Acute ischemic stroke remains one of the leading causes of mortality and long-term disability worldwide. Although reperfusion therapies, including thrombolysis and mechanical thrombectomy, have demonstrated efficacy, a substantial proportion of patients fail to achieve the expected functional recovery, highlighting the need to identify additional pathogenetic factors that may influence stroke outcomes. Among these, endothelial dysfunction plays a particularly important role. Objective: To summarize current evidence regarding the role of endothelial dysfunction in the development of complications following reperfusion therapy in acute ischemic stroke and to assess the prospects of endothelium-protective strategies. Materials and methods: A literature review of publications from the last five years was conducted, including clinical studies, meta-analyses, and systematic reviews. Contemporary concepts of vascular endothelial injury, disruption of the blood–brain barrier, reperfusion injury, hemorrhagic transformation, and the “no-reflow” phenomenon (failure of microcirculation restoration) were analyzed. Laboratory and functional methods for evaluating endothelial function, including the EASIX index, were examined, and perspectives on endothelium-protective therapeutic approaches were outlined. Results: Endothelial dysfunction was associated with an increased risk of hemorrhagic transformation, cerebral edema, and microcirculatory failure following thrombolysis and mechanical thrombectomy. Patients with elevated soluble E‑selectin, von Willebrand factor, and symmetric dimethylarginine had worse functional outcomes, with favorable recovery (modified Rankin Scale 0–2) in 38 % compared with 64 % for lower biomarker levels (p < 0.01). In 325 patients undergoing thrombectomy, 12.6 % developed parenchymal hematoma, and higher endothelial dysfunction scores were independently associated with its occurrence (adjusted odds ratio 1.43; 95 % CI 1.03–1.99; p = 0.032), improving predictive performance of conventional risk models. These findings highlight endothelial dysfunction as a clinically relevant predictor of post-reperfusion complications. Conclusions: Endothelial dysfunction is an important pathogenetic factor influencing the risk of complications and the effectiveness of reperfusion interventions. Integrating endothelial function assessment into clinical protocols may contribute to personalized treatment strategies, improved therapeutic outcomes, and better prognosis in patients with acute ischemic stroke.
An adult patient presented with acute neurological deterioration caused by spontaneous intracerebral hemorrhage in the right cerebral hemisphere. Initial computed tomography demonstrated a hyperdense intraparenchymal lesion hematoma associated with perifocal edema and mass effect. Given the lesion’s location and the goal of minimizing surgical trauma, a minimally invasive endoscopic evacuation was planned. To optimize preoperative planning, mixed reality–based holographic navigation was employed. Patient-specific three-dimensional models were generated from CT data using dedicated segmentation software and visualized through a head-mounted mixed reality device. This approach enabled accurate assessment of the hematoma’s spatial relationship to cortical and subcortical structures, facilitating precise selection of the craniotomy site and surgical trajectory. Endoscopic evacuation was performed via a tubular retractor using 0° and 30° endoscopes, achieving effective hematoma removal without intraoperative complications. Postoperative imaging confirmed satisfactory evacuation with regression of mass effect and no evidence of rebleeding. This case illustrates the potential value of mixed reality–assisted planning as a complementary tool for minimally invasive surgery in intracerebral hemorrhage, enhancing spatial understanding, reducing cognitive load, and supporting safe and targeted surgical strategies.
Recurrence or persistence of pain after microvascular decompression (MVD) for trigeminal neuralgia (TN) remains a challenging clinical problem. Revision procedures may reveal intraoperative findings underlying recurrent or persistent pain, including residual/unrecognized primary or newly developed neurovascular compression (NVC), scar-related adhesive changes, and “Teflon-associated” pathology. Objective: To identify intraoperative findings underlying pain recurrence/persistence after MVD for TN and to evaluate the outcomes of revision procedures. Materials and methods: Between 2023 and 2026, 36 patients with recurrent pain after primary MVD for TN were evaluated at the Romodanov Neurosurgery Institute of the National Academy of Medical Sciences of Ukraine. The mean interval to pain recurrence was 18.2±6.4 months. Two cases of early recurrence (≤6 months) were documented. All patients underwent clinical pain phenotyping and magnetic resonance imaging (MRI) assessment for the presence of NVC, deformation, or displacement of the trigeminal nerve root. The decision to perform revision surgery was made on an individualized basis according to clinical–instrumental concordance. Revision surgery was performed in 9 (25.0%) patients: MVD alone (re-MVD) was performed in 6 (16.7%) patients with confirmed evidence of NVC, whereas re-MVD combined with selective proximal microtomy was performed in 3 (8.3%) patients with equivocal intraoperative evidence of NVC and severe pain. The primary endpoint was pain intensity assessed using the Barrow Neurological Institute Pain Intensity Score (BNI-PS) at 6 months. A clinically meaningful outcome was defined as BNI-PS I–IIIa. Sensory disturbances were assessed using the Barrow Neurological Institute Facial Numbness Score (BNI-NS). Results: In the revision surgery subgroup (n=9), intraoperative findings related to Teflon, adhesive changes, and a clinically relevant venous component predominated. Teflon granuloma was identified in 2 (22.2%) cases, and migration/displacement of the Teflon pledget in 1 (11.1%) case. A clinically relevant venous component of NVC requiring revision was identified in 2 (22.2%) patients. In 1 (11.1%) case, microfascicles of the trigeminal nerve root were involved in dense scar tissue corresponding topographically to the pain distribution. Selective proximal microtomy was performed in 3 (33.3%) patients because convincing intraoperative evidence of NVC was lacking despite severe pain. In some patients with extensive adhesive changes in the cerebellopontine angle, whitish inclusions of the arachnoid membrane were observed microscopically. In patients without convincing indications for re-MVD, medical therapy was optimized and additional diagnostic evaluation was performed as clinically indicated. At 6 months after revision surgery, all 9 patients demonstrated improvement to BNI-PS I–IIIa; BNI-NS II was documented in 2 (22.2%) patients. A new mild sensory deficit developed in 1 (11.1%) patient. Conclusions: Standardized assessment of the clinical pain phenotype corresponding to BNI-PS >IIIb, combined with MRI verification of NVC and/or deformation or displacement of the trigeminal nerve root, may be useful for establishing indications for repeat surgery. Revision procedures after MVD for TN revealed “Teflon-associated” pathology and/or a clinically significant venous component of NVC in the setting of pronounced scar-related adhesive changes, occasionally involving microfascicles of the trigeminal nerve root corresponding to the topographic localization of pain. In this small revision-surgery series, all patients achieved a clinically meaningful outcome according to BNI-PS at 6 months; however, these findings are preliminary and require confirmation in larger cohorts with longer follow-up. Analysis of intraoperative findings supports the practical value of comprehensive clinical and imaging-based assessment when determining indications for re-MVD and highlights the need to develop standardized selection criteria and treatment algorithms for this challenging population of patients with recurrent pain after primary surgical treatment.
Glioblastoma is a primary brain tumor characterized by rapid recurrence. It accounts for 49.1% of all malignant neoplasms of the central nervous system. The tumor is characterized by aggressive infiltration and edema of the surrounding brain parenchyma, corresponding to the area of FLAIR hyperintensity on magnetic resonance imaging (MRI). The traditional gold standard of surgical treatment—gross total resection (GTR) of the contrast-enhancing tumor—is now considered insufficient, as 85% of recurrences occur within 2 cm of the resection margins [1]. Objective: to review current evidence and substantiate the advantages of supramaximal resection (SMR) over GTR as a strategy for improving patient survival. Materials and methods: The literature, predominantly published over the past five years, was reviewed. A search was conducted in the Web of Science, Scopus, and PubMed databases. Publications reporting the outcomes of SMR and comparing it with other surgical approaches were included in the analysis. The rationale for a paradigm shift from gross total tumor removal toward SMR was evaluated. Results: Based on the available evidence and current recommendations, the extent of resection is determined by the absolute residual tumor volume (cm³) following removal of the infiltrative component beyond the contrast-enhancing margins. According to the RANO Resect classification (2023), Class 1 (SMR) is defined as complete removal of the contrast-enhancing component (0 cm³) with minimization of the non-enhancing component (nCE/FLAIR ≤5 cm³). Patients achieving Class 1 resection have been reported to have a median overall survival of approximately 29 months, compared with 12–15 months following standard GTR (Class 2). Conclusions: Removal of the non-enhancing tumor component (FLAIR hyperintensity) provides an additional survival benefit and corresponds to Class 1 according to the RANO Resect framework (SMR). In patients older than 65 years, the benefits of aggressive surgery may be less pronounced because of reduced tolerance to surgical intervention. In patients with deeply located tumors, SMR may adversely affect overall survival.
Neurocysticercosis (NCC), caused by Taenia solium larvae, is the most common parasitic infection of the central nervous system. While NCC predominantly affects the brain, spinal involvement is rare, with less than 5% of cases manifesting in the spinal cord. This report describes the imaging features of spinal NCC in a 56-year-old female patient who presented with back pain and progressive lower limb weakness. A comprehensive diagnostic approach, including CT, MRI, and biopsy, confirmed the diagnosis. The article highlights the challenges in imaging and differential diagnosis, emphasizing the importance of recognizing characteristic imaging features to avoid misdiagnosis and ensure appropriate management.
