Treatment of intracranial aneurysms using the new Surpass Evolve flow diverter : Safety outcomes and six-month imaging follow-up

Background and purpose. - Several studies have reported good long-term results in the occlusion of intracranial aneurysms with flow diverter treatment. The aim of this study was to report the safety and six-month follow-up outcomes using the new Surpass Evolve flow diverter in the treatment of intracranial aneurysms. Materials and methods. - Consecutive patients with intracranial aneurysm treated with Surpass Evolve flow diverter in two high-volume neurovascular centers between May 2019 and January 2020 were retrospectively reviewed. Procedure-related complications, aneurysm occlusion (O'Kelly-Marotta grading scale), and clinical outcomes were assessed. Results. - Twenty-nine patients with 30 aneurysms were included in the study. Favorable aneurysm occlusion (O'Kelly Marotta grading scale C-D) at six-month follow-up was achieved in 21/27 (78%) aneurysms. No clinical procedure related thromboembolic complications were encountered. Twenty-three out of 24 patients with unruptured aneurysms treated with Surpass Evolve remained clinically intact at clinical follow-up. There was one fatal hemorrhagic procedure-related complication (3%). In five patients with ruptured aneurysms, no early or late rebleeds occurred from the aneurysms. Conclusions. - Surpass Evolve FD worked technically well with no intraprocedural thromboembolic complications and occlusion rates comparable to other FDs. (c) 2021 L'Auteur(s). Publie par Elsevier Masson SAS. Cet article est publie en Open Access sous licence CC BY (http://creativecommons.org/licenses/by/4.0/).Peer reviewe

Successful endovascular coil embolisation of a ruptured V1-segment vertebral artery dissecting aneurysm making a fistula with the adjacent vein

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Representational similarity analysis of EEG and fMRI responses to face identities and emotional expressions

Volume: 17Peer reviewe

Spatio-temporal dynamics of face perception

The temporal and spatial neural processing of faces has been investigated rigorously, but few studies have unified these dimensions to reveal the spatio-temporal dynamics postulated by the models of face processing. We used support vector machine decoding and representational similarity analysis to combine information from different locations (fMRI), time windows (EEG), and theoretical models. By correlating representational dissimilarity matrices (RDMs) derived from multiple pairwise classifications of neural responses to different facial expressions (neutral, happy, fearful, angry), we found early EEG time windows (starting around 130 ​ms) to match fMRI data from primary visual cortex (V1), and later time windows (starting around 190 ​ms) to match data from lateral occipital, fusiform face complex, and temporal-parietal-occipital junction (TPOJ). According to model comparisons, the EEG classification results were based more on low-level visual features than expression intensities or categories. In fMRI, the model comparisons revealed change along the processing hierarchy, from low-level visual feature coding in V1 to coding of intensity of expressions in the right TPOJ. The results highlight the importance of a multimodal approach for understanding the functional roles of different brain regions in face processing.Peer reviewe

Hidden sources of joy, fear, and sadness : Explicit versus implicit neural processing of musical emotions

Music is often used to regulate emotions and mood. Typically, music conveys and induces emotions even when one does not attend to them. Studies on the neural substrates of musical emotions have, however, only examined brain activity when subjects have focused on the emotional content of the music. Here we address with functional magnetic resonance imaging (fMRI) the neural processing of happy, sad, and fearful music with a paradigm in which 56 subjects were instructed to either classify the emotions (explicit condition) or pay attention to the number of instruments playing (implicit condition) in 4-s music clips. In the implicit vs. explicit condition, stimuli activated bilaterally the inferior parietal lobule, premotor cortex, caudate, and ventromedial frontal areas. The cortical dorsomedial prefrontal and occipital areas activated during explicit processing were those previously shown to be associated with the cognitive processing of music and emotion recognition and regulation. Moreover, happiness in music was associated with activity in the bilateral auditory cortex, left parahippocampal gyrus, and supplementary motor area, whereas the negative emotions of sadness and fear corresponded with activation of the left anterior cingulate and middle frontal gyrus and down-regulation of the orbitofrontal cortex. Our study demonstrates for the first time in healthy subjects the neural underpinnings of the implicit processing of brief musical emotions, particularly in frontoparietal, dorsolateral prefrontal, and striatal areas of the brain. (C) 2016 Elsevier Ltd. All rights reserved.Peer reviewe

Spatial confounding in Bayesian species distribution modeling

1) Species distribution models (SDMs) are currently the main tools to derive species niche estimates and spatially explicit predictions for species geographical distribution. However, unobserved environmental conditions and ecological processes may confound the model estimates if they have direct impact on the species and, at the same time, they are correlated with the observed environmental covariates. This, so-called spatial confounding, is a general property of spatial models and it has not been studied in the context of SDMs before. 2) We examine how the estimation accuracy of SDMs depends on the type of spatial confounding. We construct two simulation studies where we alter spatial structures of the observed and unobserved covariates and the level of dependence between them. We fit generalized linear models with and without spatial random effects applying Bayesian inference and recording the bias induced to model estimates by spatial confounding. After this we examine spatial confounding also with real vegetation data from northern Norway. 3) Our results show that model estimates for coarse scale covariates, such as climate covariates, are likely to be biased if a species distribution depends also on an unobserved covariate operating on a finer spatial scale. Pushing higher probability for a relatively weak and smoothly varying spatial random effect compared to the observed covariates improved the model's estimation accuracy. The improvement was independent of the actual spatial structure of the unobserved covariate. 4) Our study addresses the major factors of spatial confounding in SDMs and provides a list of recommendations for pre-inference assessment of spatial confounding and for inference-based methods to decrease the chance of biased model estimates.Peer reviewe

Screening of unruptured intracranial aneurysms in 50 to 60-year-old female smokers : a pilot study

The prevalence of unruptured intracranial aneurysms (UIAs) is around 2-3% in the general population. We hypothesized that the prevalence of small UIAs is higher among 50 to 60-year-old female smokers, since the incidence of aneurysmal subarachnoid hemorrhage (aSAH) is exceptionally high in 60 to 70-year-old female smokers. Ethics approval for this pilot study of 50 women was obtained from the hospital ethics committee. In order to minimize recruitment bias, preliminary invitation letters were sent to 50 to 60-year-old women who were known to be active smokers. Those interested in participating were further informed about the study rationale and protocol. Following written consent, participants filled a detailed questionnaire and underwent computed tomography angiography (CTA) analysis. All abnormalities were recorded. Of the 158 preliminary invitation letters, 70 potential participants initially replied. Of these, 50 returned questionnaires and written consents, 43 of which underwent CTA analysis. Most (39; 91%) were postmenopausal, and 9 (21%) were hypertensive. Two reported a family history (>= 1 first-degree members) of intracranial aneurysms. UIAs (maximum sizes of 2, 2, 3, 3 and 7 mm) were found in five (12%) female smokers. One woman was operated on, and the remaining four were treated with non-invasive preventive actions (smoking cessation and follow-ups). Small UIAs, which may be best suited for non-invasive preventive actions, may be relatively common in 50 to 60-year-old female smokers. Whether this kind of targeted screening leads to improved health in female smokers requires further investigation.Peer reviewe

Aivojen valtimo-laskimoepämuodostumat

English summar

Nenäverenvuodon angioradiologinen hoito

Kuukauden kuva

Occurrence and prognostic effect of cervical spine injuries and cervical artery injuries with concomitant severe head injury

Background Blunt cerebrovascular injuries (BCVIs) and cervical spinal injuries (CSIs) are not uncommon injuries in patients with severe head injury and may affect patient recovery. We aimed to assess the independent relationship between BCVI, CSI, and outcome in patients with severe head injury. Methods We identified patients with severe head injury from the Helsinki Trauma Registry treated during 2015-2017 in a large level 1 trauma hospital. We assessed the association between BCVI and SCI using multivariable logistic regression, adjusting for injury severity. Our primary outcome was functional outcome at 6 months, and our secondary outcome was 6-month mortality. Results Of 255 patients with a cervical spine CT, 26 patients (10%) had a CSI, and of 194 patients with cervical CT angiography, 16 patients (8%) had a BCVI. Four of the 16 BCVI patients had a BCVI-related brain infarction, and four of the CSI patients had some form of spinal cord injury. After adjusting for injury severity in multivariable logistic regression analysis, BCVI associated with poor functional outcome (odds ratio [OR] = 6.0, 95% CI [confidence intervals] = 1.4-26.5) and mortality (OR = 7.9, 95% CI 2.0-31.4). We did not find any association between CSI and outcome. Conclusions We found that BCVI with concomitant head injury was an independent predictor of poor outcome in patients with severe head injury, but we found no association between CSI and outcome after severe head injury. Whether the association between BCVI and poor outcome is an indirect marker of a more severe injury or a result of treatment needs further investigations.Peer reviewe