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Personalized Diagnosis and Treatment for Intracranial Aneurysm
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Personalized Diagnosis and Treatment for Intracranial Aneurysm

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Clinical Neurology".

Deadline for manuscript submissions: closed (30 June 2025) | Viewed by 1763

Special Issue Editors

Dr. Nina Zobenica Moore

E-Mail Website
Guest Editor
Cerebrovascular Center, Cleveland Clinic Foundation, Cleveland, OH, USA
Interests: cerebral aneurysms; arteriovenous malformations; computational fluid structure interaction modeling; subarachnoid hemorrhage
Dr. Mark D. Bain

E-Mail Website
Guest Editor
Cerebrovascular Center, Cleveland Clinic Foundation, Cleveland, Ohio, USA
Interests: neurological surgery; aneurysms; intracranial aneurysms; intracranial hemorrhage

Special Issue Information

Dear Colleagues,

This special issue will explore new strategies to predict intracranial aneurysms rupture risk and treatment optimization. Current practice decisions still depend on generalized natural history data which may not match the patient’s aneurysm and vessel anatomy.  Clinicians often are required to make a best estimate of how their patient’s aneurysm will behave. New devices for aneurysm treatment add an additional level of complexity in deciding which treatment strategy to apply. Recent advancements have started to explore the ability to generate personalized medical plans for patient’s aneurysms.  Articles of particular interest will focus on ways to personalize the diagnosis and treatment of intracranial.

Dr. Nina Zobenica Moore
Dr. Mark D. Bain
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • cerebral aneurysms
  • personalized medicine
  • predictive modeling
  • simulation imaging
  • subarachnoid hemorrhage
  • Intracranial Aneurysm

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Further information on MDPI's Special Issue policies can be found here.

Published Papers (3 papers)

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Research

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15 pages, 2116 KiB  
Article
Comparative Analysis of Single-Stage vs. Multiple-Stage Interventions in the Management of Subarachnoid Hemorrhage in Patients with Multiple Intracranial Aneurysms
by Oday Atallah, Khadeja Alrefaie and Amr Badary
J. Clin. Med. 2025, 14(13), 4705; https://doi.org/10.3390/jcm14134705 - 3 Jul 2025
Viewed by 231
Abstract
Background/Objectives: Subarachnoid hemorrhage (SAH) due to ruptured intracranial aneurysms remains a critical neurosurgical emergency with high morbidity and mortality. The presence of multiple intracranial aneurysms (MIAs) in SAH patients presents a therapeutic challenge, particularly in choosing between single-stage and multiple-stage interventions. In patients [...] Read more.
Background/Objectives: Subarachnoid hemorrhage (SAH) due to ruptured intracranial aneurysms remains a critical neurosurgical emergency with high morbidity and mortality. The presence of multiple intracranial aneurysms (MIAs) in SAH patients presents a therapeutic challenge, particularly in choosing between single-stage and multiple-stage interventions. In patients with aneurysmal SAH and multiple intracranial aneurysms, we compared single-stage vs. multiple-stage interventions regarding vasospasm occurrence, complication rates, and short-term neurological outcomes in a retrospective cohort. Methods: This retrospective cohort study included 44 patients diagnosed with aneurysmal SAH and at least one additional unruptured aneurysm. Patients were categorized based on the intervention strategy. A “single-stage” intervention was defined as treatment of both the ruptured and all unruptured aneurysms in the same operative session. A “multiple-stage” intervention referred to a planned approach in which additional aneurysms were treated in separate, subsequent procedures. Clinical severity was assessed using scores. Aneurysm characteristics and treatment modalities were recorded. Outcomes were analyzed and compared between intervention groups. Statistical analysis was performed, with p < 0.05 considered significant. Results: The cohort included 44 patients with a total of 109 aneurysms. Most patients were female (68.2%), with a mean age of 54.5 years. The majority of aneurysms were small- to medium-sized and commonly located in the anterior circulation. Among the patients, 19.0% underwent single-stage interventions, and 28.6% underwent multiple-stage procedures. Vasospasm occurred significantly more often in the single-stage group (83.9% vs. 46.2%, p = 0.028). No significant difference was found in hospital stay duration between groups. The MRS scores showed a trend toward worse outcomes in the single-stage group (p = 0.060), as did the rates of post-operative neurological deficits (p = 0.079). Conclusions: In patients with SAH and MIAs, single-stage interventions may increase vasospasm risk. Although they offer logistical benefits, outcomes should be interpreted with caution given baseline differences and limited statistical adjustment. Full article
(This article belongs to the Special Issue Personalized Diagnosis and Treatment for Intracranial Aneurysm)
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12 pages, 1930 KiB  
Article
Histological Analysis of Intracranial Cerebral Arteries for Elastin Thickness, Wall Thickness, and Vessel Diameters: An Atlas for Computational Modeling and a Proposed Predictive Multivariable Model of Elastin Thickness
by Nishanth Thiyagarajah, Alex Witek, Mark Davison, Robert Butler, Ahmet Erdemir, John Tsiang, Mohammed Shazam Hussain, Richard Prayson, Mark Bain and Nina Z. Moore
J. Clin. Med. 2025, 14(12), 4320; https://doi.org/10.3390/jcm14124320 - 17 Jun 2025
Viewed by 329
Abstract
Background/Objectives: Fluid dynamic models of the cerebral vasculature are being developed to evaluate intracranial vascular pathology. Fluid–structure interaction modeling provides an opportunity for more accurate simulation of vascular pathology by modelling the vessel wall itself in conjunction with the fluid forces. Accuracy of [...] Read more.
Background/Objectives: Fluid dynamic models of the cerebral vasculature are being developed to evaluate intracranial vascular pathology. Fluid–structure interaction modeling provides an opportunity for more accurate simulation of vascular pathology by modelling the vessel wall itself in conjunction with the fluid forces. Accuracy of these models is heavily dependent on the parameters used. Of those studied, elastin has been considered a key component used in aortic and common carotid artery modeling. We studied elastin thickness to determine if there was significant variation between cerebral artery territories to suggest its importance in cerebral blood vessel biomechanical response and provide reference data for modeling intracranial elastin. Elastin thickness was compared to vessel location, thickness, diameter, and laterality within human intracranial arteries. Methods: Tissue was taken from five human cadaveric heads preserved in formaldehyde from each intracranial vessel distribution bilaterally and stained with Van Gieson stain for elastin. A total of 160 normal cerebral vascular artery specimens were obtained from 17 different cerebrovascular regions. Two reviewers measured elastin thickness for each sample at five different locations per sample using Aperio ImageScope (Leica Biosystems, Deer Park, IL, USA). Statistical analysis of the samples was performed using mixed-models repeated measures regression methods. Results: There was a significant difference between anterior circulation (6.01 µm) and posterior circulation (4.4 µm) vessel elastin thickness (p-value < 0.05). Additionally, two predictive models of elastin thickness were presented, utilizing a combination of anterior versus posterior circulation, vessel diameter, and vessel wall thickness, which demonstrated significance for prediction with anterior versus posterior combined with vessel diameter and wall thickness. Conclusions: Elastin thicknesses are significantly different between anterior and posterior circulation vessels, which may explain the differences seen in aneurysm rupture risk for anterior versus posterior circulation aneurysms. Additionally, we propose two potential models for predicting elastin thickness based on vessel location, vessel diameter, and vessel wall thickness, all of which can be obtained using preoperative imaging techniques. These findings suggest that elastin plays an important role in cerebral vascular wall integrity, and this data will further enable fluid–structure interaction modeling parameters to be more precise in an effort to provide predictive modeling for cerebrovascular pathology. Full article
(This article belongs to the Special Issue Personalized Diagnosis and Treatment for Intracranial Aneurysm)
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Review

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14 pages, 1102 KiB  
Review
Beyond Size: Advanced MRI Breakthroughs in Predicting Intracranial Aneurysm Rupture Risk
by Jose E. Leon-Rojas
J. Clin. Med. 2025, 14(9), 3158; https://doi.org/10.3390/jcm14093158 - 2 May 2025
Viewed by 622
Abstract
Intracranial aneurysms (IAs) are present in approximately 3–5% of the global population and carry a significant risk of rupture, leading to subarachnoid haemorrhage (SAH), a condition associated with high morbidity and mortality. Even with developments in neuroimaging, fundamental clinical difficulty remains in precisely [...] Read more.
Intracranial aneurysms (IAs) are present in approximately 3–5% of the global population and carry a significant risk of rupture, leading to subarachnoid haemorrhage (SAH), a condition associated with high morbidity and mortality. Even with developments in neuroimaging, fundamental clinical difficulty remains in precisely predicting which aneurysms will rupture. Although aneurysm size, location, and patient history define traditional risk assessment, these elements by themselves have insufficient predictive ability. Key elements in rupture risk are aneurysm wall biology, haemodynamics, and inflammation; recent developments in magnetic resonance imaging (MRI) including high-resolution vascular wall imaging (VWI), 4D flow MRI, and quantitative susceptibility mapping (QSM) provide fresh insights on these aspects. The present evidence on these sophisticated MRI techniques is synthesised in this review of the literature, which also analyses their clinical relevance and addresses newly developed computational methods like machine learning for better risk stratification. I underline important studies showing the diagnostic and prognostic worth of MRI-based biomarkers, discuss present constraints, and suggest future lines of research. Personalised aneurysm care could benefit from the combination of multiparametric MRI data with artificial intelligence (AI), hence improving patient outcomes. Full article
(This article belongs to the Special Issue Personalized Diagnosis and Treatment for Intracranial Aneurysm)
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