Emerging Biomarkers and Therapeutic Approaches in Neurovascular Diseases

A special issue of Biomedicines (ISSN 2227-9059). This special issue belongs to the section "Neurobiology and Clinical Neuroscience".

Deadline for manuscript submissions: closed (31 March 2025) | Viewed by 569

Special Issue Editors


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Guest Editor
Department of Neurosurgery and Neurooncology, Medical University of Lodz, Barlicki University Hospital, Lodz, Poland
Interests: intracranial aneurysm; giant aneurysm; intracranial bypass; aneurysmal subarachnoid haemorrhage; delayed cerebral ischemia; computational fluid dynamics; neurovascular compression syndromes; biomarkers

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Guest Editor
Department of Neurosurgery and Neurooncology, Medical University of Lodz, Barlicki University Hospital, Lodz, Poland
Interests: neurosurgery; neuro-oncology; brain tumors; genetic predispostition to cancer
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Special Issue Information

Dear Colleagues,

Neurovascular disease encompasses a wide range of conditions, including stroke (both ischaemic and haemorrhagic), intracerebral haemorrhages, intracranial aneurysms, arteriovenous malformations, cavernous malformations and dural arteriovenous fistulae (DAVFs, e.g., those formed in the course of venous sinus thrombosis). These conditions can lead to potentially life-threatening bleeding and neurological complications.

Despite our growing knowledge base; the advances in treatment modalities, whether conservative, endovascular or surgical; and the increasing availability of state-of-the-art equipment in vascular laboratories and operating theatres, much remains to be clarified. For example, which intracranial aneurysms are most prone to rupture, and when, and what are the optimal treatment approaches? Should these aneurysms be treated surgically or endovascularly, and in which settings? Of those that do rupture, which patients will develop cerebral vasospasm and which will suffer delayed cerebral ischaemia (DCI)? Furthermore, which clinical, radiological, serum/plasma or CSF biomarkers can be used for the early detection of these complications, and how can this information be utilized for effective prevention?

Consider an intracerebral haemorrhage: when should it be managed conservatively and when is surgical intervention required? Should its treatment involve a decompressive craniectomy, the surgical evacuation of the bleed, or modern minimally invasive techniques such as the Artemis system? Are there biomarkers that can guide the selection of these different treatment strategies for patients, and which of these can help predict patient outcomes?

The exact pathogenesis of DAVFs remains elusive. What is the risk of bleeding from these fistulas, and what is the most effective treatment approach? Furthermore, how should patients be monitored after treatment to ensure long-term vigilance and detect potential recurrences or complications?

Many issues surrounding neurovascular disease have not been addressed here. In fact, there are numerous smaller entities and conditions that could not be included in this summary of the research topic. Even for the above questions, the answers remain incomplete, highlighting how much work remains to be done in this field. With this in mind, we encourage active participation in the development of a series of studies under the umbrella title “Emerging Biomarkers and Therapeutic Approaches in Neurovascular Diseases”. We invite the submission of original research articles and reviews that address these important questions.

Dr. Karol Wiśniewski
Dr. Bartosz Szmyd
Guest Editors

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Keywords

  • intracranial aneurysm
  • giant aneurysm
  • intracranial bypass
  • aneurysmal subarachnoid haemorrhage
  • delayed cerebral ischemia
  • computational fluid dynamics
  • neurovascular compression syndromes
  • biomarkers

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Published Papers (1 paper)

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Research

12 pages, 1069 KiB  
Article
Perimesencephalic Subarachnoid Hemorrhage Is Not Always a Benign Condition: Hemorrhage Volume as a Predictor for Complications and Clinical Outcome
by Emily Hoffmann, Công Duy Bùi, Alexandra Valls Chavarria, Michael Müther, Markus Holling, Manfred Musigmann, Max Masthoff, Mostafa Ergawy, Tobias D. Faizy, Christian Paul Stracke, Hermann Krähling and Burak Han Akkurt
Biomedicines 2025, 13(5), 1061; https://doi.org/10.3390/biomedicines13051061 - 27 Apr 2025
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Abstract
Objective: The benign nature of perimesencephalic subarachnoid hemorrhage (pmSAH) can be challenged by the occurrence of complications. Given the limited prognostic value of established clinical parameters for the development of complications in patients with pmSAH, this study evaluates the potential of volumetric hemorrhage [...] Read more.
Objective: The benign nature of perimesencephalic subarachnoid hemorrhage (pmSAH) can be challenged by the occurrence of complications. Given the limited prognostic value of established clinical parameters for the development of complications in patients with pmSAH, this study evaluates the potential of volumetric hemorrhage quantification for risk assessment and the evaluation of the clinical outcome. Material and Methods: In this retrospective single-center study, we analyzed all consecutive patients diagnosed with pmSAH between 2010 and 2023 at a tertiary care academic medical center in Germany. The volumetric quantification of the hemorrhage in cm3 was performed using non-contrast CT imaging. The occurrence of clinical complications, including hydrocephalus, vasospasm, and delayed cerebral ischemia (DCI), were assessed. Clinical outcomes were determined by the Glasgow Outcome Scale (GOS) at discharge. Multivariable logistic regression models were used to assess the correlation between quantified hemorrhage volumes and the occurrence of complications and clinical outcomes (GOS) controlled for other variables such as age, sex, cardiovascular risk factors, clinical symptoms, and the modified Fisher scale. Results: A total of 82 patients (58.5% male, 54.8 ± 12.1 years) were enrolled. The median World Federation of Neurosurgical Societies (WFNS) score for all patients at admission was 1.0 (IQR 1.0–1.0). During the clinical course, hydrocephalus occurred in 29%, vasospasm in 14.6%, and DCI in 8.5% of all patients. Hemorrhage volume quantification was found to be the strongest independent predictor for hydrocephalus (OR 1.28; 95% CI 1.02–1.61; p = 0.032) and vasospasm (OR 1.25; 95% CI 1.07–1.46; p = 0.007) and showed a high predictive accuracy in ROC analyses (AUC = 0.77 and 0.76, respectively). Conversely, neither clinical parameters nor the modified Fisher scale were associated with these complications. A higher hemorrhage volume was also significantly correlated with a worse functional outcome (GOS; β = –0.07, CI: −0.12–−0.02, p = 0.021). Conclusions: In patients with pmSAH, the volumetric quantification of hemorrhage may be an adequate prognostic parameter regarding the occurrence of hydrocephalus and vasospasm. In addition, the quantitative assessment of hemorrhage volumes was strongly associated with clinical outcomes in these patients. Despite the generally benign nature of pmSAH, this imaging biomarker could improve individualized clinical management strategies and inform about the risk for the occurrence of complications. Full article
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