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Article ; Online: Endovascular biopsy in neurointerventional surgery: A systematic review.

Shekhtman, Oleg / Sioutas, Georgios S / Piavchenko, Gennadii / Bhalla, Shubhang / Cooke, Daniel L / Winkler, Ethan / Burkhardt, Jan-Karl / Srinivasan, Visish M

Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences

2024 , Page(s) 15910199241240508

Abstract: Introduction: Endothelial cells (ECs) continuously line the cerebrovasculature. Molecular aberrations in the ECs are hallmarks and contributory factors to the development of cerebrovascular diseases, including intracranial aneurysms and arteriovenous ... ...

Abstract	Introduction: Endothelial cells (ECs) continuously line the cerebrovasculature. Molecular aberrations in the ECs are hallmarks and contributory factors to the development of cerebrovascular diseases, including intracranial aneurysms and arteriovenous malformations (AVMs). Endovascular biopsy has been introduced as a method to harvest ECs and obtain relevant biologic information. We aimed to summarize the literature on endovascular biopsy in neurointerventional surgery. Methods: We conducted a comprehensive literature search in multiple databases, identifying eligible studies focusing on neurosurgical applications of endovascular biopsy. The systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The relevant information was collected, including study characteristics, biopsy techniques, and key findings. Results: Nine studies met the inclusion criteria and were included. The studies involved the collection of ECs using various endovascular devices including coils, guide wires, different stents, and forceps. Endothelial-enrichment techniques, such fluorescence-activated cell sorting (FACS), collected ECs and facilitated downstream applications of bulk or single-cell RNA sequencing (scRNAseq). The studies provided insights into gene expression profiles and identified potential biomarkers associated with intracranial aneurysms. However, challenges were observed in obtaining an adequate number of ECs and identifying consistent biomarkers. Conclusion: Endovascular biopsy of endothelial cells (ECs) in cerebrovascular pathologies shows promise for gene expression profiling. However, many studies have been limited in sample size and underpowered to identify "signature genes" for aneurysm growth or rupture. Advancements in minimally invasive biopsy methods have potential to facilitate applications of precision medicine in the treatment of cerebrovascular disorders.
Language	English
Publishing date	2024-03-22
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1354913-3
ISSN	2385-2011 ; 1591-0199 ; 1123-9344
ISSN (online)	2385-2011
ISSN	1591-0199 ; 1123-9344
DOI	10.1177/15910199241240508
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Article ; Online: Transcriptomics of intracranial aneurysms: current state and opportunities in flow diversion.

Srinivasan, Visish M / Shekhtman, Oleg / Kandregula, Sandeep / Mannam, Sneha Sai / Yu, Ling Fai Charles / Kan, Peter

Journal of neurosurgery

2023 Volume 140, Issue 5, Page(s) 1335–1343

Abstract: Over the last 2 decades, the field of transcriptomics has emerged as a major subdiscipline in biology. Transcriptomic techniques have been used by many groups over this time to better understand intracranial aneurysm development, rupture, and treatment. ... ...

Abstract	Over the last 2 decades, the field of transcriptomics has emerged as a major subdiscipline in biology. Transcriptomic techniques have been used by many groups over this time to better understand intracranial aneurysm development, rupture, and treatment. However, only a few studies have applied transcriptomics to understand the mechanisms behind flow diversion (FD) specifically, despite its increasing importance in the neurointerventional armamentarium. FD is an increasingly safe and effective treatment option for intracranial aneurysms. However, the clinical understanding and use of FD has far outpaced the understanding of the underlying mechanisms. To make FD more predictable, clinically efficacious, and safe, it is important to understand the biological mechanisms at play that lead to successful and unsuccessful FD. In this review, the authors focus on the current understanding of FD biology, the recent advances in transcriptomics, and what future studies could be performed to deepen the understanding of FD. They propose the new concept of the FD microenvironment to be studied, which may unlock a deeper biological understanding. This review provides the background for prospective studies into the development of targeted aneurysm therapy, whether by modified devices or by medical adjuncts.
MeSH term(s)	Intracranial Aneurysm/genetics ; Humans ; Transcriptome ; Endovascular Procedures/methods ; Gene Expression Profiling
Language	English
Publishing date	2023-11-17
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	3089-2
ISSN	1933-0693 ; 0022-3085
ISSN (online)	1933-0693
ISSN	0022-3085
DOI	10.3171/2023.9.JNS23565
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Article: Neuronavigation device for stereotaxic external ventricular drainage insertion.

Konovalov, Anton / Okishev, Dmitry / Shekhtman, Oleg / Pilipenko, Yuri / Eliava, Shalva

Surgical neurology international

2021 Volume 12, Page(s) 266

Abstract: Background: The insertion of an external ventricular drainage (EVD) is one of the most frequently used neurosurgical procedures. It is performed to adjust intracranial hypertension in cases of severe craniocerebral injury, acute posthemorrhagic ... ...

Abstract	Background: The insertion of an external ventricular drainage (EVD) is one of the most frequently used neurosurgical procedures. It is performed to adjust intracranial hypertension in cases of severe craniocerebral injury, acute posthemorrhagic hydrocephalus, meningitis, and oncological diseases related to impaired circulation of cerebrospinal fluid circulation (CSF). Methods: In 2020, three patients with subarachnoid aneurysmal hemorrhage underwent insertion of an EVD navigation percutaneous stereotaxic device. Three cases introduced. Results: In all cases, satisfactory EVD functioning was noted during the surgery and during the early postoperative period. The EVD insertion procedure took an average of 10 min. The EVD insertion route calculations using the software took about 5-15 min. No cases showed any infection, hemorrhagic complications, or EVD dysfunction. According to the control brain computed tomography data, the catheter position was satisfactory and corresponded to the target coordinates in all cases. Conclusion: The use of the device, with its high accuracy and efficiency, can reduce the incidence of unsatisfactory EVD implantation cases in patients with neurosurgical pathology.
Language	English
Publishing date	2021-06-07
Publishing country	United States
Document type	Journal Article
ISSN	2229-5097
ISSN	2229-5097
DOI	10.25259/SNI_180_2021
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Article: Surgical treatment of ruptured right middle cerebral artery mycotic aneurysm and central nervous system aspergillosis: Clinical case and literature review.

Konovalov, Anton / Sharipov, Oleg / Shekhtman, Oleg / Gadzhiagaev, Vadim / Kalinin, Pavel

Surgical neurology international

2021 Volume 12, Page(s) 555

Abstract: Background: Central nervous system (CNS) aspergillosis is more often met in patients with expressed immune suppression. Still, in 50% of cases of meningitis caused by : Case description: Clinical case of a 58-year-old man who developed an : ... ...

Abstract	Background: Central nervous system (CNS) aspergillosis is more often met in patients with expressed immune suppression. Still, in 50% of cases of meningitis caused by Case description: Clinical case of a 58-year-old man who developed an Conclusion: The lack of generally accepted tactics of the treatment of this pathology requires further studies and systemic analysis. A high risk of the lethal outcome in patients with invasive mycotic infection and rupture of mycotic aneurysm highlight the importance of timely diagnostics and the beginning of antimycotic therapy. WThe issue of the evaluation of the revascularization methods effectiveness in patients after surgical treatment of a mycotic aneurysm associated with cerebral aspergillosis remains poor.
Language	English
Publishing date	2021-11-08
Publishing country	United States
Document type	Case Reports
ISSN	2229-5097
ISSN	2229-5097
DOI	10.25259/SNI_843_2021
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Article: Surgical Treatment of Unruptured Brain AVMs: Short- and Long-Term Results.

Eliava, Shalva / Gorozhanin, Vadim / Shekhtman, Oleg / Pilipenko, Yuri / Kuchina, Olga

Acta neurochirurgica. Supplement

2021 Volume 132, Page(s) 87–90

Abstract: Unruptured brain AVMs (bAVMs) remain a controversial subject for practicing neurosurgeons, especially in the light of ARUBA and other observational studies. This retrospective study aims to analyze our experience with unruptured bAVMs to see whether it ... ...

Abstract	Unruptured brain AVMs (bAVMs) remain a controversial subject for practicing neurosurgeons, especially in the light of ARUBA and other observational studies. This retrospective study aims to analyze our experience with unruptured bAVMs to see whether it is beneficial in the long-term and how it corresponds to large literature trials. The study comprised 160 adult patients with unruptured bAVMs surgically treated in Burdenko NMC (Moscow) in 2009-2017. Mean age: 33.4 ± 10лет. Clinical presentations were: seizures in 99 (61.9%), chronical headaches-49 (30.6%), ischemic symptoms-4 (2.5%), asymptomatic in 8 (5%) patients. Spetzler-Martin scale: I-18 pt. (11.3%), II-71 pt. (44.4%), III-60 pt. (37.5%), IV-11 pt. (6.8%). Good outcomes (mRS = 0-2) at discharge were achieved in 149 (93.1%), satisfactory (mRS-3)-9 (5.6%). Follow-up was complete for 97 (60.6%) patients, mean-59.3 (13-108 month). Excellent outcomes (mRS = 0-1) reached in 94.8%. For epilepsy patients, Engel I outcome was found in 50 (84.8%); for chronic headaches, 43 (66.1%) patients reported improvement. Postoperative visual field defects were followed in 22 of 55 (40%), complete recovery was reported in 6 (27%) and partial recovery in 8 (36%) patients. Overall, our results support the conclusion that surgery for low-grade bAVMs (S-M I-II) is a beneficial, low-risk option.
MeSH term(s)	Adult ; Brain ; Humans ; Intracranial Arteriovenous Malformations/surgery ; Radiosurgery ; Retrospective Studies ; Treatment Outcome
Language	English
Publishing date	2021-05-08
Publishing country	Austria
Document type	Journal Article
ISSN	0065-1419
ISSN	0065-1419
DOI	10.1007/978-3-030-63453-7_13
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Article ; Online: Liquid embolic agents for middle meningeal artery embolization in chronic subdural hematoma: Institutional experience with systematic review and meta-analysis.

Sioutas, Georgios S / Vivanco-Suarez, Juan / Shekhtman, Oleg / Matache, Irina-Mihaela / Salem, Mohamed M / Burkhardt, Jan-Karl / Srinivasan, Visish M / Jankowitz, Brian T

Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences

2023 , Page(s) 15910199231183132

Abstract: Introduction: Chronic subdural hematoma (CSDH) is associated with high recurrence rates. Middle meningeal artery embolization (MMAE) has emerged as a promising treatment option. In this systematic review and meta-analysis, we aimed to assess the safety ... ...

Abstract	Introduction: Chronic subdural hematoma (CSDH) is associated with high recurrence rates. Middle meningeal artery embolization (MMAE) has emerged as a promising treatment option. In this systematic review and meta-analysis, we aimed to assess the safety and efficacy of MMAE for CSDH using liquid embolic agents and compare them with particles. Methods: We systematically reviewed all studies describing MMAE for CSDH with liquid embolic agents, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Additionally, we included a cohort of patients from our institution using liquid and particle embolic agents. Data were analyzed using random-effects proportions and comparisons meta-analysis, and statistical heterogeneity was assessed. Results: A total of 18 studies with 507 cases of MMAE with liquid embolic agents (including our institutional experience) were included in the analysis. The success rate was 99% (95% confidence interval [CI]: 98-⁠100%), all complications rate was 1% (95% CI: 0-⁠5%), major complications rate was 0% (95% CI: 0-⁠0%), and mortality rate was 1% (95% CI: 0-⁠6%). The rate of hematoma size reduction was 97% (95% CI: 73-⁠100%), complete resolution 64% (95% CI: 33-⁠87%), radiographic recurrence 3% (95% CI: 1-⁠7%), and reoperation 3% (95% CI: 1-⁠7%). No significant differences in outcomes were found between liquid and particle embolic agents. Sensitivity analyses revealed that liquid embolic agents were associated with lower reoperation rates in upfront MMAE (risk ratio 0.13, 95% CI: 0.02-⁠0.95). Conclusion: MMAE with liquid embolic agents is safe and effective for the treatment of CSDH. Outcomes are comparable to particles, but liquids were associated with a decreased risk of reoperation in upfront MMAE. However, further studies are needed to support our findings.
Language	English
Publishing date	2023-06-15
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1354913-3
ISSN	2385-2011 ; 1591-0199 ; 1123-9344
ISSN (online)	2385-2011
ISSN	1591-0199 ; 1123-9344
DOI	10.1177/15910199231183132
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Article ; Online: Microsurgical Angioarchitectonics of Deep Brain Structures and Deep Arterial Anastomoses.

Eliava, Shalva / Shekhtman, Oleg / Varyukhina, Mariya

World neurosurgery

2019 Volume 126, Page(s) e1092–e1098

Abstract: Background: Surgeries for deep and eloquent cerebral lesions require a detailed knowledge of normal brain anatomy and accurate planning. Important parts of brain anatomy are the cerebral blood supply and collateral circulation system. In addition to ... ...

Abstract	Background: Surgeries for deep and eloquent cerebral lesions require a detailed knowledge of normal brain anatomy and accurate planning. Important parts of brain anatomy are the cerebral blood supply and collateral circulation system. In addition to well-known cortical and basal (circle of Willis) anastomoses, there is also a deep interarterial anastomotic circle that is not described in the literature. Methods: Twenty brain specimens were studied for deep arterial anastomotic connections between branches of the anterior and posterior choroidal arteries. Results: We have marked 3 symmetric zones of deep arterial anastomoses that form an epithalamic circle. Conclusions: Epithalamic anastomoses provide an additional mechanism of blood distribution that may play a role during surgical interventions or stroke.
MeSH term(s)	Brain/blood supply ; Cadaver ; Cerebral Arteries/anatomy & histology ; Humans ; Microsurgery ; Vascular Surgical Procedures
Language	English
Publishing date	2019-03-15
Publishing country	United States
Document type	Journal Article
ZDB-ID	2534351-8
ISSN	1878-8769 ; 1878-8750
ISSN (online)	1878-8769
ISSN	1878-8750
DOI	10.1016/j.wneu.2019.02.213
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Article ; Online: Middle meningeal artery patency after surgical evacuation for chronic subdural hematoma.

Sioutas, Georgios S / Shekhtman, Oleg / Dagli, Mert Marcel / Salem, Mohamed M / Ajmera, Sonia / Kandregula, Sandeep / Burkhardt, Jan-Karl / Srinivasan, Visish M / Jankowitz, Brian T

Neurosurgical review

2024 Volume 47, Issue 1, Page(s) 145

Abstract: Background: Chronic subdural hematoma (CSDH) often requires surgical evacuation, but recurrence rates remain high. Middle meningeal artery (MMA) embolization (MMAE) has been proposed as an alternative or adjunct treatment. There is concern that prior ... ...

Abstract	Background: Chronic subdural hematoma (CSDH) often requires surgical evacuation, but recurrence rates remain high. Middle meningeal artery (MMA) embolization (MMAE) has been proposed as an alternative or adjunct treatment. There is concern that prior surgery might limit patency, access, penetration, and efficacy of MMAE, such that some recent trials excluded patients with prior craniotomy. However, the impact of prior open surgery on MMA patency has not been studied. Methods: A retrospective analysis was conducted on patients who underwent MMAE for cSDH (2019-2022), after prior surgical evacuation or not. MMA patency was assessed using a six-point grading scale. Results: Of the 109 MMAEs (84 patients, median age 72 years, 20.2% females), 58.7% were upfront MMAEs, while 41.3% were after prior surgery (20 craniotomies, 25 burr holes). Median hematoma thickness was 14 mm and midline shift 3 mm. Hematoma thickness reduction, surgical rescue, and functional outcome did not differ between MMAE subgroups and were not affected by MMA patency or total area of craniotomy or burr-holes. MMA patency was reduced in the craniotomy group only, specifically in the distal portion of the anterior division (p = 0.005), and correlated with craniotomy area (p < 0.001). Conclusion: MMA remains relatively patent after burr-hole evacuation of cSDH, while craniotomy typically only affects the frontal-distal division. However, MMA patency, evacuation method, and total area do not affect outcomes. These findings support the use of MMAE regardless of prior surgery and may influence future trial inclusion/exclusion criteria. Further studies are needed to optimize the timing and techniques for MMAE in cSDH management.
MeSH term(s)	Female ; Humans ; Aged ; Male ; Retrospective Studies ; Treatment Outcome ; Hematoma, Subdural, Chronic/surgery ; Meningeal Arteries/surgery ; Embolization, Therapeutic/methods ; Hematoma
Language	English
Publishing date	2024-04-10
Publishing country	Germany
Document type	Journal Article
ZDB-ID	6907-3
ISSN	1437-2320 ; 0344-5607
ISSN (online)	1437-2320
ISSN	0344-5607
DOI	10.1007/s10143-024-02383-3
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Article: Chondrosarcoma of the Skull Base: A Case Study and Literature Review.

Konovalov, Anton / Shekhtman, Oleg / Shekhtman, Anastasia P / Bezborodova, Tatyana

Cureus

2020 Volume 12, Issue 12, Page(s) e12412

Abstract: Chondrosarcomas (CSs) are rare malignant tumors composed of cells derived from the transformed chondrocytes. Only 2% of the total cases of CS are found at the skull base, thus representing a 0.1-0.2% prevalence. We present the case of a patient with CS ... ...

Abstract	Chondrosarcomas (CSs) are rare malignant tumors composed of cells derived from the transformed chondrocytes. Only 2% of the total cases of CS are found at the skull base, thus representing a 0.1-0.2% prevalence. We present the case of a patient with CS at the middle cranial fossa who was admitted for surgery to the Burdenko National Medical Research Center of Neurosurgery. In addition, we engage in a review of the literature to discuss the current approaches to the diagnostics and surgery of CS and delve deep into its embryo- and oncogenesis.
Language	English
Publishing date	2020-12-31
Publishing country	United States
Document type	Case Reports
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.12412
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Article ; Online: A Rare Case of Brain Angiolipoma Imitating Arteriovenous Malformation: Differential Diagnosis, Surgical Treatment, and Literature Review.

Shekhtman, Oleg / Gorozhanin, Vadim / Shishkina, Lyudmila

World neurosurgery

2018 Volume 114, Page(s) 264–268

Abstract: Background: Angiolipomas are mesenchymal tumors composed of mature adipocytes with abnormal vascular elements. They are most commonly found in subcutaneous tissues of the trunk and are rarely seen at craniospinal axes.: Case description: We present ... ...

Abstract	Background: Angiolipomas are mesenchymal tumors composed of mature adipocytes with abnormal vascular elements. They are most commonly found in subcutaneous tissues of the trunk and are rarely seen at craniospinal axes. Case description: We present an untypical case of frontal lobe angiolipoma manifested with seizures and initially described as an arteriovenous malformation. Conclusion: MRI with fat-suppression sequence plays key role in angiolipomas diagnostics.
MeSH term(s)	Adolescent ; Angiolipoma/diagnostic imaging ; Angiolipoma/surgery ; Brain Neoplasms/diagnostic imaging ; Brain Neoplasms/surgery ; Diagnosis, Differential ; Female ; Humans ; Intracranial Arteriovenous Malformations/diagnostic imaging ; Intracranial Arteriovenous Malformations/surgery ; Treatment Outcome
Language	English
Publishing date	2018-06
Publishing country	United States
Document type	Case Reports ; Journal Article ; Review
ZDB-ID	2534351-8
ISSN	1878-8769 ; 1878-8750
ISSN (online)	1878-8769
ISSN	1878-8750
DOI	10.1016/j.wneu.2018.03.167
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