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We performed a comprehensive literature search in the PubMed and Scopus data bases on blister-like aneurysms

Growth and rupture of an intracranial aneurysm: the role of wall aneurysmal enhancement and CD68+

IntroductionIntracranial aneurysms occur in 3%–5% of the general population. While the precise biological mechanisms underlying the formation, growth, and sudden rupture of intracranial aneurysms remain partially unknown, recent research has shed light on the potential role of inflammation in aneurysm development and rupture. In addition, there are ongoing investigations exploring the feasibility of employing new drug therapies for controlling the risk factors associated with aneurysms. CD68, a glycosylated glycoprotein and the human homolog of macrosialin, is prominently expressed in monocyte/macrophages within inflamed tissues and has shown potential application in oncology. An observational study was conducted with the aim of comparing the histological characteristics of aneurysm walls with preoperative MRI scans, specifically focusing on CD68 activity.MethodAn observational pilot study was conducted to investigate the histological characteristics of the aneurysm wall that could be potentially associated with aneurysm growth and rupture. A total of 22 patients diagnosed with ruptured and unruptured intracranial aneurysms who had undergone conventional clipping between January 2017 and December 2022 were included in the study.ResultsA histopathological analysis of the aneurysm wall was performed in all patients, particularly focusing on the presence of CD68. A preoperative MRI with gadolinium was conducted in 10 patients with unruptured aneurysms and six patients with ruptured aneurysms. An emergency clipping was performed in the remaining six patients. The results showed that CD68 positivity and wall enhancement were significantly associated with intracranial aneurysm wall degeneration, growth, and rupture.ConclusionThe histological and radiological inflammatory findings observed in the wall of cerebral aneurysms, as well as the CD68 positivity, are significantly associated with the risk of intracranial aneurysm growth and rupture. This study highlights the crucial importance of considering clinical and medical data when making treatment decisions for intracranial aneurysms. Furthermore, it emphasizes the relevance of evaluating wall enhancement in MRI scans as part of the diagnostic and prognostic process

Intrasaccular Flow Disruptor-Assisted Coiling of Intracranial Aneurysms Using the Novel Contour Neurovascular Systems and NEQSTENT: A Single-Center Safety and Feasibility Study

Brain aneurysms; Endovascular treatment; Intrasaccular devicesAneurismas cerebrales; Tratamiento endovascular; Dispositivos intrasacularesAneurismes cerebrals; Tractament endovascular; Dispositius intrasacularsBackground: Intrasaccular flow disruptors (IFD) have been introduced in the treatment of intracranial aneurysms (IAs) to overcome the low aneurysm occlusion rate and the high recanalization rate of the coiling technique. Among them, the Contour Neurovascular System (CNS) and the Neqstent (NQS) were designed to reconstruct the aneurysmal neck and both can be used as assisting coiling devices. We aimed to report our preliminary experience with the flow disruptor-assisted coiling (IFD-AC) technique. Methods: We performed a retrospective analysis of prospectively collected data of all patients with IAs treated with the IFD-AC. Results: Between February 2021 and April 2022, we treated 15 IAs with the IFD-AC: 10 ruptured and 5 unruptured. The IFD-AC was successfully performed in 13 cases, with a post-operative RROC 1 in 12 cases (92.3%) and RROC 2 in 1 case (7.7%). There was one ischemic event (6.7%) and no hemorrhagic complications. Twelve patients underwent a mid-term radiologic follow-up: Ten IAs (83.4%) presented an adequate occlusion, while 2 (16.7%) had a recurrence. Conclusions: The IFD-AC, both with the CNS and the NQS, seems a safe technique with promising efficacy profile. The IFD-AC has proved to be safe without antiplatelet therapy in ruptured cases. Further studies are needed to confirm our preliminary results

Defining activities in neurovascular microsurgery training : entrustable professional activities for vascular neurosurgery

Background Entrustable professional activities (EPAs) represent an assessment framework with an increased focus on competency-based assessment. Originally developed and adopted for undergraduate medical education, concerns over resident ability to practice effectively after graduation have led to its implementation in residency training but yet not in vascular neurosurgery. Subjective assessment of resident or fellow performance can be problematic, and thus, we aim to define core EPAs for neurosurgical vascular training. Methods We used a nominal group technique in a multistep interaction between a team of experienced neurovascular specialists and a medical educator to identify relevant EPAs. Panel members provided feedback on the EPAs until they reached consent. Results The process produced seven core procedural EPAs for vascular residency and fellowship training, non-complex aneurysm surgery, complex aneurysm surgery, bypass surgery, arteriovenous malformation resection, spinal dural fistula surgery, perioperative management, and clinical decision-making. Conclusion These seven EPAs for vascular neurosurgical training may support and guide the neurosurgical society in the development and implementation of EPAs as an evaluation tool and incorporate entrustment decisions in their training programs.Peer reviewe

Trigeminal Neuralgia: A New Neuroimaging Perspective

[No abstract available

Endovascular Neurosurgery in Europe and in Italy: What Is in the Future?

BACKGROUND: The cerebrovascular discipline has undergone dramatic changes in recent years. This has been made possible by the work of pioneers in the fields of neurosurgery and neuroradiology. METHODS: In this article we review the evolution and fundamental stages that led to the birth of endovascular treatment and discuss why, also in Europe, this treatment must be included in neurosurgery, encouraging the training of endovascular neurosurgeons who can collaborate with their interventional neuroradiology colleagues in order to form unbiased surgeons who understand the disease from both the endovascular as well as the surgical prospective. We examine how the new generation of European cerebrovascular specialists, including neurosurgeons, neuroradiologists, and some neurologists, will attain their requisite endovascular training. Finally, we briefly review the current state of endovascular neurosurgery in Europe and in Italy and speculate about what its role will be in the near and distant future. CONCLUSIONS: To remain at the forefront of evaluating, caring for, and treating patients with cerebrovascular disease, vascular neurosurgery must evolve toward a specialty, mastering the knife as well as the catheter. We think it is time for European neurosurgeons to start training residents in endovascular neurosurgery in the same way we train neurosurgeons in every other neurosurgical discipline

Endovascular superselective treatment of brain tumors: a new endovascular era? A quick review

Background Intra-arterial therapy for malignant brain tumors, especially high-grade gliomas, has been administered since the 1950s and 1960s when the structure of the blood-brain barrier was first described. However, only with the advent of modern techniques used by endovascular neurosurgeons has it been possible to proceed with the release of chemotherapeutic agents in an ultraselective mode by superselective intraarterial cerebral infusion (SIACI). Methods A brief review was performed of all the published works from January 2000 to December 2013 in which the main issue was the superselective endovascular treatment of brain tumors with chemotherapy drugs. Results Intra-arterial non-selective therapy has been reported to be effective in chemosensitive tumors whereas the results in glioblastoma, at least in the prebevacizumab era, have been disappointing. Conclusions If the SIACI method for delivering bevacizumab after disruption of the blood-brain barrier is proved to be safe and effective in larger phase II and III trials, this paradigm may significantly alter the way chemotherapies are delivered to patients with both diffusely infiltrating low-grade and those with high-grade malignant brainstem gliomas and open a new endovascular era

In Reply to" A Limited Study on Brain Diseases in Kitāb al-Taysīr (Liber Teisir) of Ibn Zuhr (Avenzoar)"

Aciduman et al. made a very attentive and authoritative evaluation of our letter, “The ventricular system in the Renaissance”. Avenzoar reported the Nemesius of Emesa’s three brain compartments and In the chapter on de mania, Avenzoar also follows the Nemesius of Emesa’s brain cells theory. The absence of anatomical brain reference in Avenzoar’s writings other than anterior or posterior, prevents a document-based statement. Avenzoar followed the Nemesius of Emesa’s traditional teachings, and the location of functions in the brain cannot be attributed to him

Clinical remarks on acute post-traumatic atlanto-axial rotatory subluxation in pediatric-aged patients.

Objective. This study aimed to identify specific findings related to acute posttraumatic atlanto-axial rotatory subluxation in pediatric patients. Methods. We studied 14 children with acute atlanto-axial rotatory subluxations admitted to a hospital over a 5-year period after craniocervical injury. Clinical and radiological findings were reviewed to identify new findings related to atlanto-axial rotatory subluxation. Results. Most patients exhibited a typical picture of atlanto-axial rotatory subluxation, but one child also experienced transient blindness that was related to peculiar anatomical findings on neuroradiological images. A characteristic C2-C3 anterior pseudo-subluxation was detected among the radiographic signs. Magnetic resonance imaging showed no clear break in the alar ligaments, which were oriented horizontally. However, unlike the case in adult anatomy, in these children, the alar ligaments were laterally attached at the occipital condyle-axis condylar joints. In all children, atlanto-axial rotatory subluxation spontaneously reduced within a few hours after short bed rest without halter traction but with a cervical collar. No recurrence was observed during follow-up. Conclusions. Acute posttraumatic atlanto-axial rotatory subluxation in pediatric-aged patients is a rapidly resolving disease of the cranio-cervical junction. The disease appears to be related to an elasticity of the contralateral alar ligament, which is attached to the occipital condyle-axis condylar joint. Neurological symptoms (blindness) occurred in one patient when the vertebrobasilar blood flow was impaired and no compensation was provided from the anterior circulation. Use of a cervical collar and short bed rest without halter traction is recommended, based on our observations of complete recovery and no recurrence following the use of this treatment strategy

Letter to the Editor concerning "Rotational vertebral artery occlusion ('bow hunter syndrome')" by Schulz R, Donoso R, Weissman K (Eur Spine J. 2021 Jan 2. doi:10.1007/s00586-020-06, 680-5)

A case of bow hunter syndrome, secondary to rotational vertebral artery occlusion is reported by Schulz et al. After one year of conservative treatment and symptoms worsening a dynamic angio-CT showed absence of blood flow in the left vertebral artery. A posterior C1-C2 arthrodesis was performed with relief of symptoms. This case encourages a debate on appropriate criteria for selecting a C1-C2 fixation in patients with suspected posterior circulatory cerebro-vascular insufficiency syndrome