Rabab Alshahrani, MD, FRCSC, FAANS

All Publications

• Dome protection prior to microsurgical clipping versus direct microsurgical clipping of ruptured intracranial aneurysms: A multicenter analysis. Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia Roy, J. M., Musmar, B., Patel, P., Kaul, A., Pontarelli, M. K., El-Hajj, V. G., Jaffer, A., Chen, A. Y., Shteingart, J., Busarajan, S., Rizzuto, M., Hoglund, Z., Scott, K. W., Charcos, I., Burkhardt, J. K., Srinivasan, V., Tonetti, D., Tjoumakaris, S. I., Gooch, M. R., Alshahrani, R., Rosenwasser, R. H., Jabbour, P. M. 2026; 150: 112070

  Abstract

  Dome protection involves partial coil embolization of an intracranial aneurysm prior to definitive treatment. The present study compared outcomes of dome protection followed by microsurgical clipping with direct microsurgical clipping of ruptured intracranial aneurysms.This multicenter study included patients who underwent either dome protection followed by microsurgical clipping or direct microsurgical clipping of a ruptured intracranial aneurysm at three participating centers across North America. Propensity score weighting was carried out using the inverse probability of treatment weights (IPTW) to adjust for confounders. Outcomes of interest were intra-operative rupture (IOR), vasospasm, non home discharge (NHD), in-hospital mortality and length of stay (LOS).Of 208 patients, 15.72% (N = 33) underwent dome protection followed by microsurgical clipping and 84.18% (N = 175) underwent direct microsurgical clipping. After IPTW adjustment, dome protection was not associated with decreased risk for IOR (OR: 0.59, 95% CI: 0.14--2.52, P = 0.481), vasospasm (OR: 0.79, 95% CI: 0.28--2.25, P = 0.654), NHD (OR: 0.52, 95% CI: 0.19--1.39, P = 0.193) or in-hospital mortality (OR: 0.2, 95% CI: 0.02--1.75, P = 0.148) compared to direct microsurgical clipping. Patients who underwent dome protection experienced significantly longer LOS compared to direct microsurgical clipping, with an average of 4.59 days, 95% CI: 1.15--8.03, P < 0.01).Dome protection prior to microsurgical clipping is associated with comparable rates of IOR, vasospasm, in hospital mortality and NHD compared to direct microsurgical clipping of ruptured aneurysms. Patients who underwent dome protection experienced longer LOS compared to those who underwent direct microsurgical clipping. Future studies could evaluate the cost-effectiveness and clinical utility of dome protection in the management of ruptured intracranial aneurysms.

  View details for DOI 10.1016/j.jocn.2026.112070

  View details for PubMedID 42096731

• Evaluating a biaxial radial workflow for flow diverter placement: clinical and technical outcomes using the RIST guide catheter. Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia El-Hajj, V. G., Gharios, M., Roy, J. M., Musmar, B., Fuleihan, A., Kata, R., Jaffer, A., Kim, W. J., Rizzuto, M., Ellens, N., Alshahrani, R., Tjoumakaris, S., Gooch, M., Rosenwasser, R. H., Jabbour, P. 2026; 150: 112072

  Abstract

  Triaxial systems are widely presumed to enhance support and distal microcatheter stability in the setting of delivery of a flow diverter; however, advances in radial-specific guide catheters may reduce the need for added complexity. This study evaluates procedural and clinical outcomes of a uniform biaxial-only radial workflow using the RIST guide catheter for intracranial flow diverter treatment.We performed a retrospective, single-center review of all consecutive patients undergoing transradial flow diverter placement for intracranial aneurysms using the RIST system between 2021 and 2024. Primary outcomes were technical success, conversion to triaxial support or femoral access, and intraprocedural complications.Fifty-three patients were included. Median age was 52 years (IQR, 39-59), and 26% were male. Most aneurysms were unruptured (91%) and located along the internal carotid artery. Flow diverters included Pipeline Shield (66%), FRED X (15%), Pipeline Vantage (13%), Surpass Evolve (3.8%), and Pipeline Flex (1.9%). Three procedures were unsuccessful (technical success rate: 94%), including one requiring conversion to a triaxial system (1.9%); no case required femoral conversion. Intraprocedural complications were rare (3.8%), consisting of one cervical carotid dissection and one episode of severe but reversible radial artery spasm. Median hospital stay was 1 day (IQR, 1-2). No procedure-related mortality was observed.A radial-first, biaxial-only workflow using the RIST guide catheter provides reliable support for flow diverter deployment with high technical success and infrequent complications. The extremely low need for conversion to triaxial support suggests that contemporary radial-specific guide catheters may preclude routine use of intermediate catheters in most cases. This strategy may reduce procedural complexity and cost without compromising safety.

  View details for DOI 10.1016/j.jocn.2026.112072

  View details for PubMedID 42096733

• Safety and efficacy of preoperative embolization in the treatment of brain arteriovenous malformations with perinidal aneurysms and single draining vein: a multicenter study with propensity score-weighting. Journal of neurointerventional surgery Musmar, B., Adeeb, N., Abdalrazeq, H., Salim, H. A., Roy, J., Tjoumakaris, S. I., Kandregula, S., Ogilvy, C. S., Kondziolka, D., Sheehan, J. P., Dmytriw, A. A., Aslan, A., Patel, P., Lan, M., Baldassari, M. P., Koduri, S., Atallah, E., Zeineddine, H., Pontarelli, M. K., Abou-Al-Shaar, H., El Naamani, K., Abdelsalam, A., Ironside, N., Kumbhare, D., Gummadi, S., Baskaya, M., Ataoglu, C., Mccarthy, F., Sanchez-Forteza, A., Essibayi, M. A., Keles, A., Muram, S., Sconzo, D., Riina, H., Rezai, A., Alwakaa, O., Tos, S. M., Mantziaris, G., Park, M. S., Hanalioglu, S., Erginoglu, U., Pöppe, J., Sen, R. D., Griessenauer, C. J., Ocampo-Navia, M. I., Devia, D. A., Perez-Mendez, W., Puentes, J. C., Abo Kasem, R., Spiotta, A. M., Puri, A. S., Singh, J., Kuhn, A. L., Burkhardt, J. K., Starke, R. M., Sekhar, L. N., Levitt, M., Altschul, D., Haranhalli, N., McAvoy, M., Eltiti, M., Abushehab, A., Foreman, P., Shakir, H. J., Zaidat, O. O., AlMajali, M., Ruppert-Gomez, M., See, A. P., Abla, A. A., Stapleton, C. J., Patel, A., Nguyen, A., Koch, M. J., Srinivasan, V. M., Chen, P. R., Blackburn, S., Alshahrani, R., Gooch, M. R., Rosenwasser, R. H., Bulsara, K. R., Kan, P., Kim, L. J., Choudhri, O., Pukenas, B., Simonato, D., Li, Y. L., Alaraj, A., Fuschi, M., Patel, A. B., Savardekar, A., Notarianni, C., Cuellar, H. H., Lawton, M. T., Guthikonda, B., Morcos, J., Jabbour, P. 2026; 18 (8): 1765-1772

  Abstract

  Arteriovenous malformations (AVMs) with perinidal aneurysms and single draining vein are associated with an elevated risk of rupture and increased procedural complexity. The role of preoperative embolization in this high-risk anatomical subset remains unclear. This study aimed to evaluate the safety and efficacy of microsurgery with preoperative embolization, compared with microsurgery alone in patients with such AVMs.We conducted a multicenter retrospective analysis of an AVM registry from the MISTA (Multicenter International Study for Treatment of Brain AVMs) consortium and included AVMs with perinidal aneurysms and a single draining vein. Baseline characteristics, angiographic outcomes, functional outcomes, and complication rates were compared. Propensity score weighting (PSW) using the covariate balancing method was applied to adjust for baseline differences.Out of a total of 1919 patients, 65 met the inclusion criteria; 45 patients underwent preoperative embolization followed by microsurgery, and 20 underwent microsurgery alone. After adjustment, complete obliteration rates were similar between groups (OR 0.87, 95% CI 0.04 to 16.33, P=0.92), as were rates of functional independence at discharge and follow-up. Overall complication, symptomatic complication, and mortality rates did not differ significantly between groups. However, permanent complications were significantly lower in patients with preoperative embolization (OR 0.06, 95% CI 0.004 to 0.84, P=0.03).In patients with AVMs featuring perinidal aneurysms and single draining vein, preoperative embolization followed by microsurgery was associated with fewer permanent complications and no increase in adverse outcomes compared with microsurgery alone. However, given the small number of events, this finding should be interpreted cautiously.

  View details for DOI 10.1136/jnis-2025-023873

  View details for PubMedID 40846482

• Clinical Outcomes of Isolated Subarachnoid Hemorrhage after Mechanical Thrombectomy. AJNR. American journal of neuroradiology Roy, J. M., Musmar, B., El-Hajj, V. G., Momin, A., Busarajan, S., Henshey, B., Dakhel, S., Pontarelli, M. K., Patel, S., Kim, W. J., Ellens, N., Tjoumakaris, S. I., Gooch, M. R., Alshahrani, R., Rosenwasser, R. H., Jabbour, P. M. 2026

  Abstract

  Subarachnoid hemorrhage (SAH) after mechanical thrombectomy (MT) occurs in about 4.51-7.23% of cases. This study evaluates the impact of isolated SAH after MT on clinical outcomes.This was a retrospective analysis of patients who underwent mechanical thrombectomy for acute ischemic stroke between January 2017-December 2024 at a single center in the United States. Cases were patients with SAH on their post-operative imaging, while controls were patients who did not exhibit signs of hemorrhagic conversion on their imaging. Patients with contrast leakage, intraparenchymal hemorrhage or subdural hemorrhage were excluded. Propensity-score weighting was used to adjust for confounders.A total of 471 patients were included. 12.14% (n= 51) were cases and 89.16% (n= 420) were controls. After propensity score weighting, patients who developed SAH after MT did not have increased risk for higher NIHSS on discharge (log beta= 0.004 (95% CI:-0.334, 0.343), P= 0.98 or increased length of stay (log beta=-0.081 (-0.302, 0.14), P= 0.472). Rates of 30-day readmission (OR: 0.61, 95% CI: 0.14-2.68, P= 0.513) and 90-day functional dependence (OR: 0.69, 95% CI: 0.28-1.68, P= 0.412) did not differ among patients who developed SAH and those who did not.In our retrospective study, isolated SAH after MT was not associated with increased risk for higher NIHSS on discharge, increased LOS, 30 day readmission or 90 day functional dependence. Further prospective studies with larger sample sizes could aim to validate these findings.

  View details for DOI 10.3174/ajnr.A9503

  View details for PubMedID 42373209

• Endovascular treatment of tumor-related dural sinus stenosis, venous outflow obstruction, and secondary intracranial hypertension: a systematic review of the literature. Journal of neuro-oncology El-Hajj, V. G., Gharios, M., Roy, J. M., Musmar, B., Carey, P., Mualem, W., Chanbour, H., Feghali, J., Naik, A., Staartjes, V. E., Elmi-Terander, A., Atallah, E., Alshahrani, R., Mouchtouris, N., Rosenwasser, R. H., Tjoumakaris, S., Gooch, M. R., Jabbour, P. 2026; 178 (3)

  Abstract

  Tumors involving dural venous sinuses can lead to venous outflow obstruction and secondary intracranial hypertension. While surgical resection can decompress the sinus, such procedures carry significant risks. With the success of endovascular interventions for idiopathic intracranial hypertension (IIH), venous sinus stenting (VSS) and angioplasty have emerged as potential treatments for tumor-related sinus stenosis. However, evidence remains limited and dispersed. This systematic review aimed to synthesize the available literature on the safety and efficacy of endovascular treatment for tumor-related venous sinus obstruction.A systematic search of PubMed, Embase, and Web of Science was conducted from database inception to November 2025. Eligible studies included any report describing endovascular treatment (VSS and/or angioplasty) for tumor-related venous sinus obstruction, whether due to tumor invasion or compression, or even stenosis following surgery or radiotherapy. Data on patient demographics, tumor characteristics, procedural details, and outcomes were extracted and summarized descriptively.Twenty studies comprising 57 patients were included. Most patients were female (65%) with a mean age of 48 years. Meningioma represented the most common underlying tumor (75%). The majority of obstructions resulted from tumor compression or invasion (86%), and most patients underwent VSS alone (74%), while the rest underwent VSS and angioplasty (23%). No periprocedural complications were reported. Mean trans-stenotic pressure gradient decreased by 10 ± 9 mmHg post-treatment and mean lumbar opening pressure decreased by 11 ± 12 cmH2O. Clinical improvement was reported in 63% of patients, including resolution or improvement of papilledema in 94% and vision changes in 94%. Repeat intervention was required in 28% of cases, and only about half of patients achieved further improvement after reintervention.Endovascular therapy for tumor-related venous sinus stenosis appears safe and effective, leading to meaningful pressure reduction and symptomatic improvement in two-thirds of patients. These findings support VSS as a viable adjunct or alternative to surgery in selected patients. Nonetheless, the certainty of evidence remains very low, and current data cannot establish definitive conclusions.

  View details for DOI 10.1007/s11060-026-05687-0

  View details for PubMedID 42364002

  View details for PubMedCentralID 8563316

• Treatment of Idiopathic Intracranial Hypertension With Bilateral Trans-stenotic Pressure Gradients: Unilateral Versus Bilateral Venous Sinus Stenting. Neurosurgery El-Hajj, V. G., Gharios, M., Roy, J. M., Musmar, B., Momin, A., Kim, W. J., Rizzuto, M., Ellens, N., Alshahrani, R., Atallah, E., Tjoumakaris, S., Gooch, M. R., Rosenwasser, R. H., Jabbour, P. 2026

  Abstract

  Venous sinus stenting (VSS) is an established treatment for medically refractory idiopathic intracranial hypertension (IIH), yet the clinical significance of bilateral trans-stenotic venous pressure gradients and the optimal stenting strategy in this setting remains poorly defined.We retrospectively reviewed prospectively collected data on consecutive IIH patients undergoing VSS at a single institution (2021-2024). Only patients with a trans-stenotic gradient ≥8 mm Hg confirmed by venous manometry were included. Primary outcomes included symptom improvement, overall treatment response, and need for repeat VSS.Ninety-two patients were included, of whom 44 (48%) demonstrated bilateral venous pressure gradients. Bilateral gradients were more prevalent among Black patients (P = .041) but were not associated with differences in lumbar puncture opening pressure, presenting symptoms, or emergent presentation (P ≥ .05). Among patients with bilateral gradients, unilateral stenting was associated with lower rates of satisfactory clinical response (23% vs 74%; P = .002) and higher rates of repeat intervention (62% vs 3.2%; P < .001) compared with bilateral stenting. Tinnitus resolution was significantly more frequent following bilateral stenting (11% vs 68%; P = .005). Clinical outcomes after staged bilateral stenting after failed unilateral treatment were comparable with those achieved with index bilateral stenting.Bilateral venous pressure gradients are common in IIH and identify a subgroup in whom unilateral stenting alone may be insufficient. In these cases, up-front bilateral stenting is often necessary, safe, and associated with superior clinical outcomes.

  View details for DOI 10.1227/neu.0000000000004135

  View details for PubMedID 42307224

• Distinct Clinical Phenotypes in Moyamoya Disease: A Multicenter Comparison of Ischemic and Hemorrhagic Presentations. Neurosurgery Gabriel El-Hajj, V., Musmar, B., Roy, J. M., El Naamani, K., Piper, K., Patel, S., Kim, W. J., Ellens, N., Rizzuto, M., Alshahrani, R., Chen, C. J., Jabre, R., Saad, H., Grossberg, J. A., Dmytriw, A. A., Patel, A. B., Khorasanizadeh, M., Ogilvy, C. S., Thomas, A. J., Monteiro, A., Siddiqui, A., Orscelik, A., Savastano, L., Cortez, G. M., Hanel, R. A., Porto, G., Spiotta, A. M., Piscopo, A. J., Hasan, D. M., Ghorbani, M., Weinberg, J., Nimjee, S. M., Bekelis, K., Salem, M. M., Burkhardt, J. K., Zetchi, A., Matouk, C., Howard, B. M., Lai, R., Du, R., Tjoumakaris, S. I., Gooch, M. R., Rosenwasser, R. H., Jabbour, P. 2026

  Abstract

  Moyamoya disease (MMD) is a progressive occlusive arteriopathy marked by stenosis of the major cerebral arteries and the development of fragile basal collaterals. Although ischemic and hemorrhagic phenotypes of MMD are well described, comparative evidence evaluating differences in surgical safety and long-term treatment response between these subgroups remains limited. This study aimed to compare perioperative complications and long-term stroke risk after revascularization surgery in patients with ischemic-type vs hemorrhagic-type MMD.We conducted a multicenter retrospective cohort study across 13 North American academic centers (2008-2022), including 485 patients with 502 revascularized hemispheres for angiographically confirmed MMD. Hemispheres were stratified by presenting phenotype. Primary outcomes were overall postoperative complications and long-term stroke events. Propensity score matching (2:1) and multivariable logistic regression were used. A sensitivity analysis including only hemispheres with ≥2 years of follow-up was performed.Of 502 hemispheres, 423 (84%) presented with ischemia and 79 (16%) with hemorrhage. Before and after matching, ischemic-onset MMD demonstrated significantly higher overall postoperative complication rates (post-match: 10% vs 2.6%, P = .043). Stroke patterns at long-term follow-up reflected initial presentation: ischemic-onset hemispheres experienced predominantly ischemic recurrences, whereas hemorrhagic-onset hemispheres showed higher rates of hemorrhagic or mixed-pattern strokes (P < .001). In the sensitivity cohort (≥2-year follow-up; mean 78.5 months), hemorrhagic presentation was independently associated with an 8-fold higher risk of long-term stroke, as compared with ischemic presentation (adjusted odds ratio 8.23; 95% CI 1.84-36.8; P = .006). Stroke risk did not differ significantly between hemorrhage subtypes.Ischemic and hemorrhagic MMD represent distinct clinical phenotypes with meaningful differences in safety and long-term response to surgical revascularization. Ischemic-type MMD is more prone to postoperative complications, whereas hemorrhagic-type MMD was associated with a substantially elevated long-term stroke risk. These findings underscore the need to consider MMD phenotypes as separate entities when counseling patients, choosing treatment strategies, and initiating long-term surveillance.

  View details for DOI 10.1227/neu.0000000000004125

  View details for PubMedID 42283475

• Utilisation of the Scepter Mini dual-lumen balloon - An illustrative series. Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences O'Reilly, S. T., Hendriks, E. J., Itsekson, Z., Alshahrani, R., Chung, E., Radovanovic, I., Agid, R., Nicholson, P., Krings, T. 2026; 32 (3): 1027-1034

  Abstract

  BackgroundDual-lumen balloon microcatheters can aid in the safety and efficacy of endovascular embolisation of cerebrospinal vascular malformations. The Scepter Mini dual-lumen balloon is a novel device with a smaller profile than previous balloon microcatheters, opening up new indications not only in the treatment of cerebrospinal malformations but in various other neurovascular therapeutic and diagnostic scenarios.MethodsFollowing institutional ethics review board approval, a retrospective review of our prospectively maintained database of cases employing the Scepter Mini dual-lumen microballoon catheter was conducted. Five cases in particular were highlighted, demonstrating utilisation of this device, which may be of interest to the Neurointerventionalist. Patient demographics, procedure details, complications and clinical outcome data were reviewed.ResultsFive cases employing the Scepter Mini dual-lumen microballoon catheter are presented; trans-arterial embolisation of cerebral AVM, pre-operative tumour embolisation, diagnostic angiography, trans-venous embolisation of cerebral AVM and trans-arterial embolisation of DAVF. No intraprocedural complications were recorded, one patient had a delayed haemorrhage.ConclusionPotential utilisation of the Scepter Mini lies not only in the trans-arterial embolisation of cerebrospinal vascular malformations, but in a range of other diagnostic and therapeutic indications as demonstrated.

  View details for DOI 10.1177/15910199231216759

  View details for PubMedID 38018015

  View details for PubMedCentralID PMC13294577

• Venous Sinus Stenting Versus Ventriculoperitoneal Shunting for Idiopathic Intracranial Hypertension: A Propensity Score-Weighted Comparative Analysis of Safety and Clinical Outcomes. Neurosurgery El-Hajj, V. G., Tziviskos, N., Roy, J. M., Musmar, B., Momin, A., Kim, W. J., Rizzuto, M., Ellens, N., Alshahrani, R., Staartjes, V. E., Elmi-Terander, A., Atallah, E., Tjoumakaris, S., Gooch, M. R., Rosenwasser, R. H., Jabbour, P. 2026

  Abstract

  Venous sinus stenting (VSS) and ventriculoperitoneal shunting (VPS) are established interventions for idiopathic intracranial hypertension (IIH), yet comparative evidence remains limited. Treatment selection is often influenced by institutional preference, and retrospective studies are frequently affected by baseline differences between patient groups. This study aimed to compare outcomes between VSS and VPS using propensity score overlap weighting to reduce confounding by indication and achieve balanced comparison.A retrospective cohort study was conducted including all patients treated with VSS or VPS for IIH at a single institution between 2021 and 2024. Baseline demographics, clinical characteristics, procedural details, and postoperative outcomes were collected. Propensity scores were estimated using logistic regression, and overlap weights were applied to generate a balanced pseudopopulation. Weighted logistic regression was used to compare postoperative complications, clinical outcomes, unsatisfactory treatment response, and need for salvage procedures.A total of 139 patients were included (VSS: n = 99; VPS: n = 40). Overlap weighting achieved near-perfect covariate balance (all standardized mean difference <0.1). After weighting, VSS was associated with significantly lower odds of postoperative complications compared with VPS [odds ratio (OR) 0.06, 95% CI 0.02-0.23; P < .001]. Persistently elevated postoperative opening pressure was more frequent after VSS (OR 10.64, 95% CI 1.88-60.15; P = .008). Rates of unsatisfactory treatment response (OR 0.51, P = .153), need for salvage procedures (OR 1.80, P = .326), and resolution of headache, papilledema, tinnitus, and visual symptoms were not significantly different between treatments (all P ≥.05).In this propensity score-weighted comparison, VSS and VPS produced similar symptom-based outcomes and rates of unsatisfactory treatment response. However, VSS demonstrated a substantially more favorable procedural safety profile, with significantly fewer and less severe complications. These findings suggest that VSS may offer a safer alternative to VPS for appropriately selected patients while providing comparable clinical effectiveness.

  View details for DOI 10.1227/neu.0000000000004075

  View details for PubMedID 42059592

• Safety and long-term outcomes following bypass surgery in pediatric versus adult patients with Moyamoya disease: a multicenter cohort study. Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery El-Hajj, V. G., Roy, J. M., Musmar, B., Naamani, K. E., Piper, K., Rastegar, V., Kim, W. J., Ellens, N., Rizzuto, M., Alshahrani, R., Chen, C. J., Jabre, R., Saad, H., Grossberg, J. A., Dmytriw, A. A., Patel, A. B., Khorasanizadeh, M., Ogilvy, C. S., Thomas, A. J., Monteiro, A., Siddiqui, A., Orscelik, A., Savastano, L., Cortez, G. M., Hanel, R. A., Porto, G., Spiotta, A. M., Piscopo, A. J., Hasan, D. M., Ghorbani, M., Weinberg, J., Nimjee, S. M., Bekelis, K., Salem, M. M., Burkhardt, J. K., Zetchi, A., Matouk, C., Howard, B. M., Lai, R., Du, R., Tjoumakaris, S. I., Gooch, M. R., Rosenwasser, R. H., Jabbour, P. 2026; 42 (1)

  Abstract

  Moyamoya disease (MMD) is a progressive cerebrovascular disorder and an important cause of childhood stroke. Surgical revascularization is the established treatment for symptomatic disease. However, comparative data examining perioperative safety and long-term outcomes between pediatric and adult patients remain limited. This study hence aimed to evaluate whether age influences postoperative complications, early neurological outcomes, and long-term stroke risk following direct and/or indirect bypass surgery.We conducted a retrospective multicenter cohort study of patients with MMD who underwent surgical revascularization at 13 academic centers across North America between 2008 and 2022. The primary outcomes were overall postoperative complications and long-term stroke occurrence. Comparisons between pediatric (≤ 18 years) and adult (> 18 years) hemispheres were performed using overlap propensity score weighting (PSW) to adjust for differences in baseline characteristics. Sensitivity analyses were conducted in patients with ≥ 2 years of follow-up.A total of 567 hemispheres (523 adult, 44 pediatric) were included. Adults had higher rates of vascular comorbidities, whereas pediatric patients more frequently presented with congenital conditions and earlier Suzuki grades. Pre- and post-PSW analyses demonstrated no significant age-related differences in outcomes (p ≥ 0.05). On weighted regression, age was not associated with postoperative complications (OR 0.92; 95% CI 0.41-2.05), discharge neurological status (mRS: OR 1.08; 95% CI 0.52-2.21; and NIHSS: OR 0.97; 95% CI 0.45-2.10), or long-term cerebrovascular events (OR 0.88; 95% CI 0.28-2.74). On sensitivity analysis of patients with > 2 years of follow-up, no pediatric hemispheres experienced stroke compared with 12% of adult hemispheres, though this difference was not statistically significant (p = 0.14).Despite marked differences in baseline comorbidities and angiographic severity, pediatric and adult patients experienced similar perioperative outcomes and long-term stroke risk after bypass surgery. These findings support the durability and safety of both direct and indirect revascularization across age groups.

  View details for DOI 10.1007/s00381-026-07270-4

  View details for PubMedID 42026373

  View details for PubMedCentralID 5008504

• Predictors of enucleation after intra-arterial chemotherapy for retinoblastoma. Journal of neurointerventional surgery Roy, J., El-Hajj, V. G., Attaseth, T., Pan, A., Musmar, B., Fayek, F. B., Kim, W. J., Tjoumakaris, S. I., Gooch, R., Rosenwasser, R. H., Alshahrani, R., Shields, C. L., Jabbour, P. 2026

  Abstract

  Intra-arterial chemotherapy (IAC) has emerged as a minimally invasive treatment modality for globe salvage in patients with retinoblastoma (Rb). There is limited knowledge of the factors that influence rates of enucleation after IAC.Our study identifies predictors of enucleation among Rb patients receiving IAC.This was a retrospective study of Rb patients who received IAC between January 2010 and December 2024 at a single center in the United States. The primary outcome was enucleation at last follow-up.Of 305 patients, 26.89% (n=82) underwent enucleation and 73.11% (n=223) did not. On multivariate analysis, factors associated with increased risk for enucleation were greatest basal diameter (OR 1.07, 95% CI 1.00 to 1.15, p=0.035), bilateral Rb (OR 2.82, 95% CI 1.36 to 5.81, p=0.005), and advanced-stage disease at presentation (OR 7.45, 95% CI 1.92 to 28.9, p=0.004). The use of combination chemotherapy was associated with lower odds for enucleation compared with single-agent chemotherapy (OR 0.29, 95% CI 0.11 to 0.80, p=0.016), whereas double-agent chemotherapy was not significantly associated with enucleation (OR 0.90, 95% CI 0.46 to 1.75, p=0.75).Larger tumors, bilateral disease, and advanced-stage disease were linked to higher odds of enucleation, whereas combination chemotherapy was associated with lower odds compared with single-agent chemotherapy. Future studies could help validate these results.

  View details for DOI 10.1136/jnis-2026-025227

  View details for PubMedID 41895846

• Venous sinus stenting versus ventriculoperitoneal shunting for idiopathic intracranial hypertension: propensity score weighted, cost consequence analysis. Journal of neurointerventional surgery El-Hajj, V. G., Roy, J., Musmar, B., Tziviskos, N., Momin, A. A., Kim, W. J., Rizzuto, M., Ellens, N., Alshahrani, R., Atallah, E., Tjoumakaris, S. I., Gooch, M. R., Rosenwasser, R. H., Jabbour, P. 2026

  Abstract

  Idiopathic intracranial hypertension (IIH) is characterized by elevated intracranial pressure, papilledema, and neurological symptoms. When medical management fails, treatment options include venous sinus stenting (VSS) and ventriculoperitoneal shunting (VPS). Comparative data on cost effectiveness remain limited. We aimed to compare clinical outcomes, healthcare utilization, and costs between VSS and VPS in patients with IIH using a propensity score weighted analysis.This was a retrospective single center study. Baseline characteristics, complications, reoperations, unplanned 30 day emergency department visits and readmissions, unsatisfactory treatment response, salvage procedures, and inflation adjusted index procedure costs were collected. Propensity score weighting with overlap weights was applied to balance covariates. Weighted regression analyses were used to compare outcomes between groups.139 patients were treated with VSS (n=99) or VPS (n=40). Baseline characteristics were well balanced after overlap weighting. Inflation adjusted index procedure costs and length of stay were similar between the VSS and VPS groups. VSS was associated with significantly lower rates of any complication (3.5% vs 37.7%, P<0.001), unplanned 30 day emergency department visits (11.1% vs 36.6%, P=0.002), 30 day readmissions (1.3% vs 33%, P<0.001), and reoperations, including revisions and surgically treated complications (1.3% vs 30.9%, P<0.001). There were no significant differences in unsatisfactory treatment response, need for salvage procedures, or overall subsequent procedures.While initial costs and clinical outcomes were similar, VPS was associated with higher complication rates, more revision related reoperations, and greater short term healthcare utilization. These findings suggest that VSS may provide a safer and more cost effective approach for patients with IIH who have failed medical therapy.

  View details for DOI 10.1136/jnis-2025-024875

  View details for PubMedID 41781209

• Safety of carotid endarterectomy in the elderly and octogenarian population: a nationwide study including 80,000 patients. Neurosurgical review El-Hajj, V. G., Roy, J. M., Musmar, B., Kim, W. J., Rizzuto, M., Ellens, N., Alshahrani, R., Staartjes, V. E., Elmi-Terander, A., Tummala, R. P., Tjoumakaris, S., Gooch, M. R., Rosenwasser, R. H., Khabbaz, Z., Jabbour, P. 2026; 49 (1): 226

  Abstract

  Carotid endarterectomy (CEA) is an established procedure for stroke prevention in patients with carotid artery stenosis. While CEA is considered safe in younger patients, perioperative risks in octogenarians remain debated, with current guidelines classifying the procedure as "high-risk" in this patient population. This study aimed to evaluate short-term outcomes of CEA across age groups and to assess whether comorbidity burden better predicts outcomes than chronological age.The ACS-NSQIP database (2013-2020), was used to identify patients eligible for inclusion. The cohort was stratified based on age < 60, 60-80, and > 80 years. Propensity score matching and multivariable logistic regression were used to compare outcomes across age groups and assess predictors of 30-day complications, readmission, reoperation, non-home discharge, and mortality. Interaction analyses were performed to evaluate the combined impact of age, functional status and comorbidity (ASA classification) on outcomes.Of 82,427 patients, 15,111 (18%) were > 80 years. Octogenarians had significantly higher 30-day complication, readmission, reoperation, non-home discharge, and mortality rates compared with patients aged 60-80 (all p < 0.001), even after propensity matching. Logistic regression confirmed increased risk in octogenarians (aOR 1.34, 95% CI 1.27-1.42), but comorbidity burden and functional dependency were stronger predictors; severe comorbidity (ASA 4-5; aOR 2.17, 95% CI 1.91-2.47) and full dependency (aOR 2.61, 95% CI 1.89-3.59). Interaction analysis demonstrated that octogenarians with low comorbidity had risks comparable to younger patients with moderate comorbidity.CEA is associated with a worse risk profile among octogenarians. Nonetheless, comorbidity burden and functional status are stronger predictors of adverse outcomes, as compared to age alone. CEA can be performed safely in carefully selected octogenarians with low to moderate comorbidity, whereas severe comorbidity or dependency may represent relative contraindications. Surgical candidacy should be guided by physiological reserve and function rather than chronological age alone.

  View details for DOI 10.1007/s10143-026-04174-4

  View details for PubMedID 41688807

  View details for PubMedCentralID PMC12904964

• Outcomes of Bypass Surgery in Patients with Moyamoya Syndrome Secondary To Sickle Cell Disease: a Multicenter Study. Translational stroke research Musmar, B., Roy, J. M., Abdalrazeq, H., Yacoub, C., Adeeb, N., Fuleihan, A. A., Koduri, S., Baldassari, M., Lan, M., Patel, P., Momin, A. A., Atallah, E., Alshahrani, R., Karadimas, S., Sizdahkhani, S., Garg, A., Naamani, K. E., Chen, C. J., Jabre, R., Saad, H., Grossberg, J. A., Dmytriw, A. A., Patel, A. B., Khorasanizadeh, M., Ogilvy, C. S., Thomas, A. J., Monteiro, A., Siddiqui, A., Cortez, G. M., Hanel, R. A., Kasem, R. A., Porto, G., Spiotta, A. M., Piscopo, A. J., Hasan, D. M., Ghorbani, M., Weinberg, J., Nimjee, S. M., Bekelis, K., Salem, M. M., Burkhardt, J. K., Zetchi, A., Matouk, C., Howard, B. M., Lai, R., Du, R., Abbas, R., Amllay, A., Munoz, A., Herial, N. A., Tjoumakaris, S. I., Gooch, M. R., Notarianni, C., Guthikonda, B., Morcos, J., Rosenwasser, R. H., Jabbour, P. 2026; 17 (1): 18

  Abstract

  Moyamoya syndrome (MMS) associated with sickle cell disease (SCD) is a severe vasculopathy that significantly increases stroke risk. While cerebral revascularization is increasingly considered in this population, concerns about perioperative safety and long-term outcomes have limited its use in clinical practice.We conducted a multicenter, retrospective cohort study of 553 patients with MMS who underwent surgical revascularization across 13 centers. Patients were grouped by SCD status (SCD-MMS vs. moyamoya disease (MMD)). Primary outcomes included perioperative stroke, perioperative complications, and functional status at discharge. Secondary outcomes included length of stay, and follow-up stroke.Of 553 patients, 32 (5.8%) had SCD. There were no significant differences in overall perioperative stroke (OR 1.05, 95% CI 0.19 to 5.54), symptomatic perioperative stroke (OR 0.94, 95% CI 0.09 to 8.94), perioperative complications (OR 1.66, 95% CI 0.47 to 5.86), or follow-up stroke (OR 0.88, 95% CI 0.17 to 4.55). Functional outcomes at discharge were similarly favorable in both groups (mRS 0-1: OR 0.84, 95% CI 0.29 to 2.40). SCD was associated with a longer hospital stay (beta 2.78 days, 95% CI 0.60 to 4.96).Surgical revascularization for MMS in patients with SCD does not confer additional procedural risk and yields outcomes comparable to those of patients without SCD. These findings support the role of bypass surgery as a viable treatment option in this high-risk population.

  View details for DOI 10.1007/s12975-026-01412-1

  View details for PubMedID 41563633

  View details for PubMedCentralID 4747069

• Risk factors for in-stent stenosis after flow-diverter implantation for intracranial aneurysm: a single center analysis of 161 consecutive patients. Acta neurochirurgica Alshahrani, R., Karadimas, S., Alvi, M. A., Nicholson, P. J., Krings, T. 2025; 167 (1): 194

  Abstract

  Flow diverters (FD) are used for the treatment of intracranial aneurysms, by redirecting flow and serving as a scaffold for endothelial coverage of the aneurysm ostium. However, in-stent stenosis has been observed in some patients treated with these devices, the cause of which and the epidemiology remaining elusive. In the current study we aimed to elucidate potential factors leading to higher degree of in-stent stenosis including gender, location, and type of FD.The authors queried their institutional Electronic Health Record (EHR) for all patients undergoing FD for intracranial saccular aneurysms. We excluded cases where an FD was performed for a dissecting aneurysm, or other indications. We also excluded patients who had no available follow up.We identified 161 patients undergoing FD for aneurysms, with a mean age of 57.4 (SD = 12.94) and141 (87.6%) of which were females. A total of 24 patients (14.9%) had an in-stent stenosis at a median interval of 10 months; 9 (5.6%) had a severe (i.e. symptomatic or requiring treatment) stenosis. When subsetting for females, we found that females with any in-stent stenosis were significantly younger compared to those without stenosis (51.045, SD = 15.7 vs 58.5, SD = 12.31, p = 0.013). Females with severe in-stent stenosis were even younger (42.2, SD = 14.2 vs 58.3, SD = 12.54; p < 0.001) compared to the rest of the females. Patients presenting with ruptured aneurysm had a higher rate of severe in-stent stenosis (16.7%, n = 4/24, p = 0.014). Regarding devices, patients who underwent treatment with a high-braid FD were more likely to have severe in-stent stenosis (18.8%, n = 3/16; p = 0.016).Our findings indicate that younger age, presentation with rupture and high-braid FD may be associated with higher risk of severe in-stent stenosis. These findings may provide more insight into the selection of treatment modality and/or device in patients undergoing management of their cerebral aneurysms.

  View details for DOI 10.1007/s00701-025-06597-2

  View details for PubMedID 40676336

  View details for PubMedCentralID PMC12271242

• Use of the neuroform atlas for stenting of intracranial atherosclerotic disease: Clinical and angiographic outcomes. Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences Ellenbogen, Y., Hendriks, E. J., Karadimas, S., O'Reilly, S., Itsekzon Hayosh, Z., Alshahrani, R., Agid, R., Schaafsma, J., Krings, T., Nicholson, P. 2023: 15910199231195134

  Abstract

  Intracranial atherosclerotic disease (ICAD) is a potential cause of ischemic stroke. Treatment of ICAD can include intracranial stenting. There are specifically designed stents for this use-case; however, less is known about the off-label use of the Neuroform Atlas stent. In this study, we describe the outcomes of the Neuroform Atlas stent for treatment of ICAD.Adult patients with symptomatic ICAD failing best medical treatment undergoing elective intracranial stenting using the Neuroform Atlas stent between November 2018 and March 2021 were included. Patient demographics, procedure-related details and clinical and imaging outcomes were analyzed.Eighteen patients met the inclusion criteria, with a mean follow-up duration of 9.6 ± 6.8 (standard deviation) months. There were two procedure-related mortalities (one massive intracranial hemorrhage and one groin site complication with sepsis). Fifteen patients were alive at the 6-month follow-up, all with satisfactory stent patency on follow-up imaging without any new ischemic events. Modified Rankin Scale at latest follow-up was 1.9 (interquartile range 5).In this single-center consecutive series, intracranial stenting with the Neuroform Atlas stent was a safe and effective treatment for symptomatic ICAD patients failing best medical management.

  View details for DOI 10.1177/15910199231195134

  View details for PubMedID 37817560

• Cross-sectional analysis of women in neurosurgery: a Canadian perspective. Neurosurgical focus Veilleux, C., Samuel, N., Yan, H., Bass, V., Al-Shahrani, R., Mansur, A., Rutka, J. T., Zadeh, G., Hodaie, M., Milot, G. 2021; 50 (3): E13

  Abstract

  Although the past decades have seen a steady increase of women in medicine in general, women continue to represent a minority of the physician-training staff and workforce in neurosurgery in Canada and worldwide. As such, the aim of this study was to analyze the experiences of women faculty practicing neurosurgery across Canada to better understand and address the factors contributing to this disparity.A historical, cross-sectional, and mixed-method analysis of survey responses was performed using survey results obtained from women attending neurosurgeons across Canada. A web-based survey platform was utilized to collect responses. Quantitative analyses were performed on the responses from the study questionnaire, including summary and comparative statistics. Qualitative analyses of free-text responses were performed using axial and open coding.A total of 19 of 31 respondents (61.3%) completed the survey. Positive enabling factors for career success included supportive colleagues and work environment (52.6%); academic accomplishments, including publications and advanced degrees (36.8%); and advanced fellowship training (47.4%). Perceived barriers reported included inequalities with regard to career advancement opportunities (57.8%), conflicting professional and personal interests (57.8%), and lack of mentorship (36.8%). Quantitative analyses demonstrated emerging themes of an increased need for women mentors as well as support and recognition of the contributions to career advancement of personal and family-related factors.This study represents, to the authors' knowledge, the first analysis of factors influencing career success and satisfaction in women neurosurgeons across Canada. This study highlights several key factors contributing to the low representation of women in neurosurgery and identifies specific actionable items that can be addressed by training programs and institutions. In particular, female mentorship, opportunities for career advancement, and increased recognition and integration of personal and professional roles were highlighted as areas for future intervention. These findings will provide a framework for addressing these factors and improving the recruitment and retention of females in this specialty.

  View details for DOI 10.3171/2020.12.FOCUS20959

  View details for PubMedID 33789236

• Authors' response: 'Predictors of patient satisfaction in an emergency care centre in central Saudi Arabia: a prospective study'. Emergency medicine journal : EMJ Abolfotouh, M. A., Al-Assiri, M. H., Alshahrani, R. T., Almutairi, Z. M., Hijazi, R. A., Alaskar, A. S. 2017; 34 (4): 269-270

  View details for DOI 10.1136/emermed-2016-206403

  View details for PubMedID 27872143

• Predictors of patient satisfaction in an emergency care centre in central Saudi Arabia: a prospective study. Emergency medicine journal : EMJ Abolfotouh, M. A., Al-Assiri, M. H., Alshahrani, R. T., Almutairi, Z. M., Hijazi, R. A., Alaskar, A. S. 2017; 34 (1): 27-33

  Abstract

  This study aimed to (i) assess the level of patient satisfaction and its association with different sociodemographic and healthcare characteristics in an emergency care centre (ECC) in Saudi Arabia and (ii) to identify the predictors of patients' satisfaction.A prospective cohort study of 390 adult patients with Canadian triage category III and IV who visited ECC at King Abdulaziz Medical City, Riyadh, Saudi Arabia, between 1 July and end of September 2011 was conducted. All patients were followed up from the time of arrival at the front desk of ECC until being seen by a doctor, and were then interviewed. Patient satisfaction was measured using a previously validated interview-questionnaire, within two domains: clarity of medical information and relationship with staff. Patient perception of health status after as compared with before the visit, and overall life satisfaction were also measured. Data on patient characteristics and healthcare characteristics were collected. Multiple linear regression analysis was used, and significance was considered at p≤0.05.One-third (32.8%) of patients showed high level of overall satisfaction and 26.7% were unsatisfied, with percentage mean score of 70.36% (17.40), reflecting moderate satisfaction. After adjusting for all potential confounders, lower satisfaction with the ED visit was significantly associated with male gender (p<0.001), long waiting time (p=0.032) and low perceived health status compared with status at admission (p<0.001). Overall life satisfaction was not a significant predictor of patient satisfaction.An appreciation of waiting time as the only significant modifiable risk factor of patient satisfaction is essential to improve the healthcare services, especially at emergency settings.

  View details for DOI 10.1136/emermed-2015-204954

  View details for PubMedID 27480456

  View details for PubMedCentralID PMC5256124