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Introduction: Intracranial atherosclerotic disease (ICAD) is a major cause of stroke worldwide. The optimal management of patients with symptomatic ICAD is controversial. Therefore, the aim of this systematic review is to compare medical management versus surgical bypass for the treatment of symptomatic ICAD., Methods: A literature review was performed to identify studies reporting outcomes of patients with ICAD who were managed medically or surgically with either direct or indirect bypass. Baseline, treatment, and outcomes data were analyzed. Complications included ischemic stroke, intracranial hemorrhage, and cerebrovascular death. Secondary analyses of the surgically treated cohort were performed to compare the outcomes of direct versus indirect bypass., Results: The pooled analysis was derived from 18 studies, comprising a total of 2160 patients with ICAD, including 1790 managed medically and 370 treated with surgical bypass. The rates of ischemic stroke, intracranial hemorrhage, and cerebrovascular death were 16%, 1%, and 4.5% in the medical cohort, respectively, versus 8%, 0.6%, and 1.9% in the surgical cohort, respectively. Among patients with ICAD who underwent bypass surgery, the rates of ischemic stroke and cerebrovascular death were 7% and 1.9% in the direct bypass group, respectively, versus 19% and 2.1% in the indirect bypass group, respectively., Conclusions: Direct or indirect bypass surgery is a reasonable treatment option for appropriately selected patients with ICAD. Careful preoperative evaluation of hemodynamic parameters and the relevant donor and recipient vessels is crucial to maximizing the success of bypass for ICAD. Further studies remain necessary to clarify the roles of medical versus surgical management for ICAD., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Objective: External ventricular drain (EVD) placement is a common neurosurgical procedure performed in both the intensive care unit (ICU) and operating room (OR). The optimal setting for EVD placement in regard to safety and accuracy of placement is poorly defined., Methods: A retrospective chart review was performed on 150 consecutive patients who underwent EVD placement at a tertiary care center from January of 2013 to February of 2014. Clinical and radiographic data were obtained and used to compare safety and accuracy of placement between EVDs placed in the ICU versus OR., Results: One hundred and thirty eight patients were evaluated. Complications (hemorrhage, infection, non-functional drain) occurred in 21.5% of ICU placements and 6.7% of OR placements (p = 0.028). Grade 1, 2, and 3 placements occurred in 67.7%, 25.8%, and 6.5% of ICU placements, respectively, versus 55.6%, 42.2%, and 2.2% of OR placements (p = 0.258). No patient who received pre-placement antibiotics suffered a ventriculostomy associated infection (VAI)., Conclusion: Patients who underwent ventriculostomy placement in the ICU differed in important ways (i.e. indication for placement and the administration of pre-procedure prophylactic antibiotics) from patients treated in the OR. However, the available data suggests that complications of hemorrhage, infection, and non-functional drains may be mitigated by ventriculostomy placement in the OR., (Copyright © 2014. Published by Elsevier B.V.)

Venous thromboembolism (VTE) is a recognized source of morbidity and mortality in patients suffering traumatic brain injury (TBI). While traumatic brain injury is a recognized risk factor for the development of VTE, its presence complicates the decision to begin anticoagulation due to fear of exacerbating the intracranial hemorrhagic injury. The role of chemoprophylaxis in this setting is poorly defined, leading to a wide variability in clinical practice. A comprehensive review of the literature was performed in an effort to summarize relevant data and construct a chemoprophylaxis protocol to be implemented in a Level I Trauma Center. The review reveals robust evidence regarding the safety and efficacy of chemoprophylaxis in the setting of TBI following demonstration of a stable intracranial injury. In light of this data, a protocol is assembled that, in the absence of predetermined exclusion criteria, will initiate chemoprophylaxis within 24h after the demonstration of a stable intracranial injury by computed tomography (CT)., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Malignant gliomas are highly lethal because of their resistance to conventional treatments. Recent evidence suggests that a minor subpopulation of cells with stem cell properties reside within these tumors. These tumor stem cells are more resistant to radiation and chemotherapies than their counterpart differentiated tumor cells and may underlie the persistence and recurrence of tumors following treatment. The various mechanisms by which tumor stem cells avoid or repair the damaging effects of cancer therapies are discussed.