Mechanical thrombectomy utilizing combined manual aspiration with a stent retriever is an effective and safe strategy for endovascular recanalization of large vessel occlusions presenting within the context of AIS.

The role of regulatory T cells (Tregs) in mediating immune suppression of anti-tumor immune responses is increasingly becoming appreciated in patients with malignancies -especially within the malignant glioma patient population. This review will discuss the role and prognostic significance of Tregs within glioma patients and will delineate potential approaches for their inhibition that can be used either alone or in combination with other immune therapeutics in clinical trials and in the clinical settings of recurrent and/or residual disease. Keywordsregulatory T cells; glioblastoma multiforme; central nervous system; immunotherapy; vaccine; prognosis Overview of immunosuppressive TregsThe function of the immune system is to recognize foreign materials in the body and distinguish them from normal body tissues and cells. Immune responses consist of cell-mediated (T cells, natural killer cells, and phagocytes) and/or humoral (B cells, antibodies, and complement) responses modified and regulated by cytokines. Antigen-presenting cells (APCs) such as dendritic cells (DCs) and macrophages take up antigens, partially degrade them, and present them to T cells in the context of major histocompatibility complex (MHC) molecules. To fully activate the adaptive immune response, the T cells must receive two signals: one through the T cell receptor and the other through the co-stimulatory receptor CD28, which recognizes the co-stimulatory molecules CD80 and CD86 expressed on the surface of APCs. Failure to do so Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access Author ManuscriptNeurosurg Clin N Am. Author manuscript; available in PMC 2011 January 1. Although the mechanism by which nTregs exert their effects on the effector T cells has yet to be fully elucidated [31][32][33][34], it likely results from downregulation of IL-2 cytokine production and may involve membrane-bound cytotoxic T lymphocyte antigen-4 (CTLA-4), a negative regulator of T cell activation, a member of the CD28/B7 immunoglobulin superfamily that is constitutively expressed on Tregs [35], and whose expression is up-regulated in activated T cells [36,37]. . The development of nTregs is regulated by the Foxp3 gene in CD4 + /CD25 + T cells [38]. The primary role of nTregs is suspected to be maintenance of a constant homeostatic balance by curtailing the effects of autoreactive T cells in noninflammatory settings [32].Tregs in circulating peripheral blood include not only nTregs differentiated in the thymus but also Foxp3 + Tregs generated extrathymically by the conversion of naïve T cells via chro...

A patient with a giant symptomatic vertebrobasilar aneurysm was treated by endoscopic third ventriculostomy for obstructive hydrocephalus followed by treatment of the aneurysm by flow diversion using a Pipeline Embolization Device. After an uneventful procedure and initial periprocedural period, the patient experienced an unexpected fatal subarachnoid hemorrhage 1 week later. Autopsy demonstrated extensive subarachnoid hemorrhage and aneurysm rupture (linear whole wall rupture). The patent Pipeline Embolization Device was in its intended location, as was the persistent coil occlusion of the distal left vertebral artery. The aneurysm appeared to rupture in a linear manner and contained a thick large expansile clot that seemed to disrupt or rupture the thin aneurysm wall directly opposite the basilar artery/Pipeline Embolization Device. We feel the pattern of aneurysm rupture in our patient supports the idea that the combination of flow diversion and the resulting growing intra-aneurysmal thrombus can create a mechanical force with the potential to cause aneurysm rupture.