Page 32 - WNS 2024 -e-Program Edition_Neat

Cerebrovascular

Big Things Are Happening for Small Aneurysms
Phil Taussky, MD
Beth Israel Deaconess Medical Center, Harvard Medical School
Sam Pettersson MD, Mira Salih MD, Michael Young DO, Max Shutran MD,
Christopher Ogilvy MD (same institution)
Introduction: Identifying predictors for rupture of small intracranial
aneurysms (sIAs) have become a growing topic in the literature given the
relative paucity of data on their natural history. The authors performed a
meta-analysis to identify reliable predictors.
Methods: PubMed, Scopus, and Web of Science were used to
systematically extract references which involved at least 10 IAs <7mm which
including a control group experiencing no rupture. All potential predictors
reported in the literature were evaluated in the meta-analysis.
Results: Fifteen studies yielding 4,739 sIAs were included in the meta-
analysis. Four studies were prospective and 11 were retrospective. Univariate
analysis identified 7 predictors which contradicted or are absent in the
current scoring systems, while allowing to perform subgroup analysis for
further reliability: patient age (MD -1.97, 95%CI -3.47-0.48; P = 0.01), the
size ratio (MD 0.40, 95%CI 0.26-0.53; P < 0.00001), the aspect ratio (MD
0.16, 95%CI 0.11-0.22; P < 0.00001), bifurcation point (OR 3.76, 95%CI
2.41-5.85; P < 0.00001), irregularity (OR 2.95, 95%CI 1.91-4.55; P <
0.00001), the pressure loss coefficient (MD -0.32, 95%CI -0.52-0.11; P =
0.002), wall sheer stress (Pa) (MD -0.16, 95%CI -0.28-0.03; P = 0.01). All
morphology related predictors listed above have been confirmed as
independent predictors via multivariable analysis among the individual
studies.
Conclusions: Morphology related predictors are superior to the classic
patient demographic predictors present in most scoring systems. Given that
morphology predictors take time to measure, our findings may be of great
interest to developers seeking to incorporate artificial intelligence into the
treatment decision-making process.

Micro Neurosurgery in Edinburgh: Reflections from the Past
Guiding the Future
Ioannis Fouyas, MD PhD
Dept. Clinical Neurosciences, Univ. of Edinburgh, UK

Edinburgh has contributed to the birth and evolution of vascular - including
neurovascular - surgery. Professor Hunter, credited with the "Hunterian
ligation" was the President of the Royal College of Surgeons and Professor
Dott, the first clinician to surgically protect an intracranial aneurysm, was
the first Professor of Clinical Neurosciences at the University of Edinburgh.
Their legacy has been perpetuated by their successors, with the Academic
Department contributing significantly to the establishment of evidence
based medicine. ISAT and ARUBA trials, are both pertinent examples. More
recently, the Academic department has organized the CARE trial, a pilot
randomized study addressing the treatment of symptomatic cavernomas.
Ironically, the success of these trials has resulted in fewer opportunities to
preserve technical competence. The dissemination of the necessary
microsurgical skills has been facilitated by cadaveric workshops run at the
College of Surgeons, with regular international contributors. In addition,
Edinburgh attracts high calibre trainees, who provide a vital contribution to
the professional ethos for the preservation of excellence. This includes the
application of evolving technologies for the improvement of surgical
outcomes, which will be elaborated.