Journal of cerebrovascular and endovascular neurosurgery最新文献

Objective: Multiple randomized controlled trials have demonstrated the efficacy of mechanical thrombectomy (MT) for acute ischemic stroke with a large ischemic core caused by large-vessel occlusion. Despite successful recanalization, more than half of the patients do not achieve a favorable prognosis, a phenomenon referred to as futile recanalization (FR). We aimed to identify the risk factors for, and incidence of, FR in patients with large ischemic cores.

Methods: Eighty-four patients with a large ischemic core who underwent MT between January 2015 and December 2024 at three hospitals were retrospectively reviewed. Patients were divided into two groups-FR and no-FR-according to functional independence at 90 days (modified Rankin Scale (mRS) score ≥4). Factors influencing FR were identified using multivariate logistic regression and receiver operating characteristic curve analyses.

Results: Eighty-four patients fulfilled the inclusion criteria, and FR was observed in 57 patients (67.9%). Multivariable regression analysis revealed that older age (odds ratio [OR], 1.09; 95% confidence interval [CI], 1.01-1.18; P=0.011), concomitant diabetes (OR, 11.2; 95% CI, 1.13-111.1; P=0.012), diffusion-weighted imaging-Alberta Stroke Program Early Computed Tomography Score (OR, 0.32; 95% CI, 0.11-0.79; P=0.012), and an increased number of passes (OR, 1.91; 95% CI, 1.00-4.16; P=0.046) were independently associated with FR after MT.

Conclusions: Older age, concomitant diabetes, diffusion-weighted imaging-Alberta Stroke Program Early Computed Tomography Score, and an increased number of passes are independently associated with FR after MT in patients with a large ischemic core.

Objective: Microsurgical excision of intracranial arteriovenous malformations (AVMs) remains a surgical challenge that requires neurosurgical experience as well as neurosurgical tools. Advances in medical devices widen the range of tools that can be used to ensure patients' safety and procedural integrity. There is limited data published regarding the role of intraoperative ultrasound to ensure proper cerebral arteriovenous malformation excision.

Methods: Patients who underwent ultrasound-assisted microsurgical excision of cerebral arteriovenous malformations were reviewed in a single center from 2021 through 2024. Patients' clinical, radiological, and intraoperative data were retrieved and analyzed.

Results: Twenty patients were included in the study. All lesions were in the cerebral regions. The study included 20 patients, 11 (55%) of whom were males and the patients' ages ranged from 5 to 55 years. Sixteen patients (80%) presented with headache, 13 patients (65%) with seizures, 8 patients (40%) with syncope, 2 patients (10%) with vomiting, and 6 patients (30%) with weakness.Thirteen patients (65%) had intracranial hemorrhage (ICH) on presentation. For all cases, intraoperative ultrasound (IOUS) was successful in confirming total resection of the lesion. In 13 cases that involved an intracerebral hematoma took place, the hematoma was visualized easily with grey-scale B-mode ultrasound, as well as its relation to the nidus was clearly delineated.

Conclusions: Intraoperative ultrasonography is a useful, cost-effective, and non-invasive tool for guiding through cerebral arteriovenous malformation microsurgical excision.

A traumatic carotid-cavernous fistula (CCF) is a significant neurovascular condition characterized by an abnormal connection between the carotid artery and the cavernous sinus, often resulting from head trauma. This condition can lead to serious complications, necessitating effective management strategies. Endovascular treatment is the preferred approach for managing this condition. We present a case of a 23-year-old male with persistent left eye pain and redness seven months post-motor vehicle collision. Cerebral angiography confirmed a high-flow CCF with compromised intracranial flow, successfully treated with a 5 mm PK Papyrus covered stent using a novel tri-axial delivery system. This case highlights the efficacy of covered stents in neurovascular interventions and introduces an innovative approach for deploying a large-diameter stent across the cavernous internal carotid artery.

Subgaleal hematoma (SGH) is a rare condition in adults, typically resulting from trauma. It has primarily been treated with traditional methods, such as aspiration and needle puncture. However, Conventional treatments, such as simple compression dressings and needle aspiration, have been found inadequate in addressing refractory SGH. To overcome these challenges, we performed endovascular treatment (EVT), involving selective coil embolization of the vessels feeding the hematoma, followed by percutaneous hematoma aspiration and compression dressing. In this case report, a 37-year-old female patient with head trauma developed a recurrent subgaleal hematoma despite conservative treatments. Endovascular treatment was performed, resulting in significant improvement and no recurrence. This case suggests that EVT provides a viable and effective treatment alternative for adult patients with refractory SGH, offering a less invasive approach compared to surgical incision and drainage, with promising long-term outcomes.

An 18-year-old male underwent a tracheostomy that was complicated by an iatrogenic left-sided common carotid artery laceration, leading to loss of blood flow and a minor stroke in the anterior and medial territories of the left cerebral circulation. After the lesion was identified, carotid exploration was performed, followed by a vascular reconstruction using a synthetic graft to repair the damaged segment. This manuscript details the microsurgical techniques utilized and discusses the indications for this intervention, with a particular emphasis on stroke prevention.

Objective: Subarachnoid hemorrhage (SAH) is a severe neurological condition often associated with elevated intracranial pressure (ICP), which can impact patient outcomes. The present study aimed to evaluate the prognostic significance of ICP thresholds in predicting prognosis in SAH patients.

Methods: A retrospective cohort study was conducted, including patients diagnosed with SAH who underwent ventriculostomy between January 2019 and December 2024. Prognostic factors were estimated from various clinical-radiographic characteristics and ICP using the Cox regression model. Additional analyses were performed to evaluate the relationship between ICP thresholds and hazard ratio by dose-response analysis.

Results: A total of 110 SAH patients were included in the study. The analysis demonstrated a significant association between elevated ICP and poor outcomes (Hazard ratio (HR) 1.06, 95% CI 1.03-1.09). In multivariable analysis, ICP value was significantly associated with prognosis when the model was adjusted with pupillary light reflex (HR 1.04, 95% CI 1.01-1.08). In addition, SAH patients were divided into two groups based on the ICP cutoff value of 24 mmHg. Consequently, the group with ICP values of 24 mmHg or higher was strongly associated with poor prognosis (p-value of log-rank test=0.01).

Conclusions: Our study demonstrates that elevated ICP, particularly beyond the threshold of 24 mmHg, is strongly associated with poor outcomes in SAH patients. These findings support the inclusion of ICP thresholds in prognostic assessment and underscore the need for vigilant ICP monitoring and early intervention in the neurocritical care setting.

Spontaneous scalp arteriovenous malformations (AVMs) are often present at birth but are usually noticed when they cause aesthetic problems in adulthood. Concerning treatment; there has been a shift towards endovascular treatment alone or in combination with surgical resection. In developing countries, endovascular options might not be readily available. We hereby report a case of a large spontaneous scalp AVM managed successfully via surgical excision only. A 35-year-old man presented with a large pulsating mass located in the occipital region of the scalp. This mass had been present from birth and had been growing over the years. Computed tomography (CT) scan and CT-angiography showed an occipital, contrast-enhancing mass, mostly lateralized to the right and fed by the right occipital artery. The patient did not benefit from digital subtraction angiography or pre-operative embolization. An indication for surgical excision was made. The first step was geared at controlling hemorrhage which was only partially effective due to another feeder that was missed on the CT-angiography. The second step involved dissecting and de-vascularizing the lesion. Complete excision of the AVM was achieved along with excision of the adjacent galea. Management of large scalp AVMs is possible even in resource strained environments. Knowledge of the behavior of feeders regarding lateral or midline disease, coupled with meticulous interpretation of available imaging, is essential in planning surgery. Intra- operative bleeding can be controlled by early temporary clipping or ligation of the main feeders and then one can proceed with the surgical resection.

Stent-assisted coiling is an essential technique for managing wide-neck intracranial aneurysms. However, complications such as stent dislodgement can pose significant challenges, potentially compromising procedural success and patient outcomes. We present the case of a 73-year-old woman with an unruptured basilar tip aneurysm who experienced intra-procedural stent dislodgement into the target aneurysm during a Y-stent-assisted coiling attempt. Recognizing the instability of the displaced stent and the risk of further complications, we employed a modified "waffle cone technique" using a Solitaire AB stent to successfully secure the aneurysm while preserving parent vessel patency. This case highlights the importance of prompt recognition and innovative problem-solving strategies in managing stent-related complications during neuro-interventions. The rescue waffle cone technique represents a viable alternative for addressing complex stent dislodgement scenarios and improving patient outcomes.

This study presents the rare case of an intraosseous dural arteriovenous fistula (DAVF) draining into the diploic veins in the left frontal bone with high-flow feeder, successfully treated with transarterial Onyx embolization. A 59-year-old male exhibited mild right hemiparalysis and aphasia without prior head trauma, surgery, or venous sinus thrombosis. Imaging identified DAVF, fed by the bilateral superficial temporal arteries, left middle meningeal artery, and left occipital artery, draining retrogradely solely through the diploic veins into the superior sagittal sinus, causing cortical venous reflux (CVR). Treatment involved Onyx embolization under flow control, preventing Onyx (Medtronic, Irvine, CA, USA) migration and achieving complete DAVF occlusion, resolving the neurological deficits. This case highlights the clinical significance of diagnosing and managing DAVF draining exclusively into the diploic veins, emphasizing the effectiveness of Onyx embolization in such cases.