Purpose: Acute ischemic stroke (AIS) due to tandem lesions (TLs) of extracranial Internal Carotid Artery and Anterior Cerebral Circulation are challenging for endovascular treatment (EVT). This study aims to evaluate feasibility, safety and efficacy of EVT for TLs’ AIS, with or without emergent carotid artery stenting (eCAS), in a real-life scenario. Methods: Retrospective review of prospectively collected non-randomized thrombectomy databases from five stroke centers between 2015 and 2019. Consecutive patients with TLs’ AIS were selected. Clinical, neuroimage and procedure features, as well as antiplatelet therapy regimen, were evaluated. Primary outcome was 90-day mRS ≤ 2. Secondary outcomes included: mTICI score 2b-3, extracranial recanalization, procedural complications, symptomatic intracerebral hemorrhage (SICH) and 90-day mortality. Results: Two hundred twenty-seven patients were enrolled (67.8% males; mean age 65.9 ± 12.9 years). We obtained mTICI 2b-3 in 77.1%, extracranial recanalization in 86.8%, 90-day mRS (available in 201/227 cases) ≤ 2 in 49.8%. Procedural complications occurred in 16.7%, SICH in 9.7%; 90-day mortality rate (available in 201/227 cases) was 14.4%. The strongest predictors of good clinical outcome were young age (p < 0.0001), low baseline NIHSS (p = 0.008), high baseline ASPECTS (p < 0.0001), good collateral flow (p = 0.013) and extracranial recanalization (p = 0.001). The most significant predictors of SICH were low baseline ASPECTS (p < 0.0001), occurrence of complications (p < 0.0001) and eCAS (p = 0.002). Conclusion: In our real-life series, the EVT for TLs’ AIS was feasible, safe and effective in improving 90-day functional outcome with acceptable morbi-mortality rates. ECAS increased the risk of SICH, independently from the antiplatelet therapy regimen.

To evaluate the effectiveness of baseline screening and follow-up with magnetic resonance imaging (MRI) for detecting trilateral retinoblastoma (TRb) and assessing the risk of TRb development. Prospective multicenter cohort study. A total of 607 retinoblastoma patients from 2012 through 2022 were included and followed up until September 1, 2023. At each center, a neuroradiologist categorized pineal glands on baseline and follow-up scans into 4 groups: (A) normal, (B) cystic gland, (C) suspicious gland, or (D) TRb. Different follow-up schedules were assigned to each category. Categories B and C were followed up with MRI after approximately 3 months and repeated 3 months later if suspicion remained. On each MRI, they measured the height and width, evaluated the aspect (solid, partly cystic, and completely cystic) of the pineal gland, and evaluated radiologic features suspicious of pineal TRb. The effectiveness of the current TRb screening method was assessed by evaluating its sensitivity and specificity to detect TRb. Determining the TRb incidence was a secondary outcome measure. Heritable retinoblastoma patients had a risk of 3.78% to develop TRb. One of 4 pineal TRbs was detected during a follow-up scan and 4 of 5 nonpineal TRbs were detected on the baseline MRI. Screening for pineal TRb had a sensitivity of 25% and specificity of 100%; for nonpineal TRb, the sensitivity was 80%. It required 494 follow-up scans to detect 1 pineal TRb. However, when restricting the follow-up to solely suspicious glands, only 22 scans were required to detect 1 pineal TRb. During extended follow-up after baseline MRI, only 1 pineal trilateral retinoblastoma was detected in our study. Follow-up after 3 months should be restricted to patients with a suspicious pineal gland defined as irregular thickening of the cyst wall (>2 mm), fine nodular aspect of the cyst wall, or when a solid or cystic gland exceeds the upper 99% prediction interval for size; patients with an unsuspicious cystic gland should not be followed up. Baseline MRI screening was able to detect most nonpineal trilateral retinoblastomas.

To identify a brain plasticity index (BPI) that accounts for the cortical variation in language function on the basis of preoperative/postoperative navigated transcranial magnetic stimulation (nTMS) mapping. This was a prospective, monocentric study of preoperative/postoperative nTMS mapping. A Python-based open-source pipeline was created to objectively quantify BPI maps, calculated with 2-dimensional nearest-neighbor interpolation of nTMS points for the 2 hemispheres (right/left). BPI maps registered on the Montreal Neurological Institute neuro-anatomy-atlas. Tumoral segmentation was performed with the BraTS toolkit. Between January 2024 and December 2024, 40 subjects were selected and 41 nTMS procedures (65.8% bilateral) were performed preoperatively/postoperatively. Data for language mapping on 40 patients were analyzed on the basis of the lesion volumes: average: 60.85 cm³ (standard deviation: 66.04 cm³). A subanalysis of 7 high-grade (HGG) and 7 low-grade gliomas (LGG) was then performed. Quantitative analyses: Estimation of BPI values specific for Language function: for patients with HGG, BPI was greater in the left hemisphere (46.07 powered by Editorial Manager and ProduXion Manager from Aries Systems Corporation, in mm). Conversely, for patients with LGG, a greater BPI was found in the right hemisphere (57.58 mm). However, an overall greater BPI value was obtained for HGG (46.70 mm) than for LGG (28.19 mm). Qualitative analyses showed linguistic pathway reshaping from temporoparietal areas to the inferior frontal gyrus. The relationship between BPI and Mini-Mental State Examination showed that for HGG, the greater the BPI, the more difficult cognitive recovery was (R = -0.80). Coherently, for LGG the trend was the same (R = -0.17). The variation in different linguistic components at the Aachen Aphasia test documented that linguistic performance had an average greater value for patients with HGG than LGG, with comparable final recovery (90.67% vs. 90%). Identifying a subject-specific BPI may noninvasively define functional reshaping of corticosubcortical circuits.