Background: Rupture of intracranial aneurysms (RIA) leads to subarachnoid hemorrhage (SAH) with severe consequences. Although risks for RIA are established, the results vary between ethnic groups and were never studied in Kazakhstan. This study aimed to establish the risk factors of RIA in the Kazakh population. Methods: Retrospective analysis of 762 patients with single IAs, who attended the neurosurgical center from 2008 until 2018, was conducted. Demographic characteristics, such as age, sex, smoking status, and hypertension were considered. Descriptive and bivariate analyses were performed. A multivariable logistic regression model was built to identify factors correlated with RIA. Results: The mean age of participants was 48.49 ± 0.44 years old. The majority (68.37%) of IAs have ruptured. Of the ruptured aneurysms, 43.76% were < 6 mm, and 38.39% were located on the anterior cerebral and anterior communicating arteries (ACA). Logistic regression model indicates younger age group (16–40 years), smoking, having stage 3 hypertension, smaller IA size and its location on ACA increase the odds of rupture. Conclusions: This study has revealed that younger, smoking patients with stage 3 arterial hypertension are at higher risk for RIA. Small aneurysms (< 6 mm) and location on ACA had increased odds of rupture, while larger aneurysms on internal carotid arteries had lower odds.

Background: Deep brain stimulation (DBS) is an effective treatment for movement disorders, but its long-term efficacy may be undermined by hardware complications such as lead fractures. These complications increase healthcare costs and necessitate surgical revisions. The frequency, timing, and clinical factors associated with lead fractures remain poorly understood. Objective: This study aimed to determine the incidence, timing, and clinical factors associated with lead fractures in a large cohort of DBS patients over a 10-year period. Methods: This retrospective study analyzed data from 325 patients who underwent bilateral DBS implantation at the National Centre for Neurosurgery from 2013 to 2023. The analysis specifically focused on 17 patients who experienced lead fractures during the long-term follow-up period. Results: Among the 325 patients, lead fractures were identified in 17 patients (5.23%), affecting 18 electrodes. The majority of cases involved patients with Parkinson’s disease (76.5%) or dystonia (23.5%), with an average age of 59.17 ± 8.77 years. Nearly all patients with lead fractures had a history of trauma. Additionally, two cases were associated with active engagement in sports, particularly activities involving movements like pulling up on a horizontal bar, while Twiddler’s Syndrome was identified in two other cases. All electrode fractures required surgical revision. Conclusions: Lead fractures, while rare, remain a significant complication in DBS systems. Precise surgical techniques, early detection, and advancements in DBS hardware design may help to mitigate this risk. Future innovations, such as durable leads or wireless systems, may improve long-term outcomes in DBS therapy for movement disorders.

Safety and efficacy of flow diverter stents in the treatment of bifurcation cerebral aneurysms: single-center experience - Diagnostic and Interventional Radiology

Background: Moyamoya disease (MMD) is a progressive cerebrovascular disorder and an important cause of ischemic stroke in children. Surgical revascularization is the mainstay of treatment; however, data on functional and angiographic outcomes in pediatric populations, particularly from Central Asia, remain limited. Methods: We conducted a retrospective single-centre cohort study of 45 pediatric patients with MMD who underwent surgical revascularization between 2013 and 2025. Clinical outcomes were assessed using the modified Rankin Scale (mRS), and angiographic outcomes were evaluated using the Matsushima grading system. Associations between clinical, surgical, and radiological factors and functional outcomes were analysed. Results: The mean age at diagnosis was 9.5 ± 3.8 years, with a mean follow-up of 20.6 ± 17.5 months. Headache was the most common presenting symptom (77.8%), while ischemic stroke was the predominant cerebrovascular presentation, occurring in more than 70% of patients. More than 75% of patients had advanced angiographic disease (Suzuki stages IV–V). Functional outcomes improved significantly following surgery, with mean mRS decreasing from 2.09 ± 1.26 to 1.64 ± 1.00 (p = 0.004). At follow-up, 82.2% of patients achieved favorable outcomes (mRS 1–2). Bilateral revascularization was performed in 64.4% of cases. No significant differences were observed between direct, indirect, and combined techniques, although a trend toward improved outcomes with direct and combined approaches was noted. Postoperative collateral formation was strongly associated with functional outcome (p = 0.005). Conclusions: Surgical revascularization is associated with significant functional improvement and low recurrence rates in pediatric MMD. The quality of collateral formation, rather than the surgical technique itself, appears to be the primary determinant of outcome.