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A special issue of Brain Sciences (ISSN 2076-3425). This special issue belongs to the section "Neurosurgery and Neuroanatomy".

Deadline for manuscript submissions: closed (25 August 2023) | Viewed by 18987

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Special Issue Editor

Dr. Andrew P. Carlson

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Guest Editor

Department of Neurosurgery, University of New Mexico, Albuquerque, NM 87131, USA
Interests: cerebrovascular and endovascular neurosurgery; aneurysm; arteriovenous malfor-mation; dural fistula; cavernous malformation; stroke; carotid stenosis; complex cranial neurosurgery

Special Issue Information

Dear Colleagues,

The cerebrovascular system is an intricate set of structures that delivers blood, nutrients, and oxygen to the brain and drains deoxygenated blood and other waste products. Dysfunction of this highly regulated system can lead to stroke, hemorrhage, and other physiologic derangements. Cerebrovascular diseases are a global health problem, and we are living in a time of unprecedented advances in effective neurosurgical therapies, including surgical intervention refinements, novel endovascular approaches, and physiologically targeted monitoring and therapies.

This Special Issue aims to present the latest research in the field of cerebrovascular neurosurgery to introduce novel techniques and approaches to improve neurosurgical care.

We welcome papers on surgical and endovascular approaches to cerebrovascular diseases, as well as advances in physiological monitoring and therapies. We particularly welcome topics related to multidisciplinary collaborative approaches, such as combined surgical and endovascular techniques, multi-specialty decision making, and neurosurgical monitoring (multimodality monitoring) coupled with neurocritical care management in cerebrovascular diseases.

We are accepting original research studies, reviews, case reports, perspectives, and opinion articles.

Dr. Andrew P. Carlson
Guest Editor

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Keywords

stroke
brain hemorrhages
delayed cerebral ischemia
endovascular procedures
multimodality monitoring

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Published Papers (9 papers)

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Research

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17 pages, 621 KiB

Open AccessArticle

Assessing the Relationship between Surgical Timing and Postoperative Seizure Outcomes in Cavernoma-Related Epilepsy: A Single-Institution Retrospective Analysis of 63 Patients with a Review of the Literature

by Elsa Nico, Christopher O. Adereti, Ashia M. Hackett, Andrea Bianconi, Anant Naik, Adam T. Eberle, Pere J. Cifre Serra, Stefan W. Koester, Samuel L. Malnik, Brandon M. Fox, Joelle N. Hartke, Ethan A. Winkler, Joshua S. Catapano and Michael T. Lawton

Brain Sci. 2024, 14(5), 494; https://doi.org/10.3390/brainsci14050494 - 13 May 2024

Viewed by 1428

Abstract

Background: Patients with supratentorial cavernous malformations (SCMs) commonly present with seizures. First-line treatments for cavernoma-related epilepsy (CRE) include conservative management (antiepileptic drugs (AEDs)) and surgery. We compared seizure outcomes of CRE patients after early (≤6 months) vs. delayed (>6 months) surgery. Methods: We compared outcomes of CRE patients with SCMs surgically treated at our large-volume cerebrovascular center (1 January 2010–31 July 2020). Patients with 1 sporadic SCM and ≥1-year follow-up were included. Primary outcomes were International League Against Epilepsy (ILAE) class 1 seizure freedom and AED independence. Results: Of 63 CRE patients (26 women, 37 men; mean ± SD age, 36.1 ± 14.6 years), 48 (76%) vs. 15 (24%) underwent early (mean ± SD, 2.1 ± 1.7 months) vs. delayed (mean ± SD, 6.2 ± 7.1 years) surgery. Most (32 (67%)) with early surgery presented after 1 seizure; all with delayed surgery had ≥2 seizures. Seven (47%) with delayed surgery had drug-resistant epilepsy. At follow-up (mean ± SD, 5.4 ± 3.3 years), CRE patients with early surgery were more likely to have ILAE class 1 seizure freedom and AED independence than those with delayed surgery (92% (44/48) vs. 53% (8/15), p = 0.002; and 65% (31/48) vs. 33% (5/15), p = 0.03, respectively). Conclusions: Early CRE surgery demonstrated better seizure outcomes than delayed surgery. Multicenter prospective studies are needed to validate these findings. Full article

(This article belongs to the Special Issue Cerebrovascular Neurosurgery)

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9 pages, 216 KiB

Open AccessArticle

Racial and Socioeconomic Status among a Patient Population Presenting with Aneurysmal Subarachnoid Hemorrhage versus Unruptured Intracranial Aneurysm: A Single-Center Study

by Ashia M. Hackett, Christopher O. Adereti, Ariel P. Walker, Elsa Nico, Lea Scherschinski, Emmajane G. Rhodenhiser, Adam T. Eberle, Anant Naik, Juan P. Giraldo, Joelle N. Hartke, Redi Rahmani, Ethan A. Winkler, Joshua S. Catapano and Michael T. Lawton

Brain Sci. 2024, 14(4), 394; https://doi.org/10.3390/brainsci14040394 - 18 Apr 2024

Cited by 2 | Viewed by 1804

Abstract

Racial and socioeconomic health disparities are well documented in the literature. This study examined patient demographics, including socioeconomic status (SES), among individuals presenting with aneurysmal subarachnoid hemorrhage (aSAH) and unruptured intracranial aneurysm (UIA) to identify factors associated with aSAH presentation. A retrospective assessment was conducted of all patients with aSAH and UIA who presented to a large-volume cerebrovascular center and underwent microsurgical treatment from January 2014 through July 2019. Race and ethnicity, insurance type, and SES data were collected for each patient. Comparative analysis of the aSAH and UIA groups was conducted. Logistic regression models were also employed to predict the likelihood of aSAH presentation based on demographic and socioeconomic factors. A total of 640 patients were included (aSAH group, 251; UIA group, 389). Significant associations were observed between race and ethnicity, SES, insurance type, and aneurysm rupture. Non-White race or ethnicity, lower SES, and having public or no insurance were associated with increased odds of aSAH presentation. The aSAH group had poorer functional outcomes and higher mortality rates than the UIA group. Patients who are non-White, have low SES, and have public or no insurance were disproportionately affected by aSAH, which is historically associated with poorer functional outcomes. Full article

(This article belongs to the Special Issue Cerebrovascular Neurosurgery)

12 pages, 1868 KiB

Open AccessArticle

Analysis of Serum Markers of Perioperative Brain Injury and Inflammation Associated with Endovascular Treatment of Intracranial Aneurysms: A Preliminary Study

by Mikołaj Zimny, Piotr Paździora, Damian Kocur, Bartłomiej Błaszczyk, Daria Gendosz de Carrillo, Jan Baron, Halina Jędrzejowska-Szypułka and Adam Rudnik

Brain Sci. 2023, 13(9), 1308; https://doi.org/10.3390/brainsci13091308 - 11 Sep 2023

Viewed by 1180

Abstract

Embolization is the preferred method for treating intracranial aneurysms due to its less invasive nature. However, recent findings suggest that even uncomplicated embolization may cause structural damage to the brain through ischemic or inflammatory mechanisms. This study aimed to find possible biomarkers of brain injury and inflammation in patients suffering from intracranial aneurysms who underwent endovascular treatment by measuring serological markers indicating brain damage. The study involved 26 patients who underwent uncomplicated intravascular stenting for unruptured intracranial aneurysms between January 2020 and December 2021. Blood samples were collected before the procedure, at 6–12 h, and at 24 h after the procedure. The following protein biomarkers levels were tested with ELISA: S100B, hNSE, TNF, hsCRP, FABP7, NFL, and GP39. Statistical analysis of the results revealed significant increases in serum levels for the four biomarkers: FABP7—before 0.25 (ng/mL) vs. 6–12 h 0.26 (p = 0.012) and vs. 24 h 0.27 (p < 0.001); GP39—before 0.03 (pg/mL) vs. 6–12 h 0.64 (p = 0.011) and vs. 24 h 0.57 (p = 0.001); hsCRP—before 1.65 (μg/mL) vs. 24 h 4.17 (p = 0.037); NFL—before 0.01 (pg/mL) vs. 6–12 h 3.99 (p = 0.004) and vs. 24 h 1.86 (p = 0.033). These biomarkers are recognized as potential indicators of neurovascular damage and should be monitored in clinical settings. Consequently, serum levels of NFL, GP39, hsCRP, and FABP7 measured before and 24 h after endovascular procedures can serve as important markers for assessing brain damage and indicate avenues for further research on biomarkers of neurovascular injury. Full article

(This article belongs to the Special Issue Cerebrovascular Neurosurgery)

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11 pages, 3643 KiB

Open AccessArticle

Real-Time MRI Monitoring of Liquid Embolic Agent (Onyx) Injection in a Swine Arteriovenous Malformation Model

by Michał Zawadzki, Miłosz Pinkiewicz, Mateusz Pinkiewicz, Jerzy Walecki, Piotr Walczak, Dominika Gołubczyk, Maria Sady and Zdzisław Gajewski

Brain Sci. 2023, 13(6), 915; https://doi.org/10.3390/brainsci13060915 - 6 Jun 2023

Cited by 1 | Viewed by 2484

Abstract

The paradigm is gradually shifting, with radiosurgery and endovascular embolization being increasingly chosen over surgical resection in the selected cases of brain arteriovenous malformations. Routinely used X-ray monitoring of liquid embolic infusion has very good spatial and temporal resolution but is not without significant drawbacks regarding poor visualization of the complex AVM angioarchitecture, especially after many embolizations in the past and therefore limiting the technical ability of the embocure—total occlusion of the feeding arteries, nidus, and draining veins. The purpose of this study was to evaluate the use of real-time MRI guidance in endovascular embolization with Onyx (instead of X-ray) in a single swine rete mirabile (RM) AVM model in order to provide the scaffolding for the real-time MRI guidance method. Onyx propagation was observed in real-time dynamic GE-EPI scan with initial ipsilateral RM filling followed by main cerebral arterial branch distribution. The relatively bright signal within RM and the brain prior to Onyx injection provided a good background for the dark, low signal of the embolic agent spreading in rete mirabile and brain arteries. X-ray picture confirmed Onyx cast distribution at the end of the procedure. In this initial experience, real-time MRI seems to be a promising method that may significantly improve liquid embolic agent infusion monitoring in the future, although requiring further development before clinical use. Full article

(This article belongs to the Special Issue Cerebrovascular Neurosurgery)

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17 pages, 6672 KiB

Open AccessArticle

Role of Protein Tyrosine Phosphatase 1B Inhibitor in Early Brain Injury of Subarachnoid Hemorrhage in Mice

by Zhong-Hua Zhang, Xiao-Ming Zhou and Xin Zhang

Brain Sci. 2023, 13(5), 816; https://doi.org/10.3390/brainsci13050816 - 18 May 2023

Cited by 3 | Viewed by 2438

Abstract

Clinically, early brain injury (EBI), which refers to the acute injuries to the whole brain in the phase of the first 72 h following subarachnoid hemorrhage (SAH), is intensely investigated to improve neurological and psychological function. Additionally, it will be meaningful to explore new therapeutic approaches for EBI treatment to improve the prognosis of patients with SAH. To investigate the underlying neuroprotection mechanism in vitro, the Protein tyrosine phosphatase 1B inhibitor (PTP1B-IN-1) was put in primary neurons induced by OxyHb to observe neuroapoptosis, neuroinflammation, and ER stress. Then, one hundred forty male mice were subjected to Experiment two and Experiment three. The mice in the SAH24h + PTP1B-IN-1 group were given an intraperitoneal injection of 5 mg/kg PTP1B-IN-1 30 min before anesthesia. SAH grade, neurological score, brain water content, Western blot, PCR, and Transmission Electron Microscopy (TEM) were performed to observe the underlying neuroprotection mechanism in vivo. Overall, this study suggests that PTP1B-IN-1 could ameliorate neuroapoptosis, neuroinflammation, and ER stress in vitro and in vivo by regulating the IRS-2/AKT signaling pathway, suggesting that PTP1B-IN-1 may be a candidate drug for the treatment of early brain injury after SAH. Full article

(This article belongs to the Special Issue Cerebrovascular Neurosurgery)

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Review

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15 pages, 1216 KiB

Open AccessReview

The Role of Cisternostomy and Cisternal Drainage in the Treatment of Aneurysmal Subarachnoid Hemorrhage: A Comprehensive Review

by Alberto Vandenbulcke, Mahmoud Messerer, Roy T. Daniel and Giulia Cossu

Brain Sci. 2023, 13(11), 1580; https://doi.org/10.3390/brainsci13111580 - 11 Nov 2023

Cited by 5 | Viewed by 1952

Abstract

Aneurysmal subarachnoid hemorrhage (aSAH) provokes a cascade reaction that is responsible for early and delayed brain injuries mediated by intracranial hypertension, hydrocephalus, cerebral vasospasm (CV), and delayed cerebral ischemia (DCI), which result in increased morbidity and mortality. During open microsurgical repair, cisternal access is achieved essentially to gain proximal vascular control and aneurysm exposition. Cisternostomy also allows brain relaxation, removal of cisternal clots, and restoration of the CSF dynamics through the communication between the anterior and posterior circulation cisterns and the ventricular system, with the opening of the Membrane of Liliequist and lamina terminalis, respectively. Continuous postoperative CSF drainage through a cisternal drain (CD) is a valuable option for treating acute hydrocephalus and intracranial hypertension. Moreover, it efficiently removes the blood and toxic degradation products, with a potential benefit on CV, DCI, and shunt-dependent hydrocephalus. Finally, the CD is an effective pathway to administer vasoactive, fibrinolytic, and anti-oxidant agents and shows promising results in decreasing CV and DCI rates while minimizing systemic effects. We performed a comprehensive review to establish the adjuvant role of cisternostomy and CD performed in cases of direct surgical repair for ruptured intracranial aneurysms and their role in the prevention and treatment of aSAH complications. Full article

(This article belongs to the Special Issue Cerebrovascular Neurosurgery)

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12 pages, 1548 KiB

Open AccessReview

Inflammatory Mechanisms in a Neurovascular Disease: Cerebral Cavernous Malformation

by Ying Li, Abhinav Srinath, Roberto J. Alcazar-Felix, Stephanie Hage, Akash Bindal, Rhonda Lightle, Robert Shenkar, Changbin Shi, Romuald Girard and Issam A. Awad

Brain Sci. 2023, 13(9), 1336; https://doi.org/10.3390/brainsci13091336 - 17 Sep 2023

Cited by 1 | Viewed by 2282

Abstract

Cerebral cavernous malformation (CCM) is a common cerebrovascular malformation causing intracranial hemorrhage, seizures, and focal neurologic deficits. A unique CCM lesional inflammatory microenvironment has been shown to influence the clinical course of the disease. This review addresses the inflammatory cell infiltrate in the CCM lesion and the role of a defined antigen-driven immune response in pathogenicity. We summarize immune mechanisms associated with the loss of the CCM gene and disease progression, including the potential role of immunothrombosis. We also review evidence of circulating inflammatory biomarkers associated with CCM disease and its clinical activity. We articulate future directions for this research, including the role of individual cell type contributions to the immune response in CCM, single cell transcriptomics of inflammatory cells, biomarker development, and therapeutic implications. The concepts are applicable for developing diagnostic and treatment strategies for CCM and for studying other neurovascular diseases. Full article

(This article belongs to the Special Issue Cerebrovascular Neurosurgery)

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Other

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7 pages, 1089 KiB

Open AccessOpinion

Perspectives and Implications of Coanda Effect in Aneurysms

by Vicentiu-Mircea Saceleanu, Razvan-Adrian Covache-Busuioc, Luca-Andrei Glavan, Antonio-Daniel Corlatescu and Alexandru Vlad Ciurea

Brain Sci. 2023, 13(6), 966; https://doi.org/10.3390/brainsci13060966 - 19 Jun 2023

Cited by 2 | Viewed by 2194

Abstract

It is yet unknown how the formation of an aneurysm inside the human body occurs. Thus, understanding and analyzing the Coanda effect will result in a better overview of the overall fluid mechanics that develop inside such a structure, leading not only to better treatment plans, but also to diminished postoperative risks. This paper presents how the fluid behaves in this situation, and takes into consideration how this physical phenomenon influences the hemodynamics inside numerous anatomical regions, located in the central nervous system, where aneurysms usually develop. Analyzing the three main areas in which cerebral aneurysms form, the Coanda effect can potentially lead to the rupture of the aneurysm by changing the blood flow trajectory; this should be taken into consideration when choosing a treatment plan, especially in postoperative care. In addition, there are other factors that can influence the evolution of an aneurysm, such as its shape, size, localization and the patient’s health condition. Understanding and analyzing the Coanda effect will result in a better overview of the overall fluid mechanics that develop inside such a structure, leading not only to better treatment plans, but also to diminished postoperative risks. Full article

(This article belongs to the Special Issue Cerebrovascular Neurosurgery)

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8 pages, 1634 KiB

Open AccessCase Report

Direct Burr Hole Access for Transverse–Sigmoid Junction DAVF Embolization: A Case Report

by James Withers, Robert W. Regenhardt, Adam A. Dmytriw, Justin E. Vranic, Rudolph Marciano, Christopher J. Stapleton and Aman B. Patel

Brain Sci. 2023, 13(6), 871; https://doi.org/10.3390/brainsci13060871 - 27 May 2023

Viewed by 2162

Abstract

Dural arteriovenous fistulas (DAVFs) are rare intracranial vascular malformations that present with a variety of clinical signs and symptoms. Among these, intracranial hemorrhage is a severe complication. A 72-year-old male presented with headache and pulsatile tinnitus. Cerebral angiography revealed a Borden II/Cognard IIa+b DAVF. He underwent stage 1 transarterial embolization of the occipital artery which reduced shunting by 30%. Several attempts were made to access the fistula during stage 2 transvenous embolization, but it was not possible to access the left transverse sinus fistula site since there was no communication across the torcula from the right transverse sinus and the left inferior sigmoid–jugular bulb was occluded. Therefore, a single burr hole was drilled and direct access to the DAVF was achieved with a micropuncture needle under neuronavigational guidance. The left transverse–sigmoid sinus junction was then embolized with coils. After the procedure, angiography revealed that the DAVF was cured with no residual shunting. This case demonstrates how minimally invasive surgery provides an alternative method to access a DVAF when conventional transarterial and/or transvenous embolization treatment options are not possible. Each DAVF case has unique anatomy and physiology, and creative multi-disciplinary strategies can often yield the best results. Full article

(This article belongs to the Special Issue Cerebrovascular Neurosurgery)

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