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Introduction: Intracranial hemorrhage (ICH) causes often devastating brain injury. Predicting long-term motor prognosis and identifying neurosurgical candidates in cases of ICH has been an imprecise practice. Diffusion tensor tractography (DTT) is an imaging modality that may aid in this challenge. This literature review aimed to investigate DTT applications in patients with spontaneous ICH for either motor function prognosis or surgical intervention. Materials and methods: A PubMed and Ovid literature review was performed to select and evaluate studies utilizing DTT for motor prognostication or analysis/optimization of surgical outcomes in patients with spontaneous hypertensive ICH. Studies investigating ICH due to suspected vascular anomalies were excluded. Results: Forty-two studies met criteria. Six studies addressed surgical application. Surgery was not associated with increased mortality but was associated with decreased hematoma volume and CST compression and improved motor outcomes. Prognostic studies demonstrated that DTT correlates with motor function at multiple timepoints. Conclusion: DTT is a relatively new imaging technique that may help predict prognosis of patients’ motor function after spontaneous ICH. Additionally, it could possibly serve as an adjunct for determining which patients would benefit from surgical decompression or even help guide surgical approach to hematomas that displace the CST.

Background: Rupture of a blood-blister like aneurysm (BBLA) of the internal carotid artery (ICA) is a rare etiology of subarachnoid hemorrhage (SAH). Historically, BBLAs have been difficult to treat. Open surgical clipping and endovascular coiling techniques have both had high rates of failure. Recently, flow-diverting stents (FDS) have been used to treat BBLAs with success, but concerns exist regarding the need for dual anti-platelet therapy, the delayed occlusion of the aneurysm that occurs with flow-diversion, and the potential difficulty of treating cerebral vasospasm and hydrocephalus. Methods: Clinical data and imaging from the index case were reviewed, and a systematic review of the medical literature was performed. Medical databases including PubMed and Medline were searched using multiple combinations of keywords. The bibliographies of each result were then used to identify additional publications. Only English language case reports of ruptured, intracranial ICA blood blister-like aneurysms treated exclusively with flow-diverting stents were included. Results: Given the results from our literature search and this patient's characteristics, we chose to treat her ruptured BBLA with a FDS. Although the FDS was deployed successfully, her clinical course was complicated by cerebral vasospasm, which was managed with induced hypertension. Subsequently, she developed hydrocephalus and underwent successful placement of a ventriculoperitoneal shunt while on dual antiplatelet therapy, which was briefly held. She had no operative complications and made an excellent recovery. Follow-up angiography performed at 3 and 6 months confirmed total occlusion of the aneurysm. Conclusions: A literature review revealed numerous successful treatments of ruptured BBLA with FDS monotherapy. A variety of different pharmacological treatment adjuncts were used; oral aspirin and clopidogrel being the most common. Overall, patients with ruptured BBLAs of the ICA treated only with FDS monotherapy had superior outcomes when compared to patients with ruptured BBLAs treated with open microsurgical clipping or endovascular coiling alone. Keywords: Blister aneurysm, Endovascular, Flow-diverting stent, Internal carotid artery, Pipeline, Subarachnoid hemorrhage

Peripheral nerve injuries (PNI) are caused by a range of etiologies and result in a broad spectrum of disability. While nerve autografts are the current gold standard for the reconstruction of extensive nerve damage, the limited supply of autologous nerve and complications associated with harvesting nerve from a second surgical site has driven groups from multiple disciplines, including biomedical engineering, neurosurgery, plastic surgery, and orthopedic surgery, to develop a suitable or superior alternative to autografting. Over the last couple of decades, various types of scaffolds, such as acellular nerve grafts (ANGs), nerve guidance conduits, and non-nervous tissues, have been filled with Schwann cells, stem cells, and/or neurotrophic factors to develop tissue engineered nerve grafts (TENGs). Although these have shown promising effects on peripheral nerve regeneration in experimental models, the autograft has remained the gold standard for large nerve gaps. This review provides a discussion of recent advances in the development of TENGs and their efficacy in experimental models. Specifically, TENGs have been enhanced via incorporation of genetically engineered cells, methods to improve stem cell survival and differentiation, optimized delivery of neurotrophic factors via drug delivery systems (DDS), co-administration of platelet-rich plasma (PRP), and pretreatment with chondroitinase ABC (Ch-ABC). Other notable advancements include conduits that have been bioengineered to mimic native nerve structure via cell-derived extracellular matrix (ECM) deposition, and the development of transplantable living nervous tissue constructs from rat and human dorsal root ganglia (DRG) neurons. Grafts composed of non-nervous tissues, such as vein, artery, and muscle, will be briefly discussed.