CSF-Venous Fistulas: a practical guide for interventionalists

Neurovascular interventions rely on low-friction synthetic equipment, from multiple polymer-based and polymer-coated devices to plastic gloves. The paper discussed in this podcast highlights the discovery of quantifiable release of microplastics (MPs), nanoplastics (NPs), and per- and polyfluoroalkyl substances (PFAS) into the flush fluid during simulated neurovascular interventions. The study concludes that levels of PFAS, also called 'forever chemicals', released during thrombectomies were double those produced in aneurysm procedures. MP and NP levels did not differ between thrombectomy and aneurysm simulations. Although the exact impact on the human body is still understudied, the potential consequences remain concerning in all cases. JNIS Editor-in-Chief, Dr. Michael Chen, speaks with the corresponding author of the study, Dr. Sophia Hohenstatt (Department of Neuroradiology, University Hospital Heidelberg, Germany). Read the paper, "Workflow level release of microplastics, nanoplastics, and perfluoroalkyl and polyfluoroalkyl substances during simulated neurovascular interventions" (https://jnis.bmj.com/content/early/2026/09/15/jnis-2026-025917), freely available on the JNIS website. Please subscribe to the JNIS podcast on your favourite platform to get the latest podcast every month. If you enjoy our podcast, you can leave us a review or a comment on Apple Podcasts (https://apple.co/4aZmlpT) or Spotify (https://spoti.fi/3UKhGT5). We'd love to hear your feedback on social media - @JNIS_BMJ.

Diagnosing and managing cerebrospinal fluid-venous fistulas (CSFs) requires navigating complex venous anatomy and nuanced imaging techniques. In this episode, JNIS Editor-in-Chief, Dr. Michael Chen, speaks with associate editor Dr. Emanuele Orru (Lahey Hospital and Medical Center, Burlington, Massachusetts, USA) about establishing a systematic, multidisciplinary framework to identify and treat these low-pressure CSF leaks. Dr. Emanuele Orru is the corresponding author of the paper: Cerebrospinal Fluid–Venous Fistulas: Pathophysiology, Diagnosis, and Management (https://jnis.bmj.com/content/early/2026/07/16/jnis-2026-025062), freely available on the JNIS website. Please subscribe to the JNIS podcast on your favourite platform to get the latest podcast every month. If you enjoy our podcast, you can leave us a review or a comment on Apple Podcasts (https://apple.co/4aZmlpT) or Spotify (https://spoti.fi/3UKhGT5). We'd love to hear your feedback on social media - @JNIS_BMJ.

Large language models (LLMs) are moving beyond simple data extraction to complex, guideline-based triage in emergency stroke care. In this episode, JNIS Editor-in-Chief, Dr. Michael Chen, speaks with Dr. Ayman Meddeb, a senior consultant and interventional neuroradiologist at Charité - Universitätsmedizin Berlin, Germany. They discuss his latest paper, "Evaluating accuracy and reasoning capabilities of large language models for acute ischemic stroke management" (https://jnis.bmj.com/content/early/2026/06/23/jnis-2026-025429). Please subscribe to the JNIS podcast on your favourite platform to get the latest podcast every month. If you enjoy our podcast, you can leave us a review or a comment on Apple Podcasts (https://apple.co/4aZmlpT) or Spotify (https://spoti.fi/3UKhGT5). We'd love to hear your feedback on social media - @JNIS_BMJ.

Evaluating device performance, safety, and procedural efficacy remains essential as mechanical thrombectomy technology for large vessel occlusion (LVO) rapidly evolves. In this episode, JNIS Editor-in-Chief, Dr. Michael Chen, talks with Dr. Marc Ribo, an interventional neurologist at Vall d'Hebron University Hospital in Barcelona, Spain. They discuss his systematic review paper, "Super large bore catheters in the treatment of stroke: systematic review" (https://jnis.bmj.com/content/early/2026/03/27/jnis-2026-025001).  They discuss published data on super large bore catheters (SLACs; inner diameter ≥0.080 inch), highlighting key metrics including first-pass effect, overall recanalization rates, and navigability through tortuous intracranial vasculature. Please subscribe to the JNIS podcast on your favourite platform to get the latest podcast every month. If you enjoy our podcast, you can leave us a review or a comment on Apple Podcasts (https://apple.co/4aZmlpT) or Spotify (https://spoti.fi/3UKhGT5). We'd love to hear your feedback on social media - @JNIS_BMJ.

Optimising mechanical thrombectomy speed and efficiency remains a primary focus in acute ischemic stroke management. In this episode, JNIS Editor, Dr. Michael Chen, talks with Dr. Keiko Fukuda, a neurointerventional fellow at UCLA and practising neurointerventionalist in Monterey, California, and Dr. Victor Szeder, Professor of Radiology, Neurology, and Neurosurgery and Director of the Neurointerventional Fellowship at UCLA. They talk about their multi-centre paper, "Faster reperfusion with combined delivery catheter systems and aspiration first stroke thrombectomy: a multicenter analysis" (https://jnis.bmj.com/content/early/2026/06/19/jnis-2025-024700). The authors discuss data comparing combined delivery catheter systems against standard aspiration setups, highlighting significantly faster times from groin puncture to clot contact and an impressive 67% first-pass effect. They also share key clinical insights on overcoming severe arterial tortuosity. Please subscribe to the JNIS podcast on your favourite platform to get the latest podcast every month. If you enjoy our podcast, you can leave us a review or a comment on Apple Podcasts (https://apple.co/4aZmlpT) or Spotify (https://spoti.fi/3UKhGT5). We'd love to hear your feedback on social media - @JNIS_BMJ.

Evaluating the 90-day safety and technical feasibility of a percutaneous transvenous approach represents a critical milestone for routing cerebrospinal fluid (CSF) – the clear liquid that cushions the brain and spine – directly into the venous system. In this episode, JNIS Editor, Dr. Michael Chen, talks with corresponding author Professor Adel Malek (Tufts Medical Center, Boston) (1) to discuss his high-impact paper, "Safety of endovascular shunting for normal pressure hydrocephalus from a prospective, multicenter, single-arm study”. They discuss the results of this 66-patient, prospective trial, exploring how the novel eShunt system accesses the cerebellopontine angle cistern to drain CSF and relieve pressure.  Please subscribe to the JNIS podcast on your favourite platform to get the latest podcast every month. If you enjoy our podcast, you can leave us a review or a comment on Apple Podcasts (https://apple.co/4aZmlpT) or Spotify (https://spoti.fi/3UKhGT5). We'd love to hear your feedback on social media - @JNIS_BMJ. (1) Neurosurgeon Adel Malek, MD, PhD. Chief of the Cerebrovascular and Endovascular Division in the Department of Neurosurgery, Tufts Medical Center; Professor of Neurosurgery, Tufts University School of Medicine, Boston, USA. The JNIS Podcast is produced by Letícia Amorim, and is edited by Pritesh Kapadia.  

Achieving near-complete reperfusion in medium vessel occlusions (MeVO) is linked to smaller final infarct volumes.  However, this did not translate into a statistically significant shift in 90-day functional independence.   In this episode,  JNIS Editor-in-Chief, Dr. Michael Chen, and Professor Johanna Ospel (1) discuss the post-hoc analysis of the ESCAPE-MeVO trial, titled "Reperfusion grade and clinical outcome following medium vessel occlusion thrombectomy in the Endovascular Treatment to Improve Outcomes for Medium Vessel Occlusion trial".  Please subscribe to the JNIS podcast on your favourite platform to get the latest podcast every month. If you enjoy our podcast, you can leave us a review or a comment on Apple Podcasts (https://apple.co/4aZmlpT) or Spotify (https://spoti.fi/3UKhGT5). We'd love to hear your feedback on social media - @JNIS_BMJ. (1) Clinical Associate Professor at the University of Calgary and Senior Lecturer at the University of Basel. The JNIS Podcast is produced by Letícia Amorim, and is edited by Pritesh Kapadia.

Headache affects up to 90% of patients following aneurysmal subarachnoid hemorrhage (aSAH), often requiring high-dose opioids that can complicate neurological monitoring.  In this episode, JNIS Editor-in-Chief, Dr. Michael Chen, is joined by Professor Peter Kan¹ to discuss a prospective pilot study investigating a novel dural therapy: the infusion of lidocaine (with or without dexamethasone) via the middle meningeal artery (MMA) during aneurysm embolisation.  They explore the safety of this targeted approach, its impact on Visual Analog Scale (VAS) pain scores, and its potential as an opioid-sparing strategy in the neuro-ICU. Link to the discussed paper: "Middle meningeal artery infusion for headaches after aneurysmal subarachnoid hemorrhage: a pilot study". Please subscribe to the JNIS podcast on your favourite platform to get the latest podcast every month. If you enjoy our podcast, you can leave us a review or a comment on Apple Podcasts (https://apple.co/4aZmlpT) or Spotify (https://spoti.fi/3UKhGT5). We'd love to hear your feedback on social media - @JNIS_BMJ. (1) Department of Neurosurgery, The University of Texas Medical Branch at Galveston, Texas, USA

Can aqueductal stenosis be treated through a minimally invasive endovascular approach without transgressing brain parenchyma? In this episode, JNIS Editor-in-Chief, Dr. Michael Chen, speaks with neuro-interventional radiologist Dr. Michal Obrzut¹ about a neurointerventional approach to the management of obstructive hydrocephalus secondary to aqueductal stenosis. The author describes the underlying concept, technical feasibility in cadaveric models, and potential implications for minimally invasive neurosurgical practice. Link to the discussed paper: "A novel neurointerventional subarachnoid aqueductoplasty technique for the treatment of aqueductal stenosis: a cadaveric feasibility study"   Please subscribe to the JNIS podcast on your favourite platform to get the latest podcast every month. If you enjoy our podcast, you can leave us a review or a comment on Apple Podcasts (https://apple.co/4aZmlpT) or Spotify (https://spoti.fi/3UKhGT5). We'd love to hear your feedback on social media - @JNIS_BMJ.   (1) Neurosurgery, Cleveland Clinic Florida, Weston, Florida, USA          

Medical professionals can oftentimes fall under the category of "second victims", as they experience burnout and moral injury from the impacts of their work. Over the course of a neurointerventionalist's medical career, serious complications in procedures are sadly inevitable. These can be difficult to process, and there are not always the systems in place to provide the support needed, either inside or outside of the hospital. A new survey has been carried out to assess the severity and prevalence of negative psychological effects on physicians who have experienced these complications. Dr. Ansaar Rai¹ joins JNIS Editor-in-Chief Dr. Michael Chen to discuss the original research piece, "Unseen wounds: a multinational investigation of neurointerventionalists on the psychological toll of complications".  (1) Interventional Neuroradiology, West Virginia University Rockefeller Neuroscience Institute, Morgantown, West Virginia, USA Please subscribe to the JNIS podcast on your favourite platform to get the latest podcast every month. If you enjoy our podcast, you can leave us a review or a comment on Apple Podcasts (https://apple.co/4aZmlpT) or Spotify (https://spoti.fi/3UKhGT5). We'd love to hear your feedback on social media - @JNIS_BMJ.