The Latest Exploration of Cerebrovascular Diseases: From Preclinical Research to Treatment

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

Deadline for manuscript submissions: 3 February 2025 | Viewed by 7793

Special Issue Editors


E-Mail Website
Guest Editor
1. Department of Neurosurgery, St. Gallen Cantonal Hospital, 9000 St. Gallen, Switzerland
2. Department of Neuroradiology, Timone Hospital, Marseille, France
Interests: aneurysm wall biology; animal models for the study of endovascular technologies; cerebrovascular surgery and minimally invasive procedures; intraoperative technology; device development
Special Issues, Collections and Topics in MDPI journals

E-Mail Website
Guest Editor
1. Department of Neurosurgery, University Hospital Zurich, 8091 Zurich, Switzerland
2. Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
Interests: functional neuroimaging; brain hemodynamics; BOLD functional MRI to assess cerebrovascular reactivity in cerebrovascular diseases (brain AVM, large athero-sclerotic vessel occlusion, Moyamoya disease); role of surgical revascularization in acute stroke

Special Issue Information

Dear Colleagues,

The latest exploration of cerebrovascular diseases, which encompasses a range of conditions affecting blood flow to the brain and cerebral hemodynamic status, has marked significant advancements from preclinical research to clinical treatments. Preclinical studies have delved into the intricate mechanisms of these diseases, uncovering critical insights into risk factors, genetic predispositions, and molecular pathways. Breakthroughs in neuroimaging and biomarker identification have enhanced early detection and diagnosis, paving the way for more targeted interventions.

On the diagnostic and treatment front, innovative approaches are emerging. Novel, non-invasive, and quantitative imaging techniques to assess brain hemodynamics and collateral vessel status through innovative MRI methods shape our understanding and broaden the multimodal treatment options for various neurovascular diseases, including acute ischemic stroke. Cutting-edge therapies, such as neuroprotective drugs and advanced endovascular techniques, are showing promise in reducing the impact of strokes and other cerebrovascular events. Regenerative medicine, including stem cell therapy, offers hope for repairing brain damage and restoring function. Furthermore, personalized medicine is gaining traction, with treatments tailored to the individual’s genetic and clinical profile, improving outcomes and reducing adverse effects.

Integrating artificial intelligence and machine learning revolutionizes research and clinical practice, enabling more precise diagnosis, disease progression prediction, and treatment strategy optimization. This multi-faceted approach, from preclinical discoveries to personalized treatments, signifies a new era in the fight against cerebrovascular diseases, offering hope for improved patient outcomes and quality of life.

Dr. Basil Grüter
Dr. Martina Sebök
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Brain Sciences is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2200 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • intracranial aneurysm
  • arterio-venous malformation (AVM)
  • dural arterio-venous fistula (AVF)
  • ischaemic stroke
  • chronic steno-occlusive disease

Benefits of Publishing in a Special Issue

  • Ease of navigation: Grouping papers by topic helps scholars navigate broad scope journals more efficiently.
  • Greater discoverability: Special Issues support the reach and impact of scientific research. Articles in Special Issues are more discoverable and cited more frequently.
  • Expansion of research network: Special Issues facilitate connections among authors, fostering scientific collaborations.
  • External promotion: Articles in Special Issues are often promoted through the journal's social media, increasing their visibility.
  • e-Book format: Special Issues with more than 10 articles can be published as dedicated e-books, ensuring wide and rapid dissemination.

Further information on MDPI's Special Issue polices can be found here.

Published Papers (10 papers)

Order results
Result details
Select all
Export citation of selected articles as:

Research

Jump to: Other

12 pages, 2621 KiB  
Article
Clinical Presentations and Treatment Approaches in a Retrospective Analysis of 128 Intracranial Arteriovenous Malformation Cases
by Corneliu Toader, Mugurel Petrinel Radoi, Milena-Monica Ilie, Razvan-Adrian Covache-Busuioc, Vlad Buica, Luca-Andrei Glavan, Christian-Adelin Covlea, Antonio Daniel Corlatescu, Horia-Petre Costin, Carla Crivoi and Leon Danaila
Brain Sci. 2024, 14(11), 1136; https://doi.org/10.3390/brainsci14111136 - 12 Nov 2024
Viewed by 504
Abstract
Background: Intracranial AVMs are a highly heterogeneous group of lesions that, while not very common, can pose significant risks. The therapeutic management of AVMs is complicated by ambiguous guidelines, particularly regarding which Spetzler–Martin grades should dictate specific treatment options. This study analyzed the [...] Read more.
Background: Intracranial AVMs are a highly heterogeneous group of lesions that, while not very common, can pose significant risks. The therapeutic management of AVMs is complicated by ambiguous guidelines, particularly regarding which Spetzler–Martin grades should dictate specific treatment options. This study analyzed the clinical presentations and treatment approaches of 128 brain AVM cases managed between 2014 and 2022 at the National Institute of Neurology and Neurovascular Diseases in Bucharest, Romania. Methods: A retrospective analysis was conducted on patient demographics, clinical symptoms, Spetzler–Martin categorization, nidus localization, therapeutic management, and outcomes. Statistical analysis was performed using Python 3.10. Results: In our cohort of patients, the median age was 45 years, with a slight male predominance (67 males, 61 females). At admission, 51.5% presented with elevated blood pressure. The majority of patients had a Spetzler–Martin score of 2 (37.5%), followed by scores of 3 (31.3%) and 1 (20.3%). Treatment strategies included microsurgical resection in 32% of cases, conservative management in 31.2%, Gamma Knife radiosurgery in 22.6%, and endovascular embolization in 13.3%. Notably, open surgery was predominantly chosen for Grade II AVMs. The functional outcomes were favorable, with 69.5% achieving a good recovery score on the Glasgow Outcome Scale. Only four in-hospital deaths occurred, all in patients who underwent open surgery, and no deaths were recorded during the two-year follow-up. Conclusions: AVMs within the same Spetzler–Martin grade display considerable complexity, necessitating personalized treatment strategies. Our findings highlight the limitations of open surgery for Grade I cases but affirm its effectiveness for Grade II AVMs. Full article
Show Figures

Figure 1

9 pages, 1624 KiB  
Article
Radiological Outcome of Middle Meningeal Artery Embolization in Relation to Chronic Subdural Hematoma Cause and Architecture
by Ahmed Abdelghafar, Andrew Falzon, Eef J. Hendriks, Ivan Radovanovic, Hugo Andrade, Joanna D. Schaafsma and Pascal J. Mosimann
Brain Sci. 2024, 14(11), 1097; https://doi.org/10.3390/brainsci14111097 - 30 Oct 2024
Viewed by 452
Abstract
Background/Objectives: MMAE (middle meningeal artery embolization) has emerged as a potential effective treatment for cSDH (chronic subdural hematoma). In this study, MMAE efficiency with regards to cSDH cause and architecture was explored. The comparability of cSDH thickness and volume as parameters for [...] Read more.
Background/Objectives: MMAE (middle meningeal artery embolization) has emerged as a potential effective treatment for cSDH (chronic subdural hematoma). In this study, MMAE efficiency with regards to cSDH cause and architecture was explored. The comparability of cSDH thickness and volume as parameters for cSDH pre- and post-MMAE assessment was also analyzed. Methods: In this retrospective cohort study, 52 consecutive cSDH patients treated with MMAE in a single tertiary center were included. The cohort was divided into two group pairs pertaining to cSDH cause (spontaneous or traumatic) and cSDH architecture (non-mature or mature). The radiological outcome was compared in each group before and after MMAE and between each group pair using CT imaging. A correlation analysis between cSDH thickness and volume before and after MMAE was also performed. Results: A statistically significant positive linear association between cSDH thickness and volume at admission and at each follow-up interval (1–3, 3–6, 6–12 months) was noticed. cSDH thickness and volume reduction in each group was statistically significant, except for a traumatic cSDH volume reduction at 6–12 months. There was no statistically significant difference between each group pair in the cSDH thickness and volume reduction difference at all the follow-up intervals. Conclusions: A comparable efficiency of MMAE may be achieved in non-mature and mature as well as in spontaneous and traumatic cSDH, with an advantage for spontaneous cSDH at 6–12 months follow-up compared to traumatic cSDH. Traumatic cSDH may require a relatively long-term follow-up post-MMAE. cSDH thickness and volume, as parameters for pre- and post-MMAE cSDH evaluation, appear similar. Full article
Show Figures

Figure 1

16 pages, 1332 KiB  
Article
Microsurgical Clipping of Unruptured Middle Cerebral Artery Bifurcation Aneurysms: A Single-Center Experience
by Nico Stroh-Holly, Philip Rauch, Harald Stefanits, Philipp Hermann, Helga Wagner, Michael Sonnberger, Maria Gollwitzer, Stefan Aspalter, Andreas Gruber and Matthias Gmeiner
Brain Sci. 2024, 14(11), 1068; https://doi.org/10.3390/brainsci14111068 - 26 Oct 2024
Viewed by 685
Abstract
Background/Objectives: Microsurgical clipping has traditionally been considered a standard treatment for middle cerebral artery (MCA) aneurysms. Recently, a caseload reduction related to improved endovascular treatment options has occurred in cerebrovascular neurosurgery. Therefore, studies that report the clinical and radiological outcomes after clipping are [...] Read more.
Background/Objectives: Microsurgical clipping has traditionally been considered a standard treatment for middle cerebral artery (MCA) aneurysms. Recently, a caseload reduction related to improved endovascular treatment options has occurred in cerebrovascular neurosurgery. Therefore, studies that report the clinical and radiological outcomes after clipping are highly warranted. Methods: Patients with an unruptured MCA bifurcation aneurysm, who were surgically treated at the Department of Neurosurgery in Linz between 2002 and 2019, were included in this study. Clinical and radiological outcome parameters were evaluated for each patient. Results: Overall, 272 patients were eligible for inclusion. Complete aneurysm occlusion was demonstrated in 266 (99.3%) of the 268 (98.5%) patients who underwent postoperative digital subtraction angiography. In six (2.2%) patients, a permanent new neurological deficit (pNND) persisted after treatment. Intraoperative aneurysm rupture was a significant factor (p = 0.0049) in the logistic regression. At the last follow-up, only two patients (0.7%) had an unfavorable outcome (mRS > 2). More recent surgeries were associated with fewer cases of pNND (p = 0.009). A transient new neurological deficit occurred in 13 patients (4.8%), with aneurysm size being a significant risk factor (p = 0.009). Surgical site infections were reported in four patients (1.5%), with patient age (p = 0.039) and time (p = 0.001) being significant factors. Two patients died (0.7%) perioperatively and two patients (0.7%) needed a retreatment in the long-term follow-up. Conclusions: The findings indicate that microsurgical clipping is a safe procedure with minimal need for retreatment. It achieves a high occlusion rate while maintaining a very low rate of adverse outcomes. Continuous intraoperative enhancements over time have contributed to a progressive improvement in clinical outcomes in recent years. This trend is exemplified by the absence of detectable pNND in the era of ICG angiography. Consequently, these data support the conclusion that microsurgical clipping should still be considered an appropriate treatment option for unruptured MCA bifurcation aneurysms. Full article
Show Figures

Figure 1

14 pages, 4655 KiB  
Article
Fluid–Structure Interaction Simulations of the Initiation Process of Cerebral Aneurysms
by Jozsef Nagy, Wolfgang Fenz, Veronika M. Miron, Stefan Thumfart, Julia Maier, Zoltan Major, Harald Stefanits, Johannes Oberndorfer, Nico Stroh, Vanessa Mazanec, Philip-Rudolf Rauch, Andreas Gruber and Matthias Gmeiner
Brain Sci. 2024, 14(10), 977; https://doi.org/10.3390/brainsci14100977 - 27 Sep 2024
Viewed by 797
Abstract
Background: Hemodynamics during the growth process of cerebral aneurysms are incompletely understood. We developed a novel fluid–structure interaction analysis method for the identification of relevant scenarios of aneurysm onset. Method: This method integrates both fluid dynamics and structural mechanics, as well as their [...] Read more.
Background: Hemodynamics during the growth process of cerebral aneurysms are incompletely understood. We developed a novel fluid–structure interaction analysis method for the identification of relevant scenarios of aneurysm onset. Method: This method integrates both fluid dynamics and structural mechanics, as well as their mutual interaction, for a comprehensive analysis. Patients with a single unruptured cerebral aneurysm were included. Results: Overall, three scenarios were identified. In scenario A, wall shear stress (WSS) was low, and the oscillatory shear index (OSI) was high in large areas within the region of aneurysm onset (RAO). In scenario B, the quantities indicated a reversed behavior, where WSS was high and OSI was low. In the last scenario C, a behavior in-between was found, with scenarios A and B coexisting simultaneously in the RAO. Structural mechanics demonstrated a similar but independent trend. Further, we analyzed the change in hemodynamics between the onset and a fully developed aneurysm. While scenarios A and C remained unchanged during aneurysm growth, 47% of aneurysms in scenario B changed into scenario A and 20% into scenario C. Conclusions: In conclusion, these findings suggest that WSS and the OSI are reciprocally regulated, and both low and high WSS/OSI conditions can lead to aneurysm onset. Full article
Show Figures

Figure 1

14 pages, 13792 KiB  
Article
Assessment of Interrater Reliability and Accuracy of Cerebral Aneurysm Morphometry Using 3D Virtual Reality, 2D Digital Subtraction Angiography, and 3D Reconstruction: A Randomized Comparative Study
by Attill Saemann, Daniel de Wilde, Jonathan Rychen, Michel Roethlisberger, Marek Żelechowski, Balázs Faludi, Philippe Claude Cattin, Marios-Nikos Psychogios, Jehuda Soleman and Raphael Guzman
Brain Sci. 2024, 14(10), 968; https://doi.org/10.3390/brainsci14100968 - 26 Sep 2024
Viewed by 959
Abstract
Background/Objectives: Detailed morphometric analysis of an aneurysm and the related vascular bifurcation are critical factors when determining rupture risk and planning treatment for unruptured intracranial aneurysms (UIAs). The standard visualization of digital subtraction angiography (DSA) and its 3D reconstruction on a 2D monitor [...] Read more.
Background/Objectives: Detailed morphometric analysis of an aneurysm and the related vascular bifurcation are critical factors when determining rupture risk and planning treatment for unruptured intracranial aneurysms (UIAs). The standard visualization of digital subtraction angiography (DSA) and its 3D reconstruction on a 2D monitor provide precise measurements but are subject to variability based on the rater. Visualization using virtual (VR) and augmented reality platforms can overcome those limitations. It is, however, unclear whether accurate measurements of the aneurysm and adjacent arterial branches can be obtained on VR models. This study aimed to assess interrater reliability and compare measurements between 3D VR, standard 2D DSA, and 3D DSA reconstructions, evaluating the reliability and accuracy of 3D VR as a measurement tool. Methods: A pool of five neurosurgeons performed three individual analyses on each of the ten UIA cases, measuring them in completely immersed 3D VR and the standard on-screen format (2D DSA and 3D reconstruction). This resulted in three independent measurements per modality for each case. Interrater reliability of measurements and morphology characterization, comparative differences, measurement duration, and VR user experience were assessed. Results: Interrater reliability for 3D VR measurements was significantly higher than for 3D DSA measurements (3D VR mean intraclass correlation coefficient [ICC]: 0.69 ± 0.22 vs. 3D DSA mean ICC: 0.36 ± 0.37, p = 0.042). No significant difference was observed between 3D VR and 2D DSA (3D VR mean ICC: 0.69 ± 0.22 vs. 2D DSA mean ICC: 0.43 ± 0.31, p = 0.12). A linear mixed-effects model showed no effect of 3D VR and 3D DSA (95% CI = −0.26–0.28, p = 0.96) or 3D VR and 2D DSA (95% CI = −0.02–0.53, p = 0.066) on absolute measurements of the aneurysm in the anteroposterior, mediolateral, and craniocaudal dimensions. Conclusions: 3D VR technology allows for reproducible, accurate, and reliable measurements comparable to measurements performed on a 2D screen. It may also potentially improve precision for measurements of non-planar aneurysm dimensions. Full article
Show Figures

Figure 1

10 pages, 2469 KiB  
Article
Clinical and Anatomical Characteristics of Perforator Aneurysms of the Posterior Cerebral Artery: A Single-Center Experience
by Anahita Malvea, Shigeta Miyake, Ronit Agid, Hugo Andrade Barazarte, Richard Farb, Timo Krings, Pascal John Roger Mosimann, Patrick Joseph Nicholson, Ivan Radovanovic, Karel Terbrugge, Robert Willinsky, Joanna Danielle Schaafsma and Eef J. Hendriks
Brain Sci. 2024, 14(9), 934; https://doi.org/10.3390/brainsci14090934 - 19 Sep 2024
Viewed by 666
Abstract
Introduction: Posterior cerebral artery (PCA) aneurysms represent up to 1% of all cerebral aneurysms. P1-P2 perforator aneurysms are thought to be even less prevalent and often require complex treatment strategies due to their anatomical and morphological characteristics, with risk of a perforator infarct. [...] Read more.
Introduction: Posterior cerebral artery (PCA) aneurysms represent up to 1% of all cerebral aneurysms. P1-P2 perforator aneurysms are thought to be even less prevalent and often require complex treatment strategies due to their anatomical and morphological characteristics, with risk of a perforator infarct. We studied the treatment of P1-P2 perforator aneurysms in a single-center cohort from a high-volume tertiary center, reporting clinical and anatomical characteristics, treatment strategies, and outcomes. Methods: A retrospective analysis of adult patients with a P1-P2 perforator aneurysm who presented at our institution between January 2000 and January 2023 was performed. The patients were analyzed for demographics, clinical presentation, imaging findings, treatment techniques, outcomes, and complications. Subgroup analyses between ruptured versus non-ruptured cases were included. Results: Out of 2733 patients with a cerebral aneurysm, 14 patients (0.5%) presented with a P1-P2 perforator aneurysm. All six patients with a ruptured aneurysm were treated by endovascular coiling, of whom one patient (16.7%) required surgical clipping of a recurrence. One out of eight (12.5%) patients with unruptured aneurysms was treated by surgical clipping. P1-P2 perforator aneurysms predominantly affected middle-aged individuals (median 59.5 years), with 10/14 (71.4%) being female. Endovascular coiling was the primary treatment modality overall, yielding favorable technical outcomes, however, it was complicated by a perforator infarct in two patients (33.3%) without new permanent morbidity or mortality secondary to treatment. Conclusions: P1-P2 perforator aneurysms are a rare subtype of intracranial aneurysm. Endovascular coiling could present an effective treatment modality; however, care should be taken for ischemic complications in the dependent perforator territory. Larger studies are required to provide more insights. Full article
Show Figures

Figure 1

13 pages, 2104 KiB  
Article
Ultrasound-Induced Release Profile of Nimodipine from Drug-Loaded Block Copolymers after Singular vs. Repeated Sonication: In Vitro Analysis in Artificial Cerebrospinal Fluid
by Katja Döring, Swetlana Sperling, Milena Ninkovic, Heinrich Lanfermann, Frank Streit, Andreas Fischer, Veit Rohde and Vesna Malinova
Brain Sci. 2024, 14(9), 912; https://doi.org/10.3390/brainsci14090912 - 10 Sep 2024
Viewed by 656
Abstract
Objective: Nimodipine still represents a unique selling point in the prevention of delayed cerebral ischemia (DCI) following aneurysmal subarachnoid hemorrhage (aSAH). Its intrathecal effect is limited by a low oral bioavailability, leading to the development of nanocarrier systems to overcome this limitation. This [...] Read more.
Objective: Nimodipine still represents a unique selling point in the prevention of delayed cerebral ischemia (DCI) following aneurysmal subarachnoid hemorrhage (aSAH). Its intrathecal effect is limited by a low oral bioavailability, leading to the development of nanocarrier systems to overcome this limitation. This study investigated the ultrasound-induced release profile of nimodipine from drug-loaded copolymers in artificial cerebrospinal fluid (CSF) within 72 h after a singular versus repeated sonication. Methods: Pluronic® F127 copolymers (Sigma-Aldrich, Taufkirchen, Germany)were loaded with nimodipine by direct dissolution. Spontaneous and on-demand drug release by ultrasound (1 MHz at 1.7 W/cm2) was determined in artificial cerebrospinal fluid using the dialysis bag method. Nimodipine concentrations were measured at predefined time points within 72 h of sonication. Results: Spontaneous release of nimodipine was enhanced by ultrasound application with significantly increased nimodipine concentrations two hours after a repeated sonication compared to a singular sonication (median 1.62 vs. 17.48 µg/µL, p = 0.04). A further trend was observed after four hours (median 1.82 vs. 22.09 µg/µL, p = 0.06). There was no difference in the overall nimodipine concentrations between the groups with a singular versus repeated sonication (357.2 vs. 540.3 µg/µL, p = 0.60) after 72 h. Conclusions: Repeated sonication resulted in an acceleration of nimodipine release from the drug-loaded copolymer in a CSF medium. These findings confirm the proof of principle of an on-demand guidance of nimodipine release from nimodipine-loaded nanodrugs by means of ultrasound, which suggests that evaluating the concept in an animal model may be appropriate. Full article
Show Figures

Figure 1

13 pages, 3354 KiB  
Article
BOLD Cerebrovascular Reactivity and NOVA Quantitative MR Angiography in Adult Patients with Moyamoya Vasculopathy Undergoing Cerebral Bypass Surgery
by Loris Garbani Nerini, Jacopo Bellomo, Lara Maria Höbner, Vittorio Stumpo, Elisa Colombo, Christiaan Hendrik Bas van Niftrik, Tilman Schubert, Zsolt Kulcsár, Susanne Wegener, Andreas Luft, Luca Regli, Jorn Fierstra, Martina Sebök and Giuseppe Esposito
Brain Sci. 2024, 14(8), 762; https://doi.org/10.3390/brainsci14080762 - 29 Jul 2024
Viewed by 898
Abstract
Revascularization surgery for the symptomatic hemisphere with hemodynamic impairment is effective for Moyamoya vasculopathy patients. However, careful patient selection is crucial and ideally supported by advanced quantitative hemodynamic imaging. Recently, blood oxygenation level-dependent cerebrovascular reactivity (BOLD-CVR) and quantitative magnetic resonance angiography with non-invasive [...] Read more.
Revascularization surgery for the symptomatic hemisphere with hemodynamic impairment is effective for Moyamoya vasculopathy patients. However, careful patient selection is crucial and ideally supported by advanced quantitative hemodynamic imaging. Recently, blood oxygenation level-dependent cerebrovascular reactivity (BOLD-CVR) and quantitative magnetic resonance angiography with non-invasive optimal vessel analysis (qMRA-NOVA) have gained prominence in assessing these patients. This study aims to present the results of BOLD-CVR and qMRA-NOVA imaging along with the changes in cerebral hemodynamics and flow status following flow augmentation with superficial temporal artery–middle cerebral artery (STA-MCA) bypass in our Moyamoya vasculopathy patient cohort. Symptomatic patients with Moyamoya vasculopathy treated at the Clinical Neuroscience Center of the University Hospital Zurich who underwent hemodynamic and flow imaging (BOLD-CVR and qMRA-NOVA) before and after bypass were included in the analysis. Reduced hemispheric volume flow rates, as well as impaired BOLD-CVR, were measured in all 12 patients with Moyamoya vasculopathy before STA-MCA bypass surgery. Following the surgical procedure, post-operative BOLD-CVR demonstrated a non-significant increase in BOLD-CVR values within the revascularized, symptomatic middle cerebral artery territory and cerebral hemisphere. The results of the statistical tests should be viewed as indicative due to the small sample size. Additionally, post-operative qMRA-NOVA revealed a significant improvement in the hemispheric volume flow rate of the affected hemisphere due to the additional bypass flow rate. Our findings affirm the presence of hemodynamic and flow impairments in the symptomatic hemisphere of the Moyamoya vasculopathy patients. Bypass surgery proves effective in improving both BOLD-CVR impairment and the hemispheric volume flow rate in our patient cohort. Full article
Show Figures

Figure 1

Other

Jump to: Research

12 pages, 528 KiB  
Systematic Review
Neurosurgical Microvascular Anastomosis: Systematic Review of the Existing Simulators and Proposal of a New Training Classification System
by Lelio Guida, Martina Sebök, Marcelo Magaldi Oliveira, Christiaan Hendrik Bas van Niftrik, Fady T. Charbel, Marco Cenzato, Luca Regli and Giuseppe Esposito
Brain Sci. 2024, 14(10), 1031; https://doi.org/10.3390/brainsci14101031 - 17 Oct 2024
Viewed by 639
Abstract
Background: The literature lacks a combined analysis of neurosurgical microvascular anastomosis training models. We performed a systematic literature search to provide an overview of the existing models and proposed a classification system based on the level of simulation and reproducibility of the microvascular [...] Read more.
Background: The literature lacks a combined analysis of neurosurgical microvascular anastomosis training models. We performed a systematic literature search to provide an overview of the existing models and proposed a classification system based on the level of simulation and reproducibility of the microvascular anastomosis. Methods: The systematic literature search followed the PRISMA guidelines. We consulted MEDLINE, Web of Knowledge, and EMBASE independently for papers about bypass training models. Every training model was analyzed according to six tasks supposed to esteem their fidelity to the real operative setting by using a scoring system from zero to two. Finally, authors classified the models into five classes, from A to E, by summing the individual scores. Results: This study included 109 papers for analysis. Training models were grouped into synthetic tubes, ex vivo models (animal vessels, fresh human cadavers, human placentas) and in vivo simulators (live animals—rats, rabbits, pigs). By applying the proposed classification system, live animals and placentas obtained the highest scores, falling into class A (excellent simulators). Human cadavers and animal vessels (ex vivo) were categorized in class B (good simulators), followed by synthetic tubes (class C, reasonable simulators). Conclusions: The proposed classification system helps the neurosurgeon to analyze the available training models for microvascular anastomosis critically, and to choose the most appropriate one according to the skills they need to improve Full article
Show Figures

Figure 1

8 pages, 725 KiB  
Brief Report
The Impact of Revascularization Surgery on Headaches in Association with Cerebrovascular Reactivity in Patients with Moyamoya Angiopathy
by Francy D. Gallego Moyano, Helena C. Janssen, Lashmi Venkatraghavan, David J. Mikulis, Hugo Andrade Barazarte, Ivan Radovanovic, Eef J. Hendriks and Joanna D. Schaafsma
Brain Sci. 2024, 14(10), 967; https://doi.org/10.3390/brainsci14100967 - 26 Sep 2024
Viewed by 676
Abstract
Background/Objectives: Headaches in Moyamoya angiopathy are common but poorly understood. We aimed to investigate if headaches in Moyamoya angiopathy improve after revascularization surgery and whether this is associated with improvement in cerebrovascular reactivity on MRI (CVR-MRI). Methods: We included consecutive adult patients with [...] Read more.
Background/Objectives: Headaches in Moyamoya angiopathy are common but poorly understood. We aimed to investigate if headaches in Moyamoya angiopathy improve after revascularization surgery and whether this is associated with improvement in cerebrovascular reactivity on MRI (CVR-MRI). Methods: We included consecutive adult patients with Moyamoya angiopathy who had chart data on headaches, CVR-MRI, and underwent extracranial–intracranial bypass surgery between January 2010 and September 2022 at a tertiary neurovascular referral center. Clinical and CVR-MR imaging data of all patients were collected through systematic chart review, complemented by standard-of-care headache questionnaires from patients who were operated between 2018 and 2022. We evaluated headache features and explored the association between headaches and CVR before and after revascularization surgery. Results: Fifty-nine patients were included (mean age 47 ± 14 years, 43 females (73%)); among them, 41/59 (69%) reported headaches pre-surgery. Headache improved in 28/41 (68%) patients after revascularization surgery with a reduction in pain severity (median VAS-score from 5/10 to 2.5/10; p = 0.002), analgesic use (from 84% to 40%; p = 0.007), and sick leave (from 60% to 16%; p < 0.001). Improvement in headaches was associated with improvement in CVR (OR 5.3; 95% CI: 1.2–23.5) and sick leave reduction (OR 1.4; 95% CI: 1.6–121.4). Conclusions: Headaches in Moyamoya angiopathy are common and disabling. They may improve in most patients after revascularization surgery and seem to be associated with improvement in CVR, supporting the hypothesis of a potential vascular origin of the headaches. Full article
Show Figures

Figure 1

Back to TopTop