Cerebral aneurysm rupture, the predominant cause of non-traumatic subarachnoid hemorrhage, underscores the need for effective treatment and early detection methods. A study in Neurosurgical Review compared microsurgical clipping to endovascular therapy in 130 patients with middle cerebral artery (MCA) aneurysms, finding significantly fewer serious adverse events (SAEs) and neurological complications in the endovascular group. This suggests endovascular therapy\'s superiority in safety and reducing complications for MCA aneurysm patients. Furthermore, a systematic review and meta-analysis assessed the diagnostic accuracy of AI algorithms in detecting cerebral aneurysms, revealing a high sensitivity but notable false-positive rates, indicating AI\'s potential while highlighting the need for further validation. Machine learning algorithms also showed promise in predicting cerebral aneurysm rupture risk, demonstrating reasonable sensitivity and specificity. Additionally, AI-based radiomics models are advancing rapidly, offering enhanced predictive accuracy and personalized treatment planning by analyzing imaging data to identify features indicative of aneurysm conditions. Collectively, these findings emphasize the advantages of endovascular therapy for MCA aneurysms and the emerging role of AI and machine learning in improving early detection and personalized management of cerebral aneurysms.

BACKGROUND: Treatment outcomes of octogenarians with aneurysmal subarachnoid hemorrhage (aSAH), are often considered poor. With ongoing advancements and experience in endovascular technology, we sought to evaluate the outcomes of octogenarians treated for aSAH in the second post-ISAT/BRAT trial decade.
METHODS: A single-center database of aSAH was reviewed to identify patients aged 80 or above undergoing aneurysm treatment. Mortality and favorable neurological outcome (defined as mRS <3) were assessed among the series and compared across several subgroups.
RESULTS: Octogenarian patients constituted 6% of the aSAH cohort (38/619) over the reviewed period. Twenty-one percent were high grade (Hunt-Hess IV-V). Endovascular treatment was the first-line modality in 90% of patients. During a median follow-up of 17 months, the overall mortality was 39%. Higher mortality was associated with poor Hunt-Hess grade (100% for Grade-V, 47% for III-IV, 13% for I-II, P=0.004) and non-independent baseline function status (100% mortality for non-independent vs. 28% for independent group, P=0.002). At last follow-up, 53% of patients achieved a favorable neurological outcome. The stratified rate was 80% in Hunt-Hess grade I-II and over 60% in patients with premorbid independent function status or less than 5 frailty components (P≤0.02 vs. poorer counterparts).
CONCLUSIONS: Neurological outcomes of octogenarian patients with aSAH are improving in the second post-trial decade, particularly given the preponderance of endovascular treatment. Baseline functional status and comorbidities of octogenarians should be considered in addition to the Hunt-Hess grade in prognostication.

OBJECTIVE: Cerebral aneurysm (CA) has been considered one of the most common cerebrovascular diseases, affecting millions of people worldwide. A therapeutic agent is currently missing for the treatment of CA. Nesfatin-1 (Nes-1) is an 82-amino acid adipokine which possesses a wide range of biological functions. However, the physiological function of Nes-1 in CA is still unknown. Here, we aimed to assess the preventive effects of Nes-1 in the pathological development of CA and elucidate the mechanisms behind this.
METHODS: We used an elastase-induced CA model, accompanied by a high-salt diet to induce hypertension. Additionally, diverse experimental techniques, including Verhoeff-Van Gieson staining, real time PCR, enzyme-linked immuno sorbent assay (ELISA), and immunofluorescence staining, were employed to assess CA formation, gene and protein expression, as well as the macrophage infiltration.
RESULTS: Our results indicate that administration of Nes-1 significantly decreased the aneurysm size. Additionally, Nes-1 prevented inflammatory response by inhibiting the expression of interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and monocyte chemoattractant protein 1 (MCP-1) at both the mRNA and protein levels in the Circle of Willis (COW) region. Also, the increased levels of matrix metalloproteinase-2 (MMP-2) and matrix metalloproteinase-9 (MMP-9) in the COW region were reduced by Nes-1. We found that Nes-1 administration suppressed the invasion of macrophages. Mechanistically, Nes-1 activated Nrf-2 by promoting its nuclear translocation but prevented the activation of the IκBα/NF-κB signaling pathway.
CONCLUSIONS: These findings suggest that Nes-1 might be used as a promising agent for the prevention of CA.

OBJECTIVE: Flow diverting stents (FDS) are used to treat cerebral aneurysms, by promoting thrombosis and occlusion of the aneurysm sac. However, retreatment is required in some cases, and the biologic basis behind treatment outcome is not known. The goal of this study was to understand how changes in hemodynamic flow after FDS placement affect aneurysmal endothelial cell (EC) activity.
METHODS: Three-dimensional models of patient-specific aneurysms were created to quantify the EC response to FDS placement. Computational fluid dynamic simulations were used to determine the hemodynamic impact of FDS. Two identical models were created for each patient; into one a FDS was inserted. Each model was then populated with human carotid ECs and subjected to patient-specific pulsatile flow for 24 h. ECs were isolated from aneurysm dome from each model and bulk RNA sequencing was performed.
RESULTS: Paired untreated and treated models were created for four patients. Aneurysm dome EC analysis revealed 366 (2.6%) significant gene changes between the untreated and FDS conditions, out of 13909 total expressed genes. Gene set enrichment analysis of the untreated models demonstrated enriched gene ontology terms related to cell adhesion, growth/tensile activity, cytoskeletal organization, and calcium ion binding. In the FDS models, enriched terms were related to cellular proliferation, ribosomal activity, RNA splicing, and protein folding.
CONCLUSIONS: Treatment of cerebral aneurysms with FDS induces significant EC gene transcription changes related to aneurysm hemodynamics in patient-specific in vitro 3D-printed models subjected to pulsatile flow. Further investigation is needed into the relationship between transcriptional change and treatment outcome.

BACKGROUND: Cerebral aneurysms in children have a low incidence and accounts for less than 4% of all cerebral aneurysms. These aneurysms have been linked to various factors. Severe headache, seizures, and motor-sensory deficits are common presentations.
METHODS: We describe the case of a 2-month-old male patient who presented with generalized tonic-clonic seizures for 4 days. At the hospital, he was stabilized with ventilatory support, sedation, and antiepileptic drugs. A NCCT (Head) showed intraparenchymal hemorrhage in the left fronto-parieto-temporal lobe and subarachnoid hemorrhage. Subsequently a CT angiogram revealed an aneurysm of the left M3 segment of MCA. Successfully, the patient underwent microsurgical clipping of aneurysm and evacuation of hematoma.
CONCLUSIONS: Pediatric cerebral aneurysms differ from their adult counterparts, mainly in their etiology and evolution. As per literature, aneurysmal clipping and neurological endovascular therapy have shown similar results.

Cerebral aneurysms, affecting 2-5% of the global population, are often asymptomatic and commonly located within the Circle of Willis. A recent study in Neurosurgical Review highlights a significant reduction in the annual rupture rates of unruptured cerebral aneurysms (UCAs) in Japan from 2003 to 2018. By analyzing age-adjusted mortality rates of subarachnoid hemorrhage (SAH) and the number of treated ruptured cerebral aneurysms (RCAs), researchers found a substantial decrease in rupture rates-from 1.44 to 0.87% and from 0.92 to 0.76%, respectively (p < 0.001). This 88% reduction was largely attributed to improved hypertension management. Recent advancements in artificial intelligence (AI) and machine learning (ML) further support these findings. The RAPID Aneurysm software demonstrated high accuracy in detecting cerebral aneurysms on CT Angiography (CTA), while ML algorithms showed promise in predicting aneurysm rupture risk. A meta-analysis indicated that ML models could achieve 83% sensitivity and specificity in rupture prediction. Additionally, deep learning techniques, such as the PointNet + + architecture, achieved an AUC of 0.85 in rupture risk prediction. These technological advancements in AI and ML are poised to enhance early detection and risk management, potentially contributing to the observed reduction in UCA rupture rates and improving patient outcomes.

Parent artery occlusion for large or giant internal carotid artery aneurysms remains a necessary procedure in the era of flow diverters. Endovascular parent artery occlusion is currently performed using detachable balloons or coils, which are difficult to obtain or costly. At our institution, we have devised a technique for combining n-butyl-2-cyanoacrylate and coils with flow control to solve this problem. Patients who underwent parent artery occlusion for large or giant internal carotid artery aneurysms with a follow-up period of more than 12 months were included. Imaging outcomes were evaluated for complete or incomplete aneurysmal occlusion and with or without aneurysmal shrinkage. The clinical outcome was based on changes in the modified Rankin Scale. Ten patients (ten aneurysms) were included. Their average age and average follow-up period were 68.4 years and 36 months, respectively. Complete occlusion and favorable clinical outcome were observed in all cases. The parent artery occlusion using a combination of coils and n-butyl-2-cyanoacrylate with flow control technique is effective for both imaging and clinical outcomes.

OBJECTIVE: This study aimed to investigate the association between intracerebral aneurysms and cranial nerve (CN) palsies, focusing on nerves other than the oculomotor nerve. It sought to determine the prevalence, risk factors, and clinical outcomes of these nerve palsies and compare the effectiveness of microsurgical clipping versus endovascular coiling in restoring nerve function.
METHODS: Following PRISMA guidelines, a comprehensive literature search was conducted using databases like PubMed, Scopus, and Google Scholar, covering studies from 1975 to April 2024. The inclusion criteria targeted patients with non-oculomotor nerve palsies diagnosed with cerebral aneurysms. Studies published before 1975 and non-English studies were excluded. Data extraction included study design, patient characteristics, and intervention outcomes. The Joanna Briggs Institute and Newcastle-Ottawa scales were used to assess study quality. Data were synthesized narratively and statistically analysed using SPSS v27.
RESULTS: The analysis included 47 patients (53.2% female, mean age 44.8 years). The internal carotid artery (ICA) was the most common aneurysm site (44.7%), and the abducent nerve (CN VI) was most frequently affected. Ruptured aneurysms had better recovery outcomes (88.9%) than unruptured ones (66.7%). Hypertension was present in 9.2%. Unilateral aneurysms were seen in 80.9%, with 76.6% having a single nerve palsy. Non-ruptured aneurysms accounted for 58.1%, and ruptured for 41.9% of associated cranial nerve palsies. Treatment included microsurgical approaches (42.6%), endovascular approaches (34%), combined approaches (6.4%), and conservative management (17%). Recovery of the palsy was observed in 75.6%, with endovascular procedures showing higher recovery (93.3%) compared to conservative treatment (28.6%).
CONCLUSIONS: Intracerebral aneurysms are significantly associated with non-oculomotor CN palsies. Endovascular procedures yield higher recovery rates than conservative management, particularly in ruptured aneurysms. Timely and appropriate treatment is crucial for improving nerve function recovery in these patients.

In this study, we investigated the application of distributed learning, including federated learning and cyclical weight transfer, in the development of computer-aided detection (CADe) software for (1) cerebral aneurysm detection in magnetic resonance (MR) angiography images and (2) brain metastasis detection in brain contrast-enhanced MR images. We used datasets collected from various institutions, scanner vendors, and magnetic field strengths for each target CADe software. We compared the performance of multiple strategies, including a centralized strategy, in which software development is conducted at a development institution after collecting de-identified data from multiple institutions. Our results showed that the performance of CADe software trained through distributed learning was equal to or better than that trained through the centralized strategy. However, the distributed learning strategies that achieved the highest performance depend on the target CADe software. Hence, distributed learning can become one of the strategies for CADe software development using data collected from multiple institutions.

BACKGROUND: Birth weight has been linked with various health outcomes. The association between birth weight and cerebral aneurysm remains unknown.
METHODS: The two-sample Mendelian randomization (MR) approach was used to evaluate the causal effect of birth weight on cerebral aneurysm based on genome-wide association studies (GWAS), comprising 261,932 UKB participants for birth weight and 204,060 FinnGen participants for cerebral aneurysm. The inverse variance weighted (IVW) method was used as the primary method. Alternative methods were used for comparison. Sensitivity analysis was conducted to evaluate the robustness of the results. Multivariable MR (MVMR) was further conducted to evaluate the direct effect of the birth weight on cerebral aneurysm.
RESULTS: The IVW detected a causal association between higher birth weight and increased risk of cerebral aneurysm (OR = 0.521, 95% CI = 0.356 ∼ 0.763, P = 7.88 × 10-4), which was supported by alternative MR models. Sensitivity analysis did not find any evidence of heterogeneity or pleiotropy. MVMR further identified a direct effect of birth weight on cerebral aneurysm, independent of obesity-related traits or smoking.
CONCLUSIONS: This MR study found evidence of the association between birth weight and cerebral aneurysm, providing novel insight into the etiology of cerebral aneurysm, indicating the promising role of birth weight as a marker for screening populations at higher risk of cerebral aneurysm.