactic was turned into a definitive bypass. In case 2, the superior thyroid artery was used because the radial artery was not long enough to reach the external carotid artery. The recipient vessel was modified from the middle cerebral artery to the ophthalmic segment of the ICA. In case 3, the graft was occluded after surgery because of carotid artery reconstruction. In case 4, after surgery/radiotherapy for meningioma, the patient developed wound dehiscence and was reoperated for bypass occlusion. The graft was weak and bled intraoperatively, without infarction. The three first patients are intact, and the fourth remains disabled (Glasgow Outcome Scale: 3; Rankin Scale: 5). Conclusion The superior thyroid artery was adequate for proximal anastomosis in EC-IC procedures in the situations described.

Background: Dopamine agonists (DA) effectively reduce tumor size of macroprolactinomas, with the consequent improvement of eventual visual impairment., Aim: To study the visual outcomes in patients with macroprolactinoma treated with DA., Material and Methods: Retrospective cohort study which included patients with macroprolactinoma controlled at a Neuro-endocrinology and Neuro-ophthalmology Department between 1997 and 2011, and treated exclusively with DA (bromocriptine or cabergoline). Patients who were operated or had previous radiotherapy and those with an incomplete follow up, were excluded. We analyzed and compared the visual status before and after the beginning of DA treatment., Results: Thirty one patients aged 8 to 59 years, were included. Eighteen patients (58%) had visual impairment at the moment of diagnosis (group 1) and 13 had no alterations (group 2). Mean follow up was 36.5 months. Fifteen patients from group 1 (83%) had visual improvement, two remained stable (11 %) and one had a visual deterioration (6%). In group 2, only one non-compliant patient had a visual deterioration., Conclusions: DAs are effective in the management of neuro-ophthalmic complications associated to macroprolactinomas and should be considered as first choice therapy in these tumors.