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= 0.993, respectively), with both interest and research in the field increasing. The rate of publications in each group also increased. In recent years, increasing numbers of global institutions have researched and published on IC-IC bypasses.

As more work is undertaken on IC-IC bypasses, it is critical for knowledge to be shared through research, collaboration, publication, and early teaching within residency training programs. This field has increased exponentially in the past 2 decades and has yet to reach an inflection point, indicating possible additional interest and growth over time.

As more work is undertaken on IC-IC bypasses, it is critical for knowledge to be shared through research, collaboration, publication, and early teaching within residency training programs. This field has increased exponentially in the past 2 decades and has yet to reach an inflection point, indicating possible additional interest and growth over time.A 32-year-old woman presented with chronically progressive spastic quadriparesis. Detailed clinicoradiological evaluation led to the diagnosis of irreducible atlantoaxial dislocation and basilar invagination, with associated "kissing" carotids and an anomalous right vertebral artery (VA). Both internal carotid arteries had an abnormally tortuous course, "kissing" retropharyngeally at the level of C1-C2. The right VA became intradural at the level of C2-C3, an extremely rare anomaly-C3 segmental artery. Despite the deformed joints and the possibility of injuring the anomalous right VA during C2-C3 instrumentation, a tailored posterior-only approach was used to circumvent the arterial fence created by both vascular anomalies. The patient underwent bilateral C1-C2 joint opening and left C1-C2 joint spacer placement, followed by bilateral occipito-C3-C4 fixation. This is possibly the first reported case of a complex craniovertebral junction anomaly associated with both kissing carotids and a C3 segmental VA.

Many studies, mainly original articles and reviews, have been reported on congenital scoliosis (CS), but there is a lack of bibliometric analyses. This study aimed to systematically analyze the developments and focuses in CS and related research fields.

Data were retrieved from the Web of Science Core Collection database, and the top 100 most-cited studies were analyzed emphatically. The Web of Science Results Analysis and Citation Report was used to analyze different aspects of the literature. CiteSpace was used to analyze the cooperation network, reference co-citation, burst keywords, and burst citations.

The final analysis included 749 studies. CS and related research has been rapidly expanding. Several journals have published relevant studies and most-cited studies on this topic. Cooperation was noted among authors, institutions, and countries/regions in multiple instances. Surgical techniques (hemivertebra resection/posterior vertebral column resection/vertical expandable prosthetic titanium rib/doshould be studied further.

Meningiomas are a common primary central nervous system tumor that lack a U.S. Food and Drug Administration-approved pharmacotherapy. Approximately 20%-35% of meningiomas are classified as higher grade with poor outcome, whereas patients with lower-grade meningiomas are known to have long-term neurologic deficits and reduced overall survival. Recent efforts to understand the epigenetic landscape of meningiomas have highlighted the importance of DNA methylation for predicting tumor outcomes and prognosis; therefore, inhibition of these pathways may present a viable therapy for these tumors.

In this study, we perform dose-response curves of decitabine, a DNA methyltransferase inhibitor, on patient-cultured tumors and meningioma cell lines.

Thirty total samples were evaluated, including 24 patient-cultured tumors and 6 established meningioma cell lines. Meningiomas were found to have a significant reduction in cell viability after decitabine treatment in a dose dependent manner. The effect was primarily driven by 11 of the 30 tumors in our cohort, or 36.7%. Decitabine significantly reduced cell viability across all grades, tumors from different sexes, recurrent and primary tumors, as well as tumors without a history of previous radiation. Surprisingly, our single radiation-induced tumor did demonstrate greater viability after decitabine treatment.

Our work has identified a potential drug candidate in decitabine for the treatment of meningiomas regardless of clinical subgroup. These data require further evaluation in preclinical models, and the conclusions based on clinical subgroups need to be evaluated in a larger cohort to achieve appropriate statistical power.

Our work has identified a potential drug candidate in decitabine for the treatment of meningiomas regardless of clinical subgroup. These data require further evaluation in preclinical models, and the conclusions based on clinical subgroups need to be evaluated in a larger cohort to achieve appropriate statistical power.Some giant intracranial aneurysms can develop serpentine morphology, secondary to a peculiar near-complete intra-aneurysmal thrombosis. The resulting complex angioarchitecture, along with atypical clinical presentations (i.e., mass effect, distal ischemia) seen, makes management of such aneurysms technically challenging. These aneurysms are not amenable to endovascular treatment, and hence the only remaining treatment option is a tailored microsurgical procedure (clipping/parent vessel occlusion or reconstruction/trapping/aneurysmorrhaphy) accompanied by a safety bypass (high-flow, low-flow, or in situ bypass, subject to dependence of distal circulation on proximal trunk with reference to aneurysm). The microsurgical procedure can be performed either in 1 or 2 stages (bypass followed by aneurysm treatment at a later date). Superficial temporal artery (STA)-middle cerebral artery (MCA) bypass followed by aneurysm trapping/decompression is the most routinely performed microsurgical procedure for such aneurysms. The operative video illustrates an alternative surgical treatment of a giant serpentine aneurysm of the MCA resection and end-to-end anastomosis. A 20-year-old man underwent microsurgery for a giant right MCA serpentine aneurysm. In view of the poor distal flow in the ipsilateral MCA territory, an STA-MCA bypass with aneurysm trapping/decompression was planned. Intraoperatively, the presence of a stretched and elongated ipsilateral MCA (secondary to aneurysm mass effect) plus the relatively narrow neck of the thrombosed aneurysm provided a rare opportunity to perform resection and end-to-end anastomosis (Video 1). Intraoperative and postoperative angiography confirmed the anastomosis patency. The patient's recovery was uneventful. This treatment can save operating time, eliminate donor artery-related morbidity, and offer a surgical alternative to the conventional strategy of STA-MCA bypass.Carotid endarterectomy is a standard treatment for patients with symptomatic carotid artery stenosis.1 Surgical techniques require a full-thickness incision (longitudinal, diagonal, or transverse) through the carotid wall. This incision results in significant plaque disruption and precludes harvesting of intact specimens for research. The video demonstrates an endarterectomy technique for removal of intact plaques using an extra-intimal approach. A 70-year-old man presented to our service with a history of aphasia. Neuroimaging showed the presence of an 80%-90% calcified stenosis of the left internal carotid artery. Brain magnetic resonance imaging revealed multiple acute and subacute left hemispheric strokes. The decision was made to proceed with extra-intimal carotid endarterectomy of the left internal carotid artery after obtaining informed consent. To this end, after appropriate exposure of the carotid artery bifurcation, the adventitia and the tunica media were transected longitudinally followed by the creation of a circumferential dissection plane between the tunica media and the intima (i.e., extra-intimal). After sharply transecting the intimal inlets and outlet of the atheroma, the arteriotomy was repaired in usual fashion (Video 1). The patient was discharged home the next day without complications and remained asymptomatic at 1-year follow-up. To date, this technique has been successfully used in 55 consecutive patients with no intraoperative or postoperative complications. This technique is fast, reproducible, and effective even in highly calcified lesions that are otherwise hard to cut. The approach requires minimal arterial wall and atheroma manipulation and procures intact specimens for high-quality research.

We aim to evaluate the role of frailty and inflammatory markers in predicting the short-term outcomes after catheter-associated urinary tract infections (CAUTI) and central line-associated bloodstream infections (CLABSI).

Data regarding the patients' characteristics, isolates on CAUTI and CLABSI, antibiotic susceptibility, frailty (11-point Modified Frailty Index), and inflammatory markers were retrospectively collected. Their impact on the short-term outcomes was assessed using regression modeling response.

One hundred and one patients with CAUTI (n= 71) and CLABSI (n= 30) between January 2018 and December 2019 were included in this study. The pooled incidence rates for CAUTI were 5.50 and for CLABSI 3.58 episodes/1000 catheter-days. We observed 74.7% drug resistance in our CAUTI isolates and 93.3% in CLABSI. In the multivariate analysis, frailty (P= 0.006), neutrophil/lymphocyte ratio (NLR) (P= 0.007) and the presence of sepsis (P= 0.029) were found to be significant predictors of in-hospital mortalitIn patients with CLABSI, frailty (P = 0.029) and NLR (P = 0.029) were found significant and along with sepsis (P = 0.069) resulted in a regression model with good accuracy in predicting mortality. The receiver operating characteristic curve showed that 11-point Modified Frailty Index and NLR as well as the regression model significantly predicted mortality with an area under the curve of 86.1%, 81.4%, and 95.4%, respectively, in CAUTI, and 70.9%, 77.8%, and 95.2%, respectively, in CLABSI.

Few studies have evaluated flow diversion with magnetic resonance angiography (MRA). Studies have shown better success of MRA in assessing the aneurysm response, but limited success in assessing stent patency. The patency of arterial branches on MRA remains to be explored.

Retrospective evaluation of 31 consecutive cases of carotid aneurysms treated with flow diversion was performed with noncontrast time-of-flight (TOF), contrast-enhanced TOF, and cine MRA (time-resolved angiography with interleaved stochastic trajectories) independently by 2 investigators for aneurysm occlusion, stent patency, and arterial branch patency. Digital subtraction angiography served as the gold standard technique.

Patients were 6 men and 25 women with a mean ± SD age of 57.8 ± 12.27 years (range, 32-79 years). Stent patency, aneurysm occlusion, and branch patency mostly revealed substantial to perfect interobserver agreement (κ >0.60). Sensitivity, specificity, positive predictive value, and negative predictive value for stent patency on raw data images of TOF were 0.