Publications
2026
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Radiosurgery for Spetzler-Martin Grade III Arteriovenous Malformations of the Brain. Comparison of the Results of a Single Institution in Finland with a Systematic Literature Review
CONCLUSIONS: Radiosurgical results for SM III bAVMs are generally favorable, and our results suggest that in a low volume center, a dedicated team with formal training can achieve results comparable to high-volume centers. Larger prospective studies on the influence of case volumes on radiosurgical outcomes and on radiosurgery´s role in downgrading bAVMs prior to resection are warranted. -
Posterior Cervical Fixation: Accuracy and Safety of Free-Hand Inserted Screws
CONCLUSION: Clinical failure after posterior cervical spine fixation occurs significantly more frequently in patients with screw malposition compared with those without malposition. The overall rate of screw insertion-related clinical failure was 6.0%. These findings suggest that improving screw placement accuracy may reduce the risk of complications. -
Performance of Risk Scores in Predicting Intracranial Aneurysm Instability
CONCLUSION: In the ruptured aneurysm cohort, PHASES showed the highest sensitivity for identifying rupture-prone aneurysms. In the conservatively managed cohort, ELAPSS and triple-S best discriminated instability, and all models except Juvela showed high sensitivity for rupture. All models had low positive predictive value and limited specificity, indicating that current risk scores alone are insufficient for treatment selection and require further refinement. -
Inflammation in Aneurysmal Subarachnoid Hemorrhage: Cause, Consequence, or Both? Focus on Pathogen Pattern Recognition
Inflammation plays a key role in the formation, progression, and rupture of intracranial aneurysms, leading to aneurysmal subarachnoid hemorrhage. Pathogen PPRs (pattern recognition receptors) that are activated by pathogen-derived molecules are key mediators of the innate immune response against microbes. As PPRs are activated by molecules resembling microbes, that is, pathogen-associated molecular patterns or damage-associated molecular patterns that can be of nonmicrobial origin, exposure to... -
Translational relevance of animal models available on brain arteriovenous malformations, a systematic review
We conducted a systematic review to identify and evaluate animal models of true brain arteriovenous malformations (bAVMs), focusing on how they replicate human disease. Outcomes assessed included bAVM growth, rupture, seizures, and survival. The review adhered to PRISMA guidelines and SYRCLE's protocol for animal studies. A search on PubMed and Embase was conducted (April 19, 2023; updated October 24, 2024). Exclusion criteria were; (1) Not an original, peer-reviewed full length research... -
Pain Management in Aneurysmatic Subarachnoid Haemorrhage: A Survey of Nordic Physicians
CONCLUSIONS: In the Nordic countries, paracetamol, opioids, and NSAIDs were reported as the most frequently used analgesics in the management of aSAH related pain in the ICU. Use of gabapentinoids was commonly reported by Danish respondents, unlike respondents from other Nordic countries. Neurosurgeons reported that they rarely prescribe opioids at hospital discharge. -
Corrigendum to "Surgery of Atlantoaxial Osteoarthritis" [World Neurosurgery Volume 203 (2025)]
No abstract -
Emerging approaches in the management of intracranial hemorrhage: ARISE II consensus recommendations
No abstract
2025
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Data-Driven Approach to Predict Aneurysm Rupture Risk
No abstract -
Treatment outcomes of Spetzler-Ponce grade A brain AVMs in a low-volume center: a systematic review and single institution experience
Arteriovenous malformations of the brain (bAVMs) are complex lesions in the treatment of which patient volumes and subsequent experience are likely to reflect on the outcome. We investigated whether a small neurosurgical center with a limited caseload can achieve similar results to larger centers in treatment of low grade bAVMs. We performed a systematic literature review of studies that have reported outcomes for Spetzler-Ponce A bAVM patients and completed a statistical analysis with a binary... -
Corrigendum to "Surgery of Atlantoaxial Osteoarthritis" [World Neurosurgery Volume 203 (2025)]
No abstract -
Intracranial Aneurysm Wall Phenotypes: Clinical, Morphological, and Hemodynamic Influences
CONCLUSION: These results suggest that IA wall remodeling follows a continuum influenced by an interplay of clinical, morphological, and hemodynamic factors. Recognizing these distinct phenotypes may improve risk stratification and inform personalized treatment strategies. Although the direct prediction of rupture risk remains to be established, this multidimensional approach provides novel insights into the pathophysiological evolution of IA wall characteristics and highlights potential avenues... -
Surgery of Atlantoaxial Osteoarthritis
CONCLUSIONS: These findings suggest that both C1-2 fixation and C2 nerve root decompression are safe and effective methods for pain caused by AAOA, the latter especially when symptoms are related to C2 radiculopathy. -
Clinical and radiological presentation of cavernomas according to the Zabramski classification
CONCLUSIONS: Most CCMs are asymptomatic, incidental findings, in particular, nearly all Zabramski type IV CCMs. If symptoms are present, they are mainly associated with Zabramski type I CCMs and occasionally with Zabramski type II or III CCMs. Although most Zabramski type I CCMs will regress to type II or III and remain asymptomatic, over long-term follow-up, up to one-quarter develop new symptoms. -
Patient-derived glioma organoids real time identification of IDH mutation, 1p/19q-codeletion and CDKN2A/B homozygous deletion with differential ion mobility spectrometry
CONCLUSION: DMS suitability to differentiate IDH-mutated PGOs was thus validated in ex vivo cultured samples, PGOs. Preliminary results regarding 1p/19q codeleted PGOs and CDKN2A/B loss PGOs identification endorse testing in a prospective intraoperative glioma patient cohort. Our results reveal a sample classification set-up that is compatible with real-time intraoperative surgery guidance.
2024
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Vascular Endothelial Growth Factor and the Pathogenesis of Intracranial Aneurysms: A Systematic Review on the Missing Link in a Complex Pathway
CONCLUSIONS: Despite lacking definitive evidence of a causal relationship, the wealth of supporting data substantiates VEGF as a promising topic for future investigation into aneurysm pathophysiology and as a potential therapeutic target. -
Patient-derived glioma organoids real time identification of IDH mutation, 1p/19q-codeletion and CDKN2A/B homozygous deletion with differential ion mobility spectrometry
CONCLUSION: DMS suitability to differentiate IDH-mutated PGOs was thus validated in ex vivo cultured samples, PGOs. Preliminary results regarding 1p/19q codeleted PGOs and CDKN2A/B loss PGOs identification endorse testing in a prospective intraoperative glioma patient cohort. Our results reveal a sample classification set-up that is compatible with real-time intraoperative surgery guidance. -
Trends in the incidence of newly diagnosed cerebral cavernous malformations in Finland: a population-based retrospective cohort study
BACKGROUND: The few previous studies that have estimated the incidence of cerebral cavernous malformations (cavernomas) have reported incidence rates of 0.2-1.9/100,000 for diagnosed cavernomas. Our aim was to describe incidence trends of cavernomas by clinical presentation. -
Non-technical skills for neurosurgeons: An international survey
INTRODUCTION: Neurosurgery is considered a technically demanding specialty; nonetheless, it also requires non-technical skills (NTSs) to reach mastery. -
Description of the local hemodynamic environment in intracranial aneurysm wall subdivisions
Intracranial aneurysms (IAs) pose severe health risks influenced by hemodynamics. This study focuses on the intricate characterization of hemodynamic conditions within the IA walls and their influence on bleb development, aiming to enhance understanding of aneurysm stability and the risk of rupture. The methods emphasized utilizing a comprehensive dataset of 359 IAs and 213 IA blebs from 268 patients to reconstruct patient-specific vascular models, analyzing blood flow using finite element... -
Distribution of rupture sites and blebs on intracranial aneurysm walls suggests distinct rupture patterns in ACom and MCA aneurysms
The mechanisms behind intracranial aneurysm formation and rupture are not fully understood, with factors such as location, patient demographics, and hemodynamics playing a role. Additionally, the significance of anatomical features like blebs in ruptures is debated. This highlights the necessity for comprehensive research that combines patient-specific risk factors with a detailed analysis of local hemodynamic characteristics at bleb and rupture sites. Our study analyzed 359 intracranial... -
Most Promising Approaches to Improve Brain AVM Management: ARISE I Consensus Recommendations
Brain arteriovenous malformations (bAVMs) are complex, and rare arteriovenous shunts that present with a wide range of signs and symptoms, with intracerebral hemorrhage being the most severe. Despite prior societal position statements, there is no consensus on the management of these lesions. ARISE (Aneurysm/bAVM/cSDH Roundtable Discussion With Industry and Stroke Experts) was convened to discuss evidence-based approaches and enhance our understanding of these complex lesions. ARISE identified... -
CNS-associated macrophages contribute to intracerebral aneurysm pathophysiology
Intracerebral aneurysms (IAs) are pathological dilatations of cerebral arteries whose rupture leads to subarachnoid hemorrhage, a significant cause of disability and death. Inflammation is recognized as a critical contributor to the formation, growth, and rupture of IAs; however, its precise actors have not yet been fully elucidated. Here, we report CNS-associated macrophages (CAMs), also known as border-associated macrophages, as one of the key players in IA pathogenesis, acting as critical... -
Pretreatment with a dual antiplatelet and anticoagulant (APAC) reduces ischemia-reperfusion injury in a mouse model of temporary middle cerebral artery occlusion-implications for neurovascular procedures
CONCLUSIONS: Pretreatment with APAC or UFH was safe and effective in reducing brain injury in a model of cerebral ischemia induced by transient middle cerebral artery occlusion. Further studies on the use of APAC to limit ischemic injury during temporary occlusion in neurovascular procedures are indicated. -
Reply to the letter by Yin et al. 'Reevaluating the impact of antihypertensive medication on intracranial aneurysm formation: a call for clarification and further study'
No abstract
2023
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Correction to: The clinical course and outcomes of non-aneurysmal subarachnoid hemorrhages in a single-center retrospective study
No abstract -
The clinical course and outcomes of non-aneurysmal subarachnoid hemorrhages in a single-center retrospective study
CONCLUSIONS: Non-aneurysmal SAH seems to have a good prognosis for majority of patients, especially for patients with a PSAH. Non-aneurysmal SAH patients are however affected by vasospasm and hydrocephalus and have similar risk factors for poor outcome as patients with aneurysmal SAH. This suggests that it is the severity of the bleed rather than the etiology that associates with poor outcome. -
Impact of Timing of Surgery and Adjuvant Treatment on Survival of Adult IDH-wild-type Glioblastoma: A Single-center Study of 392 Patients
CONCLUSIONS: Interval from referral to surgery in the range of 4-10 weeks was not associated with decreased survivals in IDH-wt glioblastomas. In contrast, delay exceeding 30 days from surgery to adjuvant treatment may decrease long-term survival. -
Effect of xenon on brain injury, neurological outcome, and survival in patients after aneurysmal subarachnoid hemorrhage-study protocol for a randomized clinical trial
BACKGROUND: Aneurysmal subarachnoid hemorrhage (aSAH) is a neurological emergency, affecting a younger population than individuals experiencing an ischemic stroke; aSAH is associated with a high risk of mortality and permanent disability. The noble gas xenon has been shown to possess neuroprotective properties as demonstrated in numerous preclinical animal studies. In addition, a recent study demonstrated that xenon could attenuate a white matter injury after out-of-hospital cardiac arrest. -
Recurrence of arteriovenous malformations of the brain after complete surgical resection. Kuopio University Hospital experience and systematic review of the literature
Treatment for arteriovenous malformations of the brain (bAVMs) aims to achieve complete removal or occlusion of the lesion in order to eradicate the risk of rupture and subsequent morbidity associated with these lesions. Despite initially successful treatment, bAVMs may carry a risk of recurrence especially in younger patients. We studied the rate of recurrence of surgically treated bAVMs at Kuopio University Hospital (KUH) in 1981-2021. The study population was collected retrospectively from... -
Unlike severe periodontitis, caries does not associate with intracranial aneurysms or aneurysmal subarachnoid hemorrhage
CONCLUSION: Unlike severe periodontitis, caries does not increase the risk of IAs and aSAHs. However, cariogenic bacteria may participate to IA pathology by disseminating to circulation via inflamed gingival tissue.
2022-2021
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Size at Which Aneurysms Rupture: A Hospital-Based Retrospective Cohort From 3 Decades
CONCLUSION: Small size should not be used to exclude unruptured IAs from prophylactic treatment. The observation that the size at which IAs rupture has previously decreased, suggesting a change in relative importance of risk factors or characteristics of a contemporary patient population compared with older cohorts. -
Unlike severe periodontitis, caries does not associate with intracranial aneurysms or aneurysmal subarachnoid hemorrhage
CONCLUSION: Unlike severe periodontitis, caries does not increase the risk of IAs and aSAHs. However, cariogenic bacteria may participate to IA pathology by disseminating to circulation via inflamed gingival tissue. -
Association of blood lipid levels with the risk of intracranial aneurysm formation and rupture calls for further studies: A commentary on the article by Zhang et al
No abstract -
Risk factor management matters more than pharmaceutical cyclooxygenase-2 inhibition in the prevention of de novo intracranial aneurysms
CONCLUSION: For the prevention of de novo sIA formation, risk factor management with focus on cessation of smoking and treating hypertension adequately seems more important than pharmaceutical COX-2 inhibition. -
Use of antihypertensive medication and formation of de novo intracranial aneurysms
CONCLUSIONS: Antihypertensive agents were not associated with a reduction of de novo sIA formation, but irregular use of antihypertensive agents was associated with an increased risk of de novo sIA formation. -
Reader Response: Substantial Within-Country Variation in the Incidence of Subarachnoid Hemorrhage: A Nationwide Finnish Study
No abstract -
Prediction of bleb formation in intracranial aneurysms using machine learning models based on aneurysm hemodynamics, geometry, location, and patient population
CONCLUSIONS: Based on the premise that aneurysm characteristics prior to bleb formation resemble those derived from vascular reconstructions with their blebs virtually removed, machine learning models can identify aneurysms prone to bleb development with good accuracy. Pending further validation with longitudinal data, these models may prove valuable for assessing the propensity of IAs to progress to vulnerable states and potentially rupturing.