Karashash Menlibayeva

Background: Chronic carotid artery occlusive disease is associated with a high risk of ischemic events and long-term neurological deficits. Optimising surgical revascularisation outcomes requires an integrated understanding of anatomical, hemodynamic, and functional factors. This study aims to assess the neuro-radiological, clinical, and cognitive outcomes following cerebral revascularisation in patients with chronic internal carotid artery occlusion. Methods: This single-centre, prospective, open-label interventional longitudinal study includes 60 patients with chronic internal carotid artery occlusion undergoing superficial temporal artery-to-middle cerebral artery (STA–MCA) bypass at National Centre for Neurosurgery in Kazakhstan. The primary endpoint of the study is the incidence of ischemic stroke during the 6-month follow-up period after surgery. Pre- and postoperative evaluations include detailed angiographic assessment of collateral circulation and donor vessel diameter, as well as cerebral perfusion imaging using arterial spin labelling MRI. Neurological and cognitive function are assessed using standardized clinical and neuropsychological tests. Early and six-month follow-up evaluations focus on bypass patency, perfusion changes, and clinical outcomes. Discussion: By integrating anatomical, hemodynamic, and functional data, this study aims to identify predictors of successful revascularisation and favorable clinical outcomes. Correlation of postoperative angiographic and perfusion findings with cognitive and neurological recovery may refine surgical decision-making, enhance risk stratification, and optimize individualized patient care. Ultimately, this comprehensive approach seeks to improve the overall efficacy and safety of STA-MCA bypass in patients with chronic carotid artery occlusive disease. Trial registration: ClinicalTrials.gov NCT07396025 . Registered on February 5, 2026.

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.

To assess the long-term clinical outcomes of a hybrid approach combining double-barrel superficial temporal artery to middle cerebral artery (STA-MCA) bypass with endovascular parent artery occlusion in the treatment of giant complex intracranial aneurysms. This retrospective observational study included patients with giant or fusiform intracranial aneurysms who underwent double-barrel STA-MCA bypass followed by endovascular occlusion of the parent artery between January 2019 and January 2025. The primary outcomes were bypass patency, aneurysm exclusion, and ischaemic complications. Secondary outcomes included postoperative neurological status (assessed using the modified Rankin Scale [mRS]), radiological follow-up results, and procedural complications. Follow-up was conducted at 1-, 3-, and 6-month post-procedure and annually thereafter, including clinical assessment and imaging with MRI/MRA or DSA. Seven patients (mean age, 44.7 ± 27.5 years; 57.1% male) were included in the analysis. Most aneurysms were fusiform (85.7%) and located in the MCA (71.4%). All patients underwent double-barrel bypass and endovascular occlusion. Postoperative DSA confirmed aneurysm exclusion and preserved perfusion in all cases. No permanent neurological deficits or bypass failures were observed. One patient developed transient hemiparesis, which was resolved spontaneously without intervention. In one emergency case, a double-barrel bypass was performed following coil prolapse and occlusion of both M2 segments during endovascular embolization; the patient was discharged with mild residual contralateral paresis. At long-term follow-up, all aneurysms remained completely occluded, and bypass patency was maintained in all patients. In appropriately selected cases, a hybrid approach combining double-barrel STA-MCA bypass with endovascular parent artery occlusion offers a safe and effective treatment option for complex intracranial aneurysms. This strategy provides reliable flow restoration and durable aneurysm exclusion, particularly when performed in a hybrid operating setting.

Objective: This study aims to analyze the diagnostic patterns of cavernoma-related epilepsy, the management of antiseizure medications, and clinical outcomes following microsurgical treatment in patients with late-diagnosed epilepsy secondary to cavernous malformations in the Central Asian region. Methods: A retrospective cross-sectional study was conducted on 60 patients who underwent microsurgical resection for brain cavernous malformations over a 12-year period (2010–2022) at the National Centre for Neurosurgery, Astana, Kazakhstan. All participants were 18 years or older and presented with seizures. Follow-up evaluations were conducted by neurologists, and seizure outcomes were assessed using the 2017 classification criteria of the International League Against Epilepsy. Results: The mean follow-up period was 83.77 ± 39.81 months. In total, 51.67% of participants demonstrated positive ILAE outcomes, 33.33% had moderate ILAE outcomes, and the remaining 15.00% experienced negative ILAE outcomes. Approximately 47% of patients received antiseizure medication before surgery, primarily as monotherapy with carbamazepine (33%), and administered at a low dose (40%). Early microsurgical resection showed a positive post-surgery seizure outcome. Approximately 67% of patients who experienced seizures within one year prior to surgery showed positive ILAE outcomes, whereas those with a seizure history extending beyond five years were roughly 32% seizure-free (p = 0.01). Conclusions. Cavernoma-related epilepsy in Central Asia remains a significant clinical challenge, particularly with respect to diagnostic accuracy and antiseizure medication management. In our cohort, only approximately half of patients achieved favorable seizure control following microsurgical resection. Notably, early surgical intervention within one year of seizure onset was associated with improved outcomes, whereas delayed surgery, restricted availability of intraoperative technologies, and suboptimal antiseizure medication practices were linked to less favorable outcomes. Strengthening diagnostic pathways, antiseizure medication management, and expanding access to advanced surgical technologies are critical steps to improving treatment outcomes in a studied patient population.

Background: Carotid atherosclerotic diseases are managed with carotid endarterec-tomy or carotid artery stenting, both associated with low risks of stroke and mortality during the procedure. However, in cases of severe carotid artery disease where the vessels are tortuous or the femoral or radial arteries are occluded, conventional access methods can be challenging. In such situations, direct puncture via the cut-down technique of the carotid artery offers an alternative approach for stenting severe stenosis. Case presentation: Two patients (75 and 57 years old) presented with a right-sided hemiparesis and a history of transient ischemic attacks, strokes, or amaurosis fugax corresponding to a carotid stenosis of ≥50% and of ≥90%. Femoral angiography of both patients showed occlusion of the common and internal iliac arteries. The surgical procedure entailed a direct carotid artery puncture with a microsurgical dissection technique to expose the carotid artery within a neuroendovascular operating room under general anesthesia. All subsequent endovascular procedures were conducted through the sheath. Following the completion of the endovascular intervention, the sheath was removed, and closure of the puncture sites was directly achieved using either Prolene sutures or a purse-string suture technique. The patients had a smooth postoperative recovery devoid of neurological deficits. Conclusions: Direct carotid artery puncture via the cut-down method for carotid artery stenting promises procedural safety, precision, and good clinical outcomes, despite potential cost increases and specialized personnel needs.

Background/Objectives: Brain arteriovenous malformations (bAVMs) are rare vascular anomalies characterized by direct connections between arteries and veins, bypassing the capillary network. This study aimed to identify potential genetic factors contributing to the development of sporadic bAVMs. Methods: Three patients (AVM1–3) from Kazakhstan who underwent microsurgical resection at the National Centre for Neurosurgery (NCN) in Astana, Kazakhstan, were analyzed. Brain AVMs were diagnosed using magnetic resonance imaging (MRI). Genomic DNA was isolated from whole venous blood samples, and whole-exome sequencing was performed on the NovaSeq 6000 platform (Illumina). Variants were filtered according to standard bioinformatics protocols, and candidate gene prioritization was conducted using the ToppGene tool. Results: In silico analysis further revealed candidate genes likely associated with lesion development, including COL3A1, CTNNB1, LAMA1, NPHP3, SLIT2, SLIT3, SMO, MAPK3, LRRK2, TTN, ERBB2, PARD3, and OBSL1. It is essential to focus on the genetic variants affecting the following prioritized genes: ERBB2, SLIT3, SMO, MAPK3, and TTN. Mutations in these genes were predicted to be “damaging”. Most of these genes are involved in signaling pathways that control vasculogenesis and angiogenesis. Conclusions: Defects in genes associated with ciliary structure and function may be critical to the pathogenesis of brain AVMs. These findings provide valuable insights into the molecular underpinnings of bAVM development, emphasizing key biological pathways and potential candidate genes. Further research is needed to establish robust correlations between specific genetic mutations and clinical phenotypes, which could ultimately inform the development of improved diagnostic, therapeutic, and prognostic approaches.

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.

Purpose This technical note introduces the novel faucet technique, which enables neurosurgeons to evaluate the patency of a bypass during superficial temporal artery–middle cerebral artery bypass surgery. The technique is particularly useful when there is a lack of equipment such as micro-Doppler or indocyanine green in the operating rooms. This is often the case in Central Asian countries. Methods The faucet technique involves carefully examining the graft by gently opening a valve, comparable to a faucet, to observe the blood flow through the bypassed vessel. Overall, 36 procedures underwent the faucet technique for assessing the superficial temporal artery–middle cerebral artery bypass patency. Results The results indicate that the bypass remained patent in all cases, as confirmed through the intraoperative faucet technique, postoperative magnetic resonance angiography, or cerebral angiography. Conclusion By visually inspecting the blood flow through the faucet technique, surgeons can confirm the effectiveness of the graft and ensure that the bypass remains unobstructed during the surgery.

BACKGROUND AND IMPORTANCE: The case describes the management of a giant and recurrent aneurysm in a patient. The treatment involved a combination of microsurgical protective low-flow, followed by high-flow revascularization and parent artery occlusion. CLINICAL PRESENTATION: The patient presented with severe headaches and progressive visual impairment. Brain magnetic resonance imaging revealed a giant saccular intracranial aneurysm in the left internal carotid artery. The examination also revealed hypoplasia of the right anterior cerebral artery and a fetal-type left posterior cerebral artery originating from the neck of the aneurysm. Considering the location and size of the aneurysm, a combination of endovascular and microsurgical approaches was applied. A protective low-flow procedure was followed by high-flow revascularization and occlusion of the parent artery. After 12 months, the aneurysm recanalized through the graft. To address the recurrence of giant complex aneurysms, endovascular embolization was performed through the radial artery grafts. These interventions showed positive midterm outcomes for the patient's giant aneurysm. CONCLUSION: In the treatment of complex giant aneurysms, it is important to consider both endovascular and microsurgical approaches as complementary, rather than mutually exclusive. Endovascular embolization using radial artery grafts may be used when dealing with retrograde recanalization and the challenges associated with accessing the aneurysm.