Journal of cerebrovascular and endovascular neurosurgery最新文献

Objective: Intracranial atherosclerotic disease (ICAD) is an important cause of ischemic stroke. Balloon angioplasty for ICAD with or without a stent is associated with a high complication rate. The Tenzing support catheter (Route92 Medical) is a tapering offset catheter designed for improving aspiration catheter delivery in large vessel occlusion ischemic stroke (LVO). In LVO secondary to ICAD, we noted that the Tenzing could be used for angioplasty. In this study, we report our experience with the Tenzing angioplasty technique (T-Plasty) for ICAD treatment in the absence of LVO.

Methods: A prospectively maintained database of all adult ICAD patients without LVO treated with T-Plasty at our institution was reviewed. Information on demographics, procedural details, clinical outcomes, and complications is reported here based on the National Institute of Health Stroke Scale (NIHSS) and the modified Rankin Scale (mRS). Student's T-test was applied to evaluate for statistical significance when appropriate.

Results: From September 2024 to April 2025, 18 adult patients underwent T-Plasty for symptomatic ICAD without LVO. All patients experienced an improvement; the early cohort had a 4.5 points reduction in NIHSS immediate post T-Plasty, and both the elective and early cohorts experienced close to 1 point improvement in baseline mRS. No operative or post-operative related complications were noted up to 30-day follow-up.

Conclusions: T-Plasty for the elective treatment of chronic symptomatic ICAD and acute hypoperfusion syndrome is an option for improving neurologic outcome.

Objective: To evaluate the impact of preoperative embolization on intraoperative blood loss and surgical duration in patients undergoing cerebellar intracranial arteriovenous malformation (AVM) resection (2011-2022).

Methods: A descriptive, retrospective, preliminary study (n=10 with complete data) classified patients into a Hybrid group (embolization+surgery, n=8) and a Surgery-only group (n=2). Intergroup comparisons for surgical metrics used the Mann-Whitney U test.

Results: The Hybrid group demonstrated significantly improved intraoperative metrics. This cohort showed a highly significant decrease in blood loss (437.14 cc vs. 3,400 cc; p=0.018) and a significant reduction in surgical time (325 minutes vs. 530 minutes; p=0.018). Functionally, the Hybrid group achieved excellent recovery (median modified Rankin Scale [mRS] 1 at 6 months) despite having worse baseline morbidity (median mRS 3 vs. 1.5). The study found no significant difference in mRS improvement between groups.

Conclusions: Preoperative embolization is associated with reduced blood loss and shorter surgical duration in cerebellar AVM resection. These findings support embolization as a valuable adjunctive therapy. The results provide strong preliminary evidence of efficacy and intraoperative safety, but validation in prospective studies with larger samples is required.

Objective: Mean platelet volume (MPV) is a laboratory marker that reflects platelet activity and has been linked to a higher risk of thromboembolic events. This study aimed to evaluate MPV as a potential biomarker for clinical outcomes in acute ischemic stroke.

Methods: A systematic search was conducted in PubMed, Embase, Scopus, Web of Science, and Google Scholar up to March 2024. Risk of bias was assessed using the Newcastle-Ottawa Scale. When meta-analysis was not feasible, a narrative synthesis was performed. Subgroup and sensitivity analyses were planned, and the certainty of evidence was graded using the GRADE approach.

Results: Out of 534 studies, 57 were included (10,979 patients). Higher MPV levels were associated with poor functional outcomes (modified Rankin Scale [mRS] >2) at 90 days, although with high heterogeneity (MD: 0.50; 95% CI: 0.31-0.70; I2=82%). A weak positive correlation was found between MPV and impairment measure (National Institutes of Health Stroke Scale [NIHSS]: r=0.140-0.221). MPV was also associated with mortality at 3 months (OR: 3.88) and 1 year (OR: 1.76). No significant associations were observed with one-year disability, hemorrhagic transformation, cerebral microbleeds, or in-hospital complications.

Conclusions: In summary, MPV may be associated with worse 90-day functional outcomes and mortality; however, its correlation with impairment severity measured by NIHSS was weak. Further studies are needed to establish optimal cut-off values and incorporate MPV into predictive models.

Objective: Carotid webs, first described in 1968, are increasingly recognized as a surgically treatable cause of ischemic stroke, particularly in young patients. Despite growing attention, the literature remains fragmented. We conducted the first advanced bibliometric analysis of carotid web research to map its historical foundations, identify key contributors, and illustrate emerging trends.

Methods: The Web of Science database (inception-2025) was queried for carotid web publications. Articles and metadata were analyzed using Bibliometrix (R) and Python libraries. Reference publication year spectroscopy (RPYS) was employed to analyze the field's roots by analyzing citation frequency by publication year.

Results: A total of 281 publications from 109 sources and 1,129 authors were identified. Annual publication growth averaged 6.15%, with 90% published after 2016. International collaboration was modest (9-11%), led by the U.S., China, France, and Canada. Shifts in keyword frequency reflected the field's evolution from early nosological uncertainty toward recognition of carotid webs as a distinct, high-risk lesion underlying ischemic stroke. Stroke and Journal of Vascular Surgery emerged as early key sources. Author analysis identified the most prolific contributors, though coauthorship networks remained small. RPYS revealed 19 seminal studies (1968-2021) that shaped the field's progression from early pathology descriptions to recognition of carotid webs as high-risk lesions for stroke.

Conclusions: Carotid web research has rapidly expanded, evolving into a multidisciplinary field. RPYS identified 19 seminal publications tracing the intellectual trajectory of the field. Ongoing challenges include limited collaboration, unresolved questions of pathogenesis, and variability in terminology and diagnostic criteria.

Twig-like middle cerebral artery (T-MCA) is a vascular anomaly in which the M1 segment of the MCA is replaced by a plexiform network of small vessels. It may present with hemorrhagic or ischemic stroke or be detected incidentally. In this paper, we report three rare cases of T-MCA and describe their clinical and radiological characteristics as well as their clinical courses. A secondary objective was to provide a rough estimate of the occurrence of T-MCA among patients who underwent cerebral angiography in our center. From 2019 to 2023, 810 patients underwent brain digital subtraction angiography (DSA) at our center, of which three (0.37%) had T-MCA. Two patients presented with subarachnoid hemorrhage, and one was incidentally diagnosed. None were candidates for bypass surgery due to comorbidities, overall clinical condition, or patient preference, and all received conservative management. Two patients were discharged alert and without deficits, while one had a poor outcome, remaining in a vegetative state after complications of hemorrhage, hydrocephalus, and meningitis. T-MCA is a rare congenital anomaly with an estimated occurrence of approximately 0.37% among patients undergoing cerebral angiography in our center. This study adds three new patients to the limited literature and highlights their clinical presentations, radiological features, management decisions, and short-term outcomes. Further studies are needed to clarify its epidemiology, natural history, and optimal management strategies.

Objective: Malignant middle cerebral artery infarction is associated with high mortality and severe disability despite decompressive craniectomy. The thalamus plays a central role in arousal and sensorimotor integration and may be vulnerable to early compression from cerebral mass effect. This study evaluates whether preoperative ipsilateral thalamic volume reduction predicts functional outcomes following decompressive craniectomy.

Methods: This retrospective cohort study included 41 adult patients with malignant middle cerebral artery infarction who underwent decompressive craniectomy between April 2017 and September 2022. Preoperative computed tomography scans were analysed for infarct volume, midline shift, herniation markers, and percentage ipsilateral thalamic volume reduction. Functional outcomes were assessed at discharge and 90 days using the Full Outline of UnResponsiveness score, National Institutes of Health Stroke Scale, modified Rankin Scale, Barthel Index, and Disability Rating Scale. Logistic regression and receiver operating characteristic analyses were performed.

Results: Mean ipsilateral thalamic volume reduction was 15.1%. Each 1% increase in thalamic volume loss independently increased the odds of poor functional outcome, defined as modified Rankin Scale scores of 5-6, at discharge and 90 days. Greater thalamic distortion was associated with higher National Institutes of Health Stroke Scale scores. Receiver operating characteristic analysis demonstrated good discrimination, with optimal thresholds of 14% at discharge and 19% at 90 days. Increased thalamic compression was associated with postoperative infections and longer hospital stays.

Conclusions: Preoperative ipsilateral thalamic volume reduction is a strong imaging biomarker for predicting outcomes after decompressive craniectomy in malignant middle cerebral artery infarction.

Internal Jugular Vein (IJV) compression is a common cause of cerebral venous hypertension symptoms such as headache and pulsatile tinnitus. Various causes are identified with cervical compression by the C1 transverse process being a rare one. Surgical styloidectomy and transverse process resection are commonly performed to relieve the pressure placed upon the IJV, however, minimally invasive treatments such as venous stenting are promising solutions. A 73-year-old patient presented to our outpatient clinic with peripheral vertigo, nystagmus, and gait instability. Computed tomography revealed stenosis of the left IJV caused by compression from the C1 transverse process. This rare anatomical variant was treated successfully with venous stenting, leading to significant symptomatic improvement. This case highlights the importance of considering extracranial venous stenosis as a differential diagnosis in patients with unexplained vertigo and demonstrates the utility of advanced endovascular techniques in managing such cases. This case illustrates that clinical presentation of venous hypertension could rarely be caused by extrinsic compression of jugular veins, either by vertebral transverse processes or styloid processes. Although generally treated surgically, we consider that minimally invasive endovascular venous stenting is a potentially effective treatment strategy. This is demonstrated by venous manometric pressure improvement and symptom resolution in the presented patient. This treatment approach deserves further research to demonstrate its clinical impact, recommendations, and long-term impact.

We report stentless reconstructive embolization of a high-flow vertebrovertebral arteriovenous fistula using a double-balloon jailing technique with microsnare-guided retrograde exchange. A 70-year-old woman had pulsatile tinnitus and a cervical bruit. Angiography demonstrated a V3-to-suboccipital cavernous sinus fistula with a single short tract, draining into vertebral venous plexuses and via the posterior condylar vein to the sigmoid sinus, without cortical reflux. Targeted embolization was planned by jailing an embolization microcatheter within the tract using arterial and venous balloon microcatheters. Direct transvenous navigation was prevented by septations and high shunt flow; therefore, an arterial microcatheter was advanced antegrade into the internal jugular vein, where it was captured with a microsnare introduced from the venous side, then drawn back as a coupled system to secure venous access. Subsequent inflation of both balloon microcatheters immobilized the embolization microcatheter and enabled dense coil packing. Angiography confirmed complete obliteration which persisted after balloon deflation. Tinnitus resolved immediately, and imaging showed durable occlusion with no recurrence at 5 years. This approach enables reconstructive obliteration of selected high-flow vertebrovertebral arteriovenous fistulas (VVAVFs) without stent implantation, potentially reducing antiplatelet exposure while preserving bailout options. Microsnare-guided retrograde exchange facilitates device delivery in cases of challenging transvenous navigation.

Objective: Chronic subdural hematoma (CSDH) commonly affects older adults and remains associated with recurrence despite surgical evacuation. Coagulation of middle meningeal artery (MMA) during burr-hole drainage may be useful where MMA embolization is unavailable, however reliable external landmarks for MMA localization are poorly defined. This study aimed to identify the MMA confluence point on 3D cranial CT scans of elderly Filipino patients and define its relationship to external cranial landmarks to support pre-operative planning.

Methods: A retrospective cross-sectional morphometric study was performed using plain cranial CT scans of patients aged ≥65 years from 2019 to 2023. Scans with intact calvarial anatomy and adequate visualization of MMA groove were included. Threedimensional reconstructions were generated, and bilateral distances from lateral canthus, external auditory canal, and canthomeatal line to MMA confluence point were measured. Analyses were performed by sex and laterality (p<0.05).

Results: A total of 221 patients were included (mean age 76 years; 63% female). The external auditory canal and lateral canthus showed low variability. Male patients had greater external auditory canal and canthomeatal line distances (p<0.05), while confluence measurements did not differ by sex. The confluence point was located farther from the canthomeatal line on the left (p=0.0125).

Conclusions: These findings provide a practical framework for MMA localization during pre-operative planning. In settings without MMA embolization, landmark-based localization offers a low-cost method to guide burr-hole placement and potential MMA coagulation, supporting resource-adapted strategy to reduce CSDH recurrence.

Objective: This study aims to analyze the angiographic features, demographic factors, and outcomes of endovascular treatment for ruptured intracranial aneurysms (IAs) in Central India.

Methods: This retrospective observational study was conducted in the Department of Interventional Radiology at a tertiary care hospital in Central India. It included 102 patients diagnosed with subarachnoid haemorrhage due to ruptured IAs between December 2021 and November 2024. Demographic data, comorbidities, angiographic features (size, location, morphology, and multiplicity), and clinical severity were analyzed. Patients underwent endovascular treatments such as unassisted coiling, stent-assisted coiling, and other techniques. Functional outcomes were evaluated using the Modified Rankin Scale (mRS).

Results: Females (62.8%) were more affected than males, with a peak incidence in the 51-60 years age group. Hypertension (44.1%) was the most common comorbidity. Most aneurysms (88.4%) were located in the anterior circulation, with the anterior communicating artery (27.7%) being the most common site. Small (<5 mm) and saccular aneurysms (96.4%) predominated. Unassisted coiling was the most performed procedure (68.6%). At admission, 83.3% of patients had poor functional outcomes (mRS 3-6), but 68.6% achieved good outcomes (mRS 0-2) by discharge.

Conclusions: Ruptured IAs in Central India predominantly affect females and involve the anterior circulation. Endovascular treatment significantly improves functional outcomes by reducing the re-rupture risk of an aneurysm, underscoring its effectiveness in managing this high-risk condition.