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Seizures occur in 20–45% of patients with cerebral arteriovenous malformations (AVMs) and can potentially influence their quality of life. Some studies have suggested risk factors influencing their development, but the evidence is limited to small cohorts. To analyze seizure presentation and factors influencing seizure development in patients with cerebral AVMs using a multi-institutional consortium. Retrospective multicenter registry from multiple centers in North America and Europe of patients aged 1 to 89 years who had undergone any intervention for brain AVMs between January 2010 and December 2023. Demographics, functional assessment (modified Rankin Scale; mRS), and AVM characteristics, were evaluated to assess for relationship with seizures using a multivariate generalized linear mixed-effects model. 1,005 AVM patients were analyzed; the median age was 42, 73% had a baseline mRS ≤ 2. The median nidus size was 2.2 cm, and most AVMs were Spetzler-Martin grade II (37%). Seizure was the presenting symptom in 237 patients (24%). After adjusting for significant variables, patient-specific factors associated with seizures were younger age (OR 0.99, CI95% 0.98–1), male sex (OR 1.65, CI95% 1.18–2.30), and smoking history (OR 1.69, CI95% 1.17–2.44). AVM-specific factors associated with seizures included rupture status (OR 0.42, CI95% 0.30–0.61); eloquent cortex (OR 1.61, CI95% 1.13–2.29); frontal (OR 1.54, CI95% 1.01–2.35), temporal (OR 1.93, CI95% 1.26–2.96) and parietal (OR 1.71 CI95% 1.08–2.71) location; larger nidal size (OR = 1.23, CI95% 1.08–1.39), and superficial draining vein location (OR 1.86, CI95% 1.15–3.01). In this multicenter consortium, after controlling for significant variables, the incidence of AVM-related seizures was associated with younger age, male sex, smoking history, larger AVMs, eloquent locations, and AVMs in the frontal, temporal, and parietal cortices. Conversely, rupture status, deep venous drainage, and cerebellar locations were negatively associated with seizures. [ABSTRACT FROM AUTHOR]

The article discusses the effectiveness of repurposing vintage operative microscopes in low- and middle-income countries (LMICs) to enhance surgical practice and training. The study challenges the assumption that only modern equipment can ensure high-quality surgical care by demonstrating the success of using cost-effective surplus microscopes. Through training sessions and donations of modified vintage microscopes, surgeons in LMICs reported significant improvements in visualization and precision during complex procedures. The initiative highlights the potential of vintage microscopes to transform surgical education and patient care in resource-limited settings, providing a sustainable solution for improving global surgical outcomes. [Extracted from the article]

The article discusses the establishment of microsurgery laboratory training in 35 centers across 20 low- and middle-income countries (LMICs) to enhance surgical skills and capacity in these regions. The initiative provided basic and advanced microsurgery training kits, microscopes, and hands-on courses in microvascular anastomosis through offline, live-streamed, and in-person sessions. The success of the program demonstrates the effectiveness of combining low-cost training tools with comprehensive support, highlighting the potential for expanding surgical training in resource-limited settings. The initiative aims to improve surgical outcomes and patient care in underserved regions by building local capacity for advanced surgical care. [Extracted from the article]

The article published in the Journal of Neurological Surgery explores the endoscopic transorbital transincisural approach to the ventral brainstem through cadaveric dissection. The study demonstrates the step-by-step procedure on four cadaver heads, highlighting key anatomical landmarks and surgical techniques. The results show successful exposure of the ventral brainstem, providing access to safe zones for various brainstem surgery applications. The endoscopic approach is deemed feasible and promising for future neurosurgical procedures. [Extracted from the article]

The article in the Journal of Neurological Surgery. Part B. Skull Base discusses a detailed anatomical study on posterior petrosectomy, focusing on exposing the round and oval windows in the middle ear. The study outlines a step-by-step approach to drilling the petrous bone between the facial nerve and the chorda tympani to access key landmarks in the middle ear. This technique is valuable for addressing tumors in the middle ear and facilitating cochlear implant surgeries during the same procedure. The research was conducted on cadaveric specimens at the University of Wisconsin-Madison Microneurosurgery Laboratory. [Extracted from the article]

The article "Cadaveric Endoscopic Transmeatal Approach to the Internal Acoustic Canal and the Middle Ear" published in the Journal of Neurological Surgery explores the neurosurgical perspective on using endoscopic techniques to access the middle ear and internal acoustic canal. The study documents step-by-step procedures for this approach, including identifying key anatomical landmarks and utilizing high-speed drills to open the internal acoustic canal. The authors successfully performed the endoscopic transmeatal approach, showcasing its potential as a minimally invasive option for certain cases in lateral skull base surgery. [Extracted from the article]

This article in the Journal of Neurological Surgery details a cadaveric step-by-step endoscopic transorbital approach to the cavernous sinus, highlighting its potential uses in neurosurgical procedures. The study conducted at the University of Wisconsin's Microneurosurgery Laboratory utilized specific endoscopic equipment and techniques to successfully expose the lateral wall of the cavernous sinus in cadaver heads. The findings suggest that this minimally invasive approach could improve surgical outcomes and reduce recovery times in skull base surgery, making it a feasible option for various applications in the field. [Extracted from the article]

The article "Endoscopic Transorbital Anterior Clinoidectomy: A Cadaveric Study" published in the Journal of Neurological Surgery. Part B. Skull Base details the procedure for performing an endoscopic transorbital anterior clinoidectomy, analyzing its technique, safety, and potential applications. The study conducted on cadaver heads at the University of Wisconsin utilized Storz endoscopes to successfully remove the anterior clinoid without damaging the optic nerve or carotid artery. The findings suggest that this technique can be safely executed via an endoscopic transorbital approach, offering valuable tools for skull base and vascular neurosurgery. [Extracted from the article]

This article in the Journal of Neurological Surgery explores multiple endoscopic perspectives of the petroclival region (PCR) using various approaches and multiport combinations for surgical purposes. The study highlights the challenges of operating in the PCR due to its complex anatomy and the benefits of endoscopic-assisted neurosurgery for skull base exposure. Different approaches such as extended endonasal transsphenoidal, superolateral transorbital, anterior and posterior transpetrosal, and retrosigmoid are discussed, along with their potential for enhancing surgical freedom and exposure in the PCR. The research emphasizes the importance of selecting the appropriate approach based on the location of lesions in the PCR. [Extracted from the article]

Rapid identification of the type and origin of a stroke is crucial for prompt and appropriate treatment, which can significantly influences patient outcomes. We report a multidisciplinary management case involving a 76-year-old man who presented with left-sided weakness and mild dysarthria. Imaging revealed a completely occluded right internal carotid artery. Despite multiple endovascular recanalization attempts, adequate flow could not be achieved, leading to the decision to perform an open thrombo-endarterectomy. The patient underwent carotid endarterectomy with microsurgical techniques under general anesthesia. The atheroma plaque and central thrombus were removed, which reestablished flow. Continuous intraoperative neuromonitoring was utilized to ensure patient safety. The patient woke up without new deficits and was discharged for rehabilitation. Follow-up imaging confirmed arterial patency, and the patient eventually made an excellent recovery, including being independent over one and a half years. Emergent recanalization with carotid endarterectomy following a failed endovascular recanalization is both safe and feasible, emphasizing the need for collaboration between different treatment providers to ensure optimal patient outcomes. Our report highlights the importance of a multidisciplinary approach and the advantages of a hybrid operating room in the treatment of acute complete carotid artery occlusion. [ABSTRACT FROM AUTHOR]

Datasets have relevant and irrelevant features whose evaluations are fundamental for classification or clustering processes. The effects of these relevant features make classification accuracy more accurate and stable. At this point, optimization methods are used for feature selection process. This process is a feature reduction process finding the most relevant feature subset without decrement of the accuracy rate obtained by original feature sets. Varied nature inspiration-based optimization algorithms have been proposed as feature selector. The density of data in construction projects and the inability of extracting these data cause various losses in field studies. In this respect, the behaviors of leaders are important in the selection and efficient use of these data. The objective of this study is implementing Artificial Bee Colony (ABC) algorithm as a feature selection method to predict the leadership perception of the construction employees. When Random Forest, Sequential Minimal Optimization and K-Nearest Neighborhood (KNN) are used as classifier, 84.1584% as highest accuracy result and 0.805 as highest F-Measure result were obtained by using KNN and Random Forest classifier with proposed ABC Algorithm as feature selector. The results show that a nature inspiration-based optimization algorithm like ABC algorithm as feature selector is satisfactory in prediction of the Construction Employee's Leadership Perception. [ABSTRACT FROM AUTHOR]

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Introduction: The impact of multiple feeding arteries on clinical outcomes of cerebral arteriovenous malformations (AVMs) is not well understood. This study aims to compare outcomes between AVMs with multiple versus single feeding arteries., Patients and Methods: Data from the Multicenter International Study for Treatment of Brain AVMs (MISTA) consortium were analyzed. Propensity score matching (PSM) was used to balance cohorts. Subgroup analysis was conducted for ruptured and unruptured AVMs and different treatment options, and multivariable logistic regression was applied to assess the impact of feeding artery origin., Results: Among 953 patients, 661(69.4%) had multiple feeding arteries, and 292 (30.6%) had a single feeding artery. After PSM, which included 422 matched patients (211 in each group), the differences in obliteration rates (68.7% vs 74.8%, OR 0.73, 95% CI: 0.48-1.12, p  = 0.16) and symptomatic complications (15.6% vs 11.8%, OR 1.37, 95% CI: 0.78-2.41, p  = 0.25) were not significant. Subgroup analysis comparing ruptured and unruptured AVMs and different treatment options showed no significant differences across all subgroups. Multivariable analysis identified PICA feeders as significantly associated with increased odds of all complications (OR 7.33, 95% CI: 2.14-25.1, p  = 0.002)., Discussion and Conclusion: AVMs with a single feeding artery were more likely to present with rupture, but no significant differences in obliteration rates or complications were observed between the groups after PSM. These findings suggest that while the number of feeding arteries may influence the initial presentation, it does not appear to impact overall treatment success or patient prognosis. Further prospective studies are needed to confirm these findings., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Arteriovenous malformations (AVMs) are complex vascular anomalies with a high risk of hemorrhage and neurological deficits, especially when located in eloquent brain regions. The eloquence of an AVM location is a critical factor in the treatment planning, influencing both the risk of complications and long-term functional outcomes. This study aims to compare outcomes between eloquent and non-eloquent AVMs., Methods: This multicenter, retrospective study utilized data from the Multicenter International Study for Treatment of Brain AVMs (MISTA) consortium. Patients with eloquent and non-eloquent AVMs were compared on baseline characteristics, angiographic outcomes, and functional outcomes using the modified Rankin Scale (mRS). Propensity score weighting (IPTW) was applied to adjust for confounding variables., Results: The study included 1,013 patients, with 498 (49.2%) AVMs located in eloquent regions and 515 (50.8%) in non-eloquent regions. In unadjusted analysis, eloquent AVMs had lower complete obliteration rates (67.6% vs. 79.5%, OR: 0.53, 95% CI: 0.39-0.72, p < 0.001) and higher complication rates (24.5% vs. 19.0%, OR: 1.38, 95% CI: 1.02-1.86, p = 0.03) compared to non-eloquent AVMs. After IPTW adjustment, eloquent AVMs continued to show significantly higher odds of overall complications (OR: 1.68, 95% CI: 1.12-2.52, p = 0.01) and symptomatic complications (OR: 1.77, 95% CI: 1.12-2.80, p = 0.01). Secondary analysis within the eloquent group indicated that embolization was linked to an elevated risk of complications. Surgery and radiosurgery showed comparable functional outcomes at last follow-up and complications rates with higher complete obliteration rates in surgery., Conclusion: AVMs in eloquent brain areas present higher risks of complications and lower obliteration rates, emphasizing the need for cautious, individualized treatment planning. Within the eloquent group, embolization increased the risk of complications, while surgery and radiosurgery showed comparable functional outcomes at last follow-up and complication rates with higher complete obliteration rates in surgery. These findings highlight the importance of location in AVM management and support further research focusing on comparing treatment strategies for AVMs in eloquent brain areas.

Background: Brain arteriovenous malformations (AVMs) are abnormal connections between feeding arteries and draining veins, associated with significant risks of haemorrhage, seizures and other neurological deficits. Preoperative embolization is commonly used as an adjunct to microsurgical resection, with the aim of reducing intraoperative complications and improving outcomes. However, the efficacy and safety of this approach remain controversial., Methods: This study is a subanalysis of the Multicenter International Study for Treatment of Brain AVMs consortium. We retrospectively analysed 486 patients with brain AVMs treated with microsurgical resection between January 2010 and December 2023. Patients were divided into two groups: those who underwent microsurgery alone (n=245) and those who received preoperative embolization, followed by microsurgery (n=241). Propensity score matching was employed, resulting in 288 matched patients (144 in each group). The primary outcomes were rates of complete AVM obliteration and functional outcomes (measured by the modified Rankin Scale (mRS)). Secondary outcomes included complication rates, mortality, hospital length of stay and postsurgical rupture., Results: After matching, the complete obliteration rate was 97% with no significant difference between the microsurgery-only group and the preoperative embolization group (p=0.12). The proportion of patients with an mRS score of 0-2 at the last follow-up was similar in both groups (83% vs 84%; p=0.67). The median hospital stay was significantly longer for the embolisation group (9 days vs 7 days; p=0.017). Complication rates (24% vs 22%; p=0.57) and mortality rates (4.9% vs 2.1%; p=0.20) were comparable between the two groups. No significant differences were observed in postsurgical rupture, recurrence or retreatment rates., Conclusions: In this large multicentre study, preoperative embolization did not significantly improve AVM obliteration rates, functional outcomes or reduce complications compared with microsurgery alone., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2025. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Background: Arteriovenous malformations (AVMs) are uncommon cerebral lesions that can cause significant neurological complications. Surgical resection is the gold standard for treatment, but endovascular embolization and stereotactic radiosurgery (SRS) are viable alternatives., Objective: To compare the outcomes of endovascular embolization versus SRS in the treatment of AVMs with Spetzler-Martin grades I-III., Methods: This study combined retrospective data from 10 academic institutions in North America and Europe. Patients aged 1 to 90 years who underwent endovascular embolization or SRS for AVMs with Spetzler-Martin grades I-III between January 2010 and December 2023 were included., Results: The study included 244 patients, including 84 who had endovascular embolization and 160 who had SRS. Before propensity score matching (PSM), complete obliteration at the last follow-up was achieved in 74.5% of the SRS group compared with 57.8% of the embolization group (OR=0.47; 95% CI 0.26 to 0.48; P=0.01). After propensity score matching, SRS still achieved significantly higher occlusion rates at last follow-up (78.9% vs 55.3%; OR=0.32; 95% CI 0.12 to 0.90; P=0.03).Hemorrhagic complications were higher in the embolization group than in the SRS group, although this difference did not reach statistical significance after PSM (13.2% vs 2.6%; OR=5.6; 95% CI 0.62 to 50.47; P=0.12). Similarly, re-treatment rate was higher in the embolization group (10.5% vs 5.3%; OR=2.11; 95% CI 0.36 to 12.31; P=0.40) compared with the SRS group., Conclusion: Our findings indicate that SRS has a significantly higher obliteration rate at last follow-up compared with endovascular embolization. Also, SRS has a higher tendency for fewer hemorrhagic complications and lower re-treatment rate. Further prospective studies are needed., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)