Search Results (261)

Background: Extracranial arteriovenous malformations (eAVMs) are aggressive vascular anomalies consisting of abnormal blood vessels (BVs) and multiple other cell types, including macrophages. Although inflammation and the presence of immune cells are characteristics of eAVMs, the contribution of macrophage polarization to eAVM pathophysiology is unknown. Methods: In this study, pediatric eAVM tissues and adjacent control tissues were analyzed using immunohistochemistry (IHC) and immunofluorescence (IF) to assess M1 and M2 macrophage localization, loss of endothelial CD31 expression, and expression of the immune-regulatory protein PDL-1. In addition, serum samples from eAVM patients were analyzed using a human inflammation antibody array to profile cytokines and other circulating factors associated with M2 macrophage and immunosuppressive microenvironment. Results: eAVM tissues demonstrate accumulation of M2-polarized macrophages around abnormal CD31^−ve BVs, while M1 macrophages were primarily associated with normal appearing CD31^+ve vessels. eAVM tissues demonstrated increased expression of PD-L1 in regions enriched with M2 macrophages, which were absent in paired control tissues. Serum analysis revealed increased levels of circulating factors associated with M2 macrophages and immune suppression, including PDGF-BB, IL-4, and IL-16. Conclusions: These findings suggest that CD31^−ve vessels in eAVMs are associated with enrichment of M2 macrophages and a microenvironment suggestive of localized immune regulation. These observations are hypothesis-generating and warrant validation in larger patient cohorts and future mechanistic studies. Full article

Background and Objectives: Three-dimensional (3D) coils offer stable initial framing in intracranial aneurysm embolization, but their utility in pulmonary and visceral vascular lesions has not been well established. The objective of this study was to assess the feasibility, safety, and effectiveness of 3D coils used as the primary framing device in pulmonary and visceral embolization. Materials and Methods: This retrospective study included 13 patients with 14 lesions, comprising seven pulmonary arteriovenous malformations (PAVMs), six splenic artery aneurysms (SAAs), and one hepatic artery pseudoaneurysm (HAP), treated between 2024 and 2025. In all lesions, a 0.018-inch 3D coil was deployed as the initial framing coil, followed by further packing with additional 3D or non-3D coils. Technical success, angiographic success, and clinical outcomes were evaluated. Results: Technical success was achieved in all lesions (14/14, 100%; 95% CI, 78.5–100). Angiographic success was achieved in 13 of 14 lesions (92.9%; 95% CI, 68.5–98.7), and clinical success was achieved in 12 of 13 lesions (92.3%; 95% CI, 66.7–98.6). Post-embolization syndrome (PES) developed in five patients with SAAs and in one patient with HAP; all complications were minor and resolved with conservative management. No coil migration or major complications occurred. Conclusions: When used as the initial framing device, 3D coils were technically feasible and achieved acceptable short-term angiographic and clinical outcomes in this small, heterogeneous series; these preliminary findings require confirmation in comparative studies. Full article

Capillary malformation–arteriovenous malformation syndrome is a rare spectrum of vascular anomalies characterized by capillary malformations and high-flow vascular malformations, caused by loss-of-function mutations in the RASA1 and/or EPHB4 genes. These mutations disrupt vascular differentiation and lead to complex malformations involving the brain, skin, and systemic vasculature. Since the first description in 2003, more than 200 cases have been reported, but intracranial arteriovenous shunts during the neonatal period remain extremely rare, as well as reports of the dual mutation RASA1 + EPHB4 or the immunological impact of the EPHB4 mutation. We report three cases of neonates presenting with early-onset high-flow shunts, each exhibiting a distinct genetic signature: CM-AVM1 (RASA1 mutation), CM-AVM2 (EPHB4 mutation), and dual variant (combined EPHB4 and RASA1 mutations). We analyzed and compared the clinical evolution, Doppler ultrasound trends, EEG, MRI and genetic data to highlight the distinct genotype–phenotype spectrum. Early multimodal hemodynamic evaluation of neonates with CM-AVM allows the identification and optimum management of life-threatening shunts at the earliest possible stage. Full article

Background/Objective: Intracranial arteriovenous malformations (AVMs) are high-flow cerebrovascular lesions associated with a significant risk of intracranial hemorrhage, neurological morbidity, and mortality. Current management strategies, including microsurgical resection, endovascular embolization, stereotactic radiosurgery, and conservative observation, remain limited by procedural risk and uncertain long-term outcomes. Beta-blockers, particularly propranolol, have recently attracted interest as potential adjunctive therapies because of their vasoconstrictive, antiangiogenic, and vascular remodeling properties. This review evaluates the mechanistic rationale and current evidence regarding beta-blocker use in intracranial AVMs. Methods: A comprehensive literature review was conducted using PubMed, Scopus, and Google Scholar databases through January 2026 using combinations of the terms “arteriovenous malformation,” “AVM,” “beta-blocker,” “propranolol,” “angiogenesis,” “hemorrhage,” and “cerebral cavernous malformation.” Eligible studies included experimental investigations, translational studies, observational cohorts, case reports, clinical trials, systematic reviews, and meta-analyses evaluating beta-blocker use in intracranial AVMs or related vascular malformations. Studies unrelated to cerebrovascular lesions, duplicate reports, and non-English publications were excluded. Given the heterogeneity and limited volume of available AVM-specific literature, findings were synthesized narratively rather than through formal systematic review methodology. Discussion: Preclinical studies suggest that beta-blockers modulate molecular pathways implicated in AVM pathophysiology, including VEGF, HIF-1α, SDF1α/CXCR4, MMP-9, and Notch-associated signaling. These mechanisms may reduce abnormal angiogenesis, endothelial instability, and pathological vascular remodeling. Clinical evidence, however, remains limited to retrospective studies, perioperative reports, and indirect evidence from cerebral cavernous malformations. Observational studies have reported associations between beta-blocker exposure and certain favorable AVM characteristics, including lower rates of hemorrhagic presentation and less complex angioarchitecture. However, these findings are highly susceptible to confounding, reverse causation, and selection bias and should not be interpreted as evidence of disease modification. Conclusions: Beta-blockers cannot currently be recommended as definitive therapy for intracranial AVMs. Their established role remains perioperative hemodynamic control, while potential disease-modifying effects require validation through prospective studies and randomized clinical trials. Full article

Objective: On 28 February 2026, Israel entered direct large-scale hostilities with Iran under Operation Roaring Lion. The opening phase was characterized by repeated missile alerts, civilian protected-space instructions, and rapid reorganization of hospital activity into protected areas. We observed an apparent increase in strict spontaneous intracerebral hemorrhage admissions during March 2026 within our linked neurology/neurosurgery services dataset. The aim of this preliminary single-center study was to determine whether March 2026 was temporally associated with a higher proportional burden of strict spontaneous intracerebral hemorrhage admissions compared with March cohorts from the preceding decade and whether this pattern was also observed for acute ischemic stroke or non-traumatic subarachnoid hemorrhage. Methods: We performed a retrospective observational cohort study of all unique March admissions captured within a linked neurology/neurosurgery services dataset from 2016 through 2026. Hospitalizations were deduplicated by admission number. March 2026 was treated as the first full March occurring after the onset of direct Israel–Iran hostilities on 28 February 2026. Strict spontaneous ICH was defined using diagnosis-text phenotyping that included intraparenchymal or intracerebral hemorrhage terminology while excluding trauma, subarachnoid hemorrhage, subdural hematoma, aneurysm, arteriovenous malformation, tumor-related hemorrhage, cavernoma, venous sinus thrombosis, dissection, and other clearly secondary etiologies. Comparator phenotypes included acute ischemic stroke and non-traumatic subarachnoid hemorrhage (SAH). Results: Across 3855 unique March admissions, 68 met criteria for strict spontaneous ICH. In March 2026, 9 of 223 admissions (4.0%) were classified as strict spontaneous ICH, compared with 59 of 3632 admissions (1.6%) across March 2016–2025, yielding a rate ratio of 2.48 (95% CI 1.25–4.94; p = 0.015). Patients with strict spontaneous ICH in March 2026 were older (mean age 72.3 vs. 65.8 years), and 7 of 9 cases (77.8%) occurred in patients aged ≥70 years compared with 25 of 59 (42.4%) historically (p = 0.073). Acute ischemic stroke did not increase in March 2026 (7.6% vs. 9.4%; p = 0.475), and non-traumatic SAH showed only a non-significant numerical increase (2.7% vs. 1.4%; p = 0.147). Sensitivity analyses showed a directionally consistent but statistically non-significant increase when March 2026 was compared with March 2025 alone (4.0% vs. 1.2%; rate ratio 3.36, 95% CI 0.92–12.27; p = 0.076) and with a rolling 3-year March baseline from 2023 through 2025 (4.0% vs. 2.1%; rate ratio 1.93, 95% CI 0.88–4.23; p = 0.143). In-hospital mortality among strict spontaneous ICH patients was 1 of 9 (11.1%) in March 2026 versus 4 of 59 (6.8%) in March 2016–2025. Conclusions: In this preliminary single-center neurology/neurosurgery services cohort, March 2026 showed a higher proportional burden of strict spontaneous intracerebral hemorrhage admissions than March cohorts from the preceding decade, while acute ischemic stroke did not increase. Sensitivity analyses using March 2025 alone and a rolling 3-year March baseline were directionally consistent but did not reach statistical significance. These findings should therefore be interpreted as a hypothesis-generating temporal association rather than evidence of causality or population-level incidence. Wartime-related psychological stress, sleep disruption, altered healthcare access, blood pressure dysregulation, and medication nonadherence are biologically plausible contributors, but individual-level blood pressure, medication exposure, body mass index, time-to-admission, direct stress exposure, and detailed outcome data were not available in the present dataset. Multicenter, hospital-wide, and registry-based validation with seasonal and systems-level sensitivity analyses is required. Full article

Background/Objectives: Endovascular treatment of cerebral arteriovenous malformations (AVMs) and arteriovenous fistulas (AVFs) is associated with substantial radiation exposure due to procedural complexity and repeated angiographic acquisitions. This study evaluates radiation exposure during AVM and AVF embolization and establishes local diagnostic reference levels (DRLs). Methods: A single-center retrospective dose audit was conducted, encompassing 114 endovascular procedures performed using a low-dose workflow. Radiation exposure was quantified using dose area product (DAP), reference air kerma (K_a,r), fluoroscopy time (FT), and the number of digital subtraction angiography (DSA) frames per procedure. Median values were defined as the median (P50), and local DRLs as the 75th percentile (P75). Comparative analyses were conducted between AVM and AVF procedures, between male and female patients, and within selected AVM subgroups. Results: The analysis comprised 86 AVM procedures and 28 AVF procedures. For AVMs, the local DRLs (P75) were 28.9 Gy·cm² for DAP, 400 mGy for K_a,r, 310 DSA frames per procedure, and 1619 s for FT. For AVFs, the respective values were 47.3 Gy·cm², 465 mGy, 478 DSA frames, and 1820 s. No statistically significant differences were identified between female and male patients. However, AVF procedures demonstrated significantly higher radiation exposure than AVM procedures for all parameters except FT. Within the AVM subgroup, no significant differences were observed between single-stage and other AVM procedures or between female and male patients. Conclusions: AVM and AVF embolization procedures are dose-intensive neuroendovascular interventions. Establishing local DRLs for AVM and AVF may enhance radiation monitoring and facilitate procedure-specific dose optimization. Full article

Background: Anterior cranial fossa dural arteriovenous fistulas (ACF DAVFs) usually receive ethmoidal dural supply. Pial arterial supply has been described in intracranial DAVFs, including ACF DAVFs, but a dominant orbitofrontal pial feeder can create diagnostic overlap with mixed pial-dural arteriovenous malformation and make endovascular treatment hazardous. Case Presentation: A 75-year-old man with atrial fibrillation presented with right middle cerebral artery occlusion and underwent intravenous thrombolysis followed by mechanical thrombectomy. During right internal carotid angiography, transient arterial-phase opacification of a contralateral frontal draining vein through the anterior communicating artery prompted post-recanalization angiography. A high-grade left ACF DAVF was diagnosed, with dominant supply from the left orbitofrontal artery, minor anterior ethmoidal supply, two venous drainage routes, cortical venous reflux, and a varix. Although the DAVF was incidental to the ischemic presentation, it was considered to require treatment because of high-risk angioarchitecture, including Borden type III/Cognard type IV drainage, cortical venous reflux, and venous ectasia. No intraparenchymal nidus or normal venous-phase use of the refluxing veins was identified. Because pial transarterial access and complete transvenous closure were considered unsafe or uncertain, microsurgical draining-vein disconnection was performed. Postoperative angiography confirmed complete obliteration. Conclusions: In this case, microsurgical disconnection achieved angiographic cure, and the patient was transferred for rehabilitation with a modified Rankin Scale score of 1. The central diagnostic and therapeutic issue in pial-feeder-dominant ACF DAVF is not rarity alone, but angiographic differentiation from mixed pial-dural arteriovenous malformation and assessment of whether the shunt can be closed without compromising normal pial arteries or venous outflow. The thrombectomy angiogram provided the route to diagnosis, whereas pial arterial dominance and divided venous drainage determined the curative strategy. Full article

Extremity vascular malformations in children and adolescents are congenital vascular developmental abnormalities that often present to pediatric orthopedic surgeons with pain, swelling, restricted motion, contracture, gait disturbance, limb asymmetry, and growth-related deformity rather than with an obvious vascular phenotype. The orthopedic importance of these lesions lies less in surface appearance than in their potential to affect muscle balance, joint integrity, osseous development, and peri-procedural safety. This review translates contemporary vascular anomaly classification and multidisciplinary management pathways into a practical orthopedic framework for diagnosis, referral, and longitudinal limb management. The most useful first step is to distinguish low-flow from high-flow lesions and then define lesion depth, periarticular or osseous involvement, coagulopathy risk, and syndromic overgrowth phenotype. Ultrasound is usually the first-line imaging modality for flow characterization, whereas magnetic resonance imaging is the cornerstone for defining extent and planning treatment. Plain radiographs remain highly relevant for identifying phleboliths, osseous remodeling, arthropathy, contracture-related deformity, and limb-length discrepancy. Venous malformations generally warrant pathway-based coagulation assessment, especially D-dimer and fibrinogen, because localized intravascular coagulopathy has direct implications for intervention and surgery. Arteriovenous malformations are best managed within specialist multidisciplinary teams. Fibro-adipose vascular anomaly and syndromic overgrowth phenotypes warrant particular attention because they frequently drive pain, contracture, and progressive limb imbalance. Outcome assessment in this field should extend beyond lesion size and incorporate pain, function, quality of life, and growth-related consequences. For pediatric orthopedic surgeons, management should move from late deformity correction toward early classification, early referral, longitudinal surveillance of joint and growth-related complications, and careful integration of local, surgical, and systemic therapies. Full article

Background: Cerebral arteriovenous malformations (AVMs) are high-flow shunts in which abnormal arteriovenous connections expose draining veins to venous hypertension, arterialization, and altered oxygenation. While digital subtraction angiography (DSA) remains the reference standard for dynamic angioarchitecture, it does not directly characterize venous oxygenation or microhemorrhagic tissue changes. Objective: To synthesize current evidence on susceptibility-based MRI-susceptibility-weighted imaging (SWI) and quantitative susceptibility mapping (QSM) for characterization, risk-related features, and treatment monitoring in cerebral AVMs. Methods: Narrative review of the foundational and contemporary literature on AVM pathophysiology, SWI and QSM technical principles, and clinical applications including venous drainage depiction, microhemorrhage detection, oxygenation-related biomarkers, and post-treatment surveillance. Results: SWI provides high-resolution, non-contrast depiction of venous drainage and perinidal hemorrhagic/calcific components, improving visualization of draining veins and microhemorrhages compared with conventional MRI and complementing TOF-MRA. Arterialized draining veins may show altered SWI signal consistent with elevated venous oxygen saturation, though interpretation is indirect and influenced by flow and orientation. QSM extends susceptibility imaging by quantifying tissue susceptibility and enabling indirect estimation of venous oxygenation (SvO₂), offering a potential physiological biomarker of shunt severity and treatment response after radiosurgery or embolization. Key limitations include lack of dynamic flow timing, flow-related artifacts, orientation dependence, confounding from hemorrhage/calcification, and limited standardization and prospective validation. Conclusions: Susceptibility-based MRI does not replace DSA but meaningfully enriches multimodal AVM assessment by adding structural and physiological information-particularly venous mapping, microhemorrhage detection, and oxygenation-sensitive biomarkers. Standardized acquisition/reconstruction and prospective studies are needed to validate susceptibility-derived metrics for risk stratification and longitudinal monitoring. Full article

Background and Clinical Significance: Vascular lesions of the face, particularly arteriovenous malformations (AVM) and mixed hemangiomas (MH), pose significant diagnostic and therapeutic challenges because of their complex anatomy, unpredictable behavior, and high risk of bleeding. Surgical planning should be individualized and often requires a staged approach with meticulous interdisciplinary coordination to ensure patient safety. The presence of a concomitant odontogenic infection further complicates management, as local inflammation may exacerbate vascular instability and increase the risk of life-threatening complications. Local inflammation and infection might cause some life-threatening conditions, especially when an abscess occurs in the area of any vascular lesion. Ensuring that the oral cavity is free from potential odontogenic infections is a particularly important issue in many complex cases, especially in patients treated for oral, head, and neck cancer or in those with other coexisting morbidities affecting the oral and facial regions. Case Presentation: A 72-year-old man was referred for management of a severe odontogenic infection associated with an extensive facial vascular lesion. The patient’s medical history was significant for arterial hypertension and chronic liver dysfunction (CLD) of unclear etiology. Complete blood testing, including coagulation assessment and liver ultrasonography, was performed, with no contraindication to surgery identified. The scope of odontogenic-related infections was scheduled for simultaneous removal during initial surgery. Preparation for surgery included the local application of sclerotherapy agents. Conclusions: Quite often, a routine panoramic radiograph can help in assessing the status of bone and dentition to undertake all necessary treatment. Severe odontogenic disease, including multiple retained roots, periapical infections, and odontogenic cystic lesions in the context of poor oral hygiene, may lead to the occurrence of possible inflammation. In case of any vascular lesion, a careful diagnostic and therapeutic strategy is needed. This case report highlights that maintaining an infection-free oral environment is a critical component of care in patients with complex facial MH and should be regarded as an essential element of overall treatment planning. Full article

Background: Vascular malformations are congenital structural abnormalities of the blood vessels that may present at any age. In the vulvovaginal region, these lesions are uncommon and frequently misdiagnosed because their clinical appearance overlaps with common gynecologic conditions, particularly Bartholin’s gland cyst or abscess. Inappropriate surgical intervention without prior vascular evaluation may result in hemorrhage, incomplete treatment, and recurrence. Methods: A structured narrative review of the literature was performed using PubMed/MEDLINE and EMBASE databases (January 2000–April 2024) to summarize the classification, pathophysiology, clinical presentation, imaging characteristics, differential diagnosis, and management of vulvovaginal vascular malformations. Publications addressing vascular anomalies in other anatomical locations were also included when clinically relevant. A representative clinical case confirmed by histopathologic and molecular analysis is presented to illustrate the diagnostic pitfalls. Results: Vulvovaginal vascular malformations are predominantly low-flow venous lesions but may include high-flow arteriovenous malformations. A clinical examination alone is insufficient for diagnosis. Doppler ultrasonography is the recommended initial imaging modality, followed by magnetic resonance imaging to define the lesion extent and flow characteristics. Misdiagnosis most commonly occurs when lesions are treated as Bartholin’s gland pathology without prior imaging. Low-flow lesions are generally managed with sclerotherapy or planned surgical excision, whereas high-flow lesions require embolization and multidisciplinary care. Hormonal and hemodynamic changes, including pregnancy, may precipitate enlargement or thrombosis. Conclusions: Vascular malformations should be considered in the differential diagnosis of atypical vulvar masses. Preoperative imaging is essential in order to avoid inappropriate surgical procedures. A structured diagnostic approach combining clinical assessment and imaging enables correct classification and guides treatment. The presented case demonstrates a typical diagnostic pitfall and emphasizes the importance of recognizing vascular lesions in gynecologic practice. Full article

Patients with atrial fibrillation (AF) who are not candidates for long-term anticoagulation present a complex therapeutic dilemma due to competing risks of cardioembolic stroke and intracerebral hemorrhage (ICH). This challenge is particularly pronounced in neurologically vulnerable individuals, including those with prior ICH, cerebral amyloid angiopathy (CAA), or neuroimaging markers of cerebral small vessel disease (SVD). Left atrial appendage occlusion (LAAO) has emerged as an alternative stroke prevention strategy for patients with contraindications to anticoagulation; however, optimal patient selection and post-procedural antithrombotic management remain uncertain, largely because existing bleeding risk scores inadequately capture ICH risk. Most hemorrhagic risk scores were designed to estimate systemic bleeding and demonstrate limited ability to predict ICH, as they do not incorporate hemorrhage etiology or neuroimaging features. Importantly, ICH recurrence risk varies substantially by subtype, with the highest risk observed in CAA-related hemorrhage, the lowest in hypertensive SVD, and intermediate risk in mixed or secondary etiologies. These distinctions have direct implications for anticoagulation decisions and consideration of LAAO. Finally, we synthesize contemporary evidence on ICH risk stratification, neuroimaging biomarkers, and antithrombotic strategies following LAAO. We propose a multidisciplinary, evidence-based decision-making framework integrating clinical risk scores, neuroimaging findings, and hemorrhage phenotype to support individualized stroke prevention strategies in high-risk patients with AF. Full article

Background: Gamma Knife radiosurgery (GKS) delivers highly conformal intracranial irradiation, yet clinical decision-making still relies predominantly on physical dose metrics that do not account for fractionation, dose rate, treatment time, or DNA repair. Classical radiobiological models—including the linear–quadratic (LQ) formula and the Jones–Hopewell single-session repair model—do not extend naturally to 3- and 5-fraction GKS. Meanwhile, growing evidence suggests that biologically effective dose (BED) may better capture radiosurgical response in selected pathologies. A unified, biologically grounded, multi-fraction GKS framework has been lacking. Methods: We developed AI-BED-Fx, the first multi-fraction extension of the Jones–Hopewell radiobiological model capable of computing fraction-resolved BED for 1-, 3-, and 5-fraction GKS. The framework incorporates α/β ratio, dual-component repair kinetics, isocentre geometry, beam-on–time structure, and lesion-specific biological parameters. Four synthetic pathology-specific cohorts—arteriovenous malformation (AVM), meningioma (MEN), vestibular schwannoma (VS), and brain metastasis (BM)—were generated using distinct radiobiological signatures. Machine-learning models were trained to quantify the predictive value of physical dose versus BED for local control or obliteration. Additional experiments included Bayesian estimation of α/β and a neural-network surrogate for fast BED prediction. An exploratory comparison with a 60-lesion clinical brain–metastasis dataset was performed to assess whether key trends observed in the synthetic BM cohort were consistent with real radiosurgical outcomes. Results: AI-BED-Fx produced realistic pathology-specific BED distributions (AVM 60–210 Gy_2.47; MEN 41–85 Gy_3.5; VS 46–68 Gy₃; BM 37–75 Gy₁₀) and biologically coherent dose–response relationships. Predictive modeling demonstrated strong pathology dependence. In AVM, the three models achieved AUCs of 0.921 (Model A), 0.922 (Model B), and 0.924 (Model C), with corresponding Brier scores of 0.054, 0.051, and 0.051, with BED-based models performing best. In meningioma, BED was the dominant predictor, with AUCs of 0.642 (Model A), 0.660 (Model B), and 0.661 (Model C) and Brier scores of 0.181, 0.177, and 0.179, respectively. In vestibular schwannoma, the narrow BED range resulted in minimal BED contribution, with AUCs of 0.812, 0.827, and 0.830 and Brier scores of 0.165, 0.160, and 0.162, with physical dose and tumor volume determining performance. In brain metastases, outcomes were driven primarily by volume and physical dose, with AUCs of 0.614, 0.630, and 0.629 and Brier scores of 0.254, 0.250, and 0.253, showing negligible improvement from BED. AI-BED-Fx also accurately recovered the true α/β from synthetic outcomes (posterior mean 2.54 vs. true 2.47), and a neural-network surrogate reproduced full radiobiological BED calculations with near-perfect fidelity (R² = 0.9991). Conclusions: AI-BED-Fx provides the first unified, biologically explicit framework for modeling single- and multi-fraction Gamma Knife radiosurgery. The findings show that the predictive usefulness of BED is pathology-specific rather than universal, and that radiobiological dose provides additional predictive value only when repair kinetics and dose–response biology support it. By integrating mechanistic radiobiology with machine learning, AI-BED-Fx establishes the conceptual and computational foundations for biologically adaptive, AI-guided radiosurgery, and cross-pathology comparison of treatment response. This work uses large radiobiologically grounded synthetic cohorts for methodological validation; limited real-patient data are included only for exploratory consistency checks, and full clinical validation is planned. Full article

Cerebral aneurysms and arteriovenous malformations are life-threatening hemodynamic pathologies of the brain. While surgical intervention is often essential to prevent fatal outcomes, it carries significant risks both during the procedure and in the postoperative period, making the management of these conditions highly challenging. Parameters of cerebral blood flow, routinely monitored during medical interventions or with modern noninvasive high-resolution imaging methods, could potentially be utilized in machine-learning-assisted protocols for risk assessment and therapeutic prognosis. To this end, we developed a linear oscillatory model of blood velocity and pressure for clinical data acquired from neurosurgical operations. Using the method of Sparse Identification of Nonlinear Dynamics (SINDy), the parameters of our model can be reconstructed online within milliseconds from a short time series of the hemodynamic variables. The identified parameter values enable automated classification of the blood-flow pathologies by means of logistic regression, achieving a balanced accuracy of 74%. Our results demonstrate the potential of this model for both diagnostic and prognostic applications, providing a robust and interpretable framework for assessing cerebral blood vessel conditions. Full article

Background/Objectives: The use of near-infrared fluorescence (NIRF) imaging with indocyanine green (ICG) has gained increasing attention in the management of vascular malformations, offering real-time visualization of vascular and lymphatic structures that may improve surgical precision and outcomes. Methods: A systematic review was conducted in accordance with PRISMA guidelines, searching PubMed, Web of Science, CINAHL, and EMBASE databases for studies evaluating the intraoperative use of ICG in vascular malformations, which was prospectively registered in PROSPERO (CRD420251131951). Two independent reviewers screened all records based on predefined eligibility criteria. Extracted data included study design, patient characteristics, ICG administration protocols, clinical applications, and perioperative outcomes. Results: A total of 33 studies comprising 433 patients treated between 2014 and 2025 were included for qualitative synthesis. Nineteen (57.6%) were case reports, seven (21.2%) retrospective descriptive studies, two (6.1%) retrospective comparative studies, three (9.1%) prospective comparative trials, and two (6.1%) prospective descriptive studies. Clinical indications for ICG included capillary and venous malformations (5 studies), arteriovenous malformations (9 studies), and lymphatic malformations (19 studies). Quality assessment with the MINORS tool showed that most studies scored < 17, while only seven reached 18–24, reflecting higher methodological quality. Conclusions: Intraoperative ICG fluorescence imaging represents a promising adjunct in the treatment of vascular malformations, providing real-time visualization that may facilitate lesion delineation, guide resection, and support minimally invasive techniques such as lymphaticovenous anastomosis. However, current evidence is largely descriptive, with very limited comparative outcome data, and high-quality studies are needed to determine whether these technical advantages translate into improved long-term clinical outcomes. Full article