Paraclinoid aneurysms exhibit a markedly lower rupture risk compared to intracranial aneurysms (IAs) located in other regions. We aimed to identify the hemodynamic and morphological factors underlying this reduced rupture propensity. We analyzed data from 538 unruptured IAs (179 paraclinoid) in the Chinese Intracranial Aneurysm Project (CIAP). Hemodynamic parameters were analyzed using computational fluid dynamics (CFD), and morphological features were quantified using computer-assisted semiautomated measurement (CASAM). Univariate and multivariate logistic regression analyses identified differences between paraclinoid and IAs in other locations. Paraclinoid aneurysms were independently associated with younger age (OR = 1.031, P = 0.024), female sex (OR = 0.474, P = 0.011), and less frequent use of lipid-lowering medications (OR = 3.156, P < 0.001). Hemodynamically, they exhibited lower combined hemodynamic parameter (CHP; OR = 1.055, P = 0.011), normalized pressure (NP; OR = 1.469, P < 0.001), and low shear area (LSA) ratio (OR = 1.065, P < 0.001). Morphologically, they had smaller maximum diameter (OR = 1.203, P < 0.001), lower non-sphericity index (NSI; OR = 1.099, P = 0.002), larger parent artery diameter (OR = 0.157, P < 0.001), and less frequent bifurcation involvement (OR = 9.361, P < 0.001). Paraclinoid aneurysms exhibit lower NP, LSA, and CHP, along with smaller maximum diameter, lower NSI, and a sidewall configuration. Collectively, these features are associated with a stable hemodynamic and morphological environment that underlies their lower rupture risk. Future prospective studies with a large cohort are needed to confirm these findings.

BACKGROUND:Spinal dural arteriovenous fistulas (SDAVFs) are frequently misdiagnosed as inflammatory myelitis, resulting in inappropriate steroid therapy that may trigger acute deterioration. However, the long-term prognostic significance of pretreatment steroid exposure is poorly understood. We aimed to analyze long-term outcomes and identify predictors of recovery in the largest SDAVF cohort to date. METHODS:This retrospective study analyzed 516 patients with confirmed SDAVFs treated between October 2012 and December 2021. All patients were followed for a minimum of 3 years, with a mean follow-up of 79.38 months. The primary outcome was clinical improvement, defined as a ≥1-point decrease on the modified Aminoff-Logue Scale (mALS). Multivariable logistic regression was used to identify independent prognostic factors. RESULTS:Clinical improvement on the mALS was observed in 68.7% (355/516) of patients . The multivariable analysis revealed three independent prognostic factors: a longer disease course (OR 0.686; 95% CI 0.534 to 0.882) and pretreatment steroid application (OR 0.559; 95% CI 0.401 to 0.778) were associated with poorer prognosis. Conversely, a more severe pretreatment mALS score paradoxically predicted a higher likelihood of improvement (OR 2.458; 95% CI 1.805 to 3.347). Additionally, sensory deficits proved refractory to treatment in most patients, with only 26.1% experiencing relief. CONCLUSIONS:The long-term prognosis of treated SDAVFs is multifactorial. A higher mALS score was a strong predictor of greater improvement in patients. This study also highlights that a shorter disease course is strongly predictive of improvement, while pretreatment steroid application is linked to a poorer prognosis. Therefore, prompt and accurate diagnosis and treatment are the prerequisites for improving the prognosis of SDAVFs.

BACKGROUND AND PURPOSE:Accurate cerebral arteriovenous malformation (CAVM) nidus volume measurement is important for evaluating treatment strategy and neurologic prognosis. This study aimed to compare the accuracy of silent MRA for measuring CAVM nidus volume with TOF-MRA and to analyze the clinical factors that may affect the nidus volume measurement. MATERIALS AND METHODS:A total of 45 patients diagnosed with CAVM who received silent MRA, TOF-MRA, and DSA examinations were retrospectively enrolled. A standardized protocol was used for nidus volume measurement using thresholding by these three imaging tools. RESULTS:The mean nidus volume measured by 3D-DSA, silent MRA, and TOF-MRA was 9.073 (SD, 7.667) mL, 9.55 (SD, 7.814) mL, and 7.773(SD, 7.11) mL, respectively. The linear correlation coefficient of the nidus volume was 0.976 (P < .001) and .966 (P < .001), respectively. Silent MRA was significantly higher than TOF MRA in nidus overlap volume (0.775 [SD. 0.109] versus 0.538 [SD. 0.206] P = .00), while TOF MRA was significantly higher than silent MRA in absolute volume difference (0.196 [SD. 0.192] versus 0.114 [SD. 0.147], P = .005). For both silent MRA and TOF-MRA, the nidus overlap volume and absolute volume difference were significantly associated with previous embolization status. CONCLUSIONS:Nidus volume measurement by silent MRA is comparable with DSA and is practical. Silent MRA can be used for nidus volume measurement and as a follow-up tool for evaluating nidus volume change after therapy.

Primary central nervous system (CNS) mucosa-associated lymphoid tissue (MALT) lymphoma is a rare, low-grade B-cell lymphoma that typically arises in the dura, and its occurrence within the ventricular system is exceedingly rare. We report a case of primary CNS MALT lymphoma located in the right lateral ventricle of a 62-year-old man. The patient underwent gross total resection, followed by postoperative treatment with ifosfamide combined with a Bruton’s tyrosine kinase (BTK) inhibitor, and adjuvant radiotherapy. At the latest follow-up, no evidence of recurrence was observed. A review of the literature revealed only eight previously reported cases of ventricular MALT lymphoma, many of which were initially misdiagnosed on imaging as meningioma, metastasis, or ependymoma. Although chronic inflammation has been implicated in MALT lymphomas outside the CNS, potential infectious or inflammatory triggers in ventricular MALT lymphoma remain unclear. This case expands the recognized anatomical spectrum of CNS MALT lymphoma and proposes a hypothesis that lateral ventricular tumors may originate from the pia mater folds of the choroid plexus, highlighting the need to consider MALT lymphoma in the differential diagnosis of intraventricular lesions.

OBJECTIVE:This prospective cohort study aimed to evaluate the long-term outcomes of patients with spinal dural arteriovenous fistulas (SDAVFs) nearly 10 years after treatment and identify prognostic factors influencing recovery and progression. METHODS:Seventy-six patients diagnosed with SDAVF from two centers in China were treated with microsurgery, endovascular therapy, or combined therapy based on angiographic findings. Baseline data collected included age, gender, disease duration, modified Aminoff-Logue Scale (mALS) scores, the presence of numbness and pain (modified Denis Scale [mDS] scores), fistula location, and treatment method. Follow-up evaluations were conducted at 3 months, 6 months, 1 year, 6 years, and nearly 10 years after treatment, in which mALS and mDS scores were recorded. RESULTS:The mean follow-up duration was 121.6 (SD 3.8) months. Fistulas were predominantly in the lower thoracic spine (T7-12, 48.7%), and 82.9% of the patients were male. Improvement was observed in 63.2% of the patients, whereas 55.3% had poor outcomes (mALS score ≥ 4) and 32.9% showed late clinical deterioration. Patient age > 55 years (OR 4.316, 95% CI 1.312-14.196; p = 0.016) and pretreatment disability (moderate: OR 10.160, 95% CI 1.932-53.433, p = 0.006; severe: OR 22.112, 95% CI 2.440-200.344, p = 0.006) were predictors of poor 10-year outcomes. Pretreatment disability (moderate: OR 8.432, 95% CI 1.008-70.512, p = 0.049; severe: OR 12.838, 95% CI 1.231-133.907, p = 0.033) were further associated with late clinical deterioration. CONCLUSIONS:Patients with SDAVFs show early functional improvement but progressive decline over time. Older age and moderate to severe pretreatment disability predicted poor outcomes, while moderate to severe pretreatment disability was associated with late clinical deterioration. These findings highlight the need for early intervention and long-term rehabilitation to mitigate functional decline.

Woven EndoBridge (WEB™) has been shown to be safe and effective in the treatment of wide-necked bifurcation aneurysms (WNBAs). However, the use of this device has not been studied in China. This study assessed safety and effectiveness of WEB for the treatment of intracranial WNBAs in a Chinese population. The WEB Intrasaccular Therapy China Study (WEB-IT China) was a prospective, single-arm study allowing enrollment of adult WNBA patients treated with the WEB device between June 2017 and August 2019 among 8 centers in China. The primary effectiveness endpoint was treatment success rate, defined as complete aneurysm occlusion without retreatment, recurrent subarachnoid hemorrhage (SAH), or >50

OBJECTIVE:Arteriovenous shunts below the conus medullaris (AVS-BC) have an unstudied natural history. The aim of this study was to elucidate the natural history of AVS-BC and to clarify the clinical onset, progression, and treatment outcomes for management strategy optimization. METHODS:A prospectively maintained database was retrospectively reviewed for consecutive symptomatic patients with AVS-BC between January 2000 and July 2023. Onset and deterioration patterns were categorized as acute or gradual and assessed using the modified Aminoff-Logue Scale (mALS) and modified Denis Pain and Numbness Scale (mDS). Time to deterioration before and after treatment was evaluated using Kaplan-Meier analysis, restricted cubic splines, and Cox and logistic regression modeling. RESULTS:The analysis included 132 patients (113 male, median age 54.5 years) with AVS-BC, with a median observational period of 9.00 months (IQR 5.25-12.00 months). Acute onset occurred in 18.2% of patients, with 16.7% experiencing acute deterioration. The overall pretreatment deterioration rate was 6.5% per month. Deterioration risk was highest shortly after the initial onset. Patients aged 50-70 years were less likely to experience deterioration (p = 0.02). Half the patients underwent embolization and 43.9% underwent microsurgery, with an anatomical cure achieved in most patients. The overall monthly deterioration rate after treatment was 0.5%. The mALS grade at admission was a significant risk factor for spinal motor deterioration (HR 0.60, 95% CI 0.45-0.79; p < 0.001). For sensory deterioration, risk factors included dural AVS-BC (HR 2.98, 95% CI 1.02-8.69; p = 0.046), a drainage diameter of 1.5-2.0 mm (HR 2.48, 95% CI 1.05-5.84; p = 0.038), and the admission mDS score (HR 1.66, 95% CI 1.24-2.21; p < 0.001). Deeper segments (L5-S1, HR 2.70, p = 0.024; S2-5, HR 13.00, p < 0.001) predicted embolization as the treatment modality. CONCLUSIONS:Rapid deterioration was observed among patients with AVS-BC, particularly after onset. While early treatments were beneficial for most patients, gradual deterioration after treatment warrants further research.

BACKGROUND AND OBJECTIVES: Intermittent reports of spinal cord arteriovenous shunts (SCAVSs)-induced paralysis during pregnancy and puerperium have raised significant concerns. This study aimed to assess whether women with SCAVSs are at an elevated clinical risk during this period. METHODS: Consecutive female patients with SCAVSs from 10 referral centers were included. Only clinical data within reproductive age were analyzed. The primary outcome was the occurrence of clinical deterioration associated with SCAVSs, categorized into acute and gradual patterns based on the modified Aminoff and Logue scale. RESULTS: A total of 480 patients were included. Before initial treatment, 262 patients experienced pregnancy. Both acute (17.88%/y vs 4.87%/y, P < .0001) and gradual (9.67%/y vs 3.27%/y, P < .0001) deterioration during pregnancy and puerperium were significantly elevated. In the matched cohort of 72 pregnant patients with untreated SCAVSs and their nonpregnant control, acute deterioration was significantly higher in the pregnant patients (26.09%/y vs 6.97%/y, P = .013). After partial SCAVSs obliteration, acute (33.74%/y vs 5.15%/y, P < .0001) and gradual (18.40%/y vs 2.61%/y, P = .0008) deterioration rates during this period were still significantly elevated. In the matched cohort of 23 pregnant patients with residual SCAVSs and their nonpregnant control, acute deterioration was still significantly higher in the pregnant patients (39.50%/y vs 6.25%/y, P = .043). In addition, no significant decrease in the clinical deterioration was observed after partial treatment compared with nontreated patients during this period. CONCLUSION: The risk of clinical deterioration associated with SCAVSs is significantly elevated during pregnancy and puerperium.

It has been five years since the last version of the clinical practice guidelines for the management of adult diffuse gliomas was published by the Asian Glioma Genome Atlas (AGGA). Significant progress and revisions have occurred in the diagnosis and treatment of adult diffuse gliomas in recent years. In response to these updates, the joint guideline committee of the Chinese Glioma Cooperative Group (CGCG), the Society for Neuro-Oncology of China (SNO-China), and the Chinese Brain Cancer Association (CBCA) has revised the clinical practice guidelines. This updated guideline emphasizes molecular and pathological diagnostics, as well as the primary treatment modalities of surgery, radiotherapy, chemotherapy, and targeted therapy. Additionally, we have incorporated findings from recent clinical trials of new therapies to align with cutting-edge treatment strategies. This guideline is designed to serve as a practical resource for all professionals involved in managing adult diffuse glioma patients, while also providing valuable information for insurance companies and other institutions responsible for regulating cancer care costs in China and beyond.

BACKGROUND AND OBJECTIVES:Comparing microsurgery and embolization for spinal cord arteriovenous malformations (SCAVMs) is challenging because of the disease's rarity and the highly heterogeneous angioarchitecture. The aim of this study was to compare outcomes between microsurgery and embolization using a grading system for SCAVMs that effectively stratifies angioarchitectural complexities. METHODS:A total of 714 patients were included, with 308 undergoing microsurgery. The grading system was developed based on independent risk factors of incomplete resection, including anterior sulcal artery supply, metameric manifestations, the maximum diameter of lesion, and lesion depth. Each parameter was assigned one point, stratifying angioarchitectural complexities of SCAVMs into five grades. RESULTS:Microsurgery carried significantly higher treatment risks than embolization across all grades. For patients scoring 0 to 2 points, microsurgery achieved significantly higher complete obliteration rates than embolization. For patients scoring 3 or 4 points, the complete obliteration rates between the two methods were similar. Long-term clinical deterioration after microsurgery was significantly more frequent after embolization for patients scoring 1; for patients scoring 0, the higher long-term deterioration rate after embolization was also observed, but not statistically significant; for patients scoring 2 to 4 points, risks of long-term clinical deterioration between the two methods were comparable. At the last follow-up, the rate of poor prognosis was similar between the two methods for patients scoring 0 points. For the remaining groups, microsurgery showed a worse prognosis. CONCLUSION:Embolization should be the primary treatment option for patients with SCAVMs; however, microsurgery should be considered as an alternative for patients scoring 0 or 1 point if endovascular treatment fails to achieve complete obliteration.

Glioblastoma (GBM) is the most common primary malignant intracranial tumor, accounting for over 50% of central nervous system tumors. Among EGFR mutations in GBM, A289 is a prevalent point mutation associated with poor prognosis, yet its unique characteristics and role in malignant progression remain unclear. To address this, we analyzed EGFR A289 mutation frequency by integrating tumor mutation data from TCGA and CGGA databases as well as Beijing Tiantan Hospital's Neuropathology Center. We established U87-MG cell lines carrying EGFR A289T/V/D mutations via lentiviral transduction and performed transcriptome sequencing. Differential gene expression analysis was assessed by integrating the cell lines' and TCGA tumor tissues' transcriptomic data. Followed by gene correlation analysis, univariate logistic regression, and LASSO regression, the key differential expressed genes were identified, leading to the development of a multivariable logistic regression model to decode the EGFR A289 mutation. Our study identified EGFR A289 as the most frequent EGFR missense mutation in GBM. The prediction model and nomogram, based on EGFR, CLEC18B, and PDK1 expression, exhibited strong predictive performance. Additionally, drug sensitivity analysis and in vitro validation demonstrated that gefitinib and XAV939 hold therapeutic potential for GBM with EGFR A289 mutations, showing significant synergistic effects. These findings provide critical insights into the role of EGFR A289 mutation in GBM, enabling precise diagnosis and offering targeted therapeutic strategies to overcome chemoresistance.

OBJECTIVE:Recurrence after an initial angiography-determined cure of dural arteriovenous fistula (DAVF) has been reported, with risk factors identified in a few studies; however, some findings remain controversial. The objective of this study was to evaluate a large cohort of patients with DAVFs to estimate the recurrence rate and identify factors influencing recurrence. METHODS:Patient data for this study were derived from the Dural Arteriovenous Fistula Research and Management in China (DREAM-INI) database, compiled from a single-center retrospective study conducted in China. This analysis included only patients in whom an immediate complete cure was achieved who had subsequent angiographic follow-up. Two patient groups were compared: patients in whom a sustained durable cure was achieved and those who experienced recurrence following the initial cure. In addition to comparing baseline characteristics and follow-up results, potential risk factors for recurrence were examined and a time-to-recurrence analysis was performed. RESULTS:Among the 1101 patients included in the DREAM-INI dataset, 510 met the inclusion criteria for this study. Of these, 41 patients with an initially cured DAVF had 47 recurrence events; 48.8% developed new fistulas at distant sites, 36.6% had in situ recurrence, and 14.6% had both types of recurrence. The overall recurrence rate was 8.0%, with anticipated recurrence rates of 13.9% at 36 months and 24.1% at 105 months. Recurrence was more frequently observed in Borden type II DAVFs. Identified risk factors for recurrence included age < 45 years, a transverse-sigmoid sinus location, multiple fistulae, pial arterial supply, and venous congestion. CONCLUSIONS:DAVF recurrence can be classified as in situ recurrence and recurrence at other sites, both of which are closely linked to unresolved venous hypertension and the previously masked portion of the fistula. Risk factors for recurrence included age younger than 45 years, a transverse-sigmoid sinus location, multiple fistulae, pial arterial supply, and venous congestion. All patients with cured DAVFs, particularly those with identified risk factors, were advised to undergo angiographic follow-up beyond 1 year.

BACKGROUND AND OBJECTIVES:The prevalence of pial arterial supply (PAS) to intracranial dural arteriovenous fistulas (DAVFs) and its implications for the management of these fistulas have been limited to relatively small cohort studies and remain somewhat controversial. We conducted a retrospective study to characterize PAS in DAVFs and explore its implications for treatment. METHODS:Consecutive patients evaluated over a 21-year period were retrospectively reviewed. Angiograms were examined to characterize the angioarchitecture of DAVFs and identify the presence of PAS. PAS was classified into 2 types: dilated preexisting dural branches and pure pial supply. Baseline characteristics, treatment approaches, and treatment and follow-up outcomes were compared between the DAVF cohorts with and without PAS. To minimize patient selection bias, the 2 cohorts were matched in a 1:1 ratio using propensity score matching. RESULTS:In this cohort, 259 out of 1101 patients (23.5%) exhibited an additional PAS. Multivariate analysis identified 7 independent predictors of PAS: younger age ( P < .001), longer disease duration ( P = .021), multiple DAVFs ( P < .001), tentorial DAVFs ( P < .001), transverse-sigmoid sinus DAVFs ( P < .001), and the presence of venous ectasia ( P = .019) and congestion ( P < .001). Complication rates were higher in the PAS group, particularly for postoperative hemorrhage ( P < .001) and ischemia-related complications ( P < .001), which remained significant even after propensity score matching ( P = .013 and P = .001). CONCLUSION:The findings suggest that embolization of PAS before DAVF closure may significantly increase the risk of both intracranial hemorrhagic and ischemic complications. Therefore, routine embolization of PAS before DAVF closure is not supported by these results, particularly given the exceptionally low incidence of presumed hemorrhagic complications arising from an unobliterated "pure" pial supply before DAVF obliteration.

Arteriovenous malformations (AVMs) in the basal ganglia, the thalamus, and the insular lobe of the brain are rare and difficult-to-treat diseases that require integrated multimodal management. This study aimed to determine the safety and disadvantages of embolization as an independent therapy for deep-seated AVMs. The authors reviewed 76 patients from a single center with cerebral deep-seated AVMs from 2010 to 2020. Clinical hemorrhage refers to the initial clinical presentation with bleeding, the first occurrence of bleeding, and delayed postoperative hemorrhage refers to subsequent bleeding following the initial hemorrhage. After interventional therapy, 8 patients experienced delayed postoperative hemorrhage during the total follow-up of 94,631 person-years, with an annual postoperative hemorrhage rate of 3.1%. Compared with the overall clinical hemorrhage rate before treatment (15.9%/person-year), 11 patients experienced clinical hemorrhage during 25,238 person-years, indicating a significantly decreased risk of clinical hemorrhage after treatment. A total of 28.9% (22/76) of patients achieved angiographic obliteration. Multivariate analysis showed that pretreatment limb weakness and a high Spetzler-Martin grade predicted poor clinical outcomes ( P = 0.043 and 0.005). Fewer feeding arteries predicted AVMs' obliteration ( P = 0.048). Endovascular procedure-related complications, mortality, and morbidity were, respectively, reported in 7.9% (6/76), 1.3% (1/76), and 14.8% (8/54) of patients. Endovascular embolization significantly lowered the risk of clinical deterioration and delayed hemorrhage, indicating it to be a safe and effective therapy for deep-seated AVMs. Lesions with a simple angioarchitecture were more likely to be completely obliterated.

Background Vertebral–basilar artery dissecting aneurysms (VADAs) are an uncommon phenomenon in all fields of cerebrovascular disease. The flow diverter (FD) can be used as an endoluminal reconstruction device that promotes neointima formation at the aneurysmal neck and preserves the parent artery. To date, imaging examinations such as CT angiography, MR angiography, and DSA are the main methods used to evaluate the vasculature of patients. However, none of these imaging methods can reveal the situation of neointima formation, which is of great importance in evaluating occlusion of VADAs, especially those treated with a FD. Methods Three patients were included in the study from August 2018 to January 2019. All patients underwent preprocedural, postprocedural, and follow-up evaluations with high resolution MRI, DSA, and optical coherence tomography (OCT), as well as the formation of intima on the surface of the scaffold at the 6 month follow-up. Results Preprocedural, postoperative, and follow-up high resolution MRI, DSA, and OCT of all three cases successfully evaluated occlusion of the VADAs and occurrence of in stent stenosis from different views of intravascular angiography and neointima formation. Conclusions OCT was feasible and useful to further evaluate VADAs treated with FD from a near pathological perspective, which may contribute toward guiding the duration of antiplatelet medication and early intervention of in stent stenosis.

BACKGROUND AND OBJECTIVES:Craniocervical junction (CCJ) arteriovenous fistulas (AVFs) are rare. Variability in clinical manifestations and treatment strategies for CCJ AVFs stems from differences in their angioarchitecture. Our study aims to categorize CCJ AVFs based on their angioarchitecture and explore the associated clinical features and treatment modalities for distinct CCJ AVF types. METHODS:The authors conducted a retrospective analysis of patients with CCJ AVFs treated at a single neurosurgical facility over the past decade. These patients were classified based on the angioarchitecture of their CCJ AVFs. The analysis included an evaluation of angioarchitecture, clinical characteristics, treatment strategies, and outcomes. RESULTS:The study included 155 patients, with a median age of 56 years, collectively manifesting 165 CCJ AVFs. Our classification identified 4 distinct CCJ AVF types: epidural AVFs (19 [11.5%]), dural AVFs (98 [59.4%]), radicular AVFs (33 [20.0%]), and perimedullary AVFs (15 [9.1%]). Further differentiation was applied based on the presence of pial feeders. The predominant fistula location was at cervical-1 (77.0%). Ascending intradural drainage (52.7%) and descending intradural drainage (52.1%) were frequently observed drainage patterns. Patients with dural AVF predominantly presented with venous hypertensive myelopathy, whereas patients with other types of CCJ AVFs showed a higher incidence of subarachnoid hemorrhage (P = .012). Microsurgery was the predominant treatment, applied in the management of 126 (76.4%) AVFs, whereas 8 (4.8%) AVFs exclusively underwent interventional embolization and 25 (15.2%) received a combination of interventional embolization and microsurgical treatment. CONCLUSION:CCJ AVFs can be distinguished based on the fistula location and the arterial feeders. Currently, microsurgery stands as the preferred treatment strategy for CCJ AVFs, whereas interventional embolization plays a distinctive role in cases with specific angioarchitecture or as a pretreatment measure before microsurgery.

OBJECTIVE The highly intricate nature of the cervical spinal cord can cause arteriovenous shunts in these segments that may be associated with heightened clinical risks and treatment complexities. In this article, the authors aimed to provide a comprehensive analysis of the detailed natural course, treatment, and clinical outcomes of cervical spinal cord arteriovenous shunts (SCAVSs) based on the largest cohort to date. METHODS Two hundred forty consecutive patients were included. Data on clinical presentation, angioarchitecture, treatment, and follow-up were retrospectively reviewed. RESULTS The cohort demonstrated a greater prevalence of acute onset (63.3% vs 36.7%). Spontaneous recovery was observed in 63.7% of patients after onset, with a significantly elevated recovery rate observed among patients experiencing acute onset (72.4% vs 48.9%, p < 0.001). The risks of acute and gradual clinical deterioration after onset was 11.9%/year and 13.4%/year, respectively. Microsurgery was performed in 39.6% of patients, while the remaining 60.4% exclusively underwent embolization. The complete obliteration rate was 65.3% after microsurgery and 21.4% after embolization. The rate of treatment-related deterioration was 14.7% after microsurgery and 6.2% after embolization. After partial treatment, the acute and gradual deterioration rates were 4.1%/year and 6.6%/year, respectively. Lack of spontaneous recovery after onset was an independent predictor of embolization-related deterioration (OR 17.905, p = 0.007) and long-term gradual deterioration after partial treatment (HR 2.325, p = 0.021). After a median follow-up period of 32.55 months, prognosis was unfavorable in 16.7% of patients, with the sole independent risk factor being the absence of spontaneous recovery after onset (OR 2.476, p = 0.018). CONCLUSIONS The outcomes of patients with cervical SCAVS were generally favorable, even in patients with only partial obliteration of the lesions. However, patients who did not show a trend toward spontaneous recovery after onset had a significantly elevated risk of unfavorable prognosis, highlighting the need for prompt clinical intervention.

Background Although stent-assisted coiling embolization (SAC) has been associated with a higher risk of ischemic and hemorrhagic complications, the use of SAC continues to rise for treating ruptured intracranial aneurysms (RIAs). This study aims to assess the safety and effectiveness of dual antiplatelet therapy (DAPT) in the context of RIAs. Methods We conducted a retrospective analysis at a single center, involving patients with aneurysmal subarachnoid hemorrhage (aSAH) between May 1, 2017 and December 31, 2021. Patients were categorized into two groups: the SAC group and the non-SAC (NSC) group. Patients in the SAC group received DAPT. We compared modified Rankin Scale (mRS) score, along with hemorrhagic and ischemic complications, between the two groups to evaluate the safety and efficacy of DAPT for SAC. Results The study included a total of 541 patients, of whom 38 (7.0%) experienced hemorrhagic complications and 48 (8.9%) developed ischemic complications. Additionally, 99 (18.3%) and 84 (15.5%) had poor clinical outcomes at discharge and 6 months, respectively. However, no statistically significant differences were observed between the two groups. Our analysis revealed that aneurysm location in the posterior circulation was a significant risk factor for an unfavorable prognosis when antiplatelet drugs were used following SAC ( p = 0.025). Conclusions Administering antiplatelet drugs after SAC for RIAs has demonstrated both safety and effectiveness. However, caution should be exercised when considering this treatment strategy for RIAs located in the posterior circulation due to the potentially elevated risk.

Background Surgical resection of the lesions remains the main treatment method for most symptomatic spinal cord cavernous malformations (SCCMs) to eliminate the occupation and associated subsequent lifelong haemorrhagic risk. However, the timing of surgical intervention remains controversial, especially for patients in the acute stage after severe haemorrhage.Methods Patients diagnosed with SCCMs who were surgically treated between January 2002 and December 2021 were selected and retrospectively reviewed. The Modified McCormick Scale (MMS) was used to evaluate neurological and disability status. All medical information was reviewed, and all patients were followed up for at least 6 months.Results A total of 279 patients were ultimately included. With regard to long-term outcomes, 110 (39.4%) patients improved, 159 (57.0%) remained unchanged and 10 (3.6%) worsened. For patients with an MMS score of 2–5 on admission, in univariate and multivariate analyses, a ≤6 weeks period between onset and surgery (adjusted OR 3.211, 95% CI 1.504 to 6.856, p=0.003) was a significant predictor of improved MMS. Among 69 patients who first presented with severe haemorrhage, undergoing surgery within 6 weeks of the onset of severe haemorrhage (adjusted OR 4.901, 95% CI 1.126 to 21.325, p=0.034) was significantly associated with improvement of MMS score.Conclusion Surgical timing can influence the long-term outcome of SCCMs. For patients with symptomatic SCCMs, especially those with severe haemorrhage, early surgical intervention within 6 weeks can provide more benefit.

Background: Cerebral cavernous malformations (CCMs) are vascular disorders with a diverse natural history causing stroke and epilepsy. This multicenter cohort study aimed to unravel the correlation between genotype and clinical presentation in CCMs. Methods: We conducted a multicenter cohort study across three reference centers in China. In this study, we employed whole-exome sequencing, droplet digital PCR, and targeted panel sequencing to analyze 290 surgical specimens of CCMs. We also conducted an observational study of patients managed conservatively prior to surgical resection of CCMs to elucidate their natural history. Findings: Between January 2013 and May 2023, 201 out of 290 surgically resected CCMs had mutations in MAP3K3, PIK3CA, or CCM germline mutations, and were subsequently included in further analysis. Patients with solitary PIK3CA mutations exhibited a higher likelihood of hemorrhage (P < .001), while those with MAP3K3 mutations were more prone to epilepsy onset (P < .001). The mutation spectrum correlated with various clinical parameters, influencing hemorrhage risk (P < .001), lesion diameter (P = .020), onset of non-hemorrhage epilepsy (P < .001), Zabramski classifications (P < .001), DVA (P < .001) and edema in the MRI appearance (P < .001). Over the study period, patients with PIK3CA mutations showed significantly higher 1-, 2-, and 5-year cumulative risks of hemorrhage (34.8%, 51.7%, and 62.7%, respectively) higher cumulative risks of hemorrhage compared to MAP3K3 mutations (P < .017) and double mutations (P < .001). Adjusted analyses confirmed the increased risk of subsequent hemorrhage in patients with PIK3CA mutations (adjusted HR = 8.816, 95% CI: 1.478-9.855, P = .045). Independent risk factors for epilepsy included age of onset (adjusted OR = 0.956, 95% CI: 0.928-0.983, P = .002), lesion diameter (adjusted OR= 0.545, 95% CI: 0.325-0.914, P = .021), and lesion locations (adjusted OR = 0.545, 95% CI: 0.325-0.914, P < .001). Notably, patients with germline mutations experienced earlier symptom onset (P = .003) and larger lesions (P = .019) compared to those with somatic mutations. Interpretation: This study's findings highlight a significant correlation between CCM genotype and clinical phenotypes, particularly regarding hemorrhage risk and seizures. The results offer insights into predicting the clinical course of CCM patients with different phenotypes, potentially leading to personalized treatment adjustments.Funding: National Natural Science Foundation of China (No. 82220108010, 81971104, 82201440, 82122020, 82101369, 82102009 and 82330038). Beijing Municipal Commission of Education (BPHR20220113).Declaration of Interest: Tao Hong, Hongqi Zhang, Jian Ren report grants from National Natural Science Foundation of China. Tao Hong reports grants from Beijing Municipal Commission of Education. Hongqi Zhang, and Tao Hong declare no competing interests.Ethical Approval: This study was conducted in compliance with the approval of the local ethics committee and involved a prospectively maintained database. Furthermore, all patients provided informed consent, or consent was obtained from their legal guardian in cases involving participants with cognitive impairment or those aged younger than 18 years.