Objective: This study aims to analyze the angiographic features, demographic factors, and outcomes of endovascular treatment for ruptured intracranial aneurysms (IAs) in Central India. Methods: This retrospective observational study was conducted in the Department of Interventional Radiology at a tertiary care hospital in Central India. It included 102 patients diagnosed with subarachnoid haemorrhage due to ruptured IAs between December 2021 and November 2024. Demographic data, comorbidities, angiographic features (size, location, morphology, and multiplicity), and clinical severity were analyzed. Patients underwent endovascular treatments such as unassisted coiling, stent-assisted coiling, and other techniques. Functional outcomes were evaluated using the Modified Rankin Scale (mRS). Results: Females (62.8%) were more affected than males, with a peak incidence in the 51–60 years age group. Hypertension (44.1%) was the most common comorbidity. Most aneurysms (88.4%) were located in the anterior circulation, with the anterior communicating artery (27.7%) being the most common site. Small (<5 mm) and saccular aneurysms (96.4%) predominated. Unassisted coiling was the most performed procedure (68.6%). At admission, 83.3% of patients had poor functional outcomes (mRS 3–6), but 68.6% achieved good outcomes (mRS 0–2) by discharge. Conclusions Ruptured IAs in Central India predominantly affect females and involve the anterior circulation. Endovascular treatment significantly improves functional outcomes by reducing the re-rupture risk of an aneurysm, underscoring its effectiveness in managing this high-risk condition.

Objective: Saccular aneurysms of the basilar artery (BA) trunk are a significant challenge in neurosurgery due to their rarity and the complexity of surgical approaches. This study examines the efficacy and outcomes of microsurgical treatment for these aneurysms, highlighting the advantages over endovascular methods in terms of occlusion rates and complication management. Methods: A retrospective review of 23 patients with BA trunk aneurysms treated microsurgically at the Moscow Regional Clinical Research Institute from June 2019 to April 2024 was conducted. Patient demographics, aneurysm characteristics, surgical techniques, and postoperative outcomes were analyzed. Results: The study group included 16 women and 7 men, with an average age of 51.2 years. Notably, 19 of 23 patients (82.6%) presented with subarachnoid hemorrhage (SAH), while 4 had unruptured aneurysms (2 asymptomatic, 2 with mass effect). Aneurysms were predominantly located at the origin of the superior cerebellar artery (SCA). Surgical approaches varied based on aneurysm location, with most utilizing the orbito-pterional approach. Complete occlusion was achieved in all cases and was maintained over the follow-up period without signs of recanalization. Complications included transient oculomotor nerve dysfunction in 5 patients, with a substantial recovery rate. Favorable outcomes (mRS 0–2) were achieved in 87% of patients, including most SAH cases, highlighting the safety and effectiveness of treatment. Conclusions Microsurgical treatment of BA trunk aneurysms provides a reliable occlusion with a low rate of complications and excellent clinical outcomes. This series supports microsurgery as a preferred option for managing these challenging aneurysms, particularly when located at the SCA origin.

Y-configuration stent deployment strategies for aneurysms with complex configurationare well recognized, with and without subsequent coil placement. Delivery of flow diverters in this configuration has no precedent in the literature and may be a viable alternative when feasible. A case is presented in which this configuration for a complex anterior cerebral artery aneurysm was achieved, with subsequent successful aneurysm closure.

Background: Kissing middle cerebral artery bifurcation aneurysms (KMCBA) are rare vascular lesions. Their complex morphology and limited surgical experience may predispose patients to devastating complications.Cases: Among 100 patients who underwent microsurgical clipping for cerebral aneurysms between May 2022 and April 2025, two were diagnosed with unruptured KMCBA. In Case 1, the two aneurysm sacs of a left KMCBA were clipped separately using interlocking and fenestrated clips without premature rupture. In Case 2, both aneurysm sacs of a right KMCBA were clipped simultaneously with a long J-shaped clip. Postoperatively, the patient developed left hemiparesis due to clip-induced encroachment of the superior trunk of M2. Revision clipping with a shorter L-shaped clip restored flow, and the patient was discharged with a modified Rankin scale (mRS) score of 4. Conclusions Successful microsurgical clipping of KMCBA requires meticulous surgical strategies to avoid parent artery encroachment, including separate clipping of each aneurysm neck whenever feasible, appropriate clip selection, and the use of multimodal intraoperative anatomical and physiological monitoring.

Objective: This study compared clinical and cosmetic outcomes of cranioplasty using customized three-dimensional (3-D) printed implants versus autologous bone in patients with aneurysmal subarachnoid hemorrhage (aSAH) after decompressive craniectomy (DC). Methods: We retrospectively reviewed 50 patients who underwent cranioplasty after DC for aSAH between July 2018 and December 2023. Patients were divided into the three-dimensional cranioplasty(3-DC, n=26) and autologous bone cranioplasty (AC, n=24) groups. Demographics, aneurysm characteristics, surgical parameters, morphometric analysis of defect coverage, complications, and functional outcomes assessed by the modified Rankin Scale (mRS) were compared. Results: A total of 54 hemispheres underwent cranioplasty. Compared with AC, the 3-DC group had larger defects but achieved higher coverage (96.7% vs. 93.4%, p=0.044) and smaller residual defects (338.7±274.2 mm² vs. 528.5±331.3 mm², p=0.049). Complication rates were lower in 3-DC (9 cases) than AC (15 cases, p=0.0994). Wound dehiscence and fluid collection were more frequent with 3-DC, while bone flap resorption and epidural abscess occurred only with AC. Revision surgery was required in six patients, five initially treated with autologous bone. Neurological outcomes (mRS) were maintained or improved in both groups. Conclusions In aSAH patients undergoing cranioplasty after DC, customized 3-D printed implants achieved significantly better anatomical restoration and showed a numerical trend toward fewer complications compared with autologous bone. While AC remains feasible, its risks of resorption and infection often necessitate revision. 3-D printed implants may be considered a reasonable alternative, particularly in aSAH patients at higher risk of complications.

Alagille syndrome (ALGS), also known as arteriohepatic dysplasia, is a rare multisystem vascular disorder affecting brain, liver, heart, ophthalmic and skeletal systems. Moyamoya syndrome is a rare arteriopathy due to an underlying cause that can lead to ischemic and hemorrhagic strokes. Here, we report a rare case of ALGS in a patient with congenital narrowing of bilateral internal carotid arteries (ICA) with superimposed intracranial arteriopathy and associated moyamoya syndrome. A 34-year-old female presented with progressively worsening intermittent right eye visual blurriness, associated headache, and dizziness. Digital subtraction angiogram findings were consistent with the bilateral intracranial steno-occlusive disease at the ICA terminus with moyamoya collaterals at the skull base; bilateral posterior communicating arteries supplied the bilateral middle cerebral arteries, and the left ophthalmic artery supplied the distal right anterior cerebral artery. Her right-sided vision abnormalities were highly concerning for branch retinal artery occlusion based on fundoscopic exam. She continued antiplatelet therapy and was scheduled for an ophthalmology follow-up as an outpatient. The patient was monitored in outpatient stroke clinic with surveillance scans. Due to patient preference and the absence of further strokes on preventive medications, the initial plan of external carotid artery to ICA bypass was deferred. Early identification of moyamoya syndrome and initiation of secondary stroke preventive therapy in symptomatic patients can reduce the incidence of ischemic strokes. This is an important consideration for patients transitioning from pediatric to adult neurologists, as the latter may not be as familiar with managing this condition.

Objective: We aimed to investigate the predictors of aneurysm occlusion following flow diversion treatment for unruptured intracranial aneurysms (UIA) using the Surpass Evolve (SE) stent. Methods: The radiological and clinical outcomes of UIAs treated using SE stent at a single tertiary hospital were reviewed retrospectively. We categorized radiological outcome into the poor (O’Kelly-Marotta [OKM] grade A-B) and favorable occlusion group (OKM grade C-D). Univariate and multivariate analyses were conducted to identify risk factors associated with poor occlusion. Results: A total of 68 unruptured intracranial aneurysms in 52 patients were treated in our institution from December 2019 to July 2024. At last radiological follow-up (mean 17.5±10.1 months), the overall favorable occlusion rate was 79.4% (n=52). Multivariate analysis showed larger aneurysm (p=0.011, OR=0.89, 95% CI [0.81-0.98]) and presence of incorporated branch (p=0.007, OR=8.26, 95% CI [1.78-38.28]) were associated with independent factors for poor occlusion, respectively. Procedural mortality and morbidity were 0% (n=0) and 1.9% (n=1). One patient presented with delayed ischemic stroke (1.9%, n=1) without permanent neurological deficit. Conclusions Treatment for UIAs using the Surpass Evolve flow-diverting stent might be feasible for efficacy and safety. In this study, larger size of aneurysm and branch incorporated aneurysm were associated with poor occlusion after flow-diversion using SE stent.

The adhesion of arteries to aneurysm domes can pose significant technical challenges during surgical clipping. Dissection of these vessels carries a risk of iatrogenic wall damage and subsequent complications. We present the case of a 67-year-old woman with three unruptured intracranial aneurysms. Following successful coil embolization of a right posterior communicating artery aneurysm, surgical clipping was planned for the remaining left middle cerebral artery and anterior choroidal artery aneurysms. Intraoperatively, the M2 inferior division was found to be densely adherent to an aneurysm located at the bifurcation of the M2 superior division. After temporary clipping of the parent artery, careful dissection was performed, and the aneurysm was successfully clipped. Postoperatively, the patient failed to regain consciousness. A computed tomography scan revealed diffuse subarachnoid hemorrhage, and subsequent angiography confirmed active contrast extravasation from the dissected M2 inferior division. The family declined reoperation, and the patient subsequently expired after brain death was declared. This case illustrates that in instances of strong arterial adhesion, extreme caution is warranted during dissection. Even without evident intraoperative bleeding, subtle vessel wall injury can lead to fatal delayed rupture. Meticulous inspection and, when necessary, reinforcement of dissected arterial segments is crucial to prevent such devastating outcomes.

Middle meningeal arteriovenous fistulas (MMAVFs) are known as rare diseases, often associated with head trauma, with idiopathic cases being exceedingly uncommon. Here, we present a clinical case of spontaneous and simultaneous bilateral MMAVFs in a 37-year-old woman. She presented with persistent pulsatile tinnitus but no history of head trauma. Bilateral MMAVFs were identified via Time-of-Flight Magnetic Resonance Angiography. Subsequent digital subtraction angiography revealed a fistula between the middle meningeal artery (MMA) and middle meningeal vein (MMV) without definite intracranial venous reflux. We had planned coil embolization via a trans-arterial approach for both sides. Remarkably, after six days, the right-sided MMAVF observed in the previous external carotid artery (ECA) angiogram disappeared spontaneously. The left-sided MMAVF was successfully treated with coil embolization, achieving complete obliteration of fistula flow. Postoperatively, the patient’s pulsatile tinnitus disappeared, and she was discharged without medication. There are a few possible mechanisms of spontaneous MMAVFs, such as middle meningeal artery aneurysm and trivial head trauma. Trans-arterial embolization with coils appears to be an effective and safe treatment option for complete obliteration of fistula flow.