Intracranial aneurysms represent a major global health burden. Rupture of an intracranial aneurysm is a catastrophic event. Without access to treatment, the fatality rate is 50% in the first 30 days. Over the last three decades, treatment approaches for intracranial aneurysms have changed dramatically. There have been improvements in the medical management of aneurysmal subarachnoid haemorrhage, and there has been an evolution of treatment strategies. Endovascular therapy is now the mainstay of the treatment of ruptured intracranial aneurysms based on robust randomised controlled trial data. There is now an expansion of treatment indications for unruptured intracranial aneurysms to prevent rupture with both microsurgical clipping and endovascular treatment. Both microsurgical and endovascular treatment modalities have evolved, in particular with the introduction of innovative endovascular treatment options including flow diversion and intra-saccular flow disruption. These novel therapies allow clinicians to treat more complex and previously untreatable aneurysms. We aim to review the evolution of treatment strategies for intracranial aneurysms over time, and discuss emerging technologies that could further improve treatment safety and functional outcomes for patients with an intracranial aneurysm.

(2018). Resting-state fMR evidence of network reorganization induced by navigated transcranial magnetic repetitive stimulation in phantom limb pain. Neurological Research: Vol. 40, No. 4, pp. 241-248.

Background: Blunt cerebrovascular injuries (BCVIs) may occur following trauma and lead to ischemic stroke if untreated. Antithrombotic therapy decreases this risk, however, the optimal agent has yet to be determined in this population. Aim of this study was to compare the risk-benefit profile of antiplatelet (AP) versus anticoagulant (AC) therapy in rates of ischemic stroke and hemorrhagic complications in BCVI patients. Methods: We performed a retrospective review of BCVI patients at our tertiary care Trauma hospital from 2010-2015, and a systematic review and meta-analysis of the literature. The OVID Medline, Embase, Web of Science, and Cochrane Library databases were searched from inception to September 16, 2019. References of included publications were searched manually for other relevant papers. The search was limited to articles in humans, in patients >= 18 years of age, and English. Studies that reported treatment-stratified clinical outcomes following AP or AC treatment in BCVI patients were included. Exclusion criteria included case reports, case series with n<5, review articles, conference abstracts, animal studies, and non-peer reviewed publications. Data was extracted from each study independently by two reviewers, including study design, country of origin, sex and age of patients, injury severity score, Biffl grade, type of treatment, ischemic stroke rate and hemorrhage rate. Pooled estimates using odds-ratio were combined using a random-effects model using a Mantel-Hanzel weighting. The main outcome of interest was ischemic stroke rate due to BCVI and the secondary outcome was hemorrhage rate based on AC or AP treatment. Results: In total, there were 2044 BCVI patients, as reported in the 22 studies in combination with our institutional data. The stroke rate was not significantly different between the two treatment groups (OR 1.27, 95% CI 0.40-3.99); however, the hemorrhage rate was decreased in AP versus AC treated groups (OR 0.38, 95% CI 0.15-1.00). Conclusions: Based on this meta-analysis, both AC and AP seem similarly effective in preventing ischemic stroke, but AP is better tolerated in the trauma population. This suggests that antiplatelet therapy may be preferred, but this should be further assessed with prospective randomized trials. Type of study Review Article Level of evidence II