Journal of NeuroInterventional Surgery最新文献

{"title":"Unseen wounds: a multinational investigation of neurointerventionalists on the psychological toll of complications.","authors":"Ansaar T Rai, Emanuele Orru, Kyle M Fargen, Fabian Arnberg Sandor, Ricardo A Hanel, James M Milburn, Thanh N Nguyen, Nathan Farkas, Adam A Dmytriw, Adnan H Siddiqui","doi":"10.1136/jnis-2025-024288","DOIUrl":"https://doi.org/10.1136/jnis-2025-024288","url":null,"abstract":"<p><strong>Background: </strong>Complications not only affect patients but also impose a significant psychological burden on physicians. Quantitative data in neurointerventional surgery regarding the 'second victim' phenomenon are lacking. This study aimed to assess the prevalence and severity of post-traumatic stress symptoms among neurointerventionalists after major complications.</p><p><strong>Methods: </strong>A survey was developed by a committee of experienced neurointerventionalists and distributed internationally via multiple platforms. Respondents were anonymous. Demographic information, complication type, and institutional support availability were queried. Psychological distress was measured using the validated Impact of Event Scale-Revised (IES-R), which assesses intrusion, avoidance, and hyperarousal domains. Descriptive statistics and regression analyses were performed to identify factors associated with post-traumatic stress symptoms.</p><p><strong>Results: </strong>Of 1042 invited physicians, 503 responded (48%), with 413 completing the full survey (40%). The most common pathology was cerebral aneurysm, and the most frequent complication was hemorrhage. Overall, 64% scored above the IES-R threshold for possible post-traumatic stress disorder (PTSD) (≥24), with many reaching levels (≥37) associated with long-term stress and physiological sequelae. Intrusion was the dominant symptom domain, particularly distressing reminders about the complication. Lack of institutional support was significantly associated with possible PTSD (OR 1.63, 95% CI 1.1 to 2.5, P=0.02). No differences were observed by specialty, but geographic variations were present. High stress scores persisted long after the index event.</p><p><strong>Conclusion: </strong>Complications exert a profound emotional and physiological toll on neurointerventionalists, with high rates of possible PTSD and a strong association with inadequate institutional support. Systematic support programs are urgently needed to safeguard physician well-being and patient safety.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145355064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A novel neurointerventional subarachnoid aqueductoplasty technique for the treatment of aqueductal stenosis: a cadaveric feasibility study.","authors":"Serdar Rahmanov, Mohammadmahdi Sabahi, Yatin Srinivash Ramesh Babu, Natalia Jedlinska-Obrzut, Hamid Borghei-Razavi, Badih Adada, Michal Obrzut","doi":"10.1136/jnis-2025-024209","DOIUrl":"https://doi.org/10.1136/jnis-2025-024209","url":null,"abstract":"<p><strong>Objective: </strong>Aqueductal stenosis is a common cause of obstructive hydrocephalus, resulting in ventricular dilation and neurological deterioration. Standard treatments such as shunting, endoscopic third ventriculostomy, and traditional aqueductoplasty are effective but are associated with risks including parenchymal injury, infection, and long-term failure. As neurosurgery shifts toward minimally invasive techniques, there is a growing interest in approaches that avoid brain parenchyma transgression. This study introduces a novel neurointerventional method for treating aqueductal stenosis via the subarachnoid route through the foramen magnum and the fourth ventricle using standard endovascular tools.</p><p><strong>Methods: </strong>Five formalin-fixed, silicone-injected, alcohol-preserved cadaveric heads were studied. Contrast was injected into the ventricular system. Catheters were introduced via simulated lumbar puncture or cisterna magna access and then advanced via the foramen of Magendie into the fourth ventricle and then through the aqueduct, utilizing Cone-beam CT, needle guidance software, and biplane fluoroscopy-guided navigation. A self-expanding stent was deployed in the aqueduct, and balloon aqueductoplasty was performed. Anatomical accuracy and technical success were confirmed via endoscopy through a transcallosal approach.</p><p><strong>Results: </strong>Aqueductal access was successfully achieved in all specimens without brain parenchymal violation. Stent placement and balloon dilation were performed without complications and confirmed endoscopically.</p><p><strong>Conclusion: </strong>This novel, image-guided, minimally invasive approach enables aqueductal catheterization via the subarachnoid route. It offers a brain-sparing alternative for treating aqueductal stenosis and may extend to future subarachnoid procedures such as third ventriculostomy or cyst fenestration. In vivo studies are warranted.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145355120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Short-term safety of dual versus single antiplatelet therapy in flow diversion for distal intracranial aneurysms: results from the DART trial.","authors":"Luis Henrique de Castro-Afonso, Saulo Villas-Boas, Guilherme Seizem Nakiri, Gustavo Andrade, Ítalo Emmanuel Lima Ferreira, José Laércio Júnior Silva, Eric Homero Albuquerque Paschoal, Elias Antônio Tanus Machado, Jose Alberto Almeida Filho, Cesar Augusto Ferreira Alves Filho, Ricardo Santos de Oliveira, Benedicto Oscar Colli, Daniel Giansante Abud","doi":"10.1136/jnis-2025-024144","DOIUrl":"https://doi.org/10.1136/jnis-2025-024144","url":null,"abstract":"<p><strong>Background and purpose: </strong>Flow diverters (FDs) have become one of the primary treatments for intracranial aneurysms (IAs). However, their use in distal IA has been associated with higher complication rates compared with other techniques. The development of coated FDs, in combination with novel antiplatelet regimens, offers promising strategies to improve the safety profile of FDs in this context. This trial aimed to compare mono antiplatelet therapy (MAPT) using prasugrel versus dual antiplatelet therapy (DAPT) with aspirin and prasugrel for the treatment of distal IA using the p48 MW HPC FD (WallabyPhenox).</p><p><strong>Methods: </strong>This was a multicenter, prospective, parallel-group, single-blind, non-inferiority randomized trial. Between February 2021 and February 2025, 140 patients were enrolled. After excluding 11 patients, 129 were included in the final analysis. The primary endpoint was the absence of new neurological deficits, defined as no shift in the modified Rankin Scale (mRS) score. The secondary endpoint was the incidence of any stroke.</p><p><strong>Results: </strong>At the 30-day follow-up, 66 patients (98.5%) in the MAPT group and 59 patients (95.2%) in the DAPT group showed no new neurological deficits. With a predefined non-inferiority margin of 5%, the difference of 3.35% confirmed the non-inferiority of MAPT compared with DAPT (p=0.002). The incidence of any stroke was 4/67 (5.9%) in the MAPT group and 6/62 (9.6%) in the DAPT group (p=0.431).</p><p><strong>Conclusion: </strong>Prasugrel monotherapy for the treatment of distal IAs using the p48 MW HPC was non-inferior to DAPT within the first 30 days following treatment.</p><p><strong>Clinical trial registration: </strong>https://ensaiosclinicos.gov.br/rg/RBR-3q9zb73. UTN code: U1111-1290-2489. Research Ethics Committee of the Hospital das Clínicas de Ribeirão Preto - Universidade de São Paulo. CAAE number: 29848720.0.1001.5440.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145345732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Middle meningeal artery infusion for headaches after aneurysmal subarachnoid hemorrhage: a pilot study.","authors":"Tongyu Zhang, Matias Luis Costa, Magdy Selim, Tao Hong, Peter Kan","doi":"10.1136/jnis-2025-024125","DOIUrl":"https://doi.org/10.1136/jnis-2025-024125","url":null,"abstract":"<p><strong>Introduction: </strong>Headache is a common and disabling symptom after aneurysmal subarachnoid hemorrhage (aSAH), often requiring high-dose opioids. Meningeal inflammation and dural nociceptor activation may contribute. The middle meningeal artery (MMA), which supplies the dura, offers a route for targeted therapy.</p><p><strong>Objective: </strong>To evaluate whether dural infusion of lidocaine±dexamethasone during aneurysm embolization reduces pain and opioid use.</p><p><strong>Methods: </strong>Between February and June 2025, nine patients with aSAH (Hunt and Hess grade 1-2 with Visual Analog Scale (VAS) score ≥7 were prospectively assigned to: (1) lidocaine+dexamethasone (L+D, n=3), (2) lidocaine only (L, n=3), or (3) no infusion (Control, n=3). MMA infusion was performed during embolization using a standard microcatheter technique. VAS was recorded at baseline, immediately postoperatively, 4-24 hours, 7 days, and 1 month. Primary outcomes were pain reduction and opioid use (oral morphine equivalents, OME). Statistical comparisons used non-parametric tests.</p><p><strong>Results: </strong>Postoperative median VAS fell from 7.0 to 6.0 in Controls (14%), 8.0 to 2.0 in L+D (75%), 8.0 to 4.0 in L (50%) (pooled P=0.016). First-day pain burden: 31 (Control), 9 (L+D), 21 (L), 15 (pooled; P=0.012). Early subacute burden: 9 (Control), 5 (L+D), 7 (L), 6 (pooled; P=0.024). Late subacute: 6 (Control), 3 (L+D), 5 (L), 4 (pooled; P=0.029). Cumulative burden: 42 (Control), 16 (L+D), 30 (L), 23 (pooled; P=0.012). Median OME: 16.7 mg (Control), 5.6 mg (L+D), 0 mg (L), 2.8 mg (pooled). There were no complications.</p><p><strong>Conclusion: </strong>MMA infusion appears safe and may provide sustained, opioid-sparing pain relief after aSAH. Larger studies are needed to confirm efficacy and to optimize protocols.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145345744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incremental value of pericarotid adipose tissue radiomics in predicting in-stent restenosis after carotid artery stenting.","authors":"Dongqing Ren, Yu Lan, Hongyi Li, Dongbo Li, Ronghui Ju, Yang Hou","doi":"10.1136/jnis-2025-023865","DOIUrl":"https://doi.org/10.1136/jnis-2025-023865","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the potential of pericarotid adipose tissue radiomics to improve the prediction of in-stent restenosis (ISR) after carotid artery stenting (CAS).</p><p><strong>Methods: </strong>This retrospective study included 191 patients who underwent carotid CT angiography (CTA) and CAS within 1 week at two centers from September 2019 to December 2023. ISR was defined as ≥50% stenosis on follow-up Doppler ultrasound or CTA. Three predictive models were developed and defined as follows: Model A (Clinical), Model B (Clinical + Imaging), and Model C (Clinical + Imaging + Radiomics) using receiver operating characteristic (ROC) analysis, calibration curves, and decision curve analysis.</p><p><strong>Results: </strong>ISR occurred in 44 patients with a mean time interval of 11.3 months. Multivariate Cox regression analyses identified diabetes, fibrinogen, systolic blood pressure, calcified plaque volume, and pericarotid adipose tissue radiomics as independent predictors of ISR. The radiomics score, derived from 15 significant characteristics, outperformed conventional imaging markers. In the training set, Model C (AUC=0.881) significantly outperformed Model A (AUC=0.664) and Model B (AUC=0.840), with statistically significant differences (Model A vs Model C: P=0.001; Model B vs Model C: P=0.0246). This trend was consistent in the validation sets. Calibration curves showed good agreement between predicted and actual ISR probabilities, and decision curve analysis indicated that Model C provided greater net benefits.</p><p><strong>Conclusion: </strong>The radiomic characteristics of pericarotid adipose tissue provide incremental value in predicting ISR after CAS and serve as a valuable biomarker for restenosis risk assessment.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145345682","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the need for late angiography for complete obliteration of AVMs after endovascular treatment: collaborative AVM center experience and a systematic review.","authors":"Elle Vermeulen, Michael Bruneau, Fons Potters, Martin Podlogar, Wilmar M T Jolink, Roel Haeren, Bart A J M Wagemans, Julie Staals, F J A Meijer, Catharina J M Klijn, Saman Vinke, Joost De Vries, Wim H van Zwam, Hieronymus D Boogaarts","doi":"10.1136/jnis-2025-024046","DOIUrl":"https://doi.org/10.1136/jnis-2025-024046","url":null,"abstract":"<p><p>Brain arteriovenous malformations (bAVMs) can be treated curatively by endovascular embolization. However, limited data exist on late recanalization rates. We investigated the rate of late bAVM recanalization following complete endovascular obliteration, confirmed by primary control angiography.We performed a single-center retrospective cohort study on late recurrences in adult patients with bAVMs after complete endovascular obliteration at a Radboud - Isala - MUMC+ (RIM) collaborative AVM center in the Netherlands between 2014 and 2022.Additionally, we conducted a systematic review to evaluate the rate of late recanalization following complete endovascular obliteration, confirmed on primary control angiography, in adults with bAVMs. The protocol for this review was registered in PROSPERO (CRD42024546875).Our retrospective study revealed 42 adult patients treated by endovascular means only; 90.5% (38 patients with mean age of 48.1 years) had confirmed complete obliteration. Both primary (6 months post-treatment) and secondary (more than 1 year post-treatment) angiographic control confirmed complete obliteration in 21 of 23 patients with complete follow-up. Mean follow-up was 47.8 months. Two late recurrences (9.5%) were detected at 5- and 6-years' follow-up imaging.Our systematic review included two studies encompassing a total of 19 patients with mean angiographical follow-up of 20.8 months. There were no late recurrences.Late bAVM recurrence after endovascular treatment with proven complete obliteration may be underestimated owing to limited long-term follow-up. Our findings suggest that after a 6-month angiographic confirmed obliteration, a 5-year angiographic imaging control is justified.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145312946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transumbilical access for neonatal vein of Galen malformation and pial arteriovenous fistula embolization.","authors":"Maximilian Jeremy Bazil, Johanna T Fifi, Alejandro Berenstein, Tomoyoshi Shigematsu","doi":"10.1136/jnis-2024-021921","DOIUrl":"10.1136/jnis-2024-021921","url":null,"abstract":"<p><strong>Background: </strong>In the neonatal period, transfemoral access may be complicated by sheath size needed for embolization, especially if retreatment is required. A viable alternative is access through an umbilical artery (UA) which allows for preservation of the femoral artery for access in future intervention.</p><p><strong>Methods: </strong>We conducted a retrospective study from January 2014 to March 2023, focusing on 19 vein of Galen malformation, dural arteriovenous (AV) fistula, and pial AV fistula cases treated via transumbilical (TU) access for endovascular embolization in neonates.</p><p><strong>Results: </strong>TU access was achieved successfully in 20 out of 21 intended cases, with a 4 French sheath placed intraprocedurally in all instances. We observed a median retreatment time of 7 months for patients requiring subsequent femoral artery access, highlighting the importance of preserving femoral access for future interventions. There were no complications associated with TU access or sheath retention and no procedural mortality attributed to this approach. Despite intraprocedural and periprocedural complications of other etiologies (including post-procedural hemorrhages and fever requiring antibiotic treatment), the TU approach demonstrated overall safety and efficacy.</p><p><strong>Conclusions: </strong>Our findings align with previous reports of TU access in vascular malformations, emphasizing its role as a vital technique in neonatal neurointervention. The TU approach offers advantages such as sparing femoral arteries for future treatments and potential applicability to other high-flow brain fistulas. Our study contributes to the growing body of evidence supporting the use of TU access in neonatal neuroendovascular interventions, underscoring its importance in managing complex vascular malformations in this vulnerable population.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"1155-1159"},"PeriodicalIF":4.3,"publicationDate":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142467892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Off-label in-silico flow diverter performance assessment in posterior communicating artery aneurysms.","authors":"Michael MacRaild, Ali Sarrami-Foroushani, Shuang Song, Qiongyao Liu, Christopher Kelly, Nishant Ravikumar, Tufail Patankar, Toni Lassila, Zeike A Taylor, Alejandro F Frangi","doi":"10.1136/jnis-2024-022000","DOIUrl":"10.1136/jnis-2024-022000","url":null,"abstract":"<p><strong>Background: </strong>The posterior communicating artery (PComA) is among the most common intracranial aneurysm locations, but flow diverter (FD) treatment with the widely used pipeline embolization device (PED) remains an off-label treatment that is not well understood. PComA aneurysm flow diversion is complicated by the presence of fetal posterior circulation (FPC), which has an estimated prevalence of 4-29% and is more common in people of black (11.5%) than white (4.9%) race. We present the FD-PComA in-silico trial (IST) into FD treatment performance in PComA aneurysms. ISTs use computational modeling and simulation in cohorts of virtual patients to evaluate medical device performance.</p><p><strong>Methods: </strong>We modeled FD treatment in 118 virtual patients with 59 distinct PComA aneurysm anatomies, using computational fluid dynamics to assess post-treatment outcome. Boundary conditions were prescribed to model the effects of non-fetal and FPC, allowing for comparison between these subgroups.</p><p><strong>Results: </strong>FD-PComA predicted reduced treatment success in FPC patients, with an average aneurysm space and time-averaged velocity reduction of 67.8% for non-fetal patients and 46.5% for fetal patients (P<i><</i>0.001). Space and time-averaged wall shear stress on the device surface was 29.2 Pa averaged across fetal patients and 23.5 Pa across non-fetal (P<i><</i>0.05) patients, suggesting FD endothelialization may be hindered in FPC patients. Morphological variables, such as the size and shape of the aneurysm and PComA size, did not affect the treatment outcome.</p><p><strong>Conclusions: </strong>FD-PComA had significantly lower treatment success rates in PComA aneurysm patients with FPC. We suggest that FPC patients should be treated with an alternative to single PED flow diversion.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"1160-1167"},"PeriodicalIF":4.3,"publicationDate":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142558074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"15 years of WEB embolization: a transformative journey in aneurysm treatment.","authors":"Laurent Pierot, Adam S Arthur, Christophe Cognard, Istvan Szikora, Hongqi Zhang, Jianmin Liu, David Fiorella, Laurent Spelle","doi":"10.1136/jnis-2025-023513","DOIUrl":"10.1136/jnis-2025-023513","url":null,"abstract":"","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"1138-1140"},"PeriodicalIF":4.3,"publicationDate":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144258276","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of pediatric pial arteriovenous fistulas with a single connection: two illustrative cases.","authors":"Matias Luis Costa, Bryce Garrison Dennis, Karen Chen, Peter Kan","doi":"10.1136/jnis-2024-021955","DOIUrl":"10.1136/jnis-2024-021955","url":null,"abstract":"<p><p>Pediatric arteriovenous fistulas (PAVFs) are rare, representing only 7.3-17.2% of all pediatric shunts.1 2 In a number of cases they can lead to life-threatening venous hypertension, hydrocephalus and macrocrania,3 heart failure,1 hemorrhagic stroke,4 5 seizures,3 and cognitive developmental issues.1-3 In selected circumstances, early and aggressive treatment is recommended.We present two cases of single-connection, high-flow PAVFs. Case 1 represents a mid-basilar PAVF treated through a transarterial approach, while case 2 represents a quadrigeminal cistern PAVF treated with several transarterial sessions followed by a final transvenous session. The procedures are shown in video 1 neurintsurg;17/11/1265/V1F1V1Video 1 Clinical cases demonstrating endovascular treatment of pediatric pial arteriovenous fistulas.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"1265"},"PeriodicalIF":4.3,"publicationDate":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141860005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}