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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

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

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

Post-traumatic hydrocephalus after decompressive craniectomy.

The diagnosis of hydrocephalus after decompressive craniectomy (DC) for severe traumatic brain injury is exclusively radiological in the first 2–3 weeks. The appearance on CT scan of progressive ventricular enlargement is pathognomonic, sometimes preceded by characteristic interhemispheric cerebrospinal fluid collection. The distance of the medial margin of the craniectomy from the midline in the past has been a significant factor for post-traumatic hydrocephalus. To date the largest post-DC cohort series, now reported by Williams, drives us to consider nonsignificant the medial craniectomy margin distance from midline to favour hydrocephalus after DC

A systematic review and meta-analysis of treatment and outcome of blister-like aneurysms

BACKGROUND AND PURPOSE: Blister-like aneurysms are uncommon but challenging lesions. Their small size and atypical location often make the diagnosis difficult. Microsurgery and endovascular procedures have been used for their treatment, but there is no consensus on the best treatment technique. We conducted a systematic review and meta-analysis of treatments and outcomes of these vascular lesions. MATERIALS AND METHODS: We reviewed English-language articles on "blood blister-like aneurysms" published between January 1997 and November 2014. All studies reporting patients with these aneurysms treated with surgery, endovascular procedures, or combined therapy with data on treatment modalities and clinical and/or angiographic outcomes were selected, including case reports and series. We performed a meta-analysis on the 2 largest treatment groups (surgery and endovascular management). RESULTS: Sixty studies with 334 patients met our inclusion criteria. Surgery was performed in 114 patients (34.2%), and endovascular treatment, in 199 patients (59.5%). A combined treatment was used in 19 patients (5.7%). A favorable outcome (mRS 0-2) was reported in 67.4% and 78.9% of patients treated with surgery and with endovascular therapy, respectively (P = .034). CONCLUSIONS: Blister-like aneurysms are challenging vascular lesions. The choice of treatment method must be based on the initial clinical presentation and an analysis of the radiologic features of the lesion to select the best technique. Endovascular treatment seems to have lower morbidity and mortality and provides a better outcome compared with surgical approaches. Further prospective studies must be performed to confirm such interesting result

Emerging strategies and future perspective in neuro-oncology using transcranial focused ultrasonography technology

Background: Despite the progress achieved in recent years, the prognosis of patients with primary brain tumors remains poor. Research efforts have therefore focused on identifying more effective and minimally invasive treatment methods. Magnetic resonance–guided transcranial focused ultrasonography (MRgFUS) is a consolidated minimally invasive therapeutic technique, which has recently acquired a role also in the treatment of some nononcologic intracranial diseases. Methods: We reviewed the latest studies to take stock of the potential of MRgFUS. Results: The objective of the research in the last decade was to apply FUS also to the treatment of intracranial neoplastic diseases, using both the thermal effects (thermal ablation) and, above all, the ability to permeabilize the blood-brain barrier and modify the tumor microenvironment. This strategy may allow the use of drugs that are poorly active on the central nervous system or active selectively at high doses, minimize the side effects, and substantially modify the prognosis of patients affected by these diseases. Conclusions: In the future, targeted drug delivery, immunotherapy, and gene therapy will probably become main players in the treatment of brain neoplasms, with the aid of MRgFUS. In this way, it will be possible to directly intervene on tumor cells and preserve healthy tissue